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Chemotherapy has been used for the past 3 months to treat a client with pancreatic cancer. The CA 19-9 levels are rising. Which explanation would the nurse attribute as the most likely cause?
- A. It is normal for this antigen to rise for up to 6 months.
- B. The client is having an adverse response to the chemotherapy.
- C. The chemotherapy is effectively destroying the cancer cells.
- D. The cancer is growing despite the chemotherapy treatment.
Correct Answer: D
Rationale: Elevation of specific tumor markers, such as CA 19-9, is indicative of progression and proliferation of the cancer cells. If the chemotherapy was successful in the treating of the pancreatic cancer cells, the tumor marker would be decreased. Increased production of antibody development is not a usual adverse reaction of chemotherapy.
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The nurse is caring for a client with a newly discovered tumor that may be benign or malignant. The client asks, 'What makes a malignant tumor different from a benign one?' What should the nurse include in the response? Select all that apply.
- A. The cells of the tumor bear little resemblance to the cells in the tissue where the tumor started.'
- B. It grows by invasion and infiltrates the surrounding tissues.'
- C. The tumor grows slowly and may stop.'
- D. It does not spread to other areas of the body through blood and lymph channels.'
- E. The tumor may regress after its initial growth.'
Correct Answer: A,B
Rationale: The nurse should include the statements 'The cells of the tumor bear little resemblance to the cells in the tissue where the tumor started' and 'It grows by invasion and infiltrates the surrounding tissues' in the response. Undifferentiated cells and growth by invasion are both characteristics of malignant tumors. Benign tumors are characterized by slow growth, not metastasizing, and the possibility of regression, while malignant tumors are not.
A client asks the nurse what is causing the fatigue following radiotherapy. What is the nurse's best response?
- A. The cancer is spreading to other parts of the body.
- B. The cancer cells are dying in large numbers.
- C. Fighting off infection is an exhausting venture.
- D. Substances are released when tumor cells are destroyed.
Correct Answer: D
Rationale: Fatigue results from substances being released when tumor cells are destroyed during radiotherapy. The spreading of cancer can cause many symptoms dependent on location and type of cancer, but it is not a significant factor in the development of fatigue with radiotherapy. The production of healthy cells can increase metabolic rate, but death of cancer cells does not support fatigue in this case. Fighting infection can cause fatigue, but there is no evidence provided to support the presence of infection in this client.
The public health nurse is teaching a local community group about warning signs of cancer. What should the nurse include in the teaching? Select all that apply.
- A. Sores that do not heal
- B. Unusual bleeding or discharge
- C. Unexplained weight gain
- D. Tenderness or pain
- E. Persistent indigestion
Correct Answer: A,B,D,E
Rationale: Warning signs of cancer include sores that do not heal, unusual bleeding or discharge, tenderness or pain, and persistent indigestion. Unexplained weight loss, not weight gain, is a warning sign of cancer.
While completing an admission assessment, the client reports a family history of breast cancer among a maternal grandmother, aunt, and sister. The nurse knows that these cancers are most likely associated with what etiology?
- A. Inherited gene mutation
- B. Smoking and tobacco use
- C. Exposure to chemicals and spermicides
- D. Increased tumor suppressor genes
Correct Answer: A
Rationale: Tumor suppressor genes assist the body in normal cell production and death. Tobacco use and chemical carcinogens can contribute to the development of cancer, but there is not enough information provided to suggest a common link. Oncogenes are genes that have mutated and activate out-of-control cell growth. Inherited gene mutation occurs when the DNA is passed to the next generation.
A client diagnosed with cancer makes the following statement to the nurse: 'I guess I will tell my health care provider to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die.' Which of the following facts supports the use of chemotherapy for this client?
- A. Nausea and vomiting are only a factor for the first 24 hours after treatment.
- B. Most clients believe the discomfort is well worth the cure for cancer.
- C. Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects.
- D. Clinical trials are opening up new cancer treatments all the time.
Correct Answer: C
Rationale: Chemotherapy is not one drug for all clients. The therapy can be specifically designed to optimize effects while limiting adverse effects with supplemental anti emetics to control the nausea and vomiting. It is true that nausea and vomiting are most prevalent in the first 24 hours after each chemotherapy treatment, but this fact does not eliminate the fears expressed by this client. No one can state the worth of any treatment, and a cure is never promised. Clinical trials open new options for treatment, but the process is lengthy and is not a certainty for a client in need of immediate treatment.