Oncology Care AI.pptx

LEARNING OUTCOMES After reviewing required reading and active participation in class students will be able to: 1. Compare & Contrast subjective and objective assessment data to design a plan of care for patients with cancer. 2. Make use of ADPIE to prevent complications associated with side effec...

LEARNING OUTCOMES After reviewing required reading and active participation in class students will be able to: 1. Compare & Contrast subjective and objective assessment data to design a plan of care for patients with cancer. 2. Make use of ADPIE to prevent complications associated with side effects associated with cancer and their treatment. 3. Verbalize empathy for patients experiencing interruptions to their lives associated with cancer and cancer treatment. CANCER  2nd leading cause of death……  heart disease still #1  Cancer screening, prevention, and treatments have extended life.  Incidence of many cancers have declined largely due to prevention efforts.  More than 16.9 million Americans are alive today who have a history of Cancer.  Cancer evolving into a chronic illness NEOPLASMS (TUMORS)  Classified as Malignant or Benign  Benign  Composed of “well-differentiated” cells in terms of structure and function, but have lost the ability to control cell proliferation  Malignant  Uncontrolled cell differentiation and proliferation BENIGN OR MALIGNANT? Benign Malignant  Well differentiated  Undifferentiated  Encapsulated  No defined borders. Margins are  Grows by expansion  Does not spread by metastasis  Rarely recur or grow back when removed not clearly separated from surrounding normal tissue  Grows by invasion, spreading into surrounding tissue  Metastasizes to other areas of the body through blood or lymph channels  Frequent recurrence CATEGORIES OF MALIGNANT CANCERS  Solid Tumors  Initially confined to a specific tissue or organ  “Cancer in Situ”  Original cancer cells before spreading  Metastases  Cells of the original cancer detach and enter the blood or lymph and spread to other regions of the body  Hematologic Cancers  Involves cells normally found within blood and lymph  The cells are disseminated from the beginning COMMONLY OCCURRING CANCERS  Skin Cancer  Lung Cancer  Prostate Cancer  Breast Cancer  Colon and Rectal Cancer  Multiple Myeloma  Acute and Chronic myelocytic leukemia  Acute and Chronic lymphocytic leukemia  Non-Hodgkin’s Lymphoma  Hodgkin’s Lymphoma PREVENTION IS KEY  Elimination of Risk Factors…  Smoking cessation  Weight loss  Wear sunscreen/ Avoid tanning bed exposure  Balanced diet with fruits, vegetables, fiber…  Limit alcohol use  Regular exercise & adequate rest  Regular physical examinations  Awareness of the seven warning signs of cancer SEVEN WARNING SIGNS OF CANCER C… change in bowel or bladder habits A… A sore that does not heal U… Unusual bleeding or discharge from any body orifice T… Thickening or a lump in the breast or elsewhere I… Indigestion or difficulty in swallowing O… Obvious change in a wart or mole N… Nagging cough or hoarseness 8 NURSE’S ROLE IN PREVENTION AND EARLY DETECTION?  Education…  Risk Factors and how to reduce them  Health Promotion  Screening  Warning Signs of Cancer… 9 BREAST CANCER SCREENING Population? Population? Modality Modality and and Interval? Interval? Discontinuation Discontinuation ?? 1) Recommend all average-risk Mammogram every 1-2y​If life expectancy is <10y females age 40-75 receive OR biennial screening (Grade B) >74 (USPSTF). New update 5/23. 2) ACS – 40 – 44 individual decision making, yearly screening 45 – 54, biennial screening 55 and older 20 30 40 ACS: until life expectancy <10y 50 60 70 80 COLON CANCER SCREENING Population? Population? Average-risk patients ages 4575 (age 45-49 is Grade B, 50-75 Grade A) (age 76-84 selectively offer Grade C) In pts with 1st degree relatives with hx of CRC. Start screening 10 years before relatives age at diagnosis 20 30 40 Modality Modality and and Interval? Interval? Colonoscopy q10 y q1y q3y gFOBT/FIT sFIT+DNA CT colonography q5y or sigmoidoscopy Discontinuatio Discontinuatio n? n? Age >85y or earlier depending on patient factors Colonoscopy – q10y gFOBT/ FIT – q1y sFIT+DNA – q3y CT colonography sigmoidoscopy – q5y 50 60 70 80 CERVICAL CANCER SCREENING Modality Modality and and Interval? Interval? Population? Population? 21-29y USPSTF Guidelines Starting age 21 (Grade A) 30-65y ACS Guidelines Starting age 25 Discontinuatio Discontinuatio n? n? Cytology q3y >65y with normal screening in prior 10y Cytology q3y OR HPV ± cytology q5y Hysterectomy with Primary HPV q5y removal of cervix + no q5y prior history of highHPV + cytology grade precancerous lesion q3y Cytology ACS USPTF 20 30 40 50 60 70 80 LUNG CANCER SCREENING Modality Modality and and Interval? Interval? Population? Population? Discontinuatio Discontinuatio n? n? Ages 50-80 with at least Annual low-dose CT scan 20 pack-year history + smoked within the past 15y (Grade B) If quit smoking >15y ago OR Limited life expectancy Medicare requires a shared decision-making visit prior to first screening. Annual low dose CT scan 20 30 40 50 60 70 80 PROSTATE CANCER SCREENING Modality Modality and and Interval? Interval? Population? Population? Males aged 55-69y individual decision making s/p discussion about risks/benefits USPFTF(Grade C) Discontinuatio Discontinuatio n? n? No screening or PSA every 1-2y​ If >70y Benefits: earlier detection of aggressive malignancy Risks: false pos, unnecessary biopsy, overtreating slow growing, non life threatening lesion, incontinence, ED as complications of treatment 20 30 40 ± PSA q1-2y 50 60 70 80 HOW TO DIAGNOSE CANCER…  Patient Presentation  Lumps, bumps, sores and bruises that won’t go away  Bleeding from GI tract, GU tract, or nose and mouth bleeding that won’t stop  Shortness of breath without evidence of infection  Pain that won’t go away with traditional treatments  Unintentional weight loss  Testing Methods  Biopsies and surgeries  Radiologic testing  Blood testing (tumor marker tests) CLASSIFICATION OF CANCER: TWO METHODS TNM  T = Tumor (primary)  N = Spread to lymphnodes  M = Metastasis Staging NURSING CONSIDERATIONS RELATED TO THE DIAGNOSES OF CANCER  Expect that the patient may experience fear and anxiety  Fear of the unknown before a definitive diagnosis is often the most difficult time  Actively listen to patient’s concerns  Give clear explanations; repeat if necessary  Give written information for reinforcement  Refer to oncology team when possible 17 MANAGE YOUR OWN DISCOMFORT    Learn to recognize your own discomfort during difficult conversations Listening is an important skill at this time Avoid the self-protective communication strategies, such as:  Providing false reassurances  Redirecting the discussions to more comfortable topics  Generalizing what other patients have experienced  Use of overly technical language 18 CANCER TREATMENT  Goal of Treatment may be…  Cure  Control  Palliation  Goals will be determined by…  Staging of cancer  Patients physical and psychological health  Patients wishes….  Quality of life defined by the patient 19 THERAPIES FOR PATIENTS WITH CANCER  Chemotherapy (IV, SQ, PO, IT)  “Kills” the cancer cells  Chemotherapy keeps the cells from further multiplying and forming more cells.  Used for cure, control or palliation  Radiation therapy  “Shrinks” the tumor by hitting it directly with gamma rays  Surgery  Eliminates the cancer tumor  Alternative treatments  Palliative care  Homeopathic care ADMINISTRATION OF CHEMOTHERAPY  Doses of chemotherapy are usually individualized according to body weight  Requires special training and certifications  All persons preparing and administering cytotoxic drugs  Preparation, administration, and disposal of hazardous drugs may expose workers to high levels of toxins.  Bags are clearly labeled and tubing must be primed by pharmacy, typically under the hood (controlled environment)  When administering chemotherapy…  Wear PPE gown, chemotherapy safe gloves, masks, goggles  Guidelines have been established for the safe handling of chemotherapy agents by the National Institute for Occupational Safety and Health (OSHA), and the Oncology Nursing Society (ONS). IV ADMINISTRATION  Never in a hand  Check for positive blood return very frequently (hourly)  Teach patients to call if site begins to burn/hurt  Exposure to toxins may occur when administering chemotherapy…  Leaking from tubing or syringes  Handling excreta of patients  For 48 hours following administration  Handling chemotherapy spills  Double-glove to clean up the drug spill  Wear a mask and eye protection for cleaning up powdered medications  Place spilled substance in a double plastic bag and label biohazard 22 PROTOCOLS FOR EXTRAVASATION…  Irritant: agent that causes discomfort in or around the vein when it escapes into the surrounding tissue  Vessicant: agent capable of causing blistering, tissue sloughing, or necrosis when it escapes from the intended vascular pathway into surrounding tissue.  Extravasation: Tissue injury from a vesicant which has infiltrated into the tissue surrounding the infusion site 23 NURSING ROLE  MUST do the following…  STOP the infusion  Call the doctor for further orders  Prepare to administer antidote  Pull back as much fluid as possible from the site  May apply ice or heat depending on the chemotherapy given 24 HORMONAL AGENTS  Not considered true chemotherapeutic agents  However, they are used in treatment  Examples…  Corticosteroids  Sex hormones  Slows growth of hormone-dependent tumors  Estrogen slows the growth of prostatic cancer in men  Androgens may be given to treat breast cancer in pre- menopausal women  Antiestrogens  Tamoxifen and Fluvestrant  Treat breast cancer tumors that are estrogen-dependent  Tamoxifen has also been shown to increase the risk of uterine cancer  Adverse effects include hot flashes, fatigue, irregular menses… IMMUNOTHERAPIES ImmunoTherapies… May also be referred to as “Biologic” Therapy Uses the bodies immune system to fight cancer Immunotherapies can… Boost or manipulate the immune system Attack cancer cells directly Interfere with the cancer cells ability to metastasize Immunotherapies include… Vaccines Cytokines Monoclonal antibodies (Most effective) Antibodies produced by the immune system that bind to the antigen TARGETED THERAPIES  More selective than Chemotherapy  Less damage to normal, healthy cells  Targets specific cell receptors  Work on the sites that are on the cell surface  Example…  Tyrosine Kinase Inhibitors (TKIs)  Inhibit TK, which is responsible for activation of many proteins.. RADIATION THERAPY  Ionizing radiation acts to break the chemical bonds in DNA, resulting in cell death  DNA is damaged, resulting in cell death  Different types of ionizing radiation can be used to treat cancer…  External Beam Radiation  Stereostatic Radiation  Brachytherapy  Intracavitary  Interstitial 28 RADIATION SAFETY Time Distance Shielding 29 SKIN REACTIONS TO RADIATION  Localized skin changes within the treatment fields  Reaction will vary based on dosage, technique…  Newer techniques spare the skin more efficiently  Erythema develops within 24 hours of first treatment  Generally continues to worsen throughout 30 NURSING CONSIDERATIONS FOR SKIN  Protect radiated skin from temperature extremes  No Heating Pads, Ice Packs or hot water bottles  Avoid constrictive garments  Avoid harsh chemicals, deodorants…  Lubricate dry skin with nonirritating lotion  Encourage Aloe Vera to prevent skin problems 31 SURGICAL THERAPY Eliminates the cancer tumor, examples: Breast Cancer: Simple, Skin-sparing, Modified Radical, Radical, and Nipplesparing Lung Cancer: Lobectomy, Segmenectomy, Wedge Resection, Pneumonectomy 32 NURSE’S ROLE  Education  Treatment Regimen  Anticipatory Guidance  Emotional Support  Encourage Adherence  Resources…  Manage Adverse Effects  Supportive Care  Assessment  Emotional and Physical 33 NURSING MANAGEMENT OF THE PATIENT UNDERGOING TREATMENT FOR CANCER  Total body effects  Hematological effects  Pain from tumor  Fatigue  Anemia (red)  Neutropenia (white)  Hair loss  Depression  Thrombocytopenia  Electrolyte imbalances  Spontaneous infections  Uric Acid increase  GI effects  Nausea/vomiting  Anorexia  Diarrhea  Mucositis  Constipation 34 Management of Cancer Pain  Under-treatment of pain leads to…  Needless suffering, Decreased quality of life  Increased burden on family caregivers  Fear of addiction is unwarranted  Inadequate pain assessment is single greatest barrier to effective cancer pain management MANAGEMENT OF CANCER PAIN  Numerous drug options for pain management  Medication management..  Narcotic administration  Fentanyl patches, long acting morphine…  Often need around the clock, pain medication!  Non-narcotic methods  Non-narcotic analgesics  Acupuncture, hot packs, ice packs, movement, massage, relaxation therapy, guided imagery… MANAGEMENT OF CANCER TREATMENT COMPLICATIONS Protein and Calorie Malnutrition  Fat and muscle depletion  Interventions:  Nutritional counseling  Soft, high-protein, high calorie foods  Avoid tobacco, alcohol, spicy or rough foods  Encourage nutritional supplements, Ensure  Monitor Albumin levels… Cancer Cachexia or “Wasting Syndrome”  Manifestations  Anorexia and/or unintended loss of weight  Generalized tissue and skeletal muscle wasting  Immune dysfunction, Metabolic abnormalities  Interventions  Typically not reversed by nutrition alone  Treating Cancer is best treatment  Megestrol (Megace): Hormone indicated  Cannibinoids such as Dronabinol (Marinol)  Ensure, vitamins… for anorexia and weight loss  Nausea and Vomiting  Small, frequent meals  Avoid fatty or spicy foods  Notify prescriber if vomiting persists for 24 hours or more  Take antiemetic prophylactically for 48 – 72 hours after chemotherapy treatment  Ondansetron (Zofran)  Palonosetron (Aloxi)  Lorazepam (Ativan)  Haloperidol (Haldol)  Scopolamine patch  Prochlorperazine (Compazine)  Promethazine (Phenergan)  Dexamethosone (Decadron)  Altered taste (dysgeusia)  Physiologic basis of altered taste is unknown  Cancer cells may release substances that stimulate the bitter taste buds.  Education:  Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste  Experiment with spices and seasonings to mask alterations  Avoid using metal silverware Fatigue Monitor for anemia Oxygen administration, blood transfusions for anemia… Ritalin for energy Frequent rest periods, limit activities Depression Encourage the patient to voice his feelings, refer to a counselor Frequently prescribed medications for depression Hair Loss** Begins approximately 2 weeks after drug administration Continues for about 3-5 months after last chemotherapy treatment Wigs, scarves, hats Limit time outdoors where heat loss can occur 40  Diarrhea  Interventions:  Medications:  Diphenoxylate/Atropine (Lomotil)  Loperamide (Imodium)  Monitor number of stools, hydration status and electrolyte balance  May need electrolyte replacement  Education:  Low residue, high protein, high calorie diet  Eliminate irritating foods…  Alcohol, coffee, cold liquids, popcorn  Avoid milk products and chocolate  Mucositis  Frequent mouth care with a soft toothbrush  Magic mouthwash (Benadryl, Lidocaine, Maalox…)  Nystatin swish and swallow for yeast infections  Bland diet, no citrus foods  Thrush  Frequent mouth care  Nystatin rinse  Constipation  High fiber diets, lots of water, exercise  Encourage drinking warm liquids  Bowel Regimen  Cytopenias  Bone marrow suppression decreases RBC, WBC, Plt production  Interventions:  Blood Transfusions  Education  Medications:  Erythropoietin-Stimulating Agents  Procrit, Aranesp  Granulocyte-Colony Stimulating Factor  Neupogen, Neulasta  Thrombopoeitic Growth Factor  Neumega  Interleukin 2: Stimulates B and T Cells  Proleukin  Intravenous Immune Globulin  IVIG  Electrolyte imbalances  Monitor electrolytes & replace when necessary  Uric Acid increase  Caused by rapid tumor breakdown causing large cells to form crystals that may obstruct kidney filtration  Allopurinol may be given prophylactically  Encourage fluids  Nephrotoxicity  Monitor BUN and serum creatinine  Monitor I&O ONCOLOGIC EMERGENCIES  Any acute, potentially life-threatening event in the oncology patient  Directly or indirectly related to cancer or treatment  May develop at any stage of treatment o Diagnosis o Relapse or Progression  Delay in treatment may result in adverse outcomes o Pain and suffering o Death  Immediate intervention is required ONCOLOGIC EMERGENCY CATEGORIES  Metabolic o TLS, Hypercalcemia, SIADH, Hyper/hypoglycemia  Structural o SVC obstruction, Airway obstruction, Cord compression, Effusion, ICP, Seizure  Hematologic o Fever, Leukostasis/Viscosity, Bleeding, Thrombosis, DIC  Infusional o Extravasation, Anaphylaxis, Reactions METABOLIC EMERGENCIES “TUMOR LYSIS SYNDROME”  Life threatening emergency  Rapid cellular destruction ÞRelease of intracellular components ÞElectrolyte imbalances ÞHyperkalemia ÞHyperphosphatemia ÞHyperuricemia ÞRenal Failure METABOLIC EMERGENCIES “HYPERCALCEMIA OF MALIGNANCY”  Most common oncologic emergency  25% of cancer patients  Most common in  Breast  Lung  Myeloma  Lymphoma STRUCTURAL EMERGENCIES “SUPERIOR VENA CAVA OBSTRUCTION SYNDROME”  Compression or invasion of SVC  3-4% of cancer patients  80% caused by tumor:  Lung  Lymphoma  Thyroid  Head and Neck Structural Emergencies “Malignant Spinal Cord Compression”  5-14% of patients  Second most common neurologic complication in CA  Most common:  Metastases  Myeloma  Lymphoma  Renal Cell HEMATOLOGIC EMERGENCIES “FEVER AND SEPSIS”  10th Leading Cause of Death in US  High mortality  1st cause of non-relapse mortality in cancer patients  1 in 10 neutropenic fever patients will die of sepsis 51 “NEUTROPENIC FEVER”  FEVER ≥ 38°C (oral) on 2 occasions 1 hour apart OR a single temperature of ≥ 38.3°C AND  ANC of <500cells/mm³ or an ANC expected to decrease to <500cells/mm³ during next 48 hours  Treatment:  Vital signs o Volume resuscitation o Oxygen support  Labs o CBCd, CMP, PT/INR, fibrinogen, lactate  Cultures o Blood (line/peripheral), urine, sputum, wound/lesions, abscess, etc.  ANTIBIOTICS o DO NOT DELAY antibiotics for labs, diagnostic testing or any cultures OTHER THAN blood cultures  Diagnostic testing o CXR, CT, US, Bronchoscopy, etc. 52 CASE STUDY: Stephanie is a 42yo F presents to the pre-op area with her wife at her side after a new diagnosis of small (0.9 cm) grade III infiltrating ductal carcinoma with some associated ductal carcinoma-in-situ (DCIS) that is estrogen positive. Her oncologist has laid out a plan of surgery for a partial mastectomy followed by radiation and then hormonal therapy. The patient states, “this is all happening so fast, I wonder how I will feel after surgery?” What is the first thing the nurse will do?  ROS  VS  Labs  IV  Anticipatory Guidance  What would you want to educate the patient about pre-surgery?  Side effects  Post-Op care  You are assigned to care for the patient again in the post-op area. Her surgical site is covered with a large dressing. She is having pain. What do you do?  Rate and assess her pain  Assess her sensation and motion in her left arm (the same side as the mastectomy)  Educate about RICE and pain management at home  Give pain medicine  You are Stephanie’s nurse in the oncology clinic. You’re seeing her have 2 weeks of radiation therapy. What do you do first?  ROS  Side effects? Fatigue, erythema, swelling, peeling of skin?  Stephanie says that she has been using her favorite Tropical Breeze lotion on her skin but it doesn’t seem to be helping her erythema and peeling skin. What would you do next as her nurse?  Education! Using unscented, mild lotions when receiving radiation therapy to help with erythema and peeling.  Several weeks later, you see Stephanie again in the infusion center. She is being started on Tamoxifen. The provider has just consented her for this hormonal therapy and she asks you how she should be taking it. What do you do?  Tamoxifen is an anti-estrogen hormonal therapy used to prevent breast cancer. What are some general things you’ll want to discuss with Stephanie?  Education!  Take Tamoxifen at the same time each day  Medication adherence is important for preventing recurrence  Side effects: Nausea, Fatigue, Blood Clots, Constipation CASE STUDY: James is a 38yo M recently diagnosed with Stage 2 DLBCL who is being started on R-CHOP chemotherapy today in the infusion center. You will be his nurse today. What is the first thing you do for James?  VS  Weight  Labs  Make sure you have a chemo consent   Check Chemo James says to you, “I wonder if I’m going to lose my hair with this?” What do you do next?  Anticipatory guidance:  Hair Loss  N/V  Constipation  Neuropathy You and a second nurse complete the double-check for James and hang his Ritxumab. When you change the rate per protocol from 100mL/h to 150mL/h, James starts to have rigors and starts vomiting. What do you do first?  STOP THE INFUSION What do you do next?  Notify the provider  Administer rescue medication – Benadryl and Tylenol  Draw blood cultures  Send blood to blood bank for transfusion reaction work-up The following week, James returns to clinic for a nadir check. What is the first thing you do?  VS  Labs  ROS James’ labs come back as the following. What do you notice? 138 12 4.8 0.9 9.7 0.4 72 He says to you that he’s been very tired at home and noticed that he was light headed this morning. VS:  Temp 38.4℃  HR 135  RR 18  BP 92/56  O2 Sat 95% on RA What do you do next?  Notify the provider What do you anticipate the provider will order?  Blood Cultures, urine culture, IVF, IV antibiotics How quickly do you want to try to get the above accomplished?  ONE HOUR!! NEOPLASM CAN BE CLASSIFIED AS EITHER BENIGN OR MALIGNANT. THE FOLLOWING ARE CHARACTERISTICS OF MALIGNANT TUMOR EXCEPT FOR: A.Metastases B.Infiltrates Surrounding Tissue C.Encapsulated D.Poorly differentiated Cells WHICH OF THE FOLLOWING STATEMENTS IS CORRECT ABOUT THE RATE OF CELL GROWTH IN RELATION TO CHEMOTHERAPY? A. Faster growing cells are less susceptible to chemotherapy B. Non-dividing cells are more susceptible to chemotherapy C. Faster growing cells are more susceptible to chemotherapy D. Slower growing cells are more susceptible to chemotherapy A 25 YEAR OLD PATIENT IS INQUIRING ABOUT THE METHODS OR WAYS TO DETECT CANCER EARLIER. THE NURSE LEAST LIKELY IDENTIFY THIS METHOD BY STATING: A. Annual chest x-ray B. Annual PAP smear whether sexually active or not C. Colonoscopy every 10 years beginning at age 50 D. Yearly physical exam A PATIENT HAD UNDERGONE RADIATION THERAPY (EXTERNAL). THE EXPECTED SIDE EFFECTS INCLUDE THE FOLLOWING APART FROM: A.Hair Loss B.Ulceration of mucosal membranes C.Constipation D.Headache CHEMOTHERAPY IS ONE OF THE THERAPEUTIC MODALITIES FOR CANCER. THIS TREATMENT IS CONTRAINDICATED TO WHICH OF THE FOLLOWING CONDITIONS? A. Recent surgery B. Illness C. Pregnancy D. Bone marrow suppression E. All of the Above A PATIENT IS TAKING CYCLOPHOSPHAMIDE (CYTOXAN) FOR THE TREATMENT OF LYMPHOMA. THE NURSE IS VERY CAUTIOUS IN ADMINISTERING THE MEDICATION BECAUSE THIS DRUG POSES THE FATAL SIDE EFFECT OF: A. Alopecia B. Myeloma C. CNS Toxicity D. Hemorrhagic Cystitis SKIN REACTIONS ARE COMMON IN RADIATION THERAPY. NURSING RESPONSIBILITIES ON PROMOTING SKIN INTEGRITY SHOULD BE PROMOTED APART FROM: A.Avoiding the use of ointments, powders, and scented lotions to the area B.Using soft cotton fabric for clothing C.Washing the area with mild soap and water and patting it dry D.Avoiding direct sunshine or cold ON A CLINIC VISIT A CLIENT WHO HAS A RELATIVE WITH CANCER, IS ASKING ABOUT THE WARNING SIGNS THAT MAY RELATE TO CANCER. THE NURSE CORRECTLY IDENTIFIES THE WARNING SIGNS OF CANCER BY RESPONDING: A.If a sore took a month or more to heal, cancer should be suspected B.Presence of a dry cough is a warning sign of cancer C.A lump that resolves spontaneously in the breast area may be a sign of cancer D.Sudden, unintentional weight loss can be a warning sign of cancer. THE NURSE IS PREPARING CYCLOPHOSPHAMIDE (CYTOXAN). SAFE HANDLING OF THE DRUG SHOULD BE IMPLEMENTED TO PROTECT THE NURSE FROM INJURY. WHICH OF THE FOLLOWING ACTIONS BY THE NURSE SHOULD BE USED? A.The nurse should wear PPE including chemotherapy gloves B.Return the drug to pharmacy if the tubing is not primed C.Label the hanging IV bottle with “Antineoplastic Chemotherapy” sign D.Vent vials after mixing NAUSEA AND VOMITING IS AN EXPECTED SIDE EFFECT OF CHEMOTHERAPEUTIC DRUG USE. WHICH OF THE FOLLOWING DRUG SHOULD BE ADMINISTERED TO A CLIENT ON CHEMOTHERAPY TO PREVENT NAUSEA AND VOMITING? A.Succimer (Chemet) B.Anastrazole (Arimidex) C.Ondansetron (Zofran) D.Busulfan (Myleran) IN STAGING AND GRADING NEOPLASM TNM SYSTEM IS USED. TNM STANDS FOR: A.Time, neoplasm, mode of growth B.Tumor, node, metastasis C.Tumor, neoplasm, mode of growth D.Time, node, metastasis WHICH PRECAUTION IS MOST IMPORTANT FOR THE NURSE TO TEACH A CLIENT RECEIVING RADIATION THERAPY FOR HEAD AND NECK CANCER? A.Avoid eating red meat during treatment B.Pace your activities to prevent fatigue C.See your dentist twice yearly for the rest of your life D.Avoid using headphones or headsets until your hair grows back. A PATIENT BEING TREATED FOR ADVANCED STAGE BREAST CANCER WITH CHEMOTHERAPY REPORTS THAT SHE MUST BE ALLERGIC TO ONE OF HER DRUGS BECAUSE HER ENTIRE FACE IS SWOLLEN. WHAT ASSESSMENT DOES THE NURSE PERFORM? A.Asks whether the client has other known allergies B.Checks for capillary refill on fingernails bilaterally C.Examines the client’s neck and chest for edema and engorged veins D.Compares blood pressure measured in the right arm with that in the left arm A PATIENT WHO IS BEING TREATED FOR STAGE IV LUNG CANCER TELLS THE NURSE ABOUT NEW-ONSET BACK PAIN. WHICH ACTION SHOULD THE NURSE TAKE FIRST? A.Assess for sensation and strength in the legs B.Give the patient the prescribed PRN opioid C.Notify the health care provider about the symptoms D.Teach the patient how to use relaxation to reduce pain AFTER CHANGE-OF-SHIFT REPORT ON THE ONCOLOGY UNIT, WHICH PATIENT SHOULD THE NURSE ASSESS FIRST? A.Patient who has a platelet count of 82,000/mL after chemotherapy B.Patient who has xerostomia after receiving head and neck radiation C.Patient who is worried about getting the prescribed long-acting opioid on time D.Patient who is neutropenic and has a temperature of 101.1 (38.4) A PATIENT TAKING A CHEMOTHERAPEUTIC AGENT UNDERSTANDS THE EFFECTS OF THERAPY BY STATING: A. “I will avoid eating hot and spicy foods.” B. “I should stay in my room all the time.” C. “I should limit my fluid intake to about 500 ml per day.” D. “I should notify the physician immediately if I feel chilled.” WHICH OF THE FOLLOWING LABORATORY VALUES IS EXPECTED FOR A CLIENT JUST DIAGNOSED WITH CHRONIC LYMPHOCYTIC LEUKEMIA? A. Elevated sedimentation rate B. Uncontrolled proliferation of granulocytes C. Thrombocytopenia and increased lymphocytes D. Elevated aspartate aminotransferase and alanine aminotransferase levels. ACCORDING TO A STANDARD STAGING CLASSIFICATION OF HODGKIN’S DISEASE, WHICH OF THE FOLLOWING CRITERIA REFLECTS STAGE II? A. Involvement of extralymphatic organs or tissues B. Involvement of single lymph node region or structure C. Involvement of two or more lymph node regions or structures D. Involvement of lymph node regions or structures on both sides of the diaphragm WHICH OF THE FOLLOWING CONDITIONS IS NOT A COMPLICATION OF HODGKIN’S DISEASE? A. Anemia B. Infection C. Myocardial Infarction D. Nausea THE CLASSIC SYMPTOMS THAT DEFINE BREAST CANCER INCLUDES THE FOLLOWING EXCEPT: A. Erythematous skin B. Solitary, irregularly shaped mass C. Firm, nontender, nonmobile mass D. Abnormal discharge from the nipple AN OLDER ADULT WHO HAS COLORECTAL CANCER IS RECEIVING IVF AT 175 ML/H IN CONJUNCTION WITH THE PRESCRIBED CHEMOTHERAPY. WHICH FINDING IS MOST IMPORTANT FOR THE NURSE TO REPORT TO THE HEALTH CARE PROVIDER? A. Patient complains of severe fatigue B. Patient needs to void every hour during the day C. Patient takes only 50%of meals and avoids snacks D. Patient has audible crackles in midline posterior chest A PATIENT WHO HAS SMALL CELL LUNG CARCINOMA DEVELOPS SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE (SIADH). THE NURSE SHOULD NOTIFY THE HEALTHCARE PROVIDER OF WHICH ABNORMAL FINDING? A. Reported weight gain B. Serum hematocrit of 42% C. Serum Sodium level of 120 mg/dL D. Total urinary output of 280mL in the last 8h AFTER 3 WEEKS OF RADIATION THERAPY, THE PATIENT HAS LOST 10 POUNDS AND DOES NOT EAT WELL BECAUSE OF MUCOSITIS. AN APPROPRIATE NURSING DIAGNOSIS FOR THIS PATIENT IS: a. Risk for infection related to poor nutrition b. Ineffective self-health management related to refusal to eat. c. Imbalanced nutrition: less than body requirements related to inflammation and ulceration. d. Ineffective health maintenance related to lack of knowledge of nutritional requirements during radiation therapy. A PATIENT WHO IS SCHEDULED FOR A RIGHT BREAST BIOPSY ASKS THE NURSE THE DIFFERENCE BETWEEN A BENIGN TUMOR AND A MALIGNANT TUMOR. WHICH ANSWER BY THE NURSE IS CORRECT? a. “Benign tumors do not cause damage to other tissues.” b. ”Benign tumors are likely to recur in the same location.” c. ”Malignant tumors may spread to other tissues or organs” d. “Malignant cells reproduce more rapidly than normal cells.” THE NURSE ADMINISTERS AN IV VESICANT CHEMOTHERAPEUTIC AGENT TO A PATIENT. WHAT ACTION IS MOST IMPORTANT FOR THE NURSE TO TAKE? a. Infuse the medication over a short period of time b. Stop the infusion if swelling is observed at the site c. Administer the chemotherapy through a small-bore catheter. d. Hold the medication unless a central venous line is available.