exam 3 - cancer

· ***As a shift leader making out patient assignments for the oncoming shift, how would you assign care of a patient that has had a sealed radiation source placed? o You decide to rotate staff and assign a nurse who has not provided care for the patient. o You decide to assign the same nurse who had the patient yesterday to continue providing quality care. o You decide to assign one nurse to care for all the patients undergoing sealed radiation therapy to provide continum of care. o None of the options are correct. Sealed radiation therapy has no special staffing restrictions.

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***The nurse is working on an oncology unit with a client who is currently receiving chemotherapy, and is finishing a bed bath. What is the priority? · Labeling and properly disposing of waste · Ensuring the IV pumps are plugged in to the wall to preserve battery life · Letting the family know they can come back in the room · Changing out the enteral feeding tubing

1 A client who is actively receiving chemotherapy must have bodily waste labeled appropriately and disposed of in a proper manner. The nurse must ensure that this is done as a part of client care. Most facilities require chemotherapy waste to be handled with specific gloves and trash bags.

The oncology nurse is caring for a client with leukemia. The nurse knows that the purpose of chemotherapy in this client is for which reason? · To wipe out the bone marrow completelyA client with a blood cancer such as leukemia receives chemotherapy to completely wipe out their bone marrow so that the bone marrow can be replaced with healthy bone marrow cells. · To eliminate cancer cells in the blood to prepare the client for targeted radiation therapy to the bone marrow · To catch the microscopic cancer cells that could have been missed during surgery · To reduce the size of the tumor

1 Leukemia is cancer of the body's blood-forming tissues, including the bone marrow and the lymphatic system. · Acute lymphocytic leukemia. (ALL) · Acute myeloid leukemia. (AML) · Chronic lymphocytic leukemia.(CLL) · Chronic myeloid leukemia. (CML) Survivorship is a mindset that clients begin the moment they receive a diagnosis of cancer. They have already been through a struggle, and they are considered a survivor from the beginning of their cancer journey.

A 29-year-old woman is being seen in the healthcare clinic after a diagnosis of stage 2 breast cancer. The nurse knows that women from which ethnic background are at increased risk of developing breast cancer? Select all that apply. · African American · Arab American · Caucasian · Pacific Islander · Eastern Indian

1, 3 Caucasian and African American women are at greater risk than other ethnic groups of developing this type of cancer

A nurse works on an interdisciplinary team to provide care for a client with lung cancer. The client is unable to effectively clear their airway. The nurse should ensure that which interdisciplinary team member is present to provide professional input? · The social worker · The respiratory therapist · The provider · The pharmacist

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· You are teaching a group of new nurse graduates hired on your oncology unit about oncological disorders. Which statement by a nursing graduate about Hodgkin's Disease require re-education?* o A positive CT scan of liver and spleen presents. o This disease always presents with hallmark signs of bone pain in the ribs, spine, and pelvis. o Reed Stenberg cells are present in the nodes. o A positive biopsy of the lymph nodes with cervical nodes most often affected.

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***Nausea and vomiting is an expected side effect of chemotherapeutic drug use. Which of the following drug should be administered to a client on chemotherapy to prevent nausea and vomiting? A Metochlopramide (Metozol) B Succimer (Chemet) C Anastrazole (Arimidex) D Busulfan (Myleran)

A Metochlopramide (Metozol) - antiemetic. Succimer (Chemet) - chelating agent for lead poisoning. Anastrazole (Arimidex) - hormone regulator. Busulfan (Myleran) - alkylating agent

A client taking a chemotherapeutic agent understands the effects of therapy by stating: A "I will avoid eating hot and spicy foods." B "I should stay in my room all the time." C "I should limit my fluid intake to about 500 ml per day." D "I should notify the physician immediately if a urine color change is observed."

A The client should prevent hot and spicy food because of the stomatitis side effect. The client should avoid people with infection but should not isolate himself in his room all the time. Fluid intake should be increased. Urine color change is normal.

The nurse is preparing Cyclophosphamide (Cytoxan). Safe handling of the drug should be implemented to protect the nurse from injury. Which of the following action by the nurse should be corrected? A The nurse should wear mask and gloves. B Air bubbles should be expelled on wet cotton. C Label the hanging IV bottle with "ANTINEOPLASTIC CHEMOTHERAPY" sign. D Vent vials after mixing.

A The nurse should be corrected if she is only wearing mask and glove because gowns should also be worn in handling chemotherapeutic drugs. The vials should be vent after mixing to reduce the internal pressure. Air bubbles are expelled on wet cotton to prevent the spread of the chemotherapeutic agent particles.

8. The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective? A. Fresh fruit salad B. Orange sherbet C. Strawberry yogurt D. French fries

ANS C Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Orange sherbet is lower in fat and protein than yogurt. French fries are high in calories from fat but low in protein.

***6. Which of the following foods should a client with leukemia avoid? a. White bread b. Carrot sticks c. Stewed apples d. Medium rare steak

ANSWER B. A low-bacteria diet would be indicated with excludes raw fruits and vegetables.

***8. Which of the following clients is most at risk for developing multiple myeloma? a. A 20-year-old Asian woman b. A 30-year-old White man c. A 50-year-old Hispanic woman d. A 60-year-old Black man

ANSWER D. Multiple myeloma is more common in middle-aged and older clients (the median age at diagnosis is 60 years) and is twice as common in Blacks as Whites. It occurs most often in Black men.

A client had undergone radiation therapy (external). The expected side effects include the following apart from: A Hair loss B Ulceration of oral mucous membranes C Constipation D Headache

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Anastrozole (Arimidex)

advanced prostate carcinoma

myeloma

blood cancer, malignancy of the plasma cells most prominent sign of cancer is bone pain

protect heart against side effects of dysrhythmia

calcium and potassium (calcium gluconate)

kidney electrolytes

calcium, phosphate -prevent against metabolic acidosis (calcium and bicarb)

cortisone

can cause hyperglycemia, cushings, hypertension, electrolyte disturbances

which type of leukemia is more common in children vs adults

children ALL, AML adults get AML, CLL

hodgkins disease

classified as a lymphoma & blood cancer. cancer of lymphatic system all the blood cells decrease (pancytropenia) -As the cancer progresses, it limits the body's ability to fight infection. -Lymph nodes in the neck, armpits, or groin may swell. Fatigue, fever, and chills are some symptoms. -Treatments include chemotherapy, radiation, and in rare cases stem-cell transplant.

modified radical

don't remove axillary nodes, -complication of lymphedema is less likely here --always try to keep the axillary nodes bc of this

non-hodgkin's disease

reed sternberg (coloring of the cells - red) -The condition occurs when the body produces too many abnormal lymphocytes, a type of white blood cell. -Symptoms include swollen lymph nodes, fever, belly pain, or chest pain. -Treatments may include chemotherapy, radiation therapy, stem-cell transplant, or medications.

nadir

when everything is very low -lowest point

· A patient who has underwent a bone marrow transplant is at most risk for what?* o Bleeding and infection o Liver failure o HIV o Congestive heart failure

1 Patients who have underwent a bone marrow transplant are at major risk for bleeding and infection. The bone marrow is responsible for producing infection and bleeding fighting agents such as WBCs and platelets. Therefore, when a patient receives this from a donor it takes time for the body to build up normal levels.

***A client is taking Cyclophosphamide (Cytoxan) for the treatment of lymphoma. The nurse is very cautious in administering the medication because this drug poses the fatal side effect of: A Alopecia B Myeloma C CNS toxicity D Hemorrhagic cystitis

D Hemorrhagic cystitis is the potentially fatal side effect of Cytoxan. Myeloma is an indication for giving this medication. Alopecia is a common side effect (check urine for blood).

· As an oncological nurse, you know what finding is correct regarding breast cancer?* o Nipple retraction is never present. o Women who've had a late menarche and early menopause are at risk for breast cancer. o The mass is typically painful and red. o Masses are usually felt in the upper outer quadrant beneath the nipple or axilla.

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· Which patient is at highest risk for cervical cancer?* o A 60 year old with a history of syphillis and cigarette smoking. o A 32 year old in a monogamous relationship who declined the HPV vaccine. o None of the patients are at risk for cervical cancer. o A 21 year old who reports first sexual partner at the age of 14 and that she has had at least 10 sex partners

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9. Which of the following substances has abnormal values early in the course of multiple myeloma (MM)? a. Immunoglobulins b. Platelets c. Red blood cells d. White blood cells

ANSWER A. MM is characterized by malignant plasma cells that produce an increased amount of immunoglobin that isn't functional. As more malignant plasma cells are produced, there's less space in the bone marrow for RBC production. In late stages, platelets and WBC's are reduced as the bone marrow is infiltrated by malignant plasma cells.

Allogeneic HSCT

Allogeneic HSCT requires a donor to supply suitable stem cells. Doctors performing this type of HSCT need to ensure that the donor is an appropriate match for a recipient. Often, this is a close relative, although other donors, matched through tissue typing, are also used.

Which best describes the development of cachexia in a client with stomach cancer? · Wasting of fat and muscle tissue · Abdominal swelling because of fluid shifts due to protein energy malnutrition · The need for total parenteral nutrition because of vitamin deficiencies · Purposeful withholding of food and fluid intake by the client

1 · Cachexia is a term used to describe wasting of adipose and muscle tissue in a client with severe illness such as cancer. A client with cachexia may lose up to 20 percent of original body weight and may appear withdrawn and emaciated. It is caused by an increase in metabolic activity in the body as a result of the illness and not necessarily because of decreased food or fluid intake. · Abdominal swelling because of fluid shifts due to protein energy malnutrition This is called "kwashiorkor" in children with malnutrition. Children who have a shortage of all food, develops "marasmus" - deficiency of protein, carbs and fat

· A patient with leukemia is entering the period known as "the nadir". As the nurse, you know the following about this period:* o The patient is at greatest risk for blood clots and the patient may experience a platelet count of 500,000 or more. o The patient is at greatest risk for bleeding and the patient can experience a platelet count of 50,000 or less during this period. o The patient will need to be placed in reverse isolation due to low WBC count. o The patient is at risk for elevated hgb and hct, therefore, are at risk for stroke.

2 o During this period, bone marrow suppression is the greatest, therefore, the platelet count may be extremely low. This is the nadir period.

· You are developing a plan of care for a patient with multiple myeloma. What nursing intervention(s) would be included in their plan of care?* o Assist with coughing and deep breathing exercises. o Encourage at least 2 Liters of fluids per day and skeletal support during moving. o Apply antiembolic stockings as prescribed. o Discuss infertility issues with the patient.

2 o Multiple myeloma is proliferation of plasma cells. This causes increased uric acid and calcium levels. This, therefore, increases the patient's risk for renal failure and bone problems. Encourage fluids to keep the kidneys "flushed" and skeletal support for the bones helps with further complications.

***The new graduate nurse on a surgical oncology floor is reviewing osteosarcoma signs and symptoms. Which of the following findings does the nurse review that can be seen in a client with osteosarcoma? Select all that apply. · Increased range of motion · Palpable mass · Gait disturbance · Localized acute pain · Increased appetite

2, 4 Osteosarcoma is a type of cancer that produces immature bone. It is the most common type of cancer that arises in bones, and it is usually found at the end of long bones, often around the knee. Most people diagnosed with osteosarcoma are under the age of 25, and it is thought to occur more often in males than females. · Bone pain or tenderness. · A mass (tumor) that can be felt through the skin. · Swelling and redness at the site of the tumor. · Increased pain with lifting (if it affects an arm). · Limping (if it affects a leg). · Limited movement (if it affects a joint). · A carcinoma forms in the skin or tissue cells that line the body's internal organs, such as the kidneys and liver. A sarcoma grows in the body's connective tissue cells, which include fat, blood vessels, nerves, bones, muscles, deep skin tissues and cartilage

· A 28 year old female patient asks you when it is best to perform a self breast exam. Your response is the following:* o It is best to perform a self breast exam on the same time every month of the day. o It is best to perform a self breast exam on the day after ovulation. o It is best to perform a self breast exam 7 to 10 days after menses. o It is best to perform a self breast exam every 6 months on the 1st day of bleeding.

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· On assessment of a patient with leukemia, how would the patient present clinically?* o Normal hgb and hct, normal platelets, and increased WBCs. o Decreased hgb and hct, increased platelets, and elevated WBCs. o Decreased hgb and hct, decreased platelets, and elevated or normal WBCs with enlarged lymph nodes. o Elevated hgb and hct, decreased platelets, decreased WBCs, and bradycardia.

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· You are educating a group of young men on preventing testicular cancer. What is a correct statement by a participant regarding a testicular exam?* o "The testicle should feel hard but firm." o "I perform a self testicular exam once every 6 months." o "The best time to perform a self exam is after a shower." o "The testicle may have minor lumps or swelling due to monthly hormonal changes."

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***Which of the following drugs is an example of an antitumor antibiotic that may be given to a client with cancer? · Ampicillin · Gentamicin · Bleomycin · Tetracycline

3 · Bleomycin is medication known as an anti-tumor antibiotic given to clients with cancer as a form of treatment. It is a chemotherapy agent that differs from standard antibiotics in that it interferes with the DNA of the cancer cells, which stops the cancer from growing and spreading in the body. Bleomycin is given as an IM injection or intravenously, once or twice a week.

A client who has recovered from cancer surgery requires lymphedema therapy. Which best describes an activity that would occur with this type of therapy? · Cognitive-behavioral therapy · Pain medication administration · Compression garment wear · Upper arm strengthening

3 · Lymphedema is the swelling that sometimes occurs following certain types of surgery. It most often develops in the groin, arms, legs, or neck. Compression garments are used to control edema and fluid, and to promote venous return of blood to the heart. Compression garments are typically fitted by a professional who can educate the client about their use. Lymphedema occurs when the lymph system is damaged or blocked. Fluid builds up in soft body tissues and causes swelling. It is a common problem that may be caused by cancer and cancer treatment. Over time, lymphedema (especially if poorly treated) often results in number of complications including infections, disfigurement, pain, and disability.

A client who has smoked cigarettes for 30 years is discussing health issues with a nurse. The nurse is advising the client about how quitting smoking can reduce the risk of certain types of cancer. Smoking is related to an increased risk of which of the following types of cancer? · Bone cancer · Prostate cancer · Leukemia · Stomach cancer

4 · Smoking is associated with a number of different health problems. Most clients who smoke are aware of the many health issues caused by the toxins found in cigarette smoke. However, smoking is associated with several types of cancer about which the client may not be aware. In addition to a link with lung cancer, smoking may also increase the risk of stomach cancer, pancreatic cancer, liver cancer, and kidney cancer.

11. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia.Which observation by the RN caring for the patient indicates that the nurse should take action? A. The patient's visitors bring in some fresh peaches from home. B. The patient ambulates several times a day in the room. C. The patient uses soap and shampoo to shower every other day. D. The patient cleans with a warm washcloth after having a stool.

ANS A Fresh, thinned-skin peaches are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help to prevent perineal skin breakdown and infection.

14. When assessing a patient's needs for psychologic support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information? A. "Can you tell me what has been helpful to you in the past when coping with stressful events?" B. "How long ago were you diagnosed with this cancer?" C. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?" D. "How do you feel about having a possibly terminal illness?"

ANS A Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient's need for support. The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. The patient with stage I cancer is not considered to have a terminal illness at this time, and this question is likely to worry the patient unnecessarily.

2. A 40-year-old divorced mother of four school-age children is hospitalized with metastatic cancer of the ovary. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is A. "Why don't we talk about the options you have for the care of your children?" B. "Many patients with cancer live for a long time, so there is time to plan for your children." C. "For now you need to concentrate on getting well, not worry about your children." D. "Perhaps your ex-husband will take the children when you can't care for them."

ANS A This response expresses the nurse's willingness to listen and recognizes the patient's concern. The responses beginning "Many patients with cancer live for a long time" and "For now you need to concentrate on getting well" close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient's ex-husband will take the children, more assessment information is needed before making plans.

12. Which action by a nursing assistant (NA) when caring for a patient who is pancytopenic indicates a need for the nurse to intervene? A. The NA assists the patient to use dental floss after eating. B. The NA makes an oral rinse using 1 teaspoon of salt in a liter of water. C. The NA adds baking soda to the patient's saline oral rinses. D. The NA puts fluoride toothpaste on the patient's toothbrush.

ANS A Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient. Pancytopenia is a condition in which a person's body has too few red blood cells, white blood cells, and platelets.

***7. A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not responded to chemotherapy. In discussing the treatment with the patient, the nurse explains that A. hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT). B. the transplant of the donated cells is painful because of the nerves in the tissue lining the bone. C. donor bone marrow cells are transplanted immediately after an infusion of chemotherapy. D. the transplant procedure takes place in a sterile operating room to minimize the risk for infection.

ANS A The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to the transplanted cells by the chemotherapy drugs.

5. The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient may indicate a need for a change in treatment? A. "I have frequent muscle aches and pains." B. "I rarely have the energy to get out of bed." C. "I take acetaminophen (Tylenol) every 4 hours." D. "I experience chills after I inject the interferon."

ANS B Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use Tylenol every 4 hours. interferon is a genetically produced version of the natural body protein for use as a drug that stimulates the body's immune system to find and kill CANCER cells. It is also used to treat virus infections (e.g., chronic hepatitis B, chronic hepatitis C, condylomata acuminata).

***4. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is to A. protect normal kidney cells from the damaging effects of chemotherapy. B. enhance the patient's immunologic response to tumor cells. C. stimulate malignant cells in the resting phase to enter mitosis. D. prevent the bone marrow depression caused by chemotherapy.

ANS B IL-2 enhances the ability of the patient's own immune response to suppress tumor cells. IL-2 does not protect normal cells from damage caused by chemotherapy, stimulate malignant cells to enter mitosis, or prevent bone marrow depression. In neoadjuvant (also called preoperative or primary) chemotherapy, drug treatment takes place before surgical extraction of a tumor. This is in contrast with adjuvant chemotherapy, which is drug treatment after surgery. Oncologists administer neoadjuvant therapy with the objective of reducing tumor size.

6. Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider? A. Hemoglobin of 10 g/L B. WBC count of 1700/µl C. Platelets of 65,000/µl D. Serum creatinine level of 1.2 mg/dl

ANS B Neutropenia places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that white blood cell (WBC) growth factors such as filgrastim (Neupogen) are needed. The other laboratory data do not indicate any immediate life-threatening adverse effects of the chemotherapy. Neupogen can be given IV or SC.

9. The nurse has identified the nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation in a patient with lung cancer who has had a 10% loss in weight. An appropriate nursing intervention that addresses the etiology of this problem is to A. provide foods that are highly spiced to stimulate the taste buds. B. avoid presenting foods for which the patient has a strong dislike. C. add strained baby meats to foods such as soups and casseroles. D. teach the patient to eat whatever is nutritious since food is tasteless.

ANS B The patient will eat more if disliked foods are avoided and foods that patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding baby meats to foods will increase calorie and protein levels, but does not address the issue of taste. Patients will not improve intake by eating foods that are beneficial but have unpleasant taste.

10. After the nurse has explained the purpose of and schedule for chemotherapy to a 23-year-old patient who recently received a diagnosis of acute leukemia, the patient asks the nurse to repeat the information. Based on this assessment, which nursing diagnosis is most likely for the patient? A. Acute confusion related to infiltration of leukemia cells into the central nervous system B. Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment C. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis D. Risk for ineffective adherence to treatment related to denial of need for chemotherapy

ANS C The patient who has a new cancer diagnosis is likely to have high anxiety, which may impact learning and require that the nurse repeat and reinforce information. The patient's history of a recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the confusion. The patient asks for the information to be repeated, indicating that lack of interest in learning and denial are not etiologic factors.

***13. A with tumor lysis syndrome (TLS) is taking allopurinol (Zyloprim). Which laboratory value should the nurse monitor to determine the effectiveness of the medication? A. Blood urea nitrogen (BUN) B. Serum phosphate C. Serum potassium D. Uric acid level

ANS D Allopurinol is used to decrease uric acid levels. BUN, potassium, and phosphate levels are also increased in TLS but are not affected by allopurinol therapy.

3. A patient who has terminal cancer of the liver and is cared for by family members at home tells the nurse, "I have intense pain most of the time now." The nurse recognizes that teaching regarding pain management has been effective when the patient A. uses the ordered opioid pain medication whenever the pain is greater than 5 on a 10-point scale. B. states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief. C. agrees to take the medications by the IV route to improve effectiveness. D. takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.

ANS D For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain. Taking the medications only when pain reaches a certain level does not provide effective pain control. Although nonopioid analgesics may also be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved. The IV route is not more effective than the oral route and the oral route is preferred.

15. A 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg) tells the nurse that she has a glass of wine two or three times a week. The patient works for the post office and has a 5-mile mail-delivery route. This is her first contact with the health care system in 20 years. Which of these topics will the nurse plan to include in patient teaching about cancer? (Select all that apply.) A. Alcohol use B. Physical activity C. Body weight D. Colorectal screening E. Tobacco use F. Mammography G. Pap testing H. Sunscreen use

ANS D, F, G, H The patient's age, gender, and history indicate a need for teaching about or screening or both for colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use excessive alcohol or tobacco, she is physically active, and her body weight is healthy.

***10. For which of the following conditions is a client with multiple myeloma (MM) monitored? * a. Hypercalcemia b. Hyperkalemia c. Hypernatremia d. Hypermagnesemia

ANSWER A. Calcium is released when the bone is destroyed. This causes an increase in serum calcium levels. MM doesn't affect potassium, sodium, or magnesium levels.

15. A centrally located tumor would produce which of the following symptoms? a. Coughing b. Hemoptysis c. Pleuritic pain d. Shoulder pain

ANSWER A. Centrally located pulmonary tumors are found in the upper airway (vocal cords) and usually obstruct airflow, producing such symptoms as coughing, wheezing, and stridor. Small cell tumors tend to be located in the lower airways and often cause hemoptysis. As the tumor invades the pleural space, it may cause pleuritic pain. Pancoast tumors that occur in the apices may cause shoulder pain.

16. Which of the following interventions is the key to increasing the survival rates of clients with lung cancer? a. Early bronchoscopy b. Early detection c. High-dose chemotherapy d. Smoking cessation

ANSWER B. Early detection of cancer when the cells may be premalignant and potentially curable would be most beneficial. However, a tumor must be 1 cm in diameter before it's detectable on a chest x-ray, so this is difficult. A bronchoscopy may help identify cell type but may not increase survival rate. High-dose chemotherapy has minimal effect on long-term survival. Smoking cessation won't reverse the process but may help prevent further decompensation.

19. Which of the following is the primary goal for surgical resection of lung cancer? a. To remove the tumor and all surrounding tissue. b. To remove the tumor and as little surrounding tissue as possible. c. To remove all of the tumor and any collapsed alveoli in the same region. d. To remove as much as the tumor as possible, without removing any alveoli.

ANSWER B. The goal of surgical resection is to remove the lung tissue that has a tumor in it while saving as much surrounding tissue as possible. It may be necessary to remove alveoli and bronchioles, but care is taken to make sure only what's absolutely necessary is removed.

17. A client has been diagnosed with lung cancer and requires a wedge resection. How much of the lung is removed? a. One entire lung b. A lobe of the lung c. A small, localized area near the surface of the lung. d. A segment of the lung, including a bronchiole and its alveoli.

ANSWER C. A small area of tissue close to the surface of the lung is removed in a wedge resection. An entire lung is removed in a pneumonectomy. A segment of the lung is removed in a segmental resection and a lobe is removed in a lobectomy.

13. The client with which of the following types of lung cancer has the best prognosis? a. Adenocarcinoma b. Oat cell c. Squamous cell d. Small cell

ANSWER C. Squamous cell carcinoma is a slow-growing, rarely metastasizing type of cancer. Adenocarcinoma is the next best lung cancer to have in terms of prognosis. Oat cell and small cell carcinoma are the same. Small cell carcinoma grows rapidly and is quick to metastasize.

4. According to a standard staging classification of Hodgkin's disease, which of the following criteria reflects stage II? a. Involvement of extralymphatic organs or tissues b. Involvement of single lymph node region or structure c. Involvement of two or more lymph node regions or structures. d. Involvement of lymph node regions or structures on both sides of the diaphragm.

ANSWER C. Stage II involves two or more lymph node regions. Stage I only involves one lymph node region; stage III involves nodes on both sides of the diaphragm; and stage IV involves extralymphatic organs or tissues.

5. Which of the following statements is correct about the rate of cell growth in relation to chemotherapy? a. Faster growing cells are less susceptible to chemotherapy. b. Non-dividing cells are more susceptible to chemotherapy c. Faster growing cells are more susceptible to chemotherapy d. Slower growing cells are more susceptible to chemotherapy.

ANSWER C. The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy. Slow-growing and non-dividing cells are less susceptible to chemotherapy. Repeated cycles of chemotherapy are used to destroy nondividing cells as they begin active cell division.

11. Giving instructions for breast self-examination is particularly important for clients with which of the following medical problems? a. Cervical dysplasia b. A dermoid cyst c. Endometrial polyps d. Ovarian cancer

ANSWER D. Clients with ovarian cancer are at increased risk for breast cancer. Breast self-examination supports early detection and treatment and is very important.

20. If the client with lung cancer also has preexisting pulmonary disease, which of the following statements best describes how the extent of that can be performed? a. It doesn't affect it. b. It may require a whole lung to be removed. c. The entire tumor may not be able to be removed d. It may prevent surgery if the client can't tolerate lung tissue removal.

ANSWER D. If the client's preexisting pulmonary disease is restrictive and advanced, it may be impossible to remove the tumor, and the client may have to be treated with on;t chemotherapy and radiation.

12. During a routine physical examination, a firm mass is palpated in the right breast of a 35-year-old woman. Which of the following findings or client history would suggest cancer of the breast as opposed to fibrocystic disease? a. History of early menarche b. Cyclic changes in mass size c. History of anovulatory cycles d. Increased vascularity of the breast

ANSWER D. Increase in breast size or vascularity is consistent with cancer of the breast. Early menarche as well as late menopause or a history of anovulatory cycles are associated with fibrocystic disease. Masses associated with fibrocystic disease of the breast are firm, most often located in the upper outer quadrant of the breast, and increase in size prior to menstruation. They may be bilateral in a mirror image and are typically well demarcated and freely moveable.

7. A client with leukemia has neutropenia. Which of the following functions must be frequently assessed? a. Blood pressure b. Bowel sounds c. Heart sounds d. Breath sounds

ANSWER D. Pneumonia, both viral and fungal, is a common cause of death in clients with neutropenia, so frequent assessment of respiratory rate and breath sounds is required. Although assessing blood pressure, bowel sounds, and heart sounds is important, it won't help detect pneumonia.

14. Warning signs and symptoms of lung cancer include persistent cough, bloody sputum, dyspnea, and which of the other following symptoms? a. Dizziness b. Generalized weakness c. Hypotension d. Recurrent pleural effusion

ANSWER D. Recurring episodes of pleural effusions can be caused by the tumor and should be investigated. Dizziness, generalized weakness, and hypotension aren't typically considered warning signals, but may occur in advanced stages of cancer.

18. When a client has a lobectomy, what fills the space where the lobe was? a. The space stays empty. b. The surgeon fills the space with gel c. The lung space fills up with serous fluid d. The remaining lobe or lobes overexpand to fill the space.

ANSWER D. The remaining lobe or lobes overexpand slightly to fill the space previously occupied by the removed tissue. The diaphragm is carried higher on the operative side to further reduce the empty space. The space can't remain "empty" because truly empty would imply a vacuum, which would interfere with the intrathoracic pressure changes that allow breathing. The surgeon doesn't use a gel to fill the space. Serous fluid overproduction would compress the remaining lobes, diminish their function and possibly, cause a mediastinal shift.

1. A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin's lymphoma. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the nurse to the patient's concerns is A. "Radiation does not cause the problems with sexual functioning that occur with chemotherapy or surgical procedures used to treat cancer." B. "It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children." C. "The radiation will make you sterile, but your ability to have sexual intercourse will not be changed by the treatment." D. "You may have some temporary impotence during the course of the radiation, but normal sexual function will return."

Answer: B. The impact on sperm count and erectile function depends on the patient's pretreatment status and on the amount of exposure to radiation. The patient should consider sperm donation before radiation. Radiation (like chemotherapy or surgery) may affect both sexual function and fertility either temporarily or permanently.

Autologous HSCT

Autologous HSCT avoids the issue of trying to find a matching donor because stem cells are harvested from the patients themselves. The cells are cleaned and frozen before being reintroduced to the individual after they receive the chemotherapy drugs.

***In staging and grading neoplasm TNM system is used. TNM stands for: A Time, neoplasm, mode of growth B Tumor, node, metastasis C Tumor, neoplasm, mode of growth D Time, node, metastasis

B

***A client is diagnosed with progressive prostate cancer. The nurse expects which drug is given? A Anstrazole (arimidex) B Estramustine (Emcyt) C Pclitaxel (Taxol) D Irinotecan (Camptosar)

B Anstrazole (arimidex)- treatment of advanced breast cancer in post menopausal women following tamoxifen therapy. Estramustine (Emcyt) - palliative treatment of metastatic and progressive prostate cancer. Pclitaxel (Taxol) - treatment of ovarian cancer, breast cancer and AIDS related to Kaposi's sarcoma. Irinotecan (Camptosar)- treatment of metastatic colon or rectal cancer after treatment with 5-FU.

A 25 year old patient is inquiring about the methods or ways to detect cancer earlier. The nurse least likely identify this method by stating: A Annual chest x-ray. B Annual Pap smear for sexually active women only. C Annual digital rectal examination for persons over age 40. D Yearly physical and blood examination

B Early detection of cancer is promoted by annual oral examination, monthly BSE from age 20, annual chest x-ray, yearly digital rectal examination for persons over age 40, annual Pap smear from age 40 and annual physical and blood examination. Letter B is wrong because it says Pap smear should be done yearly for sexually active women. All women should have an annual pap smear by age 40 and up whether sexually active or not.

Chemotherapeutic agents have different specific classifications. The following medications are antineoplastic antibiotics except: A Doxorubicin (Adriamycin) B Fluorouracil (Adrucil) C Mitoxantrone (Novantrone) D Bleomycin (Blenoxane)

B Fluorouracil (Adrucil) is an antimetabolite.

A client is diagnosed with breast cancer. The tumor size is up to 5 cm with axillary and neck lymph node involvement. The client is in what stage of breast cancer? A Stage I B Stage II C Stage III D Stage IV

B Stage I - tumor size up to 2 cm. Stage II - tumor size up to 5 cm with axillary and neck lymph node involvement. Stage III - tumor size is more than 5 cm with axillary and neck lymph node involvement. Stage IV - metastasis to distant organs (liver, lungs, bone and brain).

Breast self examination (BSE) is one of the ways to detect breast cancer earlier. The nurse is conducting a health teaching to female clients in a clinic. During evaluation the clients are asked to state what they learned. Which of the following statement made by a client needs further teaching about BSE? A "BSE is done after menstruation." B "BSE palpation is done by starting at the center going to the periphery in a circular motion." C "BSE can be done in either supine or standing position." D "BSE should start from age 20."

B This client needs further teaching as palpation in BSE should start at the periphery going to the center in a circular motion.

The following are teaching guidelines regarding radiation therapy except: A The therapy is painless B To promote safety, the client is assisted by therapy personnel while the machine is in operation. C The client may communicate all his concerns or needs or discomforts while the machine is operating. D Safety precautions are necessary only during the time of actual irradiation.

B To promote safety to the personnel, the client will remain alone in the treatment room while the machine is in operation. The client may voice out any concern throughout the treatment because a technologist is just outside the room observing through a window or closed circuit TV. There is no residual radioactivity after radiation therapy. Safety precautions are necessary only during the time of actual irradiation. The client may resume normal activities of daily living afterwards.

***Specific classification of the chemotherapeutic agent, Vincristine (Oncovin) is: A Hormone modulator B Mitotic inhibitor C Antineoplastic antibiotic D Antimetabolite

B Vincristine is a mitotic inhibitor

Surgical procedure to treat breast cancer involves the removal of the entire breast, pectoralis major muscle and the axillary lymph nodes is:* A Simple mastectomy B Modified radical mastectomy C Halstead Surgery D Radical mastectomy

B removal of the entire breast, pectoralis major muscle and the axillary lymph nodes is a surgical procedure called modified radical mastectomy. Simple mastectomy is the removal of the entire breast but the pectoralis muscles and nipples remain intact. Halstead surgery also called radical mastectomy involves the removal of entire breast, pectoralis major and minor muscles and neck lymph nodes. It is followed by skin grafting.

***Neoplasm can be classified as either benign or malignant. The following are characteristics of malignant tumor apart from: A Metastasis B Infiltrates surrounding tissues C Encapsulated D Poorly differentiated cells

C Benign: grows slowly, localized, encapsulated, well differentiated cells, no metastasis, not harmful to host. Malignant: Grows rapidly, infiltrates surrounding tissues, not encapsulated, poorly differentiated, metastasis present, always harmful

Radiation protection is very important to implement when performing nursing procedures. When the nurse is not performing any nursing procedures what distance should be maintained from the client? A 1 feet B 2 feet C 2.5 feet D 3 feet

D The distance of at least 3 feet / 0.9 or 1 meter should be maintained when a nurse is not performing any nursing procedures.

2. Which of the following laboratory values is expected for a client just diagnosed with chronic lymphocytic leukemia? a. Elevated sedimentation rateb. B. Uncontrolled proliferation of granulocytesc. C. Thrombocytopenia and increased lymphocytes d. Elevated aspartate aminotransferase and alanine aminotransferase levels.

C Chronic lymphocytic leukemia shows a proliferation of small abnormal mature B lymphocytes and decreased antibody response. Thrombocytopenia also is often present. Uncontrolled proliferation of granulocytes occurs in myelogenous leukemia.

***The classic symptoms that define breast cancer includes the following except: A "pink peel" skin B Solitary, irregularly shaped mass C Firm, nontender, nonmobile mass D Abnormal discharge from the nipple

C Classic symptoms that define breast cancer includes: Firm, nontender, nonmobile mass. Solitary, irregularly shaped mass. Adherence to muscle or skin causing dimpling effect. Involvement of the upper outer quadrant or central nipple portion. Asymmetry of the breasts. "Orange peel" skin. Retraction of nipple. Abnormal discharge from nipple.

***1. Which of the following conditions is not a complication of Hodgkin's disease? a. Anemia b.Infection c. Myocardial Infarction d. Nausea

C Complications of Hodgkin's are pancytopenia, nausea, and infection. Cardiac involvement usually doesn't occur.

Skin reactions are common in radiation therapy. Nursing responsibilities on promoting skin integrity should be promoted apart from: A Avoiding the use of ointments, powders and lotion to the area B Using soft cotton fabrics for clothing C Washing the area with a mild soap and water and patting it dry not rubbing it. D Avoiding direct sunshine or cold.

C No soap should be used on the skin of the client undergoing radiation. Soap and irritants and may cause dryness of the patient's skin. Only water should be used in washing the area.

Contact of client on radiation therapy should be limited only to how many minutes to promote safety of the therapy personnel? A 1 minute B 3 minutes C 5 minutes D 10 minutes

C Principles of Radiation protection follows the DTS system. Distance (D), Time (T) and Shielding (S). Distance - at least 3 feet should be maintained when a nurse is not performing any nursing procedures. Time - limit contact to 5 minutes each time. Shielding - use lead shield during contact with client.

Nurse Janet is assigned in the oncology section of the hospital. Which of the following orders should the nurse question if a client is on radiation therapy? A Analgesics before meals B Saline rinses every 2 hours C Aspirin every 4 hours D Bland diet

C Radiation therapy makes the platelet count decrease. Thus, nursing responsibilities should be directed at promoting safety by avoiding episodes of hemorrhage or bleeding such as physical trauma and aspirin administration. Analgesics are given before meals to alleviate the pain caused by stomatitis. Bland diet and saline rinses every 2 hours should also be done to manage stomatitis.

***To provide relief from the cytarabine syndrome, which drug is given? A Analgesic B Aspirin C Steroids D Allopurinol

C Steroids may be prescribed to promote relief from cytarabine syndrome. Allopurinol is given for hyperurecemia that will result from taking some chemotherapeutic agent.

3. At the time of diagnosis of Hodgkin's lymphoma, which of the following areas is often involved? a. Back b. Chest c. Groind. d. Neck

D At the time of diagnosis, a painless cervical lesion is often present. The back, chest, and groin areas aren't involved.

Chemotherapy is one of the therapeutic modalities for cancer. This treatment is contraindicated to which of the following conditions? A Recent surgery B Pregnancy C Bone marrow depression D All of the above

D Chemotherapy is contraindicated in cases of infection (chemotherapeutic agents are immunosuppressive), recent surgery (chemotherapeutic agent may retard the healing process), impaired renal and hepatic function (drugs are nephrotoxic and hepatotoxic), recent radiation therapy (immunosuppressive treatment), pregnancy (drugs can cause congenital defects) and bone marrow depression (chemo. Agents may aggravate the condition).

***Cytarabine (Ara-C) is an antimetabolite that can cause a common cytarabine syndrome which includes the following apart from: A Fever B Myalgia C Chest pain D Diarrhea

D Cytarabine syndrome includes fever, myalgia, bone pain, chest pain, rash, conjunctivitis and malaise. No diarrhea is included in this syndrome thus; letter D is the best choice (common for cancer pain, steroids are common for this pt).

***The removal of entire breast, pectoralis major and minor muscles and neck lymph nodes which is followed by skin grafting is a procedure called:* A Simple mastectomy B Modified radical mastectomy C Radiation therapy D Radical mastectomy

D Halstead surgery also called radical mastectomy involves the removal of entire breast, pectoralis major and minor muscles and neck lymph nodes. It is followed by skin grafting. Removal of the entire breast, pectoralis major muscle and the axillary lymph nodes is a surgical procedure called modified radical mastectomy. Simple mastectomy is the removal of the entire breast but the pectoralis muscles and nipples remain intact.

On a clinic visit a client who has a relative with cancer, is asking about the warning signs that may relate to cancer. The nurse correctly identifies the warning signs of cancer by responding: A "If a sore healing took a month or more to heal, cancer should be suspected." B "Presence of dry cough is one of the warning signs of cancer." C "A lump located only in the breast area may suggest the presence of cancer." D "Sudden weight loss of unexplained etiology can be a warning sign of cancer."

D Unexplained sudden weight loss is a warning signal of cancer. Letter A is wrong because the sore in cancer does not heal. Nagging cough not dry cough and hoarseness of voice is a sign of cancer. Presence of lump is not limited to the breast only; it can grow elsewhere that is why letter C is wrong.

Tumor lysis syndrome (TLS)

is a condition that occurs when a large number of cancer cells die within a short period, releasing their contents in to the blood. ... When cancer cells break down quickly in the body, levels of uric acid, potassium, and phosphorus rise faster than the kidneys can remove them. Clinically, the syndrome is characterized by rapid development of hyperuricemia,hyperkalemia, hyperphosphatemia, hypocalcemia, and acute kidney injury.