Prep-U: Management of Patients with Oncologic Disorders

1 Explanation: 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).

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? 1. Antimetabolite 2. Alkylating 3. Nitrosoureas 4. Mitotic spindle poisons

2 Explanation: Bleomycin has cumulative toxic effects on lung function. Thus, it will be important to assess lung sounds.

A client has received several treatments of bleomycin. It is now important for the nurse to assess? 1. Skin integrity 2. Lung sounds 3. Urine output 4. Hand grasp

1 Explanation: 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.

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: 1. show movement of the GI tract. 2. remove a tissue sample from the GI tract. 3. show tumor "hot spots" in the GI tract. 4. provide a three-dimensional cross-sectional view.

4 Explanation: 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.

A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse? 1. It stimulates the immune system against the tumor cells. 2. It treats drug-related anemia. 3. It prevents alopecia. 4. It lowers serum and uric acid levels.

c Explanation: 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.

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

2 Explanation: Also called preventive surgery, prophylactic surgery may be done when there is a family history or genetic predisposition, ability to detect cancer at an early stage, and client acceptance of the postoperative outcome. Local excision is done when an existing tumor is removed along with a small margin of healthy tissue. Palliative surgery relieves symptoms. Cryosurgery uses cold to destroy cancerous cells.

An oncologist advises a client with an extensive family history of breast cancer to consider a mastectomy. What type of surgery would the nurse include in teaching? 1. cryosurgery 2. prophylactic 3. local excision 4. palliative

2 Explanation: 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.

Chemotherapeutic agents have which effect associated with the renal system? 1. Hypokalemia 2. Increased uric acid excretion 3. Hypophosphatemia 4. Hypercalcemia

2 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.

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? 1. Administering aspirin if the temperature exceeds 102° F (38.8° C) 2. Inspecting the skin for petechiae once every shift 3. Providing for frequent rest periods 4. Placing the client in strict isolation

1 Explanation: Cell division occurs in mitosis. RNA and protein synthesis occurs in the G1 phase. DNA synthesis occurs during the S phase. DNA synthesis is complete, and the mitotic spindle forms in the G2 phase.

In which phase of the cell cycle does cell division occur? 1. Mitosis 2. G1 phase 3. S phase 4. G2 phase

4 Explanation: 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.

The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse? 1. "I will eat clear liquids for the next 24 hours." 2. "Hair loss may not occur until after the second round of therapy." 3. "I will use birth control measures until after all treatment is completed." 4. "I can continue taking my vitamins and herbs because they make me feel better."

3 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.

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? 1. Random, rapid growth of the tumor 2. Cells colonizing to distant body parts 3. Tumor pressure against normal tissues 4. Emission of abnormal proteins

1 Explanation: 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.

The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? 1. Extravasation 2. Stomatitis 3. Nausea and vomiting 4. Bone pain

800 mg Explanation: 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.

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?

3 Explanation: 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.

Which is a growth-based classification of tumors? 1. Sarcoma 2. Carcinoma 3. Malignancy 4. Leukemia

1 Explanation: 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.

Which oncologic emergency involves the accumulation of fluid in the pericardial space? 1. Cardiac tamponade 2. Disseminated intravascular coagulation (DIC) 3. Syndrome of inappropriate antidiuretic hormone release (SIADH) 4. Tumor lysis syndrome

1, 2, 3 Explanation: Most cancer occurs in people older than 65 years. Although the overall rate of cancer deaths has declined, cancer death rates in Black men remain substantially higher than those among White men and twice those of Hispanic men. Excessive exposure to the ultraviolet rays of the sun, especially in fair-skinned people, increases the risk of skin cancers. Factors such as clothing styles (sleeveless shirts or shorts), the use of sunscreens, occupation, recreational habits, and environmental variables, including humidity, altitude, and latitude, all play a role in the amount of exposure to ultraviolet light. Tobacco smoke, thought to be the single most lethal chemical carcinogen, accounts for at least 30% of cancer deaths in humans (Fontham et al., 2009). Smoking is strongly associated with cancers of the lung, head and neck, esophagus, stomach, pancreas, cervix, kidney, and bladder and with acute myeloblastic leukemia. Marital status is not associated with risk for cancer.

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. 1. Age 2. Cigarette smoking 3. Occupation 4. Race 5. Marital status

4 Explanation: 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.

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? 1. Perform a cardiovascular assessment every 4 hours. 2. Check the client's history for a congenital link to thrombocytopenia. 3. Monitor daily platelet counts. 4. Closely observe the client's skin for petechiae and bruising.

1 Explanation: 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.

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? 1. It inhibits deoxyribonucleic acid (DNA) synthesis. 2. It inhibits ribonucleic acid (RNA) synthesis. I 3. t's cell cycle-phase specific. 4. It inhibits protein synthesis.

1 Explanation: 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.

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? 1. Avoiding using soap on the irradiated areas 2. Applying talcum powder to the irradiated areas daily after bathing 3. Wearing a lead apron during direct contact with the client 4. Removing thoracic skin markings after each radiation treatment

4 Explanation: The nurse advises the client undergoing radiation therapy to use a soft toothbrush to avoid gum lacerations and allow the toothbrush to air dry before storing. Gargling after each meal, flossing before going to bed, and treating cavities immediately are general oral hygiene instructions.

A client is receiving radiation therapy and asks the nurse about oral hygiene. What teaching specific to the client's situation should the nurse include? 1. Gargle after each meal. 2. Floss before going to bed. 3. Treat cavities immediately. 4. Use a soft toothbrush and allow it to air dry before storing.

1 Explanation: 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 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? 1. "I guess the doctor could not remove the entire tumor." 2. "I am so glad the doctor was able to remove the entire tumor." 3. "I will be glad to finally be done with treatments for this thing." 4. "Thank goodness the tumor is contained and curable."

2 Explanation: Fear of the unknown is probably the major concern for this client. This includes fear of the diagnosis of cancer, fear of the effects of the surgery, and fear of loss of control and functioning. Sexual Dysfunction may be one of the fears but not primary at this stage. Knowledge Deficit is unclear at this time. Grieving would not be a likely response at this time.

A client is scheduled for a nerve-sparing prostatectomy. The emotional spouse confides in the nurse that the client will not talk about the cancer and/or upcoming surgery. Which nursing diagnosis will the nurse choose as primary diagnosis for this client? 1. Sexual Dysfunction 2. Fear 3. Knowledge Deficit 4. Grieving

2 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.

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? 1. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis 2. Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis 3. Can't assess tumor or regional lymph nodes and no evidence of metastasis 4. Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis

4 Explanation: The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to 10 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.

A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms? 1. Neutropenia 2. Extravasation 3. Nadir 4. Stomatitis

3 Explanation: By asking the client talk may open the door for further discussion and sharing of feelings, fears, etc. A bath will make the client feel better and asking if the client wishes to skip the bath today are matter-of-fact comments and disconnect, resulting in a shutdown to further communication. The nurse stating that medication could be given is a quick fix and demonstrates a nontherapeutic response.

A client with advanced cancer makes the following comment to the nurse: "Why are you bathing me? I am going to die no matter what." What is the most appropriate response of the nurse? 1. "A bath will make you feel better." 2. "Do you want to skip the bath today?" 3. "Would you like to talk about what you are feeling?" 4. "I can give you some medicine to make you feel better."

2 Explanation: 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 sta

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? 1. cell division or mitosis during the M phase of the cell cycle 2. normal cellular processes during the S phase of the cell cycle 3. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle-nonspecific) 4. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cycle-nonspecific)

3 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 absolute neutrophil count.

A decrease in circulating white blood cells (WBCs) is referred to as 1. Granulocytopenia 2. Thrombocytopenia 3. Leukopenia 4. Neutropenia

1 Explanation: 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.

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: 1. inhalation of aerosols. 2. absorption through the gown. 3. absorption through the gloves. 4. absorption through the goggles.

3 Explanation: One of the major side effects of Aromasin is hypocalcemia and the subsequent loss of bone. Therefore, the patient needs to have periodic blood work done, have bone density tests done, and follow a diet that will supply needed calcium that is being pulled from the bone tissue.

A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to: 1. Report the unusual sign of nausea. 2. Be alarmed if she notices fluid retention. 3. Increase her intake of calcium-rich foods. 4. Report the unexpected sign of increased appetite and weight gain.

3 Explanation: 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.

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? 1. Erythema 2. Flare 3. Extravasation 4. Thrombosis

4 Explanation: 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.

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? 1. "You will need to continue for the rest of your life." 2. You need to continue obtaining a Pap test for only the next 5 years." 3. "You could have stopped immediately after your hysterectomy." 4. "You may choose to discontinue this test."

2

A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? 1. White blood cell (WBC) count of 9,000 cells/mm3 2. Stage 3 pressure ulcer on the left heel 3. Temperature of 98.3° F (36.8° C) 4. Ate 75% of all meals during the day

1 Explanation: 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.

A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action? 1. Place the client in a private room. 2. Place a chair next to the bed to allow the spouse to sit. 3. Have visitors wear dosimeters for safety. 4. Allow visitors to telephone only.

3 Explanation: A diet high in vitamin C and citrus may help reduce the risk of certain cancers, such as stomach and esophageal cancers. Hot dogs and smoked and cured foods are high in nitrates, which may be linked to esophageal and gastric cancers. Steak is a high-fat food that may increase the risk of breast, colon, and prostate cancers.

A nurse is teaching a community class about how to decrease the risk of cancer. Which food should the nurse recommend? 1. Low-fat hot dogs 2. Smoked ham 3. Oranges 4. Medium-rare steak

3 Explanation: Patients who are undergoing surgery for the diagnosis or treatment of cancer may be anxious about the surgical procedure, possible findings, postoperative limitations, changes in normal body functions, and prognosis. The patient and family require time and assistance to process the possible changes and outcomes resulting from the surgery. The nurse serves as the patient advocate and liaison and encourages the patient and family to take an active role in decision making when possible. If the patient or family asks about the results of diagnostic testing and surgical procedures, the nurse's response is guided by the information that was conveyed previously. The nurse may be asked to explain and clarify information for patients and families that was provided initially but was not grasped because of anxiety and overwhelming feelings. It is important that the nurse, as well as other members of the health care team, provide information that is consistent from one clinician to another.

A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient? 1. Clarify information provided by the physician. 2. Provide aseptic care to the incision postoperatively. 3. Provide time for the patient to discuss her concerns. 4. Counsel the patient about the possibility of losing her breast.

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

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? 1. Normal finding 2. Benign fibrocystic disease 3. Malignant tumor 4. Malignant tumor with metastasis to surrounding tissue

2 Explanation: Cryoablation 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. Chemosurgery is the use of medication. Laser surgery is the use of a laser. Radiofrequency ablation is the use of thermal energy.

A patient is scheduled for cryoablation for cervical cancer and tells the nurse, "I am not exactly sure what the surgeon is going to do." What is the best response by the nurse? 1. "The surgeon is going to use medication to inject the area." 2. "The surgeon is going to use liquid nitrogen to freeze the area." 3. "The surgeon is going to use a laser to remove the area." 4. "The surgeon is going to use radiofrequency to ablate the area."

1 Explanation: 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.

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? 1. Excisional biopsy 2. Incisional biopsy 3. Needle biopsy 4. Punch biopsy

2 Explanation: In external-beam radiation therapy (EBRT), the total radiation dose is delivered over several weeks in daily doses called fractions. This allows healthy tissue to repair and achieves greater cell kill by exposing more cells to the radiation as they begin active cell division. Repeated radiation treatments over time (fractionated doses) also allow for the periphery of the tumor to be reoxygenated repeatedly, because tumors shrink from the outside inward. This increases the radiosensitivity of the tumor, thereby increasing tumor cell death.

A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse? 1. "It allows time for you to cope with the treatment." 2. "It will allow time for the repair of healthy tissue." 3. "It will decrease the incidence of leukopenia and thrombocytopenia." 4. "It is not really understood why you have to go for 6 weeks of treatment."

2 Explanation: 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.

A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with: 1. anorexia. 2. seizure. 3. weight gain. 4. myalgia.

1 Explanation: 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.

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: 1. "You will need to practice birth control measures." 2. "You will continue having your menses every month." 3. "You will experience menopause now." 4. "You will be unable to have children."

3 Explanation: Risk for infection takes highest priority in clients with severe bone marrow depression because they have a decrease in the number of white blood cells, the cells that fight infection. Making clients aware that they are at risk for injuries can help prevent such injuries as falls. The nurse should institute the facility's falls prevention protocol and supply assistive devices, such as a walker, cane, or wheelchair, when needed. Imbalanced nutrition: Less than body requirements is also of concern but doesn't take priority over preventing infection. Anxiety is likely present in clients with severe bone marrow depression; however, anxiety doesn't take priority over preventing infection.

After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority? 1. Risk for injury 2. Imbalanced nutrition: Less than body requirements 3. Risk for infection 4. Anxiety

3 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.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? 1. Serving small portions of bland food 2. Encouraging rhythmic breathing exercises 3. Administering metoclopramide and dexamethasone as ordered 4. Withholding fluids for the first 4 to 6 hours after chemotherapy administration

4 Explanation: Invasion, which refers to the growth of the primary tumor into the surrounding host tissues, occurs in several ways. Malignant cells are less likely to adhere than are normal cells. Malignant cells do not cause healthy cells to mutate. Malignant cells do not eat other cells.

An oncology client will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another? 1. Adhering to primary tumor cells 2. Inducing mutation of cells of another organ 3. Phagocytizing healthy cells 4. Invading healthy host tissues

1 Explanation: 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.

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? 1. "I clean my teeth gently several times per day." 2. "I replace my toothbrush every month." 3. "I lubricate my lips with petroleum jelly." 4. "I use an alcohol-based mouthwash every morning."

1 Explanation: 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.

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? 1. symptoms of gout 2. symptoms of hypertension 3. symptoms of constipation 4. symptoms of anemia

1 Explanation: If the source of donor cells is from a donor other than the patient, it is termed allogeneic. Autologous donor cells come from the patient. Syngeneic donor cells are from an identical twin. Homogenic is not a type of stem cell transplant.

Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient? 1. Allogeneic 2. Autologous 3. Syngeneic 4. Homogenic

2 Explanation: Dietary substances such as nitrate-containing and red meats appear to increase the risk of cancer. Exercising 30 minutes on 5 days or more is recommended for adults. Measures are taken to protect those people who work around radiation. Alcohol consumption recomm

The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice? 1. uses the treadmill for 30 minutes on 5 days each week 2. eats red meat such as steaks or hamburgers every day 3. works as a secretary at a medical radiation treatment center 4. drinks one glass of wine at dinner each night

2 Explanation: 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.

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? 1. nadir. 2. graft-versus-host disease. 3. metastasis. 4. acute leukopenia.

2 Explanation: The sentinel node is the first node in which a tumor will drain; if no malignant cells are found there, additional excision or radical removal will not be necessary. Excision of the lump along with a wide margin of cancer-free tissue is standard treatment for malignant tumors.

The client is scheduled for a breast lump excision and sentinel node biopsy. What should the nurse know in planning care for the client with a positive biopsy? 1. A lump excision is not necessary. 2. A wide excision of lump will be performed. ' 3. The lump and all axillary lymph nodes will be excised. 4. The entire breast and all regional lymph nodes will be excised.

1 Explanation: Other cytokines include interferon alfa and filgrastim. Monoclonal antibodies include rituximab, trastuzumab, and gemtuzumab. Retinoic acid is an example of a retinoid. Antimetabolites are cell cycle-specific antineoplastic agents.

The drug interleukin-2 is an example of which type of biologic response modifier? 1. Cytokine 2. Monoclonal antibodies 3. Retinoids 4. Antimetabolites

1 Explanation: Stomatitis is an inflammatory process of the mouth, including the mucosa and tissues surrounding the teeth. Manifestations of stomatitis include changes in sensation, erythema, and edema, or if severe, painful ulcerations, bleeding, and infection. It commonly develops within 3 to 14 days after receiving certain chemotherapeutic agents. Actions to prevent the development of stomatitis include brushing the teeth with a soft toothbrush for 90 seconds after every meal. Smoking dries oral tissues and should be avoided. Spicy foods can irritate the oral tissues and should be avoided. Alcohol is drying to the oral tissues and should be avoided.

The nurse instructs a client receiving chemotherapy on actions to prevent the development of stomatitis. Which client statement indicates to the nurse that teaching has been effective? 1. "I will brush my teeth after every meal." 2. "I will reduce smoking to after meals only." 3. "I will eat spicy foods with a cool beverage." 4. "I will limit alcoholic beverages to one a day."

1 Explanation: An autologous stem cell transplant comes from the client not from a donor. The doctor will remove the stem cells from the bone marrow before beginning chemotherapy and treat the client until most if not all the cancer is eliminated before reinfusing the stem cells. Clients are at risk for infection and will be closely monitored for at least 3 months, but not in protective isolation.

The nurse is caring for a client is scheduled for chemotherapy followed by autologous stem cell transplant. Which of the following statements by the client indicates a need for further teaching? 1. "I hope they find a bone marrow donor who matches." 2. "The doctor will remove cells from my bone marrow before beginning chemotherapy." 3. "I will receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back." 4. "I will need to attend follow-up visits for up to 3 months after treatment."

3 Explanation: 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.

The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy? 1. It is used to remove cancerous cells using a needle. 2. It removes an entire lesion and the surrounding tissue. 3. It removes a wedge of tissue for diagnosis. 4. It treats cancer with lymph node involvement.

1 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.

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? 1. "The hair loss is usually temporary." 2. "New hair growth will return without any change to color or texture." 3. "Clients with alopecia will have delay in grey hair." 4. "Wigs can be used after the chemotherapy is completed."

b Explanation: 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 caring for a client with a benign breast tumor. The tumor may have which characteristic? 1. Ability to invade other tissues 2. Slow rate of growth 3. Causes generalized symptoms 4. Undifferentiated cells

4 Explanation: The client stating the cancer has spread to the liver shows that the client has an understanding the primary cancer of the colon with spread to the liver. The client's expectation of being "fine" and "happy" once the tumor is removed shows a lack of understanding that metastases are not always resectable. The client mentioning having cancer twice is incorrect because it demonstrates a misunderstanding of metastasis.

The nurse is caring for a client with the diagnosis of colon cancer with metastasis to the liver. Which statement made by the client indicates an understanding of the diagnosis? 1. "Once the colon tumor is removed, I will be fine." 2. "I will be happy once all the cancer is cut out." 3. "How could I be so unlucky to get cancer twice?" 4. "My cancer has now spread to my liver."

2 Explanation: Iodine 131 is a systemic internal radiation that is excreted through body fluids, especially urine. Flushing the toilet several times after each use will avoid the exposure of others to radioactive exposure. Shielding the throat area is not effective because this form of treatment is systemic. Preparing food separately is not necessary, but use of separate eating utensils will be necessary for the first 8 days.

The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important? 1. Shield your throat area when near others. 2. Flush the toilet several times after every use. 3. Prepare food separately from family members. 4. Use disposable utensils for the next month.

4 Explanation: 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.

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? 1. Onset of cancer after age 50 in family member 2. A first cousin diagnosed with cancer 3. A second cousin diagnosed with cancer 4. An aunt and uncle diagnosed with cancer

4 Explantion: Clients with a platelet count of 60,000/mm3 are at mild risk for bleeding. Appropriate nursing interventions include avoiding the use of products such as aspirin that may interfere with the client's clotting systems; avoiding taking temperature rectally and administering suppositories; providing the client with an electric shaver for shaving; and avoiding commercial mouthwashes because of their potential to dry out oral mucosa, which can lead to cracking and bleeding.

The nurse is evaluating bloodwork results of a client with cancer who is receiving chemotherapy. The client's platelet count is 60,000/mm3. Which is an appropriate nursing action? 1. Taking the client's temperature rectally 2. Providing commercial mouthwash to the client 3. Providing a razor so the client can shave 4. Avoiding the use of products containing aspirin

2 Explanation: Until transplanted stem cells begin to produce blood cells, these clients have no physiologic means to fight infection, which makes them very prone to infection. They are at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent infection. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client getting an infection.

The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant? 1. Monitor the client's toilet patterns. 2. Monitor the client closely to prevent infection. 3. Monitor the client's physical condition. 4. Monitor the client's heart rate.

2 Explanation: Radiation therapy helps prevent cellular growth. It may be used to cure the cancer or to control malignancy when the tumor cannot be removed or when lymph node involvement is present; also, it can be used prophylactically to prevent spread. Biopsy is used to analyze lymph nodes or to destroy the surrounding tissues around the tumor.

The physician is attending to a 72-year-old client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation? 1. To remove the tumor from the brain 2. To prevent the formation of new cancer cells 3. To analyze the lymph nodes involved 4. To destroy marginal tissues

1, 2, 3 Explanation: 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.

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. 1. dietary substances 2. environmental factors 3. viruses 4. gender 5. age

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

What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen? 1. It attacks cancer cells during their vulnerable phase. 2. It functions against disseminated disease. 3. It causes a systemic reaction. 4. It targets normal body cells as well as cancer cells.

1 Explanation: 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.

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? 1. Encourage fluid intake to dilute the urine. 2. Take measures to acidify the urine and prevent uric acid crystallization. 3. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. 4. Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis.

3 Explanation: Before the HSCT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before an HSCT procedure, the nurse need not evaluate client's family, drug, or allergy history.

Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure? 1. Family history 2. Drug history 3. Blood studies 4. Allergy history

1 Explanation: By this mechanism, the tumor metastasizes to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rate 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.

Which of the following is a characteristic of a malignant tumor? 1. It gains access to the blood and lymphatic channels. 2. It demonstrates cells that are well differentiated. 3. It is usually slow growing. 4. It grows by expansion.

1 Explanation: A benign neoplasm's rate of growth is usually progressive and slow. Malignant neoplasms have undifferentiated cells, grow by invasion, and gain access to the blood and lymph channels to metastasize to other areas of the body.

Which of the following would be consistent with a benign neoplasm? 1. Usually progressive and slow 2. Grows by invasion 3. Gains access to the blood and lymph channels to metastasize 4. Cells are undifferentiated

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

Which of the following would be inconsistent as a common side effect of chemotherapy? 1. Weight gain 2. Alopecia 3. Myelosuppression 4. Fatigue

1 Explanation: 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 primary cancer treatment goal is prolonged survival and containment of cancer cell growth? 1. Control 2. Cure 3. Palliation 4. Prevention

3 Explanation: Before the BMT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before a BMT procedure, the nurse need not evaluate the client's family, drug, or allergy history.

Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure? 1. Family history 2. Drug history 3. Blood studies 4. Allergy history

2 Explanation: 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.

Which statement is true about malignant tumors? 1. They demonstrate cells that are well differentiated. 2. They gain access to the blood and lymphatic channels. 3. They usually grow slowly. 4. They grow by expansion.

4 Explanation: If extravasation of a chemotherapeutic medication is suspected, the nurse immediately stops the medication. Depending on the drug, the nurse may then attempt to aspirate any remaining drug, apply a warm or cold compress, administer a neutralizing solution, or all these measures.

While administering cisplatin to a client, the nurse assesses swelling at the insertion site. What is the nurse's first action? 1. Administer a neutralizing solution. 2. Apply a warm compress. 3. Aspirate as much of the fluid as possible. 4. Discontinue the intravenous medication.

1 Explanation: Specialized tests have been developed for tumor markers, specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. The nurse cannot say that cancer can be avoided with healthy behaviors; this is inaccurate information. A family history is a reason for the client to be concerned. Cancer does not skip a generation; this response minimizes and negates the client's concern.

While doing a health history, a client tells the nurse that her mother, her grandmother, and her sister died of breast cancer. The client asks what she can do to keep from getting cancer. What is the best response by the nurse? 1. "Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level." 2. "If you eat right, exercise, and get enough rest, you can always prevent breast cancer." 3. "With your family history, there is nothing you can do to prevent getting cancer, so be mindful of your family risk factors." 4. "Cancer often skips a generation, so don't worry about it."

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

You are the nurse caring for a client with cancer. The client complains of pain and nausea. When assessed, you note that the client appears fearful. What other factor must you consider when a client with cancer indicates signs of pain, nausea, and fear? 1. Infection 2. Fatigue 3. Ulceration 4. High cholesterol levels