Cancer PrepU
A client is concerned with lumps that have developed in her breasts and is fearful of cancer. The client reports variability in the size of the lumps. What would the physician indicate is the client's condition? a. breast cancer b. fibrocystic breast disease c. lactating mastitis d. All options are correct
b. fibrocystic breast disease Fibrocystic breast disease is a benign breast condition that affects women primarily between the ages of 30 and 50 years. When fibrocystic disease develops, single or multiple breast cysts appear in one or both breasts.
Cancer is the second leading cause of death in the United States, second only to heart disease. Half of all men and one third of all women will develop cancer during their lifetimes. Which types of cancer have the highest prevalence among both men and women? a. skin and brain b. lung and colon c. colon and skin d. lung and skin
b. lung and colon Common cancers in men include prostate, lung, and colon. Breast, lung, and colon cancer most commonly affect women.
The nurse is caring for an adult client recently diagnosed with the early stages of lung cancer. The nurse is aware that the preferred method of treating clients with non-small cell tumors is what method? a. Radiation b. Bronchoscopic opening of the airway c. Surgical resection d. Chemotherapy
c. Surgical resection Surgical resection is the preferred method of treating clients with localized non-small cell tumors with no evidence of metastatic spread and adequate cardiopulmonary function. The other listed treatment options may be considered, but surgery is preferred.
Which is the earliest and the most common symptom of endometrial cancer? a. loss of weight b. pain c. bleeding d. pressure on the bladder
c. bleeding Bleeding is the earliest and the most common sign of endometrial cancer.
A nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by: a. chest X-ray. b. mammography. c. fine needle aspiration. d. breast self-examination.
c. fine needle aspiration. Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.
The nurse teaches the client whose surgery will result in a sigmoid colostomy that the feces expelled through the colostomy will be a. semi mushy. b. mushy. c. solid. d. fluid.
c. solid. With a sigmoid colostomy, the feces are solid. With a descending colostomy, the feces are semi mushy. With a transverse colostomy, the feces are mushy. With an ascending colostomy, the feces are fluid.
A nurse is caring for a client with a chest tube connected to a dry suction water seal drainage system. The nurse notes 2 cm of water and intermittent bubbling in the water seal chamber. Which action will the nurse take? a. Document the findings. b. Notify the health care provider. c. Add water to the water seal chamber. d. Check for an air leak.
a. Document the findings. The water seal chamber of the dry suction water seal drainage system should have 2 cm of water in it and should show intermittent bubbling. These findings are normal and expected so the nurse will document the findings. Continuous bubbling in the water seal chamber indicates an air leak. There is not a reason to notify the health care provider, according to this scenario.
What is the reason for chest tubes after thoracic surgery? a. Draining secretions, air, and blood from the thoracic cavity is necessary. b. Chest tubes allow air into the pleural space. c. Chest tubes indicate when the lungs have re-expanded by ceasing to bubble. d. Draining secretions and blood while allowing air to remain in the thoracic cavity is necessary.
a. Draining secretions, air, and blood from the thoracic cavity is necessary. After thoracic surgery, draining secretions, air, and blood from the thoracic cavity is necessary to allow the lungs to expand.
The nurse is instructing an adolescent female who is not sexually active on potential vaccinations available. Which vaccination would the nurse state that decreases the risk of cervical cancer? a. Human papilloma viral (HPV) b. Herpes zoster c. Hepatitis B d. Meningococcal
a. Human papilloma viral (HPV) Human papilloma viral (HPV) infection is the most commonly transmitted sexual disease in the United States. A strain of this infection can cause cervical cancer. An HPV vaccine is available to both females and males. For females, the vaccine decreases the risk of cervical cancer and genital warts. For males, the vaccine decreases the risk of genital warts and anal cancers. Hepatitis B vaccine protects against a liver disease. Herpes zoster is the vaccine for shingles. The meningococcal vaccine protects against several diseases including meningitis.
Which is one of the most important prognostic factors in breast cancer? a. Age of the client b. Status of lymph nodes c. Obesity d. Family history
b. Status of lymph nodes The two most important prognostic factors in breast cancer is the status of the lymph nodes and tumor size. Obesity, client age, and family history are not the most important prognostic factors in breast cancer.
A client is diagnosed with colon cancer, located in the lower third of the rectum. What does the nurse understand will be the surgical treatment option for this client? a. A low colectomy b. Colectomy c. Abdominoperineal resection d. Segmental resection
c. Abdominoperineal resection A cancerous mass in the lower third of the rectum will result in an abdominoperineal resection with a wide excision of the rectum and the creation of a sigmoid colostomy. An encapsulated colorectal tumor may be removed without taking away surrounding healthy tissue. This type of tumor, however, may call for partial or complete surgical removal of the colon (colectomy). Occasionally, the tumor causes a partial or complete bowel obstruction. If the tumor is in the colon and upper third of the rectum, a segmental resection is performed. In this procedure, the surgeon removes the cancerous portion of the colon and rejoins the remaining portions of the GI tract to restore normal intestinal continuity.
The nurse is caring for a client with breast cancer and removal of axillary lymph nodes. Which assessment finding is documented and brought to the physician's attention as potential lymphedema? a. Fluid accumulation under in the axilla b. A reddened area around the breast c. Enlargement of the arm or hand d. Drainage from the areola
c. Enlargement of the arm or hand Lymphedema, soft-tissue swelling from accumulated lymphatic fluid, occurs in some women after they have undergone breast cancer surgery and the removal or irradiating of axillary lymph nodes. Lymphedema does not impact the breast area or axilla.
A nurse is teaching a client about why ovarian cancer is largely considered to be a lethal cancer of the female reproductive system. What should the nurse include in the teaching? Select all that apply. - Tumors are typically far advanced and inoperable by the time of diagnosis. - There is no effective screening test. - Tumor-specific antigens are helpful in screening. - Ovarian cancer's vague symptoms are often ignored. - Tumors present with nonspecific symptoms.
- Tumors are typically far advanced and inoperable by the time of diagnosis. - There is no effective screening test. - Ovarian cancer's vague symptoms are often ignored. - Tumors present with nonspecific symptoms. Although other types of female reproductive system cancers occur with greater incidence, ovarian tumors are the leading cause of death from gynecologic malignancies. Tumors of the ovary have been lethal largely because they present with nonspecific symptoms, which are often ignored. There is no effective screening test; tumors frequently are far advanced and inoperable by the time the tumors are diagnosed. Tumor-specific antigens are used after diagnosis of ovarian cancer.
The health care provider recommends that parents have their daughter vaccinated with HPV vaccine. What is this vaccine for? a. Help prevent lung cancer b. Help prevent leukemia c. Help prevent cervical cancer d. Help prevent breast cancer
c. Help prevent cervical cancer The vaccines that are approved for use in the United States include the human papilloma virus (HPV), which may help prevent women from getting cervical, head, and neck cancers. There are no vaccines for the prevention of lung cancer, breast cancer, or leukemia.
A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan? a. Removing thoracic skin markings after each radiation treatment b. Applying talcum powder to the irradiated areas daily after bathing c. Wearing a lead apron during direct contact with the client d. Avoiding using soap on the irradiated areas
d. Avoiding using soap on the irradiated areas Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed.
Following a colposcopy, the confirmation of in situ carcinoma of the cervix has been determined. Which comment by the client indicates an appropriate understanding of the diagnosis? a. "The cancer has not spread." b. "I can wait until I have finished having babies to seek treatment." c. "I will not need any further treatment." d. "I will need surgery and chemotherapy to increase my odds for survival."
a. "The cancer has not spread." Carcinoma in situ means the cancer has not left the original site and therefore has not invaded other tissues. Further treatment is required, which usually consists of cryosurgery or hysterectomy. Surgery with adjuvant chemotherapy is usually reserved for cancers that are more advanced. Even though cervical cancers tend to be slower growing, treatment should not be delayed.
The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia? a. "The hair loss is usually temporary." b. "Wigs can be used after the chemotherapy is completed." c. "New hair growth will return without any change to color or texture." d. "Clients with alopecia will have delay in grey hair."
a. "The hair loss is usually temporary." Alopecia associated with chemotherapy is usually temporary and will return after the therapy is completed. New hair growth may return unchanged, but there is no guarantee and color, texture, and quality of hair may be changed. There is no correlation between chemotherapy and delay in greying of hair. Use of wigs, scarves, and head coverings can be used by clients at any time during treatment plan.
The nurse received a client from the post-anesthesia care unit (PACU) who has a chest tube to a closed drainage system. Report from the PACU nurse included drainage in the chest tube at 80 mL of bloody fluid. Fifteen minutes after transfer from the PACU, the chest tube indicates drainage as pictured. The client is reporting pain at "8" on a scale of 0 to 10. The first action of the nurse is to: a. Assess pulse and blood pressure. b. Administer prescribed pain medication. c. Notify the physician. d. Lay the client's head to a flat position.
a. Assess pulse and blood pressure. The client has bled 120 mL of bloody drainage in the chest drainage system within 15 minutes. It is most important for the nurse to assess for signs and symptoms of hemorrhage, which may be indicated by a rapid pulse and decreasing blood pressure. The nurse may then lay the client in a flat position and notify the physician.
An adult woman's mother died of left breast cancer. If the client and her physician opt for prophylactic treatment, the nurse should prepare the woman for what intervention? a. Bilateral mastectomy b. Radiation therapy c. Left mastectomy d. More aggressive chemotherapy
a. Bilateral mastectomy Right mastectomy would be considered a prophylactic measure to reduce the risk of cancer in the client's unaffected breast. None of the other listed interventions would be categorized as being prophylactic rather than curative.
The nurse is providing education to a client with cancer radiation treatment options. The nurse determines that the client understands the teaching when the client states that which type of radiation aims to protect healthy tissue during the treatment? a. Brachytherapy b. Proton therapy c. External d. Teletherapy
a. Brachytherapy In internal radiation, or brachytherapy, a dose of radiation is delivered to a localized area inside the body through the use of an implant. With this type of therapy, the farther the tissue is from the radiation source, the lower the dose. This helps to protect normal tissue from the radiation therapy.
Which intervention should the nurse teach a client who is at risk for hypercalcemia? a. Consume 2 to 4 L of fluid daily. b. Avoid the use of stool softeners. c. Take laxatives daily. d. Restrict calcium intake.
a. Consume 2 to 4 L of fluid daily. The nurse should encourage clients at risk for hypercalcemia to consume 3 to 4 L of fluid daily unless contraindicated by existing renal or cardiac disease to address the constipation and dehydration that results from this condition. Dietary and pharmacologic interventions for constipation such as stool softeners and laxatives may be appropriate for the client, although daily laxative use may not be. The nurse should advise clients to maintain nutritional intake without restricting normal calcium intake.
A client with lung cancer develops pleural effusion. During chest auscultation, which breath sound should the nurse expect to hear? a. Decreased breath sounds b. Wheezes c. Crackles d. Rhonchi
a. Decreased breath sounds In pleural effusion, fluid accumulates in the pleural space, impairing transmission of normal breath sounds. Because of the acoustic mismatch, breath sounds are diminished. Crackles commonly accompany atelectasis, interstitial fibrosis, and left-sided heart failure. Rhonchi suggest secretions in the large airways. Wheezes result from narrowed airways, such as in asthma, chronic obstructive pulmonary disease, and bronchitis.
A client's most recent diagnostic imaging has revealed that lung cancer has metastasized to the bones and liver. What is the most likely mechanism by which the client's cancer cells spread? a. Lymphatic circulation b. Angiogenesis c. Invasion d. Apoptosis
a. Lymphatic circulation Lymph and blood are key mechanisms by which cancer cells spread. Lymphatic spread (the transport of tumor cells through the lymphatic circulation) is the most common mechanism of metastasis. Apoptosis is a normal cell mechanism of programmed cellular death that helps eliminate cells that have DNA mutations to prevent disease. Cancer cells, however, can bypass this protective function, survive, and proliferate. Therefore, apoptosis would prevent the spread of cancer, not promote it. Invasion in cancer is the direct extension and penetration by cancer cells through neighboring tissue; the bones and liver in this case, however, are not neighboring tissues. Angiogenesis is the growth of new blood vessels that allow cancer cells to grow. However, it, in itself, is not a mechanism by which cancer cells spread.
The client arrives at a public health clinic worried that she has breast cancer since finding a lump in her breast. When assessing the breast, which assessment finding is characteristic of fibrocystic disease? a. The lump is round and movable. b. The lump is firm and immovable. c. One breast is larger than the other. d. Nipple retractions are noted.
a. The lump is round and movable. When assessing a breast with fibrocystic disease, the lumps typically are different from cancerous lumps. The characteristic breast mass of fibrocystic disease is soft to firm, circular, movable, and unlikely to cause nipple retraction. A cancerous mass is typically irregular in shape, firm, and immovable. Lumps typically do not make one breast larger than the other. Nipple retractions are suggestive of cancerous masses.
After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes? a. Water-seal chamber b. Suction control chamber c. Air-leak chamber d. Collection chamber
a. Water-seal chamber Fluctuations in the water-seal compartment are called tidal movements and indicate normal function of the system as the pressure in the tubing changes with the client's respirations. The air-leak meter — not chamber — detects air leaking from the pleural space. The collection chamber connects the chest tube from the client to the system. Drainage from the tube drains into and collects in a series of calibrated columns in this chamber. The suction control chamber provides the suction, which can be controlled to provide negative pressure to the chest.
A client asks the nurse what PSA is. The nurse should reply that it stands for: a. prostate-specific antigen, which is used to screen for prostate cancer. b. protein serum antigen, which is used to determine protein levels. c. pneumococcal strep antigen, which is a bacteria that causes pneumonia. d. Papanicolaou-specific antigen, which is used to screen for cervical cancer.
a. prostate-specific antigen, which is used to screen for prostate cancer. PSA stands for prostate-specific antigen, which is used to screen for prostate cancer.
Which client has the highest risk of ovarian cancer? a. 36-year-old woman who had her first child at age 22 b. 45-year-old woman who has never been pregnant c. 30-year-old woman taking hormonal contraceptives d. 40-year-old woman with three children
b. 45-year-old woman who has never been pregnant The incidence of ovarian cancer increases in women who have never been pregnant, are older than age 40, are infertile, or have menstrual irregularities. Other risk factors include a family history of breast, bowel, or endometrial cancer. The risk of ovarian cancer is reduced in women who have taken hormonal contraceptives, have had multiple births, or have had a first child at a young age.
The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment. Which teaching point is most important? a. Shield your throat area when near others. b. Flush the toilet several times after every use. c. Use disposable utensils for the next month. d. Prepare food separately from family members.
b. Flush the toilet several times after every use. Iodine 131 is a systemic internal radiation that is excreted through body fluids, especially urine. Flushing the toilet several times after each use will avoid the exposure of others to radioactive exposure. Shielding the throat area is not effective because this form of treatment is systemic. Preparing food separately is not necessary, but use of separate eating utensils will be necessary for the first 8 days.
A 30-year-old client whose mother died of breast cancer at age 44, and whose sister has ovarian cancer, is concerned about developing cancer. As a member of the oncology multidisciplinary team, the nurse should suggest that the client ask the physician about which topic? a. Papanicolaou (Pap) testing every 6 months b. Genetic counseling c. Mammogram d. Contacting the American Cancer Society
b. Genetic counseling The nurse should suggest that the client ask the physician about genetic counseling. Genetic counseling is indicated for those at high risk because of family or personal cancer history. Genetic counseling involves obtaining a detailed medical and three-generational family history; calculating a personalized risk assessment; providing options for prevention, surveillance, and genetic testing; coordinating and interpreting genetic testing; and developing a management plan based on the test results. Mammography will assist with early detection of most breast cancers, but it won't establish a risk assessment and provide options for prevention, surveillance, and genetic testing. Pap testing every 6 months assists in early detection of most cervical cancers, but it won't establish a risk assessment. Contacting the American Cancer Society will provide the client with information about cancer but the organization won't help assess the client's risk for developing cancer.
Which finding is an early indicator of bladder cancer? a. Nocturia b. Painless hematuria c. Dysuria d. Occasional polyuria
b. Painless hematuria Initially, as cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria. (Pain is a late symptom of bladder cancer.) Occasional polyuria may occur with diabetes mellitus or increased alcohol or caffeine intake. Nocturia commonly accompanies benign prostatic hypertrophy. Dysuria may indicate a urinary tract infection.
A nurse is transporting a client with chest tubes to a treatment room. The chest tube becomes disconnected and falls between the bed rail. What is the priority action by the nurse? a. Notify the health care provider. b. Place the chest tube in sterile water. c. Immediately reconnect the chest tube to the drainage apparatus. d. Clamp the chest tube close to the connection site.
b. Place the chest tube in sterile water. If the client is lying on a stretcher and must be transported to another area, place the drainage system below the chest level. If the tubing disconnects, place the end of the chest tube in sterile water. Reattaching the chest tube to the drainage system is a source for infection. Do not clamp the chest tube during transport. Notifying the health care provider will not help the client in the situation.
A client has just been diagnosed with small cell lung cancer. The client asks the nurse why the doctor is not offering surgery as a treatment for the cancer. What fact about lung cancer treatment should inform the nurse's response? a. The cells in small cell cancer of the lung are not large enough to visualize in surgery. b. Small cell cancer of the lung grows rapidly and metastasizes early and extensively. c. Clients with small cell lung cancer are not normally stable enough to survive surgery. d. Small cell lung cancer is self-limiting in many clients and surgery should be delayed.
b. Small cell cancer of the lung grows rapidly and metastasizes early and extensively. Surgery is primarily used for non-small cell lung cancer, because small cell cancer of the lung grows rapidly and metastasizes early and extensively. Difficult visualization and a client's medical instability are not the limiting factors. Lung cancer is not a self-limiting disease.
An oncology client will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another? a. Inducing mutation of cells of another organ b. Adhering to primary tumor cells c. Invading healthy host tissues d. Phagocytizing healthy cells
c. Invading healthy host tissues Invasion, which refers to the growth of the primary tumor into the surrounding host tissues, occurs in several ways. Malignant cells are less likely to adhere than are normal cells. Malignant cells do not cause healthy cells to mutate. Malignant cells do not eat other cells.
A nurse is receiving a client with a radioactive implant for the treatment of cervical cancer. What is the nurse's best action? a. Place a chair next to the bed to allow the spouse to sit. b. Allow visitors to telephone only. c. Place the client in a private room. d. Have visitors wear dosimeters for safety.
c. Place the client in a private room. Safety precautions are used for the client with a radioactive implant. They include assigning the client to a private room, seeing that visitors maintain a 6-foot distance from the radiation source, prohibiting visits by children, and preventing exposure to those who may be or are pregnant. Staff needs to wear dosimeters. Family may visit for up to 30 minutes per day.
The nurse is caring for a client who is ordered a sentinel lymph node biopsy. The physician explained the procedure and desired outcome. Which statement, made by the client, indicates a need for further instruction? a. The procedure allows for conservation of breast tissue. b. The procedure includes minimal surrounding tissue damage. c. The procedure removes all cancer from the body. d. The procedure allows for an understanding of the spread of cancer cells.
c. The procedure removes all cancer from the body. Sentinel lymph node mapping involves identifying the first (sentinel) lymph nodes through which the breast cancer cells would spread to regional lymph nodes in the axilla. Validating the lack of lymph node metastasis allows the surgeon to preserve more breast tissue, axillary tissue and chest muscle. Further instruction would be needed to explain that the sentinel lymph node biopsy does not remove cancer from the body.
A client who underwent thoracic surgery to remove a lung tumor had a chest tube placed anteriorly. The surgical team places this catheter to: a. administer IV medication. b. ventilate the client. c. remove air from the pleural space. d. remove fluid from the lungs.
c. remove air from the pleural space. After thoracic surgery, draining secretions, air, and blood from the thoracic cavity is necessary to allow the lungs to expand. A catheter placed in the pleural space provides a drainage route through a closed or underwater-seal drainage system to remove air. Sometimes two chest catheters are placed following thoracic surgery: one anteriorly and one posteriorly. The anterior catheter removes air; the posterior catheter removes fluid.
A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient? a. Wear a lead apron when providing direct patient care. b. Maintain as much distance as possible from the patient while in the room. c. Alert family members that they should restrict their visiting to 5 minutes at any one time. d. Explain to the patient that she will continue to emit radiation while the implant is in place.
d. Explain to the patient that she will continue to emit radiation while the implant is in place. When the patient has a radioactive implant in place, the nurse and other health care providers need to protect themselves, as well as the patient, from the effects of radiation. Patients receiving internal radiation emit radiation while the implant is in place; therefore, contact with the health care team is guided by principles of time, distance, and shielding to minimize exposure of personnel to radiation. Safety precautions used in caring for a patient receiving brachytherapy include assigning the patient to a private room, posting appropriate notices about radiation safety precautions, having staff members wear dosimeter badges, making sure that pregnant staff members are not assigned to the patient's care, prohibiting visits by children or pregnant visitors, limiting visits from others to 30 minutes daily, and seeing that visitors maintain a 6-foot distance from the radiation source.
The nurse knows the mortality rate is high in lung cancer clients due to which factor? a. Increased exposure to industrial pollutants b. Increase in women smokers c. Increased incidence among the elderly d. Few early symptoms
d. Few early symptoms Because lung cancer produces few early symptoms, its mortality rate is high. Lung cancer has increased in incidence due to an increase in the number of women smokers, a growing aging population, and exposure to pollutants but these are not directly related to the incidence of mortality rates.
A client diagnosed with cancer has the tumor staged and graded based on what factors? a. How they spread and differentiate b. How they differentiate the cell type c. How they spread and tend to grow d. How they tend to grow and the cell type
d. How they tend to grow and the cell type Tumors are staged and graded based upon how they tend to grow and the cell type before a client is treated for cancer.
Which of the following is a characteristic of a malignant tumor? a. It is usually slow growing. b. It demonstrates cells that are well differentiated. c. It grows by expansion. d. It gains access to the blood and lymphatic channels.
d. It gains access to the blood and lymphatic channels. By this mechanism, the tumor metastasizes to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rate of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.
A client is undergoing a left modified radical mastectomy for breast cancer. Postoperatively, blood pressure should be obtained from the right arm, and the client's left arm and hand should be elevated as much as possible to prevent which condition? a. IV infusion infiltration b. Muscle atrophy c. Trousseau's sign d. Lymphedema
d. Lymphedema Lymphedema is a common postoperative effect of modified radical mastectomy and lymph node dissection. Elevation of the left arm and hand will allow gravity to assist lymph drainage. Other preventive measures include exercises in which the arms are elevated. Trousseau's sign is a sign of hypocalcemia and isn't an expected finding in this situation. IV infusions shouldn't be given in the left arm nor should venipunctures be done in this arm. Although muscle atrophy is a potential adverse effect if the client doesn't exercise her left arm, it wouldn't be prevented by elevation.
The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as a. external beam radiation therapy. b. systemic radiation. c. a contact mold. d. brachytherapy.
d. brachytherapy. Brachytherapy is the only term used to denote the use of internal radiation implants.
