Chapter 25: The Patient with Cancer
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. Which statement best defines concepts to be included in a teaching plan for a patient with
cancer?
a.
Cancer is a group of diseases. The cancer cells are different from the cells in the
tissue of its origin in both the growth and spreading of abnormal cells.
b.
Cancer is the third leading cause of death in the United States. Many hospitals
have the highest number of patients with this diagnosis.
c.
Americans who have a diagnosis of cancer die within 1 year or less.
d.
When a person is genetically predisposed to a type of cancer, nothing can be done
to prevent its occurrence.
2. A nurse explains that the seven warning signs of cancer written by the American Cancer
Society (ACS) can be recalled by the acronym CAUTION. What should the nurse change to
point out that the A in the acronym represents?
a.
A sore that will not heal
b.
Alopecia
c.
Abscess
d.
Anorexia
3. A home health nurse is compiling a patient profile on a 23-year-old obese woman who
smokes one-half pack of cigarettes a day and drinks 1 beer a week. She works as a cook in a
long-term care facility. She has two children and eats a diet high in fats. She exercises 30
minutes a day. Both parents are dead of heart disease. How many risk factors for cancer in this
profile should the nurse identify?
a.
2
b.
3
c.
5
d.
6
4. What phase is considered the latent period before the period of rapid growth of tumors?
a.
Initiation
b.
Promotion
c.
Progression
d.
Metastasis
5. Which is true about both malignant tumors and benign tumors?
a.
Both contain cells that closely resemble those in the tissue of origin.
b.
Both travel quickly to invade and destroy other tissues and organs.
c.
Both always grow and multiply very rapidly, competing for space and nutrients
and causing severe pain.
d.
Both may press on nearby surrounding tissues, such as nerves and blood vessels,
causing pain.
6. A patient newly diagnosed with cancer says, “I feel like I’ve lost my future. I feel so much
harm has been done to me that I’m overwhelmed.” To what type of coping strategies should
the nurse recognize this attitude will most likely lead the patient?
a.
Avoidant
b.
Problem solving
c.
Approach oriented
d.
Confrontational
7. A patient has a cancer that has been TNM staged as T3 (1-4, size of primary tumor), N2 (0-3,
degree of spread to regional lymph nodes), and M2 (0-1, presence of metastasis). He has an as
needed order of 4 mg of morphine intramuscularly every 3 to 4 hours. He requests another
pain injection approximately hours after the last one. What is the most appropriate nursing
action?
a.
Inform the patient that this narcotic may be given only every 4 hours to prevent
addiction.
b.
Ignore the call bell for 20 minutes and then take at least 10 minutes to prepare and
administer the injection.
c.
Give the morphine and evaluate the results of pain relief. Arrange for the physician
to evaluate for breakthrough pain.
d.
Ask the family to assist in helping the patient accept waiting longer to receive an
addicting medication such as morphine.
8. A patient is scheduled for a chemotherapy treatment in approximately 30 minutes. Breakfast
trays have arrived and are being served on the unit. What is the nurse’s best intervention?
a.
Encourage the patient to eat all his breakfast to keep up his strength to fight the
cancer. Remind the patient that breakfast is about one third of his daily intake.
b.
Listen attentively to any concerns that the patient expresses regarding the
treatment. Offer to hold his tray until after the treatment.
c.
Offer to call the family to come and be present after the treatment. Encourage the
patient to drink at least all of the orange juice and coffee.
d.
Suggest that the patient request a dose of strong analgesic instead of eating because
this treatment is very painful.
9. A nurse explains that drugs such as cannabinoids, Benadryl, and Vistaril are frequently
ordered for patients with cancer who are taking chemotherapy. What do these types of drugs
accomplish?
a.
Promote amnesia to dampen the fear.
b.
Maintain fluid retention to prevent dehydration.
c.
Control nausea, vomiting, and taste disorders caused by the therapy.
d.
Control bouts of diarrhea or uncomfortable constipation.
10. While bathing a patient with cancer, a nurse assessed several large new bruises on the
patient’s upper arms and thighs. What is the best understanding of the possible causes and the
correct nurse’s actions for these findings?
a.
The patient must have fallen last night walking to the bathroom. Teach the patient
to use the call bell when assistance is needed.
b.
The patient may have disseminated intravascular coagulation. The size, shape,
location, color, and tenderness must be reported and recorded fully.
c.
An intravascular fluid overload is occurring because of the chemotherapy. Place
the patient on strict input/output (I/O) status and limit fluids.
d.
The patient must have had a drug-induced seizure, which caused arm and leg
thrashing and the bruises. Report and record the findings, and pad the side rails.
11. What manifestations might be assessed by a nurse when a patient is diagnosed with the
oncologic emergency hypercalcemia?
a.
Hypertension and bradycardia
b.
Fatigue, confusion, and weakness
c.
Laboratory test results of potassium 3.5 mEq/L, sodium 143 mEq/L
d.
Urine output less than 30 mL/hr
12. A female college student has had a melanoma of the forehead surgically removed and given a
course of chemotherapy. Which comment demonstrates an understanding of the treatments
and prognosis?
a.
“Why did you bring me this shampoo? You guys took all my hair, so I don’t have
anything to wash or fix.”
b.
“Why don’t my friends from school come to visit? Did you tell them to stay
away?”
c.
“My spring dance is only 3 weeks away. Do you think I could find a wig to cover
my head where the hair fell out from the chemo?”
d.
“Well, this looks like the end of the problem for me, thank goodness! I won’t have
to bother that doctor again until I graduate in a couple of years because all my
shots must be up to date now.”
13. A patient whose cancer has been staged at T4 N2 M2 has been assigned for care. What is the
best interpretation of this staging information in planning care for this patient?
a.
The primary tumor has shrunk, although some lymph nodes remain involved.
Teach the patient that this is good news.
b.
The primary tumor has now responded to a combination of chemotherapy and
radiation. The patient should now receive much less analgesic medication.
c.
The primary tumor is quite large and has extended to lymph glands and distant
areas. Gentle touch and therapeutic listening will be especially helpful.
d.
After the series of radiation treatments, the distant metastases are still present.
Prepare the patient to accept only the cure of the primary tumor.
14. Which symptom reported by a patient taking doxorubicin (Adriamycin) should be considered
a priority for intervention?
a.
Nausea
b.
Visual disturbances
c.
Headache and dizziness
d.
Rapid heartbeat
15. A diagnosis of breast cancer is first made at stage T1 N0 M0. Which nursing diagnosis would
be appropriate?
a.
“Risk for disturbed body image, related to threats of anticipated changes.”
b.
“Risk of anxiety, related to outcome of treatments.”
c.
“Risk for infection, related to decreased white blood cell count.”
d.
“Risk for ineffective coping, related to husband’s expectations regarding
anticipated treatments.”
16. What is the most common site of cancer in adult women?
a.
Breast
b.
Lung
c.
Kidney
d.
Uterus
17. Which complaint should a nurse consider a warning sign for cancer?
a.
Intense pain in an area such as a hip or groin after carrying several gallons of paint
up a ladder and painting the garage
b.
Persistent indigestion associated with difficulty swallowing
c.
Diarrhea that lasts 2 days after an all-day picnic at the beach
d.
A painful lump under the umbilicus that recedes when pushed but comes out again
with a sneeze or hard cough
18. What is the most common site of cancer in adult men?
a.
Colon
b.
Lung
c.
Pancreas
d.
Prostate
19. Which patient assessment should lead a nurse to conclude a patient diagnosed with cancer is
beginning the acceptance stage?
a.
Begins to act in a cheerful manner
b.
Inquires about support groups
c.
Cries over loss of health
d.
Actively interacts with his or her family
20. A family is concerned about the possibility of addiction as a result of the frequent doses of
Roxanol. What is the nurse’s best response?
a.
“At this stage, addiction is the least of our worries.”
b.
“This is a low–dose drug, and it controls pain without the problems of addiction.”
c.
“Addiction is rare, but we have drugs that can counteract the effect of this
narcotic.”
d.
“You may want to share your concerns with the physician. He can order another
drug that is not addictive.”
21. Which cytologic test, usually performed in outpatient settings, suggests the probability of a
need for further testing for cancer cells?
a.
Chest radiography
b.
Koch test
c.
Papanicolaou (Pap) test
d.
Tine test
22. What is the cause of cell death when a patient receives radiation as a treatment for cancer?
a.
Separation of the cell from normal cells
b.
Damage of the cell membrane
c.
Alteration of the DNA of the cell
d.
Reduction of cell nutrition
23. What is the best menu choice for a patient with nausea who is undergoing radiation treatments
every other day?
a.
Bowl of vegetable soup, chopped egg and pickle sandwich on wheat bread, one
apple, and 8 oz of orange juice
b.
Broiled chicken with rice, 1-oz slice of plain American cheese, one-quarter cup of
spinach, one-half ripe banana, and 8 oz of grape juice
c.
Spanish rice, one-half cup of mixed green salad, one-half cup of canned peaches,
and 8 oz of Coke
d.
Spaghetti with tomato sauce, cheddar cheese toast strips, six celery sticks with
peanut butter, and 8 oz of whole milk
24. A patient is close to death with terminal liver cancer with widespread metastases and calls the
nursing staff to his room every 5 minutes. Which interventions will be most supportive and in
the best interest of the patient?
a.
Encourage and insist that the family request a transfer to hospice care because the
general hospital does not have enough staff members to keep responding to the
patient’s end-stage frequent calling and requests for minor help.
b.
Use fixed interval and cocktail medication administration. Frequently evaluate for
breakthrough pain and anxieties. Answer the call bell quickly on the intercom or in
person.
c.
Tell the family that as of this afternoon, all of the patient’s questions, comments,
and expressed fears of dying and financial worries will be referred to the social
worker, physician, or clergy. Otherwise, one of them can come in and sit beside
the bed.
d.
Plan to limit strictly the time spent with the patient because the nurse cannot do
much that could be beneficial at this point.
25. Which statement by a patient should lead the nurse to conclude that the precolonoscopy
instruction provided has been effective?
a.
“I know that the lighted tube he will use will help the doctor look at my tumor, and
he might take a small piece of tissue to look at in the lab.”
b.
“I know that the light on the tube will help cure my cancer.”
c.
“I know the colonoscopy is very painful and embarrassing, and I hope no one sees
me in that position.”
d.
“My daughter is coming in to see me today. I am glad to be looking forward to
something pleasant.”
MULTIPLE RESPONSE
1. Which conditions of middle-aged persons promote the formation of malignant cells? (Select
all that apply.)
a.
Childbearing
b.
Increasing age
c.
Hormonal changes
d.
Chronic irritation of tissue
e.
Diet
2. What recommendations should a nurse make to a visitor of a patient who has an internal
radiation implant? (Select all that apply.)
a.
Avoid visitation if you are pregnant.
b.
Take off all metals, such as your watch and belt.
c.
Limit your visitation time.
d.
Wear a protective lead apron.
e.
Stay at least 6 feet away from bedside.
3. Why is adjuvant therapy given to patients with cancer who are free of signs of the disease?
(Select all that apply.)
a.
Ensures eradication of undetected cells
b.
Stabilizes normal cells
c.
Diminishes recurrence of breast cancer
d.
Reduces the extent of the tumor before surgery or radiation
e.
Changes the pH of the system to inhibit cell growth
4. What action should a nurse implement if an intravenous vesicant cancer drug has
extravasated? (Select all that apply.)
a.
Place a warm compress on the area.
b.
Chill the area with an ice pack.
c.
Raise the patient’s arm above the level of the heart.
d.
Stop the infusion.
e.
Notify the charge nurse.
5. When is surgical remedy for cancer most successful? (Select all that apply.)
a.
Cancer is detected early.
b.
The tumors are fast growing.
c.
Cancer cells have invaded only a nonvital structure.
d.
Lymph glands have not been involved.
e.
Cancer cells are confined to only two areas.
COMPLETION
1. A nurse clarifies that cells that change from their tissues of origin and have multiple nuclei are
categorized as _____.
2. Radiation is now measured in GRAY rather than RADS. One GRAY is equal to _____
RADS.
OTHER
1. List the tumors in order based on the following tissue of origin: 1, fat; 2, fibrous; 3, smooth
muscle; 4, glands; 5, bone. (Separate letters by a comma and space as follows: A, B, C, D.)
A. Sarcoma
B. Lipoma
C. Leiomyoma
D. Fibroma
E. Carcinoma
