Care of Patients with Cancer - Ch. 22 (Iggy)

A patient with a lung tumor is suspected of having thickening in the alveolar membrane and damaged pulmonary vessels. Which condition is most likely to develop in the patient? 1 Hypoxia 2 Dyspnea 3 Hypoxemia 4 Pulmonary edema

1 A patient with a lung tumor is most likely to develop thickening in the alveolar membrane and damage to the pulmonary blood vessels. As a result, the gas exchange may be compromised, which leads to an increased risk for hypoxia. Thickening in the alveolar membrane and damaged pulmonary vessels may not increase the risk of dyspnea, hypoxemia, and pulmonary edema.

A patient with an abdominal tumor is given nutritional support. What finding is most likely to indicate improvement in the patient's condition? 1 Increase in body weight 2 Increase in muscle mass 3 Decrease in food requests 4 Increase of the basal metabolic rate (BMR)

1 A patient with an abdominal tumor may suffer from malnutrition, and nutritional support should be provided to alleviate the condition. An improvement in the patient's condition can be checked by weight gain. The assessment of other parameters such as muscle mass, basic metabolic rate, and frequency of food intake by the patient are performed later.

Which chemotherapy agent inhibits cell division in cancer cells by cross-linking their deoxyribonucleic acid (DNA) and preventing the synthesis of DNA and ribonucleic acid (RNA)? 1 Alkylating agents 2 Antimetabolites 3 Antimitotic agents 4 Antitumor antibiotics

1 Alkylating agents act by cross-linking DNA, which prevents proper synthesis of RNA and DNA, preventing cell division. Antimetabolites act by replacing the actual metabolites in the cells. Counterfeit metabolites are unable to carry out the cellular function resulting in cell death. Antimitotic agents prevent mitosis by interfering with the function and formation of microtubules that have a significant role in cell division. Antitumor antibiotics act by damaging the cell's DNA and preventing the synthesis of DNA and RNA.

Which chemotherapy drug is an alkylating agent? 1 Altretamine 2 Capecitabine 3 Erlotinib 4 Everolimus

1 Altretamine is an alkylating agent and is most commonly used for ovarian cancer. Capecitabine is an antimetabolite. Erlotinib is an epidermal growth factor receptor inhibitor. Everolimus is an angiogenesis inhibitor.

What disorder is the cancer patient receiving chemotherapy at risk for? 1 Decreased platelets 2 Pathologic fractures 3 Hypoxemia 4 Decreased lung capacity

1 Chemotherapy can cause a decrease in the platelet count. Pathologic fractures, hypoxemia, and decreased lung capacity are caused by cancer and tumors, not chemotherapy specifically.

Which treatment strategy increases the risk of developing tumor lysis syndrome? 1 Chemotherapy 2 Antibiotic therapy 3 Antiemetic therapy 4 Benzodiazepine therapy

1 Chemotherapy destroys large numbers of tumor cells, resulting in tumor lysis syndrome. Antibiotics such as declomycin are used to treat the syndrome of inappropriate antidiuretic hormone. Antiemetics interfere with contraceptive action and increase the risk of unplanned pregnancy. Benzodiazepines, such as lorazepam, produce amnesia as an adverse effect.

What is the best option for long-term control of the cancer that causes superior vena cava syndrome? 1 Chemotherapy 2 Oral hydration 3 Erlotinib therapy 4 Everolimus therapy

1 Chemotherapy is the best option for long-term control of the cancer that causes superior vena cava syndrome. Oral hydration treats hypercalcemia. Erlotinib is an oral chemotherapeutic drug that treats pancreatic cancer. Everolimus is an oral chemotherapeutic drug that treats advanced renal cell carcinoma.

The laboratory reports of a patient with cancer indicate severe hyperkalemia and hyperuricemia. Which treatment does the nurse anticipate will be effective for this patient? 1 Dialysis 2 Chemotherapy 3 Allopurinol therapy 4 Epoetin alfa therapy

1 Dialysis is an effective treatment for severe hyperkalemia and hyperuricemia. Chemotherapy can reduce the risk of cancer, but does not maintain normal potassium and uric acid levels.

Which treatment is recommended for a patient with severe cancer-induced hypercalcemia? 1 Dialysis 2 Meperidine 3 Trastuzumab 4 Oral hydration

1 Dialysis is the best treatment option for severe cancer-induced hypercalcemia. Meperidine manages severe rigors. Trastuzumab is a targeted therapy agent. Oral hydration is the primary treatment for hypercalcemia, but not for severe conditions.

Which condition may develop due to the effect of leukemia on white blood cells (WBC)? 1 Increased risk of infection 2 Increased risk of dyspnea 3 Increased risk of impaired clotting 4 Increase risk for allergic reactions

1 In cancer patients, a decreased white blood cell count increases the risk of infection. Healthy white blood cells are associated with normal functioning of the immune system. Thus, cancer patients are more prone to infections. Dyspnea may be a consequence if the patient develops anemia. The blood clotting function gets impaired when there is a low platelet count. A low count of eosinophils places the patient at risk for allergic reactions.

A patient with a transhumeral prosthesis is diagnosed with cancer. What risk does the nurse expect in the patient? 1 Sepsis 2 Cyanosis 3 Hemorrhage 4 Muscle weakness

1 In sepsis, microorganisms enter the bloodstream and cause infection. A transhumeral prosthesis device can increase the risk of sepsis. Cyanosis and hemorrhage are symptoms of superior vena cava syndrome. Muscle weakness is sign of spinal cord compression.

What condition may result in hypoxia? 1 Lung tumor 2 Ovarian tumor 3 Abdominal tumor 4 Spinal cord tumor

1 Lung tumors disrupt oxygenation and cause airway obstruction. Lung tumors decrease the capacity of the lungs and may further lead to hypoxia. Tumors in the spinal cord, ovaries, and abdominal area may not lead to hypoxia.

Which type of surgery is performed to remove tissues that are at risk of becoming cancerous? 1 Prophylactic 2 Diagnostic 3 Curative 4 Cytoreductive

1 Prophylactic surgery is performed to remove tissues that run the risk of becoming cancerous in future. This is a preventive approach against the development of cancer. Diagnostic surgery is performed to remove tissue, which is used for diagnostic tests and examinations. Curative surgery helps remove all cancerous tissues. Cytoreductive surgery is performed to reduce the bulk of cancerous tissue, increasing the efficacy of other cancer treatments.

The nurse is caring for a patient with cancer who developed an infection in the bloodstream. Which term does the nurse expect to see documented in the health record to describe this condition? 1 Sepsis 2 Hypercalcemia 3 Superior vena cava syndrome 4 Disseminated intravascular coagulation (DIC)

1 Sepsis is an infection in the blood and is a life-threatening condition. This is one type of consequence of cancer that can develop when organisms enter the bloodstream. DIC is a problem with the blood-clotting process. Superior vena cava syndrome is when the superior vena cava is obstructed by tumor growth or clots. Hypercalcemia is an increased serum calcium level, which occurs in up to a third of patients with cancer.

Which treatment should be provided to a patient with spinal cord compression to rearrange the bony tissue? 1 Surgery 2 Everolimus 3 Epoetin alfa 4 Parenteral fluid

1 Surgery is recommended to relieve pressure on the spinal cord caused by spinal cord compression. Surgery removes the tumor and rearranges the bony tissue. Everolimus is an oral chemotherapeutic drug used to treat advanced renal cell carcinoma. Epoetin alfa treats anemia associated with chemotherapy. Parenteral fluid is recommended for tumor lysis syndrome.

The laboratory report of a patient with cancer shows serum sodium levels of 108 mEq/L. Which complication does the nurse anticipate in the patient? 1 Seizures 2 Amnesia 3 Neutropenia 4 Somnolence syndrome

1 The normal range of serum sodium level is 135 to 145 mEq/L. Serum sodium levels of 108 mEq/L indicate decreased sodium levels that may affect electrical activity of the brain and result in seizures. Lorazepam treatment can cause amnesia. Chemotherapy for cancer can cause neutropenia. An adverse effect of radiation therapy is somnolence syndrome.

Which patient is at a high risk for sepsis? 1 A patient with cancer 2 A patient with xerostomia 3 A patient taking progestin 4 A patient taking dexamethasone

1 The patient with cancer has a low white blood cell count and impaired immune function, resulting in a higher risk for sepsis. Xerostomia causes dryness of the mouth, but it does not affect the white blood cell count or increase the risk of sepsis. A potential side effect of progestin is gynecomastia. Taking dexamethasone can increase the risk of hypertension.

The nurse is caring for a patient with cancer who is experiencing shortness of breath. The patient asks the nurse what caused this condition. Which reasons does the nurse give for the patient's shortness of breath? Select all that apply. 1 Airway tumor 2 Chest tumor 3 Gastric tumor 4 Bladder tumor 5 Sigmoid colon tumor

1, 2 Tumors in the airway and chest may cause airway obstruction and decreased lung capacity, which may cause the patient to experience shortness of breath (dyspnea) and hypoxemia. Gastric tumors are located in abdominal structures; they do not affect gas exchange. Bladder tumors are located in the bladder structure, and sigmoid colon tumors affect the sigmoid colon function; neither affect gas exchange.

What are the common side effects of chemotherapy on the bone marrow? Select all that apply. 1 Anemia 2 Neutropenia 3 Thrombocytopenia 4 Alopecia 5 Mucositis

1, 2, 3 Chemotherapeutic agents have suppressive effects on bone marrow. Anemia can result from the decreased production of red blood cells and hemoglobin. Neutropenia refers to a reduced number of white blood cells, leading to lowered immunity. Thrombocytopenia, or a reduced number of platelets, may increase the risk of bleeding. Alopecia, or hair loss, and mucositis are common distressing side effects not specific to bone marrow chemotherapy treatment.

Which cancers may most often increase the risk for impaired immunity and blood-producing functions of the body? Select all that apply. 1 Leukemia 2 Myeloma 3 Lymphoma 4 Adenocarcinoma 5 Neurofibrosarcoma

1, 2, 3 Leukemia begins in the bone marrow and results in uncontrolled, abnormal white blood cell production. Myeloma arises from plasma cells that produce antibodies; myeloma increases the risk for impaired immunity and blood-producing functions. Lymphoma is blood cell cancer that results from lymphatic cells; patients with lymphoma may also have a compromised immune system. Adenocarcinoma occurs in the mucus-secreting glands, and neurofibrosarcoma affects the nerves in the arms and legs. Both of these cancers may not interfere with the immune function and blood cell production.

Which potential side effects does the nurse include in the teaching plan for a patient undergoing radiation therapy for laryngeal cancer? Select all that apply. 1 Fatigue 2 Changes in color of hair 3 Change in taste 4 Changes in skin of the neck 5 Difficulty swallowing

1, 3, 4, 5 Radiation therapy to any site produces fatigue in most patients and may cause patients to report changes in taste. Radiation side effects are site-specific. The larynx is in this area; therefore, changes in the skin may occur. Dysphagia (difficulty swallowing) may occur from radiation to the throat area. Chemotherapy, which causes alopecia, may cause changes in the color or texture of hair; this does not normally occur with radiation therapy.

A patient with cancer is receiving morphine sulfate to manage pain. The nurse finds that the patient has muscle cramps, fatigue, and loss of appetite. The patient's laboratory report indicates serum sodium levels of 118 mEq/L. Which interventions would be beneficial for the patient in this situation? Select all that apply. 1 Limiting fluid intake 2 Administering heparin 3 Offering alkaline fluids 4 Adding extra salt in the diet 5 Administering bisphosphonate

1, 4 Morphine sulfate stimulates the posterior pituitary to secrete antidiuretic hormone and causes the syndrome of inappropriate antidiuretic hormone (SIADH). Muscle cramps, fatigue, and loss of appetite are symptoms of inadequate antidiuretic hormone. Fluid retention occurs in this condition; therefore, the nurse should instruct the patient to limit fluid intake. Sodium levels are decreased in this condition. The normal range of serum sodium levels are 135 to 145 mEq/L. Serum sodium levels of 118 mEq/L indicate decreased levels. Therefore, the patient should increase sodium intake by adding additional salt to the diet. Heparin is recommended for disseminated intravascular coagulation. Alkaline fluids are recommended for the patient at risk for uric acid deposition. Bisphosphonate is recommended for hypercalcemia.

The nurse is caring for several patients with cancer. Which conditions does the nurse monitor for due to their status as oncological emergencies? Select all that apply. 1 Sepsis 2 Alopecia 3 Bone marrow suppression 4 Disseminated intravascular coagulation (DIC) 5 Chemotherapy-induced peripheral neuropathy 6 Syndrome of inappropriate antidiurhetic hormone (SIADH)

1, 4, 6 Sepsis, DIC, and SIADH are life-threatening complications of cancer and cancer therapy and therefore are considered oncological emergencies. Although alopecia, bone marrow suppression, and chemotherapy-induced peripheral neuropathy are negative side effects of cancer and cancer therapy, they are not life-threatening and are therefore not oncological emergencies.

A patient is diagnosed with a brain tumor. The nurse finds that the patient has neck vein distention, muscle cramps, decreased appetite, and a bounding pulse. Which laboratory parameter needs to be assessed in the patient? 1 Serum calcium levels 2 Serum sodium levels 3 White blood cell count 4 International normalized ratio

2 A brain tumor may cause the syndrome of inappropriate antidiuretic hormone. Neck vein distention, muscle cramps, decreased appetite, and a bounding pulse are symptoms of the syndrome of inappropriate antidiuretic hormone. Serum sodium levels decrease in the syndrome of inappropriate antidiuretic hormone. Therefore, serum sodium levels should be assessed in the patient. Serum calcium level is measured if the patient has symptoms of hypercalcemia. White blood cell count is monitored if the patient has symptoms of infection. International normalized ratio is monitored before administering aprepitant to a patient already receiving warfarin.

The nurse finds that a patient with thymoma has hemorrhage, decreased cardiac output, hypotension, and cyanosis, and reports to the primary health care provider. What is the ideal nursing action in this situation? 1 Observing the electrocardiogram 2 Performing radiographic imaging 3 Checking serum phosphate levels 4 Checking serum potassium levels

2 A patient with thymoma is at an increased risk for superior vena cava syndrome. Hemorrhage, decreased cardiac output, hypotension, and cyanosis are symptoms of superior vena cava syndrome. The primary health care provider, or a trained radiologist, should perform radiographic imaging for diagnosis and treatment planning, rather than the nurse. The electrocardiogram is monitored for a patient with hypercalcemia. Serum phosphate and potassium levels are monitored in a patient with tumor lysis syndrome.

Which term describes the administration of chemotherapy along with surgery or radiation? 1 Combination chemotherapy 2 Adjuvant therapy 3 Intraperitoneal chemotherapy 4 Curative intent chemotherapy

2 Adjuvant therapy is the use of chemotherapy along with surgery or radiation. Combination chemotherapy is the use of more than one chemotherapy agent to enhance effect. Intraperitoneal designates the instillation of chemotherapy into the peritoneum. Cure is often the goal with many types of therapy; in some instances, cancer may be cured with surgery alone, radiation alone, or single-agent chemotherapy.

The nurse is caring for a patient who is receiving rituximab for treatment of lymphoma. During the infusion, it is essential for the nurse to observe for which side effect? 1 Alopecia 2 Allergy 3 Fever 4 Chills

2 Allergy is the most common side effect of monoclonal antibody therapy (rituximab). Monoclonal antibody therapy does not cause alopecia. Although fever and chills are side effects of monoclonal antibody therapy, they would not take priority over an allergic response that could potentially involve the airway.

Which method of radiation treatment delivery uses radioactive isotopes either in solid form or within body fluids? 1 Teletherapy 2 Brachytherapy 3 Stereotactic body radiotherapy (SBRT) 4 Intensity-modulated radiation therapy (IMRT)

2 Brachytherapy uses radioactive isotopes either in solid form or within body fluids. With all types of brachytherapy, the radiation source is within the patient; therefore, the patient emits radiation for a period of time and is a hazard to others. Teletherapy is radiation delivered from a source outside of the patient; because the source is external, the patient is not radioactive and is not hazardous to others. SBRT is a type of teletherapy, which uses three-dimensional tumor imaging to identify the exact tumor location to allow more precise delivery of higher radiation doses and spare more surrounding tissue. IMRT is also teletherapy which breaks up the single beam into thousands of smaller beams that allow better focus on the tumor.

The nurse is caring for a patient with cancer who has altered GI structure and function with resulting changes in taste. What may this patient experience as a result? 1 Late satiety 2 Reduced appetite 3 Improved intake 4 Food cravings

2 Changes in taste can result in reduced appetite and early, not late, satiety. Changes in taste do not lead to food cravings. Because of changes in taste, intake is usually decreased, not improved.

What does the phrase chemo brain refer to? 1 Development of a seizure disorder during chemotherapy 2 Reduction in cognitive function related to chemotherapy 3 Intracranial hemorrhage following aggressive chemotherapy 4 Decreased risk of brain metastasis with long-term chemotherapy

2 Chemo brain is an expression used to describe the changes in cognitive function that occur during chemotherapy treatment in some patients-most commonly, a reduced ability to concentrate, memory loss, and difficulty learning new information. Aggressive chemotherapy can induce inflammation and general biochemical changes that reduce cognitive function, at least temporarily. The development of hemorrhage and seizures are not part of chemo brain symptoms, nor does the expression refer to a risk of metastasis.

The nurse monitors fluid overload in a patient with a cancer-associated syndrome of inappropriate antidiuretic hormone. What risk does the nurse prevent in the patient through this intervention? 1 Infection 2 Heart failure 3 Hypovolemic shock 4 Deep vein thrombosis

2 Fluid overload can result in pulmonary edema and subsequent heart failure. Therefore, the nurse monitors fluid overload in a patient with a cancer-associated syndrome of inappropriate antidiuretic hormone. The nurse monitors the patient's white blood cell count to prevent infection. The nurse monitors the patient's blood loss to prevent hypovolemic shock. The nurse monitors the patient's coagulating factors to prevent deep vein thrombosis.

1 "I should drink plenty of water to stay hydrated." 2 "A sudden increase in my appetite is a symptom of hypercalcemia." 3 "Approximately one-third of people with cancer develop hypercalcemia." 4 "If I develop hypercalcemia, we can treat it with vigorous intravenous hydration."

2 Hypercalcemia causes a loss of appetite, nausea, and vomiting, not an increased appetite. It is true that approximately one-third of people with cancer develop hypercalcemia. Dehydration worsens hypercalcemia, so the patient should drink plenty of water. Hypercalcemia is often treated with vigorous intravenous hydration with normal saline at an infusion rate for 500 mL/hour. Correcting the dehydration that often accompanies hypercalcemia restores urine output.

A patient with metastatic breast cancer experiences severe nausea and vomiting after chemotherapy and is unable to eat. What is the nurse's most appropriate action? 1 Provide nutritional counseling. 2 Administer antiemetic medications as prescribed. 3 Encourage the patient to eat prior to chemotherapy. 4 Encourage the patient to eat immediately after chemotherapy.

2 If the patient is experiencing nausea and vomiting, the most appropriate action of the nurse is to administer medication to address the symptoms. Nutritional counseling may assist the patient with choices but the patient's immediate symptoms need to be addressed. Eating prior to chemotherapy will not prevent nausea and vomiting, and in some cases, it may intensify the symptoms. Eating after chemotherapy is not appropriate because of the nausea and vomiting.

Mercaptopurine is an oral chemotherapeutic agent used in acute lymphocytic leukemia. Which drug category does it belong to? 1 Multikinase inhibitor 2 Antimetabolite 3 Tyrosine kinase inhibitor 4 Topoisomerase inhibitor

2 Mercaptopurine belongs to the antimetabolite drug category, which acts by posing as an actual metabolite of the cells, thus interfering with cell function. Examples of multikinase inhibitors include pazopanib and sorafenib. Nilotinib and dasatinib are tyrosine kinase inhibitors. Topotecan is a topoisomerase inhibitor.

Which complication does the nurse expect in a patient who has multiple myeloma? 1 Amnesia 2 Hypercalcemia 3 Superior vena cava syndrome 4 Syndrome of inappropriate antidiuretic hormone

2 Multiple myeloma cancer secretes parathyroid hormone and releases calcium from the bones, resulting in hypercalcemia. Lorazepam treatment can cause amnesia. Superior vena cava syndrome causes compression of the superior vena cava. Gastrointestinal cancer stimulates the posterior pituitary gland to secrete antidiuretic hormone and causes the syndrome of inappropriate antidiuretic hormone.

A cancer patient is experiencing restlessness, anxiety, wheezing, and blood-tinged frothy sputum. The nurse identifies that the patient is experiencing what cancer-related disorder? 1 Pneumonia 2 Pulmonary edema 3 Pulmonary embolus 4 Congestive heart failure

2 Pulmonary edema symptoms include anxiety, wheezing, shortness of breath, and blood-tinged frothy sputum due to a buildup of fluid in the lungs. This causes decreased oxygenation of the lungs. Pneumonia is characterized by shortness of breath and is caused by infection. A pulmonary embolus may present with pink frothy sputum but also includes pain. Congestive heart failure is characterized by shortness of breath and anxiety because the heart is unable to pump enough blood throughout the body.

A patient with cancer is receiving radiation therapy. During a follow-up visit, the nurse finds that the patient has cloudy urine, flank pain, muscle weakness, and vomiting. What reason does the nurse anticipate for these findings? 1 Decreased blood platelet count 2 Large number of destroyed tumor cells 3 Compression of the superior vena cava 4 Collapse of vertebrae from tumor degradation

2 Radiation therapy causes the rapid destruction of tumor cells and leads to tumor lysis syndrome. Cloudy urine, flank pain, muscle weakness, and vomiting are symptoms of tumor lysis syndrome. A decreased blood platelet count causes thrombocytopenia. Compression of the superior vena cava causes superior vena cava syndrome. Collapse of vertebrae from tumor degradation causes spinal cord compression.

The nurse is caring for a patient with superior vena cava (SVC) syndrome. Which causative factor does the nurse expect to find in the patient's history? 1 Hypercalcemia 2 Lymphoma tumors in the mediastinum 3 Chemotherapy for germ cell tumors 4 Vertebral collapse from tumor degradation

2 SVC syndrome occurs due to compression of the superior vena cava and often occurs in patients with lymphoma who have developed tumors in the mediastinum. Hypercalcemia is not associated with SVC syndrome. Chemotherapy for germ cell tumors may cause tumor lysis syndrome, not SVC syndrome. The collapse of vertebrae from tumor degradation causes spinal cord compression, not SVC syndrome.

Which class of drug is used for the treatment of cancer-induced spinal cord compression? 1 Diuretics 2 Corticosteroids 3 Bisphosphonates 4 Xanthine oxidase inhibitor

2 Spinal cord compression is a condition that arises when the tumor directly enters the spinal cord or spinal column. It causes neurological complications in the patient. Corticosteroids are administered to treat the conditions such as edema and decreased blood congestion. Diuretics are given for the treatment of cancer-induced hypercalcemia. Xanthine oxidase inhibitors are used to promote purines excretion in tumor lysis syndrome. Bisphosphonates are used in blocking the calcium reabsorption by bones and are used to treat cancer-induced hypercalcemia.

A patient with cancer reports back pain, a sensation of heaviness in the legs, numbness in the hands, and an inability to distinguish hot and cold. Which complication does the nurse expect in the patient? 1 Peripheral neuropathy 2 Spinal cord compression 3 Superior vena cava syndrome 4 Syndrome of inappropriate antidiuretic hormone

2 Spinal cord compression occurs when a cancer tumor directly enters the spinal cord or when a vertebra collapses due to degradation of the bone from a tumor. Back pain, a sensation of heaviness in the legs, numbness in the hands, and the inability to distinguish hot and cold sensations are symptoms of spinal cord compression. Chemotherapy causes peripheral neuropathy. Edema of the face, tightness of the shirt, hemorrhage, and cyanosis are symptoms of superior vena cava syndrome. Cyclophosphamide treatment may cause the syndrome of inappropriate antidiuretic hormone.

The nurse is caring for a patient with end-stage ovarian cancer who needs clarification on the purpose of palliative surgery. Which outcome should the nurse teach the patient regarding the goal of palliative surgery? 1 Cure of the cancer 2 Relief of symptoms or improved quality of life 3 Allowing other therapies to be more effective 4 Prolonging the patient's survival time

2 The focus of palliative surgery is to improve quality of life during the survival time. Curative surgery removes all cancer cells, visible and microscopic. Debulking is a procedure that removes some cancerous tissue, allowing other therapies to be more effective. Many therapies such as surgery, chemotherapy, and biotherapy increase the patient's chance of cure and survival, but palliation improves quality of life.

Which oncologic emergency is a positive sign of the effectiveness of chemotherapy? 1 Hypercalcemia 2 Tumor lysis syndrome 3 Spinal cord compression 4 Superior vena cava syndrome

2 Tumor lysis syndrome is characterized by the rapid destruction of a large number of cells. The intracellular components of lysed cells, containing purines and potassium, are released into the circulation. Tumor lysis syndrome indicates that the cancer therapy has been effective. Hypercalcemia is an oncologic emergency and occurs in patients with bone metastasis. When a tumor directly enters the spinal cord, or when a tumor degrades the bone, the vertebrae may collapse. These collapsed vertebrae can compress the spinal cord and lead to neurological problems. Superior vena cava syndrome occurs when the superior vena cava becomes obstructed either by the tumor or by blood clots.

When caring for the patient with hyperuricemia associated with tumor lysis syndrome (TLS), for which medication does the nurse anticipate an order? 1 Recombinant erythropoietin 2 Allopurinol 3 Potassium chloride 4 Radioactive iodine 131 ( 131I)

2 Tumor lysis syndrome results in hyperuricemia (elevation of uric acid in the blood), hyperkalemia, and other electrolyte imbalances; allopurinol decreases uric acid production and is indicated in TLS. Recombinant erythropoietin is used to increase red blood cell (RBC) production and is not a treatment for hyperuricemia. Administering additional potassium is dangerous. Radioactive iodine 131 is indicated in the treatment of thyroid cancer, not TLS.

The nurse is reviewing laboratory results on a patient receiving chemotherapy. Which result should the nurse report to the provider immediately? 1 Hemoglobin 11.9 g/L 2 White blood cells 1.5/μL 3 Platelets 135,000/μL 4 Red blood cells 4.2/μL

2 With a white blood cell count of 1.5/μL, this patient is at risk for infection and the nurse should notify the health care provider immediately. The hemoglobin and red blood cells are within normal limits. While the platelets are low, they are not as high a priority as the white blood cell count.

A patient with cancer is experiencing hypercalcemia. The nurse assesses the patient for what symptoms? Select all that apply. 1 Diarrhea 2 Skeletal pain 3 Increased appetite 4 Irregular heart rate 5 Increased urine output

2, 4, 5 High levels of calcium in the blood can cause changes in electrocardiographic (ECG), heart rhythm, constipation, skeletal pain, and increased urine output. Diarrhea is not a symptom of hypercalcemia. The appetite would be decreased with hypercalcemia.

What can be the consequences if superior vena cava syndrome is left untreated? Select all that apply. 1 Edema of the face 2 Engorged blood vessels 3 Tightness of blouse or shirt 4 Erythema of the upper body 5 Edema in the arms and hands

2, 4, 5 In patients with superior vena cava syndrome, the blood from the neck, head, and upper extremity gets obstructed due to tumor growth. The manifestations appear due to the blockage of venous return from the head, neck, and upper trunk. The worsening of compression results in engorged blood vessels, erythema of the upper body, and edema in the arms and hands. The other manifestations such as edema of the face and tightness of blouse or shirt appear at the initial stage.

What manifestations may indicate spinal cord compression (SCC) in a patient with cancer? Select all that apply. 1 Cyanosis 2 Back pain 3 Hemorrhage 4 Muscle weakness 5 Sensation of heaviness in arms and legs

2, 4, 5 SCC involves damage to the spinal cord. The tumor directly enters the spinal cord or spinal column, or the vertebrae collapse from tumor degradation of bone. This may cause many neurological complications in the patient. The patient may experience back pain, muscle weakness, and heaviness in the arms and legs. Super vena cava syndrome may manifest as cyanosis and hemorrhage.

Which conditions should a nurse identify in a patient as a cause of gram negative sepsis? Select all that apply. 1 Asthma 2 Cirrhosis 3 Glaucoma 4 Metabolic acidosis 5 Intravascular hemolysis

2, 4, 5 Sepsis involves the entry of microorganisms into the bloodstream, resulting in infection. The presence of other conditions may also cause sepsis. These conditions include liver disease such as cirrhosis, intravascular hemolysis, or metabolic acidosis. Asthma and glaucoma may not be a cause for sepsis. Asthma may be a cause for developing chronic obstructive pulmonary disease while glaucoma may cause permanent blindness.

The patient reports a metallic taste to the nurse. What disease-related consequence is the patient likely experiencing? Select all that apply. 1 Late satiety 2 Food aversions 3 Food cravings 4 Weight gain 5 Reduced appetite

2, 5 Cancer treatments can cause food aversions and reduced appetite due to such effects as a metallic taste in the mouth. Late satiety, food cravings, and weight gain are not related to cancer treatments.

Which statement made by a patient allows the nurse to recognize whether the patient receiving brachytherapy for ovarian cancer understands the treatment plan? 1 "I may lose my hair during this treatment." 2 "I must be positioned in the same way during each treatment." 3 "I will have a radioactive device in my body for a short time." 4 "I will be placed in a semiprivate room for company."

3 Brachytherapy refers to short-term insertion of a radiation source. Side effects of radiation therapy are site-specific; this patient is unlikely to experience hair loss from treating ovarian cancer with radiation. The patient undergoing teletherapy (external beam radiation), not brachytherapy, must be positioned precisely in the same position each time. The patient who is receiving brachytherapy must be in a private room.

Breast reconstruction after a mastectomy is an example of which surgery type? 1 Second-look 2 Palliative 3 Reconstructive 4 Prophylactic

3 Breast reconstruction after a mastectomy is an example of reconstructive or rehabilitative surgery. The surgery is performed to improve the function and enhance the appearance of the breast. Second-look surgeries are performed to re-diagnose cancer and determine the stage or spread of the cancer. Palliative surgeries are meant to improve the quality of life; its objective is not to cure the disease. Prophylactic surgeries are performed for the prevention of cancer in high-risk individuals.

What is a possible reason for cachexia in a cancer patient? 1 Increased food intake and increased catabolism 2 Increased food intake and decreased catabolism 3 Decreased food intake and increased catabolism 4 Decreased food intake and decreased catabolism

3 Cachexia is defined as extreme body wasting and malnutrition. This condition is caused by decreased food intake and increased energy use (catabolism).

Which route of administration is preferable for chemotherapy treatment of ovarian cancer? 1 Intrathecal 2 Intraventricular 3 Intraperitoneal 4 Intravesicular

3 Chemotherapy for ovarian cancer may be administered through an intraperitoneal route, which involves instilling the chemotherapy agent into the peritoneal cavity. The intrathecal route involves delivering the drug into the spinal cord. In an intraventricular administration, the drug is instilled into the ventricles of the brain. In the intravesicular route, the chemotherapy agent is instilled into the bladder.

Which therapy is effective in returning antidiuretic hormone production to normal levels in a patient with melanoma? 1 Fluoxymesterone 2 Medroxyprogesterone 3 Cancer therapy with radiation 4 Intravenous infusions of glucose and insulin

3 Immediate cancer therapy with radiation causes enough tumor regression and helps to return antidiuretic hormone production to normal levels. Fluoxymesterone and medroxyprogesterone are used for hormonal manipulation of cancer. Intravenous infusions containing glucose and insulin are administered to a patient to reduce excess potassium levels.

A patient diagnosed with lymphoma asks the nurse about the risk for infection. What is the nurse's best response? 1 "Infection is a risk for anyone with cancer." 2 "Because you have lymphoma, the risk for infection is very low." 3 "Lymphoma is a bone marrow cancer, so you are at increased risk for infection." 4 "Lymphoma is not a bone marrow cancer, so you are not at increased risk for infection."

3 Lymphoma is a bone marrow cancer, so the patient is at increased risk for infection. All patients with cancer are at increased risk for infection, but this does not address the patient's question regarding lymphoma. Because lymphoma is a bone marrow cancer, there is a risk for infection.

A patient with terminal cancer asks about the potential for chronic pain. Which response by the nurse is most accurate? 1 "Pain is not a common problem for those with terminal cancer." 2 "Pain is a generally minor problem for those with terminal cancer." 3 "Pain can be a major problem for those with terminal cancer." 4 "Pain is not associated with terminal cancer."

3 Pain can be a major problem for those with terminal cancer. Pain is not always associated with cancer, but is a concern for patients and families and must be addressed.

Which component is released into the bloodstream after the destruction of tumor cells? 1 Calcium 2 Sodium 3 Potassium 4 Magnesium

3 Potassium is released into the bloodstream after the destruction of tumor cells, resulting in hyperkalemia. Cancers can secrete parathyroid hormone and can cause the bones to release calcium. Sodium and magnesium are not released into the bloodstream after the destruction of tumor cells.

Which therapy given to a patient with cancer may alter taste and cause fatigue? 1 Chemotherapy 2 Surgical therapy 3 Radiation therapy 4 Molecularly targeted therapy

3 Radiation therapy may cause altered taste and fatigue in a patient receiving the therapy. Chemotherapy may cause alopecia, mucositis, and bone marrow suppression. Surgical therapy may lead to change in appearance or lifestyle. The side effects of molecularly targeted therapy may include skin reactions, hypertension, and impaired wound healing.

Which statement listed by a nursing student regarding radiation-induced fatigue indicates a need for further learning? 1 It can be debilitating and may last for months. 2 Exercise and sleep interventions are helpful in managing it. 3 The intensity of fatigue depends upon the radiation site. 4 It is the outcome of increased energy demands needed to repair damaged cells.

3 The intensity of radiation-induced fatigue does not depend upon the radiation site and the cause. Radiation-induced fatigue can be debilitating and may last for months. Exercise and sleep interventions are helpful in managing the radiation-induced fatigue. This type of fatigue may be due to increased energy demands needed to repair damaged cells.

When caring for a patient receiving chemotherapy, the nurse plans care during the nadir of bone marrow activity to prevent which complication? 1 Drug toxicity 2 Polycythemia 3 Infection 4 Dose-limiting side effects

3 The lowest point of bone marrow function is referred to as the nadir; risk for infection is highest during this phase. The peak of bone marrow function occurs when the patient's blood levels are at their highest. Trough, which means low, is typically used in reference to drug levels. Adjuvant refers to use of radiation therapy or surgery along with chemotherapy in cancer treatment.

Which condition in a patient with cancer facilitates the entry of its own normal flora through a site of skin breakdown to cause severe infection? 1 Anemia 2 Eosinophilia 3 Neutropenia 4 Thrombocytopenia

3 The normal flora of a patient can enter the bloodstream through any site of skin breakdown causing a severe infection. This condition may occur when the patient has neutropenia or low counts of neutrophils, indicating low immunity. Anemia may indicate a low red blood cell count, while eosinophilia indicates low white blood cells and would be a manifestation of any infectious condition. Thrombocytopenia may indicate a low platelet count.

patient has an obstructive airway tumor. The family asks the nurse to explain the patient's condition. What information should the nurse provide to the family to prepare them for the patient's imminent death? 1 "The tumor is causing cachexia and poor gas exchange." 2 "The tumor is causing 'chemo brain' and poor gas exchange." 3 "The tumor is closing off the airway and causing poor gas exchange." 4 "The tumor is causing a biological moderation response and poor gas exchange."

3 The nurse is expected to explain the pathology to the family in layman's terms. Stating that the tumor is closing off the airway and causing poor gas exchange explains that a tumor has obstructed the airway, which will lead to hypoxia and imminent death. The terms "biological moderation," "cachexia," and "chemo brain" address other disease-related consequences of cancer and are not articulated in laymen's terms.

A patient receiving chemotherapy develops tumor lysis syndrome. What instructions regarding diet should the nurse provide to the patient to prevent complications? 1 "You must avoid alkaline fluids." 2 "You must include seafood in your diet." 3 "You must drink at least 3000 ml of water daily." 4 "You must include green leafy vegetables in your diet."

3 Tumor lysis syndrome (TLS) involves rapid destruction of a large number of tumor cells. As a result, the serum level of potassium and uric acid increases. Therefore, the patient must drink at least 3000 ml of fluids daily to dilute the serum potassium level. The flow rate of the kidney is also increased by the fluid intake. The patient should take alkaline fluids to prevent uric acid deposition in the kidneys. Seafood and fish are rich sources of protein, so they will further aggravate the situation by increasing the uric acid content in the patient. Green leafy vegetables, which are a rich source of calcium, should be avoided, as the patient is already hypercalcemic.

The nurse teaches a patient about measures to be followed to improve spinal cord compression. During a follow-up visit, the nurse finds improvement in the patient. Which action of the patient is responsible for this improvement? 1 Decrease in mobility 2 Increase in fluid intake 3 Use of external back braces 4 Consumption of high-fiber food

3 Using an external back brace reduces the weight borne by the spinal column and pressure on the spinal nerves. Therefore, the patient may show reduced risk associated with spinal cord compression during a follow-up visit. Decreasing mobility will aggravate the condition and worsen hypercalcemia. The patient should increase fluid intake in tumor lysis syndrome. High-fiber food is recommended for chemotherapy-induced peripheral neuropathy.

While reviewing the laboratory reports of a patient with cancer, the nurse anticipates that the patient has tumor lysis syndrome. Which finding indicates this condition? Select all that apply. 1 Increased calcium levels 2 Decreased sodium levels 3 Increased uric acid levels 4 Increased potassium levels 5 Decreased phosphorus levels

3, 4 Tumor lysis syndrome causes the destruction of a large number of tumor cells. The intracellular contents of tumor cells, such as purines, in the form of uric acids and potassium, are released into the bloodstream quickly. Therefore, increased uric acid and potassium levels are observed in the patient. Serum calcium levels are increased in hypercalcemia. Decreased sodium levels indicate the syndrome of inappropriate antidiuretic hormone. Phosphorus levels are increased in tumor lysis syndrome.

Which adverse effects are observed when a vesicant agent extravasates during chemotherapy? Select all that apply. 1 Itching 2 Redness 3 Pain 4 Infection 5 Tissue loss

3, 4, 5 Extravasation is a serious complication of intravenous chemotherapy. It refers to the leaking of the IV drug or fluid into the surrounding tissues. Vesicants can cause tissue damage following an extravasation. Adverse effects can include pain, infection, and tissue loss. Itching and redness are less severe common symptoms and not specific to contact with vesicants.

The nurse observes that a cancer patient's platelet level is 35,000 μL. What disorder is the patient experiencing? 1 Infection 2 Anemia 3 Leukemia 4 Thrombocytopenia

4 A platelet count of 35,000 μL is low and indicates thrombocytopenia. Infection and leukemia are indicated by white blood cell counts. Low red blood cells indicate anemia.

Which side effect is commonly found in women who are taking androgen for the hormonal manipulation of cancer? 1 Irregular menses 2 Fluid retention 3 Breast tenderness 4 Facial and chest hair

4 Androgen, used for the hormonal manipulation of cancer, may cause the development of masculine features in women. Such women may develop chest and facial hair. Irregular menses, fluid retention, and breast tenderness may occur when receiving estrogen or progestin.

Which medication is used to treat hypercalcemia temporarily in a patient who has cancer? 1 Sunitinib 2 Febuxostat 3 Temsirolimus 4 Bisphosphonate

4 Bisphosphonate blocks the bone resorption of calcium and is used to treat hypercalcemia temporarily, in patients with cancer. Sunitinib is a multikinase inhibitor that treats renal cell carcinoma. Febuxostat treats tumor lysis syndrome. Temsirolimus is an angiogenesis inhibitor that inhibits the activity of the mammalian target of rapamycin. It suppresses the growth of renal cell carcinomas.

How is cancer-related cachexia defined? 1 Reduced liver function 2 Changes in taste and smell 3 Less energy for meal preparation or eating 4 Extreme body wasting and malnutrition

4 Cachexia is defined as extreme body wasting and malnutrition related to an imbalance between food intake and energy use with cancer. Although reduced energy, reduced liver function, and changes in taste and smell may occur with cancer, none of those factors describe cachexia.

The nurse is caring for a patient who is receiving cancer treatment. What disease-related consequence will contribute to sensory and motor deficits in this patient? 1 Increased risk for fatigue 2 Increased risk for impaired clotting 3 Increased risk for shortness of breath 4 Increased risk for peripheral neuropathy

4 Cancer treatments contribute to sensory and motor deficits, causing increased risk for peripheral neuropathy. Increased risk for fatigue, impaired clotting, and shortness of breath are disease-related consequences of reduced immunity and blood-producing functions.

Which medication does the nurse anticipate will be effective for a patient with post-chemotherapy fatigue? 1 Sipuleucel-T 2 Filgrastim 3 Oprelvekin 4 Darbepoetin alfa

4 Darbepoetin alfa is a drug used in chemotherapy; it is used to treat fatigue and anemia. Sipuleucel-T is a drug used to treat hormone-refractory prostate cancer. Filgrastim is a chemotherapeutic drug that is used to treat neutropenia. Oprelvekin is a chemotherapeutic drug that may cause thrombocytopenia.

What is a manifestation of disseminated intravascular coagulation? 1 Pruritus 2 Muscle aches 3 Penile atrophy 4 Bowel necrosis

4 Disseminated intravascular coagulation causes clot formation and decreases blood flow to the major body organs, resulting in bowel necrosis. Pruritus and muscle aches are side effects of a proteasome inhibitor. Penile atrophy is a side effect of hormonal manipulation.

Which complication occurs due to gram-negative sepsis in a patient with cancer? 1 Pneumonia 2 Gynecomastia 3 Somnolence syndrome 4 Disseminated intravascular coagulation

4 Gram-negative sepsis causes the release of endotoxins, which may result in disseminated intravascular coagulation in the patient with cancer. Disseminated intravascular coagulation impairs the blood clotting process. Radiation therapy for cancer may cause pneumonia as an adverse effect. Antiandrogen receptor drugs may cause gynecomastia as a side effect. Radiation therapy for cancer may cause somnolence syndrome as an adverse effect.

Which treatment should be provided to reduce the symptoms of superior vena cava (SVC) syndrome? 1 Bicalutamide 2 Oral hydration 3 Glucocorticoid 4 High-dose radiation therapy

4 High-dose radiation therapy is recommended for the upper chest area to provide temporary relief for patients with SVC syndrome. Bicalutamide is used for hormonal manipulation of cancer. Oral hydration and glucocorticoids are used to treat hypercalcemia.

Which is an early manifestation of super vena cava syndrome in a patient with cancer? 1 Cyanosis 2 Hemorrhage 3 Hypotension 4 Facial edema

4 In superior vena cava syndrome, the blood from and to the cranial, neck, and upper extremity is obstructed by tumor growth in the vessel, thereby causing congestion. The early manifestation of this disorder includes edema of the face. The other manifestations such as cyanosis, hemorrhage, and hypotension appear at a later stage of this disease.

The nurse cares for a patient with tumor lysis syndrome and finds that nausea prevents adequate fluid intake in the patient. What should be the nursing action for this situation? 1 Giving clotting factors 2 Administering fluoxymesterone 3 Administering aminoglutethimide 4 Notifying the primary health care provider

4 Inadequate fluid intake can result in dehydration. If the patient has difficulty consuming fluids, the nurse should report to the primary health care provider to administer parenteral fluids. Clotting factors are given to a patient when disseminated intravascular coagulation has progressed and is associated with hemorrhage. Fluoxym

Which term describes the occurrence where bone marrow activity and white blood cell counts are at their lowest levels after chemotherapy? 1 Bone marrow suppression 2 Thrombocytopenia 3 Neutropenia 4 Nadir

4 Nadir is the term used for when blood cell counts are the lowest after chemotherapy. Bone marrow suppression is the effect of chemotherapy on cells in the bone marrow, and it can impact all of the blood-forming cells. Thrombocytopenia refers to a low platelet (or thrombocyte) count. Neutropenia is specific to white blood cells or neutrophils.

Which hormone secretion releases calcium from the bones in cancer? 1 Estrogen hormone 2 Progestin hormone 3 Antidiuretic hormone 4 Parathyroid hormone

4 Parathyroid hormone releases calcium from the bones in cancer, resulting in hypercalcemia. Estrogen and progestin hormones regulate the secondary sexual characteristics and do not release calcium from the bones. Antidiuretic hormone maintains blood pressure and does not release calcium from the bones.

The nurse is teaching measures to be followed by a patient who receives radiation therapy for cancer. Which action of the patient indicates effective learning? 1 Drinking 500 mL of fluid the day before the radiation therapy 2 Staying on nothing by mouth status (NPO) the day before the therapy 3 Avoiding consuming alkaline fluids the day before the radiation therapy 4 Drinking 5000 mL of fluid, the day before, on the day of, and for 3 days after the treatment

4 Radiation therapy can cause tumor lysis syndrome in the patient. Adequate hydration prevents and manages tumor lysis syndrome by diluting the serum potassium levels and increasing kidney flow rates. Hydration also prevents the precipitation of uric acid crystals, increases the excretion of potassium, and flushes any kidney precipitates. Therefore, the patient receiving radiation therapy should drink 5000 mL of fluid the day before, on the day of, and for 3 days after the treatment. Drinking 500 mL of fluid would not provide adequate hydration. Radiation therapy can result in anorexia. Therefore, the patient should not be on NPO status the day before the therapy. Alkaline fluids prevent uric acid precipitation so the patient should consume alkaline fluids.

Which energy type is commonly used for radiation therapy? 1 X-rays 2 Alpha particles 3 Beta particles 4 Gamma rays

4 Radioactive elements emit three types of energy: gamma rays, alpha particles, and beta particles. Gamma rays are commonly used for radiation therapy because they can penetrate deeper tissues. X-rays are a form of radiation generated by machines for diagnostic purposes. Alpha particles are not used in cancer treatment. Beta particles are weaker in damaging cells and are therefore used in brachytherapy.

Which class of medications treats chemotherapy-induced nausea and vomiting? 1 Diuretics 2 Corticosteroids 3 Bisphosphonates 4 Serotonin antagonists

4 Serotonin antagonists treat chemotherapy-induced nausea and vomiting. Diuretics increase excretion of urine and lower overall water in the body. Corticosteroids reduce inflammation. Both of these drug classes are used to manage many medical conditions. Bisphosphonates prevent the loss of bone density and are used to treat osteoporosis.

For individuals with cancer who are undergoing chemotherapy, bone marrow suppression places these individuals at risk for life-threatening infections. What is the most common cause of these infections? 1 Poor hand hygiene when performing personal cleansing 2 Inadequate handwashing when handling food products 3 Exposure to individuals who are harboring an infection 4 Overgrowth of the patient's own normal flora

4 The most common cause of life-threatening infections in individuals with bone marrow suppression is overgrowth of their own normal flora. Hand hygiene, careful preparation of food, and avoiding exposure to individuals harboring an infection help to decrease the risks secondary to external organisms. These actions, however, do not affect the risk of normal flora overgrowth.

The nurse recognizes that patients with cancer are at an increased risk of infection for what reason? 1 They have decreased number of platelets 2 They have decreased respiratory function 3 They have decreased number of red blood cells (RBC) 4 They have decreased production of white blood cells (WBC)

4 The production of healthy WBCs is reduced by the entry of tumor cells in the bone marrow. Patients diagnosed with cancer have a decreased WBC count and are at an increased risk for infection because WBCs are responsible for normal immune function. The decreased platelet count caused by cancer invasion may result in thrombocytopenia. Patients with cancer may have decreased respiratory function because of impaired oxygenation. The decreased number of red blood cells in cancer patients will place the patient at increased risk of anemia.

Which complication may occur in a patient if tumor lysis syndrome delays treatment? 1 Leukopenia 2 Bradycardia 3 Neutropenia 4 Tissue damage

4 Tumor lysis syndrome causes the rapid destruction of tumor cells. Tumor lysis syndrome may cause tissue damage if it remains untreated. Leukopenia occurs due to chemotherapy. Granisetron can cause bradycardia as an adverse effect. Chemotherapy can cause neutropenia as an adverse effect.

When reviewing the laboratory data of a cancer patient, the nurse finds that the white blood cell (WBC) count is 1.2/mm 3. What causes does the nurse suspect? Select all that apply. 1 The patient had an infection. 2 The cancer has metastasized. 3 Chemotherapy is depleting the cells. 4 The patient may have leukemia. 5 Cancers cells have invaded the bone marrow.

4, 5 A WBC of 1.2/mm 3 is low and may be associated with leukemia, or may indicate that tumor cells have invaded the bone marrow. A WBC count greater than 10/mm 3 may indicate the patient has an infection. A low WBC count alone does not indicate metastasis or cells being depleted due to chemotherapy.

The nurse is caring for a patient with cancer who also has anemia. What has likely caused the anemia? Select all that apply. 1 Impaired immune function 2 Impaired respiratory function 3 Impaired platelet production 4 Impaired tissue oxygenation 5 Impaired blood-producing function

4, 5 Impaired tissue oxygenation and impaired blood-producing function are linked to anemia as a consequence of cancer. Impaired immune function is related to the cancer, causing a reduction in healthy white blood cells. Impaired respiratory function is a related consequence linked to respiratory system involvement. Impaired platelet production is characteristic of thrombocytopenia linked to reduced blood-producing function.