Chapter 12: Management of Patients with Oncologic Disorders

While doing a health history, a client tells the nurse that her mother, her grandmother, and her sister died of breast cancer. The client asks what she can do to keep from getting cancer. What is the best response by the nurse? a) "Cancer often skips a generation, so don't worry about it." b) "With your family history, there is nothing you can do to prevent getting cancer, so be mindful of your family risk factors." c) "Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level." d) "If you eat right, exercise, and get enough rest, you can always prevent breast cancer."

"Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level." Explanation: Specialized tests have been developed for tumor markers, specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. The nurse cannot say that cancer can be avoided with healthy behaviors; this is inaccurate information. A family history is a reason for the client to be concerned. Cancer does not skip a generation; this response minimizes and negates the client's concern. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Diagnosis of Cancer(table12-4), p. 311.

A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching? a) "I take a stool softener every morning." b) "I floss my teeth every morning." c) "I use an electric razor to shave." d) "I removed all the throw rugs from the house."

"I floss my teeth every morning." Explanation: A client with a platelet count of 30,000/mm3 is at risk for bleeding and shouldn't floss his teeth. Flossing may increase the risk of bleeding in a client with a platelet count less than 40,000/mm3. Using an electric razor is appropriate because doing so helps minimize the risk of cutting when shaving. Taking a stool softener helps decrease potential trauma to the GI tract that may cause bleeding. Removing throw rugs from the house helps prevent falls, which could lead to uncontrolled bleeding. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Nursing Care of the Patient with Cancer, p. 340.

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? a) Placing the client in strict isolation b) Providing for frequent rest periods c) Inspecting the skin for petechiae once every shift d) Administering aspirin if the temperature exceeds 102° F (38.8° C)

Inspecting the skin for petechiae once every shift Explanation: Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Nursing Care of the Patient with Cancer, p. 358.

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse? a) Tumor pressure against normal tissues b) Random, rapid growth of the tumor c) Cells colonizing to distant body parts d) Emission of abnormal proteins

Tumor pressure against normal tissues Explanation: Benign tumors grow more slowly than malignant tumors and do not emit tumor-specific antigens or proteins. Benign tumors do not metastasize to distant sites. Benign tumors can compress tissues as it grows, which can result in impaired organ functioning. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Pathophysiology of the Malignant, p. 303.

An oncology client has presented with the signs of possible cardiac tamponade with pericardial effusion. What diagnostic and medical procedures should the nurse prepare the client for? Select all that apply. a) Computed tomography (CT) scan b) Echocardiogram c) Chest x-ray d) Prolonged prothrombin time (PT) and prolonged thrombin time (TT) e) Pericardiocentesis

- Chest x-ray - Pericardiocentesis - Computed tomography (CT) scan - Echocardiogram Explanation: Cardiac tamponade with pericardial effusion results in an accumulation of fluid in the pericardial space. The fluid compresses the heart and thereby impedes expansion of the ventricles, limiting cardiac filling during diastole. Diagnostic testing and medical management includes echocardiogram, CT scan, chest x-ray, and Pericardiocentesis; all are directed at confirming and withdrawing the fluid associated with the condition. A PT and TT are related to determining coagulation function and appropriate when suspecting disseminated intravascular coagulation (DIC) which results in thrombosis and bleeding. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Table 12-13, p. 360.

Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client? a) Autologous b) Therapeutic c) Prophylactic d) Allogeneic

Autologous Explanation: Autologous vaccines are made from the client's own cancer cells, which are obtained during diagnostic biopsy or surgery. Prophylactic vaccines, such as the polio vaccine, are given to prevent people from developing a disease. Therapeutic vaccines are given to kill existing cancer cells and to provide long-lasting immunity against further cancer development. Allogeneic vaccines are made from cancer cells that are obtained from other people who have a specific type of cancer. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Management of Cancer, Immunotherapy and Targeted Therapy, p. 331.

A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan? a) Wearing a lead apron during direct contact with the client b) Avoiding using soap on the irradiated areas c) Applying talcum powder to the irradiated areas daily after bathing d) Removing thoracic skin markings after each radiation treatment

Avoiding using soap on the irradiated areas Explanation: Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Nursing Care of the Patient with Cancer, p. 338.

The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? a) Stomatitis b) Extravasation c) Bone pain d) Nausea and vomiting

Extravasation Explanation: The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, MANAGEMENT OF CANCER, p. 320.

A decrease in circulating white blood cells (WBCs) is referred to as a) Granulocytopenia b) Neutropenia c) Leukopenia d) Thrombocytopenia

Leukopenia Explanation: A decrease in circulating WBCs is referred to as leukopenia. Granulocytopenia is a decrease in neutrophils. Thrombocytopenia is a decrease in the number of platelets. Neutropenia is an abnormally low absolute neutrophil count. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Management of Cancer, Radiation Therapy, p. 318.

The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest? a) Malignant tumor b) Malignant tumor with metastasis to surrounding tissue c) Benign fibrocystic disease d) Normal finding

Malignant tumor Explanation: A fast-growing lump is suggestive of a malignant tumor. Metastasis can only be determined by cytology, not by palpation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders.

According to the tumor-node-metastasis (TNM) classification system, T0 means there is

No evidence of primary tumor Explanation: T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Diagnosis of Cancer, Chart 12-3, p. 312.

A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms? a) Extravasation b) Neutropenia c) Stomatitis d) Nadir

Stomatitis Explanation: The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to 10 days after the administration of certain chemotherapeutic agents or radiation therapy to the head and neck. Chemotherapy and radiation produce chemical toxins that lead to the breakdown of cells in the mucosa of the epithelium, connective tissue, and blood vessels in the oral cavity. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Nursing Care of the Patient with Cancer, Maintaining Tissue Integrity, p. 336.

A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately a) Gives prednisolone IV b) Administers diphenhydramine c) Places the client on oxygen by nasal cannula d) Stops the chemotherapeutic infusion

Stops the chemotherapeutic infusion Explanation: The client may be experiencing a type I hypersensitivity reaction, which may progress to systemic anaphylaxis. The most immediate action of the nurse is to discontinue the medication followed by initiating emergency protocols. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, MANAGEMENT OF CANCER, pp. 320-321.

A nurse is caring for a client with prostate cancer and assesses bleeding gums and hematuria. What serum indicator should the nurse relate the bleeding? a) lymphocyte count of 30% b) reticulocyte count of 1% c) platelet count of 60,000/mm3 d) neutrophil count of 40%

platelet count of 60,000/mm3 Explanation: Thrombocytopenia, a decrease in the circulating platelet count, is the most common cause of bleeding in patients with cancer and is usually defined as a count less than 100,000/mm3. The risk of bleeding increases as the count drops lower. The risk of spontaneous bleeding occurs with a count of less than 20,000/mm3. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, NURSING CARE OF THE PATIENT WITH CANCER, p. 357.

A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with a) weight gain. b) anorexia. c) seizure. d) myalgia.

seizure. Explanation: A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with seizures, abnormal reflexes, papilledema, coma, and death. Anorexia, weight gain, and myalgia are associated with serum sodium concentrations lower than 120 mEq/L. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Cancer Survivorship, TABLE 12-13 Oncologic Emergencies: Manifestations and Management (continued), p. 362.

Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient? a) Allogeneic b) Homogenic c) Autologous d) Syngeneic

Allogeneic Explanation: If the source of donor cells is from a donor other than the patient, it is termed allogeneic. Autologous donor cells come from the patient. Syngeneic donor cells are from an identical twin. Homogenic is not a type of stem cell transplant. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, MANAGEMENT OF CANCER, p. 326.

A nurse is assessing a 75-year-old woman who had a total hysterectomy when she was 30 years old and normal Pap test results for the past 10 years. The client asks about continuing the Pap test. What is the best response by the nurse? a) "You could have stopped immediately after your hysterectomy." b) "You will need to continue for the rest of your life." c) "You need to continue obtaining a Pap test for only the next 5 years." d) "You may choose to discontinue this test."

"You may choose to discontinue this test." Explanation: The American Cancer Society recommendations for women 66+ years or older who have had normal Pap tests for 10 years and who have had a total hysterectomy may choose to stop having Pap tests for cervical cancer screening. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Detection and Prevention of Cancer, p. 310.

The nurse is conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome? a) A first cousin diagnosed with cancer b) Onset of cancer after age 50 in family member c) An aunt and uncle diagnosed with cancer d) A second cousin diagnosed with cancer

An aunt and uncle diagnosed with cancer Explanation: The hallmarks of hereditary cancer syndrome include cancer in two or more first-degree or second-degree relatives, early onset of cancer in family members younger than age 50, the same type of cancer in several family members, individual family members with more than one type of cancer, and a rare cancer in one or more family members. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Pathophysiology of the Malignant Process, Proliferative Patterns, p. 307.

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? a) Sodium level of 142 mEq/L b) Urine output of 400 ml in 8 hours c) Blood pressure of 120/64 to 130/72 mm Hg d) Serum potassium level of 2.6 mEq/L

Serum potassium level of 2.6 mEq/L Explanation: Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders.

The client is scheduled for a breast lump excision and sentinel node biopsy. What should the nurse know in planning care for the client with a positive biopsy? a) A lump excision is not necessary. b) A wide excision of lump will be performed. c) The entire breast and all regional lymph nodes will be excised. d) The lump and all axillary lymph nodes will be excised.

A wide excision of lump will be performed. Explanation: The sentinel node is the first node in which a tumor will drain; if no malignant cells are found there, additional excision or radical removal will not be necessary. Excision of the lump along with a wide margin of cancer-free tissue is standard treatment for malignant tumors. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Management of Cancer, p. 313.

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? a) Repeat biopsy is needed before treatment begins. b) Palliative care is likely. c) No further treatment is indicated. d) Adjuvant therapy is likely.

Adjuvant therapy is likely. Explanation: T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Management of Cancer, p. 312.

Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure? a) Allergy history b) Family history c) Blood studies d) Drug history

Blood studies Explanation: Before the BMT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before a BMT procedure, the nurse need not evaluate the client's family, drug, or allergy history. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Cell Kill and the Cell Cycle, Hematopoietic Stem Cell Transplantation, p. 328.

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? a) Take measures to acidify the urine and prevent uric acid crystallization. b) Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. c) Encourage fluid intake to dilute the urine. d) Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis.

Encourage fluid intake to dilute the urine. Explanation: The nurse should ensure adequate fluid hydration before, during, and after drug administration and assess intake and output. Adequate fluid volume dilutes drug levels, which can help prevent renal damage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Management of Cancer, p. 325.

In which phase of the cell cycle does cell division occur? a) S phase b) G2 phase c) Mitosis d) G1 phase

Mitosis Explanation: Cell division occurs in mitosis. RNA and protein synthesis occurs in the G1 phase. DNA synthesis occurs during the S phase. DNA synthesis is complete, and the mitotic spindle forms in the G2 phase. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders.

A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client? a) Monitor the client's heart rate. b) Monitor the client's physical condition. c) Monitor the client's toilet patterns. d) Monitor the client to prevent sepsis.

Monitor the client to prevent sepsis. Explanation: Until transplanted bone marrow begins to produce blood cells, clients who have undergone a bone marrow transplant have no physiologic means to fight infection, which puts them at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent sepsis. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client becoming septic. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Cell Kill and the Cell Cycle, p. 328.

You are a clinic nurse. One of your clients has found she is at high risk for breast cancer. She asks you what can be done to reduce her risk. What is a means of reducing the risk for breast cancer? a) Reduction surgery b) Prophylactic surgery c) Palliative surgery d) Curative surgery

Prophylactic surgery Explanation: Prophylactic or preventive surgery may be done if the client is at considerable risk for cancer. Palliative surgery is done when no curative treatment is available. Curative surgery is performed to cure the disease process. Reduction surgery is a distractor. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, MANAGEMENT OF CANCER, p. 314.

A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient? a) Counsel the patient about the possibility of losing her breast. b) Provide aseptic care to the incision postoperatively. c) Clarify information provided by the physician. d) Provide time for the patient to discuss her concerns.

Provide time for the patient to discuss her concerns. Explanation: Patients who are undergoing surgery for the diagnosis or treatment of cancer may be anxious about the surgical procedure, possible findings, postoperative limitations, changes in normal body functions, and prognosis. The patient and family require time and assistance to process the possible changes and outcomes resulting from the surgery. The nurse serves as the patient advocate and liaison and encourages the patient and family to take an active role in decision making when possible. If the patient or family asks about the results of diagnostic testing and surgical procedures, the nurse's response is guided by the information that was conveyed previously. The nurse may be asked to explain and clarify information for patients and families that was provided initially but was not grasped because of anxiety and overwhelming feelings. It is important that the nurse, as well as other members of the health care team, provide information that is consistent from one clinician to another. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders.

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? a) The client states he is nauseous. b) The client begins to shiver. c) The I.V. site is red and swollen. d) The laboratory reports a white blood cell (WBC) count of 1,000/mm3.

The I.V. site is red and swollen. Explanation: A red, swollen I.V. site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates. The nurse should immediately stop the medication, apply ice to the site, and notify the physician. Although nausea, WBC count of 1,000/mm3, and shivering require interventions, these findings aren't a high priority at this time. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, MANAGEMENT OF CANCER, p. 320.

The nurse is to administer a vesicant chemotherapeutic drug to a client who had a right mastectomy and inserts the intravenous line a) In the client's right forearm b) In the client's left hand c) With a butterfly needle d) With a soft, plastic catheter

With a soft, plastic catheter Explanation: Vesicant chemotherapy should never be administered in the peripheral veins involving the hand or wrist. A person with breast cancer is to avoid injections in the affected extremity. A soft, plastic catheter should be used, not a butterfly needle. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, MANAGEMENT OF CANCER, p. 320.

A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include: a) reinforcement of the client's medication regimen. b) expected chemotherapy-related adverse effects. c) signs and symptoms of infection. d) chemotherapy exposure and risk factors.

chemotherapy exposure and risk factors. Explanation: The raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify her teaching plan to include content related to chemotherapy exposure and its associated risk factors. Because the client has received chemotherapy, the plan should already include information about expected adverse effects, signs and symptoms of infection, and reinforcement of the medication regimen. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders.

According to the TNM classification system, T0 means there is a) no regional lymph node metastasis. b) no evidence of primary tumor. c) no distant metastasis. d) distant metastasis.

no evidence of primary tumor. Explanation: T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 12: Management of Patients with Oncologic Disorders, Diagnosis of Cancer, Chart 12-3, p. 312.