Exam 4 - Cancers

A 70-year-old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and reports nausea and constipation. Which complication of cancer is this most likely caused by? a. Hypercalcemia b. Tumor lysis syndrome c. Spinal cord compression d. Superior vena cava syndrome

A

A patient has recently been diagnosed with early stages of breast cancer. What is most appropriate for the nurse to focus on? a. Maintaining the patient's hope b. Preparing a will and advance directives c. Discussing replacement child care for the patient's children d. Discussing the patient's past experiences with her grandmother's cancer

A

To prevent capsular formation after breast reconstruction with implants, teach the patient to a. gently massage the area around the implant. b. bind the breasts tightly with elastic bandages. c. avoid strenuous exercise until the implant has healed. d. exercise the arm on the affected side to promote drainage.

A

When discussing risk factors for breast cancer with a group of women, you emphasize that the greatest known risk factor for breast cancer is a. being a woman over age 60. b. experiencing menstruation for 30 years or more. c. using hormone therapy for 5 years for menopausal symptoms. d. having a paternal grandmother with postmenopausal breast cancer.

A

A patient with a genetic mutation of BRCA1 and a family history of breast cancer is admitted to the surgical unit where she is scheduled that day for a bilateral simple mastectomy. What is the reason for this procedure? a. Prevent breast cancer b. Diagnose breast cancer c. Cure or control breast cancer d. Provide palliative care for untreated breast cancer

A A simple mastectomy can be done to prevent breast cancer in this woman with high risk. Mastectomy can also be used to control, cure, or provide palliative care for breasts with cancerous tumors. A mastectomy would not be used for biopsy or otherwise to establish a diagnosis of cancer.

A patient with a lung mass found on chest x-ray is undergoing further testing. The nurse explains that a definitive diagnosis of lung cancer can be confirmed using which diagnostic test? a. Lung biopsy b. Lung tomograms c. Pulmonary angiography d. CT scans

A Although chest x-rays, lung tomograms, CT scans, MRI, and positron emission tomography (PET) can identify tumors and masses, a definitive diagnosis of a lung cancer requires identification of malignant cells in a biopsy or cytologic study of bronchial washings.

A nurse is reviewing the medical record of a client who has suspected ovarian cancer. Which of the following findings should the nurse identify as a risk factor for ovarian cancer? (Select all that apply) a. Previous treatment for endometriosis b. Family history of colon cancer c. First pregnancy at age 24 d. Report of first period at age 14 e. Use of oral contraceptives for 10 years

A, B

A patient with breast cancer has a lumpectomy with sentinel lymph node biopsy that is positive for cancer. You explain that, of the other tests done to determine the risk for cancer recurrence or spread, the results that support the more favorable prognosis are (select all that apply) a. well-differentiated tumor. b. estrogen receptor-positive tumor. c. overexpression of HER-2 cell marker. d. involvement of two to four axillary nodes. e. aneuploidy status from cell proliferation studies.

A, B

Postoperative care for the patient who had an abdominal hysterectomy includes (select all that apply) a. monitoring urine output. b. changing position frequently. c. restricting all food for 24 hours. d. observing perineal pad for bleeding. e. encouraging leg exercises to promote circulation.

A, B, E

During a health promotion program, why should the nurse plan to target women in a discussion of lung cancer prevention (select all that apply)? a. Women develop lung cancer at a younger age than do men. b. More women die from lung cancer than die from breast cancer. c. Women have a worse prognosis from lung cancer than do men. d. Black women have a higher rate of lung cancer than other ethnic groups. e. Nonsmoking women are at greater risk for developing lung cancer than nonsmoking men are.

A, B, E Smoking by women is taking a great toll, as reflected by the increasing incidence and deaths from lung cancer in women, who develop lung cancer at a younger age than men. Nonsmoking women are at greater risk of developing lung cancer than nonsmoking men. Men still have a worse prognosis than women from lung cancer. White women have a higher rate of lung cancer than other ethnic groups.

You are a community health nurse planning a program on breast cancer screening guidelines for women in the neighborhood. Which recommendations you would include? (select all that apply) a. Women over age 55 may have biennial screening. b. Screening should end when the women reaches age 65. c. Women aged 45 to 54 years should be screened annually. d. Regular screening mammography should start at age 45 years. e. Clinical breast examinations can be used if the woman has average risk.

A, C, D

Which factors would place a patient at a higher risk for prostate cancer (select all that apply)? a. Older than 65 years b. Asian or Native American c. Long-term use of an indwelling urethral catheter d. Father diagnosed and treated for early-stage prostate cancer e. Previous history of undescended testicle and testicular cancer

A, D

A patient scheduled for a radical prostatectomy for prostate cancer expresses the fear that he will have erectile dysfunction. In responding to this patient, the nurse should keep in mind that a. PD5 inhibitors are not recommended in prostatectomy patients. b. erectile dysfunction can occur even with a nerve-sparing procedure. c. the most common complication of this surgery is bowel incontinence. d. the provider will place a penile implant during surgery to treat any dysfunction.

B

The nurse receives an order for a patient with lung cancer to receive influenza vaccine and pneumococcal vaccines. The nurse will a. call the health care provider to question the order. b. give both vaccines at the same time in different arms. c. give the pneumococcal vaccine and obtain a nasal influenza vaccine. d. give the flu shot and tell the patient to come back in 1 week to have the pneumococcal vaccine.

B

A patient with advanced lung cancer refuses pain medication, saying, "I deserve everything this cancer can give me." What is the nurse's best response to this patient? a. "Would talking to a counselor help you?" b. "Can you tell me what the pain means to you?" c. "Are you using the pain as a punishment for your smoking?" d. "Pain control will help you deal more effectively with your feelings."

B Before making any judgments about the patient's statement, it is important to explore what meaning they find in the pain. It may be that the patient feels the pain is deserved punishment for smoking, but further information must be obtained from the patient. Immediate referral to a counselor negates the nurse's responsibility in helping the patient, and there is no indication that the patient is not dealing effectively with their feelings.

A small lesion is found in a patient's lung when an x-ray is done for cervical spine pain. What is the definitive method of determining if the lesion is malignant? a. Lung scan b. Tissue biopsy c. Oncofetal antigens in the blood d. CT or positron emission tomography (PET) scan

B Biopsy with pathologic evaluation is the only definitive method of determining malignancy. The other tests may be used in diagnosing the presence and extent of cancer.

The nurse is counseling a group of people over the age of 50 years with average risk for cancer about screening tests for cancer. Which screening recommendation should be done to screen for colorectal cancer? a. Barium enema every year b. Colonoscopy every 10 years c. Fecal occult blood every 5 years d. Annual prostate-specific antigen (PSA) and digital rectal examination

B Healthy men and women should have a colonoscopy every 10 years, an annual fecal occult blood test, or a barium enema every 5 years (see Chapter 42). These frequencies may change depending on the results. Annual prostate-specific antigen (PSA) and digital rectal examinations screen for prostate problems, although the decision to test is made by the patient with his HCP.

What characteristics should the nurse be aware of in planning care for the patient with Hodgkin's lymphoma? a. Staging of Hodgkin's lymphoma is not important to predict prognosis. b. Management of the patient being treated for Hodgkin's lymphoma includes measures to prevent infection. c. Hodgkin's lymphoma is characterized by proliferation of malignant activated B cells that destroy the kidneys. d. An important nursing intervention in the care of patients with Hodgkin's lymphoma is increasing fluids to manage hypercalcemia.

B The patient is monitored for infection because leukopenia and thrombocytopenia may develop from the disease or usually as a consequence of treatment. Staging of Hodgkin's disease is important to determine treatment. Multiple myeloma is characterized by proliferation of malignant activated B cells that destroy the bones. The intervention of increasing fluid to manage hypercalcemia is used with multiple myeloma.

A nurse is providing teaching about colon cancer to a group of females 45 to 65 years of age. Which of the following statements should the nurse include in the teaching? a. "Colonoscopies for individuals with no family history of cancer should begin at age 40." b. "A sigmoidoscopy is recommended every 5 years beginning at age 60." c. "Fecal occult blood tests should be done annually beginning at age 50." d. "An MRI provides a definitive diagnosis of colon cancer."

C

A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate a. hyperkalemia. b. hyperuricemia. c. hypercalcemia. d. CNS myeloma.

C

A patient with pancreatic cancer is admitted to the hospital for evaluation of treatment options. The patient asks the nurse to explain the Whipple procedure that the surgeon has described. The explanation includes the information that a Whipple procedure involves a. creating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum. b. resection of the entire pancreas and the distal part of the stomach, with anastomosis of the common bile duct and the stomach into the duodenum. c. removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum. d. removal of the pancreas, the duodenum, and the spleen, and attachment of the stomach to the jejunum, which requires oral supplementation of pancreatic digestive enzymes and insulin replacement therapy.

C

A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that a. chemotherapy will begin after the patient recovers from the surgery. b. both chemotherapy and radiation can be used as palliative treatments. c. follow-up colonoscopies will be needed to ensure that the cancer does not recur. d. a wound, ostomy, and continence nurse will visit the patient to identify the site for the ostomy.

C

Postoperatively, a patient who has had a laser prostatectomy has continuous bladder irrigation with a 3-way urinary catheter with a 30-mL balloon. When he reports bladder spasms with the catheter in place, the nurse should a. deflate the balloon to 10 mL to decrease bulk in the bladder. b. deflate the balloon and then reinflate to ensure that the catheter is patent. c. explain that this feeling is normal and that he should not try to urinate around the catheter. d. stop the irrigation, assess the patient's vital signs, and notify the HCP of possible obstruction.

C

The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is that a. Hodgkin's lymphoma occurs only in young adults. b. Hodgkin's lymphoma is considered potentially curable. c. non-Hodgkin's lymphoma can manifest in multiple areas. d. non-Hodgkin's lymphoma is treated only with radiation therapy.

C

Trends in the incidence and death rates of cancer include the fact that a. a higher percent of women than men have lung cancer. b. lung cancer is the most common type of cancer in men. c. blacks have a higher death rate from cancer than whites. d. breast cancer is the leading cause of cancer deaths in women.

C

A 60-year-old male farmer is diagnosed with multiple myeloma. He has pain in his ribs with movement and his diagnostic studies show hypercalcemia. What nursing interventions should be implemented for this patient as the interprofessional care is being initiated (select all that apply)? a. Provide privacy b. Complete bed rest c. Adequate hydration d. Prepare for dialysis e. Assess for infection f. Encourage ambulation

C, E, F Because he has hypercalcemia, adequate hydration and ambulation, not bed rest, are implemented to dilute calcium and prevent protein precipitates from causing renal tubular obstruction and help bones resorb some calcium with weight bearing. Assessing for infection must be done because the excess plasma cells are monoclonal and ineffective against infection. Privacy would be provided for all patients. Although this patient may need dialysis in the late states of multiple myeloma, it is not needed at this time. Analgesia for rib pain will be provided as prescribed by the HCP.

A nurse is reviewing the plan of care for a client who has leukemia and has developed thrombocytopenia. Which of the following actions should the nurse take first? a. Instruct the client to take rest periods throughout the day. b. Encourage the client to reposition in bed every 2 hr. c. Check temperature every 4 hr. d. Monitor platelet counts.

D

Multiple drugs are often used in combinations to treat leukemia and lymphoma because a. there are fewer toxic and side effects. b. the chance that one drug will be effective is increased. c. the drugs are more effective without causing side effects. d. the drugs work by different mechanisms to maximize killing of cancer cells.

D

Nursing care for the patient with endometrial cancer who had a total abdominal hysterectomy and salpingectomy and oophorectomy includes a. maintaining absolute bed rest. b. keeping the patient in high-Fowler's position. c. need for supplemental estrogen after removal of ovaries. d. encouraging movement and walking as much as tolerated.

D

You are caring for a patient with breast cancer following a simple mastectomy. Postoperatively, to restore arm function on the affected side, you would a. apply heating pads or blankets to increase circulation. b. place daily ice packs to minimize the risk for lymphedema. c. teach passive exercises with the affected arm in a dependent position. d. emphasize regular exercises for the affected shoulder to increase range of motion.

D

A patient with a 40 pack-year smoking history has recently stopped smoking because of the fear of developing lung cancer. The patient asks the nurse what he can do to learn about whether he develops lung cancer. What is the best response from the nurse? a. "You should get a chest x-ray every 6 months to screen for any new growths." b. "It would be very rare for you to develop lung cancer now that you have stopped smoking." c. "You should monitor for any persistent cough, wheezing, or difficulty breathing, which could indicate tumor growth." d. "Adults aged 55 to 77 years with a history of heavy smoking who quit in the past 15 years should be screened yearly with low-dose CT."

D Adults ages 55 to 77 years with a history of smoking (30-pack year smoking history or currently smoke) or who quit smoking but <15 years ago should have annual screening for lung cancer. Screening is done using low-dose CT. The use of x-ray has also been shown to detect lung cancer at earlier stages when it is suspected. Sputum cytology may be used, but malignant cells are seldom present in sputum. A patient who has a smoking history always has an increased risk for lung cancer compared with an individual who has never smoked, but the risk decreases to that of a nonsmoker after 15 years of nonsmoking.

A patient is admitted with acute myelogenous leukemia and a history of Hodgkin's lymphoma. What is the nurse most likely to find in the patient's history? a. Work as a radiation chemist b. Epstein-Barr virus diagnosed in vitro c. Intense tanning throughout the lifetime d. Alkylating agents for treating the Hodgkin's lymphoma

D Alkylating agents are used to treat Hodgkin's lymphoma and are carcinogens associated with initiation of acute myelogenous leukemia. Working with radiation would lead to a higher incidence of bone cancer. Epstein-Barr virus is seen in vitro with Burkitt's lymphoma. Intense tanning or exposure to ultraviolet radiation is associated with skin cancers.

Indicate whether the following characteristics are associated with Hodgkin's lymphoma (HL), non-Hodgkin's lymphoma (NHL), or both (B). a. ________ Affects all ages b. ________ Presence of Reed-Sternberg cells c. ________ Associated with Epstein-Barr virus d. ________ Multiple histopathologic classifications e. ________ Originates in lymph nodes in most patients f. ________ Often widely disseminated at time of diagnosis g. ________ Treated with chemotherapy and possibly radiation h. ________ Ingested alcohol-induced pain at the site of disease i. ________ Primary initial clinical manifestation is painless lymph node enlargement

a. NHL b. HL c. B d. NHL e. HL f. NHL g. B h. NHL i. B