Chapter 15: Management of Patients with Oncologic disorders

The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? A.) Stomatitis B.) Nausea and vomiting C.) Extravasation D.) Bone pain

Answer: C.) Extravasation

A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? A.) Urine output of 400 ml in 8 hours B.) Serum potassium level of 2.6 mEq/L C.) Blood pressure of 120/64 to 130/72 mm Hg D.) Sodium level of 142 mEq/L

Answer: B.) Serum potassium level of 2.6 mEq/L Rationale: Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include a serum potassium level below 3.5 mEq/L, decreased urine output (less than 40 ml/hour), and abnormally low blood pressure. Urine output of 400 ml in 8 hours, serum sodium level of 142 mEq/L, and a blood pressure of 120/64 to 130/72 mm Hg aren't abnormal findings.

A nurse is caring for a client receiving chemotherapy. Which assessment finding places the client at the greatest risk for an infection? A.) White blood cell (WBC) count of 9,000 cells/mm3 B.) Stage 3 pressure ulcer on the left heel C.) Temperature of 98.3° F (36.8° C) D.) Ate 75% of all meals during the day

Answer: B.) Stage 3 pressure ulcer on the left heel Rationale: A stage 3 pressure ulcer is a break in the skin's protective barrier, which could lead to infection in a client who is receiving chemotherapy. The WBC count and temperature are within normal limits. Eating 75% of meals is normal and doesn't increase the client's risk for infection. A client who is malnourished is at a greater risk for infection.

What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss? A.) Alopecia related to chemotherapy is relatively uncommon. B.) The hair will grow back within 2 months post therapy. C.) The client should consider getting a wig or cap prior to beginning treatment. D.) The hair will grow back the same as it was before treatment.

Answer: C.) The client should consider getting a wig or cap prior to beginning treatment.

The nurse is conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome? A.) Onset of cancer after age 50 in family member B.) A first cousin diagnosed with cancer C.) A second cousin diagnosed with cancer D.) An aunt and uncle diagnosed with cancer

Answer: D.) An aunt and uncle diagnosed with cancer Rationale: The hallmarks of hereditary cancer syndrome include cancer in two or more first-degree or second-degree relatives, early onset of cancer in family members younger than age 50, the same type of cancer in several family members, individual family members with more than one type of cancer, and a rare cancer in one or more family members.

A client is recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed? A.) "I guess the doctor could not remove the entire tumor." B.) "I am so glad the doctor was able to remove the entire tumor." C.) "I will be glad to finally be done with treatments for this thing." D.) "Thank goodness the tumor is contained and curable."

Answer: A.) "I guess the doctor could not remove the entire tumor." Rationale: Debulking is a reference made when a tumor cannot be completely removed, often due to its extension far into healthy tissue. Without complete removal, this is not a cure and, the cancer cells will continue to replicate and require adjuvant therapies to prevent further invasion. The physician, not the nurse, will need to clarify the details of the surgery.

Which type of surgery is used in an attempt to relieve complications of cancer? A.) Palliative B.) Prophylactic C.) Reconstructive D.) Salvage

Answer: A.) Palliative Rationale: Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing nonvital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or to obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.

A nurse is administering a chemotherapeutic medication to a client, who reports generalized itching and then chest tightness and shortness of breath. The nurse immediately A.) Stops the chemotherapeutic infusion B.) Administers diphenhydramine C.) Gives prednisolone IV D.) Places the client on oxygen by nasal cannula

Answer: A.) Stops the chemotherapeutic infusion Rationale: The client may be experiencing a type I hypersensitivity reaction, which may progress to systemic anaphylaxis. The most immediate action of the nurse is to discontinue the medication followed by initiating emergency protocols.

A decrease in circulating white blood cells (WBCs) is referred to as A.) Granulocytopenia B.) Thrombocytopenia C.) Leukopenia D.) Neutropenia

Answer: C.) Leukopenia

When a client receives vincristine, an antineoplastic agent that inhibits DNA and protein synthesis, the client needs to be informed to report which symptoms that would be expected side effects of motor neuropathy? Select all that apply. - burning and tingling sensations in the extremities - muscle weakness - cramps and spasms in the legs - loss of balance and coordination - alopecia

Answer: - muscle weakness - cramps and spasms in the legs - loss of balance and coordination Rationale: Muscle weakness, cramps and leg spasms, and loss of balance and coordination are expected side effects of motor nerve damage. Burning and tingling sensations are signs of sensory nerve damage. Alopecia is hair loss, not a motor nerve damage sign.

The clinic nurse is caring for a client who has just been diagnosed with a tumor. The client says to the nurse "The doctor says my tumor is benign. What does that mean?" What is the nurse's best response? A.) "Benign tumors don't usually cause death." B.) "Benign tumors grow very rapidly." C.) "Benign tumors can spread from one place to another." D.) "Benign tumors invade surrounding tissue."

Answer: A.) "Benign tumors don't usually cause death."

According to the tumor-node-metastasis (TNM) classification system, T0 means there is A.) No evidence of primary tumor B.) No regional lymph node metastasis C.) No distant metastasis D.) Distant metastasis

Answer: A.) No evidence of primary tumor

Which of the following would be inconsistent as a common side effect of chemotherapy? A.) Weight gain B.) Alopecia C.) Myelosuppression D.) Fatigue

Answer: A.) Weight gain

Which of the following is generally NOT considered to be a carcinogen? A.) Parasites B.) Viruses C.) Dietary substances D.) Defective genes

Answer: A.) Parasites

A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication? A.) Erythema B.) Flare C.) Extravasation D.) Thrombosis

Answer: C.) Extravasation

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia? A.) Perform a cardiovascular assessment every 4 hours. B.) Check the client's history for a congenital link to thrombocytopenia. C.) Monitor daily platelet counts. D.) Closely observe the client's skin for petechiae and bruising.

Answer: D.) Closely observe the client's skin for petechiae and bruising. Rationale: The nurse should closely observe the client's skin for petechiae and bruising. Daily laboratory testing may not reflect the client's condition as quickly as subtle changes in the client's skin. Performing a cardiovascular assessment every 4 hours and checking the clients history for a congenital link to thrombocytopenia don't help detect early signs and symptoms of thrombocytopenia.

A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse? A.) It stimulates the immune system against the tumor cells. B.) It treats drug-related anemia. C.) It prevents alopecia. D.) It lowers serum and uric acid levels.

Answer: D.) It lowers serum and uric acid levels. Rationale: The use of allopurinol with chemotherapy is to prevent renal toxicity. Tumor lysis syndrome occurrence can be reduced with allopurinol's action of reducing the conversion of nucleic acid byproducts to uric acid, in this way preventing urate nephropathy and subsequent oliguric renal failure. Allopurinol does not stimulate the immune system, treat anemia, or prevent alopecia.

A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because: A.) The three drugs can be given at lower doses. B.) The second and third drugs increase the effectiveness of the first drug. C.) The first two drugs are toxic to cancer cells, and the third drug promotes cell growth. D.) The three drugs have a synergistic effect and act on the cancer cells with different mechanisms.

Answer: D.) The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. Rationale: Multiple drug regimens are used because the drugs have a synergistic effect. The drugs have different cell-cycle lysis effects, different mechanisms of action, and different toxic adverse effects. They are usually given in combination to enhance therapy. Dosage is not affected by giving the drugs in combination. The second and third drugs do not increase the effectiveness of the first. It is not true that the first two drugs are toxic to cancer cells while the third drug promotes cell growth.

The nurse is caring for a client is scheduled for chemotherapy followed by autologous stem cell transplant. Which of the following statements by the client indicates a need for further teaching? A.) "I hope they find a bone marrow donor who matches." B.) "The doctor will remove cells from my bone marrow before beginning chemotherapy." C.) "I will receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back." D.) "I will need to attend follow-up visits for up to 3 months after treatment."

Answer: A.) "I hope they find a bone marrow donor who matches." Rationale: An autologous stem cell transplant comes from the client not from a donor. The doctor will remove the stem cells from the bone marrow before beginning chemotherapy and treat the client until most if not all the cancer is eliminated before reinfusing the stem cells. Clients are at risk for infection and will be closely monitored for at least 3 months, but not in protective isolation.

The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia? A.) "The hair loss is usually temporary." B.) "New hair growth will return without any change to color or texture." C.) "Clients with alopecia will have delay in grey hair." D.) "Wigs can be used after the chemotherapy is completed."

Answer: A.) "The hair loss is usually temporary." Rationale: Alopecia associated with chemotherapy is usually temporary and will return after the therapy is completed. New hair growth may return unchanged, but there is no guarantee and color, texture, and quality of hair may be changed. There is no correlation between chemotherapy and delay in greying of hair. Use of wigs, scarves, and head coverings can be used by clients at any time during treatment plan.

A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is A.) "You will need to practice birth control measures." B.) "You will continue having your menses every month." C.) "You will experience menopause now." D.) "You will be unable to have children."

Answer: A.) "You will need to practice birth control measures." Rationale: Following chemotherapy female clients may experience normal ovulation, early menopause, or permanent sterility. Clients are advised to use reliable methods of birth control until reproductivity is known.

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent? A.) Antimetabolite B.) Alkylating C.) Nitrosoureas D.) Mitotic spindle poisons

Answer: A.) Antimetabolite RATIONALE: 5-FU is an antimetabolite. An example of an alkylating agent is nitrogen mustard. A nitrosourea is streptozocin. A mitotic spindle poison is vincristine (VCR).

A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan? A.) Avoiding using soap on the irradiated areas B.) Applying talcum powder to the irradiated areas daily after bathing C.) Wearing a lead apron during direct contact with the client D.) Removing thoracic skin markings after each radiation treatment

Answer: A.) Avoiding using soap on the irradiated areas Rationale: Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed.

A client has just received stem cell transplantation as treatment for leukemia. What are the post procedural nursing interventions for clients receiving any form of stem cell transplantation? A.) Closely monitor the client for at least 3 months. B.) Closely monitor the client for at least 3 days. C.) Closely monitor the client for at least 4 weeks. D.) Closely monitor the client for at least 5 months.

Answer: A.) Closely monitor the client for at least 3 months. Rationale: After stem cell transplantation, the nurse closely monitors the client for at least 3 months because complications related to the transplant are still possible and infections are very common.

Which of the following is a type of procedure that uses liquid nitrogen to freeze tissue and cause cell destruction? A.) Cryosurgery B.) Electrosurgery C.) Chemosurgery D.) Laser surgery

Answer: A.) Cryosurgery Rationale: Cryosurgery uses liquid nitrogen or a very cold probe to freeze tissue to cause cell destruction. Electrosurgery, chemosurgery, and laser surgery do not use liquid nitrogen to freeze tissue.

A side-effect of chemotherapy is renal damage. To prevent this, the nurse should: A.) Encourage fluid intake, if possible, to dilute the urine. B.) Withhold medication when the blood urea nitrogen level exceeds 20 mg/dL. C.) Limit fluids to 1,000 mL/day to minimize stress on the renal tubules. D.) Modify the diet to acidify the urine, thus preventing uric acid crystallization.

Answer: A.) Encourage fluid intake, if possible, to dilute the urine.

A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue? A.) Excisional biopsy B.) Incisional biopsy C.) Needle biopsy D.) Punch biopsy

Answer: A.) Excisional biopsy Rationale: Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis.

In which phase of the cell cycle does cell division occur? A.) Mitosis B.) G1 phase C.) S phase D.) G2 phase

Answer: A.) Mitosis Rationale: Cell division occurs in mitosis. RNA and protein synthesis occurs in the G1 phase. DNA synthesis occurs during the S phase. DNA synthesis is complete, and the mitotic spindle forms in the G2 phase.

What is the best way for the nurse to assess the nutritional status of a patient with cancer? A.) Weigh the patient daily. B.) Monitor daily caloric intake. C.) Observe for proper wound healing. D.) Assess BUN and creatinine levels.

Answer: A.) Weigh the patient daily. rationale: Common nutritional problems in clients with cancer include anorexia, malabsorption, and the extreme weight loss of cancer-related anorexia-cachexia syndrome (CACS). Because malnutrition may occur due to problems with absorption of nutrients or increased metabolic demands, weighing the client regularly is the best way to monitor nutritional status. The client's caloric intake should also be monitored, keeping in mind that nutritional status may suffer even if caloric intake may seem sufficient.

The nurse is conducting a community education program using the American Cancer Society's colorectal screening and prevention guidelines. The nurse determines that the participants understand the teaching when they identify that people over the age of 50 should have which screening test every 10 years? A.) Fecal occult blood test B.) Colonoscopy C.) Prostate-specific antigen (PSA) D.) Papanicolaou (Pap)

Answer: B.) Colonoscopy Rationale: Recommendations for screening for colorectal cancer include a screening colonoscopy every 10 years. Fecal occult blood tests should be completed annually in people over age 50. The test for PSA is used as a screening tool for prostate cancer. A Pap test is a screening tool for cervical cancer.

A client is scheduled for a nerve-sparing prostatectomy. The emotional spouse confides in the nurse that the client will not talk about the cancer and/or upcoming surgery. Which nursing diagnosis will the nurse choose as primary diagnosis for this client? A.) Sexual Dysfunction B.) Fear C.) Knowledge Deficit D.) Grieving

Answer: B.) Fear

A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client? A.) Monitor the client's toilet patterns. B.) Monitor the client to prevent sepsis. C.) Monitor the client's physical condition. D.) Monitor the client's heart rate.

Answer: B.) Monitor the client to prevent sepsis. Rationale: Until transplanted bone marrow begins to produce blood cells, clients who have undergone a bone marrow transplant have no physiologic means to fight infection, which puts them at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent sepsis. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client becoming septic.

You are a clinic nurse. One of your clients has found she is at high risk for breast cancer. She asks you what can be done to reduce her risk. What is a means of reducing the risk for breast cancer? A.) Palliative surgery B.) Prophylactic surgery C.) Curative surgery D.) Reduction surgery

Answer: B.) Prophylactic surgery Rationale: Prophylactic or preventive surgery may be done if the client is at considerable risk for cancer. Palliative surgery is done when no curative treatment is available. Curative surgery is performed to cure the disease process. Reduction surgery is a distractor.

A nurse assesses an oncology client with stomatitis during a chemotherapy session. Which nursing intervention would most likely decrease the pain associated with stomatitis? A.) Recommend that the client discontinue chemotherapy. B.) Provide a solution of viscous lidocaine for use as a mouth rinse. C.) Monitor the client's platelet and leukocyte counts. D.) Check regularly for signs and symptoms of stomatitis.

Answer: B.) Provide a solution of viscous lidocaine for use as a mouth rinse. Rationale: To decrease the pain of stomatitis, the nurse should provide a solution of viscous lidocaine for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer systemic analgesics as ordered. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn't be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection, but wouldn't decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn't decrease the pain.

The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice? A.) uses the treadmill for 30 minutes on 5 days each week B.) eats red meat such as steaks or hamburgers every day C.) works as a secretary at a medical radiation treatment center D.) drinks one glass of wine at dinner each night

Answer: B.) eats red meat such as steaks or hamburgers every day Rationale: Dietary substances such as nitrate-containing and red meats appear to increase the risk of cancer. Exercising 30 minutes on 5 days or more is recommended for adults. Measures are taken to protect those people who work around radiation. Alcohol consumption recommendations include drink no more than one drink per day for women or two per day for men.

A client with ovarian cancer is ordered hydroxyurea, an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. What mechanism of action do antimetabolites interferes with? A.) cell division or mitosis during the M phase of the cell cycle B.) normal cellular processes during the S phase of the cell cycle C.) the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle-nonspecific) D.) one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cycle-nonspecific)

Answer: B.) normal cellular processes during the S phase of the cell cycle Rationale: Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They're most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.

The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides that they are very depressed. The nurse recognizes depression as which of the following? A.) A psychiatric diagnosis everyone has at one time or another. B.) A side effect of the neoplastic drugs. C.) A normal reaction to the diagnosis of cancer. D.) An aberrant psychologic reaction to the chemotherapy.

Answer: C.) A normal reaction to the diagnosis of cancer. Rationale: Clients have many reactions, ranging from anxiety, fear, and depression to feelings of guilt related to viewing cancer as a punishment for past actions or failure to practice a healthy lifestyle. They also may express anger related to the diagnosis and their inability to be in control. While depression is understandable, it also needs to be acknowledged and treated if necessary. Depression is not a side effect of the neoplastic drugs nor is it an aberrant psychologic reaction to the chemotherapy.

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention? A.) Serving small portions of bland food B.) Encouraging rhythmic breathing exercises C.) Administering metoclopramide and dexamethasone as ordered D.) Withholding fluids for the first 4 to 6 hours after chemotherapy administration

Answer: C.) Administering metoclopramide and dexamethasone as ordered Rationale: The nurse should assign highest priority to administering an antiemetic, such as metoclopramide, and an anti-inflammatory agent, such as dexamethasone, because it may reduce the severity of chemotherapy-induced nausea and vomiting. This intervention, in turn, helps prevent dehydration, a common complication of chemotherapy. Serving small portions of bland food, encouraging rhythmic breathing exercises, and withholding fluids for the first 4 to 6 hours are less likely to achieve this outcome.

Which does a nurse thoroughly evaluate before a hematopoietic stem cell transplant (HSCT) procedure? A.) Family history B.) Drug history C.) Blood studies D.) Allergy history

Answer: C.) Blood studies Rationale: Before the HSCT procedure, the nurse thoroughly evaluates the client's physical condition; organ function; nutritional status; complete blood studies, including assessment for past exposure to antigens such as HIV, hepatitis, or cytomegalovirus; and psychosocial status. Before an HSCT procedure, the nurse need not evaluate client's family, drug, or allergy history.

Which oncologic emergency involves the accumulation of fluid in the pericardial space? A.) Disseminated intravascular coagulation (DIC) B.) Syndrome of inappropriate antidiuretic hormone release (SIADH) C.) Cardiac tamponade D.) Tumor lysis syndrome

Answer: C.) Cardiac tamponade Rationale: Cardiac tamponade is an accumulation of fluid in the pericardial space. DIC is a complex disorder of coagulation and fibrinolysis that results in thrombosis and bleeding. SIADH is a result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH). Tumor lysis syndrome is a rapidly developing oncologic emergency that results from the rapid release of intracellular contents as a result of radiation- or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia.

A client diagnosed with cancer makes the following statement to the nurse: "I guess I will tell my health care provider to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die." Which of the following facts supports the use of chemotherapy for this client? A.) Nausea and vomiting are only a factor for the first 24 hours after treatment. B.) Most clients believe the discomfort is well worth the cure for cancer. C.) Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. D.) Clinical trials are opening up new cancer treatments all the time.

Answer: C.) Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects.

The health care provider recommends that parents have their daughter vaccinated with HPV vaccine. What is this vaccine for? A.) Help prevent lung cancer B.) Help prevent breast cancer C.) Help prevent cervical cancer D.) Help prevent leukemia

Answer: C.) Help prevent cervical cancer

The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy? A.) It is used to remove cancerous cells using a needle. B.) It removes an entire lesion and the surrounding tissue. C.) It removes a wedge of tissue for diagnosis. D.) It treats cancer with lymph node involvement.

Answer: C.) It removes a wedge of tissue for diagnosis. Rationale: The three most common biopsy methods are excisional, incisional, and needle. In an incisional biopsy, a wedge of tissue is removed from the tumor and analyzed. In an excisional biopsy, the surgeon removes the tumor and the surrounding marginal tissues. Needle aspiration biopsy involves aspirating tissue fragments through a needle guided into the cancer cells.

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse? A.) Random, rapid growth of the tumor B.) Cells colonizing to distant body parts C.) Tumor pressure against normal tissues D.) Emission of abnormal proteins

Answer: C.) Tumor pressure against normal tissues Rationale: Benign tumors grow more slowly than malignant tumors and do not emit tumor-specific antigens or proteins. Benign tumors do not metastasize to distant sites. Benign tumors can compress tissues as it grows, which can result in impaired organ functioning.

During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? A.) Promotion B.) Initiation C.) Prolongation D.) Progression

Answer: D.) Progression Rationale: Progression is the third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize. During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information, even after long latency periods. During initiation, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. No stage of cellular carcinogenesis is termed prolongation.