ATI Med Surg: Oncology – Flashcards
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A nurse is developing a care plan for a client immediately following a bone marrow transplant. Which of the following post transplact concerns should be the nurse's highest priority? a. pain b. social isolation c. risk for infection d. graft-versus-host disease
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C The major cause of death in the first week to 10 days following a bone marrow transplant is infection. A great deal of the client's care should be directed at maintaining a micro-organism-free environment making this the priority concern.
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A client with breast cancer is receiving a combination of chemotherapy agents. The nurse identifies the rationale for this combined treatment modality is that the a. risk for renal toxicity is lessened b. agents act at different stages of cellular mitosis c. length of treatment will be shorter d. potential for bone marrow suppression is eliminated
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B Different chemotherapeutic agents act at various stages of cellular mitosis (division). By combining agents, medication therapy is more effective in stopping or slowing the growth of cancerous cells by interfering with their ability to multiply
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A client is receiving external radiation therapy. Which of the following statements indicates to the nurse that the client understands the discharge teaching plan? a. I need to protect the area from sunlight b. I'm going to apply skin cream every day to the area c. I'll massage the area once a day d. I will wash the markings off after each therapy treatment
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A Areas of skin that have received radiation should be protected from sunlight. This prevents skin irritation and subsequent breakdown
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A client with multiple myeloma is admitted to the unit with a white blood cell count of 2,200/mm3. Which of the following foods should the nurse prohibit family members from bringing to the client? a. fried chicken from a fast food shop b. a gift basket of bagels c. a factory-sealed box of chocolates d. a fresh fruit basket
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D Raw fruits and vegetables are contraindicated for this client since the skin may harbor bacteria that can cause an infection in this client. These foods should not be brought into the client's room or consumed by the client.
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A client with leukemia suffers a relapse, and the provider recommends a bone marrow transplant. After the provider leaves, the client asks the nurse, "do they put the marrow back in me the same way they took it out for a biopsy?" Which of the following responses should the nurse make? a. No, it's transfused just like any other blood component into your central IV line b. Yes, it's replaced directly into the bone like a biopsy, but it requires several sites c. Yes, however, you will not feel it because they will do it in the OR under anesthesia d. I'll get the doctor back in here to answer the rest of your questions
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A Harvested marrow is transfused into the recipient like any other blood component via the client's central IV line
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A nurse is preparing to discharge a client who had a right radical mastectomy 2 days ago and will be going home with drains still in the incision. When developing a discharge plan of care for this client, which of the following is appropriate for the nurse to include? a. empty the reservoir bulb attached to the drain once a day b. avoid exercises that raise the right arm over the head for 6 weeks c. take your blood pressure on the left arm d. report numbness of the inner right arm to the provider
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C Due to the risk of lymphedema from lymph node removal, the client's blood pressure should never be taken in the right arm
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A nurse is caring for a client who has just begun chemotherapy for acute lymphoma. The plan of care indicates that signs of tumor lysis syndrome should be part of the nursing assessment. Which of the following assessment findings are consistent with tumor lysis syndrome? a. polyuria b. muscle weakness c. flank pain d. hypotension
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C Tumor lysis syndrome is the development of electrolyte and metabolic disturbances that may result in life-threatening complications if not managed appropriately. Tumor lysis syndrome is caused by the sudden rapid death of cells, particularly cancer cells in clients with leukemia or lymphoma, in response to chemotherapy. Lab results will show high potassium, uric acid, and phosphorous levels and low calcium levels in the blood. If untreated, progression of tumor lysis syndrome may cause acute kidney failure, cardiac arrythmias, seizures, loss of muscle control, and death. Flank pain is a symptom of tumor lysis syndrome secondary to the strain placed on the kidneys to excrete large amounts of intracellular metabolites.
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A client is being evaluated in an oncology clinic after referral by the client's provider for suspicion of Hodgkin's disease. Secondary to this possible diagnosis, the nurse should focus on assessing for which of the following? a. bone and joint pain b. enlarged lymph nodes c. difficulty swallowing d. patchy alopecia
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B Hodgkin's disease is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. The first sign of cancer is often an enlarged lymph node which appears without a known cause. The disease can spread to adjacent lymph nodes and later may spread outside the lymph nodes to the lungs, liver, bones, or bone marrow
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A nurse is caring for a client who has been diagnosed with cancer in situ. The client asks the nurse what type of cancer this is. An appropriate response by the nurse would be that cancer in situ is when abnormal cell production a. has spread to a distant site b. has infiltrated the lymph nodes c. has invaded surrounding tissue d. has developed with a localized area
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D Cancer-in-situ is an early stage of cancer that is limited to the site of origin
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A nurse is developing a plan of care for a client with metastatic lung cancer who is at risk for the development of superior vena cava syndrome. The nurse includes in the plan to assess the client frequently for early manifestations of superior vena cava syndrome including a. irregular cardiac rhythm b. change in the level of consciousness c. wasting of the arms d. facial edema
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D Superior vena cava syndrome is a partial occlusion of the superior vena cava. This leads to a lower than normal blood flow through this major vein. Most cases of superior vena cava syndrome are associated with cancers involving the upper chest, such as advanced lung cancers and lymphoma. Cancers that have metastasized to the chest have also been shown to cause superior vena cava syndrome. The earliest manifestations of superior vena cava syndrome are facial and upper extremity edema.
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A nurse in an oncology clinic is conducting an assessment on a client with multiple myeloma. In relation to lab findings commonly associated with this diagnosis, the nurse should carefully assess the client for manifestations related to which of the following? a. hypocalcemia b. thrombocytopenia c. leukocytosis d. polycythemia
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B Multiple myeloma is the excessive growth and proliferation of abnormal plasma cells in the lymph nodes and bone marrow. The growth of these extra plasma cells interferes with the production of red blood cells (causing anemia), white blood cells (causing increased susceptibility to infection), and platelets, or thrombocytes (causing bleeding tendencies). Other effects include bone pain, destruction, and renal failure.
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Four weeks after a bone marrow transplant, a client develops a fever and a rash on the hands and feet. Based on these findings the nurse should suspect that the client is experiencing which of the following conditions? a. an allergic response to medication b. side effects of radiation therapy c. veno-occlusive disease of the liver d. graft-versus-host disease
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D Temperature elevation and rash on the hands and feet are early manifestations of graft-versus-host disease (GVHD), which usually occurs between 10 and 100 days following the transplant. In GVHD, T-cells from the donor bone marrow attack and destroy vulnerable host cells. Glucocorticoids and cyclosporine may be used to treat the condition.
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A client is admitted to the hospital after being treated with vincristine for cancer. The client reports being diagnosed with peripheral neuropathy due to chemotherapy. When assessing the client, the nurse should expect to see which of the following clinical manifestations in the client's extremities? a. edema b. tingling c. ataxia d. spasms
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B Several chemotherapeutic agents, including vincristine, may cause peripheral neuropathy. One of the major manifestations of peripheral neuropathy is numbness and/or tingling of an extremity.
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A client who has a suspected ovarian tumor is scheduled to have a pelvic ultrasound. In preparing the client for the procedure, the nurse instructs the client to a. drink 4-6 glasses of water and do not void b. have nothing to eat or drink after midnight c. self-administer an enema the night before the procedure d. abstain from sexual intercourse the night before
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A The ultrasound machine sends out high-frequency sound waves which bounce off body structures to create a picture. A pelvic ultrasound requires a full bladder to batter visualize and identify the organs and structures in the pelvis. To accomplish this, the nurse should instruct the client to drink 4-6 full glasses of water just prior to the procedure and not to void.
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A sibling of a client recently diagnosed with colon cancer questions the nurse in regard to the carcinoembryonic antigen (CEA) blood test. Appropriate information from the nurse should include, "the CEA test is a. most helpful in monitoring the progress of the disease in clients already being treated for colon cancer b. an effective screening test and is indicated due to your family history of colon cancer c. recommended by the American Cancer Association to be performed yearly starting at age 50 d. Used to confirm the diagnosis if a client has symptoms consistent with colon or rectal cancer.
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A CEA is a substance produced by cells of most colon and rectal cancers and released into the blood stream. CEA levels should return to normal following successful treatment. If follow-up tests detect a steady increase in CEA levels, additional testing is recommended to find out if the cancer, it is not used as a screening test for colon cancer in clients who have not been diagnosed with cancer and appear to be healthy
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A client with uterine cancer is receiving chemotherapy and develops thrombocytopenia. Due to this side effect, the nurse should plan to give the greatest consideration to which of the following? a. monitoring visitors for signs of infection b. reminding the client to use an electric razor c. encouraging frequent rest periods d. instructing the client to vigorously brush and floss the teeth
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B Thrombocytopenia is a decrease in the client's platelet count, which places the client at an increased risk of bleeding due to an inability to clot. Therefore, nursing measures that include taking bleeding precautions should be instituted, which include the use of electric, rather than blade, razors when shaving the face, underarms, and legs.
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A client with bladder cancer is being treated with intravesical administration of immunotherapy. During the treatment, the nurse should do which of the following? a. maintain the client in the trendelenburg position for at least 2 hours b. tell the client to get up to urinate when he feels the urge c. assist the client with changing positions every 15 minutes for 2 hours d. have a gown and mask ready for removal of the fluid from the bladder
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C Intravesical therapy is a procedure where Bacillus Calmetter-Guerin (BCG) or interferon-alpha, is instilled directly into the bladder through a catheter. This local administration of therapy reduces the side effects often present with traditional systemic chemotherapy. The goal of intravesical therapy is to prevent bladder tumors from growing or progressing. BCG, a bacterium similar to that sometimes used to vaccinate people against tuberculosis, is a type of intravesical immunotherapy that is very useful for treating recurrent bladder cancer. The medication remains in the bladder for up to 2 hours. During that time, the nurse assists the client in changing position every 15 min to evenly distribute the medication on the bladder and tumor surfaces.
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A nurse anticipates that a client who is receiving antineoplastic medications may manifest which of the following side effects? a. gingival hyperplasia b. hirsutism c. aplastic anemia d. weight gain
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C Aplastic anemia is a sign of bone marrow suppression, which is a common side effect chemotherapeutic agents. Aplastic anemia results in pancytopenia, a decrease in white blood cells, red blood cells, and platelet count.
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An adolescent female client who had a successful bone marrow transplant is being discharged. Which of the following information should the nurse include as a part of the discharge plan? Select all that apply a. take you temperature twice a day b. you may return to school if you feel strong enough c. it is important to always wear shoes d. clean your toothbrush weekly with isopropyl alcohol e. avoid using tampons
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Clients post bone marrow transplant are immunosuppressed and should continually monitor for signs of infection. A temperature that is greater than 38 C should be reported immediately to the provider A client who had a bone marrow transplant is immunosuppressed and should wear shoes to prevent injury and increase the risk for infection The use of tampons is discouraged because they can disrupt the muscousal layer of the vagina and if left in too long can support the growth of bacteria
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A client receiving chemotherapy every few weeks is told by the provider what is nadir was at his last treatment. When asked by the client what a nadir is, an appropriate answer by the nurse would be which of the following? The nadir is the a. lowest point your blood count reached after treatment b. highest point your blood count reaches after treatment c. point at which the next dose of chemo can be given again d. point at which chemo is determined to be effective
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The nadir is the lowest point that blood counts reach prior to recover and after an antineoplastic treatment is given. This occurs approximately 10 days after an antineoplastic treatment
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In providing health teaching to a group of clients, it is important for the nurse to emphasize that melanoma is characterized by lesions that have which of the following appearances? a. are predominatly one solid color b. are symmetrical in shape c. are less than 6 mm in diameter d. have an irregular border
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D using the ABCD pneumonic a melanotic skin lesion may exhibit one or more of the following characteristics; asymmetry of the shape, border irregularity, color that varies within the lesion, and a diameter than is 6 mm or greater
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A nurse is teaching a client how to perform a BSE. which finding should the nurse instruct the client to report promptly to her provider? a. lumps that are mobile and tender upon palpation prior to a menstrual period b. multiple round masses that are tender and found in both breasts c. bilaterally darkened areolas d. one non-tender hard lump that is palpated in the upper outer quadrant of the breast
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D cancerous tumors are typically hard and non-tender to palpation. The upper-outer quadrant of the breast is the most common site for breast cancer to occur. The client should be taught to notify the provider promptly if a hard, non-tender lump is palpated in the upper-outer quadrant of the breast.
