N406: Unit 9 Exam 3 PREPU (CANCER)

A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately: a. Stops the chemotherapeutic infusion b. Administers diphenhydramine c. Gives prednisolone IV d. Places the client on oxygen by nasal cannula

a. Stops the chemotherapeutic infusion Rationale: The client may be experiencing a type I hypersensitivity reaction, which may progress to systemic anaphylaxis. The most immediate action of the nurse is to discontinue the medication followed by initiating emergency protocols.

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

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

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? a. Potassium b. Vitamin K c. Vitamin B d. Oral bile acids

b. Vitamin K Rationale: Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery.

The clinic nurse is caring for a client who has just been diagnosed with a tumor. The client says to the nurse "The doctor says my tumor is benign. What does that mean?" What is the nurse's best response? a. "Benign tumors don't usually cause death." b. "Benign tumors grow very rapidly." c. "Benign tumors can spread from one place to another." d. "Benign tumors invade surrounding tissue."

a. "Benign tumors don't usually cause death." Rationale: Benign tumors remain at their site of development. They may grow large, but their growth rate is slower than that of malignant tumors. They usually do not cause death unless their location impairs the function of a vital organ, such as the brain.

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

a. Liver Rationale: The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites.

You are a clinic nurse. One of your clients has found she is at high risk for breast cancer. She asks you what can be done to reduce her risk. What is a means of reducing the risk for breast cancer? a. Palliative surgery b. Prophylactic surgery c. Curative surgery d. Reduction surgery

b. Prophylactic surgery Rationale: Prophylactic or preventive surgery may be done if the client is at considerable risk for cancer. Palliative surgery is done when no curative treatment is available. Curative surgery is performed to cure the disease process. Reduction surgery is a distractor.

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

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

The physician is attending to a 72-year-old client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician's recommendation? a. To remove the tumor from the brain b. To prevent the formation of new cancer cells c. To analyze the lymph nodes involved d. To destroy marginal tissues

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

The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply: a. dietary substances b. environmental factors c. viruses d. gender e. age

a, b, c Rationale: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, lifestyle factors, and medically prescribed interventions. Although age and gender may increase a person's risk for developing certain types of cancer, they are not carcinogens in and of themselves.

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage according to Kübler-Ross? a. Denial b. Anger c. Bargaining d. Acceptance

b. Anger Rationale: Anger is the second stage and is exhibited by statement similar to "Why me?" Denial occurs when the person refuses to believe certain information. Bargaining is an attempt to postpone death. During the acceptance stage, the dying clients accept their fate and make peace spiritually and with those to whom they are close.

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

b. Monitor the client to prevent sepsis Rationale: Until transplanted bone marrow begins to produce blood cells, clients who have undergone a bone marrow transplant have no physiologic means to fight infection, which puts them at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent sepsis. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client becoming septic.

Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure? a. Family history b. Drug history c. Blood studies d. Allergy history

c. Blood studies Rationale: Before the BMT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before a BMT procedure, the nurse need not evaluate the client's family, drug, or allergy history.

The nurse is providing education to a client with cancer radiation treatment options. The nurse determines that the client understands the teaching when the client states that which type of radiation aims to protect healthy tissue during the treatment? a. Proton therapy b. Teletherapy c. Brachytherapy d. External

c. Brachytherapy In internal radiation, or brachytherapy, a dose of radiation is delivered to a localized area inside the body through the use of an implant. With this type of therapy, the farther the tissue is from the radiation source, the lower the dose. This helps to protect normal tissue from the radiation therapy.

A decrease in circulating white blood cells (WBCs) is referred to as: a. Granulocytopenia b. Thrombocytopenia c. Leukopenia d. Neutropenia

c. Leukopenia Rationale: A decrease in circulating WBCs is referred to as leukopenia. Granulocytopenia is a decrease in neutrophils. Thrombocytopenia is a decrease in the number of platelets. Neutropenia is an abnormally low absolute neutrophil count.

Which is a growth-based classification of tumors? a. Sarcoma b. Carcinoma c. Malignancy d. Leukemia

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

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 unusual sign of nausea. b. Be alarmed if she notices fluid retention. c. Increase her intake of calcium-rich foods. d. Report the unexpected sign of increased appetite and weight gain.

c. Increase her intake of calcium-rich foods. Rationale: One of the major side effects of Aromasin is hypocalcemia 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.

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

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

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

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

A 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: a. expected chemotherapy-related adverse effects. b. chemotherapy exposure and risk factors. c. signs and symptoms of infection. d. reinforcement of the client's medication regimen.

b. chemotherapy exposure and risk factors. Rationale: 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 with ovarian cancer is ordered hydroxyurea, an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. What mechanism of action do antimetabolites interferes with? a. cell division or mitosis during the M phase of the cell cycle b. normal cellular processes during the S phase of the cell cycle c. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle-nonspecific) d. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cycle-nonspecific)

b. normal cellular processes during the S phase of the cell cycle Rationale: Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They're most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.

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

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

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

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

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. Check the client's history for a congenital link to thrombocytopenia. c. Monitor daily platelet counts. d. Closely observe the client's skin for petechiae and bruising.

d. Closely observe the client's skin for petechiae and bruising. Rationale: The nurse should closely observe the client's skin for petechiae and bruising. Daily laboratory testing may not reflect the client's condition as quickly as subtle changes in the client's skin. Performing a cardiovascular assessment every 4 hours and checking the clients history for a congenital link to thrombocytopenia don't help detect early signs and symptoms of thrombocytopenia.

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 floss my teeth every morning." b. "I use an electric razor to shave." c. "I take a stool softener every morning." d. "I removed all the throw rugs from the house."

a. "I floss my teeth every morning." Rationale: 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 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 am so glad the doctor was able to remove the entire tumor." c. "I will be glad to finally be done with treatments for this thing." d. "Thank goodness the tumor is contained and curable."

a. "I guess the doctor could not remove the entire tumor." Rationale: Debulking is a reference made when a tumor cannot be completely removed, often due to its extension far into healthy tissue. Without complete removal, this is not a cure and, the cancer cells will continue to replicate and require adjuvant therapies to prevent further invasion. The physician, not the nurse, will need to clarify the details of the surgery.

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

a. Autologous Rationale: 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.

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

a. Avoiding using soap on the irradiated areas Rationale: Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed.

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

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

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth? a. Control b. Cure c. Palliation d. Prevention

a. Control Rationale: 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.

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

a. Cytokine Rationale: 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.

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. Maintain as much distance as possible from the patient while in the room. c. Alert family members that they should restrict their visiting to 5 minutes at any one time. 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. Rationale: When the patient has a radioactive implant in place, the nurse and other health care providers need to protect themselves, as well as the patient, from the effects of radiation. Patients receiving internal radiation emit radiation while the implant is in place; therefore, contact with the health care team is guided by principles of time, distance, and shielding to minimize exposure of personnel to radiation. Safety precautions used in caring for a patient receiving brachytherapy include assigning the patient to a private room, posting appropriate notices about radiation safety precautions, having staff members wear dosimeter badges, making sure that pregnant staff members are not assigned to the patient's care, prohibiting visits by children or pregnant visitors, limiting visits from others to 30 minutes daily, and seeing that visitors maintain a 6-foot distance from the radiation source.

A 50-year-old client is an alcoholic. The client has been diagnosed with pancreatic cancer and underwent surgery to remove the tumor. Despite the tumor being removed, the physician informs the client that chemotherapy needs to be started immediately. Using evidence-based practice, which intervention might the nurse expect the physician to include, with the goal of improving quality of life, mood, and median survival. a. Palliative care b. Radiation c. Angiogenesis d. Respite care

a. Palliative care Rationale: In a study of referral to palliative care for clients newly diagnosed with a disease with very poor prognosis, researchers found that those clients receiving palliative care plus standard oncology demonstrated improved quality of life and mood and had longer median survival. Radiation is primarily used when a cancer spreads to other organs, and it has not been proven to affect mood. 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. Respite care is provided on an occasional basis to relieve the family caregivers.

A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action? a. Place the client in a private room. b. Place a chair next to the bed to allow the spouse to sit. c. Have visitors wear dosimeters for safety. d. Allow visitors to telephone only.

a. Place the client in a private room. Rationale: Safety precautions are used for the client with a radioactive implant. They include assigning the client to a private room, seeing that visitors maintain a 6-foot distance from the radiation source, prohibiting visits by children, and preventing exposure to those who may be or are pregnant. Staff needs to wear dosimeters. Family may visit for up to 30 minutes per day.

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? a. Risk for infection related to inadequate defenses b. Fatigue related to deficient blood cells c. Activity intolerance related to side effects of chemotherapy d. Anxiety related to change in role function

a. Risk for infection related to inadequate defenses Rationale: Physiological needs, such as risk for infection, take priority over the client's other needs.

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

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

A client with 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? a. To prevent metastasis b. Angiogenesis c. Stomatitis d. Fatigue

a. To prevent metastasis Rationale: 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.

Which of the following would be consistent with a benign neoplasm? a. Usually progressive and slow b. Grows by invasion c. Gains access to the blood and lymph channels to metastasize d. Cells are undifferentiated

a. Usually progressive and slow Rationale: A benign neoplasm's rate of growth is usually progressive and slow. Malignant neoplasms have undifferentiated cells, grow by invasion, and gain access to the blood and lymph channels to metastasize to other areas of the body.

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

a. Wear disposable gloves and protective clothing Rationale: A nurse must wear disposable gloves and protective clothing to prevent skin contact with chemotherapeutic agents. The nurse shouldn't recap or break needles. The nurse should use a sterile gauze pad when priming I.V. tubing, connecting and disconnecting tubing, inserting syringes into vials, breaking glass ampules, or other procedures in which chemotherapeutic agents are being handled. Contaminated needles, syringes, I.V. tubes, and other equipment must be disposed of in a leak-proof, puncture-resistant container.

The 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 nonspecific. b. cell-cycle specific in the S phase. c. cell-cycle specific in the M phase. d. cell-cycle specific in the P phase.

a. cell-cycle nonspecific.

Carcinogens are factors related to the formation of various malignancies. Which factor has the greatest impact on the development of all cancers? a. chemical agents b. environmental factors c. viruses d. defective genes

a. chemical agents Rationale: 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

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

b. Avoid spicy and fatty foods Rationale: The nurse advises a client undergoing chemotherapy to avoid hot and very cold liquids and spicy and fatty foods. The nurse also encourages the client to have small meals and appropriate fluid intake.

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

b. Increased uric acid excretion Rationale: 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. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.

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

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

The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest? a. Normal finding b. Benign fibrocystic disease c. Malignant tumor d. Malignant tumor with metastasis to surrounding tissue

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

A client with a brain tumor recently stopped radiation and chemotherapy for treatment of the cancer. The client recently reported dry mouth. Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth? a. Begin 9% normal saline IV at 125 mL/hr. b. Place two drops of atropine ophthalmic 1% solution sublingually. c. Provide gentle oral care after each meal. d. Gently suction the client's mouth and buccal cavity.

c. Provide gentle oral care after each meal. Rationale: Dry mouth can generally be managed through nursing measures such as mouth care. The use of artificial hydration (IV fluids) carries considerable risks and does not contribute to comfort at the end of life. Atropine ophthalmic 1% drops administered sublingually help to reduce oral secretions. Gentle oral suctioning reduces the production of secretions.

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? a. Time, distance, and shielding b. The use of disposable utensils and wash cloths c. Avoid showering or washing over skin markings. d. Inspect the skin frequently.

d. Inspect the skin frequently Rationale: 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 nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse? a. It stimulates the immune system against the tumor cells. b. It treats drug-related anemia. c. It prevents alopecia. d. It lowers serum and uric acid levels.

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

The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks? a. Pool and water safety b. Breast and testicular self-exams c. Hand washing and infection prevention d. Sun safety and use of sunscreen

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