NCLEX Review Guide: Cancer - Hematological & Oncological Nursing

Cancer Cell Characteristics

• Malignant transformation occurs when normal cells lose growth control mechanisms and develop uncontrolled proliferation, invasion, and metastasis capabilities.
• Cancer cells exhibit anaplasia (loss of differentiation), pleomorphism (varied shapes), and hyperchromatic nuclei distinguishing them from normal cells.
• Metastasis spreads through lymphatic, hematogenous, or direct extension pathways, with lymph nodes often being the first site of spread.

Chemotherapy Nursing Management

• Vesicant chemotherapy drugs can cause severe tissue necrosis if extravasated - monitor IV site continuously and stop infusion immediately if infiltration suspected.
• Nadir period occurs 7-14 days post-chemotherapy when blood counts reach lowest levels, requiring infection precautions and bleeding monitoring.
• Pre-chemotherapy assessment includes complete blood count, liver/kidney function, and cardiac status to ensure safe drug administration.

1. Verify two patient identifiers and chemotherapy order with another nurse
2. Ensure informed consent is obtained and documented
3. Administer pre-medications (antiemetics, corticosteroids) as ordered
4. Use appropriate PPE and follow cytotoxic drug handling protocols
5. Monitor for immediate hypersensitivity reactions during first 15 minutes

Radiation Therapy

• External beam radiation requires skin care with mild soap, avoiding lotions, and protecting from sun exposure to prevent radiation dermatitis.
• Internal radiation (brachytherapy) requires radiation precautions including time, distance, and shielding principles to protect staff and visitors.

Oncological Emergencies

• Tumor lysis syndrome occurs when rapid cell destruction releases intracellular contents, causing hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia.
• Superior vena cava syndrome presents with facial edema, jugular vein distention, and dyspnea requiring immediate intervention to restore venous drainage.
• Spinal cord compression symptoms include back pain, motor weakness, and sensory changes - early recognition prevents permanent neurological damage.

Priority Nursing Actions

• Always assess airway, breathing, circulation first in oncological emergencies before specific interventions.
• Infection prevention is priority when ANC < 1000 - implement neutropenia precautions immediately.