Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Topics
Oncology Nursing
Hodgkin’s Disease
Lung Cancer
Chemotherapy
Brachytherapy
1. Anemia
2. Infection
3. Myocardial Infarction
4. Nausea
1. Back
2. Chest
3. Groin
4. Neck
1. White bread
2. Carrot sticks
3. Stewed apples
4. Medium rare steak
1. Blood pressure
2. Bowel sounds
3. Heart sounds
4. Breath sounds
1. Immunoglobulins
2. Platelets
3. Red blood cells
4. White blood cells
10. For which of the following conditions is a client with multiple
myeloma (MM) monitored?
1. Hypercalcemia
2. Hyperkalemia
3. Hypernatremia
4. Hypermagnesemia
1. Cervical dysplasia
2. A dermoid cyst
3. Endometrial polyps
4. Ovarian cancer
13. The client with which of the following types of lung cancer has the
best prognosis?
1. Adenocarcinoma
2. Oat cell
3. Squamous cell
4. Small cell
14. Warning signs and symptoms of lung cancer include persistent
cough, bloody sputum, dyspnea, and which of the other following
symptoms?
1. Dizziness
2. Generalized weakness
3. Hypotension
4. Recurrent pleural effusion
1. Coughing
2. Hemoptysis
3. Pleuritic pain
4. Shoulder pain
1. Early bronchoscopy
2. Early detection
3. High-dose chemotherapy
4. Smoking cessation
17. A client has been diagnosed with lung cancer and requires a wedge
resection. How much of the lung is removed?
19. Which of the following is the primary goal for surgical resection of
lung cancer?
20. If the client with lung cancer also has preexisting pulmonary
disease, which of the following statements best describes how the
extent of that can be performed?
21. The client with a benign lung tumor is treated in which of the
following ways?
1. Abdominal pain
2. Increased activity level
3. Increased appetite
4. Petechiae
26. Which of the following assessment findings in a client with
leukemia would indicate that the cancer has invaded the brain?
1. Lumbar puncture
2. Liver function studies
3. Complete blood count (CBC)
4. Peripheral blood smear
30. Which of the following immunizations should not be given to a 4-
month-old sibling of a client with leukemia?
31. Which of the following medications usually is given to a client with leukemia
as prophylaxis against P. carinii pneumonia?
1. Bactrim
2. Oral nystatin suspension
3. Prednisone
4. Vincristine (Oncovin)
1. No treatment is indicated.
2. Acyclovir (Zovirax) should be started on exposure
3. Varicella-zoster immunoglobulin (VZIG) should be given with the evidence of
disease
4. VZIG should be given within 72 hours of exposure.
34. Nausea and vomiting are common adverse effects of radiation and
chemotherapy. When should a nurse administer antiemetics?
1. Immediately
2. Within 1 to 2 weeks
3. Within 5 to 8 weeks
4. Within 3 to 6 months
1. Viral factors
2. Stress
3. Low-fat and high-fiber diets
4. Exposure to radiation
39. A client is diagnosed with multiple myeloma. The client asks the
nurse about the diagnosis. The nurse bases the response on which of
the following descriptions of this disorder?
41. The nurse is developing a plan of care for the client with multiple
myeloma. The nurse includes which priority intervention in the plan of
care?
1. Coughing and deep breathing
2. Encouraging fluids
3. Monitoring red blood cell count
4. Providing frequent oral care
47. 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?
1. Fever
2. Chills
3. Tachycardia
4. Dyspnea
48. 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?
49. When caring for a client with a central venous line, which of the
following nursing actions should be implemented in the plan of care for
chemotherapy administration? Select all that apply.
50. 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:
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic alkalosis
4. Metabolic acidosis
51. A 32-year-old woman meets with the nurse on her first office visit
since undergoing a left mastectomy. When asked how she is doing, the
woman states her appetite is still not good, she is not getting much
sleep because she doesn’t go to bed until her husband is asleep, and
she is really anxious to get back to work. Which of the following
nursing interventions should the nurse explore to support the client’s
current needs?
1. Call the physician to discuss allowing the client to return to work earlier.
2. Suggest that the client learn relaxation techniques to help with her insomnia
3. Perform a nutritional assessment to assess for anorexia
4. Ask open-ended questions about sexuality issues related to her mastectomy
1. Administration of antihistamines
2. Steroids
3. Silk sheets
4. Medicated cool baths
1. Hiatal hernia
2. Stomatitis
3. Radiation enteritis
4. Esophagitis
Answers and Rationale
3. Answer: 4. Neck
At the time of diagnosis, a painless cervical lesion is often present. The back,
chest, and groin areas aren’t involved.
Stage II involves two or more lymph node regions. Stage I only involves one
lymph node region; stage III involves nodes on both sides of the diaphragm;
and stage IV involves extralymphatic organs or tissues.
The faster the cell grows, the more susceptible it is to chemotherapy and
radiation therapy. Slow-growing and non-dividing cells are less susceptible to
chemotherapy. Repeated cycles of chemotherapy are used to destroy
nondividing cells as they begin active cell division.
6. Answer: 2. Carrot sticks
A low-bacteria diet would be indicated with excludes raw fruits and vegetables.
Pneumonia, both viral and fungal, is a common cause of death in clients with
neutropenia, so frequent assessment of respiratory rate and breath sounds is
required. Although assessing blood pressure, bowel sounds, and heart sounds is
important, it won’t help detect pneumonia.
Multiple myeloma is more common in middle-aged and older clients (the median
age at diagnosis is 60 years) and is twice as common in Blacks as Whites. It
occurs most often in Black men.
9. Answer: 1. Immunoglobulins
Recurring episodes of pleural effusions can be caused by the tumor and should
be investigated. Dizziness, generalized weakness, and hypotension aren’t
typically considered warning signals, but may occur in advanced stages of
cancer.
Centrally located pulmonary tumors are found in the upper airway (vocal cords)
and usually obstruct airflow, producing such symptoms as coughing, wheezing,
and stridor. Small cell tumors tend to be located in the lower airways and often
cause hemoptysis. As the tumor invades the pleural space, it may cause
pleuritic pain. Pancoast tumors that occur in the apices may cause shoulder
pain.
Early detection of cancer when the cells may be premalignant and potentially
curable would be most beneficial. However, a tumor must be 1 cm in diameter
before it’s detectable on a chest x-ray, so this is difficult. A bronchoscopy may
help identify cell type but may not increase survival rate. High-dose
chemotherapy has minimal effect on long-term survival. Smoking cessation
won’t reverse the process but may help prevent further decompensation.
17. Answer: 3. A small, localized area near the surface of the lung.
A small area of tissue close to the surface of the lung is removed in a wedge
resection. An entire lung is removed in a pneumonectomy. A segment of the
lung is removed in a segmental resection and a lobe is removed in a lobectomy.
18. Answer: 4. The remaining lobe or lobes overexpand to fill the space.
The remaining lobe or lobes overexpand slightly to fill the space previously
occupied by the removed tissue. The diaphragm is carried higher on the
operative side to further reduce the empty space. The space can’t remain
“empty” because truly empty would imply a vacuum, which would interfere with
the intrathoracic pressure changes that allow breathing. The surgeon doesn’t
use a gel to fill the space. Serous fluid overproduction would compress the
remaining lobes, diminish their function and possibly, cause a mediastinal shift.
The goal of surgical resection is to remove the lung tissue that has a tumor in it
while saving as much surrounding tissue as possible. It may be necessary to
remove alveoli and bronchioles, but care is taken to make sure only what’s
absolutely necessary is removed.
20. Answer: 4. It may prevent surgery if the client can’t tolerate lung
tissue removal.
The tumor is removed to prevent further compression of the lung tissue as the
tumor grows, which could lead to respiratory decompensation. If for some
reason it can’t be removed, then radiation or chemotherapy may be used to try
to shrink the tumor.
The client with terminal lung cancer may have extreme pleuritic pain and should
be treated to reduce his discomfort. Preparing the client and his family for the
impending death and providing emotional support is also important but
shouldn’t be the primary focus until the pain is under control. Nutritional
support may be provided, but as the terminal phase advances, the client’s
nutritional needs greatly decrease. Nursing care doesn’t focus on helping the
client prepare the will.
23. Answer: 3. Histologic type of disease, initial WBC count, and client’s
age at diagnosis
The most frequent signs and symptoms of leukemia are a result of infiltration of
the bone marrow. These include fever, pallor, fatigue, anorexia, and petechiae,
along with bone and joint pain. Increased appetite can occur but it usually isn’t
a presenting symptom. Abdominal pain may be caused by areas of inflammation
from normal flora within the GI tract or any number of other causes.
Acute lymphoblastic leukemia, which accounts for more than 80% of all
childhood cases, carries the best prognosis. Acute myelogenous leukemia, with
several subtypes, accounts for most of the other leukemias affecting children.
Basophilic and eosinophilic leukemia are named for the specific cells involved.
These are much rarer and carry a poorer prognosis.
Liver and kidney function studies are done before initiation of chemotherapy to
evaluate the child’s ability to metabolize the chemotherapeutic agents. A CBC is
performed to assess for anemia and white blood cell count. A peripheral blood
smear is done to assess the maturity and morphology of red blood cells. A
lumbar puncture is performed to assess for central nervous system infiltration.
OPV is a live attenuated virus excreted in the stool. The excreted virus can be
communicated to the immunosuppressed child, resulting in an overwhelming
infection. Inactivated polio vaccine would be indicated because it isn’t a live
virus and wouldn’t pose the threat of infection. DTP, Hib, and hepatitis B
vaccines can be given accordingly to the recommended schedule.
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. If the antiemetic was
given with the medication or after the medication, it could lose its maximum
effectiveness when needed.
35. Answer: 3. Within 5 to 8 weeks
36. Answer: 2. The best time for the examination is after a shower
Viruses may be one of multiple agents acting to initiate carcinogenesis and have
been associated with several types of cancer. Increased stress has been
associated with causing the growth and proliferation of cancer cells. Two forms
of radiation, ultraviolet and ionizing, can lead to cancer. A diet high in fat may
be a factor in the development of breast, colon, and prostate cancers. High-fiber
diets may reduce the risk of colon cancer.
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. Chemotherapy slows cell division. Not all
chemotherapeutic agents affect molecular structure. All cells are susceptible to
drug toxins, but not all chemotherapeutic agents are toxins.
49. Answer: 1, 2, 4, 5.
The content of the client’s comments suggests that she is avoiding intimacy
with her husband by waiting until he is asleep before going to bed. Addressing
sexuality issues is appropriate for a client who has undergone a mastectomy.
Rushing her return to work may debilitate her and add to her exhaustion.
Suggesting that she learn relaxation techniques to help her with her insomnia is
appropriate; however, the nurse must first address the psychosocial and sexual
issues that are contributing to her sleeping difficulties. A nutritional assessment
may be useful, but there is no indication that she has anorexia.
Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis,
which is a common complication of radiation therapy of the chest wall.