Chapter 17: Clients with Cancer Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 17: Clients with Cancer

MULTIPLE CHOICE

1. The nurse is reviewing the American Cancer Society (ACS) recommendations for breast cancer screening with a 50-year-old female client. The nurse should emphasize the recommendation for

a.

breast examination by a health care professional semi-annually.

b.

breast self-examination (BSE) monthly.

c.

chest x-ray study yearly when the client is over age 40.

d.

mammography when a lump is detected.

ANS: A

ACS recommends annual mammography for women 40 years of age and older. ACS also recommends monthly BSE beginning at age 20. Chest x-ray has no value in screening women for breast cancer.

DIF: Application/Applying REF: p. 266 OBJ: Intervention

MSC: Health Promotion and Maintenance Health Screening

2. The recommendation the nurse should share with a 22-year-old sexually active client who is seeking information on the prevention of cervical cancer is that a Pap smear

a.

is needed annually by all women over age 18.

b.

should be done annually until two tests are negative, then once every 2-3 years, in women over 30.

c.

should be done biannually for clients who have been sexually active for 3 years but not later than age 21.

d.

should be performed twice a year for all sexually active women over age 18.

ANS: B

Sexually active women, regardless of age, and those 18 or older should have an annual Pap smear. Women over age 30 can be screened every 2 to 3 years after they have had 2 normal tests in a row.

DIF: Comprehension/Understanding REF: p. 267 OBJ: Intervention

MSC: Health Promotion and Maintenance Health Screening

3. After a client has a series of diagnostic tests, the studies confirm the presence of rectal cancer. The nurses primary intervention should be to

a.

assess the meaning and effect of cancer as perceived by the client.

b.

determine if the client is emotionally ready to deal with the diagnosis of cancer.

c.

reassure the client that many treatment modalities are available.

d.

support the physician when the client is informed of the diagnosis.

ANS: A

Client reactions to cancer vary greatly. The nurse should actively listen for remarks that describe the meaning and effect of cancer as experienced by the client.

DIF: Application/Applying REF: pp. 264, 299-300

OBJ: Intervention MSC: Psychosocial Integrity Coping Mechanisms

4. The nurse caring for a client with cancer of the thyroid gland has a tumor classified as T2, N1, M0. The nurse explains that the T in this classification schema represents

a.

number of years the tumor has been present.

b.

site of the tumor.

c.

size of the tumor.

d.

virulence of malignancy.

ANS: C

The TMN system is the accepted system for cancer staging today; T refers to tumor, N to the regional lymph nodes, and M to metastasis. T1-T4 defines the increasing tumor size and involvement.

DIF: Knowledge/Remembering REF: p. 270

OBJ: Comprehension/Understanding

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

5. A 32-year-old client who has a history of familial polyposis but no manifestations still wants to explore the possibility of preventive surgery. The most appropriate response the nurse can make is

a.

Cancer is not always hereditary, and you should change risk factors in your life.

b.

It is an overreaction to seek radical treatment before you develop symptoms.

c.

Monthly rectal smears may allay your anxiety without surgery.

d.

Subtotal colectomy is a procedure you might seek further information about.

ANS: D

Clients with familial polyposis have a 50% risk of developing colon cancer by age 40. By age 70, all clients with this inherited trait have developed colon cancer. Clients with ulcerative colitis also have an increased risk for colon cancer. Prophylactic subtotal colectomies may be indicated for this group of clients.

DIF: Application/Applying REF: p. 272 OBJ: Intervention

MSC: Health Promotion and Maintenance Disease Prevention

6. Yesterday a 28-year-old client was diagnosed with rectal cancer. The nurse has made the nursing diagnosis of Anxiety Related to Fear of the Unknown, as manifested by anger. The best approach for the nurse to take in relation to the clients need for information is to

a.

offer suggestions to modify the clients expressions of anger.

b.

provide the client with a detailed plan for future interventions.

c.

provide the client with simple explanations of proposed treatments.

d.

specifically discuss the scientific facts related to rectal cancer.

ANS: C

Informational needs are very high during the diagnostic and treatment periods. Tests, procedures, and treatment, which are often very technical and complicated, need to be explained. During this time of anxiety and stress, the simplest explanation is usually the most appropriate and is all that the client can assimilate. But be sure to incorporate all the details the client and family wants.

DIF: Application/Applying REF: p. 300 OBJ: Intervention

MSC: Psychosocial Integrity Coping Mechanisms

7. The nurse is administering medication in phase III trials to a client with lung cancer. Assessments made in this phase of the drug investigation involve

a.

determination of the maximum tolerated dose.

b.

evaluation of the drugs general effectiveness.

c.

explanation of how the drug compares with standard treatments.

d.

description of the type and severity of side effects.

ANS: C

Phase III trials compare the new agent with standard treatments.

DIF: Comprehension/Understanding REF: p. 287 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

8. The client is receiving a drug in a phase I clinical trial. Regarding the type of malignancy for which the client is being treated, the nurse makes the assumption that the cancer

a.

and its treatment are not covered by the clients insurance.

b.

is limited in size and virulence.

c.

is not following the expected disease course.

d.

will not respond to other known treatments for cancer.

ANS: D

Phase I trials may involve significant risks for the subject and only minimal, if any, benefit; they are offered only to those with advanced disease and for whom there are no other known treatment options.

DIF: Comprehension/Understanding REF: p. 286 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

9. The nurse caring for a client who has an implanted radiation source should reduce self-exposure by incorporating the strategy of

a.

limiting the time spent close to the client to 30 minutes per 8-hour shift.

b.

remaining 6 feet away from the client except for essential care.

c.

wearing a lead-shielded apron whenever entering the clients room.

d.

wearing a radiation meter or film badge to measure exposure.

ANS: A

Three key principles for working with radiation are distance, time, and shielding. Nurses should strive to minimize the amount of time they are exposed to a radiation source, although they must still meet the clients care and needs. Exposure time generally should be limited to 30 minutes of direct care per 8-hour shift. Remaining 6 feet away from the client would reduce exposure as compared to standing 3 feet away, but is not the recommended course of action. A lead apron would also reduce exposure, but nurses have found them too cumbersome to use and they are not routinely worn. The radiation meter or film badge does nothing to reduce exposure, but does measure it.

DIF: Application/Applying REF: p. 274 OBJ: Intervention

MSC: Safe, Effective Care Environment Handling Hazardous and Infectious Materials

10. The nursing action that has the highest priority for a 32-year-old client with an implanted radiation source should focus on

a.

assessing the clients reaction to the diagnosis and treatment.

b.

preventing skin problems related to radiation.

c.

promoting regular activity while confined to the room.

d.

safeguarding the client and others from unnecessary radiation exposure.

ANS: D

Sealed-source radioactive implants require a private room and bath because of the risk of implant dislodgment and subsequent exposure of other people to the radiation. Rooms at the ends of halls or stairwells may be designated for use by such clients because their location provides a decreased chance of exposure to others.

DIF: Analysis/Analyzing REF: p. 274 OBJ: Intervention

MSC: Safe, Effective Care Environment Handling Hazardous and Infectious Materials

11. A client is receiving interleukin-2 (IL-2) as part of the therapeutic plan to manage malignant melanoma. The nurse should emphasize the ability of this agent to

a.

increase oxygenation to cells that are not malignant.

b.

physically dissolve the tumor mass.

c.

replace damaged and diseased cells from bone marrow.

d.

strengthen the clients immune response.

ANS: D

Interleukins are proteins that serve as regulators of the immune system. IL-2 is derived from T cells, augments various other T-cell activities, and enhances the function of natural killer cells. Interleukins have none of the other effects.

DIF: Application/Applying REF: p. 285 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

12. The nurse administering granulocyte colony-stimulating factor (G-CSF; Neupogen) to a client who is also receiving chemotherapy should assess the client for

a.

a rash.

b.

bone pain.

c.

fatigue.

d.

muscle aches.

ANS: B

Bone pain is the most commonly reported side effect of G-CSF, although the other options can also occur.

DIF: Application/Applying REF: pp. 284-285 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

13. When there is extravasation of vincristine (Oncovin), the nurse should initially

a.

apply cold compresses to the site.

b.

apply manual pressure to delay further circulation.

c.

call the physician immediately.

d.

leave the cannula in place and aspirate.

ANS: D

In the case of an extravasation, the cannula should be left in place and an attempt made to aspirate the drug from the cannula and site. The nurse should then remove the needle and apply warm compresses. Direct pressure should not be applied to the site. The site is observed for enduration, erythema, necrosis, and pain. The physician should be notified after the nurse has treated the client.

DIF: Application/Applying REF: p. 284 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

14. When the client questions why the chemotherapeutic drug is being administered by intracavitary instillation, the nurse could best answer by explaining that this approach is a

a.

cost-effective and more rapidly-acting method of treatment.

b.

diffuse method of systemic administration that avoids side effects.

c.

means to allow high concentrations of drugs to be directed at the tumor.

d.

non-invasive method of administration.

ANS: C

With the intracavitary method, a high concentration of a chemotherapeutic agent is delivered to the local tumor site.

DIF: Comprehension/Understanding REF: p. 283 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

15. When a client undergoing systemic chemotherapy reaches the nadir of treatment, priority care by the nurse should be directed toward

a.

assisting the client to eat an adequate amount of food to maintain nutrition.

b.

enhancing the effects of chemotherapy by encouraging mild activity.

c.

improving the mental state of the client by using mental imagery.

d.

protecting the client from infection and bleeding.

ANS: B

The time after chemotherapy administration when the white blood cell or platelet count is at the lowest point is referred to as the nadir. For most myelosuppressive agents, the nadir occurs within 7 days after drug administration. Knowledge of blood count nadirs helps to predict when the client is at greatest risk for infection and bleeding.

DIF: Analysis/Analyzing REF: p. 290 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Alteration in Body Systems

16. Before the specially trained nurse gives the prescribed dose of a chemotherapeutic agent, the nurse should

a.

collect an extra syringe and needle in case of contamination.

b.

cover the client with a water-resistant shield.

c.

explain the expected side effects of the drug to the client.

d.

verify dose, drug, and schedule with another nurse.

ANS: D

As a precaution against medication error, the chemotherapeutic drug should be verified by another licensed professional. Chemotherapy should be administered only by adequately prepared registered professional nurses who have taken special courses in administering chemotherapy and who are highly skilled.

DIF: Application/Applying REF: pp. 278, 279 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Error Prevention

17. The nurse can best avoid catheter occlusion in a client with a recently inserted venous access device (VAD) by

a.

administering medications in small volumes.

b.

flushing the catheter per agency protocol.

c.

instructing the client to keep the arm extended during administration.

d.

using the catheter only for vesicant drugs.

ANS: B

Intraluminal occlusion may occur secondary to a blood clot or precipitate. Prevention strategies include proper flushing, vigilance for drug incompatibilities, and adherence to proper drug dilutions. Procedures for the care and maintenance of VADs vary with each clinical setting and type of device.

DIF: Application/Applying REF: p. 282 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

18. The specially prepared nurse administering chemotherapeutic drugs should

a.

administer intravenous medications only through VADs.

b.

apply ice to the area after an intramuscular injection of chemotherapy.

c.

wear a mask during administration of the agent.

d.

wear gloves and a gown during preparation and administration of the drugs.

ANS: D

Several organizations, including the Occupational Safety and Health Administration, National Study Commission on Cytotoxic Exposure, and Oncology Nursing Society, have prepared guidelines for the safe preparation, handling, and disposal of antineoplastics. These guidelines call for the use of gloves and gowns during preparation and administration and the use of a biologic safety cabinet for drug preparation. VADs are not required for chemotherapy, although they are in widespread use. Chemotherapy is not given via the IM route. A mask is not required for administration of chemotherapy.

DIF: Application/Applying REF: p. 284 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Handling Hazardous and Infectious Materials

19. The nurse should closely assess a client undergoing chemotherapy for a tumor that is responding to the therapy for any indication of tumor lysis syndrome, which is marked by

a.

hypercalcemia.

b.

hyperkalemia.

c.

increase in antidiuretic hormone (ADH).

d.

platelet count below 20,000/mm3.

ANS: B

Cellular death of the tumor caused by the chemotherapy releases potassium, causing hyperkalemia.Cellular death of the tumor caused by the chemotherapy releases potassium, causing hyperkalemia.

DIF: Analysis/Analyzing REF: p. 296 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Alteration in Body Systems

20. The nurse has assigned the nursing diagnosis Imbalanced Nutrition: Less than Body Requirements, Related to Anorexia for a client with colon cancer. Nursing goals include the maintenance of present body weight. To achieve this goal, the nurse should suggest a diet that is high in

a.

calories and low in cholesterol.

b.

fat and calories.

c.

fat and low in bulk.

d.

protein and calories.

ANS: D

Adequate hydration and a high-protein, high-calorie diet are vital to the recovery of normal cells from the adverse effects of chemotherapy.

DIF: Application/Applying REF: p. 292 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Alteration in Body Systems

21. The nurse caring for a neutropenic, 75-year-old man undergoing treatment for prostate cancer assesses an oral temperature of 100.4 F. The most appropriate interpretation of this finding is that the client

a.

is experiencing an expected, systemic chemotherapeutic effect.

b.

is experiencing the expected increase in metabolism that accompanies malignancy.

c.

may have a medical emergency and needs prompt further assessment.

d.

may have a urinary tract infection causing a low-grade fever.

ANS: C

Fever is the cardinal, and often the only, manifestation of infection in the neutropenic client. The development of fever in a neutropenic client should be treated as a medical emergency and mandates prompt assessment, diagnosis, and intervention. The source could be a urinary tract infection, but the client needs a work-up to determine the source of any infection (e.g., blood cultures, a chest x-ray, and a urinalysis).

DIF: Analysis/Analyzing REF: pp. 290-291 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Alteration in Body Systems

22. The nurse caring for a client receiving chemotherapy assesses for indication of thrombocytopenia. Based on laboratory values, the client becomes at high risk for hemorrhage at the point when the platelet count is less than

a.

60,000/mm3.

b.

50,000/mm3.

c.

25,000/mm3.

d.

20,000/mm3.

ANS: D

Thrombocytopenia increases a clients risk of bleeding. A high risk of hemorrhage exists when the platelet count is less than 20,000/mm3.

DIF: Comprehension/Understanding REF: p. 291 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Alteration in Body Systems

23. A client undergoing a course of chemotherapy feels lonely and isolated and tells the nurse he wants to resume some normal activities. The precaution that the nurse should give the client when resuming activities is

a.

avoid crowds.

b.

do not eat outside the home.

c.

drink only bottled water.

d.

use only the clients own bathroom.

ANS: A

The nurse should teach chemotherapy clients measures to protect against infection: maintain adequate nutrition and fluid intake and avoid crowds, people with infections, and clients recently vaccinated with live or attenuated vaccines. The other three options are not standard precautions for the client receiving chemotherapy.

DIF: Application/Applying REF: p. 291 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Alteration in Body Systems

24. The nurse is developing a long-term plan for a 45-year-old client with a malignancy. The factor that would disqualify this client from receiving hospice services is

a.

a life expectancy of less than 6 months.

b.

an annual income of more than $30,000.

c.

initiation of a course of curative chemotherapy.

d.

living alone in an apartment complex.

ANS: C

To qualify for hospice services, clients must have a life expectancy of less than 6 months and must be receiving only supportive treatment.

DIF: Application/Applying REF: p. 301 OBJ: Assessment

MSC: Psychosocial Integrity End of Life Care

25. A 31-year-old male client who is to receive chemotherapy for treatment of lymphoma has expressed concern about the possible side effects of chemotherapy on reproduction and fertility. An appropriate response by the nurse to these concerns is to

a.

discuss pretreatment sperm banking as a reproductive alternative.

b.

reassure the client that sexual function will return to normal after treatments.

c.

review sexual functioning and discuss the previous pregnancy.

d.

suggest artificial insemination for the clients wife.

ANS: A

Pretreatment sperm banking offers the possibility of retaining reproductive capacity for some clients. Surgery, XRT, and chemotherapy can affect sexual health and functioning, so option b is not appropriate. The client has not indicated a need for information on basic sexual functioning, and a discussion of a previous pregnancy would not be helpful, so option c would not be beneficial. Artificial insemination might be an option if the client is sterile, but the nurse does not have that information.

DIF: Application/Applying REF: p. 295 OBJ: Intervention

MSC: Health Promotion Family Planning

26. The nurse assesses that the client most at risk for breast cancer is the

a.

26-year-old multipara whose father died from lung cancer.

b.

38-year-old primigravida who had menarche at age 9.

c.

42-year-old multipara who had menarche at age 14.

d.

68-year-old nullipara receiving treatment for osteoporosis.

ANS: B

Women especially at risk for breast cancer had early menarche and late menopause, are nulliparous, and have a first-degree relative with breast cancer.

DIF: Comprehension/Understanding REF: p. 266 OBJ: Assessment

MSC: Health Promotion and Maintenance Health Screening

27. The client whose father and uncle died of colorectal cancer asks the nurse how to modify a diet to reduce the risk of this cancer. The nurse can suggest

a.

decreasing consumption of alcohol.

b.

decreasing consumption of unrefined whole-grain products.

c.

increasing consumption of organ meats.

d.

increasing consumption of vitamin A.

ANS: A

Alcohol consumption and a sedentary lifestyle are contributing risk factors for colorectal cancer. Diet modification includes a high-fiber, low-fat diet and increased intake of vitamins C and E.

DIF: Comprehension/Understanding REF: pp. 266-267 OBJ: Intervention

MSC: Health Promotion and Maintenance Lifestyle Choices

28. A client with an advanced stage laryngeal cancer with widespread metastases is scheduled for surgery tomorrow morning. The nurse realizes that preoperative teaching has been effective when the client states

a.

After the operation, how soon will I know if they got it all?

b.

I will be glad to have this tumor removed so I can breathe better.

c.

My family cant wait for this to be over so we can travel to Europe.

d.

So what is the cure rate for this kind of cancer?

ANS: B

Surgery can be used for diagnosis, cure, palliation, reconstruction, or prevention of cancer. In this case, with an advanced cancer and widespread metastases, the client is probably undergoing surgery for palliation of symptoms, specifically airway obstruction.

DIF: Evaluation/Evaluating REF: p. 272 OBJ: Evaluation

MSC: Physiological Integrity Physiological Adaptation-Illness Management

29. A client with prostate cancer calls the clinic to ask for a physical therapy (PT) consult because his back has been hurting. Which action by the nurse is most appropriate?

a.

Advise the client to try a heating pad for 3 days before initiating a PT consult.

b.

Call in a prescription for nonsteroidal anti-inflammatory medications.

c.

Collaborate with the physician to arrange the physical therapy consult.

d.

Instruct the client to come in for a back x-ray immediately.

ANS: D

In a client with known cancer, new-onset back pain is a red flag signaling possible spinal cord compression. If not treated, this can lead to permanent neurologic damage, including paralysis. This client needs immediate evaluation to rule out this oncologic emergency.

DIF: Analysis/Analyzing REF: p. 297 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures/Health Alteration

MULTIPLE RESPONSE

1. A client has the nursing diagnosis Hopelessness, related to concern over cancer diagnosis. The nurse can encourage hope in this client by (Select all that apply)

a.

affirming the clients worth as a human.

b.

assisting with goal setting.

c.

providing symptom relief as needed by the client.

d.

reviewing mortality statistics for this type of cancer.

ANS: A, B, C

According to research, nurses need to inspire and support clients positivity and hope while they undergo treatment for cancer. Options a, b, and c have all been shown to be valuable nursing interventions to support hope in the cancer client. Option d might reduce hope if the statistics were not favorable.

DIF: Application/Applying REF: p. 288 OBJ: Intervention

MSC: Psychosocial Integrity Coping Mechanisms

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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