Chapter 16: Cancer My Nursing Test Banks

Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 16: Cancer

Test Bank

MULTIPLE CHOICE

1. While being prepared for a biopsy of a lump in the right breast, the patient asks the nurse about the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct?

a.

Benign tumors do not cause damage to other tissues.

b.

Benign tumors are likely to recur in the same location.

c.

Malignant tumors may spread to other tissues or organs.

d.

Malignant cells reproduce more rapidly than normal cells.

ANS: C

The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors never metastasize. The other statements are inaccurate. Both types of tumors may cause damage to adjacent tissues. Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not usually recur.

DIF: Cognitive Level: Comprehension REF: 263

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

2. A patient is receiving intravesical bladder chemotherapy. The nurse will monitor for

a.

nausea.

b.

alopecia.

c.

mucositis.

d.

hematuria.

ANS: D

The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy.

DIF: Cognitive Level: Application REF: 276-277 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

3. The nurse in the outpatient clinic is caring for a 50-year-old who smokes heavily. To reduce the patients risk of dying from lung cancer, which action will be best for the nurse to take?

a.

Educate the patient about the seven warning signs of cancer.

b.

Plan to monitor the patients carcinoembryonic antigen (CEA) level.

c.

Discuss the risks associated with cigarettes during every patient encounter.

d.

Teach the patient about the use of annual chest x-rays for lung cancer screening.

ANS: C

Education about the risks associated with cigarette smoking is recommended at every patient encounter, since cigarette smoking is associated with multiple health problems. A tumor must be at least 0.5 cm large before it is detectable by current screening methods and may already have metastasized by that time. Oncofetal antigens such as CEA may be used to monitor therapy or detect tumor reoccurrence, but are not helpful in screening for cancer. The seven warning signs of cancer are actually associated with fairly advanced disease.

DIF: Cognitive Level: Application REF: 265 | 267-269

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

4. After the nurse has finished teaching a patient who is scheduled to receive external beam radiation for abdominal cancer about appropriate diet, which dietary selection by the patient indicates that the teaching has been effective?

a.

Fresh fruit salad

b.

Roasted chicken

c.

Whole wheat toast

d.

Cream of potato soup

ANS: B

To minimize the diarrhea that is commonly associated with bowel radiation, the patient should avoid foods high in roughage, such as fruits and whole grains. Lactose-intolerance may develop secondary to radiation, so dairy products also should be avoided.

DIF: Cognitive Level: Application REF: 283 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

5. During a routine health examination, a 30-year-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next?

a.

Educate the patient about the need for a colonoscopy at age 50.

b.

Teach the patient how to do home testing for fecal occult blood.

c.

Obtain more information from the patient about the family history.

d.

Schedule a sigmoidoscopy to provide baseline data about the patient.

ANS: C

The patient may be at increased risk for colon cancer, but the nurses first action should be further assessment. The other actions may be appropriate, depending on the information that is obtained from the patient with further questioning.

DIF: Cognitive Level: Application REF: eTable 16-3

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

6. When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer is staged as Tis, N0, M0. The nurse will teach the patient that

a.

the cancer is localized to the cervix.

b.

the cancer cells are well-differentiated.

c.

further testing is needed to determine the spread of the cancer.

d.

it is difficult to determine the original site of the cervical cancer.

ANS: A

Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time. Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the origin is the cervix. Further testing is not indicated given that the cancer has not spread.

DIF: Cognitive Level: Comprehension REF: 268-269

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

7. Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates that the nurses teaching about the purpose of the biopsy has been effective?

a.

The biopsy will remove the cancer in my prostate gland.

b.

The biopsy will determine how much longer I have to live.

c.

The biopsy will help decide the treatment for my enlarged prostate.

d.

The biopsy will indicate whether the cancer has spread to other organs.

ANS: C

A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed. Biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patients life; the three remaining statements indicate a need for patient teaching.

DIF: Cognitive Level: Application REF: 270-271 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

8. The nurse is teaching a postmenopausal patient with stage III breast cancer about the expected outcomes of her cancer treatment. Which patient statement indicates that the teaching has been effective?

a.

After cancer has not recurred for 5 years, it is considered cured.

b.

The cancer will be cured if the entire tumor is surgically removed.

c.

Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation.

d.

I will need to have follow-up examinations for many years after I have treatment before I can be considered cured.

ANS: D

The risk of recurrence varies by the type of cancer. For breast cancer in postmenopausal women the patient needs at least 20 disease-free years to be considered cured. Some cancers are considered cured after a shorter time span, or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up.

DIF: Cognitive Level: Application REF: 271-272 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

9. A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure. The nurse explains that the expected outcome of this surgery is

a.

relief of pain by cutting sensory nerves in the stomach.

b.

control of the tumor growth by removal of malignant tissue.

c.

decrease in tumor size to improve the effects of other therapy.

d.

promotion of better nutrition by relieving the pressure in the stomach.

ANS: C

A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective. Debulking surgeries do not control tumor growth. The tumor is debulked because it is attached to the liver, a vital organ (not to relieve pressure on the stomach). Debulking does not sever the sensory nerves, although pain may be lessened by the reduction in pressure on the abdominal organs.

DIF: Cognitive Level: Comprehension REF: 273

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

10. External-beam radiation is planned for a patient with endometrial cancer. The nurse teaches the patient that an important measure to prevent complications from the effects of the radiation is to

a.

test all stools for the presence of blood.

b.

maintain a high-residue, high-fiber diet.

c.

clean the perianal area carefully after every bowel movement.

d.

inspect the mouth and throat daily for the appearance of thrush.

ANS: C

Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection. Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation.

DIF: Cognitive Level: Application REF: 284

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

11. A patient with Hodgkins lymphoma who is undergoing external radiation therapy tells the nurse, I am so tired I can hardly get out of bed in the morning. An appropriate intervention for the nurse to plan with the patient is to

a.

minimize activity until the treatment is completed.

b.

exercise vigorously when fatigue is not as noticeable.

c.

establish a time to take a short walk almost every day.

d.

consult with a psychiatrist for treatment of depression.

ANS: C

Walking programs are used to keep the patient active without excessive fatigue. Vigorous exercise when the patient is less tired may lead to increased fatigue. Fatigue is expected during treatment and is not an indication of depression. Minimizing activity may lead to weakness and other complications of immobility.

DIF: Cognitive Level: Application REF: 283 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

12. Which information obtained by the nurse about a patient with colon cancer who is scheduled for external radiation therapy to the abdomen indicates a need for patient teaching?

a.

The patient swims a mile 5 days a week.

b.

The patient has a history of dental caries.

c.

The patient eats frequently during the day.

d.

The patient showers with Dove soap daily.

ANS: A

The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change the habits of eating frequently or showering with a mild soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation.

DIF: Cognitive Level: Application REF: 284-285

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

13. A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. Which patient statement indicates that the nurses teaching about management of the skin reaction has been effective?

a.

I can buy some aloe vera gel to use on the area.

b.

I will expose the treatment area to a sun lamp daily.

c.

I can use ice packs to relieve itching in the treatment area.

d.

I will scrub the area with warm water to remove the scales.

ANS: A

Aloe vera gel and cream may be used on the radiated skin area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.

DIF: Cognitive Level: Application REF: 285 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

14. A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. An important nursing intervention for the patient is to

a.

teach about the importance of nutrition during treatment.

b.

have the patient eat large meals when nausea is not present.

c.

offer dry crackers and carbonated fluids during chemotherapy.

d.

administer prescribed antiemetics 1 hour before the treatments.

ANS: D

Treatment with antiemetics before chemotherapy may help prevent nausea. Although nausea may lead to poor nutrition, there is no indication that the patient needs instruction about nutrition. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea.

DIF: Cognitive Level: Application REF: 283

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

15. When the nurse is administering a vesicant chemotherapeutic agent intravenously, an important consideration is to

a.

infuse the medication over a short period of time.

b.

stop the infusion if swelling is observed at the site.

c.

administer the chemotherapy through small-bore catheter.

d.

hold the medication unless a central venous line is available.

ANS: B

Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapeutic drug. These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred.

DIF: Cognitive Level: Application REF: 276

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

16. A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To maintain the patients self-esteem, the nurse plans to

a.

suggest that the patient limit social contacts until regrowth of the hair occurs.

b.

encourage the patient to purchase a wig or hat and wear it once hair loss begins.

c.

have the patient wash the hair gently with a mild shampoo to minimize hair loss.

d.

inform the patient that the hair will grow back once the chemotherapy is complete.

ANS: B

The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicle and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is not immediately helpful in maintaining the patients self-esteem.

DIF: Cognitive Level: Application REF: 281 | 286 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

17. A patient with ovarian cancer is distressed because her husband rarely visits and tells the nurse, He just doesnt care. The husband indicates to the nurse that I never know what to say to help her. An appropriate nursing diagnosis is

a.

compromised family coping related to disruption in lifestyle.

b.

impaired home maintenance related to perceived role changes.

c.

risk for caregiver role strain related to burdens of caregiving responsibilities.

d.

dysfunctional family processes related to effect of illness on family members.

ANS: D

The data indicate that this diagnosis is most appropriate because poor communication among the family members is affecting family processes. No data suggest a change in lifestyle or its role as an etiology. The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities.

DIF: Cognitive Level: Application REF: 296 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

18. A patient receiving head and neck radiation has ulcerations over the oral mucosa and tongue and thick, ropey saliva. The nurse will teach the patient to

a.

remove food debris from the teeth and oral mucosa with a stiff toothbrush.

b.

use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth.

c.

gargle and rinse the mouth several times a day with an antiseptic mouthwash.

d.

rinse the mouth before and after each meal and at bedtime with a saline solution.

ANS: D

The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate the oral mucosa and are not recommended.

DIF: Cognitive Level: Application REF: 284

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

19. Which nursing action will be most effective in improving oral intake for a patient with the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers?

a.

Offer the patient frequent small snacks between meals.

b.

Assist the patient to choose favorite foods from the menu.

c.

Provide education about the importance of nutritional intake.

d.

Apply the ordered anesthetic gel to oral lesions before meals.

ANS: D

Since the etiology of the patients poor nutrition is the painful oral ulcers, the best intervention is to apply anesthetic gel to the lesions before the patient eats. The other actions might be helpful for other patients with impaired nutrition, but would not be as helpful for this patient.

DIF: Cognitive Level: Application REF: 281 | 284 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

20. A 40-year-old divorced mother of four school-age children is hospitalized with metastatic ovarian cancer. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is

a.

Why dont we talk about the options you have for the care of your children?

b.

Perhaps your ex-husband will take the children when you cant care for them.

c.

For now you need to concentrate on getting well, not worry about your children.

d.

Many patients with cancer live for a long time, so there is time to plan for your children.

ANS: A

This response expresses the nurses willingness to listen and recognizes the patients concern. The responses beginning Many patients with cancer live for a long time and For now you need to concentrate on getting well close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patients ex-husband will take the children, more assessment information is needed before making plans.

DIF: Cognitive Level: Application REF: 270 | 297

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

21. A patient who has severe pain associated with terminal liver cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective?

a.

The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness.

b.

The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale).

c.

The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.

d.

The patient states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief.

ANS: C

For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain. Taking the medications only when pain reaches a certain level does not provide effective pain control. Although nonopioid analgesics also may be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved. The IV route is not more effective than the oral route, and the oral route is preferred.

DIF: Cognitive Level: Application REF: 295-296 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

22. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is to

a.

enhance the patients immunologic response to tumor cells.

b.

stimulate malignant cells in the resting phase to enter mitosis.

c.

prevent the bone marrow depression caused by chemotherapy.

d.

protect normal cells from the harmful effects of chemotherapy.

ANS: A

IL-2 enhances the ability of the patients own immune response to suppress tumor cells. IL-2 does not protect normal cells from damage caused by chemotherapy, stimulate malignant cells to enter mitosis, or prevent bone marrow depression.

DIF: Cognitive Level: Comprehension REF: 288-289

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

23. The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient may indicate a need for a change in treatment?

a.

I have frequent muscle aches and pains.

b.

I rarely have the energy to get out of bed.

c.

I experience chills after I inject the interferon.

d.

I take acetaminophen (Tylenol) every 4 hours.

ANS: B

Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use Tylenol every 4 hours.

DIF: Cognitive Level: Application REF: 288-290

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

24. A patient with leukemia is considering whether to have hematopoietic stem cell transplantation. Which information will be included in patient teaching?

a.

Transplant of the donated cells is painful because of the nerves in the tissue lining the bone.

b.

Donor bone marrow cells are transplanted through an incision into the sternum or hip bone.

c.

The transplant procedure takes place in a sterile operating room to minimize the risk for infection.

d.

Hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT).

ANS: D

The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room or incision required.

DIF: Cognitive Level: Comprehension REF: 291-292 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

25. The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective?

a.

Orange sherbet

b.

Fresh fruit salad

c.

Strawberry yogurt

d.

Cream cheese bagel

ANS: C

Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Orange sherbet is lower in fat and protein than yogurt. Cream cheese is low in protein.

DIF: Cognitive Level: Application REF: 293 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

26. A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action is most appropriate?

a.

Add strained baby meats to foods such as casseroles.

b.

Teach the patient about foods that are high in nutrition.

c.

Avoid giving the patient foods that are strongly disliked.

d.

Put extra spice in the foods that are served to the patient.

ANS: C

The patient will eat more if disliked foods are avoided and foods that the patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding baby meats to foods will increase calorie and protein levels, but does not address the issue of taste. The patients poor intake is not caused by a lack of information about nutrition.

DIF: Cognitive Level: Application REF: 293

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

27. While teaching a patient who has a new diagnosis of acute leukemia about the complications associated with chemotherapy, the patient is restless and is looking away, never making eye contact. After the teaching, the patient asks the nurse to repeat all of the information. Based on this assessment, which nursing diagnosis is most likely for the patient?

a.

Risk for ineffective adherence to treatment related to denial of need for chemotherapy

b.

Acute confusion related to infiltration of leukemia cells into the central nervous system

c.

Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis

d.

Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment

ANS: C

The patient who has a new cancer diagnosis is likely to have high anxiety, which may impact learning and require that the nurse repeat and reinforce information. The patients history of a recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the confusion. The patient asks for the information to be repeated, indicating that lack of interest in learning and denial are not etiologic factors.

DIF: Cognitive Level: Application REF: 270 TOP: Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

28. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the RN caring for the patient indicates that the nurse should take action?

a.

The patient ambulates several times a day in the room.

b.

The patients visitors bring in some fresh peaches from home.

c.

The patient cleans with a warm washcloth after having a stool.

d.

The patient uses soap and shampoo to shower every other day.

ANS: B

Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help to prevent skin breakdown and infection.

DIF: Cognitive Level: Application REF: eTable 16-5 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

29. A patient with tumor lysis syndrome (TLS) is taking allopurinol (Xyloprim). Which laboratory value should the nurse monitor to determine the effectiveness of the medication?

a.

Uric acid level

b.

Serum potassium

c.

Serum phosphate

d.

Blood urea nitrogen

ANS: A

Allopurinol is used to decrease uric acid levels. BUN, potassium, and phosphate levels are also increased in TLS but are not affected by allopurinol therapy.

DIF: Cognitive Level: Application REF: 295 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

30. When assessing the need for psychologic support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information?

a.

How long ago were you diagnosed with this cancer?

b.

Do you have any concerns about body image changes?

c.

Can you tell me what has been helpful to you in the past when coping with stressful events?

d.

Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?

ANS: C

Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patients need for support. The patients knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. Since surgical interventions for stage I cancer of the colon may not cause any body image changes, this question is not appropriate at this time.

DIF: Cognitive Level: Application REF: 296

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

31. Which finding in a patient who is receiving interleukin-2 indicates a need for rapid action by the nurse?

a.

Generalized muscle aches

b.

Complaints of nausea and anorexia

c.

Oral temperature of 100.6 F (38.1 C)

d.

Crackles heard at the lower scapular border

ANS: D

Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2; the patient may need oxygen and the nurse should rapidly notify the health care provider. The other findings are common side effects of interleukin-2.

DIF: Cognitive Level: Application REF: 289-290 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

32. The nurse obtains information about a hospitalized patient who is receiving chemotherapy for cancer of the colon. Which information about the patient is most indicative of a need for a change in therapy?

a.

Poor oral intake

b.

Increase in CEA

c.

Frequent loose stools

d.

Complaints of nausea

ANS: B

An increase in CEA indicates that the chemotherapy is not effective for the patients cancer and may need to be modified. The other patient findings are common adverse effects of chemotherapy. The nurse may need to address these, but they would not indicate a need for a change in therapy.

DIF: Cognitive Level: Application REF: 267-268 | 281-282

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

33. Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider?

a.

Hematocrit of 30%

b.

Platelets of 95,000/l

c.

Hemoglobin of 10 g/L

d.

WBC count of 1700/l

ANS: D

The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that white blood cell (WBC) growth factors such as filgrastim (Neupogen) are needed. The other laboratory data do not indicate any immediate life-threatening adverse effects of the chemotherapy.

DIF: Cognitive Level: Application REF: 280 | 282

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

34. When caring for a patient who is pancytopenic, which action by nursing assistive personnel (NAP) indicates a need for the RN to intervene?

a.

The NAP assists the patient to use dental floss after eating.

b.

The NAP adds baking soda to the patients saline oral rinses.

c.

The NAP puts fluoride toothpaste on the patients toothbrush.

d.

The NAP has the patient rinse after meals with a saline solution.

ANS: A

Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.

DIF: Cognitive Level: Application REF: eTable 16-5

OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation

MSC: NCLEX: Safe and Effective Care Environment

35. When caring for a patient with a temporary radioactive cervical implant, which action by nursing assistive personnel (NAP) indicates that the RN should intervene?

a.

The NAP flushes the toilet once after emptying the patients bedpan.

b.

The NAP stands by the patients bed for 30 minutes talking with the patient.

c.

The NAP places the patients bedding in the laundry container in the hallway.

d.

The NAP gives the patient an alcohol-containing mouthwash to use for oral care.

ANS: B

Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine/feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated.

DIF: Cognitive Level: Application REF: 280

OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation

MSC: NCLEX: Safe and Effective Care Environment

36. After receiving change-of-shift report, which of these patients should the nurse assess first?

a.

35-year-old who has wet desquamation associated with abdominal radiation

b.

42-year-old who is sobbing after receiving a new diagnosis of ovarian cancer

c.

24-year-old who is receiving neck radiation and has blood oozing from the neck

d.

56-year-old who has a new pericardial friction rub after receiving chest radiation

ANS: C

Since neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first. The diagnoses and clinical manifestations for the other patients are not immediately life threatening.

DIF: Cognitive Level: Analysis REF: 295

OBJ: Special Questions: Multiple Patients TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

MULTIPLE RESPONSE

1. The nurse at the clinic is interviewing a 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)?

a.

Pap testing

b.

Tobacco use

c.

Sunscreen use

d.

Mammography

e.

Colorectal screening

ANS: A, C, D, E

The patients age, gender, and history indicate a need for screening and/or teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use excessive alcohol or tobacco, she is physically active, and her body weight is healthy.

DIF: Cognitive Level: Analysis REF: 269-270 | eTable 16-3

OBJ: Special Questions: Alternate Item Format TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

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