INSTRUCTIONS Renal cell carcinoma, part 2

TEST INSTRUCTIONS

* Read the article. The test for this nursing continuing professional development (NCPD) activity is to be taken online at http://www.nursingcenter.com/CE/nursing. Tests can no longer be mailed or faxed.

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Renal cell carcinoma, part 2

LEARNING OUTCOME: To demonstrate competency in clinical reasoning regarding the classification of renal masses, the manifestations of RCC, and priority nursing interventions for patients who have the disorder by achieving a minimum score of 70% on the outcomes-based posttest. LEARNING OBJECTIVES: After completing this continuing professional development activity, the participant will be able to apply knowledge gained to: 1. Recognize classification systems used to assess renal masses. 2. Identify the pathophysiologic manifestations of RCC. 3. Select the recommended treatment options for RCC. 4. Choose post-op interventions for patients treated for RCC.

1. According to the Bosniak classification system of renal cystic masses, Bosniak II describes a mildly complex cyst that

a. requires a partial nephrectomy.

b. has a malignancy risk of 0%.

c. does not have calcifications.

2. A cystic mass that has a thickened, smooth or irregular wall, measurable enhancement, and a 55% to 90% risk of malignancy is classified as Bosniak

a. II-F.

b. III.

c. IV.

3. RCC that is locally invasive and/or involves nearby lymph nodes but has no distant lymph node involvement and no spread to other organs is classified as Stage

a. I.

b. II.

c. III.

4. About 10% of patients with RCC initially manifest with the classic triad of clinical manifestations of RCC: flank pain, a palpable mass in the abdomen, and

a. hematuria.

b. weight loss.

c. bilirubinemia.

5. Chronic inflammation from inflammatory cytokines released by tumors typically causes elevations in

a. creatine kinase.

b. antinuclear antibodies.

c. erythrocyte sedimentation rate.

6. Patients with RCC are at greater risk for thromboembolism due to an increase in production of

a. renin.

b. erythropoietin.

c. parathyroid peptide.

7. Patients with RCC are at greater risk for Cushing syndrome due to increased production of

a. cortisol.

b. parathyroid peptide.

c. inflammatory cytokines.

8. A recommended treatment for patients who have Stage I RCC smaller than 3 cm is

a. simple nephrectomy.

b. radical nephrectomy.

c. radiofrequency ablation.

9. You are caring for KL following a partial nephrectomy performed laparoscopically to treat RCC in her left kidney. To reduce the patient's risk of atelectasis and pneumonia, you

a. emphasize the importance of a diet high in fiber.

b. remind the patient to use her incentive spirometer regularly.

c. encourage the patient to rest in bed until she feels comfortable ambulating.

10. KL tells you she is experiencing moderate pain in her left shoulder when she sits up. You

a. explain that it is expected due to nerve irritation from carbon dioxide instilled during surgery.

b. tell her that it is most likely a muscle strain due to positioning on the surgical table.

c. reassure her that her shoulder pain will likely resolve in about a week.