Chapter 15 Med Surg

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A nurse is teaching a community class about how to decrease the risk of cancer. Which food should the nurse recommend?

Low-fat hot dogs
Smoked ham
Oranges
Medium-rare steak

Oranges (329) A diet high in vitamin C and citrus may help reduce the risk of certain cancers, such as stomach and esophageal cancers. Hot dogs and smoked and cured foods are high in nitrates, which may be linked to esophageal and gastric cancers. Steak is a high-fat food that may increase the risk of breast, colon, and prostate cancers.

A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean?

No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis

Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis

Can’t assess tumor or regional lymph nodes and no evidence of metastasis

Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis

Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis (335) TIS, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can’t be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.

During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?

Recommending that the client discontinue chemotherapy

Providing a solution of viscous lidocaine for use as a mouth rinse

Monitoring the client’s platelet and leukocyte counts

Checking regularly for signs and symptoms of stomatitis

Providing a solution of viscous lidocaine for use as a mouth rinse (357) To decrease the pain of stomatitis, the nurse should provide a solution of hydrogen viscous lidocaine for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer systemic analgesics as ordered. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn’t be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection but wouldn’t decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn’t decrease the pain.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?

Serving small portions of bland food

Encouraging rhythmic breathing exercises
Administering metoclopramide and dexamethasone as ordered

Withholding fluids for the first 4 to 6 hours after chemotherapy administration

Administering metoclopramide and dexamethasone as ordered (344) 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.

An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates that teaching was successful?

"I clean my teeth gently several times per day."

"I replace my toothbrush every month."

"I lubricate my lips with petroleum jelly."

"I use an alcohol-based mouthwash every morning."

"I clean my teeth gently several times per day." (360) The client demonstrates understanding when he states that he’ll clean his teeth gently several times per day. Frequent gentle cleaning of the mouth or rinsing reduces bacteria build-up in the oral cavity, thus reducing the risk for oropharyngeal infection. Changing the toothbrush each month reduces the bacteria in the mouth for the first few uses only. Petroleum jelly moistens the lips, but doesn’t prevent breakdown of the mucous membranes or reduce the risk for oropharyngeal infection. Alcohol-based products cause drying of the mucous membrane, increasing the likelihood of oropharyngeal infection.

After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client’s cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority?

Risk for injury

Imbalanced nutrition: Less than body requirements

Risk for infection

Anxiety

Risk for infection (376) Risk for infection takes highest priority in clients with severe bone marrow depression because they have a decrease in the number of white blood cells, the cells that fight infection. Making clients aware that they are at risk for injuries can help prevent such injuries as falls. The nurse should institute the facility’s falls prevention protocol and supply assistive devices, such as a walker, cane, or wheelchair, when needed. Imbalanced nutrition: Less than body requirements is also of concern but doesn’t take priority over preventing infection. Anxiety is likely present in clients with severe bone marrow depression; however, anxiety doesn’t take priority over preventing infection.

Which statement by a client undergoing external radiation therapy indicates the need for further teaching?

"I’ll wash my skin with mild soap and water only."

"I’ll not use my heating pad during my treatment."

"I’ll wear protective clothing when outside."

"I’m worried I’ll expose my family members to radiation."

"I’m worried I’ll expose my family members to radiation." (339) The client undergoing external radiation therapy requires further teaching when he voices a concern that he might expose his family to radiation. Internal radiation, not external radiation, poses a risk to the client’s family. The client requires no further teaching if he states that he should wash his skin with mild soap and water, wear protective clothing when outside, and avoid using a heating pad.

Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure?

Family history
Drug history
Blood studies
Allergy history

Blood studies (272) 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.

Which is a growth-based classification of tumors?

Sarcoma
Carcinoma
Malignancy
Leukemia

Malignancy (257) 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.

Which type of vaccine uses the client’s own cancer cells, which are killed and prepared for injection back into the client?

Autologous
Prophylactic
Therapeutic
Allogeneic

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

Which is a sign or symptom of septic shock?

Hypertension
Warm, moist skin
Altered mental status Increased urine output

Altered mental status (315) Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension.

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 closely to prevent infection.

Monitor the client’s physical condition.

Monitor the client’s heart rate.

Monitor the client closely to prevent infection. (350) 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. Monitoring client’s toilet patterns, physical condition, and heart rate does not prevent the possibility of the client getting an infection.

The nurse is caring for a client newly diagnosed with cancer. Which of the following therapies is used to treat something other than cancer?

Surgery
Radiation therapy Electroconvulsive therapy Chemotherapy

Electroconvulsive therapy (334) Cancer is frequently treated with a combination of therapies using standardized protocols. Three basic methods used to treat cancer are surgery, radiation therapy, and chemotherapy. Electroconvulsive therapy (ECT) is a method of treatment for mental distress or illness.

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?

"Benign tumors don’t usually cause death."

"Benign tumors grow very rapidly."

"Benign tumors can spread from one place to another."

"Benign tumors invade surrounding tissue."

"Benign tumors don’t usually cause death." (326) 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 has cancer of the neck and is receiving external beam radiation therapy to the site. The client is experiencing trauma to the irradiated skin. The nurse does all of the following. (Select all that apply.)

inspects for skin damage of the chest area

assesses the client for any sun exposure

uses cool water to wash the neck area

applies an over-the-counter ointment to the skin

avoids shaving the irradiated skin

assesses the client for any sun exposure avoids shaving the irradiated skin The client receiving external beam radiation therapy may experience trauma to the irradiated skin. To prevent further skin damage, the client is to avoid sun exposure and shaving the irradiated skin area. Other skin areas are not damaged, only the irradiated skin. Lukewarm water is to be used to bathe the area. Water of extreme temperature should be avoided. Many over-the-counter ointments contain metals and may cause additional skin damage.

Which oncologic emergency involves the accumulation of fluid in the pericardial space?

Cardiac tamponade

Disseminated intravascular coagulation (DIC)

Syndrome of inappropriate antidiuretic hormone release (SIADH)

Tumor lysis syndrome

Cardiac tamponade Cardiac tamponade is an accumulation of fluid in the pericardial space. DIC is a complex disorder of coagulation and fibrinolysis that results in thrombosis and bleeding. SIADH is a result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH). Tumor lysis syndrome is a rapidly developing oncologic emergency that results from the rapid release of intracellular contents as a result of radiation- or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia.

Which of the following is a term used to describe the process by which a new blood supply is formed?

Angiogenesis
Mitosis
Apoptosis
Carcinogenesis

Angiogenesis (325) Angiogenesis is the process by which a new blood supply is formed. Apoptosis is the innate cellular process of programmed cell death. Mitosis is the phase of the cell cycle in which cell division occurs. Carcinogenesis is the process by which cancer arises.

A decrease in circulating white blood cells (WBCs) is referred to as

Granulocytopenia Thrombocytopenia Leukopenia
Neutropenia

Leukopenia 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.

The nurse assesses that extravasation of a chemotherapy agent has occurred. What should the initial action of the nurse be?

Apply a warm compress to the area.

Discontinue the infusion.

Inject an antidote, if required.

Place ice over the site of infiltration.

Discontinue the infusion. (348) If extravasation is suspected, the medication administration is stopped immediately, and depending on the drug, the nurse may attempt to aspirate any remaining drug from the extravasation site. The other actions listed may be appropriate to perform, but should occur after discontinuing the infusion.

A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:

Encourage fluid intake, if possible, to dilute the urine.

Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL.

Limit fluids to 1,000 mL/day to minimize stress on the renal tubules.

Modify the diet to acidify the urine, thus preventing uric acid crystallization.

Encourage fluid intake, if possible, to dilute the urine. (345) To prevent renal damage, it is helpful to dilute the urine by increasing fluids as tolerated.

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?

Anticipatory grieving

Impaired swallowing

Disturbed body image

Chronic low self-esteem

Anticipatory grieving (368) Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isn’t associated with gallbladder cancer. Although surgery typically is done to remove the gallbladder and, possibly, a section of the liver, it isn’t disfiguring and doesn’t cause Disturbed body image. Chronic low self-esteem isn’t an appropriate nursing diagnosis at this time because the diagnosis has just been made.

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication?

Urine output of 400 ml in 8 hours

Serum potassium level of 2.6 mEq/L

Blood pressure of 120/64 to 130/72 mm Hg

Sodium level of 142 mEq/L

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

A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching?

"I floss my teeth every morning."

"I use an electric razor to shave."

"I take a stool softener every morning."

"I removed all the throw rugs from the house."

"I floss my teeth every morning." (361) 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.

Your client is receiving radiation therapy. The client asks you about oral hygiene. What advice regarding oral hygiene should you offer?

Gargle after each meal.

Floss before going to bed.

Treat cavities immediately.

Use a soft toothbrush and avoid an electronic toothbrush.

Use a soft toothbrush and avoid an electronic toothbrush. (361) The nurse advises the client undergoing radiation therapy to use a soft toothbrush and avoid electronic toothbrushes to avoid skin lacerations. Gargling after each meal, flossing before going to bed, and treating cavities immediately are general oral hygiene instructions.

In which phase of the cell cycle does cell division occur?

Mitosis

G1 phase

S phase

G2 phase

Mitosis (341) Cell division occurs in mitosis. RNA and protein synthesis occurs in the G1 phase. DNA synthesis occurs during the S phase. DNA synthesis is complete, and the mitotic spindle forms in the G2 phase.

What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss?

The client should consider getting a wig or cap prior to beginning treatment.

Alopecia related to chemotherapy is relatively uncommon.

The hair will grow back within 2 months post therapy.

The hair will grow back the same as it was before treatment.

The client should consider getting a wig or cap prior to beginning treatment. (363) 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.

According to the tumor-node-metastasis (TNM) classification system, T0 means there is

No evidence of primary tumor

No regional lymph node metastasis

No distant metastasis

Distant metastasis

No evidence of primary tumor (15-3) T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis.

A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms?

Neutropenia

Extravasation

Nadir

Stomatitis

Stomatitis The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to 10 days after the administration of certain chemotherapeutic agents or radiation therapy to the head and neck. Chemotherapy and radiation produce chemical toxins that lead to the breakdown of cells in the mucosa of the epithelium, connective tissue, and blood vessels in the oral cavity.

The physician is attending to a 72-year-old client with a malignant brain tumor. The physician recommends immediate radiation therapy. What is a reason for the physician’s recommendation?

To remove the tumor from the brain

To prevent the formation of new cancer cells

To analyze the lymph nodes involved

To destroy marginal tissues

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

The nurse at the clinic explains to the patient that the surgeon will be removing a mole on the patient’s back that has the potential to develop into cancer. The nurse informs the patient that this is what type of procedure?

Diagnostic

Palliative

Prophylactic

Reconstructive

Prophylactic Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk of developing cancer. When surgical cure is not possible, the goals of surgical interventions are to relieve symptoms, make the patient as comfortable as possible, and promote quality of life as defined by the patient and family. Palliative surgery and other interventions are performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusions (Table 15-6). Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Diagnostic surgery, or biopsy, is performed to obtain a tissue sample for histologic analysis of cells suspected to be malignant.

A nurse caring for a client who has just received chemotherapy infusion is wearing a disposable gown, gloves, and goggles for protection. The nurse knows that accidental exposure to chemotherapy agents can occur through:

inhalation of aerosols.

absorption through the gown.

absorption through the gloves.

absorption through the goggles.

inhalation of aerosols. (349) Aerosol inhalation or absorption through the skin can cause accidental chemotherapy exposure. A nurse must wear a disposable gown and gloves when preparing and administering chemotherapy. She won’t absorb chemicals through an intact gown, protective gloves, or goggles.

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:

expected chemotherapy-related adverse effects.

chemotherapy exposure and risk factors.

signs and symptoms of infection.

reinforcement of the client’s medication regimen.

chemotherapy exposure and risk factors. (348) 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.

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior?

Promotion
Initiation
Prolongation
Progression

Progression (257) Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information, even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.

The nurse evaluates teaching as effective when a female client states that she will

Use sunscreen when outdoors.

Decrease tobacco smoking from one pack/day to half a pack/day.

Exercise 30 minutes 3 times each week.

Obtain a cancer history from her parents.

Use sunscreen when outdoors. (328) Use of sunscreens play a role in the amount of exposure to ultraviolet light. Even decreasing the use of tobacco still exposes a person to risk of cancer. The American Cancer Society recommends adults to engage in at least 30 minutes of moderate to vigorous physical activity on 5 or more days each week. It is recommended to obtain a cancer history from at least three generations.

The nurse is providing client teaching for a client undergoing chemotherapy. What dietary modifications should the nurse advise?

Eat wholesome meals.

Avoid spicy and fatty foods.

Avoid intake of fluids.

Eat warm or hot foods.

Avoid spicy and fatty foods. (360) The nurse advises a client undergoing chemotherapy to avoid hot and very cold liquids and spicy and fatty foods. The nurse also encourages the client to have small meals and appropriate fluid intake.

The client is scheduled for a breast lump excision and sentinel node biopsy. What should the nurse know in planning care for the client with a negative biopsy report?

A lump excision is not necessary.

A wide excision of lump will be performed.

The lump and all axillary lymph nodes will be excised.

The entire breast and all regional lymph nodes will be excised.

A wide excision of lump will be performed. (336) The sentinel node is the first node in which a tumor will drain; if no malignant cells are found there, additional excision or radical removal will not be necessary. Excision of the lump along with a wide margin of cancer-free tissue is standard treatment for malignant tumors.

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?

Random, rapid growth of the tumor

Cells colonizing to distant body parts

Tumor pressure against normal tissues

Emission of abnormal proteins

Tumor pressure against normal tissues (326) 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.

When the client complains of increased fatigue following radiotherapy, the nurse knows this is most likely to be related to which factor?

The cancer is spreading.

The cancer cells are dying in large numbers.

Fighting off infection is an exhausting venture.

Radiation can result in myelosuppression.

Radiation can result in myelosuppression. (339) Fatigue results from anemia associated with myelosuppression and decreased RBC production. The spreading of cancer can cause many symptoms dependent on location and type of cancer but not a significant factor to support fatigue with radiotherapy. The production of healthy cells can increase metabolic rate, but death of cancer cells does not support fatigue in this case. Fighting infection can cause fatigue, but there is no evidence provided to support presence of infection in this client.

A cancer client makes the following statement to the nurse: "I guess I will tell my doctor to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die."Which of the following facts supports the use of chemotherapy for this client?

Nausea and vomiting are only a factor for the first 24 hours after treatment.

Most clients believe the discomfort is well worth the cure for cancer.

Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects.

Clinical trials are opening up new cancer treatments all the time.

Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. (344) Chemotherapy is not one drug for all clients. The therapy can be specifically designed to optimize effects while limiting adverse effects with supplemental anti emetics to control the nausea and vomiting. It is true that nausea and vomiting are most prevalent in the first 24 hours after each chemotherapy treatment but does not eliminate the fears expressed by this client. No one can state the worth of any treatment, and a cure is never promised. Clinical trials open up new options for treatment, but the process is lengthy and is not a certainty for a client in need of immediate treatment.

What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action?

Eggs and milk

Fish and poultry

Ham and bacon

Green, leafy vegetables

Ham and bacon (329) Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate and nitrite-containing foods, and red and processed meats. Nitrates are added to cured meats, such as ham and bacon.

A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention?

The I.V. site is red and swollen.

The client states he is nauseous.

The laboratory reports a white blood cell (WBC) count of 1,000/mm3.

The client begins to shiver.

The I.V. site is red and swollen. (342) A red, swollen I.V. site indicates possible infiltration. Daunorubicin is a vesicant chemotherapeutic agent and can be very damaging to tissue if it infiltrates. The nurse should immediately stop the medication, apply ice to the site, and notify the physician. Although nausea, WBC count of 1,000/mm3, and shivering require interventions, these findings aren’t a high priority at this time.

A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client’s care plan?

Avoiding using soap on the irradiated areas

Applying talcum powder to the irradiated areas daily after bathing

Wearing a lead apron during direct contact with the client

Removing thoracic skin markings after each radiation treatment

Avoiding using soap on the irradiated areas (359) 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.

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?

Administering aspirin if the temperature exceeds 102° F (38.8° C)

Inspecting the skin for petechiae once every shift

Providing for frequent rest periods

Placing the client in strict isolation

Inspecting the skin for petechiae once every shift Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.

A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication?

Erythema

Flare

Extravasation

Thrombosis

Extravasation (342) The client is exhibiting signs of extravasation, which occurs when the medication leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site. Erythema is redness of the skin that results from skin irritation. Flare is a spreading of redness that occurs as a result of drawing a pointed instrument across the skin. Thrombosis is the formation of clot within the vascular system.

A benign tumor of the blood vessels is a(n)

osteoma.
hemangioma.
neuroma.
chondroma.

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

A decrease in circulating white blood cells is

granulocytopenia. thrombocytopenia. leukopenia.
neutropenia.

leukopenia. 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 type of surgery is used in an attempt to relieve complications of cancer?

Palliative
Prophylactic Reconstructive
Salvage

Palliative (337) Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing nonvital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or to obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.

The nurse is evaluating the client’s risk for cancer and recommends changes when the client states she

uses the treadmill for 30 minutes on 5 days each week

eats red meat such as steaks or hamburgers every day

works as a secretary at a medical radiation treatment center

drinks 1 glass of wine at dinner each night

eats red meat such as steaks or hamburgers every day (329) Dietary substances such as nitrate-containing, nitrite-containing, and red meats appear to increase the risk of cancer. Exercising 30 minutes on 5 days or more is recommended for adults. Measures are taken to protect those people who work around radiation. It is OK to drink 1 glass of wine per day.

You are an oncology nurse caring for a client who tells you that their tastes have changed. They go on to say that "meat tastes bad". What is a nursing intervention to increase protein intake for a client with taste changes?

Stay away from protein beverages.

Encourage maximum fluid intake.

Encourage cheese and sandwiches.

Suck on hard candy during treatment.

Encourage cheese and sandwiches. (364) The nurse encourages the clients with taste changes to eat cheese and sandwiches. Encouraging the client to take in the maximum amount of fluids does not increase protein intake. The nurse advises the client to drink protein beverages. Sucking on hard candies during treatment does not increase protein intake.

The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides that they are very depressed. The nurse recognizes depression as which of the following?

A psychiatric diagnosis everyone has at one time or another.

A side effect of the neoplastic drugs.

A normal reaction to the diagnosis of cancer.

An aberrant psychologic reaction to the chemotherapy.

A normal reaction to the diagnosis of cancer. (375) Clients have many reactions, ranging from anxiety, fear, and depression to feelings of guilt related to viewing cancer as a punishment for past actions or failure to practice a healthy life-style. They also may express anger related to the diagnosis and their inability to be in control. While depression is a psychiatric diagnosis not everyone has the diagnosis sometime in their life; depression is not a side effect of the neoplastic drugs nor is it an aberrant psychologic reaction to the chemotherapy.

Which of the following is a sign or symptoms of septic shock?

Altered mental status Hypertension
Warm, moist skin Increased urine output

Altered mental status (377) Signs of septic shock include altered mental status, cool and clammy skin, decreased urine output, and hypotension.

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?

Control
Cure
Palliation
Prevention

Control (334) 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.

During a client’s examination and consultation, the physician keeps telling the client,"You have an abdominal neoplasm." Which statements accurately paraphrase the physician’s statement? Select all that apply.

"You have a new growth of abnormal tissue in your abdomen."

"You have an abdominal tumor."

"You have an abdominal malignancy."

"You have abdominal cancer."

"You have a new growth of abnormal tissue in your abdomen." "You have an abdominal tumor." (327) New growths of abnormal tissue are called "tumors." Tumors may be benign or malignant; not all tumors are cancerous.

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?

"I guess the doctor could not remove the entire tumor."

"I am so glad the doctor was able to remove the entire tumor."

"I will be glad to finally be done with treatments for this thing."

"Thank goodness the tumor is contained and curable."

"I guess the doctor could not remove the entire tumor." (336) 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.

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?

Time, distance, and shielding

The use of disposable utensils and wash cloths

Avoid showering or washing over skin markings.

Inspect the skin frequently.

Inspect the skin frequently (340) 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.

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?

"The hair loss is usually temporary."

"New hair growth will return without any change to color or texture."

"Clients with alopecia will have delay in grey hair."

"Wigs can be used after the chemotherapy is completed."

"The hair loss is usually temporary." (363) Alopecia associated with chemotherapy is usually temporary and will return after the therapy is completed. New hair growth may return unchanged, but there is no guarantee and color, texture, and quality of hair may be changed. There is no correlation between chemotherapy and delay in greying of hair. Use of wigs, scarves, and head coverings can be used by clients at any time during treatment plan.

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 (342) The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.

The nurse is conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome?

Onset of cancer after age 50 in family member

A first cousin diagnosed with cancer

A second cousin diagnosed with cancer

An aunt and uncle diagnosed with cancer

An aunt and uncle diagnosed with cancer 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.

The nurse is working with a client who has had an allohematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of

nadir.
graft-versus-host disease. metastasis.
acute leukopenia.

graft-versus-host disease. Graft-versus-host disease is a major cause of morbidity and mortality in clients who have had allogeneic transplant. Clinical manifestations of the disease include diffuse rash that progresses to blistering and desquamation, and mucosal inflammation of the eyes and the entire gastrointestinal tract with subsequent diarrhea, abdominal pain, and hepatomegaly.

What does the nurse understand is the rationale for administering allopurinol for a patient receiving chemotherapy?

It stimulates the immune system against the tumor cells.

It treats drug-related anemia.

It prevents alopecia.

It lowers serum and uric acid levels.

It lowers serum and uric acid levels. (345) Adequate hydration, diuresis, alkalinization of the acid crystals, and administration of allopurinol (Zyloprim) may be used to prevent renal toxicity.

A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells?

Liver
Colon
Reproductive tract White blood cells (WBCs)

Liver (336) 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.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?

Serving small portions of bland food

Encouraging rhythmic breathing exercises

Administering metoclopramide and dexamethasone as ordered

Withholding fluids for the first 4 to 6 hours after chemotherapy administration

Administering metoclopramide and dexamethasone as ordered (344) 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.

A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with

anorexia.
seizure.
weight gain.
myalgia.

seizure. (265) A serum sodium concentration lower than 115 mEq/L (115 mmol/L) is associated with seizures, abnormal reflexes, papilledema, coma, and death. Anorexia, weight gain, and myalgia are associated with serum sodium concentrations lower than 120 mEq/L.

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?

Risk for infection related to inadequate defenses

Fatigue related to deficient blood cells

Activity intolerance related to side effects of chemotherapy

Anxiety related to change in role function

Risk for infection related to inadequate defenses (376) Physiological needs, such as risk for infection, take priority over the client’s other needs.

The drug interleukin-2 is an example of which type of biologic response modifier?

Cytokine

Monoclonal antibodies

Retinoids

Antimetabolites

Cytokine (354) 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.

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. (326) By this mechanism, the tumor metastasizes to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rate of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.

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.

dietary substances environmental factors viruses
gender
age

environmental factors viruses dietary substances (327) 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 without symptoms or complaints receives a diagnosis of prostate cancer after a routine physical. What factors contributed to this diagnosis? Select all that apply.

client history
risk factors
tumor markers environmental factors

client history risk factors tumor markers (333) The physician, using information obtained during the history and physical examination, selects tests that help to establish a diagnosis. Specific cancers alter the chemical composition of blood and other body fluids. Specialized tests have been developed for specific proteins, antigens, hormones, genes, or enzymes that cancer cells release.

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode will the nurse anticipate?

No further treatment is indicated.

Adjuvant therapy is likely.

Palliative care is likely.

Repeat biopsy is needed before treatment begins.

Adjuvant therapy is likely. (335) T3 indicates a large tumor size with N1 indicating regional lymph node involvement. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor staging of stage IV is indicative of palliative care.

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?

Excisional biopsy Incisional biopsy
Needle biopsy
Punch biopsy

Excisional biopsy (335) Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis.

A client is receiving the cell cycle-nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of chemotherapy regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects?

It interferes with deoxyribonucleic acid (DNA) replication only.

It interferes with ribonucleic acid (RNA) transcription only.

It interferes with DNA replication and RNA transcription.

It destroys the cell membrane, causing lysis.

It interferes with DNA replication and RNA transcription. (343) Thiotepa interferes with DNA replication and RNA transcription. It doesn’t destroy the cell membrane.

To combat the most common adverse effects of chemotherapy, a nurse should administer an:

antiemetic.
antimetabolite.
antibiotic.
anticoagulant.

antiemetic. (348) Antiemetics, antihistamines, and certain steroids treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli.

A nurse is caring for a recently married, 29-year-old female client, who was diagnosed with acute lymphocytic leukemia. The client is preparing for an allogeneic bone marrow transplant. Which statement by the client demonstrates she understands the informed consent she gave about the diagnosis and treatment?

"I should be able to finally start a family after I’m finished with the chemo."

"I always had a good appetite. Even with chemo I shouldn’t have to make any changes to my diet."

"I’ll have to remain in the hospital for about 3 months after my transplant."

"I’ll only need chemotherapy treatment before receiving my bone marrow transplant."

"I’ll only need chemotherapy treatment before receiving my bone marrow transplant." (350) This client demonstrates understanding about treatment when she states that she’ll need chemotherapy before receiving a bone marrow transplant. Most clients receive chemotherapy before undergoing bone marrow transplantation. Most women older than age 26 can’t bear children after undergoing treatment because they experience the early onset of menopause. Clients who undergo chemotherapy or radiation must avoid all fresh fruits and vegetables, and all foods should be cooked to avoid bacterial contamination. Clients who undergo bone marrow transplantation typically remain hospitalized for 20 to 25 days.

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?

Perform a cardiovascular assessment every 4 hours.

Check the client’s history for a congenital link to thrombocytopenia.

Monitor daily platelet counts.

Closely observe the client’s skin for petechiae and bruising.

Closely observe the client’s skin for petechiae and bruising. (378) 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

Which type of vaccine uses the client’s own cancer cells, which are killed and prepared for injection back into the client?

Autologous
Prophylactic
Therapeutic
Allogeneic

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

You are an oncology nurse caring for a client who is taking antineoplastic agents. What symptoms must you consider when monitoring this client?

Symptoms of gout Symptoms of hypertension Symptoms of diarrhea Symptoms of anemia

Symptoms of gout (383) The nurse monitors the client being administered an antineoplastic agent for symptoms of gout, which include increased uric acid levels, joint pain, and edema. Administering antineoplastic agents does not cause hypertension, diarrhea, and anemia.

The nurse is caring for a client newly diagnosed with cancer. Which of the following therapies is used to treat something other than cancer?

Surgery
Radiation therapy Electroconvulsive therapy Chemotherapy

Electroconvulsive therapy (334) Cancer is frequently treated with a combination of therapies using standardized protocols. Three basic methods used to treat cancer are surgery, radiation therapy, and chemotherapy. Electroconvulsive therapy (ECT) is a method of treatment for mental distress or illness.

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?

Palliative surgery Prophylactic surgery Curative surgery Reduction surgery

Prophylactic surgery (337) 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 client, 66 years old, has just been diagnosed with multiple myeloma (a cancer of the plasma) and will be initiating chemotherapy. The nurse, in an outpatient clinic, reviews the medications the client has been taking at home. The medications include pantoprazole (Protonix) for gastroesophageal reflux disease (GERD) and an over-the-counter calcium supplement to prevent osteoporosis. The nurse does the following interventions: (Select all that apply.)

instructs the client to discontinue calcium

asks about nausea and vomiting

restricts fluids to 1500 mL per day

teaches the client to report abdominal or bone pain

provides information about antidiarrheal medication

asks about nausea and vomiting teaches the client to report abdominal or bone pain instructs the client to discontinue calcium (382) The client with cancer is at risk for hypercalcemia from bone breakdown. The client should not take an over-the-counter calcium supplement that would increase blood levels of calcium. Signs and symptoms of hypercalcemia include nausea and vomiting. The client may also report abdominal or bone pain with cancer. The client should increase fluid intake to 2 to 4 L per day. Intake would have to be adjusted based on the client’s other medical conditions. GERD would not negate an increase in fluid intake. The client most likely would have constipation with hypercalcemia, not diarrhea.

Which of the following is a type of procedure that uses liquid nitrogen to freeze tissue and cause cell destruction?

Cryosurgery Electrosurgery Chemosurgery Laser surgery

Cryosurgery (336) Cryosurgery uses liquid nitrogen or a very cold probe to freeze tissue to cause cell destruction. Electrosurgery, chemosurgery, and laser surgery do not use liquid nitrogen to freeze tissue.

Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from a donor other than the patient?

Allogeneic
Autologous
Syngeneic
Homogenic

Allogeneic (349) 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.

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent?

Antimetabolite
Alkylating
Nitrosoureas
Mitotic spindle poisons

Antimetabolite (343) 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).

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?

Normal finding

Benign fibrocystic disease

Malignant tumor

Malignant tumor with metastasis to surrounding tissue

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

Which statement is true about malignant tumors?

They demonstrate cells that are well differentiated.

They gain access to the blood and lymphatic channels.

They usually grow slowly.

They grow by expansion.

They gain access to the blood and lymphatic channels. (15-1) By gaining access to blood and lymphatic channels, a tumor can metastasize to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rates of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.

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?

To prevent metastasis Angiogenesis
Stomatitis
Fatigue

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

The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as

brachytherapy.

external beam radiation therapy.

systemic radiation.

a contact mold.

brachytherapy. Brachytherapy is the only term used to denote the use of internal radiation implants.

A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient?

Clarify information provided by the physician.

Provide aseptic care to the incision postoperatively.

Provide time for the patient to discuss her concerns.

Counsel the patient about the possibility of losing her breast.

Provide time for the patient to discuss her concerns. (337) Patients who are undergoing surgery for the diagnosis or treatment of cancer may be anxious about the surgical procedure, possible findings, postoperative limitations, changes in normal body functions, and prognosis. The patient and family require time and assistance to process the possible changes and outcomes resulting from the surgery (Chart 15-4). The nurse serves as the patient advocate and liaison and encourages the patient and family to take an active role in decision making when possible. If the patient or family asks about the results of diagnostic testing and surgical procedures, the nurse’s response is guided by the information that was conveyed previously. The nurse may be asked to explain and clarify information for patients and families that was provided initially but was not grasped because of anxiety and overwhelming feelings. It is important that the nurse, as well as other members of the health care team, provide information that is consistent from one clinician to another.

The nurse assesses that extravasation of a chemotherapy agent has occurred. What should the initial action of the nurse be?

Apply a warm compress to the area.

Discontinue the infusion.

Inject an antidote, if required.

Place ice over the site of infiltration.

Discontinue the infusion. (348) If extravasation is suspected, the medication administration is stopped immediately, and depending on the drug, the nurse may attempt to aspirate any remaining drug from the extravasation site. The other actions listed may be appropriate to perform, but should occur after discontinuing the infusion.

When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply.

Hypercalcemia Hyperkalemia Hyperuricemia Hyperphosphatemia

Hyperphosphatemia Hyperuricemia Hyperkalemia (383) When intracellular contents are released into the bloodstream, phosphorous is elevated. This results in an inverse decline in the levels of calcium, so hypercalcemia would not occur.

An important nursing function is monitoring factors that may indicate that bleeding is occurring. One serum indicator is a (an):

Lymphocyte count of 30%.

Platelet count of 60,000/mm3.

Neutrophil count of 60%.

Reticulocyte count of 1%.

Platelet count of 60,000/mm3. (377) Thrombocytopenia, a decrease in the circulating platelet count, is the most common cause of bleeding in patients with cancer and is usually defined as a count less than 100,000/mm3. The risk of bleeding increases as the count drops lower. The risk of spontaneous bleeding occurs with a count of less than 20,000/mm3.

A nurse is developing a care plan for bone marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable?

24 hours
2 to 4 days
7 to 14 days
21 to 28 day

7 to 14 days Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.

An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates that teaching was successful?

"I clean my teeth gently several times per day."

"I replace my toothbrush every month."

"I lubricate my lips with petroleum jelly."

"I use an alcohol-based mouthwash every morning."

"I clean my teeth gently several times per day." (360) The client demonstrates understanding when he states that he’ll clean his teeth gently several times per day. Frequent gentle cleaning of the mouth or rinsing reduces bacteria build-up in the oral cavity, thus reducing the risk for oropharyngeal infection. Changing the toothbrush each month reduces the bacteria in the mouth for the first few uses only. Petroleum jelly moistens the lips, but doesn’t prevent breakdown of the mucous membranes or reduce the risk for oropharyngeal infection. Alcohol-based products cause drying of the mucous membrane, increasing the likelihood of oropharyngeal infection.

The nurse is to administer a vesicant chemotherapeutic drug to a client who had a right mastectomy and inserts the intravenous line

In the client’s left hand

With a butterfly needle

In the client’s right forearm

With a soft, plastic catheter

With a soft, plastic catheter (342) Vesicant chemotherapy should never be administered in the peripheral veins involving the hand or wrist. A person with breast cancer is to avoid injections in the affected extremity. A soft, plastic catheter should be used, not a butterfly needle.

A client with cancer is receiving chemotherapy and reports to the nurse that his mouth is painful and he has difficulty ingesting food. The nurse does which of the following:

Asks the client to open his mouth to facilitate inspection of the oral mucosa

Rinses the client’s mouth with alcohol-based mouthwash every 2 hours

Instructs the client to brush the teeth with a soft toothbrush

Consults with the healthcare provider about use of nystatin (Mycostatin)

Teaches the client to floss his teeth once every 24 hours

Asks the client to open his mouth to facilitate inspection of the oral mucosa Consults with the healthcare provider about use of nystatin (Mycostatin) Instructs the client to brush the teeth with a soft toothbrush (360-361) The description of the client’s report is stomatitis following chemotherapy treatment. The nurse should assess the oral mucosa based on the client’s report of pain and difficulty eating. The client is to use a soft toothbrush to minimize trauma to the mouth. Nystatin is a topical medication that may provide healing for the client’s mouth. The client avoids alcohol-based mouthwashes as these are irritants. Flossing the teeth may cause additional trauma to the mouth.

A client has just received stem cell transplantation as treatment for leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation?

Closely monitor the client for at least 3 months.

Closely monitor the client for at least 3 days.

Closely monitor the client for at least 4 weeks.

Closely monitor the client for at least 5 months.

Closely monitor the client for at least 3 months. (348)

A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse?

"It allows time for you to cope with the treatment."

"It will allow time for the repair of healthy tissue."

"It will decrease the incidence of leukopenia and thrombocytopenia."

"It is not really understood why you have to go for 6 weeks of treatment."

"It will allow time for the repair of healthy tissue." (340) In external-beam radiation therapy (EBRT), the total radiation dose is delivered over several weeks in daily doses called fractions. This allows healthy tissue to repair and achieves greater cell kill by exposing more cells to the radiation as they begin active cell division. Repeated radiation treatments over time (fractionated doses) also allow for the periphery of the tumor to be reoxygenated repeatedly, because tumors shrink from the outside inward. This increases the radiosensitivity of the tumor, thereby increasing tumor cell death (Kelvin, 2010).

A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse’s priority responsibility be for this patient?

Explain to the patient that she will continue to emit radiation while the implant is in place.

Maintain as much distance as possible from the patient while in the room.

Alert family members that they should restrict their visiting to 5 minutes at any one time.

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. (341) 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.

After a bone marrow transplant (BMT), the client should be monitored for at least

30 days
14 days
100 days
60 days

100 days (351) After a BMT, the nurse closely monitors the client for at least 100 days or more after the procedure because complications related to the transplant can occur 100 days or more as post procedure infections are one common complication that may lead to sepsis and transplant failure.

Chemotherapeutic agents have which effect associated with the renal system?

Hypokalemia

Increased uric acid excretion

Hypophosphatemia

Hypercalcemia

Increased uric acid excretion (345) 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.

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.

Apply a warm compress.

Aspirate as much of the fluid as possible.

Discontinue the intravenous medication.

Discontinue the intravenous medication. (342) If extravasation of a chemotherapeutic medication is suspected, the nurse immediately stops the medication. Depending on the drug, the nurse may then attempt to aspirate any remaining drug, apply a warm or cold compress, administer a neutralizing solution, or all these measures.

What are considered carcinogens?

Parasites
Medical procedures Dietary substances Infective genes

Dietary substances (326) Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions.

Which grade of tumor is also known as a well-differentiated tumor?

Grade I
Grade II
Grade III
Grade IV

Grade I (333) 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).

Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode will the nurse anticipate?

No further treatment is indicated.

Adjuvant therapy is likely.

Palliative care is likely.

Repeat biopsy is needed before treatment begins.

Adjuvant therapy is likely. (335) T3 indicates a large tumor size with N1 indicating regional lymph node involvement. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor staging of stage IV is indicative of palliative care.

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