Ch. 15 - Cancer

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 antigens released by all cancer cells. c. producing blocking factors that immobilize cancer cells. d. reacting to a new set of antigenic determinants on cancer cells.

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

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

A Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or worsen hypercalcemia. The manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting.

A patient has recently been diagnosed with early stages of breast cancer. What is most appropriate for the nurse to focus on? a. Maintaining the patient's hope b. Preparing a will and advance directives c. Discussing replacement child care for the patient's children d. Discussing the patient's past experiences with her grandmother's cancer

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

What features of cancer cells distinguish them from normal cells (select all that apply)? a. Cells lack contact inhibition. b. Cells undergo rapid proliferation. 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.

A, C, E Cancer cells proliferate at the same rate as the normal cells of the tissue from which they arise. However, cancer cells respond differently than normal cells to the intracellular signals that regulate cell proliferation and death. The result is that the proliferation of the cancer cells is indiscriminate and continuous. They lack contact inhibition. Cancer cells may have altered cell-surface antigens because of malignant transformation. These antigens are termed tumor-associated antigens. Normally the differentiated cell is stable and will not dedifferentiate. Cancer cells can dedifferentiate. Abilities and properties that the cell had in fetal development are again expressed.

"The nurse explains to a patient undergoing brachytherapy of the cervix that she a. must undergo simulation to locate the treatment area. b. requires the use of radioactive precautions during nursing care. c. may have desquamation of the skin on the abdomen and upper legs. d. requires shielding of the ovaries during treatment to prevent ovarian damage.

B Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or next to the tumor. It would not be possible to shield the ovaries during therapy. Caring for the person undergoing brachytherapy requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, and shielding are vital to health care professional safety. Simulation is a process by which external radiation treatment fields are defined. Desquamation is an effect of external radiation

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

B Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is often premedicated with acetaminophen to try to prevent or decrease the intensity of these symptoms. Large amounts of fluids help decrease symptoms

The goals of cancer treatment are based on the principle that a. surgery is the single most effective treatment for cancer. b. initial treatment is always directed toward cure of the cancer. c. a combination of treatment modalities is effective for controlling many cancers. d. although cancer cure is rare, quality of life can be increased with treatment modalities.

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

Trends in the incidence and death rates of cancer include the fact that a. a higher percent of women than men have lung cancer. b. lung cancer is the most common type of cancer in men. c. blacks have a higher death rate from cancer than whites. d. breast cancer is the leading cause of cancer deaths in women.

C Cancer incidence and death rates are disproportionately higher among Blacks than among other minority groups and white people.

A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9 × 103/μL, hemoglobin of 10.8 g/dL, and a platelet count of 99 × 103/μL. Based on the CBC results, what is the most serious clinical finding? a. Cough, rhinitis, and sore throat b. Fatigue, nausea, and skin redness at site of radiation c. Temperature of 101.9° F, fatigue, and shortness of breath d. Skin redness at site of radiation, headache, and constipation

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

A characteristic of the stage of progression in cancer development 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.

D : Progression is the last 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 (e.g., metastasis). Progression occurs because of rapid proliferation and decreased cell adhesion.

The most effective method of administering a chemotherapy agent that is a vesicant is to a. give it orally. b. give it intraarterially. c. use an Ommaya reservoir. d. use a central venous access device.

D Infusion with central venous access devices reduces the risk of infiltration of chemotherapy agents that are vesicants. If vesicants are inadvertently infiltrated into the skin, severe local tissue breakdown and necrosis may result.

The nurse counsels the patient receiving radiation therapy or chemotherapy that a. effective birth control methods should be used for the rest of the patient's life. b. after successful treatment, patients can expect a return to their previous level of function. c. the cycle of fatigue-depression-fatigue that may occur during treatment may be reduced by restricting activity. d. nausea and vomiting can usually be managed with antiemetic drugs, diet modification, and other interventions."

D Nausea and vomiting can usually be managed with antiemetic drugs, diet modification, and other nondrug interventions. Some cancer survivors may continue to have symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. Maintaining activity within tolerable limits is helpful in managing fatigue. Lifelong birth control is not necessary.

A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing intervention would be a priority? a. Discuss with the provider the need for parenteral nutrition. b. Teach the patient to eat foods that are fatty, fried, or high in calories. c. Tell the patient to drink a nutritional supplement beverage three times a day. d. Have the patient try various spices and seasonings to enhance the flavor of food."

D Teach the patient to try different ways to mask the taste changes. Some find stronger seasonings and spices effective. Others find it better to avoid strong flavors and eat more bland foods. Avoiding strong smells, drinking more water with food, oral care before eating, eating smaller amounts more often, and using plastic utensils may help.

The nurse is caring for a 59-year-old woman who had surgery 1 day ago to remove an ovarian cancer mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to a. motivate change in an unhealthy lifestyle. b. teach her about the 7 warning signs of cancer. c. discuss healthy stress relief and coping practices. d. let her communicate about the meaning of this experience.

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