Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 16

Chapter 16: Cancer
Test Bank
MULTIPLE CHOICE
1. A patient who is scheduled for a right breast biopsy asks the nurse the difference between a
benign tumor and a malignant tumor. Which answer by the nurse is correct?
a. Benign tumors do not cause damage to other tissues.
b. Benign tumors are likely to recur in the same location.
c. Malignant tumors may spread to other tissues or organs.
d. Malignant cells reproduce more rapidly than normal cells.
ANS: C
The major difference between benign and malignant tumors is that malignant tumors invade
adjacent tissues and spread to distant tissues and benign tumors never metastasize. The other
statements are inaccurate. Both types of tumors may cause damage to adjacent tissues.
Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not
usually recur.
DIF: Cognitive Level: Understand (comprehension) REF: 253

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
2. The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse
should monitor for which adverse effect?
a. Nausea
b. Alopecia
c. Mucositis
d. Hematuria
ANS: D
The adverse effects of intravesical chemotherapy are confined to the bladder. The other
adverse effects are associated with systemic chemotherapy.
DIF: Cognitive Level: Apply (application) REF: 261

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
3. The nurse is caring for a patient who smokes 2 packs/day. To reduce the patients risk of lung
cancer, which action by the nurse is best?
a. Teach the patient about the seven warning signs of cancer.
b. Plan to monitor the patients carcinoembryonic antigen (CEA) level.
c. Discuss the risks associated with cigarettes during every patient encounter.
d. Teach the patient about the use of annual chest x-rays for lung cancer screening.
ANS: C
Teaching about the risks associated with cigarette smoking is recommended at every patient
encounter because cigarette smoking is associated with multiple health problems. A tumor
must be at least 0.5 cm large before it is detectable by current screening methods and may
already have metastasized by that time. Oncofetal antigens such as CEA may be used to
monitor therapy or detect tumor reoccurrence, but are not helpful in screening for cancer. The
seven warning signs of cancer are actually associated with fairly advanced disease.
DIF: Cognitive Level: Apply (application) REF: 255-256
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
4. The nurse should include which food choice when providing dietary teaching for a patient
scheduled to receive external beam radiation for abdominal cancer?
a. Fresh fruit salad
b. Roasted chicken
c. Whole wheat toast
d. Cream of potato soup
ANS: B
To minimize the diarrhea that is commonly associated with bowel radiation, the patient should
avoid foods high in roughage, such as fruits and whole grains. Lactose intolerance may
develop secondary to radiation, so dairy products should also be avoided.

5. During a routine health examination, a 40-year-old patient tells the nurse about a family
history of colon cancer. Which action should the nurse take next?
a. Teach the patient about the need for a colonoscopy at age 50.
b. Teach the patient how to do home testing for fecal occult blood.
c. Obtain more information from the patient about the family history.
d. Schedule a sigmoidoscopy to provide baseline data about the patient.
ANS: C
The patient may be at increased risk for colon cancer, but the nurses first action should be
further assessment. The other actions may be appropriate, depending on the information that is
obtained from the patient with further questioning.

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
6. A patient who is diagnosed with cervical cancer that is classified as Tis, N0, M0 asks the nurse
what the letters and numbers mean. Which response by the nurse is most appropriate?
a.The cancer involves only the cervix.
b.The cancer cells look almost like normal cells.
c.Further testing is needed to determine the spread of the cancer.
d.It is difficult to determine the original site of the cervical cancer.
ANS: A
Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this
time. Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the
origin is the cervix. Further testing is not indicated given that the cancer has not spread.

7. The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure.
Which statement, if made by the patient, indicates that teaching was effective?
a. The biopsy will remove the cancer in my prostate gland.
b. The biopsy will determine how much longer I have to live.
c. The biopsy will help decide the treatment for my enlarged prostate.
d. The biopsy will indicate whether the cancer has spread to other organs.
ANS: C
A biopsy is used to determine whether the prostate enlargement is benign or malignant, and
determines the type of treatment that will be needed. A biopsy does not give information about
metastasis, life expectancy, or the impact of cancer on the patients life.

8. The nurse teaches a postmenopausal patient with stage III breast cancer about the expected
outcomes of cancer treatment. Which patient statement indicates that the teaching has been
effective?
a. After cancer has not recurred for 5 years, it is considered cured.
b. The cancer will be cured if the entire tumor is surgically removed.
c. Cancer is never considered cured, but the tumor can be controlled with surgery,
chemotherapy, and radiation.
d. I will need to have follow-up examinations for many years after I have treatment
before I can be considered cured.
ANS: D
The risk of recurrence varies by the type of cancer. Some cancers are considered cured after a
shorter time span or after surgery, but stage III breast cancer will require additional therapies
and ongoing follow-up.

9. A patient with a large stomach tumor that is attached to the liver is scheduled to have a
debulking procedure. Which information should the nurse teach the patient about the outcome
of this procedure?
a. Pain will be relieved by cutting sensory nerves in the stomach.
b. Relief of pressure in the stomach will promote better nutrition.
c. Tumor growth will be controlled by the removal of malignant tissue.
d. Tumor size will decrease and this will improve the effects of other therapy.
ANS: D
A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy
more effective. Debulking surgeries do not control tumor growth. The tumor is debulked
because it is attached to the liver, a vital organ (not to relieve pressure on the stomach).
Debulking does not sever the sensory nerves, although pain may be lessened by the reduction
in pressure on the abdominal organs.
DIF: Cognitive Level: Understand (comprehension) REF: 258

10. External-beam radiation is planned for a patient with cervical cancer. What instructions should
the nurse give to the patient to prevent complications from the effects of the radiation?
a. Test all stools for the presence of blood.
b. Maintain a high-residue, high-fiber diet.
c. Clean the perianal area carefully after every bowel movement.
d. Inspect the mouth and throat daily for the appearance of thrush.
ANS: C
Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause
frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown
and infection. Stools are likely to have occult blood from the inflammation associated with
radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will
not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when
patients receive abdominal radiation.

11. A patient with Hodgkins lymphoma who is undergoing external radiation therapy tells the
nurse, I am so tired I can hardly get out of bed in the morning. Which intervention should
the nurse add to the plan of care?
a. Minimize activity until the treatment is completed.
b. Establish time to take a short walk almost every day.
c. Consult with a psychiatrist for treatment of depression.
d. Arrange for delivery of a hospital bed to the patients home.
ANS: B
Walking programs are used to keep the patient active without excessive fatigue. Having a
hospital bed does not necessarily address the fatigue. The better option is to stay as active as
possible while combating fatigue. Fatigue is expected during treatment and is not an
indication of depression. Minimizing activity may lead to weakness and other complications
of immobility.

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
12. The nurse is caring for a patient with colon cancer who is scheduled for external radiation
therapy to the abdomen. Which information obtained by the nurse would indicate a need for
patient teaching?
a. The patient swims a mile 3 days a week.
b. The patient snacks frequently during the day.
c. The patient showers everyday with a mild soap.
d. The patient has a history of dental caries with amalgam fillings.
ANS: A
The patient is instructed to avoid swimming in salt water or chlorinated pools during the
treatment period. The patient does not need to change habits of eating frequently or showering
with a mild soap. A history of dental caries will not impact the patient who is scheduled for
abdominal radiation.

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
13. A patient undergoing external radiation has developed a dry desquamation of the skin in the
treatment area. The nurse teaches the patient about management of the skin reaction. Which
statement, if made by the patient, indicates the teaching was effective?
a. I can buy some aloe vera gel to use on the area.
b. I will expose the treatment area to a sun lamp daily.
c. I can use ice packs to relieve itching in the treatment area.
d. I will scrub the area with warm water to remove the scales.
ANS: A
Aloe vera gel and cream may be used on the radiated skin area. Ice and sunlamps may injure
the skin. Treatment areas should be cleaned gently to avoid further injury.

14. A patient with metastatic cancer of the colon experiences severe vomiting following each
administration of chemotherapy. Which action, if taken by the nurse, is most appropriate?
a. Have the patient eat large meals when nausea is not present.
b. Offer dry crackers and carbonated fluids during chemotherapy.
c. Administer prescribed antiemetics 1 hour before the treatments.
d. Give the patient two ounces of a citrus fruit beverage during treatments.
ANS: C
Treatment with antiemetics before chemotherapy may help prevent nausea. The patient should
eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause
nausea. The acidity of citrus fruits may be further irritating to the stomach.

15. The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is
most important for the nurse to take?
a.Infuse the medication over a short period of time.
b.Stop the infusion if swelling is observed at the site.
c.Administer the chemotherapy through a small-bore catheter.
d.Hold the medication unless a central venous line is available.
ANS: B
Swelling at the site may indicate extravasation, and the IV should be stopped immediately.
The medication generally should be given slowly to avoid irritation of the vein. The size of
the catheter is not as important as administration of vesicants into a running IV line to allow
dilution of the chemotherapeutic drug. These medications can be given through peripheral
lines, although central vascular access devices (CVADs) are preferred.

16. A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the
nurse take to maintain the patients self-esteem?
a. Tell the patient to limit social contacts until regrowth of the hair occurs.
b. Encourage the patient to purchase a wig or hat and wear it once hair loss begins.
c. Teach the patient to gently wash hair with a mild shampoo to minimize hair loss.
d. Inform the patient that hair usually grows back once the chemotherapy is
complete.
ANS: B
The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats.
Limiting social contacts is not appropriate at a time when the patient is likely to need a good
social support system. The damage occurs at the hair follicle and will occur regardless of
gentle washing or use of a mild shampoo. The information that the hair will grow back is not
immediately helpful in maintaining the patients self-esteem.

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity
17. A patient who has ovarian cancer is crying and tells the nurse, My husband rarely visits. He
just doesnt care. The husband indicates to the nurse that he never knows what to say to help
his wife. Which nursing diagnosis is most appropriate for the nurse to add to the plan of care?
a. Compromised family coping related to disruption in lifestyle
b. Impaired home maintenance related to perceived role changes
c. Risk for caregiver role strain related to burdens of caregiving responsibilities
d. Dysfunctional family processes related to effect of illness on family members
ANS: D
The data indicate that this diagnosis is most appropriate because poor communication among
the family members is affecting family processes. No data suggest a change in lifestyle or its
role as an etiology. The data do not support impairment in home maintenance or a burden
caused by caregiving responsibilities.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity
18. A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral
mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this
patient?
a. Remove food debris from the teeth and oral mucosa with a stiff toothbrush.
b. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth.
c. Gargle and rinse the mouth several times a day with an antiseptic mouthwash.
d. Rinse the mouth before and after each meal and at bedtime with a saline solution.
ANS: D
The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used
for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate
the oral mucosa and are not recommended.

19. A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body
requirements related to painful oral ulcers. Which nursing action will be most effective in
improving oral intake?
a. Offer the patient frequent small snacks between meals.
b. Assist the patient to choose favorite foods from the menu.
c. Provide teaching about the importance of nutritional intake.
d. Apply the ordered anesthetic gel to oral lesions before meals.
ANS: D
Because the etiology of the patients poor nutrition is the painful oral ulcers, the best
intervention is to apply anesthetic gel to the lesions before the patient eats. The other actions
might be helpful for other patients with impaired nutrition, but would not be as helpful for this
patient.

20. A widowed mother of four school-age children is hospitalized with metastatic ovarian cancer.
The patient is crying and tells the nurse that she does not know what will happen to her
children when she dies. Which response by the nurse is most appropriate?
a. Why dont we talk about the options you have for the care of your children?
b. Im sure you have friends that will take the children when you cant care for
them.
c. For now you need to concentrate on getting well and not worrying about your
children.
d. Many patients with cancer live for a long time, so there is still time to plan for
your children.
ANS: A
This response expresses the nurses willingness to listen and recognizes the patients concern.
The responses beginning Many patients with cancer live for a long time and For now you
need to concentrate on getting well close off discussion of the topic and indicate that the
nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer
may not have a long time to plan. Although it is possible that the patients friends will take the
children, more assessment information is needed before making plans.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
21. A patient who has severe pain associated with terminal pancreatic cancer is being cared for at
home by family members. Which finding by the nurse indicates that teaching regarding pain
management has been effective?
a. The patient uses the ordered opioid pain medication whenever the pain is greater
than 5 (0 to 10 scale).
b. The patient agrees to take the medications by the IV route in order to improve
analgesic effectiveness.
c. The patient takes opioids around the clock on a regular schedule and uses
additional doses when breakthrough pain occurs.
d. The patient states that nonopioid analgesics may be used when the maximal dose
of the opioid is reached without adequate pain relief.
ANS: C
For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional
doses as needed for breakthrough pain. Taking the medications only when pain reaches a
certain level does not provide effective pain control. Although nonopioid analgesics also may
be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved.
The IV route is not more effective than the oral route, and usually the oral route is preferred.

22. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell
carcinoma. Which information should the nurse include when explaining the purpose of this
therapy to the patient?
a. IL-2 enhances the immunologic response to tumor cells.
b. IL-2 stimulates malignant cells in the resting phase to enter mitosis.
c. IL-2 prevents the bone marrow depression caused by chemotherapy.
d. IL-2 protects normal cells from the harmful effects of chemotherapy.
ANS: A
IL-2 enhances the ability of the patients own immune response to suppress tumor cells. IL-2
does not protect normal cells from damage caused by chemotherapy, stimulate malignant cells
to enter mitosis, or prevent bone marrow depression.
DIF: Cognitive Level: Understand (comprehension) REF: 252-253

23. The home health nurse cares for a patient who has been receiving interferon therapy for
treatment of cancer. Which statement by the patient indicates a need for further assessment?
a. I have frequent muscle aches and pains.
b. I rarely have the energy to get out of bed.
c. I experience chills after I inject the interferon.
d. I take acetaminophen (Tylenol) every 4 hours.
ANS: B
Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms, such
as muscle aches and chills, are common side effects with interferon use. Patients are advised
to use acetaminophen every 4 hours.

24. A patient with leukemia is considering whether to have hematopoietic stem cell
transplantation (HSCT). The nurse will include which information in the patients teaching
plan?
a. Transplant of the donated cells is painful because of the nerves in the tissue lining
the bone.
b. Donor bone marrow cells are transplanted through an incision into the sternum or
hip bone.
c. The transplant procedure takes place in a sterile operating room to minimize the
risk for infection.
d. Hospitalization will be required for several weeks after the stem cell transplant
procedure is performed.
ANS: D
The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT
while waiting for the transplanted marrow to start producing cells. The transplanted cells are
infused through an IV line, so the transplant is not painful, nor is an operating room or
incision required.
DIF: Cognitive Level: Understand (comprehension) REF: 275-276

25. The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet
choices. Which snack choice by the patient indicates that the teaching has been effective?
a. Lime sherbet
b. Blueberry yogurt
c. Cream cheese bagel
d. Fresh strawberries and bananas
ANS: B
Yogurt has high biologic value because of the protein and fat content. Fruit salad does not
have high amounts of protein or fat. Lime sherbet is lower in fat and protein than yogurt.
Cream cheese is low in protein.

26. A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body
requirements related to altered taste sensation. Which nursing action is most appropriate?
a. Add strained baby meats to foods such as casseroles.
b. Teach the patient about foods that are high in nutrition.
c. Avoid giving the patient foods that are strongly disliked.
d. Add extra spice to enhance the flavor of foods that are served.
ANS: C
The patient will eat more if disliked foods are avoided and foods that the patient likes are
included instead. Additional spice is not usually an effective way to enhance taste. Adding
baby meats to foods will increase calorie and protein levels, but does not address the issue of
taste. The patients poor intake is not caused by a lack of information about nutrition.

27. During the teaching session for a patient who has a new diagnosis of acute leukemia the
patient is restless and is looking away, never making eye contact. After teaching about the
complications associated with chemotherapy, the patient asks the nurse to repeat all of the
information. Based on this assessment, which nursing diagnosis is most appropriate for the
patient?
a. Risk for ineffective adherence to treatment related to denial of need for
chemotherapy
b. Acute confusion related to infiltration of leukemia cells into the central nervous
system
c. Risk for ineffective health maintenance related to anxiety about new leukemia
diagnosis
d. Deficient knowledge: chemotherapy related to a lack of interest in learning about
treatment
ANS: C
The patient who has a new cancer diagnosis is likely to have high anxiety, which may impact
learning and require that the nurse repeat and reinforce information. The patients history of a
recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the
confusion. The patient asks for the information to be repeated, indicating that lack of interest
in learning and denial are not etiologic factors.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity
28. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia.
Which observation by the nurse would indicate a need for further teaching?
a.The patient ambulates several times a day in the room.
b.The patients visitors bring in some fresh peaches from home.
c.The patient cleans with a warm washcloth after having a stool.
d.The patient uses soap and shampoo to shower every other day.
ANS: B
Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria
being present. The patient should ambulate in the room rather than the hospital hallway to
avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and
increase infection risk, showering every other day is acceptable. Careful cleaning after having
a bowel movement will help prevent skin breakdown and infection.
DIF: Cognitive Level: Apply (application) REF: eTable 16-16

29. The nurse is caring for a patient who has been diagnosed with stage I cancer of the colon.
When assessing the need for psychologic support, which question by the nurse will provide
the most information?
a. How long ago were you diagnosed with this cancer?
b. Do you have any concerns about body image changes?
c. Can you tell me what has been helpful to you in the past when coping with
stressful events?
d. Are you familiar with the stages of emotional adjustment to a diagnosis like
cancer of the colon?
ANS: C
Information about how the patient has coped with past stressful situations helps the nurse
determine usual coping mechanisms and their effectiveness. The length of time since the
diagnosis will not provide much information about the patients need for support. The
patients knowledge of typical stages in adjustment to a critical diagnosis does not provide
insight into patient needs for assistance. Because surgical interventions for stage I cancer of
the colon may not cause any body image changes, this question is not appropriate at this time.

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
30. The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse
report immediately to the health care provider?
a. Generalized muscle aches
b. Complaints of nausea and anorexia
c. Oral temperature of 100.6 F (38.1 C)
d. Crackles heard at the lower scapular border
ANS: D
Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-
2. The patient may need oxygen and the nurse should rapidly notify the health care provider.
The other findings are common side effects of interleukin-2.

31. The nurse obtains information about a hospitalized patient who is receiving chemotherapy for
colorectal cancer. Which information about the patient alerts the nurse to discuss a possible
change in therapy with the health care provider?
a. Poor oral intake
b. Frequent loose stools
c. Complaints of nausea and vomiting
d. Increase in carcinoembryonic antigen (CEA)
ANS: D
An increase in CEA indicates that the chemotherapy is not effective for the patients cancer
and may need to be modified. The other patient findings are common adverse effects of
chemotherapy. The nurse may need to address these, but they would not necessarily indicate a
need for a change in therapy.

32. The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which
laboratory result is most important to report to the health care provider?
a. Hematocrit of 30%
b. Platelets of 95,000/L
c. Hemoglobin of 10 g/L
d. White blood cell (WBC) count of 2700/L
ANS: D
The low WBC count places the patient at risk for severe infection and is an indication that the
chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim
(Neupogen) are needed. Although the other laboratory data indicate decreased levels, they do
not indicate any immediate life-threatening adverse effects of the chemotherapy.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
33. When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel
(UAP) indicates a need for the nurse to intervene?
a.The UAP assists the patient to use dental floss after eating.
b.The UAP adds baking soda to the patients saline oral rinses.
c.The UAP puts fluoride toothpaste on the patients toothbrush.
d.The UAP has the patient rinse after meals with a saline solution.
ANS: A
Use of dental floss is avoided in patients with pancytopenia because of the risk for infection
and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.
DIF: Cognitive Level: Apply (application) REF: 266 | 268

OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
34. The nurse supervises the care of a patient with a temporary radioactive cervical implant.
Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would
require an intervention?
a. The UAP flushes the toilet once after emptying the patients bedpan.
b. The UAP stands by the patients bed for 30 minutes talking with the patient.
c. The UAP places the patients bedding in the laundry container in the hallway.
d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.
ANS: B
Because patients with temporary implants emit radioactivity while the implants are in place,
exposure to the patient is limited. Laundry and urine/feces do not have any radioactivity and
do not require special precautions. Cervical radiation will not affect the oral mucosa, and
alcohol-based mouthwash is not contraindicated.

OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation
35. The nurse receives change-of-shift report on the oncology unit. Which patient should the
nurse assess first?
a. 35-year-old patient who has wet desquamation associated with abdominal
radiation
b. 42-year-old patient who is sobbing after receiving a new diagnosis of ovarian
cancer
c. 24-year-old patient who received neck radiation and has blood oozing from the
neck
d. 56-year-old patient who developed a new pericardial friction rub after chest
radiation
ANS: C
Because neck bleeding may indicate possible carotid artery rupture in a patient who is
receiving radiation to the neck, this patient should be seen first. The diagnoses and clinical
manifestations for the other patients are not immediately life threatening.
DIF: Cognitive Level: Analyze (analysis) REF: 278-279

OBJ: Special Questions: Multiple Patients TOP: Nursing Process: Planning
36. Which action should the nurse take when caring for a patient who is receiving chemotherapy
and complains of problems with concentration?
a. Teach the patient to rest the brain by avoiding new activities.
b. Teach that chemo-brain is a short-term effect of chemotherapy.
c. Report patient symptoms immediately to the health care provider.
d. Suggest use of a daily planner and encourage adequate rest and sleep.
ANS: D
Use of tools to enhance memory and concentration such as a daily planner and adequate rest
are helpful for patients who develop chemo-brain while receiving chemotherapy. Patients
should be encouraged to exercise the brain through new activities. Chemo-brain may be short-
or long-term. There is no urgent need to report common chemotherapy side effects to the
provider.

37. The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of
rituximab (Rituxan). Which assessment finding would require the most rapid action by the
nurse?
a. Shortness of breath
b. Temperature 100.2 F (37.9 C)
c. Shivering and complaint of chills
d. Generalized muscle aches and pains
ANS: A
Rituximab (Rituxan) is a monoclonal antibody. Shortness of breath should be investigated
rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration. The
nurse will need to rapidly take actions such as stopping the infusion, assessing the patient
further, and notifying the health care provider. The other findings will also require action by
the nurse, but are not indicative of life-threatening complications.

38. A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back
pain. Which action should the nurse take first?
a. Give the patient the prescribed PRN opioid.
b. Assess for sensation and strength in the legs.
c. Notify the health care provider about the symptoms.
d. Teach the patient how to use relaxation to reduce pain.
ANS: B
Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the
epidural space. The nurse will need to assess the patient further for symptoms such as
decreased leg sensation and strength and then notify the health care provider. Administration
of opioids or use of relaxation may be appropriate but only after the nurse has assessed for
possible spinal cord compression.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
39. The nurse is caring for a patient with left-sided lung cancer. Which finding would be most
important for the nurse to report to the health care provider?
a. Hematocrit 32%
b. Pain with deep inspiration
c. Serum sodium 126 mEq/L
d. Decreased breath sounds on left side
ANS: C
Syndrome of inappropriate antidiuretic hormone (and the resulting hyponatremia) is an
oncologic metabolic emergency and will require rapid treatment in order to prevent
complications such as seizures and coma. The other findings also require intervention, but are
common in patients with lung cancer and not immediately life threatening.

40. An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hour in
conjunction with the prescribed chemotherapy. Which finding by the nurse is most important
to report to the health care provider?
a. Patient complains of severe fatigue.
b. Patient needs to void every hour during the day.
c. Patient takes only 50% of meals and refuses snacks.
d. Patient has audible crackles to the midline posterior chest.
ANS: D
Rapid fluid infusions may cause heart failure, especially in older patients. The other findings
are common in patients who have cancer and/or are receiving chemotherapy.

41. After change-of-shift report on the oncology unit, which patient should the nurse assess first?
a. Patient who has a platelet count of 82,000/L after chemotherapy
b. Patient who has xerostomia after receiving head and neck radiation
c. Patient who is neutropenic and has a temperature of 100.5 F (38.1 C)
d. Patient who is worried about getting the prescribed long-acting opioid on time
ANS: C
Temperature elevation is an emergency in neutropenic patients because of the risk for rapid
progression to severe infections and sepsis. The other patients also require assessments or
interventions, but do not need to be assessed as urgently. Patients with thrombocytopenia do
not have spontaneous bleeding until the platelets are 20,000/L. Xerostomia does not require
immediate intervention. Although breakthrough pain needs to be addressed rapidly, the patient
does not appear to have breakthrough pain.
DIF: Cognitive Level: Analyze (analysis) REF: 277

OBJ: Special Questions: Prioritization; Multiple Patients
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
MULTIPLE RESPONSE
1. The nurse at the clinic is interviewing a 64-year-old woman who is 5 feet, 3 inches tall and
weighs 125 pounds (57 kg). The patient has not seen a health care provider for 20 years. She
walks 5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the
nurse plan to include in patient teaching about cancer screening and decreasing cancer risk
(select all that apply)?
a. Pap testing
b. Tobacco use
c. Sunscreen use
d. Mammography
e. Colorectal screening
ANS: A, C, D, E
The patients age, gender, and history indicate a need for screening and/or teaching about
colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use
excessive alcohol or tobacco, she is physically active, and her body weight is healthy.
DIF: Cognitive Level: Analyze (analysis) REF: 255

TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance
2. A patient develops neutropenia after receiving chemotherapy. Which information about ways
to prevent infection will the nurse include in the teaching plan (select all that apply)?
a. Cook food thoroughly before eating.
b. Choose low fiber, low residue foods.
c. Avoid public transportation such as buses.
d. Use rectal suppositories if needed for constipation.
e. Talk to the oncologist before having any dental work done.
ANS: A, C, E
Eating only cooked food and avoiding public transportation will decrease infection risk. A
high-fiber diet is recommended for neutropenic patients to decrease constipation. Because
bacteria may enter the circulation during dental work or oral surgery, the patient may need to
postpone dental work or take antibiotics.
DIF: Cognitive Level: Apply (application) REF: 265 | eTable 16-16


Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 16

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Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 16

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Chapter 16: Cancer

DIF: Cognitive Level: Understand (comprehension) REF: 253

DIF: Cognitive Level: Apply (application) REF: 261

DIF: Cognitive Level: Apply (application) REF: 268

DIF: Cognitive Level: Apply (application) REF: 255-256

DIF: Cognitive Level: Apply (application) REF: 254

DIF: Cognitive Level: Apply (application) REF: 256

DIF: Cognitive Level: Apply (application) REF: 257

DIF: Cognitive Level: Understand (comprehension) REF: 258

DIF: Cognitive Level: Apply (application) REF: 268

DIF: Cognitive Level: Apply (application) REF: 265

DIF: Cognitive Level: Apply (application) REF: 270

DIF: Cognitive Level: Apply (application) REF: 269

DIF: Cognitive Level: Apply (application) REF: 266

DIF: Cognitive Level: Apply (application) REF: 259

DIF: Cognitive Level: Apply (application) REF: 266

DIF: Cognitive Level: Apply (application) REF: 279-280

DIF: Cognitive Level: Apply (application) REF: 266

DIF: Cognitive Level: Apply (application) REF: 268-269

DIF: Cognitive Level: Apply (application) REF: 280

DIF: Cognitive Level: Apply (application) REF: 279

DIF: Cognitive Level: Understand (comprehension) REF: 252-253

DIF: Cognitive Level: Apply (application) REF: 273

DIF: Cognitive Level: Understand (comprehension) REF: 275-276

DIF: Cognitive Level: Apply (application) REF: 276

DIF: Cognitive Level: Apply (application) REF: 277

DIF: Cognitive Level: Apply (application) REF: 256

DIF: Cognitive Level: Apply (application) REF: eTable 16-16

DIF: Cognitive Level: Apply (application) REF: 280

DIF: Cognitive Level: Apply (application) REF: 273

DIF: Cognitive Level: Apply (application) REF: 253

DIF: Cognitive Level: Apply (application) REF: 265

DIF: Cognitive Level: Apply (application) REF: 266 | 268

DIF: Cognitive Level: Apply (application) REF: 264

DIF: Cognitive Level: Analyze (analysis) REF: 278-279

DIF: Cognitive Level: Apply (application) REF: 267

DIF: Cognitive Level: Apply (application) REF: 272-273

DIF: Cognitive Level: Apply (application) REF: 277

DIF: Cognitive Level: Apply (application) REF: 278

DIF: Cognitive Level: Apply (application) REF: 278

DIF: Cognitive Level: Analyze (analysis) REF: 277

DIF: Cognitive Level: Analyze (analysis) REF: 255

DIF: Cognitive Level: Apply (application) REF: 265 | eTable 16-16

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