MS2 - Exam 4 - Cancer Questions Flashcards
The nurse receives an order for a patient with lung cancer to receive influenza vaccine and pneumococcal vaccines. The nurse will
a. call the health care provider to question the order.
b. administer both vaccines at the same time in different arms.
c. administer the flu shot and tell the patient to come back 1 week later to receive the pneumococcal vaccine.
d. administer the pneumococcal vaccine and suggest FluMist (nasal vaccine) instead of the influenza injection.
b. administer both vaccines at the same time in different arms.
Rationale: Patients at risk for pneumonia (e.g., patients with lung cancer) should obtain influenza and pneumococcal vaccines. The vaccines may be administered at the same time in different arms.
During admission of a patient diagnosed with non–small cell lung carcinoma, the nurse questions the patient related to a history of which risk factors for this type of cancer (select all that apply)?
a. Asbestos exposure
b. Exposure to uranium
c. Chronic interstitial fibrosis
d. History of cigarette smoking
e. Geographic area in which he was born
a. Asbestos exposure
b. Exposure to uranium
d. History of cigarette smoking
Non–small cell carcinoma is associated with cigarette smoking and exposure to environmental carcinogens, including asbestos and uranium. Chronic interstitial fibrosis is associated with the development of adenocarcinoma of the lung. Exposure to cancer-causing substances in the geographic area where the patient has lived for some time may be a risk, but not necessarily where the patient was born.
When planning appropriate nursing interventions for a patient with metastatic lung cancer and a 60-pack-per-year history of cigarette smoking, the nurse recognizes that the smoking has most likely decreased the patient’s underlying respiratory defenses because of impairment of
a. cough reflex.
b. mucociliary clearance.
c. reflex bronchoconstriction.
d. ability to filter particles from the air.
b. mucociliary clearance.
Smoking decreases the ciliary action in the tracheobronchial tree, resulting in impaired clearance of respiratory secretions and particles, chronic cough, and frequent respiratory infections.
While ambulating a patient with metastatic lung cancer, the nurse observes a drop in oxygen saturation from 93% to 86%. Which nursing intervention is most appropriate based upon these findings?
a. Continue with ambulation since this is a normal response to activity.
b. Obtain a physician’s order for arterial blood gas determinations to verify the oxygen saturation.
c. Obtain a physician’s order for supplemental oxygen to be used during ambulation and other activity.
d. Move the oximetry probe from the finger to the earlobe for more accurate monitoring during activity.
c. Obtain a physician’s order for supplemental oxygen to be used during ambulation and other activity.
An oxygen saturation level that drops below 90% with activity indicates that the patient is not tolerating the exercise and needs to use supplemental oxygen. The patient will need to rest to resaturate. ABGs or moving the probe will not be needed as the pulse oximeter was working at the beginning of the walk.
Trends in the incidence and death rates of cancer include the fact that
a. lung cancer is the most common type of cancer in men.
b. a higher percentage of women than men have lung cancer.
c. breast cancer is the leading cause of cancer deaths in women.
d. African Americans have a higher death rate from cancer than whites.
d. African Americans have a higher death rate from cancer than whites.
Rationale: Cancer incidence and death rates are disproportionately higher among African Americans than among other minority groups and white people.
What features of cancer cells distinguish them from normal cells (select all that apply)?
a. Cells lack contact inhibition.
b. Cells return to a previous undifferentiated state.
c. Oncogenes maintain normal cell expression.
d. Proliferation occurs when there is a need for more cells.
e. New proteins characteristic of embryonic stage emerge on cell membrane.
a. Cells lack contact inhibition.
b. Cells return to a previous undifferentiated state.
e. New proteins characteristic of embryonic stage emerge on cell membrane.
Rationale: Two major dysfunctions in the process of cancer are defective cell proliferation (i.e., growth) and defective cell differentiation. Cancer cells lack contact inhibition and are poorly differentiated. Cancer cell growth is infiltrative and expansive, and cancer cells are abnormal and become more unlike parent cells.
A characteristic of the stage of progression in the development of cancer is
a. oncogenic viral transformation of target cells.
b. a reversible steady growth facilitated by carcinogens.
c. a period of latency before clinical detection of cancer.
d. proliferation of cancer cells in spite of host control mechanisms.
d. proliferation of cancer cells in spite of host control mechanisms.
Rationale: Progression is the final stage of cancer. This stage is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (i.e., metastasis). Progression occurs as a result of the following characteristics of cancer cells: rapid proliferation and decreased cell adhesion.
The primary protective role of the immune system related to malignant cells is
a. surveillance for cells with tumor-associated antigens.
b. binding with free antigen released by malignant cells.
c. production of blocking factors that immobilize cancer cells.
d. responding to a new set of antigenic determinants on cancer cells.
a. surveillance for cells with tumor-associated antigens.
Rationale: Cancer cells may display altered cell surface antigens as a result of malignant transformation. These antigens are called tumor-associated antigens (TAAs). One of the functions of the immune system is to respond to TAAs.
The primary difference between benign and malignant neoplasms is the
a. rate of cell proliferation.
b. site of malignant tumor.
c. requirements for cell nutrients.
d. characteristic of tissue invasiveness.
d. characteristic of tissue invasiveness.
Rationale: The ability of malignant cells to invade and metastasize is the major difference between benign and malignant neoplasms. Other differences between benign and malignant neoplasms are presented in Table 16-3.
The nurse is caring for a 59-year-old woman who had surgery 1 day ago for removal of a suspected malignant abdominal mass.
The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to
a. motivate change in an unhealthy lifestyle.
b. teach her about the seven warning signs of cancer.
c. instruct her about healthy stress relief and coping practices.
d. allow her to communicate about the meaning of this experience.
d. allow her to communicate about the meaning of this experience.
Rationale: While the patient is waiting for diagnostic study results, you should be available to actively listen to the patient’s concerns, and you should be skilled in techniques that can engage the patient and the family members or significant others in a discussion about their cancer-related fears.
The goals of cancer treatment are based on the principle that
a. surgery is the single most effective treatment for cancer.
b. initial treatment is always directed toward cure of the cancer.
c. a combination of treatment modalities is effective for controlling many cancers.
d. although cancer cure is rare, quality of life can be increased with treatment modalities.
c. a combination of treatment modalities is effective for controlling many cancers.
Rationale: The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the particular cancer being treated and may involve local therapies (i.e., surgery or irradiation) alone or in combination, with or without periods of adjunctive systemic therapy (i.e., chemotherapy).
The most effective method of administering a chemotherapy agent that is a vesicant is to
a. give it orally.
b. give it intraarterially.
c. use an Ommaya reservoir.
d. use a central venous access device.
d. use a central venous access device.
Rationale: If vesicants are inadvertently infiltrated into the skin, severe local tissue breakdown and necrosis may result. It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs. The infusion should be immediately turned off, and protocols for drug-specific extravasation procedures should be followed to minimize further tissue damage. Infusion with central venous access devices can reduce the risk of infiltration of chemotherapy agents that are vesicants.
The nurse explains to a patient undergoing brachytherapy of the cervix that she
a. must undergo simulation to locate the treatment area.
b. requires the use of radioactive precautions during nursing care.
c. may experience desquamation of the skin on the abdomen and upper legs.
d. requires shielding of the ovaries during treatment to prevent ovarian damage.
b. requires the use of radioactive precautions during nursing care.
Rationale: Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or adjacent to the tumor. Caring for the person undergoing brachytherapy or receiving radiopharmaceuticals requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, and shielding are vital to health care professional safety in caring for the person with an internal radiation source.
A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9 × 103/μL, hemoglobin of 10.8 g/dL, and a platelet count of 99 × 103/μL. Based on the CBC results, what is the most serious clinical finding?
a. Cough, rhinitis, and sore throat
b. Fatigue, nausea, and skin redness at site of radiation
c. Temperature of 101.9° F, fatigue, and shortness of breath
d. Skin redness at site of radiation, headache, and constipation
c. Temperature of 101.9° F, fatigue, and shortness of breath
Rationale: Neutropenia is more common in patients receiving chemotherapy than in those receiving radiation, and it can seriously increase the risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly because fever in the setting of neutropenia is a medical emergency.
To prevent fever and shivering during an infusion of rituximab (Rituxan), the nurse should premedicate the patient with
a. aspirin.
b. acetaminophen.
c. sodium bicarbonate.
d. meperidine (Demerol).
b. acetaminophen.
Rationale: Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is commonly premedicated with acetaminophen in an attempt to prevent or decrease the intensity of these symptoms, and large amounts of fluids help decrease symptoms.
The nurse counsels the patient receiving radiation therapy or chemotherapy that
a. effective birth control methods should be used for the rest of the patient’s life.
b. if nausea and vomiting occur during treatment, the treatment plan will be modified.
c. after successful treatment, a return to the person’s previous functional level can be expected.
d. the cycle of fatigue-depression-fatigue that may occur during treatment can be reduced by restricting activity.
c. after successful treatment, a return to the person’s previous functional level can be expected.
Rationale: Some cancer survivors may continue to experience symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. A cancer diagnosis can affect many aspects of a patients’ life; cancer survivors commonly report financial, vocational, marital, and emotional concerns long after treatment is over. Resources for survivors are listed in Table 16-20.
A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing intervention would be a priority?
a. Advise the patient to eat foods that are fatty, fried, or high in calories.
b. Discuss with the physician the need for parenteral or enteral feedings.
c. Advise the patient to drink a nutritional supplement beverage at least three times a day.
d. Advise the patient to experiment with spices and seasonings to enhance the flavor of food.
d. Advise the patient to experiment with spices and seasonings to enhance the flavor of food.
Rationale: Instruct the patient to experiment with spices and other seasoning agents in an attempt to mask taste alterations. Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste of certain meats and fish. Bacon bits, onion, and pieces of ham may enhance the taste of vegetables.
A 70-year-old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and complains of nausea and constipation. Which complication of cancer is this most likely caused by?
a. Hypercalcemia
b. Tumor lysis syndrome
c. Spinal cord compression
d. Superior vena cava syndrome
a. Hypercalcemia
Rationale: Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or exacerbate hypercalcemia. The primary manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting.
A patient has recently been diagnosed with early stages of breast cancer. What is most appropriate for the nurse to focus on?
a. Maintaining the patient’s hope
b. Preparing a will and advance directives
c. Discussing replacement child care for the patient’s children
d. Discussing the patient’s past experiences with her grandmother’s cancer
a. Maintaining the patient’s hope
Rationale: Maintain hope, which is the key to effective cancer care. Hope depends on the status of the patient: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care.
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. A woman who has a body mass index of 35 kg/m2 and smoked cigarettes for 20 years
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 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. “Before the transplant I will have chemotherapy and possibly full body radiation.”
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.
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. “Have you had a fever?”
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.
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. Provide high-protein and high-calorie, soft foods every 2 hours.
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 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. Serum sodium level of 118 mEq/L
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.
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. Hypocalcemia
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 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. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.
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.
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. 1 tsp salt in 1 L water mouth rinse
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.
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. Risk for infection
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.
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. A bland, low-fiber diet
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 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. It has spread locally.
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.
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
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.
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. Epstein-Barr virus
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.
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. Teach the patient promoting factors to avoid.
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.
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
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 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. It is probably benign.
Benign tumors usually are encapsulated and have normally differentiated cells. They do not metastasize and rarely recur as malignant tumors do.
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. Cells are abnormal and moderately differentiated.
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 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. Maintain hope.
b. Exhibit a caring attitude.
e. Be available to listen to fears and concerns.
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 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. Avoid heat and cold to the treatment area.
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 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. “You can get a wig now to match your hair so you will not look different.”
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 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 (Tylenol)
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.
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. Turn off the chemotherapy infusion.
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.
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. A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration.
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.
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 time the nurse spends at what distance from the patient
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 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. “What does the pain feel like?”
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 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. Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TK)
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.
A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of
a. an intolerance to the feedings.
b. extension of the tumor into the aorta.
c. leakage of fluid or foods into the mediastinum.
d. esophageal perforation with fistula formation into the lung.
c. leakage of fluid or foods into the mediastinum.
Rationale: After esophageal surgery, the nurse should observe the patient for signs of leakage from the feeding tube into the mediastinum. Symptoms that indicate leakage are pain, increased temperature, and dyspnea.
An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about
a. cancer support groups, alopecia, and stomatitis.
b. avitaminosis, ostomy care, and community resources.
c. prosthetic devices, skin conductance, and grief counseling.
d. wound and skin care, nutrition, drugs, and community
resources.
d. wound and skin care, nutrition, drugs, and community
resources.
Rationale: Radiation therapy is used as an adjuvant to surgery or for palliation in treatment of stomach cancer. The nurse’s role is to provide detailed instructions, to reassure the patient, and to ensure completion of the designated number of treatments. The nurse should start by assessing the patient’s knowledge of radiation therapy. The nurse should teach the patient about skin care, the need for nutrition and fluid intake during therapy, and the appropriate use of antiemetic drugs.
A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient?
a. Barium swallow
b. Endoscopic biopsy
c. Capsule endoscopy
d. Endoscopic ultrasonography
b. Endoscopic biopsy
Because of this patient’s history of excessive alcohol intake, smoking, hemoptysis, and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. An endoscopic ultrasonography may be used to stage esophageal cancer. Capsule endoscopy can show alterations in the esophagus but is more often used for small intestine problems. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer when it is suspected.