NUR425 Comprehensive Final Exam

The nurse is presenting a class on the biology of cancer to a group of new graduate nurses, and is comparing cancer cells with normal cells. Which of these is a characteristic of cancer cells? 1 Cancer cells return to a previous undifferentiated state. 2 Proliferation of the cancer cells occurs at an intermittent rate. 3 Cancer cells will not invade the boundary of cells around them. 4 Undifferentiated cells, known as stem cells, become cancer cells.

1 Defective cell differentiation is a characteristic of cancer cells. Cancer cells revert to a previous undifferentiated state. Proliferation of the cancer cells is indiscriminate and continuous. Sometimes they produce more than two cells at the time of mitosis. In this way, there is continuous growth of a tumor mass. Normal cells respect the boundaries and territory of the cells surrounding them. They will not invade a territory that is not their own. Stem cells do not become cancer cells.

A female patient who is HIV positive is prescribed Efavirenz (Sustiva) in large doses. What question should the nurse ask of the patient before administering the therapy to ensure drug safety? 1 "Are you pregnant?" 2 "Is your partner HIV positive?" 3 "Are you on your menses?" 4 "Have you ever had a blood transfusion?"

1 Efavirenz (Sustiva) is an antiretroviral drug. Large doses could cause fetal anomalies; therefore, it is important to know if the patient is pregnant. Asking about the HIV status of the partner is unrelated to administration of the drug. The information about the patient's menses does not impact the antiretroviral therapy. A history of blood transfusion helps ascertain the mode of infection, but does not impact the drug therapy.

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? 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.

1 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 reviewing statistics regarding the incidence and death rates of cancer. Which of these statements are true? 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 nurse is caring for an older adult patient with multiple myeloma. This patient has developed hypercalcemia. The primary health care provider advises hydration therapy for the patient and also prescribes diuretics. What is the reason for prescribing diuretics to the patient? 1 To prevent heart failure or edema 2 To inhibit the action of osteoclasts 3 To reduce serum calcium levels 4 To prevent bone complications

1 Hypercalcemia of high calcium levels is a metabolic emergency in patients with advanced cancers. Hydration therapy is the choice of treatment to prevent irreversible kidney failure. However, elderly patients may develop heart failure or edema if infused with 3L of fluids per day. Therefore, diuretics may need to be added with hydration therapy to prevent heart failure or edema as a result of fluid overload. Bisphosphonates are used to inhibit the action of osteoclasts, reduce serum calcium levels, and prevent bone complications.

A human immunodeficiency virus (HIV)-infected patient tells the nurse that he or she is worried that he or she might have acquired immunodeficiency syndrome (AIDS). When is a diagnosis of AIDS in an HIV-infected patient confirmed? 1 The patient's CD4+ T cell count is below 200/μL. 2 The patient has flu-like symptoms. 3 Lipodystrophy with metabolic abnormalities is present. 4 Elevated platelet and white blood cell (WBC) counts are present.

1 AIDS is diagnosed when an individual with HIV meets one of several criteria; one criterion is a CD4+ T cell count below 200 cells/μL. Flu-like symptoms can be indicative of other diseases. Changes in WBC or platelet counts are not diagnostic criteria for AIDS (and WBC and platelet levels decrease, not increase). Changes in body shape because of lipodystrophy are not definitive diagnoses for AIDS.

A nurse is collecting health history information from a patient who states, "I had cancer in the cartilage of my leg." The nurse recalls that this type of malignancy found in connective tissue is known as: 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

A patient who is undergoing external beam radiation therapy for cancer asks, "Will I be radioactive after the treatment?" What is an appropriate nursing response? 1 The patient will not be radioactive at any time. 2 Only the patient's urine and stool will be radioactive. 3 The patient will be radioactive only during the treatment period. 4 Although the patient's blood is radioactive, it will not affect anyone else.

1 In external beam radiation therapy, gamma radiation is focused toward the treatment field. The patient does not absorb or retain any of the radiation particles during the treatment and is therefore not radioactive during or after the treatment period. A patient is only radioactive when there is some form of internal radiation, such as brachytherapy, as a sealed source, or an unsealed liquid radioactive source. These sources have short half-lives and are weak emitters. In these types of radiation treatments stool and urine and blood will emit some radiation. The principles of ALARA (as low as reasonably achievable) and TDS (time, distance, and shielding), should always be followed.

A patient is receiving an infusion of monoclonal antibodies (MoAb) for non-Hodgkin's lymphoma. The nurse finds that the patient has developed an anaphylactic reaction. Which action should the nurse perform first? 1 Stop the infusion. 2 Reduce the rate of the infusion. 3 Stabilize the airway, breathing, and circulation. 4 Inform the health care provider

1 Monoclonal antibodies are a type of targeted therapy used for treating non-Hodgkin's lymphoma and chronic lymphocytic leukemia. Some patients may develop an anaphylactic reaction during the therapy, which can be life-threatening. If the patient develops such anaphylaxis, the infusion should immediately be stopped to prevent worsening of the anaphylactic reaction. Reducing the dose may also worsen the anaphylaxis. The airway, breathing, and circulation can be stabilized once the infusion is stopped. The primary health care provider can be informed once the infusion is stopped and the patient is stabilized

During an assessment, the nurse finds that a patient who is HIV+ has whitish yellow patches in the mouth, GI tract, and esophagus. Which opportunistic infection is the patient likely experiencing? 1 Candida albicans 2 Coccidiodes immitis 3 Cryptosporidium muris 4 Cryptococcus neoformans

1 Opportunistic infections are caused by microorganisms that normally do not cause disease but which become pathogenic when the immune system is impaired and unable to fight off infection. AIDS patients are susceptible to opportunistic diseases. Whitish yellow patches in mouth, GI tract, and esophagus, and the presence of thrush indicate Candida albicans . Infection by Coccidiodes immitis manifests with symptoms like pneumonia, fever, weight loss, and cough. Cryptosporidium muris gastroenteritis is characterized by watery diarrhea, abdominal pain, and weight loss. Meningitis, cognitive impairment, motor dysfunction, fever, seizures, and headache are symptoms of Cryptococcus neoformans.

The human immunodeficiency virus (HIV)-infected patient is taught health promotion activities, including good nutrition, avoiding alcohol, tobacco, drug use, and exposure to infectious agents, keeping up to date with vaccines, getting adequate rest, and stress management. The nurse knows that the rationale behind these interventions is best described as? 1 Delaying disease progression 2 Preventing disease transmission 3 Helping to cure the HIV infection 4 Enabling an increase in self-care activities

1 These health promotion activities , along with mental health counseling, support groups, and a therapeutic relationship with health care providers, will promote a healthy immune system which may delay disease progression. These measures will not cure HIV infection, prevent disease transmission, or increase self-care activities.

Thrombocytopenia develops in a patient being treated with chemotherapy for Hodgkin's disease. What is the goal 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.

A patient is being treated with radioactive iodine (131I) for thyroid cancer. With which major source of contamination from this patient should the nurse take precautions? 1 Urine 2 Feces 3 Blood 4 Sputum

1 Urine is the major source of contamination with this form of radioactive treatment. The nurse must be careful in handling bedpans, urinals, and linens and apply standard radiation precautions of time, distance, and shielding. Feces, blood, and sputum tend to contain lower levels of radiation contamination, but they should still be handled with the use of standard precautions.

The nurse is caring for a 49-year-old woman who had surgery one day ago for removal of a suspected malignant breast mass. The patient is awaiting the pathology report. She is tearful and says that she is afraid to die. Which of these is the most effective nursing intervention at this time? 1 Actively listen and allow her to talk about her fears. 2 Teach the patient about the seven warning signs of cancer. 3 Discuss the need to make changes in an unhealthy lifestyle. 4 Remind the patient that there is probably nothing to worry about.

1 While patients are waiting for the results of diagnostic studies, be available to actively listen to their concerns. It is not an appropriate time to teach about the warning signs of cancer, or to provide patient teaching regarding lifestyle changes. Do not provide false reassurances by telling her there is nothing to worry about.

The nurse recalls that interferons may be used in the treatment of certain diseases. What is the clinical use of β-Interferon? 1 As a treatment for multiple sclerosis 2 As a treatment for multiple myeloma 3 As a treatment for hairy cell leukemia 4 As a treatment for renal cell carcinoma

1 β-Interferon is used in treating multiple sclerosis. Cytokines instruct cells to alter their proliferation, differentiation, secretion, or activity. Cytokines play an important role in hematopoiesis. α-interferon is used to treat multiple myeloma, hairy cell leukemia, and renal cell carcinoma.

A patient is given lymphocyte immune globulin (Atgam) as an induction therapy before a liver transplant. What is the importance of administering this medication to the patient? Select all that apply. 1 It helps to prevent early rejection. 2 It helps to reduce antibody production. 3 It stimulates leukocytosis. 4 It helps to provide passive immunity. 5 It prevents iatrogenic infection

1 & 2 Lymphocyte immune globulin is a polyclonal antibody used to severely immunosuppress an individual. This reduces the production of antibodies and thus helps in prevention of early organ rejection. Lymphocyte immune globulin inhibits leukocytosis. The drug does not provide passive immunity. Since it reduces antibody production, it increases the risk of an iatrogenic infection

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 12mg/dL. The nurse recognizes that which treatments could be helpful for the patient? Select all that apply. 1 Adequate hydration 2 Administration of mesna [Mesnex] 3 Infusion of bisphosphonate zoledronate (Zometa) 4 Administration of allopurinol (Zyloprim) 5 Administration of demeclocycline (Declomycin)

1 & 3 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 (Zometa) to prevent formation of calcium stones in the kidney. Mesna [Mesnex] is used for the treatment of hemorrhagic cystitis. Allopurinol (Zyloprim) is useful for managing tumor lysis syndrome and not hypercalcemia. Demeclocycline (Declomycin) is used for treating syndrome of inappropriate antidiuretic hormone.

A patient with lung cancer develops headaches, facial edema, periorbital edema, and distention of the veins in the head, neck, and chest. The nurse expects that what will be included in the patient's treatment plan? Select all that apply. 1 Prepare the patient for radiation therapy. 2 Administer a narcotic and reassure the patient. 3 Administer a diuretic agent and reassure the patient. 4 Inform the patient that chemotherapy may be required. 5 Inform the patient that the symptoms are due to obstruction of the bronchus.

1 & 4 A lung cancer patient who presents with headaches, facial edema, periorbital edema, and distension of veins of the head, neck, and chest is indicative of superior vena cava syndrome. Management of this condition involves treating the patient with localized radiation therapy. If the cancer is sensitive to drugs, then the patient may also be treated with chemotherapy. Superior vena cava syndrome is a medical emergency, hence, just administering a pain killer and diuretic will only provide symptomatic relief without any effect on disease progression. Superior vena cava syndrome is due to obstruction of the superior vena cava and not the bronchus

A nurse is caring for a patient who is admitted for a kidney transplant. A crossmatch prior to the transplant is positive. What will the nurse tell the patient and his relatives? Select all that apply. 1 Transplantation cannot be done. 2 It is safe to proceed with the transplantation. 3 A renal scan needs to be done to confirm transplantation. 4 If transplanted, the organ would undergo a hyperacute rejection. 5 It is safe to proceed with the transplantation for now, but chronic rejection is anticipated.

1 & 4 A positive crossmatch indicates that the recipient has cytotoxic antibodies to the donor and is an absolute contraindication to transplantation. If transplanted, the organ would undergo hyperacute rejection. It is not safe to proceed with transplantation if the crossmatch is positive. A renal scan will not help in this procedure.

A patient with lung cancer has been treated with an anticancer drug that has a high propensity to cause myelosuppression. What nursing interventions would be helpful to this patient? Select all that apply. 1 Monitoring the red blood cell (RBC) count 2 Monitoring the platelet count 3 Monitoring the basophil count 4 Monitoring the neutrophil count 5 Monitoring the eosinophil count

1, 2, & 4 Monitoring the RBC count helps the nurse to detect the severity of anemia and assess the need for administering RBC growth factors or an RBC transfusion. Monitoring the platelet count helps to detect the risk of bleeding in the patient and the need for using platelet growth factors or a platelet transfusion. Monitoring the neutrophil count helps to detect the risk of infection and the need for using white blood cell (WBC) growth factors and measures to prevent infection. Eosinophil and basophil counts should be assessed only in patients who have an allergic predisposition or if the drug is known to produce allergic reactions.

The patient and the patient's family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation? Select all that apply. 1 Maintain hope 2 Exhibit a caring attitude 3 Plan realistic long-term goals 4 Give them antianxiety medications 5 Be available to listen to fears and concerns 6 Teach them about all the types of cancer that could be diagnosed

1, 2, & 5 Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use, as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching the patient and family about the diagnostic procedures also would be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family ant-anxiety medications would not be appropriate.

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 oxygen therapy 2 Administration of IV hydration 3 Administration of vasodilators 4 Placement of a pericardial catheter 5 Surgical establishment of a pericardial window

1, 2, 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.

A nurse is caring for a patient experiencing severe side effects of chemotherapy. On examination, the nurse notices stomatitis. Which interventions should the nurse perform to relieve stomatitis? Select all that apply. 1 Apply topical anesthetics. 2 Give diuretics and laxatives regularly. 3 Encourage nutritional supplements. 4 Encourage oral application of alcohol. 5 Discourage the use of oral irritants like tobacco.

1, 3, & 5 Stomatitis is the inflammation of the mouth. It occurs when the epithelial cells get damaged due to chemotherapy or radiation therapy. Topical anesthetics such as viscous lidocaine may be used to provide local pain relief. Nutritional supplements helps to meet the nutritional demands when the food intake decreases due to stomatitis. Giving diuretics and laxatives regularly promotes bladder and bowel elimination, but does not help in relieving stomatitis. Oral application of alcohol may have a drying effect on the mucosa and may worsen stomatitis. Use of oral irritants like tobacco should be discouraged as they can worsen stomatitis and increase discomfort.

The nurse is monitoring a patient who is experiencing a hyperacute rejection following transplantation of an organ. Which of these statements is true about this type of rejection? Select all that apply. 1 It occurs minutes to hours after transplantation. 2 Hyperacute rejection can be treated with muromonab-CD3 (Orthoclone OKT3). 3 It is a rare event because a final cross-match is performed just before the transplant. 4 Hyperacute rejection is a process that occurs over months or years and is irreversible. 5 There is no treatment for hyperacute rejection, and the transplanted organ is removed.

1, 3, 5 Hyperacute rejection occurs minutes to hours after transplantation because the blood vessels are destroyed rapidly. There is no treatment for hyperacute rejection, and the transplanted organ is removed. Fortunately, hyperacute rejection is a rare event because the final cross-match just before transplant usually determines whether the recipient is sensitized to any of the donor HLAs. Muromonab-CD3 is used for short periods to prevent early rejection or reverse acute rejection. Chronic rejection is a process that occurs over months or years and is irreversible.

A nurse is caring for a patient experiencing severe side effects of chemotherapy. On examination, the nurse notices stomatitis. Which interventions should the nurse perform to relieve stomatitis? Select all that apply. 1 Apply topical anesthetics. 2 Give diuretics and laxatives regularly. 3 Encourage nutritional supplements. 4 Encourage oral application of alcohol. 5 Discourage the use of oral irritants like tobacco

1, 3, 5 Stomatitis is the inflammation of the mouth. It occurs when the epithelial cells get damaged due to chemotherapy or radiation therapy. Topical anesthetics such as viscous lidocaine may be used to provide local pain relief. Nutritional supplements helps to meet the nutritional demands when the food intake decreases due to stomatitis. Giving diuretics and laxatives regularly promotes bladder and bowel elimination, but does not help in relieving stomatitis. Oral application of alcohol may have a drying effect on the mucosa and may worsen stomatitis. Use of oral irritants like tobacco should be discouraged as they can worsen stomatitis and increase discomfort.

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.

While giving instructions to a group of caregivers working at the organ transplantation unit, what instructions should the nurse give? Select all that apply. 1 Two organs can be transplanted together. 2 Living donors can donate only a part of the organ. 3 Patients are matched to the available donors according to their age. 4 Segments of organs can be transplanted instead of the complete organ. 5 On imminent death of a donor or patient, organs can be donated with the consent of the legal next of kin.

1, 4, & 5 Some organs are transplanted individually, and others can be transplanted together, such as kidney and pancreas, kidney and liver, and kidney and heart. For instance, some diabetic patients undergoing pancreas transplant might also end up having a kidney transplant. This is mainly because they suffered from renal failure due to diabetes. Living donors can donate a part of an organ as well as certain complete organs such as their kidneys. In cases of organs like the liver and intestine, only their segments can be transplanted. Patients are matched to available donors based on blood group, human leukocyte antigen (HLA) typing, medical urgency, geographical location, etc. On imminent death of a person, legal next of kin gives consent for donation. It is therefore important to inform the next of kin if one desires to donate organs.

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 since the platelet levels are below 20,000/μL. The nurse should avoid any invasive procedures as 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.

A nurse is teaching a group of nursing students about cancer cell proliferation. Which are the tissues in the human body where cell proliferation is rapid? Select all that apply. 1 Bone marrow 2 Cartilage 3 Myocardium 4 Hair follicles 5 Epithelial lining of the GI tract

1, 4, & 5 The tissues in the human body that proliferate very rapidly include bone marrow, hair follicles, and epithelial lining of the gastrointestinal (GI) tract. The rapid rate of proliferation of these tissues makes them susceptible to developing cancers. Cartilage and myocardial cells do not proliferate or proliferate very slowly. Therefore, these cells are less prone to developing cancers.

A nurse is attending a seminar on the causes of death in the United States. Which disease is considered the second most common cause of death in the United States? 1 Heart disease 2 Cancer 3 HIV infection 4 Tuberculosis

2 Cancer is the second most common cause of death in the United States. Heart disease is the primary cause of death in the United States. HIV infection, which can lead to acquired immunodeficiency syndrome, is not among the leading causes of death in the United States. Tuberculosis is an infection of the lungs, and is not among the most common causes of death.

A patient is about to receive an infusion of α-interferon (Roferon-A). The nurse will premedicate the patient with which of these drugs to prevent fever and shivering during this infusion? 1 Aspirin 2 Acetaminophen 3 Morphine sulfate 4 Ondansetron (Zofran)

2 Common side effects of interferons include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, photosensitivity, anorexia, and nausea. Acetaminophen administered every four hours, as prescribed, often reduces the severity of the flu-like syndrome. The patient is commonly premedicated with acetaminophen in an attempt to prevent or decrease the intensity of these symptoms. In addition, large amounts of fluids help decrease the symptoms. Aspirin would not be appropriate because of its platelet aggregation inhibiting effect. Morphine is an opioid analgesic. Ondasetron is for prevention and treatment of nausea.

The nurse is caring for a patient newly diagnosed with human immunodeficiency virus (HIV). The patient asks what would determine the actual development of acquired immunodeficiency syndrome (AIDS). The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? 1 Presence of HIV antibodies 2 CD4+ T cell count below 200/µL 3 Presence of oral hairy leukoplakia 4 White blood cell (WBC) count below 5000/µL

2 Diagnostic criteria for AIDS include a CD4+ T cell count below 200/µL or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The presence of HIV antibodies or oral hairy leukoplakia or WBC count below 5000/µL may be found in patients with HIV disease, but do not define the advancement of HIV infection to AIDS.

The nurse is explaining the stages of cancer development to a support group of cancer survivor families. Which of these is a characteristic of the promotion stage in the development of cancer? 1 Mutation of the cell's genetic structure. 2 A period of latency before clinical detection of cancer. 3 An irreversible steady growth facilitated by carcinogens. 4 Proliferation of cancer cells in spite of host control mechanisms.

2 During the promotion stage, a period of time known as the latent period, ranging from 1 to 40 years elapses between the initial genetic alteration and the actual clinical evidence of cancer. During the promotion stage, development of cancer is characterized by the reversible proliferation of the altered cells. The initiation stage of cancer development is characterized by mutation of the cell's genetic structure. Proliferation of cancer cells occurs during the third stage of cancer development, known as the progression stage.

After a successful organ transplant, a patient began receiving immunosuppressive therapy, specifically tacrolimus (Prograf), methylprednisolone (Solu-Medrol), and mycophenolate mofetil (CellCept). Which food should the nurse instruct the patient to avoid during this therapy? 1 Jackfruit 2 Grapefruit 3 Dragon fruit 4 Passion fruit

2 Grapefruit contains a chemical substance that interferes with the metabolism of tacrolimus, causing drug toxicity events. Jackfruit, dragon fruit, and passion fruit do not interfere with the metabolism of these medications.

A 75-year-old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day, has no energy or appetite, and does not seem to care about anything. He also has been getting up more at night to urinate. 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 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 complains that it is painful. What is the first action the nurse will take? 1 Slow the infusion rate. 2 Turn off the infusion. 3 Check the patient's vital signs. 4 Notify the primary health care provider.

2 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.

Which cytokine is used in the treatment of multiple sclerosis? 1 Interferon-alpha 2 Interferon-beta 3 Interleukin-2 4 Interleukin-11

2 Multiple sclerosis is associated with inflammation and demyelination of the neurons in the brain and the spinal cord. Interferon-beta prevents inflammation and demyelination of neurons and used in the treatment of multiple sclerosis. Interferon-alpha is used in the treatment of hepatitis B and C, malignant melanoma, and renal cell carcinoma. Interleukin-2 is used in the treatment of metastatic melanoma and metastatic renal cell carcinoma. Interleukin-11 prevents thrombocytopenia after chemotherapy.

The nurse providing care for a patient with suspected cancer recalls that the only diagnostic procedure that is definitive for a diagnosis of cancer is: 1 MRI 2 Biopsy 3 CT scan 4 Tumor marker

2 Only a biopsy is a definitive means of diagnosing cancer, because it actually identifies the pathological cells. Many tests, such as MRI, CT scan, and tumor markers, are indicative of cancer, but they do not confirm the presence of cancer cells as examination of a specimen obtained by biopsy does.

The nurse was stuck accidently with a needle used on a human immunodeficiency virus (HIV)-positive patient. After reporting this, what care should this nurse first receive? 1 Personal protective equipment 2 Combination antiretroviral therapy 3 Counseling to report blood exposures 4 A negative evaluation by the manager

2 Postexposure prophylaxis with combination antiretroviral therapy can decrease significantly the risk of infection. Personal protective equipment should be available, although it may not have stopped this needle stick. The needle stick has been reported. The negative evaluation may or may not be needed, but would not occur first.

A 33-year-old patient recently has been diagnosed with stage II cervical cancer. The nurse should understand what about the patient's cancer? 1 It is in situ 2 It has metastasized 3 It has spread locally 4 It has spread extensively

2 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.

A human immunodeficiency virus (HIV)-infected patient is about to receive treatment with antiretroviral drugs. Which statement by the nurse reflects a correct understanding of the purpose of these drugs? 1 "Antiretroviral drugs can cure HIV infection." 2 "These drugs work by decreasing the viral load." 3 "Antiretroviral drugs will prevent opportunistic diseases." 4 "These drugs only work in the initial replication stage of the virus."

2 The goals of drug therapy in HIV infection are to decrease the viral load, maintain or raise CD4+ T cell counts, and delay onset of HIV-related symptoms and opportunistic diseases. Antiretroviral drugs do not cure HIV infection nor do they prevent opportunistic diseases. Drugs used to treat HIV work at various points in the HIV replication cycle.

What can the nurse do to facilitate cancer prevention for the patient in the promotion stage of cancer development? 1 Teach the patient to exercise daily 2 Teach the patient promoting factors to avoid 3 Tell the patient to have the cancer surgically removed now 4 Teach the patient which vitamins will improve the immune system

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

Certain types of tumor cells secrete substances that may be detected in the blood. When their concentrations in the serum are increased, these substances may be used to diagnose certain types of cancer. The nurse recalls that these substances are known as: 1 Carcinogens 2 Tumor markers 3 Malignant viruses 4 Neoplastic oncogenes

2 Tumor markers are substances secreted by cancerous cells that serve as indicators of malignant cell presence and activity. Carcinogens are cancer-causing agents. Some cancers are linked to viral agents, such as those seen in HIV disease. Neoplastic oncogenes are genes in certain viruses that have the ability to induce a cell to become malignant.

A patient who has undergone a modified radical mastectomy sees the surgical site for the first time. The patient appears shocked and exclaims, "I look horrible! Will it ever look better?" Which response by the nurse is most appropriate? 1 "Would you like to meet another patient who's had a mastectomy?" 2 "You're shocked by the change in your appearance from the surgery?" 3 "After it heals and you're dressed, you won't even know you've had surgery." 4 "Don't worry. You know that the tumor is gone, and the area will heal very soon."

2 When a patient appears shocked by her appearance after a mastectomy, the nurse should help her express her feelings and offer supportive care. Reflecting the patient's statement will allow her to expand and discuss her feelings. "After it heals" and "Don't worry" diminish the patient's distress regarding having undergone a modified radical mastectomy. "Would you like me to?" is an appropriate statement but does not allow the patient to verbalize her fears and concerns.

A nurse is caring for a patient who is undergoing plasmapheresis for glomerulonephritis. The nurse should be observant for which symptoms indicating citrate toxicity? 1 Sneezing 2 Headache 3 Hypertension 4 Conjunctivitis

2 When caring for a patient undergoing plasmapheresis, the nurse should be observant for headache. Citrate toxicity is a common complication of plasmapheresis because citrate is used as an anticoagulant and may cause hypocalcemia, which in turn manifests as headache, paresthesias, and dizziness. Another common complication of plasmapheresis is hypotension caused by a vasovagal reaction or transient volume changes. Sneezing and conjunctivitis are not manifestations of citrate toxicity but are common symptoms of allergy.

The patient is admitted with metabolic acidosis. Which system is not functioning normally? 1 Buffer system 2 Kidney system 3 Hormone system 4 Respiratory system

2 When the patient has metabolic acidosis , the kidneys are not combining H+ with ammonia to form ammonium or eliminating acid with secretion of free hydrogen into the renal tubule. The buffer system neutralizes hydrochloric acid by forming a weak acid. The hormone system is not related directly to acid-base balance. The respiratory system releases CO2 that combines with water to form hydrogen ions and bicarbonate. The hydrogen then is buffered by the hemoglobin.

The nurse is attending to a patient who will receive a kidney transplant. What information or instruction should the nurse share with the patient to prepare the patient for the transplant? Select all that apply. 1 Production of urine will be delayed after surgery. 2 Lifelong immunosuppressive drugs daily will be required. 3 Symptoms of rejection include a decrease in temperature and blood pressure. 4 Avoid all exercise, work, and sports activities. 5 Transplantation will be performed only if the crossmatching is negative.

2 & 5 Immunosuppressive agents are administered to reduce the immune system's tendency to reject the transplanted organ. A crossmatch uses serum from the recipient mixed with donor lymphocytes to test for any preformed anti-HLA antibodies to the potential donor organ. A negative crossmatch indicates that no preformed antibodies are present, and it is safe to proceed with transplantation. Urine production occurs almost immediately. If the transplant is rejected, the patient may experience a rise in temperature and blood pressure due to fluid retention. Although recreation and exercise are encouraged, strenuous sports activities should be strictly avoided.

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. 1 Encourage fluid intake. 2 Administer furosemide (Lasix). 3 Administer 0.9% saline solution. 4 Administer 3% sodium chloride solution. 5 Withhold demeclocycline (Declomycin)

2, 3, 4 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 (Declomycin) is helpful in moderate cases of SIADH.

The nurse is providing education about transmission of human immunodeficiency virus (HIV) for a patient who is infected with the virus to another person. Which of these is a potential method of HIV transmission? Select all that apply. 1 Shaking hands and sharing eating utensils. 2 Unprotected anal or vaginal sexual intercourse. 3 Exposure to HIV-infected blood through needle stick. 4 Sharing of needles, syringes, pipes, and straws during drug use. 5 Transmission from mother to infant during labor and delivery and breastfeeding.

2, 3, 4, & 5 HIV can be transmitted as a result of contact with infected blood, semen, vaginal secretions, or breast milk. Transmission of HIV occurs through sexual intercourse with an infected partner, type of exposure to HIV-infected blood or blood products, and perinatal transmission during pregnancy, at delivery, or through breastfeeding. HIV is not spread through casual contact, such as shaking hands, hugging, or sharing utensils.

A patient is treated with radiation therapy for lung cancer. The nurse finds that the patient has dry desquamation of the skin due to the radiation therapy. How should the nurse prevent infection and facilitate healing of the skin? Select all that apply. 1 Apply ice packs. 2 Avoid the use of heating pads. 3 Avoid constricting garments. 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.

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.

The nurse caring for a patient with a central venous access device is unable to infuse fluids into the catheter. Which nursing interventions are appropriate for the patient's treatment plan to address the issue of the catheter occlusion? Select all that apply. 1 Instruct the patient to remain supine in bed and not to move. 2 Assess the catheter for clamping and kinking, and alleviate the cause. 3 Force-flush the device with normal saline using a 10-mL syringe. 4 Perform fluoroscopy to determine the cause and evaluate the site. 5 Administer anticoagulant or thrombolytic agents.

2, 4, 5 Occlusion is a common problem with central venous catheters. If occlusion is suspected, the nurse should instruct the patient to change position, raise the arm, and cough, which helps move any blockage. The nurse must assess the catheter for clamping and kinking and undo it if found. The nurse should inform the health care provider about the catheter occlusion so that fluoroscopy can be performed if needed to determine the cause and site of occlusion. In addition, anticoagulants or antithrombolytic agents can be administered. Having the patient lie supine and motionless is not appropriate when assessing possible occlusion. Flushing is a very important step in maintaining the patency of the catheter. Flushing should be done with normal saline in a 10-mL syringe to avoid pressure on the catheter. Force should not be applied if resistance is felt.

The nurse assesses a patient with recently diagnosed human immunodeficiency virus disease who has been admitted to the hospital with a new diagnosis of acquired immunodeficiency syndrome (AIDS). What assessment finding is most diagnostic of AIDS? 1 Sleeping 6 to 8 hours per night 2 Feelings of fatigue in the evening 3 Steady weight loss over the past several months 4 Feelings of profound helplessness and hopelessness

3 A very common complaint of patients with acquired immunodeficiency syndrome (AIDS) is steady weight loss regardless of attempts to maintain or gain weight. Other common findings include anorexia, decreased sleep, constipation, and anxiety. Sleeping 6 to 8 hours per night, fatigue in the evening, and feelings of helplessness and hopelessness may be seen with human immunodeficiency virus/AIDS, but they are not as diagnostic as unexplained steady weight loss.

A nurse is learning about the different types of cancers. Which cancer has the highest incidence among men? 1 Lung cancer 2 Colon cancer 3 Prostate cancer 4 Thyroid cancer

3 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.

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, non-medicated 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.

Shortly after having a central IV catheter inserted into the subclavian vein, the patient experiences shortness of breath, anxiety, and restlessness. What is the highest priority for the nurse? 1 Administering a sedative 2 Advising the patient to relax 3 Auscultating the breath sounds 4 Obtaining an arterial blood gas analysis

3 Because this is an acute episode, the nurse should first listen to the patient's lungs to see whether anything has changed. In this situation the probability is high that the patient sustained a pneumothorax during the subclavian IV catheter insertion procedure. The patient will need oxygen, and the doctor should be notified of the findings. Administering a sedative is not appropriate. Advising the patient to relax does provide reassurance, but the anxiety and restlessness are probably due to hypoxia. Obtaining an arterial blood gas analysis would likely be the next nursing action.

Which cellular dysfunction in the process of cancer development allows defective cell proliferation? 1 Protooncogenes 2 Cell differentiation 3 Dynamic equilibrium 4 Activation of oncogenes

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

The female patient is having whole brain radiation for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? 1 "When your hair grows back it will be patchy." 2 "Don't use your curling iron and that will slow down the loss." 3 "You can get a wig now to match your hair so you will not look different." 4 "You should contact 'Look Good, Feel Better' to figure out what to do about this."

3 Hair loss with radiation usually is permanent. The best response by the nurse is to suggest getting a wig before the patient loses her hair so she will not look or feel so different. When hair grows back after chemotherapy it is frequently a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss, but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern.

A patient undergoes ABO compatibility tests. When administering the patient a prescribed blood transfusion, the nurse monitors for what type of hypersensitivity reaction? 1 Type I: IgE-mediated 2 Type III: Immune-complex 3 Type II: Cytotoxic and cytolytic 4 Type IV: Delayed hypersensitivity

3 In type II hypersensitivity reactions, cellular structures are destroyed. These reactions mostly involve the destruction of red blood cells, platelets, and leukocytes. When incompatible blood types are mixed, agglutination occurs. As a result, hemoglobin may be released into the urine and plasma, causing acute kidney failure. Type I, III, and IV are not responsible for ABO incompatibility reactions. Type I hypersensitivity reactions occur during allergic rhinitis and asthma. Type III hypersensitivity reactions occur in disease conditions like rheumatoid arthritis. Type IV reactions occur in contact dermatitis.

What is the primary function of interferon-beta? 1 Proliferation and differentiation of monocytes 2 Proliferation and differentiation of neutrophils 3 Production of red blood cells in the bone marrow 4 Activation of natural killer cells and macrophages

4 Interferon-beta activates natural killer cells, inhibits viral replication, and has antiproliferative effects on tumor cells. Granulocyte-macrophage colony-stimulating factor (GM-CSF) is responsible for the proliferation and differentiation of monocytes. GM-CSF stimulates the proliferation and differentiation of neutrophils. Production of red blood cells in the bone marrow is the function of erythropoietin.

The patient was told that he or she would have intraperitoneal chemotherapy. The patient 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? 1 It is delivered via an Ommaya reservoir and extension catheter. 2 It is instilled in the bladder via a urinary catheter and retained for one to three hours. 3 A Silastic catheter will be placed percutaneously into the peritoneal cavity for chemotherapy administration. 4 The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

3 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.

A pregnant woman who was tested and diagnosed with human immunodeficiency virus (HIV) infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? 1 "The baby probably will be infected with HIV." 2 "Only an abortion will keep your baby from having HIV." 3 "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." 4 "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."

3 On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism, as well as host immune status, are variables related to transmission via blood, semen, vaginal secretions, or breast milk.

A nurse discusses chemotherapy treatment with a patient with colon cancer. Which body system does the nurse tell the patient is most susceptible to the side effects of commonly used antineoplastic drugs? 1 Lymphatic 2 Respiratory 3 Bone marrow 4 Cardiovascular

3 One of the most common side effects of chemotherapeutic drugs is bone marrow suppression, which decreases the production of blood cells. Bone marrow is susceptible to chemotherapy because of the rapid cell cycles and replacement of blood-forming tissue in bone marrow. The lymphatic, respiratory, and cardiovascular systems may be affected by chemotherapy drugs but vary in their levels of severity and involvement, whereas bone marrow suppression is common in all forms of antineoplastic therapy.

The nurse provides education to a patient who has expressed concern about HIV infection. Which statement indicates that the patient understands the teaching? 1 "I can't contract HIV unless there's an opportunistic infection present." 2 "Using a condom with a spermicide will give 100% protection from HIV." 3 "Using a condom with a spermicide will reduce my risk of contracting HIV." 4 "Kaposi's sarcoma is one of the first opportunistic infections to show up in someone with HIV."

3 Research indicates that using a condom with a spermicidal jelly containing nonoxynol-9 provides the greatest reduction of risk of contracting HIV during sexual intercourse. An opportunistic infection does not have to be present, a condom with spermicide does not provide 100% protection, and Kaposi's sarcoma is not one of the first opportunistic infections to appear in someone infected with HIV.

A nurse is caring for a patient with metastatic breast cancer. The nurse finds that the patient has developed facial and periorbital edema, and has distention of veins of the face, neck, and chest. What condition do these findings indicate to the nurse? 1 Spinal cord compression 2 Third space syndrome 3 Superior vena cava syndrome 4 Tumor lysis syndrome

3 Superior vena cava syndrome (SVCS) is an obstructive emergency. There can be many causes, including lung cancer, metastatic breast cancer, and non-Hodgkin's lymphoma. In these instances, SVCS results due to the obstruction of the superior vena cava by a tumor or thrombosis. Spinal cord compression is also an obstructive emergency caused by a malignant tumor in the epidural space of the spinal cord. It can be caused by breast, lung, prostate, GI, and renal tumors and melanomas. Third space syndrome is an obstructive emergency caused by the shifting of fluid from the vascular space to the interstitial space. It may occur due to extensive surgical procedures, biologic therapy, or septic shock. Tumor lysis syndrome is a metabolic emergency caused by rapid release of intracellular components in response to chemotherapy.

The nurse is discussing the effects of chemotherapy with a patient who has a new diagnosis of cancer. Which statement by the patient reflects an adequate understanding of the teaching? 1 "I will need to use effective birth control methods for the rest of my life." 2 "My doctor will stop the chemotherapy if nausea and vomiting occur during treatment." 3 "I will join a support group after my therapy is finished to help me get back on my feet." 4 "I probably won't be able to do anything I used to do anymore now that I have cancer."

3 The impact of a cancer diagnosis can affect many aspects of a patient's life, with cancer survivors commonly reporting financial, vocational, marital, and emotional concerns even long after treatment is over. These psychosocial effects can play a profound role in a patient's life after cancer, with issues related to living in uncertainty being encountered frequently. Participation in appropriate supportive care and community resources would benefit the patient in recovery or ongoing care. It will not be necessary for the patient to use birth control for the rest of the patient's life; nausea and vomiting are expected effects of chemotherapy and treatment will continue unless the vomiting becomes severe.

A nurse is administering mycophenolate mofetil (CellCept) as a part of triple immunosuppressive therapy for a posttransplant patient. Which is the most important nursing intervention? 1 Give large doses as intravenous (IV) bolus. 2 Reconstitute the drug in normal saline. 3 Administer the drug over 2 or more hours. 4 Educate the patient about gastrointestinal side effects.

3 The most important nursing intervention when administering mycophenolate mofetil is to infuse this medication over 2 or more hours. Giving the drug slowly helps to decrease the side effects. The drug should never be given as an IV bolus and should always be reconstituted in D5W. Thereafter, the nurse may educate the patient about the gastrointestinal side effects.

The nurse is reviewing the genetic testing results of a patient, and sees that the patient has a human leukocyte antigen (HLA) allele that is positive for ankylosing spondylitis. Which of these statements is true about the HLA antigens and disease conditions? 1 This patient already has developed ankylosing spondylitis. 2 This patient will develop ankylosing spondylitis at some point in his or her lifetime. 3 This patient has a higher risk than the general population for developing ankylosing spondylitis. 4 Further testing is needed to discover the degree of risk the patient has for developing ankylosing spondylitis.

3 The possession of a particular HLA allele does not mean that the person will necessarily develop the associated disease—only that the relative risk is greater than in the general population. The patient has not developed ankylosing spondylitis already and may not ever develop it. The patient already has had genetic testing for ankylosing spondylitis.

A nurse finds that the patient undergoing radiotherapy has developed erythema and desquamation. Which measure should the nurse include when teaching the patient about skin care in the radiation treatment area? 1 Wear fabrics such as wool and corduroy to prevent exposure to cold. 2 Use perfumes and cosmetics on the treatment area as desired. 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, as they can traumatize the skin. Chemicals like perfumes, cosmetics, and powders should not be used on the treatment area, as 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 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. 1 Administer fibrinolytic agents. 2 Discourage fluid intake. 3 Replace fluids and electrolytes. 4 Administer plasma protein replacement. 5 Prepare the patient for radiation therapy

3, 4 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

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

A nurse is caring for a patient who is diagnosed with AIDS. The nurse should inform the patient that the virus can be spread through which method? 1 Shaking hands 2 Sharing a toilet seat 3 Eating from the same utensils 4 Having unprotected sex

4 AIDS can be transmitted from one individual to another by unprotected anal or vaginal sexual intercourse. Any sexual activity that involves contact with body fluids, such as semen, vaginal secretions, or blood, can spread the infection. Shaking hands, using common toilet seats, and sharing utensils do not involve contact with body fluids. Therefore, the HIV infection cannot be transmitted through these modes.

The patient is receiving biologic and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? 1 Morphine sulfate 2 Ibuprofen (Advil) 3 Ondansetron (Zofran) 4 Acetaminophen (Tylenol)

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

The nurse is caring for an older patient who is receiving intravenous (IV) fluids postoperatively. During the 8 am assessment of this patient, the nurse notes that the IV solution, which was prescribed to infuse at 125 mL/hr, has infused 950 mL since it was hung at 4 am. What is the priority nursing intervention? 1 Notify the health care provider and complete an incident report. 2 Slow the rate to keep the vein open until the next bag is due at noon. 3 Obtain a new bag of IV solution to maintain patency of the site. 4 Listen to the patient's lung sounds and assess respiratory status.

4 After four hours of infusion time, 500 mL of IV solution should have infused, not 950 mL. This patient is at risk for fluid volume excess, and the nurse should assess the patient's respiratory status and lung sounds as the priority action and then notify the health care provider for further prescriptions.

A patient has been advised to undergo an autologous bone marrow transplant. A nurse explains the procedure to the patient. Which patient statement indicates that the teaching has been understood? 1 "It involves transfusing stem cells from an identical twin." 2 "It involves transfusing stem cells from a family member." 3 "It involves transfusing stem cells from a donor from a bone marrow registry." 4 "It involves transfusing stem cells harvested from myself."

4 Bone marrow transplants are very effective in treating malignancies of the bone marrow. There are three types of bone marrow transplantation. An autologous stem cell transplant requires harvesting the stem cells from the patient, and transfusing it back to the patient after myeloablative therapy. Syngeneic transplantation involves obtaining stem cells from one identical twin and infusing them into the other. An allogeneic transplantation involves obtaining stem cells from a donor who is human leukocyte antigen (HLA) matched to the patient. It can be a family member or a donor from a bone marrow registry.

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 had the greatest impact as a carcinogen for this patient? 1 Bacteria 2 Sun exposure 3 Most chemicals 4 Epstein-Barr virus

4 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 recognizes that a patient is demonstrating signs of a transplant rejection after a renal transplant. Which phenomenon is responsible for the rejection of donor organs and tissue? 1 Innate immunity 2 Passive immunity 3 Humoral immunity 4 Cell-mediated immunity

4 Cell-mediated immunity involves various cells, including natural killer cells. The natural killer cells are responsible for identifying "self" and "non-self" tissues, which sometimes results in rejection of grafts and transplants. Innate immunity is present after birth. It involves a non-specific response through neutrophils and monocytes and is not responsible for graft rejections. Passive immunity results when antibodies are acquired by the body and not produced within. Humoral immunity involves immunoglobulin production and is responsible for allergic reactions

The nurse caring for a patient undergoing chemotherapy finds that the patient has a low white blood cell (WBC) count. Which is an appropriate intervention? 1 Request that the chemotherapy dose be reduced. 2 Monitor the respiratory rate of the patient. 3 Allow the patient to visit with family and friends. 4 Administer white blood cell growth factors.

4 Chemotherapy may suppress the proliferation of bone marrow resulting in neutropenia or low white blood cell counts. Low WBC count makes the patient prone for developing infection; therefore, the nurse should consult the health care provider and get WBC growth factors administered. In addition, the nurse should monitor the temperature of the patient, as it can indicate fever. The number of visitors should be limited to prevent risk of infection. The chemotherapy dose need not be reduced, as neutropenia is a common side effect. Respiratory rate is routinely monitored, but in this case it is not directly related to the patient's WBC.

A patient who is undergoing a diagnostic workup for cancer expresses anxiety about the results. Which is the best nursing response? 1 "It is probably nothing." 2 "Let's discuss that later." 3 "Everyone feels that way." 4 "Let's talk about your concerns."

4 During the diagnostic workup of cancer, it is common for patients to be anxious. The nurse should actively listen to all concerns expressed. The nurse should not use communication patterns that may hinder exploration of feelings and meanings. "It is probably nothing" may indicate that the nurse is giving false reassurances. "Let's discuss that later" may mean that the nurse is delaying the discussion, and "Everyone feels this way" means that the nurse is generalizing the patient's concern. By using these strategies, the nurse may deny patients the opportunity to share the meaning of their experience.

The nurse is providing patient education for a newly diagnosed human immunodeficiency virus (HIV)-infected patient. Which of these statements by the patient reflects a need for further teaching? 1 "I need to keep my appointments for follow-up laboratory work." 2 "I will call my health care provider if I am too sick to take these drugs." 3 "I won't take any new drugs or herbal products without checking with my health care provider first." 4 "Once my tests show that the virus has decreased, I cannot give HIV to another person."

4 Even at the point when the viral load is undetectable, HIV still can be transmitted to others and the patient will need to continue protection measures. It is important to keep the appointments for follow-up laboratory work to monitor the effectiveness of the antiretroviral therapy (ART). Patients should be instructed to take all medications as prescribed without stopping any of them. If the patient is unable to tolerate even one of the drugs, then the health care provider needs to be notified immediately. Instruct patients not to take any other medications, including over-the-counter and herbal products, without checking with the health care provider first.

A patient has an undetectable level of plasma human immunodeficiency virus (HIV) RNA after 6 months of antiretroviral therapy. The patient exclaims, "I'm so glad to be cured!" Which response by the nurse is most therapeutic and accurate? 1 "Oh, that is wonderful. I'm glad everything worked out so well for you." 2 "No, you're wrong. You're never going to be cured— this is a lifelong illness." 3 "You should be very pleased, and I think you should celebrate the good news." 4 "An undetectable level means that your therapy was successful but not that you were cured."

4 Human immunodeficiency virus antiretroviral therapy can reduce viral load, resulting in an undetectable serum level. This does not indicate a cure; rather, it indicates that the therapy is working and that the patient must continue to take the medication. Congratulating the patient, or telling her to celebrate, is inaccurate and incorrect; telling her that she is wrong and will never be cured is nontherapeutic.

The nurse is reviewing the pathophysiology of human immunodeficiency virus (HIV) infection. Which of these statements about HIV infection is true? 1 HIV is able to replicate outside a living cell. 2 The virus replicates going from DNA to RNA. 3 Infection of monocytes may occur, but antibodies quickly destroy these cells. 4 The immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells.

4 Immune dysfunction in HIV infection is predominantly the result of damage to and destruction of CD4+ T cells (also known as T helper cells or CD4+ T lymphocytes). HIV cannot replicate unless it is inside a living cell. HIV replicates in a "backward" manner (going from RNA to DNA). Antibodies do not destroy the infected monocytes.

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).

4 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.

The nurse provides instructions regarding markings on the skin to a patient who is undergoing radiation therapy. What explanation should the nurse provide regarding the markings? 1 They are permanent effects of radiation therapy. 2 They indicate that previous treatments have been unsuccessful. 3 They are a warning of potentially serious side effects of radiation. 4 They should be protected, because they are landmarks for the radiation therapy.

4 Markings should be protected from being washed or removed because they are landmarks for the radiation therapy treatment field. They are not permanent; nor are they an indication that previous treatment has been unsuccessful or a warning about the side effects of radiation.

Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? 1 Acute pain 2 Hypothermia 3 Powerlessness 4 Risk for infection

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

A human immunodeficiency virus (HIV)-infected patient asks the nurse, "I've heard about opportunistic diseases in HIV-infected people. What does that mean? I already have the HIV infection." Which response by the nurse is correct? 1 "These diseases are usually benign." 2 "Opportunistic diseases only occur at the end-stages of HIV infection." 3 "Unfortunately, opportunistic diseases are not treatable if they occur." 4 "These are caused by organisms that do not cause severe disease in those with functioning immune systems."

4 Opportunistic diseases generally do not occur in the presence of a functioning immune system. Organisms that do not cause severe disease in people with functioning immune systems can cause debilitating, disseminated, and life-threatening infections during this stage. Several opportunistic diseases may occur at the same time, compounding the difficulties of diagnosis and treatment. Advances in HIV treatment have decreased the occurrence of opportunistic diseases. These diseases can occur early in the process of HIV infection and sometimes are used to diagnose the presence of HIV.

Which organ produces lymphocytes? 1 Spleen 2 Tonsils 3 Thymus 4 Bone marrow

4 Production of lymphocytes takes place in the bone marrow. The spleen is responsible for filtering foreign antigens that enter the bloodstream. Tonsils are lymphoid tissue that act as a first-line defense against ingested or inhaled pathogens. The thymus produces mature T-lymphocytes.

A patient is scheduled for pelvic radiation therapy. The patient asks why the instructions state to go for radiation therapy with a full bladder. What explanation should the nurse give? 1 A full bladder indicates adequate fluid intake. 2 A full bladder improves effectiveness of the treatment. 3 A full bladder prevents harmful effects of radiation therapy on the bladder. 4 A full bladder moves the bowels out of the treatment field.

4 Radiation therapy may compromise the gastrointestinal function, leading to diarrhea. The small bowel is highly sensitive to radiation therapy and may not tolerate significant doses. A full bladder helps to move the bowels out of the treatment field and minimizes the radiation effects on it. An adequate urine output indicates an adequate fluid intake. A full bladder does not improve the effectiveness of the therapy, and does not prevent harmful effects of radiation therapy on the bladder.

Which item would be most beneficial when providing oral care to a patient with cancer who is at risk for oral-tissue injury? 1 Hydrogen peroxide rinses 2 Use of oral swabs only 3 Alcohol-based mouthwash 4 Soft-bristled toothbrush

4 Soft-bristled toothbrushes will prevent further irritation to oral tissue that is fragile. Alcohol-based mouthwash and hydrogen peroxide may further damage fragile oral tissue. Oral swabs may be used; however, these are not as effective in cleaning the oral cavity and teeth and reducing bacteria accumulation in the mouth.

The patient has been diagnosed with non-small cell lung cancer. Which type of targeted therapy most likely will be used for this patient to suppress cell proliferation and promote programmed tumor cell death? 1 Proteasome inhibitors 2 BCR-ABL tyrosine kinase inhibitors 3 CD20 monoclonal antibodies (MoAb) 4 Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TK)

4 Targeted therapies are more selective for specific molecular targets. Thus they are able to kill cancer cells with less damage to normal cells than with chemotherapy. Epidermal growth factor receptor (EGFR) is a transmembrane molecule that works through activation of intracellular tyrosine kinase (TK) to suppress cell proliferation and promote apoptosis of non-small cell lung cancer, and some colorectal, head and neck, and metastatic breast cancers. Proteasome inhibitors promote accumulation of proteins that promote tumor cell death for multiple myeloma. BCR-ABL tyrosine kinase inhibitors target specific oncogenes for chronic myeloid leukemia and some gastrointestinal stromal tumors. CD20 monoclonal antibodies (MoAb) bind with CD20 antigen, causing cytotoxicity in non-Hodgkin's lymphoma and chronic lymphocytic leukemia

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 nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate for the nurse to use to increase the patient's nutritional intake? 1 Increase intake of liquids at mealtime to stimulate the appetite. 2 Serve three large meals per day plus snacks between each meal. 3 Avoid the use of liquid protein supplements to encourage eating at mealtime. 4 Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

4 The nurse can increase the nutritional density of foods by adding items high in protein or calories (such as peanut butter, skim milk powder, cheese, or honey) 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 tolerated best. Supplements can be helpful.

A patient is receiving tacrolimus (Prograf, FK506) as a part of triple immunosuppressant therapy after a kidney transplant. Which instruction is most important when teaching the patient about this particular medicine? 1 Wear a mask when going out. 2 Eat a healthy and nutritious diet. 3 Avoid meeting people who have a cold. 4 Avoid consuming grapefruit or its juice

4 The nurse should educate the patient to avoid consuming grapefruit or grapefruit juice, as it can interact with tacrolimus and prevent its metabolism. This decreased metabolism can lead to toxicity of the drug through accumulation. Wearing a mask when going out, eating a healthy diet, and avoiding people who have an infection are general measures to prevent contracting infections when on immunosuppressive therapy but are not specifically related to consuming this medication.

A patient newly diagnosed with HIV wishes to know the ways to prevent transmission of HIV to others. Which instruction should the nurse include in her teachings? 1 Do not hug or kiss other people. 2 Do not shake hands with people. 3 Avoid sharing utensils with others. 4 Avoid sexual contact with noninfected partners

4 The nurse should inform the patient that HIV can be transmitted through sexual contact, and the patient should abstain from any kind of sexual activity that involves contact with body fluids. In addition, HIV can also be transmitted through exposure to HIV-infected blood or blood products; and perinatal transmission during pregnancy, at delivery, or through breastfeeding. However, HIV cannot be transmitted through hugging or kissing, shaking hands with people, or sharing utensil

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 cares 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.

A nurse is caring for a patient with breast cancer. The primary health care provider has prescribed trastuzumab (Herceptin) 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 over-expressed 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 (Avastin) prevents blood vessel growth by binding with vascular endothelial growth factor. Imatinib (Gleevec) inhibits BCR-ABL tyrosine kinase that suppresses proliferation of cancer cells and promotes apoptosis.

A patient's laboratory report reveals that the patient's CD4+ T-cell count has dropped below 200 cells/μL. The patient is diagnosed with Burkitt's lymphoma and has herpes simplex with chronic ulcers. The nurse weighs the patient and finds that there is a loss of 10% of body mass. Which infection is likely to be found in this patient? 1 Parvovirus 2 Varicella-zoster 3 Adenoviruses infection 4 Human immunodeficiency virus infection

4 n human immunodeficiency virus infection, the CD4+ T-cell count drops below 200 cells/μL due to the destruction of the white blood cells. As a result, immunity decreases. Due to the decreased immunity, opportunistic infections such as herpes simplex and Burkitt's lymphoma may occur. Due to the ongoing infectious process, the body goes into a state of catabolism, resulting in significant weight loss. Parvovirus produces gastroenteritis. Varicella-zoster virus causes chickenpox and shingles. Adenoviruses cause upper respiratory tract infections and pneumonia.

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 which 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

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

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 patient has multiple myeloma and will be treated with autologous hematopoietic stem cell transplantation because a suitable donor has not been found. In which order will the following procedures occur? Put a comma and space between each answer choice (1, 2, 3, 4, etc.). 1. Myeloablative chemotherapy is administered. 2. Stem cells are infused after chemotherapy has been eliminated from the body. 3. Peripheral stem cells are obtained from the peripheral blood in an outpatient procedure. 4. Filgrastim (Neupogen), a granulocyte colony-stimulating factor, is administered with plerixafor (Mozobil). 5. Stem cells are treated to remove undetected cancer cells, then cryopreserved and stored until needed.

When the patient donates the stem cells for the autologous hematopoietic stem cell transplantation, first filgrastim or another granulocyte colony-stimulating factor is given along with plerixafor to increase the number of stem cells released from the bone marrow into the bloodstream. Peripheral stem cells are collected at an outpatient center, treated to remove undetected cancer cells, and cryopreserved to be stored for later use. Then the patient is treated with myeloablative chemotherapy to destroy the bone marrow. The preserved stem cells are then infused after the chemotherapy has been eliminated from the patient's body, approximately 24 to 48 hours after the last dose of chemotherapy.