Chapter 15- Oncologic PrepU

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

Oranges 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 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." A client with a platelet count of 30,000/mm3 is at risk for bleeding and shouldn’t floss his teeth. Flossing may increase the risk of bleeding in a client with a platelet count less than 40,000/mm3. Using an electric razor is appropriate because doing so helps minimize the risk of cutting when shaving. Taking a stool softener helps decrease potential trauma to the GI tract that may cause bleeding. Removing throw rugs from the house helps prevent falls, which could lead to uncontrolled bleeding.

A 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:

chemotherapy exposure and risk factors. 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.

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

Blood studies 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?

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

A decrease in circulating white blood cells is

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 occurs when fluid accumulates in the pericardial space and compresses the heart?

Cardiac tamponade Cardiac tamponade is an accumulation of fluid in the pericardial space. SVCS occurs when the superior vena cava is compressed or invaded by a tumor, lymph nodes are enlarged, intraluminal thrombosis obstructs venous circulation, or drainage occurs from the head, neck, arms, and thorax. SIADH is the continuous, uncontrolled release of ADH. DIC is a complex disorder of coagulation or fibrinolysis that results in thrombosis or bleeding.

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

eats red meat such as steaks or hamburgers every day 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.

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 closely to prevent infection. Until transplanted bone marrow begins to produce blood cells, these clients have no physiologic means to fight infection, which makes them very prone to infection. They are at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent infection. Monitoring client’s toilet patterns, physical condition, and heart rate does not prevent the possibility of the client getting an infection.

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

Use a soft toothbrush and avoid an electronic toothbrush. 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.

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

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.

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 wide excision of lump will be performed. 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.

Based on the understanding of the effects of chemotherapy, the nurse would anticipate which of the following clinical findings in a client 2 weeks post therapy?

Ease of bruising The effects of chemotherapy can include myelosuppression, resulting in anemia or bleeding tendencies, as exhibited in ease in bruising. Elevated temperature and WBCs are signs of infection and are anticipated findings after chemotherapy treatment. Re growth of hair after alopecia can result in change of hair color but not anticipated 2 weeks post treatment.

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

No evidence of primary tumor 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 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 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.

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?

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.

A client is undergoing chemotherapy treatment for prostate cancer and has lost considerable weight due to nausea and vomiting. Which nursing intervention is appropriate for the client?

Adjusting the client’s meal plan before and after chemotherapy The nurse should readjust the client’s meal plan before and after chemotherapy administration. The nurse should take into consideration the client’s likes and dislikes and avoid foods with strong odors. The nurse should ensure adequate fluid hydration before, during, and after drug administration when the client has side effects of nausea and vomiting. Fresh fruits are not recommended when the client is at risk of infection, such as during chemotherapy. Beta-blockers are not administered to control nausea and vomiting.

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?

Ham and bacon 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.

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

Platelet count of 60,000/mm3. 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 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?

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

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 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 has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis?

Red, open sores on the oral mucosa The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.

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

Administering metoclopramide and dexamethasone as ordered 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 nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection?

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

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

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

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

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.

While administering cisplatin (Platinol-AQ) to a client, the nurse assesses swelling at the insertion site. The first action of the nurse is to

Discontinue the intravenous medication. 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.

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

Avoid spicy and fatty foods. 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.

Which of the following is a term used to describe the process of programmed cell death?

Apoptosis 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. Angiogenesis is the process by which a new blood supply is formed.

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

Angiogenesis

Which of the following would be inconsistent as a common side effect of chemotherapy?

Weight gain Common side effects seen with chemotherapy include myelosuppression, alopecia, nausea and vomiting, anorexia, and fatigue.

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 stem cell transplant?

Monitor the client closely to prevent infection. Until transplanted stem cells begin 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 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." 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 nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy?

It removes a wedge of tissue for diagnosis. The three most common biopsy methods are excisional, incisional, and needle. In an incisional biopsy, a wedge of tissue is removed from the tumor and analyzed. In an excisional biopsy, the surgeon removes the tumor and the surrounding marginal tissues. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.

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

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.

A patient is scheduled for cryosurgery for cervical cancer and tells the nurse, "I am not exactly sure what the doctor is going to do." What is the best response by the nurse?

"The physician is going to use liquid nitrogen to freeze the area." Cryoablation, or cryosurgery, is the use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction. It is used for cervical, prostate, and rectal cancers.

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen?

Encourage fluid intake to dilute the urine. The nurse should ensure adequate fluid hydration before, during, and after drug administration and assess intake and output. Adequate fluid volume dilutes drug levels, which can help prevent renal damage.

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

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

A nurse is caring for a client receiving chemotherapy. Which nursing action is most appropriate for handling chemotherapeutic agents?

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

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?

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

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

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 client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit?

"I’ll play card games with my friends." During chemotherapy, playing cards is an appropriate diversional activity because it doesn’t require a great deal of energy. To conserve energy, the client should avoid such activities as taking long trips, bowling, and eating in restaurants every day. However, the client may take occasional short trips and dine out on special occasions.

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?

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.

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 infection 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.

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

Progression 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.

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

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

Use sunscreen when outdoors. 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 client has received chemotherapy and 1 week later is at home experiencing nausea and vomiting. The first action of the nurse is to recommend

Taking prescribed ondansetron (Zofran) Serotonin blockers, such as ondansetron, may decrease nausea and vomiting. Once these symptoms are relieved, the client can use other strategies, such as relaxation, imagery, and acupressure. These strategies, when used with serotonin blockers, provide improved anti-emetic protection.

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?

Encourage cheese and sandwiches. 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.

A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin’s disease. The nurse explains to the client that the three drugs are given over an extended period because:

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

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

Mitosis 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. 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.

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

Radiation can result in myelosuppression. 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?

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

Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure?

Blood studies Before the HSCT 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 an HSCT procedure, the nurse need not evaluate client’s family, drug, or allergy history.

The nurse is conducting a community education program using the American Cancer Society’s colorectal screening and prevention guidelines. The nurse determines that the participants understand the teaching when they identify that people over the age of 50 should have which screening test every 10 years?

Colonoscopy Recommendations for screening for colorectal cancer include a screening colonoscopy every 10 years. Fecal occult blood tests should be completed annually in people over age 50. The test for PSA is used as a screening tool for prostate cancer. A Pap test is a screening tool for cervical cancer.

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 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.

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

antiemetic. 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.

Which is a sign or symptom of septic shock?

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

A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately

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

Cancer has many characteristics. What is one of the most discouraging characteristics of cancer?

Metastasis Metastasis is one of cancer’s most discouraging characteristics because even one malignant cell can give rise to a metastatic lesion in a distant part of the body. Not all cancerous tumors are large in size. Carcinogenesis is the process of malignant transformation and it is not a characteristic of cancer. Cancer grows rapidly, not slowly.

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."

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?

Prophylactic surgery 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.

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

Control 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.

Which oncologic emergency involves the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH)?

Syndrome of inappropriate antidiuretic hormone release (SIADH) SIADH is a result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH). Cardiac tamponade is an accumulation of fluid in the pericardial space. DIC is a complex disorder of coagulation and fibrinolysis, which results in thrombosis and bleeding. 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.

While doing a health history, a client tells the nurse that her mother, grandmother, and sister died of cancer. The client wants to know what she can do to keep from getting cancer. What would be the nurse’s best response?

"You can’t prevent cancer, but you can have your blood analyzed for tumor markers to see what your risk level is." Specialized tests have been developed for tumor markers, specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. Telling the client to make lifestyle changes and that there is nothing the client can do with their family history would be giving inaccurate information. Telling the client that cancer often skips a generation and not to worry is incorrect because it minimizes and negates the clients concern.

Palliation refers to

relief of symptoms of disease and promotion of comfort and quality of life. Palliation is the goal for care of clients with terminal cancer. Alopecia is the term that refers to hair loss. Metastasis is the term that refers to the spread of cancer cells from the primary tumor to distant sites. Nadir is the term that refers to the lowest point of white blood cell depression after therapy that has toxic effects on bone marrow.

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 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?

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.

What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen?

It targets normal body cells as well as cancer cells. Chemotherapy agents affect both normal and malignant cells; therefore, their effects are often widespread, affecting many body systems.

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

Discontinue the infusion. 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. To prevent renal damage, it is helpful to dilute the urine by increasing fluids as tolerated.

A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client?

Wear personal protective equipment when handling blood, body fluids, and feces. Chemotherapy drugs are present in the waste and body fluids of clients for 48 hours after administration. The nurse should wear personal protective equipment when handling blood, body fluids, or feces. Gloves offer minimal protection against exposure. The nurse should wear a face shield, gown, and gloves when exposure to blood or body fluid is likely. Placing incontinence pads in the regular trash container and providing a urinal or bedpan don’t protect the nurse caring for the client.

According to the TNM classification system, T0 means there is

no evidence of primary tumor. 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.

While administering cisplatin (Platinol-AQ) to a client, the nurse assesses swelling at the insertion site. The first action of the nurse is to

Discontinue the intravenous medication. 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.

A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is

"You will need to practice birth control measures." Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.

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

Cryosurgery 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.

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

Antimetabolite 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).

While completing an admission assessment, the client reports a family history of ovarian cancer among a maternal grandmother, aunt, and sister. The nurse knows that these cancers are most likely associated with what etiology?

Inherited gene mutation Tumor suppressor genes assist the body in normal cell production and death. Tobacco use and chemical carcinogens can contribute to the development of cancer, but there is not enough information provided to suggest a common link. Ontogenesis are genes that have mutated and activates out of control cell growth. Inherited gene mutation occurs when the DNA is passed to the next generation.

A client with advanced cancer makes the following comment to the nurse: "Why are you bathing me? I am going to die no matter what." What is the most appropriate response of the nurse?

"Would you like to talk about what you are feeling?" By asking the client talk may open the door for further discussion and sharing of feelings, fears, etc. A bath will make the client feel better and asking if the client wishes to skip the bath today are matter-of-fact comments and disconnect, resulting in a shutdown to further communication. The nurse stating that medication could be given is a quick fix and demonstrates a nontherapeutic response.

A newly diagnosed cancer client is crying and states the following to the nurse: "I promised God that I will be a better person if I can just get better." What is the appropriate assessment of this comment by the nurse?

The cancer is viewed as a punishment from past actions. The comment made by the client is reflective of the bargaining stage of grief in which the client is bargaining with God to gain time. Denial is the first stage of grief in which the client uses to protect self, which is not reflective of the comment made. Anger is the second stage of grief and is not reflective of the statement made. Acceptance of inevitable loss is the final stage of grief, which is not reflective in the comment made.

What can the nurse do to meet the challenges in caring for a patient with cancer?

Identify own perception of cancer and set realistic goals. Nurses need to identify their own perception of cancer and set realistic goals to meet the challenges inherent in caring for patients with cancer. In addition, nurses caring for patients with cancer must be prepared to support patients and families through a wide range of physical, emotional, social, cultural, financial, and spiritual challenges. Cancer is a diverse set of diseases, so the nurse would not make the same goals for all patients with cancer. The causes of many types of cancer are still unknown, so the nurse should not attempt to tell the patient what he or she has done to cause the cancer. The nurse need not ensure that the patient has the financial means to afford the care.

A patient is taking vincristine, a plant alkaloid for the treatment of cancer. What system should the nurse be sure to assess for symptoms of toxicity?

Nervous system With repeated doses, the taxanes and plant alkaloids, especially vincristine, can cause cumulative peripheral nervous system damage with sensory alterations in the feet and hands.

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?

Extravasation 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 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin’s disease. The nurse explains to the client that the three drugs are given over an extended period because:

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

The patient diagnosed with thrombocytopenia is at risk for which of the following adverse effects:

Bleeding The patient diagnosed with thrombocytopenia is at risk for bleeding and infection until blood cell counts return to normal. Headache, diminished reflexes, and stomatitis are not adverse effects related to the diagnosis.

The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks?

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

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

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.

Nursing action for extravasation of a chemotherapeutic agent would include which of the following nursing actions? Select all that apply.

Stop the medication infusion at the first sign of extravasation. Aspirate any residual drug from the IV line. Administer an antidote, if indicated. All of the answers except D are appropriate nursing actions. The application of warmth would be contraindicated because it would cause vasodilation, which would increase the absorption of irritant into the local tissues.

The nurse is evaluating bloodwork results of a client with cancer who is receiving chemotherapy. The client’s platelet count is 60,000/mm3. Which is an appropriate nursing action?

Avoiding the use of products containing aspirin Clients with a platelet count of 60,000/mm3 are at mild risk for bleeding. Appropriate nursing interventions include avoiding the use of products such as aspirin that may interfere with the client’s clotting systems; avoiding taking temperature rectally and administering suppositories; providing the client with an electric shaver for shaving; and avoiding commercial mouthwashes because of their potential to dry out oral mucosa, which can lead to cracking and bleeding.

The nurse is providing education to a client with cancer radiation treatment options. The nurse determines that the client understands the teaching when the client states that which type of radiation aims to protect healthy tissue during the treatment?

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

A 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?

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

The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply.

Egg white omelet with spinach and mushrooms Steamed broccoli and carrots Turkey breast on whole wheat bread Foods high in fat and those that are smoked or preserved with salt or nitrates are associated with increased cancer risks. An omelet made of egg whites and vegetables is a healthy low fat selection as are steamed broccoli/carrots and turkey breast on whole grain bread. A salad can be a healthy selection but Caesar salads contain much fat from the dressing and addition of cheeses and fried chicken. Salmon that is not smoked would be a good selection. Quiche usually contains high-fat milk, crème, eggs, and cheese.

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?

Encourage cheese and sandwiches. 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.

Which procedure uses liquid nitrogen to freeze tissue, thereby destroying cells?

Cryoablation Cryoablation uses liquid nitrogen or a very cold probe to freeze tissue, causing cell destruction. Electrosurgery, chemosurgery, and laser surgery do not use liquid nitrogen to freeze tissue.

A client diagnosed with cancer has their tumor staged and graded based on what?

How they tend to grow and the cell type Tumors are staged and graded based upon how they tend to grow and the cell type before a client is treated for cancer.

The nurse is caring for a client with the diagnosis of colon cancer with metastasis to the liver. Which statement made by the client indicates an understanding of the diagnosis?

"My cancer has now spread to my liver." The client stating the cancer has spread to the liver shows that the client has an understanding the primary cancer of the colon with spread to the liver. The client stating that they will be fine after the surgery does not address the metastasis. The client stating they will be happy after the surgery is incorrect because metastases are not always resectable. The client stating having cancer twice is incorrect because it shows a lack of understanding about what metastasis is.

The nurse is conducting a community education program using the American Cancer Society’s colorectal screening and prevention guidelines. The nurse determines that the participants understand the teaching when they identify that people over the age of 50 should have which screening test every 10 years?

Colonoscopy Recommendations for screening for colorectal cancer include a screening colonoscopy every 10 years. Fecal occult blood tests should be completed annually in people over age 50. The test for PSA is used as a screening tool for prostate cancer. A Pap test is a screening tool for cervical cancer.

While doing a health history, a client tells you that her mother, her grandmother, and her sister died of breast cancer. The client wants to know what she can do to keep from getting cancer. What would be your best response?

You can’t prevent cancer, but you can have your blood analyzed for tumor markers to see what your risk level is." Specialized tests have been developed for tumor markers, specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. Options B and C are incorrect and giving the client these responses would be giving inaccurate information. Options D is incorrect because it minimizes and negates the client’s concern.

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 -Instructs the client to brush the teeth with a soft toothbrush -Consults with the healthcare provider about use of nystatin (Mycostatin) 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.

The nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. The nurse

Places the client in a private room Safety precautions are used for the client with a radioactive implant. They include assigning the client to a private room, seeing that visitors maintain a 6-foot distance from the radiation source, prohibiting visits by children, and preventing exposure to those who may be or are pregnant, as in the case of the nursing assistant.

A client has received several treatments of bleomycin. It is now important for the nurse to assess

Lung sounds Bleomycin has cumulative toxic effects on lung function. Thus, it will be important to assess lung sounds.

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?

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

A patient is scheduled for cryosurgery for cervical cancer and tells the nurse, "I am not exactly sure what the doctor is going to do." What is the best response by the nurse?

"The physician is going to use liquid nitrogen to freeze the area." Cryoablation, or cryosurgery, is the use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction. It is used for cervical, prostate, and rectal cancers.

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

Adjuvant therapy is likely. 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.

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 normal reaction to the diagnosis of cancer. 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.

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 -teaches the client to report abdominal or bone pain 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.

The client has a body surface area of 2.05 m². He is prescribed vincristine (Oncovin) 1.4 mg/m². Vincristine is available as 1 mg/1 mL. How many mL will the nurse administer? Round your answer

2.9 The dose ordered is 1.4 mg for each 1 m² of the client’s body surface area, which is 2.05. 1.4 mg/m² x 2.05 m² = 2.87 mg. The dose available is 1 mg for each 1 mL. 1 mg/1 mL x 2.87 mg = 2.87 mL. Rounding your answer to 1 decimal place would be 2.9 mL.