Prep U Chp 7

During a client's examination and consultation, the physician keeps telling the client, "You have an abdominal neoplasm." Which statements accurately paraphrase the physician's statement? Select all that apply. a. "You have a new growth of abnormal tissue in your abdomen." b. "You have an abdominal tumor." c. "You have an abdominal malignancy." d. "You have abdominal cancer."

a, b New growths of abnormal tissue are called "tumors." Tumors may be benign or malignant; not all tumors are cancerous.

A client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer? a. Persistent nausea b. Rash c. Indigestion d. Chronic ache or pain

c Indigestion is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but isn't one of the seven major warning signs. Rash and chronic ache or pain seldom indicate cancer.

The nursing instructor is discussing the diagnosis of cancer with their nursing class. The instructor tells her students that scientists have predicted that gene therapy will one day play a large role in the prediction, diagnosis, and treatment of cancer. What cancer is gene therapy currently being investigated in the treatment of? a. Pancreatic b. Osteosarcomas c. Leukemia d. Melanoma

d Scientists predict that gene therapy will play a significant role in the future prediction, diagnosis, and treatment of cancer. It is currently being investigated in the treatment of brain tumors, melanoma, and renal, breast, ovarian, lung, and colon cancers.

The client is to receive cyclophosphamide (Cytoxan) 50 mg/kg intravenously in divided doses over 5 days. The client weighs 176 pounds. How many mg of cyclophosphamide will the client receive each day? Enter the correct number ONLY.

800 The client's weight of 176 pounds equals 80 kg. The client is to receive 50 mg of cyclophosphamide for each 1 kg of body weight. This is to be divided into 5 doses. 80 kg x 50 mg/kg = 4000 mg. 4000 mg/5 days = 800 mg.

A client with a recent history of GI disturbance has been scheduled for a barium study. The physician ordered this particular test for this client because it will: a. show movement of the GI tract. b. remove a tissue sample from the GI tract. c. show tumor "hot spots" in the GI tract. d. provide a three-dimensional cross-sectional view.

a A barium study is an example of fluoroscopy, which is used to show continuous x-ray images on a monitor, allowing the movement of a body structure to be viewed. Fluoroscopy does not involve the biopsy of tissue samples. Nuclear imaging, not a barium study, uses IV tracers to reveal tumor hot spots. CT scans provide three-dimensional cross-sectional views of tissues to determine tumor density, shape, size, volume, and location as well as highlighting blood vessels that feed the tumor.

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

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

Which of the following would be inconsistent as a common side effect of chemotherapy? a. Weight gain b. Alopecia c. Myelosuppression d. Fatigue

a Common side effects seen with chemotherapy include myelosuppression, alopecia, nausea and vomiting, anorexia, and fatigue.

A client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit? a. "I'll play card games with my friends." b. "I'll take a long trip to visit my aunt." c. "I'll bowl with my team after discharge." d. "I'll eat lunch in a restaurant every day."

a During chemotherapy, playing cards is an appropriate diversional activity because it doesn't require a great deal of energy. To conserve energy, the client should avoid such activities as taking long trips, bowling, and eating in restaurants every day. However, the client may take occasional short trips and dine out on special occasions.

The lethal tumor dose is defined as the dose that will eradicate what percentage of the tumor yet preserve normal tissue? a. 95% b. 85% c. 75% d. 65%

a The radiation dosage is dependent on the sensitivity of the target tissues to radiation and on the tumor size. The lethal tumor dose is defined as the dose that will eradicate 95% of the tumor yet preserve normal tissue.

The nurse is teaching a client about carcinogens. What carcinogens does the nurse include in the teaching? Select all that apply. a. dietary substances b.environmental factors c. viruses d. chemical agents e. defective genes f. hormone replacement therapy

a, b, c, d, e, f Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions such as hormone replacement therapy.

A client reports a new onset of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. The health care provider orders a diagnostic workup, which reveals end-stage gallbladder cancer. What nursing intervention should be used to facilitate adaptive coping? a. Refer client for professional counseling. b. Encourage ventilation of negative feelings. c. Assist with self-care activities of daily living. d. Provide written education for prescribed treatments.

a. Referring the client for professional counseling will facilitate adaptive coping. Encouraging ventilation of negative feelings will allow for emotional expression, but may not facilitate coping. Physical well-being will increase self-esteem, but won't necessarily help the patient cope with the diagnosis. Providing written education is for client teaching, not to facilitate coping.

A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with a. anorexia. b. seizure. c. weight gain. d. myalgia.

b A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with seizures, abnormal reflexes, papilledema, coma, and death. Anorexia, weight gain, and myalgia are associated with serum sodium concentrations lower than 120 mEq/L.

Chemotherapeutic agents have which effect associated with the renal system? a. Hypokalemia b. Increased uric acid excretion c. Hypophosphatemia d. Hypercalcemia

b Chemotherapeutic agents can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. Urinary excretion of uric acid increases with the use of chemotherapeutic agents. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.

When a client receives vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the client needs to be informed to report which symptoms that would be expected side effects of motor neuropathy? Select all that apply. a. burning and tingling sensations in the extremities b. muscle weakness c. cramps and spasms in the legs d. loss of balance and coordination e. alopecia

b, c, d Muscle weakness, cramps and leg spasms, and loss of balance and coordination are expected side effects of motor nerve damage. Burning and tingling sensations are signs of sensory nerve damage. Alopecia is hair loss, not a motor nerve damage sign.

A decrease in circulating white blood cells is a. granulocytopenia. b. thrombocytopenia. c. leukopenia. d. neutropenia.

c 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 absolute neutrophil count.

What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action? a. Eggs and milk b. Fish and poultry c. Ham and bacon d. Green, leafy vegetables

c Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate and nitrite-containing foods, and red and processed meats. Nitrates are added to cured meats, such as ham and bacon.

Palliation refers to a. the spread of cancer cells from the primary tumor to distant sites. b. hair loss. c. relief of symptoms of disease and promotion of comfort and quality of life. d. the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow.

c Palliation is the goal for care of clients with terminal cancer. Alopecia is the term that refers to hair loss. Metastasis is the term that refers to the spread of cancer cells from the primary tumor to distant sites. Nadir is the term that refers to the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow.

The nurse is conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome? a. Onset of cancer after age 50 in family member b. A first cousin diagnosed with cancer c. A second cousin diagnosed with cancer d. An aunt and uncle diagnosed with cancer

c The hallmarks of hereditary cancer syndrome include cancer in two or more first-degree or second-degree relatives, early onset of cancer in family members younger than age 50, the same type of cancer in several family members, individual family members with more than one type of cancer, and a rare cancer in one or more family members.

You are presenting a class on cancer for a local community group. You inform the attendees that chemical agents in the environment are believed to account for 75% of all cancers. Which organs are most susceptible to cancer caused by these chemical agents? a. Bone, breast, and thyroid b. Prostate, colon, and breast c. Eyes, breast, and prostrate d. Lungs, liver, and kidneys

c The lungs, liver, and kidneys are affected mostly because they are involved with biotransformation and excretion of chemicals.

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? a. Promotion b. Initiation c. Prolongation d. Progression

d 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.

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

d. Chemotherapy agents affect both normal and malignant cells; therefore, their effects are often widespread, affecting many body systems.

A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is a. "You will need to practice birth control measures." b. "You will continue having your menses every month." c. "You will experience menopause now." d. "You will be unable to have children."

a Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.

What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss? a. The client should consider getting a wig or cap prior to beginning treatment. b. Alopecia related to chemotherapy is relatively uncommon. c. The hair will grow back within 2 months post therapy. d. The hair will grow back the same as it was before treatment.

a If hair loss is anticipated and causing the client anxiety, a wig, cap, or scarf should be purchased before therapy begins. Alopecia develops because chemotherapy affects the rapidly growing cells of the hair follicles. Hair usually begins to grow again within 4 to 6 months after therapy. Clients should know that new growth may have a slightly different color and texture.

Which statement is true about malignant tumors? a. They demonstrate cells that are well differentiated. b. They gain access to the blood and lymphatic channels. c. They usually grow slowly. d. They grow by expansion.

b By gaining access to blood and lymphatic channels, a tumor can metastasize to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rates of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.

A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client? a. Monitor the client's toilet patterns. b. Monitor the client to prevent sepsis. c. Monitor the client's physical condition. d. Monitor the client's heart rate.

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

A 67-year-old client is admitted for diagnostic studies to rule out cancer. The patient is white, married, has been employed as a landscaper for 40 years, and has a 36-year history of smoking a pack of cigarettes daily. What significant risk factors does the nurse recognize this patient has? Select all that apply. a. Age b. Cigarette smoking c. Occupation d. Race e. Marital status

a, b, c

A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include: a. expected chemotherapy-related adverse effects. b. chemotherapy exposure and risk factors. c. signs and symptoms of infection. d. reinforcement of the client's medication regimen.

b The raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify her teaching plan to include content related to chemotherapy exposure and its associated risk factors. Because the client has received chemotherapy, the plan should already include information about expected adverse effects, signs and symptoms of infection, and reinforcement of the medication regimen.

When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply. a. Hypercalcemia b. Hyperkalemia c. Hyperuricemia d. Hyperphosphatemia

b, c, d When intracellular contents are released into the bloodstream, phosphorous is elevated. This results in an inverse decline in the levels of calcium, so hypercalcemia would not occur.

After a bone marrow transplant (BMT), the client should be monitored for at least a. 30 days b. 14 days c. 100 days d. 60 days

c After a BMT, the nurse closely monitors the client for at least 100 days or more after the procedure because complications related to the transplant can occur 100 days or more as post procedure infections are one common complication that may lead to sepsis and transplant failure.

A bowel resection is scheduled for a client with the diagnosis of colon cancer with metastasis to the liver and bone. Which statement by the nurse best explains the purpose of the surgery? a. "Removing the tumor is a primary treatment for colon cancer." b. "This surgery will prevent further tumor growth." c. "Once the tumor is removed, cell pathology can be determined." d. "Tumor removal will promote comfort."

c Palliative surgeries, such as bowel resection, may be performed to promote comfort by relieving pain and pressure on organs within the abdominal cavity. Primary treatment refers to surgery that is likely to provide a cure, which is not likely in metastatic disease. With metastasis, primary tumor removal does not prevent further tumor growth in distant sites. The diagnosis of colon cancer with metastasis suggests cell pathology has already been determined.

The nurse is teaching a healthy lifestyle class to a group of adolescents. The nurse recommends a. Eating four servings of vegetables and fruits per each day b. Decreasing caloric intake to maintain a body mass index lower than 24 c. Exercising at least 60 minutes per day doing moderate to vigorous activities at least 5 days per week d. Increasing proteins to more than 5 1/2 ounces per day for the male students to build muscle mass

c The American Cancer Society recommendations are for adolescents to engage in at least 60 minutes of moderate to vigorous physical activity at least 5 days per week. The MyPyramid recommendations include 4 1/2 cups of fruits and vegetables every day. People who have a body mass index less than 24 are at increased risk for problems associated with poor nutritional status. Ingesting more protein will not necessarily build more muscle mass and is not recommended for normal healthy individuals.

A client asks the nurse what is causing the fatigue following radiotherapy. What is the nurse's best response? a. The cancer is spreading to other parts of the body. b. The cancer cells are dying in large numbers. c. Fighting off infection is an exhausting venture. d. Substances are released when tumor cells are destroyed.

d Fatigue results from substances being released when tumor cells are destroyed during radiotherapy. The spreading of cancer can cause many symptoms dependent on location and type of cancer, but it is not a significant factor in the development of 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 the presence of infection in this client.

The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client? a. Suppression of the bone marrow b. Enhance action of the chemotherapy c. Decrease the need for additional adjuvant therapies d. Shorten the period of neutropenia

d Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation. The suppression of bone marrow creates the need for interferon use, not a result of the use. Although some BRMs can inhibit tumor growth, the primary use is for reducing neutropenia. Interferon use does not replace standard cancer treatments or decrease the need for those treatments.

The nurse is to administer a vesicant chemotherapeutic drug to a client who had a right mastectomy and inserts the intravenous line a. In the client's left hand b. With a butterfly needle c. In the client's right forearm d. With a soft, plastic catheter

d Vesicant chemotherapy should never be administered in the peripheral veins involving the hand or wrist. A person with breast cancer is to avoid injections in the affected extremity. A soft, plastic catheter should be used, not a butterfly needle.

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

a 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.

Which of the following advice does the nurse offer clients who are undergoing unsealed radiation therapy to reduce exposure? a. Avoid drinking plenty of fluids. b. Avoid eating for 3 hours after therapy. c. Avoid applying skin moisturizers. d. Avoid kissing and sexual contact.

d Clients who are undergoing unsealed radiation therapy are advised to avoid kissing and sexual contact. Clients are encouraged to drink plenty of fluids to help flush radioactive substances. Client may be asked to apply mild moisturizers and are not asked not to eat after the therapy.

A nurse caring for a client who has just received chemotherapy infusion is wearing a disposable gown, gloves, and goggles for protection. The nurse knows that accidental exposure to chemotherapy agents can occur through: a. inhalation of aerosols. b. absorption through the gown. c. absorption through the gloves. d. absorption through the goggles.

a Aerosol inhalation or absorption through the skin can cause accidental chemotherapy exposure. A nurse must wear a disposable gown and gloves when preparing and administering chemotherapy. She won't absorb chemicals through an intact gown, protective gloves, or goggles.

Based on the understanding of the effects of chemotherapy, the nurse would anticipate which clinical finding in a client 2 weeks after therapy? a. change in hair color b. fever c. elevated white blood cells count d. constipation

b The effects of chemotherapy two weeks after treatment can result in a fever. Regrowth of hair after alopecia can result in change of hair color, but this effect is not anticipated 2 weeks after treatment. White blood cell count will be decreased 2 weeks after chemotherapy. Constipation is not usually seen 2 weeks after chemotherapy treatment.

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. Blood pressure of 120/64 to 130/72 mm Hg d. Sodium level of 142 mEq/L

b. 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.

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? a. Antimetabolite b. Alkylating c. Nitrosoureas d. Mitotic spindle poisons

a 5-FU is an antimetabolite. An example of an alkylating agent is nitrogen mustard. A nitrosourea is streptozocin. A mitotic spindle poison is vincristine (VCR).

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

a. T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? a. Serving small portions of bland food b. Encouraging rhythmic breathing exercises c. Administering metoclopramide and dexamethasone as ordered d. Withholding fluids for the first 4 to 6 hours after chemotherapy administration

c 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.

A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because: a. The three drugs can be given at lower doses. b. The second and third drugs increase the effectiveness of the first drug. c. The first two drugs are toxic to cancer cells, and the third drug promotes cell growth. d. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms.

D Multiple drug regimens are used because the drugs have a synergistic effect. The drugs have different cell-cycle lysis effects, different mechanisms of action, and different toxic adverse effects. They are usually given in combination to enhance therapy. Dosage is not affected by giving the drugs in combination. The second and third drugs do not increase the effectiveness of the first. It is not true that the first two drugs are toxic to cancer cells while the third drug promotes cell growth.

Which of the following does a nurse have to assess during the bone marrow transplant (BMT) procedure? a. Psychological status b. Blood pressure status c. Urine gravity status d. Electrolyte levels

a During the BMT procedure, the nurse assesses the patient's psychological status. Patients experience many mood swings and need emotional support and help throughout this process. Assessing the patient's blood pressure, urine gravity, and electrolyte levels is important for patients undergoing chemotherapy.

A nurse is administering a peripheral chemotherapeutic agent. What nursing actions are used for extravasation of a chemotherapeutic agent? Select all that apply. a. Stop the medication infusion at the first sign of extravasation b. Aspirate any residual drug from the IV line c. Administer an antidote, if indicated d. Apply warm compresses to the irritated site to encourage healing e. Schedule the client for implanted device

a, b, c All of the answers except application of a warm compress are appropriate nursing actions. The application of warmth would be contraindicated because it would cause vasodilation, which would increase the absorption of irritant into the local tissues. Short term chemotherapy can be done with peripheral catheters so the client may not need an implanted device.

The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply. a. dietary substances b. environmental factors c. viruses d. gender e. age

a, b, c Carcinogens include chemical agents, environmental factors, dietary substances, viruses, lifestyle factors, and medically prescribed interventions. Although age and gender may increase a person's risk for developing certain types of cancer, they are not carcinogens in and of themselves.

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? a. Encourage fluid intake to dilute the urine. b. Take measures to acidify the urine and prevent uric acid crystallization. c. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. d. Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis.

a. The nurse should ensure adequate fluid hydration before, during, and after drug administration and assess intake and output. Adequate fluid volume dilutes drug levels, which can help prevent renal damage.

Which of the following are true statements about effective radiation therapy? Select all that apply. a. Cells are least vulnerable during DNA synthesis. b. Slower-growing tissues at rest (muscle) are more radioresistant. c. Tumors that are well oxygenated are more sensitive to radiation. d. Tumors that are small in size and dividing rapidly are more sensitiv

b, c, d All of the statements are true except for A. Cells are most vulnerable during DNA synthesis and mitosis. Tissues that experience frequent cellular division are most sensitive to radiation.

A client has cancer of the neck and is receiving external beam radiation therapy to the site. The client is experiencing trauma to the irradiated skin. The nurse does all of the following. (Select all that apply.) a. inspects for skin damage of the chest area b. assesses the client for any sun exposure c. uses cool water to wash the neck area d. applies an over-the-counter ointment to the skin e. avoids shaving the irradiated skin

b, e The client receiving external beam radiation therapy may experience trauma to the irradiated skin. To prevent further skin damage, the client is to avoid sun exposure and shaving the irradiated skin area. Other skin areas are not damaged, only the irradiated skin. Lukewarm water is to be used to bathe the area. Water of extreme temperature should be avoided. Many over-the-counter ointments contain metals and may cause additional skin damage.

Which is a growth-based classification of tumors? a. Sarcoma b. Carcinoma c. Malignancy d. Leukemia

c Tumors classified on the basis of growth are described as benign or malignant. Tumors that are classified on the basis of the cell or tissue of origin are carcinomas, sarcomas, lymphomas, and leukemias.

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia? a. Perform a cardiovascular assessment every 4 hours. b. Check the client's history for a congenital link to thrombocytopenia. c. Monitor daily platelet counts. d. Closely observe the client's skin for petechiae and bruising.

d The nurse should closely observe the client's skin for petechiae and bruising. Daily laboratory testing may not reflect the client's condition as quickly as subtle changes in the client's skin. Performing a cardiovascular assessment every 4 hours and checking the clients history for a congenital link to thrombocytopenia don't help detect early signs and symptoms of thrombocytopenia.

The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse? a. "I will eat clear liquids for the next 24 hours." b. "Hair loss may not occur until after the second round of therapy." c. "I will use birth control measures until after all treatment is completed." d. "I can continue taking my vitamins and herbs because they make me feel better."

d Herbal products are not regulated by the U.S. Food and Drug Administration (FDA);although some can decrease the risk of cancer, others can have serious side effects and liver toxicity. Use of vitamins and herbals should be reviewed with the oncologist. Use of clear liquids is recommended for the client experiencing nausea and vomiting. Because hair follicles are sensitive to chemotherapy drugs, it is likely for alopecia to occur especially with consecutive treatments. Chemotherapy includes cytotoxic drugs that are harmful to rapid dividing cells such as cell development in the fetus. To prevent damage to the fetus, birth control is recommended during treatment.

A nurse is assessing a 75-year-old woman who had a total hysterectomy when she was 30 years old and normal Pap test results for the past 10 years. The client asks about continuing the Pap test. What is the best response by the nurse? a. "You will need to continue for the rest of your life." b. You need to continue obtaining a Pap test for only the next 5 years." c. "You could have stopped immediately after your hysterectomy." d. "You may choose to discontinue this test."

d The American Cancer Society recommendations for women 66+ years or older who have had normal Pap tests for 10 years and who have had a total hysterectomy may choose to stop having Pap tests for cervical cancer screening.

Which statement by a client undergoing external radiation therapy indicates the need for further teaching? a. "I'll wash my skin with mild soap and water only." b. "I'll not use my heating pad during my treatment." c. "I'll wear protective clothing when outside." d. "I'm worried I'll expose my family members to radiation."

d. 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.

Which oncologic emergency involves the accumulation of fluid in the pericardial space? a. Cardiac tamponade b. Disseminated intravascular coagulation (DIC) c. Syndrome of inappropriate antidiuretic hormone release (SIADH) d. Tumor lysis syndrome

a Cardiac tamponade is an accumulation of fluid in the pericardial space. DIC is a complex disorder of coagulation and fibrinolysis that results in thrombosis and bleeding. SIADH is a result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH). Tumor lysis syndrome is a rapidly developing oncologic emergency that results from the rapid release of intracellular contents as a result of radiation- or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia.

A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching? a. "I floss my teeth every morning." b. "I use an electric razor to shave." c. "I take a stool softener every morning." d. "I removed all the throw rugs from the house."

a A client with a platelet count of 30,000/mm3 is at risk for bleeding and shouldn't floss his teeth. Flossing may increase the risk of bleeding in a client with a platelet count less than 40,000/mm3. Using an electric razor is appropriate because doing so helps minimize the risk of cutting when shaving. Taking a stool softener helps decrease potential trauma to the GI tract that may cause bleeding. Removing throw rugs from the house helps prevent falls, which could lead to uncontrolled bleeding.

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? a. The I.V. site is red and swollen. b. The client states he is nauseous. c. The laboratory reports a white blood cell (WBC) count of 1,000/mm3. d. The client begins to shiver.

a A red, swollen I.V. site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates. The nurse should immediately stop the medication, apply ice to the site, and notify the physician. Although nausea, WBC count of 1,000/mm3, and shivering require interventions, these findings aren't a high priority at this time.

The nurse is teaching a client newly diagnosed with cancer about chemotherapy. The nurse tells the client he'll receive an antitumor antibiotic. The nurse knows that this type of medications is: a. cell-cycle nonspecific. b. cell-cycle specific in the S phase. c. cell-cycle specific in the M phase. d. cell-cycle specific in the P phase.

a Antitumor antibiotics are cell-cycle nonspecific; they interfere with deoxyribonucleic acid (DNA) synthesis by binding with the DNA. They also prevent ribonucleic acid synthesis. Other cell-cycle nonspecific drugs include nitrosoureas and hormonal agents. Drugs that are cell-cycle specific in the S phase include topoisomerase I inhibitors and antimetabolites. Miotic spindle poisons are cell-cycle specific in the M phase. There isn't a drug class that's specific to the P phase.

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

a Apoptosis is the innate cellular process of programmed cell death. Mitosis is the phase of the cell cycle in which cell division occurs. Carcinogenesis is the process by which cancer arises. Angiogenesis is the process by which a new blood supply is formed.

What is the best way for the nurse to assess the nutritional status of a patient with cancer? a. Weigh the patient daily. b. Monitor daily caloric intake. c. Observe for proper wound healing. d. Assess BUN and creatinine levels.

a Common nutritional problems in clients with cancer include anorexia, malabsorption, and the extreme weight loss of cancer-related anorexia-cachexia syndrome (CACS). Because malnutrition may occur due to problems with absorption of nutrients or increased metabolic demands, weighing the client regularly is the best way to monitor nutritional status. The client's caloric intake should also be monitored, keeping in mind that nutritional status may suffer even if caloric intake may seem sufficient.

A client is recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed? a. "I guess the doctor could not remove the entire tumor." b. "I am so glad the doctor was able to remove the entire tumor." c. "I will be glad to finally be done with treatments for this thing." d. "Thank goodness the tumor is contained and curable."

a Debulking is a reference made when a tumor cannot be completely removed, often due to its extension far into healthy tissue. Without complete removal, this is not a cure and, the cancer cells will continue to replicate and require adjuvant therapies to prevent further invasion. The physician, not the nurse, will need to clarify the details of the surgery.

A patient is to receive Bacille Calmette-Guerin (BCG), a nonspecific biologic response modifier. Why would the patient receive this form of treatment? a. For cancer of the bladder b. For cancer of the breast c. For cancer of the lungs d. For skin cancer

a Early investigations of the stimulation of the immune system involved nonspecific agents such as bacille Calmette-Guérin (BCG) and Corynebacterium parvum. When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells. Extensive animal and human investigations with BCG have shown promising results, especially in treating localized malignant melanoma. In addition, BCG bladder instillation is a standard form of treatment for localized bladder cancer.

A client is diagnosed with metastatic adenocarcinoma of the stomach. The physician orders mitomycin and other chemotherapeutic agents for palliative treatment. How does mitomycin exert its cytotoxic effects? a. It inhibits deoxyribonucleic acid (DNA) synthesis. b. It inhibits ribonucleic acid (RNA) synthesis. c. It's cell cycle-phase specific. d. It inhibits protein synthesis.

a Mitomycin (Mutamycin) exerts its cytotoxic effects by inhibiting DNA synthesis rather than RNA synthesis. It's cell cycle-phase nonspecific and doesn't inhibit protein synthesis.

Which type of surgery is used in an attempt to relieve complications of cancer? a. Palliative b. Prophylactic c. Reconstructive d. Salvage

a Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing nonvital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or to obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.

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

a Requesting her wig and makeup indicates that the patient with alopecia is becoming interested in looking her best and that her body image and self-esteem may be improving. The other options may indicate that other nursing goals are being met, but they don't assess improved body image and self-esteem.

A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action? a. Place the client in a private room. b. Place a chair next to the bed to allow the spouse to sit. c. Have visitors wear dosimeters for safety. d. Allow visitors to telephone only.

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

You are doing client teaching in the oncology clinic. One of your clients will undergo sealed radiation therapy. What should you teach this client and their family? a. Clients must avoid contact with other people for at least 2 months after the implant. b. Clients must isolate themselves when the radiation is most active. c. Clients may interact with other people freely. d. Clients must maintain a vegetarian diet.

a Sealed brachytherapy sources include interstitial and intracavitary implants. Clients generally go home if they have permanent implants. Clients must stay away from other people for a few days when the radiation is most active. They must restrict close contact with children or pregnant women to 5 minutes and be no closer to them than 6 feet for 2 months after the implant. Maintaining a vegetarian diet will not help clients minimize radiation.

An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates that teaching was successful? a. "I clean my teeth gently several times per day." b. "I replace my toothbrush every month." c. "I lubricate my lips with petroleum jelly." d. "I use an alcohol-based mouthwash every morning."

a The client demonstrates understanding when he states that he'll clean his teeth gently several times per day. Frequent gentle cleaning of the mouth or rinsing reduces bacteria build-up in the oral cavity, thus reducing the risk for oropharyngeal infection. Changing the toothbrush each month reduces the bacteria in the mouth for the first few uses only. Petroleum jelly moistens the lips, but doesn't prevent breakdown of the mucous membranes or reduce the risk for oropharyngeal infection. Alcohol-based products cause drying of the mucous membrane, increasing the likelihood of oropharyngeal infection.

A nurse is teaching a client who is receiving radiation treatment for left lower lobe lung cancer. Which client statement indicates a need for further teaching? a. "I'll use hats to protect my head from the sun when my hair falls out." b. "If I get nauseous, I'll try to eat several small, bland meals each day." c. "I'll allow myself plenty of time to rest between activities." d. "Most of the adverse effects should go away shortly after my last radiation treatment."

a The client requires additional teaching if he mentions that he will lose the hair on his head as a result of radiation therapy. Alopecia is an acute, localized adverse effect of radiation. The treatment area for this client's cancer will be localized to the lower aspects of his lungs, not his head. Nausea and fatigue are expected generalized adverse effects of radiation therapy. Most adverse effects of radiation are temporary and will stop when treatment is complete.

Which statement by a client undergoing external radiation therapy indicates the need for further teaching? a. "I'll wash my skin with mild soap and water only." b. "I'll not use my heating pad during my treatment." c. "I'll wear protective clothing when outside." d. "I'm worried I'll expose my family members to radiation."

a 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.

An oncology nurse is caring for a client who is taking antineoplastic agents. What symptoms would the nurse consider with tumor lysis syndrome when monitoring this client? a. symptoms of gout b. symptoms of hypertension c. symptoms of constipation d. symptoms of anemia

a The nurse monitors the client being administered an antineoplastic agent for symptoms of gout, which include increased uric acid levels, joint pain, and edema, with the consideration of tumor lysis syndrome. Administering antineoplastic agents does not cause hypertension, constipation, or anemia.

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

a The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth? a. Control b. Cure c. Palliation d. Prevention

a The range of possible treatment goals may include complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control), or relief of symptoms associated with the disease (palliation). Prevention is not a treatment goal when the patient has already been diagnosed with cancer. Prevention of metastasis to a secondary site may be a goal.

Which of the following is the single largest preventable cause of cancer? a. Tobacco b. Pesticides c. Arsenic d. Asbestos

a Tobacco remains the single largest preventable cause of disease and early death and accounts for at least 30% of all cancer deaths. The list of suspected carcinogens, such as pesticides, arsenic, and asbestos, continues to grow.

A client returns to the surgeon's office for a report on a diagnostic procedure to determine the cell composition of the client's abdominal neoplasm. Which term is significant to indicate the likelihood of the tumor spreading? a. benign b. neoplasm c. primary site d. lesion

a Tumors are classified according to their cell of origin and whether their growth is benign, meaning not invasive or spreading; or malignant, meaning invasive and capable of spreading. New growths of abnormal tissue are called neoplasms or tumors. The term 'primary site' may be used in reference to the origins of an initial tumor if metastasis, or the development of a secondary tumor from the primary tumor at a distant location. A lesion generally appears on the skin and looks like a mole.

A client diagnosed with cancer has the tumor staged and graded based on what? a. How the tumor tends to grow and the cell type b. How the tumor spreads and tends to grow c. How the tumor differentiates the cell type d. How the tumor spreads and differentiates

a Tumors are staged and graded based upon how they tend to grow and the cell type before a client is treated for cancer.

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. Maintain as much distance as possible from the patient while in the room. c. Alert family members that they should restrict their visiting to 5 minutes at any one time. d. Wear a lead apron when providing direct patient care.

a 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.

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 usually temporary." b. "New hair growth will return without any change to color or texture." c. "Clients with alopecia will have delay in grey hair." d. "Wigs can be used after the chemotherapy is completed."

a 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.

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 for gastroesophageal reflux disease (GERD) and an over-the-counter calcium supplement to prevent osteoporosis. What interventions should the nurse take? Select all that apply. a. instructs the client to discontinue calcium b. asks about nausea and vomiting c. restricts fluids to 1500 mL per day d. teaches the client to report abdominal or bone pain e. provides information about antidiarrheal medication

a, b, d 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.

The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply. a. Egg white omelet with spinach and mushrooms b. Crispy chicken Caesar Salad c. Steamed broccoli and carrots d. Turkey breast on whole wheat bread e. Smoked salmon f. Vegetable and cheddar quiche

a, c, d Foods high in fat and those that are smoked or preserved with salt or nitrates are associated with increased cancer risks. An omelet made of egg whites and vegetables is a healthy low fat selection as are steamed broccoli/carrots and turkey breast on whole grain bread. A salad can be a healthy selection but Caesar salads contain much fat from the dressing and addition of cheeses and fried chicken. Salmon that is not smoked would be a good selection. Quiche usually contains high-fat milk, crème, eggs, and cheese.

A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue? a. Excisional biopsy b. Incisional biopsy c. Needle biopsy d. Punch biopsy

a. Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis.

The nurse is assessing the diet of a female client. To decrease the risk of cancer in general, the nurse instructs the client to a. Decrease cigarette smoking from one pack/day to 1/2 pack/day. b. Limit alcohol ingestion to one drink per day. c. Ingest two to three servings of fruits and vegetables each day. d. Include at least 6 ounces of meat in meals every day.

b Alcohol increases the risks of certain cancers and should be limited to no more than one drink per day for women. Smoking is strongly associated with certain cancers, and tobacco may act synergistically with other substances. Even decreasing use of tobacco still places one at risk for cancer. Recommendation by the U.S. Department of Agriculture for fruits and vegetables is 4 1/2 cups per day and for protein is 5 1/2 ounces per day with low-fat or lean meat and poultry and/or other proteins such as fish, beans, peas, nuts, and seeds.

A client with ovarian cancer is ordered hydroxyurea, an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. What mechanism of action do antimetabolites interferes with? a. cell division or mitosis during the M phase of the cell cycle b. normal cellular processes during the S phase of the cell cycle c. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle-nonspecific) d. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cycle-nonspecific)

b Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They're most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.

A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan? a. Avoiding using soap on the irradiated areas b. Applying talcum powder to the irradiated areas daily after bathing c. Wearing a lead apron during direct contact with the client d. Removing thoracic skin markings after each radiation treatment

b Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed.

The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic? a. Ability to invade other tissues b. Slow rate of growth c. Causes generalized symptoms d. Undifferentiated cells

b Benign tumors have a slow rate of growth and well-differentiated cells. Benign tumors do not invade surrounding tissue and do not cause generalized symptoms unless the location of the tumor interferes with the functioning of vital organs.

The nurse is working with a client who has had an allo-hematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of a. nadir. b. graft-versus-host disease. c. metastasis. d. acute leukopenia.

b Graft-versus-host disease is a major cause of morbidity and mortality in clients who have had allogeneic transplant. Clinical manifestations of the disease include diffuse rash that progresses to blistering and desquamation, and mucosal inflammation of the eyes and the entire gastrointestinal tract with subsequent diarrhea, abdominal pain, and hepatomegaly.

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? a. No further treatment is indicated. b. Adjuvant therapy is likely. c. Palliative care is likely. d. Repeat biopsy is needed before treatment begins.

b T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed.

The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? a. Eat wholesome meals. b. Avoid spicy and fatty foods. c. Avoid intake of fluids. d. Eat warm or hot foods.

b The nurse advises a client undergoing chemotherapy to avoid hot and very cold liquids and spicy and fatty foods. The nurse also encourages the client to have small meals and appropriate fluid intake.

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

b The transport of tumor cells through the lymphatic circulation is the most common mechanism of metastasis. Tumor emboli enter the lymph channels by way of the interstitial fluid, which communicates with lymphatic circulation. Breast tumors frequently metastasize in this manner through axillary, clavicular, and thoracic lymph channels.

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

b 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.

An oncology nurse is caring for a client who relates that certain tastes have changed. The client states that "meat tastes bad." What nursing intervention can be used to increase protein intake for a client with taste changes? a. Stay away from protein beverages. b. Encourage maximum fluid intake. c. Encourage eating cheese, eggs, and legumes d. Suck on hard candy during treatment.

c The nurse encourages the clients with taste changes to eat cheese, eggs, and legumes. Encouraging the client to take in the maximum amount of fluids does not increase protein intake. The nurse advises the client to drink protein beverages. Sucking on hard candies during treatment does not increase protein intake.

A nurse assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis? a. Recommend that the client discontinue chemotherapy. b. Provide a solution of viscous lidocaine for use as a mouth rinse. c. Monitor the client's platelet and leukocyte counts. d. Check regularly for signs and symptoms of stomatitis.

b. To decrease the pain of stomatitis, the nurse should provide a solution of viscous lidocaine for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer systemic analgesics as ordered. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn't be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection, but wouldn't decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn't decrease the pain.

The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest? a. Normal finding b. Benign fibrocystic disease c. Malignant tumor d. Malignant tumor with metastasis to surrounding tissue

c A fast-growing lump is suggestive of a malignant tumor. Metastasis can only be determined by cytology, not by palpation.

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. Random, rapid growth of the tumor b. Cells colonizing to distant body parts c. Tumor pressure against normal tissues d. Emission of abnormal proteins

c 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 teaching a client with bone marrow suppression about the time frame when bone suppression will be noticeable after administration of floxuridine. What is the time frame the nurse should include with client teaching? a. 24 hours b. 2 to 4 days c. 7 to 14 days d. 21 to 28 days

c Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.

A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client? a. Wear sterile gloves. b. Place incontinence pads in the regular trash container. c. Wear personal protective equipment when handling blood, body fluids, and feces. d. Provide a urinal or bedpan to decrease the likelihood of soiling linens.

c Chemotherapy drugs are present in the waste and body fluids of clients for 48 hours after administration. The nurse should wear personal protective equipment when handling blood, body fluids, or feces. Gloves offer minimal protection against exposure. The nurse should wear a face shield, gown, and gloves when exposure to blood or body fluid is likely. Placing incontinence pads in the regular trash container and providing a urinal or bedpan don't protect the nurse caring for the client.

The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides that they are very depressed. The nurse recognizes depression as which of the following? a. A psychiatric diagnosis everyone has at one time or another. b. A side effect of the neoplastic drugs. c. A normal reaction to the diagnosis of cancer. d. An aberrant psychologic reaction to the chemotherapy.

c Clients have many reactions, ranging from anxiety, fear, and depression to feelings of guilt related to viewing cancer as a punishment for past actions or failure to practice a healthy lifestyle. They also may express anger related to the diagnosis and their inability to be in control. While depression is understandable, it also needs to be acknowledged and treated if necessary. Depression is not a side effect of the neoplastic drugs nor is it an aberrant psychologic reaction to the chemotherapy.

The nurse is caring for a client with cancer who is treating her cancer with deep-tissue massage in addition to radiation therapy. The nurse documents the use of which therapy on the client's chart? a. Alternative therapy b. Global medicine c. Integrative medicine d. Compliant medicine

c 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.

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

c Most chemotherapeutic agents cause myelosuppression (depression of bone marrow function), resulting in decreased production of blood cells. Myelosuppression decreases the number of WBCs (leukopenia), red blood cells (RBCs) (anemia), and platelets (thrombocytopenia), and increases the risk of infection and bleeding. It does not typically affect electrolytes, creatinine, BUN, and CRP levels.

A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication? a. Erythema b. Flare c. Extravasation d. Thrombosis

c The client is exhibiting signs of extravasation, which occurs when the medication leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site. Erythema is redness of the skin that results from skin irritation. Flare is a spreading of redness that occurs as a result of drawing a pointed instrument across the skin. Thrombosis is the formation of clot within the vascular system.

The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy? a. It is used to remove cancerous cells using a needle. b. It removes an entire lesion and the surrounding tissue. c. It removes a wedge of tissue for diagnosis. d. It treats cancer with lymph node involvement.

c The three most common biopsy methods are excisional, incisional, and needle. In an incisional biopsy, a wedge of tissue is removed from the tumor and analyzed. In an excisional biopsy, the surgeon removes the tumor and the surrounding marginal tissues. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.

A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse? a. It stimulates the immune system against the tumor cells. b. It treats drug-related anemia. c. It prevents alopecia. d. It lowers serum and uric acid levels.

d The use of allopurinol with chemotherapy is to prevent renal toxicity. Tumor lysis syndrome occurrence can be reduced with allopurinol's action of reducing the conversion of nucleic acid byproducts to uric acid, in this way preventing urate nephropathy and subsequent oliguric renal failure. Allopurinol does not stimulate the immune system, treat anemia, or prevent alopecia.

The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks? a. Pool and water safety b. Breast and testicular self-exams c. Hand washing and infection prevention d. Sun safety and use of sunscreen

d. Pool and water safety as well as infection prevention are important teaching topics but will not decrease cancer risk. While performing breast and testicular self-exams may identify cancers in the early stage, this teaching is not usually initiated in school-age children. Severe sunburns that occur in young children can place the child at risk for skin cancers later in life. Because children spend much time out of doors, the use of sunscreen and protective clothing/hats can protect the skin and decrease the risk.