Ch16 - Practice Questions PDF

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Chapter 16: Cancer Test Bank MULTIPLE CHOICE 1. A patient who is scheduled for a right breast biopsy asks the nurse the difference between a

benign tumor and a malignant tumor. Which answer by the nurse is correct? “Benign tumors do not cause damage to other tissues.” “Benign tumors are likely to recur in the same location.” “Malignant tumors may spread to other tissues or organs.” “Malignant cells reproduce more rapidly than normal cells.”

a. b. c. d.

ANS: C

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. The other statements are inaccurate. Both types of tumors may cause damage to adjacent tissues. Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not usually recur. DIF: Cognitive Level: Understand (comprehension) REF: 253 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 2. The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse

should monitor for which adverse effect? Nausea Alopecia Mucositis Hematuria

a. b. c. d.

ANS: D

The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy. DIF: Cognitive Level: Apply (application) REF: 261 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 3. The nurse is caring for a patient who smokes 2 packs/day. To reduce the patient’s risk of lung

cancer, which action by the nurse is best? Teach the patient about the seven warning signs of cancer. Plan to monitor the patient’s carcinoembryonic antigen (CEA) level. Discuss the risks associated with cigarettes during every patient encounter. Teach the patient about the use of annual chest x-rays for lung cancer screening.

a. b. c. d.

ANS: C

Teaching about the risks associated with cigarette smoking is recommended at every patient encounter because cigarette smoking is associated with multiple health problems. A tumor must be at least 0.5 cm large before it is detectable by current screening methods and may already have metastasized by that time. Oncofetal antigens such as CEA may be used to monitor therapy or detect tumor reoccurrence, but are not helpful in screening for cancer. The seven warning signs of cancer are actually associated with fairly advanced disease.

DIF: Cognitive Level: Apply (application) REF: 255-256 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 4. The nurse should include which food choice when providing dietary teaching for a patient

scheduled to receive external beam radiation for abdominal cancer? Fresh fruit salad Roasted chicken Whole wheat toast Cream of potato soup

a. b. c. d.

ANS: B

To minimize the diarrhea that is commonly associated with bowel radiation, the patient should avoid foods high in roughage, such as fruits and whole grains. Lactose intolerance may develop secondary to radiation, so dairy products should also be avoided. DIF: Cognitive Level: Apply (application) REF: 268 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 5. During a routine health examination, a 40-year-old patient tells the nurse about a family

history of colon cancer. Which action should the nurse take next? Teach the patient about the need for a colonoscopy at age 50. Teach the patient how to do home testing for fecal occult blood. Obtain more information from the patient about the family history. Schedule a sigmoidoscopy to provide baseline data about the patient.

a. b. c. d.

ANS: C

The patient may be at increased risk for colon cancer, but the nurse’s first action should be further assessment. The other actions may be appropriate, depending on the information that is obtained from the patient with further questioning. DIF: Cognitive Level: Apply (application) REF: 255-256 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 6. A patient who is diagnosed with cervical cancer that is classified as Tis, N0, M0 asks the nurse

what the letters and numbers mean. Which response by the nurse is most appropriate? “The cancer involves only the cervix.” “The cancer cells look almost like normal cells.” “Further testing is needed to determine the spread of the cancer.” “It is difficult to determine the original site of the cervical cancer.”

a. b. c. d.

ANS: A

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. DIF: Cognitive Level: Apply (application) REF: 254 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 7. The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure.

Which statement, if made by the patient, indicates that teaching was effective? a. “The biopsy will remove the cancer in my prostate gland.”

b. “The biopsy will determine how much longer I have to live.” c. “The biopsy will help decide the treatment for my enlarged prostate.” d. “The biopsy will indicate whether the cancer has spread to other organs.” ANS: C

A biopsy is used to determine whether the prostate enlargement is benign or malignant, and determines the type of treatment that will be needed. A biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient’s life. DIF: Cognitive Level: Apply (application) REF: 256 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 8. The nurse teaches a postmenopausal patient with stage III breast cancer about the expected

outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective? a. “After cancer has not recurred for 5 years, it is considered cured.” b. “The cancer will be cured if the entire tumor is surgically removed.” c. “Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation.” d. “I will need to have follow-up examinations for many years after I have treatment before I can be considered cured.” ANS: D

The risk of recurrence varies by the type of cancer. Some cancers are considered cured after a shorter time span or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up. DIF: Cognitive Level: Apply (application) REF: 257 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 9. A patient with a large stomach tumor that is attached to the liver is scheduled to have a

debulking procedure. Which information should the nurse teach the patient about the outcome of this procedure? a. Pain will be relieved by cutting sensory nerves in the stomach. b. Relief of pressure in the stomach will promote better nutrition. c. Tumor growth will be controlled by the removal of malignant tissue. d. Tumor size will decrease and this will improve the effects of other therapy. ANS: D

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. DIF: Cognitive Level: Understand (comprehension) REF: 258 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 10. External-beam radiation is planned for a patient with cervical cancer. What instructions should

the nurse give to the patient to prevent complications from the effects of the radiation? a. Test all stools for the presence of blood. b. Maintain a high-residue, high-fiber diet.

c. Clean the perianal area carefully after every bowel movement. d. Inspect the mouth and throat daily for the appearance of thrush. ANS: C

Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection. 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. DIF: Cognitive Level: Apply (application) REF: 268 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 11. A patient with Hodgkin’s lymphoma who is undergoing external radiation therapy tells the

nurse, “I am so tired I can hardly get out of bed in the morning.” Which intervention should the nurse add to the plan of care? a. Minimize activity until the treatment is completed. b. Establish time to take a short walk almost every day. c. Consult with a psychiatrist for treatment of depression. d. Arrange for delivery of a hospital bed to the patient’s home. ANS: B

Walking programs are used to keep the patient active without excessive fatigue. Having a hospital bed does not necessarily address the fatigue. The better option is to stay as active as possible while combating fatigue. Fatigue is expected during treatment and is not an indication of depression. Minimizing activity may lead to weakness and other complications of immobility. DIF: Cognitive Level: Apply (application) REF: 265 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 12. The nurse is caring for a patient with colon cancer who is scheduled for external radiation

therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching? a. The patient swims a mile 3 days a week. b. The patient snacks frequently during the day. c. The patient showers everyday with a mild soap. d. The patient has a history of dental caries with amalgam fillings. ANS: A

The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change 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. DIF: Cognitive Level: Apply (application) REF: 270 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 13. A patient undergoing external radiation has developed a dry desquamation of the skin in the

treatment area. The nurse teaches the patient about management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective?

a. b. c. d.

“I can buy some aloe vera gel to use on the area.” “I will expose the treatment area to a sun lamp daily.” “I can use ice packs to relieve itching in the treatment area.” “I will scrub the area with warm water to remove the scales.”

ANS: A

Aloe vera gel and cream may be used on the radiated skin area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury. DIF: Cognitive Level: Apply (application) REF: 269 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 14. A patient with metastatic cancer of the colon experiences severe vomiting following each

administration of chemotherapy. Which action, if taken by the nurse, is most appropriate? Have the patient eat large meals when nausea is not present. Offer dry crackers and carbonated fluids during chemotherapy. Administer prescribed antiemetics 1 hour before the treatments. Give the patient two ounces of a citrus fruit beverage during treatments.

a. b. c. d.

ANS: C

Treatment with antiemetics before chemotherapy may help prevent nausea. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea. The acidity of citrus fruits may be further irritating to the stomach. DIF: Cognitive Level: Apply (application) REF: 266 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 15. The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is

most important for the nurse to take? Infuse the medication over a short period of time. Stop the infusion if swelling is observed at the site. Administer the chemotherapy through a small-bore catheter. Hold the medication unless a central venous line is available.

a. b. c. d.

ANS: B

Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should 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 chemotherapeutic drug. These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred. DIF: Cognitive Level: Apply (application) REF: 259 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 16. A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the

nurse take to maintain the patient’s self-esteem? Tell the patient to limit social contacts until regrowth of the hair occurs. Encourage the patient to purchase a wig or hat and wear it once hair loss begins. Teach the patient to gently wash hair with a mild shampoo to minimize hair loss. Inform the patient that hair usually grows back once the chemotherapy is complete.

a. b. c. d.

ANS: B

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. DIF: Cognitive Level: Apply (application) REF: 266 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 17. A patient who has ovarian cancer is crying and tells the nurse, “My husband rarely visits. He

just doesn’t care.” The husband indicates to the nurse that he never knows what to say to help his wife. Which nursing diagnosis is most appropriate for the nurse to add to the plan of care? a. Compromised family coping related to disruption in lifestyle b. Impaired home maintenance related to perceived role changes c. Risk for caregiver role strain related to burdens of caregiving responsibilities d. Dysfunctional family processes related to effect of illness on family members ANS: D

The data indicate that this diagnosis is most appropriate because poor communication among the family members is affecting family processes. No data suggest a change in lifestyle or its role as an etiology. The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities. DIF: Cognitive Level: Apply (application) REF: 279-280 TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity 18. A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral

mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient? 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. ANS: D

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. DIF: Cognitive Level: Apply (application) REF: 266 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 19. A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body

requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake? a. Offer the patient frequent small snacks between meals. b. Assist the patient to choose favorite foods from the menu. c. Provide teaching about the importance of nutritional intake. d. Apply the ordered anesthetic gel to oral lesions before meals. ANS: D

Because the etiology of the patient’s poor nutrition is the painful oral ulcers, the best intervention is to apply anesthetic gel to the lesions before the patient eats. The other actions might be helpful for other patients with impaired nutrition, but would not be as helpful for this patient. DIF: Cognitive Level: Apply (application) REF: 268-269 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 20. A widowed mother of four school-age children is hospitalized with metastatic ovarian cancer.

The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate? a. “Why don’t we talk about the options you have for the care of your children?” b. “I’m sure you have friends that will take the children when you can’t care for them.” c. “For now you need to concentrate on getting well and not worrying about your children.” d. “Many patients with cancer live for a long time, so there is still time to plan for your children.” ANS: A

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 friends will take the children, more assessment information is needed before making plans. DIF: Cognitive Level: Apply (application) REF: 280 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 21. A patient who has severe pain associated with terminal pancreatic cancer is being cared for at

home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective? a. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale). b. The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness. c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. d. The patient states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief. ANS: C

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 also may 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 usually the oral route is preferred. DIF: Cognitive Level: Apply (application) REF: 279 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

22. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell

carcinoma. Which...