Pneumothorax and pleural effusion- diagnosis and management with MCQs

left sided pneumothorax

PNEUMOTHORAX

Pneumothorax is the presence of air in the pleural space.

Two types

• Traumatic pneumothorax
• Spontaneous pneumothorax

• Results from penetrating or non-penetrating chest injuries.

• Transthoracic needle aspiration
• Thoracentesis
• The insertion of central intravenous catheters

• Primary Pneumothorax

1. No evidence of overt lung disease.
2. Due to rupture of a small subpleural emphysematous bulla or pleural bleb, or the pulmonary end of a pleural adhesion
3. Occur almost exclusively in smokers
4. one-half of patients will have a recurrence

• Secondary Pneumothorax

1. Underlying lung disease, most commonly COPD and TB;
2. also seen in asthma, lung abscess, pulmonary infarcts, bronchogenic carcinoma, all forms of fibrotic and cystic lung disease

Tension pneumothorax

• Results from a wound in the chest wall which acts as a valve that permits air to enter the pleural cavity but prevents its escape
• Intrapleural pressure rises to well above atmospheric levels. 
• The pressure causes mediastinal displacement towards the opposite side, with compression of the opposite normal lung 
• Impairment of systemic venous return, causing cardiovascular compromise

Closed pneumothorax

• Communication between the airway and the pleural space seals off
• mean pleural pressure remains negative
• reabsorption of air, re-expansion, infection is uncommon

Open pneumothorax

• Communication fails to seal and air continues to pass freely
• Occur following rupture of an emphysematous bulla, tuberculous cavity or lung abscess into the pleural space
• Infection is common

Clinical Features of tension pneumothorax

• sudden-onset unilateral pleuritic chest pain or breathlessness
• larger pneumothorax (> 15% of the hemithorax) results in decreased or absent breath sounds
• combination of absent breath sounds and resonant percussion note is diagnostic of pneumothorax.

• Inspection

• Tachypnoea (pain, deflation reflex)

• Palpation

• ↓Expansion

• Percussion

• Resonant or hyper-resonant

• Auscultation

• Absent breath sounds

Tension pneumothorax also causes

• Deviation of trachea to opposite side
• Tachycardia and hypotension
• Cyanosis 

Investigations for pneumothorax

• Chest X-ray

• Sharply defined edge of the deflated lung with complete translucency
• Extent of any mediastinal displacement and reveal any pleural fluid or underlying pulmonary disease.

• CT scan
•  In doubt, distinguish bullae from pleural air.

Treatment of tension pneumothorax

• Primary pneumothorax with lung edge < 2 cm from the chest wall, not breathless requires no intervention.

Percutaneous needle aspiration of air 

• In young patients with a moderate or large spontaneous primary pneumothorax
• Intercostal tube drainage
• In those over 50 years old and those with respiratory compromise

Surgical pleurodesis 

• Recommended following a second pneumothorax
• should be considered following the first episode of secondary pneumothorax if low respiratory reserve makes recurrence hazardous. 

• Pleurodesis can be achieved by pleural abrasion or parietal pleurectomy at thoracotomy or thoracoscopy.
• Prevents recurrences

Post Chest Tube monitoring: what to look for after keeping a chest tube

• After 24 hours;  if lungs reinflated and no bubblingremove drain
• Continuing bubbling after 5- 7days  is indication of surgery
• High flow O2 supplement- may speed resolution
• If bubbling stops before full inflation of lung then tube is either blocked , kinked or displaced
• Pleural Effusion 

Pleural effusion:

Pleural Fluid

• Excessive accumulation of fluid in the pleural space. 
• Detected clinically, when ≥ 500 mL is present.
• Produced and absorbed at a rate of 15mL per day
• Each pleural space contains 10mL of fluid

Causes of pleural effusion:

Pathophysiology of pleural effusion:

Fluid enters the pleural space:

• from the capillaries in the parietal pleura
• from the peritoneal cavity via small holes in the diaphragm
• Fluid removed via the lymphatics situated in the parietal pleura. 

lymphatics have capacity to absorb 20 times more fluid than is normally formed.

Pleural fluid accumulates when:

pleural fluid formation >pleural fluid absorption. 

Exudative or Transudative

Alteration of hydrostatic and/or oncotic factors Increases the formation or decreases the reabsorption Transudate

Direct or cytokine induced pleural membrane and/or vascular damage Increased capillary permeability Exudate

Types of pleural effusion:

Transudative effusion

1. Congestive Heart failure
2. Cirrhosis 
3. Pulmonary embolization 
4. Neoplastic syndrome
5. Constrictive pericarditis
6. Hypothyroidism

Exudative effusion:

1. Bacterial pneumonia (common)
2. Tuberculosis
3. Carcinoma of the bronchus
4. Pulmonary infarction
5. Autoimmune 
6. -Rheumatic diseases
7. – SLE 

Clinical features of pleural effuion:

• Shortness of breath
• Chest pain, especially on breathing in deeply (pleurisy, or pleuritic pain)
• Fever
• Cough

How Patient Presents in pleural effusion?

History in pleural effusion

• Pain on inspiration and coughing
• Often  asymptomatic
• Pleurisy 

Examination finding in pleural effusion:

1. Chest wall movement : Reduced in affected side 
2. trachea and mediastinum shift away from affected side
3.  With massive effusion (>1000ml)]
4. Percussion note: Stony dull 
5. Breath sounds: Vesicular
6. (Reduced or absent)
7. Vocal resonance: Reduced or absent

On Chest Examination of pleural effusion following findings  can be found:

• Bronchial breathing may be present
• Expansion ↓
• Percussion stony dull
• Air entry ↓
• Vocal resonance ↓
• With massive effusion (>1000ml) trachea and mediastinum shift away from affected side

Diagnostic Approach in pleural effusion

Light’s criteria for Exudative Effusion

• Pleural fluid protein: serum protein >0.5
• Pleural fluid LDH: serum LDH >0.6
• Pleural fluid LDH > 2/3 upper limit of normal for serum
• Investigations 
• Serum
• CBC
• LDH
• protein
• Coagulation studies (PT, PTT, INR )

Pleural fluid analysis for pleural effusion:

• Note color and consistency
• Chemistries: Protein, albumin, LDH, glucose, pH
• Cell count with differential
• Microbiological stains and culture 
• Cytology

Pleural fluid finding in effusion

Lateral decubitus x ray in pleural effusion:

• Demonstrates fluidity
• Suggest for thoracentesis if fluid layer > 1cm. 
• Transudates
• Usually resolve with treatment of underlying cause
• Therapeutic thoracentesis in persistent larger effusion
• Pleurodesis, shunts, or placement of a indwelling pleural catheter for palliation

Treatment of pleural effuusion:

• Simple Parapneumonic Effusion

• Antiobiotics
• Selected base on causing organism
• Generally anaerobic coverage
•   ( clindamycine, imipenem, extended spectrum penicillin )
• Close observation

• Complicated Parapneumonic Effusion
• Antiobiotics

• Early thoracostomy tube drainage
• Surgical decortication if extensive pleural thickening, fibrous organization, and /or multiple loculations.
• Malignant Pleural Effusion
• 2nd most common type of exudative pleural effusion (lung carcinoma, breast carcinoma, & lymphoma)
• Diagnosis: cytology of the pleural fluid
• If cytology is negative, thoracoscopy is done if malignancy is suspected

Management  of pleural effusion

• Symptomatic treatment 
• Tube thoracostomy ( sclerosing agents : doxycycline )
• Plurodesis when there is rapid reaccumulation of fluid
• Insertion of indwelling pleural catheter

Complications of pleural effsuion if untreated

1. empyema
2. constrictive fibrosis
3. Sepsis
4.  lung cancer

Nursing care for pleural effusion and chest tube inserted patient

• Observe for infection, local inflammation
• Check dressing
• Check if tube is blocked
• Mobilization care
• Check for amount and color of drainage
• Pain management
• Ensure breathing and lung reexpansion in case of collapse
• Prevent clamping
• Ensure positioning

References

• Davidson’s Principles and Practice of Medicine 21st edition
• Harrison’s Principle of Internal Medicine, 18th edition

MCQs related to pleral effusion:

What is pleural effusion?

a) Accumulation of air in the pleural space

b) Collection of fluid in the pleural space

c) Infection of the pleural cavity

Answer: b) Collection of fluid in the pleural space

What is pneumothorax?

a) Collection of fluid in the pleural space

b) Accumulation of air in the pleural space

c) Infection of the pleural cavity

Answer: b) Accumulation of air in the pleural space

Which condition is more likely to cause chest pain?

a) Pleural effusion

b) Pneumothorax

c) Both conditions can cause chest pain

Answer: c) Both conditions can cause chest pain

Which condition is more likely to cause shortness of breath?

a) Pleural effusion

b) Pneumothorax

c) Both conditions can cause shortness of breath

Answer: c) Both conditions can cause shortness of breath

Which of the following imaging studies is most commonly used to diagnose pleural effusion?

a) Chest x-ray

b) Computed tomography (CT)

c) Magnetic resonance imaging (MRI)

Answer: a) Chest x-ray

Which of the following conditions can be diagnosed by thoracentesis?

a) Pleural effusion

b) Pneumothorax

c) Both conditions can be diagnosed by thoracentesis

Answer: a) Pleural effusion

Which of the following imaging studies is most commonly used to diagnose pneumothorax?

a) Chest x-ray

b) Computed tomography (CT)

c) Magnetic resonance imaging (MRI)

Answer: a) Chest x-ray

Which of the following conditions can be treated with a chest tube?

a) Pleural effusion

b) Pneumothorax

c) Both conditions can be treated with a chest tube

Answer: c) Both conditions can be treated with a chest tube

What is the primary treatment for small, uncomplicated pneumothorax?

a) Observation

b) Chest tube insertion

c) Surgery

Answer: a) Observation

What is the primary treatment for large, complicated pneumothorax?

a) Observation

b) Chest tube insertion

c) Surgery

Answer: b) Chest tube insertion

Which of the following is a potential complication of pleural effusion?

a) Respiratory failure

b) Cardiac arrest

c) Seizures

Answer: a) Respiratory failure

Which of the following is a potential complication of pneumothorax?

a) Respiratory failure

b) Cardiac arrest

c) Seizures

Answer: a) Respiratory failure

Which of the following conditions is more common in individuals with chronic obstructive pulmonary disease (COPD)?

a) Pleural effusion

b) Pneumothorax

c) Both conditions are equally common in individuals with COPD

Answer: b) Pneumothorax

Which of the following conditions is more common in individuals with heart failure?

a) Pleural effusion

b) Pneumothorax

c) Both conditions are equally common in individuals with heart failure

Answer: a) Pleural effusion

What is the most important factor in determining the severity of pneumothorax?

a) The size of the pneumothorax

b) The cause of the pneumothorax

c) The location of the pneumothorax

Answer: a) The size of the pneumothorax

✌

What is Comprehensive Abortion Care?

Introduction

Comprehensive Abortion Care (CAC) is a patient-centered, comprehensive approach to abortion that includes services ranging from counseling and medical procedures to post-abortion care and support. It prioritizes women’s health, safety, and well-being while protecting their reproductive rights. CAC addresses not only the medical elements of abortion, but also the social, emotional, and psychological issues that influence a woman’s decision-making process. This article discusses the significance of comprehensive abortion treatment and its components.

Understanding Comprehensive Abortion Care

Abortion Care that is Comprehensive goes beyond the typical focus on medical procedures. It recognizes that women’s needs and experiences vary, and that these must be taken into account while providing abortion services. CAC’s basic components are as follows:

Safe and Legal Abortion Services:

CAC guarantees that women have safe and legal abortion methods available to them. Abortions are performed in a clinical setting by qualified healthcare professionals in accordance with medical standards and guidelines. Legal frameworks must protect women’s right to choose abortion without fear of legal prosecution.

Pre-Abortion Counseling:

Proper counseling is crucial to ensure that women make informed decisions about their reproductive health. It involves providing accurate information about abortion methods, potential risks, and available support services. Counseling also addresses emotional and psychological concerns, helping women feel confident in their choices.

Medical Procedures:

Proper counseling is essential to ensuring that women make educated reproductive health decisions. It entails disseminating correct information regarding abortion methods, dangers, and available support services. Counseling also tackles emotional and psychological issues, allowing women to feel more confidence in their decisions.

Post-Abortion Care:

Comprehensive care goes beyond the actual abortion. Follow-up consultations to check on physical healing and treat any issues are part of post-abortion care. To assist women in overcoming any potential emotional difficulties, counseling and emotional support are also available.

Contraceptive Services:

Access to contraceptive advice and services is a component of CAC in order to avoid future unwanted pregnancies. Based on their health, lifestyle, and reproductive objectives, this assists women in selecting an effective contraceptive technique.

Respect for Women’s Autonomy and Rights:

Women’s right to make their own decisions about their reproductive health is upheld by CAC. It acknowledges that every woman has a special situation, and that her decisions should be respected without bias or pressure.

Importance of Comprehensive Abortion Care

Here is teh importance of CAC explained in detail.

Promoting Women’s Health and Well-being:

Women’s health and safety are given top priority by CAC, lowering the likelihood of unsafe and unauthorized abortions. Abortion is a safe medical procedure with few risks when done by qualified specialists.

Reducing Maternal Mortality and Morbidity:

Abortions performed unsafely play a substantial role in maternal mortality and morbidity rates around the world. By guaranteeing that women have access to secure abortion services, CAC plays a crucial part in lowering these dangers.

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Supporting Reproductive Rights:

An essential reproductive right is the availability of comprehensive abortion care. Women are given more control over their bodies and destinies thanks to CAC, which promotes gender equality and women’s empowerment.

Addressing Stigma and Emotional Well-being:

The emotional and psychological effects of abortion are acknowledged by CAC. It aids women in overcoming any stigma or emotional difficulties they may experience by offering counseling and support.

Preventing Unintended Pregnancies:

Contraceptive services are a part of CAC, which supports family planning and reproductive health by assisting women in preventing future unplanned pregnancies.

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Conclusion

Comprehensive abortion care includes counseling, support, and empowerment in addition to medical treatments. It is a comprehensive strategy that defends women’s rights, respects their autonomy, and advances their health. To protect women’s health, lower maternal mortality, and advance reproductive justice, access to CAC must be ensured. In order to guarantee that women have the support and tools they need to make educated decisions about their reproductive health, it is critical to promote and emphasize comprehensive abortion care as societies change.

जुका भनेको के हो? Juka bhaneko ke ho?

Abdominal pain

Juka in English जुकालाई अंग्रेजिमा के भनिन्छ?

जुका एक परजीवी जनावरको संक्रमणले गर्दा पेटमा हुने समस्या हो।

जुकालाई अङ्ग्रेजीमा राउण्ड वर्म “round worm” भनिन्छ। यो aschelminthes ग्रुपमा पर्ने एक परजीवी हो। जुकाले पेटमा गएर आन्द्राको भित्री भागमा घाउ बनाउँछ र त्यहाँबाट रगत र पौष्टिक तत्व चुस्ने गर्दछ।

Juka ko symptoms जुकाका लक्षणहरू

सुरुसुरुमा जुका परेको बेला कुनै पनि लक्षण नदेखिन सक्छन्। बिस्तारै पेट बाउँडिने, वाकवाकी लाग्ने, बान्ता आउने, खाना नपच्ने, पखाला लाग्ने आदि लक्षण देखिन सक्छन्। 

धेरै जुका परेको खण्डमा यी लक्षण झनै कडा हुन्छन् र कहिलेकाहीं आन्द्रा बन्द हुने र अपरेसन गर्न पर्ने अवस्था समेत आउन सक्छ।

Juka

pet ma juka parnu पेटमा जुका पर्नुका लक्षणहरु:

पेटमा जुका पर्नुको अर्थ आन्द्रामा जुका पर्नु हो। जुका फोहोर हात, खानेकुराबाट सरेर मानिसको मुखमा पुग्छ र निलिएर पेट सम्म पुग्छ। यदि सो जुका को अण्डा पेटको पाचन प्रणालीले मार्न सकेन भने त्यो आन्द्रामा पुग्छ र त्यहा बढ्न थाल्छ। त्यसपछि लक्षणहरु देखा पर्दछन। 

Juka in stomach symptoms, symptoms of juka जुकाका लक्षणहरु

जुका परेमा निम्न लक्षणहरु देखा पर्न सक्छन:

1. पेट दुख्ने
2. वा्न्ता आउने, वाकवाकि लाग्ने
3. पखाला लाग्ने
4. खाना नरुच्ने
5. कब्जियत हुने
6. बच्चको केसमा, रुने, कराउने
7. कमजोरि हुने
8. थकान महसुस हुने
9. खाना नपच्ने
10. रगतको कमि हुने

Juka ko aushadhi, juka ko dabai

जुका लागेको भएमा डाक्टरले तलका मध्ये कुनै औषधि दिन सक्नुहुन्छ:

1. Albendazoole
2. Mebendazole
3.  Pyrantel pamoate for pergnant ladies

Juka ko aushadhi in english

एल्बेनडाजोल, मेबेन्डाजोल र पाइरेनटल पामोएट लाई जुकाको उपचारको लागि प्रयोग गर्न सकिन्छ।

Juka ko medicine name

Albendazoole, Mebendazole, Pyrantel pamoate for pergnant ladies

Namle juka in english Called?

नाम्ले जुकालाई English मा tape worm ( टेप वोर्म) भनिन्छ। 

अन्य प्रकारका जुकाहरु: Other worm types

मानव सरीरमा अन्य थुप्रै प्रकारका परजीवी जुका जस्ता प्राणीको संक्रमण हुने गर्दछ। जस्तै::

1. नाम्ले जुका
2. चुर्ना जुका
3. कलेजि जुका
4. हात्तिपाइले
5. अंकुसे जुका

अंग्रेजीमा: 

1. Ascariasis
2. Hookworm Infection
3. Pinworm Infection (Enterobiasis)
4. Trichinosis
5. Tapeworm Infections
6. Liver Fluke Infection (Fascioliasis)
7. Schistosomiasis (Bilharzia)
8. Strongyloidiasis
9. Trichuriasis
10. Dracunculiasis (Guinea Worm Disease)

Churna juka in English called?

चुर्ना जुका लाई अंग्रेजीमा  Pinworm भनिन्छ।

2 best resources to Prepare MCAT in 2024 UWorld Vs Kaplan

Introduction

Tumor markers – Which tumor marker to send?

a cancer Image by mcmurryjulie from Pixabay

Introduction of Tumor markers

Where do tumor markers come from ?

What the common tumor markers and what are they used to diagnose ? List

Here are some common tumor markers and the types of cancer they are associated with:

Some MCQs with solution in Pathophysiology/ Oncology

Some MCQs with solution in Pathophysiology/ Oncology

Question No 1

Following routine colonoscopy screening, a client is told that he had several polyps removed. The client began crying stating, “I just can’t deal with cancer. I’m too young.” The nurse responds:

A) “Don’t worry. We have some great cancer doctors on staff. I’m sure chemo will help you fight it.”

B) “Maybe if you’re lucky, they have stopped it from metastasizing to your liver.”

C) “A simple intestinal surgery will cure you.”

D) “Most colon polyps are not cancerous. The biopsy results will direct your care.”

Question No 2

A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung tumor in a client. Which of the following characteristics is associated with this client’s neoplasm?

A) The tumor will grow by expansion and is likely encapsulated.

B) The cells that constitute the tumor are undifferentiated, with atypical structure.

C) If left untreated, the client’s tumor is likely to metastasize.

D) The tumor is likely to infiltrate the lung tissue that presently surrounds it.

Question No 3

A newly diagnosed lung cancer client asks how his tumor spread (metastasized) so fast without displaying many signs/symptoms. The nurse responds that malignant tumors affect area tissues by:

A) Increasing tissue blood flow

B) Providing essential nutrients

C) Liberating enzymes and toxins

D) Forming fibrous membranes

Question No 4

A client had a positive Pap smear. The surgeon diagnosed “cancer in situ of the cervix.” The client asks, “What does this mean?” From the following statements, which is most appropriate in response to this question? The tumor has:

A) Been walled off within a strong fibrous capsule

B) Developed a distant infiltration

C) Not crossed the basement membrane, so it can be surgically removed with little chance of growing back

D) Grown undifferentiated cells that no longer look like the tissue from which it arose

Question No 5

While studying to become chemo-certified, the nurse reviews some basic concepts about cancer cells. When a client asks about why the tumor grows so fast, the nurse will respond based on which of the following physiological principles? Select all that apply.

A) Cancer cells have shorter cell cycle times than normal cells.

B) Cancer cells do not die when they are programmed to die.

C) Growth factors prevents cancer cells from entering resting (G0) cell cycle phase.

D) Cancer cells will reach a balance between cell birth and cell death rate.

E) Cancer cells never reach a flattened growth rate.

Question No 6

While looking at cancer cells under a microscope, the instructor asks the students to describe the cells. Which of the student answers are accurate? Select all that apply.

A) The cells are in different sizes and shapes.

B) The nucleoli are larger than normal.

C) The cells are contact inhibited.

D) The cells do not resemble the tissue of origin.

E) The cells are attached to an extracellular matrix.

Question No 7

The angiogenesis process, which allows tumors to develop new blood vessels, is triggered and regulated by tumor-secreted:

A) Procoagulants

B) Growth factors

C) Attachment factors

D) Proteolytic enzymes

Question No 8

Which of the following processes characterizes an epigenetic contribution to oncogenesis?

A) A DNA repair mechanism is disrupted.

B) A tumor suppressor gene is present, but it is not expressed.

C) Cells lose their normal contact inhibition.

D) Regulation of apoptosis in impaired, resulting in accumulation of cancer cells.

Question No 9

An oncology nurse is caring for a client with newly diagnosed B-cell lymphoma. Extensive blood work has been drawn and sent to the lab. Results reveal an elevated antiapoptotic protein BCL-2 level. The client/family asks, “What does this mean?” The health care provider bases his or her response on the fact that:

A) The client’s immune system is trying to kill the cancer cell by sending this protein to engulf it.

B) This is a good result. Normal cells undergo apoptosis if DNA is damaged in any way.

C) This means the cancer cells have found a way to survive and grow even with damaged DNA.

D) The client’s body is trying to limit the blood supply to the cancer cells by producing high levels of this protein.

Question No 10

A farmer’s long-term exposure to pesticides has made the cells in his alveoli and bronchial tree susceptible to malignancy. Which of the following processes has taken place in the farmer’s lungs?

A) Promotion

B) Progression

C) Initiation

D) Differentiation

Question No 11

Genetic screening may be indicated for individuals who have a family history of which of the following neoplasms?

A) Liver cancer

B) Multiple myeloma

C) Leukemia

D) Breast cancer

Question No 12

A public health nurse has cited a reduction in cancer risk among the many benefits of maintaining a healthy body mass index. Which of the following facts underlies the relationship between obesity and cancer?

A) Obesity can cause inflammation and hormonal changes that are associated with cancer.

B) Adipose tissue is more susceptible to malignancy than other types of connective tissue.

C) Increased cardiac workload and tissue hypoxia can interfere with normal cell differentiation.

D) Increased numbers of body cells increase the statistical chances of neoplastic cell changes.

Question No 13

Which of the following dietary guidelines should a nurse provide to a group of older adults to possibly decrease their risks of developing colon cancer?

A) “As much as possible, try to eat organic foods.”

B) “Regular vitamin supplements and a low-carbohydrate diet are beneficial.”

C) “Try to minimize fat and maximize fiber when you’re planning your meals.”

D) “Eat enough fiber in your diet that you have bowel movement at least once daily.”

Question No 14

A 40-year-old female has been diagnosed with hepatocellular carcinoma. When asked what causes this cancer, the physician looks at the history and responds, “I see in your history, you have had:

A) Hepatitis B related to IV drug use as a teenager.”

B) Numerous admissions for COPD exacerbations requiring steroids.”

C) Three miscarriages with no live births.”

D) Your uterus and ovaries removed for endometriosis.”

Question No 15

A male client with a diagnosis of liver cancer has been recently admitted to a palliative care unit following his recent development of bone metastases. His family shares with the nurse that even though he is usually a “big eater,” he just isn’t interested in food. This has resulted in a loss of muscle mass. Which of the following factors may underlie the client’s change in nutritional status?

A) The action of cytokines and persistent inflammation

B) Loss of appetite due to fatigue and pain

C) Changes in peptide hormone levels

D) Production of onconeural antigens by cancerous cells

Question No 16

Although clinical manifestations vary with the type of cancer and organs involved, the oncology nurses have observed that the most frequent side effects clients with cancer experience are: Select all that apply.

A) Copious lymph flow

B) Sleep disturbances

C) Involuntary weight gain

D) Visceral organ expansion

E) Lack of energy

Question No 17

Paraneoplastic syndromes are manifestations of cancer that often result from:

A) Radiation and chemotherapy

B) Compression of area vessels

C) Tumor-related tissue necrosis

D) Inappropriate hormone release

Question No 18

A client with nonspecific signs/symptoms has gone to the primary health care provider. The client’s chief complaints revolve around extreme fatigue, unplanned weight loss, and being so weak in the muscles. The diagnostic workup included a carcinoembryonic antigen (CEA) tumor marker. The CEA result was elevated. The nurse should anticipate the physician will order which of the following diagnostic tests related to the elevated CEA? Select all that apply.

A) Testicular ultrasound

B) Colonoscopy

C) Mammogram

D) Thyroid scan

E) Brain CT

Question No 19

A client is scheduled for a bronchoscopy related to a history of “bronchitis” for the last 3 months that has been unresponsive to antibiotics. The nurse shares with the client that a primary purpose for this bronchoscopy is to help diagnose the problem by:

A) Visualizing airways looking for adhesions

B) Opening airways looking for any aspirated food

C) Flushing out the airway to remove debris and sputum

D) Taking tissue biopsy and looking for abnormal cells

Question No 20

A breast cancer client has just learned that her tumor clinical stage is T3, N2, M0. After the physician leaves, the client asks the nurse to explain this to her again. The nurse will use which of the following statements in his or her answer? Your:

A) Tumor is very small and has zero number of mitoses.

B) Tumor has metastasized to at least three distal sites and you have cancer in your lymph nodes.

C) Tumor is large and at least two lymph nodes are positive for cancer cells.

D) Extent of disease is unknown, but it looks like your cancer has stayed intact and not spread to the bloodstream.

Question No 21

Which of the following subjective/objective findings can be considered an adverse effect to the radiation treatment the client is undergoing to “shrink” a tumor prior to surgery? Select all that apply.

A) Urine output less than 30 mL/hr (low)

B) Increase production of nasal secretions

C) Stiff, painful joints in the AM

D) Hemoglobin 9.0 g/dL (low)]

E) Complains of frequent nausea and vomiting

Question No 22

A 51-year-old client has been diagnosed with stage IV breast cancer with lung metastases. The oncologist sits down with the client/family to explain treatment options. The nurse knows that which of the following treatment options will be discussed for her cancers?

A) Radiation therapy

B) Chemotherapy

C) Surgery

D) Hormone therapy

Question No 23

A client’s oncologist has presented the possibility of implementing biotherapy in the treatment of the client’s brain tumor. Which of the following mechanisms of action provide the therapeutic effects of biotherapy? Select all that apply.

A) Stimulating the immune response to tumor cells

B) Inhibiting tumor protein synthesis

C) Reversing angiogenesis

D) Altering the hormonal environment of tumor cells

E) Causing breaks in the DNA of tumor cells

Question No 24

A 2-year-old child has been diagnosed with neuroblastoma. The tumor is extremely large. Parents ask how this cancer could be so extensive, yet the child has not displayed many symptoms until this past week. Nurses explain that early diagnosis of childhood cancers is often difficult because the signs and symptoms are:

A) Already present at birth

B) Absent until the late stage

C) Similar to those of other childhood diseases

D) Seen as developmental delays

Question No 25

A 5-year-old girl’s diagnosis of bone cancer required an aggressive treatment regimen. The client immediately receives doxorubicin chemotherapy. The nurse administering this medication should perform a detailed assessment of which body system that has been greatly affected by this drug?

A) CNS

B) Renal

C) Cardiac

D) Respiratory