MS Quiz 11-The Patient with Cancer

2. A nurse explains that the seven warning signs of cancer written by the American Cancer Society (ACS) can be recalled by the acronym CAUTION. What should the nurse change to point out that the A in the acronym represents? a. A sore that will not heal b. Alopecia c. Abscess d. Anorexia

ANS: A. A sore that will not heal The acronym is a change in bowel or bladder habits, a sore that will not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, indigestion or difficulty swallowing, and a nagging cough or hoarseness.

3. A home health nurse is compiling a patient profile on a 23-year-old obese woman who smokes one-half pack of cigarettes a day and drinks 1 beer a week. She works as a cook in a long-term care facility. She has two children and eats a diet high in fats. She exercises 30 minutes a day. Both parents are dead of heart disease. How many risk factors for cancer in this profile should the nurse identify? a. 2 b. 3 c. 5 d. 6

ANS: B 3 Cancer risks identified are obesity, smoker, and high-fat

4. What phase is considered the latent period before the period of rapid growth of tumors? a. Initiation b. Promotion c. Progression d. Metastasis

ANS: B Promotion The stage of promotion is the latest period in which a cell is quiet, just before the rapid growth and tumor production, which begins in the progression phase.

22. What is the cause of cell death when a patient receives radiation as a treatment for cancer? a. Separation of the cell from normal cells b. Damage of the cell membrane c. Alteration of the DNA of the cell d. Reduction of cell nutrition

ANS: B. Damage of the cell membrane The immediate effect of radiation is cell death as a result of damage to the cell membrane. The delayed effect is the alteration of the DNS so that it cannot replicate.

1. List the tumors in order based on the following tissue of origin: 1, fat; 2, fibrous; 3, smooth muscle; 4, glands; 5, bone. (Separate letters by a comma and space as follows: A, B, C, D.) A. Sarcoma B. Lipoma C. Leiomyoma D. Fibroma E. Carcinoma

ANS: B, D, C, E, A LIPOMA FIBROMA LEIMYOMA CARCINOMA SARCOMA Tumors are associated with the tissue from which they arise: fat tumors are lipomas, fibrous tissue tumors are fibromas, smooth muscle tumors are leiomyomas, and bone tumors are sarcomas. Carcinomas include glands.

2. Radiation is now measured in GRAY rather than RADS. One GRAY is equal to _____ RADS.

ANS: 100 One GRAY is equal to 100 RADS.

25. Which statement by a patient should lead the nurse to conclude that the precolonoscopy instruction provided has been effective? a. "I know that the lighted tube he will use will help the doctor look at my tumor, and he might take a small piece of tissue to look at in the lab." b. "I know that the light on the tube will help cure my cancer." c. "I know the colonoscopy is very painful and embarrassing, and I hope no one sees me in that position." d. "My daughter is coming in to see me today. I am glad to be looking forward to something pleasant."

ANS: A"I know that the lighted tube he will use will help the doctor look at my tumor, and he might take a small piece of tissue to look at in the lab." Colonoscopy diagnostic procedures are essentially painless but have no curative benefit.

3. Why is adjuvant therapy given to patients with cancer who are free of signs of the disease? (Select all that apply.) a. Ensures eradication of undetected cells b. Stabilizes normal cells c. Diminishes recurrence of breast cancer d. Reduces the extent of the tumor before surgery or radiation e. Changes the pH of the system to inhibit cell growth

ANS: A, C a. Ensures eradication of undetected cells c. Diminishes recurrence of breast cancer Adjuvant therapy is given to symptom-free patients with cancer to eradicate undetected cells and to diminish the recurrence of breast cancer. Administration before surgery or radiation to reduce tumor bulk is called nonadjuvant therapy. The therapy does not stabilize normal cells or alter the pH.

5. When is surgical remedy for cancer most successful? (Select all that apply.) a. Cancer is detected early. b. The tumors are fast growing. c. Cancer cells have invaded only a nonvital structure. d. Lymph glands have not been involved. e. Cancer cells are confined to only two areas.

ANS: A, D a. Cancer is detected early. d. Lymph glands have not been involved. Surgical remedies have a high success rate if the cancer is detected early, the tumors are not fast growing, the cancer cells have not invaded any vital structure, the lymph glands have not been involved, and the cancer cells are isolated in one area.

6. A patient newly diagnosed with cancer says, "I feel like I've lost my future. I feel so much harm has been done to me that I'm overwhelmed." To what type of coping strategies should the nurse recognize this attitude will most likely lead the patient? a. Avoidant b. Problem solving c. Approach oriented d. Confrontational

ANS: A. . Avoidant Persons who appraise their cancer diagnosis as harm or loss are more likely to use avoidant coping strategies. DIF: Cognitive Level: Comprehension REF: p. 404 OBJ: 6 TOP: Coping Styles KEY: Nursing Process Step: Assessment

1. A nurse clarifies that cells that change from their tissues of origin and have multiple nuclei are categorized as _____.

ANS: undifferentiated Undifferentiated cells are those that change from normal cells of tissue origin. These cells may have a large nucleus or multiple nuclei.

19. Which patient assessment should lead a nurse to conclude a patient diagnosed with cancer is beginning the acceptance stage? a. Begins to act in a cheerful manner b. Inquires about support groups c. Cries over loss of health d. Actively interacts with his or her family

ANS: B. Inquires about support groups Directed planning for support for the diagnosis is indicative of acceptance. Crying and a cheerful manner are not necessarily positive. Interaction with the family is not indicative of acceptance.

20. A family is concerned about the possibility of addiction as a result of the frequent doses of Roxanol. What is the nurse's best response? a. "At this stage, addiction is the least of our worries." b. "This is a low-dose drug, and it controls pain without the problems of addiction." c. "Addiction is rare, but we have drugs that can counteract the effect of this narcotic." d. "You may want to share your concerns with the physician. He can order another drug that is not addictive."

ANS: B. This is a low-dose drug, and it controls pain without the problems of addiction." Roxanol is a low-dose narcotic with very little potential for addiction.

23. What is the best menu choice for a patient with nausea who is undergoing radiation treatments every other day? a. Bowl of vegetable soup, chopped egg and pickle sandwich on wheat bread, one apple, and 8 oz of orange juice b. Broiled chicken with rice, 1-oz slice of plain American cheese, one-quarter cup of spinach, one-half ripe banana, and 8 oz of grape juice c. Spanish rice, one-half cup of mixed green salad, one-half cup of canned peaches, and 8 oz of Coke d. Spaghetti with tomato sauce, cheddar cheese toast strips, six celery sticks with peanut butter, and 8 oz of whole milk

ANS: B.Broiled chicken with rice, 1-oz slice of plain American cheese, one-quarter cup of spinach, one-half ripe banana, and 8 oz of grape juice Food choices for a nauseated patient should be mild and easily digested, with no spicy sauces or dark colas.

11. What manifestations might be assessed by a nurse when a patient is diagnosed with the oncologic emergency hypercalcemia? a. Hypertension and bradycardia b. Fatigue, confusion, and weakness c. Laboratory test results of potassium 3.5 mEq/L, sodium 143 mEq/L d. Urine output less than 30 mL/hr

ANS: B.Fatigue, confusion, and weakness The indications for hypercalcemia are fatigue, confusion, weakness, and poor muscle tone. If left untreated, renal failure and death may occur.

8. A patient is scheduled for a chemotherapy treatment in approximately 30 minutes. Breakfast trays have arrived and are being served on the unit. What is the nurse's best intervention? a. Encourage the patient to eat all his breakfast to keep up his strength to fight the cancer. Remind the patient that breakfast is about one third of his daily intake. b. Listen attentively to any concerns that the patient expresses regarding the treatment. Offer to hold his tray until after the treatment. c. Offer to call the family to come and be present after the treatment. Encourage the patient to drink at least all of the orange juice and coffee. d. Suggest that the patient request a dose of strong analgesic instead of eating because this treatment is very painful.

ANS: B.Listen attentively to any concerns that the patient expresses regarding the treatment. Offer to hold his tray until after the treatment. Chemotherapy causes nausea and vomiting. Holding the tray until later provides for better intake and for holding the food in the stomach for digestion.

17. Which complaint should a nurse consider a warning sign for cancer? a. Intense pain in an area such as a hip or groin after carrying several gallons of paint up a ladder and painting the garage b. Persistent indigestion associated with difficulty swallowing c. Diarrhea that lasts 2 days after an all-day picnic at the beach d. A painful lump under the umbilicus that recedes when pushed but comes out again with a sneeze or hard cough

ANS: B.Persistent indigestion associated with difficulty swallowing. Persistent indigestion associated with dysphagia is an American Cancer Society-published risk for a cancerous sign.

10. While bathing a patient with cancer, a nurse assessed several large new bruises on the patient's upper arms and thighs. What is the best understanding of the possible causes and the correct nurse's actions for these findings? a. The patient must have fallen last night walking to the bathroom. Teach the patient to use the call bell when assistance is needed. b. The patient may have disseminated intravascular coagulation. The size, shape, location, color, and tenderness must be reported and recorded fully. c. An intravascular fluid overload is occurring because of the chemotherapy. Place the patient on strict input/output (I/O) status and limit fluids. d. The patient must have had a drug-induced seizure, which caused arm and leg thrashing and the bruises. Report and record the findings, and pad the side rails.

ANS: B.The patient may have disseminated intravascular coagulation. The size, shape, location, color, and tenderness must be reported and recorded fully. These signs of hemorrhage may indicate the oncologic emergency of disseminated intravascular coagulation. Serious signs need to be reported in a timely manner and fully described.

24. A patient is close to death with terminal liver cancer with widespread metastases and calls the nursing staff to his room every 5 minutes. Which interventions will be most supportive and in the best interest of the patient? a. Encourage and insist that the family request a transfer to hospice care because the general hospital does not have enough staff members to keep responding to the patient's end-stage frequent calling and requests for minor help. b. Use fixed interval and cocktail medication administration. Frequently evaluate for breakthrough pain and anxieties. Answer the call bell quickly on the intercom or in person. c. Tell the family that as of this afternoon, all of the patient's questions, comments, and expressed fears of dying and financial worries will be referred to the social worker, physician, or clergy. Otherwise, one of them can come in and sit beside the bed. d. Plan to limit strictly the time spent with the patient because the nurse cannot do much that could be beneficial at this point.

ANS: B.Use fixed interval and cocktail medication administration. Frequently evaluate for breakthrough pain and anxieties. Answer the call bell quickly on the intercom or in person. Therapeutic touch, the nurse's presence, and sufficient pain medication to make the patient comfortable are appropriate nursing actions.

12. A female college student has had a melanoma of the forehead surgically removed and given a course of chemotherapy. Which comment demonstrates an understanding of the treatments and prognosis? a. "Why did you bring me this shampoo? You guys took all my hair, so I don't have anything to wash or fix." b. "Why don't my friends from school come to visit? Did you tell them to stay away?" c. "My spring dance is only 3 weeks away. Do you think I could find a wig to cover my head where the hair fell out from the chemo?" d. "Well, this looks like the end of the problem for me, thank goodness! I won't have to bother that doctor again until I graduate in a couple of years because all my shots must be up to date now."

ANS: C "My spring dance is only 3 weeks away. Do you think I could find a wig to cover my head where the hair fell out from the chemo?" Acceptance of the diagnosis, treatments, side effects, and prognosis by the patient are reflected in her understanding that she will be bald.

9. A nurse explains that drugs such as cannabinoids, Benadryl, and Vistaril are frequently ordered for patients with cancer who are taking chemotherapy. What do these types of drugs accomplish? a. Promote amnesia to dampen the fear. b. Maintain fluid retention to prevent dehydration. c. Control nausea, vomiting, and taste disorders caused by the therapy. d. Control bouts of diarrhea or uncomfortable constipation.

ANS: C. Control nausea, vomiting, and taste disorders caused by the therapy. Cannabinoids, Benadryl, and Vistaril are useful to help control nausea.

21. Which cytologic test, usually performed in outpatient settings, suggests the probability of a need for further testing for cancer cells? a. Chest radiography b. Koch test c. Papanicolaou (Pap) test d. Tine test

ANS: C. Papanicolaou (Pap) test Preventive testing (Pap test) and screening reduce the risks for cancer and increase the chances of early treatment and is the most commonly performed screening test.

13. A patient whose cancer has been staged at T4 N2 M2 has been assigned for care. What is the best interpretation of this staging information in planning care for this patient? a. The primary tumor has shrunk, although some lymph nodes remain involved. Teach the patient that this is good news. b. The primary tumor has now responded to a combination of chemotherapy and radiation. The patient should now receive much less analgesic medication. c. The primary tumor is quite large and has extended to lymph glands and distant areas. Gentle touch and therapeutic listening will be especially helpful. d. After the series of radiation treatments, the distant metastases are still present. Prepare the patient to accept only the cure of the primary tumor.

ANS: C. The primary tumor is quite large and has extended to lymph glands and distant areas. Gentle touch and therapeutic listening will be especially helpful. Correct interpretation and differentiating components of staging data are used to plan effective nursing care.

7. A patient has a cancer that has been TNM staged as T3 (1-4, size of primary tumor), N2 (0-3, degree of spread to regional lymph nodes), and M2 (0-1, presence of metastasis). He has an as needed order of 4 mg of morphine intramuscularly every 3 to 4 hours. He requests another pain injection approximately hours after the last one. What is the most appropriate nursing action? a. Inform the patient that this narcotic may be given only every 4 hours to prevent addiction. b. Ignore the call bell for 20 minutes and then take at least 10 minutes to prepare and administer the injection. c. Give the morphine and evaluate the results of pain relief. Arrange for the physician to evaluate for breakthrough pain. d. Ask the family to assist in helping the patient accept waiting longer to receive an addicting medication such as morphine.

ANS: C.Give the morphine and evaluate the results of pain relief. Arrange for the physician to evaluate for breakthrough pain. Terminal care does not include concerns about morphine addiction. Medication may be given 15 minutes before or after an allotted time. The occurrence of breakthrough pain is a real concern for this patient.

5. Which is true about both malignant tumors and benign tumors? a. Both contain cells that closely resemble those in the tissue of origin. b. Both travel quickly to invade and destroy other tissues and organs. c. Both always grow and multiply very rapidly, competing for space and nutrients and causing severe pain. d. Both may press on nearby surrounding tissues, such as nerves and blood vessels, causing pain.

ANS: D .Both may press on nearby surrounding tissues, such as nerves and blood vessels, causing pain. Both benign and malignant tumors may create pressure on or obstruct an organ.

18. What is the most common site of cancer in adult men? a. Colon b. Lung c. Pancreas d. Prostate

ANS: D. Prostate Gender defines some of the potential risks for cancer. Prostate cancer accounts for 33% of the reported cases of cancer in men.

14. Which symptom reported by a patient taking doxorubicin (Adriamycin) should be considered a priority for intervention? a. Nausea b. Visual disturbances c. Headache and dizziness d. Rapid heartbeat

ANS: D.Rapid heartbeat Adriamycin is cardiotoxic medication and can cause heart failure.

16. What is the most common site of cancer in adult women? a. Breast b. Lung c. Kidney d. Uterus

ANS: a. Breast The gender of the person determines the risk for some cancers and the need for early detection. The incidence of breast cancer is 31% of the reported cases of cancer.

1. Which statement best defines concepts to be included in a teaching plan for a patient with cancer? a. Cancer is a group of diseases. The cancer cells are different from the cells in the tissue of its origin in both the growth and spreading of abnormal cells. b. Cancer is the third leading cause of death in the United States. Many hospitals have the highest number of patients with this diagnosis. c. Americans who have a diagnosis of cancer die within 1 year or less. d. When a person is genetically predisposed to a type of cancer, nothing can be done to prevent its occurrence.

ANS: a. Cancer is a group of diseases. The cancer cells are different from the cells in the tissue of its origin in both the growth and spreading of abnormal cells. Information about the disease and disease process is helpful to allay anxiety, as well as to instruct about its pathophysiologic changes.

15. A diagnosis of breast cancer is first made at stage T1 N0 M0. Which nursing diagnosis would be appropriate? a. "Risk for disturbed body image, related to threats of anticipated changes." b. "Risk of anxiety, related to outcome of treatments." c. "Risk for infection, related to decreased white blood cell count." d. "Risk for ineffective coping, related to husband's expectations regarding anticipated treatments."

ANS: b. "Risk of anxiety, related to outcome of treatments. Early stages of cancer create anxiety about the outcome of treatments for the patient.

2. What recommendations should a nurse make to a visitor of a patient who has an internal radiation implant? (Select all that apply.) a. Avoid visitation if you are pregnant. b. Take off all metals, such as your watch and belt. c. Limit your visitation time. d. Wear a protective lead apron. e. Stay at least 6 feet away from bedside.

a. Avoid visitation if you are pregnant. c. Limit your visitation time. e. Stay at least 6 feet away from bedside. Visitors are important to reduce the isolation of the patient who is undergoing radiation, but pregnant women should not visit. The visits of all persons should be limited to a few minutes, and they should be at least 6 feet from the bedside. Removing metal objects and wearing protective devices are not necessary.

1. Which conditions of middle-aged persons promote the formation of malignant cells? (Select all that apply.) a. Childbearing b. Increasing age c. Hormonal changes d. Chronic irritation of tissue e. Diet

b. Increasing age c. Hormonal changes d. Chronic irritation of tissue e. Diet Increased age, hormonal changes, chronic irritation of internal tissue, and a poor diet are possible sources of increased incidence of cancer in middle-aged persons.

4. What action should a nurse implement if an intravenous vesicant cancer drug has extravasated? (Select all that apply.) a. Place a warm compress on the area. b. Chill the area with an ice pack. c. Raise the patient's arm above the level of the heart. d. Stop the infusion. e. Notify the charge nurse.

d. Stop the infusion. e. Notify the charge nurse. The licensed practical nurse should stop the infusion and notify the charge nurse so that specially trained personnel can intervene.