OCN

A patient with metastatic renal cell cancer is tired, confused, has not had a bowel movement in five days, and requires assistance with ambulation. Vital signs include heart rate, 55 beats per minute; respiratory rate, 18 breaths per minute; and blood pressure, 100/60 mm Hg. What is the patient most likely experiencing? a. Spinal cord compression b. Treatment side effects c. Hypercalcemia d. Symptoms of metastasis

A delay in diagnosis of hypercalcemia often occurs due to nonspecificity of symptoms, which include constipation, lethargy, and confusion. The patient with hypercalcemia may also present with bradycardia due to depression of the conduction system.

A signal transduction inhibitor is what? a. The group of drugs that controls the conduction pathways of the heart b. The type of targeted therapy that stimulates production of normal immune cells by crowding out the signals from cancer cells c. A drug that blocks signals going to the cell nucleus and telling it to divide d. The concept of using electronic signals to compete with normal cell pathways.

A drug that blocks signals going to the cell nucleus and telling it to divide. A signal transduction inhibitor blocks a key signaling cascade, causing disruption to the cell's function.

A patient reports pruritus above the peripheral IV site while receiving an infusion of doxorubicin. The nurse observes redness along the vein, with a brisk, sustained blood return. This most likely indicates: a. a flare reaction. b. radiation recall. c. a psychosomatic response. d.an extravasation.

A flare reaction may cause itching, blotchiness or streaking along or next to the vein receiving the infusion, without the presence of swelling or pain.

A centiGray is what? a. A unit of measure of radiation energy b. The color of tissue after radiation therapy treatment c. One-hundredth of the radiation dose delivered d. A description of cell kill fraction

A unit of measure of radiation energy. Radiation is measured and prescribed in centiGray. The older term for this is a rad.

Acetylsalicylic acid has been shown to reduce the mortality rate for which type of cancer?

Acetylsalicylic acid use has consistently displayed effectiveness in reducing mortality rates for patients with gastrointestinal cancers.

Taxanes

Act in G2 and M phase causing inhibition of cell division

Adjuvant

After primary therapy. Chemo/radiation given after surgery to kill remaining cells in the body that may be undetectable

Which of the following are cancer risk factors? Selected: a. Being of advanced age and having a history of heavy alcohol ingestion b. Having environmental exposure to asbestos and taking supplemental vitamin C c. Eating a diet high in fiber d. Smoking cigarettes and eating lots of fruits and vegetables

Age is an example of a unmodifiable risk; alcohol use is a modifiable risk. Smoking cigarettes increases one's risk for cancer, but eating fruits and vegetables does not. Environmental exposure to asbestos is a cancer risk factor, but taking supplemental vitamin C is not. Eating a diet high in fiber is not a known cancer risk factor. Advanced age, along with a history of heavy alcohol ingestion, would place an individual at higher risk for cancer development.

A patient newly diagnosed with Hodgkin lymphoma is determined to have an unfavorable prognosis through which of the following clinical findings

An absolute lymphocyte count of less than 600/mm3 is an unfavorable prognostic finding for a patient with advanced Hodgkin lymphoma

Mrs. Jones has anorexia from her chemotherapy treatments. She has lost 10 pounds. You would expect her management plan to include what? a. Appetite-stimulating medication b. Antiemetic medication c. High-fiber, low-fat, low-protein diet d. Antidiarrheal medication

Appetite-stimulating medication

In a pain assessment, the mnemonic ABCDE stands for what? a. Ask, Buy, Category, Dose, Efficacy b. Ask, Believe, Choose, Deliver, Empower/Enable c. Always, Be, Certain, Dose, Effective d. Addiction, Be, Careful, Drug, Encourage

Ask, Believe, Choose, Deliver, Empower/Enable. The suggested method of pain assessment begins by asking/assessing and continues through empowering patients and families.

Informed consent accomplishes which of the following? a. Assurance of the patient's free access to experimental therapies b. Patient protection from harm c. Assurance that the patient understands and agrees with the physician's recommendation d. Avoidance of exploitation of the patient

Avoidance of exploitation of the patient. Informed consent is a decision made freely by the patient or his or her legal representative upon full understanding of all elements of the treatment. The purpose is to promote autonomy, protect the patient from harm, and ensure that good clinical practice has occurred.

Neoadjuvant therapy

Before primary therapy. Chemo or radiating therapy before the surgery to shrink the tumor so its easier to remove and can preserve maximum function

Aromatase inhibitors

Block estrogen production by the adrenals. -Used in postmenopausal women who have their ovaries removed (estrogen primarily produced by overies in premenopausal, and primarily by adrenal glands in postmenopausal) Ex: anastrozole and letrozole

Tamoxifen

Blocks estrogen from the tumor cells but does not stop the production of estrogen

Leucopenia, anemia, and thrombocytopenia are possible manifestations or characteristics of what? a. Carcinogenesis b. Angiogenesis c. Cancer cell mutations d. Bone marrow suppression after cancer treatment

Bone marrow suppression after cancer treatment

In what way do B lymphocytes differ from T lymphocytes? a. B lymphocytes are immortal and T lymphocytes are not. b. B lymphocytes travel faster in the body than T lymphocytes. c. B lymphocytes make antibodies and T lymphocytes do not. d. B lymphocytes are smaller than T lymphocytes.

C- B lymphocytes make antibodies and T lymphocytes do not B lymphocytes are important in antibody-related immunity. When microorganisms invade the body, B lymphocytes make an antibody just like the invading antigen so it can seek out and kill other invasions of the same microorganism. T lymphocytes are important in cell-mediated immunity and can immobilize the immunity and attack invading cells and microorganisms.

Which of the following characteristics distinguishes a normal cell from a cancer cell? a. A normal cell has lost its ability to divide. b. A normal cell has the ability to migrate away from its neighbors. c. A normal cell has contact inhibition. d. A normal cell has lost similarity to the parent cell.

C- normal cell has contact inhibition Cancer cells lack the general adherence, or "sticktogetherness," of normal cells and are not inhibited by crowded conditions or contact with other cells and structures. Malignant (cancer) cells have the following characteristics: structure different from parent tissue, uncontrolled cell division, loosely adherent without contact inhibition, migratory, and potential for angiogenesis.

Which of the following is false about tumor suppressor genes? a. They oppose proto-oncogenes so that a growth balance exists within the cell. b. They can become mutated and lead to malignant transformation. c. They lead to tumor initiation and growth. d. They suppress unneeded cell division and growth.

C- they lead to tumor initiation and growth Tumor suppressor genes do NOT lead to tumor initiation and growth!

What is the best strategy for management of cancer-related anxiety or depression? a. Private discussion with the patient's partner to find out his or her history b. Encouragement to join support groups as soon as possible c. Early identification and intervention d. Pharmacologic intervention

C. Early identification of at-risk patients and early intervention if symptoms are present are the best strategies for management.

Pain that originates from bone metastasis can be categorized as what? a. Visceral pain b. Phantom limb pain c. Somatic pain d. Neuropathic pain

C. Somatic pain

In people with cancer, if a screening test is able to detect a certain type of cancer 98% of the time with few false positives, this test has high what? a. Control b. Reliability c. Sensitivity d. Specificity

C. sensitivity

Differences between normal and cancer cells include what? a. Normal cell uses oxygen, whereas a cancer cell is anaerobic. b. Cancer's structure and function is different from the parent cell. c. Both types cannot divide unless they are touching another cell. d. Normal cells can migrate, whereas cancer cells stay fixed.

Cancer's structure and function is different from the parent cell.

Sarcoma

Cancers that form in the bone and soft tissue such as muscle, fat, blood vessel, fibrous tissue (ligament/tendon)

Doxorubicin side effects

Cardio toxicity which can occur months to years after therapy. Diarrhea, N&V, esophagitis/stomatitis -Max lifetime dose is 450-550mg/m2 -If receiving concurrent cytoxan or who have received radiation to the chest you should not exceed 250 mg/m2

what chemo drugs can cause palmar-plantar erythrodysesthesia

Chemotherapy drugs known to cause HFS include: capecitabine (Xeloda®), fluorouracil (5-FU), liposomal doxorubicin (Doxil®), doxorubicin (Adriamycin®), cytarabine (Ara-c®), sunitinib (Sutent®) and sorafenib (Nexavar®).

Chronic radiation side effects can be distinguished from acute, in that chronic effects have which of the following characteristics? a. Chronic effects are predictable and occur during radiation treatment. b. Chronic effects occur in rapidly dividing tissues, such as bone marrow. c. Chronic effects can occur weeks or months after radiation treatment. d. Chronic effects are always reversible within one to two years.

Chronic effects can occur weeks or months after radiation treatment.This answer is correct.Correct! Chronic means long lasting, and chronic side effects persist or occur weeks to months after treatment is complete. Acute side effects occur during treatment and subside when treatment is complete.

Obesity increases risk for which cancers

Colon, upper stomach, postmenopausal breast, uterine, kidney, esophageal

Which of the following most likely indicates an early symptom of increased intracranial pressure? 1. Periorbital edema 2. Bradycardia 3. Decortication 4. Confusion

Confusion Early signs and symptoms of increased intracranial pressure may include restlessness and confusion

Which of the following interventions is most appropriate for a patient with noticeable skin sloughing and tissue breakdown following an extravasation? a. Application of a heat pack b. Administration of dexrazoxane c. Consultation with plastic surgery d.Consultation with infectious disease

Consult of plastics Patients demonstrating significant tissue damage following an extravasation should receive specialized care and consultation with plastic surgery.

5-FU side effects

Continuous IV infusion can cause severe diarrhea and mucositis. Can cause heaert issues (angina, hypotension, ekg changes/arrhythmias,MI- usually within the first two days). Hand & foot syndrome, visual changes, N & V. Avoid sun exposure. -Giving leucovorin with it enhances the activity but also increases diarrhea -Ice chips in mouth 10-15 min before/after IV bolus can help prevent mucositis.

The extended stage of survival focuses on what? a. Diagnosis through active treatment b. Coping with symptoms during treatment c. Quality-of-life issues and palliative care concerns d. Completion of initial treatment and maintenance therapy

Coping with symptoms during treatment

Which of the following medications is a vesicant 1. Topotecan 2. Melphalan 3. Dacarbazine 4. Dactinomycin

Dactinomycin

Alkylating agents

Damage intracellular DNA. Cancer cells cannot repair DNA as well as normal cells, so they undergo apoptosis. Ex: cyclophosphamide, platins, dacarbazine

Radiation kills cancer cells by doing what? a. Starving the cells by preventing oxygen uptake b. Directly damaging DNA chromosomal structure c. Preventing the formation of new blood vessels d. poisoning the cell using heavy metals

Directly damaging DNA chromosomal structure Radiation causes direct damage to the chromosomal DNA structure of cancer cells and normal cells.

Certain chemotherapy agents can cause damage to the heart muscle. Which of the following is a way to minimize severe heart damage? a. Teach the patient to report daily temperature. b. Do weekly LFTs. c. Do a baseline heart test, and repeat it periodically during treatment. d. Teach the patient to take a prescribed sleeping pill.

Do a baseline heart test, and repeat it periodically during treatment. Baseline studies will show if a person has preexisting cardiac damage and can also provide information for later in treatment should symptoms related to cardiac toxicity manifest. Repeating the studies is recommended with and without symptoms.

Hyperkalemia symptoms

EKG changes, muscle weakness or cramping, twitching, tingling, paresthesia, nausea, vomiting, diarrhea, lethargy, syncope

A nulliparous 60-year-old obese female with diabetes is experiencing postmenopausal bleeding. The patient is at greatest risk for developing which type of cancer a. ovarian b. cervical c. endometrial d. tubal

Endometrial Risk factors for endometrial cancer include obesity, nulliparity, hypertension, diabetes, and development of menopause after the age of 52.

Reiki therapy is a type of what? a. Energy therapyThis answer is correct.Correct. Reiki is a type of energy or biofield therapy. b. Manipulative and body-based method c. Integrative therapy d. Mind-body intervention

Energy therapy. Reiki is a type of energy or biofield therapy.

Which of the following interventions is helpful to a cancer survivor? a. Discussing long-distance resources b. Protecting him or her from the community c. Making decisions for him or her d. Facilitating rehabilitation

Facilitating rehabilitation

True or false Cancer cells from a specific cancer, such as colon cancer, metastasize to all other organs in the body.

False

True or false: Mucositis is the term used to describe only the inflammation of mucosa in the mouth.

False

True or false: Confusion and dementia, once diagnosed in the patient with cancer, will become chronic conditions for which adaptations must be made.

False Although these symptoms may be permanent for some patients, confusion and dementia are reversible, depending on the cause

True or false: Currently, there are no treatment vaccines available for cancer, but research is promising.

False. Treatment vaccines exist for prostate cancer and superficial bladder lesions.

True/False Cancer risk factors cannot be modified.

False. There are many lifestyle and exposure risks that can be modified

True or False: Late surgical effects of breast surgery include lymphedema, sexual dysfunction, and hemorrhoids.

False. You already seem to know that hemorrhoids is not a late surgical effect for breast surgery.

True or false: Proto-oncogenes alone are required to transform a normal cell into a malignant cell

False: both proto-oncogenes and tumor suppressor genes are associated with malignancy

Which of the following are signs and symptoms of anemia? a. Fatigue and headache b. Decreased heart rate and blood pressure c. Erythema of the face d. Bleeding and ecchymoses

Fatigue and headache. Anemia can cause symptoms related to inadequate oxygen supply to the body's tissues.

adenocarcinoma

Forms in epithelial cells that produce fluids or mucus. Ex: cancer of breast, colon, prostate

Squamous cell carcinoma

Forms in squamous cells which are epithelial cells that lie just beneath the skin. Also lines stomach, intestines, lungs, bladder, kidneys

Grades of cancer

G1: well differentiated, similar to parent cell G2: moderately differentiated, less similar to parent cell G3: Poorly differentiated, dissimilar to parent cell G4: undifferentiated, very dissimilar to parent cell Cancer of unknown origin: no numeric grade. Extremely dissimilar, unable to determine type of parent cell

Which of the following radiation energy rays penetrates the farthest? a. Radionuclides b. Alpha rays c. Gamma rays d. Beta rays

Gamma rays. Gamma rays penetrate the farthest and require lead shielding. Alpha rays penetrate the least and can be stopped by paper. Beta rays penetrate farther than alpha rays and can be stopped by plastic or a person's body when given internally. Radionuclides used in internal radiation treatment vary in radioactivity and penetration.

Which of the following would be a secondary prevention strategy for a 60-year-old woman? a. Stop smoking or never smoke cigarettes. b. Have a mammogram and physical breast examination annually.

Having a mammogram/breast exam annually is a secondary prevention

Hydroxyurea side effects

Hyperpigmentation, erythema of hands and face, alopecia, mild N&V, myelosuppresion. -Patients should NOT take missed doses or double up on doses

Etoposide side effects

Hypotension with rapid infusion neuropathy, N&V, diarrhea

Extravasation & chemo

Ice/icepack is recommended for the initial management of all chemotherapy extravasation except vinca alkaloids (vincristine, vinblastine), and epipodophyllotoxins (etoposide). Cold helps vasoconstrict which limits the spread of the vesicant. Warm for vinca alkaloids and etop helps to dilate the tissue to assist the drug to leave the area

The major reasons cancer-related pain can still be poorly managed in some patients are what? a. Provider and patient fear of respiratory arrest and addiction b. Inadequate patient assessment, expense of medications, and patient fear of side effects c. Inefficient discharge planning and referrals d. Cultural differences between the pharmacist and the patient

Inadequate patient assessment, expense of medications, and patient fear of side effects. There are other causes of poorly managed cancer pain, but these are the most significant.

Which of the following is a pathologic process of syndrome of inappropriate antidiuretic hormone? 1. Urine osmolality less than serum osmolality 2. Increased reabsorption of water by the renal tubules 3. Decreased sodium secretion by the kidneys 4. Increased serum sodium concentration

Increased reabsorption of water by the renal tubules

What are three general side effects of surgery? a. Deep vein thrombosis, death, and kidney stones b. Edema, anasarca, and pulmonary edema c. Mycotic valve deposits, urinary retention, and sudden death d. Infection, bleeding, and incomplete wound healing

Infection, bleeding, and incomplete wound healing. You may already know that the complications noted in the other options may be complications but are not common or routinely expected to occur.

Which statement about CAM is correct? a. Integrative therapy means that the natural treatment is integrated with traditional therapy. b. Complementary therapy is mind-body therapy, whereas integrative therapy is a type of energy therapy. c. Alternative therapies mean you receive both natural and traditional therapies. d. There are no differences between the types of CAM therapies; they are all integrative.

Integrative therapy means that the natural treatment is integrated with traditional therapy. Integrative therapy integrates evidence-based data for natural treatments with conventional treatments.

Vinca Alkaloids

Interfere with microtubule formation and function which is necessary for cell division and intracellular communication. -peripheral neuropathy is a side effect Ex: vincristine, vinblastine, vinorelbine

Which of the following factors play a major role in the prevention of colon cancer? a. Acetaminophen b. Diet c. Vitamins d. Exercise

It is estimated that 80% of colon cancers can be prevented by dietary change.

Which of the following is correct in regard to dry desquamation? a. It presents as scaly, flaky skin due to damage to the epidermis. b. It is characterized by general reddening of the skin in the treatment field. c. It is characterized by red, weeping skin due to complete destruction of skin. d. It can be prevented by washing the skin in hot water with Dove® soap.

It presents as scaly, flaky skin due to damage to the epidermis.

Luteinizing hormone releasing hormone drugs (LHRH)

Lower the amount of testosterone made in the testicles. Ex: leuprolide (lupron), triptolelin (trelstar

Which cancer is estimated to cause the most cancer related deaths for both men and women

Lung cancer

Carcinoma

Most common form of cancer. Formed by epithelial cells. Types- adenocarcinoma, basal cell carcinoma, squamous cell carcinoma, transitional cell carcinoma

Antitumor antibiotics (anthracyclines)

Most cytotoxic effect is cause by free radical formation (attacking cell membranes) and topoisomers II enzyme inhibition (creates double-strand breaks in DNA) - the release of free radicals cause cardiac toxicities Ex: bleomycin, dactinomycin, doxorubicin

Hyperuricemia

Nausea, vomiting, diarrhea, anorexia, edema, flank pain, hematuria, lethargy, malaise, fatigue, weakness, pruritus

Vincristine side effects

Necrosis with extravasation -hypo/hypertension, azoospermia/amenorrhea, N&V, diarrhea, SOB, syndrome of inappropriate antidiuretic hormone secretion, urinary retention -may develop paralytic ileus- recommended prophylactic stool softener

Ms. Jones is receiving chemotherapy that will shrink her breast tumor, making a lumpectomy possible. This type of chemotherapy is called what? a. Palliative chemotherapy b. Adjuvant chemotherapy c. Segmental chemotherapy d. Neoadjuvant chemotherapy

Neoadjuvant

Acute side effects to radiation

Occur during radiation and several months after. Predictable and reversible unless the mazx dose is exceeded. Hair loss, tender/reddened tissue lining of the mouth (or wherever else there are more rapidly dividing cells"

Chronic side effects to radiation

Occur several years after completing treatment Typically occur in tissues with slowly dividing cells (connective tissue and muscle). Can be permanent

Cisplatin side effects

One of the most severe emetogens. Acute renal failure can occur. Vigorous hydration necessary. Can cause peripheral neuropathy w/prolonged use, electrolyte abnormalities, bradycardia, hypo/hypertension

T cells

Participate humoral immunity but also have significant roll in cell-mediated immunity (protect against viruses, fungi, tumor cells, protozoa, transplanted tissue)

Culture refers to what? a. Belief system held by members of the same group involving political and spiritual issues b. Person's country and date of birth c. Pattern of behavior determined by one's family and friends d. Group's distinct knowledge and habits, passed on from generation to generation

Pattern of behavior determined by one's family and friends

A trial that examines the maximum tolerable dose and the acceptability of toxicity of an agent or regimen is known as what? a. Phase I clinical trial b. Phase II clinical trial c. Phase III clinical trial d. Phase IV clinical trial

Phase I clinical trial Dose-limiting toxicities and maximum tolerated doses are the foci of a phase I trial.

Simulation is best described as which of the following? a. Pretending to give radiation therapy to see what the effect on the body is b. Precise determination of the radiation treatment field c. Positioning the body on the treatment table in line with the machine d. Protection of all body parts from deep effects of radiation

Precise determination of the radiation treatment field. he first step in treatment planning, simulation, precisely defines the area to be treated and identifies the areas requiring protection from radiation.

Common cancers treated with hormone therapy include which of the following? a. Gastrointestinal cancers b. Ovarian and testicular cancers c. Prostate and breast cancers d. Renal cell and adrenal cancers

Prostate and breast cancers. Prostate and breast cancers are most often associated with hormone therapy. Anti-androgen drugs are often successful in decreasing cancer of the prostate by shutting down androgen growth signals. Anti-estrogen therapy may be used to stop the growth of breast cancer cells.

Which type of cells is more highly sensitive to the effects of radiation therapy? a. Rapidly dividing cells and well-oxygenated cells b. Rapidly dividing cells c. Well-oxygenated cells d. Poorly oxygenated cells

Rapidly dividing cells and well-oxygenated cells

A patient with sepsis reports hematuria and dyspnea. The laboratory values include platelets 37,000/mm3, prothrombin time 21 seconds, partial thromboplastin time 43 seconds, and fibrinogen 100 mg/dL. Which of the following is the most likely cause? a. Hemorrhagic cystitis b. Heparin-induced thrombocytopenia c. Idiopathic thrombocytopenic purpura d. Disseminated intravascular coagulation

Sepsis and infection can disrupt the clotting cascade, causing disseminated intravascular coagulation

Tyrosine kinase inhibitors (TKI's) -side effects -examples

Side effects: rash, fluid retention, N&V, diarrhea, fatigue ex: sprycel, imatinib (gleevac), nilotinib (tasigna) -a lot of drug interaction. Be careful with even over the counter meds

Smoking and cancer

Smoking accounts for 30% cancer death and 87% lung cancer death

Which of the following would be a primary prevention strategy for a 55-year-old man? a. Undergo a PSA test and prostate examination every three years. b. Stop smoking or never smoke cigarettes.

Stop smoking/never smoke is a primary prevention

The phase of the cell cycle when the cell duplicates its DNA (protein) in preparation to make a daughter cell is called what?

Synthesis phase- this phase has DNA synthesis and DNA protein is replicated G0- resting phase Mitosis-Actual cell division and creation of daughter cell

When referring to TNM staging, what does each letter stand for?

T: Tumor (the original tumor) N: Lymph node involvement M: mets

Hypocalcemia

Tetany, positive chvostek and trousseau signs, twitching, paresthesia, muscle cramps, seizure, syncope, hypotension, anorexia, EKG changes, irritability, anxiety, confusion, hallucinations, diarrhea

What does molecular targeted therapy mean? a. That this therapy needs to be given alone as a single target before any other therapy b. That side effects will be targeted to one body system only c. That it is targeted against molecular processes or mistakes in a cancer cell d. That it is a therapy directed against all molecules in the body

That it is targeted against molecular processes or mistakes in a cancer cell. Molecular targeted therapy is targeted against molecular processes or mistakes in the cancer cell. This is one of the ways that it works.

Which of the following cancers is associated with the development of disseminated intravascular coagulation a. Acral lentiginous melanoma b. Mucin-secreting adenocarcinoma of the breast c. Nonhyperdiploid variant multiple myeloma d. Primary peritoneal carcinoma

The incidence of disseminated intravascular coagulation is associated mostly with mucin-secreting adenocarcinomas of the prostate, lung, and breast.

AHA's Patients' Bill of Rights (which has been replaced with a plain language document) provides what? a. The patient's rights and responsibilities while in a hospital b. Legal counsel if a patient has wrong-site surgery c. Legal assistance for patients who wish to sue d. The patient's rights when in a courtroom

The patient's rights and responsibilities while in a hospital. The Patient's Bill of Rights was developed by the AHA guaranteeing patients certain rights.

A patient with breast cancer who received cyclophospamide five years ago reports a new onset of bruising and fatigue. The nurse suspects

The risk of secondary leukemia increases with the use of alkylating agents

Cells that are sensitive to radiation damage have all of the following characteristics EXCEPT which of the following? a. They are in the mitotic phase. b. They are well differentiated. c. They are well oxygenated. d. They divide rapidly.

They are well differentiated. Cells most sensitive to radiation are those that are poorly differentiated, rapidly dividing, and well oxygenated.

When is tissue necrosis most likely to occur after a doxorubicin extravasation?

Tissue necrosis is usually evident two to three weeks after extravasation.

The goal of biotherapy is what? a. To trap cancer cells in the lymph nodes b. To remove lymphatic tissue c. To improve the action of the heart d. To help the immune system fight cancer cells.

To help the immune system fight cancer cells. Biotherapy theoretically stimulates various entities of the immune system to fight the growth or spread of cancer cells.

Why are drugs given in combination? a. To permit higher drug doses b. To be convenient for clinic administration c. To cause less damage to normal cells d. To overcome drug resistance

To overcome drug resistance. Drug combinations are better able than single agents to overcome drug resistance. Combination therapies can often cause more, not less, damage to normal cells and typically require lower doses. Combination therapies are less convenient for clinic administration because of the complexity of most regimens.

A patient with pulmonary metastasis has received repeated thoracenteses. The nurse is most concerned for the development of what?

Trapped lung Repeated thoracenteses may result in the development of an unexpanded, or trapped, lung.

True or False: vA phase III clinical trial compares a new drug with the current standard of care

True

True or False: The more closely a cancer cell resembles and functions like a normal cell of the parent tissue, the better its differentiation.

True

True or False: Breast reconstructive surgery should be discussed and planned prior to mastectomy.

True Reconstructive surgery is able to be performed immediately following mastectomy in some cases.

True or false: Biotherapy relies on the immune system to be effective

True.

Which situation would most likely be a cause of cancer-related pain? a. Tumor pressure on nerves. b. Anorexia and weight loss c. Too much or too little sleep d. Real or imagined cancer-related problems

Tumor pressure on nerves. Tumor invasion and pressure on nerves are the most common causes of cancer pain.

Which of the following is NOT a way that gene therapy can be achieved? a. Injecting cancer genes with substances that make them more sensitive to treatment b. Using waves and particles at the molecular level to treat cancer c. Replacing mutated genes with healthy genes d. Stimulating the body's immune system to fight the cancer naturally

Using waves and particles at the molecular level to treat cancer. This describes the principle behind radiation therapy, not biotherapy treatment. The other three options all describe ways that gene therapy can be achieved.

Examples of mind-body interventions are what? a. Naturopathic medicine and Ayurveda b. Diet and nutritional therapies c. Reiki and pulse fields d. Visualization, relaxation, and yoga

Visualization, relaxation, and yoga

When does acute nausea and vomiting occur after a person receives chemotherapy? a. After 24 hours b. One week later c. Within 24 hours d. After three days

Within 24 hours. Acute CINV occurs within 24 hours of chemotherapy. After 24 hours, it is referred to as delayed CINV.

A patient is evaluated to participate in a phase 2 clinical trial. Which of the following is the most important consideration for patient selection? a. The patient has an adequate performance status. b. The patient must have metastatic disease. c. The patient has exhausted all approved treatments. d. The patient must have had no prior exposure to chemotherapy.

adequate performance status Since a response rate is the primary endpoint of a phase 2 clinical trial, patients entered into these studies must have a specific diagnosis, a good performance status, and minimal prior exposure to chemotherapy (at most 1 or 2 prior regimens).

Intraperitoneal

administered in the peritoneal cavity. Once chemo instilled, the patient will be asked to change positions to distribute the drug

Adrenocorticosteroids

anticancer effect most significant in inhibiting lymphocyte production and most often used in acute &chronic lymphoblastic leukemia, hodgkin disease, non-hodgkin lymphoma, and multiple myeloma. ex- hydrocortisone, perdnisolone, dexamethasone

Surgical side effects

aspiration pneumonia, infection, bleeding, incomplete wound healing, risk of death thromboembolism Surgical risks specific to cancer patients: nutritional deficits, blood disorder (anemia, thrombocutopenia, leukopenia), thromboembolism, physical compromise

osteosarcoma

cancer of the bone

In order to divide, the cell progresses through the cell cycle in an orderly manner. What is the sequence of phases? a. G1, G2, mitosis, synthesis b. G2, G1, mitosis, synthesis c. Synthesis, mitosis, G2, G1 d. G1, synthesis, G2, mitosis

d. G1, synthesis, G2, mitosis

Intravesicular

delivered into the bladder to avoid side effects from systemic chemo

Intrathecal

delivers directly into the cerebrospinal fluids. Used to reach malignant cells that cannot be reached by the systemic chemo d/t blood brain barrier

Toxicities associated with checkpoint inhibitors:

events are driven by an inflammatory response to immune-mediated activity which results in inflammation within one or more organ system

Tamoxifen

for HR+, metastatic breast, early-stage in adjuvant setting, and breast cancer prevention in high-risk individuals. Its an estrogen receptor antagonist. Binds to estrogen receptors in tumors and other tissues so that estrogen can't. Side effects: endometrial cancer, DVT, PE, flushing, hypertension, peripheral edema, hot flashes, vaginal bleeding/discharge, etc. Consideration: can increase ovulation in premenopausal women

Leuprolide

for breast (HR+) and prostate cancer. It blocks LHRH from the hypothalamus which prevents the release of luteinizing hormone and follicle stimulation hormone from the pituitary gland. Side effects: mood changes, hot flashes, decreased libido, musculoskeletal weakness, decreased bone density

cyclophosphamide

highly emetogenic w/doses over 1 gram. Acute hemorrhagic cystitis can occur- encourage aggressive hydration and frequent voiding

Intrapleural

insertion of thoracotomy tube into the pleural lining. This can help close the gap between lung and thoracic activity for lung cancers that produce pleural effusions repeatedly.

Types of risk

o Attributable risk: amount of disease within the population that could be prevented by alteration of a risk factor o Absolute risk: measures the occurrence of cancer in the general population (NOT high-risk population) o Relative risk: incidence or deaths among those with a particular risk factor and those without that particular risk factor o Proportional risk: does not implicate which disease an individual will develop

Allogenic vs autogenic transplant

o Auto- yourself o Allo- from another person

Sensitivity v. Specificity

o Sensitivity: a test to correctly identify those with the disease (true positive). Highly sensitive=few false negatives o Specificity: ability of the test to correctly identify those without the disease (true negative)

delayed nausea

occurs more than 24 hours after chemotherapy administration; typically peaks 48-72 hours and may last as long as 7 days

Hyperphosphatemia

oliguria or anuria, hypertension, edema

Physical activity and colon cancer

physical activity is associated with 30% lower risk for colon cancer

B lymphocytes

protect the body from bacterial infection or specific antigens. They synthesize antibodies that are specific to the antigen. This marks the foreign cell for death and removal by other immune cells

What is the most likely cause of palmar-plantar erythrodysesthesia? 1. Overexposure of fast-growing skin cells 2. Increased circulation during infusion 3. Rupture of capillaries from pressure and friction 4. Decreased circulation after infusion

rupture of capillaries from pressure and friction Palmar-plantar erythrodysesthesia changes to skin can be related to capillary rupture occurring while walking or during other weight-bearing activities.

types of pain

somatic- skin, muscles, bones, joints. localized to specific area. Described as aching, throbbing, -visceral: pain of organs

carboplatin & nadir

thrombocytopenia nadir occurs on days 14-21 w/ recovery around day 28. Leukocyte nadir occurs on days 21 with recovery in 5-6 weeks

Cytokines

-a classification of immunotherapy -small protein molecules released by lymphocytes. Alter the immune response in some way. It may cause amplification of the body's natural immune response so the body can destroy cancer cells, can stimulate the growth of more WBCs for the fight, and regulate the inflammatory process -Increasing cytokine formation increases the inflammatory response ( so, symptoms can include: fever, chills, aches, fatigue, etc)

Common skin changes with radiation

1. Erythema: reddening within treatment field. May develop after 5-10 treatments. Itchy, red, raised vesicles. 2. Dry desquamation: appears flaky, scaly skin. Causes itching, shedding, peeling. 3. Moist desquamation: reddened weeping skin. Warm and tight to the touch. Shiny. Produces clear to cloudy drainage. Occurs in response to epiermis damage. Painful & looks like 2nd degree burn. Can become infected

tumor lysis syndrome labs

1. Hyperkalemia 2. Hyperphosphatemia 3. Hypocalcemia 4. hyperuricemia

Process of carcinogenesis

1. Initiation: exposure to the cancer causing agent 2. Promotion: Further exposure which increases malignant transformation. Can still be reversible if carcinogen is removed 3. Progression: malignant development

3 levels of prevention

1. Primary: risk reduction before diagnosis by avoidance of known carcinogens 2. Secondary: early detection. Ex: getting annual mammograms 3. Tertiary: effective treatment after diagnosis

3 types of genes that contribute to cancer

1. proto-oncogene: involved in normal cell growth and division. 2. Tumor suppressor gene: control growth and division 3. DNA repair gene: fixes damaged DNA

What percentage of cancers are related to inherited risk?

5-10%

When does nadir typically occur after the completion of a chemotherapy treatment cycle

8-12 days, but varies