Exam 2: Cancer
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 a laser to remove the area." "The surgeon is going to use liquid nitrogen to freeze the area." "The surgeon is going to use medication to inject the area." "The surgeon is going to use radiofrequency to ablate the area."
"The surgeon is going to use liquid nitrogen to freeze the area." Explanation: Cryoablation is the use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction. It is used for cervical, prostate, and rectal cancers. Chemosurgery is the use of medication. Laser surgery is the use of a laser. Radiofrequency ablation is the use of thermal energy.
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 need to continue obtaining a Pap test for only the next 5 years." "You may choose to discontinue this test." "You will need to continue for the rest of your life." "You could have stopped immediately after your hysterectomy."
"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.
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. Repeat biopsy is needed before treatment begins. Palliative care is likely. No further treatment is indicated.
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.
Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient? Syngeneic Allogeneic Homogenic Autologous
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.
5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? Mitotic spindle poisons Antimetabolite Alkylating 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).
Which of the following advice does the nurse offer clients who are undergoing unsealed radiation therapy to reduce exposure? Avoid drinking plenty of fluids. Avoid eating for 3 hours after therapy. Avoid kissing and sexual contact. Avoid applying skin moisturizers.
Avoid kissing and sexual contact. Explanation: Clients who are undergoing unsealed radiation therapy are advised to avoid kissing and sexual contact. Clients are encouraged to drink plenty of fluids to help flush radioactive substances. Client may be asked to apply mild moisturizers and are not asked not to eat after the therapy.
Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure? Drug history Blood studies Allergy history Family history
Blood studies Explanation: Before the BMT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before a BMT procedure, the nurse need not evaluate the client's family, drug, or allergy history.
A decrease in circulating white blood cells (WBCs) is referred to as Granulocytopenia Leukopenia Neutropenia Thrombocytopenia
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 has received several treatments of bleomycin. It is now important for the nurse to assess Urine output Lung sounds Hand grasp Skin integrity
Lung sounds Explanation: Bleomycin has cumulative toxic effects on lung function. Thus, it will be important to assess lung sounds.
Which type of surgery is used in an attempt to relieve complications of cancer? Palliative Reconstructive Salvage Prophylactic
Palliative Explanation: Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing nonvital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or to obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.
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 Fatigue related to deficient blood cells Anxiety related to change in role function
Risk for infection related to inadequate defenses Explanation: Physiological needs, such as risk for infection, take priority over the client's other needs.
The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as systemic radiation. external beam radiation therapy. a contact mold. brachytherapy.
brachytherapy. Explanation: Brachytherapy is the only term used to denote the use of internal radiation implants.
Which of the following would be consistent with a benign neoplasm? Grows by invasion Usually progressive and slow Gains access to the blood and lymph channels to metastasize Cells are undifferentiated
Usually progressive and slow Explanation: A benign neoplasm's rate of growth is usually progressive and slow. Malignant neoplasms have undifferentiated cells, grow by invasion, and gain access to the blood and lymph channels to metastasize to other areas of the body.
A nurse caring for a client who has just received chemotherapy infusion is wearing a disposable gown, gloves, and goggles for protection. The nurse knows that accidental exposure to chemotherapy agents can occur through: inhalation of aerosols. absorption through the gloves. absorption through the gown. absorption through the goggles.
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.
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. loss of balance and coordination burning and tingling sensations in the extremities cramps and spasms in the legs alopecia muscle weakness
muscle weakness cramps and spasms in the legs loss of balance and coordination Muscle weakness, cramps and leg spasms, and loss of balance and coordination are expected side effects of motor nerve damage. Burning and tingling sensations are signs of sensory nerve damage. Alopecia is hair loss, not a motor nerve damage sign.
A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? Sodium level of 142 mEq/L Blood pressure of 120/64 to 130/72 mm Hg Serum potassium level of 2.6 mEq/L Urine output of 400 ml in 8 hours
Serum potassium level of 2.6 mEq/L Explanation: Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.
The nursing instructor is discussing the diagnosis of cancer with their nursing class. The instructor tells her students that scientists have predicted that gene therapy will one day play a large role in the prediction, diagnosis, and treatment of cancer. What cancer is gene therapy currently being investigated in the treatment of? Osteosarcomas Melanoma Pancreatic Leukemia
Melanoma Explanation: Scientists predict that gene therapy will play a significant role in the future prediction, diagnosis, and treatment of cancer. It is currently being investigated in the treatment of brain tumors, melanoma, and renal, breast, ovarian, lung, and colon cancers.
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 environmental factors viruses 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.
After a bone marrow transplant (BMT), the client should be monitored for at least 100 days 14 days 30 days 60 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.
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 if the patient vomits or believes he will soon vomit. Administer antiemetics in anticipation of the patient's nausea. Prioritize nonpharmacological treatments over medications. Provide the patient with antiemetics at his first complaint of nausea.
Administer antiemetics in anticipation of the patient's nausea. Explanation: The prevention of chemotherapy-induced nausea and vomiting is a priority. It is inappropriate to reject pharmacological treatments or to wait until the patient experiences nausea and/or vomiting before providing medication.
After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? Withholding fluids for the first 4 to 6 hours after chemotherapy administration Administering metoclopramide and dexamethasone as ordered Encouraging rhythmic breathing exercises 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.
Which is a sign or symptom of septic shock? Increased urine output Warm, moist skin Hypertension Altered mental status
Altered mental status Explanation: Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension.
The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? Avoid intake of fluids. Eat warm or hot foods. Avoid spicy and fatty foods. Eat wholesome meals.
Avoid spicy and fatty foods. Explanation: 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.
A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia? Perform a cardiovascular assessment every 4 hours. Check the client's history for a congenital link to thrombocytopenia. Closely observe the client's skin for petechiae and bruising. Monitor daily platelet counts.
Closely observe the client's skin for petechiae and bruising. Explanation: The nurse should closely observe the client's skin for petechiae and bruising. Daily laboratory testing may not reflect the client's condition as quickly as subtle changes in the client's skin. Performing a cardiovascular assessment every 4 hours and checking the clients history for a congenital link to thrombocytopenia don't help detect early signs and symptoms of thrombocytopenia.
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. Report the unusual sign of nausea. Be alarmed if she notices fluid retention. Report the unexpected sign of increased appetite and weight gain.
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.
A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells? Reproductive tract Liver Colon White blood cells (WBCs)
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.
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. Monitor vital signs once a shift. Check intake and output records. Apply pressure to the bleeding sites. Assist the client to a chair.
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.
A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient? Wear a lead apron when providing direct patient care. Maintain as much distance as possible from the patient while in the room. Alert family members that they should restrict their visiting to 5 minutes at any one time. Explain to the patient that she will continue to emit radiation while the implant is in place.
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.
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? Palliative Prophylactic Diagnostic Reconstructive
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. Counsel the patient about the possibility of losing her breast. Clarify information provided by the physician. Provide aseptic care to the incision postoperatively.
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.
The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic? Slow rate of growth Undifferentiated cells Ability to invade other tissues Causes generalized symptoms
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.
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? Extravasation Nadir Neutropenia Stomatitis
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.
A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents? Break needles after the infusion is discontinued. Wear disposable gloves and protective clothing. Disconnect I.V. tubing with gloved hands. Throw I.V. tubing in the trash after the infusion is stopped.
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.
What is the best way for the nurse to assess the nutritional status of a patient with cancer? Assess BUN and creatinine levels. Observe for proper wound healing. Monitor daily caloric intake. Weigh the patient daily.
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.
Which of the following would be inconsistent as a common side effect of chemotherapy? Weight gain Fatigue Alopecia Myelosuppression
Weight gain Explanation: Common side effects seen with chemotherapy include myelosuppression, alopecia, nausea and vomiting, anorexia, and fatigue.
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 clean my teeth gently several times per day." "I lubricate my lips with petroleum jelly." "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 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 removed all the throw rugs from the house." "I floss my teeth every morning." "I use an electric razor to shave." "I take a stool softener every morning."
"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.
A bowel resection is scheduled for a client with the diagnosis of colon cancer with metastasis to the liver and bone. Which statement by the nurse best explains the purpose of the surgery? "Tumor removal will promote comfort." "Removing the tumor is a primary treatment for colon cancer." "Once the tumor is removed, cell pathology can be determined." "This surgery will prevent further tumor growth."
"Tumor removal will promote comfort." Explanation: Palliative surgeries, such as bowel resection, may be performed to promote comfort by relieving pain and pressure on organs within the abdominal cavity. Primary treatment refers to surgery that is likely to provide a cure, which is not likely in metastatic disease. With metastasis, primary tumor removal does not prevent further tumor growth in distant sites. The diagnosis of colon cancer with metastasis suggests cell pathology has already been determined.
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 experience menopause now." "You will continue having your menses every month." "You will be unable to have children." "You will need to practice birth control measures."
"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 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. Cigarette smoking Marital status Race Occupation Age
Age Cigarette smoking Occupation Explanation: Most cancer occurs in people older than 65 years. Although the overall rate of cancer deaths has declined, cancer death rates in Black men remain substantially higher than those among White men and twice those of Hispanic men. Excessive exposure to the ultraviolet rays of the sun, especially in fair-skinned people, increases the risk of skin cancers. Factors such as clothing styles (sleeveless shirts or shorts), the use of sunscreens, occupation, recreational habits, and environmental variables, including humidity, altitude, and latitude, all play a role in the amount of exposure to ultraviolet light. Tobacco smoke, thought to be the single most lethal chemical carcinogen, accounts for at least 30% of cancer deaths in humans (Fontham et al., 2009). Smoking is strongly associated with cancers of the lung, head and neck, esophagus, stomach, pancreas, cervix, kidney, and bladder and with acute myeloblastic leukemia. Marital status is not associated with risk for cancer.
An oncology nurse is caring for a client who relates that certain tastes have changed. The client states that "meat tastes bad." What nursing intervention can be used to increase protein intake for a client with taste changes? Encourage eating cheese, eggs, and legumes Encourage maximum fluid intake. Stay away from protein beverages. Suck on hard candy during treatment.
Encourage eating cheese, eggs, and legumes Explanation: The nurse encourages the clients with taste changes to eat cheese, eggs, and legumes. Encouraging the client to take in the maximum amount of fluids does not increase protein intake. The nurse advises the client to drink protein beverages. Sucking on hard candies during treatment does not increase protein intake.
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? Thrombosis Extravasation 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.
Which grade of tumor is also known as a well-differentiated tumor? Grade I Grade II Grade IV Grade III
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 nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse? It prevents alopecia. It stimulates the immune system against the tumor cells. It lowers serum and uric acid levels. It treats drug-related anemia.
It lowers serum and uric acid levels. Explanation: 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.
You are presenting a class on cancer for a local community group. You inform the attendees that chemical agents in the environment are believed to account for 75% of all cancers. Which organs are most susceptible to cancer caused by these chemical agents? Lungs, liver, and kidneys Bone, breast, and thyroid Prostate, colon, and breast Eyes, breast, and prostrate
Lungs, liver, and kidneys Explanation: The lungs, liver, and kidneys are affected mostly because they are involved with biotransformation and excretion of chemicals.
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 Benign fibrocystic disease Malignant tumor with metastasis to surrounding tissue Normal finding
Malignant tumor Explanation: A fast-growing lump is suggestive of a malignant tumor. Metastasis can only be determined by cytology, not by palpation.
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? palliative prophylactic cryoablation local excision
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 client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse? Random, rapid growth of the tumor Cells colonizing to distant body parts Emission of abnormal proteins Tumor pressure against normal tissues
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.
The lethal tumor dose is defined as the dose that will eradicate what percentage of the tumor yet preserve normal tissue? 75% 65% 85% 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.
Which of the following is a characteristic of a malignant tumor? It is usually slow growing. It gains access to the blood and lymphatic channels. It grows by expansion. It demonstrates cells that are well differentiated.
It gains access to the blood and lymphatic channels. Explanation: By this mechanism, the tumor metastasizes to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rate 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.
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's toilet patterns. Monitor the client's physical condition. Monitor the client's heart rate. Monitor the client to prevent sepsis.
Monitor the client to prevent sepsis. Explanation: Until transplanted bone marrow begins to produce blood cells, clients who have undergone a bone marrow transplant have no physiologic means to fight infection, which puts them at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent sepsis. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client becoming septic.
Carcinogens are factors related to the formation of various malignancies. Which factor has the greatest impact on the development of all cancers? environmental factors chemical agents defective genes viruses
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.
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 first cousin diagnosed with cancer Onset of cancer after age 50 in family member A second cousin diagnosed with cancer
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.
Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth? Control Palliation Cure Prevention
Control Explanation: The range of possible treatment goals may include complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control), or relief of symptoms associated with the disease (palliation). Prevention is not a treatment goal when the patient has already been diagnosed with cancer. Prevention of metastasis to a secondary site may be a goal.
What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen? Take measures to acidify the urine and prevent uric acid crystallization. Encourage fluid intake to dilute the urine. Limit fluids to 1,000 mL daily to prevent accumulation of the drug's end products after cell lysis. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL.
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.
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 Incisional Biopsy Needy Biopsy Brachytherapy
Excisional biopsy Explanation: Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis.
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. Active bleeding Effectiveness of the antidote Tissue necrosis Sloughing tissue
Sloughing tissue Tissue necrosis Effectiveness of the antidote Explanation: Extravasation of vesicant chemotherapeutic agents can lead to erythema, sloughing, and necrosis of surrounding tissue, muscle, and tendons. To reduce the likelihood and severity of symptoms due to extravasation of a vesicant, antidotes matched to the vesicant are administered. Nurses caring for a client who experienced extravasation of a vesicant should assess for sloughing tissue, tissue necrosis, erythema, and effectiveness of the antidote.
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 client begins to shiver. The I.V. site is red and swollen.
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.
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." "I am so glad the doctor was able to 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 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.
The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important? Shield your throat area when near others. Use disposable utensils for the next month. Flush the toilet several times after every use. Prepare food separately from family members.
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.
Cancer has many characteristics. What is one of the most discouraging characteristics of cancer? Metastasis Large size tumors Carcinogenesis Slow growth
Metastasis Explanation: Metastasis is one of cancer's most discouraging characteristics because even one malignant cell can give rise to a metastatic lesion in a distant part of the body. Not all cancerous tumors are large in size. Carcinogenesis is the process of malignant transformation and it is not a characteristic of cancer. Cancer grows rapidly, not slowly.
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 Nadir Extravasation Stomatitis
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.
What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss? The hair will grow back the same as it was before treatment. The client should consider getting a wig or cap prior to beginning treatment. Alopecia related to chemotherapy is relatively uncommon. The hair will grow back within 2 months post therapy.
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 patient with cancer who developed neutropenia several days ago has consequently been placed in a single-bed room that has positive pressure. His daughter has just come to visit her father after arriving from her home in another state and has asked you for his room number. You notice that the daughter has reddened eyes, sniffles, and a dry cough. What instruction should you provide to the daughter? "It's very important that you wash your hands thoroughly before you enter your father's room and as soon as you come out." "Even though it might be difficult, it's best for your father's health if you get well before visiting him in person, since he's so vulnerable right now." "Your father is under neutropenic precautions right now so you're not allowed to visit him." "Your father is extremely vulnerable to infections right now, so I'm going to ask you to make sure you wear a gown when you go into his room."
"Even though it might be difficult, it's best for your father's health if you get well before visiting him in person, since he's so vulnerable right now." Explanation: Patients who are neutropenic need to be protected from exposure to infection. This means that visitors who are ill should not enter the patient's room. This should be explained clearly, but empathically, by the nurse. Handwashing and wearing a gown are not sufficient measures to protect a neutropenic patient. A visitor is unlikely to understand the term "neutropenic precautions."
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? An aberrant psychologic reaction to the chemotherapy. A psychiatric diagnosis everyone has at one time or another. 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.
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. Rinses the client's mouth with alcohol-based mouthwash every 2 hours Consults with the healthcare provider about use of nystatin 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 Teaches the client to floss the teeth once every 24 hours
Asks the client to open his or her mouth to facilitate inspection of the oral mucosa Instructs the client to brush the teeth with a soft toothbrush Consults with the healthcare provider about use of nystatin Explanation: The description of the client's report is stomatitis following chemotherapy treatment. The nurse should assess the oral mucosa based on the client's report of pain and difficulty eating. The client is to use a soft toothbrush to minimize trauma to the mouth. Nystatin (Mycostatin) is a topical medication that may provide healing for the client's mouth. The client avoids alcohol-based mouthwashes as these are irritants. Flossing the teeth may cause additional trauma to the mouth.
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? Removing thoracic skin markings after each radiation treatment Wearing a lead apron during direct contact with the client Applying talcum powder to the irradiated areas daily after bathing Avoiding using soap on the irradiated areas
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.
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 Increased white blood cells and c-reactive protein (CRP) Decreased sodium levels and decreased potassium levels Increased creatinine and blood urea nitrogen (BUN)
Decreased platelets and red blood cells Most chemotherapeutic agents cause myelosuppression (depression of bone marrow function), resulting in decreased production of blood cells. Myelosuppression decreases the number of WBCs (leukopenia), red blood cells (RBCs) (anemia), and platelets (thrombocytopenia), and increases the risk of infection and bleeding. It does not typically affect electrolytes, creatinine, BUN, and CRP levels.
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? Avoid showering or washing over skin markings. Time, distance, and shielding Inspect the skin frequently. The use of disposable utensils and wash cloths
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.
