Deck 15: Management of Patients With Oncologic Disorders

Question 1

The public health nurse is presenting a health-promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America?

A) Monthly self-breast exams
B) Smoking cessation
C) Annual colonoscopies
D) Monthly testicular exams

Answer 1

Smoking cessation

Question 2

A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the patients skin appears yellow. Which blood tests should be done to further explore this clinical sign?

A) Liver function tests (LFTs)
B) Complete blood count (CBC)
C) Platelet count
D) Blood urea nitrogen and creatinine

Answer 2

Liver function tests (LFTs)

Question 3

The school nurse is teaching a nutrition class in the local high school. One student states that he has heard that certain foods can increase the incidence of cancer. The nurse responds, Research has shown that certain foods indeed appear to increase the risk of cancer. Which of the following menu selections would be the best choice for potentially reducing the risks of cancer?

A) Smoked salmon and green beans
B) Pork chops and fried green tomatoes
C) Baked apricot chicken and steamed broccoli
D) Liver, onions, and steamed peas

Answer 3

Baked apricot chicken and steamed broccoli

Question 4

Traditionally, nurses have been involved with tertiary cancer prevention. However, an increasing emphasis is being placed on both primary and secondary prevention. What would be an example of primary prevention?

A) Yearly Pap tests
B) Testicular self-examination
C) Teaching patients to wear sunscreen
D) Screening mammograms

Question 5

The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery?

A) Salvage surgery
B) Palliative surgery
C) Prophylactic surgery
D) Reconstructive surgery

Question 6

The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient?

A) Impaired nutritional status
B) Cognitive changes
C) Diarrhea
D) Alopecia

Question 7

While a patient is receiving IV doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize what action?

A) Stopping the administration of the drug immediately
B) Notifying the patients physician
C) Continuing the infusion but decreasing the rate
D) Applying a warm compress to the infusion site

Question 8

A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe?

A) Pruritis (itching)
B) Nausea and vomiting
C) Altered glucose metabolism
D) Confusion

Question 9

A patient on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in patients at risk for thrombocytopenia?

A) Interrupted sleep pattern
B) Hot flashes
C) Epistaxis (nose bleed)
D) Increased weight

Question 10

The nurse is orienting a new nurse to the oncology unit. When reviewing the safe administration of antineoplastic agents, what action should the nurse emphasize?

A) Adjust the dose to the patients present symptoms.
B) Wash hands with an alcohol-based cleanser following administration.
C) Use gloves and a lab coat when preparing the medication.
D) Dispose of the antineoplastic wastes in the hazardous waste receptacle.

Question 11

A nurse provides care on a bone marrow transplant unit and is preparing a female patient for a hematopoietic stem cell transplantation (HSCT) the following day. What information should the nurse emphasize to the patients family and friends?

A) Your family should likely gather at the bedside in case theres a negative outcome.
B) Make sure she doesnt eat any food in the 24 hours before the procedure.
C) Wear a hospital gown when you go into the patients room.
D) Do not visit if youve had a recent infection.

Question 12

A nurse is creating a plan of care for an oncology patient and one of the identified nursing diagnoses is risk for infection related to myelosuppression. What intervention addresses the leading cause of infection-related death in oncology patients?

A) Encourage several small meals daily.
B) Provide skin care to maintain skin integrity.
C) Assist the patient with hygiene, as needed.
D) Assess the integrity of the patients oral mucosa regularly.

Question 13

You are caring for an adult patient who has developed a mild oral yeast infection following chemotherapy. What actions should you encourage the patient to perform? Select all that apply.

A) Use a lip lubricant.
B) Scrub the tongue with a firm-bristled toothbrush.
C) Use dental floss every 24 hours.
D) Rinse the mouth with normal saline.
E) Eat spicy food to aid in eradicating the yeast.

Question 14

The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for HSCT. What is a priority nursing diagnosis for this patient?

A) Fatigue related to altered metabolic processes
B) Altered nutrition: less than body requirements related to anorexia
C) Risk for infection related to altered immunologic response
D) Body image disturbance related to weight loss and anorexia

Question 15

An oncology nurse is caring for a patient who has developed erythema following radiation therapy. What should the nurse instruct the patient to do?

A) Periodically apply ice to the area.
B) Keep the area cleanly shaven.
C) Apply petroleum jelly to the affected area.
D) Avoid using soap on the treatment area.

Question 16

The nurse is caring for a patient has just been given a 6-month prognosis following a diagnosis of extensive stage small-cell lung cancer. The patient states that he would like to die at home, but the team believes that the patients care needs are unable to be met in a home environment. What might you suggest as an alternative?

A) Discuss a referral for rehabilitation hospital.
B) Panel the patient for a personal care home.
C) Discuss a referral for acute care.
D) Discuss a referral for hospice care.

Question 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 are an unfortunately inevitable part of living with cancer.
C) Try not to be concerned about these symptoms. Every patient feels this way after having radiation therapy.
D) Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying.

Question 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 she 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.

Question 19

A 50-year-old man diagnosed with leukemia will begin chemotherapy. What would the nurse do to combat the most common adverse effects of chemotherapy?

A) Administer an antiemetic.
B) Administer an antimetabolite.
C) Administer a tumor antibiotic.
D) Administer an anticoagulant.

Question 20

A 58-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest $\mathrm{x}$ -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 are here.
B) The doctor left orders for you not to smoke.
C) You are anxious about the surgery. Do you see smoking as helping?
D) Smoking is OK right now, but after your surgery it is contraindicated.

Question 21

An oncology nurse educator is providing health education to a patient who has been diagnosed with skin cancer. The patients wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite?

A) Malignant cells contain more fibronectin than normal body cells.
B) Malignant cells contain proteins called tumor-specific antigens.
C) Chromosomes contained in cancer cells are more durable and stable than those of normal cells.
D) The nuclei of cancer cells are unusually large, but regularly shaped.

Question 22

A patients most recent diagnostic imaging has revealed that his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the patients cancer cells spread?

A) Hematologic spread
B) Lymphatic circulation
C) Invasion
D) Angiogenesis

Question 23

The nurse is describing some of the major characteristics of cancer to a patient who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply.

A) Rate of growth
B) Ability to cause death
C) Size of cells
D) Cell contents
E) Ability to spread

Question 24

A 54-year-old has a diagnosis of breast cancer and is tearfully discussing her diagnosis with the nurse. The patient states, They tell me my cancer is malignant, while my coworkers breast tumor was benign. I just dont understand at all. When preparing a response to this patient, the nurse should be cognizant of what characteristic that distinguishes malignant cells from benign cells of the same tissue type?

A) Slow rate of mitosis of cancer cells
B) Different proteins in the cell membrane
C) Differing size of the cells
D) Different molecular structure in the cells

Question 25

An oncology patient will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another?

A) Adhering to primary tumor cells
B) Inducing mutation of cells of another organ
C) Phagocytizing healthy cells
D) Invading healthy host tissues

Question 26

The nurse is performing an initial assessment of an older adult resident who has just relocated to the long-term care facility. During the nurses interview with the patient, she admits that she drinks around 20 ounces of vodka every evening. What types of cancer does this put her at risk for? Select all that apply.

A) Malignant melanoma
B) Brain cancer
C) Breast cancer
D) Esophageal cancer
E) Liver cancer

Question 27

The clinic nurse is caring for a patient whose grandmother and sister have both had breast cancer. She
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 provide all the protection you need against breast cancer.
B) Research has shown that taking the drug 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 there is little you can do to reduce your risk of breast cancer if you have a genetic predisposition.

Question 28

A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity?

A) Disease prophylaxis
B) Risk reduction
C) Secondary prevention
D) Tertiary prevention

Question 29

A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The patient has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this patient most likely undergo?

A) Lymphadenectomy
B) Needle biopsy
C) Open biopsy
D) Sentinel node biopsy

Question 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) Palliative
B) Reconstructive
C) Salvage
D) Prophylactic

Question 31

The nurse is caring for a patient with an advanced stage of breast cancer and the patient has recently learned that her cancer has metastasized. The nurse enters the room and finds the patient struggling to breath and the nurses rapid assessment reveals that the patients jugular veins are distended. The nurse should suspect the development of what oncologic emergency?

A) Increased intracranial pressure
B) Superior vena cava syndrome (SVCS)
C) Spinal cord compression
D) Metastatic tumor of the neck

Question 32

The hospice nurse is caring for a patient with cancer in her home. The nurse has explained to the patient and the family that the patient is at risk for hypercalcemia and has educated them on that signs and symptoms of this health problem. What else should the nurse teach this patient and family to do to reduce the patients risk of hypercalcemia?

A) Stool softeners are contraindicated.
B) Laxatives should be taken daily.
C) Consume 2 to $4 \mathrm{~L}$ of fluid daily.
D) Restrict calcium intake.

Question 33

The home health nurse is performing a home visit for an oncology patient discharged 3 days ago after completing treatment for non-Hodgkin lymphoma. The nurses assessment should include examination for the signs and symptoms of what complication?

A) Tumor lysis syndrome (TLS)
B) Syndrome of inappropriate antiduretic hormone (SIADH)
C) Disseminated intravascular coagulation (DIC)
D) Hypercalcemia

Question 34

The nurse is admitting an oncology patient to the unit prior to surgery. The nurse reads in the electronic health record that the patient has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem?

A) Cognitive deficits
B) Impaired wound healing
C) Cardiac tamponade
D) Tumor lysis syndrome

Question 35

An oncology patient has just returned from the postanesthesia care unit after an open hemicolectomy. This patients plan of nursing care should prioritize which of the following?

A) Assess the patient hourly for signs of compartment syndrome.
B) Assess the patients fine motor skills once per shift.
C) Assess the patients wound for dehiscence every 4 hours.
D) Maintain the patients head of bed at 45 degrees or more at all times.

Question 36

The hospice nurse has just admitted a new patient to the program. What principle guides hospice care?

A) Care addresses the needs of the patient as well as the needs of the family.
B) Care is focused on the patient centrally and the family peripherally.
C) The focus of all aspects of care is solely on the patient.
D) The care team prioritizes the patients physical needs and the family is responsible for the patients emotional needs.

Question 37

A 60-year-old patient with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this patients subsequent plan of care?

A) Limit the time that visitors spend at the patients bedside.
B) Teach the patient to perform all aspects of basic care independently.
C) Assign male nurses to the patients care whenever possible.
D) Situate the patient in a shared room with other patients receiving brachytherapy.

Question 38

An oncology patient has begun to experience skin reactions to radiation therapy, prompting the nurse to make the diagnosis Impaired Skin Integrity: erythematous reaction to radiation therapy. What intervention best addresses this nursing diagnosis?

A) Apply an ice pack or heating pad PRN to relieve pain and pruritis
B) Avoid skin contact with water whenever possible
C) Apply phototherapy PRN
D) Avoid rubbing or scratching the affected area

Question 39

A patient with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location precludes the use of enteral feeding. What intervention should the nurse identify as best meeting this patients nutritional needs?

A) Administration of parenteral feeds via a peripheral IV
B) TPN administered via a peripherally inserted central catheter
C) Insertion of an NG tube for administration of feeds
D) Maintaining NPO status and IV hydration until treatment completion

Question 40

An oncology nurse is contributing to the care of a patient who has failed to respond appreciably to conventional cancer treatments. As a result, the care team is considering the possible use of biologic response modifiers (BRFs). The nurse should know that these achieve a therapeutic effect by what means?

A) Promoting the synthesis and release of leukocytes
B) Focusing the patients immune system exclusively on the tumor
C) Potentiating the effects of chemotherapeutic agents and radiation therapy
D) Altering the immunologic relationship between the tumor and the patient