Ch 57 Cancer

25. The nurse is caring for a client who undergoes a radical mastectomy for localized breast cancer. What type of surgery does this represent? a. curative b. elective c. palliative d. reconstructive

ANS: A Curative surgery involves complete removal of the tumor, the surrounding tissue involved, and the regional lymph nodes. Curative surgery is performed to heal the client and is most successful when performed at an early stage of disease. The nurse's primary role is to provide thorough, appropriate pre- and postoperative care to the client; to keep the client's family informed; and to prepare the client for any adjustments in lifestyle that may result from the surgery. The nurse can also reinforce the need for regular follow-up care.

13. Which of these persons would be at greatest risk for developing skin cancer? a. a fair-skinned female who has multiple nevi b. a male with a family history of the disease c. a female with freckles or birthmarks d. a male who vacations at the beach once a year

ANS: A The risk factors for developing skin cancer include excessive exposure to ultraviolet radiation; fair complexion; working with tar, coal, pitch, or creosote; and multiple or atypical nevi. Heredity links have not been established as a risk factor for skin cancer.

59. The nurse is providing teaching for health promotion related to the risk factors of gastric cancer. The nurse determines that a client needs additional teaching if the client states that which of the following is a risk factor for this type of cancer? a. history of gastric polyps b. history of heavy alcohol consumption c. a diet of smoked, highly salted, and pickled foods d. a diet of high-fiber and high-residue foods

ANS: D The consumption of a diet of high-fiber and high-residue foods plays a role in the reduction of gastric cancer. The remaining options are risk factors for the development of gastric cancer.

48. The nursing student is caring for a client with cancer of the abdomen. The client is experiencing the accumulation of fluid in the abdomen and dyspnea. The student nurse is aware that a complication of this type of cancer is: a. ascites b. anorexia c. cachexia d. stomatitis

ANS: A Abdominal cancer may lead to ascites, which causes difficulty breathing as well as abdominal swelling. The nurse should regularly monitor the client's abdominal girth and observe for signs of normal peristalsis. It is important for the nurse to weigh the client daily to document weight gain. Keeping the client in Fowler's position will aid ventilation, and providing good skin care, particularly to the abdomen, is essential. The nurse may also support the client if the physician performs a paracentesis.

45. The client undergoing chemotherapy or radiation treatments is experiencing thinning or loss of hair. The nurse explains to the client that this reaction to the treatment is: a. alopecia b. ascites c. cachexia d. dysphagia

ANS: A Alopecia is usually the result of chemotherapy or radiation therapy; the extent depends on the dose and duration of therapy. The nurse can reassure the client that hair loss is not permanent and that hair will begin to regrow within 2 months after therapy is completed.

37. The client receiving biological response modifiers to stimulate the body's natural immune response. The nurse is aware that a serious complication related to this treatment is: a. anaphylaxis b. extravasation c. metastasis d. vesicle formation

ANS: A Biological response modifiers are agents that stimulate the body's natural immune system to destroy cancer cells. A serious complication that needs to be monitored closely is an anaphylactic reaction.

24. Surgery to heal or restore health is classified as: a. curative b. elective c. palliative d. reconstructive

ANS: A Curative surgery involves complete removal of the tumor, the surrounding tissue involved, and the regional lymph nodes. Curative surgery is performed to heal the client and is most successful when performed at an early stage of disease. The nurse's primary role is to provide thorough, appropriate pre- and postoperative care to the client; to keep the client's family informed; and to prepare the client for any adjustments in lifestyle that may result from the surgery. The nurse can also reinforce the need for regular follow-up care.

46. Appropriate nursing actions for a client with dyspnea would include which of the following? a. auscultating lungs every four hours b. closing privacy curtains or room doors at all times c. including regular periods for exercise d. placing the client in the Sims' position

ANS: A Dyspnea may develop as a result of fluid accumulation in the chest, respiratory infections, fibrosis, or anemia. The nurse should monitor the client for any respiratory complications and for oxygen status via pulse oximetry. Placing the client in high Fowler's position helps improve ventilation. Minimizing client activity will also balance oxygen requirements and supply, and improving air flow around the client's unit is also helpful.

15. While caring for a client, the client asks the nurse, "What is the primary cause of lung cancer?" The MOST appropriate response for the nurse to provide is: a. "Cigarette smoking." b. "Environmental hazards such as asbestos exposure." c. "Familial predisposition." d. "Metastasis of other primary cancers to the lung."

ANS: A It is important for nurses to recognize major cancer risk factors so that they can assist individuals in planning interventions to reduce these risks. For example, a person who smokes may be generally aware of the link between smoking and lung cancer but continue to smoke anyway.

51. The nurse is caring for a client with superior vena cava syndrome. The nurse is aware that an appropriate nursing intervention for this condition would be: a. providing a restful environment b. closely monitoring intake and output c. elevating client's feet and legs d. placing the client in the Sims' position

ANS: A The client with superior vena cava syndrome experiences dyspnea, swelling of the face and neck, edema in the upper extremities, chest pain, and cough. The client should be placed in Fowler's position with the head elevated but not the lower extremities, so that venous return will not be increased. Activities should be limited.

14. When teaching a client about the risk factors for prostate cancer, the nurse should include: a. a diet high in animal fat b. recurrent viral infections c. elevated bilirubin levels d. a history of multiple sexual partners

ANS: A The risk factors for the development of prostate cancer include family history of this type of cancer, a diet high in animal fat, and an increasing risk with age.

53. A nurse is caring for a client with laryngeal cancer. The nurse would expect which MOST common risk factor for this type of cancer to be documented in the client's history? a. use of chewing tobacco b. cigarette smoking c. urban living d. alcohol abuse

ANS: A Use of smokeless tobacco products can result in cancer of the mouth, esophagus, pharynx, and larynx; smoking cigarettes, pipes, or cigars can also cause cancer of the lung, pancreas, uterus, cervix, kidney, and bladder.

1. The nurse is aware that typical symptoms seen in clients diagnosed with prostate cancer are which of the following? (Select all that apply.) a. dysuria b. hematuria c. painful intercourse d. back pain e. elevated temperature f. family history of prostate cancer

ANS: A, B, D Early symptoms of prostate cancer include weak urinary stream, increased urinary frequency, dysuria, and difficulty in starting and stopping urination. Some pain may be noted in the lower back, pelvis, or upper thighs. Warning signs include difficulty urinating, painful urination, and blood in the urine.

2. The nurse is caring for a client with cancer who has developed a low white blood cell count and is placed on neutropenic precautions. Which of the following menu selections would be the BEST selection for this client? a. meatloaf b. apple c. salad with tomatoes d. gelatin e. medium-well hamburger f. strawberries g. mashed potatoes h. baked potato

ANS: A, D, G A client who has developed a low white blood cell count and is placed on neutropenic precautions should avoid fresh and undercooked foods to prevent the ingestion of microorganisms. In addition, hand-washing techniques should be reinforced with the client and family to prevent the spread of microorganisms.

42. Appropriate nursing interventions for a client with cachexia would include which of the following? a. assisting in self-care activities to improve outward appearance b. encouraging the client to eat any foods that are appealing c. scheduling regular exercise time d. providing a bland diet high in vitamins A and D

ANS: B Nutritional alterations may result from secretion of cytokines that make the body digest muscle for energy instead of stored body fat, resulting in cachexia (malnutrition and protein wasting). If untreated, the cachexia may decrease the effectiveness of cancer treatment, increase the side effects of these treatments, or cause death. Nurses should assist clients to find a registered dietitian who is knowledgeable about cancer cachexia and ways to reduce its impact. Nurses can encourage clients to select foods that are appealing and to use appropriate nutritional supplements. Enteral or parenteral nutrition may be prescribed for these clients.

2. Which of these terms describes any abnormal growth of new tissue? a. a malignancy b. a neoplasm c. a vesicant d. leukemia

ANS: B Benign neoplasms are nonmalignant growths that develop slowly; they are encapsulated and well-defined and do not pose a major health problem unless they are found in areas that interfere with vital functions.

20. When teaching a male client about the screening tools used for prostate cancer, the nurse would include screening for which of the following in the teaching plan? a. urine screen for protein b. PSA-serum level c. serum testosterone d. complete blood count

ANS: B The risk factors for the development of prostate cancer include family history of this type of cancer, a diet high in animal fat, and an increasing risk with age. Screen tools or tumor marks used to detect the possibility of prostate cancer would include screening for PSA-serum level.

4. When teaching a client about benign neoplasms, the nurse would state that: a. They are able to multiply quickly and spread to distant body parts. b. They are irregular in shape with fingerlike projections. c. They are not cancerous and are usually harmless. d. They are usually found in infection-fighting organs such as lymphatic tissue.

ANS: C Benign neoplasms are nonmalignant growths that develop slowly; they are encapsulated and well-defined and do not pose a major health problem unless they are found in areas that interfere with vital functions.

36. The client is receiving an agent that stimulates the body's natural immune system to control and destroy malignant cells. The nurse explains that this type of therapy is known as: a. antineoplastics b. antibiotics c. biological response modifiers d. inotropics

ANS: C Biological response modifiers are agents that stimulate the body's natural immune system to destroy cancer cells. A serious complication that needs to be monitored closely is an anaphylactic reaction.

8. A client is diagnosed with cancer that occurs in the lymphatic system. The nurse is aware that this type of cancer is: a. carcinoma b. leukemia c. lymphoma d. sarcoma

ANS: C Cancers are named according to the site of the primary neoplasm or the type of tissue involved. The four main classifications by tissue type include lymphomas, cancers occurring in lymphatic tissue and similar infection-fighting organs; leukemias, cancers occurring in blood-forming organs such as bone marrow; sarcomas, cancers occurring in connective tissue such as bone; and carcinomas, cancers occurring in epithelial tissue such as skin.

55. A nurse is caring for a client with cancer who is receiving chemotherapy. The client develops thrombocytopenia related to bone marrow dysfunction. The priority intervention for this client would be to monitor the: a. client for skin infections b. client's temperature c. client for bleeding d. client for pathological fractures

ANS: C Clients who develop lowered platelet counts (below 50,000/mm3) are at risk for bleeding. Nurses should monitor these clients for development of bruises or petechiae, for evidence of blood in urine or stools, and for bleeding from any site. Clients should be instructed to use a soft toothbrush and to avoid taking any medication containing acetylsalicylic acid.

17. Which of these women are at greatest risk of developing breast cancer? a. those who breast-fed infants for more than 1 year b. those who experienced early menarche c. those who had their first full-term pregnancy after age 30 d. those who have smoked for a year or more

ANS: C The risk factors of the development of breast cancer include a family history (immediate female relatives), high-fat diet, obesity after menopause, early menarche, first child after 30, and postmenopausal hormone therapy.

30. Nursing care of a client receiving internal radiation would include which of these approaches? a. having one primary nurse care for the client b. having the client perform personal care activities without assistance c. limiting time of exposure to the client d. wearing gown and gloves when in the client's room

ANS: C The role of the nurse when internal radiation is used involves providing for personal and client safety by following established protocols for the specific type of radiation source. The body fluids of a client receiving radiation from sealed sources are not radioactive; however, the nurse must minimize personal exposure to radiation by limiting the time exposed to the radiation source, maintaining adequate distance from the radiation source, and using protective shielding.

22. The physician has ordered a serum test that can identify a substance indicating the possible presence of malignancy in the client. The nurse understands that this test is used to identify a: a. biological response modifier b. carcinogen c. tumor marker d. virus

ANS: C Tumor markers are substances such as specific protein antigens, enzymes, genes, or hormones that are found in the serum and indicate the possible presence of malignancy. These tests are used to determine the progression or regression of specific types of cancer. Tumor markers do not provide a definitive diagnosis of cancer.

52. A nurse is providing education to a client receiving external radiation. The nurse acknowledges that the client needs further education if the client states the need to: a. avoid exposure to sunlight b. wash the skin with a mild soap and pat dry c. apply pressure on the radiated area to prevent bleeding d. eat a high-protein diet

ANS: C When external radiation is prescribed, the nurse's role is to teach the client about caring for skin around the radiation site, to avoid added exposure to sunlight, and to help the client deal with any side effects, which most often include gastrointestinal upset or skin reactions. The client should avoid pressure on the radiated area by wearing loose-fitting clothing.

9. A client is diagnosed with cancer that occurs in the connective tissue. The nurse is aware that this type of cancer is: a. carcinoma b. leukemia c. lymphoma d. sarcoma

ANS: D Cancers are named according to the site of the primary neoplasm or the type of tissue involved. The four main classifications by tissue type include lymphomas, cancers occurring in lymphatic tissue and similar infection-fighting organs; leukemias, cancers occurring in blood-forming organs such as bone marrow; sarcomas, cancers occurring in connective tissue such as bone; and carcinomas, cancers occurring in epithelial tissue such as skin.

57. A client has an insertion of an internal cervical radiation implant. When providing care, the nurse discovers the implant has come out. The MOST appropriate action for the nurse to take immediately is to: a. call the physician b. pick up the implant with gloved hands and flush it down the toilet c. reinsert the implant into the vagina immediately d. pick up the implant with long-handled forceps and place into a lead container

ANS: D In internal radiation, radioactive isotopes are placed within the body. The role of the nurse when internal radiation is used involves providing for personal and client safety by following established protocols for the specific type of radiation source. The body fluids of a client receiving radiation from sealed sources are not radioactive; however, the nurse must minimize personal exposure to radiation by limiting the time exposed to the radiation source, maintaining adequate distance from the radiation source, and using protective shielding. Unsealed radioisotopes such as iodine are excreted in urine and stool; the nurse follows agency policy for personal protection and never touches the item directly.

56. A nurse is caring for a client with a diagnosis of a bowel tumor. The physician has ordered several diagnostic tests. Which test does the nurse understand will confirm the diagnosis of malignancy? a. magnetic resonance imaging (MRI) b. computerized tomography (CT) scan c. abdominal ultrasound d. biopsy of the tumor

ANS: D A biopsy is used to determine whether a tumor is malignant or benign. Other diagnostic tests, such as an MRI, CT scan, and ultrasound may determine the presence of a mass but will not confirm a diagnosis of malignancy.

7. Which of these statements about cancer is TRUE? a. Clients who are diagnosed after metastasis has occurred usually have good prognoses. b. Metastasis usually occurs when malignant cells multiply and spread to other body parts through the central nervous system. c. Metastatic patterns resulting from the same type of cancer will differ from person to person. d. Patterns of metastasis differ depending on the type of cancer.

ANS: D Because of their rapid growth, cancer cells often spread from an initial site to other parts of the body via the blood or lymph systems; this spread is known as metastasis and its progress depends on the type of cancer.

54. The LPN is caring for a client who is receiving an intravenous (IV) infusion of chemotherapy. The client complains of pain at the insertion site during infusion. The LPN notes redness, swelling, and a decreased infusion rate. The LPN's MOST appropriate action would be to: a. elevate the extremity of the IV site and slow the infusion b. apply ice and maintain the infusion rate, as prescribed c. administer pain medication to reduce the discomfort d. notify the registered nurse

ANS: D Chemotherapy medications escaping into the tissues surrounding the injection site can cause pain, tissue damage, and necrosis. The signs of extravasation are redness or swelling at the insertion site and a decreased infusion rate. The LPN should notify the registered nurse immediately.

34. A client is receiving intravenous (IV) chemotherapy. The nurse is aware that the chemotherapeutic agents are so irritating to tissues that they can cause blistering or necrosis. These types of chemotherapeutic agents are considered to be: a. carcinogens b. corticosteroids c. scabicides d. vesicants

ANS: D Extravasation is the leakage of chemotherapeutic drugs from the vein into the surrounding tissues. This is a serious complication of the administration of intravenous (IV) vesicants that can lead to blistering or necrosis of the involved tissue.

44. When medicating a client for cancer pain, the nursing goal should be to: a. avoid the use of narcotics for as long as possible b. give the correct amount of medication in relation to the client's level of pain c. medicate the client within 10 minutes of each request for pain medication d. prevent pain rather than treat it after its occurrence

ANS: D Pain can result from metastasis of cancer to the bone or obstruction of venous or lymphatic circulation; it usually does not occur until the client's cancer is in advanced stages. The effects of a client's pain are both physical and psychological. It is essential for the nurse and the family to try to prevent pain whenever possible, to rely on the client's self-report of pain, and to use prescribed medications and therapies to provide adequate pain relief.

28. Surgery that reestablishes function or improves cosmetic effect is classified as: a. curative b. elective c. palliative d. reconstructive

ANS: D Reconstructive surgery can be used following curative surgery to reestablish function or to improve appearance. The nurse's role will largely depend on the location of the surgery and its desired effect but involves preparing the client for the procedure and the postoperative course and providing support to the client and family.

16. A nursing student teaching a client about risk factors for colorectal cancer would include: a. heavy alcohol consumption b. exposure to secondhand smoke c. eating a high-fiber diet d. history of rectal polyps

ANS: D The link between dietary intake and the development of some types of colorectal cancer continues to be investigated; obesity, dietary fiber intake, history of polyps, and certain food additives are currently considered to be risk factors.

35. The nurse is monitoring a client receiving intravenous (IV) chemotherapy. The nurse knows that the treatment would be discontinued if which sign appears? a. blood return in the tubing b. itching at the infusion site c. client anxiety d. pain or swelling at the infusion site

ANS: D The nurse's role includes careful monitoring to prevent complications, such as drug extravasation from intravenous administration. Signs and symptoms for extravasation include pain or swelling at the infusion site, redness, or burning.

21. A client is having radiation therapy following a mastectomy. Client education should emphasize which of the following? a. increasing dietary fiber b. screening her sons for prostate cancer c. prohibiting exercise for 6 months d. monitoring all female family members for breast cancer

ANS: D The risk factors of the development of breast cancer include a family history (immediate female relatives), high-fat diet, obesity after menopause, early menarche, first child after 30, and postmenopausal hormone therapy.

3. When teaching the client regarding factors that can influence the cancer survival rate, the nurse determines that the MOST significant factor would be the: a. age of the client at initial diagnosis b. client's response to diagnosis c. racial and ethnic background d. type of cancer

ANS: D The type of cancer plays the largest role in the cancer survival rate. The remaining choices have minimal significance to the growth rate of cancer cells.

12. Which of these statements related to cancer risk is FALSE? a. Exposure to coal tar constitutes a risk factor for lung cancer. b. Melanoma can develop with even limited exposure to ultraviolet rays. c. Smokeless tobacco poses less risk for cancer than cigarettes. d. Heavy alcohol consumption primarily increases risk for lung cancer.

ANS: D Use of tobacco products can result in cancer of the mouth, esophagus, pharynx, and larynx; smoking cigarettes, pipes, or cigars can also cause cancer of the lung, pancreas, uterus, cervix, kidney, and bladder. Extensive alcohol use can lead to cancer of the mouth, throat, esophagus, and liver; alcohol used in combination with tobacco increases the risk for oral and esophageal cancers. Exposure to sunlight, even for a limited time period, can cause skin cancers such as melanoma.

29. The nurse providing education for a client who is having external radiation therapy should include which of these points? a. Side effects are usually minimal. b. Hospitalization is required for the duration of treatment. c. Radiation will eradicate cancer from the body. d. Side effects may not occur until after treatment is completed.

ANS: D When external radiation is prescribed, the nurse's role is to teach the client about caring for skin around the radiation site and to help the client deal with any side effects, which most often include gastrointestinal upset or skin reactions. These side effects may not occur until after treatment is completed.

40. A client receiving radiation and chemotherapy for treatment of cancer might have a falling white cell count because of which of the following? a. Cancer treatments kill both malignant and normal cells in bone marrow. b. Infection commonly accompanies treatment. c. Malignant cells are destroying white cells. d. White cells decrease when no longer needed to fight cancer cells.

ANS: A Bone marrow dysfunction may result from destruction of normal and malignant cells in bone marrow by treatment modalities. The lowered white cell count that ensues places the client at greater risk of developing infection. It is essential that nurses use meticulous hand-washing techniques and maintain strict asepsis during dressing changes or invasive procedures. Nurses should monitor the client for any signs of infection and take vital signs at least every 4 hours. Clients should be instructed to avoid contact with anyone who is ill and to use antimicrobial soaps.

39. For a client receiving chemotherapy for cancer, the nurse is aware that the MOST important lab values to monitor during treatment is: a. blood counts b. drug levels c. T4 and thyroid-stimulating hormone (TSH) d. urine protein and pH

ANS: A Bone marrow dysfunction may result from destruction of normal and malignant cells in bone marrow by treatment modalities. The most important lab values to monitor during treatment are white cell count and platelet counts.

1. The client asks the nurse to explain the statement "the uncontrolled growth of malignant cells." The nurse would determine that the BEST term for this statement is: a. cancer b. diabetes mellitus c. sarcoidosis d. toxoplasmosis

ANS: A Cancer cells are malignant neoplasms that develop rapidly, growing at the expense of healthy tissue.

10. Cancers that occur in epithelial tissue such as skin are called: a. carcinoma b. leukemia c. lymphoma d. sarcoma

ANS: A Cancers are named according to the site of the primary neoplasm or the type of tissue involved. The four main classifications by tissue type include lymphomas, cancers occurring in lymphatic tissue and similar infection-fighting organs; leukemias, cancers occurring in blood-forming organs such as bone marrow; sarcomas, cancers occurring in connective tissue such as bone; and carcinomas, cancers occurring in epithelial tissue such as skin.

50. The nurse is caring for a client with advanced-stage cancer. Which of the following is a medical emergency that occurs in these clients? a. cardiac tamponade b. pathological fractures c. hypertension d. ascites

ANS: A Cardiac tamponade is a medical emergency characterized by the formation of pericardial fluid surrounding the heart. Pathological fractures, hypertension, and ascites are complications of cancer.

31. A client is undergoing chemotherapy. The nurse is aware that the drugs that inhibit the growth and reproduction of malignant cells are called: a. antineoplastics b. antivirals c. biological response modifiers d. inotropics

ANS: A Chemotherapy involves the use of antineoplastic drugs to cure, prevent, or relieve cancer symptoms. These drugs inhibit the growth and reproduction of malignant cells by affecting DNA synthesis or function.

32. The client receiving chemotherapy asked the nurse how most anticancer drugs kill cancer cells. The nurse's response would include that the mechanism of action works by: a. affecting DNA synthesis or function b. damaging the plasma membrane and making the cell vulnerable to osmotic pressure c. inhibiting cell-wall synthesis during active multiplication d. inhibiting dependent RNA polymerase in susceptible cells, blocking protein synthesis

ANS: A Chemotherapy involves the use of antineoplastic drugs to cure, prevent, or relieve cancer symptoms. These drugs inhibit the growth and reproduction of malignant cells by affecting DNA synthesis or function; they vary in how they affect the cell cycle and are classified as either cell-cycle specific (most effective against rapidly growing tumors) or cell-cycle nonspecific (used for large tumors with fewer actively dividing cells).

58. A nurse is caring for a client receiving chemotherapy and notes that the platelet count is 10,000/mm3. Based on this information, the priority nursing intervention is to monitor: a. level of consciousness b. temperature c. bowel sounds d. skin turgor

ANS: A Clients who develop lowered platelet counts (below 50,000/mm3) are at risk for bleeding. Nurses should monitor these clients for a high risk of hemorrhage. The client should be monitored for changes in level of consciousness, which may be an early indication of an intracranial hemorrhage.

61. In teaching the client about reducing the risk factors for the development of cancer, the nurse is aware that which of the following foods can have the greatest increase for the risk of cancer? a. broccoli and cauliflower b. fried foods c. chicken and fish d. cake and bread

ANS: B The link between dietary intake and the development of some types of cancer continues to be investigated; obesity, decreased dietary fiber intake, fried foods, and certain food additives are currently considered to be risk factors.

47. Nursing interventions for a client with cancer experiencing diarrhea secondary to treatment would include which of the following? a. monitoring the client's calcium level b. offering bananas and sports drinks c. providing adult-size diapers d. offering warm liquids frequently

ANS: B Diarrhea may be caused by radiation therapy, chemotherapy, stress, antibiotics, tube feedings, or some dietary supplements. The nurse should monitor the client for signs of fluid and electrolyte imbalance; encourage the client to eat foods low in residue if taking a chemotherapy drug known to cause diarrhea; and urge the client to avoid foods, such as warm liquids, that stimulate the gastrointestinal tract. The client should be monitored for any signs of skin breakdown, and the perineum should be cleansed and dried after each loose stool. Sitz baths may be prescribed for client comfort and antidiarrheal medications may also be prescribed.

18. When teaching a client about the risk factors for cancer, the nurse is aware that which risk factor cannot be changed? a. alcohol consumption b. family heredity c. overexposure to ultraviolet rays d. smoking

ANS: B Genetic factors are risk factors for cancer that cannot be changed. These are related to the high incidence of certain types of cancer in some families; leukemia and cancers of the breast, colon, stomach, prostate, lung, and ovary are among those that tend to run in families.

49. The nurse is providing education to a client who has hypercalcemia. Teaching should include which statement? a. The client will retain large quantities of sodium. b. The client is at increased risk for cardiac arrest. c. The client will excrete calcium secondary to renal failure. d. The client will have serum calcium levels less than 5 mg/dL.

ANS: B Hypercalcemia can be a fatal complication if the serum level rises above 10.5 mg/dL. The immediate concern is for the effects of calcium on the heart and the risk for cardiac arrest.

38. The nurse is aware that the MOST effective method of treating leukemia is: a. blood transfusion b. chemotherapy c. radiation therapy d. surgery

ANS: B Leukemias are cancers occurring in blood-forming organs such as bone marrow. The most effective method of treating leukemia is chemotherapy.

6. The client is diagnosed with malignant neoplasms that have multiplied quickly and spread to distant body parts. The nurse is aware that this process is called: a. cellular transition b. metastasis c. osmosis d. transposition

ANS: B Malignant neoplasms form irregularly shaped masses that have fingerlike projections. Because of their rapid growth, cancer cells often spread from an initial site to other parts of the body via the blood or lymph systems; this spread is known as metastasis and its progress depends on the type of cancer.

11. When discussing risk factors of cancer with a client, the nurse can BEST describe carcinogens as: a. biological agents used to treat certain cancers b. chemical substances that initiate or promote the development of cancer c. genetic predispositions that increase the risk of cancer d. organic substances that reduce the risk of some types of cancer

ANS: B Risk factors for developing cancer can be classified as environmental, lifestyle, genetic, and viral. Environmental factors include occupational exposure to various chemicals known to be carcinogenic (e.g., asbestos, vinyl chloride, coal, tar, arsenic) or to substances such as radium or secondhand smoke. The effect of these factors usually depends on the dose; the larger the dose or the longer the duration of exposure, the greater the risk of cancer development.

19. Which of these women would be at greatest risk for developing cervical cancer? a. one who had her first child at age 35 b. one who became sexually active at age 13 c. one who is overweight d. one who avoids use of condoms during sexual intercourse

ANS: B Risk factors for the development of cervical cancer include history of multiple sexual partners, having sex at an early age, exposure to human papillomavirus (HPV), and smoking.

33. The nurse is caring for a client receiving intravenous (IV) chemotherapy. The nurse notes the leakage of the chemotherapeutic drug from the vein into the surrounding tissues and is aware that this is which complication? a. invasion b. extraction c. extravasation d. intrusion

ANS: C Extravasation is the leakage of chemotherapeutic drugs from the vein into the surrounding tissues. This is a serious complication in the administration of intravenous (IV) chemotherapy.

23. The nurse is caring for a client who has a grade IV tumor. The nurse understands that this means which of the following? a. The prognosis will depend on the location and size of the tumor. b. Tumor cells have retained many of the identifiable tissue characteristics of the original cell. c. The tumor is undifferentiated and the prognosis is poor. d. The tumor is well differentiated and the prognosis is poor.

ANS: C Grading evaluates the tumor cells in comparison to normal cells. A grade IV tumor is the most undifferentiated and is more aggressive in growth, leading to a poorer prognosis.

5. When describing neoplasms that become progressively worse and often result in death to a client, the nurse would be teaching about which type of neoplasm? a. benign b. leukemia c. malignant d. vesicles

ANS: C Malignant neoplasms form irregularly shaped masses that have fingerlike projections. Because of their rapid growth, cancer cells often spread from an initial site to other parts of the body via the blood or lymph systems; this spread is known as metastasis and its progress depends on the type of cancer.

41. The client with cancer is experiencing a state of malnutrition and loss of muscle mass caused by the cytokine production from a tumor. The nurse is aware that the client is exhibiting manifestations of what nutrition complication? a. alopecia b. anorexia c. cachexia d. wasting

ANS: C Nutritional alterations may result from secretion of cytokines that make the body digest muscle for energy instead of stored body fat, resulting in cachexia (malnutrition and protein wasting). If untreated, the cachexia may decrease the effectiveness of cancer treatment, increase the side effects of these treatments, or cause death. Nurses should assist clients to find a registered dietitian who is knowledgeable about cancer cachexia and ways to reduce its impact. Nurses can encourage clients to select foods that are appealing and to use appropriate nutritional supplements. Enteral or parenteral nutrition may be prescribed for these clients.

43. What is the MOST reliable indicator to use in determining a client's level of pain? a. increased heart rate and blood pressure from baseline readings b. nonverbal signals such as grimacing or diaphoresis during normal activities c. the client's self-report of pain d. the stage of the client's disease

ANS: C Pain is considered to be subject data. The most reliable indicator to use in determining a client's level of pain is the client's self-report of pain.

26. Surgery that does not alter the course of disease but is effective in relieving symptoms in more advanced stages of cancer is classified as: a. curative b. elective c. palliative d. reconstructive

ANS: C Palliative surgery is performed primarily to relieve symptoms that arise when the original cancer has metastasized; it does not change the outcome or course of the disease. The nurse's primary role following this type of surgery is to keep the client comfortable.

27. A client who has end-stage colorectal cancer has an ileostomy and a central venous line. The surgery that constructed the ostomy is classified as: a. curative b. elective c. palliative d. reconstructive

ANS: C Palliative surgery is performed primarily to relieve symptoms that arise when the original cancer has metastasized; it does not change the outcome or course of the disease. The nurse's primary role following this type of surgery is to keep the client comfortable.

60. The nurse is conducting a health promotion program at a local hospital. The nurse determines that additional teaching is needed if a participant states that a risk factor associated with cancer is: a. viral factors b. stress c. low-fat and high-fiber diets d. exposure to radiation

ANS: C Risk factors for developing cancer can be classified as environmental, lifestyle, genetic, and viral. Choices about diet and exposure to the sun's ultraviolet rays are also related to lifestyle. The link between dietary intake and the development of some types of cancer continues to be investigated; obesity, low dietary fiber and high dietary fat intake, and certain food additives are currently considered to be risk factors.