Introduction to Cancer and Phases of Cancer Therapy

Every question here, with the answer

1. A client with leukemia and a very high white blood cell count is scheduled to start chemotherapy tomorrow. Which order should the nurse expect to carry out before the first dose?

   1. Potassium supplements to prevent hypokalemia
   2. Fluid restriction to prevent overload
   3. Hydration therapy and allopurinol or rasburicase
   4. A high-protein diet to support cell repair

   Answer: Hydration therapy and allopurinol or rasburicase

   When many cancer cells are in the blood, clients must be pretreated with hydration therapy, allopurinol or rasburicase, and electrolyte management to prevent tumor lysis syndrome. Restricting fluids works against the hydration the client needs, and tumor lysis causes hyperkalemia, so potassium supplements would be harmful. Diet is not part of the pretreatment described.

2. Several hours after the first dose of chemotherapy for non-Hodgkin lymphoma, the nurse reviews the client's laboratory results. Which findings are consistent with tumor lysis syndrome? Select all that apply.

   1. Hyperphosphatemia
   2. Hypocalcemia
   3. Hypernatremia
   4. Alkalosis
   5. Hyperkalemia

   Answer: Hyperphosphatemia, Hypocalcemia, Hyperkalemia

   Tumor lysis syndrome is characterized by acidosis, hyperkalemia, hyperphosphatemia, and hypocalcemia, caused by cellular debris and electrolytes released into the blood. Alkalosis is the opposite of the acidosis seen in TLS, and sodium changes are not part of the syndrome as described.

3. A client asks the nurse why her doctor recommended genetic testing for BRCA1 and BRCA2 when she has no signs of cancer. Which response is accurate?

   1. A positive result means you already have breast cancer.
   2. These mutations develop after birth from carcinogen exposure.
   3. Finding these genes early allows closer surveillance and earlier detection and intervention.
   4. These genes are caused by smoking, so testing shows whether you should quit.

   Answer: Finding these genes early allows closer surveillance and earlier detection and intervention.

   BRCA1 and BRCA2 are inherited oncogenes present at birth, and identifying them before cancer develops gives options for improved surveillance, early detection and intervention. They are germline mutations, not caused by smoking or carcinogens after birth, and carrying them raises the risk rather than meaning cancer is present.

4. A client with a large, bulky solid tumor is starting chemotherapy. A new nurse says tumor lysis syndrome only happens with blood cancers. How should the charge nurse respond?

   1. Tumor lysis syndrome occurs only with sarcomas.
   2. That is correct; solid tumors cannot cause tumor lysis syndrome.
   3. Tumor lysis is most common in blood cancers but can occasionally occur with very large, bulky solid tumors.
   4. Tumor lysis syndrome only happens if the client has a BRCA mutation.

   Answer: Tumor lysis is most common in blood cancers but can occasionally occur with very large, bulky solid tumors.

   Tumor lysis occurs most commonly in hematologic cancers, but it may occasionally occur with solid tumors that are very large and bulky, so the nurse should stay alert. The other statements restrict TLS in ways the section does not support.

5. A nurse is reviewing a client's history for environmental exposures that can cause cell mutations. Which exposures should the nurse note? Select all that apply.

   1. Previous chemotherapy
   2. Benzenes
   3. Tobacco products
   4. Asbestos
   5. Regular aerobic exercise

   Answer: Previous chemotherapy, Benzenes, Tobacco products, Asbestos

   The most common environmental exposures listed are tobacco products, benzenes, petroleum-based products, asbestos, and certain drugs, including chemotherapies. Exercise is not an environmental carcinogen.

6. A client with advanced cancer has lost weight and has abnormal electrolytes. The client's spouse asks how a tumor can cause these problems. Which explanation by the nurse is accurate?

   1. Weight loss means the cancer is shrinking.
   2. A growing tumor can cause pain, compression, nutritional deficiencies, weight loss, and fluid and electrolyte imbalances.
   3. Tumors never cause symptoms until they spread.
   4. These changes are caused only by chemotherapy, not by the cancer itself.

   Answer: A growing tumor can cause pain, compression, nutritional deficiencies, weight loss, and fluid and electrolyte imbalances.

   As cancer cells keep growing they can cause pain, compression, nutritional deficiencies, weight loss, and fluid and electrolyte imbalances. The section does not blame these only on chemotherapy, and weight loss is an effect of cancer development, not a sign of shrinking.