G.) Compare and Contrast adult and childhood cancers.
**The pediatric nurse understands that the most common cancer found in children is?**
a.) Non-hodgkin's lymphoma
b.) Acute lymphocytic leukemia
c.) Chronic lymphocytic leukemia
d.) Ewing's sarcoma
- Answer: b, this is the most common form of cancer found in children is acute lymphocytic leukemia. 

H.) Construct a plan of care for a pt with each of the exemplar diseases, integrate the following concepts: physiologic, psychosocial, developmental and spiritual concepts as well as end-of-life planning.
** A 65-year old male patient has been receiving chemotherapy and radiation for six months to treat stage 4 colorectal cancer. The pt tells the nurse he no longer wishes to continue with treatment. A family member speaks to the pt and says "don't give up, you haven't given treatment enough time to work." Which stage of the Kubler-Ross Model of Grief is the family member expressing?
a.) Acceptance
b.) Depression
c.) Disorganization
d.) Denial
- Answer: d, Denial. 

I.) Demonstrate developmentally appropriate therapeutic communication techniques when caring for pt's with cancer and their families. 
** A 3-year old patient is diagnosed with Acute Lymphoctyic Leukemia (ALL). Her mother exclaims, “I can’t lose my baby!” What is the best response from the nurse?**
a.) Remain silent and allow the mother to grieve.
b.) “It sounds like you are upset about the diagnosis.”
c.) “She’ll be fine! You shouldn’t get so worked up in front of her.”
d.) “Most children have a good prognosis when treatment is started right away.”
- Answer: B, A and C are not therapeutic responses. D leads to a guarantee that the child will survive. B leaves the conversation open and allows the mother to further express her concerns.

J.) Identify community resources and support groups for pt's and families with cancer. 

A.   A 60-year-old female with breast cancer stage 3 that lives a sedentary lifestyle.

B.    A 70-year-old man with newly diagnosed prostate cancer diagnosed as Tis, N0, M0.

C.    A 75-year-old male with stage 3 lung cancer that smokes a pack a day.

D.   A 55-year-old woman that just had an abnormal pap smear.
The nurse is teaching a student about cellular regulation. Which statement made by the student indicates need for further instruction?

A.   Apoptosis is a normal process of programmed cellular suicide via genetic signal

B.    Natural killer cells attack cancer cells and do not need an immune response

C.    Cellular regulation can be altered by chemicals, environmental toxins, radiation, or infectious agents

D.   Necrosis is a normal process that occurs from ischemia
The patient has been diagnosed with a 6mm malignant adenocarcinoma of the ascending colon. The patient understands the difference between malignant and benign tumors when he makes the following statement.

A.   Benign tumors are hard and immobile, malignant are mobile and soft

B.    Malignant tumors are slow-growing and do not continuously divide, benign tumors rapidly reproduce and grow disorganized fashion

C.    Benign tumors are considered non-cancerous, malignant tumors have the ability to metastasize

D.   Malignant tumors have cells that look like the parent cells, benign tumors cells look nothing like the parent cell
A patient is scheduled for a colonoscopy. The nurse knows needs more teaching when he states…

A.   I will stop eating all nut seeds and popcorn three days prior, one day prior I will begin a clear, liquid diet, and drink 8 glasses of water to avoid dehydration.

B.    I will not drink anything colored red, orange, green, or blue because they will interrupt the visibility of the intestines, or mistaken for blood.

C.    I am able to drive myself home shortly after the procedure

D.   I will mix 64 oz of liquid with 8.3 oz of Miralax and place in the refrigerator and drink up til midnight before the procedure.  
A 30-year-old woman has recently been diagnosed with breast cancer in the right breast. Her doctors she is T1, N1, M0. The nurse correctly explains to the patient what this means when she says…

A.   Your tumor is still small, your lymph nodes minimally involved, and it has not metastasized

B.    Your tumor is the size of a pin-pong ball, it has spread to all of your lymph nodes, and metastasized to lungs and spine. 

C.    They can’t determine the size of it, but it appears you have breast cancer

D.   You tumor is stage 4, and immobile. 

 

cancer. 
-The RN is teaching a patient about modifiable risk factors associated with CRC. The RN knows teaching has been successful when the patient states I will avoid _____. SATA.
A. Smoking
B. Exercise
C. NSAIDS
D. Red meat
E. Alcohol

Identify the symptoms and complications of colorectal cancer.
-A patient presents with pain, acute changes in bowel habits, and bright red bloody stools. The RN suspects CRC in which segment of the intestine?
A. Ascending colon
B. Transverse colon
C. Descending colon
D. Cecum

Predict the diagnostics used in colorectal cancer and explain the nurse’s 

collaborative role.
-The RN is teaching a patient how to prepare for a colonoscopy. What is most important to teach?
A. Eat a soft diet the day before the procedure.
B. Eat a low residue or full liquid diet the day before.
C. Eat high fiber foods to promote motility.
D. Remain NPO 16 hours before procedure.
E. No dietary changes are necessary.

Identify and describe colorectal cancer treatments as they relate to the disease 

stage, including the interprofessional and nursing care for each.
-A patient is diagnosed with stage I CRC, the patient is asking the nurse about treatment. How should the nurse respond?
A. Polyps will be removed.
B. Chemotherapy and radiation will be started.
C. Monitor progression and do a follow up colonoscopy.
D. Resect affected portion of colon including tissue 5 cm above and below the tumor. 

Examine pre- and post-operative care for the surgical patient with a colostomy, a 

colectomy, and an ileostomy. 
-A patient with a new colostomy is crying. When caring for him, he states that he is worried that his wife will look at him differently. An appropriate therapeutic response would be _____.
A. You look upset. Tell me more about your concerns.
B. You should avoid intimacy.
C. You will have to talk to your therapist about this.
D. Your wife loves you no matter what. You have nothing to worry about.