ONCOLOGY QUIZ

1.

A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy?
- A.
  
  Urine output of 400 ml in 8 hours
- B.
  
  Serum potassium level of 3.6 mEq/L
- C.
  
  Blood pressure of 120/64 to 130/72 mm Hg
- D.
  
  Dry oral mucous membranes and cracked lips
Correct Answer
D. Dry oral mucous membranes and cracked lips

Explanation
Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L.

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2.

For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?
- A.
  
  Administering aspirin if the temperature exceeds 102° F (38.8° C)
- B.
  
  Inspecting the skin for petechiae once every shift
- C.
  
  Providing for frequent rest periods
- D.
  
  Placing the client in strict isolation
Correct Answer
B. Inspecting the skin for petechiae once every shift

Explanation
Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.

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3.

Which intervention is appropriate for the nurse caring for a male client in severe pain receiving a continuous I.V. infusion of morphine?
- A.
  
  Assisting with a naloxone challenge test before therapy begins
- B.
  
  Discontinuing the drug immediately if signs of dependence appear
- C.
  
  Changing the administration route to P.O. if the client can tolerate fluids
- D.
  
  Obtaining baseline vital signs before administering the first dose
Correct Answer
D. Obtaining baseline vital signs before administering the first dose

Explanation
The nurse should obtain the client’s baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy. A naloxone challenge test may be administered before using a narcotic antagonist, not a narcotic agonist. The nurse shouldn’t discontinue a narcotic agonist abruptly because withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the ability to tolerate fluids.

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4.

A 35 years old client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis (inflammation of the mouth)?
- A.
  
  White, cottage cheese–like patches on the tongue
- B.
  
  Yellow tooth discoloration
- C.
  
  Red, open sores on the oral mucosa
- D.
  
  Rust-colored sputum
Correct Answer
C. Red, open sores on the oral mucosa

Explanation
The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese–like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.

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5.

During chemotherapy, an oncology client has a nursing diagnosis of impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?
- A.
  
  Recommending that the client discontinue chemotherapy
- B.
  
  Providing a solution of hydrogen peroxide and water for use as a mouth rinse
- C.
  
  Monitoring the client’s platelet and leukocyte counts
- D.
  
  Checking regularly for signs and symptoms of stomatitis
Correct Answer
B. Providing a solution of hydrogen peroxide and water for use as a mouth rinse

Explanation
To decrease the pain of stomatitis, the nurse should provide a solution of hydrogen peroxide and water for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer viscous lidocaine or systemic analgesics as prescribed. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn’t be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection but wouldn’t decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn’t decrease the pain.

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6.

A male client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis may be appropriate for this client?
- A.
  
  Anticipatory grieving
- B.
  
  Impaired swallowing
- C.
  
  Disturbed body image
- D.
  
  Chronic low self-esteem
Correct Answer
A. Anticipatory grieving

Explanation
Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isn’t associated with gallbladder cancer. Although surgery typically is done to remove the gallbladder and, possibly, a section of the liver, it isn’t disfiguring and doesn’t cause Disturbed body image. Chronic low self-esteem isn’t an appropriate nursing diagnosis at this time because the diagnosis has just been made.

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7.

Which intervention is appropriate for the nurse caring for a male client in severe pain receiving a continuous I.V. infusion of morphine?
- A.
  
  Assisting with a naloxone challenge test before therapy begins
- B.
  
  Discontinuing the drug immediately if signs of dependence appear
- C.
  
  Changing the administration route to P.O. if the client can tolerate fluids
- D.
  
  Obtaining baseline vital signs before administering the first dose
Correct Answer
D. Obtaining baseline vital signs before administering the first dose

Explanation
The nurse should obtain the client’s baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy. A naloxone challenge test may be administered before using a narcotic antagonist, not a narcotic agonist. The nurse shouldn’t discontinue a narcotic agonist abruptly because withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the ability to tolerate fluids.

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Oncology Quiz

A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy?

For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?

Which intervention is appropriate for the nurse caring for a male client in severe pain receiving a continuous I.V. infusion of morphine?

A 35 years old client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis (inflammation of the mouth)?

During chemotherapy, an oncology client has a nursing diagnosis of impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?

A male client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis may be appropriate for this client?

Which intervention is appropriate for the nurse caring for a male client in severe pain receiving a continuous I.V. infusion of morphine?