Chapter 22: Care of Patients with Cancer – Flashcards
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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?
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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 client's ability to understand, retain, and recall information. The nurse should call the client at home the next day to review the teaching and to answer questions
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A nurse reads on a hospitalized client's chart that the client is receiving teletherapy. What action by the nurse is best?
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Coordinate continuation of the therapy. The client needs to continue with radiation therapy, and the nurse can coordinate this with the appropriate department.
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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?
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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 facility's policy for handling and disposing of this type of waste
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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?
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"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.
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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?
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"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.
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A client is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important?
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Assessing the IV site 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 should check hourly to ensure the IV site is patent, or frequently depending on facility policy. Education and monitoring for side effects such as nausea are important for all clients receiving chemotherapy. Warm packs may be helpful for comfort, but if the client reports that an IV site is painful, the nurse needs to assess further.
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A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the client's oral chemotherapy medications. What action by the nurse is most appropriate?
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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.
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The nurse working with oncology clients understands that which age-related change increases the older client's susceptibility to infection during chemotherapy?
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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.
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After receiving the hand-off report, which client should the oncology nurse see first?
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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.
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A client has a platelet count of 9800/mm3. What action by the nurse is most appropriate?
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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.
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A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL. What medication should the nurse prepare to administer?
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Epoetin alfa (Epogen) The client's hemoglobin is low, so the nurse should prepare to administer epoetin alfa, a colony-stimulating factor that increases production of red blood cells
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A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority?
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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.
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A client is receiving interleukins along with chemotherapy. What assessment by the nurse takes priority?
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Blood pressure Interleukins can cause capillary leak syndrome and fluid shifting, leading to intravascular volume depletion. Although all assessments are important in caring for clients with cancer, blood pressure and other assessments of fluid status take priority.
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A client is receiving rituximab (Rituxan) and asks how it works. What response by the nurse is best?
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"It prevents the start of cell division in the cancer cells."
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Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients should the nurse assess first?
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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.
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A nurse is assessing a female client who is taking progestins. What assessment finding requires the nurse to notify the provider immediately?
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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. Irregular menses, edema in the lower extremities, and breast tenderness are common side effects of the therapy.
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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?
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Assess the client's 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.
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The nurse has taught a client with cancer ways to prevent infection. What statement by the client indicates that more teaching is needed?
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"It's 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.
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A client has received a dose of ondansetron (Zofran) for nausea. What action by the nurse is most important?
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Assist the client in getting out of bed. Ondansetron side effects include postural hypotension, vertigo, and bradycardia, all of which increase the client's risk for injury. The nurse should assist the client when getting out of bed.
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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?
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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. Not all clients will have the same reaction, but some possible actions the client can take are buying a wig ahead of time, buying attractive hats and scarves, and having a hairdresser modify a wig to look like the client's own hair.
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A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate?
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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.
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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?
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Ensuring that informed consent is on the chart
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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?
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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.
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A client with cancer has anorexia and mucositis, and is losing weight. The client's family members continually bring favorite foods to the client and are distressed when the client won't eat them. What action by the nurse is best?
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Help the family show other ways to demonstrate love and caring. Families often become distressed when their loved ones won't eat. Providing food is a universal sign of caring, and 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.
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A client in the emergency department reports difficulty breathing. The nurse assesses the client's appearance as depicted below: What action by the nurse is the priority?
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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.
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The student nurse caring for clients who have cancer understands that the general consequences of cancer include which client problems? (Select all that apply.)
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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 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. Clotting problems often occur due to thrombocytopenia (not enough platelets), not thrombocythemia (too many platelets).
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A nurse is preparing to administer IV chemotherapy. What supplies does this nurse need? (Select all that apply.)
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"Chemo" gloves Facemask Isolation gown 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), a facemask, and a gown.
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A client on interferon therapy is reporting severe skin itching and irritation. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)
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Apply moisturizers to dry skin. Bathe the client using mild soap.
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A client has thrombocytopenia. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)
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Apply the client's 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 client's 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.
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A client has mucositis. What actions by the nurse will improve the client's nutrition? (Select all that apply.)
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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. 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.
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A client's 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.)
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Ask the family to describe their concerns more fully. Consult with a social worker, chaplain, or ethics committee. Explain the client's right to know and ask for their assistance.
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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.)
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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.
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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?
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Relief of symptoms or improved quality of life
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Which statement made by a client allows the nurse to recognize whether the client receiving brachytherapy for ovarian cancer understands the treatment plan?
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"I will have a radioactive device in my body for a short time." Brachytherapy refers to short-term insertion of a radiation source. Side effects of radiation therapy are site-specific; this client is unlikely to experience hair loss from treating ovarian cancer with radiation.
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When caring for a client receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication?
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Infection The lowest point of bone marrow function is referred to as the nadir; risk for infection is highest during this phase.
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The nurse teaches a client that intraperitoneal chemotherapy will be delivered to which part of the body?
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Abdominal cavity
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The oncology nurse is caring for a group of clients receiving chemotherapy. The client with which sign/symptom is displaying bone marrow suppression?
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Hemoglobin of 7.4 and hematocrit of 21.8 Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; the client with a hemoglobin of 7.4 and hematocrit of 21.8 has anemia demonstrated by low hemoglobin and hematocrit.
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The nurse corrects the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance?
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The student teaches the client that symptoms of neutropenia include fatigue and weakness. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected.
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When caring for the client with chemotherapy-induced mucositis, which intervention will be most helpful?
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Providing oral care with a disposable mouth swab The client with mucositis would benefit most from oral care; mouth swabs are soft and disposable and therefore clean and appropriate to provide oral care.
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A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which nursing intervention is indicated at this time?
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Allow the client an opportunity to express her feelings. Although no specific intervention for this side effect is known, therapeutic communication and listening may be helpful to the client.
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Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy?
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Potential for injury related to sensory and motor deficits
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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?
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Allergy Allergy is the most common side effect of monoclonal antibody therapy (rituximab).
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The oncology nurse should use which intervention to prevent disseminated intravascular coagulation (DIC)?
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Using strict aseptic technique to prevent infection Sepsis is a major cause of DIC, especially in the oncology client.
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When caring for the client with hyperuricemia associated with tumor lysis syndrome (TLS), for which medication does the nurse anticipate an order?
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Allopurinol (Zyloprim) TLS results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances; allopurinol decreases uric acid production and is indicated in TLS.
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The nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia?
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Monitor weight
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Which finding alarms the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3?
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Change in mental status A change in mental status could result from spontaneous bleeding; in this case, a cerebral hemorrhage may have developed
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Which instruction is most appropriate for the nurse to convey to the client with chemotherapy-induced neuropathy?
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Consume a diet high in fiber. A high-fiber diet will assist with constipation due to neuropathy.
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Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea and vomiting?
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Ondansetron (Zofran)
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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?
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A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to correct anemia.
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The RN working on an oncology unit has just received report on these clients. Which client should be assessed first?
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Client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune-suppressed people; the nurse should see the client with chemotherapy-induced neutropenia first.
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An outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection?
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Reducing all direct and indirect sources of light Lighting of all types must be kept to a minimum with clients receiving photodynamic therapy; it can lead to burns of the skin and damage to the eyes because these clients' eyes are sensitive to light
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Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately?
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Edema of arms and hands Edema of the arms and hands indicates worsening compression of the superior vena cava consistent with superior vena cava syndrome. The compression must be relieved immediately, often with radiation therapy, because death can result without timely intervention.
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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.)
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Fatigue Change in taste Changes in skin of the neck Difficulty swallowing
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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.)
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Bruises fever petechiae epistaxis
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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? (Select all that apply.) assessment: Neuro: Episodes of confusion Cardiac: Pulse 88 and regular Musculoskeletal: Weakness, tremors Diagnostic findings: Na: 115 K: 4.2 Creatinine: 0.8 medication: ondansetron (Zofran) cyclophosphamide (Cytoxan)
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Hyponatremia Mental status changes Weakness
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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.)
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Encourage the client to participate in changing the ostomy. Offer to have a person who is coping with a colostomy visit. Encourage the client and family members to express their feelings and concerns.
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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.)
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Assess for fever. Administer pegfilgrastim (Neulasta). Do not permit fresh flowers or plants in the room. Teach the client to omit raw fruits and vegetables from the diet.
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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.)
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Breast tenderness Deep vein thrombosis
