Evolve Chapter 22: Care of Patients with Cancer

Question 23 of 26 The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which interventions does the nurse plan to implement? Select all that apply. A. Assess for fever. B. Observe for bleeding. C. Administer pegfilgrastim (Neulasta). D. Do not permit fresh flowers or plants in the room. E. Do not allow the client's 16-year-old son to visit. F. Teach the client to omit raw fruits and vegetables from the diet.

A. Assess for fever. C. Administer pegfilgrastim (Neulasta). D. Do not permit fresh flowers or plants in the room. F. Teach the client to omit raw fruits and vegetables from the diet. Rational: Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately to the health care provider. Administration of biological response modifiers, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), is indicated in neutropenia to prevent infection and sepsis. Flowers and plants may harbor organisms such as fungi or viruses and are to be avoided for the immune-suppressed client. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms.Thrombocytopenia, or low platelet levels, causes bleeding, not low neutrophils (a type of white blood cell). The client is at risk for infection, not the visitors, if they are well. However, very small children, who may get frequent colds and viral infections, may pose a risk.

Question 22 of 26 When caring for the client receiving cancer chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? Select all that apply. A. Bruises B. Fever C. Petechiae D. Epistaxis E. Pallor

A. Bruises C. Petechiae D. Epistaxis Rationale: Bruising, petechiae, and epistaxis (nosebleeds) are symptoms of a low platelet count (thrombocytopenia). Fever is a sign of infection secondary to neutropenia. Pallor is a sign of anemia.

Question 5 of 26 The RN working on an oncology unit has just received report on these clients. Which client should be assessed first? A. Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature B. Client with lymphoma who will need administration of an antiemetic before receiving chemotherapy C. Client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour D. Client with xerostomia associated with laryngeal cancer who needs oral care before breakfast

A. Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature Rationale: The nurse should see the client with chemotherapy-induced neutropenia first. Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune-suppressed people. The client with lymphoma and the client with metastatic breast cancer are not in distress and can be assessed later. The client with dry mouth (xerostomia) can be assessed later, or the nurse can delegate mouth care to unlicensed assistive personnel.

Question 19 of 26 Which potential side effects does the nurse include in the teaching plan for a client undergoing radiation therapy for laryngeal cancer? Select all that apply. A. Fatigue B. Changes in color of hair C. Change in taste D. Changes in skin of the neck E. Difficulty swallowing

A. Fatigue C. Change in taste D. Changes in skin of the neck E. Difficulty swallowing Rationale: Radiation therapy to any site produces fatigue in most clients, and may cause clients to report changes in taste. Radiation side effects are site-specific. The larynx is in the neck, so changes in the skin of the neck may occur. Dysphagia (difficulty swallowing) may occur from radiation to the throat area. Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair, but this does not normally occur with radiation therapy.

Question 20 of 26 The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression? A. Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% B. Potassium level of 2.9 mEq/L (2.9 mmol/L) and diarrhea C. 250,000 platelets/mm3 (250 × 109/L) D. 5000 white blood cells/mm3 (5 × 109/L)

A. Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% Rationale: Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; the client with a hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8% has anemia demonstrated by low hemoglobin and hematocrit levels. The client with diarrhea and a potassium level of 2.9 mEq/L (2.9 mmol/L) has hypokalemia and electrolyte imbalance. The client with 250,000 platelets/mm3 (250 × 109/L) and the client with 5000 white blood cells/mm3 (5 × 109/L) demonstrate normal values.

Question 24 of 26 When monitoring a client with suspected syndrome of inappropriate antidiuretic hormone (SIADH), the nurse reviews the client's medical record, which contains the following information. The nurse notifies the health care provider for which signs and symptoms consistent with this syndrome? Physical Assessment Findings Diagnostic Findings Medications Neuro: Episodes of confusion Cardiac: Pulse 88 and regular Musculoskeletal: Weakness, tremors Na: 115 mEq/L (115 mmol/L) K: 4.2 mEq/L (4.2 mmol/L) Creatinine: 0.8 mg/dL (70.8 mcmol/L) Ondansetron (Zofran) Cyclophosphamide (Cytoxan) Select all that apply. A. Hyponatremia B. Mental status changes C. Azotemia D. Bradycardia E. Weakness

A. Hyponatremia B. Mental status changes E. Weakness Rationale: Antidiuretic hormone (ADH) is secreted or produced ectopically, resulting in water retention and sodium dilution. Dilutional hyponatremia (low sodium level) results from ADH secretion, causing confusion and changes in mental status. Weakness results from hyponatremia. Azotemia refers to a buildup of nitrogenous waste products in the blood, typically from renal damage. Bradycardia is not part of the constellation of symptoms related to SIADH; tachycardia may result from fluid volume excess.

Question 11 of 26 The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia? A. Monitor weight. B. Trend red blood cells and hemoglobin and hematocrit. C. Monitor platelets. D. Observe for motor deficits.

A. Monitor weight. Rationale: Cachexia results in extreme body wasting, malnutrition, and severe weight loss. Anemia and bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. Motor deficits result from spinal cord compression.

Question 3 of 26 The nurse is caring for a client who is receiving rituximab (Rituxan) for treatment of lymphoma. During the infusion, it is essential for the nurse to observe for which side effect? A. Alopecia B. Allergy C. Fever D. Chills

B. Allergy Rationale: Allergy is the most common side effect of monoclonal antibody therapy (rituximab), and the nurse must be aware of any allergic reactions the client may exhibit. Monoclonal antibody therapy does not cause alopecia. Although fever and chills are side effects of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.

Question 15 of 26 The nurse is caring for a client with hyperuricemia associated with tumor lysis syndrome (TLS). Which medication does the nurse anticipate being ordered? A. Recombinant erythropoietin (Procrit) B. Allopurinol (Zyloprim) C. Potassium chloride D. Radioactive iodine-131 (131I)

B. Allopurinol (Zyloprim) Rationale: The nurse expects allopurinol (Zyloprim) to be ordered, because allopurinol decreases uric acid production and is indicated in TLS. TLS results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances. Recombinant erythropoietin is used to increase red blood cell production and is not a treatment for hyperuricemia. Administering additional potassium is dangerous because the client is already hyperkalemic. Radioactive iodine-131 is indicated in the treatment of thyroid cancer, not TLS.

Question 26 of 26 Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately? A. New onset of fatigue B. Edema of arms and hands C. Dry cough D. Weight gain

B. Edema of arms and hands Rationale: Edema of the arms and hands indicates worsening compression of the superior vena cava consistent with superior vena cava syndrome. The compression must be relieved immediately, often with radiation therapy, because death can result without timely intervention. New onset of fatigue may likely be an early manifestation of hypercalcemia, which usually develops slowly, but because it is an early manifestation, and not the priority. Dry cough is not a manifestation that is specific to an oncologic emergency; however, it may be a side effect of chemotherapy. Weight gain could be an early sign of syndrome of inappropriate antidiuretic hormone (SIADH). Although this should be addressed, it is an early sign so it is not the priority.

1 of 26 When caring for a client who has had a colostomy created during treatment for colon cancer, which nursing actions help support the client in accepting changes in appearance or function? Select all that apply. A. Explain to the client that the colostomy is only temporary. B. Encourage the client to participate in changing the ostomy. C. Obtain a psychiatric consultation. D. Offer to have a person who is coping with a colostomy visit with the client. E. Encourage the client and family members to express their feelings and concerns.

B. Encourage the client to participate in changing the ostomy. D. Offer to have a person who is coping with a colostomy visit with the client. E. Encourage the client and family members to express their feelings and concerns. Rationale: Encouraging the client to participate in changing the ostomy is an appropriate way for the client to become familiar with the ostomy and its care. A visit from a person who is successfully coping with an ostomy can demonstrate to the client that many aspects of life can be the same after surgery. Offering to listen to feelings and concerns is part of a therapeutic relationship and therapeutic communication. Ostomies may be temporary for bowel rest, such as after a perforation, but are typically permanent for cancer treatment. Obtaining a psychiatric consultation may need to be done for clients with persistent depression, but would not be done immediately.

Question 16 of 26 Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting? A. Morphine B. Ondansetron (Zofran) C. Naloxone (Narcan) D. Diazepam (Valium)

B. Ondansetron (Zofran) Rationale: Ondansetron (Zofran) is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Lorazepam, a benzodiazepine, may also be given for nausea. Morphine is a narcotic analgesic or opiate and may cause nausea. Naloxone is a narcotic antagonist used for opiate overdose. Diazepam, a benzodiazepine, is an antianxiety medication only.

Question 4 of 26 Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy? A. Potential for lack of understanding related to side effects of chemotherapy B. Potential for injury related to sensory and motor deficits C. Potential for ineffective coping strategies related to loss of motor control D. Altered sexual function related to erectile dysfunction

B. Potential for injury related to sensory and motor deficits Rationale: The highest priority is safety. Although knowing the side effects of chemotherapy may be helpful, the priority is the client's safety because of the lack of sensation or innervation to the extremities. Every chemotherapy client needs to be taught related side effects of chemotherapy. The nurse should address the client's coping only after providing for safety. Erectile dysfunction may be a manifestation of peripheral neuropathy, but the priority is still the client's safety.

Question 12 of 26 The nurse is caring for a client with end-stage ovarian cancer who needs clarification on the purpose of palliative surgery. Which outcome should the nurse teach the client is the goal of palliative surgery? A. Cure of the cancer B. Relief of symptoms or improved quality of life C. Allowing other therapies to be more effective D. Prolonging the client's survival time

B. Relief of symptoms or improved quality of life Rationale: The focus and goal of palliative surgery is to help relieve symptoms of end-stage cancer and improve quality of life during the survival time. Curative surgery removes all cancer cells, visible and microscopic. Debulking is a procedure that removes some cancerous tissue, allowing other therapies to be more effective. Many therapies, such as surgery, chemotherapy, and biotherapy, increase the client's chance of cure and survival, but palliation improves quality of life.

Question 9 of 26 Which statement made by a client allows the nurse to recognize whether the client receiving brachytherapy for ovarian cancer understands the treatment? A. "I may lose my hair during this treatment." B. "I must be positioned in the same way during each treatment." C. "I will have a radioactive device in my body for a short time." D. "I will be placed in a semi private room for company."

C. "I will have a radioactive device in my body for a short time." Rationale: Brachytherapy refers to short-term insertion of a radiation source. Side effects of radiation therapy are site-specific. Because radiation therapy is site-specific; this client is unlikely to experience hair loss from treating ovarian cancer with radiation. The client undergoing teletherapy (external beam radiation), not brachytherapy, must be positioned precisely in the same position each time. The client who is receiving brachytherapy must be in a private room.

Question 2 of 26 A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which client is most appropriate to assign to the new graduate? A. A 30-year-old with acute lymphocytic leukemia who will receive combination chemotherapy today B. A 40-year-old with chemotherapy-induced nausea and vomiting who has had no urine output for 16 hours C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) D. A 72-year-old with tumor lysis syndrome who is receiving normal saline IV at a rate of 250 mL/hr

C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) Rationale: A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to correct anemia. The clients with acute lymphocytic leuke mia and chemotherapy-induced nausea are complex clients requiring a nurse certified in chemotherapy administration. The client with tumor lysis syndrome has complicated needs for assessment and care and should be cared for by an RN with more oncology experience.

Question 18 of 26 Which finding alarms the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3 (17 × 109/L)? A. Increasing shortness of breath B. Diminished bilateral breath sounds C. Change in mental status D. Weight gain of 4 pounds (1.8 kg) in 1 day

C. Change in mental status Rationale: A change in mental status could result from spontaneous bleeding and, in this case, a cerebral hemorrhage may have developed. Increasing shortness of breath is typically related to anemia, not to thrombocytopenia. Diminished breath sounds may be related to many factors, including poor respiratory excursion, infection, and atelectasis, which are not related to thrombocytopenia. A large weight gain in a short period may be related to kidney or heart failure; bleeding is the major complication of thrombocytopenia.

Question 6 of 26 Which instruction is most appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy? A. Bathe in cold water. B. Wear cotton gloves when cooking. C. Consume a diet high in fiber. D. Make sure shoes are snug.

C. Consume a diet high in fiber. Rationale: A high-fiber diet will assist with constipation related to neuropathy. The client should bathe in warm not cold water, not hotter than 96°F. Cotton gloves may prevent harm from scratching, but protective gloves should be worn for cooking, washing dishes, and gardening. Wearing cotton gloves while cooking can increase the risk for burns. Shoes should allow sufficient length and width to prevent blisters. Shoes that are snug can increase the risk for blisters in a client with peripheral neuropathy. N232 Evolve Questions Unit 3

Question 21 of 26 When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication? A. Drug toxicity B. Polycythemia C. Infection D. Dose-limiting side effects

C. Infection Rationale: The lowest point of bone marrow function is referred to as the nadir; risk for infection is highest during this phase. Drug toxicity can develop when drug levels exceed peak concentrations. Polycythemia refers to an increase in the number of red blood cells; typically chemotherapy causes reduction of red blood cells or anemia. Dose limiting side effects occur when the dose or frequency of chemotherapy need to be altered or held, such as in the case of severe neutropenia or neurologic dysfunction.

Question 10 of 26 When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful? A. Administering a biological response modifier B. Encouraging oral care with commercial mouthwash C. Providing oral care with a disposable mouth swab D. Maintaining NPO until the lesions have resolved

C. Providing oral care with a disposable mouth swab Rationale: The client with mucositis would benefit most from oral care; mouth swabs are soft and disposable and therefore clean and appropriate to provide oral care. Biological response modifiers are used to stimulate bone marrow production of immune system cells; mucositis or sores in the mouth will not respond to these medications. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa. Keeping the client NPO is not necessary because nutrition and hydration are important during cancer treatment; a local anesthetic may be prescribed.

Question 13 of 26 The nurse corrects the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance? A. The student demonstrates asepsis by scrubbing the hub of IV tubing before administering an antibiotic. B. The nurse overhears the student explaining to the client the importance of handwashing. C. The student teaches the client that symptoms of neutropenia include fatigue and weakness. D. The nurse observes the student educating the client about hygiene and perineal care.

C. The student teaches the client that symptoms of neutropenia include fatigue and weakness. Rationale: Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected. Asepsis with IV lines is an appropriate action. Handwashing is an essential component of client care, especially when the client is at risk for neutropenia. Hygiene and perineal care help prevent infection and sepsis.

Question 25 of 26 The oncology nurse should use which intervention to prevent disseminated intravascular coagulation (DIC)? A. Monitoring platelets B. Administering packed red blood cells C. Using strict aseptic technique to prevent infection D. Administering low-dose heparin therapy for clients on bedrest

C. Using strict aseptic technique to prevent infection Rationale: Sepsis is a major cause of DIC, especially in the oncology client. The oncology nurse must use strict asepsis to prevent any infection. Monitoring platelets will help detect DIC, but will not prevent it. Red blood cells are used for anemia, not for bleeding/coagulation disorders. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.

Question 17 of 26 A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time? A. Explain that this occurs in some clients and is usually permanent. B. Inform the client that a small glass of wine may help her relax. C. Protect the client from infection. D. Allow the client an opportunity to express her feelings.

D. Allow the client an opportunity to express her feelings. Rationale: Although no specific intervention for this side effect is known, therapeutic communication and listening may be helpful to the client. Evidence regarding problems with concentration and memory loss with chemotherapy is not complete, but the current thinking is that this process is usually temporary. The client should be advised to avoid the use of alcohol and recreational drugs at this time because they also impair memory. Chemotherapeutic agents are implicated in central nervous system function in this scenario, not infection.

Question 8 of 26 The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body? A. Veins of the legs B. Lung C. Heart D. Abdominal cavity

D. Abdominal cavity Rationale: Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity. Intravenous drugs are delivered through veins. Chemotherapy delivered into the lungs is typically placed in the pleural space (intrapleural). Chemotherapy is not typically delivered into the heart.

Question 14 of 26 The nurse is teaching a client who is receiving an antiestrogen drug about the side effects she may encounter. Which side effects does the nurse include in the discussion? Select all that apply. A. Heavy menses B. Smooth facial skin C. Hyperkalemia D. Breast tenderness E. Weight loss F. Deep vein thrombosis

D. Breast tenderness F. Deep vein thrombosis Rationale: Breast tenderness and shrinking breast tissue may occur with antiestrogen therapy. Venous thromboembolism may also occur. Irregular menses or no menstrual period is the typical side effect of antiestrogen therapy. Acne may also develop. Hypercalcemia, not hyperkalemia, may also occur. Fluid retention with weight gain also typically happens.

Question 7 of 26 An outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection? A. Storing drugs in dark locations at room temperature B. Wearing soft clothing C. Wearing a hat and sunglasses when going outside D. Reducing all direct and indirect sources of light

D. Reducing all direct and indirect sources of light Rationale: Lighting of all types must be kept to a minimum with clients receiving photodynamic therapy. It can lead to burns of the skin and damage to the eyes because these clients' eyes are sensitive to light. Any drug that the client is prescribed should be considered for its photosensitivity properties. Drugs should be stored according to the recommendations, but this is not the primary concern for this client. Clothing must cover the skin to prevent burns from direct or indirect light. Texture of the clothing is not a concern for the client receiving this treatment. The client will be homebound for 1 to 3 months after the treatment and should not go outside.