Chapter 15 Cancer Answer Keys for Questions • Rationales for Bridge to NCLEX Examination Questions 1. Correct answer: c Rationale: Cancer incidence and death rates are disproportionately higher among Blacks than among other minority groups and white people. 2. Correct answers: a, c, e Rationale: Cancer cells proliferate at the same rate as the normal cells of the tissue from which they arise. However, cancer cells respond differently than normal cells to the intracellular signals that regulate cell proliferation and death. The result is that the proliferation of the cancer cells is indiscriminate and continuous. They lack contact inhibition. Cancer cells may have altered cell-surface antigens because of malignant transformation. These antigens are termed tumor-associated antigens. Normally the differentiated cell is stable and will not dedifferentiate. Cancer cells can dedifferentiate. Abilities and properties that the cell had in fetal development are again expressed. 3. Correct answer: d Rationale: Progression is the last stage of cancer. This stage is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (e.g., metastasis). Progression occurs because of rapid proliferation and decreased cell adhesion. 4. Correct answer: a Copyright © 2020 by Elsevier, Inc. All rights reserved. Rationale: Cancer cells may have altered cell surface antigens because of malignant transformation. These antigens are called tumor-associated antigens (TAAs). One of the functions of the immune system is to respond to TAAs. 5. Correct answer: d Rationale: While the patient is waiting for diagnostic study results, you should be available to actively listen to the patient’s concerns. You should be skilled in techniques that can engage the patient and caregivers in a discussion about their cancer-related fears. 6. Correct answer: c Rationale: The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the cancer being treated and may involve local therapies (e.g., surgery or radiation) alone or in combination, with or without adjunctive systemic therapy (e.g., chemotherapy). 7. Correct answer: d Rationale: Infusion with central venous access devices reduces the risk of infiltration of chemotherapy agents that are vesicants. If vesicants are inadvertently infiltrated into the skin, severe local tissue breakdown and necrosis may result. 8. Correct answer: b Rationale: Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or next to the tumor. It would not be possible to shield the ovaries during therapy. Caring for the person undergoing brachytherapy requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, Copyright © 2020 by Elsevier, Inc. All rights reserved. and shielding are vital to health care professional safety. Simulation is a process by which external radiation treatment fields are defined. Desquamation is an effect of external radiation. 9. Correct answer: c Rationale: Neutropenia is more common in patients receiving chemotherapy than in those receiving radiation. It can seriously increase the risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly because fever in the setting of neutropenia is a medical emergency. 10. Correct answer: b Rationale: Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is often premedicated with acetaminophen to try to prevent or decrease the intensity of these symptoms. Large amounts of fluids help decrease symptoms. 11. Correct answer: d Rationale: Nausea and vomiting can usually be managed with antiemetic drugs, diet modification, and other nondrug interventions. Some cancer survivors may continue to have symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. Maintaining activity within tolerable limits is helpful in managing fatigue. Lifelong birth control is not necessary. 12. Correct answer: d Rationale: Teach the patient to try different ways to mask the taste changes. Some find stronger seasonings and spices effective. Others find it better to avoid strong flavors and eat more bland foods. Avoiding strong smells, drinking more water with food, oral care before eating, eating smaller amounts more often, and using plastic utensils may help. Copyright © 2020 by Elsevier, Inc. All rights reserved. 13. Correct answer: a Rationale: Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or worsen hypercalcemia. The manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting. 14. Correct answer: a Rationale: Maintain hope, which is the key to effective cancer care. Hope depends on the status of the patient: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care. Copyright © 2020 by Elsevier, Inc. All rights reserved.