Ch. 12 Med-Surg: Management of Patients with Oncologic Disorders

The hospice nurse has just admitted a new client to the program. What principle guides hospice care? A. Care addresses the needs of the client as well as the needs of the family. B. Care is focused on the client centrally and the family peripherally. C. The focus of all aspects of care is solely on the client. D. The care team prioritizes the client's physical needs and the family is responsible for the client's emotional needs.

A. Care addresses the needs of the client as well as the needs of the family. Rationale: The focus of hospice care is on the family as well as the client. The family is not solely responsible for the client's emotional well-being. P 363

The nurse is caring for a client who is to begin receiving external radiation for a malignant tumor of the neck. While providing client education, what potential adverse effects should the nurse discuss with the client? A. Impaired nutritional status B. Cognitive changes C. Diarrhea D. Alopecia

A. Impaired nutritional status Rationale: Alterations in oral mucosa, change and loss of taste, pain, and dysphasia often occur as a result of radiotherapy to the head and neck. The client is at an increased risk of impaired nutritional status. Radiotherapy does not cause cognitive changes. Diarrhea is not a likely concern for this client because of the location of the radiotherapy. Radiation only results in alopecia when targeted at the whole brain; radiation of other parts of the body does not lead to hair loss. P 336

The nurse is conducting a health education about cancer prevention to a group of adults. What menu best demonstrates dietary choices for potentially reducing the risks of cancer? A. Smoked salmon and green beans B. Pork chops and fried green tomatoes C. Baked apricot chicken and steamed broccoli D. Liver, onions, and steamed peas

C. Baked apricot chicken and steamed broccoli Rationale: Fruits and vegetables appear to reduce cancer risk. Salt-cured foods, such as ham and processed meats, as well as red meats, should be limited. P 309

Which nursing action best demonstrates primary cancer prevention? A. Encouraging yearly Pap tests B. Teaching testicular self-examination C. Promoting and providing vaccines D. Facilitating screening mammograms

C. Promoting and providing vaccines Rationale: Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as promoting vaccines that prevent cancer. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Pap tests, mammograms, and testicular exams. P 331

A client with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this client's plan of care? A. Limit the time that visitors spend at the client's bedside. B. Teach the client to perform all aspects of basic care independently. C. Assign male nurses to the client's care whenever possible. D. Situate the client in a shared room with other clients receiving brachytherapy.

A. Limit the time that visitors spend at the client's bedside. Rationale: To limit radiation exposure, visitors should generally not spend more than 30 minutes with the client. Pregnant nurses or visitors should not be near the client, but there is no reason to limit care to nurses who are male. All necessary care should be provided to the client and a single room should be used. P 319

When discussing with a client factors that distinguish malignant cells from benign cells of the same tissue type, which characteristic should the nurse mention? A. Slow rate of mitosis of cancer cells B. Different proteins in the cell membrane C. Differing size of the cells D. Different molecular structure in the cells

B. Different proteins in the cell membrane Rationale: The cell membrane of malignant cells also contains proteins called tumor-associated antigens (e.g., carcinoembryonic antigen [CEA] and prostate-specific antigen [PSA]), which develop over time as the cells become less differentiated (mature). These proteins distinguish malignant cells from benign cells of the same tissue type. P 303

A client's most recent diagnostic imaging has revealed that lung cancer has metastasized to the bones and liver. What is the most likely mechanism by which the client's cancer cells spread? A. Apoptosis B. Lymphatic circulation C. Invasion D. Angiogenesis

B. Lymphatic circulation Rationale: Lymph and blood are key mechanisms by which cancer cells spread. Lymphatic spread (the transport of tumor cells through the lymphatic circulation) is the most common mechanism of metastasis. Apoptosis is a normal cell mechanism of programmed cellular death that helps eliminate cells that have DNA mutations to prevent disease. Cancer cells, however, can bypass this protective function, survive, and proliferate. Therefore, apoptosis would prevent the spread of cancer, not promote it. Invasion in cancer is the direct extension and penetration by cancer cells through neighboring tissue; the bones and liver in this case, however, are not neighboring tissues. Angiogenesis is the growth of new blood vessels that allow cancer cells to grow. However, it, in itself, is not a mechanism by which cancer cells spread. P 312

An oncology nurse educator is providing health education to a client who has been diagnosed with skin cancer. The client's wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite? A. Malignant cells possess greater mobility than normal body cells. B. Malignant cells contain proteins called tumor-associated antigens. C. Chromosomes contained in cancer cells are more durable and stable than those of normal cells. D. The nuclei of cancer cells are unusually large, but regularly shaped.

B. Malignant cells contain proteins called tumor-associated antigens. Rationale: The cell membranes are altered in cancer cells, which affect fluid movement in and out of the cell. The cell membrane of malignant cells also contains proteins called tumor-associated antigens. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism), though they are not always mobile. Fragility of chromosomes is commonly found when cancer cells are analyzed. P 308

A client was diagnosed with cancer several weeks ago and family members describe the client as "utterly distraught." The client has fully withdrawn from social and family contact. What is the nurse's best action? A. Reassure the client and the family that these types of responses to cancer are common. B. Refer the client to the appropriate mental health provider. C. Educate the client about the mental health benefits of exercise. D. Reassure the family that the client is grieving and will eventually come to terms with the diagnosis.

B. Refer the client to the appropriate mental health provider. Rationale: Emotional responses to cancer diagnosis are expected, but this client's response is atypical. The nurse should avoid false reassurance and exercise alone is unlikely to provide a solution. For these reasons, a referral is necessary. P 355

The public health nurse is presenting a health promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America? A. Monthly self-breast exams B. Smoking cessation C. Annual colonoscopies D. Monthly testicular exams

B. Smoking cessation Rationale: The leading causes of cancer death, in order of frequency, are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women. Smoking cessation is the health promotion initiative directly related to lung cancer. P 305

Which intervention should the nurse teach a client who is at risk for hypercalcemia? A. Avoid the use of stool softeners. B. Take laxatives daily. C. Consume 2 to 4 L of fluid daily. D. Restrict calcium intake.

C. Consume 2 to 4 L of fluid daily. Rationale: The nurse should encourage clients at risk for hypercalcemia to consume 3 to 4 L of fluid daily unless contraindicated by existing renal or cardiac disease to address the constipation and dehydration that results from this condition. Dietary and pharmacologic interventions for constipation such as stool softeners and laxatives may be appropriate for the client, although daily laxative use may not be. The nurse should advise clients to maintain nutritional intake without restricting normal calcium intake. P 362

During a routine mammogram, a client asks the nurse whether breast cancer causes the most deaths. Which type of cancer is the leading cause of death in the United States? A. Colorectal B. Prostate C. Lung D. Breast

C. Lung Rationale: Lung cancer is the leading cause of cancer-related deaths in the United States, followed by prostate cancer in men and breast cancer in women. Colorectal cancer is the third-leading cause of cancer-related deaths in the United States. Cancer is a common health problem worldwide. P 303

A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity? A. Disease prophylaxis B. Risk reduction C. Secondary prevention D. Tertiary prevention

C. Secondary prevention Rationale: Secondary prevention involves screening and early detection activities that seek to identify early-stage cancer in individuals who lack signs and symptoms suggestive of cancer. Primary prevention is concerned with reducing the risks of disease through health promotion strategies. Tertiary prevention is the care and rehabilitation of the client after having been diagnosed with cancer. P 308

A nurse provides care on a bone marrow transplant unit and is preparing a client for a hematopoietic stem cell transplantation (HSCT) the following day. Which information should the nurse emphasize to the client's family and friends? A. "Your family should likely gather at the bedside in case there is a negative outcome." B. "Make sure the client doesn't eat any food in the 24 hours before the procedure." C. "Wear a hospital gown when you go into the client's room." D. "Do not visit if you've had a recent infection."

D. "Do not visit if you've had a recent infection." Rationale: Before HSCT, clients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they have had a recent illness or vaccination. Gowns should indeed be worn, but this is secondary in importance to avoiding the client's contact with ill visitors. Prolonged fasting is unnecessary. Negative outcomes are possible, but the procedure would not normally be so risky as to require the family to gather at the bedside. P 329

A client with terminal small-cell lung cancer has been given a six-month prognosis and wants to die at home. The health care team believes the condition warrants inpatient care. The nurse might suggest which compromise? A. Discuss a referral for rehabilitation hospital. B. Panel the client for a personal care home. C. Discuss a referral for acute care. D. Discuss a referral for hospice care

D. Discuss a referral for hospice care Rationale: Hospice care can be provided in several settings. Because of the high cost associated with free-standing hospices, care is often delivered by coordinating services provided by both hospitals and the community. The primary goal of hospice care is to provide support to the client and family. Clients who are referred to hospice care generally have fewer than six months to live. Each of the other listed options would be less appropriate for the client's physical and psychosocial needs. P 363

While on spring break, a 22-year-old client was taken to the hospital for heat stroke and alcohol poisoning. The client is worried and states that a biopsy was taken and showed "some kind of benign condition." Which response by the nurse would be best? A. "I understand that you are worried. Benign conditions are noncancerous, but let's look at your chart to see your results." B. "You have every right to be upset; a benign condition means you may have cancerous cells. Let me call your health care provider to talk to you." C. "Are you sure a biopsy was done? Your admitting diagnosis would not prompt that kind of procedure." D. "Do not worry; if something was wrong, your primary health care provider would have told you and started treatment."

A. "I understand that you are worried. Benign conditions are noncancerous, but let's look at your chart to see your results." Rationale: As a therapeutic listener, it is important to acknowledge the client's feelings and try to provide a resolution. Benign conditions are defined as noncancerous, and any treatment ordered would have been known by nursing. There is no reason to doubt the client's word regarding the biopsy, and, in any case, the nurse can confirm that the biopsy was performed by reviewing the client's chart. The client's admitting diagnosis could have promoted this test. Heat stroke and alcohol poisoning could enhance the body's inability to regulate internal temperatures and increase skin damage. The primary care provider may not have had time yet to discuss the details of the finding or to have initiated any treatment necessary. Also, this response does not provide the explanation of what "benign" means. P 354

An adult client with leukemia will soon begin chemotherapy. What would the nurse do to combat the most common adverse effects of chemotherapy? A. Administer an antiemetic. B. Administer an antimetabolite. C. Administer a tumor antibiotic. D. Administer an anticoagulant

A. Administer an antiemetic. Rationale: Antiemetics are used to treat nausea and vomiting, the most common adverse effects of chemotherapy. Antihistamines and certain steroids are also used to treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli. P 326

A nurse who works in an oncology clinic is assessing a client who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the client's skin appears yellow. Which blood tests should be done to further explore this clinical sign? A. Liver function tests (LFTs) B. Complete blood count (CBC) C. Platelet count D. Blood urea nitrogen and creatinine

A. Liver function tests (LFTs) Rationale: Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count, and tests of renal function would not directly assess for liver disease. P 328

While a client is receiving intravenous (IV) doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize which action? A. Stopping the administration of the drug immediately B. Notifying the client's health care provider C. Continuing the infusion but decreasing the rate D. Applying a warm compress to the infusion site

A. Stopping the administration of the drug immediately Rationale: Doxorubicin hydrochloride is a chemotherapeutic vesicant that can cause severe tissue damage. The nurse should stop the administration of the drug immediately and then notify the client's health care provider. Ice can be applied to the site once the drug therapy has stopped. P 325

The nurse is admitting an oncology client to the unit prior to surgery. The nurse reads in the electronic health record that the client has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem? A. Cognitive deficits B. Impaired wound healing C. Cardiac tamponade D. Tumor lysis syndrome

B. Impaired wound healing Rationale: Combining other treatment methods, such as radiation and chemotherapy, with surgery contributes to postoperative complications, such as infection, impaired wound healing, altered pulmonary or renal function, and the development of deep vein thrombosis. Cardiac tamponade, cognitive effects, and tumor lysis syndrome are less commonly associated with combination therapy. P 315

A client is hospitalized because a large abdominal tumor was seen on the computed tomography scan. A biopsy is ordered, and the client wants to know if "this will cause a big scar." Which type of biopsy will this client likely experience? A. Excisional B. Incisional C. Needle D. Fine needle

B. Incisional Rationale: An incisional biopsy is performed if the tumor is too large to be removed. An excisional biopsy is used for small, easily accessible tumors. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible. Fine needle biopsy aspirates cells rather than tissue. Needle biopsies are usually done in an outpatient setting. The biopsy type is chosen based on size, location, and whether a cancer diagnosis was confirmed. The client will have a scar and the size will depend on whether it will be performed by endoscopy or laparotomy. P 313

The nurse is caring for a client with an advanced stage of breast cancer and the client has recently learned that the cancer has metastasized. The nurse enters the room and finds the client struggling to breathe, and the nurse's rapid assessment reveals that the client's jugular veins are distended. The nurse should suspect the development of what oncologic emergency? A. Increased intracranial pressure B. Superior vena cava syndrome (SVCS) C. Spinal cord compression D. Metastatic tumor of the neck

B. Superior vena cava syndrome (SVCS) Rationale: SVCS occurs when there is gradual or sudden impaired venous drainage giving rise to progressive shortness of breath (dyspnea), cough, hoarseness, chest pain, and facial swelling; edema of the neck, arms, hands, and thorax and reported sensation of skin tightness and difficulty swallowing; as well as possibly engorged and distended jugular, temporal, and arm veins. Increased intracranial pressure may be a part of SVCS, but it is not what is causing the client's symptoms. The scenario does not mention a problem with the client's spinal cord. The scenario says that the cancer has metastasized, but not that it has metastasized to the neck. P 360

A client has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray showed carcinoma. The client reports feeling anxious and asks to smoke. Which statement by the nurse would be most therapeutic? A. "Smoking is the reason you are here." B. "The doctor left orders for you not to smoke." C. "You are anxious about the surgery. Do you see smoking as helping?" D. "Smoking is OK right now, but after your surgery it is contraindicated."

C. "You are anxious about the surgery. Do you see smoking as helping?" Rationale: Stating, "You are anxious about the surgery. Do you see smoking as helping?" acknowledges the client's feelings and encourages the client to assess their previous behavior. Saying, "Smoking is the reason you are here," belittles the client. Citing the doctor's orders does not address the client's anxiety. Giving approval for smoking would be highly detrimental to this client. Smoking is the single most lethal chemical carcinogen and accounts for about 30% of all cancer-related deaths. P 315

The nurse manager is orienting a new nurse to the oncology unit. When reviewing the safe administration of antineoplastic agents, which action should the nurse manager emphasize? A. Adjust the dose to the client's present symptoms. B. Wash hands with an alcohol-based cleanser following administration. C. Use gloves and a lab coat when preparing the medication. D. Dispose of the antineoplastic wastes in the hazardous waste receptacle.

D. Dispose of the antineoplastic wastes in the hazardous waste receptacle. Rationale: The nurse should use surgical gloves and disposable long-sleeved gowns when administering antineoplastic agents. The antineoplastic wastes are disposed of as hazardous materials. Dosages are not adjusted on a short-term basis. Hand and arm hygiene must be performed before and after administering the medication. P 327

A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The client has asked if they will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this client most likely undergo? A. Lymphadenectomy B. Needle biopsy C. Open biopsy D. Sentinel node biopsy

D. Sentinel node biopsy Rationale: Sentinel lymph node biopsy (SLNB), also known as sentinel lymph node mapping, is a minimally invasive surgical approach that, in some instances, has replaced more invasive lymph node dissections (lymphadenectomy) and their associated complications such as lymphedema and delayed healing. SLNB has been widely adopted for regional lymph node staging in selected cases of melanoma and breast cancer. P 313

The clinic nurse is caring for an adult oncology client who reports extreme fatigue and weakness after the first week of radiation therapy. Which response by the nurse would best reassure this client? A. "These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory studies and test results." B. "These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer." C. "Try not to be concerned about these symptoms. Every client feels this way after having radiation therapy." D. "Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying."

A. "These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory studies and test results." Rationale: Fatigue and weakness result from radiation treatment and usually do not represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the client and should not be belittled. Radiation destroys both cancerous and normal cells. P 318

The nurse is caring for a client who has just been told that the client's stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the client the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? A. Palliative B. Reconstructive C. Salvage D. Prophylactic

A. Palliative Rationale: When cure is not possible, the goals of treatment are to make the client as comfortable as possible and to promote quality of life as defined by the client and family. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or 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. Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk to develop cancer. P 315

The nurse is describing some of the major characteristics of cancer to a client who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply. A. Rate of growth B. Ability to cause death C. Cell size D. Cell location E. Ability to spread

A. Rate of growth B. Ability to cause death E. Ability to spread Rationale: Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant. Both benign and malignant cells can occur anywhere in the body. P 303

A 16-year-old female client has post-chemotherapy alopecia. This prompts the nursing diagnoses of Disturbed Body Image and Situational Low Self-Esteem. Which response by the client would best indicate improved coping related to these diagnoses? A. Requests that her family bring her makeup and a wig B. Begins to discuss the future with her family C. Reports less disruption from pain and discomfort D. Cries openly when discussing her disease

A. Requests that her family bring her makeup and a wig Rationale: Requesting her wig and makeup indicates that the client with alopecia is becoming interested in looking her best and that her body image and self-esteem may be improving. The other options may indicate that other nursing goals are being met, but they do not necessarily indicate improved body image and self-esteem. P 342

The home health nurse is performing a home visit for an oncology client discharged three days ago after completing chemotherapy treatment for non-Hodgkin lymphoma. The nurse's priority assessment should include examination for the signs and symptoms of which complication? A. Tumor lysis syndrome (TLS) B. Syndrome of inappropriate antidiuretic hormone (SIADH) C. Disseminated intravascular coagulation (DIC) D. Hypercalcemia

A. Tumor lysis syndrome (TLS) Rationale: TLS is a potentially fatal complication that occurs spontaneously or more commonly following radiation, biotherapy, or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia, lymphoma, and small-cell lung cancer. DIC, SIADH, and hypercalcemia are less likely complications following this treatment and diagnosis. P 362

A client newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe? A. Pruritis (itching) B. Nausea and vomiting C. Altered glucose metabolism D. Confusion

B. Nausea and vomiting Rationale: Nausea and vomiting, the most common side effects of chemotherapy, may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these clients. Confusion, alterations in glucose metabolism, and pruritus are less common adverse effects. P 322

The nurse is performing an initial assessment of a 75-year-old client who has just relocated to the long-term care facility. During the nurse's interview with the client, the client admits drinking around 600 mL (20 oz) of vodka every evening. What types of cancer does this put the client at risk for? Select all that apply. A. Malignant melanoma B. Brain cancer C. Breast cancer D. Esophageal cancer E. Liver cancer

C. Breast cancer D. Esophageal cancer E. Liver cancer Rationale: Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods, and red and processed meats. Alcohol increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast. P 307

A client on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in clients at risk for thrombocytopenia? A. Interrupted sleep pattern B. Hot flashes C. Epistaxis D. Increased weight

C. Epistaxis Rationale: Clients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. Clients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight. P 348

A woman with a family history of breast cancer received a positive result on a breast tumor marking test and is requesting a bilateral mastectomy. This surgery is an example of which type of oncologic surgery? A. Salvage surgery B. Palliative surgery C. Prophylactic surgery D. Reconstructive surgery

C. Prophylactic surgery Rationale: Prophylactic surgery is used when there is an extensive family history and nonvital tissues are removed. 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. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. P 314

The nurse on a bone marrow transplant unit is caring for a client with cancer who has just begun hematopoietic stem cell transplantation (HSCT). What is the priority nursing diagnosis for this client? A. Fatigue related to altered metabolic processes B. Altered nutrition: less than body requirements related to anorexia C. Risk for infection related to altered immunologic response D. Body image disturbance related to weight loss and anorexia

C. Risk for infection related to altered immunologic response Rationale: Risk for infection related to altered immunologic response is the priority nursing diagnosis. HSCT involves intravenous infusion of autologous or allogeneic stem cells to promote red blood cell production in clients with compromised bone marrow or immune function, such as due to blood or bone marrow cancer. It carries an increased risk of sepsis and bleeding. The client's immunity is suppressed by the underlying condition necessitating the HSCT, the HSCT itself, and any cancer medications received. The client has a high risk for infection. Fatigue is appropriate but not the most critical nursing diagnosis. Altered nutrition and body image disturbance could be valid nursing diagnoses but would be of lower priority than risk for infection. P 337