NCLEX cancer

The nurse is teaching a 47-year-old woman about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse's instructions? A. "My mother and grandmother had breast cancer, so I am at risk." B. "I get a mammogram every 2 years since I turned 30." C. "A clinical breast examination is performed every month since I turned 40." D. "A computed tomography (CT) scan will be done every year after I turn 50."

A. "My mother and grandmother had breast cancer, so I am at risk." A strong family history of breast cancer indicates a risk for breast cancer. Annual rather than biannual screening may be indicated for a strong family history. An annual mammogram is performed after age 40 or in younger clients with a strong family history. The client may perform a self-breast examination monthly; a clinical examination by a health care provider is indicated annually. Annual CT breast scans after age 50 are not a current recommendation.

A woman tells the nurse that "there's been a lot of cancer in my family." The nurse should instruct the client to report which possible sign of cervical cancer? A. Pain B. Leg edema C. Urinary and rectal symptoms D. Light bleeding or watery vaginal discharge

Answer: D. Light bleeding or watery vaginal discharge. Rationale: In its early stages, cancer of the cervix is usually asymptomatic, which underscores the importance of regular Pap smears. A light bleeding or serosanguineous discharge may be apparent as the first noticeable symptom. Pain, leg edema, urinary and rectal symptoms, and weight loss are late signs of cervical cancer.

28. The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective? a. Fresh fruit salad b. Orange sherbet c. Strawberry yogurt d. French fries

C Rationale: Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Orange sherbet is lower in fat and protein than yogurt. French fries are high in calories from fat but low in protein.

A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the nurse. Which statement by the client is most important to communicate to the health care provider? A. "I am allergic to iodine." B. "My urinary stream is very weak." C. "My legs are numb and weak." D. "I am incontinent when I cough."

C. "My legs are numb and weak." Numbness and weakness should be reported to the physician because paralysis caused by spinal cord compression can occur. Prostate cancer may frequently metastasize to the bone, specifically the spine. Allergy to iodine should be reported when contrast media will be used, but dye is not used in radiation therapy. A weak urinary stream and incontinence are common clinical manifestations of prostate cancer. Incontinence associated with coughing is typical of stress incontinence and is not a complication of cancer.

33. A with tumor lysis syndrome (TLS) is taking allopurinol (Xyloprim). Which laboratory value should the nurse monitor to determine the effectiveness of the medication? a. Blood urea nitrogen (BUN) b. Serum phosphate c. Serum potassium d. Uric acid level

D Rationale: Allopurinol is used to decrease uric acid levels. BUN, potassium, and phosphate levels are also increased in TLS but are not affected by allopurinol therapy.

A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause? A. A diagnosis of diabetes treated with insulin and diet B. An exercise regimen of jogging 3 miles four times a week C. A history of cardiac disease D. Advancing age

D. Advancing age Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases. Diabetes is not known to cause lung cancer. Regular exercise is not a risk factor for lung cancer, nor does having cardiac disease predispose a person to lung cancer.

The home health nurse is caring for a client who has a history of a kidney transplant and takes cyclosporine (Sandimmune) and prednisone (Deltasone) to prevent rejection. Which assessment finding is most important to communicate to the transplant team? A. Temperature of 96.6° F B. Reports of joint pain C. Pink and dry oral mucosa D. Palpable lump in the client's axilla

D. Palpable lump in the client's axilla Clients taking immunosuppressive drugs to prevent rejection are at increased risk for the development of cancer; any lump should be reported to the physician. Fever should be reported to the physician, but this client's temperature is normal. It is not necessary to report joint pain to the transplant team; it is not a sign of rejection and is not a complication of transplant. A pink and dry oral mucosa may be a sign of dehydration, but it is not necessary to report this to the transplant team.

3. A patient who smokes tells the nurse, "I want to have a yearly chest x-ray so that if I get cancer, it will be detected early." Which response by the nurse is most appropriate? a. "Chest x-rays do not detect cancer until tumors are already at least a half-inch in size." b. "Annual x-rays will increase your risk for cancer because of exposure to radiation." c. "Insurance companies do not authorize yearly x-rays just to detect early lung cancer." d. "Frequent x-rays damage the lungs and make them more susceptible to cancer."

A Rationale: A tumor must be at least 1 cm large before it is detectable by an x-ray and may already have metastasized by that time. Radiographs have low doses of radiation, and an annual x-ray alone is not likely to increase lung cancer risk. Insurance companies do not usually authorize x-rays for this purpose, but it would not be appropriate for the nurse to give this as the reason for not doing an x-ray. A yearly x-ray is not a risk factor for lung cancer.

31. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the RN caring for the patient indicates that the nurse should take action? a. The patient's visitors bring in some fresh peaches from home. b. The patient ambulates several times a day in the room. c. The patient uses soap and shampoo to shower every other day. d. The patient cleans with a warm washcloth after having a stool.

A Rationale: Fresh, thinned-skin peaches are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help to prevent perineal skin breakdown and infection.

34. When assessing a patient's needs for psychologic support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information? a. "Can you tell me what has been helpful to you in the past when coping with stressful events?" b. "How long ago were you diagnosed with this cancer?" c. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?" d. "How do you feel about having a possibly terminal illness?"

A Rationale: Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient's need for support. The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. The patient with stage I cancer is not considered to have a terminal illness at this time, and this question is likely to worry the patient unnecessarily.

16. When the nurse is administering a vesicant chemotherapeutic agent intravenously, an important consideration is to a. stop the infusion if swelling is observed at the site. b. infuse the medication over a short period. c. administer the chemotherapy through small-bore catheter. d. hold the medication unless a central venous line is available.

A Rationale: Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication should generally be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapy drug. These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred.

13. Which information obtained by the nurse about a patient with colon cancer who is scheduled for external radiation therapy to the abdomen indicates a need for patient teaching? a. The patient swims a mile 5 days a week. b. The patient eats frequently during the day. c. The patient showers with Dove soap daily. d. The patient has a history of dental caries.

A Rationale: The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change the habits of eating frequently or showering with a mild soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation.

27. A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not responded to chemotherapy. In discussing the treatment with the patient, the nurse explains that a. hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT). b. the transplant of the donated cells is painful because of the nerves in the tissue lining the bone. c. donor bone marrow cells are transplanted immediately after an infusion of chemotherapy. d. the transplant procedure takes place in a sterile operating room to minimize the risk for infection.

A Rationale: The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to the transplanted cells by the chemotherapy drugs.

22. A 40-year-old divorced mother of four school-age children is hospitalized with metastatic cancer of the ovary. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is a. "Why don't we talk about the options you have for the care of your children?" b. "Many patients with cancer live for a long time, so there is time to plan for your children." c. "For now you need to concentrate on getting well, not worry about your children." d. "Perhaps your ex-husband will take the children when you can't care for them."

A Rationale: This response expresses the nurse's willingness to listen and recognizes the patient's concern. The responses beginning "Many patients with cancer live for a long time" and "For now you need to concentrate on getting well" close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient's ex-husband will take the children, more assessment information is needed before making plans.

32. Which action by a nursing assistant (NA) when caring for a patient who is pancytopenic indicates a need for the nurse to intervene? a. The NA assists the patient to use dental floss after eating. b. The NA makes an oral rinse using 1 teaspoon of salt in a liter of water. c. The NA adds baking soda to the patient's saline oral rinses. d. The NA puts fluoride toothpaste on the patient's toothbrush.

A Rationale: Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.

Which information must the organ transplant nurse emphasize before a client is discharged? A. "Taking immunosuppressant medications increases your risk for cancer and the need for screenings." B. "You are at increased risk for cancer when you reach 60 years of age." C. "Immunosuppressant medications will decrease your risk for developing cancers." D. "After 6 months, you may stop immunosuppressant medications, and your risk for cancer will be the same as that of the general population."

A. "Taking immunosuppressant medications increases your risk for cancer and the need for screenings." Use of immunosuppressant medications to prevent organ rejection increases the risk for cancer. Advanced age is a risk factor for all people, not just for organ transplant recipients. Immunosuppressant medications must be taken for the life of the organ; the risk for developing cancer remains.

The nurse explains to a client that which risk factor of those listed most likely contributed to the client's primary liver carcinoma? A. Infection with hepatitis B virus B. Consuming a diet high in animal fat C. Exposure to radon D. Familial polyposis

A. Infection with hepatitis B virus Hepatitis B and C are risk factors for primary liver cancer. Alcohol abuse is also a risk factor for the development of liver cancer. Consuming a diet high in animal fat may predispose a person to colon or breast cancer. Exposure to radon is a risk factor for lung cancer.

The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility? A. Testing of stool specimens for occult blood B. Teaching about the importance of dietary fiber C. Referring clients for colonoscopy procedures D. Giving vitamin and mineral supplements

A. Testing of stool specimens for occult blood Testing of stool specimens for occult blood is done according to a standardized protocol and can be delegated to nursing assistants. Client education is within the scope of practice of the RN, not of the LPN or nursing assistant. Referral for further care is best performed by the RN. Administration of medications is beyond the nursing assistant's scope of practice and should be done by licensed nursing personnel.

6). A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which of the following may be prescribed? Select all that apply 1. Radiation 2. Chemotherapy 3. Increased fluid intake 4. Serum sodium levels 5. Decreased oral sodium intake 6. Medication that is antagonistic to antidiuretic hormone

Answer: 1,2,4,6 Rational: Cancer is a common cause of syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.

9). A patient who smokes tells the nurse, "I want to have a yearly chest x-ray so that if I get cancer, it will be detected early." Which response by the nurse is most appropriate? 1. "Chest x-rays do not detect cancer until tumors are already at least a half-inch in size." 2. "Annual x-rays will increase your risk for cancer because of exposure to radiation." 3. "Insurance companies do not authorize yearly x-rays just to detect early lung cancer." 4. "Frequent x-rays damage the lungs and make them more susceptible to cancer."

Answer: 1-"Chest x-rays do not detect cancer until tumors are already at least a half-inch in size." Rational: A tumor must be at least 1 cm large before it is detectable by an x-ray and may already have metastasized by that time. Radiographs have low doses of radiation, and an annual x-ray alone is not likely to increase lung cancer risk. Insurance companies do not usually authorize x-rays for this purpose, but it would not be appropriate for the nurse to give this as the reason for not doing an x-ray. A yearly x-ray is not a risk factor for lung cancer.

8). A nurse is teaching a client who is receiving radiation treatment for left lower lobe lung cancer. Which client statement indicates a need for further treatment? 1. "I'll use hats to protect my head from the sun when my hair falls out" 2. "If I get nauseous, I'll try to eat several small, bland meals each day" 3. "I'll allow myself plenty of time to rest between activities" 4. "Most of the adverse effects should go away shortly after my last radiation treatment"

Answer: 1-"I'll use hats to protect my head from the sun when my hair falls out" Rational: The client requires additional teaching if he mentions that he will lose the hair on his head a result of radiation therapy. Alopecia as an acute, localized adverse effect of radiation. The treatment area for this client's cancer will be localized to the lower aspects of his lungs, not his head. Nausea and fatigue are expected generalized adverse effects of radiation therapy. Most adverse effects of radiation are temporary and will stop when treatment is complete.

2). The client is 4 hours post-lobectomy for lung cancer. Which assessment data warrants immediate intervention by the nurse? 1. Intake of 1500 mL IV and output of 1000 mL. 2. 450 mL of bright red drainage in the chest tube. 3. Complaining of pain at a 10 on a 1-10 scale. 4. Absent lung sound on the side of surgery.

Answer: 2- 450 mL of bright red drainage in the chest tube. Rational: This is about a pint of blood and could indicate a hemorrhage. HINT: Blood is always a priority.

10). Which of the following is the primary goal for surgical resection of lung cancer? 1. To remove the tumor and all surrounding tissue 2. To remove the tumor and as little surrounding tissue as possible 3. To remove the entire tumor and any collapsed alveoli in the same region 4. To remove as much of the tumor as possible, without removing any alveoli

Answer: 2- To remove the tumor and as little surrounding tissue as possible Rational: The goal of surgical resection is to remove the lung tissue that has a tumor in it while saving as much surrounding tissue as possible. It may be necessary to remove alveoli and bronchioles, but care is taken to make sure only what's absolutely necessary is removed.

3). Which clinical manifestation would the nurse expect to find in newly diagnosed intrinsic LC? 1. Dysphagia 2. Foul smelling breath 3. Hoarseness 4. Weight loss

Answer: 3- Hoarseness Rational: Hoarseness is an early sign.

7). A client with suspected lung cancer is scheduled for thoracentesis as part of the diagnostic workup. The nurse reviews the client's history for conditions that might contraindicate this procedure. Which condition is a contraindication for thoracentesis? 1. A seizure disorder 2. Chronic obstructive pulmonary disease (COPD) 3. Anemia 4. A bleeding disorder

Answer: 4- A bleeding disorder Rational: A bleeding disorder is a contraindication for thoracentesis because a hemorrhage may occur during or after this procedure, possibly causing death. Although a history of a seizure disorder, COPD, or anemia calls for caution, it doesn't contraindicate thoracentesis.

4). A 69-year-old patient was diagnosed with lung cancer. He is receiving chemotherapy and the nurse caring for him reviewed the laboratory results showing a platelet count is 18,000/mm3 and a pH of 7.36. Which of the following measures would the nurse implement based on the laboratory result? 1. Contact isolation 2. Reverse isolation 3. Respiratory isolation 4. Bleeding precautions

Answer: 4- Bleeding precautions Rational: Normal platelet count is 150,000-400,000/mm3. Bleeding precautions should be implemented with a platelet count below 50,000/mm3. Patients receiving chemotherapy are at risk for thrombocytopenia. Bleeding precautions include avoiding anticoagulant and antiplatelet medications, using an electric razor, stool softeners to prevent straining, and avoiding dental floss.

1).The nurse is taking the social history of a client diagnosed with SCLC (Single Cell Lung Cancer).Which information is significant for this disease? 1. Worked with asbestos for a short time many years ago. 2. Has no family Hx of this type of lung cancer. 3. Has numerous tattoos on upper and lower arms. 4. Has smoked 2 packs of cigarettes/day for 20 years.

Answer: 4- Has smoked 2 packs of cigarettes/day for 20 years. Rational: Smoking is greatest risk for LC.

5). A 71-year-old patient diagnosed with lung cancer is receiving chemotherapy on an outpatient basis. The nurse must provide which of the following home care instructions to the patient? 1. During chemotherapy, use disposable plates and plastic utensils 2. All members of the family can share a bathroom 3. Do not consider urine and stool as contaminated 4. If necessary, contaminated linens should be washed separately and then washed a second time with other laundry.

Answer: 4- If necessary, contaminated linens should be washed separately and then washed a second time with other laundry. Rational: Any contaminated linen or clothing should be washed separately and then washed a second time with other laundry to prevent exposure to chemotherapy in body fluids.

6) Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which of the following dietary modifications should the nurse recommend? A. A bland, low-fiber diet B. A high-protein, high-calorie diet C. A diet high in fresh fruits and vegetables D. A diet emphasizing whole and organic foods

Answer: A - A bland, low-fiber diet

The husband of a client with cervical cancer says to the nurse, "The doctor told my wife that her cancer is curable. Is he just trying to make us feel better?" Which would be the nurse's most accurate response? A. "When cervical cancer is detected early and treated aggressively, the cure rate is almost 100%" B. "The 5-year survival rate is about 75%, which makes the odds pretty good." C. "Saying a cancer is curable means that 50% of all women with the cancer survive at least 5 years." D. "Cancers of the female reproductive tract tend to be slow-growing and respond well to treatment."

Answer: A. "When cervical cancer is detected early and treated aggressively , the cure rate is almost 100%" Rationale: When cervical cancer is detected early and treated aggressively, the cure rate approaches 100%. The incidence of cervical cancer has increased among African Americans, Native Americans, and Latinas, and these women often have a poorer prognosis because the cancer is not identified early. Papanicolaou (Pap) smears and colposcopy have the potential to decrease mortality from invasive carcinoma when these screening and treatment programs are utilized by women.

A 22 year old client asks about the purpose of the HPV vaccine (Gardasil). What is an appropriate nursing explanation? A. It is to lower the risk of contracting melanoma. B. It is a vaccine that prevents infection by all strains of HPV. C. The vaccine treats infections of HPV. D. The vaccine can lower the risk of cervical cancer.

Answer: D. The vaccine can lower the risk of cervical cancer. Rationale: The HPV vaccine can prevent infection by certain strains of HPV, not all strains. It is useful in that it can lower the risk of developing cervical cancer. It does not treat preexisting infection, but can prevent infection by other types.

A 40-year-old divorced mother of four school-age children is hospitalized with metastatic cancer of the ovary. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is A. "Why don't we talk about the options you have for the care of your children?" B. "Many patients with cancer live for a long time, so there is time to plan for your children." C. "For now you need to concentrate on getting well, not worry about your children." D. "Perhaps your ex-husband will take the children when you can't care for them."

Answer: A. "Why don't we talk about the options you have for the care of your children?"  Rationale: This response expresses the nurse's willingness to listen and recognizes the patient's concern. The responses beginning "Many patients with cancer live for a long time" and "For now you need to concentrate on getting well" close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient's ex-husband will take the children, more assessment information is needed before making plans.

A 58-year-old woman calls the health clinic when she has a moderate amount of vaginal bleeding after 6 years of menopause. The nurse will anticipate scheduling the patient for A. endometrial biopsy. B. dilation and curettage (D&C). C. laser endometrial ablation. D. uterine balloon therapy.

Answer: A. endometrial biopsy Rationale: A postmenopausal woman with vaginal bleeding should be evaluated for endometrial cancer, and endometrial biopsy is the primary test for endometrial cancer. D&C will be needed only if the biopsy does not provide sufficient information to make a diagnosis. Endometrial ablation and balloon therapy are used to treat menorrhagia, which is unlikely in this patient

7) The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which of the following abnormalities associated with this oncologic emergency? A. Hypokalemia B. Hypocalcemia C. Hypouricemia D. Hypophosphatemia

Answer: B - Hypocalcemia

A 50 year old female client complains of bloating and indigestion and tells the nurse she has gained two inches in her waist recently. Which question should the nurse ask the client? A:"What do you eat before you feel bloated?" B:"Have you had your ovaries removed?" C:"Are your stools darker in color lately?" D:"Is this indigestion worse when you lie down?"

Answer: B. "Have you had your ovaries removed?" Rationale: Ovarian Cancer has vague symptoms of abdominal discomfort, but increasing abdominal girth is the most common symptom. If the client has had the ovaries removed, then the nurse could assess for another cause.

A female client has a mother who died from ovarian cancer and sister diagnosed with it. Which recommendations should the nurse make regarding early detection of ovarian cancer? A:The client should consider having a prophylactic bilateral oophorectomy B:The client should have a trans-vaginal ultrasound and a CA-125 lab test every 6 months C:The client should have yearly MRI scans D:The client should have a biannual gyn exam with flexible sigmoidoscopy

Answer: B. The client should have a trans-vaginal ultrasound and a CA-125 lab test every 6 months Rationale: A trans-vaginal ultrasound is a sonogram probe is inserted into the vagina and sound waves are directed toward the ovaries. The CA-125 tumor marker is elevated in several cancers. It is nonspecific but, coupled with the sonogram, can provide info about ovarian cancer for early diagnosis.

10. What would be most important for the nurse to teach the patient to protect themselves from infection? A) Avoiding crowds and taking antipyretics such as Aspirin TID to avoid a fever. B) Assessing their vital signs weekly and reporting a persistent fever of 102 degrees or greater. C) Bathing daily and washing their hands frequently, especially after using restroom or handling contaminated objects. D) Interacting only with individuals who have recently been vaccinated with live or attenuated vaccines.

Answer: C - Bathing daily and washing their hands frequently, especially after using restroom or handling contaminated objects.

When planning care for a client being treated for cervical cancer, it would be a priority for the nurse to include which of the following in the plan of care? A. Instruction on birth control methods. B. Vigorous fluid hydration. C. Assessment of sexual function. D. Daily weights.

Answer: C. Assessment of sexual function. Rationale: Surgery and radiation therapy for cervical cancer often result in shortening of the vagina, vaginal dryness, and loss of libido due to emotional issues related to sexuality and femininity. Therefore, the client's feelings about sexuality and the partner's feelings should be assessed. If a client is not sexually active, instructions should be given in the use of a vaginal dilator and lubricant to prevent adhesion of the vaginal walls. While instruction about birth control methods may be needed for some clients, treatment for cervical cancer may include total abdominal hysterectomy, so that this would not be appropriate for all clients. Encouraging fluids and daily weights are not priorities for cervical cancer care.

In educating a client, what would the nurse NOT mention as a risk factor that increases the risk of developing endometrial cancer? A. Obesity B. Increased age C. Having had several children D. Diabetes

Answer: C. Having had several children.

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which of the following strategies would be most appropriate for the nurse to use to increase the patient's nutritional intake? A) Increase intake of liquids at mealtime to stimulate appetite. B) Serve three large meals per day plus snacks between each meal C) Avoid the use of liquid protein supplements to encourage eating at mealtime D) Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods

Answer: D - Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

9) Which of the following nursing diagnoses is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D.Risk for infection

Answer: D - Risk for infection

Mina, who is suspected of an ovarian tumor, is scheduled for a pelvic ultrasound. The nurse provides which pre-procedure instruction to the client? A. Eat a light breakfast only B. Maintain an NPO status before the procedure C. Wear comfortable clothing and shoes for the procedure D. Drink six to eight glasses of water without voiding before the test

Answer: D. Drink six to eight glasses of water without voiding before the test Rationale: A pelvic ultrasound requires the ingestion of large volumes of water just before the procedure. A full bladder is necessary so that it will be visualized as such and not mistaken for a possible pelvic growth. An abdominal ultrasound may require that the client abstain from food or fluid for several hours before the procedure. Option C is unrelated to this specific procedure.

7. Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates that the patient understands the purpose of a biopsy? a. "The biopsy will tell the doctor whether the cancer has spread to my other organs." b. "The biopsy will help the doctor decide what treatment to use for my enlarged prostate." c. "The biopsy will determine how much longer I have to live." d. "The biopsy will indicate the effect of the cancer on my life."

B Rationale: A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed. Biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life; the three remaining statements indicate a need for patient teaching.

20. A patient who is receiving interleukin-2 (IL-2) therapy (Proleukin) complains to the nurse about all of these symptoms. Which one is most important to report to the health care provider? a. Generalized aches b. Dyspnea c. Decreased appetite d. Insomnia

B Rationale: Dyspnea may indicate capillary leak syndrome and pulmonary edema, which requires rapid treatment. The other symptoms are common with IL-2 therapy, and the nurse should teach the patient that these are common adverse effects that will resolve at the end of the therapy.

25. The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient may indicate a need for a change in treatment? a. "I have frequent muscle aches and pains." b. "I rarely have the energy to get out of bed." c. "I take acetaminophen (Tylenol) every 4 hours." d. "I experience chills after I inject the interferon."

B Rationale: Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use Tylenol every 4 hours.

24. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is to a. protect normal kidney cells from the damaging effects of chemotherapy. b. enhance the patient's immunologic response to tumor cells. c. stimulate malignant cells in the resting phase to enter mitosis. d. prevent the bone marrow depression caused by chemotherapy.

B Rationale: IL-2 enhances the ability of the patient's own immune response to suppress tumor cells. IL-2 does not protect normal cells from damage caused by chemotherapy, stimulate malignant cells to enter mitosis, or prevent bone marrow depression.

26. Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider? a. Hemoglobin of 10 g/L b. WBC count of 1700/µl c. Platelets of 65,000/µl d. Serum creatinine level of 1.2 mg/dl .

B Rationale: Neutropenia places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that white blood cell (WBC) growth factors such as filgrastim (Neupogen) are needed. The other laboratory data do not indicate any immediate life-threatening adverse effects of the chemotherapy

4. In teaching about cancer prevention to a community group, the nurse stresses promotion of exercise, normal body weight, and low-fat diet because a. most people are willing to make these changes to avoid cancer. b. dietary fat and obesity promote growth of many types of cancer. c. people who exercise and eat healthy will make other lifestyle changes. d. obesity and lack of exercise cause cancer in susceptible people.

B Rationale: Obesity and dietary fat promote the growth of malignant cells, and decreasing these risk factors can reduce the chance of cancer development. Many people are not willing to make these changes. Good diet and exercise habits are not a guarantee that other healthy lifestyle changes will then occur. Obesity and lack of exercise do not cause cancer, but they promote the growth of altered cells.

14. A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse knows that teaching about management of the skin reaction has been effective when the patient says a. "I can use ice packs to relieve itching in the treatment area." b. "I can buy a steroid cream to use on the itching area." c. "I will expose the treatment area to a sun lamp daily." d. "I will scrub the area with warm water to remove the scales."

B Rationale: Steroid (over-the-counter [OTC] hydrocortisone) cream may be used to reduce itching in the area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.

21. A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin's lymphoma. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the nurse to the patient's concerns is a. "Radiation does not cause the problems with sexual functioning that occur with chemotherapy or surgical procedures used to treat cancer." b. "It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children." c. "The radiation will make you sterile, but your ability to have sexual intercourse will not be changed by the treatment." d. "You may have some temporary impotence during the course of the radiation, but normal sexual function will return."

B Rationale: The impact on sperm count and erectile function depends on the patient's pretreatment status and on the amount of exposure to radiation. The patient should consider sperm donation before radiation. Radiation (like chemotherapy or surgery) may affect both sexual function and fertility either temporarily or permanently.

1. While being prepared for a biopsy of a lump in the right breast, the patient asks the nurse what the difference is between a benign tumor and a malignant tumor. The nurse explains that a benign tumor differs from a malignant tumor in that benign tumors a. do not cause damage to adjacent tissue. b. do not spread to other tissues and organs. c. are simply an overgrowth of normal cells. d. frequently recur in the same site.

B Rationale: The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors never metastasize. Both types of tumors may cause damage to adjacent tissues. The cells differ from normal in both benign and malignant tumors. Benign tumors usually do not recur.

17. A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To maintain the patient's self-esteem, the nurse plans to a. suggest that the patient limit social contacts until regrowth of the hair occurs. b. encourage the patient to purchase a wig or hat and wear it once hair loss begins. c. have the patient wash the hair gently with a mild shampoo to minimize hair loss. d. inform the patient that hair loss will not be permanent and that the hair will grow back.

B Rationale: The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicle and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is not immediately helpful in maintaining the patient's self-esteem.

29. The nurse has identified the nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation in a patient with lung cancer who has had a 10% loss in weight. An appropriate nursing intervention that addresses the etiology of this problem is to a. provide foods that are highly spiced to stimulate the taste buds. b. avoid presenting foods for which the patient has a strong dislike. c. add strained baby meats to foods such as soups and casseroles. d. teach the patient to eat whatever is nutritious since food is tasteless.

B Rationale: The patient will eat more if disliked foods are avoided and foods that patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding baby meats to foods will increase calorie and protein levels, but does not address the issue of taste. Patients will not improve intake by eating foods that are beneficial but have unpleasant taste.

8. The nurse is teaching a postmenopausal patient with breast cancer about the expected outcomes of her cancer treatment. The nurse evaluates that the teaching has been effective when the patient says a. "After cancer has not recurred for 5 years, it is considered cured." b. "I will need to have follow-up examinations for many years after I have treatment before I can be considered cured." c. "Cancer is considered cured if the entire tumor is surgically removed." d. "Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation." .

B Rationale: The risk of recurrence varies by the type of cancer; for breast cancer in postmenopausal women, the patient needs at least 20 disease-free years to be considered cured. Some cancers (e.g., leukemia) are cured by nonsurgical therapies such as radiation and chemotherapy

The nurse reviews the chart of a client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means? A. "Two lymph nodes are involved in this tumor of the glial cells, and another tumor is present." B. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." C. "This type of tumor in the brain is small with some lymph node involvement; another tumor is present somewhere else in your body." D. "Glioma means this tumor is benign, so I will have to ask your health care provider the reason for the chemotherapy and radiation."

B. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." T1 means that the tumor is increasing in size to about 2 cm, and that no regional lymph nodes are present in the brain. M0 means that no distant metastasis has occurred. NX means that no regional lymph nodes can be assessed. A glioma is a benign tumor of the brain, but the client is diagnosed with a glioblastoma, which means a malignant tumor of the glial cells of the brain.

The nurse suspects metastasis from left breast cancer to the thoracic spine when the client has which symptom? A. Vomiting B. Back pain C. Frequent urination D. Cyanosis of the toes

B. Back pain Typical sites of breast cancer metastasis include bone (manifested by back pain), lung, liver, and brain. Signs of metastasis to the spine may include numbness, pain, paresthesias and tingling, and loss of bowel and bladder control, but not vomiting. Although frequent urination may be a sign of bladder cancer, incontinence is more indicative of spinal metastasis. Cyanosis of the toes indicates decreased tissue perfusion, often related to atherosclerotic disease.

The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding? A. Easy bruising B. Dyspnea C. Night sweats D. Chest wound

B. Dyspnea Dyspnea is a sign of lung cancer, as are cough, hoarseness, shortness of breath, bloody sputum, arm or chest pain, and dysphagia. Easy bruising is a nonspecific finding. Night sweats is a symptom of the lymphomas. A chest wound is not specific to lung cancer.

Which activity performed by the community health nurse best reflects primary prevention of cancer? A. Assisting women to obtain free mammograms B. Teaching a class on cancer prevention C. Encouraging long-term smokers to get a chest x-ray D. Encouraging sexually active women to get annual Papanicolaou (Pap) smears

B. Teaching a class on cancer prevention Primary prevention involves avoiding exposure to known causes of cancer; education assists clients with this strategy. Mammography is part of a secondary level of prevention, defined as screening for early detection. Chest x-ray is a method of detecting a cancer that is present—secondary prevention and early detection. A Pap smear is a means of detecting cervical cancer early—secondary prevention.

2. A patient who has been told by the health care provider that the cells in a bowel tumor are poorly differentiated asks the nurse what is meant by "poorly differentiated." Which response should the nurse make? a. "The cells in your tumor do not look very different from normal bowel cells." b. "The tumor cells have DNA that is different from your normal bowel cells." c. "Your tumor cells look more like immature fetal cells than normal bowel cells." d. "The cells in your tumor have mutated from the normal bowel cells."

C Rationale: An undifferentiated cell has an appearance more like a stem cell or fetal cell and less like the normal cells of the organ or tissue. The DNA in cancer cells is always different from normal cells, whether the cancer cells are well differentiated or not. All tumor cells are mutations form the normal cells of the tissue.

11. Which action by a nursing assistant (NA) caring for a patient with a temporary radioactive cervical implant indicates that the RN should intervene? a. The NA places the patient's bedding in the laundry container in the hallway. b. The NA flushes the toilet once after emptying the patient's bedpan. c. The NA stands by the patient's bed for an hour talking with the patient. d. The NA gives the patient an alcohol-containing mouthwash for oral care. .

C Rationale: Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine/feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated

10. External-beam radiation is planned for a patient with endometrial cancer. The nurse teaches the patient that an important measure to prevent complications from the effects of the radiation is to a. test all stools for the presence of blood. b. inspect the mouth and throat daily for the appearance of thrush. c. perform perianal care with sitz baths and meticulous cleaning. d. maintain a high-residue, high-fat diet.

C Rationale: Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation.

30. After the nurse has explained the purpose of and schedule for chemotherapy to a 23-year-old patient who recently received a diagnosis of acute leukemia, the patient asks the nurse to repeat the information. Based on this assessment, which nursing diagnosis is most likely for the patient? a. Acute confusion related to infiltration of leukemia cells into the central nervous system b. Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment c. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis d. Risk for ineffective adherence to treatment related to denial of need for chemotherapy

C Rationale: The patient who has a new cancer diagnosis is likely to have high anxiety, which may impact learning and require that the nurse repeat and reinforce information. The patient's history of a recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the confusion. The patient asks for the information to be repeated, indicating that lack of interest in learning and denial are not etiologic factors.

15. A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. An important nursing intervention for the patient is to a. teach about the importance of nutrition during treatment. b. have the patient eat large meals when nausea is not present. c. administer prescribed antiemetics 1 hour before the treatments. d. offer dry crackers and carbonated fluids during chemotherapy.

C Rationale: Treatment with antiemetics before chemotherapy may help to prevent anticipatory nausea. Although nausea may lead to poor nutrition, there is no indication that the patient needs instruction about nutrition. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea.

12. A patient with Hodgkin's lymphoma is undergoing external radiation therapy on an outpatient basis. After 2 weeks of treatment, the patient tells the nurse, "I am so tired I can hardly get out of bed in the morning." An appropriate intervention for the nurse to plan with the patient is to a. exercise vigorously when fatigue is not as noticeable. b. consult with a psychiatrist for treatment of depression. c. establish a time to take a short walk every day. d. maintain bed rest until the treatment is completed.

C Rationale: Walking programs are used to keep the patient active without excessive fatigue. Vigorous exercise when the patient is less tired may lead to increased fatigue. Fatigue is expected during treatment and is not an indication of depression. Bed rest will lead to weakness and other complications of immobility.

A 52-year-old client relates to the nurse that she has never had a mammogram because she is terrified that she will have cancer. Which response by the nurse is therapeutic? A. "Don't worry, most lumps are discovered by women during breast self-examination." B. "Does anyone in your family have breast cancer?" C. "Finding a cancer in the early stages increases the chance for cure." D. "Have you noticed a lump or thickening in your breast?"

C. "Finding a cancer in the early stages increases the chance for cure." Providing truthful information addresses the client's concerns. Mammography can detect lumps smaller than those discovered by palpation. Asking about family history or symptoms is not therapeutic because it does not address the client's fear of cancer.

. A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure. The nurse explains that the expected outcome of this surgery is a. control of the tumor growth by removal of malignant tissue. b. promotion of better nutrition by relieving the pressure in the stomach. c. relief of pain by cutting sensory nerves in the stomach. d. reduction of the tumor burden to enhance adjuvant therapy.

D Rationale: A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective. Debulking surgeries do not control tumor growth. The tumor is debulked because it is attached to the liver, a vital organ (not to relieve pressure on the stomach). Debulking does not sever the sensory nerves, although pain may be lessened by the reduction in pressure on the abdominal organs.

6. When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer is staged as Tis, N0, M0. The nurse will teach the patient that a. the cancer cells are well-differentiated. b. it is difficult to determine the original site of the cervical cancer. c. further testing is needed to determine the spread of the cancer. d. the cancer is localized to the cervix.

D Rationale: Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time. Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the origin is the cervix. Further testing is not indicated given that the cancer has not spread.

23. A patient who has terminal cancer of the liver and is cared for by family members at home tells the nurse, "I have intense pain most of the time now." The nurse recognizes that teaching regarding pain management has been effective when the patient a. uses the ordered opioid pain medication whenever the pain is greater than 5 on a 10-point scale. b. states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief. c. agrees to take the medications by the IV route to improve effectiveness. d. takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.

D Rationale: For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain. Taking the medications only when pain reaches a certain level does not provide effective pain control. Although nonopioid analgesics may also be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved. The IV route is not more effective than the oral route and the oral route is preferred.

8. A patient with ovarian cancer tells the nurse, "I don't think my husband cares about me anymore. He rarely visits me." On one occasion when the husband was present, he told the nurse he just could not stand to see his wife so ill and never knew what to say to her. An appropriate nursing diagnosis in this situation is a. compromised family coping related to disruption in lifestyle and role changes. b. impaired home maintenance related to perceived role changes. c. risk for caregiver role strain related to burdens of caregiving responsibilities. d. interrupted family processes related to effect of illness on family members.

D Rationale: The data indicate that this diagnosis is most appropriate because the family members are impacted differently by the patient's cancer diagnosis. There are no data to suggest a change in lifestyle or role as an etiology. The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities.

5. During a routine health examination, a 30-year-old patient tells the nurse about a family history of colon cancer. The nurse will plan to a. teach the patient about the need for a colonoscopy at age 50. b. ask the patient to bring in a stool specimen to test for occult blood. c. schedule a sigmoidoscopy to provide baseline data about the patient. d. have the patient ask the doctor about specific tests for colon cancer.

D Rationale: The patient is at increased risk and should talk with the health care provider about needed tests, which will depend on factors such as the exact type of family history and any current symptoms. Colonoscopy at age 50 is used to screen for individuals without symptoms or increased risk, but earlier testing may be needed for this patient because of family history. For fecal occult blood testing, patients use a take-home multiple sample method rather than bring one specimen to the clinic. The health care provider will take multiple factors into consideration before determining whether a sigmoidoscopy is needed at age 30.

19. A patient receiving head and neck radiation and systemic chemotherapy has ulcerations over the oral mucosa and tongue and thick, ropey saliva. An appropriate intervention for the nurse to teach the patient is to a. remove food debris from the teeth and oral mucosa with a stiff toothbrush. b. use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. c. gargle and rinse the mouth several times a day with an antiseptic mouthwash. d. rinse the mouth before and after each meal and at bedtime with a saline solution.

D Rationale: The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate the oral mucosa and are not recommended.

MULTIPLE RESPONSE 1. A 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg) tells the nurse that she has a glass of wine two or three times a week. The patient works for the post office and has a 5-mile mail-delivery route. This is her first contact with the health care system in 20 years. Which of these topics will the nurse plan to include in patient teaching about cancer? (Select all that apply.) a. Alcohol use b. Physical activity c. Body weight d. Colorectal screening e. Tobacco use f. Mammography g. Pap testing h. Sunscreen use

D, F, G, H Rationale: The patient's age, gender, and history indicate a need for teaching about or screening or both for colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use excessive alcohol or tobacco, she is physically active, and her body weight is healthy.

Original Alphabetical The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult client indicates understanding of the nurse's instructions? A. "Cigarette smoking always causes lung cancer." B. "Taking multivitamins will prevent me from developing cancer." C. "If I have only one shot of whiskey a day, I probably will not develop cancer." D. "I need to report the pain going down my legs to my health care provider."

D. "I need to report the pain going down my legs to my health care provider." Pain in the back of the legs could indicate prostate cancer in an older man. Cigarette smoking is implicated in causing lung cancer and other types of cancer, but it does not always cause cancer. Investigation is ongoing about the efficacy of vitamins A and C in cancer prevention. Limiting alcohol to one drink per day is only one preventive measure.

The nurse presents a cancer prevention program to teens. Which instruction will have the greatest impact in cancer prevention? A. Avoid asbestos. B. Wear sunscreen. C. Get the human papilloma virus (HPV) vaccine. D. Do not smoke cigarettes.

D. Do not smoke cigarettes. All of these actions are part of cancer prevention; however, tobacco is the single most important source of preventable carcinogenesis. Asbestos may be found in older homes and buildings. Most schools have been through an asbestos abatement program so should not pose a risk. It would be important to share with teens who may be involved in the construction industry during the summer to be aware of asbestos risks. Although asbestos may present a risk for lung cancer, it is not a likely exposure for teens. Lifetime exposure to the sun and the use of tanning beds will increase the risk for cancer, but not as much as tobacco use. The HPV vaccine will decrease the risk for cervical cancer, but will not have as much of an impact on cancer prevention as avoiding tobacco.

Which type of cancer has been associated with Down syndrome? A. Breast cancer B. Colorectal cancer C. Malignant melanoma D. Leukemia

D. Leukemia Leukemia is associated with Down syndrome and Turner syndrome. Breast cancer is often found clustered in families, not in association with Down syndrome. Colorectal cancer is associated with familial polyposis. Malignant melanoma is associated with familial clustering and sun exposure.