Stromberg: Medical-Surgical Nursing, 5th Edition Chapter 8: Care of Patients With Cancer Answer Guidelines for Think Critically What are the characteristics of malignant cells that differ from those of normal cells? Malignant cells are cancer; they invade the tissues and may break away and travel to distant tissue sites in the body. Cancer cells do not behave like normal cells because of damage to their DNA. Identify carcinogens that you may be exposed to in your home or workplace. What can you do to reduce your exposure and decrease the risk of cancer? Common carcinogenic chemicals are pesticides, tobacco, asphalt, nitrates, and nitrites. Exposure can be reduced by following directions carefully, using protective outerwear such as gloves, and making sure not to ingest foods or drugs that are carcinogenic. Avoiding cooking foods to a charred state helps reduce oncogenic potential. Being certain the area is well ventilated when using chemical cleaners indoors is protective. Thoroughly washing the hands and any exposed skin after using compounds containing carcinogenic chemicals provides protection. You are caring for a patient who has a history of type 2 diabetes and who has just been diagnosed with cancer. What types and amounts of whole grains, fruits, and vegetables would you advise the patient to eat? A balanced diet with a glow glycemic index is best for cancer and diabetes. The recommendations are: Consider a 9" plate: ½ of the surface should be covered with vegetables, fruits and/or beans. These are fibercontaining foods that slow stomach emptying, making them low in glycemic index. ¼ of the surface is covered by starches, such as rice or potatoes. These potentially have a higher glycemic index, but with significant differences depending on the choices you make. ¼ of the surface is covered by lean protein sources. Protein slows carbohydrate absorption. Choose lower fat options and plant sources of fat, such as olive oil, to limit saturated fats. Identify three specific changes you could make in your personal diet and exercise program that might decrease your risk for cancer? How would you change your diet and exercise plan? Ingesting ascorbic acid with nitrates reduces risk. Reducing consumption of alcohol and tobacco reduces risk. Stopping consumption of barbecued meat reduces risk. Reducing calories so that obesity is reduced is also a good way to protect against cancer. Eating less meat and more fresh fruits and vegetables is helpful. A regular exercise program can also reduce risk. The student’s answer will vary based on their current level of activity. Copyright © 2023 by Elsevier Inc. All rights reserved. Can you prepare a teaching plan for the care of the skin in a patient having external beam radiation to the chest? Use mild shampoos and soaps and avoid all lotions. Because the skin is very dry and sometimes brittle, do not rub the skin. It is better to pat the skin dry. Also, do not soak for long periods in the tub, as this can make the skin even drier. There are many skin products available specifically for patients undergoing radiation therapy. These may be prescribed by the health care provider and are useful in keeping the skin moist. You came to work with a slightly scratchy throat and a drippy nose this morning. The charge nurse has assigned you to a cancer patient who has bone marrow suppression. What would you do in this situation? Ask the charge nurse to assign you to activities where you will not come in contact with immunosuppressed patients. Wear a mask and wash hands frequently during the day for all other care activities assigned. A patient with advanced cancer tells you that the long-acting opioid currently being taken for pain control is not effective. How would you assess the patient’s level of pain? What can you suggest to the health care provider to enhance the patient’s pain relief? You should first approach the health care provider and ask for a time to discuss the patient, and you should be prepared with specific details as to the pain level, location, and nature of the pain. You need to discuss how often the patient asks for relief and state the behaviors the patient exhibits, specifying why you think the patient’s regimen is not working and what would be an acceptable pain level for the patient. You should be prepared with what will work, in case the health care provider asks. Copyright © 2023 by Elsevier Inc. All rights reserved. Answers and Rationales for Clinical Judgment and Next-Generation NCLEX® Examination–Style Questions 1. Correct Answer: 2 Carcinogenic means cancer causing. (1) Biologic relates to biology. (3) Emetogenic means causing nausea and vomiting. (4) Immunotherapeutic means treatment of disease by enhancing the immune system. 2. Correct Answers: 2, 4 Complying with radiation therapy schedules is important since the patient will probably be treated on an outpatient basis. Protecting the skin from sunlight is also important. (1) No precautions for exposing others need to be taken. Family members are not at risk from exposure to the patient. (3) No lotions should be applied to the radiated area except those recommended by the health care provider. (5) Wearing snug-fitting clothing is not advised. 3. Correct Answers: 1, 2 Good hand hygiene reduces the risk for infection. Neutropenic patients have weakened immune systems and must avoid any diet that could introduce bacteria. (3) White blood cells are not part of the coagulation process. (4) Sore throat and fever are signs of infection. Neutropenic patients are at increased risk for infection, so these signs need to be reported and are not normal. 4. Correct Answer: 1 Infiltration of a vesicant can cause tissue necrosis. (2) Orthostatic hypotension is a sign of hypovolemia. (3) Dehydration may occur but is not the priority. (4) Blood in the urine or stool is not an expected adverse effect. 5. Correct Answer: 1 A low platelet count can result in bleeding. (2) Potassium is not part of bleeding and clotting. (3) A low white blood cell count puts the patient at high risk for infection. (4) Low hemoglobin does not increase bleeding risk. 6. Correct Answer: 3 The most rapidly dividing normal cells are hair cells. Cancer drugs target rapidly dividing cells, which are characteristic of cancer but also include hair cells. (2) Hair loss is not an effective measure of therapeutic benefit. (2) A lack of protein in the diet is not the reason for hair loss. (4) Patients receiving chemotherapy have a low white blood cell count, but this is not the cause of hair loss. 7. Correct Answers: 1, 2, 4 Copyright © 2023 by Elsevier Inc. All rights reserved. When a dying patient is confused or delirious, explain the behavior to the family and explain that speaking in quiet tones can help calm the patient. When a dying patient is confused or delirious, provide a calm environment. (3) Physical restraints are applied only when other remedies are ineffective and when a patient is a danger to themself or others. (5) Often fluids are not tolerated by a dying patient, and therefore this intervention will not help. 8. Correct Answer: 2 Atropine administered by eye drops can dry up secretions and help calm noisy breathing. (1) Pain medication will not reduce noisy breathing but is not contraindicated. (3) Supine position will aggravate the problem. The head of the bed elevated and the patient slightly to one side may be helpful. (4) Hospitalization is not appropriate for an actively dying patient. 9. Correct Answer: 3 Irritation of the gums will cause bleeding for the patient with thrombocytopenia. (1) Taking the temperature may be done, but it is not an intervention for thrombocytopenia. (2) This diet is not an appropriate intervention. (4) Antiseptic mouthwash may be appropriate for some patients, but it is not an intervention for thrombocytopenia. 10. Correct Answer: 4 Flu-like symptoms are common with this category of chemotherapy. (1, 2, 3) Severe alopecia, constipation, decreased appetite, cough, and shortness of breath are not usual side effects of biologic response modifiers. 11. Choose the most likely options for the information missing from the statements below by selecting from the list of options provided. OPTIONS Chemotherapy Sore throat Bleeding Vomiting Fever Call the oncologist People Gums Wear a mask When reviewing his teaching plan, the nurse identifies items that should be reinforced specifically and that the patient should call the oncologist if fever or sore throat occur. Remind him to wear a mask when with people. Type of Question: Cloze Cognitive Level: Generate Solutions 12. There are multiple known side effects to chemotherapy medications. For the side effects shown, choose from the list the possible complication(s) that each side effect could cause. Copyright © 2023 by Elsevier Inc. All rights reserved. POSSIBLE COMPLICATIONS Restricted mobility Vision disturbances Anemia Hemorrhage Decreased immunity Syncope Electrolyte abnormalities Hypoxemia Fatigue Anorexia Infection SIDE EFFECT Low red blood cell count Constipation Muscle pain Low white blood cell count Dysrhythmias Vomiting Low platelet count POSSIBLE COMPLICATION Fatigue, hypoxemia, syncope Anorexia, electrolyte abnormalities Restricted mobility, fatigue Infection, decreased immunity Syncope Electrolyte abnormalities, anorexia Hemorrhage Vision disturbance can be a side effect of the listed medications but is not considered a complication. Having fewer red cells means that there is less oxygen carrying capacity, resulting in less circulating oxygen. Low blood oxygen levels (hypoxemia) cause fatigue and sometimes dizziness and fainting (syncope). Constipation usually causes loss of appetite and can lead to electrolyte disturbances. Generalized muscle pain restricts mobility due to discomfort, and chronic pain is exhausting. Leukopenia (low white cell count) indicates that the immune system is not able to respond in a normal manner, which often leads to infection. Abnormalities in heart rhythm (dysrhythmias) affect cardiac output, which may cause dizziness or fainting. Continued vomiting will cause a loss of electrolytes from the GI system. Nausea and vomiting suppress appetite. Decreased platelets inhibit the body’s ability to form clots. Decreased clotting ability may result in hemorrhage. Type of Question: Matrix Multiple Choice Cognitive Level: Evaluate Outcomes Copyright © 2023 by Elsevier Inc. All rights reserved. Answer Guidelines for Nursing Care Plan Applying Clinical Judgment Nursing Care Plan 8.1: Care of the Patient With Cancer 1. What additional problem statements may apply to a patient who is receiving chemotherapy that are not listed above? The student may choose any of several problem statements/nursing diagnoses. The most common would be (a) diarrhea related to effects of cancer treatment, (b) fatigue related to effects of chemotherapy, (c) risk for infection secondary to effects of chemotherapy, (d) altered nutrition secondary to the effects of chemotherapy and/or radiation therapy, and (e) altered ability for self-care related to the effects of therapy. 2. Why should you be concerned about infection in a patient who is receiving chemotherapy? All antineoplastic drugs cause some degree of bone marrow suppression, but some can cause severe suppression. This places the patient at an increased risk for infection and is an indication to you to become very attentive to good, frequent, and thorough hand hygiene and to maintain strict asepsis in all aspects of patient care. If the neutrophil count is below 500/mm3, follow the policy and procedures for protective isolation to prevent infection. Copyright © 2023 by Elsevier Inc. All rights reserved.
