3962 Cancer – Flashcards
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You are caring for a patient with an advanced stage of breast cancer. The cancer has metastasized. You enter the room and find the patient struggling to breath. You note that this patient's jugular veins are distended. What would you suspect is happening with this patient? 1. Spinal cord compression 2. Superior vena cava syndrome (SVCS) 3. Increased intracranial pressure 4. Metastatic tumor of the neck
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2. Superior vena cava syndrome (SVCS) Superior vena cava syndrome (SVCS) occurs when there is gradual or sudden impaired venous drainage giving rise to progressive shortness of breath (dyspnea), cough, hoarseness, chest pain, and facial swelling; edema of the neck, arms, hands, and thorax and reported sensation of skin tightness and difficulty swallowing; as well as possibly engorged and distended jugular, temporal, and arm veins. Option A is incorrect; increased intracranial pressure may be a part of SVCS, but it is not what is causing the patient's symptoms. Option C is incorrect; the scenario does not mention a problem with the patient's spinal cord. Option D is incorrect; the scenario says that the cancer has metastasized but not that it has metastasized to the neck.
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You are the nurse caring for an 87-year-old Mexican-American female patient who is in end-stage renal disease. The physician has just been in to see the patient and her family to tell them that nothing more can be done for the patient and that death is not far off. The physician offers to discharge the patient home to hospice care. The patient and family refuse. After the physician leaves, the patient's daughter approaches you and asks what hospice care is. What would this lack of knowledge about hospice care be perceived as? 1. Lack of an American education of the patient and her family 2. A barrier to hospice care for this patient 3. A language barrier to hospice care for this patient 4. Inability to grasp American concepts of health care
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2. A barrier to hospice care for this patient Historical mistrust of the health care system and unequal access to even basic medical care may underlie the beliefs and attitudes among ethnically diverse populations. In addition, lack of education or knowledge about end-of-life care treatment options and language barriers influence decisions among many socioeconomically disadvantaged groups. The scenario does not indicate whether the patient's family has an American education, whether they are unable to grasp American concepts of health care, or whether they can speak or understand English. This makes options A, B, and D incorrect.
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While a patient is receiving intravenous doxorubicin hydrochloride, the nurse observes that there is swelling and pain at the IV site. The nurse should 1. apply a warm compress to the site. 2. continue to administer but decrease the rate of infusion. 3. notify the patient's physician. 4. stop the administration of the drug immediately.
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4. stop the administration of the drug immediately. Doxorubicin hydrochloride is a chemotherapeutic vessicant that can cause severe tissue damage. The nurse should stop the administration of the drug immediately and then notify the patient's physician. Ice can be applied to the site once the drug therapy has stopped.
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Your patient has just been told that her illness is terminal. The patient states, "I can't believe I am going to die. Why me?" What is your best response? 1. "You have lived a long life." 2. "This must be very difficult for you." 3. "I know how you are feeling." 4. "Life can be so unfair."
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2. "This must be very difficult for you." The most important intervention the nurse can provide is listening empathetically. To communicate effectively, the nurse should ask open-ended questions and acknowledge the patient's fears. This makes options A, B, and D incorrect.
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The nursing instructor is discussing the difference between normal cells and cancer cells with the prenursing class in pathophysiology. What would the instructor cite as a characteristic of a cancer cell? 1. Nuclei of cancer cells are large and regularly shaped. 2. Malignant cells contain more fibronectin. 3. Chromosomes are commonly found to be strong. 4. The cell membrane of malignant cells also contains proteins called tumor-specific antigens.
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4. The cell membrane of malignant cells also contains proteins called tumor-specific antigens. The cell membranes are altered in cancer cells, which affect fluid movement in and out of the cell. The cell membrane of malignant cells also contains proteins called tumor-specific antigens. Malignant cellular membranes also contain less fibronectin, a cellular cement. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism). Fragility of chromosomes is commonly found when cancer cells are analyzed.
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Much research has been done on the care of the terminally ill. What have these studies shown is a potential deficiency in the care of the dying in hospital settings? 1. Care is poorly planned. 2. Patients often receive unwanted care at the end of life. 3. Patients make poor dietary choices. 4. Patients are oversedated to achieve pain control.
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2. Patients often receive unwanted care at the end of life. Studies have found that deficiencies in the care of dying patients in hospital settings include many patients receiving unwanted care at the end of life, clinicians not being aware of the patient's preference for life-sustaining treatment even though preferences were documented, pain being poorly controlled, and efforts to enhance communication being ineffective. Option B is incorrect; patients are not oversedated to achieve pain control. Option C is incorrect; patients' dietary choices are not a potential deficiency in the care of the dying in hospital settings. Option D is incorrect; care is not poorly planned, it simply does not meet the needs of the dying patient.
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You are the clinic nurse in an oncology clinic. Your patient arrives for a 2-month follow-up appointment following chemotherapy. You note that the patient's skin appears yellow. Which blood tests should be done to further explore this clinical sign? 1. Electrolytes 2. CBC 3. Liver function test 4. Platelet count
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3. Liver function test Surveillance for cancer spread, recurrence, or second cancers: colonoscopy post colon cancer, mammography post breast cancer, Liver function tests post colon cancer, prostate-specific antigen post prostate cancer. Yellow skin is a sign of jaundice. The liver is a common organ affected by metastatic disease. A liver function test should be done to determine if the liver is functioning. Option B is incorrect; a CBC would show an altered white blood cell count indicating possible infection. Option C is incorrect; a platelet count tells whether the blood sample has an adequate number of platelets, necessary for blood clotting. Option D is incorrect; a blood test for electrolytes would not identify the cause of the jaundice.
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The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for engraphment for a bone marrow transplant. What is a priority nursing diagnosis for this patient? 1. Altered nutrition: less than body requirements due to anorexia 2. Body image disturbance related to weight loss and anorexia 3. Risk for infection related to altered immunologic response 4. Fatigue and activity intolerance
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3. Risk for infection related to altered immunologic response A priority nursing diagnosis for this patient is risk for infection related to altered immunologic response. Because the patient's immunity is suppressed, he or she will be at a high risk for infection. Options A, B, and D all are valid nursing diagnoses, but they are not as much of a priority as is risk for infection.
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Your patient has just died. The patient's spouse says, "I knew this was coming, but I feel so numb and hollow inside." You know that these are characteristic of what? 1. The depression stage of dying 2. Complicated grief and mourning 3. Uncomplicated grief and mourning 4. The acceptance stage of dying
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3. Uncomplicated grief and mourning Uncomplicated grief and mourning are characterized by emotional feelings of sadness, anger, guilt, and numbness; physical sensations such as hollowness in the stomach and tightness in the chest, weakness, and lack of energy; cognitions that include preoccupation with the loss and a sense of the deceased as still present; and behaviors such as crying, visiting places that are reminders of the deceased, social withdrawal, and restless overactivity. Option A is incorrect; complicated grief and mourning occur at a prolonged time after the death. Options C and D are stages of death and dying, not a characteristic of death and dying.
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The nurse is assessing a patient who was diagnosed with metastatic prostate cancer. The nurse notes that the patient is exhibiting signs of loss, grief, and intense sadness. Based upon this assessment data, the nurse will document that the patient is in what stage of death and dying? 1. Depression 2. Anger 3. Acceptance 4. Denial
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1. Depression Loss, grief, and intense sadness indicate depression. Denial is indicated by the refusal to admit the truth or reality. Anger is indicated by rage and resentment. Acceptance is indicated by a gradual, peaceful withdrawal from life.
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Patients receiving internal radiation emit radiation while the implant is in place. 1. True 2. False
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1. True
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Traditionally, nurses have been involved with tertiary prevention with their cancer patients. However, emphasis is also placed on both primary and secondary prevention. What would be an example of primary prevention? 1. Testicular self-examination 2. Screening mammogram 3. Yearly Papanicolaou tests 4. Teaching patients to wear sunscreen
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4. Teaching patients to wear sunscreen Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as use of sunscreen. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Papanicolaou tests, mammograms, and testicular exams.
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The nursing instructor is teaching a class in oncology nursing to her junior nursing students. The instructor is aware that infection is a significant consideration when providing care to an oncology patient. The leading cause of death in an oncology patient is infection caused by what? 1. Broken oral mucosa 2. Malnutrition 3. Poor hygiene 4. Impaired skin integrity
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4. Impaired skin integrity Nursing care for patients with skin reactions includes maintaining skin integrity, cleansing the skin, promoting comfort, reducing pain, preventing additional trauma, and preventing and managing infection. Option A is incorrect; malnutrition in oncology patients may be present, but it is not the leading cause of death. Option C is incorrect; oncology patients do not have poor hygiene at a rate any higher than other patients, and it does not cause death. Option D is incorrect; broken oral mucosa may be an avenue for infection, but it is not the leading cause of death in an oncology patient.
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Palliative care is based on interdisciplinary collaboration. How does interdisciplinary collaboration differ from multidisciplinary practice? 1. It is based on communication and cooperation. 2. It is based on expertise and patient preference. 3. It is based on the participation of clinicians without a team leader. 4. It is based on clinicians of varied backgrounds integrating their separate plans of care.
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1. It is based on communication and cooperation. Interdisciplinary collaboration, which is different from multidisciplinary practice, is based on communication and cooperation among the various disciplines, each member of the team contributing to a single integrated care plan that addresses the needs of the patient and family. Multidisciplinary care refers to participation of clinicians with varied backgrounds and skill sets but without coordination and integration. This makes options A and B incorrect. Option D is incorrect because interdisciplinary collaboration is not based on patient preference.
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You are caring for a patient who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the patient the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? 1. Palliative 2. Reconstructive 3. Prophylactic 4. Salvage
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1. Palliative When cure is not possible, the goals of treatment are to make the patient as comfortable as possible and to promote quality of life as defined by the patient and his or her family. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk to develop cancer.
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The nurse is caring for a patient who has terminal lung cancer and is unconscious. Which assessment would indicate to the nurse that the patient's death is imminent? 1. Shallow breathing 2. Increased swallowing 3. Slow steady pulse 4. Mottling of the lower limbs
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4. Mottling of the lower limbs The time of death is generally preceded by a period of gradual diminishment of bodily functions in which increasing intervals between respirations, weakened and irregular pulse, and skin color changes or mottling may be observed. The patient will not be able to swallow secretions, so suctioning, frequent and gentle mouth care, and, possibly, the administration of a transdermal anticholinergic drug. Therefore options B, C, and D are incorrect.
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You are the hospice nurse caring for a 45-year-old mother of three young children in her home. When you make your visit, you discover that your patient has an altered mental status. Your assessment indicates the patient is delirious. What would your nursing interventions be aimed at? 1. Making arrangements to move the patient to an acute-care facility 2. Teaching family members how to interact with and ensure safety for the patient with delirium 3. Helping the family to understand why the patient needed to be sedated 4. Explaining to the family that death is near and the patient needs around-the-clock nursing care
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2. Teaching family members how to interact with and ensure safety for the patient with delirium Nursing interventions are aimed at identifying the underlying causes of delirium; acknowledging the family's distress over its occurrence; reassuring family members about what is normal; teaching family members how to interact with and ensure safety for the patient with delirium; and monitoring the effects of medications used to treat severe agitation, paranoia, and fear. Options A, B, and C are incorrect; the scenario does not indicate the need to either sedate the patient or move her to an acute-care facility. If the family has the resources, there is no need to bring in nurses to be with the patient around-the-clock, and the scenario does not indicate that death is imminent.
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Characteristics of cancer cells include: (Choose all that apply.) A. Cancer cells promote aniogenesis. B. Cancer cells lack anchorage dependence. C. Cancer cells retain contact inhibition. D. Cancer cells are immortal. E. Cancer cells are well differentiated. F. Cancer cells have proteins called tumor-specific antigens or TSA on their cell membranes.
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A. Cancer cells promote aniogenesis. B. Cancer cells lack anchorage dependence. D. Cancer cells are immortal. F. Cancer cells have proteins called tumor-specific antigens or TSA on their cell membranes.
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You are giving a report in your pathophysiology class. The subject of your report is cancer cells. In differentiating between benign and malignant cells, what characteristics would you cite? Select all that apply. Answers: A. Size of cells B. Cell contents C. Rate of growth D. Ability to spread E. Ability to cause death
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C. Rate of growth D. Ability to spread E. Ability to cause death Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant. Cell contents are essentially similar but their behavior is different.
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The nurse is teaching family members about precautions to take in visiting a client who has neutropenia. Which instructions should the nurse include in the discussion? (Select all that apply.) A. Fresh flowers will help to provide a cheerful environment. B. Fresh fruits and vegetables will help fortify the client's immune system. C. People who have colds or infectious diseases should not visit. D. It is helpful to keep the client's water pitcher full to prevent dehydration. E. Visitors must wash their hands before and after a visit.
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C. People who have colds or infectious diseases should not visit. E. Visitors must wash their hands before and after a visit.
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Research has identified the key processes of mourning. What are they? (Mark all that apply.) 1. Reinvestment 2. Relinquishing old attachments 3. Re-experiencing the relationship 4. Readjustment to adapt to the new world by forgetting the old 5. Anger at the deceased
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1. Reinvestment 2. Relinquishing old attachments 3. Re-experiencing the relationship Six key processes of mourning allow people to accommodate to the loss in a healthy way: 1.Recognition of the loss 2.Reaction to the separation, and experiencing and expressing the pain of the loss 3.Recollection and re-experiencing the deceased, the relationship, and the associated feelings 4.Relinquishing old attachments to the deceased 5.Readjustment to adapt to the new world without forgetting the old 6.Reinvestment
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You are the nurses giving palliative care to a patient with a diagnosis of COPD. What is the goal of palliative care? 1. To help the patient develop a separate plan with each discipline of the health care team 2. To provide physical support for the patient 3. To support aggressive treatment for cure 4. To improve the patient's and family's quality of life
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4. To improve the patient's and family's quality of life The goal of palliative care is to improve the patient's and the family's quality of life. The support should include the patient's physical, emotional, and spiritual well-being. Each discipline should contribute to a single care plan that addresses the needs of the patient and family. Options B, C, and D are incorrect; the goal of palliative care is not aggressive support for curing the patient. Providing physical support for the patient is also not the goal of palliative care. Palliative care does not strive to achieve separate plans of care developed by the patient with each discipline of the health care team.
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The key difference between palliative care and hospice care is that hospice care deals with end of life and preparation for death. 1. False 2. True
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2. True
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The staff educator is giving a class on oncology nursing for a group of nurses new to the unit. What is the most common mechanism of metastasis of cancer cells? 1. Invasion 2. Hematologic spread 3. Lymphatic circulation 4. Angiogenisis
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3. Lymphatic circulation Lymph and blood are key mechanisms by which cancer cells spread. Lymphatic spread (the transport of tumor cells through the lymphatic circulation) is the most common mechanism of metastasis.
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Ethical issues have been raised within hospitals regarding patient care. Ethical committees have been formed to address these numerous ethical issues. As health care professionals, nurses are often members of these ethical committees. What issue has raised the most troubling ethical issues? Answers: 1. The increase in cultural diversity 2. Staffing shortages in health care and questions concerning quality of care 3. The increased cost of health care 4. The ability of technology to prolong life beyond meaningful quality of life
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4. The ability of technology to prolong life beyond meaningful quality of life The application of technology to prolong life has raised several ethical issues. The major question is, Because we can prolong life through increasingly sophisticated technology, does it necessarily follow that we must do so? Technologic advances have prolonged life for many. The ability of technology to prolong life beyond the point that some would consider meaningful has raised some troubling ethical issues. Option A is incorrect; the increase in cultural diversity has not raised ethical issues in health care. Option B is incorrect; the ethical issue here is, how many patients can we provide optimal care for with a less-than-optimal number of staff? This is not the most troubling ethical issue we face. Option C is incorrect; the increased cost of health care is definitely an issue in today's health care arena, but it is not the most troubling ethical issue we face.
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Your patient is receiving carmustine, a chemotherapy agent. A significant side effect of this medication is thrombocytopenia. Which symptom would the nurse assess for in patients at risk for thrombocytopenia? 1. Hot flashes 2. Nose bleed 3. Interrupted sleep pattern 4. Increased weight
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2. Nose bleed Patients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. A priority goal for this patient is to prevent trauma related to decreased platelet count. A soft toothbrush or an electric razor can be used. No invasive procedures should be performed. Patients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight.
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The attitudes of health care clinicians' toward the terminally ill and dying remain the greatest barrier to improving care at the end of life. 1. True 2. False
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1. True
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Adverse effects to chemotherapy are dealt with by patients and their caregivers every day. What would the nurse do to combat the most common adverse effects of chemotherapy? Answers: 1. Administer a tumor antibiotic 2. Administer an antimetabolite 3. Administer an antiemetic 4. Administer an anticoagulant
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3. Administer an antiemetic Antiemetics are used to treat nausea and vomiting, the most common adverse effects of chemotherapy. Antihistamines and certain steroids are also used to treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli.
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You are the clinic nurse caring for a patient who was just told he was cancer free at 5 years after diagnosis. The patient has been told he is a cancer survivor. What is cancer survivorship? 1. The period just after being pronounced cancer-free 5 years after being diagnosed 2. The time during which the patient lives with an active diagnosis of cancer 3. The end of cancer care 4. A phase of cancer care that comes after primary treatment and lasts until cancer recurrence or the end of life
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4. A phase of cancer care that comes after primary treatment and lasts until cancer recurrence or the end of life Cancer survivorship refers to a distinct phase of cancer care that follows primary treatment for cancer and lasts until cancer recurrence or end of life.
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Your patient has a diagnosis of bladder cancer with metastasis. The patient asks you about hospice. Which principle applies to a hospice setting? 1. Death must be accepted. 2. Terminally ill patients should die in the hospital. 3. Each member of the interdisciplinary team develops an individual plan of care for the patient. 4. Symptoms of terminal illness should not be treated.
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1. Death must be accepted. The principles underlying hospice care are as follows: death must be accepted, bereavement care must be provided to family members, and the patient should remain at home as long as possible with support provided. Each member of the interdisciplinary team will contribute to a single integrated care plan that will address the needs of the patient and family. Options B, C, and D are incorrect as they are not principles of hospice care.
