Chapter 12: Management of Patients with Oncologic Disorders Flashcards
- The public health nurse is presenting a health promotion class to a group at a local
community center. Which intervention most directly addresses the leading cause of
cancer deaths in North America?
A. Monthly self-breast exams
B. Smoking cessation
C. Annual colonoscopies
D. Monthly testicular exams
ANS: B
Rationale: The leading causes of cancer death, in order of frequency, are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women. Smoking cessation is the health promotion initiative directly related to lung cancer.
- A nurse who works in an oncology clinic is assessing a client who has arrived for a
2-month follow-up appointment following chemotherapy. The nurse notes that the
client’s skin appears yellow. Which blood tests should be done to further explore this
clinical sign?
A. Liver function tests (LFTs)
B. Complete blood count (CBC)
C. Platelet count
D. Blood urea nitrogen and creatinine
ANS: A
Rationale: Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count, and tests of renal function would not directly assess for liver disease.
- The nurse is conducting a health education about cancer prevention to a group of
adults. What menu best demonstrates dietary choices for potentially reducing the risks
of cancer?
A. Smoked salmon and green beans
B. Pork chops and fried green tomatoes
C. Baked apricot chicken and steamed broccoli
D. Liver, onions, and steamed peas
ANS: C
Rationale: Fruits and vegetables appear to reduce cancer risk. Salt-cured foods, such as ham and processed meats, as well as red meats, should be limited.
- Which nursing action best demonstrates primary cancer prevention?
A. Encouraging yearly Pap tests
B. Teaching testicular self-examination
C. Promoting and providing vaccines
D. Facilitating screening mammograms
ANS: C
Rationale: Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as promoting vaccines that prevent cancer. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Pap tests, mammograms, and testicular exams.
- A woman with a family history of breast cancer received a positive result on a breast
tumor marking test and is requesting a bilateral mastectomy. This surgery is an example
of which type of oncologic surgery?
A. Salvage surgery
B. Palliative surgery
C. Prophylactic surgery
D. Reconstructive surgery
ANS: C
Rationale: Prophylactic surgery is used when there is an extensive family history and nonvital tissues are removed. 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. Palliative surgery is performed in an attempt to relieve
complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect.
- The nurse is caring for a client who is to begin receiving external radiation for a
malignant tumor of the neck. While providing client education, what potential adverse
effects should the nurse discuss with the client?
A. Impaired nutritional status
B. Cognitive changes
C. Diarrhea
D. Alopecia
ANS: A
Rationale: Alterations in oral mucosa, change and loss of taste, pain, and dysphasia often occur as a result of radiotherapy to the head and neck. The client is at an increased risk of impaired nutritional status. Radiotherapy does not cause cognitive changes. Diarrhea is not a likely concern for this client because of the location of the radiotherapy. Radiation only results in alopecia when targeted at the whole brain; radiation of other parts of the body does not lead to hair loss.
- While a client is receiving intravenous (IV) doxorubicin hydrochloride for the treatment
of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize
which action?
A. Stopping the administration of the drug immediately
B. Notifying the client’s health care provider
C. Continuing the infusion but decreasing the rate
D. Applying a warm compress to the infusion site
ANS: A
Rationale: Doxorubicin hydrochloride is a chemotherapeutic vesicant that can cause severe tissue damage. The nurse should stop the administration of the drug immediately
and then notify the client’s health care provider. Ice can be applied to the site once the drug therapy has stopped.
- A client newly diagnosed with cancer is scheduled to begin chemotherapy treatment
and the nurse is providing anticipatory guidance about potential adverse effects. When
addressing the most common adverse effect, what should the nurse describe?
A. Pruritis (itching)
B. Nausea and vomiting
C. Altered glucose metabolism
D. Confusion
ANS: B
Rationale: Nausea and vomiting, the most common side effects of chemotherapy, may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these clients. Confusion, alterations in glucose metabolism, and
pruritus are less common adverse effects.
- A client on the oncology unit is receiving carmustine, a chemotherapy agent, and the
nurse is aware that a significant side effect of this medication is thrombocytopenia. Which
symptom should the nurse assess for in clients at risk for thrombocytopenia?
A. Interrupted sleep pattern
B. Hot flashes
C. Epistaxis
D. Increased weight
ANS: C
Rationale: Clients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. Clients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight.
- The nurse manager is orienting a new nurse to the oncology unit. When reviewing the
safe administration of antineoplastic agents, which action should the nurse manager
emphasize?
A. Adjust the dose to the client’s present symptoms.
B. Wash hands with an alcohol-based cleanser following administration.
C. Use gloves and a lab coat when preparing the medication.
D. Dispose of the antineoplastic wastes in the hazardous waste receptacle.
ANS: D
Rationale: The nurse should use surgical gloves and disposable long-sleeved gowns when administering antineoplastic agents. The antineoplastic wastes are disposed of as hazardous materials. Dosages are not adjusted on a short-term basis. Hand and arm hygiene must be performed before and after administering the medication.
- A nurse provides care on a bone marrow transplant unit and is preparing a client for
a hematopoietic stem cell transplantation (HSCT) the following day. Which information
should the nurse emphasize to the client’s family and friends?
A. “Your family should likely gather at the bedside in case there is a negative
outcome.”
B. “Make sure the client doesn’t eat any food in the 24 hours before the procedure.”
C. “Wear a hospital gown when you go into the client’s room.”
D. “Do not visit if you’ve had a recent infection.”
ANS: D
Rationale: Before HSCT, clients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they have had a recent illness or vaccination. Gowns should indeed be worn, but this is secondary in importance to avoiding the client’s contact with ill visitors. Prolonged fasting is unnecessary. Negative outcomes are possible, but the procedure would not normally be so risky as to require the family to gather at the bedside.
- During a routine mammogram, a client asks the nurse whether breast cancer causes
the most deaths. Which type of cancer is the leading cause of death in the United States?
A. Colorectal
B. Prostate
C. Lung
D. Breast
ANS: C
Rationale: Lung cancer is the leading cause of cancer-related deaths in the United States, followed by prostate cancer in men and breast cancer in women. Colorectal cancer is the
third-leading cause of cancer-related deaths in the United States. Cancer is a common health problem worldwide.
- The nurse on a bone marrow transplant unit is caring for a client with cancer who has
just begun hematopoietic stem cell transplantation (HSCT). What is the priority nursing
diagnosis for this client?
A. Fatigue related to altered metabolic processes
B. Altered nutrition: less than body requirements related to anorexia
C. Risk for infection related to altered immunologic response
D. Body image disturbance related to weight loss and anorexia
ANS: C
Rationale: Risk for infection related to altered immunologic response is the priority nursing diagnosis. HSCT involves intravenous infusion of autologous or allogeneic stem
cells to promote red blood cell production in clients with compromised bone marrow or immune function, such as due to blood or bone marrow cancer. It carries an increased
risk of sepsis and bleeding. The client’s immunity is suppressed by the underlying condition necessitating the HSCT, the HSCT itself, and any cancer medications received. The client has a high risk for infection. Fatigue is appropriate but not the most critical nursing diagnosis. Altered nutrition and body image disturbance could be valid nursing diagnoses but would be of lower priority than risk for infection.
- While on spring break, a 22-year-old client was taken to the hospital for heat stroke
and alcohol poisoning. The client is worried and states that a biopsy was taken and
showed “some kind of benign condition.” Which response by the nurse would be best?
A. “I understand that you are worried. Benign conditions are noncancerous, but
let’s look at your chart to see your results.”
B. “You have every right to be upset; a benign condition means you may have
cancerous cells. Let me call your health care provider to talk to you.”
C. “Are you sure a biopsy was done? Your admitting diagnosis would not prompt
that kind of procedure.”
D. “Do not worry; if something was wrong, your primary health care provider would
have told you and started treatment.”
ANS: A
Rationale: As a therapeutic listener, it is important to acknowledge the client’s feelings and try to provide a resolution. Benign conditions are defined as noncancerous, and any
treatment ordered would have been known by nursing. There is no reason to doubt the client’s word regarding the biopsy, and, in any case, the nurse can confirm that the biopsy was performed by reviewing the client’s chart. The client’s admitting diagnosis could have promoted this test. Heat stroke and alcohol poisoning could enhance the body’s inability to regulate internal temperatures and increase skin damage. The primary care provider may not have had time yet to discuss the details of the finding or to have initiated any treatment necessary. Also, this response does not provide the explanation of what “benign” means.
- A client with terminal small-cell lung cancer has been given a six-month prognosis
and wants to die at home. The health care team believes the condition warrants inpatient
care. The nurse might suggest which compromise?
A. Discuss a referral for rehabilitation hospital.
B. Panel the client for a personal care home.
C. Discuss a referral for acute care.
D. Discuss a referral for hospice care.
ANS: D
Rationale: Hospice care can be provided in several settings. Because of the high cost associated with free-standing hospices, care is often delivered by coordinating services
provided by both hospitals and the community. The primary goal of hospice care is to provide support to the client and family. Clients who are referred to hospice care generally have fewer than six months to live. Each of the other listed options would be less appropriate for the client’s physical and psychosocial needs.
- 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.”
ANS: A
Rationale: 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 16-year-old female client has post-chemotherapy alopecia. This prompts the
nursing diagnoses of Disturbed Body Image and Situational Low Self-Esteem. Which
response by the client would best indicate improved coping related to these diagnoses?
A. Requests that her family bring her makeup and a wig
B. Begins to discuss the future with her family
C. Reports less disruption from pain and discomfort
D. Cries openly when discussing her disease
ANS: A
Rationale: Requesting her wig and makeup indicates that the client with alopecia is becoming interested in looking her best and that her body image and self-esteem may be improving. The other options may indicate that other nursing goals are being met, but they do not necessarily indicate improved body image and self-esteem.
- An adult client with leukemia will soon begin chemotherapy. What would the nurse do
to combat the most common adverse effects of chemotherapy?
A. Administer an antiemetic.
B. Administer an antimetabolite.
C. Administer a tumor antibiotic.
D. Administer an anticoagulant.
ANS: A
Rationale: Antiemetics are used to treat nausea and vomiting, the most common adverse effects of chemotherapy. Antihistamines and certain steroids are also used to treat
nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli.
- A client has been hospitalized for a wedge resection of the left lower lung lobe after a
routine chest x-ray showed carcinoma. The client reports feeling anxious and asks to
smoke. Which statement by the nurse would be most therapeutic?
A. “Smoking is the reason you are here.”
B. “The doctor left orders for you not to smoke.”
C. “You are anxious about the surgery. Do you see smoking as helping?”
D. “Smoking is OK right now, but after your surgery it is contraindicated.”
ANS: C
Rationale: Stating, “You are anxious about the surgery. Do you see smoking as helping?” acknowledges the client’s feelings and encourages the client to assess their previous
behavior. Saying, “Smoking is the reason you are here,” belittles the client. Citing the doctor’s orders does not address the client’s anxiety. Giving approval for smoking would
be highly detrimental to this client. Smoking is the single most lethal chemical carcinogen and accounts for about 30% of all cancer-related deaths.
- An oncology nurse educator is providing health education to a client who has been
diagnosed with skin cancer. The client’s wife has asked about the differences between
normal cells and cancer cells. What characteristic of a cancer cell should the educator
cite?
A. Malignant cells possess greater mobility than normal body cells.
B. Malignant cells contain proteins called tumor-associated antigens.
C. Chromosomes contained in cancer cells are more durable and stable than those
of normal cells.
D. The nuclei of cancer cells are unusually large, but regularly shaped.
ANS: B
Rationale: The cell membranes are altered in cancer cells, which affect fluid movement in and out of the cell. The cell membrane of malignant cells also contains proteins called
tumor-associated antigens. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism), though they are not always mobile. Fragility of chromosomes is commonly found when cancer cells are analyzed.
- A client’s most recent diagnostic imaging has revealed that lung cancer has
metastasized to the bones and liver. What is the most likely mechanism by which the
client’s cancer cells spread?
A. Apoptosis
B. Lymphatic circulation
C. Invasion
D. Angiogenesis
ANS: B
Rationale: Lymph and blood are key mechanisms by which cancer cells spread. Lymphatic spread (the transport of tumor cells through the lymphatic circulation) is the most common mechanism of metastasis. Apoptosis is a normal cell mechanism of programmed cellular death that helps eliminate cells that have DNA mutations to prevent disease. Cancer cells, however, can bypass this protective function, survive, and proliferate. Therefore, apoptosis would prevent the spread of cancer, not promote it. Invasion in cancer is the direct extension and penetration by cancer cells through neighboring tissue; the bones and liver in this case, however, are not neighboring tissues. Angiogenesis is the growth of new blood vessels that allow cancer cells to grow. However, it, in itself, is not a mechanism by which cancer cells spread.
- The nurse is describing some of the major characteristics of cancer to a client who has
recently received a diagnosis of malignant melanoma. When differentiating between
benign and malignant cancer cells, the nurse should explain differences in which of the
following aspects? Select all that apply.
A. Rate of growth
B. Ability to cause death
C. Cell size
D. Cell location
E. Ability to spread
ANS: A, B, E
Rationale: Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant. Both benign and malignant cells can occur anywhere in the body.
- When discussing with a client factors that distinguish malignant cells from benign
cells of the same tissue type, which characteristic should the nurse mention?
A. Slow rate of mitosis of cancer cells
B. Different proteins in the cell membrane
C. Differing size of the cells
D. Different molecular structure in the cells
ANS: B
Rationale: The cell membrane of malignant cells also contains proteins called tumor-associated antigens (e.g., carcinoembryonic antigen [CEA] and prostate-specific
antigen [PSA]), which develop over time as the cells become less differentiated (mature). These proteins distinguish malignant cells from benign cells of the same tissue type.
- The nurse is performing an initial assessment of a 75-year-old client who has just
relocated to the long-term care facility. During the nurse’s interview with the client, the
client admits drinking around 600 mL (20 oz) of vodka every evening. What types of
cancer does this put the client at risk for? Select all that apply.
A. Malignant melanoma
B. Brain cancer
C. Breast cancer
D. Esophageal cancer
E. Liver cancer
ANS: C, D, E
Rationale: 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. Alcohol increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast.
