Week 1: Ch 15
To prevent fever and shivering during an infusion of rituximab (Rituxan), the nurse should premedicate the patient with: A. aspirin B. acetaminophen C. sodium bicarbonate D. meperidine (Demerol)
B. acetaminophen Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is often premedicated with acetaminophen to try to prevent or decrease the intensity of these symptoms. Large amounts of fluids help decrease symptoms.
A nurse is collecting information from a client in a provider's office. Which of the following findings should the nurse identify as an indication of possible cancer? (Select all that apply) A. Temperature 102° F (38.9°C) for more than 48 hr B. Sore that does not heal C. Difficulty swallowing D. Unusual discharge E. Weight gain 4 lb (1.8kg) in 2 weeks
B, C, D, E A sore that does not heal is a finding of possible cancer. Difficulty swallowing is a finding of possible cancer. The presence of unusual discharge is a finding of possible cancer. Weight gain or loss can indicate possible cancer
The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg, and it is getting worse. Which question would best determine treatment measures for the patient's pain? A. "Where is the pain?" B. "Is the pain getting worse?" C. "What does the pain feel like?" D. "Do you use medications to relieve the pain?"
C. "What does the pain feel like?" The UAP told the nurse the location of the patient's pain and the patient reports worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.
A female patient is having chemotherapy for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? A. "When your hair grows back, it will be patchy." B. "Use your curling iron since that will slow down the loss." C. "You can get a wig now to match your hair so you will not look different." D. "You should contact "Look Good, Feel Better" to figure out what to do about this."
C. "You can get a wig now to match your hair so you will not look different." The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. Although hair loss with chemotherapy is usually reversible, hair loss with radiation is usually permanent in the areas radiation was administered. When hair grows back, it could be a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern.
A nurse is teaching a client who is scheduled for a shave biopsy for suspected cancer. Which of the following client statements indicates an understanding of the procedure? A. "A test of my bone marrow will be performed." B. "A lymph node will be removed." C. "A needle will be inserted into the mass." D. "A small skin sample will be obtained."
D. "A small skin sample will be obtained." A shave biopsy is a sampling of the outer skin layer using a scalpel or razor blade.
A nurse is caring for a client who has cervical cancer and is scheduled for brachytherapy. Which of the following actions should the nurse take? (Select all that apply) A. Permit visitors to stay with the client 30 min at a time B. Warn pregnant individuals to visit the room only once daily C. Wear a dosimeter when in the client's room D. Place soiled dressings in a biohazard bag before discarding in the regular trash E. Dispose soiled linens in the hamper outside the client's room
A, B, C Visitors should remain for no more than 30 minutes at a time and maintain a distance of at least 6 ft. Pregnant individuals should not enter the room of a client receiving brachytherapy. Healthcare personnel should wear a dosimeter when there is potential exposure to radiation, such as in the radiology department or in the room of a client receiving brachytherapy. Do not discard the client's dressings in the regular trash, because secretions are radioactive. Do not place objects from the client's room in the hallway because they are radioactive, but should dispose of them following facility protocol.
Patients may reduce the risk of developing cancer using health promotion strategies. Identify modifiable strategies which can reduce the risk of developing cancer. (Select all that apply) A. Stop smoking B. Use sunscreen C. Limit alcohol use D. Undergo genetic testing E. Maintain a healthy weight F. Receive appropriate immunizations
A, B, C, E, F Changing a person's lifestyle can limit cancer promotors, which is key in cancer prevention. Immunizations such as human papilloma virus (HPV) can prevent cervical cancer. Use of sunscreen (SPF 15 or greater) can prevent cell damage and development of skin cancer. Smoking can initiate or promote cancer development. Alcohol use combined with smoking can promote esophageal and bladder cancers. Management of weight can reduce the risk of cancer. Genetic testing (i.e., APC gene) identifies the predisposition to some cancers but is not modifiable.
The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation? (Select all that apply.) A. Maintain hope. B. Exhibit a caring attitude. C. Plan realistic long-term goals. D. Give them antianxiety medications. E. Be available to listen to fears and concerns. F. Teach them about the type of cancers that could be diagnosed.
A, B, E Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching them about the diagnostic procedures would also be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.
What features of cancer cells distinguish them from normal cells? (Select all that apply) A. Cells lack contact inhibition B. Cells undergo rapid proliferation C. Cells return to a previous undifferentiated state D. Proliferation occurs when there is a need for more cells E. New proteins characteristic of embryonic stage emerge on cell membrane
A, C, E Cancer cells proliferate at the same rate as the normal cells of the tissue from which they arise. However, cancer cells respond differently than normal cells to the intracellular signals that regulate cell proliferation and death. The result is that the proliferation of the cancer cells is indiscriminate and continuous. They lack contact inhibition. Cancer cells may have altered cell-surface antigens because of malignant transformation. These antigens are termed tumor-associated antigens. Normally the differentiated cell is stable and will not dedifferentiate. Cancer cells can dedifferentiate. Abilities and properties that the cell had in fetal development are again expressed.
The nurse assesses a patient with chronic myeloid leukemia receiving chemotherapy using a kinase inhibitor medication. Which question is most important for the nurse to ask? A. "Have you had a fever?" B. "Have you lost any weight?" C. "Has diarrhea been a problem?" D. "Have you noticed any hair loss?"
A. "Have you had a fever?" An adverse effect of kinase inhibitors is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in patients with cancer. Patients should report a temperature of 100.4° F or higher. The other options are possible while undergoing chemotherapy but do not represent the highest priority for assessment.
Previous administrations of chemotherapy agents to a patient with cancer have resulted in diarrhea. Which dietary modification should the nurse recommend? A. A bland, low-fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods
A. A bland, low-fiber diet Patients with diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.
The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? A. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years B. Family history of colorectal cancer and consumes a high-fiber diet C. Limits fat consumption and has regular mammography and Pap screenings D. Exercises five times every week and does not consume alcoholic beverages
A. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years Cancer prevention and early detection are associated with the following behaviors: limited alcohol use, regular physical activity, maintaining a normal body weight, obtaining regular cancer screenings, avoiding cigarette smoking and other tobacco use, using sunscreen with SPF 15 or higher, and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).
The laboratory reports that the cells from the patient's tumor biopsy are grade II. What should the nurse know about this histologic grading? A. Cells are abnormal and moderately differentiated. B. Cells are very abnormal and poorly differentiated. C. Cells are immature, primitive, and undifferentiated. D. Cells differ slightly from normal cells and are well-differentiated.
A. Cells are abnormal and moderately differentiated. Grade II cells are more abnormal than grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.
A nurse is planning care for a client who is scheduled for genetic testing for suspected cancer. Which of the following interventions should the nurse include in the plan of care? A. Determine the need for informed consent. B. Send testing results to the client's insurance agency. C. Verify the prescription for a tumor marker assay. D. Ensure the client is placed in a recovery position after testing.
A. Determine the need for informed consent. A signed informed consent form should be obtained prior to the procedure. Genetic testing information is confidential. Do not send the information unless the client requests it. A tumor marker assay is a laboratory test to identify the presence of specific body proteins in blood, body secretions, and tissue. It is not component of genetic testing. Genetic testing involves collection of blood or saliva. Recovery positioning is not required following testing.
A nurse in a clinic is talking with a client scheduled for a sentinel lymph node biopsy. Which of the following information should the nurse include? A. Dye is used during the procedure. B. The lymph nodes closest to the tumor are removed during the biopsy. C. A small amount of chemotherapy is used to test the lymph node response. D. A 2 mm plug of tissue is removed during the biopsy.
A. Dye is used during the procedure. The client will receive a dye or colloid as a tracer to help identify lymph nodes during a sentinel lymph node biopsy. The lymph nodes close to the tumor might be removed in a later procedure if the sentinel lymph node is positive for cancer. Chemotherapy is not administered during a sentinel lymph node biopsy. A punch biopsy involves removing a 2 to 6 mm plug of tissue.
A 70-year-old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and reports nausea and constipation. Which complication of cancer is this most likely caused by? A. Hypercalcemia B. Tumor Lysis Syndrome C. Spinal Cord Compression D. Superior Vena Cava Syndrome
A. Hypercalcemia Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or worsen hypercalcemia. The manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting.
A patient has recently been diagnosed with early stages of breast cancer. What is the most appropriate for the nurse to focus on? A. Maintaining the patient's hope B. Preparing a will and advance directives C. Discussing replacement child care for the patient's children D. Discussing the patient's past experiences with her grandmother's cancer
A. Maintaining the patient's hope Maintain hope, which is the key to effective cancer care. Hope depends on the status of the patient: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care.
A nurse plans a community education program related to prevention of cancer with the highest death rates in both women and men. What should the nurse include in the teaching plan? A. Smoking cessation B. Screening with colonoscopy C. Regular examination of reproductive organs D. Use of sunscreen as protection from ultraviolet light
A. Smoking cessation The highest number of cancer deaths by site are for cancer of the lung and bronchus. Smoking is the leading cause of lung and bronchial cancer.
The primary protective role of the immune system related to malignant cell is: A. Surveillance for cells with tumor-associated antigens B. Binding with fee antigens released by all cancer cells C. Producing blocking factors that immobilize cancer cells D. Reacting to a new set of antigenic determinants on cancer cells
A. Surveillance for cells with tumor-associated antigens Cancer cells may have altered cell surface antigens because of malignant transformation. These antigens are called tumor-associated antigens (TAAs). One of the functions of the immune system is to respond to TAAs.
During the promotion stage of cancer development, which statement by the nurse most facilitates patient cancer prevention? A. "Exercise every day for 30 minutes." B. "Follow smoking cessation recommendations." C. "Following a vitamin regime is highly recommended." D. "I recommend excision of the cancer as soon as possible."
B. "Follow smoking cessation recommendations." The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Cigarette smoking is a promoting factor and a carcinogen. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be consistent with the nurse's role.
A nurse is teaching a client who is scheduled for nuclear imaging for suspected cancer. Which of the following statements should the nurse give? A. "The presence of a liver enzyme will be identified." B. "You will be given an injection of a radioactive substance." C. "An endoscope will be inserted through your mouth." D. "The tumor will be aspirated."
B. "You will be given an injection of a radioactive substance." Nuclear imaging involves the administration of an oral or IV radioactive tracer to identify cancerous tissue.
Which patient is statistically and medically at the highest risk of developing cancer? A. A 68-yr-old white woman who has BRCA-1 gene and is obese B. A 56-yr-old black man with hepatitis C who drinks alcohol daily C. An 18-yr-old Hispanic man who eats fast food once per week and drinks alcohol D. An 80-yr-old Asian woman with coronary artery disease on blood pressure medication.
B. A 56-yr-old black man with hepatitis C who drinks alcohol daily The combination of statistically identified risk factors in addition to current liver disease (hepatitis C that is linked to the development of liver cancer) and the added promotor of alcohol makes this patient at the highest risk. Second is the white woman with the gene for breast cancer and the added promotor of obesity. Most cancer cases are diagnosed in people older than 55 years of age. The overall incidence of cancer is higher in men than women. Cancer incidence is higher in blacks, then whites, and then people from other cultures.
To prevent the debilitating cycle of fatigue-depression-fatigue that can occur in patients with cancer, an appropriate nursing intervention is to A. Have the patient rest after expending any major energy B. Encourage the patient to implement a daily walking program C. Teach the patient to ignore the fatigue to maintain normal daily activities D. Prevent depression by informing the patient to expect fatigue during cancer treatment
B. Encourage the patient to implement a daily walking program Exercise and activity within tolerable limits are often helpful in managing fatigue. Walking programs are a way for most patients to stay active without being overtaxed.
A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to maintain the patients self-esteem? A. Tell the patient to limit social contacts until regrowth of the hair occurs. B. Encourage the patient to purchase a wig or hat and wear it once hair loss begins. C. Teach the patient to gently wash hair with a mild shampoo to minimize hair loss. D. Inform the patient that hair usually grows back once the chemotherapy is complete.
B. Encourage the patient to purchase a wig or hat and wear it once hair loss begins. The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicle and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is not immediately helpful in maintaining the patients self-esteem.
The nurse explains to a patient undergoing brachytherapy of the cervix that she: A. Must undergo simulation to locate the treatment area B. Requires the use of radioactive precautions during nursing care C. May have desquamation of the skin on the abdomen and upper legs D. Requires shielding of the ovaries during treatment to prevent ovarian damage
B. Requires the use of radioactive precautions during nursing care Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or next to the tumor. It would not be possible to shield the ovaries during therapy. Caring for the person undergoing brachytherapy requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, and shielding are vital to health care professional safety. Simulation is a process by which external radiation treatment fields are defined. Desquamation is an effect of external radiation.
The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? A. Ask the patient if the site hurts. B. Turn off the chemotherapy infusion. C. Call the ordering health care provider. D. Administer sterile saline to the reddened area.
B. Turn off the chemotherapy infusion. Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation, the infusion should first be stopped. Then the protocol for the drug-specific extravasation procedures should be followed to minimize further tissue damage. The site of extravasation usually hurts, but it may not. It is more important to stop the infusion immediately. The health care provider may be notified by another nurse while the patient's nurse starts the drug-specific extravasation procedures, which may or may not include sterile saline.
The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? A. It is delivered via an Ommaya reservoir and extension catheter. B. It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. C. A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration. D. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.
C. A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration. Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump.
The goals of cancer treatment are based on the principle that A. Surgery is the single most effective treatment for cancer B. Initial treatment is always directed toward cure of the cancer C. A combination of treatment modalities is effective for controlling many cancers. D. Although cancer cure is rare, quality of life can be increased with treatment modalities.
C. A combination of treatment modalities is effective for controlling many cancers. The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the cancer being treated and may involve local therapies (e.g., surgery or radiation) alone or in combination, with or without adjunctive systemic therapy (e.g., chemotherapy).
A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. Which action, if taken by the nurse, is most appropriate? A. Have the patient eat large meals when nausea is not present. B. Offer dry crackers and carbonated fluids during chemotherapy. C. Administer prescribed antiemetics 1 hour before the treatments. D. Give the patient two ounces of a citrus fruit beverage during treatments.
C. Administer prescribed antiemetics 1 hour before the treatments. Treatment with antiemetics before chemotherapy may help prevent nausea. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea. The acidity of citrus fruits may be further irritating to the stomach.
A patient with breast cancer is having teletherapy radiation treatments after surgery. What should the nurse teach the patient about skin care? A. Use Dial soap to feel clean and fresh. B. Scented lotion can be used on the area. C. Avoid heat and cold to the treatment area. D. Wear the new bra to comfort and support the area.
C. Avoid heat and cold to the treatment area. Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.
Trends in the incidence and death rates of cancer include the fact that: A. A higher percent of women than men have lung cancer B. Lung cancer is the most common type of cancer in men C. Blacks have a higher death rate from cancer than whites D. Breast cancer is the leading cause of cancer deaths in women
C. Blacks have a higher death rate from cancer than whites Cancer incidence and death rates are disproportionately higher among Blacks than among other minority groups and white people.
The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that the patient is at risk for tumor lysis syndrome (TLS) and will monitor for which abnormality associated with this oncologic emergency? A. Hypokalemia B. Hypercalcemia C. Hyperuricemia D. Hypophosphatemia
C. Hyperuricemia TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.
After 3 weeks of radiation therapy, a patient has lost 10 pounds and does not eat well because of mucositis. Which nursing diagnosis would be most appropriate? A. Risk of infection related to poor nutrition B. Ineffective health management related to refusal to eat C. Imbalanced nutrition: less than body requirements related to oral ulcerations D. Ineffective health maintenance related to lack of knowledge of nutritional requirements during radiation therapy
C. Imbalanced nutrition: less than body requirements related to oral ulcerations The nursing problem is imbalanced nutrition related to mucositis.
The patient is told that an adenoma tumor is not encapsulated but has normally differentiated cells and surgery will be needed. The patient asks the nurse what this means. What should the nurse's response be to the patient? A. It will recur. B. It has metastasized. C. It is probably benign. D. It is probably malignant.
C. It is probably benign. Benign tumors are usually encapsulated, have normally differentiated cells, and do not metastasize. Malignant tumors are rarely encapsulated, have poorly differentiated cells, and are capable of metastasis.
The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider? A. Hematocrit 32% B. Pain with deep inspiration C. Serum sodium 126 mEq/L D. Decreased breath sounds on left side
C. Serum sodium 126 mEq/L Syndrome of inappropriate antidiuretic hormone (and the resulting hyponatremia) is an oncologic metabolic emergency and will require rapid treatment in order to prevent complications such as seizures and coma. The other findings also require intervention, but are common in patients with lung cancer and not immediately life threatening.
A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9 (10^3)/uL, hemoglobin of 10.8 g/dL, and a platelet count of 99 (10^3)/uL. Based on the CBC results, what is the most serious clinical finding? A. Cough, rhinitis, and sore throat B. Fatigue, nausea, skin redness at the site of radiation C. Temperature of 101.9F, fatigue, and shortness of breath D. Skin redness at the site of radiation, headache, and constipation
C. Temperature of 101.9F, fatigue, and shortness of breath Neutropenia is more common in patients receiving chemotherapy than in those receiving radiation. It can seriously increase the risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly because fever in the setting of neutropenia is a medical emergency.
The nurse is caring for an 18-yr-old patient with acute lymphocytic leukemia who is scheduled for hematopoietic stem cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure? A. "I understand the transplant procedure has no dangerous side effects." B. "After the transplant, I will feel better and can go home in 5 to 7 days." C. "My brother will be a 100% match for the cells used during the transplant." D. "Before the transplant, I will have chemotherapy and possibly full-body radiation."
D. "Before the transplant, I will have chemotherapy and possibly full-body radiation." Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.
A patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis? A."The cancer is found at the point of origin only." B. "Tumor cells have been identified in the cervical region." C. "The cancer has been identified in the cervix and the liver." D. "Your cancer was identified in the cervix and has limited local spread."
D. "Your cancer was identified in the cervix and has limited local spread." Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ or at the point of origin only; stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread. Stage IV denotes metastasis such as to the liver.
When providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy, what would be most beneficial to teach the patient to use? A. Firm-bristle toothbrush B. Hydrogen peroxide rinse C. Alcohol-based mouthwash D. 1 tsp salt in 1 L water mouth rinse
D. 1 tsp salt in 1 L water mouth rinse A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy. A soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.
The patient is receiving immunotherapy and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? A. Morphine sulfate B. Ibuprofen (Advil) C. Ondansetron (Zofran) D. Acetaminophen (Tylenol)
D. Acetaminophen (Tylenol) Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic but is not used first to combat flu-like symptoms such as headache, fever, chills, and myalgias.
The nurse is caring for a patient with anorexia secondary to chemotherapy. Which strategy would be most appropriate to increase the patient's nutritional intake? A. Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtimes. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.
D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods. The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (e.g., peanut butter, skim milk powder, cheese, honey, brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.
A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? A. Bacteria B. Sun exposure C. Most chemicals D. Epstein-Barr virus
D. Epstein-Barr virus Burkitt's lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. Bacteria do not initiate cancer. Sun exposure causes cell alterations leading to melanoma and squamous and basal cell skin carcinoma. Long-term exposure to certain chemicals (e.g., ethylene oxide, chloroform, benzene) is known to initiate cancer.
A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing interventions would be a priority? A. Discuss with the provider the need for parenteral nutrition B. Teach the patient to eat foods that are fatty, fried, or high in calories C. Tell the patient to drink a nutritional supplement beverage three times a day D. Have the patient try various spices and seasonings to enhance the flavor of food
D. Have the patient try various spices and seasonings to enhance the flavor of food Teach the patient to try different ways to mask the taste changes. Some find stronger seasonings and spices effective. Others find it better to avoid strong flavors and eat more bland foods. Avoiding strong smells, drinking more water with food, oral care before eating, eating smaller amounts more often, and using plastic utensils may help.
When caring for the patient with cancer, what does the nurse understand is the response of the immune system to antigens of the malignant cells? A. Metastasis B. Tumor angiogenesis C. Immunologic escape D. Immunologic surveillance
D. Immunologic surveillance Immunologic surveillance is the process in which lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance that allows the cancer cells to reproduce.
The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in therapy with the health care provider? A. Poor oral intake B. Frequent loose stools C. Complaints of nausea and vomiting D. Increase in carcinoembryonic antigen (CEA)
D. Increase in carcinoembryonic antigen (CEA) An increase in CEA indicates that the chemotherapy is not effective for the patients cancer and may need to be modified. The other patient findings are common adverse effects of chemotherapy. The nurse may need to address these, but they would not necessarily indicate a need for a change in therapy.
The nurse is caring for a 59-year-old woman who has surgery 1 day ago to remove an ovarian cancer mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to: A. Motivate change in an unhealthy lifestyle B. Teach her about the 7 warning signs of cancer C. Discuss healthy stress relief and coping practices D. Let her communicate about the meaning of this experience
D. Let her communicate about the meaning of this experience While the patient is waiting for diagnostic study results, you should be available to actively listen to the patient's concerns. You should be skilled in techniques that can engage the patient and caregivers in a discussion about their cancer-related fears.
After 3 weeks of radiation therapy and chemotherapy, H.J. tells you he wants to stop treatment because he wants to have children someday. What is your best response? A. There is no need to worry as the testes are not sensitive to radiation B. Reproduction is not a priority at this time in your treatment C. The combination of radiation and chemotherapy reduces the chances of developing side effects D. Low sperm counts and loss of motility are often seen with testicular cancer before therapy has begun
D. Low sperm counts and loss of motility are often seen with testicular cancer before therapy has begun The nurse should encourage discussion of issues related to reproduction and sexuality, offer specific suggestions, and make a referral for counseling
The nurse counsels the patient receiving radiation therapy or chemotherapy that: A. Effective birth control methods should be used for the rest of the patient's life B. After successful treatment, patients can expect a return to their previous level of function C. The cycle of fatigue-depression-fatigue that may occur during treatment may be reduced by restricting activity D. Nausea and vomiting can usually be managed with antiemetic drugs, diet modification, and other interventions
D. Nausea and vomiting can usually be managed with antiemetic drugs, diet modification, and other interventions Nausea and vomiting can usually be managed with antiemetic drugs, diet modification, and other non-drug interventions. Some cancer survivors may continue to have symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. Maintaining activity within tolerable limits is helpful in managing fatigue. Lifelong birth control is not necessary
A characteristic of the stage of progression in cancer development is: A. Oncogenic viral transformation of target cells B. A reversible steady growth facilitated by carcinogens C. A period of latency before clinical detection of cancer D. Proliferation of cancel cells despite host control mechanisms
D. Proliferation of cancel cells despite host control mechanisms Progression is the last stage of cancer. This stage is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (e.g., metastasis). Progression occurs because of rapid proliferation and decreased cell adhesion.
A patient who is receiving radiation to the head and neck as treatment for an invasive cancer reports mouth sores and pain. Which intervention should the nurse add to the plan of care? A. Provide ice chips to soothe the irritation. B. Weigh the patient every month to monitor for weight loss. C. Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. D. Provide high-protein and high-calorie, soft foods every 2 hours.
D. Provide high-protein and high-calorie, soft foods every 2 hours. A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories to aid healing. Extremes of temperature are to be avoided. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Patients should be weighed at least twice each week to monitor for weight loss.
Which problem is of most concern for a patient with myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D. Risk for infection
D. Risk for infection Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible when patients undergo chemotherapy, but the threat of infection is paramount.
A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? A. Weight gain of 6 lb B. Nausea and vomiting C. Urine specific gravity of 1.004 D. Serum sodium level of 118 mEq/L
D. Serum sodium level of 118 mEq/L Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. The other options listed are also symptoms of hyponatremia but are not as critical to report to the health care provider.
The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? A. The medications the patient is taking B. The nutritional supplements that will help the patient C. How much time is needed to provide the patient's care D. The time the nurse spends at what distance from the patient
D. The time the nurse spends at what distance from the patient The principles of ALARA (as low as reasonably achievable) and time, distance, and shielding are essential to maintain the nurse's safety when the patient is a source of internal radiation. The patient's medications, nutritional supplements, and time needed to complete care will not protect the nurse caring for a patient with brachytherapy for cervical cancer.
The most effective method of administering a chemotherapy agent that is a vesicant is to: A. Give it orally B. Give it intraarterially C. Use an Ommaya reservoir D. Use a central venous access device
D. Use a central venous access device Infusion with central venous access devices reduces the risk of infiltration of chemotherapy agents that are vesicants. If vesicants are inadvertently infiltrated into the skin, severe local tissue breakdown and necrosis may result.
The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? A. Hematocrit of 30% B. Platelets of 95,000/L C. Hemoglobin of 10 g/L D. White blood cell (WBC) count of 2400/L
D. White blood cell (WBC) count of 2400/L The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim (Neupogen) are needed. Although the other laboratory data indicate decreased levels, they do not indicate any immediate life-threatening adverse effects of the chemotherapy.
