Chapter 15: Management of Patients with Oncologic Disorders
A nurse caring for a client who has just received chemotherapy infusion is wearing a disposable gown, gloves, and goggles for protection. The nurse knows that accidental exposure to chemotherapy agents can occur through:
inhalation of aerosols.
In which phase of the cell cycle does cell division occur?
Mitosis
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?
Malignant Tumor
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?
Pallor, tachycardia, and a sore tongue
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 negative biopsy report?
A wide excision of lump will be performed.
The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as:
brachytherapy.
The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise?
Avoid spicy and fatty foods.
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?
Avoiding the use of products containing aspirin
A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?
"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."
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?
"I floss my teeth every morning."
The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?
"I have difficulty breathing when walking 30 feet."
A client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit?
"I'll play card games with my friends."
A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse?
"I'll see a genetic counselor before starting a family."
Which statement by a client undergoing external radiation therapy indicates the need for further teaching?
"I'm worried I'll expose my family members to radiation."
A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse?
"It will allow time for the repair of healthy tissue."
The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia?
"The hair loss is usually temporary."
A bowel resection is scheduled for a client with the diagnosis of colon cancer with metastasis to the liver and bone. Which statement by the nurse best explains the purpose of the surgery?
"Tumor removal will promote comfort."
While doing a health history, a client tells you that her mother, her grandmother, and her sister died of breast cancer. The client wants to know what she can do to keep from getting cancer. What would be your best response?
"You can't prevent cancer, but you can have your blood analyzed for tumor markers to see what your risk level is."
A nurse is developing a care plan for bone marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable?
7-14 Days
The client is to receive cyclophosphamide (Cytoxan) 50 mg/kg intravenously in divided doses over 5 days. The client weighs 176 pounds. How many mg of cyclophosphamide will the client receive each day?
800mg
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?
Adjusting the client's meal plan before and after chemotherapy
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode will the nurse anticipate?
Adjuvant therapy
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?
Administering metoclopramide and dexamethasone as ordered
Which of the following is a term used to describe the process by which a new blood supply is formed?
Angiogenesis
The most common cause of iron deficiency anemia in men and postmenopausal women is:
Bleeding
Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure?
Blood Studies
A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order?
CBC
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean?
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis
A cancer client makes the following statement to the nurse: "I guess I will tell my doctor to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die."Which of the following facts supports the use of chemotherapy for this client?
Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects.
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?
Colonoscopy
Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?
Control
What are considered carcinogens?
Dietary substances
The nurse is caring for a client with external bleeding. What is the nurse's priority intervention?
Direct pressure
The nurse assesses that extravasation of a chemotherapy agent has occurred. What should the initial action of the nurse be?
Discontinue the infusion.
While administering cisplatin (Platinol-AQ) to a client, the nurse assesses swelling at the insertion site. The first action of the nurse is to
Discontinue the intravenous medication.
A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?
Dyspnea, tachycardia, and pallor
A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient?
Explain to the patient that she will continue to emit radiation while the implant is in place.
A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication?
Extravasation
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?
Extravasation
What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action?
Ham and bacon
The nurse understands that the client should be with human papilloma virus (HPV) vaccine per the health care provider's orders. What is this vaccine for?
Help prevent cervical cancer
A benign tumor of the blood vessels is a(n)
Hemangioma
A patient with ESRD is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication?
Hemoglobin level
Characteristic of a malignant tumor
It gains access to the blood and lymphatic channels.
What does the nurse understand is the rationale for administering allopurinol for a patient receiving chemotherapy?
It lowers serum and uric acid levels.
The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy?
It removes a wedge of tissue for diagnosis.
What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen?
It targets normal body cells as well as cancer cells.
A decrease in circulating white blood cells is
Leukopenia
A client with sickle cell anemia has a:
Low hematocrit
The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a bone marrow transplant?
Monitor the client closely to prevent infection.
According to the TNM classification system, T0 means there is
No evidence of primary tumor.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior?
Progression
The nurse at the clinic explains to the patient that the surgeon will be removing a mole on the patient's back that has the potential to develop into cancer. The nurse informs the patient that this is what type of procedure?
Prophylactic
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?
Prophylactic surgery
During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?
Providing a solution of viscous lidocaine for use as a mouth rinse
When the client complains of increased fatigue following radiotherapy, the nurse knows this is most likely to be related to which factor?
Radiation can result in myelosuppression.
A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis?
Red, open sores on the oral mucosa
After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority?
Risk for infection
A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with:
Seizures
A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication?
Serum potassium level of 2.6 mEq/L
The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic?
Slow rate of growth
A patient with sickle cell disease comes to the emergency department complaining of severe pain in the back, right hip, and right arm. What intervention is important for the nurse to provide?
Start an intravenous line with dextrose 5% in 0.25 normal saline
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
Stops the chemotherapeutic infusion
The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks?
Sun safety and use of sunscreen
Which oncologic emergency involves the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH)?
Syndrome of inappropriate antidiuretic hormone release (SIADH)
A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because:
The three drugs have a synergistic effect and act on the cancer cells with different mechanisms.
The Pediatric Nurse Practitioner is doing a physical examination of a client with sickle cell anemia. Why would the nurse practitioner auscultate the lungs and heart?
To detect the abnormal sounds suggestive of acute chest syndrome and heart failure
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?
To prevent metastasis
The nurse should advise a client with iron deficiency anemia to take which action in order to prevent staining of the teeth?
Use a straw or place a spoon at the back of the mouth to take the liquid supplement.
The nurse evaluates teaching as effective when a female client states that she will:
Use sunscreen when outdoors
Which medication is the antidote to warfarin?
Vitamin K
Which of the following would be inconsistent as a common side effect of chemotherapy?
Weight Gain
The nurse is evaluating the client's risk for cancer and recommends changes when the client states she
eats red meat such as steaks or hamburgers every day
A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is
"You will need to practice birth control measures."
To combat the most common adverse effects of chemotherapy, a nurse should administer an:
Antiemetic
Which is a growth-based classification of tumors?
Malignancy
A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection?
Stage 3 pressure ulcer on the left heel
A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client?
Anticipatory grieving
Which of the following is a term used to describe the process of programmed cell death?
Apoptosis
A nurse caring for a client who has hemophilia is getting ready to take the client's vital signs. What should the nurse do before taking a blood pressure?
Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.
A client has been receiving chemotherapy. Upon assessing the client during morning rounds, the nurse notes the client is now bleeding from intravenous and venipuncture sites. Stool is positive for occult blood. The client is requesting to sit in a chair for a meal. The nurse implements the following interventions:
Assess level of consciousness. Apply pressure to the bleeding sites. Check intake and output records.
What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen?
Encourage fluid intake to dilute the urine.
A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for?
The onset of a bacterial infection
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?
To prevent the formation of new cancer cells
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?
Tumor pressure against normal tissues
Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia?
Apply prolonged pressure to needle sites or other sources of external bleeding
Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client?
Autologous
When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods?
Beans, dried fruits, and leafy, green vegetables
Which oncologic emergency involves the accumulation of fluid in the pericardial space?
Cardiac tamponade
You are an oncology nurse caring for a client who tells you that their tastes have changed. They go on to say that "meat tastes bad". What is a nursing intervention to increase protein intake for a client with taste changes?
Encourage cheese and sandwiches
A client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?
Indigestion
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?
Inspecting the skin for petechiae once every shift
The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides that they are very depressed. The nurse recognizes depression as which of the following?
A normal reaction to the diagnosis of cancer.
A patient is scheduled for cryosurgery for cervical cancer and tells the nurse, "I am not exactly sure what the doctor is going to do." What is the best response by the nurse?
"The physician is going to use liquid nitrogen to freeze the area."
A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse?
Obtain the pain medication and delay the bath and position change until the medication reaches its peak.
Which of the following is the single largest preventable cause of cancer?
Tobacco
Which is a growth-based classification of tumors?
Malignacy
What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss?
The client should consider getting a wig or cap prior to beginning treatment.
Which is a sign or symptom of septic shock?
Altered mental status
A client is prescribed 325 mg/day of oral ferrous sulfate. What does the nurse include in client teaching?
Take 1 hour before breakfast
