Chapter 11. Nursing Care of Patients With Cancer My Nursing Test Banks

Chapter 11. Nursing Care of Patients With Cancer

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse is reviewing the function of DNA and RNA with a group of students. Which structure should the nurse explain as providing the genetic code for a gene?
a. Cell
b. Protein
c. Piece of DNA
d. Piece of RNA
____ 2. A patient with lung cancer is receiving chemotherapy. Why should the nurse closely monitor the patients white blood cell (WBC) count?
a. Chemotherapy drugs cause polycythemia and can precipitate thrombosis.
b. Chemotherapy drugs attack WBCs and shorten their life span, which increases risk for infection.
c. Chemotherapy drugs cause proliferation of blood cells, which can lead to sluggish circulation.
d. Chemotherapy drugs depress the bone marrow, which can lead to infection and an increase in WBC count.
____ 3. A patient asks what dietary changes can be made to help protect against cancer. The nurse should base his or her response to the patients question on which of the following?
a. Reduced dietary fat intake can lower cancer risk.
b. Reduced dietary salt intake reduces malignancy development.
c. Increased intake of beef and poultry decrease the risk of malignancy.
d. Increased intake of milk products will lower risk of cancer development.
____ 4. A patient is diagnosed with a malignant tumor of the bone. Which term should the nurse consider when documenting this patients health problem?
a. Sarcoma
b. Osteoma
c. Adenoma
d. Carcinoma
____ 5. A patient who has been treated for breast cancer is undergoing routine laboratory work. Which laboratory finding would cause the nurse to be most concerned about metastasis?
a. Elevated serum calcium
b. Decreased serum calcium
c. Elevated serum potassium
d. Decreased serum potassium
____ 6. A patient is scheduled for a needle biopsy of the breast. Which statement indicates that teaching has been effective?
a. A small needle will be used to inject chemotherapy into my tumor.
b. The doctor will use a needle to go into the tumor for a sample of cells.
c. A needle will be implanted into the tumor so medication can be injected.
d. The doctor is going to make a small incision in my breast to get some tumor cells.
____ 7. A patient is scheduled for radiation treatments before having surgery to remove a tumor. What should the nurse cite as the reason for the radiation treatments?
a. Reduces the need for chemotherapy
b. Reduces the size of the tumor before surgery
c. Reduces the need for radiation after the surgery
d. Reduces the spread of cancer cells during the surgery
____ 8. A patient with prostate cancer asks the nurse the meaning of his high prostate-specific antigen (PSA) level. Which response by the nurse is correct?
a. PSA is a tumor marker that is elevated in patients with prostate cancer.
b. PSA levels are done routinely to determine whether your prostate cancer has spread to a new site.
c. The doctor orders PSA measurements to monitor the level of chemotherapy medication in your blood.
d. A PSA test allows the pathologist to view the cancer cells under the microscope to monitor the progression of cancer.
____ 9. A patient is diagnosed with a stage I tumor in situ (TIS). Which explanation of TIS by the nurse is the best?
a. The tumor has spread and is generalized throughout the body.
b. The tumor has not invaded any tissues beyond the original site.
c. The tumor has spread to the lymph nodes in the immediate area.
d. The tumor is situated between two tissues, so there is risk for metastasis to both tissues.
____ 10. A patient with cancer is scheduled for palliative surgery. Which explanation should the nurse use to describe the purpose of this surgery?
a. Palliative surgery is done to reconstruct tissues damaged by the cancer.
b. Palliative surgery is done to increase the patients comfort when cure is not possible.
c. Palliative surgery is done to remove a cancer completely and increase the chances for cure.
d. Palliative surgery is done to remove surrounding lymph nodes, reducing the risk for spread of the primary tumor.
____ 11. A patient receiving radiation therapy for a tumor in the salivary gland is complaining of a very dry mouth. How should the nurse document this finding?
a. Halitosis noted.
b. Patient reports xerostomia.
c. Grade II stomatitis present.
d. Patient experiencing dysphagia with liquids.
____ 12. The nurse is planning care for a patient with a radioactive implant. Which intervention should the nurse select to help prevent social isolation in this patient?
a. Visit the patient frequently, but do not touch the patient.
b. Help provide diversional activities that the patient enjoys.
c. Have only one nurse provide care to increase consistency.
d. Encourage family to stay with the patient, but have them wear masks and gloves at all times.
____ 13. The nurse is assessing a patient and notes drainage on the sheets from the site of a radioactive colloid injection. What should the nurse do first?
a. Change the patients sheets.
b. Assist the patient with skin care.
c. Stay with the patient while calling for help.
d. Follow hospital policy for radioactive waste cleanup.
____ 14. The nurse is preparing to teach a patient about the effects of chemotherapy on other body tissues. What should the nurse explain as the reason why hair, blood, skin, and gastrointestinal (GI) tract cells are more likely to be adversely affected by chemotherapy than other cells?
a. Because they are fast growing
b. Because they are exposed to air
c. Because they are all porous tissues
d. Because they are less able to excrete waste products
____ 15. A patient receiving doxorubicin (Adriamycin) voids urine that is bright red. Which action by the nurse is appropriate?
a. Notify the physician STAT.
b. Withhold all red dye from the patients diet.
c. Draw a hemoglobin sample and prepare for possible blood transfusion.
d. Check the patients urine, and tell the patient that this is a common side effect of Adriamycin.
____ 16. The intravenous line of a patient receiving a vesicant chemotherapy agent has disconnected and is lying on the floor. The medication is dripping all over the floor. Which action should the nurse take first?
a. Reconnect the IV tubing immediately.
b. Wipe it up as quickly as possible with disposable cloths.
c. No special precautions are needed for vesicant drug cleanups.
d. Use gloves and a protective gown to clean the spill according to agency policy.
____ 17. A patient develops alopecia related to doxorubicin (Adriamycin) therapy. Which statement should the nurse use to explain this side effect?
a. Uric acid collects in hair cells.
b. Antibiotics stop all hair growth.
c. Bone marrow suppression prevents nourishment of hair follicles.
d. Anti-neoplastics, such as Adriamycin, attack all rapidly dividing cells.
____ 18. When inspecting the IV site of a patient receiving a vesicant chemotherapy agent, the licensed practical nurse (LPN) notes a small area of swelling. What should the LPN do first?
a. Check the site every hour.
b. Document the finding in the chart.
c. Discontinue the infusion and notify the RN.
d. No action is needed; this is an expected finding.
____ 19. The nurse is caring for a patient with leukopenia. Which item creates the greatest risk for this patient?
a. A fresh apple brought in by a friend
b. A can of soda from a vending machine
c. A get-well card from a family member
d. A paperback book purchased at the hospital gift shop
____ 20. A patient on chemotherapy after surgery develops thrombocytopenia. Which manifestation should the nurse report immediately to the physician?
a. Headache
b. Tarry stools
c. Pain at the surgical site
d. Blood pressure 136/88 mm Hg
____ 21. Based on the diagnosis Imbalanced Nutrition related to nausea and vomiting, the goal of maintaining a stable weight during chemotherapy was identified for a patient receiving care. Which statement provides the best evidence that the goal has been met?
a. Patients weight is unchanged during treatment.
b. Patient states nausea and vomiting are controlled.
c. Patient is able to eat 90% of meals without nausea.
d. Patients nausea and vomiting are controlled with antiemetic medication.
____ 22. The nurse educator is preparing a seminar on cancer for a group of nursing students. Which definition should the nurse educator use to accurately describe cancer?
a. Cancer is a name for cells that produce toxins that destroy body organs.
b. Cancer is a term used to describe all new abnormal growths in the body.
c. Cancer is a name given to a disease caused primarily from toxins in the environment.
d. Cancer is a name for a large group of diseases characterized by cells that multiply rapidly and invade normal tissue.
____ 23. The nurse is planning care for a patient with leukopenia caused by chemotherapy. Which nursing intervention is most important for the nurse to include in this patients plan of care?
a. Protect the patient from injury.
b. Observe for bruising or bleeding.
c. Ensure that staff members practice good hand washing.
d. Assist the patient with activities of daily living (ADLs).
____ 24. A patient undergoing chemotherapy telephones the clinic to complain of a nosebleed 2 days after a treatment. Which nursing diagnosis should the nurse consider while further assessing the patient?
a. Ineffective Protection related to thrombocytopenia
b. Imbalanced Nutrition: less than body requirements
c. Risk for Infection related to low WBC count
d. Disturbed Body Image related to effects of chemotherapy
____ 25. A patient develops fatigue related to radiation therapy. Which intervention is the most appropriate for this patient?
a. Discuss the patients views concerning blood transfusion.
b. Encourage moderate exercise between radiation treatments.
c. Encourage larger portions of foods rich with calories and protein.
d. Encourage the patient to prioritize activities around frequent rest periods.
____ 26. The nurse is caring for a patient with lung cancer who is receiving chemotherapy. Which assessment finding suggests that the patient is experiencing pericardial effusion?
a. Bruising and tarry stools
b. Edema and shortness of breath
c. Nausea and decreased bowel sounds
d. Peripheral numbness and tingling
____ 27. A patient being treated with chemotherapy for breast cancer also is being given epoetin alfa for anemia. During the assessment, of what finding should the nurse be most observant?
a. Dyspnea
b. Bone pain
c. Fluid retention
d. Elevated blood pressure
____ 28. The nurse is checking the laboratory reports of a patient being treated with paclitaxel. Which platelet count might indicate spontaneous bleeding?
a. 15,000/mm3
b. 60,000/mm3
c. 175,000/mm3
d. 300,000/mm3
____ 29. A nurse is teaching a patient about risk factors for cancer. Which statement by the patient indicates a need for further teaching?
a. I should eat plenty of fruits and vegetables.
b. I should eat a low-fat diet that is high in fiber.
c. I understand that eating a high-fat diet increases my risk of breast cancer.
d. I know that eating pickled and smoked foods can help prevent GI cancers.
____ 30. The nurse is assessing a 58-year-old patient. For what yearly screening test for colorectal cancer should the nurse assess the patient?
a. Colonoscopy
b. Barium enema
c. Stool test for blood
d. Flexible sigmoidoscopy
____ 31. A nurse is conducting a community education class on cancer risk. The nurse knows that teaching has been effective when women recognize that they are most at risk of dying of which type of cancer?
a. Lung cancer
b. Breast cancer
c. Uterine cancer
d. Ovarian cancer
____ 32. The nurse is reviewing a patients diagnostic test report. For which tumor diameter should the nurse evaluate the report to determine if cancer is present?
a. 0.5 cm
b. 1 cm
c. 2 cm
d. 5 cm
____ 33. The nurse is reviewing laboratory results and becomes concerned about one patient being treated for cancer. Which patient does the nurse suspect is in need of nutritional support?
a. An 18-year-old with an albumin of 2.5
b. A 60-year-old with a calcium level of 8 mg/dL
c. A 43-year-old with a platelet level of 180,000/mm3
d. A 56-year-old with a white cell count of 6000/mm3
____ 34. The nurse is preparing an oral chemotherapeutic medication for a patients cancer treatment. What should the nurse do to ensure personal safety when preparing this medication?
a. Wear gloves while preparing.
b. Wash hands before administering.
c. Apply a lead apron when providing.
d. Crush the medication before providing.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 35. The nurse is reviewing the process of cellular mutation with a patient newly diagnosed with cancer. What should the nurse explain about cellular mutation? (Select all that apply.)
a. The cell becomes malignant.
b. The cell can no longer divide.
c. DNA mistakes have been made.
d. The cell membrane is punctured.
e. Proteins are no longer synthesized.
f. There has been a genetic change in the cell.
____ 36. The nurse is explaining mitosis to a group of nursing students. What should the nurse explain as the characteristics of a cell that has undergone mitosis? (Select all that apply.)
a. 23 chromosomes
b. 46 chromosomes
c. A nuclear membrane
d. Two sets of amino acids
e. A strengthened cell wall
f. Fewer organelles than the parent cell
____ 37. The nurse is explaining the characteristics of a malignant tumor to a patient who is newly diagnosed with cancer. What should the nurse include in this explanation? (Select all that apply.)
a. The growth rate is rapid.
b. Tissue damage is minimal.
c. The cells resemble the tissue of origin.
d. The cells may invade surrounding tissues.
e. The cells can travel to distant organs and initiate new tumors.
____ 38. A patient is experiencing mucositis as a result of radiation therapy. Which interventions should the nurse include in the plan of care? (Select all that apply.)
a. Provide oral care once daily.
b. Discourage use of alcohol and tobacco.
c. Encourage citrus juice for vitamin C supplementation.
d. Advise the patient to avoid very cold foods and drinks.
e. Heat all liquids before drinking to promote oral blood flow.
f. Advise the patient to use a neutral mouthwash, such as diphenhydramine (Benadryl), and water.
____ 39. A patient is diagnosed with a blood disorder after receiving chemotherapy. Which colony-stimulating drugs should the nurse expect might be prescribed to help treat this disorder? (Select all that apply.)
a. Filgrastim (Neupogen)
b. Pegfilgrastim (Neulasta)
c. Hydroxyurea (Hydrea)
d. Epoetin alfa (Epogen)
e. Exemestane (Casodex)
f. Irinotecan (Camptosar)
____ 40. The nurse is explaining cancer cells to a patient newly diagnosed with cancer. Which of the following should the nurse tell the patient are characteristic of cancer cells? (Select all that apply).
a. They have division limits.
b. They usually grow slowly.
c. They are considered immortal.
d. They result from mutations of cellular genes.
e. They destroy the gluelike substance found between normal cells.
f. They take on the characteristics of the cells in the tissue to which they migrate.
____ 41. The nurse is providing dietary teaching to help a patient reduce the risk of cancer. Which foods should the nurse instruct the patient to avoid? (Select all that apply.)
a. Alcohol
b. Whole grains
c. Smoked meats
d. Root vegetables
e. Charbroiled meat
f. Cruciferous vegetables
____ 42. The nurse is preparing a seminar on cancer incidence for a group of community members. Which types of cancer are common for both men and women? (Select all that apply.)
a. Skin
b. Lung
c. Breast
d. Kidney
e. Prostate
f. Colorectal
____ 43. The nurse is planning a teaching seminar for members of a Native American tribal community on ways to prevent the development of cancer. What should the nurse include in this teaching? (Select all that apply.)
a. Encourage traditional customs of physical fitness and exercise.
b. Provide teaching materials in the participants native language.
c. Identify healing practices that can be incorporated into tribal customs.
d. Emphasize the use of same-sex caregivers when seeking preventive care.
e. Discuss the importance of dietary portion control and healthy food preparation.
____ 44. A patient with cancer is receiving a dose of an oral radioactive isotope. What should the nurse keep in mind to ensure personal safety when caring for this patient? (Select all that apply.)
a. The best skin care approaches for the patient
b. The time needed to provide quality patient care
c. The distance between the patient and caregivers
d. The use of a barrier to protect from radiation exposure
e. The types of foods the patient should abstain from ingesting
____ 45. The nurse identifies the diagnosis Imbalanced nutrition: Less than body requirements for a patient experiencing nausea from chemotherapy. Which interventions should the nurse include in this patients plan of care? (Select all that apply.)
a. Add nutmeg to foods.
b. Provide oral care before meals.
c. Provide large meals with hot foods.
d. Offer sour foods containing lemon.
e. Spray the room with disinfectant before meals.
____ 46. A patient with lung cancer is experiencing neck edema and shortness of breath. What actions can the nurse take to help relieve this patients symptoms? (Select all that apply.)
a. Restrict fluids.
b. Elevate the head of the bed.
c. Remove restrictive clothing.
d. Insert an indwelling urinary catheter.
e. Avoid using the arms for venipuncture.

Chapter 11. Nursing Care of Patients With Cancer
Answer Section

MULTIPLE CHOICE

1. ANS: B
B. Specific regions of DNA are called genes; a gene is the code for one protein. The genetic code of DNA is the code for the amino acid sequences needed to synthesize a cells proteins. C. A complimentary copy of the DNAs gene is made by a molecule called messenger RNA (mRNA). A. The mRNA then moves to the cytoplasm of the cell and attaches to the ribosomes. D. Transfer RNA (tRNA) molecules bring the necessary amino acids to the proper places on the mRNA molecule, and enzymes of the ribosomes catalyze the formation of peptide bonds to link the amino acids into the primary structure of a protein.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

2. ANS: D
D. Chemotherapy is toxic to the bone marrow, where the blood cells are produced. Numbers of blood cells, especially WBCs, drop after approximately 7 to 14 days, depending on the drug. A. Chemotherapy is more likely to cause bleeding because of lack of platelets, not thrombosis. B. Chemotherapy does not directly attack WBCs. C. Chemotherapy does not cause proliferation of cells, although excess immature cells may be present.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

3. ANS: A
A. Diet is a large factor in both cause and prevention of malignancies. People who eat high-fat, low-fiber diets are more prone to develop colon cancers. High-fat diets are linked to breast cancer in women and prostate cancer in men. B. Reduced salt intake reduces blood pressure and fluid retention, not cancer. C. D. Increased intake of milk, beef, and poultry will not lower cancer risk.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

4. ANS: A
A. Cancer cells affecting connective tissue, including fat, the sheath that contains nerves, cartilage, muscle, and bone, are called sarcomas. B. Osteomas are benign. C. Adenomas originate from glandular tissue. D. Neoplasms occurring in the epithelial cells are called carcinomas.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentManagement of Care | Cognitive Level: Application

5. ANS: A
A. Hypercalcemia is associated with the release of calcium into the blood from bone deterioration related to metastasis and is common in patients with metastasis; it often occurs with breast cancer. B. A drop in calcium level does not indicate bone metastasis. C. D. Potassium imbalances are not commonly associated with metastasis.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

6. ANS: B
B. Needle aspiration biopsy involves insertion of a needle into tissue for fluid or tissue aspiration. A. C. A needle biopsy is done for diagnostic purposes, not to inject chemotherapy. D. An incision is not made in a needle biopsy.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

7. ANS: B
B. Radiation can be used before surgery to decrease the size of a large tumor. A. Radiation before surgery does not reduce the need for chemotherapy. C. Radiation before surgery does not reduce the need for radiation after the surgery. D. Radiation before surgery does not reduce the spread of cancer cells during the surgery.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

8. ANS: A
A. PSA is a tumor marker. Tumor markers, also called biochemical markers, are proteins, antigens, genes, hormones, and enzymes produced and secreted by tumor cells. Tumor markers help confirm a diagnosis of cancer, detect cancer origin, monitor the effect of cancer therapy, and determine cancer remission. B. The PSA level does not determine if the cancer has spread to a new site. C. PSA may monitor effectiveness of treatment, but it does not monitor blood levels of chemotherapy. D. The PSA level does not view cancer cells to monitor the progression of cancer.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

9. ANS: B
B. The TNM staging system classifies solid tumors by size and tissue involvement. TNM stages are T0 (no tumor), TIS (tumor in situ, no invasion of other tissues), and T1 through T4 (progressive increase in tumor size or involvement). A. Metastasis is described as M0, no metastasis, to M1, metastasis to some area. C. Extent of lymph node involvement ranges from N0, no nodes, to N4, a large amount of lymph node involvement. D. There is no designation for a tumor being between two tissues.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

10. ANS: B
B. The goals of palliative surgery are to increase comfort and quality of life. A. Reconstructive surgery can be done for cosmetic enhancement or for return of function of a body part. C. D. It is not done to treat or cure the cancer.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

11. ANS: B
B. Dry mouth is called xerostomia. A. Halitosis is bad breath. C. Stomatitis is an inflammation. D. Dysphagia is difficulty swallowing.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

12. ANS: B
B. Providing diversional activities for the patient may help reduce feelings of isolation. A. Limited contact and distance are used to protect the nurse, visitors, and other personnel from radiation exposure when a patient is being treated with radiation therapy. C. Assigning only one nurse increases that nurses exposure, which is not safe. D. Mask and gloves will not protect family from radiation.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

13. ANS: D
D. Drainage from the site of a radioactive colloid injection is considered radioactive. Radioactive materials must never be touched with unprotected hands; shielding is required to prevent exposure to radiation. Hospital policy should be followed for cleanup. A. C. Changing the sheets or staying with the patient exposes the nurse to radiation. B. Skin care may be necessary, but it is not the first priority.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Application

14. ANS: A
A. Hair, blood, and skin have rapidly dividing cells that are more susceptible to chemotherapy. B. Exposure to air does not adversely affect tissues. C. D. They are not necessarily porous or less able to excrete waste.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

15. ANS: D
D. Red urine is a common side effect of Adriamycin. A. There is no reason to notify the physician. B. This is not due to red dye. C. This finding is not related to blood loss.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

16. ANS: D
D. Chemotherapy agents are toxic and can be harmful to health care workers cleaning up spills. Agency policy, which will include protecting the nurse, should be followed when cleaning up the spill. B. Disposable cloths are not used to clean a vesicant medication. C. Special precautions are needed. A. An IV tube that is lying on the floor is no longer sterile and should not be reconnected. New tubing will be needed.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Application

17. ANS: D
D. Chemotherapy affects the cell cycle in different ways to stop division and growth, so rapidly dividing cells are most affected. Hair is rapidly dividing. A. B. Antibiotics do not stop hair growth or cause uric acid to collect in hair. C. Bone marrow suppression does not directly affect the hair cells.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

18. ANS: C
C. Vesicant drugs cause blistering of tissue, eventually leading to necrosis if the drugs infiltrate soft tissue by leaking out of the blood vessel. If this occurs, the infusion must be stopped immediately. A. B. D. Serious damage can occur if the nurse takes time to document or rechecks in an hour.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

19. ANS: A
A. Fresh fruits that cannot be pealed create the greatest risk for a patient with leukopenia. B. C. D. The risk is less from a can of soda, get-well card, or a paperback book.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Analysis

20. ANS: B
B. Tarry stools are a sign of GI bleeding for which the patient with low platelets is at risk. A, C, and D may be problems also, but they are not life-threatening and are therefore lower priorities.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

21. ANS: A
A. The most objective measure of stable weight is that weight will be unchanged during treatment. B, C, and D are also good measures; however, they do not provide the best evidence that the goal has been met.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Evaluation

22. ANS: D
D. Cancer is not one disease; it is many diseases with different causes, manifestations, treatments, and prognoses. Cancer is a group of cells that grow out of control, taking over the function of the affected organ. Cancer cells are described as poorly constructed, loosely formed, and without organization. A. The growth, not toxins, destroys organs. B. Not all growths are cancerous. C. There are many causes of cancer, including environmental toxins.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

23. ANS: C
C. Leukopenia is low WBC count, which places the patient at risk for infection. Hand washing is the best defense against infection. A. B. Bruising and bleeding and the resulting need for protection from injury result from low platelet count. D. Patients with low red blood cell counts are often fatigued and need assistance with ADLs.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

24. ANS: A
A. Low platelets place the patient at risk for bleeding. B. C. D. Nutrition, body image, and low WBC count may also be concerns, but bleeding is the priority at this time.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

25. ANS: D
D. Spacing activities with rest can help the patient have the energy to do activities that are important to him or her. A. It is not the nurses role to diagnose need for blood transfusion. B. Exercise is not appropriate at this time. C. Food may be appropriate if the patient has lost weight, but there is no evidence of weight loss in the data.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

26. ANS: B
B. Pericardial effusion, or cardiac tamponade, is a condition usually caused by direct invasion of the cancer, causing the pericardial sac to fill with fluid. Nursing care for the patient with cardiac tamponade includes monitoring respiratory status, vital signs, and intake and output; keeping the head of the bed elevated for maximum lung expansion; and assessing for edema.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

27. ANS: D
D. Epoetin alfa has a black box warning for heart disease risk. The patients blood pressure and hematocrit should be monitored. A. B. C. Many drugs can cause fluid retention or dyspnea, and other colony-stimulating factors are more likely to cause bone pain.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

28. ANS: A
The risk for spontaneous bleeding occurs when the count is less than 20,000. B. Potential for bleeding exists when the platelet count is 50,000. C. D. The normal platelet level is 150,000 to 300,000/mm3.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

29. ANS: D
D. Consumption of large amounts of pickled, smoked, and charbroiled foods has been linked with esophageal and stomach cancers. A. A diet low in vitamins A, C, and E is associated with cancers of the lungs, esophagus, mouth, larynx, cervix, and breast. B. People who eat high-fat, low-fiber diets are more prone to develop colon cancers. C. High-fat diets are linked to breast cancer in women and prostate cancer in men.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

30. ANS: C
C. The American Cancer Society recommends one of the following five options to screen for colorectal cancer, beginning at age 50: (1) an annual stool test for blood, (2) a flexible sigmoidoscopy every 5 years, (3) a yearly stool test for blood and flexible sigmoidoscopy every 5 years, (4) a double-contrast barium enema every 5 years, and (5) a colonoscopy every 10 years. Screening should begin earlier and take place more frequently in high-risk people.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

31. ANS: A
A. More women experience breast cancer than any other type, but they are more likely to die of lung cancer. C. D. Uterine and ovarian cancers carry a lower risk.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

32. ANS: B
B. A neoplastic growth is very difficult to detect until it contains about 500 cells and is approximately 1 cm. A. A tumor of 0.5 cm is difficult to detect. C. D. A tumor can be detected before it reaches 2 cm or 5 cm in size.

PTS: 1 DIF: Easy
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

33. ANS: A
A. Serum albumin less than 3 g/dL indicates poor nutrition and possible need for nutritional support. B. C. D. Calcium levels, platelet levels, and WBC counts are not used to determine if nutritional support is needed.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Analysis

34. ANS: A
A. The nurse administering oral chemotherapy should wear chemotherapy safety gloves. B. Washing hands before administering will not ensure personal safety when preparing this medication. C. A lead apron is not necessary when preparing oral chemotherapy medication. D. Oral chemotherapy pills should never be crushed or broken.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Application

MULTIPLE RESPONSE

35. ANS: A, C, E
A. C. E. DNA mistakes acquired during life are called mutations. A mutation is any change in the DNA code. Ultraviolet rays or exposure to certain chemicals may cause structural changes in the DNA code. Mutations may kill an affected cell or irreversibly alter its function. Such altered cells may become malignant. B, D, and F are associated with slowed growth or cell death.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

36. ANS: B, C
B. C. Mitosis is the process by which a cell reproduces itself. After its 46 chromosomes have duplicated themselves, one cell divides into two cells, each with membrane, cytoplasm, and organelles from the original cell and a complete set of chromosomes. D. Amino acids are the building blocks of proteins. E. Human cells have a cellular membrane, not a cell wall. F. The parent cell and reproduced cell are identical.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

37. ANS: A, D, E
A. D. E. Malignant cells tend to travel (metastasize) to distant sites, and their growth rate is often rapid. C. Normal cells resemble their tissue of origin; most cancers are not well differentiated. Cancer cells also lack contact inhibition, and so they invade surrounding tissue. B. Tissue damage can be severe.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

38. ANS: B, D, F
B. D. F Mucositis is inflammation of the mucous membranes, especially of the mouth and throat. C. E. Smoking, alcohol, acidic foods or drinks, extremely hot or cold foods and drinks, and commercial mouthwash can irritate inflamed mucous membranes. The use of a neutral mouthwash is appropriate. A. Frequent mouth care is important to reduce the risk of infection.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

39. ANS: A, B, D
A, B, and D stimulate the bone marrow to increase proliferation of cells. Hydroxyurea, procarbazine, and Irinotecan are chemotherapeutic agents.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

40. ANS: C, D, E
C. D. E. Cancer cells do not have a division limit and are considered immortal. The progression from a normal cell to a malignant cell follows a pattern of mutation, defective division and abnormal growth cycles, and defective cell communication. Cell mutation occurs when a sudden change affects the chromosomes, causing the new cell to differ from the parent. The malignant cell enzymes destroy the gluelike substance found between normal cells, which disrupt the transfer of information used for normal cell structure. B. F. They do not take on characteristics of normal tissues, and they are usually fast growing, not slow growing.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

41. ANS: A, C, E
A. C. E. Individuals should limit excessive meat, especially when smoked, salted, charbroiled, or cooked at high temperatures, excessive fat, excessive calories, and alcohol. B. F. Cruciferous vegetables and whole grains are encouraged. D. Root vegetables are neither encouraged nor discouraged in regard to cancer risk.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

42. ANS: A, B
A. B. Skin and lung cancers are the most common cancer in both women and men. Breast cancer is more common in women. Prostate and colorectal cancer is more common in men. Kidney cancer is more common in young people.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

43. ANS: A, C, E
A. C. E. Teaching to decrease cancer risk among Native-American populations should include encouraging traditional customs of physical fitness and exercise, identify healing practices that can be incorporated into tribal customs, and discussing the importance of dietary portion control and healthy food preparation. B. Teaching materials in the participants native language is not as important, since there is less of a language barrier when caring for individuals of Native American descent. D. Same-sex caregivers is not a major concern with caring for individuals of Native American descent.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

44. ANS: B, C, D
B. C. D. Time, distance, and shielding are factors to keep in mind when caring for a patient receiving this type of radiation therapy. Time includes the preparation and administration of care; distance involves the amount of space between the radioisotope and the nurse; and shielding involves the use of a barrier such as a lead apron. A. Skin care approaches will not ensure personal safety for the nurse. D. The types of foods that the patient should abstain from ingesting will not ensure personal safety for the nurse.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Application

45. ANS: A, B, D
A. B. D. Actions to help reduce nausea at mealtime for the patient receiving chemotherapy include adding nutmeg to foods, providing oral care before meals, and offering sour foods containing lemon. C. Small, high-calorie, frequent meals will help reduce feelings of nausea. E. The environment should be free of strong odors, such as disinfectants, to reduce the onset of nausea.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityBasic Care and Comfort | Cognitive Level: Application

46. ANS: B, C, E
B. C. E. The patient could be experiencing superior vena cava syndrome (SVCS), which occurs in patients with lung cancer when the tumor or enlarged lymph nodes block circulation in the vena cava. This causes edema of the head, neck, and arms. Symptoms include shortness of breath, cough, chest pain, facial redness, and swollen neck veins. Nursing interventions for the patient would include removing restrictive clothing, avoiding using the arms for venipunctures, and elevating the head of the bed to decrease feelings of dyspnea. A. Fluids do not need to be restricted for this health problem. D. An indwelling urinary catheter will not help relieve the symptoms of this health problem.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

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