Chapter 20: Concepts of Care for Patients With Cancer Flashcards
A client receiving radiation for head and neck cancer reports that the skin in the radiation field is itching and painful. Which nursing education will the nurse provide?
A. “This is likely from medication, not the radiation treatment.”
B. “Cover the area with soft clothing.”
C. “Be sure to wash your hands well before touching the area.”
D. “Sunlight to the radiated area can help the skin heal.”
E. “Use a washcloth to thoroughly clean the area with soap and water.”
F. “Do not remove the ink markings on the skin.”
Answers: B, C, F
Rationale:
The skin is likely irritated from the radiation and priority care is to teach the client to protect the radiated skin. The area can be covered with soft, non-irritating clothing and the client should wash the hands with soap and water before touching the skin to prevent infection. Skin in the radiation path is photosensitive. As such, the nurse will teach the client to avoid the sun. The skin is very fragile and friction from a washcloth should be avoided. Wash the skin, gently with the hand. The nurse will teach the client to leave the markings on the skin as those markings are used to ensure that the radiation path is consistent with each treatment.
The nurse is observing the unlicensed assistive personnel (UAP) provide care to a client who is neutropenic. Which action by the UAP requires the nurse to intervene?
A. Performing a bed bath because the client is too tired to get in the shower.
B. Using the unit mobile blood pressure machine to assess the client’s vitals.
C. Using alcohol-based hand foam before touching the client.
D. Cleaning the client’s bathroom with disinfectant.
Answer: B
Rationale:
The hospitalized client who is neutropenic should have dedicated equipment that is not shared with other clients. The nurse would intervene if the UAP attempted to use the mobile blood pressure cuff that is used for all clients and teach the UAP to use a dedicated blood pressure cuff and stethoscope that is at the bedside in the client’s room. All other options are correct actions for the UAP.
The nurse is teaching about infection prevention to a client with cancer who is neutropenic. Which client statement requires additional teaching?
A. “I will call the healthcare provider if I get a temperature of 100.4 or greater.
B. “I will wash my hands after attending church.”
C. “I will wear a condom when having intercourse.”
D. “I will not drink anything that has been at room temperature for more than an hour.”
Answer: B
Rationale:
The client with cancer who is actively experiencing neutropenia should avoid crowds and large gatherings until the white blood cell count recovers. While washing hands is appropriate, attending church should be avoided while neutropenic to decrease the risk of infection. All other responses are appropriate for the neutropenic client.
The nurse is assessing a client that has advanced bone cancer. Which client assessment data causes the nurse to suspect spinal cord compression? Select all that apply.
A. Reports of a headache for the past 7 hours.
B. Decreased breath sounds in the left lung.
C. Worsening mid-thoracic back pain.
D. Tingling in the right lower extremity.
E. Unsteady gait when ambulating to the bathroom.
F. Reports of difficulty sleeping.
Answers: C, D, E
Rationale:
Spinal cord compression can occur if a tumor invades the spinal column or when the vertebrate collapses due to degradation of the bone from cancer. Back pain is often a first symptom. The nurse should assess for worsening low back pain, numbness and tingling in the extremities, unsteady gait and neurologic changes. A headache, decreased breath sounds, and difficulty sleeping are not indicators of spinal cord compression.
A client with chemotherapy induced neutropenia is prescribed filgrastim. The client states, “The bones in my legs are aching so bad.” What nursing response is appropriate?
A. “The pain in your legs is likely from the cancer.”
B. “Bone pain is a side effect of filgrastim that improves with time.”
C. “Increasing activity will help with the bone pain.”
D. “Have you had any fever or nausea?”
Answer: B
Rationale:
Filgrastim is a colony stimulating factor that is used as supportive therapy during chemotherapy. Bone pain is a common side effect that is usually managed with ibuprofen, and occasionally requires opioid prescriptions. However, the pain is usually short lived and improves with time.
The nurse is caring for a client with a sealed radiation implant for the treatment of cancer. Which nursing intervention is appropriate? Select all that apply.
A. Place a caution sign on the door of the client’s room.
B. Wear a dosimeter badge for protection when providing care.
C. Allow the client’s spouse to stay with the client at least 6 feet away for 4 hours.
D. Do not allow children to visit the client for any length of time.
E. Keep the door to the client’s room closed.
Answers: A, D, E
Rationale:
A sealed radiation implant emits radiation near the tumor bed continuously. The nurse will place a caution sign on the client’s door warning of radioactive material. The nurse will wear a dosimeter. However, this does not provide protection, only detection of exposure to radiation. The nurse can allow the client’s spouse to visit for a total of 30 minutes per day at a distance of 6 feet away from the client. Children and pregnant women are not allowed to visit. The nurse should keep the door to the client’s room closed as much as possible.
The nurse is teaching a client who has been prescribed an oral chemotherapy agent. What teaching will the nurse include?
A. “Oral chemotherapy drugs are not as toxic as IV chemotherapy.”
B. “Do not crush, split, break, or chew the oral chemotherapy drug.”
C. “You may dispose of unused oral chemotherapy drugs in the trash.”
D. “Oral chemotherapy drugs are not absorbed through the skin.”
Answer: B
Rationale:
The nurse will teach the client that oral chemotherapy agents cannot be broken, chewed, split, or crushed. The nurse will teach the client that oral chemotherapy drugs are just as toxic as IV chemotherapy, cannot be disposed of in the trash, and can be absorbed through the skin.
When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication?
Infection
Drug toxicity
Polycythemia
Dose-limiting side effects
CORRECT: A
Infection
The lowest point of bone marrow function is referred to as the nadir; risk for infection is highest during this phase.
The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body?
A. Lung
B. Veins of the legs
C. Abdominal cavity
D. Heart
CORRECT: C
Abdominal cavity
Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity.
When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful?
A. Providing oral care with a disposable mouth swab
B. Maintaining NPO until the lesions have resolved
C. Encouraging oral care with commercial mouthwash
D. Administering a biological response modifier
CORRECT: A
Providing oral care with a disposable mouth swab
The client with mucositis would benefit most from oral care; mouth swabs are soft and disposable and therefore clean and appropriate to provide oral care. Biological response modifiers are used to stimulate bone marrow production of immune system cells; mucositis or sores in the mouth will not respond to these medications. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa. Keeping the client NPO is not necessary because nutrition and hydration are important during cancer treatment; a local anesthetic may be prescribed.
Which client problem does the nurse determine as the priority for the client experiencing chemotherapy-induced peripheral neuropathy?
A. Potential for injury related to sensory and motor deficits
B. Altered sexual function related to erectile dysfunction
C. Potential for ineffective coping strategies related to loss of motor control
CORRECT: A
Potential for injury related to sensory and motor deficits
The highest priority is safety. Although knowing the side effects of chemotherapy may be helpful, the priority is the client’s safety because of the lack of sensation or innervation to the extremities.
The nurse is caring for a client who is receiving rituximab for treatment of lymphoma. During the infusion, it is essential for the nurse to observe for which side effect?
A. Alopecia
B. Fever
C. Allergy
D. Chills
CORRECT: C
Allergy
Allergy is the most common side effect of monoclonal antibody therapy (rituximab), and the nurse must be aware of any allergic reactions the client may exhibit.
Which intervention will the oncology nurse use to prevent disseminated intravascular coagulation (DIC)?
A. Monitoring platelets
B. Using strict aseptic technique to prevent infection
C. Administering packed red blood cells
D. Administering low-dose heparin therapy for clients on bedrest
CORRECT: B
Using strict aseptic technique to prevent infection
Sepsis is a major cause of DIC, especially in the oncology client. The oncology nurse must use strict asepsis to prevent any infection. Monitoring platelets will help detect DIC, but will not prevent it. Red blood cells are used for anemia, not for bleeding/coagulation disorders. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.
The nurse is caring for a client with hyperuricemia associated with tumor lysis syndrome (TLS). Which medication does the nurse anticipate being prescribed?
A. Radioactive iodine-131
B. Allopurinol
C. Recombinant erythropoietin
D. Potassium chloride
CORRECT: B
Allopurinol
The nurse expects allopurinol to be prescribed, because allopurinol decreases uric acid production and is indicated in TLS. TLS results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances.
The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia?
A. Observe for motor deficits.
B. Monitor weight.
C.Monitor platelets.
D. Trend red blood cells and hemoglobin and hematocrit.
CORRECT: B
Monitor weight.
Cachexia results in extreme body wasting, malnutrition, and severe weight loss. Anemia and bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. Motor deficits result from spinal cord compression.
