Chapter 17: Cancer My Nursing Test Banks

Chapter 17: Cancer

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. When planning an educational program on cancer for a group of older adults, the nurse incorporates information regarding racial and ethnic patterns of cancer in the United States that includes evidence that:

a.

the incidence of cancer is highest among African Americans.

b.

Native Americans have the highest overall incident rates of cancer.

c.

incidence rates for lung cancer are lowest for white women.

d.

Hispanic women have the lowest incidence rates of cervical cancer.

ANS: A

Cancer affects Americans of all racial and ethnic groups; however, the incidence of cancer does demonstrate patterns according to racial and ethnic origins. African Americans have higher overall incidence rates than whites, whereas Hispanic Americans and Native Americans have lower incidence rates overall.

DIF: Remembering (Knowledge) REF: Page 297 OBJ: 17-2

TOP: Teaching-Learning MSC: Physiologic Integrity

2. An older adult patient asks the nurse why so many of her friends are developing cancers. The nurse responds best when answering:

a.

Cancer cells generally develop as a result of prolonged exposure to external agents.

b.

The longer we live the more exposure we have to environmental toxins.

c.

Aberrant growth seems to be the risk factor in the older adult that is not well understood.

d.

As we age, our cells are less able to regulate replication appropriately.

ANS: D

The aging cell has a tendency toward aberration or abnormalcy as it replicates. Aberrant cell growth is related to failure of growth control mechanisms, which leads to less cell regulation during replication. Cancer occurs more commonly in replicating than in nonreplicating cell groups, which suggests that changes in internal cellular control mechanisms give rise to cancer.

DIF: Understanding (Comprehension) REF: Page 299 OBJ: 17-1

TOP: Teaching-Learning MSC: Physiologic Integrity

3. An older adult patient expresses concern about developing cancer in the future and asks the nurse advice about cancer prevention. The nurse shares that:

a.

Eating foods high in protein, such as chicken and fish, promote cell growth and repair, thus minimizing the risk.

b.

Although there are some behaviors that can help minimize your risk, the possibility of developing cancer is usually determined by age 65.

c.

Most cancers that develop after age 65 generally respond well to cancer treatment modalities.

d.

Cancers that develop late in life are generally slow growing, so they generally do not contribute to this groups mortality.

ANS: B

Most cancers are the result of a lifelong exposure, so the risk of developing malignant disease after age 65 is probably already determined by the time one reaches that age. If exposure to promoters can be avoided or reduced and antipromoters can be used, then cancerous transformation may not take place or may be delayed. The other statements are not accurate.

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TOP: Teaching-Learning MSC: Physiologic Integrity

4. An older adult patient has rheumatoid arthritis, which limits her manual dexterity and ability to perform breast self-examinations. To address the patients need for breast health promotion, the nurse teaches the patient to:

a.

use the palm of her hand to perform monthly breast examinations.

b.

schedule a mammogram every 12 months.

c.

check each breast while in the shower if possible.

d.

visit her physician yearly for a breast examination.

ANS: A

Older women, while having the highest incidence of breast cancer, have been shown to have the least knowledge about the importance of breast examination. Modifying and encouraging selfbreast examination would be the most effective intervention to promote breast health. The other actions are good but not as helpful as adapting the technique of self-exam so the woman can accomplish it.

DIF: Applying (Application) REF: N/A OBJ: 17-3

TOP: Teaching-Learning MSC: Health Promotion

5. Which statement, if made by an older Caucasian adult man, indicates the need for further teaching about prostate cancer and its prevention?

a.

Digital rectal examinations arent needed for screening.

b.

I should discuss having a yearly PSA test.

c.

Prostate cancer can look a lot like an enlarged prostate.

d.

I am not in a high-risk category for prostate cancer.

ANS: A

The digital rectal exam and prostate-specific antigen (PSA) blood test are the two main screening methods for prostate cancer. Men should begin discussions about screening for this cancer when they are 50. The digital rectal exam is less costly than a blood test. The other statements show understanding.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 17-3

TOP: Nursing Process: Evaluation MSC: Health Promotion

6. When obtaining a health history, the nurse recognizes that an older adult patient has a risk factor for colorectal cancer when he reports:

a.

that he is a vegetarian who eats soy products.

b.

that he often needs laxatives for constipation.

c.

a history of inflammatory bowel disease.

d.

that diarrhea occurs at least monthly.

ANS: C

A personal or family history of colorectal cancer, polyps, or inflammatory bowel disease has been associated with increased colorectal cancer risk. The other options do not increase this patients risk.

DIF: Remembering (Knowledge) REF: Page 305 OBJ: 17-1

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

7. While awaiting the results of testing to determine a diagnosis of cancer, an older adult patient asks a nurse to explain what happens when cancer metastasizes. The nurse responds:

a.

It is the result of prolonged exposure to an external agent.

b.

Cancer cells convert from transformed cells into small clusters of clonal cells.

c.

Cell control mechanisms fail, giving rise to aberrant cell growth.

d.

Cancer cells move from one location to another unconnected location.

ANS: D

Metastasis involves a change in location of the cancer cells from one organ or part of the body to another that is not directly connected. The other statements are not correct.

DIF: Understanding (Comprehension) REF: Page 299 OBJ: 17-1

TOP: Teaching-Learning MSC: Physiologic Integrity

8. The family of an older adult diagnosed with cancer asks the nurse to explain how gene therapy might be beneficial. The nurse responds:

a.

The treatment decreases blood flow to the tumor and it dies.

b.

A virus is injected into the tumor and then it cant grow.

c.

The cancer cells nucleus is destroyed and the cell shrivels.

d.

Photosensitizers are introduced into the cells so lasers can kill them.

ANS: B

Gene therapy involves the injection of a virus that makes the cancer cells incapable of reproducing.

DIF: Understanding (Comprehension) REF: Page 308 OBJ: 17-1

TOP: Teaching-Learning MSC: Physiologic Integrity

9. The nurse observes a suspicious mole on the back of an older adult who is undergoing palliative radiotherapy for brain metastasis. The nurse suspects that the mole:

a.

is a result of the radiation.

b.

is a secondary cancer.

c.

will not be screened.

d.

was the primary cancer.

ANS: C

Screening should not be conducted if there is no intent or ability to pursue findings with more complete evaluation and treatment. The goal of screening is to detect early cancer that is amenable to treatment; this patient is undergoing palliation, which means he or she is not expected to live but is getting the radiation for symptom control.

DIF: Analyzing (Analysis) REF: N/A OBJ: 17-3

TOP: Nursing Process: Analysis MSC: Physiologic Integrity

10. An older adult patient with breast cancer is reluctant to agree to the suggested treatment plan because I have heard such horrible things about radiation therapy. The nurse responds:

a.

Radiation therapy no longer causes such terrible side effects.

b.

Your chances of recovery are best when radiation is included.

c.

Ask the oncologist if there are alternative treatments.

d.

Actually there is very effective symptom control now.

ANS: A

Cancer care has changed dramatically over the years; however, many older adults remember friends or relatives who were treated with now outdated therapies that had devastating side effects. The other statements do not address the primary concern, which is side effects of the treatment.

DIF: Understanding (Comprehension) REF: Page 309 OBJ: 17-4

TOP: Communication and Documentation MSC: Physiologic Integrity

11. After a course of chemotherapy for cancer of the throat, an older adult patient is admitted to the hospital with persistent nausea and vomiting. The nurse should initially assess the patient for:

a.

weight loss and weak gag reflex.

b.

anemia and poor muscle tone.

c.

oral inflammation and ulceration.

d.

dehydration and infection.

ANS: D

Drug-induced nausea and vomiting can result in dehydration, decreased caloric intake, and weight loss. Chemotherapy in general will impact the immune systems ability to combat infections. All assessments are important, but dehydration and infection (or sepsis) need to be treated immediately.

DIF: Applying (Application) REF: N/A OBJ: 17-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

12. The daughter of an older adult woman who had a colostomy as a result of colon cancer tells the nurse, Mom seems to be so withdrawn; she has stopped going out with her friends and Im really concerned. The most relevant nursing diagnosis for the patients reaction is:

a.

Ineffective individual coping.

b.

Dysfunctional grieving.

c.

Social isolation.

d.

Hopelessness.

ANS: C

Voluntary social isolation may result when an older adult with cancer no longer feels comfortable in social settings because of his or her situation, including, for example, changes in body image, energy levels, or interests. Older persons with cancer may withdraw because they perceive that others are uncomfortable in their presence and because they believe, rightly or wrongly, that others are avoiding them because of the cancer diagnosis. Coping may be disturbed in this patient as well. The patient may be grieving loss of her former healthy self, and she may feel hopeless. But social isolation fits the daughters data.

DIF: Applying (Application) REF: N/A OBJ: 17-6

TOP: Nursing Process: Diagnosis MSC: Psychosocial Integrity

13. An older adult patient diagnosed with colon cancer is being evaluated for surgical removal of the tumor. The nurse explains that the primary consideration is the:

a.

absence of any chronic disorders.

b.

absence of metastasis.

c.

tumors staging status.

d.

patients presurgical health status.

ANS: D

The curability of cancer in older adults is largely predicted by an individuals ability to tolerate major surgery. The absence of metastasis and the tumor stage will impact additional treatments. Absence of chronic illness is not a factor in and of itself.

DIF: Understanding (Comprehension) REF: Page 309 OBJ: 17-4

TOP: Teaching-Learning MSC: Physiologic Integrity

14. An older adult patient is undergoing palliative surgery for colon cancer metastasis. The nurse explains to the family that this intervention is intended to:

a.

prolong the patients life by several months.

b.

improve the effectiveness of the chemotherapy.

c.

relieve the pain associated with spread of the tumor.

d.

prevent further tumor growth.

ANS: C

Surgery may be indicated for palliative care in cases in which large primary or metastatic tumors can be reduced; the size or location of the tumor can create problems such as compression of surrounding tissues and organs, leading to pain, necrosis, or organ failure. Palliative procedures are designed to manage symptoms.

DIF: Understanding (Comprehension) REF: Page 309 OBJ: 17-4

TOP: Teaching-Learning MSC: Physiologic Integrity

15. The nurse is admitting a patient to the hospital who has cancer and a neutrophil count of 430/mm3. What action by the nurse is best?

a.

Place the patient in a private room.

b.

Use good handwashing with all contact.

c.

Place the patient in protective precautions.

d.

Initiate contact precautions.

ANS: C

A patient whose neutrophil count is below 500/mm3 is at extreme risk of infection and should be placed on protective isolation. A private room and good handwashing are also necessary, but the best intervention is isolation.

DIF: Applying (Application) REF: N/A OBJ: 17-5

TOP: Nursing Process: Implementation MSC: Safe Effective Care Environment

16. A patient is admitted to the hospital for chemotherapy and has severe mucositis. What action by the nurse is best?

a.

Provide frequent oral care with saline.

b.

Have the family bring the favorite mouthwash.

c.

Document the patients oral assessment.

d.

Ensure teeth are brushed with a firm toothbrush.

ANS: A

Frequent oral care is a must for patients with mucositis. However, commercial products contain alcohol, and the patient needs gentle products that do not contain alcohol. Saline is a good option. Documentation should occur, but the nurse should act to address the problem. A soft toothbrush or swab is preferred for comfort.

DIF: Applying (Application) REF: N/A OBJ: 17-5

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

17. A patient has severe watery diarrhea from chemotherapy and is embarrassed having to be cleaned up frequently. The nurse notes several open areas on the patients rectal area that cause pain. What nursing diagnosis takes priority?

a.

Acute pain

b.

Impaired skin integrity

c.

Ineffective coping

d.

Decreased cardiac output

ANS: B

Physical needs take priority over psychosocial ones. The patient has open areas and impaired skin integrity, but no information shows decreased cardiac output. The pain is related to the impaired skin, so treating that will diminish the pain.

DIF: Analyzing (Analysis) REF: N/A OBJ: 17-5

TOP: Nursing Process: Diagnosis MSC: Physiologic Integrity

18. An older patient getting cisplatin (Platinol) asks the nurse how it works. What is the best response?

a.

Prevents RNA transcription and DNA replication

b.

Interferes with synthesis of chromosomal nucleic acid

c.

Formed from soil fungi; prevents RNA and DNA synthesis

d.

Binds to cell proteins and inhibit mitosis

ANS: A

Cisplatin is an alkylating agent, which prevents RNA transcription and DNA replication. Antimetabolites interfere with synthesis of chromosomal nucleic acid. Antitumor antibiotics prevent RNA and DNA synthesis. Plant alkaloids bind to cell proteins and inhibit mitosis.

DIF: Remembering (Knowledge) REF: Page 311 OBJ: 17-4

TOP: Teaching-Learning MSC: Physiologic Integrity

19. An older patient on chemotherapy is in the oncology clinic for follow-up. The nurse notes the patient appears depressed. What action by the nurse should occur first?

a.

Assess the patient for depression.

b.

Review the patients chemotherapy.

c.

Ask the patient about suicidal ideation.

d.

Inquire how the patient has been feeling.

ANS: B

The nurse should assess the patient for depression; however, prior to doing so, the nurse should review the patients chemotherapy. Some chemotherapy drugs can cause depression, and it may be a confusing picture. Depending on the results of the screening, asking about self-harm may be appropriate. Inquiring how the patient is feeling is appropriate, but it is not the most important action.

DIF: Applying (Application) REF: N/A OBJ: 17-6

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

20. The family of an older patient recently diagnosed with cancer reports that the patient seems to be in denial, refusing to choose treatments and planning an extended vacation. What response by the nurse is best?

a.

Ask the patient how he or she feels about the diagnosis.

b.

Tell the patient treatment started early has the best results.

c.

Refer the patient to a licensed mental health professional.

d.

Tell the family that the patient will get over it in his own time.

ANS: A

This patient may be experiencing a compensatory form of grief and not allowing him- or herself to ponder the enormity of the situation at one time. Rather, the patient may be allowing bits of information to seep into his or her existence slowly in order to make sense of it. This is adaptive and the nurse should ask the patient how he or she feels about the cancer. Telling the patient that treatment must start early may be too harsh and the patient may not be ready to make decisions. The patient probably does not need a mental health professional; rather the patient should be left to come to terms with this diagnosis on her or his own terms. Using phrases like get over it are judgmental and imply the patient is doing something wrong.

DIF: Applying (Application) REF: N/A OBJ: 17-5

TOP: Caring MSC: Psychosocial Integrity

MULTIPLE RESPONSE

1. The nurse is using a tool to assess the quality of life of a hospice patient. The nurse addresses the appropriate areas of concern when asking which of the following questions? (Select all that apply.)

a.

Are you able to bathe yourself?

b.

Did your grandson get the grass cut like he planned?

c.

How would you rate your pain on a scale of 1 to 10?

d.

Do you still have concerns about your will?

e.

Can we talk about why you never remarried?

ANS: A, B, C, D

Quality of life was measured by the Missoula-Vitas Quality of Life Index (MVQOLI), an instrument designed specifically for use with terminally ill patients. The MVQOLI determines levels of symptom distress, patient ability to function, social support, affairs in order, and religious comfort or support. Asking about why the patient never married is not appropriate at this time.

DIF: Understanding (Comprehension) REF: Page 317 OBJ: 17-6

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

2. The nurse suspects the older adult patient will require diagnostic testing for possible lung cancer when the patient does which of the following? (Select all that apply.)

a.

Reports smoking two packs of cigarettes daily

b.

Reports severe chest pain

c.

Loses 10 pounds in 1 month

d.

Takes several naps daily

e.

Locates a palpable lump on the left lateral chest

ANS: A, C, D

The classic clinical presentation of lung cancer is a persistent cough, sputum streaked with blood, chest pain, and recurring pneumonia or bronchitis. This constellation of symptoms is also associated with cigarette smoking, and their significance as indicators of cancer may be overlooked. Other symptoms include more systemic complaints such as anorexia, weight loss, and fatigue. Older persons more often experience dyspnea and weight loss, whereas pain is less frequent.

DIF: Remembering (Knowledge) REF: Page 301 OBJ: 17-3

TOP: Nursing Process: Assessment MSC: Health Promotion

3. The nurse is preparing discharge education for an older patient and his family. The patients hemoglobin is currently 8.2 mg/dL as a result of cancer treatment therapy. To best address the patients hematology status, the nurse includes instructions to do what? (Select all that apply.)

a.

Include eggs or an egg substitute into the daily diet.

b.

Avoid strenuous exercise until hemoglobin improves.

c.

Regularly take both a mid-morning and mid-afternoon nap.

d.

Have a green leafy salad with vegetables at meals.

e.

Check for bruising to the extremities and the gums.

ANS: A, B, C, D

Instruct the patient and family to increase rest and sleep periods as well as to incorporate foods into the diet that are high in iron, such as eggs, lean meat, green leafy vegetables, carrots, and raisins. These interventions are directed toward conserving energy and providing iron. Avoiding strenuous activity will decrease the chance of injury. Bleeding and bruising would indicate low platelet count.

DIF: Applying (Application) REF: N/A OBJ: 17-5

TOP: Teaching-Learning MSC: Physiologic Integrity

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