sherpath EAQ- cancer- MOC Exam 4

A patient's laboratory report reveals that the cells from the tumor biopsy are grade II. Which interpretation would the nurse make about the tumor cells? Abnormal and moderately differentiated Very abnormal and poorly differentiated Immature, primitive, and undifferentiated Differing slightly from normal cells, well differentiated

Abnormal and moderately differentiated Grade II cells are more abnormal than grade I cells and are moderately 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. Grade I cells differ slightly from normal cells and are well differentiated.

Which is the primary function of beta interferon (β-IFN)? Proliferation and differentiation of monocytes Proliferation and differentiation of neutrophils Production of red blood cells in the bone marrow Activation of natural killer cells and macrophages

Activation of natural killer cells and macrophages β-IFN activates natural killer cells and macrophages, inhibits viral replication, and has antiproliferative effects on tumor cells. Granulocyte-macrophage colony-stimulating factor (GM-CSF) is responsible for the proliferation and differentiation of monocytes. G-CSF stimulates the proliferation and differentiation of neutrophils. Production of red blood cells in the bone marrow is the function of erythropoietin.

A patient awaiting a biopsy pathology report states, "I am afraid to die." Which response would the nurse make? Actively listen and allow the patient to talk about his or her fears. Teach the patient about the seven warning signs of cancer. Discuss the need to make changes in an unhealthy lifestyle. Remind the patient that there is probably no reason to worry.

Actively listen and allow the patient to talk about his or her fears. While patients are waiting for the results of diagnostic studies, be available to actively listen to their concerns. It is not an appropriate time to teach about the warning signs of cancer or to provide patient teaching regarding lifestyle changes. Do not provide false reassurances by telling the patient there is nothing to worry about.

Which statement about providing an opioid to a dying patient who is experiencing severe cancer pain is consistent with the rule of double effect? The opioids will likely hasten the person's death. Opioids in this situation may cause addiction and should not be given. The opioids will probably be no more effective than nonopioids for pain relief. Administering opioids to a dying patient in pain is an appropriate nursing action.

Administering opioids to a dying patient in pain is an appropriate nursing action. The rule of double effect provides ethical justification. This rule states that if an unwanted consequence (e.g., hastened death) occurs because of an action taken to achieve a moral good (e.g., pain relief), the action is justified if the nurse's intent is to relieve pain and not to hasten death. Opioids for chronic, severe cancer pain are an appropriate intervention for a dying patient, and the opioids may be titrated upward many times over the course of therapy to maintain adequate pain control. Opioids in this situation will not hasten the patient's death nor will they cause addiction. The opioids will likely be more effective than a nonopioid.

The family of a patient with a recent diagnosis of late-stage cancer asks the nurse whether cancer is related to their African American race. Which response by the nurse correctly reflects cancer incidence in relation to race? "Sadly, racial disparities related to cancer death rates are increasing." "Cancer rates for African American women are much higher than those for white women." "African Americans are generally at a later stage of cancer when they receive a diagnosis." "The rates of cancer for African American men is high, but cancer rates are higher for Hispanic men."

African Americans are generally at a later stage of cancer when they receive a diagnosis. Overall, racial disparities in relation to cancer death rates are decreasing. The incidence of cancer in women is highest among white women, not African American women. The cancer incidence among African Americans is higher than that for Hispanic men.

Which information regarding the incidence and death rates of cancer is accurate? Select all that apply. Select all that apply African Americans have a higher death rate from cancer than whites. Thyroid cancer is more prevalent in women than in men. Colon cancer is the most common type of cancer in men. A higher percentage of women than men have lung cancer. More men than women die from cancer-related deaths each year.

African Americans have a higher death rate from cancer than whites. Thyroid cancer is more prevalent in women than in men. More men than women die from cancer-related deaths each year. African Americans have a higher death rate from cancer than whites. Thyroid cancer is more prevalent in women. Cancer-related deaths are higher in men than in women. Prostate cancer is the most common type of cancer in men. The incidence of lung cancer is the same for men and women.

While teaching a community group about women's health, which guidelines would the nurse include? "Mammograms are necessary if you have a family history of breast cancer." "It's recommended that you get a mammogram each year after you turn 45." "If you are not able to perform breast self-examination (BSE), you should go for regular mammograms." "If you are an average-risk woman and your health care provider performs a clinical breast examination (CBE) annually, then you will not need to have a mammogram."

Annual mammograms are recommended after age 45. They are recommended for all women, not solely those with a family history of breast cancer. BSE is not a replacement for mammography. The American Cancer Society does not recommend depending on clinical breast examination (CBE) for breast cancer screening among average-risk women at any age."

Which interventions should the nurse perform to relieve stomatitis for a patient experiencing severe side effects of chemotherapy? Select all that apply. Select all that apply Apply topical anesthetics. Encourage nutritional supplements. Give diuretics and laxatives regularly. Encourage oral application of alcohol. Discourage the use of irritants like tobacco.

Apply topical anesthetics. Encourage nutritional supplements. Discourage the use of irritants like tobacco. Stomatitis is an inflammation of the mouth. It occurs when the epithelial cells are damaged due to chemotherapy or radiation therapy. Topical anesthetics such as viscous lidocaine may be used to provide local pain relief. Nutritional supplements help to meet the nutritional demands when the food intake decreases due to stomatitis. Giving diuretics and laxatives regularly promotes bladder and bowel elimination, but does not help in relieving stomatitis. Oral application of alcohol may have a drying effect on the mucosa and may worsen stomatitis. Use of oral irritants like tobacco should be discouraged because they can worsen stomatitis and increase discomfort.

Which suggestions would the nurse include when teaching a patient about the prevention of breast cancer? Select all that apply. Select all that apply Avoid smoking. Avoid exposure to harmful radiation. Increase the use of oral contraceptives. Avoid gaining excess weight during adulthood. Use combined hormone therapy (progesterone and estrogen) after menopause.

Avoid smoking. Avoid exposure to harmful radiation. Avoid gaining excess weight during adulthood. Modifiable risk factors for breast cancer include smoking and alcohol intake. Environmental exposure to radiation may cause breast cancer. Excess weight gain during adulthood or sedentary lifestyle may also enhance the risks. A link may exist between recent oral contraceptive use and increased risk of breast cancer for younger women. The hormones estrogen and progesterone may act as tumor promoters to stimulate breast cancer growth. The use of combined hormone therapy (estrogen plus progesterone) increases the risk of breast cancer and also the risk of having a larger, more advanced breast cancer at diagnosis.

A patient with breast cancer is having external beam radiation treatments. Which information would the nurse teach the patient about the care of the skin? Use antibacterial soap to feel clean. Scented lotion can be used on the area. Avoid heat and cold to the treatment area. Wear a new bra to comfort and support the 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.

Which laboratory finding may be associated with metastatic bone cancer in the left leg? Calcium 7.5 mg/dL Sodium 130 mEq/L Calcium 11.0 mg/dL Potassium 6.5 mEq/L

Calcium 11.0 mg/dL High serum calcium levels are seen with metastatic bone cancer as a result of calcium being released from damaged bones. A patient with metastatic bone cancer may present with a calcium level of 11.0 mg/dL, which is higher than normal (8.5 to 10.5 mg/dL). Calcium 7.5 mg/dL is a low serum calcium level. Although a sodium level of 130 mEq/L and a potassium level of 6.5 mEq/L are not normal ( sodium 135 to 145 mEq/L; potassium 3.5 to 5.5 mEq/L), neither sodium nor potassium levels are affected by metastatic bone cancer.

Chronic exposure to ultraviolet (UV) rays has which effects on the skin that increase the risk for skin cancer? Select all that apply. Select all that apply Increases blood flow to the skin Decreases the water content of the skin Causes an error in the skin's genetic code Causes degeneration of elastic fibers in skin tissue Decreases the skin's ability to repair cellular damage

Causes an error in the skin's genetic code Decreases the skin's ability to repair cellular damage Chronic exposure to the sun decreases the skin's capacity to repair cellular damage, which could predispose an individual to skin cancer. UV radiation damages DNA, causing an error in the genetic code and resulting in abnormal skin cells. Increased blood flow to the skin does not cause skin cancer. Increased blood flow is manifested as increase in skin temperature and reddening of skin. Decrease in the water content of the skin and degeneration of elastic fibers are brought about by aging and do not predispose an individual to cancer.

When a patient is diagnosed with stage IV malignant cancer, to which extent is the malignancy present? The cancer is still in situ. Tumor growth is localized. The spread of cancer cells is limited. Cells have undergone metastasis.

Cells have undergone metastasis. In a patient with stage IV malignant cancer, the cells have undergone metastasis. Cancer in situ indicates stage 0 malignancy. The limited spread of cancer cells indicates stage II malignancy. Localized growth of the tumor indicates stage III malignancy.

Which goals are treatment goals of cancer? Select all that apply. Cure Control Palliation Prevention Early detection Clinical staging

Cure Control Palliation The treatment goals for cancer include cure, control, and palliation. Prevention and early detection are goals for the health care team before a diagnosis of cancer. Clinical staging is done as part of the completion of a diagnostic workup to guide effective treatment selection.

The patient is using a fentanyl patch for control of chronic cancer pain. For which potential adverse effect would the nurse observe? Hypertension Pupillary dilation Urinary incontinence Decreased respiratory rate

Decreased respiratory rate Respiratory depression is a potentially life-threatening adverse effect of fentanyl, which is an opioid analgesic, via any route. Pupillary dilation, urinary incontinence, and hypertension are not potential side effects of fentanyl.

A nurse is teaching a group of patients who are at high risk of developing cancer due to family history. Which agents should the nurse describe as cancer-promoting? Select all that apply. Select all that apply Radiation Dietary fats Chemical agents Cigarette smoking Alcohol consumption

Dietary fats, cigarette smoking, and alcohol consumption are cancer-promoting agents and need to be excluded from the patients' lifestyles. Promotion is the second stage of cancer development, in which the altered cells undergo reversible proliferation. This proliferation is promoted by promoting agents, such as single alteration of the genetic structure of the dietary fat, obesity, cigarette smoking, and alcohol consumption. Changing a person's lifestyle to modify these risk factors can reduce the chance of cancer development. Radiation and chemical agents are cancer-initiating agents rather than promoting agents.

Which action by the student nurse indicates effective learning about measures to be followed for a patient who is receiving radiation therapy for head and neck cancer? Suggesting use of facial massage therapy to help with relaxation Instructing patients to apply lotion just before radiation treatment Encouraging bed rest until the series of radiation treatments are complete Educating patients to avoid using over-the-counter lotions on irradiated skin

Educating patients to avoid using over-the-counter lotions on irradiated skin Patients undergoing radiation therapy should use only prescribed lotions in the areas of radiation exposure because some over-the-counter lotions may contain chemicals such as alcohol that will further dry and damage skin. Since skin is damaged by radiation, the patient should avoid vigorous rubbing or pressure over irradiated areas. Lotions should not be used within two hours prior to scheduled radiation. Fatigue associated with radiation therapy can be reduced by mild exercises such as walking for 15 to 30 minutes daily.

Which characteristics describe a benign tumor? Select all that apply. Select all that apply Metastatic Encapsulated Well differentiated Low rate of recurrence Infiltrate surrounding areas

Encapsulated Well differentiated Low rate of recurrence Benign tumors are encapsulated and have a well-defined border. They have well-differentiated cells. Once treated, benign tumors have a low rate of recurrence. Unlike malignant tumors, benign tumors are not metastatic and do not infiltrate the neighboring areas.

Which actions are examples of primary prevention strategies? Select all that apply. Select all that apply Having a colonoscopy at age 50 Exercising at the gym three times a week Obtaining a booster immunization for tetanus Performing monthly breast self-examinations Eating a diet that is low in fat and processed sugars

Exercising at the gym three times a week Obtaining a booster immunization for tetanus Eating a diet that is low in fat and processed sugars Primary prevention refers to measures, such as suitable exercise, timely immunizations, and proper diet, that prevent the occurrence of a specific disease. Having a colonoscopy and performing breast self-examinations are examples of secondary prevention activities, which are aimed at early detection of disease.

The nurse reviews the medical record of a patient who is hospitalized with a suspected bowel obstruction. The nurse identifies that which factor in the patient's history places the patient at risk for colorectal cancer? Osteoarthritis (OA) Familial adenomatous polyposis (FAP) Gastroesophageal reflux disease (GERD) Daily use of nonsteroidal antiinflammatory drugs (NSAIDs)

FAP Risk factors for colorectal cancer include a family or personal history of FAP. This tissue can degenerate over time and become malignant. Daily use of NSAIDs, GERD, and osteoarthritis do not place the patient at risk for colorectal cancer.

A patient undergoing radiotherapy has developed erythema and desquamation. Which information would the nurse include when educating the patient about skin care in the radiated area? Use perfumes and cosmetics on the treatment area as desired. Wear fabrics such as wool and corduroy to prevent exposure to cold. Gently cleanse the skin using a mild soap, tepid water, and a soft cloth. Allow brief periods of direct exposure to sunlight for good bone health.

Gently cleanse the skin using a mild soap, tepid water, and a soft cloth. The skin should be gently cleansed using a mild soap, tepid water, and a soft cloth. Fabrics such as wool and corduroy should not be worn because they can traumatize the skin. Chemicals like perfumes, cosmetics, and powders should not be used on the treatment area because they are harsh on skin and can increase the irritation of the skin. The skin should not be exposed to direct sunlight. Protective clothing should be worn if exposure to sun is expected.

A patient is illiterate and has cancer. Which factors would the nurse anticipate to be associated with this patient? Select all that apply. Higher risk of death Less hospitalization Increased use of cancer screening Greater use of emergency department care Decreased ability to use medications correctly

Higher risk of death Greater use of emergency department care Decreased ability to use medications correctly An illiterate patient may be unaware of the cancer treatment plan. Because of this factor, the patient will be at higher risk of death and will require greater use of the emergency department. Illiteracy will also factor into the patient's decreased ability to use medications correctly. This patient will have decreased use of cancer screening and will be associated with more hospitalization.

Which clinical manifestation is an early sign of laryngeal cancer? Discolored purulent nasal drainage Hoarseness for more than two weeks Tenderness at the ethmoidal sinuses Nasal cavity filled with mucous fluid

Hoarseness for more than two weeks is an early sign of laryngeal cancer. Discolored purulent nasal drainage and tenderness at the ethmoidal sinuses are signs of acute sinusitis. Rhinorrhea, a condition where the nasal cavity is filled with mucous fluid, is a sign for influenza.

Along with the Papanicolaou (Pap) test, which test is used to screen for cervical cancer? CA-125 test Colposcopy Cervical biopsy Human papillomavirus (HPV) test

Human papillomavirus (HPV) test An HPV test is used to identify the high-risk HPV types 16 and 18, which are associated with cervical cancer. A CA-125 test is used in conjunction with an ultrasound and a yearly pelvic exam to screen women at high risk for ovarian cancer. A colposcopy is used in conjunction with a biopsy as a diagnostic tool, not a screening tool.

Which response does the immune system normally make to antigens of malignant cells? Metastasis Tumor angiogenesis Immunologic escape Immunologic surveillance

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, which allows the cancer cells to reproduce.

Which information would the nurse include when teaching a patient about a Papanicolaou (Pap) test? Select all that apply. Select all that apply It is a microscopic study of exfoliated cells. A vaginal specimen is cultured. There is a direct microscopic study. Cells are obtained directly from the endocervix and ectocervix. Avoid douching for 24 hours after examination.

It is a microscopic study of exfoliated cells. Cells are obtained directly from the endocervix and ectocervix. The nurse should inform the patient that a Pap test is a microscopic study of exfoliated cells by a special staining fixation technique to detect abnormal cells in the endocervix and ectocervix (from which cells are obtained directly). A Pap test does not involve the culture of vaginal discharge or direct microscopic examination. The patient should be instructed to avoid douching for 24 hours before the examination, not after.

The nurse is educating a patient about cancer prevention and early detection. Which instructions would the nurse include? Select all that apply. Limit alcohol consumption. Stop or reduce cigarette smoking. Get regular physical examinations. Know the seven warning signs of cancer. Exercise for 20 minutes three times a week.

Limit alcohol consumption. Stop or reduce cigarette smoking. Get regular physical examinations. Know the seven warning signs of cancer. Limiting or reducing alcohol intake and tobacco use, regular physical examinations, and understanding the seven warning signs of cancer are all educational topics about cancer prevention. The recommendation for exercise is 30 minutes of moderate exercise five times a week.

Family members are shocked that their mother has a diagnosis of lung cancer. They ask the nurse whether it is common for women to have lung cancer. Which response would the nurse provide? "Lung cancer is the second most common cancer for both men and women." "Sadly, it is not that unusual; lung cancer is now the leading cancer for women." "It is unusual that your mother would have lung cancer because fewer women smoke than men." "Lung cancer is not as common as colorectal cancer, but more women are receiving this diagnosis."

Lung cancer has the second-highest incidence for both men and women. Breast cancer, not lung cancer, is the leading cancer in women. The idea that fewer women smoke does not reflect this individual woman's risk. Lung cancer is twice as common as colon cancer in women.

On which interventions would the nurse focus for a patient who is diagnosed with early-stage cervical cancer? Select all that apply. Select all that apply Maintain the patient's hope. Explain the upcoming radiation therapy in detail. Listen actively to the patient's fears and concerns. Assist the patient in maintaining usual lifestyle patterns. Discuss replacement child care for the patient's children.

Maintain the patient's hope. Listen actively to the patient's fears and concerns. Assist the patient in maintaining usual lifestyle patterns. Maintaining hope is the key to effective cancer care. Listening to the patient's fears and concerns provides a basis for therapeutic communication. It is also important to assist the patient in maintaining usual lifestyle patterns as much as possible. Discussing replacement child care is not appropriate at this time. Provide essential information is important, but extreme details about future possible treatment may increase anxiety.

A patient and family are upset that the patient may have cancer. Which nursing actions would the nurse use to facilitate their coping during the diagnostic phase? Select all that apply. Select all that apply Maintain hope. Exhibit a caring attitude. Plan realistic long-term goals. Be available to listen to fears and concerns. Teach about each type of cancer that could be diagnosed.

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 the patient and family about the diagnostic procedures also would be important. Realistic long-term goals and teaching about the type of cancer are not pertinent until the cancer is diagnosed, and may increase their anxiety.

A nurse is preparing to teach a patient with cancer about pain management. Which information would the nurse include in the teaching plan? Select all that apply. Select all that apply Nonpharmacologic pain relief therapies Mechanism of action of the pain medications Pathophysiology of the development of pain in cancer Side effects and complications associated with medications Adjustments in drug dosages that may be required over time

Nonpharmacologic pain relief therapies Side effects and complications associated with medications Adjustments in drug dosages that may be required over time The goal of a teaching plan about pain management is to ensure a safe and effective delivery of drugs and adequate pain relief. Nonpharmacologic therapies are preferable to drugs meant for pain relief because there is a smaller chance of side effects and adverse reactions. Side effects and complications associated with analgesic use should be taught to the patient. The patient should be instructed to tell the health care provider if these effects are present. The analgesic effect of the drugs may decrease over time, and dosages may need to be adjusted for effective pain relief. The mechanism of the action of drugs or the pathophysiology of the development of pain in cancer need not be addressed while teaching pain management.

A patient has neutropenia and a body temperature of 100.4° F (38° C). Which action would the nurse take? Initiate parenteral fluids. Give aspirin to the patient. Administer pamidronate to the patient. Notify the health care provider.

Notify the health care provider. A patient with cancer who has neutropenia (low white blood cell count) is vulnerable to infection. A body temperature of 100.4° F (38° C) indicates hyperthermia. The nurse should immediately notify the health care provider in this situation. Hydration therapy with parenteral fluids will treat hypocalcemia, which is a complication of cancer and may cause nephrocalcinosis. Aspirin can reduce hyperthermia; however, it is not preferable for a patient with a low white blood cell count. Pamidronate is a bisphosphonate that inhibits serum calcium levels and helps to treat hypercalcemia effectively.

Which is the most common symptom of lung cancer? Fatigue Anorexia Hoarseness Persistent cough

Persistent cough A persistent cough is the most common symptom of lung cancer. It may be accompanied with blood-tinged sputum due to bleeding caused by the cancer. Later manifestations include hoarseness, which may occur due to laryngeal nerve involvement, as well as fatigue and anorexia, which are nonspecific symptoms.

A patient with lung cancer develops headaches, facial edema, periorbital edema, and distention of the veins in the head, neck, and chest. Which items will the nurse expect to be included in the patient's collaborative treatment plan? Select all that apply. Prepare the patient for radiation therapy. Administer a narcotic and reassure the patient. Administer a diuretic agent and reassure the patient. Inform the patient that chemotherapy may be required. Inform the patient that the symptoms are due to obstruction of a bronchus.

Prepare the patient for radiation therapy. Inform the patient that chemotherapy may be required. A lung cancer patient who presents with headaches, facial edema, periorbital edema, and distension of veins of the head, neck, and chest is indicative of superior vena cava syndrome. Management of this condition involves treating the patient with localized radiation therapy. If the cancer is sensitive to drugs, then the patient may also be treated with chemotherapy. Superior vena cava syndrome is a medical emergency; hence, just administering a pain killer and diuretic will only provide symptomatic relief without any effect on disease progression. Superior vena cava syndrome is due to obstruction of the superior vena cava and not the bronchus.

Which stage in the development of cancer is characterized by the reversible proliferation of the altered cells? Initiation Promotion Metastasis Progression

Promotion is the second stage of cancer, which is characterized by the reversible proliferation of the altered cells. Initiation is the first stage of cancer, which involves the mutation of the cell's genetic structure. Metastasis is the spread of cancer to a distant site; this is a characteristic of the progression stage. Progression is the final stage in the natural history of cancer.

The nurse is developing a program for the type of cancer with the highest incidence among males. On which type of cancer will the nurse focus the program? Lung cancer Colon cancer Thyroid cancer Prostate cancer

Prostate cancer Among all the cancers in men, prostate cancer has the highest incidence (19%). Lung cancer has the highest death rate among men (26%). The incidence of colon cancer in males is 9%. Thyroid cancer is more common in women than men.

When a patient with a 40-year history of cigarette smoking is diagnosed with lung cancer and tells the nurse, "Lots of people who smoke are healthy, so I don't think that I need to quit," which defense mechanism is being used? Denial Regression Use of humor Rationalization

Rationalization Rationalization is demonstrated when a patient uses incorrect reasoning to justify not making a change, such as stating that since some people who smoke are healthy, there is no reason to quit. A patient using denial would refuse to acknowledge a lung cancer diagnosis. A patient using regression as a defense mechanism would display behaviors more appropriate to an earlier developmental stage to avoid dealing with a cancer diagnosis. A patient using humor as a defense mechanism might deflect any discussion about quitting smoking with a joke.

The nurse is educating a student nurse about the seven warning signs of cancer. Which warning sign stated by the student nurse indicates a need for further clarification? Indigestion Severe headache Unusual bleeding Difficulty in swallowing

Severe headache is not a warning sign of cancer. Severe headache may indicate a stroke. Indigestion may indicate stomach cancer. Unusual bleeding may indicate uterine cancer. Difficulty in swallowing may indicate esophageal cancer.

When a patient with lung cancer experiences edema of the neck and face, which complication does the nurse suspect? Pleural effusion Cardiac tamponade Paraneoplastic syndrome Superior vena cava syndrome

Superior vena cava syndrome Superior vena cava syndrome is a complication of cancer that is caused by thrombosis in the superior vena cava. This blockage of the superior vena cava results in edema of the neck and face. A pleural effusion is the presence of excess fluids around the lungs, which is one of the late signs of lung cancer. Cardiac tamponade is a complication of cancer that is associated with compression of the heart due to accumulation of fluid in the pericardial sac. Paraneoplastic syndrome is a complication of cancer that is associated with an excess release of hormones into the bloodstream.

A patient is in the promotion stage of cancer development. What action can the nurse take to facilitate cancer prevention? Tell the patient to exercise daily. Teach the patient about factors to avoid. Tell the patient to have the cancer surgically removed now. Teach the patient which vitamins will improve the immune system.

Teach the patient about factors to avoid. 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. 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 the nurse's role.

Which statement explains the primary protective role of the immune system related to malignant cells? Immune cells bind with free antigen released by malignant cells. Immune cells produce blocking factors that immobilize cancer cells. The immune system produces antibodies that attack the cancer cells. The immune system provides surveillance for tumor-associated antigens (TAAs).

The immune system provides surveillance for tumor-associated antigens (TAAs). It is believed that one of the functions of the immune system is to respond to TAAs, which are altered cell-surface antigens that occur on a cancer cell as a result of malignant transformation. This immune function is known as immunologic surveillance. Immune cells do not bind with free antigens released by malignant cells, nor do they produce blocking factors that immobilize cancer cells. The immune system does not produce antibodies to attack cancer cells.

The nurse is educating a group of adolescent girls about cervical cancer. Which information does the nurse include in the discussion? Select all that apply. Select all that apply The incidence rate is highest among Hispanic women. A risk factor is smoking. Taking oral contraceptives lowers the risk of cervical cancer. Having regular Pap tests is important to screen for cervical cancer. The Center for Disease Control (CDC) recommends that all children, males and females, receive the HPV vaccine at age 11 to 12.

The incidence rate is highest among Hispanic women. A risk factor is smoking. Having regular Pap tests is important to screen for cervical cancer. The Center for Disease Control (CDC) recommends that all children, males and females, receive the HPV vaccine at age 11 to 12. Smoking increases the risk of cervical cancer. The incidence rate is highest among Hispanic women. The Pap test helps to find changes in cervical cells that may indicate precancerous changes. The CDC recommends that all children, males and females, be vaccinated at age 11 to 12, when the immune system has a better uptake of the vaccine. There is no relationship between oral contraceptives and cervical cancer.

A patient who is undergoing external beam radiation therapy asks, "Will I be radioactive after the treatment?" Which information will the nurse provide in response? The patient will not be radioactive at any time. Only the patient's urine and stool will be radioactive. The patient will be radioactive only during the treatment period. Although the patient's blood is radioactive, it will not affect others.

The patient will not be radioactive at any time. In external beam radiation therapy, gamma radiation is focused toward the treatment field. The patient does not absorb or retain any of the radiation particles during the treatment and is therefore not radioactive during or after the treatment period. A patient is only radioactive when there is some form of internal radiation, such as brachytherapy as a sealed source, or an unsealed liquid radioactive source. These sources have short half-lives and are weak emitters. In these types of radiation treatments, stool, and urine, and blood will emit some radiation. The principles of ALARA (as low as reasonably achievable) and TDS (time, distance, and shielding) should always be followed.

The patient is being treated with brachytherapy for cervical cancer. Which factor affects the nurse's health when caring for this patient? The prescribed medications the patient is taking The nutritional supplements that will help the patient How much time is needed to provide the patient's care The time the nurse is with the patient and at what distance

The time the nurse is with the patient and at what distance 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 the time needed to complete care will not protect the nurse who is caring for a patient with brachytherapy for cervical cancer.

Which explanation would the nurse provide about the skin markings to a patient who is undergoing radiation therapy? They are permanent effects of radiation therapy. They indicate that previous treatments have been unsuccessful. They are a warning of potentially serious side effects of radiation. They should be protected because they are landmarks for the therapy.

They should be protected because they are landmarks for the therapy. Markings should be protected from being washed or removed because they are landmarks for the radiation therapy treatment field. They are not permanent; nor are they an indication that previous treatment has been unsuccessful or a warning about the side effects of radiation.

Which parameters are taken into account in the TNM staging of cancers? Select all that apply. Select all that apply Tumor size Metastasis Number of tumors Lymph node involvement Response to hormonal therapy

Tumor size Metastasis Lymph node involvement The TNM system is the most widely accepted staging method for breast cancer. This system uses tumor size (T), presence of metastasis (M), and nodal involvement (N) to determine the stage of disease. Numbers of tumors and response to hormonal therapy are not the parameters used to stage the cancer according to the TNM staging system.

The nurse is educating a group of women about breast cancer. Which area would the nurse identify as the location where most breast cancers occur? Nipple area of the breast Upper medial area of the breast Lower medial area of the breast Lower outer quadrant of the breast Upper outer quadrant of the breast

Upper outer quadrant of the breast Most (50%) breast cancers are diagnosed in the upper outer quadrant of the breast. The next most frequent site is the nipple area (18%), followed by the upper medial area (15%), the lower outer quadrant (11%), and the lower medial area (6%).

Which instruction would the nurse give the patient regarding care of the skin at the site of external beam radiation therapy? Expose the area to sunlight twice a week. Apply an ointment to the area to prevent irritation. Use talcum powder on the area to promote comfort. Wash the area with lukewarm water and lightly pat it dry.

Wash the area with lukewarm water and lightly pat it dry. The area undergoing radiation therapy may safely be washed with lukewarm water if it is done gently and if care is taken not to injure the skin. A patient undergoing radiation therapy should avoid anything that may be irritating to the skin, such as sunlight, lotions, ointments, or talcum powder.

The nurse who is preparing educational information about lung cancer notes that which factor is the primary risk related to its development? Genetics Chewing tobacco Cigarette smoking Occupational exposure

cigs

Which information in the health history indicates that a patient has a complete carcinogen risk factor for the development of cancer? Obesity Diet high in fat Cigarette smoking Alcohol consumption

cigs Cigarette smoke is a complete carcinogen because it is capable of both initiating and promoting the development of cancer. Although alcohol consumption, dietary fat, and obesity are all promoting factors for cancer, they are not considered complete carcinogens.

Which teaching strategy is best for the nurse to use when teaching a group of patients about breast cancer self-screening techniques? Handouts Support group Demonstration Lecture-discussion

demonstration Self-screening for breast cancer is a skill; therefore, it is best taught through demonstration. Printed materials such as handouts are useful for non-skill patient teaching, but are not as helpful in teaching a skill. Support groups are useful for patients with chronic illness, but will not be as helpful in learning a skill that is typically done in a standardized manner. Lecture-discussion involves presentation of information and then an exchange of points of view within a group and will not be as helpful in teaching breast self-exam, where point of view will not change how the skill is done.

A patient has been diagnosed with Burkitt's lymphoma. Which exposure would the nurse expect to find in the patient's history? Solar radiation Ethylene oxide Epstein-Barr virus Bacterial infection

epstein-barr virus Burkitt's lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. 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. Bacteria do not initiate cancer.

Which tumor feature is known if a patient has been diagnosed with stage II cervical cancer? It is in situ. It has metastasized. It has spread locally. It has spread extensively.

it has spread locally Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ. Stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread, and stage IV denotes metastasis.

A patient who has bone cancer reports intolerable pain in the thigh. Which drug would the nurse expect to be prescribed for this patient? Aspirin Diclofenac Morphine Ibuprofen

morphine Opioid medications such as morphine are most commonly prescribed for moderate to severe pain. Aspirin is usually prescribed for mild to moderate pain. Diclofenac and ibuprofen are weaker analgesics and are not effective in treating severe cancer pain.

Which mode of treatment would be included in the hospice plan of care for the patient in the terminal stage of breast cancer? Opioids Mastectomy Chemotherapy Radiation therapy

opioids Hospice care provides support and care for patients in the last phases of a terminal disease so they might live as fully and as comfortably as possible. Unlike palliative care, hospice care does not include curative treatment. Providing pain relief is an important function of hospice care. Opioids are the drug of choice for pain relief in hospice care. Chemotherapy, radiotherapy, and mastectomy are curative therapies for cancer and are not provided in hospice care centers.

A patient with lung cancer develops paraneoplastic syndrome. The nurse reviews the patient's medical record and identifies which example of the syndrome? Cor pulmonale Polycythemia Raynaud's phenomenon Paroxysmal nocturnal hemoglobinuria (PNH)

polychtemia Lung cancers can cause paraneoplastic syndrome. Paraneoplastic syndrome may be caused by hormones, cytokines, enzymes (secreted by tumor cells), or antibodies (made by the body in response to the tumor) that destroy healthy cells. Examples of paraneoplastic syndrome include hypercalcemia, syndrome of inappropriate antidiuretic hormone secretion (SIADH), adrenal hypersecretion, polycythemia, and Cushing syndrome. Cor pulmonale, a condition in which the right side of the heart fails, is not caused by lung cancer. Raynaud's phenomenon, a medical condition in which spasm of arteries cause episodes of reduced blood flow, is not caused by lung cancer. PNH, a rare blood disease in which the immune system attacks red blood cells in the body and breaks them down, is not caused by lung cancer.

A patient states, "I had cancer in the cartilage of my leg." Which term would the nurse expect to find in the patient's health record? Sarcoma Osteoma Adenoma Myeloma

sarcoma Cancer of the connective tissue is known as a sarcoma. Osteoma refers to cancer originating in bone. Adenoma refers to cancer originating in glandular tissue. Myeloma refers to cancer originating in blood-forming tissues such as bone marrow.

The nurse reviews the subjective and objective data of a patient who presents to a health care provider office for a routine physical examination. Considering the findings, the nurse identifies that which additional information is the most important to obtain from the patient? Ethnicity Tobacco use Activity level Sun exposure

tobacco

Which tumor feature would the nurse expect when a patient's histology report mentions grade IV tumors? Undifferentiated Well differentiated Poorly differentiated Moderately differentiated

undifferated In histologic grading of tumors, both the appearance of cells and the degree of differentiation are evaluated pathologically. The cells in grade IV tumors are immature, primitive, and undifferentiated, and the cell of origin is difficult to determine (high grade). The cells in grade I tumors differ slightly from normal cells and are well differentiated. Cells in grade III tumors are very abnormal and are poorly differentiated. Grade II tumor cells are more abnormal and are moderately differentiated.

The nurse suspects that a patient with lung cancer has brain metastasis based on which assessment finding? Unsteady gait Muscle wasting Pleural effusion Edema of the face and neck

unsteady gait A patient with lung cancer who has brain metastasis may have neurologic problems such as an unsteady gait. Muscle wasting is related to musculoskeletal problems, which are a late manifestation of lung cancer. Pleural effusions are respiratory system manifestations of lung cancer. Edema of the face and neck is observed in patients with superior vena cava syndrome.

After the nurse has finished teaching about how to manage fatigue induced by radiation therapy, which patient statement indicates effective teaching? "I will keep myself busy continuously throughout the daylight hours." "I will walk three to four hours every day to increase my level of energy." "It's most important for me to avoid asking for help so I can become more independent." "Because I have the most energy in the morning, I will plan my errands during this time."

"Because I have the most energy in the morning, I will plan my errands during this time." Since fatigue is a common complication of radiation therapy, the nurse will teach the patient to do activities during the time of day when energy is highest and to rest when energy is low. A patient statement about keeping busy continuously during the day indicates a need for more teaching about the level of fatigue that is likely with radiation therapy. Patients are encouraged to walk for 15 to 30 minutes daily to help improve energy, but attempting to walk for three or four hours will exhaust the patient further. Patients are encouraged to identify support sources and ask for assistance when needed during radiation therapy.

Which question would the nurse ask to determine if a patient is at risk for cancer due to radiation exposure? "What are the usual foods in your diet?" "Have you received the hepatitis B vaccination?" "Are you exposed to benzene in your workplace?" "Do you use sunscreen when exposed to sunlight?"

"Do you use sunscreen when exposed to sunlight?" Exposure to the sun (ultraviolet rays) is a form of radiation; therefore this question is appropriate to ask to determine the patient's risk for cancer due to radiation exposure. While a diet high in fat is a risk factor for cancer, it is not a radiation carcinogen. Hepatitis B is a viral carcinogen. Benzene is a chemical carcinogen.

Which question should the nurse include in the health history interview to determine if a patient is at risk for cancer due to a viral carcinogen? "What are the usual foods in your diet?" "Have you received the hepatitis B vaccination?" "Are you exposed to benzene in your workplace?" "Do you use sunscreen when exposed to sunlight?"

"Have you received the hepatitis B vaccination?" The hepatitis B virus is considered a viral carcinogen because it is linked to the development of certain types of cancer; therefore this question is appropriate to determine the patient's exposure to viral carcinogens. While a diet high in fat is a risk factor for cancer, it is not a viral carcinogen. Benzene is a chemical carcinogen. Sun exposure is a radiation carcinogen.

A patient with cancer has dysgeusia and tells the student nurse, "I don't want to eat. Everything tastes bitter." Which patient advice planned by the student nurse indicates the need for further teaching? "Add onions to the vegetables." "Increase use of spicy seasonings." "Use mint juice while cooking fish." "Marinate the meat with lemon juice."

"Increase use of spicy seasonings." A patient with cancer may develop dysgeusia because cancer cells release substances that make the taste buds bitter. Using different spices and seasoning agents will help to enhance the taste. However, increasing spices and seasoning will not reduce dysgeusia and in fact may further increase gastric irritation in the patient. Onions help to enhance the taste of vegetables so the patient will have reduced bitterness. Mint and lemon juice helps to enhance the taste of meat and fish so the patient will have reduced dysgeusia.

For which reason would a patient with cancer have an elevated serum alpha-fetoprotein level? "It may be newly formed due to altered expression of protooncogenes." "It may normally get elevated and should not be associated with cancer." "It may be newly formed due to altered expression of a tumor-inducing gene." "It may be newly formed due to altered expression of a tumor-inhibiting gene."

"It may be newly formed due to altered expression of protooncogenes." Carcinogens may induce the unlocking of protooncogenes and cause genetic alterations and mutations. The new proteins, such as alpha-fetoprotein, can be produced by the cancerous cells and can be detected in human blood. Therefore this elevated level may be associated with an altered expression of protooncogenes, because they are associated with cancer and their elevated level should not be considered normal. The alteration of tumor-inducing genes and tumor-inhibiting genes may not be associated with high levels of alpha-fetoprotein.

Which statement would the nurse use to explain the loss of contact inhibition in cancer cells? "The cell differentiation is unstable." "The cells grow on top of one another." "The cell loses its potential to perform all the body functions." "The cells do not revert back to their previous undifferentiated state."

"The cells grow on top of one another." Contact inhibition is a normal mechanism for controlling cell proliferation that ensures that each cell does not cross another's boundary. This mechanism is inhibited in cancer. Therefore cells disregard boundaries and grow on top of one another. The cell differentiation activity is unstable in cancer cells. The cancerous cells lose the potential to perform all body functions because of differentiation defect. The cells do not dedifferentiate because of the defect in cell differentiation.

Which statements would the nurse include in teaching about gender differences related to cancer? Select all that apply. Select all that apply "Women are more likely to develop liver cancer than men." "The mortality rate of lung cancer is higher in men than in women." "More women than men die from cancer-related deaths every year." "The cancer with the highest incidence among men is prostate cancer." "Head and neck cancers occur more frequently in men than in women."

"The mortality rate of lung cancer is higher in men than in women." "The cancer with the highest incidence among men is prostate cancer." "Head and neck cancers occur more frequently in men than in women." The mortality rate from lung cancer is higher in men than in women. The highest incidence of cancer among men is prostate cancer. Head and neck cancers occur more frequently in men than in women. Therefore the nurse should include these statements in the teaching session. Men, not women, are more likely to develop liver cancer. Men are also more likely than women to die from cancer-related deaths each year.

The nurse is assisting a patient with stage IV lung cancer who is upset. Which statement by the nurse would help this patient cope with the diagnosis? "Lung cancers are easily treatable." "Anyone diagnosed with cancer feels the way you do." "Let's discuss this later, when you have your family with you." "This must be very difficult for you. Let me know how I can help."

"This must be very difficult for you. Let me know how I can help." That's right! Rationale The statement, "This must be very difficult for you," would be appropriate for communicating with the patient. This statement doesn't provide a false assurance and helps the patient to share his or her feelings. The statement, "Lung cancers are easily treatable," will provide a false assurance. The statement, "Let's discuss this when you have your family with you," redirects the discussion. The statement, "Anyone diagnosed with cancer feels the way you do" is a generalized statement; these statements are self-protective strategies, which deny the patient's opportunity to share the meaning of their experience.

A patient who is undergoing brachytherapy of the cervix tells the nurse, "I feel like I'll be alone in this room forever!" Which response would the nurse provide? "The staff is trying to provide privacy for you as much as possible." "Is there a family member we can call to stay with you during the treatment?" "Let me call your health care provider to see if the therapy can be removed early." "We have to limit time that we are in your room, but the treatment is almost finished."

"We have to limit time that we are in your room, but the treatment is almost finished." \\ 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 when caring for the person with an internal radiation source. To minimize anxiety and confusion, tell the patient the reason for time and distance limitations before the procedure. The reason the patient is in isolation is not to provide privacy. It is not appropriate for a family member to put themselves at risk by staying with the patient. Therapy would not be stopped early except in an emergency.

The community nurse is teaching preventive cancer measures to a group. Which statements indicate effective learning by the participants? Select all that apply. Select all that apply "We should sleep for at least four to five hours." "We should avoid smoked and salt-cured meats." "We should exercise for about 30 minutes in a week." "We should add whole grains and fiber foods in our diet." "We should be familiar with our family history regarding health."

"We should avoid smoked and salt-cured meats." "We should add whole grains and fiber foods in our diet." "We should be familiar with our family history regarding health." Nitrites acts as carcinogenic agents. Smoked and salt-cured meats have a high nitrite concentration; therefore smoked and salt-cured meats should be avoided to prevent cancer. Eating a balanced diet containing whole grains and adequate fiber can also prevent cancer. Awareness about one's family's health history can be useful in early screening of the disease. Adequate, consistent periods of rest for at least six to eight hours are required to prevent cancer. Regular exercise for 30 minutes or more at least five times a week is beneficial to prevent cancer.

Which explanation would the nurse provide to a patient who will have an excisional biopsy? "A core piece of tissue is removed and preserved for analysis." "You will have a surgical procedure to remove the entire lesion." "You will have a partial excision of the lesion using a dermal punch." "A small-gauge needle is used to remove cells for cytologic examination."

"You will have a surgical procedure to remove the entire lesion." An excisional biopsy is a surgical procedure during which the entire lesion is removed. A large-core biopsy involves the removal of a core piece of tissue that is preserved for analysis. An incisional biopsy is the partial excision of a lesion with a scalpel or dermal punch. A fine-needle aspiration (FNA) biopsy is performed with a small-gauge needle; this biopsy is used to remove cells for cytologic examination.

Which cancer diagnosis has the highest mortality rate for a female? Lung cancer Breast cancer Uterine cancer Pancreatic cancer

A lung cancer diagnosis has a 26% death rate for women. Uterine, breast, and pancreatic cancers have death rates of 15%, 4%, and 7%, respectively.

Which is the only definitive means of diagnosing cancer? Tissue biopsy Mammography Liver function studies CT scan

A tissue biopsy the pathologic evaluation of a tissue sample, is the only definitive way to diagnose cancer. Liver function studies are blood tests that can help evaluate the function of the liver. A mammography is a screening tool for breast cancer. A CT scan can help identify areas of abnormality and help determine the stage and metastasis of an existing tumor.