Deck 25: The Patient With Cancer

Question 1

The nurse assesses the patient taking doxorubicin (Adriamycin)very carefully when the patient complains of:

A) Nausea
B) Visual disturbances
C) Headache and dizziness
D) Rapid heartbeat

Answer 1

Rapid heartbeat

Question 2

The nurse closely monitors for hypercalcemia,an oncologic emergency that is manifested by:

A) Hypertension and bradycardia
B) Fatigue, confusion, and weakness
C) Laboratory test results of potassium 3.5 mEq/L, sodium 143 mEq/L
D) Urine output less than 30 ml/hr.

Answer 2

Fatigue, confusion, and weakness

Question 3

The statement that best defines concepts to be included in a teaching plan for a patient with cancer is:

A) Cancer is a group of diseases. The cancer cells are different from the cells in the tissue of its origin in both the growth and spreading of abnormal cells.
B) Cancer is the third leading cause of death in the United States. Many hospitals have the highest number of patients with this diagnosis.
C) Americans who have a diagnosis of cancer die within 1 year or less.
D) When a person is genetically predisposed to a type of cancer, nothing that can be done to prevent its occurrence.

Answer 3

Cancer is a group of diseases. The cancer cells are different from the cells in the tissue of its origin in both the growth and spreading of abnormal cells.

Question 4

A patient whose cancer has been staged at T4 N2 M2 has been assigned for care.What is the best interpretation of this staging information in planning care for this patient?

A) The primary tumor has shrunk, although some lymph nodes remain involved. Teach the patient that this is good news.
B) The primary tumor has now responded to a combination of chemotherapy and radiation. The patient should now receive much less analgesic medication.
C) The primary tumor is quite large and has extended to lymph glands and distant areas. Gentle touch and therapeutic listening will be especially helpful.
D) After the series of radiation treatments, the distant metastases are still present. Prepare the patient to accept only the cure of the primary tumor.

Question 5

The nurse explains that drugs such as cannabinoids,Benadryl,and Vistaril are frequently ordered for patients with cancer who are taking chemotherapy to help:

A) Promote amnesia to dampen the fear.
B) Maintain fluid retention to prevent dehydration.
C) Control nausea, vomiting, and taste disorders caused by the therapy.
D) Control bouts of diarrhea or uncomfortable constipation.

Question 6

The nurse explains that the seven warning signs of cancer written by the American Cancer Society (ACS)can be recalled by the acronym CAUTION.The nurse points out that the A in the acronym stands for:

A) A sore that will not heal
B) Alopecia
C) Abscess
D) Anorexia

Question 7

The complaint the nurse should consider as a warning sign for cancer would be:

A) Intense pain in an area such as a hip or groin after carrying several gallons of paint up a ladder and painting the garage.
B) Persistent indigestion associated with difficulty swallowing.
C) Diarrhea that lasts 2 days after an all-day picnic at the beach.
D) A painful lump under the umbilicus that recedes when pushed, but comes out again with a sneeze or hard cough.

Question 8

The family is concerned about the possibility of addiction as a result of the frequent doses of Roxanol.The nurse's best response is:

A) "At this stage, addiction is the least of our worries."
B) "This is a low-dose drug, and it controls pain without the problems of addiction."
C) "Addiction is rare, but we have drugs that can counteract the effect of this narcotic."
D) "You may want to share your concerns with the physician. He can order another drug that is not addictive."

Question 9

The nurse includes in the teaching plan that malignant tumors are similar to benign tumors because both:

A) Contain cells that closely resemble those in the tissue of origin.
B) Travel quickly to invade and destroy other tissues and organs.
C) Always grow and multiply very rapidly, competing for space and nutrients and causing severe pain.
D) May press on nearby surrounding tissues, such as nerves and blood vessels, causing pain.

Question 10

When the patient with newly diagnosed with cancer says,"I feel like I've lost my future.I feel so much harm has been done to me that I'm overwhelmed," the nurse recognizes that this attitude will most likely lead the patient to coping strategies that are:

A) Avoidant
B) Problem solving
C) Approach oriented
D) Confrontational

Question 11

The nurse assesses beginning acceptance of the diagnosis of cancer when the patient:

A) Begins to act in a cheerful manner.
B) Inquires about support groups.
C) Cries over loss of health.
D) Actively interacts with his or her family.

Question 12

The home health nurse is compiling a patient profile on a 23-year-old obese woman who smokes one-half pack of cigarettes a day and indulges in 1 beer a week.She works as a cook in a long-term care facility.She has two children and eats a diet high in fats.She exercises 30 minutes a day.Both parents are dead of heart disease.The number of risks for cancer in this profile that the nurse should assess are:

A) 2
B) 3
C) 5
D) 6

Question 13

While bathing a patient with cancer,the nurse assessed several large new bruises on the patient's upper arms and thighs.An understanding of the possible causes and the correct nurse's actions for these findings are that:

A) The patient must have fallen last night walking to the bathroom. Teach the patient to use the call bell when assistance is needed.
B) The patient may have disseminated intravascular coagulation. The size, shape, location, color, and tenderness must be reported and recorded fully.
C) An intravascular fluid overload is occurring because of the chemotherapy. Place the patient on strict input/output (I/O) status and limit fluids.
D) The patient must have had a drug-induced seizure, which caused arm and leg thrashing and the bruises. Report and record the findings, and pad the side rails.

Question 14

The nurse cautions that the most common site of cancer in adult men is the:

A) Colon
B) Lung
C) Pancreas
D) Prostate

Question 15

A patient is scheduled for a chemotherapy treatment in approximately 30 minutes.Breakfast trays have arrived and are being served on the unit.The nurse's best intervention would be to:

A) Encourage the patient to eat all his breakfast to keep up his strength to fight the cancer. Remind the patient that breakfast is about one third of his daily intake.
B) Listen attentively to any concerns that the patient expresses regarding the treatment. Offer to hold his tray until after the treatment.
C) Offer to call the family to come and be present after the treatment. Encourage the patient to drink at least all of the orange juice and coffee.
D) Suggest that the patient request a dose of strong analgesic instead of eating, because this treatment is very painful.

Question 16

A female college student has had a melanoma of the forehead surgically removed and given a course of chemotherapy.The comment that demonstrates her understanding of the treatments and prognosis is:

A) "Why did you bring me this shampoo? You guys took all my hair, so I don't have anything to wash or fix."
B) "Why don't my friends from school come to visit? Did you tell them to stay away?"
C) "My spring dance is only 3 weeks away. Do you think I could find a wig to cover my head where the hair fell out from the chemo?"
D) "Well, this looks like the end of the problem for me, thank goodness! I won't have to bother that doctor again until I graduate in a couple of years because all my shots must be up to date now."

Question 17

The nurse counsels that the most common site of cancer in adult women is the:

A) Breast
B) Lung
C) Kidney
D) Uterus

Question 18

The nurse uses a diagram to show the progress of a normal cell being transformed to a malignant cell.The latent period before the period of rapid growth of tumors is the phase of:

A) Initiation
B) Promotion
C) Progression
D) Metastasis

Question 19

A patient has a cancer that has been TNM staged as T3 (1-4: size of primary tumor),N2 (0-3: degree of spread to regional lymph nodes),and M2 (0-1: presence of metastasis).He has a as needed (PRN)order of 4 mg morphine,intramuscularly (IM)every 3 to 4 hours.He requests another pain shot approximately hours after the last one.An appropriate nursing action would be to:

A) Inform the patient that this narcotic may be given only every 4 hours to prevent addiction.
B) Ignore the call bell for 20 minutes, and then take at least 10 minutes to prepare and administer the injection.
C) Give the morphine, and evaluate the results of pain relief. Arrange for the physician to evaluate for breakthrough pain.
D) Ask the family to assist in helping the patient accept waiting longer to receive an addicting medication such as morphine.

Question 20

When a diagnosis of breast cancer is first made at stage T1 N0 M0,the nursing diagnosis that would be appropriate is:

A) "Risk for disturbed body image, related to threats of anticipated changes."
B) "Risk of anxiety, related to outcome of treatments."
C) "Risk for infection, related to decreased white blood cell count."
D) "Risk for ineffective coping, related to husband's expectations regarding anticipated treatments."

Question 21

The nurse explains that adjuvant therapy is given to patients with cancer who are free of signs of the disease to:

A) Ensure eradication of undetected cells.
B) Stabilize normal cells.
C) Diminish recurrence of breast cancer.
D) Reduce the extent of the tumor before surgery or radiation.
E) Change the pH of the system to inhibit cell growth.

Question 22

The nurse evaluates the precolonoscopy instruction as effective when the patient says:

A) "I know that the lighted tube he will use will help the doctor look at my tumor and he might take a small piece of tissue to look at in the lab."
B) "I know that the light on the tube will help cure my cancer."
C) "I know the colonoscopy is very painful and embarrassing, and I hope no one sees me in that position."
D) "My daughter is coming in to see me today. I am glad to be looking forward to something pleasant."

Question 23

The nurse reassures the patient that the surgical remedy for cancer is very successful if:

A) Cancer is detected early.
B) The tumors are fast growing.
C) Cancer cells have invaded only a non-vital structure.
D) Lymph glands have not been involved.
E) Cancer cells are confined to only two areas.

Question 24

The nurse cautions a group of middle-aged persons that conditions that promote the formation of malignant cells are:

A) Childbearing
B) Increasing age
C) Hormonal changes
D) Chronic irritation of tissue
E) Diet

Question 25

The nurse clarifies that radiation has an immediate effect on cells,which is cell death by:

A) Separating the cell from normal cells
B) Damaging the cell membrane
C) Altering the DNA of the cell
D) Reducing the nutrition of the cell

Question 26

When the nurse sees that an intravenous (IV)vesicant cancer drug has extravasated,the nurse should:

A) Place a warm compress on the area.
B) Chill the area with an ice pack.
C) Raise the patient's arm above the level of the heart.
D) Stop the infusion.
E) Notify the charge nurse.

Question 27

The nurse clarifies that cells that change from their tissues of origin and have multiple nuclei are categorized as ____________________.

Question 28

The nurse reminds a visitor to a patient who has an internal radiation implant to:

A) Avoid visitation if you are pregnant.
B) Take off all metals, such as your watch and belt.
C) Limit your visitation time.
D) Wear a protective lead apron.
E) Stay at least 6 feet away from bedside.

Question 29

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

Question 30

List the tumors in order based on the following tissue of origin: TISSUE:
1)FAT
2)FIBROUS
3)SMOOTH MUSCLE
4)GLANDS
5)BONE

A) Sarcoma
B) Lipoma
C) Leiomyoma
D) Fibroma
E) Carcinoma

Question 31

A patient is close to death with terminal liver cancer with widespread metastases and calls the nursing staff to his room every 5 minutes.The interventions that will be most supportive and in the best interest of the patient are to:

A) Encourage and insist that the family request a transfer to hospice care, because the general hospital does not have enough staff members to keep responding to the patient's end-stage frequent calling and requests for minor help.
B) Use fixed interval and cocktail medication administration. Frequently evaluate for breakthrough pain and anxieties. Answer the call bell quickly on the intercom or in person.
C) Tell the family that as of this afternoon, all the patient's questions, comments, and expressed fears of dying and financial worries will be referred to the social worker, physician, or clergy. Otherwise, one of them can come in and sit beside the bed.
D) Plan to limit strictly the time spent with the patient, because the nurse cannot do much that could be beneficial at this point.

Question 32

The best menu choice for a patient with nausea who is undergoing radiation treatments every other day is:

A) Bowl of vegetable soup, chopped egg and pickle sandwich on wheat bread, one apple, and 8 ounces of orange juice.
B) Broiled chicken with rice, 1-ounce slice of plain American cheese; one-quarter cup of spinach; one-half ripe banana; and 8 ounces of grape juice.
C) Spanish rice, one-half cup of mixed green salad, one-half cup of canned peaches, and 8 ounces of Coke.
D) Spaghetti with tomato sauce, cheddar cheese toast strips, six celery sticks with peanut butter, and 8 ounces of whole milk.

Question 33

The nurse explains that the most common cytologic test,usually performed in outpatient settings,that suggests the probability of a need for further testing for cancer cells is a:

A) Chest x-ray
B) Koch test
C) Papanicolaou (Pap) test
D) Tine test