Chapter 22: Care of Patients with Cancer

4. In evaluating dietary teaching for a client with chemotherapy-induced neutropenia, the nurse becomes concerned when the client makes which food choice? a. Fruit salad b. Applesauce c. Steamed broccoli d. Baked potato

ANS: A The client who is neutropenic should be taught to eat a low-bacteria diet. This includes avoiding raw fruits or vegetables and undercooked meat, eggs, or fish.

8. The nurse working with oncology clients understands that which age-related change increases the older clients susceptibility to infection during chemotherapy? a. Decreased immune function b. Diminished nutritional stores c. Existing cognitive deficits d. Poor physical reserves

ANS: A As people age, there is an age-related decrease in immune function, causing the older adult to be more susceptible to infection than other clients. Not all older adults have diminished nutritional stores, cognitive dysfunction, or poor physical reserves.

23. A nurse works on an oncology unit and delegates personal hygiene to an unlicensed assistive personnel (UAP). What action by the UAP requires intervention from the nurse? a. Allowing a very tired client to skip oral hygiene and sleep b. Assisting clients with washing the perianal area every 12 hours c. Helping the client use a soft-bristled toothbrush for oral care d. Reminding the client to rinse the mouth with water or saline

ANS: A Even though clients may be tired, they still need to participate in hygiene to help prevent infection. The other options are all appropriate.

13. A client is receiving interleukins along with chemotherapy. What assessment by the nurse takes priority? a. Blood pressure b. Lung assessment c. Oral mucous membranes d. Skin integrity

ANS: A Interleukins can cause capillary leak syndrome and fluid shifting, leading to intravascular volume depletion. Although all assessments are important in caring for clients with cancer, blood pressure and other assessments of fluid status take priority.

2. A nurse reads on a hospitalized clients chart that the client is receiving teletherapy. What action by the nurse is best? a. Coordinate continuation of the therapy. b. Place the client on radiation precautions. c. No action by the nurse is needed at this time. d. Restrict visitors to only adults over age 18.

ANS: A The client needs to continue with radiation therapy, and the nurse can coordinate this with the appropriate department. The client is not radioactive, so radiation precautions and limiting visitors are not necessary.

11. A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL. What medication should the nurse prepare to administer? a. Epoetin alfa (Epogen) b. Filgrastim (Neupogen) c. Mesna (Mesnex) d. Oprelvekin (Neumega)

ANS: A The clients hemoglobin is low, so the nurse should prepare to administer epoetin alfa, a colony-stimulating factor that increases production of red blood cells. Filgrastim is for neutropenia. Mesna is used to decrease bladder toxicity from some chemotherapeutic agents. Oprelvekin is used to increase platelet count.

17. A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important? a. Assess the clients gait and balance. b. Ask the client about the ease of urine flow. c. Document the report completely. d. Inquire about the clients job risks.

ANS: A This client has manifestations of spinal cord compression, which can be seen with prostate cancer. This may affect both gait and balance and urinary function. For client safety, assessing gait and balance is the priority. Documentation should be complete. The client may or may not have occupational risks for low back pain, but with his history of prostate cancer, this should not be where the nurse starts investigating.

25. A client in the emergency department reports difficulty breathing. The nurse assesses the clients appearance as depicted below: What action by the nurse is the priority? a. Assess blood pressure and pulse. b. Attach the client to a pulse oximeter. c. Have the client rate his or her pain. d. Start high-dose steroid therapy.

ANS: A This client has superior vena cava syndrome, in which venous return from the head, neck, and trunk is blocked. Decreased cardiac output can occur. The nurse should assess indicators of cardiac output, including blood pressure and pulse, as the priority. The other actions are also appropriate but are not the priority.

20. A nurse working with clients who experience alopecia knows that which is the best method of helping clients manage the psychosocial impact of this problem? a. Assisting the client to pre-plan for this event b. Reassuring the client that alopecia is temporary c. Teaching the client ways to protect the scalp d. Telling the client that there are worse side effects

ANS: A Alopecia does not occur for all clients who have cancer, but when it does, it can be devastating. The best action by the nurse is to teach the client about the possibility and to give the client multiple choices for preparing for this event. Not all clients will have the same reaction, but some possible actions the client can take are buying a wig ahead of time, buying attractive hats and scarves, and having a hairdresser modify a wig to look like the clients own hair. Teaching about scalp protection is important but does not address the psychosocial impact. Reassuring the client that hair loss is temporary and telling him or her that there are worse side effects are both patronizing and do not give the client tools to manage this condition.

6. A client has bone cancer. What intervention does the nurse implement as a priority for this client? a. Using a lift sheet when repositioning the client b. Positioning the clients heels to keep them from touching the mattress c. Providing small, frequent meals rich in calcium and phosphorus d. Applying pressure for 5 minutes after intramuscular injections

ANS: A Bone metastasis of cancer can cause such bone destruction that grasping or pulling a client can result in a pathologic fracture. Using a lift sheet spreads the clients weight more evenly, preventing excessive force on any one body area. Preventing pressure on the heels will help prevent pressure ulcers; this is a good intervention for all clients but does not take priority over preventing fractures. Adding calcium and phosphorus to meals will not prevent fractures. Applying pressure after IM injections is not related to this clients condition.

1. A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best? a. Call the client at home the next day to review teaching. b. Give the client information about a cancer support group. c. Provide all the preoperative instructions in writing. d. Reassure the client that surgery will be over soon.

ANS: A Clients are often overwhelmed at a sudden diagnosis of cancer and may be more overwhelmed at the idea of a major operation so soon. This stress significantly impacts the clients ability to understand, retain, and recall information. The nurse should call the client at home the next day to review the teaching and to answer questions. The client may or may not be ready to investigate a support group, but this does not help with teaching. Giving information in writing is important (if the client can read it), but in itself will not be enough. Telling the client that surgery will be over soon is giving false reassurance and does nothing for teaching.

28. The nurse questions which activity for the client with thrombocytopenia? a. Application of warm compresses to bruises b. Cleaning teeth with a soft-bristled brush c. Taking acetaminophen (Tylenol) for pain d. Using stool softeners daily for constipation

ANS: A Ice should be applied to areas of bruising or trauma to decrease bleeding. Warm compresses would lead to vasodilation and potentially to more bleeding. It is important to implement measures to decrease the risk of bleeding. A soft-bristled toothbrush decreases trauma to gums, which could cause bleeding. Straining at the stool could increase risk for rectal bleeding, so stool softeners may be prescribed. Acetaminophen does not affect platelet function and bleeding as do aspirin products.

6. A client is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important? a. Assessing the IV site every hour b. Educating the client on side effects c. Monitoring the client for nausea d. Providing warm packs for comfort

ANS: A Intravenous chemotherapy can cause local tissue destruction if it extravasates into the surrounding tissues. Peripheral IV lines are more prone to this than centrally placed lines. The most important intervention is prevention, so the nurse should check hourly to ensure the IV site is patent, or frequently depending on facility policy. Education and monitoring for side effects such as nausea are important for all clients receiving chemotherapy. Warm packs may be helpful for comfort, but if the client reports that an IV site is painful, the nurse needs to assess further.

22. A client with advanced cancer is being treated with intravenous mithramycin (Mithracin). Which clinical manifestation indicates that the treatment is effective? a. Bowel sounds are active in all four quadrants. b. The clients serum sodium level is 138 mEq/L. c. The pulse rate is 68 beats/min and bounding. d. Urine output has increased to 30 mL/hr.

ANS: A Mithramycin is used to treat hypercalcemia, which is seen most often in oncology clients who have bone metastases. Hypercalcemia reduces excitable membrane activity, causing decreased intestinal motility. Return of intestinal motility is an indication that serum calcium levels are decreasing. Mithramycin has no direct effect on serum sodium levels or urine output. The pulse rate most likely would be rapid and irregular with hypercalcemia and would normalize as calcium levels return to normal.

15. What is the priority problem for a client experiencing chemotherapy-induced anemia? a. Risk for injury related to fatigue b. Fatigue related to decreased oxygenation c. Body image problems related to skin color changes d. Inadequate nutrition related to anorexia

ANS: A Safety is always a client priority. The client who is anemic will be fatigued and may need assistance with activity to prevent injury. The other problems may apply; however, they do not take priority over safety.

16. A client is hospitalized for chemotherapy. The registered nurse intervenes when observing which action by the nursing assistant? a. Allowing the client to rest instead of making him or her perform oral hygiene b. Helping the client wash the groin and axillary areas every 12 hours c. Cutting food and opening food packages when the clients meal tray arrives d. Reminding the client to use the incentive spirometer every hour while awake

ANS: A The biggest dangers to clients on chemotherapy are neutropenia and the risk of serious infection or sepsis. Most infections arise from overgrowth of the clients own normal flora, so personal hygiene is critical. The client must perform hygiene measures on a schedule, even if he or she is very tired. Instead of allowing the client to rest, the nursing assistant should help the client perform oral hygiene and other measures. The other actions would be acceptable.

5. What teaching is essential for a client who has received an injection of iodine-131? a. Do not share a toilet with anyone else or let anyone clean your toilet. b. You need to save all your urine for the next week. c. No special precautions are needed because this type of radiation is weak. d. Avoid all contact with other people until the radiation device is removed.

ANS: A The radiation source is an unsealed isotope that is eliminated from the body in waste products, especially urine and feces. This material is radioactive for about 48 hours after instillation of the isotope. Having the client not share a toilet with other people or allowing anyone to clean the clients toilet for a specific period of time ensures that the isotope has been completely eliminated, and that the clients wastes are no longer radioactive.

22. A client is having a catheter placed in the femoral artery to deliver yttrium-90 beads into a liver tumor. What action by the nurse is most important? a. Assessing the clients abdomen beforehand b. Ensuring that informed consent is on the chart c. Marking the clients bilateral pedal pulses d. Reviewing client teaching done previously

ANS: B This is an invasive procedure requiring informed consent. The nurse should ensure that consent is on the chart. The other actions are also appropriate but not the priority.

24. A client is receiving high-dose chemotherapy for multiple myeloma. Which intervention is most important for the nurse to implement to prevent complications during chemotherapy? a. Ensure that the clients fluid intake is 3000 to 5000 mL/day. b. Monitor telemetry every hour during therapy. c. Apply pressure to all injection sites for 5 minutes. d. Assist the client in all ambulatory activities.

ANS: A This client is at high risk for tumor lysis syndrome. Tumor lysis syndrome is the precipitation of intracellular products released when tumor cells are destroyed rapidly. These products, particularly purines, can increase uric acid crystal precipitation in the kidney tubules and may cause acute tubular necrosis. In addition, serum potassium levels can become high. Maintaining adequate hydration and urine output is essential in preventing complications.

25. The nurse teaches a client with superior vena cava syndrome that improvement is characterized by which clinical manifestation? a. The clients hands are less swollen. b. Breath sounds are clear bilaterally. c. The clients back pain is relieved. d. Pedal edema is present.

ANS: A With superior vena cava syndrome, blood flow through the vena cava is compromised as a result of tumor growth. Blood backs up into the periphery, and the client experiences upper body swelling, including the hands and feet. Compression of the superior vena cava has no effect on breath sounds. This would occur when blood is impeded from leaving the lungs, and with disorders that affect the left side of the heart. Back pain is not associated with this disorder.

6. A clients family members are concerned that telling the client about a new finding of cancer will cause extreme emotional distress. They approach the nurse and ask if this can be kept from the client. What actions by the nurse are most appropriate? (Select all that apply.) a. Ask the family to describe their concerns more fully. b. Consult with a social worker, chaplain, or ethics committee. c. Explain the clients right to know and ask for their assistance. d. Have the unit manager take over the care of this client and family. e. Tell the family that this secret will not be kept from the client.

ANS: A, B, C The clients right of autonomy means that the client must be fully informed as to his or her diagnosis and treatment options. The nurse cannot ethically keep this information from the client. The nurse can ask the family to explain their concerns more fully so everyone understands the concerns. A social worker, chaplain, or ethics committee can become involved to assist the nurse, client, and family. The nurse should explain the clients right to know and ask the family how best to proceed. The nurse should not abdicate responsibility for this difficult situation by transferring care to another nurse. Simply telling the family that he or she will not keep this secret sets up an adversarial relationship. Explaining this fact along with the concept of autonomy would be acceptable, but this by itself is not.

2. A nurse is preparing to administer IV chemotherapy. What supplies does this nurse need? (Select all that apply.) a. Chemo gloves b. Facemask c. Isolation gown d. N95 respirator e. Shoe covers

ANS: A, B, C The Occupational Safety and Health Administration (OSHA) and the Oncology Nurses Society have developed safety guidelines for those preparing or administering IV chemotherapy. These include double gloves (or chemo gloves), a facemask, and a gown. An N95 respirator and shoe covers are not required.

4. A client has thrombocytopenia. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply the clients shoes before getting the client out of bed. b. Assist the client with ambulation. c. Shave the client with a safety razor only. d. Use a lift sheet to move the client up in bed. e. Use the Waterpik on a low setting for oral care.

ANS: A, B, D Clients with thrombocytopenia are at risk of significant bleeding even with minor injuries. The nurse instructs the UAP to put the clients shoes on before getting the client out of bed, assist with ambulation, shave the client with an electric razor, use a lift sheet when needed to reposition the client, and use a soft-bristled toothbrush for oral care.

5. A client has mucositis. What actions by the nurse will improve the clients nutrition? (Select all that apply.) a. Assist with rinsing the mouth with saline frequently. b. Encourage the client to eat room-temperature foods. c. Give the client hot liquids to hold in the mouth. d. Provide local anesthetic medications to swish and spit. e. Remind the client to brush teeth gently after each meal.

ANS: A, B, D, E Mucositis can interfere with nutrition. The nurse can help with rinsing the mouth frequently with water or saline; encouraging the client to eat cool, slightly warm, or room-temperature foods; providing swish-and-spit anesthetics; and reminding the client to keep the mouth clean by brushing gently after each meal. Hot liquids would be painful for the client.

3. A client on interferon therapy is reporting severe skin itching and irritation. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply moisturizers to dry skin. b. Apply steroid creams to the skin. c. Bathe the client using mild soap. d. Help the client with a hot water bath. e. Teach the client to avoid sunlight.

ANS: A, C The nurse can delegate applying unscented moisturizer and using mild soap for bathing. Steroid creams are not used for this condition. Hot water will worsen the irritation. Client teaching is a nursing function.

7. A client receiving chemotherapy has a white blood cell count of 1000/mm3. What actions by the nurse are most appropriate? (Select all that apply.) a. Assess all mucous membranes every 4 to 8 hours. b. Do not allow the client to eat meat or poultry. c. Listen to lung sounds and monitor for cough. d. Monitor the venous access device appearance with vital signs. e. Take and record vital signs every 4 to 8 hours.

ANS: A, C, D, E Depending on facility protocol, the nurse should assess this client for infection every 4 to 8 hours by assessing all mucous membranes, listening to lung sounds, monitoring for cough, monitoring the appearance of the venous access device, and recording vital signs. Eating meat and poultry is allowed.

3. The nurse is caring for a client who has a sealed radiation implant for cervical cancer. Which activities by the nurse are appropriate? (Select all that apply.) a. Inform the supervisor of the nurses positive pregnancy test. b. Obtain the dosimeter badge from the nurse going off shift. c. Keep the clients door open for frequent observation. d. Dispose of dirty linen in a red biohazard bag. e. Wear a lead apron while providing client care.

ANS: A, E Pregnant nurses should never care for clients with sealed implants of radioactive material, so if the nurse suspects she is pregnant, she should inform her supervisor and request a different assignment. Nurses should wear lead aprons while providing care, ensuring that the apron always faces the client. Each nurse should have his or her own dosimeter film badge. The clients door should be kept closed whenever possible and dirty linens kept in the clients room until the radiation source is removed.

2. The nurse is planning care for a client with hypercalcemia secondary to bone metastasis. Which interventions are included in the plan? (Select all that apply.) a. Increase oral fluids. b. Place an oral airway at the bedside. c. Monitor for Chvosteks sign. d. Implement seizure precautions. e. Assess for hyperactive reflexes. f. Observe for muscle weakness.

ANS: A, F Early manifestations of hypercalcemia include fatigue, loss of appetite, nausea, vomiting, constipation, and polyuria (increased urine output). More serious problems include severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, and electrocardiographic changes. An oral airway is not needed. Chvosteks sign is an assessment for hypocalcemia. Seizures and hyperactive reflexes do not occur with hypercalcemia.

10. A client has a platelet count of 9800/mm3. What action by the nurse is most appropriate? a. Assess the client for calf pain, warmth, and redness. b. Instruct the client to call for help to get out of bed. c. Obtain cultures as per the facilitys standing policy. d. Place the client on protective isolation precautions.

ANS: B A client with a platelet count this low is at high risk for serious bleeding episodes. To prevent injury, the client should be instructed to call for help prior to getting out of bed. Calf pain, warmth, and redness might indicate a deep vein thrombosis, not associated with low platelets. Cultures and isolation relate to low white cell counts.

24. A client with cancer has anorexia and mucositis, and is losing weight. The clients family members continually bring favorite foods to the client and are distressed when the client wont eat them. What action by the nurse is best? a. Explain the pathophysiologic reasons behind the client not eating. b. Help the family show other ways to demonstrate love and caring. c. Suggest foods and liquids the client might be willing to try to eat. d. Tell the family the client isnt able to eat now no matter what they bring.

ANS: B Families often become distressed when their loved ones wont eat. Providing food is a universal sign of caring, and to some people the refusal to eat signifies worsening of the condition. The best option for the nurse is tohelp the family find other ways to demonstrate caring and love, because with treatment-related anorexia and mucositis, the client is not likely to eat anything right now. Explaining the rationale for the problem is a good idea but does not suggest to the family anything that they can do for the client. Simply telling the family the client is not able to eat does not give them useful information and is dismissive of their concerns.

9. After receiving the hand-off report, which client should the oncology nurse see first? a. Client who is afebrile with a heart rate of 108 beats/min b. Older client on chemotherapy with mental status changes c. Client who is neutropenic and in protective isolation d. Client scheduled for radiation therapy today

ANS: B Older clients often do not exhibit classic signs of infection, and often mental status changes are the first observation. Clients on chemotherapy who become neutropenic also often do not exhibit classic signs of infection. The nurse should assess the older client first. The other clients can be seen afterward.

19. A client has received a dose of ondansetron (Zofran) for nausea. What action by the nurse is most important? a. Assess the client for a headache. b. Assist the client in getting out of bed. c. Instruct the client to reduce salt intake. d. Weigh the client daily before the client eats.

ANS: B Ondansetron side effects include postural hypotension, vertigo, and bradycardia, all of which increase the clients risk for injury. The nurse should assist the client when getting out of bed. Headache and fluid retention are not side effects of this drug.

4. A client in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate? a. Are you getting adequate rest and sleep each day? b. It is normal to be fatigued even for years afterward. c. This is not normal and Ill let the provider know. d. Try adding more vitamins B and C to your diet.

ANS: B Regardless of the cause, radiation-induced fatigue can be debilitating and may last for months or years after treatment has ended. Rest and adequate nutrition can affect fatigue, but it is most important that the client understands this is normal.

5. A client tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate? a. Avoid getting salt water on the radiation site. b. Do not expose the radiation area to direct sunlight. c. Have a wonderful time and enjoy your vacation! d. Remember you should not drink alcohol for a year.

ANS: B The skin overlying the radiation site is extremely sensitive to sunlight after radiation therapy has been completed. The nurse should inform the client to avoid sun exposure to this area. This advice continues for 1 year after treatment has been completed. The other statements are not appropriate.

2. A client is undergoing radiation therapy and asks the nurse about skin care for the exposed area. Which statement by the nurse is most accurate? a. No products work well to reduce the skin reactions you get from radiation. b. No one product works best, so you can choose what you would like to use. c. The only medication that works well for skin reactions is very expensive. d. No good studies on skin care with radiation have been conducted to date.

ANS: B A recent placebo-controlled study showed that none of three products used to manage radiation-related skin reactions was superior to the others. Researchers concluded that clients should use products that are easy to obtain and use and are within the clients budget. Simply stating that no one product works well does not give the client enough information to make an informed choice. Prescription medications for skin reactions can be expensive, but again this response does not help the client make a decision.

18. A client with prostate cancer is taking estrogen daily to control tumor growth. He reports that his left calf is swollen and painful. Which is the nurses best action? a. Instruct the client to keep the leg elevated. b. Measure and compare calf circumferences. c. Apply ice to the calf after massaging it. d. Document this expected response.

ANS: B An adverse reaction to hormonal manipulation therapy is the development of thrombus formation. The nurse should measure both calf circumferences and compare them; the side with a thromboembolism will be larger. Elevation may be helpful, but first the nurse needs to assess the situation. Massaging a calf that is swollen and painful is never correct, because this action might break a clot to form an embolus, which could then travel to the lungs.

19. A client is receiving interleukin-2 (IL-2) for cancer. Which drug is the nurse prepared to administer if needed? a. Lorazepam (Ativan) b. Meperidine (Demerol) c. Furosemide (Lasix) d. Epoetin alfa (Epogen)

ANS: B Clients receiving IL-2 therapy usually experience chills, fever, and rigors during the infusion, especially the first time that they receive the drug. These reactions are a normal response to the administration of biological response modifiers such as IL-2. Clients are treated symptomatically for the discomfort. Demerol is used to treat the chills and rigor. The other medications would not treat a side effect of IL-2 therapy.

21. A client has small cell lung cancer. Which laboratory result requires immediate intervention by the nurse? a. Serum potassium of 5.1 mEq/L b. Serum sodium of 118 mEq/L c. Hematocrit of 45% d. Blood urea nitrogen (BUN) of 10 mg/dL

ANS: B In the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), secretion of antidiuretic hormone (ADH) from the posterior pituitary gland is increased, causing the client to reabsorb water from the distal convoluted tubule and collecting duct. As a result, weight increases, and serum sodium and hematocrit levels are diluted. Blood urea nitrogen (BUN) and hematocrit are normal. Potassium is slightly high, but very low sodium places the client at risk for seizures and even death.

12. A clients spouse reports that the last time the client received lorazepam (Ativan) before receiving chemotherapy, the client was extremely drowsy and didnt remember the trip home. Which is the nurses best action? a. Hold the dose of lorazepam for this round of chemotherapy. b. Explain that this is a normal response to the drug. c. Perform a Mini-Mental State Examination. d. Document the response in the clients chart.

ANS: B Lorazepam, a benzodiazepine, induces sedation and amnesia, in addition to having antiemetic effects. Many clients have little if any memory about events occurring within a few hours after receiving lorazepam. This is an expected side effect and does not denote any permanent reduced cognition in the client. Both the client and the spouse should be aware of this effect so that the client is not at risk for injury. Driving, cooking, or operating mechanical equipment should not be performed until the drugs effects have worn off.

7. A client is undergoing radiation therapy and says, I will be so glad when this is over and I dont have to worry about my skin. What response by the nurse is most appropriate? a. Unfortunately, your skin will be permanently damaged from the radiation. b. You need to protect your skin from the sun for at least a year afterward. c. You can get a prescription for special lotions that reduce the effects of radiation. d. You're having skin problems? That is unusual; let me take a look at your skin.

ANS: B Skin that has been in the path of external radiation is more susceptible to sun damage and must be protected from the sun for at least a year after completion of radiation therapy. Skin changes due to radiation are common but may not be permanent, depending on the amount of radiation absorbed. No one skin care product has been shown to significantly help radiation-related skin problems.

9. A clients radiation implant has become dislodged overnight, and the nurse finds it in the clients bed. What does the nurse do first? a. Assess the clients skin for radiation burns. b. Use tongs to put the implant into the radiation container. c. Notify the safety officer and move the client to a different room. d. Don gloves and attempt to replace the implant.

ANS: B The implant does emit radiation and should be placed into the secure, lead-lined container in the clients room. The nurse does not directly touch this implant but uses long-handled tongs for this purpose. The nurse does not need to assess the clients skin, nor should he or she attempt to replace the source. Moving the client is not necessary, although in keeping with facility policy, the radiation safety officer may need to be notified.

1. The student nurse caring for clients who have cancer understands that the general consequences of cancer include which client problems? (Select all that apply.) a. Clotting abnormalities from thrombocythemia b. Increased risk of infection from white blood cell deficits c. Nutritional deficits such as early satiety and cachexia d. Potential for reduced gas exchange e. Various motor and sensory deficits

ANS: B, C, D, E The general consequences of cancer include reduced immunity and blood-producing functions, altered GI structure and function, decreased respiratory function, and motor and sensory deficits. Clotting problems often occur due to thrombocytopenia (not enough platelets), not thrombocythemia (too many platelets).

1. In planning a teaching session for a client undergoing photodynamic therapy for lung cancer, the nurse includes which statements? (Select all that apply.) a. This is a palliative treatment that should decrease your pain. b. Avoid exposure to the sun for 1 to 3 months after the treatment. c. Do not eat or drink anything before your treatments. d. Do not remove skin markings between treatments. e. You need to wear sunglasses to protect your eyes after treatments. f. Make sure you keep your curtains closed at home afterward.

ANS: B, E, F Phototherapy causes general sensitivity to light for up to 12 weeks. During this time, the client is at high risk for light sensitivity and eye pain. After the procedure, the client is taught to decrease exposure to sunlight (to the point of being homebound).

14. A client is receiving rituximab (Rituxan) and asks how it works. What response by the nurse is best? a. It causes rapid lysis of the cancer cell membranes. b. It destroys the enzymes needed to create cancer cells. c. It prevents the start of cell division in the cancer cells. d. It sensitizes certain cancer cells to chemotherapy.

ANS: C Rituxan prevents the initiation of cancer cell division. The other statements are not accurate.

21. A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate? a. Administer a dose of allopurinol (Aloprim). b. Assess the clients serum potassium level. c. Gently inquire about advance directives. d. Prepare the client for emergency surgery.

ANS: C Superior vena cava syndrome is often a late-stage manifestation. After the client is stabilized and comfortable, the nurse should initiate a conversation about advance directives. Allopurinol is used for tumor lysis syndrome. Potassium levels are important in tumor lysis syndrome, in which cell destruction leads to large quantities of potassium being released into the bloodstream. Surgery is rarely done for superior vena cava syndrome.

15. Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients should the nurse assess first? a. Client with dry, itchy, peeling skin b. Client with a serum calcium of 9.2 mg/dL c. Client with a serum potassium of 2.8 mEq/L d. Client with a weight gain of 0.5 pound (1.1 kg) in 1 day

ANS: C TKIs can cause electrolyte imbalances. This potassium level is very low, so the nurse should assess this client first. Dry, itchy, peeling skin can be a problem in clients receiving biologic response modifiers, and the nurse should assess that client next because of the potential for discomfort and infection. This calcium level is normal. TKIs can also cause weight gain, but the client with the low potassium level is more critical.

8. A client scheduled to undergo radiation therapy for breast cancer asks why 6 weeks of daily treatment is necessary. What is the nurses best response? a. Your cancer is widespread and requires more than the usual amount of radiation treatment. b. Giving larger doses of radiation for a shorter period of time does not produce better effects and has worse side effects. c. Research has shown that more cancer cells are killed if radiation is given in smaller doses over a longer time period. d. It is less likely that your hair will fall out or that you will become anemic if radiation is given in this manner.

ANS: C Because of varying responses of all cancer cells within a given tumor, small doses of radiation are given on a daily basis for a set period of time. This method allows multiple opportunities to destroy cancer cells while minimizing damage to normal tissues.

10. A client is receiving a chemotherapeutic agent intravenously through a peripheral line. What is the nurses first action when the client reports burning at the site? a. Check for a blood return. b. Slow the rate of infusion. c. Discontinue the infusion. d. Apply a cold compress.

ANS: C Both irritants and vesicants can cause tissue damage. If the nurse suspects extravasation, he or she should immediately stop the infusion. Even if the IV has a good blood return, some of the chemotherapeutic agent can still be leaking into the tissues. Slowing the rate of infusion is not sufficient to prevent further leakage and damage. Applying a cold compress may or may not be the correct action, depending on the specific agent. However, the compress would be applied only after the infusion has been discontinued.

17. The student nurse overhears several staff members referring to a client who is receiving chemotherapy as having chemo brain. The student asks the instructor what that means. Which response by the instructor is best? a. That is an awful thing to say and the staff should not call a client by that name. b. It refers to the clients brain as being irreversibly damaged by the chemotherapy. c. The client has reduced cognitive function that may last for several years. d. The client has delirium related to the toxic effects of the chemotherapy.

ANS: C Chemo brain refers to the changes in concentration, memory, and learning that sometimes accompany chemotherapy. It usually is not present at 3 years after chemotherapy has been completed, so clients should be reassured that this is a temporary condition. Although the staff should be more sensitive, simply criticizing them does not help the student understand the situation.

29. The nurse prioritizes which intervention in a client with xerostomia secondary to radiation therapy to the neck area? a. Applying lotions and oils to affected areas b. Wearing a hat to decrease heat loss c. Providing oral care after meals and at bedtime d. Monitoring vital signs every 4 hours

ANS: C Head and neck radiation may damage the salivary glands, may cause dry mouth (xerostomia), and may increase the clients lifelong risk for tooth decay. Instruct clients to avoid using lotions or ointments in these areas unless the radiologist prescribes them. Xerostomia is not associated with hair loss, which might require a hat. Monitoring vital signs is important for any client receiving radiation therapy but is not a priority for the client with xerostomia.

30. Which statement indicates that the client needs more teaching about mucositis? a. I will rinse my mouth with water after every meal. b. I will use a soft-bristled toothbrush to prevent trauma. c. I should use an alcohol-based mouth rinse to kill bacteria. d. I cannot use floss because it may irritate my gums.

ANS: C Mouthwashes that contain alcohol are drying and can exacerbate mucosal irritation, leading to painful mouth sores. Rinsing the mouth with water or normal saline is indicated. Interventions aimed at decreasing risk for trauma or irritation are matters of priority because of inflammation associated with mucositis.

23. A nurse is reviewing the white blood cell count with differential for a client receiving chemotherapy for cancer. Which finding alerts the nurse to the possibility of sepsis? a. Total white blood cell count is 9000/mm3. b. Lymphocytes outnumber basophils. c. Bands outnumber segs. d. Monocyte count is 1800/mm3.

ANS: C Normally, mature segmented neutrophils (segs) are the major population of circulating leukocytes, constituting 55% to 70% of the total white blood cell count. Less than 3% to 5% of circulating white blood cells should be the less mature band neutrophils. A left shift occurs when the bone marrow releases more immature neutrophils than mature neutrophils. This condition indicates severe infection with possible sepsis and must be explored further.

3. A new nurse has been assigned a client who is in the hospital to receive iodine-131 treatment. Which action by the nurse is best? a. Ensure the client is placed in protective isolation. b. Hand off a pregnant client to another nurse. c. No special action is necessary to care for this client. d. Read the policy on handling radioactive excreta.

ANS: D This type of radioisotope is excreted in body fluids and excreta (urine and feces) and should not be handled directly. The nurse should read the facilitys policy for handling and disposing of this type of waste. The other actions are not warranted.

3. A client who has just had a mastectomy is crying. When the nurse asks about her crying, the client responds, I know I shouldnt cry because this surgery may well save my life. What is the nurses best response? a. It is all right to cry. Mourning this loss will help make you stronger. b. I know this is hard, but your chances of survival are better now. c. I can arrange for someone who had a mastectomy to come visit if you like. d. How have you coped with difficult situations in the past?

ANS: C Often, cancer surgery involves the loss of a body part or a decrease in function. Mourning or grieving for a body image alteration is a healthy part of adapting or adjusting to a new image. Visiting with someone who has experienced the same situation as the client is very helpful in showing the client that many aspects of life can be the same afterward. If the opportunity to arrange this type of visit is available, this would be the nurses best response. The other options do not provide any assistance to the client in coping with her new body image and grieving for her loss.

13. A client is on chemotherapy and has a platelet count of 25,000. Which intervention is most important to teach this client? a. Eat a low-bacteria diet. b. Take your temperature daily. c. Use a soft-bristled toothbrush. d. Avoid alcohol-based mouthwashes.

ANS: C This client has thrombocytopenia, which is a common side effect of chemotherapy. This increases the clients risk for prolonged bleeding in response to even minor injury, especially from highly vascular areas such as the gums. The client should be taught to use a soft toothbrush. A low-bacteria diet and daily temperature monitoring would be used in a client who is neutropenic. Alcohol-based mouthwashes will dry mucous membranes.

20. A nurse manager on an oncology nursing unit notes an increased incidence of infection and serious consequences for clients on the unit. Which action by the nursing manager is most beneficial in this situation? a. Review asepsis policies at a mandatory in-service for staff. b. Spot-check all staff for good handwashing practices. c. Develop standard protocols to identify and treat clients with infection. d. Institute protective precautions for all clients receiving chemotherapy.

ANS: C Treatment delays have a serious negative impact on neutropenic clients with infection. Nursing units should have standardized protocols to obtain cultures and diagnostic tests, and to start antibiotics as soon as a client is suspected of having an infection. In-services and spot-checking for good handwashing practice are good ideas as part of a comprehensive infection control practice but are not as important as standard protocols that ensure rapid diagnosis and treatment. Not all clients on chemotherapy will need protective precautions.

16. A nurse is assessing a female client who is taking progestins. What assessment finding requires the nurse to notify the provider immediately? a. Irregular menses b. Edema in the lower extremities c. Ongoing breast tenderness d. Red, warm, swollen calf

ANS: D All clients receiving progestin therapy are at risk for thromboembolism. A red, warm, swollen calf is a manifestation of deep vein thrombosis and should be reported to the provider. Irregular menses, edema in the lower extremities, and breast tenderness are common side effects of the therapy.

12. A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority? a. Helping clients adjust to their appearance b. Reassuring clients that this change is temporary c. Referring clients to a reputable wig shop d. Teaching measures to prevent scalp injury

ANS: D All of the actions are appropriate for clients with alopecia. However, the priority is client safety, so the nurse should first teach ways to prevent scalp injury.

18. The nurse has taught a client with cancer ways to prevent infection. What statement by the client indicates that more teaching is needed? a. I should take my temperature daily and when I dont feel well. b. I will wash my toothbrush in the dishwasher once a week. c. I wont let anyone share any of my personal items or dishes. d. Its alright for me to keep my pets and change the litter box.

ANS: D Clients should wash their hands after touching their pets and should not empty or scoop the cat litter box. The other statements are appropriate for self-management.

7. A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the clients oral chemotherapy medications. What action by the nurse is most appropriate? a. Crush the medications if the client cannot swallow them. b. Give one medication at a time with a full glass of water. c. No special precautions are needed for these medications. d. Wear personal protective equipment when handling the medications.

ANS: D During the administration of oral chemotherapy agents, nurses must take the same precautions that are used when administering IV chemotherapy. This includes using personal protective equipment. These medications cannot be crushed, split, or chewed. Giving one at a time is not needed.

26. A client has late-stage colon cancer with metastasis to the spine and bones. Which nursing intervention does the nurse add to the care plan to address a priority problem? a. Provide six small meals and snacks daily. b. Offer the client prune juice twice a day. c. Ensure that the client gets adequate rest. d. Give the client pain medications around the clock.

ANS: D Although all interventions might be appropriate, a client with late-stage cancer and bone metastases is at risk for severe pain. Giving the client pain medication around the clock is the best way to manage this type of pain.

1. What statement indicates that the client understands teaching about neutropenia? a. I need to use a soft toothbrush. b. I have to wear a mask at all times. c. My grandchildren may get an infection from me. d. I will call my doctor if I have an increase in temperature.

ANS: D Bone marrow suppression leads to neutropenia and increases the clients risk for infection. Decreased numbers of neutrophils and other white blood cells can minimize the clinical manifestations of infection. For this reason, the client may not develop a high temperature, even with severe infection, and any elevation of temperature should be reported immediately to the health care provider. The client does not need to wear a mask or use a soft toothbrush (although if the client has low platelets, he or she should use a soft toothbrush to avoid causing trauma). The client is not contagious.

14. A client with chemotherapy-induced bone marrow suppression has received filgrastim (Neupogen). Which laboratory finding indicates that this therapy is effective for the client? a. Hematocrit is 28%. b. Hematocrit is 38%. c. Segmented neutrophil count is 2500/mm3. d. Segmented neutrophil count is 3500/mm3.

ANS: D Filgrastim is a single-lineage growth factor that stimulates the maturation and release of only segmented neutrophils. This drug is not given unless the neutrophil count is dangerously low. The near-normal range of neutrophils indicates effective therapy.

11. A client receiving intravenous chemotherapy asks the nurse the reason for wearing a mask, gloves, and gown while administering drugs to the client. What is the nurses best response? a. These coverings protect you from getting an infection from me. b. I am preventing the spread of infection from you to me or any other client here. c. The policy is for any nurse giving these drugs to wear a gown, gloves, and mask. d. The clothing protects me from accidentally absorbing these drugs.

ANS: D Most chemotherapy drugs are absorbed through the skin and mucous membranes. As a result, health care workers who prepare or give these drugs, especially nurses and pharmacists, are at risk for absorbing them. Even at low doses, chronic exposure to chemotherapy drugs can affect health. The Oncology Nursing Society and the Occupational Safety and Health Administration (OSHA) have specific guidelines for using caution and wearing protective clothing whenever preparing, giving, or disposing of chemotherapy drugs.

27. After receiving change-of-shift report, which client does the nurse assess first? a. Client with leukemia who needs an antiemetic before chemotherapy b. Client with breast cancer scheduled for external beam radiation c. Client with xerostomia associated with laryngeal cancer d. Client with neutropenia who has just been admitted with a possible infection

ANS: D The most complex, potentially unstable client is the one with neutropenia with suspected infection. Because the onset of infection is insidious in clients with neutropenia, this client is at risk for sepsis. All other clients are stable.