midterm 2 cancer

Nagging cough or hoarseness is the cause of what type of cancer?

Lung cancer

Break down of tissues in GI tract

Mucositis

When do we have to report drainage 24 hours after a mastectomy?

if above >25 mL in 24 hours

What are some primary screenings of cancer?

-Avoidance of known or potential carcinogens Modification of associated factors -Removal of "at-risk" tissues -Chemoprevention -Vaccination

What are some secondary screenings of cancer?

-Regular screening -Altering damaged genes -Genetic screening

What are the signs and symptoms of superior vena cava syndrome?

-SOB -nosebleeds -HTN -edema -Decrease LOC

What are important elements of nursing care for client undergoing radiation therapy?

-skin changes -Altered taste sensations -Fatigue fibrosis and scarring Teaching to help patient cope -Do not remove markings -Administer skin care -Use lotions to protect skin (per agency policy)- may not really help, no miracle product -Avoid direct skin exposure to sunlight for up to 1 year after radiation -Care for xerostomia (dry mouth) -Protect from fracture

What are some post care interventions for a child who had a brain tumor?

-steroids to keep ICP down -anticonvulsants for supratentorial tumor -High dose chemo with stem cell rescue common -Radiation done sparingly due to concern of damage to normal tissue

Match each chemotherapy side effect below with the correct intervention. A. Anemia B. Neutropenia C. Thrombocytopenia 1. Inspect IV sites every 4 hours for signs of infection. 2. Avoid IM injections and venipunctures. 3. Administer epoetin alfa subcutaneously once a week.

1. Inspect IV sites every 4 hours for signs of infection. -B. 2. Avoid IM injections and venipunctures. -C. 3. Administer epoetin alfa subcutaneously once a week. -A.

A nurse teach a client who is at high risk for colon cancer. Which dietary recommendation should the nurse teach the client? A. "Add vegetables such as broccoli to your diet." B. "Eat low fiber and low residue foods." C. "White rice and bread are easier to digest." D. "Foods high in animal fat protect the intestinal mucosa."

A. "Add vegetables such as broccoli to your diet."

A nurse is looking at photographs of a friends infant. The nurse notes a whitish glow in the Childs eyes, and the friend asks why to baby looks so odd. Which response by the nurse is the most accurate? A. "This is called leukocoria and may signify retinoblastoma." B. "If his eyes look like this by 6 months then he may need to see a doctor." C. Take him to the doctor to see what's wrong with his eyes. D. Your baby may have a brain tumor. Take him to the hospital.

A. "This is called leukocoria and may signify retinoblastoma."

When is the patient with acute leukemia at greatest risk of developing tumor lysis syndrome? A. After the first cycle of chemotherapy B. After the second cycle of chemotherapy C. After the last cycle of chemotherapy D. Anytime during the patient's treatment course

A. After the first cycle of chemotherapy

A client has dumping syndrome after a partial gastrectomy. Which action by the nurse would be most helpful? A. Arrange a dietary consult B. Increase fluid intake C. Limit the client's salt intake D. Make the client NPO

A. Arrange a dietary consult

Which risk factor is responsible for the majority of deaths from lung cancer? A. Cigarette smoking B. Occupational radiation exposure C. Chronic exposure to asbestos D. Air pollution

A. Cigarette smoking

Which client diagnosed with prostate cancer is not a candidate for active surveillance? A. Client who refuses digital exams (DREs) B. Client with very early prostate cancer C. Client who has no symptoms of prostate cancer D. Client who wants to avoid treatment side effect of incontinence

A. Client who refuses digital exams (DREs)

A nurse cares for a client who has a new colostomy. Which action should the nurse take? A. Empty the pouch frequently to remove excess gas collection. B. Change the stony pouch and wafer every morning C. Allow the pouch to completely fill with stool prior to emptying it. D. Use surgical tape to secure the pouch and prevent leakage.

A. Empty the pouch frequently to remove excess gas collection.

Which side effect is a patient receiving radiation therapy for breast cancer most likely to experience? A. Fatigue B. Mucositis C. Hair loss D. Nausea and vomiting

A. Fatigue

The patient is discharged and home health services are arranged. What are the home health nurse's assessment priorities? (Select all that apply.) A. Gastrointestinal status B. Condition of the stoma C. Peristomal skin condition D. Patient and family's coping skills E. Results of daily laxative prescription

A. Gastrointestinal status B. Condition of the stoma C. Peristomal skin condition D. Patient and family's coping skills

A woman is receiving brachytherapy for endometrial cancer. Which statement by the woman indicates a need for further education about this treatment? A. I must stay away from my young grandchildren for 6 weeks. B. I may go about my usual activities between treatments. C. I might experience more fatigue than usual during therapy. D. I should report any fever over 100 degrees to my doctor.

A. I must stay away from my young grandchildren for 6 weeks.

At the primary care clinic, the patient tells the nurse that he has been experiencing vomiting and straining to have BMs. He states that he is tired all the time and has lost about 15 pounds over the past month. What diagnostic test would take priority at this time? A. Stool for fecal occult blood B. Serum electrolytes C. Colonoscopy D. EGD

A. Stool for fecal occult blood

A client on chemotherapy has a platelet count of 25,000. Which intervention is most important for the nurse to teach the client? A. Use a soft-bristled tooth brush B. Don't eat any unpeeled fruit C. Take your temperature daily D. Avoid alcohol-based mouth washes

A. Use a soft-bristled tooth brush

A client has undergone cryosurgery for stage 1 cervical cancer. Which precaution or action does the nurse teach the client? A. Use sanitary napkins (pads) to manage discharge for the next several weeks. B. Avoid sexual intercourse or becoming pregnant for the next 12 months. C. If you should become pregnant you will be at higher risk for preterm labor. D. Your next menstrual cycle will be delayed because of this procedure.

A. Use sanitary napkins (pads) to manage discharge for the next several weeks.

20. A nurse working with clients who experience alopecia knows that which is the best method of helping clients manage the psychosocial impact of this problem? a. Assisting the client to pre-plan for this event b. Reassuring the client that alopecia is temporary c. Teaching the client ways to protect the scalp d. Telling the client that there are worse side effects

ANS: A Alopecia does not occur for all clients who have cancer, but when it does, it can be devastating. The best action by the nurse is to teach the client about the possibility and to give the client multiple choices for preparing for this event. Not all clients will have the same reaction, but some possible actions the client can take are buying a wig ahead of time, buying attractive hats and scarves, and having a hairdresser modify a wig to look like the client's own hair. Teaching about scalp protection is important but does not address the psychosocial impact. Reassuring the client that hair loss is temporary and telling him or her that there are worse side effects are both patronizing and do not give the client tools to manage this condition.

8. The nurse working with oncology clients understands that which age-related change increases the older client's susceptibility to infection during chemotherapy? a. Decreased immune function b. Diminished nutritional stores c. Existing cognitive deficits d. Poor physical reserves

ANS: A As people age, there is an age-related decrease in immune function, causing the older adult to be more susceptible to infection than other clients. Not all older adults have diminished nutritional stores, cognitive dysfunction, or poor physical reserves.

1. A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best? a. Call the client at home the next day to review teaching. b. Give the client information about a cancer support group. c. Provide all the preoperative instructions in writing. d. Reassure the client that surgery will be over soon.

ANS: A Clients are often overwhelmed at a sudden diagnosis of cancer and may be more overwhelmed at the idea of a major operation so soon. This stress significantly impacts the client's ability to understand, retain, and recall information. The nurse should call the client at home the next day to review the teaching and to answer questions. The client may or may not be ready to investigate a support group, but this does not help with teaching. Giving information in writing is important (if the client can read it), but in itself will not be enough. Telling the client that surgery will be over soon is giving false reassurance and does nothing for teaching.

23. A nurse works on an oncology unit and delegates personal hygiene to an unlicensed assistive personnel (UAP). What action by the UAP requires intervention from the nurse? a. Allowing a very tired client to skip oral hygiene and sleep b. Assisting clients with washing the perianal area every 12 hours c. Helping the client use a soft-bristled toothbrush for oral care d. Reminding the client to rinse the mouth with water or saline

ANS: A Even though clients may be tired, they still need to participate in hygiene to help prevent infection. The other options are all appropriate.

13. A client is receiving interleukins along with chemotherapy. What assessment by the nurse takes priority? a. Blood pressure b. Lung assessment c. Oral mucous membranes d. Skin integrity

ANS: A Interleukins can cause capillary leak syndrome and fluid shifting, leading to intravascular volume depletion. Although all assessments are important in caring for clients with cancer, blood pressure and other assessments of fluid status take priority.

6. A client is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important? a. Assessing the IV site every hour b. Educating the client on side effects c. Monitoring the client for nausea d. Providing warm packs for comfort

ANS: A Intravenous chemotherapy can cause local tissue destruction if it extravasates into the surrounding tissues. Peripheral IV lines are more prone to this than centrally placed lines. The most important intervention is prevention, so the nurse should check hourly to ensure the IV site is patent, or frequently depending on facility policy. Education and monitoring for side effects such as nausea are important for all clients receiving chemotherapy. Warm packs may be helpful for comfort, but if the client reports that an IV site is painful, the nurse needs to assess further.

2. A nurse reads on a hospitalized client's chart that the client is receiving teletherapy. What action by the nurse is best? a. Coordinate continuation of the therapy. b. Place the client on radiation precautions. c. No action by the nurse is needed at this time. d. Restrict visitors to only adults over age 18.

ANS: A The client needs to continue with radiation therapy, and the nurse can coordinate this with the appropriate department. The client is not radioactive, so radiation precautions and limiting visitors are not necessary.

11. A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL. What medication should the nurse prepare to administer? a. Epoetin alfa (Epogen) b. Filgrastim (Neupogen) c. Mesna (Mesnex) d. Oprelvekin (Neumega)

ANS: A The client's hemoglobin is low, so the nurse should prepare to administer epoetin alfa, a colony-stimulating factor that increases production of red blood cells. Filgrastim is for neutropenia. Mesna is used to decrease bladder toxicity from some chemotherapeutic agents. Oprelvekin is used to increase platelet count.

17. A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important? a. Assess the client's gait and balance. b. Ask the client about the ease of urine flow. c. Document the report completely. d. Inquire about the client's job risks.

ANS: A This client has manifestations of spinal cord compression, which can be seen with prostate cancer. This may affect both gait and balance and urinary function. For client safety, assessing gait and balance is the priority. Documentation should be complete. The client may or may not have occupational risks for low back pain, but with his history of prostate cancer, this should not be where the nurse starts investigating.

25. A client in the emergency department reports difficulty breathing. The nurse assesses the client's appearance as depicted below: What action by the nurse is the priority? a. Assess blood pressure and pulse. b. Attach the client to a pulse oximeter. c. Have the client rate his or her pain. d. Start high-dose steroid therapy.

ANS: A This client has superior vena cava syndrome, in which venous return from the head, neck, and trunk is blocked. Decreased cardiac output can occur. The nurse should assess indicators of cardiac output, including blood pressure and pulse, as the priority. The other actions are also appropriate but are not the priority.

4. A client has thrombocytopenia. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply the client's shoes before getting the client out of bed. b. Assist the client with ambulation. c. Shave the client with a safety razor only. d. Use a lift sheet to move the client up in bed. e. Use the Waterpik on a low setting for oral care.

ANS: A, B, D Clients with thrombocytopenia are at risk of significant bleeding even with minor injuries. The nurse instructs the UAP to put the client's shoes on before getting the client out of bed, assist with ambulation, shave the client with an electric razor, use a lift sheet when needed to reposition the client, and use a soft-bristled toothbrush for oral care.

10. A client has a platelet count of 9800/mm3. What action by the nurse is most appropriate? a. Assess the client for calf pain, warmth, and redness. b. Instruct the client to call for help to get out of bed. c. Obtain cultures as per the facility's standing policy. d. Place the client on protective isolation precautions.

ANS: B A client with a platelet count this low is at high risk for serious bleeding episodes. To prevent injury, the client should be instructed to call for help prior to getting out of bed. Calf pain, warmth, and redness might indicate a deep vein thrombosis, not associated with low platelets. Cultures and isolation relate to low white cell counts.

24. A client with cancer has anorexia and mucositis, and is losing weight. The client's family members continually bring favorite foods to the client and are distressed when the client won't eat them. What action by the nurse is best? a. Explain the pathophysiologic reasons behind the client not eating. b. Help the family show other ways to demonstrate love and caring. c. Suggest foods and liquids the client might be willing to try to eat. d. Tell the family the client isn't able to eat now no matter what they bring.

ANS: B Families often become distressed when their loved ones won't eat. Providing food is a universal sign of caring, and to some people the refusal to eat signifies worsening of the condition. The best option for the nurse is to help the family find other ways to demonstrate caring and love, because with treatment-related anorexia and mucositis, the client is not likely to eat anything right now. Explaining the rationale for the problem is a good idea but does not suggest to the family anything that they can do for the client. Simply telling the family the client is not able to eat does not give them useful information and is dismissive of their concerns.

9. After receiving the hand-off report, which client should the oncology nurse see first? a. Client who is afebrile with a heart rate of 108 beats/min b. Older client on chemotherapy with mental status changes c. Client who is neutropenic and in protective isolation d. Client scheduled for radiation therapy today

ANS: B Older clients often do not exhibit classic signs of infection, and often mental status changes are the first observation. Clients on chemotherapy who become neutropenic also often do not exhibit classic signs of infection. The nurse should assess the older client first. The other clients can be seen afterward.

19. A client has received a dose of ondansetron (Zofran) for nausea. What action by the nurse is most important? a. Assess the client for a headache. b. Assist the client in getting out of bed. c. Instruct the client to reduce salt intake. d. Weigh the client daily before the client eats.

ANS: B Ondansetron side effects include postural hypotension, vertigo, and bradycardia, all of which increase the client's risk for injury. The nurse should assist the client when getting out of bed. Headache and fluid retention are not side effects of this drug.

4. A client in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate? a. "Are you getting adequate rest and sleep each day?" b. "It is normal to be fatigued even for years afterward." c. "This is not normal and I'll let the provider know." d. "Try adding more vitamins B and C to your diet."

ANS: B Regardless of the cause, radiation-induced fatigue can be debilitating and may last for months or years after treatment has ended. Rest and adequate nutrition can affect fatigue, but it is most important that the client understands this is normal.

5. A client tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate? a. "Avoid getting salt water on the radiation site." b. "Do not expose the radiation area to direct sunlight." c. "Have a wonderful time and enjoy your vacation!" d. "Remember you should not drink alcohol for a year."

ANS: B The skin overlying the radiation site is extremely sensitive to sunlight after radiation therapy has been completed. The nurse should inform the client to avoid sun exposure to this area. This advice continues for 1 year after treatment has been completed. The other statements are not appropriate.

22. A client is having a catheter placed in the femoral artery to deliver yttrium-90 beads into a liver tumor. What action by the nurse is most important? a. Assessing the client's abdomen beforehand b. Ensuring that informed consent is on the chart c. Marking the client's bilateral pedal pulses d. Reviewing client teaching done previously

ANS: B This is an invasive procedure requiring informed consent. The nurse should ensure that consent is on the chart. The other actions are also appropriate but not the priority.

1. The student nurse caring for clients who have cancer understands that the general consequences of cancer include which client problems? (Select all that apply.) a. Clotting abnormalities from thrombocythemia b. Increased risk of infection from white blood cell deficits c. Nutritional deficits such as early satiety and cachexia d. Potential for reduced gas exchange e. Various motor and sensory deficits

ANS: B, C, D, E The general consequences of cancer include reduced immunity and blood-producing functions, altered GI structure and function, decreased respiratory function, and motor and sensory deficits. Clotting problems often occur due to thrombocytopenia (not enough platelets), not thrombocythemia (too many platelets).

14. A client is receiving rituximab (Rituxan) and asks how it works. What response by the nurse is best? a. "It causes rapid lysis of the cancer cell membranes." b. "It destroys the enzymes needed to create cancer cells." c. "It prevents the start of cell division in the cancer cells." d. "It sensitizes certain cancer cells to chemotherapy."

ANS: C Rituxan prevents the initiation of cancer cell division. The other statements are not accurate.

21. A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate? a. Administer a dose of allopurinol (Aloprim). b. Assess the client's serum potassium level. c. Gently inquire about advance directives. d. Prepare the client for emergency surgery.

ANS: C Superior vena cava syndrome is often a late-stage manifestation. After the client is stabilized and comfortable, the nurse should initiate a conversation about advance directives. Allopurinol is used for tumor lysis syndrome. Potassium levels are important in tumor lysis syndrome, in which cell destruction leads to large quantities of potassium being released into the bloodstream. Surgery is rarely done for superior vena cava syndrome.

15. Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients should the nurse assess first? a. Client with dry, itchy, peeling skin b. Client with a serum calcium of 9.2 mg/dL c. Client with a serum potassium of 2.8 mEq/L d. Client with a weight gain of 0.5 pound (1.1 kg) in 1 day

ANS: C TKIs can cause electrolyte imbalances. This potassium level is very low, so the nurse should assess this client first. Dry, itchy, peeling skin can be a problem in clients receiving biologic response modifiers, and the nurse should assess that client next because of the potential for discomfort and infection. This calcium level is normal. TKIs can also cause weight gain, but the client with the low potassium level is more critical.

The next morning the patient is scheduled for surgery to remove the tumor and place a sigmoid colostomy. He returns to the unit with a clear ostomy pouch system in place. The stoma appears healthy. Three days later, the stoma is functioning. What assessment of stool would the nurse expect? A. Mostly gas with liquid stool B. Large quantity liquid stool C. Pasty soft stool D. More solid stool

D. More solid stool

16. A nurse is assessing a female client who is taking progestins. What assessment finding requires the nurse to notify the provider immediately? a. Irregular menses b. Edema in the lower extremities c. Ongoing breast tenderness d. Red, warm, swollen calf

ANS: D All clients receiving progestin therapy are at risk for thromboembolism. A red, warm, swollen calf is a manifestation of deep vein thrombosis and should be reported to the provider. Irregular menses, edema in the lower extremities, and breast tenderness are common side effects of the therapy.

12. A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority? a. Helping clients adjust to their appearance b. Reassuring clients that this change is temporary c. Referring clients to a reputable wig shop d. Teaching measures to prevent scalp injury

ANS: D All of the actions are appropriate for clients with alopecia. However, the priority is client safety, so the nurse should first teach ways to prevent scalp injury.

18. The nurse has taught a client with cancer ways to prevent infection. What statement by the client indicates that more teaching is needed? a. "I should take my temperature daily and when I don't feel well." b. "I will wash my toothbrush in the dishwasher once a week." c. "I won't let anyone share any of my personal items or dishes." d. "It's alright for me to keep my pets and change the litter box."

ANS: D Clients should wash their hands after touching their pets and should not empty or scoop the cat litter box. The other statements are appropriate for self-management.

The patient's stool is positive for occult blood and he is admitted to the inpatient oncology unit 3 hours later. Two hours after admission, the patient is passing bright red blood from his rectum. Which location does this suggest for the patient's tumor? A. Transverse colon B. Descending colon C. Ascending colon D. Rectosigmoid colon

D. Rectosigmoid colon

What do we have to do with anemia?

Administer epoetin alfa subcutaneously once a week.

What type of tumors do children have?

Almost all are primary

What do we have to do with thrombocytopenia?

Avoid IM injections and venipunctures.

What is the expected outcome related to hair loss for a patient who is undergoing chemotherapy? A. Hair loss may be permanent. It is not possible to predict. B. Hair regrowth usually begins about 1 month after completion of chemotherapy. C. New hair growth will likely be identical to previous hair growth in color and texture. D. A number of treatments exist for the prevention of alopecia.

B. Hair regrowth usually begins about 1 month after completion of chemotherapy

Which of the following is an example of a primary prevention strategy for reducing cancer risk ? A. Yearly mammography for women > 40 years B. Regular physical exercise C. Colonoscopy at age 50 then every 10 years D. Avoiding red meat in the diet

B. Regular physical exercise

In preparing a community teaching program, which information does the nurse plan to present regarding secondary prevention of cancer? A. Having adolescent children receive the Gardasil vaccination. B. Receiving cancer treatment with chemotherapy C. Annual mammography for women over age 50 D. Avoiding known cancer causing substances or conditions

C. Annual mammography for women over age 50

Which ethnic group has a higher incidence of colorectal cancer? A. Hispanic/Latino B. Asian C. Caucasian D. African-American

D. African-American

What does hormone therapy do?

Decreasing hormone effects can slow growth rate of some tumor types.

7. A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the client's oral chemotherapy medications. What action by the nurse is most appropriate? a. Crush the medications if the client cannot swallow them. b. Give one medication at a time with a full glass of water. c. No special precautions are needed for these medications. d. Wear personal protective equipment when handling the medications.

During the administration of oral chemotherapy agents, nurses must take the same precautions that are used when administering IV chemotherapy. This includes using personal protective equipment. These medications cannot be crushed, split, or chewed. Giving one at a time is not needed.

In cancer what are the most dividing cells most affected?

GI system (mouth, esophagus, intestines, rectum, sperm and blood forming)

This uses patient's own T cells which are modified to target cancer cells then reinfused, genetically altered viruses used to target and destroy cancer cells.

Gene therapy

compare cancer cell to normal cells of tissue from which cancer arose- helps to determine prognosis and best treatment

Grading

What does alopecia mean?

Hair loss

Is the person receiving radiation therapy a danger to others?

If receiving external beam radiation (teletherapy), no.

What therapy allows you to take bigger doses of chemo without the dangerous side effects?

Immunotherapy: Biological response modifiers

What do we have to do with neutropenia?

Inspect IV sites every 4 hours for signs of infection.

How are chemotherapy drugs given?

PO, lazer radiation, intrathecal route, & IV as main route

What does vascular Endothelial Growth Factor/ Receptor Inhibitor do?

Prevents binding to receptors

Can be temporary or permanent. Emit low dose radiation. Wastes not radioactive. Is high dose type in which implant is placed for 1 hour or so then removed. When source not in body, not radioactive.

Sealed brachytherapy

What position does a patient need to be placed in after a thoracotomy?

Semi Fowlers

What is an oncologic emergency?

Sepsis and DIC

What do we do if someone complains of burning with extravasation?

Stop the IV

If radiation source is within body, they emit radiation and are a potential hazard. (Usually liquid given orally or IV) enter body fluids, wastes are contaminated. After isotope is eliminated the patient and wastes are not radioactive. Depends on half-life of isotope

Unsealed brachytherapy

Indigestion or trouble swallowing is the cause of what type of cancer?

esophageal cancer

What cancer is most commonly found in the belly of infants?

neuroblastoma

A procedure that is done to treat recurrent collapsed lungs or fluid build up between the lung and chest wall lining that will not go away. Medicines (Doxycycline or talc powder) are put into the space between your lung and chest

pleurodesis

How is mucositis managed?

saline rinse & soft tooth brush

location and extent of tumor

staging