Adult Health Oncology

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

A. eats red meat such as steaks or hamburgers every day Rationale: 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 recommendations include drink no more than one drink per day for women or two per day for men.

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. Prevents Alopecia B. Treats drug-related anemia C. Stimulates the immune system against the tumor cells D. Lowers serum and uric acid levels

D. Lowers serum and uric acid levels Rationale: 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 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? A. "I will brush my teeth after every meal." B. "I will reduce smoking to after meals only." C. "I will limit alcoholic beverages to one a day." D. "I will eat spicy foods with a cool beverage."

A. "I will brush my teeth after every meal." Rationale 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 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? A. Monitor the client closely to prevent infection. B. Monitor the client's heart rate. C. Monitor the client's physical condition. D. Monitor the client's toilet patterns.

A. Monitor the client closely to prevent infection. 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.

Which type of surgery is used in an attempt to relieve complications of cancer? A. Palliative B. Salvage C. Reconstructive D. Prophylactic

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

A. Stage 3 pressure ulcer on the left heel Rationale: A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection.

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. The hair will grow back the same as it was before treatment. C. he hair will grow back within 2 months post therapy. D. Alopecia related to chemotherapy is relatively uncommon.

A. The client should consider getting a wig or cap prior to beginning treatment. Rationale: 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.

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. A second cousin diagnosed with cancer B. An aunt and uncle diagnosed with cancer C. Onset of cancer after age 50 in family member D. A first cousin diagnosed with cancer

B. An aunt and uncle diagnosed with cancer

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

B. Extravasation Rationale: 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.

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. Extravasation C. Flare D. Thrombosis

B. Extravasation 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 patient is taking vincristine, a plant alkaloid for the treatment of cancer. What system should the nurse be sure to assess for symptoms of toxicity? A. Gastrointestinal system B. Nervous system C. Urinary system D. Pulmonary system

B. Nervous system Rationale With repeated doses, the taxanes and plant alkaloids, especially vincristine, can cause cumulative peripheral nervous system damage with sensory alterations in the feet and hands.

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. Repeat biopsy is needed before treatment begins. C. Adjuvant therapy is likely. D. Palliative care is likely.

C. Adjuvant therapy is likely. 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.

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

C. Inspecting the skin for petechiae once every shift Rationale: 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.

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 use an electric razor to shave." B. "I removed all the throw rugs from the house." C. "I take a stool softener every morning." D. "I floss my teeth every morning."

D. "I floss my teeth every morning." Rationale: 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.

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth? A. Cure B. Palliation C. Prevention D. Control

D. Control Rationale: 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.

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? A. Sexual Dysfunction B. Knowledge Deficit C. Grieving D. Fear

D. Fear Rationale: 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.

The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as A. external beam radiation therapy. B. a contact mold. C. systemic radiation. D. brachytherapy.

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