Oncology Flashcards

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Terms in this set (457)
The nurse is caring for a patient receiving an initial

C. TLS is a metabolic
dose of chemotherapy to treat a rapidly growing
complication characterized by
metastatic colon cancer. The nurse is aware that this
rapid release of intracellular
patient is at risk for tumor lysis syndrome (TLS) and
components in response to
will monitor the patient closely for which
chemotherapy. This can rapidly
abnormality associated with this oncologic
lead to acute renal injury. The
emergency?
hallmark signs of TLS are
HYPERuricemia,
A. Hypokalemia
HYPERphosphatemia,
B. Hypouricemia
HYPERkalemia, and
C. Hypocalcemia
HYPOcalcemia.
D. Hypophosphatemia
A patient with tumor lysis syndrome is taking

D. Allopurinol is used to allopurinol. Which laboratory value should the
decrease uric acid levels. BUN, nurse monitor to determine the effectiveness of this
Potassium and phosphate medication?
levels are increased in TLS but A. BUN
are not affected by allopurinol B. Serum Phosphate
therapy C. Serum Potassium
D. Uric Acid Levels
Oncology
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The student nurse's teaching has been effective

when they can identify ways to prevent risk for
infection in febrile neutropenia. Select all that apply:
a, b, d
I need to perform good hand hygiene
Rational: Aseptic conditions
I need to maintain protective isolation
should be maintained in the
I should include a diet that includes poultry eggs
case where a patient is at risk
and cheese
for infection. They should not
My family should limit any household constructiona,
eat poultry, eggs and cheese
b, d
as they are considered "high
Rational: Aseptic conditions should be maintained in
risk" foods and can bring with
the case where a patient is at risk for infection. They
them bacteria that is harmful to
should not eat poultry, eggs and cheese as they are
immunosuppressant patients
considered "high risk" foods and can bring with
them bacteria that is harmful to immunosuppressant
patients
A nurse has gone through the teaching about how

b
to prevent infection for a 5 year old cancer patient,
Patients and family should
which response from the mother indicates the need
refrain from receiving live virus
for further teaching?
because the spores can be
Eat a well balanced diet and plenty of fluids
excreted and passed on to the
Patient and family should receive varicella vaccine
patient. The patient should not
Patient and family should receive an inactive
receive a live vaccine because
influenza vaccine
of the risk of contracting the
Patient should be getting sufficient amounts of
disease from the live antigen.
sleep and rest
Oncology
d. DIC is a clinical syndrome Which client would be most at risk for developing
that develops as a disseminated intravascular coagulation (DIC)?
complication of a wide variety
of other disorders, with sepsis a. A 35 year old pregnant client with placenta previa
being the most common cause b. A 42 year old client with a pulmonary embolus
of DIC. Abruption placenta, c. A 60 year old client receiving hemodialysis 3 days
not placenta previa is a a week
condition that can trigger DIC. d. A 78 year old client with septicemia
Pulmonary embolus and
hemodialysis do not trigger
DIC.
a.- ineffective tissue perfusion. A nurse is caring for a 5 year old child with
The most important secondary burns over 40% of the body. The child
consideration with this child is has just been diagnosed with disseminated
to ensure there is adequate intravascular coagulation (DIC). Which is the priority
tissue perfusion. Impaired nursing diagnosis based on the most recent
urinary elimination, risk for condition?
deficient volume, and impaired
physical mobility are accurate a. Ineffective tissue perfusion
nursing diagnoses, but not the Impaired urinary elimination
priority in the acute phase of Risk for deficient fluid volume
DIC. Impaired physical mobility
Test Taking Tip - Use the ABCs
to determine priority. Note the
vascular problem with DIC. This
is a clue that there would be a
perfusion problem, thus
eliminate options B and D.
Eliminate option C because an
actual problem (tissue
perfusion) would be a priority
over a potential problem (risk).
Oncology
Answer: D The nurse is taking care of a patient who is

Rationale: A side effect of preparing to donate stem cells, the nurse knows the
taking neupogen in patient understands the side effects of taking
preparation for a stem cell neupogen before the procedure when they state
"donation" is bone pain due to I may have abdominal pain as a result of taking
the development of new white neupogen for this procedure
blood cells in the bone I will only have to take neupogen for 3 days before
marrow, which can create the procedure
pressure and pain with the There will be a decreased risk of rejection as a
excess of WBCs being created. result of taking neupogen for this procedure
Abdominal pain is not a I may have bone pain as a result of receiving
concern. You need to take neupogen for this procedure
neupogen until your neutrophil
count is high enough for them
to extract. Neupogen does not
decrease the risk for rejection.
Answer: A, C, D A patient recently had a stem cell transplant. The

Rationale: A -> GVHD can nurse knows that immediate action is needed when
cause a rash that start on palms the patient starts showing what signs of graft vs.
& soles of feet and potential host disease? (select all that apply)
spread to the rest of the body a. Rash on palms & soles of feet
B -> Ascites is not a sign of b. Ascites
GVHD c. Jaundice
C -> jaundice is not a sign of d. Nausea & vomiting
GVHD e. Clammy skin
D -> nausea & vomiting is a sign f. Watery eyes
of GVHD
E-> clammy skin is not a sign of
GVHD
F-> Dry eyes are a sign of
GVHD
Oncology
7 year old is admitted 1-week post chemo with signs

A, B, C: These results are of sepsis. Which lab values does the nurse
expected results for a sepsis anticipate? (Select all that apply)
patient. The nurse would Positive blood culture
expect an abnormal platelet WBC count of 3,500
count High Lactic acid level
Platelet count of 175
B. Rationale: TLS causes a build A patient with metastatic breast cancer who
up of uric acid which inundates received chemotherapy treatment 2 days ago
the kidneys causing crystals to presents back to the hospital with flank pain and
form in the renal tubules oliguria. Which acute disorder does the nurse
leading to acute kidney failure suspect the patient has?
which has the symptom so A. Disseminated Intravascular Coagulation
flank pain and oliguria. TLS is B. Tumor lysis syndrome
most likely to occur 48-72 C. Graft vs. Host disease
hours after chemotherapy D. Sepsis
treatment and is most common
in aggressive forms of cancer
A. Rationale: One of the main A. Rationale: One of the main symptoms of tumor
symptoms of tumor lysis lysis syndrome is hyperuricemia (a build up of uric
syndrome is hyperuricemia (a acid). Hypermagnesemia and buffalo hump are not
build up of uric acid). symptoms associated with TLS. TLS is most likely to
Hypermagnesemia and buffalo cause HYPERphosphatemia not
hump are not symptoms HYPOphosphatemia
associated with TLS. TLS is most
likely to cause
HYPERphosphatemia not
HYPOphosphatemia
Oncology
You are the nurse evaluating a patient with

suspected DIC. What assessment findings are
ABD. Shortness of breath and consistent with this diagnosis? (select all that apply)
fruity breath are not signs and A. petechiae
symptoms of DIC or bleeding B. low blood pressure
problems. C. shortness of breath
D. spontaneous bruising
E. fruity breath
Place the sequence of DIC in the correct order

1. ___ A. Widespread clotting occurs within the
microvasculature.
2. ___ B. Damage to endothelial, tissue factors, or
toxins stimulate the clotting cascade
B, D, A, E, C. This is the order
3. ___ C. Clotting factors and platelets are consumed
listed
faster than can be replaced
4. ___ D. Excess thrombin within the circulation
overwhelms naturally occurring anticoagulant
5. ___ E. thrombi and emboli impair tissue perfusion
leading to ischemia, infarction, and necrosis
The role of the nurse working with a stem cell

transplant patient post-op includes (Select all that
A and B
apply):
Rationale: The nurse is not
a. support the patient by helping them identify and
supposed to assure safety at all
answer questions regarding treatment
costs due to the potential for
b. make sure the patient understands and can
complications. Long periods of
consent to treatment
isolation may be necessary
c. relieve anxiety by assuring safety of treatment
post-op to prevent infections.
without complications.
d. encourage family visits as much as possible
Oncology
When teaching a student nurse about stem cell

transplant, the nurse manager knows the teaching is
successful when the student nurse states... (Select
all that apply)
B, C, D a. the transplant can take up to 2 hours
Rationale: Transplants take b. engraftment of stem cells can take up to 14-25
between 30-60 minutes. days
c. acute GVHD can occur within 100 days after the
stem cell transplant
d. chronic GVHD can occur after 100 days from the
stem cell transplant
The nurse is caring for a patient C) Hypocalcemia

receiving an initial dose of
chemotherapy to treat a TLS is a metabolic complication characterized by
rapidly growing metastatic rapid release of intracellular components in
colon cancer. The nurse is response to chemotherapy. This can rapidly lead to
aware that this patient is at risk acute renal injury. The hallmark signs of TLS are
for tumor lysis syndrome (TLS) hyperuricemia, hyperphosphatemia, hyperkalemia,
and will monitor the patient and hypocalcemia.
closely for which abnormality
associated with this oncologic
emergency?
A) Hypokalemia
B) Hypouricemia
C) Hypocalcemia
D) Hypophosphatemia
Oncology
The nurse is caring for a patient D) Add items such as skim milk powder, cheese,
suffering from anorexia honey, or peanut butter to selected foods.
secondary to chemotherapy.
Which strategy would be most The nurse can increase the nutritional density of
appropriate for the nurse to foods by adding items high in protein and/or
use to increase the patient's calories (such as peanut butter, skim milk powder,
nutritional intake? cheese, honey, or brown sugar) to foods the patient
A) Increase intake of liquids at will eat. Increasing fluid intake at mealtime fills the
mealtime to stimulate the stomach with fluid and decreases the desire to eat.
appetite. Small frequent meals are best tolerated.
B) Serve three large meals per Supplements can be helpful.
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.
Which item would be most D) 1 tsp salt in 1 L water mouth rinse

beneficial when providing oral
care to a patient with A salt-water mouth rinse will not cause further
metastatic cancer who is at risk irritation to oral tissue that is fragile because of
for oral tissue injury secondary mucositis, which is a side effect of chemotherapy. A
to chemotherapy? soft-bristle toothbrush will be used. One teaspoon
A) Firm-bristle toothbrush of sodium bicarbonate may be added to the salt-
B) Hydrogen peroxide rinse water solution to decrease odor, alleviate pain, and
C) Alcohol-based mouthwash dissolve mucin. Hydrogen peroxide and alcohol-
D) 1 tsp salt in 1 L water mouth based mouthwash are not used because they would
rinse damage the oral tissue.
Oncology
Which nursing diagnosis is D) Risk for infection

most appropriate for a patient
experiencing Myelosuppression is accompanied by a high risk of
myelosuppression secondary infection and sepsis. Hypothermia, powerlessness,
to chemotherapy for cancer and acute pain are also possible nursing diagnoses
treatment? for patients undergoing chemotherapy, but the
A) Acute pain threat of infection is paramount.
B) Hypothermia
C) Powerlessness
D) Risk for infection
Previous administrations of A) A bland, low-fiber diet

chemotherapy agents to a
cancer patient have resulted in Patients experiencing diarrhea secondary to
diarrhea. Which dietary chemotherapy and/or radiation therapy often
modification should the nurse benefit from a diet low in seasonings and roughage
recommend? before the treatment. Foods should be easy to
A) A bland, low-fiber diet digest and low in fat. Fresh fruits and vegetables are
B) A high-protein, high-calorie high in fiber and should be minimized during
diet treatment. Whole and organic foods do not prevent
C) A diet high in fresh fruits and diarrhea.
vegetables
D) A diet emphasizing whole
and organic foods
Oncology
C) Dynamic equilibrium
Which cellular dysfunction in Dynamic equilibrium is the regulation of

the process of cancer proliferation that usually only occurs to equal cell
development allows defective degeneration or death or when the body has a
cell proliferation? physiologic need for more cells. Cell differentiation
A) Proto-oncogenes is the orderly process that progresses a cell from a
B) Cell differentiation state of immaturity to a state of differentiated
C) Dynamic equilibrium maturity. Mutations that alter the expression of
D) Activation of oncogenes proto-oncogenes can activate them to function as
oncogenes, which are tumor-inducing genes and
alter their differentiation.
A patient has been diagnosed D) Epstein-Barr virus

with Burkitt's lymphoma. In the
initiation stage of cancer, the Burkitt's lymphoma consistently shows evidence of
cells genetic structure is the presence of Epstein-Barr virus in vitro. Bacteria
mutated. Exposure to what may do not initiate cancer. Sun exposure causes cell
have functioned as a alterations leading to melanoma and squamous and
carcinogen for this patient? basal cell skin carcinoma. Long-term exposure to
A) Bacteria certain chemicals (e.g., ethylene oxide, chloroform,
B) Sun exposure benzene) is known to initiate cancer.
C) Most chemicals
D) Epstein-Barr virus
Oncology
What can the nurse do to B) Teach the patient promoting factors to avoid.
facilitate cancer prevention for
the patient in the promotion The promotion stage of cancer is characterized by
stage of cancer development? the reversible proliferation of the altered cells.
A) Teach the patient to exercise Changing the lifestyle to avoid promoting factors
daily. (dietary fat, obesity, cigarette smoking, and alcohol
B) Teach the patient promoting consumption) can reduce the chance of cancer
factors to avoid. development. Daily exercise and vitamins alone will
C) Tell the patient to have the not prevent cancer. Surgery at this stage may not be
cancer surgically removed possible without a critical mass of cells, and this
now. advice would not be the nurse's role.
D) Teach the patient which
vitamins will improve the
immune system.
D) Immunologic surveillance
Immunologic surveillance is the process where

When caring for the patient
lymphocytes check cell surface antigens and detect
with cancer, what does the
and destroy cells with abnormal or altered antigenic
nurse understand as the
determinants to prevent these cells from
response of the immune
developing into clinically detectable tumors.
system to antigens of the
Metastasis is increased growth rate of the tumor,
malignant cells?
increased invasiveness, and spread of the cancer to
A) Metastasis
a distant site in the progression stage of cancer
B) Tumor angiogenesis
development. Tumor angiogenesis is the process of
C) Immunologic escape
blood vessels forming within the tumor itself.
D) Immunologic surveillance
Immunologic escape is the cancer cells' evasion of
immunologic surveillance that allows the cancer
cells to reproduce.
Oncology
The patient is told that the C) It is probably benign.

adenoma tumor is not
encapsulated but has normally Benign tumors usually are encapsulated and have
differentiated cells and that normally differentiated cells. They do not
surgery will be needed. The metastasize and rarely recur as malignant tumors
patient asks the nurse what this do.
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.
The laboratory reports that the A) Cells are abnormal and moderately
cells from the patient's tumor differentiated.
biopsy are Grade II. What
should the nurse know about Grade II cells are more abnormal than Grade I and
this histologic grading? moderately differentiated. Grade I cells differ
A) Cells are abnormal and slightly from normal cells and are well-
moderately differentiated. differentiated. Grade III cells are very abnormal and
B) Cells are very abnormal and poorly differentiated. Grade IV cells are immature,
poorly differentiated. primitive, and undifferentiated; the cell origin is
C) Cells are immature, difficult to determine.
primitive, and undifferentiated.
D) Cells differ slightly from
normal cells and are well-
differentiated.
Oncology
The patient and his family are A) Maintain hope.

upset that the patient is going B) Exhibit a caring attitude.
through procedures to E) Be available to listen to fears and concerns.
diagnose cancer. What nursing
actions should the nurse use Maintaining hope, exhibiting a caring attitude, and
first to facilitate their coping being available to actively listen to fears and
with this situation (select all concerns would be the first nursing interventions to
that apply)? use as well as assessing factors affecting coping
A) Maintain hope. during the diagnostic period. Providing relief from
B) Exhibit a caring attitude. distressing symptoms for the patient and teaching
C) Plan realistic long-term them about the diagnostic procedures would also
goals. be important. Realistic long-term goals and
D) Give them antianxiety teaching about the type of cancer cannot be done
medications. until the cancer is diagnosed. Giving the family
E) Be available to listen to fears antianxiety medications would not be appropriate.
and concerns.
F) Teach them about all the
types of cancer that could be
diagnosed.
The patient with breast cancer C) Avoid heat and cold to the treatment area.
is having teletherapy radiation
treatments after her surgery. Avoiding heat and cold in the treatment area will
What should the nurse teach protect it. Only mild soap and unscented,
the patient about the care of nonmedicated lotions may be used to prevent skin
her skin? damage. The patient will want to avoid wearing
A) Use Dial soap to feel clean tight-fitting clothing such as a bra over the
and fresh. treatment field and will want to expose the area to
B) Scented lotion can be used air as often as possible.
on the area.
C) Avoid heat and cold to the
treatment area.
D) Wear the new bra to
comfort and support the area.
Oncology
The female patient is having C) "You can get a wig now to match your hair so
whole brain radiation for brain you will not look different."
metastasis. She is concerned
about how she will look when Hair loss with radiation is usually permanent. The
she loses her hair. What is the best response by the nurse is to suggest getting a
best response by the nurse to wig before she loses her hair so she will not look or
this patient? feel so different. When hair grows back after
A) "When your hair grows back chemotherapy, it is frequently a different color or
it will be patchy." texture. Avoiding use of electric hair dryers, curlers,
B) "Don't use your curling iron and curling irons may slow the hair loss but will not
and that will slow down the answer the patient's concern. The American Cancer
loss." Society's "Look Good, Feel Better" program will be
C) "You can get a wig now to helpful, but this response is avoiding the patient's
match your hair so you will not immediate concern.
look different."
D) "You should contact "Look
Good, Feel Better" to figure
out what to do about this."
The patient is receiving D) Acetaminophen (Tylenol)

biologic and targeted therapy
for ovarian cancer. What Acetaminophen is administered before therapy and
medication should the nurse every 4 hours to prevent or decrease the intensity
expect to administer before of the severe flu-like symptoms, especially with
therapy to combat the most interferon which is frequently used for ovarian
common side effects of these cancer. Morphine sulfate and ibuprofen will not
medications? decrease flu-like symptoms. Ondansetron is an
A) Morphine sulfate antiemetic, but not used first to combat flu-like
B) Ibuprofen (Advil) symptoms of headache, fever, chills, myalgias, etc.
C) Ondansetron (Zofran)
D) Acetaminophen (Tylenol)
Oncology
B) Turn off the chemotherapy infusion.

The patient is receiving an IV
vesicant chemotherapy drug.
Because extravasation of vesicants may cause
The nurse notices swelling and
severe local tissue breakdown and necrosis, with
redness at the site. What
any sign of extravasation the infusion should first be
should the nurse do first?
stopped. Then the protocol for the drug-specific
A) Ask the patient if the site
extravasation procedures should be followed to
hurts.
minimize further tissue damage. The site of
B) Turn off the chemotherapy
extravasation usually hurts, but it may not. It is more
infusion.
important to stop the infusion immediately. The
C) Call the ordering health
health care provider may be notified by another
care provider.
nurse while the patient's nurse starts the drug-
D) Administer sterile saline to
specific extravasation procedures, which may or
the reddened area.
may not include sterile saline.
Oncology
The patient was told that he C) A Silastic catheter will be percutaneously placed
would have intraperitoneal into the peritoneal cavity for chemotherapy
chemotherapy. He asks the administration.
nurse when the IV will be
started for the chemotherapy. Intraperitoneal chemotherapy is delivered to the
What should the nurse teach peritoneal cavity via a temporary percutaneously
the patient about this type of inserted Silastic catheter and drained from this
chemotherapy delivery? catheter after the dwell time in the peritoneum. The
A) It is delivered via an Ommaya reservoir is used for intraventricular
Ommaya reservoir and chemotherapy. Intravesical bladder chemotherapy
extension catheter. is delivered via a urinary catheter. Intraarterial
B) It is instilled in the bladder chemotherapy is delivered via a surgically placed
via a urinary catheter and catheter that delivers chemotherapy via an external
retained for 1 to 3 hours. or internal infusion pump.
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.
Oncology
The patient is being treated D) The time the nurse spends at what distance from
with brachytherapy for cervical the patient
cancer. What factors must the
nurse be aware of to protect The principles of ALARA (as low as reasonably
herself when caring for this achievable) and time, distance, and shielding are
patient? essential to maintain the nurse's safety when the
A) The medications the patient patient is a source of internal radiation. The patient's
is taking medications, nutritional supplements, and time
B) The nutritional supplements needed to complete care will not protect the nurse
that will help the patient caring for a patient with brachytherapy for cervical
C) How much time is needed cancer.
to provide the patient's care
D) The time the nurse spends at
what distance from the patient
The patient has osteosarcoma C) "What does the pain feel like?"
of the right leg. The unlicensed
assistive personnel (UAP) The unlicensed assistive personnel (UAP) told the
reports that the patient's vital nurse the location of the patient's pain and the
signs are normal, but the worsening of pain (pattern). Asking about the quality
patient says he still has pain in of the pain will help in planning further treatment.
his leg and it is getting worse. The nurse should already know if the patient is using
What assessment question medication to relieve the pain or can check the
should the nurse ask the patient's medication administration record to see if
patient to determine treatment analgesics have been administered. The intensity of
measures for this patient's pain using a pain scale should also be assessed.
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?"
Oncology
The nurse is teaching a B) A woman who has a body mass index of 35

wellness class to a group of kg/m2 and smoked cigarettes for 20 years
women at their workplace. The
nurse knows that which woman Cancer prevention and early detection are
is at highest risk for developing associated with the following behaviors: limited
cancer? alcohol use; regular physical activity; maintaining a
A) A woman who obtains normal body weight; obtaining regular cancer
regular cancer screenings and screenings; avoiding cigarette smoking and other
consumes a high-fiber diet tobacco use; using sunscreen with SPF 15 or higher;
B) A woman who has a body and practicing healthy dietary habits (e.g., reduced
mass index of 35 kg/m2 and fat and increased fruits and vegetables).
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
Oncology
The nurse is caring for an 18- D) "Before the transplant I will have chemotherapy
year-old female patient with and possibly full body radiation."
acute lymphocytic leukemia
who is scheduled to receive Hematopoietic stem cell transplantation (HSCT)
hematopoietic stem cell requires eradication of diseased or cancer cells. This
transplantation (HSCT). Which is accomplished by administering higher-than-usual
statement, if made by the dosages of chemotherapy with or without radiation
patient, indicates a correct therapy. A relative such as a brother would not be a
understanding of the perfect match with human leukocyte antigens; only
procedure? identical twins are an exact match. HSCT is an
A) "After the transplant I will intensive procedure with adverse effects and
feel better and can go home in possible death. HSCT recipients can expect a 2- to
5 to 7 days." 4-week hospitalization after the transplant.
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."
The nurse assesses a 76-year- A) "Have you had a fever?"

old man with chronic myeloid
leukemia receiving nilotinib An adverse effect of nilotinib is neutropenia.
(Tasigna). It is most important Infection is common in neutropenic patients and is
for the nurse to ask which the primary cause of death in cancer patients.
question? Patients should report a temperature of 100.4o F or
A) "Have you had a fever?" higher. Other adverse effects of nilotinib are
B) "Have you lost any weight?" thrombocytopenia, bleeding, nausea, fatigue,
C) "Has diarrhea been a elevated lipase level, fever, rash, pruritus, diarrhea,
problem?" and pneumonia.
D) "Have you noticed any hair
loss?"
Oncology
A 64-year-old male patient C) Provide high-protein and high-calorie, soft foods

who is receiving radiation to every 2 hours.
the head and neck as
treatment for an invasive A patient with stomatitis should have soft,
malignant tumor complains of nonirritating foods offered frequently. The diet
mouth sores and pain. Which should be high in protein and high in calories. Saline
intervention should the nurse or water should be used to cleanse the mouth (not
add to this patient's plan of hydrogen peroxide). Palifermin is administered
care? intravenously as a growth factor to stimulate cells
A) Weigh the patient every on the surface layer of the mouth to grow. Patients
month to monitor for weight should be weighed at least twice each week to
loss. 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.
What features of cancer cells A) Cells lack contact inhibition.

distinguish them from normal B) Cells return to a previous undifferentiated state.
cells (select all that apply)? E) New proteins characteristic of embryonic stage
A) Cells lack contact inhibition. emerge on cell membrane.
B) Cells return to a previous
undifferentiated state. Two major dysfunctions in the process of cancer are
C) Oncogenes maintain normal defective cell proliferation (i.e., growth) and
cell expression. defective cell differentiation. Cancer cells lack
D) Proliferation occurs when contact inhibition and are poorly differentiated.
there is a need for more cells. Cancer cell growth is infiltrative and expansive, and
E) New proteins characteristic cancer cells are abnormal and become more unlike
of embryonic stage emerge on parent cells.
cell membrane.
Oncology
A characteristic of the stage of D) proliferation of cancer cells in spite of host

progression in the control mechanisms.
development of cancer is
A) oncogenic viral Progression is the final stage of cancer. This stage is
transformation of target cells. characterized by increased growth rate of the
B) a reversible steady growth tumor, increased invasiveness, and spread of the
facilitated by carcinogens. cancer to a distant site (i.e., metastasis). Progression
C) a period of latency before occurs as a result of the following characteristics of
clinical detection of cancer. cancer cells: rapid proliferation and decreased cell
D) proliferation of cancer cells adhesion.
in spite of host control
mechanisms.
The primary protective role of A) surveillance for cells with tumor-associated

the immune system related to antigens.
malignant cells is
A) surveillance for cells with Cancer cells may display altered cell surface
tumor-associated antigens. antigens as a result of malignant transformation.
B) binding with free antigen These antigens are called tumor-associated
released by malignant cells. antigens (TAAs). One of the functions of the immune
C) production of blocking system is to respond to TAAs.
factors that immobilize cancer
cells.
D) responding to a new set of
antigenic determinants on
cancer cells.
Oncology
The primary difference D) characteristic of tissue invasiveness.

between benign and malignant
neoplasms is the The ability of malignant cells to invade and
A) rate of cell proliferation. metastasize is the major difference between benign
B) site of malignant tumor. and malignant neoplasms. Other differences
C) requirements for cell between benign and malignant neoplasms are
nutrients. presented in Table 16-3.
D) characteristic of tissue
invasiveness.
The nurse is caring for a 59- D) allow her to communicate about the meaning of
year-old woman who had this experience.
surgery 1 day ago for removal
of a suspected malignant While the patient is waiting for diagnostic study
abdominal mass. The patient is results, you should be available to actively listen to
awaiting the pathology report. the patient's concerns, and you should be skilled in
She is tearful and says that she techniques that can engage the patient and the
is scared to die. The most family members or significant others in a discussion
effective nursing intervention about their cancer-related fears.
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.
Oncology
The goals of cancer treatment C) a combination of treatment modalities is effective

are based on the principle that for controlling many cancers.
A) surgery is the single most
effective treatment for cancer. The goals of cancer treatment are cure, control, and
B) initial treatment is always palliation. When cure is the goal, treatment is
directed toward cure of the offered that is expected to have the greatest
cancer. chance of disease eradication. Curative cancer
C) a combination of treatment therapy depends on the particular cancer being
modalities is effective for treated and may involve local therapies (i.e., surgery
controlling many cancers. or irradiation) alone or in combination, with or
D) although cancer cure is rare, without periods of adjunctive systemic therapy (i.e.,
quality of life can be increased chemotherapy).
with treatment modalities.
D) use a central venous access device.
If vesicants are inadvertently infiltrated into the skin,

The most effective method of severe local tissue breakdown and necrosis may
administering a chemotherapy result. It is extremely important to monitor for and
agent that is a vesicant is to promptly recognize symptoms associated with
A) give it orally. extravasation of a vesicant and to take immediate
B) give it intraarterially. action if it occurs. The infusion should be
C) use an Ommaya reservoir. immediately turned off, and protocols for drug-
D) use a central venous access specific extravasation procedures should be
device. followed to minimize further tissue damage. Infusion
with central venous access devices can reduce the
risk of infiltration of chemotherapy agents that are
vesicants.
Oncology
The nurse explains to a patient B) requires the use of radioactive precautions

undergoing brachytherapy of during nursing care.
the cervix that she
A) must undergo simulation to Brachytherapy consists of the implantation or
locate the treatment area. insertion of radioactive materials directly into the
B) requires the use of tumor or adjacent to the tumor. Caring for the
radioactive precautions during person undergoing brachytherapy or receiving
nursing care. radiopharmaceuticals requires the nurse to take
C) may experience special precautions. The principles of ALARA (as low
desquamation of the skin on as reasonably achievable) and of time, distance, and
the abdomen and upper legs. shielding are vital to health care professional safety
D) requires shielding of the in caring for the person with an internal radiation
ovaries during treatment to source.
prevent ovarian damage.
A patient on chemotherapy C) Temperature of 101.9° F, fatigue, and shortness of

and radiation for head and breath
neck cancer has a WBC count
of 1.9 × 103/µL, hemoglobin of Neutropenia is more common in patients receiving
10.8 g/dL, and a platelet count chemotherapy than in those receiving radiation, and
of 99 × 103/µL. Based on the it can seriously increase the risk for life-threatening
CBC results, what is the most infection and sepsis. Any sign of infection should be
serious clinical finding? treated promptly because fever in the setting of
A) Cough, rhinitis, and sore neutropenia is a medical emergency.
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
Oncology
B) acetaminophen.
To prevent fever and shivering
during an infusion of rituximab Common side effects of rituximab include
(Rituxan), the nurse should constitutional flu-like symptoms, including
premedicate the patient with headache, fever, chills, myalgias, fatigue, malaise,
A) aspirin. weakness, anorexia, and nausea. The patient is
B) acetaminophen. commonly premedicated with acetaminophen in an
C) sodium bicarbonate. attempt to prevent or decrease the intensity of
D) meperidine (Demerol). these symptoms, and large amounts of fluids help
decrease symptoms.
The nurse counsels the patient C) after successful treatment, a return to the
receiving radiation therapy or person's previous functional level can be expected.
chemotherapy that
A) effective birth control Some cancer survivors may continue to experience
methods should be used for symptoms or functional impairment related to
the rest of the patient's life. treatment for years after treatment. Others who
B) if nausea and vomiting occur have successful treatment may not have any
during treatment, the treatment functional limitations. A cancer diagnosis can affect
plan will be modified. many aspects of a patients' life; cancer survivors
C) after successful treatment, a commonly report financial, vocational, marital, and
return to the person's previous emotional concerns long after treatment is over.
functional level can be Resources for survivors are listed in Table 16-20.
expected.
D) the cycle of fatigue-
depression-fatigue that may
occur during treatment can be
reduced by restricting activity.
Oncology
A patient on chemotherapy for D) Advise the patient to experiment with spices and
10 weeks started at a weight of seasonings to enhance the flavor of food.
121 lb. She now weighs 118 lb
and has no sense of taste. Instruct the patient to experiment with spices and
Which nursing intervention other seasoning agents in an attempt to mask taste
would be a priority? alterations. Lemon juice, onion, mint, basil, and fruit
A) Advise the patient to eat juice marinades may improve the taste of certain
foods that are fatty, fried, or meats and fish. Bacon bits, onion, and pieces of ham
high in calories. may enhance the taste of vegetables.
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.
A 70-year-old male patient has A) Hypercalcemia

multiple myeloma. His wife
calls to report that he sleeps Hypercalcemia can occur with multiple myeloma.
most of the day, is confused Immobility and dehydration can contribute to or
when awake, and complains of exacerbate hypercalcemia. The primary
nausea and constipation. manifestations of hypercalcemia include apathy,
Which complication of cancer depression, fatigue, muscle weakness,
is this most likely caused by? electrocardiographic changes, polyuria and
A) Hypercalcemia nocturia, anorexia, nausea, and vomiting.
B) Tumor lysis syndrome
C) Spinal cord compression
D) Superior vena cava
syndrome
Oncology
Which assessment finding of a B) The presence of an irregularly shaped mole that

70-year-old male patient's skin the patient states is new
should the nurse prioritize?
A) The patient's complaint of Although all of the noted assessment findings are
dry skin that is frequently itchy significant, the presence of an irregular mole that is
B) The presence of an new is suggestive of a neoplasm and warrants
irregularly shaped mole that immediate follow-up.
the patient states is new
C) The presence of veins on
the back of the patient's leg
that are blue and tortuous
D) The presence of a rash on
the patient's hand and forearm
to which the patient applies a
corticosteroid ointment
Which patient would be more A) A fair-skinned woman who uses a tanning booth
likely to have the highest risk of regularly
developing malignant
melanoma? Risk factors for malignant melanoma include a fair
A) A fair-skinned woman who complexion and exposure to ultraviolet light.
uses a tanning booth regularly Psoriasis, eczema, short-duration phototherapy, and
B) An African American patient a family history of other cancers are less likely to be
with a family history of cancer linked to malignant melanoma.
C) An adult who required
phototherapy as an infant for
the treatment of
hyperbilirubinemia
D) A Hispanic male with a
history of psoriasis and eczema
that responded poorly to
treatment
Oncology
The nurse should teach a A) Tetracycline

patient who is taking which
drug to avoid prolonged sun Several antibiotics, including tetracycline, may cause
exposure? photosensitivity. This is not the case with
A) Tetracycline ipratropium, morphine, or oral contraceptives.
B) Ipratropium
C) Morphine sulfate
D) Oral contraceptives
The nurse should recognize B) A 59-year-old man who is being treated for stage
which patient as likely to have IV malignant melanoma
the poorest prognosis?
A) A 60-year-old diagnosed Late detection of malignant melanoma is associated
with nodular ulcerative basal with a poor outcome. Basal cell carcinomas often
cell carcinoma have very effective treatment success rates.
B) A 59-year-old man who is Although late squamous cell carcinoma (SCC) has
being treated for stage IV worse outcomes than superficial SCC, these are
malignant melanoma both exceeded in mortality by late-stage malignant
C) A 70-year-old woman who melanoma.
has been diagnosed with late
squamous cell carcinoma
D) A 51-year-old woman whose
biopsy has revealed superficial
squamous cell carcinoma
Oncology
What practice should the nurse D) Apply a layer of medication that is just thick
teach a patient to follow when enough to ensure coverage.
the patient is applying topical
medication? Patients should be directed to avoid applying
A) Avoid applying medications topical medications too thickly. Medications may be
directly on to dressings. applied directly on to dressings, and regions with
B) Use a tongue blade medications may be covered. A tongue blade is not
whenever the patient's skin normally used for the application of a thin coat.
integrity allows.
C) Avoid covering skin regions
that have topical medication in
place.
D) Apply a layer of medication
that is just thick enough to
ensure coverage.
The nurse is teaching about C) A 55-year-old woman with fair skin and red hair
skin cancer prevention at the who has a family history of skin cancer
community center. Which
individual is most at risk for Risk factors for skin cancer include having fair skin
developing skin cancer? (with red hair) and a family history of skin cancer.
A) A 67-year-old bald-headed Allergies, acrochordons (skin tags), psoriasis, type 2
man with psoriasis and type 2 diabetes mellitus, and chronic kidney disease are
diabetes mellitus not risk factors associated with the development of
B) A 76-year-old Hispanic man skin cancer.
who has a latex allergy and
numerous acrochordons
C) A 55-year-old woman with
fair skin and red hair who has a
family history of skin cancer
D) A 62-year-old woman with
chronic kidney disease who has
blond hair with dry, pale skin
and pruritus
Oncology
In teaching a patient with A) the thickness of the lesion.

malignant melanoma about this
disorder, the nurse recognizes The most important prognostic factor is tumor
that the patient's prognosis is thickness at the time of diagnosis. Two methods are
most dependent on used to determine thickness. The Breslow
A) the thickness of the lesion. measurement indicates the depth of the tumor in
B) the degree of asymmetry in millimeters, and the Clark level indicates the depth
the lesion. of invasion of the tumor. The higher the number, the
C) the amount of ulceration in deeper the melanoma.
the lesion.
D) how much the lesion has
spread superficially.
Which patient is most likely to B) A 23-year-old African American man who has a
experience anemia related to diagnosis of sickle cell disease
an increased destruction of red
blood cells? A result of a sickling episode in sickle cell anemia
A) A 59-year-old man whose involves increased hemolysis of the sickled cells.
alcoholism has precipitated Thalassemias and folic acid deficiencies cause a
folic acid deficiency decrease in erythropoiesis, whereas the anemia
B) A 23-year-old African related to menstruation is a direct result of blood
American man who has a loss.
diagnosis of sickle cell disease
C) A 30-year-old woman with a
history of "heavy periods"
accompanied by anemia
D) A 3-year-old child whose
impaired growth and
development is attributable to
thalassemi
Oncology
What nursing intervention B) Administration of oral or IV corticosteroids

should be the priority in the
care of a 30-year-old woman Common treatment modalities for ITP include
who has a diagnosis of immune corticosteroid therapy to suppress the phagocytic
thrombocytopenic purpura response of splenic macrophages. Blood
(ITP)? transfusions, administration of clotting factors, and
A) Administration of packed reverse isolation are not interventions that are
red blood cells indicated in the care of patients with ITP. Standard
B) Administration of oral or IV precautions are used with all patients.
corticosteroids
C) Administration of clotting
factors VIII and IX
D) Maintenance of reverse
isolation and application of
standard precautions
The patient with cancer is A) Strict hand washing

having chemotherapy D) Daily skin care and oral hygiene
treatments and has now F) Private room with a high-efficiency particulate air
developed neutropenia. What (HEPA) filter
care should the nurse expect
to provide and teach the Strict hand washing and daily skin and oral hygiene
patient about (select all that must be done with neutropenia, because the patient
apply)? is predisposed to infection from the normal body
A) Strict hand washing flora, other people, and uncooked meats, seafood,
B) Daily nasal swabs for culture eggs, unwashed fruits and vegetables, and fresh
C) Monitor temperature every flowers or plants. The private room with HEPA
hour. filtration reduces the aerosolized pathogens in the
D) Daily skin care and oral patient's room. Blood cultures and antibiotic
hygiene treatment are used when the patient has a
E) Encourage eating all foods temperature of 100.4° F or more, but temperature is
to increase nutrients. not monitored every hour.
F) Private room with a high-
efficiency particulate air
(HEPA) filter
Oncology
B) Attaining remission
A 57-year-old patient has been

Attaining remission is the initial goal of collaborative
diagnosed with acute
care for leukemia. The methods to do this are
myelogenous leukemia (AML).
decided based on age and cytogenetic analysis.
The nurse explains to the
The treatments include leukapheresis or
patient that collaborative care
hydroxyurea to reduce the WBC count and risk of
will focus on what?
leukemia-cell-induced thrombosis. A combination of
A) Leukapheresis
chemotherapy agents will be used for aggressive
B) Attaining remission
treatment to destroy leukemic cells in tissues,
C) One chemotherapy agent
peripheral blood, and bone marrow and minimize
D) Waiting with active
drug toxicity. In nonsymptomatic patients with
supportive care
chronic lymphocytic leukemia (CLL), waiting may be
done to attain remission, but not with AML.
Oncology
A 22-year-old female patient B) Two to four cycles of ABVD: doxorubicin

has been diagnosed with stage (Adriamycin), bleomycin, vinblastine, and
1A Hodgkin's lymphoma. The dacarbazine
nurse knows that which
chemotherapy regimen is most The patient with stage favorable prognosis early-
likely to be prescribed for this stage Hodgkin's lymphoma will receive two to four
patient? cycles of ABVD. The unfavorable prognostic
A) Brentuximab vedotin featured (stage 1B) Hodgkin's lymphoma would be
(Adcetris) treated with four to six cycles of chemotherapy.
B) Two to four cycles of ABVD: Advanced-stage Hodgkin's lymphoma is treated
doxorubicin (Adriamycin), more aggressively with more cycles or with
bleomycin, vinblastine, and BEACOPP. Brentuximab vedotin (Adcetris) is a
dacarbazine newer agent that will be used to treat patients who
C) Four to six cycles of ABVD: have relapsed or refractory disease.
doxorubicin (Adriamycin),
bleomycin, vinblastine, and
dacarbazine
D) BEACOPP: bleomycin,
etoposide, doxorubicin
(Adriamycin),
cyclophosphamide, vincristine
(Oncovin), procarbazine, and
prednisone
Oncology
The patient is being treated for D) Treatment type and expected side effects
non-Hodgkin's lymphoma
(NHL). What should the nurse The patient should first be taught about the type of
first teach the patient about the treatment and the expected and potential side
treatment? effects. Nursing care is related to the area affected
A) Skin care that will be by the disease and treatment. Skin care will be
needed affected if radiation is used. Not all patients will
B) Method of obtaining the have gastrointestinal tract effects of NHL or
treatment treatment. The method of obtaining treatment will
C) Gastrointestinal tract effects be included in the teaching about the type of
of treatment treatment.
D) Treatment type and
expected side effects
The patient is admitted with A) Multiple myeloma

hypercalcemia, polyuria, and
pain in the pelvis, spine, and Multiple myeloma typically manifests with skeletal
ribs with movement. Which pain and osteoporosis that may cause
hematologic problem is likely hypercalcemia, which can result in polyuria,
to display these manifestations confusion, or cardiac problems. Serum
in the patient? hyperviscosity syndrome can cause renal, cerebral,
A) Multiple myeloma or pulmonary damage. Thrombocytopenia,
B) Thrombocytopenia megaloblastic anemia, and myelodysplastic
C) Megaloblastic anemia syndrome are not characterized by these
D) Myelodysplastic syndrome manifestations.
Oncology
The nurse instructs an African C) "When my vision is blurred, I will close my eyes
American man who has sickle and rest for an hour."
cell disease about symptom
management and prevention of Blurred vision should be reported immediately and
sickle cell crisis. The nurse may indicate a detached retina or retinopathy.
determines further teaching is Hypoxia (at high altitudes) and infection are
necessary if the patient makes common causes of a sickle cell crisis. Severe pain
which statement? may occur during a sickle cell crisis, and narcotic
A) "When I take a vacation, I analgesics are indicated for pain management.
should not go to the
mountains."
B) "I should avoid contact with
anyone who has a respiratory
infection."
C) "When my vision is blurred, I
will close my eyes and rest for
an hour."
D) "I may experience severe
pain during a crisis and need
narcotic analgesics."
A 64-year-old man with D) Check stools for presence of frank or occult

leukemia admitted for severe blood.
hypovolemia after prolonged
diarrhea has a platelet count of A platelet count
43,000/µL. It is most important
for the nurse to take which
action?
A) Administer prescribed
enoxaparin (Lovenox).
B) Insert two 18-gauge IV
catheters.
C) Monitor the patient?s
temperature every 2 hours.
D) Check stools for presence
Oncology
of frank or occult blood.
The nurse is assigned to care C) A 40-year-old patient with a temperature of

for several patients on a 100.8o F (38.2o C) and a neutrophil count of 256/µL
medical unit. Which patient
should the nurse check on A low-grade fever greater than 100.4° F (38° C) in a
first? patient with a neutrophil count below 500/µL is a
A) A 60-year-old patient with a medical emergency and may indicate an infection.
blood pressure of 92/64 mm An infection in a neutropenic patient could lead to
Hg and hemoglobin of 9.8 g/dL septic shock and possible death if not treated
B) A 50-year-old patient with a immediately.
respiratory rate of 26
breaths/minute and an
elevated D-dimer
C) A 40-year-old patient with a
temperature of 100.8o F (38.2o
C) and a neutrophil count of
256/µL
D) A 30-year-old patient with a
pulse of 112 beats/minute and a
white blood cell count of
14,000/µL
In a severely anemic patient, A) dyspnea and tachycardia.

the nurse would expect to find
A) dyspnea and tachycardia. Patients with severe anemia (hemoglobin level, less
B) cyanosis and pulmonary than 6 g/dL) exhibit the following cardiovascular
edema. and pulmonary manifestations: tachycardia,
C) cardiomegaly and increased pulse pressure, systolic murmurs,
pulmonary fibrosis. intermittent claudication, angina, heart failure,
D) ventricular dysrhythmias and myocardial infarction, tachypnea, orthopnea, and
wheezing. dyspnea at rest.
Oncology
A) monitoring CBC.
B) optimal pain management and O2 therapy.
C) blood transfusions if required and iron chelation.
D) rest as needed and deep vein thrombosis
prophylaxis.
The nursing management of a
patient in sickle cell crisis Complete blood count (CBC) is monitored.
includes (select all that apply) Infections are common with elevated white blood
A) monitoring CBC. cell counts, and anemia may occur with low
B) optimal pain management hemoglobin levels and low RBC counts. Oxygen
and O2 therapy. may be administered to treat hypoxia and control
C) blood transfusions if sickling. Rest may be instituted to reduce metabolic
required and iron chelation. requirements, and prophylaxis for deep vein
D) rest as needed and deep thrombosis (with anticoagulants) is prescribed.
vein thrombosis prophylaxis. Transfusion therapy is indicated when an aplastic
E) administration of IV iron and crisis occurs. Patients may require iron chelation
diet high in iron content. therapy to reduce transfusion-produced iron
overload. Pain occurring during an acute crisis is
usually undertreated; patients should have optimal
pain control with opioid analgesics, nonsteroidal
antiinflammatory agents, antineuropathic pain
medications, local anesthetics, or nerve blocks.
When caring for a patient with A) dab his or her nose instead of blowing.
thrombocytopenia, the nurse
instructs the patient to Patients with thrombocytopenia should avoid aspirin
A) dab his or her nose instead because it reduces platelet adhesiveness, which
of blowing. contributes to bleeding. Patients should not
B) be careful when shaving perform vigorous exercise or lift weights. If a patient
with a safety razor. is weak and at risk for falling, supervise the patient
C) continue with physical when he or she is out of bed. Blowing the nose
activities to stimulate forcefully should be avoided. The patient should
thrombopoiesis. gently pat the nose with a tissue if needed. Instruct
D) avoid aspirin because it may patients not to shave with a blade; an electric razor
mask the fever that occurs with should be used.
Oncology
thrombocytopenia
A) administering the prescribed antibiotic STAT.

B) drawing peripheral and central line blood
Priority nursing actions when
cultures.
caring for a hospitalized
C) ongoing monitoring of the patient's vital signs for
patient with a new-onset
septic shock.
temperature of 102.2° F and
D) taking a full set of vital signs and notifying the
severe neutropenia include
physician immediately.
(select all that apply)
A) administering the
Early identification of an infective organism is a
prescribed antibiotic STAT.
priority, and cultures should be obtained from
B) drawing peripheral and
various sites. Serial blood cultures (at least two) or
central line blood cultures.
one from a peripheral site and one from a venous
C) ongoing monitoring of the
access device should be obtained promptly. In a
patient's vital signs for septic
febrile neutropenic patient, antibiotics should be
shock.
started immediately (within 1 hour). Cultures of the
D) taking a full set of vital signs
nose, throat, sputum, urine, stool, obvious lesions,
and notifying the physician
and blood may be indicated. Ongoing febrile
immediately.
episodes or a change in the patient's assessment
E) administering transfusions of
findings (or vital signs) necessitates a call to the
WBCs treated to decrease
physician for additional cultures, diagnostic tests,
immunogenicity.
addition of antimicrobial therapies, or a combination
of these.
The most common type of D) chronic lymphocytic leukemia.

leukemia in older adults is
A) acute myelocytic leukemia. Chronic lymphocytic leukemia is a disease primarily
B) acute lymphocytic leukemia. of older adults.
C) chronic myelocytic
leukemia.
D) chronic lymphocytic
leukemia.
Oncology
Multiple drugs are often used D) the drugs work by different mechanisms to
in combinations to treat maximize killing of malignant cells.
leukemia and lymphoma
because Combination therapy is the mainstay of treatment
A) there are fewer toxic and for leukemia. The three purposes for using multiple
side effects. drugs are to (1) decrease drug resistance, (2)
B) the chance that one drug minimize the drug toxicity to the patient by using
will be effective is increased. multiple drugs with varying toxic effects, and (3)
C) the drugs are more effective interrupt cell growth at multiple points in the cell
without causing side effects. cycle.
D) the drugs work by different
mechanisms to maximize killing
of malignant cells.
The nurse is aware that a major C) non-Hodgkin's lymphoma can manifest in

difference between Hodgkin's multiple organs.
lymphoma and non-Hodgkin's
lymphoma is that Non-Hodgkin's lymphoma can originate outside the
A) Hodgkin's lymphoma occurs lymph nodes, the method of spread can be
only in young adults. unpredictable, and most affected patients have
B) Hodgkin's lymphoma is widely disseminated disease.
considered potentially curable.
C) non-Hodgkin's lymphoma
can manifest in multiple organs.
D) non-Hodgkin's lymphoma is
treated only with radiation
therapy.
Oncology
A patient with multiple C) hypercalcemia.

myeloma becomes confused
and lethargic. The nurse would Bone degeneration in multiple myeloma causes
expect that these clinical calcium to be lost from bones, which eventually
manifestations may be results in hypercalcemia. Hypercalcemia may cause
explained by diagnostic results renal, gastrointestinal, or neurologic manifestations,
that indicate such as polyuria, anorexia, or confusion, and may
A) hyperkalemia. ultimately cause seizures, coma, and cardiac
B) hyperuricemia. problems.
C) hypercalcemia.
D) CNS myeloma.
The nurse is caring for a patient B) Spinal shock syndrome

admitted with a spinal cord
injury following a motor vehicle About 50% of people with acute spinal cord injury
accident. The patient exhibits a experience a temporary loss of reflexes, sensation,
complete loss of motor, and motor activity that is known as spinal shock.
sensory, and reflex activity Central cord syndrome is manifested by motor and
below the injury level. The sensory loss greater in the upper extremities than
nurse recognizes this condition the lower extremities. Anterior cord syndrome
as which of the following? results in motor and sensory loss but not reflexes.
A) Central cord syndrome Brown-Séquard syndrome is characterized by
B) Spinal shock syndrome ipsilateral loss of motor function and contralateral
C) Anterior cord syndrome loss of sensory function.
D) Brown-Séquard syndrome
Which clinical manifestation A) Bradycardia

would the nurse interpret as a
manifestation of neurogenic Neurogenic shock is due to the loss of vasomotor
shock in a patient with acute tone caused by injury and is characterized by
spinal cord injury? bradycardia and hypotension. Loss of sympathetic
A) Bradycardia innervations causes peripheral vasodilation, venous
B) Hypertension pooling, and a decreased cardiac output. Thus
C) Neurogenic spasticity hypertension, neurogenic spasticity, and bounding
D) Bounding pedal pulses pedal pulses are not seen in neurogenic shock.
Oncology
When planning care for a D) Ineffective airway clearance caused by high

patient with a C5 spinal cord cervical spinal cord injury
injury, which nursing diagnosis
has the highest priority? Maintaining a patent airway is the most important
A) Risk for impairment of tissue goal for a patient with a high cervical fracture.
integrity caused by paralysis Although all of these are appropriate nursing
B) Altered patterns of urinary diagnoses for a patient with a spinal cord injury,
elimination caused by respiratory needs are always the highest priority.
tetraplegia Remember the ABCs.
C) Altered family and individual
coping caused by the extent of
trauma
D) Ineffective airway clearance
caused by high cervical spinal
cord injury
The nurse is providing care for C) Respiratory assessment

a patient who has been
diagnosed with Guillain-Barré Although all of the assessments are necessary in the
syndrome. Which assessment care of patients with Guillain-Barré syndrome, the
should be the nurse's priority? acute risk of respiratory failure necessitates vigilant
A) Pain assessment monitoring of the patient's respiratory status.
B) Glasgow Coma Scale
C) Respiratory assessment
D) Musculoskeletal assessment
Oncology
Which manifestations in a A) Headache and rising blood pressure

patient with a T4 spinal cord
injury should alert the nurse to Manifestations of autonomic dysreflexia are
the possibility of autonomic hypertension (up to 300 mm Hg systolic), a
dysreflexia? throbbing headache, bradycardia, and diaphoresis.
A) Headache and rising blood Respiratory manifestations, decreased level of
pressure consciousness, and gastrointestinal manifestations
B) Irregular respirations and are not characteristic manifestations.
shortness of breath
C) Decreased level of
consciousness or hallucinations
D) Abdominal distention and
absence of bowel sounds
Which intervention should the A) Urinary catheterization

nurse perform in the acute
care of a patient with Because the most common cause of autonomic
autonomic dysreflexia? dysreflexia is bladder irritation, immediate
A) Urinary catheterization catheterization to relieve bladder distention may be
B) Administration of necessary. Benzodiazepines are contraindicated,
benzodiazepines and suctioning is likely unnecessary. The patient
C) Suctioning of the patient's should be positioned upright.
upper airway
D) Placement of the patient in
the Trendelenburg position
Oncology
The patient with peripheral C) Administration of corticosteroid medications

facial paresis on the left side of D) Dark glasses and artificial tears to protect the
her face is diagnosed with eyes
Bell's palsy. What should the Self-care for Bell's palsy includes corticosteroid
nurse include in teaching the medications to decrease inflammation of the facial
patient about self-care (select nerve (CNVII) and protecting the cornea from
all that apply)? drying out because of the inability to close the
A) Administration of antiseizure eyelid. Antiseizure medications, a nerve block, or
medications surgeries are used for trigeminal neuralgia.
B) Preparing for a nerve block
to relieve pain
C) Administration of
corticosteroid medications
D) Dark glasses and artificial
tears to protect the eyes
E) Surgeries available if
conservative therapy is not
effective
While on a mission trip, the B) Tracheostomy for mechanical ventilation

nurse is caring for a patient E) Control of spasms with diazepam (Valium)
diagnosed with tetanus. The
patient has been given tetanus Control of the spasms of tetanus is essential
immune globulin (TIG). What because the laryngeal and respiratory system
should be the focus of spasms cause apnea and anoxia. A tracheostomy is
collaborative care (select all performed early so mechanical ventilation may be
that apply)? done to maintain ventilation. Penicillin is
A) Administration of penicillin administered for neurosyphilis. Use of polyvalent
B) Tracheostomy for antitoxin and teaching the correct canning process
mechanical ventilation is done for botulism.
C) Administration of polyvalent
antitoxin
D) Teach correct processing of
canned foods.
E) Control of spasms with
Oncology
diazepam (Valium)
After learning about D) "With rehabilitation, I will be able to function at

rehabilitation for his spinal cord my highest level of wellness."
tumor, which statement shows
the patient understands what Rehabilitation is an interdisciplinary endeavor
rehabilitation is and can do for carried out with a team approach to teach and
him? enable the patient to function at the patient's
A) "I want to be rehabilitated highest level of wellness and adjustment. It will be a
for my daughter's wedding in 2 lot of work for all involved and take longer than 2
weeks." weeks. With neurologic dysfunction, the patient will
B) "Rehabilitation will be more not be able to do all the normal activities in the
work done by me alone to try same way as before the lesion, so this statement
to get better." should be discussed.
C) "I will be able to do all my
normal activities after I go
through rehabilitation."
D) "With rehabilitation, I will be
able to function at my highest
level of wellness."
Oncology
A 68-year-old patient with a B) Eat 20-30 g of fiber per day.

spinal cord injury has a D) Drink 1800 to 2800 mL of water or juice.
neurogenic bowel. Beyond the
use of bisacodyl (Dulcolax) The patient with a spinal cord injury and neurogenic
suppositories and digital bowel should eat 20-30 g of fiber and drink 1800 to
stimulation, which measures 2800 mL of water or juice each day. Milk may cause
should the nurse teach the constipation. Daily oral laxatives may cause diarrhea
patient and the caregiver to and are avoided unless necessary. Bowel
assist the patient with bowel evacuation time is usually established 30 minutes
evacuation (select all that after the first meal of the day to take advantage of
apply)? the gastrocolic reflex induced by eating.
A) Drink more milk.
B) Eat 20-30 g of fiber per day.
C) Use oral laxatives every day.
D) Drink 1800 to 2800 mL of
water or juice.
E) Establish bowel evacuation
time at bedtime.
Oncology
C) Encourage him to verbalize his feelings.
A 25-year-old male patient To help him with his coping and prevent self-harm,
who is a professional the nurse should create a therapeutic patient
motocross racer has anterior environment that encourages his self-expression
spinal cord syndrome at T10. and verbalization of thoughts and feelings. This
His history is significant for patient is at high risk for depression and self-injury
tobacco, alcohol, and because he is likely to lose function below the
marijuana use. What is the umbilicus involving lost motor and sensory function.
nurse's priority during In addition, he is a young adult male patient who is
rehabilitation? likely to need a wheelchair, have impaired sexual
A) Prevent urinary tract function, and is unlikely to resume his racing career.
infections. Because the patient uses tobacco, alcohol, and
B) Monitor the patient every 15 marijuana frequently, hospitalization is likely to
minutes. result in a loss of these habits that can make coping
C) Encourage him to verbalize especially difficult for him. Prevention of urinary
his feelings. tract infections and facilitating bowel evacuation
D) Teach him about using the with the gastrocolic reflex will be important but not
gastrocolic reflex. as important as helping him cope. In rehabilitation,
monitoring every 15 minutes is not needed unless he
is on a suicide watch.
Oncology
The nurse cares for a 63-year- B) "I will take these medications for 2 to 3 months."
old woman taking prednisone
(Deltasone) and acyclovir Prednisone and acyclovir will usually be prescribed
(Zovirax) for Bell's palsy. It is for 10 days. Prednisone will be tapered over the last
most important for the nurse to 4 days of treatment. Oral prednisone and acyclovir
follow up on which patient may be taken with food or milk to decrease
statement? gastrointestinal upset. Patients with Bell's palsy
A) "I can take both medications usually begin recovery in 2 to 3 weeks, and most
with food or milk." patients have complete recovery in 2 to 3 months.
B) "I will take these medications Patients have the best chance for full recovery if
for 2 to 3 months." prednisone is initiated before complete paralysis
C) "I can take acetaminophen occurs. There are no serious drug interactions
with the prescribed among prednisone, acyclovir, and acetaminophen.
medications."
D) "Chances of a full recovery
are good if I take the
medications."
A 42-year-old man is admitted C) Elevated serum creatinine and blood urea

to the hospital with a diagnosis nitrogen (BUN)
of Guillain-Barré syndrome.
The physician orders include IV Patients receiving IV administration of high-dose
Sandoglobulin. What is immunoglobulin (Sandoglobulin) need to be well
important for the nurse to hydrated and have adequate renal function.
assess for before Elevated serum creatinine and blood urea nitrogen
administration? indicate impaired renal function.
A) Elevated fasting blood
glucose and serum albumin
B) Elevated activated partial
thromboplastin time (aPTT)
C) Elevated serum creatinine
and blood urea nitrogen (BUN)
D) Elevated aspartate
aminotransferase and alanine
aminotransferase
Oncology
The nurse performs discharge A) "I will perform self-catheterization at least six
teaching for a 34-year-old times per day."
male patient with a T2 spinal
cord injury resulting from a Autonomic dysreflexia is usually caused by a
construction accident. Which distended bladder. Performing self-catheterization
statement, if made by the five or six times a day prevents bladder distention.
patient to the nurse, indicates Signs and symptoms of autonomic dysreflexia
that teaching about include a severe headache. Patients should raise the
recognition and management head of the bed to 45 to 90 degrees. This action
of autonomic dysreflexia is helps to relieve hypertension (systolic pressure up
successful? to 300 mm Hg) that occurs with autonomic
A) "I will perform self- dysreflexia.
catheterization at least six
times per day."
B) "A reflex erection may cause
an unsafe drop in blood
pressure."
C) "If I develop a severe
headache, I will lie down for 15
to 20 minutes."
D) "I can avoid this problem by
taking medications to prevent
leg spasms."
Oncology
A 19-year-old man is admitted D) Methylprednisolone sodium succinate (Solu-

to the emergency department Medrol)
with a C6 spinal cord injury
after a motorcycle crash. Which Methylprednisolone (MP) blocks lipid peroxidation
medication should the nurse by-products and improves blood flow and reduces
anticipate that she will edema in the spinal cord. High-dose MP should be
administer first? administered within 8 hours of injury. Enoxaparin is a
A) Enoxaparin (Lovenox) low-molecular-weight heparin used to prevent
B) Metoclopramide (Reglan) deep vein thrombosis. Metoclopramide is used to
C) IV immunoglobulin treat delayed gastric emptying. IV immunoglobulin
(Sandoglobulin) (Sandoglobulin) is used to treat Guillain-Barré
D) Methylprednisolone sodium syndrome.
succinate (Solu-Medrol)
A 22-year-old female with C) Assess bowel movements for frequency,

paraplegia after a spinal cord consistency, and volume.
injury tells the home care nurse
that bowel incontinence occurs The nurse should establish baseline bowel function
two or three times each day. and explore the patient's current knowledge of an
Which action by the nurse is appropriate bowel management program after
most appropriate? spinal cord injury. To prevent constipation, caffeine
A) Take magnesium citrate intake should be limited, but not eliminated. Oral
(Citroma) every morning with saline laxatives such as magnesium citrate are not
breakfast. indicated for long-term management of bowel
B) Teach the patient to elimination. Instruction on high-fiber foods is
gradually increase intake of indicated if the patient has a knowledge deficit.
high-fiber foods.
C) Assess bowel movements
for frequency, consistency, and
volume.
D) Instruct the patient to avoid
all caffeinated and carbonated
beverages.
Oncology
A) inspect all aspects of the mouth and teeth.

D) test for temperature and sensation perception on
the face.
E) ask the patient to describe factors that initiate an
During assessment of the episode.
patient with trigeminal
neuralgia, the nurse should Assessment of the attacks, including the triggering
(select all that apply) factors, characteristics, frequency, and pain
A) inspect all aspects of the management techniques, helps the nurse plan for
mouth and teeth. patient care. Painful episodes are usually triggered
B) assess the gag reflex and by light cutaneous stimulation at a specific point
respiratory rate and depth. (i.e., trigger zone) along the distribution of the nerve
C) lightly palpate the affected branches. Precipitating stimuli include chewing,
side of the face for edema. tooth brushing, a hot or cold blast of air on the
D) test for temperature and face, washing the face, yawning, or talking. Touch
sensation perception on the and tickle seem to predominate as causative
face. triggers, rather than pain or changes in ambient
E) ask the patient to describe temperature. The nursing assessment should include
factors that initiate an episode. the patient's nutritional status, hygiene (especially
oral), and behavior (including withdrawal). As a
result of the attacks, the patient may eat improperly,
neglect hygienic practices, wear a cloth over the
face, and withdraw from interaction with others.
Oncology
During routine assessment of a D) paralysis ascending to the nerves that stimulate

patient with Guillain-Barré the thoracic area.
syndrome, the nurse finds the
patient is short of breath. The Guillain-Barré syndrome is characterized by
patient's respiratory distress is ascending, symmetric paralysis that usually affects
caused by cranial nerves and the peripheral nervous system.
A) elevated protein levels in The most serious complication of this syndrome is
the CSF. respiratory failure, which occurs as the paralysis
B) immobility resulting from progresses to the nerves that innervate the thoracic
ascending paralysis. area.
C) degeneration of motor
neurons in the brainstem and
spinal cord.
D) paralysis ascending to the
nerves that stimulate the
thoracic area.
A patient is admitted to the ICU D) ipsilateral motor loss and contralateral sensory
with a C7 spinal cord injury and loss below C7.
diagnosed with Brown-
Séquard syndrome. On Brown-Séquard syndrome is a result of damage to
physical examination, the nurse one half of the spinal cord. This syndrome is
would most likely find characterized by a loss of motor function, position
A) upper extremity weakness sense, and vibratory sense, as well as by vasomotor
only. paralysis on the same side (ipsilateral) as the injury.
B) complete motor and The opposite (contralateral) side has loss of pain
sensory loss below C7. and temperature sensation below the level of the
C) loss of position sense and injury.
vibration in both lower
extremities.
D) ipsilateral motor loss and
contralateral sensory loss
below C7.
Oncology
A patient is admitted to the D) loss of sympathetic nervous system innervation

hospital with a C4 spinal cord resulting in peripheral vasodilation.
injury after a motorcycle
collision. The patient's BP is Neurogenic shock results from loss of vasomotor
84/50 mm Hg, his pulse is 38 tone caused by injury and is characterized by
beats/minute, and he remains hypotension and bradycardia. Loss of sympathetic
orally intubated. The nurse nervous system innervation causes peripheral
determines that this vasodilation, venous pooling, and a decrease in
pathophysiologic response is cardiac output. These effects are usually associated
caused by with a cervical or high thoracic injury (T6 or higher).
A) increased vasomotor tone
after injury.
B) a temporary loss of
sensation and flaccid paralysis
below the level of injury.
C) loss of parasympathetic
nervous system innervation
resulting in vasoconstriction.
D) loss of sympathetic nervous
system innervation resulting in
peripheral vasodilation.
B) feed self with hand devices.

Goals of rehabilitation for the C) assist with transfer activities.
patient with an injury at the C6 D) drive adapted van from wheelchair.
level include (select all that E) push a wheelchair on a flat surface.
apply)
A) stand erect with leg brace. Rehabilitation goals for a patient with a spinal cord
B) feed self with hand devices. injury at the C6 level include the ability to assist with
C) assist with transfer activities. transfer and perform some self-care; feed self with
D) drive adapted van from hand devices; push a wheelchair on smooth, flat
wheelchair. surfaces; drive an adapted van from a wheelchair;
E) push a wheelchair on a flat independent computer use with adaptive
surface. equipment; and need for attendant care for only 6
hours per day.
Oncology
C) take the patient's blood pressure.
Autonomic dysreflexia is a massive, uncompensated

cardiovascular reaction mediated by the
sympathetic nervous system. Manifestations include
A patient with a C7 spinal cord
hypertension (up to 300 mm Hg systolic), throbbing
injury undergoing rehabilitation
headache, marked diaphoresis above the level of
tells the nurse he must have
the injury, bradycardia (30 to 40 beats/min),
the flu because he has a bad
piloerection, flushing of the skin above the level of
headache and nausea. The
the injury, blurred vision or spots in the visual fields,
nurse's first priority is to
nasal congestion, anxiety, and nausea. It is
A) call the physician.
important to measure blood pressure when a
B) check the patient's
patient with a spinal cord injury complains of
temperature.
headache. Other nursing interventions in this serious
C) take the patient's blood
emergency are elevation of the head of the bed 45
pressure.
degrees or sitting the patient upright, notification of
D) elevate the head of the bed
the physician, and assessment to determine the
to 90 degrees.
cause. Table 61-8 lists the causes and symptoms of
autonomic dysreflexia. The nurse must monitor
blood pressure frequently during the episode. An α-
adrenergic blocker or an arteriolar vasodilator may
be administered.
The most common early B) back pain that worsens with activity.
symptom of a spinal cord
tumor is The most common early symptom of a spinal cord
A) urinary incontinence. tumor outside the cord is pain in the back, with
B) back pain that worsens with radicular pain simulating intercostal neuralgia,
activity. angina, or herpes zoster. The location of the pain
C) paralysis below the level of depends on the level of compression. The pain
involvement. worsens with activity, coughing, straining, and lying
D) impaired sensation of pain, down.
temperature, and light touch.
Oncology
The nurse is caring for a patient Hypocalcemia

receiving an initial dose of
chemotherapy to treat a TLS is a metabolic complication characterized by
rapidly growing metastatic rapid release of intracellular components in
colon cancer. The nurse is response to chemotherapy. This can rapidly lead to
aware that this patient is at risk acute renal injury. The hallmark signs of TLS are
for tumor lysis syndrome (TLS) hyperuricemia, hyperphosphatemia, hyperkalemia,
and will monitor the patient and hypocalcemia.
closely for which abnormality
associated with this oncologic
emergency?
-Hypokalemia
-Hypouricemia
-Hypocalcemia
-Hypophosphatemia

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7/20/23, 10:47 PM Oncology Flashcards | Quizlet

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Terms in this set (457)

The nurse is caring for a patient receiving an initial

A patient with tumor lysis syndrome is taking

The student nurse's teaching has been effective

A nurse has gone through the teaching about how

Answer: D The nurse is taking care of a patient who is

Answer: A, C, D A patient recently had a stem cell transplant. The

7 year old is admitted 1-week post chemo with signs

You are the nurse evaluating a patient with

Place the sequence of DIC in the correct order

The role of the nurse working with a stem cell

When teaching a student nurse about stem cell

The nurse is caring for a patient C) Hypocalcemia

Which item would be most D) 1 tsp salt in 1 L water mouth rinse

Which nursing diagnosis is D) Risk for infection

Previous administrations of A) A bland, low-fiber diet

Which cellular dysfunction in Dynamic equilibrium is the regulation of

A patient has been diagnosed D) Epstein-Barr virus

Immunologic surveillance is the process where

The patient is told that the C) It is probably benign.

The patient and his family are A) Maintain hope.

The patient is receiving D) Acetaminophen (Tylenol)

B) Turn off the chemotherapy infusion.

The nurse is teaching a B) A woman who has a body mass index of 35

The nurse assesses a 76-year- A) "Have you had a fever?"

A 64-year-old male patient C) Provide high-protein and high-calorie, soft foods

What features of cancer cells A) Cells lack contact inhibition.

A characteristic of the stage of D) proliferation of cancer cells in spite of host

The primary protective role of A) surveillance for cells with tumor-associated

The primary difference D) characteristic of tissue invasiveness.

The goals of cancer treatment C) a combination of treatment modalities is effective

D) use a central venous access device.

If vesicants are inadvertently infiltrated into the skin,

The nurse explains to a patient B) requires the use of radioactive precautions

A patient on chemotherapy C) Temperature of 101.9° F, fatigue, and shortness of

A 70-year-old male patient has A) Hypercalcemia

Which assessment finding of a B) The presence of an irregularly shaped mole that

The nurse should teach a A) Tetracycline

In teaching a patient with A) the thickness of the lesion.

What nursing intervention B) Administration of oral or IV corticosteroids

The patient with cancer is A) Strict hand washing

A 57-year-old patient has been

A 22-year-old female patient B) Two to four cycles of ABVD: doxorubicin

The patient is admitted with A) Multiple myeloma

A 64-year-old man with D) Check stools for presence of frank or occult

The nurse is assigned to care C) A 40-year-old patient with a temperature of

In a severely anemic patient, A) dyspnea and tachycardia.

A) administering the prescribed antibiotic STAT.

The most common type of D) chronic lymphocytic leukemia.

The nurse is aware that a major C) non-Hodgkin's lymphoma can manifest in

A patient with multiple C) hypercalcemia.

The nurse is caring for a patient B) Spinal shock syndrome

Which clinical manifestation A) Bradycardia

When planning care for a D) Ineffective airway clearance caused by high

The nurse is providing care for C) Respiratory assessment

Which manifestations in a A) Headache and rising blood pressure

Which intervention should the A) Urinary catheterization

The patient with peripheral C) Administration of corticosteroid medications

While on a mission trip, the B) Tracheostomy for mechanical ventilation

After learning about D) "With rehabilitation, I will be able to function at

A 68-year-old patient with a B) Eat 20-30 g of fiber per day.