Chapter 22: Care of Patients with Cancer

Question 1

A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer.
The client has been scheduled for surgery in 3 days. What action by the nurse is best?

Answer 1

Call the client at home the next day to review teaching.

Clients are often overwhelmed at a sudden diagnosis of cancer and may be more overwhelmed at the idea of a major operation so soon. This stress significantly impacts the clients ability to understand, retain, and recall information.

Question 2

A nurse reads on a hospitalized clients chart that the client is receiving teletherapy. What action by the nurse is best?

Answer 2

Coordinate continuation of the therapy

The client needs to continue with radiation therapy, and the nurse can coordinate this with the appropriate
department.

Question 3

A new nurse has been assigned a client who is in the hospital to receive iodine-131 treatment. Which action by the nurse is best?

Answer 3

Read the policy on handling radioactive excreta.

This type of radioisotope is excreted in body fluids and excreta (urine and feces) and should not be handled
directly. The nurse should read the facilitys policy for handling and disposing of this type of waste.

Question 4

A client in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate?

Answer 4

It is normal to be fatigued even for years afterward.

Regardless of the cause, radiation-induced fatigue can be debilitating and may last for months or years after treatment has ended. Rest and adequate nutrition can affect fatigue, but it is most important that the client understands this is normal.

Question 5

A client tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate?

Answer 5

Do not expose the radiation area to direct sunlight.

The skin overlying the radiation site is extremely sensitive to sunlight after radiation therapy has been completed. The nurse should inform the client to avoid sun exposure to this area. This advice continues for 1 year after treatment has been completed.

Question 6

A client is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important?

Answer 6

Assessing the IV site (and blood return) every hour

Intravenous chemotherapy can cause local tissue destruction if it extravasates into the surrounding tissues. Peripheral IV lines are more prone to this than centrally placed lines. The most important intervention is prevention, so the nurse would check hourly to ensure the IV site is patent, or frequently depending on facility policy.

Question 7

A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the
clients oral chemotherapy medications. What action by the nurse is most appropriate?

Answer 7

Wear personal protective equipment when handling the medications.

During the administration of oral chemotherapy agents, nurses must take the same precautions that are used when administering IV chemotherapy. This includes using personal protective equipment. These medications cannot be crushed, split, or chewed.

Question 8

The nurse working with oncology clients understands that which age-related change increases the older clients susceptibility to infection during chemotherapy?

Answer 8

Decreased immune function

As people age, there is an age-related decrease in immune function, causing the older adult to be more susceptible to infection than other clients.

Question 9

After receiving the hand-off report, which client should the oncology nurse see first?

Answer 9

Older client on chemotherapy with mental status changes

Older clients often do not exhibit classic signs of infection, and often mental status changes are the first
observation. Clients on chemotherapy who become neutropenic also often do not exhibit classic signs of infection.

Question 10

A client has a platelet count of 9800/mm3. What action by the nurse is most appropriate?

Answer 10

Instruct the client to call for help to get out of bed.

A client with a platelet count this low is at high risk for serious bleeding episodes. To prevent injury, the client should be instructed to call for help prior to getting out of bed

Question 11

A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL. What medication should the nurse prepare to administer?

Answer 11

Epoetin alfa (Epogen)

The clients hemoglobin is low, so the nurse should prepare to administer epoetin alfa, a colony-stimulating factor that increases production of red blood cells.

Question 12

A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority?

Answer 12

Teaching measures to prevent scalp injury

All of the actions are appropriate for clients with alopecia. However, the priority is client safety, so the nurse
should first teach ways to prevent scalp injury.

Question 13

A client is receiving interleukins along with chemotherapy. What assessment by the nurse takes priority?

Answer 13

Blood pressure

Interleukins can cause capillary leak syndrome and fluid shifting, leading to intravascular volume depletion.

Question 14

A client is receiving rituximab (Rituxan) and asks how it works. What response by the nurse is best?

Answer 14

It prevents the start of cell division in the cancer cells.

Rituxan prevents the initiation of cancer cell division

Question 15

Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients should the nurse assess first?

a. Client with dry, itchy, peeling skin
b. Client with a serum calcium of 9.2 mg/dL
c. Client with a serum potassium of 2.8 mEq/L
d. Client with a weight gain of 0.5 pound (1.1 kg) in 1 day

Answer 15

Client with a serum potassium of 2.8 mEq/L

TKIs can cause electrolyte imbalances. This potassium level is very low, so the nurse should assess this client first. Dry, itchy, peeling skin can be a problem in clients receiving biologic response modifiers, and the nurse should assess that client next because of the potential for discomfort and infection. This calcium level is
normal. TKIs can also cause weight gain, but the client with the low potassium level is more critical.

Question 16

A nurse is assessing a female client who is taking progestins /hormone therapy for breast cancer . What assessment finding requires the nurse to notify the provider immediately?

Answer 16

Red, warm, swollen calf

All clients receiving progestin therapy are at risk for thromboembolism. A red, warm, swollen calf is a manifestation of deep vein thrombosis and should be reported to the provider

Question 17

A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain.
What action by the nurse is most important?

Answer 17

Assess the clients gait and balance

This client has manifestations of spinal cord compression, which can be seen with prostate cancer. This may affect both gait and balance and urinary function. For client safety, assessing gait and balance is the priority.

Question 18

The nurse has taught a client with cancer ways to prevent infection. What statement by the client indicates that more teaching is needed?

Answer 18

Its alright for me to keep my pets and change the litter box.

Clients should wash their hands after touching their pets and should not empty or scoop the cat litter box. Risk for toxoplasmosis.

Question 19

A client has received a dose of ondansetron (Zofran) for nausea. What action by the nurse is most
important?

Answer 19

Assist the client in getting out of bed.

Ondansetron side effects include postural hypotension, vertigo, and bradycardia, all of which increase the clients risk for injury. The nurse should assist the client when getting out of bed.

Question 20

A nurse working with clients who experience alopecia knows that which is the best method of helping clients manage the psychosocial impact of this problem?

Answer 20

Assisting the client to pre-plan for this event

Alopecia does not occur for all clients who have cancer, but when it does, it can be devastating. The best action by the nurse is to teach the client about the possibility and to give the client multiple choices for preparing for this event

Question 21

A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate?

Answer 21

Gently inquire about advance directives

Superior vena cava syndrome is often a late-stage manifestation. After the client is stabilized and comfortable, the nurse should initiate a conversation about advance directives.

Question 22

A client is having a catheter placed in the femoral artery to deliver yttrium-90 beads into a liver tumor. What action by the nurse is most important?

Answer 22

Ensuring that informed consent is on the chart

This is an invasive procedure requiring informed consent. The nurse should ensure that consent is on the chart.

Question 23

A nurse works on an oncology unit and delegates personal hygiene to an unlicensed assistive personnel
(UAP). What action by the UAP requires intervention from the nurse?

Answer 23

Allowing a very tired client to skip oral hygiene and sleep

Even though clients may be tired, they still need to participate in hygiene to help prevent infection.

Question 24

A client with cancer has anorexia and mucositis, and is losing weight. The clients family members continually bring favorite foods to the client and are distressed when the client wont eat them. What action by the nurse is best?

Answer 24

Help the family show other ways to demonstrate love and cariing.

Families often become distressed when their loved ones wont eat. Providing food is a universal sign of caring,band to some people the refusal to eat signifies worsening of the condition. The best option for the nurse is to help the family find other ways to demonstrate caring and love, because with treatment-related anorexia and mucositis, the client is not likely to eat anything right now.

Question 25

A client in the emergency department reports difficulty breathing. The nurse assesses the clients appearance as depicted below:

Answer 25

Assess blood pressure and pulse.

This client has superior vena cava syndrome, in which venous return from the head, neck, and trunk is blocked. Decreased cardiac output can occur. The nurse should assess indicators of cardiac output, including blood pressure and pulse, as the priority

Question 26

The student nurse caring for clients who have cancer understands that the general consequences of cancer
include which client problems? (Select all that apply.)

Answer 26

Increased risk of infection from white blood cell deficits

Nutritional deficits such as early satiety and cachexia

Potential for reduced gas exchange

Various motor and sensory deficits

Increased risk of bone fractures

The general consequences of cancer include reduced immunity and blood-producing functions, altered GI structure and function, decreased respiratory function, and motor and sensory deficits.

Question 27

A nurse is preparing to administer IV chemotherapy. What supplies does this nurse need? (Select all that
apply.)

Answer 27

Chemo gloves
Facemask
Isolation/Impervious gown
Eye protection

The Occupational Safety and Health Administration (OSHA) and the Oncology Nurses Society have developed safety guidelines for those preparing or administering IV chemotherapy. These include double gloves (or “chemo” gloves), eye protection, a face mask,
and a gown.

Question 28

A client on interferon/ radtiation therapy is reporting severe skin itching and irritation. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

Answer 28

Apply moisturizers to dry skin.
Bathe the client using mild soap
Help the client pat skin dry after a bath
Make sure no clothing is rubbing the site.

The nurse can delegate applying moisturizer approved by the radiation oncologist using mild
soap for bathing, and helping the client pat wet skin dry after bathing. Any clothing worn over
the site should be soft and not create friction.

Question 29

A client has thrombocytopenia. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

Answer 29

Apply the clients shoes before getting the client out of bed.
Assist the client with ambulation.
Use a lift sheet to move the client up in bed.

Clients with thrombocytopenia are at risk of significant bleeding even with minor injuries. The nurse instructs the UAP to put the clients shoes on before getting the client out of bed, assist with ambulation, shave the client with an electric razor, use a lift sheet when needed to reposition the client, and use a soft-bristled toothbrush
for oral care.

Question 30

A client has mucositis. What actions by the nurse will improve the clients nutrition? (Select all that apply.)

Answer 30

Assist with rinsing the mouth with saline frequently.

Encourage the client to eat room-temperature foods.

Provide local anesthetic medications to swish and spit.

Remind the client to brush teeth gently after each meal.

Offer the client fluids to drink each hour.

Mucositis can interfere with nutrition. The nurse can help with rinsing the mouth frequently with water or saline; encouraging the client to eat cool, slightly warm, or room-temperature foods; providing swish-and-spit anesthetics; and reminding the client to keep the mouth clean by brushing gently after each meal.

Question 31

A clients family members are concerned that telling the client about a new finding of cancer will cause extreme emotional distress. They approach the nurse and ask if this can be kept from the client. What actions by the nurse are most appropriate? (Select all that apply.)

Answer 31

Ask the family to describe their concerns more fully.

Consult with a social worker, chaplain, or ethics committee.

Explain the clients right to know and ask for their assistance.

The clients right of autonomy means that the client must be fully informed as to his or her diagnosis and treatment options. The nurse cannot ethically keep this information from the client. The nurse can ask the family to explain their concerns more fully so everyone understands the concerns. A social worker, chaplain, or ethics committee can become involved to assist the nurse, client, and family. The nurse should explain the clients right to know and ask the family how best to proceed

Question 32

A client receiving chemotherapy has a white blood cell count of 1000/mm3. What actions by the nurse are most appropriate? (Select all that apply.)

Answer 32

Assess all mucous membranes every 4 to 8 hours.

Listen to lung sounds and monitor for cough.

Monitor the venous access device appearance with vital signs.

Take and record vital signs every 4 to 8 hours.

Depending on facility protocol, the nurse should assess this client for infection every 4 to 8 hours by assessing all mucous membranes, listening to lung sounds, monitoring for cough, monitoring the appearance of the
venous access device, and recording vital signs. Eating meat and poultry is allowed

Question 33

A nurse is caring for a client admitted for Non-Hodgkin’s lymphoma and chemotherapy. The client reports nausea, flank pain, and muscle cramps. What action by the nurse is most important?

Answer 33

Request an order for serum electrolytes and uric acid

This client’s reports are consistent with tumor lysis syndrome, for which he or she is at risk due to the diagnosis. Early symptoms of TLS stem from electrolyte imbalances and can include lethargy, nausea, vomiting, anorexia, flank pain, muscle weakness, cramps, seizures, and altered mental status. The nurse would notify the primary health care provider and request an order for serum electrolytes

Question 34

The nurse has educated a client on precautions to take with thrombocytopenia. What statement by the client indicates a need to review the information?

Answer 34

“I will be careful if I need enemas for constipation.”

The thrombocytopenic client is at high risk for bleeding even from minor trauma. Due to the risk of injuring rectal and anal tissue, the client should not use enemas or rectal thermometers. This statement would indicate the client needs more information.

Question 35

A client is receiving rituximab. What assessment by the nurse takes priority?

Answer 35

Blood pressure

Rituximab can cause infusion-related reactions, including hypotension, so monitoring blood pressure is the priority. Other complications of this drug include fever with chills/rigors, headache and abdominal pain, shortness of breath, bronchospasm, nausea and vomiting, and rash.

Question 36

Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients would the nurse assess first?

a. Dry, itchy, peeling skin
b. Serum calcium of 9.2 mg/dL (2.3 mmol/L)
c. Serum potassium of 2.8 mEq/L (2.8 mmol/L)
d. Weight gain of 0.5 lb (1.1 kg) in 1 day

Answer 36

Serum potassium of 2.8 mEq/L (2.8 mmol/L)

TKIs can cause electrolyte imbalances. This potassium level is very low, so the nurse would assess this client first.

Question 37

A client with long-standing heart failure being treated for cancer has received a dose of ondansetron for nausea. What action by the nurse is most important?

Answer 37

Request a prescription for cardiac monitoring

5-HT3 antagonists, such as ondansetron, can prolong the QT interval within the cardiac conduction cycle. ECG monitoring is recommended in patients with electrolyte abnormalities (e.g., hypokalemia or hypomagnesemia), heart failure, bradyarrhythmias or patients taking other medications that can cause QT prolongation. The nurse would contact the primary
health care provider and request cardiac monitoring.