PrepU Ch 15: Oncologic Disorders

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. A side effect of the neoplastic drugs. B. An aberrant psychologic reaction to the chemotherapy. C. A normal reaction to the diagnosis of cancer. D. A psychiatric diagnosis everyone has at one time or another.

C. A normal reaction to the diagnosis of cancer. Rationale: 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.

Which of the following is a type of procedure that uses liquid nitrogen to freeze tissue and cause cell destruction? A. Laser surgery B. Chemosurgery C. Electrosurgery D. Cryosurgery

D. Cryosurgery Rationale: Cryosurgery uses liquid nitrogen or a very cold probe to freeze tissue to cause cell destruction. Electrosurgery, chemosurgery, and laser surgery do not use liquid nitrogen to freeze tissue.

A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? A. Temperature of 98.3° F (36.8° C) B. Ate 75% of all meals during the day C. White blood cell (WBC) count of 9,000 cells/mm3 D. Stage 3 pressure ulcer on the left heel

D. Stage 3 pressure ulcer on the left heel Rationale: A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection.

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: A. absorption through the gloves. B. absorption through the goggles. C. inhalation of aerosols. D. absorption through the gown.

C. inhalation of aerosols. Rationale: 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.

A decrease in circulating white blood cells is A. neutropenia. B. thrombocytopenia. C. leukopenia. D. granulocytopenia.

C. leukopenia. Rationale: 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.

Which type of surgery is used in an attempt to relieve complications of cancer? A. Reconstructive B. Prophylactic C. Salvage D. Palliative

D. Palliative Rationale: 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 nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse? A. It treats drug-related anemia. B. It prevents alopecia. C. It lowers serum and uric acid levels. D. It stimulates the immune system against the tumor cells.

C. It lowers serum and uric acid levels. Rationale: The use of allopurinol with chemotherapy is to prevent renal toxicity. Tumor lysis syndrome occurrence can be reduced with allopurinol's action of reducing the conversion of nucleic acid byproducts to uric acid, in this way preventing urate nephropathy and subsequent oliguric renal failure. Allopurinol does not stimulate the immune system, treat anemia, or prevent alopecia.

A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with A. anorexia. B. seizure. C. weight gain. D. myalgia.

B. seizure. Rationale: A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with seizures, abnormal reflexes, papilledema, coma, and death. Anorexia, weight gain, and myalgia are associated with serum sodium concentrations lower than 120 mEq/L.

Which is a growth-based classification of tumors? A. Sarcoma B. Carcinoma C. Malignancy D. Leukemia

C. Malignancy Rationale: Tumors classified on the basis of growth are described as benign or malignant. Tumors that are classified on the basis of the cell or tissue of origin are carcinomas, sarcomas, lymphomas, and leukemias.

The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as A. systemic radiation. B. external beam radiation therapy. C. brachytherapy. D. a contact mold.

C. brachytherapy. Rationale: Brachytherapy is the only term used to denote the use of internal radiation implants.

What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen? A. It attacks cancer cells during their vulnerable phase. B. It functions against disseminated disease. C. It causes a systemic reaction. D. It targets normal body cells as well as cancer cells.

D. It targets normal body cells as well as cancer cells. Rationale: Chemotherapy agents affect both normal and malignant cells; therefore, their effects are often widespread, affecting many body systems.

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? A. Cells colonizing to distant body parts B. Emission of abnormal proteins C. Random, rapid growth of the tumor D. Tumor pressure against normal tissues

D. Tumor pressure against normal tissues Rationale: 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.

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? A. Avoiding using soap on the irradiated areas B. Applying talcum powder to the irradiated areas daily after bathing C. Wearing a lead apron during direct contact with the client D. Removing thoracic skin markings after each radiation treatment

A. Avoiding using soap on the irradiated areas Rationale: 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.

Which occurs when fluid accumulates in the pericardial space and compresses the heart? A. Cardiac tamponade B. Superior vena cava syndrome (SVCS) C. SIADH D. DIC

A. Cardiac tamponade Rationale: Cardiac tamponade is an accumulation of fluid in the pericardial space. SVCS occurs when the superior vena cava is compressed or invaded by a tumor, lymph nodes are enlarged, intraluminal thrombosis obstructs venous circulation, or drainage occurs from the head, neck, arms, and thorax. SIADH is the continuous, uncontrolled release of ADH. DIC is a complex disorder of coagulation or fibrinolysis that results in thrombosis or bleeding.

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? A. To prevent the formation of new cancer cells B. To destroy marginal tissues C. To analyze the lymph nodes involved D. To remove the tumor from the brain

A. To prevent the formation of new cancer cells Rationale: Radiation therapy helps prevent cellular growth. It may be used to cure the cancer or to control malignancy when the tumor cannot be removed or when lymph node involvement is present; also, it can be used prophylactically to prevent spread. Biopsy is used to analyze lymph nodes or to destroy the surrounding tissues around the tumor.

While doing a health history, a client tells the nurse that her mother, her grandmother, and her sister died of breast cancer. The client asks what she can do to keep from getting cancer. What is the best response by the nurse? A. "If you eat right, exercise, and get enough rest, you can always prevent breast cancer." B. "Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level." C. "Cancer often skips a generation, so don't worry about it." D. "With your family history, there is nothing you can do to prevent getting cancer, so be mindful of your family risk factors."

B. "Cancer prevention and detection can be done with blood analysis for tumor markers to measure your risk level." Rationale: Specialized tests have been developed for tumor markers, specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. The nurse cannot say that cancer can be avoided with healthy behaviors; this is inaccurate information. A family history is a reason for the client to be concerned. Cancer does not skip a generation; this response minimizes and negates the client's concern.

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: A. provide a three-dimensional cross-sectional view. B. show movement of the GI tract. C. show tumor "hot spots" in the GI tract. D. remove a tissue sample from the GI tract.

B. show movement of the GI tract. Rationale: A barium study is an example of fluoroscopy, which is used to show continuous x-ray images on a monitor, allowing the movement of a body structure to be viewed. Fluoroscopy does not involve the biopsy of tissue samples. Nuclear imaging, not a barium study, uses IV tracers to reveal tumor hot spots. CT scans provide three-dimensional cross-sectional views of tissues to determine tumor density, shape, size, volume, and location as well as highlighting blood vessels that feed the tumor.

A 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? A. Needle biopsy B. Punch biopsy C. Excisional biopsy D. Incisional biopsy

C. Excisional biopsy Rationale: 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.

Which of the following is a characteristic of a malignant tumor? A. It is usually slow growing. B. It grows by expansion. C. It gains access to the blood and lymphatic channels. D. It demonstrates cells that are well differentiated.

C. It gains access to the blood and lymphatic channels. Rationale: 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.

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? A. "I use an alcohol-based mouthwash every morning." B. "I lubricate my lips with petroleum jelly." C. "I replace my toothbrush every month." D. "I clean my teeth gently several times per day."

D. "I clean my teeth gently several times per day." Rationale: 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.

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? A. Pool and water safety B. Breast and testicular self-exams C. Hand washing and infection prevention D. Sun safety and use of sunscreen

D. Sun safety and use of sunscreen Rationale: Pool and water safety as well as infection prevention are important teaching topics but will not decrease cancer risk. While performing breast and testicular self-exams may identify cancers in the early stage, this teaching is not usually initiated in school-age children. Severe sunburns that occur in young children can place the child at risk for skin cancers later in life. Because children spend much time out of doors, the use of sunscreen and protective clothing/hats can protect the skin and decrease the risk.

Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure? A. Family history B. Drug history C. Blood studies D. Allergy history

C. Blood studies Rationale: 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 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? A. "Thank goodness the tumor is contained and curable." B. "I guess the doctor could not remove the entire tumor." C. "I am so glad the doctor was able to remove the entire tumor." D. "I will be glad to finally be done with treatments for this thing."

B. "I guess the doctor could not remove the entire tumor." Rationale: 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 lethal tumor dose is defined as the dose that will eradicate what percentage of the tumor yet preserve normal tissue? A. 75% B. 65% C. 85% D. 95%

D. 95% Rationale: 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.

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? A. Nitrosoureas B. Alkylating C. Mitotic spindle poisons D. Antimetabolite

D. Antimetabolite Rationale: 5-FU is an antimetabolite. An example of an alkylating agent is nitrogen mustard. A nitrosourea is streptozocin. A mitotic spindle poison is vincristine (VCR).

A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient? A. Clarify information provided by the physician. B. Counsel the patient about the possibility of losing her breast. C. Provide time for the patient to discuss her concerns. D. Provide aseptic care to the incision postoperatively.

C. Provide time for the patient to discuss her concerns. Rationale: Patients who are undergoing surgery for the diagnosis or treatment of cancer may be anxious about the surgical procedure, possible findings, postoperative limitations, changes in normal body functions, and prognosis. The patient and family require time and assistance to process the possible changes and outcomes resulting from the surgery. The nurse serves as the patient advocate and liaison and encourages the patient and family to take an active role in decision making when possible. If the patient or family asks about the results of diagnostic testing and surgical procedures, the nurse's response is guided by the information that was conveyed previously. The nurse may be asked to explain and clarify information for patients and families that was provided initially but was not grasped because of anxiety and overwhelming feelings. It is important that the nurse, as well as other members of the health care team, provide information that is consistent from one clinician to another.

A client is receiving radiation therapy and asks the nurse about oral hygiene. What teaching specific to the client's situation should the nurse include? A. Floss before going to bed. B. Gargle after each meal. C. Use a soft toothbrush and allow it to air dry before storing. D. Treat cavities immediately.

C. Use a soft toothbrush and allow it to air dry before storing. Rationale: The nurse advises the client undergoing radiation therapy to use a soft toothbrush to avoid gum lacerations and allow the toothbrush to air dry before storing. Gargling after each meal, flossing before going to bed, and treating cavities immediately are general oral hygiene instructions.

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? A. Repeat biopsy is needed before treatment begins. B. Palliative care is likely. C. No further treatment is indicated. D. Adjuvant therapy is likely.

D. Adjuvant therapy is likely. Rationale: 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 does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure? A. Allergy history B. Drug history C. Family history D. Blood studies

D. Blood studies Rationale: Before the HSCT 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 an HSCT procedure, the nurse need not evaluate client's family, drug, or allergy history.

The nurse is conducting a community education program using the American Cancer Society's colorectal screening and prevention guidelines. The nurse determines that the participants understand the teaching when they identify that people over the age of 50 should have which screening test every 10 years? A. Fecal occult blood test B. Papanicolaou (Pap) C. Prostate-specific antigen (PSA) D. Colonoscopy

D. Colonoscopy Rationale: Recommendations for screening for colorectal cancer include a screening colonoscopy every 10 years. Fecal occult blood tests should be completed annually in people over age 50. The test for PSA is used as a screening tool for prostate cancer. A Pap test is a screening tool for cervical cancer.

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 A. "You will need to practice birth control measures." B. "You will experience menopause now." C. "You will continue having your menses every month." D. "You will be unable to have children."

A. "You will need to practice birth control measures." Rationale: Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.

A client 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? A. Closely observe the client's skin for petechiae and bruising. B. Check the client's history for a congenital link to thrombocytopenia. C. Monitor daily platelet counts. D. Perform a cardiovascular assessment every 4 hours.

A. Closely observe the client's skin for petechiae and bruising. Rationale: 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.

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? A. lung and colon B. skin and brain C. lung and skin D. colon and skin

A. lung and colon Rationale: Common cancers in men include prostate, lung, and colon. Breast, lung, and colon cancer most commonly affect women.

What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss? A. Alopecia related to chemotherapy is relatively uncommon. B. The client should consider getting a wig or cap prior to beginning treatment. C. The hair will grow back the same as it was before treatment. D. The hair will grow back within 2 months post therapy.

B. The client should consider getting a wig or cap prior to beginning treatment. Rationale: If hair loss is anticipated and causing the client anxiety, a wig, cap, or scarf should be purchased before therapy begins. Alopecia develops because chemotherapy affects the rapidly growing cells of the hair follicles. Hair usually begins to grow again within 4 to 6 months after therapy. Clients should know that new growth may have a slightly different color and texture.

A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells? A. Reproductive tract B. Colon C. Liver D. White blood cells (WBCs)

C. Liver Rationale: 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 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? A. Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis B. Can't assess tumor or regional lymph nodes and no evidence of metastasis C. Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis D. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis

C. Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Rationale: Tis, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.

A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because: A. The first two drugs are toxic to cancer cells, and the third drug promotes cell growth. B. The three drugs can be given at lower doses. C. The second and third drugs increase the effectiveness of the first drug. D. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms.

D. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. Rationale: Multiple drug regimens are used because the drugs have a synergistic effect. The drugs have different cell-cycle lysis effects, different mechanisms of action, and different toxic adverse effects. They are usually given in combination to enhance therapy. Dosage is not affected by giving the drugs in combination. The second and third drugs do not increase the effectiveness of the first. It is not true that the first two drugs are toxic to cancer cells while the third drug promotes cell growth.

A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client? A. Monitor the client to prevent sepsis. B. Monitor the client's toilet patterns. C. Monitor the client's heart rate. D. Monitor the client's physical condition.

A. Monitor the client to prevent sepsis. Rationale: 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.

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? A. "You could have stopped immediately after your hysterectomy." B. "You may choose to discontinue this test." C. "You need to continue obtaining a Pap test for only the next 5 years." D. "You will need to continue for the rest of your life."

B. "You may choose to discontinue this test." Rationale: 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.

The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice? A. drinks one glass of wine at dinner each night B. uses the treadmill for 30 minutes on 5 days each week C. eats red meat such as steaks or hamburgers every day D. works as a secretary at a medical radiation treatment center

C. eats red meat such as steaks or hamburgers every day Rationale: Dietary substances such as nitrate-containing and red meats appear to increase the risk of cancer. Exercising 30 minutes on 5 days or more is recommended for adults. Measures are taken to protect those people who work around radiation. Alcohol consumption recommendations include drink no more than one drink per day for women or two per day for men.

A side-effect of chemotherapy is renal damage. To prevent this, the nurse should: A. Modify the diet to acidify the urine, thus preventing uric acid crystallization. B. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. C. Limit fluids to 1,000 mL/day to minimize stress on the renal tubules. D. Encourage fluid intake, if possible, to dilute the urine.

D. Encourage fluid intake, if possible, to dilute the urine. Rationale: To prevent renal damage, it is helpful to dilute the urine by increasing fluids as tolerated.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? A. Withholding fluids for the first 4 to 6 hours after chemotherapy administration B. Administering metoclopramide and dexamethasone as ordered C. Serving small portions of bland food D. Encouraging rhythmic breathing exercises

B. Administering metoclopramide and dexamethasone as ordered Rationale: The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.

A 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? A. Sexual Dysfunction B. Grieving C. Knowledge Deficit D. Fear

D. Fear Rationale: Fear of the unknown is probably the major concern for this client. This includes fear of the diagnosis of cancer, fear of the effects of the surgery, and fear of loss of control and functioning. Sexual Dysfunction may be one of the fears but not primary at this stage. Knowledge Deficit is unclear at this time. Grieving would not be a likely response at this time.

A 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? A. 7 to 14 days B. 21 to 28 days C. 24 hours D. 2 to 4 days

A. 7 to 14 days Rationale: Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.

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? A. An aunt and uncle diagnosed with cancer B. A first cousin diagnosed with cancer C. A second cousin diagnosed with cancer D. Onset of cancer after age 50 in family member

A. An aunt and uncle diagnosed with cancer Rationale: The hallmarks of hereditary cancer syndrome include cancer in two or more first-degree or second-degree relatives, early onset of cancer in family members younger than age 50, the same type of cancer in several family members, individual family members with more than one type of cancer, and a rare cancer in one or more family members.

The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? A. Avoid spicy and fatty foods. B. Eat wholesome meals. C. Eat warm or hot foods. D. Avoid intake of fluids.

A. Avoid spicy and fatty foods. Rationale: 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 patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient? A. Explain to the patient that she will continue to emit radiation while the implant is in place. B. Wear a lead apron when providing direct patient care. C. Maintain as much distance as possible from the patient while in the room. D. Alert family members that they should restrict their visiting to 5 minutes at any one time.

A. Explain to the patient that she will continue to emit radiation while the implant is in place. Rationale: 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 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. A. Steamed broccoli and carrots B. Turkey breast on whole wheat bread C. Vegetable and cheddar quiche D. Egg white omelet with spinach and mushrooms E. Crispy chicken Caesar Salad F. Smoked salmon

A. Steamed broccoli and carrots B. Turkey breast on whole wheat bread D. Egg white omelet with spinach and mushrooms Rationale: Foods high in fat and those that are smoked or preserved with salt or nitrates are associated with increased cancer risks. An omelet made of egg whites and vegetables is a healthy low fat selection as are steamed broccoli/carrots and turkey breast on whole grain bread. A salad can be a healthy selection but Caesar salads contain much fat from the dressing and addition of cheeses and fried chicken. Salmon that is not smoked would be a good selection. Quiche usually contains high-fat milk, crème, eggs, and cheese.

A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents? A. Wear disposable gloves and protective clothing. B. Throw I.V. tubing in the trash after the infusion is stopped. C. Disconnect I.V. tubing with gloved hands. D. Break needles after the infusion is discontinued.

A. Wear disposable gloves and protective clothing. Rationale: 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.

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. A. environmental factors B. dietary substances C. gender D. viruses E. age

A. environmental factors B. dietary substances D. viruses Rationale: 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.

According to the TNM classification system, T0 means there is A. no evidence of primary tumor. B. no regional lymph node metastasis. C. distant metastasis. D. no distant metastasis.

A. no evidence of primary tumor. Rationale: T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis.

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: A. Use an ointment, after treatment, to decrease the feeling of burning, which may last for several hours. B. Apply a small ice compress to the treated area afterward to decrease localized redness, post-radiation. C. Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth. D. Use an approved emollient 2 hours before the radiation to give the skin time to absorb the medication and provide a shield for damage.

C. Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth. Rationale: The patient should cleanse himself with a mild soap using his fingertips rather than a wash cloth. All the other choices will irritate the skin and fail to protect it from additional injury.

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? A. Normal finding B. Benign fibrocystic disease C. Malignant tumor with metastasis to surrounding tissue D. Malignant tumor

D. Malignant tumor Rationale: A fast-growing lump is suggestive of a malignant tumor. Metastasis can only be determined by cytology, not by palpation.

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? A. Suck on hard candy during treatment. B. Encourage maximum fluid intake. C. Encourage eating cheese, eggs, and legumes D. Stay away from protein beverages.

C. Encourage eating cheese, eggs, and legumes Rationale: 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.

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? A. Initiation B. Promotion C. Progression D. Prolongation

C. Progression Rationale: Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information, even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? A. The laboratory reports a white blood cell (WBC) count of 1,000/mm3. B. The client begins to shiver. C. The I.V. site is red and swollen. D. The client states he is nauseous.

C. The I.V. site is red and swollen. Rationale: 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.