Lewis: MED-SURG: Chapter 16: Cancer

The school health nurse is presenting a health-promotion class to a group of middle-school students. Which is the best intervention to address health-promotion strategies related to the leading cause of cancer deaths in North America?

A) Monthly self-breast exams

B) Smoking cessation

C) Annual colonoscopies

D) Monthly testicular exams

Ans: B

Chapter: 16

Client Needs: B

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Teaching/Learning

Objective: 4

Page and Header: 337, Epidemiology of Cancer

Feedback: Cancer is second only to cardiovascular disease as a leading cause of death in the United States. Although the numbers of cancer deaths have decreased slightly, more than 560,000 Americans were expected to die from a malignant process in 2008. The leading causes of cancer death in the United States, in order of frequency, are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women, so smoking cessation is the health promotion initiative directly related to lung cancer. Therefore, the other options are incorrect.

You are the clinic nurse in an oncology clinic. Your patient arrives for a 2-month follow-up appointment following chemotherapy. You note that the patient's skin appears yellow. Which blood tests should be done to further explore this clinical sign?

A) Liver function test

B) CBC

C) Platelet count

D) Electrolytes

Ans: A

Chapter: 16

Client Needs: D-4

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 7

Page and Header: 391, Cancer Survivorship

Feedback: Surveillance for cancer spread, recurrence, or second cancers: colonoscopy post colon cancer, mammography post breast cancer, Liver function tests post colon cancer, prostate-specific antigen post prostate cancer. Yellow skin is a sign of jaundice. The liver is a common organ affected by metastatic disease. A liver function test should be done to determine if the liver is functioning. Option B is incorrect; a CBC would show an altered white blood cell count indicating possible infection. Option C is incorrect; a platelet count tells whether the blood sample has an adequate number of platelets, necessary for blood clotting. Option D is incorrect; a blood test for electrolytes would not identify the cause of the jaundice.

You are teaching a nutrition class in the local high school. One student tells you that he has heard that certain foods can increase the incidence of cancer. You respond, "Research has shown that certain foods appear to increase the risk of cancer." Which of the following menu selections would be the best choice for reducing the risks of cancer?

A) Smoked salmon and green beans

B) Pork chops and fried green tomatoes

C) Baked apricot chicken and steamed broccoli

D) Liver, onions, and steamed peas

Ans: C

Chapter: 16

Client Needs: B

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/Learning

Objective: 3

Page and Header: 341, Pathophysiology of the Malignant Process

Feedback: High-fiber foods; cruciferous vegetables, such as broccoli, cauliflower, and spinach; and carotenoids, such as apricots and peaches, appear to reduce cancer risk. Salt-cured foods, such as ham and processed luncheon meats, should be avoided. Options B and D are incorrect as they do not contain cruciferous vegetables.

Traditionally, nurses have been involved with tertiary prevention with their cancer patients. However, emphasis is also placed on both primary and secondary prevention. What would be an example of primary prevention?

A) Yearly Papanicolaou tests

B) Testicular self-examination

C) Teaching patients to wear sunscreen

D) Screening mammogram

Ans: C

Chapter: 16

Client Needs: B

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/Learning

Objective: 4

Page and Header: 343, Detection and Prevention of Cancer

Feedback: Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as use of sunscreen. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Papanicolaou tests, mammograms, and testicular exams.

You are caring for a 39-year-old woman with a family history of breast cancer. She has requested a breast tumor marking test and the results are positive. The patient is requesting a bilateral mastectomy. What is this surgery an example of?

A) Salvage surgery

B) Palliative surgery

C) Prophylactic surgery

D) Reconstructive surgery

Ans: C

Chapter: 16

Client Needs: D-3

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 5

Page and Header: 348, Management of Cancer

Feedback: Prophylactic surgery is used when there is an extensive family history and nonvital tissues are removed. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect.

You are caring for a patient who is to begin receiving external radiation for a malignant tumor of the head and neck. While doing patient education, what side effects should the nurse discuss with the patient that should be assessed because of the radiation treatment?

A) Impaired nutritional status

B) Pink oral mucosa

C) Diarrhea

D) Alopecia

Ans: A

Chapter: 16

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 6

Page and Header: 351, Management of Cancer

Feedback: Alterations in oral mucosa, change and loss of taste, pain, and dysphasia often occur as a result of radiotherapy to the head and neck. The patient is at an increased risk of impaired nutritional status. Option B is incorrect; the oral mucosa is normally pink. Options C and D are incorrect; diarrhea and alopecia are not concerns for this patient.

While a patient is receiving intravenous doxorubicin hydrochloride, the nurse observes that there is swelling and pain at the IV site. The nurse should

A) stop the administration of the drug immediately.

B) notify the patient's physician.

C) continue to administer but decrease the rate of infusion.

D) apply a warm compress to the site.

Ans: A

Chapter: 16

Client Needs: D-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 7

Page and Header: 355, Management of Cancer

Feedback: Doxorubicin hydrochloride is a chemotherapeutic vessicant that can cause severe tissue damage. The nurse should stop the administration of the drug immediately and then notify the patient's physician. Ice can be applied to the site once the drug therapy has stopped.

A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment. The patient asks the nurse what the most common side effect of chemotherapy is. What would be the best answer the nurse could give?

A) Alopecia

B) Nausea and vomiting

C) Altered glucose metabolism

D) Increased appetite

Ans: B

Chapter: 16

Client Needs: D-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/Learning

Objective: 7

Page and Header: 356, Management of Cancer

Feedback: Nausea and vomiting are the most common side effects of chemotherapy and may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these patients. Other side effects include bone marrow suppression, anorexia, vaginal dryness, and hair loss. Less common effects include altered glucose metabolism and jaundice.

Your patient is receiving carmustine, a chemotherapy agent. A significant side effect of this medication is thrombocytopenia. Which symptom would the nurse assess for in patients at risk for thrombocytopenia?

A) Interrupted sleep pattern

B) Hot flashes

C) Nose bleed

D) Increased weight

Ans: C

Chapter: 16

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 7

Page and Header: 357, Management of Cancer

Feedback: Patients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. A priority goal for this patient is to prevent trauma related to decreased platelet count. A soft toothbrush or an electric razor can be used. No invasive procedures should be performed. Patients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight.

You are orienting a new nurse to the oncology unit where you work. As you prepare to administer an antineoplastic agent to a one of your patients, what should you teach the new nurse about antineoplastic agents?

A) Administer only prepackaged agents from the manufacturer

B) Wash hands and arms following administration

C) Use gloves and a lab coat

D) Dispose of the antineoplastic wastes in the hazardous waste receptacle

Ans: D

Chapter: 16

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 7

Page and Header: 353, Management of Cancer

Feedback: The nurse should use surgical gloves and disposable long-sleeved gowns when administering antineoplastic agents. The antineoplastic wastes are disposed of as hazardous materials. Option A is incorrect; you do not administer only prepackaged agents from the manufacturer. Option B is incorrect; this is a valid answer, but you wash your hands and arms before and after administering the medication.

You are a nurse working on a bone marrow transplant unit. Your patient is scheduled to receive a bone marrow transplant. What information will you provide to the patient's visitors?

A) Bring plants to improve air quality.

B) Take the patient to the cafeteria for meals.

C) Wear hospital scrubs when entering the patient's room.

D) Do not visit if you've had a recent infection.

Ans: D

Chapter: 16

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 6

Page and Header: 360, Management of Cancer

Feedback: Before engraphment, patients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they've had a recent illness or vaccination. Plants should not be brought to the BMT patient. The patient cannot go to the cafeteria for meals. Disposable hospital gowns are worn when entering the patient's room.

The nursing instructor is teaching a class in oncology nursing to her junior nursing students. The instructor is aware that infection is a significant consideration when providing care to an oncology patient. The leading cause of death in an oncology patient is infection caused by what?

A) Malnutrition

B) Impaired skin integrity

C) Poor hygiene

D) Broken oral mucosa

Ans: B

Chapter: 16

Client Needs: A-2

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 7

Page and Header: 377, Nursing Care of Patients with Cancer

Feedback: Nursing care for patients with skin reactions includes maintaining skin integrity, cleansing the skin, promoting comfort, reducing pain, preventing additional trauma, and preventing and managing infection. Option A is incorrect; malnutrition in oncology patients may be present, but it is not the leading cause of death. Option C is incorrect; oncology patients do not have poor hygiene at a rate any higher than other patients, and it does not cause death. Option D is incorrect; broken oral mucosa may be an avenue for infection, but it is not the leading cause of death in an oncology patient.

You are the nurse caring for an adult patient who has developed a mild oral yeast infection following chemotherapy. What should you encourage the patient to do? (Mark all that apply.)

A) Use a lip lubricant

B) Scrub the tongue with a firm-bristled toothbrush

C) Use dental floss every 24 hours

D) Rinse the mouth with normal saline

E) Eat hot foods to aid in killing the yeast

Ans: A, C, D

Chapter: 16

Client Needs: D-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Teaching/Learning

Objective: 7

Page and Header: 377, Nursing Care of Patients with Cancer

Feedback: Stomatitis is an inflammation of the oral cavity. The patient should be encouraged to brush the teeth with a soft toothbrush after meals, use dental floss every 24 hours, rinse with normal saline, and use a lip lubricant. Mouthwashes and hot foods should be avoided.

The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for engraphment for a bone marrow transplant. What is a priority nursing diagnosis for this patient?

A) Fatigue and activity intolerance

B) Altered nutrition: less than body requirements due to anorexia

C) Risk for infection related to altered immunologic response

D) Body image disturbance related to weight loss and anorexia

Ans: C

Chapter: 16

Client Needs: D-2

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 8

Page and Header: 366, Nursing Care of Patients with Cancer

Feedback: A priority nursing diagnosis for this patient is risk for infection related to altered immunologic response. Because the patient's immunity is suppressed, he or she will be at a high risk for infection. Options A, B, and D all are valid nursing diagnoses, but they are not as much of a priority as is risk for infection.

The nursing instructor is discussing the care of oncology patients with her junior nursing students. The instructor presents this scenario: An oncology patient develops erythema following radiation therapy. What should the nurse instruct the patient to do?

A) Apply ice to the area.

B) Keep the area cleanly shaven.

C) Apply petroleum ointment to the affected area.

D) Avoid using soap on the area of treatment.

Ans: D

Chapter: 16

Client Needs: D-3

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/Learning

Objective: 6

Page and Header: 368, Nursing Care of Patients with Cancer

Feedback: Care to the affected area must focus on preventing further skin irritation, drying, and damage. Soaps, petroleum ointment, and shaving the area could worsen the erythema. Ice is also contraindicated.

You are caring for a patient has just been given a 6-month prognosis. The patient states that he would like to die at home. The patient's care needs are unable to be met in a home environment. What might you suggest as an alternative?

A) Discuss a referral for rehabilitation hospital

B) Panel the patient for a personal care home

C) Discuss a referral for acute care

D) Discuss a referral for hospice care

Ans: D

Chapter: 16

Client Needs: D-1

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Caring

Objective: 10

Page and Header: 386, Nursing Care of Patients with Cancer

Feedback: Hospice care can be provided in several settings. Because of the high cost associated with free-standing hospices, care is often delivered by coordinating services provided by both hospitals and the community. The primary goal of hospice care is to provide support to the patient and family. Patients who are referred to hospice care generally have less than 6 months to live. Option A is incorrect; a rehabilitation hospital is inappropriate at this time. Option B is incorrect; this is a distracter for this test question. Option C is incorrect; again, this is an inappropriate referral for this patient.

The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient?

A) "These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and X-ray studies."

B) "These symptoms are part of your disease and can't be helped."

C) "Don't be concerned about these symptoms. Everybody feels this way after having radiation therapy."

D) "This is a good sign. It means that only the cancer cells are dying."

Ans: A

Chapter: 16

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/Learning

Objective: 6

Page and Header: 380, Nursing Care of Patients with Cancer

Feedback: Fatigue and weakness result from radiation treatment and usually don't represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the patient and shouldn't be belittled. Radiation destroys both cancerous and normal cells.

A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that the patient is meeting the goal of improved body image and self-esteem?

A) The patient requests that her family bring her makeup and wig.

B) The patient begins to discuss the future with her family.

C) The patient reports less disruption from pain and discomfort.

D) The patient cries openly when discussing her disease.

Ans: A

Chapter: 16

Client Needs: C

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 7

Page and Header: 382, Nursing Care of Patients with Cancer

Feedback: Requesting her wig and makeup indicates that the patient with alopecia is becoming interested in looking her best and that her body image and self-esteem may be improving. The other options may indicate that other nursing goals are being met, but they don't assess improved body image and self-esteem.

Adverse effects to chemotherapy are dealt with by patients and their caregivers every day. What would the nurse do to combat the most common adverse effects of chemotherapy?

A) Administer an antiemetic

B) Administer an antimetabolite

C) Administer a tumor antibiotic

D) Administer an anticoagulant

Ans: A

Chapter: 16

Client Needs: D-2

Cognitive Level: Application

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 7

Page and Header: 357, Management of Cancer

Feedback: Antiemetics are used to treat nausea and vomiting, the most common adverse effects of chemotherapy. Antihistamines and certain steroids are also used to treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli.

A 58-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic?

A) "Smoking is the reason you're here."

B) "The doctor left orders for you not to smoke."

C) "You're anxious about the surgery. Do you see smoking as helping?"

D) "Smoking is OK right now, but after your surgery it's contraindicated."

Ans: C

Chapter: 16

Client Needs: C

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 3

Page and Header: 349, Management of Cancer

Feedback: This acknowledges the patient's feelings and encourages him to assess his previous behavior. Option A belittles the patient. Option B does not address the patient's anxiety. Option D would be highly detrimental to this patient.

The nursing instructor is discussing the difference between normal cells and cancer cells with the prenursing class in pathophysiology. What would the instructor cite as a characteristic of a cancer cell?

A) Malignant cells contain more fibronectin.

B) The cell membrane of malignant cells also contains proteins called tumor-specific antigens.

C) Chromosomes are commonly found to be strong.

D) Nuclei of cancer cells are large and regularly shaped.

Ans: B

Chapter: 16

Client Needs: D-4

Cognitive Level: Knowledge

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 1

Page and Header: 338, Pathophysiology of the Malignant Process

Feedback: The cell membranes are altered in cancer cells, which affect fluid movement in and out of the cell. The cell membrane of malignant cells also contains proteins called tumor-specific antigens. Malignant cellular membranes also contain less fibronectin, a cellular cement. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism). Fragility of chromosomes is commonly found when cancer cells are analyzed.

The staff educator is giving a class on oncology nursing for a group of nurses new to the unit. What is the most common mechanism of metastasis of cancer cells?

A) Hematologic spread

B) Lymphatic circulation

C) Invasion

D) Angiogenisis

Ans: B

Chapter: 16

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 1

Page and Header: 339, Pathophysiology of the Malignant Process

Feedback: Lymph and blood are key mechanisms by which cancer cells spread. Lymphatic spread (the transport of tumor cells through the lymphatic circulation) is the most common mechanism of metastasis.

You are giving a report in your pathophysiology class. The subject of your report is cancer cells. In differentiating between benign and malignant cells, what characteristics would you cite? (Mark all that apply.)

A) Rate of growth

B) Ability to cause death

C) Size of cells

D) Cell contents

E) Ability to spread

Ans: A, B, E

Chapter: 16

Client Needs: D-4

Cognitive Level: Application

Difficulty: Easy

Integrated Process: Teaching/Learning

Objective: 2

Page and Header: 338, Pathophysiology of the Malignant Process

Feedback: Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant; option D is incorrect; cell contents are basically the same but they act differently.

The nursing instructor is discussing benign versus malignant cells in the pathophysiology class. What distinguishes malignant cells from benign cells of the same tissue type?

A) Slow rate of mitosis of cancer cells

B) Proteins in the cell membrane

C) Size of cells

D) Stability of cells

Ans: B

Chapter: 16

Client Needs: D-4

Cognitive Level: Knowledge

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 2

Page and Header: 338, Pathophysiology of the Malignant Process

Feedback: The cell membrane of malignant cells also contains proteins called tumor-specific antigens (eg, carcinoembryonic antigen [CEA] and prostate-specific antigen [PSA]), which develop over time as the cells become less differentiated (mature). These proteins distinguish malignant cells from benign cells of the same tissue type.

Malignant disease processes have the ability to spread from one organ to another throughout the body. What is one means malignant disease processes transfer cells from one place to another?

A) Adhering to primary tumor cells

B) Causing mutation of cells of another organ

C) Phagocytizing healthy cells

D) Invading host tissues

Ans: D

Chapter: 16

Client Needs: D-4

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 2

Page and Header: 339, Pathophysiology of the Malignant Process

Feedback: Invasion, which refers to the growth of the primary tumor into the surrounding host tissues, occurs in several ways. Malignant cells are less likely to adhere than are normal cells. Malignant cells do not cause healthy cells to mutate. Malignant cells do not eat other cells.

You are doing an initial assessment of a patient newly diagnosed with cancer. The patient tells you that he drinks about a quart of scotch every evening. What types of cancer does this put him at risk for? (Mark all that apply.)

A) Pancreatic cancer

B) Brain cancer

C) Breast cancer

D) Esophageal cancer

E) Liver cancer

Ans: C, D, E

Chapter: 16

Client Needs: D-4

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 3

Page and Header: 341, Pathophysiology of the Malignant Process

Feedback: Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods, and red and processed meats. Alcohol increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast.

You are the clinic nurse caring for a patient whose grandmother, mother, and sister all had breast cancer. She has requested a screening test to determine her risk of developing breast cancer, and it has come back positive. The patient asks you what she can do to help prevent breast cancer from occurring. What would be your best response?

A) "Research has shown that eating a healthy diet can reduce your chance of breast cancer."

B) "Research has shown that taking tamoxifen can reduce your chance of breast cancer."

C) "Research has shown that exercising at least 30 minutes every day can reduce your chance of breast cancer."

D) "Research has shown that reducing your intake of red meat can reduce your chance of breast cancer."

Ans: B

Chapter: 16

Client Needs: B

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Teaching/Learning

Objective: 4

Page and Header: 343, Detection and Prevention of Cancer

Feedback: Large-scale breast cancer prevention studies supported by the National Cancer Institute (NCI) indicated that chemoprevention with the medication tamoxifen can reduce the incidence of breast cancer by 50% in women at high risk for breast cancer. Options A, C, and D are good answers, but they are not the best answer.

You are a part of a team of nurses that is developing an educational program entitled Cancer: Its Risks and What You Can Do About It. This program is an example of what?

A) Primary prevention

B) Risk reduction

C) Secondary prevention

D) Tertiary prevention

Ans: C

Chapter: 16

Client Needs: B

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/Learning

Objective: 4

Page and Header: 343, Detection and Prevention of Cancer

Feedback: Nurses in all settings can develop programs that identify risks for patients and families and that incorporate teaching and counseling into all educational efforts, particularly for patients and families with a high incidence of cancer. Primary prevention is concerned with reducing the risks of disease through health promotion strategies. Tertiary prevention is the care and rehabilitation of the patient after having been diagnosed with cancer. Option B is incorrect; the program itself does not reduce the risk of cancer.

What is a minimally invasive surgical approach that is diagnostic for cancer and has, in some instances, replaced lymph node dissections?

A) Lymphadenectomy

B) Needle biopsy

C) Open biopsy

D) Sentinel lymph node biopsy

Ans: D

Chapter: 16

Client Needs: D-4

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Teaching/Learning

Objective: 5

Page and Header: 346, Management of Cancer

Feedback: Sentinel lymph node biopsy (SLNB), also known as sentinel lymph node mapping, is a minimally invasive surgical approach that, in some instances, has replaced more invasive lymph node dissections (lymphadenectomy) and their associated complications such as lymphedema and delayed healing. SLNB has been widely adopted for regional lymph node staging in selected cases of melanoma and breast cancer. Options B and C are incorrect.

You are caring for a patient who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the patient the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer?

A) Palliative

B) Reconstructive

C) Salvage

D) Prophylactic

Ans: A

Chapter: 16

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5

Page and Header: 348, Management of Cancer

Feedback: When cure is not possible, the goals of treatment are to make the patient as comfortable as possible and to promote quality of life as defined by the patient and his or her family. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk to develop cancer.

You are caring for a patient with an advanced stage of breast cancer. The cancer has metastasized. You enter the room and find the patient struggling to breath. You note that this patient's jugular veins are distended. What would you suspect is happening with this patient?

A) Increased intracranial pressure

B) Superior vena cava syndrome (SVCS)

C) Spinal cord compression

D) Metastatic tumor of the neck

Ans: B

Chapter: 16

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 9

Page and Header: 387, Nursing Care of Patients with Cancer

Feedback: Superior vena cava syndrome (SVCS) occurs when there is gradual or sudden impaired venous drainage giving rise to progressive shortness of breath (dyspnea), cough, hoarseness, chest pain, and facial swelling; edema of the neck, arms, hands, and thorax and reported sensation of skin tightness and difficulty swallowing; as well as possibly engorged and distended jugular, temporal, and arm veins. Option A is incorrect; increased intracranial pressure may be a part of SVCS, but it is not what is causing the patient's symptoms. Option C is incorrect; the scenario does not mention a problem with the patient's spinal cord. Option D is incorrect; the scenario says that the cancer has metastasized but not that it has metastasized to the neck.

You are a hospice nurse caring for a patient with cancer in her home. You have explained to the patient and the family that the patient is at risk for hypercalcemia. You have educated them on that signs and symptoms of hypercalcemia. What else would you teach this patient and family to do to reduce the risk of hypercalcemia?

A) Stool softeners are contraindicated.

B) Laxatives should be taken daily.

C) Consume 2 to 4 L of fluid daily.

D) Restrict calcium intake.

Ans: C

Chapter: 16

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Teaching/Learning

Objective: 9

Page and Header: 388, Nursing Care of Patients with Cancer

Feedback: Identify patients at risk for hypercalcemia and assess for signs and symptoms of hypercalcemia. Educate the patient and family; prevention and early detection can prevent fatality. Teach at-risk patients to recognize and report signs and symptoms of hypercalcemia. Encourage patients to consume 2 to 4 L of fluid daily unless contraindicated by existing renal or cardiac disease. Explain the use of dietary and pharmacologic interventions such as stool softeners and laxatives for constipation. Advise patients to maintain nutritional intake without restricting normal calcium intake.

You are caring for an oncology patient at risk for disseminated intravascular coagulation (DIC). What would be the appropriate care for this patient? (Mark all that apply.)

A) Assist patient to turn, cough, and deep breathe

B) Accurate I & O

C) Prevent bleeding

D) Assess hearing disturbances

E) Maximize physical activity

Ans: A, B, C

Chapter: 16

Client Needs: D-3

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Caring

Objective: 11

Page and Header: 389, Nursing Care of Patients with Cancer

Feedback: Nursing care of the patient in DIC: Monitor vital signs. Measure and document intake and output. Assess skin color and temperature; lung, heart, and bowel sounds; level of consciousness; headache; visual disturbances; chest pain; decreased urine output; and abdominal tenderness. Inspect all body orifices, tube-insertion sites, incisions, and bodily excretions for bleeding. Review laboratory test results. Minimize physical activity to decrease injury risks and oxygen requirements. Prevent bleeding; apply pressure to all venipuncture sites, and avoid nonessential invasive procedures; provide electric rather than straight-edged razors; avoid tape on the skin and advise gentle but adequate oral hygiene. Assist the patient to turn, cough, and take deep breaths on a regular schedule. Reorient the patient, if needed; maintain a safe environment; and provide appropriate patient education and supportive measures. Option D is incorrect; hearing disturbances would be important to assess for.

You are a home health nurse caring for an oncology patient discharged home 3 days ago after completing therapy. What would you assess the patient for?

A) Tumor lysis syndrome

B) Syndrome of inappropriate antiduretic hormone

C) Disseminated intravascular coagulation

D) Hypercalcemia

Ans: A

Chapter: 16

Client Needs: D-3

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 11

Page and Header: 390, Nursing Care of Patients with Cancer

Feedback: Nursing care for tumor lysis syndrome: identify at-risk patients, including those in whom tumor lysis syndrome may develop up to 1 week after therapy has been completed. Institute essential preventive measures (eg, fluid hydration and allopurinol). Assess patients for signs and symptoms of electrolyte imbalances. Assess urine pH to confirm alkalization. Monitor serum electrolyte and uric acid levels for evidence of fluid volume overload secondary to aggressive hydration. Instruct patients to report symptoms indicating electrolyte disturbances. Options B, C, and D are incorrect.

You are admitting an oncology patient to your unit prior to surgery. The patient has just finished radiation therapy. What does this put your patient at increased risk for?

A) Nutritional deficit

B) Impaired wound healing

C) Cardiac tamponade

D) Tumor lysis syndrome

Ans: B

Chapter: 16

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 9

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Feedback: Combining other treatment methods, such as radiation and chemotherapy, with surgery also contributes to postoperative complications, such as infection, impaired wound healing, altered pulmonary or renal function, and the development of deep vein thrombosis.

Your patient has just returned from the PACU after salvage surgery for renal carcinoma. What would you assess this patient for?

A) Vasoconstriction

B) Anorexia

C) Wound dehiscence

D) Metastasis to the brain

Ans: C

Chapter: 16

Client Needs: D-3

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 9

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Feedback: Postoperatively, the nurse assesses the patient's responses to the surgery and monitors the patient for possible complications, such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid and electrolyte imbalance, and organ dysfunction. Options A, B, and D are incorrect. Vasoconstriction, anorexia, and metastasis to the brain are all things you would assess for even if your patient had not just returned from salvage surgery.

You have just admitted a new patient to the hospice program you work for. While you are doing the initial assessment, a family member states, "my sister just won't talk to any of us about what is happening to her." What should you do?

A) Strive to facilitate communication between the family and health care providers.

B) Strive to facilitate communication between the patient and health care providers.

C) Strive to facilitate communication between family members and yourself.

D) Strive to facilitate communication among family members.

Ans: D

Chapter: 16

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 10

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Feedback: Hospice programs strive to facilitate clear communication among family members and health care providers.

What is the most important focus of hospice care?

A) Focus of care is on the family as well as the patient.

B) Focus of care is on the patient centrally and the family peripherally.

C) Focus of care is solely on the patient.

D) Focus of care emotionally is totally on the family.

Ans: A

Chapter: 16

Client Needs: D-4

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 10

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Feedback: The focus of hospice care is on the family as well as the patient. Therefore options B, C, and D are incorrect.

You are caring for a 14-year-old female patient with leukemia. She has developed alopecia due to treatment for the leukemia. What would be an expected outcome found on her plan of care?

A) Maintains adequate hydration

B) Interacts and socializes with others

C) Verbalizes positive self-awareness

D) Maintains academic standing in school

Ans: B

Chapter: 16

Client Needs: D-4

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Caring

Objective: 8

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Feedback: Expected outcomes of the nursing diagnosis "impaired tissue integrity: alopecia" identifies alopecia as potential side effect of treatment. Maintains hygiene and grooming. Interacts and socializes with others. Option A is incorrect; the scenario does not indicate the patient is at risk for inadequate hydration. Option C is incorrect; you would want the patient to verbalize a positive self-image, not self-awareness. During treatment for leukemia, it would be nice to maintain academic standing, but it would not be on the care plan at this time.

You are the clinic nurse caring for a patient who was just told he was cancer free at 5 years after diagnosis. The patient has been told he is a cancer survivor. What is cancer survivorship?

A) The period just after being pronounced cancer-free 5 years after being diagnosed

B) The time during which the patient lives with an active diagnosis of cancer

C) A phase of cancer care that comes after primary treatment and lasts until cancer recurrence or the end of life

D) The end of cancer care

Ans: C

Chapter: 16

Client Needs: B

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Teaching/Learning

Objective: 8

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Feedback: Cancer survivorship refers to a distinct phase of cancer care that follows primary treatment for cancer and lasts until cancer recurrence or end of life.

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?

a. "Benign tumors do not cause damage to other tissues."

b. "Benign tumors are likely to recur in the same location."

c. "Malignant tumors may spread to other tissues or organs."

d. "Malignant cells reproduce more rapidly than normal cells."

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.

The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect?

a. Nausea

b. Alopecia

c. Mucositis

d. Hematuria

ANS: D

The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy.

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?

a. Teach the patient about the seven warning signs of cancer.

b. Plan to monitor the patient's carcinoembryonic antigen (CEA) level.

c. Discuss the risks associated with cigarettes during every patient encounter.

d. Teach the patient about the use of annual chest x-rays for lung cancer screening.

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

The nurse should include which food choice when providing dietary teaching for a patient scheduled to receive external beam radiation for abdominal cancer?

a. Fresh fruit salad

b. Roasted chicken

c. Whole wheat toast

d. Cream of potato soup

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.

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?

a. Teach the patient about the need for a colonoscopy at age 50.

b. Teach the patient how to do home testing for fecal occult blood.

c. Obtain more information from the patient about the family history.

d. Schedule a sigmoidoscopy to provide baseline data about the patient.

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.

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?

a. "The cancer involves only the cervix."

b. "The cancer cells look almost like normal cells."

c. "Further testing is needed to determine the spread of the cancer."

d. "It is difficult to determine the original site of the cervical cancer."

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.

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.

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.

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.

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.

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.

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.

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. "I can buy some aloe vera gel to use on the area."

b. "I will expose the treatment area to a sun lamp daily."

c. "I can use ice packs to relieve itching in the treatment area."

d. "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.

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?

a. Have the patient eat large meals when nausea is not present.

b. Offer dry crackers and carbonated fluids during chemotherapy.

c. Administer prescribed antiemetics 1 hour before the treatments.

d. Give the patient two ounces of a citrus fruit beverage during treatments.

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.

The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take?

a. Infuse the medication over a short period of time.

b. Stop the infusion if swelling is observed at the site.

c. Administer the chemotherapy through a small-bore catheter.

d. Hold the medication unless a central venous line is available.

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.

A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to maintain the patient's self-esteem?

a. Tell the patient to 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. Teach the patient to gently wash hair with a mild shampoo to minimize hair loss.

d. Inform the patient that hair usually grows back once the chemotherapy is complete.

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.

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.

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.

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.

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.

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.

Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient?

a. IL-2 enhances the immunologic response to tumor cells.

b. IL-2 stimulates malignant cells in the resting phase to enter mitosis.

c. IL-2 prevents the bone marrow depression caused by chemotherapy.

d. IL-2 protects normal cells from the harmful effects of chemotherapy.

ANS: A

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.

The home health nurse cares for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment?

a. "I have frequent muscle aches and pains."

b. "I rarely have the energy to get out of bed."

c. "I experience chills after I inject the interferon."

d. "I take acetaminophen (Tylenol) every 4 hours."

ANS: B

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 acetaminophen every 4 hours.

A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan?

a. Transplant of the donated cells is painful because of the nerves in the tissue lining the bone.

b. Donor bone marrow cells are transplanted through an incision into the sternum or hip bone.

c. The transplant procedure takes place in a sterile operating room to minimize the risk for infection.

d. Hospitalization will be required for several weeks after the stem cell transplant procedure is performed.

ANS: D

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 or incision required.

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. Lime sherbet

b. Blueberry yogurt

c. Cream cheese bagel

d. Fresh strawberries and bananas

ANS: B

Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Lime sherbet is lower in fat and protein than yogurt. Cream cheese is low in protein.

A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action is most appropriate?

a. Add strained baby meats to foods such as casseroles.

b. Teach the patient about foods that are high in nutrition.

c. Avoid giving the patient foods that are strongly disliked.

d. Add extra spice to enhance the flavor of foods that are served.

ANS: C

The patient will eat more if disliked foods are avoided and foods that the 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. The patient's poor intake is not caused by a lack of information about nutrition

During the teaching session for a patient who has a new diagnosis of acute leukemia the patient is restless and is looking away, never making eye contact. After teaching about the complications associated with chemotherapy, the patient asks the nurse to repeat all of the information. Based on this assessment, which nursing diagnosis is most appropriate for the patient?

a. Risk for ineffective adherence to treatment related to denial of need for chemotherapy

b. Acute confusion related to infiltration of leukemia cells into the central nervous system

c. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis

d. Deficient knowledge: chemotherapy related to a lack of interest in learning about treatment

ANS: C

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.

A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching?

a. The patient ambulates several times a day in the room.

b. The patient's visitors bring in some fresh peaches from home.

c. The patient cleans with a warm washcloth after having a stool.

d. The patient uses soap and shampoo to shower every other day.

ANS: B

Fresh, thinned-skin fruits 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 prevent skin breakdown and infection.

The nurse is caring for a patient who has been diagnosed with stage I cancer of the colon. When assessing the need for psychologic support, which question by the nurse will provide the most information?

a. "How long ago were you diagnosed with this cancer?"

b. "Do you have any concerns about body image changes?"

c. "Can you tell me what has been helpful to you in the past when coping with stressful events?"

d. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?"

ANS: C

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. Because surgical interventions for stage I cancer of the colon may not cause any body image changes, this question is not appropriate at this time

The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider?

a. Generalized muscle aches

b. Complaints of nausea and anorexia

c. Oral temperature of 100.6° F (38.1° C)

d. Crackles heard at the lower scapular border

ANS: D

Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2. The patient may need oxygen and the nurse should rapidly notify the health care provider. The other findings are common side effects of interleukin-2.

The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in therapy with the health care provider?

a. Poor oral intake

b. Frequent loose stools

c. Complaints of nausea and vomiting

d. Increase in carcinoembryonic antigen (CEA)

ANS: D

An increase in CEA indicates that the chemotherapy is not effective for the patient's cancer and may need to be modified. The other patient findings are common adverse effects of chemotherapy. The nurse may need to address these, but they would not necessarily indicate a need for a change in therapy.

The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider?

a. Hematocrit of 30%

b. Platelets of 95,000/µL

c. Hemoglobin of 10 g/L

d. White blood cell (WBC) count of 2700/µL

ANS: D

The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim (Neupogen) are needed. Although the other laboratory data indicate decreased levels, they do not indicate any immediate life-threatening adverse effects of the chemotherapy.

When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene?

a. The UAP assists the patient to use dental floss after eating.

b. The UAP adds baking soda to the patient's saline oral rinses.

c. The UAP puts fluoride toothpaste on the patient's toothbrush.

d. The UAP has the patient rinse after meals with a saline solution.

ANS: A

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.

The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention?

a. The UAP flushes the toilet once after emptying the patient's bedpan.

b. The UAP stands by the patient's bed for 30 minutes talking with the patient.

c. The UAP places the patient's bedding in the laundry container in the hallway.

d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.

ANS: B

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.

The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first?

a. 35-year-old patient who has wet desquamation associated with abdominal radiation

b. 42-year-old patient who is sobbing after receiving a new diagnosis of ovarian cancer

c. 24-year-old patient who received neck radiation and has blood oozing from the neck

d. 56-year-old patient who developed a new pericardial friction rub after chest radiation

ANS: C

Because neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first. The diagnoses and clinical manifestations for the other patients are not immediately life threatening.

Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration?

a. Teach the patient to rest the brain by avoiding new activities.

b. Teach that "chemo-brain" is a short-term effect of chemotherapy.

c. Report patient symptoms immediately to the health care provider.

d. Suggest use of a daily planner and encourage adequate rest and sleep.

ANS: D

Use of tools to enhance memory and concentration such as a daily planner and adequate rest are helpful for patients who develop "chemo-brain" while receiving chemotherapy. Patients should be encouraged to exercise the brain through new activities. Chemo-brain may be short- or long-term. There is no urgent need to report common chemotherapy side effects to the provider.

The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse?

a. Shortness of breath

b. Temperature 100.2° F (37.9° C)

c. Shivering and complaint of chills

d. Generalized muscle aches and pains

ANS: A

Rituximab (Rituxan) is a monoclonal antibody. Shortness of breath should be investigated rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration. The nurse will need to rapidly take actions such as stopping the infusion, assessing the patient further, and notifying the health care provider. The other findings will also require action by the nurse, but are not indicative of life-threatening complications

A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first?

a. Give the patient the prescribed PRN opioid.

b. Assess for sensation and strength in the legs.

c. Notify the health care provider about the symptoms.

d. Teach the patient how to use relaxation to reduce pain.

ANS: B

Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the epidural space. The nurse will need to assess the patient further for symptoms such as decreased leg sensation and strength and then notify the health care provider. Administration of opioids or use of relaxation may be appropriate but only after the nurse has assessed for possible spinal cord compression.

The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider?

a. Hematocrit 32%

b. Pain with deep inspiration

c. Serum sodium 126 mEq/L

d. Decreased breath sounds on left side

ANS: C

Syndrome of inappropriate antidiuretic hormone (and the resulting hyponatremia) is an oncologic metabolic emergency and will require rapid treatment in order to prevent complications such as seizures and coma. The other findings also require intervention, but are common in patients with lung cancer and not immediately life threatening.

An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hour in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider?

a. Patient complains of severe fatigue.

b. Patient needs to void every hour during the day.

c. Patient takes only 50% of meals and refuses snacks.

d. Patient has audible crackles to the midline posterior chest.

ANS: D

Rapid fluid infusions may cause heart failure, especially in older patients. The other findings are common in patients who have cancer and/or are receiving chemotherapy

After change-of-shift report on the oncology unit, which patient should the nurse assess first?

a. Patient who has a platelet count of 82,000/µL after chemotherapy

b. Patient who has xerostomia after receiving head and neck radiation

c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C)

d. Patient who is worried about getting the prescribed long-acting opioid on time

ANS: C

Temperature elevation is an emergency in neutropenic patients because of the risk for rapid progression to severe infections and sepsis. The other patients also require assessments or interventions, but do not need to be assessed as urgently. Patients with thrombocytopenia do not have spontaneous bleeding until the platelets are 20,000/µL. Xerostomia does not require immediate intervention. Although breakthrough pain needs to be addressed rapidly, the patient does not appear to have breakthrough pain.

The nurse at the clinic is interviewing a 64-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)?

a. Pap testing

b. Tobacco use

c. Sunscreen use

d. Mammography

e. Colorectal screening

ANS: A, C, D, E

The patient's age, gender, and history indicate a need for screening and/or teaching about 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.

A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan (select all that apply)?

a. Cook food thoroughly before eating.

b. Choose low fiber, low residue foods.

c. Avoid public transportation such as buses.

d. Use rectal suppositories if needed for constipation.

e. Talk to the oncologist before having any dental work done.

ANS: A, C, E

Eating only cooked food and avoiding public transportation will decrease infection risk. A high-fiber diet is recommended for neutropenic patients to decrease constipation. Because bacteria may enter the circulation during dental work or oral surgery, the patient may need to postpone dental work or take antibiotics.