Cancer Review Questions

A client diagnosed with cancer has the tumor staged and graded based on what? a. How the tumor tends to grow and the cell type b. How the tumor spreads and tends to grow c. How the tumor differentiates the cell type d. How the tumor spreads and differentiates

a. How the tumor tends to grow and the cell type Explanation: Tumors are staged and graded based upon how they tend to grow and the cell type before a client is treated for cancer.

The nurse is preparing to assess a client whose chart documents that the client experienced extravasation when receiving the vesicant vincristine during the previous shift. The documentation also notes that an antidote was administered immediately. The nurse prepares to assess for which conditions? Select all that apply. a. Sloughing tissue b. Tissue necrosis c. Active bleeding d. Effectiveness of the antidote

a. Sloughing tissue b. Tissue necrosis d. Effectiveness of the antidote Explanation: Extravasation of vesicant chemotherapeutic agents can lead to erythema, sloughing, and necrosis of surrounding tissue, muscle, and tendons. To reduce the likelihood and severity of symptoms due to extravasation of a vesicant, antidotes matched to the vesicant are administered. Nurses caring for a client who experienced extravasation of a vesicant should assess for sloughing tissue, tissue necrosis, erythema, and effectiveness of the antidote.

A patient is taking vincristine, a plant alkaloid for the treatment of cancer. What system should the nurse be sure to assess for symptoms of toxicity? a. Gastrointestinal system b. Nervous system c. Pulmonary system d. Urinary system

b. Nervous system Explanation: With repeated doses, the taxanes and plant alkaloids, especially vincristine, can cause cumulative peripheral nervous system damage with sensory alterations in the feet and hands.

When a client receives vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the client needs to be informed to report which symptoms that would be expected side effects of motor neuropathy? Select all that apply. a. burning and tingling sensations in the extremities b. muscle weakness c. cramps and spasms in the legs d. loss of balance and coordination e. alopecia

b. muscle weakness c. cramps and spasms in the legs d. loss of balance and coordination Explanation: Muscle weakness, cramps and leg spasms, and loss of balance and coordination are expected side effects of motor nerve damage. Burning and tingling sensations are signs of sensory nerve damage. Alopecia is hair loss, not a motor nerve damage sign.

The nurse is to administer a vesicant chemotherapeutic drug to a client who had a right mastectomy and inserts the intravenous line: a. In the client's left hand b. With a butterfly needle c. In the client's right forearm d. With a soft, plastic catheter

d. With a soft, plastic catheter Explanation: Vesicant chemotherapy should never be administered in the peripheral veins involving the hand or wrist. A person with breast cancer is to avoid injections in the affected extremity. A soft, plastic catheter should be used, not a butterfly needle.

A client diagnosed with cancer has the tumor staged and graded based on what factors? a. How they tend to grow and the cell type b. How they spread and tend to grow c. How they differentiate the cell type d. How they spread and differentiate

a. How they tend to grow and the cell type Explanation: Tumors are staged and graded based upon how they tend to grow and the cell type before a client is treated for cancer.

A patient with uterine cancer is being treated with intracavitary radiation. The patient will emit radiation while the implant is in place. The nurse is aware of the precautions necessary for the provider of care and visitors. Which of the following are appropriate guidelines to follow? Select all that apply. a. The nurse can provide direct care for up to 60 minutes per 8-hour shift. b. Family members should stand about 6 feet from the patient. c. Plastic aprons should be worn to buffer the exposure. d. Visitors may stay for 30 minutes or less.

b. Family members should stand about 6 feet from the patient. d. Visitors may stay for 30 minutes or less. Explanation: Exposure for the nurse, health care provider or visitors should be limited to 30 minutes/8-hour shift. As time increases, exposure to radiation increases. The goal is to deliver safe, efficient care in the shortest amount of time. Lead aprons can provide protection, not plastic aprons.

A client has cancer of the neck and is receiving external beam radiation therapy to the site. The client is experiencing trauma to the irradiated skin. The nurse does all of the following. (Select all that apply.) a. inspects for skin damage of the chest area b. assesses the client for any sun exposure c. uses cool water to wash the neck area d. applies an over-the-counter ointment to the skin e. avoids shaving the irradiated skin

b. assesses the client for any sun exposure e. avoids shaving the irradiated skin Explanation: The client receiving external beam radiation therapy may experience trauma to the irradiated skin. To prevent further skin damage, the client is to avoid sun exposure and shaving the irradiated skin area. Other skin areas are not damaged, only the irradiated skin. Lukewarm water is to be used to bathe the area. Water of extreme temperature should be avoided. Many over-the-counter ointments contain metals and may cause additional skin damage.

A client receiving radiation therapy develops wet desquamation of the area. Which intervention(s) will the nurse add to the client's plan of care? Select all that apply. a. Keep areas of eschar intact. b. Apply dry dressings over the areas. c. Apply silver sulfadiazine cream as prescribed. d. Break the blisters that form on the skin. e. Wash the area with lukewarm water every 4 hours.

c. Apply silver sulfadiazine cream as prescribed. Explanation: Wet desquamation describes a skin impairment caused by direct radiation to the area. Any areas of eschar should be removed to promote healing and prevent infection. If the area is weeping, a nonadhesive absorbent dressing should be applied as this is easier to remove and is associated with less pain and trauma when the drainage dries and adheres to the dressing. A prescribed cream such as silver sulfadiazine would be applied to dry a wet wound. Blisters should not be disrupted as breaking the blisters disrupts ski integrity and increases the risk of infection. The areas of wet desquamation should not be washed frequently as this increases irritation and skin damage which increases the risk of infection.

The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client? a. Suppression of the bone marrow b. Enhance action of the chemotherapy c. Decrease the need for additional adjuvant therapies d. Shorten the period of neutropenia

d. Shorten the period of neutropenia Explanation: Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation. The suppression of bone marrow creates the need for interferon use, not a result of the use. Although some BRMs can inhibit tumor growth, the primary use is for reducing neutropenia. Interferon use does not replace standard cancer treatments or decrease the need for those treatments.

A client asks the nurse what is causing the fatigue following radiotherapy. What is the nurse's best response? a. The cancer is spreading to other parts of the body. b. The cancer cells are dying in large numbers. c. Fighting off infection is an exhausting venture. d. Substances are released when tumor cells are destroyed.

d. Substances are released when tumor cells are destroyed. Explanation: Fatigue results from substances being released when tumor cells are destroyed during radiotherapy. The spreading of cancer can cause many symptoms dependent on location and type of cancer, but it is not a significant factor in the development of fatigue with radiotherapy. The production of healthy cells can increase metabolic rate, but death of cancer cells does not support fatigue in this case. Fighting infection can cause fatigue, but there is no evidence provided to support the presence of infection in this client.

The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply. a. Egg white omelet with spinach and mushrooms b. Crispy chicken Caesar Salad c. Steamed broccoli and carrots d. Turkey breast on whole wheat bread e. Smoked salmon f. Vegetable and cheddar quiche

a. Egg white omelet with spinach and mushrooms c. Steamed broccoli and carrots d. Turkey breast on whole wheat bread Explanation: Foods high in fat and those that are smoked or preserved with salt or nitrates are associated with increased cancer risks. An omelet made of egg whites and vegetables is a healthy low fat selection as are steamed broccoli/carrots and turkey breast on whole grain bread. A salad can be a healthy selection but Caesar salads contain much fat from the dressing and addition of cheeses and fried chicken. Salmon that is not smoked would be a good selection. Quiche usually contains high-fat milk, crème, eggs, and cheese.

Which of the following does a nurse have to assess during the bone marrow transplant (BMT) procedure? a. Psychological status b. Blood pressure status c. Urine gravity status d. Electrolyte levels

a. Psychological status Explanation: During the BMT procedure, the nurse assesses the patient's psychological status. Patients experience many mood swings and need emotional support and help throughout this process. Assessing the patient's blood pressure, urine gravity, and electrolyte levels is important for patients undergoing chemotherapy.

A nurse is administering a peripheral chemotherapeutic agent. What nursing actions are used for extravasation of a chemotherapeutic agent? Select all that apply. a. Stop the medication infusion at the first sign of extravasation b. Aspirate any residual drug from the IV line c. Administer an antidote, if indicated d. Apply warm compresses to the irritated site to encourage healing e. Schedule the client for implanted device

a. Stop the medication infusion at the first sign of extravasation b. Aspirate any residual drug from the IV line c. Administer an antidote, if indicated Explanation: All of the answers except application of a warm compress are appropriate nursing actions. The application of warmth would be contraindicated because it would cause vasodilation, which would increase the absorption of irritant into the local tissues. Short term chemotherapy can be done with peripheral catheters so the client may not need an implanted device.

The nurse is teaching a client about carcinogens. What carcinogens does the nurse include in the teaching? Select all that apply. a. dietary substances b. environmental factors c. viruses d. chemical agents e. defective genes f. hormone replacement therapy

a. dietary substances b. environmental factors c. viruses d. chemical agents e. defective genes f. hormone replacement therapy Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions such as hormone replacement therapy.

The nurse is preparing a teaching tool about alopecia caused by cancer treatment. Which information will the nurse emphasize in this tool? Select all that apply. a. Use a hair dryer to quickly dry the hair. b. Cut long hair before treatment begins. c. Use shampoo and conditioner every day. d. Use a wide-tooth comb to style the hair. e. Avoid hair dyes or permanent wave solutions.

b. Cut long hair before treatment begins. d. Use a wide-tooth comb to style the hair. e. Avoid hair dyes or permanent wave solutions. Explanation: Hair loss can begin shortly after starting chemotherapy or radiation therapy as treatment for cancer. The teaching tool should include information that helps minimize hair loss to include cutting long hair before treatment begins as this will reduce the weight and manipulation of the hair. A wide-toothed comb protects the scalp and prevents accidental loss of hair through routine maintenance. Hair dyes and permanent solutions should be avoided as this will protect the scalp and prevent accidental hair loss and scalp irritation. Hair dryers should be avoided as this will protect the scalp from accidental injury. Daily use of shampoos and conditioners should be avoided as this will encourage hair loss and lead to potential scalp injury. Conditioners are unnecessary.

A client has received several treatments of bleomycin. It is now important for the nurse to assess: a. Skin integrity b. Lung sounds c. Urine output d. Hand grasp

b. Lung sounds Explanation: Bleomycin has cumulative toxic effects on lung function. Thus, it will be important to assess lung sounds.

A client was diagnosed with cancer several weeks ago and family members describe the client as "utterly distraught." The client has fully withdrawn from social and family contact. What is the nurse's best action? a. Reassure the client and the family that these types of responses to cancer are common. b. Refer the client to the appropriate mental health provider. c. Educate the client about the mental health benefits of exercise. d. Reassure the family that the client is grieving and will eventually come to terms with the diagnosis.

b. Refer the client to the appropriate mental health provider. Explanation: Emotional responses to cancer diagnosis are expected, but this client's response is atypical. The nurse should avoid false reassurance and exercise alone is unlikely to provide a solution. For these reasons, a referral is necessary.

Which of the following are true statements about effective radiation therapy? Select all that apply. a. Cells are least vulnerable during DNA synthesis. b. Slower-growing tissues at rest (muscle) are more radioresistant. c. Tumors that are well oxygenated are more sensitive to radiation. d. Tumors that are small in size and dividing rapidly are more sensitive.

b. Slower-growing tissues at rest (muscle) are more radioresistant. c. Tumors that are well oxygenated are more sensitive to radiation. d. Tumors that are small in size and dividing rapidly are more sensitive. Explanation: All of the statements are true except for A. Cells are most vulnerable during DNA synthesis and mitosis. Tissues that experience frequent cellular division are most sensitive to radiation.

Based on the understanding of the effects of chemotherapy, the nurse would anticipate which clinical finding in a client 2 weeks after therapy? a. change in hair color b. fever c. elevated white blood cells count d. constipation

b. fever Explanation: The effects of chemotherapy two weeks after treatment can result in a fever. Regrowth of hair after alopecia can result in change of hair color, but this effect is not anticipated 2 weeks after treatment. White blood cell count will be decreased 2 weeks after chemotherapy. Constipation is not usually seen 2 weeks after chemotherapy treatment.

A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity? a. Disease prophylaxis b. Risk reduction c. Secondary prevention d. Tertiary prevention

c. Secondary prevention Explanation: Secondary prevention involves screening and early detection activities that seek to identify early-stage cancer in individuals who lack signs and symptoms suggestive of cancer. Primary prevention is concerned with reducing the risks of disease through health promotion strategies. Tertiary prevention is the care and rehabilitation of the client after having been diagnosed with cancer.

An oncology nurse is contributing to the care of a client who has failed to respond appreciably to conventional cancer treatments. As a result, the care team is considering the possible use of biologic response modifiers (BRMs). The nurse should know that these achieve a therapeutic effect by what means? a. Promoting the synthesis and release of leukocytes b. Focusing the client's immune system exclusively on the tumor c. Potentiating the effects of chemotherapeutic agents and radiation therapy d. Altering the immunologic relationship between the tumor and the client

d. Altering the immunologic relationship between the tumor and the client Explanation: BRMs alter the immunologic relationship between the tumor and the cancer client (host) to provide a therapeutic benefit. They do not necessarily increase white cell production or focus the immune system solely on the tumor. BRMs do not potentiate radiotherapy and chemotherapy.

A nurse is teaching a client who is receiving radiation treatment for left lower lobe lung cancer. Which client statement indicates a need for further teaching? a. "I'll use hats to protect my head from the sun when my hair falls out." b. "If I get nauseous, I'll try to eat several small, bland meals each day." c. "I'll allow myself plenty of time to rest between activities." d. "Most of the adverse effects should go away shortly after my last radiation treatment."

a. "I'll use hats to protect my head from the sun when my hair falls out." Explanation: The client requires additional teaching if he mentions that he will lose the hair on his head as a result of radiation therapy. Alopecia is an acute, localized adverse effect of radiation. The treatment area for this client's cancer will be localized to the lower aspects of his lungs, not his head. Nausea and fatigue are expected generalized adverse effects of radiation therapy. Most adverse effects of radiation are temporary and will stop when treatment is complete.

A nurse is caring for a client newly diagnosed with cancer. Which therapies are used to treat cancer? Select all that apply. a. surgery b. hyperthermia c. radiation therapy d. chemotherapy e. electroconvulsive therapy

a. surgery b. hyperthermia c. radiation therapy d. chemotherapy Explanation: Cancer is frequently treated with a combination of therapies using standardized protocols. The basic methods used to treat cancer are surgery, radiation therapy, hyperthermia, and chemotherapy. Electroconvulsive therapy is a method of treatment for mental distress or illness.

The nurse is assessing the diet of a female client. To decrease the risk of cancer in general, the nurse instructs the client to: a. Decrease cigarette smoking from one pack/day to 1/2 pack/day. b. Limit alcohol ingestion to one drink per day. c. Ingest two to three servings of fruits and vegetables each day. d. Include at least 6 ounces of meat in meals every day.

b. Limit alcohol ingestion to one drink per day. Explanation: Alcohol increases the risks of certain cancers and should be limited to no more than one drink per day for women. Smoking is strongly associated with certain cancers, and tobacco may act synergistically with other substances. Even decreasing use of tobacco still places one at risk for cancer. Recommendation by the U.S. Department of Agriculture for fruits and vegetables is 4 1/2 cups per day and for protein is 5 1/2 ounces per day with low-fat or lean meat and poultry and/or other proteins such as fish, beans, peas, nuts, and seeds.