Chapter 15: Management of Patients with Oncologic Disorders

An oncologist advises a client with an extensive family history of breast cancer to consider a mastectomy. What type of surgery would the nurse include in teaching?

prophylactic

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

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?

"Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level."

An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates that teaching was successful?

"I clean my teeth gently several times per day."

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."

Which type of surgery is used in an attempt to relieve complications of cancer?

Palliative

A client is recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed?

"I guess the doctor could not remove the entire tumor."

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."

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."

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 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."

A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse?

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.

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 admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient?

Provide time for the patient to discuss her concerns.

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 should the nurse anticipate?

Adjuvant therapy is likely. *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.

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

Autologous

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 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

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention?

The I.V. site is red and swollen.

Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure?

Blood studies

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 *Tis, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.

Which oncologic emergency involves the accumulation of fluid in the pericardial space?

Cardiac tamponade

A client diagnosed with cancer makes the following statement to the nurse: "I guess I will tell my health care provider 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.

A client has just received stem cell transplantation as treatment for leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation?

Closely monitor the client for at least 3 months.

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia?

Closely observe the client's skin for petechiae and bruising.

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

The drug interleukin-2 is an example of which type of biologic response modifier?

Cytokine

An oncology nurse is caring for a client who relates that certain tastes have changed. The client states that "meat tastes bad." What nursing intervention can be used to increase protein intake for a client with taste changes?

Encourage eating cheese, eggs, and legumes

A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue?

Excisional biopsy

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

A patient is to receive Bacille Calmette-Guerin (BCG), a nonspecific biologic response modifier. Why would the patient receive this form of treatment?

For cancer of the bladder *Early investigations of the stimulation of the immune system involved nonspecific agents such as bacille Calmette-Guérin (BCG) and Corynebacterium parvum. When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells. Extensive animal and human investigations with BCG have shown promising results, especially in treating localized malignant melanoma. In addition, BCG bladder instillation is a standard form of treatment for localized bladder cancer.

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

When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care?

Inspect the skin frequently.

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

Which is a growth-based classification of tumors?

Malignancy

In which phase of the cell cycle does cell division occur?

Mitosis

A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client?

Monitor the client to prevent sepsis.

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

No evidence of primary tumor

A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action

Place the client in a private room.

A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action?

Place the client in a private room.

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

A nurse assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis?

Provide a solution of viscous lidocaine for use as a mouth rinse.

Which of the following does a nurse have to assess during the bone marrow transplant (BMT) procedure?

Psychological status

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

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 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

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.

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 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

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

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

Weight gain

The nurse is to administer a vesicant chemotherapeutic drug to a client who had a right mastectomy and inserts the intravenous line

With a soft, plastic catheter

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:

chemotherapy exposure and risk factors.

The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice?

eats red meat such as steaks or hamburgers every day

The nurse is working with a client who has had an allohematopoietic 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

graft-versus-host disease.

A decrease in circulating white blood cells (WBCs) is referred to as

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.

Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient?

Allogeneic *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.

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?

An aunt and uncle diagnosed with cancer