Management of patients with oncologic disorders Flashcards
- A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse?
a. It stimulates the immune system against the tumor cells.
b. It treats drug-related anemia.
c. It prevents alopecia.
d. It lowers serum and uric acid levels.
d,
The use of allopurinol with chemotherapy is to prevent renal toxicity. tumor lysis syndrome occurrence can be reduced with allopurinol’s action of reducing the conversion of nucleic acid byproducts to uric acid, in this way preventing urate nephropathy and subsequent oliguric renal failure.
allopurinol does not stimulate the immune system, treat anemia, or prevent alopecia.
After cancer chemotherapy, a client experiences nausea and vomiting. the nurse should assign highest priority to which intervention?
a. serving small portions of bland food
b. encouraging rhythmic breathing exercises.
c. administering metoclopramide and dexamethasone as ordered.
d. withholding fluids for the first 4 to 6 hours after chemotherapy administration.
c.
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.
which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure?
a. family history
b. drug history
c. blood studies
d. allergy history
c
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.
a nurse is caring for a client after a bone marrow transplant. what is the nurse priority in caring for the client?
a. monitor the client’s toilet patterns.
b. monitor the client to prevent sepsis.
c. monitor the client’s physical condition.
d. monitor the client’s heart rate.
b.
until transplanted bone marrows begins to produce blood cells, clients who have undergone a bone marrow transplant have no physiologic means to fight infection, which puts them at high risk for dying from sepsis and bleeding before engraftment. therefore, a nurse must closely monitor clients and take measures to prevent sepsis.
monitoring client’s toilet patterns, physical condition, and heart rate does not prevent the possibility of the client becoming septic.
the nurse is providing client teaching for a client undergoing chemotherapy. what dietary modifications should the nurse advise?
a. eat wholesome meals.
b. avoid spicy and fatty foods.
c. avoid intake of fluids.
d. eat warm or hot foods.
b.
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 oncologic emergency involves the accumulation of fluid in the pericardial space?
a. cardiac tamponade
b. disseminated intravascular coagulation (DIC)
c. syndrome of inappropriate antidiuretic hormone release (SIADH)
d. tumor lysis syndrome
a.
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.
A client is receiving external radiation to the left thorax to treat lung cancer. which intervention should be part of this client’s care plan?
a. avoiding using soap on the irradiated areas.
b. applying talcum powder to the irradiated areas daily after bathing.
c. wearing a lead apron during direct contact with the client.
d. removing thoracic skin markings after each radiation treatment.
a.
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.
the nurse is caring for an adult client who has developed a mild oral yeast infection following chemotherapy. what actions should the nurse encourage the client to perform? select all that apply.
a. use a lip lubricant.
b. scrub the tongue with a firm-bristled toothbrush.
c. use dental floss every 24 hours.
d. rinse the mouth with normal saline.
e. eat spicy food to aid in eradicating the yeast.
a, c, d
stomatitis is an inflammation of the oral cavity. the client should be encouraged to brush the teeth with a soft toothbrush after meals, use dental floss every 24 hours, rinse with normal saline, and use a lip lubricant.
mouthwashes and hot foods should be avoided.
which of the following would be inconsistent as a common side effect of chemotherapy?
a. weight gain.
b. alopecia.
c. myelosuppresion.
d. fatigue
a.
common side effects seen with chemotherapy include myelosuppression, alopecia, nausea and vomiting, anorexia, and fatigue.
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. cells colonizing to distant body parts.
c. tumor pressure against normal tissues.
d. emission of abnormal proteins.
c.
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.
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?
a. pool and water safety.
b. breast and testicular self-exams.
c. hand washing and infection prevention.
d. sun safety and use of sunscreen.
d.
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 nurse has been working in hospice care for 10 years. based on her experience, she drafts her plan of care with the understanding that the most significant barrier to improving care at the end of life is the:
a. Attitude of health care professionals toward terminal illness.
b, Lack of social support systems for the dying patient.
c. Fear of over-medicating the patient when pain is severe.
d. Patient’s resistance to accepting care.
a.
Clinicians’ attitudes toward the terminally ill and dying remain the greatest barrier to improving care at the end of life. Clinicians’ reluctance to discuss disease and death openly with patients stems from their own anxieties about death, as well as misconceptions about what and how much patients want to know about their illnesses.
A hospice nurse is visiting the home of a client who was recently diagnosed with a terminal illness. The nurse is developing the client’s plan of care and is assessing beliefs and preferences about end-of-life care. The nurse would expect to complete this assessment at which time?
a. Over the course of several visits
b. During the initial visit
c, As the client’s condition begins to deteriorate
d. When the client exhibits signs of imminent death
a
Information about end-of-life care beliefs, preferences, and practices should be gathered in short segments over a period of time, such as over several visits. Trying to elicit the information in one visit would be overwhelming. Waiting until the client’s condition begins to deteriorate or when signs of imminent death appear would be too late. The nurse needs to integrate the client’s beliefs, preferences, and practices into the plan of care.
The nurse is preparing a teaching tool about hospice and palliative care. Which characteristics would the nurse highlight as being a part of both care approaches? Select all that apply.
a. Goals are to relieve pain
b. Include curative treatment
c. Actions are to increase comfort
d. Desire to improve the quality of life
e. Used for those not expected to live for 6 months
a, c, d
Hospice and palliative care have much in common. Both are for people with serious illnesses. Both follow treatment goals that aim to relieve pain, increase comfort, and improve quality of life for the client and family. Hospice care focuses on the same goals as palliative care except hospice excludes curative treatment and is used for those who are not expected to live longer than 6 months.
A hospice nurse is caring for a young adult client with a terminal diagnosis of leukemia. When updating this client’s plan of nursing care, what should the nurse prioritize?
a. Interventions aimed at maximizing quantity of life
b. Providing financial advice to pay for care
c. Providing realistic emotional preparation for death
d. Making suggestions to maximize family social interactions after the client’s death
c
Hospice care focuses on quality of life, but, by necessity, it usually includes realistic emotional, social, spiritual, and financial preparation for death. Financial advice and actions aimed at post-death interaction would not be appropriate priorities.
A client is in a hospice receiving palliative care for lung cancer which has metastasized to the client’s liver and bones. For the past several hours, the client has been experiencing dyspnea. What nursing action is most appropriate?
a. Administer a bolus of normal saline, as prescribed.
b. Initiate high-flow oxygen therapy.
c, Administer high doses of opioids.
d. Administer bronchodilators and corticosteroids, as prescribed.
d
Bronchodilators and corticosteroids help to improve lung function, as do low doses of opioids.
Low-flow oxygen often provides psychological comfort to the client and family. A fluid bolus is unlikely to be of benefit.
A nurse is providing hospice care in Portland, Oregon to a client with terminal liver cancer. The client confides to the nurse, “I’m in agony all the time. I want this to be over now—please help me.” Which interventions should the nurse implement? Select all that apply.
a. Control the client’s pain with prescribed medication.
b. Advise the client’s health care provider of the client’s condition.
c. Comfort the client by saying it will all be over soon.
d, Encourage the client to explain his or her wishes.
e. Recommend that the client consider physician-assisted suicide.
a, b, d
This client lives in Oregon, one of five states that have decriminalized physician-assisted suicide, the practice of providing a means by which a client can end his or her own life. This practice is controversial, with proponents arguing the client has a right to self-determination and a relief from suffering when there is no other means of palliation. Opponents, on the other hand, find it contrary to the Hippocratic Oath. In this scenario, the nurse should determine exactly what the client is asking and then support his or her wishes. It is not the nurse’s role to suggest physician-assisted suicide voluntarily, however.
A client’s rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this client’s care, the nurse should identify what primary aim?
a. To prioritize emotional needs
b. To prevent and relieve suffering
c. To bridge between curative care and hospice care
d. To provide care while there is still hope
b
Palliative care, which is conceptually broader than hospice care, is both an approach to care and a structured system for care delivery that aims to prevent and relieve suffering and to support the best possible quality of life for clients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care goes beyond simple prioritization of emotional needs; these are always considered and addressed. Palliative care is considered a “bridge,” but it is not limited to just hospice care. Hope is something clients and families have even while the client is actively dying.
The spouse of a terminally ill client is confused by the new terminology being used during discussions regarding the client’s treatment. The nurse should explain that palliative care is:
a. care that will reduce the client’s physical discomfort and manage clinical symptoms.
b. care that is provided at the very end of an illness to hasten the dying process.
c. an alternative therapy that uses massage and progressive relaxation for pain relief.
d. offered to terminally ill clients instead of hospice care.
a
Palliative care is used in conjunction with other end-of-life treatments and has many principles. Its aim is to reduce physical discomfort and other distressing symptoms but it does not hasten or delay a disease’s progression. Palliative care is applicable early in the course of illness, in conjunction with other therapies. Palliative care of a terminally ill client not only provides relief from pain and other distressing symptoms but it integrates other facets of patient care as well, including psychological and spiritual aspects. Palliative care is part of hospice care.
The nurse is describing palliative care and hospice services to a client with end-stage congestive heart failure. The client and family have many questions about the differences between palliative care and hospice. Which statement should the nurse provide the family?
a. “Hospice is the application of palliative care at the end of life.”
b. “Palliative care requires hospitalization.”
c. “Hospice occurs in a facility with specially trained staff.”
d. “Curative care can continue in hospice.”
a
Palliative care focuses on symptom management and quality of life in clients with serious symptoms and life-limiting diseases. Hospice is a type of palliative care that focuses on comfort at the end of life. Palliative care can take place in a number of settings; it does not need to take place in the inpatient hospital setting. Hospice care may also occur in a variety of settings, or it can take place in a client’s home without the need for a special facility. The client in hospice care is no longer receiving curative treatment.
Which of the following is the most effective intravesical agent for recurrent bladder cancer?
a. Bacillus Calmette-Guérin (BCG)
b. Methotrexate
c. Cisplatin
d. Vinblastine
a
BCG is now considered the most effective intravesical agent for recurrent bladder cancer, especially superficial transitional cell carcinoma, because it is an immunotherapeutic agent that enhances the body’s immune response to cancer.
Chemotherapy with a combination of methotrexate, 5-FU, vinblastine, doxorubicin (Adriamycin), and cisplatin has been effective in producing partial remission of transitional cell carcinoma of the bladder in some patients.
The nurse is providing discharge instructions for a client who was admitted to the oncology unit due to dehydration and anorexia after chemotherapy treatment. What information should the nurse provide to the client to promote improve the client’s nutritional intake at home?
a. Take prescribed pain medication prior to commencing a meal
b. Avoid any oral care prior to eating
c, Eat uninterrupted by others to eliminate distractions
d. Prepare the eating area with a pleasant room spray
a
The client needs to be clean, comfortable, and free of pain for meals, in an environment that is as attractive as possible. Ensuring adequate pain relief in advance of commencing a meal will make the experience more pleasant and tolerable. Pain is correlated with lack of appetite. Oral hygiene before meals helps to improve appetite. Offensive sights, sounds, and odors are eliminated. Creative strategies may be required to make food more palatable, provide enough fluids, and increase opportunities for socialization during meals.
A patient is receiving chemotherapy for breast cancer. Her most recent laboratory test results are as follows:
Erythrocytes 4,500,000/cu mm
Hemoglobin 12.0 gm/dL
Hematocrit 35%
Leukocytes 4,600 gm/dL
Thrombocytes 125,000/cu mm
Which results suggests some evidence of bone marrow suppression?
a. Erythrocyte count
b. Hemoglobin level
c. Leukocyte count
d. Thrombocyte count
d
The thrombocyte count is below 150,000/cu mm, indicating thrombocytopenia and bone marrow suppression.
The erythrocyte count, hemoglobin, hematocrit, and leukocyte count are within normal limits.
A client has learned of a terminal illness and impending death. The client asks the nurse to explain the concepts and care that are provided under the definition of palliative care. Which of the following would the nurse include in the explanation for this client? Select all that apply.
a. Provides pain relief
b. Includes chemotherapy
c. Integrates spirituality
d. Hastens death
e. Offers a team approach to care
f. Enhances quality of life
a, c, e, f
The principles of palliative care include providing relief from pain and distressing symptoms. In the early course of disease, chemotherapy and radiation may be used to define care needed, but in the later stages, chemotherapy is typically not used. Psychological support including spirituality and bereavement counseling for family members is available. The care does not hasten nor postpone death but is aimed at enhancing a quality of the life that is remaining. A team approach meets the needs of the client and family.
The home health nurse is performing a home visit for an oncology client discharged three days ago after completing chemotherapy treatment for non-Hodgkin lymphoma. The nurse’s priority assessment should include examination for the signs and symptoms of which complication?
a. Tumor lysis syndrome (TLS)
b, Syndrome of inappropriate antidiuretic hormone (SIADH)
c. Disseminated intravascular coagulation (DIC)
d. Hypercalcemia
a
TLS is a potentially fatal complication that occurs spontaneously or more commonly following radiation, biotherapy, or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia, lymphoma, and small-cell lung cancer.
DIC, SIADH, and hypercalcemia are less likely complications following this treatment and diagnosis.
Which diagnostic imaging modality is more accurate than computed tomography in detecting malignancies?
a. PET
b. Gallium scan
c. MRI
d. Pulmonary angiography
a
PET is more accurate in detecting malignancies than CT, and it has equivalent accuracy in detecting malignant nodules when compared with invasive procedures such as thoracoscopy.
A gallium scan is used to stage bronchogenic cancer and document tumor regression after chemotherapy or radiation.
MRI is used to characterize pulmonary nodules, to help stage bronchogenic carcinoma, and to evaluate inflammatory activity in interstitial lung disease.
Pulmonary angiography is used to investigate thromboembolic disease of the lungs.
Resection of a client’s bladder tumor has been incomplete and the client is preparing for the administration of the first ordered instillation of topical chemotherapy. When preparing the client, the nurse should emphasize the need to do which of the following?
a. Remain NPO for 12 hours prior to the treatment.
b. Hold the solution in the bladder for 2 hours before voiding.
c. Drink the intravesical solution quickly and on an empty stomach.
d. Avoid acidic foods and beverages until the full cycle of treatment is complete.
b
The client is allowed to eat and drink before the instillation procedure. Once the bladder is full, the client must retain the intravesical solution for 2 hours before voiding. The solution is instilled through the meatus; it is not consumed orally. There is no need to avoid acidic foods and beverages during treatment.
A nurse is administering a peripheral chemotherapeutic agent. What nursing actions are used for extravasation of a chemotherapeutic agent? Select all that apply.
a. Stop the medication infusion at the first sign of extravasation
b. Aspirate any residual drug from the IV line
c. Administer an antidote, if indicated
d. Apply warm compresses to the irritated site to encourage healing
e. Schedule the client for implanted device
a, b, c,
All of the answers except application of a warm compress 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. Short term chemotherapy can be done with peripheral catheters so the client may not need an implanted device.
The nurse is caring for a client on chemotherapy who is recovering from surgery for oral cancer. Which interventions will the nurse add to this client’s plan of care? Select all that apply.
a. Prevent infection
b. Maintain a patent airway
c. Ensure adequate nutritional intake
d. Provide a mechanism to communicate
e. Prevent the development of stomatitis
all choices are correct.
Cancers of the oral cavity and pharynx, which can occur in any part of the mouth or throat, are curable if discovered early. After surgery to excise the pathology, care should be focused on preventing the development of an infection of the surgical site. Postoperatively, the priority for the nurse is assessing for and maintaining a patent airway. Determination of nutritional intake goals requires consideration of the client’s weight, age, and level of activity. A daily calorie count may be necessary to determine the exact quantity of food and fluid ingested. It is vital to assess the client’s ability to communicate in writing before surgery. Pen and paper are provided postoperatively to clients who can use them to communicate. A communication board with commonly used words or pictures is obtained preoperatively and given after surgery to clients who cannot write so that they may point to needed items. Interventions should include actions to prevent the development of stomatitis, which can result from chemotherapy and radiation treatment.
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.)
a. Monitor vital signs once a shift.
b. Assess level of consciousness.
c. Assist the client to a chair.
d, Apply pressure to the bleeding sites.
e. Check intake and output records.
b, d, e
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.
The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse?
a. “I will eat clear liquids for the next 24 hours.”
b. “Hair loss may not occur until after the second round of therapy.”
c. “I will use birth control measures until after all treatment is completed.”
d. “I can continue taking my vitamins and herbs because they make me feel better.”
d
Herbal products are not regulated by the U.S. Food and Drug Administration (FDA);although some can decrease the risk of cancer, others can have serious side effects and liver toxicity. Use of vitamins and herbals should be reviewed with the oncologist.
Use of clear liquids is recommended for the client experiencing nausea and vomiting. Because hair follicles are sensitive to chemotherapy drugs, it is likely for alopecia to occur especially with consecutive treatments. Chemotherapy includes cytotoxic drugs that are harmful to rapid dividing cells such as cell development in the fetus. To prevent damage to the fetus, birth control is recommended during treatment.
A patient with an advanced laryngeal tumor is to have radiation therapy. The patient tells the nurse, “If I am going to have radiation, I won’t need surgery.” What is the best response by the nurse?
a. “That is correct. The radiation will eradicate the tumor and you won’t have to have further treatment.”
b. “Radiation is used to shrink the tumor size and is an adjunct to surgery.”
c. “All patients have to have radiation before they have surgery. It is protocol.”
d. “You really don’t have to have radiation but you won’t have to have such invasive surgery if you have the radiation first.”
b
Radiation therapy may also be used preoperatively to reduce the tumor size. Radiation therapy is combined with surgery in advanced laryngeal cancer as adjunctive therapy to surgery or chemotherapy and as a palliative measure.
The client is experiencing painful oral lesions following radiation for oropharyngeal cancer. Which instruction should the nurse give this client?
a. Spicy foods stimulate salivation and are soothing.
b. Eat food while it is hot to enhance flavor.
c. Avoid brushing teeth while lesions are present.
d. Eat soft or liquid foods.
d
Since oral lesions can be painful, a soft or liquid diet may be preferred and easier to ingest. Other strategies to reduce pain and discomfort include avoiding spicy and hot foods. The client should continue with mouth care and brushing teeth with a soft toothbrush to keep the oral cavity clean.
The clinic nurse is caring for an adult oncology client who reports extreme fatigue and weakness after the first week of radiation therapy. Which response by the nurse would best reassure this client?
a. “These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory studies and test results.”
b. “These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer.”
c. “Try not to be concerned about these symptoms. Every client feels this way after having radiation therapy.”
d. “Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying.”
a
Fatigue and weakness result from radiation treatment and usually do not represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the client and should not be belittled. Radiation destroys both cancerous and normal cells.
A client diagnosed with prostate cancer is to receive brachytherapy. Which of the following would the nurse include when discussing this therapy with the client?
a. Need for daily treatments over a 7- to 8-week period
b. Use of radioactive seeds implanted into the prostate
c. Surgical castration to decrease the level of circulating testosterone
d. Use of probes inserted using ultrasound to freeze the tissue
b
Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia.
External beam radiation therapy (teletherapy) involves the use of radiation treatments, usually 5 days/week over 7 to 8 weeks.
Surgical castration is a type of androgen-deprivation therapy.
Cryosurgery involves the insertion of transperineal probes into the prostate to freeze the tissue directly.
A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse’s best action?
a. Place the client in a private room.
b. Place a chair next to the bed to allow the spouse to sit.
c. Have visitors wear dosimeters for safety.
d. Allow visitors to telephone only.
a
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. Staff needs to wear dosimeters. Family may visit for up to 30 minutes per day.
Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer?
a. Hormone therapy
b. Brachytherapy
c. Teletherapy
d. Chemotherapy
b
Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia.
Hormone therapy for advanced prostate cancer suppresses androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of DHT. (Leuprolide and goserelin)
Teletherapy involves 6 to 7 weeks of daily radiation treatments.
High-dose ketoconazole (HDK) lowers testosterone through its abilities to decrease both testicular and endocrine production of androgen.
