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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.

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.

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

A. Control
B. Palliation
C. Cure
D. Prevention

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.

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).

A decrease in circulating white blood cells (WBC) is referred to as which of the following?

A. leukopenia.
B. neutropenia.
C. granulocytopenia.
D. thrombocytopenia.

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 (ANC).

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?

A. Providing a solution of viscous lidocaine for use as a mouth rinse
B. Checking regularly for signs and symptoms of stomatitis
C. Recommending that the client discontinue chemotherapy
D. Monitoring the client’s platelet and leukocyte counts

A. 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.

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

A. Altered mental status
B. Increased urine output
C. Hypertension
D. Warm, moist skin

A. Altered mental status

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

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

A. Disseminated intravascular coagulation (DIC)
B. Syndrome of inappropriate antidiuretic hormone release (SIADH)
C. Cardiac tamponade
D. Tumor lysis syndrome

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

A. Syndrome of inappropriate antidiuretic hormone release (SIADH)
B. Tumor lysis syndrome
C. Cardiac tamponade
D. Disseminated intravascular coagulation (DIC)
SUBMIT ANSWER

A. 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.

Which type of vaccine uses the patient’s own cancer cells that are prepared for injection back into the patient?

A. Prophylactic
B. Autologous
C. Allogeneic
D. Therapeutic

B. Autologous

-Autologous vaccines are made from the patient’s own cancer cells, which are obtained during diagnostic biopsy or surgery. Prophylactic vaccines, such as 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.

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

A. No evidence of primary tumor
B. Distant metastasis
C. No regional lymph node metastasis
D. No distant metastasis

A. 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.

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

A. To remove the tumor from the brain
B. To destroy marginal tissues
C. To analyze involved lymph nodes
D. To prevent the formation of new cancer cells

D. To prevent the formation of new cancer cells

-Radiation therapy helps in preventing 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 for analyzing the lymph nodes or for destroying the surrounding tissues around the tumor.

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 of the following screening tests every 10 years?

A. Papanicolaou (Pap)
B. Colonoscopy
C. Prostate-specific antigen (PSA)
D. Fecal occult blood test

B. Colonoscopy

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

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?

A. Palliative
B. Reconstructive
C. Diagnostic
D. Prophylactic

D. 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?

A. It attacks cancer cells during their vulnerable phase.
B. It functions against disseminated disease.
C. It causes a systemic reaction.
D. It targets normal body cells as well as cancer cells.

D. 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.

A patient is to receive Bacille Calmette-Guerin (BCG), a nonspecific biologic response modifier. Why would the patient receive this form of treatment?

A. For skin cancer
B. For cancer of the lungs
C. For cancer of the breast
D. For cancer of the bladder

D. For cancer of the bladder

-Early investigations of the stimulation of the immune system involved nonspecific agents such as bacille Calmette-Guérin (BCG) and Corynebacterium parvum. When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells. Extensive animal and human investigations with BCG have shown promising results, especially in treating localized malignant melanoma. In addition, BCG bladder instillation is a standard form of treatment for localized bladder cancer (Polovich et al, 2009).

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 of the following does a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure?

Blood studies

-Before the BMT procedure, the nurse thoroughly evaluates the patient’s physical condition; organ function; nutritional status; complete blood studies, including assessment for past antigen exposure, such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before a BMT procedure, the nurse need not evaluate patient’s family, drug, or allergy history.

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.

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 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.

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 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 been receiving chemotherapy. Upon assessing the client during morning rounds, the nurse notes the client is now bleeding from intravenous and venipuncture sites. Stool is positive for occult blood. The client is requesting to sit in a chair for a meal. The nurse implements the following interventions: (Select all that apply.)

– Assess level of consciousness.
– Apply pressure to the bleeding sites.
– Assist the client to a chair.
– Check intake and output records.

Assess level of consciousness.
Apply pressure to the bleeding sites.
Check intake and output records.-The client may be experiencing disseminated intravascular coagulation (DIC) following the cancer experience and chemotherapy treatment. When the nurse notes the client is experiencing unexpected and abnormal bleeding, the nurse will assess level of consciousness (the client can be bleeding in the brain) and intake and output records (the client may experience decreased urinary output as a result of poor renal perfusion). The nurse applies pressure to venipuncture sites to decrease bleeding. The nurse will assess vital signs more frequently than once a shift. The nurse minimizes client activities to decrease risk for injury.

A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection?

A. Ate 75% of all meals during the day
B. Temperature of 98.3° F (36.8° C)
C. Stage 3 pressure ulcer on the left heel
D. White blood cell (WBC) count of 9,000 cells/mm3

C. 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.

The physician recommends that you have your daughter vaccinated with HPV vaccine. What is this vaccine for?

A. Help prevent lung cancer
B. Help prevent breast cancer
C. Help prevent leukemia
D. Help prevent cervical cancer

D. Help prevent cervical cancer

The vaccines that are approved for use in the United States include the human papilloma virus (HPV), which may help prevent women from getting cervical cancer. There are no vaccines for the prevention of lung cancer, breast cancer, or leukemia.

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?

A. “New hair growth will return without any change to color or texture.”
B. “Wigs can be used after the chemotherapy is completed.”
C. “The hair loss is temporary.”
D. “Clients with alopecia will have delay in grey hair.”

C. “The hair loss is 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 patient undergoing an incisional biopsy. Which of the following statements does the nurse understand is true about an incisional biopsy?

A. It is used to remove the cancerous cells using a needle.
B. It removes an entire lesion and surrounding tissue.
C. It removes a wedge of tissue for diagnosis.
D. It treats cancer with lymph node involvement.

C. 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.

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

A. Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL.
B. Take measures to acidify the urine and prevent uric acid crystallization.
C. Encourage fluid intake to dilute the urine.
D. Limit fluids to 1,000 mL daily to prevent accumulation of the drug’s end products after cell lysis.

C. 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.

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?

A. Avoiding using soap on the irradiated areas
B. Wearing a lead apron during direct contact with the client
C. Removing thoracic skin markings after each radiation treatment
D. Applying talcum powder to the irradiated areas daily after bathing

A. 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.

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

A. Radiation can result in myelosuppression.
B. The cancer cells are dying in large numbers.
C. The cancer is spreading.
D. Fighting off infection is an exhausting venture.

A. Radiation can result in myelosuppression.

Fatigue results from anemia associated with myelo suppression 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.

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?

A. Eggs and milk
B. Green, leafy vegetables
C. Fish and poultry
D. Ham and bacon

D. 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.

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

A. Counsel the patient about the possibility of losing her breast.
B. Clarify information provided by the physician.
C. Provide aseptic care to the incision postoperatively.
D. Provide time for the patient to discuss her concerns.

D. Provide time for the patient to discuss her concerns.

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.

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

A. It prevents alopecia.
B. It lowers serum and uric acid levels.
C. It stimulates the immune system against the tumor cells.
D. It treats drug-related anemia.

B. 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 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?

A. Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis
B. Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis
C. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis
D. Can’t assess tumor or regional lymph nodes and no evidence of metastasis

B. 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.

Following a BMT the patient should be monitored for at least

A. 3 days.
B. 3 months.
C. 5 months.
D. 4 weeks.

B. 3 months.

After a BMT, the nurse closely monitors the patient for at least 3 months because complications related to the transplant are still possible, and infections are very common.

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

A. Reconstructive
B. Prophylactic
C. Palliative
D. Salvage

C. Palliative

Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing non-vital 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 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.

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

A. Her hair will grow back within 2 months post therapy.
B. Her hair will grow back the same as it was before treatment.
C. Alopecia related to chemotherapy is relatively uncommon.
D. She should consider getting a wig or cap before she loses her hair.

D. She should consider getting a wig or cap before she loses her hair.

If hair loss is anticipated, purchase a wig, cap, or scarf before therapy begins. Alopecia develops because chemotherapy affects 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 textures

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
-avoids shaving the irradiated skin
-uses cool water to wash the neck area
-applies an over-the-counter ointment to the skin

-assesses the client for any sun exposure
-avoids shaving the irradiated skinThe 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.

The client is receiving a vesicant anti neo plastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?

A. Nausea and vomiting
B. Extravasation
C. Bone pain
D. Stomatitis

B. Extravasation

The nurse needs to monitor IV administration of anti neo plastics (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 working with a patient who has had an allohematopoietic stem cell transplant (HSCT) and notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the patient has symptoms of which of the following?

A. Acute leukopenia
B. Nadir
C. Graft-versus-host disease
D. Metastasis

C. Graft-versus-host disease

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

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

A. “I floss my teeth every morning.”
B. “I use an electric razor to shave.”
C. “I removed all the throw rugs from the house.”
D. “I take a stool softener every morning.”

A. “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 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?

A. Flare
B. Erythema
C. Extravasation
D. Thrombosis

C. 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.

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

A. An aunt and uncle diagnosed with cancer
B. A first cousin diagnosed with cancer
C. A second cousin diagnosed with cancer
D. Onset of cancer after age 50 in family member

A. 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, 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.

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

A. Withholding fluids for the first 4 to 6 hours after chemotherapy administration
B. Encouraging rhythmic breathing exercises
C. Administering metoclopramide and dexamethasone as ordered
D. Serving small portions of bland food

C. 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 client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia?

A. Closely observe the client’s skin for petechiae and bruising.
B. Perform a cardiovascular assessment every 4 hours.
C. Monitor daily platelet counts.
D. Check the client’s history for a congenital link to thrombocytopenia.

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

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.

The nurse is assessing a 75-year-old woman who had a total hysterectomy when she was 30 years old and normal Pap test results for the past 10 years. The client asks about continuing the Pap test. The nurse states:

A. “You will need to continue for the rest of your life.”
B. “You need to continue obtaining a Pap test for only the next 5 years.”
C. “You could have stopped immediately after your hysterectomy.”
D. “You may choose to discontinue this test.”

D. “You may choose to discontinue this test.”

The American Cancer Society recommendations for women 70 years or older, who have had normal Pap tests for 10 years, and who have had a total hysterectomy may choose to stop cervical cancer screening as in a Pap test.

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

A. Chemotherapy
B. Radiation therapy
C. Electroconvulsive therapy
D. Surgery

C. Electroconvulsive therapy

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 teaching clients about cancer prevention and explain that the root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) as a result from multiple factors. You explain that which of the following are possible carcinogens? Select all that apply.

-Gender
-Dietary substances
-Viruses
-Age
-Environmental factors

-Dietary substances
-Environmental factors
-VirusesCarcinogens 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.

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

A. No further treatment is indicated.
B. Repeat biopsy is needed before treatment begins.
C. Palliative care is likely.
D. Adjuvant therapy is likely.

D. 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.

A client is recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed?

A. “Thank goodness the tumor is contained and curable.”
B. “I guess the doctor could not remove the entire tumor.”
C. “I am so glad the doctor was able to remove the entire tumor.”
D. “I will be glad to finally be done with treatments for this thing.”

B. “I guess the doctor could not remove the entire tumor.”

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.

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?

A. Incisional biopsy
B. Excisional biopsy
C. Needle biopsy
D. Punch biopsy

B. Excisional biopsy

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.

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

A. Neutrophil count of 60%.
B. Reticulocyte count of 1%.
C. Platelet count of 60,000/mm3.
D. Lymphocyte count of 30%.

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

A. Reproductive tract
B. Liver
C. Colon
D. White blood cells (WBCs)

B. Liver

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.

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

A. The client states he is nauseous.
B. The client begins to shiver.
C. The I.V. site is red and swollen.
D. The laboratory reports a white blood cell (WBC) count of 1,000/mm3.

C. The I.V. site is red and swollen.

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.

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

A. Administering aspirin if the temperature exceeds 102° F (38.8° C)
B. Placing the client in strict isolation
C. Providing for frequent rest periods
D. Inspecting the skin for petechiae once every shift

D. 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 serum sodium level lower than 110 mEq/L is associated with

A. anorexia
B. seizure.
C. weight gain.
D. myalgia.

B. seizure.

Serum sodium levels lower than 110 mEq/L is associated with seizures, abnormal reflexes, papilledema, coma, and death. Anorexia, weight gain, and myalgia are associated with serum sodium levels lower than 120 mEq/L.

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. A psychiatric diagnosis everyone has at one time or another.
B. An aberrant psychologic reaction to the chemotherapy.
C. A normal reaction to the diagnosis of cancer.
D. A side effect of the neoplastic drugs.

C. 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.

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

A. Cytokine
B. Retinoids
C. Monoclonal antibodies
D. Antimetabolites

A. Cytokine

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

A. Autologous
B. Homogenic
C. Allogeneic
D. Syngeneic

C. Allogeneic

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.

Which of the following is a characteristic of a malignant tumor?

A. It grows by expansion.
B. It demonstrates cells that are well differentiated.
C. It gains access to the blood and lymphatic channels.
D. It is usually slow growing.

C. It gains access to the blood and lymphatic channels.

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.

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

A. Antimetabolite
B. Alkylating
C. Nitrosoureas
D. Mitotic spindle poisons

A. 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).

The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest?

A. Benign fibrocystic disease
B. Malignant tumor with metastasis to surrounding tissue
C. Malignant tumor
D. Normal finding

C. Malignant tumor

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

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse?

A. Random, rapid growth of the tumor
B. Tumor pressure against normal tissues
C. Emission of abnormal proteins
D. Cells colonizing to distant body parts

B. 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.

When caring for a client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care?

A. Time, distance, and shielding
B. Inspect the skin frequently.
C. Avoid showering or washing over skin markings.
D. The use of disposable utensils and wash cloths

B. Inspect the skin frequently.

Inspecting the skin frequently will allow early identification and intervention of skin problems associated with external radiation therapy. The external markings should not be removed, but clients may shower and lightly wash over the skin. Time, distance, and shielding are key in the management of sealed, internal radiation therapy and not external beam radiation. The use of disposable utensils and care items would be important when caring for clients following systemic, unsealed, internal radiation therapy.

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

A. Clarify information provided by the physician.
B. Provide aseptic care to the incision postoperatively.
C. Provide time for the patient to discuss her concerns.
D. Counsel the patient about the possibility of losing her breast.

C. Provide time for the patient to discuss her concerns.

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.

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?

A. “It will allow time for the repair of healthy tissue.”
B. “It allows time for you to cope with the treatment.”
C. “It is not really understood why you have to go for 6 weeks of treatment.”
D. “It will decrease the incidence of leukopenia and thrombocytopenia.”

A. “It will allow time for the repair of healthy tissue.”

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).

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