Chapter: Chapter 16: Oncology: Nursing Management in Cancer Care

Multiple Choice

1. The school health nurse is presenting a health-promotion class to a group of middle-school students. Which is the best intervention to address health-promotion strategies related to the leading cause of cancer deaths in North America?A) Monthly self-breast examsB) Smoking cessationC) Annual colonoscopiesD) Monthly testicular exams

Ans: BChapter: 16Client Needs: BCognitive Level: AnalysisDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 4Page and Header: 337, Epidemiology of Cancer

Feedback: Cancer is second only to cardiovascular disease as a leading cause of death in the United States. Although the numbers of cancer deaths have decreased slightly, more than 560,000 Americans were expected to die from a malignant process in 2008. The leading causes of cancer death in the United States, in order of frequency, are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women, so smoking cessation is the health promotion initiative directly related to lung cancer. Therefore, the other options are incorrect.

2. You are the clinic nurse in an oncology clinic. Your patient arrives for a 2-month follow-up appointment following chemotherapy. You note that the patient's skin appears yellow. Which blood tests should be done to further explore this clinical sign?A) Liver function testB) CBCC) Platelet countD) Electrolytes

Ans: AChapter: 16Client Needs: D-4Cognitive Level: AnalysisDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 7Page and Header: 391, Cancer Survivorship

Feedback: Surveillance for cancer spread, recurrence, or second cancers: colonoscopy post colon cancer, mammography post breast cancer, Liver function tests post colon cancer, prostate-specific antigen post prostate cancer. Yellow skin is a sign of jaundice. The liver is a common organ affected by metastatic disease. A liver function test should be done to determine if the liver is functioning. Option B is incorrect; a CBC would show an altered white blood cell count indicating possible infection. Option C is incorrect; a platelet count tells whether the blood sample has an adequate number of platelets, necessary for blood clotting. Option D is incorrect; a blood test for electrolytes would not identify the cause of the jaundice.

3. You are teaching a nutrition class in the local high school. One student tells you that he has heard that certain foods can increase the incidence of cancer. You respond, Research has shown that certain foods appear to increase the risk of cancer. Which of the following menu selections would be the best choice for reducing the risks of cancer?A) Smoked salmon and green beansB) Pork chops and fried green tomatoesC) Baked apricot chicken and steamed broccoliD) Liver, onions, and steamed peas

Ans: CChapter: 16Client Needs: BCognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 3Page and Header: 341, Pathophysiology of the Malignant Process

Feedback: High-fiber foods; cruciferous vegetables, such as broccoli, cauliflower, and spinach; and carotenoids, such as apricots and peaches, appear to reduce cancer risk. Salt-cured foods, such as ham and processed luncheon meats, should be avoided. Options B and D are incorrect as they do not contain cruciferous vegetables.

4. Traditionally, nurses have been involved with tertiary prevention with their cancer patients. However, emphasis is also placed on both primary and secondary prevention. What would be an example of primary prevention?A) Yearly Papanicolaou testsB) Testicular self-examinationC) Teaching patients to wear sunscreenD) Screening mammogram

Ans: CChapter: 16Client Needs: BCognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 4Page and Header: 343, Detection and Prevention of Cancer

Feedback: Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as use of sunscreen. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Papanicolaou tests, mammograms, and testicular exams.

5. You are caring for a 39-year-old woman with a family history of breast cancer. She has requested a breast tumor marking test and the results are positive. The patient is requesting a bilateral mastectomy. What is this surgery an example of?A) Salvage surgeryB) Palliative surgeryC) Prophylactic surgeryD) Reconstructive surgery

Ans: CChapter: 16Client Needs: D-3Cognitive Level: ApplicationDifficulty: DifficultIntegrated Process: Nursing ProcessObjective: 5Page and Header: 348, Management of Cancer

Feedback: Prophylactic surgery is used when there is an extensive family history and nonvital tissues are removed. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect.

6. You are caring for a patient who is to begin receiving external radiation for a malignant tumor of the head and neck. While doing patient education, what side effects should the nurse discuss with the patient that should be assessed because of the radiation treatment?A) Impaired nutritional statusB) Pink oral mucosaC) DiarrheaD) Alopecia

Ans: AChapter: 16Client Needs: D-4Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 6Page and Header: 351, Management of Cancer

Feedback: Alterations in oral mucosa, change and loss of taste, pain, and dysphasia often occur as a result of radiotherapy to the head and neck. The patient is at an increased risk of impaired nutritional status. Option B is incorrect; the oral mucosa is normally pink. Options C and D are incorrect; diarrhea and alopecia are not concerns for this patient.

7. While a patient is receiving intravenous doxorubicin hydrochloride, the nurse observes that there is swelling and pain at the IV site. The nurse shouldA) stop the administration of the drug immediately.B) notify the patient's physician.C) continue to administer but decrease the rate of infusion.D) apply a warm compress to the site.

Ans: AChapter: 16Client Needs: D-2Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 7Page and Header: 355, Management of Cancer

Feedback: Doxorubicin hydrochloride is a chemotherapeutic vessicant that can cause severe tissue damage. The nurse should stop the administration of the drug immediately and then notify the patient's physician. Ice can be applied to the site once the drug therapy has stopped.

8. A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment. The patient asks the nurse what the most common side effect of chemotherapy is. What would be the best answer the nurse could give?A) AlopeciaB) Nausea and vomitingC) Altered glucose metabolismD) Increased appetite

Ans: BChapter: 16Client Needs: D-2Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 7Page and Header: 356, Management of Cancer

Feedback: Nausea and vomiting are the most common side effects of chemotherapy and may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these patients. Other side effects include bone marrow suppression, anorexia, vaginal dryness, and hair loss. Less common effects include altered glucose metabolism and jaundice.

9. Your patient is receiving carmustine, a chemotherapy agent. A significant side effect of this medication is thrombocytopenia. Which symptom would the nurse assess for in patients at risk for thrombocytopenia?A) Interrupted sleep patternB) Hot flashesC) Nose bleedD) Increased weight

Ans: CChapter: 16Client Needs: D-4Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 7Page and Header: 357, Management of Cancer

Feedback: Patients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. A priority goal for this patient is to prevent trauma related to decreased platelet count. A soft toothbrush or an electric razor can be used. No invasive procedures should be performed. Patients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight.

10. You are orienting a new nurse to the oncology unit where you work. As you prepare to administer an antineoplastic agent to a one of your patients, what should you teach the new nurse about antineoplastic agents?A) Administer only prepackaged agents from the manufacturerB) Wash hands and arms following administrationC) Use gloves and a lab coatD) Dispose of the antineoplastic wastes in the hazardous waste receptacle

Ans: DChapter: 16Client Needs: A-2Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 7Page and Header: 353, Management of Cancer

Feedback: The nurse should use surgical gloves and disposable long-sleeved gowns when administering antineoplastic agents. The antineoplastic wastes are disposed of as hazardous materials. Option A is incorrect; you do not administer only prepackaged agents from the manufacturer. Option B is incorrect; this is a valid answer, but you wash your hands and arms before and after administering the medication.

11. You are a nurse working on a bone marrow transplant unit. Your patient is scheduled to receive a bone marrow transplant. What information will you provide to the patient's visitors?A) Bring plants to improve air quality.B) Take the patient to the cafeteria for meals.C) Wear hospital scrubs when entering the patient's room.D) Do not visit if you've had a recent infection.

Ans: DChapter: 16Client Needs: A-2Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 6Page and Header: 360, Management of Cancer

Feedback: Before engraphment, patients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they've had a recent illness or vaccination. Plants should not be brought to the BMT patient. The patient cannot go to the cafeteria for meals. Disposable hospital gowns are worn when entering the patient's room.

12. The nursing instructor is teaching a class in oncology nursing to her junior nursing students. The instructor is aware that infection is a significant consideration when providing care to an oncology patient. The leading cause of death in an oncology patient is infection caused by what?A) MalnutritionB) Impaired skin integrityC) Poor hygieneD) Broken oral mucosa

Ans: BChapter: 16Client Needs: A-2Cognitive Level: AnalysisDifficulty: DifficultIntegrated Process: Nursing ProcessObjective: 7Page and Header: 377, Nursing Care of Patients with Cancer

Feedback: Nursing care for patients with skin reactions includes maintaining skin integrity, cleansing the skin, promoting comfort, reducing pain, preventing additional trauma, and preventing and managing infection. Option A is incorrect; malnutrition in oncology patients may be present, but it is not the leading cause of death. Option C is incorrect; oncology patients do not have poor hygiene at a rate any higher than other patients, and it does not cause death. Option D is incorrect; broken oral mucosa may be an avenue for infection, but it is not the leading cause of death in an oncology patient.

Multiple Selection

13. You are the nurse caring for an adult patient who has developed a mild oral yeast infection following chemotherapy. What should you encourage the patient to do? (Mark all that apply.)A) Use a lip lubricantB) Scrub the tongue with a firm-bristled toothbrushC) Use dental floss every 24 hoursD) Rinse the mouth with normal salineE) Eat hot foods to aid in killing the yeast

Ans: A, C, DChapter: 16Client Needs: D-1Cognitive Level: ApplicationDifficulty: DifficultIntegrated Process: Teaching/LearningObjective: 7Page and Header: 377, Nursing Care of Patients with CancerFeedback: Stomatitis is an inflammation of the oral cavity. The patient should be encouraged to brush the teeth with a soft toothbrush after meals, use dental floss every 24 hours, rinse with normal saline, and use a lip lubricant. Mouthwashes and hot foods should be avoided.

Multiple Choice

14. The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for engraphment for a bone marrow transplant. What is a priority nursing diagnosis for this patient?A) Fatigue and activity intoleranceB) Altered nutrition: less than body requirements due to anorexiaC) Risk for infection related to altered immunologic responseD) Body image disturbance related to weight loss and anorexia

Ans: CChapter: 16Client Needs: D-2Cognitive Level: ApplicationDifficulty: DifficultIntegrated Process: Nursing ProcessObjective: 8Page and Header: 366, Nursing Care of Patients with Cancer

Feedback: A priority nursing diagnosis for this patient is risk for infection related to altered immunologic response. Because the patient's immunity is suppressed, he or she will be at a high risk for infection. Options A, B, and D all are valid nursing diagnoses, but they are not as much of a priority as is risk for infection.

15. The nursing instructor is discussing the care of oncology patients with her junior nursing students. The instructor presents this scenario: An oncology patient develops erythema following radiation therapy. What should the nurse instruct the patient to do?A) Apply ice to the area.B) Keep the area cleanly shaven.C) Apply petroleum ointment to the affected area.D) Avoid using soap on the area of treatment.

Ans: DChapter: 16Client Needs: D-3Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 6Page and Header: 368, Nursing Care of Patients with Cancer

Feedback: Care to the affected area must focus on preventing further skin irritation, drying, and damage. Soaps, petroleum ointment, and shaving the area could worsen the erythema. Ice is also contraindicated.

16. You are caring for a patient has just been given a 6-month prognosis. The patient states that he would like to die at home. The patient's care needs are unable to be met in a home environment. What might you suggest as an alternative?A) Discuss a referral for rehabilitation hospitalB) Panel the patient for a personal care homeC) Discuss a referral for acute careD) Discuss a referral for hospice care

Ans: DChapter: 16Client Needs: D-1Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: CaringObjective: 10Page and Header: 386, Nursing Care of Patients with Cancer

Feedback: Hospice care can be provided in several settings. Because of the high cost associated with free-standing hospices, care is often delivered by coordinating services provided by both hospitals and the community. The primary goal of hospice care is to provide support to the patient and family. Patients who are referred to hospice care generally have less than 6 months to live. Option A is incorrect; a rehabilitation hospital is inappropriate at this time. Option B is incorrect; this is a distracter for this test question. Option C is incorrect; again, this is an inappropriate referral for this patient.

17. The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient?A) These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and X-ray studies.B) These symptoms are part of your disease and can't be helped.C) Don't be concerned about these symptoms. Everybody feels this way after having radiation therapy.D) This is a good sign. It means that only the cancer cells are dying.

Ans: AChapter: 16Client Needs: D-4Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 6Page and Header: 380, Nursing Care of Patients with Cancer

Feedback: Fatigue and weakness result from radiation treatment and usually don't represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the patient and shouldn't be belittled. Radiation destroys both cancerous and normal cells.

18. A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that the patient is meeting the goal of improved body image and self-esteem?A) The patient requests that her family bring her makeup and wig.B) The patient begins to discuss the future with her family.C) The patient reports less disruption from pain and discomfort.D) The patient cries openly when discussing her disease.

Ans: AChapter: 16Client Needs: CCognitive Level: AnalysisDifficulty: DifficultIntegrated Process: Nursing ProcessObjective: 7Page and Header: 382, Nursing Care of Patients with Cancer

Feedback: Requesting her wig and makeup indicates that the patient with alopecia is becoming interested in looking her best and that her body image and self-esteem may be improving. The other options may indicate that other nursing goals are being met, but they don't assess improved body image and self-esteem.

19. Adverse effects to chemotherapy are dealt with by patients and their caregivers every day. What would the nurse do to combat the most common adverse effects of chemotherapy?A) Administer an antiemeticB) Administer an antimetaboliteC) Administer a tumor antibioticD) Administer an anticoagulant

Ans: AChapter: 16Client Needs: D-2Cognitive Level: ApplicationDifficulty: EasyIntegrated Process: Nursing ProcessObjective: 7Page and Header: 357, Management of Cancer

Feedback: Antiemetics are used to treat nausea and vomiting, the most common adverse effects of chemotherapy. Antihistamines and certain steroids are also used to treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli.

20. A 58-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic?A) Smoking is the reason you're here.B) The doctor left orders for you not to smoke.C) You're anxious about the surgery. Do you see smoking as helping?D) Smoking is OK right now, but after your surgery it's contraindicated.

Ans: CChapter: 16Client Needs: CCognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Communication and DocumentationObjective: 3Page and Header: 349, Management of Cancer

Feedback: This acknowledges the patient's feelings and encourages him to assess his previous behavior. Option A belittles the patient. Option B does not address the patient's anxiety. Option D would be highly detrimental to this patient.

21. The nursing instructor is discussing the difference between normal cells and cancer cells with the prenursing class in pathophysiology. What would the instructor cite as a characteristic of a cancer cell?A) Malignant cells contain more fibronectin.B) The cell membrane of malignant cells also contains proteins called tumor-specific antigens.C) Chromosomes are commonly found to be strong.D) Nuclei of cancer cells are large and regularly shaped.

Ans: BChapter: 16Client Needs: D-4Cognitive Level: KnowledgeDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 1Page and Header: 338, Pathophysiology of the Malignant Process

Feedback: The cell membranes are altered in cancer cells, which affect fluid movement in and out of the cell. The cell membrane of malignant cells also contains proteins called tumor-specific antigens. Malignant cellular membranes also contain less fibronectin, a cellular cement. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism). Fragility of chromosomes is commonly found when cancer cells are analyzed.

22. The staff educator is giving a class on oncology nursing for a group of nurses new to the unit. What is the most common mechanism of metastasis of cancer cells?A) Hematologic spreadB) Lymphatic circulationC) InvasionD) Angiogenisis

Ans: BChapter: 16Client Needs: D-4Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 1Page and Header: 339, Pathophysiology of the Malignant Process

Feedback: Lymph and blood are key mechanisms by which cancer cells spread. Lymphatic spread (the transport of tumor cells through the lymphatic circulation) is the most common mechanism of metastasis.

Multiple Selection

23. You are giving a report in your pathophysiology class. The subject of your report is cancer cells. In differentiating between benign and malignant cells, what characteristics would you cite? (Mark all that apply.)A) Rate of growthB) Ability to cause deathC) Size of cellsD) Cell contentsE) Ability to spread

Ans: A, B, EChapter: 16Client Needs: D-4Cognitive Level: ApplicationDifficulty: EasyIntegrated Process: Teaching/LearningObjective: 2Page and Header: 338, Pathophysiology of the Malignant ProcessFeedback: Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant; option D is incorrect; cell contents are basically the same but they act differently.

Multiple Choice

24. The nursing instructor is discussing benign versus malignant cells in the pathophysiology class. What distinguishes malignant cells from benign cells of the same tissue type?A) Slow rate of mitosis of cancer cellsB) Proteins in the cell membraneC) Size of cellsD) Stability of cells

Ans: BChapter: 16Client Needs: D-4Cognitive Level: KnowledgeDifficulty: EasyIntegrated Process: Nursing ProcessObjective: 2Page and Header: 338, Pathophysiology of the Malignant Process

Feedback: The cell membrane of malignant cells also contains proteins called tumor-specific antigens (eg, carcinoembryonic antigen [CEA] and prostate-specific antigen [PSA]), which develop over time as the cells become less differentiated (mature). These proteins distinguish malignant cells from benign cells of the same tissue type.

25. Malignant disease processes have the ability to spread from one organ to another throughout the body. What is one means malignant disease processes transfer cells from one place to another?A) Adhering to primary tumor cellsB) Causing mutation of cells of another organC) Phagocytizing healthy cellsD) Invading host tissues

Ans: DChapter: 16Client Needs: D-4Cognitive Level: ComprehensionDifficulty: EasyIntegrated Process: Nursing ProcessObjective: 2Page and Header: 339, Pathophysiology of the Malignant Process

Feedback: Invasion, which refers to the growth of the primary tumor into the surrounding host tissues, occurs in several ways. Malignant cells are less likely to adhere than are normal cells. Malignant cells do not cause healthy cells to mutate. Malignant cells do not eat other cells.

Multiple Selection

26. You are doing an initial assessment of a patient newly diagnosed with cancer. The patient tells you that he drinks about a quart of scotch every evening. What types of cancer does this put him at risk for? (Mark all that apply.)A) Pancreatic cancerB) Brain cancerC) Breast cancerD) Esophageal cancerE) Liver cancer

Ans: C, D, EChapter: 16Client Needs: D-4Cognitive Level: ComprehensionDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 3Page and Header: 341, Pathophysiology of the Malignant ProcessFeedback: Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods, and red and processed meats. Alcohol increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast.

Multiple Choice

27. You are the clinic nurse caring for a patient whose grandmother, mother, and sister all had breast cancer. She has requested a screening test to determine her risk of developing breast cancer, and it has come back positive. The patient asks you what she can do to help prevent breast cancer from occurring. What would be your best response?A) Research has shown that eating a healthy diet can reduce your chance of breast cancer.B) Research has shown that taking tamoxifen can reduce your chance of breast cancer.C) Research has shown that exercising at least 30 minutes every day can reduce your chance of breast cancer.D) Research has shown that reducing your intake of red meat can reduce your chance of breast cancer.

Ans: BChapter: 16Client Needs: BCognitive Level: AnalysisDifficulty: DifficultIntegrated Process: Teaching/LearningObjective: 4Page and Header: 343, Detection and Prevention of Cancer

Feedback: Large-scale breast cancer prevention studies supported by the National Cancer Institute (NCI) indicated that chemoprevention with the medication tamoxifen can reduce the incidence of breast cancer by 50% in women at high risk for breast cancer. Options A, C, and D are good answers, but they are not the best answer.

28. You are a part of a team of nurses that is developing an educational program entitled Cancer: Its Risks and What You Can Do About It. This program is an example of what?A) Primary preventionB) Risk reductionC) Secondary preventionD) Tertiary prevention

Ans: CChapter: 16Client Needs: BCognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 4Page and Header: 343, Detection and Prevention of Cancer

Feedback: Nurses in all settings can develop programs that identify risks for patients and families and that incorporate teaching and counseling into all educational efforts, particularly for patients and families with a high incidence of cancer. Primary prevention is concerned with reducing the risks of disease through health promotion strategies. Tertiary prevention is the care and rehabilitation of the patient after having been diagnosed with cancer. Option B is incorrect; the program itself does not reduce the risk of cancer.

29. What is a minimally invasive surgical approach that is diagnostic for cancer and has, in some instances, replaced lymph node dissections?A) LymphadenectomyB) Needle biopsyC) Open biopsyD) Sentinel lymph node biopsy

Ans: DChapter: 16Client Needs: D-4Cognitive Level: ComprehensionDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 5Page and Header: 346, Management of Cancer

Feedback: Sentinel lymph node biopsy (SLNB), also known as sentinel lymph node mapping, is a minimally invasive surgical approach that, in some instances, has replaced more invasive lymph node dissections (lymphadenectomy) and their associated complications such as lymphedema and delayed healing. SLNB has been widely adopted for regional lymph node staging in selected cases of melanoma and breast cancer. Options B and C are incorrect.

30. You are caring for a patient who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the patient the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer?A) PalliativeB) ReconstructiveC) SalvageD) Prophylactic

Ans: AChapter: 16Client Needs: D-4Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 5Page and Header: 348, Management of Cancer

Feedback: When cure is not possible, the goals of treatment are to make the patient as comfortable as possible and to promote quality of life as defined by the patient and his or her family. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk to develop cancer.

31. You are caring for a patient with an advanced stage of breast cancer. The cancer has metastasized. You enter the room and find the patient struggling to breath. You note that this patient's jugular veins are distended. What would you suspect is happening with this patient?A) Increased intracranial pressureB) Superior vena cava syndrome (SVCS)C) Spinal cord compressionD) Metastatic tumor of the neck

Ans: BChapter: 16Client Needs: D-4Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 9Page and Header: 387, Nursing Care of Patients with Cancer

Feedback: Superior vena cava syndrome (SVCS) occurs when there is gradual or sudden impaired venous drainage giving rise to progressive shortness of breath (dyspnea), cough, hoarseness, chest pain, and facial swelling; edema of the neck, arms, hands, and thorax and reported sensation of skin tightness and difficulty swallowing; as well as possibly engorged and distended jugular, temporal, and arm veins. Option A is incorrect; increased intracranial pressure may be a part of SVCS, but it is not what is causing the patient's symptoms. Option C is incorrect; the scenario does not mention a problem with the patient's spinal cord. Option D is incorrect; the scenario says that the cancer has metastasized but not that it has metastasized to the neck.

32. You are a hospice nurse caring for a patient with cancer in her home. You have explained to the patient and the family that the patient is at risk for hypercalcemia. You have educated them on that signs and symptoms of hypercalcemia. What else would you teach this patient and family to do to reduce the risk of hypercalcemia?A) Stool softeners are contraindicated.B) Laxatives should be taken daily.C) Consume 2 to 4 L of fluid daily.D) Restrict calcium intake.

Ans: CChapter: 16Client Needs: D-4Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 9Page and Header: 388, Nursing Care of Patients with Cancer

Feedback: Identify patients at risk for hypercalcemia and assess for signs and symptoms of hypercalcemia. Educate the patient and family; prevention and early detection can prevent fatality. Teach at-risk patients to recognize and report signs and symptoms of hypercalcemia. Encourage patients to consume 2 to 4 L of fluid daily unless contraindicated by existing renal or cardiac disease. Explain the use of dietary and pharmacologic interventions such as stool softeners and laxatives for constipation. Advise patients to maintain nutritional intake without restricting normal calcium intake.

Multiple Selection

33. You are caring for an oncology patient at risk for disseminated intravascular coagulation (DIC). What would be the appropriate care for this patient? (Mark all that apply.)A) Assist patient to turn, cough, and deep breatheB) Accurate I & OC) Prevent bleedingD) Assess hearing disturbancesE) Maximize physical activity

Ans: A, B, CChapter: 16Client Needs: D-3Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: CaringObjective: 11Page and Header: 389, Nursing Care of Patients with CancerFeedback: Nursing care of the patient in DIC: Monitor vital signs. Measure and document intake and output. Assess skin color and temperature; lung, heart, and bowel sounds; level of consciousness; headache; visual disturbances; chest pain; decreased urine output; and abdominal tenderness. Inspect all body orifices, tube-insertion sites, incisions, and bodily excretions for bleeding. Review laboratory test results. Minimize physical activity to decrease injury risks and oxygen requirements. Prevent bleeding; apply pressure to all venipuncture sites, and avoid nonessential invasive procedures; provide electric rather than straight-edged razors; avoid tape on the skin and advise gentle but adequate oral hygiene. Assist the patient to turn, cough, and take deep breaths on a regular schedule. Reorient the patient, if needed; maintain a safe environment; and provide appropriate patient education and supportive measures. Option D is incorrect; hearing disturbances would be important to assess for.

Multiple Choice

34. You are a home health nurse caring for an oncology patient discharged home 3 days ago after completing therapy. What would you assess the patient for?A) Tumor lysis syndromeB) Syndrome of inappropriate antiduretic hormoneC) Disseminated intravascular coagulationD) Hypercalcemia

Ans: AChapter: 16Client Needs: D-3Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 11Page and Header: 390, Nursing Care of Patients with Cancer

Feedback: Nursing care for tumor lysis syndrome: identify at-risk patients, including those in whom tumor lysis syndrome may develop up to 1 week after therapy has been completed. Institute essential preventive measures (eg, fluid hydration and allopurinol). Assess patients for signs and symptoms of electrolyte imbalances. Assess urine pH to confirm alkalization. Monitor serum electrolyte and uric acid levels for evidence of fluid volume overload secondary to aggressive hydration. Instruct patients to report symptoms indicating electrolyte disturbances. Options B, C, and D are incorrect.

35. You are admitting an oncology patient to your unit prior to surgery. The patient has just finished radiation therapy. What does this put your patient at increased risk for?A) Nutritional deficitB) Impaired wound healingC) Cardiac tamponadeD) Tumor lysis syndrome

Ans: BChapter: 16Client Needs: D-4Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 9Page and Header: 348, Management of Cancer

Feedback: Combining other treatment methods, such as radiation and chemotherapy, with surgery also contributes to postoperative complications, such as infection, impaired wound healing, altered pulmonary or renal function, and the development of deep vein thrombosis.

36. Your patient has just returned from the PACU after salvage surgery for renal carcinoma. What would you assess this patient for?A) VasoconstrictionB) AnorexiaC) Wound dehiscenceD) Metastasis to the brain

Ans: CChapter: 16Client Needs: D-3Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 9Page and Header: 349, Management of Cancer

Feedback: Postoperatively, the nurse assesses the patient's responses to the surgery and monitors the patient for possible complications, such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid and electrolyte imbalance, and organ dysfunction. Options A, B, and D are incorrect. Vasoconstriction, anorexia, and metastasis to the brain are all things you would assess for even if your patient had not just returned from salvage surgery.

37. You have just admitted a new patient to the hospice program you work for. While you are doing the initial assessment, a family member states, my sister just won't talk to any of us about what is happening to her. What should you do?A) Strive to facilitate communication between the family and health care providers.B) Strive to facilitate communication between the patient and health care providers.C) Strive to facilitate communication between family members and yourself.D) Strive to facilitate communication among family members.

Ans: DChapter: 16Client Needs: D-4Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Communication and DocumentationObjective: 10Page and Header: 391, Nursing Care of Patients with Cancer

Feedback: Hospice programs strive to facilitate clear communication among family members and health care providers.

38. What is the most important focus of hospice care?A) Focus of care is on the family as well as the patient.B) Focus of care is on the patient centrally and the family peripherally.C) Focus of care is solely on the patient.D) Focus of care emotionally is totally on the family.

Ans: AChapter: 16Client Needs: D-4Cognitive Level: ComprehensionDifficulty: EasyIntegrated Process: Nursing ProcessObjective: 10Page and Header: 386, Nursing Care of Patients with Cancer

Feedback: The focus of hospice care is on the family as well as the patient. Therefore options B, C, and D are incorrect.

39. You are caring for a 14-year-old female patient with leukemia. She has developed alopecia due to treatment for the leukemia. What would be an expected outcome found on her plan of care?A) Maintains adequate hydrationB) Interacts and socializes with othersC) Verbalizes positive self-awarenessD) Maintains academic standing in school

Ans: BChapter: 16Client Needs: D-4Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: CaringObjective: 8Page and Header: 377, Nursing Care of Patients with Cancer

Feedback: Expected outcomes of the nursing diagnosis impaired tissue integrity: alopecia identifies alopecia as potential side effect of treatment. Maintains hygiene and grooming. Interacts and socializes with others. Option A is incorrect; the scenario does not indicate the patient is at risk for inadequate hydration. Option C is incorrect; you would want the patient to verbalize a positive self-image, not self-awareness. During treatment for leukemia, it would be nice to maintain academic standing, but it would not be on the care plan at this time.

40. You are the clinic nurse caring for a patient who was just told he was cancer free at 5 years after diagnosis. The patient has been told he is a cancer survivor. What is cancer survivorship?A) The period just after being pronounced cancer-free 5 years after being diagnosedB) The time during which the patient lives with an active diagnosis of cancerC) A phase of cancer care that comes after primary treatment and lasts until cancer recurrence or the end of lifeD) The end of cancer care

Ans: CChapter: 16Client Needs: BCognitive Level: ComprehensionDifficulty: EasyIntegrated Process: Teaching/LearningObjective: 8Page and Header: 391, Cancer Survivorship

Feedback: Cancer survivorship refers to a distinct phase of cancer care that follows primary treatment for cancer and lasts until cancer recurrence or end of life.