Pharm, Chapter 51: Breast Disorders, Chapter 27: Lower Respiratory Problems, Chapter 54: Male Reproductive Problems, Chapter 15: Cancer, Nurs 342 Test #1 - Ch. 15 - Cancer - Evolve NCLEX practice, Nurs 342 Test #1 - Ch. 15- Cancer - Lewis 10th ed. pr...

1 The nurse is preparing to administer cyclophosphamide (Cytoxan) and knows that the patient will experience a nadir in approximately 9 to 14 days. Which laboratory value(s) will indicate to the nurse that the patient has reached the nadir? A. Blood urea nitrogen and creatinine B. White blood cell count and absolute neutrophil count C. Ionized calcium D. Serum albumin

1 Answer: 2 Rationale: The nadir indicates that myelosuppression has occurred and is indicated by decreased blood cell counts. WBC and ANC are sensitive indicators of the nadir. Options 1, 3, and 4 are incorrect. BUN, creatinine, ionized calcium, and serum albumin are not indicators of the nadir and myelosuppression. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation

3. When discussing risk factors for breast cancer with a group of women, you emphasize that the greatest known risk factor for breast cancer is a. being a woman over age 60. b. experiencing menstruation for 30 years or more. c. using hormone therapy for 5 years for menopausal symptoms. d. having a paternal grandmother with postmenopausal breast cancer.

A

During initial chemotherapy a patient with leukemia develops hyperkalemia and hyperuricemia. The nurse recognizes these symptoms as an oncologic emergency and anticipates that the priority treatment will be to a. increase urine output with hydration therapy. b. establish electrocardiographic (ECG) monitoring. c. administer a bisphosphonate such as pamidronate (Aredia). d. restrict fluids and administer hypertonic sodium chloride solution.

A Hyperkalemia and hyperuricemia are characteristic of tumor lysis syndrome, which is the result of rapid destruction of large numbers of tumor cells. Signs include hyperuricemia that causes acute kidney injury, hyperkalemia, hyperphosphatemia, and hypocalcemia. To prevent renal failure and other problems, the primary treatment includes increasing urine production using hydration therapy and decreasing uric acid concentrations using allopurinol (Zyloprim).

Which factors will assist a patient in coping positively with having cancer (select all that apply)? a. Feeling of control b. Strong support system c. Internalization of feelings d. Possibility of cure or control e. A young person will adapt more easily f. Not having had to cope with previous stressful events

A, B, D Feeling in control, having a strong support system, and the potential of cure or control of the cancer will have a positive effect on coping with the diagnosis. The other options will make coping more difficult for the patient.

The nurse is teaching clinic patients about risk factors for testicular cancer. Which individual is at highest risk for developing testicular cancer?

A 30-yr-old white man with a history of cryptorchidism CORRECT A 30-yr-old white man with a history of cryptorchidism The incidence of testicular cancer is four times higher in white men than in African American men. Testicular tumors are also more common in men who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to exogenous estrogen, and testicular cancer in the contralateral testis.

37. The nurse assesses a patient with non Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse? a. Shortness of breath b. Shivering and chills c. Muscle aches and pains d. Temperature of 100.2° F (37.9° C)

ANS: A Rituximab (Rituxan) is a monoclonal antibody. Shortness of breath should be investigated rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration. The nurse will need to rapidly take actions such as stopping the infusion, assessing the patient further, and notifying the health care provider. The other findings will also require action by the nurse but are not indicative of life-threatening complications.

20. A widowed mother of 4 school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate? a. "Don't you have any friends that will raise the children for you?" b. "Would you like to talk about options for the care of your children?" c. "For now you need to concentrate on getting well and not worrying about your children." d. "Many patients with cancer live for a long time, so there is time to plan for your children."

ANS: B This response expresses the nurse's willingness to listen and recognizes the patient's concern. The responses beginning "Many patients with cancer live for a long time" and "For now you need to concentrate on getting well" close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient's friends will raise the children, more assessment information is needed before making plans.

11. A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which intervention should the nurse add to the plan of care? a. Minimize activity until the treatment is completed. b. Establish time to take a short walk almost every day. c. Consult with a psychiatrist for treatment of depression. d. Arrange for delivery of a hospital bed to the patient's home.

ANS: B Walking programs are used to keep the patient active without excessive fatigue. Having a hospital bed does not necessarily address the fatigue. The better option is to stay as active as possible while combating fatigue. Fatigue is expected during treatment and is not an indication of depression. Minimizing activity may lead to weakness and other complications of immobility.

25. The nurse teaches a patient with liver cancer about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective? a. Lime sherbet b. Blueberry yogurt c. Fresh strawberries d. Cream cheese bagel

ANS: B Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Lime sherbet is lower in fat and protein than yogurt. Cream cheese is low in protein.

16) The nurse knows that client education on drug interactions with doxorubicin has been successful when the client states: 1. "I can take acetaminophen if I get a fever." 2. "I can take my Celebrex for my arthritis." 3. "I can take ibuprofen for my back pain." 4. "I can take an aspirin for a headache."

Answer: 1 Explanation: Acetaminophen is appropriate to take, because it doesn't increase the risk of bleeding.

7. The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement by the patient indicates that teaching was effective? a. "The biopsy will remove the cancer in my prostate gland." b. "The biopsy will determine how much longer I have to live." c. "The biopsy will help decide the treatment for my enlarged prostate." d. "The biopsy will indicate whether the cancer has spread to other organs."

ANS: C A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed. A biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life.

17. A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband tells the nurse that he does not know what to say to his wife. Which problem is appropriate for the nurse to address in the plan of care? a. Anxiety b. Death anxiety c. Difficulty coping d. Lack of knowledge

ANS: C The data indicate that difficulty coping with the situation may be present reflected by the poor communication among the family members. The data given does not suggest death anxiety, anxiety, or lack of knowledge as an etiology.

39. The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider? a. Hematocrit of 32% b. Pain with deep inspiration c. Serum sodium of 126 mEq/L d. Decreased breath sounds on left side

ANS: C The syndrome of inappropriate antidiuretic hormone (and the resulting hyponatremia) is an oncologic metabolic emergency and requires rapid treatment to prevent complications such as seizures and coma. The other findings also require intervention but are common in patients with lung cancer and not immediately life threatening.

25) Which statement most accurately describes the action that occurs during stage S (synthesis) of the cell cycle? 1. The cell undergoes prophase, metaphase, anaphase, and telophase. 2. The cell makes additional proteins that are necessary for cell division. 3. The cell conducts metabolism, impulse conduction, contraction, or secretion. 4. The cell duplicates its DNA.

Answer: 4 Explanation: This describes stage S (synthesis). Page Ref: 1026

13. A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about the management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective? a. "I can use ice packs to relieve itching." b. "I will scrub the area with warm water." c. "I will expose my skin to a sun lamp each day." d. "I can buy some aloe vera gel to use on my skin."

ANS: D Aloe vera gel and cream may be used on the radiated skin area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.

7. What will the nurse teach a patient with metastatic breast cancer who has a new prescription for trastuzumab (Herceptin)? a. Hot flashes may occur with the medication. b. Serum electrolyte levels will be drawn monthly. c. The patient will need frequent eye examinations. d. The patient should call if she notices ankle swelling.

ANS: D Trastuzumab can lead to ventricular dysfunction, so the patient is taught to self-monitor for symptoms of heart failure. There is no need to monitor serum electrolyte levels. Hot flashes or changes in visual acuity may occur with tamoxifen, but not with trastuzumab.

35) The nurse anticipates administering which drug to stimulate neutrophil production in clients with myelosuppression? 1. Epoetin 2. Interferon alfa 3. Filgrastim 4. Oprelvekin

Answer: 3 Explanation: This is the correct answer. Page Ref: 1069

27) Which statement best explains the mechanism of action of monoclonal antibodies? 1. They alter the DNA of the tumor cells. 2. They prevent replication of the tumor cells. 3. They stimulate immune cell function. 4. They attack antigens on the surface of specific tumor cells.

Answer: 4 Explanation: This is the correct mechanism of action of monoclonal antibodies. Page Ref: 1065

14) A client is receiving chemotherapy in the treatment of breast cancer. The nurse explains that although chemotherapy has several goals, it does not attempt to: 1. control the cancer. 2. provide palliation. 3. cure the cancer. 4. prevent transmission of the cancer.

Answer: 4 Explanation: Transmission prevention is not a goal of chemotherapy. Page Ref: 1023

5. In assessing a patient for testicular cancer, the nurse understands that the manifestations of this disease often include a. urinary frequency. b. painless mass in the scrotal area. c. erectile dysfunction with retrograde ejaculation. d. rapid onset of dysuria with scrotal swelling and fever.

B

6. Preoperatively, to meet the psychologic needs of a woman scheduled for a simple mastectomy, you would a. discuss the limitations of breast reconstruction. b. include her significant other in all conversations. c. promote an environment for expression of feelings. d. explain the importance of regular follow-up screening

C

During the immediate postoperative period following a modified radical mastectomy, the nurse initially institutes which exercise for the affected arm? A. Have a patient brush or comb her hair with the affected arm. B. Perform full passive range of motion exercises to the affected arm. C. Ask the patient to flex and extend the fingers and wrist of the operative side. D. Have the patient crawl her fingers up the wall, raising her arm above her head.

C. As early as in the recovery room following a modified radical mastectomy, the patient should start flexing and extending the fingers and wrist of the affected arm with daily increases in activity. Postoperative mastectomy exercises, such as wall climbing with the fingers, shoulder rotation and extension, and hair care, are instituted gradually to prevent disruption of the wound

A patient has fibrocystic changes in her breast. The nurse explains to the patient that this condition is significant because it A. commonly becomes malignant over time B. can be controlled with hormone therapy (HT) C. make it more difficult to examine the breast D. will eventually cause atrophy of the normal breast tissue

C. Fibrocystic changes make breast difficult to examine because of fibrotic changes and multiple lumps. A woman with condition should be familiar with the characteristics changes in her breast and monitor them closely for new lumps that do not respond in a cyclic manner over 1 to 2 week. Estrogen antagonizes the condition and fibrocystic changes are not precancerous

2. You are caring for a young woman who has painful fibrocystic breast changes. Management of this patient would include a. scheduling a biopsy to rule out the presence of breast cancer. b. teaching that symptoms will subside if she stops using oral contraceptives. c. preparing her for surgical removal of the lumps, since they will become larger and more painful. d. explaining that restricting coffee and chocolate and supplementing with vitamin E may relieve some discomfort.

D

5. You are caring for a patient with breast cancer following a simple mastectomy. Postoperatively, to restore arm function on the affected side, you would a. apply heating pads or blankets to increase circulation. b. place daily ice packs to minimize the risk for lymphedema. c. teach passive exercises with the affected arm in a dependent position. d. emphasize regular exercises for the affected shoulder to increase range of motion.

D

Which diagnostic test is most accurate and adventageous in terms of time and expense in diagnosis of malignant breast disorders? A. Mammography B. Excisional biopsy C. Fine-Needle aspiration D. Core (core needle) biopsy

D. A definitive diagnosis of breast cancer can be made only by a histological examination of biopsied tissue. A core (core needle) biopsy is as reliable as an excisional biopsy and has the advantages of decreased length of time for the procedure and recovery and reduced cost. A limitation of fine needle aspiration is that if negative results are found, more definitive biopsy procedures are required.

The nurse assesses a 76-yr-old man with chronic myeloid leukemia receiving chemotherapy using a kinase inhibitor medication. Which question is most important for the nurse to ask? a. "Have you had a fever?" b. "Have you lost any weight?" c. "Has diarrhea been a problem?" d. "Have you noticed any hair loss?"

a. "Have you had a fever?" An adverse effect of kinase inhibitors is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4° F or higher. The other options are possible while undergoing chemotherapy but do not represent the highest priority for assessment.

6 A patient with cancer is started on a chemotherapeutic agent that is a known vesicant. The nurse performs which priority activity related to this drug? Monitor the patient's: A. Response to antinausea drugs. B. Intake of calcium-rich foods. C. Respiratory status for cough. D. IV port site for redness, swelling, and pain.

6 Answer: 4 Rationale: Many antineoplastics are classified as vesicant agents that can cause serious tissue injury if they leak into the surrounding tissue from an artery or vein during an infusion or injection. The nurse should closely monitor the infusion site for swelling and pain. Options 1, 2, and 3 are incorrect. Vesicants do not necessarily cause nausea. It would be inappropriate for the nurse to monitor the patient's intake of calcium-rich foods because this is not related to receiving a chemotherapy classified as a vesicant. Respiratory status is not related to the administration of a vesicant-type chemotherapy agent. Cognitive Level: Applying; Client Need: Physiological Integrity; N

3. A nurse is planning care for a client who is undergoing chemotherapy and is on neutropenic precautions. Which of the following interventions should be included in the plan of care? (select all that apply.) A. encourage a high‐fiber diet. B. eliminate standing water in the room. C. Have the client wear a mask when leaving the room. d. Have client‐specific equipment remain in the room. e. eliminate raw foods from the client's diet.

A. There is no benefit to a high‐fiber diet for a client who has neutropenia. B. CORRECT: Neutropenic precautions include the client not having contact with flowers and plants due to the presence of surface infectious agents in the water and soil. C. CORRECT: Neutropenic precautions include having the client wear a mask when leaving the room to reduce the incidence of infection. d. CORRECT: Neutropenic precautions include having equipment available that is only for use in caring for the client to reduce the incidence of infection. e. CORRECT: A client who has neutropenia should avoid consuming raw foods due to the presence of surface infectious agents on peeling and rind.

A patient with breast cancer has a lumpectomy with sentinel lymph node biopsy that is positive for cancer. For the other tests done to determine the risk for cancer recurrence or spread, what results support a more favorable prognosis (select all that apply)? A. Well-differentiated tumor B. Estrogen receptor-positive tumor C. Involvement of two to four axillary nodes D. Overexpression of the HER2 protein E. High DNA proliferative index

A. Well-differentiated tumor B. Estrogen receptor-positive tumor In general, the more well differentiated the tumor, the less aggressive it is. Poorly differentiated tumors appear morphologically disorganized and are more aggressive. Other information useful for treatment decisions and determining the prognosis is the patient's estrogen and progesterone receptor status. Receptor-positive tumors (1) commonly show histologic evidence of being well differentiated, (2) frequently have a diploid (more normal) DNA content and low proliferative indices, (3) have a lower chance for recurrence, and (4) are frequently hormone dependent and responsive to hormonal therapy. Reference: 1314

2. Which factors would place a patient at a higher risk for prostate cancer (select all that apply)? a. Older than 65 years b. Asian or Native American c. Long-term use of an indwelling urethral catheter d. Father diagnosed and treated for early-stage prostate cancer e. Previous history of undescended testicle and testicular cancer

AD

15. A patient diagnosed with breast cancer asks the nurse what "triple negative" means. What should an accurate response from the nurse about triple-negative breast cancer include? a. The tumor is not likely to be responsive to hormone therapy. b. Treatment with chemotherapy is not likely to be recommended. c. HER-2 receptor testing was repeated for a total of three samples. d. Estrogen receptor testing identified three hormones causing the cancer.

ANS: A A patient whose breast cancer tests negative for all three receptors (estrogen, progesterone, and HER-2) has triple-negative breast cancer. These cancers do not usually respond to hormone therapy or therapy for the human epidermal growth factor receptor 2 (HER-2). Chemotherapy appears to have the most success in treating triple-negative breast cancer.

11. What side effect of leuprolide (Lupron) should the nurse plan to discuss with a patient who has cancer of the prostate? a. Flushing b. Dizziness c. Infection d. Incontinence

ANS: A Hot flashes may occur with decreased testosterone production. Dizziness may occur with the alpha-blockers used for benign prostatic hyperplasia. Urinary incontinence may occur after prostate surgery, but it is not an expected side effect of medication. Risk for infection is increased in patients receiving chemotherapy.

33. When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene? a. The UAP assists the patient to use dental floss after eating. b. The UAP adds baking soda to the patient's saline oral rinses. c. The UAP puts fluoride toothpaste on the patient's toothbrush. d. The UAP has the patient rinse after meals with a saline solution.

ANS: A Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.

36. Which action should the nurse take when caring for a patient who is receiving chemotherapy and reports problems with concentration? a. Suggest use of a daily planner and encourage adequate sleep. b. Teach the patient to rest the brain by avoiding new activities. c. Teach that "chemo-brain" is a short-term effect of chemotherapy. d. Report patient symptoms immediately to the health care provider.

ANS: A Use of tools to enhance memory and concentration such as a daily planner and adequate rest are helpful for patients who develop "chemo-brain" while receiving chemotherapy. Patients should be encouraged to exercise the brain through new activities. Chemo-brain may be short or long term. There is no urgent need to report common chemotherapy side effects to the provider.

1. The nurse at the clinic is interviewing a 64-yr-old woman who is 5 feet, 3 inches tall and weighs 125 lb (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk? (Select all that apply.) a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening

ANS: A, C, D, E The patient's age, gender, and history indicate a need for screening and teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use tobacco or excessive alcohol, she is physically active, and her body weight is healthy.

2. A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan? (Select all that apply.) a. Cook food thoroughly before eating. b. Choose low fiber, low residue foods. c. Avoid public transportation such as buses. d. Use rectal suppositories if needed for constipation. e. Talk to the oncologist before having any dental work.

ANS: A, C, E Eating only cooked food and avoiding public transportation will decrease infection risk. A high-fiber diet is recommended for neutropenic patients to decrease constipation. Because bacteria may enter the circulation during dental work or oral surgery, the patient may need to postpone dental work or take antibiotics.

18. Which patient statement indicates that the nurse's teaching about tamoxifen has been effective? a. "I can expect to have leg cramps." b. "I will call if I have any eye problems." c. "I should contact you if I have hot flashes." d. "I will take the medication for 6 to 12 months."

ANS: B Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected side effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the patient should immediately notify the health care provider if pain occurs.

15. A 27 yr-old patient who has testicular cancer is being admitted for a unilateral orchiectomy. The patient does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is appropriate for the nurse to take? a. Teach the patient and the wife that impotence is unlikely after unilateralorchiectomy. b. Ask the patient if he has any questions or concerns about the diagnosis andtreatment. c. Inform the patient's wife that concerns about sexual function are common with thisdiagnosis. d. Document the patient's lack of communication on the health record and continuepreoperative care.

ANS: B The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, the nurse should not offer teaching about complications after orchiectomy. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation.

2. The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect? a. Nausea b. Alopecia c. Hematuria d. Xerostomia

ANS: C The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy.

31. The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in cancer therapy with the health care provider? a. Frequent loose stools b. Nausea and vomiting c. Elevated white blood count (WBC) d. Increased carcinoembryonic antigen (CEA)

ANS: D An increase in CEA indicates that the chemotherapy is not effective for the patient's cancer and may need to be modified. Gastrointestinal adverse effects are common with chemotherapy. The nurse may need to address these, but they would not necessarily indicate a need for a change in therapy. An elevated WBC may indicate infection but does not reflect the effectiveness of the colorectal cancer therapy.

The nurse would be most concerned when the patient's breast examination reveals which findings? A. A large, tender, movable mass in the upper inner quadrant B. An immobile, hard, nontender lesion in the upper outer quadrant C. A 2-3 cm firm, defined, mobile mass in the lower outer quadrant D. A painful, immobile mass with reddened skin in the upper outer quadrant

B. On palpitation, malignant lesions are characteristically hard, irregulary shaped poorly delineated, nontender, and ninmobile and the most common site is the upper outer quadrant of the breast. Fibrocystic lesion are usually large tender, movable masses found throughout the breast tissue. A fibroadenoma is from, defined, and mobile. A painful, immobile mass under a reddend area of skin is most typical of a local abscess

Following a mastectomy, a patient develops lymphedema of the affected arm. What does the nurse teach the patient to do? A. Avoid skin-softening agents on the arm. B. Protect the arm from any type of trauma C. Abduct and adduct the arm at the shoulder hourly D. Keep the arm positioned so that it is in straight and dependent alignment

B. Removal of the axillary lymph nodes impairs lymph drainage from the affected arm and predisposes the patient to infection of the arm. The arm must be protected from even minor trauma. BP, venipunctures, and injections should not be done on the arm. The arm should never be dependent, even during sleep, and should be elevated to promote lymph drainage

A 50-year-old patient is preparing to begin breast cancer treatment with tamoxifen (Nolvadex). What point should the nurse emphasize when teaching the patient about her new drug regimen? A. "You may find that your medication causes some breast sensitivity." B. "It's important that you let your care provider know about any changes in your vision." C. "You'll find that this drug often alleviates some of the symptoms that accompany menopause." D. "It's imperative that you abstain from drinking alcohol after you begin taking tamoxifen."

B. "It's important that you let your care provider know about any changes in your vision." Tamoxifen has the potential to cause cataracts and retinopathy. The drug is likely to exacerbate rather than alleviate perimenopausal symptoms. Breast tenderness is not associated with tamoxifen, and it is not necessary for the patient to abstain from alcohol.

A patient undergoing surgery and radiation for treatment of breast cancer has a nursing diagnosis of disturbed body image related to absences of the breast. What is an appropriate nursing intervention for this patient? A. Provide the patient with information about surgical breast reconstruction B. Restrict visitors and phone calls until he patient feels better about herself C. Arrange for a Reach to Recovery visitor or similar resource available in the community D. Encourage the patient to obtain a permanent breast prosthesis as soon as she is discharged from the hospital.

C. The Reach to Recovery program consists of volunteers, all women, who have had breast cancer and can answer questions about what to expect at home, how to tell people about the surgery, and what prosthetic devices are available. It is a valuable resource for patients who have breast cancer and should be used if available in the community. If a volunteer is not available, the nurse is responsible for assisting the patient in the same manner. Although the nurse can discuss wearing a prosthesis, a permanent prosthesis cannot be used until healing is complete and inflammation is resolved.

What features of cancer cells distinguish them from normal cells? Select all that apply a. Cells lack contact inhibition. b. Oncogenes maintain normal cell expression. c. Cells return to a previous undifferentiated state. d. Proliferation occurs when there is a need for more cells. e. New proteins characteristic of embryonic stage emerge on a cell membrane.

Correct answers: a, c, e Rationale: Two major dysfunctions in the process of cancer are defective cell proliferation (i.e., growth) and defective cell differentiation. Cancer cells lack contact inhibition and are poorly differentiated. Cancer cell growth is infiltrative and expansive, and cancer cells are abnormal and become more unlike parent cells.

ANS: A The upper outer quadrant is the location of most of the glandular tissue of the breast.

28. The nurse is teaching a patient about breast self examination. Which area on the accompanying illustration should the nurse identify as the area that most breast cancers are located? a. 1 b. 2 c. 3 d. 4 e. 5

What defect in cellular proliferation is involved in the development of cancer? a. A rate of cell proliferation that is more rapid than that of normal body cells b. Shortened phases of cell life cycles with occasional skipping of G1 or S phases c. Rearrangement of stem cell RNA that causes abnormal cellular protein synthesis d. Indiscriminate and continuous proliferation of cells with loss of contact inhibition

d. Indiscriminate and continuous proliferation of cells with loss of contact inhibition Malignant cells proliferate indiscriminately and continuously and also lose the characteristic of contact inhibition, growing on top of and in between normal cells. Cancer cells usually do not proliferate at a faster rate than normal cells, nor can cell cycles be skipped in proliferation. However, malignant proliferation is continuous, unlike normal cells.

What factor differentiates a malignant tumor from a benign tumor? a. It causes death. b. It grows at a faster rate. c. It is often encapsulated. d. It invades and metastasizes.

d. It invades and metastasizes. The major difference between malignant and benign cells is the ability of malignant tumor cells to invade and metastasize. Benign tumors can cause death by expansion into normal tissues and organs. Benign tumors are more often encapsulated and often grow at the same rate as malignant tumors.

1 The health care provider has written in the patient's chart that the cancer is at Stage I. The nurse knows that the implications for this staging are that the: A. Cancer is advanced and the patient has a poor prognosis. B. Cancerous cells are only moderately differentiated from the parent cells. C. Cancer has been detected at an early stage. D. Tumor is large and is invading surrounding tissue.

1 Answer: 3 Rationale: Stage 1 suggests that the tumor is relatively small in size, has not invaded the surrounding tissue, and has not been detected in surrounding lymph nodes; thus it has been detected at an early stage. Options 1, 2, and 4 are incorrect. Stage 1 is the earliest staging and has the best prognosis. Cell differentiation refers to grading of cancer cells, not staging of cancer cells. Stage 1 suggests that the tumor is small and has not begun to invade surrounding tissue. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation

1. A nurse is caring for a client who has lung cancer and is exhibiting manifestations of syndrome of inappropriate antidiuretic hormone (siAdH). Which of the following findings should the nurse report to the provider? (select all that apply.) A. Behavioral changes B. Client report of headache C. Urine output 40 mL/hr d. Client report of nausea e. increasedurinespecificgravity 2. A nurse is teaching a client about screening prevention for cancer. Which of the following statements by the client indicates an understanding of the teaching? A. "i will need to have a mammogram every 2 years beginning at age 45." B. "i should have a colonoscopy every 15 years beginning at age 60." C. "i will need to have an annual breast examination every year after 40." d. "i should have a fecal occult test done every 3 years." 3. A nurse is planning care for a client who has malnutrition due to cancer. Which of the following interventions should the nurse include in the plan of care? (select all that apply.) A. Advise the client to keep a food diary. B. encourage the client to brush teeth before and after meals. C. Assess the laboratory report of ferritin. d. eat nutrient‐dense foods last at meal time. e. encourage the client to limit drinking fluids during meals. 4. A nurse is reviewing the medical record of a client who had surgery to stage ovarian cancer. The nurse reviews the following diagnostic notation on the pathology report: T2‐N3‐MX. Which of the following findings should the nurse identify as a supporting diagnosis? A. The tumor is moderate in size. B. No lymph nodes contain cancer cells. C. The tumor is receptive to current medication therapy. d. The cancer has metastasized to other areas in the body.

1. A. CORRECT: Behavioral changes indicate cerebral edema due to siAdH. This finding shouldbe reported to the provider. B. CORRECT: A client report of headache indicates cerebral edema due to siAdH. This finding should be reported to the provider. C. Urine output of 40 mL/hr is a finding consistent with suspected siAdH and does not needto be reported to the provider. d. CORRECT: A client report of nausea can indicate cerebral edema due to siAdH and should be reported to the provider. e. An increased urine specific gravity is a finding consistent with siAdH and does not need to be reported to the provider. NCLEX® Connection: Physiological Adaptation, Illness Management 2. A. The client should begin annual mammograms beginning at age 40. B. The client should begin to have a colonoscopy at age 50 and then every 10 years thereafter. C. CORRECT: instruct the client that after the age of 40, they should have annual clinic breast exams. d. The client should have a fecal occult test done every year. The client can have the stool dNA test every3 years in place of fecal occult blood testing. NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention 3. A. CORRECT: The use of a food diary assists in monitoring changes in eating habits that occur in malnutrition due to cancer. B. CORRECT: Oral hygiene before and after meals promotes increased salivation and improves taste perception. C. CORRECT: Ferritin is an indicator of the protein intake of a client who has malnutrition due to cancer. d. instruct the client to eat nutrient‐dense foods first to increase adequate nutritional intake to treat malnutrition. e. CORRECT: encourage the client to limit drinking fluids with meals because fluids can cause early satiety and decrease adequate intake of food, causing malnutrition, when the client has cancer. some fluids are needed to treat dry mouth and thickened saliva. NCLEX® Connection: Basic Care and Comfort, Nutrition and Oral Hydration 4. A. CORRECT: A T2 designation describes the size and extent of the ovarian tumor using the tumor‐node‐metastasis (TNM) staging system. A T1 tumor is smallestin size, and a T4 tumor is largest. B. A N3 designation indicates that three adjacent lymph nodes show evidence of spread of cancer using the TNM staging system. C. The TNM diagnostic notation of the staging system is not used to indicate the response of a tumor to a medication therapy regimen used for treatment. d. The MX designation indicates there is no evidence of distant metastasis to other areas of the body using the TNM staging system. NCLEX® Connection: Physiological Adaptation, Pathophysiology

1. A nurse in a clinic is talking with a client scheduled for a sentinel lymph node biopsy. Which of the following information should the nurse include? A. dye is used during the procedure. B. The lymph nodes closest to the tumor are removed during the biopsy. C. A small amount of chemotherapy is used to test the lymph node response. d. A 2 mm plug of tissue is removed during the biopsy. 2. A nurse is teaching a client who is scheduled for nuclear imaging for suspected cancer. Which of the following statements should the nurse give? A. "The presence of a liver enzyme will be identified." B. "you will be given an injection of a radioactive substance." C. "An endoscope will be inserted through your mouth." d. "The tumor will be aspirated." 3. A nurse is collecting information from a client in a provider's office. Which of the following findings should the nurse identify as an indication of possible cancer? (select all that apply.) A. Temperature 102° F (38.9° C) for more than 48 hr B. sore that does not heal C. difficulty swallowing d. Unusual discharge e. Weight gain 4 lb (1.8 kg) in 2 weeks 4. A nurse is teaching a client who is scheduled for a shave biopsy for suspected cancer. Which of the following client statements indicates understanding of the procedure? A. "A test of my bone marrow will be performed." B. "A lymph node will be removed." C. "A needle will be inserted into the mass." d. "A small skin sample will be obtained." 5. A nurse is planning care for a client who is scheduled for genetic testing for suspected cancer. Which of the following interventions should the nurse include in the plan of care? A. determine the need for informed consent. B. send testing results to the client's insurance agency. C. Verify the prescription for a tumor marker assay. d. ensure the client is placed in a recovery position after testing.

1. A. CORRECT: The client will receive a dye or colloid as a tracer to help identify lymph nodes duringa sentinel lymph node biopsy. B. The lymph nodes close to the tumor might be removed in a later procedure if the sentinel lymph node is positive for cancer. C. Chemotherapy is not administered during a sentinel lymph node biopsy. d. A punch biopsy involves removing a 2 to 6 mm plug of tissue. NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention 2. A. Liver function tests involve the identification of altered liver enzymes, which can be present in a client who has cancer. They are not nuclear imaging tests. B. CORRECT: Nuclear imaging involves the administration of an oral or iV radioactive tracer to identify cancerous tissue. C. endoscopy permits visualization inside the body. it is not a form of nuclear imaging. d. A needle biopsy is performed to aspirate fluid and tissue samples for cancer cells. it is not a form of nuclear imaging. NCLEX® Connection: Physiological Adaptation, Pathophysiology 3. A. Presence of a fever for an extended period is not a finding of possible cancer. Unexplained night sweats can indicate a need to have a cancer screening. B. CORRECT: A sore that does not heal is a finding of possible cancer. C. CORRECT: difficulty swallowing is a finding of possible cancer. d. CORRECT: The presence of unusual discharge is a finding of possible cancer. e. CORRECT: Weight gain or loss can indicate possible cancer. NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention 4. A. Bone marrow aspiration is a type of needle biopsy.B. sentinel node biopsy involves excision of a lymph node. C. Needle biopsy involves aspiration of a tumor for fluid and tissue sampling.d. CORRECT: A shave biopsy is a sampling of the outer skin layer using a scalpel or razor blade. NCLEX® Connection: Physiological Adaptation, Illness Management 5. A. CORRECT: A signed informed consent form should be obtained prior to the procedure. B. Genetic testing information is confidential. do not send the information unless the client requests it. C. A tumor marker assay is a laboratory test to identify the presence of specific body proteins in blood, body secretions, and tissue. it is not a component of genetic testing. d. Genetic testing involves collection of blood or saliva. recovery positioning is not required following testing. NCLEX® Connection: Basic Care and Comfort, Nutrition and Oral Hydration

2 A patient has been receiving vincristine (Oncovin) as one of the drugs in a chemotherapy regimen. What important findings will the nurse monitor to prevent or limit the main dose-related toxicity for this patient? Select all that apply. A. Numbness of the hands or feet B. Angina and dysrhythmias C. Constipation D. Diminished reflexes E. Dyspnea and pleuritis

2 Answer: 1, 3, 4 Rationale: The main dose- limiting toxicity to occur with vincristine is neurotoxicity. Numbness of the hands and feet, constipation related to decreased peristalsis, and diminished reflexes are all signs of neurotoxicity. Options 2 and 5 are incorrect. Cardiac and pulmonary toxicities are not associated with vincristine. Cognitive Level: Analyzing; Client Need: Physiological Integ

2 Which of the following statements by a patient who is undergoing chemotherapy would be of concern to the nurse? Select all that apply. A. "I attended a meeting of a cancer support group this week." B. "My husband and I are planning a short trip next week." C. "I try to eat six small meals plus two protein shakes each day." D. "I am taking my 15-month-old granddaughter to the pediatrician next week for her baby shots." E. "I am going to go shopping at the mall next week."

2 Answer: 4, 5 Rationale: Patients and family members should avoid receiving live virus vaccination or exposure to chickenpox. Varicella (chickenpox) vaccination is usually given to children between the age of 12 and 18 months and the patient should not care for her granddaughter if immunization with live virus vaccines is planned. The patient should also avoid crowds, especially in enclosed areas, to minimize the risk of infection. Options 1, 2, and 3 are incorrect. Attending a support group, maintaining normal activities when possible, and eating small, frequent meals with sufficient protein are routine care measures during chemotherapy. Cognitive Level: Analyzing; Client Need: Physiological Integrity; Nursing Process: Evaluation

2. A nurse is reviewing the medical record of a client who has suspected ovarian cancer. Which of the following findings should the nurse identify as a risk factor for ovarian cancer? (select all that apply.) A. Previous treatment for endometriosis B. Family history of colon cancer C. First pregnancy at age 24 d. report of first period at age 14 e. Use of oral contraceptives for 10 years

2. a. CORRECT: endometriosis is a risk factor for ovarian cancer. B. CORRECT: a family history of breast, ovarian, or colon cancer is a risk factor for ovarian cancer. C. a first pregnancy after 30 years of age or nulliparity is a risk factor for ovarian cancer. D. early menarche is a risk factor for ovarian cancer. e. Birth control pills offer protection against ovarian cancer.

3 The nurse determines that the patient understands an important principle of chemotherapy when the patient makes which statement? A. "The use of multiple chemotherapy drugs affects different stages of the cancer cell's life cycle." B. "Staging describes the process of determining how responsive the cancer is to the prescribed chemotherapy." C. "Antineoplastic drugs kill the entire tumor, including the clones, and prevent repopulation." D. "Combination chemotherapy requires higher dosages of each individual agent and increases toxicity."

3 Answer: 1 Rationale: The use of multiple drugs affects different stages of the cancer cell's life cycle and attacks the various clones within the tumor via several mechanisms of action, thus increasing the percentage of cell kill. Combination chemotherapy also allows lower dosages of each individual agent, thus reducing toxicity and slowing the development of resistance. Options 2, 3, and 4 are incorrect. Staging describes the process of determining the extent of cancer in the body and where the cancer is located. Antineoplastic drugs may kill only a small portion of the tumor, leaving some clones unaffected and able to repopulate the tumor with resistant cells. Combination chemotherapy also allows lower dosages of each individual agent, thus reducing toxicity and slowing the development of resistance. Cognitive Level: Applying; Client Need: Physiological Integrity; Nursing Process: Evaluation

3 A nurse is caring for a patient who is receiving tamoxifen for treatment of breast cancer. The nurse will teach the patient that postchemotherapy monitoring will be necessary to detect or treat which drug- associated adverse effect? A. Paralytic ileus B. Alopecia C. Pulmonary fibrosis D. Endometrial cancer

3 Answer: 4 Rationale: Tamoxifen is associated with an increased risk of endometrial cancer and monitoring will be necessary to detect early changes that may indicate that this adverse effect has occurred. Options 1, 2, and 3 are incorrect. Paralytic ileus and pulmonary fibrosis are not associated with tamoxifen. Alopecia is a common adverse effect of many chemotherapy drugs but will not require long-term monitoring. Cognitive Level: Applying; Client Need: Physiological

4 A patient with acute lymphoblastic leukemia has started therapy with doxorubicin (Adriamycin). The nurse will assist the patient with what important intervention during the course of this treatment? A. Perform active or assisted range-of- motion (ROM) exercises to maintain strength. B. Participate in relaxation therapy to control pain. C. Use daily mouth rinses as prescribed. D. Maintain bed rest during treatment.

4 Answer: 3 Rationale: As with many chemotherapy drugs, doxorubicin is associated with mucositis. Daily mouth rinses will be prescribed to decrease the risk of opportunistic infections from yeast and mouth bacteria. Options 1, 2, and 4 are incorrect. Performing active or assisted ROM is an important intervention associated with drugs that cause neurotoxicities. Controlling pain is associated with chemotherapy that may cause pain as an adverse effect. Maintaining bed rest is not related to the use of chemotherapy but may be required for other reasons. Cognitive Level: Ap

4 Chemotherapy is being initiated for a patient with prostate cancer who is experiencing mucositis. Which health teaching would be most appropriate for this condition? A. Use an over-the-counter mouthwash to eliminate bacteria. B. Increase intake of citrus-containing foods and beverages. C. Eat a bland diet with low roughage and use a soft toothbrush or plain water rinses for oral care. D. This adverse effect is expected and will disappear within a few days.

4 Answer: 3 Rationale: Mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, an adverse effect of chemotherapy and radiation treatment for cancer. Patients experiencing this adverse effect should be instructed to eat a bland diet with low roughage and to use a soft toothbrush or plain water rinses for oral care if the mucositis is severe. Options 1, 2, and 4 are incorrect. Most OTC mouthwashes contain a significant amount of alcohol, which will further inflame the oral tissue and should be avoided. Citrus foods and beverages should be avoided because the acidic nature of these foods would cause the patient pain. Mucositis can last the duration of the chemotherapy treatment and should be treated rather than ignored. This condition will prevent intake of adequate nutrition to build new cells. Cognitive Level: Applyin

5 The nurse is collaborating with the interdisciplinary team regarding the care of a patient with a brain tumor. The nurse knows that the most common reason that subsequent rounds of chemotherapy may be delayed is due to what condition? A. Myelosuppression B. Alopecia C. Mucositis D. Cachexia

5 Answer: 1 Rationale: Myelosuppression is the most common dose-limiting adverse effect of chemotherapy and the one that most often causes discontinuation or delays of chemotherapy. Options 2, 3, and 4 are incorrect. Although alopecia may be distressing for the patient, its presence does not determine when the next round of chemotherapy can be administered. Mucositis is not a reason that subsequent rounds of chemotherapy should be delayed. Cachexia is the physical wasting with loss of weight and muscle mass caused by disease. Although it is considered, it is not the most common reason for delaying chemotherapy.

5 The patient will continue to take methotrexate (MTX, Rheumatrex, Trexall) for treatment of osteosarcoma. When teaching the patient prior to discharge, what over-the-counter (OTC) drugs must not be taken concurrently with methotrexate? A. Nonsteroidal anti-inflammatory drug pain relievers B. Antihistamines C. Laxatives D. Cough suppressants

5 Answer: 1 Rationale: NSAIDs may cause severe and fatal myelosuppression when taken concurrently with methotrexate. Options 2, 3, and 4 are incorrect. Antihistamines, laxatives, and cough suppressants may be used with methotrexate. However, the provider should be consulted if they are needed because symptoms associated with these drugs may indicate a more serious condition that requires additional treatment. Cognitive Level: Applying; Client Need: Physiological Integrity; Nu

6. A nurse is reviewing testicular self‐examination with a client. Which of the following client statements indicates understanding? A. "it is best to examine the testicles before bathing." B. "it is not necessary to report small lumps, unless they are painful." C. "i will examine one testicle at a time." d. "i will use my palms to feel for abnormalities."

6. a. examining the testicles after showering or bathing ensures the scrotum is relaxed, and examination is more accurate. B. The client should report any lump or swelling to the provider as soon as possible. C. CORRECT: The client should examine one testicle at a time to ensure that an abnormality is not missed. D. The client should use the thumb and fingers to examine the testes to better detect small changes because the fingertips are more sensitive.

Cancer cells go through stages of development. What accurately describes the stage of promotion (select all that apply)? a. Obesity is an example of a promoting factor. b. The stage is characterized by increased growth rate and metastasis. c. Withdrawal of promoting factors will reduce the risk of cancer development. d. Tobacco smoke is a complete carcinogen that is capable of both initiation and promotion. e. Promotion is the stage of cancer development in which there is an irreversible alteration in the cell's DNA.

A, C, D Promoting factors such as obesity and tobacco smoke promote cancer in the promotion stage of cancer development. Eliminating risk factors can reduce the chance of cancer development as the activity of promoters is reversible in this stage. Increased growth, invasion, and metastasis are seen in the progressive stage.

When teaching a 24-year-old woman desires to learn BSE, the nurses knows that it is important to do what? A. Provide time for a return demonstration. B. Emphasize the statistics related to breast cancer survival and mortality C. Have the woman set a consistent monthly date for performing the examination. D. Inform the woman that professional examinations are not necessary unless she finds an abnormality.

A. One of the major reasons why women do not examine their breast regularly is because of lack of confidence in BSE skill. A teaching program should include allowing time for women to ask questions and perform a return demonstration of the examination on themselves. Fear and denial often interferes with BSE even when women know that the perceived risk for cancer is high, know the statistics, and know that they should be done right after the menstrual period and specific dates are set for postmenstural women or those who have had hysterectomies.

A patient with a positive breast biopsy tells the nurse that she read about tamoxifen on the Internet and asks about its use. The best response by the nurse includes which information? A. Tamoxifen is the treatment of choice if the tumor has receptors for estrogen on its cells. B. Tamoxifen is the primary treatment of choice if the tumor has receptors for estrogen on its cell. C. Tamoxifen is used only to prevent the development of new primary tumors in women with high risk for breast cancer. D. Because tamoxifen has been shown to increase the risk for uterine cancer, it is used only when other treatment has not been successful.

A. Tamoxifen is an anti-estrogen agent that blocks the estrogen-receptor sites malignant cells and is the usual first choice of treatment in women with hormone receptor-positive tumors, with or without nodal involvement. Tamoxifen reduces the risk for recurrent breast cancer and also that for new primary tumors. The side effects of the drug are minimal and are the commonly associated with decreased estrogen

5. A nurse is caring for a client who has cervical cancer and is scheduled for brachytherapy. Which of the following actions should the nurse take? (select all that apply.) A. Permit visitors to stay with the client 30 min at a time. B. Warn pregnant individuals to visit the room only once daily. C. Wear a dosimeter when in the client's room. d. Place soiled dressings in a biohazard bag before discarding in the regular trash. e. dispose soiled linens in the hamper outside the client's room.

A. CORRECT: Visitors should remain for no more than 30 min at a time and maintain a distance of at least 6 ft. B. Pregnant individuals should not enter the room of a client receiving brachytherapy. C. CORRECT: Healthcare personnel should wear a dosimeter when there is potential exposure to radiation, such as in the radiology department or in the room of a client receiving brachytherapy. d. do not discard the client's dressings in the regular trash, because the client's secretions are radioactive. e. do not place objects from the client's room in the hallway because they are radioactive, but should dispose of them following facility policy.

1. A nurse is planning care for a client who has a platelet count of 10,000/mm3. Which of the following interventions should the nurse include in the plan of care? A. Apply prolonged pressure to puncture site after blood sampling. B. Administer epoetin alfa as prescribed. C. Place the client in a private room. d. Have the client use an oral topical anesthetic before meals.

A. CORRECT: implement bleeding precautions for the client who has thrombocytopenia. B. epoetin alfa is administered to the client who has anemia. C. The client who has neutropenia is placed in a private room. d. A topical oral anesthetic is used for the client who has mucositis.

2. A nurse is caring for a client who is receiving chemotherapy and has mucositis. Which of the following actions should the nurse take? A. Use a glycerin‐soaked swab to clean the client's teeth. B. encourage increased intake of citrus fruit juices. C. Obtain a culture of the lesions. d. Provide an alcohol‐based mouthwash for oral hygiene.

A. Glycerin‐based swabs should be avoided when providing oral hygiene to a client who has mucositis. B. Acidic foods should be discouraged for a client who has oral mucositis. C. CORRECT: Obtain a culture of the oral lesions to identify pathogens and determine appropriate treatment. d. Nonalcoholic mouthwashes are recommended for a client who has mucositis.

4. A nurse is caring for a client who is undergoing chemotherapy and reports severe nausea. Which of the following statements should the nurse make? A. "your nausea will lessen with each course of chemotherapy." B. "Hot food is better tolerated due to the aroma." C. "Try eating several small meals throughout the day." d. "increase your intake of red meat as tolerated."

A. Nausea usually occurs to the same extent with each session of chemotherapy. B. Cold foods are better tolerated than warm or hot foods because odors from heated foods can induce nausea. C. CORRECT: several small meals a day are usually better tolerated by the client who has nausea. d. red meat is not tolerated well by the client undergoing chemotherapy because the taste of meat is frequently altered and unpalatable.

The nurse is volunteering at a community center to teach women about breast cancer. What should the nurse include when discussing risk factors (select all that apply)? A. Nulliparity B. Age 30 or over C. Early menarche D. Late menopause E. Personal history of colon cancer

A. Nulliparity C. Early menarche D. Late menopause E. Personal history of colon cancer Women are at an increased risk for development of breast cancer if they are over the age of 50; have a family history of breast cancer; have a personal history of breast, colon, endometrial, or ovarian cancer; have a long menstrual history as seen with early menarche or late menopause; and have had a first full-term pregnancy after the age of 30 or are nulliparous.

The nurse is presenting a community education program related to cancer prevention. Based on current cancer death rates, the nurse emphasizes what as the most important preventive action for both women and men? a. Smoking cessation b. Routine colonoscopies c. Protection from ultraviolet light d. Regular examination of reproductive organs

A. Smoking Cessation Lung cancer is the leading cause of cancer deaths in the United States for both women and men and smoking cessation is one of the most important cancer prevention behaviors. Approximately one half of cancer-related deaths in the U.S. are related to tobacco use, unhealthy diet, physical inactivity, and obesity. Cancers of the reproductive organs are the second leading cause of cancer deaths.

What are the current guidelines for breast cancer screening? A. Yearly mammograms starting at age 40 B. Breast self-examination (BSE) monthly for women starting at age 20 C. Breast ultrasound every 5 years after age 50 D. Clinical breast examination (CBE) yearly starting at age 20

A. Yearly mammograms starting at age 40 Yearly mammograms should start at age 40 and continue for as long as a woman is in good health. BSE is considered optional, but if done, it should start at age 20. Breast ultrasound is used with mammography to differentiate a solid mass from a cystic mass, to evaluate a mass in a pregnant or lactating woman, or to locate and biopsy a suspicious lesion seen on magnetic resonance imaging (MRI). It is not used in screening. CBE preferably is done at least every 3 years for women between the ages of 20 and 30 years and every year for women beginning at age 40. Reference: 1306-1307

When discussing risk factors for breast cancer with a group of women, you emphasize that the greatest known risk factor for breast cancer is A. being a woman older than 60 years. B. experiencing menstruation for 40 years or longer. C. using hormone replacement therapy during menopause. D. having a paternal grandmother with postmenopausal breast cancer.

A. being a woman older than 60 years. The identifiable risk factors most associated with breast cancer include female gender and advancing age. The incidence of breast cancer in women under 25 years of age is very low and increases gradually until age 60. After age 60 the incidence increases dramatically. Reference: 1311

1. You are a community health nurse planning a program on breast cancer screening guidelines for women in the neighborhood. Which recommendations you would include? (select all that apply) a. Women over age 55 may have biennial screening. b. Screening should end when the women reaches age 65. c. Women aged 45 to 54 years should be screened annually. d. Regular screening mammography should start at age 45 years. e. Clinical breast examinations can be used if the woman has average risk.

ACD

22. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient? a. IL-2 enhances the body's immunologic response to tumor cells. b. IL-2 prevents bone marrow depression caused by chemotherapy. c. IL-2 protects normal cells from harmful effects of chemotherapy. d. IL-2 stimulates cancer cells in their resting phase to enter mitosis.

ANS: A IL-2 enhances the ability of the patient's own immune response to suppress tumor cells. IL-2 does not protect normal cells from damage caused by chemotherapy, stimulate cancer cells to enter mitosis, or prevent bone marrow depression.

16. What topic should the nurse anticipate teaching a patient who is diagnosed with lobular carcinoma in situ (LCIS)? a. Tamoxifen b. Lumpectomy c. Lymphatic mapping d. Mammaprint testing

ANS: A Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other diagnostic tests and therapies are not needed because LCIS does not usually require treatment.

30. Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first? a. A 22-yr-old patient who has noticed a firm, nontender lump on his scrotum b. A 35-yr-old patient who is concerned that his scrotum "feels like a bag of worms" c. A 40-yr-old patient who has pelvic pain while being treated for chronic prostatitis d. A 70-yr-old patient who is reporting frequent urinary dribbling after a prostatectomy

ANS: A The patient's age and symptoms suggest possible testicular cancer. Some forms of testicular cancer can be very aggressive, so the patient should be evaluated by the health care provider as soon as possible. Varicoceles do require treatment but not emergently. Ongoing pelvic pain is common with chronic prostatitis. Urinary dribbling is a common problem after prostatectomy.

26. A patient who is scheduled for a lumpectomy and axillary lymph node dissection tells the nurse, "I would rather not know much about the surgery." Which response by the nurse is best? a. "Tell me what you think is important to know about the surgery." b. "It is essential that you know enough to provide informed consent." c. "Many patients do better after surgery if they have more information." d. "You can wait until after surgery for teaching about pain management."

ANS: A This response shows sensitivity to the individual patient's need for information about the surgery. The other responses are also accurate, but the nurse should tailor patient teaching to individual patient preferences.

27. The outpatient clinic receives telephone messages from four patients. Which patient should the nurse call back first? a. A 40-yr-old patient who has left side chest and arm pain 2 months after a left modified radical mastectomy b. A 50-yr-old patient with stage 2 breast cancer who is receiving doxorubicin and has ankle swelling and fatigue c. A 21-yr-old patient with a family history of breast cancer who wants to discuss genetic testing for the BRCA gene d. A 57-yr-old patient with ductal ectasia who has sticky multicolored nipple discharge and severe nipple itching

ANS: B Although all the patients have needs that the nurse should address, the patient who is receiving a cardiotoxic medication and has symptoms of heart failure should be assessed by the nurse first. BRCA testing may be appropriate for the 21-yr-old patient, but it does not need to be done immediately. Chest and arm pain are normal up to 3 months after mastectomy. Nipple discharge and itching is a common finding with ductal ectasia.

22. A 36-yr-old patient who has a diagnosis of fibrocystic breast changes calls the nurse in the clinic reporting symptoms. Which information is likely to change the treatment plan? a. There is yellow discharge from the patient's right nipple. b. An area on the breast is hot, pink, and tender to the touch. c. Firm, moveable lumps are in the upper outer breast quadrants. d. The lumps get more painful before the patient's menstrual period.

ANS: B An area that is hot or pink suggests an infectious process such as mastitis, which would require further assessment and treatment. Manifestations of fibrocystic breast changes include one or more palpable lumps that are often round, well delineated, and freely movable within the breast. Discomfort ranging from tenderness to pain may also occur. The lump may increase in size and tenderness before menstruation. Nipple discharge associated with fibrocystic breasts is often milky, watery-milky, yellow, or green.

34. The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention? a. The UAP flushes the toilet once after emptying the patient's bedpan. b. The UAP stands by the patient's bed for 30 minutes talking with the patient. c. The UAP places the patient's bedding in the laundry container in the hallway. d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.

ANS: B Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine and feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated.

30. The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider? a. Generalized muscle aches b. Crackles at the lung bases c. Reports of nausea and anorexia d. Oral temperature of 100.6° F (38.1° C)

ANS: B Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2. The patient may need oxygen and the nurse should rapidly notify the health care provider. The other findings are common side effects of interleukin-2.

21. Which action will the nurse include in the plan of care for a patient with right arm lymphedema? a. Avoid isometric exercise on the right arm. b. Assist with application of a compression sleeve. c. Keep the right arm at or below the level of the heart. d. Check blood pressure (BP) on both right and left arms.

ANS: B Compression of the arm assists in improving lymphatic flow toward the heart. Isometric exercises may be prescribed for lymphedema. BPs should only be done on the patient's left arm. The arm should not be placed in a dependent position.

23. The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment? a. "I have frequent muscle aches and pains." b. "I rarely have the energy to get out of bed." c. "I experience chills after I inject the interferon." d. "I take acetaminophen (Tylenol) every 4 hours."

ANS: B Fatigue can be a dose-limiting toxicity for use of immunotherapy. Flu-like symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use acetaminophen every 4 hours.

28. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse indicates a need for further teaching? a. The patient ambulates around the room. b. The patient's visitors bring in fresh peaches. c. The patient cleans with a warm washcloth after having a stool. d. The patient uses soap and shampoo to shower every other day.

ANS: B Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help prevent skin breakdown and infection.

4. Which assessment finding in a 36-yr-old patient is most indicative of a need for further evaluation? a. Bilateral breast nodules that are tender with palpation. b. A breast nodule that is 1 cm in size, nontender, and fixed. c. A breast lump that increases in size before the menstrual period. d. A breast lump that is small and mobile, with a rubbery consistency.

ANS: B Painless and fixed lumps suggest breast cancer. The other findings are more suggestive of benign processes such as fibrocystic breasts and fibroadenoma

4. The nurse should suggest which food choice for a patient scheduled to receive external-beam radiation for abdominal cancer? a. Fruit salad b. Baked chicken c. Creamed broccoli d. Toasted wheat bread

ANS: B Protein is needed for wound healing. To minimize the diarrhea that is associated with bowel radiation, the patient should avoid foods high in roughage, such as fruits and whole grains. Lactose intolerance may develop secondary to radiation, so dairy products should also be avoided.

17. Which information should the nurse include in teaching a patient who is scheduled for external beam radiation to the breast? a. The radiation therapy will take a week to complete. b. Careful skin care in the radiated area will be needed. c. Visitors are restricted until the radiation therapy is completed. d. Wigs may be used until the hair regrows after radiation therapy.

ANS: B Skin care will be needed because of the damage caused to the skin by the radiation. External beam radiation is done over a 5- to 6-week period. Scalp hair loss does not occur with breast radiation therapy. Because the patient does not have radioactive implants, no visitor restrictions are necessary.

38. A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first? a. Give the patient the prescribed PRN opioid. b. Assess for sensation and strength in the legs. c. Notify the health care provider about the symptoms. d. Teach the patient how to use relaxation to reduce pain.

ANS: B Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the epidural space. The nurse will need to assess the patient further for symptoms such as decreased leg sensation and strength and then notify the health care provider. Administration of opioids or the use of relaxation may be appropriate but only after the nurse has assessed for possible spinal cord compression.

14. Which information will the nurse plan to include when teaching a young adult who has a family history of testicular cancer about testicular self-examination? a. Testicular self-examination should be done at least weekly. b. Testicular self-examination should be done in a warm room. c. The only structure normally felt in the scrotal sac is the testis. d. Call the health care provider if one testis is larger than the other.

ANS: B The testes will hang lower in the scrotum when the temperature is warm (e.g., during a shower), and it will be easier to palpate. The epididymis is also normally palpable in the scrotum. One testis is normally larger. Men at high risk should perform testicular self-examination monthly.

15. The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a. Infuse the medication over a short period of time. b. Stop the infusion if swelling is observed at the site. c. Administer the chemotherapy through a small-bore catheter. d. Hold the medication unless a central venous line is available.

ANS: B Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapy drug. These medications can be given through peripheral lines, although central vascular access devices are preferred.

8. After a 48-yr-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. What topic should the nurse plan to teach the patient? a. Estradiol b. Tamoxifen c. Raloxifene d. Trastuzumab

ANS: B Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used postmastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2 receptor.

23. The nurse notes bilateral enlargement of the breasts during examination of a 62-yr-old male patient. Which action should the nurse take first? a. Refer the patient for mammography. b. Question the patient about current medications. c. Explain that this is temporary due to hormonal changes. d. Teach the patient how to palpate the breast tissue for lumps.

ANS: B The first action should be further assessment. Because gynecomastia is a possible side effect of drug therapy, asking about the current drug regimen is appropriate. The other actions may be needed, depending on the data that are obtained with further assessment.

20. A patient with newly diagnosed lung cancer tells the nurse, "I don't think I'm going to live to see my next birthday." Which is the best initial response by the nurse? a. "Are you ready to talk with family members about dying?" b. "Can you tell me what makes you think you will die so soon?" c. "Do you think that an antidepressant medication would be helpful?" d. "Would you like to talk to the hospital chaplain about your feelings?"

ANS: B The nurse's initial response should be to collect more assessment data about the patient's statement. The answer beginning "Can you tell me what it is" is the most open-ended question and will offer the best opportunity for obtaining more data. The remaining answers offer interventions that may be helpful to the patient, but more assessment is needed to determine whether these interventions are appropriate.

12. The nurse is caring for a patient with colon cancer who is scheduled for external radiation therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching? a. The patient has a history of dental caries. b. The patient swims several days each week. c. The patient snacks frequently during the day. d. The patient showers each day with mild soap.

ANS: B The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change habits of eating frequently or showering with a mild soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation.

16. A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to support the patient's self-esteem? a. Suggest that the patient limit social contacts until hair regrowth occurs. b. Encourage the patient to purchase a wig or hat to wear when hair loss begins. c. Teach the patient to wash hair gently with mild shampoo to minimize hair loss. d. Inform the patient that hair usually grows back once chemotherapy is complete.

ANS: B The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicles and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is not immediately helpful in maintaining the patient's self-esteem.

24. A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). Which information should the nurse include in the patient's teaching plan? a. Donor bone marrow is transplanted through a sternal or hip incision. b. Hospitalization is required for several weeks after the stem cell transplant. c. The transplant procedure takes place in a sterile operating room to decrease the risk for infection. d. Transplant of the donated cells can be very painful because of the nerves in the tissue lining the bone.

ANS: B The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line so the transplant is not painful, nor is an operating room or incision required.

27. During the teaching session for a patient who has a new diagnosis of acute leukemia, the patient is restless and looks away without making eye contact. The patient asks the nurse to repeat the information about the complications associated with chemotherapy. Based on this assessment, which patient problem should the nurse identify? a. Denial b. Anxiety c. Acute confusion d. Ineffective adherence to treatment

ANS: B The patient who has a new cancer diagnosis is likely to have high anxiety, which may affect learning and require that the nurse repeat and reinforce information about health maintenance. There is no evidence to support confusion. The patient asks for the information to be repeated, indicating that denial is not present. The patient has recently been diagnosed, so adherence has not yet been required.

40) The nurse is caring for a client for myelosuppression. Which lab values would the nurse monitor for this client? Select all that apply. 1. RBC 2. WBC 3. Platelets 4. Potassium 5. Sodium

Answer: 1, 2, 3 Explanation: The nurse would monitor the client's RBCs. The nurse would monitor the client's WBCs. The nurse would monitor the client's platelet count. Page Ref: 1030

5. A 53-yr-old woman who is experiencing menopause is discussing the use of hormone therapy (HT) with the nurse. Which information about the risk of breast cancer will the nurse provide? a. HT is a safe therapy for menopausal symptoms if there is no family history of BRCA genes. b. HT does not appear to increase the risk for breast cancer unless there are other risk factors. c. The patient and her health care provider must weigh the benefits of HT against the risks of breast cancer. d. Natural herbs are as effective as estrogen in relieving symptoms without increasing the risk of breast cancer.

ANS: C Because HT is linked to an increased risk for breast cancer, the patient and health care provider must determine whether to use HT. Breast cancer incidence is increased in women using HT, independent of other risk factors. HT increases the risk for both non-BRCA-associated cancer and BRCA-related cancers. Alternative therapies can be used but are not consistent in relieving menopausal symptoms.

35. The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first? a. A 35-yr-old patient who has wet desquamation associated with abdominal radiation b. A 42-yr-old patient who is sobbing after receiving a new diagnosis of ovarian cancer c. A 24-yr-old patient who received neck radiation and has blood oozing from the neck d. A 56-yr-old patient who developed a new pericardial friction rub after chest radiation

ANS: C Because neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first. The diagnoses and clinical manifestations for the other patients are not immediately life threatening.

19. A patient has inadequate nutrition due to painful oral ulcers. Which nursing action will be most effective in improving oral intake? a. Offer the patient frequent small snacks between meals. b. Assist the patient to choose favorite foods from the menu. c. Apply prescribed anesthetic gel to oral lesions before meals. d. Teach the patient about the importance of nutritional intake.

ANS: C Because the cause of the patient's poor nutrition is the painful oral ulcers, the best intervention is to apply anesthetic gel to the lesions before the patient eats. The other actions might be helpful for other patients with impaired nutrition but would not be as helpful for this patient.

19. What health history information should the nurse obtain from the patient who has possible testicular cancer? a. Testicular torsion b. Testicular trauma c. Undescended testicles d. Sexually transmitted infection (STI)

ANS: C Cryptorchidism, or undescended testicles, is a risk factor for testicular cancer if it is not corrected before puberty. STI, testicular torsion, and testicular trauma are risk factors for other testicular conditions but not for testicular cancer.

25. The nurse is caring for a patient with breast cancer who is receiving chemotherapy with doxorubicin and cyclophosphamide. Which assessment finding is most important to communicate to the health care provider? a. The patient reports fatigue. b. The patient eats only 25% of meals. c. The patient's apical pulse is irregular. d. The patient's white blood cell count is 5000/μL.

ANS: C Doxorubicin can cause cardiac toxicity. The dysrhythmia should be reported because it may indicate a need for a change in therapy. Anorexia, fatigue, and a low-normal WBC count are expected effects of chemotherapy.

2. Which question is most pertinent for the nurse to ask a 43-yr-old patient about her risk for breast cancer? a. "Do you currently smoke tobacco?" b. "Have you ever had a breast injury?" c. "At what age did you start having menstrual periods?" d. "Is there a family history of fibrocystic breast changes?"

ANS: C Early menarche and late menopause are risk factors for breast cancer because of the prolonged exposure to estrogen that occurs. Cigarette smoking, breast trauma, and fibrocystic breast changes are not associated with increased breast cancer risk.

41. After change-of-shift report on the oncology unit, which patient should the nurse assess first? a. Patient who has a platelet count of 82,000/μL after chemotherapy. b. Patient who has xerostomia after receiving head and neck radiation. c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C). d. Patient who is worried about getting the prescribed long-acting opioid on time.

ANS: C Fever is an emergency in neutropenic patients because of the risk for rapid progression to severe infections and sepsis. The other patients also require assessments or interventions but do not need to be assessed as urgently. Patients with thrombocytopenia do not have spontaneous bleeding until the platelets are 20,000/μL. Xerostomia does not require immediate intervention. Although breakthrough pain needs to be addressed rapidly, the patient does not appear to have breakthrough pain.

21. A patient who has severe pain with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching about pain management has been effective? a. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale). b. The patient agrees to take the medications by the IV route to improve analgesic effectiveness. c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. d. The patient states that nonopioid analgesics may be used if the maximal dose of the opioid is reached without adequate pain relief.

ANS: C For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain. Taking the medications only when pain reaches a certain level does not provide effective pain control. Although nonopioid analgesics may also be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved. The IV route is not more effective than the oral route, and usually the oral route is preferred.

29. The nurse is caring for a patient diagnosed with stage I colon cancer. When assessing the need for psychologic support, which question by the nurse will provide the most information? a. "How long ago were you diagnosed with this cancer?" b. "Do you have any concerns about body image changes?" c. "Can you tell me what has been helpful when coping with past stressful events?" d. "Are you familiar with the stages of emotional adjustment to cancer of the colon?"

ANS: C Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient's need for support. The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. Because surgical interventions for stage I cancer of the colon may not cause any body image changes, this question is not appropriate at this time.

6. A 58-yr-old woman tells the nurse, "I understand that I have stage 2 breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?" Which response by the nurse is best? a. "I would have a lumpectomy, but you need to decide what is best for you." b. "It would not be appropriate for me to make a decision about your health." c. "Tell me what you understand about the surgical options that are available." d. "There is no need to make a decision rapidly, you have time to think about this."

ANS: C Inquiring about the patient's understanding shows the nurse's willingness to assist the patient with the decision-making process without imposing the nurse's values or opinions. Treatment decisions for breast cancer do need to be made relatively quickly. Imposing the nurse's opinions or showing an unwillingness to discuss the topic could cut off communication.

18. A lobectomy is scheduled for a patient with stage I non-small cell lung cancer. The patient tells the nurse, "I would rather have chemotherapy than surgery." Which response by the nurse is most appropriate? a. "Are you afraid that the surgery will be very painful?" b. "Did you have bad experiences with previous surgeries?" c. "Tell me what you know about the treatments available." d. "Surgery is the treatment of choice for stage I lung cancer."

ANS: C More assessment of the patient's concerns about surgery is indicated. An open-ended response will elicit the most information from the patient. The answer beginning, "Surgery is the treatment of choice" is accurate, but it discourages the patient from sharing concerns about surgery. The remaining two answers indicate that the nurse has jumped to conclusions about the patient's reasons for not wanting surgery. Chemotherapy is the primary treatment for small cell lung cancer. In non-small cell lung cancer, chemotherapy may be used in the treatment of nonresectable tumors or as adjuvant therapy to surgery.

22. The nurse in the clinic notes elevated prostate-specific antigen (PSA) levels in the laboratory results of these patients. Which patient's elevated PSA result requires further evaluation? a. A 38-yr-old patient who is being treated for acute prostatitis b. A 52-yr-old patient who goes on long bicycle rides every weekend c. A 48-yr-old patient whose father died of metastatic prostate cancer d. A 75-yr-old patient who uses saw palmetto to treat benign prostatic hyperplasia(BPH)

ANS: C The family history of prostate cancer and elevation of PSA indicate that further evaluation of the patient for prostate cancer is needed. Elevations in PSA for the other patients are not unusual.

1. A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is accurate? a. "Benign tumors do not cause damage to other tissues." b. "Benign tumors are likely to recur in the same location." c. "Malignant tumors may spread to other tissues or organs." d. "Malignant cells reproduce more rapidly than normal cells."

ANS: C The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors do not metastasize. The other statements are inaccurate. Both types of tumors may cause damage to adjacent tissues. Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not usually recur.

26. A patient with cancer is eating very little due to altered taste sensation. Which nursing action would address the cause of the patient problem? a. Add protein powder to foods such as casseroles. b. Tell the patient to eat foods that are high in nutrition. c. Avoid giving the patient foods that are strongly disliked. d. Add spices to enhance the flavor of foods that are served.

ANS: C The patient will eat more if disliked foods are avoided and foods that the patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding protein powder does not address the issue of taste. The patient's poor intake is not caused by a lack of information about nutrition.

8. The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective? a. "After cancer has not recurred for 5 years, it is considered cured." b. "The cancer will be cured if the entire tumor is surgically removed." c. "I will need follow-up examinations for many years after treatment before I can be considered cured." d. "Cancer is never cured, but the tumor can be controlled with surgery, chemotherapy, and radiation."

ANS: C The risk of recurrence varies by the type of cancer. Some cancers are considered cured after a shorter time span or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up.

13. A patient newly diagnosed with stage I breast cancer is discussing treatment options with the nurse. Which statement by the patient indicates that additional teaching may be needed? a. "There are several options that I can consider for treating the cancer." b. "I will probably need radiation to the breast after having the surgery." c. "Mastectomy is the best choice to decrease the chance of cancer recurrence." d. "I can probably have reconstructive surgery at the same time as a mastectomy."

ANS: C The survival rates with lumpectomy and radiation or modified radical mastectomy are comparable. The other patient statements indicate a good understanding of stage I breast cancer treatment.

14. A patient with metastatic colon cancer has severe vomiting after each administration of chemotherapy. Which action by the nurse is appropriate? a. Have the patient eat large meals when nausea is not present. b. Offer dry crackers and carbonated fluids during chemotherapy. c. Administer prescribed antiemetics 1 hour before the treatments. d. Give the patient a glass of a citrus fruit beverage during treatments.

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

24. A patient has had left-sided lumpectomy (breast-conservation surgery) and an axillary lymph node dissection. Which nursing intervention is appropriate to delegate to a licensed practical/vocational nurse (LPN/VN)? a. Teaching the patient how to avoid injury to the left arm b. Assessing the patient's range of motion for the left arm c. Evaluating the patient's understanding about drain care d. Giving an analgesic 30 minutes before scheduled arm exercises

ANS: D LPN/VN education and scope of practice include administration and evaluation of the effects of analgesics. Assessment, teaching, and evaluation of a patient's understanding of instructions are more complex tasks that are more appropriate to RN level education and scope of practice.

29. The nurse completes discharge teaching for a patient who has had a lung transplant. Which patient statement indicates that the teaching has been effective? a. "I will make an appointment to see the doctor every year." b. "I will stop taking the prednisone if I experience a dry cough." c. "I will not worry if I feel a little short of breath with exercise." d. "I will call the health care provider right away if I develop a fever."

ANS: D Low-grade fever may indicate infection or acute rejection, so the patient should notify the health care provider immediately if the temperature is elevated. Patients require frequent follow-up visits with the transplant team. Annual health care provider visits would not be sufficient. Home O2 use is not an expectation after lung transplant. Shortness of breath should be reported. Low-grade fever, fatigue, dyspnea, dry cough, and O2 desaturation are signs of rejection. Immunosuppressive therapy, including prednisone, needs to be continued to prevent rejection.

28. A patient who has been diagnosed with stage 2 prostate cancer chooses the option of active surveillance. What should the nurse plan to do? a. Vaccinate the patient with sipuleucel-T (Provenge). b. Provide the patient with information about cryotherapy. c. Teach the patient about placement of intraurethral stents. d. Schedule the patient for annual prostate-specific antigen testing.

ANS: D Patients who opt for active surveillance need to have annual digital rectal examinations and prostate-specific antigen testing. Vaccination with sipuleucel-T, cryotherapy, and stent placement are options for patients who choose to have active treatment for prostate cancer.

1. What information should the nurse include when teaching a young women's community service group about breast self-examination (BSE)? a. BSE will reduce the risk of dying from breast cancer. b. BSE should be done daily while taking a bath or shower. c. Annual mammograms should be scheduled in addition to BSE. d. Performing BSE after the menstrual period is more comfortable.

ANS: D Performing BSE at the end of the menstrual period will reduce the breast tenderness associated with the procedure. The evidence is not clear that BSE reduces mortality from breast cancer. BSE should be done monthly. Annual mammograms are not routinely scheduled for women younger than age 40 years, and newer guidelines suggest delaying them until age 50.

40. An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hr in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider? a. Patient reports having severe fatigue. b. Patient voids every hour during the day. c. Patient takes only 50% of meals and refuses snacks. d. Patient has crackles up to the midline posterior chest.

ANS: D Rapid fluid infusions may cause heart failure, especially in older patients. The other findings are common in patients who have cancer or are receiving chemotherapy.

3. The nurse is caring for a patient who smokes 2 packs/day. Which action by the nurse could help reduce the patient's risk of lung cancer? a. Teach the patient about the seven warning signs of cancer. b. Plan to monitor the patient's carcinoembryonic antigen (CEA) level. c. Teach the patient about annual chest x-rays for lung cancer screening. d. Discuss risks associated with cigarettes during each patient encounter.

ANS: D Teaching about the risks associated with cigarette smoking is recommended at every patient encounter because cigarette smoking is associated with multiple health problems. The other options may detect lung cancer that is already present but do not reduce the risk.

23. After a transurethral resection of the prostate (TURP), a 64-yr-old patient with continuous bladder irrigation reports painful bladder spasms. The nurse observes clots in the urine. Which action should the nurse take first? a. Increase the flowrate of the bladder irrigation. b. Administer the prescribed IV morphine sulfate. c. Give the patient the prescribed belladonna and opium suppository. d. Manually instill and then withdraw 50 mL of saline into the catheter.

ANS: D The assessment suggests that obstruction by a clot is causing the bladder spasms, and the nurse's first action should be to irrigate the catheter manually and to try to remove the clots. IV morphine will not decrease the spasm, although pain may be reduced. Increasing the flowrate of the irrigation will further distend the bladder and may increase spasms. The belladonna and opium suppository will decrease bladder spasms but will not remove the obstructing blood clot.

32. The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? a. Hematocrit 30% b. Platelets 95,000/μL c. Hemoglobin 10 g/L d. White blood cells (WBC) 2700/μL

ANS: D The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim (Neupogen) are needed. Although the other laboratory data indicate decreased levels, they do not indicate any immediate life-threatening adverse effects of the chemotherapy.

18. A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient? a. Remove food debris from the teeth and oral mucosa with a stiff toothbrush. b. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c. Gargle and rinse the mouth several times a day with an antiseptic mouthwash. d. Rinse the mouth before and after each meal and at bedtime with a saline solution.

ANS: D The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate the oral mucosa and are not recommended.

6) The nurse assesses several clients for their potential risk for developing cancer. Which client does the nurse assess to be at greatest risk for developing cancer? 1. The client who is an alcoholic and eats a diet high in fatty foods 2. The client who frequently forgets breast self-exams but has routine mammograms 3. The client who is 10 pounds overweight but exercises regularly 4. The client who applies sunscreen when arriving at the beach

Answer: 1 Explanation: Alcoholism and a high-fat diet are lifestyle factors that put this client at risk for developing cancer. Page Ref: 1023

37) The client experiences nausea and vomiting soon after chemotherapy treatments. What is the best action by the nurse? 1. Administer an antiemetic 1 to 2 hours before chemotherapy. 2. Increase fluid intake to flush the kidneys prior to chemotherapy. 3. Restrict food on the day the client receives chemotherapy. 4. Administer a sleeping medication during chemotherapy.

Answer: 1 Explanation: An antiemetic is usually necessary to control nausea and vomiting. Page Ref: 1031

5) A client with cancer asks the nurse where cancer comes from. What is the best explanation by the nurse? 1. "Cancer cells are body cells that have lost the ability to regulate growth." 2. "Cancer is caused primarily by viruses in the environment." 3. "Cancer is genetic, you inherited the predisposition for your cancer." 4. "Cigarette smoking and secondhand smoke are the primary causes of cancer."

Answer: 1 Explanation: Cancer is thought to result from damage to the genes that control cell growth. Page Ref: 1022

11) Folic acid analogs can be toxic to normal cells as well as to cancer cells. Which drug will the nurse administer following the administration of methotrexate to "rescue" the normal cells, causing them to be able to continue replication and development? 1. Leucovorin 2. Iron therapy 3. Immunoglobulin 4. Vitamin B12

Answer: 1 Explanation: Leucovorin is given to rescue normal cells during methotrexate administration. Page Ref: 1043

2) Classification of antineoplastics is difficult because: 1. the drugs kill cancer cells by different mechanisms and have characteristics from more than one class. 2. the drugs cannot always kill the cancer cells. 3. the drugs only have characteristics from one class, even though they kill by different mechanisms. 4. the drugs have various adverse effects.

Answer: 1 Explanation: These are the reasons classification is so difficult. Page Ref: 1037

14) The nurse is describing the mechanism of action for antibiotic antineoplastics to a client who is being treated for cancer. Which description by the nurse is most appropriate? 1. "They contain substances from bacteria that have the ability to kill cancer cells." 2. "They contain substances from plants that have the ability to kill cancer cells." 3. "They contain substances from viruses that have the ability to kill cancer cells." 4. "They contain substances from hormones that have the ability to kill cancer cells."

Answer: 1 Explanation: They do contain substances from bacteria that can kill cancer cells. Page Ref: 1048

15) Unlike alkylating agents, antitumor antibiotics: 1. are not given orally. 2. have severe adverse effects. 3. have no dose-limiting toxicities. 4. are not mitotic inhibitors.

Answer: 1 Explanation: They must be given intravenously, or through direct instillation via a catheter into a body cavity or organ. Page Ref: 1048

32) Most chemotherapeutic medications are administered intermittently, using specific dosing schedules. A factor that does not affect the dosing schedule is: 1. the psychologic stage of the client. 2. the condition of the client. 3. the type of tumor. 4. the stage of the disease.

Answer: 1 Explanation: This is not a factor in determining the dosing schedule. Page Ref: 1028

12) The acronym that the American Cancer Society recommends to help people remember what to look for when assessing themselves for cancer is: 1. CAUTION. 2. CANCER. 3. CHANGES. 4. PREVENTION.

Answer: 1 Explanation: This is the acronym the American Cancer Society recommends. Page Ref: 1023

30) When administering cyclophosphamide (Cytoxan), which has the potential adverse effect of cardiotoxicity, what is the best action by the nurse during treatment? 1. Obtain baseline and periodic ECGs. 2. Stop the drug if abnormal heart sounds are auscultated. 3. Obtain baseline and periodic echocardiograms. 4. Obtain baseline and periodic cardiac enzymes.

Answer: 1 Explanation: This is the correct answer. Page Ref: 1040

34) Many chemotherapy agents cause nausea and vomiting. The type and dose of antiemetic prescribed are based on: 1. the potential of specific antineoplastics to cause nausea and vomiting. 2. how many other medications the client is taking. 3. the severity of the client's symptoms. 4. the dose of the antineoplastics.

Answer: 1 Explanation: This is the correct answer. Page Ref: 1049

24) A client shows a proper understanding of the adverse effects of vincristine when he states: 1. "I need to let my doctor know immediately if I have any weakness in my hands or feet." 2. "If I have swelling in my legs, I should keep them elevated for a while." 3. "I can take ibuprofen if I have any pain." 4. "I need to let my doctor know immediately if I took two pills instead of one."

Answer: 1 Explanation: This is the correct response. Page Ref: 1058

9) The nurse is explaining the mechanisms of action for alkylating agents and states that alkylating agents kill cancer cells by: Select all that apply. 1. altering the shape of the DNA double helix. 2. preventing the DNA from duplicating during cell division. 3. becoming incorporated into the DNA of cancer cells. 4. interfering with DNA replication and function. 5. an unknown mechanism of action.

Answer: 1, 2 Explanation: Alkylating agents alter the shape of the DNA double helix. Alkylating agents prevent the DNA from duplicating during cell division. Page Ref: 1037

34) The nurse is preparing to administer methotrexate by mouth to a client with cancer. For what reasons would the nurse use the PO route rather than the other routes of administration? Select all that apply. 1. The PO route is more acceptable to the client. 2. The PO route decreases the risk for phlebitis. 3. The PO route decreases the risk for tissue necrosis. 4. The PO route decreases the risk for nausea. 5. The PO route decreases the risk for vomiting.

Answer: 1, 2, 3 Explanation: The PO route is more acceptable to clients than the other routes of administration. Receiving chemotherapeutic agents by mouth rather than intravenously decreases the risk for phlebitis. Receiving chemotherapeutic agents by mouth rather than intravenously decreases the risk for tissue necrosis. Page Ref: 1029

8) The community health nurse is addressing a neighborhood group concerned about high rates of cancer. The nurse describes chemical carcinogens that contribute to the incidence of cancer, such as: Select all that apply. 1. tobacco. 2. alcohol. 3. asbestos. 4. ultraviolet light. 5. human papillomavirus (HPV).

Answer: 1, 2, 3 Explanation: Tobacco is considered a chemical carcinogen. Alcohol is considered a chemical carcinogen. Asbestos is considered a chemical carcinogen. Page Ref: 1022

22) A client has been diagnosed with Stage IV pancreatic cancer. The family asks the nurse what staging is. The nurse explains that: Select all that apply. 1. staging determines the location of the cancer. 2. the involvement of lymph nodes is assessed during staging. 3. staging changes as the cancer progresses. 4. the lower the stage of cancer at diagnosis, the better the prognosis. 5. staging examines cancerous cells under a microscope and compares them to normal cells.

Answer: 1, 2, 4 Explanation: Staging does determine the location of the cancer. When solid tumors are staged, diagnostic testing also determines the involvement of the lymph nodes. Clients with cancer at a lower stage have a better prognosis than those who are diagnosed at a higher stage. Page Ref: 1024

13) The community health nurse is planning programs aimed at reducing the incidence of cancer. Which strategies would the nurse plan to implement as part of primary prevention? Select all that apply. 1. Providing health counseling and education 2. Reducing tobacco use 3. Providing annual Papanicolaou (Pap) smears 4. Instructing women in breast self-examination 5. Helping clients maintain weight within recommended levels

Answer: 1, 2, 5 Explanation: Health counseling and education are considered primary preventions against cancer. Reducing the use of tobacco is considered primary prevention against cancer. Maintaining a healthy weight is an example of primary prevention against cancer. Page Ref: 1023

1) A common theme among all the antineoplastic agents is: 1. their adverse effects. 2. their ability to kill cancer cells. 3. their drug interactions. 4. their mechanism of action.

Answer: 2 Explanation: A common theme of all antineoplastic agents is their toxicity-their ability to kill cancer cells. Page Ref: 1037

8) The client receives cisplatin (Platinol) as therapy for cancer. Which assessment finding would prompt the nurse to contact the client's healthcare provider immediately? 1. Nausea and projectile vomiting 2. A temperature greater than 101°F 3. An elevation in blood glucose 4. A complaint of painful leg cramps

Answer: 2 Explanation: A temperature greater than 101°F can indicate an infection, which can be life threatening because low WBCs are an adverse effect of cisplatin (Platinol). Page Ref: 1041

38) A large number of antineoplastic medications are absorbed through what route? 1. Fecal—oral 2. Skin and mucous membranes 3. Respiratory secretions 4. Hair follicles

Answer: 2 Explanation: Antineoplastic medications are absorbed via skin and mucous membranes. Page Ref: 1069

31) The client receives several chemotherapeutic agents as treatments for cancer. The client asks the nurse why so many drugs are needed. What is the best response by the nurse? 1. "Using multiple drugs means a shorter treatment time." 2. "Using multiple drugs will help kill more of the cancer." 3. "Using multiple drugs is more cost effective in treating cancer." 4. "Using multiple drugs decreases the incidence of side effects."

Answer: 2 Explanation: By using multiple drugs in combination, more of the cancer cells are killed. Page Ref: 1028

2) Cancer is a disease characterized by: 1. normal, controlled cell division. 2. abnormal, uncontrolled cell division. 3. normal, uncontrolled cell division. 4. abnormal, controlled cell division.

Answer: 2 Explanation: Cancer is characterized by abnormal, uncontrolled cell division. Page Ref: 1021

24) A client is receiving a cell cycle specific medication for the treatment of leukemia. The nurse recognizes that in order for these drugs to kill the most cancer cells, they should be administered in: 1. divided, infrequent doses. 2. divided, frequent doses. 3. a single dose each day. 4. a large, one-time dose.

Answer: 2 Explanation: Cell cycle specific drugs kill the most cancer cells when administered in divided, frequent doses. Page Ref: 1026

20) The nurse is discussing the use of tamoxifen with a client who has a family history of breast cancer. The nurse states that a unique approved use for tamoxifen is: 1. treatment for advanced lung cancer. 2. for prophylaxis of breast cancer. 3. treatment for estrogen receptor—negative cancers. 4. for the cure of advanced breast cancer.

Answer: 2 Explanation: It is approved for prophylaxis of breast cancer for high-risk clients who are at risk of developing the disease. Page Ref: 1053

7) The client receives cyclophosphamide (Cytoxan) as treatment for cancer and experiences oral irritation as an adverse effect. What does the best plan of the nurse include to promote oral comfort? 1. Ice fluids before drinking. 2. Teach good oral hygiene, including rinsing the mouth with plain water after eating. 3. Teach the client to drink tea to keep tissues moist. 4. Teach the client to use a firm toothbrush for brushing teeth.

Answer: 2 Explanation: Simple rinsing of the mouth with plain water may help relieve symptoms. Page Ref: 1039

35) A female client has experienced alopecia due to chemotherapy. She is distraught and feels that no one will want to look at her. How can the nurse best address the client's concerns? 1. Show the client photos of cancer survivors whose hair grew back more thickly. 2. Discuss the client's feelings about the effects of her hair loss. 3. Have a cancer survivor visit the client and discuss wearing a wig. 4. Tell the client that her hair will grow back in a few weeks.

Answer: 2 Explanation: The client needs to discuss and explore the meaning of her hair loss to deal with her feelings. Page Ref: 1032

22) Agents with antineoplastic activity that have been isolated from a number of plants work in what way? 1. They aid in attachment to the receptor sites on the cancer cell. 2. They arrest cell division, or mitosis. 3. They contain substances that have the ability to kill the cancer cells. 4. They prevent conversion from DNA to RNA.

Answer: 2 Explanation: They stop cell division, or mitosis. Page Ref: 1056

28) When discussing the outcome of treatment with a client, the nurse states that theoretically the cancer has been "cured" when: 1. The client no longer experiences the physiologic effects of cancer. 2. Every single cancer cell in the tumor has been eliminated. 3. The tumor cannot be identified on a CT scan. 4. The client's absolute neutrophil rises back to a normal level.

Answer: 2 Explanation: This defines when a client is "cured." Page Ref: 1027

10) The nurse is describing the mechanism of action of antimetabolites to a client with cancer. Which statement best describes how the antimetabolites kill cancer cells? 1. "They use the body's immune system to kill tumor cells." 2. "They disrupt metabolic pathways, slowing growth of cancer cells." 3. "They contain bacterial substances that can kill cancer cells." 4. "They change the shape of the DNA and prevent division of cancer cells."

Answer: 2 Explanation: This describes antimetabolites. Page Ref: 1034

16) Which statement is not true of adjuvant chemotherapy? 1. Adjuvant therapy is the administration of antineoplastic drugs after surgery or radiation therapy. 2. Adjuvant therapy is the administration of antineoplastic drugs before surgery or radiation therapy. 3. A goal of adjuvant therapy is to treat any micrometastases that might be developing. 4. A goal of adjuvant therapy is to rid the body of any cancerous cells that were not removed during surgery.

Answer: 2 Explanation: This describes neoadjuvant chemotherapy. Page Ref: 1024

33) A client is being prepared for the delivery of an intravenous chemotherapeutic agent. The client asks why the drug cannot be given by mouth. The nurse explains that an advantage to intravenous delivery is that: 1. it protects the client from environmental infections. 2. a consistent serum drug level can be obtained. 3. it is administered outside of the home. 4. it can protect the veins during administration.

Answer: 2 Explanation: This is an advantage of intravenous delivery. Page Ref: 1028

11) The nurse recognizes that teaching about secondary prevention has been effective when the client states: 1. "If I stop smoking, I can decrease my risk of lung cancer." 2. "I need to have a Pap smear annually to detect any signs of cervical cancer." 3. "If I get a cancerous lesion removed early, I can prevent more areas of skin cancer." 4. "If I wear sunscreen, I can prevent skin cancer."

Answer: 2 Explanation: This is an example of secondary prevention. Page Ref: 1023

31) The nurse is preparing to administer cyclophosphamide (Cytoxan), which can cause nausea and vomiting. The nurse can best manage this by: 1. giving the client bland foods during treatment. 2. administering antiemetic drugs as necessary. 3. withholding food during administration. 4. increasing fluids during administration.

Answer: 2 Explanation: This is the best way to manage nausea and vomiting. Page Ref: 1040

12) When a client taking methotrexate notifies the nurse of a sudden onset of a rash, the nurse is alerted to what life-threatening adverse effect associated with methotrexate? 1. Peptic ulcer 2. Stevens—Johnson syndrome 3. Pancreatitis 4. Myocardial infarction

Answer: 2 Explanation: This is the correct answer. Page Ref: 1045

26) Which statement is true regarding biologic response modifiers? 1. They are used to treat transplant rejections. 2. Some are immunostimulants and, when given with other antineoplastic agents, help limit severe myelosuppression. 3. They alter the body's defense system to decrease the removal of foreign cancer cells. 4. They are less toxic than are most classes of antineoplastics.

Answer: 2 Explanation: This is true regarding biologic response modifiers. Page Ref: 1063

20) Which statement is true regarding grading of cancer cells? 1. Grading has very few limitations, because tumors contain cell types that are similar in appearance. 2. If the biopsy cells appear differentiated and similar to parent cells, the tumor receives a grade of 1. 3. Grading does not change much over time as the tumor evolves. 4. If the biopsy cells appear differentiated and similar to parent cells, the tumor receives a grade of 4.

Answer: 2 Explanation: This is true regarding grading. Page Ref: 1025

27) Which statement most accurately describes the cell kill hypothesis? 1. It is a model that predicts the amount of normal cells that will be affected by antineoplastic drugs. 2. It is a model that predicts the ability of antineoplastic drugs to eliminate cancer cells. 3. It is a model that predicts how invasive a cancer has become. 4. It is a model that compares the appearance of potential cancer cells with that of normal parent cells.

Answer: 2 Explanation: This statement describes the cell kill hypothesis. Page Ref: 1027

4) The nurse is providing teaching to a client who has just been diagnosed with breast cancer. How would the nurse describe a malignant tumor? Select all that apply. 1. Slow growing 2. Invasive 3. Lethal if left untreated 4. May be classified as a carcinoma 5. May be classified as a sarcoma

Answer: 2, 3, 4, 5 Explanation: Malignant tumors are invasive. Malignant tumors can be lethal if left untreated. Malignant tumors are often classified as carcinomas. Malignant tumors are often classified as sarcomas. Page Ref: 1022

17) The nurse on an oncology unit anticipates that which clients are most likely to receive palliative cancer treatment? Select all that apply. 1. A client with Hodgkin's lymphoma 2. A client with osteosarcoma 3. A client with choriocarcinoma 4. A client with advanced pancreatic cancer 5. A client with Kaposi's sarcoma

Answer: 2, 4, 5 Explanation: A client with osteosarcoma will be treated with palliative chemotherapy. A client with advanced pancreatic cancer will be treated with palliative chemotherapy. A client with Kaposi's sarcoma will be treated with palliative chemotherapy. Page Ref: 1024

29) Which statement is not one of the reasons that clients undergoing chemotherapy usually receive several rounds of treatment spaced over time? 1. Side effects can occur, and the client needs time to recover. 2. The neutrophil count can decrease, so time between treatments is necessary for the body to make more neutrophils to boost the immune system. 3. The cost of treatments is very high. 4. Each round of chemotherapy kills only a set percentage of cancer cells.

Answer: 3 Explanation: Although treatments are expensive, this is not the reason that treatments are spaced over time. Page Ref: 1026

4) Which statement regarding the adverse effects of antineoplastic drugs is the most accurate? 1. They produce the most, but a small range of, adverse effects. 2. They produce the same amount of adverse effects as any other medication. 3. They commonly produce serious adverse effects. 4. They produce the least amount of serious adverse effects of any medication.

Answer: 3 Explanation: Antineoplastic drugs commonly produce serious adverse effects that may affect the patient's ability or willingness to continue therapy. Page Ref: 1037

5) The nurse states that bone marrow toxicity does not suppress which type of cells? 1. White blood cells 2. Platelets 3. T cells 4. Red blood cells

Answer: 3 Explanation: Bone marrow toxicity does not specifically suppress T cells. Page Ref: 1037

3) Unlike most normal cells, cancerous cells are able to move to other places in the body, traveling to distant sites where they populate new tumors. This process is called: 1. grading. 2. carcinogenesis. 3. metastasis. 4. angiogenesis.

Answer: 3 Explanation: Metastasis occurs when cancerous cells travel to distant sites and populate new tumors. Page Ref: 1022

7) Which causes are not part of the etiology of cancer? 1. Biological causes 2. Chemical causes 3. Structural causes 4. Physical causes

Answer: 3 Explanation: Structural causes are not included in the etiology of cancer. Page Ref: 1023

19) The client receives tamoxifen for treatment of breast cancer. She asks the nurse why the medicine works. What is the best response by the nurse? 1. "Tamoxifen works by inhibiting the metabolism of breast cancer cells." 2. "Tamoxifen works by inhibiting the cellular mitosis of breast cancer." 3. "Tamoxifen works by blocking estrogen receptors on breast tissue." 4. "Tamoxifen works by binding to the DNA of breast cancer cells."

Answer: 3 Explanation: Tamoxifen acts by blocking estrogen receptors. Page Ref: 1053

39) The nurse understands that clients placed in reverse isolation might exhibit signs of depression because: 1. they often have additional side effects to therapy. 2. they often have a more severe form of cancer. 3. they might believe they are in isolation and that family will not want to visit because of the need to prevent infections that could be life threatening. 4. they always become claustrophobic.

Answer: 3 Explanation: This answer is true. Page Ref: 1032

6) The nurse tells the client that alkylating agents kill cancer cells by: 1. containing substances from bacteria that can kill cancer cells. 2. disrupting critical cellular pathways of cancer cells. 3. changing the shape of the DNA double helix and preventing DNA from duplicating during cell division. 4. blocking substances necessary for continued growth of tumors.

Answer: 3 Explanation: This is the action of alkylating agents. Page Ref: 1069

38) What would be the best response by the nurse to a client who says that her friends might not accept her now that she has had a mastectomy? 1. "It is just a mastectomy, don't worry so much." 2. "You should get some new friends." 3. "I understand your concerns about your body changes. Let's talk about it." 4. "It is normal to be worried about what other people think. Your friends will get over it."

Answer: 3 Explanation: This is the best therapeutic response. Page Ref: 1032

37) The nurse who has received special training to administer chemotherapy is called: 1. an antineoplastic administrator. 2. a chemotherapy nurse. 3. an oncology nurse. 4. an IV therapy nurse.

Answer: 3 Explanation: This type of nurse is called an oncology nurse. Page Ref: 1069

26) The nurse on an oncology unit is planning care for clients with various types of cancer. The nurse recognizes that certain cancer cells have a low growth fraction and are less sensitive to chemotherapeutic agents, including: Select all that apply. 1. leukemia cells. 2. lymphoma cells. 3. breast cancer cells. 4. lung cancer cells. 5. bone marrow cells.

Answer: 3, 4 Explanation: Breast cancer cells have a low growth fraction and are less sensitive to cell cycle specific chemotherapeutic agents. Lung cancer cells have a low growth fraction and are less sensitive to cell cycle specific chemotherapeutic agents. Page Ref: 1026

36) A client who is receiving chemotherapy frequently complains of headache. The most effective nursing intervention would be to administer: 1. ibuprofen. 2. naproxen. 3. aspirin. 4. acetaminophen.

Answer: 4 Explanation: Acetaminophen is the preferred drug for chemotherapy clients because it does not precipitate bleeding. Page Ref: 1030

1) The nurse is caring for a client with cancer. The family asks the nurse to explain the differences between benign and malignant tumors. Which statement best describes the difference between benign and malignant tumors? 1. "Benign tumors are fast growing, remain localized, and can kill the host." 2. "Malignant tumors are slow growing but invasive, and they can kill the host." 3. "Benign tumors are slow growing but invasive." 4. "Malignant tumors are rapidly growing and invasive, and they can kill the host."

Answer: 4 Explanation: Malignant tumors grow rapidly, are invasive, and can kill the host. Page Ref: 1022

15) The nurse on an oncology unit recognizes that a patient with which type of advanced cancer would most likely require palliation therapy? 1. Bladder cancer 2. Liver cancer 3. Skin cancer 4. Pancreatic cancer

Answer: 4 Explanation: Pancreatic cancer benefits from palliation therapy. Page Ref: 1024

21) The staging and grading of cancer are performed: 1. after the last chemotherapy treatment is completed. 2. when the client's symptoms start to worsen. 3. after the first chemotherapy treatment is completed. 4. upon initial diagnosis of cancer.

Answer: 4 Explanation: Staging and grading are performed upon initial diagnosis of cancer to determine the best course of therapy and to predict client outcomes. Page Ref: 1024-1025

23) A client receiving antineoplastic agents in the treatment of lung cancer has been told that treatment options are limited. The nurse explains that lung cancer has a decreased sensitivity to antineoplastic agents because lung cancer cells: 1. have a very erratic cell cycle, and there is little difference between the number of replicating and resting cells. 2. grow for a long time before detection and are therefore less sensitive to antineoplastic agents. 3. grow in a high-oxygen environment and are therefore not very sensitive to antineoplastic agents. 4. have a low growth fraction, so there is little difference between the number of replicating and resting cells.

Answer: 4 Explanation: The growth fraction is the ratio of the number of replicating cells to the number of resting cells. Antineoplastic drugs are much more toxic to tissues and tumors with high growth fractions. Breast and lung cancers have a low growth fraction. Page Ref: 1026

23) When administering vincristine, the nurse knows that its dose-limiting toxicity primarily affects what system? 1. Renal 2. Pulmonary 3. Cardiac 4. Central nervous system

Answer: 4 Explanation: The system primarily affected by the dose-limiting toxicity of vincristine is the central nervous system. Page Ref: 1058

18) Which statement is true regarding hormone antagonists? 1. They are cytotoxic. 2. They enhance substances essential for hormone growth. 3. They produce debilitating adverse effects similar to those produced by the other antineoplastics. 4. They can produce debilitating adverse effects at high doses for prolonged periods.

Answer: 4 Explanation: This classification of medications can produce debilitating adverse effects when given at high doses for prolonged periods of time. Page Ref: 1051

19) An inaccurate statement about the process of staging cancer is that staging: 1. determines where the cancer is located. 2. determines the extent of the cancer invasion. 3. helps the healthcare provider determine the best course of treatment. 4. compares the appearance of cancer cells with that of normal cells.

Answer: 4 Explanation: This describes grading. Page Ref: 1024

A woman at the health clinic tells the nurse that she does not do breast self examination (BSE) because it just seems too much of a bother. What is the best response by the nurse about BSE? 1. It reduces mortality from breast cancer in women under the age of 50 2. It is useful to help women learn how their breast normally look and feel 3. BSE has little value in detection of cancer and is not recommend anymore 4. BSE is the most common way that malignant tumors of the breast are discovered

B. The value of breast self-examination is reducing mortality rates from breast cancer in women is currently controversial and under review. However, it is still a useful tool in helping women to become self-aware of how their breast normally look and feel. None of the other options have been validated at this time.

The nurse has been asked to participate in a healthy living workshop. While teaching about women's health, which guidelines should the nurse provide to the audience? A. "Mammograms are necessary if you have a family history of breast cancer." B. "It's recommended that you get a mammogram each year after you turn 40." C. "If you are not able to perform breast self-examination (BSE), you should go for regular mammograms." D. "You should ensure that your primary care provider performs a breast exam each time you visit."

B. "It's recommended that you get a mammogram each year after you turn 40." Annual mammograms are recommended after age 40. They are recommended for all women, not solely those with a family history of breast cancer. BSE is not a replacement for mammography, and clinical breast examinations are not necessary at each office visit, but recommended at least every 3 years for women in their 20s and 30s, and then every year beginning at age 40.

The 60-year-old woman comes to the clinic 3 years after her last regular appointment. She reports occasional diffuse breast tenderness, aching, and soreness. What do you anticipate will happen first? A. Magnetic resonance imaging (MRI) B. Mammography C. Teaching the patient to take vitamin E D. Teaching continual wearing of a support bra

B. Mammography Although these symptoms can indicate benign mastalgia, mammography is anticipated to exclude cancer and provide information on the cause of mastalgia. Usually, mastalgia improves after menopause, and the current recommendation for mammograms is yearly after age 40. MRI is used for screening in high-risk women, including those whose mammography or ultrasound result is suspicious for malignancy and women who previously had an occult breast cancer detected by mammography. Self-help measures to treat mastalgia are considered after cancer has been excluded.

The nurse teaches a 30-yr-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu?

Baked chicken, peas, apple slices, and skim milk A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.

The nurse is caring for an obese 67-year-old woman after a right mastectomy with axillary lymph node dissection. Which should the nurse include in the discharge instructions? A. "Arm exercises should not be started for 4 to 6 weeks." B. "Discontinue arm exercises if you have discomfort or pain." C. "Special massage therapy can decrease swelling in your arm." D. "Keep your right arm in a sling to decrease pain and swelling."

C. "Special massage therapy can decrease swelling in your arm." Decongestive therapy may be used for acute lymphedema and includes a massage-like technique to mobilize the subcutaneous accumulation of fluid. Arm exercises should be performed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation. The arm exercises should be initiated after surgery and increased gradually. Pain medications should be administered 30 minutes before arm exercises. The operative arm should be kept at the level of the heart but not in a sling; a sling discourages use of the arm.

The nurse caring for patients in a primary care clinic identifies which patient as being the most at risk for the development of breast cancer? A. A 25-year-old female with fibrocystic breast disease B. A 59-year-old male who has inherited the APC gene C. A 72-year-old female with a family history of breast cancer D. A 43-year-old male who is obese and leads a sedentary lifestyle

C. A 72-year-old female with a family history of breast cancer The risk factors most associated with breast cancer are female gender, advancing age, and family history. The incidence of breast cancer increases dramatically after age 60. Mutations in BRCA genes may cause 5% to 10% of breast cancers; APC gene is associated with colon cancer. Obesity and physical inactivity increase the risk for breast cancer. Fibrocystic breast disease is not associated with the development of breast cancer.

The nurse is caring for a patient diagnosed with breast cancer who just underwent an axillary lymph node dissection. What intervention should the nurse use to decrease the lymphedema? A. Keep affected arm flat at the patient's side. B. Apply an elastic bandage on the affected arm. C. Assess blood pressure only on unaffected arm. D. Restrict exercise of the affected arm for 1 week.

C. Assess blood pressure only on unaffected arm. Blood pressure readings, venipunctures, and injections should not be done on the affected arm. Elastic bandages should not be used in the early postoperative period because they inhibit collateral lymph drainage. The affected arm should be elevated above the heart, and isometric exercises are recommended and gradually increased starting in the recovery room to reduce fluid volume in the arm.

The nurse performs a breast examination on a 68-year-old female patient. Which clinical manifestation, if assessed by the nurse, indicates that further evaluation for breast cancer is needed? A. Bilateral pendulous breasts B. Right breast is warm, painful to touch C. Irregular, nontender lump with induration D. Palpable lump that is tender and movable

C. Irregular, nontender lump with induration Clinical manifestations of breast cancer may include a palpable lump that is hard, irregular, poorly delineated, nonmobile, and nontender. Nipple retraction, peau d'orange, induration, and dimpling of the overlying skin may also be noted. Mastitis presents with breasts that are warm to touch, indurated, and painful. Atrophy of the mammary glands associated with aging may result in pendulous breasts. Manifestations of fibrocystic breast changes include palpable lumps that are round, well delineated, and freely movable. The lump is usually tender and increases in size and tenderness before menstruation.

When doing breast self-examination, the female patient should report which findings to her physician? A. Palpable rib margins B. Denser breast tissue C. Left nipple deviation D. Different sized breasts

C. Left nipple deviation Unilateral deviation of a nipple may be a clinical indicator of breast cancer or other problem and should be reported to the health care provider. Dense breast tissue, palpable rib margins, and different sized breasts are all normal findings.

The nurse is caring for a 52-year-old woman with breast cancer who is receiving high-dose doxorubicin (Adriamycin). Which assessment is most important for the nurse to make? A. Observe for alopecia. B. Determine visual acuity. C. Monitor cardiac rhythm. E. Assess mouth and throat.

C. Monitor cardiac rhythm. Doxorubicin (especially at high doses) may cause cardiotoxicity and heart failure. The nurse should monitor for cardiac dysrhythmias, electrocardiogram changes, and clinical manifestations of heart failure. Other adverse effects of doxorubicin include stomatitis and alopecia, but these effects are not as serious as cardiac problems. Tamoxifen may cause visual changes.

You are a community health nurse planning a program on breast cancer screening guidelines for women in the neighborhood. What would you include to best promote learning and adherence of the participants (select all that apply)? A. Short audiotape on the BSE procedure B. Packet of articles from the medical literature C. Written guidelines for mammography and CBE D. Discussion of the value of early breast cancer detection E. Need to get mammogram starting at age 35

C. Written guidelines for mammography and CBE D. Discussion of the value of early breast cancer detection When teaching women about breast cancer screening guidelines, include information about potential benefits, limitations, and harm (chance of a false-positive result). Allow time for questions about the procedure and a return demonstration. At every periodic health examination, ask the woman who is performing BSE to demonstrate her technique. Demonstration of BSE and provision of written guidelines are appropriate teaching methods. Reference: 1307

During admission of a patient diagnosed with non-small cell lung cancer, the nurse questions the patient related to a history of which risk factors for this type of cancer? (Select all that apply.) Asbestos exposure Exposure to uranium Chronic interstitial fibrosis History of cigarette smoking Geographic area in which they were born

Correct Answer: Asbestos exposure Exposure to uranium History of cigarette smoking Rationale: Non-small cell cancer is associated with cigarette smoking and exposure to environmental carcinogens, including asbestos and uranium. Chronic interstitial fibrosis is associated with the development of adenocarcinoma of the lung. Exposure to cancer-causing substances in the geographic area where the patient has lived for some time may be a risk but not necessarily where the patient was born.

The nurse is developing a plan of care for a patient with metastatic lung cancer and a 60-pack-year history of cigarette smoking. What should the nurse assess this patient for? Cough reflex Mucociliary clearance Reflex bronchoconstriction Ability to filter particles from the air

Correct Answer: Mucociliary clearance Rationale: Smoking decreases the ciliary action in the tracheobronchial tree, resulting in impaired clearance of respiratory secretions and particles, chronic cough, and frequent respiratory infections.

While ambulating a patient with metastatic lung cancer, the nurse observes a decrease in oxygen saturation from 93% to 86%. Which nursing action is most appropriate? Continue with ambulation. Obtain a provider's order for arterial blood gas. Obtain a provider's order for supplemental oxygen. Move the oximetry probe from the finger to the earlobe.

Correct Answer: Obtain a provider's order for supplemental oxygen. Rationale: An oxygen saturation level that drops below 90% with activity indicates that the patient is not tolerating the exercise and needs to use supplemental oxygen. The patient will need to rest to resaturate. ABGs or moving the probe will not be needed as the pulse oximeter was working at the beginning of the walk.

The nurse is caring for a patient with unilateral lung cancer. What is the priority nursing action to enhance oxygenation in this patient? Positioning patient on right side Maintaining adequate fluid intake Positioning patient with "good lung" down Performing postural drainage every 4 hours

Correct Answer: Positioning patient with "good lung" down Rationale: Therapeutic positioning identifies the best position for the patient, thus assuring stable oxygenation status. Research indicates that positioning the patient with the unaffected lung (good lung) dependent best promotes oxygenation in patients with unilateral lung disease. For bilateral lung disease, the right lung down has best ventilation and perfusion. Increasing fluid intake and performing postural drainage will facilitate airway clearance, but positioning is most appropriate to enhance oxygenation.

A 33-yr-old patient noticed a painless lump and heaviness in his scrotum during testicular self-examination. The nurse should provide the patient information on which diagnostic test? Ultrasound Cremasteric reflex Doppler ultrasound Transillumination with a flashlight

Correct Answer: Ultrasound Rationale: When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele.

The primary protective role of the immune system related to malignant cells is a. surveillance for cells with tumor-associated antigens. b. binding with free antigen released by malignant cells. c. production of blocking factors that immobilize cancer cells. d. responding to a new set of antigenic determinants on cancer cells.

Correct answer: a Rationale: Cancer cells may display altered cell surface antigens as a result of malignant transformation. These antigens are called tumor-associated antigens (TAAs). One of the functions of the immune system is to respond to TAAs.

A 70-year-old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and complains of nausea and constipation. Which complication of cancer is this most likely caused by? a. Hypercalcemia b. Tumor lysis syndrome c. Spinal cord compression d. Superior vena cava syndrome

Correct answer: a Rationale: Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or exacerbate hypercalcemia. The primary manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting.

A patient has recently been diagnosed with early stages of breast cancer. What is most appropriate for the nurse to focus on? a. Maintaining the patient's hope b. Preparing a will and advance directives c. Discussing replacement child care for the patient's children d. Discussing the patient's past experiences with her grandmother's cancer

Correct answer: a Rationale: Maintain hope, which is the key to effective cancer care. Hope depends on the status of the patient: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care.

The nurse explains to a patient undergoing brachytherapy of the cervix that she a. must undergo simulation to locate the treatment area. b. requires the use of radioactive precautions during nursing care. c. may experience desquamation of the skin on the abdomen and upper legs. d. requires shielding of the ovaries during treatment to prevent ovarian damage.

Correct answer: b Rationale: Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or adjacent to the tumor. Caring for the person undergoing brachytherapy or receiving radiopharmaceuticals requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, and shielding are vital to health care professional safety in caring for the person with an internal radiation source.

To prevent fever and shivering during an infusion of rituximab (Rituxan), the nurse should premedicate the patient with a. aspirin. b. acetaminophen. c. sodium bicarbonate. d. meperidine (Demerol).

Correct answer: b Rationale: Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is commonly premedicated with acetaminophen in an attempt to prevent or decrease the intensity of these symptoms, and large amounts of fluids help decrease symptoms.

The nurse receives an order for a patient with lung cancer to receive influenza vaccine and pneumococcal vaccines. The nurse will a. call the health care provider to question the order. b. give both vaccines at the same time in different arms. c. give the pneumococcal vaccine and obtain a nasal influenza vaccine. d. give the flu shot and tell the patient to come back in 1 week to have the pneumococcal vaccine.

Correct answer: b Rationale: Patients at risk for pneumonia (e.g., patients with lung cancer) should have influenza and pneumococcal vaccines. The vaccines may be given at the same time in different arms.

A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9 x 10³/µL, hemoglobin of 10.8 g/dL, and a platelet count of 99 x 10³/µL. Based on the CBC results, what is the most serious clinical finding? a. Cough, rhinitis, and sore throat b. Fatigue, nausea, and skin redness at site of radiation c. Temperature of 101.9° F, fatigue, and shortness of breath d. Skin redness at site of radiation, headache, and constipation

Correct answer: c Rationale: Neutropenia is more common in patients receiving chemotherapy than in those receiving radiation, and it can seriously increase the risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly because fever in the setting of neutropenia is a medical emergency.

The nurse counsels the patient receiving radiation therapy or chemotherapy that a. effective birth control methods should be used for the rest of the patient's life. b. if nausea and vomiting occur during treatment, the treatment plan will be modified. c. after successful treatment, a return to the person's previous functional level can be expected. d. the cycle of fatigue-depression-fatigue that may occur during treatment may be reduced by restricting activity.

Correct answer: c Rationale: Some cancer survivors may continue to experience symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. A cancer diagnosis can affect many aspects of a patients' life; cancer survivors commonly report financial, vocational, marital, and emotional concerns long after treatment is over. Resources for survivors are listed in Table 15-20.

"The goals of cancer treatment are based on the principle that a. surgery is the single most effective treatment for cancer. b. initial treatment is always directed toward cure of the cancer. c. a combination of treatment modalities is effective for controlling many cancers. d. although cancer cure is rare, quality of life can be increased with treatment modalities.

Correct answer: c Rationale: The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the particular cancer being treated and may involve local therapies (i.e., surgery or radiation) alone or in combination, with or without adjunctive systemic therapy (i.e., chemotherapy).

Trends in the incidence and death rates of cancer include the fact that a. lung cancer is the most common type of cancer in men. b. a higher percentage of women than men have lung cancer. c. breast cancer is the leading cause of cancer deaths in women. d. African Americans have a higher death rate from cancer than whites.

Correct answer: d Rationale: Cancer incidence and death rates are disproportionately higher among African Americans than among other minority groups and white people.

The most effective method of administering a chemotherapy agent that is a vesicant is to a. give it orally. b. give it intraarterially. c. use an Ommaya reservoir. d. use a central venous device.

Correct answer: d Rationale: If vesicants are inadvertently infiltrated into the skin, severe local tissue breakdown and necrosis may result. It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs. The infusion should be immediately turned off, and protocols for drug-specific extravasation procedures should be followed to minimize further tissue damage. Infusion with central venous access devices can reduce the risk of infiltration of chemotherapy agents that are vesicants.

A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing intervention would be a priority? a. Advise the patient to eat foods that are fatty, fried, or high in calories. b. Discuss with the physician the need for parenteral or enteral feedings. c. Advise the patient to drink a nutritional supplement beverage at least three times a day. d. Advise the patient to experiment with spices and seasonings to enhance the flavor of food.

Correct answer: d Rationale: Instruct the patient to experiment with spices and other seasoning agents in an attempt to mask taste alterations. Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste of certain meats and fish. Onion and pieces of ham may enhance the taste of vegetables.

A characteristic of the stage of progression in the development of cancer is a. oncogenic viral transformation of target cells b. a reversible steady growth facilitated by carcinogens. c. a period of latency before clinical detection of cancer. d. proliferation of cancer cells despite host control mechanisms.

Correct answer: d Rationale: Progression is the final stage of cancer. This stage is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (i.e., metastasis). Progression occurs as a result of the following characteristics of cancer cells: rapid proliferation and decreased cell adhesion.

The nurse is caring for a 59-year-old woman who had surgery 1 day ago for removal of a malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says she is scared to die. The most effective nursing intervention at this point is to use this opportunity to a. motivate change in an unhealthy lifestyle. b. teach her about the seven warning signs of cancer. c. instruct her about healthy stress relief and coping practices. d. let her communicate about the meaning of this experience.

Correct answer: d Rationale: While the patient is waiting for diagnostic study results, you should be available to actively listen to the patient's concerns, and you should be skilled in techniques that can engage the patient and the family members or significant others in a discussion about their cancer-related fears.

Which patient probably has the highest risk of breast cancer? A. 60 year old obese man B. 58 year old woman with sedentary lifestyle C. 55 year old woman with fibrocystic breast changes D. 65 year old woman with a sister diagnosed with breast cancer

D. After the age of 60, the incidence of breast cancer increases dramatically and advanced age is the highest risk factor for females. Ninety-nine percent of breast cancer cases occur in women. A first degree relative with breast cancer is a contributing factor for breast cancer. Genetic mutation in BRCA1, BRCA 2, p53, ATM, and CHEK2 genes may increase the risk of breast cancer. Obesity and lack of physical activity are other contributing factors. Fibrocystic breast changes are neither a precursor of breast cancer nor a known risk factor for cancer

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

D. Most breast lesion are benign, and many mobile cystic lesions change in response to menstrual cycle, whereas most malignant tumors do not. Caffeine has been associated with fibrocystic changes in some women, but research has not established caffeine as a cause of breast pain or cysts. Questions regarding a patients last mammogram of family history are not closely related to the nurse's findings

The nurse teaches a 53-year-old patient about screening for early detection of breast cancer. Which statement by the patient requires an intervention by the nurse? A. "I should plan to have a mammogram every year." B. "I will see a health care provider every year for a breast examination." C. "A breast examination should be done right after my menstrual period." D. "Self-breast examination is a reliable way to detect breast cancer early."

D. "Self-breast examination is a reliable way to detect breast cancer early." Screening for the early detection of breast cancer includes yearly mammograms starting at age 40 and clinical breast examination every year at age 40. An alternative suggestion is to begin screening mammograms at age 50. Breast self-examination has benefits and limitations and may not be a reliable method for early detection of breast cancer. BSE is optional but should be done in premenopausal women right after the menstrual period when the breasts are less lumpy and tender.

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

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

20. A patient with 40 pack-year smoking history has recently stopped smoking because of the fear of developing lung cancer. The patient asks the nurse what he can do to learn about whether he develops lung cancer. What is the best response from the nurse? A. Lung tomograms B. Pulmonary angiography C. Biopsy done via bronchoscopy D. Computed tomography (CT) scans

D. Computed tomography (CT) scans The use of radiology, computed tomography (CT), and sputum cytology has been shown to detect lung cancer at earlier stages. Low-dose spiral CT scanning has been shown to decrease lung cancer mortality compared with those who had chest x-rays. To be considered for screening for lung cancer, patients must be 55 to 74 years old, current smokers with at least a 30 pack-year smoking history or former smokers who quit within the past 15 years, have no history of lung cancer, and not be on home oxygen A patient who has a smoking history always has an increased risk for lung cancer compared with an individual who has never smoked but the risk decreases as the period of nonsmoking increases

A modified radical mastectomy with an axillary lymph node dissection has been scheduled for your patient with breast cancer. What will you do postoperatively to restore arm function on the affected side? A. Apply heating pads or blankets to increase circulation. B. Place daily ice packs to minimize the risk of lymphedema. C. Teach passive exercises with the affected arm in a dependent position. D. Emphasize regular exercise for the affected shoulder to increase range of motion.

D. Emphasize regular exercise for the affected shoulder to increase range of motion. Restoring arm function on the affected side after mastectomy and axillary lymph node dissection is a key nursing goal. Place the woman in a semi-Fowler's position, with the arm on the affected side elevated on a pillow. Flexing and extending the fingers should begin in the recovery room, with progressive increases in activity encouraged. Postoperative arm and shoulder exercises are instituted gradually under a surgeon's direction. These exercises are designed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation. The goal of all exercise is a gradual return to full range of motion within 4 to 6 weeks. Reference: 1320, 1323

A young woman was just told by her physician that she has breast cancer. What is your most appropriate action? A. Offer to answer questions. B. Call the chaplain. C. Leave her alone to give her privacy. D. Encourage her to talk about her feelings.

D. Encourage her to talk about her feelings. In a crisis, talking about feelings and letting the patient take the lead is the best approach. Reference: 1323

A 51-year-old woman has recently had a unilateral, right total mastectomy and axillary node dissection for the treatment of breast cancer. What nursing intervention should the nurse include in the patient's care? A. Immobilize the patient's right arm until postoperative day 3. B. Maintain the patient's right arm in a dependent position when at rest. C. Administer diuretics prophylactically for the prevention of lymphedema. D. Promote gradually increasing mobility as soon as possible following surgery.

D. Promote gradually increasing mobility as soon as possible following surgery. Mobility should be encouraged beginning in the postanesthesia care unit (PACU) and increased gradually throughout the patient's recovery. Immobilization is counterproductive to recovery, and the limb should not be in a dependent position. Diuretics are not used to prevent lymphedema but may be used in active treatment of the problem.

In teaching a patient who wants to perform BSE, you inform her that the technique involves palpation of the breast tissue and A. palpation of cervical lymph nodes. B. hard squeezing of the breast tissue. C. a mammogram to evaluate breast tissue. D. inspection of the breasts for any changes.

D. inspection of the breasts for any changes. BSE is performed by palpation of breast tissue with three levels of pressure. Breasts also should be inspected for size, shape, redness, scaliness, or dimpling of the breast skin or nipple. Reference: 1307

19. a health promotion program, why should the nurse plan to target women in a discussion of lung cancer prevention (select all that apply)? a. Women develop lung cancer at a younger age than men. b. More women die of lung cancer than die from breast cancer. c. Women have a worse prognosis from lung cancer than do men. d. Women are more likely to develop small cell carcinoma than men. e. Nonsmoking women are at greater risk for developing lung cancer than men.

a, b, d, e. a. Women develop lung cancer at a younger age than men. b. More women die of lung cancer than die from breast cancer. d. Women are more likely to develop small cell carcinoma than men. e. Nonsmoking women are at greater risk for developing lung cancer than men. Smoking by women is taking a great toll, as reflected by the increasing incidence and deaths from lung cancer in women, who develop lung cancer at a younger age than men. Nonsmoking women are at greater risk of developing lung cancer. The incidence of small cell carcinoma is higher in women than in men. Men still have a worse prognosis than women from lung cancer.

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? a. A bland, low-fiber diet b. A high-protein, high-calorie diet c. A diet high in fresh fruits and vegetables d. A diet emphasizing whole and organic foods

a. A bland, low-fiber diet Patients experiencing diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.

For which type of malignancy should the nurse expect the use of the intravesical route of regional chemotherapy delivery? a. Bladder b. Leukemia c. Osteogenic sarcoma d. Metastasis to the brain

a. Bladder Intravesical regional chemotherapy is administered into the bladder via a urinary catheter. Leukemia is treated with IV chemotherapy. Osteogenic sarcoma is treated with intraarterial chemotherapy via vessels supplying the tumor. Metastasis to the brain is treated with intraventricular or intrathecal chemotherapy via an Ommaya reservoir or lumbar punctures.

The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? a. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years b. Family history of colorectal cancer and consumes a high-fiber diet c. Limits fat consumption and has regular mammography and Pap screenings d. Exercises five times every week and does not consume alcoholic beverages

a. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years Cancer prevention and early detection are associated with the following behaviors: limited alcohol use, regular physical activity, maintaining a normal body weight, obtaining regular cancer screenings, avoiding cigarette smoking and other tobacco use, using sunscreen with SPF 15 or higher, and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).

The laboratory reports that the cells from the patient's tumor biopsy are grade II. What should the nurse know about this histologic grading? a. Cells are abnormal and moderately differentiated. b. Cells are very abnormal and poorly differentiated. c. Cells are immature, primitive, and undifferentiated. d. Cells differ slightly from normal cells and are well-differentiated.

a. Cells are abnormal and moderately differentiated. Grade II cells are more abnormal than grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.

Patients may reduce the risk of developing cancer using health promotion strategies.Identify strategies which can reduce the risk of developing cancer. Select all that apply. a. Control weight b. Genetic testing c. Immunizations d. Use sunscreen e. Stop smoking f. Limit alcohol intake

a. Control weight b. Genetic testing c. Immunizations d. Use sunscreen e. Stop smoking f. Limit alcohol intake Changing a person's lifestyle can limit cancer promotors, which is key in cancer prevention. Immunizations such as human papilloma virus (HPV) can prevent cervical cancer. Use of sunscreen (SPF 15 or greater) can prevent cell damage and development of skin cancer. Cigarette smoke can initiate or promote cancer development. Alcohol intake combined with cigarette smoking can promote esophageal and bladder cancers. Management of weight can reduce the risk of cancer. Genetic testing (i.e., APC gene) identifies the predisposition of colorectal cancer.

To prevent the debilitating cycle of fatigue-depression-fatigue in patients receiving radiation therapy, what should the nurse encourage the patient to do? a. Implement a walking program b. Ignore the fatigue as much as possible c. Do the most stressful activities when fatigue is tolerable d. Schedule rest periods throughout the day whether fatigue is present or not

a. Implement a walking program Walking programs scheduled during the time of day when the patient feels better are a way for patients to keep active without overtaxing themselves and help to combat the depression caused by inactivity. Ignoring the fatigue or overstressing the body can make symptoms worse and the patient should rest before activity and as necessary.

The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation? Select all that apply. a. Maintain hope. b. Exhibit a caring attitude. c. Plan realistic long-term goals. d. Give them antianxiety medications. e. Be available to listen to fears and concerns. f. Teach them about the types of cancer that could be diagnosed.

a. Maintain hope. b. Exhibit a caring attitude. e. Be available to listen to fears and concerns. Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching them about the diagnostic procedures would also be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.

Which word identifies a mutation of protooncogenes? a. Oncogenes b. Retrogenes c. Oncofetal antigens d. Tumor angiogenesis factor

a. Oncogenes Oncogenes are the mutation of protooncogenes, which then induce tumors. Oncogenic viruses cause genetic alterations and mutations that allow the cell to express the abilities and properties it had in fetal development and may lead to cancer. Oncofetal antigens are antigens that are found on the surface and inside the cancer cells. They are an expression of the cells usually associated with embryonic or fetal periods of life and may be used as tumor markers to monitor treatment. Tumor angiogenesis factor is the substance within tumors that promotes blood vessel development.

A patient with a genetic mutation of BRCA1 and a family history of breast cancer is admitted to the surgical unit where she is scheduled that day for a bilateral simple mastectomy. What is the reason for this procedure? a. Prevent breast cancer b. Diagnose breast cancer c. Cure or control breast cancer d. Provide palliative care for untreated breast cancer

a. Prevent breast cancer A simple mastectomy can be done to prevent breast cancer in women with high risk and can be used to control, cure, or provide palliative care for breasts with cancerous tumors. A mastectomy would not be used for biopsy or otherwise to establish a diagnosis of cancer.

What does the presence of carcinoembryonic antigens (CEAs) and α-fetoprotein (AFP) on cell membranes indicate has happened to the cells? a. They have shifted to more immature metabolic pathways and functions. b. They have spread from areas of original development to different body tissues. c. They produce abnormal toxins or chemicals that indicate abnormal cellular function. d. They have become more differentiated as a result of repression of embryonic functions.

a. They have shifted to more immature metabolic pathways and functions. Cancer cells become more fetal and embryonic (undifferentiated) in appearance and function and some produce new proteins, such as carcinoembryonic antigen (CEA) and α-fetoprotein (AFP), on cell membranes that reflect a return to more immature functioning. The other options are unrelated to CEA and AFP.

23. A patient with advanced lung cancer refuses pain medication, saying, "I deserve everything this cancer can give me." What is the nurse's best response to this patient? a. "Would talking to a counselor help you?" b. "Can you tell me what the pain means to you?" c. "Are you using the pain as a punishment for your smoking?" d. "Pain control will help you to deal more effectively with your feelings."

b. "Can you tell me what the pain means to you?" Before making any judgments about the patient's statement, it is important to explore what meaning he or she finds in the pain. It may be that the patient feels it is deserved punishment for smoking but further information needs to be obtained from the patient. Immediate referral to a counselor negates the nurse's responsibility in helping the patient and there is no indication that the patient is not dealing effectively with his or her feelings

Which statement by the nurse most facilitates patient cancer prevention during the promotion stage of cancer development? a. "Exercise every day for 30 minutes." b. "Follow smoking cessation recommendations." c. "Following a vitamin regime is highly recommended." d. "I recommend excision of the cancer as soon as possible."

b. "Follow smoking cessation recommendations." The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Cigarette smoking is a promoting factor and a carcinogen. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be consistent with the nurse's role.

Which patient is statistically and medically at the highest risk of developing cancer? a. A 68-yr-old white woman who has BRCA-1 gene and is obese b. A 56-yr-old African American man with hepatitis C who drinks alcohol daily c. An 18-yr-old Hispanic man who eats fast food once per week and drink alcohol d. An 80-yr-old Asian woman with coronary artery disease on blood pressure medication.

b. A 56-yr-old African American man with hepatitis C who drinks alcohol daily The combination of statistically identified risk factors in addition to current liver disease (hepatitis C that is linked to the development of liver cancer) and the added promoter of alcohol makes this patient at the highest risk. Second is the white woman with the gene for breast cancer and the added promoter of obesity. The majority of cancer cases are diagnosed in individuals older than 55 years of age. The overall incidence of cancer is higher in men than women. Cancer incidence is higher in African Americans, then whites, and then people from other cultures.

The nurse is counseling a group of individuals over the age of 50 with average risk for cancer about screening tests for cancer. Which screening recommendation should be performed to screen for colorectal cancer? a. Barium enema every year b. Colonoscopy every 10 years c. Fecal occult blood every 5 years d. Annual prostate-specific antigen (PSA) and digital rectal exam

b. Colonoscopy every 10 years Healthy men and women should have a colonoscopy every 10 years, an annual fecal occult blood test, or a barium enema every 5 years. These frequencies may change depending on the results. Annual PSA and digital rectal exams screen for prostate problems, although the decision to test is made by the patient with his health care provider.

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that the patient is at risk for tumor lysis syndrome (TLS) and will monitor for which abnormality associated with this oncologic emergency? a. Hypokalemia b. Hypocalcemia c. Hypouricemia d. Hypophosphatemia

b. Hypocalcemia TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

The patient was told she has carcinoma in situ, and the student nurse wonders what that is. How should the nurse explain this to the student nurse? a. Evasion of the immune system by cancer cells b. Lesion with histologic features of cancer except invasion c. Capable of causing cellular alterations associated with cancer d. Tumor cell surface antigens that stimulate an immune response

b. Lesion with histologic features of cancer except invasion Carcinoma in situ has the histologic features except invasion. Evasion of the immune system by cancer cells by various methods is immunologic escape. Oncogenic factors are capable of causing cellular alterations associated with cancer. Tumor cell surface antigens that stimulate an immune response are tumor-associated antigens.

When the patient asks about the late effects of chemotherapy and high-dose radiation, what areas of teaching should the nurse plan to include when describing these effects? a. Third space syndrome b. Secondary malignancies c. Chronic nausea and vomiting d. Persistent myelosuppression

b. Secondary malignancies Alkylating chemotherapeutic agents and high-dose radiation are most likely to cause secondary malignancies as a late effect of treatment. The other conditions are not known to be late effects of radiation or chemotherapy.

When a patient is undergoing brachytherapy, what is it important for the nurse to be aware of when caring for this patient? a. The patient will undergo simulation to identify and mark the field of treatment. b. The patient is a source of radiation and personnel must wear film badges during care. c. The goal of this treatment is only palliative and the patient should be aware of the expected outcome. d. Computerized dosimetry is used to determine the maximum dose of radiation to the tumor within an acceptable dose to normal tissue.

b. The patient is a source of radiation and personnel must wear film badges during care. Brachytherapy is the implantation or insertion of radioactive materials directly into the tumor or in proximity to the tumor and may be curative. The patient is a source of radiation and in addition to implementing the principles of time, distance, and shielding, film badges should be worn by caregivers to monitor the amount of radiation exposure. Computerized dosimetry and simulation are used in external radiation therapy.

A small lesion is discovered in a patient's lung when an x-ray is performed for cervical spine pain. What is the definitive method of determining if the lesion is malignant? a. Lung scan b. Tissue biopsy c. Oncofetal antigens in the blood d. CT or positron emission tomography (PET) scan

b. Tissue biopsy Although other tests may be used in diagnosing the presence and extent of cancer, biopsy is the only method by which cells can be definitely determined to be malignant.

The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? a. Ask the patient if the site hurts. b. Turn off the chemotherapy infusion. c. Call the ordering health care provider. d. Administer sterile saline to the reddened area.

b. Turn off the chemotherapy infusion. Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation, the infusion should first be stopped. Then the protocol for the drug-specific extravasation procedures should be followed to minimize further tissue damage. The site of extravasation usually hurts, but it may not. It is more important to stop the infusion immediately. The health care provider may be notified by another nurse while the patient's nurse starts the drug-specific extravasation procedures, which may or may not include sterile saline.

The nurse uses many precautions during IV administration of vesicant chemotherapeutic agents, primarily to prevent a. septicemia. b. extravasation. c. catheter occlusion. d. anaphylactic shock.

b. extravasation. One of the major concerns with the IV administration of vesicant chemotherapeutic agents is infiltration or extravasation of drugs into tissue surrounding the infusion site. When infiltrated into the skin, vesicants cause pain, severe local breakdown, and necrosis. Specific measures to ensure adequate dilution, patency, and early detection of extravasation and treatment are important.

Serum tumor markers that may be elevated on diagnosis of testicular cancer and used to monitor the response to therapy include a. tumor necrosis factor (TNF) and C-reactive protein (CRP). b. α-fetoprotein (AFP) and human chorionic gonadotropin (hCG). c. prostate-specific antigen (PSA) and prostate acid phosphatase (PAP). d. carcinoembryonic antigen (CEA) and antinuclear antibody (ANA).

b. α-Fetoprotein (AFP) and human chorionic gonadotropin (hCG) are glycoproteins that may be elevated in testicular cancer. If they are elevated before surgical treatment, the levels are noted, and if response to therapy is positive, the levels will decrease. Lactate dehydrogenase (LDH) may also be elevated. Tumor necrosis factor (TNF) is a normal cytokine responsible for tumor surveillance and destruction. C-reactive protein (CRP) is found in inflammatory conditions and widespread malignancies. PSA and PAP are used for screening of prostatic cancer. Carcinoembryonic antigen (CEA) is a tumor marker for cancers of the GI system. Antinuclear antibody (ANA) is found most frequently in autoimmune disorders.

The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg and it is getting worse. Which question would best determine treatment measures for the patient's pain? a. "Where is the pain?" b. "Is the pain getting worse?" c. "What does the pain feel like?" d. "Do you use medications to relieve the pain?"

c. "What does the pain feel like?" The UAP told the nurse the location of the patient's pain and the patient reports worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.

A female patient is having chemotherapy for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? a. "When your hair grows back, it will be patchy." b. "Don't use your curling iron, and that will slow down the loss." c. "You can get a wig now to match your hair so you will not look different." d. "You should contact "Look Good, Feel Better" to figure out what to do about this."

c. "You can get a wig now to match your hair so you will not look different." The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. Although hair loss with chemotherapy is usually reversible, hair loss with radiation is usually permanent in the areas radiation was administered. When hair grows back it could be a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern.

A patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? a. Use Dial soap to feel clean and fresh. b. Scented lotion can be used on the area. c. Avoid heat and cold to the treatment area. d. Wear the new bra to comfort and support the area.

c. Avoid heat and cold to the treatment area. Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.

21. A patient with a lung mass found on chest x-ray is undergoing further testing. The nurse explains that a diagnosis of lung cancer can be confirmed using which diagnostic test? a. Lung tomograms b. Pulmonary angiography c. Biopsy done via bronchoscopy d.Computed tomography (CT) scans

c. Biopsy done via bronchoscopy Although chest x-rays, lung tomograms, CT scans, MRI, and positron emission tomography (PET) can identify tumors and masses, a definitive diagnosis of a lung cancer requires identification of malignant cells in either sputum specimens or biopsies

Which normal tissues manifest early, acute responses to radiation therapy? a. Spleen and liver b. Kidney and nervous tissue c. Bone marrow and gastrointestinal (GI) mucosa d. Hollow organs such as the stomach and bladder

c. Bone marrow and gastrointestinal (GI) mucosa Tissue that is actively proliferating, such as GI mucosa, esophageal and oropharyngeal mucosa, and bone marrow, exhibits early acute responses to radiation therapy. Radiation ionization breaks chemical bonds in DNA, which renders cells incapable of surviving mitosis. This loss of proliferative capacity yields cellular death at the time of division for both normal cells and cancer cells but cancer cells are more likely to be dividing because of the loss of control of cellular division. Cartilage, bone, kidney, and nervous tissues that proliferate slowly manifest subacute or late responses

What describes a primary use of biologic therapy in cancer treatment? a. Protect normal, rapidly reproducing cells of the gastrointestinal system from damage during chemotherapy b. Prevent the fatigue associated with chemotherapy and high-dose radiation as seen with bone marrow depression c. Enhance or supplement the effects of the host's immune responses to tumor cells that produce flu-like symptoms d. Depress the immune system and circulating lymphocytes as well as increase a sense of well-being by replacing central nervous system deficits

c. Enhance or supplement the effects of the host's immune responses to tumor cells that produce flu-like symptoms Biologic therapies are normal components of the immune system and are used therapeutically to restore, augment, or modulate host immune system mechanisms. They have direct antitumor effects or other biologic effects to assist in immune activity against cancer cells. Virtually all biologic therapies may cause a flu-like syndrome. The other options are not correct.

The patient is told that her adenoma tumor is not encapsulated but has normally differentiated cells and surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? a. It will recur. b. It has metastasized. c. It is probably benign. d. It is probably malignant.

c. It is probably benign. Benign tumors are usually encapsulated, have normally differentiated cells, and do not metastasize. Malignant tumors are rarely encapsulated, have poorly differentiated cells, and are capable of metastasis.

A 55-year-old man with a history of prostate cancer in his family asks the nurse what he can do to decrease the risk of prostate cancer. What should the nurse teach him about prostate cancer risks? a. Nothing can decrease the risk because prostate cancer is primarily a disease of aging. b. Treatment of any enlargement of the prostate gland will help to prevent prostate cancer. c. Substituting fresh fruits and vegetables for high-fat foods in the diet may lower the risk of prostate cancer. d. Using a natural herb, saw palmetto, has been found to be an effective protection against prostate cancer.

c. Most prostate cancers (about 75%) are considered sporadic. About the only modifiable risk factor for prostate cancer is its association with a diet high in red and processed meat and high-fat dairy products along with a low intake of vegetables and fruits. Age, ethnicity, and family history are risk factors for prostate cancer but are not modifiable. Simple enlargement or hyperplasia of the prostate is not a risk factor for prostate cancer.

An allogenic hematopoietic stem cell transplant is considered as treatment for a patient with acute myelogenous leukemia. What information should the nurse include when teaching the patient about this procedure? a. There is no risk for graft-versus-host disease because the donated marrow is treated to remove cancer cells. b. The patient's bone marrow will be removed, treated, stored, and then reinfused after intensive chemotherapy. c. Peripheral stem cells are obtained from a donor who has a human leukocyte antigen (HLA) match with the patient. d. There is no need for posttransplant protective isolation because the stem cells are infused directly into the blood.

c. Peripheral stem cells are obtained from a donor who has a human leukocyte antigen (HLA) match with the patient. An allogenic hematopoietic stem cell or bone marrow transplant is one in which peripheral stems cells or bone marrow from an HLA-matched donor is infused into a patient who has received high doses of chemotherapy, with or without radiation, to eradicate cancerous cells. In an autologous bone marrow transplant, the patient's own bone marrow is removed before therapy to destroy the bone marrow. The marrow is treated to remove cancer cells and may be infused shortly after conditioning treatment or frozen and stored for later use. With either source, the new bone marrow will take several weeks to produce new blood cells and protective isolation is necessary during this time.

Priority Decision: While caring for a patient who is at the nadir of chemotherapy, the nurse establishes the highest priority for nursing actions related to a. diarrhea. b. grieving. c. risk for infection. d. inadequate nutritional intake.

c. risk for infection. The nadir is the point of the lowest blood counts after chemotherapy is started and it is the time when the patient is most at risk for infection. Because infection is the most common cause of morbidity and death in cancer patients, identification of risk and interventions to protect the patient are of the highest priority. The other problems will be treated but they are not the priority.

The nurse is caring for an 18-yr-old female patient with acute lymphocytic leukemia that is scheduled for hematopoietic stem cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure? a. "I understand the transplant procedure has no dangerous side effects." b. "After the transplant, I will feel better and can go home in 5 to 7 days." c. "My brother will be a 100% match for the cells used during the transplant." d. "Before the transplant, I will have chemotherapy and possibly full-body radiation."

d. "Before the transplant, I will have chemotherapy and possibly full-body radiation." Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.

A 33-yr-old patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis? a. "The cancer is found at the point of origin only." b. "Tumor cells have been identified in the cervical region." c. "The cancer has been identified in the cervix and the liver." d. "Your cancer was identified in the cervix and has limited local spread."

d. "Your cancer was identified in the cervix and has limited local spread." Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ or at the point of origin only; stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread. Stage IV denotes metastasis such as to the liver.

Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? a. Firm-bristle toothbrush b. Hydrogen peroxide rinse c. Alcohol-based mouthwash d. 1 tsp salt in 1 L water mouth rinse

d. 1 tsp salt in 1 L water mouth rinse A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy. A soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.

The patient is receiving immunotherapy and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? a. Morphine sulfate b. Ibuprofen (Advil) c. Ondansetron (Zofran) d. Acetaminophen (Tylenol)

d. Acetaminophen (Tylenol) Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic but is not used first to combat flu-like symptoms of headache, fever, chills, myalgias, and so on.

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate to increase the patient's nutritional intake? a. Increase intake of liquids at mealtime to stimulate the appetite. b. Serve three large meals per day plus snacks between each meal. c. Avoid the use of liquid protein supplements to encourage eating at mealtimes. d. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

d. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods. The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (e.g., peanut butter, skim milk powder, cheese, honey, brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.

A patient is admitted with acute myelogenous leukemia and a history of Hodgkin's lymphoma. What is the nurse likely to find in the patient's history? a. Work as a radiation chemist b. Epstein-Barr virus diagnosed in vitro c. Intense tanning throughout the lifetime d. Alkylating agents for treating the Hodgkin's lymphoma

d. Alkylating agents for treating the Hodgkin's lymphoma Alkylating agents are used to treat Hodgkin's lymphoma and are carcinogens associated with initiation of acute myelogenous leukemia. Working with radiation would lead to a higher incidence of bone cancer. Epstein-Barr virus is seen in vitro with Burkitt's lymphoma. Intense tanning or exposure to ultraviolet radiation is associated with skin cancers.

The patient is learning about skin care related to the external radiation that he is receiving. Which instructions should the nurse include in this teaching? a. Moisturize skin with lotion b. Keep the area covered if it is sore c. Dry the skin thoroughly after cleansing it d. Avoid extreme temperatures to the area

d. Avoid extreme temperatures to the area Avoiding sources of excessive heat and cold will prevent damage to the skin. Only nonmedicated, nonperfumed lotions or creams (e.g., calendula ointment, aloe gel, Aquaphor) are recommended for dry skin. The area should be exposed to air if possible. Gentle cleansing, thorough rinsing, and patting the treatment area dry are recommended.

A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? a. Bacteria b. Sun exposure c. Most chemicals d. Epstein-Barr virus

d. Epstein-Barr virus Burkitt's lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. Bacteria do not initiate cancer. Sun exposure causes cell alterations leading to melanoma and squamous and basal cell skin carcinoma. Long-term exposure to certain chemicals (e.g., ethylene oxide, chloroform, benzene) is known to initiate cancer.

When caring for the patient with cancer, what does the nurse understand as the response of the immune system to antigens of the malignant cells? a. Metastasis b. Tumor angiogenesis c. Immunologic escape d. Immunologic surveillance

d. Immunologic surveillance Immunologic surveillance is the process in which lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance that allows the cancer cells to reproduce.

Priority Decision: The patient with advanced cancer is having difficulty controlling her pain. She says she is afraid she will become addicted to the opioids. What is the first thing the nurse should do for this patient? a. Administer a nonsteroidal antiinflammatory drug. b. Assess the patient's vital signs and behavior to determine the medication to use. c. Have the patient keep a pain diary to better assess the patient's potential addiction. d. Obtain a detailed pain history including quality, location, intensity, duration, and type of pain.

d. Obtain a detailed pain history including quality, location, intensity, duration, and type of pain. The priority in pain management is to obtain a comprehensive history of the patient's pain. This will determine the medications most useful for this patient's pain to enable giving the dose that relieves the pain with the fewest side effects. Teaching the patient about the lack of tolerance and addiction associated with effective cancer pain management will also be important for this patient's pain management.

A 64-yr-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to the plan of care? a. Provide ice chips to soothe the irritation. b. Weigh the patient every month to monitor for weight loss. c. Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. d. Provide high-protein and high-calorie, soft foods every 2 hours.

d. Provide high-protein and high-calorie, soft foods every 2 hours. A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories to aid healing. Extremes of temperature are to be avoided. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Patients should be weighed at least twice each week to monitor for weight loss.

Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? a. Acute pain b. Hypothermia c. Powerlessness d. Risk for infection

d. Risk for infection Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.

A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? a. Weight gain of 6 lb b. Nausea and vomiting c. Urine specific gravity of 1.004 d. Serum sodium level of 118 mEq/L

d. Serum sodium level of 118 mEq/L Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. The other options listed are also symptoms of hyponatremia but are not as critical to report to the health care provider.

When teaching a patient testicular self-examination, the nurse instructs the patient to report which finding? a. An irregular-feeling epididymis b. One testis larger than the other c. The spermatic cord within the testicle d. A firm, nontender nodule on the testis

d. Testicular tumors most often present on the testis as a lump or nodule that is very firm, is nontender, and cannot be transilluminated. There may also be scrotal swelling and a feeling of heaviness. All of the other options are normal findings.

The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? a. The medications the patient is taking b. The nutritional supplements that will help the patient c. How much time is needed to provide the patient's care d. The time the nurse spends at what distance from the patient

d. The time the nurse spends at what distance from the patient The principles of ALARA (as low as reasonably achievable) and time, distance, and shielding are essential to maintain the nurse's safety when the patient is a source of internal radiation. The patient's medications, nutritional supplements, and time needed to complete care will not protect the nurse caring for a patient with brachytherapy for cervical cancer.