Chapter 6: Cancer
Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client?
Autologous
The nursing instructor is discussing the difference between normal cells and cancer cells with the pre-nursing class in pathophysiology. What would the instructor cite as a characteristic of a cancer cell?
The cell membrane of malignant cells contains proteins called tumor-specific antigens
A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue?
Excisional biopsy
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?
Tumor pressure against normal tissues
Which of the following would be consistent with a benign neoplasm?
Usually progressive and slow
What is the best way for the nurse to assess the nutritional status of a patient with cancer?
Weigh the patient daily.
Which of the following would be inconsistent as a common side effect of chemotherapy?
Weight gain
The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse?
"I can continue taking my vitamins and herbs because they make me feel better."
An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates an understanding of the nurse's teaching?
"I clean my teeth gently several times per day."
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 floss my teeth every morning."
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."
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 hope they find a bone marrow donor who matches."
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 allogenic bone marrow transplant. Which statement by the client demonstrates she understands the informed consent she gave about the diagnosis and treatment?
"I'll only need chemotherapy treatment before receiving my bone marrow transplant."
Which statement by a client undergoing external radiation therapy indicates the need for further teaching?
"I'm worried I'll expose my family members to radiation."
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."
A computed tomography (CT) scan has detected a "spot" on a patient's liver, and a subsequent liver biopsy has revealed cancer and been submitted for staging and grading. The patient has asked you about the purpose of staging, stating that her oncologist's explanation left her somewhat confused. How could you best respond to this patient's question?
"Staging allows the care team to determine how large and extensive your tumor is."
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?
"The hair loss is usually temporary."
A patient is scheduled for cryoablation for cervical cancer and tells the nurse, "I am not exactly sure what the surgeon is going to do." What is the best response by the nurse?
"The surgeon is going to use liquid nitrogen to freeze the area."
The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. What response by the nurse would best reassure this patient?
"These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and X-ray studies."
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 a new growth of abnormal tissue in your abdomen." "You have an abdominal tumor."
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 may choose to discontinue this test."
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
"You will need to practice birth control measures."
After a bone marrow transplant (BMT), the client should be monitored for at least
100 days
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?
7 to 14 days
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 normal reaction to the diagnosis of cancer.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate?
Adjuvant therapy is likely.
A patient with a diagnosis of renal cell carcinoma is being treated with chemotherapy. During a previous round of chemotherapy, the patient's tumor responded well to treatment but the chemotherapy caused intense nausea and vomiting. How should the patient's potential nausea and vomiting be addressed during this current round of treatment?
Administer antiemetics in anticipation of the patient's nausea
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?
Administering metoclopramide and dexamethasone as ordered
A 67-year-old client is admitted for diagnostic studies to rule out cancer. The patient is white, married, has been employed as a landscaper for 40 years, and has a 36-year history of smoking a pack of cigarettes daily. What significant risk factors does the nurse recognize this patient has? Select all that apply.
Age Cigarette smoking Occupation
Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient?
Allogeneic
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
Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?
Control
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: Tis, N0, M0. What does this classification mean?
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis
A client diagnosed with cancer makes the following statement to the nurse: "I guess I will tell my health care provider to forego the chemotherapy. I do not want to be throwing up all of the time. I would rather die." Which of the following facts supports the use of chemotherapy for this client?
Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects
The nurse should teach the patient who is being radiated about protecting his skin and oral mucosa. An important teaching point would be to tell the patient to:
Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth.
Your patient has recently completed her first round of chemotherapy in the treatment of lung cancer. When reviewing this morning's blood work, what findings would be suggestive of myelosuppression?
Decreased platelets and red blood cells
The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply.
Egg white omelet with spinach and mushrooms Steamed broccoli and carrots Turkey breast on whole wheat bread
A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:
Encourage fluid intake, if possible, to dilute the urine
A patient with a diagnosis of prostate cancer is receiving radiation therapy, a treatment that has resulted in stomatitis. To best manage this patient's stomatitis, the nurse should:
Encourage the patient to use an oral swab rather than a regular toothbrush.
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?
Inspecting the skin for petechiae once every shift
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?
Inspecting the skin for petechiae once every shift
A client with cancer is receiving chemotherapy and reports to the nurse that his or her mouth is painful and has difficulty ingesting food. What actions should the nurse take? Select all that apply.
Instructs the client to brush the teeth with a soft toothbrush Asks the client to open his or her mouth to facilitate inspection of the oral mucosa Consults with the healthcare provider about use of nystatin
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 inhibits deoxyribonucleic acid (DNA) synthesis
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 interferes with DNA replication and RNA transcription.
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?
Malignant tumor
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 closely to prevent infection
A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client?
Monitor the client to prevent sepsis
Which type of surgery is used in an attempt to relieve complications of cancer?
Palliative
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.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior?
Progression
You are a clinic nurse. One of your clients has found she is at high risk for breast cancer. She asks you what can be done to reduce her risk. What is a means of reducing the risk for breast cancer?
Prophylactic surgery
A nurse assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis?
Provide a solution of viscous lidocaine for use as a mouth rinse.
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.
The nurse is preparing to assess a client whose chart documents that the client experienced extravasation when receiving the vesicant vincristine during the previous shift. The documentation also notes that an antidote was administered immediately. The nurse prepares to assess for which conditions? Select all that apply.
Sloughing tissue Tissue necrosis Effectiveness of the antidote
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?
Stomatitis
While a patient is receiving IV doxorubicin hydrochloride, the nurse observes that there is swelling and pain at the IV site. The nurse should:
Stop the administration of the drug immediately.
The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks?
Sun safety and use of sunscreen
A client calls the oncology office nurse and reports nausea and vomiting one week after receiving chemotherapy. What action should the nurse recommend?
Taking prescribed ondansetron
A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention?
The I.V. site is red and swollen.
A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that she is meeting the goal of improved body image and self-esteem?
The patient requests that her family bring her makeup and wig.
Which statement is true about malignant tumors?
They gain access to the blood and lymphatic channels.
The physician is attending to a 72-year-old client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation?
To prevent the formation of new cancer cells
A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client?
Wear personal protective equipment when handling blood, body fluids, and feces.
To combat the most common adverse effects of chemotherapy, a nurse should administer an:
antiemetic
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.
dietary substances environmental factors viruses
Cancer is the second leading cause of death in the United States, second only to heart disease. Half of all men and one third of all women will develop cancer during their lifetimes. Which types of cancer have the highest prevalence among both men and women?
lung and colon
When a client receives vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the client needs to be informed to report which symptoms that would be expected side effects of motor neuropathy? Select all that apply.
muscle weakness cramps and spasms in the legs loss of balance and coordination
According to the TNM classification system, T0 means there is
no evidence of primary tumor.
A nurse is caring for a client with prostate cancer and assesses bleeding gums and hematuria. What serum indicator should the nurse relate the bleeding?
platelet count of 60,000/mm3
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?
prophylactic
Palliation refers to
relief of symptoms associated with disease and promotion of comfort and quality of life.
A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with
seizure.
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 movement of the GI tract
The drug interleukin-2 is an example of which type of biologic response modifier?
Cytokine
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 bladder
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
The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as
brachytherapy.
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:
chemotherapy exposure and risk factors.
The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice?
eats red meat such as steaks or hamburgers every day
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.
The nurse provides care on an oncology unit, where many patients undergo surgery during cancer treatment and face a particularly high risk of deep vein thrombosis (DVT) because of an increase in circulating procoagulants. The nurse should prioritize which type of assessments?
Limb symmetry and calf pain
A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells?
Liver
Which is a growth-based classification of tumors?
Malignancy
A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication?
Serum potassium level of 2.6 mEq/L
The nurse is teaching a client newly diagnosed with cancer about chemotherapy. The nurse tells the client he'll receive an antitumor antibiotic. The nurse knows that this type of medications is:
cell-cycle nonspecific.
A client has cancer of the neck and is receiving external beam radiation therapy to the site. The client is experiencing trauma to the irradiated skin. The nurse does all of the following. (Select all that apply).
Assesses the client for any sun exposure Avoids shaving the irradiated skin
A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan?
Avoiding using soap on the irradiated areas
A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient?
Explain to the patient that she will continue to emit radiation while the implant is in place.
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
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?
Fear
Which grade of tumor is also known as a well-differentiated tumor?
Grade I
The nurse is working with a client who has had an allo-hematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of:
Graft-versus-host disease
You are an oncology nurse who has reconstituted a patient's scheduled chemotherapeutic drug. What action should you perform prior to administering this drug?
Have a colleague confirm the chemotherapy dose.
The health care provider recommends that parents have their daughter vaccinated with HPV vaccine. What is this vaccine for?
Help prevent cervical cancer
A client diagnosed with cancer has the tumor staged and graded based on what?
How the tumor tends to grow and the cell type
A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to:
Increase her intake of calcium-rich foods.
Chemotherapeutic agents have which effect associated with the renal system?
Increased uric acid excretion
A 66-year-old man is receiving radiation therapy and chemotherapy for the treatment of small cell lung cancer. The nurse has assessed him many times since he was admitted to the hospital. This morning, he admits that his greatest challenge he is currently facing is his overwhelming fatigue. How should the nurse respond to this patient's statement?
"That must be incredibly difficult for you. How would you rate your fatigue if you had to give it a number from 1 to 10?"
5-Fluorouracil (5FU) is classified as which type of antineoplastic agent?
Antimetabolite
Which of the following is a term used to describe the process of programmed cell death?
Apoptosis
After being seen in the oncology clinic, a client is admitted to the hospital with severe bone marrow depression. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority?
Risk for infection
A patient with a diagnosis of late-stage bladder cancer has experienced a steady decline in his platelet counts, which are currently 18,000/mm3 (0.018 × 1012/L). Which of the following nursing actions best accommodates the health risks associated with this laboratory finding?
Encouraging the patient to increase his fluid intake and providing stool softeners
