Chapter 12 - The Point - Oncologic Management
After a bone marrow transplant (BMT), the client should be monitored for at least a. 30 days b. 100 days c. 14 days d. 60 days
b. 100 days Rationale: After a BMT, the nurse closely monitors the client for at least 100 days or more after the procedure because complications related to the transplant can occur 100 days or more as post procedure infections are one common complication that may lead to sepsis and transplant failure.
A benign tumor of the blood vessels is a(n) a. chondroma. b. hemangioma. c. osteoma. d. neuroma.
b. hemangioma. Rationale: A hemangioma is a benign tumor of the blood vessels. An osteoma is a tumor of the connective tissue. A neuroma is a tumor of the nerve cells. A chondroma is a tumor of the cartilage.
Which class of antineoplastic agents is cell cycle-specific? a. Alkylating agents (cisplatin) b. Nitrosoureas (carmustine) c. Antimetabolites (5-FU) d. Antitumor antibiotics (bleomycin)
c. Antimetabolites (5-FU) Rationale: Antimetabolites are cell cycle-specific (S phase). Antitumor antibiotics, alkylating agents, and nitrosoureas are cell cycle-nonspecific.
The nurse is caring for a client with cancer who is treating her cancer with deep-tissue massage in addition to radiation therapy. The nurse documents the use of which therapy on the client's chart? a. Integrative medicine b. Alternative therapy c. Global medicine d. Compliant medicine
a. Integrative medicine Rationale: Integrative medicine is the use of therapies in conjunction with conventional medicine. This is also known as complementary medicine. Alternative therapies are used instead of conventional medicine.
A decrease in circulating white blood cells (WBCs) is referred to as a. Leukopenia b. Neutropenia c. Thrombocytopenia d. Granulocytopenia
a. Leukopenia Rationale: 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.
The nurse is working with a client who has had an allo-hematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of a. graft-versus-host disease. b. nadir. c. metastasis. d. acute leukopenia.
a. graft-versus-host disease. Rationale: Graft-versus-host disease is a major cause of morbidity and mortality in clients who have had allogeneic transplant. Clinical manifestations of the disease include diffuse rash that progresses to blistering and desquamation, and mucosal inflammation of the eyes and the entire gastrointestinal tract with subsequent diarrhea, abdominal pain, and hepatomegaly.
A decrease in circulating white blood cells is a. leukopenia. b. granulocytopenia. c. thrombocytopenia. d. neutropenia.
a. leukopenia. Rationale: 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.
A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with a. seizure. b. weight gain. c. myalgia. d. anorexia.
a. seizure. Rationale: 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.
Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure? a. Allergy history b. Blood studies c. Drug history d. Family history
b. Blood studies Rationale: Before the HSCT 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 an HSCT procedure, the nurse need not evaluate client's family, drug, or allergy history.
The physician is attending to a 72-year-old client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation? a. To remove the tumor from the brain b. To destroy marginal tissues c. To prevent the formation of new cancer cells d. To analyze the lymph nodes involved
c. To prevent the formation of new cancer cells Rationale: Radiation therapy helps prevent cellular growth. It may be used to cure the cancer or to control malignancy when the tumor cannot be removed or when lymph node involvement is present; also, it can be used prophylactically to prevent spread. Biopsy is used to analyze lymph nodes or to destroy the surrounding tissues around the tumor.
The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic? a. Causes generalized symptoms b. Slow rate of growth c. Ability to invade other tissues d. Undifferentiated cells
b. Slow rate of growth Rationale: Benign tumors have a slow rate of growth and well-differentiated cells. Benign tumors do not invade surrounding tissue and do not cause generalized symptoms unless the location of the tumor interferes with the functioning of vital organs.
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. Onset of cancer after age 50 in family member b. A second cousin diagnosed with cancer c. A first cousin diagnosed with cancer d. An aunt and uncle diagnosed with cancer
d. An aunt and uncle diagnosed with cancer Rationale: 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.
The nurse is providing education to a client with cancer radiation treatment options. The nurse determines that the client understands the teaching when the client states that which type of radiation aims to protect healthy tissue during the treatment? a. Proton therapy b. Teletherapy c. External d. Brachytherapy
d. Brachytherapy Rationale: In internal radiation, or brachytherapy, a dose of radiation is delivered to a localized area inside the body through the use of an implant. With this type of therapy, the farther the tissue is from the radiation source, the lower the dose. This helps to protect normal tissue from the radiation therapy.
Which type of surgery is used in an attempt to relieve complications of cancer? a. Reconstructive b. Prophylactic c. Salvage d. Palliative
d. Palliative Rationale: Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing nonvital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or to obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.
The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as a. systemic radiation. b. external beam radiation therapy. c. a contact mold. d. brachytherapy.
d. brachytherapy. Rationale: Brachytherapy is the only term used to denote the use of internal radiation implants.
According to the TNM classification system, T0 means there is a. no distant metastasis. b. no regional lymph node metastasis. c. distant metastasis. d. no evidence of primary tumor.
d. no evidence of primary tumor. Rationale: 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.
Which statement is true about malignant tumors? a. They demonstrate cells that are well differentiated. b. They gain access to the blood and lymphatic channels. c. They grow by expansion. d. They usually grow slowly.
b. They gain access to the blood and lymphatic channels. Rationale: By gaining access to blood and lymphatic channels, a tumor can metastasize to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rates of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.
Palliation refers to: a. the spread of cancer cells from the primary tumor to distant sites. b. relief of symptoms associated with disease and promotion of comfort and quality of life. c. the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow. d. hair loss related to the treatment of cancer.
b. relief of symptoms associated with disease and promotion of comfort and quality of life. Rationale: Palliation is the goal for care in patients with terminal cancer. Alopecia is the term that refers to hair loss. Metastasis is the term that refers to the spread of cancer cells from the primary tumor to distant sites. Nadir is the term that refers to the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow.
Which is a growth-based classification of tumors? a. Leukemia b. Sarcoma c. Carcinoma d. Malignancy
d. Malignancy Rationale: Tumors classified on the basis of growth are described as benign or malignant. Tumors that are classified on the basis of the cell or tissue of origin are carcinomas, sarcomas, lymphomas, and leukemias.
Which is a sign or symptom of septic shock? a. Warm, moist skin b. Hypertension c. Increased urine output d. Altered mental status
d. Altered mental status Rationale: Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension.
The nurse is evaluating bloodwork results of a client with cancer who is receiving chemotherapy. The client's platelet count is 60,000/mm3. Which is an appropriate nursing action? a. Taking the client's temperature rectally b. Providing commercial mouthwash to the client c. Avoiding the use of products containing aspirin d. Providing a razor so the client can shave
c. Avoiding the use of products containing aspirin Rationale: Clients with a platelet count of 60,000/mm3 are at mild risk for bleeding. Appropriate nursing interventions include avoiding the use of products such as aspirin that may interfere with the client's clotting systems; avoiding taking temperature rectally and administering suppositories; providing the client with an electric shaver for shaving; and avoiding commercial mouthwashes because of their potential to dry out oral mucosa, which can lead to cracking and bleeding.
Chemotherapeutic agents have which effect associated with the renal system? a. Hypercalcemia b. Increased uric acid excretion c. Hypophosphatemia d. Hypokalemia
b. Increased uric acid excretion Rationale: Chemotherapeutic agents can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. Urinary excretion of uric acid increases with the use of chemotherapeutic agents. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.
The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy? a. It removes a wedge of tissue for diagnosis. b. It is used to remove cancerous cells using a needle. c. It treats cancer with lymph node involvement. d. It removes an entire lesion and the surrounding tissue.
a. It removes a wedge of tissue for diagnosis. Rationale: The three most common biopsy methods are excisional, incisional, and needle. In an incisional biopsy, a wedge of tissue is removed from the tumor and analyzed. In an excisional biopsy, the surgeon removes the tumor and the surrounding marginal tissues. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.
Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client? a. Prophylactic b. Autologous c. Allogeneic d. Therapeutic
b. Autologous Rationale: 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.
Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure? a. Family history b. Blood studies c. Allergy history d. Drug history
b. Blood studies Rationale: 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.
The nurse is preparing to assess a client whose chart documents that the client experienced extravasation when receiving the vesicant vincristine during the previous shift. The documentation also notes that an antidote was administered immediately. The nurse prepares to assess for which conditions? Select all that apply. a. Active bleeding b. Tissue necrosis c. Sloughing tissue d. Effectiveness of the antidote
b. Tissue necrosis c. Sloughing tissue d. Effectiveness of the antidote Rationale: Extravasation of vesicant chemotherapeutic agents can lead to erythema, sloughing, and necrosis of surrounding tissue, muscle, and tendons. To reduce the likelihood and severity of symptoms due to extravasation of a vesicant, antidotes matched to the vesicant are administered. Nurses caring for a client who experienced extravasation of a vesicant should assess for sloughing tissue, tissue necrosis, erythema, and effectiveness of the antidote.
A client with metastatic pancreatic cancer underwent surgery to remove a malignant tumor in the pancreas. Despite the tumor being removed, the physician informs the client that chemotherapy must be started. Why might the physician opt for chemotherapy? a. Stomatitis b. To prevent metastasis c. Angiogenesis d. Fatigue
b. To prevent metastasis Rationale: Chemotherapy treats systemic and metastatic cancer. It can also be used to reduce tumor size preoperatively, or to destroy any remaining tumor cells postoperatively. Angiogenesis is the growth of new capillaries from the tissue of origin. This process helps malignant cells obtain needed nutrients and oxygen to promote growth. Fatigue and stomatitis are side effects of radiation and chemotherapy.
Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client? a. Prophylactic b. Allogeneic c. Autologous d. Therapeutic
c. Autologous Rationale: 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.
The nurse is conducting a community education program using the American Cancer Society's colorectal screening and prevention guidelines. The nurse determines that the participants understand the teaching when they identify that people over the age of 50 should have which screening test every 10 years? a. Papanicolaou (Pap) b. Fecal occult blood test c. Colonoscopy d. Prostate-specific antigen (PSA)
c. Colonoscopy Rationale: Recommendations for screening for colorectal cancer include a screening colonoscopy every 10 years. Fecal occult blood tests should be completed annually in people over age 50. The test for PSA is used as a screening tool for prostate cancer. A Pap test is a screening tool for cervical cancer.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? a. Promotion b. Prolongation c. Progression d. Initiation
c. Progression Rationale: Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information, even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.
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. Nadir b. Neutropenia c. Stomatitis d. Extravasation
c. Stomatitis Rationale: 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.
A client is undergoing chemotherapy treatment for prostate cancer and has lost considerable weight due to nausea and vomiting. Which nursing intervention is appropriate for the client? a. Decreasing dietary fluids 2 days before chemotherapy b. Administering beta-blockers as ordered by the physician c. Increasing fresh fruits in the client's diet d. Adjusting the client's meal plan before and after chemotherapy
d. Adjusting the client's meal plan before and after chemotherapy Rationale: The nurse should readjust the client's meal plan before and after chemotherapy administration. The nurse should take into consideration the client's likes and dislikes and avoid foods with strong odors. The nurse should ensure adequate fluid hydration before, during, and after drug administration when the client has side effects of nausea and vomiting. Fresh fruits are not recommended when the client is at risk of infection, such as during chemotherapy. Beta-blockers are not administered to control nausea and vomiting.
Which procedure uses liquid nitrogen to freeze tissue, thereby destroying cells? a. Laser surgery b. Electrosurgery c. Chemosurgery d. Cryoablation
d. Cryoablation Rationale: Cryoablation uses liquid nitrogen or a very cold probe to freeze tissue, causing cell destruction. Electrosurgery, chemosurgery, and laser surgery do not use liquid nitrogen to freeze tissue.
