NSG320 Topic 6 Chapter 16 NCLEX
When caring for a patient undergoing chemotherapy, which nursing measures should the nurse take to manage fatigue in the patient? Select all that apply. A. Reassure the patient that fatigue is a common side effect. B. Pace activities in accordance with energy level. C. Encourage strenuous exercise to build strength. D. Encourage the patient to be active even when tired. E. Maintain usual lifestyle patterns as much as possible.
A,B,E. Fatigue is common during cancer treatment, and the patient can be helped to manage it. The nurse should reassure the patient that fatigue is a side effect of treatment that may subside once the treatment is over. Energy-conserving strategies should be adopted, and the patient should pace activities in accordance with his or her energy level, resting when necessary. The patient should maintain usual lifestyle patterns as much as possible and avoid strenuous exercise, instead doing mild or moderate exercise, if possible. Text Reference - p. 265
The patient and his 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)? A. Maintain hope. B. Exhibit a caring attitude. C. Plan realistic long-term goals. D. Give them antianxiety medications. E. Be available to listen to fears and concerns. F. Teach them about all the types of cancer that could be diagnosed.
A,B,E. 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 them about the diagnostic procedures would also be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.
The diagnostic reports of a patient indicate a benign tumor in the glandular epithelium. What does the nurse document in this patient's medical record? A. The patient has an adenoma. B. The patient has a chondroma. C. The patient has a meningioma. D. The patient has a rhabdomyoma.
A. An adenoma is a benign tumor in the glandular epithelium. A benign tumor in the cartilage is called a chondroma. A benign tumor in the nervous tissue meninges is called a meningioma. A benign tumor in the striated muscle is called a rhabdomyoma. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 254
The nurse assesses a 76-year-old man with chronic myeloid leukemia receiving nilotinib (Tasigna). It is most important for the nurse to ask which question? A. "Have you had a fever?" B. "Have you lost any weight?" C. "Has diarrhea been a problem?" D. "Have you noticed any hair loss?"
A. An adverse effect of nilotinib is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4o F or higher. Other adverse effects of nilotinib are thrombocytopenia, bleeding, nausea, fatigue, elevated lipase level, fever, rash, pruritus, diarrhea, and pneumonia.
The laboratory reports that the cells from the patient's tumor biopsy are Grade II. What should the nurse know about this histologic grading? A. Cells are abnormal and moderately differentiated. B. Cells are very abnormal and poorly differentiated. C. Cells are immature, primitive, and undifferentiated. D. Cells differ slightly from normal cells and are well-differentiated.
A. Grade II cells are more abnormal than Grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.
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? A. Cells are abnormal and moderately differentiated. B. Cells are very abnormal and poorly differentiated. C. Cells are immature, primitive, and undifferentiated. D. Cells differ slightly from normal cells and are well differentiated.
A. 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. Text Reference - p. 254
Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? A. A bland, low-fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods
A. Patients experiencing diarrhea secondary to chemotherapy and/or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.
A patient who is undergoing a course of outpatient chemotherapy reports feeling lonely and isolated and expresses the desire to resume normal activities, such as socialization with friends. Which precaution should the nurse recommend when allowing the patient to resume these activities? A. Avoiding crowds B. Drinking only bottled water C. Refraining from eating outside the home D. Using the bathroom at home, not in public places
A. The nurse needs to teach the patient measures that will protect against infection, such as maintaining adequate nutrition and fluid intake and avoiding crowds, people with infections, and others who have been recently vaccinated with live or attenuated vaccines. Drinking bottled water, eating only at home, and using the bathroom only at home are unnecessary precautions. Text Reference - p. 266
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 ? A. Stop the infusion. B. Reduce the rate of the infusion. C. Stabilize the airway, breathing, and circulation. D. Inform the health care provider.
A. 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. Text Reference - p. 273
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. A. Apply ice packs. B. Avoid the use of heating pads. C. Avoid constricting garments. D. Suggest the use of deodorants. E. Avoid rubbing the affected area.
B,C,E. 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. Text Reference - p. 269
A patient with breast cancer is on chemotherapy. Two days after chemotherapy was initiated, laboratory reports indicate that the patient has hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia. What does the nurse interpret from these findings? A. The patient has third space syndrome. B. The patient has tumor lysis syndrome. C. The patient has spinal cord compression. D. The patient has superior vena cava syndrome.
B. A patient with breast cancer who has developed hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia two days after the start of chemotherapy has tumor lysis syndrome. Third space syndrome is a complication of cancer in which a patient will have hypovolemia due to a shift of fluid from the vascular space to the interstitial space. Spinal cord compression is a complication caused by the growth of a malignant tumor in the epidural space of the spinal cord. The presence of an obstruction in the superior vena cava caused by thrombosis results in superior vena cava syndrome. Text Reference - p. 278
The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? A. Ask the patient if the site hurts. B. Turn off the chemotherapy infusion. C. Call the ordering health care provider. D. Administer sterile saline to the reddened area.
B. Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation the infusion should first 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.
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? A. Heart disease B. Cancer C. HIV infection D. Tuberculosis
B. 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. Text Reference - p. 248
The nurse is teaching a wellness class to a group of women at their workplace. The nurse knows that which woman is at highest risk for developing cancer? A. A woman who obtains regular cancer screenings and consumes a high-fiber diet B. A woman who has a body mass index of 35 kg/m2 and smoked cigarettes for 20 years C. A woman who exercises five times every week and does not consume alcoholic beverages D. A woman who limits fat consumption and has regular mammography and Pap screenings
B. Cancer prevention and early detection are associated with the following behaviors: limited alcohol use; regular physical activity; maintaining a normal body weight; obtaining regular cancer screenings; avoiding cigarette smoking and other tobacco use; using sunscreen with SPF 15 or higher; and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).
The nurse is assessing a patient with prostate cancer and spinal cord compression. Upon further assessment, the nurse anticipates that the patient has autonomic dysfunction. Which finding supports the nurse's conclusion? A. Facial edema B. Impaired bladder function C. Distension of veins of the neck D. Reduced central venous pressure
B. Damage to the spinal column can alter the function of the autonomic nervous system. Thus, the patient will have impaired bladder function. Facial edema and distension of veins of the neck are manifestations of thrombosis or superior vena cava syndrome. Third space syndrome is a complication associated with visceral fluids. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 277
The nurse is reviewing the laboratory reports of a patient with cancer and anticipates that the patient is at an increased risk for infection. Which finding supports this conclusion? A. Anemia B. Neutropenia C. Hyperkalemia D. Hyponatremia
B. Neutropenia, or a decreased white blood cell count, indicates that the patient at risk for infection. Anemia is a complication associated with chemotherapy; anemia does not indicate that the patient has infection. Hyperkalemia and hyponatremia also do not indicate infection. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 277
The registered nurse is teaching a student nurse about the seven warning signs of cancer. Which warning sign stated by the student nurse indicates ineffective learning? A. Indigestion B. Severe headache C. Unusual bleeding D. Difficult in swallowing
B. Severe headache is not a warning sign of cancer. Severe headache may indicate a stroke. Indigestion may indicate stomach cancer. Unusual bleeding may indicate uterine cancer. Difficulty in swallowing may indicate esophageal cancer. Text Reference - p. 255
Which tumor classification in a patient indicates carcinoma in situ? A. T0 B. Tis C. Tx D. T1-4
B. The TNM classification system is used to determine the anatomic extent of the disease involvement according to three parameters: tumor size and invasiveness, presence or absence of regional spread to lymph nodes, and metastases. Carcinoma in situ (CIS) has its own designation in the system (Tis), because it has all the histologic characteristics of cancer except invasion, which is a primary feature of the TNM staging system. T0 is the designation used when there is no evidence of a primary tumor. TX is the designation used for tumors that cannot be found or measured. T1-4 is the designation used for tumors that ascend in degrees and increase in size. Text Reference - p. 254
A patient has an obstruction of the superior vena cava as shown in the following figure. What could be the cause of this complication? A. The presence of a malignant tumor in the epidural space B. An obstruction of the superior vena cava by a tumor C. A shift of fluid from the vascular space to the interstitial space D. The release of intracellular components into the bloodstream
B. The image shows that the patient has swelling in the face and neck along with impaired circulation, which indicates an obstruction of the superior vena cava caused by a tumor. The presence of a malignant tumor in the epidural space results in spinal cord compression. Therefore, the patient will have vertebral tenderness and intense back pain. Third space syndrome is an obstructive emergency associated with a shift of fluid from the vascular space to the interstitial space. Tumor lysis syndrome is a metabolic complication associated with the rapid release of intracellular components into the bloodstream after chemotherapy. Text Reference - p. 277
What can the nurse do to facilitate cancer prevention for the patient in the promotion stage of cancer development? A. Teach the patient to exercise daily. B. Teach the patient promoting factors to avoid. C. Tell the patient to have the cancer surgically removed now. D. Teach the patient which vitamins will improve the immune system.
B. The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. 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.
What can the nurse do to facilitate cancer prevention for the patient in the promotion stage of cancer development? A. Teach the patient to exercise daily B. Teach the patient promoting factors to avoid C. Tell the patient to have the cancer surgically removed now D. Teach the patient which vitamins will improve the immune system
B. The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. 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. Text Reference - p. 251
The registered nurse is teaching a student nurse about the precautionary measures that should be maintained to reduce the risk of cancer. Which statement made by the student nurse indicates the need for further teaching? A. "Include regular exercise regime in your lifestyle." B. "Include food items containing saturated fat in your diet." C. "Undergo regular screening tests for cancer including self-examination." D. "Avoid exposure to cancer-promoting agents, such as cigarette smoking."
B. The student nurse's statement about including food items containing fat into the diet indicates the need for further teaching. Saturated foods should not be consumed because tumor cells multiply using these low-density lipoproteins (LDLs). Regular exercise will help to maintain proper weight and relieve symptoms of stress. It is important to undergo regular screening tests for breast, colon, cervical, and prostate cancer as recommended by the American Cancer Society. This should be done to identify the presence of cancer in its initial stage. Avoiding exposure to cancer-promoting agents, such as cigarette smoke, will reduce the chances of initiating cancer because cigarette smoke is a carcinogen, capable of promoting cancer. Text Reference - p. 255
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: A. Carcinogens B. Tumor markers C. Malignant viruses D. Neoplastic oncogenes
B. 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. Text Reference - p. 253
The medical records of a patient indicate a chondrosarcoma. What does the nurse interpret from this finding? A. The patient has a malignant tumor in bone. B. The patient has a benign tumor in nerve cells. C. The patient has a malignant tumor in cartilage. D. The patient has a benign tumor in striated muscle
C. A chondrosarcoma is a malignant tumor in cartilage. A malignant tumor in bone is an osteosarcoma. A benign tumor in the nerve cells is called a ganglioneuroma. A benign tumor in the striated muscle is called a rhabdomyoma. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers. Text Reference - p. 254
While assessing a patient with breast cancer, the nurse finds that the patient has tender vertebrae and intense back pain, which gets worse when the Valsalva maneuver is applied. Which complication does the nurse expect in the patient? A. Third space syndrome B. Tumor lysis syndrome C. Spinal cord compression D. Superior vena cava syndrome
C. A patient with breast cancer who has tender vertebrae and intense back pain that gets worse when the Valsalva maneuver is applied probably has spinal cord compression. Third space syndrome is an obstructive emergency that manifests as low central venous pressure, hypovolemia and tachycardia. Tumor lysis syndrome is a metabolic complication associated with cell destruction after chemotherapy, resulting in hyperuricemia. Superior vena cava syndrome is an obstructive complication associated with thrombosis that manifests with facial and periorbital edema. Text Reference - p. 277
A 64-year-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to this patient's plan of care? A. Weigh the patient every month to monitor for weight loss. B. Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. C. Provide high-protein and high-calorie, soft foods every 2 hours. D. Apply palifermin (Kepivance) liberally to the affected oral mucosa.
C. A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Palifermin is administered intravenously as a growth factor to stimulate cells on the surface layer of the mouth to grow. Patients should be weighed at least twice each week to monitor for weight loss.
A nurse is learning about the different types of cancers. Which cancer has the highest incidence among men? A. Lung cancer B. Colon cancer C. Prostate cancer D. Thyroid cancer
C. 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. Text Reference - p. 248
Which is the most important parameter to help develop an effective pain management plan for a patient with cancer pain? A. Assessing the vital signs B. Assessing the sleep cycle C. Assessing the type of pain D. Assessing the patient behavior
C. Assessing the type of pain (whether it is visceral, neuropathic or bone) will help a nurse devise an effective pain management plan. Vital signs, sleep cycles and patient behavior do not provide reliable data about the pain and its progression. Text Reference - p. 279
The patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? A. Use Dial soap to feel clean and fresh. B. Scented lotion can be used on the area. C. Avoid heat and cold to the treatment area. D. Wear the new bra to comfort and support the area.
C. Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.
The patient with breast cancer is having teletherapy radiation treatments after surgery. What should the nurse teach the patient about the care of the skin? A. Use Dial soap to feel clean and fresh B. Scented lotion can be used on the area C. Avoid heat and cold to the treatment area D. Wear the new bra to comfort and support the area
C. Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing, such as a bra, over the treatment field and will want to expose the area to air as often as possible. Text Reference - p. 269
A patient diagnosed with benign lipoma is concerned about the tumor spreading to other parts of the body. Which facts should the nurse include when teaching the patient about benign tumors? A. Benign tumors are poorly differentiated. B. Benign tumors have high recurrence rate. C. Benign tumors are not capable of metastasis. D. Benign tumors have moderate vascularity.
C. Benign tumors are not metastatic and not capable of spreading from one organ to another. Benign tumors are normally differentiated, have low vascularity, and their recurrence is rare. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response. Text Reference - p. 253
The patient is told that the adenoma tumor is not encapsulated but has normally differentiated cells and that surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? A. It will recur. B. It has metastasized. C. It is probably benign. D. It is probably malignant.
C. Benign tumors usually are encapsulated and have normally differentiated cells. They do not metastasize and rarely recur as malignant tumors do.
Which cellular dysfunction in the process of cancer development allows defective cell proliferation? A. Proto-oncogenes B. Cell differentiation C. Dynamic equilibrium D. Activation of oncogenes
C. 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 proto-oncogenes 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? A. "When your hair grows back it will be patchy." B. "Don't use your curling iron and that will slow down the loss." C. "You can get a wig now to match your hair so you will not look different." D. "You should contact "Look Good, Feel Better" to figure out what to do about this."
C. Hair loss with radiation is usually permanent. The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. 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.
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? A. "When your hair grows back it will be patchy." B. "Don't use your curling iron and that will slow down the loss." C. "You can get a wig now to match your hair so you will not look different." D. "You should contact 'Look Good, Feel Better' to figure out what to do about this.
C. 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. Text Reference - p. 266
The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? A. It is delivered via an Ommaya reservoir and extension catheter. B. It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. C. A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration. D. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.
C. Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump.
A 33-year-old patient has recently been diagnosed with stage II cervical cancer. What should the nurse understand about the patient's cancer? A. It is in situ. B. It has metastasized. C. It has spread locally. D. It has spread extensively.
C. 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. Stage IV denotes metastasis.
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? A. Spinal cord compression B. Third space syndrome C. Superior vena cava syndrome D. Tumor lysis syndrome
C. 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. Text Reference - p. 277
The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency? A. Hypokalemia B. Hypouricemia C. Hypocalcemia D. Hypophosphatemia
C. TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.
The oncologist has told the patient that he or she has a benign tumor in the liver. The patient asks the nurse, "What is the main difference between benign and malignant tumors?" Which answer by the nurse is correct? A. "Malignant tumors usually are encapsulated." B. "Malignant tumors have a rare recurrence rate." C. "Benign tumors do not invade and spread to other organs." D. "Malignant tumors require less nutrients for their cells than benign tumors."
C. The ability of malignant tumor cells to invade and metastasize is the major difference between benign and malignant neoplasms. Benign tumors usually are encapsulated; metastasis is absent, and recurrence is rare. Malignant tumors rarely are encapsulated, are capable of metastasis, and are capable of recurring. Text Reference - p. 253
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? A. "I will need to use effective birth control methods for the rest of my life." B. "My doctor will stop the chemotherapy if nausea and vomiting occur during treatment." C. "I will join a support group after my therapy is finished to help me get back on my feet." D. "I probably won't be able to do anything I used to do anymore now that I have cancer."
C. 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. Text Reference - p. 61
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? A. Wear fabrics such as wool and corduroy to prevent exposure to cold. B. Use perfumes and cosmetics on the treatment area as desired. C. Gently cleanse the skin using a mild soap, tepid water, and a soft cloth. D. Allow brief periods of direct exposure to sunlight for good bone health.
C. 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, because they can traumatize the skin. Chemicals like perfumes, cosmetics, and powders should not be used on the treatment area, because 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. Text Reference - p. 270
What is the most common cause of superior vena cava syndrome? A. Ovary cancer B. Renal cancer C. Breast cancer D. Gastrointestinal cancer
C. The superior vena cava is close to the breast and chest cavity. Thus, superior vena cava syndrome is most common in patients with breast cancer Text Reference - p. 277
The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg and it is getting worse. What assessment question should the nurse ask the patient to determine treatment measures for this patient's pain? A. "Where is the pain?" B. "Is the pain getting worse?" C. "What does the pain feel like?" D. "Do you use medications to relieve the pain?"
C. The unlicensed assistive personnel (UAP) told the nurse the location of the patient's pain and the worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.
The nurse is reviewing the laboratory reports of a patient diagnosed with cancer and finds that the patient has neutropenia. On examination, the nurse finds that the patient has a body temperature of 100.4° F (38° C). What is the priority nursing intervention in this situation? A. Administering parenteral fluids B. Administering aspirin to the patient C. Administering pamidronate to the patient D. Notifying the primary health care provider
D. A patient with cancer who has neutropenia (low white blood cell count) is vulnerable to infection. A body temperature of 100.4° F (38° C) indicates hyperthermia. The nurse should immediately notify the primary health care provider in this situation. Hydration therapy with parenteral fluids will treat hypocalcaemia, which is a complication of cancer and may cause nephrocalcinosis. Aspirin can reduce hyperthermia; however, it is not preferable for a patient with a low white blood cell count. Pamidronate is a bisphosphonate that inhibits serum calcium levels and help to treat hypercalcemia effectively. Test-Taking Tip: Neutropenia is low count of white blood cell; you need to what type complications are associated with low WBC. Text Reference - p. 277
Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? A. Firm-bristle toothbrush B. Hydrogen peroxide rinse C. Alcohol-based mouthwash D. 1 tsp salt in 1 L water mouth rinse
D. A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, a side effect of chemotherapy. A soft-bristle toothbrush should be used. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue. Text Reference - p. 268
Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? A. Firm-bristle toothbrush B. Hydrogen peroxide rinse C. Alcohol-based mouthwash D. 1 tsp salt in 1 L water mouth rinse
D. A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy. A soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.
The patient is receiving 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? A. Morphine sulfate B. Ibuprofen (Advil) C. Ondansetron (Zofran) D. Acetaminophen (Tylenol)
D. Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic, but not used first to combat flu-like symptoms of headache, fever, chills, myalgias, etc.
A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? A. Bacteria B. Sun exposure C. Most chemicals D. Epstein-Barr virus
D. Burkitt's lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. Bacteria do not initiate cancer. Sun exposure causes cell alterations leading to melanoma and squamous and basal cell skin carcinoma. Long-term exposure to certain chemicals (e.g., ethylene oxide, chloroform, benzene) is known to initiate cancer.
Which technique does the surgeon use to improve tissue localization during biopsy? A. Craniotomy B. Thoracotomy C. Sigmoidoscopy D. Computed tomography
D. Computed tomography is a diagnostic procedure that can be performed in combination with biopsy to improve tissue localization; this technique helps to visualize the tumor. Craniotomy and thoracotomy are surgical procedures that are performed when the tumor is not easily accessible. Sigmoidoscopy is an endoscopic examination, which is useful to diagnose cancer, but it does not help in tumor localization. Text Reference - p. 256
A patient who is undergoing a diagnostic workup for cancer expresses anxiety about the results. Which is the best nursing response? A. "It is probably nothing." B. "Let's discuss that later." C. "Everyone feels that way." D. "Let's talk about your concerns."
D. 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. Text Reference - p. 255
The nurse is caring for an 18-year-old female patient with acute lymphocytic leukemia who is scheduled to receive hematopoietic stem cell transplantation (HSCT). Which statement, if made by the patient, indicates a correct understanding of the procedure? A. "After the transplant I will feel better and can go home in 5 to 7 days." B. "I understand the transplant procedure has no dangerous side effects." C. "My brother will be a 100% match for the cells used during the transplant." D. "Before the transplant I will have chemotherapy and possibly full body radiation."
D. Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.
When caring for the patient with cancer, what does the nurse understand as the response of the immune system to antigens of the malignant cells? A. Metastasis B. Tumor angiogenesis C. Immunologic escape D. Immunologic surveillance
D. 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.
The medical records of a patient indicate stage IV malignant cancer. What would be the anatomic extent of the disease? A. Cancer is in situ B. Tumor growth is localized C. Spread of cancer cells is limited D. Cells have undergone metastasis
D. In a patient with stage IV malignant cancer, the cells have undergone metastasis. Cancer in situ indicates stage 0 malignancy. The limited spread of cancer cells indicates stage II malignancy. Localized growth of the tumor indicates stage III malignancy. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 254
A 70-year-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? A. Weight gain of 2 lb B. Urine specific gravity of 1.015 C. Blood urea nitrogen of 20 mg/dL D. Serum sodium level of 118 mEq/L
D. Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. A weight gain may be due to fluid retention. The urine specific gravity and blood urea nitrogen are normal.
Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D. Risk for infection
D. Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.
The nurse is with a patient who appears anxious while waiting for a biopsy for cancer detection. Which statement made by the nurse will help calm this patient down and achieve accurate test results? A. "We will talk about the pain during the biopsy procedure." B. "It's nothing new; every person detected with cancer feels this way." C. "I know you are anxious but it is nothing new, you are just over thinking it." D. "You may have pain during the procedure, but you will receive treatment for it."
D. Reassuring and informing the patient that he or she will have pain during the procedure that will be treated will help reduce the patient's anxiety and ensure accurate test results. The patient is anxious that he or she may have cancer so the nurse should focus on helping the patient. Redirecting the conversation by saying "We will discuss later" will discourage open communication. Providing false reassurance by saying, "These effects are common and everyone has the same effect" will discourage communication and make the patient feel neglected. Generalizing the patient's concern by saying that it's nothing new and everyone feels same will also reduce effective communication. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 255
The patient has been diagnosed with non-small cell lung cancer. Which type of targeted therapy will most likely be used for this patient to suppress cell proliferation and promote programmed tumor cell death? A. Proteasome inhibitors B. BCR-ABL tyrosine kinase inhibitors C. CD20 monoclonal antibodies (MoAb) D. Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TK)
D. 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 GI stromal tumors. CD20 monoclonal antibodies (MoAb) bind with CD20 antigen causing cytotoxicity in non-Hodgkin's lymphoma and chronic lymphocytic leukemia.
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? A. Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.
D. The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.
The nurse is caring for a 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? A. Increase intake of liquids at mealtime to stimulate the appetite. B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.
D. 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. Text Reference - p. 276
The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? A. The medications the patient is taking B. The nutritional supplements that will help the patient C. How much time is needed to provide the patient's care D. The time the nurse spends at what distance from the patient
D. 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.
The nurse is assisting a patient with stage IV lung cancer who is stressed. Which statement by the nurse would help this patient feel better? A. "Lung cancers are easily treatable." B. "Anyone diagnosed with cancer feels the way you do." C. "Let's discuss this when you have your family with you." D. "This must be very difficult for you, let me know if I can be of any help."
D. The statement, "This must be very difficult for you," would be appropriate for communicating with the patient. This statement doesn't provide a false assurance and helps the patient to share his or her feelings. The statement, "lung cancers are easily treatable," will provide a false assurance. The statement, "Let's discuss this when you have your family with you," redirects the discussion. The statement, "Anyone diagnosed with cancer feels the way you do" is a generalized statement. These statements are self-protective strategies which deny the patient's opportunity to share the meaning of their experience. Text Reference - p. 255
