MS 3 Final Exam Study Guide: Cancer, End-of-Life Care, and More with Complete Solutions
Adios Amigos
MS 3 Final Exam Study Guide: Cancer, End-
of-Life Care, and More with Complete
Solutions
MS 3 FINAL EXAM
Mod 10 Cancer/End of life care - 18 Questions
• Tumor Lysis Syndrome-2
o Most found in rapidly proliferative tumors (Leukemia/
Lymphoma) and therapy sensitive tumors that respond quickly
to treatment.
o Pathophysiology: Rapid cell lysis with rapidly proliferative dz or
after antineoplastic treatment. Accumulation of lysing cells
causes electrolyte imbalance or renal dysfunction
o *S/S: hypocalcemia (Trousseau sign and Chvostek sign),
hypocalcemia, hyperkalemia, metabolic acidosis = 1st degree
Heart Block, tachypnea, hyperphosphatemia (renal dysfunction,
worsening symptoms: elevated BUN/CREA, decrease UOP).
Severe laryngeal contraction, numbness of the fingertips,
paresthesia, neuromuscular irritability.
o Signs of complications: Dyspnea, Transient Ischemic attack, and
cerebrovascular accidents.
o *Management: IVF with diuretics, Hyperuricemia TX (Rasburicase
or Allopurinol), Treat electrolyte abnormalities, Phosphate binders
(Amphojel), and renal failure management (CRRT hemodialysis).
• Superior Vena Cava Syndrome-2
o Most found in chest tumors, lung cancer, and lymphoma.
o *Pathophysiology: Tumor or tumor involved lymph node
compression. Reduces return of blood flow to the heart and
causes venous congestion.
o *S/S:
▪ Early: Dyspnea, upper extremity swelling, edema of neck/
face/ eyes (severe in AM).
▪ Later Signs of poor perfusion, decreased cardiac output,
confusion, cyanosis, hypotension, tachycardia.
o Management: Immediate Chemo, steroids, thrombolytics,
superior vena cava stent.
• Leukostasis-2
o Most found in acute myelocytic leukemia with high WBC counts.
MS 3 Final Exam Study Guide: Cancer, End-of-Life Care, and More with Complete Solutions
, MS 3 Final Exam Study Guide: Cancer, End-of-Life Care, and More with Complete Solutions
o *Pathophysiology: excessive immature WBCs = capillary
sludging, thrombosis, rupture of vessels. Congestion and
dysfunction due to cell migration, inflammatory response,
hemorrhage w/i organ. Most common organs affected: Kidney,
lungs, and brain.
o S/S: blurred vision, headache, transient ischemic attacks,
cerebrovascular accidents, dyspnea, poor peripheral, oliguria.
o *Interventions: IV Fluids to reduce blood viscosity, emergency
chemotherapy, leukopheresis, and supportive interventions.
• Neutropenic Precautions-2
o *Precautions: Hand hygiene, avoid crowds, sick people, small
children, and pets. Wash raw fruits & veggies. Avoid fruits like
raspberries and black berries that cannot be washed well.
o Monitor temperature daily, immediate medical attention with
fevers or illness. No live plants or cut flowers and avoid standing
water (breeds mold/bacteria).
o Medication adherence is necessary. Hospitalization precaution is
private room, own equipment, with full PPE to protect patient.
o AVOID rectal temps, suppositories, and enemas.
• Hypercalcemia-2
o *Pathophysiology: Bone demineralization, release of calcium into
systemic circulation, bone invasion by tumor, activation of
osteoclasts, tumor producing parathormone like substance, renal
dysfunction contributing to the process.
o Mostly found in cancers that metastasize to bone:
Breast/Lung/Renal cancer. Paraneoplastic hormone production:
Lung and Pancreatic cancer.
o *Note: Phos moves the opposite direction of calcium.
o *S/S: delirium, somnolence, muscle weakness, polyuria,
bradycardia, nausea, and constipation.
o *Management: hydration NS 0.9% to dilute and enhance calcium
excretion, bisphosphonates (Pamidronate/Zoledronate) to
prevent bone metastases, monoclonal antibody (Denosumab- to
lower calcium), and less often used (Calcitonin, corticosteroids,
mithracin, strontium-98).
o NA: monitor calcium levels, Phos and Renal function, assess for
s/s of hypercalcemia, and manage with hydration and meds.
• Spinal Cord Compression-2
o Most found when there are tumors near the spinal cord.
o Tumors compress or invade blood supply.
MS 3 Final Exam Study Guide: Cancer, End-of-Life Care, and More with Complete Solutions
Adios Amigos
MS 3 Final Exam Study Guide: Cancer, End-
of-Life Care, and More with Complete
Solutions
MS 3 FINAL EXAM
Mod 10 Cancer/End of life care - 18 Questions
• Tumor Lysis Syndrome-2
o Most found in rapidly proliferative tumors (Leukemia/
Lymphoma) and therapy sensitive tumors that respond quickly
to treatment.
o Pathophysiology: Rapid cell lysis with rapidly proliferative dz or
after antineoplastic treatment. Accumulation of lysing cells
causes electrolyte imbalance or renal dysfunction
o *S/S: hypocalcemia (Trousseau sign and Chvostek sign),
hypocalcemia, hyperkalemia, metabolic acidosis = 1st degree
Heart Block, tachypnea, hyperphosphatemia (renal dysfunction,
worsening symptoms: elevated BUN/CREA, decrease UOP).
Severe laryngeal contraction, numbness of the fingertips,
paresthesia, neuromuscular irritability.
o Signs of complications: Dyspnea, Transient Ischemic attack, and
cerebrovascular accidents.
o *Management: IVF with diuretics, Hyperuricemia TX (Rasburicase
or Allopurinol), Treat electrolyte abnormalities, Phosphate binders
(Amphojel), and renal failure management (CRRT hemodialysis).
• Superior Vena Cava Syndrome-2
o Most found in chest tumors, lung cancer, and lymphoma.
o *Pathophysiology: Tumor or tumor involved lymph node
compression. Reduces return of blood flow to the heart and
causes venous congestion.
o *S/S:
▪ Early: Dyspnea, upper extremity swelling, edema of neck/
face/ eyes (severe in AM).
▪ Later Signs of poor perfusion, decreased cardiac output,
confusion, cyanosis, hypotension, tachycardia.
o Management: Immediate Chemo, steroids, thrombolytics,
superior vena cava stent.
• Leukostasis-2
o Most found in acute myelocytic leukemia with high WBC counts.
MS 3 Final Exam Study Guide: Cancer, End-of-Life Care, and More with Complete Solutions
, MS 3 Final Exam Study Guide: Cancer, End-of-Life Care, and More with Complete Solutions
o *Pathophysiology: excessive immature WBCs = capillary
sludging, thrombosis, rupture of vessels. Congestion and
dysfunction due to cell migration, inflammatory response,
hemorrhage w/i organ. Most common organs affected: Kidney,
lungs, and brain.
o S/S: blurred vision, headache, transient ischemic attacks,
cerebrovascular accidents, dyspnea, poor peripheral, oliguria.
o *Interventions: IV Fluids to reduce blood viscosity, emergency
chemotherapy, leukopheresis, and supportive interventions.
• Neutropenic Precautions-2
o *Precautions: Hand hygiene, avoid crowds, sick people, small
children, and pets. Wash raw fruits & veggies. Avoid fruits like
raspberries and black berries that cannot be washed well.
o Monitor temperature daily, immediate medical attention with
fevers or illness. No live plants or cut flowers and avoid standing
water (breeds mold/bacteria).
o Medication adherence is necessary. Hospitalization precaution is
private room, own equipment, with full PPE to protect patient.
o AVOID rectal temps, suppositories, and enemas.
• Hypercalcemia-2
o *Pathophysiology: Bone demineralization, release of calcium into
systemic circulation, bone invasion by tumor, activation of
osteoclasts, tumor producing parathormone like substance, renal
dysfunction contributing to the process.
o Mostly found in cancers that metastasize to bone:
Breast/Lung/Renal cancer. Paraneoplastic hormone production:
Lung and Pancreatic cancer.
o *Note: Phos moves the opposite direction of calcium.
o *S/S: delirium, somnolence, muscle weakness, polyuria,
bradycardia, nausea, and constipation.
o *Management: hydration NS 0.9% to dilute and enhance calcium
excretion, bisphosphonates (Pamidronate/Zoledronate) to
prevent bone metastases, monoclonal antibody (Denosumab- to
lower calcium), and less often used (Calcitonin, corticosteroids,
mithracin, strontium-98).
o NA: monitor calcium levels, Phos and Renal function, assess for
s/s of hypercalcemia, and manage with hydration and meds.
• Spinal Cord Compression-2
o Most found when there are tumors near the spinal cord.
o Tumors compress or invade blood supply.
MS 3 Final Exam Study Guide: Cancer, End-of-Life Care, and More with Complete Solutions
