Oncology 1
Which statement indicates that the client needs more teaching about mucositis?
a. “I will rinse my mouth with water after every meal.”
b. “I will use a soft-bristled toothbrush to prevent trauma.”
c. “I should use an alcohol-based mouth rinse to kill bacteria.”
d. “I cannot use floss because it may irritate my gums.”
What is C?
Mouthwashes that contain alcohol are drying and can exacerbate mucosal irritation, leading to painful mouth sores. Rinsing the mouth with water or normal saline is indicated. Interventions aimed at decreasing risk for trauma or irritation are matters of priority because of inflammation associated with mucositis.
A client is hospitalized for chemotherapy. The registered nurse intervenes when observing which action by the nursing assistant?
a. Allowing the client to rest instead of making him or her perform oral hygiene
b. Helping the client wash the groin and axillary areas every 12 hours
c. Cutting food and opening food packages when the client’s meal tray arrives
d. Reminding the client to use the incentive spirometer every hour while awake
What is A?
The biggest dangers to clients on chemotherapy are neutropenia and the risk of serious infection or sepsis. Most infections arise from the overgrowth of the client’s own normal flora, so personal hygiene is critical. The client must perform hygiene measures on a schedule, even if he or she is very tired. Instead of allowing the client to rest, the nursing assistant should help the client perform oral hygiene and other measures. The other actions would be acceptable.
Which client is at highest risk of compromised immunity?
a. Client who has just had surgery
b. Client with extreme anxiety
c. Client who is awaiting surgery
d. Client who just delivered a baby
What is A?
Intact skin is a defense to prevent infection; however, a client who has recently had surgery has a portal for organisms to enter the body and cause infection.
The nurse is caring for a client who is depressed because of acute rejection following a kidney transplant. What is the nurse’s best response?
a. “This is what happens when you don’t take your transplant medications.”
b. “At least you can still have dialysis, unlike people who receive liver transplants.”
c. “One acute rejection episode does not mean that you will lose the new kidney.”
d. “You can always find another donor and get another kidney transplant.”
What is C?
An episode of acute rejection does not automatically mean that the client will lose the transplant. Pharmacologic manipulation of host immune responses at this time can limit damage to the organ and allow the graft to be maintained.
The nurse questions which activity for the client with thrombocytopenia?
a. Application of warm compresses to bruises
b. Cleaning teeth with a soft-bristled brush
c. Taking acetaminophen (Tylenol) for pain
d. Using stool softeners daily for constipation
What is A?
Ice should be applied to areas of bruising or trauma to decrease bleeding. Warm compresses would lead to vasodilation and potentially to more bleeding. It is important to implement measures to decrease the risk of bleeding. A soft-bristled toothbrush decreases trauma to gums, which could cause bleeding. Straining at the stool could increase risk for rectal bleeding, so stool softeners may be prescribed. Acetaminophen does not affect platelet function and bleeding as do aspirin products.
A client is receiving a chemotherapeutic agent intravenously through a peripheral line. What is the nurse’s first action when the client reports burning at the site?
a. Check for a blood return.
b. Slow the rate of infusion.
c. Discontinue the infusion.
d. Apply a cold compress.
What is C?
Both irritants and vesicants can cause tissue damage. If the nurse suspects extravasation, he or she should immediately stop the infusion. Even if the IV has a good blood return, some of the chemotherapeutic agent can still be leaking into the tissues. Slowing the rate of infusion is not sufficient to prevent further leakage and damage. Applying a cold compress may or may not be the correct action, depending on the specific agent. However, the compress would be applied only after the infusion has been discontinued
The nurse is caring for a client who has undergone a kidney transplant. The client asks the nurse what will happen when his body realizes that the kidney is not “his.” What is the nurse’s best response?
a. “The immune system will try to destroy the kidney if we don’t suppress it.”
b. “As long as the kidney is a ‘match’ to your blood type, there will be no problem.”
c. “You will develop a fever or other complications from the transplant.”
d. “Within a week, your body will ‘adjust’ to the new organ.”
What is A?
Because a solid organ transplanted into a host is seldom a perfectly identical match of human leukocyte antigens (unless the organ is obtained from an identical sibling) between the donated organ and the recipient host, the client’s immune system cells recognize a newly transplanted organ as non-self. Without intervention, the host’s immune system starts inflammatory and immunologic actions to destroy or eliminate these non-self cells. The immune response is suppressed so that the body will not attack the new organ.
The nurse is teaching a health promotion class about preventing cancer. Which statement by a student indicates understanding of gastric cancer development?
a. “I should skip my morning bacon and egg sandwich to reduce my risk of gastric cancer.”
b. “I have been lactose intolerant for many years, so I should have a yearly test for gastric cancer.”
c. “I should switch from regular to decaffeinated coffee to reduce my risk of gastric cancer.”
d. “I am at low risk for developing gastric cancer because I am a vegetarian and I eat only organic produce.”
What is A?
Regular consumption of processed foods with nitrates (including bacon) can increase risk for gastric cancer. Lactose intolerance, coffee intake, and vegetarian diet are not factors in gastric cancer development.
After receiving change-of-shift report, which client does the nurse assess first?
a. Client with leukemia who needs an antiemetic before chemotherapy
b. Client with breast cancer scheduled for external beam radiation
c. Client with xerostomia associated with laryngeal cancer
d. Client with neutropenia who has just been admitted with a possible infection
What is D?
The most complex, potentially unstable client is the one with neutropenia with suspected infection. Because the onset of infection is insidious in clients with neutropenia, this client is at risk for sepsis. All other clients are stable.
A client has bone cancer. What intervention does the nurse implement as a priority for this client?
a. Using a lift sheet when repositioning the client
b. Positioning the client’s heels to keep them from touching the mattress
c. Providing small, frequent meals rich in calcium and phosphorus
d. Applying pressure for 5 minutes after intramuscular injections
What is A?
Bone metastasis of cancer can cause such bone destruction that grasping or pulling a client can result in a pathologic fracture. Using a lift sheet spreads the client’s weight more evenly, preventing excessive force on any one body area. Preventing pressure on the heels will help prevent pressure ulcers; this is a good intervention for all clients but does not take priority over preventing fractures. Adding calcium and phosphorus to meals will not prevent fractures. Applying pressure after IM injections is not related to this client’s condition.
A client had a splenectomy. Which fact is most important to teach the client regarding immune function?
a. “You won’t get a fever with infection, so you need to learn to identify other symptoms.”
b. “It will no longer be necessary for you to worry about developing allergies.”
c. “Avoid people who are ill because it will be harder for you to develop antibodies.”
d. “You will need to be assessed yearly for the risk of developing cancer.”
What is C?
The spleen is involved in B-lymphocyte maturation. People who undergo splenectomies for any reason may have a decreased antibody-mediated immune response and thus would be more susceptible to infection. Clients will still develop fever after splenectomy and are not at increased risk for allergies or fever.
The nurse is caring for a client who is at risk for developing gastritis. Which finding from the client’s history leads the nurse to this conclusion?
a. Client is lactose intolerant and cannot drink milk.
b. Client recently traveled to Mexico and South America.
c. Client works at least 60 hours per week in a stressful job.
d. Client takes naproxen sodium (Naprosyn) 500 mg daily for arthritis pain.
What is D?
Motrin and other NSAIDs can cause gastritis, even if symptoms are not yet apparent. Stress, travel, and spicy foods do not increase the risk for gastritis.
A client has late-stage colon cancer with metastasis to the spine and bones. Which nursing intervention does the nurse add to the care plan to address a priority problem?
a. Provide six small meals and snacks daily.
b. Offer the client prune juice twice a day.
c. Ensure that the client gets adequate rest.
d. Give the client pain medications around the clock.
What is D?
Although all interventions might be appropriate, a client with late-stage cancer and bone metastases is at risk for severe pain. Giving the client pain medication around the clock is the best way to manage this type of pain.
In evaluating dietary teaching for a client with chemotherapy-induced neutropenia, the nurse becomes concerned when the client makes which food choice?
a. Fruit salad
b. Applesauce
c. Steamed broccoli
d. Baked potato
What is A?
The client who is neutropenic should be taught to eat a low-bacteria diet. This includes avoiding raw fruits or vegetables and undercooked meat, eggs, or fish.
A client recovering from hepatitis A asks whether he should take the vaccine to avoid contracting the disease again. What does the nurse say?
a. “Yes, because now you are more susceptible to this infection.”
b. “Yes, because the hepatitis A virus changes from year to year.”
c. “No, your liver and immune system are too impaired at this time.”
d. “No, having the infection has done the same thing a vaccination would.”
What is D?
Vaccination with hepatitis A vaccine is an artificial way of stimulating the immune system to make antibodies against hepatitis A (artificially acquired active immunity). This client’s immune system has responded to an actual infection with hepatitis A by making many antibodies to hepatitis A (naturally acquired active immunity); therefore he does not need a vaccination for this virus.
What teaching is essential for a client who has received an injection of iodine-131?
a. “Do not share a toilet with anyone else or let anyone clean your toilet.”
b. “You need to save all your urine for the next week.”
c. “No special precautions are needed because this type of radiation is weak.”
d. “Avoid all contact with other people until the radiation device is removed.”
What is A?
The radiation source is an unsealed isotope that is eliminated from the body in waste products, especially urine and feces. This material is radioactive for about 48 hours after the instillation of the isotope. Having the client not share a toilet with other people or allowing anyone to clean the client’s toilet for a specific period of time ensures that the isotope has been completely eliminated, and that the client’s wastes are no longer radioactive.
A client has a reduction in immune function. What is the nurse’s priority action for this client?
a. Determine whether it is temporary or permanent.
b. Take the client’s vital signs every 4 hours.
c. Teach family members to receive the flu shot yearly.
d. Wash hands before entering the room.
D: The nurse should take precautions to prevent infection in the client who has a reduction in immune function. It does not matter whether it is temporary or permanent. Teaching the family what to do after the client is discharged from the hospital would not be the primary action. Taking vital signs would be an important action but would not prevent infection, which is the priority.
Which type of immunity does the hepatitis B immune globulin provide for the nurse?
a. Passive
b. Artificial active
c. Natural active
d. Cell-mediated
What is A?
Passive immunity occurs when the individual is given antibodies that were created in the laboratory or by another person. Active immunity occurs after exposure of the host to an antigen or vaccination. Cell-mediated immunity is carried out by T-cells in response to specific antigens