Chapter 23 & 24 Review Questions
16. A 52-year-old client relates to the nurse that she has never had a mammogram because she is terrified that she will have cancer. Which response by the nurse is therapeutic?
"Finding a cancer in the early stages increases the chance for cure." (Providing truthful information addresses the client's concern.)
1. The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult client indicates understanding of the nurse's instructions?
"I need to report the pain going down my legs to my health care provider." (Pain in the back of the legs could indicate prostate cancer in an older man.)
2. Which statement made by the client allows the nurse to recognize whether the client who is receiving brachytherapy for ovarian cancer understands the treatment plan?
"I will have a radioactive device in my body for a short time." (Brachytherapy refers to short-term insertion of a radiation source.)
19. A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the registered nurse. Which statement by the client is most important to communicate to the physician?
"My legs are numb and weak." (Numbness and weakness should be reported to the physician because paralysis caused by spinal cord compression can occur.)
2. The nurse is teaching the 47-year-old female client about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse's instructions?
"My mother and grandmother had breast cancer, so I am at risk." (A strong family history of breast cancer indicates a risk for breast cancer)
4. The nurse reviews the chart of the client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means?
"The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." (T1 means that the tumor is increasing in size to about 2 cm, and that no regional lymph nodes are present in the brain. M0 means that no distant metastasis has occurred.)
18. The nurse has received in report that the client receiving chemotherapy has severe neutropenia. Which of the following does the nurse plan to implement? Select all that apply. * Assess for fever. Correct * Observe for bleeding. * Administer pegfilgrastim (Neulasta). Correct * Do not permit fresh flowers or plants in the room. Correct * Do not allow his 16-year-old son to visit. * Teach the client to omit raw fruits and vegetables from his diet. Correct
* Assess for fever. :Correct * Administer pegfilgrastim (Neulasta). :Correct * Do not permit fresh flowers or plants in the room. :Correct * Teach the client to omit raw fruits and vegetables from his diet. :Correct (Correct: Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately to the health care provider. Correct: Administration of biological response modifiers, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), is indicated in neutropenia to prevent infection and sepsis. Correct: Flowers and plants may harbor organisms such as fungi or viruses and are to be avoided for the immune suppressed client. Correct: All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms.)
23. A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which of these clients would be most appropriate to assign to the new graduate?
A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit). (A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to stimulate the bone marrow.)
24. The RN working on an oncology unit has just received report on these clients. Which client should be assessed first?
A client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature. (Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune suppressed people; the nurse should see this client first.)
18. The home health RN is caring for a client who has a history of a kidney transplant and takes cyclosporine (Sandimmune) and prednisone (Deltasone) to prevent rejection. Which assessment data would be most important to communicate to the transplant team?
A lump is palpable in the client's axilla. (Clients taking immune suppressive drugs to prevent rejection are at increased risk for development of cancer; any lump should be reported to the physician.)
3. A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause?
Advancing age. (Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases.)
12. The nurse is caring for a client who is receiving rituximab (Rituxan) for treatment of lymphoma. It is essential for the nurse to observe for which side effect?
Allergy. (Allergy is the most common side effect.)
15. The nurse anticipates administering which medication to treat hyperuricemia associated with tumor lysis syndrome (TLS)?
Allopurinol (Zyloprim) (Tumor lysis syndrome results in hyperuricemia, Allopurinol decreases uric acid production and is indicated in TLS.)
10. A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which intervention is indicated at this time?
Allow the client an opportunity to express her feelings. (Although no specific intervention for the side effect is known, therapeutic communication and listening may be helpful to the client.)
7. The nurse is conducting a community health education class on diet and cancer risk reduction. What should be included in the discussion? * Limit sodium intake. * Avoid beef and processed meats. * Increase consumption of whole grains. * Eat "colorful fruits and vegetables," including greens. * Avoid gas-producing vegetables such as cabbage.
Avoid beef and processed meats. :Correct Increase consumption of whole grains. :Correct Eat "colorful fruits and vegetables," including greens. :Correct (Correct: Avoiding red meat and processed foods such as lunch meats can reduce cancer risk. Correct: Consuming bran and whole grains can reduce cancer risk. Correct: Consuming foods high in vitamin A, including apricots, carrots, and leafy green and yellow vegetables, can reduce cancer risk.)
10. The nurse suspects metastasis from left breast cancer to the thoracic spine when the client has which symptom?
Back pain. (Typical sites of breast cancer metastasis include bone, manifested by back pain, lung, liver, and brain.)
22. The nurse receives report on a client with a glioblastoma. Recognizing that cancers are classified by their tissue of origin, the nurse begins to plan care for a client with which type of cancer
Brain. (The prefix "glio-" is used when cancers of the brain are named.)
5. The client has a diagnosis of lung cancer. To which areas does the nurse anticipate that this client's tumor may metastasize? Select all that apply. * Brain * Bone * Lymph nodes * Kidneys * Liver
Brain: Correct Bone: Correct Lymph nodes: Correct Liver: Correct (Correct: Typical sites of metastasis of lung cancer include the brain, bone, liver, lymph nodes, and pancreas. Correct: Typical sites of metastasis of lung cancer include the brain, bone, liver, lymph nodes, and pancreas. Correct: Typical sites of metastasis of lung cancer include the brain, bone, liver, lymph nodes, and pancreas. Correct: Typical sites of metastasis of lung cancer include the brain, bone, liver, lymph nodes, and pancreas.)
21. The nurse is teaching a client who is receiving an anti-estrogen drug about the side effects she may encounter. Which of these should the nurse include in the discussion? Select all that apply. * Heavy menses * Smooth facial skin * Hyperkalemia * Breast tenderness * Weight loss * Deep vein thrombosis (DVT)
Breast tenderness. :Correct Deep vein thrombosis (DVT). :Correct (Correct: Breast tenderness and shrinking breast tissue may occur. Correct: Venous thromboembolism may occur.)
8. Which signs or symptoms should the nurse report immediately because they indicate thrombocytopenia secondary to cancer chemotherapy? Select all that apply. * Bruises * Fever * Petechiae * Epistaxis * Pallor
Bruises :Correct Petechiae :Correct Epistaxis :Correct (Correct: Bruising is a symptom of a low platelet count. Correct: Petechiae are signs of a low platelet count. Correct: Nosebleed is a sign of a low platelet count.)
19. Which of the following findings would alarm the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3?
Change in mental status. (A change in mental status could result from spontaneous bleeding; in this case, a cerebral hemorrhage may have developed)
6. The registered nurse is teaching a nursing student about the importance of observing for bone marrow suppression during chemotherapy. Select the person who displays bone marrow suppression.
Client with hemoglobin of 7.4 and hematocrit of 21.8. (Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has anemia demonstrated by low hemoglobin and hematocrit.)
20. Which teaching is most appropriate for a client with chemotherapy-induced neuropathy?
Consume a diet high in fiber. (A high-fiber diet will assist with constipation due to neuropathy.)
8. The nurse presents a cancer prevention program to teens. Which of the following will have the greatest impact in cancer prevention?
Do not smoke cigarettes. (Tobacco is the single most important source of preventable carcinogenesis.)
14. The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding?
Dyspnea. (Dyspnea is a sign of lung cancer, as are cough, hoarseness, shortness of breath (SOB), bloody sputum, arm or chest pain, and dysphagia.)
26. Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately?
Edema of arms and hands. (Edema of the arms and hands indicates worsening compression of the superior vena cava consistent with superior vena cava syndrome. The compression must be relieved immediately, often with radiation therapy, because death can result without timely intervention.)
17. When caring for a client who has had a colostomy created as part of a regimen to treat colon cancer, which activities would help to support the client in accepting changes in appearance or function? Select all that apply. * Explain to the client that the colostomy is only temporary. * Encourage the client to participate in changing the ostomy. * Obtain a psychiatric consultation. * Offer to have a person who is coping with a colostomy visit. * Encourage the client and family members to express their feelings and concerns.
Encourage the client to participate in changing the ostomy. :Correct Offer to have a person who is coping with a colostomy visit. :Correct Encourage the client and family members to express their feelings and concerns. :Correct (Correct: This is an appropriate way for the client to become familiar with the ostomy and its care. Correct: A visit from a person who is successfully coping with an ostomy can demonstrate to the client that many aspects of life can be the same after surgery. Correct: Offering to listen to feelings and concerns is part of a therapeutic relationship and therapeutic communication.)
3. Which potential side effects should be included in the teaching plan for a client undergoing radiation therapy for laryngeal cancer? * Fatigue * Changes in color of hair * Change in taste * Changes in skin of the neck * Difficulty swallowing
Fatigue :Correct Change in taste :Correct Changes in skin of the neck :Correct Difficulty swallowing :Correct (Correct: Radiation therapy to any site produces fatigue in most clients. Correct: Radiation therapy may cause clients to report changes in taste. Correct: Radiation side effects are site specific; the larynx is in this area, therefore changes in the skin may occur. Correct: Radiation side effects are site specific; dysphagia may occur from radiation to the throat area.)
14. When caring for a client with suspected syndrome of inappropriate antidiuretic hormone secretions (SIADH), the nurse reviews the medical record to uncover which signs and symptoms consistent with this syndrome? * Hyponatremia * Mental status changes * Azotemia * Bradycardia * Weakness
Hyponatremia Correct Mental status changes Correct Weakness :Correct (Correct: ADH is secreted or produced ectopically, resulting in water retention and sodium dilution. Correct: Dilutional hyponatremia results from ADH secretion, causing confusion and changes in mental status. Correct: Weakness results from hyponatremia.)
11. The nurse explains to the client that which risk factor most likely contributed to his primary liver carcinoma?
Infection with hepatitis B virus. (Hepatitis B and C are risk factors for primary liver cancer.)
21. The registered nurse is teaching a group of nursing students about malignant transformation. Which statement about the process of malignant transformation is true?
Insulin and estrogen enhance the division of an initiated cell during the promotion phase. (These promoters increase cell division.)
5. The nurse teaches the client that intraperitoneal chemotherapy will be delivered where?
Into the abdominal cavity. (Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity.)
12. The nurse is caring for an adult client with Down syndrome who reports fatigue and shortness of breath. Which type of cancer has been identified in clients with Down syndrome?
Leukemia. (Leukemia is associated with Down syndrome and Turner syndrome.)
9. The nurse is teaching a group of clients about cancers related to tobacco or tobacco smoke. Identify the common cancers related to tobacco use. Select all that apply. * Cardiac cancer * Lung cancer * Cancer of the tongue * Skin cancer * Cancer of the larynx
Lung cancer :Correct Cancer of the tongue :Correct Cancer of the larynx :Correct (Organs exposed to the carcinogen, tobacco, are the most likely to develop cancer.)
4. The client receiving chemotherapy will experience the lowest level of bone marrow activity and neutropenia during which period?
Nadir. (The lowest point of bone marrow function is referred to as the nadir.)
22. Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea?
Ondansetron (Zofran). (Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting.)
13. The nurse includes which of the following in teaching regarding the warning signs of cancer? Select all that apply. * Persistent constipation * Scab present for 6 months * Curdlike vaginal discharge * Axillary swelling * Headache
Persistent constipation :Correct Scab present for 6 months :Correct Axillary swelling :Correct (Correct: Change in bowel habit is a warning sign of cancer Correct: A sore that does not heal is a warning signal of cancer. Correct: A lump or thickening in the breast or elsewhere is a warning signal of cancer.)
9. Which intervention will be most helpful for the client with mucositis?
Providing oral care with a disposable mouth swab. (Mouth swabs are soft and disposable and therefore clean.)
25. The outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection?
Reducing all direct and indirect sources of light. (Lighting of all types must be kept to a minimum. It can lead to burns of the skin and damage to the eyes because they are sensitive to light.)
1. Which of these does the nurse recognize as the goal of palliative surgery for the client with cancer?
Relief of symptoms or improved quality of life. (The focus of palliative surgery is to improve quality of life during the survival time.)
11. Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy?
Risk for Injury related to sensory and motor deficits. (The highest priority is safety.)
7. The registered nurse would correct the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance?
Student teaches the client that symptoms of neutropenia include fatigue and weakness. (Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected.)
17. Which information must the organ transplant nurse emphasize before each client is discharged?
Taking immune suppressant medications increases your risk for cancer and the need for screenings. (Use of immune suppressant medications to prevent organ rejection increases the risk for cancer.)
15. Which activity performed by the community health nurse best reflects primary prevention of cancer?
Teaching a class on cancer prevention. (Primary prevention involves avoiding exposure to known causes of cancer; education assists clients with this strategy.)
6. The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility?
Testing of stool specimens for occult blood. (Testing of stool specimens for occult blood is done according to a standardized protocol and can be delegated to nursing assistants.)
20. When the nurse is counseling a 60-year-old African-American male client with all of these risk factors for lung cancer, teaching should focus most on which risk factor?
Tobacco use. (Although all of these are risk factors for lung cancer, the client's tobacco use is the only factor that he can change)
13. Which intervention will be most helpful in preventing disseminated intravascular coagulation (DIC)?
Using strict aseptic technique to prevent infection. (Sepsis is a major cause of DIC, especially in the oncology client.)
16. When caring for a client with cachexia, the nurse expects to note which symptom?
Weight loss. (Cachexia results in extreme body wasting and malnutrition. Severe weight loss is expected.)