Oncology ?s
A nurse is developing a care plan for bone marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable? a) 2 to 4 days b) 21 to 28 days c) 24 hours d) 7 to 14 days
7 to 14 days Correct Explanation: Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? a) Prolongation b) Initiation c) Promotion d) Progression
Progression Explanation: Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents, escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.
A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? a) Stage 3 pressure ulcer on the left heel b) White blood cell (WBC) count of 9,000 cells/mm3 c) Temperature of 98.3° F (36.8° C) d) Ate 75% of all meals during the da
Stage 3 pressure ulcer on the left heel Explanation: A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection. (
Which statement by a client undergoing external radiation therapy indicates the need for further teaching? a) "I'm worried I'll expose my family members to radiation." b) "I'll wash my skin with mild soap and water only." c) "I'll wear protective clothing when outside." d) "I'll not use my heating pad during my treatment."
"I'm worried I'll expose my family members to radiation." Explanation: The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client's family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad
The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia? a) "The hair loss is temporary." b) "Clients with alopecia will have delay in grey hair." c) "Wigs can be used after the chemotherapy is completed." d) "New hair growth will return without any change to color or texture."
"The hair loss is temporary." Explanation: Alopecia associated with chemotherapy is usually temporary and will return after the therapy is completed. New hair growth may return unchanged, but there is no guarantee and color, texture, and quality of hair may be changed. There is no correlation between chemotherapy and delay in greying of hair. Use of wigs, scarves, and head coverings can be used by clients at any time during treatment plan
Which of the following does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure? a) Blood studies b) Drug history c) Family history d) Allergy history
Blood studies Correct Explanation: Before the HSCT procedure, the nurse thoroughly evaluates the patient's physical condition; organ function; nutritional status; complete blood studies, including assessment for past antigen exposure, such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before an HSCT procedure, the nurse need not evaluate patient's family, drug, or allergy history
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean? a) Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis b) Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis c) No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis d) Can't assess tumor or regional lymph nodes and no evidence of metastasis
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Correct Explanation: TIS, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.
Which of the following occurs when there is accumulation of fluid in the pericardial space that compresses the heart? a) SIADH b) DIC c) Cardiac tamponade d) Superior Vena Cava Syndrome (SVCS)
Cardiac tamponade Correct Explanation: Cardiac tamponade is an accumulation of fluid in the pericardial space. SVCS occurs when there is a compression or invasion of the superior vena cava by a tumor, enlarged lymph nodes, intraluminal thrombosis that obstructs venous circulation, or drainage of the head, neck, arms, and thorax. SIADH is the continuous, uncontrolled release of ADH. DIC is a complex disorder of coagulation or fibrinolysis which results in thrombosis or bleeding. (less)
Which of the following occurs when there is accumulation of fluid in the pericardial space that compresses the heart? a) Superior Vena Cava Syndrome (SVCS) b) DIC c) Cardiac tamponade d) SIADH
Cardiac tamponade is an accumulation of fluid in the pericardial space. SVCS occurs when there is a compression or invasion of the superior vena cava by a tumor, enlarged lymph nodes, intraluminal thrombosis that obstructs venous circulation, or drainage of the head, neck, arms, and thorax. SIADH is the continuous, uncontrolled release of ADH. DIC is a complex disorder of coagulation or fibrinolysis which results in thrombosis or bleeding
The nurse evaluates teaching as effective when a female client states that she will a) Decrease tobacco smoking from one pack/day to half a pack/day. b) Exercise 30 minutes 3 times each week. c) Use sunscreen when outdoors. d) Obtain a cancer history from her parents
Correct response: Use sunscreen when outdoors. Explanation: Use of sunscreens play a role in the amount of exposure to ultraviolet light. Even decreasing the use of tobacco still exposes a person to risk of cancer. The American Cancer Society recommends adults to engage in at least 30 minutes of moderate to vigorous physical activity on 5 or more days each week. It is recommended to obtain a cancer history from at least three generations
The nurse is working with a patient who has had an allohematopoietic stem cell transplant (HSCT) and notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the patient has symptoms of which of the following? a) Nadir b) Metastasis c) Graft-versus-host disease d) Acute leukopenia
Graft-versus-host disease Correct Explanation: Graft-versus-host disease is a major cause of morbidity and mortality in patients who have had allogeneic transplant. Clinical manifestation of the disease include diffuse rash that progresses to blistering and desquamation, and mucosal inflammation of the eyes and the entire GI tract with subsequent diarrhea, abdominal pain, and hepatomegaly
Chemotherapeutic agents have which effect associated with the renal system? a) Increased uric acid excretion b) Hypophosphatemia c) Hypokalemia d) Hypercalcemia
Increased uric acid excretion Explanation: Chemotherapeutic agents can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. There is increased urinary excretion of uric acid from chemotherapeutic agents. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.
When caring for a client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? a) Avoid showering or washing over skin markings. b) The use of disposable utensils and wash cloths c) Time, distance, and shielding d) Inspect the skin frequently
Inspect the skin frequently. Correct Explanation: Inspecting the skin frequently will allow early identification and intervention of skin problems associated with external radiation therapy. The external markings should not be removed, but clients may shower and lightly wash over the skin. Time, distance, and shielding are key in the management of sealed, internal radiation therapy and not external beam radiation. The use of disposable utensils and care items would be important when caring for clients following systemic, unsealed, internal radiation therapy
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? a) Providing for frequent rest periods b) Administering aspirin if the temperature exceeds 102° F (38.8° C) c) Placing the client in strict isolation d) Inspecting the skin for petechiae once every shift
Inspecting the skin for petechiae once every shift Correct Explanation: Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.
The nurse is caring for a patient with cancer who is treating her cancer with deep tissue massage in addition to radiation therapy. The nurse documents the use of which of the following on the patient's chart? a) Compliant medicine b) Integrative medicine c) Alternative therapy d) Global medicine
Integrative medicine Explanation: Integrative medicine is the use of therapies in conjunction with conventional medicine. This is also known as complementary medicine. Alternative therapies are used instead of conventional medicine.
When the client complains of increased fatigue following radiotherapy, the nurse knows this is most likely to be related to which factor? a) The cancer is spreading. b) The cancer cells are dying in large numbers. c) Radiation can result in myelosuppression. d) Fighting off infection is an exhausting venture.
Radiation can result in myelosuppression. Explanation: Fatigue results from anemia associated with myelo suppression and decreased RBC production. The spreading of cancer can cause many symptoms dependent on location and type of cancer but not a significant factor to support fatigue with radiotherapy. The production of healthy cells can increase metabolic rate, but death of cancer cells does not support fatigue in this case. Fighting infection can cause fatigue, but there is no evidence provided to support presence of infection in this clien
A male client has been unable to return to work for 10 days following chemotherapy as the result of ongoing fatigue and inability to perform usual activities. Laboratory test results are WBCs 2000/mm³, RBCs 3.2 x 10¹²/L, and platelets 85,000/mm³. The nurse notes that the client is anxious. Which of the following is the priority nursing diagnosis? a) Anxiety related to change in role function b) Activity intolerance related to side effects of chemotherapy c) Risk for infection related to inadequate defenses d) Fatigue related to deficient blood cells
Risk for infection related to inadequate defenses Correct Explanation: Physiological needs, such as risk for infection, take priority over the client's other needs.
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? a) Encouraging rhythmic breathing exercises b) Serving small portions of bland food c) Administering metoclopramide and dexamethasone as ordered d) Withholding fluids for the first 4 to 6 hours after chemotherapy administration
Administering metoclopramide and dexamethasone as ordered Explanation: The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.
Which of the following is true about a malignant tumor? a) Is usually slow growing b) Gains access to the blood and lymphatic channels c) Grows by expansion d) Demonstrates cells that are well differentiated
Anaplasia Correct Explanation: Usually, anaplastic cells are malignant. Neoplasia refers to uncontrolled cell growth that follows no physiologic demand. Dysplasia refers to bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same type of tissue. Hyperplasia refers to an increase in the number of cells of a tissue, most often associated with a period of rapid body growth.
The nurse should teach the patient who is being radiated about protecting his skin and oral mucosa. An important teaching point would be to tell the patient to: a) Apply a small ice compress to the treated area afterward to decrease localized redness, post-radiation. b) Use an ointment, after treatment, to decrease the feeling of burning, which may last for several hours. c) Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth. d) Use an approved emollient 2 hours before the radiation to give the skin time to absorb the medication and provide a shield for damage.
Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth. Explanation: The patient should cleanse himself with a mild soap using his fingertips rather than a wash cloth. All the other choices will irritate the skin and fail to protect it from additional injury.
Choice Multiple question - Select all answer choices that apply. A client, 66 years old, has just been diagnosed with multiple myeloma (a cancer of the plasma) and will be initiating chemotherapy. The nurse, in an outpatient clinic, reviews the medications the client has been taking at home. The medications include pantoprazole (Protonix) for gastroesophageal reflux disease (GERD) and an over-the-counter calcium supplement to prevent osteoporosis. The nurse does the following interventions: (Select all that apply.) a) asks about nausea and vomiting b) restricts fluids to 1500 mL per day c) instructs the client to discontinue calcium d) provides information about antidiarrheal medication e) teaches the client to report abdominal or bone pain
Correct response: c• instructs the client to discontinue calcium a• asks about nausea and vomiting e• teaches the client to report abdominal or bone pain Explanation: The client with cancer is at risk for hypercalcemia from bone breakdown. The client should not take an over-the-counter calcium supplement that would increase blood levels of calcium. Signs and symptoms of hypercalcemia include nausea and vomiting. The client may also report abdominal or bone pain with cancer. The client should increase fluid intake to 2 to 4 L per day. Intake would have to be adjusted based on the client's other medical conditions. GERD would not negate an increase in fluid intake. The client most likely would have constipation with hypercalcemia, not diarrhea. (less)
A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately a) Places the client on oxygen by nasal cannula b) Stops the chemotherapeutic infusion c) Gives prednisolone IV d) Administers diphenhydramine
Stops the chemotherapeutic infusion Explanation: The client may be experiencing a type I hypersensitivity reaction, which may progress to systemic anaphylaxis. The most immediate action of the nurse is to discontinue the medication followed by initiating emergency protocols
A patient is scheduled for cryosurgery for cervical cancer and tells the nurse, "I am not exactly sure what the doctor is going to do." What is the best response by the nurse? a) "The physician is going to use radiofrequency to ablate the area." b) "The physician is going to use a laser to remove the area." c) "The physician is going to use medication to inject the area." d) "The physician is going to use liquid nitrogen to freeze the area."
The physician is going to use liquid nitrogen to freeze the area." Explanation: Cryoablation, or cryosurgery, is the use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction. It is used for cervical, prostate, and rectal cancers.
A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? a) Urine output of 400 ml in 8 hours b) Serum potassium level of 2.6 mEq/L c) Sodium level of 142 mEq/L d) Blood pressure of 120/64 to 130/72 mm Hg
erum potassium level of 2.6 mEq/L Correct Explanation: Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings
A decrease in circulating white blood cells is a) granulocytopenia. b) neutropenia. c) leukopenia. d) thrombocytopenia.
leukopenia. Correct Explanation: A decrease in circulating WBCs is referred to as leukopenia. Granulocytopenia is a decrease in neutrophils. Thrombocytopenia is a decrease in the number of platelets. Neutropenia is an abnormally low ANC.
Choice Multiple question - Select all answer choices that apply. The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA). Such damage results from multiple factors. Which of the following is a carcinogen? a) Environmental factors b) Medically prescribed interventions c) Defective genes d) Viruses e) Chemical agents f) Dietary substances
• Dietary substances • Environmental factors • Viruses • Chemical agents • Defective genes • Medically prescribed interventions Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions.
The nurse is working with a patient who has had an allohematopoietic stem cell transplant (HSCT) and notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the patient has symptoms of which of the following? a) Nadir b) Metastasis c) Acute leukopenia d) Graft-versus-host disease
Explanation: Graft-versus-host disease is a major cause of morbidity and mortality in patients who have had allogeneic transplant. Clinical manifestation of the disease include diffuse rash that progresses to blistering and desquamation, and mucosal inflammation of the eyes and the entire GI tract with subsequent diarrhea, abdominal pain, and hepatomegaly
A patient with brain tumor is undergoing radiation and chemotherapy for treatment of cancer. Of late, the patient is complaining of swelling in the gums, tongue, and lips. Which of the following is the most likely cause of these symptoms? a) Extravasation b) Stomatitis c) Neutropenia d) Nadir
Stomatitis Correct Explanation: The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to10 days after the administration of certain chemotherapeutic agents or radiation therapy to the head and neck. Chemotherapy and radiation produce chemical toxins that lead to the breakdown of cells in the mucosa of the epithelium, connective tissue, and blood vessels in the oral cavity.
The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse? a) Tumor pressure against normal tissues b) Random, rapid growth of the tumor c) Emission of abnormal proteins d) Cells colonizing to distant body parts
Tumor pressure against normal tissues Correct Explanation: Benign tumors grow more slowly than malignant tumors and do not emit tumor-specific antigens or proteins. Benign tumors do not metastasize to distant sites. Benign tumors can compress tissues as it grows, which can result in impaired organ functioning.
A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents? a) Disconnect I.V. tubing with gloved hands. b) Wear disposable gloves and protective clothing. c) Throw I.V. tubing in the trash after the infusion is stopped. d) Break needles after the infusion is discontinued.
Wear disposable gloves and protective clothing. Explanation: A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, I.V. tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container
Choice Multiple question - Select all answer choices that apply. A client with cancer is receiving chemotherapy and reports to the nurse that his mouth is painful and he has difficulty ingesting food. The nurse does which of the following: a) Instructs the client to brush the teeth with a soft toothbrush b) Rinses the client's mouth with alcohol-based mouthwash every 2 hours c) Consults with the healthcare provider about use of nystatin (Mycostatin) d) Teaches the client to floss his teeth once every 24 hours e) Asks the client to open his mouth to facilitate inspection of the oral mucosa
• Instructs the client to brush the teeth with a soft toothbrush • Consults with the healthcare provider about use of nystatin (Mycostatin) • Asks the client to open his mouth to facilitate inspection of the oral mucosa Correct Explanation: The description of the client's report is stomatitis following chemotherapy treatment. The nurse should assess the oral mucosa based on the client's report of pain and difficulty eating. The client is to use a soft toothbrush to minimize trauma to the mouth. Nystatin is a topical medication that may provide healing for the client's mouth. The client avoids alcohol-based mouthwashes as these are irritants. Flossing the teeth may cause additional trauma to the mouth. (less)
Following a BMT the patient should be monitored for at least a) 3 months. b) 4 weeks. c) 5 months. d) 3 days.
3 months. Explanation: After a BMT, the nurse closely monitors the patient for at least 3 months because complications related to the transplant are still possible, and infections are very common.
A cancer client makes the following statement to the nurse: "I guess I will tell my doctor to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die."Which of the following facts supports the use of chemotherapy for this client? a) Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. b) Most clients believe the discomfort is well worth the cure for cancer. c) Nausea and vomiting are only a factor for the first 24 hours after treatment. d) Clinical trials are opening up new cancer treatments all the time.
Correct response: Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. Explanation: Chemotherapy is not one drug for all clients. The therapy can be specifically designed to optimize effects while limiting adverse effects with supplemental anti emetics to control the nausea and vomiting. It is true that nausea and vomiting are most prevalent in the first 24 hours after each chemotherapy treatment but does not eliminate the fears expressed by this client. No one can state the worth of any treatment, and a cure is never promised. Clinical trials open up new options for treatment, but the process is lengthy and is not a certainty for a client in need of immediate treatment
A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient? a) Explain to the patient that she will continue to emit radiation while the implant is in place. b) Alert family members that they should restrict their visiting to 5 minutes at any one time. c) Maintain as much distance as possible from the patient while in the room. d) Wear a lead apron when providing direct patient care
Explain to the patient that she will continue to emit radiation while the implant is in place. Correct Explanation: When the patient has a radioactive implant in place, the nurse and other health care providers need to protect themselves, as well as the patient, from the effects of radiation. Patients receiving internal radiation emit radiation while the implant is in place; therefore, contact with the health care team is guided by principles of time, distance, and shielding to minimize exposure of personnel to radiation. Safety precautions used in caring for a patient receiving brachytherapy include assigning the patient to a private room, posting appropriate notices about radiation safety precautions, having staff members wear dosimeter badges, making sure that pregnant staff members are not assigned to the patient's care, prohibiting visits by children or pregnant visitors, limiting visits from others to 30 minutes daily, and seeing that visitors maintain a 6-foot distance from the radiation source. (less)
Based on the understanding of the effects of chemotherapy, the nurse would anticipate which of the following clinical findings in a client 2 weeks post therapy? a) Ease of bruising b) Elevated temperature c) Elevated white blood cells count d) Change in hair color
Ease of bruising Explanation: The effects of chemotherapy can include myelo suppression, resulting in anemia or bleeding tendencies, as exhibited in ease in bruising. Elevated temperature and WBCs are signs of infection and are anticipated findings after chemotherapy treatment. Re growth of hair after alopecia can result in change of hair color but not anticipated 2 weeks post treatment.
What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen? a) It causes a systemic reaction. b) It attacks cancer cells during their vulnerable phase. c) It functions against disseminated disease. d) It targets normal body cells as well as cancer cells.
It targets normal body cells as well as cancer cells. Correct Explanation: Chemotherapy agents affect both normal and malignant cells; therefore, their effects are often widespread, affecting many body systems.
