Ch 15 Prep U
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 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.
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 "You will be unable to have children." "You will experience menopause now." "You will need to practice birth control measures." "You will continue having your menses every month."
"You will need to practice birth control measures." 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 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? Neutropenia Extravasation Stomatitis Nadir
Stomatitis 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.
After a bone marrow transplant (BMT), the client should be monitored for at least: 14 days 60 days 30 days 100 days
100 days 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.
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? Fish and poultry Eggs and milk Green, leafy vegetables Ham and bacon
HamandBacon
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? "You could have stopped immediately after your hysterectomy." "You will need to continue for the rest of your life." "You need to continue obtaining a Pap test for only the next 5 years." "You may choose to discontinue this test."
"You may choose to discontinue this test." 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 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? Grieving Knowledge Deficit Fear Sexual Dysfunction
Fear 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 has just received stem cell transplantation as treatment for leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation? Closely monitor the client for at least 3 months. Closely monitor the client for at least 5 months. Closely monitor the client for at least 4 weeks. Closely monitor the client for at least 3 days.
Closely monitor the client for at least 3 months. Explanation: After stem cell transplantation, the nurse closely monitors the client for at least 3 months because complications related to the transplant are still possible and infections are very common.
According to the tumor-node-metastasis (TNM) classification system, T0 means there is: No distant metastasis Distant metastasis No evidence of primary tumor No regional lymph node metastasis
No evidence of primary tumor Explanation: T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis.
Based on the understanding of the effects of chemotherapy, the nurse would anticipate which clinical finding in a client 2 weeks after therapy? elevated white blood cells count constipation fever change in hair color
fever Explanation: The effects of chemotherapy two weeks after treatment can result in a fever. Regrowth of hair after alopecia can result in change of hair color, but this effect is not anticipated 2 weeks after treatment. White blood cell count will be decreased 2 weeks after chemotherapy. Constipation is not usually seen 2 weeks after chemotherapy treatment.
When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply. Hyperphosphatemia Hyperkalemia Hypercalcemia Hyperuricemia
Hyperkalemia Hyperuricemia Hyperphosphatemia Explanation: When intracellular contents are released into the bloodstream, phosphorous is elevated. This results in an inverse decline in the levels of calcium, so hypercalcemia would not occur.
5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? Antimetabolite Alkylating Mitotic spindle poisons Nitrosoureas
Antimetabolite 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).
A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with: seizure. weight gain. myalgia. anorexia.
seizure. 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 client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis? Yellow tooth discoloration White, cottage cheese-like patches on the tongue Red, open sores on the oral mucosa Rust-colored sputum
Red, open sores on the oral mucosa. The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.
The drug interleukin-2 is an example of which type of biologic response modifier? Retinoids Antimetabolites Monoclonal antibodies Cytokine
Cytokine 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.
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? symptoms of constipation symptoms of anemia symptoms of gout symptoms of hypertension
symptoms of gout 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.
The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client? Enhance action of the chemotherapy Suppression of the bone marrow Shorten the period of neutropenia Decrease the need for additional adjuvant therapies
Shorten the period of neutropenia Explanation: Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation. The suppression of bone marrow creates the need for interferon use, not a result of the use. Although some BRMs can inhibit tumor growth, the primary use is for reducing neutropenia. Interferon use does not replace standard cancer treatments or decrease the need for those treatments.
The nurse is conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome? An aunt and uncle diagnosed with cancer A second cousin diagnosed with cancer A first cousin diagnosed with cancer Onset of cancer after age 50 in family member
An aunt and uncle diagnosed with cancer 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 providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? Avoid spicy and fatty foods. Avoid intake of fluids. Eat wholesome meals. Eat warm or hot foods.
Avoid spicy and fatty foods. The nurse advises a client undergoing chemotherapy to avoid hot and very cold liquids and spicy and fatty foods. The nurse also encourages the client to have small meals and appropriate fluid intake.
The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important? Prepare food separately from family members. Flush the toilet several times after every use. Use disposable utensils for the next month. Shield your throat area when near others.
Flush the toilet several times after every use. 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.
Chemotherapeutic agents have which effect associated with the renal system? Hypokalemia Hypercalcemia Hypophosphatemia Increased uric acid excretion
Increased uric acid excretion 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.
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? Use a soft toothbrush and allow it to air dry before storing. Gargle after each meal. Treat cavities immediately. Floss before going to bed.
Use a soft toothbrush and allow it to air dry before storing. 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 recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed? "I guess the doctor could not remove the entire tumor." "Thank goodness the tumor is contained and curable." "I will be glad to finally be done with treatments for this thing." "I am so glad the doctor was able to remove the entire tumor."
"I guess the doctor could not remove the entire tumor." 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.
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? Administering metoclopramide and dexamethasone as ordered Encouraging rhythmic breathing exercises Withholding fluids for the first 4 to 6 hours after chemotherapy administration Serving small portions of bland food
Administering metoclopramide and dexamethasone as ordered 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.
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: reinforcement of the client's medication regimen. expected chemotherapy-related adverse effects. signs and symptoms of infection. chemotherapy exposure and risk factors.
chemotherapy exposure and risk factors. Explanation: The raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify her teaching plan to include content related to chemotherapy exposure and its associated risk factors. Because the client has received chemotherapy, the plan should already include information about expected adverse effects, signs and symptoms of infection, and reinforcement of the medication regimen.
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? Ulceration Infection Fatigue High cholesterol levels
Fatigue 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.
Which of the following does a nurse have to assess during the bone marrow transplant (BMT) procedure? Psychological status Electrolyte levels Urine gravity status Blood pressure status
Psychological status Explanation: During the BMT procedure, the nurse assesses the patient's psychological status. Patients experience many mood swings and need emotional support and help throughout this process. Assessing the patient's blood pressure, urine gravity, and electrolyte levels is important for patients undergoing chemotherapy.
A nurse 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: Report the unexpected sign of increased appetite and weight gain. Report the unusual sign of nausea. Increase her intake of calcium-rich foods. Be alarmed if she notices fluid retention.
Increase her intake of calcium-rich foods. 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.
In which phase of the cell cycle does cell division occur? Mitosis G2 phase S phase G1 phase
Mitosis 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.
The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic? Undifferentiated cells Slow rate of growth Causes generalized symptoms Ability to invade other tissues
Slow rate of growth 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 newly discovered tumor that may be benign or malignant. The client asks, "What makes a malignant tumor different from a benign one?" What should the nurse include in the response? Select all that apply. "It does not spread to other areas of the body through blood and lymph channels." "The tumor may regress after its initial growth." "The cells of the tumor bear little resemblance to the cells in the tissue where the tumor started." "The tumor grows slowly and may stop." "It grows by invasion and infiltrates the surrounding tissues."
"The cells of the tumor bear little resemblance to the cells in the tissue where the tumor started." "It grows by invasion and infiltrates the surrounding tissues." Explanation: The nurse should include the statements: "The cells of the tumor bear little resemblance to the cells in the tissue where the tumor started" and "It grows by invasion and infiltrates the surrounding tissues" in the response. Undifferentiated cells and growth by invasion are both characteristics of malignant tumors. Benign tumors are characterized by slow growth, not metastasizing, and the possibility of regression, while malignant tumors are not.
When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? Inspect the skin frequently. Time, distance, and shielding The use of disposable utensils and wash cloths Avoid showering or washing over skin markings.
Inspect the skin frequently. Explanation: Inspecting the skin frequently will allow early identification and intervention of skin problems associated with external radiation therapy. The external markings should not be removed, but clients may shower and lightly wash over the skin. Time, distance, and shielding are key in the management of sealed, internal radiation therapy and not external beam radiation. The use of disposable utensils and care items would be important when caring for clients following systemic, unsealed, internal radiation therapy.
What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss? Alopecia related to chemotherapy is relatively uncommon. The hair will grow back the same as it was before treatment. The hair will grow back within 2 months post therapy. The client should consider getting a wig or cap prior to beginning treatment.
The client should consider getting a wig or cap prior to beginning treatment. Explanation: 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.
A client, 66 years old, has just been diagnosed with multiple myeloma (a cancer of the plasma) and will be initiating chemotherapy. The nurse, in an outpatient clinic, reviews the medications the client has been taking at home. The medications include pantoprazole for gastroesophageal reflux disease (GERD) and an over-the-counter calcium supplement to prevent osteoporosis. What interventions should the nurse take? Select all that apply. teaches the client to report abdominal or bone pain provides information about antidiarrheal medication asks about nausea and vomiting instructs the client to discontinue calcium restricts fluids to 1500 mL per day
instructs the client to discontinue calcium asks about nausea and vomiting teaches the client to report abdominal or bone pain Explanation: The client with cancer is at risk for hypercalcemia from bone breakdown. The client should not take an over-the-counter calcium supplement that would increase blood levels of calcium. Signs and symptoms of hypercalcemia include nausea and vomiting. The client may also report abdominal or bone pain with cancer. The client should increase fluid intake to 2 to 4 L per day. Intake would have to be adjusted based on the client's other medical conditions. GERD would not negate an increase in fluid intake. The client most likely would have constipation with hypercalcemia, not diarrhea.
Palliation refers to: relief of symptoms associated with disease and promotion of comfort and quality of life. the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow. the spread of cancer cells from the primary tumor to distant sites. hair loss related to the treatment of cancer.
relief of symptoms associated with disease and promotion of comfort and quality of life. Explanation: Palliation is the goal for care in patients with terminal cancer. Alopecia is the term that refers to hair loss. Metastasis is the term that refers to the spread of cancer cells from the primary tumor to distant sites. Nadir is the term that refers to the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow.
A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action? Place the client in a private room. Place a chair next to the bed to allow the spouse to sit. Allow visitors to telephone only. Have visitors wear dosimeters for safety.
Place the client in a private room. 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.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? Initiation Prolongation Progression Promotion
Progression Explanation: Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information, even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.
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? Avoiding using soap on the irradiated areas Applying talcum powder to the irradiated areas daily after bathing Wearing a lead apron during direct contact with the client Removing thoracic skin markings after each radiation treatment
Avoiding using soap on the irradiated areas 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 nurse is teaching a client with bone marrow suppression about the time frame when bone suppression will be noticeable after administration of floxuridine. What is the time frame the nurse should include with client teaching? 2 to 4 days 7 to 14 days 21 to 28 days 24 hours
7 to 14 days Explanation: Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.
The nurse understands that the client should be given human papillomavirus (HPV) vaccine per the health care provider's orders. What does this vaccine help prevent? lung cancer leukemia cervical cancer breast cancer
cervical cancer Explanation: The vaccines that are approved for use in the United States include the human papillomavirus (HPV), which may help prevent women from getting cervical cancer. There are no vaccines for the prevention of lung cancer, breast cancer, or leukemia.
During a client's examination and consultation, the physician keeps telling the client, "You have an abdominal neoplasm." Which statements accurately paraphrase the physician's statement? Select all that apply. "You have an abdominal malignancy." "You have abdominal cancer." "You have an abdominal tumor." "You have a new growth of abnormal tissue in your abdomen."
"You have a new growth of abnormal tissue in your abdomen." "You have an abdominal tumor." Explanation: New growths of abnormal tissue are called "tumors." Tumors may be benign or malignant; not all tumors are cancerous.
Which occurs when fluid accumulates in the pericardial space and compresses the heart? Cardiac tamponade SIADH Superior vena cava syndrome (SVCS) DIC
Cardiac tamponade Explanation: Cardiac tamponade is an accumulation of fluid in the pericardial space. SVCS occurs when the superior vena cava is compressed or invaded by a tumor, lymph nodes are enlarged, intraluminal thrombosis obstructs venous circulation, or drainage occurs from the head, neck, arms, and thorax. SIADH is the continuous, uncontrolled release of ADH. DIC is a complex disorder of coagulation or fibrinolysis that results in thrombosis or bleeding.
A client diagnosed with cancer has the tumor staged and graded based on what factors? How they differentiate the cell type How they tend to grow and the cell type How they spread and tend to grow How they spread and differentiate
How they tend to grow and the cell type Explanation: Tumors are staged and graded based upon how they tend to grow and the cell type before a client is treated for cancer.
The lethal tumor dose is defined as the dose that will eradicate what percentage of the tumor yet preserve normal tissue? 75% 85% 65% 95%
95% Explanation: The radiation dosage is dependent on the sensitivity of the target tissues to radiation and on the tumor size. The lethal tumor dose is defined as the dose that will eradicate 95% of the tumor yet preserve normal tissue.
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? "I use an electric razor to shave." "I take a stool softener every morning." "I floss my teeth every morning." "I removed all the throw rugs from the house."
"I floss my teeth every morning." Explanation: 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 statement by a client undergoing external radiation therapy indicates the need for further teaching? "I'll wear protective clothing when outside." "I'll not use my heating pad during my treatment." "I'm worried I'll expose my family members to radiation." "I'll wash my skin with mild soap and water only."
"I'm worried I'll expose my family members to radiation." Explanation: The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client's family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad.
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? It's cell cycle-phase specific. It inhibits protein synthesis. It inhibits deoxyribonucleic acid (DNA) synthesis. It inhibits ribonucleic acid (RNA) synthesis.
It inhibits deoxyribonucleic acid (DNA) synthesis. 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 nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse? It lowers serum and uric acid levels. It stimulates the immune system against the tumor cells. It prevents alopecia. It treats drug-related anemia.
It lowers serum and uric acid levels. 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 decrease in circulating white blood cells (WBCs) is referred to as Thrombocytopenia Granulocytopenia Leukopenia Neutropenia
Leukopenia 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 client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells? White blood cells (WBCs) Colon Liver Reproductive tract
Liver Explanation: The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites.
Which is a growth-based classification of tumors? Malignancy Carcinoma Sarcoma Leukemia
Malignant Explanation: Tumors that are classified on the basis of the cell or tissue of origin are carcinomas, sarcomas, lymphomas, and leukemias. Tumors classified on the basis of growth are described as benign or malignant.
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? Monitor the client's heart rate. Monitor the client's toilet patterns. Monitor the client's physical condition. Monitor the client closely to prevent infection.
Monitor the client closely to prevent infection. 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.
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? Nervous system Gastrointestinal system Urinary system Pulmonary system
Nervous system Explanation: 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.
Which of the following is generally NOT considered to be a carcinogen? Parasites Dietary substances Viruses Defective genes
Parasites Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions.
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? Reconstructive Prophylactic Diagnostic Palliative
Prophylactic Explanation: Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk of developing cancer. When surgical cure is not possible, the goals of surgical interventions are to relieve symptoms, make the patient as comfortable as possible, and promote quality of life as defined by the patient and family. Palliative surgery and other interventions are performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusions (Table 15-6). Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Diagnostic surgery, or biopsy, is performed to obtain a tissue sample for histologic analysis of cells suspected to be malignant.
A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient? Provide time for the patient to discuss her concerns. Provide aseptic care to the incision postoperatively. Counsel the patient about the possibility of losing her breast. Clarify information provided by the physician.
Provide time for the patient to discuss her concerns. 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 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? Risk for infection related to inadequate defenses Activity intolerance related to side effects of chemotherapy Anxiety related to change in role function Fatigue related to deficient blood cells
Risk for infection related to inadequate defenses Explanation: Physiological needs, such as risk for infection, take priority over the client's other needs.
A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? The laboratory reports a white blood cell (WBC) count of 1,000/mm3. The client states he is nauseous. The I.V. site is red and swollen. The client begins to shiver.
The I.V. site is red and swollen. Explanation: A red, swollen I.V. site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates. The nurse should immediately stop the medication, apply ice to the site, and notify the physician. Although nausea, WBC count of 1,000/mm3, and shivering require interventions, these findings aren't a high priority at this time.
Which statement is true about malignant tumors? They grow by expansion. They gain access to the blood and lymphatic channels. They usually grow slowly. They demonstrate cells that are well differentiated.
They gain access to the blood and lymphatic channels. 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.
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? Emission of abnormal proteins Tumor pressure against normal tissues Random, rapid growth of the tumor Cells colonizing to distant body parts
Tumor pressure against normal tissues 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.
Which of the following would be inconsistent as a common side effect of chemotherapy? Weight gain Myelosuppression Fatigue Alopecia
Weight gain Explanation: Common side effects seen with chemotherapy include myelosuppression, alopecia, nausea and vomiting, anorexia, and fatigue.
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. age viruses environmental factors dietary substances gender
dietary substances environmental factors viruses 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.
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: absorption through the goggles. absorption through the gloves. inhalation of aerosols. absorption through the gown.
inhalation of aerosols. 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.
Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient? Autologous Syngeneic Homogenic Allogeneic
Allogeneic 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 is a sign or symptom of septic shock? Altered mental status Increased urine output Warm, moist skin Hypertension
Altered mental status Explanation: Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension.
Which class of antineoplastic agents is cell cycle-specific? Antimetabolites (5-FU) Antitumor antibiotics (bleomycin) Nitrosoureas (carmustine) Alkylating agents (cisplatin)
Antimetabolites (5-FU) Explanation: Antimetabolites are cell cycle-specific (S phase). Antitumor antibiotics, alkylating agents, and nitrosoureas are cell cycle-nonspecific.
The nurse is providing education to a client with cancer radiation treatment options. The nurse determines that the client understands the teaching when the client states that which type of radiation aims to protect healthy tissue during the treatment? External Teletherapy Proton therapy Brachytherapy
Brachytherapy Explanation: In internal radiation, or brachytherapy, a dose of radiation is delivered to a localized area inside the body through the use of an implant. With this type of therapy, the farther the tissue is from the radiation source, the lower the dose. This helps to protect normal tissue from the radiation therapy.
What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? Encourage fluid intake to dilute the urine. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. Take measures to acidify the urine and prevent uric acid crystallization. Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis.
Encourage fluid intake to dilute the urine. 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.
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? Bone pain Extravasation Nausea and vomiting Stomatitis
Extravasation 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 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? Normal finding Benign fibrocystic disease Malignant tumor Malignant tumor with metastasis to surrounding tissue
Malignant tumor Explanation: A fast-growing lump is suggestive of a malignant tumor. Metastasis can only be determined by cytology, not by palpation.
Carcinogens are factors related to the formation of various malignancies. Which factor has the greatest impact on the development of all cancers? Chemical agents Environmental factors Viruses Defective genes
Chemical agents Explanation: Chemical agents in the environment are believed to account for 75% of all cancers. Environmental factors include prolonged exposures to sunlight, radiation, and pollutants. Although such factors have been linked to cancer, they are not considered its leading cause. Viruses and bacteria are implicated in many cancers, however they do not have the greatest impact on the development of all cancers. It is known that genes play a major role in cancer prevention or development. Defective genes are responsible for diverse cancers, however they do not have the greatest impact on the development of all cancers.
A patient is to receive Bacille Calmette-Guerin (BCG), a nonspecific biologic response modifier. Why would the patient receive this form of treatment? For cancer of the lungs For cancer of the bladder For cancer of the breast For skin cancer
For cancer of the bladder Explanation: Early investigations of the stimulation of the immune system involved nonspecific agents such as bacille Calmette-Guérin (BCG) and Corynebacterium parvum. When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells. Extensive animal and human investigations with BCG have shown promising results, especially in treating localized malignant melanoma. In addition, BCG bladder instillation is a standard form of treatment for localized bladder cancer.
Which grade of tumor is also known as a well-differentiated tumor? Grade III Grade II Grade I Grade IV
Grade I Explanation: Grade I tumors, also known as well-differentiated tumors, closely resemble the tissue of origin in structure and function. In grade II, the tumor is moderately differentiated. Tumors in grade III are poorly differentiated (little resemblance to tissue of origin). Grade IV tumors is undifferentiated (unable to tell tissue of origin).
A client is receiving the cell cycle-nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of chemotherapy regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects? It destroys the cell membrane, causing lysis. It interferes with DNA replication and RNA transcription. It interferes with deoxyribonucleic acid (DNA) replication only. It interferes with ribonucleic acid (RNA) transcription only.
It interferes with DNA replication and RNA transcription. Explanation: Thiotepa interferes with DNA replication and RNA transcription. It doesn't destroy the cell membrane.
What is the best way for the nurse to assess the nutritional status of a patient with cancer? Assess BUN and creatinine levels. Weigh the patient daily. Monitor daily caloric intake. Observe for proper wound healing.
Weigh the patient daily. Explanation: Common nutritional problems in clients with cancer include anorexia, malabsorption, and the extreme weight loss of cancer-related anorexia-cachexia syndrome (CACS). Because malnutrition may occur due to problems with absorption of nutrients or increased metabolic demands, weighing the client regularly is the best way to monitor nutritional status. The client's caloric intake should also be monitored, keeping in mind that nutritional status may suffer even if caloric intake may seem sufficient.
The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice? works as a secretary at a medical radiation treatment center drinks one glass of wine at dinner each night eats red meat such as steaks or hamburgers every day uses the treadmill for 30 minutes on 5 days each week
eats red meat such as steaks or hamburgers every day 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 recommendations include drink no more than one drink per day for women or two per day for men.
A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient? Maintain as much distance as possible from the patient while in the room. Explain to the patient that she will continue to emit radiation while the implant is in place. Alert family members that they should restrict their visiting to 5 minutes at any one time. Wear a lead apron when providing direct patient care.
Explain to the patient that she will continue to emit radiation while the implant is in place. Explanation: When the patient has a radioactive implant in place, the nurse and other health care providers need to protect themselves, as well as the patient, from the effects of radiation. Patients receiving internal radiation emit radiation while the implant is in place; therefore, contact with the health care team is guided by principles of time, distance, and shielding to minimize exposure of personnel to radiation. Safety precautions used in caring for a patient receiving brachytherapy include assigning the patient to a private room, posting appropriate notices about radiation safety precautions, having staff members wear dosimeter badges, making sure that pregnant staff members are not assigned to the patient's care, prohibiting visits by children or pregnant visitors, limiting visits from others to 30 minutes daily, and seeing that visitors maintain a 6-foot distance from the radiation source.
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? Administering aspirin if the temperature exceeds 102° F (38.8° C) Placing the client in strict isolation Providing for frequent rest periods Inspecting the skin for petechiae once every shift
Inspecting the skin for petechiae once every shift 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.
A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents? Disconnect I.V. tubing with gloved hands. Throw I.V. tubing in the trash after the infusion is stopped. Break needles after the infusion is discontinued. Wear disposable gloves and protective clothing.
Wear disposable gloves and protective clothing. Explanation: A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, I.V. tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container.
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? "I use an alcohol-based mouthwash every morning." "I lubricate my lips with petroleum jelly." "I clean my teeth gently several times per day." "I replace my toothbrush every month."
"I clean my teeth gently several times per day." 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.
A client reports a new onset of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. The health care provider orders a diagnostic workup, which reveals end-stage gallbladder cancer. What nursing intervention should be used to facilitate adaptive coping? Refer client for professional counseling. Provide written education for prescribed treatments. Encourage ventilation of negative feelings. Assist with self-care activities of daily living.
Refer client for professional counseling. Explanation: Referring the client for professional counseling will facilitate adaptive coping. Encouraging ventilation of negative feelings will allow for emotional expression, but may not facilitate coping. Physical well-being will increase self-esteem, but won't necessarily help the patient cope with the diagnosis. Providing written education is for client teaching, not to facilitate coping.
A client asks the nurse what is causing the fatigue following radiotherapy. What is the nurse's best response? The cancer cells are dying in large numbers. The cancer is spreading to other parts of the body. Fighting off infection is an exhausting venture. Substances are released when tumor cells are destroyed.
Substances are released when tumor cells are destroyed. Explanation: Fatigue results from substances being released when tumor cells are destroyed during radiotherapy. The spreading of cancer can cause many symptoms dependent on location and type of cancer, but it is not a significant factor in the development of fatigue with radiotherapy. The production of healthy cells can increase metabolic rate, but death of cancer cells does not support fatigue in this case. Fighting infection can cause fatigue, but there is no evidence provided to support the presence of infection in this client.
The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as: a contact mold. brachytherapy. systemic radiation. external beam radiation therapy.
brachytherapy. Explanation: Brachytherapy is the only term used to denote the use of internal radiation implants.
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? cryoablation local excision prophylactic palliative
prophylactic 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. Cryoablation uses cold to destroy cancerous cells.
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? "I will need to attend follow-up visits for up to 3 months after treatment." "I hope they find a bone marrow donor who matches." "I will receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back." "The doctor will remove cells from my bone marrow before beginning chemotherapy."
"I hope they find a bone marrow donor who matches." 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.
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." "It is not really understood why you have to go for 6 weeks of treatment." "It will decrease the incidence of leukopenia and thrombocytopenia." "It allows time for you to cope with the treatment."
"It will allow time for the repair of healthy tissue." 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.
Which oncologic emergency involves the accumulation of fluid in the pericardial space? Syndrome of inappropriate antidiuretic hormone release (SIADH) Tumor lysis syndrome Cardiac tamponade Disseminated intravascular coagulation (DIC)
Cardiac tamponade 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.
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? "I will reduce smoking to after meals only." "I will eat spicy foods with a cool beverage." "I will limit alcoholic beverages to one a day." "I will brush my teeth after every meal."
"I will brush my teeth after every meal." 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.
Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client? Therapeutic Prophylactic Autologous Allogeneic
Autologous Explanation: Autologous vaccines are made from the client's own cancer cells, which are obtained during diagnostic biopsy or surgery. Prophylactic vaccines, such as the polio vaccine, are given to prevent people from developing a disease. Therapeutic vaccines are given to kill existing cancer cells and to provide long-lasting immunity against further cancer development. Allogeneic vaccines are made from cancer cells that are obtained from other people who have a specific type of cancer.
A nurse is caring for a recently married, 29-year-old female client, who was diagnosed with acute lymphocytic leukemia. The client is preparing for an allogeneic bone marrow transplant. Which statement by the client demonstrates she understands the informed consent she gave about the diagnosis and treatment? "I'll have to remain in the hospital for about 3 months after my transplant." "I always had a good appetite. Even with chemo I shouldn't have to make any changes to my diet." "I'll only need chemotherapy treatment before receiving my bone marrow transplant." "I should be able to finally start a family after I'm finished with the chemo."
"I'll only need chemotherapy treatment before receiving my bone marrow transplant." Explanation: This client demonstrates understanding about treatment when she states that she'll need chemotherapy before receiving a bone marrow transplant. Most clients receive chemotherapy before undergoing bone marrow transplantation. Most women older than age 26 can't bear children after undergoing treatment because they experience the early onset of menopause. Clients who undergo chemotherapy or radiation must avoid all fresh fruits and vegetables, and all foods should be cooked to avoid bacterial contamination. Clients who undergo bone marrow transplantation typically remain hospitalized for 20 to 25 days.
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: show tumor "hot spots" in the GI tract. show movement of the GI tract. provide a three-dimensional cross-sectional view. remove a tissue sample from the GI tract.
show movement of the GI tract. 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 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 demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Can't assess tumor or regional lymph nodes and no evidence of metastasis No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis 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.
The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse? "Hair loss may not occur until after the second round of therapy." "I can continue taking my vitamins and herbs because they make me feel better." "I will use birth control measures until after all treatment is completed." "I will eat clear liquids for the next 24 hours."
"I can continue taking my vitamins and herbs because they make me feel better." 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.
A nurse is administering a peripheral chemotherapeutic agent. What nursing actions are used for extravasation of a chemotherapeutic agent? Select all that apply. Stop the medication infusion at the first sign of extravasation Aspirate any residual drug from the IV line Apply warm compresses to the irritated site to encourage healing Schedule the client for implanted device Administer an antidote, if indicated
Stop the medication infusion at the first sign of extravasation Aspirate any residual drug from the IV line Administer an antidote, if indicated Explanation: All of the answers except application of a warm compress are appropriate nursing actions. The application of warmth would be contraindicated because it would cause vasodilation, which would increase the absorption of irritant into the local tissues. Short term chemotherapy can be done with peripheral catheters so the client may not need an implanted device.
The 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? "Wigs can be used after the chemotherapy is completed." "New hair growth will return without any change to color or texture." "Clients with alopecia will have delay in grey hair." "The hair loss is usually temporary."
"The hair loss is usually temporary." 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.
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? Extravasation Thrombosis Erythema Flare
Extravasation 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.
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 psychiatric diagnosis everyone has at one time or another. An aberrant psychologic reaction to the chemotherapy. A normal reaction to the diagnosis of cancer. A side effect of the neoplastic drugs.
A normal reaction to the diagnosis of cancer. Explanation: Clients have many reactions, ranging from anxiety, fear, and depression to feelings of guilt related to viewing cancer as a punishment for past actions or failure to practice a healthy lifestyle. They also may express anger related to the diagnosis and their inability to be in control. While depression is understandable, it also needs to be acknowledged and treated if necessary. Depression is not a side effect of the neoplastic drugs nor is it an aberrant psychologic reaction to the chemotherapy.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? Repeat biopsy is needed before treatment begins. No further treatment is indicated. Palliative care is likely. Adjuvant therapy is likely.
Adjuvant therapy is likely. Explanation: 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.
A client has been receiving chemotherapy. Upon assessing the client during morning rounds, the nurse notes the client is now bleeding from intravenous and venipuncture sites. Stool is positive for occult blood. The client is requesting to sit in a chair for a meal. The nurse implements the following interventions: (Select all that apply.) Assess level of consciousness. Apply pressure to the bleeding sites. Assist the client to a chair. Check intake and output records. Monitor vital signs once a shift.
Assess level of consciousness. Apply pressure to the bleeding sites. Check intake and output records. Explanation: The client may be experiencing disseminated intravascular coagulation (DIC) following the cancer experience and chemotherapy treatment. When the nurse notes the client is experiencing unexpected and abnormal bleeding, the nurse will assess level of consciousness (the client can be bleeding in the brain) and intake and output records (the client may experience decreased urinary output as a result of poor renal perfusion). The nurse applies pressure to venipuncture sites to decrease bleeding. The nurse will assess vital signs more frequently than once a shift. The nurse minimizes client activities to decrease risk for injury.
What can the nurse do to meet the challenges in caring for a patient with cancer? Ensure that the patient has the financial means to afford their care. Set the same goals for all patients with cancer. Identify own perception of cancer and set realistic goals. Tell the patient about the things the patient has done to cause cancer.
Identify own perception of cancer and set realistic goals. Explanation: Nurses need to identify their own perception of cancer and set realistic goals to meet the challenges inherent in caring for patients with cancer. In addition, nurses caring for patients with cancer must be prepared to support patients and families through a wide range of physical, emotional, social, cultural, financial, and spiritual challenges. Cancer is a diverse set of diseases, so the nurse would not make the same goals for all patients with cancer. The causes of many types of cancer are still unknown, so the nurse should not attempt to tell the patient what he or she has done to cause the cancer. The nurse need not ensure that the patient has the financial means to afford the care.
