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What are the signs and symptoms of Extravasation and what can I do about it?

Redness, Swelling,

A cancer patient has third spacing and is on plasma protein replacement therapy. During the treatment, the nurse observes increased central venous pressure and shortness of breath. What action should the nurse take, and why?

Reduce the rate of fluid administration, because the patient may have hypervolemia which can cause central venous pressure and SOB Remember to infuse Albumin slowly because it can increase volume RAPIDLY****

A patient with cancer is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) and is now experiencing a seizure. Which treatment is most beneficial for the patient to correct the electrolyte imbalance that precipitated the seizure? 1 Furosemide 2 Oral salt tablets 3 Isotonic (0.9%) saline 4 Intravenous 3% sodium chloride

4 SIADH is a complication of cancer associated with severe water retention by tumor cells. Intravenous administration of 3% sodium chloride will help treat hyponatremia immediately. Furosemide, oral salt tablets, and isotonic (0.9%) saline will help to reduce hyponatremia and to treat SIADH. However, these medications are not highly effective for severe cases.

The diagnostic reports of a patient indicate cancer in the pancreas and gallbladder. Which oncofetal antigen is specific for this type of cancer?

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

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

A grade III histologic classification indicates severe dysplasia. Grade I indicates mild dysplasia. Anaplasia describes grade IV cells that are immature and primitive. Moderate dysplasia describes grade II cells that are more abnormal.

The nurse is caring for a patient with cancer and is monitoring the albumin and pre-albumin levels frequently. What condition does the nurse suspect the patient is at risk for? 1 Malnutrition 2 Cardiac tamponade 3 Tumor lysis syndrome 4 Third space syndrome

1 Altered albumin and prealbumin levels are indicators of malnutrition. Cardiac tamponade, tumor lysis syndrome, and third space syndrome are not associated with altered albumin and prealbumin levels.

The nurse is reviewing the histology report of a patient and finds that the patient has grade IV tumors. Which characteristic feature of tumors would be applicable to this patient with grade IV tumors? 1 Undifferentiated 2 Well differentiated 3 Poorly differentiated 4 Moderately differentiated

1 In histologic grading of tumors, both the appearance of cells and the degree of differentiation are evaluated pathologically. The cells in grade IV tumors are immature, primitive, and undifferentiated and the cell of origin is difficult to determine (high grade). The cells in grade I tumors differ slightly from normal cells and are well differentiated. Cells in grade III tumors are very abnormal and are poorly differentiated. Grade II tumor cells are more abnormal and are moderately differentiated. Text Reference - p. 254

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

1 Thrombocytopenia is a low platelet count that leaves the patient at high risk for life-threatening spontaneous hemorrhage. Diarrhea and infection are not symptoms associated with thrombocytopenia. Hypotension may be seen if hemorrhagic or hypovolemic shock develops as a result of blood loss stemming from thrombocytopenia. p.251 table 15-11

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

1 An adenoma is a benign tumor in the glandular epithelium. A benign tumor in the cartilage is called a chondroma. A benign tumor in the nervous tissue meninges is called a meningioma. A benign tumor in the striated muscle is called a rhabdomyoma.

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

1 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.

What classification system is based on the anatomic extent of the malignant disease in stages? 1 Clinical staging 2 Carcinoma in situ 3 Histologic grading 4 Tumor, node, metastasis (TNM) classification

1 Clinical staging is based on the anatomic extent of the malignant disease process. Carcinoma in situ refers to a neoplasm with cells that are localized and slow without a tendency to invade or metastasize. Histologic grading is used to evaluate tumors by the appearance of the cells and the degree of differentiation. The TNM classification system is used to determine the anatomic extent of the disease involvement in characteristics of the diseased cells. Page 241

The nurse is administering a vesicant chemotherapy agent to a patient who has colon cancer. During rounds, the nurse notes that the intravenous site is reddened and swollen, and the patient reports that it is painful. What is the first action the nurse will take? 1 Turn off the infusion. 2 Slow the infusion rate. 3 Check the patient's vital signs. 4 Notify the primary health care provider.

1 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. Immediately turn off the infusion and follow protocols for drug-specific extravasation procedures to minimize further tissue damage. It is not appropriate to slow the infusion rate. The health care provider should be notified and vital signs checked, but they are not the first action that should be taken.

The family of a recently admitted female patient are shocked that their mother has received a diagnosis of lung cancer. They ask the nurse whether it is common for women to have lung cancer. What is the nurse's best response? 1 "Lung cancer has the second highest incidence for both men and women." 2 "Sadly, it is not that unusual; lung cancer has become the leading cancer for women." 3 "It is unusual that your mother would have lung cancer, because fewer women smoke than men." 4 "Lung cancer is not as common in women as colorectal cancer, but more women are receiving this diagnosis."

1 Lung cancer has the second-highest incidence for both men and women. Breast cancer is the leading site for cancers in women. The lungs have now become the second most common site for cancers in women.

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

1 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.

What does the term "malignant" describe when referring to the anatomic classification of a tumor? 1 Behavior 2 Neoplasm 3 Anatomic site 4 Tissue of origin

1 The behavior of the tumor is described as either malignant or benign. The anatomic site describes the location of tumor. A neoplasm is an abnormal growth of tissue. The tissue of origin is the site where the tumor originated.

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

1 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.

The nurse is caring for a cancer patient and finds that the patient has tumor lysis syndrome. Which other condition should the nurse monitor for? 1 Renal failure 2 Cardiac arrest 3 Venous thrombosis 4 Rheumatoid arthritis

1 Tumor lysis syndrome occurs when large numbers of neoplastic cells are killed rapidly due to chemotherapy. This cellular destruction is characterized by a rapid development of hyperuricemia and hyperphosphatemia, and can lead to acute renal failure. Cardiac arrest and rheumatoid arthritis are not common complications with tumor lysis syndrome. Venous thrombosis would occur with a patient who has a tumor in the superior vena cava.

The nurse is caring for a patient diagnosed with superior vena cava syndrome. What clinical manifestations does the nurse assess for? Select all that apply. 1 Seizures 2 Periorbital edema 3 Reports of headache 4 Distention of veins of head, neck, chest 5 Bruit ausculated bilateral carotid arteries

1, 2, 3, 4 Clinical manifestations of superior vena cava syndrome are facial edema; periorbital edema; distention of veins of head, neck, and chest; headache; seizures; and a mediastinal mass is observed on chest x-ray. A bruit is not diagnostic related to this syndrome.

A patient with breast cancer experiences a 3-kilogram weight loss over the course of a week. The nurse is evaluating the patient after teaching necessary interventions to reduce the risk of malnutrition. Which statement made by the patient indicates effective learning? Select all that apply. 1 "I can use packages of instant breakfast." 2 "I can add cheese to sandwiches or snacks." 3 "I can take low-calorie foods throughout the day." 4 "I can supplement puddings and cereals with Ensure." 5 "I can use raw milk when preparing milkshakes and sauces."

1, 2, 4 A cancer patient who has lost 3 kilograms in a week is at a high risk of malnutrition. Instant breakfast packages can be sprinkled over puddings and sausages because they contain protein. Cheese contains protein and calories, which are essential for a patient suffering from weight loss. Ensure is a commercial nutritional supplement that provides adequate protein and fat for the patient. Low-calorie foods can further cause weight loss in the patient. Raw milk may contain bacteria, which would place the patient at a high risk of infection.

The registered nurse is explaining about cancer cell biology to a student nurse. Which statement should be included while teaching? Select all that apply. 1 "The cell growth occurs one on top of the other." 2 "The cell proliferation is indiscriminate and continuous." 3 "The cell proliferation is equivalent to cell degeneration." 4 "The cell proliferation is activated only when the cell degenerates." 5 "The cell proliferation rate is normal with different response to intracellular signals that maintain equilibrium."

1, 2, 5 Cancer cells lose the contact inhibition mechanism and cross cell boundaries, allowing these cells to potentially grow on top of one another. The cell proliferation in cancer is indiscriminate and occurs as a continuous process. The cells proliferate at a normal rate, but the response to intracellular signals that maintains dynamic equilibrium is different. A normal cell is characterized by the maintenance of dynamic equilibrium. It is maintained by the equivalency of cell proliferation to cell degeneration. The normal cells proliferate after the cell degenerates. Text Reference - p. 249

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

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

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

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

The nurse is educating a patient about cancer prevention and early detection. Which instructions should the nurse include in the discussion? Select all that apply. 1 Limit alcohol consumption. 2 Cut down on cigarette smoking. 3 Get regular physical examinations. 4 Obtain adequate rest (6-8 hours a night). 5 Know the seven warning signs of cancer. 6 Exercise for 20 minutes three times a week.

1, 3, 4, 5, Regular physical examinations, adequate consistent rest for at least 6-8 hours a night, understanding the seven warning signs of cancer, and limiting alcohol intake are all educational topics about cancer prevention. Cigarette smoking should be avoided completely, and the recommendation for exercise is 30 minutes of moderate exercise five times a week. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

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

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

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

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

A patient is diagnosed with early stages of cervical cancer. What interventions are most appropriate for the nurse to focus at this time? Select all that apply. 1 Maintain the patient's hope. 2 Listen actively to the patient's fears and concerns. 3 Assist the patient in maintaining usual lifestyle patterns. 4 Discuss replacement child care for the patient's children. 5 Explain in detail the aspects of the upcoming radiation therapy.

1,2,3 Provide essential information (not extreme details) regarding cancer and cancer care that is accurate and establishes realistic expectations about what the patient will experience. Maintaining hope is the key to effective cancer care. Hope varies, depending on the patient's status: 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, hope to achieve meaningful goals, 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. 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.

A nurse caring for a patient with breast cancer receiving chemotherapy has developed alopecia and is noticeably upset. Which nursing actions are appropriate for this patient? Select all that apply. 1 Suggest the patient use scarves and wigs. 2 Instruct the patient to use shampoo every day. 3 Suggest the patient cut long hair before therapy. 4 Instruct the patient to avoid the use of hair dryers. 5 Instruct the patient to brush and comb hair frequently.

1,3,4 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.

Which complication of head and neck cancer would cause the nurse to apply firm pressure to the neck with the finger(s) of one hand? 1 Carotid tamponade 2 Carotid artery rupture 3 Tumor lysis syndrome 4 Third space syndrome

2 A carotid artery rupture is an infiltrative emergency commonly seen in a patient with head or neck cancer. Because this ruptured artery results in a blowout, the nurse should apply firm pressure to the carotid artery to reduce the blood flow. Cardiac tamponade is a complication associated with accumulation of fluid in the pericardial space. Third space syndrome and tumor lysis syndrome are obstructive and metabolic complications that are not associated with blowout from the artery.

A patient is advised to have radiotherapy for ovarian cancer. Applying radiation to which body areas or regions may increase the patient's risk of developing myelosuppression? Select all that apply. 1 Pelvis 2 Sternum 3 Cervical vertebrae 4 Thoracic vertebrae 5 Lumbar vertebrae

1,4, 5 Myelosuppression is a side effect of radiation therapy to specific treatment fields. Radiation to large marrow-containing regions of the body produces the most clinically significant myelosuppression. Therefore radiation therapy to the pelvis, thoracic, and lumbar vertebrae may cause myelosuppression. The sternum and cervical vertebrae do not contain as much bone marrow and are therefore not as prone to myelosuppression.

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

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

Which does a grade III histologic classification of a cell indicate? 1 Anaplasia 2 Mild dysplasia 3 Severe dysplasia 4 Moderate dysplasia

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

Which cancer diagnosis for a female patient is most likely to cause death? 1. Lung cancer 26% 2. Breast cancer 15% 3. Uterine cancer 4% 4. Pancreatic cancer 7%

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

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

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

A patient is diagnosed with carcinoma in situ. What tumor classification does the nurse observe on the medication record? 1. T 0 2. T is 3. T x 4. T 1-4

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

The oncology nurse finds that a person is using a sunscreen lotion with sun protection factor (SPF) 10. What is the accurate response of the nurse in this situation? 1 "You should use a sunscreen of SPF 5." 2 "You should use a sunscreen of SPF 15." 3 "You should apply this sunscreen only to your face." 4 "You should apply it at least 30 minutes before going out in the day time."

2 A sunscreen lotion of SPF 15 can help protect the skin against harmful ultraviolet radiations, which cause cancer. A sunscreen of SPF 5 may not protect the skin against harmful ultraviolet radiations. Using a sunscreen of SPF 10 only on the face does not prevent exposure of the body to ultraviolet radiations. Applying the sunscreen 30 minutes before going out does not effectively act against ultraviolet radiations, which cause cancer. Text Reference - p. 255

A patient is suspected of having stage II lung cancer. Which procedure will the nurse prepare the patient for? 1 Incisional biopsy 2 Excisional biopsy 3 Large-core biopsy 4 Fine-needle aspiration

2 Excisional biopsy is a surgical procedure that involves the removal of the entire lesion, lymph node, nodule, or mass. This biopsy, unlike others, involves the removal of a piece of the tumor for pathologic analysis. Incisional biopsy is partial excision of the tumor, which can be performed through a scalpel or dermal punch. It is performed only if an excisional biopsy is not possible. Endoscopic biopsy is performed to remove a sample of tissue for pathologic analysis from the lungs or other intraluminal lesions (esophageal, colon, and bladder). Percutaneous biopsy is commonly performed for tissues that can be safely reached through the skin. Text Reference - p. 256 Excisional biopsy is a process that involves the surgical removal of an entire lesion. Incisional biopsy is performed when excisional biopsy is not feasible; it involves partial excision of a lesion. In large-core biopsy, an actual piece of tissue is obtained with cutting needles. This procedure helps to preserve the histologic architecture of the tissue specimen. In fine-needle aspiration, cells from the lesion are aspirated through a small needle gauge for cytologic examination.

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 also reports nocturia. Which complication of cancer is this most likely caused by? 1 Hypokalemia 2 Hypercalcemia 3 Tumor lysis syndrome 4 Spinal cord compression

2 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 symptoms, and significant calcium elevations can be life threatening. The symptoms are not indicative of tumor lysis syndrome, spinal cord compression, or hypokalemia.

The laboratory reports of a patient who is undergoing aggressive chemotherapy for cancer show increased DNA and RNA components in the blood. What does the nurse interpret from this finding? 1 The patient has cardiac tamponade. 2 The patient has tumor lysis syndrome. 3 The patient has carotid artery rupture. 4 The patient has superior vena cava syndrome.

2 Tumor lysis syndrome is caused by the destruction of cells due to chemotherapy. As cells are destroyed, DNA, RNA, and intracellular components are released into the bloodstream. Cardiac tamponade is a complication associated with an increase of fluid in the pericardial space. Carotid artery rupture is an infiltrative emergency, which results in the blowout of blood from the ruptured artery. Superior vena cava syndrome involves an obstruction of the superior vena cava due to thrombosis.

After reviewing the prescription order of a patient, the nurse tells the patient, "You will need to increase your intake of fiber and fluids because you are at a risk for constipation." Which medication does the nurse find in the patient's prescription? 1Amoxicillin/clavulanate 2Vincristine 3 Furosemide 4 Demeclocycline

2 Vincristine (Marqibo) is a chemotherapeutic agent that can cause GI side effects including stomach pain and constipation. Amoxicillin/clavulanate (Augmentin) and demeclocycline (Declomycin) are antibiotics that commonly cause some degree of diarrhea, not constipation. Furosemide (Lasix) is a loop diuretic that can cause stomach pain and diarrhea but typically not constipation.

A patient with lung cancer has persistent back pain, tender vertebrae, autonomic dysfunction, and sensory paresthesia. What first line of treatment will the nurse prepare the patient for? 1 Decompressive laminectomy 2 Radiation therapy in conjunction with corticosteroids 3 Aggressive chemotherapy with vincristine and cyclophosphamide 4 IV administration of 3% sodium chloride solution and demeclocycline

2 A patient with cancer who is suffering from back pain with tender vertebrae, autonomic dysfunction, and sensory paresthesia has spinal cord compression. Radiation therapy in conjunction with corticosteroids is the first line of treatment to reduce inflammation and pain. Decompressive laminectomy is a surgical treatment performed when radiation therapy is not effective to the patient. Aggressive chemotherapy with vincristine and cyclophosphamide will result in water retention or syndrome of inappropriate antidiuretic hormone. IV administration of 3% sodium chloride solution and demeclocycline would be effective to reduce water retention in a patient with syndrome of inappropriate antidiuretic hormone.

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

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

Which type of chemotherapy drug will cause severe local tissue breakdown and necrosis if inadvertently infiltrated into the skin? 1 Irritant 2 Vesicant 3 Extravasation 4 Intraarterial chemotherapy

2 A vesicant will cause severe local tissue breakdown and necrosis if it is inadvertently infiltrated into the skin. An irritant will damage the intima of the vein and cause phlebitis and sclerosis; however, it will not damage the skin. Extravasation is the process by which drugs are infiltrated into the tissues surrounding the infusion site. Intraarterial chemotherapy is a route used to deliver drugs to the tumor via the arteries that supply it

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

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

The patient is receiving an intravenous (IV) vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? 1 Ask the patient if the site hurts 2 Turn off the chemotherapy infusion 3 Call the prescribing health care provider 4 Administer sterile saline to the reddened area

2 Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation the infusion first should 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.

The nurse observes that a patient's diagnostic results indicate the presence of a chondrosarcoma. What does the nurse interpret from this finding? 1 The patient has a malignant tumor in bone. 2 The patient has a benign tumor in nerve cells. 3 The patient has a malignant tumor cartilage. 4 The patient has a benign tumor in striated muscle.

3 chondrosarcoma is a malignant tumor in cartilage. A malignant tumor in bone is an osteosarcoma. A benign tumor in the nerve cells is called a ganglioneuroma. A benign tumor in the striated muscle is called a rhabdomyoma.

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

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

The nurse is assessing a patient with prostate cancer and spinal cord compression. Upon further assessment, the nurse anticipates that the patient has autonomic dysfunction. Which finding supports the nurse's conclusion? 1 Facial edema 2 Impaired bladder function 3 Distension of veins of the neck 4 Reduced central venous pressure

2 Damage to the spinal column can alter the function of the autonomic nervous system. Thus, the patient will have impaired bladder function. Facial edema and distension of veins of the neck are manifestations of thrombosis or superior vena cava syndrome. Third space syndrome is a complication associated with visceral fluids.

The patient with cancer is scheduled to have epidural analgesia. What should the nurse educate the patient regarding the administration of this medication? 1 It will increase urine production. 2 It will minimize the use of opioid drugs. 3It will minimize the risk of false calcium levels. 4 It will increase the effectiveness of furosemide.

2 Epidural analgesia minimizes the use of opioids in patients with cancer to relieve pain. Hydration therapy increases urine production and reduces the risk of hyperurecimia. Furosemide is not dependent on analgesic drugs. Low albumin levels in the blood cause false calcium levels; these levels will not be reduced by epidural analgesia.

Which term is used when cancer cells produce more than two cells at the time of mitosis? 1Doubling time 2Pyramid effect 3Generation time 4Contact inhibition

2 Proliferation of cancer cells is indiscriminate and continuous. Sometimes, they produce more than two cells at the time of mitosis, which means there is a continuous growth of the tumor mass. This is termed the pyramid effect. Doubling time is the time required for the tumor mass to double its size. The time from when the cell enters the cell cycle till when the cell divides into two identical cells is called the generation time. Contact inhibition is the mechanism that controls proliferation in the normal cells.

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

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

The registered nurse is explaining to a student nurse about the risk of different types of cancer associated with the alteration of specific tumor suppressor genes. Which statement made by the student nurse demonstrates the need for further education? 1 " p53 tumor suppressor gene alteration increases the risk for liver cancer." 2 " APC tumor suppressor gene alteration increases the risk for lung cancer." 3 " BRCA1 tumor suppressor gene alteration increases the risk for breast cancer." 4 " BRCA2 tumor suppressor gene alteration increases the risk for ovarian cancer."

2 The alterations in the APC gene may increase the risk of familial adenomatous polyposis, not lung cancer. The p53 tumor suppressor gene alteration increases the risk of liver cancer. The BRCA1 tumor suppressor gene alteration is associated with an increased risk of breast cancer. The BRCA2 tumor suppressor gene alteration is associated with an increased risk of ovarian cancer. Text Reference - p. 250

What is an oncogene? 1 carcinogen 2 protooncogene 3 A tumor-inducing gene 4 A tumor-suppressing gene

3 An oncogene is a tumor-inducing gene. A tumor-suppressing gene regulates cell growth. A carcinogen is a cancer-causing agent capable of producing cell alterations. A protooncogene is a normal cell gene that regulates cell processes.

A patient with lung cancer presents with intense, localized, and persistent back pain. The patient also has motor and sensory disturbances. What nursing interventions would be helpful to this patient? Select all that apply. 1 Withhold narcotics. 2 Administer corticosteroids. 3 Encourage a graded increase in patient activity. 4 Prepare the patient for a laminectomy. 5 Prepare the patient for radiation therapy

2, 4, 5 A lung cancer patient with symptoms of intense, persistent, and localized back pain associated with motor and sensory disturbances is suggestive of 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 be immobilized and administered pain killers. page 263

While assessing a patient with breast cancer, the nurse finds that the patient has a fluid shift from the vascular space to the interstitial space. Which symptoms does the nurse associate with the patient's condition? Select all that apply. 1 Bradycardia 2 Hypovolemia 3 Hypertension 4 Decreased urine output 5 Low central venous pressure

2, 4, 5 A shift of fluid from the vascular space to the interstitial space indicates third space syndrome. Because of this fluid imbalance, the patient may have hypovolemia, low urine output, and low central venous pressure. Hypovolemia is blood loss associated with loss of shift in fluid. Urine output will decrease because of low fluids in the body. Central venous pressure is also reduced due to hypovolemia. Bradycardia and hypertension are not associated with this space syndrome.

A patient is treated with radiation therapy for lung cancer. The nurse observes that the patient has dry desquamation of the skin. How should the nurse prevent infection and facilitate healing of the skin? Select all that apply. 1 Apply ice packs. 2 Avoid constricting garments. 3 Avoid the use of heating pads. 4 Suggest the use of deodorants. 5 Avoid rubbing the affected area.

2,3,5 Radiation therapy may cause skin changes due to desquamation, and the skin is prone to infection. The nurse should avoid extreme temperatures on the affected area. Heating pads may cause burns and should be avoided. Constricting garments may traumatize the skin and should be avoided. Rubbing the affected area may also traumatize the skin and should be avoided. Ice packs may cause damage to the affected skin. Deodorants are chemicals and may irritate and traumatize the affected area, and should be avoided.

Which interventions will the nursing management of a patient with leukopenia include? Select all that apply. 1 Administering antiemetic drugs 2 Teaching the patient to avoid large crowds 3 Monitoring the patient's white blood cell count 4 Instructing the patient to take stool softeners as needed 5 Teaching the patient to report any temperature elevation 6 Monitoring the patient's hemoglobin and hematocrit levels

2,3,5 The nurse should monitor the white blood cell count, especially the neutrophils, of a patient with leukopenia because this patient is immunocompromised. In addition, the nurse should teach the patient to avoid large crowds and report temperature elevations because infections are the most frequent cause of morbidity and death in cancer patients. Patients with anemia should have their hemoglobin and hematocrit levels monitored. Antiemetics are administered prophylactically before chemotherapy and as needed. Stool softeners are used if a patient is constipated.

Which surgical interventions are often used for palliative care? Select all that apply. 1 Biopsy 2 Colostomy 3 Tonsillectomy 4 Laminectomy 5 Insertion of a feeding tube 6 Prophylactic mastectomy

2,4,5 A colostomy, an insertion of a feeding tube, and a laminectomy are surgical procedures that provide supportive care to maximize bodily function without curing cancer on their own. A tonsillectomy is not a supportive surgical procedure; it is done to cure tonsil problems. A prophylactic mastectomy is a preventative measure. A biopsy is the removal of a tissue sample for pathologic analysis; it is diagnostic and would not benefit a patient receiving palliative care.

A patient with a renal tumor has spinal cord compression. Which symptom does the nurse associate with the patient's condition? 1 Nocturia 2 Periorbital edema 3 Sensory paresthesia 4 Jugular vein distension

3 A patient with a spinal cord compression will have intense back pain and sensory paresthesia. A patient who has hypercalcemia associated with multiple myeloma will have nocturia. Periorbital edema and jugular vein distension are complications associated with superior vena cava syndrome. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect.

While assessing a patient with breast cancer, the nurse finds that the patient has tender vertebrae and intense back pain, which gets worse when the Valsalva maneuver is applied. Which complication does the nurse expect in the patient? 1 Third space syndrome 2 Tumor lysis syndrome 3 Spinal cord compression 4 Superior vena cava syndrome

3 A patient with breast cancer who has tender vertebrae and intense back pain that gets worse when the Valsalva maneuver is applied probably has spinal cord compression. Third space syndrome is an obstructive emergency that manifests as low central venous pressure, hypovolemia and tachycardia. Tumor lysis syndrome is a metabolic complication associated with cell destruction after chemotherapy, resulting in hyperuricemia. Superior vena cava syndrome is an obstructive complication associated with thrombosis that manifests with facial and periorbital edema. Text Reference - p. 277

Which cells have the most rapid rate of proliferation? 1 Ova or sperm cells 2 Cells of the hair follicles 3 Bone marrow stem cells 4 Epithelial cells of the gastrointestinal tract

3 Bone marrow stem cells have a 6- to 24-hour generation time; these have the most rapid rate of proliferation. The cells of the hair follicles have a 24-hour generation time. The epithelial cells that line the gastrointestinal tract have a 12- to 24-hour generation time. Ova and sperm cells have a 24- to 36-hour generation time.

The nurse is reviewing the laboratory test results for a 67-year-old patient with cancer and diabetes mellitus. The total serum protein level is 6.4 mg/dL. The nurse interprets this finding as: 1 The total protein level is normal; however, the patient would benefit from albumin infusion 2 The protein level is reduced, which is consistent with malnutrition 3 The protein level is normal, and therefore the patient does not have malnutrition 4 The protein level is increased, which is a common finding in patients with cancer

3 Total serum protein level should be between 6.0 and 8.0 g/dL. A protein level of 6.4 is normal.

A patient with cancer has third spacing and is on plasma protein replacement therapy. During the treatment, the nurse observes increased central venous pressure and shortness of breath. Which intervention would provide effective treatment? 1 Administering corticosteroids 2 Administering cyclophosphamide 3 Reducing rate of fluid administration 4 Administering potassium sparing diuretic

3 Although plasma protein replacement therapy will help to treat third spacing effectively, the patient may have hypervolemia, which leads to an increase in central venous pressure and shortness of breath. An effective treatment is to reduce fluid administration. Corticosteroids will help to reduce surgical spinal compression. Cyclophosphamide is an alkylating agent that increases antidiuretic hormone levels; the patient will have complications if this drug is administered. Potassium-sparing diuretics do not reduce the side effects of plasma protein replacement.

The nurse is developing a plan of care for a patient with cancer that is experiencing pain. Which is the most important parameter the nurse should use to develop an effective pain management plan for this patient? 1 Assessing the vital signs 2 Assessing the sleep cycle 3 Assessing the type of pain 4 Assessing the patient behavior

3 Assessing the type of pain (whether it is visceral, neuropathic, or bone) will help a nurse devise an effective pain management plan. Vital signs, sleep cycles, and patient behavior do not provide reliable data about the pain and its progression.

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

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

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

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

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

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

The nurse is performing an assessment on a patient who has been receiving chemotherapy and radiation for breast cancer. The patient's most recent complete blood count (CBC) results are shown in the chart. Considering the patient's CBC results, which of these additional assessment findings is of most concern? Refer to the chart. 1 Nausea 2 Fatigue 3 Temperature of 101.8° F 4 Skin redness at site of radiation

3 Neutropenia is most common in patients receiving chemotherapy and can place them at serious 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. Nausea, fatigue, and skin redness at the site of radiation are expected effects of chemotherapy and radiation therapy. Text Reference - p. 33

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

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

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

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

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

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

A patient with cancer has dysgeusia and tells the student nurse, "I don't want to eat. Everything tastes bitter." Which advice given by the student nurse indicates the need for further teaching? "You should add onions to the vegetables." "You should use mint juice while cooking fish." "You should use lemon juice marinade to the meat." 4 "You should increase spices and seasoning in your food."

4 A patient with cancer may develop dysgeusia because cancer cells release substances that make the taste buds bitter. Using different spices and seasoning agents will help to enhance the taste. However, increasing spices and seasoning will not reduce dysgeusia and in fact may further increase gastric irritation in the patient. Onions help to enhance the taste of vegetables so the patient will have reduced bitterness. Mint and lemon juice helps to enhance the taste of meat and fish so the patient will have reduced dysgeusia. Text Reference - p. 277

The nurse is reviewing the laboratory reports of a patient diagnosed with cancer and finds that the patient has neutropenia. On examination, the nurse finds that the patient has a body temperature of 100.4° F (38° C). What is the priority nursing intervention in this situation? 1 Administering parenteral fluids 2 Administering aspirin to the patient 3 Administering pamidronate to the patient 4 Notifying the primary health care provider

4 A patient with cancer who has neutropenia (low white blood cell count) is vulnerable to infection. A body temperature of 100.4° F (38° C) indicates hyperthermia. The nurse should immediately notify the primary health care provider in this situation. Hydration therapy with parenteral fluids will treat hypocalcaemia, which is a complication of cancer and may cause nephrocalcinosis. Aspirin can reduce hyperthermia; however, it is not preferable for a patient with a low white blood cell count. Pamidronate is a bisphosphonate that inhibits serum calcium levels and help to treat hypercalcemia effectively. Test-Taking Tip: Neutropenia is low count of white blood cell; you need to what type complications are associated with low WBC. Text Reference - p. 277

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

4 In a patient with stage IV malignant cancer, the cells have undergone metastasis. Cancer in situ indicates stage 0 malignancy. The limited spread of cancer cells indicates stage II malignancy. Localized growth of the tumor indicates stage III malignancy. Text Reference - p. 254

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

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

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

4 Among all the cancers in men, prostate cancer has the highest incidence (29%). Lung cancer has the highest death rate among men (29%). The incidence of colon cancer in males is 9%. Thyroid cancer is more common in women than men. Page 235

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

4 Immunologic surveillance 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.

Which type of radiation therapy involves the oral administration of radioactive sources? 1Particulate 2Teletherapy 3Brachytherapy 4Radiopharmaceutical

4 Radiopharmaceutical therapy involves the oral administration of radioactive sources. Teletherapy involves exposing the patient to external radiation. A patient who undergoes brachytherapy is exposed to internal radiation. Particulate radiation is a type of ionizing radiation used to treat cancer.

A patient undergoes modified radical mastectomy with axillary node dissection. After the surgical incision is sufficiently healed, the patient is to undergo radiation therapy. What instruction should the nurse give the patient regarding care of the skin at the site of radiation therapy? 1 Expose the area to sunlight twice a week 2 Apply an ointment to the area to prevent irritation 3 Apply talcum powder to the area to promote comfort 4 Wash the area gently with lukewarm water and lightly pat it dry

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

4 The 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.

Which description below best describes the pyramid effect of cancer cells? 1 Differentiation of cells 2 Time required for a mass to double 3 Discrimination and continuous production of cells 4 The production of more than two cells during mitosis

4 The pyramid effect is the production of more than two cells during mitosis. Cancer cells are indiscriminate, proliferative, unstable, and de-differentiated. The time required for a mass to double is known as the doubling time, not the pyramid effect

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

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

A patient with cancer is receiving massive doses of chemotherapeutic agents. The nurse reviews the patient's laboratory results to assess for which findings that suggest the development of tumor lysis syndrome (TLS)? Select all that apply. 1 Hypokalemia 2 Hyponatremia 3 Hypercalcemia 4 Hyperuricemia 5 Hyperphosphatemia

4, 5 Tumor lysis syndrome is a metabolic change that occurs whenever a tumor sensitive to chemotherapy is subjected to chemotherapeutic agents. It is characterized by hyperuricemia and hyperphosphatemia. Hyperkalemia is associated with tumor lysis syndrome, but not hypokalemia. Tumor lysis syndrome is not associated with hyponatremia. In tumor lysis syndrome there is hypocalcemia, but not hypercalcemia.

Which surgical interventions are often used for palliative care? Select all that apply. Multiple selection question Biopsy Colostomy Tonsillectomy Laminectomy Insertion of a feeding tube Prophylactic mastectomy

A colostomy, an insertion of a feeding tube, and a laminectomy are surgical procedures that provide supportive care to maximize bodily function without curing cancer on their own. A tonsillectomy is not a supportive surgical procedure; it is done to cure tonsil problems. A prophylactic mastectomy is a preventative measure. A biopsy is the removal of a tissue sample for pathologic analysis; it is diagnostic and would not benefit a patient receiving palliative care. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer.

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

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

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

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

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

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

What is the anatomic classification of a malignant bone tumor? 1 Carcinoma 2 Osteosarcoma 3 Neuroblastoma 4 Chondrosarcoma

An osteosarcoma is a malignancy found in bones. A carcinoma is a malignancy found in tissues. A chondrosarcoma is a malignancy found in cartilage. A neuroblastoma is a malignancy found in nerve cells.

Which tumor classification in a patient indicates carcinoma in situ? A. T0 B. Tis C. Tx D. T1-4

B. The TNM classification system is used to determine the anatomic extent of the disease involvement according to three parameters: tumor size and invasiveness, presence or absence of regional spread to lymph nodes, and metastases. Carcinoma in situ (CIS) has its own designation in the system (Tis), because it has all the histologic characteristics of cancer except invasion, which is a primary feature of the TNM staging system. T0 is the designation used when there is no evidence of a primary tumor. TX is the designation used for tumors that cannot be found or measured. T1-4 is the designation used for tumors that ascend in degrees and increase in size. Text Reference - p. 254

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

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

The nurse is explaining cancer cell biology to a student nurse. Which statement may be specifically used with regard to contact inhibition? 1 "The cell differentiation is unstable." 2 "The cells grow on top of one another." 3 "The cell loses its potential to perform all the body functions." 4 "The cells do not revert back to their previous undifferentiated state."

Contact inhibition is a normal mechanism for controlling cell proliferation that ensures that each cell does not cross another's boundary. This mechanism is inhibited in cancer. Therefore, cells disregard boundaries and grow on top of one another. The cell differentiation activity is unstable in cancer cell. The cancerous cells lose the potential to perform all body functions because of differentiation defect only. The cells do not dedifferentiate because of the defect in cell differentiation.

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

Excisional biopsy is a surgical procedure that involves the removal of the entire lesion, lymph node, nodule, or mass. This biopsy, unlike others, involves the removal of a piece of the tumor for pathologic analysis. Incisional biopsy is partial excision of the tumor, which can be performed through a scalpel or dermal punch. It is performed only if an excisional biopsy is not possible Endoscopic biopsy is performed to remove a sample of tissue for pathologic analysis from the lungs or other intraluminal lesions (esophageal, colon, and bladder). Percutaneous biopsy is commonly performed for tissues that can be safely reached through the skin. Text Reference - p. 256

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

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

A patient has a grade IV histologic tumor. What condition does the nurse determine this patient has?

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

A patient with metastatic bone cancer has a low albumin level. Which complication would be difficult to diagnose in the patient? 1 Hyperkalemia 2 Hyponatremia 3 Hyperurecimia 4 Hypercalcemia

Hypercalcemia Serum calcium levels give a false normal value when a patient has low albumin levels. Ionized calcium values should be obtained in order to diagnose hypercalcemia. Hyperkalemia and hyperurecimia are complications of tumor lysis syndrome; uric acid and potassium concentrations are not affected by albumin levels. Hyponatremia is a complication of syndrome of inappropriate antidiuretic hormone (SIADH); low albumin levels do not affect sodium concentration.

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

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.

Melanomas, squamous cell carcinomas, and basal cell carcinomas are associated with which type of carcinogen? 1 Viral 2 Chemical 3 Ultraviolet radiation 4 Inherited genetic mutation

Melanomas, squamous cell carcinomas, and basal cell carcinoma are types of skin cancer, which are associated with ultraviolet radiation. Viral carcinomas are associated with oncogenic viruses. Inherited genetic mutations are passed on from a parent. Chemical carcinogens are cancer-causing agents capable of producing cell alterations.

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

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

The nurse is reviewing the medical records of different patients. Which patient does the nurse expect to require a change in treatment?

Patient B has bone pain associated with multiple myeloma. Radiopharmaceuticals like samarium-153 would be more effective to treat the patient; thus this patient should not be treated with ibuprofen. Patient A has visceral pain associated with stomach cancer; the administration of opioids such as morphine would be effective for the patient. Patient C has neuropathic pain associated with brain tumor; adjuvant therapy such as antidepressants would treat the patient effectively. Patient D has pain associated with chemotherapy; analgesic medications such as opioids and nonsteroidal antiinflammatory drugs would treat the patient effectively.

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

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

The patient has a low-grade carcinoma on the left lateral aspect of the prostate gland and has been on "watchful waiting" status for 5 years. Six months ago his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations now indicate that the prostate cancer may be growing and he needs a change in his care (select all that apply)? Casts in his urine Presence of α-fetoprotein Serum PSA level 10 ng/mL Onset of erectile dysfunction Nodularity of the prostate gland

Serum PSA level Nodularity of the prostate gland The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth.