Cancer (Med-Surg EAQs)

A patient with lung cancer tells the nurse, "I know I am going to die pretty soon, perhaps in the next month." What is the best response by the nurse? 1. "What are your feelings about being so sick and thinking you may die soon?" 2. "None of us know when we are going to die. Is this a particularly difficult day?" 3. "Would you like me to call your spiritual advisor so you can talk about your feelings?" 4. "Perhaps you are depressed about your illness; I will speak to the health care provider about getting some medication for you."

1. "What are your feelings about being so sick and thinking you may die soon?" (The best response to psychosocial questions is to acknowledge the patient's feelings and explore his or her concerns. "What are your feelings about being so sick and thinking you may die soon?" does both and is a helpful response that encourages further communication between patient and nurse. Calling the spiritual advisor is permissible; however, this does not increase communication and rapport between the patient and the nurse. The patient is expressing feelings; medication is not indicated for this. Ignoring the patient's feelings is not therapeutic communication.)

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? 1. A bland, low-fiber diet 2. A high-protein, high calorie diet 3. A diet high in fresh fruits and vegetables 4. A diet emphasizing whole and organic foods

1. A bland, low-fiber diet (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. High protein, high calorie, and whole and organic foods do not prevent diarrhea.)

A patient with multiple myeloma presents with sudden onset of depression, fatigue, muscle weakness, polyuria, nocturia, and vomiting. The serum calcium level is in excess of 12 mg/dL. The nurse recognizes that which treatments could be helpful for the patient? Select all that apply. 1. Adequate hydration 2. Administration of mesna 3. Administration of allopurinol 4. Administration of demeclocycline 5. Infusion of bisphosphonate zoledronate

1. Adequate hydration 5. Infusion of bisphosphonate zoledronate (The clinical features of depression, fatigue, muscle weakness, polyuria, nocturia, and vomiting in a patient suffering from multiple myeloma are suggestive of hypercalcemia. Interventions for this condition involve adequate hydration and using bisphosphonate zoledronate to prevent formation of calcium stones in the kidney. Mesna is used for the treatment of hemorrhagic cystitis. Allopurinol is useful for managing tumor lysis syndrome and not hypercalcemia. Demeclocycline is used for treating syndrome of inappropriate antidiuretic hormone.)

A patient has a grade IV histologic tumor. What condition does the nurse determine this patient has? 1. Anaplasia 2. Mild dysplasia 3. Severe dysplasia 4. Moderate dysplasia

1. Anaplasia Grade IV of histologic classification of tumors is associated with anaplasia. The grade I histologic classification is associated mild dysplasia. The grade III histologic classification of tumors indicates severe dysplasia. The grade II histologic classification of tumors is associated with moderate dysplasia.

The nurse is reviewing statistics regarding the incidence and death rates of cancer. What statement does the nurse recognize has basis in fact? Select all that apply. 1. Thyroid cancer is more prevalent in women than in men. 2. Colon cancer is the most common type of cancer in men. 3. A higher percentage of women than men have lung cancer. 4. More men than women die from cancer-related deaths each year. 5. African Americans have a higher death rate from cancer than whites.

1. Thyroid cancer is more prevalent in women than in men. 4. More men than women die from cancer-related deaths each year. 5. African Americans have a higher death rate from cancer than whites. (Cancer-related deaths are higher in men than in women; African Americans have a higher death rate from cancer than whites. Thyroid cancer is more prevalent in women. Prostate cancer is the most common type of cancer in men. The incidence of lung cancer is the same for men and women.)

A patient is being treated with radioactive iodine (131I) for thyroid cancer. For what major source of contamination from this patient should the nurse take precautions? 1. Urine 2. Feces 3. Blood 4. Sputum

1. Urine (Urine is the major source of contamination with this form of radioactive treatment. The nurse must be careful in handling bedpans, urinals, and linens and apply standard radiation precautions of time, distance, and shielding. Feces, blood, and sputum tend to contain lower levels of radiation contamination, but they should also be handled with the use of standard precautions.)

The nurse is educating a group of adolescents about prevention of skin cancer. What should the nurse be sure to include regarding sun protection? 1. "You should use a sunscreen of SPF 5." 2. "You should use a sunscreen of SPF 15." 3. "You should apply this sunscreen only to your face." 4. "You should apply it at least 30 minutes before going out in the day time."

2. "You should use a sunscreen of SPF 15." (A sunscreen lotion of SPF 15 can help protect the skin against harmful ultraviolet radiations, which cause cancer. A sunscreen of SPF 5 may not protect the skin against harmful ultraviolet radiations. Using a sunscreen of SPF 10 only on the face does not prevent exposure of the body to ultraviolet radiations. Applying the sunscreen 30 minutes before going out does not effectively act against ultraviolet radiations, which cause cancer.)

Which statement by the nurse is appropriate when conducting a teaching session for a patient who will have an excisional biopsy to determine the presence of cancer cells? 1. "A core piece of tissue is removed and preserved for analysis." 2. "You will have a surgical procedure to remove the entire lesion." 3. "You will have a partial excision of the lesion using a dermal punch." 4. "A small-gauge needle is used to remove cells for cytologic examination."

2. "You will have a surgical procedure to remove the entire lesion." (An excisional biopsy is a surgical procedure during which the entire lesion is removed. A large-core biopsy involves the removal of a core piece of tissue that is preserved for analysis. An incisional biopsy is the partial excision of a lesion with a scalpel or dermal punch. A fine-needle aspiration (FNA) biopsy is performed with a small-gauge needle; this biopsy is used to remove cells for cytologic examination.)

A nurse is caring for a patient with cancer of the neck. While assessing the vital signs of the patient, the nurse notices bleeding in the cancerous area. Which nursing action is a priority? 1. Start intravenous fluids 2. Apply pressure on the site 3. Inform the primary health care provider 4. Obtain a prescription for a blood transfusion

2. Apply pressure on the site (Carotid artery rupture is a common complication in cancers of the head and neck. The artery can rupture due to invasion of the blood vessel wall by the tumor. It can also be caused by erosion of the arterial wall following surgery or radiation therapy. In the case of bleeding at the carotid artery, the nurse should immediately apply pressure on the bleeding site to stop bleeding. Intravenous fluids should be administered to maintain the intravascular volume; however, this intervention is not the priority. A blood transfusion may be necessary; however, it is not a priority. The primary health care provider should be informed after pressure is applied to the site of the bleeding.)

The nurse is educating a student nurse about the seven warning signs of cancer. Which warning sign stated by the student nurse indicates the student requires further education? 1. Indigestion 2. Severe headache 3. Unusual bleeding 4. Difficult in swallowing

2. Severe headache (Severe headache is not a warning sign of cancer. Severe headache may indicate a stroke. Indigestion may indicate stomach cancer. Unusual bleeding may indicate uterine cancer. Difficulty in swallowing may indicate esophageal cancer.)

A patient on chemotherapy for eight weeks started at a weight of 130 lb. The patient now weighs 125 lb and complains that he or she cannot taste food anymore. Which nursing interventions would be a priority? 1. Advise the patient to try foods that are fatty, fried, or high in calories. 2. Suggest that the patient try foods with various spices and seasonings that are not spicy. 3. Advise the patient to drink a nutritional supplement beverage at least five times a day. 4. Confer with the primary health care provider about the need for parenteral or enteral feedings.

2. Suggest that the patient try foods with various spices and seasonings that are not spicy. (Tell the patient to experiment with spices and other seasoning agents in an attempt to mask the taste alterations. Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste of certain meats and fish. Bacon bits, onion, and ham may enhance the taste of vegetables. It is not recommended for a patient to eat foods high in fat and fried. It is not necessary for the patient to drink nutritional supplements five times daily. The patient does not need parenteral or enteral feedings at this point.)

A patient is diagnosed with carcinoma in situ. What tumor classification does the nurse observe on the medication record? 1. T0 2. T is 3. T x 4. T 1-4

2. T is (The TNM classification system is used to determine the anatomic extent of the disease involvement according to three parameters: tumor size and invasiveness, presence or absence of regional spread to lymph nodes, and metastases. Carcinoma in situ (CIS) has its own designation in the system (T is) because it has all the histologic characteristics of cancer except invasion, which is a primary feature of the TNM staging system. T 0 is the designation used when there is no evidence of a primary tumor. T X is the designation used for tumors that cannot be found or measured. T 1-4 is the designation used for tumors that ascend in degrees and increase in size.)

The nurse is reviewing the laboratory test results for a patient with cancer. The total serum protein level is 6.4 mg/dL. What does the nurse interpret this finding to mean for the patient? 1. The protein level is reduced, which is consistent with malnutrition. 2. The protein level is normal, and therefore the patient does not have malnutrition. 3. The protein level is increased, which is a common finding in patients with cancer. 4. The total protein level is increased; the patient would benefit from albumin infusion.

2. The protein level is normal, and therefore the patient does not have malnutrition. (Total serum protein level should be between 6.0 and 8.0 g/dL. A protein level of 6.4 is normal.)

Following a surgery for colorectal cancer, the patient still has persistent carcinoembryonic antigen (CEA) levels. Which is a correct interpretation of high CEA levels? 1. The tumor has spread to other organs. 2. The tumor has not been completely removed. 3. The patient is suffering from chronic liver disease. 4. Carcinoembryonic antigen is not a reliable indicator.

2. The tumor has not been completely removed. =(Persistent high CEA levels after surgery for colorectal cancer indicate that the tumor has not been removed completely. CEA is found on the surfaces of cancer cells derived from the gastrointestinal tract and from normal cells from the fetal gut, liver, and pancreas. CEA levels can be used as tumor markers that may be clinically useful to monitor the effect of therapy and indicate tumor recurrence. CEA can be affected by many factors, which need to be accounted for when reviewing these results.)

A patient has an increased risk for liver cancer. What tumor suppressor gene mutation does the nurse observe the patient has? 1. APC gene 2. p53 gene 3. BRCA1 and BRCA2 4. Carcinoembryonic antigen (CEA)

2. p53 gene (Mutations in the p53 tumor suppressor genes increase a person's risk for liver cancer. Mutations in the APC gene can result in an increased risk for familial adenomatous polyposis, which is a precursor for colorectal cancer. Mutations in BRCA1 and BRCA2 can increase the risk for breast cancer. Carcinoembryonic antigens (CEA) are the oncofetal antigens present on the surface and inside the cancer cells. Elevated levels of CEA are found in nonmalignant conditions.)

Which question should the nurse include in the health history interview to determine if a patient is at risk for cancer due to a chemical carcinogen? 1. "What foods are in your diet?" 2. "Have you received the hepatitis B vaccination?" Correct3 3. "Are you exposed to benzene through your occupation?" 4. "Do you use sunscreen when exposed to sunlight for large periods of time?"

3. "Are you exposed to benzene through your occupation?" (Benzene is a chemical carcinogen that can increase the risk for cancer; therefore, this question is appropriate for determining if the patient is at risk for cancer from exposure to a chemical. While a diet high in fat is a risk factor for cancer, it is not a chemical carcinogen. Hepatitis B is a viral carcinogen. Sun exposure is a radiation carcinogen.)

A patient is having whole brain radiation for brain metastasis and is concerned about how they will look when hair loss occurs. What is the best response by the nurse to this patient? 1. "When your hair grows back, it will be patchy." 2. "Don't use a curling iron and that will slow down the loss." 3. "You can get a wig now to match your hair so you will not look different." 4. "You should contact 'Look Good, Feel Better' to figure out what to do about this."

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

A patient is being prepared for intraperitoneal chemotherapy and asks the nurse when the IV will be started for the chemotherapy. What is the best response by the nurse to educate the patient about this type of chemotherapy delivery? 1.It is delivered via an Ommaya reservoir and extension catheter. 2. It is instilled in the bladder via a urinary catheter and retained for one to three hours. 3. A Silastic catheter will be placed percutaneously into the peritoneal cavity for chemotherapy administration. 4. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

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

A patient is scheduled for pelvic radiation therapy. The patient asks why the instructions state to go for radiation therapy with a full bladder. What explanation should the nurse give? 1. A full bladder indicates adequate fluid intake 2. A full bladder improves effectiveness of treatment 3. A full bladder moves the bowels out of the treatment field 4. A full bladder prevents harmful effects of radiation therapy on the bladder

3. A full bladder moves the bowels out of the treatment field (Radiation therapy may compromise the gastrointestinal function, leading to diarrhea. The small bowel is highly sensitive to radiation therapy and may not tolerate significant doses. A full bladder helps to move the bowels out of the treatment field and minimizes the radiation effects on it. An adequate urine output indicates an adequate fluid intake. A full bladder does not improve the effectiveness of the therapy and does not prevent harmful effects of radiation therapy on the bladder.)

The patient with breast cancer is having teletherapy radiation treatments after surgery. What should the nurse teach the patient about the care of the skin? 1. Use dial soap to feel clean and fresh 2. Scented lotion can be used on the area 3. Avoid heat and cold to treatment area 4. Wear the new bra to comfort and support the area

3. Avoid heat and cold to treatment area (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.)

Which diagnostic tool should the nurse include in the plan of care when determining the needs of a patient who is suspected of having leukemia? 1. BRAC studies 2. Liver function testing 3. Bone marrow aspiration 4. Estrogen and progesterone status

3. Bone marrow aspiration (Bone marrow examinations, such as a bone marrow aspiration, is a diagnostic tool for leukemia. BRAC studies are conducted for a patient suspected of having breast cancer. Liver function testing is conducted for a patient suspected of having liver cancer. Estrogen and progesterone status checks are performed for patients suspected of having uterine cancer.)

Which data collected by the nurse indicates the patient has a complete carcinogen risk factor for the development of cancer? 1. Type 1 obesity 2. Diet high in fat 3. Cigarette smoking 4. Alcohol consumption

3. Cigarette smoking (Cigarette smoke is a complete carcinogen because it is capable of both initiating and promoting the development of cancer. Although alcohol consumption, dietary fat, and obesity are all promoting factors for cancer, they are not considered complete carcinogens.)

A nurse assesses that a patient undergoing radiotherapy has developed erythema and desquamation. Which should the nurse include when educating the patient about skin care in the radiation treatment area? 1. Use perfumes and cosmetics on the treatment area as desired. 2.Wear fabrics such as wool and corduroy to prevent exposure to cold. 3. Gently cleanse the skin using a mild soap, tepid water, and a soft cloth. 4. Allow brief periods of direct exposure to sunlight for good bone health.

3. Gently cleanse the skin using a mild soap, tepid water, and a soft cloth. (The skin should be gently cleansed using a mild soap, tepid water, and a soft cloth. Fabrics such as wool and corduroy should not be worn because they can traumatize the skin. Chemicals like perfumes, cosmetics, and powders should not be used on the treatment area because they are harsh on skin and can increase the irritation of the skin. The skin should not be exposed to direct sunlight. Protective clothing should be worn if exposure to sun is expected.)

The nurse is educating a patient about nutritional methods to decrease the risk of cancer. Which foods should the nurse advise the patient to avoid to decrease the risk of cancer? Select all that apply. 1. Fresh fruit 2. Vegetables 3. Smoked ham 4. Salt-cured meat 5. Poached egg whites

3. Smoked ham 4. Salt-cured meat (Foods that increase the risk for cancer included smoked ham and salt-cured meats because they have high amounts of nitrates used as preservatives. The consumption of these foods should be discouraged. Intake of fresh fruit and vegetables should be encouraged. Poached egg whites are low-fat and should also be encouraged.)

A patient's laboratory report indicates excess human epidermal growth factor receptor 2 (HER-2). What does the nurse interpret from this finding? 1. The patient has lung cancer 2. The patient has colon cancer 3. The patient has breast cancer 4. The patient has prostate cancer

3. The patient has breast cancer (An excess amount of human epidermal growth factor receptor 2 (HER-2) indicates that the patient has breast cancer. Lung cancer is associated with an increase of the epidermal growth factor. kRAS is the specific tumor marker for colon cancer. Prostate-specific antigen (PSA) is specific for prostate cancer.)

The patient is receiving biologic and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? 1. Ibuprofen 2. Ondansetron 3. Acetaminophen 4. Morphine sulfate

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

The primary health care provider prescribes cyclophosphamide to a patient with multiple myeloma. Which complication should the nurse monitor the patient for that can be suspected in this patient? 1. Kaposi sarcoma 2. Burkitt's lymphoma 3. Squamous cell carcinomas 4. Acute myelogenous leukemia

4. Acute myelogenous leukemia (There are certain drugs, which are identified as carcinogens, such as cyclophosphamide. This drug may increase the risk of acute myelogenous leukemia. Kaposi sarcoma may be associated with human immunodeficiency virus (HIV). The risk of Burkitt's lymphoma may be increased due to Epstein-Barr virus (EBV) infection. Squamous cell carcinoma may be caused due to lesions induced by the human papilloma virus.)

A patient has been diagnosed with non-small cell lung cancer. Which type of targeted therapy most likely will be used for this patient to suppress cell proliferation and promote programmed tumor cell death? 1. Proteasome inhibitors 2. CD20 monoclonal antibodies 3. BRC-ABL tyrosine kinase inhibitors 4. Epidermal growth factor receptor-tyrosine kinase inhibitors

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

A patient has been diagnosed with Burkitt's lymphoma. What does the nurse inform the patient that they most likely have had exposure to? 1. Bacteria 2. Sun exposure 3. Most chemicals 4. Epstein-Barr virus

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

The nurse is educating a patient about the early detection of cancer. What should the nurse recommend to this patient to facilitate detection? 1. Eating a diet high in fiber 2. Maintaining a healthy weight 3. Participating in regular exercise 4. Getting routine health screenings

4. Getting routine health screenings (Recommending that the patient get routine health screenings facilitates the early detection of cancer. Eating a diet high in fiber, maintaining a healthy weight, and exercising are all preventative measures related to the development of cancer, but they do not facilitate the early detection of it.)

When caring for the patient with cancer, what does the nurse determine is the response of the immune system to antigens of the malignant cells? 1. Metastasis 2. Tumor angiogenesis 3. Immunologic escape 4. Immunologic surveillance

4. Immunologic surveillance (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, which allows the cancer cells to reproduce.)

The nurse is developing a program for a population with a high incidence of cancer and determines that the male population would benefit. What form of cancer for males should the nurse focus on? 1. Lung cancer 2. Colon cancer 3. Thyroid cancer 4. Prostate cancer

4. Prostate cancer (Among all the cancers in men, prostate cancer has the highest incidence (29%). Lung cancer has the highest death rate among men (29%). The incidence of colon cancer in males is 9%. Thyroid cancer is more common in women than men.)

The nurse reviews the medical record of a patient who had a tumor of the skin that has increased in size to 3 cm. What stage does the nurse determine it could potentially be? 1. T x 2. T 0 3. T is 4. T 4

4. T 4 (In T1-4 stage, the size of the tumor increases, which is measurable. In Tx stage, the tumor size is not measurable. T0 stage indicates no evidence of primary tumor. Tis stage indicates carcinoma in situ.)

A nurse is caring for a patient with breast cancer. The primary health care provider has prescribed trastuzumab for the patient. How does this drug control cell growth in breast cancer? 1. The drug prevents the mechanisms and pathways necessary for vascularization of tumors. 2. The drug prevents blood vessel growth by binding with vascular endothelial growth factor. 3. The drug inhibits BCR-ABL tyrosine kinase that suppresses proliferation of cancer cells and promotes apoptosis. 4. The drug inhibits the abnormal growth of cells by targeting the human epidermal growth factor receptor2 (HER-2) protein.

4. The drug inhibits the abnormal growth of cells by targeting the human epidermal growth factor receptor2 (HER-2) protein. (Trastuzumab (Herceptin) targets the human epidermal growth factor receptor 2 (HER-2). HER-2 is overexpressed in certain cells, especially in breast cancer cells. Trastuzumab acts by binding to HER-2 receptors and inhibits the growth of cells. Angiogenesis inhibitors prevent the mechanisms and pathways necessary for vascularization of tumors. Bevacizumab prevents blood vessel growth by binding with vascular endothelial growth factor. Imatinib inhibits BCR-ABL tyrosine kinase that suppresses proliferation of cancer cells and promotes apoptosis.)

The nurse is reviewing the role of the immune system in cancer development. Which of these statements explains the primary protective role of the immune system related to malignant cells? 1. Immune cells bind with free antigen released by malignant cells 2. Immune cells produce blocking factors that immobilize cancer cells 3. The immune system produces antibodies that attack the cancer cells 4. The immune system provides surveillance for cells with tumor-associated antigens (TAAs)

4. The immune system provides surveillance for cells with tumor-associated antigens (TAAs) (It is believed that one of the functions of the immune system is to respond to TAAs, which are altered cell-surface antigens that occur on a cancer cell as a result of malignant transformation. This immune function is known as immunologic surveillance. Immune cells do not bind with free antigens released by malignant cells, nor do they produce blocking factors that immobilize cancer cells. The immune system does not produce antibodies to attack cancer cells.)

The surgeon uses laparotomy while collecting a tissue sample for cytologic examination. What could be the reason behind this intervention? 1. The lesion is large 2. The lesion in superficial 3. The lesion is not localized 4. The lesion is not easily accessible

4. The lesion is not easily accessible (Laparotomy involves making a large incision in the abdominal wall, which helps provide accessibility to the inner tissues of the abdomen when the lesion is not easily reached. A large lesion is easily accessible, so laparotomy is not required. A superficial lesion is easily accessible, so the patent will not require laparotomy. Computed tomography and magnetic resonance imaging help improve tissue localization.)

The patient is being treated with brachytherapy for cervical cancer. What factors of protection must the nurse be aware of when caring for this patient? 1. The medications the patient if taking 2. The nutritional supplements that will help the patient 3. How much time is needed to provide the patient's care 4. The time the nurse spends with the patient and at what distance

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

The nurse provides instructions regarding markings on the skin to a patient who is undergoing radiation therapy. What explanation should the nurse provide regarding the markings? 1. They are permanent effects of radiation therapy. 2.They indicate that previous treatments have been unsuccessful. 3. They are a warning of potentially serious side effects of radiation. 4. They should be protected because they are landmarks for the radiation therapy.

4. They should be protected because they are landmarks for the radiation therapy. (Markings should be protected from being washed or removed because they are landmarks for the radiation therapy treatment field. They are not permanent; nor are they an indication that previous treatment has been unsuccessful or a warning about the side effects of radiation.)

Which immune response cells produce antibodies that are often detectable in a cancer patient's serum and saliva? 1. B cells 2. T cells 3. Macrophages 4. Natural killer cells

B cells (B cells can produce specific antibodies that bind to tumor cells. These antibodies are often detectable in the patient's saliva and serum. IgA is the principle antibody found in secretions such as saliva, serum, tears, milk, and respiratory and intestinal secretions. T cells stimulate the production of antibodies by the B cells. Macrophages do not produce antibodies. Natural killer cells are able to directly lyse tumor cells.)

A patient with cancer has an elevated serum alpha-fetoprotein level. What does the nurse determine is the reason why this level may be elevated? 1. "The protein may be newly formed due to altered expression of protooncogenes." 2. "This protein may normally get elevated and should not be associated with cancer." 3. "The protein may be newly formed due to altered expression of a tumor-inducing gene." 4. "The protein may be newly formed due to altered expression of a tumor-inhibiting gene."

1. "The protein may be newly formed due to altered expression of protooncogenes." (Carcinogens may induce the unlocking of protooncogenes and cause genetic alterations and mutations. The new proteins, such as alpha-fetoprotein, can be produced by the cancerous cells and can be detected in human blood. Therefore this elevated level may be associated with an altered expression of protooncogenes, because they are associated with cancer and their elevated level should not be considered normal. The alteration of tumor-inducing genes and tumor-inhibiting genes may not be associated with high levels of alpha-fetoprotein.)

A patient with cancer develops sudden onset of chest heaviness, shortness of breath, tachycardia, hoarseness, and a reduced level of consciousness with muted heart sounds. The nurse expects that the immediate treatment plan for this patient will include what interventions? Select all that apply. 1. Administration of IV hydration 2. Administration of vasodilators 3. Administration of oxygen therapy 4. Placement of a pericardial catheter 5. Surgical establishment of a pericardial window

1. Administration of IV hydration 3. Administration of oxygen therapy 4. Placement of a pericardial catheter 5. Surgical establishment of a pericardial window (Sudden onset of heaviness in the chest, shortness of breath, tachycardia, hoarseness, and a reduced level of consciousness with muted heart sounds are suggestive of cardiac tamponade. The nurse manages this patient by administering oxygen to promote tissue oxygenation. A pericardial catheter or surgical establishment of a pericardial window is necessary to relieve pressure from the heart. The patient should be given IV hydration for maintaining fluid balance. The patient should be administered vasopressor therapy, not vasodilators, to avoid a fall in blood pressure.)

The nurse is performing an assessment on a patient who is taking chemotherapy for breast cancer and observes loss of hair in small round areas on the scalp. How will the nurse document this assessment? 1. Alopecia 2. Exotropia 3. Seborrhea 4. Amblyopia

1. Alopecia (Alopecia is the correct term used for hair loss. Exotropia is a form of strabismus in which the eyes deviate outward. Seborrhea, also known as dandruff, is a form of inflammation of the skin resulting in redness and flaking. It may be seen on any part of the body but is usually seen on the scalp. Amblyopia is a visual disturbance characterized by poor vision in one eye with or without structural abnormalities.)

A nurse is caring for a patient experiencing severe side effects of chemotherapy. On examination, the nurse notices stomatitis. Which interventions should the nurse perform to relieve stomatitis? Select all that apply. 1. Apply topical anesthetics 2. Encourage nutritional supplements 3. Give diuretics and laxatives regularly 4. Encourage oral application of alcohol 5. Discourage the use of oral irritants like tobacco

1. Apply topical anesthetics 2. Encourage nutritional supplements 5. Discourage the use of oral irritants like tobacco (Stomatitis is an inflammation of the mouth. It occurs when the epithelial cells get damaged due to chemotherapy or radiation therapy. Topical anesthetics such as viscous lidocaine may be used to provide local pain relief. Nutritional supplements help to meet the nutritional demands when the food intake decreases due to stomatitis. Giving diuretics and laxatives regularly promotes bladder and bowel elimination, but does not help in relieving stomatitis. Oral application of alcohol may have a drying effect on the mucosa and may worsen stomatitis. Use of oral irritants like tobacco should be discouraged because they can worsen stomatitis and increase discomfort.)

A nurse is caring for a patient with lung cancer. The patient's laboratory reports reveal a platelet level of 19,000/μL. What nursing actions will help prevent bleeding complications associated with this lab finding? Select all that apply. 1. Avoid invasive procedures. 2. Ensure proper hand washing. 3. Include iron-rich food in the diet. 4. Obtain a prescription for a platelet transfusion. 5. Instruct the patient to avoid activities that increase the risk of injury.

1. Avoid invasive procedures. 4. Obtain a prescription for a platelet transfusion. 5. Instruct the patient to avoid activities that increase the risk of injury. (The patient is at increased risk of bleeding because the platelet levels are below 20,000/μL. The nurse should avoid any invasive procedures because they can cause bleeding. Platelet transfusion should be performed to increase the platelet levels. The patient should avoid all activities that increase the risk of injury and bleeding because even a minor injury can result in huge blood loss. Proper hand washing should be performed before and after handling any patient; however, it does not help to decrease the bleeding risk. Including iron-rich food in the diet helps to manage anemia, but may not be helpful in decreasing the risk of bleeding.)

A patient undergoing outpatient chemotherapy reports feeling lonely and isolated and expresses the desire to resume normal activities, such as socialization with friends. Which precaution should the nurse recommend when allowing the patient to resume these activities? 1. Avoiding crowds 2. Drinking only bottled water 3. Refraining from eating outside the home 4. Using the bathroom at home, not in public places

1. Avoiding crowds (The nurse needs to teach the patient measures that will protect against infection, such as maintaining adequate nutrition and fluid intake and avoiding crowds, people with infections, and others who have been recently vaccinated with live or attenuated vaccines. Drinking bottled water, eating only at home, and using the bathroom only at home are unnecessary precautions.)

A patient is suspected of having ovarian cancer. What oncofetal antigen does the nurse anticipate seeing when the laboratory results return? 1. CA-125 2. CA-15-3 3. CA-19-9 4. CA-27-29

1. CA-125 (Oncofetal antigens are a type of tumor antigens. They are found on both the surfaces and the inside of cancer cells and fetal cells. These antigens are an expression of the shift of cancerous cells to a more immature pathway, which is associated with fetal periods of life. CA-125 is the oncofetal antigen found in ovarian carcinoma. CA-15-3 is the oncofetal antigen found in breast cancer. CA-19-9 is the oncofetal antigen found in pancreatic and gall bladder cancers. CA-27-29 is found in breast cancer.)

The laboratory report reveals that the cells from the patient's tumor biopsy are Grade II. What should the nurse know about this histologic grading? 1. Cells are abnormal and moderately differentiated 2. Cells are very abnormal and poorly differentiated 3. Cells are immature, primitive, and undifferentiated 4. Cells differ slightly from normal cells and are well differentiated

1. Cells are abnormal and moderately differentiated (Grade II cells are more abnormal than Grade I and moderately 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. Grade I cells differ slightly from normal cells and are well differentiated.)

The nurse is conducting a community seminar regarding cancer prevention and detection. Which diagnostic tool should the nurse include as one that decreases cancer mortality rate through early detection? 1. Colonoscopy 2. Polyp excision 3. Fecal occult blood test 4. Culture and sensitivity test

1. Colonoscopy (A colonoscopy is a diagnostic tool that increases early detection and decreases the mortality rate for colon cancer. Polyp excisions are considered preventative and not diagnostic. Fecal occult blood testing may indicate a problem with the colon that requires further testing; however, this test is a laboratory test and not a diagnostic tool. A culture and sensitivity test will determine if there is a bacterial, fungal, or viral infection; however, this test is laboratory test and not a diagnostic tool.)

The nurse is caring for a patient with Hodgkin's disease who has developed thrombocytopenia after receiving chemotherapy. What is the outcome of highest priority in the nursing plan of care? 1. Controlling bleeding 2. Controlling diarrhea 3. Controlling infection 4. Controlling hypotension

1. Controlling bleeding (Thrombocytopenia is a low platelet count that leaves the patient at high risk for life-threatening spontaneous hemorrhage. Diarrhea and infection are not symptoms associated with thrombocytopenia. Hypotension may be seen if hemorrhagic or hypovolemic shock develops as a result of blood loss stemming from thrombocytopenia)

The patient has multiple myeloma and will be treated with autologous hematopoietic stem cell transplantation because a suitable donor has not been found. In which order will the following procedures occur? Myeloablative chemotherapy is administered. Stem cells are infused after chemotherapy has been eliminated from the body. Peripheral stem cells are obtained from the peripheral blood in an outpatient procedure. Filgrastim, a granulocyte colony-stimulating factor, is administered with plerixafor. Stem cells are treated to remove undetected cancer cells, then cryopreserved and stored until needed.

1. Filgrastim, a granulocyte colony-stimulating factor, is administered with plerixafor. 2. Peripheral stem cells are obtained from the peripheral blood in an outpatient procedure. 3. Stem cells are treated to remove undetected cancer cells, then cryopreserved and stored until needed. 4. Myeloablative chemotherapy is administered. 5. Stem cells are infused after chemotherapy has been eliminated from the body. (When the patient donates the stem cells for the autologous hematopoietic stem cell transplantation, first filgrastim or another granulocyte colony-stimulating factor is given along with plerixafor to increase the number of stem cells released from the bone marrow into the bloodstream. Peripheral stem cells are collected at an outpatient center, treated to remove undetected cancer cells, and cryopreserved to be stored for later use. Then the patient is treated with myeloablative chemotherapy to destroy the bone marrow. The preserved stem cells are then infused after the chemotherapy has been eliminated from the patient's body, approximately 24 to 48 hours after the last dose of chemotherapy.)

Which cancer diagnosis for a female patient is most likely to cause death? 1. Lung cancer 2. Breast cancer 3. Uterine cancer 4. Pancreatic cancer

1. Lung cancer (A lung cancer diagnosis has a 26% death rate for women. Uterine, breast, and pancreatic cancers have death rates of 15%, 4%, and 7%, respectively.)

The nurse is conducting a teaching session within the community regarding cancer prevention and detection. Which type of cancer should the nurse include based on the highest incidence among both men and women? 1. Lung cancer 2. Thyroid cancer 3. Colorectal caner 4. Non-Hodgkin lymphoma

1. Lung cancer (Aside from prostate cancer for men and breast cancer for women, lung cancer has the highest incidence among both men and women. Thyroid cancer affects 7% of women but is not ranked for men. Colorectal cancer is the third most common cancer; however, it ranks below lung cancer. Non-Hodgkin lymphoma affects 5% of men and 4% of women; it also ranks below lung cancer for both sexes.)

The patient and family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation? Select all that apply. 1. Maintain hope 2. Exhibit a caring attitude 3. Plan realistic long-term goals 4. Give them anti-anxiety medications 5. Be available to listen to fears and concerns 6. Teach them about all the types of cancer that could be diagnosed

1. Maintain hope 2. Exhibit a caring attitude 5. Be available to listen to fears and concerns (Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use, as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching the patient and family about the diagnostic procedures also would be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.)

A patient with ovarian cancer is receiving radiation therapy. A nurse finds that the patient has developed anemia as a side effect of radiation therapy. What interventions are appropriate for this patient? Select all that apply. 1. Monitor hemoglobin and hematocrit levels. 2.Monitor WBC count, especially neutrophils. 3. Administer iron supplements and erythropoietin. 4. Promote foods that increase hemoglobin levels. 5. Teach the patient to avoid large crowds and people with infections.

1. Monitor hemoglobin and hematocrit levels. 3. Administer iron supplements and erythropoietin. 4. Promote foods that increase hemoglobin levels. (The hemoglobin and hematocrit levels should be monitored to determine the severity of anemia and the effectiveness of the treatment. Iron supplements and erythropoietin are administered to increase hemoglobin levels. Promoting foods that increase hemoglobin levels help to treat anemia. Monitoring WBC counts and teaching the patient to stay away from crowds are management techniques done in cases of leukopenia.)

A patient with lung cancer has been treated with an anticancer drug that has a high propensity to cause myelosuppression. What nursing interventions would be helpful to this patient? Select all that apply. 1. Monitoring the platelet count 2. Monitoring the basophil count 3. Monitoring the neutrophil count 4. Monitoring the eosinophil count 5. Monitoring the red blood cell (RBC) count

1. Monitoring the platelet count 3. Monitoring the neutrophil count 5. Monitoring the red blood cell (RBC) count (Monitoring the RBC count helps the nurse to detect the severity of anemia and assess the need for administering RBC growth factors or an RBC transfusion. Monitoring the platelet count helps to detect the risk of bleeding in the patient and the need for using platelet growth factors or a platelet transfusion. Monitoring the neutrophil count helps to detect the risk of infection and the need for using white blood cell (WBC) growth factors and measures to prevent infection. Eosinophil and basophil counts should be assessed only in patients who have an allergic predisposition or if the drug is known to produce allergic reactions.)

A patient with a cancer diagnosis is undergoing excisional biopsy. Which anatomic specimen may be removed during the procedure? Select all that apply. 1. Nodule 2. Lymph node 3. Entire lesion 4. Core of tissue 5. Cells from mass

1. Nodule 2. Lymph node 3. Entire lesion (Excisional biopsy involves the surgical removal of nodule, lymph node, or the entire lesion. Large-core biopsy uses the core of the tissue to diagnose cancer. Fine needle aspiration aspirates cells from the mass for cytologic examination.)

When caring for a patient undergoing chemotherapy, which nursing actions should the nurse take to manage fatigue in the patient? Select all that apply 1. Pace activities in accordance with energy level 2. Encourage strenuous exercise to build strength 3. Encourage the patient to be active even when tired 4. Maintain usual lifestyle patterns as much as possible 5. Reassure the patient that fatigue is a common side effect

1. Pave activities in accordance with energy level 4. Maintain usual lifestyle patterns as much as possible 5. Reassure the patient that fatigue is a common side effect (Fatigue is common during cancer treatment, and the patient can be helped to manage it. The nurse should reassure the patient that fatigue is a side effect of treatment that may subside once the treatment is over. Energy-conserving strategies should be adopted, and the patient should pace activities in accordance with his or her energy level, resting when necessary. The patient should maintain usual lifestyle patterns as much as possible and avoid strenuous exercise, instead doing mild or moderate exercise, if possible.)

The nurse is caring for a patient awaiting the results of a diagnostic study for cancer. Which nursing intervention can help decrease the patient's anxiety? 1. Provide written information in simple terms to the patient and family 2. Assure the patient that everyone who may have cancer feels anxious 3. Explain the purpose of the diagnostic test using medical terminology 4. Encourage the patient to wait until after the diagnosis to discuss questions

1. Provide written information in simple terms to the patient and family (Providing the patient and family written information in simple terms will help to decrease anxiety since this information is easily understandable. They will also be able to reference it at a later date if necessary. The purpose of diagnostic tests should be explained in simple, easy-to-understand language. Everyone who may have cancer does not experience the same feelings. Waiting until after the diagnosis to discuss questions does not promote a healing relationship with the family. It allows incorrect information to contribute to increased anxiety over time.)

A nurse is collecting health history information from a patient who states, "I had cancer in the cartilage of my leg." What does the nurse recognize this type of malignancy in the connective tissue is called? 1. Sarcoma 2. Osteoma 3. Adenoma 4. Myeloma

1. Sarcoma (Cancer of the connective tissue is known as a sarcoma. Osteoma refers to cancer originating in bone. Adenoma refers to cancer originating in glandular tissue. Myeloma refers to cancer originating in blood-forming tissues such as bone marrow.)

The diagnostic reports of a patient indicate a benign tumor in the glandular epithelium. What does the nurse document in this patient's medical record? 1. The patient has an adenoma 2. The patient has a chondroma 3. The patient has a meningioma 4. The patient has a rhabdomyoma

1. The patient has an adenoma

A nurse is caring for a patient undergoing brachytherapy for prostate cancer. What actions should the nurse take to protect his or herself from radiation hazards? Select all that apply. 1. Use shielding when providing any care to the patient. 2. Organize care to limit the time spent in direct contact with the patient. 3. Share the film badge with a colleague who forgot his or her own badge. 4. Wear the film badge at all places of work to indicate your nature of work. 5. Limit close proximity to the patient to only those care tasks that must be performed near the source.

1. Use shielding when providing any care to the patient. 2. Organize care to limit the time spent in direct contact with the patient. 5. Limit close proximity to the patient to only those care tasks that must be performed near the source. (When working with patients receiving radiation therapy, the nurse should exercise all precaution to prevent radiation hazards. The precautions include using as low of a dose as possible, limiting the time and distance with and around patient, and shielding oneself. The nurse should organize care to limit the time spent in direct contact with the patient. The nurse should use shielding whenever possible. A film badge indicates cumulative radiation exposure, and all the health professionals in the radiation therapy unit should wear it. The badge should not be shared and should be worn only when working in the radiation therapy unit.)

Which question should the nurse include in the health history interview to determine if a patient is at risk for cancer due to a viral carcinogen? 1. "What foods are in your diet?" 2. "Have you received the hepatitis B vaccination?" 3. "Are you exposed to benzene through your occupation?" 4. "Do you use sunscreen when exposed to sunlight for large periods of time?"

2. "Have you received the hepatitis B vaccination?" (The hepatitis B virus is considered a viral carcinogen because it is linked to the development of certain types of cancer; therefore, this question is appropriate to determine the patient's exposure to viral carcinogens. While a diet high in fat is a risk factor for cancer, it is not a viral carcinogen. Benzene is a chemical carcinogen. Sun exposure is a radiation carcinogen.)

The community nurse is teaching preventive cancer measures to a group of people. Which statements indicate effective learning by the participants? Select all that apply. 1. "We should sleep for at least four to five hours." 2. "We should avoid smoked and salt-cured meats." 3. "We should exercise for about 30 minutes in a week." 4. "We should add whole grains and fiber foods in our diet." 5. "We should be familiar with our family history regarding health."

2. "We should avoid smoked and salt-cured meats." 4. "We should add whole grains and fiber foods in our diet." 5. "We should be familiar with our family history regarding health." (Nitrites acts as carcinogenic agents. Smoked and salt-cured meats have a high nitrite concentration; therefore, smoked and salt-cured meats should be avoided to prevent cancer. Eating a balanced diet containing whole grains and adequate fiber can also prevent cancer. Awareness about one's family's health history can be useful in early screening of the disease. Adequate, consistent periods of rest for at least six to eight hours are required to prevent cancer. Regular exercise for 30 minutes or more at least five times a week is beneficial to prevent cancer.)

A patient with cancer of the esophagus presents with weight gain without edema, anorexia, and oliguria. Which nursing measures would help to relieve the patient's symptoms? Select all that apply. 1. Encourage fluid intake. 2. Administer furosemide. 3. Withhold demeclocycline. 4. Administer 0.9% saline solution. 5. Administer 3% sodium chloride solution.

2. Administer furosemide. 4. Administer 0.9% saline solution. 5. Administer 3% sodium chloride solution. (The presence of weight gain without edema, anorexia, and oliguria in a patient with cancer of the esophagus is suggestive of syndrome of inappropriate antidiuretic hormone (SIADH). It involves increased secretion of antidiuretic hormone (ADH). The management involves administering furosemide in the initial stages to facilitate excretion of excess fluid. Isotonic solutions like 0.9% saline solution are administered in mild cases to prevent dehydration; 3% saline solution is administered in severe cases. Patients should have fluid restrictions. Demeclocycline is helpful in moderate cases of SIADH.)

A nurse is caring for a patient with a benign breast tumor. What are the characteristics that differentiate a benign tumor from a malignant tumor? Select all that apply. 1. Benign tumors are metastatic. 2. Benign tumors are encapsulated. 3. Benign tumors are well differentiated. 4. Benign tumors have a low rate of recurrence. 5. Benign tumors infiltrate the neighboring areas.

2. Benign tumors are encapsulated. 3. Benign tumors are well differentiated. 4. Benign tumors have a low rate of recurrence. (Benign tumors of the breast are encapsulated and have a well-defined border. They have well-differentiated cells. Once treated, benign tumors have a low rate of recurrence. Unlike malignant tumors, benign tumors are not metastatic and do not infiltrate the neighboring areas.)

The diagnostic reports of a patient indicate cancer in the pancreas and gallbladder. Which oncofetal antigen is specific for this type of cancer? 1. Carbohydrate antigen-125 (CA-125) 2. Carbohydrate antigen-19-9 (CA-19-9) 3. Carbohydrate antigen-15-3 (CA-15-3) 4. Carbohydrate antigen-19-9 (CA-27-9)

2. Carbohydrate antigen-19-9 (CA-19-9) (Cancers of the pancreas and gall bladder have specific oncofetal antigens, CA-19-9. CA-125 is the oncofetal antigen specific to ovarian cancer. CA-15-3 and CA-27-9 are the oncofetal antigens specific to breast cancer.)

A patient has a brain tumor. Which biopsy used as a surgical procedure to diagnose and remove the tumor will the nurse prepare the patient for? 1. Incisional biopsy 2. Excisional biopsy 3. Endoscopic biopsy 4. Percutaneous biopsy

2. Excisional biopsy (Excisional biopsy is a surgical procedure that involves the removal of the entire lesion, lymph node, nodule, or mass. This biopsy, unlike others, involves the removal of a piece of the tumor for pathologic analysis. Incisional biopsy is partial excision of the tumor, which can be performed through a scalpel or dermal punch. It is performed only if an excisional biopsy is not possible. Endoscopic biopsy is performed to remove a sample of tissue for pathologic analysis from the lungs or other intraluminal lesions (esophageal, colon, and bladder). Percutaneous biopsy is commonly performed for tissues that can be safely reached through the skin.)

A patient needs surgical removal of the lymph node. Which intervention should the nurse prepare the patient for? 1. Incisional biopsy 2. Excisional biopsy 3. Large-core biopsy 4. Fine needle aspiration

2. Excisional biopsy (Excisional biopsy is performed for complete removal of a lesion, lymph node, nodule, or mass. Incisional biopsy is a partial excision. Large-core biopsy is performed to remove actual pieces of tissue so they can be investigated. Fine needle aspiration is performed to aspirate cells from the mass for cytologic examination.)

A nurse is caring for a patient receiving chemotherapy for osteosarcoma of the tibia and experiencing nausea and vomiting. What explanation does the nurse give to the patient related to these side effects? Select all that apply. 1. Depression of bone marrow 2. Release of intracell breakdown products 3. Destruction of gastrointestinal (GI) lining 4. Release of TNF and IL - 1 from macrophages 5. Precipitation of metabolites of cell breakdown

2. Release of intracell breakdown products 3. Destruction of gastrointestinal (GI) lining (Nausea and vomiting are common side effects of chemotherapy. These are caused when the intracell breakdown products formed in response to chemotherapy stimulate the vomiting center in the brain. Destruction of the gastrointestinal (GI) lining as a result of chemotherapy may interfere with the digestion process and cause nausea and vomiting. Release of tumor necrosis factors (TNF) and interleukin-1 (IL-1) from macrophages has an appetite-suppressing action and tends to cause anorexia. Precipitation of metabolites of cell breakdown may cause nephrotoxicity. Depression of bone marrow does not cause nausea and vomiting; it may cause anemia, leukopenia, and thrombocytopenia.)

The family of an African American patient with a recent diagnosis of late-stage cancer is asking the nurse whether cancer is related to their race. Which response by the nurse correctly reflects the cancer incidence in relation to racial disparities? 1. "Sadly, racial disparities related to cancer death rates are increasing." 2. "Cancer rates for African American women are much higher than those for white women." 3. "African Americans are generally at a later stage of cancer when they receive a diagnosis." 4. "The rates of cancer for African American men is high, but cancer rates are much higher for Native American men."

3. "African Americans are generally at a later stage of cancer when they receive a diagnosis." (African Americans are generally at a later stage of cancer when they receive a diagnosis. Overall, racial disparities in relation to cancer death rates are decreasing. The incidence of cancer in women is highest among white women, not African-American women. The cancer incidence among African Americans is higher than that for Native American men.)

The nurse is conducting a health history for a patient during an annual physical examination. Which question is appropriate for determining the patient's risk for cancer related to inflammation? 1. "Are you exposed to radiation at work?" 2. "How many cigarettes do you smoke daily?" 3. "How do you manage your ulcerative colitis?" 4. "Are you prescribed hormone replacement therapy?"

3. "How do you manage your ulcerative colitis?" (Ulcerative colitis is a condition that causes chronic inflammation and an increased risk for cancer; therefore, this question is appropriate for assessing the cancer risk related to inflammation. Although radiation, hormone replacement, and cigarettes all increase the risk for cancer, these questions do not determine the risk for cancer caused by chronic inflammation.)

The nurse is discussing the effects of chemotherapy with a patient who has a new diagnosis of cancer. Which statement by the patient reflects an adequate understanding of the teaching? 1. "I will need to use effective birth control methods for the rest of my life." 2. "My doctor will stop the chemotherapy if nausea and vomiting occur during treatment." 3. "I will join a support group after my therapy is finished to help me get back on my feet." 4. "I probably won't be able to do anything I used to do anymore now that I have cancer."

3. "I will join a support group after my therapy is finished to help me get back on my feet." (The impact of a cancer diagnosis can affect many aspects of a patient's life, with cancer survivors commonly reporting financial, vocational, marital, and emotional concerns even long after treatment is over. These psychosocial effects can play a profound role in a patient's life after cancer, with issues related to living in uncertainty being encountered frequently. Participation in appropriate supportive care and community resources would benefit the patient in recovery or ongoing care. It will not be necessary for the patient to use birth control for the rest of the patient's life; nausea and vomiting are expected effects of chemotherapy and treatment will continue unless the vomiting becomes severe; and though some of the patient's normal activities may be affected, not all will be affected.)

The registered nurse is teaching a student nurse about cancer cell proliferation. Which statement given by the student nurse indicates a need for further teaching? 1. "The cancer cells respond differently to the intracellular signals." 2. "The rate of proliferation of cancer cells is the same as normal cells." 3. "The rate of proliferation of cancer cells is more rapid than normal cells." 4. "There is an indiscriminate and continuous proliferation of cancer cells."

3. "The rate of proliferation of cancer cells is more rapid than normal cells." (The rate of proliferation of cancer cells is not as rapid as that of normal cells. Cancer cells respond differently to the intracellular signals that regulate the state of equilibrium in the body. The rate of proliferation of cancer cells is the same as that of normal cells in the tissue from which they originate. The only difference between the normal cells and cancer cells is the indiscriminate and continuous proliferation of cancer cells, unlike the normal body cells.)

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency? 1. Hypokalemia 2. Hypouricemia 3. Hypocalcemia 4. Hypophosphatemia

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

A patient recently has been diagnosed with stage II cervical cancer. What should the nurse determine regarding the patients diagnosis? 1. It is in situ. 2. It has metastasized. 3. It has spread locally. 4. It has spread extensively.

3. It has spread locally. (Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ. Stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread and stage IV denotes metastasis.)

The patient is told that the adenoma tumor is encapsulated, but has normally differentiated cells and that surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? 1. It will recur 2. It has metastasized 3. It is probably benign 4. It is probably malignant

3. It is probably benign (Benign tumors usually are encapsulated and have normally differentiated cells. They do not metastasize and rarely recur as malignant tumors do. Surgery is necessary because the tumor may become malignant and has the potential to cause health complications over time.)

When discussing cancer diagnoses with a patient, which should the nurse identify as the only definitive method? 1. Genetic markers 2. Radiographic studies 3. Pathologic evaluation 4. Endoscopic examination

3. Pathologic evaluation (Pathologic examinations are the only definitive method for cancer diagnosis. Genetic markers, radiographic studies, and endoscopic examinations may all be used in the diagnostic process, but these methods are not definitive for the diagnosis of cancer on their own.)

A patient with breast cancer who recently had extensive surgical procedures develops hypotension, tachycardia, and decreased urinary output. Which nursing actions would be useful for management of this patient? Select all that apply. 1. Discourage fluid intake. 2. Administer fibrinolytic agents. 3. Replace fluids and electrolytes. 4. Administer plasma protein replacement. 5. Prepare the patient for radiation therapy.

3. Replace fluids and electrolytes. 4. Administer plasma protein replacement. (Extensive surgical procedures in a cancer patient can lead to third space syndrome, which involves a shift of fluid from the vascular space to the interstitial space. Its management involves replacement of plasma proteins and fluid and electrolytes. The use of fibrinolytic agents further aggravates the patient's condition. Fluid intake should be encouraged, not discouraged. Use of radiation therapy does not prevent the shifting of fluids.)

The nurse is preparing a patient for diagnostic testing for a suspected malignancy. What is the most appropriate statement by the nurse? 1. "Everyone feels this way." 2. "Let's discuss this more later." 3. "There is probably nothing wrong." 4. "Here is information about the biopsy."

4. "Here is information about the biopsy." (Providing the patient with easily understandable information regarding the process of diagnostic testing is an appropriate response by the nurse. The nurse should avoid communication patterns that may hinder exploration of feelings and meaning, such as providing false reassurances (for example, "There is probably nothing wrong"), redirecting the discussion (for example, "Let's discuss that later"), generalizing (for example, "Everyone feels this way"), and using overly technical language.)

Which patient statement indicates the need for further education regarding cancer prevention after a teaching session with the outpatient clinic nurse? 1. "I will reduce stressors in my life." 2. "I will eat a diet that is low in preservatives." 3. "I will get at least six hours of sleep each night." 4. "I will exercise for 20 minutes three days a week."

4. "I will exercise for 20 minutes three days a week." (Participating in regular exercise is a cancer prevention strategy; however, 30 minutes of activity five days a week (not 20 minutes three days a week) is the generally accepted recommendation. Reducing stress, eating a diet low in preservatives, and sleeping at least six hours each night are all indicative of correct understanding of the information presented.)

The nurse is with a patient who is anxious while waiting for a biopsy for cancer detection. Which statement made by the nurse will help alleviate the anxiety and achieve accurate test results? 1. "We will talk about the pain during the biopsy procedure." 2. "It's nothing new; every person detected with cancer feels this way." 3. "I know you are anxious, but it is nothing new. You are just over thinking it." 4. "You may have pain during the procedure, but you will receive treatment for it."

4. "You may have pain during the procedure, but you will receive treatment for it." (Reassuring and informing the patient that he or she will have pain during the procedure that will be treated will help reduce the patient's anxiety and ensure accurate test results. The patient is anxious that he or she may have cancer, so the nurse should focus on helping the patient. Redirecting the conversation by saying "We will discuss later" will discourage open communication. Providing false reassurance by saying, "These effects are common and everyone has the same effect" will discourage communication and make the patient feel neglected. Generalizing the patient's concern by saying that it's nothing new and everyone feels same will also reduce effective communication.)

The nurse is caring for a patient with anorexia secondary to chemotherapy. Which strategy would be most appropriate for the nurse to use to increase the patient's nutritional intake? 1. Increase intake of liquids and mealtime to stimulate appetite 2. Serve three large meals per day plus snacks between each meal 3. Avoid the use of liquid protein supplements to encourage eating at mealtime 4. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods

4. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods (The nurse can increase the nutritional density of foods by adding items high in protein or calories (such as peanut butter, skim milk powder, cheese, or honey) 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 tolerated best. Supplements can be helpful to promote improved nutritional status so should not be avoided.)

A patient is diagnosed with stage IV malignant cancer. What anatomic extent of the disease does the nurse determine is present? 1. Cancer is in situ 2. Tumor growth is localized 3. Spread of cancer cells is limited 4. Cells have undergone metastasis

4. Cells have undergone metastasis (In a patient with stage IV malignant cancer, the cells have undergone metastasis. Cancer in situ indicates stage 0 malignancy. The limited spread of cancer cells indicates stage II malignancy. Localized growth of the tumor indicates stage III malignancy. )

The nurse is preparing a patient to have a biopsy. What documentation on the surgical permit does the nurse ensure is correct that will improve tissue localization during the procedure? 1. Craniotomy 2. Thoracotomy 3. Sigmoidoscopy 4. Computed tomography

4. Computed tomography (Computed tomography is a diagnostic procedure that can be performed in combination with biopsy to improve tissue localization; this technique helps to visualize the tumor. Craniotomy and thoracotomy are surgical procedures that are performed when the tumor is not easily accessible. Sigmoidoscopy is an endoscopic examination, which is useful to diagnose cancer, but it does not help in tumor localization.)