CHAPTER 16 ONCOLOGY!
The patient is receiving biologic and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? A. Morphine sulfate B. Ibuprofen (Advil) C. Ondansetron (Zofran) D. Acetaminophen (Tylenol)
D
When caring for the patient with cancer, what does the nurse understand as the response of the immune system to antigens of the malignant cells? A. Metastasis B. Tumor angiogenesis C. Immunologic escape D. Immunologic surveillance
D
Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? A. Firm-bristle toothbrush B. Hydrogen peroxide rinse C. Alcohol-based mouthwash D. 1 tsp salt in 1 L water mouth rinse
D
Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D. Risk for infection
D
The primary difference between benign and malignant neoplasms is the a. rate of cell proliferation b. site of malignant tumor c. requirements of cellular nutrients d. characteristic of tissue invasiveness
d
The laboratory reports that the cells from the patient's tumor biopsy are Grade II. What should the nurse know about this histologic grading? A. Cells are abnormal and moderately differentiated. B. Cells are very abnormal and poorly differentiated. C. Cells are immature, primitive, and undifferentiated. D. Cells differ slightly from normal cells and are well-differentiated.
A
Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? A. A bland, low-fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods
A
The nurse assesses a 76-year-old man with chronic myeloid leukemia receiving nilotinib (Tasigna). It is most important for the nurse to ask which question? A. "Have you had a fever?" B. "Have you lost any weight?" C. "Has diarrhea been a problem?" D. "Have you noticed any hair loss?"
A
The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation (select all that apply)? A. Maintain hope. B. Exhibit a caring attitude. C. Plan realistic long-term goals. D. Give them anti anxiety medications. E. Be available to listen to fears and concerns. F. Teach them about all the types of cancer that could be diagnosed.
A, B, E
The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency? A. Hypokalemia B. Hypouricemia C. Hypocalcemia D. Hypophosphatemia
C
A 64-year-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to this patient's plan of care? A. Weigh the patient every month to monitor for weight loss. B. Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. C. Provide high-protein and high-calorie, soft foods every 2 hours. D. Apply palifermin (Kepivance) liberally to the affected oral mucosa.
C
The female patient is having whole brain radiation for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? A. "When your hair grows back it will be patchy." B. "Don't use your curling iron and that will slow down the loss." C. "You can get a wig now to match your hair so you will not look different." D. "You should contact "Look Good, Feel Better" to figure out what to do about this."
C
The nurse is teaching a wellness class to a group of women at their workplace. The nurse knows that which woman is at highest risk for developing cancer? A. A woman who obtains regular cancer screenings and consumes a high-fiber diet B. A woman who has a body mass index of 35 kg/m2 and smoked cigarettes for 20 years C. A woman who exercises five times every week and does not consume alcoholic beverages D. A woman who limits fat consumption and has regular mammography and Pap screenings
B
The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? A. Ask the patient if the site hurts. B. Turn off the chemotherapy infusion. C. Call the ordering health care provider. D. Administer sterile saline to the reddened area.
B
What can the nurse do to facilitate cancer prevention for the patient in the promotion stage of cancer development? A. Teach the patient to exercise daily. B. Teach the patient promoting factors to avoid. C. Tell the patient to have the cancer surgically removed now. D. Teach the patient which vitamins will improve the immune system.
B
A 33-year-old patient has recently been diagnosed with stage II cervical cancer. What should the nurse understand about the patient's cancer? A. It is in situ. B. It has metastasized. C. It has spread locally. D. It has spread extensively.
C
The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg and it is getting worse. What assessment question should the nurse ask the patient to determine treatment measures for this patient's pain? A. "Where is the pain?" B. "Is the pain getting worse?" C. "What does the pain feel like?" D. "Do you use medications to relieve the pain?"
C
The patient is told that the adenoma tumor is not encapsulated but has normally differentiated cells and that surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? A. It will recur. B. It has metastasized. C. It is probably benign. D. It is probably malignant.
C
The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? A. It is delivered via an Ommaya reservoir and extension catheter. B. It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. C. A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration. D. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.
C
The patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? A. Use Dial soap to feel clean and fresh. B. Scented lotion can be used on the area. C. Avoid heat and cold to the treatment area. D. Wear the new bra to comfort and support the area.
C
Which cellular dysfunction in the process of cancer development allows defective cell proliferation? A. Proto-oncogenes B. Cell differentiation C. Dynamic equilibrium D. Activation of oncogenes
C
A 70-year-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? A. Weight gain of 2 lb B. Urine specific gravity of 1.015 C. Blood urea nitrogen of 20 mg/dL D. Serum sodium level of 118 mEq/L
D
A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? A. Bacteria B. Sun exposure C. Most chemicals D. Epstein-Barr virus
D
The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate for the nurse to use to increase the patient's nutritional intake? A. Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.
D
The nurse is caring for an 18-year-old female patient with acute lymphocytic leukemia who is scheduled to receive hematopoietic stem cell transplantation (HSCT). Which statement, if made by the patient, indicates a correct understanding of the procedure? A. "After the transplant I will feel better and can go home in 5 to 7 days." B. "I understand the transplant procedure has no dangerous side effects." C. "My brother will be a 100% match for the cells used during the transplant." D. "Before the transplant I will have chemotherapy and possibly full body radiation."
D
The patient has been diagnosed with non-small cell lung cancer. Which type of targeted therapy will most likely be used for this patient to suppress cell proliferation and promote programmed tumor cell death? A. Proteasome inhibitors B. BCR-ABL tyrosine kinase inhibitors C. CD20 monoclonal antibodies (MoAb) D. Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TK)
D
The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? A. The medications the patient is taking B. The nutritional supplements that will help the patient C. How much time is needed to provide the patient's care D. The time the nurse spends at what distance from the patient
D
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
d
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 G1 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
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
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 in spite of host control mechanisms
d
A patient on chemotherapy for 10 weeks started at a weight of 121 pounds now weighs 118 pounds and has no sense of taste. Which intervention would be a priority? A. advise the patient to eat foods that are fatty, fried, or high in calories b. discuss with the physician the need for parenteral or enteral feedings c. advise the patient to drink nutritional supplement beverages at least three times a day d. advise the patient to experiment with spices and seasonings to enhance the flavor of food
d
14. A patient with the genetic mutation of capital 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
17. Which classification of chemotherapy drugs is cell cycle phase- nonspecific, breaks that DNA helix which interviews with the capital of DNA replication, and crosses the blood- brain barrier? a. nitrosureas b. antimetabolites c. mitotic inhibitors d. antitumor antibiotics
a
19. 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 on the brain
a
25. To prevent a 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. To the most stressful activities when fatigue is tolerable d. Schedule rest periods throughout the day whether fatigue is present or not
a
30. During initial chemotherapy a patient with leukemia develops hyperkalemia and hyperuricemia. The nurse recognizes these symptoms as a 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 Aredia d. Restrict fluids and administer hypertonic sodium chloride solution
a
9. Which word identifies a mutation of protooncogenes? A. Oncogenes B. Retrogenes c. oncofetal antigens D. tumor angiogenesis factor
a
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 patients hope b. Preparing a will and advance directives c. Discussing replacement child care for the patients children d. Discussing the patient's past experience with her grandmother's cancer
a
As 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 complication of cancer is this most likely caused by: a. hypercalcemia b. tumor lysis syndrome c. Spinal cord compression d. Superior Vena Cava syndrome
a
The nurse is presenting to a community education program related to cancer prevention. Based on current cancer death rates, the nurse emphasizes what as the most important preventive action for both men and women? a. smoking cessation b. routine colonoscopies c. protection from ultraviolet light d. regular examination of reproductive organs
a
The primary protective role of the immune system related to malignant cells is a. surveillance for cells with tumor-associated antigens b. binding with free antigen released by malignant cells c. production of blocking factors that immobilize cancer cells d. responding to a new set of antigenic determinant of cancer cells
a
32. Which factors will assist patient and coping positively with having cancer? SATA a. Feeling of control b. Strong support system c. Internalization of feelings d. Possibility of cure or control e. A young person will adapt more easily f. Not having had to cope with previous stressful events
a, b, d
What features of cancer cells distinguish them from normal cells? SATA a. Cells lack contact inhibition b. Cells return to previous undifferentiated state c. oncogenes maintain normal cell expression d. Proliferation occurs when there is a need for more cells e. New proteins characteristic of embryonic stage emerge on cell membrane
a, b, e
cancer cells go through stages of development. What accurately describes the stage of promotion? SATA 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
12. The nurse is canceling a group of individuals over the age of 50 with average risk for cancer of all screening tests for cancer. Which screening recommendations should be performed to screen for colorectal cancer? A. Barium enema every year B. colonoscopy every 10 years c. Fecal occult blood every five years d. Annual prostate specific antigen and digital rectal exam
b
13. A small lesion is discovered in a patient's lung when x-ray is performed for cervical spine pain. What is the definitive method of determining if the lesion is malignant? A. Once can B. Tissue biopsy C. Oncofetal antigens in the blood D. CT or PET scan
b
16. What patient would be most likely to be cured with chemotherapy as a treatment matter? A. small cell lung cancer B. New neuroblastoma C. Small tumor of the bone D. Large hepatocellular carcinoma
b
21. when teaching the patient with cancer about chemotherapy, which approach should the nurse take? a. Avoid telling the patient of all possible side effects of the drugs to prevent anticipatory anxiety b. explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control side effects c. Assure the patient up the side effects from chemotherapy and are uncomfortable but never life threatening d. Inform the patient that chemotherapy related alopecia is usually permanent but can Be managed with Life-long use of wigs
b
24. When a patient is undergoing brachytherapy, what is it 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 badge is during care c. The goal of this treatment is only palliative and 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
26. 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 myelosuppresion
b
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
b
The nurses uses many precautions during IV administration of vesicant chemotherapeutic agents primarily to prevent a. septicemia b. extravasation c. catheter occlusion d. anaphylactic shock
b
To prevent fever and shivering during infusion of rituxan, the notion pre-medicate the patient with: a. Aspirin b. Acetaminophen c. sodium bicarbonate d. demerol
b
The most effective method of administering a chemo agent that is a vesicant is to A. give it orally b. give it intraarterially c. use an Ommaya reservoir d. use a central venous access device
d
a patient is admitted with AML and has a history of Hodgkin's lymphoma. What is the nurse likely 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
28. 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
29. An allogenic hematopoietic stem cell transplant is considered as treatment for a patient with AML. What information should the nurse include when teaching the patient about this procedure? a. There's no risk for graft vs. host disease because the donated marrow is treated to remove cancer cells b. The patients bone marrow will be removed, treated, sorted, 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 post transplant protective isolation because the stem cells are infused directly into the blood
c
A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9, hemoglobin of 10.8, and a platelet count of 99. Based on the CBC results, what is the most serious clinical finding a. Cough, Rhinitis, and sore throat b. fatigue, nausea, and skin redness at site of radiation c. Temperature of 101.9 F, fatigue, and shortness of breath d. Skin redness at site of radiation, headache, and constipation
c
The goals of cancer treatment are based on the principle 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 modification
c
The nurse counsels the patient receiving radiation therapy or chemotherapy that A. effective birth control should be used for the rest of the patients life b. if N/V occur during treatment, the treatment plan will be modified c. following successful treatment, a return to the persons previous functional level can be expected d. the cycle of fatigue-depression-fatigue that may occur during treatment can be reduced by restricting activity
c
What describes a primary use of biologic therapy in cancer treatment? a. protect normal rapidly reproducing cells of the GI system from damage during chemotherapy b. prevent the fatigue associated with chemotherapy and high dose radiation as seen with bone marrow depression c. enhance or supplement the effects of the host's immune responses to tumor cells that produce flu-like symptoms d. depress the immune system and circulating lymphocytes, as well as increasing a sense of well-being by replacing central nervous system deficits
c
Which normal tissues manifest early, acute responses to radiation therapy? a. spleen and liver b. kidney and nervous tissue c. bone marrow and gastrointestinal mucosa d. hollow organs such as the stomach and bladder
c
The nurse is care for a 59 year old woman who had surgery one day ago for removal of a suspected malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and say that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to a. motivate change in unhealthy lifestyle b. educate her about the seven warning signs of cancer c. instruct her about healthy stress relief and coping practices d. allow her to communicate about the meaning of this experience
d
20. Which delivery system would be used to deliver regional chemotherapy for metastasis from primary colorectal cancer? a. intrathecal b. intraarterial c. intravenous d. intraperitoneal
d
23. The patient is learning about skin care related to the external radiation that he is receiving. Which instructions should the nurse including these teaching? a. Moisturize skin with lotion b. Keep the area covered if it is sore c. Try the skin thoroughly after cleansing it d. Avoid extreme temperatures to the area
d
31. 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 an NSAID b. Assess the patient vital signs and behavior to determine the medication to use c. Have the patient keep a pain diary to better assess the patient potential addiction d. Obtain a detailed pain history including quality, location, intensity, duration, and type of pain
d
