TERM 3 EXAM 3 Ch 22 Care of Patients with Cancer
What are the common side effects of chemotherapy on the bone marrow? Select all that apply. 1 Anemia 2 Neutropenia 3 Thrombocytopenia 4 Alopecia 5 Mucositis
-Anemia -Neutropenia -Thrombocytopenia Chemotherapeutic agents have suppressive effects on bone marrow. Anemia can result from the decreased production of red blood cells and hemoglobin. Neutropenia refers to a reduced number of white blood cells, leading to lowered immunity. Thrombocytopenia, or a reduced number of platelets, may increase the risk of bleeding. Alopecia, or hair loss, and mucositis are common distressing side effects not specific to bone marrow chemotherapy treatment.
When caring for the client receiving cancer chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? Select all that apply. 1 Bruises 2 Fever 3 Petechiae 4 Epistaxis 5 Pallor
-Bruises -Petechiae -Epistaxis Bruising, petechiae, and nosebleeds are symptoms of a low platelet count. Fever is a sign of infection secondary to neutropenia. Pallor is a sign of anemia.
What are key points for the nurse to include in client education about skin care during radiation therapy? Select all that apply. 1 Clean skin cautiously to avoid removing ink or dye markings. 2 Avoid exposure of the irradiated skin areas to heat or sun. 3 Protect the irradiated area with soft, nonconstrictive clothing. 4 Over-the-counter lotions and ointments may be used for soothing. 5 Use a washcloth rather than a loofah for cleansing.
-Clean skin cautiously to avoid removing ink or dye markings. -Avoid exposure of the irradiated skin areas to heat or sun. -Protect the irradiated area with soft, nonconstrictive clothing. The irradiated area should be washed gently each day with either water or a mild soap and water as prescribed by the radiologist. Clients should take care not to remove ink or dye markings used for radiation beam focusing. Irradiated skin should not be exposed to sun or heat; therefore, clients should avoid midday outings or direct sun. Clients should use only ointments, powders, or lotions that are prescribed by the radiation oncology staff. The client should use his or her hand when cleansing, rather than a washcloth or loofah, to be gentler on the skin.
Which potential side effects does the nurse include in the teaching plan for a client undergoing radiation therapy for laryngeal cancer? Select all that apply. 1 Fatigue 2 Changes in color of hair 3 Change in taste 4 Changes in skin of the neck 5 Difficulty swallowing
-Fatigue -Change in taste -Changes in skin of the neck -Difficulty swallowing Radiation therapy to any site produces fatigue in most clients, and may cause clients to report changes in taste. Radiation side effects are site-specific. The larynx is in this area; therefore, changes in the skin may occur. Dysphagia (difficulty swallowing) may occur from radiation to the throat area. Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair; this does not normally occur with radiation therapy.
Which personal protective equipment (PPE) are necessary when preparing, giving, or disposing of chemotherapy drugs? Select all that apply. 1 Mask 2 Gown 3 Gloves 4 Head gear 5 Eye shield
-Mask -Gloves -Gown -Eye shield PPE should be worn when preparing, giving, or disposing of chemotherapy drugs because these drugs can be absorbed through the skin and mucus membranes. Masks, gowns, double gloves, and eye shields should be used to prevent exposure to chemotherapy agents. Head gear may not be useful when preparing, giving, or disposing of chemotherapy drugs.
A client has been diagnosed with cancer. Which primary factors determine which type of cancer treatment the client may receive? Select all that apply. 1 Availability of insurance coverage 2 Presence of genetic risk factors 3 Specific type of cancer 4 Evidence of cancer spread 5 Client's general health
-Specific type of cancer -Evidence of cancer spread -Client's general health Cancer treatment planning is based on scientific evidence from clinical trials and clinical expertise. The specific type of cancer and evidence of cancer spread usually determine the treatment recommendations. Further planning is based on overall health of the client, especially in terms of how well the client will be able to tolerate the treatment. Although insurance can be a major concern for the client/family, it is not a primary factor in treatment considerations. Genetics are playing an increasing role in cancer treatment; those related to risk are more important for prevention and early detection.
A nurse performs a skin screening for a client who has numerous skin lesions. Which lesion does the nurse evaluate first? a.Beige freckles on the backs of both hands b.Irregular blue mole with white specks on the lower leg c.Large cluster of pustules in the right axilla d.Thick, reddened papules covered by white scales
ANS: B This mole fits two of the criteria for being cancerous or precancerous: variation of color within one lesion, and an indistinct or irregular border. Melanoma is an invasive malignant disease with the potential for a fatal outcome. Freckles are a benign condition. Pustules could mean an infection, but it is more important to take care of the potentially cancerous lesion first. Psoriasis vulgaris manifests as thick reddened papules covered by white scales. This is a chronic disorder and is not the priority.
Which term describes the occurrence where bone marrow activity and white blood cell counts are at their lowest levels after chemotherapy? 1 Bone marrow suppression 2 Thrombocytopenia 3 Neutropenia 4 Nadir
Nadir Nadir is the term used for when blood cell counts are the lowest after chemotherapy. Bone marrow suppression is the effect of chemotherapy on cells in the bone marrow and it can impact all of the blood-forming cells. Thrombocytopenia refers to a low platelet (or thrombocyte) count. Neutropenia is specific to white blood cells or neutrophils.
Which statement correctly describes oral chemotherapy agents as compared to traditional intravenous agents? 1 Their use avoids the safety risks associated with traditional intravenous agents. 2 Their schedule allows for more flexibility without dependence on intravenous access. 3 Oral chemotherapy drugs are just as toxic as traditional intravenous chemotherapy agents. 4 Self-management is easy for clients and families to accomplish with oral chemotherapy drugs.
Oral chemotherapy drugs are just as toxic as traditional intravenous chemotherapy agents. Oral cancer agents have the potential to be just as toxic to the person taking or handling the drugs as IV agents do. They don't avoid the safety risks associated with IV agents, other than infiltration. It is also important for clients to realize the importance of following the recommended plan of administration; although regarded as "easy" to administer, these agents place greater responsibility for self-management on the client and family. They must clearly understand the schedule, anticipated side effects, and when to report side effects or other problems.
For individuals with cancer who are undergoing chemotherapy, bone marrow suppression places these individuals at risk for life-threatening infections. What is the most common cause of these infections? 1 Poor hand hygiene when performing personal cleansing 2 Inadequate handwashing when handling food products 3 Exposure to individuals who are harboring an infection 4 Overgrowth of the client's own normal flora
Overgrowth of the client's own normal flora The most common cause of life-threatening infections in individuals with bone marrow suppression is overgrowth of their own normal flora. Hand hygiene, careful preparation of food, and avoiding exposure to individuals harboring an infection help to decrease the risks secondary to external organisms. These actions however, do not affect the risk of normal flora overgrowth.
The nurse corrects the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance? 1 The student scrubs the hub of IV tubing before administering an antibiotic. 2 The nurse overhears the student explaining to the client the importance of handwashing. 3 The student teaches the client that symptoms of neutropenia include fatigue and weakness. 4 The nurse observes the student providing oral hygiene and perineal care.
The student teaches the client that symptoms of neutropenia include fatigue and weakness. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected. Asepsis with IV lines is an appropriate action. Handwashing is an essential component of client care, especially when the client is at risk for neutropenia. Hygiene and perineal care help prevent infection and sepsis.
