Evolve Ch 16-Cancer

The nurse assesses a 76-year-old man with chronic myeloid leukemia receiving nilotinib (Tasigna). It is most important for the nurse to ask which question? A: "Have you had a fever?" B: "Have you lost any weight?" C: "Has diarrhea been a problem?" D: "Have you noticed any hair loss?"

A An adverse effect of nilotinib is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4o F or higher. Other adverse effects of nilotinib are thrombocytopenia, bleeding, nausea, fatigue, elevated lipase level, fever, rash, pruritus, diarrhea, and pneumonia.

The laboratory reports that the cells from the patient's tumor biopsy are Grade II. What should the nurse know about this histologic grading? A. Cells are abnormal and moderately differentiated. B. Cells are very abnormal and poorly differentiated. C. Cells are immature, primitive, and undifferentiated. D. Cells differ slightly from normal cells and are well-differentiated.

A Grade II cells are more abnormal than Grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? A. A bland, low-fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods

A Patients experiencing diarrhea secondary to chemotherapy and/or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.

The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation (select all that apply)? A: Maintain hope. B: Exhibit a caring attitude. C: Plan realistic long-term goals. D: Give them antianxiety medications. E: Be available to listen to fears and concerns. F: Teach them about all the types of cancer that could be diagnosed.

A, B, E Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching them about the diagnostic procedures would also be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.

What is the process by which cancers are able to develop their own blood vessels called? A. Angiogenesis B. Proliferation C. Hematogenesis D. Vascularization

A. Angiogenesis As the tumor increases in size, development of its own blood supply is critical to its survival and growth. The process of the formation of blood vessels within the tumor itself is called tumor angiogenesis, and it is facilitated by tumor angiogenesis factors produced by the cancer cells. Reference: 265

What cellular features of cancer cells distinguish them from normal cells (select all that apply)? A. Cells lack contact inhibition. B. Cells return to a previous undifferentiated state. C. Oncogenes maintain normal cellular expression. D. Proliferation occurs when there is a need for more cells. E. New proteins characteristic of embryonic stage emerge on cell membrane.

A. Cells lack contact inhibition. B. Cells return to a previous undifferentiated state. E. New proteins characteristic of embryonic stage emerge on cell membrane. Two major dysfunctions in the process of cancer are defective cellular proliferation (growth) and defective cellular differentiation. Cancer cells lack contact inhibition and are poorly differentiated. Cancer cell growth is infiltrative and expansive, and cancer cells are abnormal and become more unlike parent cells. Reference: 262

A 70-year-old man has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and complains of nausea and constipation. Which complication of cancer is this? A. Hypercalcemia B. Tumor lysis syndrome C. Spinal cord compression D. Superior vena cava syndrome

A. Hypercalcemia Hypercalcemia can occur with multiple myeloma; immobility and dehydration can contribute to or exacerbate hypercalcemia. The primary manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting. Reference: 294

A patient has been diagnosed with early-stage breast cancer. What is most appropriate for you to focus on? A. Maintaining the patient's hope B. Preparing a will and advance directives C. Discussing replacement child care for the patient's children D. Discussing the patient's past experiences with her grandmother's cancer

A. Maintaining the patient's hope Maintain hope, which is the key to effective cancer care. Hope depends on the status of the patient—hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer care. Reference: 297

To assess for tumor lysis syndrome after chemotherapy, what should you monitor? A. Serum electrolytes B. Platelet and white blood cell (WBC) counts C. Arterial blood gas values D. Hemoglobin and hematocrit

A. Serum electrolytes Acute tumor lysis syndrome (TLS) is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. The four hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia. Early symptoms include weakness, muscle cramps, diarrhea, nausea, and vomiting. TLS usually occurs within the first 24 to 48 hours after initiation of chemotherapy and may persist for approximately 5 to 7 days. The primary goal of TLS management is prevention of renal failure and severe electrolyte imbalances. Reference: 295

The primary protective role of the immune system related to malignant cells is A. surveillance for cells with tumor-associated antigens. B. binding with free antigen released by malignant cells. C. production of blocking factors that immobilize cancer cells. D. responding to a new set of antigenic determinants on cancer cells.

A. surveillance for cells with tumor-associated antigens. Cancer cells may display altered cell surface antigens as a result of malignant transformation. These antigens are called tumor-associated antigens (TAAs). A function of the immune system is to respond to TAAs. Reference: 267

The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? A. Ask the patient if the site hurts. B. Turn off the chemotherapy infusion. C. Call the ordering health care provider. D. Administer sterile saline to the reddened area.

B Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation the infusion should first be stopped. Then the protocol for the drug-specific extravasation procedures should be followed to minimize further tissue damage. The site of extravasation usually hurts, but it may not. It is more important to stop the infusion immediately. The health care provider may be notified by another nurse while the patient's nurse starts the drug-specific extravasation procedures, which may or may not include sterile saline.

The nurse is teaching a wellness class to a group of women at their workplace. The nurse knows that which woman is at highest risk for developing cancer? A: A woman who obtains regular cancer screenings and consumes a high-fiber diet B: A woman who has a body mass index of 35 kg/m2 and smoked cigarettes for 20 years C: A woman who exercises five times every week and does not consume alcoholic beverages D: A woman who limits fat consumption and has regular mammography and Pap screenings

B Cancer prevention and early detection are associated with the following behaviors: limited alcohol use; regular physical activity; maintaining a normal body weight; obtaining regular cancer screenings; avoiding cigarette smoking and other tobacco use; using sunscreen with SPF 15 or higher; and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).

What can the nurse do to facilitate cancer prevention for the patient in the promotion stage of cancer development? A. Teach the patient to exercise daily. B. Teach the patient promoting factors to avoid. C. Tell the patient to have the cancer surgically removed now. D. Teach the patient which vitamins will improve the immune system.

B The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be the nurse's role.

The patient with leukemia asks you about the different types of hematopoietic stem cell transplantation (HSCT). The patient wants to use his own cells. Which type of transplantation is this? A. Syngeneic B. Autologous C. Allogeneic D. Familial

B. Autologous In autologous transplantation, patients' own stem cells are reinfused after myeloablative (destroying bone marrow) chemotherapy. Reference: 291

9. You are reviewing the tissue pathology report for a patient that identifies abnormal cells with moderate dysplasia with cells only moderately differentiated. You would expect the histology report to record a grade of A. I. B. II. C. III. D. IV.

B. II. Grade I: Cells differ slightly from normal cells (mild dysplasia) and are well differentiated (low grade). Grade II: Cells are more abnormal (moderate dysplasia) and moderately differentiated (intermediate grade). Grade III: Cells are very abnormal (severe dysplasia) and poorly differentiated (high grade). Grade IV: Cells are immature and primitive (anaplasia) and undifferentiated; the cell of origin is difficult to determine (high grade). Grade X: Grade cannot be assessed. Reference: 268

What is the most common complication of hematopoietic transplantation? A. Anemia B. Infection C. Graft-versus-host disease D. Liver failure

B. Infection Bacterial, viral, and fungal infections are common after HSCT. Prophylactic antibiotic therapy may reduce their incidence. A potentially serious complication of an allogeneic transplant is graft-versus-host disease. Reference: 292

What helps to regulate cell growth? A. Stem cells B. Tumor suppressor genes C. Oncogenes D. Protooncogenes

B. Tumor suppressor genes Tumor suppressor genes function to regulate cell growth. Mutations that alter tumor suppressor genes render them inactive, resulting in a loss of their tumor-suppressing action. Reference: 263

A 64-year-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to this patient's plan of care? A: Weigh the patient every month to monitor for weight loss. B: Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. C: Provide high-protein and high-calorie, soft foods every 2 hours. D: Apply palifermin (Kepivance) liberally to the affected oral mucosa.

C A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Palifermin is administered intravenously as a growth factor to stimulate cells on the surface layer of the mouth to grow. Patients should be weighed at least twice each week to monitor for weight loss.

The patient is told that the adenoma tumor is not encapsulated but has normally differentiated cells and that surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? A. It will recur. B. It has metastasized. C. It is probably benign. D. It is probably malignant.

C Benign tumors usually are encapsulated and have normally differentiated cells. They do not metastasize and rarely recur as malignant tumors do.

Which cellular dysfunction in the process of cancer development allows defective cell proliferation? A. Proto-oncogenes B. Cell differentiation C. Dynamic equilibrium D. Activation of oncogenes

C Dynamic equilibrium is the regulation of proliferation that usually only occurs to equal cell degeneration or death or when the body has a physiologic need for more cells. Cell differentiation is the orderly process that progresses a cell from a state of immaturity to a state of differentiated maturity. Mutations that alter the expression of proto-oncogenes can activate them to function as oncogenes, which are tumor-inducing genes and alter their differentiation.

The female patient is having whole brain radiation for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? A. "When your hair grows back it will be patchy." B. "Don't use your curling iron and that will slow down the loss." C. "You can get a wig now to match your hair so you will not look different." D. "You should contact "Look Good, Feel Better" to figure out what to do about this."

C Hair loss with radiation is usually permanent. The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. When hair grows back after chemotherapy, it is frequently a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern.

The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? A. It is delivered via an Ommaya reservoir and extension catheter. B. It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. C. A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration. D. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

C Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump.

A 33-year-old patient has recently been diagnosed with stage II cervical cancer. What should the nurse understand about the patient's cancer? A. It is in situ. B. It has metastasized. C. It has spread locally. D. It has spread extensively.

C Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ; stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread. Stage IV denotes metastasis.

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency? A: Hypokalemia B: Hypouricemia C: Hypocalcemia D: Hypophosphatemia

C TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

The unlicensed assistive personnel (UAP) told the nurse the location of the patient's pain and the worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg and it is getting worse. What assessment question should the nurse ask the patient to determine treatment measures for this patient's pain? A. "Where is the pain?" B. "Is the pain getting worse?" C. "What does the pain feel like?" D. "Do you use medications to relieve the pain?"

C The unlicensed assistive personnel (UAP) told the nurse the location of the patient's pain and the worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.

The patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? A. Use Dial soap to feel clean and fresh. B. Scented lotion can be used on the area. C. Avoid heat and cold to the treatment area. D. Wear the new bra to comfort and support the area.

C Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.

The goals of cancer treatment are based on what principle? A. Surgery is the single most effective treatment for cancer. B. Initial treatment is always directed toward cure of the cancer. C. A combination of treatment modalities is effective for controlling many cancers. D. Although cancer cure is rare, quality of life can be increased with treatment modalities.

C. A combination of treatment modalities is effective for controlling many cancers. The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy differs according to the particular cancer being treated and may involve local therapies (i.e., surgery or irradiation) alone or in combination, with or without periods of adjunctive systemic therapy (i.e., chemotherapy). Reference: 271

How do you counsel the patient receiving radiation therapy or chemotherapy? A. Effective birth control methods should be used for the rest of the patient's life. B. If nausea and vomiting occur during treatment, the treatment plan will be modified. C. After successful treatment, a return to the person's previous functional level can be expected. D. The cycle of fatigue-depression-fatigue that may occur during treatment can be reduced by restricting activity.

C. After successful treatment, a return to the person's previous functional level can be expected. Some cancer survivors may continue to experience symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. The impact of a cancer diagnosis can affect many aspects of a patients' life, with cancer survivors commonly reporting financial, vocational, marital, and emotional concerns long after treatment is over. Resources for survivors are listed in Table 16-20. Reference: 297

Which is an example of a complete carcinogen? A. Ultraviolet light B. Alcohol C. Cigarette smoking D. Radiation

C. Cigarette smoking Some carcinogens are capable of initiating and promoting the development of cancer. They carcinogens are called complete carcinogens. Cigarette smoke is an example of a complete carcinogen capable of initiating and promoting cancer. Reference: 265

The process of gene therapy involves which of the following? A. Altering the person's genetic makeup B. Changes in the genes of cancer cells C. Injecting genetic material into a patient's cells D. Decreasing the number of tumor markers

C. Injecting genetic material into a patient's cells Gene therapy is an experimental therapy that involves introducing genetic material into a person's cells to fight disease. Reference: 292

A patient receiving chemotherapy and irradiation for head and neck cancer has a white blood cell (WBC) count of 1.9 × 103/μL, hemoglobin level of 10.8 g/dL, and a platelet count of 99 × 103/μL. Based on the complete blood cell (CBC) results, what is the most serious clinical finding? A. Cough, rhinitis, and sore throat B. Fatigue, nausea, and skin redness at site of irradiation C. Temperature of 101.9° F, fatigue, and shortness of breath D. Skin redness at site of irradiation, headache, and constipation

C. Temperature of 101.9° F, fatigue, and shortness of breath Neutropenia is most common in patients receiving chemotherapy, and it can place them at serious risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly because fever in the setting of neutropenia is a medical emergency. Reference: 280

Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? A: Firm-bristle toothbrush B: Hydrogen peroxide rinse C: Alcohol-based mouthwash D: 1 tsp salt in 1 L water mouth rinse

D A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy. A soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.

The patient is receiving biologic and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? A. Morphine sulfate B. Ibuprofen (Advil) C. Ondansetron (Zofran) D. Acetaminophen (Tylenol)

D Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic, but not used first to combat flu-like symptoms of headache, fever, chills, myalgias, etc.

A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? A. Bacteria B. Sun exposure C. Most chemicals D. Epstein-Barr virus

D Burkitt's lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. Bacteria do not initiate cancer. Sun exposure causes cell alterations leading to melanoma and squamous and basal cell skin carcinoma. Long-term exposure to certain chemicals (e.g., ethylene oxide, chloroform, benzene) is known to initiate cancer.

The nurse is caring for an 18-year-old female patient with acute lymphocytic leukemia who is scheduled to receive hematopoietic stem cell transplantation (HSCT). Which statement, if made by the patient, indicates a correct understanding of the procedure? A: "After the transplant I will feel better and can go home in 5 to 7 days." B: "I understand the transplant procedure has no dangerous side effects." C: "My brother will be a 100% match for the cells used during the transplant." D: "Before the transplant I will have chemotherapy and possibly full body radiation."

D Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.

When caring for the patient with cancer, what does the nurse understand as the response of the immune system to antigens of the malignant cells? A. Metastasis B. Tumor angiogenesis C. Immunologic escape D. Immunologic surveillance

D Immunologic surveillance is the process where lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance that allows the cancer cells to reproduce.

A 70-year-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? A: Weight gain of 2 lb B: Urine specific gravity of 1.015 C: Blood urea nitrogen of 20 mg/dL D: Serum sodium level of 118 mEq/L

D Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. A weight gain may be due to fluid retention. The urine specific gravity and blood urea nitrogen are normal.

The patient has been diagnosed with non-small cell lung cancer. Which type of targeted therapy will most likely be used for this patient to suppress cell proliferation and promote programmed tumor cell death? A. Proteasome inhibitors B. BCR-ABL tyrosine kinase inhibitors C. CD20 monoclonal antibodies (MoAb) D. Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TK)

D Targeted therapies are more selective for specific molecular targets. Thus they are able to kill cancer cells with less damage to normal cells than with chemotherapy. Epidermal growth factor receptor (EGFR) is a transmembrane molecule that works through activation of intracellular tyrosine kinase (TK) to suppress cell proliferation and promote apoptosis of non-small cell lung cancer and some colorectal, head and neck, and metastatic breast cancers. Proteasome inhibitors promote accumulation of proteins that promote tumor cell death for multiple myeloma. BCR-ABL tyrosine kinase inhibitors target specific oncogenes for chronic myeloid leukemia and some GI stromal tumors. CD20 monoclonal antibodies (MoAb) bind with CD20 antigen causing cytotoxicity in non-Hodgkin's lymphoma and chronic lymphocytic leukemia.

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate for the nurse to use to increase the patient's nutritional intake? A: Increase intake of liquids at mealtime to stimulate the appetite. B: Serve three large meals per day plus snacks between each meal. C: Avoid the use of liquid protein supplements to encourage eating at mealtime. D: Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

D The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.

The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? A. The medications the patient is taking B. The nutritional supplements that will help the patient C. How much time is needed to provide the patient's care D. The time the nurse spends at what distance from the patient

D The principles of ALARA (as low as reasonably achievable) and time, distance, and shielding are essential to maintain the nurse's safety when the patient is a source of internal radiation. The patient's medications, nutritional supplements, and time needed to complete care will not protect the nurse caring for a patient with brachytherapy for cervical cancer.

Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D. A.Risk for infection

D Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.

A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing intervention is a priority? A. Advise the patient to eat foods that are fatty, fried, or high in calories. B. Discuss the need for parenteral or enteral feedings with the physician. C. Advise the patient to drink nutritional supplement beverage at least three times per day. D. Advise patient to experiment with spices and seasonings to enhance the flavor of food.

D. Advise patient to experiment with spices and seasonings to enhance the flavor of food. Instruct the patient to experiment with spices and other seasoning agents in an attempt to mask taste alterations. Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste of certain meats and fish. Bacon bits, onion, and pieces of ham may enhance the taste of vegetables. Reference: 293

Trends in the incidence and death rates of cancer include which of the following facts? A. Lung cancer is the most common type of cancer in men. B. A higher percentage of women than men have lung cancer. C. Breast cancer is the leading cause of cancer death in women. D. African Americans have a higher death rate from cancer than whites.

D. African Americans have a higher death rate from cancer than whites. Cancer incidence and death rates are disproportionately higher among African Americans than whites and other minority groups.

What is the primary difference between benign and malignant neoplasms? A. Rate of cell proliferation B. Site of malignant tumor C. Requirements for cellular nutrients D. Characteristic of tissue invasiveness

D. Characteristic of tissue invasiveness The clinical staging classification system determines the anatomic extent of the malignant disease process by stages. The TNM classification system (Table 16-5) is used to determine the anatomic extent of the disease involvement according to three parameters: tumor size and invasiveness (T), presence or absence of regional spread to the lymph nodes (N), and metastasis to distant organ sites (M). Reference: 268-269

You give priority for obtaining a blood pressure in the patient receiving A. A colony-stimulating factor B. Monoclonal antibodies C. Erythropoietin D. Interferon

D. Interferon Tachycardia and orthostatic hypotension are also commonly reported. Interleukin-2 (IL-2) and monoclonal antibodies can cause capillary leak syndrome, which can result in pulmonary edema. Other toxic effects may involve the central nervous system (CNS), renal and hepatic systems, and cardiovascular system. These effects are found particularly with interferons and IL-2. Reference: 290

What is a characteristic of the stage of progression in the development of cancer? A. Oncogenic viral transformation of target cells B. A reversible steady growth facilitated by carcinogens C. A period of latency before clinical detection of cancer D. Proliferation of cancer cells in spite of host control mechanisms

D. Proliferation of cancer cells in spite of host control mechanisms Progression is the final stage of cancer. This stage is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (metastasis). Progression occurs as a result of the following characteristics of cancer cells: rapid proliferation, decreased cell adhesion, and production of metalloproteinase enzymes. Reference: 265

You are caring for a 59-year-old woman who had surgery 1 day earlier for removal of a suspected malignant abdominal mass and who is awaiting the pathology report. The patient is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to A. motivate change in unhealthy lifestyles. B. educate her about the seven warning signs of cancer. C. instruct her about healthy stress relief and coping practices. D. allow her to communicate about the meaning of this experience.

D. allow her to communicate about the meaning of this experience. While the patient is waiting for diagnostic study results, you should be available to actively listen to the patient's concerns and skilled in techniques that will engage her and the family members or significant others in a discussion about their cancer-related fears. Reference: 270