Exam 3

A patient with lung cancer tells the nurse, "I know I am going to die pretty soon, perhaps in the next month." In which way would the nurse respond?

"What are your feelings about 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 thinking you may die soon?" does both and is a helpful response that encourages further communication between patient and nurse. Ignoring the patient's feelings is not respectful or therapeutic communication. Calling the spiritual advisor is reasonable but shuts off communication in the short term. The patient is expressing feelings; medication is not indicated.

A patient with lung cancer develops headaches, facial edema, periorbital edema, and distention of the veins in the head, neck, and chest. Which items will the nurse expect to be included in the patient's collaborative treatment plan? Select all that apply.

A lung cancer patient who presents with headaches, facial edema, periorbital edema, and distension of veins of the head, neck, and chest is indicative of superior vena cava syndrome. Management of this condition involves treating the patient with localized radiation therapy. If the cancer is sensitive to drugs, then the patient may also be treated with chemotherapy. Superior vena cava syndrome is a medical emergency; hence, just administering a pain killer and diuretic will only provide symptomatic relief without any effect on disease progression. Superior vena cava syndrome is due to obstruction of the superior vena cava and not the bronchus.

A patient with lung cancer has intense, localized, persistent back pain and motor and sensory disturbances. Which interventions may be included in this patient's collaborative plan of care? Select all that apply.

A patient with lung cancer who has symptoms of intense, persistent, and localized back pain associated with motor and sensory disturbances may have spinal cord compression. Therefore this patient would require administration of corticosteroids, radiation therapy, and surgical decompression (laminectomy). Corticosteroids help to prevent inflammation related to the spinal cord compression. Radiation therapy helps to control metastasis. Surgical decompression helps to relieve the pressure from the nerves and provide relief from symptoms. To provide symptomatic relief, the patient needs to receive narcotics and be immobilized.

patient's laboratory report reveals that the cells from the tumor biopsy are grade II. Which interpretation would the nurse make about the tumor cells?

Abnormal and moderately differentiated Grade II cells are more abnormal than grade I cells and are 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.

Which medication would the nurse expect to administer before biologic and targeted therapy for ovarian cancer?

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 it is not used first to combat flu-like symptoms such as headache, fever, chills, and myalgias.

The nurse performing an assessment on a patient who is taking chemotherapy observes hair loss in small areas of the scalp. How will the nurse document this finding?

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 patient with breast cancer who is receiving chemotherapy has developed alopecia and is noticeably upset. Which recommendations would the nurse make? Select all that apply.

Alopecia refers to loss of hair from the head or the body and is a common side effect of cancer treatment. The patient can use scarves and wigs to improve body image. Long hair should be cut before therapy, because it needs more care and is more prone to fall out. Hair dryers should be avoided because their use can worsen alopecia. Shampoos are chemicals that may harm the hair and should not be used daily. Brushing and combing should be done carefully and infrequently because excessive brushing and combing can worsen alopecia.

A patient with lung cancer who is being treated with chemotherapy reports anorexia. Which actions will the nurse take to support this patient's nutritional status? Select all that apply.

Anorexia refers to a decrease in appetite and is a common side effect of chemotherapy. It increases the risk of malnutrition in the patient. The nurse should monitor the weight of the patient frequently to determine any weight loss. Nutritional supplements can be used to meet the increased demand of nutrients due to cancer and its treatment. The patient's food should be high in calories and proteins to meet the energy requirements and compensate for the protein loss due to cell lysis. Nausea and vomiting are symptoms of anorexia and should be managed to promote food intake. Small and frequent meals are better tolerated than large meals.

The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. Which action would the nurse take first?

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

Which characteristics describe a benign tumor? Select all that apply.

Benign tumors 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.

A patient states, "I had cancer in the cartilage of my leg." Which term would the nurse expect to find in the patient's health record?

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.

A patient undergoing chemotherapy has a low white blood cell (WBC) count. Which intervention would the nurse anticipate?

Chemotherapy may suppress the proliferation of bone marrow, resulting in neutropenia, or low WBC counts. Low WBC count makes the patient prone to developing infections; therefore the nurse should consult the health care provider and get WBC growth factors administered. In addition, the nurse should monitor the temperature of the patient because it can indicate fever. The number of visitors should be limited to prevent risk of infection. The chemotherapy dose need not be reduced, because neutropenia is a common side effect. Respiratory rate is routinely monitored, but in this case it is not directly related to the patient's WBC.

A patient who is undergoing a diagnostic workup for cancer expresses anxiety about the results. Which response would the nurse make?

During the diagnostic workup of cancer, it is common for patients to be anxious. The nurse should actively listen to all concerns expressed. The nurse should not use communication patterns that may hinder exploration of feelings and meanings. "It is probably nothing" may indicate that the nurse is giving false reassurances. "Let's discuss that later" may mean that the nurse is delaying the discussion, and "Everyone feels this way" means that the nurse is generalizing the patient's concern. By using these strategies, the nurse may deny patients the opportunity to share the meaning of their experience.

Which actions would the nurse include to help manage fatigue in a patient undergoing chemotherapy? Select all that apply.

Fatigue is common during cancer treatment, and the patient can be helped to manage it. 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 should reassure the patient that fatigue is a side effect of treatment that may subside once the treatment is over. Moderate exercise may be helpful, but strenuous activities and pushing when tired are not recommended.

A patient with multiple myeloma is sleeping most of the day, has no energy or appetite, and does not seem to care about anything. The patient reports nocturia. Which complication will the nurse suspect?

Hypercalcemia can occur with multiple myeloma. The primary manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, ECG changes, polyuria and nocturia, anorexia, nausea, and vomiting. Serum levels of calcium in excess of 12 mg/dL (3 mmol/L) often produce these symptoms, and significant calcium elevations can be life threatening. The symptoms are not indicative of tumor lysis syndrome, spinal cord compression, or hypokalemia.

Which response does the immune system normally make to antigens of malignant cells?

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.

A patient who is undergoing external beam radiation therapy asks, "Will I be radioactive after the treatment?" Which information will the nurse provide in response?

In external beam radiation therapy, gamma radiation is focused toward the treatment field. The patient does not absorb or retain any of the radiation particles during the treatment and is therefore not radioactive during or after the treatment period. A patient is only radioactive when there is some form of internal radiation, such as brachytherapy as a sealed source, or an unsealed liquid radioactive source. These sources have short half-lives and are weak emitters. In these types of radiation treatments, stool, and urine, and blood will emit some radiation. The principles of ALARA (as low as reasonably achievable) and TDS (time, distance, and shielding) should always be followed.

Which statement explains the primary protective role of the immune system related to malignant cells?

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.

On which interventions would the nurse focus for a patient who is diagnosed with early-stage cervical cancer? Select all that apply

Maintaining hope is the key to effective cancer care. Listening to the patient's fears and concerns provides a basis for therapeutic communication. It is also important to assist the patient in maintaining usual lifestyle patterns as much as possible. Discussing replacement child care is not appropriate at this time. Provide essential information is important, but extreme details about future possible treatment may increase anxiety.

Which explanation would the nurse provide about the skin markings to a patient who is undergoing 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 item would the nurse recommend to a patient with cancer who is at risk for oral-tissue injury?

Oral assessment and meticulous intervention to keep the oral cavity moist, clean, and free of debris are essential to prevent infection and promote nutritional intake. Soft-bristled toothbrushes will prevent further irritation to oral tissue that is fragile. Hydrogen peroxide or alcohol-based mouthwash may further damage fragile oral tissue. Oral swabs may be used; however, these are not as effective in cleaning the oral cavity and teeth and reducing bacteria accumulation in the mouth.

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification would the nurse recommend?

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.

Following a surgery for colorectal cancer, a patient still has persistent carcinoembryonic antigen (CEA) levels. Which interpretation would the nurse make for these high CEA levels?

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.

The nurse is caring for a patient with anorexia secondary to chemotherapy. Which strategy would the nurse use to increase the patient's caloric intake?

Small, frequent meals of high-protein, high-calorie foods are better tolerated than large meals. 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 and so should not be avoided.

Which interventions should the nurse perform to relieve stomatitis for a patient experiencing severe side effects of chemotherapy? Select all that apply.

Stomatitis is an inflammation of the mouth. It occurs when the epithelial cells are 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.

Which condition is associated with tumor lysis syndrome (TLS)?

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.

Which instruction would the nurse give the patient regarding care of the skin at the site of external beam radiation therapy?

The area undergoing radiation therapy may safely be washed with lukewarm water if it is done gently and if care is taken not to injure the skin. A patient undergoing radiation therapy should avoid anything that may be irritating to the skin, such as sunlight, lotions, ointments, or talcum powder.

The biopsy report of a patient states that the patient has stage I cervical cancer. In which way would the nurse explain this stage to the patient?

The clinical staging classification system is used to determine the anatomic extent of the growth of the tumor. At stage I, the tumor is limited to the tissue of origin. A stage II tumor has a limited local growth and has not yet metastasized. A stage III tumor has extensive local and regional spread. At stage IV, the tumor has metastasized to other parts.

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?

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.

A patient undergoing outpatient chemotherapy reports feeling lonely and isolated and wants to resume normal activities, such as socialization with friends. Which precaution would the nurse recommend for the patient when resuming these activities?

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.

Immunologic escape

The process by which cancer cells evade the immune system

Metastasis

The spread of cancer cells beyond their original site

The patient is being treated with brachytherapy for cervical cancer. Which factor affects the nurse's health when caring for this patient?

The time the nurse is 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 the time needed to complete care will not protect the nurse who is caring for a patient with brachytherapy for cervical cancer.

The nurse is reviewing the laboratory test results for a patient with cancer. The total serum protein level is 6.4 g/dL. The laboratory range states that the total serum protein level should be between 6.0 and 8.0 g/dL. Which interpretation would the nurse make?

Total serum protein level should be between 6.0 and 8.0 g/dL. A protein level of 6.4 g/dL is normal, so the patient does not have malnutrition. The protein value of 6.4 g/dL is not reduced or increased.

In which way does trastuzumab control cell growth in a patient who has breast cancer?

Trastuzumab (Herceptin) targets HER-2. HER-2 is overexpressed in certain cells, especially in breast cancer cells. Trastuzumab acts by binding to HER-2 receptors and inhibiting 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.

A patient who has undergone a modified radical mastectomy sees the surgical site for the first time. The patient exclaims, "I look horrible! Will it ever look better?" Which response would the nurse provide?

When a patient appears shocked by her appearance after a mastectomy, the nurse should help her express her feelings and offer supportive care. Reflecting the patient's statement will allow her to expand and discuss her feelings. "I will schedule you to meet another person who had a mastectomy" does not address the patient's expressed concern, although it may be helpful at a later time to ask the patient if she would like to meet someone. "After it heals" and "Don't worry" diminish the patient's distress regarding having undergone a modified radical mastectomy.

A patient who has multiple myeloma will be treated with autologous hematopoietic stem cell transplantation because a suitable donor has not been found. In which order will the procedures occur?

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.

Tumor angiogenesis

the process of the formation of blood vessels within the tumor itself

Immunologic surveillance

the response of the immune system to antigens of the malignant cells