Chapter 12: Management of Patients with Oncologic Disorders
The nurse is conducting a health education about cancer prevention to a group of adults. What menu best demonstrates dietary choices for potentially reducing the risks of cancer?
A. Smoked salmon and green beans
B. Pork chops and fried green tomatoes
C. Baked apricot chicken and steamed broccoli
D. Liver, onions, and steamed peas
ANS: C
Rationale: Fruits and vegetables appear to reduce cancer risk. Salt-cured foods, such as ham and processed meats, as well as red meats, should be limited.
A nurse is caring for a client who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the client's sacral area and petechiae on the forearms. In addition to informing the client's primary care provider, the nurse should perform what action?
A. Initiate measures to prevent venous thromboembolism (VTE).
B. Check the client's most recent platelet level.
C. Place the client on protective isolation.
D. Ambulate the client to promote circulatory function.
ANS: B
Rationale: The client's signs are suggestive of thrombocytopenia, thus the nurse should check the client's most recent platelet level. VTE is not a risk and this does not constitute a need for isolation. Ambulation and activity may be contraindicated due to the risk of bleeding.
A nurse is completing the nutritional status of a client who has been admitted with AIDS-related complications. What components should the nurse include in this assessment? Select all that apply.
A. Serum albumin level
B. Weight history
C. White blood cell count
D. Body mass index
E. Blood urea nitrogen (BUN) level
ANS: A, B, D, E
Rationale: Nutritional status is assessed by obtaining a dietary history and identifying factors that may interfere with oral intake, such as anorexia, nausea, vomiting, oral pain, or difficulty swallowing. In addition, the client's ability to purchase and prepare food is assessed. Weight history (i.e., changes over time); anthropometric measurements; and blood urea nitrogen (BUN), serum protein, albumin, and transferrin levels provide objective measurements of nutritional status. White cell count is not a typical component of a nutritional assessment.
A client with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the client's treatment?
A. Decisional conflict
B. Deficient knowledge
C. Death anxiety
D. Disturbed thought processes
ANS: C
Rationale: The sudden hemorrhage that accompanies variceal bleeding is intensely anxiety-provoking. The nurse must address the client's likely fear of death, which is a realistic possibility. For most clients, anxiety is likely to be a more acute concern than lack of knowledge or decisional conflict. The client may or may not experience disturbances in thought processes.
The nurse providing care for a client with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk?
A. Establish fall-prevention measures.
B. Encourage bed rest whenever possible.
C. Encourage the use of assistive devices.
D. Provide constant supervision.
ANS: A
Rationale: The nurse should take action to limit the client's risk for falls. However, bed rest has too many harmful effects, and assistive devices may or may not be necessary. Constant supervision is not normally required or practicable.
A nurse who works in an oncology clinic is assessing a client who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the client's skin appears yellow. Which blood tests should be done to further explore this clinical sign?
A. Liver function tests (LFTs)
B. Complete blood count (CBC)
C. Platelet count
D. Blood urea nitrogen and creatinine
ANS: A
Rationale: Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count, and tests of renal function would not directly assess for liver disease.
A 60-year-old client with chronic myeloid leukemia (CML) will be treated in the home setting, and the nurse is preparing appropriate health education. Which topic should the nurse emphasize?
A. The importance of adhering to the prescribed drug regimen
B. The need to ensure that vaccinations are up to date
C. The importance of daily physical activity
D. The need to avoid shellfish and raw foods
ANS: A
Rationale: Nurses need to understand that the effectiveness of the drugs used to treat CML is based on the ability of the client to adhere to the medication regimen as prescribed. Adherence is often incomplete, thus this must be a focus of health education. Vaccinations normally would not be given during treatment, and daily physical activity may be impossible for the client. Dietary restrictions are not normally necessary.
A nurse is assessing the skin integrity of a client who has AIDS. When performing this inspection, the nurse should prioritize assessment of what skin surfaces?
A. Perianal region and oral mucosa
B. Sacral region and lower abdomen
C. Scalp and skin over the scapulae
D. Axillae and upper thorax
ANS: A
Rationale: The nurse should inspect all the client's skin surfaces and mucous membranes, but the oral mucosa and perianal region are particularly vulnerable to skin breakdown and fungal infection.
A client with a diagnosis of esophageal varices has undergone endoscopy to gauge the progression of this complication of liver disease. Following the completion of this diagnostic test, what nursing intervention should the nurse perform?
A. Keep client NPO until the results of test are known.
B. Keep client NPO until the client's gag reflex returns.
C. Administer analgesia until post-procedure tenderness is relieved.
D. Give the client a cold beverage to promote swallowing ability.
ANS: B
Rationale: After the examination, fluids are not given until the client's gag reflex returns. Lozenges and gargles may be used to relieve throat discomfort if the client's physical condition and mental status permit. The result of the test is known immediately. Food and fluids are contraindicated until the gag reflex returns.
The nurse is providing care for an older adult client whose current medication regimen includes levothyroxine. As a result, the nurse should be aware of the heightened risk of adverse sedation effects when administering an intravenous (IV) dose of what medication?
A. A fluoroquinolone antibiotic
B. A loop diuretic
C. A proton pump inhibitor (PPI)
D. A benzodiazepine
ANS: D
Rationale: Oral thyroid hormones interact with many other medications. Even in small IV doses, hypnotic and sedative agents may induce profound somnolence, lasting far longer than anticipated and leading to narcosis (stupor-like condition). Furthermore, they are likely to cause respiratory depression, which can easily be fatal because of decreased respiratory reserve and alveolar hypoventilation. Benzodiazepine is a sedative and may be used to treat seizures and alcohol withdrawal. Concurrent usage with levothyroxine can increase benzodiazepine’s sedation effects. Concurrent use of fluoroquinolone antibiotics can decrease absorption of the antibiotic. A loop diuretic and proton pump inhibitor IV have no adverse sedation effects. A PPI taken in pill form can inhibit levothyroxine absorption if taken together.
The nurse is caring for a client who has just been told that the client’s stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the client the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer?
A. Palliative
B. Reconstructive
C. Salvage
D. Prophylactic
ANS: A
Rationale: When cure is not possible, the goals of treatment are to make the client as comfortable as possible and to promote quality of life as defined by the client and family. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk to develop cancer.
A nurse is caring for a client who is being treated for leukemia in the hospital. The client was able to maintain nutritional status for the first few weeks following the diagnosis but is now exhibiting early signs and symptoms of malnutrition. In collaboration with the dietitian, the nurse should implement what intervention?
A. Arrange for total parenteral nutrition (TPN).
B. Facilitate placement of a percutaneous endoscopic gastrostomy (PEG) tube.
C. Provide the client with several small, soft-textured meals each day.
D. Assign responsibility for the client's nutrition to the client's friends and family.
ANS: C
Rationale: For clients experiencing difficulties with oral intake, the provision of small, easily chewed meals may be beneficial. This option would be trialed before resorting to tube feeding or TPN. The family should be encouraged to participate in care, but should not be assigned full responsibility.
A client has a diagnosis of AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate?
A. Position the client in the high Fowler position whenever possible.
B. Temporarily eliminate animal protein from the client's diet.
C. Make sure the client eats at least two servings of raw fruit each day.
D. Obtain a stool culture to identify possible pathogens.
ANS: D
Rationale: A stool culture should be obtained to determine the possible presence of microorganisms that cause diarrhea. Clients should generally avoid raw fruit when having diarrhea. There is no need to avoid animal protein or increase the height of the bed.
A client with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this client's treatment, the nurse should anticipate what intervention?
A. Administration of immune globulins
B. A regimen of antiviral medications
C. Rest and watchful waiting
D. Administration of fresh-frozen plasma (FFP)
ANS: B
Rationale: There is no benefit from rest, diet, or vitamin supplements in HCV treatment. Studies have demonstrated that antiviral agents are most effective. Immune globulins and FFP are not indicated.
A client with hyperthyroidism is being treated with radioactive iodine therapy. After receiving the dose of radioiodine, the nurse would assess the client for:
A. hypothyroidism.
B. thyroid storm.
C. hypothermia.
D. agranulocytosis.
ANS: B
Rationale: Radioactive iodine ablation initially causes an acute release of thyroid hormone from the thyroid gland and may cause an increase of symptoms. The client is observed for signs of thyroid storm, not hypothyroidism. Hyperpyrexia, not hypothermia, is associated with thyroid storm. Agranulocytosis is a complication associated with antithyroid drug therapy.
A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity?
A. Disease prophylaxis
B. Risk reduction
C. Secondary prevention
D. Tertiary prevention
ANS: C
Rationale: Secondary prevention involves screening and early detection activities that seek to identify early-stage cancer in individuals who lack signs and symptoms suggestive of cancer. Primary prevention is concerned with reducing the risks of disease through health promotion strategies. Tertiary prevention is the care and rehabilitation of the client after having been diagnosed with cancer.
A client who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this client's needs for physical activity?
A. Teach the client about the risks of immobility and the benefits of exercise.
B. Assist the client to a chair during awake times, as tolerated.
C. Collaborate with the physical therapist to arrange for stair exercises.
D. Teach the client to perform deep breathing and coughing exercises.
ANS: B
Rationale: Sitting up in a chair is preferable to bed rest, even if a client is experiencing severe fatigue. A client who has debilitating fatigue would not likely be able to perform stair exercises. Teaching about mobility may be necessary, but education must be followed by interventions that actually involve mobility. Deep breathing and coughing reduce the risk of respiratory complications but are not substitutes for physical mobility in preventing deconditioning.
A health care provider is taking post-exposure prophylaxis (PEP) medications for exposure to a client with human immunodeficiency virus (HIV). Which topics will the health care provider need to understand regarding PEP administration prior to beginning this regimen? Select all that apply.
A. Potential drug toxicities
B. Needed dietary changes
C. Potential drug interactions
D. Sleep pattern disturbances
E. Adherence requirements
ANS: A, C, E
Rationale: The health care provider will need to understand potential drug toxicities, such as rashes and hypersensitivity reactions, which could imitate acute HIV seroconversion and require monitoring. The health care provider will also need to understand potential drug interactions, such as with supplements and vitamins, which could change the effectiveness of PEP. The health care provider will also need to understand adherence requirements, as adherence to the daily use of the PEP is paramount to its effectiveness. Typically, for most of PEP, there are no specific dietary changes needed. Sleep pattern disturbances generally do not happen with administration of these medications.
A 55-year-old female client with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment?
A. Destruction of the client's liver tumor
B. Restoration of portal vein patency
C. Destruction of a liver abscess
D. Reversal of metastasis
ANS: A
Rationale: Using radiofrequency ablation, a tumor up to 5 cm in size can be destroyed in one treatment session. This technique does not address circulatory function or abscess formation. It does not allow for the reversal of metastasis.
A client with Cushing syndrome has been hospitalized after a fall. The dietitian works with the client to improve the client's nutritional intake. What foods should a client with Cushing syndrome eat to optimize health? Select all that apply.
A. Foods high in vitamin D
B. Foods high in calories
C. Foods high in protein
D. Foods high in calcium
E. Foods high in sodium
ANS: A, C, D
Rationale: Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the client in selecting appropriate foods that are also low in sodium and calories.
The nurse is performing an initial assessment of a 75-year-old client who has just relocated to the long-term care facility. During the nurse's interview with the client, the client admits drinking around 600 mL (20 oz) of vodka every evening. What types of cancer does this put the client at risk for? Select all that apply.
A. Malignant melanoma
B. Brain cancer
C. Breast cancer
D. Esophageal cancer
E. Liver cancer
ANS: C, D, E
Rationale: Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods, and red and processed meats. Alcohol increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast.
After receiving a diagnosis of acute lymphocytic leukemia, a client is visibly distraught, stating, "I have no idea where to go from here." How should the nurse prepare to meet this client's psychosocial needs?
A. Assess the client's previous experience with the health care system.
B. Reassure the client that treatment will be challenging but successful.
C. Assess the client's specific needs for education and support.
D. Identify the client's plan of medical care.
ANS: C
Rationale: In order to meet the client's needs, the nurse must first identify the specific nature of these needs. According to the nursing process, assessment must precede interventions. The plan of medical care is important, but not central to the provision of support. The client's previous health care is not a primary consideration, and the nurse cannot assure the client of successful treatment.
The nurse is applying standard precautions in the care of a client who has an immunodeficiency. What are key elements of standard precautions? Select all that apply.
A. Using appropriate personal protective equipment
B. Placing clients in negative pressure isolation rooms
C. Placing clients in positive pressure isolation rooms
D. Using safe injection practices
E. Performing hand hygiene
ANS: A, D, E
Rationale: Some of the key elements of standard precautions include performing hand hygiene; using appropriate personal protective equipment, depending on the expected type of exposure; and using safe injection practices. Isolation is an infection control strategy but is not a component of standard precautions.
A client with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the client's fluid volume excess? Select all that apply.
A. Administering diuretics
B. Administering calcium channel blockers
C. Implementing fluid restrictions
D. Implementing a 1500 kcal/day restriction
E. Enhancing client positioning
ANS: A, C, E
Rationale: Administering diuretics, implementing fluid restrictions, and enhancing client positioning can optimize the management of fluid volume excess. Calcium channel blockers and calorie restriction do not address this problem.
The nurse is caring for a client at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the client? Select all that apply.
A. Epistaxis
B. Pallor
C. Rapid respiratory rate
D. Bounding pulse
E. Hypotension
ANS: B, C, E
Rationale: The client at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness. Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis.