Chapter 15: Cancer

The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA). Such damage results from multiple factors. Which of the following is a carcinogen? a) Dietary substances b) Environmental factors c) Defective genes d) Medically prescribed interventions e) Viruses f) Chemical agents

a) Dietary substances b) Environmental factors c) Defective genes d) Medically prescribed interventions e) Viruses f) Chemical agents

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) "I guess the doctor could not remove the entire tumor." b) "I will be glad to finally be done with treatments for this thing." c) "I am so glad the doctor was able to remove the entire tumor." d) "Thank goodness the tumor is contained and curable."

a) "I guess the doctor could not remove the entire tumor." 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.

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode will the nurse anticipate? a) Adjuvant therapy is likely. b) No further treatment is indicated. c) Palliative care is likely. d) Repeat biopsy is needed before treatment begins.

a) Adjuvant therapy is likely. T3 indicates a large tumor size with N1 indicating regional lymph node involvement. 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 staging of stage IV is indicative of palliative care.

Nursing action for extravasation of a chemotherapeutic agent would include which of the following nursing actions? Select all that apply. a) Administer an antidote, if indicated. b) Aspirate any residual drug from the IV line. c) Stop the medication infusion at the first sign of extravasation. d) Apply warm compresses to the irritated site to encourage healing.

a) Administer an antidote, if indicated. b) Aspirate any residual drug from the IV line. c) Stop the medication infusion at the first sign of extravasation. All of the answers except D are appropriate nursing actions. The application of warmth would be contraindicated because it would cause vasodilation, which would increase the absorption of irritant into the local tissues.

The nurse is conducting a screening for familial predisposition of cancer. Which of the following should the nurse note as a possible indication of hereditary cancer syndrome? a) An aunt and uncle diagnosed with cancer b) Onset of cancer after age 50 in family member c) A second cousin diagnosed with cancer d) A first cousin diagnosed with cancer

a) An aunt and uncle diagnosed with cancer 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, 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.

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? a) Antimetabolite b) Alkylating c) Mitotic spindle poisons d) Nitrosoureas

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

Which of the following classes of antineoplastic agents is cell cycle-specific? a) Antimetabolites (5-FU) b) Alkylating agents (cisplatin) c) Nitrosoureas (carmustine) d) Antitumor antibiotics (bleomycin)

a) Antimetabolites (5-FU) Antimetabolites are cell cycle-specific (S phase). Antitumor antibiotics are cell cycle-nonspecific. Alkylating agents are cell-cycle nonspecific. Nitrosoureas are cell cycle-nonspecific.

A 28-year-old female client with a recent history of GI disturbance has been scheduled for a barium study. Why did the physician order this particular test for this client? a) Because it will show movement of the GI tract b) Because it will remove a tissue sample from the GI tract c) Because it will show tumor "hot spots" in the GI tract d) Because it provides a three-dimensional cross-sectional view

a) Because it will show movement of the GI tract Fluoroscopy is used to show continuous x-ray images on a monitor, allowing the movement of a body structure to be viewed. A barium study involves fluoroscopy, not 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 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) Alert family members that they should restrict their visiting to 5 minutes at any one time. c) Maintain as much distance as possible from the patient while in the room. d) Wear a lead apron when providing direct patient care.

a) Explain to the patient that she will continue to emit radiation while the implant is in place. 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.

Chemotherapeutic agents have which effect associated with the renal system? a) Increased uric acid excretion b) Hypophosphatemia c) Hypokalemia d) Hypercalcemia

a) Increased uric acid excretion Chemotherapeutic agents can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. There is increased urinary excretion of uric acid from chemotherapeutic agents. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.

What does the nurse understand is the rationale for administering allopurinol for a patient receiving chemotherapy? a) It lowers serum and uric acid levels. b) It treats drug-related anemia. c) It prevents alopecia. d) It stimulates the immune system against the tumor cells.

a) It lowers serum and uric acid levels. Adequate hydration, diuresis, alkalinization of the acid crystals, and administration of allopurinol (Zyloprim) may be used to prevent renal toxicity.

A patient with uterine cancer is being treated with intracavitary radiation. The patient will emit radiation while the implant is in place. The nurse is aware of the precautions necessary for the provider of care and visitors. Which of the following are appropriate guidelines to follow? Select all that apply. a) Lead aprons should be worn to buffer the exposure. b) Family members should stand about 6 feet from the patient. c) The nurse can provide direct care for up to 60 minutes per 8-hour shift. d) Visitors may stay for 30 minutes or less.

a) Lead aprons should be worn to buffer the exposure. b) Family members should stand about 6 feet from the patient. d) Visitors may stay for 30 minutes or less. Exposure for the nurse, health care provider or visitors should be limited to 30 minutes/8-hour shift. As time increases, exposure to radiation increases. The goal is to deliver safe, efficient care in the shortest amount of time.

As a nurse, you understand that cancer is the second leading cause of death in the United States, second only to heart disease. One half of all men and one third of all women will develop cancer during their lifetimes. You inform your clients that which of the following types of cancer have the highest prevalence among both men and women? a) Lung and colon b) Colon and skin c) Lung and skin d) Skin and brain

a) Lung and colon Common cancers in men include prostate, lung, and colon. Breast, lung, and colon cancer most commonly affect women.

The oncologist advises a 32-year-old female client who had a lumpectomy 2 years previously to consider a mastectomy when her cancer reappears. This procedure would be considered which type of surgery? a) Salvage b) Prophylactic c) Local excision d) Palliative

a) Salvage Salvage surgeryis done when there is a local recurrence of cancer. Also called preventative surgery, prophylactic surgery may be done when there is a family history or genetic predisposition, ability to detect surgery at an early stage, and client acceptance of the postoperative outcome. Local excision is done when the tumor is removed along with a small margin of healthy tissue. The client's first lumpectomy is an example of local excision. This type of surgery helps to relieve uncomfortable symptoms or prolong life.

A client has cancer of the neck and is receiving external beam radiation therapy to the site. The client is experiencing trauma to the irradiated skin. The nurse does all of the following. (Select all that apply.) a) assesses the client for any sun exposure b) avoids shaving the irradiated skin c) uses cool water to wash the neck area d) applies an over-the-counter ointment to the skin e) inspects for skin damage of the chest area

a) assesses the client for any sun exposure b) avoids shaving the irradiated skin The client receiving external beam radiation therapy may experience trauma to the irradiated skin. To prevent further skin damage, the client is to avoid sun exposure and shaving the irradiated skin area. Other skin areas are not damaged, only the irradiated skin. Lukewarm water is to be used to bathe the area. Water of extreme temperature should be avoided. Many over-the-counter ointments contain metals and may cause additional skin damage.

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) inhalation of aerosols. b) absorption through the goggles. c) absorption through the gown. d) absorption through the gloves.

a) inhalation of aerosols. 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.

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 replace my toothbrush every month." b) "I clean my teeth gently several times per day." c) "I use an alcohol-based mouthwash every morning." d) "I lubricate my lips with petroleum jelly."

b) "I clean my teeth gently several times per day." The client demonstrates understanding when he states that he'll clean his teeth gently several times per day. Frequent gentle cleaning of the mouth or rinsing reduces bacteria build-up in the oral cavity, thus reducing the risk for oropharyngeal infection. Changing the toothbrush each month reduces the bacteria in the mouth for the first few uses only. Petroleum jelly moistens the lips, but doesn't prevent breakdown of the mucous membranes or reduce the risk for oropharyngeal infection. Alcohol-based products cause drying of the mucous membrane, increasing the likelihood of oropharyngeal infection.

A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching? a) "I take a stool softener every morning." b) "I floss my teeth every morning." c) "I use an electric razor to shave." d) "I removed all the throw rugs from the house."

b) "I floss my teeth every morning." 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 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? a) "Wigs can be used after the chemotherapy is completed." b) "The hair loss is temporary." c) "Clients with alopecia will have delay in grey hair." d) "New hair growth will return without any change to color or texture."

b) "The hair loss is temporary." 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.

The 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. The nurse states: a) "You will need to continue for the rest of your life." b) "You may choose to discontinue this test." c) "You could have stopped immediately after your hysterectomy." d) You need to continue obtaining a Pap test for only the next 5 years."

b) "You may choose to discontinue this test." The American Cancer Society recommendations for women 70 years or older, who have had normal Pap tests for 10 years, and who have had a total hysterectomy may choose to stop cervical cancer screening as in a Pap test.

A client with cancer is receiving chemotherapy and reports to the nurse that his mouth is painful and he has difficulty ingesting food. The nurse does which of the following: a) Teaches the client to floss his teeth once every 24 hours b) Asks the client to open his mouth to facilitate inspection of the oral mucosa c) Rinses the client's mouth with alcohol-based mouthwash every 2 hours d) Consults with the healthcare provider about use of nystatin (Mycostatin) e) Instructs the client to brush the teeth with a soft toothbrush

b) Asks the client to open his mouth to facilitate inspection of the oral mucosa d) Consults with the healthcare provider about use of nystatin (Mycostatin) e) Instructs the client to brush the teeth with a soft toothbrush The description of the client's report is stomatitis following chemotherapy treatment. The nurse should assess the oral mucosa based on the client's report of pain and difficulty eating. The client is to use a soft toothbrush to minimize trauma to the mouth. Nystatin is a topical medication that may provide healing for the client's mouth. The client avoids alcohol-based mouthwashes as these are irritants. Flossing the teeth may cause additional trauma to the mouth.

The nurse is preparing to assess a patient whose chart documents that the patient experienced extravasation when receiving the vesicant Vincristine on the previous shift. The documentation also notes that an antidote was administered immediately. The nurse prepares to assess for which of the following? Select all that apply. a) Active bleeding b) Effectiveness of antidote c) Sloughing tissue d) Tissue necrosis

b) Effectiveness of antidote c) Sloughing tissue d) Tissue necrosis Extravasation of vesicant chemotherapeutic agents can lead to erythema, sloughing, and necrosis of surrounding tissue, muscle and tendons. To reduce the likelihood/severity of symptoms due to extravasation of a vesicant, antidotes matched to the vesicant are administered. Nurses caring for a patient who experienced extravasation of a vesicant should assess for sloughing tissue, tissue necrosis, erythema, and effectiveness of the antidote.

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) Punch biopsy b) Excisional biopsy c) Incisional biopsy d) Needle biopsy

b) Excisional biopsy 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.

You are the nurse caring for a client with cancer. The client complains of pain and nausea. When assessed, you note that the client appears fearful. What other factor must you consider when a client with cancer indicates signs of pain, nausea, and fear? a) Infection b) Fatigue c) Ulceration d) High cholesterol levels

b) Fatigue Clients with cancer experience fatigue, which is a side effect of cancer treatments that rest fails to relieve. The nurse must assess the client for other stressors that contribute to fatigue such as pain, nausea, fear, and lack of adequate support. The nurse works with other healthcare team members to treat the client's fatigue. The above indications do not contribute to infections, ulcerations, or high cholesterol levels.

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) Liver c) White blood cells (WBCs) d) Colon

b) Liver 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.

The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse? a) "I will use birth control measures until after all treatment is completed." b) "Hair loss may not occur until after the second round of therapy." c) "I can continue taking my vitamins and herbs because they make me feel better." d) "I will eat clear liquids for the next 24 hours."

c) "I can continue taking my vitamins and herbs because they make me feel better." 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.

Which statement by a client undergoing external radiation therapy indicates the need for further teaching? a) "I'll not use my heating pad during my treatment." b) "I'll wear protective clothing when outside." c) "I'm worried I'll expose my family members to radiation." d) "I'll wash my skin with mild soap and water only."

c) "I'm worried I'll expose my family members to radiation." 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 cancer client makes the following statement to the nurse: "I guess I will tell my doctor to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die."Which of the following facts supports the use of chemotherapy for this client? a) Most clients believe the discomfort is well worth the cure for cancer. b) Nausea and vomiting are only a factor for the first 24 hours after treatment. c) Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. d) Clinical trials are opening up new cancer treatments all the time.

c) Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. Chemotherapy is not one drug for all clients. The therapy can be specifically designed to optimize effects while limiting adverse effects with supplemental anti emetics to control the nausea and vomiting. It is true that nausea and vomiting are most prevalent in the first 24 hours after each chemotherapy treatment but does not eliminate the fears expressed by this client. No one can state the worth of any treatment, and a cure is never promised. Clinical trials open up new options for treatment, but the process is lengthy and is not a certainty for a client in need of immediate treatment.

The nurse is caring for a client newly diagnosed with cancer. Which of the following therapies is used to treat something other than cancer? a) Chemotherapy b) Radiation therapy c) Electroconvulsive therapy d) Surgery

c) Electroconvulsive therapy Cancer is frequently treated with a combination of therapies using standardized protocols. Three basic methods used to treat cancer are surgery, radiation therapy, and chemotherapy. Electroconvulsive therapy (ECT) is a method of treatment for mental distress or illness.

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

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

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) Ineffective Coping b) Sexual Dysfunction c) Fear d) Knowledge Deficit

c) Fear Fear of the unknown is probably the major concern for this client. 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. Ineffective Coping can be illustrated by the client's refusal to talk about the problem, but no excess or abnormal behavior has been identified at this time.

A patient is to receive Bacille Calmette-Guerin (BCG), a nonspecific biologic response modifier. Why would the patient receive this form of treatment? a) For cancer of the lungs b) For cancer of the breast c) For cancer of the bladder d) For skin cancer

c) For cancer of the bladder Early investigations of the stimulation of the immune system involved nonspecific agents such as bacille Calmette-Guérin (BCG) and Corynebacterium parvum. When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells. Extensive animal and human investigations with BCG have shown promising results, especially in treating localized malignant melanoma. In addition, BCG bladder instillation is a standard form of treatment for localized bladder cancer.

Which grade of tumor is also known as a well-differentiated tumor? a) Grade IV b) Grade III c) Grade I d) Grade II

c) Grade I Grade I tumors, also known as well-differentiated tumors, closely resemble the tissue of origin in structure and function. In grade II, the tumor is moderately differentiated. Tumors in grade III are poorly differentiated (little resemblance to tissue of origin). Grade IV tumors is undifferentiated (unable to tell tissue of origin).

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? a) Initiation b) Promotion c) Progression d) Prolongation

c) Progression 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.

What should the nurse tell a female client who is about to begin chemotherapy and anxious about losing her hair? a) Her hair will grow back within 2 months post therapy. b) Alopecia related to chemotherapy is relatively uncommon. c) She should consider getting a wig or cap before she loses her hair. d) Her hair will grow back the same as it was before treatment.

c) She should consider getting a wig or cap before she loses her hair. If hair loss is anticipated, purchase a wig, cap, or scarf before therapy begins. Alopecia develops because chemotherapy affects 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 textures.

A nurse is caring for a recently married, 29-year-old female client, who was diagnosed with acute lymphocytic leukemia. The client is preparing for an allogeneic bone marrow transplant. Which statement by the client demonstrates she understands the informed consent she gave about the diagnosis and treatment? a) "I always had a good appetite. Even with chemo I shouldn't have to make any changes to my diet." b) "I'll have to remain in the hospital for about 3 months after my transplant." c) "I should be able to finally start a family after I'm finished with the chemo." d) "I'll only need chemotherapy treatment before receiving my bone marrow transplant."

d) "I'll only need chemotherapy treatment before receiving my bone marrow transplant." This client demonstrates understanding about treatment when she states that she'll need chemotherapy before receiving a bone marrow transplant. Most clients receive chemotherapy before undergoing bone marrow transplantation. Most women older than age 26 can't bear children after undergoing treatment because they experience the early onset of menopause. Clients who undergo chemotherapy or radiation must avoid all fresh fruits and vegetables, and all foods should be cooked to avoid bacterial contamination. Clients who undergo bone marrow transplantation typically remain hospitalized for 20 to 25 days.

Following a BMT the patient should be monitored for at least a) 3 days. b) 4 weeks. c) 5 months. d) 3 months.

d) 3 months. After a BMT, the nurse closely monitors the patient for at least 3 months because complications related to the transplant are still possible, and infections are very common.

A nurse is developing a care plan for bone marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable? a) 21 to 28 days b) 24 hours c) 2 to 4 days d) 7 to 14 days

d) 7 to 14 days Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.

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) Serving small portions of bland food c) Encouraging rhythmic breathing exercises d) Administering metoclopramide and dexamethasone as ordered

d) Administering metoclopramide and dexamethasone as ordered 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.

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) 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) Apply a small ice compress to the treated area afterward to decrease localized redness, post-radiation. d) Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth.

d) Cleanse the skin with a mild soap, using his fingertips, not a rough wash cloth. 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.

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) Perform a cardiovascular assessment every 4 hours. b) Monitor daily platelet counts. c) Check the client's history for a congenital link to thrombocytopenia. d) Closely observe the client's skin for petechiae and bruising.

d) Closely observe the client's skin for petechiae and bruising. 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.

You are an oncology nurse caring for a client who tells you that their tastes have changed. They go on to say that "meat tastes bad". What is a nursing intervention to increase protein intake for a client with taste changes? a) Suck on hard candy during treatment. b) Stay away from protein beverages. c) Encourage maximum fluid intake. d) Encourage cheese and sandwiches.

d) Encourage cheese and sandwiches. The nurse encourages the clients with taste changes to eat cheese and sandwiches. Encouraging the client to take in the maximum amount of fluids does not increase protein intake. The nurse advises the client to drink protein beverages. Sucking on hard candies during treatment does not increase protein intake.

A nurse has agreed to draft a medication teaching plan for a patient who is taking the hormonal agent, Aromasin, an aromatase inhibitor for postmenopausal women with breast cancer. The nurse knows that a major teaching point is to tell the patient to: a) Report the unexpected sign of increased appetite and weight gain. b) Report the unusual sign of nausea. c) Be alarmed if she notices fluid retention. d) Increase her intake of calcium-rich foods.

d) Increase her intake of calcium-rich foods. One of the major side effects of Aromasin is hypercalcemia and the subsequent loss of bone. Therefore, the patient needs to have periodic blood work done, have bone density tests done, and follow a diet that will supply needed calcium that is being pulled from the bone tissue.

When caring for a client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? a) The use of disposable utensils and wash cloths b) Time, distance, and shielding c) Avoid showering or washing over skin markings. d) Inspect the skin frequently.

d) Inspect the skin frequently. 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.

A client has received several treatments of bleomycin. It is now important for the nurse to assess a) Hand grasp b) Skin integrity c) Urine output d) Lung sounds

d) Lung sounds Bleomycin has cumulative toxic effects on lung function. Thus, it will be important to assess lung sounds.

A patient is taking vincristine, a plant alkaloid for the treatment of cancer. What system should the nurse be sure to assess for symptoms of toxicity? a) Urinary system b) Pulmonary system c) Gastrointestinal system d) Nervous system

d) Nervous system With repeated doses, the taxanes and plant alkaloids, especially vincristine, can cause cumulative peripheral nervous system damage with sensory alterations in the feet and hands.

What is the best way for the nurse to assess the nutritional status of a patient with cancer? a) Monitor daily caloric intake. b) Observe for proper wound healing. c) Assess BUN and creatinine levels. d) Weigh the patient daily.

d) Weigh the patient daily. Assessment of the patient's nutritional status is conducted at diagnosis and monitored throughout the course of treatment and follow-up. Early identification of patients at risk for problems with intake, absorption, and cachexia, particularly during the early stages of disease, can facilitate timely implementation of specifically targeted interventions that attempt to improve quality of life, treatment outcomes, and survival (Gabison et al., 2010). Current weight, weight loss, diet and medication history, patterns of anorexia, nausea and vomiting, and situations and foods that aggravate or relieve symptoms are assessed and addressed.

The nurse is teaching a client newly diagnosed with cancer about chemotherapy. The nurse tells the client he'll receive an antitumor antibiotic. The nurse knows that this type of medications is: a) cell-cycle specific in the P phase. b) cell-cycle specific in the M phase. c) cell-cycle specific in the S phase. d) cell-cycle nonspecific.

d) cell-cycle nonspecific. Antitumor antibiotics are cell-cycle nonspecific; they interfere with deoxyribonucleic acid (DNA) synthesis by binding with the DNA. They also prevent ribonucleic acid synthesis. Other cell-cycle nonspecific drugs include nitrosoureas and hormonal agents. Drugs that are cell-cycle specific in the S phase include topoisomerase I inhibitors and antimetabolites. Miotic spindle poisons are cell-cycle specific in the M phase. There isn't a drug class that's specific to the P phase.