CANCER

CANCER
A. Description
1. Cancer is a neoplastic disorder that can
involve all body organs
2. Cells lose their normal growth-controlling
mechanism, and the growth of cells is
uncontrolled
3. Cancer produces serious health problems
such as impaired immune and hematoietic
(blood producing) function, altered
gastrointestinal tract structure and function,
motor and sensory deficits, decreased
respiratory function
CANCER
B . Metastasis
1. Cancer cells move from their location to
other sites.
2. Routes of metastasis
a. Local seeding: Distribution of shed
cancer cells occurs in the local area of the
primary tumor.
b. Blood-borne metastasis: Tumor cells
enter the blood, which is the most
common cause of cancer spread
c. Lymphatic spread: Primary sites rich
in lymphatics are more susceptible to early
metastatic spread.
CLASSICATION OF CANCER
A. Benign neoplasia
1. Cells adhere to each other and the
growth remains circumscribed
2. Generally not life threatening unless
they occur in a restricted area (e.g., skull)
3. Classified according to the tissue
involved, e.g. glanular tissue (adenoma),
bone (osteotoma), nerve cells (neuroma),
fibrous tissue (fibroma)
CLASSICATION OF CANCER
B. Malignant neoplasia
1. Cells infiltrate surrounding tissue
2. Cells invade other tissues and produce
secondary lesions
3. May spread (metastasize) by direct
extension, lympathic permeation and
embolization, and diffusion of cancer cells
by mechanical means
4. Tumors are classified according to the
tissue involved, e.g., glandular epithelial
tissue (adenocarcinoma), epithelial
surface tissue (carcinoma), connective
tissue (sarcoma), melanocytes
(melanoma)


5. Tumors are often classified by a
universal system of staging classification,
the TNM system
a. T designates a primary tumor
b. N designates lymph node
involvement
c. M designates metastasis
d. A 0 to 4 after any of the above letters
designates degree of involvement
e. TIS designates carcinoma in situ or
one that is noninfiltrating
Etiologic agents (carcinogens)
A. Viruses
1. oncogenic viruses
2. may be one of the multiple agents
acting to initiate carcinogenesis.
3. Prolonged or frequent viral infections
may cause breakdown of the immune
system or overwhelm the immune system.
Failure of the Immune Response Theory.
Etiologic agents (carcinogens)
B. Chemical carcinogens
1. Act by causing cell mutation or
alteration in cell enzymes and proteins
altered cell replication
2. EX.
2.1. Industrial compounds
a. fertilizers
b. Dyes
c. Tobacco
d. Alcohol
2.2 Hormones
2.3 Food preservatives
C. Physical agents
1. Radiation
2. Physical irritation / trauma
D. Hormones
1. Estrogen as replacement therapy
increases incidence of vaginal and cervical
adenocarcinoma
E. Genetics
1. Oncogene (hidden / repressed genetic
code for cancer that exists in all
individuals) when exposed to
carcinogens changes in cell structure
becomes malignant
2. Regardless of the cause, several
cancers are associated with familial
patterns
2.1 Retinoblastoma,
pheochromocytoma, lung Ca, breast
cancer
Pathogenesis of Cancer
A. Cellular Transformation and derangement
theory
1. Conceptualizes that normal cells may
be transformed into cancer cells due to
exposure to some etiologic agents

Pathogenesis of Cancer

B. Failure of the Immune Response Theory
1. Advocates that all individuals possess
cancer cells. However, the cancer cells
are recognized by the immune response
system. So, the cancer cells undergo
destruction. Failure of the immune
response system leads to inability to
destroy the cancer cells
Predisposing Factors
A. Age
1. Older individuals are more prone to
Cancer; they have been exposed to
carcinogens longer; they may have
developed immune system alteration
B. Sex
1. Women- more prone to breast, uterus,
cervix cancer
2. Men- more prone to prostate, lung
cancer.
Predisposing Factors
C. Urban vs Rural residence
1. Cancer is more common among urban
dwellers than rural residents (because of
greater exposure to carcinogens)
D. Occupation
1. E.g. Chemical factory workers, farmers,
radiology department personnel
E. Heredity
1. Greater risk with positive family history
F. Stress
1. Depression, grief, anger, aggression,
despair or life stresses decrease
immunocompetence
2. Immunodeficiency may spur the growth
and proliferation of Ca cells
G. Precancerous lesions
1. E.g., pigmented moles, burn scars
H. Obesity
1. Studies have linked obesity to breast
and colorectal cancer
WARNING SIGNALS OF CANCER
C- Change in bowel or bladder habits
A- sore that does not heal
U- unusual bleeding or discharge
U- unexplained sudden weight loss
U- unexplained anemia
T- thickening or lump in the breast or elsewhere
I- Indigestion
O- obvious change in wart or mole
N- nagging cough or hoarseness of voice

Comparison of the characteristics of the benign
and malignant neoplasm
Characteristics Benign Malignant
Speed of Growth Grows slowly Grows rapidly
Mode of Growth Remains localized Infiltrates surrounding
tissues
Capsule
Encapsulated Not encapsulated
Cell characteristic Well differentiated
mature cell; cells
function poorly
Poorly differentiated
Recurrence Extremely unusual
when surgically
removed
Common following
surgery
Metastasis Never occur Very common
Effect of neoplasm Not harmful to host Always harmful
Prognosis Very good prognosis
Poor prognosis
Early Detection
1. Mammography
2. Papanicolaous (Pap) Test
3. Stools for occult blood
4. Sigmoidoscopy; colonoscopy
5. Breast Self-examination
6. Testicular examination
7. Skin inspection


Breast Self-examination
A. Performing BSE
1. Perform 7 to 10 days after menses
2. Postmenopausal client or clients who
have had a hysterectomy should select a
specific day of the month and perform
BSE monthly on that day

Testicular self-examination
A. Performing testicular self-examination:
Select a day of the month and perform the
examination on the same day each month
B. The best time to perform this examination
is right after shower when your scrotal skin
is moist and relaxed, making the testicles
easy to feel.
C. Gently lift each side. Each one should
feel like an egg, firm but not hard, smooth
with no lumps.
Diagnostics Tests
A. Biopsy
1. Description
a. Biopsy is the definitive means of
diagnosing cancer and provides
histological proof of malignancy
b. Biopsy involves the surgical incision
of a small piece of tissue for microscopic
examination

Diagnostics Tests
2. Types
a. Needle: aspiration of cells
b. Incisional: Removal of a wedge of
suspected tissue from a larger mass
c. Excisional: Complete removal of the
entire lesion
d. Staging: Multiple needle or incisional
biopsies in tissues where metastasis is
suspected or likely
3. Tissue examination
a. Following excision, frozen section or
a permanent paraffin section is prepared
to examine the specimen
b. The advantage of the frozen section
is the speed with which the section can be
prepared and the diagnosis made because
only minutes are required for this test
c. Permanent paraffin section takes
about 24 hours; however, it provides
clearer details than does the frozen
section

Pain Control
A. Causes of pain
1. Bone destruction
2. Obstruction of an organ
3. Compression of peripheral nerves
4. Infiltration/distention of tissue
5. Inflammation/necrosis
6. Psychological, such as fear or anxiety
B. Interventions
1. Assess the clients pain; pain is what
the client describes or says that it is.
2. Collaborate with other members of the
health care team to develop a pain
management program
3. Administer oral preparations if possible
and if they provide adequate relief of pain.
4. Mild or moderate pain may be treated
with salicylates, acetaminophen, and non-
steroidal anti-inflammatory drugs
5. Severe pain is treated with narcotics,
such as codeine sulfate, meperidine
(Demerol), morphine sulfate, and
hydromorphone hydrochloride (Dilaudid)

6. Subcutaneous injections and
continuous intravenous (IV) infusions of
narcotics provide better pain control than
via the oral route
7. Monitor vital signs and for the side
effects of medications
8. Monitor for effectiveness of
medications.
9. Do not undermedicate the cancer client
who is in pain
Surgery
A. Description: Surgery is used to diagnose, stage,
and treat cancer
B. Prophylactic surgery
1. Prophylactic surgery is performed in clients
with an existing premalignant condition or a
known family history that strongly predisposes
the person to the development of cancer
2. An attempt is made to remove the tissue or
organ at risk and thus prevent the development
of cancer
Surgery
C. Curative surgery: All gross and
microscopic tumor is removed or
destroyed.
D. Control (cytoreductive) surgery
1. Control surgery is a debulking
procedure that consists of removing part of
the tumor
2. Surgery decreases the number of
cancer cells and increases the chance that
other therapies will be successful.
E. Palliative
1. Palliative surgery is performed to
improve quality of life during the survival
time
2. Palliative surgery is performed to
reduce pain, relieve airway obstruction,
relieve obstructions in the gastrointestinal
or urinary tract, relieve pressure on the
brain or spinal cord, prevent hemorrhage,
remove infected or ulcerated tumors, or
drain abscesses.
F. Reconstructive or rehabilitative surgery is
performed to improve quality of life by restoring
maximal function and appearance, such as
breast reconstruction after mastectomy
G. Side effects
1. Loss or loss of function of a specific body part
2. reduced function as a result of organ loss
3. Scarring or disfigurement
4. Grieving about altered body image or
imposed change in lifestyle
Chemotherapy
A. Description
1. Chemotherapy kills or inhibits the
reproduction of neoplastic cells and also
attacks and kills normal cells
2. The effects are systemic; chemotherapy
affects healthy cells and cancerous cells.
3. Normal cells most profoundly affected
include those of the skin, hair, and lining of
the gastrointestinal tract, and
hematopoietic cells.

Chemotherapy
4. Usually several medications are used in
combination (combination therapy) to
increase the therapeutic response
5. Antineoplastic therapy may be
combined with other treatments, such as
surgery and radiation

6. The preferred route of administration is
intravenously.
7. Side effects include alopecia, nausea
and vomiting, mucositis, skin changes,
immunosuppression, anemia,
thrombocytopenia.


Antineoplastic drugs
A. Alkylating Agents
1. Cell-cycle nonspecific; attack the DNA
of rapidly dividing cells
2. Examples: chlorambucil (Leukeran),
cisplatin (Platinol), cyclophosphamide
(Cytoxan)
3. Use: Leukemias; multiple myeloma;
neuroblastoma, ovarian, breast lung
cancers; Hodgkins disease


B. Antibiotics
1. Cell-cycle specific; inhibit RNA and
protein synthesis of rapidly dividing cells
2. Examples: doxorubicin hydrochloride
(Adriamycin), Mithramycin (Mithracin)
3. Use: Cancer of thyroid, lung, bladder,
breast, and ovary; acute leukemia;
lymphomas

C. Antimetabolites
1. Cell cycle specific; inhibit protein
synthesis in rapidly dividing cells
2. Examples: azathiophrine (Imuran),
fluorouracil (5-FU), hydroxyurea (Hydrea),
methotrexate (Mexate)
3. Use: Acute lymphoblastic leukemia;
cancer of breast, lung, testes, ovary, head,
and neck; choriocarcinoma
D. Hormones
1. Exact mechanism is not completely
understood
2. Believed that hormonal agents hinder
use of steroids necessary for cell growth.
3. Hormonal therapy keeps cancer cells in
resting phase, thus decreasing growth of
tumor
4. No direct cytotoxic effectof hormonal
agents so they are unbale to cure cancer
5. Antihormonal agents
a. Antiestrogen- Tamoxifen (Nolvadex)
b. Use: Advenced breast cancer in pre
and postmenopausal women
6. Antiadrenal- Aminoglutethamide
(Cytadren)
a. Use: Adrenal and metastatic breast
cancer
b. Adverse effects: drowsiness, anorexia,
nausea, vomiting, severe pancytopenia; rash;
and adrenal insufficiency


E. Vinca alkaloids- Vincristine (Oncovin)
a. Acts on cells undergoing mitosis
thus stopping cell division
b. Use: acute leukemia; lymphomas;
cancer of brain, breast, cervix, testes
Radiation Therapy
A. Description
1. Radiation therapy destroys cancer cells
with minimal exposure of normal cells to
the damaging effects of radiation; the cells
damaged die or become unable to divide.
2. Radiation therapy is effective on tissues
directly within the path of the radiation
beam

Radiation Therapy
A. Description
3. Side effects include skin changes and
irritation, alopecia, fatigue, and altered
taste sensation; also, the effects vary
according to the site of treatment.
4. Teletherapy and brachytherapy are the
types of radiation therapy most commonly
used to treat cancer
B. Teletherapy
1. Teletherapy also is called beam
radiation; the actual radiation source is
external to client.
2.The client does not emit radiation and
does not pose a hazard to anyone else.
C. Brachytherapy
1. The radiation source comes into direct,
continuous contact with tumor tissues for a
specific time.
2. The radiation source is within the client;
for a period of time; the client emits
radiation and can pose a hazard to others.
3. Brachytherapy includes an unsealed
source or a sealed source of radiation
4. Unsealed radiation source
a. Administration is via the oral or IV
route or by instillation into body cavities
b. The source is not confined
completely to one area, and it enters body
fluids and eventually is eliminated via
various excreta, which are radioactive and
harmful to others; most of the source is
eliminated from the body within 48 hours;
then neither the client nor the excreta are
radioactive or harmful

5. Sealed radiation source
a. A sealed, temporary or permanent
radiation source (solid implant) is
implanted within the tumor target tissues.
b. The client emits radiation while the
implant is in place, but the excreta are not
radioactive.

6. Removal of sealed radiation sources
a. The client is no longer radioactive
b. Inform the client that sexual partners
cannot catch cancer
c. Inform the female client that she may
resume sexual intercourse after 7 to 10
days, if the implant was cervical or vaginal
d. Provide a povidine-iodine douche if
prescribed, if the implant was placed in the
cervix
7. A dislodged Radiation source
a. Do not touch a dislodged radiation
source with bare hands
b. If the radiation source dislodges, use
long-handled forceps to place the source
in the lead container kept in the clients
room, and call the physician
c. If unable to locate the radiation
source, bar visitors and notify physician
Bone marrow transplantation
A. Description
1. Bone marrow transplantation is used to treat
leukemia in clients who have closely matched
donors and who are experiencing temporary
remission with chemotherapy.
2. The goal of treatment is to rid the client of all
leukemic or other malignant cells through
treatment with high doses of chemotherapy and
whole body irradiation
3. Because these treatments are lethal to bone
marrow function through transplantation, the
client would die if infection or hemorrhage.
Bone marrow transplantation
B. Types of donor marrow
1. Allogeneic: marrow donor is usually a sibling
or parent with a similar tissue type.
2. Syngeneic: Bone marrow is from an identical
twin.
3. Autologous
a. Autologous donation is the most common
type.
b. The marrow donor is also the recipient
c. Marrow is harvested during disease
remission and is stored frozen to be reinfused
later
C. Procedure
1. Harvest
a. Marrow is harvested through multiple
aspirations from the iliac crest to retrieve sufficient
bone marrow for the transplant
b. Five hundred to 1000 ml of marrow is aspirated
c. Marrow is filtered for any residual cancer cells
and to deplete cells that may cause graft-versus-host
disease
d. Allogeneic marrow is transfused immediately;
autologous marrow is frozen for later use.
e. Harvest is obtained before the initiation of the
conditioning regimen

2. Conditioning refers to an
immunosuppression therapy regimen used
to eradicate all malignant cells, provide a
state of immunosuppression, and create
space in the bone marrow for the
engraftment of the new marrow.
3. Transplantation
a. Bone marrow is administered through the
clients central line in a manner similar to a blood
transfusion.
b. Marrow is infused over a 30-minute period
or administered by IV push directly into the
central line.
4. Engraftment
a. The transfused bone marrow cells move to
the marrow-forming sites of the recipients
bones.
b. Engraftment occurs when the white blood
cell, erythrocyte, and platelet counts begin to
rise
c. When successful, the engraftment process
takes 2 to 5 weeks
D. Posttransplantation period
1. The client remains without any natural
immunity until the donor marrow begins to
proliferate and engraftment
2. Infection and severe thrombocytopenia
are major concerns until engraftment
occurs.
E. Complications
1. Failure to engraft: if the transplanted bone
marrow fails to engraft, the client will die unless
another transplantation is attempted and is
successful
2. Graft-versus-host disease
a. Although the recipient cannot recognize
the donated bone marrow cells as foreign or
non-self because of the total
immunosuppression, the immune competent
cells of the donated marrow recognize the
clients cells as foreign and mount an immune
offense against them.

b. The graft actually is trying to attack
the host
c. Graft-versus-host disease is
managed with immunosuppressive agents
with caution to avoid suppressing the new
immune system to extent that the client
becomes more susceptible to infection or
transplanted cells stop engulfing.
3. Venoocclusive disease
a. The disease involves occlusion of
the hepatic venules by thrombosis or
phlebitis
b. Signs include right upper quadrant
abdominal pain, jaundice, ascites, weight
gain, and hepatomegaly
c. Early detection is critical because
there is no known way to open the hepatic
vessel
d. The client will be treated with fluids
and supportive therapy.
NEOPLASTIC DISORDERS
HODGKINS DISEASE
A. Description
1. Hodgkins disease (lymphoma) is a
malignancy of the lymph nodes that
originates in a single lymph node or single
chain of nodes.
2. Metastasis occurs to other, adjacent
lymph structures and eventually invades
nonlymphoid tissue.
3. The disease usually involves lymph
nodes, tonsils, spleen, and bone marrow
and is characterized by the presence of
the Reed-Sternberg cell in the nodes.

B. Assessment
1. Fever
2. Malaise, fatigue and weakness
3. Night sweats
4. Loss of appetite and significant weight loss
5. Anemia and thrombocytopenia
6. Enlarged lymph nodes, spleen, and liver
7. Positive biopsy of lymph nodes, with cervical
nodes most often affected first
8. Presence of Reed-Sternberg cell in nodes
9. Positive computed tomography scan of the
liver and spleen.
C. Interventions
1. For stages I and II without mediastinal node
involvement, the treatment of choice is extensive
external radiation of the involved lymph node
regions.
2. With more extensive disease, radiation along
with multiagent chemotherapy is used.
3. Monitor for side effects related to
chemotherapy or radiation therapy.
4. Monitor for signs of infection and bleeding.
5. Maintain infection and bleeding precautions.
6. Discuss the possibility of sterility with the male
client receiving radiation, and inform the client of
options related to sperm banks.

III. MULTIPLE MYELOMA
A. Description
1. A malignant proliferation of plasma cells
and tumors within the bone.
2. An excessive number of abnormal plasma
cells invade the bone marrow, develop into
tumors, and ultimately destroy bone; invasion of
the lymph nodes, spleen and liver occurs.
3. The abnormal plasma cells produce and
abnormal antibody (myeloma protein or the
Bence Jones protein) that is found in the blood
and urine.

III. MULTIPLE MYELOMA
4. Multiple myeloma causes decreased
production of immunoglobulin and
antibodies and increased levels of uric
acid and calcium, which can lead to renal
failure.
5. The cause of the disease is
unknown.

B. Assessment
1. Bone (skeletal) pain, especially in the
pelvis, spine, and ribs
2. weakness and fatigue
3. recurrent infections
4. Anemia
5. Bence Jones proteinuria and elevated
serum protein level

B. Assessment
6. Osteoporosis (bone loss and the
development of pathological fractures)
7. Thrombocytopenia and
granulocytopenia
8. Elevated calcium and uric acid levels
9. Renal failure
10. Spinal cord compression and
paraplegia
C. Interventions
1. Administer chemotherapy as prescribed
2. Provide supportive care to control symptoms and
prevent complications, especially bone fractures,
renal failure, and infections
3. Maintain neutropenic and bleeding precautions as
necessary.
4. Monitor for signs of bleeding, infection, and
skeletal fractures.
5. Encourage fluids up to 3 to 4 L a day to offset
potential problems associated with hypercalcemia,
hyperuricemia, and proteinuria.
6. Monitor for signs of Renal failure.
7. Encourage ambulation to prevent renal problems
and to slow down bone resorption.

8. Provide skeletal support during moving, turning,
and ambulating to prevent pathological fractures;
provide a hazard-free environment.
9. Administer IV fluids and diuretics as prescribed to
increase renal excretion of calcium.
10. Administer blood transfusions as prescribed for
anemia.
11. Administer analgesics as prescribed to control
pain.
12. Administer antibiotics as prescribed for
infections.
13. Prepare the client for local radiation therapy if
prescribed.
14. Instruct the client in home care measures and
the signs and symptoms of infection.
QUESTIONS:
1. Which nursing intervention is most
appropriate for a client with multiple
myeloma?
a. monitoring respiratory status
b. balancing rest and activity
c. restricting fluid intake
d. preventing bone injury
QUESTIONS:
2. A client is undergoing tests for multiple
myeloma. Diagnostic study findings in
multiple myeloma include:
a. a decreased serum creatinine level
b. hypocalcemia
c. Bence jones protein in the urine
d. a low serum protein level

3. The nurse is assessing a client with
multiple myeloma. The nurse should keep
in mind that clients with multiple myeloma
are at risk for:
a. chronic liver failure
b. pathologic bone fractures
c. acute heart failure
d. hypoxemia

IV. Testicular Cancer
A. Description
1. Testicular cancer arises from germinal
epithelium from the sperm-producing germ
cells or from nongerminal epithelium from
other structures
2. Testicular cancer most often occurs
between the ages of 15 and 40.
3. Metastasis occurs to the lung, liver,
bone, and adrenal glands.
IV. Testicular Cancer
C. Assessment
1. Painless testicular swelling occurs
2. Dragging sensation is evident in the
scrotum
3. Palpable lymphadenopathy, abdominal
masses, and gynecomastia may indicate
metastasis
4. Late signs include back or bone pain
and respiratory problems


D. Interventions
1. Administer chemotherapy as prescribed
2. Prepare the client for radiation therapy as
precribed
3. Prepare the client for unilateral orchiectomy, if
prescribed, for diagnosis and primary surgical
management
4. Prepare the client for radical retroperitoneal lymph
node dissection, if prescribed, to stage the disease
and reduce tumor volume so that chemotherapy and
radiation therapy are more effective
5. Discuss reproduction, sexuality, and fertility
information and options with the client
6. Identify reproductive options such as sperm
storage, donor insemination, and adoption
E. Postoperative interventions
1. Monitor for signs of bleeding and wound infection
2. Monitor intake and output
3. Notify physician if chills, fever, increasing pain or
tenderness at the incision site, or drainage of the incision
occurs
4. Instruct the client that he may resume normal activities
within 1 week, except for lifting objects heavier than 20 lb
or stair climbing
5. Instruct the client to perform a monthly testicular self-
examination on the remaining testicle
6. Inform the client that sutures will be removed 7 to
days after surgery
QUESTIONS:
1. A client is undergoing a diagnostic workup
for suspected testicular cancer. When
obtaining the clients history, the nurse
checks for known risk factors for this type
of cancer. Testicular cancer has been
linked to:
a. testosterone therapy during childhood
b. sexually transmitted disease
c. early onset of puberty
d. cryptorchidism
QUESTIONS:
2. The nurse is teaching a male client to
perform monthly testicular self-
examinations. Which of the following
points would be appropriate to make?
a. testicular cancer is a highly curable type
of cancer
b. testicular cancer is very difficult to
diagnose
c. testicular cancer is the number cause of
cancer deaths in males
d. testicular cancer is more common in
older men

V. CERVICAL CANCER
A. Description
1. Preinvasive cancer is limited to the cervix
2. Invasive cancer is in the cervix and other
pelvic structures
3. Metastasis usually is confined to the pelvis,
but distnat metastasis usually is confined to the
pelvis, but distant metastasis occurs through
lymphatic spread.
4. Premalignant changes are described on a
continuum from dysplasia, which is the earliest
premalignancy change, to carcinoma in situ, the
most advanced premalignant change.

B. Precipitating factors
1. Low socioeconomic groups
2. Early first marriage
3. Early and frequent intercourse
4. Multiple sex partners
5. Poor hygiene
C. Assessment
1. Painless vaginal bleeding
postmenstrually and postcoitally
2. Foul smelling or serosanguineous
vaginal discharge
3. Pelvic, lower back, leg, or groin pain
4. Anorexia and weight loss
5. Dysuria
6. Hematuria
7. Cytological changes on Papanicolaous
test
D. Management
1. Chemotherapy
2. Laser therapy
a. Laser therapy is used when all boundaries
of the lesion are visible during colposcopic
examination
b. Energy from the beam is absorbed by fluid
in the tissues, causing them to vaporize
c. Minimal bleeding is associated with the
procedure
d. Slight vaginal discharge is expected
following the procedure, and healing occurs in 6
to 12 weeks.

3. Cryosurgery
a. Cryosurgery involves freezing of the
tissues by a probe with subsequent
necrosis
b. No anesthesia is required, although
cramping may occur during the procedure
c. A heavy, watery discharge will occur
for several weeks following the procedure
d. Instruct the client to avoid
intercourse and the use of tampons while
the discharge is present
4. External radiation
5. Internal radiation
6. Hysterectomy
a. Hysterectomy is performed for
microinvasive cancer if childbearing is not
desired
b. A vaginal approach is most
commonly performed
c. A radical hysterectomy and bilateral
lymph node dissection may be performed
for cancer that has spread beyond the
cervix but not to the pelvic wall.
QUESTIONS:
1. A client receives a sealed radiation
implant to treat cervical cancer. When
caring for this client, the nurse should:
a. consider the clients urine, feces, and
vomitus to be highly radioactive
b. consider the client to be radioactive for
10 days after implant removal
c. allow soiled linens to remain in the room
until after the client is discharged
d. maintain the client on complete bed rest
with bathroom privileges only

VI. Ovarian cancer
A. Description
1. Ovarian cancer grows rapidly, spreads
fast, and is often bilateral
2. Metastasis occurs by direct spread to
the organs in the pelvis, by distal spread
through lymphatic drainage, or by
peritoneal seeding
3. Prognosis is usually poor because the
tumor usually is detected late
4. An exploratory laparotomy is performed
to diagnose and stage the tumor
B. Assessment
1. Abdominal discomfort or swelling
2. Gastrointestinal disturbances
3. Dysfunctional vaginal bleeding
4. Abdominal mass

C. Interventions
1. External radiation is used if the tumor
has invaded other organs
2. Chemotherapy is used postoperatively
for all stages of ovarian cancer
3. Intraperitoneal chemotherapy involves
the instillation of chemotherapy into the
abdominal cavity
4. Immunotherapy alters the
immunological response of the ovary and
promotes tumor resistnace
5. Total abdominal hysterectomy and
bilateral salpingo-oophorectomy may be
necessary

QUESTIONS:
1. Which client has the highest risk of
ovarian cancer?
a. 30-year old woman taking oral
contraceptives
b. 45-year old woman who has never been
pregnant
c. 40-year-old woman with three children
d. 36-year-old woman who had her first
child at age 22

B. Precipitating factors
1. History of uterine polyps
2. Nulliparity
3. Polycystic ovary disease
4. Estrogen stimulation
5. Late menopause
6. Family history
B. Precipitating factors
1. History of uterine polyps
2. Nulliparity
3. Polycystic ovary disease
4. Estrogen stimulation
5. Late menopause
6. Family history
C. Assessment
1. Postmenopausal bleeding
2. Watery, serosanguineous discharge
3. Low back, pelvic, or abdominal pain
4. Enlarged uterus in advanced stages


D. Non surgical interventions
1. External radiation or internal radiation is used alone or
in combination with surgery, depending on the stage of
cancer
2. Chemotherapy is used to treat advanced or recurrent
disease
3. Progestational therapy with medication such
medroxyprogesterone (Depo-Provera) or megestrol
acetate (Megace) is used for estrogen-dependent tumors
4. Tamoxifen (Nolvadex, an antiestrogen, also may be
precribed

E. Surgical inreventions: total abdominal hysterectomy and
bilateral salphingo-oophorectomy
VIII. Breast Cancer

A. Description

1. Breast cancer is classified as invasive when is
penetrates the tissue surrounding the mammary
duct and grows in an irregular pattern
2. Metastasis occurs via lymph nodes
3. Common sites of metastasis are the bone,
lungs; metastasis also occurs to the brain and
liver
4. Diagnosis is made by breast biopsy through a
needle aspiration or by surgical removal of the
tumor with microscopic examination for
malignant cells
B. Precipitating factors
1. Family history
2. Early menarche and late menopause
3. Previous cancer of the breast, uterus, or
ovaries
4. Nulliparity
5. Obesity
6. High dose radiation exposure to chest
stages

C. Assessment
1. Mass felt during BSE
2. Mass usually felt in the upper outer
quadrant or beneath the nipple
3. A fixed, irregular nonencapsulated mass
4. A painless mass except in the late
stages
5. Nipple retraction or elevation
6. Asymmetry, with the affected breast
being higher
7. Bloody or clear nipple discharge
8. Skin dimpling, retraction, or ulceration
9. Skin edema
10. Axillary lymphadenopathy
11. Lymphedema of affected arm
12. Symptoms of bone or lung metastasis
13. Presence of the lesion on
mammography
D. Prevention: Monthly BSE
E. Nonsurgical interventions
1. Chemotherapy
2. Radiation therapy
3. Hormonal manipulation via the use of
medication in postmenopausal women or
other medications such as tomoxifen
(Nolvadex) for estrogen receptor-positive
tumors
F. Surgical interventions
1. Lumpectomy
a. Tumor is excised and removed
b. Lymph node dissection may also be
performed
2. Simple Mastectomy
a. Breast tissue and the nipple are
removed
b. Lymph nodes are left intact

F. Surgical interventions
3. Modified Radical Mastectomy
a. Breast tissue, nipple, and lymph
nodes are removed
b. Muscles are left intact
4. Halsted Radical Mastectomy
a. Breast tissue, nipple, underlying
muscles, and lymph nodes are removed
E. Postoperative interventions
1. Monitor vital signs
2. Position in semi-Fowlers position; turn from
back to unaffected side, with the affected arm
elevated above the level of the heart to promote
drainage and prevent lymphedema
3. Encourage coughing and deep breathing
4. If a drain (usually Jackson-Pratt) is in place,
maintain suction and record the amount of
drainage and drainage characteristics
5. Assess operative site for infection, swelling, or
the presence of fluid collection under the skin
flaps

E. Postoperative interventions
6. Monitor incision site for restriction of dressing,
impaired sensation, or color changes of the skin.
7. Place a sign above the bed stating NO IVs,
NO injections, NO BPs, No Venipunctures in
Affected Arm; the affected arm is protected for
life, and any intervention that could traumatize
the affected arm is avoided
8. Administer diuretics and provide a low-salt
diet as prescribed for severe lymphedema
9. Assist with exercise as prescribed to decrease
lymphedema and muscle weakness
QUESTIONS:
1. A 52-year-old female tell the nurse that she has
found a painless lump in her right breast during
her monthly self examination. Which
assessment finding would strongly suggest that
this clients lump is cancerous?
a. eversion of the right nipple and mobile mass
b. nonmobile mass with irregular edges
c. mobile mass that is soft and easily delineated
d. nonpalpable axillary lymph nodes



QUESTIONS:
2. During a breast examination, which finding
most strongly suggest that the client has breast
cancer?
a. slight asymmetry of the breast
b. a fixed nodular mass with dimpling of the
underlying skin
c. bloody discharge from the nipple
d. Multiple firm, round, freely movable masses
that change with the menstrual cycle


3. At a public health fair, the nurse teaches a
group of women about breast cancer
awareness. Possible signs of breast
cancer include:
a. fever
b. breast changes during menstruation
c. nipple discharge and a breast nodule
d. fever and erythema of the breast



4.The nurse is teaching a client who
suspects that she has a lump in her
breast. The nurse instructs the client that a
diagnosis of breast cancer is confirmed by:
a. breast-self examination
b. mammography
c. fine needle aspiration
d. chest x-ray

5. Several days before admission, a client
reports finding a small lump in the left
breast near the nipple. What should the
nurse tell the client to do?
a. inform the physician immediately
b. squeeze the nipple to check for
drainage
c. check the area after the next menstrual
period
d. put a heating pad on the area to reduce
inflammation
XII. Lung cancer
A. Description
1. Lung cancer is a malignant tumor of the
lung that may be primary or metastatic
2. The lungs are a common target for
metastasis from other organs
3. Brochiogenic carcinoma spreads
through direct extension and lymphatic
dissemination

XII. Lung cancer
4. The four major types of lung cancer
include small cell (oat cell), epidermal
(squamous cell), adenocarcinoma, and
large cell anaplastic carcinoma
5. Diagnosis is made by a chest x-ray,
which will show a lesion or mass, and
bronchoscopy and sputum studies, which
will demonstrate a positive cytological
study for cancer cells

B. Causes
1. Cigarette smoking
2. Exposure to environmental pollutants
3. Exposure to occupational pollutants


C. Assessment
1. Cough
2. Dyspnea
3. Hoarseness
4. Hemoptysis
5. Chest pain
6. Anorexia and weight loss
7. Weakness
10. Provide activity as tolerated, rest
periods, and active and passive range-of-
motion exercises
11. Provide a high-calorie, high-protein,
high-vitamin diet.
12. Provide activity as tolerated, rest
periods, and active and passive range-of-
motion exercises
13. Monitor for bleeding, infection, and
electrolyte imbalances

E. Nonsurgical interventions
1. Radiation therapy for localized
intrathoracic lung cancers and for
palliation of hemoptysis, obstructions,
dysphagia, and pain.
2. Chemotherapy
3. Immunotherapy directed at enhancing
an effective immune response, which
favorably affects the course of the disease
D. Interventions
1. Monitor vital signs
2. Monitor breathing patterns and breath
sounds and for signs of respiratory
impairment
3. Assess for tracheal deviation
4. Administer analgesics as prescribed for
pain management
5. Place in Fowlers position for ease
breathing.

D. Interventions
6. Administer oxygen as prescribed and
humidification to moisten and loosen
secretions
7. Monitor pulse oximetry
8. Provide respiratory treatments as
prescribed.
9. Administer brochodilators and
corticosteroids as prescribed
F. Surgical interventions
1. Laser therapy: To relieve endobronchial
obstruction
2. Thoracentesis and pleurodesis: to
remove pleural fluid and relieve hypoxia.
3. Thoracotomy with pneumonectomy:
surgical removal of a lung

4. Thoracotomy with lobectomy: surgical
removal of one lobe of the lung for tumors
confined to a single lobe.
5. Thoracotomy with segmental resection:
surgical removal of a lobe segment for
clients unable to tolerate lobectomy or
pneumonectomy.
QUESTION:
1. The nurse is caring for a client with
bronchogenic carcinoma. Which nursing
diagnosis takes highest priority?
a. Body image disturbance related to
changes in body functions
b. Ineffective airway clearance related to
obstruction by a tumor or secretions
c. Anxiety related to actual threat to health
status and changes in family dynamics
d. Altered nutrition: less than body weight
requirements related to anorexia and
vomiting secondary to chemotherapy

XIII. Laryngeal cancer
A. Description
1. Laryngeal cancer is a malignant tumor
of the larynx
2. Laryngeal cancer presents as malignant
ulcerations with underlying infiltration.
3. Metastasis to the lung is common
4. Diagnosis is made by laryngoscopy and
biopsy showing a positive cytological study
for cancer cells.

B. Causes
1. Cigarette smoking
2. Exposure to environmental pollutants
3. Exposure to radiation
4. Voice strain

D. Interventions
1. Place in Fowlers position to promote optimal
air exchange
2. Monitor respiratory status
3. Monitor for signs of aspiration of food and fluid
4. Administer oxygen as prescribed
5. Provide activity as tolerated,
6. Provide a high-calorie, high-protein, high-
vitamin diet
7. Provide nutritional support via total parenteral
nutrition, nasogastric tube feedings, or
gastrostomy or jejunostomy tube as prescribed.
8. Administer analgesics as prescribed for pain
C. Assessment
1. Persistent hoarseness and sore throat
2. Painless neck mass
3. A feeling of a lump in the throat
4. Burning sensation in the throat
5. Dysphagia
6. Dyspnea
7. Weakness and weight loss
8. Hemoptysis
9. Change in voice quality
10. Foul breath odor
E. Nonsurgical interventions
1.Radiation therapy if the cancer is limited
to a small area in one vocal cord
2. Chemotherapy, which may be done in
combination with radiation and surgery.


F. Surgical interventions
1. Surgical intervention depends on the
tumor size and the amount of tissue to be
resected.
2. Types of resection include cordal
stripping, cordectomy, partial
laryngectomy, and total laryngectomy
3. A tracheostomy is performed with a total
laryngectomy; this airway opening is
always permanent and is referred to as a
laryngectomy.
QUESTIONS:
1. As part of a primary cancer prevention program,
the oncology nurse answers questions from the
public at a health fair. When someone asks
about laryngeal cancer, the nurse should explain
that:
a. laryngeal cancer is one of the most
preventable types of cancer
b. inhaling polluted air isnt a risk factor for
laryngeal cancer
c. laryngeal cancer occurs primarily in women
d. adenocarcinoma accounts for most cases for
laryngeal cancer

XIV. Prostate Cancer
A. Description
1. This slow-growing cancer of the prostate
gland is usually a androgen-dependent type of
adenocarcinoma
2. The risk increases in men with each decade
after age 50.
3. Prostate cancer can spread via direct invasion
of surrounding tissues or by metastasis, through
the bloodstream and lymphatics, to the bony
pelvis and spine
4. Bone metastasis is a concern

B. Assessment
1. Asymptomatic in early stages
2. Hard, pea-sized nodule palpated on rectal
examination
3. Hematuria
4. Late symptoms such as weight loss, urinary
obstruction, and pain radiating from the
lumbosacral area down the leg.
5. Prostate-specific antigen test is not
necessarily an indicator of malignancy and use
is routine to monitor the clients response to
therapy
6. Spread and metastasis is indicated by
elevated serum acid phosphatase
C. Nonsurgical interventions
1. Prepare the client for hormone manipulation
therapy as prescribed.
2. Administer luteinizing hormone, such as
leuprolide acetate (Lupron), flutamide (Eulexin),
or diethylstilbestrol (DES), as prescribed to slow
the rate of growth of the tumor
3. Goserelin acetate (Zoladex) may be
prescribed for palliation in advanced prostatic
cancer when orchiectomy or estrogen
administration is not acceptable or indicated for
the client

4. Prepare the client for radiation (internal
or external), which may be prescribed
alone or along with surgery and may be
prescribed preoperatively or
postoperatively to reduce the lesion and
limit metastasis
5. Prepare the client for the administration
of chemotherapy in cases of hormone-
resistant tumors
D. Surgical interventions
1. Prepare the client for orchiectomy
(palliative) if prescribed, which will limit the
production of testosterone
2. Prepare the client for transurethral
resection of the prostate (TURP) or
prostatectomy if prescribed.
3. Cyrosurgical ablation is a minimally
invasive procedure is a minimally invasive
procedure that may be an alternative to
radical prostatectomy; liquid nitrogen
freezes the gland, and dead cells are
absorbed by the body.
E. TURP
1. The procedure involves insertion of a
scope into the urethra to excise prostatic
tissue.
2. Bleeding is common following TURP,
and monitoring for hemorrhage is an
important nursing intervention.

3. Bladder spasms are common are
common following surgery, and
antispasmodics may be prescribed
4. Dribbling or incontinence may occur
postoperatively, and it is important for the
nurse to instruct the client to monitor for
these occurrences.
5. Sterility may or may not occur following
the surgical procedure

F. Suprapubic prostatectomy
1. Suprapubic prostatectomy is removal of
the prostate gland by an abdominal
incision.
2. The client will have an abdominal
dressing that may drain copious amounts
of urine, and the abdominal dressing will
need to be changed frequently
3. Severe hemorrhage is possible, and
monitoring for blood loss is an important
nursing intervention
4. Bladder spasms are common are
common following surgery, and
antispasmodics may be prescribed.
5. Continuous bladder irrigation is
prescribed and administered to keep the
urine pink
6. A longer healing process is involved as
compared with TURP.
7. Sterility occurs with this procedure.
G. Retropubic prostatectomy
1. Retropubic prostatectomy is removal of
the prostate gland by a low abdominal
incision without opening the bladder.
2. Less bleeding occurs with this
procedure compared with the suprapubic
procedure, and the client experiences
fewer bladder spasms.
3. Abdominal drainage is minimal.
4. Continuous bladder irrigation may be
used.
5. Sterility occurs with this procedure.
H. Perineal Prostatectomy
1. The prostate gland is removed through an
incision made between the scrotum and anus.
2. Minimal bleeding occurs with this procedure.
3. The client needs to be monitored closely for
infection, because the risk of infection is
increased with this type of prostatectomy.
4. Urinary incontinence is common.
5. The procedure causes sterility.
6. Teach the client how to perform perineal
exercises.
7. Avoid inserting rectal tubes, taking the
temperature rectally or administering enemas.

QUESTIONS:

1. A client asks the nurse asks what PSA is.
The nurse should reply that this stands for:
a. prostate-specific antigen, which is used
to screen for prostate cancer
b. protein-serum antigen, which is used to
determine protein levels
c. pneumococcal strep antigen, which is a
bacteria that causes pneumonia
d. papanicolaou-specific antigen, which is
used to screen for cervical cancer


QUESTIONS:


2. What should a male patient over age 50 do to
help ensure early identification of prostate
cancer?
a. Have a digital rectal examination and
prostate-specific antigen (PSA) test done yearly
b. Have transrectal ultrasound every 5 years
c. Perform monthly testicular self-examinations,
especially after age of 50
d. Have a complete blood count (CBC), blood
urea nitrogen (BUN) and creatinine levels
checked yearly


XV. BLADDER CANCER
A. Description
1. Bladder cancer is papillomatous growths in the
bladder urothelium that undergo malignant changes
and that may infiltrate the bladder wall.
2. Predisposing factors include cigarette smoking,
exposure to industrial chemicals and exposure to
radiation.
3. Common sites of metastasis include the liver,
bones, and lungs.
4. As the tumor progresses, it can extend into the
rectum, vagina, other pelvic soft tissues and
retroperitoneal structures.
B. Assessment
1. Gross, painless hematuria
2. Frequency, urgency, dysuria
3. Clot-induced obstruction
4. Bladder biopsy confirms diagnosis
C. Radiation
1. Most bladder cancers are poorly radiosensitive and
require high doses of radiation.
2. Radiation therapy is more acceptable for advanced
disease that cannot be eradicated by surgery.
3. Palliative radiation may be used to relieve pain and
bowel obstruction and control potential hemorrhage and
leg edema caused by venous or lymphatic obstruction.
4. Intracavitary radiation may be prescribed, which
protects adjacent tissue.
5. External radiation combined with chemotherapy or
surgery may be prescribed because the external
radiation alone may be ineffective.
6. Complications of radiation
a. Abacterial cystitis
b. Fistula formation
d. Ileitis or colitis
e. Bladder ulceration and hemorrhage
D. Chemotherapy
1. Intravesical instillation
a. An alkylating chemotherapeutic agent is instilled
into the bladder.
b. This method provides a concentrated topical treatment
with little systematic absorption.
c. Chemotherapeutic agents used may include thiotepa,
mitomycin (Mutamycin), doxorubicin (Adriamycin),
cyclophosphamide (Cytoxan).
d. The medication is injected into a urethral catheter and
retained for 2 hours.
e. Following instillation, the clients position is rotated
every 15-30 minutes, starting in the supine position to
avoid lying on a full bladder.
f. After 2 hours, the client voids in a sitting position and is
instructed to increase fluids to flush the bladder.
g. Treat the urine as biohazard and send to the
radioisotope laboratory for monitoring
h. For 6 hours following intravesical chemotherapy,
disinfect the toilet with household bleach after the client
has avoided

2. Systemic chemotherapy
a. Systemic chemotherapy is used to treat
inoperable or late tumors
b. Agents used may include cisplatin (Platinol),
doxorubicin (Adriamycin), cyclosphosphamide (Cytoxan),
methotrexate (Folex) and pyridoxine.
3. Complications of chemotherapy
a. Bladder irritation
b. Hemorrhagic cystitis
E. Surgical interventions
1. Transurethral resection of bladder tumor
a. Local resection and fulguration (destruction of
tissue by electrical current through electrodes placed in
direct contact with the tissue
b. Performed for early tumors for cure or inoperable
tumors for palliation
2. Partial cystectomy
a. Partial cystectomy is the removal of up to half of
the bladder
b. The procedure is done for early tumors and for
clients who cannot tolerate a radical cystectomy.
c. During the initial postoperative period, bladder
capacity is reduced greatly to about 60 mL; however, as
the bladder tissue expands, the capacity increases to
200 to 400 ml.
3. Ileal conduit
a. The ileal conduit also is called ureteroileostomy or
Brickers procedure
b. Ureters are implanted into a segment of the ileum,
with the formation of an abdominal stoma.
c. The urine flows into the conduit and is propelled
continually out through the stoma by peristalsis
d. The client is required to wear an appliance over the
stoma to collect the urine.
e. Complications include obstruction, pyelonephritis,
leakage at the anastomosis site, stenosis,
hydronephrosis, skin irritation, and ulceration, and
stomal defects.


QUESTIONS:
1. Which finding is an early indicator of bladder cancer?
a. painless hematuria c. nocturia
b. occasional polyuria d. dysuria


XVI. ONCOLOGICAL EMERGENCIES
A. Sepsis and disseminated intravascular
coagulation (DIC)
1. Description: The client with an oncological
disorder is at increased risk for infection; DIC is
caused by sepsis
2. Interventions
a. Maintain strict aseptic technique with the
immunocompromised client and monitor closely
for infection.
b. Administer antibiotics intravenously as
prescribed
c. Administer anticoagulants as prescribed during the early
phase of DIC
d. Administer cryoprecipitated clotting factors, as prescribed,
when DIC progresses and hemorrhage is the primary problem
B. Syndrome of inappropriate antidiuretic hormone
1. Description
a. Tumors can produce, secrete, or stimulate the brain to
synthesize antidiuretic hormone
b. Mild symptoms include weakness, muscle cramps, loss of
appetite, and fatigue; serum sodium levels range from 115 to 120
mEq/L
c. Monitor serious signs and symptoms relate to water
intoxication and include weight gain, personality changes, confusion
and extreme muscle weakness
d. As the serum sodium level approaches 110 mEq/L, seizures,
coma, and eventually death will occur, unless the condition is
treated rapidly
2. Interventions
a. Initiate fluid restriction and increased sodium
intake as prescribed
b. Administer demeclocycline (Declomycin) as
prescribed, an antagonist to antidiuretic hormone
c. Monitor serum sodium levels
C. Spinal cord compression
1. Description
a. Spinal cord compression occurs when a tumor
directly enters the spinal cord or when the vertebral
column collapses from tumor entry.
b. Spinal cord compression causes back pain,
usually before neurological deficits occur.
c. Neurological deficits relate to the spinal level of
compression and include numbness; tingling; loss of
urethral, vaginal, rectal sensation
D. Hypercalcemia
1. Description
a. Hypercalcemia is a late manifestation of extensive
malignancy that occurs most often in clients with bone
metastasis
b. Decreased physical mobility contributes to or
worsens hypercalcemia
c. Early signs include fatigue, anorexia, nausea,
vomiting, constipation, and polyuria
d. More serious signs and symptoms include severe
muscle weakness, diminished deep tendon reflexes,
paralytic ileus, dehydration, and electrocardiogram
changes.
E. Superior vena cava syndrome
1. Description
a. Superior vena cava syndrome occurs when the
vein is compressed or obstructed by tumor growth
b. Signs and symptoms result from blockage of
blood flow in the venous system of the head, neck, and
upper trunk.
c. Early signs and symptoms generally occur in the
morning include edema of the face, especially around
the eyes, and tightness of the shirt or blouse collar
(Stokes sign)
d. Life-threatening signs and symptoms include
hemorrhage, cyanosis, mental status changes,
decreased cardiac output, and hypotension.
QUESTIONS:
1. A client with cancer is scheduled for radiation therapy.
The nurse knows that radiation at any treatment site may
cause a certain adverse effect. Therefore, the nurse
should prepare the client to expect:
a. hair loss c. fatigue
b. stomatitis d. vomiting
2. To combat the most common adverse effects of
chemotherapy, the nurse would administer an:
a. antiemetic c. antibiotic
b. antimetabolite d. anticoagulant

4. The nurse is interviewing a client about his past medical
history. Which preexisting condition may lead the nurse
to suspect that a client has colorectal cancer?
a. duodenal ulcers c. weight gain
b. hemorrhoids d. polyps
5. A client has been receiving chemotherapy to treat
cancer. Which finding suggest that the client has
developed stomatitis?
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
5. A client is in isolation after receiving an internal
radioactive implant to treat cancer. Two hours later, the
nurse discovers the implant in bed linens. What should
the nurse do first?
a. stand as far away from the implant as possible and
call for help
b. pick-up the implant with long-handled forceps and
place it in a lead-lined container
c. leave the room and notify the radiation therapy
department immediately
d. put the implant back in place, using forceps and a
shield for self-protection, and call for help
6. A client who reports increasing difficulty swallowing,
weight loss, and fatigue is diagnosed with esophageal
cancer. Because this client has difficulty swallowing, the
nurse should assign highest priority to:
a. helping the client cope with body image changes
b. ensuring adequate nutrition
c. maintaining a patent airway
d. preventing injury
7. For a 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

8. During a routine check-up, the nurse assesses a client
with acquired immune deficiency syndrome (AIDS) for
signs and symptoms of cancer. What is the most
common AIDS-related cancer?
a. squamous cell carcinoma
b. multiple myeloma
c. leukemia
d. Kaposis sarcoma
9. The nurse administers chemotherapeutic drugs to a
client with cancer. What adverse effects are most
common?
a. painful mouth sores
b. frequent diarrhea
c. nausea and vomiting
d. constipation

10. A client seeks care for hoarseness that has lasted for 1
month. To elicit the most appropriate information about
this problem, the nurse should ask which question?
a. Do you smokes cigarettes, cigars, or a pipe?
b. Have you strained your voice recently?
c. Do you eat a lot of red meat?
d. Dou you eat spicy foods.
11. A client with cancer is being evaluated for possible
metastasis. Which of the following is one of the most
common metastasis sites for cancer cells?
a. Liver
b. colon
c. reproductive tract
d. white blood cells