Chapter 15: Management of Patients with Oncologic Disorders

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." 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.

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." Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.

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 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.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?

Administering metoclopramide and dexamethasone as ordered The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.

Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client?

Autologous 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 providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise?

Avoid spicy and fatty foods. The nurse advises a client undergoing chemotherapy to avoid hot and very cold liquids and spicy and fatty foods. The nurse also encourages the client to have small meals and appropriate fluid intake.

A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan?

Avoiding using soap on the irradiated areas 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.

Which occurs when fluid accumulates in the pericardial space and compresses the heart?

Cardiac tamponade Cardiac tamponade is an accumulation of fluid in the pericardial space. SVCS occurs when the superior vena cava is compressed or invaded by a tumor, lymph nodes are enlarged, intraluminal thrombosis obstructs venous circulation, or drainage occurs from the head, neck, arms, and thorax. SIADH is the continuous, uncontrolled release of ADH. DIC is a complex disorder of coagulation or fibrinolysis that results in thrombosis or bleeding.

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 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.

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?

Control The range of possible treatment goals may include complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control), or relief of symptoms associated with the disease (palliation). Prevention is not a treatment goal when the patient has already been diagnosed with cancer. Prevention of metastasis to a secondary site may be a goal.

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. 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.

A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:

Encourage fluid intake, if possible, to dilute the urine. To prevent renal damage, it is helpful to dilute the urine by increasing fluids as tolerated.

The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?

Extravasation 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.

The nurse is assessing the diet of a female client. To decrease the risk of cancer in general, the nurse instructs the client to

Limit alcohol ingestion to one drink per day. Alcohol increases the risks of certain cancers and should be limited to no more than one drink per day for women. Smoking is strongly associated with certain cancers, and tobacco may act synergistically with other substances. Even decreasing use of tobacco still places one at risk for cancer. Recommendation by the U.S. Department of Agriculture for fruits and vegetables is 4 1/2 cups per day and for protein is 5 1/2 ounces per day with low-fat or lean meat and poulty and/or other proteins such as fish, beans, peas, nuts, and seeds.

Which is a growth-based classification of tumors?

Malignancy 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.

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior?

Progression 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.

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 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.

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 Fatigue results from anemia associated with myelosuppression and decreased RBC production. The spreading of cancer can cause many symptoms dependent on location and type of cancer but not a significant factor to support fatigue with radiotherapy. The production of healthy cells can increase metabolic rate, but death of cancer cells does not support fatigue in this case. Fighting infection can cause fatigue, but there is no evidence provided to support presence of infection in this client.

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 The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.

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 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.

The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client?

Shorten the period of neutropenia Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation. The suppression of bone marrow creates the need for interferon use, not a result of the use. Although some BRMs can inhibit tumor growth, the primary use is for reducing neutropenia. Interferon use does not replace standard cancer treatments or decrease the need for those treatments.

Question 1 See full question 35s 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 stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection.

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?

Stomatitis 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

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. If hair loss is anticipated and causing the client anxiety, a wig, cap, or scarf should be purchased before therapy begins. Alopecia develops because chemotherapy affects the rapidly growing cells of the hair follicles. Hair usually begins to grow again within 4 to 6 months after therapy. Clients should know that new growth may have a slightly different color and texture.

Your client is receiving radiation therapy. The client asks you about oral hygiene. What advice regarding oral hygiene should you offer?

Use a soft toothbrush and avoid an electronic toothbrush. The nurse advises the client undergoing radiation therapy to use a soft toothbrush and avoid electronic toothbrushes to avoid skin lacerations. Gargling after each meal, flossing before going to bed, and treating cavities immediately are general oral hygiene instructions.

The nurse evaluates teaching as effective when a female client states that she will

Use sunscreen when outdoors. Use of sunscreens play a role in the amount of exposure to ultraviolet light. Even decreasing the use of tobacco still exposes a person to risk of cancer. The American Cancer Society recommends adults to engage in at least 30 minutes of moderate to vigorous physical activity on 5 or more days each week. It is recommended to obtain a cancer history from at least three generations.

A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents?

Wear disposable gloves and protective clothing. A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, I.V. tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container.

Which of the following would be inconsistent as a common side effect of chemotherapy?

Weight gain Common side effects seen with chemotherapy include myelosuppression, alopecia, nausea and vomiting, anorexia, and fatigue.

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 Dietary substances such as nitrate-containing, nitrite-containing, and red meats appear to increase the risk of cancer. Exercising 30 minutes on 5 days or more is recommended for adults. Measures are taken to protect those people who work around radiation. It is OK to drink 1 glass of wine per day.

A benign tumor of the blood vessels is a(n)

hemangioma. 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.

A decrease in circulating white blood cells is

leukopenia 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.

According to the TNM classification system, T0 means there is

no evidence of primary tumor. 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.

A client with ovarian cancer is ordered hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with:

normal cellular processes during the S phase of the cell cycle. Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They're most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.