Med Surg Chapter 15: Set 2

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.

ANS: 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.

When caring for a patient with a temporary radioactive cervical implant, which action by nursing assistive personnel (NAP) indicates that the RN should intervene? a. The NAP flushes the toilet once after emptying the patients bedpan. b. The NAP stands by the patients bed for 30 minutes talking with the patient. c. The NAP places the patients bedding in the laundry container in the hallway. d. The NAP gives the patient an alcohol-containing mouthwash to use for oral care.

ANS: B Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine/feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated.

Which statement by the nurse most facilitates patient cancer prevention during the promotion stage of cancer development? A "Exercise every day for 30 minutes." B "Follow smoking cessation recommendations." C "Following a vitamin regime is highly recommended." D "I recommend excision of the cancer as soon as possible."

ANS: 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. Cigarette smoking is a promoting factor and a carcinogen. 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 consistent with the nurse's role.

A 33-yr-old patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis? A "The cancer is found at the point of origin only." B "Tumor cells have been identified in the cervical region." C "The cancer has been identified in the cervix and the liver." D "Your cancer was identified in the cervix and has limited local spread."

ANS: D Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ or at the point of origin only; 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 such as to the liver.

The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? A. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years B Family history of colorectal cancer and consumes a high-fiber diet C Limits fat consumption and has regular mammography and Pap screenings D Exercises five times every week and does not consume alcoholic beverages

ANS: A Cancer prevention and early detection are associated with the following behaviors: limited alcohol use, regular physical activity, maintaining a normal body weight, obtaining regular cancer screenings, avoiding cigarette smoking and other tobacco use, using sunscreen with SPF 15 or higher, and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).

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

ANS: A 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. Whole and organic foods do not prevent diarrhea.

. When caring for a patient who is pancytopenic, which action by nursing assistive personnel (NAP) indicates a need for the RN to intervene? a. The NAP assists the patient to use dental floss after eating. b. The NAP adds baking soda to the patients saline oral rinses. c. The NAP puts fluoride toothpaste on the patients toothbrush. d. The NAP has the patient rinse after meals with a saline solution.

ANS: A Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.

Trends in the incidence and death rates of cancer include the fact that A. lung cancer is the most common type of cancer in men B. a higher percentage of women than men have lung cancer C. breast cancer is the leading cause of cancer deaths in women D. African Americans have a higher death rate from cancer than whites.

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

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 malgnant cells C. production of blocking factors that immobilize cancer cells D. reacting to anew set of antigenic determinants on cancer cells.

ANS: 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.

The nurse at the clinic is interviewing a 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)? a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening

ANS: A, C, D, E The patients age, gender, and history indicate a need for screening and/or teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use excessive alcohol or tobacco, she is physically active, and her body weight is healthy.

What features of cancer cells distinguish them from normal cells? A. Cells lack contact inhibition B. Oncogenes maintain normal cell expression C. Cells return to a previous undifferentiated state D. Proliferation occurs when there is a need for more cells E. New proteins characteristic of embryonic stage emerge on cell membrane.

ANS: A, C, E 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.

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for cancer of the colon. Which information about the patient is most indicative of a need for a change in therapy? a. Poor oral intake b. Increase in CEA c. Frequent loose stools d. Complaints of nausea

ANS: B An increase in CEA indicates that the chemotherapy is not effective for the patients cancer and may need to be modified. The other patient findings are common adverse effects of chemotherapy. The nurse may need to address these, but they would not indicate a need for a change in therapy.

Which patient is statistically and medically at the highest risk of developing cancer? A A 68-yr-old white woman who has BRCA-1 gene and is obese I B A 56-yr-old African American man with hepatitis C who drinks alcohol daily C An 18-yr-old Hispanic man who eats fast food once per week and drink alcohol D An 80-yr-old Asian woman with coronary artery disease on blood pressure medication.

ANS: B The combination of statistically identified risk factors in addition to current liver disease (hepatitis C that is linked to the development of liver cancer) and the added promotor of alcohol makes this patient at the highest risk. Second is the white woman with the gene for breast cancer and the added promotor of obesity. The majority of cancer cases are diagnosed in individuals older than 55 years of age. The overall incidence of cancer is higher in men than women. Cancer incidence is higher in African Americans, then whites, and then people from other cultures.

A 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.

ANS: 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 her adenoma tumor is not encapsulated but has normally differentiated cells and 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.

ANS: C Benign tumors are usually encapsulated, have normally differentiated cells, and do not metastasize. Malignant tumors are rarely encapsulated, have poorly differentiated cells, and are capable of metastasis.

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 in the abdomen for chemotherapy administration. D The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

ANS: 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.

. After receiving change-of-shift report, which of these patients should the nurse assess first? a. 35-year-old who has wet desquamation associated with abdominal radiation b. 42-year-old who is sobbing after receiving a new diagnosis of ovarian cancer c. 24-year-old who is receiving neck radiation and has blood oozing from the neck d. 56-year-old who has a new pericardial friction rub after receiving chest radiation

ANS: C Since neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first. The diagnoses and clinical manifestations for the other patients are not immediately life threatening.

A female patient is having chemotherapy for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? A "When your hair grows back, it will be patchy." B "Don't use your curling iron, and that will slow down the loss." C "You can get a wig now to match your hair so you will not look different." D "You should contact "Look Good, Feel Better" to figure out what to do about this."

ANS: C 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. Although hair loss with chemotherapy is usually reversible, hair loss with radiation is usually permanent in the areas radiation was administered. When hair grows back it could be 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 64-yr-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to the plan of care? A Provide ice chips to soothe the irritation. Incorrect B Weigh the patient every month to monitor for weight loss. C Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. D Provide high-protein and high-calorie, soft foods every 2 hours.

ANS: D A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories to aid healing. Extremes of temperature are to be avoided. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Patients should be weighed at least twice each week to monitor for weight loss.

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

ANS: 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 immunotherapy 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)

ANS: 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 is not used first to combat flu-like symptoms of headache, fever, chills, myalgias, and so on.

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 Incorrect C Most chemicals D Epstein-Barr virus

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

The nurse is caring for an 18-yr-old female patient with acute lymphocytic leukemia that is scheduled for hematopoietic stem cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure? A "I understand the transplant procedure has no dangerous side effects." B "After the transplant, I will feel better and can go home in 5 to 7 days." C "My brother will be a 100% match for the cells used during the transplant." D "Before the transplant, I will have chemotherapy and possibly full-body radiation."

ANS: D Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.

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

ANS: D 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 that allows the cancer cells to reproduce.

A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? A Weight gain of 6 lb B Nausea and vomiting C Urine specific gravity of 1.004 D Serum sodium level of 118 mEq/L

ANS: D Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. The other options listed are also symptoms of hyponatremia but are not as critical to report to the health care provider.

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 despite host control mechanisms

ANS: 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.

Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider? a. Hematocrit of 30% b. Platelets of 95,000/l c. Hemoglobin of 10 g/L d. WBC count of 1700/l

ANS: D The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that white blood cell (WBC) growth factors such as filgrastim (Neupogen) are needed. The other laboratory data do not indicate any immediate life-threatening adverse effects of the chemotherapy.

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate 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 mealtimes. Incorrect D Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

ANS: D The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (e.g., peanut butter, skim milk powder, cheese, honey, 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.

The nurse is caring for a 59- year old woman who had surgery 1 day ago for removal of a malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says she is scared to die. The MOST effective nursing intervention is A. motivate change in unhealthy lifestyle B. teach her about the seven warning signs of cancer C. instruct her about healthy stress relief and coping practices D. let her communicate about the meaning of this experience

ANS: 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 nurse assesses a 76-yr-old man with chronic myeloid leukemia receiving chemotherapy using a kinase inhibitor medication. Which question is most important for the nurse to ask? A "Have you had a fever?" B "Have you lost any weight?" C "Has diarrhea been a problem?" D "Have you noticed any hair loss?"

ANS:A An adverse effect of kinase inhibitors is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4° F or higher. The other options are possible while undergoing chemotherapy but do not represent the highest priority for assessment.