test 3

Question 1

Chemotherapy complications

Answer 1

N/V/anorexia
Immunosuppression/neutropenia
Alopecia
Oral effects- Mucositis and stomatitis
Anemia and thrombocytopenia

Question 2

Neutropenic precautions

Answer 2

Private room
* Client in mask if they leave
the room
* Protect from sources of
infection
* Frequent hand hygiene
* No ill visitors
* Avoid invasive procedures
* Dedicated equipment in
room

Question 3

Immunosuppression/neutropenia education

Answer 3

Avoid crowds
* Daily temp
* Avoid food that could
contain bacteria
* Avoid yard work
* Avoid cleaning pet’s litter
box
* Discard beverage sitting
at room temp >1 hour
* Wash dishes in hot,
soapy water or
dishwasher
* Do not share toiletry or
personal hygiene items
w/others

Question 4

when should you report a fever during chemo?

Answer 4

Report temp > 37.8 C (100 F) immediately

Question 5

what kind of catheter do you use for chemo?

Answer 5

central catheter

Question 6

Nursing considerations for Nausea and vomiting

Answer 6

Give antiemetics before chemo and when
CINV present
» Administer for several days afterwards
– Non-pharmacological methods to reduce
nausea
– Remove vomiting cues
– Calorie counts to ensure adequate intake
» Liquid nutritional supplement PRN
– Megesterol to increase appetite
– Mouth care prior to meals – enhance appetite

Question 7

oral effects complications for chemo nursing considerations

Answer 7

Education
– Rinse mouth w/0.9% NaCL, room-temp
tap water, salt/soda water
» Frequency depends on mucositis
– Gentle flossing/brushing
– Rinse mouth before/after meals
– Meds to prevent infection as prescribed
– Soft, bland foods/supplements high in
calories
– Avoid alcohol/smoking
– At least 2L water/day

Question 8

adverse effects of cytotoxic chemo

Answer 8

unintentional harm to normal cells
* i.e. – mucous membranes in GI tract, hair follicles,
bone marrow

Question 9

Alopecia education

Answer 9

Avoid using damaging hair care measures
– Consider cutting short before treatment
– After hair loss – protect from sun exposure

Question 10

when does alopecia normally begin?

Answer 10

7-10 days after treatment and hair should return about 1 month after treatment

Question 11

Anemia/thrombocytopenia nursing considerations

Answer 11

Nursing (thrombocytopenia)
– Monitor for petechiae, bleeding (gums,
nosebleeds), frank blood in stool, urine, vomit
– Bleeding precautions
» Avoid IV’s/injections
» If necessary – smallest needle
possible
» Pressure for 10 minutes
» Handle gently/avoid trauma
– Admin thromopoietic meds to stimulate platelet
production
– Prepare to admin platelets if count
<10,000/mm3

Question 12

what is brachytherapy

Answer 12

internal – body fluids contaminated, body waste
disposed of appropriately
Radiation placed close to target tissue
* Tumor and limited amount of surrounding
tissues
* Clients remain in facility until therapy complete
– Seed implants may be able to go home

Question 13

brachytherapy nursing considerations

Answer 13

Private room, door closed
* Sign on door warning of radiation source
* Wear a dosimeter film badge
– Records personal amount of radiation
exposure
* Limit visitors to 30 minutes, remain 6 feet from
source
Nursing (cont’d)
* Lead apron when providing care
* Lead container in room, tongs available
* Follow protocol re: removal of dressings and
bedding
– Generally, kept in room until rad source is
removed

Question 14

what is teletherapy

Answer 14

External does not cause client to be radioactive

Question 15

teletherapy

Answer 15

Skin over target area marked with tattoos
– Guide position of external rad source
* Well balanced meal
– No red meat
– Can cause altered taste
* Fatigue
– Schedule activities w/rest periods
* Monitor for skin/mucous membrane injury
– Skin: blanching, redness, sloughing,
hemorrhage, outer layer of skin shedding
– Mouth: mucositis, dry mouth
– Neck: diff swallowing
– Abdomen: gastroenteritis

Question 16

Mammogram screening

Answer 16

annually >40 y.o

Question 17

Clinical breast exam

Answer 17

annually >40
y.o.; every 3 years 20 to 39

Question 18

colonoscopy

Answer 18

At age 50, then q10
years

Question 19

Fecal occult blood

Answer 19

annually for adults

Question 20

Digital rectal exam

Answer 20

men greater than 50

Question 21

Gene mutations screening

Answer 21

clients w/strong
family hx of breast or colon CA

Question 22

cancer complications

Answer 22

malnutrition due to anorexia and weight loss
Constipation/gastric stasis/intestinal obstruction due to opioids
Paraneoplastic syndromes
– Result when ‘T’ cells attack normal cells rather than cancerous
cells

Question 23

Oncological emergencies

Answer 23

Superior vena cava syndrome
– Tumor/lymph node compresses superior vena
cava; reduced blood flow to the heart & venous
congestion, put client in high fowlers and give radiation

hypercalcemia- Manifestations: anorexia, N/V, shortened QT interval, kidney stones, bone pain, changes in mental status
– Nursing: admin 0.9% NaCl, furosemide,
pamidronate, phosphates as rx.

Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)Findings: N/V, lethargy, hostility,
seizures, coma
* Hematologic disorders
– Caused by CA or CA tx
* Anemia
* Disseminated intravascular
coagulation (DIC)

Question 24

Lung cancer complications

Question 25

lung cancer prevention

Answer 25

stop smoking – Use PPE (mask), proper ventilation in areas where carcinogens may be in the air – Screen annually for those at high risk (CT Scan)

Question 26

lung cancer risk factors

Answer 26

Risk Factors – Cigarette smoking (inc. secondhand) – Radiation exposure – Inhaled environmental irritants

Question 27

lung cancer findings

Answer 27

Persistent cough – poss. hemoptysis – Hoarseness – Alteration in breathing – Altered breath sounds (wheezing) * Diminished/absent (obstruction) – Clubbing of fingers – Increased work of breathing

Question 28

Leukemia

Answer 28

Cancer of the white blood cells

Question 29

Hodgkin’s lymphoma (HL)

Answer 29

Peaks in teens/young adults & adults in 50’s and 60’s * Viral infections and chemical agents * Starts in node or chain of nodes containing Reed- Sternberg cell. * Predictable spread – one group of lymph nodes to next * One of most treatable forms of cancer

Question 30

Non-Hodgkin’s lymphoma (NHL)

Answer 30

More common – men & older adults * Gene damage, viral infections, autoimmune disease, exposure to radiation/toxic chemicals * All lymphoid cancers that do not have Reed-Sternberg cell * Spreads in lymph system in erratic pattern

Question 31

Leukemia

Answer 31

Bone pain * Joint swelling * Enlarged liver/spleen * Anemia * Bleeding * Poor wound healing

Question 32

Hodgkin’s and non-Hodgkin’s lymphoma

Answer 32

Enlarged lymph nodes * Fever * Night sweats * Fatigue * Infections * Unplanned weight loss

Question 33

Leukemia and Lymphoma * Nursing care – Monitor for and prevent infection

Answer 33

Neutropenic precautions Frequent/thorough hand washing priority – Private room – Only healthy visitors; screen visitors – Restrict foods – think bacteria – no fresh/raw fruits or vegetables – Eliminate standing water; live plants flowers not allowed (depends on facility policy) – Encourage personal hygiene – Monitor WBC Prevent injury * Monitor platelets * Assess for bleeding * Protect and avoid trauma – Conserve energy

Question 34

Leukemia and Lymphoma * Complications

Answer 34

Pantocytopenia * Serious infection risk – ANC less than 1,000/mm3 * Neutropenic precautions – Thrombocytopenia * Increased risk of bleeding – Greatest risk – platelets less than 50,000/mm3 – Spontaneous bleeding less than 20,000/mm3 – HSCT Complications * Failure of stem cells to grow * Graft rejection

Question 35

Leukemia and Lymphoma * Therapeutic procedures

Answer 35

Hematopoietic stem cell transplantation Leukemia- chemo