MS2 - Exam 4 - Cancer Questions Flashcards Preview

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Flashcards in MS2 - Exam 4 - Cancer Questions Deck (120):
1

The nurse receives an order for a patient with lung cancer to receive influenza vaccine and pneumococcal vaccines. The nurse will
a. call the health care provider to question the order.
b. administer both vaccines at the same time in different arms.
c. administer the flu shot and tell the patient to come back 1 week later to receive the pneumococcal vaccine.
d. administer the pneumococcal vaccine and suggest FluMist (nasal vaccine) instead of the influenza injection.

b. administer both vaccines at the same time in different arms.

Rationale: Patients at risk for pneumonia (e.g., patients with lung cancer) should obtain influenza and pneumococcal vaccines. The vaccines may be administered at the same time in different arms.

2

During admission of a patient diagnosed with non–small cell lung carcinoma, the nurse questions the patient related to a history of which risk factors for this type of cancer (select all that apply)?
a. Asbestos exposure
b. Exposure to uranium
c. Chronic interstitial fibrosis
d. History of cigarette smoking
e. Geographic area in which he was born

a. Asbestos exposure
b. Exposure to uranium
d. History of cigarette smoking

Non–small cell carcinoma is associated with cigarette smoking and exposure to environmental carcinogens, including asbestos and uranium. Chronic interstitial fibrosis is associated with the development of adenocarcinoma of the lung. Exposure to cancer-causing substances in the geographic area where the patient has lived for some time may be a risk, but not necessarily where the patient was born.

3

When planning appropriate nursing interventions for a patient with metastatic lung cancer and a 60-pack-per-year history of cigarette smoking, the nurse recognizes that the smoking has most likely decreased the patient's underlying respiratory defenses because of impairment of
a. cough reflex.
b. mucociliary clearance.
c. reflex bronchoconstriction.
d. ability to filter particles from the air.

b. mucociliary clearance.

Smoking decreases the ciliary action in the tracheobronchial tree, resulting in impaired clearance of respiratory secretions and particles, chronic cough, and frequent respiratory infections.

4

While ambulating a patient with metastatic lung cancer, the nurse observes a drop in oxygen saturation from 93% to 86%. Which nursing intervention is most appropriate based upon these findings?
a. Continue with ambulation since this is a normal response to activity.
b. Obtain a physician's order for arterial blood gas determinations to verify the oxygen saturation.
c. Obtain a physician's order for supplemental oxygen to be used during ambulation and other activity.
d. Move the oximetry probe from the finger to the earlobe for more accurate monitoring during activity.

c. Obtain a physician's order for supplemental oxygen to be used during ambulation and other activity.

An oxygen saturation level that drops below 90% with activity indicates that the patient is not tolerating the exercise and needs to use supplemental oxygen. The patient will need to rest to resaturate. ABGs or moving the probe will not be needed as the pulse oximeter was working at the beginning of the walk.

5

Trends in the incidence and death rates of cancer include the fact that
a. lung cancer is the most common type of cancer in men.
b. a higher percentage of women than men have lung cancer.
c. breast cancer is the leading cause of cancer deaths in women.
d. African Americans have a higher death rate from cancer than whites.

d. African Americans have a higher death rate from cancer than whites.

Rationale: Cancer incidence and death rates are disproportionately higher among African Americans than among other minority groups and white people.

6

What features of cancer cells distinguish them from normal cells (select all that apply)?
a. Cells lack contact inhibition.
b. Cells return to a previous undifferentiated state.
c. Oncogenes maintain normal cell expression.
d. Proliferation occurs when there is a need for more cells.
e. New proteins characteristic of embryonic stage emerge on cell membrane.

a. Cells lack contact inhibition.
b. Cells return to a previous undifferentiated state.
e. New proteins characteristic of embryonic stage emerge on cell membrane.

Rationale: Two major dysfunctions in the process of cancer are defective cell proliferation (i.e., growth) and defective cell differentiation. Cancer cells lack contact inhibition and are poorly differentiated. Cancer cell growth is infiltrative and expansive, and cancer cells are abnormal and become more unlike parent cells.

7

A characteristic of the stage of progression in the development of cancer is
a. oncogenic viral transformation of target cells.
b. a reversible steady growth facilitated by carcinogens.
c. a period of latency before clinical detection of cancer.
d. proliferation of cancer cells in spite of host control mechanisms.

d. proliferation of cancer cells in spite of host control mechanisms.

Rationale: Progression is the final stage of cancer. This stage is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (i.e., metastasis). Progression occurs as a result of the following characteristics of cancer cells: rapid proliferation and decreased cell adhesion.

8

The primary protective role of the immune system related to malignant cells is
a. surveillance for cells with tumor-associated antigens.
b. binding with free antigen released by malignant cells.
c. production of blocking factors that immobilize cancer cells.
d. responding to a new set of antigenic determinants on cancer cells.

a. surveillance for cells with tumor-associated antigens.

Rationale: Cancer cells may display altered cell surface antigens as a result of malignant transformation. These antigens are called tumor-associated antigens (TAAs). One of the functions of the immune system is to respond to TAAs.

9

The primary difference between benign and malignant neoplasms is the
a. rate of cell proliferation.
b. site of malignant tumor.
c. requirements for cell nutrients.
d. characteristic of tissue invasiveness.

d. characteristic of tissue invasiveness.

Rationale: The ability of malignant cells to invade and metastasize is the major difference between benign and malignant neoplasms. Other differences between benign and malignant neoplasms are presented in Table 16-3.

10

The nurse is caring for a 59-year-old woman who had surgery 1 day ago for removal of a suspected malignant abdominal mass.
The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to
a. motivate change in an unhealthy lifestyle.
b. teach her about the seven warning signs of cancer.
c. instruct her about healthy stress relief and coping practices.
d. allow her to communicate about the meaning of this experience.

d. allow her to communicate about the meaning of this experience.

Rationale: While the patient is waiting for diagnostic study results, you should be available to actively listen to the patient’s concerns, and you should be skilled in techniques that can engage the patient and the family members or significant others in a discussion about their cancer-related fears.

11

The goals of cancer treatment are based on the principle that
a. surgery is the single most effective treatment for cancer.
b. initial treatment is always directed toward cure of the cancer.
c. a combination of treatment modalities is effective for controlling many cancers.
d. although cancer cure is rare, quality of life can be increased with treatment modalities.

c. a combination of treatment modalities is effective for controlling many cancers.

Rationale: The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the particular cancer being treated and may involve local therapies (i.e., surgery or irradiation) alone or in combination, with or without periods of adjunctive systemic therapy (i.e., chemotherapy).

12

The most effective method of administering a chemotherapy agent that is a vesicant is to
a. give it orally.
b. give it intraarterially.
c. use an Ommaya reservoir.
d. use a central venous access device.

d. use a central venous access device.

Rationale: If vesicants are inadvertently infiltrated into the skin, severe local tissue breakdown and necrosis may result. It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs. The infusion should be immediately turned off, and protocols for drug-specific extravasation procedures should be followed to minimize further tissue damage. Infusion with central venous access devices can reduce the risk of infiltration of chemotherapy agents that are vesicants.

13

The nurse explains to a patient undergoing brachytherapy of the cervix that she
a. must undergo simulation to locate the treatment area.
b. requires the use of radioactive precautions during nursing care.
c. may experience desquamation of the skin on the abdomen and upper legs.
d. requires shielding of the ovaries during treatment to prevent ovarian damage.

b. requires the use of radioactive precautions during nursing care.

Rationale: Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or adjacent to the tumor. Caring for the person undergoing brachytherapy or receiving radiopharmaceuticals requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, and shielding are vital to health care professional safety in caring for the person with an internal radiation source.

14

A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9 × 103/μL, hemoglobin of 10.8 g/dL, and a platelet count of 99 × 103/μL. Based on the CBC results, what is the most serious clinical finding?
a. Cough, rhinitis, and sore throat
b. Fatigue, nausea, and skin redness at site of radiation
c. Temperature of 101.9° F, fatigue, and shortness of breath
d. Skin redness at site of radiation, headache, and constipation

c. Temperature of 101.9° F, fatigue, and shortness of breath

Rationale: Neutropenia is more common in patients receiving chemotherapy than in those receiving radiation, and it can seriously increase the risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly because fever in the setting of neutropenia is a medical emergency.

15

To prevent fever and shivering during an infusion of rituximab (Rituxan), the nurse should premedicate the patient with
a. aspirin.
b. acetaminophen.
c. sodium bicarbonate.
d. meperidine (Demerol).

b. acetaminophen.

Rationale: Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is commonly premedicated with acetaminophen in an attempt to prevent or decrease the intensity of these symptoms, and large amounts of fluids help decrease symptoms.

16

The nurse counsels the patient receiving radiation therapy or chemotherapy that
a. effective birth control methods should be used for the rest of the patient’s life.
b. if nausea and vomiting occur during treatment, the treatment plan will be modified.
c. after successful treatment, a return to the person’s previous functional level can be expected.
d. the cycle of fatigue-depression-fatigue that may occur during treatment can be reduced by restricting activity.

c. after successful treatment, a return to the person’s previous functional level can be expected.

Rationale: Some cancer survivors may continue to experience symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. A cancer diagnosis can affect many aspects of a patients’ life; cancer survivors commonly report financial, vocational, marital, and emotional concerns long after treatment is over. Resources for survivors are listed in Table 16-20.

17

A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing intervention would be a priority?
a. Advise the patient to eat foods that are fatty, fried, or high in calories.
b. Discuss with the physician the need for parenteral or enteral feedings.
c. Advise the patient to drink a nutritional supplement beverage at least three times a day.
d. Advise the patient to experiment with spices and seasonings to enhance the flavor of food.

d. Advise the patient to experiment with spices and seasonings to enhance the flavor of food.

Rationale: Instruct the patient to experiment with spices and other seasoning agents in an attempt to mask taste alterations. Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste of certain meats and fish. Bacon bits, onion, and pieces of ham may enhance the taste of vegetables.

18

A 70-year-old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and complains of nausea and constipation. Which complication of cancer is this most likely caused by?
a. Hypercalcemia
b. Tumor lysis syndrome
c. Spinal cord compression
d. Superior vena cava syndrome

a. Hypercalcemia

Rationale: Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or exacerbate hypercalcemia. The primary manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting.

19

A patient has recently been diagnosed with early stages of breast cancer. What is most appropriate for the nurse to focus on?
a. Maintaining the patient’s hope
b. Preparing a will and advance directives
c. Discussing replacement child care for the patient’s children
d. Discussing the patient’s past experiences with her grandmother’s cancer

a. Maintaining the patient’s hope

Rationale: Maintain hope, which is the key to effective cancer care. Hope depends on the status of the patient: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care.

20

The nurse is teaching a wellness class to a group of women at their workplace. The nurse knows that which woman is at highest risk for developing cancer?
a. A woman who obtains regular cancer screenings and consumes a high-fiber diet
b. A woman who has a body mass index of 35 kg/m2 and smoked cigarettes for 20 years
c. A woman who exercises five times every week and does not consume alcoholic beverages
d. A woman who limits fat consumption and has regular mammography and Pap screenings

b. A woman who has a body mass index of 35 kg/m2 and smoked cigarettes for 20 years

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 and other tobacco use; using sunscreen with SPF 15 or higher; and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).

21

The nurse is caring for an 18-year-old female patient with acute lymphocytic leukemia who is scheduled to receive hematopoietic stem cell transplantation (HSCT). Which statement, if made by the patient, indicates a correct understanding of the procedure?
a. “After the transplant I will feel better and can go home in 5 to 7 days.”
b. “I understand the transplant procedure has no dangerous side effects.”
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.”

d. “Before the transplant I will have chemotherapy and possibly full body radiation.”

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.

22

The nurse assesses a 76-year-old man with chronic myeloid leukemia receiving nilotinib (Tasigna). It is most important for the nurse to ask which question?
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?”

a. “Have you had a fever?”

An adverse effect of nilotinib is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4o F or higher. Other adverse effects of nilotinib are thrombocytopenia, bleeding, nausea, fatigue, elevated lipase level, fever, rash, pruritus, diarrhea, and pneumonia.

23

A 64-year-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to this patient’s plan of care?
a. Weigh the patient every month to monitor for weight loss.
b. Cleanse the mouth every 2 to 4 hours with hydrogen peroxide.
c. Provide high-protein and high-calorie, soft foods every 2 hours.
d. Apply palifermin (Kepivance) liberally to the affected oral mucosa.

c. Provide high-protein and high-calorie, soft foods every 2 hours.

A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Palifermin is administered intravenously as a growth factor to stimulate cells on the surface layer of the mouth to grow. Patients should be weighed at least twice each week to monitor for weight loss.

24

A 70-year-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 2 lb
b. Urine specific gravity of 1.015
c. Blood urea nitrogen of 20 mg/dL
d. Serum sodium level of 118 mEq/L

d. Serum sodium level of 118 mEq/L

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. A weight gain may be due to fluid retention. The urine specific gravity and blood urea nitrogen are normal.

25

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency?
a. Hypokalemia
b. Hypouricemia
c. Hypocalcemia
d. Hypophosphatemia

c. Hypocalcemia

TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

26

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate for the nurse to use 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 mealtime.
d. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

d. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (such as peanut butter, skim milk powder, cheese, honey, or 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.

27

Which item would be most beneficial when providing oral care to a patient with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy?
a. Firm-bristle toothbrush
b. Hydrogen peroxide rinse
c. Alcohol-based mouthwash
d. 1 tsp salt in 1 L water mouth rinse

d. 1 tsp salt in 1 L water mouth rinse

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 soft-bristle toothbrush will be used. One teaspoon of sodium bicarbonate may be added to the salt-water solution to decrease odor, alleviate pain, and dissolve mucin. Hydrogen peroxide and alcohol-based mouthwash are not used because they would damage the oral tissue.

28

Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment?
a. Acute pain
b. Hypothermia
c. Powerlessness
d. Risk for infection

d. Risk for infection

Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.

29

Previous administrations of chemotherapy agents to a cancer patient 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

a. A bland, low-fiber diet

Patients experiencing diarrhea secondary to chemotherapy and/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.

30

A 33-year-old patient has recently been diagnosed with stage II cervical cancer. What should the nurse understand about the patient's cancer?
a. It is in situ.
b. It has metastasized.
c. It has spread locally.
d. It has spread extensively.

c. It has spread locally.

Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ; 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.

31

Which cellular dysfunction in the process of cancer development allows defective cell proliferation?
a. Proto-oncogenes
b. Cell differentiation
c. Dynamic equilibrium
d. Activation of oncogenes

c. Dynamic equilibrium

Dynamic equilibrium is the regulation of proliferation that usually only occurs to equal cell degeneration or death or when the body has a physiologic need for more cells. Cell differentiation is the orderly process that progresses a cell from a state of immaturity to a state of differentiated maturity. Mutations that alter the expression of proto-oncogenes can activate them to function as oncogenes, which are tumor-inducing genes and alter their differentiation.

32

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

d. Epstein-Barr virus

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.

33

What can the nurse do to facilitate cancer prevention for the patient in the promotion stage of cancer development?
a. Teach the patient to exercise daily.
b. Teach the patient promoting factors to avoid.
c. Tell the patient to have the cancer surgically removed now.
d. Teach the patient which vitamins will improve the immune system.

b. Teach the patient promoting factors to avoid.

The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. 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 the nurse's role.

34

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

d. Immunologic surveillance

Immunologic surveillance is the process where 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.

35

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

c. It is probably benign.

Benign tumors usually are encapsulated and have normally differentiated cells. They do not metastasize and rarely recur as malignant tumors do.

36

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.

a. Cells are abnormal and moderately differentiated.

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.

37

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 (select all that apply)?
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 all the types of cancer that could be diagnosed.

a. Maintain hope.
b. Exhibit a caring attitude.
e. Be available to listen to fears and concerns.

Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching them about the diagnostic procedures would also be important. 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.

38

The patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin?
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.

c. Avoid heat and cold to the treatment area.

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.

39

The female patient is having whole brain radiation 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. "Don't use your curling iron and 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."

c. "You can get a wig now to match your hair so you will not look different."

Hair loss with radiation is usually permanent. 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. When hair grows back after chemotherapy, it is frequently 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.

40

The patient is receiving biologic 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)

d. Acetaminophen (Tylenol)

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 not used first to combat flu-like symptoms of headache, fever, chills, myalgias, etc.

41

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.

b. Turn off the chemotherapy infusion.

Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation the infusion should first be stopped. Then the protocol for the drug-specific extravasation procedures should be followed to minimize further tissue damage. 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.

42

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 into the peritoneal cavity for chemotherapy administration.
d. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

c. A Silastic catheter will be percutaneously placed into the peritoneal cavity for chemotherapy administration.

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.

43

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

d. The time the nurse spends at what distance from the patient

The principles of ALARA (as low as reasonably achievable) and time, distance, and shielding are essential to maintain the nurse's safety when the patient is a source of internal radiation. 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.

44

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. What assessment question should the nurse ask the patient to determine treatment measures for this 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?"

c. "What does the pain feel like?"

The unlicensed assistive personnel (UAP) told the nurse the location of the patient's pain and the 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.

45

The patient has been diagnosed with non-small cell lung cancer. Which type of targeted therapy will most likely be used for this patient to suppress cell proliferation and promote programmed tumor cell death?
a. Proteasome inhibitors
b. BCR-ABL tyrosine kinase inhibitors
c. CD20 monoclonal antibodies (MoAb)
d. Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TK)

d. Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TK)

Targeted therapies are more selective for specific molecular targets. Thus they are able to kill cancer cells with less damage to normal cells than with chemotherapy. Epidermal growth factor receptor (EGFR) is a transmembrane molecule that works through activation of intracellular tyrosine kinase (TK) to suppress cell proliferation and promote apoptosis of non-small cell lung cancer and some colorectal, head and neck, and metastatic breast cancers. Proteasome inhibitors promote accumulation of proteins that promote tumor cell death for multiple myeloma. BCR-ABL tyrosine kinase inhibitors target specific oncogenes for chronic myeloid leukemia and some GI stromal tumors. CD20 monoclonal antibodies (MoAb) bind with CD20 antigen causing cytotoxicity in non-Hodgkin's lymphoma and chronic lymphocytic leukemia.

46

A patient who has undergone an esophagectomy for esophageal cancer develops increasing pain, fever, and dyspnea when a full liquid diet is started postoperatively. The nurse recognizes that these symptoms are most indicative of
a. an intolerance to the feedings.
b. extension of the tumor into the aorta.
c. leakage of fluid or foods into the mediastinum.
d. esophageal perforation with fistula formation into the lung.

c. leakage of fluid or foods into the mediastinum.

Rationale: After esophageal surgery, the nurse should observe the patient for signs of leakage from the feeding tube into the mediastinum. Symptoms that indicate leakage are pain, increased temperature, and dyspnea.

47

An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about
a. cancer support groups, alopecia, and stomatitis.
b. avitaminosis, ostomy care, and community resources.
c. prosthetic devices, skin conductance, and grief counseling.
d. wound and skin care, nutrition, drugs, and community
resources.

d. wound and skin care, nutrition, drugs, and community
resources.

Rationale: Radiation therapy is used as an adjuvant to surgery or for palliation in treatment of stomach cancer. The nurse’s role is to provide detailed instructions, to reassure the patient, and to ensure completion of the designated number of treatments. The nurse should start by assessing the patient’s knowledge of radiation therapy. The nurse should teach the patient about skin care, the need for nutrition and fluid intake during therapy, and the appropriate use of antiemetic drugs.

48

A patient is seeking emergency care after choking on a piece of steak. The nursing assessment reveals a history of alcoholism, cigarette smoking, and hemoptysis. Which diagnostic study is most likely to be performed on this patient?
a. Barium swallow
b. Endoscopic biopsy
c. Capsule endoscopy
d. Endoscopic ultrasonography

b. Endoscopic biopsy

Because of this patient's history of excessive alcohol intake, smoking, hemoptysis, and the current choking episode, cancer may be present. A biopsy is necessary to make a definitive diagnosis of carcinoma, so an endoscope will be used to obtain a biopsy and observe other abnormalities as well. A barium swallow may show narrowing of the esophagus, but it is more diagnostic for achalasia. An endoscopic ultrasonography may be used to stage esophageal cancer. Capsule endoscopy can show alterations in the esophagus but is more often used for small intestine problems. A barium swallow, capsule endoscopy, and endoscopic ultrasonography cannot provide a definitive diagnosis for cancer when it is suspected.

49

The patient is having a gastroduodenostomy (Billroth I operation) for stomach cancer. What long-term complication is occurring when the patient reports generalized weakness, sweating, palpitations, and dizziness 15 to 30 minutes after eating?
a. Malnutrition
b. Bile reflux gastritis
c. Dumping syndrome
d. Postprandial hypoglycemia

c. Dumping syndrome

After a Billroth I operation, dumping syndrome may occur 15 to 30 minutes after eating because of the hypertonic fluid going to the intestine and additional fluid being drawn into the bowel. Malnutrition may occur but does not cause these symptoms. Bile reflux gastritis cannot happen when the stomach has been removed. Postprandial hypoglycemia occurs with similar symptoms, but 2 hours after eating.

50

A patient with stage I colorectal cancer is scheduled for surgery. Patient teaching for this patient would include an explanation that
a. chemotherapy will begin after the patient recovers from the surgery.
b. both chemotherapy and radiation can be used as palliative treatments.
c. follow-up colonoscopies will be needed to ensure that the cancer does not recur.
d. a wound, ostomy, and continence nurse will visit the patient to identify an abdominal site for the ostomy.

c. follow-up colonoscopies will be needed to ensure that the cancer does not recur.

Rationale: Stage 1 colorectal cancer is treated with surgical removal of the tumor and reanastomosis, and so there is no ostomy. Chemotherapy is not recommended for stage I tumors. Follow-up colonoscopy is recommended because colorectal cancer can recur.

51

The nurse identifies that which patient is at highest risk for developing colon cancer?
a. A 28-year-old male who has a body mass index of 27 kg/m2
b. A 32-year-old female with a 12-year history of ulcerative colitis
c. A 52-year-old male who has followed a vegetarian diet for 24 years
d. A 58-year-old female taking prescribed estrogen replacement therapy

b. A 32-year-old female with a 12-year history of ulcerative colitis

Risk for colon cancer includes personal history of inflammatory bowel disease (especially ulcerative colitis for longer than 10 years); obesity (body mass index ≥ 30 kg/m2); family (first-degree relative) or personal history of colorectal cancer, adenomatous polyposis, hereditary nonpolyposis colorectal cancer syndrome; red meat (=7 servings/week); cigarette use; and alcohol (=4 drinks/week).

52

A 58-year-old woman is being discharged home today after ostomy surgery for colon cancer. The nurse should assign the patient to which staff member?
a. A nursing assistant on the unit who also has hospice experience
b. A licensed practical nurse who has worked on the unit for 10 years
c. A registered nurse with 6 months of experience on the surgical unit
d. A registered nurse who has floated to the surgical unit from pediatrics

c. A registered nurse with 6 months of experience on the surgical unit

The patient needs ostomy care directions/reinforcement at discharge and should be assigned to a registered nurse with experience in providing discharge teaching for ostomy care. Teaching should not be delegated to a licensed practical/vocational nurse or unlicensed assistive personnel.

53

The nurse is conducting discharge teaching for a patient with metastatic lung cancer who was admitted with a bowel impaction. Which instructions would be most helpful to prevent further episodes of constipation?
a. Maintain a high intake of fluid and fiber in the diet.
b. Reduce intake of medications causing constipation.
c. Eat several small meals per day to maintain bowel motility.
d. Sit upright during meals to increase bowel motility by gravity.

a. Maintain a high intake of fluid and fiber in the diet.

Increased fluid intake and a high-fiber diet reduce the incidence of constipation caused by immobility, medications, and other factors. Fluid and fiber provide bulk that in turn increases peristalsis and bowel motility. Analgesics taken for lung cancer probably cannot be reduced. Other medications may decrease constipation, but it is best to avoid laxatives. Eating several small meals per day and position do not facilitate bowel motility. Defecation is easiest when the person sits on the commode with the knees higher than the hips.

54

The nurse is planning care for a 68-year-old patient with an abdominal mass and suspected bowel obstruction. Which factor in the patient's history increases the patient's risk for colorectal cancer?
a. Osteoarthritis
b. History of colorectal polyps
c. History of lactose intolerance
d. Use of herbs as dietary supplements

b. History of colorectal polyps

A history of colorectal polyps places this patient at risk for colorectal cancer. This tissue can degenerate over time and become malignant. Osteoarthritis, lactose intolerance, and the use of herbs do not pose additional risk to the patient.

55

In planning care for a patient with metastatic liver cancer, the nurse should include interventions that
a. focus primarily on symptomatic and comfort measures.
b. reassure the patient that chemotherapy offers a good prognosis.
c. promote the patient’s confidence that surgical excision of the tumor will be successful.
d. provide information necessary for the patient to make decisions regarding liver transplantation.

a. focus primarily on symptomatic and comfort measures.

Rationale: Nursing intervention for a patient with liver cancer focuses on keeping the patient as comfortable as possible. The prognosis for patients with liver cancer is poor. The cancer grows rapidly, and death may occur within 4 to 7 months as a result of hepatic encephalopathy or massive blood loss from gastrointestinal (GI) bleeding.

56

A patient with pancreatic cancer is admitted to the hospital for evaluation of possible treatment options. The patient asks the nurse to explain the Whipple procedure that the surgeon has described.
The explanation includes the information that a Whipple procedure involves
a. creating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum.
b. resection of the entire pancreas and the distal portion of the stomach, with anastomosis of the common bile duct and the stomach into the duodenum.
c. removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum.
d. radical removal of the pancreas, the duodenum, and the spleen, and attachment of the stomach to the jejunum, which requires oral supplementation of pancreatic digestive enzymes and insulin replacement therapy.

c. removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum.

Rationale: The classic operation for pancreatic cancer is a radical pancreaticoduodenectomy, or Whipple procedure. This entails resection of the proximal pancreas (i.e., proximal pancreatectomy), the adjoining duodenum (i.e., duodenectomy), the distal portion of the stomach (i.e., partial gastrectomy), and the distal segment of the common bile duct. The pancreatic duct, common bile duct, and stomach are anastomosed to the jejunum.

57

The nurse is caring for a group of patients. Which patient is at highest risk for pancreatic cancer?
a. A 38-year-old Hispanic female who is obese and has hyperinsulinemia
b. A 23-year-old who has cystic fibrosis–related pancreatic enzyme insufficiency
c. A 72-year-old African American male who has smoked cigarettes for 50 years
d. A 19-year-old who has a 5-year history of uncontrolled type 1 diabetes mellitus

c. A 72-year-old African American male who has smoked cigarettes for 50 years

Risk factors for pancreatic cancer include chronic pancreatitis, diabetes mellitus, age, cigarette smoking, family history of pancreatic cancer, high-fat diet, and exposure to chemicals such as benzidine. African Americans have a higher incidence of pancreatic cancer than whites. The most firmly established environmental risk factor is cigarette smoking. Smokers are two or three times more likely to develop pancreatic cancer as compared with nonsmokers. The risk is related to duration and number of cigarettes smoked.

58

The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the patient has developed liver cancer?
a. Serum α-fetoprotein level
b. Ventilation/perfusion scan
c. Hepatic structure ultrasound
d. Abdominal girth measurement

c. Hepatic structure ultrasound

Hepatic structure ultrasound, CT, and MRI are used to screen and diagnose liver cancer. Serum α-fetoprotein level may be elevated with liver cancer or other liver problems. Ventilation/perfusion scans do not diagnose liver cancer. Abdominal girth measurement would not differentiate between cirrhosis and liver cancer.

59

The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a contraindication for liver transplantation?
a. Has completed a college education
b. Has been able to stop smoking cigarettes
c. Has well-controlled type 1 diabetes mellitus
d. The chest x-ray showed another lung cancer lesion.

d. The chest x-ray showed another lung cancer lesion.

Contraindications for liver transplant include severe extrahepatic disease, advanced hepatocellular carcinoma or other cancer, ongoing drug and/or alcohol abuse, and the inability to comprehend or comply with the rigorous post-transplant course.

60

The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be used to establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment?
a. Spiral CT scan
b. A PET/CT scan
c. Abdominal ultrasound
d. Cancer-associated antigen 19-9

d. Cancer-associated antigen 19-9

The cancer-associated antigen 19-9 (CA 19-9) is the tumor marker used for the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment. Although a spiral CT scan may be the initial study done and provides information on metastasis and vascular involvement, this test and the PET/CT scan or abdominal ultrasound do not provide additional information.

61

You are a community health nurse planning a program on breast cancer screening guidelines for women in the neighborhood. To best promote the participants’ learning and adherence, you would include (select all that apply)
a. a short audiotape on the BSE procedure.
b. a packet of articles from the medical literature.
c. written guidelines for mammography and CBE.
d. a discussion of the value of early breast cancer detection.
e. community resources where they can obtain an ultrasound and MRI.

c. written guidelines for mammography and CBE.
d. a discussion of the value of early breast cancer detection.

Rationale: When teaching women about breast cancer screening guidelines, include information related to potential benefits, limitations, and harm (e.g., chance of a false-positive result). Allow time for questions about the procedure and a return demonstration. At every periodic health examination, ask the woman who is performing breast self-examination (BSE) to demonstrate her technique. Demonstration of BSE and providing written guidelines are appropriate teaching methods.

62

In teaching a patient who wants to perform BSE, you inform her that the technique involves both the palpation of the breast tissue and
a. palpation of cervical lymph nodes.
b. hard squeezing of the breast tissue.
c. a mammogram to evaluate breast tissue.
d. inspection of the breasts for any changes.

d. inspection of the breasts for any changes.

Rationale: BSE is performed by palpation of breast tissue with three levels of pressure. The breasts should be inspected for size, shape, redness, scaliness, or dimpling of the breast skin or nipple.

63

You are caring for a young woman who has painful fibrocystic breast changes. Management of this patient would include
a. scheduling a biopsy to rule out malignant changes.
b. teaching that symptoms will probably subside if she stops using oral contraceptives.
c. preparing her for surgical removal of the lumps, since they will become larger and more painful.
d. explaining that restrictions of coffee and chocolate and supplements of vitamin E may relieve some discomfort.

d. explaining that restrictions of coffee and chocolate and supplements of vitamin E may relieve some discomfort.

Rationale: Some relief for cyclic breast pain may be obtained with reductions in caffeine and dietary fat; taking vitamins E, A, and B-complex and gamma-linolenic acid (i.e., evening primrose oil); and continually wearing a support bra. Compresses, ice, analgesics, and antiinflammatory drugs may help. Drugs may be recommended, including oral contraceptives and danazol (Danocrine).

64

When discussing risk factors for breast cancer with a group of women, you emphasize that the greatest known risk factor for breast cancer is
a. being a woman over age 60.
b. experiencing menstruation for 30 years or more.
c. using hormone therapy for 5 years for menopausal symptoms.
d. having a paternal grandmother with postmenopausal breast cancer.

a. being a woman over age 60.

Rationale: The identifiable risk factors most associated with breast cancer include female gender and advancing age. The incidence of breast cancer is very low in women younger than 25 years and increases gradually with age until 60 years. After age 60, the incidence increases dramatically.

65

A patient with breast cancer has a lumpectomy with sentinel lymph node dissection that is positive for cancer. You explain that, of the other tests done to determine the risk for cancer recurrence or spread, the results that support the more favorable prognosis are (select all that apply)
a. well-differentiated tumor.
b. estrogen receptor–positive tumor.
c. overexpression of HER-2 cell marker.
d. involvement of two to four axillary nodes.
e. aneuploidy status from cell proliferation studies.

a. well-differentiated tumor.
b. estrogen receptor–positive tumor.

Rationale: In general, the more well-differentiated the tumor is, the less aggressive it is. Poorly differentiated tumors appear morphologically disorganized and are more aggressive. Another diagnostic test useful for treatment decisions and prognosis is determination of estrogen and progesterone receptor status. Receptor-positive tumors (1) commonly show histologic evidence of being well differentiated, (2) frequently have a diploid (more normal) DNA content and low proliferative indices, (3) have a lower chance for recurrence, and (4) are frequently hormone dependent and responsive to hormonal therapy.

66

A modified radical mastectomy has been scheduled for your patient with breast cancer. Postoperatively, to restore arm function on the affected side, you would
a. apply heating pads or blankets to increase circulation.
b. place daily ice packs to minimize the risk of lymphedema.
c. teach passive exercises with the affected arm in a dependent position.
d. emphasize regular exercises for the affected shoulder to increase range of motion.

d. emphasize regular exercises for the affected shoulder to increase range of motion.

Rationale: Restoring arm function on the affected side after mastectomy and axillary lymph node dissection is a key nursing goal. Place the woman in a semi-Fowler’s position with the arm on the affected side elevated on a pillow. Flexing and extending the fingers should begin in the recovery room, and progressive increases in activity should be encouraged. Postoperative arm and shoulder exercises are instituted gradually under a surgeon’s direction. These exercises are designed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation. The goal of all exercise is a gradual return to full range of motion within 4 to 6 weeks.

67

Preoperatively, to meet the psychologic needs of a woman scheduled for a modified radical mastectomy, you would
a. discuss the limitations of breast reconstruction.
b. include her significant other in all conversations.
c. promote an environment for expression of feelings.
d. explain the importance of regular follow-up screening.

c. promote an environment for expression of feelings.

Rationale: Throughout interactions with a woman with breast cancer, you should be aware of the extensive psychologic impact of the disease. Effective care includes sensitivity to the woman’s efforts to cope with a life-threatening disease. You should provide a safe environment for the expression of the full range of feelings.

68

To prevent capsular formation after breast reconstruction with implants, teach the patient to
a. gently massage the area around the implant.
b. bind the breasts tightly with elastic bandages.
c. exercise the arm on the affected side to promote drainage.
d. avoid strenuous exercise until the implant has healed.

a. gently massage the area around the implant.

Rationale: Surgeons have different approaches to the prevention of contracture formation, although gentle manual massage around the implant is routine.

69

The nurse teaches a 53-year-old patient about screening for early detection of breast cancer. Which statement by the patient requires an intervention by the nurse?
a. “I should plan to have a mammogram every year.”
b. “I will see a health care provider every year for a breast examination.”
c. “A breast examination should be done right after my menstrual period.”
d. “Self-breast examination is a reliable way to detect breast cancer early.”

d. “Self-breast examination is a reliable way to detect breast cancer early.”

Screening for the early detection of breast cancer includes yearly mammograms starting at age 40 and clinical breast examination every year at age 40. An alternative suggestion is to begin screening mammograms at age 50. Breast self-examination has benefits and limitations and may not be a reliable method for early detection of breast cancer. BSE is optional but should be done in premenopausal women right after the menstrual period when the breasts are less lumpy and tender.

70

The nurse caring for patients in a primary care clinic identifies which patient as being the most at risk for the development of breast cancer?
a. A 25-year-old female with fibrocystic breast disease
b. A 59-year-old male who has inherited the APC gene
c. A 72-year-old female with a family history of breast cancer
d. A 43-year-old male who is obese and leads a sedentary lifestyle

c. A 72-year-old female with a family history of breast cancer

The risk factors most associated with breast cancer are female gender, advancing age, and family history. The incidence of breast cancer increases dramatically after age 60. Mutations in BRCA genes may cause 5% to 10% of breast cancers; APC gene is associated with colon cancer. Obesity and physical inactivity increase the risk for breast cancer. Fibrocystic breast disease is not associated with the development of breast cancer.

71

The nurse performs a breast examination on a 68-year-old female patient. Which clinical manifestation, if assessed by the nurse, indicates that further evaluation for breast cancer is needed?
a. Bilateral pendulous breasts
b. Right breast is warm, painful to touch
c. Irregular, nontender lump with induration
d. Palpable lump that is tender and movable

c. Irregular, nontender lump with induration

Clinical manifestations of breast cancer may include a palpable lump that is hard, irregular, poorly delineated, nonmobile, and nontender. Nipple retraction, peau d’orange, induration, and dimpling of the overlying skin may also be noted. Mastitis presents with breasts that are warm to touch, indurated, and painful. Atrophy of the mammary glands associated with aging may result in pendulous breasts. Manifestations of fibrocystic breast changes include palpable lumps that are round, well delineated, and freely movable. The lump is usually tender and increases in size and tenderness before menstruation.

72

The nurse is caring for a 52-year-old woman with breast cancer who is receiving high-dose doxorubicin (Adriamycin). Which assessment is most important for the nurse to make?
a. Observe for alopecia.
b. Determine visual acuity.
c. Monitor cardiac rhythm.
d. Assess mouth and throat.

c. Monitor cardiac rhythm.

Doxorubicin (especially at high doses) may cause cardiotoxicity and heart failure. The nurse should monitor for cardiac dysrhythmias, electrocardiogram changes, and clinical manifestations of heart failure. Other adverse effects of doxorubicin include stomatitis and alopecia, but these effects are not as serious as cardiac problems. Tamoxifen may cause visual changes.

73

The nurse is caring for an obese 67-year-old woman after a right mastectomy with axillary lymph node dissection. Which should the nurse include in the discharge instructions?
a. “Arm exercises should not be started for 4 to 6 weeks.”
b. “Discontinue arm exercises if you have discomfort or pain.”
c. “Special massage therapy can decrease swelling in your arm.”
d. “Keep your right arm in a sling to decrease pain and swelling.”

c. “Special massage therapy can decrease swelling in your arm.”

Decongestive therapy may be used for acute lymphedema and includes a massage-like technique to mobilize the subcutaneous accumulation of fluid. Arm exercises should be performed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation. The arm exercises should be initiated after surgery and increased gradually. Pain medications should be administered 30 minutes before arm exercises. The operative arm should be kept at the level of the heart but not in a sling; a sling discourages use of the arm.

74

The nurse is caring for a patient diagnosed with breast cancer who just underwent an axillary lymph node dissection. What intervention should the nurse use to decrease the lymphedema?
a. Keep affected arm flat at the patient's side.
b. Apply an elastic bandage on the affected arm.
c. Assess blood pressure only on unaffected arm.
d. Restrict exercise of the affected arm for 1 week.

c. Assess blood pressure only on unaffected arm.

Blood pressure readings, venipunctures, and injections should not be done on the affected arm. Elastic bandages should not be used in the early postoperative period because they inhibit collateral lymph drainage. The affected arm should be elevated above the heart, and isometric exercises are recommended and gradually increased starting in the recovery room to reduce fluid volume in the arm.

75

The nurse is volunteering at a community center to teach women about breast cancer. What should the nurse include when discussing risk factors (select all that apply)?
a. Nulliparity
b. Age 30 or over
c. Early menarche
d. Late menopause
e. Personal history of colon cancer

a. Nulliparity
c. Early menarche
d. Late menopause
e. Personal history of colon cancer

Women are at an increased risk for development of breast cancer if they are over the age of 50; have a family history of breast cancer; have a personal history of breast, colon, endometrial, or ovarian cancer; have a long menstrual history as seen with early menarche or late menopause; and have had a first full-term pregnancy after the age of 30 or are nulliparous.

76

The nurse has been asked to participate in a healthy living workshop. While teaching about women's health, which guidelines should the nurse provide to the audience?
a. "Mammograms are necessary if you have a family history of breast cancer."
b. "It's recommended that you get a mammogram each year after you turn 40."
c. "If you are not able to perform breast self-examination (BSE), you should go for regular mammograms."
d. "You should ensure that your primary care provider performs a breast exam each time you visit."

b. "It's recommended that you get a mammogram each year after you turn 40."

Annual mammograms are recommended after age 40. They are recommended for all women, not solely those with a family history of breast cancer. BSE is not a replacement for mammography, and clinical breast examinations are not necessary at each office visit, but recommended at least every 3 years for women in their 20s and 30s, and then every year beginning at age 40.

77

A 29-year-old primiparous patient has a 3-week-old infant whom she is breastfeeding. The woman has sought care because of recent breast tenderness, redness, and fever. Which teaching point should the nurse prioritize when following up her care?
a. Encourage patient to continue breastfeeding her infant.
b. Refer patient for a mammogram as quickly as possible.
c. Ensure patient adheres to her prescribed antibiotic regimen.
d. Teach patient to use warm compresses and educate her about self-limiting nature of illness.

c. Ensure patient adheres to her prescribed antibiotic regimen.

Mastitis normally requires antibiotic therapy, the success of which is often dependent on close adherence to the prescribed regimen. Breastfeeding should indeed be continued if possible, but effective treatment of her infection would be the immediate priority. If a palpable mass develops, the patient should obtain medical follow-up because she may be developing an abscess. Mastitis is not necessarily self-limiting, and mammography is not normally indicated.

78

A 51-year-old woman has recently had a unilateral, right total mastectomy and axillary node dissection for the treatment of breast cancer. What nursing intervention should the nurse include in the patient's care?
a. Immobilize the patient's right arm until postoperative day 3.
b. Maintain the patient's right arm in a dependent position when at rest.
c. Administer diuretics prophylactically for the prevention of lymphedema.
d. Promote gradually increasing mobility as soon as possible following surgery.

d. Promote gradually increasing mobility as soon as possible following surgery.

Mobility should be encouraged beginning in the postanesthesia care unit (PACU) and increased gradually throughout the patient's recovery. Immobilization is counterproductive to recovery, and the limb should not be in a dependent position. Diuretics are not used to prevent lymphedema but may be used in active treatment of the problem.

79

Which task could the registered nurse delegate to unlicensed assistive personnel (UAP) during the care of a patient who has had recent transverse rectus abdominis musculocutaneous (TRAM) flap surgery?
a. Document the condition of the patient's incisions.
b. Mobilize the patient in a slightly hunched position.
c. Change the patient's abdominal and chest dressings.
d. Change the parameters of the patient-controlled analgesic (PCA) pump.

b. Mobilize the patient in a slightly hunched position.

Mobilization of a postsurgical patient may be delegated, and the patient who has had a TRAM flap should not stand or walk fully erect, in order to minimize strain on the incisions. Changing dressings, assessing wounds, and reprogramming a PCA pump are not appropriate tasks to delegate to UAP.

80

A 50-year-old patient is preparing to begin breast cancer treatment with tamoxifen (Nolvadex). What point should the nurse emphasize when teaching the patient about her new drug regimen?
a. "You may find that your medication causes some breast sensitivity."
b. "It's important that you let your care provider know about any changes in your vision."
c. "You'll find that this drug often alleviates some of the symptoms that accompany menopause."
d. "It's imperative that you abstain from drinking alcohol after you begin taking tamoxifen."

b. "It's important that you let your care provider know about any changes in your vision."

Tamoxifen has the potential to cause cataracts and retinopathy. The drug is likely to exacerbate rather than alleviate perimenopausal symptoms. Breast tenderness is not associated with tamoxifen, and it is not necessary for the patient to abstain from alcohol.

81

A nurse is teaching a health promotion workshop to a group of women in their 40s and 50s. What information about nipple discharge should the nurse teach to participants?
a. Inappropriate lactation necessitates breast biopsy.
b. Nipple discharge of any type is considered a precursor to cancer.
c. Unexpected nipple discharge of any type warrants medical follow-up.
d. Galactorrhea is a normal age-related change and a frequent perimenopausal symptom.

c. Unexpected nipple discharge of any type warrants medical follow-up.

Although most cases of nipple discharge are not related to malignancy, further medical assessment is indicated. Other testing would be done for inappropriate lactation before a breast biopsy would be necessary. Galactorrhea is not considered a normal age-related change, nor is it a common perimenopausal symptom.

82

A 24-year-old patient who has undergone breast augmentation earlier in the day will be discharged home in the early evening. What instructions should the nurse provide in order to minimize the patient's risk of complications in the immediate recovery period?
a. Avoid wearing a bra until postoperative day 3.
b. Ask the patient to avoid strenuous exercise during her recovery period.
c. Sleep in a semi-Fowler's position until her scheduled follow-up appointment.
d/ Enlist a friend or family member to perform passive range-of-motion exercises.

b. Ask the patient to avoid strenuous exercise during her recovery period.

As with all types of breast surgery, strenuous exercise is contraindicated during the recovery period following breast augmentation. A bra should be worn to prevent dehiscence and provide comfort. Sleeping in a semi-Fowler's position is not necessary, and passive range-of-motion exercises should be avoided at first.

83

When doing breast self-examination, the female patient should report which findings to her physician?
a. Palpable rib margins
b. Denser breast tissue
c. Left nipple deviation
d. Different sized breasts

c. Left nipple deviation

Unilateral deviation of a nipple may be a clinical indicator of breast cancer or other problem and should be reported to the health care provider. Dense breast tissue, palpable rib margins, and different sized breasts are all normal findings.

84

When caring for female patients, the nurse should be aware that most cancers occur where on the breast?
a. Lower medial area
b. Upper outer quadrant
c. Upper medial area
d. Nipple area

b. Upper outer quadrant

Most (50%) breast cancers are diagnosed in the upper outer quadrant of the breast. The next most frequent site is the nipple area (18%), followed by the upper medial area (15%), the lower outer quadrant (11%), and the lower medial area (6%).

85

The patient with breast cancer has a left mastectomy with axillary node dissection. Ten lymph nodes are resected with three positive for malignant cells. The patient has stage IIB breast cancer. What is the best nursing intervention to use in planning care?
a. Evaluate left arm lymphatic accumulation.
b. Maintain joint flexibility and left arm function.
c. Teach her about chemotherapy and radiation therapy.
d. Assess the patient's response to the diagnosis of breast cancer.

d. Assess the patient's response to the diagnosis of breast cancer.

Assessment is the first step in planning patient care. Because the nurse is the patient's advocate and this is an extremely stressful time for the patient and family, the nurse should focus on the patient's response to the diagnosis of breast cancer when planning care for this patient. The approach for the care of the left arm and teaching the patient about further therapy will be based on this assessment.

86

A 72-year-old patient who had a mastectomy for breast cancer 6 months ago wants to have breast reconstructive surgery. The nurse knows that what is the most likely motivation for this patient seeking this surgery?
a. Improve the woman's self-image
b. Be able to experience sexual arousal
c. To get a tummy tuck as well as the breast mound
d. Restore the pre-mastectomy appearance of the breast

a. Improve the woman's self-image

The most likely motivation for this patient to seek breast reconstructive surgery is to improve her self-esteem. With this surgery, she will not be able to experience sexual arousal or restore the pre-mastectomy appearance of the breast. The abdominoplasty (tummy tuck) effect will only be a possibility with the transverse rectus abdominis musculocutaneous (TRAM) flap, not with a breast implant or tissue expansion.

87

Nursing responsibilities related to the patient receiving brachytherapy for endometrial cancer include
a. maintaining absolute bed rest.
b. keeping the patient in high Fowler’s position.
c. allowing visitors if they stay 3 ft (1 m) from the bed.
d. limiting direct nurse-to-patient contact to 30 minutes per shift.

a. maintaining absolute bed rest.

Rationale: During brachytherapy, the patient is placed on absolute bed rest.

88

A 55-year-old woman diagnosed with endometrial cancer is receiving brachytherapy. The nurse is most concerned if what is observed?
a. The patient develops foul-smelling vaginal discharge.
b. The patient has 5 to 8 liquid stools over a period of 24 hours.
c. The patient uses a bedpan instead of a bedside commode or toilet.
d. The patient requests a nursing assistant to stay in the room for company.

d. The patient requests a nursing assistant to stay in the room for company.

Brachytherapy is internal radiation applied directly to the tumor. Health care providers should limit close contact with the patient to less than 30 minutes per day. Internal radiation causes the destruction of cells and results in a foul-smelling vaginal discharge. Internal radiation may cause systemic reactions such as nausea, vomiting, diarrhea, and malaise. The patient receiving brachytherapy is placed in a lead-lined private room and on absolute bed rest.

89

What should the nurse include when teaching about early detection of ovarian cancer?
a. Report any pelvic or vaginal bleeding soon.
b. Use estrogen with progestin for menopause.
c. Obtain annual bimanual pelvic examinations.
d. Receive a preventive bilateral oophorectomy.

c. Obtain annual bimanual pelvic examinations.

Because it is difficult for a patient to detect early clinical indicators of ovarian cancer, the best method of early detection is to have a yearly bimanual pelvic examination to palpate for an ovarian mass. Although pelvic or vaginal bleeding should be reported soon after it occurs, this rarely occurs with ovarian cancer and is not an early symptom. Oral contraceptives may be used or a preventive bilateral oophorectomy may be done to reduce the risk, but they would not be done to detect early ovarian cancer.

90

Which factors would place a patient at higher risk for prostate cancer (select all that apply)?
a. Older than 65 years
b. Asian or Native American
c. Long-term use of an indwelling urethral catheter
d. Father diagnosed and treated for early stage prostate cancer
e. Previous history of undescended testicle and testicular cancer

a. Older than 65 years
d. Father diagnosed and treated for early stage prostate cancer

Rationale: Age, ethnicity, and family history are risk factors for prostate cancer. The incidence of prostate cancer rises markedly after age 50, and more than 66% of men with this diagnosis are older than 65 years. The incidence of prostate cancer worldwide is higher in African Americans than in any other ethnic group (except Jamaican men of African descent). A family history of prostate cancer, especially cancer in first-degree relatives (e.g., fathers, brothers), is associated with an increased risk.

91

A patient scheduled for a prostatectomy for prostate cancer
expresses the fear that he will have erectile dysfunction. In responding to this patient, the nurse should keep in mind that
a. erectile dysfunction can occur even with a nerve-sparing
procedure.
b. retrograde ejaculation affects sexual function more frequently than erectile dysfunction.
c. the most common complication of this surgery is postoperative bowel incontinence.
d. preoperative sexual function is the most important factor in determining postoperative erectile dysfunction.

a. erectile dysfunction can occur even with a nerve-sparing
procedure.

Rationale: A major complication after prostatectomy (even with nerve-sparing procedures) is erectile dysfunction.

92

In assessing a patient for testicular cancer, the nurse understands that the manifestations of this disease often include
a. acute back spasms and testicular pain.
b. rapid onset of scrotal swelling and fever.
c. fertility problems and bilateral scrotal tenderness.
d. painless mass and heaviness sensation in the scrotal area.

d. painless mass and heaviness sensation in the scrotal area.

Rationale: Clinical manifestations of testicular cancer include a painless lump in the scrotum, scrotal swelling, and a feeling of heaviness. The scrotal mass usually is not tender and is very firm. Some patients complain of a dull ache or heavy sensation in the lower abdomen, perianal area, or scrotum.

93

The nurse teaches a 30-year-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu?
a. Grilled steak, French fries, and vanilla shake
b. Hamburger with cheese, pudding, and coffee
c. Baked chicken, peas, apple slices, and skim milk
d. Grilled cheese sandwich, onion rings, and hot tea

c. Baked chicken, peas, apple slices, and skim milk

A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.

94

The nurse is teaching clinic patients about risk factors for testicular cancer. Which individual is at highest risk for developing testicular cancer?
a. A 30-year-old white male with a history of cryptorchidism
b. A 48-year-old African American male with erectile dysfunction
c. A 19-year-old Asian male who had surgery for testicular torsion
d. A 28-year-old Hispanic male with infertility caused by a varicocele

a. A 30-year-old white male with a history of cryptorchidism

The incidence of testicular cancer is four times higher in white males than in African American males. Testicular tumors are also more common in males who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to DES, and testicular cancer in the contralateral testis.

95

The patient has a low-grade carcinoma on the left lateral aspect of the prostate gland and has been on "watchful waiting" status for 5 years. Six months ago his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations now indicate that the prostate cancer may be growing and he needs a change in his care (select all that apply)?
a. Casts in his urine
b. Presence of α-fetoprotein
c. Serum PSA level 10 ng/mL
d. Onset of erectile dysfunction
e. Nodularity of the prostate gland

c. Serum PSA level 10 ng/mL
e. Nodularity of the prostate gland

The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth.

96

A 33-year-old patient noticed a painless lump in his scrotum on self-examination of his testicles and a feeling of heaviness. The nurse should first teach him about what diagnostic test?
a. Ultrasound
b. Cremasteric reflex
c. Doppler ultrasound
d. Transillumination with a flashlight

a. Ultrasound

When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele.

97

You are caring for a patient with esophageal cancer. Which task could be delegated to a UAP?
1. Assisting the patient with oral hygiene
2. Observing the patient's response to feedings
3. Facilitating expression of grief or anxiety
4. Initiating daily weighings

1. Assisting the patient with oral hygiene

Rationale:
Oral hygiene is within the scope of duties of the UAP. It is the responsibility of the nurse to observe response to treatments and to help the patient deal with loss or anxiety. The UAP can be directed to weigh the patient but should not be expected to know when to initiate that measurement.

98

A 56-year-old patient comes to the walk-in clinic reporting scant rectal bleeding and intermittent diarrhea and constipation for the past several months. There is a history of polyps and a family history of colorectal cancer. While you are trying to teach about colonoscopy, the patient becomes angry and threatens to leave. What is the priority diagnosis?
1. Diarrhea/Constipation related to altered bowel patterns
2. Deficient Knowledge related to the disease process and diagnostic procedure
3. Risk for Deficient Fluid Volume related to rectal bleeding and diarrhea
4. Anxiety related to unknown outcomes and perceived threats to body integrity

4. Anxiety related to unknown outcomes and perceived threats to body integrity

Rationale:
The patient's physical condition is currently stable, but emotional needs are affecting his or her ability to receive the information required to make an informed decision. The other diagnoses are relevant, but if the patient leaves the clinic the interventions may be delayed or ignored.

99

Which patient is at greatest risk for pancreatic cancer?
1. An elderly African-American man who smokes
2. A young white obese woman with gallbladder disease
3. A young African-American man with type 1 diabetes
4. An elderly white woman who has pancreatitis

1. An elderly African-American man who smokes

Rationale:
Pancreatic cancer is more common in African-Americans, males, and smokers. Other associated factors include alcohol use, diabetes, obesity, history of pancreatitis, exposure to organic chemicals, consumption of a high-fat diet, and previous abdominal irradiation.

100

Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions are needed for patients who must be placed on bleeding precautions? (Select all that apply.)
1. Provide mouthwash with alcohol for oral rinsing.
2. Use paper tape on fragile skin.
3. Provide a soft toothbrush or oral sponge.
4. Gently insert rectal suppositories.
5. Avoid aspirin or aspirin-containing products.
6. Avoid overinflation of blood pressure cuffs.
7. Pad sharp corners of furniture.

2. Use paper tape on fragile skin.
3. Provide a soft toothbrush or oral sponge.
5. Avoid aspirin or aspirin-containing products.
6. Avoid overinflation of blood pressure cuffs.
7. Pad sharp corners of furniture.

Rationale:
Mouthwash should not include alcohol, because it has a drying action that leaves mucous membranes more vulnerable. Insertion of suppositories, probes, or tampons into the rectal or vaginal cavity is not recommended. All other options are appropriate.

101

When care assignments are being made for patients with alterations related to gastrointestinal (GI) cancer, which patient would be the most appropriate to assign to an LPN/LVN under the supervision of a team leader RN?
1. A patient with severe anemia secondary to GI bleeding
2. A patient who needs enemas and antibiotics to control GI bacteria
3. A patient who needs preoperative teaching for bowel resection surgery
4. A patient who needs central line insertion for chemotherapy

2. A patient who needs enemas and antibiotics to control GI bacteria

Rationale:
Administering enemas and antibiotics is within the scope of practice of LPNs/LVNs. Although some states and facilities may allow the LPN/LVN to administer blood, in general, administering blood, providing preoperative teaching, and assisting with central line insertion are the responsibilities of the RN.

102

The physician tells the patient with cancer that there will be an initial course of treatment with continued maintenance treatments and ongoing observation for signs and symptoms over a prolonged period of time. Which patient statement would concern you the most?
1. "My symptoms will eventually be cured; I'm so happy that I don't have to worry any longer."
2. "My doctor is trying to help me control the symptoms; I am grateful for the extension of time with my family."
3. "My pain will be relieved, but I am going to die soon; I would like to have control over my own life and death."
4. "Initially, I may have to take some time off of work for my treatments; I can probably work full time in the future."

3. "My pain will be relieved, but I am going to die soon; I would like to have control over my own life and death."

Rationale:
Further assess what the patient means by having “control over my own life and death.” This could be an indirect statement of suicidal intent. A patient who believes he will be cured should also be assessed for misunderstanding what the physician said; however, the patient may need to use denial as a temporary defense mechanism. The patient's acknowledgment that the treatments are for control of symptoms or plans: for the immediate future suggest an understanding of what the physician said.

103

For a patient who is experiencing side effects of radiation therapy, which task would be the most appropriate to delegate to the UAP?
1. Helping the patient to identify patterns of fatigue
2. Recommending participation in a walking program
3. Reporting the amount and type of food consumed from the tray
4. Checking the skin for redness and irritation after the treatment

3. Reporting the amount and type of food consumed from the tray

Rationale:
The UAP can observe the amount that the patient eats (or what is gone from the tray) and report to the nurse. Assessing patterns of fatigue and skin reaction is the responsibility of the RN. The initial recommendation for exercise should come from the physician.

104

For a patient receiving the chemotherapeutic drug vincristine (Oncovin), which side effects should be reported to the physician?
1. Fatigue
2. Nausea and vomiting
3. Paresthesia
4. Anorexia

3. Paresthesia

Rationale:
Paresthesia is a side effect associated with some chemotherapy drugs such as vincristine. The physician can modify the dosage or discontinue the drug. Fatigue, nausea, vomiting, and anorexia are common side effects of many chemotherapy medications. The nurse can assist the patient by planning for rest periods, giving antiemetics as ordered, and encouraging small meals containing high-protein and high-calorie foods.

105

For a patient who is receiving chemotherapy, which laboratory result is of particular importance?
1. White blood cell (WBC) count
2. Prothrombin time and partial thromboplastin time
3. Electrolyte levels
4. Blood urea nitrogen level

1. White blood cell (WBC) count

Rationale:
WBC count is especially important, because chemotherapy can cause decreases in WBCs, particularly neutrophils (known as neutropenia), which leave the patient vulnerable to infection. The other tests are important in the total management but are less directly specific to chemotherapy in general.

106

For care of a patient who has oral cancer, which task would be appropriate to delegate to an LPN/LVN?
1. Assisting the patient to brush and floss
2. Explaining when brushing and flossing are contraindicated
3. Giving antacids and sucralfate suspension as ordered
4. Recommending saliva substitutes

3. Giving antacids and sucralfate suspension as ordered

Rationale:
Giving medications is within the scope of practice of the LPN/LVN. Assisting the patient in brushing and flossing should be delegated to the UAP. Explaining contraindications is the responsibility of the RN. Recommendations for saliva substitutes should come from the physician or pharmacist.

107

When staff assignments are made for the care of patients who are receiving chemotherapy, what is the major consideration regarding chemotherapeutic drugs?
1. During preparation, drugs may be absorbed through the skin or inhaled.
2. Many chemotherapeutic drugs are vesicants.
3. Chemotherapeutic drugs are frequently given through central venous access devices.
4. Oral and venous routes of administration are the most common.

1. During preparation, drugs may be absorbed through the skin or inhaled.

Rationale:
Chemotherapy drugs should be given by nurses who have received additional training in how to safely prepare and deliver the drugs and protect themselves and others from exposure. The other options express concerns, but the general principles of drug administration apply.

108

Following chemotherapy, a patient is being closely monitored for tumor lysis syndrome. Which laboratory value requires particular attention?
1. Platelet count
2. Electrolyte levels
3. Hemoglobin level
4. Hematocrit

2. Electrolyte levels

Rationale:
Tumor lysis syndrome can result in severe electrolyte imbalances and potential kidney failure. The other laboratory values are important to monitor to identify general chemotherapy side effects but are less pertinent to tumor lysis syndrome.

109

In the care of a patient with neutropenia, what tasks can be delegated to a UAP? (Select all that apply.)
1. Taking vital signs every 4 hours
2. Reporting temperature of more than 100.4° F (38° C)
3. Assessing for sore throat, cough, or burning with urination
4. Gathering the supplies to prepare the room for protective isolation
5. Reporting superinfections, such as candidiasis
6. Practicing good hand-washing technique

1. Taking vital signs every 4 hours
2. Reporting temperature of more than 100.4° F (38° C)
4. Gathering the supplies to prepare the room for protective isolation
6. Practicing good hand-washing technique

Rationale:
Measuring vital signs and reporting on specific parameters, practicing good hand washing, and gathering equipment are within the scope of duties for a UAP. Assessing for symptoms of infections and superinfections is the responsibility of the RN.

110

A primary nursing responsibility is the prevention of lung cancer by assisting patients in cessation of smoking or other tobacco use. Which task would be appropriate to delegate to an LPN/LVN?
1. Development of a "quit plan"
2. Explanation of how to apply a nicotine patch
3. Discussion of strategies to avoid relapse
4. Suggestion of ways to deal with urges for tobacco

2. Explanation of how to apply a nicotine patch

Rationale:
An LPN/LVN is versed in medication administration and able to teach patients standardized information. The other options require more in-depth assessment, planning, and teaching, which should be performed by the RN. Helping patients with smoking cessation is a Core Measure.

111

You are providing end-of-life-care for a patient with terminal liver cancer. The patient is weak and restless. Her skin is cool and mottled. Dyspnea develops and the patient appears anxious and frightened. What should you do?
1. Obtain an order for morphine elixir.
2. Alert the rapid response team and call the physician for orders.
3. Deliver breaths at 20/min with a bag-valve mask and prepare for intubation.
4. Sit quietly with the patient and offer emotional support and comfort.

1. Obtain an order for morphine elixir.

Rationale:
Morphine elixir is the therapy of choice because it is thought to reduce anxiety and the subjective sensation of air hunger. It also increases venous capacitance. End-of-life-care should not include aggressive measures such as intubation or resuscitation. Support and comfort are always welcome, but in this case you should not sit quietly because there is an option that would offer some physical relief for the patient.

112

You are asked to float to a different nursing unit. During report, you are told that the patient is receiving IV administration of vincristine (Oncovin) that should be completed within the next 15 minutes. The IV site is intact, and the patient is not having any problems with the infusion. You are not certified in chemotherapy administration. What is your priority action?
1. Ask the nurse to stay until the infusion is finished, because you are not certified.
2. Assess the IV site; check the progress of the infusion and the patient's condition.
3. Contact the charge nurse and explain that you are not chemotherapy certified.
4. Look up drug side effects and monitor, because the infusion is almost complete.

3. Contact the charge nurse and explain that you are not chemotherapy certified.

Rationale:
Explain that you are not chemotherapy certified so that the charge nurse can quickly rearrange the patient assignments. You can assess the patient, site, and infusion; however, you do not have the expertise to recognize the side effects of the medication or to give specialized care that may be needed. Asking the nurse to stay is not the best solution, because the care of the patient and the effects of the medication continue after the infusion has been completed. Looking up the side effects of the drug is okay for your own information, but you are still not qualified to deal with this situation. In addition, knowing how to properly discontinue the infusion and dispose of the equipment are essential for your own safety and the safety of others.

113

You are caring for a patient with uterine cancer who is being treated with intracavitary radiation therapy. The UAP reports that the patient insisted on ambulating to the bathroom and now "something feels like it is coming out." What is the priority action?
1. Assess the UAP's knowledge; explain the rationale for strict bed rest.
2. Assess for dislodgment; use forceps to retrieve and a lead container to store as needed.
3. Assess the patient's knowledge of the treatment plan and her willingness to participate.
4. Notify the physician about the potential or confirmed dislodgment of the radiation implant.

2. Assess for dislodgment; use forceps to retrieve and a lead container to store as needed.

Rationale:
If the radiation implant has obviously been expelled (i.e., is on the bed linens), use a pair of forceps to place the radiation source in a lead container. The other options would be appropriate after safety of the patient and personnel are ensured.

114

You are caring for a 21-year-old client who had a left orchiectomy for testicular cancer on the previous day. Which nursing activity will you delegate to an LPN/LVN?
1. Educating the client about post-orchiectomy chemotherapy and radiation
2. Administering the prescribed "as needed" (PRN) oxycodone (Roxicodone) to the client
3. Teaching the client how to perform testicular self-examination on the remaining testicle
4. Assessing the client's knowledge level about post-orchiectomy fertility

2. Administering the prescribed "as needed" (PRN) oxycodone (Roxicodone) to the client

Rationale:
Administration of narcotics and the associated client monitoring are included in LPN/LVN education and scope of practice. Assessments and teaching are more complex skills that require RN-level education and are best accomplished by an RN with experience in caring for clients with this diagnosis.

115

You are the charge nurse on the oncology unit. Which client is best to assign to an RN who has floated from the ED?
1. Client who needs doxorubicin (Adriamycin) to treat metastatic breast cancer
2. Client who needs discharge teaching after surgery for stage II ovarian cancer
3. Client with metastatic prostate cancer who requires frequent assessment and treatment for breakthrough pain
4. Client with testicular cancer who requires preoperative teaching about orchiectomy and lymph node resection

3. Client with metastatic prostate cancer who requires frequent assessment and treatment for breakthrough pain

Rationale:
An RN from the ED would be experienced in assessment and management of pain. Because of their diagnoses and treatments, the other clients should be assigned to RNs who are experienced in caring for clients with cancer.

116

A client has had a needle biopsy of the prostate gland using the transrectal approach. Which statement is most important to include in the client teaching plan?
1. "The doctor will call you about the test results in a day or two."
2. "Serious infections may occur as a complication of this test."
3. "You will need to call the doctor if you develop a fever or chills."
4. "It is normal to have a small amount of rectal bleeding after the test."

3. "You will need to call the doctor if you develop a fever or chills."

Rationale:
Although infection occurs only rarely as a complication of transrectal prostate biopsy, it is important that the client receive teaching about checking his temperature and calling the physician if there is any fever or other signs of systemic infection. The client should understand that the test results will not be available immediately but that he will be notified about the results. Transient rectal bleeding may occur after the biopsy, but bleeding that lasts for more than a few hours indicates that there may have been rectal trauma.

117

When assessing a client with cervical cancer who had a total abdominal hysterectomy yesterday, you obtain the following data. Which information has the most immediate implications for planning of the client's care?
1. Fine crackles are audible at the lung bases.
2. The client's right calf is swollen, and she reports calf tenderness.
3. The client uses the patient-controlled analgesia device every 30 minutes.
4. Urine in the collection bag is amber and clear.

2. The client's right calf is swollen, and she reports calf tenderness.

Rationale:
Right calf swelling and tenderness indicate the possible presence of deep vein thrombosis. This will change the plan of care, because the client should be placed on bed rest, whereas the usual plan is to ambulate the client as soon as possible after surgery. The other data indicate the need for common postoperative nursing actions such as having the client cough, assessing her pain, and increasing her fluid intake.

118

You observe a student nurse who is caring for a client who has an intracavitary radioactive implant in place to treat cervical cancer. Which action by the student requires that you intervene immediately?
1. Standing next to the client for 5 minutes while assisting with her bath
2. Asking the client how she feels about losing her childbearing ability
3. Assisting the client to the bedside commode for a bowel movement
4. Offering to get the client whatever she would like to eat or drink

3. Assisting the client to the bedside commode for a bowel movement

Rationale:
Clients with intracavitary implants are kept in bed during the treatment to avoid dislodgement of the implant. The other actions may also require you to intervene by providing guidance to the student. Minimal time should be spent close to clients who are receiving internal irradiation. Asking the client about her reaction to losing childbearing abilities may be inappropriate at this time. Clients are frequently placed on low-residue diets to decrease bowel distention while implants are in place.

119

You are working on a medical unit staffed with LPNs/LVNs and UAP when a client with stage IV ovarian cancer and recurrent ascites is admitted for paracentesis. Which activity is best to delegate to an experienced LPN/LVN?
1. Obtaining a paracentesis tray from the central supply area
2. Completing the short-stay client admission form
3. Measuring vital signs every 15 minutes after the procedure
4. Providing discharge instructions after the procedure

3. Measuring vital signs every 15 minutes after the procedure

Rationale:
LPN/LVN education includes vital sign monitoring; an experienced LPN/LVN would recognize and report significant changes in vital signs to the RN. The paracentesis tray could be obtained by a UAP. Client admission assessment and teaching require RN-level education and experience, although part of the data gathering may be done by an LPN/LVN.

120

While you are working in the clinic, a healthy 32-year-old woman whose sister is a carrier of the BRCA gene asks you which form of breast cancer screening is the most effective for her. Which response is best?
1. "An annual mammogram is usually sufficient screening for women your age."
2. "Monthly self-breast examination is recommended because of your higher risk."
3. "A yearly breast examination by a health care provider should be scheduled."
4. "Magnetic resonance imaging is recommended in addition to annual mammography."

4. "Magnetic resonance imaging is recommended in addition to annual mammography."

Rationale:
The current national guidelines, supported by nonrandomized screening trials and observational data, call for first-degree relatives of clients with the BRCA gene to be screened with both annual mammography and magnetic resonance imaging (MRI). Although annual mammography, breast self-examination, and clinical breast examination by a health care provider may help to detect cancer, the best option for this client is annual mammography and MRI.