MED SURG 2 EAQ CH. 25

The nurse is caring for a patient who wants more information about complementary and alternative therapies in cancer. Which statement indicates that the nurse's teaching has been effective? 1. "Prayer or other spiritual practices may help improve quality of life." 2. "Acupuncture is proven to relieve all of my pain that is associated with cancer." 3. "Aromatherapy may contain many different chemicals—some medicinal, some poisonous." 4. "The American Cancer Society discourages the use of any complementary or alternative therapies in cancer."

1. "Prayer or other spiritual practices may help improve quality of life." Prayer and spiritual practices are one of the complementary/alternative therapies identified by the American Cancer Society (ACS) to relieve symptoms or side effects, ease pain, and increase enjoyment of life. Acupuncture is not identified by the ACS as a complementary or alternative therapy for cancer treatment and is not guaranteed to relieve pain. Herbs, rather than aromatherapy, may contain different chemicals that can be medicinal or poisonous. The ACS identifies multiple complementary therapies that may be beneficial for cancer patients.

A patient with prostate cancer reports that he recently learned the cancer has moved to his bones. Which is the term for this process? 1. Metastasis 2. Differentiation 3. Regional invasion 4. Malignant transformation

1. Metastasis Metastasis is the process by which cancer spreads to distant sites. Differentiation refers to how different cells are from their parent cells. Regional invasion is the movement of cancer cells into adjoining tissue. Malignant transformation occurs when normal cells are exposed to substances that damage cell DNA.

A patient is in the last stage of pulmonary fibrosis. What teaching interventions can be implemented by the nurse to prevent further complications? Select all that apply. 1. Teach to avoid exhaustion 2. Teach turning, coughing, and deep breathing exercises 3. Teach to allow adequate rest after any activity of daily living 4. Teach to perform all activities of daily living without assistance 5. Teach to tell family members not to visit with upper respiratory infections

1. Teach to avoid exhaustion 2. Teach turning, coughing, and deep breathing exercises 3. Teach to allow adequate rest after any activity of daily living 5. Teach to tell family members not to visit with upper respiratory infections A patient with pulmonary fibrosis should be taught interventions to prevent further injury. These interventions include: to avoid exhaustion; turning, coughing, and deep breathing exercises; allowing adequate rest after any activity of daily living; and to tell family members not to visit with upper respiratory infections. The patient needs assistance with all activities of daily living at this stage of pulmonary fibrosis.

patient is experiencing painful cancer treatment-related oral xerostomia and stomatitis and has been provided with instructions. Which patient statement indicates the need for further teaching? 1. "I'll use sugar-free gum or hard candy daily." 2. "I'll perform mouth care with a firm toothbrush." 3. "I'll utilize artificial saliva substitutes throughout the day." 4. "I'll monitor my body weight daily and will contact the health care provider if I lose weight."

2. "I'll perform mouth care with a firm toothbrush." A patient with stomatitis and xerostomia should understand instructions for symptom management. The patient should perform oral care with a soft toothbrush, not a firm toothbrush. The patient should use sugar-free gum or hard candy, and artificial saliva substitutes during the day. The patient should notify the health care provider if weight loss is experienced

A nurse is conducting health screenings and educating patients about risk factors for cancer. After consulting with four patients, the nurse determines that which patient has the highest risk for developing breast cancer based on risk factors? 1. A 22-year-old African-American female whose grandmother died of breast cancer. 2. A 50-year-old Caucasian female who is obese and currently smokes 1 pack of cigarettes per day. 3. A 43-year-old African-American female who consumes a high-fat diet and has a sister with Down syndrome. 4. A 60-year-old African-American female who drinks a glass of red wine nightly and exercises four times per week.

2. A 50-year-old Caucasian female who is obese and currently smokes 1 pack of cigarettes per day. Risk for breast cancer increases with age. Caucasians are more likely to develop cancer. The 50-year-old Caucasian female has the most risk factors: age, ethnicity, obesity, and current smoker. The 22-year-old African-American female is the youngest, with the risk factor of a family member with breast cancer. The 43-year-old African-American female's age and diet are risk factors, but Down syndrome increases the risk for leukemia. The 60-year-old African-American female is oldest, but a glass of red wine does not constitute excessive alcohol intake, and her exercise habits work to reduce her risk for cancer

A patient has recently undergone surgery to remove a large melanoma from his back. The patient is experiencing severe, incision-related pain and has been prescribed an opioid analgesic medication by the health care provider. Which symptoms is the patient likely to experience? 1. Diarrhea 2. Constipation 3. Peripheral neuropathy 4. Extrapyramidal symptoms

2. Constipation Opioids can cause constipation and changes in bowel function when used to alleviate pain. Opiate analgesic medications are not likely to cause diarrhea, peripheral neuropathy, or extrapyramidal symptoms.

The nurse is caring for a cancer patient who is experiencing severe xerostomia. Which measures are most helpful for the nurse to recommend? Select all that apply. 1. Limit fluid intake to help with increased salivation. 2. Try chewing sugar-free gum or sucking on ice chips. 3. Use lemon and glycerin swabs to relieve symptoms. 4. Eat only soft foods, and avoid any foods that are salty. 5. Rinse the mouth with a solution of 1 tablespoon of hydrogen peroxide in 1 glass of water.

2. Try chewing sugar-free gum or sucking on ice chips. 5. Rinse the mouth with a solution of 1 tablespoon of hydrogen peroxide in 1 glass of water. Xerostomia is dry mouth. Sugar-free gum or ice chips may improve or relieve symptoms of dry mouth. A mouthwash solution of hydrogen peroxide in water may help relieve dry mouth. Fluid intake should be increased to counteract dry mouth. Lemon and glycerin swabs are no longer recommended, as they may be drying and increase the risk for infection. Selecting soft foods and avoiding salty foods are recommendations for patients with mucositis.

The nurse should inform the patient of which commonly experienced side effects of monoclonal antibodies? 1. Alopecia, mucositis, dysphagia 2. Neuropathy, anemia, mucositis 3. Headaches, muscle aches, fever 4. Constipation, sedation, xerostomia

3. Headaches, muscle aches, fever Understanding and applying the actions of specific classifications of antineoplastic agents enables nurses to deliver proactive symptom management. Monoclonal antibodies may cause headaches, muscle aches, and fever. They do not generally cause alopecia, dysphagia, neuropathy, anemia, mucositis, constipation, sedation, or xerostomia.

Which patient statement alerts the nurse to a warning sign of cancer? 1. "I have a bowel movement every 4 days." 2. "I had a wart on my finger that lasted for 2 weeks." 3. "I have a blister on my toe that never seems to get well." 4. "I experience moderately heavy bleeding with my periods every month."

3. "I have a blister on my toe that never seems to get well." A sore that does not heal is a warning sign of cancer. A bowel movement every 4 days does not indicate any change in bowel habits. Warts often last for several weeks, and the patient did not describe any change in appearance. Moderately heavy bleeding in conjunction with menstruation is normal and not unusual.

Which statement indicates that the patient understands the nurse's teaching about thrombocytopenia in cancer? 1. "I will check my temperature every day." 2. "I will wear a mask when I go to the store." 3. "I will use a soft toothbrush and an electric razor." 4. "I will alternate periods of activity with periods of rest."

3. "I will use a soft toothbrush and an electric razor." Thrombocytopenia in cancer increases the risk for bleeding. A soft toothbrush and an electric razor are safe choices for a patient at increased risk for bleeding. Checking temperature helps the patient identify warning of a potential infection but does not decrease the risk for bleeding. Wearing a mask works to prevent infection. Alternating activity with periods of rest helps fatigue associated with anemia but does not decrease risk for bleeding.

A nurse is obtaining a health history on a patient who was admitted with lung cancer. Which question is most important for the nurse to ask to gather data about the chief complaint? 1. "How often, if at all, do you drink alcohol?" 2. "Do you see a primary care health care provider regularly?" 3. "Do you have any history of serious diseases or cancer in your immediate family?" 4. "Can you tell me more about the problem that caused you to come to the hospital?"

4. "Can you tell me more about the problem that caused you to come to the hospital?" The chief complaint is the patient's main complaint or concern, and the nurse should seek a complete description of the problem with related signs and symptoms. Asking about alcohol consumption and medical checkups are components of a functional assessment. Incidence of familial diseases composes part of family history.

A nurse is counseling a young male patient who will begin chemotherapy next week. He asks if treatments will prevent him from being able to have more children. Which is the nurse's best response? 1. "You need to discuss your concerns with the health care provider." 2. "Your wife should not become pregnant within 2 years of your treatments." 3. "Certain chemotherapy drugs can harm reproductive cells, but at least you already have one child." 4. "Chemotherapy can lower sperm production, so you may want to consider banking your sperm before starting treatments."

4. "Chemotherapy can lower sperm production, so you may want to consider banking your sperm before starting treatments." Male patients should be aware before starting treatment of potential reproductive side effects, so that they may make an informed decision about sperm banking. While the patient may need to discuss concerns with the health care provider in more detail, it ignores the patient's concerns. Female patients receiving chemotherapy should not become pregnant within 2 years of treatment. Chemotherapy can harm reproductive cells, but the assertion that having one child should be enough is insensitive and inappropriate.

The nurse is caring for a patient with terminal cancer who has decided to undergo palliative chemotherapy treatments. A family member angrily asks the nurse, "Why would you all want to put him through this when we know he is going to die? What is the nurse's best response? 1. "Chemotherapy may prolong your loved one's life." 2. "There is a chance that chemotherapy may cure your loved one." 3. "Your loved one has agreed to this treatment, so you should discuss it with him." 4. "Sometimes, chemotherapy is used to decrease symptoms and reduce suffering caused by cancer."

4. "Sometimes, chemotherapy is used to decrease symptoms and reduce suffering caused by cancer." Palliative chemotherapy treatments may be used to decrease symptoms, reduce suffering, or improve quality of life in terminal cancer patients. Palliative chemotherapy is not administered in hopes of merely extending length of life or to attempt to cure a terminally ill patient. Deflecting the family member's anger and question toward the patient does not address the concern and puts the patient in a position to justify his decision.

A 36-year-old patient is receiving chemotherapy and biotherapy for treatment of non-Hodgkin lymphoma. What condition is the patient at risk for developing because her white blood cell counts are very low? 1. Fatigue 2. Bruising 3. Bleeding 4. Infection

4. Infection Evidence supports that individuals with cancer treatment-related neutropenia are at greater risk for infection due to immunosuppression. Low platelet counts cause bleeding and bruising. Low red blood cell counts cause fatigue.

A patient is receiving daily radiation therapy for treatment of breast cancer. She complains of red, peeling skin that is painful to the touch. Which daily self-care interventions should the nurse recommend? 1. Avoid using lotions on the affected skin. 2. Cleanse the affected skin regularly with soap. 3. Soak the affected skin frequently in warm water. 4. Wear a form-fitting bra to support the affected skin.

1. Avoid using lotions on the affected skin. The patient should be instructed to avoid lotions on the affected skin, as this could cause further skin damage with radiation therapy. Soaps would likely irritate the skin further. The patient should not soak the skin frequently, as this can damage the tissue. Form-fitting clothing could cause further discomfort.

A nurse is educating a patient about the neoplastic medication procarbazine. In order to avoid a potentially severe hypertensive reaction, the nurse should advise the patient to restrict intake of which foods? 1. Bananas, cheese, and liver 2. Green beans, potato chips, and ice cream 3. Apple juice, leafy green vegetables, and oats 4. Potatoes, pastas, and breads with processed flour

1. Bananas, cheese, and liver Patients on procarbazine should avoid foods that are high in tyramine, which include bananas, aged cheeses, beer, caffeinated beverages, and liver. Green beans, potato chips, ice cream, apple juice, green vegetables, oats, potatoes, pastas, and processed flour are not high in tyramine.

The nurse is caring for a patient with metastatic bone cancer. The patient is weak and confused, with a blood pressure of 180/64 mm Hg and a heart rate of 112 beats per minute. Which laboratory finding would lead the nurse to suspect a potential oncologic emergency? 1. Calcium 12.7 mEq/l 2. Sodium 138 mEq/l 3. Albumin of 3.3 g/dl 4. Platelets 117,000/mm3

1. Calcium 12.7 mEq/l Hypercalcemia may cause weakness, confusion, hypertension, and tachycardia. Patients with metastatic bone cancer are at increased risk for hypercalcemia. The serum sodium level is normal. The albumin level is slightly low and reflects nutritional status. The patient's platelets are slightly low, but would not cause confusion or hypertension.

patient undergoing daily pelvic radiation therapy for treatment of prostate cancer is experiencing significant treatment-related side effects. What side effects is this patient likely experiencing as result of treatment? Select all that apply. 1. Cystitis 2. Diarrhea 3. Arthralgia 4. Dehydration 5. Xerostomia 6. Pneumonitis

1. Cystitis 2. Diarrhea 4. Dehydration The bowel and bladder are in the treatment field, and subsequent treatment will cause temporary irritation to the irradiated organs and affected body systems. The patient could experience cystitis (inflammation of the bladder), diarrhea, and dehydration. Arthralgia is pain in the joints and is not a side effect of daily pelvic radiation therapy. Xerostomia is a decrease in the production of saliva and is not a side effect of daily pelvic radiation therapy. Pneumonitis is inflammation of the lungs and is not a side effect of daily pelvic radiation therapy.

A patient is highly anxious and concerned about what the future holds now that she has been diagnosed with an advanced stage, malignant brain tumor. What interventions could be included in the nursing care plan? 1. Encourage the patient to talk about the cancer and her feelings. 2. Counsel the patient not to worry about the cancer and what comes next. 3. Discourage the patient from sharing her feelings about the cancer with others. 4. Advise the patient to avoid large groups of people to help decrease her anxiety.

1. Encourage the patient to talk about the cancer and her feelings. The patient should be encouraged to talk about the cancer and her feelings. It is nontherapeutic to counsel the patient not to worry or to discourage her from sharing feelings with others. Advising the patient to avoid large groups of people may not be the issue, since that was not mentioned in the situation.

A patient with multiple myeloma and metastatic bony lesions is experiencing profound fatigue, confusion, and tachycardia. Which condition is most likely the cause of this patient's symptoms? 1. Hypercalcemia 2. Hyperglycemia 3. Superior vena cava syndrome 4. Syndrome of inappropriate antidiuretic hormone

1. Hypercalcemia Profound fatigue, confusion, and tachycardia correlate with hypercalcemia, an oncological emergency. Hyperglycemia is elevated blood sugar. Superior vena cava syndrome causes symptoms of edema of the upper body. Syndrome of inappropriate antidiuretic hormone causes water intoxication and hyponatremia.

A patient with alopecia from radiation expresses that she feels strange and self-conscious. The nurse reassures the patient that her feelings are normal. What should the nurse say next? 1. Inform the patient that some patients wish to use head coverings, while others do not. 2. Warn the patient that hair will likely never return after large radiation doses to the head. 3. Educate the patient that her hair will be a different color or texture when it starts to grow again. 4. Advise the patient that her hair will begin to grow back 4 to 6 months after completion of therapy.

1. Inform the patient that some patients wish to use head coverings, while others do not. Mentioning head coverings offers an optional solution and reassures the patient about her body image. There is no guarantee that hair will not grow back or will be different in color or texture, and these responses are not therapeutic. Hair does not always grow back after completion of therapy.

The nurse is caring for a patient who is experiencing severe chemotherapy-induced nausea. Which actions can the nurse take to try to reduce the patient's nausea? Select all that apply. 1. Instruct the patient to limit intake of spicy foods. 2. Instruct the patient to avoid room temperature foods. 3. Determine the best time for the patient to eat and drink. 4. Encourage the patient to take small, frequent sips of water. 5. Administer sedatives as ordered while antineoplastic drugs are being administered.

1. Instruct the patient to limit intake of spicy foods. 3. Determine the best time for the patient to eat and drink. 4. Encourage the patient to take small, frequent sips of water. 5. Administer sedatives as ordered while antineoplastic drugs are being administered. Spicy foods can exacerbate nausea and should be avoided. Certain patients experience less nausea when eating at specific times, either before or after treatment. Small frequent sips of water throughout the day help to reduce nausea and maintain hydration. Sedatives are sometimes ordered in conjunction with antineoplastic medications so that the patient can sleep and to decrease the amount of time the patient is awake and nauseated. Patients should eat food at room temperature and should avoid extremely hot or cold foods.

A patient presents to the clinic for her annual mammogram. She asks the nurse what actions she can take to reduce her risk for breast cancer. Which actions are most appropriate? Select all that apply. 1. Limit intake of fatty foods. 2. Abstain from alcohol consumption. 3. Drink six to eight glasses of water each day. 4. Consume at least three servings of fruits and vegetables each day. 5. Participate in moderate exercise for at least 30 minutes most days of the week.

1. Limit intake of fatty foods. 2. Abstain from alcohol consumption. 5. Participate in moderate exercise for at least 30 minutes most days of the week. Breast cancer has been linked to high-fat diets. High alcohol intake is associated with breast cancer. Moderate exercise 30 minutes in length helps maintain healthy weight and reduces breast cancer risk. Adequate hydration does not reduce the risk for breast cancer. Three daily servings of fruit and vegetables are inadequate (five servings are recommended).

Which is the nurse's priority action for a patient with cancer who is experiencing suppressed production of red blood cells, white blood cells, and platelets? 1. Protect the patient from infection. 2. Closely monitor blood test results. 3. Prevent the patient from being overly stressed. 4. Schedule frequent rest periods for the patient.

1. Protect the patient from infection. Although all of the interventions are important, infections for the patient experiencing suppression of white blood cells can be fatal. Secondarily, the nurse should closely monitor blood test results, prevent the patient from being overly stressed, and schedule frequent rest periods for the patient.

A patient with cancer is experiencing spinal cord compression. Which is the priority nursing intervention for this patient? 1. Palpate for bladder distention. 2. Administer analgesics as ordered. 3. Frequently assess for constipation. 4. Perform neurologic checks every 4 hours.

2. Administer analgesics as ordered. Spinal cord compression is caused by a tumor in the epidural space that is pressing on the spinal cord, resulting in intense pain. Although the other interventions are important, the priority intervention would be to administer analgesics. After administering analgesics as ordered, the nurse would palpate for bladder distention, frequently assess for constipation, and perform neurologic checks every 4 hours.

What are the common characteristic features of malignant tumors? Select all that apply. 1. Recurrence after removal 2. Growth rate is usually slow. 3. Growth occurs with invasion of surrounding tissue. 4. Necrosis or ulceration occurs with tissue destruction. 5. Tumor cells closely resemble those of tissue of origin.

1. Recurrence after removal 3. Growth occurs with invasion of surrounding tissue. 4. Necrosis or ulceration occurs with tissue destruction. Tumors are either benign or malignant. Malignant tumors generally recur after removal due to metastatic spread. Random, disorganized, and uncontrolled growth of malignant tumor cells results in invasion of the surrounding tissue. Tissue destruction can cause necrosis, ulceration, or perforation. The growth rate of malignant tumors is typically rapid, and the usual growth rate for benign tumors is usually slow and encapsulated. Due to rapid changes in the appearance of cells, malignant tumor cells are undifferentiated and the tissue of origin is not readily identifiable; benign tumor cells closely resemble those of the tissue of origin.

A patient is receiving a multiagent chemotherapy regimen for treatment of ovarian cancer. She is experiencing treatment-related nausea that greatly limits her ability to eat and drink. Which interventions should the nurse recommend? Select all that apply. 1. Take antiemetics as directed. 2. Avoid sweets and fatty foods. 3. Take antidiarrheals as directed. 4. Avoid fluid intake at mealtimes. 5. Create a pleasant environment for eating. 6. Increase fluid intake, especially at mealtimes. 7. Increase intake of calorie-rich foods at mealtimes.

1. Take antiemetics as directed. 2. Avoid sweets and fatty foods. 4. Avoid fluid intake at mealtimes. 5. Create a pleasant environment for eating. A patient who is experiencing difficulty with eating and drinking should take antiemetics as directed and should avoid fluid intake at mealtimes. The patient should also avoid sweets and fatty foods and should eat in a pleasant environment. It is not beneficial to increase the intake of fluids or calorie-rich foods at mealtimes. Antidiarrheals can be recommended if the patient has diarrhea, but this situation does not indicate that.

The nurse is providing patient education to help a patient taking chemotherapy to manage the nausea and vomiting she is experiencing. Which instructions, as suggested by the National Cancer Institute (2008), should be provided by the nurse? Select all that apply. 1. Take antinausea medicine. 2. Eat foods at room temperature. 3. Eat immediately after treatment. 4. Take small sips of water during the day. 5. Wear a face mask to reduce food smells

1. Take antinausea medicine. 2. Eat foods at room temperature. 4. Take small sips of water during the day. Suggestions from the National Cancer Institute (2008) to help the patient get enough to eat and drink include taking antinausea medicine, eating foods at room temperature, taking small sips of water during the day, and waiting 1 hour after treatment to eat. If the smell of foods bothers the patient, she should ask others to cook.

What type of information is most relevant to a 21-year-old patient who will be undergoing surgery and radiotherapy for treatment of cancer of the testis? 1. A discussion about deep breathing to prevent pneumonia 2. A discussion about sperm banking because of possible sterility 3. A referral to the Look Good, Feel Better program because of altered body image 4. A referral to the Agency for Healthcare Research and Quality to manage cancer pain

2. A discussion about sperm banking because of possible sterility Individuals in childbearing age and/or function should be informed of possible treatment-related changes and implications for reproduction. The Look Good, Feel Better program is not as relevant as the reproductive concerns. Pneumonia is not a common issue for the 21-year-old patient. A referral for cancer pain is not necessary at this point, and is not as relevant to the 21-year-old.

A young male patient is undergoing a bone marrow transplant as a treatment for leukemia. His brother has been identified as his bone marrow donor. Which type of transplant is the patient having? 1. Stem cell transplant 2. Allogeneic transplant 3. Autologous transplant 4. Matched unrelated donor transplant

2. Allogeneic transplant If a patient receives cells from a sibling or other relative, it is classified as an allogeneic transplant. Stem cell transplantation can be used to treat the destruction of the bone marrow caused by the chemotherapy and radiotherapy. If a patient donates his or her own bone marrow before therapy, it is classified as an autologous transplant. If a patient receives cells that are donated from an unrelated donor, it is classified as a matched unrelated donor transplant.

The nurse is caring for a patient who just undergone a bone marrow biopsy and aspiration. The nurse should plan to monitor the patient most carefully for which potential complication? 1. Shock 2. Bleeding 3. Infection 4. Allergic reaction

2. Bleeding Bone marrow biopsies are sterile procedures performed using a large needle, and patients are at a risk for bleeding, especially those who may have lower platelet counts. Shock is not the primary concern post biopsy. Infection is also a potential complication, but use of surgical asepsis works to decrease the risk for infection. A potential allergy to sedation would likely occur during the procedure, and is less likely than bleeding or infection.

A patient is being seen at the family health clinic and asks the nurse which foods to eat to reduce her risk for cancer. The nurse correctly lists which foods? Select all that apply. 1. Bacon 2. Brown rice 3. Black beans 4. Strawberries 5. Summer sausage

2. Brown rice 3. Black beans 4. Strawberries Brown rice, black beans, and strawberries are all recommended by the American Cancer Society to help reduce the risk of cancer as they fall into two key categories (grains, rice, pasta, and beans; and fruits and vegetables). Bacon and summer sausage are not recommended because diets high in salt-cured, smoked, and nitrate-cured foods are associated with esophageal and stomach cancers.

Benign tumors are relatively harmless, but surgical removal is often recommended because the benign tumors can cause which problem? 1. Have abnormal proteins on their cell surfaces 2. Can create pressure on or obstruct body organs 3. Have the ability to migrate from one tissue or organ to another 4. Have a random, disorganized, and uncontrolled growth pattern

2. Can create pressure on or obstruct body organs Benign tumors can cause problems if they create pressure on or obstruct body organs. Malignant tumors have abnormal proteins on their cell surfaces, the ability to migrate from one tissue or organ to another, and have a random, disorganized, and uncontrolled growth pattern.

A patient with ovarian cancer is receiving an infusion of intravenous chemotherapy. What serious condition is she at risk for if the infused agent leaks into the surrounding tissue? 1. Edema 2. Extravasation 3. Superior vena cava syndrome 4. Disseminated intravascular coagulation

2. Extravasation Infusion of chemotherapy into a vein can result in injury to that structure. This type of adverse event is a major safety concern when administrating chemotherapeutic agents.

Place the steps in the transformation of normal cells into cancerous cells in the correct order. 1. Promotion 2. Initiation 3. Metastasis 4. Progression

2. Initiation 1. Promotion 4. Progression 3. Metastasis Initiation, promotion, progression, and metastasis is the correct sequence of steps in the transformation of normal cells into cancerous cells.

he nurse is planning a presentation to a group of college students regarding skin cancer. After the presentation, the nurse knows the students understand the information presented if the students identify which type of cancer as the most deadly type of skin cancer? 1. Sarcoma 2. Melanoma 3. Basal cell carcinoma 4. Squamous cell carcinoma

2. Melanoma Melanoma is the most deadly type of skin cancer. Sarcoma is not a type of skin cancer; it is a soft-tissue cancer. Basal cell carcinoma is often easily detected and has a successful treatment record. Squamous cell carcinoma has a high cure rate when properly treated.

The nurse is assisting with data collection for a patient with leukemia. The nurse observes that the patient has slightly increased pulse and respiratory rates and will not make eye contact. What should the nurse do next? 1. Ask if the patient would like to have another nurse. 2. Offer the patient an opportunity to talk about any feelings or concerns. 3. Ask the family members to leave the room in order to speak to the patient privately. 4. Bring the fresh flowers from the nurses' station into the patient's room to make the environment more welcoming.

2. Offer the patient an opportunity to talk about any feelings or concerns. Increased pulse and respirations, along with poor eye contact, are signs that the patient may be anxious. Offering the patient a chance to express feelings or concerns may relieve some of the anxiety. Asking if the patient would like another nurse does not work to relieve anxiety and may make the patient feel guilty or uncomfortable. Asking family members to leave the room can enhance anxiety by making the patient feel alone or abandoned. Fresh flowers are often contraindicated for patients with low white blood cell counts, and bringing in flowers does not address the patient's feelings.

The nurse is caring for a patient who underwent sealed-source radiation. In order to ensure patient and caregiver safety, which precautions should the nurse plan to take? Select all that apply. 1. Don a lead apron before patient contact. 2. Question assignment of the patient to a pregnant nurse. 3. Strive to limit active care time to a total of 1 hour each shift. 4. Check all bed linens and bedpans for any dislodged source prior to disposal. 5. Place an alert sign on the patient's door designating the room as a radiation area.

2. Question assignment of the patient to a pregnant nurse. 4. Check all bed linens and bedpans for any dislodged source prior to disposal. 5. Place an alert sign on the patient's door designating the room as a radiation area. Pregnant women, even staff, should not enter this patient's room. It is important to recognize that sealed sources can be dislodged accidentally, so bedpans and linens should be carefully examined. Signage that designates the room as a radiation area is important to alert visitors and staff prior to entering. Lead aprons do not provide adequate protection in this situation. Efficient care can be provided in a total of 30 minutes each shift for most patients.

Which nursing care interventions are indicated for a patient with lung cancer who is experiencing syndrome of inappropriate antidiuretic hormone? 1. Give analgesics as ordered; perform neurologic checks. 2. Reinforce fluid restriction; monitor intake and output records. 3. Give blood products and heparin as ordered; assess for bleeding. 4. Elevate the head and arms, but not legs; reassure that symptoms resolve in 2 to 3 days.

2. Reinforce fluid restriction; monitor intake and output records. Understanding and applying the possible implications of oncologic emergencies enables nurses to deliver proactive symptom management and interventions. It is essential to reinforce fluid restriction and to monitor intake and output records, since this emergency can cause water intoxication and dilutional hyponatremia. Analgesics and neurologic checks are interventions for spinal cord compression. Blood products and heparin are interventions for disseminated intravascular coagulation. Elevating the head and arms is an intervention for superior vena cava syndrome.

Which is the proper notation of staging for a tumor that is of minimal size and extension, with an increased involvement of the regional lymph nodes, and with the presence of distant metastasis? 1. T4N1M1 2. T1N2M1 3. T0N0M0 4. TisN2M1

2. T1N2M1 T1N2M1 is correct for a tumor that is minimal in size and extension, with increased involvement of the regional lymph nodes, and with the presence of distant metastasis. T4N1M1 would indicate a tumor that is large in size and extension, with minimal regional lymph node involvement, and with the presence of distant metastasis. T0N0M0 would indicate no tumor that could be located after treatment, no regional lymph node involvement, and no distant metastasis. TisN2M1 would indicate malignancy in epithelial tissue but not in the basement membrane, with increased involvement of the regional lymph nodes, and with the presence of distant metastasis.

Cancer patients who have the most difficulty coping with their diagnosis exhibit which behaviors? 1. Confront their problems directly 2. Tend not to think about their situation 3. Actively seek personal support from others 4. Actively look for information about their disease

2. Tend not to think about their situation Patients who have the most difficulty coping with their cancer diagnosis are those who tend to try not to think about the situation, passively accept treatment, lack personal support, and tend to expect the worst outcomes.

A 44-year-old patient has been admitted to the hospital to undergo internal radiation therapy for treatment of cervical cancer. Which safety measures are necessary to protect visitors and health care professionals from excessive exposure to radiation? Select all that apply. 1. No visitors should be allowed. 2. The patient should be placed in a private room. 3. A portable lead shield provides some protection. 4. The nurse providing the most care should wear a film badge. 5. A lead apron should be worn when working with the patient. 6. Equipment removed from the room must be checked for radioactivity. 7. A sign indicating a radiation area should be hung on the patient's door.

2. The patient should be placed in a private room. 3. A portable lead shield provides some protection. 4. The nurse providing the most care should wear a film badge. 7. A sign indicating a radiation area should be hung on the patient's door. Following established recommendations for radiation safety reduces the risk for radiation exposure for staff and visitors. The patient should be in a private room. A portable lead shield provides some protection. The nurses who provide the most care should wear a film badge when providing care. There should be a sign on the patient's door indicating radiation area. Visitors are allowed; however, the visitors must follow the same policies. Those younger than 18 years of age and pregnant visitors are not allowed. It is not necessary to wear a lead apron or to check removed equipment for radiation.

The nurse is conducting a community awareness seminar about skin cancer prevention and treatment. Which information is most important for the nurse to include in the teaching plan? 1. See a dermatologist monthly for preventive exams. 2. Rely on cosmetics with sunscreen added to protect skin. 3. Report any uneven borders or other obvious changes in warts. 4. Sexually active women should undergo yearly Pap smears for early detection of abnormal cells.

3. Report any uneven borders or other obvious changes in warts. Changes in warts, like uneven borders, are a warning sign of skin cancer. Monthly exams are too frequent for preventive exams. Patients should understand the dangers of unprotected sun exposure and should not rely solely on cosmetics for sunscreen. Yearly Pap smears help to prevent cervical cancer, not skin cancer.

A patient is about to undergo chemotherapy treatment for the first time. The patient tells the nurse, "I know that this treatment will make me deathly sick." What is the nurse's best response? 1. "One of the primary side effects is anorexia." 2. "You need this treatment if you want to get better." 3. "Would you like to talk more about your concerns?" 4. "You probably won't get sick with your first treatment."

3. "Would you like to talk more about your concerns?" Asking the patient to elaborate about the concern allows the nurse to specifically address any fears or misconceptions. The medical term anorexia may not be a term the patient understands, and listing one side effect does not address the patient's concern completely. Telling the patient that treatment is needed to get well does not address the patient's concern and is not therapeutic. Telling the patient he won't get sick with the first treatment dismisses the patient's concern and provides false reassurance, and it is also likely that the patient will experience some side effects.

A patient expresses concern to the nurse about a nagging cough that will not stop. The patient asks, "Does this mean that I have cancer?" Which is the nurse's best response? 1. "I am sure that this is only a side effect from your medication." 2. "A nagging cough is one of the seven warning signs of cancer in adults." 3. "Your cough may be caused by conditions other than cancer but should be evaluated further." 4. "Many cancers like throat cancer are curable, especially if they are diagnosed and treated in the early stages."

3. "Your cough may be caused by conditions other than cancer but should be evaluated further." Medical evaluation is needed for a correct diagnosis, since this warning sign may also be associated with conditions other than cancer. While a cough can be a side effect from medication, this response offers false reassurance and fails to emphasize the need for additional medical evaluation. Simply stating that a nagging cough is a warning sign of cancer confirms the patient's fears without addressing them therapeutically. There is no evidence for the nurse to suggest that the patient has throat cancer.

A patient has just been informed that she will need to receive antineoplastic drugs to treat breast cancer. The patient asks about the most dangerous adverse effect of antineoplastic drugs. Which adverse effect would the nurse discuss with the patient? 1. Alopecia 2. Nausea and vomiting 3. Bone marrow suppression 4. Numbness and tingling of extremities

3. Bone marrow suppression The most dangerous adverse effect of antineoplastic drugs used in chemotherapy is bone marrow suppression. Alopecia (loss of hair) is a side effect of chemotherapy and, although a distressing side effect, is not considered the most dangerous. Nausea and vomiting are likely to be the most distressing adverse effect. Neurotoxic medications have adverse effects manifested most often by numbness and tingling, but these effects are not considered the most dangerous.

A patient undergoing chemotherapy has a hemoglobin level of 7.3 g/dL. Which patient manifestations alert the nurse that the patient's anemia is causing tissue hypoxia? Select all that apply. 1. Thirst 2. Polyuria 3. Dyspnea 4. Palpitations 5. Pale nail beds

3. Dyspnea 4. Palpitations 5. Pale nail beds Low hemoglobin levels decrease the blood's ability to carry oxygen. Hypoxia results from insufficient oxygen to the tissues. Less oxygenated tissue may cause patients to display shortness of breath. To compensate, the body tries to send oxygenated blood to the vital organs such as the brain, heart, and kidneys. The patient may experience palpitations or chest discomfort related to reduced oxygen in the tissues. The patient's nail beds may display pallor as blood is sent away from the extremities to vital organs. Hypoxia does not cause thirst. Frequent urination is not associated with hypoxia.

The nurse is caring for a terminally ill patient who is receiving large amounts of scheduled pain medication. During the nurse's assessment, the patient complains of severe back pain and asks the nurse for additional medication. What should the nurse do next? 1. Notify the health care provider of the patient's drug-seeking behavior. 2. Inform the patient that pain medications should not be given on request. 3. Inform the health care provider and request an order for a short-acting opioid. 4. Reposition the patient and offer the patient a back massage to reduce the discomfort.

3. Inform the health care provider and request an order for a short-acting opioid. The patient is likely experiencing breakthrough pain. The health care provider should be advised that pain is not controlled, and a short-acting opioid may help manage the patient's breakthrough pain. Pain medication should not be withheld due to fears of patient drug-seeking or addiction. PRN pain medications are given on request. While nonpharmacologic pain management techniques may also be utilized, the patient likely requires medication in order to achieve pain control.

A patient has cancer and is experiencing syndrome of inappropriate antidiuretic hormone. Which would be the priority nursing action for this patient? 1. Monitor vital signs. 2. Monitor mental status. 3. Maintain fluid restriction. 4. Maintain intake and output.

3. Maintain fluid restriction. Maintaining fluid restriction is the most important nursing intervention because this syndrome is caused by hyponatremia, which is the result of fluid retention. Secondarily, the nurse should monitor vital signs, monitor mental status, and maintain intake and output.

The nurse has been asked to help create an educational handout listing ways for patients to evaluate the safety of herbal and complementary therapies. Which statements should be included on the handout? Select all that apply. 1. Alternative therapies are proven cancer therapies. 2. Herbal labels stating the products are natural and safe to use 3. Research the therapies or products thoroughly to learn about them. 4. Some herbal products can affect the action of prescribed medications. 5. Before taking herbal products, first check with your health care provider. 6. Herbal products are regulated by the Food and Drug Administration (FDA). 7. Some complementary therapies can help to relieve symptoms or side effects.

3. Research the therapies or products thoroughly to learn about them. 4. Some herbal products can affect the action of prescribed medications. 5. Before taking herbal products, first check with your health care provider. 7. Some complementary therapies can help to relieve symptoms or side effects. Herbal or complementary products should be researched thoroughly. Patients should be educated about the possible risks/benefits of complementary and herbal therapies to help reduce the likelihood of lowering effectiveness or contraindications of these agents on proven methods of cancer treatment. Some complementary therapies can help relieve symptoms. Before taking any herbal products, it is essential for the patient to check with the health care provider, as some herbal products can affect the action of prescribed medications. Just because a label claims the product is safe, it may not be. There are no known cancer therapies from alternative therapies, although some relief of symptoms may be obtained. Herbal products are not regulated by the FDA

The primary focus of hospice care for patients with terminal illness is to manage which area of care? 1. Alopecia 2. Anorexia 3. Symptoms 4. Inflammation

3. Symptoms Management of quality of life issues such as side effects and symptoms of disease should be the major focus for patients with terminal illness. The focus of care is on reducing symptoms. Alopecia (hair loss), anorexia (loss of appetite), and inflammation are not priorities of care until the symptoms are reduced.

The nurse is caring for a patient with cancer that has been staged T2, N2, M0. How should the nurse interpret this information? 1. The treatment successfully eliminated the primary tumor. 2. The primary tumor is minimal in size with a small amount of lymph node involvement. 3. The primary tumor is actively growing, extending, and spreading to more regional lymph nodes but has not yet spread to distant sites. 4. The primary tumor is large and spreading extensively to regional lymph nodes with distant metastasis.

3. The primary tumor is actively growing, extending, and spreading to more regional lymph nodes but has not yet spread to distant sites. T0 would indicate successful elimination of primary tumor. T2 describes a primary tumor that is actively growing and extending. N2 indicates more regional lymph node involvement. M0 indicates that the tumor has not yet spread extensively, and distant metastasis is not yet present.

A student nurse is reviewing a patient's chart. The student notes that the patient is receiving radiation therapy for a diagnosis of throat cancer and records that the patient is experiencing xerostomia as a side effect of this treatment. Which nursing intervention on the patient's care plan is intended to help the patient with this side effect? 1. Encourage the patient to discuss feelings regarding alopecia. 2. Prepare the patient for red blood cell transfusion to deal with anemia. 3. Use prescribed medication in the patient's mouth to deal with dryness. 4. Encourage the family to bring in the patient's food to deal with anorexia.

3. Use prescribed medication in the patient's mouth to deal with dryness. Xerostomia is the medical term for dry mouth, which is a special problem with radiation of the head and neck. Alopecia is the medical term for loss of hair. Anemia results from a deficiency of red blood cells. Anorexia is the medical term for loss of appetite.

A nurse working at a long-term care center accompanies a resident to the scheduled external radiotherapy appointment. The nurse demonstrates understanding of safety instructions when remaining how many feet away from the radiation source? 1. 3 2. 4 3. 5 4. 6

4. 6 Unless direct care is being given, caregivers should remain at least 6 feet away from the source of radiation. Standing closer than 6 feet away increases the nurse's exposure to radiation.

A patient expresses concern about the markings used on his skin during radiation therapy. The most appropriate instruction to the patient should be to avoid which activity? 1. Attempting to wash the area 2. Applying lotion to the markings 3. Exposing the markings to the sun 4. Attempting to remove the markings

4. Attempting to remove the markings To mark the area for the radiotherapist, the markings must remain in place until the treatment ends. The nurse should instruct the patient to avoid attempting to wash the area, applying lotion to the markings, and exposing the markings to the sun, but these interventions are not the priority.

Which is a single, specific cause of cancer? 1. Genetics 2. Carcinogens 3. Environmental factors 4. It has not been identified

4. It has not been identified A single, specific cause of cancer has not been identified. Carcinogens such as cigarette smoke, asbestos, and nitrites are commonly found in the environment. Both genetic and environmental factors appear to increase the risk for developing cancer.

The nurse is caring for a patient who is scheduled for a biopsy of a tumor. The patient asks what distinguishes benign tumors from malignant tumors. Which information should the nurse provide the patient? 1. Benign tumors are usually composed of more rapidly growing cells. 2. Benign tumors are incapable of causing damage to nearby tissues or organs. 3. Malignant tumors are usually encapsulated, while benign tumors lack specific form. 4. Malignant tumors are composed of disorganized, abnormal cells that may spread to other parts of the body.

4. Malignant tumors are composed of disorganized, abnormal cells that may spread to other parts of the body. Malignant tumors are composed of disorganized cells that may metastasize to other sites. Benign tumor cells usually have a slow growth rate. Benign tumors can cause tissue damage if they grow enough to put pressure on or obstruct body organs. Benign tumors are usually encapsulated, while malignant tumors may lack specific form.

Which step of malignant cell transformation is characterized by an accelerated growth rate, enhanced invasiveness, an altered appearance, and biochemical activity in the cells? 1. Initiation 2. Promotion 3. Metastasis 4. Progression

4. Progression There are four steps in the transformation of normal cells into malignant cells. Progression is the third step in the transformation process and is characterized by an accelerated growth rate, enhanced invasiveness, an altered appearance, and biochemical activity in the cells. Initiation is the first step of the transformation process and is characterized by irreversible changes in deoxyribonucleic acid (DNA). Promotion is the second step of the transformation process and is characterized by enhanced cell growth with the help of a promoter or agent. Metastasis is the fourth step in the transformation process and is characterized by the penetration of tumor cells into capillaries and other body structures and cavities.