Quiz 13

47.Which of the following substances has abnormal values early in the course of multiple myeloma (MM)? A. Red blood cells B. Immunoglobulins C. White blood cells D. Platelets

RATIONALE: B. MM is characterized by malignant plasma cells that produce an increased amount of immunoglobulin that isn't functional.

"If you ask anything of me in my name, I will do it"

John 14:14

7. Which nursing action will be included in the plan of care for a patient admitted with multiple myeloma? A. Monitor fluid intake and output. B. Administer calcium supplements. C. Assess lymph nodes for enlargement. D. Limit weight-bearing and ambulation.

RATIONALE: A. A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the patient's calcium level and are not used.

16.During a routine physical examination, a firm mass is palpated in the right breast of a 35-year-old woman. Which of the following findings or client history would suggest cancer of the breast as opposed to fibrocystic disease? A. Increased vascularity of the breast B. History of anovulatory cycles C. Cyclic changes in mass size D. History of early menarche

RATIONALE: A. An increase in breast size or vascularity indicates the growth of a tumor and is consistent with cancer of the breast.

2. The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? A. Polyps B. Weight gain C. Hemorrhoids D. Duodenal ulcers

RATIONALE: A. Colorectal polyps are common with colon cancer. These polyps can develop into cancer over time depending on the type of polyps such as adenomatous polyps and sessile serrated polyps. Option B: Weight loss — not gain — is an indication of colorectal cancer. Options C and D: Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer.

19.A nurse assesses a client who is prescribed 5-fluorouracil (5-FU) chemotherapy intravenously for the treatment of colon cancer. Which assessment finding should alert the nurse to contact the health care provider? A. White blood cell (WBC) count of 1500/mm3 B. Fatigue C. Nausea and diarrhea D. Mucositis and oral ulcers

RATIONALE: A. Common side effects of 5-FU include fatigue, leukopenia, diarrhea, mucositis, mouth ulcers & peripheral neuropathy. However, the client's WBC count is very low (normal range is 5000 to 10,000/mm3), so the provider should be notified. She may want to delay chemotherapy by a day or two. Certainly the client is at high risk for infection. The other assessment findings are consistent with common side effects of 5-FU that would not need to be reported immediately.

37.According to a standard staging classification of Hodgkin's disease, which of the following criteria reflects stage III? A. Involvement of lymph node regions or structures on both sides of the diaphragm B. Involvement of two or more lymph node regions or structures C. Involvement of single lymph node region or structure D. Involvement of extralymphatic organs or tissues

RATIONALE: A. Hodgkin lymphoma is classified into stages to determine the state of the disease and where it has already spread. Stage III involves nodes on both sides of the diaphragm.

23.The nurse is developing a plan of care for the client with multiple myeloma. The nurse includes which priority intervention in the plan of care? A. Encouraging fluids B. Providing frequent oral care C. Coughing and deep breathing D. Monitoring red blood cell count

RATIONALE: A. Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain an output of 1.5 to 2 L a day. Clients require about 3 L of fluid per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in renal tubules. Options B, C, and D: These are components in the plan of care but are not the priority in this client.

46.A 37-year-old client with uterine cancer asks the nurse, "Which is the most common type of cancer in women?" The nurse replies that it's breast cancer. Which type of cancer causes the most deaths in women? A. Lung cancer B. Colon and rectal cancer C. Brain cancer D. Breast cancer

RATIONALE: A. Lung cancer is the most deadly type of cancer in both women and men. Breast cancer ranks second in women, followed (in descending order) by colon and rectal cancer, pancreatic cancer, ovarian cancer, uterine cancer, lymphoma, leukemia, liver cancer, brain cancer, stomach cancer, and multiple myeloma.

44.Which of the following clients is most at risk for developing multiple myeloma? A. A 60-year-old African-American man B. A 52-year-old Hispanic woman C. A 35-year-old White man D. A 25-year-old Asian woman

RATIONALE: A. Multiple myeloma is more common in middle-aged and older clients (the median age at diagnosis is 60 years) and is twice as common in Blacks as Whites. It occurs most often in Black men.

25.The client with which of the following types of lung cancer has the best prognosis? A. Squamous cell B. Oat cell C. Small cell D. Adenocarcinoma

RATIONALE: A. Squamous cell carcinoma is a slow-growing, rarely metastasizing type of cancer. Options B and C: Oat cell and small cell carcinoma are the same. Small cell carcinoma grows rapidly and is quick to metastasize. Option D: Adenocarcinoma is the next best lung cancer to have in terms of prognosis.

35.The client with a benign lung tumor is treated in which of the following ways? A. The tumor is removed, involving the least possible amount of tissue B. The tumor is left alone unless symptoms are present C. The tumor is treated with radiation only D. The tumor is treated with chemotherapy only

RATIONALE: A. The tumor is removed to prevent further compression of the lung tissue as the tumor grows, which could lead to respiratory decompensation. Options B, C, and D: If for some reason it can't be removed, then radiation or chemotherapy may be used to try to shrink the tumor.

14.A pneumonectomy is a surgical procedure sometimes indicated for treatment of non-small-cell lung cancer. A pneumonectomy involves removal of: A. One lobe of a lung B. An entire lung field C. One or more segments of a lung lobe D. A small, wedge-shaped lung surface

RATIONALE: B. A pneumonectomy is the removal of an entire lung field indicated for the treatment of non-small cell lung cancer that has not spread outside of the lung tissue. It is performed on patients who will have adequate lung function in the unaffected lung. Option D: A wedge resection refers to the removal of a wedge-shaped section of lung tissue. It may be used to remove a tumor and a small amount of normal tissue around it. Option A: A lobectomy is the removal of one lobe. Option C: Removal of one or more segments of a lung lobe is called a partial lobectomy.

29.A client is being evaluated for cancer of the colon. In preparing the client for barium enema, the nurse should: A. Render an oil retention enema and give laxative the night before B. Give laxative the night before and a cleansing enema in the morning before the test C. Place the client on CBR a day before the study D. Instruct the client to swallow 6 radiopaque tablets the evening before the study

RATIONALE: B. Barium enema is the radiologic visualization of the colon using a die. To obtain accurate results in this procedure, the bowels must be emptied of fecal material thus the need for laxative and enema.

31.When teaching a client about the signs of colorectal cancer, Nurse Trish stresses that the most common complaint of persons with colorectal cancer is: A. Change in caliber of stools B. Change in bowel habits C. Hemorrhoids D. Abdominal pain

RATIONALE: B. Constipation, diarrhea, and/or constipation alternating with diarrhea are the most common symptoms of colorectal cancer.

42.The removal of entire breast, pectoralis major and minor muscles and neck lymph nodes which is followed by skin grafting is a procedure called: A. Radiation therapy B. Halstead surgery C. Modified radical mastectomy D. Simple mastectomy

RATIONALE: B. Halstead surgery also called radical mastectomy involves the removal of the entire breast, pectoralis major and minor muscles, and neck lymph nodes. It is followed by skin grafting. Option A: Radiation therapy uses high doses radiation to kill cancer cells and their ability to grow and divide. Option C: Removal of the entire breast, pectoralis major muscle and the axillary lymph nodes is a surgical procedure called modified radical mastectomy. Option D: Simple mastectomy is the removal of the entire breast but the pectoralis muscles and nipples remain intact.

1. A diagnosis of Hodgkin's disease was made to a 58- year old man and is admitted for the initial cycle of chemotherapy. During the hospitalization, the nurse should watch out for the following complication, except? A. Fertility problems B. Benign prostatic hyperplasia C. Secondary cancer D. Infection

RATIONALE: B. Hodgkin's disease (Hodgkin's lymphoma) is a type of cancer that affects the lymphatic system (bone marrow, spleen, liver, and lymph node tissue. Symptoms include painless swelling of a lymph node, recurrent fever, night sweats, pruritus, and unexplained weight loss. Prostate involvement is rare in Hodgkin's disease. Options A, C, and D: Complications of the disease would lead to a weakened immune system resulting in various infections, It can also result in fertility problems related to chemotherapy, and a probability of secondary cancers in the future.

18.The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder? A. Increased WBC's B. Increased calcium levels C. Decreased blood urea nitrogen D. Decreased number of plasma cells in the bone marrow.

RATIONALE: B. Hypercalcemia (increased calcium level) is caused by the release of calcium from the deteriorating bone tissue in multiple myeloma. This may cause symptoms of excessive thirst, constipation, dehydration, nausea, frequent urination, dizziness, confusion, and eventually to coma. Options A and C: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow and elevated uric acid levels. Option D: An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.

11.Warning signs and symptoms of lung cancer include persistent cough, bloody sputum, dyspnea, and which of the other following symptoms? A. Generalized weakness B. Recurrent pleural effusion C. Dizziness D. Hypotension

RATIONALE: B. If cancer is suspected in the lungs, it can cause fluid accumulation in the pleura called pleural effusion. This fluid build-up takes up space and fills the pleural cavity resulting in the compression of the lungs making it hard for the client to breathe properly. Options A, C, and D: Dizziness, generalized weakness, and hypotension aren't typically considered warning signals, but may occur in advanced stages of cancer.

39.In the client with terminal lung cancer, the focus of nursing care is on which of the following nursing interventions? A. Prepare the client's will B. Provide pain control C. Provide nutritional support D. Provide emotional support

RATIONALE: B. The client with terminal lung cancer may have extreme pleuritic pain and should be treated to reduce his discomfort therefore improving the quality of life of the patient. Examples of pain medication used with advanced cancer are opioids such as morphine, oxycodone, fentanyl, or methadone. Option A: Nursing care doesn't focus on helping the client prepare the will. Option D: Preparing the client and his family for the impending death and providing emotional support is also important but shouldn't be the primary focus until the pain is under control. Option C: Nutritional support may be provided, but as the terminal phase advances, the client's nutritional needs greatly decrease.

50.A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin's lymphoma. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the nurse to the patient's concerns is A. "Radiation does not cause the problems with sexual functioning that occur with chemotherapy or surgical procedures used to treat cancer." B. "It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children." C. "The radiation will make you sterile, but your ability to have sexual intercourse will not be changed by the treatment." D. "You may have some temporary impotence during the course of the radiation, but normal sexual function will return."

RATIONALE: B. The impact on sperm count and erectile function depend on the patient's pretreatment status and on the amount of exposure to radiation. The patient should consider sperm donation before radiation. Options A, C, and D: Radiation (like chemotherapy or surgery) may affect both sexual function and fertility either temporarily or permanently.

15.A nurse cares for a client newly diagnosed with colon cancer who has become withdrawn from family members. Which action should the nurse take? A. Contact the provider and recommend a psychiatric consult for the client. B. Encourage the client to verbalize feelings about the diagnosis. C. Provide education about new treatment options with successful outcomes. D. Ask family and friends to visit the client and provide emotional support.

RATIONALE: B. The nurse recognizes that the client may be expressing feelings of grief. The nurse should encourage the client to verbalize feelings and identify fears to move the client through the phases of the grief process. A psychiatric consult is not appropriate for the client. The nurse should not brush aside the client's feelings with discussions related to cancer prognosis and treatment. The nurse should not assume that the client desires family or friends to visit or provide emotional support.

36.A temporary colostomy is performed on the client with colon cancer. The nurse is aware that the proximal end of a double barrel colostomy: A. Is the opening on the client's left side B. Is the opening on the client's right side C. Is the opening on the distal end on the client's left side D. Is the opening on the distal right side

RATIONALE: B. The proximal end of the double-barrel colostomy is the end toward the small intestines. This end is on the client's right side.

45.Before discharge, the nurse scheduled the client who had a colostomy for colorectal cancer for discharge instruction about resuming activities. The nurse should plan to help the client understands that: A. Most sports activities, except for swimming, can be resumed based on the client's overall physical condition. B. With counseling and medical guidance, a near normal lifestyle, including complete sexual function is possible. C. Activities of daily living should be resumed as quickly as possible to avoid depression and further dependency. D. After surgery, changes in activities must be made to accommodate for the physiologic changes caused by the operation.

RATIONALE: B. There are few physical restraints on activity postoperatively, but the client may have emotional problems resulting from the body image changes.

48.Breast self examination (BSE) is one of the ways to detect breast cancer earlier. The nurse is conducting health teaching to female clients in a clinic. During evaluation the clients are asked to state what they learned. Which of the following statements made by a client needs further teaching about BSE? A. "BSE is done after menstruation." B. "BSE palpation is done by starting at the center going to the periphery in a circular motion." C. "BSE can be done in a lying position." D. "BSE should start from age 20."

RATIONALE: B. This client needs further teaching as palpation in BSE should start at the periphery going to the center in a circular motion. Option A: BSE is performed 7-10 days after menstruation when the breast are less tender and lumpy. Option C: The breast can be examined in a lying position since this position flattens the breast and makes it easier to examine. Option D: All women age 20 and older must do self-breast exams where breast tumors can be easily detected at this age.

30.The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further education is needed if a nursing staff member states which of the following is characteristic of the disease? A. Prognosis depends on the stage of the disease B. Occurs most often in the older client C. Presence of Reed-Sternberg cells D. Involvement of lymph nodes, spleen, and liver

RATIONALE: B: Hodgkin's disease is a disorder of young people up to age 40 and among adults. It is more common in adolescents between the ages of 15 and 19. Option A: Hodgkin's lymphoma prognosis depends on the stage of the disease. It is treatable in the early stages of the stages. Option C: Hodgkin's disease is marked by the presence of Reed-Sternberg cells which are the abnormal B lymphocytes (WBC that produces antibodies that are essential in combating infections). Option D: The disease spread through the lymph vessels from lymph node to lymph node. It can also travel to other parts such as the lung, liver, and spleen.

32.A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following? A. "Cancer cells are susceptible to drug toxins." B. "Chemotherapy affects all rapidly dividing cells." C. "Chemotherapy encourages cancer cells to divide." D. "The molecular structure of the DNA is altered."

RATIONALE: B: There are many mechanisms of action for chemotherapeutic agents, but most affect the rapidly dividing cells—both cancerous and noncancerous. Cancer cells are characterized by rapid cell division. Option A: All cells are susceptible to drug toxins, but not all chemotherapeutic agents are toxins. Options C and D: Chemotherapy slows cell division. Not all chemotherapeutic agents affect the molecular structure.

13.A nurse prepares a client for a colonoscopy scheduled for tomorrow. The client states, "My doctor told me that the fecal occult blood test was negative for colon cancer. I don't think I need the colonoscopy and would like to cancel it." How should the nurse respond? A. Your doctor should not have given you that information prior to the colonoscopy. B. The colonoscopy is required due to the high percentage of false negatives with the blood test. C. A negative fecal occult blood test does not rule out the possibility of colon cancer. D. I will contact your doctor so that you can discuss your concerns about the procedure.

RATIONALE: C. A negative result from a fecal occult blood test does not completely rule out the possibility of colon cancer. To determine whether the client has colon cancer, a colonoscopy should be performed so the entire colon can be visualized and a tissue sample taken for biopsy. The client may want to speak with the provider, but the nurse should address the clients concerns prior to contacting the provider.

40.A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy? A. Serum potassium level of 3.6 mEq/L B. Blood pressure of 120/64 to 130/72 mm Hg C. Dry oral mucous membranes and cracked lips D. Urine output of 400 ml in 8 hours

RATIONALE: C. Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L. Options A, B, and D: These values are within the normal limits.

22.A nurse teaches a client who is recovering from a colon resection. Which statement should the nurse include in this clients plan of care? A. You may experience nausea and vomiting for the first few weeks. B. Carbonated beverages can help decrease acid reflux from anastomosis sites. C. Take a stool softener to promote softer stools for ease of defecation. D. You may return to your normal workout schedule, including weight lifting.

RATIONALE: C. Clients recovering from a colon resection should take a stool softener as prescribed to keep stools a soft consistency for ease of passage. Nausea and vomiting are symptoms of intestinal obstruction and perforation and should be reported to the provider immediately. The client should be advised to avoid gas-producing foods and carbonated beverages, and avoid lifting heavy objects or straining on defecation.

21.A 56-year-old woman is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She calls her health care provider to report that she has pain while swallowing and burning and tightness in her chest. Which of the following complications of radiation therapy is A. Radiation enteritislikely responsible for her symptoms? A. Radiation enteritis B. Stomatitis C. Esophagitis D. Hiatal hernia

RATIONALE: C. Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis, which is a common complication of radiation therapy of the chest wall. Option A: Radiation enteritis is a damage to the intestinal lining caused by radiation therapy. Symptoms include diarrhea, rectal pain, and bleeding or mucus from the rectum. Option B: Stomatitis results from the local effects of radiation to the oral mucosa. Symptoms include mouth ulcers, red patches, swelling, and oral dysaesthesia. Option D: Hiatal hernia may also cause symptoms of dysphagia and chest pain but is not related to radiation therapy.

33.Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by: A. Breast self-examination B. Mammography C. Fine needle aspiration D. Chest X-ray

RATIONALE: C. Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. During the procedure, a needle is inserted into the lump and a sample of tissue is taken for examination. Option A: A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Option B: Mammography is used to detect tumors that are too small to palpate. Option D: Chest X-rays can be used to pinpoint rib metastasis.

17.A nurse cares for a client with colon cancer who has a new colostomy. The client states, "I think it would be helpful to talk with someone who has had a similar experience." How should the nurse respond? A. I have a good friend with a colostomy who would be willing to talk with you. B. The enterostomal therapist will be able to answer all of your questions. C. I will make a referral to the United Ostomy Associations of America. D. You'll find that most people with colostomies don't want to talk about them.

RATIONALE: C. Nurses need to become familiar with community-based resources to better assist clients. The local chapter of the United Ostomy Associations of America has resources for clients and their families, including Ostomates (specially trained visitors who also have ostomies). The nurse should not suggest that the client speak with a personal contact of the nurse. Although the enterostomal therapist is an expert in ostomy care, talking with him or her is not the same as talking with someone who actually has had a colostomy. The nurse should not brush aside the client's request by saying that most people with colostomies do not want to talk about them. Many people are willing to share their ostomy experience in the hope of helping others.

24.A nurse teaches a client who is at risk for colon cancer. Which dietary recommendation should the nurse teach this client? A. Eat low-fiber and low-residual foods. B. White rice and bread are easier to digest. C. Add vegetables such as broccoli and cauliflower to your new diet. D. Foods high in animal fat help to protect the intestinal mucosa.

RATIONALE: C. The client should be taught to modify his or her diet to decrease animal fat and refined carbohydrates. The client should also increase high-fiber foods and Brassica vegetables, including broccoli and cauliflower, which help to protect the intestinal mucosa from colon cancer.

20.Which of the following is the primary goal for surgical resection of lung cancer? A. To remove all of the tumor and any collapsed alveoli in the same region B. To remove as much as the tumor as possible, without removing any alveoli C. To remove the tumor and as little surrounding tissue as possible D. To remove the tumor and all surrounding tissue

RATIONALE: C. The goal of surgical resection is to remove the lung tissue that has a tumor in it while saving as much surrounding tissue as possible. There is a possibility of cancer cells remaining in the body after the operation so additional treatment modalities such as chemotherapy and radiation therapy are done.

8. A nurse assessing a client with colorectal cancer auscultates high-pitched bowel sounds and notes the presence of visible peristaltic waves. Which action should the nurse take? A. Ask if the client is experiencing pain in the right shoulder. B. Perform a rectal examination and assess for polyps. C. Contact the provider and recommend computed tomography. D. Administer a laxative to increase bowel movement activity.

RATIONALE: C. The presence of visible peristaltic waves, accompanied by high-pitched or tingling bowel sounds, is indicative of partial obstruction caused by the tumor. The nurse should contact the provider with these results and recommend a computed tomography scan for further diagnostic testing. This assessment finding is not associated with right shoulder pain; peritonitis and cholecystitis are associated with referred pain to the right shoulder. The registered nurse is not qualified to complete a rectal examination for polyps, and laxatives would not help this client.

28.Which diet is associated with an increased risk of colorectal cancer? A. High protein, simple carbohydrates B. Low carbohydrates, complex proteins C. Low protein, complex carbohydrates D. High fat, refined carbohydrates

RATIONALE: D. A diet that is high in fat and refined carbohydrates increases the risk of colorectal cancer. High fat content results in an increase in fecal bile acids, which facilitate carcinogenic changes. Refined carbohydrates increase the transit time of food through the gastrointestinal tract and increase the exposure time of the intestinal mucosa to cancer-causing substances.

38.A 34-year-old female client is requesting information about mammograms and breast cancer. She isn't considered at high risk for breast cancer. What should the nurse tell this client? A. She should have had a baseline mammogram before age 30 B. When she begins having yearly mammograms, breast self-examinations will no longer be necessary C. She should perform breast self-examination during the first 5 days of each menstrual cycle D. She should eat a low-fat diet to further decrease her risk of breast cancer

RATIONALE: D. A low-fat diet (one that maintains weight within 20% of recommended body weight) has been found to decrease a woman's risk of breast cancer. Option A: A baseline mammogram should be done between ages 30 and 40. Option B: The client should continue to perform monthly breast self-examinations even when receiving yearly mammograms. Option C: Monthly breast self-examinations should be done between days 7 and 10 of the menstrual cycle.

41.A client has been diagnosed with lung cancer and requires a wedge resection. How much of the lung is removed? A. A segment of the lung, including a bronchiole and its alveoli B. One entire lung C. A lobe of the lung D. A small, localized area near the surface of the lung

RATIONALE: D. A wedge resection is a surgical procedure that involves the removal of a small area of tissue close to the surface of the lung. It is indicated for clients with certain types of lung cancer such as non-small cell lung cancer (NSCLC). It is done in combination with chemotherapy and radiation therapy.

27.A female client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include: A. A decreased serum creatinine level B. A low serum protein level C. Hypocalcemia D. Bence Jones protein in the urine

RATIONALE: D. Bence-Jones protein is an antibody fragment called a light chain that is not detectable in the urine. A presence of Bence Jones may indicate excess light chain production of a single type of antibody by the bone marrow cells. Option A: The serum creatinine level may also be increased. Option B: Serum protein electrophoresis shows elevated globulin spike. Option C: Serum calcium levels are elevated because calcium is lost from the bone and reabsorbed in the serum.

4. A nurse assesses clients at a community health center. Which client is at highest risk for the development of colorectal cancer? A. A 37-year-old who drinks eight cups of coffee daily B. A 44-year-old with irritable bowel syndrome (IBS) C. A 60-year-old lawyer who works 65 hours per week D. A 72-year-old who eats fast food frequently

RATIONALE: D. Colon cancer is rare before the age of 40, but its incidence increases rapidly with advancing age. Fast food tends to be high in fat and low in fiber, increasing the risk for colon cancer. Coffee intake, IBS, and a heavy workload do not increase the risk for colon cancer.

49. Which of the following interventions is the key to increasing the survival rates of clients with lung cancer? A. High-dose chemotherapy B. Early bronchoscopy C. Smoking cessation D. Early Detection

RATIONALE: D. Early detection of cancer when the cells may be premalignant and potentially curable would be most beneficial. However, a tumor must be 1 cm in diameter before it's detectable on a chest x-ray, so this is difficult.

34.Which of the following characteristics are risk factors for colorectal cancer? A. Age younger than 40 B. History of skin cancer C. Low fat, low protein, high fiber diet D. Familial polyposis

RATIONALE: D. Family history of colon cancer or familial polyposis is a risk factor for colorectal cancer.

6. A male client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment findings would the nurse expect to note specifically in the client? A. Fatigue B. Weakness C. Weight gain D. Enlarged lymph nodes

RATIONALE: D. Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extra lymphatic sites, such as the spleen and liver. Options A and B: Fatigue and weakness may occur but are not related significantly to the disease. Option C: Weight loss is most likely to be noted.

10.When assessing a patient's needs for psychologic support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information? A. "How do you feel about having a possibly terminal illness?" B. "How long ago were you diagnosed with this cancer?" C. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?" D. "Can you tell me what has been helpful to you in the past when coping with stressful events?"

RATIONALE: D. Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. Option A: The patient with stage I cancer is not considered to have a terminal illness at this time, and this question is likely to worry the patient unnecessarily. Option B: The length of time since the diagnosis will not provide much information about the patient's need for support. Option C: The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient's needs for assistance.

43.If the client with lung cancer also has preexisting pulmonary disease, which of the following statements best describes the extent of a surgery that can be performed? A. It doesn't affect it B. It may require a whole lung to be removed C. The entire tumor may not be able to be removed D. It may prevent surgery if the client can't tolerate lung tissue removal

RATIONALE: D. It may prevent surgery if the client can't tolerate lung tissue removal. Option D: If the client's preexisting pulmonary disease is restrictive and advanced, it may be impossible to remove the tumor, and the client may have to be treated with chemotherapy and radiation.

3. Nurse Andrei is caring for a client with multiple myeloma. During the review of the laboratory results. The nurse will monitor the client for which of the following conditions? A. Hypermagnesemia B. Hyperkalemia C. Hypernatremia D. Hypercalcemia

RATIONALE: D. Patients with multiple myeloma develop a bone disease that causes bone destruction. Calcium is released during this, causing an increase in serum calcium levels.

26.A nurse cares for a client who has a family history of colon cancer. The client states, "My father & brother had colon cancer. What is the chance that I will get cancer?" How should the nurse respond? A. If you eat a low-fat and low-fiber diet, your chances decrease significantly. B. You are safe. This is an autosomal dominant disorder that skips generations. C. Preemptive surgery and chemotherapy will remove cancer cells and prevent cancer. D. You should have a colonoscopy more frequently to identify abnormal polyps early.

RATIONALE: D. The nurse should encourage the client to have frequent colonoscopies to identify abnormal polyps and cancerous cells early. The abnormal gene associated with colon cancer is an autosomal dominant gene mutation that does not skip a generation and places the client at high risk for cancer. Changing the client's diet, preemptive chemotherapy, and removal of polyps will decrease the client's risk but will not prevent cancer. However, a client at risk for colon cancer should eat a low-fat and high-fiber diet.

9. A patient with multiple myeloma is complaining about pain. What instructions will the nurse give the patient to help to reduce pain during activity? A. Stay in bed until symptoms pass B. Limit activity to once a day. C. Limit fluids to prevent going to the bathroom. D. Do not lift more than 10 pounds.

RATIONALE: D. The patient with multiple myeloma needs education about activity instructions such as lifting no more than 10 pounds and using proper body mechanics. Braces may be needed. The patient should have activity and would not be instructed to stay in bed or limit activity as he or she would become very stiff. Limiting fluids would be contraindicated. The patient needs to remain well hydrated.

12.Maria was recently diagnosed with Hodgkin's lymphoma. Upon the early diagnosis, the nurse will expect which of the following areas is often involved? A. Chest B. Neck C. Groin D. Pelvis

RATIONALEB: B. A common early sign of Hodgkin lymphoma is swelling in one or more lymph nodes, which is often seen in the neck. Options A, C, and D: Lymph nodes can also be found in the chest, groin, and pelvis but aren't yet involved in the earliest stage of the disease.

5. 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"

Rationale: A. 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."