Ch 18 Caring for Clients with Cancer

You are a public health nurse giving a talk on the warning signals of cancer to a local community group. Which of the following are the warning signals of cancer? Select all that apply. A) Sores that don't heal B) Unusual bleeding or discharge C) Yellow discoloration of body area D) Tenderness or pain E) Persistent indigestion

Ans: A, B, E Feedback:Seven warning signals of cancer should be familiar to all: (1) a change in bowel habits or bladder function, (2) sores that do not heal, (3) unusual bleeding or discharge, (4) thickening or lump in breast or other body parts, (5) persistent indigestion or difficulty swallowing, (6) a change in a wart or mole, and (7) a persistent nagging cough or hoarseness.

Which of the following is an important nursing intervention when managing clients receiving a bone marrow transplant? a. monitor for signs of elevated urine specific gravity b. monitor for signs fo infection c. monitor for signs of elevated blood urea nitrogen d. monitor for signs of elevated blood pressure

monitor for signs fo infection

A client is recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed? A) "I guess the doctor could not remove the entire tumor." B) "I am so glad the doctor was able to remove the entire tumor." C) "I will be glad to finally be done with treatments for this thing." D) "Thank goodness the tumor is contained and curable."

Ans: A Feedback: Debulking is a reference made when a tumor cannot be completely removed, often due to its extension far into healthy tissue. Without complete removal, this is not a cure and, the cancer cells will continue to replicate and require adjuvant therapies to prevent further invasion. The physician, not the nurse, will need to clarify the details of the surgery.

Following surgery for adenocarcinoma, the client learns the tumor stage is T3, N1, M0. What treatment mode will the nurse anticipate? A) No further treatment is indicated. B) Adjuvant therapy is likely. C) Palliative care is likely. D) Repeat biopsy is needed before treatment begins.

Ans: B Feedback:T3 indicates a large tumor size with N1 indicating regional lymph node involvement. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor staging of stage IV is indicative of palliative care.

Which of the following can be considered carcinogens? A) Parasites B) Medical procedures C) Dietary substances D) Infective genes

Ans: C Feedback: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions. Therefore, options A, B, and D are incorrect.

The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest? A) Normal finding B) Benign fibrocystic disease C) Malignant tumor D) Malignant tumor with metastasis to surrounding tissue

Ans: C Feedback: A fast-growing lump is suggestive of a malignant tumor. Metastasis can only be determined by cytology, not by palpation.

The nurse recognizes which of the following alternative therapies as appropriate in the care of cancer clients? Select all that apply. A) Reminiscing B) Patient-controlled analgesia C) Hot and cold therapy D) Epidural stimulators E) Alternating analgesics F) Nonopioid use

Ans: A, C Feedback: Distracting techniques, such as reminiscing, can be helpful in taking the focus off pain. Hot and cold therapy is a holistic approach to restoring natural balance to the body, as practiced by some cultures. PCA, epidural stimulators, and nonopioid use are physician-prescribed treatments and not considered a diversion.

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 twice after every use. C) Prepare food separately from family members. D) Use disposable utensils for the next month.

Ans: B Feedback: Iodine 131 is a systemic internal radiation that is excreted through body fluids, especially urine. Flushing the toilet twice after every 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.

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 temporary." B) "New hair growth will return without any change to color or texture." C) "Clients with alopecia will have delay in grey hair." D) "Wigs can be used after the chemotherapy is completed."

Ans: A Feedback: 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.

While doing a health history, a client tells you that her mother, grandmother, and sister died of cancer. The client wants to know what she can do to keep from getting cancer. What would be your best response? A) "You can't prevent cancer, but you can have your blood analyzed for tumor markers to see what your risk level is." B) "If you eat right, exercise, and get enough rest, you can prevent breast cancer." C) "With your family history, there is nothing you can do to prevent getting cancer." D) "Cancer often skips a generation, so don't worry about it."

Ans: A Feedback: Specialized tests have been developed for tumor markers, specific proteins, antigens, hormones, genes, or enzymes that cancer cells release. Options B and C are incorrect, and giving the client these responses would be giving inaccurate information. Options D is incorrect because it minimizes and negates the clients concern.

A nurse practitioner is concerned that a client has not had regular checkups as a means of catching any abnormalities early. Which of the following is an early warning sign and symptom of cancer? a. fibrocystic breast disease b. yeast infection c. stasis ulcers d. a change in a wart or mole

a change in a wart or mole

The nurse is caring for a client who is experiencing a poor appetite while receiving chemotherapy. Which of the following strategies is most appropriate for the nurse to use to increase the patient's nutritional intake? 1 - add instant breakfast or milk powder, cheese, or peanut butter to selected foods 2 - avoid liquid protein supplements to encourage eating at mealtime 3 - increase intake of liquids at mealtime to stimulate the appetite 4 - serve three large meals per day plus snacks between each meal

add instant breakfast or milk powder, cheese, or peanut butter to selected foods

At a routine clinic visit, the nurse weighs a client who has cancer and finds that the client has lost 40 kg since beginning cancer treatment. What is the nurse's best suggestion for increasing the client's caloric intake? 1 - advise the client to eat small, frequent meals 2 - inform the client to eat foods high in fat 3 - suggest that the client eat larger portions 4 - tell the client to increase red meat intake

advise the client to eat small, frequent meals

You are providing client teaching for a client undergoing chemotherapy. What dietary modifications should you advise? A) Eat wholesome meals. B) Avoid spicy and fatty foods. C) Avoid intake of fluids. D) Eat warm or hot foods.

Ans: B Feedback: The nurse advises a client undergoing chemotherapy to avoid hot and very cold liquids and spicy and fatty foods. The nurse also encourages the client to have small meals and appropriate fluid intake.

Which of the following instructions does the nurse provide to clients receiving radiation therapy? a. report when there is difficulty with swallowing b. report when there are mood swings c. report when there is a loss of appetite d. report when there are sleep disorders

report when there is difficulty with swallowing

Which of the following laboratory findings, would be identified by the nurse as the greatest risk for a cancer client scheduled for implantable port? A) White blood cell count 10,800/mm3 B) Hemoglobin 10 g/dL C) Hematocrit 36.0% D) Platelet count 98,000/mm3

Ans: D Feedback:Although the WBC, HGB, and HCT are all slightly outside the normal range, the platelet count is very low and places the client at risk for bleeding. This is especially a concern with a surgical procedure.

The nurse knows that interferon agents are used in association with chemotherapy to produce which effects in the client? A) Suppression of the bone marrow B) Enhance action of the chemotherapy C) Decrease the need for additional adjuvant therapies D) Shorten the period of neutropenia

Ans: D Feedback: Interferon agents are a type of biologic response modifiers (BRMs) used in conjunction with chemotherapy to reduce the risk of infection by shortening the period of neutropenia through bone marrow stimulation. The suppression of bone marrow creates the need for interferon use, not a result of the use. Although some BRMs can inhibit tumor growth, the primary use is for reducing neutropenia. Interferon use does not replace standard cancer treatments or decrease the need for those treatments.

A client diagnosed with cancer comes to the clinic after receiving a combination of radiation and chemotherapies. The client complains of nausea, vomiting, and diarrhea. Which of the following signs requires an initial focused assessment by the nurse? 1 - anemia 2 - dehydration 3 - fatigue 4 - infection

dehydration

When advising a client on diet modifications to reduce the risk of cancer, the nurse is correct in recommending which of the following? a. increase intake of red meat b. decrease intake of dietary fiber c. increase intake of processed meat d. increase intake of cruciferous vegetables

increase intake of cruciferous vegetables

A client asks the nurse about the stage fo the recently diagnosed malignant tumor. The client states "My doctor told me it is T1, N0, MX" What is the nurses best response? a. the tumor is connected to another organ b. the tumor is small with no evidence of metastasis at this time c. the tumor is small with no evidence of metastasis at this time d. the tumor is well defined and will respond well to treatment

the tumor is small with no evidence of metastasis at this time

The nurse's client is told that the malignant tumor is at state T2, N0, M0. The client asks the nurse what this means. What is the nurse's best response? 1- The cancer is widespread beyond the tumor margins 2- There is evidence of metastasis in another organ 3- the tumor has spread to the surrounding lymph nodes 4- this tumor can be measured but has not extended or metastasized.

this tumor can be measured but has not extended or metastasized.

When caring for a client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? A) Time, distance, and shielding B) The use of disposable utensils and wash cloths C) Avoid showering or washing over skin markings. D) Inspect the skin frequently.

Ans: D Feedback: Inspecting the skin frequently will allow early identification and intervention of skin problems associated with external radiation therapy. The external markings should not be removed, but clients may shower and lightly wash over the skin. Time, distance, and shielding are key in the management of sealed, internal radiation therapy and not external beam radiation. The use of disposable utensils and care items would be important when caring for clients following systemic, unsealed, internal radiation therapy.

A client diagnosed with cancer has his tumor staged and graded based on what factors? A) How they tend to grow and the cell type B) How they spread and tend to grow C) How they differentiate the cell type D) How they spread and differentiate

Ans: A Feedback: Tumors are staged and graded based upon how they tend to grow and the cell type before a client is treated for cancer.

Cancer has many characteristics. What is one of the most discouraging characteristics of cancer? A) Large size B) Carcinogenesis C) Metastasis D) Slow growth

Ans: C Feedback:Metastasis is one of cancer's most discouraging characteristics because even one malignant cell can give rise to a metastatic lesion in a distant part of the body. Not all cancerous tumors are large in size. Carcinogenesis is the process of malignant transformation, and it is not a characteristic of cancer. Cancer grows rapidly, not slowly.

The nurse is caring for a client with the diagnosis of colon cancer with metastasis to the liver. Which statement made by the client indicates an understanding of the diagnosis? A) "Once the colon tumor is removed, I will be fine." B) "I will be happy once all the cancer is cut out." C) "How could I be so unlucky to get cancer twice?" D) "My cancer has now spread to my liver."

Ans: D Feedback: Response D shows that he has an understanding that he has primary cancer of the colon with spread to the liver. Choice A does not address the metastasis. Choice B is incorrect because metastases are not always resectable. Choice C is incorrect because it shows a lack of understanding about what metastasis is.

A client newly diagnosed with cancer receives external radiation therapy. Which nursing instruction regarding bathing is most appropriate? 1- avoid getting the irradiated skin wet 2- cover the reddened irradiated area with clear plastic 3- use alcohol instead of soap on the irradiated skin 4- use a soft washcloth to wash the irradiated skin

use a soft washcloth to wash the irradiated skin

Based on the understanding of the effects of chemotherapy, the nurse would anticipate which of the following clinical findings in a client 2 weeks posttherapy? A) Change in hair color B) Elevated temperature C) Elevated white blood cells count D) Ease of bruising

Ans: D Feedback: The effects of chemotherapy can include myelosuppression, resulting in anemia or bleeding tendencies, as exhibited in ease in bruising. Elevated temperature and WBCs are signs of infection and are anticipated findings after chemotherapy treatment. Regrowth of hair after alopecia can result in change of hair color but not anticipated 2 weeks posttreatment.

A client with advanced cancer makes the following comment to the nurse: "Why are you bathing me? I am going to die no matter what." What is the most appropriate response of the nurse? A) "A bath will make you feel better." B) "Do you want to skip the bath today?" C) "Would you like to talk about what you are feeling?" D) "I can give you some medicine to make you feel better."

Ans: C Feedback:By asking the client talk may open the door for further discussion and sharing of feelings, fears, etc. Statements A and B are matter-of-fact comments and disconnect, resulting in a shutdown to further communication. Statement D is a quick fix and demonstrates a nontherapeutic response.

You are an oncology nurse caring for a client who is taking antineoplastic agents. What adverse symptoms must you monitor for in this client? A) Symptoms of gout B) Symptoms of hypertension C) Symptoms of diarrhea D) Symptoms of anemia

Ans: A Feedback: The nurse monitors the client being administered an antineoplastic agent for symptoms of gout because they increase uric acid levels, joint pain, and edema. Administering antineoplastic agents does not cause hypertension, diarrhea, and anemia.

When the client complains of increased fatigue following radiotherapy, the nurse knows this is most likely to be related to which factor? A) The cancer is spreading. B) The cancer cells are dying in large numbers. C) Fighting off infection is an exhausting venture. D) Radiation can result in myelosuppression.

Ans: D Feedback: Fatigue results from anemia associated with myelosuppression and decreased RBC production. The spreading of cancer can cause many symptoms dependent on location and type of cancer but not a significant factor to support fatigue with radiotherapy. The production of healthy cells can increase metabolic rate, but death of cancer cells does not support fatigue in this case. Fighting infection can cause fatigue, but there is no evidence provided to support presence of infection in this client.

The nurse is caring for a client is scheduled for chemotherapy followed by autologous stem cell transplant. Which of the following statements by the client indicates a need for further teaching? A) "I hope they find a bone marrow donor who matches." B) "The doctor will remove cells from my bone marrow before beginning chemotherapy." C) "I will receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back." D) "I will need to be in protective isolation for up to 3 months after treatment."

Ans: A Feedback:An autologous stem cell transplant comes from the client not from a donor. The doctor will remove the stem cells from the bone marrow before beginning chemotherapy and treat the client until most if not all the cancer is eliminated before reinfusing the stem cells. Clients are at risk for infection and will be closely monitored for at least 3 months.

While completing an admission assessment, the client reports a family history of ovarian cancer among a maternal grandmother, aunt, and sister. The nurse knows that these cancers are most likely associated with what etiology? A) Inherited gene mutation B) Smoking and tobacco use C) Exposure to chemicals and spermicides D) Increased tumor suppressor genes

Ans: A Feedback:Tumor suppressor genes assist the body in normal cell production and death. Tobacco use and chemical carcinogens can contribute to the development of cancer, but there is not enough information provided to suggest a common link. Oncogenes are genes that have mutated and activates out of control cell growth. Inherited gene mutation occurs when the DNA is passed to the next generation.

A newly diagnosed cancer client is crying and states the following to the nurse: "I promised God that I will be a better person if I can just get better." What is the appropriate assessment of this comment by the nurse? A) The client is just trying to protect self from potential loss. B) Anger directed toward nursing staff is not unusual in dealing with cancer clients. C) The cancer is viewed as a punishment from past actions. D) Loss is inevitable so client is making final plans.

Ans: C Feedback: The comment made by the client is reflective of the bargaining stage of grief in which the client is bargaining with God to gain time. Denial is the first stage of grief in which the client uses to protect self, which is not reflective of the comment made. Anger is the second stage of grief and is not reflective of the statement made. Acceptance of inevitable loss is the final stage of grief, which is not reflective in the comment made.

The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant? A) Monitor the client's toilet patterns. B) Monitor the client closely to prevent infection. C) Monitor the client's physical condition. D) Monitor the client's heart rate.

Ans: B Feedback: Until transplanted stem cells begin to produce blood cells, these clients have no physiologic means to fight infection, which makes them very prone to infection. They are at high risk for dying from sepsis and bleeding before engraftment. Therefore, a nurse must closely monitor clients and take measures to prevent infection. Monitoring client's toilet patterns, physical condition, and heart rate does not prevent the possibility of the client getting an infection.

When providing care for a client with stage IV cancer, the nurse knows to include which intervention in the plan of care? A) Incorporating touching and listening B) Encouraging the expression of life regrets C) Assessing signs and symptoms of impending death D) Discussing ways for the client to handle the dying process

Ans: A Feedback:Psychological support can be given via therapeutic touch and through listening to the concerns and fears associated with the progressive disease. Encouraging the client to express life regrets suggests the client did not experience a fulfilled life. To discuss how the client can handle dying is not appropriate, and nurses do not possess the expertise in this area. Assessing for signs and symptoms of impending death is a part of the nursing process but not the priority care for this client.

The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? A) Extravasation B) Stomatitis C) Nausea and vomiting D) Bone pain

Ans: A Feedback: The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.

Which nursing interventions are most important when implementing care for a client receiving temporary internal sealed radiation therapy? Select all that apply. A) Time, distance, and shielding B) Count wires, threads, or needles every shift C) Maintain indelible skin markings. D) Provide rest periods between treatments. E) Administer treatment through IV access port. F) Avoid standing in direct path of implants.

Ans: A, B, F Feedback:Internal sealed radiation implants are in the form of needles, seeds, pellets, wires etc. These forms contain radioactive material and must be counted each shift to ensure accidental exposure does not occur to staff or others who may come in contact with the material. Standing in the direct path the implanted forms can increase the exposure to radiation. Since the radiation implants are placed in a cavity for a specific time limit and is continuous in treatment modality, rest periods between treatments are not indicated. Indelible skin marking are only used with external beam radiation. Chemotherapy is the cancer treatment given through IV access.

The nurse is providing an educational presentation on dietary recommendations for reducing the risk of cancer. Which of the following food selections would demonstrate a good understanding of the information provided in the presentation? Select all that apply. A) Egg white omelet with spinach and mushrooms B) Crispy chicken Caesar Salad C) Steamed broccoli and carrots D) Turkey breast on whole wheat bread E) Smoked salmon F) Vegetable and cheddar quiche

Ans: A, C, D Feedback:Foods high in fat and those that are smoked or preserved with salt or nitrates are associated with increased cancer risks. An omelet made of egg whites and vegetables is a healthy low fat selection as are steamed broccoli/carrots and turkey breast on whole grain bread. A salad can be a healthy selection but Caesar salads contain much fat from the dressing and addition of cheeses and fried chicken. Salmon that is not smoked would be a good selection. Quiche usually contains high-fat milk, crème, eggs, and cheese.

A client with a 4-cm breast mass is scheduled for biopsy with frozen section followed by lumpectomy and possible mastectomy. The client asks the nurse, "Why can't the doctor tell me specifically whether I will need to have my entire breast removed"? Which is the best response from the nurse? A) "The doctor will know which surgery is required, once the tumor is exposed." B) "The frozen section will determine presence of cancer and type of surgery required." C) "You need to trust your doctor to provide you with the best of care." D) "You seem anxious about your upcoming surgery."

Ans: B Feedback: Although experienced surgeons can often predict the type of tumor upon opening, seeing the tumor does not determine presence or absence of cancer cells. The client may be anxious about upcoming surgery, but this response does not address the question posed by the client. Trusting the surgeon is important, but this response is not appropriate for the question asked. A frozen section during surgery allows the pathologist to quickly examine the tissue under microscope allowing the surgeon to make a decision for best surgical approach.

A client who is being treated for bladder cancer expresses his concern of passing cancer to his wife during intercourse. Which is the best response by the nurse? A) "You should avoid intercourse until your cancer is cured." B) "Cancer is not transferred from person to person via direct contact." C) "I understand you are concerned about your wife, but don't worry." D) "Perhaps you should have your sperm tested for presence of cancer cells."

Ans: B Feedback: Bladder cancer, depending on staging, is treated over a long period of time. Abstaining from intercourse may not be realistic and is unnecessary because cancer is not transferred from person to person via body fluids. It is never appropriate for a nurse to tell a client not to worry.

The client is scheduled for a breast lump excision and sentinel node biopsy. What should the nurse know in planning care for the client with a negative biopsy report? A) A lump excision is not necessary. B) A wide excision of lump will be performed. C) The lump and all axillary lymph nodes will be excised. D) The entire breast and all regional lymph nodes will be excised.

Ans: B Feedback: The sentinel node is the first node in which a tumor will drain; if no malignant cells are found there, additional excision or radical removal will not be necessary. Excision of the lump along with a wide margin of cancer-free tissue is standard treatment for malignant tumors.

A client is scheduled for a nerve-sparing prostatectomy. The emotional spouse confides in the nurse that the client will not talk about the cancer and/or upcoming surgery. Which nursing diagnosis will the nurse choose as primary diagnosis for this client? A) Sexual Dysfunction B) Fear C) Knowledge Deficit D) Ineffective Coping Ans: BFeedback:Fear of the unknown is probably the major concern for this client. Fear of the diagnosis of cancer, fear of the effects of the surgery, and fear of loss of control and functioning. Sexual dysfunction may be one of the fears but not primary at this stage. Knowledge Deficit is unclear at this time. Ineffective Coping can be illustrated by the client's refusal to talk about the problem, but no excess or abnormal behavior has been identified at this time.

Ans: B Feedback:Fear of the unknown is probably the major concern for this client. Fear of the diagnosis of cancer, fear of the effects of the surgery, and fear of loss of control and functioning. Sexual dysfunction may be one of the fears but not primary at this stage. Knowledge Deficit is unclear at this time. Ineffective Coping can be illustrated by the client's refusal to talk about the problem, but no excess or abnormal behavior has been identified at this time.

An elderly client has been diagnosed with metastatic cancer and has a poor prognosis of survival. The family asks the nurse for advice on whether to tell the client of the diagnosis or to keep it quiet. Which is the best response from the nurse? A) "I wouldn't tell, if I were you." B) "In my experience, clients who know are more likely to be involved with their plan of care." C) "The shock of learning the diagnosis may be too much stress for an elderly person." D) "This is a private concern that should include the physician, not me."

Ans: B Feedback:Sharing known facts that can enhance client care is advocating for the client and family. Clients do have the right to know their diagnosis so informed decisions can be made. Comments A and C are a reflection of personal opinion of the nurse, and opinions should be avoided. Statement D may leave the family feeling as if the nurse is cold uncaring.

A cancer client makes the following statement to the nurse: "I guess I will tell my doctor to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die." Which of the following facts supports the use of chemotherapy for this client? A) Nausea and vomiting are only a factor for the first 24 hours after treatment. B) Most clients believe the discomfort is well worth the cure for cancer. C) Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. D) Clinical trials are opening up new cancer treatments all the time.

Ans: C Feedback: Chemotherapy is not one drug for all clients. The therapy can be specifically designed to optimize effects while limiting adverse effects with supplemental antiemetics to control the nausea and vomiting. It is true that nausea and vomiting are most prevalent in the first 24 hours after each chemotherapy treatment but does not eliminate the fears expressed by this client. No one can state the worth of any treatment, and a cure is never promised. Clinical trials open up new options for treatment, but the process is lengthy and is not a certainty for a client in need of immediate treatment.

A client with cancer stage T4, N3, M1 is ordered morphine sulfate 4 mg, subcutaneous every 3 to 4 hours. Two hours after the last injection, the client rings the call bell to report a pain scale of 9. Which is the appropriate action by the nurse? A) Explain to the client that the medication can only be given every 3 to 4 hours. B) Ignore the call bell and stall until it is time to administer the next dose. C) Notify the physician of the breakthrough pain in an attempt to obtain additional orders. D) Ask the family to attempt diversion activities until the next dose can be given.

Ans: C Feedback:Pain is a major problem for clients with metastatic cancer, and control of the pain is a priority. Explaining to the client is not appropriate and will not correct the issue of pain. Ignoring the client is a form of neglect and violates the rights of the client to receive prompt care. Although diversion techniques (meditation, prayer, yoga, music therapy, etc.) can be used to lessen pain, the family should not be asked to complete nursing care.

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse? A) Random, rapid growth of the tumor B) Cells colonizing to distant body parts C) Tumor pressure against normal tissues D) Emission of abnormal proteins

Ans: C Feedback: Benign tumors grow more slowly than malignant tumors and do not emit tumor-specific antigens or proteins. Benign tumors do not metastasize to distant sites. Benign tumors can compress tissues as it grows, which can result in impaired organ functioning.

The physician recommends that you have your daughter vaccinated with HPV vaccine. What is this vaccine for? A) Help prevent lung cancer B) Help prevent breast cancer C) Help prevent cervical cancer D) Help prevent leukemia

Ans: C Feedback: 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 cancer. There are no vaccines for the prevention of lung cancer, breast cancer, or leukemia.

Chemotherapy has been used for the past 3 months to treat a client with pancreatic cancer. The CA 19-9 levels are rising. Which explanation would the nurse attribute as the most likely cause? A) It is normal for this antigen to rise for up to 6 months. B) The client is having an adverse response to the chemotherapy. C) The chemotherapy is effectively destroying the cancer cells. D) The cancer is growing despite the chemotherapy treatment.

Ans: D Feedback: Elevation of specific tumor markers, such as CA 19-9, is indicative of progression and proliferation of the cancer cells. If the chemotherapy was successful in the treating of the pancreatic cancer cells, the tumor marker would be decreased. Increased production of antibody development is not a usual adverse reaction of chemotherapy.

Which of the following advice does the nurse offer clients who are undergoing unsealed radiation therapy to reduce exposure? A) Avoid drinking plenty of fluids. B) Avoid eating for 3 hours after therapy. C) Avoid applying skin moisturizers. D) Avoid kissing and sexual contact.

Ans: D Feedback:Clients who are undergoing unsealed radiation therapy are advised to avoid kissing and sexual contact due to the spread of radioactivity. Clients are encouraged to drink plenty of fluids to help flush radioactive substances. Client may be asked to apply mild moisturizers and are not asked not to eat after the therapy.

The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse? A) "I will eat clear liquids for the next 24 hours." B) "Hair loss may not occur until after the second round of therapy." C) "I will use birth control measures until after all treatment is completed." D) "I can continue taking my vitamins and herbs because they make me feel better."

Ans: D Feedback:Herbal products are not regulated by the U.S. Food and Drug Administration (FDA); although some can decrease the risk of cancer, others can have serious side effects and liver toxicity. Use of vitamins and herbals should be reviewed with the oncologist. Use of clear liquids is recommended for the client experiencing nausea and vomiting. Because hair follicles are sensitive to chemotherapy drugs, it is likely for alopecia to occur especially with consecutive treatments. Chemotherapy includes cytotoxic drugs that are harmful to rapid dividing cells such as cell development in the fetus. To prevent damage to the fetus, birth control is recommended during treatment.

A bowel resection is scheduled for a client with the diagnosis of colon cancer with metastasis to the liver and bone. Which statement by the nurse best explains the purpose of the surgery? A) "Removing the tumor is a primary treatment for colon cancer." B) "This surgery will prevent further tumor growth." C) "Once the tumor is removed, cell pathology can be determined." D) "Tumor removal will promote comfort."

Ans: D Feedback:Palliative surgeries, such as bowel resection, may be performed to promote comfort by relieving pain and pressure on organs within the abdominal cavity. Primary treatment refers to surgery that is likely to provide a cure, which is not likely in metastatic disease. With metastasis, primary tumor removal does not prevent further tumor growth in distant sites. The diagnosis of colon cancer with metastasis suggests cell pathology has already been determined.

The nurse is invited to present a teaching program to parents of school-age children. Which topic would be of greatest value for decreasing cancer risks? A) Pool and water safety B) Breast and testicular self-exams C) Handwashing and infection prevention D) Sun safety and use of sunscreen

Ans: D Feedback: Pool and water safety as well as infection prevention are important teaching topics but will not decrease cancer risk. While performing breast and testicular self-exams may identify cancers in the early stage, this teaching is not usually initiated in school-age children. Severe sunburns that occur in young children can place the child at risk for skin cancers later in life. Because children spend much time out of doors, the use of sunscreen and protective clothing/hats can protect the skin and decrease the risk.

A client is being treated with radiation therapy and develops thrombocytopenia. What nursing intervention has the highest priority? a. advise the client to shave w/ electric razor b. avoid using soap and friction on irradiated area c. keep clients lips moist with lip balm d. tell the client to wear loose cotton clothing

advise the client to shave w/ electric razor

A nurse instructs a group of young adults at a community center about behaviors that can decrease the risk of cancer. Which information is most applicable for this age group? 1- avoid smoking and prolonged sun exposure 2- eat a diet low in salt and fat 3 - perform self-examination techniques four times a year 4 - schedule yearly mammograms or prostate exams

avoid smoking and prolonged sun exposure

A client is receiving chemotherapy for cancer. After several treatments, blood studies demonstrate that the client is experiencing bone marrow suppression. The LPN can expect that he client will exhibit which of the following s/s? Select all 1- bleeding from gums 2- bone pain 3- easy bruising 4- fatigue 5- headaches

bleeding from gums easy bruising fatigue

A client tells the nurse that the primary provider wants to examine the tumor density, shape, size, volume, and location as well as looking at the blood vessels that feed the tumor. The client asks what is the test that does this. Which of the following tests does the nurse correctly state? a. nuclear scan b. computed tomography c. ultrasound d. fluoroscopy exam

computed tomography

The nurse is explaining the client's upcoming surgery for cancer, stating that liquid nitrogen is used to freeze and destroy cancer cells. The nurse is describing what kind of surgery? a. electrosurgery b. laser c. cryosurgery d. chemosurgery

cryosurgery

Which of the following safety measures must the nurse implement to minimize radiation effects when working with clients who have just undergone treatment with radioisotopes? a. wear a special uniform to block radiation b. do not attend the client for the first 14 hrs c. wear a face mask and gloves d. limit time spent with client

limit time spent with client

Which of the following is a nursing intervention when managing clients receiving radiation therapy? a. monitor clients for signs of bone marrow suppression b. monitor clients for dehydration c. monitor clients for insufficient urine output d. monitor clients for signs of increased blood sugar levels

monitor clients for signs of bone marrow suppression