Chapter 15Cancer Management My Nursing Test Banks

Chapter 15Cancer Management

MULTIPLE CHOICE

1.The nurse realizes that for a cell to become cancer, it needs to progress through four stages. Which of the following is not a stage of this process?

1.

Initiation

2.

Metastasis

3.

Progression

4.

Stimulation

ANS: 4

The four stages of oncogenesis or carcinogenesis are: 1) initiation, 2) promotion, 3) progression, and 4) metastasis. Stimulation is not a stage of carcinogenesis.

PTS:1DIF:AnalyzeREF:Carcinogenesis

2.A clients most recent prostate-specific antigen level has decreased since starting treatment for prostate cancer. The nurse realizes this level would indicate that the client:

1.

no longer has the disease.

2.

has an increase in the severity of the disease process.

3.

is responding to treatment.

4.

should be retested.

ANS: 3

A decrease in a tumor marker is important in the assessment of cancer, monitoring tumor response during treatment strategies, and diagnosis of recurrence of disease. A decrease in the prostate-specific antigen level once treatment has begun for prostate cancer would indicate that the client is responding to treatment. A drop in the level does not mean that the client no longer has the disease, that the disease is progressing, or that the client needs to be retested.

PTS:1DIF:AnalyzeREF:Laboratory Tests

3.A clients tumor was staged using the TNM system. The tumor was staged as T4,N1,Mx. The nurse realizes that this staging means:

1.

tumor in situ, minimal node involvement, no presence of metastasis.

2.

large tumor, no node involvement, presence of metastasis.

3.

medium tumor, multiple nodes involvement, no presence of metastasis.

4.

large tumor, single node involvement, unable to assess metastasis.

ANS: 4

The larger the number in the TNM staging system, the increasing involvement or larger size of the tumor, node, and metastasis. T4 reflects the size of the tumor. N1 describes the regional node involvement. Mx signals the inability to assess the presence or absence of distant metastasis.

PTS:1DIF:AnalyzeREF:Staging and Grading

4.Which of the following statements made by a client after receiving instruction regarding internal radiation would indicate that teaching has been successful?

1.

My children can come visit me after school.

2.

Individuals will need to keep at least 3 feet away when possible.

3.

I will be sharing a room near the nursing station.

4.

The hospital staff will limit the amount of time in my room.

ANS: 4

General guidelines include assigning the patient to a private room; postradiation precaution signage; limiting the amount of time in the room; observing a distance of at least 6 feet from the source when possible; and prohibiting pregnant staff, family, visitors, and children from interacting or visiting with the patient. The other choices would indicate the need for additional instruction and are incorrect.

PTS:1DIF:AnalyzeREF:Internal Radiation

5.A client, prescribed to begin chemotherapy, asks the nurse How does chemotherapy work? Which of the following should the nurse respond to this client?

1.

It prevents the process of cell growth and replication.

2.

It kills only cancer cells.

3.

It treats the exposed area only with high-energy rays.

4.

Agents are implanted in an area to inhibit cancer growth.

ANS: 1

Chemotherapy is the use of drugs that prevent, kill, or block the growth and spread of cancer cells. Some noncancerous cells can be damaged during chemotherapy. External radiation treats an exposed area with high-energy rays. Internal radiation uses implanted agents.

PTS:1DIF:ApplyREF:Chemotherapy

6.A client is prescribed interferon as part of treatment for cancer. Which of the following should the nurse instruct the client regarding this medication?

1.

Flu-like symptoms should be reported to the physician.

2.

General fatigue while receiving this medication is common.

3.

Seek emergency care with a high fever.

4.

Side effects are short term and will resolve in a few days.

ANS: 2

Side effects vary by the type of biological agent, including a flu-like illness, high fever, headache, and general fatigue. These are expected effects and do not need to be reported to the physician. Side effects of these medications are long term and can vary in intensity during the course of treatment.

PTS:1DIF:ApplyREF:Biological Therapy

7.A client recovering from bone marrow transplantation is experiencing vomiting, fatigue, and skin reactions. Which of the following should the nurse do to help this client?

1.

Prepare to administer platelets as prescribed.

2.

Prepare to administer red blood cells as prescribed.

3.

Limit fluids.

4.

Explain that the client is experiencing expected short-term side effects.

ANS: 4

Clients who undergo bone marrow transplantation may experience short-term side effects, including nausea, vomiting, fatigue, loss of appetite, mouth sores, hair loss, and skin reactions. These side effects are not treated with platelets or red blood cells. Limiting fluids can make the side effects worse.

PTS: 1 DIF: Apply REF: Blood and Bone Marrow Transplantation

8.A client receiving chemotherapy for cancer has a hemoglobin level of 9.7 g/dL. Which of the following should the nurse anticipate as treatment for this client?

1.

Place client in reverse isolation.

2.

Administer antibiotics as prescribed.

3.

Administer epoetin alfa as prescribed.

4.

Administer filgrastim as prescribed.

ANS: 3

Treatment for moderate anemia in the client receiving chemotherapy for cancer would include the administration of epoetin alfa as prescribed. This medication elevates hemoglobin levels and improves the quality of life for clients. The other choices would be appropriate for the client diagnosed with neutropenia and not anemia.

PTS: 1 DIF: Apply REF: Anemia

9.A client receiving chemotherapy has a platelet count of 85,000. Which of the following should the nurse do to assist this client?

1.

Assess for bruising and frank bleeding.

2.

Provide a razor for shaving.

3.

Remind the client to floss before brushing the teeth each day.

4.

Provide NSAIDs as prescribed.

ANS: 1

A platelet count of less than 100,000 indicates thrombocytopenia, and the client should be assessed for bruising and frank bleeding. The client should avoid the use of a razor, avoid flossing, and NSAIDs should not be provided since they promote bleeding.

PTS:1DIF:ApplyREF:Thrombocytopenia

10.A client receiving chemotherapy tells the nurse that he is concerned that he may be developing Alzheimers disease since he is having a new onset of memory loss. Which of the following should the nurse do to help this client?

1.

Discuss the clients memory issues with the physician.

2.

Suggest the client use a journal to aid with short-term chemo fog problems.

3.

Assess for signs of pending stroke.

4.

Notify the physician and plan for transferring the client to an intensive care area.

ANS: 2

Twenty to 50% of cancer clients receiving chemotherapy describe cognitive changes such as being in a fog. To aid this client, the nurse should suggest the client keep a log or journal to document activities in order to identify when the fog is more acute. Chemo fog can last up to 2 years after treatment, but it is not permanent. The clients memory issues do not need to be discussed with a physician. The client is not experiencing a stroke. The client does not need to be transferred to an intensive care area.

PTS:1DIF:ApplyREF:Cognitive Disorders

11.A client is experiencing nausea and vomiting 1 day after chemotherapy has begun for cancer treatment. The nurse realizes this clients nausea and vomiting would be considered:

1.

anticipatory.

2.

acute.

3.

delayed.

4.

chronic.

ANS: 3

Delayed nausea and vomiting occurs more than 24 hours after chemotherapy. Anticipatory nausea and vomiting occur before, during, or after chemotherapy, and they appear earlier than expected. Acute nausea and vomiting occur within 24 hours after starting chemotherapy. Chronic nausea and vomiting affect people with advanced cancer and is not well understood.

PTS: 1 DIF: Analyze REF: GI System

12.The nurse is planning interventions to address the potential problem of mucositis for a client receiving chemotherapy. Which of the following assessment findings caused the nurse to identify the client as being at risk for this side effect?

1.

Client prescribed chemotherapy

2.

Client age 50

3.

Client lives alone

4.

Client is fatigued

ANS: 1

High risks for developing mucositis include age younger than 20, hematologic or head and neck cancer, preexisting oral disease, and chemotherapy and radiation. Age greater than 50, living arrangements, and level of fatigue do not increase a clients risk of developing mucositis.

PTS: 1 DIF: Analyze REF: Mucositis

13.Even though a client has completed a course of chemotherapy and has been found to be cancer free at this time, she continues to experience fatigue. Which of the following should the nurse instruct this client?

1.

Fatigue is the first warning sign of cancer and should be reported to the physician.

2.

Fatigue indicates a poor diet.

3.

Fatigue is caused by poor fluid intake.

4.

Fatigue can persist after treatment ends, but it will eventually improve.

ANS: 4

Fatigue is the most common symptom associated with cancer and cancer treatment. Fatigue is more often a result of the treatment than the cancer itself. The client should be informed that fatigue may persist after cancer therapy is completed, but it will eventually improve.

PTS: 1 DIF: Apply REF: Fatigue

MULTIPLE RESPONSE

1.A client is diagnosed with cancer. The nurse realizes that which of the following are characteristics of this type of cell? (Select all that apply.)

1.

Aneuploid

2.

Cohesive

3.

Migratory

4.

Poorly differentiated

5.

Specific morphology

6.

Abnormal chromosomes

ANS: 1, 3, 4, 6

Characteristics of malignant cells include uncontrolled cell division; large, variably shaped nuclei; anaplasia; poor differentiation; noncohesion; migration; lack of contact inhibition; aneuploidy; and abnormal chromosomes. Specific morphology and cohesiveness are characteristics of either benign or normal cells.

PTS:1DIF:AnalyzeREF:Malignant Cells

2.A nurse is teaching at a health fair about the early warning signs of cancer. Which of the following would the nurse include as early warning signs? (Select all that apply.)

1.

A sore that does not heal

2.

Change in bladder or bowel habits

3.

Family history

4.

Unusual discharge

5.

Obvious change in nevus

6.

Nagging cough

ANS: 1, 2, 4, 5, 6

Early warning signs can be easily remember using the acronym CAUTION: C, change in bladder or bowel habits; A, a sore that does not heal; U, unusual bleeding or discharge; T, presence of a lump or thickening; I, indigestion; O, obvious change in a wart or mole; and N, a nagging cough or hoarseness.

PTS: 1 DIF: Apply REF: Box 15-1 Warning Signs of Cancer

3.A client is experiencing nausea and vomiting related to chemotherapy. Which of the following strategies can the nurse use to improve nutrition in this client? (Select all that apply.)

1.

Adding peppermint to foods

2.

Administering ondansetron

3.

Drinking adequate fluids

4.

Drinking hot beverages

5.

Eating food at room temperature

6.

Sipping ice water

ANS: 1, 2, 3, 5

Strategies to improve nutrition in the client experiencing nausea and vomiting from chemotherapy include using herbs such as peppermint, administering prescribed anti-emetics, ensuring an adequate intake of fluids, and ingesting foods at room temperature. Foods and fluids of extreme temperatures such as hot beverages and ice water  should be avoided by the patient with nausea and vomiting.

PTS: 1 DIF: Apply REF: Chemotherapy: Side Effects

4.A client asks the nurse what he can do to prevent the onset of cancer. The nurse realizes that which of the following contribute to the development of cancer? (Select all that apply.)

1.

Heredity

2.

Environment

3.

Lifestyle

4.

Stress

5.

Age

6.

Blood pressure

ANS: 1, 2, 3, 5

The factors known to contribute to the development of cancer include heredity, environment, and lifestyle. Aging has a direct effect on ones risk of developing cancer. The longer one lives, the greater the risk for developing cancer. Stress and blood pressure are not factors known to contribute to the development of cancer.

PTS: 1 DIF: Analyze REF: Etiology

5.The nurse is planning to instruct a client on strategies to lessen the impact of lifestyle on the development of cancer. Which of the following should the nurse include in these instructions? (Select all that apply.)

1.

Follow a low-fat diet.

2.

Avoid prescribed medications.

3.

Exercise regularly.

4.

Limit sun exposure.

5.

Sleep less than 7 hours each night.

6.

Do not smoke or use any tobacco products.

ANS: 1, 3, 4, 6

Strategies to lessen the impact of lifestyle on the development of cancer include following a low-fat diet, exercising regularly, limiting sun exposure, and avoiding all use of tobacco products. Prescribed medications will not lessen the impact of lifestyle on the development of cancer. Sleeping less than 7 hours each night will not lessen the impact of lifestyle on the development of cancer.

PTS: 1 DIF: Apply REF: Lifestyle

6.A client is prescribed a selective estrogen receptor modulator as treatment for ovarian cancer. Which of the following should the nurse instruct the client regarding side effects of this medication? (Select all that apply.)

1.

Hot flashes

2.

Blood clots

3.

Drop in blood pressure

4.

Reduce libido

5.

Increased risk of developing other cancer

6.

Weight gain

ANS: 1, 2, 4, 5

Side effects of selective estrogen modulator medications include hot flashes, blood clots, loss of interest in sex, and a higher risk of other cancers. Drop in blood pressure and weight gain are not side effects associated with this classification of medication.

PTS:1DIF:ApplyREF:Hormone Therapy

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