Chapter 12: Book Qs & Evolve

Question 1

1. Which personal factor is the most common cause of cancer development?

A. Living in a geographic area with poor sanitation B. Having parents who died of cancer C. Eating a high-fat diet D. Advancing age

Answer 1

D

Question 2

2. How do most cytotoxic chemotherapy drugs rid the body of cancer cells?

A. Interfering with cancer cell division B. Preventing cancer cells from receiving needed vitamins C. Enhancing the immune system’s ability to recognize and kill cancer cells D. Forcing cancer cells to undergo reverse transformation to become normal cells

Answer 2

A

Question 3

3. Which chemotherapy drug has the highest potential to induce nausea and vomiting?

A. azacitidine (Vidaza) B. fludarabine (Fludara) C. cyclophosphamide (Cytoxan) D. irinotecan (Camptosar)

Answer 3

C

Question 4

4. Which agents for targeted therapy belong to the epidermal growth factor receptor inhibitor (EGRFI) class of drug? (Select all that apply.)

A. bevacizumab (Avastin) B. cetuximab (Erbitux) C. gefitinib (Iressa) D. imatinib (Gleevec) E. lapatinib (Tykerb) F. rituximab (Rituxan) G. trastuzumab (Herceptin)

Answer 4

B C G

Question 5

5. Which class of chemotherapy drugs exert their effects by preventing the actions needed for proper DNA maintenance so that DNA breakage occurs leading to cancer cell death?

A. Antitumor antibiotics B. Hormone antagonists C. Multikinase inhibitors D. Topoisomerase inhibitors

Answer 5

D

Question 6

6. Which of the following chemotherapy agents listed belong to the alkylating agent class? Select all that apply.

A. azacitidine (Vidaza) 
B. bleomycin (Blenoxane) 
C. busulfan (Busulfex) 
D. cyclophosphamide (Cytoxan) 
E. docetaxel (Taxotere) 
F. irinotecan (Camptosar) 
G. methotrexate (Mexate) 
H. procarbazine (Matulane) 
I. oxaliplatin (Eloxatin) 
J. temozolomide (Temodar)

Answer 6

C D I J

Question 7

7. Which action is most important to prevent nausea and vomiting in the patient prescribed intravenous cytotoxic chemotherapy?

A. Keeping the patient NPO (nothing by mouth) during the time the chemotherapy drugs are infusing B. Administering antiemetic medications before administering chemotherapy C. Ensuring that the chemotherapy is infused over a 4- to 6-hour period D. Assessing the patient’s responses hourly during the infusion period

Answer 7

B

Question 8

8. A patient asks why cancer cell growth is considered “uncontrolled.” What is your best response?

A. “Cancer cells always divide more rapidly than normal cells.” B. “When each cancer cell divides, it usually produces more than two cells.” C. “As you age, your immune system is less active, which allows cancer cells to grow faster.” D. “Cancer cells divide almost continuously, and normal cells divide only when they are needed.”

Answer 8

D

Question 9

9. A patient with breast cancer asks why so many drugs are used together to treat her cancer. What is your best response?

A. “Each drug works against cancer cells in different ways, and using several increases the likelihood that the cancer will be cured.”

B. “By using several drugs together, we can avoid using radiation therapy, which would cause many more permanent side effects.”

C. “Each drug goes to a separate body area. That way, because your cancer has spread to so many areas, all areas with cancer will receive the right drug.”

D. “The doctors are not sure which drug will work best against the cancer type that you have. Using several at the same time improves the chances that one will work.”

Answer 9

A

Question 10

10. You are monitoring a patient receiving IV chemotherapy that was started by a chemotherapy-certified nurse. After 2 hours the patient reports burning and pain at the IV site. Lowering the IV results in an observable brisk blood return. What is your best first action?

A. Stop the drug infusion and run at least 100mL of normal saline into IV access.

B. Notify the chemotherapy-certified nurse who started the infusion.

C. Slow the rate of infusion but continue it because there is a good blood return.

D. Discontinue the infusion, remove the IV, and document the site condition.

Answer 10

D

Question 11

11. A patient receiving tamoxifen (Nolvadex) asks how this therapy helps fight breast cancer. In addition to telling her that the breast cancer cells need estrogen to continue growing, what is your best response?

A. “This agent reduces the availability of estrogen to your cancer cells.”

B. “This agent causes you to secrete testosterone instead of estrogen.”

C. “This agent kills off both the normal estrogen-secreting cells and the cancer cells.”

D. “This agent destroys circulating estrogen and all other female hormones.”

Answer 11

A

Question 12

12. A patient who has just been diagnosed with lymphoma asks why the treatment plan does not include the drug rituximab (Rituxan) about which he has read. What is your best response?

A. “Your immune system is too weak to tolerate Rituxan.”

B. “This drug is experimental and too dangerous for you to take before trying other therapies.”

C. “Your lymphoma cells do not have the protein on which this drug works, so you would not benefit from this therapy.”

D. “You are young and can better tolerate the standard therapies for lymphoma that have been proven effective but have strong side effects.”

Answer 12

C

Question 13

The oncology nurse knows that what cancer treatments actually kill cancer cells?

Chemotherapy

Hormonal therapy

Immunotherapy

Targeted therapy

Answer 13

Chemotherapy

Chemotherapy is the treatment of cancer with chemical agents, which can increase survival time and may cure the disease. The killing effect on cancer cells is related to the ability of chemotherapy to damage DNA and interfere with cell division. These drugs damage both normal cells and cancer cells. The normal cells most affected by these drugs are those that divide rapidly, including skin, hair, intestinal tissues, and blood-forming cells. Hormone manipulation therapy can control the growth of some cancers but usually does not cure the cancer. Immunotherapy or biological response modifiers (BRMs) modify a patient’s biologic responses to tumor cells. The BRMs in current use as cancer therapy are cytokines, which are small protein hormones made by WBCs. Targeted therapy involves a group of drugs for cancer treatment that takes advantage of one or more differences in cancer cell growth or metabolism that either are not present or are less common in normal cells. The therapy, by itself, does not actually kill the cells.

Question 14

How is therapy with biological response modifiers (BRMs) different from targeted therapy?

BRMs are always administered as oral agents, whereas targeted therapies must be administered intravenously to prevent deactivation by the intestinal tract enzymes.

Targeted therapy is effective only for those cancers that are inherited or familial, and BRMs are most effective against cancers that do not run in families.

BRMs can affect the general immune response of anyone who takes the drug, and targeted therapies affect only the cancer cell that has a specific target.

There is no difference between these two therapies. BRMs are just another name for targeted therapy.

Answer 14

BRMs can affect the general immune response of anyone who takes the drug, and targeted therapies affect only the cancer cell that has a specific target.

BRMs induce immune system changes that are fairly general. The targeted therapies work only on cancer cells that express a cellular target for the drug.

Question 15

A patient admitted to rule out cancer asks the nurse what are some of the risk factors for cancer. The nurse knows that what is the most important risk factor for cancer?

Pollution

Genetics

Worksite chemicals

A person’s age

Answer 15

A person’s age

Advancing age is the most important risk factor for cancer. Exposure to carcinogens adds up over a lifetime, and immune protection decreases with age. Cancer is more likely to occur in older people, those whose immune systems are not functioning at optimal levels, and those who have inherited a mutated gene that increases cancer risk. External factors, including environmental exposure, are responsible for about 80% of cancer development. Environmental carcinogens are chemical, physical, or viral agents that cause cancer, but they are not the greatest risk. Personal factors, including immune function, age, and genetic risk, also affect whether a person is likely to develop cancer. Personal factors interact with external factors to affect any person’s risk for cancer, but they also are not the greatest risk factor.

Question 16

The oncology nurse knows that colony-stimulating factors are a type of biological response modifiers (BRMs). For what type of cancer is this therapy contraindicated?

Bone

Brain

Prostate

Leukemia

Answer 16

Leukemia

Colony-stimulating factors may stimulate the growth of leukemia cells and are not given to patients with leukemia. Colony-stimulating factors are used for supportive therapy during cancer treatment. These factors induce more rapid recovery of the bone marrow after chemotherapy. Bone, brain, and prostate cancers do not prevent this treatment from being given.

Question 17

A patient asks the nurse about the difference between cancerous tumors and benign tumors. What statement by the nurse is true?

Cancerous tumors do not migrate.

Benign tumors can become cancers.

Benign tumors grow by expansion.

Cancerous tumors can become benign tumors.

Answer 17

Benign tumors grow by expansion.

Benign tumors grow by expansion rather than by invasion and do not spread. Cancer cells were once normal cells but changed and no longer look, grow, or function normally. Cancerous tumors are abnormal cell growth that serve no useful purpose, are invasive, and without intervention, lead to death. Cancerous tumors do migrate. Benign tumors do not become cancerous. However, precancerous tumors can become malignant. Cancerous tumors do not transform into benign tumors.

Question 18

The nurse is caring for a patient receiving high-dose biologic response mediators (BRMs) therapy. Where should the patient receive this type of cancer treatment?

Cancer care floor unit

Outpatient clinic

Intensive care unit

Emergency department

Answer 18

Intensive care unit

Patients receiving high-dose biological response modifiers (BRMs) therapy should receive care in an intensive care monitoring unit. BRMs modify a patient’s biologic responses to tumor cells. Many BRMs induce symptoms of mild inflammation during and immediately after receiving the drug. These problems are worse when higher doses are given. Cancer care floor units and outpatient clinics would not have the trained support and monitoring capabilities needed to keep these patients safe. Emergency departments are very crowded and often understaffed and are unable to assign special staff to monitor the severe symptoms related to this therapy.

Question 19

A specialized oncology nurse is assessing the learning needs of an oncology patient and family and coordinating the highly complex patient/family education. What cancer therapy side effect can be life threatening and is the most common reason for changing the therapy’s dose or schedule?

Changes in cognitive function

Bone marrow blood cell formation suppression

Dehydration related to nausea/vomiting

Open sores on mucous membranes (mucositis)

Answer 19

Bone marrow blood cell formation suppression

Side effects that suppress bone marrow blood cell formation can be life threatening and are the most common reason for changing the dose or schedule. The suppressive effects on the bone marrow cause anemia, neutropenia, and thrombocytopenia. Less serious but common distressing side effects include nausea, vomiting, hair loss (alopecia), open sores on mucous membranes (mucositis), and changes in cognitive function. Consult a cancer specialty textbook to learn about the extensive teaching needed to prevent complications and manage the numerous side effects of this therapy.

Question 20

A patient with breast cancer asks the oncology nurse why she can’t have the same targeted therapy her friend, who is having great results, is receiving. What is the nurse’s best response?

“Targeted therapy isn’t compatible with your therapy.”

“Your friend’s cancer must be different.”

“Your friend’s cell targets must be stronger.”

“Not all cells have enough of a target for the therapy to work.”

Answer 20

“Not all cells have enough of a target for the therapy to work.”

It is important to remember that targeted therapy drugs will not work unless the cancer cell overexpresses the actual target substance. Not all patients with the same cancer type would benefit from the use of targeted therapy. Each person’s cancer cells must be tested in the laboratory to determine whether or not the cells have enough of a target to be affected by targeted therapy. Targeted therapy is not typically contraindicated with most therapies. Not all cancers of the same type have the right “targets” for targeted therapy, so it cannot be assumed that the patient’s friend has a different type of cancer, or that the friend’s cell targets must be stronger than the patient’s.

Question 21

The nurse is caring for a patient with cancer. The nurse knows that what is the main reason healthy cells change into cancer cells?

Loss of balance between cell division and death

Exposure to carcinogens

Age of the cell

Ability of a cancer cell to move from a primary location to a secondary location

Answer 21

Loss of balance between cell division and death

Although cancer cells were once normal cells, they have undergone genetic changes that result in loss of balance and control over cell division and death. These cells generally have continuous cell division and reenter the cell cycle for mitosis almost as soon as they leave it. They also may divide more quickly than normal cells and do not respond to signals for normal cell death. Carcinogens such as chemicals, physical agents, or viruses are substances or events that can damage normal cell genes and may increase the risk of cancer development. Metastasis occurs when cancer cells move from the primary location by breaking off from the original group and establishing new tumors in remote areas. Tumors that have spread and formed new tumors elsewhere are called metastatic or secondary tumors.

Question 22

The nurse is caring for a patient receiving intravenous therapy (IV). The nurse knows that what is the most important intervention to prevent (IV) extravasation?

Changing the IV tubing according to hospital policy

Using an IV pump

Checking IV flow rate and the infusion site

Documentation

Answer 22

Checking IV flow rate and the infusion site

The most important intervention for extravasation is prevention with frequent assessment. Assess the IV flow rate and infusion site at least every 30 minutes. Check for swelling or redness at the site, which may indicate extravasation. Determine whether a blood return is present. Ask the patient about any pain or burning at the infusion site. Extravasation is a condition in which a chemotherapy drug or vesicant leaks into tissues surrounding the infusion site, causing tissue damage. Changing IV tubing is an intervention to prevent IV infection, not extravasation. Documentation is important if extravasation happens but is not a preventive intervention. Use of an IV pump can sometimes cause an extravasation.

Question 23

A patient receiving hormone manipulation with estrogen for cancer therapy has all of the following side effects. For which one should the prescriber be notified immediately?

Acne and darkening of the skin

Breast swelling and tenderness

Fluid retention with weight gain

Redness, pain, and swelling of the calf

Answer 23

Redness, pain, and swelling of the calf

Hormone manipulation with estrogen increases the risk for deep vein thrombosis, which can be life threatening if emboli break off and go to the lungs or brain.

Question 24

A patient with multiple myeloma asks the nurse, “How does thalidomide (Thalomid) work?” What is the nurse’s best response?

“Thalidomide increases the formation of blood vessels in tumors.”

“With thalidomide, tumor blood vessels are reduced.”

“Thalidomide blocks hormones from enhancing tumor cells.”

“Thalidomide stimulates the immune system cells to attack and destroy cancer cells.”

Answer 24

“With thalidomide, tumor blood vessels are reduced.”

One drug classified as a biological response modifier (BRM) that has a somewhat different action is thalidomide (Thalomid). This drug reduces the formation of blood vessels in tumors. When tumor blood vessels are reduced, the tumor is poorly nourished, and cancer cells die. It does not increase the formation of blood vessels in tumors. Hormone inhibitors inhibit production of specific hormones in the normal hormone-producing organs. Hormone manipulators and not thalidomide block hormones from enhancing tumor cells. Some BRM agents and not thalidomide can stimulate specific immune system cells to attack and destroy cancer cells; other agents block cancer cell access to an essential function or nutrient.

Question 25

The oncology nurse is caring for a cancer patient receiving treatment. The nurse knows that what less-than-normal patient assessment can delay the administration of chemotherapy the morning of a scheduled treatment?

Height and weight

Vital signs

Low white blood cell (WBC) count (neutropenia)

Platelet count of 2000,000/mm3

Answer 25

Low white blood cell (WBC) count (neutropenia)

The side effects of chemotherapy suppress bone marrow blood cell formation like WBCs and are the most common reasons for changing the dose or schedule. The suppressive effects on the bone marrow cause anemia, neutropenia, and thrombocytopenia. It is important to ensure that patient’s WBC count is high enough before administering chemotherapy. The WBC count is usually performed the day before or the morning of the scheduled treatment. Most agencies have their own specific blood value protocols for chemotherapy administering. Checking the patient’s height and weight is important, but less-than-normal results are not something that would delay treatment. The patient’s vital signs are important, but less-than-normal results are not something that would delay treatment. The patient’s platelet count is important, but a less-than-normal result is not something that would delay treatment. Patients with a low platelet count may require the transfusion of platelets or drug therapy.

Question 26

A patient with lung cancer asks the nurse why a brain scan has been scheduled. The nurse’s response should be based on what knowledge?

Brain cancer often metastasizes to the lung.

To rule out any metastasis to the brain

Brain cancer and lung cancer frequently originate simultaneously.

Lung cancer often results from brain cancer.

Answer 26

To rule out any metastasis to the brain

The best response to the patient is that a brain scan could rule out metastasis to the brain. Metastasis occurs when cancer cells move from the primary location by breaking off from the original group and establishing new tumors in remote areas. Tumors that have spread and formed new tumors elsewhere are called metastatic or secondary tumors. Even though the tumor is now in another organ, it is still a cancer from the original altered tissue. For example, when breast cancer spreads to the lung and bone, it is breast cancer in the lung and bone, not lung cancer and not bone cancer. Brain cancer does not often metastasize to the lungs. Brain cancer and lung cancer do not originate simultaneously. Brain cancer does not lead to lung cancer.