Chapter 16, Lewis Ch16 – cancer – Flashcards
Unlock all answers in this set
Unlock answersquestion
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 of the following abnormalities associated with this oncologic emergency? A) Hypokalemia B) Hypocalcemia C) Hypouricemia D) Hypophosphatemia
answer
B
question
The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which of the following strategies 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.
answer
D
question
tumor lysis syndrome
answer
TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal failure. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.
question
Which of the following items 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
answer
d
question
salt-water mouth rinse and oral care
answer
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.
question
Which of the following nursing diagnoses 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
answer
d
question
Myelosuppression
answer
A condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets. Myelosuppression is a side effect of some cancer treatments. When myelosuppression is severe, it is called myeloablation. Myelosuppression is accompanied by a high risk of infection and sepsis.
question
Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which of the following dietary modifications 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
answer
a
question
Patients experiencing diarrhea secondary to chemotherapy and/or radiation therapy often benefit from a diet:
answer
low in seasonings and roughage. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.
question
A 33-year-old patient has recently been diagnosed with stage II cervical cancer. The nurse would understand that the patient's cancer A) Is in situ. B) Has metastasized. C) Has spread locally. D) Has spread extensively.
answer
C
question
Stage I
answer
initiation, is a mutation in the cell's genetic structure resulting from an inherited mutation, an error that occurs during DNA replication, or following exposure to a chemical, radiation, or viral agent.
question
Stage II
answer
development of cancer, is characterized by the reversible proliferation of the altered cells
question
final stage
answer
characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (metastasis)
question
tumor-associated antigens
answer
Cancer cells may display altered cell surface antigens as a result of malignant transformation. Immunologic surveillance is the response of the immune system to these antigens.
question
immunologic escape
answer
The process by which cancer cells evade the immune system
question
Oncofetal antigens are
answer
a type of tumor antigen that can be used as tumor markers that may be clinically useful to monitor the effect of therapy and indicate tumor recurrence
question
Tumors can be classified according to
answer
anatomic site, histologic grading, and extent of disease (staging)
question
The TNM classification system uses three parameters:
answer
tumor size and invasiveness (T), presence or absence of regional spread to the lymph nodes (N), and metastasis to distant organ sites (M).
question
allogeneic transplantation
answer
stem cells are acquired from a donor who has been determined to be human leukocyte antigen (HLA)-matched to the recipient
question
Syngeneic transplantation
answer
type of allogeneic transplant that involves obtaining stem cells from one identical twin and infusing them into the other.
question
autologous transplantation
answer
patients receive their own stem cells back following myeloablative (destroying bone marrow) chemotherapy
question
Oncologic emergencies
answer
can result from the cancer or cancer treatment. They are classified as obstructive, metabolic, or infiltrative. These commonly include superior vena cava syndrome, spinal cord compression, syndrome of inappropriate antidiuretic hormone secretion, hypercalcemia, tumor lysis syndrome, disseminated intravascular coagulopathy, and cardiac tamponade
question
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 leadince cause of cancer deaths in women d. Aferican Americans havve a higher death rate from cancer than whites
answer
d
question
What cellular 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 cellular expression d. proliferation occurs when there is a need for more cells e. new proteins characteristic of embryonic stage emerge on cell membranes
answer
a,b,e
question
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
answer
d
question
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
answer
a
question
the primary difference between benign and malignant neoplasms is the a. rate of cell proliferation b. site of malignant tumor c. requirements for cellular nutrients d. characteristic of tissue invasiveness
answer
d
question
The nurse is caring for a 59-year-old women who had surgery 1 day ago for removal of a suspected malignant abdominal mass. The patient is awaiting the pathologic 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 unhealthy lifestyles b. educate her about the seven warning signs of cancer c. instruct her about health stress relief and coping practices d. allow her to communicate about the meaning of this experience
answer
d
question
The goals of cancer treatment are based on the principle that surgery 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 moralities is effective for controlling many cancers d. although cancer cure is rare, quality of life can be increased with treatment moralities
answer
c
question
The most effective method of administering a chemotherapeutic 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
answer
d
question
central venous access device chemo treatment
answer
If vesicants are inadvertently infiltrated into the skin, it may cause severe local tissue breakdown and necrosis. 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. Central venous access can reduce the risk of infiltration of chemotherapeutic agents that are vesicants.
question
The nurse explains to a patient undergoing brachytherapy of the cervix that she a. must undergo simulation to locate the treatment area b. requires that 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
answer
b
question
Brachytherapy
answer
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 when caring for the person with an internal radiation source.
question
A patient on chmotherapy and radiation for head and neck cancer has a WBC count of 1.9x10^3/microL, hemoglobin of 10.8 g/dL, and a platelet count of 99x10^3. Based on the CBC results, which of the following 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, HA, and constipation
answer
c
question
Neutropenia
answer
is most common in patients receiving chemotherapy and can place them at serious 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.
question
During the initial dose of rituximab (Rituxan), the patient starts to complain of feeling cold with the subsequent development of shivering. The first course of action the nurse should take is to a. administer one ampule of sodium bicarbonate b. cover the patient with a blanket and offer a war beverage c. stop the infusion of rituximab and administer normal saline d. place emergency medication and equipment by the patient's infusion chair
answer
c
question
Common side effects of rituximab include
answer
constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, photosensitivity, anorexia, and nausea.
question
Acetaminophen administered
answer
every 4 hours, as prescribed, often reduces the severity of the flu-like syndrome. 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 to decrease symptoms.
question
The nurse counsels the patient receiving radiation therapy or chemotherapy that a. effective birth control methods shold be used for the rest of the patient's life b. if N/V occur during treatment, the treatment plan will be modified c. following successful treatment, a return to the person's previous function level can be expected d. the cycle of fatigue-depression-fatigue that may occur during treatment can be reduced by restricting activity
answer
c
question
A patient on chemotherapy for 10 weeks started at a wight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing interventions would be a priority? a. Advise the paient 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 drinking 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
answer
d
question
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
answer
a
question
Hypercalcemia
answer
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.
question
A paient has recently been diagnosed with early stage of breast cancer. Which of the following 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
answer
a
question
D
answer
Trends int he 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 that 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
question
A, B, E
answer
What cellular features of cancer 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 cellular expression D. proliferation occurs when there is a need for more cells E. new proteins characteristic of embryonic stage emerge on cell membrane
question
D
answer
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
question
A
answer
The primary protective roll 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
question
D
answer
The primary difference between benign and malignant neoplasms is the: A. rate of cell proliferation B. site of malignant tumor C. requirements for cellular nutrients D. characteristic of tissue invasiveness
question
D
answer
The nurse is caring for a 59 year old woman who had surgery 1 day ago for the removal of a suspected malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says she is scared to die. The most effective nursing intervention at this point is to use this opportunity to: A. motivate change in unhealthy lifestyles B. educate her about the 7 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
question
C
answer
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
question
D
answer
The most effective method of administering a chemotherapeutic 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
question
B
answer
The nurse explains to a patient undergoing brachytherapy of the cervix that she: A. must undergo stimulation 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
question
C
answer
A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9x10^3/uL, hemoglobin of 10.8g/dL, and a platelet count of 99x10^3/uL. Based on the CBC results, which of the following is the most serious clinical finding? A. cough, rhinitis, and sore throat B. fatigue, nausea, and skin redness at the site of radiation C. temperature of 101.9, fatigue, and shortness of breath D. skin redness at the site of radiation, headache, and constipation
question
C
answer
During the initial dose of rituximab (Rituxan), the patient starts to feel cold with a subsequent development of shivering. The first course of action the nurse should take is to: A. administer one ampule of sodium bicarbonate B. cover the patient with a blanket and offer a warm beverage C. stop the infusion of rituxan and administer normal saline D. place emergency medication and equipment by the patient's infusion chair
question
C
answer
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. following successful treatment, a return to the person's previous functional levels can be expected D. the cycle of fatigue-depression-fatigue may occur during the treatment and can be reduced by restricting activity
question
D
answer
A patient on chemotherapy for 10 weeks started at a weight of 121lb. She now weighs 118lb and has no sense of taste. Which nursing intervention should 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 3 times per day D. advise the patient to experiment with spices and seasonings to enhance the flavor of food
question
A
answer
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
question
A
answer
A patient has recently been diagnosed with early stage breast cancer. Which if the following is most appropriate for the nurse to focus on? A. maintaining the patient's hope B. preparing a will and advanced directives C. discussing replacement child care for the patent's children D. discussing the patient's past experiences with her grandmother's cancer
