Cancer

Question 1

When providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy, what would be most beneficial to teach the patient to use?
a) Firm-bristle toothbrush
b) Hydrogen peroxide rinse
c) Alcohol-based mouthwash
d) 1 tsp salt in 1 L water mouth rinse

Answer 1

d
A salt-water mouth rinse will not cause further irritation to oral tissue that is fragile because of mucositis, which is a side effect of chemotherapy.
a-A soft-bristletoothbrush will be used.
b,c-Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.

Question 1

A patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis?
a) “The cancer is found at the point of origin only.”
b) “Tumor cells have been identified in the cervical region.”
c) “The cancer has been identified in the cervix and the liver.”
d) “Your cancer was identified in the cervix and has limited local spread.”

Answer 1

d
Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ or at the point of origin only; stage I denotes tumor limited to the tissue of origin with localized tumor growth.Stage III denotes extensive local and regional spread. Stage IV denotes metastasis such as to the liver.

Question 2

The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient?
a) The medications the patient is taking
b) The nutritional supplements that will help the patient
c) How much time is needed to provide the patient’s care
d) The time the nurse spends at what distance from the patient

Answer 2

d
Time, distance, and shielding are essential to maintain the nurse’s safety
The patient’s medications, nutritional supplements, and time needed to complete care will not protect the nurse caring for a patient with brachytherapy for cervical cancer.

Question 3

Previous administrations of chemotherapy agents to a patient with cancer have resulted in diarrhea. Which dietary modification should the nurse recommend?
a) A bland, low-fiber diet
b) A high-protein, high-calorie diet
c) A diet high in fresh fruits and vegetables
d) A diet emphasizing whole and organic foods

Answer 3

a
Patients with diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.

Question 4

A patient with breast cancer is having teletherapy radiation treatments after surgery. What should the nurse teach the patient about skin care?
a) Use Dial soap to feel clean and fresh.
b) Scented lotion can be used on the area.
c) Avoid heat and cold to the treatment area.
d) Wear the new bra to comfort and support the area.

Answer 4

c
Avoiding heat and cold in the treatment area will protect it.
Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage.
The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.

Question 5

The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer?
a) Body mass index of 35 kg/m2 and smoking cigarettes for 20 years
b) Family history of colorectal cancer and consumes a high-fiber diet
c) Limits fat consumption and has regular mammography and Pap screenings
d) Exercises five times every week and does not consume alcoholic beverages

Answer 5

a
Cancer prevention and early detection are associated with the following behaviors: limited alcohol use, regular physical activity, maintaining a normal body weight, obtaining regular cancer screenings, avoiding cigarette smoking,using sunscreen with SPF 15 or higher, and practicing healthy dietary habits

Question 6

Which problem is of most concern for a patient with myelosuppression secondary to chemotherapy for cancer treatment?
a) Acute pain
b) Hypothermia
c) Powerlessness
d) Risk for infection

Answer 6

d
Myelosuppression is accompanied by a high risk of infection and sepsis.
Hypothermia, powerlessness, and acute pain are also possible when patients undergo chemotherapy, but the threat of infection is paramount.
myelosuppression also called marrow suppression, is a decrease in bone marrow activity that results in reduced production of blood cells.

Question 7

The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient’s vital signs are normal, but the patient says he still has pain in his leg, and it is getting worse. Which question would best determine treatment measures for the patient’s pain?
a) “Where is the pain?”
“b) Is the pain getting worse?”
c) “What does the pain feel like?”
d) “Do you use medications to relieve the pain?”

Answer 7

c
The UAP told the nurse the location of the patient’s pain and the patient reports worsening of pain (pattern).
Asking about the quality of the pain will help in planning further treatment.
The nurse should already know if the patient is using medication to relieve the pain or can check the patient’s medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.

Question 8

Which patient is statistically and medically at the highest risk of developing cancer?
a) A 68-yr-old white woman who has BRCA-1 gene and is obese
b) A 56-yr-old black man with hepatitis C who drinks alcohol daily
c) An 18-yr-old Hispanic man who eats fast food once per week and drinks alcohol
d) An 80-yr-old Asian woman with coronary artery disease on blood pressure medication.

Answer 8

b
The combination of statistically identified risk factors in addition to current liver disease (hepatitis C that is linked to the development of liver cancer) and the added promotor of alcohol makes this patient at the highest risk.
Second is the white woman with the gene for breast cancer and the added promotor of obesity.
Most cancer cases are diagnosed in people older than 55 years of age. The overall incidence of cancer is higher in men than women. Cancer incidence is higher in blacks, then whites, and then people from other cultures.

Question 9

The nurse is caring for an 18-yr-old patient with acute lymphocytic leukemia who is scheduled for hematopoietic stem cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure?
a) “I understand the transplant procedure has no dangerous side effects.”
b) “After the transplant, I will feel better and can go home in 5 to 7 days.”
c) “My brother will be a 100% match for the cells used during the transplant.”
d) “Before the transplant, I will have chemotherapy and possibly full-body radiation.”

Answer 9

d
Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.

Question 10

The nurse is caring for a patient with anorexia secondary to chemotherapy. Which strategy would be most appropriate to increase the patient’s nutritional intake?
a) Increase intake of liquids at mealtime to stimulate the appetite.
b) Serve three large meals per day plus snacks between each meal.
c) Avoid the use of liquid protein supplements to encourage eating at mealtimes.
d) Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

Answer 10

d
The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (e.g., peanut butter, skim milk powder, cheese, honey, brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.

Question 11

Patients may reduce the risk of developing cancer using health promotion strategies. Identify modifiable strategies which can reduce the risk of developing cancer. (Select all that apply.)
a) Stop smoking
b) Use sunscreen
c) Limit alcohol use
d) Undergo genetic testing
e) Maintain a healthy weight
f) Receive appropriate immunizations

Answer 11

a,b,c,e,f
Changing a person’s lifestyle can limit cancer promotors, which is key in cancer prevention. Immunizations such as human papilloma virus (HPV) can prevent cervical cancer. Use of sunscreen (SPF 15 or greater) can prevent cell damage and development of skin cancer. Smoking can initiate or promote cancer development. Alcohol use combined with smoking can promote esophageal and bladder cancers. Management of weight can reduce the risk of cancer. Genetic testing (i.e., APC gene) identifies the predisposition to some cancers but is not modifiable.

Question 12

The patient is receiving immunotherapy and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications?
a) Morphine sulfate
b) Ibuprofen (Advil)
c) Ondansetron (Zofran)
d) Acetaminophen (Tylenol)

Answer 12

d
Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic but is not used first to combat flu-like symptoms such as headache, fever, chills, and myalgias.

Question 13

The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery?
a) It is delivered via an Ommaya reservoir and extension catheter.
b) It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours.
c) A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration.
d) The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

Answer 13

c
Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump.

Question 14

A patient who is receiving radiation to the head and neck as treatment for an invasive cancer reports mouth sores and pain. Which intervention should the nurse add to the plan of care?
a) Provide ice chips to soothe the irritation.
b) Weigh the patient every month to monitor for weight loss.
c) Cleanse the mouth every 2 to 4 hours with hydrogen peroxide.
d) Provide high-protein and high-calorie, soft foods every 2 hours.

Answer 14

d
A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories to aid healing. Extremes of temperature are to be avoided. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Patients should be weighed at least twice each week to monitor for weight loss.

Question 15

A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider?
a) Weight gain of 6 lb
b) Nausea and vomiting
c) Urine specific gravity of 1.004
d) Serum sodium level of 118 mEq/L

Answer 15

d
Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. The other options listed are also symptoms of hyponatremia but are not as critical to report to the health care provider.

Question 16

When caring for the patient with cancer, what does the nurse understand is the response of the immune system to antigens of the malignant cells?
a) Metastasis
b) Tumor angiogenesis
c) Immunologic escape
d) Immunologic surveillance

Answer 16

d
Immunologic surveillance is the process in which lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells’ evasion of immunologic surveillance that allows the cancer cells to reproduce.

Question 17

A female patient is having chemotherapy for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient?
a) “When your hair grows back, it will be patchy.”
b) “Use your curling iron since that will slow down the loss.”
c) “You can get a wig now to match your hair so you will not look different.”
d) “You should contact “Look Good, Feel Better” to figure out what to do about this.”

Answer 17

c
The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. Although hair loss with chemotherapy is usually reversible, hair loss with radiation is usually permanent in the areas radiation was administered. When hair grows back, it could be a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss but will not answer the patient’s concern. The American Cancer Society’s “Look Good, Feel Better” program will be helpful, but this response is avoiding the patient’s immediate concern.

Question 18

The laboratory reports that the cells from the patient’s tumor biopsy are grade II. What should the nurse know about this histologic grading?
a) Cells are abnormal and moderately differentiated.
b) Cells are very abnormal and poorly differentiated.
c) Cells are immature, primitive, and undifferentiated.
d) Cells differ slightly from normal cells and are well-differentiated.

Answer 18

a
Grade II cells are more abnormal than grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.

Question 19

A patient has been diagnosed with Burkitt’s lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient?
a) Bacteria
b) Sun exposure
c) Most chemicals
d) Epstein-Barr virus

Answer 19

d
Burkitt’s lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. Bacteria do not initiate cancer. Sun exposure causes cell alterations leading to melanoma and squamous and basal cell skin carcinoma. Long-term exposure to certain chemicals (e.g., ethylene oxide, chloroform, benzene) is known to initiate cancer.

Question 20

The nurse assesses a patient with chronic myeloid leukemia receiving chemotherapy using a kinase inhibitor medication. Which question is most important for the nurse to ask?
a) “Have you had a fever?”
b) “Have you lost any weight?”
c) “Has diarrhea been a problem?”
d) “Have you noticed any hair loss?”

Answer 20

a
An adverse effect of kinase inhibitors is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in patients with cancer. Patients should report a temperature of 100.4° F or higher. The other options are possible while undergoing chemotherapy but do not represent the highest priority for assessment.

Question 21

The patient is told that an adenoma tumor is not encapsulated but has normally differentiated cells and surgery will be needed. The patient asks the nurse what this means. What should the nurse’s response be to the patient?
a) It will recur.
b) It has metastasized.
c) It is probably benign.
d) It is probably malignant.

Answer 21

c
Benign tumors are usually encapsulated, have normally differentiated cells, and do not metastasize. Malignant tumors are rarely encapsulated, have poorly differentiated cells, and are capable of metastasis.
Benign tumors
those that stay in their primary location without invading other sites of the body. They do not spread to local structures or to distant parts of the body.
Metastasis.
pread to other sites in the body by metastasis.

Question 22

During the promotion stage of cancer development, which statement by the nurse most facilitates patient cancer prevention?
a) “Exercise every day for 30 minutes.”
b) “Follow smoking cessation recommendations.”
c) “Following a vitamin regime is highly recommended.”
d) “I recommend excision of the cancer as soon as possible.”

Answer 22

b
The promotion stage of cancer is characterized by the reversible proliferation of the altered cellsChanging the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Cigarette smoking is a promoting factor and a carcinogen.
Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be consistent with the nurse’s role.

Question 23

The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation? (SATA)
a) Maintain hope.
b) Exhibit a caring attitude.
c) Plan realistic long-term goals.
d) Give them antianxiety medications.
e) Be available to listen to fears and concerns.
f) Teach them about the type of cancers that could be diagnosed.

Answer 23

a,b,e
Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.

Question 24

The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first?
a) Ask the patient if the site hurts.
b) Turn off the chemotherapy infusion.
c) Call the ordering health care provider.
d) Administer sterile saline to the reddened area.

Answer 24

b
Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation, the infusion should first be stopped. The site of extravasation usually hurts, but it may not. It is more important to stop the infusion immediately. The health care provider may be notified by another nurse while the patient’s nurse starts the drug-specific extravasation procedures, which may or may not include sterile saline.

Question 25

A nurse is teaching a pt about screening prevention for cancer. Which of the following statements by the pt indicates an understanding?
a) I will need to have mamo every 2 years begining at age 45
b) I shuld have a colonoscopy evry 15 years begining at age 60
c) I will need to have an annual breast examination every year after 40
d) I should have a feacal occult test done every 3 years

Answer 25

c
a- annual mamo biging age 40
b-age 50 and every 10 years
d-every year

Question 26

A nurse is collecting info from a pt in an office. Which of the following findings should the nurse identify as an indication of possible cancer? SATA
a) Temp 102 for more than 48hr
b) Sore that does not heal
c) Difficulty swallowing
d) Unusual discharge

Answer 26

b,c,d,

Question 27

A nurse is planning care for a pt who has a platelet count of 10,000. Which of the following interventions should the nurse include?
a) apply prolonged pressure to the puncture site after blood sampling
b) administer epoetin alfa as prescribed
c) Place the pt in a private room
d) have the pt use an oral topical anesthetic before meals

Answer 27

a
epoetin alfa for anmia

Question 28

A nurse is caring for a pt who is receving chemo and has mucositis. Which of the following actions should the nruse take?
a) Use glycerin-soaked swab to clean pt’e teeth
b) Encourage incerased intake of citurus fruits juicies
c) obtain a culture of the lesion
d) Provide an alcohol based mouthwash for oral haygine

Answer 28

c

Question 29

A nurse is caring for a pt who is undergoing chemo and reports severe nausea. Which of the following statements should the nurse make?
a) your nausea will lessen with each course of chemo
b) hot food is better tolerated due to the aroma
c) try eating several sma;; meals throughout the day
d) increase your intake of red meat as tolerated

Answer 29

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Question 30

A nurse is caring for a pt who has cervical cancer and is scheduled for brachytherapy. Which of the following actions should the nurse take? SATA
a) Permanent visitors to stay with the pt 30 min at a time
b) warn pregnant individuals to visit the room only once a day
c) Wear a dosimeter when in the pt’s room
d) place soiled dressing in a biohazard bag before discharging in the regular trash
e) dispose soiled lines in the hamper outside the pt’s room

Answer 30

a,b,c