Chapter 64
1. You are obtaining histories and physicals on several clients in the outpatient clinic. As an
RN, one of your roles is to provide appropriate disease prevention education for clients.
Which of the following clients do you assess as most in need of cancer prevention education?
1. A 44-year-old African American woman who is overweight, whose mother had breast
cancer at age 50, who smokes 1 to 2 cigarettes per day, and who drinks 3 cups of coffee daily.
2. A 35-year-old Caucasian male who is overweight, has a family history of heart disease, and
is a vegetarian.
3. A 65-year-old women who is within normal body weight, exercises five times a week, eats
a variety of vegetables and fruits, eats red meat once a month, and does not smoke.
4. A 47-year-old Hispanic female, who has a mother and father with history of type II
diabetes and an aunt with breast cancer, is overweight by 30 lbs, walks three times weekly
with her mother, eats canned fruits and vegetables, and is a nonsmoker.
Answer: A 44-year-old African American woman who is overweight, whose mother had
breast cancer at age 50, who smokes 1 to 2 cigarettes per day, and who drinks 3 cups of
coffee daily.
Rationale:
The client who needs the most education is the one with the most risk factors. The 44-yearold African American smokes cigarettes, which is the most deadly carcinogen, is overweight
(approximately 20% of all cancer deaths are attributed to nutrition), and her mother had
breast cancer. Therefore, there is a genetic predisposition for the development of breast
cancer. The 35-year-old is at greater risk for heart disease than cancer. The 65-year-old has no
risk factors other than age. The 47-year-old has two risk factors, the genetic predisposition
and being overweight.
2. The nurse is assisting a client newly diagnosed with leukemia with discharge from the
hospital. The client asks what the health care provider means when she discuses survival rates
for his kind of leukemia. The nurse explains that survival is the:
1. Number of persons with leukemia and the likelihood of their dying over several time
periods.
2. Measurement of all cancer cases at a designated point in time.
3. Number of deaths from leukemia in a specific period.
4. Number of newly diagnosed cases of cancer.
Answer: Number of persons with leukemia and the likelihood of their dying over several time
periods.
Rationale:
Survival is the observation of persons with cancer over time and the likelihood of their dying
over several time periods. Mortality is the number of deaths from cancer in a specific period
of time and within an identified population. Prevalence is the measurement of all cancer cases
at a designated point in time. The number is divided by the total population living at the time.
Incidence is the number of newly diagnosed cases of cancer in a specific time period in a
defined population.
3. The nurse is caring for a 58-year-old male who has just been diagnosed with colon cancer.
The health care provider explains to the client that the cancer is a stage 2. The nurse knows
the client understands what the health care provider said when she states:
1. “I am glad it was caught at this stage; hopefully the treatment will work.”
2. “I guess I won’t see another Christmas.”
3. “I think the doctor is mistaken.”
4. “I guess I have had this cancer for a long time, and it has grown extensively throughout my
body.”
Answer: “I am glad it was caught at this stage, hopefully the treatment will work.”
Rationale:
Staging is the portion of the classification system that describes the extent of the tumor and
evidence of metastasis throughout the body. There are four stages of cancer spread. Stage 2
means the lesion is still localized with deep growth into adjacent structures. Cancers in stage
2 are not as extensive as stages 3 and 4. Therefore, there is hope of a cure with treatment. The
statement about “not seeing another Christmas” would be incorrect, as there is a chance of a
cure with treatment. The statement about “the doctor is mistaken” is denial and unrealistic.
The statement “I guess I have had this cancer for a long time and it has grown extensively
through out my body” would be associated with stage 4, not stage 2.
4. The difference between a benign and a malignant tumor is that malignant tumors:
1. May recur after treatment, may occur in other tissues, and have an irregular shape.
2. Rarely recur after treatment, remain localized, and have a regular shape.
3. May recur after treatment, are well differentiated, and have an irregular shape.
4. Rarely recur after treatment, stay localized, and have moderate irregularity.
Answer: May recur after treatment, may occur in other tissues, and have an irregular shape.
Rationale:
Benign tumors are usually slow growing, are expansive, are localized or encapsulated, have a
fibrous capsule, rarely recur after removal, are usually regular in shape, are well
differentiated, and have slight vascularity. Malignant tumors may proliferate rapidly or grow
slowly, have infiltrative patterns, metastasize throughout the body and invade nearby tissue,
have no enclosing capsule, may recur even after treatment, have an irregular shape with a
poorly defined border, are poorly differentiated, and have moderate to significant vascularity.
5. You are teaching a group of children about what can cause cancer. You understand that
cancer tumor development can be caused by:
Select all that apply.
1. Chemical factors.
2. Biologic factors.
3. Environmental factors.
4. Psychological factors.
5. Vascular factors.
Answer: 1. Chemical factors.
2. Biologic factors.
3. Environmental factors.
Rationale:
Chemical factors. Tobacco and asbestos are examples of chemical factors. Biologic factors.
Biologic factors include inherited alterations in the genes, such as the BRCA1 and BRCA2
(short for breast cancer 1 and breast cancer 2), which are associated with hereditary breast
and ovarian cancer. Environmental factors. Examples of environmental factors that are
associated with cancer include the sun and radon. Psychological factors. Psychological
factors do not specifically cause cancer. Vascular factors. Vascular factors impact blood
vessels and blood flow. They do not cause cancer.
6. Serosal seeding of a tumor can be due to:
Select all that apply.
1. Embolization of tumor cells.
2. Surgical instrumentation.
3. Biopsies.
4. Tumor palpation.
5. Exercise.
Answer: 1. Embolization of tumor cells.
2. Surgical instrumentation.
3. Biopsies.
Rationale:
Embolization of tumor cells. Serosal seeding is a mechanism by which tumor cells
demonstrate direct spreading; it occurs after malignant cells invade local tissues and infiltrate
body cavities. Surgical instrumentation. Serosal seeding is a mechanism by which tumor cells
demonstrate direct spreading. Surgical instrumentation has been shown to participate in the
direct spread of cancerous cells by the contamination of normal cells during surgical
procedures. Biopsies. Serosal seeding is a mechanism by which tumor cells demonstrate
direct spreading. Biopsies can cause serosal seeding as needles are withdrawn, thereby
seeding malignant cells. Tumor palpation. Serosal seeding is a mechanism by which tumor
cells demonstrate direct spreading. Palpation of tumors is not a cause of serosal seeding.
Exercise. Serosal seeding is a mechanism by which tumor cells demonstrate direct spreading.
Exercise is not a cause of serosal seeding.
7. You are caring for a client who has just been told his prostate cancer has reoccurred. He
asks you where prostate cancer usually spreads. You inform him that the most common sites
include:
Select all that apply.
1. Bone.
2. Lung.
3. Liver.
4. Bowel.
5. Kidney.
6. Lymph nodes.
Answer: 1. Bone.
2. Lung.
3. Liver.
4. Bowel.
5. Kidney.
6. Lymph nodes.
Rationale:
Bone. Bones are among the most common sites for prostate cancer metastasis to occur. Lung.
Lungs are among the most common sites for prostate cancer metastasis to occur. Liver. The
liver is among the most common sites for prostate cancer metastasis to occur. Bowel. The
bowel is among the most common sites for prostate cancer metastasis to occur. Kidney. The
kidney is among the most common sites for prostate cancer metastasis to occur. Lymph
nodes. Lymph nodes are among the most common sites for prostate cancer metastasis to
occur.
8. A nurse is teaching a group of high school students about risk factors for the development
of cancer. The nurse explains that alcohol is the leading etiologic factor in developing cancer
of the oral cavity, larynx, and esophagus. The nurse goes on to explain that when alcohol is
combined with ___________, it increases the chances even more.
1. Tobacco
2. Spicy foods
3. Sweet foods
4. Soda
Answer: Tobacco
Rationale:
When combined with tobacco use, alcohol is the leading etiologic factor in developing
squamous cell carcinoma of the oral cavity, larynx, and esophagus. It is quite possible alcohol
may behave like a co-carcinogen or have a synergistic effect with tobacco. Tobacco is the
most deadly carcinogen. Therefore, combining alcohol and tobacco significantly increases the
risk for the development of cancer. Soda or sweet and spicy foods do not have a similar effect
when combined with use of alcohol.
9. Which types of cancers are responsive to hormones?
Select all that apply.
1. Brain
2. Breast
3. Endometrium
4. Prostate
5. Bone
Answer: 1. Brain
2. Breast
3. Endometrium
4. Prostate
Rationale:
Brain. Cancer of the brain occurs in target tissues, or those that are hormone responsive.
Hormones have not been proven to have a direct carcinogenic effect. Rather, they support
carcinogenesis by preparing target tissues so they are ripe for the carcinogen insult, by
permitting the carcinogenesis to continue, or by modifying the growth of an established
tumor. The duration in which tissue has been exposed to a hormone may influence
carcinogenesis. Breast. Cancer of the breast occurs in target tissues, or those that are hormone
responsive. Hormones have not been proven to have a direct carcinogenic effect. Rather, they
support carcinogenesis by preparing target tissues so they are ripe for the carcinogen insult,
by permitting the carcinogenesis to continue, or by modifying the growth of an established
tumor. The duration in which tissue has been exposed to a hormone may influence
carcinogenesis. Endometrium. Cancer of the endometrium occurs in target tissues, or those
that are hormone responsive. Hormones have not been proven to have a direct carcinogenic
effect. Rather, they support carcinogenesis by preparing target tissues so they are ripe for the
carcinogen insult, by permitting the carcinogenesis to continue, or by modifying the growth
of an established tumor. The duration in which tissue has been exposed to a hormone may
influence carcinogenesis. Prostate. Cancer of the prostate occurs in target tissues, or those
that are hormone responsive. Hormones have not been proven to have a direct carcinogenic
effect. Rather, they support carcinogenesis by preparing target tissues so they are ripe for the
carcinogen insult, by permitting the carcinogenesis to continue, or by modifying the growth
of an established tumor. The duration in which tissue has been exposed to a hormone may
influence carcinogenesis. Bone. Bone cancer is not responsive to hormones.
10. The nurse is caring for a 72-year-old female with head and neck cancer who had surgery 2
weeks ago to remove the tumor. She is scheduled to begin external beam radiation therapy 1
week after discharge from the hospital. When discussing the radiation treatment, the nurse
understands that it is important to stress:
Select all that apply.
1. Getting lots of rest.
2. Meticulous skin care.
3. Protecting the scalp from alopecia.
4. Monitoring blood pressure.
5. Monitoring weight gain.
Answer: 1. Getting lots of rest.
2. Meticulous skin care.
Rationale:
Getting lots of rest. Many patients who receive radiotherapy experience fatigue. The exact
causative mechanism is unknown, although it is thought to be due to the result of tumor
breakdown, which releases by-products into the bloodstream. Fatigue typically begins during
the third or fourth week of treatment and will gradually wane once the treatment is over.
Meticulous skin care. One side effect experienced by most radiation therapy patients is skin
changes. Skin reactions may occur within 2 weeks of beginning treatment. Erythema may be
noted to range from mild, light pink to deep and dusky red. Meticulous skin care is necessary
in order to prevent a skin infection. These patients need education focused on maintaining
good hygiene and when to alert their health care provider for signs of skin infection.
Protecting the scalp from alopecia. There is not anything that can be done to protect the scalp
from alopecia. Monitoring blood pressure. There are no specific blood pressure changes
associated with radiation. Monitoring weight gain. Weight gain is not a problem for radiation
clients. Loss of appetite followed by weight loss is a common occurrence with radiation.
11. You are the RN giving discharge instructions to your client who has metastatic lung
cancer and mucositis. You know the client understands the instructions when she says:
1. “I will use half-strength normal saline rinses at least three times per day until my mouth
sores heal.”
2. “I will swab my mouth with mouthwash every 4 hours to reduce the sores.”
3. “I will refrain from brushing and flossing my teeth until the sores heal.”
4. “I will rinse my mouth with full-strength peroxide every hour until the sores heal.”
Answer: “I will use half-strength normal saline rinses at least three times per day until my
mouth sores heal.”
Rationale:
It is beneficial to rinse with half-strength normal saline because it has a cleansing effect,
while not irritating the sores. It would irritate the mouth sores to swab over them, especially if
the swab contained an irritating solution. Refraining from brushing and flossing the teeth
would increase the chance of infection and tooth decay. Full-strength peroxide would be
irritating to the sores and painful for the client.
12. While developing the care plan for a 41-year-old female who has just had a mastectomy
for breast cancer, the nurse knows the nursing diagnoses for this client includes:
Select all that apply.
1. Infection, Risk for.
2. Body Image, Disturbed.
3. Perfusion, Risk for Impaired Renal.
4. Gas Exchange, Impaired.
5. Hope, Readiness for Enhanced.
Answer: 1. Infection, Risk for.
2. Body Image, Disturbed.
Rationale:
Infection, Risk for. Cancer causes bone marrow depression, which results in an altered
immune response. Body Image, Disturbed. A mastectomy is a disfiguring surgery, resulting in
an altered body image. Perfusion, Risk for Impaired Renal. There is nothing in the question to
suggest that this patient has altered renal perfusion. Altered renal perfusion is more associated
with kidney disease and heart failure. Gas Exchange, Impaired. There is nothing in the
question to suggest that this patient has inadequate gas exchange. Impaired gas exchange is
more associated with lung disease. Hope, Readiness for Enhanced. There is nothing in the
question about this client’s feelings of hope or hopelessness.
13. The nurse who is teaching a 57-year-old male client who has gastric cancer about the side
effects of chemotherapy understands that it is important to stress that:
Select all that apply.
1. Side effects can occur anywhere in the gastrointestinal track.
2. Chemotherapy can cause alopecia.
3. Few to no side effects typically occur.
4. Chemotherapy can cause an increased absolute neutrophil count (ANC).
5. Chemotherapy is very painful.
Answer: 1. Side effects can occur anywhere in the gastrointestinal track.
2. Chemotherapy can cause alopecia.
Rationale:
Side effects can occur anywhere in the gastrointestinal track. This is a true statement. Some
of the most common side effects of chemotherapy are nausea and vomiting. Chemotherapy
can cause alopecia. Alopecia, although temporary, is a common side effect of chemotherapy.
Few to no side effects typically occur. This is not a true statement and therefore is misleading.
There are many side effects associated with chemotherapy. Chemotherapy can cause an
increased absolute neutrophil count (ANC). The ANC decreases with chemotherapy.
Chemotherapy is very painful. Chemotherapy is not typically painful. It is the side effects,
such as nausea and vomiting, that are painful.
14 A client's family member asks the nurse which type of gift would be appropriate for a
client who has an absolute neutrophil count (ANC) of 600. The nurse would suggest:
1. Flavored bottled water.
2. A fresh fruit basket.
3. Long-stemmed roses.
4. A cool mist humidifier.
Answer: Flavored bottled water.
Rationale:
An ANC of 600 is low. Therefore, this client is immunocompromised. Flowers, fresh fruit,
and humidifiers harbor organisms that would increase the risk for an opportunistic infection.
Flavored water has been processed, and therefore would be less likely to have contaminates
that would infect this client.
15. The RN is caring for a client receiving chemotherapy for breast cancer. The client states
that he has a sore mouth, nausea and vomiting, and anorexia. Which of the following reflects
appropriate client teaching by the nurse?
1. "These are the expected side effects of your chemotherapy, and the health care provider has
already ordered some medications that will help."
2. "You may be allergic to the chemotherapy; I will place a call to the health care provider."
3. "You may be developing the flu, and I can give you an antinausea medication."
4. "These are symptoms of your cancer, and more frequent oral care will help."
Answer: "These are the expected side effects of your chemotherapy, and the health care
provider has already ordered some medications that will help."
Rationale:
A sore mouth, nausea and vomiting, and anorexia are common side effects of cancer.
Typically, health care providers write orders for medications and treatments for these clinical
manifestations. These clinical manifestations are not an indication that the client is allergic to
the chemotherapy, and therefore that would be an incorrect answer. These symptoms do
mimic the flu, but they are more than likely from the chemotherapy. These are not typical
cancer symptoms.
16. What is the most prevalent symptom in clients with cancer?
1. Fatigue
2. Hair loss
3. Anorexia
4. Nausea
Answer: Fatigue
Rationale:
Fatigue is reported as the most prevalent symptom in patients afflicted with cancer. Hair loss
is dependent on the type of cancer treatment; it is not universally experienced by everyone.
Nausea and anorexia, or loss of appetite, can be due to the cancer or the prescribed treatment;
it is not universally experienced by cancer clients.
17. The nurse is caring for a 78-year-old male with Hodgkin’s disease who has received both
chemotherapy and radiation. He was admitted to the hospital to evaluate an unexplained
increasing fatigue and inability to care for himself. Nursing responsibilities include:
Select all that apply.
1. Monitoring hemoglobin and hematocrit.
2. Spacing activities to allow for periods of rest.
3. Obtaining a nutrition consult.
4. Mobilizing the client every hour.
5. Limiting oral intake.
Answer: 1. Monitoring hemoglobin and hematocrit.
2. Spacing activities to allow for periods of rest.
3. Obtaining a nutrition consult.
Rationale:
Monitoring hemoglobin and hematocrit. Both cancer and cancer treatments cause bone
marrow suppression, which decreases the hemoglobin and hematocrit. Therefore it is
essential to monitor these values, in order to determine when replacement treatment is
necessary. Spacing activities to allow for periods of rest. Cancer and cancer treatment can
both cause fatigue. Clustering patient care activities together will allow for prolonged periods
of rest for patients who are experiencing fatigue. Obtaining a nutrition consult. Since
anorexia is such a common problem with cancer clients, having a nutrition consult would be
advantageous. Mobilizing the client every hour. Since fatigue is a factor with cancer clients,
mobilizing the client every hour would be contraindicated. Limiting oral intake. There is no
reason to limit oral intake with this client.
18. A 56-year-old female is being admitted for complications related to chemotherapy for
metastatic breast cancer. The client is thrombocytopenic. What nursing precautions are
essential for this client?
Select all that apply.
1. Use soft oral swabs
2. Avoid injections
3. Use electric razors
4. Avoid rectal suppositories
5. Placed in a private room
Answer: 1. Use soft oral swabs
2. Avoid injections
3. Use electric razors
4. Avoid rectal suppositories
Rationale:
Use soft oral swabs. Soft swabs will help prevent bleeding gums. Avoid injections. Avoiding
injections will help prevent bleeding from shaving. Use electric razors. Electric razors are
safer when there is an increased risk for bleeding. Avoid rectal suppositories. Rectal
suppositories increase the risk for rectal bleeding and should be avoided. Placed in a private
room. It is not necessary to place a client who is at risk for bleeding in a private room.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
