Oncology

Joseph who had a history of long-term smoking and alcoholism is diagnosed with oropharyngeal cancer. He is admitted into the chemo unit for the initiation of chemotherapy. Which of the following tests is performed before the infusion of chemotherapeutic agents?

• Complete blood count (CBC)

• Peripheral blood smear

• Lumbar puncture

• Liver function test

Answer explanation

Correct Answer: D. Liver function test

Option D: Liver and kidney function studies are done before the initiation of chemotherapy to evaluate the client’s ability to metabolize the chemotherapeutic agents.

Option A: A CBC is performed to assess for anemia and white blood cell count.

Option B: A peripheral blood smear is done to assess the maturity and morphology of red blood cells.

Option C: A lumbar puncture is performed to assess for central nervous system infiltration.

Nausea and vomiting are common adverse effects of radiation and chemotherapy. When should a nurse administer antiemetics?

• When therapy is completed

• Immediately after nausea begins

• With the administration of therapy

• 30 minutes before the initiation of therapy

Answer explanation

Correct Answer: D. 30 minutes before the initiation of therapy

Option D: Antiemetics are most beneficial when given before the onset of nausea and vomiting. To calculate the optimum time for administration, the first dose is given 30 minutes to 1 hour before nausea is expected, and then every 2, 4, or 6 hours for approximately 24 hours after chemotherapy.

Options A, B, and C: If the antiemetic was given with the medication or after the medication, it could lose its maximum effectiveness when needed.

The client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention is the highest priority in the nursing plan of care?

• Monitoring temperature

• Monitoring for pathological factors

• Ambulation three times a day

• Monitoring the platelet count

Answer explanation

Correct Answer: D. Monitoring the platelet count

Option D: Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding.

Option A: Relates to monitoring for infection particularly if leukopenia is present.

Options B and C: Although monitoring the pathological factors and ambulation are important in the plan of care. They are not related directly to thrombocytopenia.

Which of the following nursing interventions would be most helpful in making the respiratory effort of a client with metastatic lung cancer more efficient?

• Teaching the client diaphragmatic breathing techniques

• Administering cough suppressants as ordered

• Teaching and encouraging pursed-lip breathing

• Placing the client in a low semi-Fowlers position

Answer explanation

Correct Answer: C. Teaching and encouraging pursed-lip breathing

Option C: For clients with obstructive versus restrictive disorders, extending exhalation through pursed-lip breathing will make the respiratory effort more efficient. The usual position of choice for this client is the upright position, leaning slightly forward to allow greater lung expansion.

Option A: Teaching diaphragmatic breathing techniques will be more helpful to the client with a restrictive disorder.

Option B: Administering cough suppressants will not help the respiratory effort.

Option D: A low semi-Fowler’s position does not encourage lung expansion. Lung expansion is enhanced in the upright position.

The nurse is teaching a 17-year old client and the client’s family about what to expect with high-dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client?

• Dyspnea

• Fever

• Tachycardia

• Chills

Answer explanation

Correct Answer: B. Fever

Option B: A patient with neutropenia has a decreased number of neutrophils. These cells are responsible for fighting off bacteria once they enter the body. A complication of neutropenia is infection. An early sign is a fever that requires clinical intervention to identify potential causes.

Options A and D: Chills and dyspnea may or may not be observed.

Option C: Tachycardia can be an indicator in a variety of clinical situations when associated with infection; it usually occurs in response to an elevated temperature or change in cardiac function.

A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following?

• “Cancer cells are susceptible to drug toxins.”

• “Chemotherapy affects all rapidly dividing cells.”

• “Chemotherapy encourages cancer cells to divide.”

• “The molecular structure of the DNA is altered.”

Answer explanation

Correct Answer: B. “Chemotherapy affects all rapidly dividing cells.”

Option B: There are many mechanisms of action for chemotherapeutic agents, but most affect the rapidly dividing cells—both cancerous and noncancerous. Cancer cells are characterized by rapid cell division.

Option A: All cells are susceptible to drug toxins, but not all chemotherapeutic agents are toxins.

Options C and D: Chemotherapy slows cell division. Not all chemotherapeutic agents affect the molecular structure.

A client with stomach cancer is admitted to the oncology unit after vomiting for 3 days. Physical assessment findings include irregular pulse, muscle twitching, and complaints of prickling sensations in the fingers and hands. Laboratory results include a potassium level of 2.9 mEq/L, a pH of 7.46, and a bicarbonate level of 29 mEq/L. The client is experiencing:

• Metabolic alkalosis

• Respiratory acidosis

• Metabolic acidosis

• Respiratory alkalosis

The nurse is preparing Cytoxan (cyclophosphamide). Safe handling of the drug should be implemented to protect the nurse from injury. Which of the following actions by the nurse should be corrected?

• The nurse should wear a mask and gloves

• Air bubbles should be expelled on wet cotton

• Review order to check the rate, solution, and frequency of the drug

• Vent vials after mixing

Answer explanation

Correct Answer: A. The nurse should wear a mask and gloves

Option A: The nurse should be corrected if she is only wearing a mask and glove because additional protective equipment (gown, goggles, and face shields) should also be worn in handling chemotherapeutic drugs.

Option B: Air bubbles are expelled on wet cotton to prevent the spread of the chemotherapeutic agent particles.

Option C: Ensures the IV chemotherapy solution is correct and helps avoid medication error.

Option D: The vials should be vent after mixing to reduce the internal pressure.

Neoplasm can be classified as either benign or malignant. The following are characteristics of malignant tumor apart from:

• Encapsulated

• Infiltrates surrounding tissues

• Metastasis

• Poorly differentiated cells

Answer explanation

Correct Answer: A. Encapsulated

Option A: Benign: grows slowly, localized, encapsulated, well-differentiated cells, no metastasis, not harmful to host.

Options B, C, and D: Malignant: Grows rapidly, infiltrate surrounding tissues, not encapsulated, poorly differentiated, metastasis present, always harmful.

Warning signs and symptoms of lung cancer include persistent cough, bloody sputum, dyspnea, and which of the other following symptoms?

• Generalized Weakness

• Recurrent Pleural Effusion

• Dizziness

• Hypotension

Answer explanation

Correct Answer: B. Recurrent pleural effusion

Option B: If cancer is suspected in the lungs, it can cause fluid accumulation in the pleura called pleural effusion. This fluid build-up takes up space and fills the pleural cavity resulting in the compression of the lungs making it hard for the client to breathe properly.

Options A, C, and D: Dizziness, generalized weakness, and hypotension aren’t typically considered warning signals, but may occur in advanced stages of cancer.