Chapter 08: Care of Patients with Cancer My Nursing Test Banks

Chapter 08: Care of Patients with Cancer

MULTIPLE CHOICE

1. The 40-year-old female who was diagnosed with a benign growth in her colon is concerned about the growth spreading. The nurse can allay her anxiety by explaining that benign neoplasms:

a.

arrest their growth on their own.

b.

never interfere with normal structures or functions.

c.

are easily controlled with radiation.

d.

are surrounded by fibrous tissue that prevents spread.

ANS: D

Benign neoplasms are encapsulated with a fibrous membrane that interferes with their spreading. They do not self-limit their growth and may obstruct passages or impinge on an organ. They are not treated with radiation.

DIF: Cognitive Level: Application REF: 145 OBJ: 1 (theory)

TOP: Physiology of Cancer KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

2. The 26-year-old patient with a malignant neoplasm has experienced a 10-pound weight loss in 3 weeks. The nurse takes into consideration that the rapid weight loss is most likely related to:

a.

disinterest in eating food in general.

b.

a fitness and weight-training exercise program.

c.

the malignancys high nutritional demand.

d.

a self-imposed rigid diet regimen.

ANS: C

Rapid cell growth of the malignancy robs nutrients from normal cells and results in weight loss.

DIF: Cognitive Level: Comprehension REF: 145-146 OBJ: 1 (theory)

TOP: Physiology of Cancer KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

3. The nurse recognizes the staging T3, N2, M2 of the patients cancer to mean that there is a:

a.

small tumor with fewer than two lymph nodes involved.

b.

large tumor that is localized.

c.

small tumor with adjacent nodes involved.

d.

large tumor with extensive lymph node involvement.

ANS: D

The staging means a large tumor (T3) with involvement in regional lymph nodes (N2) and metastasis to distant lymph nodes (M2).

DIF: Cognitive Level: Analysis REF: 146-147 OBJ: 1 (theory)

TOP: TNM Staging KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

4. In assessing several patients in the outpatient clinic, the nurse identifies the patient who is at the greatest risk for cancer as the:

a.

23-year-old car repairman who repaints cars.

b.

30-year-old overweight CPA in New York who has smoked for 10 years and rarely exercises.

c.

45-year-old farmer from Texas who has worked on his familys cotton farm since the age of 12.

d.

60-year-old ski instructor in Colorado.

ANS: C

The cotton farmer in Texas has the most exposure to carcinogens. Chemicals, pesticides, and sun are the carcinogens that this farmer has been exposed to for at least 33 years.

DIF: Cognitive Level: Analysis REF: 147-150 OBJ: 2 (theory)

TOP: Cancer Risk KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

5. The nurse recognizes a promoter that, although not a carcinogen itself, allows cancer to occur faster in the patient that:

a.

is more than 25 pounds overweight.

b.

works in a hospital lab.

c.

abuses cocaine.

d.

drinks heavily.

ANS: D

Alcohol and smoking are promoters that facilitate the occurrence of cancer. Being overweight, working in a hospital lab, and abusing cocaine are not considered promoters in regard to cancer risk.

DIF: Cognitive Level: Application REF: 148 OBJ: 2 (theory)

TOP: Causative Factors KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

6. The x-ray technician wears a badge that is monitored frequently to measure the amount of radiation he has absorbed. Such occupational exposure to radiation frequently results in a specific cancer, which is:

a.

bladder cancer.

b.

leukemia.

c.

melanoma.

d.

lung cancer.

ANS: B

The blood cancer leukemia is associated with radiation exposure. Bladder, melanoma, and lung cancer are associated with other carcinogens.

DIF: Cognitive Level: Application REF: 148-149 OBJ: 3 (theory)

TOP: Causative Factors KEY: Nursing Process Step: NA

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

7. The nurse outlines a diet that would be helpful in the prevention of cancer. This diet includes:

a.

adequate nitrites.

b.

no more than 40% fats.

c.

vitamin B complex.

d.

citrus fruits.

ANS: D

Vitamin C helps combat the effects of nitrites; fats should be no more than 30%, and vitamin B has not been proven effective for cancer prevention.

DIF: Cognitive Level: Application REF: 150 OBJ: 3 (theory)

TOP: Prevention of Cancer KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

8. The young college student who wants a tan before spring break asks the nurse what the safest method would be. The nurses best response is:

a.

take advantage of morning sun while using sunscreen with an SPF of 30.

b.

use a spray-on tanning solution.

c.

use a sun lamp for only 20 minutes a day.

d.

use a tanning salon for no more than 10 minutes per visit.

ANS: B

Spray-on tanning solution is the safest. All other options increase ultraviolet exposure, even with the use of sunscreen.

DIF: Cognitive Level: Application REF: 147 | Table 8-1

OBJ: 3 (theory) TOP: Prevention of Cancer

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

9. The nurse reminds the 40-year-old female patient that the American Cancer Society (ACS) recommendations for early detection of cancer include that she should:

a.

get a Pap smear every year.

b.

get an annual fecal occult blood exam.

c.

plan a sigmoidoscopy every 5 years.

d.

have a mammogram done every year.

ANS: D

The ACS recommends that 40-year-old women have an annual mammogram and a Pap smear every 2 to 3 years. Yearly fecal occult blood studies and sigmoidoscopy are recommended beginning at age 50.

DIF: Cognitive Level: Comprehension REF: 153 | Box 8-1

OBJ: 4 (theory) TOP: Prevention of Cancer

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

10. In assessing a man who is to have a prostate-specific antigen (PSA) test done, the nurse identifies the situation that will delay the test, which is:

a.

having eaten shellfish 48 hours previously.

b.

identification of an enlarged prostate.

c.

recent urinary tract infection.

d.

temperature of 100 F.

ANS: C

The PSA would be delayed in the event of a recent urinary tract infection.

DIF: Cognitive Level: Application REF: 155 | Box 8-2

OBJ: 4 (theory) TOP: Prostate-Specific Antigen Test (PSA)

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

11. In planning care for the patient who is on a protocol of bleomycin, an antitumor antibiotic, the nurse will add to the care plan an intervention to:

a.

assess hearing acuity.

b.

measure urinary output.

c.

weigh daily to assess fluid retention.

d.

monitor cardiac arrhythmias.

ANS: D

Bleomycin is cardiotoxic and can cause cardiac arrhythmias; therefore, this would be the highest priority intervention. Chemotherapies that are ototoxic would warrant a hearing test; urinary output and fluid retention should be assessed with most chemotherapy drugs, and especially for those that are nephrotoxic.

DIF: Cognitive Level: Analysis REF: 163 | Table 8-4

OBJ: 5 (theory) TOP: Chemotherapy: Bleomycin

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. When caring for a patient with cancer who is receiving vincristine, a vesicant, the nurse is especially careful to avoid:

a.

the patient getting chilled.

b.

the drug extravasating.

c.

an infusion time greater than 2 hours.

d.

feeding the patient during the infusion.

ANS: B

A vesicant such as vincristine can cause tissue damage if it extravasates. The degree of damage is based on the amount of drug that has leaked and the length of time it was in the tissue.

DIF: Cognitive Level: Application REF: 163 OBJ: 5 (theory)

TOP: Chemotherapy: Vincristine KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. The nurse includes in the instructions to a 50-year-old male patient taking estrogens as treatment of prostate cancer that he may develop:

a.

blurred vision.

b.

gynecomastia.

c.

enlarged gonads.

d.

acne.

ANS: B

Men taking estrogen experience a redistribution of fat and develop enlarged breasts (gynecomastia).

DIF: Cognitive Level: Application REF: 164-165 OBJ: 6 (theory)

TOP: Chemotherapy: Hormones KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

14. The nurse instructs a patient who is on a biologic response modifier (BMR) colony-stimulating drug that the effect of this type of drug is to:

a.

increase appetite.

b.

seek out and kill specific colonies of neoplasms.

c.

enhance recovery of bone marrow.

d.

reduce pain.

ANS: C

BMRs enhance and support the recovery of suppressed bone marrow resulting from radiation and chemotherapy.

DIF: Cognitive Level: Comprehension REF: 165 OBJ: 6 (theory)

TOP: Chemotherapy: Biologic Response Modifiers

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

15. The patient on radiation therapy has developed diarrhea. The nurse suggests foods that would decrease diarrhea, such as:

a.

broccoli.

b.

cauliflower.

c.

cheese and crackers.

d.

apples and pears.

ANS: C

Food low in fiber, such as cheese and crackers, will help slow diarrhea. All other options are high-fiber foods that stimulate bowel evacuation.

DIF: Cognitive Level: Application REF: 167 OBJ: 6 (theory)

TOP: Radiation Side Effects: Diarrhea KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

16. The nurse instructing fatigue management to the patient who is taking radiation will include information about:

a.

prioritizing activities.

b.

planning 4 to 5 hours of daytime bed rest.

c.

decreasing fluid intake.

d.

avoiding between-meal snacks.

ANS: A

Prioritizing activities is essential to balance energy with expenditure. These patients should not spend long periods of daytime in bed, and they should increase fluids and plan between-meal snacks to keep energy up.

DIF: Cognitive Level: Analysis REF: 169 OBJ: 6 (theory)

TOP: Radiation Side Effects: Fatigue KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. The 32-year-old mother who is undergoing radiation from a sealed-source modality and has been isolated in a private room for 3 days is preparing to be visited by her 8-year-old twins. The nurse should include what in the preparations?

a.

Instruct the children to visit at the bedside one at a time.

b.

Inform family that children cannot visit patients undergoing radiation.

c.

Put chairs in the hall for long-distance visitation.

d.

Allow visitation of only 3 minutes without any physical contact.

ANS: C

Children and pregnant people should not visit at the bedside, but a visit from a safe distance or by phone helps relieve the boredom of isolation.

DIF: Cognitive Level: Application REF: 161 | Box 8-4

OBJ: 4 (clinical) TOP: Radiation Care Problems

KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

18. The nurse evaluated that the 50-year-old male recently diagnosed with early stage cancer of the prostate has begun to accept his diagnosis when he:

a.

jokes, Well, I guess this just about cancels any plans for a second honeymoon.

b.

calls his lawyer to update his will.

c.

requests current information on prostate cancer.

d.

asks his wife to call their children home from college to visit.

ANS: C

Well-adjusted patients should seek information on the disease and varied treatments. Joking is a form of denial. Gathering family and making final arrangements reflect loss of hope and do not coincide with the prognosis of early stage prostate cancer. Humor is a positive coping strategy, but requesting information about the disease is more indicative of acceptance.

DIF: Cognitive Level: Analysis REF: 171 OBJ: 4 (clinical)

TOP: Acceptance of Diagnosis KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

19. Following a visit from his family, the 55-year-old male patient with terminal cancer tearfully says, I am so afraid and begins to cry. The nurses most supportive response is to:

a.

ask, Would you like to have your pain medication now?

b.

sit down and say, Lets talk about what you are afraid of.

c.

offer to call the hospital chaplain.

d.

darken the room and leave to give the patient privacy.

ANS: B

Verbalizing fears to a caring nurse is comforting. Offering medications, chaplains, and privacy is not helpful or supportive as a first nursing response in this situation.

DIF: Cognitive Level: Application REF: 171 OBJ: 5 (clinical)

TOP: Fear KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

20. The family becomes distressed when the dying 85-year-old patient becomes delirious and laughs and talks with old friends who have long since died. The nurses best intervention would be to:

a.

medicate the patient with the prescribed sedative.

b.

encourage a family member to talk to the patient calmly.

c.

stimulate and reorient the patient.

d.

suggest the family leave the patient for while.

ANS: B

Delirious patients can still hear. A familiar voice is comforting. Medicating the patient with a sedative is not appropriate. Stimulating and trying to reorient the patient may cause the patient to become irritated. The family should remain with the patient.

DIF: Cognitive Level: Analysis REF: 174 OBJ: 5 (clinical)

TOP: Delirium KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

21. The student nurse demonstrates an understanding of cancer risk factors by identifying which patient as being at the highest risk for developing colorectal cancer?

a.

50-year-old male who has been exposed to arsenic in the workplace

b.

45-year-old female with a doctorate degree in psychology who smokes occasionally

c.

38-year-old female who had her first child one year ago

d.

29-year-old male who has had Crohns disease since the age of 13

ANS: D

Inflammatory diseases of the colon increase the risk of colorectal cancer. Arsenic exposure places the patient at risk for lung cancer. Women with a high level of education have been found to fall into the high risk category for developing breast cancer, as well as having the first child after the age of 30.

DIF: Cognitive Level: Application REF: 152 | Box 8-2

OBJ: 4 (theory) TOP: Risk Factors KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

22. Which patient statement indicates understanding of patient teaching regarding cancer diagnostic exams?

a.

I will have less scarring if my surgeon uses an incision to biopsy my breast.

b.

My CEA level will be low if my pancreatic cancer returns.

c.

The doctor will monitor my ovarian cancer remission with the CA-125 test.

d.

My colonoscopy results were great, so I wont need another one for 5 years.

ANS: C

The CA-125 is one of the tests the physician will monitor to detect the presence of ovarian cancer or recurrence of ovarian cancer after therapy. Fine-needle biopsy causes the least amount of scarring during breast cancer biopsy. The patients CEA level will rise if pancreatic cancer is present. Recommendations suggest a colonoscopy every 10 years if the exam is negative and there is no family history of colon cancer.

DIF: Cognitive Level: Application REF: 153 | Box 8-1, 154-155

OBJ: 3 and 4 (theory) TOP: Diagnostics

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

23. The wife of a terminally ill cancer patient who is receiving palliative care asks the hospice nurse how her husbands pain will be controlled as he nears death. The nurses best response is:

a.

Most of the time we can manage the pain with oral morphine and transdermal pain medication.

b.

We will probably have to start an IV to administer morphine to control the intense pain he may be experiencing.

c.

Dying patients typically do not have any pain, so this will not be an issue.

d.

I will have to check with your husbands physician to see how he wants us to handle pain control.

ANS: A

Oral and transdermal pain control methods are most often used for the terminally ill patient near death. An IV is not typically started on a patient near death who is receiving palliative care. Dying patients do experience pain. The plan of care should be in place for the patient receiving palliative care, so the physician would not be contacted for pain medication orders.

DIF: Cognitive Level: Application REF: 169-170 | 174

OBJ: 5 (clinical) TOP: Pain Control KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE

24. The nurse uses a visual aid to demonstrate the characteristics of a malignant neoplasm, which are: (Select all that apply.)

a.

very small nuclei.

b.

disorganization.

c.

altered DNA.

d.

invasion of nearby organs.

e.

travel through body fluid.

ANS: B, C, D, E

Malignant neoplasms have large rather than small nuclei. Disorganization, altered DNA, invasion of nearby organs, and the ability to travel through body fluid are all characteristics of malignancies.

DIF: Cognitive Level: Comprehension REF: 145-146 OBJ: 1 (theory)

TOP: Physiology of Cancer KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

25. The classifications of malignant neoplasms are: (Select all that apply.)

a.

carcinomas.

b.

lymphomas.

c.

fibromas.

d.

lipomas.

e.

sarcomas.

ANS: A, B, E

The categories of malignancy are sarcomas, carcinomas, leukemias, and lymphomas. Fibromas and lipomas are benign.

DIF: Cognitive Level: Application REF: 146 OBJ: 1 (theory)

TOP: Classification of Tumors KEY: Nursing Process Step: NA

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

26. The nurse explains that metastasis from the original site to a new site is accomplished by malignant cells via: (Select all that apply.)

a.

traveling through tissues.

b.

transplantation via surgical instruments during surgery.

c.

entering a body cavity and attaching to an organ.

d.

traveling through the lymphatic system.

e.

relocation from contaminated gloves during surgery.

ANS: B, C, D, E

Traveling through blood rather than tissues is a common mechanism for metastasis.

DIF: Cognitive Level: Comprehension REF: 146 OBJ: 1 (theory)

TOP: Metastasis KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

27. The nurse explains that viruses are responsible for some specific cancers, such as: (Select all that apply.)

a.

liver cancer from hepatitis B virus.

b.

Burkitts lymphoma from Epstein-Barr virus.

c.

cervical cancer from human papillomavirus.

d.

lung cancer from measles virus.

e.

Kaposi sarcoma from human immunodeficiency virus.

ANS: A, B, C, E

Measles do not cause lung cancer. All other options are examples of cancer caused by a virus.

DIF: Cognitive Level: Application REF: 149 OBJ: 2 (theory)

TOP: Causative Factors KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

28. The biologic response modifier drugs include: (Select all that apply.)

a.

interleukins.

b.

colony-stimulating factors.

c.

monoclonal antibodies.

d.

cyclosporines.

e.

gene therapies.

ANS: A, B, C, E

Cyclosporines are drugs that are used to prevent tissue transplant rejection and are considered a carcinogen for non-Hodgkins lymphoma. In addition to the biologic response modifiers (BRM) listed, vaccines are also a BRM.

DIF: Cognitive Level: Comprehension REF: 165 OBJ: 5 (theory)

TOP: Biologic Response Modifiers (BMRs) KEY: Nursing Process Step: NA

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

COMPLETION

29. The nurse cautions that stress over a long period of time can contribute to the risk for cancer as prolonged stress suppresses the ____________.

ANS:

immune system

The immune system can be suppressed by prolonged stress.

DIF: Cognitive Level: Comprehension REF: 150 OBJ: 2 (theory)

TOP: Causative Factors KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

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