Chapter 22 - Care of Patients with Cancer
When caring for a client who has had a colostomy created during treatment for colon cancer, which nursing actions help support the client in accepting changes in appearance or function? Select all that apply.
- Explain to the client that the colostomy is only temporary.
- Encourage the client to participate in changing the ostomy.
- Obtain a psychiatric consultation.
- Offer to have a person who is coping with a colostomy visit with the client.
- Encourage the client and family members to express their feelings and concerns.
B. Encourage the client to participate in changing the ostomy.
D. Offer to have a person who is coping with a colostomy visit with the client.
E. Encourage the client and family members to express their feelings and concerns.
A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which client is most appropriate to assign to the new graduate?
- A 30-year-old with acute lymphocytic leukemia who will receive combination chemotherapy today
- A 40-year-old with chemotherapy-induced nausea and vomiting who has had no urine output for 16 hours
- A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit)
- A 72-year-old with tumor lysis syndrome who is receiving normal saline IV at a rate of 250 mL/hr
C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit)
The nurse is caring for a client who is receiving rituximab (Rituxan) for treatment of lymphoma. During the infusion, it is essential for the nurse to observe for which side effect?
Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy?
- Potential for lack of understanding related to side effects of chemotherapy
- Potential for injury related to sensory and motor deficits
- Potential for ineffective coping strategies related to loss of motor control
- Altered sexual function related to erectile dysfunction
B. Potential for injury related to sensory and motor deficits
The RN working on an oncology unit has just received report on these clients. Which client should be assessed first?
- Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature
- Client with lymphoma who will need administration of an antiemetic before receiving chemotherapy
- Client with metastatic breast cancer who is scheduled for external beam radiation in 1 hour
- Client with xerostomia associated with laryngeal cancer who needs oral care before breakfast
A. Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature
Which instruction is most appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy?
- Bathe in cold water.
- Wear cotton gloves when cooking.
- Consume a diet high in fiber.
- Make sure shoes are snug.
C. Consume a diet high in fiber.
An outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection?
- Storing drugs in dark locations at room temperature
- Wearing soft clothing
- Wearing a hat and sunglasses when going outside
- Reducing all direct and indirect sources of light
D. Reducing all direct and indirect sources of light
The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body?
- Veins of the legs
- Abdominal cavity
D. Abdominal cavity
Which statement made by a client allows the nurse to recognize whether the client receiving brachytherapy for ovarian cancer understands the treatment?
- “I may lose my hair during this treatment.”
- “I must be positioned in the same way during each treatment.”
- “I will have a radioactive device in my body for a short time.”
- “I will be placed in a semiprivate room for company.”
C. “I will have a radioactive device in my body for a short time.”
When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful?
- Administering a biological response modifier
- Encouraging oral care with commercial mouthwash
- Providing oral care with a disposable mouth swab
- Maintaining NPO until the lesions have resolved
C. Providing oral care with a disposable mouth swab
The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia?
- Monitor weight.
- Trend red blood cells and hemoglobin and hematocrit.
- Monitor platelets.
- Observe for motor deficits.
A. Monitor weight.
The nurse is caring for a client with end-stage ovarian cancer who needs clarification on the purpose of palliative surgery. Which outcome should the nurse teach the client is the goal of palliative surgery?
- Cure of the cancer
- Relief of symptoms or improved quality of life
- Allowing other therapies to be more effective
- Prolonging the client’s survival time
B. Relief of symptoms or improved quality of life
The nurse corrects the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance?
- The student demonstrates asepsis by scrubbing the hub of IV tubing before administering an antibiotic.
- The nurse overhears the student explaining to the client the importance of handwashing.
- The student teaches the client that symptoms of neutropenia include fatigue and weakness.
- The nurse observes the student educating the client about hygiene and perineal care.
C. The student teaches the client that symptoms of neutropenia include fatigue and weakness.
The nurse is teaching a client who is receiving an antiestrogen drug about the side effects she may encounter. Which side effects does the nurse include in the discussion? Select all that apply.
- Heavy menses
- Smooth facial skin
- Breast tenderness
- Weight loss
- Deep vein thrombosis
D. Breast tenderness
F. Deep vein thrombosis
The nurse is caring for a client with hyperuricemia associated with tumor lysis syndrome (TLS). Which medication does the nurse anticipate being ordered?
- Recombinant erythropoietin (Procrit)
- Allopurinol (Zyloprim)
- Potassium chloride
- Radioactive iodine-131 (131I)
B. Allopurinol (Zyloprim)
Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting?
- Ondansetron (Zofran)
- Naloxone (Narcan)
- Diazepam (Valium)
B. Ondansetron (Zofran)
A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time?
- Explain that this occurs in some clients and is usually permanent.
- Inform the client that a small glass of wine may help her relax.
- Protect the client from infection.
- Allow the client an opportunity to express her feelings.
D. Allow the client an opportunity to express her feelings.
Which finding alarms the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3 (17 × 109/L)?
- Increasing shortness of breath
- Diminished bilateral breath sounds
- Change in mental status
- Weight gain of 4 pounds (1.8 kg) in 1 day
C. Change in mental status
Which potential side effects does the nurse include in the teaching plan for a client undergoing radiation therapy for laryngeal cancer? Select all that apply.
- Changes in color of hair
- Change in taste
- Changes in skin of the neck
- Difficulty swallowing
C. Change in taste
D. Changes in skin of the neck
E. Difficulty swallowing
The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression?
- Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8%
- Potassium level of 2.9 mEq/L (2.9 mmol/L) and diarrhea
- 250,000 platelets/mm3 (250 × 109/L)
- 5000 white blood cells/mm3 (5 × 109/L)
A. Hemoglobin of 7.4 g/dL (74 mmol/L) and hematocrit of 21.8%
When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication?
- Drug toxicity
- Dose-limiting side effects
When caring for the client receiving cancer chemotherapy, which signs or symptoms related to thrombocytopenia should the nurse report to the health care provider? Select all that apply.
The nurse has received in report that a client receiving chemotherapy has severe neutropenia. Which interventions does the nurse plan to implement? Select all that apply.
- Assess for fever.
- Observe for bleeding.
- Administer pegfilgrastim (Neulasta).
- Do not permit fresh flowers or plants in the room.
- Do not allow the client’s 16-year-old son to visit.
- Teach the client to omit raw fruits and vegetables from the diet.
A. Assess for fever.
C. Administer pegfilgrastim (Neulasta).
D. Do not permit fresh flowers or plants in the room.
F. Teach the client to omit raw fruits and vegetables from the diet.
When monitoring a client with suspected syndrome of inappropriate antidiuretic hormone (SIADH), the nurse reviews the client’s medical record, which contains the following information. The nurse notifies the health care provider for which signs and symptoms consistent with this syndrome? Physical Assessment Findings Diagnostic Findings Medications Neuro: Episodes of confusion Cardiac: Pulse 88 and regular Musculoskeletal: Weakness, tremors Na: 115 mEq/L (115 mmol/L)K: 4.2 mEq/L (4.2 mmol/L)Creatinine: 0.8 mg/dL (70.8 mcmol/L)Ondansetron (Zofran) Cyclophosphamide (Cytoxan) Select all that apply.
- Mental status changes
B. Mental status changes
The oncology nurse should use which intervention to prevent disseminated intravascular coagulation (DIC)?
- Monitoring platelets
- Administering packed red blood cells
- Using strict aseptic technique to prevent infection
- Administering low-dose heparin therapy for clients on bedrest
C. Using strict aseptic technique to prevent infection
Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately?
- New onset of fatigue
- Edema of arms and hands
- Dry cough
- Weight gain
B. Edema of arms and hands