The client has AML and is scheduled to receive an allogenic bone marrow transplant. What do you tell the client about the allogenic transplant?
In an allogenic bone marrow transplant, the client’s relatives or an unrelated donor match can be used as long as the HLA type matches the client. Umbilical cord blood can be enough but may not have enough volume. The client usually has high dose chemotherapy before the transplant.
The client is having an autologous transplant. How does the nurse explain this type of bone marrow transplant?
The cells come from stem cells that come from the client and have been purged of tumor cells. It is often used in treating leukemia, lymphomas, and several types of solid tumors. Chemotherapy and sometimes radiation are used prior to giving back the stem cells.
You tell the client that there are complications of a stem cell transplant. What do you say?
Complications of a stem cell transplant include graft versus host disease, failure to engraft the cells, or a life-threatening bacterial, viral, and fungal infections.
You talk to the female client about the potential for having a child after total body irradiation. What do you say?
With regard to the potential to have a child, you can tell the client that if she is under the age of 26, she may still be fertile. There is a chance for a secondary malignancy but this does not apply to sterility.
The client is experiencing cancer pain. How does the nurse help the client? Select all that apply.
Please select 3 correct answers
The nurse should identify the intensity of the pain but the specific source is not necessary. Narcotics do not need to be used as a last resort but are not needed if there is no pain. Nonpharmacological methods of pain relief should be taught.
The client is experiencing a great deal of fatigue with cancer treatment. What does the nurse say or do?
The nurse can give the client a Piper Fatigue questionnaire. Fatigue is the most common symptom of cancer treatment. Rest and caffeine do not counteract or relieve the pain.
The client wants something to improve the fatigue of chemotherapy. What can the nurse give?
Good treatments for the fatigue of chemotherapy are erythropoietin, oxygen, and blood products to help anemia and oxygenation. Caffeine and phenobarbital will not help relieve the fatigue.
The client has neutropenia as a result of chemotherapy. You recognize that neutropenia involves a WBC count of less than what value?
Absolute neutropenia involves a WBC count of less than 1000/ml.
The nurse is monitoring the client for signs of infection after chemotherapy. The most reliable indicator of infection is what?
The most reliable indicator of infection is a fever of a degree or more above normal. The neutrophil count is generally low after chemotherapy. Mental status changes can be from other sources and bruising is a sign of thrombocytopenia after chemotherapy.
The family of a chemotherapy client asks about prevention of infection. What does the nurse say?
The client and family should practice strict handwashing techniques. A gown, gloves, and mask are usually not required. The family does not need to take antibiotics and children who are not ill may see the client.
The client has a fever and chills after chemotherapy. What does the nurse give? Select all that apply.
Please select 2 correct answers
Acetaminophen can be given for fever and Demerol can be given for shaking chills. Aspirin and NSAIDs cannot be given because of the potential for thrombocytopenia.
The client is having nausea from chemotherapy. What nursing interventions do you do?
Instruct the client on relaxation techniques and take antiemetics around the clock. Sit up for thirty minutes after eating and eat fewer sweet, greasy, or spicy foods.
The client has stomatitis after chemotherapy. What can you tell the client?
The client should use viscous xylocaine for pain relief. They should avoid popcorn, nuts, hard candy, and gum will only irritate the stomatitis.
The client is having constipation after chemotherapy. As the nurse, what do you suggest?
For constipation, take in extra fiber. Dairy products should be avoided in diarrhea. The client should drink extra fluids and take stool softeners.
The client is having problems coping because of her cancer diagnosis. How can the nurse help? Select all that apply.
Please select 3 correct answers
The client with coping problems may be depressed so you should look for evidence of depression and assess for suicide plans. Get a substance abuse history and encourage group support. Homicide is not usually a problem in cancer patients and alcohol can make things worse. Often, some kind of intervention is necessary.
A client is suffering from electrolyte complications of cancer. What is the most common electrolyte complication of cancer?
Up to 40 percent of all cancer patients will suffer from hypercalcemia. The others are not considered electrolyte complications of cancer.
The client is suffering from hypercalcemia from cancer. What does the nurse do about medications?
Bisphosphonates can decrease serum calcium levels. Clients are more sensitive to digoxin so you need to give less. Milk increases calcium levels and should be avoided. Narcotics can be given for pain.
The client with cancer has had mediastinal lymphadenopathy and has developed a sudden onset of shortness of breath, head swelling, swelling of the eyes, severe headache, neck, and arm swelling. What is most likely going on?
The client most likely has superior vena cava syndrome with a lack of blood return from the upper part of the body that normally is drained by the superior vena cava. The superior vena cava is most likely being impinged upon by mediastinal lymphadenopathy. The other choices do not carry the same constellation of symptoms.
The client has small cell cancer of the lung and has had a weight gain of greater than 5 pounds in one day, nausea and vomiting, confusion, fatigue, a serum sodium of 125 and decreased urinary output. What might be going on?
The client has SIADH from small cell cancer and is producing too much antidiuretic hormone. Too much IV fluids would give an increased urine output and renal failure or renal involvement in cancer would be much rarer in this type of cancer.
The client has SIADH from cancer. What are some nursing interventions that might be done?
Please select 3 correct answers
The client with SIADH needs fluid restriction and can be offered sugarless candy to cope with fluid restriction. Daily weights are indicated. The client does not need extra IV fluids nor do they need extra salt in spite of the fact that their sodium level will be low. Hypotonic saline would make the situation worse.
A client with leukemia has the acute onset of muscle twitching, seizures, lethargy, confusion and cardiac arrhythmias after receiving chemotherapy. What is going on?
The client is suffering from tumor lysis syndrome, which can happen when tumor cells die and release large amounts of potassium, phosphorus, and uric acid into the bloodstream. This can result in cardiac arrhythmias from hyperkalemia and cardiac arrest. The potassium level will be high from tumor lysis. The calcium level will be low and this cannot be from dehydration.
The smoking client has gross hematuria that is painless and suprapubic, rectal and back pain. What do you suspect?
The client needs a cystoscopy or urinary tumor cell evaluation for transitional cell cancer of the bladder. It is most often caused by smoking. Pyelonephritis would usually give flank pain and a UTI generally doesn’t have painless hematuria. Prostatitis usually doesn’t have gross hematuria.
The client has superficial transitional cell cancer of the bladder. What treatment would he likely get?
For superficial transitional cell cancer of the bladder, BCG is often given intravesically for six weeks. The other treatments are for more advanced bladder cancer.
The male client is a smoker and has had excessive occupational exposure to lead cadmium and hematuria. What kind of cancer is he likely to have?
Renal cell cancer is often found in men who have had occupational exposure to lead cadmium. His most likely early symptom is hematuria. Prostate, bladder, and urethral cancer are not found in patients with lead cadmium exposure and hematuria.
The client has metastatic renal cell cancer. What can you tell the client about sites of metastases?
Renal cell cancer usually spreads by direct extension to the renal vein or vena cava. It does not commonly spread to the brain, the other kidney or to the bladder.
The female client has been diagnosed with breast cancer. What do you tell the client in order to educate her?
Stage I and stage II cancer of the breast are 70-90 percent curable. It is the most common cancer in women and it usually occurs in the upper outer quadrant of the breast. Advanced cases are capable of metastases.
The 75 year old female client has a red breast, with an orange-peel appearance to the skin and a painful breast. What could be going on?
Inflammatory breast cancer occurs in women who present with a red breast, an orange-peel appearance to the skin and a painful breast. Ductal and lobular breast cancer do not present this way and mastitis is rare in a 75 year old woman.
The client wants to know the most common areas of metastasis for her breast cancer? What do you say?
The most common sites of metastasis for breast cancer are the bone, lung, liver and brain. The other sites are much less likely.
The client tells you she is scheduled for a simple mastectomy for her breast cancer and asks you what this means. What do you tell her?
A simple mastectomy involves removal of the breast, the nipple and the skin. A lumpectomy is removal of the lump and surrounding breast tissue only; a modified mastectomy includes the lymph nodes as well; a radical mastectomy includes removal of the pectoral muscles.
The client with breast cancer is to have a sentinel lymph node biopsy. What do you tell her about this procedure?
In a sentinel lymph node biopsy, dye is injected into the lymph system, looking for the first draining axillary lymph node.
The client is scheduled for radiation following lumpectomy. How do you educate the client about this procedure?
If radiation is performed, it is done about three weeks after the lump is removed. This allows some time for surgical healing to take place.
The patient is being given Herceptin after treatment of breast cancer. How does the nurse explain the role of Herceptin?
Herceptin is a monoclonal antibody therapy that is used to stop the growth of tumors that express the HER2 gene.
The client recently underwent a CT scan for headaches that showed a mass on the brain. What do you tell the client about the brain mass?
It is statistically more likely that the brain mass is a metastasis versus a primary brain cancer. Brain tumors can be benign or malignant and not all are fatal. Surgery and radiation are used to rid the brain of a brain tumor, regardless of cause.
The client has a metastatic brain tumor. He asks about the most common way of treating this type of condition. How do you respond?
Most metastatic treatments are treated with radiation therapy although some are resistant to radiation. Chemotherapy does not work on most brain cancers and stereotactic surgery is only done some of the time. The choice not to treat depends on the client.
The client with cervical cancer asks about her risk factors for the disease. What do you tell her about her risk factors? Select all that apply.
Please select 3 correct answers
Risk factors for cervical cancer are cigarette smoking, human papillomavirus, low socioeconomic status, having multiple sexual partners and having sex before the age of 17.
The client is wondering about the best way to avoid getting cervical cancer. What do you say on prevention of cervical cancer?
The best prevention of cervical cancer is to have annual pap tests upon becoming sexually active. Colposcopy is done only if the Pap smear is abnormal. Avoiding douching and alcohol intake are not risk factors for cervical cancer.
The client is scheduled for a colposcopy. What do you tell the client in the way of education about colposcopy?
Colposcopy involves putting acetic acid on the cervix and visualizing it under magnification. It is done as an outpatient without general anesthesia. It can involve a biopsy but not removal of the entire cervix.
A 55 year old woman is diagnosed with cervical cancer. What is the main treatment of choice?
For a woman who is not of childbearing years, a total abdominal hysterectomy and lymphadenectomy is recommended. A cone biopsy is insufficient and radiation is not recommended.
Nursing interventions for a client treated for cervical cancer include the following. Select all that apply.
Please select 2 correct answers
Bladder retraining is necessary if the client has a suprapubic catheter. Intake and output does not have to be measured. No tampons, douching or sex for 2-4 weeks.
The client has been diagnosed with colon cancer and asks why he got the disease. What do you say in terms of risk factors for colon cancer?
Having a diet high in red meat and low in vegetables is a risk factor for colon cancer as well as having Crohn’s disease or ulcerative colitis. Lupus is not a risk factor. Having a family history of colon cancer is a risk factor for the disease.
The client has metastatic colon cancer. What is the most common site of metastatic colon cancer?
The most common site for metastatic colon cancer is the liver. Secondary sites include the bone, brain, and liver.
The client is asked about the best prevention of colon cancer. What do you tell the client?
The best prevention is to have a colonoscopy every ten years after age 50 to remove any precancerous polyps. Drinking less will reduce the risk factors. A FIT test is an alternative to a colonoscopy. By the time you have blood in the stool it may already mean you have colon cancer.
The client is having surgery to remove colon cancer the next day. What does the nurse expect to do?
Oral antibiotics and a GoLytely prep should be given the day before surgery. A Dulcolax suppository is insufficient and IV antibiotics aren’t given until the day of surgery. Fluids should be encouraged the day before surgery.
The client has colon cancer in the sigmoid colon. What procedure is the client likely to have to treat this condition?
The treatment of left-sided colon cancer is always a left hemicolectomy. Sigmoidectomy is not enough and a total colectomy is too much. The right hemicolectomy is on the wrong side of the affected colon.
Priority nursing interventions for a client who is undergoing colon surgery for colon cancer includes:
After surgery, monitor the client for anastomotic leak (fever, abdominal pain). Expect some sexual dysfunction. Education on diet is not a priority right after surgery. Bladder dysfunction is not expected.
The client is at risk for endometrial cancer. What are her risks?
There are several risk factors for endometrial cancer, including being Caucasian, being older than age 50, being infertile, being nulliparous, having obesity, diabetes, and hypertension.
Common metastatic sites for endometrial cancer include the following:
The most common sites of metastases from endometrial cancer includes the cervix and the vagina.
The best method of detecting endometrial cancer is what?
An endometrial biopsy detects endometrial cancer 90 percent of the time and is the best method of detecting endometrial cancer. Hysterectomy is a treatment for the disease.
The client has gastric cancer and wonders about his risks for getting the disease. What are they?
Risk factors for the disease include being African-American, Japanese, Chinese, Hawaiian, male over the age of 40, poor nutritional habits, family history, previous gastric resection, pernicious anemia, gastric atrophy, gastritis, and a Helicobacter pylori. Being a rubber worker or coal miner are risk factors as well.
The client has metastatic gastric cancer. Where is a likely metastasis?
Pancreas, esophagus, and liver are the main sites of metastases from gastric cancer because it spreads through direct extension.
The client has cancer of the larynx and wonders how he got it. What is a main risk factor for laryngeal cancer?
Smoking and drinking account for 95 percent of these types of cancers.
The client has metastatic cancer of the larynx. Where is the major site of metastasis?
The most likely metastasis of laryngeal cancer is local spread to other head and neck areas. Distant metastatic spread is rare.
The client has persistent hoarseness, throat pain, and a painless mass in the neck. What is the most likely diagnosis?
Persistent hoarseness, throat pain, and a painless mass, especially in the presence of tobacco and alcohol use, is high risk for laryngeal cancer.
The client has nasopharyngeal cancer. What can he expect as the main form of therapy?
All are treatments for nasopharyngeal cancer but radiation treatment is considered the primary treatment.
The client has weight loss, unexplained bleeding, splenomegaly, anemia, low platelet count and a WBC count of 50,000. What do you expect is going on?
The symptoms of weight loss, unexplained bleeding, anemia, low platelet count, and high WBC count are most consistent with acute leukemia.
The primary treatment for leukemia and multiple myeloma is what?
The primary treatment for leukemia and multiple myeloma is chemotherapy followed by bone marrow transplant.
The client has been diagnosed with lung cancer and wonders how he got it. What does the nurse say about the primary cause of lung cancer?
Cigarette smoking is the number one cause of lung cancer, while the other causes are secondary factors.
The client is suspected of having lung cancer by a suspicious x-ray of the chest. What follow-up test is most appropriate to detect whether or not the suspicious area is cancer?
A bronchoscopy with biopsy is a good follow-up test to identify cancer in a suspicious lesion.
The client has been diagnosed with localized small cell cancer. What is the standard treatment for this disease?
Chemotherapy is the standard treatment for small cell cancer. Surgery and brachytherapy are not recommended, but radiation can be used in small cell cancer as well.
Nursing interventions for those who have had a lobectomy for lung cancer include the following:
In a lobectomy, the client should lie on the opposite side of the surgery and should encourage the stoppage of smoking altogether. Breathing, coughing, and ambulation are important as is managing the chest tubes.
The client has been diagnosed with ovarian cancer. How do you educate the client about the disease?
A total of 60-70 percent of people are diagnosed at stage III or IV. The peak age at onset is 55-59. There are no risk factors. The five-year survival rate is 30-35 percent.
The client has metastatic cervical cancer. Where are the most likely site(s) for metastasis of this type of cancer?
The most likely site of cancer metastasis of cervical cancer is fallopian tubes, uterus, bladder, and peritoneum.
The routine treatment for ovarian cancer is what?
The main therapy for ovarian cancer is a total abdominal hysterectomy and bilateral oophorectomy.
The client has discovered he has prostate cancer and wants to know details. How do you educate him on the disease?
Prostate cancer has a nearly 100 percent survival rate but is still the second leading cause of cancer death. It is much more common in African-Americans. It is most common in men older than 65.
The client has metastatic prostate cancer. What is the major site of prostate cancer metastases?
A large amount of prostate cancer patients have metastases to bones. It can go to the liver, lung, and bladder as well.
The client has a weak urinary stream and an inability to start or stop the flow of urine. He has frequent nocturia and hematuria. What kind of cancer might he have?
The symptoms are most consistent with prostate cancer.
Surgical management of prostate cancer include what?
The main surgical management of prostate cancer involves a radical prostatectomy, which removes the prostate, the seminal vesicles, some lymph nodes, and ejaculatory ducts.
Adjuvant therapy for prostate cancer includes:
Adjuvant therapy for prostate cancer includes brachytherapy and hormonal therapy, which can involve giving estrogen and removing the testes. Leuprolide and goserelin can be given as part of hormonal manipulation of prostate cancer.
Nursing interventions for prostate cancer clients include the following:
The client is to have a urinary catheter for several weeks after surgery. The client should ambulate as soon as possible after surgery and should turn and cough regularly. Laxatives should not be given but stool softeners are acceptable. Report to physician voiding difficulties and evidence of infection after receiving brachytherapy.
After brachytherapy for prostate cancer, the client should be instructed by telling him this:
The client should be kept in the hospital until radioactivity decreases. The client is not a radioactive hazard to those around him but should stay away from pregnant women and children as a precaution. Strain the urine and wear a condom to look for dislodged seeds.
The client has been diagnosed with skin cancer. How do you educate the client as to skin cancer?
Actinic keratoses can lead to squamous cell cancer. Seborrheic keratoses do not lead to cancer. Basal cell cancer is practically never fatal. Melanoma is the third most common skin cancer.
The client has been diagnosed with melanoma. How do you educate the client on melanoma?
Melanoma is most common among women who are Caucasian. It arises from melanocytes in the dermis of the skin. It can be prevented by wearing hats and using sunscreen.
Risk factors for melanoma include:
Risk factors for melanoma include excessive exposure to UVA and UVB rays, not wearing sunscreen, getting bad sunburns in childhood, having a fair complexion, having HIV, and being exposed in the workplace to various chemicals. Having atypical nevi is also a risk factor.
Melanoma can be identified by what characteristics?
Melanoma lesions have irregular, asymmetric borders and a non-uniform color to the lesion. Pearly lesions are common in basal cell carcinoma.
Treatment of a basal cell or squamous cell skin cancer includes:
The treatment of a basal cell or squamous cell cancer involves making a wide excision to include healthy tissue. A punch biopsy is insufficient and chemotherapy/radiation are rarely used.
Common adjuvant therapy for melanoma cancer includes:
External beam radiation is a commonly used form of adjuvant therapy for melanoma. Brachytherapy is not used. Chemotherapy often fails and removal of lymph nodes is part of primary therapy and staging for melanoma.
The patient has been diagnosed with osteosarcoma. Where is the tumor originating from?
Osteosarcoma originates in bone. Chondrosarcoma originates in cartilage. Fibrosarcoma originates in fibrous tissue, and Ewing’s sarcoma originates in reticuloendothelial tissue.
The client has been diagnosed with osteosarcoma. How do you educate the client with regard to this tumor?
Osteosarcoma is rare but is the most common bone tumor. The survival rate with chemotherapy is 50 percent. Chemotherapy is used to treat the cancer.
The client has osteosarcoma and wonders about risk factors for the disease. What do you say?
The disease is most common in males between the ages of 10 and 25 and in older adults who have Paget’s disease. Previous radiation is a risk factor.
The client has metastatic osteosarcoma. What do you say about the most common metastatic sites?
Osteosarcoma is usually metastatic to the lungs. It is rarely metastatic to bowel, liver, or brain.
Nursing interventions for soft tissue sarcomas include what? Select all that apply.
Please select 3 correct answers
The nurse should provide emotional support for changes in body image and should collaborate with occupational and physical therapy. Teach transfer techniques after surgery and prepare the client for phantom limb pain after surgery if amputation is done. Fluid increase and electrolyte monitoring are not exclusive to sarcomas and speech therapy is generally not required.
The client has been diagnosed with testicular cancer. How do you educate the client about this type of cancer?
Testicular cancer is most often occurring in Caucasian men between the ages of 15 and 35. The incidence is highest in Scandinavian countries. The cancer is rare but is very aggressive. It is curable if caught early.
The male client has found a small, hard scrotal mass. What do you suspect?
A small hard, scrotal mass is most consistent with testicular cancer. An undescended testicle is a risk factor for testicular cancer. A varicocele is not hard to the touch and testicular torsion is pain and swelling of the entire testicle.
A common blood test for testicular cancer is what?
Blood tests for serum alpha fetoprotein or beta HCG are elevated in 85 percent of cases of testicular cancer.
The client asks the nurse about mortality from cancer. How does the nurse respond?
About five million people diagnosed with cancer each year will live for five years or more.
The client indicates that he has heard that all men get prostate cancer at some point in their lives. How does the nurse educate the client?
Prostate cancer is the most frequently diagnosed cancer in men. Lung cancer is second. It is more common among African-Americans and there is screening available for this cancer.
