Cancer Queustions (Back of book, Evolve, Study Guide)

Which diagnostic test uses high-frequency sound waves to examine internal structures of the body? 1Ultrasound testing 2Tomography 3Radioisotope studies 4Magnetic resonance imaging

1 Ultrasound testing uses high-frequency sound waves to examine internal structures of the body. A transducer is moved over the area being studied, an ultrasound beam is directed through the tissues, which reflects back to the transducer. The sound waves are converted into electrical impulses, which produce an image on a display screen. Ultrasound can show the size, consistency, and shape of a structure being studied. Tomography is a special technique of making multiple radiographic films at different depths of a specific area, organ, or structure. The details of each thin section can clearly be visualized. Radioisotope studies require the injection or ingestion of a radioactive substance. A scanning device is used to identify the distribution of the substance in different areas of the body. Concentration of the radioisotope in a specific organ, such as the thyroid gland or brain, identifies a tumor in that location. Magnetic resonance imaging is a painless diagnostic procedure that does not involve any exposure to radiation. As the person reclines on a narrow surface moved into a cylindrical tunnel containing magnetic coils, radiofrequency energy waves produce signals that are processed by a computer and displayed as images on a video monitor.REF: Pages 2023-2024

When caring for a female patient with cancer, the nurse notices that the patient's daughter is worried about her mother, as well as herself, and her own cancer risk. What knowledge will the nurse base responses to the daughter's questions about hereditary cancers? 1Smokers are more likely to develop lung cancer if they have a family history of the disease. 2Hereditary cancers are usually diagnosed at an advanced age. 3The incidence of breast cancer is the same whether there is a family history of the disease. 4About 50% of cancers are inherited.

1 The incidence of lung cancer in smokers with a family history of this disease is greater than in smokers without a family history of the disease. Hereditary cancers are usually diagnosed at an earlier age—usually 15 to 20 years earlier than cancers that are not inherited. Often, several relatives have the same or related cancers; they are more likely to be bilateral, and multiple cancers are seen in single individuals. The incidence of postmenopausal breast cancer is three times higher and the incidence of premenopausal breast cancer is five times higher in women with a family history of the disease. Breast cancer is rare in Asian women and common in white women. About 10% of cancers are inherited. Hereditary cancers are those cancers that arise from germline mutations.REF: Page 2018

16. A 63-year-old patient has a diagnosis of cancer of the prostate gland with metastasis and is experiencing cachexia. How is cachexia best described? 1. Poor health, malnutrition, weakness, and emaciation 2. Increased appetite and nervousness 3. Irritability and anger 4. Depression, fear, and anxiety

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2. A patient has terminal lung cancer. To maintain optimal pain control, when should analgesics be administered? 1. At scheduled intervals 2. Every 2 hours 3. As required 4. In relation to the patient's activity level

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5. A 61-year-old patient is receiving chemotherapy. The patient becomes anemic and has petechiae and ecchymoses scattered over her upper trunk, especially her arms. What side effect is the patient experiencing? 1. Bone marrow suppression 2. Cardiac suppression 3. Liver toxicity 4. Pulmonary toxicity

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6. Before the insertion of a cervical implant, the nurse tells the patient what to expect while it is in place. Which statement is accurate? 1. "Nurses will always be available, but they will spend only a short time at your bedside." 2. "Personal cleanliness is essential, so you will be given a complete bed bath each day." 3. "Pain or discomfort is a common side effect of this type of radiation." 4. "Your bed linens will be completely changed each day to minimize radioactive contamination."

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8. A 42-year-old patient has palpated a small lump on her left breast during her monthly BSE. She has scheduled an appointment with her health care provider. Which test will be used to make a definite diagnosis of a benign or malignant tumor of her breast? 1. Biopsy 2. Mammography 3. Tomography 4. Ultrasonography

1(check back of book if it seems wrong)

The nurse is providing education to a patient about prevention and detection of cancer. What is the most appropriate information for the nurse to include when educating this patient? Select all that apply. 1Eat a balanced diet that includes vegetables, fruit, whole grains, and fiber. 2Know the seven warning signs of cancer. 3Seek out stress in order to "fully experience" life. 4Perform monthly breast examinations only if you are female. 5Seek immediate medical care if you notice a change in what is normal for you.

1,2,5 A balanced diet that includes vegetables (green, yellow, and orange), fresh fruit, whole grains, and adequate amounts of fiber helps prevent certain types of cancer. Other important dietary teaching points include reducing the amount of fat and preservatives consumed, including smoked and salt-cured meats. The seven warning signs of cancer are important to know. These are: change in bowel or bladder habits; a sore that does not heal; unusual bleeding or discharge; thickening or lump in the breast or elsewhere; indigestion or difficulty swallowing; obvious change in a wart or mole; and nagging cough or hoarseness. Seeking immediate medical care if a change in what is normal for you is noticed; it is an important strategy in early cancer detection. Early detection of cancer has a positive impact on the prognosis. Better advice for your patient is to eliminate, reduce, or change the perceptions of stressors in one's life and enhance the ability to cope effectively with stressors. Monthly breast examinations are important both for men and women in detecting breast cancer at an earlier stage.REF: Pages 2017-2018, 2020

What cancer antigen may be detected in the blood and may be elevated in gynecologic cancers? 1)PSA 2)CA-125 3)CEA 4)Calcitonin level

2 CA-125 is a cancer antigen that may be detected in the blood and peritoneal ascites. It may be elevated in gynecologic cancers (including ovarian) and cancer of the pancreas. This marker is useful primarily to signal a recurrence of ovarian cancer. Other conditions (endometriosis, hepatitis, pregnancy, and pelvic inflammatory disease) may increase CA-125 levels in the blood. PSA, or prostate-specific antigen, is a biologic marker specific for prostate cancer. It is useful in diagnosing prostate cancer, as well as staging the disease and monitoring for recurrence. CEA, or carcinoembryonic antigen, is an antigen whose production stops before birth, but may begin again in the presence of cancer. It also may be elevated in persons who smoke. Calcitonin is a hormone secreted by the thyroid gland in response to a rising serum calcium level. This level is increased in people who have cancer of the thyroid; it may be elevated in breast and oat cell lung cancer.REF: Page 2025

An older adult patient tells the nurse, "All of my friends have cancer, it seems. Why is that?" In formulating a response, the nurse recalls the following true statement about cancer and the older adult? 1Breast and lung cancers are rarely seen in older adults. 2The incidence of cancer increases with age. 3Multiple myeloma is seen more frequently in younger adults than in older adults. 4It is easy to distinguish between cancer and normal changes of aging.

2 The incidence of cancer increases with aging, possibly as a result of the decreasing effectiveness of the immune system and changes in deoxyribonucleic acid (DNA). Breast and lung cancers are among the types of cancers often seen in older adults, as are prostate and colon-rectal cancer. Other cancers often seen in the older adult include cancers of the skin, bladder, vagina, and vulva. Multiple myeloma and chronic lymphocytic leukemia are seen more frequently in older adults than in younger people. Many of the early signs and symptoms of cancer may be misdiagnosed as normal changes of aging. The importance of routine medical screening and self-examination should be stressed to the aging individual.REF: Page 2016

11. A patient is receiving chemotherapy and has a low WBC count. What patient statement indicates the need for further teaching? 1. "I check my mouth and teeth after each meal." 2. "I've been very constipated and need an enema." 3. "My husband and I have been using a vaginal lubrication before intercourse." 4. "My lips are dry and cracking. I need some lubricant."

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15. A patient has a history of oat cell carcinoma of the lung and is being treated with chemotherapy. His WBC count is 2.5/mm3. What is the nurse's greatest concern to prevent complications? 1. Prevention of hemorrhage 2. Prevention of infection 3. Prevention of dehydration 4. Prevention of electrolyte imbalance

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4. A patient has received a diagnosis of stage I breast cancer. She is receiving adjuvant chemotherapy and radiation therapy after a lumpectomy. What teaching point should be included in this patient's plan of care? 1. Chemotherapy-related hair loss is reversible and temporary. 2. All chemotherapeutic agents result in alopecia. 3. Hair that grows back may have a different texture and color. 4. Hair loss may result from the medication therapy.

2 (check back of book if it seems wrong) Answer should be 1,3 and 4.... maybe this was suppose to be an all except question

The nurse is caring for an oncology patient about to undergo chemotherapy. What expectations will the nurse have when providing care to this patient? 1Complete baldness always results from chemotherapy. 2Leukocytosis is a common problem for patients receiving chemotherapy. 3Fresh flowers should be discouraged in the room of a patient with neutropenia. 4Chemotherapy only affects malignant cells.

3 Fresh flowers and live plants should be discouraged in the room of a patient with neutropenia. Mites, gnats, and other microscopic organisms could be a potential source of infection for the patient. The patient's diet should also be monitored with the goal of avoiding fresh fruits and vegetables due to the presence of microscopic pathogens. The pattern and extent of hair loss from chemotherapy cannot be accurately predicted for any given patient. It can begin within a few days or weeks of treatment, but when drug induced, is never permanent. Hair loss occurs due to the destruction of the hair follicles. Leukopenia, or a reduction in the number of circulating white blood cells, is a common problem for patients receiving chemotherapy due to bone marrow depression. It can render the patient susceptible to life-threatening infections. Both malignant and normal cells are affected by chemotherapy. Cells that multiply rapidly are affected the most, such as cells of the hematopoietic system, the hair follicles, and the gastrointestinal tract.REF: Page 2029

10. What is a therapeutic approach by the nurse to assist a patient with terminal cancer in the management of his pain? 1. Anti-inflammatory agents are effective analgesics for severe pain. 2. Opioids should be withheld because they are addictive. 3. Pain is what the patient says it is. 4. One can increase one's tolerance for pain.

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12. According to the American Cancer Society, what would have the greatest influence in reducing the risk of lung cancer? 1. Five fruits and vegetables a day 2. Yearly chest radiograph for people age 50 years and older 3. Cessation of smoking 4. Reduction of environmental and chemical carcinogens

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3. What is true regarding cancer prevention and health care promotion behaviors for patients with a diagnosis of cancer? 1. They will not decrease the risk of developing a second malignancy. 2. They will not be affected by personal choices related to diet and smoking. 3. They are increasingly important with the growing population of cancer survivors. 4. They would include only routine physical examinations.

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7. A 24-year-old patient has been receiving chemotherapy for acute lymphoblastic leukemia. Which patient statement indicates that he understands discharge teaching concerning leukopenia? 1. "I am cured and have no limitations." 2. "My family can catch leukopenia, so I need to be careful to not get too close to any of them." 3. "I should avoid close contact with people who might give me an infection." 4. "I need to be careful not to cut myself when shaving because I may not be able to stop the bleeding."

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1. A 58-year-old patient with colon cancer is receiving combined radiation therapy and chemotherapy. He has developed diarrhea. The patient asks the nurse why he is now having diarrhea. What nursing response is most accurate? 1. "Your diagnosis of colon cancer has caused diarrhea." 2. "Because you are unable to eat or drink much during treatment, you are having loose stools." 3. "Radiation is very irritating to the lining of your GI track, which has caused diarrhea." 4. "You most likely have an imbalance in your fluid and electrolyte levels."

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13. The patient is receiving chemotherapy and has the nursing diagnosis of Imbalanced nutrition: less than body requirements. What are likely reasons for this imbalance in nutrition? (Select all that apply.) 1. Impaired tissue integrity, related to damage to integumentary tissue 2. Alopecia and leukopenia 3. Stomatitis and anorexia 4. Myelosuppression and infection 5. Vomiting and diarrhea

3,5 (check back of book if it seems wrong)

Which dietary choice is most associated with risk factors for cancer? 1Excessive consumption of fruits and vegetables 2High-fiber, low-fat diet 3Limited exposure to ultraviolet rays of the sun 4Frequent heavy consumption of alcohol

4 Frequent heavy consumption of alcohol is a risk factor for cancer of the esophagus, larynx, throat, and liver, as well as oral cancer. The National Cancer Institute has launched a program called "5 a day for Better Health," that aims to show how adding five servings of fruits and vegetables can help reduce cancer risk. Approximately 20% of the United States population consumes five daily servings of fruits and vegetables. Obesity is a risk factor for breast, prostate, gallbladder, ovarian, and uterine cancers. Diet plays a role in the development of cancer of the colon, rectum, and breast. A diet high in fiber and low in fat is recommended to reduce the risks of these cancers. Excessive exposure to ultraviolet rays of the sun is a factor in the development of basal and squamous cell cancers and melanoma. Exposure to sunlamps and tanning booths carry the same risks. Exposure should be limited and monitored.REF: Page 2017

What is true regarding cell mechanisms and growth? 1)Abnormal cell growth or proliferation equates with cancer. 2)Cancer cells divide and multiply in the same manner as the cells from which they are derived. 3)The loss of immunosurveillance, or B-cell function, increases the risk of certain cancers. 4)Metastasis can occur via direct spread, circulation, or transplantation.

4 Metastasis can occur via direct spread (diffusion to other body cavities), circulation (via blood and lymphatic channels), or transplantation (direct transport of tumor cells from one site to another). Abnormal cell growth or proliferation does not equate with cancer. Abnormal cell growth can be categorized as either nonneoplastic growth or neoplastic growth. The four common nonneoplastic growth patterns are hypertrophy, hyperplasia, metaplasia, and dysplasia. Although not neoplastic conditions, these may precede the development of cancer. Cancer cells are not subject to the usual restrictions placed on cell proliferation by the host. When malignant cells change, they become unlike parent cells. They are not differentiated or recognizable as being the same in size or shape as normal cells. They can divide and multiply, but not in a normal manner. The loss of immunosurveillance, or T-cell function, increases the risk of certain cancers. When a cell becomes malignant, it carries a tumor-specific antigen on its membranes that is recognized by the body as nonself and destroyed. If age, drugs, poor nutrition, alcohol, serious infections, or certain disease processes suppress T-cell function, the risk of cancer increases.REF: Page 2021

What statement reflects accurate information regarding the use of radiation therapy for the treatment of cancer? 1Skin care for the patient receiving external radiation therapy includes the use of powder or ointment on the marked area where the external radiation will be directed. 2Unsealed internal radiation is also known as brachytherapy. 3A patient with a radioactive implant will have radiation in the urine. 4Nursing care includes limiting time in the room.

4 The nurse should follow the principles of time, distance, and shielding when caring for a patient with a radioactive implant. Directions supplied by the hospital related to the radioactive substance being used should be followed. In general, nursing care for the patient with a radioactive implant should be carried out as quickly as possible with the time spent in the patient room limited. The area on the body where the external radiation will be directed must be kept clean, dry, and protected. No lotions or creams should be used unless specifically prescribed by the physician (and usually only if the skin is becoming excessively dry from the radiation treatments). The area should also be protected from direct sunlight and the application of heat or cold. The use of sealed internal radiation is also known as brachytherapy. These are implants that are temporarily or permanently inserted into hollow cavities, within body tissues, or on the body's surface. The radioactive source delivers a specific radiation dose continuously over hours or days. The highly concentrated dose of radiation is delivered in or near a tumor. A patient who is treated with unsealed internal radiation (administered intravenously or orally) will have radiation in the urine and other body fluids, since it is distributed throughout the body. Special precautions must be taken to prevent exposure to radiation from direct contact with the patient or any of his body tissue or fluid.REF: Pages 2026-2028

A patient with cancer is about to undergo surgery. Which is the most accurate statement regarding the role of surgical interventions in the treatment of cancer? 1If cancer has already metastasized to other areas of the body, surgery is pointless. 2A radical surgical approach to operable tumors is considered to be the standard of care. 3The use of a laser beam as an alternative to some surgical procedures has the drawback of excessive bleeding. 4When surgery may result in an altered body image, the patient may benefit from talking with another patient who has undergone a similar operation.

4 When surgery may result in an altered body image, such as with a mastectomy, laryngectomy, or the formation of an ostomy, the patient may benefit from talking with another patient who has undergone a similar operation. The American Cancer Society sponsors support groups and prepares volunteers to visit people who need these types of surgeries. If cancer has already metastasized to other areas of the body, surgery may provide palliation by relieving some of the associated problems, such as obstruction, ulceration, hemorrhage, and pain. A radical surgical approach to operable tumors is no longer routinely used because of more sensitive and accurate diagnostic methods, a greater variety of surgical procedures, more sophisticated staging techniques, and more available advanced treatment options. The use of a laser beam as an alternative to some surgical procedures is increasing. It vaporizes tissue with little bleeding and low risk of infection. The major uses for laser surgery are in ophthalmology, gynecology, urology, neurosurgery, and otolaryngology.REF: Pages 2025-2026

14. A patient has a vaginal radiation implant in place. What nursing intervention should be added to the patient's plan of care? 1. Instruct her to turn from side to side for comfort. 2. Restrict fluid intake to prevent bladder distention. 3. Promote intake of a high-residue diet to prevent constipation. 4. Monitor vital signs every 4 hours and report temperature higher than 100° F.

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9. The nurse educator is discussing the importance of the reduction of carcinogens in primary prevention of cancer. Which risk factor is considered significant in many types of cancer? 1. Diet low in fat 2. Occasional moderate use of alcohol 3. High pollen count in the environment 4. Smoking

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41. 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 MSC: NCLEX: Health Promotion and Maintenance

40. 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 MSC: NCLEX: Health Promotion and Maintenance

39. 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 MSC: NCLEX: Physiological Integrity

11. 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 MSC: NCLEX: Health Promotion and Maintenance

20. 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." "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 MSC: NCLEX: Safe, Effective Care Environment

7. 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 MSC: NCLEX: Physiological Integrity

5. 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 MSC: NCLEX: Physiological Integrity

14. 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 MSC: NCLEX: Physiological Integrity

21. 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 MSC: NCLEX: Physiological Integrity

32. 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 MSC: NCLEX: Physiological Integrity

34. 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 MSC: NCLEX: Health Promotion and Maintenance

33. 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 MSC: NCLEX: Health Promotion and Maintenance

2. 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 MSC: NCLEX: Physiological Integrity

29. 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 MSC: NCLEX: Physiological Integrity

10. 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 MSC: NCLEX: Physiological Integrity

3. 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 MSC: NCLEX: Physiological Integrity

4. 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 MSC: NCLEX: Physiological Integrity

36. 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 MSC: NCLEX: Health Promotion and Maintenance

38. 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 MSC: NCLEX: Physiological Integrity

35. 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 MSC: NCLEX: Health Promotion and Maintenance

37. 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 MSC: NCLEX: Health Promotion and Maintenance

26. 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 MSC: NCLEX: Physiological Integrity

17. 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 MSC: NCLEX: Physiological Integrity

28. 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 MSC: NCLEX: Physiological Integrity

18. 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 MSC: NCLEX: Physiological Integrity

19. 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 MSC: NCLEX: Physiological Integrity

16. 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 MSC: NCLEX: Safe, Effective Care Environment

13. 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 MSC: NCLEX: Physiological Integrity

27. 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 MSC: NCLEX: Physiological Integrity

30. 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 MSC: NCLEX: Psychosocial Integrity

9. 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 MSC: NCLEX: Physiological Integrity

8. 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 MSC: NCLEX: Physiological Integrity

6. 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 MSC: NCLEX: Safe, Effective Care Environment

25. 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 MSC: NCLEX: Physiological Integrity

23. 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. 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 MSC: NCLEX: Physiological Integrity

24. 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 MSC: NCLEX: Physiological Integrity

12. 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 MSC: NCLEX: Health Promotion and Maintenance

31. 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 MSC: NCLEX: Health Promotion and Maintenance

15. 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 MSC: NCLEX: Safe, Effective Care Environment

1. 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 MSC: NCLEX: Physiological Integrity

22. 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 MSC: NCLEX: Physiological Integrity

42. 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 MSC: NCLEX: Health Promotion and Maintenance

43. 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 MSC: NCLEX: Health Promotion and Maintenance

31. What is the single most important lifestyle modification the can reduce risk for cancer(2017) 1. Eat a low-fat, high fiber diet 2. Stopsmoking. 3. Avoid excessive sun exposure. 4. Limit alcohol consumption.

Answer 2: According to the American Cancer Society, smoking is the most preventable cause of death from lung cancer. Many other cancers are associated with smoking. The other lifestyle modifications are also important as contributing factors to select cancers.

33. The patient states that she knows vitamin C is an important nutrient in the prevention of can- cer, but she really dislikes citrus fruits. What is the best alternative source that the nurse could suggest? (2018) 1. Taking a vitamin C supplement 2. Trying citrus juice in place of fruit 3. Eating strawberries or tomatoes 4. Eating carrots or cauliflower

Answer 3: The nurse could suggest trying strawberries, peppers, tomatoes, or cantaloupe. Fresh food sources are better than supplements. The patient might accept juice, but compliance is unlikely since she dislikes citrus fruits. Carrots and cauliflower are good anticancer vegetables, but offer less vitamin C

32. Which dietary recommendation to decrease risk for cancer comes from the National Cancer Institute? (2018) 1. Eat four to five servings of lean protein each day. 2. Eat at least two servings of yellow cheese each day. 3. Add several types of beans to your diet every week. 4. Eat at least five servings of fruit and vegetables each day.

Answer 4: Fruit and vegetable consumption is currently low in the United States. Fruits and vegetables are particularly important in preventing GI cancers, but also contain nutrients that decrease overall risk

29. The nurse knows that a 5% weight loss places the patient at risk for malnutrition and the health care notified. If a patient weighs 140pounds, how many pounds would be considered a 5% loss? __________________ pounds (2037)

Answer 7 pounds 140 pounds × 0.05 = 7 pounds

Name five common concerns voiced by cancer patients (2038)

Any five of the following: (1) fear of recurrence, (2) chronic or acute pain, (3) sexual problems, (4) fatigue, (5) guilt for delaying screening or treatment, (6) behavior that may have increased the risk for cancer, (7) changes in physical appearance, (8) depression, (9) sleep problems, (10) change in role performance, and (11) being a financial burden on loved ones

If a female has genes BRCA1 or BRCA2, she has a 25% risk of having breast cancer during her lifetime. (2019) T or F

False : If a female has genes BRCA1 or BRCA2, she has a 60% risk of having breast cancer during her lifetime.

Four types of biopsy

See Figure 56-3, p. 2024

Cancer cells are not subject to the usual restrictions placed on cell proliferation by the host. (2022) T or F

True

Cancer incidence is higher in African Americans than in any other race. (2017) T or F

True

The American Cancer Society indicates that in the United States, one out of every two men will develop cancer in their lifetime. (2016) T or F

True

7. carcinoma(2022)

a

22. What are cancer's seven warning signals? (2021)

a. Changes in bowel or bladder habits b. A sore that does not heal c. Unusual bleeding or discharge d. Thickening or lump in breast or elsewhere e. Indigestion or difficulty swallowing f. Obvious change in warts or moles g. Nagging cough or hoarseness CAUTION

5. cachexia(2036)

b

21. What are the leading primary cancer sites for women? (2016)

breast; lung; colon; rectum

1. alopecia(2032)

c

4. biopsy(2023)

d

2. autologous(2035)

e

9. dysgeusia(2037)

f

3. benign(2022)

g

6. carcinogen(2017

h

8. immunosurveillance(2022)

i

12. metastasis(2022)

j

10. leukopenia(2029)

k

14. palliative(2026)

l

11. malignant(2022)

m

17. thrombocytopenia(2031)

n

13. neoplasm(2026)

o

16. sarcoma(2022)

p

20. What are the leading primary cancer sites for men? (2016)

prostate; lung; colon; rectum

15. stomatitis(2032)

q

18. What are four quality-of-life factors that affect cancer patients and their families? (2038)

social, psychological, physical, and spiritual