Chapter 12 - Oncologic Management PrepU
The nurse is caring for a client is scheduled for chemotherapy followed by autologous stem cell transplant. Which of the following statements by the client indicates a need for further teaching? · "The doctor will remove cells from my bone marrow before beginning chemotherapy." · "I will need to attend follow-up visits for up to 3 months after treatment." · "I hope they find a bone marrow donor who matches." · "I will receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back."
A Explanation: An autologous stem cell transplant comes from the client not from a donor. The doctor will remove the stem cells from the bone marrow before beginning chemotherapy and treat the client until most if not all the cancer is eliminated before reinfusing the stem cells. Clients are at risk for infection and will be closely monitored for at least 3 months, but not in protective isolation.
The nurse instructs a client receiving chemotherapy on actions to prevent the development of stomatitis. Which client statement indicates to the nurse that teaching has been effective? · "I will brush my teeth after every meal." · "I will limit alcoholic beverages to one a day." · "I will reduce smoking to after meals only." · "I will eat spicy foods with a cool beverage."
A Explanation: Stomatitis is an inflammatory process of the mouth, including the mucosa and tissues surrounding the teeth. Manifestations of stomatitis include changes in sensation, erythema, and edema, or if severe, painful ulcerations, bleeding, and infection. It commonly develops within 3 to 14 days after receiving certain chemotherapeutic agents. Actions to prevent the development of stomatitis include brushing the teeth with a soft toothbrush for 90 seconds after every meal. Smoking dries oral tissues and should be avoided. Spicy foods can irritate the oral tissues and should be avoided. Alcohol is drying to the oral tissues and should be avoided.
A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching? · "I floss my teeth every morning." · "I take a stool softener every morning." · "I removed all the throw rugs from the house." · "I use an electric razor to shave."
A · 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.
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 · Malignant tumor with metastasis to surrounding tissue · Normal finding · Benign fibrocystic disease
A · 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? · prophylactic · palliative · cryosurgery · local excision
A · 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. Cryosurgery uses cold to destroy cancerous cells.
A nurse is planning caring for a client who has developed erythema following radiation therapy for a lesion on the left lower leg. Which intervention would the nurse include in the client's plan of care to best support skin recovery at the affected site? Select all that apply. · Cleanse with lukewarm water and pat dry · Periodically apply ice · Apply an emollient immediately before treatment · Keep the area cleanly shaven · Wear clothing that fits snugly
A · Explanation: · Erythema is a term used to describe redness of body tissue. Care to the affected area must focus on preventing further skin irritation, drying, and damage; the client should cleanse the area with lukewarm water and mild, nondeodorant soap, and pat dry. Application of ice, shaving, and wearing tight fitting clothing over the area could further damage the already traumatized tissue. Emollients may be used as directed by the radiation oncologist to soothe and moisturize irritated skin. However, even approved emollients should not be used up to 4 hours before the treatment time.
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 · Needle biopsy · Punch biopsy · Incisional biopsy
A · 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.
Which type of surgery is used in an attempt to relieve complications of cancer? · Palliative · Reconstructive · Salvage · Prophylactic
A · 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 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. · Clarify information provided by the physician. · Counsel the patient about the possibility of losing her breast. · Provide aseptic care to the incision postoperatively.
A · 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.
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. · Provide aseptic care to the incision postoperatively. · Clarify information provided by the physician. · Counsel the patient about the possibility of losing her breast.
A · 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 who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia? · "Wigs can be used after the chemotherapy is completed." · "The hair loss is usually temporary." · "Clients with alopecia will have delay in grey hair." · "New hair growth will return without any change to color or texture."
B Explanation: Alopecia associated with chemotherapy is usually temporary and will return after the therapy is completed. New hair growth may return unchanged, but there is no guarantee and color, texture, and quality of hair may be changed. There is no correlation between chemotherapy and delay in greying of hair. Use of wigs, scarves, and head coverings can be used by clients at any time during treatment plan.
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? · 21 to 28 days · 7 to 14 days · 2 to 4 days · 24 hours
B · Explanation: · Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.
A client being treated for breast cancer reports pain as being 7 on a scale from 0 to 10. Which type of pain indicates to the nurse that the client is experiencing lymph obstruction from the disease? · Distention, crampy · Dull, aching, tightness · Burning, sharp, tingling · Sharp, throbbing
B · Explanation: · Cancer can cause all types of pain. The pain associated with breast cancer due to lymphatic or venous obstruction can be described as dull, aching, and tight. Sharp, throbbing pain is caused by ischemia. Distention and cramping is associated with organ infiltration. Burning, sharp, and tingling pain is caused by nerve compression and infiltration.
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 radiofrequency to ablate the area." · "The surgeon is going to use medication to inject the area."
B · 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.
What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action? · Eggs and milk · Ham and bacon · Green, leafy vegetables · Fish and poultry
B · Explanation: · Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate and nitrite-containing foods, and red and processed meats. Nitrates are added to cured meats, such as ham and bacon.
The drug interleukin-2 is an example of which type of biologic response modifier? · Monoclonal antibodies · Cytokine · Retinoids · Antimetabolites
B · Explanation: · Other cytokines include interferon alfa and filgrastim. Monoclonal antibodies include rituximab, trastuzumab, and gemtuzumab. Retinoic acid is an example of a retinoid. Antimetabolites are cell cycle-specific antineoplastic agents.
Which statement by a client undergoing external radiation therapy indicates the need for further teaching? · "I'll wear protective clothing when outside." · "I'm worried I'll expose my family members to radiation." · "I'll wash my skin with mild soap and water only." · "I'll not use my heating pad during my treatment."
B · Explanation: · The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client's family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad.
A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include: · expected chemotherapy-related adverse effects. · chemotherapy exposure and risk factors. · signs and symptoms of infection. · reinforcement of the client's medication regimen.
B · Explanation: · The raised toilet lid exposes the child playing in the bathroom to the risk of inhaling or ingesting chemotherapy agents. The nurse should modify her teaching plan to include content related to chemotherapy exposure and its associated risk factors. Because the client has received chemotherapy, the plan should already include information about expected adverse effects, signs and symptoms of infection, and reinforcement of the medication regimen.
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: Tis, N0, M0. What does this classification mean? · Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis · 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 · Can't assess tumor or regional lymph nodes and no evidence of metastasis
B · Explanation: · 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.
While completing an admission assessment, the client reports a family history of breast cancer among a maternal grandmother, aunt, and sister. The nurse knows that these cancers are most likely associated with what etiology? · Smoking and tobacco use · Inherited gene mutation · Exposure to chemicals and spermicides · Increased tumor suppressor genes
B · Explanation: · Tumor suppressor genes assist the body in normal cell production and death. Tobacco use and chemical carcinogens can contribute to the development of cancer, but there is not enough information provided to suggest a common link. Ontogenesis are genes that have mutated and activate out-of-control cell growth. Inherited gene mutation occurs when the DNA is passed to the next generation.
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? · Administering aspirin if the temperature exceeds 102° F (38.8° C) · Placing the client in strict isolation · Inspecting the skin for petechiae once every shift · Providing for frequent rest periods
C · Explanation: · Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.
Carcinogens are factors related to the formation of various malignancies. Which factor has the greatest impact on the development of all cancers? · defective genes · viruses · chemical agents · environmental factors
C · 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.
A client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit? · "I'll bowl with my team after discharge." · "I'll take a long trip to visit my aunt." · "I'll play card games with my friends." · "I'll eat lunch in a restaurant every day."
C · Explanation: · During chemotherapy, playing cards is an appropriate diversional activity because it doesn't require a great deal of energy. To conserve energy, the client should avoid such activities as taking long trips, bowling, and eating in restaurants every day. However, the client may take occasional short trips and dine out on special occasions.
The nurse is working with a client who has had an allo-hematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of · acute leukopenia. · metastasis. · graft-versus-host disease. · nadir.
C · Explanation: · Graft-versus-host disease is a major cause of morbidity and mortality in clients who have had allogeneic transplant. Clinical manifestations of the disease include diffuse rash that progresses to blistering and desquamation, and mucosal inflammation of the eyes and the entire gastrointestinal tract with subsequent diarrhea, abdominal pain, and hepatomegaly.
According to the tumor-node-metastasis (TNM) classification system, T0 means there is · No distant metastasis · Distant metastasis · No evidence of primary tumor · No regional lymph node metastasis
C · Explanation: · 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.
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.
C · 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 client with a terminal prognosis following a diagnosis of extensive stage small-cell lung cancer has made the informed decision to seek a referral for hospice care. Which are primary goals of this form of end-of-life care? Select all that apply. · Dying at home · Including family in health care decisions · Having professional support with the grieving process for client and family · Having pain managed effectively · Continuing curative treatment
C,D, Explanation: Hospice programs facilitate clear communication among family members and health care providers as well as supporting the client and family through the grief process. Hospice care staff gives constant attention to providing the client with effective pain management. Curative treatment is not a goal or component of hospice care since the client's prognosis is terminal. While hospice staff would strive to meet a client's wish to die at home, if possible, this is not a primary goal of all hospice care.
A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? · Ate 75% of all meals during the day · White blood cell (WBC) count of 9,000 cells/mm3 · Temperature of 98.3° F (36.8° C) · Stage 3 pressure ulcer on the left heel
D Explanation: 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 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? · Fatigue related to deficient blood cells · Activity intolerance related to side effects of chemotherapy · Anxiety related to change in role function · Risk for infection related to inadequate defenses
D Explanation: Physiological needs, such as risk for infection, take priority over the client's other needs.
A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention? · The client states he is nauseous. · The client begins to shiver. · The laboratory reports a white blood cell (WBC) count of 1,000/mm3. · The I.V. site is red and swollen.
D · 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 serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with · myalgia. · weight gain. · anorexia. · seizure.
D · Explanation: · 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.
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? · Emission of abnormal proteins · Cells colonizing to distant body parts · Random, rapid growth of the tumor · Tumor pressure against normal tissues
D · 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.
Which of the following is a characteristic of a malignant tumor? · It grows by expansion. · It is usually slow growing. · It demonstrates cells that are well differentiated. · It gains access to the blood and lymphatic channels.
D · 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.
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 side effect of the neoplastic drugs. · A normal reaction to the diagnosis of cancer.
D · 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.
The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice? · uses the treadmill for 30 minutes on 5 days each week · drinks one glass of wine at dinner each night · works as a secretary at a medical radiation treatment center · eats red meat such as steaks or hamburgers every day
D · Explanation: · 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.
The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse? · "I will use birth control measures until after all treatment is completed." · "I will eat clear liquids for the next 24 hours." · "Hair loss may not occur until after the second round of therapy." · "I can continue taking my vitamins and herbs because they make me feel better."
D · Explanation: · Herbal products are not regulated by the U.S. Food and Drug Administration (FDA);although some can decrease the risk of cancer, others can have serious side effects and liver toxicity. Use of vitamins and herbals should be reviewed with the oncologist. Use of clear liquids is recommended for the client experiencing nausea and vomiting. Because hair follicles are sensitive to chemotherapy drugs, it is likely for alopecia to occur especially with consecutive treatments. Chemotherapy includes cytotoxic drugs that are harmful to rapid dividing cells such as cell development in the fetus. To prevent damage to the fetus, birth control is recommended during treatment.
What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss? · Alopecia related to chemotherapy is relatively uncommon. · The hair will grow back the same as it was before treatment. · The hair will grow back within 2 months post therapy. · The client should consider getting a wig or cap prior to beginning treatment.
D · 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.
The lethal tumor dose is defined as the dose that will eradicate what percentage of the tumor yet preserve normal tissue? · 85% · 75% · 65% · 95%
D · 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.
A client returns to the surgeon's office for a report on a diagnostic procedure to determine the cell composition of the client's abdominal neoplasm. Which term is significant to indicate the likelihood of the tumor spreading? · primary site · lesion · neoplasm · benign
D · Explanation: · Tumors are classified according to their cell of origin and whether their growth is benign, meaning not invasive or spreading; or malignant, meaning invasive and capable of spreading. New growths of abnormal tissue are called neoplasms or tumors. The term 'primary site' may be used in reference to the origins of an initial tumor if metastasis, or the development of a secondary tumor from the primary tumor at a distant location. A lesion generally appears on the skin and looks like a mole.
A client with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location rules out the use of enteral feeding. What intervention will best meet this client's nutritional needs? · Administration of parenteral feeds via a peripheral IV · Insertion of an NG tube for administration of feeds · Parenteral nutrition given via a peripherally inserted central catheter · Maintaining NPO status and IV hydration until treatment completion
C · Explanation: · If malabsorption is severe, or the cancer involves the upper GI tract, parenteral nutrition may be necessary. TPN is given by way of a central line, not a peripheral IV. An NG would be contraindicated for this client. Long-term NPO status would result in malnutrition.
While administering an intravenous chemotherapeutic medication to a client, the nurse assesses swelling at the insertion site. What is the nurse's first action? · Administer a neutralizing solution. · Aspirate as much of the fluid as possible. · Discontinue the intravenous medication. · Apply a warm compress.
C · Explanation: · If extravasation of a chemotherapeutic medication is suspected, the nurse must immediately stop the medication. Depending on the drug, the nurse may then attempt to aspirate any remaining drug, apply a warm or cold compress, administer a neutralizing solution, or all these measures.
An oncology client will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another? · Adhering to primary tumor cells · Phagocytizing healthy cells · Invading healthy host tissues · Inducing mutation of cells of another organ
C · Explanation: · Invasion, which refers to the growth of the primary tumor into the surrounding host tissues, occurs in several ways. Malignant cells are less likely to adhere than are normal cells. Malignant cells do not cause healthy cells to mutate. Malignant cells do not eat other cells.
The physician is attending to a client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation? · To destroy marginal tissues · To remove the tumor from the brain · To prevent the formation of new cancer cells · To analyze the lymph nodes involved
C · Explanation: · 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.
Which is a sign or symptom of septic shock? · Hypertension · Increased urine output · Altered mental status · Warm, moist skin
C · Explanation: · Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension.
The client is to receive cyclophosphamide (Cytoxan) 50 mg/kg intravenously in divided doses over 5 days. The client weighs 176 pounds. How many mg of cyclophosphamide will the client receive each day? Enter the correct number ONLY.
800 Explanation: The client's weight of 176 pounds equals 80 kg. The client is to receive 50 mg of cyclophosphamide for each 1 kg of body weight. This is to be divided into 5 doses. 80 kg x 50 mg/kg = 4000 mg. 4000 mg/5 days = 800 mg.
5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? · Antimetabolite · Nitrosoureas · Alkylating · Mitotic spindle poisons
A · 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).
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? · Extravasation · Stomatitis · Bone pain · Nausea and vomiting
A · Explanation: · The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.
The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply. · dietary substances · gender · age · environmental factors · viruses
A,D,E · 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.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? · Palliative care is likely. · Adjuvant therapy is likely. · Repeat biopsy is needed before treatment begins. · No further treatment is indicated.
B · 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.
When addressing a community group, the nurse identifies consumption of which substance(s) as a risk factor for the development of cancer? Select all that apply. · Cruciferous vegetables · Alcohol · Processed meats · Tobacco · Organic grown orange vegetables
B,C,D Explanation: Research evidence has shown that higher intake of red and processed meat is specifically associated with high-risk or colorectal cancer while tobacco smoking and alcohol consumption are associated with the development of several different forms. There is research that supports that both orange vegetables (e.g., carrots, pumpkin, sweet potatoes) and cruciferous vegetables (e.g., cabbage, broccoli, cauliflower) contain potential cancer chemopreventive properties.
What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen? · It causes a systemic reaction. · It attacks cancer cells during their vulnerable phase. · It targets normal body cells as well as cancer cells. · It functions against disseminated disease.
C Explanation: Chemotherapy agents affect both normal and malignant cells; therefore, their effects are often widespread, affecting many body systems.
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 stimulates the immune system against the tumor cells. · It prevents alopecia. · It lowers serum and uric acid levels. · It treats drug-related anemia.
C 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.
The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant? · Monitor the client's heart rate. · Monitor the client's toilet patterns. · Monitor the client closely to prevent infection. · Monitor the client's physical condition
C · Explanation: · Until transplanted stem cells begin to produce blood cells, these clients have no physiologic means to fight infection, which makes them very prone to infection. They are at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent infection. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client getting an infection.
Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient? · Homogenic · Autologous · Syngeneic · Allogeneic
D · 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.
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? · The use of disposable utensils and wash cloths · Time, distance, and shielding · Avoid showering or washing over skin markings. · Inspect the skin frequently.
D · 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.
The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise? · Eat warm or hot foods. · Avoid intake of fluids. · Eat wholesome meals. · Avoid spicy and fatty foods. · Explanation:
D · 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 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 continue having your menses every month." · "You will need to practice birth control measures." · "You will be unable to have children." · "You will experience menopause now."
B · 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 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? · "Thank goodness the tumor is contained and curable." · "I guess the doctor could not remove the entire tumor." · "I am so glad the doctor was able to remove the entire tumor." · "I will be glad to finally be done with treatments for this thing."
B · 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.
A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication? · Extravasation · Erythema · Thrombosis · Flare
A · 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.
A client has just received stem cell transplantation as treatment for leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation? · Closely monitor the client for at least 4 weeks. · Closely monitor the client for at least 3 months. · Closely monitor the client for at least 5 months. · Closely monitor the client for at least 3 days.
B Explanation: After stem cell transplantation, the nurse closely monitors the client for at least 3 months because complications related to the transplant are still possible and infections are very common.
Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure? · Allergy history · Blood studies · Drug history · Family history
B · Explanation: · 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.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? · Prolongation · Progression · Promotion · Initiation
B · Explanation: · 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.
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? · Breast and testicular self-exams · Hand washing and infection prevention · Pool and water safety · Sun safety and use of sunscreen
D · Explanation: · 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.
PAfter cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? · Serving small portions of bland food · Encouraging rhythmic breathing exercises · Withholding fluids for the first 4 to 6 hours after chemotherapy administration · Administering metoclopramide and dexamethasone as ordered
D · 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.
