Chapter 24 Care of Patients with Cancer (Nclex) – Flashcards

B. Relief of symptoms or improved quality of life Rationale A. Curative surgery removes all cancer cells, visible and microscopic. B. The focus of palliative surgery is to improve quality of life during the survival time. C. Debulking is a procedure that removes some cancerous tissue, allowing other therapies to be more effective. D. Many therapies such as surgery, chemotherapy, and biotherapy increase the client's chance of cure and survival. Palliation improves quality of life.

C. "I will have a radioactive device in my body for a short time." Rationale A. Side effects of radiation therapy are site specific. B. The client undergoing teletherapy (external beam radiation) must be positioned precisely in the same position each time. C. Brachytherapy refers to short-term insertion of a radiation source. D. The client who is receiving brachytherapy must be in a private room.

A. Fatigue C. Change in taste D. Changes in skin of the neck E. Difficulty swallowing Rationale Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair.

C. Nadir Rationale A. The peak of bone marrow function occurs when the client's blood levels are at their highest. B. Trough, which means low, is typically used in reference to drug levels. C. The lowest point of bone marrow function is referred to as the nadir. D. Adjuvant refers to use of radiation therapy or surgery along with chemotherapy in cancer treatment.

D. Into the abdominal cavity Rationale A. Intravenous drugs are delivered through veins. B. Chemotherapy delivered into the lungs is typically placed in the pleural space or is intrapleural. C. Chemotherapy is not typically delivered into the heart. D. Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity.

A. Client with hemoglobin of 7.4 and hematocrit of 21.8 Rationale A. Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has anemia demonstrated by low hemoglobin and hematocrit. B. Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has hypokalemia and electrolyte imbalance. C. Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has a normal platelet level. D. Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has a normal white blood cell count.

C. Student teaches the client that symptoms of neutropenia include fatigue and weakness. Rationale A. Asepsis with IV lines is an appropriate action; the student does not require correction. B. Handwashing is an essential component of client care, especially when the client is at risk for neutropenia; the student does not require correction. C. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected. D. Hygiene and perineal care help prevent infection and sepsis; the student does not require correction.

A. Bruises C. Petechiae D. Epistaxis Rationale Fever is a sign of infection secondary to neutropenia.

C. Providing oral care with a disposable mouth swab Rationale A. Biological response modifiers are used to stimulate bone marrow production of immune system cells; mucositis or sores in the mouth will not respond to these medications. B. Commercial mouthwashes should be avoided because they may contain alcohol or other drying agents that may further irritate the mucosa. C. Mouth swabs are soft and disposable and therefore clean. D. Keeping the client NPO is not necessary; nutrition is important during cancer treatment; a local anesthetic may be prescribed for comfort.

D. Allow the client an opportunity to express her feelings. Rationale A. Although evidence on this topic is not complete, the current thinking is that this process is usually temporary. B. The client is advised to avoid the use of alcohol and recreational drugs at this time because they also impair memory. C. The pharmacologic agents are implicated in central nervous system (CNS) function, not infection. D. Although no specific intervention for the side effect is known, therapeutic communication and listening may be helpful to the client.

B. Risk for Injury related to sensory and motor deficits Rationale A. Although this information may be helpful, the priority is the client's safety because of lack of sensation or innervation. B. The highest priority is safety. C. The nurse should address the client's coping, after providing for safety. D. Erectile dysfunction may be a manifestation of peripheral neuropathy, but the priority is the client's safety.

B. Allergy Rationale A. Monoclonal antibody therapy does not cause alopecia. B. Allergy is the most common side effect. C. Although fever is a side effect of monoclonal antibody therapy, it would not take priority over an allergic response that could potentially involve the airway. D. Although chills are a side effect of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.

C. Using strict aseptic technique to prevent infection Rationale A. This intervention will help detect DIC but will not prevent it. B. Red blood cells are used for anemia, not for bleeding/coagulation disorders. C. Sepsis is a major cause of DIC, especially in the oncology client. D. Heparin may be administered to clients with DIC who have developed clotting, but this has not been proven to prevent the disorder.

A. Hyponatremia B. Mental status changes E. Weakness Rationale Azotemia refers to buildup of nitrogenous waste products in the blood, typically from renal damage.

B. Allopurinol (Zyloprim) Rationale A. Tumor lysis syndrome results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances; Procrit is used to increase red blood cell (RBC) production and is not a treatment for hyperuricemia. B. Tumor lysis syndrome results in hyperuricemia, Allopurinol decreases uric acid production and is indicated in TLS. C. Tumor lysis syndrome results in hyperuricemia, hyperkalemia, and other electrolyte imbalances; administering additional potassium is dangerous. D. Radioactive iodine 131 is indicated in the treatment of thyroid cancer, not TLS.

A. Weight loss Rationale A. Cachexia results in extreme body wasting and malnutrition. Severe weight loss is expected. B. Anemia results from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. C. Bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. D. Motor deficits result from spinal cord compression.

B. Encourage the client to participate in changing the ostomy. D. Offer to have a person who is coping with a colostomy visit. E. Encourage the client and family members to express their feelings and concerns. Rationale Ostomies may be temporary for bowel rest, such as after a perforation, but are typically permanent for cancer treatment.

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 his diet. Rationale Thrombocytopenia, or low platelet levels, cause bleeding, not low neutrophils (a type of white blood cell [WBC]).

C. Change in mental status Rationale A. Increasing shortness of breath is typically related to anemia, not to thrombocytopenia. B. Diminished breath sounds may be related to many factors, including poor respiratory excursion, infection, and atelectasis, which is not related to thrombocytopenia. C. A change in mental status could result from spontaneous bleeding; in this case, a cerebral hemorrhage may have developed. D. A large weight gain in a short period may be related to renal or heart failure; bleeding is the major complication of thrombocytopenia.

C. Consume a diet high in fiber. Rationale A. The client should bathe in warm water, not greater than 96° F. B. Cotton gloves may prevent harm from scratching; protective gloves should be worn for washing dishes and gardening. Wearing cotton gloves while cooking can increase the risk for burns. C. A high-fiber diet will assist with constipation due to neuropathy. D. Shoes should allow sufficient length and width to prevent blisters. Shoes that are snug can increase the risk for blisters in a client with peripheral neuropathy.

D. Breast tenderness F. Deep vein thrombosis (DVT) Rationale Irregular menses or no menstrual period is the typical side effect.

B. Ondansetron (Zofran) Rationale A. Morphine is a narcotic analgesic or opiate; it may cause nausea. B. Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. C. Naloxone is a narcotic antagonist used for opiate overdose. D. Diazepam is a benzodiazepine, which is an antianxiety medication only. Lorazepam, a benzodiazepine, may be used for nausea.

C. A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) Rationale A. This is a complex client requiring a nurse certified in chemotherapy administration. B. This client is developing acute renal failure and requires complex assessment and treatment. C. A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to stimulate the bone marrow. D. This client has complicated needs for assessment and care and should be cared for by RNs with more oncology experience.

A. A client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature Rationale A. Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune suppressed people; the nurse should see this client first. B. The client can be assessed later; he is not currently nauseated. C. This client is not in distress and can be assessed later. D. The client with dry mouth can be assessed later, or the nurse can delegate mouth care to unlicensed assistant personnel.

D. Reducing all direct and indirect sources of light Rationale A. Any drug that the client is prescribed should be considered for its photosensitivity properties. Drugs should be stored according to the recommendations, but this is not the primary concern for this client. B. Clothing must cover the skin to prevent burns from direct or indirect light. Texture is not a concern for the client receiving this treatment. C. The client will be homebound for 1 to 3 months after the treatment and should not go outside. D. Lighting of all types must be kept to a minimum. It can lead to burns of the skin and damage to the eyes because they are sensitive to light.

B. Edema of arms and hands Rationale A. New onset of fatigue may likely be an early manifestation of hypercalcemia, which usually develops slowly. Because it is an early manifestation, this is not the priority. B. 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. C. Dry cough is not a manifestation that is specific to an oncologic emergency; however, it may be a side effect of chemotherapy. D. Weight gain could be an early sign of syndrome of inappropriate antidiuretic hormone. Although this should be addressed, it is an early sign; thus it is not the priority.

D. "When lung cancer is in the bones, it can prevent production of immune system cells, making you less resistant to infection." Rationale A. Other people are not at risk for becoming infected as a result of contact with a person who has lung cancer. Reference: p. 410, Health Promotion and Maintenance B. Lung cancer that has spread to the bone is still lung cancer; it is not a bone marrow malignancy. Reference: p. 410, Health Promotion and Maintenance C. It is true that the person with lung cancer may produce more mucus, which can harbor microorganisms, but this is not the main reason why the client should avoid crowds and people who are ill. Reference: p. 410, Health Promotion and Maintenance D. Tumor cells that enter the bone marrow reduce the production of healthy white blood cells (WBCs), which are needed for normal immune function. Therefore clients who have cancer, especially leukemia, are at an increased risk for infection. Reference: p. 410, Health Promotion and Maintenance

C. See your dentist twice yearly for the rest of your life. Rationale: Radiation therapy that is directed in or around the oral cavity has a variety of actions that increase the risk for dental caries (cavities) and tooth decay. The salivary glands are affected, which changes the composition of the person's saliva and often causes "dry mouth." This result allows rapid bacterial overgrowth, which leads to cavity formation. In addition, the radiation damages the integrity of the enamel and also damages some of the living cells in the tooth. All contribute to an increased risk for dental infections and cavities. Reference: p. 414, Health Promotion and Maintenance

C. Blood pressure change from 130/90 mm Hg to 148/98 mm Hg Rationale Epoetin alfa and other erythropoiesis-stimulating agents (ESAs) such as darbepoetin alfa (Aranesp) and epoetin alfa (Epogen, Procrit) increase the production of many blood cell types, not just erythrocytes, which increases the client's risk for hypertension, blood clots, strokes, and heart attacks, especially among older adults. Dosing is based on individual client hemoglobin and hematocrit levels to ensure that just enough red blood cells are produced to avoid the need for transfusion but not to bring hemoglobin or hematocrit levels up to normal. The increased blood pressure is an indication to stop this therapy immediately.

B. Administer antiemetic drugs before administering chemotherapy. Rationale: When emetogenic chemotherapy drugs are prescribed, the client should receive antiemetic drugs before the chemotherapy drugs are administered. This allows time for prevention of chemotherapy-associated nausea and vomiting; however, the antiemetic therapy cannot stop until all risks for nausea and vomiting have passed. Clients become nauseated and vomit even if they are NPO. Reference: p. 422, Safe and Effective Care Environment

C. Examines the client's neck and chest for edema and engorged veins Rationale: The client's swollen face indicates possible superior vena cava syndrome, which is an oncologic emergency. Manifestations result from the blockage of venous return from the head, neck, and upper trunk. Early manifestations occur when the client arises after a night's sleep and include edema of the face, especially around the eyes, and tightness of the shirt or blouse collar. As the compression worsens, the client develops engorged blood vessels and erythema of the upper body, edema in the arms and hands, dyspnea, and epistaxis. Interventions at this stage are more likely to be successful. Late manifestations include hemorrhage, cyanosis, mental status changes, decreased cardiac output, and hypotension. Death results if compression is not relieved.