Exam 2 - Chapter 6 Cancer Care

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 psychiatric diagnosis everyone has at one time or another. A side effect of the neoplastic drugs. A normal reaction to the diagnosis of cancer. An aberrant psychologic reaction to the chemotherapy.

A normal reaction to the diagnosis of cancer.

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? Decreasing dietary fluids 2 days before chemotherapy Adjusting the client's meal plan before and after chemotherapy Increasing fresh fruits in the client's diet Administering beta-blockers as ordered by the physician

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? No further treatment is indicated. Adjuvant therapy is likely. Palliative care is likely. Repeat biopsy is needed before treatment begins.

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.

Which of the following is a term used to describe the process of programmed cell death? Apoptosis Mitosis Carcinogenesis Angiogenesis

Apoptosis

Mrs. Unger is a 53-year-old woman who was diagnosed with breast cancer following a process that began with abnormal screen mammography results. Mrs. Unger, her oncologist, and surgeon have agreed on a mastectomy as treatment and have discussed the importance of rigorously assessing whether her cancer has metastasized. What action will best detect possible metastasis of Mrs. Unger's breast cancer? Serial bone marrow biopsies Biopsy of the axillary lymph nodes Careful grading of the tumor cells Gauging her response to radiation therapy

Biopsy of the axillary lymph nodes

Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure? Family history Drug history Blood studies Allergy history

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? No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Can't assess tumor or regional lymph nodes and no evidence of metastasis Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis

Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth? Control Cure Palliation Prevention

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.

Your patient has recently completed her first round of chemotherapy in the treatment of lung cancer. When reviewing this morning's blood work, what findings would be suggestive of myelosuppression? Decreased sodium levels and decreased potassium levels Increased creatinine and blood urea nitrogen (BUN) Decreased platelets and red blood cells Increased white blood cells and c-reactive protein (CRP)

Decreased platelets and red blood cells

You are a nurse working on a bone marrow transplant (BMT) unit. Your patient is scheduled to receive a bone marrow transplant. What information will you provide to the patient's visitors? Bring plants to improve air quality. Take the patient to the cafeteria for meals. Wear hospital scrubs when entering the patient's room. Do not visit if they've had a recent infection.

Do not visit if they've had a recent infection.

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? Stay away from protein beverages. Encourage maximum fluid intake. Encourage eating cheese, eggs, and legumes Suck on hard candy during treatment.

Encourage eating cheese, eggs, and legumes

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. Take measures to acidify the urine and prevent uric acid crystallization. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis.

Encourage fluid intake to dilute the urine.

A side-effect of chemotherapy is renal damage. To prevent this, the nurse should: Encourage fluid intake, if possible, to dilute the urine. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. Limit fluids to 1,000 mL/day to minimize stress on the renal tubules. Modify the diet to acidify the urine, thus preventing uric acid crystallization.

Encourage fluid intake, if possible, to dilute the urine.

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? Erythema Flare Extravasation Thrombosis

Extravasation

The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? Extravasation Stomatitis Nausea and vomiting Bone pain

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.

You are the nurse caring for a client with cancer. The client complains of pain and nausea. When assessed, you note that the client appears fearful. What other factor must you consider when a client with cancer indicates signs of pain, nausea, and fear? Infection Fatigue Ulceration High cholesterol levels

Fatigue Clients with cancer experience fatigue, which is a side effect of cancer treatments that rest fails to relieve. The nurse must assess the client for other stressors that contribute to fatigue such as pain, nausea, fear, and lack of adequate support. The nurse works with other healthcare team members to treat the client's fatigue. The above indications do not contribute to infections, ulcerations, or high cholesterol levels.

A client is scheduled for a nerve-sparing prostatectomy. The emotional spouse confides in the nurse that the client will not talk about the cancer and/or upcoming surgery. Which nursing diagnosis will the nurse choose as primary diagnosis for this client? Sexual Dysfunction Fear Knowledge Deficit Grieving

Fear

You are an oncology nurse who has reconstituted a patient's scheduled chemotherapeutic drug. What action should you perform prior to administering this drug? Aspirate 5 to 10 mL of blood from the patient's IV access device. Teach the patient about the pharmacodynamics of the drug. Administer a prophylactic antibiotic as ordered. Have a colleague confirm the chemotherapy dose.

Have a colleague confirm the chemotherapy dose. Because of the high potential for error related to chemotherapy dosing, the standard expectation is that two nurses verify the chemotherapy doses to ensure accuracy. It is not necessary to aspirate blood from the patient's IV, and prophylactic antibiotics are not used. Patient teaching is appropriate and necessary, but it is not normally necessary to address pharmacodynamics.

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." "I use an electric razor to shave." "I take a stool softener every morning." "I removed all the throw rugs from the house."

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.

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? Time, distance, and shielding The use of disposable utensils and wash cloths Avoid showering or washing over skin markings. Inspect the skin frequently.

Inspect the skin frequently.

What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen? It attacks cancer cells during their vulnerable phase. It functions against disseminated disease. It causes a systemic reaction. It targets normal body cells as well as cancer cells.

It targets normal body cells as well as cancer cells.

In which phase of the cell cycle does cell division occur? Mitosis G1 phase S phase G2 phase

Mitosis

The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant? Monitor the client's toilet patterns. Monitor the client closely to prevent infection. Monitor the client's physical condition. Monitor the client's heart rate.

Monitor the client closely to prevent infection.

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's toilet patterns. Monitor the client to prevent sepsis. Monitor the client's physical condition. Monitor the client's heart rate.

Monitor the client to prevent sepsis. Until transplanted bone marrow begins to produce blood cells, clients who have undergone a bone marrow transplant have no physiologic means to fight infection, which puts them at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent sepsis. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client becoming septic.

As a nurse who provides care for many patients with cancer, you are aware that cancer makes patients susceptible to many other health problems. Which of the following assessments addresses the leading cause of death among patients who have cancer? Assessing patients' lower legs for redness, swelling, or pain on dorsiflexion Arranging for serial electrocardiograms (ECGs) or cardiac telemetry whenever possible Monitoring white blood cell (WBC) counts and assessing patients' integumentary systems Auscultating patients' lungs thoroughly and monitoring oxygen saturation levels

Monitoring white blood cell (WBC) counts and assessing patients' integumentary systems For patients in all stages of cancer, the nurse assesses risk factors for infection and observes for clinical signs and symptoms, as infection is the leading cause of death in cancer patients. The nurse monitors laboratory studies to detect early changes in WBC counts. Common sites of infection, such as the oropharynx, skin, perianal area, urinary tract, gastrointestinal tract, and respiratory tract, are assessed frequently. Infectious processes are a more common cause of death than respiratory illnesses, cardiac disease, or deep vein thrombosis (DVT).

According to the tumor-node-metastasis (TNM) classification system, T0 means there is No evidence of primary tumor No regional lymph node metastasis No distant metastasis Distant metastasis

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. Place a chair next to the bed to allow the spouse to sit. Have visitors wear dosimeters for safety. Allow visitors to telephone only.

Place the client in a private room. Safety precautions are used for the client with a radioactive implant. They include assigning the client to a private room, seeing that visitors maintain a 6-foot distance from the radiation source, prohibiting visits by children, and preventing exposure to those who may be or are pregnant. Staff needs to wear dosimeters. Family may visit for up to 30 minutes per day.

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? Promotion Initiation Prolongation Progression

Progression

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? Palliative surgery Prophylactic surgery Curative surgery Reduction surgery

Prophylactic surgery

A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis? White, cottage cheese-like patches on the tongue Yellow tooth discoloration Red, open sores on the oral mucosa Rust-colored sputum

Red, open sores on the oral mucosa

After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority? Risk for injury Imbalanced nutrition: Less than body requirements Risk for infection Anxiety

Risk for infection

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? Urine output of 400 ml in 8 hours Serum potassium level of 2.6 mEq/L Blood pressure of 120/64 to 130/72 mm Hg Sodium level of 142 mEq/L

Serum potassium level of 2.6 mEq/L

A client calls the oncology office nurse and reports nausea and vomiting one week after receiving chemotherapy. What action should the nurse recommend? Practicing relaxation techniques Taking prescribed ondansetron Using imagery techniques Obtaining acupressure treatments

Taking prescribed ondansetron Serotonin blockers, such as ondansetron (Zofran), may decrease nausea and vomiting. Once these symptoms are relieved, the client can use other strategies, such as relaxation, imagery, and acupressure. These strategies, when used with serotonin blockers, provide improved anti-emetic protection.

A newly diagnosed cancer client is crying and states the following to the nurse: "I promised God that I will be a better person if I can just get better." What is the appropriate assessment of this comment by the nurse? The client is just trying to protect self from potential loss. Anger directed toward nursing staff is not unusual in dealing with cancer clients. The cancer is viewed as a punishment from past actions. Loss is inevitable so client is making final plans.

The cancer is viewed as a punishment from past actions.

A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that she is meeting the goal of improved body image and self-esteem? The patient requests that her family bring her makeup and wig. The patient begins to discuss the future with her family. The patient reports less disruption from pain and discomfort. The patient cries openly when discussing her disease.

The patient requests that her family bring her makeup and wig.

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 remove the tumor from the brain To prevent the formation of new cancer cells To analyze the lymph nodes involved To destroy marginal tissues

To prevent the formation of new cancer cells

The nurse is teaching a client about cancer prevention. The nurse evaluates teaching as most effective when a female client states that she will Use sunscreen when outdoors. Decrease tobacco smoking from one pack/day to half a pack/day. Exercise 30 minutes 3 times each week. Obtain a cancer history from her parents.

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.

The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as brachytherapy. external beam radiation therapy. systemic radiation. a contact mold.

brachytherapy. Brachytherapy is the only term used to denote the use of internal radiation implants.

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: expected chemotherapy-related adverse effects. chemotherapy exposure and risk factors. signs and symptoms of infection. reinforcement of the client's medication regimen.

chemotherapy exposure and risk factors.

A benign tumor of the blood vessels is a(n) osteoma. hemangioma. neuroma. chondroma.

hemangioma.

A decrease in circulating white blood cells is granulocytopenia. thrombocytopenia. leukopenia. neutropenia.

leukopenia.

According to the TNM classification system, T0 means there is no evidence of primary tumor. no regional lymph node metastasis. no distant metastasis. distant metastasis.

no evidence of primary tumor.