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Nursing Management of the Patient with Bone Metastases - Post Test

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  1. Bone metastases can cause a patient to develop:
    1. Hyperkalemia, hypocalcemia and pain
    2. Pathologic fracture, spinal cord compression and pain
    3. Pain, nausea and diarrhea
    4. None of the above
  2. All of the following are types of bone metastases, except:
    1. Osteolytic
    2. Osteoporosis
    3. Osteoblastic
    4. Mixed osteolytic & blastic
  3. As cancer cells invade the bone:
    1. Growth factors are released that further promote tumor growth.
    2. Healthy bone is destroyed.
    3. Growth factors are suppressed and tumor growth slows.
    4. A & B
  4. Pain is the most common presenting symptom of bone metastases. This pain can be caused by:
    1. Pressure of the tumor cells within the bone.
    2. Release of cytokines by the tumor cells in the bone.
    3. The tumor's affect on bone strength and integrity.
    4. All of the above
  5. Your patient, a 48-year-old female with breast cancer, calls to report worsening back pain over the last few days. You should:
    1. Tell her to take her pain medication and call back tomorrow to update you.
    2. Inquire about further neurologic symptoms, such as bowel/bladder incontinence and lower extremity weakness.
    3. Know that she requires urgent evaluation to rule out spinal cord compression.
    4. B & C
  6. The American Society for Radiation Oncology Guidelines for palliative radiotherapy in bone metastases state that a single dose of radiation (8Gy) is NOT as effective in providing pain relief as multiple doses.
    1. True
    2. False
  7. When a patient is receiving a radioisotope for treatment of their cancer, the nurse should understand:
    1. Radioisotopes provide effective pain relief in 80% of patients.
    2. Radioisotopes are myelosuppressive and the patient should be educated on low blood count precautions.
    3. Other systemic therapies should not be given for 6 weeks after treatment with a radioisotope.
    4. All of the above
  8. Bisphosphonates are generally well tolerated, but can cause elevated serum creatinine. Measures to prevent this from occurring include:
    1. Giving the patient hydration prior to the bisphosphonates infusion.
    2. Infusion times should not be shorter than advised in the product packaging (2 hours for pamidronate and 15 minutes for zoledronic acid).
    3. Patients with mild to moderate renal impairment should receive reduced doses.
    4. All the above
  9. Osteonecrosis of the Jaw (ONJ) is a rare, but debilitating side effect associated with the chronic use of IV bisphosphonates. Preventive measures include all except:
    1. Undergo a complete dental evaluation, cleaning and optimization of dental health prior to starting bisphosphonates.
    2. Educate patient to report any concerning symptoms, such as jaw pain or numbness, exposed bone or drainage.
    3. Advise the patient that frequent flossing can help prevent ONJ.
    4. Advise the patient who requires dental surgery and has been on therapy for more than 3 years that the American Association of Oral Maxillofacial Surgery recommends discontinuing bisphosphonates for 3 months prior to surgery.
  10. If there are no contraindications, patients receiving bisphosphonates or denosumab should receive supplemental calcium and vitamin D.
    1. True
    2. False

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