Chapter 15: Oncology Care
Your patient has recently completed her first round of chemotherapy in the treatment of lung cancer. When reviewing this morning's blood work, what findings would be suggestive of myelosuppression? Increased creatinine and blood urea nitrogen (BUN) Decreased platelets and red blood cells Increased white blood cells and c-reactive protein (CRP) Decreased sodium levels and decreased potassium levels
Decreased platelets and red blood cells
While administering cisplatin (Platinol-AQ) to a client, the nurse assesses swelling at the insertion site. The first action of the nurse is to Administer a neutralizing solution. Aspirate as much of the fluid as possible. Discontinue the intravenous medication. Apply a warm compress.
Discontinue the intravenous medication.
Based on the understanding of the effects of chemotherapy, the nurse would anticipate which of the following clinical findings in a client 2 weeks post therapy? Change in hair color Elevated white blood cells count Ease of bruising Elevated temperature
Ease of bruising
Which of the following is a characteristic of a malignant tumor? It gains access to the blood and lymphatic channels. It demonstrates cells that are well differentiated. It is usually slow growing. It grows by expansion.
It gains access to the blood and lymphatic channels.
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 bone marrow transplant? Monitor the client's toilet patterns. Monitor the client's physical condition. Monitor the client's heart rate. Monitor the client closely to prevent infection.
Monitor the client closely to prevent infection. Until transplanted bone marrow begins 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.
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? Cells colonizing to distant body parts Emission of abnormal proteins Random, rapid growth of the tumor Tumor pressure against normal tissues
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.
Which of the following would be consistent with a benign neoplasm? Grows by invasion Usually progressive and slow Gains access to the blood and lymph channels to metastasize Cells are undifferentiated
Usually progressive and slow
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. age viruses dietary substances gender environmental factors
dietary substances environmental factors viruses
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 use an electric razor to shave." "I floss my teeth every morning." "I removed all the throw rugs from the house." "I take a stool softener every morning."
"I floss my teeth every morning."
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? "New hair growth will return without any change to color or texture." "Wigs can be used after the chemotherapy is completed." "Clients with alopecia will have delay in grey hair." "The hair loss is usually temporary."
"The hair loss is usually temporary."
Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient? Homogenic Allogeneic Autologous Syngeneic
Allogeneic 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.
A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client? Disturbed body image Anticipatory grieving Impaired swallowing Chronic low self-esteem
Anticipatory grieving
Which of the following advice does the nurse offer clients who are undergoing unsealed radiation therapy to reduce exposure? Avoid drinking plenty of fluids. Avoid eating for 3 hours after therapy. Avoid kissing and sexual contact. Avoid applying skin moisturizers.
Avoid kissing and sexual contact.
A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient? Maintain as much distance as possible from the patient while in the room. Wear a lead apron when providing direct patient care. Explain to the patient that she will continue to emit radiation while the implant is in place. Alert family members that they should restrict their visiting to 5 minutes at any one time.
Explain to the patient that she will continue to emit radiation while the implant is in place.
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? Extravasation Stomatitis Nausea and vomiting Bone pain
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.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode will the nurse anticipate? Adjuvant therapy is likely. Palliative care is likely. No further treatment is indicated. Repeat biopsy is needed before treatment begins.
Grade 1 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).
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? Monitor daily platelet counts. Perform a cardiovascular assessment every 4 hours. Closely observe the client's skin for petechiae and bruising. Check the client's history for a congenital link to thrombocytopenia.
Closely observe the client's skin for petechiae and bruising.
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 Punch biopsy Needle biopsy Excisional biopsy
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.
Chemotherapeutic agents have which effect associated with the renal system? Hypercalcemia Hypokalemia Hypophosphatemia Increased uric acid excretion
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. Urinary excretion of uric acid increases with the use of chemotherapeutic agents.
According to the TNM classification system, T0 means there is distant metastasis. no distant metastasis. no regional lymph node metastasis. no evidence of primary tumor.
no evidence of primary tumor.
A patient, age 67 years, is admitted for diagnostic studies to rule out cancer. The patient is Caucasian, married, has been employed as a landscaper for 40 years, and has a 36-year history of smoking a pack of cigarettes daily. What significant risk factors does the nurse recognize this patient has? (Select all that apply.) Race Age Marital status Occupation Cigarette smoking
Age Cigarette smoking Occupation Most cancer occurs in people older than 65 years. Although the overall rate of cancer deaths has declined, cancer death rates in African American men remain substantially higher than those among Caucasian men and twice those of Hispanic men. Excessive exposure to the ultraviolet rays of the sun, especially in fair-skinned people, increases the risk of skin cancers. Factors such as clothing styles (sleeveless shirts or shorts), the use of sunscreens, occupation, recreational habits, and environmental variables, including humidity, altitude, and latitude, all play a role in the amount of exposure to ultraviolet light. Tobacco smoke, thought to be the single most lethal chemical carcinogen, accounts for at least 30% of cancer deaths in humans
