ONCOLOGY

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 can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.

A nurse in an oncology clinic is reviewing the health record of a client who had surgery to stage ovarian cancer. The nurse reviews the following diagnostic notation on the pathology report: T2-N3-MX. Which of the following is an expected finding that supports this diagnosis? A. The tumor is 4 cm in size involving the ovary and adjacent tissues. B. No lymph nodes contain cancer cells. C. The tumor is receptive to current medication therapy. D. The cancer has metastasized to other areas in the body.

A. CORRECT: A T2 designation describes the size and extent of the ovarian tumor using the tumor‑node-metastasis (TNM) staging system. B. INCORRECT: A N3 designation indicates that three adjacent lymph nodes show evidence of spread of cancer using the TNM staging system. C. INCORRECT: The TNM diagnostic notation of the staging system is not used to indicate the response of a tumor to a medication therapy regimen used for treatment. D. INCORRECT: The MX designation indicates there is no evidence of distant metastasis to other areas of the body using the TNM staging system.

A nurse is planning care for a client who will undergo genetic testing for suspected cancer. Which of the following interventions should be included in the plan of care? A. Obtain a signed informed consent form. B. Withhold all medications prior to the procedure. C. Verify the prescription for a tumor marker assay. D. Ensure the client is placed in a recovery position after testing.

A. CORRECT: A signed informed consent form should be obtained prior to the procedure. B. INCORRECT: Medication does not affect the results of genetic testing. C. INCORRECT: A tumor marker assay is a laboratory test to identify the presence of specific body proteins in blood, body secretions and tissue and is not a component of genetic testing. D. INCORRECT: Genetic testing involves collection of blood or saliva and a recovery positioning is not required following testing.

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." Correct D. "You should contact "Look Good, Feel Better" to figure out what to do about this."

C Hair loss with radiation is usually permanent. The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. 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 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 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. Stage IV denotes metastasis.

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

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 unlicensed assistive personnel (UAP) told the nurse the location of the patient's pain and the worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.

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 A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy. A soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.

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 Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic, but not used first to combat flu-like symptoms of headache, fever, chills, myalgias, etc.

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 Immunologic surveillance is the process where lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance that allows the cancer cells to reproduce.

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 determinants on cancer cells

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

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

d. Intraperitoneal regional chemotherapeutic administration is used to treat metastasis from a primary colorectal cancer. Intrathecal administration is used with the spinal cord or the brain. Intraarterial administration is used to deliver chemotherapy to tumors via specific vessels. IV administration is used for systemic administration.

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 Grade II cells are more abnormal than Grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.

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 Correct 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 Patients experiencing diarrhea secondary to chemotherapy and/or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.

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 antianxiety medications. Incorrect 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 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 them about the diagnostic procedures would also 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 nurse is caring for a client who has lung cancer and is exhibiting manifestations of syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse report to the provider? (Select all that apply.) A. Behavioral changes B. Client report of headache C. Urine output 40 mL/hr D. Client report of nausea E. Increased urine specific gravity

A. CORRECT: Behavioral changes indicate cerebral edema due to SIADH. This finding should be reported to the provider. B. CORRECT: A client report of headache indicates cerebral edema due to SIADH. This finding should be reported to the provider. C. INCORRECT: Urine output of 40 mL/hr is a finding consistent with suspected SIADH and does not need to be reported to the provider. D. CORRECT: A client report of nausea can indicate cerebral edema due to SIADH and should be reported to the provider. E. INCORRECT: An increased urine specific gravity is a finding consistent with SIADH and does not need to be reported to the provider.

A nurse is planning care for a client who has a platelet count of 25,000/mm3. Which of the following interventions should be included in the plan of care? A. Apply prolonged pressure to puncture site after blood sampling. B. Administer epoetin alfa (Epogen) as prescribed. C. Place the client in a private room. D. Have the client use an oral topical anesthetic before meals.

A. CORRECT: Bleeding precautions should be implemented for the client who has thrombocytopenia. B. INCORRECT: Epoetin alfa (Epogen) is administered to the client who has anemia. C. INCORRECT: The client who is neutropenic is placed in a private room. D. INCORRECT: A topical oral anesthetic is used for the client who has mucositis.

A nurse in a clinic is caring for a client who has suspected uterine cancer. Which of the following assessment techniques should the nurse anticipate the provider will perform on this client? A. Bimanual pelvic examination B. Papanicolaou (Pap) test with cultures C. Digital rectal examination D. Percussion of the upper abdominal quadrants for tympany

A. CORRECT: Due to the location of uterine cancer, a bimanual pelvic examination will need to be performed to assess for uterine size, shape, and contour, which may be altered by a mass. B. INCORRECT: A Pap test with cultures is performed when screening for cervical cancer. C. INCORRECT: A digital rectal examination is performed when screening for prostate or rectal cancer. D. INCORRECT: Percussion of the upper abdominal quadrants for tympany is a screening tool for detecting an abdominal mass.

A nurse is teaching a client about maintaining a diet that may prevent certain cancers. The nurse should inform the client that the intake of which of the following may be beneficial? (Select all that apply.) A. Low saturated fats B. Fiber C. Red meats D. Simple carbohydrates E. Fish

A. CORRECT: Foods that are low in saturated fats provide protection against certain types of cancers. B. CORRECT: A diet high in fiber provides protection against certain types of cancers. C. INCORRECT: The consumption of red meat can increase the risk of cancer. D. INCORRECT: Eating simple carbohydrates can increase the risk of cancer. E. CORRECT: Eating fish can provide protection against certain types of cancers.

A nurse is caring for a client who is to undergo neurolytic ablation. The nurse should recognize that this treatment is used only when other measures have failed due to the risk of A. irreversible nerve damage. B. increased pain. C. myelosuppression. D. thrombocytopenia.

A. CORRECT: Neurolytic ablation causes permanent nerve destruction and is used only after other methods have been unsuccessful. B. INCORRECT: Increased pain is not related to neurolytic ablation. C. INCORRECT: Myelosuppression is not related to neurolytic ablation. D. INCORRECT: Thrombocytopenia is not related to neurolytic ablation.

A nurse is caring for a client who has chronic cancer pain and has a permanent epidural catheter for administration of a fentanyl/bupivacaine solution. The nurse should monitor the client for which of the following findings? (Select all that apply.) A. Respiratory depression B. Hypotension C. Sedation D. Muscle spasticity E. Motor blockage

A. CORRECT: Respiratory depression is an adverse effect of epidural analgesic and should be monitored. B. CORRECT: Hypotension is an adverse effect of epidural analgesic which can be corrected by administration of fluids and should be monitored. C. CORRECT: Sedation is an adverse effect of epidural analgesic and should be monitored. D. INCORRECT: Muscle weakness, not spasticity, is an adverse effect of epidural analgesic and should be monitored. E. CORRECT: Motor blockage is an adverse effect of epidural analgesic and should be monitored.

A nurse is caring for a client who has cervical cancer and undergoing brachytherapy. Which of the following are appropriate nursing interventions? (Select all that apply.) A. Permit visitors to stay 30 min at a time. B. Place the client on bed rest. C. Insert an indwelling urinary catheter. D. Administer fiber laxatives. E. Allow the skin "tattoo" guides for therapy to remain in place.

A. CORRECT: The client who has cervical cancer will have a vaginal radiation implant, so visitors should remain for 30 min at a time and maintain a distance of 6 ft. B. CORRECT: The client who has cervical cancer will have a vaginal radiation implant, and bed rest is needed to prevent displacement of the implant. C. CORRECT: The client who has cervical cancer will have a vaginal radiation implant, and a catheter is needed to prevent displacement of the implant during ambulation. D. INCORRECT: Fiber laxatives, which stimulate bowel movements, are not used to prevent displacing the vaginal radiation implant. E. INCORRECT: Skin "tattoo" guides are used for the client undergoing external radiation therapy, not brachytherapy.

A nurse is planning care for a client who has malnutrition due to cancer. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Have the client keep a food diary. B. Encourage tooth brushing before and after meals. C. Assess laboratory test report of ferritin. D. Monitor for changes in mental status. E. Explain that fluid intake should occur between meals.

A. CORRECT: The use of a food diary assists in monitoring the client's changes in eating habits that occur in malnutrition due to cancer. B. CORRECT: Oral hygiene before and after meals promotes increased salivation and improves the client's taste perception. C. CORRECT: Ferritin is an indicator of the protein intake of a client who has malnutrition due to cancer. D. INCORRECT: The nurse should monitor the client who has malnutrition due to cancer for changes related to the desire for food and the ability to eat. E. INCORRECT: Fluid intake should be encouraged with meals due to the dry mouth and thickened saliva that are present in the client who has malnutrition due to cancer.

A nurse is reviewing preoperative teaching with a client who will undergo a shave biopsy for suspected cancer. Which of the following statements by the client indicates understanding of the procedure? A. "A test of my bone marrow will be performed." B. "A lymph node will be removed." C. "A needle will be inserted into the mass." D. "A small skin sample will be obtained."

A. INCORRECT: A bone marrow aspiration is a type of needle biopsy. B. INCORRECT: A sentinel node biopsy involves excision of a lymph node. C. INCORRECT: A needle biopsy involves aspiration of a tumor for fluid and tissue sampling. D. CORRECT: A shave biopsy is a sampling of the outer skin layer using a scalpel or razor blade.

A nurse is planning care for a client who has cancer and is to undergo cryoanalgesia. Which of the following interventions should be included in the plan of care? A. Monitor oxygen saturation during the procedure. B. Instruct client to apply heat to the insertion site. C. Assess for irritated oral mucous membranes following the procedure D. Evaluate bladder control after the procedure.

A. INCORRECT: Blood pressure is the focus of vital sign monitoring to identify hypotension during and after cryoanalgesia. B. INCORRECT: The client should be instructed to apply cold to the insertion site for pain after cryoanalgesia. C. INCORRECT: The client's skin should be monitored for irritation following cryoanalgesia. D. CORRECT: Loss of bladder or bowel control is an effect of cryoanalgesia.

A nurse is caring for a client who has mucositis due to chemotherapy to treat cancer. Which of the following actions should the nurse take? A. Use a glycerin-soaked swab to clean the client's teeth. B. Encourage increased intake of citrus fruit juices. C. Obtain a culture of the lesions. D. Provide an alcohol-based mouthwash for oral hygiene.

A. INCORRECT: Glycerin-based swabs should be avoided when providing oral hygiene to the client who has mucositis. B. INCORRECT: Acidic foods should be discouraged for the client who has oral mucositis. C. CORRECT: A culture of oral lesions is obtained to identify pathogens and determine appropriate treatment. D. INCORRECT: Nonalcoholic mouthwashes are recommended for the client who has mucositis.

A nurse is completing preprocedure teaching for a client who will undergo nuclear imaging for suspected cancer. Which of the following is an appropriate statement by the nurse? A. "The presence of a liver enzyme will be identified." B. "You will be given an injection of a radioactive substance." C. "An endoscope will be inserted through your mouth." D. "The tumor will be aspirated."

A. INCORRECT: Liver function tests involve the identification of altered liver enzymes, which may be present in a client who has cancer. They are not nuclear imaging tests. B. CORRECT: Nuclear imaging involves the administration of an oral or IV radioactive tracer to identify cancerous tissue. C. INCORRECT: Endoscopy permits visualization inside the body and is not a form of nuclear imaging. D. INCORRECT: A needle biopsy is performed to aspirate fluid and tissue samples for cancer cells and is not a form of nuclear imaging.

A nurse is caring for a client who has cancer. The goal of palliative pain management is to increase which of the following? (Select all that apply.) A. Mental acuity B. Physical mobility C. Time spent at home D. Quality of life E. Bowel function

A. INCORRECT: Maintaining mental clarity, rather than increasing it, is a goal of palliative therapy. B. CORRECT: Improved physical mobility occurs as a result of effective palliative pain management. C. CORRECT: Increased time in the home setting occurs as a result of effective palliative pain management. D. CORRECT: An increase in the quality of life occurs as a result of effective palliative pain management. E. INCORRECT: Effective pain management may alter or reduce bowel function as an adverse effect of the medication.

A nurse is caring for a client who is undergoing chemotherapy and reports severe nausea. Which of the following statements is appropriate for the nurse to make? A. "Your nausea will lessen with each course of chemotherapy." B. "Hot food is better tolerated because of the aroma." C. "Try eating several small meals throughout the day." D. "Increase your intake of red meat as tolerated."

A. INCORRECT: Nausea usually occurs to the same extent with each session of chemotherapy. B. INCORRECT: Cold foods are better tolerated than warm/hot foods because odors from heated foods can induce nausea. C. CORRECT: Several small meals a day are usually better tolerated by the client who has nausea. D. INCORRECT: Red meat is not tolerated well by the client undergoing chemotherapy because the taste of meat is frequently altered and unpalatable.

A nurse is caring for a client who has cancer pain. Which of the following is the most reliable indicator of the client's pain? A. Change in pulse rate B. Facial expression of pain C. Verbal report of pain D. Massaging an area of pain

A. INCORRECT: Physiologic changes can indicate the presence of pain, but they are not the most reliable indicators. B. INCORRECT: Nonverbal indicators can support the presence of pain, but they are not the most reliable indicator. C. CORRECT: A client's verbal report of pain in the most reliable indicator of pain. D. INCORRECT: Nonverbal indicators can support the presence of pain, but they are not the most reliable indicator.

A nurse at a health fair is reviewing possible warning signs of cancer that a client should watch for. Which of the following information should be included in this review? (Select all that apply.) A. Presence of a fever of 102° F (38.9° C) for more than 48 hr B. A sore that does not heal C. Difficulty swallowing D. Presence of unusual discharge E. Weight gain of 4 lb (1.8 kg) in 2 weeks

A. INCORRECT: Presence of a fever for an extended period is not a warning sign for cancer. B. CORRECT: A sore that does not heal is a warning sign for cancer. C. CORRECT: Difficulty swallowing is a warning sign for cancer. D. CORRECT: The presence of unusual discharge is a warning sign for cancer. E. INCORRECT: Weight gain is not a warning sign for cancer.

A nurse is planning care for a client who is undergoing chemotherapy and is placed on neutropenic precautions. Which of the following interventions should be included in the plan of care? (Select all that apply.) A. Encourage a high-fiber diet. B. Remove plants from the room. C. Have the client wear a mask when leaving the room. D. Have client-specific equipment remain in the room. E. Eliminate raw foods from the client's diet.

A. INCORRECT: There is no benefit in placing a client who has neutropenia on a high-fiber diet. B. CORRECT: Neutropenic precautions include the client not having contact with flowers and plants due to the presence of surface infectious agents in the water and soil. C. CORRECT: Neutropenic precautions include having the client wear a mask when leaving the room to reduce the incidence of infection. D. CORRECT: Neutropenic precautions include having equipment available that is only for use in caring for the client to reduce the incidence of infection. E. CORRECT: A client who is neutropenic should avoid consuming raw foods due to the presence of surface infectious agents on peeling and rind.

A nurse is teaching a client about the risk for cancer. Which of the following client statements indicates the need for further teaching? A. "I see a dermatologist regularly for the mole on my thigh." B. "I take Milk of Magnesia for occasional constipation." C. "I tan using an indoor tanning lotion instead of laying out in the sun." D. "I used to smoke but switched to chewing tobacco 3 years ago."

A. INCORRECT: This statement indicates understanding of the risk of skin exposure to environmental effects as a cause of cancer. B. INCORRECT: This statement indicates awareness of potential changes in bowel habits as a risk factor for cancer. C. INCORRECT: This statement indicates understanding of the risk of skin exposure to environmental effects as a cause of cancer. D. CORRECT: Chewing tobacco is a cause of oral cancer, and places the client at the same risk as smoking tobacco.

The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse dofirst? 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 Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation the infusion should first be stopped. 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.

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 The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be the nurse's role.

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 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.

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 Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.

The 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 Benign tumors usually are encapsulated and have normally differentiated cells. They do not metastasize and rarely recur as malignant tumors do.

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

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

Which cellular dysfunction in the process of cancer development allows defective cell proliferation? A. Proto-oncogenes B. Cell differentiation C. Dynamic equilibrium Correct D. Activation of oncogenes

C Dynamic equilibrium is the regulation of proliferation that usually only occurs to equal cell degeneration or death or when the body has a physiologic need for more cells. Cell differentiation is the orderly process that progresses a cell from a state of immaturity to a state of differentiated maturity. Mutations that alter the expression of proto-oncogenes can activate them to function as oncogenes, which are tumor-inducing genes and alter their differentiation.

A 70-year-old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and complains of nausea and constipation. Which complication of cancer is this most likely caused by? a. Hypercalcemia b. Tumor lysis syndrome c. Spinal cord compression d. Superior vena cava syndrome

Correct answer: a Rationale: Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or exacerbate hypercalcemia. The primary manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting.

To prevent fever and shivering during an infusion of rituximab (Rituxan), the nurse should premedicate the patient with a. aspirin. b. acetaminophen. c. sodium bicarbonate. d. meperidine (Demerol).

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

The nurse counsels the patient receiving radiation therapy or chemotherapy that a. effective birth control methods should be used for the rest of the patient's life. b. if nausea and vomiting occur during treatment, the treatment plan will be modified. c. after successful treatment, a return to the person's previous functional level can be expected. d. the cycle of fatigue-depression-fatigue that may occur during treatment can be reduced by restricting activity.

Correct answer: c Rationale: Some cancer survivors may continue to experience symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. A cancer diagnosis can affect many aspects of a patients' life; cancer survivors commonly report financial, vocational, marital, and emotional concerns long after treatment is over. Resources for survivors are listed in Table 16-20.

A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing 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 a nutritional supplement beverage at least three times a day. d. Advise the patient to experiment with spices and seasonings to enhance the flavor of food.

Correct answer: d Rationale: Instruct the patient to experiment with spices and other seasoning agents in an attempt to mask taste alterations. Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste of certain meats and fish. Bacon bits, onion, and pieces of ham may enhance the taste of vegetables.

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 Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.

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) Correct

D 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 GI stromal tumors. CD20 monoclonal antibodies (MoAb) bind with CD20 antigen causing cytotoxicity in non-Hodgkin's lymphoma and chronic lymphocytic leukemia.

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 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.

A paient has recently been diagnosed with early stage of breast cancer. Which of the following is most appropriate for the nurse to focus on? a. maintaining the patient's hope b. preparing a will and advance directives c. discussing replacement child care for the patient's children d. discussing the patient's past experiences with her grandmother's cancer

a Maintain hope, which is the key to effective cancer care. Hope depends on the status of the patient: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care.

Which factors will assist a patient in coping positively with having cancer (select all that apply)? 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. Feeling in control, having a strong support system, and the potential of cure or control of the cancer will have a positive effect on coping with the diagnosis. The other options will make coping more difficult for the patient. (See Table 16-19.)

Cancer cells go through stages of development. What accurately describes the stage of promotion (select all that apply)? 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. Promoting factors such as obesity and tobacco smoke promote cancer in the promotion stage of cancer development. Eliminating risk factors can reduce the chance of cancer development as the activity of promoters is reversible in this stage. Increased growth, invasion, and metastasis are seen in the progressive stage.

What cellular features of cancer cells distinguish them from normal cells (select all that apply)? a. cells lack contact inhibition b. cells return to a previous undifferentiated state c. oncogenes maintain normal cellular expression d. proliferation occurs when there is a need for more cells e. new proteins characteristic of embryonic stage emerge on cell membranes

a,b,e Rationale: Two major dysfunctions in the process of cancer are defective cell proliferation (i.e., growth) and defective cell differentiation. Cancer cells lack contact inhibition and are poorly differentiated. Cancer cell growth is infiltrative and expansive, and cancer cells are abnormal and become more unlike parent cells.

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

a. A simple mastectomy can be done to prevent breast cancer in women with high risk and can be used to control, cure, or provide palliative care for breasts with cancerous tumors. A mastectomy would not be used for biopsy or otherwise to establish a diagnosis of cancer.

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

a. Cancer cells become more fetal and embryonic (undifferentiated) in appearance and function and some produce new proteins, such as carcinoembryonic antigen (CEA) and α-fetoprotein (AFP), on cell membranes that reflect a return to more immature functioning. The other options are unrelated to CEA and AFP.

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

a. Hyperkalemia and hyperuricemia are characteristic of tumor lysis syndrome, which is the result of rapid destruction of large numbers of tumor cells. Signs include hyperuricemia that causes acute kidney injury, hyperkalemia, hyperphosphatemia, and hypocalcemia. To prevent renal failure and other problems, the primary treatment includes increasing urine production using hydration therapy and decreasing uric acid concentrations using allopurinol (Zyloprim).

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

a. Intravesical regional chemotherapy is administered into the bladder via a urinary catheter. Leukemia is treated with IV chemotherapy. Osteogenic sarcoma is treated with intraarterial chemotherapy via vessels supplying the tumor. Metastasis to the brain is treated with intraventricular or intrathecal chemotherapy via an Ommaya reservoir or lumbar punctures.

The nurse is presenting 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 women and men? a. Smoking cessation b. Routine colonoscopies c. Protection from ultraviolet light d. Regular examination of reproductive organs

a. Lung cancer is the leading cause of cancer deaths in the United States for both women and men and smoking cessation is one of the most important cancer prevention behaviors. Approximately one half of cancer-related deaths in the U.S. are related to tobacco use, unhealthy diet, physical inactivity, and obesity. Cancers of the reproductive organs are the second leading cause of cancer deaths.

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

a. Mutations in the p53 tumor suppressor gene have been found in many cancers, including bladder, breast, colorectal, esophageal, liver, lung, and ovarian cancers. APC gene mutations increase a person's risk for familiar adenomatous polyposis, which is a precursor for colorectal cancer. BRCA1 and BRCA2 mutations increase the risk for breast and ovarian cancer.

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

a. Nitrosureas are cell cycle phase-nonspecific, break the DNA helix, and cross the blood-brain barrier. Antimetabolites are cell cycle phase-specific drugs that mimic essential cellular metabolites to interfere with DNA synthesis. Mitotic inhibitors are cell cycle phase-specific drugs that arrest mitosis. Antitumor antibiotics bind with DNA to block RNA production.

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

a. Oncogenes are the mutation of protooncogenes, which then induce tumors. Oncogenic viruses cause genetic alterations and mutations that allow the cell to express the abilities and properties it had in fetal development and may lead to cancer. Oncofetal antigens are antigens that are found on the surface and inside the cancer cells. They are an expression of the cells usually associated with embryonic or fetal periods of

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

a. Walking programs scheduled during the time of day when the patient feels better are a way for patients to keep active without overtaxing themselves and help to combat the depression caused by inactivity. Ignoring the fatigue or overstressing the body can make symptoms worse and the patient should rest before activity and as necessary.

The nurse explains to a patient undergoing brachytherapy of the cervix that she a. must undergo simulation to locate the treatment area b. requires that 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 Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or adjacent to the tumor. Caring for the person undergoing brachytherapy or receiving radiopharmaceuticals requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, and shielding are vital to health care professional safety in caring for the person with an internal radiation source.

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

b. Although other tests may be used in diagnosing the presence and extent of cancer, biopsy is the only method by which cells can be definitely determined to be malignant.

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

b. Neuroblastomas are cured with chemotherapy. A positive response of cancer cells to chemotherapy is most likely in solid or hematopoietic tumors that arise from tissue that has a rapid rate of cellular proliferation and new tumors with cells that are rapidly dividing. A state of optimum health and a positive attitude of the patient will also promote the success of chemotherapy.

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

b. One of the major concerns with the IV administration of vesicant chemotherapeutic agents is infiltration or extravasation of drugs into tissue surrounding the infusion site. When infiltrated into the skin, vesicants cause pain, severe local breakdown, and necrosis. Specific measures to ensure adequate dilution, patency, and early detection of extravasation and treatment are important.

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 badges during care. c. The goal of this treatment is only palliative and the patient should be aware of the expected outcome. d. Computerized dosimetry is used to determine the maximum dose of radiation to the tumor within an acceptable dose to normal tissue.

b. Brachytherapy is the implantation or insertion of radioactive materials directly into the tumor or in proximity to the tumor and may be curative. The patient is a source of radiation and in addition to implementing the principles of time, distance, and shielding, film badges should be worn by caregivers to monitor the amount of radiation exposure. Computerized dosimetry and simulation are used in external radiation therapy.

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

b. Carcinoma in situ has the histologic features except invasion. Evasion of the immune system by cancer cells by various methods is immunologic escape. Oncogenic factors are capable of causing cellular alterations associated with cancer. Tumor cell surface antigens that stimulate an immune response are tumor-associated antigens.

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

b. Healthy men and women should have a colonoscopy every 10 years, an annual fecal occult blood test, or a barium enema every 5 years. These frequencies may change depending on the results. Annual PSA and digital rectal exams screen for prostate problems, although the decision to test is made by the patient with his health care provider.

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

b. Patients should always be taught what to expect during a course of chemotherapy, including side effects and expected outcome. Side effects of chemotherapy are serious but it is important that patients be informed about what measures can be taken to help them to cope with the side effects of therapy. Hair loss related to chemotherapy is usually reversible and wigs, scarves, or turbans can be used during and following chemotherapy until the hair grows back.

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

b. Alkylating chemotherapeutic agents and high-dose radiation are most likely to cause secondary malignancies as a late effect of treatment. The other conditions are not known to be late effects of radiation or chemotherapy.

A patient on chmotherapy and radiation for head and neck cancer has a WBC count of 1.9x10^3/microL, hemoglobin of 10.8 g/dL, and a platelet count of 99x10^3. Based on the CBC results, which of the following 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, HA, and constipation

c Neutropenia is more common in patients receiving chemotherapy than in those receiving radiation, and it can seriously increase the risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly because fever in the setting of neutropenia is a medical emergency.

The goals of cancer treatment are based on the principle that surgery 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 moralities is effective for controlling many cancers d. although cancer cure is rare, quality of life can be increased with treatment moralities

c The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the particular cancer being treated and may involve local therapies (i.e., surgery or irradiation) alone or in combination, with or without periods of adjunctive systemic therapy (i.e., chemotherapy).

What describes a primary use of biologic therapy in cancer treatment? a. Protect normal, rapidly reproducing cells of the gastrointestinal 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 increase a sense of well-being by replacing central nervous system deficits

c. Biologic therapies are normal components of the immune system and are used therapeutically to restore, augment, or modulate host immune system mechanisms. They have direct antitumor effects or other biologic effects to assist in immune activity against cancer cells. Virtually all biologic

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

c. An allogenic hematopoietic stem cell or bone marrow transplant is one in which peripheral stems cells or bone marrow from an HLA-matched donor is infused into a patient who has received high doses of chemotherapy, with or without radiation, to eradicate cancerous cells. In an autologous bone marrow transplant, the patient's own bone marrow is removed before therapy to destroy the bone marrow. The marrow is treated to remove cancer cells and may be infused shortly after conditioning treatment or frozen and stored for later use. With either source, the new bone marrow will take several weeks to produce new blood cells and protective isolation is necessary during this time.

A patient's breast tumor originates from embryonal ectoderm. It has moderate dysplasia and moderately differentiated cells. It is a small tumor with minimal lymph node involvement and no metastases. What is the best description of this tumor? a. Sarcoma, grade II, T3N4M0 b. Leukemia, grade I, T1N2M1 c. Carcinoma, grade II, T1N1M0 d. Lymphoma, grade III, T1N0M

c. The breast cancer origination gives it the anatomic classification of a carcinoma. Grade II has moderate abnormal cells with moderate differentiation. T1N1M0 represents a small tumor with only minimal regional spread to the lymph nodes and no metastasis. Sarcomas originate from embryonal mesoderm or connective tissue, muscle, bone, and fat. Leukemias and lymphomas originate from the hematopoietic system. The other histologic grading and TNM classifications do not represent this patient's tumor.

Priority Decision: 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. The nadir is the point of the lowest blood counts after chemotherapy is started and it is the time when the patient is most at risk for infection. Because infection is the most common cause of morbidity and death in cancer patients, identification of risk and interventions to protect the patient are of the highest priority. The other problems will be treated but they are not the priority.

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

c. Tissue that is actively proliferating, such as GI mucosa, esophageal and oropharyngeal mucosa, and bone marrow, exhibits early acute responses to radiation therapy. Radiation ionization breaks chemical bonds in DNA, which renders cells incapable of surviving mitosis. This loss of proliferative capacity yields cellular death at the time of division for both normal cells and cancer cells but cancer cells are more likely to be dividing because of the loss of control of cellular division. Cartilage, bone, kidney, and nervous tissues that proliferate slowly manifest subacute or late responses.

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

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 Progression is the final stage of cancer. This stage is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (i.e., metastasis). Progression occurs as a result of the following characteristics of cancer cells: rapid proliferation and decreased cell adhesion.

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 leadince cause of cancer deaths in women d. Aferican Americans havve a higher death rate from cancer than whites

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

the primary difference between benign and malignant neoplasms is the a. rate of cell proliferation b. site of malignant tumor c. requirements for cellular nutrients d. characteristic of tissue invasiveness

d The ability of malignant cells to invade and metastasize is the major difference between benign and malignant neoplasms. Other differences between benign and malignant neoplasms are presented in Table 16-3.

The nurse is caring for a 59-year-old women who had surgery 1 day ago for removal of a suspected malignant abdominal mass. The patient is awaiting the pathologic report. She is tearful and says 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 lifestyles b. educate her about the seven warning signs of cancer c. instruct her about health stress relief and coping practices d. allow her to communicate about the meaning of this experience

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

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

d. Avoiding sources of excessive heat and cold will prevent damage to the skin. Only nonmedicated, nonperfumed lotions or creams (e.g., calendula ointment, aloe gel, Aquaphor) are recommended for dry skin. The area should be exposed to air if possible. Gentle cleansing, thorough rinsing, and patting the treatment area dry are recommended.

What is the name of a tumor from the embryonal mesoderm tissue of origin located in the anatomic site of the meninges that has malignant behavior? a. Meningitis b. Meningioma c. Meningocele d. Meningeal sarcoma

d. Meningeal sarcoma is from the embryonal mesoderm, is located in the meninges, and is malignant. A meningioma has the same tissue of origin and anatomic site but it is benign. Meningitis is inflammation or infection of the meninges. Meningocele is a hernia cyst filled with cerebrospinal fluid.

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. Malignant cells proliferate indiscriminately and continuously and also lose the characteristic of contact inhibition, growing on top of and in between normal cells. Cancer cells usually do not proliferate at a faster rate than normal cells, nor can cell cycles be skipped in proliferation. However, malignant proliferation is continuous, unlike normal cells.

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. The major difference between malignant and benign cells is the ability of malignant tumor cells to invade and metastasize. Benign tumors can cause death by expansion into normal tissues and organs. Benign tumors are more often encapsulated and often grow at the same rate as malignant tumors.

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

d. The priority in pain management is to obtain a comprehensive history of the patient's pain. This will determine the medications most useful for this patient's pain to enable giving the dose that relieves the pain with the fewest side effects. Teaching the patient about the lack of tolerance and addiction associated with effective cancer pain management will also be important for this patient's pain management.

A patient is admitted with acute myelogenous leukemia and 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. Alkylating agents are used to treat Hodgkin's lymphoma and are carcinogens associated with initiation of acute myelogenous leukemia. Working with radiation would lead to a higher incidence of bone cancer. Epstein-Barr virus is seen in vitro with Burkitt's lymphoma. Intense tanning or exposure to ultraviolet radiation is associated with skin cancers.