oncology

major side effect of taxol

AG/AB

when can filgrastim be given to patients at risk for infection after chemotherapy

24 hours after chemotherapy

what is the most significant risk factor for cervical cancer

being infected with certain human papillomavirus (HPV)

what are symptoms of hypercalcemia

sleepiness, polyuria, confusion, increased thirst, belly pain, nausea, bone pain, muscle weakness, confusion, and fatigue.

what is the difference between benign and malignant neoplasms

the ability of a malignant tumor cell to invade and metastasize

what does grade I mean

cells differ slightly (well differentiated)

when should a complete list of medications be provided

upon transfer to another setting, change in level of care, and discharge from a facility

what is typical of candida

white, patchy lesions

what are some common adverse effects of antineoplastic chemotherapy

diarrhea (GI side effects), alopecia (hair loss) are common side effects

what is peau d'orange

dimpling or "orange peel" appearance of the skin

what should nurse do if infiltration and/or phlebitis is suspected

discontinue the infusion and restart at another site

what are symptoms of GI obstruction

distended abdomen, N/V,

what is a vesicant

drug that if it gets into tissue it causes terrible damage because it just sits there it does not metabolize quickly

what are oncologic complications of spinal cord compression

dull radiating pain not relieved by lying down

when do super infections usually occur

during antibiotic treatment when normal flora are disrupted

what is the purpose of multi lumen catheters

each lumen can be used as a separate IV line

What is secondary prevention

early detection and intervention

what should nurse do to affected limb if infiltration and/or phlebitis occured

elevate it and apply warm compresses

what are symptoms of superior vena cava syndrome

facial edema, SOB, neck vein distention, plethora (flushing),

what are the risk factors for breast cancer

female, postmenapausal, (women over the age of 60) and nulliparous or first full-term pregnancy after age 30, early menarche (age 12 or younger), late onset of menopause (age 55 or older).

when is the correct time to obtain through level

fifteen minutes prior to administration of next dose of drug

when is Gardasil a quadrivalent vaccine recommended

for girls and young women between 9 and 26

what should nurse do in order to help patient with mucositis irritations

high protein, low fiber diet, no spicy, no salt, no crunchy foods and encourage bland diet

why does nurse want to advocate for central line if patient is on adriamycin

if patient gets adriamycin peripherally it has potential to cause trauma to lining of vein

what are signs of infiltration and/or phlebitis

increased discomfort at site, swelling at site, sluggish fluid infusion of normal saline

what are the symptoms of CHF

increasing SOB, weight gain

what does malignant mean

infectious or aggressive

what kinds of symptoms can a client with hypokalemia experience

anorexia, nausea, vomiting, muscle weakness, and burning sensation in vein

how can lymphedema be managed

arm elevation and the use of an arm, sleeve, sequential compression device to promote fluid return

how is anastrozole (Arimidex) classified

as a aromatase inhibitor

what should a nurse do to alleviate symptoms of sepsis

intravenous antibiotics

how should nurse treat a patient on adriamycin

like a CHF patient; assess SOB, fatigue, swollen legs, and rapid heartbeat. put them on a heart monitor and know EF

what are nursing priorities for superior vena cava syndrome

maintain airway and provide 02

what should a nurse do to alleviate symptoms of vena cava syndrome

maintain airway, give 02

The nurse has admitted a client to the clinical nursing unit after undergoing a right mastectomy. The nurse should plan to place the right arm in which position? Elevated on a pillow Level with the right atrium Dependent to the right atrium Elevated above shoulder level

The client's operative arm should be positioned so that it is elevated on a pillow and not exceeding shoulder elevation. This position promotes optimal drainage from the limb, without impairing the circulation to the arm. If the arm is positioned flat (option 2) or dependent (option 3), this could increase the edema in the arm, which is contraindicated because of lymphatic disruption caused by surgery.

A client is admitted to the hospital with a tentative diagnosis of bladder cancer. The nurse expects the client history to reveal which earliest manifestations of the disease? Proteinuria and dysuria Hematuria with no pain Painful urination and hematuria Pyuria and palpable abdominal mass

The earliest signs and symptoms of bladder cancer are hematuria that is not accompanied by pain. The hematuria is intermittent at first. Later symptoms include hematuria with dysuria and frequency because of bladder irritation. Pyuria and proteinuria are not part of the clinical picture. A mass is usually not palpable.

is cyclophosphamide (cytoxan) cell cycle specific

no it is cell cycle non specific

what does benign mean

not harmful

what kinds of cancers can vincristine (Oncovin) be used on

(BOLLUKE and HODGKINS)

what can nurse do to alleviate symptoms of a patient on Bleomycin

start low and build up dose over 5 days, give benadryl tylenol for AG/AB, monitor VS, LOC , do chest xray, check lung sounds, O2 therapy

how can you avoid causing trauma to lining of vein if it has to be given peripherally

start low and move up

what kinds of cancers can Bleomycin be used on

testicular, squamous cell, non hodgkins (HODGKINS)

where does prostate cancer usually metastasize to

to the lymph nodes and the bones.

where does breast cancer usually metastasize to

to the lymph nodes, liver, lungs, bones, and brain

what does Gardasil a quadrivalent vaccine protect against

4 types of HPV (6,11,16,18) infection

What are the side effects of Lorazepam Ativan

Amnesia confusion Independence Station

What are the side effects of Decadron dexamethasone

And hypertension hyperglycemia fluid retention

what kinds of cancers can doxorubicin (Adriamycin) be used on

colon plus (BL and Luke)

where does lung cancer usually metastasize to

The most common areas that lung cancer spreads to are the lymph nodes (in the chest, abdomen, neck or armpit), the liver, the bones and the brain.

What does Lorazepam Ativan do

Decreases emesis if a person is anxious

what does allupurinol do

Allopurinol is used to treat gout or kidney stones, and to decrease levels of uric acid in certain cancer patients.

what should a nurse do to alleviate symptoms of tumor lysis syndrome

give fluids and allopurinal

what should a nurse do to treat venous thrombosis

give heparin/coumadin

when is the best time to perform BSE

7 days after start of menstrual flow when the breasts are least engorged and tender

what is pleural effusion

A buildup of fluid between the tissues that line the lungs and the chest.

A nurse would identify that which food should be increased in the diet to help decrease the risk of cancer development? Bacon Broccoli Bologna Broiled beef

Broccoli is a cruciferous vegetable, which is helpful in reducing the risk of cancer. Other cruciferous vegetables are cauliflower, Brussels sprouts, and cabbage. Red meat (bacon) and meats with nitrites (bologna and broiled beef) can increase the risk of developing cancer.

A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder? Altered red blood cell production Altered production of lymph nodes Malignant exacerbation in the number of leukocytes Malignant proliferation of plasma cells within the bone

Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Options 1 and 2 are not characteristics of multiple myeloma. Option 3 describes the leukemic process.

why is anastrozole (Arimidex) useful?

They are useful in postmenopausal women who are not producing estrogen from their ovaries and instead are producing estrogen with aromatase found in body fat

what is TNM

a way to classify tumors based on extent of spread

Which clinical manifestation is consistent with the medical diagnosis of chronic lymphocytic leukemia (CLL)? Anemia Bleeding Pancytopenia Lymphadenopathy

CLL causes a slow increase in immature B cells. These cells infiltrate the bone marrow, lymph nodes, spleen, and liver. CLL eventually causes bone marrow failure; therefore the client will have enlarged and swollen lymph nodes. Options 1 and 2 are clinical manifestations of acute leukemias. Option 3 is a clinical manifestation of hairy cell leukemia.

The nurse is preparing to care for a client with a diagnosis of metastatic cancer. The nurse notes documentation in the client's chart that the client is experiencing cachexia. Which should the nurse expect to note on assessment of the client? Elevated blood pressure and ascites Sunken eyes and a hollow cheek appearance Periorbital edema and swelling around the ears Generalized edema and the presence of weight gain

Cachexia accompanies chronic wasting diseases and conditions such as cancer, dehydration, and starvation. Assessment findings in a client with cachexia include sunken eyes; hollow cheeks; and an exhausted, defeated expression. Options 1, 3, and 4 are not characteristic of a cachectic appearance.

CHF a side effect of what chemo medication

adriamycin

what might peau d'orange indicate

advanced breast cancer

when are arm range of motion exercises typically started in postmastectomy period

after drain is removed or one week after surgery

when can a nurse initiate privacy and postoperative teaching

after patient is physiologically stable

what does AG/AB mean

allergy anaphalactic

what is radiation recall

an acute inflammatory reaction confined to previously irradiated areas that can be triggered when chemotherapy agents are administered after radiotherapy

What happens during a low dose computed tomography

an x ray machine scans the body using low dose radiation to take detailed pictures of the lungs

why should you provide antiemedics before, during and after chemotherapy?

antineoplastic drugs often stimulate the chemoreceptor trigger zone (CTZ), leading to nausea and vomiting. nausea and vomiting may also be caused by irritation of GI tract

what should a immunosuppressed patient report to a PCP immediately

any signs of infection such as a low grade fever, persistent cough, any unusual drainage

what does filgrastim do

considered a WBC booster it helps body increase WBC to decrease risk for infection or to help fight infection

What is tertiary prevention

correction and prevention of deterioration of a disease state

what are the symptoms of tumor lysis syndrome

dehydration, initial hyperkalemia

what are the symptoms of ascites

distended abdomen, difficulty breathing, peripheral edema

what are oncologic complications of ascites

distended abdomen, difficulty breathing, peripheral edema,

which family member having breast cancer would put client at higher risk for developing breast cancer

first degree relative such as mother, sister, daughter especially if family member was premenopausal or had bilateral disease

what should nurse do to decrease diarrhea stools in patients taking 5 FU

get doctor to prescribe Imodium

where do leukemias originate from

hematopoietic system

where do lymphomas originate from

hematopoietic system

what are risk factors for cervical cancer

human papillomavirus infection, cigarette smoking, low socioeconomic status, early age at first coitus, multiple sexual partners, history of sexually transmitted disease, high risk male partner, compromised immunity, including human immunodeficiency virus infection, early age at first pregnancy, multiparity, especially AA, Hispanics, and native americans, prostitution

which complication of cancer makes a person sleep all day, be confused while awake, an complain of nausea and constipation

hypercalcemia

what does M mean in TNM

if tumor metastasized it is a 1

what is the highest priority if lymphedema occurs

impaired tissue perfusion so ensure that no tissue damage has occured

what is an expected effect of chemotherapy

neutropenia which is an abnormal reduction in neutrophils

will irritation of lining of bladder caused by cyclophosphamide (cytoxan) affect platelet count

no it is an irritation

what are symptoms of spinal cord compression

numbness and tingling, dull pain not relieved by lying down

how is ascites treated

paracentesis

What is primary prevention

prevention of problem before they occur

what does T mean in TNM

primary tumor range

how is GI obstruction treated

probable surgery

why are arm range of motion exercises important to start

promotes muscle movement without stretching

what are adverse effects of Bleomycin

pulmonary fibrosis, low BP, mental confusion, AG/AB

what are oncologic complications of tumor lysis syndrome

s/s of dehydration, initial hyperkalemia,

when is the correct time to obtain serum peak level

thirty minutes after administeriation of the most recent dose of the drug

how is pleural effusion treated

thoracentesis to remove excess fluid or pleurodesis to make linings stick together leaving no space for fluid to enter into

why is it important for a patients arm to be elevated on a pillow postmastectomy

to promote fluid return and prevent lymphedema

after sutures are removed it is important to move shoulder in all directions several times a day, why?

to stretch and regain full range of motion

where does pancreatic cancer usually metastasize to

to the liver, the lining of the abdominal cavity called the peritoneum, and lungs.

how does Tamoxifen (Nolvadex) work?

It works by competing for the binding site normally occupied by estrogen.

The community health nurse is providing a session to community members about the risks associated with laryngeal cancer. Which statement by a person attending the session indicates correct understanding of the risk factors? "Exposure to airborne carcinogens can cause this type of cancer." "Alcohol consumption is not associated with this type of cancer." "Cigarette smoking does not contribute to the development of this type of cancer." "Overuse of the voice is not associated with this type of cancer unless it causes spitting up of blood."

To decrease the risk of laryngeal cancer, the client should be instructed to avoid cigarette smoking, alcohol consumption, exposure to airborne carcinogens, and vocal abuse. The client is instructed to schedule routine physical examinations. The client also should be instructed to seek medical care if difficulty in swallowing, persistent hoarseness, enlarged lymph nodes in the neck, or unexplained weight loss occurs.

What is the current standard for treating emesis after chemo

Zofran and dexamethasone if that doesn't work add Aprepitant (Emend) but you need to lower the dexamethasone

what symptoms are produced by decrease of estrogen

menopausal experience; hot flashes, dry skin, nausea, menstrual irregularities

what kinds of cancers can cisplatin (Platinol) be used on

metastatic testicular tumor and metastatic ovarian tumor off label use for carcinoma of endometrium of bladder, head and neck

what is an expected side effect of filgrastim

mild to moderate bone pain and general muscle aches often occur and can usually be lessened by non narcotic pain releivers

what kinds of cancers can cyclophosphamide (cytoxan) be used on

multiple myeloma, lupus, RA (BOLUKE)

how is candida treated

nystatin (Mycostatin)

what should a nurse do to alleviate symptoms of spinal cord compression

pain relief and bed rest

What does metoclopramide Reglan do

Effects dopamine it's a week 5-ht3 antagonist enhances gastric emptying time

what is paracentesis

Paracentesis is a procedure in which a needle or catheter is inserted into the peritoneal cavity to obtain ascitic fluid

The community health nurse is preparing a poster for an educational session for a group of women and will be discussing the risk factors associated with breast cancer. Which risk factors for breast cancer should the nurse list on the poster? Select all that apply. Multiparity Early menarche Early menopause Family history of breast cancer High-dose radiation exposure to chest Previous cancer of the breast, uterus, or ovaries

Risk factors for breast cancer include early menarche, late menopause, or both; family history of breast cancer; age older than 40 years; high-dose radiation exposure to the chest previous cancer of the breast, uterus, or ovaries; and nulliparity or first child born after age 30 years.

what are symptoms of pleural effusion

SOB, dyspnea on exertion, quiet lung sounds

What is the goal of antiemetics

To prevent nausea and vomiting by pharmacologically inhibiting your transmitters that stimulate the reflex arc of nausea and vomitings

what is a tumor

a lump that has no purpose or function in the body is formed from excessive growth of rogue cells (neoplastic cells) that do not die when they should

what is a neoplasm

an abnormal growth of tissue caused by the rapid division of cells that have undergone some form of mutation.

why is adriamycin so awful

because it can cause CHF even if patient was normal before taking this chemo drug

how should adriamycin be administered to avoid infiltration/ extravasation into tissue

check blood, give 1 to 2 mL, check blood, give 1 to 2 mL, until all chemo is done

what kinds of cancers can 5 fluorouracil be used on

colon, rectal, stomach, pancreatic, skin (gI cancers)

what is the antidote for adriamycin

dexrazoxane

where do most palpable masses occur on the breast

upper outer quadrant of the breast

what chemo complication manifests as a clot formation

venous thrombosis

when is a chest x-ray warranted for a central line

when the nurse suspects the central line has become displaced

The community health nurse conducts a health promotion program for community members regarding testicular cancer. The nurse determines that further information needs to be provided if a community member states that which is a sign of testicular cancer? Alopecia Back pain Painless testicular swelling Heavy sensation in the scrotum

Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as a result of radiation or chemotherapy. The remaining options are assessment findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes.

A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client? "You can take aspirin (acetylsalicylic acid) as needed for headache." "You can drink beverages containing alcohol in moderate amounts each evening." "You need to consult with the health care provider (HCP) before receiving immunizations." "It is fine to receive a flu vaccine at the local health fair without HCP approval because the flu is so contagious."

Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without an HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side/adverse effects.

The nurse is reviewing the progress notes for a client admitted to the nursing unit with a suspected diagnosis of leukemia. The nurse notes that the diagnosis of leukemia has been confirmed. The nurse interprets that results have been reported to the health care provider for which diagnostic test? Platelet count Bone marrow biopsy White blood cell count Complete blood cell count

Bone marrow aspiration or biopsy allows examination of blast cells and other hypercellular activity. Blood studies will not provide a definitive diagnosis of leukemia.

A client with acute myelocytic leukemia is being treated with busulfan (Myleran, Busulfex). Which laboratory value would the nurse specifically monitor during treatment with this medication? Clotting time Uric acid level Potassium level Blood glucose level

Busulfan (Myleran, Busulfex) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute kidney injury. Options 1, 3, and 4 are not specifically related to this medication.

A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that the health care provider will request which prescriptions? Select all that apply Radiation Chemotherapy Increased fluid intake Decreased oral sodium intake Serum sodium level determination Medication that is antagonistic to antidiuretic hormone

Cancer is a common cause of syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.

What are the nursing interventions for Appleton MN

Check usage with with Warfarin Coumadin and oral contraceptives

What does CTC mean

Chemoreceptor trigger Zone

The nurse is reviewing the record of a client who was admitted to the hospital with a diagnosis of ovarian cancer. The nurse understands that which assessment finding is unlikely to occur with this disorder? Pain Frequent diarrhea Abdominal distention Urinary frequency and urgency

Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pain from pressure caused by the growing tumor, and urinary or bowel obstruction and constipation. Diarrhea is not likely to be seen in the client with ovarian cancer.

what does grade III mean

cells very abnormal (poorly differentiated)

what should a nurse do to alleviate symptoms of ascites

HOB up

The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which is a late sign of this oncological emergency? Headache Dysphagia Constipation Electrocardiographic changes

Hypercalcemia is a manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave.

what does Imodium do

It works by slowing down the movement of the gut .This decreases the number of bowel movements and makes the stool less watery

The nurse is caring for a client with bladder cancer and bone metastasis. What signs/symptoms would the nurse recognize as indications of a possible oncological emergency? Select all that apply. Facial edema in the morning Serum calcium level of 12 mg/dL Weight loss of 20 lb in 1 month Serum sodium level of 136 mg/dL Serum potassium level of 3.4 mg/dL Numbness and tingling of the lower extremities

Oncological emergencies include sepsis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome. Blockage of blood flow to the venous system of the head resulting in facial edema is a sign of superior vena cava syndrome. A serum calcium level of 12 mg/dL indicates hypercalcemia. Numbness and tingling of the lower extremities could be a sign of spinal cord compression. Mild hypokalemia and weight loss are not oncological emergencies. A sodium level of 136 mg/dL is a normal level.

A client calls the ambulatory care clinic and tells the nurse that she found an area that looks like the peel of an orange when performing breast self-examination (BSE) but found no other changes. What is the nurse's best response to this client? "Good job performing your BSE. I am sure that is nothing to be concerned about." "Make sure you tell the health care provider your finding at your next regularly scheduled visit." "I am glad you called to report this finding. Can you come to the clinic to see your health care provider tomorrow?" "Do you have a thermometer? You need to take your temperature and call back if you have a fever over 101° F/38.3° C."

Peau d'orange, or orange peel appearance, of the skin over the breast is associated with late breast cancer. Therefore, the nurse would arrange for the client to come to the clinic as soon as possible. Peau d'orange is not indicative of an infection.

what are oncologic complications of superior vena cava syndrome

SOB, neck vein distention, facial edema, plethora

What is a nursing consideration for Lorazepam Ativan

Safety

A client has been hospitalized for a cervical radiation implant for treating cancer. The implant is removed, and the nurse provides home care instructions to the client. Which statement made by the client indicates a need for further instructions? "Cream may be used to relieve dryness or itching." "Some vaginal bleeding is expected for 1 to 3 months." "Sexual intercourse may be resumed after 7 to 10 days." "Foul-smelling vaginal discharge is a sign of an infection."

Some foul-smelling vaginal discharge is expected and is not a sign of an infection in this client, and this type of discharge will occur for some time after removal of a cervical radiation implant. All other options are accurate discharge instructions.

Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The nurse administering the medication understands that which is the primary action of this medication? It increases DNA and RNA synthesis. It promotes the biosynthesis of nucleic acids. It increases estrogen concentration and estrogen response. It competitively binds to estrogen receptors on tumors and other tissue targets.

Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response.

A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? Glucose level Calcium level Potassium level Prothrombin time

Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium level should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

A client is admitted to the hospital with suspected bladder cancer. The nurse assesses the client for which as the earliest manifestation(s) of the disease? Proteinuria and dysuria Hematuria with no pain Painful urination and hematuria Pyuria and palpable abdominal mass

The most common earliest manifestation of bladder cancer is hematuria that is not accompanied by pain. The hematuria is intermittent at first. Later signs and symptoms include hematuria with dysuria and frequency because of bladder irritation. Pyuria and proteinuria are not part of the clinical picture. A mass usually is not palpable.

what does alkylating agent mean

a substance that has mutagenic activity (changes the genetic material) that inhibits cell division and growth

to prevent fever and shivering during an infusion of rituximab (Rituxan) what would a nurse premedicate the patient with

acetaminophen (Tylenol)

why should nurse teach patient to report burning at IV site

because adriamycin is a vesicant

why do we not deviate from less than max dose of adriamycin

because it can throw them into failure

why is a history of how many sexual partners a patient has had important

because multiple sexual partners increases risk of exposure to HPV

why should you give cyclophosphamide early

because nurse is going to give cyclophosphamide (cytoxan) with alot of fluids and patient is going to be going to bathroom alot

what cancer do we use cyclophosphamide (cytoxan) on most

breast cancer

what is Taxol used for

breast, ovarian, lung cancers

what is a commonly occurring super infection

candida which is a fungal infection

what does grade X mean

cannot be assessed

what are side effects of adriamycin

cardiotoxicity, red urine, vesicant, radiation recall

where do carcinomas originate from

embryonal ectoderm (skin and glands) and embryonic endoderm (mucous membrane linings of the respiratory tract, GI tract, and genitourinary tract)

where do sarcomas originate from

embryonal mesoderm (connective tissue, muscle, bone, and fat)

which nursing actions have highest priority in initial postmastectomy period

ensure respiratory and cardiac homeostasis is maintained by monitoring vital signs and oxygen levels and assessing for postoperative bleeding and pain control to help patient move and breath more efficiently

what are side effects of tamoxifen (Nolvadex)

fatigue, DVT, PE, and stroke, osteoporosis which leads to bone fractures, night sweats

what is hemorrhagic cystitis

is the sudden onset of hematuria combined with bladder pain and irritative bladder symptoms.

what complication is most often associated with tamoxifen (Nolvadex)

it increases risk for blood clots and endometrial cancer

what does cyclophosphamide (cytoxan) do

it interferes with DNA replication and RNA transcription, ultimately disrupting protein synthesis

what drug type is cyclophosphamide (cytoxan)

it is an antineoplastic , immunosuppressant, alkylating agent

what is most important to implement to avoid blood related transfusion reactions

it is required that two personnel match label on bag with patient identification band

what does knowing through of medication help determine

it provides useful information about the dosage of the medication to reduce risk of drug toxicity

what should nurse do if one or more lumens becomes disfunctional

label non functioning lumens as non functional and use remaining lumens for the purpose at hand

where do colon cancer usually spread to

liver

what should nurse assess for in 5 FU

low blood counts due to BMD, mucositis,diarrhea

what is screening for lung cancer

low dose computed tomography (LDCT)

what does N mean in TNM

lymph node involvement

complaining of palpitations and a heavy feeling in the chest warrants further assessment why?

may represent cardiac dysrrhythmias that are life threatening

A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which condition? Rupture of the bladder The development of a vesicovaginal fistula Extreme stress caused by the diagnosis of cancer Altered perineal sensation as a side effect of radiation therapy

A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina. The client's complaint is not associated with options 1, 3, or 4.

What does aprepitant men do

Affect substance P which is a neurotransmitter that causes nausea and depression

The nurse is caring for a client who has undergone a radical neck dissection and creation of a tracheostomy because of laryngeal cancer and is providing discharge instructions to the client. Which should be included in the instructions? Select all that apply. Protect the stoma from water. Use a humidifier if dryness is a problem. Keep powders and sprays away from the stoma site. Use an air conditioner to provide cool air to assist in breathing. Apply a thin layer of petrolatum to the skin around the stoma to prevent cracking.

Air conditioners should be avoided to prevent excessive coldness. The remaining options are appropriate interventions regarding stoma care after radical neck dissection and creation of a tracheotomy.

A client with ovarian cancer is being treated with vincristine (Vincasar). The nurse monitors the client, knowing that which manifestation indicates an adverse effect specific to this medication? Diarrhea Hair loss Chest pain Peripheral neuropathy

An adverse effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.

how does anastrozole (Arimidex) work?

Aromatase inhibitors block the synthesis of estrogen from adrenal androgens.

what is Ascites

Ascites is excess fluid in the space between the membranes lining the abdomen and abdominal organs (the peritoneal cavity).

The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse contacts the health care provider before administering the medication if which disorder is documented in the client's history? Pancreatitis Diabetes mellitus Myocardial infarction Chronic obstructive pulmonary disease

Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between dose administrations. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.

The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of Hodgkin's disease. Which assessment findings noted in the client's record is associated with this diagnosis? Select all that apply. Fever Weight loss Night sweats Visual changes Enlarged, painless lymph nodes

Assessment of a client with Hodgkin's disease most often reveals enlarged, painless lymph nodes along with fever, malaise, and night sweats. Weight loss may be a feature in metastatic disease. Visual changes are not specifically associated with Hodgkin's disease.

why would Gardasil a quadrivalent vaccine be most effective if given before clients become sexually active.

Because we know the vaccine can protect against acquiring HPV infection which can cause cervical cancer, but we don't know if it can treat established infection.

A client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? Echocardiography Electrocardiography Cervical radiography Pulmonary function studies

Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.

The nurse is teaching a group of adults about the warning signs of cancer. Which signs should the nurse provide to the group? Select all that apply. Areas of alopecia Sores that do not heal Nagging cough or hoarseness Indigestion or difficulty swallowing Change in bowel or bladder habits Absence or decreased frequency of menses

Cancer is a neoplastic disorder that can involve all body systems. In cancer, cells lose their normal growth-controlling mechanism. Some signs include sores that do not heal, a nagging cough or hoarseness, indigestion or difficulty swallowing, and a change in bowel or bladder habits. Areas of alopecia occur following cancer chemotherapy. Absence of menses is not a specific sign; however, abnormal occurrence of menses may be.

The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching is necessary related to colorectal cancer if the client identifies which item as an associated risk factor? Age younger than 50 years History of colorectal polyps Family history of colorectal cancer Chronic inflammatory bowel disease

Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease.

what does 1-4 mean in TNM

if its a 4 the tumor had to be pretty big to be able to move away from primary location, if it is a 1 the tumor stayed in primary location (has to do with size)

when can finger and wrist flexion and extension exercises be performed in postmastectomy period

immediately after surgery and progress to flexion of the elbow

Which should be identified by the nurse as the purpose of cytoreductive (debulking) surgery for ovarian cancer? Cancer control by reducing the size of the tumor Cancer prevention by removing precancerous tissue Cancer cure by removing all gross and microscopic tumor cells Cancer rehabilitation by improving the appearance of a previously treated body part

Cytoreductive or debulking surgery may be used if a large tumor cannot be completely removed, as is often the case with late-stage ovarian cancer (e.g., the tumor is attached to a vital organ or has spread throughout the abdomen). When this occurs, as much tumor as possible is removed, and adjuvant chemotherapy or radiation may be prescribed. Therefore the remaining options are incorrect purposes for cytoreductive surgery.

What does Decadron dexamethasone do

Decreases swelling in the CTC of the brain

A community health nurse is providing an educational session on cancer of the cervix to women living in the community. The nurse informs the community residents that which is an early sign of this type of cancer? Abdominal pain Constant and profuse bleeding Irregular vaginal bleeding or spotting Dark and foul-smelling vaginal drainage

Early cancer of the cervix usually is asymptomatic. The two chief symptoms are leukorrhea (vaginal discharge) and irregular vaginal bleeding or spotting. The vaginal discharge increases gradually in amount and becomes watery and finally dark and foul-smelling because of necrosis and infection of the tumor mass. As the disease progresses, the bleeding may become constant and may increase in amount.

According to the American Cancer Society, fecal occult blood testing should be done annually after which age? 30 40 50 60

Fecal occult blood testing for colorectal cancer should be done annually for both men and women after the age of 50 years. The other options are incorrect.

The nurse is performing an admission assessment for a client with a diagnosis of bladder cancer. The nurse should expect to note which symptom as the most likely initial assessment finding in this client? Burning Urgency Hematuria Frequency

Gross, painless hematuria most frequently is the first manifestation of bladder cancer. As the disease progresses, the client may experience dysuria, frequency, and urgency.

what are symptoms of intracranial pressure

HA, seizures,

What are the side effects of metoclopramide Reglan

Hallucinations diarrhea drowsiness fatigue anticholinergic effects

What are the side effects of Zofran

Headache, GI, cardiac conduction issues, black black box warning lethal arrhythmias

A client seeks treatment in an ambulatory clinic for a complaint of hoarseness that has lasted for 6 weeks. On the basis of this symptom, the nurse should consider developing a plan of care on which possible medical diagnosis? Thyroid cancer Acute laryngitis Laryngeal cancer Bronchogenic cancer

Hoarseness is a common early sign of laryngeal cancer but not of bronchogenic or thyroid cancer. Hoarseness that lasts for 6 weeks is not associated with an acute problem, such as laryngitis.

A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client? Fatigue Weakness Weight gain Enlarged lymph nodes

Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.

The nurse is developing a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? Encouraging fluids Providing frequent oral care Coughing and deep breathing Monitoring the red blood cell count

Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules. Options 2, 3, and 4 may be components of the plan of care but are not the priority in this client.

what should nurse monitor in a patient taking cyclophosphamide (cytoxan)

I/O because nurse is going to encourage liberal fluid intake

what is NPSG highest priority at discharge

Joint Commission requires accurate and complete reconciliation of medications across the continuum of care

The new nurse is assigned to provide care for a client recently diagnosed with a melanoma. The charge nurse asks the nurse about the characteristics of this type of skin lesion. Which statement by the nurse indicates an understanding of this type of lesion? "It is contagious." "Metastasis is rare." "It is highly metastatic." "It is characterized by local invasion."

Melanomas are pigmented malignant lesions originating in the melanin-producing cells of the epidermis. This skin cancer is highly metastatic, and the affected person's survival depends on early diagnosis and treatment. It is not a contagious lesion. Basal cell carcinomas arise in the basal cell layer of the epidermis. Early malignant basal cell lesions often go unnoticed, and although metastasis is rare, underlying tissue destruction can progress to include vital structures. Squamous cell carcinomas are malignant neoplasms of the epidermis. They are characterized by local invasion and the potential for metastasis.

The home health care nurse is visiting a client who has undergone a mastectomy. The nurse determines that the client demonstrates greatest adjustment to the loss of the breast if which behavior is noted? The client looks at the surgical site. The client performs the prescribed arm exercises. The client takes the pain medication as prescribed. The client has read all of the postoperative materials provided by the hospital nurse.

Of the options provided, the client behavior in the correct option demonstrates the greatest adaptation or adjustment (looking at the surgical site). This indicates that the client has acknowledged and is beginning to cope with the loss of the breast. Reading postoperative care booklets and performing prescribed exercises indicate an interest in self-care and are positive signs indicating adjustment. Taking pain medication is not related to adjustment to the loss of the breast.

The clinic nurse has conducted a health screening clinic to identify clients who are at risk for cervical cancer. The nurse is reviewing the assessment findings in the records of the clients who attended the clinic. Which client is at lowest risk for developing this type of cancer? A multiparity client A single white client A client with a history of chronic cervicitis A client who had early, frequent intercourse with multiple sexual partners

Risk factors associated with cervical cancer include early, frequent intercourse with multiple sexual partners, multiparity, chronic cervicitis, and a history of genital herpes or human papilloma. Cervical cancer also occurs with higher frequency in African Americans. Regarding the options provided, the single white client is at lowest risk for the development of cervical cancer.

What does Zofran do

Serotonin antagonist

A client with laryngeal cancer has undergone laryngectomy and is now receiving external radiation therapy to the head and neck. The nurse should monitor the client for which adverse effects of external radiation? Select all that apply. Cystitis Stomatitis Dysgeusia Leukopenia Xerostomia Thrombocytopenia

Stomatitis (inflammation of the mucous lining in the mouth), dysgeusia (distorted sense of taste), and xerostomia (dry mouth) are local effects of external radiation. Options 4 and 6 are systemic effects and would most likely occur if radiation were applied to areas around the bone marrow. Option 1 is unrelated to the client's condition.

what are the symptoms of sepsis

Symptoms include fever, difficulty breathing, low blood pressure, fast heart rate, and mental confusion.

The nurse has provided instructions to a client regarding testicular self-examination (TSE). Which client statement indicates the need for further teaching regarding TSE? "I know to report any small lumps." "I examine myself every 2 months." "I examine myself after I take a warm shower." "I feel a hard and cord-like thing in back and going up."

TSE should be performed every month. Small lumps or abnormalities should be reported. The spermatic cord finding (option 4) is normal. After a warm bath or shower, the scrotum is relaxed, making it easier to perform TSE.

The home health care nurse is providing instructions to a client after a vulvectomy. Which instruction should the nurse provide to the client? "You can engage in sexual activity in 2 weeks." "It is all right to begin to drive a car as long as you do not drive long distances." "Resume activities slowly, keeping in mind that walking is a beneficial activity." "It is important to rest and sit in a chair with your legs elevated as much as possible."

The client should resume activities slowly, and walking is a beneficial activity. Sexual activity is prohibited for approximately 4 to 6 weeks after surgery. Activities to be avoided include driving, heavy housework, wearing tight clothing, crossing the legs, and prolonged sitting and standing. The client should not be instructed to sit in a chair as much as possible because pressure on the surgical site could lead to complications related to the surgery.

A 27-year-old female client is undergoing evaluation of lumps in her breasts. In determining whether the client could have fibrocystic breast disorder, the nurse should ask her whether the breast lumps seem to become more prominent or troublesome at which time? After menses Before menses During menses At any time, regardless of the menstrual cycle

The nurse assesses the client with fibrocystic breast disorder for worsening of symptoms (breast lumps, painful breasts, and possible nipple discharge) before the onset of menses. This is associated with cyclical hormone changes. Therefore the other options are incorrect.

The ambulatory care nurse is providing discharge instructions to a female client who underwent cryosurgery with laser therapy because of a positive Papanicolaou smear. Which statement, if made by the client, indicates an understanding of the instructions? "I should take sitz baths every 4 hours for the next week." "I should expect the vaginal discharge to be clear and watery." "Very strong pain medications will be needed to relieve any discomfort that I may have." "If I note any odor to the vaginal discharge, I should call the health care provider immediately."

Vaginal discharge should be clear and watery after cryosurgery with laser therapy. The client should be told that the vaginal discharge may be odorous as a result of the sloughing of dead cell debris. This vaginal odor takes about 8 weeks to resolve. The client should be instructed to avoid any sitz baths or tub baths while the area is healing, which takes approximately 10 weeks. Pain is mild after this procedure, and very strong pain medication will not be needed.

why does cyclophosphamide (cytoxan) cause hemorrhagic cystitis

as cancer cells break down, by products can cause irritation in lining of bladder

what does grade IV mean

cells immature and primitive (undifferentiated)

what does grade II mean

cells more abnormal (moderately differentiated)

how is tamoxifen (Nolvadex) classified

classified as a selective estrogen receptor modulator.

what are nursing priorities for tumor lysis syndrome

fluids and give allopurinol

what should a nurse do to alleviate symptoms of hypercalcemia

fluids and initiate fall safety risk

what is the characteristic description of a cancerous breast mass that is palpable

hard, irregular shape, poorly delineated, non tender, and non mobile

how should a nurse treat anaphylaxis

have emergency equipment available, give benadryl/ epinephrine

what are nursing priorities for spinal cord compressions

pain relief and provide bed rest

what are nursing priorities for ascites

paracentesis and maintain head of bed up

what is the risk with being neutropenic

patient is at greater risk of infection from normal flora and opportunistic organisms

what can happen if BMD occurs with 5 FU

portal for infection

what should a nurse do to alleviate intracranial pressure

raise HOB to 30 degrees and avoid intra abdominal pressure

what are symptoms of anaphylaxis

rash, difficulty breathing

what is pulmonary fibrosis

scarring of lungs making it hard to breath

the likelihood of developing an infection is dependent on what?

the duration of the neutropenia

why is urine red when patient is on adriamycin

the dye is red and is excreted in urine

what does the through reflect

the lowest amount of drug circulating in the clients system

why is it important to start some type of resistive exercise regimen after 6 weeks postmastectomy

to strengthen arm and shoulder and regain total use of arm and shoulder

what are adverse effects of vincristine (oncovin)

vesicant, peripheral neuropathies,AG/AB

A client with liver cancer who is receiving chemotherapy tells the nurse that some foods taste bitter. The nurse would try to limit which food that is most likely to cause this bitter taste for the client? Pork Custard Potatoes Cantaloupe

Chemotherapy may cause distortion of taste. Frequently, beef and pork are reported to taste bitter or rancid. The nurse can promote client nutrition by helping the client choose alternative sources of protein in the diet, such as mild-tasting fish, cold chicken, turkey, eggs, or cheese. Custard, potatoes, and cantaloupe are not likely to cause distortion of taste.

A 67-year-old man is receiving outpatient radiation treatments for carcinoma of the oropharynx and has developed dysphagia. The nurse develops a teaching plan regarding dysphagia and includes which interventions in the plan? Select all that apply. Teach the man to speak slowly. Teach the man to enunciate clearly. Encourage the man to drink only thin liquids. Teach the man to examine his oral mucosa daily. Encourage the man to use artificial saliva to manage dryness.

Epithelial cells of the head and neck are destroyed by radiation. Examining the oral mucosa is a preventive intervention so that changes in the mucosa will be noted immediately. Inflammation and ulceration also occur because of rapid cell destruction, thereby impairing normal saliva excretion and distribution. Artificial saliva aids in preventing further damage by lubricating the affected area. The client with dysphagia has difficulty swallowing, not difficulty speaking; therefore teaching him to speak slowly and enunciate clearly will provide no health benefit for his impairment in swallowing. A client with difficulty swallowing should avoid drinking thin liquids because of the increased risk of aspiration owing to epiglottis dysfunction related to radiation therapy.

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? Increased calcium level Increased white blood cells Decreased blood urea nitrogen level Decreased number of plasma cells in the bone marrow

Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.

A client with a medical diagnosis of breast cancer is undergoing chemotherapy. The client complains to the nurse about losing her hair and severe fatigue from the treatment. Which interventions should the nurse implement for this client? Select all that apply. Teach the client how to resolve specific concerns of her personal life. Review side effects of chemotherapy and treatment with the client. Teach the client to pace activities with rest so as to maintain strength. Offer information on available counseling services and support groups. Tell the client about some other clients who have had breast cancer treatment. Inquire how the cancer diagnosis and treatment affect the client's normal routine.

It is not therapeutic nor is it the nurse's role to teach the client how to resolve specific concerns of her personal life. The nurse should determine how the cancer diagnosis and treatment are affecting the client's normal routine, and the client should be aware of potential side effects of treatment so as to cope with the events with medications or other measures. It is important for the nurse to inform clients about support groups available so the client does not feel isolated (i.e., Reach for Recovery). Teaching clients to pace activities even when they feel well will conserve energy so they ultimately feel stronger and less fatigued. It is a breach of confidentiality and the Health Insurance Portability and Accountability Act (HIPAA) laws for the nurse to discuss other clients and their medical problems.

A nurse is providing discharge instructions to a client who has undergone treatment of cervical cancer with a radiation (cesium) implant. Which instruction should the nurse provide to the client? Avoid douching for at least 1 year. Use a vaginal dilator three times a week. Sexual activity can be resumed in about 2 months. Bed rest is recommended for at least 1 week after discharge.

Radiation causes scarring and fibrosis of the vagina, with a decrease in normal vaginal secretions. The client is instructed to use a vaginal dilator to prevent vaginal narrowing and stenosis. A vaginal discharge often occurs, and the woman may need to douche twice daily for as long as the discharge and odor persist. Sexual activity after internal radiation treatment can be resumed in about 3 weeks. Bed rest is not required.

A client is having a diagnostic workup for colorectal cancer. Which factors in the client's history will place the client at increased risk for this type of cancer? Select all that apply.Rationale: A high-fiber diet A diet high in fats Minimal alcohol intake A diet high in carbohydrates A history of inflammatory bowel disease A maternal grandfather who had a history of heart disease

A high-fiber diet actually lessens the chances of developing colorectal cancer. This type of cancer most often occurs in populations with diets low in fiber and high in refined carbohydrates, fats, and meats. Other risk factors include a family history of the disease, rectal polyps, and active inflammatory disease of at least 10 years' duration.

The community nurse is conducting a health promotion program, and the topic of the discussion relates to the risk factors for gastric cancer. Which item, if identified as a risk factor by a client, indicates a need for further discussion? Smoking A low-fat diet Foods containing nitrates A diet of smoked, highly salted, and spiced foods

A low-fat diet is not a risk factor for gastric cancer. A high-fat diet plays a role in the development of cancer of the pancreas and other types of cancer. The remaining options are risk factors related to gastric cancer.

The client is preparing for discharge from the hospital after radical vulvectomy. The nurse plans to teach this client that which activity is acceptable after discharge because it will not precipitate complications? Walking Driving a car Sexual activity Sitting for lengthy periods

The client should resume activity slowly, but walking is a beneficial activity. The client should know to rest when fatigued. Sexual activity is prohibited for 4 to 6 weeks after surgery. Activities to be avoided include driving, heavy housework, wearing tight clothing, crossing the legs, and prolonged standing or sitting.

The nurse is reviewing the laboratory test results for a client with a diagnosis of leukemia who is receiving chemotherapy. The nurse notes that the client's platelet count is 20,000 cells/mm3. The nurse should prepare to implement which specific action based on this finding? Remove the fresh flowers from the client's room. Remove the rectal thermometer from the client's room. Instruct family members to wear a mask when entering the client's room. Call the dietary department to report that the client will be on a low-bacteria diet.

When the client's platelet count is low, he or she is at risk for bleeding. Options 1, 3, and 4 relate to the risk for infection. Rectal temperatures should not be taken on the client who is at risk for bleeding because the thermometer could cause an alteration in the delicate rectal membranes and lead to bleeding.

The nurse is caring for a client after intravesical instillation of an alkylating chemotherapeutic agent for the treatment of bladder cancer. After the instillation, which action should the nurse instruct the client to take? Urinate immediately. Maintain strict bed rest. Change position every 15 minutes. Retain the instillation fluid for 30 minutes.

With intravesical instillation, normally the medication is injected into the bladder through a urethral catheter, the catheter is clamped or removed, and the client is asked to retain the fluid for 2 hours. The client changes position every 15 to 30 minutes, usually from side to side and from supine to prone. The client then voids and is instructed to drink water to flush the bladder.

The nurse is performing a skin assessment on a client diagnosed with malignant melanoma. The nurse should expect to note which characteristic of this type of skin lesion? An irregularly shaped lesion A small papule with a dry, rough scale A firm nodular lesion topped with crust A pearly papule with a central crater and a waxy border

A melanoma is an irregularly shaped pigmented papule or plaque with a red, white, or blue tone. Actinic keratosis, a premalignant lesion, appears as a small macule or papule with a dry, rough adherent yellow or brown scale. Squamous cell carcinoma is a firm nodular lesion topped with a crust or a central area of ulceration. Basal cell carcinoma appears as a pearly papule with a central crater and rolled waxy border.

The nurse has provided discharge instructions to a client who underwent a right mastectomy with axillary lymph node dissection. Which statement, if made by the client, indicates a need for further instruction regarding home care measures? "It is all right to use a straight razor to shave under my arms." "I must be sure to use thick potholders when I am cooking." "I must be sure not to have blood pressures taken or blood drawn from my right arm." "I should inform all of my other health care providers that I have had this surgical procedure."

After mastectomy with axillary lymph node dissection, the client is at risk for arm edema and infection. The client should be instructed regarding home care measures to prevent these complications. The client should be told to avoid activities such as carrying heavy objects or having blood pressure measurements taken on the affected arm. The client also should be instructed in the techniques to avoid trauma to the affected arm, such as using an electric razor to shave under the arms, using gloves when working in the garden, and using or wearing thick potholders when cooking.

A client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim). The nurse should tell the client that the purpose of the allopurinol is to prevent which symptom? Nausea Alopecia Vomiting Hyperuricemia

Allopurinol decreases uric acid production and reduces uric acid concentrations in serum and urine. In the client receiving chemotherapy, uric acid levels increase as a result of the massive cell destruction that occurs because of the chemotherapy. This medication prevents or treats hyperuricemia caused by chemotherapy. Allopurinol is not used to prevent alopecia, nausea, or vomiting.

A client receiving chemotherapy is experiencing mucositis. The nurse should advise the client to use which item as the best substance to rinse the mouth? Alcohol-based mouthwash Hydrogen peroxide mixture Lemon-flavored mouthwash Weak salt and bicarbonate mouth rinse

An acidic environment in the mouth is favorable for bacterial growth, particularly in an area already compromised from chemotherapy. Therefore the client is advised to rinse the mouth before every meal and at bedtime with a weak salt and sodium bicarbonate mouth rinse. This lessens the growth of bacteria and limits plaque formation. The other substances are irritating to oral tissue. If hydrogen peroxide must be used because of the presence of severe plaque, it should be a weak solution, because hydrogen peroxide dries the mucous membranes.

A client with small cell lung cancer is being treated with etoposide (Toposar). The nurse monitors the client during administration, knowing that which adverse effect is specifically associated with this medication? Alopecia Chest pain Pulmonary fibrosis Orthostatic hypotension

An adverse effect specific to etoposide is orthostatic hypotension. Etoposide should be administered slowly over 30 to 60 minutes to avoid hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.

The nurse is assigned to the care of a client scheduled for surgery for a right colon tumor. Which is the most characteristic manifestation of cancer at this site? Frequent diarrhea Crampy gas pains Flat, ribbon-like stools Dull abdominal pain exacerbated by walking

Characteristic symptoms of right colon tumors include vague, dull, abdominal pain exacerbated by walking, and dark red- or mahogany-colored blood mixed in the stool. The symptoms described in the other options are associated with left colon tumors.

During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? Diarrhea Hypermenorrhea Abnormal bleeding Abdominal distention

Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.

A client is diagnosed as having a bowel tumor. The nurse should monitor the client for which complications of this type of tumor? Select all that apply. Flatulence Peritonitis Hemorrhage Fistula formation Bowel perforation Lactose intolerance

Complications of bowel tumors include bowel perforation, which can result in hemorrhage and peritonitis. Other complications include bowel obstruction, and fistula formation. Flatulence can occur but is not a complication; lactose intolerance also is not a complication of intestinal tumor.

The nurse is counseling a woman about decreasing her risk for cervical cancer. Which statement by the client indicates a need for further counseling? "I need to seek prompt treatment for vaginitis." "Condoms are needed only if I do not trust a new partner." "A partner who is uncircumcised will present an increased risk." "I need to keep appointments for Pap smears at the frequency advised by my health care provider."

Condoms should be used for adequate protection, especially with new partners. Sexually transmitted infections (which could be acquired without condom use) increase the client's risk of cervical cancer. Uncircumcised partners may present an increased risk. The woman should adhere to guidelines for early detection of cervical cancer (by Pap smear) and should seek prompt treatment of vaginitis and cervicitis if they occur.

A nurse is reviewing a plan of care for a client with cancer of the cervix who is undergoing treatment with a cesium (radiation) implant. Which nursing interventions are appropriate for this client? Select all that apply. Maintain the client on bed rest. Place the client on a low-fiber diet. Keep the head of the bed flat at all times. Restrict visitors to visiting for 60 minutes per day. Stand at the entrance of the room to communicate with the client when possible.

During application of the cesium implant, the client is on bed rest. The client may be logrolled from side to side, and the head of the bed may be raised to 45 degrees. The client is given a low-fiber diet to prevent frequent bowel movements, which is a side effect of the radiation. To minimize radiation exposure, the nurse stands at the head of the bed or at the entrance to the room. Visitors are limited to 30 minutes per day in the radiation area.

As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement? "I should avoid blowing my nose." "I may need a platelet transfusion if my platelet count is too low." "I'm going to take aspirin for my headache as soon as I get home." "I will count the number of pads and tampons I use when menstruating."

During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000 cells/mm3. The correct option describes an incorrect statement by the client. Aspirin and nonsteroidal antiinflammatory drugs and products that contain aspirin should be avoided because of their antiplatelet activity. Options 1, 2, and 4 are correct statements by the client to prevent and monitor bleeding.

A client who is receiving chemotherapy for breast cancer develops myelosuppression. Which instructions should the nurse include in the client's discharge teaching plan? Select all that apply. Avoid contact sports. Wash hands frequently. Increase intake of fresh fruits and vegetables. Avoid crowded places such as shopping malls. Treat a sore throat with over-the-counter products. Avoid people who have received live attenuated vaccines.

Effective measures should be employed to protect the client from infection and bleeding. A variety of interventions are essential to keep the client who is receiving chemotherapy safe. Live attenuated vaccines can easily infect clients with myelosuppression, and crowded places usually have people who are sick and coughing and sneezing, which can easily cause illness in myelosuppressed clients. Contact sports can result in injury or bleeding, and handwashing is the mainstay of asepsis and protection from infection. The client with myelosuppression should not eat fresh fruits and vegetables because of the risk of contamination or infection. All foods should be thoroughly cooked. Option 5 is incorrect because many over-the-counter products contain acetaminophen (Tylenol) or aspirin, which could potentially mask an elevated temperature. Additionally, aspirin is an antiplatelet and can cause bleeding. Clients receiving chemotherapy should not take any other medications without direction from the health care provider.

The nurse is providing instructions to the client receiving external radiation therapy. Which statement, if made by the client, indicates the need for further instruction? "I will dry affected areas with patting motions." "I will wear soft clothing over the affected site." "I will use a washcloth to wash the affected area." "I need to make sure I carry my purse on the unaffected side."

External radiation therapy requires markings to be placed on the skin so that therapy can be aimed at the affected areas. The hand rather than a washcloth should be used to wash the area to avoid irritation. The nurse should instruct the client undergoing external radiation therapy to dry affected areas with a patting (rather than rubbing) motion so as not to disrupt the markings on the skin. Soft clothing should be worn so that the affected area is not irritated. The client should be sure to carry her purse on the unaffected side.

A client has undergone abdominal perineal resection for a bowel tumor. The nurse interprets that the client's colostomy is beginning to function if which sign is noted? Absent bowel sounds The passage of flatus Blood drainage from the colostomy The client's ability to tolerate food

Following abdominal perineal resection, a colostomy should begin to function within 72 hours after surgery, although it may take up to 5 days. The nurse should monitor for a return of peristalsis by listening for bowel sounds and checking for the passage of flatus. Absent bowel sounds indicate that peristalsis has not returned. The client would remain NPO until bowel sounds return and the colostomy is functioning. Bloody drainage is not expected from a colostomy.

The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? Placing cool compresses on the affected arm Elevating the affected arm on a pillow above heart level Avoiding arm exercises in the immediate postoperative period Maintaining an intravenous site below the antecubital area on the affected side

Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring.

The nurse is reviewing the medical record for a client who has been diagnosed with Hodgkin's disease. The nurse would expect to note which most likely assessment finding related to this diagnosis? Weight gain Increased appetite Swollen cervical lymph nodes Complaints of lack of energy

Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue. It is characterized by painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss rather than weight gain is most likely to be noticed. The client also may have a decreased appetite rather than an increased appetite. Weakness, fatigue, and complaints of lack of energy are other possible findings, but these are not specifically related to the disease.

The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further teaching is needed if a nursing staff member states that which is a characteristic of the disease? Reed-Sternberg cells are present. The lymph nodes, spleen, and liver are involved. The prognosis depends on the stage of the disease. The disease occurs most often in those older than 75 years of age.

Hodgkin's lymphoma is a cancer that can occur at any age but appears to peak in two different age groups: in teens and young adults and in adults in their 50s and 60s. The remaining options are characteristics of this disease.

Hormone therapy is prescribed as the mode of treatment for a client with prostate cancer. The nurse should understand that which is the goal of this form of treatment? To increase testosterone levels To increase prostaglandin levels To limit the amount of circulating androgens To increase the amount of circulating androgens

Hormone therapy (androgen deprivation) is a mode of treatment for prostatic cancer. The goal is to limit the amount of circulating androgens, because prostate cells depend on androgen for cellular maintenance. Deprivation of androgen often can lead to regression of disease and improvement of symptoms. The remaining options do not identify the goals of this form of treatment.

The nurse is reviewing the laboratory test results for a client with bladder cancer with bone metastasis. Which finding should alert the nurse that health care provider (HCP) notification is required? Calcium level of 15 mg/dL Potassium level of 3.8 mEq/L Platelet count of 200,000 cells/mm3 White blood cell (WBC) count of 6,000 cells/mm3

Hypercalcemia is a serum calcium level greater than 10.0 mg/dL. It most often occurs in clients who have bone metastasis and is a late manifestation of extensive malignancy. The presence of cancer in the bone causes the bone to release calcium into the bloodstream. Hypercalcemia is an oncological emergency, and the HCP needs to be notified. Options 2, 3, and 4 indicate normal laboratory values.

A client is receiving external radiation to the neck for cancer of the larynx. Which is the most likely expected effect? Dyspnea Diarrhea Sore throat Constipation

In general, only the area in the treatment field is affected by the radiation. Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side effects occur only when specific areas are involved in treatment. A client receiving radiation to the larynx is most likely to experience a sore throat. Dyspnea may occur with lung involvement. Diarrhea and constipation may occur with radiation to the gastrointestinal tract.

A client is admitted to the nursing unit after undergoing radical prostatectomy for cancer. The nurse anticipates that which problem would be of most concern to the client in the immediate postoperative period? Concern about the outcome of surgery Continuous pain because of the effects of cancer Appearance disturbance as a result of the presence of a suprapubic catheter Concern about caring for self at home because of insufficient help after discharge

In the immediate postoperative period, the client who has had surgery for cancer may experience fear or concern related to the uncertain outcome of surgery. Postoperative pain is classified as acute, not continuous. The client may experience an alteration in appearance, but this is more likely to be related to the anticipated change in sexual function rather than the presence of the suprapubic catheter. The priority focus in the immediate postoperative period is not on concerns that apply to hospital discharge.

The nurse is reviewing the laboratory test results for a client receiving chemotherapy. The nurse notes that the white blood cell count is extremely low and places the client on neutropenic precautions. Which interventions are a component of these types of precautions? Select all that apply. Allowing only fresh fruits in the client's room Removing fresh-cut flowers from the client's room Encouraging the client to eat any type of fresh vegetables Instructing family members on the proper technique for hand washing Instructing family members to wear a mask when entering the client's room

In the immunocompromised client a low-bacteria diet is necessary. This includes avoiding the intake of fresh fruits and vegetables. Thorough cooking of all food also is required. Cut flowers or any standing water is removed from the room because either tends to harbor bacteria. Anyone who enters the client's room should perform strict and thorough hand washing and wear a mask.

A nurse in the health care provider's office is performing a postoperative assessment of a client who underwent mastectomy of her right breast 2 weeks ago. The client tells the nurse that she is very concerned because she has numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow. The nurse should provide which information to the client about her complaint? These sensations are signs of a complication. These sensations probably will be permanent. These sensations dissipate over several months and usually resolve after 1 year. It is nothing to worry about because most women who have this type of surgery experience this problem.

Numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow occurs in most women after mastectomy. It is a result of injury to the nerves that provide sensation to the skin in those areas. These sensations may be described as heaviness, pain, tingling, burning, or "pins and needles." These sensations dissipate over several months and usually resolve by 1 year after surgery. These sensations are not a sign of a complication and are not permanent. The nurse would not tell the client that a complaint is nothing to worry about because this is nontherapeutic and avoids the client's concern.

The nurse is caring for a client undergoing external radiation. The client has developed a dry desquamation of the skin in the treatment area and the nurse is teaching him or her about management of the skin reaction. Which comment made by the client suggests understanding of the instructions? "I don't need to stay out of the sun or put on sunscreen." "I can use ice packs to relieve itching in the treatment area." "When bathing I will use lukewarm water on the affected area." "I can lubricate the irritated area with an ointment like bacitracin."

Radiation therapy causes skin cells to break down and die. This can cause a disruption in skin integrity. The client needs to use special and gentle skin care during treatment. This means washing with lukewarm water and not rubbing skin. The client will need to protect the skin from the sun even after radiation therapy is completed. The sun can burn the skin even on cloudy days or when the client is outside even for just a few minutes. The health care provider may prescribe a high sun protection factor sunscreen. Care should be taken to not use extreme water temperatures, heating pads, ice packs, or other hot or cold items on the treatment area; these items can disrupt skin integrity. No products (creams, lotions, ointments, perfumes) should be used on the skin during radiation without approval of the health care provider.

The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. Which are risk factors for cervical cancer? Select all that apply. Smoking Multiple sex partners Human papillomavirus infection Annual gynecological examinations First intercourse before 17 years of age

Risk factors for cervical cancer include human papillomavirus infection, active and passive cigarette smoking, certain high-risk sexual activities (first intercourse before 17 years of age, multiple sex partners, male partners with multiple sex partners). Screening via regular gynecological examinations and Papanicolaou smears (Pap tests) with treatment of precancerous abnormalities decreases the incidence and mortality of cervical cancer.

A nurse is caring for a client with metastatic breast cancer. The client describes a new and sudden sharp pain in the back. Based on this assessment finding, which is the priority nursing intervention? Document the findings. Administer pain medication. Notify the health care provider (HCP). Place a heating pad on the client's back.

Spinal cord compression should be suspected in a client with metastatic disease, particularly with sudden onset of new back pain. Spinal cord compression causes back pain before neurological changes occur. Spinal cord compression constitutes an oncological emergency, so the HCP should be notified. Although the nurse would document this finding, this is not the priority action. The nurse would not administer pain medication or place a heating pad on the client unless the cause of the new pain has been determined. Additionally, a prescription from the HCP is needed for the use of a heating pad.

A nurse is reviewing the diagnostic test results for a client who had a Papanicolaou smear performed. The nurse notes that the health care provider has documented stage I cancer of the cervix. The nurse should make which interpretation? The carcinoma is strictly confined to the cervix. The carcinoma has extended to the pelvic wall and the lower third of the vagina. The carcinoma has extended beyond the cervix but has not extended to the pelvic wall. The carcinoma has extended beyond the true pelvis or has clinically involved the bladder or rectal mucosa.

Stage I carcinoma is strictly confined to the cervix. In stage II, the carcinoma has extended beyond the cervix but has not extended to the pelvic wall. Stage III carcinoma has extended to the pelvic wall at the lower third of the vagina, and in stage IV, carcinoma has extended beyond the true pelvis or has clinically involved the mucosa of the bladder or rectum.

For the client with stomatitis resulting from chemotherapy for leukemia, the care plan should include which intervention? Inspect the mouth every week for fungus. Encourage foods with neutral or cool temperatures. Give the client spicy foods to stimulate the sense of taste. Perform frequent oral hygiene using a commercial alcohol-based mouthwash.

Stomatitis is inflammation of the oral cavity, and using commercial mouthwashes containing alcohol or encouraging spicy foods will cause pain. Foods are better tolerated by the client with stomatitis when the food is cool or of neutral temperature. It is important to monitor for oral fungal infections, but this assessment should be completed at least daily.

The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency? Cyanosis Arm edema Periorbital edema Mental status changes

Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Cyanosis and mental status changes are late signs.

The client reports to the nurse that while performing testicular self-examination, he found a lump the size and shape of a pea. Which statement is the appropriate response to the client? "Lumps like that are normal. Don't worry." "Let me know if it gets bigger next month." "That's important to report even though it might not be serious." "That could be cancer. I'll ask the health care provider (HCP) to examine you."

Testicular cancer almost always occurs in only one testicle and is usually a pea-sized, painless lump when discovered. The cancer is highly curable if found early. The finding should be reported to the HCP.

The nurse is teaching a client who has had a laryngectomy for laryngeal cancer how to use an artificial larynx. Which statement should the nurse include in the teaching? "Hold the device alongside the neck." "Insert the device into the tracheostomy." "Swallow air into the esophagus to make speech." "Hold the device over the upper portion of the sternum."

The artificial larynx is an electronic device that assists the client after laryngectomy to produce speech. There are two types-one is held at the side of the neck and the other is inserted into the mouth. The vibration produces a mechanical-sounding speech that is monotone in quality but intelligible. There is no need to insert the device into the tracheostomy, to swallow air, or to hold the device over the sternum.

The client has undergone mastectomy. The nurse determines that the client is making the best adjustment to the loss of the breast if which behavior is observed? Refusing to look at the wound Reading the postoperative care booklet Asking for pain medication when needed Participating in the care of the surgical drain

The client demonstrates the best adaptation by participating in her own care. This would include care of surgical drains that are in place for a short time after discharge. Refusing to look at the wound indicates no adaptation to the loss. Reading the postoperative care booklet is useful but is not the best of the options presented here. Asking for pain medication is an action-oriented option, but it does not relate to acceptance of the loss of the breast.

The nurse should include which intervention in the care of a client who has undergone a vaginal hysterectomy for the treatment of cancer? Select all that apply. Elevate the knee gatch on the bed. Encourage ambulation as prescribed. Remove antiembolism stockings twice daily. Assist with range-of-motion (ROM) leg exercises. Check placement of pneumatic compression boots.

The client is at risk for deep vein thrombosis (DVT) or thrombophlebitis after this surgery, as with any other major surgery. The nurse should avoid using the knee gatch in the bed because doing so inhibits venous return, thus placing the client at greater risk for DVT or thrombophlebitis. The nurse will implement measures that prevent deep vein thrombosis (DVT) or thrombophlebitis such as ROM exercises, ambulation, antiembolism stockings, and pneumatic compression boots are all helpful.

The nurse has provided instructions to a client receiving external radiation therapy. Which client statement would indicate a need for further instruction regarding self-care related to the radiation therapy? "I need to eat a high-protein diet." "I need to avoid exposure to sunlight." "I need to wash my skin with a mild soap and pat dry." "I need to apply pressure on the irritated area by wearing snug clothing to prevent bleeding."

The client should avoid pressure on the irritated area and should wear loose-fitting clothing. Specific health care provider instructions would be necessary to obtain if an alteration in skin integrity occurred as a result of the radiation therapy. Options 1, 2, and 3 are accurate measures to implement after radiation therapy.

The home care nurse visits a client who has just returned home from the hospital after a mastectomy. The client has a Jackson Pratt drain in place. The nurse instructs the client to avoid which action? Emptying the drain to prevent infection Elevation of the arm when lying or sitting Full range-of-motion exercises to the upper arm Applying lotion to the area after the incision heals

The client should be instructed to limit upper-arm range-of-motion exercises to the level of the shoulder only. Once the Jackson Pratt drain has been removed, the client can begin full range-of-motion exercises to the upper arm as prescribed. The client should elevate the arm while sitting down or lying, and the client will be able to apply lotion to the incision once it has healed. The drain is emptied as needed.

The nurse is providing care to a client who has undergone modified right radical mastectomy for the treatment of breast cancer. Which activity should the nurse incorporate in the plan of care? Keep Jackson-Pratt drains fully inflated to provide adequate suction. Perform venipunctures and blood pressures on the operative side only. Inform the client that drains will be removed on the second postoperative day. Maintain head of the bed elevation at 30 degrees with the right arm elevated on a pillow.

The client should have the head of the bed elevated at least 30 degrees with the affected arm elevated on a pillow. Keeping the affected arm elevated promotes lymphatic fluid return after removal of lymph nodes and channels. Gentle suction must be maintained on the Jackson-Pratt bulb to prevent fluid accumulation at the operative site. With short hospital stays, drainage tubes are usually removed about 1 to 3 weeks after hospital discharge when the client returns for an office visit. All staff must avoid using the affected arm for measuring blood pressure, giving injections, or drawing blood.

The nurse is caring for a client with cancer of the prostate who has undergone a prostatectomy. Which action should the nurse tell the client to take when providing discharge instructions? Avoid driving the car for a few days. Restrict fluid intake to prevent incontinence. Avoid lifting objects heavier than 20 lb for at least 6 weeks. Notify the health care provider if small blood clots are noticed during urination.

The client who has undergone a prostatectomy should avoid lifting objects heavier than 20 lb for at least 6 weeks. Driving a car and sitting for long periods are restricted for at least 3 weeks. A high daily fluid intake should be maintained to limit clot formation and prevent infection. Small pieces of tissue or blood clots may be passed during urination for up to 2 weeks after surgery; this is an expected occurrence.

A cervical radiation implant is placed in a client who is undergoing treatment of cervical cancer. The nurse should initiate which activity prescription as the most appropriate for this client? Bed rest Out of bed ad lib Out of bed in a chair only Ambulation to the bathroom only

The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees, and, with the body in straight alignment, the client is logrolled.

The oncology nurse is providing a teaching session to a group of nursing students regarding the risks and causes of bladder cancer. Which statement by a student would indicate a need for further teaching? "Bladder cancer most often occurs in women." "Using cigarettes and coffee drinking can increase the risk." "Bladder cancer generally is seen in clients older than age 40." "Environmental health hazards have been implicated as a cause."

The incidence of bladder cancer is greater in men than in women and affects whites twice as often as blacks. The remaining options describe risks associated with bladder cancer.

The nurse is admitting a client with laryngeal cancer to the nursing unit. What should the nurse assess for as the most common risk factor for this type of cancer? Alcohol abuse Cigarette smoking Use of chewing tobacco Exposure to air pollutants

The most common risk factor associated with laryngeal cancer is cigarette smoking. Heavy alcohol use and the combined use of alcohol and tobacco increase the risk. Another risk factor is exposure to environmental pollutants.

The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common symptom of this type of cancer? Dysuria Hematuria Urgency on urination Frequency of urination

The most common symptom in clients with cancer of the bladder is hematuria. The client also may experience irritative voiding symptoms such as frequency, urgency, and dysuria, and these symptoms often are associated with carcinoma in situ. Dysuria, urgency, and frequency of urination are also signs of a bladder infection.

The nurse is caring for a client with leukemia who is receiving intravenous chemotherapy. The nurse reviews the laboratory results and notes that the white blood cell count is 2000 cells/mm3, the platelet count is 150,000 cells/mm3, the clotting time is 10 minutes, and the ammonia level is 20 mcg/dL. Which nursing action would be appropriate? Place the client on bleeding precautions. Place the client on neutropenic precautions. Remove the rectal thermometer from the client's room. Instruct the dietary department to eliminate all proteins from the diet.

The normal white blood cell count is 4500 to 11,000 cells/mm3. When the white blood cell count drops, neutropenic precautions need to be implemented. This includes protective isolation techniques to protect the client from infection. Bleeding precautions need to be initiated when the platelet count drops below 90,000 to 100,000 cells/mm3. The normal platelet count is 150,000 to 450,000 cells/mm3. The normal clotting time is 8 to 15 minutes, and the normal ammonia level is 10 to 80 mcg/dL. Removing the rectal thermometer from the client's room would be done if bleeding precautions were initiated. There is no useful reason to eliminate all protein from the diet.

The nurse is preparing a list of home care instructions regarding stoma and laryngectomy care to a client with laryngeal cancer who had a laryngectomy. Which instructions should be included in the list? Select all that apply. Restrict fluid intake. Obtain a Medic-Alert bracelet. Keep the humidity in the home low. Prevent debris from entering the stoma. Avoid exposure to people with infections. Avoid swimming and use care when showering.

The nurse should teach the client how to care for the stoma, depending on the type of laryngectomy performed. Most interventions focus on protection of the stoma and the prevention of infection. Interventions include to obtain a Medic-Alert bracelet, to prevent debris from entering the stoma, to avoid exposure to people with infections, and to avoid swimming and use care when showering. Additional interventions include wearing a stoma guard or high-collared clothing to protect the stoma, increasing the humidity in the home, and increasing fluid intake to 3000 mL/day to keep the secretions thin.

A nurse has instructed the client in the correct technique for breast self-examination (BSE). For a portion of the examination, the client will lie down. If the client were to examine the right breast, the nurse would tell the client to place a pillow in which location? Under the left scapula Under the left shoulder Under the right shoulder Under the small of the back

The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the right breast is to be examined, the pillow would be placed under the right shoulder, and vice versa. Therefore options 1, 2, and 4 are incorrect.

A woman has just been told by the health care provider that she has breast cancer. The woman responds, "Oh, no! Does this mean I'm going to die?" The nurse interprets the woman's initial reaction as which response? Fear Rage Denial Anxiety

The woman's reaction is one of fear. The woman has verbalized the object of fear (dying), which makes anxiety incorrect. There is no evidence of rage or denial in the woman's statement.

Which interventions are appropriate for a client with leukemia who is experiencing thrombocytopenia? Select all that apply. Use a straight-edge razor for shaving. Obtain a rectal temperature every 8 hours. Check secretions for frank or occult blood. Give vitamin K by the intramuscular route. Encourage fluid intake to avoid constipation. Provide oral sponges or a soft toothbrush for oral care.

Thrombocytopenia is a condition in which the platelets fall below the number needed for normal coagulation. When a client has thrombocytopenia, the risk of bleeding is greatly increased. To monitor for bleeding, the nurse should check all secretions for frank or occult blood. Valsalva maneuvers (as in straining to have a stool, vomiting, or sneezing) could cause intracerebral bleeding when the platelet count is low. To avoid constipation, the nurse would encourage the client to take more fluids and increase his or her dietary fiber. The nurse should encourage the client to use a soft toothbrush or oral sponges to decrease irritation to the mouth and bleeding from the gums. An electric razor is recommended for shaving during times when the client is thrombocytopenic. The nurse should not take rectal temperatures or use any rectal suppositories because of the risk for injury to the rectal membranes with resultant bleeding. Medications should not be given subcutaneously or intramuscularly because use of these routes carries a risk for hemorrhage into the tissues.

A client with bladder cancer has undergone surgical removal of the bladder with construction of an ileal conduit. Which assessment findings by the nurse would indicate that the client is developing complications? Select all that apply. Dusky appearance of the stoma Stoma protrusion from the skin Sharp abdominal pain with rigidity Urine output greater than 30 mL/hr Mucus shreds in the urine collection bag

To create an ileal conduit, the surgeon takes a short segment of the small intestine and reconnects the remaining intestine so that it functions normally. One end of the removed segment of intestine is placed at the skin surface to create the stoma. The stoma should be red and moist. A pale, dusky stoma indicates poor vascular supply that could result in necrosis. The stoma should be flush to the skin. The client should not have sharp abdominal pain with rigidity. Any of these findings should be reported to the health care provider. Options 4 and 5 are normal findings.

Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to perform which assessment before administering chemotherapy? Measure the client's abdominal girth. Calculate the client's body mass index. Ask the client about his or her weight and height. Measure the client's current weight and height.

To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total body surface area (BSA), which requires a current accurate height and weight for BSA calculation (before each medication administration). Asking the client about his or her height and weight may lead to inaccuracies in determining a true BSA and dosage. Calculating body mass index and measuring abdominal girth will not provide the data needed.

A nurse is reviewing the preoperative prescriptions for a client with a colon tumor who is scheduled for abdominal perineal resection and notes that the health care provider has prescribed neomycin (Mycifradin) for the client. The nurse determines that this medication has been prescribed primarily for which purpose? To prevent an immune dysfunction Because the client has an infection To decrease the bacteria in the bowel Because the client is allergic to penicillin

To reduce the risk of contamination at the time of surgery, the surgeon may prescribe that the bowel is emptied and cleansed. Laxatives and enemas are given to empty the bowel. Intestinal anti-infectives such as neomycin or kanamycin are administered to decrease the bacteria in the bowel. The medication does not prevent immune dysfunction. There is no data in the question that indicates that the client has an infection or is allergic to penicillin.

The nurse is taking a history from a client suspected of having testicular cancer. Which data will be most helpful in determining the risk factors for this type of cancer? Age and race Marital status Number of children Number of sexual partners

Two basic but important risk factors for testicular cancer are age and race. The disease occurs most frequently in white males, generally between the ages of 15 and 34 years. Other risk factors include a history of undescended testis and a family history of testicular cancer. Marital status and number of children are not associated with increased risk of testicular cancer. In addition, the number of sexual partners is not associated with testicular cancer

A nurse monitoring an oncological client assesses for which early sign of vena cava syndrome? Cyanosis Arm edema Periorbital edema Mental status changes

Vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Mental status changes and cyanosis are late signs.