Medical-Surgical Nursing: Assessment and Management of Clinical Problems

The nurse is presenting a community education program related to cancer prevention. Based on current cancer death rate, the nurse emphasizes what as the most important preventative action for both women and men? a. Smoking cessation b. Routine colonoscopies c. Frequent imaging tests d. Regular examination of reproductive organs a. Smoking cessation What defect in cellular proliferation is involved in the development of cancer? a. A rate of cell proliferation that is more rapid than that of normal body cells. b. Shortened phases of cell life cycles with occasional skipping of GI or S phases c. Rearrangement of stem cell RNA that causes abnormal cellular protein synthesis d. Indiscriminate and continuous proliferation of cells with loss of contact inhibition d. indiscriminate and continuous proliferation of cells with loss of contact inhibition What does the presence of carcinoembryonic antigens (CEAs) and a-fetoprotein (AFP) on cell membranes indicate has happened to the cells? a. They have shifted to more immature metabolic pathways and functions b. They have spread from areas of original development to different body tissues c. They produce abnormal toxins or chemicals that indicate abnormal cellular function d. They have become more differentiated as a result of repression of embryonic function a. They have shifted to more immature metabolic pathways and functions What factor differentiates a malignant tumor from a benign tumor? a. It causes death b. it grows at a faster rate c. It is often encapsulated d. It invades and metastasizes d. it invades and metastasizes A patient is admitted with acute myelogenous leukemia and a history of Hodgkin's lymphoma. What is the nurse most likely going to find in the patient's history? a. Work as a radiation chemist b. Epstein-Barr virus diagnosed in vitro c. Intense tanning throughout the lifetime d. Alkylating agents for treating the Hodgkin's lymphoma d. Alkylating agents for treating the Hodgkin's lymphoma Which mutated tumor suppressor gene is most likely to contribute to many types of cancer, including bladder, breast, colorectal and lung? a. p53 b. APC c. BRCA1 D. BRCA2 a. p53 Cancer cells go though stages of development. What accurately describes the stage of promotion? Select all that applies: a. Obesity is an example of a promoting factor b. The stage is characterized by increased growth rate and metastasis c. Withdrawal of promoting factors will reduce the risk of cancer development d. Tobacco smoke is a complete carcinogen that is capable of both initiation and promotion e. Promotion is the stage of cancer development in which there is an irreversible alteration in the cell's DNA a....c....d The patient was told she has carcinoma in situ, and the student nurse wonders what that is. how should the nurse explain this to the student nurse? a. Evasion of the immune system by cancer cells b. Lesion with histologic features of cancer except invasion c. Capable of causing cellular alterations associated with cancer d. Tumor cell surface antigens that stimulate an immune responce b. Lesion with histologic features of cancer except invasion Which word identifies a mutation of proto-oncogenes? a. Oncogenes b. Retrogenes c. Oncofetal antigens d. Tumor angiogenesis factor a. Oncogenes A patient's breast tumor originates from embryonal ectoderm. It has moderate dysplasia and moderately differentiated cells. It is a small tumor with minimal lymph node involvement and no metastases. What is the best description of this tumor? a. Sarcoma, grade II T3 N4 M0 b. Leukemia, grade I T1 N2 M1 c. Carcinoma, grade II T1 N1 M0 d. Lymphoma, grade III T1 N0 M0 c. Carcinoma grade II T1 N1 M0 The nurse is counseling a group of individuals over the age of 50 with the average risk of cancer about screening tests for cancer. Which screening recommendation should be performed to screen for colorectal cancer? a. Barium enema every year b. Colonoscopy every 10 years c. Fecal occult blood every 5 years d. Annual prostate-specific antigen (PSA) and digital rectal exam b. Colonoscopy every 10 years A small lesion is discovered in a patient's lung when an x-ray is performed for cervical spine pain. What is the definitive method of determining if the lesion is malignant? a. Lung scan b. Tissue biopsy c. Oncofetal antigens d. CT or positron emission tomography (PET) scan b. Tissue biopsy A patient with a genetic mutation of BRCA1 and a family history of breast cancer is admitted to the surgical unit where she is scheduled that day for a bilateral simple mastectomy. What is the reason for this procedure? a. Prevent breast cancer b. Diagnose breast cancer c. Cure or control breast cancer d. Provide palliative care for untreated breast cancer a. Prevent breast cancer Which condition would be most likely to be cured with chemotherapy as a treatment measure? a. Neuroblastoma b. Small cell lung cancer c. Small tumor of the bone d. Large hepatocellular carcinoma a. Neuroblastoma Which classification of chemotherapy drugs is cell cycle phase-nonspecific, breaks the DNA helix that interferes with DNA replication and crosses the blood-brain barrier? a. Nitrosureas b. Antimetabolites c. Mitotic inhibitors d. Antitumor antibiotics a. Nitrosureas The nurse uses many precautions during IV administration of vesicant chemotherapy agents primarily to prevent? a. septicemia b. extravasation c. catheter occlusion d. anaphylactic shock b. extravasation Which factors will assist a patient in coping positively with having cancer? (select all that applies) a. Feeling of control b. Strong support system c. Internalization of feelings d. Possibility of cure or control e. Easier adaptability of a young person f. Not having had to cope with previous stressful events a...b...d The patient with advanced cancer is having difficulty controlling her pain. She says she is afraid she will become addicted to the opioids. What is the FIRST thing the nurse should do for this patient? a. Administer a nonsteroidal anti-inflammatory drug b. Assess the patient's vital signs and behavior to determine the medication to use c. Have the patient keep a pain diary to better assess the patient's potential addiction d. Obtain a detailed pain history including quality, location, intensity, duration, and type of pain d. Obtain a detailed pain history including quality, location, intensity duration and type of pain During initial chemotherapy, a patient with leukemia develops hyperkalemia and hyperuricemia. The nurse recognizes these symptoms as an oncologic emergency and anticipates that the priority treatment will be to: a. increase urine output with hydration therapy b. establish ECG monitoring c. administer a bisphosphonate such as pamidronate d. restrict fluids and administer hypertonic sodium chloride solution a. increase urine output with hydration therapy For which type of malignancy should the nurse expect the use of the intravesical route of regional chemotherapy delivery? a. Bladder b. Leukemia c. Osteogenic sarcoma d. Metastasis to the brain a. Bladder Which delivery system would be used to deliver regional chemotherapy for metastasis from a primary colorectal cancer? a. Intrathecal b. Intraarterial c. Intravenous d. Intraperitoneal d. Intraperitoneal When teaching a patient with cancer about chemotherapy, which approach should the nurse take? a. Avoid telling the patient about possible side effects of the drugs to prevent anticipatory anxiety b. Assure the patient that the side effects from chemotherapy are uncomfortable but never life threatening c. Explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control the side effects d. Inform the patient that chemotherapy related alopecia is usually permanent but can be managed with lifelong use of wigs c. Explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control the side effects Which normal tissues manifest early, acute responses to pelvic radiation therapy? a. Spleen and liver b. kidney and nervous tissue c. Bone marrow and GI mucosa d. Hollow organs such as stomach and bladder c. Bone marrow and GI mucosa The patient is learning about skin care related to external radiation that he is receiving. Which instructions should the nurse include in this teaching? a. Keep area shaved of hair b. Keep the area covered if it is sore c. Dry the skin thoroughly after cleansing it d. Avoid extreme temperatures to the area d. Avoid extreme temperatures to the area When a patient is undergoing brachytherapy, what is important for the nurse to be aware of when caring for this patient? a. The patient will undergo simulation to identify and mark the field of treatment b. The patient is a source of radiation, and personnel must wear film badges during care c. The goal of this treatment is only palliative, and the patient should be aware of the expected outcome d. Computerized dosimetry is used to determine the maximum dose of radiation to the tumor within an acceptable dose to normal tissue b. The patient is a source of radiation, and personnel must wear film badges during care To prevent the debilitating cycle of fatigue-depression-fatigue in patients receiving radiation therapy, what should the nurse encourage the patient to do? a. Implement a walking program b. Ignore the fatigue as much as possible c. Do the most stressful activities when fatigue is tolerable d. Schedule rest periods throughout the day whether fatigue is present or not a. Implement a walking program