Nurs 301 oncology
What is the nurse primarily attempting to prevent when caring for a client in the initial stages of chronic lymphocytic leukemia (CLL)? Injury Fatigue Infection Cachexia
Infection Although lymphocytosis is always present, defects in humoral and cellular immunity increase the risk for infection. Injury becomes an issue later in the disease when thrombocytopenia may develop. Fatigue becomes an issue later in the disease when anemia may develop. Although excessive weight loss is a concern, it does not pose the same threat as infection for clients with CLL.
A client is diagnosed with multiple myeloma. What does the nurse expect the plan of care to include? Radiotherapy on an outpatient basis Human leukocyte interferon therapy Surgery to remove the invasive lesions Chemotherapy employing a combination of drugs
Chemotherapy employing a combination of drugs Chemotherapy employing a combination of drugs is the treatment of choice; a variety of chemotherapeutic drugs affect rapidly dividing cells at different stages of cell division. Although radiotherapy on an outpatient basis may be used to alleviate pain and treat acute vertebral lesions, it is not the primary approach. Although human leukocyte interferon therapy may be done, it is not the primary treatment. Multiple myeloma is a diffuse disorder of the bone, and no single lesion can be removed.
A nurse is performing an assessment on a client with probable acute lymphocytic leukemia (ALL). Which clinical manifestation will the nurse expect to be present? Alopecia Insomnia Ecchymosis Hypertension
Ecchymosis Bleeding tendencies occur because of bone marrow suppression and rapidly proliferating leukocytes. Alopecia is associated with chemotherapy; there is no change in hair with leukemia. The client more likely will be sleeping excessively. Hypertension is not a clinical manifestation of leukemia.
A client with the diagnosis of breast cancer is scheduled to receive radiation therapy to the affected area. The nurse teaches the client about how to care for the area that will be irradiated. Which client statement indicates the nurse needs to follow up? "I will leave the skin markings intact." "I will protect the skin from sources of heat." "I will wear soft clothing over the upper body." "I will use an oatmeal-based lotion after each treatment."
"I will use an oatmeal-based lotion after each treatment." While undergoing radiation therapy, lotions, powders, and ointments should not be applied to the area. The skin markings should not be removed, because they form the parameters for the delivery of radiation. To protect the irradiated skin, sunlight and heat should be avoided. Nonirritating clothing should be worn over the area to prevent trauma to the delicate irradiated skin.
Which statements are true regarding chondrosarcoma? Select all that apply. Chondrosarcoma can arise from benign bone tumors. Chondrosarcoma develops in the medullary cavity of long bones. Chondrosarcoma is mostly treated by radiation and chemotherapy. Chondrosarcoma occurs mostly in young males between ages 10 and 25 years. Chondrosarcoma most commonly occurs in cartilage in the arm, leg, and pelvic bones.
Chondrosarcoma can arise from benign bone tumors Chondrosarcoma most commonly occurs in cartilage in the arm, leg, and pelvic bones. Chondrosarcoma is a malignant type of bone tumor that can arise from benign bone tumors. Chrondrosarcoma most commonly occurs in cartilage in the arm, leg, and pelvic bones. Ewing's sarcoma develops in the medullary cavity of long bones. Chondrosarcoma is mostly treated by wide surgical resection. Chondrosarcoma occurs mostly in older adults between ages 50 and 70 years.
What are the priority care issues during chemotherapy? Select all that apply. Resources available for the nurse Handling the chemotherapy drugs Managing the client's complications Protecting the client from side effects Treatment areas in which to serve clients
Managing the client's complications Protecting the client from side effects Managing the client's complications and protecting the client from side effects are the high-priority care issues to be considered during chemotherapy. Handling resources available for the nurse, the chemotherapy drugs, and the treatment areas in which to serve clients can be managed by effective planning of the healthcare team.
Which group of clients should the nurse anticipate to have the highest incidence of non-Hodgkin lymphomas? Children Older adults Young adults Middle-aged persons
Older adults The incidence increases with age; the disease is more common in men and older adults. Younger individuals have a lower incidence of non-Hodgkin lymphomas.
A client with a history of chronic myelogenous leukemia and splenomegaly is admitted to the hospital. What should the nurse expect to identify when completing the admission assessment? Increased urinary output Tender mass in the left upper abdomen Elevated erythrocytes, platelets, and granulocytes Polydipsia, increased appetite, and urinary frequency
Tender mass in the left upper abdomen Splenomegaly usually accompanies chronic myelogenous leukemia; the spleen usually is gross, palpable, and tender and necessitates removal. The spleen is located high in the abdomen on the left side and usually is not palpable unless it is enlarged. The urinary output is not affected with these conditions. With leukemia and splenomegaly there is increased destruction of blood cells; the erythrocyte count will be low. Polydipsia, increased appetite, and urinary frequency are not associated with leukemia or splenomegaly, but rather diabetes.
A client with laryngeal cancer is receiving chemotherapy. Which laboratory report is most important for the nurse to monitor when considering the effects of chemotherapy Platelets Hemoglobin level Red blood cell count White blood cell count
White blood cell count Antineoplastic drugs depress bone marrow, which results in leukopenia; the client must be protected from infection, which is a primary cause of death in the client with cancer. Platelets may decrease rapidly, but complications may be limited by infusions of platelets. Although the hemoglobin level diminishes, a transfusion with packed red blood cells (RBCs) will alleviate the anemia. RBCs diminish slowly and may be replaced with a transfusion of packed red blood cells.
A nurse teaches about osteochondroma. Which information should the nurse include in the teaching session? It is a common malignant tumor. It occurs most often in the age group of 10 to 25. It has a high rate of local occurrence after surgery. It frequently arises in cancellous ends of arm and leg bones.
It occurs most often in the age group of 10 to 25. Osteochondroma is common in the age group of 10 to 25 years. It is a primary benign tumor. Osteoclastoma has a high rate of local occurrence after surgery and chemotherapy. Osteoclastoma frequently arises in cancellous ends of arm and leg bones; osteocondroma occurs in the metaphyseal portion of long bones.
A client receiving chemotherapy asks the nurse why an antibiotic was prescribed. Which tissue affected by chemotherapy should the nurse consider when formulating a response? Liver Blood Bone marrow Lymph nodes
Bone marrow Prolonged chemotherapy may slow production of leukocytes in bone marrow, thus suppressing the immune system. Antibiotics may be required to help counter infections that the body can no longer handle easily. The liver does not produce leukocytes. Although leukocytes are in both blood and lymph nodes, these cells are more mature than those found in the bone marrow and thus are more resistant to the effects of chemotherapy.
A client who had been receiving palliative care for cancer has deteriorated and now needs end-of-life care. The nurse identifies that which types of care will now be removed from the treatment plan? Select all that apply. Chemotherapy Repositioning Regular oral care Blood transfusion Radiation therapy
Chemotherapy Blood transfusion Radiation therapy Palliative care is a combination of care provided when cure is not possible for a chronic disease. It may include symptom management and comfort measures. Chemotherapy, radiation therapy, and blood transfusions are a part of palliative care meant to alleviate symptoms and promote well-being. These therapies may not be required in a client who is about to die and is receiving end-of-life care. End-of-life care comprises measures to make the client as comfortable as possible. It may include measures such as regular oral care and repositioning.
A client with multiple myeloma asks how the disease and therapy progresses. What would be appropriate to include in the client's teaching? Blood transfusions may be necessary. Frequent urinary tract infections may result. Intravenous (IV) fluid therapy may be administered in the home. The disease is exacerbated by exposure to ultraviolet rays
Blood transfusions may be necessary. Blood products (packed red blood cells [RBCs] or platelets) are administered when warranted. Renal insufficiency, not infections, may occur because of chronic hypercalcemia, proteinemia, and hyperuricemia. Fluid replacement should be provided in carefully supervised clinical settings, because if dehydration occurs it may result in renal shutdown. Ultraviolet rays are not related to exacerbations.
A young adult male client is undergoing tests to confirm the diagnosis of Hodgkin lymphoma. The wife states, "Don't you think it is unlikely for someone like my husband to have cancer?" The nurse's response is based on what information about Hodgkin lymphoma? More likely to affect women than men Diagnosed during adolescence and young adulthood Primarily a disease of older rather than younger adults Common among populations of Asian heritage
Diagnosed during adolescence and young adulthood Hodgkin lymphoma occurs most often between the ages of 15 and 35 years and above 55 years of age. Hodgkin lymphoma is twice as prevalent in men as in women. The incidence of Hodgkin lymphoma is not limited to people in older age groups. The prevalence of Hodgkin lymphoma is increased in teenagers and young adults (15 to 30 years of age). No mention of a cultural prevalence related to the development of Hodgkin lymphoma.
When receiving chemotherapy for non-Hodgkin lymphoma, a client states, "I get so sick to my stomach. The medication is useless." What is the best response by the nurse that uses the technique of paraphrasing? "You get sick to your stomach." "Tell me more about how you feel." "I'll get a prescription for an antiemetic." "You don't think the medication is helping you."
"You don't think the medication is helping you." Rewording of the client's statement is paraphrasing that promotes further verbalization. The response "You get sick to your stomach" is not paraphrasing; this repeats the client's exact words. The response "Tell me more about how you feel" is clarifying, a therapeutic technique; it is not paraphrasing. The response "I'll get a prescription for an antiemetic" is not an interviewing technique; it does not address the theme in the client's statement, and it cuts off communicatio
What is the most definitive test to confirm a diagnosis of multiple myeloma? Bone marrow biopsy Serum test for hypercalcemia Urine test for Bence Jones protein X-ray films of the ribs, spine, and skull
Bone marrow biopsy A definite confirmation of multiple myeloma can be made only through a bone marrow biopsy; this is a plasma cell malignancy with widespread bone destruction. Although calcium is lost from bone tissue and hypercalcemia results, this is not a confirmation of the disease. Although Bence Jones protein is found in the urine, it does not confirm the disease. X-ray films will show the characteristic "punched-out" areas caused by the increased number of plasma cells, which contributes to the making of the diagnosis. The definitive diagnosis is made on biopsy.
A client has a tentative diagnosis of Hodgkin disease. How does the nurse expect the diagnosis to be confirmed? Bone scan Lymph node biopsy Computed tomography (CT) scan Radioactive iodine ( 131I) uptake study
Lymph node biopsy The diagnosis depends on the identification of characteristic histologic features of an excised lymph node. A bone scan is a diagnostic device to assess bony metastasis of cancers. CT scans identify the extent of the disease in the abdominal and thoracic cavities. A radioactive iodine ( 131I) uptake study is not indicated for Hodgkin disease; it is used for radiotherapy or diagnosis of thyroid diseases.
A nurse is caring for a child with newly diagnosed acute lymphoblastic leukemia. What clinical findings does the nurse anticipate when assessing the child? Select all that apply. Pallor Fatigue Jaundice Multiple bruises Generalized edema
Pallor Fatigue Multiple bruises Pallor is the result of anemia associated with leukemia. Fatigue is the result of anemia associated with leukemia. Multiple bruises are the result of thrombocytopenia associated with leukemia. Jaundice usually indicates liver damage or excessive hemolysis and is not an early sign of leukemia. Edema is not a manifestation of the disease because the pathophysiology does not involve transport of fluids.
A primary healthcare provider recommends that an adolescent with the diagnosis of osteogenic sarcoma have the affected leg amputated and then be treated with chemotherapy. The parents are concerned about what to tell their child and ask the nurse for advice. What should the nurse suggest they discuss? Causes of cancer and details about the treatment Chemotherapy and the possibility of an amputation The amputation and information about chemotherapy Treatment choices and that it is too soon for a final decision
The amputation and information about chemotherapy Honesty is essential in helping the adolescent accept the loss of the leg; only a brief discussion of chemotherapy is needed, because otherwise the adolescent may be overwhelmed. A theoretical discussion and detailed information will not be heard or understood during a crisis situation. The amputation is necessary; lying avoids the issue and may destroy the adolescent's trust in parents and staff.
A client with multiple myeloma who is receiving chemotherapy has a temperature of 102.2° F (39° C). The temperature was 99.2° F (37.3° C) when it was taken 6 hours ago. What is a priority nursing intervention in this case? Assess the amount and color of urine; obtain a specimen for a urinalysis. Administer the prescribed antipyretic and notify the primary health care provider. Note the consistency of respiratory secretions and obtain a specimen for culture. Obtain the respirations, pulse, and blood pressure; recheck the temperature in 1 hour.
Administer the prescribed antipyretic and notify the primary health care provider. Because an elevated temperature increases metabolic demands, the pyrexia must be treated immediately. The practitioner should be notified because this client is immunodeficient from both the disease and the chemotherapy. A search for the cause of the pyrexia then can be initiated. More vigorous intervention than obtaining the respirations, pulse, and blood pressure is rechecking the temperature in 1 hour. This client has a disease in which the immunoglobulins are ineffective and the therapy further suppresses the immune system. Assessing the amount and color of urine and obtaining a specimen for a urinalysis is not the immediate priority, although it is important because the cause of the pyrexia must be determined. Also, the increased amount of calcium and urates in the urine can cause renal complications if dehydration occurs. Noting the consistency of respiratory secretions and obtaining a specimen for culture is not the priority, although important because respiratory tract infections are a common occurrence in clients with multiple myeloma.
A client with newly diagnosed multiple myeloma asks, "How long do you think I have to live?" What is the most appropriate response by the nurse? "Let me ask your primary healthcare provider for you." "I can understand why you are worried." "Tell me about your concerns as of the moment." "It depends on whether the tumor has spread."
"Tell me about your concerns as of the moment." The response, "Tell me about your concerns as of the moment," encourages the client to review facts and provides an opportunity to talk about feelings. While clients are waiting for the results of diagnostic studies, be available to actively listen to their concerns. Their anxiety may arise from myths and misconceptions about cancer. Correcting those misconceptions can help to minimize their anxiety. Avoid communication patterns that may hinder exploration of feelings and meaning, such as providing false reassurances, redirecting the discussion, generalizing, and using overly technical language as a means of distancing yourself from the client. These self-protective strategies deny clients the opportunity to share the meaning of their experience. In addition, they can jeopardize your ability to build a trusting relationship with your clients. The response, "Let me ask your primary healthcare provider for you," suggests the nurse does not want to discuss the subject; it abdicates the nurse's responsibility to explore the issue with the client. Although it is an empathic answer, the response, "I can understand why you are worried," does not encourage the client to explore feelings; it may increase anxiety. Although the statement, "It depends on whether the tumor has spread," is true, the response does not encourage the client to examine feelings.
Parents are considering a bone marrow transplant for their child who has recurrent leukemia. The parents ask the nurse for clarification about the procedure. What is the best response by the nurse? "Bone marrow transplantation is rarely performed in children these days." "The hematopoietic stem cells are surgically implanted in the bone marrow." "Your child's immune system must be destroyed before the transplantation can take place." "It is a simple procedure with little preparation needed, and the stem cells are infused as in a blood transfusion."
"Your child's immune system must be destroyed before the transplantation can take place." An intensive preparatory regimen is needed to destroy the child's immune system. The procedure is performed in children for recurrent malignancies. Once the process is started, no rescue therapy except for the transplant is provided. The child's bone marrow must be clear of all cells before transfusion of the stem cells is performed.
Which diagnostic test is performed under general anesthesia to detect non-Hodgkin lymphoma and requires the client to sign an informed consent form? A thoracentesis A bronchoscopy A mediastinoscopy Computed tomography (CT
A mediastinoscopy A mediastinoscopy is a surgical procedure that requires the client to sign an informed consent form. This procedure is performed under general anesthesia and is used to detect non-Hodgkin lymphoma. A thoracentesis is a diagnostic procedure used to obtain a specimen of pleural fluid for diagnosis, to remove pleural fluid, or to instill medication. A bronchoscopy is used to diagnose a condition, to biopsy, to collect a specimen, or to suction mucous plugs, and remove foreign objects. Computed tomography (CT) is performed to diagnose lesions difficult to assess via conventional X-ray studies.
A client who has bone pain of insidious onset is suspected of having multiple myeloma. The nurse expects which diagnostic finding specific for multiple myeloma?> Occult blood in the stool Low serum calcium levels Bence Jones protein in the urine Positive bacterial culture of sputum
Bence Jones protein in the urine Bence Jones protein (globulin) results from tumor cell metabolites. It is present in clients with multiple myeloma. Occult blood in the stool is not specific for the diagnosis of multiple myeloma; it is a late complication of multiple myeloma related to coagulation defects. Hypercalcemia, not hypocalcemia, occurs with multiple myeloma because of bone erosion. Multiple myeloma is not caused by a bacterial infection.
A client with Hodgkin disease enters a remission period and remains symptom free for 6 months before a relapse occurs. The client is diagnosed at stage IV. What therapy option does the nurse expect to be implemented? Radiation therapy Combination chemotherapy Radiation with chemotherapy Surgical removal of the affected no
Combination chemotherapy A protocol consisting of three or four chemotherapeutic agents that attack the dividing cells at various phases of development is the therapy of choice at this stage; alternating courses of different protocols generally are used. Radiation, alone or in combination with chemotherapy, is used in stages IA, IB, IIA, IIB, and IIIA. Radiation with chemotherapy is recommended for use in stage IIIA. Surgical removal of the affected nodes is not a therapy for Hodgkin disease at any stage. The nodes may be removed for biopsy or irradiated as part of therapy.
A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which assessment findings would alert the nurse to the possible development of thrombocytopenia? Select all that apply. Fever Diarrhea Headache Hematuria Ecchymosis
Headache Hematuria Ecchymosis Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood. This reduction in platelet activity impairs blood clotting, so any assessment finding associated with potentially abnormal bleeding would alert the nurse to the possibility of thrombocytopenia. This includes headache (bleeding into brain tissue), hematuria (bleeding within the renal system) and ecchymosis (bleeding into skeletal soft tissue). Fever and diarrhea are common side effects of chemotherapy, but are not findings specifically attributed to thrombocytopenia.
A nurse obtains a health history from the parents of a toddler who is admitted to the pediatric unit with the diagnosis of acute lymphocytic leukemia (ALL). What problems does the nurse expect the parents to report? Select all that apply. Loss of appetite Sores in the mouth Paleness of the skin Inability to fall asleep Purplish spots on the skin
Loss of appetite Paleness of the skin Purplish spots on the skin Anorexia, a presenting symptom of ALL, may be the result of enlarged lymph nodes, areas of inflammation in the intestinal tract, and catabolism. Pallor is another presenting sign of ALL; the number of red blood cells (RBCs) is decreased (anemia) because of bone marrow depression. Decreased platelet production results in bleeding tendencies; petechiae often are a presenting sign of ALL. Sores in the mouth are not a presenting sign of ALL but often result from chemotherapy. Because of bone marrow depression there is a reduced number of RBCs and therefore less oxygen being carried to body cells. The child will be lethargic and sleep excessively.
A client is diagnosed with acute lymphoid leukemia and is receiving chemotherapy. The nurse should monitor what thrombocytopenic side effects of chemotherapy? Select all that apply. Nausea Melena Purpura Diarrhea Hematuria
Melena Purpura Hematuria Black, tarry feces caused by the action of intestinal secretions on blood are associated with bleeding in the gastrointestinal tract; bleeding is related to a reduced number of thrombocytes, which are part of the coagulation process. Hemorrhages into the skin and mucous membranes (purpura) may occur with reduced numbers of thrombocytes, which are part of the coagulation process. Blood in the urine (hematuria) may occur with a reduced number of thrombocytes, which are part of the coagulation process. Nausea and vomiting are not related to thrombocytopenia; they occur because of the effect of chemotherapy on the rapidly dividing cells of the mucous membranes of the gastrointestinal system. Diarrhea may be a side effect of chemotherapy, but it is not a thrombocytopenic side effect.
A client with an invasive carcinoma of the bladder is receiving radiation to the lower abdomen in an attempt to shrink the tumor before surgery. What should the nurse do considering the side effects of radiation? Observe the feces for the presence of blood. Monitor the blood pressure for hypertension. Administer enemas to remove sloughing tissue. Provide a high-bulk diet to prevent constipation.
Observe the feces for the presence of blood. Radiation may damage the bowel mucosa, causing bleeding. Blood pressure changes are not expected during radiation therapy. Enemas are contraindicated with lower abdominal radiation because of the damaged intestinal mucosa. Diarrhea, not constipation, occurs with radiation that influences the intestine.
The registered nurse observes the student nurse caring for the skin of the client who recently underwent radiation therapy. Which actions made by the student nurse should the nurse correct? Select all that apply. Using a washcloth for cleaning the radiated site Rinsing soap thoroughly from the skin of the client Drying the irradiated area with rubbing motions Wearing loose clothing over the skin at the radiation site Removing the ink marks that identify the location of the focused beam of radiation
Using a washcloth for cleaning the radiated site Drying the irradiated area with rubbing motions Removing the ink marks that identify the location of the focused beam of radiation The nurse should use a hand rather than a washcloth when cleansing the radiated site. This is to provide gentle care to the site. The irradiated area should be dried using patting motions rather than rubbing motions. The ink marks present on the site exactly identify where the location of beam radiation is to be focused. The nurse should take care not to remove these. The skin of the client should be thoroughly rinsed using a mild soap as prescribed by the radiation oncology department. The client's clothing should be loose over the radiation site.
The nurse is making rounds on a client who has developed severe bone marrow depression after receiving chemotherapy for cancer. Which of these actions by the nurse is appropriate? Select all that apply. Monitor for signs of alopecia. Encourage an increase in fluids. Wash hands before entering the client's room. Advise use of a soft toothbrush for oral hygiene. Report an elevation in temperature immediately. Encourage the client to eat raw, fresh fruits and vegetables.
Wash hands before entering the client's room. Advise use of a soft toothbrush for oral hygiene. Report an elevation in temperature immediately. It is essential to prevent infection in a client with severe bone marrow depression; thorough handwashing before touching the client or client's belongings is important. Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the primary healthcare provider immediately because it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. This is not related to bone marrow suppression. Clients who have severe bone marrow depression must avoid eating raw fruits and vegetables and undercooked meat, eggs, and fish to prevent possible exposure to microbes.