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Oncology Exam 275 Questions with Verified Answers
Which risk factor is most significant for developing cancer? a) advancing age b) smoking tobacco c) drinking alcohol d) fam h/o cancer - CORRECT ANSWER a (advancing age) Which demonstrates the nurse's correct understanding of neutropenic precautions? a) moving client to semi-private room b) encouraging fam to visit often c) having room dusted/cleaned frequently d) encouraging fam members to bring fresh flowers - CORRECT ANSWER c (clean/dust frequently) For the client receiving external radiation therapy, which nursing diagnosis is the highest priority? a) altered oral mucuous membrane b) pain c) self-care deficit d) risk for impaired skin integrity - CORRECT ANSWER d (impaired skin integrity) The client diagnosed with terminal cancer blames the medical staff for not operating soon enough. Which stage of the grieving process is the client most likely in? a) denial b) anger c) guilt d) depression - CORRECT ANSWER b (anger) Which assessment measure is indicated for the client receiving radiation therapy for Hodgkin's lymphoma?
a) careful observation of skin b) assessment of DTR's c) measurement of BP & P d) palpation of lymph nodes - CORRECT ANSWER a (careful observation of skin due to side effects of radiation therapy) Which is the most life-threatening side effect of chemotherapy? a) alopecia b) bone marrow suppression c) vomiting d) mucositis - CORRECT ANSWER b (bone marrow suppression - results in decreased leukocytes, erythrocytes, and platelets) The client with terminal cancer says to the nurse, "I just want to make it to my daughter's wedding. If I can just make it to that, then I will be ready to die." The nurse expects the client to be in which stage of the grief process? a) anger b) denial c) bargaining d) acceptance - CORRECT ANSWER c (bargaining - making a deal, usually in regards to more time) What are the most common side effects of external radiation therapy? - CORRECT ANSWER -skin reactions/irritations -fatigue -nausea -anorexia After two weeks of chemotherapy, the client's WBCs are down to 2,000. This is most likely do to which factor? a) weight loss b) polycythemia c) bone marrow depression
ex: heart muscle cells no longer divide after birth, they are fixed birth --> the size of the heart increases as people grow b/c each cell gets larger, but the number of heart muscle cells doesn't increase (hypertrophy) What is the highest priority for the cancer patient receiving narcotic analgesics for pain from metastatic lung cancer? a) increased comfort b) effective airway & respirations c) reduction in perceived pain d) effective coping - CORRECT ANSWER b (airway& respirations --> crucial to monitor resp. b/c cancer patients receive large doses of analgesics & resp. depression is an adverse effect of narcotics) When should antiemetics be administered to a patient receiving chemotherapy? - CORRECT ANSWER before the chemotherapy begins (repeated based on response and duration of CINV) important to coordinate w/ pt & HCP to ensure adequate control of CINV What is any new or continued cell growth that is not needed for normal development or replacement of dead/damaged tissues called? - CORRECT ANSWER neoplasia (always abnormal* even if it doesn't cause any harm) What is the main factor that differentiates cancer cells from normal cells? - CORRECT ANSWER cancer cells lack cellular regulation (cancer cells were once normal cells but underwent genetic mutations to no longer look, grow, or function normally, they have lost their cellular regulations) What is the feature of normal cells in which each normal cell type has a distinct and recognizable appearance, size, and shape? - CORRECT ANSWER specific morphology (a feature of normal cells) What is the predictable factor of normal cells in which the nucleus of the cell is small compared to the rest of the cell, including the cytoplasm? - CORRECT ANSWER smaller nuclear-to-cytoplasmic ratio (a feature of normal cells)
What is the term that means that every normal cell has at least one function that it performs to contribute to the whole-body function? - CORRECT ANSWER differentiated function (a feature of normal cells) What occurs because normal cells make proteins that protrude from the membranes, allowing the cells to bind closely and tightly together? - CORRECT ANSWER tight adherence (a feature of normal cells) fibronectin (except for RBCs & WBCs) prevents cell wandering from one tissue to the next (nonmigratory = feature of normal cells ----> except blood cells) What are the two reasons in which normal cells undergo mitosis (cell division)? - CORRECT ANSWER 1. to develop normal tissue
- to replace lost or damaged normal tissue Which phase of the cell cycle do most normal cells spend most of their lives, actively carrying out their functions but not dividing? - CORRECT ANSWER G (reproductive resting state) Cellular regulation occurs through proteins that are produced by what? - CORRECT ANSWER suppressor genes (these proteins control the amount of cyclins present & ensure that cell division only occurs when it's needed) (cell division depends on the presence & absence of specific cellular regulation proteins - balance between cyclins & suppressor gene products) What are the proteins that promote cells to enter and complete cell division produce by & what are they called? - CORRECT ANSWER produced by oncogenes & known as cyclins (activated cyclins allow cells to leave G0 phase and enter the reproductive cycle) Explain the different phases of the cell cycle (division). - CORRECT ANSWER G0 - living cells carrying out their function but not dividing
What are the ways in which malignant cells differ from normal cells? - CORRECT ANSWER malignant cells are abnormal, serve no useful function, and are harmful to normal body tissues -cell division: rapid/continuous -appearance: anaplastic (cell loses specific appearance of parents -- smaller & rounded , look like other cancer types) -nuclear-to-cytoplasmic ratio: larger -differentiated functions: some or none -adherence: loose (no fibronectin = easily broken off from main tumor) -migratory: yes (metastasize) -growth: invasion -chromosomes: aneuploid -mitotic index: high -no contact inhibition -no apoptosis= immortal (main difference = lack of cellular regulation) What is the process of changing a normal cell into a cancer cell? - CORRECT ANSWER malignant transformation, occurring through a loss of cellular regulation, leading to steps of initiation, promotion, progression, and metastasis (carcinogenesis & oncogenesis = terms for cancer development) Describe the first step of carcinogenesis. - CORRECT ANSWER initiation: -change in gene expression caused by carcinogens leading to loss of cellular regulation -leads to excessive cell division through DNA damage that results in either loss of suppressor gene function or an enhancement of oncogene function -irreversible -cells becomes cancer if loss of cellular regulation continues What are carcinogens? - CORRECT ANSWER substances that changes the activity of a cell's genes so that it becomes a cancer cell
-external: chemicals, physical agents, or viruses (responsible for 80% of cancer in US) The second step of malignant transformation is promotion, describe what happens in this step. - CORRECT ANSWER promotion: -enhanced growth of an initiated cell by promoters (insulin/estrogen) --> make cells divide more frequently -exposure to promoters can shorten latency period & develop into overt tumors quicker What is the time between a cell's initiation and the development of an overt tumor? - CORRECT ANSWER latency period What is the 3rd step of malignant transformation, progression? - CORRECT ANSWER progession: -continued change of cancer, making it more malignant over time to become a health problem: -tumor develops own blood supply (angiogenesis) -new cells change features from the original, initiated cell & form new groups (selection advantages- allow them to live/divide no matter how surrounding conditions change) What is the step of malignant transformation in which cancer cells move from the primary location by breaking off the original group & establish remote colonies? - CORRECT ANSWER metastasis (additional tumors = metastatic or secondary tumors) -even though the tumor is now in another area, it is still a cancer from the original altered tissue (primary) What is the original tumor, identified by the tissue from which is arose (parent tissue)? - CORRECT ANSWER primary tumor What is the most common cause of cancer spread? - CORRECT ANSWER bloodborne metastasis (cancer cells penetrate blood vessels & spread to distant organs/tissues)
True or False: Cancers are classified by the type of tissue from which they arise, biologic behavior, anatomic site, and degree of differentiation - CORRECT ANSWER true True or False: Cancers are either solid (develop from specific tissues) or hematologic (arise from blood cell-forming tissues) - CORRECT ANSWER true (breast cancer or lung cancer vs. leukemia or lymphoma) If a cancer has the prefix "adeno", you know that the tissue of origin is what? - CORRECT ANSWER epithelial glands benign = adenoma malignant = adenosarcoma What is the tissue of origin if the cancer's prefix is "chondro"? - CORRECT ANSWER cartilage benign = chondroma malignant = chondrosarcoma What is the tissue of origin for a cancer with the prefix "glio"? - CORRECT ANSWER glial cells (brain) benign = glioma malignant = gliobastoma If a cancer begins with "leiomyo", you know that the tissue of origin is what? - CORRECT ANSWER smooth muscle benign = leiomyoma
malignant = leiomyosarcoma What are the different types of malignant lymphomas? - CORRECT ANSWER - Hodgkin's lymphoma -Non-hodgkin's lymphoma -Burkitt's lymphoma -Cutaneous T-cell What is the tissue of origin for a cancer that begins with "meningioma"? - CORRECT ANSWER meninges benign = meningioma malignant = malignant meningioma or meningioblastoma True or False: A cancer that begins with "neuro" has a tissue of origin in the brain - CORRECT ANSWER FALSE --> tissue of origin = nerve tissue benign = neuoma or neurofibroma malignant = neurosarcoma or neuroblastoma What is the tissue of origin for a cancer that begins with "Rhabdo"? - CORRECT ANSWER skeletal muscle benign = rhabdomyoma malignant = rhabdomyosarcoma Papilloma is a benign tumor with what tissue of origin? - CORRECT ANSWER epithelial layer of skin, MM, or organ linings (prefix = "squamos")
surgical: assesses tumor size, number, sites, and spread by inspection at surgery pathologic: MOST DEFINITIVE - determines tumor size, number, sites, & spread by pathologic examination of tissues obtained at surgery What is the staging system used to describe the anatomic extent of cancers? - CORRECT ANSWER TNM Classification (not useful for leukemia or lymphomas) Primary Tumor (T): Tx- primary tumor cannot be assessed T0- no evidence of primary tumor Tis - carcinoma in situ T1, T2, T3, T4 - increasing size and/or local extent of primary tumor Regional Lymph Nodes (N): Nx- regional lymph nodes cannot be assessed N0- no regional lymph node metastasis N1, N2, N3- increasing involvement of regional lymph nodes Distant Metastasis (M): Mx- presence of metastasis cannot be assessed M0- no distant metastasis M1- distant metastasis higher numbers = later stages = decreased chance for cure/long-term survival What is tumor growth assessed in terms of? - CORRECT ANSWER doubling time (amount of time it takes a tumor to double in size) mitotic index (percentage of actively dividing cells within a tumor) (<10% = slow growing, > 85% = fast growing) What is the size of the smallest detectable tumor? - CORRECT ANSWER 1 cm (contains 1 billion cells)
(to reach this size it must undergo at least 30 doublings) What three factors influence cancer development & account for variation in cancer development from one person to another, even when exposed to the same hazards? - CORRECT ANSWER 1. exposure to carcinogens
- genetic predisposition
- immune function What is the main mechanism of carcinogenesis? - CORRECT ANSWER oncogene activation = excessive cylcin production = uncontrolled cell division (overexpressed due to mutations damaging suppressor genes and preventing them from producing the proteins that control cellular regulation) What two chemical substances act as co-carcinogens, enhancing each other's carcinogenic activity when taken together? - CORRECT ANSWER alcohol & tobacco (only mildly carcinogenic when separate, cancer development requires chronic, long-term exposure to large amounts) 30% of cancer in US RT to tobacco use What is the single most preventable source of carcinogenesis? - CORRECT ANSWER tobacco (long term tobacco use first initiates, then promotes cancer) Tissues with the greatest risk for tobacco-induced cancer are those that have direct contact with tobacco or tobacco smoke, but tobacco use & cigarette smoking also promote the development of other cancers. What are the common cancer types associated with tobacco use? - CORRECT ANSWER -lung -oral cavity -pharynx/larynx -esophagus -pancreas -uterine cervix -kidney -bladder -liver -stomach
What are some common dietary habits that reduce cancer risk? - CORRECT ANSWER -avoid excessive intake of animal fat -avoid nitrites (prepared lunch meats, sausage, bacon) -minimize intake of red meat -limit alcohol intake to no more than 2 drinks/day -eat more bran -eat more cruciferous veggies (broccoli, cauliflower, brussels sprouts, cabbage) -eat foods high in vitamin A & C (apricots, carrots, leafy green/yellow veggies// fresh fruits & veggies, especially citrus fruits) Which of the following are primary prevention efforts? (SATA) a) demonstrating breast self-exam methods to women b) instructing people on the use of chemoprevention c) providing vaccinations against certain cancers d) screening teenage girls for cervical cancer e) teaching teens the dangers of tanning booths - CORRECT ANSWER b, c, e (primary prevention of cancer involves avoiding exposure to known causes of cancer) True or False: Benign tumors grow by expansion whereas malignant tumors grow by invasion - CORRECT ANSWER true What are the personal factors that affect whether a person is likely to develop cancer or not? - CORRECT ANSWER -immune function (NK & T-cells provide immune surveillance from non-self cells -- higher risk if older than 60 due to reduced immunity) -age (immunity decreases and carcinogen exposure accumulates -genetic risk True or False:
Organ transplant recipients taking immunosuppressive drugs to prevent organ rejection are at a higher risk for developing cancer - CORRECT ANSWER true True or False: In patients with AIDS, cancer incidence may be as high as 70% - CORRECT ANSWER true A 65 yo client tells the nurse she does not have mammograms b/c there is no history of breast cancer in her family. What is the nurse's best response? a) "You are correct. Breast cancer is an inherited type of malignancy & your family history indicates a low risk for you." b) "Performing breast self-exams monthly at home is sufficient screening for someone with your family history." c) "B/c your breasts are no longer as dense as they were when you were younger, your risk for breast cancer is now decreased." d) "Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age." - CORRECT ANSWER d True or False: Genetic testing can diagnose the presence of cancer - CORRECT ANSWER FALSE ---> testing only provides risk information (only done if family history clearly indicates possibility to increased genetic risk & the patient wishes to have the test results) positive test results increase the risk for cancer development but the cancer may still never develop ___________ prevention is the use of strategies to prevent the actual occurrence of cancer, most effective when there's a known cause for a cancer type; _____________ prevention is the use of screening strategies to detect cancer early, at a time when cure/control is more likely. - CORRECT ANSWER -primary -secondary
(if a pattern emerges, inform the patient about the benefits of genetic screening & advise pt to talk w/ oncologist or genetics professional) Metastasizing cancers disrupt critical physiologic processes. Which of the following are often caused by advanced cancers? (SATA) a) reduced immunity and blood-producing functions b) altered GI structure and function c) increased respiratory function d) motor and sensory deficits e) weight gain & edema - CORRECT ANSWER a, b, d (cancers reduce respiratory function & cause cachexia) Why are patients with cancer, especially leukemia, at an increased risk for infection? - CORRECT ANSWER tumor cells enter bone marrow and reduce production of healthy WBCs that are needed for normal immune function When cancer cells invade bone marrow, what are the effects that it has on the normal function? - CORRECT ANSWER -reduced production of WBCs -decreased number of RBCs (anemia) -decreased number of platelets (thrombocytopenia) can be caused by cancer itself or by the treatment (chemo) Because of the effects that cancer has when it invades bone marrow, how might you expect the patient to feel? - CORRECT ANSWER weak & fatigued and at risk for impaired clotting w/ bleeding -pt's may be SOB due to anemia, especially if respiratory involvement RT cancer What effects could cancer have on the GI system? - CORRECT ANSWER -tumors can obstruct structures, reducing ability to absorb nutrients & eliminate wastes (liver tumors lead to malnutrition & death) -increased metabolic rate & need for nutrients when pt has less energy for meal prep/eating
-anorexia that interferes w/ ability to meet energy needs ---> cachexia (extreme body wasting & malnutrition) develops from an imbalance b/w food intake & energy use (increased catabolism) (can occur when intake appears adequate) -changes in taste (from cancer or treatment) can result in reduced appetite & food aversions -early satiety/fullness & inability to eat even w/ small amts of food Due to the GI changes that occur due to cancer or it's treatment, what kind of diet is often prescribed to cancer patients? - CORRECT ANSWER diets high in protein & carbs to help maintain weight & provide nutrients needed for energy and cellular repair (currently no one nutrition plan meets the needs of all patients w/ cancer but patients and families believe cancer can be cured more easily if weight is gained/maintained) challenges RT food intake often become an emotional prob for fam What are the motor & sensory deficits that occur due to cancer that invades the bone or brain or compress nerves? - CORRECT ANSWER primary cancer started in another organ (lung, prostate, breast, etc) -thinned bones = increased risk for pathologic fractures w/ minimal truama -bone metastasis causes pain, fractures, spinal cord compression, hypercalcemia, which all reduce mobility -sensory changes occur if spinal cord is damaged/nerves are compressed -sensory, motor, & cognitive function is impaired if cancer spreads to brain (any tumor in brain, cancer or benign, can destroy healthy brain tissue and cause death)
