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WorksheetsNUR 221 Pathophysiology: Chapter 20 – Neoplasms & Cancer
Total questions: 41
Worksheet time: 41mins
Metastatic Adenocarcinoma. A 65-year-old woman presents with chronic nonproductive cough, mild exertional dyspnea, intermittent abdominal discomfort for 1 year, and unintentional 8 lb. weight loss over 3 months. She has a 30 30-pack-year smoking history (quit 10 years ago) and uses NSAIDs occasionally for osteoarthritis. Which of the following historical features are clinically relevant risk factors or red flags for possible metastatic adenocarcinoma? Select all that apply.
Remote smoking history of 30 pack-years
Occasional NSAID is used for osteoarthritis
Age older than 60 years
No known family history of cancer
Unintentional weight loss
Adenocarcinoma. A 62-year-old patient with recently diagnosed colon adenocarcinoma reports new-onset headache and blurred vision. Which nursing action is the priority?
Reassure the patient that these symptoms reflect cancer-related fatigue
Administer an antiemetic for associated nausea and observe response
Notify the provider urgently and prepare the patient for immediate brain imaging
Increase IV fluids to improve hydration and reassess symptoms
Radiation Therapy A client receiving external-beam radiation to the head and neck develops painful oral mucositis that limits oral intake. Which intervention is the highest priority?
Encourage frequent saline or sodium bicarbonate mouth rinses and gentle oral hygiene
Administer prescribed topical oral anesthetic immediately before meals to enable intake
Offer soft, bland, nonacidic foods to reduce mucosal irritation
Assess carefully for signs of secondary infection or mucosal bleeding
Neutropenia A 54-year-old female, 7 days post-chemotherapy, reports fever and sore throat. Labs: WBC 1,200/μL; ANC 500/μL. Which is the priority of nursing action?
Begin broad-spectrum IV antibiotics immediately
Obtain blood cultures and wait for results before antibiotics
Administer PRN acetaminophen for fever control
Place the patient in semi-Fowler’s position and monitor
Neutropenia. A patient undergoing chemotherapy has a temperature of 100.8°F (38.2°C) and an ANC of 450/mm³. What is the priority of nursing intervention?
Administer antipyretics to lower the temperature
Initiate neutropenic precautions and notify the provider for urgent evaluation and empiric antibiotics
Encourage increased oral fluid intake and observation
Delay the next chemotherapy cycle until counts recover
Pancreatic Cancer. A patient with late-stage pancreatic cancer has lost 15 pounds in 3 weeks. Which nursing intervention should be prioritized?
Offer low-fat snacks between meals to reduce steatorrhea
Encourage only increased fluid intake to prevent dehydration
Consult a registered dietitian to develop an individualized nutritional support plan
Advise a high-fiber diet to regulate bowel function
Hypercalcemia in Cancer: A 55-year-old man with lung cancer presents with weakness and elevated serum calcium. What is the priority nursing action?
Administer oral calcium supplements to stabilize levels
Initiate aggressive IV fluid resuscitation and continuously monitor cardiac rhythm
Position the patient prone to relieve symptoms
Restrict oral fluids to prevent fluid overload
Tumor Lysis: A patient with acute leukemia begins chemotherapy. Labs: K+ 6.2 mmol/L, Ca2+ 7.1 mg/dL, creatinine 2.1 mg/dL. Which nursing action is the highest priority?
Start seizure precautions for hypocalcemia risk
Administer IV calcium gluconate to stabilize cardiac membranes
Begin aggressive IV fluids and initiate uric-acid–lowering therapy (Allopurinol)
Administer sodium polystyrene sulfonate to lower potassium immediately
Chemotherapy. A patient with acute leukemia is admitted after beginning chemotherapy. The nurse reviews the following laboratory results: Potassium: 6.2 mEq/L; Hemoglobin: 9.5 g/dL; White blood cell count: 3,200/µL; Platelets: 120,000/µL. Which laboratory value requires the nurse’s immediate intervention?
Potassium 6.2 mEq/L
Hemoglobin 9.5 g/dL
White blood cell counts 3,200/µL
Platelets 120,000/µL
Chemotherapy. A patient recovering from chemotherapy reports difficulty concentrating and memory lapses. Which nursing action is most appropriate initially?
Advise fluid restriction before bedtime to improve cognition
Refer the patient to a cognitive rehabilitation support program and provide coping strategies
State that these symptoms indicate cancer recurrence and require immediate imaging
Ms. Alvarez, 54, completed chemotherapy 6 months ago and reports persistent fatigue, insomnia, and forgetfulness. Which is the most comprehensive first-step approach?
Conduct a focused fatigue assessment and refer to physical therapy for graded exercise
Provide sleep hygiene education only
Reassure the patient that cognitive lapses are normal and require no intervention
Schedule routine follow-up with oncology without targeted assessment
Which option best describes cachexia commonly seen in advanced malignancy?
Multiple opportunistic infections
Severe tissue wasting with loss of lean body mass
Severe bleeding from tumor erosion
Profound fatigue only
Which factor primarily determines histologic grading of a newly diagnosed malignant tumor?
Number of lymph nodes involved
Extent of metastatic spread
Degree of cellular differentiation and mitotic activity
Size of the primary tumor
Which reason best explains the poor prognosis frequently seen with ovarian cancer?
No effective treatments are available
The ovaries cannot be examined clinically
Tumor markers are identical across many cancers types
Specific signs often do not appear until the disease has spread beyond the ovary
Benign Tumors: Which characteristic is most consistent with a benign tumor?
Produces systemic paraneoplastic effects
Unencapsulated and locally invasive behavior
Cells closely resemble their tissue of origin (well differentiated)
Comprised of undifferentiated, highly anaplastic cells
Malignant Tumor: A 47-year-old patient is diagnosed with a malignant tumor arising from connective tissues. Which term best classifies this neoplasm?
Tumor originating from mesenchymal tissue
Malignancy of epithelial cells
Pigmented skin cell carcinoma
Benign fibrous growth
Which statement best defines a neoplasm?
Normal tissue growths with no physiological function
Abnormal growths of tissue with a physiological function
Normal tissue growths with a physiological function
Abnormal growths of tissue with no physiological function
Which cell type is considered highly undifferentiated in cell biology?
Progenitor cells
Mature cells
Stem cells
Cancer cells
What is the term for the origin and development of cancerous neoplasms?
Photosynthesis
Carcinogenesis
Homeostasis
Metabolism
What is the benign suffix for a neoplasm originating from fatty tissue?
-sarcoma
-blastoma
-carcinoma
-oma
Which root word is associated with neoplasms originating from glandular epithelium?
lip-
fibro-
adeno-
osteo-
What is the malignant suffix for a neoplasm originating from fibrous connective tissue?
-sarcoma
-blastoma
-carcinoma
-oma
Which example corresponds to a benign neoplasm of fatty tissue?
Adenocarcinoma
Osteosarcoma
Lipoma
Fibrosarcoma
Which statement is true about the capsule of benign tumors?
Always invasive
Never encapsulated
No capsule; invasive
Usually encapsulated
Which systemic effect is commonly associated with malignant tumors?
Weight loss, anemia, cachexia
Rare
No systemic effects
Increased energy
How do benign tumors typically behave in terms of metastasis?
Can invade & metastasize via blood/lymph
Metastasizes slowly
Remains localized
Always metastasizes
During the promotion phase of cancer, what causes mutated cells to proliferate?
Carcinogens
Hormones and chronic inflammation
Metastasis
Genetic mutations
What role does Vascular Endothelial Growth Factor (VEGF) play in the pathophysiology of malignant tumors?
Stimulates new capillary growth
Promotes apoptosis
Inhibits cell division
Reduces inflammation
Which process allows malignant tumors to develop their own blood supply?
Apoptosis
Necrosis
Angiogenesis
Differentiation
Which statement best describes metastasis?
Local invasion of surrounding tissues
Spread of cancer cells to distant organs via blood or lymph
Growth within the original tissue
Encapsulation of tumor cells
Which feature is most characteristic of malignant cells?
Well-differentiated structure
Slow growth
Poorly differentiated and invasive
Encapsulated borders
Which of the following are known risk factors for cancer development? (Select all that apply)
Tobacco use
Chronic inflammation
High HDL levels
Exposure to radiation
Daily multivitamin use
What is the purpose of tumor markers in cancer care?
To cure cancer
To monitor treatment response and detect recurrence
To prevent metastasis
To replace biopsy
Which side effect should the nurse monitor for in a patient receiving radiation to the abdomen?
Alopecia
Diarrhea and nausea
Peripheral neuropathy
Bone marrow suppression
In the TNM staging system, what does “M” represent?
Tumor size
Lymph node involvement
Presence of metastasis
Mitotic rate
Which lab value should the nurse monitor closely in a patient receiving chemotherapy?
ALT
WBC count
Amylase
Hemoglobin A1C
Which instruction should the nurse give a patient receiving external beam radiation?
“Avoid applying lotions or creams to the treatment site unless prescribed.”
“Use heating pads to relieve discomfort.”
“Scrub the area daily with antibacterial soap.”
“Expose the area to sunlight to promote healing.”
Which statement best describes how cancer cells differ from normal cells in terms of apoptosis?
Cancer cells undergo apoptosis more frequently
Cancer cells promote apoptosis in surrounding tissues
Cancer cells evade apoptosis and continue dividing
Cancer cells trigger immune-mediated apoptosis
A patient is diagnosed with breast cancer and has positive axillary lymph nodes. What does this finding indicate?
The tumor is benign
The cancer is localized
The cancer has begun to metastasize
The tumor is encapsulated
Which of the following are modifiable risk factors for cancer? (Select all that apply)
Tobacco use
High-fat diet
Age over 65
Excessive alcohol consumption
Family history of cancer
A tumor is described as poorly differentiated. What does this indicate about the tumor’s behavior?
It closely resembles normal tissue
It is likely benign
It is more aggressive and likely malignant
It is in early development
