Hondros Nursing 212 Exam 1

1. What are the differences of cancer in men than women?:  -More men

than women die from cancer-related deaths each year.

-Mortality rate from lung cancer is higher in men (26%.)

-Cancer with the highest incidence among men is prostate cancer (19%.)

-Men are more likely to develop liver cancer.

-Head and neck cancers occur more often in men.

2. What are the differences of cancer in women than men?:  -Cancer

with the highest death rate among women is lung cancer (25%.)

-Cancer with the highest incidence among women is breast cancer (30%.)

-Thyroid cancer is more prevalent in women.

-Women are less likely to have colon cancer screenings.

3. What does it mean if a tumor has a Grade I Histologic rating?:  Cells

differ slightly from normal cells (mild dysplasia) and are well differentiated (low

grade.)

4. What does it mean if a tumor has a Grade II Histologic rating?:  Cells

are more abnormal (moderate dysplasia) and moderately differentiated (intermediate

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grade.)

5. What does it mean if a tumor has a Grade III Histologic rating?: Cells are

very abnormal (severe dysplasia) and poorly differentiated (high grade.)

6. What does it mean if a tumor has a Grade IV Histologic rating?: Cells are

immature, primitive (anaplasia), and undifferentiated; cell of origin is hard to

determine (high grade.)

7. What does it mean if a tumor has a Grade X Histologic rating?: Grade cannot

be assessed.

8. What does a Stage 0 cancer indicate?: Cancer in situ.

9. What does a Stage I cancer indicate?: Tumor limited to the tissue of origin;

localized tumor growth.

10. What does a Stage II cancer indicate?: Limited local spread.

11. What does a Stage III cancer indicate?: Extensive local and regional spread.

12. What does a Stage IV cancer indicate?: Metastasis (spread of the cancer to a

distant site.)

13. What should you teach patients and the public about cancer

prevention and early detection?: -Limit alcohol use.

-Get regular physical activity (e.g., 30 minutes or more of moderate physical activity 5

times weekly.)

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-Maintain a normal body weight.

-Have regular physical examinations.

-Obtain regular colorectal screenings.

-Avoid cigarette smoking and other tobacco use.

-Get regular mammography screening and Pap tests.

-Be familiar with your own family history and risk factors for cancer.

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-Obtain adequate, consistent periods of rest (at least 6 to 8 hours per night.)

-Use sunscreen with a sun protection factor of 15 or higher. Avoid the use of tanning beds.

-Eliminate, reduce or change the perception of stressors and enhance the ability to

effectively cope with stress.

-Eat a balanced diet that includes vegetables and fresh fruits, whole grains, and adequate

amounts of fiber. Reduce dietary fat and preservatives, including smoked and salt-cured

meats with high nitrate concentrations.

14. What are the warning signs of cancer?: -Change in bowel or bladder habits.

-A sore that does not heal.

-Unusual bleeding or discharge from any body orifice.

-Thickening or a lump in the breast or elsewhere.

-Indigestion or difficulty in swallowing.

-Obvious change in a wart or mole.

-Nagging cough or hoarseness.

15. What are some problems caused by chemotherapy and radiation

therapy?-

: -Hyperuricemia

-Cardiotoxicity
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-Pericarditis and Myocarditis

-Fatigue

-Anorexia

-Constipation

-Diarrhea

-Hepatotoxicty

-Nausea and Vomiting

-Stomatitis, Mucositis, and Esophagitis

-Hemorrhagic Cystitis

-Nephrotoxicity

-Reproductive Problems

-Anemia

-Leukopenia

-Thrombocytopenia

-Alopecia

-Chemotherapy-Induced Skin Changes

-Radiation Skin Changes (dry to moist desquamation)

-Cognitive Changes ("chemo brain")

-Intracranial Pressure

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-Peripheral Neuropathy

-Pneumonitis

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16. What are some examples of oncologic emergencies?: -Spinal Cord Com-

pression

-Superior Vena Cava Syndrome (SVCS)

-Third Space Syndrome

-Hypercalcemia

-Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

-Tumor Lysis Syndrome (TLS)

-Cardiac Tamponade

-Carotid Artery Rupture

17. What are the manifestations of Superior Vena Cava Syndrome?: -Facial

edema, periorbital edema

-Distention of veins of head, neck, and chest

-Headache- seizures

-Mediastinal mass on chest x-ray

18. What are factors that affect how patients cope with cancer?: -Ability to

cope with stressful events in the past.

-Ability to express feelings and concerns.

-Age at the time of diagnosis.

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-Attitude associated with the cancer.

-Availability of significant other.

-Disruption of body image.

-Extent of disease.

-Past experiences with cancer.

-Symptoms.

19. In the TNM Classification System, what does TX indicate?: Tumor cannot be

measured.

20. In the TNM Classification System, what does T0 indicate?: No evidence of

primary tumor (tumor cannot be found.)

21. In the TNM Classification System, what does Tis indicate?: Tumor in situ,

meaning only malignant cells only within superficial layer of tissue; no extension into

deeper tissue.

22. In the TNM Classification System, what does T1/T2/T3/T4 indicate?: A de-

scription of primary tumor based on size and/or invasion into nearby structures; the higher

the T number, the larger the tumor and/or the more it has grown into nearby tissues.

23. In the TNM Classification System, what does NX indicate?: Nearby lymph

nodes cannot be evaluated.

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24. In the TNM Classification System, what does N0 indicate?: No evidence of

cancer cells in regional lymph nodes.

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25. In the TNM Classification System, what does N1/N2/N3 indicate?: A

descrip- tion of size, location, and/or number of lymph nodes involved; the higher the N

number, the more extensive the lymph node involvement.

26. In the TNM Classification System, what does MX indicate?: Metastasis can-

not be evaluated.

27. In the TNM Classification System, what does M0 indicate?: No evidence of

metastasis can be found.

28. In the TNM Classification System, what does M1/M2/M3/M4 indicate?:

A description of extent of metastasis; the higher the M number, the more extensive the

metastasis.

29. What is palliative care?: A holistic approach to care or treatment that focuses on

reducing the severity of disease symptoms, rather than trying to delay or reverse the

progression of the disease itself or provide a cure.

30. What are the goals of palliative care?: -Regard dying as a normal process.

-Provide relief from symptoms, including pain.

-Affirm life and neither hasten nor postpone death.

-Support holistic patient care and enhance quality of life.

-Offer support to patients to live as actively as possible until death.

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-Offer support to the family during the patient's illness and in their own bereavement.

31. What are the main goals of hospice care?: To assist the patient to live as fully

and comfortably as possible while dying with dignity.

32. What is the major difference between palliative care and hospice care?-

: Palliative care allows a person to simultaneously receive curative and palliative

treatments.

33. When does hospice care become an option?: When the physician deter-

mines a person has 6 months or less to live and that person or health care proxy decides

to forgo curative treatments.

34. What are the goals of end of life care?: -Provide comfort and supportive care

during the dying process.

-Improve quality of the patient's remaining life.

-Help ensure a dignified death.

-Provide emotional support to the family.

35. What are the physical manifestations at end of life related to the

cardiovas- cular system?: -Increased heart rate, later slowing and weakening of pulse

-Irregular rhythm

-Decreased BP

-Delayed absorption of drugs given IM or subcutaneously

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36. What are the physical manifestations at end of life related to the gas-

trointestinal system?: -Slowing or cessation of GI function (may be enhanced by

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pain-relieving drugs)

-Gas accumulation

-Distention and nausea

-Loss of sphincter control, producing incontinence

-Bowel movement before imminent death or at time of death

37. What are the physical manifestations at end of life related to the

integu- mentary system?: -Mottling on hands, feet, arms and legs

-Cold, clammy skin

-Cyanosis of nose, nail beds, knees

-"Waxlike" skin when very near death

38. What are the physical manifestations at end of life related to the

muscu- loskeletal system?: -Gradual loss of ability to move

-Sagging of jaw resulting from loss of facial muscle tone

-Difficulty speaking

-Swallowing becoming more difficult

-Difficulty maintaining body posture and allighment

-Loss of gag reflex

-Jerking seen in patients on high doses of opioids

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39. What are the physical manifestations at end of life related to the

respiratory system?: -Increased respiratory rate

-Cheyne-Stokes respiration

-Inability to cough or clear secretions resulting in grunting, gurgling, or noisy con- gested

breathing (death rattle or terminal secretions)

-Irregular breathing, gradually slowing down to terminal gasps (may be described as guppy

breathing)

40. What are the physical manifestations at end of life related to the

sensory system?: -Hearing usually last sense to disappear

-Blurring of vision

-Sinking and glazing of eyes

-Blink reflex absent

-Eyelids stay half-open

-Taste and smell become decreased with disease progression

-Decreased sensation of pain and touch

41. What are the physical manifestations at end of life related to the

urinary system?: -Gradual decrease in urine output

-Incontinence of urine

-Inability to urinate

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42. What are the psychosocial manifestations at end of life?: -Altered decision

making

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-Anxiety about unfinished business

-Decreased socialization

-Fear of loneliness

-Fear of meaninglessness of one's life

-Fear of pain

-Helplessness

-Life review

-Peacefulness

-Restlessness

-Saying goodbyes

-Unusual communication

-Vision-like experiences

-Withdrawal

43. What are the five stages in the Kubler-Ross Model of Grief?: 1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance
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44. What might a person say while in the Denial stage of grief?: "No, not me, it

cannot be true."

45. What might a person say while in the Anger stage of grief?: "Why me?"

46. What might a person say while in the Bargaining stage of grief?: "Yes me,

but..."

47. What might a person say while in the Depression stage of grief?: "Yes me,

and I am sad."

48. What might a person say while in the Acceptance stage of grief?: "Yes

me, but it is okay."

49. How does the nurse manage an individual's psychosocial needs at the

end of their life?: -Encourage the dying person and family to share their feelings of

sadness, loss, forgiveness and to touch, hug, cry. Allow the patient and family privacy to

express their feelings and comfort one another.

-Assess spiritual needs. Allow patient to express his or her spiritual needs.

-Encourage visit by appropriate spiritual care service provider, chaplain, or family member.

-Encourage the family to talk with and reassure the dying person.

-Affirm the dying person's experience as a part of transition from this life.

-Converse as though the patient were alert, using a soft voice and gentle touch.

50. How does the nurse provide postmortem care?: -Close the patient's eyes

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and jaw.

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-Replace dentures, remove jewelry and eyeglasses.

-Wash the body as needed then apply a clean gown and bed linen.

-Place a waterproof pad or incontinence brief to absorb urine and feces.

-Comb and arrange the hair neatly.

-Remove tubes and dressings if appropriate.

-Straighten the body, placing the arms at their sides or across the abdomen with palms

down.

-Place a pillow under the head.

51. What are the goals of treatment for Inflammatory Bowel Disease?: -Rest

the bowel

-Control the inflammation

-Combat infection

-Correct malnutrition

-Provide symptomatic relief

-Improve quality of life

52. What types of diagnostic assessments would you perform if a patient

has IBD?: -History and physical examination

-CBC, erythrocyte sedimentation rate

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-Serum chemistries

-Testing of stool for occult blood and infection

-Capsule endoscopy

-Radiologic studies with barium contrast

-Sigmoidoscopy and/or colonoscopy with biopsy

53. What type of diet should a person with IBD be on?: High calorie, high

vitamin, high protein, low residue, lactose free (if lactase deficiency.)

54. What are the assessment findings related to Ulcerative Colitis?: -Anorexia

-Weight loss

-Malaise

-Abdominal tenderness and cramping

-Severe diarrhea that may contain blood and mucus

-Malnutrition, dehydration, and electrolyte imbalances

-Anemia

-Vitamin K deficiency

55. What are the assessment findings related to Crohn's Disease?: -Fever

-Cramp-like and colicky pain after meals

-Diarrhea (semisolid), which may contain mucus and pus

-Abdominal distention

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-Anorexia, nausea and vomiting

-Weight loss

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-Anemia
-Dehydration
-Electrolyte imbalances
-Malnutrition (may be worse than that seen in ulcerative colitis)

56. What are the differences of lung cancer in men compared to women?: -

Men have a 1 in 15 chance of developing lung cancer (smokers and nonsmokers.)

-Men are diagnosed with lung cancer more than women.

-More men die from lung cancer more than women.

-Male smokers are 10 times more likely to develop lung cancer than nonsmokers.

-Lung cancer incidence and deaths are decreasing in men.

57. What are the differences of lung cancer in women compared to men?: -

-Women have a 1 in 17 chance of developing lung cancer (smokers and nonsmok- ers.)

-Lung cancer incidence and deaths are increasing in women.

-Women develop lung cancer after fewer years of smoking than men.

-Women develop lung cancer at a younger age than men.

-Nonsmoking women are at greater risk for developing lung cancer than nonsmoking men.

-Women with lung cancer live, on the average, 12 months longer than men.

58. What is the most common symptom that is reported first if someone has

lung cancer?: A persistent cough.

59. What are the assessment findings related to lung cancer?: -Cough
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-Wheezing, dyspnea

-Hoarseness

-Hemoptysis, blood-tinged or purulent sputum

-Chest pain

-Anorexia and weight loss

-Weakness

-Diminished or absent breath sounds, respiratory changes

60. What type of diagnostic assessments would you perform if a patient

has lung cancer?: -History and physical examination

-Chest x-ray

-Bronchoscopy

-Cytologic study of bronchial washings or pleural space fluid

-Transbronchial or percutaneous fine-needle aspiration

-CT scan, MRI, PET

-Mediastinoscopy

-Video assisted thoracoscopic surgery (VATS)

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61. What are the risk factors for breast cancer?: -Age 50 years or older

-Alcohol use

-Benign breast disease with atypical epithelial hyperplasia, lobular carcinoma in situ

-Early menarche (before age 12), late menopause (after age 55)

-Exposure to ionizing radiation

-Family history

-Female

-Full term pregnancy after age 30, nulliparity, no breastfeeding

-Genetic factors (BRCA1, BRCA2, P53, PTEN, PALB2, ATM, CHEK2, NBM)

-Hormone use

-Long term heavy smoking

-Personal history of breast, colon, endometrial, or ovarian cancer

-Physical inactivity

-Weight gain and obesity after menopause

62. What are the assessment findings related to breast cancer?: -Mass felt

during BSE (usually felt in the upper outer quadrant, beneath the nipple, or in axilla)

-Presence of lesion on mammography

-A fixed, irregular nonencapsulated mass; typically painless except in the l ate stages
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-Asymmetry

-Blood or clear nipple discharge

-Nipple retraction or elevation

-Skin dimpling, retraction, or ulceration

-Skin edema or peau d'orange skin

-Axillary lymphadenopathy

-Lymphedema of the affected arm

-Symptoms of bone or lung metastasis in late stage

63. What is Euthanasia?: The deliberate act of hastening death.

64. What is Physician-Assisted Suicide?: The physician provides the means

and/or information about how the patient can commit suicide.

65. What is Palliative Sedation?: The use of medications to intentionally produce

sedation to relieve intractable symptoms and distress in a patient who is imminently dying.

66. What is the Principle of Double Effect?: A principle that regards it morally

permissible to give a medication that has the potential for harm if it is given with the intent

of relieving pain and suffering and not intended to hasten death.

67. What are the common adverse effects of Letrozole?: Musculoskeletal pain

and nausea. Other reactions include headache, arthralgia, fatigue, constipation,

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 steoporosis,
dyspnea, cough, vomiting, diarrhea, and hot flashes. It can also cause o fractures,

and rarely thromboembolism.

68. What are the common adverse effects of Tamoxifen?: Hot flashes, fluid re-

tention, vaginal discharge, nausea, vomiting, and menstrual irregularities. In and a flare
women in
with
a small risk of
bone metastases, tamoxifen may cause transient hypercalcemia

bone pain. Because of its estrogen agonist actions, tamoxifen poses thromboembolic

events, including deep vein thrombosis, pulmonary embolism, and stroke. The biggest
h involves a
concern is endometrial cancer.

69. What is the 1st stage of cancer development?: Initiation, whic

mutation in the cell's genetic structure.

70. What is the 2nd stage of cancer development?: Promotion, w hich is charac-

terized by the reversible proliferation of the altered cells.

71. What is the 3rd (last) stage of cancer development?: Progression, which is
iveness, and
characterized by increased growth rate of the tumor, increased invas

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metastasis.

72. When does Acute toxicity occur?: During and right after drug administration. It

includes anaphylactic and hypersensitivity reactions, extravasation or a flare reaction,

anticipatory nausea and vomiting, and dysrhythmias.

73. What is involved in Chronic toxicities?: Damage to organs, such as the heart,

liver, kidneys and lungs. Chronic toxicities can be either long term effects that develop

rized
during or right after treatment and persist or late effects that are absent during by
treatment
nied by gener-
and manifest later. nd metabolic

74. What is cachexia?: A complex, multifactorial syndrome characte

anorexia and/or unintended loss of weight and appetite. It is accompa alized

tissue wasting, skeletal muscle atrophy, immune dysfunction, a problems.

75. cellular regulation: all functions carried out within a cell to maintain homeosta- sis,

including its responses to extracellular signals and the way each cell produces an

intracellular response

76. proliferation: reproduction of new cells through cell growth and cell division

77. Differentiation: process that progresses from a state of immaturity to a state of

maturity

78. protooncogenes: normal cell genes that are important regulators of normal cell

processes

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79. oncogens: mutation of protoocogenes, which then induce tumors. oncogenic

viruses cause genetic alterations and mutations that allow the cell to express the abilities

and properties it had in fetal development and may lead to cancer

80. carcinogens: agents that cause cancer can be chemical radiation or viral

81. BRCA1

BRCA2 (tumor suppressor genes): alterations in these genes increase a persons risk

for breast and ovarian cancer

82. APC gene (tumor suppressor gene): alterations in this gene increase a per-

sons risk for familial adenomatous polyposis, which is a precursor for colorectal cancer

83. p53 (tumor suppressor gene): mutations of this gene MANY cancers

bladder

breast colorectal

esophageal liver

lung

ovarian cancers

84. three stages of the development of cancer: initiation

promotion

progression
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85. initiation (first stage of the development of cancer): involves a mutation in

the cells genetic structure

86. mutation: any change in the usual DNA sequence

87. promotion (second stage of development of cancer): reversible proliferation

of the altered cells

88. latent period: includes both the initiation and promotion stages in the history of

cancer

89. progression (final stage of development of cancer): characterized by in-

creased growth rate of tumor,increased invasiveness, and metastasis

90. metastasis: spread of cancer to a distant site

91. tumor angiogenesis: process of the formation of blood vessels within the tumor

itself

92. most frequent sites of metastasis: lungs, brain, bone, liver, and adrenal glands

93. immunologic escape: process by which cancer cells evade the immune system

94. cancer stage 0: cancer in situ

95. cancer stage I: tumor limited to the tissue of origin:localized tumor growth

96. cancer stage II: limited local spread

97. cancer stage III: extensive local and regional spread

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98. cancer stage IV: metastasis

99. TNM classification system: Primary tumor (T)

Regional Lynph nodes (N)

Distant Metastases (M)

100. seven warning signs of cancer:

CAUTION change in bowel or bladder habits

a sore that does not heal

unusual bleeding or discharge from any body orifice

thickening of a lump in the breast or elsewhere

indigestion or difficulty in swallowing

obvious change in a wart or mole

nagging cough or hoarseness

101. prevention and early detection of cancer: limit alcohol use

get regular physical activity

maintain normal body weight

obtain regular colorectal screenings

avoid cigarette smoking and other tobacco use get

regular screening and pap tests

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use sunscreen with a sun protection factor of 15 or higher

practice healthy dietary habits, such as reducing fat consumption, avoid eating processed

meats, and increasing fruit and vegetable consumption

102. goals of cancer treatment: cure

control

palliation

103. teletherapy: external beam radiation, most common

104. brachytherapy: close or internal radiation treatment, implantation or insertion of

radioactive materials directly into the tumor, or in close proximity of the tumor

105. immunotherapy: uses the immune system, biologic therapy

106. targeted therapy: interferes with cancer growth by targeting specific cell re-

ceptors and pathways that are important in tumor growth

107. cancer cachexia: wasting syndrome, is a complex, multifactorial syndrome

characterized by anorexia and/or unintended loss of weight and apetite

108. oncologic emergencies: life threatening emergencies that can occur as a re- sult

of cancer or cancerhormome treatment, these emergencies can be obstructive, metabolic or

infiltrative

109. pain assessment in cancer patients: location

intensity

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quality

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pattern

relief measures

110. palliation: relieves pain

relieve obstruction

improve sense of well being

111. control: breast cancer

non hodgkins lympjome small

cell lung cancer ovarian

cancer

112. cure: burkitts lymphoma

wilms tumor

neuroblastomaacute lymphoctic leukemia hodgkins

lymphoma

testicular cancer

113. chemotherapy (antineplastic therapy): is the use of chemicals as a systemic

therapy for cancer

114. biopsy: removal of a tissue sample for pathologic analysis

115. benign neoplasms: well differentiated

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116. malignant neoplasms: range from well differentiated to undifferentiated

the ability of malignant tumor cells to invade and metastasize is the major difference

between benign and malignant neoplasms

117. carcinoma in situ (CIS): refers to a neoplasm whose cells are localized and

show no tendency to invade or metastasize to other tissues

118. what defect of cellular proliferation is involved in the development of

cancer?: indiscriminate and continuous proliferation of cells with loss of contact

inhibition

119. A patient is admitted with acute myelognous leukemia and a history of

Hodgkins lymphoma, what is the nurse most likely to find n patients

history?-

: alkylating agents for treating the hodgkins lympjoma

120. what is the name of a tumor from the embryonal mesoderm tissue of

origin located in the anatomic site of the meninges that has malignant

behav- ior?: meningeal sarcoma

121. which condition would be most likely to be cured with chemotherapy

as a treatment measure?: neuroblastoma

122. nitrosoureas: cell cycle phase- non specific, break the DNA helix, and cross the

blood brain barrier

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123. antimetabolites: cell cycle phase- specific drugs that mimic essential cellular

metabolites to interfere with DNA synthesis

124. mitotic inhibitors: cell cycle phase-specific drugs that arrest mitosis

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125. antitumor antibiotics: cell cycle phase- non specific but bind with DNA to

block RNA

126. bladder cancer treatment?: intravesical regional chemotherapy is adminis-

tered into the bladder via a urinary catheter

127. leukemia treatment?: IV chemotherapy

128. osteogenic sarcoma treatment?: intraarterial chemotherapy via vessels sup-

plying tumor

129. metastasis to the brain treatment?: intraventricular or intrathecal chemother-

apy via an ommaya reservoir or lumbar punctures

130. metastasis from a primary colorectal cancer treatment?: intraperitoneal

regional chemotherapy

131. intrathecal chemotherapy administration is used for?: spinal cord or the

brain

132. intraarterial chemotherapy administration is used for?: tumors to specific

vessels

133. What should be done when there is an obstruction in a chest tube

and why?: Milk the tube, never strip due to pressure changes

134. When is it normal to find bleeding in a chest tube?: Only with a hemothorax
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135. Is tidaling normal with a chest tube?: Yes, on respirations

136. What does it mean when there is no longer tidaling with a chest tube?: -

That the tube is ready to be taken out

137. Is constant bubbling with a chest tube good or bad?: Bad

138. Is crepidous supposed to be at the chest tube site?: No, but usually re-

solves back into the body

139. What is crepidous?: Air bubbles in the subcutaneous tissue surrounding chest tube

site

140. How should a chest tube be observed for any issues?: From the patient to

the machine

141. What is the first thing the nurse should do if she suspects any issues

with a patients chest tube?: Make sure the chest tube connections are secure

142. What are the steps to a self breast exam?: Step 1: Lie down and place left

arm behind head (lying down spreads breast tissue evenly)

Step 2: Use finger pads of 3 middle fingers on your right hand to feel for lumps in the left

breast. Use overlapping dime-sized circular motions to feel breast tissue. Light, medium,

and firm pressure to feel each layers. (A firm ridge on the curve of each breast is normal)

Step 3: Move around breast in a vertical pattern at an imaginary straight line down your

side from the underarm.

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Respect for right breast.

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Step 4: Stand in front of mirror and tighten pectoral muscles for any redness, lumps,

shapes, or scaliness near nipples.

Step 5: Examine each underarm for and knot, or thickening tissue

143. What prevents lymphedema?: Exercise, healthy diet (health maintenance)

144. Treatment for lymphedema?: Healthy diet, exercise, compression stockings,

good skin/nail care, decongestive therapy, elevate extremity, isometric exercises

145. What are neutropenic precautions?: Avoid fresh fruits/veggies, no fresh

flowers, good hand hygiene (infection prevention)

146. Signs and symptoms of thrombocytopenia?: Most patients are asympto-

matic, but s\s include bleeding (mucosal or cutaneous), bruising, petechiae, purpura, and s\s

of hemmorhaging.

147. Adverse affects of chemo/radiation?: Nausea, vomiting, anorexia, diarrhea,

skin breakdown, reproductive dysfunction, nephrotoxicity, neuropathy, anemia

148. Fatigue management for chemo?: Encourage moderate exercise as tolerat- ed,

encourage rest when fatigued but to continue to maintain lifestyle patterns as much as

possible while pacing activities to energy level, and reassure that fatigue is a common side

affect

149. Stages of cancer?: 1-Initiation

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2-Promotion-Can be reversed with lifestyle changes. 3-

Latent

4-Progression

150. Initiation stage: Injury to DNA, genetic changes.

151. Promotion stage: Proliferation, reversible (lifestyle changes can reduce risk)

152. Latent stage: Tumor present, no evidence of cancer

153. Progression stage: Tumor has own blood supply, increased growth rate, in-

vading surrounding cells, metastases

154. Are all side effects of chemo instant?: No, can be latent for a few days to a

week

155. Proper PPE for nurse administering chemo?: Gloves, gown, and mask

156. Proper skin care for a patient on radiation therapy?: Aloe or lotion without

perfume, metal, alcohol, or additives. No heating pads or ice packs. Frequent skin

assessments.

157. S\S of adverse affects of IV chemo?: Painful, red, swollen, or blistered IV site.

158. Primary prevention for cancer?: Lifestyle changes, healthy diet, exercise,

smoking cessation.

159. Secondary prevention for cancer?: Screenings (breast/testicle self exam,

Pap smear, PSA)

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160. What is an important nursing intervention for a patient with a mastecto-

my: No BP or injections on the side with mastectomy, and elevate arm to help with flow

of lymph due to the risk of lymphedema

161. Characteristics of benign tumors?: slow steady growth, remains localized,

contained within a capsule, crowds normal tissue, rarely fatal, rarely reoccurs after

removal, movable when palpated

162. A patient is receiving chemo, which lab result would mean the

patient should be put on neutropenic precautions?: WBC

163. The nurse is teaching a nursing student about the stages of cancer

development. Which statement by the student indicates a need for

further teaching?

1. The promotion stage includes strategies for preventing cancer.

2.Progression indicates that abnormal cells are being produced at the

same rate as normal cells without stopping.

3.The event that begins the initiation stage is when the DNA in a cell is

damaged or altered: Progression indicates that abnormal cells are being produced at the

same rate as normal cells without stopping.

164. A patient is being treated with chemotherapy for breast cancer. The pa-
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tient's meal tray was just delivered. What foods would the nurse remove

from the tray?

1. Roast beef with gravy

2. Salad with ranch dressing

3. Steamed vegetables

4. Chocolate cake: Salad with ranch dressing

165. A patient is being treated with chemotherapy for breast cancer. What

lab test would the nurse evaluate to determine if there is concern for

spontaneous bleeding?

1. White blood cell

count 2.Hemoglobin

3. Basophil count

4. Platelet count: Platelet count

166. Which genetic marker indicates that a patient may be at an increased

risk of breast and/or ovarian cancer?: BRCA1/BRCA2

167. Anatomical site classifications of cancer: Carcinoma-skin, glands, mucous

membranes.

Sarcoma-muscle, connective tissue, bone, and fat.

Lymphoma/leukemia-Originate in blood.
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168. Cancer Staging: Stage 0-Cancer in situ-localized cells with no threat of metas-

tasis.

Stage 1-Limited local growth-limited to tissue of origin. Stage 2-

Limited local spread.

Stage 3-Extensive local and regional spread.

Stage 4-Metastasis.

169. TNM classification: T-Tumor size and invasiveness.

N-Spread to lymph nodes.

M-Metastasis.

170. CAUTION: C-changes in bowel/bladder habits. A-

A sore that doesn't heal.

U-Unusual bleeding or discharge.

T-Thickening or a lump in breast or elsewhere. I-

Indigestion or difficulty swallowing.

O-Obvious changes in wart or mole. N-

Nagging cough or hoarseness.

171. Thrombocytopenia: Platelet count <50,000.

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DELAYED TOXICITY caused by chemotherapy, may cause bleeding and hemor- rhage.

Pt should avoid straining, platelet transfusion may be needed.

172. Caused by radiation to head and neck and chemo: Mucousitis, Stomatitis,

Esophagitis

173. Delayed effects of chemotherapy: Occur 2 hours to months after treatment.

Include: alopecia, mucousitis, neurotoxicity, thrombocytopenia, bone marrow sup-

pression, neutropenia, anemia, fatigue that interferes with normal daily living, nau- sea,

vomiting diarrhea.

174. Acute toxicity: Occurs during or immediately after chemo administration. Usu- ally

anaphylactic or hypersensitivity reaction. Nausea, vomiting, and heart dysrhyth- mias are

anticipated.

175. Cell cycle phase specific chemo: Attacks cells in proliferation stage to reduce

spread of cancer.

176. Cell cycle phase non-specific: Will attack any area of cell proliferation, in any

cell cycle.

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177. Breast cancer screening guidelines: Consistent monthly self breast exams

starting at age 20.

Age 45-54-annual mammograms.

Age 55 and older, mammograms every 2 years.

178. Clinical manifestations of lung cancer: Early signs-nagging cough, mild to

severe chest pain, dyspnea.

Late signs-anorexia, vomiting, cardiac tamponade, dysrhythmias.

179. Non-small cell lung cancer (NSCLC): a group of lung cancers that includes

squamous cell carcinoma (slow progression), adenocarcinoma (moderate progres- sion),

and large cell carcinoma (rapid progression).

180. Small cell lung cancer (SCLC): Very rapid progression, most malignant form of

lung cancer. Spreads via lymph and blood with frequent metastasis to the brain. Radiation

and chemo may be used to shrink tumor and make breathing easier.

181. Tamoxifen: Used for treatment of breast cancer, can precipitate thromboem-

bolism/pulmonary embolism-monitor closely. May cause irregular vaginal bleeding and

decreased visual acuity. Pt should report vision changes. Females with history of DVT

should avoid smoking and oral contraceptives.

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182. Pneumothorax: Complication of lung cancer, may require chest tube.

183. Radical mastectomy (Halsted mastectomy): Removal of breast tissue, nip-

ple, lymph nodes, muscles are left in tact. Increased risk for lymphedema. Assess cap

refill, brachial and radial pulses, monitor pain and skin color.

184. Lactated Ringers (LR): If prescribed for patients with liver issues/psorosis-call

Dr. to verify order. Monitor closely.

185. A confused patient recently began an antidiuretic, what actions

should the nurse take?: Offer water frequently, monitor mucous membranes.

186. Letrazole (Femara): May cause osteoporosis, pt. should take vitamin D/calci- um

supplement.

187. The diet for stomatitis: Soft foods, neutral or cool temp-avoid very hot and

very cold foods. Avoid spicy foods and strong spices.

188. Diet for cachexia (malnutrition) with non small cell lung cancer:

High protein, high calorie.

189. Kubler-Ross stages of grief: 1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

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190. Hyoscine (scopolamine): Used sublingually to decrease drooling in hospice

patients.

191. Cheyne-Stokes respirations: An irregular pattern of breathing characterized by

alternating rapid or shallow respiration followed by slower respiration or periods of apnea.

192. Highest priority symptoms to manage for dying patient:: Pain, agitation,

nausea.

193. Solu-Medrol (Methylprednisolone) side effects: Potassium loss, weight

gain/fluid retention, insomnia.

194. Physical manifestations at end of life: Cheyne Stokes respirations, de-

creased sensation, irregular pulse, mottling skin/wax like appearance, wet/noisy

respirations.

195. Goals of palliative care: 1. Provide relief from symptoms including pain.

2. Offer support to the family during illness and bereavement.

3. Regard dying as normal process. 4. Support holistic patient care and quality of life.

5. Support patients to live as actively as possible until death.

6. Affirm life and neither hasten nor postpone death.

196. Cancer Grading: Grade I-cells differ slightly from normal cells are are well

differentiated.
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Grade II-cells are more abnormal and are moderately differentiated. Grade III-

cells are very abnormal and are poorly differentiated.

Grade IV-cells are immature and undifferentiated; cell of origin is difficult to deter- mine.

197. Platelets (thrombocytes): 150,000-400,000

198. white blood cell count: 5,000-10,000

199. Hemoglobin (Hgb): 12-18

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