Chapter 23: Cancer Development Nursing School Test Banks

Chapter 23: Cancer Development

Test Bank

MULTIPLE CHOICE

1. The nurse includes which information about benign tumors when presenting an in-service on cancer?

a.

They can wander far throughout the body.

b.

They are smaller than 2 cm.

c.

They retain a small nuclear-to-cytoplasmic ratio.

d.

They look different from the tissue they arose from.

ANS: C

Benign tumors are made up of normal cells growing in the wrong place or growing when they are not needed. Benign tumors retain the characteristics of normal cells in that they do not migrate in the body, they retain a small nuclear-to-cytoplasmic ratio, and they look similar to the tissue from which they arose. Size is not related to malignancy or to being benign.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 398

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Teaching/Learning

2. In reviewing the pathophysiology of a particular type of cancer, the nurse correlates the generation time for cancer development with which description?

a.

The rate at which cancer cells are able to migrate and metastasize to different sites

b.

How long it takes for a malignant tumor to double in size by mitotic cell divisions

c.

The period of time needed for one cell to divide into two cells by mitosis

d.

The period of time between cell damage and expression of a malignancy

ANS: C

Generation time is defined as the period of time necessary for one cell to complete a round of cell division.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 397

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Analysis)

3. Which biologic characteristic is specific to normal differentiated adult cells but not to cancer cells?

a.

Anaplasia

b.

Hypertrophy

c.

Aneuploidy

d.

Loose adherence

ANS: B

Some normal tissues increase in size by having individual cells get larger, a process called hypertrophy. Cancer cells tend to grow by hyperplasia. The other characteristics are associated with cancer cells.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 397

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Analysis)

4. A client states that his brain tumor is benign and does not need to be removed. What is the nurses best response?

a.

As your tumor grows, it can damage your brain, so it should be removed.

b.

Benign tumors consist of normal cells, so removal is only for cosmetic purposes.

c.

Benign tumors turn into cancer, so they should be removed as soon as possible.

d.

Because benign tumors can migrate, they should be removed before they spread.

ANS: A

Even though benign tumors do not migrate (metastasize) or become cancerous, they can compromise or even destroy surrounding normal tissue. This is particularly a problem when a benign tumor arises in a location that does not expand to accommodate growth, such as in the skull.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

5. Which comment made by a client with breast cancer indicates a need for clarification regarding cancer causes and prevention?

a.

I will eat a low-fat, high-fiber diet from now on.

b.

Probably nothing I did or didnt do caused this cancer.

c.

I hope my daughter doesnt develop breast cancer.

d.

Regular mammograms on my other breast will prevent cancer.

ANS: D

Regular mammography can help detect breast cancer at an early stage, but it does not prevent breast cancer. For the most part, the specific cause of many cancers is unknown. Some associations have been noted with dietary habits. High fat, low fiber, high intake of red meat, and eating food with preservatives and other additives all have been suspected to contribute to carcinogenesis. Breast cancer has familial and hereditary forms.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health and Wellness)

MSC: Integrated Process: Teaching/Learning

6. Malignant cell growth is uncontrolled because of which action?

a.

Cancer cells always divide more rapidly than normal cells.

b.

Mitosis of malignant cells usually produces more than two daughter cells.

c.

Malignant cells bypass one or more phases of the cell cycle during cell division.

d.

Malignant cells enter the cell cycle frequently, making cell division continuous.

ANS: D

Malignant cells have bypassed the normal control mechanisms that restrict entry into the cell cycle, so they re-enter the cell cycle as soon as they finish a round of cell division. Thus, cancer cell division is relentless.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 399

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Analysis)

7. A client has known lung cancer and has been admitted for abdominal pain and jaundice. A computed tomography (CT) scan reveals tumors in the clients liver. The client is distraught and says, So now I have liver cancer too? Which response by the nurse is most appropriate?

a.

Yes, liver cancer is common in people who already have lung cancer.

b.

Yes, your chemotherapy left you vulnerable to a virus that causes liver cancer.

c.

No, the tumors are actually from your lung cancer, which has metastasized.

d.

No, having tumors in two different organs is rare; you probably have hepatitis.

ANS: C

When a cancer metastasizes to another organ, it is still the same cancer from the original spot. This client has lung cancer that has metastasized to the liver.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Communication and Documentation

8. An occupational health nurse is working with management in a firm that provides commercial building restoration, including asbestos removal. Which action does the nurse recommend to management?

a.

Provide annual screening chest x-rays for those exposed to asbestos.

b.

Purchase protective gear and develop policies mandating its use.

c.

Offer stop smoking programs on site several times a year.

d.

Routinely distribute testing kits for occult fecal blood.

ANS: B

Asbestos is a powerful carcinogen. Chronic exposure, even to small amounts of loose asbestos fibers, increases the risk for development of lung cancer. Employees should wear personal protective gear when working with asbestos. Management should provide this gear and should develop policies requiring employees to use it. Stop-smoking programs would not be as beneficial in preventing cancer in this group of people as would limiting asbestos exposure. Routine chest x-rays and fecal occult blood testing will not prevent cancer.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems)

MSC: Integrated Process: Nursing Process (Implementation)

9. The nurse correlates initiation in cancer development with which action?

a.

Inflicting mutations that lead to excessive cell division

b.

Increasing the capacity of the transformed cell for error-free DNA repair

c.

Stimulating contact inhibition in cells damaged by a carcinogen

d.

Making cancer cells appear more normal to escape immune surveillance

ANS: A

The process of initiation induces changes in the genes that allow proto-oncogenes to be activated to oncogene status and to be expressed.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 399

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Analysis)

10. The middle-aged client with lung cancer asks whether his adult children are at increased risk for this cancer. What is the nurses best response?

a.

This disease is a random event and there is no way to prevent it.

b.

This disease is inherited, so your children have a 50% risk for developing it.

c.

Smoking is the main cause. Helping your children not smoke decreases their risk.

d.

They can avoid cancer by decreasing the fat they eat and by exercising more.

ANS: C

Long-term cigarette smoking is the major risk factor for lung cancer. Not smoking is the best way to prevent it.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (High-Risk Behaviors)

MSC: Integrated Process: Teaching/Learning

11. An adult client who has a suspicious mammogram says that her mother died of bone cancer when she was around the same age. Which is the most important question for the nurse to ask this client?

a.

Have any other members of your family had bone cancer?

b.

Did your mother ever have any other type of cancer?

c.

How old were you when you started your periods?

d.

Did your mother have regular mammograms?

ANS: B

Breast cancer often spreads to the bone. Many laypersons do not understand that breast cancer in the bone is still breast cancer. It would be very important to know whether this clients mother had breast cancer because a genetic component is associated with it. Asking about other family members who have had bone cancer may give the nurse useful information but would not be as important as finding out about other cancers. Menstrual cycle and mammogram information also would not provide as relevant information as inquiring about other types of cancer, specifically breast cancer.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Assessment)

12. A client with prostate cancer says that he is now having a lot of pain in his lower back and legs. The nurse educates the client about which intervention?

a.

X-rays of the spine and legs

b.

Administering ibuprofen (Motrin) for pain

c.

Referral to the pain control specialist

d.

Referral to physical therapy

ANS: A

The primary site of metastasis for prostate cancer is the bone of the spine and legs. Pain in these areas in a client with prostate cancer is highly suggestive of cancer progression and metastasis. The client needs x-rays to assess for metastasis.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

13. A middle-aged client is having a physical examination and is worried about cancer risk. Which question is most important for the nurse to ask?

a.

How much time do you spend in the sun?

b.

How many servings of fruits and vegetables do you eat every day?

c.

How often do you eat processed meats like bologna?

d.

Do you smoke cigarettes or have you ever used tobacco products?

ANS: D

Tobacco is related to about 30% of all cancers in North America and is the most important source of preventable carcinogen exposure. The other questions are related to carcinogenesis, but not to the degree that tobacco is.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (High-Risk Behaviors)

MSC: Integrated Process: Nursing Process (Assessment)

14. The nurse is counseling a client who smokes and drinks heavily about cancer risk. The client is adamant that he or she will never stop smoking. Which question by the nurse is most appropriate?

a.

Would you be willing to stop drinking alcohol?

b.

Have you ever tried the nicotine patch?

c.

Why are you so determined to continue smoking?

d.

Do you understand that smoking is the leading cause of cancer?

ANS: A

Both tobacco and alcohol are carcinogenic, but their effects are multiplied when ingested together. Because the client is refusing to stop smoking, the nurse could help him or her reduce cancer risk by not drinking. Although it is not as beneficial as avoiding tobacco, this could at least decrease the risk. The client does not want to stop smoking, so asking about the nicotine patch, the reasons behind continued smoking, and knowledge regarding cancer risk might only serve to make the client more resolved to continue the habit or might make the client angry.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (High-Risk Behaviors)

MSC: Integrated Process: Nursing Process (Assessment)

15. A clients cancer is staged by the TNM classification as T1, N3, M1. What is the nurses interpretation of this classification?

a.

The client has a large tumor involving the lymph nodes, but no distant metastasis.

b.

The client has a tumor, and metastasis cannot be determined by the staging method.

c.

The client has a 2-cm tumor, one involved lymph node, and local metastasis.

d.

The client has a small tumor, many involved lymph nodes, and distant metastasis.

ANS: D

T = primary tumor. T1 indicates that a primary tumor is detectable but still relatively small. N = regional lymph nodes. N3 indicates that several regional lymph nodes are involved. M = distant metastasis. M1 indicates that distant metastasis is evident in at least one site.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests) MSC: Integrated Process: Nursing Process (Analysis)

16. A client says that she has heard that the origin of most cancers is genetic and wants genetic testing because of a family history of cancer. What is the nurses best response?

a.

I will ask your physician about a referral for genetic testing.

b.

Lets look at your family history back to your grandparents generation.

c.

Genetic testing is so expensive; lets talk about reducing your risk instead.

d.

Inherited cancers are much more common in males than in females.

ANS: B

Genetic testing for the risk of developing a few specific cancers is available but is expensive. The nurse should first assess the clients family cancer history by creating a three-generation family tree. If the client actually does have a strong family history of cancers with a genetic component, the nurse can facilitate testing for the client. Teaching the client to reduce risk is always important, but simply telling the client about the expense involved in testing belittles the clients concerns. Genetically related cancers are not more prevalent in men than in women, and again, this response belittles the clients concerns.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

17. In preparing a community teaching program, which information does the nurse plan to present to address secondary cancer prevention?

a.

Receiving cancer treatment with chemotherapy

b.

Annual measurement of prostate-specific antigen levels

c.

Avoiding known cancer-causing substances or conditions

d.

Having adolescent children receive the Gardasil vaccination

ANS: B

Secondary prevention focuses on screening and early diagnosis. Annual prostate-specific antigen (PSA) levels are a screening tool for prostate cancer. Chemotherapy is tertiary prevention (treatment and rehabilitation). Both avoiding carcinogens and receiving the Gardasil vaccination are primary preventions.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Teaching/Learning

18. The nurse correlates the role of suppressor genes in cancer development with which action?

a.

The presence of suppressor genes increases risks for gene damage by carcinogens.

b.

People with a greater number of suppressor genes are at increased risk for getting cancer.

c.

Suppressor genes enhance immune function, suppressing cancer development.

d.

Suppressor genes limit cell division, reducing risks for developing cancer.

ANS: D

Suppressor genes are responsible for ensuring that cell division occurs only when needed. Cancer cells lose this inhibition and re-enter the cell cycle frequently, leading to rapid growth.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 397

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Analysis)

19. The nurse most likely would construct a three-generation pedigree for a client who had a relative treated for which cancer?

a.

Lung cancer

b.

Prostate cancer

c.

Cervical cancer

d.

Bone cancer

ANS: B

Prostate cancer has a sporadic form and a familial form. If a client has relatives diagnosed with prostate cancer, the nurse should assess for a genetic risk because the risk for this cancer can be inherited. The place to start this assessment is with a family tree.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Assessment)

20. The nurse counsels a woman who has a BRCA1 gene that she has what chance for developing breast cancer during her lifetime?

a.

None; this gene has a protective effect

b.

Same as the general population

c.

Lower than the general population

d.

Higher than the general population

ANS: D

BRAC1 is a genetic mutation that increases risk for both breast and ovarian cancer.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 407

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Implementation)

21. The nurse wishes to present a cancer program to a group of people at high risk for cancer. In planning the program, which group does the nurse consider the priority?

a.

Older adults

b.

People who smoke

c.

Clients with family histories of cancer

d.

People with poor immune function

ANS: A

Advancing age is the single most important risk factor for cancer because of age-related decline in immune function and accumulated exposure to carcinogens. All of the people listed are at some increased risk for cancer, but older adults have the highest risk overall.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Aging Process)

MSC: Integrated Process: Nursing Process (Planning)

22. The nurse is planning a cancer education event in an Asian community center. The nurse plans to present information specifically on which types of cancer?

a.

Breast and colorectal

b.

Skin and lymphoma

c.

Liver and stomach

d.

Uterine and ovarian

ANS: A

Asians have higher rates of breast, colorectal, prostate, lung, and stomach cancers than are seen in the general population.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Planning)

23. In preparing a cancer risk reduction pamphlet for African-American clients, it is most important that the nurse include information on prevention and early detection for which types of cancer?

a.

Lung and prostate

b.

Bone and leukemia

c.

Skin and lymphoma

d.

Stomach and esophageal

ANS: A

African Americans have higher incidences of lung, prostate, breast, colorectal, and uterine cancers than are seen in the general population.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Planning)

24. The nurse is seeing clients in a clinic. Which client does the nurse assess further for the development of cancer?

a.

Client with a cough that has lasted for 4 months

b.

Client whose mother died of lung cancer

c.

Client with a 10-pound weight gain

d.

Woman whose last mammogram was 3 years ago

ANS: A

The seven warning signs of cancer include changes in bowel/bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or a lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart/mole, and nagging cough/hoarseness. The other clients do not have warning signs of cancer.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)

MSC: Integrated Process: Nursing Process (Assessment)

25. It is most important that the nurse include which activity for the young adult client with Down syndrome?

a.

Encouraging more fruit and leafy green vegetables in the diet

b.

Teaching him how to perform testicular self-examination

c.

Assessing the skin for unusual bruises and petechiae

d.

Testing the clients stool for occult blood

ANS: C

All screening and prevention activities are appropriate. However, people with Down syndrome have an increased lifetime risk for the development of leukemia.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems)

MSC: Integrated Process: Nursing Process (Implementation)

26. The nurse is interested in primary prevention for cancer. Which activity does the nurse most likely participate in?

a.

Distributing occult fecal blood test kits to people at the shopping mall

b.

Arranging transportation volunteers for clients undergoing radiation therapy

c.

Teaching high school students the dangers of using tobacco

d.

Educating adolescent girls about getting an annual Papanicolaou (PAP) smear

ANS: C

Primary prevention focuses on activities that occur before an illness, such as education and vaccinations. Occult fecal blood testing and PAP smears are secondary prevention activities designed for screening and early diagnosis. Arranging transportation for a client who is undergoing radiation therapy is tertiary prevention.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Health Promotion/Disease Prevention) MSC: Integrated Process: Teaching/Learning

27. The nurse assesses which client most carefully for cancer development?

a.

Young man receiving radiation therapy for a brain tumor

b.

Young adult woman who recently had postpartum hemorrhage

c.

Adolescent male recently diagnosed with acquired immune deficiency syndrome (AIDS)

d.

Older woman undergoing chemotherapy for bowel cancer

ANS: D

Age and immune suppression are two of the greatest risk factors for cancer development. The young man with brain cancer and the adolescent are at increased risk, but their risk is not as great as that of the older woman undergoing chemotherapy for bowel cancer. Postpartum hemorrhage is not related to cancer development.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Analysis)

MULTIPLE RESPONSE

1. A client has colorectal cancer. Which activities are especially important for the nurse to conduct for this client? (Select all that apply.)

a.

Monitor liver function studies.

b.

Maintain accurate intake and output.

c.

Obtain daily weight using the same scale.

d.

Palpate lymph nodes at each clinic visit.

e.

Ask the client about changes in belly size.

ANS: A, D, E

Common sites of metastasis for colorectal cancer include the liver, lymph nodes, and adjacent structures such as the abdominal cavity. Intake and output and daily weights would not provide data related to possible metastases.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

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