Chapter 15: Management of Patients with Oncologic Disorders

antiemetic. Antiemetics, antihistamines, and certain steroids treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli.

To combat the most common adverse effects of chemotherapy, a nurse should administer an: anticoagulant. antiemetic. antimetabolite. antibiotic.

Control The range of possible treatment goals may include complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control), or relief of symptoms associated with the disease (palliation). Prevention is not a treatment goal when the patient has already been diagnosed with cancer. Prevention of metastasis to a secondary site may be a goal.

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth? Control Cure Prevention Palliation

cytokine 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.

The drug interleukin-2 is an example of which type of biologic response modifier? Monoclonal antibodies Cytokine Antimetabolites Retinoids

Blood studies 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.

Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure? Blood studies Family history Drug history Allergy history

Altered mental status Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension.

Which is a sign or symptom of septic shock? Warm, moist skin Hypertension Increased urine output Altered mental status

Cardiac tamponade 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.

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

Apoptosis Apoptosis is the innate cellular process of programmed cell death. Mitosis is the phase of the cell cycle in which cell division occurs. Carcinogenesis is the process by which cancer arises. Angiogenesis is the process by which a new blood supply is formed.

Which of the following is a term used to describe the process of programmed cell death? Angiogenesis Apoptosis Carcinogenesis Mitosis

"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.

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."

palliative 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.

Which type of surgery is used in an attempt to relieve complications of cancer? Reconstructive Prophylactic Salvage Palliative

Autologous Autologous vaccines are made from the client's own cancer cells, which are obtained during diagnostic biopsy or surgery. Prophylactic vaccines, such as the polio vaccine, are given to prevent people from developing a disease. Therapeutic vaccines are given to kill existing cancer cells and to provide long-lasting immunity against further cancer development. Allogeneic vaccines are made from cancer cells that are obtained from other people who have a specific type of cancer.

Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client? Autologous Therapeutic Prophylactic Allogeneic

hemangioma. A hemangioma is a benign tumor of the blood vessels. An osteoma is a tumor of the connective tissue. A neuroma is a tumor of the nerve cells. A chondroma is a tumor of the cartilage.

A benign tumor of the blood vessels is a(n) chondroma. osteoma. neuroma. hemangioma.

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

A nurse is caring for a client newly diagnosed with cancer. Which therapies are used to treat cancer? Select all that apply. surgery chemotherapy radiation therapy electroconvulsive therapy hyperthermia

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

Inspecting the skin for petechiae once every shift 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.

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? Inspecting the skin for petechiae once every shift Providing for frequent rest periods Administering aspirin if the temperature exceeds 102° F (38.8° C) Placing the client in strict isolation

Tumor pressure against normal tissues Benign tumors grow more slowly than malignant tumors and do not emit tumor-specific antigens or proteins. Benign tumors do not metastasize to distant sites. Benign tumors can compress tissues as it grows, which can result in impaired organ functioning.

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse? Tumor pressure against normal tissues Emission of abnormal proteins Random, rapid growth of the tumor Cells colonizing to distant body parts

Ham and bacon 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.

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? Fish and poultry Ham and bacon Green, leafy vegetables Eggs and milk

Extravasation 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 client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? Nausea and vomiting Stomatitis Extravasation Bone pain

"I will brush my teeth after every meal." 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.

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 reduce smoking to after meals only." "I will brush my teeth after every meal." "I will limit alcoholic beverages to one a day." "I will eat spicy foods with a cool beverage."

Colonoscopy 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.

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? Fecal occult blood test Prostate-specific antigen (PSA) Colonoscopy Papanicolaou (Pap)

Identify own perception of cancer and set realistic goals. Nurses need to identify their own perception of cancer and set realistic goals to meet the challenges inherent in caring for patients with cancer. In addition, nurses caring for patients with cancer must be prepared to support patients and families through a wide range of physical, emotional, social, cultural, financial, and spiritual challenges. Cancer is a diverse set of diseases, so the nurse would not make the same goals for all patients with cancer. The causes of many types of cancer are still unknown, so the nurse should not attempt to tell the patient what he or she has done to cause the cancer. The nurse need not ensure that the patient has the financial means to afford the care.

What can the nurse do to meet the challenges in caring for a patient with cancer? Ensure that the patient has the financial means to afford their care. Tell the patient about the things the patient has done to cause cancer. Identify own perception of cancer and set realistic goals. Set the same goals for all patients with cancer.

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.

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

The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. 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 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: The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. The second and third drugs increase the effectiveness of the first drug. The three drugs can be given at lower doses. The first two drugs are toxic to cancer cells, and the third drug promotes cell growth.

Dull, aching, tightness 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 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? Sharp, throbbing Dull, aching, tightness Distention, crampy Burning, sharp, tingling

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.

A client diagnosed with cancer makes the following statement to the nurse: "I guess I will tell my health care provider 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? Most clients believe the discomfort is well worth the cure for cancer. Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. Clinical trials are opening up new cancer treatments all the time. Nausea and vomiting are only a factor for the first 24 hours after treatment.

Assess level of consciousness. Apply pressure to the bleeding sites. Check intake and output records. The client may be experiencing disseminated intravascular coagulation (DIC) following the cancer experience and chemotherapy treatment. When the nurse notes the client is experiencing unexpected and abnormal bleeding, the nurse will assess level of consciousness (the client can be bleeding in the brain) and intake and output records (the client may experience decreased urinary output as a result of poor renal perfusion). The nurse applies pressure to venipuncture sites to decrease bleeding. The nurse will assess vital signs more frequently than once a shift. The nurse minimizes client activities to decrease risk for injury.

A client has been receiving chemotherapy. Upon assessing the client during morning rounds, the nurse notes the client is now bleeding from intravenous and venipuncture sites. Stool is positive for occult blood. The client is requesting to sit in a chair for a meal. The nurse implements the following interventions: (Select all that apply.) Apply pressure to the bleeding sites. Monitor vital signs once a shift. Assess level of consciousness. Assist the client to a chair. Check intake and output records.

Serum potassium level of 2.6 mEq/L Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? Blood pressure of 120/64 to 130/72 mm Hg Urine output of 400 ml in 8 hours Sodium level of 142 mEq/L Serum potassium level of 2.6 mEq/L

Avoiding using soap on the irradiated areas 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.

A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan? Removing thoracic skin markings after each radiation treatment Avoiding using soap on the irradiated areas Applying talcum powder to the irradiated areas daily after bathing Wearing a lead apron during direct contact with the client

To prevent metastasis Chemotherapy treats systemic and metastatic cancer. It can also be used to reduce tumor size preoperatively, or to destroy any remaining tumor cells postoperatively. Angiogenesis is the growth of new capillaries from the tissue of origin. This process helps malignant cells obtain needed nutrients and oxygen to promote growth. Fatigue and stomatitis are side effects of radiation and chemotherapy.

A client with metastatic pancreatic cancer underwent surgery to remove a malignant tumor in the pancreas. Despite the tumor being removed, the physician informs the client that chemotherapy must be started. Why might the physician opt for chemotherapy? Stomatitis To prevent metastasis Fatigue Angiogenesis

Provide a solution of viscous lidocaine for use as a mouth rinse. To decrease the pain of stomatitis, the nurse should provide a solution of viscous lidocaine for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer systemic analgesics as ordered. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn't be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection, but wouldn't decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn't decrease the pain.

A nurse assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis? Recommend that the client discontinue chemotherapy. Provide a solution of viscous lidocaine for use as a mouth rinse. Check regularly for signs and symptoms of stomatitis. Monitor the client's platelet and leukocyte counts.

"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.

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 removed all the throw rugs from the house." "I use an electric razor to shave." "I take a stool softener every morning."

platelet count of 60,000/mm3 Thrombocytopenia, a decrease in the circulating platelet count, is the most common cause of bleeding in patients with cancer and is usually defined as a count less than 100,000/mm3. The risk of bleeding increases as the count drops lower. The risk of spontaneous bleeding occurs with a count of less than 20,000/mm3.

A nurse is caring for a client with prostate cancer and assesses bleeding gums and hematuria. What serum indicator should the nurse relate the bleeding? neutrophil count of 40% platelet count of 60,000/mm3 lymphocyte count of 30% reticulocyte count of 1%

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.

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? Incisional biopsy Excisional biopsy Needle biopsy Punch biopsy

"It will allow time for the repair of healthy tissue." In external-beam radiation therapy (EBRT), the total radiation dose is delivered over several weeks in daily doses called fractions. This allows healthy tissue to repair and achieves greater cell kill by exposing more cells to the radiation as they begin active cell division. Repeated radiation treatments over time (fractionated doses) also allow for the periphery of the tumor to be reoxygenated repeatedly, because tumors shrink from the outside inward. This increases the radiosensitivity of the tumor, thereby increasing tumor cell death.

A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse? "It is not really understood why you have to go for 6 weeks of treatment." "It allows time for you to cope with the treatment." "It will allow time for the repair of healthy tissue." "It will decrease the incidence of leukopenia and thrombocytopenia."

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

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.

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? Progression Prolongation Initiation Promotion

"I hope they find a bone marrow donor who matches." 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 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? "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." "I will need to attend follow-up visits for up to 3 months after treatment." "The doctor will remove cells from my bone marrow before beginning chemotherapy."

eats red meat such as steaks or hamburgers every day 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 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 eats red meat such as steaks or hamburgers every day works as a secretary at a medical radiation treatment center

Avoid spicy and fatty foods. 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.

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

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

To prevent the formation of new cancer cells 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.

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