Cellular Regulation+Breast Cancer Clicker Questions + Cancer/Breast Cancer EAQ's

Which cancer diagnosis for a female patient is most likely to cause death? 1) Lung cancer 2) Breast cancer 3) Uterine cancer 4) Pancreatic cancer

Correct 1 A lung cancer diagnosis has a 26% death rate for women. Uterine, breast, and pancreatic cancers have death rates of 15%, 4%, and 7%, respectively.

Which are treatment goals of cancer? Select all that apply. 1) Cure 2) Control 3) Palliation 4) Prevention 5) Early detection 6) Clinical staging

Correct 1, 2, 3, The treatment goals for cancer include cure, control, and palliation. Prevention and early detection are goals for the health care team before a diagnosis of cancer. Clinical staging is done as part of the completion of a diagnostic workup to guide effective treatment selection.

Which patient statements indicate correct understanding of preventative measures for cancer after a teaching session with the nurse? Select all that apply. 1) "I will limit my alcohol intake." 2) "I will use sunscreen when outdoors." 3) "I will reduce my fatty food consumption." 4) "I will obtain regular colorectal screenings." 5) "I will get regular mammograms as suggested by my doctor."

Correct 1, 2, 3, Preventative measures for cancer include limiting alcohol intake, using sunscreen when outdoors, and reducing fatty food consumption. Colorectal screenings and mammograms are early detection procedures and not preventative measures.

A patient has been diagnosed with breast cancer and has been prescribed doxorubicin. Which assessments should the nurse make before administering the drug? Select all that apply. 1) Check for signs and symptoms of infections. 2) Check whether any recent live vaccinations have been received by the patient. 3) Check whether the patient has high sugar levels. 4) Check whether the patient is in contact with any person who has received live attenuated virus. 5) Check the cholesterol levels of the patient.

Correct 1, 2, 4 Doxorubicin is a cytotoxic drug that also causes suppression of the immune system. Therefore, any existing infections could become more severe due to the effect of this drug. Vaccinations may become ineffective when this drug is used; moreover, doxorubicin can worsen the side effects of the vaccinations. Doxorubicin lowers the immunity and increases the chances of contracting infections. Therefore, it is important to ask if the patient has been in contact with any person who has received live attenuated virus. Doxorubicin does not affect the sugar levels or cholesterol levels in the body.

The nurse is conducting a teaching session for a patient who will have a fine-needle aspiration (FNA) biopsy to determine the presence of cancer cells. Which is the most appropriate statement by the nurse? 1) "A core piece of tissue is removed and preserved for analysis." 2) "You will have a surgical procedure to remove the entire lesion." 3) "You will have a partial excision of the lesion using a dermal punch." 4) "A small-gauge needle is used to remove cells for cytologic examination."

An FNA biopsy involves the use of a small-gauge needle to remove cells for cytologic examination. A core piece of tissue is removed and preserved for analysis during a large-core biopsy. An excisional biopsy is a surgical procedure during which a lesion is removed. An incisional biopsy, also referred to as a partial excision, is removal of lesion with a scalpel or dermal punch.

The nurse is conducting a community seminar regarding cancer prevention and detection. Which diagnostic tool should the nurse include as one that decreases cancer mortality rate through early detection? 1) Colonoscopy 2) Polyp excision 3) Fecal occult blood test 4) Culture and sensitivity test

Correct 1 A colonoscopy is a diagnostic tool that increases early detection and decreases the mortality rate for colon cancer. Polyp excisions are considered preventative and not diagnostic. Fecal occult blood testing may indicate a problem with the colon that requires further testing; however, this test is a laboratory test and not a diagnostic tool. A culture and sensitivity test will determine if there is a bacterial, fungal, or viral infection; however, this test is laboratory test and not a diagnostic tool.

The nurse is caring for a patient with cancer and is monitoring the albumin and prealbumin levels frequently. What condition does the nurse suspect the patient is at risk for? 1) Malnutrition 2) Cardiac tamponade 3) Tumor lysis syndrome 4) Third space syndrome

Correct 1 Altered albumin and prealbumin levels are indicators of malnutrition. Cardiac tamponade, tumor lysis syndrome, and third space syndrome are not associated with altered albumin and prealbumin levels.

The nurse is conducting a teaching session within the community regarding cancer prevention and detection. Which type of cancer should the nurse include based on the highest incidence among both men and women? 1) Lung cancer 2) Thyroid cancer 3) Colorectal cancer 4) Non-Hodgkin lymphoma

Correct 1 Aside from prostate cancer for men and breast cancer for women, lung cancer has the highest incidence among both men and women. Thyroid cancer affects 7% of women but is not ranked for men. Colorectal cancer is the third most common cancer; however, it ranks below lung cancer. Non-Hodgkin lymphoma affects 5% of men and 4% of women; it also ranks below lung cancer for both sexes.

A nurse is caring for a patient who is in the terminal stage of breast cancer at a hospice care center. Which mode of treatment would be included in the hospice care for this patient? 1) Opioids 2) Mastectomy 3) Chemotherapy 4) Radiation therapy

Correct 1 Hospice care provides support and care for patients in the last phases of a terminal disease so that they might live as fully and as comfortable as possible. Unlike palliative care, hospice care does not include curative treatment. Providing pain relief is an important function of hospice care. Opioids are the drug of choice for pain relief in hospice care. Chemotherapy, radiotherapy, and mastectomy are curative cares for cancer and are not done in hospice care centers.

The family of a recently admitted female patient are shocked that their mother has received a diagnosis of lung cancer. They ask the nurse whether it is common for women to have lung cancer. What is the nurse's best response? 1) "Lung cancer has the second highest incidence for both men and women." 2) "Sadly, it is not that unusual; lung cancer has become the leading cancer for women." 3) "It is unusual that your mother would have lung cancer, because fewer women smoke than men." 4) "Lung cancer is not as common in women as colorectal cancer, but more women are receiving this diagnosis."

Correct 1 Lung cancer has the second-highest incidence for both men and women. Breast cancer is the leading site for cancers in women. The lungs have now become the second most common site for cancers in women.

A nurse is reviewing the record of a patient with breast cancer to determine the cancer stage according to the TNM system (tumor size, nodal involvement, presence of metastasis). Which parameters are taken into account in TNM staging of cancers? Select all that apply. 1) Tumor size 2) Metastasis 3) Number of tumors 4) Lymph node involvement 5) Response to hormonal therapy

Correct 1, 2, 4, The TNM system is the most widely accepted staging method for breast cancer. This system uses tumor size (T), presence of metastasis (M), and nodal involvement (N) to determine the stage of disease. Numbers of tumors or response to hormonal therapy are not the parameters used to stage the cancer according to the TNM staging system.

The nurse is caring for a patient with lung cancer. The nurse is legally able to delegate which of the following tasks to unlicensed assistive personnel (UAP)? 1) Taking vital signs 2) Suctioning the upper airway 3) Administrating blood products 4) Changing a central line dressing

Correct 1 Unlicensed assistive personnel are not able to perform skills that require ongoing assessment and evaluation. Nursing interventions that require independent nursing knowledge, skill, or judgment are the nurse's responsibility and cannot be delegated. Vital signs can be taken by unlicensed assistive personnel and reported to the registered nurse. Administration of blood products, central line dressing changes, and suctioning of the upper airway are tasks that the registered nurse must perform.

Which is the only definitive means of diagnosing cancer? 1) Tissue biopsy 2) Mammography 3) Liver function studies 4) Computed tomographic (CT) scan

Correct 1 A tissue biopsy, the pathologic evaluation of a tissue sample, is the only definitive way to diagnose cancer. Liver function studies are blood tests that can help evaluate the function of the liver. A mammography is a screening tool for breast cancer. A CT scan can help identify areas of abnormality and help determine the stage and metastasis of an existing tumor.

The nurse is caring for a patient awaiting the results of a diagnostic study for cancer. Which nursing intervention can help decrease the patient's anxiety? 1) Provide written information in simple terms to the patient and family. 2) Assure the patient that everyone who may have cancer feels anxious. 3) Explain the purpose of the diagnostic tests using medical terminology. 4) Encourage the patient to wait until after the diagnosis to discuss questions.

Correct 1 Providing the patient and family written information in simple terms will help to decrease anxiety since this information is easily understandable. They will also be able to reference it at a later date if necessary. The purpose of diagnostic tests should be explained in simple, easy-to-understand language. Everyone who may have cancer does not experience the same feelings. Waiting until after the diagnosis to discuss questions does not promote a healing relationship with the family. It allows incorrect information to contribute to increased anxiety over time.

An older adult patient who had a mastectomy for breast cancer six months ago wants to have breast reconstructive surgery. The nurse knows that what is the most likely motivation for this patient seeking this surgery? 1) Improvement of the woman's self-image 2) Being able to experience sexual arousal 3) Getting a tummy tuck as well as the breast mound 4) Restoring the premastectomy appearance of the breast

Correct 1 The most likely motivation for this patient to seek breast reconstructive surgery is to improve her self-esteem. This surgery is not intended to increase sexual arousal or restore the premastectomy appearance of the breast. The abdominoplasty (tummy tuck) effect will only be a possibility with the transverse rectus abdominis musculocutaneous (TRAM) flap, not with a breast implant or tissue expansion.

The nurse is caring for a patient newly admitted reporting fever and chills. The patient was diagnosed four months ago with pancreatic cancer, is undergoing radiation treatment, takes fentanyl for pain, and has a medical port. The patient appears anxious and is sweating. What are the priority nursing assessments? 1) Time of last pain medication and vital signs 2) Level of pain intensity and pancreatic enzymes 3) White blood cell count and time of last pain medication 4) Date of last radiation treatment and white blood cell count

Correct 1 Time of last pain medication and vital signs are the priority nursing assessments since the patient may be in opioid withdrawal as evidenced by the anxiety and sweating. Vital signs help to rule out a septic process beginning in the medical port that may be manifested by fever and chills. Level of pain intensity is important to help determine the type and amount of medication to be used, but this is not the immediate priority. Pancreatic enzyme levels and a white blood cell count need to be ordered by a physician before the nurse uses them as part of the assessment. Date of the last radiation treatment is important but not a priority.

The nurse is caring for a cancer patient and finds that the patient has tumor lysis syndrome. Which other condition should the nurse monitor for? 1) Renal failure 2) Cardiac arrest 3) Venous thrombosis 4) Rheumatoid arthritis

Correct 1 Tumor lysis syndrome occurs when large numbers of neoplastic cells are killed rapidly due to chemotherapy. This cellular destruction is characterized by a rapid development of hyperuricemia and hyperphosphatemia, and can lead to acute renal failure. Cardiac arrest and rheumatoid arthritis are not common complications with tumor lysis syndrome. Venous thrombosis would occur with a patient who has a tumor in the superior vena cava.

Which should the nurse recommend to a patient as a prevention method regarding cancer development? Select all that apply. 1) Eating a diet high in fiber 2) Maintaining a healthy weight 3) Participating in regular exercise 4) Having an annual complete physical 5) Scheduling a colonoscopy upon physician recommendation

Correct 1, 2, 3 Prevention methods for developing cancer include eating a diet high in fiber, maintaining a healthy weight, and participating in regular exercise. Physical examinations and screenings as well as colonoscopies are early detection methods, not prevention methods.

A patient with breast cancer underwent a partial mastectomy with radiation therapy. For which symptoms should the nurse tell the patient to be observant? Select all that apply. 1) Arm swelling 2) Breast soreness 3) Skin reactions 4) Excessive hair loss 5) Gastrointestinal disturbances

Correct 1, 2, 3, After a partial mastectomy with radiation therapy, the patient should be told to watch for arm swelling, breast soreness, and skin reactions. Excessive hair loss and gastrointestinal symptoms are not common side effects of radiation therapy but could be present with chemotherapy.

When teaching a patient about the prevention of breast cancer, what should be included as helpful in decreasing the risk of breast cancer? Select all that apply. 1) Prevent smoking and alcohol intake. 2) Prevent exposure to harmful radiation. 3) Increase the use of oral contraceptives. 4) Prevent gaining excess weight during adulthood. 5) Use combined hormone therapy (progesterone and estrogen) after menopause.

Correct 1, 2, 4 Modifiable risk factors for breast cancer include smoking and alcohol intake. Environmental exposure to radiation may cause breast cancer. Excess weight gain during adulthood or sedentary lifestyle may also enhance the risks. A link may exist between recent oral contraceptive use and increased risk of breast cancer for younger women. The hormones estrogen and progesterone may act as tumor promoters to stimulate breast cancer growth. The use of combined hormone therapy (estrogen plus progesterone) increases the risk of breast cancer and also the risk of having a larger, more advanced breast cancer at diagnosis.

Which methods of treatment are most appropriate for treating cancer? Select all that apply. 1) Chemotherapy 2) Surgical staging 3) Radiation therapy 4) Hormone therapy 5) Bronchial washing 6) Positron emission tomography (PET) scan

Correct 1, 3, 4 Radiation therapy, chemotherapy, and hormone therapy are methods often used to treat cancer. Surgical staging refers to determining the extent of the disease with surgical excision, exploration, and/or lymph node sampling; this is diagnostic. A PET scan is an imaging test, another diagnostic tool. Bronchial washing is also a diagnostic study performed to examine cellular cytology in the respiratory tract.

A patient has been diagnosed as having breast cancer stage TNM IIIC. The nurse has to convey the meaning of TNM IIIC. Which points should the nurse include in the explanation? Select all that apply. 1) The tumor size is more than 5 cm. 2) The tumor will respond well to hormone therapy. 3) The cancer has affected the bone and spinal cord. 4) The cancer has spread to more than 10 adjacent lymph nodes. 5) The cancer is unresponsive to therapy.

Correct 1, 4 The TNM system is the most commonly used system for staging breast cancer. This system uses tumor size (T), nodal involvement (N), and presence of metastasis (M) to determine the stage of disease. In stage IIIC, the tumor size is more than 5 cm; more than 10 lymph nodes, including axillary, internal mammary, or infraclavicular nodes, have been affected; and no signs of metastasis to other parts of the body are present. The TNM classification system does not have a response to hormone therapy as one of its components.

The nurse is educating a group of women about breast cancer. Where should the nurse inform the group that most breast cancers occur? 1) Nipple area 2) Upper outer quadrant of the breast 3) Upper medial area 4) Lower outer quadrant

Correct 2 Most (50%) breast cancers are diagnosed in the upper outer quadrant of the breast. The next most frequent site is the nipple area (18%), followed by the upper medial area (15%), the lower outer quadrant (11%), and the lower medial area (6%).

The nurse is reviewing the laboratory reports of a patient with cancer and anticipates that the patient is at an increased risk for infection. Which finding supports this conclusion? 1) Anemia 2) Neutropenia 3) Hyperkalemia 4) Hyponatremia

Correct 2 Neutropenia, or a decreased white blood cell count, indicates that the patient at risk for infection. Anemia is a complication associated with chemotherapy; anemia does not indicate that the patient has infection. Hyperkalemia and hyponatremia also do not indicate infection.

The family of a patient who has reached the end stages of pancreatic cancer is concerned that the patient has suddenly become very religious, despite rarely having participated in religion throughout his or her life. Which therapeutic statement by the nurse provides the best explanation of this behavior? 1) "Sometimes near the end, patients begin to have visions that often are religious." 2) "It is common for patients facing death to turn to religion to help provide order to the world." 3) "It is good that your family member has decided to turn to religion so that the soul will be saved upon leaving the body." 4) "I wouldn't worry too much about it; if it is what your family member needs at this point in time, we just need to provide support."

Correct 2 When patients are facing the end of life, they often turn to religion to help provide order to the world. The question does not contain enough data to determine whether the patient is having visions. Stating that it is good that the patient has turned to religion places the nurse's subjective values on the behavior and would not be appropriate in this situation. Telling the family not to worry is dismissive and not a therapeutic response.

Which statement by the nurse is appropriate when conducting a teaching session for a patient who will have an excisional biopsy to determine the presence of cancer cells? 1) "A core piece of tissue is removed and preserved for analysis." 2) "You will have a surgical procedure to remove the entire lesion." 3) "You will have a partial excision of the lesion using a dermal punch." 4) "A small-gauge needle is used to remove cells for cytologic examination."

Correct 2 An excisional biopsy is a surgical procedure during which the entire lesion is removed. A large-core biopsy involves the removal of a core piece of tissue that is preserved for analysis. An incisional biopsy is the partial excision of a lesion with a scalpel or dermal punch. A fine-needle aspiration (FNA) biopsy is performed with a small-gauge needle; this biopsy is used to remove cells for cytologic examination.

A patient is preparing to begin breast cancer treatment with tamoxifen. What point should the nurse emphasize when teaching the patient about the new drug regimen? 1) "You may find that your medication causes some breast sensitivity." 2) "It's important that you let your health care provider know about any changes in your vision." 3) "You'll find that this drug often alleviates some of the symptoms that accompany menopause." 4) "It's imperative that you abstain from drinking alcohol after you begin taking tamoxifen."

Correct 2, Tamoxifen has the potential to cause cataracts and retinopathy. The drug is likely to exacerbate rather than alleviate perimenopausal symptoms. Breast tenderness is not associated with tamoxifen, and it is not necessary for the patient to abstain from alcohol.

A nurse is explaining the procedures involved in modified radical mastectomy surgery to a patient with breast cancer. Which statements best describe the procedure? Select all that apply. 1) Wide excision of the tumor 2) Removal of the breast 3) Removal of axillary lymph nodes 4) Removal of pectoralis major muscle 5) Insertion of implant under the musculofascial layer of the chest wall

Correct 2, 3 A modified radical mastectomy surgery involves removal of the breast and axillary lymph nodes. It involves the removal or excision not just of the tumor, as seen in a partial mastectomy, but rather of the entire breast. This procedure preserves the pectoralis major muscle. Insertion of an implant under the musculofascial layer of the chest wall is not a part of this surgery.

Which ethnic group has the highest rate of lung cancer for men? 1) Whites 2) Hispanics 3) African Americans 4) Asian/Pacific Islanders

Correct 3 African American men have a higher rate of lung cancer than other ethnic groups. Whites, Hispanics, and Asian/Pacific Islanders do not have a higher rate than African Americans.

A patient is suspected to have distant metastasis of breast cancer to the spinal cord. What clinical manifestation does the nurse anticipate assessing? 1) Muscular weakness 2) Swelling in the abdomen 3) Change in bowel function 4) Loss of sensation on one side

Correct 3 Metastasis to the spinal cord is manifested by a change in bowel or bladder function. Muscular weakness is a manifestation of metastasis to the brain. When breast cancer cells reach the liver, abdominal swelling is seen. A unilateral loss of sensation only on one side of the body is a clinical manifestation of metastasis to the brain.

The nurse is caring for a patient who has terminal cancer. Which interventions by the nurse would facilitate effective coping? Select all that apply. 1) Making all the necessary lifestyle modifications of the patient 2) Being available 24 hours for the patient and the patient's family 3) Touching the patient's arm while talking about the patient's experience 4) Documenting the medical records while listening to the patient's concern 5) Being open and realistic about the treatment and survival with the patient

Correct 2, 3, 5 The nurse should always be available for the patient to help build the patient's trust. Touching a patient's arm or squeezing his or her hand indicates support. The nurse should be open and realistic while providing information about the treatment. Providing false hope will reduce the patient's trust. The nurse should make sure that the patient can maintain as much of his or her usual lifestyle as possible to reduce any distress. The nurse should listen to the patient actively, because this indicates that the nurse is attentive. Listening to the patient while documenting something will make the patient think that the nurse is not interested.

A patient with breast cancer has been prescribed tamoxifen. What side effects should the nurse advise the patient to monitor for while taking this medication? Select all that apply. 1) Chest pain 2) Blurred vision 3) Leg cramps 4) Gastrointestinal disturbances 5) Irregular vaginal bleeding

Correct 2, 3, 5, Women receiving tamoxifen may experience blurred vision, leg cramps, and irregular vaginal bleeding. Visual symptoms may be irreversible. It also increases the risk of blood clots; therefore, monitoring for leg cramps is very important. Irregular vaginal bleeding or spotting is a side effect of tamoxifen. Chest pain and gastrointestinal disturbances are not associated with this medication.

Which statements should the nurse include when conducting a teaching session regarding gender differences related to cancer? Select all that apply. 1) "Women are more likely to develop liver cancer than are men." 2) "The mortality rate of lung cancer is higher in men than in women." 3) "More women than men die from cancer-related deaths every year." 4) "The cancer with the highest incidence among men is prostate cancer." 5) "Head and neck cancers occur more frequently in men than in women."

Correct 2, 4, 5 The mortality rate from lung cancer is higher in men than in women. The highest incidence of cancer among men is prostate cancer. Head and neck cancers occur more frequently in men than in women. Therefore the nurse should include these statements in the teaching session. Men, not women, are more likely to develop liver cancer. Men are also more likely than women to die from cancer-related deaths each year.

The family of an African American patient with a recent diagnosis of late-stage cancer is asking the nurse whether cancer is related to their race. Which response by the nurse correctly reflects the cancer incidence in relation to racial disparities? 1) "Sadly, racial disparities related to cancer death rates are increasing." 2) "Cancer rates for African American women are much higher than those for white women." 3) "African Americans are generally at a later stage of cancer when they receive a diagnosis." 4) "The rates of cancer for African American men is high, but cancer rates are much higher for Native American men."

Correct 3 African Americans are generally at a later stage of cancer when they receive a diagnosis. Overall, racial disparities in relation to cancer death rates are decreasing. The incidence of cancer in women is highest among white women, not African-American women. The cancer incidence among African Americans is higher than that for Native American men.

The home health nurse is visiting a patient diagnosed with end-stage bone cancer. Which of the following statements made by the spouse indicate a cause for the nurse to be concerned? 1) "I am keeping his bed warm and dry so that he is comfortable." 2) "His elderly mother came over to visit him yesterday, but he was not aware she was here." 3) "I am feeling overwhelmed by the amount of care he requires during the day and night." 4) "Our daughter comes over and helps with his care on the weekend days when she is off work."

Correct 3 Caregiver responsibilities become more demanding as chronic illness progresses. The caregiver vocalizing that he or she is feeling overwhelmed by the amount of care the patient requires is a cue that caregiver respite is needed. Attending to the patient's needs, such as taking measures to ensure comfort, is not an indicator of caregiver stress. Discussing the visit by the patient's mother is acknowledging the patient's decline. Sharing that the daughter helps with care on the weekends indicates a supportive family structure.

Which goal of a cancer treatment plan focuses on cancers that cannot be eradicated but are responsive to anticancer therapies? 1) Cure 2) Biopsy 3) Control 4) Palliation

Correct 3 Control is the goal of the treatment plan for cancers that cannot be eradicated but are responsive to anticancer therapies. Treatment with the goal of a cure is expected to have the greatest chance of disease eradication. A biopsy is removal of tissue for pathologic analysis; this is a diagnostic tool, not part of treatment. Palliation is the part of the treatment plan in which the primary objective is relief or control of symptoms but not of the disease itself.

The nurse is planning teaching sessions for patients who are newly diagnosed with breast cancer. Which of these is the best approach when considering the diverse learning needs of adults? 1) Presenting material in a lecture format. 2) Developing self-learning packets for the patients to review. 3) Providing opportunities for the patient to learn from other adults with similar experiences. 4) Delaying practice of new skills until the patient can try the skill independently at home.

Correct 3 Patients dealing with common problems, such as cancer, alcoholism, and eating disorders, can benefit from other adults with similar experiences (peer teaching). A variety of approaches may be used; teaching should not be limited to a single format such as lectures or self-learning packets. Patients need to practice skills immediately after a teaching session so that the nurse can verify learning by return demonstration.

The nurse is conducting a health history for a patient during an annual physical examination. Which question is appropriate for determining the patient's risk for cancer related to inflammation? 1) "Are you exposed to radiation at work?" 2) "How many cigarettes do you smoke daily?" 3) "How do you manage your ulcerative colitis?" 4) "Are you prescribed hormone replacement therapy?"

Correct 3 Ulcerative colitis is a condition that causes chronic inflammation and an increased risk for cancer; therefore, this question is appropriate for assessing the cancer risk related to inflammation. Although radiation, hormone replacement, and cigarettes all increase the risk for cancer, these questions do not determine the risk for cancer caused by chronic inflammation.

The nurse is educating a patient about nutritional methods to decrease the risk of cancer. Which foods should the nurse advise the patient to avoid to decrease the risk of cancer? Select all that apply. 1) Fresh fruit 2) Vegetables 3) Smoked ham 4) Salt-cured meat 5) Poached egg whites

Correct 3, 4 Foods that increase the risk for cancer included smoked ham and salt-cured meats because they have high amounts of nitrates used as preservatives. The consumption of these foods should be discouraged. Intake of fresh fruit and vegetables should be encouraged. Poached egg whites are low-fat and should also be encouraged.

The patient with breast cancer has a left mastectomy with axillary node dissection. Ten lymph nodes are resected, with three positive for malignant cells. The patient has stage IIB breast cancer. What is the best nursing intervention to use in planning care? 1) Evaluate left arm lymphatic accumulation. 2) Maintain joint flexibility and left arm function. 3) Teach the patient about chemotherapy and radiation therapy. 4) Assess the patient's response to the diagnosis of breast cancer.

Correct 4 Assessment is the first step in planning patient care. Because the nurse is the patient's advocate and this is an extremely stressful time for the patient and family, the nurse should focus on the patient's response to the diagnosis of breast cancer when planning care for this patient. The approach for the care of the left arm and teaching the patient about further therapy will be based on this assessment.

A patient is awaiting breast biopsy results. The patient's family history includes a sister and mother with breast cancer. The patient has a history of multiple breast biopsies. Which nursing action will most help alleviate this patient's anxiety? 1) Reassure her that everyone feels anxious as they await biopsy results. 2) Redirect questions by encouraging her to listen to music while she waits. 3) Let the patient know it is most likely a benign cyst similar to past biopsies. 4) Correct misconceptions by providing evidence-based answers to questions.

Correct 4 Correcting misconceptions by providing evidence-based answers to questions helps to open the lines of communication with this patient. Reassuring her that everyone feels anxious as they await biopsy results does not acknowledge and individualize this patient's feelings and experience. Redirecting questions by encouraging her to listen to music while she waits delays dealing with difficult questions and topics and does not cultivate the nurse-patient relationship. Letting the patient know it is most likely a benign cyst similar to past biopsies leads to false reassurances.

A patient has been diagnosed with a noninvasive form of breast cancer. What type of cancer should the nurse educate the patient about? 1) Tubular carcinoma 2) Mucinous carcinoma 3) Medullary carcinoma 4) Ductal carcinoma in situ

Correct 4 Ductal carcinoma in situ is identified as noninvasive breast cancer. If left untreated, it progresses into invasive breast cancer. Tubular carcinoma, mucinous carcinoma, and medullary carcinoma are examples of invasive breast cancer.

A patient recently has had a unilateral, right total mastectomy and axillary node dissection for the treatment of breast cancer. What nursing intervention should the nurse include in the patient's care? 1) Immobilize the patient's right arm until postoperative day three. 2) Maintain the patient's right arm in a dependent position when at rest. 3) Administer diuretics prophylactically for the prevention of lymphedema. 4) Promote gradually increasing mobility as soon as possible following surgery.

Correct 4 Mobility should be encouraged beginning in the postanesthesia care unit (PACU) and increased gradually throughout the patient's recovery. Immobilization is counterproductive to recovery and the limb should not be in a dependent position. Diuretics are not used to prevent lymphedema but may be used in active treatment of the problem.

The nurse is educating a patient about the early detection of cancer. What should the nurse recommend to this patient to facilitate detection? 1) Eating a diet high in fiber 2) Maintaining a healthy weight 3) Participating in regular exercise 4) Getting routine health screenings

Correct 4 Recommending that the patient get routine health screenings facilitates the early detection of cancer. Eating a diet high in fiber, maintaining a healthy weight, and exercising are all preventative measures related to the development of cancer, but they do not facilitate the early detection of it.

A nurse is caring for a patient with metastatic breast cancer. The nurse finds that the patient has developed facial and periorbital edema, and has distention of veins of the face, neck, and chest. What condition do these findings indicate to the nurse? 1) Third space syndrome 2) Tumor lysis syndrome 3) Spinal cord compression 4) Superior vena cava syndrome

Correct 4 Superior vena cava syndrome (SVCS) is an obstructive emergency. There can be many causes, including lung cancer, metastatic breast cancer, and non-Hodgkin's lymphoma. In these instances, SVCS results due to the obstruction of the superior vena cava by a tumor or thrombosis. Spinal cord compression is also an obstructive emergency caused by a malignant tumor in the epidural space of the spinal cord. It can be caused by breast, lung, prostate, GI, and renal tumors and melanomas. Third space syndrome is an obstructive emergency caused by the shifting of fluid from the vascular space to the interstitial space. It may occur due to extensive surgical procedures, biologic therapy, or septic shock. Tumor lysis syndrome is a metabolic emergency caused by rapid release of intracellular components in response to chemotherapy.

A patient who is undergoing a diagnostic workup for cancer expresses anxiety about the results. Which is the best nursing response? 1) "It is probably nothing." 2) "Let's discuss that later." 3) "Everyone feels that way." 4) "Let's talk about your concerns."

Correct 4 During the diagnostic workup of cancer, it is common for patients to be anxious. The nurse should actively listen to all concerns expressed. The nurse should not use communication patterns that may hinder exploration of feelings and meanings. "It is probably nothing" may indicate that the nurse is giving false reassurances. "Let's discuss that later" may mean that the nurse is delaying the discussion, and "Everyone feels this way" means that the nurse is generalizing the patient's concern. By using these strategies, the nurse may deny patients the opportunity to share the meaning of their experience.

A patient is diagnosed with stage IV malignant cancer. What anatomic extent of the disease does the nurse determine is present? 1) Cancer is in situ. 2) Tumor growth is localized. 3) Spread of cancer cells is limited. 4) Cells have undergone metastasis.

Correct 4 In a patient with stage IV malignant cancer, the cells have undergone metastasis. Cancer in situ indicates stage 0 malignancy. The limited spread of cancer cells indicates stage II malignancy. Localized growth of the tumor indicates stage III malignancy.

A patient who is diagnosed with cervical cancer that is classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is most appropriate? A. "The cancer involves only the cervix." B. "The cancer cells look almost like normal cells." 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."

Correct 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.

Which precaution is most important for the nurse to teach the client who has chemotherapy-induced peripheral neuropathy? A.Avoid taking aspirin or any aspirin-containing products. B.Use a bath thermometer to check bath water temperature. C.Do not use mouthwashes that contain alcohol or glycerin. D.Bathe daily using an antimicrobial soap or gel.

Correct B Peripheral neuropathy reduces the ability to discriminate temperature sensation. It is very easy for a person with neuropathy to be unaware of water temperature and to become injured as a result of water for bathing or showering being too hot. Aspirin, although important to avoid when platelets are low, is not contraindicated with peripheral neuropathy. Alcohol or glycerin mouthwashes are contraindicated for mucositis, not peripheral neuropathy. Bathing with an antimicrobial soap helps prevent infection but does not prevent injury.

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? 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 a small-bore catheter. D. Hold the medication unless a central venous line is available.

Correct 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.

The HCP of a patient with a 2 cm breast tumor has recommended a lumpectomy with radiation or a modified radical mastectomy. The patient confides that she doesn't know what to do and asks the female nurse what she would do in the same situation. What is the nurse's best response? A."It doesn't matter what I would do. This is a decision you must make for yourself." B."There are advantages and disadvantages to both procedures. Can you tell me what you know about each of them?" C."I would choose the modified radical mastectomy because I would want to know that the whole tumor was removed." D."The lumpectomy preserves most of the breast, but the survival rate is not as good as with the mastectomy.

Correct B Either treatment choice is indicated for women with early stage breast cancer because the 10 year survival rate is about equal.Each procedure has advantages and disadvantages.It is important for the patient to consider these when deciding, so the nurse needs to make the proper information available to the patient.This requires asking what the patient already knows.

The nurse would be most concerned when the patient's breast exam reveals which finding? A.A large, tender, moveable mass in the upper inner quadrant B.An immobile, hard, nontender lesion in the upper outer quadrant C.A 3 cm firm, defined, mobile mass in the lower outer quadrant D.A painful, immobile mass with reddened skin in the upper outer quadrant

Correct B On palpation, malignant lesions are characteristically hard, irregularly shaped, poorly delineated, nontender and nonmobile.The most common site is the upper outer quadrant of the breast.Fibrocystic lesions are usually large, tender, and moveable and can be found throughout the breast.A fibroadenoma is firm, defined, and mobile.A painful, immobile mass under a reddened area of skin is usually an abcess.

During the immediate postoperative period following a modified radical mastectomy, the nurse institutes which exercises for the affected arm? A.Have the patient brush or comb her hair with the affected arm. B.Perform full passive ROM with the affected arm. C.Ask the patient to flex and extend the fingers and wrist of the operative side. D.Keep the arm positioned so that it is straight and dependent.

Correct C As early as in the recovery room, the patient should flex and extend the fingers and wrist.The other postoperative mastectomy exercises listed are instituted gradually to avoid disrupting the wound.

A patient who is scheduled for a right breast biopsy asks the nurse 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."

Correct 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.

A widowed mother of four school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate? A."I'm sure you have friends that will take the children when you can't care for them." B. "For now you need to concentrate on getting well and not worrying about your children." C. "Why don't we talk about the options you have for the care of your children?" D. "Many patients with cancer live for a long time, so there is still time to plan for your children."

Correct C This response expresses the nurse's willingness to listen and recognizes the patient's 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 patient's friends will take the children, more assessment information is needed before making plans.

A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. Which action, if taken by the nurse, is most appropriate? A. Have the patient eat large meals when nausea is not present. B. Offer dry crackers and carbonated fluids during chemotherapy. C. Administer prescribed antiemetics 1 hour before the treatments. D. Give the patient two ounces of a citrus fruit beverage during treatments.

Correct C Treatment with antiemetics before chemotherapy may help prevent nausea. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea. The acidity of citrus fruits may be further irritating to the stomach.

A patient has fibrocystic changes in her breasts. The nurse explains to the patient that this condition is significant because it A.Commonly becomes malignant over time. B.Can be controlled with hormone therapy. C.Makes it more difficult to examine the breasts. D.Will eventually cause atrophy of normal breast tissue.

Correct C Fibrocystic changes make breasts difficult to examine because the patient may have many changes in density and lumps. A woman with this characteristic needs to become familiar with the normal cyclic changes to her breasts and monitor for anything new.

During a routine health examination, a 40-year-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? A. Teach 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.Schedule a sigmoidoscopy to provide baseline data about the patient. D. Obtain more information from the patient about the family history.

Correct D The patient may be at increased risk for colon cancer, but the nurse's 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.

Which diagnostic test is most accurate and advantageous in terms of time and expense in the diagnosis of malignant breast cancer? A.Mammography B.Excisional biopsy C.Fine-needle aspiration D.Core needle biopsy

Correct D A definitive diagnosis of breast cancer can be made only by a histological examination of the breast tissue. A core needle biopsy is as reliable as an excisional biopsy and has the advantages of decreased time, recovery, and cost. Fine needle aspiration requires more definitive tests if any abnormalities are found.

A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake?A. Offer the patient frequent small snacks between meals.B. Assist the patient to choose favorite foods from the menu.C. Provide teaching about the importance of nutritional intake.D. Apply the ordered anesthetic gel to oral lesions before meals.

Correct D Because the etiology of the patient's 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.

While examining a patient's breasts, the nurse notes multiple, bilateral mobile lumps. To assess the patient further, what is the most appropriate response by the nurse? A."Do you have a high caffeine intake?" B."When did you last have a mammogram?" C."Is there a history of breast cancer in your mother or sisters?" D."Do the size and tenderness of the lumps change with your menstrual cycle?"

Correct D Most breast lesions are benign.Many mobile, cystic lesions change with the menstrual cycle, but malignant tumors do not.Caffeine has been associated with fibrocystic changes in some women, but no evidence has shown caffeine as a cause for breast pain or cysts.Questions regarding the patient's last mammogram or family history are not related to the findings.

The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of 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."

Correct D The risk of recurrence varies by the type of cancer. 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.

When discussing cancer diagnoses with a patient, which should the nurse identify as the only definitive method? 1) Genetic markers 2) Radiographic studies 3) Pathologic evaluation 4) Endoscopic examination

Pathologic examinations are the only definitive method for cancer diagnosis. Genetic markers, radiographic studies, and endoscopic examinations may all be used in the diagnostic process, but these methods are not definitive for the diagnosis of cancer on their own.