CH 16 CANCER MANAGEMENT
The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider? A. Generalized muscle aches - can indicate liver problems B. Complaints of nausea and anorexia C. Oral temperature of 100.6 degrees F (38.1 degrees C) D. Crackles heard at the lower scapular border
Crackles heard at the lower scapular border. Rationale: Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2. The patient may need oxygen and the nurse should rapidly notify the health care provider. The other findings are common side effects of interleukin-2.
A 70-year-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? A. Weight gain of 2 lb B. Urine specific gravity of 1.015 C. Blood urea nitrogen of 20 mg/dL D. Serum sodium level of 118 mEq/L
Serum sodium level of 118 mEq/L Rationale: Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. A weight gain may be due to fluid retention. The urine specific gravity and blood urea nitrogen are normal.
The nurse is preparing Cyclophosphamide (Cytoxan). Safe handling of the drug should be implemented to protect the nurse from injury. Which of the following action by the nurse should be corrected? A. The nurse should wear mask and gloves. B. Air bubbles should be expelled on wet cotton. C. Label the hanging IV bottle with "ANTINEOPLASTIC CHEMOTHERAPY" sign. D. Vent vials after mixing.
The nurse should wear mask and gloves. Rationale: The nurse should be corrected if she is only wearing mask and glove because gowns should also be worn in handling chemotherapeutic drugs. The vials should be vent after mixing to reduce the internal pressure. Air bubbles are expelled on wet cotton to prevent the spread of the chemotherapeutic agent particles.
Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? A. Firm-bristle toothbrush B. Hydrogen peroxide rinse C. Alcohol-based mouthwash D. 1 tsp salt in 1 L water mouth rinse
1 tsp salt in 1 L water mouth rinse Rationale: A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy. A soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.
After 3 weeks of radiation therapy, H.J. has lost 10 pounds and does not eat well because of mucositis. An appropriate nursing diagnosis for the patient is: A. Risk for infection related to poor nutrition B. Ineffective self-health management related to refusal to eat C. Imbalanced nutrition: less than body requirements related to oral inflammation and ulceration D. Ineffective health maintenance related to lack of knowledge of nutritional requirements during radiation therapy
Imbalanced nutrition: less than body requirements related to oral inflammation and ulceration Rationale: Oral Mucositis is irritation, inflammation, and/or ulceration of the oral mucosa that is common in patients receiving radiation to the head and neck.
A 33-year-old patient has recently been diagnosed with stage II cervical cancer. What should the nurse understand about the patient's cancer? A. It is in situ. B. It has metastasized. C. It has spread locally. D. It has spread extensively.
It has spread locally. Rationale: Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ; stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread. Stage IV denotes metastasis.
A characteristic of the stage of Progression in the development of Cancer is: A. oncogenic viral transformation of target cells B. a reversible steady growth facilitated by carcinogens C. a period of latency before clinical detection of cancer D. proliferation of cancer cells in spite of host control mechanisms
Proliferation of cancer cells in spite of host control mechanisms Rationale: Progression is the final stage of cancer. This stage is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (i.e., metastasis). Progression occurs as a result of the following characteristics of cancer cells: rapid proliferation and decreased cell adhesion.
The nurse explains to a patient undergoing brachytherapy of the cervix that she: A. must undergo simulation to locate the treatment area B. requires the use of radioactive precautions during nursing care C. many experience desquamation of the skin on the abdomen and upper legs D. requires shielding of the ovaries during treatment to prevent ovarian damage
Requires the use of radioactive precautions during nursing care Rationale: Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or adjacent to the tumor. Caring for the person undergoing brachytherapy or receiving radiopharmaceuticals requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, and shielding are vital to health care professional safety in caring for the person with an internal radiation source.
A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure. Which information should the nurse teach the patient about the outcome of this procedure? A. Pain will be relieved by cutting sensory nerves in the stomach. B. Relief of pressure in the stomach will promote better nutrition. C. Tumor growth will be controlled by the removal of malignant tissue. D. Tumor size will decrease and this will improve the effects of other therapy.
Tumor size will decrease and this will improve the effects of other therapy. Rationale: A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective. Debulking surgeries do not control tumor growth. The tumor is debulked because it is attached to the liver, a vital organ (not to relieve pressure on the stomach). Debulking does not sever the sensory nerves, although pain may be lessened by the reduction in pressure on the abdominal organs.
The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? A. Ask the patient if the site hurts. B. Turn off the chemotherapy infusion. C. Call the ordering health care provider. D. Administer sterile saline to the reddened area.
Turn off the chemotherapy infusion. Rationale: Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation the infusion should first be stopped. Then the protocol for the drug-specific extravasation procedures should be followed to minimize further tissue damage. The site of extravasation usually hurts, but it may not. It is more important to stop the infusion immediately. The health care provider may be notified by another nurse while the patient's nurse starts the drug-specific extravasation procedures, which may or may not include sterile saline.
When caring for the patient with cancer, what does the nurse understand as the response of the immune system to antigens of the malignant cells? A. Metastasis B. Tumor angiogenesis C. Immunologic escape D. Immunologic surveillance
Immunologic surveillance Rationale: Immunologic surveillance is the process where lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance that allows the cancer cells to reproduce.
In staging and grading neoplasm TNM system is used. TNM stands for: A. Time, neoplasm, mode of growth B. Tumor, node, metastasis C. Tumor, neoplasm, mode of growth D. Time, node, metastasis
Tumor, node, metastasis
A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following? A. "Chemotherapy affects all rapidly dividing cells." B. "The molecular structure of the DNA is altered." C. "Cancer cells are susceptible to drug toxins." D. "Chemotherapy encourages cancer cells to divide."
"Chemotherapy affects all rapidly dividing cells." Rationale: There are many mechanisms of action for chemotherapeutic agents, but most affect the rapidly dividing cells—both cancerous and noncancerous. Cancer cells are characterized by rapid cell division. Chemotherapy slows cell division. Not all chemotherapeutic agents affect molecular structure. All cells are susceptible to drug toxins, but not all chemotherapeutic agents are toxins.
The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was effective? A. "The biopsy will remove the cancer in my prostate gland." B "The biopsy will determine how much longer I have to live." C. "The biopsy will help decide the treatment for my enlarged prostate." D. "The biopsy will indicate whether the cancer has spread to other organs."
"The biopsy will help decide the treatment for my enlarged prostate." Rationale: A biopsy is used to determine whether the prostate enlargement is benign or malignant, and determines the type of treatment that will be needed. A biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life.
The nurse is teaching a wellness class to a group of women at their workplace. The nurse knows that which woman is at highest risk for developing cancer? A. A woman who obtains regular cancer screenings and consumes a high-fiber diet B. A woman who has a body mass index of 35 kg/m2 and smoked cigarettes for 20 years C. A woman who exercises five times every week and does not consume alcoholic beverages D. A woman who limits fat consumption and has regular mammography and Pap screenings
A woman who has a body mass index of 35 kg/m2 and smoked cigarettes for 20 years Rationale: Cancer prevention and early detection are associated with the following behaviors: limited alcohol use; regular physical activity; maintaining a normal body weight; obtaining regular cancer screenings; avoiding cigarette smoking and other tobacco use; using sunscreen with SPF 15 or higher; and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).
Which of the following medications usually is given to a client with leukemia as prophylaxis against P. carinii pneumonia? 1. Bactrim 2. Oral nystatin suspension 3. Prednisone 4. Vincristine (Oncovin)
Bactrim Rationale: The most frequent cause of death from leukemia is overwhelming infection. P. carinii infection is lethal to a child with leukemia. As prophylaxis against P. carinii pneumonia, continuous low doses of co-trimoxazole (Bactrim) are frequently prescribed. Oral nystatin suspension would be indicated for the treatment of thrush. Prednisone isn't an antibiotic and increases susceptibility to infection. Vincristine is an antineoplastic agent.
A client with leukemia has neutropenia. Which of the following functions must be frequently assessed? A. Blood pressure B. Bowel sounds C. Heart sounds D. Breath sounds
Breath Sounds Rationale: Pneumonia, both viral and fungal, is a common cause of death in clients with neutropenia. Frequent assessment of respiratory rate and breath sounds is required. Although assessing blood pressure, bowel sounds, and heart sounds is important, it won't help detect pneumonia.
The laboratory reports that the cells from the patient's tumor biopsy are Grade II. What should the nurse know about this histologic grading? A. Cells are abnormal and moderately differentiated. B. Cells are very abnormal and poorly differentiated. C. Cells are immature, primitive, and undifferentiated. D. Cells differ slightly from normal cells and are well-differentiated.
Cells are abnormal and moderately differentiated. Rationale: Grade II cells are more abnormal than Grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.
A patient has recently been diagnosed with early stages of breast cancer. What is most appropriate for the nurse to focus on? A. maintaining the patient's hope B. preparing a will and Advance directives C. discussing replacement child care for patient's children D. discussing the patient's past experience with her grandmother's cancer
Maintaining the patient's hope Rationale: Maintain hope, which is the key to effective cancer care. Hope depends on the status of the patient: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care.
After change-of-shift report on the oncology unit, which patient should the nurse assess first? A. Patient who has a platelet count of 82,000/µL after chemotherapy B. Patient who has xerostomia after receiving head and neck radiation - ORAL CARE IS VERY IMPORTANT C. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C) D. Patient who is worried about getting the prescribed long-acting opioid on time
Patient who is neutropenic and has a temperature of 100.5° F (38.1° C) Rationale: Temperature elevation is an emergency in neutropenic patients because of the risk for rapid progression to severe infections and sepsis. The other patients also require assessments or interventions, but do not need to be assessed as urgently. Patients with thrombocytopenia do not have spontaneous bleeding until the platelets are 20,000/µL. Xerostomia does not require immediate intervention. Although breakthrough pain needs to be addressed rapidly, the patient does not appear to have breakthrough pain.
The female patient is having whole brain radiation for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? A. "When your hair grows back it will be patchy." B. "Don't use your curling iron and that will slow down the loss." C. "You can get a wig now to match your hair so you will not look different." D. "You should contact "Look Good, Feel Better" to figure out what to do about this."
"You can get a wig now to match your hair so you will not look different." Rationale: Hair loss with radiation is usually permanent. The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. When hair grows back after chemotherapy, it is frequently a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern.
To prevent fever and shivering during an infusion of Rituzimab (Rituxan), the nurse should premedicate the patient with A. Aspirin B. Acetaminophen C. Sodium Bicarbonate D. Meperidine (Demerol)
Acetaminophen Rationale: Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is commonly premedicated with acetaminophen in an attempt to prevent or decrease the intensity of these symptoms, and large amounts of fluids help decrease symptoms.
The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate for the nurse to use to increase the patient's nutritional intake? A.Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.
Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods. Rationale: The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.
The nurse is caring for a 59-year-old woman who had surgery 1 day ago for removal of suspected malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to: A. motivate change in an unhealthy lifestyle B. teach her about the seven warning signs of cancer C. instruct her about healthy stress relief and coping practices D. allow her to communicate about the meaning of this experience
Allow her to communicate about the meaning of this experience Rationale: While the patient is waiting for diagnostic study results, you should be available to actively listen to the patient's concerns, and you should be skilled in techniques that can engage the patient and the family members or significant others in a discussion about their cancer-related fears.
A 25 year old patient is inquiring about the methods or ways to detect cancer earlier. The nurse least likely identify this method by stating: A. Annual chest x-ray. B. Annual Pap smear for sexually active women only. C. Annual digital rectal examination for persons over age 40. D. Yearly physical and blood examination
Annual Pap smear for sexually active women only. Rationale: Early detection of cancer is promoted by annual oral examination, monthly BSE from age 20, annual chest x-ray, yearly digital rectal examination for persons over age 40, annual Pap smear from age 40 and annual physical and blood examination. Letter B is wrong because it says Pap smear should be done yearly for sexually active women. All women should have an annual pap smear by age 40 and up whether sexually active or not.
Which cellular dysfunction in the process of cancer development allows defective cell proliferation? A. Proto-oncogenes B. Cell differentiation C. Dynamic equilibrium D. Activation of oncogenes
Dynamic Equilibrium Rationale: Dynamic equilibrium is the regulation of proliferation that usually only occurs to equal cell degeneration or death or when the body has a physiologic need for more cells. Cell differentiation is the orderly process that progresses a cell from a state of immaturity to a state of differentiated maturity. Mutations that alter the expression of proto-oncogenes can activate them to function as oncogenes, which are tumor-inducing genes and alter their differentiation.
To prevent the debilitating cycle of fatigue-depression-fatigue that can occur in patients with cancer, an appropriate nursing intervention is to: A. Have the patient rest after any major energy expenditure B. Encourage the patient to implement a daily walking program C. Teach the patient to ignore the fatigue to maintain normal daily activities D. Prevent the development of depression by informing the patient to expect fatigue during cancer treatment
Encourage the patient to implement a daily walking program Rationale: Maintaining exercise and activity within tolerable limits is often helpful in managing fatigue. Walking programs are a way for most patients to keep active without overtaxing them. Patients should plan energy conservation strategies by identifying days/times when they feel better and can tolerate activity. Resting before activity and having others assist with work or home management may be necessary. Ignoring fatigue and overstressing the body can lead to an increase in symptoms
ONLINE The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency? A. Hypokalemia B. Hypouricemia C. Hypocalcemia D. Hypophosphatemia
Hypocalcemia Rationale: TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.
During a routine physical examination, a firm mass is palpated in the right breast of a 35-year-old woman. Which of the following findings or client history would suggest cancer of the breast as opposed to fibrocystic disease? A. History of early menarche B. Cyclic changes in mass size C. History of anovulatory cycles D. Increased vascularity of the breast
Increased vascularity of the breast Rationale: Increase in breast size or vascularity is consistent with cancer of the breast. Early menarche as well as late menopause or a history of anovulatory cycles are associated with firbrocystic disease. Masses associated with fibrocystic disease of the breast are firm, most often located in the upper outer quadrant of the breast, and increase in size prior to menstruation. They may be bilateral in a mirror image and are typically well demarcated and freely moveable.
The client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care? A. Ambulation three times a day B. Monitoring temperature C. Monitoring the platelet count D. Monitoring for pathological factors
Monitoring the platelet count Rationale: Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option 2 relates to monitoring for infection particularly if leukopenia is present. Options 1 and 4, although important in the plan of care are not related directly to thrombocytopenia.
A 64-year-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to this patient's plan of care? A. Weigh the patient every month to monitor for weight loss. B. Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. C. Provide high-protein and high-calorie, soft foods every 2 hours. D. Apply palifermin (Kepivance) liberally to the affected oral mucosa.
Provide high-protein and high-calorie, soft foods every 2 hours. Rationale: A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Palifermin is administered intravenously as a growth factor to stimulate cells on the surface layer of the mouth to grow. Patients should be weighed at least twice each week to monitor for weight loss.
Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D. Risk for infection
Risk for Infection Rationale: Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.
A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching? A. The patient ambulates several times a day in the room B. The patient's visitors bring in some fresh peaches/ plants from home. C. The patient cleans with a warm washcloth after having a stool D. The patient uses soap and shampoo to shower every other day.
The patient's visitors bring in some fresh peaches/ plants from home. Rationale: Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help prevent skin breakdown and infection.
A patient who is scheduled for a right breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct? A. "Benign tumors do not cause damage to other tissues." B. "Benign tumors are likely to recur in the same location." C. "Malignant tumors may spread to other tissues or organs." D. "Malignant cells reproduce more rapidly than normal cells."
"Malignant tumors may spread to other tissues or organs." Rationale: The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors never metastasize. The other statements are inaccurate. Both types of tumors may cause damage to adjacent tissues. Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not usually recur.
The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg and it is getting worse. What assessment question should the nurse ask the patient to determine treatment measures for this patient's pain? A. "Where is the pain?" B. "Is the pain getting worse?" C. "What does the pain feel like?" D. "Do you use medications to relieve the pain?"
"What does the pain feel like?" Rationale: The unlicensed assistive personnel (UAP) told the nurse the location of the patient's pain and the worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.
The patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? A. Use Dial soap to feel clean and fresh. B. Scented lotion can be used on the area. C. Avoid heat and cold to the treatment area. D. Wear the new bra to comfort and support the area.
Avoid heat and cold to the treatment area. Rationale: Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.
A 70-year-old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day is confused when awake and complains of nausea and constipation. Which complication of cancer is this most likely caused by? A. Hypercalcemia B. Tumor Lysis Syndrome C. Spinal Cord Compression D. Superior Vena Cava Syndrome
Hypercalcemia Rationale: Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or exacerbate hypercalcemia. The primary manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting.
The patient is told that the adenoma tumor is not encapsulated but has normally differentiated cells and that surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? A. It will recur. B. It has metastasized. C. It is probably benign. D. It is probably malignant.
It is probably benign. Rationale: Benign tumors usually are encapsulated and have normally differentiated cells. They do not metastasize and rarely recur as malignant tumors do.
The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? A. Infuse the medication over a short period of time. B. Stop the infusion if swelling is observed at the site. C. Administer the chemotherapy through a small-bore catheter. D. Hold the medication unless a central venous line is available.
Stop the infusion if swelling is observed at the site. Rationale: Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapeutic drug. These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred.
NCLEX Q's According to a standard staging classification of Hodgkin's disease, which of the following criteria reflects stage II? A. Involvement of extralymphatic organs or tissues B. Involvement of single lymph node region or structure C. Involvement of two or more lymph node regions or structures. D. Involvement of lymph node regions or structures on both sides of the diaphragm.
Involvement of two or more lymph node regions or structures. Rationale: Stage II involves two or more lymph node regions. Stage I only involves ONE lymph node region; Stage III involves nodes on both sides of the diaphragm; Stage IV involves fetus may be in distress
The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? A. It is delivered via an Ommaya reservoir and extension catheter. B. It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. C. A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration. D. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.
A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration. Rationale: A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration.
The goals of cancer treatment are based on the principle that: A. Surgery is the single most effective treatment for cancer B. Initial treatment is always directed toward cure of the cancer C. A combination of treatment modalities is effective for controlling many cancers D. Although cancer is rare, quality of life can be increased with treatment modalities
A combination of treatment modalities is effective for controlling many cancers Rationale: The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the particular cancer being treated and may involve local therapies (i.e., surgery or irradiation) alone or in combination, with or without periods of adjunctive systemic therapy (i.e., chemotherapy).
The nurse assesses a patient with non- Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse? A. Shortness of breath B. Temperature of 100.2 degrees F (37.9 degrees C) C. Shivering and complaint of chills D. Generalized muscle aches and pains
Shortness of breath Rationale: Rituximab (Rituxan) is a monoclonal antibody. Shortness of breath should be investigated rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration. The nurse will need to rapidly take actions such as stopping the infusion, assessing the patient further, and notifying the health care provider. The other findings will also require action by the nurse, but are not indicative of life-threatening complications.
The primary protective role of the immune system related to malignant cells is: A. surveillance for cells with tumor-associated antigens B. binding with free antigen released by malignant cells C. production of blocking factors that immobilize cancer cells D. responding to a new set of antigenic determinants on cancer cells
Surveillance for cells with tumor-associated antigens Rationale: Cancer cells may display altered cell surface antigens as a result of malignant transformation. These antigens are called tumor-associated antigens (TAAs). One of the functions of the immune system is to respond to TAAs.
What can the nurse do to facilitate cancer prevention for the patient in the promotion stage of cancer development? A. Teach the patient to exercise daily. B. Teach the patient promoting factors to avoid. C. Tell the patient to have the cancer surgically removed now. D. Teach the patient which vitamins will improve the immune system.
Teach the patient promoting factors to avoid. Rationale: The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be the nurse's role.
A patient on chemotherapy and radiation for head and neck cancer has a WBC of 1.9x10^3; HGB 10.8 g/dL, and platelet count of 99x10^3. Based on the CBC results what is the most serious clinical finding? A. cough, rhinitis, and sore throat B. fatigue, nausea, and skin redness at site of radiation C. temp 101.9, fatigue, & SOB D. skin redness at side of radiation, headache, and constipation
Temp 101.9, fatigue, & SOB Rationale: Neutropenia is more common in patients receiving chemotherapy than in those receiving radiation, and it can seriously increase the risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly because fever in the setting of neutropenia is a medical emergency.
The nurse is caring for an 18-year-old female patient with acute lymphocytic leukemia who is scheduled to receive hematopoietic stem cell transplantation (HSCT). Which statement, if made by the patient, indicates a correct understanding of the procedure? A. "After the transplant I will feel better and can go home in 5 to 7 days." B. "I understand the transplant procedure has no dangerous side effects." C. "My brother will be a 100% match for the cells used during the transplant." D. "Before the transplant I will have chemotherapy and possibly full body radiation."
"Before the transplant I will have chemotherapy and possibly full body radiation." Rationale: Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.
The nurse assesses a 76-year-old man with chronic myeloid leukemia receiving nilotinib (Tasigna). It is most important for the nurse to ask which question? A. "Have you had a fever?" B. "Have you lost any weight?" C. "Has diarrhea been a problem?" D. "Have you noticed any hair loss?"
"Have you had a fever?" Rationale: An adverse effect of nilotinib is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4o F or higher. Other adverse effects of nilotinib are thrombocytopenia, bleeding, nausea, fatigue, elevated lipase level, fever, rash, pruritus, diarrhea, and pneumonia.
Nausea and vomiting are common adverse effects of radiation and chemotherapy. When should a nurse administer antiemetics? A. 30 minutes before the initiation of therapy. B. With the administration of therapy. C. Immediately after nausea begins. D. When therapy is completed.
30 minutes before the initiation of therapy. Rationale: Antiemetics are most beneficial when given before the onset of nausea and vomiting. To calculate the optimum time for administration, the first dose is given 30 minutes to 1 hour before nausea is expected, and then every 2, 4, or 6 hours for approximately 24 hours after chemotherapy. If the antiemetic was given with the medication or after the medication, it could lose its maximum effectiveness when needed.
TEXTBOOK Trends in the incidence of and death rates of cancer include the fact that: A. lung cancer is the most common type of cancer in men B. a higher percentage of woman then men have lung cancer C. breast cancer is the leading cause of cancer deaths in women D. AA have a higher death rate from cancer than whites
AA have a higher death rate from cancer than whites Rationale: Cancer incidence and death rates are disproportionately higher among African Americans than among other minority groups and white people.
The patient is receiving biologic and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? A. Morphine sulfate B. Ibuprofen (Advil) C. Ondansetron (Zofran) D. Acetaminophen (Tylenol)
Acetaminophen (Tylenol) Rationale: Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic, but not used first to combat flu-like symptoms of headache, fever, chills, myalgias, etc.
A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lbs and has no sense of taste. Which nursing intervention would be a priority? A. advise the patient to eat foods that are fatty, fried, or high in calories B. discuss with the physician the need for parenteral or enteral feedings C. advise the patient to drink a nutritional supplement beverage at least 3x/daily D. advise the patient to experiment with spices and seasonings to enhance the flavor of food
Advise the patient to experiment with spices and seasonings to enhance the flavor of food Rationale: Instruct the patient to experiment with spices and other seasoning agents in an attempt to mask taste alterations. Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste of certain meats and fish. Bacon bits, onion, and pieces of ham may enhance the taste of vegetables.
The nurse counsels the patient receiving radiation therapy of chemotherapy that: A. effective birth control methods should be used for the rest of the patient's life B. if nausea/vomiting occur during treatment, the treatment plan will be modified C. after successful treatment, a return to the person's previous functional level can be expected D. the cycle of fatigue -depression - fatigue that may occur during treatment can be reduced by restricting activity
After successful treatment, a return to the person's previous functional level can be expected Rationale: Some cancer survivors may continue to experience symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. A cancer diagnosis can affect many aspects of a patients' life; cancer survivors commonly report financial, vocational, marital, and emotional concerns long after treatment is over. Resources for survivors are listed in Table 16-20.
Chemotherapy is one of the therapeutic modalities for cancer. This treatment is contraindicated to which of the following conditions? A. Recent surgery B. Pregnancy C. Bone marrow depression D. All of the above
All of the Above Rationale: Chemotherapy is contraindicated in cases of infection (chemotherapeutic agents are immunosuppressive), recent surgery (chemotherapeutic agent may retard the healing process), impaired renal and hepatic function (drugs are nephrotoxic and hepatotoxic), recent radiation therapy (immunosuppressive treatment), pregnancy (drugs can cause congenital defects) and bone marrow depression (chemo. Agents may aggravate the condition).
A nurse is providing education in a community setting about general measures to avoid excessive sun exposure. Which of the following recommendations is appropriate? A. Apply sunscreen only after going in the water. B. Avoid peak exposure hours from 9am to 1pm C. Wear loosely woven clothing for added ventilation D. Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure.
Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure. Rationale: A sunscreen with a SPF of 15 or higher should be worn on all sun-exposed skin surfaces. It should be applied before sun exposure and reapplied after being in the water. Peak sun exposure usually occurs between 10am to 2pm. Tightly woven clothing, protective hats, and sunglasses are recommended to decrease sun exposure. Suntanning parlors should be avoided.
The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing assessment is which of the following? A. Assess level of consciousness B. Assess temperature C. Assess bowel sounds D. Assess skin turgor
Assess level of consciousness Rationale: A high risk of hemorrhage exists when the platelet count is fewer than 20,000. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is fewer than 10,000. The client should be assessed for changes in levels of consciousness, which may be an early indication of an intracranial hemorrhage. Option 2 is a priority nursing assessment when the white blood cell count is low and the client is at risk for an infection.
What features of cancer cells distinguish them from normal cells? (SATA) A. cells lack contact inhibition B. cells return to a previous undifferentiated state C. oncogenes maintain normal cell expression D. proliferation occurs when there is a need for more cells E. new proteins characteristic of embryonic stage emerge on cell membrane.
Cells lack contact inhibition Cells return to a previous undifferentiated state New proteins characteristic of embryonic stage emerge on cell membrane. Rationale: Two major dysfunctions in the process of cancer are defective cell proliferation (i.e., growth) and defective cell differentiation. Cancer cells lack contact inhibition and are poorly differentiated. Cancer cell growth is infiltrative and expansive, and cancer cells are abnormal and become more unlike parent cells.
The primary difference between benign and malignant neoplasms is the: A. rate of cell proliferation B. site of malignant tumor C. requirements for cell nutrition D. characteristic of tissue invasiveness
Characteristic of tissue invasiveness Rationale: The ability of malignant cells to invade and metastasize is the major difference between benign and malignant neoplasms. Other differences between benign and malignant neoplasms are presented in Table 16-3.
Which of the following interventions is the key to increasing the survival rates of clients with lung cancer? A. Early bronchoscopy B. Early detection C. High-dose chemotherapy D. Smoking cessation
Early detection Rationale: Early detection of cancer when the cells may be premalignant and potentially curable would be most beneficial. However, a tumor must be 1 cm in diameter before it's detectable on a chest x-ray, so this is difficult. A bronchoscopy may help identify cell type but may not increase survival rate. High-dose chemotherapy has minimal effect on long-term survival. Smoking cessation won't reverse the process but may help prevent further decompensation
Neoplasm can be classified as either benign or malignant. The following are characteristics of malignant tumor apart from: A. Metastasis B. Infiltrates surrounding tissues C. Encapsulated D. Poorly differentiated cells
Encapsulated Rationale: Benign: grows slowly, localized, encapsulated, well differentiated cells, no metastasis, not harmful to host. Malignant: Grows rapidly, infiltrates surrounding tissues, not encapsulated, poorly differentiated, metastasis present, always harmful
The patient has been diagnosed with non-small cell lung cancer. Which type of targeted therapy will most likely be used for this patient to suppress cell proliferation and promote programmed tumor cell death? A. Proteasome inhibitors B. BCR-ABL tyrosine kinase inhibitors C. CD20 monoclonal antibodies (MoAb) D. Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TK)
Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TK) Rationale: Targeted therapies are more selective for specific molecular targets. Thus they are able to kill cancer cells with less damage to normal cells than with chemotherapy. Epidermal growth factor receptor (EGFR) is a transmembrane molecule that works through activation of intracellular tyrosine kinase (TK) to suppress cell proliferation and promote apoptosis of non-small cell lung cancer and some colorectal, head and neck, and metastatic breast cancers. Proteasome inhibitors promote accumulation of proteins that promote tumor cell death for multiple myeloma. BCR-ABL tyrosine kinase inhibitors target specific oncogenes for chronic myeloid leukemia and some GI stromal tumors. CD20 monoclonal antibodies (MoAb) bind with CD20 antigen causing cytotoxicity in non-Hodgkin's lymphoma and chronic lymphocytic leukemia.
A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? A. Bacteria B. Sun exposure C. Most chemicals D. Epstein-Barr virus
Epstein-Barr virus Rationale: Burkitt's lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. Bacteria do not initiate cancer. Sun exposure causes cell alterations leading to melanoma and squamous and basal cell skin carcinoma. Long-term exposure to certain chemicals (e.g., ethylene oxide, chloroform, benzene) is known to initiate cancer.
Which of the following statements is correct about the rate of cell growth in relation to chemotherapy? A. Faster growing cells are less susceptible to chemotherapy. B. Non-dividing cells are more susceptible to chemotherapy C. Faster growing cells are more susceptible to chemotherapy D. Slower growing cells are more susceptible to chemotherapy
Faster growing cells are more susceptible to chemotherapy Rationale: The faster the cell grows, the MORE susceptible it is to chemotherapy and radiation therapy. Slow growing & non-dividing cells are less susceptible to chemotherapy. Repeated cycles of chemotherapy are used to destroy non-dividing cells as they begin active cell division
The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect? A. Nausea B. Alopecia C. Mucositis D. Hematuria
Hematuria Rationale: The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy
A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan? A. Transplant of the donated cells is painful because of the nerves in the tissue lining the bone. B. Donor bone marrow cells are transplant through an incision into the sternum or hip bone. C. The transplant procedure takes place in a sterile operating room to minimize the risk for infection. D. Hospitalization will be required for several weeks after the stem transplant procedure is performed.
Hospitalization will be required for several weeks after the stem transplant procedure is performed. Rationale:The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room or incision required.
A 36-year-old man with lymphoma presents with signs of impending septic shock 9 days after chemotherapy. The nurse could expect which of the following to be present? A. Flushing, decreased oxygen saturation, mild hypotension B. Low-grade fever, chills, tachycardia C. Elevated temperature, oliguria, hypotension D. High-grade fever, normal blood pressure, increased respirations
Low-grade fever, chills, tachycardia Rationale: Nine days after chemotherapy, one would expect the client to be immunocompromised. The clinical signs of shock reflect changes in cardiac function, vascular resistance, cellular metabolism, and capillary permeability. Low-grade fever, tachycardia, and flushing may be early signs of shock. The client with impending signs of septic shock may not have decreased oxygen saturation levels. Oliguria and hypotension are late signs of shock. Urine output can be initially normal or increased.
The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation (select all that apply)? A. Maintain hope. B. Exhibit a caring attitude. C. Plan realistic long-term goals. D. Give them antianxiety medications. E. Be available to listen to fears and concerns. F. Teach them about all the types of cancer that could be diagnosed.
Maintain hope. Exhibit a caring attitude. Be available to listen to fears and concerns. Rationale: Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching them about the diagnostic procedures would also be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.
Warning signs and symptoms of lung cancer include persistent cough, bloody sputum, dyspnea, and which of the other following symptoms? A. Dizziness B. Generalized weakness C. Hypotension D. Recurrent pleural effusion
Recurrent pleural effusion Rationale: Recurring episodes of pleural effusions can be caused by the tumor and should be investigated. Dizziness, generalized weakness, and hypotension aren't typically considered warning signals, but may occur in advanced stages of cancer.
The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? A. The medications the patient is taking B. The nutritional supplements that will help the patient C. How much time is needed to provide the patient's care D. The time the nurse spends at what distance from the patient
The time the nurse spends at what distance from the patient Rationale: The principles of ALARA (as low as reasonably achievable) and time, distance, and shielding are essential to maintain the nurse's safety when the patient is a source of internal radiation. The patient's medications, nutritional supplements, and time needed to complete care will not protect the nurse caring for a patient with brachytherapy for cervical cancer.
Which of the following is the primary goal for surgical resection of lung cancer? A. To remove the tumor and all surrounding tissue. B. To remove the tumor and as little surrounding tissue as possible. C. To remove all of the tumor and any collapsed alveoli in the same region. D. To remove as much as the tumor as possible, without removing any alveoli.
To remove the tumor and as little surrounding tissue as possible. Rationale: The goal of surgical resection is to remove the lung tissue that has a tumor in it while saving as much surrounding tissue as possible. It may be necessary to remove alveoli and bronchioles, but care is taken to make sure only what's absolutely necessary is removed.
The client with a benign lung tumor is treated in which of the following ways? A. The tumor is treated with radiation only. B. The tumor is treated with chemotherapy only. C. The tumor is left alone unless symptoms are present. D. The tumor is removed, involving the least possible amount of tissue.
Tumor is removed, involving the least possible amount of tissue Rationale: The tumor is removed to prevent further compression of the lung tissue as the tumor grows, which could lead to respiratory decompensation. If for some reason it can't be removed, then radiation or chemotherapy may be used to try to shrink the tumor.
The most effective method for administering a chemotherapy agent that is a vesicant is to: A. give it orally B. give it intraarterially C. use an Ommaya reservoir D. use a central venous access device
Use a central venous access device Rationale: If vesicants are inadvertently infiltrated into the skin, severe local tissue breakdown and necrosis may result. It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs. The infusion should be immediately turned off, and protocols for drug-specific extravasation procedures should be followed to minimize further tissue damage. Infusion with central venous access devices can reduce the risk of infiltration of chemotherapy agents that are vesicants.
Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? A. A bland, low-fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods
a bland, low-fiber diet Rationale: Patients experiencing diarrhea secondary to chemotherapy and/or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.
