Tumors and Cancer - NCLEX-PN
Card 1 of 636
The oncology nurse cares for a patient who has been newly diagnosed with leukemia. Which of the following sets of symptoms would the nurse not expect during the initial physical assessment?
The oncology nurse cares for a patient who has been newly diagnosed with leukemia. Which of the following sets of symptoms would the nurse not expect during the initial physical assessment?
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Leukemia is a cancer of white blood cells, limiting the ability of the body to fight infection. Patients with leukemia exhibit altered leukocyte counts (less than 
), as well as ulcerations of the mouth and throat, pneumonia, septicemia, anemia, fatigue, lethargy, weakness, pallor, weight loss, headache, disorientation, and forms of bleeding, including bleeding gums, ecchymosis, petechiae, and retinal hemorrhaging. Patients with leukemia do not usually exhibit weight gain (usually loss), high red blood cell counts (usually anemic), and flushing (usually pallor).
Leukemia is a cancer of white blood cells, limiting the ability of the body to fight infection. Patients with leukemia exhibit altered leukocyte counts (less than
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Which of the following image modalities would be best suited to diagnose a suspected lung cancer?
Which of the following image modalities would be best suited to diagnose a suspected lung cancer?
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A CT scan is the preferred imaging modality to view a tumor in the lung tissue. A chest x-ray might initially find a nodule or abnormal marking in the lungs, but it must be followed up with a CT scan to be diagnostic. EKG looks at the heart and EEG looks at the brain.
A CT scan is the preferred imaging modality to view a tumor in the lung tissue. A chest x-ray might initially find a nodule or abnormal marking in the lungs, but it must be followed up with a CT scan to be diagnostic. EKG looks at the heart and EEG looks at the brain.
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You are the nurse taking care of a patient newly diagnosed with ovarian cancer. Which of the following biomarkers is typically followed to assess the progress of disease (or response to treatment) in ovarian cancer patients?
You are the nurse taking care of a patient newly diagnosed with ovarian cancer. Which of the following biomarkers is typically followed to assess the progress of disease (or response to treatment) in ovarian cancer patients?
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The correct answer is "Cancer antigen (CA-125)" because CA-125, also known as mucin 16, is a glycoprotein that is found to have elevated serum levels in patients with a variety of cancers (including ovarian cancer) and benign conditions, as compared to patients without such conditions. As a result, monitoring CA-125 levels can be used as a method of tracking disease progression or response to treatment based upon what the initial CA-125 level is at the time of diagnosis.
On the other hand, the other choices are incorrect. Cancer antigen 19-9 (CA 19-9) is incorrect as this is a biomarker in pancreatic cancer, not ovarian cancer.Prostate specific antigen (PSA) is incorrect as this is a biomarker in prostate cancer (and other prostate conditions), not ovarian cancer. c-KIT is incorrect as this is a biomarker in gastrointestinal stromal tumors, not ovarian cancer. BCR/ABL is incorrect as this is the translocation found in the Philadelphia Chromosome implicated in chronic myelogenous leukemia, not ovarian cancer.
The correct answer is "Cancer antigen (CA-125)" because CA-125, also known as mucin 16, is a glycoprotein that is found to have elevated serum levels in patients with a variety of cancers (including ovarian cancer) and benign conditions, as compared to patients without such conditions. As a result, monitoring CA-125 levels can be used as a method of tracking disease progression or response to treatment based upon what the initial CA-125 level is at the time of diagnosis.
On the other hand, the other choices are incorrect. Cancer antigen 19-9 (CA 19-9) is incorrect as this is a biomarker in pancreatic cancer, not ovarian cancer.Prostate specific antigen (PSA) is incorrect as this is a biomarker in prostate cancer (and other prostate conditions), not ovarian cancer. c-KIT is incorrect as this is a biomarker in gastrointestinal stromal tumors, not ovarian cancer. BCR/ABL is incorrect as this is the translocation found in the Philadelphia Chromosome implicated in chronic myelogenous leukemia, not ovarian cancer.
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You are the nurse taking care of a patient newly diagnosed with pancreatic cancer. Which of the following biomarkers is typically followed to assess the progress of disease (or response to treatment) in pancreatic cancer patients?
You are the nurse taking care of a patient newly diagnosed with pancreatic cancer. Which of the following biomarkers is typically followed to assess the progress of disease (or response to treatment) in pancreatic cancer patients?
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The correct answer is "Cancer antigen 19-9 (CA 19-9)" because CA 19-9 is often elevated in patients who have pancreatic cancer (or certain types of colon cancers), and can be used to assess response to treatment and/or disease progression.
On the other hand, the other choices are incorrect. Cancer antigen-125 (CA-125) is incorrect as this is a tumor marker used to track ovarian cancer, not pancreatic cancer. CD20 antigen is a tumor marker for B-cell lymphomas and leukemias, not pancreatic cancer. CD30 antigen is a tumor marker for anaplastic large cell lymphoma, not pancreatic cancer. BRAF is a tumor marker for melanoma, not pancreatic cancer.
The correct answer is "Cancer antigen 19-9 (CA 19-9)" because CA 19-9 is often elevated in patients who have pancreatic cancer (or certain types of colon cancers), and can be used to assess response to treatment and/or disease progression.
On the other hand, the other choices are incorrect. Cancer antigen-125 (CA-125) is incorrect as this is a tumor marker used to track ovarian cancer, not pancreatic cancer. CD20 antigen is a tumor marker for B-cell lymphomas and leukemias, not pancreatic cancer. CD30 antigen is a tumor marker for anaplastic large cell lymphoma, not pancreatic cancer. BRAF is a tumor marker for melanoma, not pancreatic cancer.
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You are the nurse taking care of a patient in an oncology clinic who was treated with chemotherapy and radiation therapy for anal cancer. The patient finished treatment two weeks ago. Which of the following treatment side effects would you expect to see?
You are the nurse taking care of a patient in an oncology clinic who was treated with chemotherapy and radiation therapy for anal cancer. The patient finished treatment two weeks ago. Which of the following treatment side effects would you expect to see?
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The correct answer is "rectal bleeding." This answer is correct, as the patient is being treated with chemotherapy and radiation therapy for anal cancer, and is multiple weeks removed from treatment. Rectal bleeding is a very common side effect in patients who recently received radiation therapy to the anus, as numerous blood vessels are treated by the radiation therapy, and the body's immunologic response to radiation therapy also promotes vascular permeability. Rectal bleeding, unless profuse and uncontrolled is often a self-limiting phenomenon in the setting of radiation and while troublesome for the patient, does not pose much of an acute threat to the patient's stability.
Fever is something that should be taken seriously in any cancer patient, especially one receiving chemotherapy. However, it should not necessarily be expected. It should always be assessed for.
Headache is a common side effect in patients actively receiving chemotherapy, often either directly due to the chemotherapy drug itself, or to dehydration as a side effect of treatment/lack of appetite. This patient is multiple weeks removed from chemotherapy though, so headache would not be expected as a treatment side effect at this time.
Pupil dilation and eye redness are not typical side effects of chemotherapy or radiation therapy for anal cancer.
The correct answer is "rectal bleeding." This answer is correct, as the patient is being treated with chemotherapy and radiation therapy for anal cancer, and is multiple weeks removed from treatment. Rectal bleeding is a very common side effect in patients who recently received radiation therapy to the anus, as numerous blood vessels are treated by the radiation therapy, and the body's immunologic response to radiation therapy also promotes vascular permeability. Rectal bleeding, unless profuse and uncontrolled is often a self-limiting phenomenon in the setting of radiation and while troublesome for the patient, does not pose much of an acute threat to the patient's stability.
Fever is something that should be taken seriously in any cancer patient, especially one receiving chemotherapy. However, it should not necessarily be expected. It should always be assessed for.
Headache is a common side effect in patients actively receiving chemotherapy, often either directly due to the chemotherapy drug itself, or to dehydration as a side effect of treatment/lack of appetite. This patient is multiple weeks removed from chemotherapy though, so headache would not be expected as a treatment side effect at this time.
Pupil dilation and eye redness are not typical side effects of chemotherapy or radiation therapy for anal cancer.
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You are the nurse at an oncology practice taking care of an otherwise healthy 22-year old male being treated with chemotherapy and radiation for Hodgkin's lymphoma. His chemotherapy regimen consists of doxorubicin, bleomycin, vinblastine, and dacarbazine. He is not receiving any other medications. He reports feeling well aside from fatigue, and numbness and tingling of his hands and feet. Which of the following is the most likely cause of the hand and foot numbness and tingling?
You are the nurse at an oncology practice taking care of an otherwise healthy 22-year old male being treated with chemotherapy and radiation for Hodgkin's lymphoma. His chemotherapy regimen consists of doxorubicin, bleomycin, vinblastine, and dacarbazine. He is not receiving any other medications. He reports feeling well aside from fatigue, and numbness and tingling of his hands and feet. Which of the following is the most likely cause of the hand and foot numbness and tingling?
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The correct answer is "Vinblastine-induced neuropathy."
This is the most likely explanation for this patient's peripheral neuropathy, as the patient is described as being healthy aside from Hodgkin's lymphoma, and on no medications aside from his chemotherapy regimen. As a result, diabetic neuropathy and selective serotonin reuptake inhibitor discontinuation syndrome can each be ruled out as etiologies. Similarly, given that he is otherwise healthy and not complaining of any additional neurological symptoms (and given that he is young and actively receiving chemotherapy) it is unlikely that he is experiencing posterior spinal cord degeneration.
Thus, in a young patient with lymphoma who is receiving chemotherapy and experiencing peripheral neuropathy, the most likely etiology is one of the chemotherapy medications that he is receiving. In this patient's case, he is receiving doxorubicin, bleomycin, vinblastine, and dacarbazine. Of these medications, vinblastine is the most strongly associated with peripheral neuropathy, as this is a fairly common side effect of vinblastine and other agents in the same class (vinca alkaloids). As such, vinblastine-induced neuropathy is the most likely etiology.
The correct answer is "Vinblastine-induced neuropathy."
This is the most likely explanation for this patient's peripheral neuropathy, as the patient is described as being healthy aside from Hodgkin's lymphoma, and on no medications aside from his chemotherapy regimen. As a result, diabetic neuropathy and selective serotonin reuptake inhibitor discontinuation syndrome can each be ruled out as etiologies. Similarly, given that he is otherwise healthy and not complaining of any additional neurological symptoms (and given that he is young and actively receiving chemotherapy) it is unlikely that he is experiencing posterior spinal cord degeneration.
Thus, in a young patient with lymphoma who is receiving chemotherapy and experiencing peripheral neuropathy, the most likely etiology is one of the chemotherapy medications that he is receiving. In this patient's case, he is receiving doxorubicin, bleomycin, vinblastine, and dacarbazine. Of these medications, vinblastine is the most strongly associated with peripheral neuropathy, as this is a fairly common side effect of vinblastine and other agents in the same class (vinca alkaloids). As such, vinblastine-induced neuropathy is the most likely etiology.
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You are a nurse at an oncology clinic taking care of a 65-year old male with stage one non-small cell lung cancer (NSCLC) who is one year removed from a wedge resection and chemotherapy. Which of the following tests would be best to assess treatment response in this patient?
You are a nurse at an oncology clinic taking care of a 65-year old male with stage one non-small cell lung cancer (NSCLC) who is one year removed from a wedge resection and chemotherapy. Which of the following tests would be best to assess treatment response in this patient?
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The correct answer is "PET-CT." This is the correct answer because a PET-CT shows not only spatial information from the serial slices taken on CT imaging, which would include the size and location of any potential tumor, scarring, or nodal involvement, but also the FDG-avidity or uptake of the contents of the image, which would help correlate the spatial findings with possible disease activity. Nodules observed on a CT scan can be non-descript, ranging from malignant, to indeterminate, to benign (which may still be infectious or inflammatory). The addition of PET to a CT allows the observer to see which nodules, nodes, or lesions are more likely to be indicative of disease burden, as tumors and infections will have greater FDG uptake since they are more metabolically active than surrounding tissues.
MRI is not typically used to assess treatment in lung cancer as CT coupled with PET is more commonly used. X-ray does not provide enough resolution to adequately assess response to cancer treatment. Pulmonary function tests, while a useful measure of lung functionality, do not give a specific picture of the lung cancer burden and as such are not the best treatment response assessment tool.
The correct answer is "PET-CT." This is the correct answer because a PET-CT shows not only spatial information from the serial slices taken on CT imaging, which would include the size and location of any potential tumor, scarring, or nodal involvement, but also the FDG-avidity or uptake of the contents of the image, which would help correlate the spatial findings with possible disease activity. Nodules observed on a CT scan can be non-descript, ranging from malignant, to indeterminate, to benign (which may still be infectious or inflammatory). The addition of PET to a CT allows the observer to see which nodules, nodes, or lesions are more likely to be indicative of disease burden, as tumors and infections will have greater FDG uptake since they are more metabolically active than surrounding tissues.
MRI is not typically used to assess treatment in lung cancer as CT coupled with PET is more commonly used. X-ray does not provide enough resolution to adequately assess response to cancer treatment. Pulmonary function tests, while a useful measure of lung functionality, do not give a specific picture of the lung cancer burden and as such are not the best treatment response assessment tool.
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You are the nurse in an oncology clinic taking care of a patient with a glioblastoma who has been receiving chemotherapy and radiation therapy. You want to assess response to treatment. Which of the following images should would best assess treatment response?
You are the nurse in an oncology clinic taking care of a patient with a glioblastoma who has been receiving chemotherapy and radiation therapy. You want to assess response to treatment. Which of the following images should would best assess treatment response?
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The correct answer is "MRI Head." This is the correct answer because in evaluating brain parenchyma, which is relatively soft tissue, MRI provides the greatest degree of spatial resolution, which would best allow assessment of any residual, recurrent, or new tumor burden within the brain. CT imaging is commonly used to assess the brain when evaluating for bleeds or fractures, among other conditions, as it is far more expedient than MRI. However, it does not visualize the soft tissue of the brain parenchyma as well as MRI, and treatment response MRI scans are often not emergent, and therefore MRI would be preferred. PET-CT, while often highly useful in oncologic assessments is of limited value in evaluating the brain for cancer response, because the entire brain is highly metabolically active in nearly all patients, and therefore the entire brain typically has a great deal of FDG uptake uniformly, limiting the value of the scan.
The correct answer is "MRI Head." This is the correct answer because in evaluating brain parenchyma, which is relatively soft tissue, MRI provides the greatest degree of spatial resolution, which would best allow assessment of any residual, recurrent, or new tumor burden within the brain. CT imaging is commonly used to assess the brain when evaluating for bleeds or fractures, among other conditions, as it is far more expedient than MRI. However, it does not visualize the soft tissue of the brain parenchyma as well as MRI, and treatment response MRI scans are often not emergent, and therefore MRI would be preferred. PET-CT, while often highly useful in oncologic assessments is of limited value in evaluating the brain for cancer response, because the entire brain is highly metabolically active in nearly all patients, and therefore the entire brain typically has a great deal of FDG uptake uniformly, limiting the value of the scan.
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What muscle pathology is often linked to small cell lung cancer?
What muscle pathology is often linked to small cell lung cancer?
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Approximately 60% of patients diagnosed with Lambert-Eaton syndrome have an underlying cancer, most often small cell lung cancer. Lambert-Eaton syndrome is an autoimmune disorder in which the release of neurotransmitter is not permitted due to antibodies against the presynaptic calcium channels. This results in muscle weakness in the limbs. The other conditions listed are not associated with any respiratory cancers.
Approximately 60% of patients diagnosed with Lambert-Eaton syndrome have an underlying cancer, most often small cell lung cancer. Lambert-Eaton syndrome is an autoimmune disorder in which the release of neurotransmitter is not permitted due to antibodies against the presynaptic calcium channels. This results in muscle weakness in the limbs. The other conditions listed are not associated with any respiratory cancers.
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60% of cases of stomach cancer in the United States are associated with what infection?
60% of cases of stomach cancer in the United States are associated with what infection?
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Helicobacter pylori is present in the stomach of 60% of individuals with gastric cancer. Cancer in these cases may be caused by chronic inflammation at the site of infection, resulting in metaplasia.
Staphylococcus aureus, Salmonella enterica, and Escherichia coli are all common causes of gastroenteritis but are not associated with malignancy.
Helicobacter pylori is present in the stomach of 60% of individuals with gastric cancer. Cancer in these cases may be caused by chronic inflammation at the site of infection, resulting in metaplasia.
Staphylococcus aureus, Salmonella enterica, and Escherichia coli are all common causes of gastroenteritis but are not associated with malignancy.
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Which of the following is not a risk factor for renal cell carcinoma?
Which of the following is not a risk factor for renal cell carcinoma?
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Smoking, obesity, and high blood pressure are among the most common risk factors for development of renal cell carcinoma. Other risk factors include genetic susceptibility, diuretic use, and male gender. Alcohol consumption has not been associated with increased rates of renal cell cancer.
Smoking, obesity, and high blood pressure are among the most common risk factors for development of renal cell carcinoma. Other risk factors include genetic susceptibility, diuretic use, and male gender. Alcohol consumption has not been associated with increased rates of renal cell cancer.
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Renal cell carcinoma can cause what paraneoplastic syndrome?
Renal cell carcinoma can cause what paraneoplastic syndrome?
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Renal cell carcinoma can cause hypercalcemia, due to secretion of PTHrP (parathyroid hormone-related protein).
SIADH and Lambert-Eaton myasthenic syndrome are both associated with small-cell lung cancer, while polymyositis is associated with non-Hodgkin lymphoma.
Renal cell carcinoma can cause hypercalcemia, due to secretion of PTHrP (parathyroid hormone-related protein).
SIADH and Lambert-Eaton myasthenic syndrome are both associated with small-cell lung cancer, while polymyositis is associated with non-Hodgkin lymphoma.
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What cell line is metaplastic in multiple myeloma?
What cell line is metaplastic in multiple myeloma?
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Multiple myeloma is caused by metaplasia of plasma cells. No other white blood cell type is typically metaplastic, though abnormal plasma cell accumulation in bone marrow does interfere with the synthesis of all other blood cell types.
Multiple myeloma is caused by metaplasia of plasma cells. No other white blood cell type is typically metaplastic, though abnormal plasma cell accumulation in bone marrow does interfere with the synthesis of all other blood cell types.
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Hepatocellular carcinoma is also associated with what toxin?
Hepatocellular carcinoma is also associated with what toxin?
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Hepatocellular carcinoma is associated with exposure to aflatoxin, from Aspergillus species, which can be found in many foods. Most commonly contaminated foods are corn, peanuts (and peanut butter), pistachios, brazil nuts, chillies, black pepper, dried fruit, and figs.
Asbestos is linked to mesothelioma, organophosphate exposure is linked to leukemia, and lead exposure has not been directly associated with any increase in malignancy, although current studies are pending further evidence.
Hepatocellular carcinoma is associated with exposure to aflatoxin, from Aspergillus species, which can be found in many foods. Most commonly contaminated foods are corn, peanuts (and peanut butter), pistachios, brazil nuts, chillies, black pepper, dried fruit, and figs.
Asbestos is linked to mesothelioma, organophosphate exposure is linked to leukemia, and lead exposure has not been directly associated with any increase in malignancy, although current studies are pending further evidence.
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Which of the following is a consequence of a carcinogen?
Which of the following is a consequence of a carcinogen?
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Carcinogens cause cancer by making changes to the host's DNA. They can be chemical (ex. pharmaceutical drugs), or viral (ex. Epstein-Barr). Additionally, exposure to radiation has also been known to damage DNA and is another form of a carcinogen.
Carcinogens cause cancer by making changes to the host's DNA. They can be chemical (ex. pharmaceutical drugs), or viral (ex. Epstein-Barr). Additionally, exposure to radiation has also been known to damage DNA and is another form of a carcinogen.
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A patient is suffering from alopecia secondary to chemotherapy. Which of the following is the correct course of action for the nurse?
A patient is suffering from alopecia secondary to chemotherapy. Which of the following is the correct course of action for the nurse?
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Hair loss can be alarming if large amounts of hair are seen in linens. Shampooing, brushing, heat tools, and hair dyes can increase fallout. The nurse should welcome healthy discussion about self esteem if appropriate.
Hair loss can be alarming if large amounts of hair are seen in linens. Shampooing, brushing, heat tools, and hair dyes can increase fallout. The nurse should welcome healthy discussion about self esteem if appropriate.
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Which of the following would raise suspicion for thrombocytopenia?
Which of the following would raise suspicion for thrombocytopenia?
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Thrombocytopenia occurs when the blood does not have a high enough platelet count. Slow clotting blood, increased bruising, or petechiae can all point to thrombocytopenia.
Thrombocytopenia occurs when the blood does not have a high enough platelet count. Slow clotting blood, increased bruising, or petechiae can all point to thrombocytopenia.
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Anemia, a side effect of many chemotherapeutic agents, involves which of the following?
Anemia, a side effect of many chemotherapeutic agents, involves which of the following?
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Anemia is a condition caused the the deficiency of healthy red blood cells in the blood stream. This results in lack of sufficient oxygen delivery to tissues.
Anemia is a condition caused the the deficiency of healthy red blood cells in the blood stream. This results in lack of sufficient oxygen delivery to tissues.
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Which of the following is not a proven risk-factor for the development of oral cancer?
Which of the following is not a proven risk-factor for the development of oral cancer?
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All of the above are proven risk factors with the exception of mouthwash use. Poor dental care, prolonged present irritation (such as excessive flossing), tobacco and alcohol use, infection with certain strains of HPV, and an unbalanced diet can increase the risk of oral cancer.
All of the above are proven risk factors with the exception of mouthwash use. Poor dental care, prolonged present irritation (such as excessive flossing), tobacco and alcohol use, infection with certain strains of HPV, and an unbalanced diet can increase the risk of oral cancer.
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With what co-infection is Burkitt lymphoma associated?
With what co-infection is Burkitt lymphoma associated?
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EBV infection is common in Burkitt lymphoma. In malaria-endemic areas, it is thought that the cancer is actually caused by chronic malarial infection increasing a person's susceptibility to chronic EBV infection. The same is assumed about HIV co-infection with EBV in the United States.
None of the other infections listed are associated with Burkitt lymphoma.
EBV infection is common in Burkitt lymphoma. In malaria-endemic areas, it is thought that the cancer is actually caused by chronic malarial infection increasing a person's susceptibility to chronic EBV infection. The same is assumed about HIV co-infection with EBV in the United States.
None of the other infections listed are associated with Burkitt lymphoma.
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