Cancer PQs

15. To educate clients, the nurse should understand that the most common site of cancer for a female is the 1. Uterine cervix. 2. Uterine body. 3. Vagina. 4. Fallopian tubes.

(1) Cervical cancer is the most common site and squamous cell cancer is the most common cell type.

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. DIF: Cognitive Level: Apply (application) REF: 235 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX:

23. Which nursing diagnosis should receive highest priority in a client who is receiving the chemotherapeutic agent that causes bone marrow suppression? 1. Risk of infection. 2. Activity intolerance. 3. Altered oral mucous membranes. 4. Altered nutrition: less than body requirements.

(1) Chemotherapeutic drugs that depress the bone marrow interfere with the production of WBCs. The resultant leukopenia can be life-threatening; therefore, risk of infection is the highest priority. The other nursing diagnoses, although appropriate for this client, would be of lower priority.

1. When the nurse is counseling a client about preventive measures for cancer, one of the most important behaviors to emphasize is to 1. Decrease fat intake. 2. Avoid exposure to the sun. 3. Avoid smoking. 4. Obtain adequate rest and avoid stress.

(3) Avoiding smoking is a primary cancer preventive behavior. Smoking is believed to be the cause of 75% of lung cancers in the United States. All of the other behaviors are also important preventive measures, but tobacco is a known carcinogen.

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 correct? a. "Benign tumors do not cause damage to other tissues." b. "Benign tumors are likely to recur in the same location." c. "Malignant tumors may spread to other tissues or organs." d. "Malignant cells reproduce more rapidly than normal cells."

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. DIF: Cognitive Level: Understand (comprehension) REF: 240 TOP: Nursing Process: Implementation MSC: NCLEX:

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. DIF: Cognitive Level: Apply (application) REF: 243 TOP: Nursing Process: Evaluation MSC: NCLEX:

3. A client has just received a report from her physician that describes a tumor that was recently biopsied. If the result she receives is listed as "T0, N0, M0," the client will know that she has 1. No evidence of a primary tumor, lymph node involvement, and metastasis. 2. No primary tumor, but evidence of a degree of distant metastasis. 3. A primary tumor and regional nodes involved. 4. Carcinoma in situ

(1) The staging of the cancer according to cancer classification means that there is no evidence of a primary tumor (T0), regional lymph nodes are not abnormal (N0), and there is no evidence of distant metastasis (M0).

14. A patient with metastatic cancer of the colon experiences severe vomiting after each administration of chemotherapy. Which action, if taken 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. DIF: Cognitive Level: Apply (application) REF: 251 TOP: Nursing Process: Implementation MSC: NCLEX:

2. Of the following screening methods for prevention of cancer, the most important one for the client to be aware of is 1. Magnetic resonance imaging (MRI). 2. Breast self-examination. 3. Risk assessment. 4. Sigmoidoscopy

(2) Breast self-examination (BSE) is the most important method to instruct the client about because it is a primary prevention method. It is performed every month (whereas a mammogram is done every year after age 50), and many breast lumps are first found by the woman when she is examining her breasts. An MRI (1) would be done for diagnosis. Risk assessment (3) and sigmoidoscopy (4) are also important preventive measures, but in priority fall below a BSE.

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 and/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.

MULTIPLE RESPONSE 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 two or three 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. DIF: Cognitive Level: Analyze (analysis) REF: 235 TOP: Nursing Process: Planning MSC: NCLEX:

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. DIF: Cognitive Level: Apply (application) REF: 253 TOP: Nursing Process: Planning MSC: NCLEX:

28. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate 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. DIF: Cognitive Level: Apply (application) REF: 253 TOP: Nursing Process: Evaluation MSC: NCLEX:

25. The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective? a. Lime sherbet c. Fresh strawberries b. Blueberry yogurt 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. DIF: Cognitive Level: Apply (application) REF: 261 TOP: Nursing Process: Evaluation MSC: NCLEX:

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 Temperature elevation 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. DIF: Cognitive Level: Analyze (analysis) REF: 253 OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients TOP: Nursing Process: Assessment MSC: NCLEX:

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

ANS: D Because the etiology of the patient's poor nutrition is the painful oral ulcers, the best intervention is to apply anesthetic gel to the lesions before the patient eats. The other actions might be helpful for other patients with impaired nutrition but would not be as helpful for this patient. DIF: Cognitive Level: Analyze (analysis) REF: 254 TOP: Nursing Process: Planning MSC: NCLEX:

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. DIF: Cognitive Level: Apply (application) REF: 251 TOP: Nursing Process: Implementation MSC: NCLEX:

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 this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency? A. Hypokalemia B. Hypouricemia C. Hypocalcemia D. Hypophosphatemia

C. 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.