Med Surg Chapter 15: Cancer Study Questions, Lewis Chapter 15 Cancer, Chapter 15: Cancer

Stage II

Limited local spread

What is the difference between initiation and promotion

activity of promoters is reversible

Stage III

extensive local and regional spread

define oncogenes

tumor inducing genes

Define immunologic escape

the process by which cancer cells evade the immune system

What is the goal of cancer?

cure, control and palliation

What is simulation

a process by which the radiation treatment fields are defined, filmed and marked out on the skin

For which type of malignancy should the nurse expect the use of the intravesical route of regional chemotherapy delivery? a. Bladder b. Leukemia c. Osteogenic sarcoma d. Metastasis to the brain

a. Bladder

Incisional biopsy

may be performed with a scalpel or dermal punch

What are the delayed effects of chemo

nausea, vomiting, mucositis, alopecia, skin rashes, bone marrow suppression, altered bowel function and a variety of cumulative neurotoxicities

True or False: Teletherapy is used in Internal radiation

False: external radiation

Name some palliative care measures

1. debulking of the tumor to relieve pain or pressure 2. Colostomy for the relief of a bowel obstruction 3. Laminectomy for the relief of a spinal cord compression

The nurse is caring for a 59- year old woman who had surgery 1 day ago for removal of a malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says she is scared to die. The MOST effective nursing intervention is A. motivate change in unhealthy lifestyle B. teach her about the seven warning signs of cancer C. instruct her about healthy stress relief and coping practices D. let her communicate about the meaning of this experience

ANS: D While the patient is waiting for diagnostic study results, you should be available to actively listen to the patient's concerns, and you should be skilled in techniques that can engage the patient and the family members or significant others in a discussion about their cancer-related fears.

Grade II

Cells are more abnormal and moderately differentiated (moderate dysplasia and intermediate grade)

Burkitt's lymphoma is associated with what?

Epstein-Barr visrus

A patient with a genetic mutation of BRCA1 and a family history of breast cancer is admitted to the surgical unit where she is scheduled that day for a bilateral simple mastectomy. What is the reason for this procedure? a. Prevent breast cancer b. Diagnose breast cancer c. Cure or control breast cancer d. Provide palliative care for untreated breast cancer

a. Prevent breast cancer

The nurse is presenting a community education program related to cancer prevention. Based on current cancer death rate, the nurse emphasizes what as the most important preventative action for both women and men? a. Smoking cessation b. Routine colonoscopies c. Frequent imaging tests d. Regular examination of reproductive organs

a. Smoking cessation

The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect? a. Nausea b. Alopecia c. Hematuria d. Xerostomia

c. Hematuria The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy.

Which delivery system would be used to deliver regional chemotherapy for metastasis from a primary colorectal cancer? a. Intrathecal b. Intraarterial c. Intravenous d. Intraperitoneal

d. Intraperitoneal

What factor differentiates a malignant tumor from a benign tumor? a. It causes death b. it grows at a faster rate c. It is often encapsulated d. It invades and metastasizes

d. it invades and metastasizes

Excisional biopsy

involves the surgical removal of the entire lesion, lymph node, nodule or mass

Which mutated tumor suppressor gene is most likely to contribute to many types of cancer, including bladder, breast, colorectal and lung? a. p53 b. APC c. BRCA1 D. BRCA2

a. p53

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

ANS:A Patients experiencing diarrhea secondary to chemotherapy 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.

What can be used to minimize the requirements for opioids and treat unrelieved pain

Nerve blocks or epidural or intrathecal analgesia

What do B cells produce?

They can produce specific antibodies that bind to tumor cells. They can be detected in the serum and saliva

True or False: under most circumstances, immune surveillance prevents these transformed cells from developing into clinically detectable tumors

True

Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient? a. IL-2 enhances the body's immunologic response to tumor cells. b. IL-2 prevents bone marrow depression caused by chemotherapy. c. IL-2 protects normal cells from harmful effects of chemotherapy. d. IL-2 stimulates cancer cells in their resting phase to enter mitosis.

a. IL-2 enhances the body's immunologic response to tumor cells. 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 cancer cells to enter mitosis, or prevent bone marrow depression.

Which condition would be most likely to be cured with chemotherapy as a treatment measure? a. Neuroblastoma b. Small cell lung cancer c. Small tumor of the bone d. Large hepatocellular carcinoma

a. Neuroblastoma

What does chronic toxicities involve?

damage to the organs such as heart, liver, kidneys and lungs

Name some promoting factors

dietary fat, obesity, cigarette smoking, and alcohol consumption

True or False, Cancer cells proliferate at the same rate as the normal cells of the tissue form which they arise

true

Stage 1

tumor limited to the tissue of origin; localized tumor growth

A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan? (Select all that apply.) a. Cook food thoroughly before eating. b. Choose low fiber, low residue foods. c. Avoid public transportation such as buses. d. Use rectal suppositories if needed for constipation. e. Talk to the oncologist before having any dental work.

A, C, E Eating only cooked food and avoiding public transportation will decrease infection risk. A high-fiber diet is recommended for neutropenic patients to decrease constipation. Because bacteria may enter the circulation during dental work or oral surgery, the patient may need to postpone dental work or take antibiotics.

A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. Which patient statement indicates that the nurses teaching about management of the skin reaction has been effective? a. I can buy some aloe vera gel to use on the area. b. I will expose the treatment area to a sun lamp daily. c. I can use ice packs to relieve itching in the treatment area. d. I will scrub the area with warm water to remove the scales.

ANS: A Aloe vera gel and cream may be used on the radiated skin area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.

A 70-year old male patient 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 complications of cacner is this MOST likely caused by? A. Hypercalcemia B. Tumor lysis syndrome C. Spinal cord compression D. Superior vena cava syndrome.

ANS: A 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.

The nurse explains to a patient undergoing brachytherapy of the cervix that she A. must undergo simulation to locate the treatment area B. requires the use of radioactive precautions during nursing care C. may experience desquamation of the skin on the abdomen and upper legs D. requires shielding of the ovaries during treatment to prevent ovarian damage.

ANS: B Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or adjacent to the tumor. Caring for the person undergoing brachytherapy or receiving radiopharmaceuticals requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, and shielding are vital to health care professional safety in caring for the person with an internal radiation source.

To prevent fever and shivering during an infusion of rituximab (Rituxan) , the nurse should premedicate the patient with A. aspirin B. acetaminophen C. sodium bicarbonate D. meperidine (Demerol)

ANS: B Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is commonly premedicated with acetaminophen in an attempt to prevent or decrease the intensity of these symptoms, and large amounts of fluids help decrease symptoms.

Which statement by the nurse most facilitates patient cancer prevention during the promotion stage of cancer development? A "Exercise every day for 30 minutes." B "Follow smoking cessation recommendations." C "Following a vitamin regime is highly recommended." D "I recommend excision of the cancer as soon as possible."

ANS: 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. Cigarette smoking is a promoting factor and a carcinogen. 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 consistent with the nurse's role.

Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates that the nurses teaching about the purpose of the biopsy has been effective? a. The biopsy will remove the cancer in my prostate gland. b. The biopsy will determine how much longer I have to live. c. The biopsy will help decide the treatment for my enlarged prostate. d. The biopsy will indicate whether the cancer has spread to other organs.

ANS: C A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed. Biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patients life; the three remaining statements indicate a need for patient teaching.

A 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.

ANS: 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 nurse in the outpatient clinic is caring for a 50-year-old who smokes heavily. To reduce the patients risk of dying from lung cancer, which action will be best for the nurse to take? a. Educate the patient about the seven warning signs of cancer. b. Plan to monitor the patients carcinoembryonic antigen (CEA) level. c. Discuss the risks associated with cigarettes during every patient encounter. d. Teach the patient about the use of annual chest x-rays for lung cancer screening.

ANS: C Education about the risks associated with cigarette smoking is recommended at every patient encounter, since cigarette smoking is associated with multiple health problems. A tumor must be at least 0.5 cm large before it is detectable by current screening methods and may already have metastasized by that time. Oncofetal antigens such as CEA may be used to monitor therapy or detect tumor reoccurrence, but are not helpful in screening for cancer. The seven warning signs of cancer are actually associated with fairly advanced disease.

A patient who has severe pain associated with terminal liver cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective? a. The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness. b. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale). c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. d. The patient states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief.

ANS: C 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 also may 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.

During a routine health examination, a 30-year-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Educate the patient about the need for a colonoscopy at age 50. b. Teach the patient how to do home testing for fecal occult blood. c. Obtain more information from the patient about the family history. d. Schedule a sigmoidoscopy to provide baseline data about the patient.

ANS: C The patient may be at increased risk for colon cancer, but the nurses first action should be further assessment. The other actions may be appropriate, depending on the information that is obtained from the patient with further questioning.

A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action is most appropriate? a. Add strained baby meats to foods such as casseroles. b. Teach the patient about foods that are high in nutrition. c. Avoid giving the patient foods that are strongly disliked. d. Put extra spice in the foods that are served to the patient.

ANS: C The patient will eat more if disliked foods are avoided and foods that the 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. The patients poor intake is not caused by a lack of information about nutrition.

The patient is receiving immunotherapy 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)

ANS: 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 is not used first to combat flu-like symptoms of headache, fever, chills, myalgias, and so on.

A 70-yr-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 6 lb B Nausea and vomiting C Urine specific gravity of 1.004 D Serum sodium level of 118 mEq/L

ANS: 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. The other options listed are also symptoms of hyponatremia but are not as critical to report to the health care provider.

. A patient is receiving intravesical bladder chemotherapy. The nurse will monitor for a. nausea. b. alopecia. c. mucositis. d. hematuria.

ANS: D The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy.

What are the seven warning signs of cancer?

C: change in bowel or bladder habits A: a sore that does not heal or go away U: unusual bleeding or discharge from any body orifice T: thickening or a lump in the breast or elsewhere I: indigestion or difficulty swallowing O: obvious change in a wart or mole N: nagging cough or hoarsness

Grade IV

Cells are immature and primitive and undifferentiated; cell of origin is difficult to determine (anaplasia and high grade)

Grade III

Cells are very abnormal and poorly differentiate (Severe dysplasia and high grade)

Grade I

Cells differ slightly from normal cells and are well differentiated (mild dysplasia and low grade)

A patient who is diagnosed with cervical cancer classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is accurate? a. "The cancer involves only the cervix." b. "The cancer cells look like normal cells." c. "Further testing is needed to determine the spread of the cancer." d. "It is difficult to determine the original site of the cervical cancer."

a. "The cancer involves only the cervix." Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time. Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the origin is the cervix. Further testing is not indicated given that the cancer has not spread.

To prevent the debilitating cycle of fatigue-depression-fatigue in patients receiving radiation therapy, what should the nurse encourage the patient to do? a. Implement a walking program b. Ignore the fatigue as much as possible c. Do the most stressful activities when fatigue is tolerable d. Schedule rest periods throughout the day whether fatigue is present or not

a. Implement a walking program

Which classification of chemotherapy drugs is cell cycle phase-nonspecific, breaks the DNA helix that interferes with DNA replication and crosses the blood-brain barrier? a. Nitrosureas b. Antimetabolites c. Mitotic inhibitors d. Antitumor antibiotics

a. Nitrosureas

Which word identifies a mutation of proto-oncogenes? a. Oncogenes b. Retrogenes c. Oncofetal antigens d. Tumor angiogenesis factor

a. Oncogenes

The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse? a. Shortness of breath b. Shivering and chills c. Muscle aches and pains d. Temperature of 100.2° F (37.9° C)

a. Shortness of breath Rituximab (Rituxan) is a monoclonal antibody. Shortness of breath should be investigated rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration. The nurse will need to rapidly take actions such as stopping the infusion, assessing the patient further, and notifying the health care provider. The other findings will also require action by the nurse but are not indicative of life-threatening complications.

When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene? a. The UAP assists the patient to use dental floss after eating. b. The UAP adds baking soda to the patient's saline oral rinses. c. The UAP puts fluoride toothpaste on the patient's toothbrush. d. The UAP has the patient rinse after meals with a saline solution.

a. The UAP assists the patient to use dental floss after eating. 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.

The nurse is counseling a group of individuals over the age of 50 with the average risk of cancer about screening tests for cancer. Which screening recommendation should be performed to screen for colorectal cancer? a. Barium enema every year b. Colonoscopy every 10 years c. Fecal occult blood every 5 years d. Annual prostate-specific antigen (PSA) and digital rectal exam

b. Colonoscopy every 10 years

A small lesion is discovered in a patient's lung when an x-ray is performed for cervical spine pain. What is the definitive method of determining if the lesion is malignant? a. Lung scan b. Tissue biopsy c. Oncofetal antigens d. CT or positron emission tomography (PET) scan

b. Tissue biopsy

Which normal tissues manifest early, acute responses to pelvic radiation therapy? a. Spleen and liver b. kidney and nervous tissue c. Bone marrow and GI mucosa d. Hollow organs such as stomach and bladder

c. Bone marrow and GI mucosa

An allogeneic hematopoietic stem cell transplant is considered as treatment for a patient with acute myelogenous leukemia. What information should the nurse include when teaching the patient about this procedure? a. There is no risk for graft versus host disease because the donated marrow is treated to remove cancer cells b. The patient's bone marrow will be removed, treated, stored and then reinfused after intensive chemotherapy c. Peripheral stem cells are obtained from a donor who has a human leukocyte antigen match with the patient d. There is no need for posttransplant protective isolation because the stem cells are infused directly into the blood

c. Peripheral stem cells are obtained from a donor who has a human leukocyte antigen match with the patient

The patient is learning about skin care related to external radiation that he is receiving. Which instructions should the nurse include in this teaching? a. Keep area shaved of hair b. Keep the area covered if it is sore c. Dry the skin thoroughly after cleansing it d. Avoid extreme temperatures to the area

d. Avoid extreme temperatures to the area

Stage IV

metastasis

Define surgical staging

the extent of the disease as determined by surgical excision, exploration and or lymph node sampling.

Where is the rate of cell proliferation rapid?

bone marrow, hair follicles and epithelial lining of the GI tract

The nurse is caring for a patient diagnosed with stage I colon cancer. When assessing the need for psychologic support, which question by the nurse will provide the most information? a. "How long ago were you diagnosed with this cancer?" b. "Do you have any concerns about body image changes?" c. "Can you tell me what has been helpful when coping with past stressful events?" d. "Are you familiar with the stages of emotional adjustment to cancer of the colon?"

c. "Can you tell me what has been helpful when coping with past stressful events?" 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. Because surgical interventions for stage I cancer of the colon may not cause any body image changes, this question is not appropriate at this time.

The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective? a. "After cancer has not recurred for 5 years, it is considered cured." b. "The cancer will be cured if the entire tumor is surgically removed." c. "I will need follow-up examinations for many years after treatment before I can be considered cured." d. "Cancer is never cured, but the tumor can be controlled with surgery, chemotherapy, and radiation."

c. "I will need follow-up examinations for many years after treatment before I can be considered cured." The risk of recurrence varies by the type of cancer. Some cancers are considered cured after a shorter time span or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up.

A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is accurate? a. "Benign tumors do not cause damage to other tissues." b. "Benign tumors are likely to recur in the same location." c. "Malignant tumors may spread to other tissues or organs." d. "Malignant cells reproduce more rapidly than normal cells."

c. "Malignant tumors may spread to other tissues or organs." The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors do not metastasize. The other statements are inaccurate. Both types of tumors may cause damage to adjacent tissues. Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not usually recur.

The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement by the patient indicates that teaching was effective? a. "The biopsy will remove the cancer in my prostate gland." b. "The biopsy will determine how much longer I have to live." c. "The biopsy will help decide the treatment for my enlarged prostate." d. "The biopsy will indicate whether the cancer has spread to other organs."

c. "The biopsy will help decide the treatment for my enlarged prostate." A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed. A biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life.

The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first? a. A 35-yr-old patient who has wet desquamation associated with abdominal radiation b. A 42-yr-old patient who is sobbing after receiving a new diagnosis of ovarian cancer c. A 24-yr-old patient who received neck radiation and has blood oozing from the neck d. A 56-yr-old patient who developed a new pericardial friction rub after chest radiation

c. A 24-yr-old patient who received neck radiation and has blood oozing from the neck Because neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first. The diagnoses and clinical manifestations for the other patients are not immediately life threatening.

A patient with metastatic colon cancer has severe vomiting after each administration of chemotherapy. Which action by the nurse is appropriate? a. Have the patient eat large meals when nausea is not present. b. Offer dry crackers and carbonated fluids during chemotherapy. c. Administer prescribed antiemetics 1 hour before the treatments. d. Give the patient a glass of a citrus fruit beverage during treatments.

c. Administer prescribed antiemetics 1 hour before the treatments. Treatment with antiemetics before chemotherapy may help prevent nausea. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea. The acidity of citrus fruits may be further irritating to the stomach.

A patient has inadequate nutrition due to painful oral ulcers. Which nursing action will be most effective in improving oral intake? a. Offer the patient frequent small snacks between meals. b. Assist the patient to choose favorite foods from the menu. c. Apply prescribed anesthetic gel to oral lesions before meals. d. Teach the patient about the importance of nutritional intake.

c. Apply prescribed anesthetic gel to oral lesions before meals. Because the cause of the patient's poor nutrition is the painful oral ulcers, the best intervention is to apply anesthetic gel to the lesions before the patient eats. The other actions might be helpful for other patients with impaired nutrition but would not be as helpful for this patient.

patient with cancer is eating very little due to altered taste sensation. Which nursing action would address the cause of the patient problem? a. Add protein powder to foods such as casseroles. b. Tell the patient to eat foods that are high in nutrition. c. Avoid giving the patient foods that are strongly disliked. d. Add spices to enhance the flavor of foods that are served.

c. Avoid giving the patient foods that are strongly disliked. The patient will eat more if disliked foods are avoided and foods that the patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding protein powder does not address the issue of taste. The patient's poor intake is not caused by a lack of information about nutrition.

A patient's breast tumor originates from embryonal ectoderm. It has moderate dysplasia and moderately differentiated cells. It is a small tumor with minimal lymph node involvement and no metastases. What is the best description of this tumor? a. Sarcoma, grade II T3 N4 M0 b. Leukemia, grade I T1 N2 M1 c. Carcinoma, grade II T1 N1 M0 d. Lymphoma, grade III T1 N0 M0

c. Carcinoma grade II T1 N1 M0

The nurse at the clinic is interviewing a 64-yr-old woman who is 5 feet, 3 inches tall and weighs 125 lb (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk? (Select all that apply.) a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening

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

Name some supportive care measures

1. Insertion of a feeding tube to maintain nutrition during head and neck cancer treatment. 2. Placement of central venous access devices to deliver chemotherapy agents 3. Prophylactic surgical fixation of bones at risk for pathologic fracture

A patient with tumor lysis syndrome (TLS) is taking allopurinol (Xyloprim). Which laboratory value should the nurse monitor to determine the effectiveness of the medication? a. Uric acid level b. Serum potassium c. Serum phosphate d. Blood urea nitrogen

ANS: A 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.

A patient receiving head and neck radiation has ulcerations over the oral mucosa and tongue and thick, ropey saliva. The nurse will teach the patient to a. remove food debris from the teeth and oral mucosa with a stiff toothbrush. b. use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c. gargle and rinse the mouth several times a day with an antiseptic mouthwash. d. rinse the mouth before and after each meal and at bedtime with a saline solution.

ANS: D The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate the oral mucosa and are not recommended.

The nurse assesses a 76-yr-old man with chronic myeloid leukemia receiving chemotherapy using a kinase inhibitor medication. Which question is most important for the nurse to ask? 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?"

ANS:A An adverse effect of kinase inhibitors is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4° F or higher. The other options are possible while undergoing chemotherapy but do not represent the highest priority for assessment.

Stage 0

Cancer in situ

When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer is staged as Tis, N0, M0. The nurse will teach the patient that a. the cancer is localized to the cervix. b. the cancer cells are well-differentiated. c. further testing is needed to determine the spread of the cancer. d. it is difficult to determine the original site of the cervical cancer.

ANS: A Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time. Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the origin is the cervix. Further testing is not indicated given that the cancer has not spread.

The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? A. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years B Family history of colorectal cancer and consumes a high-fiber diet C Limits fat consumption and has regular mammography and Pap screenings D Exercises five times every week and does not consume alcoholic beverages

ANS: A 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).

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.

ANS: 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.

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. enhance the patients immunologic response to tumor cells. b. stimulate malignant cells in the resting phase to enter mitosis. c. prevent the bone marrow depression caused by chemotherapy. d. protect normal cells from the harmful effects of chemotherapy.

ANS: A IL-2 enhances the ability of the patients 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.

A patient has recently been diagnosed with early stages of breast cancer. What is the MOST appropriate for the nurse to focus on? A. Maintaining the patient's hope B. Preparing a wil land advance directives C. Discussing replacement child care for the patient's children D. Discussing the patient's past experiences with her grandmother's cancer.

ANS: A 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 and cancer care.

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

ANS: A Patients experiencing diarrhea secondary to chemotherapy 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.

Which information obtained by the nurse about a patient with colon cancer who is scheduled for external radiation therapy to the abdomen indicates a need for patient teaching? a. The patient swims a mile 5 days a week. b. The patient has a history of dental caries. c. The patient eats frequently during the day. d. The patient showers with Dove soap daily.

ANS: A The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change the habits of eating frequently or showering with a mild soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation

A 40-year-old divorced mother of four school-age children is hospitalized with metastatic ovarian cancer. 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 dont we talk about the options you have for the care of your children? b. Perhaps your ex-husband will take the children when you cant care for them. c. For now you need to concentrate on getting well, not worry about your children. d. Many patients with cancer live for a long time, so there is time to plan for your children.

ANS: A This response expresses the nurses willingness to listen and recognizes the patients 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 patients ex-husband will take the children, more assessment information is needed before making plans.

. When caring for a patient who is pancytopenic, which action by nursing assistive personnel (NAP) indicates a need for the RN to intervene? a. The NAP assists the patient to use dental floss after eating. b. The NAP adds baking soda to the patients saline oral rinses. c. The NAP puts fluoride toothpaste on the patients toothbrush. d. The NAP has the patient rinse after meals with a saline solution.

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.

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 malgnant cells C. production of blocking factors that immobilize cancer cells D. reacting to anew set of antigenic determinants on cancer cells.

ANS: A Cancer cells may display altered cell surface antigens as a result of malignant transformation. These antigens are called tumor-associated antigens (TAAs). One of the functions of the immune system is to respond to TAAs.

The nurse at the clinic is interviewing a 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)? a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening

ANS: A, C, D, E The patients age, gender, and history indicate a need for screening and/or teaching about 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.

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 experience chills after I inject the interferon. d. I take acetaminophen (Tylenol) every 4 hours.

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.

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

ANS: A, C, E Two major dysfunctions in the process of cancer are defective cell proliferation (i.e., growth) and defective cell 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.

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for cancer of the colon. Which information about the patient is most indicative of a need for a change in therapy? a. Poor oral intake b. Increase in CEA c. Frequent loose stools d. Complaints of nausea

ANS: B An increase in CEA indicates that the chemotherapy is not effective for the patients cancer and may need to be modified. The other patient findings are common adverse effects of chemotherapy. The nurse may need to address these, but they would not indicate a need for a change in therapy.

When caring for a patient with a temporary radioactive cervical implant, which action by nursing assistive personnel (NAP) indicates that the RN should intervene? a. The NAP flushes the toilet once after emptying the patients bedpan. b. The NAP stands by the patients bed for 30 minutes talking with the patient. c. The NAP places the patients bedding in the laundry container in the hallway. d. The NAP gives the patient an alcohol-containing mouthwash to use for oral care.

ANS: B Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine/feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated.

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 ambulates several times a day in the room. b. The patients visitors bring in some fresh peaches from home. c. The patient cleans with a warm washcloth after having a stool. d. The patient uses soap and shampoo to shower every other day.

ANS: B Fresh, thinned-skin fruits 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 skin breakdown and infection.

When the nurse is administering a vesicant chemotherapeutic agent intravenously, an important consideration is to a. infuse the medication over a short period of time. b. stop the infusion if swelling is observed at the site. c. administer the chemotherapy through small-bore catheter. d. hold the medication unless a central venous line is available.

ANS: B Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapeutic drug. These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred.

Which patient is statistically and medically at the highest risk of developing cancer? A A 68-yr-old white woman who has BRCA-1 gene and is obese I B A 56-yr-old African American man with hepatitis C who drinks alcohol daily C An 18-yr-old Hispanic man who eats fast food once per week and drink alcohol D An 80-yr-old Asian woman with coronary artery disease on blood pressure medication.

ANS: B The combination of statistically identified risk factors in addition to current liver disease (hepatitis C that is linked to the development of liver cancer) and the added promotor of alcohol makes this patient at the highest risk. Second is the white woman with the gene for breast cancer and the added promotor of obesity. The majority of cancer cases are diagnosed in individuals older than 55 years of age. The overall incidence of cancer is higher in men than women. Cancer incidence is higher in African Americans, then whites, and then people from other cultures.

A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To maintain the patients self-esteem, the nurse plans to a. suggest that the patient limit social contacts until regrowth of the hair occurs. b. encourage the patient to purchase a wig or hat and wear it once hair loss begins. c. have the patient wash the hair gently with a mild shampoo to minimize hair loss. d. inform the patient that the hair will grow back once the chemotherapy is complete.

ANS: B The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicle and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is not immediately helpful in maintaining the patients self-esteem.

After the nurse has finished teaching a patient who is scheduled to receive external beam radiation for abdominal cancer about appropriate diet, which dietary selection by the patient indicates that the teaching has been effective? a. Fresh fruit salad b. Roasted chicken c. Whole wheat toast d. Cream of potato soup

ANS: B To minimize the diarrhea that is commonly associated with bowel radiation, the patient should avoid foods high in roughage, such as fruits and whole grains. Lactose-intolerance may develop secondary to radiation, so dairy products also should be avoided.

A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure. The nurse explains that the expected outcome of this surgery is a. relief of pain by cutting sensory nerves in the stomach. b. control of the tumor growth by removal of malignant tissue. c. decrease in tumor size to improve the effects of other therapy. d. promotion of better nutrition by relieving the pressure in the stomach.

ANS: C A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective. Debulking surgeries do not control tumor growth. The tumor is debulked because it is attached to the liver, a vital organ (not to relieve pressure on the stomach). Debulking does not sever the sensory nerves, although pain may be lessened by the reduction in pressure on the abdominal organs.

The patient is told that her adenoma tumor is not encapsulated but has normally differentiated cells and 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.

ANS: C Benign tumors are usually encapsulated, have normally differentiated cells, and do not metastasize. Malignant tumors are rarely encapsulated, have poorly differentiated cells, and are capable of metastasis.

The nurse counsels the patient receiving radiation therapy or chemotherapy that A. effective birth control methods should be used for the rest of the patient's life B. if N/V 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 may be reduced by restricting activity .

ANS: C 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. A cancer diagnosis can affect many aspects of a patients' life; cancer survivors commonly report financial, vocational, marital, and emotional concerns long after treatment is over.

When assessing the need 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. How long ago were you diagnosed with this cancer? b. Do you have any concerns about body image changes? c. Can you tell me what has been helpful to you in the past when coping with stressful events? d. Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?

ANS: C 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 patients need for support. The patients knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. Since surgical interventions for stage I cancer of the colon may not cause any body image changes, this question is not appropriate at this time.

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 in the abdomen for chemotherapy administration. D The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

ANS: 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.

External-beam radiation is planned for a patient with endometrial cancer. The nurse teaches the patient that an important measure to prevent complications from the effects of the radiation is to a. test all stools for the presence of blood. b. maintain a high-residue, high-fiber diet. c. clean the perianal area carefully after every bowel movement. d. inspect the mouth and throat daily for the appearance of thrush.

ANS: C Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection. Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation.

. After receiving change-of-shift report, which of these patients should the nurse assess first? a. 35-year-old who has wet desquamation associated with abdominal radiation b. 42-year-old who is sobbing after receiving a new diagnosis of ovarian cancer c. 24-year-old who is receiving neck radiation and has blood oozing from the neck d. 56-year-old who has a new pericardial friction rub after receiving chest radiation

ANS: C Since neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first. The diagnoses and clinical manifestations for the other patients are not immediately life threatening.

A female patient is having chemotherapy 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."

ANS: C 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. Although hair loss with chemotherapy is usually reversible, hair loss with radiation is usually permanent in the areas radiation was administered. When hair grows back it could be 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 goals of cancer treatment are based on the principal that 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

ANS: C 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 depends on the particular cancer being treated and may involve local therapies (i.e., surgery or radiation) alone or in combination, with or without adjunctive systemic therapy (i.e., chemotherapy).

While being prepared for a biopsy of a lump in the right breast, the patient asks the nurse about the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct? a. Benign tumors do not cause damage to other tissues. b. Benign tumors are likely to recur in the same location. c. Malignant tumors may spread to other tissues or organs. d. Malignant cells reproduce more rapidly than normal cells.

ANS: C The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors never metastasize. The other statements are inaccurate. Both types of tumors may cause damage to adjacent tissues. Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not usually recur.

While teaching a patient who has a new diagnosis of acute leukemia about the complications associated with chemotherapy, the patient is restless and is looking away, never making eye contact. After the teaching, the patient asks the nurse to repeat all of the information. Based on this assessment, which nursing diagnosis is most likely for the patient? a. Risk for ineffective adherence to treatment related to denial of need for chemotherapy b. Acute confusion related to infiltration of leukemia cells into the central nervous system c. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis d. Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment

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 patients 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.

A patient with Hodgkins lymphoma who is undergoing external radiation therapy tells the nurse, I am so tired I can hardly get out of bed in the morning. An appropriate intervention for the nurse to plan with the patient is to a. minimize activity until the treatment is completed. b. exercise vigorously when fatigue is not as noticeable. c. establish a time to take a short walk almost every day. d. consult with a psychiatrist for treatment of depression.

ANS: C Walking programs are used to keep the patient active without excessive fatigue. Vigorous exercise when the patient is less tired may lead to increased fatigue. Fatigue is expected during treatment and is not an indication of depression. Minimizing activity may lead to weakness and other complications of immobility.

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. Orange sherbet b. Fresh fruit salad c. Strawberry yogurt d. Cream cheese bagel

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. Cream cheese is low in protein.

A 64-yr-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 the plan of care? A Provide ice chips to soothe the irritation. Incorrect B Weigh the patient every month to monitor for weight loss. C Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. D Provide high-protein and high-calorie, soft foods every 2 hours.

ANS: D A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories to aid healing. Extremes of temperature are to be avoided. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Patients should be weighed at least twice each week to monitor for weight loss.

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

ANS: 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.

Trends in the incidence and death rates of cancer include the fact that 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 deaths in women D. African Americans have a higher death rate from cancer than whites.

ANS: D Cancer incidence and death rates are disproportionately higher among African Americans than among other minority groups and white people.

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 Incorrect C Most chemicals D Epstein-Barr virus

ANS: 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.

Which finding in a patient who is receiving interleukin-2 indicates a need for rapid action by the nurse? a. Generalized muscle aches b. Complaints of nausea and anorexia c. Oral temperature of 100.6 F (38.1 C) d. Crackles heard at the lower scapular border

ANS: D Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2; the patient may need oxygen and the nurse should rapidly notify the health care provider. The other findings are common side effects of interleukin-2.

The nurse is caring for an 18-yr-old female patient with acute lymphocytic leukemia that is scheduled for hematopoietic stem cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure? A "I understand the transplant procedure has no dangerous side effects." B "After the transplant, I will feel better and can go home in 5 to 7 days." 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."

ANS: 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

ANS: D Immunologic surveillance is the process in which 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 patient on chemo for 10 weeks had a starting weight of 121 lbs and is now 118 lbs and has no sense of taste. Which nursing intervention should be a priority? A. advise the patient to eat foods that are fatty, friend, or high in calories B. Discuss with the physician the need of parenteral or enteral feedings C. Advise the patient to drink a nutritional supplement beverage at least three times a day. D. Advise the patient to experiment with spices and seasonings to enhance food taste.

ANS: D 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. Onion and pieces of ham may enhance the taste of vegetables.

A characteristic of the stage of progression in the development of cancer is 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 despite host control mechanisms

ANS: D 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 (i.e., metastasis). Progression occurs as a result of the following characteristics of cancer cells: rapid proliferation and decreased cell adhesion.

Which nursing action will be most effective in improving oral intake for a patient with the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers? a. Offer the patient frequent small snacks between meals. b. Assist the patient to choose favorite foods from the menu. c. Provide education about the importance of nutritional intake. d. Apply the ordered anesthetic gel to oral lesions before meals.

ANS: D Since the etiology of the patients poor nutrition is the painful oral ulcers, the best intervention is to apply anesthetic gel to the lesions before the patient eats. The other actions might be helpful for other patients with impaired nutrition, but would not be as helpful for this patient.

A 33-yr-old patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis? A "The cancer is found at the point of origin only." B "Tumor cells have been identified in the cervical region." C "The cancer has been identified in the cervix and the liver." D "Your cancer was identified in the cervix and has limited local spread."

ANS: D Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ or at the point of origin only; 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 such as to the liver.

A patient with ovarian cancer is distressed because her husband rarely visits and tells the nurse, He just doesnt care. The husband indicates to the nurse that I never know what to say to help her. An appropriate nursing diagnosis is a. compromised family coping related to disruption in lifestyle. b. impaired home maintenance related to perceived role changes. c. risk for caregiver role strain related to burdens of caregiving responsibilities. d. dysfunctional family processes related to effect of illness on family members.

ANS: D The data indicate that this diagnosis is most appropriate because poor communication among the family members is affecting family processes. No data suggest a change in lifestyle or its role as an etiology. The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities.

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. Hematocrit of 30% b. Platelets of 95,000/l c. Hemoglobin of 10 g/L d. WBC count of 1700/l

ANS: D The low WBC count 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.

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate 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 mealtimes. Incorrect D Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

ANS: D The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (e.g., peanut butter, skim milk powder, cheese, honey, 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.

A patient with leukemia is considering whether to have hematopoietic stem cell transplantation. Which information will be included in patient teaching? a. Transplant of the donated cells is painful because of the nerves in the tissue lining the bone. b. Donor bone marrow cells are transplanted through an incision into the sternum or hip bone. c. The transplant procedure takes place in a sterile operating room to minimize the risk for infection. d. Hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT).

ANS: D 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 or incision required.

The nurse is teaching a postmenopausal patient with stage III breast cancer about the expected outcomes of her cancer treatment. Which patient statement indicates that the teaching has been effective? a. After cancer has not recurred for 5 years, it is considered cured. b. The cancer will be cured if the entire tumor is surgically removed. c. Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation. d. I will need to have follow-up examinations for many years after I have treatment before I can be considered cured.

ANS: D The risk of recurrence varies by the type of cancer. For breast cancer in postmenopausal women the patient needs at least 20 disease-free years to be considered cured. Some cancers are considered cured after a shorter time span, or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up.

A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. An important nursing intervention for the patient is to a. teach about the importance of nutrition during treatment. b. have the patient eat large meals when nausea is not present. c. offer dry crackers and carbonated fluids during chemotherapy. d. administer prescribed antiemetics 1 hour before the treatments.

ANS: D Treatment with antiemetics before chemotherapy may help prevent nausea. Although nausea may lead to poor nutrition, there is no indication that the patient needs instruction about nutrition. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea.

The MOST effectice method of administrating a chemotherapy agent that is a vesicant is to A. give it orally B. give it intraarterially C. use a Ommaya reservoir D. use a central venous access device

ANS:D If vesicants are inadvertently infiltrated into the skin, severe local tissue breakdown and necrosis may result. It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs. The infusion should be immediately turned off, and protocols for drug-specific extravasation procedures should be followed to minimize further tissue damage. Infusion with central venous access devices can reduce the risk of infiltration of chemotherapy agents that are vesicants.

Which action should the nurse take when caring for a patient who is receiving chemotherapy and reports problems with concentration? a. Suggest use of a daily planner and encourage adequate sleep. b. Teach the patient to rest the brain by avoiding new activities. c. Teach that "chemo-brain" is a short-term effect of chemotherapy. d. Report patient symptoms immediately to the health care provider.

a. Suggest use of a daily planner and encourage adequate sleep. Use of tools to enhance memory and concentration such as a daily planner and adequate rest are helpful for patients who develop "chemo-brain" while receiving chemotherapy. Patients should be encouraged to exercise the brain through new activities. Chemo-brain may be short or long term. There is no urgent need to report common chemotherapy side effects to the provider.

What does the presence of carcinoembryonic antigens (CEAs) and a-fetoprotein (AFP) on cell membranes indicate has happened to the cells? a. They have shifted to more immature metabolic pathways and functions b. They have spread from areas of original development to different body tissues c. They produce abnormal toxins or chemicals that indicate abnormal cellular function d. They have become more differentiated as a result of repression of embryonic function

a. They have shifted to more immature metabolic pathways and functions

During initial chemotherapy, a patient with leukemia develops hyperkalemia and hyperuricemia. The nurse recognizes these symptoms as an oncologic emergency and anticipates that the priority treatment will be to: a. increase urine output with hydration therapy b. establish ECG monitoring c. administer a bisphosphonate such as pamidronate d. restrict fluids and administer hypertonic sodium chloride solution

a. increase urine output with hydration therapy

Cancer cells go though stages of development. What accurately describes the stage of promotion? Select all that applies: a. Obesity is an example of a promoting factor b. The stage is characterized by increased growth rate and metastasis c. Withdrawal of promoting factors will reduce the risk of cancer development d. Tobacco smoke is a complete carcinogen that is capable of both initiation and promotion e. Promotion is the stage of cancer development in which there is an irreversible alteration in the cell's DNA

a....c....d

Which factors will assist a patient in coping positively with having cancer? (select all that applies) a. Feeling of control b. Strong support system c. Internalization of feelings d. Possibility of cure or control e. Easier adaptability of a young person f. Not having had to cope with previous stressful events

a...b...d

What are the acute toxicity effects of chemo?

anaphylactic and hypersensitivity reactions, extravasation or flare reaction, anticipatory nausea and vomiting, cardiac dysrhythmias

When the patient asks about the late effects of chemotherapy and high-dose radiation, what areas of teaching should the nurse plan to include when describing these effects? a. Third space syndrome b. Secondary malignancies c. Chronic nausea and vomiting d. Persistent myelosuppression

b. secondary malignancies

The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment? a. "I have frequent muscle aches and pains." b. "I rarely have the energy to get out of bed." c. "I experience chills after I inject the interferon." d. "I take acetaminophen (Tylenol) every 4 hours."

b. "I rarely have the energy to get out of bed." Fatigue can be a dose-limiting toxicity for use of immunotherapy. Flu-like symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use acetaminophen every 4 hours.

A widowed mother of 4 school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate? a. "Don't you have any friends that will raise the children for you?" b. "Would you like to talk about options for the care of your children?" c. "For now you need to concentrate on getting well and not worrying about your children." d. "Many patients with cancer live for a long time, so there is time to plan for your children."

b. "Would you like to talk about options for the care of your children?" 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 friends will raise the children, more assessment information is needed before making plans.

During the teaching session for a patient who has a new diagnosis of acute leukemia, the patient is restless and looks away without making eye contact. The patient asks the nurse to repeat the information about the complications associated with chemotherapy. Based on this assessment, which patient problem should the nurse identify? a. Denial b. Anxiety c. Acute confusion d. Ineffective adherence to treatment

b. Anxiety The patient who has a new cancer diagnosis is likely to have high anxiety, which may affect learning and require that the nurse repeat and reinforce information about health maintenance. There is no evidence to support confusion. The patient asks for the information to be repeated, indicating that denial is not present. The patient has recently been diagnosed, so adherence has not yet been required.

A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first? a. Give the patient the prescribed PRN opioid. b. Assess for sensation and strength in the legs. c. Notify the health care provider about the symptoms. d. Teach the patient how to use relaxation to reduce pain.

b. Assess for sensation and strength in the legs. Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the epidural space. The nurse will need to assess the patient further for symptoms such as decreased leg sensation and strength and then notify the health care provider. Administration of opioids or the use of relaxation may be appropriate but only after the nurse has assessed for possible spinal cord compression.

The nurse should suggest which food choice for a patient scheduled to receive external-beam radiation for abdominal cancer? a. Fruit salad b. Baked chicken c. Creamed broccoli d. Toasted wheat bread

b. Baked chicken Protein is needed for wound healing. To minimize the diarrhea that is associated with bowel radiation, the patient should avoid foods high in roughage, such as fruits and whole grains. Lactose intolerance may develop secondary to radiation, so dairy products should also be avoided.

The nurse teaches a patient with liver cancer about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective? a. Lime sherbet b. Blueberry yogurt c. Fresh strawberries d. Cream cheese bagel

b. Blueberry yogurt Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Lime sherbet is lower in fat and protein than yogurt. Cream cheese is low in protein.

The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider? a. Generalized muscle aches b. Crackles at the lung bases c. Reports of nausea and anorexia d. Oral temperature of 100.6° F (38.1° C)

b. Crackles at the lung bases Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2. The patient may need oxygen and the nurse should rapidly notify the health care provider. The other findings are common side effects of interleukin-2.

A patient with a large stomach tumor attached to the liver is scheduled for a debulking procedure. What should the nurse teach the patient about the outcome of this procedure? a. Pain will be relieved by cutting sensory nerves in the stomach. b. Decreasing the tumor size will improve the effects of other therapy. c. Relieving the pressure in the stomach will promote optimal nutrition. d. Tumor growth will be controlled by removing all the cancerous tissue.

b. Decreasing the tumor size will improve the effects of other therapy. A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective. Debulking surgeries do not control tumor growth. The tumor is debulked because it is attached to the liver, a vital organ (not to relieve pressure on the stomach). Debulking does not sever the sensory nerves, although pain may be lessened by the reduction in pressure on the abdominal organs.

A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to support the patient's self-esteem? a. Suggest that the patient limit social contacts until hair regrowth occurs. b. Encourage the patient to purchase a wig or hat to wear when hair loss begins. c. Teach the patient to wash hair gently with mild shampoo to minimize hair loss. d. Inform the patient that hair usually grows back once chemotherapy is complete.

b. Encourage the patient to purchase a wig or hat to wear when hair loss begins. The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicles and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is not immediately helpful in maintaining the patient's self-esteem.

A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which intervention should the nurse add to the plan of care? a. Minimize activity until the treatment is completed. b. Establish time to take a short walk almost every day. c. Consult with a psychiatrist for treatment of depression. d. Arrange for delivery of a hospital bed to the patient's home.

b. Establish time to take a short walk almost every day. Walking programs are used to keep the patient active without excessive fatigue. Having a hospital bed does not necessarily address the fatigue. The better option is to stay as active as possible while combating fatigue. Fatigue is expected during treatment and is not an indication of depression. Minimizing activity may lead to weakness and other complications of immobility.

A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). Which information should the nurse include in the patient's teaching plan? a. Donor bone marrow is transplanted through a sternal or hip incision. b. Hospitalization is required for several weeks after the stem cell transplant. c. The transplant procedure takes place in a sterile operating room to decrease the risk for infection. d. Transplant of the donated cells can be very painful because of the nerves in the tissue lining the bone.

b. Hospitalization is required for several weeks after the stem cell transplant. 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 or incision required.

The patient was told she has carcinoma in situ, and the student nurse wonders what that is. how should the nurse explain this to the student nurse? a. Evasion of the immune system by cancer cells b. Lesion with histologic features of cancer except invasion c. Capable of causing cellular alterations associated with cancer d. Tumor cell surface antigens that stimulate an immune responce

b. Lesion with histologic features of cancer except invasion

During a routine health examination, a 40-yr-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Schedule a sigmoidoscopy to provide baseline data. b. Obtain more information about the patient's relatives. c. Teach the patient about the need for a colonoscopy at age 50. d. Teach the patient how to do home testing for fecal occult blood.

b. Obtain more information about the patient's relatives. The patient may be at increased risk for colon cancer, but the nurse's first action should be further assessment. The other actions may be appropriate, depending on the information that is obtained from the patient with further questioning.

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a. Infuse the medication over a short period of time. b. Stop the infusion if swelling is observed at the site. c. Administer the chemotherapy through a small-bore catheter. d. Hold the medication unless a central venous line is available.

b. Stop the infusion if swelling is observed at the site. Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapy drug. These medications can be given through peripheral lines, although central vascular access devices are preferred.

The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention? a. The UAP flushes the toilet once after emptying the patient's bedpan. b. The UAP stands by the patient's bed for 30 minutes talking with the patient. c. The UAP places the patient's bedding in the laundry container in the hallway. d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.

b. The UAP stands by the patient's bed for 30 minutes talking with the patient. Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine and feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated.

When a patient is undergoing brachytherapy, what is important for the nurse to be aware of when caring for this patient? a. The patient will undergo simulation to identify and mark the field of treatment b. The patient is a source of radiation, and personnel must wear film badges during care c. The goal of this treatment is only palliative, and the patient should be aware of the expected outcome d. Computerized dosimetry is used to determine the maximum dose of radiation to the tumor within an acceptable dose to normal tissue

b. The patient is a source of radiation, and personnel must wear film badges during care

The nurse is caring for a patient with colon cancer who is scheduled for external radiation therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching? a. The patient has a history of dental caries. b. The patient swims several days each week. c. The patient snacks frequently during the day. d. The patient showers each day with mild soap.

b. The patient swims several days each week. The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change habits of eating frequently or showering with a mild soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation.

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse indicates a need for further teaching? a. The patient ambulates around the room. b. The patient's visitors bring in fresh peaches. c. The patient cleans with a warm washcloth after having a stool. d. The patient uses soap and shampoo to shower every other day.

b. The patient's visitors bring in fresh peaches. Fresh, thinned-skin fruits 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 prevent skin breakdown and infection.

The nurse uses many precautions during IV administration of vesicant chemotherapy agents primarily to prevent? a. septicemia b. extravasation c. catheter occlusion d. anaphylactic shock

b. extravasation

External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation? a. Test all stools for the presence of blood. b. Maintain a high-residue, high-fiber diet. c. Clean the perianal area carefully after every bowel movement. d. Inspect the mouth and throat daily for the appearance of thrush.

c. Clean the perianal area carefully after every bowel movement. Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection. Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation.

A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband tells the nurse that he does not know what to say to his wife. Which problem is appropriate for the nurse to address in the plan of care? a. Anxiety b. Death anxiety c. Difficulty coping d. Lack of knowledge

c. Difficulty coping The data indicate that difficulty coping with the situation may be present reflected by the poor communication among the family members. The data given does not suggest death anxiety, anxiety, or lack of knowledge as an etiology.

What describes a primary use of immunotherapy in cancer treatment? a. Protects normal, rapidly reproducing cells of the GI system from damage during chemotherapy b. Prevents the fatigue associated with chemotherapy and high-dose radiation as seen with bone marrow depression c. Enhances or supplement the effects of the host's immune responses to tumor cells that produce flu-like symptoms d. Depresses the immune system and circulating lymphocytes as well as increase a sense of well-being by replacing central nervous system deficits

c. Enhances or supplement the effects of the host's immune responses to tumor cells that produce flu-like symptoms

When teaching a patient with cancer about chemotherapy, which approach should the nurse take? a. Avoid telling the patient about possible side effects of the drugs to prevent anticipatory anxiety b. Assure the patient that the side effects from chemotherapy are uncomfortable but never life threatening c. Explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control the side effects d. Inform the patient that chemotherapy related alopecia is usually permanent but can be managed with lifelong use of wigs

c. Explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control the side effects

After change-of-shift report on the oncology unit, which patient should the nurse assess first? a. Patient who has a platelet count of 82,000/µL after chemotherapy. b. Patient who has xerostomia after receiving head and neck radiation. c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C). d. Patient who is worried about getting the prescribed long-acting opioid on time.

c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C). Fever is an emergency in neutropenic patients because of the risk for rapid progression to severe infections and sepsis. The other patients also require assessments or interventions but do not need to be assessed as urgently. Patients with thrombocytopenia do not have spontaneous bleeding until the platelets are 20,000/µL. Xerostomia does not require NURSINGTB.COM

The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider? a. Hematocrit of 32% b. Pain with deep inspiration c. Serum sodium of 126 mEq/L d. Decreased breath sounds on left side

c. Serum sodium of 126 mEq/L The syndrome of inappropriate antidiuretic hormone (and the resulting hyponatremia) is an oncologic metabolic emergency and requires rapid treatment to prevent complications such as seizures and coma. The other findings also require intervention but are common in patients with lung cancer and not immediately life threatening.

A patient who has severe pain with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching about pain management has been effective? a. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale). b. The patient agrees to take the medications by the IV route to improve analgesic effectiveness. c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. d. The patient states that nonopioid analgesics may be used if the maximal dose of the opioid is reached without adequate pain relief.

c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. 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 usually the oral route is preferred.

While caring for a patient who is at the nadir of chemotherapy, the nurse establishes the highest priority for nursing actions related to: a. diarrhea b. grieving c. risk for infection d. inadequate nutritional intake

c. risk for infection

These cells have no regard for cell boundaries and grow on top of one another and also on top of or between normal cells

contact inhibition

A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about the management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective? a. "I can use ice packs to relieve itching." b. "I will scrub the area with warm water." c. "I will expose my skin to a sun lamp each day." d. "I can buy some aloe vera gel to use on my skin."

d. "I can buy some aloe vera gel to use on my skin." Aloe vera gel and cream may be used on the radiated skin area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.

A patient is admitted with acute myelogenous leukemia and a history of Hodgkin's lymphoma. What is the nurse most likely going to find in the patient's history? a. Work as a radiation chemist b. Epstein-Barr virus diagnosed in vitro c. Intense tanning throughout the lifetime d. Alkylating agents for treating the Hodgkin's lymphoma

d. Alkylating agents for treating the Hodgkin's lymphoma

The nurse is caring for a patient who smokes 2 packs/day. Which action by the nurse could help reduce the patient's risk of lung cancer? a. Teach the patient about the seven warning signs of cancer. b. Plan to monitor the patient's carcinoembryonic antigen (CEA) level. c. Teach the patient about annual chest x-rays for lung cancer screening. d. Discuss risks associated with cigarettes during each patient encounter.

d. Discuss risks associated with cigarettes during each patient encounter. Teaching about the risks associated with cigarette smoking is recommended at every patient encounter because cigarette smoking is associated with multiple health problems. The other options may detect lung cancer that is already present but do not reduce the risk.

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in cancer therapy with the health care provider? a. Frequent loose stools b. Nausea and vomiting c. Elevated white blood count (WBC) d. Increased carcinoembryonic antigen (CEA)

d. Increased carcinoembryonic antigen (CEA) An increase in CEA indicates that the chemotherapy is not effective for the patient's cancer and may need to be modified. Gastrointestinal adverse effects are common with chemotherapy. The nurse may need to address these, but they would not necessarily indicate a need for a change in therapy. An elevated WBC may indicate infection but does not reflect the effectiveness of the colorectal cancer therapy.

The patient with advanced cancer is having difficulty controlling her pain. She says she is afraid she will become addicted to the opioids. What is the FIRST thing the nurse should do for this patient? a. Administer a nonsteroidal anti-inflammatory drug b. Assess the patient's vital signs and behavior to determine the medication to use c. Have the patient keep a pain diary to better assess the patient's potential addiction d. Obtain a detailed pain history including quality, location, intensity, duration, and type of pain

d. Obtain a detailed pain history including quality, location, intensity duration and type of pain

An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hr in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider? a. Patient reports having severe fatigue. b. Patient voids every hour during the day. c. Patient takes only 50% of meals and refuses snacks. d. Patient has crackles up to the midline posterior chest.

d. Patient has crackles up to the midline posterior chest. Rapid fluid infusions may cause heart failure, especially in older patients. The other findings are common in patients who have cancer or are receiving chemotherapy.

A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient? a. Remove food debris from the teeth and oral mucosa with a stiff toothbrush. b. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c. Gargle and rinse the mouth several times a day with an antiseptic mouthwash. d. Rinse the mouth before and after each meal and at bedtime with a saline solution.

d. Rinse the mouth before and after each meal and at bedtime with a saline solution. The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate the oral mucosa and are not recommended.

The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? a. Hematocrit 30% b. Platelets 95,000/µL c. Hemoglobin 10 g/L d. White blood cells (WBC) 2700/µL

d. White blood cells (WBC) 2700/µL The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim (Neupogen) are needed. Although the other laboratory data indicate decreased levels, they do not indicate any immediate life-threatening adverse effects of the chemotherapy.

What defect in cellular proliferation is involved in the development of cancer? a. A rate of cell proliferation that is more rapid than that of normal body cells. b. Shortened phases of cell life cycles with occasional skipping of GI or S phases c. Rearrangement of stem cell RNA that causes abnormal cellular protein synthesis d. Indiscriminate and continuous proliferation of cells with loss of contact inhibition

d. indiscriminate and continuous proliferation of cells with loss of contact inhibition

Large-core biopsy

delivers an actual piece of tissue that can be analyzed with the advantage of preserving the histologic architecture of the tissue specimen

define initiation

mutation in the cell's genetic structure

What is the only definitive means to diagnose cancer?

pathological evaluation of a tissue

Fine needle aspiration

provides cells from the mass for cytologic examination

what is believed to be one of the functions of the immune system?

respond to tumor-associated antigens (TAAs)

Cardiac Tamponade symptoms and treatment

symptoms: heavy feeling over chest, shortness of breath, tachycardia, cough, dysphagia, hiccups , hoarseness, decreased level of consciousness, distant or muted heart sounds Treatment: decrease fluid around heart by either surgery to create a pericardial window or an indwelling pericardial catheter. Administer O2 therapy, IV hydration and vasopressor therapy