Chapter 57 Care of the Patient with Cancer

The nurse remarks that the American Cancer Society (ACS) reports that cancer is the leading cause of death in the United States.

ANS: second The ACS reports that cancer is the second leading cause of death in the United States. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2015 OBJ: 1 TOP: Incidence of cancer KEY: Nursing Process Step: Implementation

What is another term for promotion? a. Reward b. Advancement c. Lift d. Bubble

ANS: B Advancement may result from additional preparation or additional experience. It may be gained by learning the position more thoroughly and by assuming new and greater responsibilities. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2045 OBJ: 12 TOP: New graduate KEY: Nursing Process Step: N/A

A new graduate who has achieved the goal of getting others to do something that is believed necessary has demonstrated what skill? a. Management b. Leadership c. Influence d. Control

ANS: B Leadership is the art of getting others to want to do something that is perceived as necessary. PTS: 1 DIF: Cognitive Level: Application REF: Page 2056 OBJ: 13 TOP: New graduate KEY: Nursing Process Step: N/A

What is the best way to resolve most disagreements? a. Agreement b. Argument c. Communication d. Withdrawing

ANS: C Most problems can best be resolved by communication at the most basic level. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2044 OBJ: 13 TOP: New graduate KEY: Nursing Process Step: N/A

A test screens for occult blood in the stool.

ANS: guaiac The guaiac test is a screening test for occult blood in the stool. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2025 OBJ: 1 TOP: Guaiac test KEY: Nursing Process Step: N/A

Men over age 50 should consider an annual test and rectal examination.

ANS: PSA (prostate-specific antigen) PSA prostate-specific antigen Men over age 50 should consult with their physician to consider the benefits of having a prostate-specific antigen (PSA) test and rectal examination once a year. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2020 OBJ: 3 TOP: Cancer prevention KEY: Nursing Process Step: Assessment

The term refers to the process by which a normal cell is transformed into a cancer cell.

ANS: carcinogenesis Carcinogenesis is the process by which a normal cell is transformed into a cancer cell. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2016 OBJ: 3 TOP: Development of cancer KEY: Nursing Process Step: Assessment

After transcribing each order in a list of orders, the nurse should the order.

ANS: check off The nurse should check off each order as it is transcribed to ensure that each order is implemented. PTS: 1 DIF: Cognitive Level: Application REF: Pages 2058-2059 OBJ: 19 TOP: Orders KEY: Nursing Process Step: Implementation

The experienced nurse who assists a novice to learn the skills of the profession is called a(n)

ANS: mentor The nurse who guides a novice in the skills of the profession is called a mentor. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2043 OBJ: 11 TOP: Mentoring KEY: Nursing Process Step: N/A

What type of leadership uses four different styles—directing, coaching, supporting, and delegating? a. Autocratic b. Situational c. Democratic d. Authoritative

ANS: B Situational leadership identifies four typical styles for leaders. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2057 OBJ: 14 TOP: Leadership KEY: Nursing Process Step: N/A

The American Cancer Society recommends a clinical breast examination by a health care professional for women between the age of 20 and 39 years every years.

ANS: 3 three Women between the age of 20 to 39 should have a clinical breast examination by health care professionals every 3 years. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2010, Table 56-1 OBJ: 3 TOP: Breast cancer KEY: Nursing Process Step: Assessment

Which setting provides greater nurse autonomy and continuity of care and is less costly for insurance companies? a. Hospice b. Hospitals c. Home health d. Long-term care

ANS: C The advantages of home health are greater nurse autonomy and continuity of care, as well as less cost to insurance. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2053 OBJ: 12 TOP: New graduate KEY: Nursing Process Step: N/A

What type of leadership involves a leader who displays little trust or confidence in employees and therefore makes all the decisions? a. Democratic b. Laissez-faire c. Autocratic d. Authoritative

ANS: C The autocratic leader displays little trust in employees, and therefore makes all decisions. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2056 OBJ: 14 TOP: Leadership KEY: Nursing Process Step: N/A

A patient, age 39, receiving chemotherapy for treatment of her cancer has a white blood cell count of 1600/mm3. This finding requires nursing interventions to provide which of the following? a. Adequate fluid intake b. Protection from falls c. Protection against infection d. Frequent small nutritious snacks

ANS: C The nurse needs to protect the patient against pathogens, monitor the patient for signs of infections, and respond aggressively if an infection occurs. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2028 OBJ: 13 TOP: Leukopenia KEY: Nursing Process Step: Planning

What is the name of the licensing law that defines the title and regulations governing the practice of nursing and states the requirements for licensure? a. State practice act b. Nurse regulation act c. Nurse practice act d. Legislative act

ANS: C The nurse practice act defines the title and regulations governing the practice of nursing. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2052 OBJ: 9 TOP: Licensure KEY: Nursing Process Step: N/A

Which organization specifically supports and meets the needs of the LVN/LPN? a. NAPNES b. NLN c. ANA d. NCLEX

ANS: A National Association for Practical Nurse Education and Service (NAPNES) is the professional organization that is specifically for LVN/LPNs. The National League for Nursing (NLN) and the American Nurses Association (ANA) are not specific to the LPN. The National Council Licensure Exam (NCLEX) is the test that is taken for licensure. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2047 OBJ: 5 TOP: New graduate KEY: Nursing Process Step: N/A

The nurse instructs a patient who has been smoking for 5 years about the warning signs of cancer. The nurse tells him that one of cancer's seven warning signals include: a. nagging cough or hoarseness. b. a sore that does not heal rapidly. c. gallbladder disease. d. hematopoietic changes.

ANS: A Cancer's seven warning signals include nagging cough or hoarseness. PTS: 1 DIF: Cognitive Level: Application REF: Page 2020, Box 56-1 OBJ: 13 TOP: Warning signs of cancer KEY: Nursing Process Step: Implementation

Which statement is most appropriate for a nurse to tell a patient before insertion of the radioactive implant? a. "Nurses will always be available, but they will spend only short periods of time at your bedside." b. "Personal cleanliness is essential, so you will be given a complete bed bath each day." c. "Your diet will be changed to a high-fiber diet to encourage daily bowel movements." d. "Your bed linens will be completely changed each day to minimize radioactive contamination."

ANS: A Generally, it is recommended that the nurse spend no more than 10 minutes at a time in the room of a patient with an implant. Baths and linen changes are not given daily. A low-residue diet is the norm to minimize peristalsis and bowel movements that might dislodge the implant. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2027 OBJ: 13 TOP: Internal radiation therapy KEY: Nursing Process Step: Implementation

Which health care employment setting would provide the nurse a very good salary, the opportunity to refuse to take an assignment, and more flexibility in the personal schedule but with an uncertainty of work availability? a. Temporary agency b. Long-term care center c. Outpatient clinic d. Adult day care center

ANS: A In a temporary agency, the salary is good, and an LPN/LVN has the right to refuse assignments. However, one disadvantage is the uncertainty of work availability. PTS: 1 DIF: Cognitive Level: Application REF: Page 2054 OBJ: 12 TOP: New graduate KEY: Nursing Process Step: N/A

What should the home health nurse advise the patient who found a lump in her breast a week ago during breast self-examination? a. Arrange for an examination by her physician b. Wait until her next ovulatory cycle and check the lump again c. Postpone appointment until the lump enlarges d. Apply warm, moist compresses

ANS: A Nurses should teach to all patients, both men and women, that any identifiable problem should be brought to the attention of a physician. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2020 OBJ: 3 TOP: Self-examination KEY: Nursing Process Step: Implementation

After an elevation of his PSA, the patient has blood drawn for a CA-19-9. When he asks the nurses the purpose of this new test, what is the most appropriate response? a. It tests for hepatobiliary cancer b. It tests for colorectal cancer c. It tests for bladder cancer d. It tests for lung cancer

ANS: A The CA-19-9 is a tumor marker for tumors in the hepatobiliary system. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2025 OBJ: 11 TOP: CA-19-9 KEY: Nursing Process Step: Implementation

What happens during the process of immunosurveillance? a. T cells recognizing and destroying the abnormal cell b. White cells (WBC) destroying the abnormal cell c. Excretion of histamine to interfere with the replication of the abnormal cell d. B cells attaching to abnormal cell

ANS: A The T cells are responsible for immunosurveillance by recognizing an abnormal cell and destroying it. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2021 OBJ: 8 TOP: Immunosurveillance KEY: Nursing Process Step: Implementation

A male patient is undergoing external radiation therapy on an outpatient basis for treatment of Hodgkin disease. After 2 weeks of treatment, he tells the nurse that he is so tired he can hardly get out of bed in the morning. Which is an appropriate goal? a. Take two rest periods during the day b. Ambulate in the hall four times a day c. Select two activities for distraction d. Investigate a consultation with a psychiatrist for treatment of depression

ANS: A The person undergoing radiation therapy should be assured that lethargy and fatigue are not uncommon during treatment, and that frequent rest periods are helpful. Periods of rest are very beneficial. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2027 OBJ: 13 TOP: External radiation therapy KEY: Nursing Process Step: Planning

Which of the following are nursing interventions for the nursing diagnosis of Imbalanced nutrition: less than body requirements? (Select all that apply.) a. Provide adequate, easily digestible, soft, bland foods. b. Give small, frequent, highly nutritional meals. c. Allow extra time to eat. d. Offer three regular meals of highly nutritious foods.

ANS: A, B, C A nursing diagnosis of Imbalanced nutrition: less than body requirements will require the nurse to give small, frequent, highly nutritional meals; to allow extra time to eat; and to provide adequate, easily digestible, soft, bland foods. PTS: 1 DIF: Cognitive Level: Application REF: Page 2030, Nursing Care Plan OBJ: N/A TOP: Nutrition KEY: Nursing Process Step: Implementation

What data are necessary to compile an effective end-of-shift report? (Select all that apply.) a. Patient's mental status b. Status of lung sounds c. All pertinent nursing care d. The patient's favorite TV shows e. Visitors the patient had during the shift

ANS: A, B, C The patient's mental status, status of lung sounds, and pertinent nursing care performed during the shift should all be included in an end-of-shift report. The patient's favorite TV shows and visitors that the patient had during the shift would not normally be included in the end-of-shift report. PTS: 1 DIF: Cognitive Level: Application REF: Page 2060 OBJ: 20 TOP: End-of-shift report KEY: Nursing Process Step: N/A

What are considered duties of a team leader? (Select all that apply.) a. Receiving reports on assigned patients b. Making patient assignments for team members c. Assessing all assigned patients d. Administering medications to all patients e. Conferring with team members

ANS: A, B, C, E Receiving reports on assigned patients, making patient assignments, assessing all assigned patients, and conferring with team members are duties of the team leader. Assisting team members with medication administration is a duty of the team leader, not actually administering the medications to all the patients. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2057 OBJ: 15 TOP: Team leading KEY: Nursing Process Step: N/A

A manager is concerned that one of the nurses on the unit is experiencing burnout. Which symptoms would support the concerns? (Select all that apply.) a. Fatigue b. Forgetfulness c. Increased energy d. Negative outlook e. Changes in eating habits

ANS: A, B, D, E Symptoms of burnout include fatigue, forgetfulness, decreased energy, negative outlook, and changes in eating habits. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2060, Box 57-12 OBJ: 22 TOP: Burnout KEY: Nursing Process Step: N/A

Which questions should the nurse consider before delegating care to another team member? (Select all that apply.) a. Is this the right task? b. Is this the right time? c. Is this the right person? d. Is this the right supervision? e. Is this the right circumstance?

ANS: A, C, D, E The five rights of delegation are right task, right circumstance, right person, right direction, and right supervision. Right time is not included in the five rights of delegation. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2050, Coordinated Care Box OBJ: 16 TOP: Delegation KEY: Nursing Process Step: N/A

A nursing instructor is preparing her class for the NCLEX-PN examination. Which statements by the students indicate understanding of the testing process? (Select all that apply.) a. "It will be a computerized adaptive test." b. "I will have a maximum of 265 questions." c. "The maximum time allowed for testing is 5 hours." d. "The minimum number of questions on the test is 60." e. "My state board of nursing must approve my application to test."

ANS: A, C, E The NCLEX-PN examination is a computerized adaptive test. The minimum number of questions for the PN examination is 85, and the maximum number of questions is 205. The maximum time allowed for the test is 5 hours. The state board of nursing must approve the applicant for testing before the authorization to test is issued. PTS: 1 DIF: Cognitive Level: Application REF: Pages 2050-2051 OBJ: 7 TOP: NCLEX exam KEY: Nursing Process Step: N/A

The nurse is aware that American men and women have which of the following three sites for cancer in common? (Select all that apply.) a. Lung b. Brain c. Colon d. Liver e. Rectum f. Thyroid

ANS: A, C, E The three common cancer sites that American men and women share are cancer of the lung, colon, and rectum. PTS: 1 DIF: Cognitive Level: Comprehension REF: Pages 2016-2017 OBJ: 2 TOP: Common cancer sites KEY: Nursing Process Step: Planning

Select the foods that are recommended for prevention of colorectal cancer in men. (Select all that apply.) a. Oranges b. Ham c. Skinless chicken d. Asparagus e. Cheddar cheese f. Squash

ANS: A, C, F Eating plenty of fruits, vegetables, and whole grain foods and limiting intake of high-fat foods will help prevent cancer. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2010, Health Promotion OBJ: 3 TOP: Cancer preventing foods KEY: Nursing Process Step: Implementation

Which of the following men should be highest priority for referral for a prostate-specific antigen (PSA)? a. 43-year-old Hispanic man b. 45-year-old African American man c. 49-year-old Korean man d. 50-year-old Native American man

ANS: B African American men are a high-risk population for prostate cancer. Orientals and Native Americans have a relatively low incidence of prostate cancer. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2020 OBJ: 3 TOP: PSA testing KEY: Nursing Process Step: Assessment

The difference between an excisional biopsy and an incisional biopsy is that an excisional biopsy involves the: a. use of a needle to obtain fluid samples. b. removal of the entire lesion. c. taking a "bite" from the lesion for study. d. shaving of the superficial layers of the lesion.

ANS: B An excisional biopsy involves the excision of the entire lesion. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2023 OBJ: 12 TOP: Cancer identification KEY: Nursing Process Step: Implementation

A home health patient undergoing radiation therapy says, "I feel so useless. I have no energy, no appetite and I fall asleep whenever I sit down." What is the nurse's most therapeutic response? a. "Fatigue is part of your illness. Taking several long naps in the daytime is helpful." b. "Fatigue is an unfortunate side effect of radiation. It will improve when you finish treatment." c. "You really shouldn't be fatigued. Let me make an appointment with your physician to get this checked out." d. "Don't worry about it. You probably deserve the rest!"

ANS: B Fatigue is a side effect of radiation. Patients should be reassured that energy levels will improve when treatment is finished. PTS: 1 DIF: Cognitive Level: Application REF: Page 2027 OBJ: 13 TOP: Radiation fatigue KEY: Nursing Process Step: Implementation

A patient, age 56, has been advised that his prostate-specific antigen (PSA) level is elevated. The physician then performed a digital rectal examination (DRE). What should the next definitive diagnostic test be? a. CA-125 test b. Transrectal ultrasound c. Needle biopsy of the prostate d. MRI

ANS: B Men over the age of 50 should be advised to have a prostate-specific antigen (PSA) test and rectal examination once a year. Two other screening methods—DRE and transrectal ultrasonography (TRUS)—are used alone and in combination in the early detection of prostate cancer. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2025 OBJ: 11 TOP: Prostate cancer KEY: Nursing Process Step: Planning

How would the nurse explain to the patient who is taking cyclophosphamide (Cytoxan), an alkylating agent, about how the medication works? a. It inhibits DNA and RNA synthesis b. It interferes with DNA replication c. It damages the cell in S phase of replication d. It alters the hormonal environment that promotes cancer growth

ANS: B Most chemotherapeutic agents work by interfering with the cell's ability to multiply or reproduce. Cytoxan interferes with DNA replication. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2028 OBJ: 13 TOP: Chemotherapy KEY: Nursing Process Step: Implementation

What is the physical, emotional, and spiritual exhaustion that can occur among caregivers? a. Excessiveness b. Burnout c. Fatigue d. Weariness

ANS: B Physical, emotional, and spiritual exhaustion among caregivers is sometimes called burnout. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2061 OBJ: 22 TOP: Burnout KEY: Nursing Process Step: N/A

Which employment setting would likely involve a daytime schedule with weekends off, and would focus on prevention and patient teaching? a. Long-term care b. Physician's office c. Hospice setting d. Adult day care

ANS: B Physician offices typically involve a daytime schedule with most weekends off. The setting focuses on prevention and includes opportunities for patient teaching. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2054 OBJ: 12 TOP: New graduate KEY: Nursing Process Step: N/A

Why is it important for new graduates to purchase their own malpractice insurance rather than depend on an institutional policy? a. A private policy will not cover them unless they are on their primary job. b. A private policy will carry personal liability coverage. c. A private policy will protect them against all lawsuits. d. A private policy will protect them from losing their license.

ANS: B The new graduate should purchase private malpractice insurance in addition to that of the institution to ensure that there is personal liability coverage. The private policy will cover the new graduate at any nursing job in which they are employed. No malpractice insurance policy can guarantee that there will not be any lawsuit or loss of license. PTS: 1 DIF: Cognitive Level: Application REF: Page 2061 OBJ: 21 TOP: Malpractice insuranceKEY: Nursing Process Step: N/A

In what employment setting does the nurse give total care to one patient; is totally independent; provides care in the home, hospital, or other facility; is paid directly by the patient; and is legally responsible for his or her own actions? a. Home health nursing b. Private duty nursing c. Patient care nursing d. Agency care nursing

ANS: B The private duty nurse gives total care to one patient and is paid directly by the patient or responsible party. The nurse is legally responsible for his or her own actions. PTS: 1 DIF: Cognitive Level: Application REF: Page 2055 OBJ: 12 TOP: New graduate KEY: Nursing Process Step: N/A

Technical and scientific changes have resulted in a multiplicity and complexity of functions placed on nurses, and sometimes job descriptions have not been rewritten. What is true of the role of the LPN/LVN? a. It is constantly enlarging b. It is constantly changing c. It is constantly improving d. It is constantly growing

ANS: B The role of the LPN/LVN is constantly changing. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2045 OBJ: 6 TOP: New graduate KEY: Nursing Process Step: N/A

What is the term for the commission of an act that a prudent nurse should not have done, or the omission of an act a prudent nurse should have done, that results in injury or harm to another person? a. Malpractice b. Negligence c. Neglect d. Disregard

ANS: B To qualify as negligence, it must be proved that a prudent member of the profession would have acted differently. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2052 OBJ: 10 TOP: Negligence KEY: Nursing Process Step: N/A

What would the nurse encourage the patient to look for during self-testicular testing? (Select all that apply.) a. Smooth consistency of testicle b. Stomachache c. Breast enlargement d. Heavy feeling in the scrotum e. Enlarged blood vessels in scrotum f. Hematuria

ANS: B, C, D Signs and symptoms of a scrotal tumor include an ache in the groin or stomach, feeling of heaviness in the scrotum, and breast enlargement. PTS: 1 DIF: Cognitive Level: Application REF: Page 2020 OBJ: 3 TOP: Testicular examination KEY: Nursing Process Step: Implementation

How do cancer cells differ from normal cells? (Select all that apply.) a. They replicate in an organized manner. b. They have larger nuclei. c. They have an irregular shape. d. They have a different number of chromosomes. e. They have a different mitosis process.

ANS: B, C, D, E Cancer cells are disorderly in replication, have larger nuclei, an irregular shape, a different number of chromosomes, and a different process of mitosis. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2021 OBJ: 7 TOP: Cancer cells KEY: Nursing Process Step: Implementation

Which of the following are risk factors for cancer? (Select all that apply.) a. Ethnicity b. Environmental irritants c. Alcoholism d. Hereditary factors e. Excessive exercise f. Exposure to ultraviolet light

ANS: B, C, D, F Cancer risk factors include smoking and the use of smokeless tobacco, environmental irritants, alcoholism, hereditary factors, and dietary habits. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2016 OBJ: 4 TOP: Cancer risk factors KEY: Nursing Process Step: Implementation

Which actions would best aid the new nurse in coping with working the night shift? (Select all that apply.) a. Eat large meals during the night to stay awake b. Use dark shades to block out light when sleeping c. Obtain a prescription for sedatives to aid sleep d. Wear sunglasses on the drive home from work e. Go directly to bed when arriving home from work

ANS: B, D Dark shades or room darkening blinds will block the sunshine and allow for darkness when sleeping during the daytime hours. Wear sunglasses on the drive home from work to reduce the melatonin-reducing effect of sunshine. It is best to eat light, balanced meals during the night. Sedatives and alcohol should not be used as an aid to sleep. Allow time to unwind after work before going to bed, and try to follow the same routine daily. PTS: 1 DIF: Cognitive Level: Application REF: Page 2040, Box 57-6 OBJ: 3 TOP: Night shift KEY: Nursing Process Step: N/A

What are the signs and symptoms of prostatic enlargement? (Select all that apply.) a. Rotten egg odor to urine b. Hematuria c. Swollen scrotum d. Difficulty starting urine flow e. Strong flow of urine

ANS: B, D Indicators of prostatic hypertrophy are hematuria, difficulty starting urine flow, and weak urine stream. PTS: 1 DIF: Cognitive Level: Application REF: Page 2020 OBJ: 3 TOP: Prostatic hypertrophy KEY: Nursing Process Step: Implementation

The nurse explains to a 43-year-old patient with a benign tumor in her right breast that a benign tumor differs from a malignant tumor in that benign tumors: a. do not cause damage to adjacent tissue. b. are simply an overgrowth of normal cells. c. do not spread to other tissues and organs. d. frequently recur in the same site.

ANS: C A benign tumor differs from a malignant tumor because benign tumors are not recurrent or progressive and are nonmalignant. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2020, Table 56-2 OBJ: 8 TOP: Benign tumor KEY: Nursing Process Step: Implementation

Professional Roles and Leadership Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition 1. What is the correct term for a concise, one- or two-page summary of educational and work experience, activities and honors, and concrete skills and interests? a. Introduction b. Review c. Résumé d. Composite

ANS: C A résumé is a one- or two-page summary of the applicant's education and experience. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2042 OBJ: 1 TOP: New graduate KEY: Nursing Process Step: N/A

An employee failed to perform the duties listed in the employment contract. What is the term for this failure? a. Lawsuit b. Termination c. Breach of contract d. Reprimand

ANS: C Failure by the nurse or employer to perform contractual duties is known as a breach of contract. A breach of contract may result in a reprimand, termination, or lawsuit. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2042 OBJ: 2 TOP: New graduate KEY: Nursing Process Step: N/A

A patient, age 63, has terminal cancer of the liver and is cared for by his wife at home. His abdominal pain has become increasingly severe, and he now says it is intense most of the time. The nurse recognizes that teaching regarding pain management has been effective based on which measure implemented by this patient? a. Limiting the use of opiate analgesics to prevent addiction b. Using analgesics only when the pain becomes more than he can tolerate c. Taking analgesics around the clock on a regular schedule, using additional doses for breakthrough pain d. Resigning himself to the fact that pain is an inevitable consequence of cancer

ANS: C Fixed dosage schedules with adequate doses for pain relief provide more constant blood levels and predictable pain relief. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2035 OBJ: 16 TOP: Pain management KEY: Nursing Process Step: Evaluation

The nurse knows which of the following to be characteristics of malignant tumors? a. Smooth, well defined; movable when palpated b. Resembles parent tissue; rarely fatal c. Rate of growth varies; rarely contained within a capsule d. Remains localized; slow growth

ANS: C Malignant tumors are rarely contained within a capsule and their rate of growth varies; little resemblance to parent tissue; fatal without treatment; irregular and immobile when palpated. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2020, Table 56-2 OBJ: 7 TOP: Cancer identification KEY: Nursing Process Step: Assessment

A female patient, age 59, has lost 10 lb in the first 3 weeks of her chemotherapy and does not eat because nothing tastes good. What would be the appropriate nursing diagnosis for the plan of care? a. Ineffective health maintenance, related to lack of knowledge of nutritional requirements during radiation therapy b. Risk for infection, related to poor nutrition c. Imbalanced nutrition: less than body requirements, related to anorexia d. Ineffective therapeutic regimen management, related to refusal to eat

ANS: C Nursing diagnosis includes imbalanced nutrition: less than body requirements, related to anorexia from changes in taste and smell. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2030, Nursing Care Plan OBJ: 13 TOP: Chemotherapy KEY: Nursing Process Step: Diagnosis

What measures would the home health nurse, designing nursing interventions for a patient receiving external radiation treatments for a malignancy, recommend to protect the patient's skin? a. Applying warm compresses to damaged skin b. Encouraging patient to apply fragrant lotion to skin c. Patting the skin dry after the bath d. Exposing skin to sun for 10 minutes a day

ANS: C Patting the skin dry rather than rubbing is less damaging to the skin. Lotions, sun exposure, and applications of heat or cold are not beneficial. PTS: 1 DIF: Cognitive Level: Application REF: Page 2027 OBJ: 13 TOP: External radiation therapy KEY: Nursing Process Step: Implementation

Which of the following people should avoid visiting a patient being treated with internal radiation therapy? a. A 78-year-old using a walker b. An18-year-old woman c. A woman pregnant in the third trimester d. A 24-year-old nursing mother

ANS: C Persons under the age of 18 and persons who are pregnant should not be allowed to visit a patient with internal radiation. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2027 OBJ: 13 TOP: Psychological support KEY: Nursing Process Step: Diagnosis

When should the nurse schedule the oral administration of metoclopramide (Reglan)? a. Only at bedtime b. With meals c. 30 minutes before meals d. 30 minutes after meals

ANS: C Reglan should be given 30 minutes before meals and at bedtime. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2031 OBJ: 13 TOP: Medications KEY: Nursing Process Step: Planning

When a résumé reflects too many job changes, the employer may question it. How long should an employee remain at the first place of employment? a. 6 months b. 3 months c. 1 year d. 2 years

ANS: C Resigning from a position properly is another skill that the LPN/LVN will need to have. Employers will sometimes question a résumé that reflects frequent job changes; therefore, it is best to remain at the first place of employment at least 1 year. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2045 OBJ: 1 TOP: New graduate KEY: Nursing Process Step: N/A

Why is seeking medical attention when any cancer warning signs occur frequently delayed? a. Difficulty accessing a physician or getting a referral consult. b. Lack of knowledge of the seven warning signs of cancer. c. Fear of the possible diagnosis of cancer and hoping signs will go away. d. Self-examination being complex and difficult to perform.

ANS: C Seeking medical attention when any warning signs occur is frequently delayed because people fear the possible diagnosis of cancer and hope the signs and symptoms will just go away. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2037 OBJ: N/A TOP: Cancer identification KEY: Nursing Process Step: Assessment

What is the function of organizations like The Lost Chord Club, Reach for Recovery, and I Can Cope? a. Arrange for transportation to a clinic b. Provide a small amount of financial support to patients c. Send volunteers to speak with a person facing a lifestyle change d. Arrange for reduced drug costs

ANS: C Support groups like The Lost Chord Club, Reach for Recovery, and I Can Cope are available to send volunteers to talk with persons facing lifestyle changes because of cancer. PTS: 1 DIF: Cognitive Level: Application REF: Page 2026 OBJ: N/A TOP: Cancer KEY: Nursing Process Step: Implementation

Using the TNM staging classification system, what does a tumor staged as T4N3M2 mean? a. No evidence of primary tumor, lymph node involvement, or distant metastasis b. Carcinoma in situ, regional lymph node involvement, and metastasis to one site c. Enlarging tumor, increasing lymph node involvement, and distant metastasis d. Enlarging tumor, no lymph node involvement, or distant metastasis

ANS: C TNM cancer staging classification system T4N3M2 means progressive increase in tumor size and involvement, increasing involvement of regional lymph nodes, and distant metastasis present. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2020, Box 56-2 OBJ: 10 TOP: Cancer staging KEY: Nursing Process Step: Assessment

How many minutes of daily exercise does the American Cancer Society recommend as a prevention of cancer? a. 10 minutes b. 15 minutes c. 20 minutes d. 30 minutes

ANS: C The ACS recommends 150 minutes of moderate exercise weekly, which comes to around 20 minutes a day. PTS: 1 DIF: Cognitive Level: Application REF: Page 2020, Health Promotion OBJ: 13 TOP: ACS recommendations KEY: Nursing Process Step: Implementation

Which of the following are thrombocytopenic precautions? a. Requesting an order for aspirin for discomfort b. Trimming toenails close c. Using an electric razor d. Vigorous tooth cleaning

ANS: C The patient should be taught to use an electric shaver. Thrombocytopenia is a reduction in the number of circulating platelets, due to the depression of the bone marrow. When the platelet count is less than 20,000/mm3, spontaneous bleeding can occur. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2030 OBJ: N/A TOP: Thrombocytopenia KEY: Nursing Process Step: Planning

A nurse may practice in another state if he or she has passed the NCLEX-PN examination in the nurse's own state and meets the other state's educational requirements. What is the process of transferring licensure from one state to another called? a. Auxiliary b. Co-licensure c. Endorsement d. Qualified licensure

ANS: C This licensure transfer from one state to another is called endorsement. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2051 OBJ: 10 TOP: Licensure KEY: Nursing Process Step: N/A

Nursing interventions for the nursing diagnosis of Imbalanced nutrition: less than body requirements would include all these except: a. provide adequate, easily digestible, soft, bland foods. b. give small, frequent, highly nutritional meals. c. allow extra time to eat. d. offer three regular meals of highly nutritious foods.

ANS: D A nursing diagnosis of Imbalanced nutrition: less than body requirements will require the nurse to give small, frequent, highly nutritional meals; to allow extra time to eat; and to provide adequate, easily digestible, soft, bland foods. PTS: 1 DIF: Cognitive Level: Application REF: Page 2030, Nursing Care Plan OBJ: N/A TOP: Nutrition KEY: Nursing Process Step: Implementation

A patient who has malignant cancer secondary to a high-grade lymphoma has been admitted with muscle weakness, tetany, paresthesia, and convulsion. The nurse notices the patient is being treated for tumor lysis syndrome (TLS) and initial treatment has not been successful. What should the nurse tell the family is the next step in treatment? a. Whole blood transfusion b. A bone marrow biopsy c. Immediate radiation treatment d. Dialysis

ANS: D A nursing intervention for TLS is to prepare the patient and family for dialysis if other measures are not effective. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2033 OBJ: 15 TOP: Tumor lysis syndrome KEY: Nursing Process Step: Implementation

Which of the following is a meal that would represent foods that help prevent cancer? a. Broiled steak, baked potato, whole wheat roll, soy milk b. Baked ham, rice and gravy, apples stewed in butter, whole milk c. Fried pork chops, candied sweet potatoes, white rolls and butter, iced tea d. Broiled chicken, cabbage with onion and garlic, and soy milk

ANS: D Green and yellow vegetables, cruciferous vegetables, whole grain and soy products, reduction of processed meats and red meat are all examples of foods that prevent cancer. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2020, Health Promotion OBJ: 3 TOP: Cancer prevention KEY: Nursing Process Step: Assessment

Which of the following characteristics is common in malignant tumors? a. Usually contained within a capsule b. Divide and multiply in the same manner as normal cells c. Proliferate and respond to treatment d. Progress and destroy surrounding tissues while spreading to distant parts of the body

ANS: D Malignant tumors destroy surrounding tissues and may spread to distant parts of the body causing a secondary tumor to grow in that area. Malignant cells divide and multiply but not in the same manner as normal parent cells and are rarely contained within a capsule. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 2020, Table 56-2 OBJ: 7 TOP: Tumor classification KEY: Nursing Process Step: Assessment

In what setting can the LPN/LVN's management and leadership skills be developed best? a. Acute care hospital b. Rehabilitation hospital c. Trauma center d. Long-term care facility

ANS: D Management and leadership skills of the LPN/LVN can best be developed in long-term care settings with RN supervision. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2053 OBJ: 12 TOP: New graduate KEY: Nursing Process Step: N/A

The nurse caring for a patient who is being treated for cancer of the cervix by a radioactive implant discovers that the applicator with the radioactive material has become dislodged and is lying in the bed between the patient's legs. What should the nurse do? a. Using long-handled forceps grasp the applicator and wrap it in a towel b. Help the patient to a chair and cover the applicator with a rubber sheet c. Reassure the patient by staying at the bedside and call for help d. Notify the charge nurse

ANS: D The applicator should not be touched. Reassure the patient and go to report the incident to the charge nurse. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 2028 OBJ: 13 TOP: Internal radiation therapy KEY: Nursing Process Step: Implementation

A patient has developed stomatitis from chemotherapy. What should the appropriate intervention for this condition include? a. Instruction in the following of a liquid diet b. Using a commercial mouthwash after each meal c. Cleaning teeth with a cotton swab dipped in hydrogen peroxide d. Using a soft toothbrush

ANS: D The use of a soft toothbrush to clean the teeth and rinsing with normal saline or soda will prevent added discomfort and bleeding. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 2029 OBJ: 13 TOP: Stomatitis KEY: Nursing Process Step: Implementation

The patient receiving radiation therapy complains of the conspicuous markings on the skin. What can the nurse explain about these markings? a. They are residues of the treatment and can be washed off. b. They are caused by radiation and will fade in time. c. They are indicators of the amount of radiation the patient is receiving. d. They are gridlines for treatment and should be left on.

ANS: D When external radiation is planned, the specific area on the body is marked to indicate the part at which external radiation will be directed. These markings must not be washed off. PTS: 1 DIF: Cognitive Level: Application REF: Page 2027 OBJ: 13 TOP: External radiation therapy KEY: Nursing Process Step: Implementation