AH Chap 15: Oncology Prep U

What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen?

It targets normal body cells as well as cancer cells.

As a nurse, you understand that cancer is the second leading cause of death in the United States, second only to heart disease. One half of all men and one third of all women will develop cancer during their lifetimes. You inform your clients that which of the following types of cancer have the highest prevalence among both men and women? a. lung and skin b. lung and colon c. lung and breast

b. lung and colon

A client diagnosed with acute myelocytic leukemia (AML) has been receiving chemotherapy. During the last two 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?

Closely observe the client's skin for petechiae and bruising.

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. Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis.

a. Encourage fluid intake to dilute the urine.

The nurse is conducting a screening for familial predisposition of cancer. Which of the following should the nurse note as a possible indication of hereditary cancer syndrome? a. aunt or uncle b. first cousin c. second cousin d. family member who has developed cancer over the age of 50

a. aunt or uncle

The client is receiving a vesicant anti neo plastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? a. extravasion b. bone pain c. nausea/vomiting d. stomatitis

a. extravasion

Which of the following would be consistent with a benign neoplasm? a. progressive and slow b. undifferentiated c. gain access to blood and lymph d. grow via invasion

a. progressive and slow

Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient?

allogenic

Which of the following is true about a malignant tumor? a. gain access to blood and lymph b. highly differentiated c. slow rate of growth

a. gain access to blood and lymph

A nurse is developing a care plan for bone marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable? a. 2 to 4 days b. 7-14 days c. 24 hr d. 21-28 days

b. 7-14 days Bone marrow suppression becomes noticeable 7 to 14 days Bone marrow recovery occurs in 21 to 28 days.

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 a soft toothbrush to brush my teeth everyday b. I floss everyday c. I use an electric razor to shave my face d. I take a stool softener to prevent constipation

b. I floss everyday

The nurse is to administer a vesicant chemotherapeutic drug to a client who had a right mastectomy and inserts the intravenous line

w. a soft plastic catheter 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 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 normal reaction to the diagnosis of cancer. b. something everyone will experience at one pt or another c.normal side effect of drugs

a. normal reaction to diagnosis of cancer

A male client has been unable to return to work for 10 days following chemotherapy as the result of ongoing fatigue and inability to perform usual activities. Laboratory test results are WBCs 2000/mm³, RBCs 3.2 x 10¹²/L, and platelets 85,000/mm³. The nurse notes that the client is anxious. Which of the following is the priority nursing diagnosis?

a. risk for 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? a. Risk for Infection b. Imbalanced nutrition: Less than body requirements c. Anxiety

a. risk for infection

The nurse is caring for a patient undergoing an incisional biopsy. Which is true about an incisional biopsy?

It removes a wedge of tissue for diagnosis.

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 can continue taking my vitamins and herbs because they make me feel better." b. i should start w. a clear liquid diet c. i will use a reliable birth control while receiving treatment d. alopecia is likely during the second treatment, even though it didnt occur during the first

"I can continue taking my vitamins and herbs because they make me feel better."

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?

"It will allow time for the repair of healthy tissue."

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 mg 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.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? a. Administering metoclopramide and dexamethasone as ordered b. providing bland, easily digested food c. withhold fluids for first 4-6 hr d. encouraging rhythmic breathing exercises

Administering metoclopramide and dexamethasone as ordered

A patient, age 67 years, is admitted for diagnostic studies to rule out cancer. The patient is Caucasian, 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.) Age Cigarette smoking Occupation Race Marital status

Age Cigarette smoking Occupation

A client with cancer is receiving chemotherapy and reports to the nurse that his mouth is painful and he has difficulty ingesting food. The nurse does which of the following: a. Asks the client to open his mouth to facilitate inspection of the oral mucosa b. Consults with the healthcare provider about use of nystatin (Mycostatin) c.Instructs the client to brush the teeth with a soft toothbrush d. teach client to floss everyday e. use alcohol based mouthwash

Asks the client to open his mouth to facilitate inspection of the oral mucosa Consults with the healthcare provider about use of nystatin (Mycostatin) Instructs the client to brush the teeth with a soft toothbrush .

The nurse is completing an admission assessment on a patient receiving interstitial implants for his prostate cancer. The nurse documents this as being which of the following?

Brachytherapy

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?

Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis

What does the nurse understand is the rationale for administering allopurinol for a patient receiving chemotherapy?

It lowers serum and uric acid levels. Adequate hydration, diuresis, alkalinization of the acid crystals, and administration of allopurinol (Zyloprim) may be used to prevent renal toxicity that occurs w. chemo

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 once a month c. i was my mouth out w. an alcohol containing mouth wash d. i will apply petroleum jelly to my lips once a day

a. "I clean my teeth gently several times per day."

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode will the nurse anticipate? a. adjuvant therapy is likely b. pallative care is likely c. treatment is unnecessary d. an additional biopsy should be completed

a. Adjuvant therapy is likely. stage IV is indicative of palliative care

Which grade of tumor is also known as a well-differentiated tumor? a. I b. II c. III d. IV

a. I

The drug interleukin-2 is an example of which type of biologic response modifier? a. cytokine b. Monoclonal antibodie c. retinoid d. antimetabolites

a. cytokine 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 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 negative biopsy report? a. A lump excision is not necessary. b. A wide excision of lump will be performed. c. lump and lymph will be removed

b. A wide excision of lump will be performed.

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. incisional b. exiscional c. needle

b. excisional

The nurse is caring for a client is scheduled for chemotherapy followed by auto logous stem cell transplant. Which of the following statements by the client indicates a need for further teaching? a. I will be in isolation for 3 mo postop b. after my cells are removed, I will receive high doses of chemo c. "I hope they find a bone marrow donor who matches."

c. "I hope they find a bone marrow donor who matches."

Following a BMT the patient should be monitored for at least a. 3 days b. 4 weeks c. 3 months

c. 3 months

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? a. mitotic spindle poisons b. alkylating agent c. Antimetabolite d. nitrosourea

c. Antimetabolite

What are considered carcinogens?

chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions.

Which statement by a client undergoing external radiation therapy indicates the need for further teaching? a. I should wash my skin with mild soap and water. b. I should wear protective clothing when outside c. I should avoid using a heating bad over treatment area d. I'm worried I'll expose my family members to radiation

d. I'm worried I'll expose my family members to radiation

You are an oncology nurse caring for a client who tells you that their tastes have changed. They go on to say that "meat tastes bad". What is a nursing intervention to increase protein intake for a client with taste changes? a. advise client to suck on hard candies b. continue to encourage them to eat meat in order to reach necessary protein intake c. encourage client to increase fluid intake d. encourage client to eat cheese sandwiches instead

d. encourage client to eat cheese sandwiches instead

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? a. pt is experiencing nausea b. pt WBC is 1,000/mm3 c. pt begins to shiver d. iv site is red and swollen

d. iv site is red and swollen 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 --> nurse should immediately stop infusion

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?

ham and bacon processed meats/red meat

The physician recommends that parents have their daughter vaccinated with HPV vaccine. What is this vaccine for?

helps prevent cervical cancer

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

inhalation of aerosols

When caring for a client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care?

inspect skin frequently

Which of the following is a growth-based classification of tumors? a. malignant b. carcinoma c. sarcoma d. leukemia

malignant

According to the TNM classification system, T0 means there is

no evidence of primary tumor

Which type of surgery is utilized in an attempt to relieve complications of cancer?

palliative

An important nursing function is monitoring factors that may indicate that bleeding is occurring. One serum indicator is a (an)

platelet count less than 100,000/mm3

The nurse at the clinic explains to the patient that the surgeon will be removing a mole on the patient's back that has the potential to develop into cancer. The nurse informs the patient that this is what type of procedure?

prophylactic

You are a clinic nurse. One of your clients has found she is at high risk for breast cancer. She asks you what can be done to reduce her risk. What is a means of reducing the risk for breast cancer?

prophylactic surgery

A patient with brain tumor is undergoing radiation and chemotherapy for treatment of cancer. Of late, the patient is complaining of swelling in the gums, tongue, and lips. Which of the following is the most likely cause of these symptoms? a. dermatitis b. 2nd degree burns from radiation c. mucositis d. stomatitis

stomatitis -usually occurs 5-10 days after treatment

The physician is attending to a 72-year-old patient with a malignant brain tumor. The physician recommends immediate radiation therapy. Which of the following is a reason for the physician's recommendation?

to prevent formation of new cancer cells radiation therapy helps in preventing 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.

Which of the following classes of antineoplastic agents is cell cycle-specific? a. Antimetabolites (5-FU) b. Nitrosoureas c. Antitumor antibiotic d. Alkylating agents

a. Antimetabolites (5-FU) -the other options are cell cycle nonspecific

A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately

Stops the chemotherapeutic infusion The client may be experiencing a type I hypersensitivity reaction, which may progress to systemic anaphylaxis. The most immediate action of the nurse is to discontinue the medication followed by initiating emergency protocols.

A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client? a. Anticipatory grieving b. Impaired swallowing c. Disturbed body image d. Chronic low self-esteem

a. Anticipatory grieving

When the client complains of increased fatigue following radiotherapy, the nurse knows this is most likely to be related to which factor? a. Radiation can result in myelosuppression. b. the cancer is spreading c. increase cell death of cancer cells d. patient is fighting off an infection

a. Radiation can result in myelosuppression.

A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client? a. Wear personal protective equipment when handling blood, body fluids, and feces. b. wash hands and put on gloves c. provide bedpan for pt d. place incontinence pads in trash

a. Wear personal protective equipment when handling blood, body fluids, and feces.

Which of the following is a sign or symptoms of septic shock? a. altered mental status b. hypertension c. increased urine output d. warm, moist skin

a. altered mental status Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension

A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient? a. visitors can only visit for a max of 5 min b. a lead vest should be worn when caring for pt c. explain to the patient that she will continue to emit radiation while the implant is in place.

c. explain to the patient that she will continue to emit radiation while the implant is in place.

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. metastasis of tumor b. angiogenesis of tumor c. tumor pressure against normal tissues

c. Tumor pressure against normal tissues

What should the nurse tell a female client who is about to begin chemotherapy and anxious about losing her hair? a. Client should shave head as soon as possible in order to come to terms with hair loss before beginning treatment b. hair should have same texture and color when it grows back c. Warn client that hair loss may be permanent d. advise client to she can get a wig or cap before she loses her hair.

d. advise client to she can get a wig or cap before she loses her hair.

The nurse is evaluating the client's risk for cancer and recommends changes when the client states she a. eats red meat such as steaks or hamburgers every day b. exercises 30 minutes on 5 days or more c. drinks a glass of wine everyday with dinner

a. eats red meat such as steaks or hamburgers every day

The nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. The nurse a. encourage visitors to improve pt mood b. place client in private room c. assign pregnant nursing assistant to pt

b. place client in private room precautions 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, as in the case of the nursing assistant.

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. hair loss is temporary b. hair color and texture will not change once hair regrows c. you can start wearing wigs after completing treatment d. treatment will delay the greying of your hair

a. hair loss is temporary

client with cancer is being evaluated for possible metastasis. Which of the following is one of the most common metastasis sites for cancer cells? a. Liver b. Colon c. Reproductive tract d. White blood cells (WBCs)

a. liver The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites.

A patient with metastatic pancreatic cancer underwent surgery for removal of a malignant tumor in his pancreas. Despite the tumor being removed, the physician informs the patient that he needs to start chemotherapy. Which of the following may be a reason for the physician to opt for chemotherapy? a. metastasis b. angiogenesis c. stomatitis d. fatigue

a. metastasis

Nursing action for extravasation of a chemotherapeutic agent would include which of the following nursing actions? 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. application of warm compress to aid healing

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.

Which of the following occurs when there is accumulation of fluid in the pericardial space that compresses the heart? a. Cardiac tamponade b. SVCS c. SIADH d. DIC

a.cardiac tamponade -Cardiac tamponade: accumulation of fluid in the pericardial space -SVCS: compression or invasion of the superior vena cava by a tumor, enlarged lymph nodes, intraluminal thrombosis that obstructs venous circulation, or drainage of the head, neck, arms, and thorax -SIADH is the continuous, uncontrolled release of ADH. -DIC is a complex disorder of coagulation or fibrinolysis which results in thrombosis or bleeding.

Which type of vaccine uses the patient's own cancer cells, which are prepared for injection, back into the patient?

autologous

A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient? a. Provide aseptic care to the incision postoperatively. b. Provide time for the patient to discuss her concerns. c.

b. Provide time for the patient to discuss her concerns.

A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan? a. lead apron should be worn during treatment b. avoid using soap on the irradiated areas c. skin markings should be removed prior to treatment

b. avoid using soap on the irradiated areas

Based on the understanding of the effects of chemotherapy, the nurse would anticipate which of the following clinical findings in a client 2 weeks post therapy? a. high fever b. ease of bruising c. elevated WBC d. change in haircolor

b. ease of bruising The effects of chemotherapy can include myelo suppression, resulting in anemia or bleeding tendencies, as exhibited in ease in bruising. Elevated temperature and WBCs are signs of infection and are anticipated findings after chemotherapy treatment. Re growth of hair after alopecia can result in change of hair color but not anticipated 2 weeks post treatment.

The nurse is working with a patient who has had an allohematopoietic stem cell transplant (HSCT) and notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the patient has symptoms of which of the following? a. graft versus tumor disease b. graft versus host disease c. hypersensitivity reaction d. anaphylaxis

b. graft versus host disease Clinical manifestation of the disease include diffuse rash that progresses to blistering and desquamation, and mucosal inflammation of the eyes and the entire GI tract with subsequent diarrhea, abdominal pain, and hepatomegaly

A patient is undergoing chemotherapy treatment for prostate cancer and has lost considerable weight due to nausea and vomiting. Which of the following nursing interventions is appropriate for the patient? a. nurse should limit fluid intake b. nurse should provide fresh fruits for client c. administer beta blockers d. adjust meal plan before/after chemotherapy

d. adjust meal plan before/after chemotherapy

The 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. The nurse states: a. you may choose to discontinue this test b. you will need to continue this test for the rest of your lfie c. you need to continue this test but only for 5 more yrs

a. you may choose to discont. this test women 70 years or older, who have had normal Pap tests for 10 years, and who have had a total hysterectomy may choose to stop cervical cancer screening as in a Pap test.

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. malignant tumor that has metastasized b. benign fibrocystic c. malignant tumor

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

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:

Increase her intake of calcium-rich foods.

Chemotherapeutic agents have which effect associated with the renal system? a. hypokalemia b. hypercalcemia c. hypophosphatemia d. increased uric acid excretion

Increased uric acid excretion . Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.

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. chemotherapy exposure and risk factors. b. signs and symptoms of infection c. reinforcement of medication regime d. information on potential adverse effects

a. chemotherapy exposure and risk factors. raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. 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.

A serum sodium level lower than 110 mEq/L is associated with a. myalgia b. seizure c. anorexia d. weight gain

b. seizure Serum sodium levels lower than 110: seizures, abnormal reflexes, papilledema, coma, and death Anorexia, weight gain, and myalgia are associated with serum sodium levels lower than 120 mEq/L.

A client with ovarian cancer is ordered hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with: a. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle-nonspecific). b. normal cellular processes during the S phase of the cell cycle.

b. normal cellular processes during the S phase of the cell cycle. (cell-cycle specific) Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. 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 (cell cycle nonspecific) Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.

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 second and third drugs do not increase the effectiveness of the first b. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms c. The first two drugs are toxic to cancer cells while the third drug promotes cell growth.

b. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms 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.