Medical-Surgical Nursing Concepts and Practice 3rd Edition Test Bank Chapter 08: Care of Patients with Cancer

MEDICAL SURGICAL NURSING CONCEPTS AND PRACTICE 3RD EDITION DEWIT TEST BANK
Chapter 08: Care of Patients with Cancer

deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition
MULTIPLE CHOICE
1. The 40-year-old female who was diagnosed with a benign growth in her colon is concerned
about the growth spreading. Which explanation best allays the patient’s anxiety?
a. “Benign growths arrest their growth on their own.”
b. “Benign growths never interfere with normal structures or functions.”
c. “Benign growths are easily controlled with radiation.”
d. “Benign growths are surrounded by fibrous tissue that prevents spread.”
ANS: D
Benign neoplasms are encapsulated with a fibrous membrane that interferes with their
spreading. They do not self-limit their growth and may obstruct passages or impinge on an
organ. They are not treated with radiation.
PTS: 1 DIF: Cognitive Level: Application REF: 145

OBJ: 1 (theory) TOP: Physiology of Cancer
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
2. The 26-year-old patient with a malignant neoplasm has experienced a 10-pound weight loss in
3 weeks. To which factor is this patient’s rapid weight loss most likely related?
a. Disinterest in eating food in general
b. Changes in the nutritional content of the patient’s diet
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c. The malignancy’s high nutritional demand
d. A self-imposed rigid diet regimen
ANS: C
Rapid cell growth of the malignancy robs nutrients from normal cells and results in weight
loss.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 146

KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
3. The nurse recognizes the staging T3, N2, M2 of the patient’s cancer. Which interpretation is
correct?
a. Small tumor with fewer than two lymph nodes involved.
b. Large tumor that is localized.
c. Small tumor with adjacent nodes involved.
d. Large tumor with extensive lymph node involvement.
ANS: D
The staging means a large tumor (T3) with involvement in regional lymph nodes (N2) and
metastasis to distant lymph nodes (M2).
PTS: 1 DIF: Cognitive Level: Analysis REF: 147

OBJ: 1 (theory) TOP: TNM Staging
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KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance
4. The nurse assesses several patients in the outpatient clinic. Which patient has the greatest risk
for developing cancer?
a. 23-year-old car repairman who repaints cars
b. 30-year-old overweight certified public accountant in New York who has smoked
for 4 years and rarely exercises
c. 45-year-old farmer from Texas who has worked on his family’s cotton farm since
the age of 12
d. 60-year-old ski instructor in Colorado
ANS: C
The cotton farmer in Texas has the most exposure to carcinogens. Chemicals, pesticides, and
sun are the carcinogens that this farmer has been exposed to for at least 33 years.

OBJ: 4 (theory) TOP: Cancer Risk KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance
5. The nurse recognizes that smoking is a “promoter” that, although not a carcinogen itself,
allows cancer to occur faster in the patients. Which factor is also a promoter of cancer?
a. Obesity
b. Occupational hazards
c. Cocaine abuse
d. Heavy alcohol intake
ANS: D
Alcohol and smoking are “promoters” that facilitate the occurrence of cancer. Being
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overweight, occupational hazards, and abusing cocaine are not considered “promoters” in
regard to cancer risk.

OBJ: 2 (theory) TOP: Causative Factors
6. The nurse is caring for an x-ray technician who wears a badge that is monitored frequently to
measure the amount of radiation he has absorbed. The nurse advises the technician that he has
the highest risk for developing which type of cancer?
a. Bladder cancer
b. Leukemia
c. Melanoma
d. Lung cancer
ANS: B
The blood cancer leukemia is associated with radiation exposure. Bladder, melanoma, and
lung cancer are associated with other carcinogens.
PTS: 1 DIF: Cognitive Level: Application REF: 148, Table 8-1

OBJ: 2 (theory) TOP: Causative Factors KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
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7. The nurse is outlining a diet that would be helpful in the prevention of cancer. Which
instructions should the nurse include?
a. Eliminate all red meat.
b. Use margarine instead of butter.
c. Avoid foods with vitamin B complex.
d. Eat a variety of citrus fruits.
ANS: D
Vitamin C helps combat the effects of nitrites. Fats should be no more than 30%, and both
butter and margarine should be used sparingly. Vitamin B has neither been proven effective
for cancer prevention nor deemed harmful.
PTS: 1 DIF: Cognitive Level: Application

REF: 150, Nutritional Considerations OBJ: 3 (theory) TOP: Prevention of Cancer
8. The nurse is advising a young college student who wants a tan before spring break. Which
method is safest for the student to use?
a. Take advantage of morning sun while using sunscreen with an SPF of 30.
b. Use a spray-on tanning solution.
c. Use a sun lamp for a maximum of 20 minutes a day.
d. Use a tanning salon for no more than 10 minutes per visit.
ANS: B
Spray-on tanning solution is the safest. All other options increase ultraviolet exposure, even
with the use of sunscreen.
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PTS: 1 DIF: Cognitive Level: Application REF: 148, Table 8-1
OBJ: 3 (theory) TOP: Prevention of Cancer
9. The nurse is educating the 40-year-old female patient about the American Cancer Society
(ACS) recommendations for early detection of cancer. Which information should she include
when teaching?
a. Obtain a Pap smear every year.
b. Get an annual fecal occult blood examination.
c. Plan a sigmoidoscopy every 5 years.
d. Obtain a mammogram every year.
ANS: D
The ACS recommends that 40-year-old women have an annual mammogram and a Pap smear
every 2 to 3 years. Yearly fecal occult blood studies and sigmoidoscopy are recommended
beginning at age 50.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 156, Box 8-1

OBJ: 4 (theory) TOP: Prevention of Cancer
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10. The nurse assesses a man who is scheduled for a prostate-specific antigen (PSA) test. The
nurse understands that which situation could delay the test?
a. The patient reports he ate shellfish 48 hours previously.
b. The patient reports that he has a history of an enlarged prostate.
c. The patient reports having a recent urinary tract infection (UTI).
d. The patient’s temperature is 99.0° F.
ANS: C
The PSA test would be delayed in the event of a recent UTI. Other considerations include
teaching about abstaining from sexual activity for 24 to 48 hours before the test and collecting
the blood sample prior to the digital examination. Eating shellfish or having a slightly elevated
temperature should not alter the test in any way. A history of an enlarged prostate is a good
reason to perform a PSA test.
PTS: 1 DIF: Cognitive Level: Application REF: 156, Box 8-2

OBJ: 4 (theory) TOP: Prostate-Specific Antigen Test (PSA)
11. The nurse is planning care for the patient who is on a protocol of bleomycin. Since bleomycin
is an antitumor antibiotic, which intervention should the nurse add to the care plan?
a. Assess hearing acuity.
b. Measure urinary output.
c. Weigh daily to assess fluid retention.
d. Monitor for cardiac arrhythmias.
ANS: D
Bleomycin is cardiotoxic and can cause cardiac arrhythmias; therefore, this would be the
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highest priority intervention. Chemotherapies that are ototoxic would warrant a hearing test;
urinary output and fluid retention should be assessed with most chemotherapy drugs, and
especially for those that are nephrotoxic.
PTS: 1 DIF: Cognitive Level: Analysis REF: 163, Table 8-4

OBJ: 5 (theory) TOP: Chemotherapy: Bleomycin
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
12. The nurse is caring for a patient with cancer who is receiving vincristine. Which precaution is
most important for the nurse to take?
a. Prevent the patient from getting chilled.
b. Administer a stool softener as ordered.
c. Offer the patient a soft toothbrush.
d. Feed the patient a snack during the infusion.
ANS: B
Certain antineoplastic drugs, such as vincristine, vinblastine, and paclitaxel, cause
constipation. Increasing fluids (as allowed), adding fiber to the diet, administering stool
softeners and fiber laxatives, exercise, and monitoring vigilantly for the beginning signs of
constipation are the usual measures taken. Suppositories or enemas may be necessary.
Preventing chills does provide comfort but does not work to actively prevent constipation.
Offering a soft tooth brush is an appropriate intervention for mediations that increase bleeding
risk. Feeding the patient a snack during the infusion may exacerbate constipation.
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PTS: 1 DIF: Cognitive Level: Analysis REF: 164, Table 8-5

OBJ: 10 (clinical) TOP: Chemotherapy: Vincristine
13. The nurse is teaching a 50-year-old male patient who is taking estrogens as treatment of
prostate cancer. The nurse should educate the patient about which expected side effect?
a. Blurred vision
b. Gynecomastia
c. Enlarged gonads
d. Acne
ANS: B
Men taking estrogen experience a redistribution of fat and develop enlarged breasts
(gynecomastia). Estrogen should not result in blurred vision, enlarged gonads, or acne.

OBJ: 10 (clinical) TOP: Chemotherapy: Hormones
14. The nurse is instructing a patient who is on a biologic response modifier (BRM)
colony-stimulating drug. The nurse teaches that about which desired action from this
medication?
a. Increased appetite
b. Increased hair growth
c. Enhanced recovery of bone marrow
d. Decreased cholesterol NURSINGTB.COM
ANS: C
BRMs enhance and support the recovery of suppressed bone marrow resulting from radiation
and chemotherapy.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 166

OBJ: 5 (theory) TOP: Chemotherapy: Biologic Response Modifiers
15. The patient on radiation therapy has developed diarrhea. Which food should the nurse suggest
to help slow the diarrhea?
a. Broccoli
b. Cauliflower
c. Cheese and crackers
d. Apples and pears
ANS: C
Food low in fiber, such as cheese and crackers, will help slow diarrhea. Broccoli, cauliflower,
apples, and pears are high-fiber foods that stimulate bowel evacuation.

OBJ: 6 (theory) TOP: Radiation Side Effects: Diarrhea
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16. The nurse is constructing a teaching plan about fatigue management for a patient who is
taking radiation treatments. Which information should the nurse include?
a. Prioritize activities and alternate rest with periods of activity.
b. Plan to spend at least 4 to 5 hours of the day in bed.
c. Discontinue pain medications that may cause drowsiness.
d. Avoiding snacking in between meals.
ANS: A
Prioritizing activities is essential to balance energy with expenditure. These patients should
not spend long periods of daytime in bed, and they should increase fluids and plan
between-meal snacks to keep energy up.

OBJ: 6 (theory) TOP: Radiation Side Effects: Fatigue
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
17. A 32-year-old mother is undergoing radiation from a sealed-source modality and has been
isolated in a private room for 3 days. How should the nurse best prepare for the patient’s
8-year-old twins to visit?
a. Instruct the children to visit at the bedside one at a time.
b. Inform family that children cannot visit patients undergoing radiation.
c. Put chairs in the hall for “long-distance” visitation.
d. Allow visitation for no longer than 3 minutes without any physical contact.
ANS: C NURSINGTB.COM
Children and pregnant people should not visit at the bedside, but a visit from a safe distance or
by phone helps relieve the boredom of isolation.

OBJ: 11 (clinical) TOP: Radiation Care Problems
KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control
18. Which statement indicates to the nurse that the 50-year-old male recently diagnosed with early
stage cancer of the prostate has begun to accept his diagnosis?
a. “Well, I guess this just about cancels any plans for a second honeymoon.”
b. “I need to call my lawyer in order to update my will.”
c. “Do you have any current information on prostate cancer?”
d. “My children should come home from college to visit.”
ANS: C
Well-adjusted patients should seek information on the disease and varied treatments. Joking is
a form of denial. Gathering family and making final arrangements reflect loss of hope and do
not coincide with the prognosis of early stage prostate cancer. Humor is a positive coping
strategy, but requesting information about the disease is more indicative of acceptance.

OBJ: 11 (clinical) TOP: Acceptance of Diagnosis
KEY: Nursing Process Step: Evaluation
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MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
19. Following a visit from his family, the 55-year-old male patient with terminal cancer tearfully
says, “I am so afraid” and begins to cry. Which response is most supportive?
a. “Would you like to have your pain medication now?”
b. “Let’s talk about the things that make you afraid.”
c. “Would you like for me to call the hospital chaplain.”
d. “I will leave to give you some privacy.”
ANS: B
Verbalizing fears to a caring nurse is comforting. Offering medications, chaplains, and
privacy is not helpful or supportive as a first nursing response in this situation.

OBJ: 12 (clinical) TOP: Fear KEY: Nursing Process Step: Implementation
20. The family becomes distressed when the dying 85-year-old patient becomes delirious and
laughs and talks with old friends who have long since died. Which intervention is most
appropriate?
a. Medicate the patient with the prescribed sedative.
b. Encourage a family member to talk to the patient calmly.
c. Stimulate and reorient the patient.
d. Suggest the family to leave the patient for a while.
ANS: B
Delirious patients can still hear. A familiar voice is comforting. Medicating the patient with a
sedative is not appropriate. Stimulating and trying to reorient the patient may cause the patient
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to become irritated. The family should remain with the patient.

OBJ: 12 (clinical) TOP: Delirium KEY: Nursing Process Step: Implementation
21. The student nurse is teaching a community group about risk factors for colorectal cancer.
Based on risk factors, which patient has the highest risk for developing colorectal cancer?
a. 50-year-old male who has been exposed to arsenic in the workplace
b. 45-year-old female with a doctorate degree in psychology who smokes
occasionally
c. 38-year-old female who had her first child 1 year ago
d. 29-year-old male who has had Crohn disease since the age of 13
ANS: D
Inflammatory diseases of the colon increase the risk of colorectal cancer. Arsenic exposure
places the patient at risk for lung cancer. Women with a high level of education have been
found to fall into the high-risk category for developing breast cancer, as well as having the
first child after the age of 30.

OBJ: 3 (theory) TOP: Risk Factors KEY: Nursing Process Step: Planning
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22. Which statement indicates that the patient understands teaching about diagnostic examinations
for cancer?
a. “I will have less scarring if my surgeon uses an incision to biopsy my breast.”
b. “My CEA level will be low if my pancreatic cancer returns.”
c. “The doctor will monitor my ovarian cancer remission with the CA-125 test.”
d. “My colonoscopy results were great, so I won’t need another one for 5 years.”
ANS: C
The CA-125 is one of the tests the physician will monitor to detect the presence of ovarian
cancer or recurrence of ovarian cancer after therapy. Fine-needle biopsy causes the least
amount of scarring during breast cancer biopsy. The patient’s CEA level will rise if pancreatic
cancer is present. Recommendations suggest a colonoscopy every 10 years if the examination
is negative and there is no family history of colon cancer.

OBJ: 3 and 4 (theory) TOP: Diagnostics
KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance
23. The nurse is caring for a terminally ill cancer patient who is receiving palliative care. The
patient’s wife asks how her husband’s pain will be controlled as he nears death. Which is the
nurse’s best response?
a. “Most of the time we can manage the pain with oral morphine and transdermal
pain medication.”
b. “We will probably have to start an IV to administer morphine to control the intense
pain he may be experiencing.”
c. “Dying patients typically do not have any pain, so this will not be an issue.”
d. “I will have to check with your husband’s physician to see how he wants us to
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handle pain control.”
ANS: A
Oral and transdermal pain control methods are most often used for the terminally ill patient
near death. An IV is not typically started on a patient near death who is receiving palliative
care. Dying patients do experience pain. The plan of care should be in place for the patient
receiving palliative care, so the physician would not be contacted for pain medication orders.

OBJ: 12 (clinical) TOP: Pain Control KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
MULTIPLE RESPONSE
24. Which description(s) is/are characteristic of a malignant neoplasm? (Select all that apply.)
a. Very small nuclei
b. Disorganization
c. Altered DNA
d. Invasion of nearby organs
e. Travel through body fluid
ANS: B, C, D, E
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Malignant neoplasms have large rather than small nuclei. Disorganization, altered DNA,
invasion of nearby organs, and the ability to travel through body fluids are all characteristics
of malignancies.

25. Which categories are classifications of malignant neoplasms? (Select all that apply.)
a. Carcinomas
b. Lymphomas
c. Fibromas
d. Lipomas
e. Sarcomas
ANS: A, B, E
The categories of malignancy are sarcomas, carcinomas, leukemias, and lymphomas.
Fibromas and lipomas are benign.

OBJ: 1 (theory) TOP: Classification of Tumors KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
26. The nurse explains that metastasis from the original site to a new site can occur in a variety of
ways. Which mechanisms do malignant cells use to metastasize? (Select all that apply.)
a. Traveling through tissues.
b. “Transplantation” via surgicalNURSINGTB.COM
instruments during surgery.
c. Entering a body cavity and attaching to an organ.
d. Traveling through the lymphatic system.
e. “Relocation” from contaminated gloves during surgery.
ANS: B, C, D, E
Traveling through blood rather than tissues is a common mechanism for metastasis.

OBJ: 1 (theory) TOP: Metastasis KEY: Nursing Process Step: Implementation
27. Which viruses are responsible for specific cancers? (Select all that apply.)
a. Liver cancer from hepatitis B virus
b. Burkitt lymphoma from Epstein-Barr virus
c. Cervical cancer from human papillomavirus
d. Lung cancer from measles virus
e. Kaposi sarcoma from human immunodeficiency virus
ANS: A, B, C, E
Hepatitis B virus can cause liver cancer, Epstein-Barr virus can lead to Burkitt lymphoma,
HPV can cause cervical cancer, and HIV can lead to Kaposi sarcoma. Measles do not cause
lung cancer.
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28. Which medications are biologic response modifier (BRM) drugs? (Select all that apply.)
a. Interleukins
b. Colony-stimulating factors
c. Monoclonal antibodies
d. Cyclosporines
e. Gene therapies
ANS: A, B, C, E
Cyclosporines are drugs that are used to prevent tissue transplant rejection and are considered
a carcinogen for non-Hodgkin lymphoma. In addition to the BRM listed, vaccines are also a
BRM.

OBJ: 5 (theory) TOP: Biologic Response Modifiers (BRMs)
KEY: Nursing Process Step: N/A
COMPLETION
29. The nurse cautions that stress over a long period of time can contribute to the risk for cancer
as prolonged stress suppresses the ____________.
ANS:
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immune system
The immune system can be suppressed by prolonged stress.

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MEDICAL SURGICAL NURSING CONCEPTS AND PRACTICE 3RD EDITION DEWIT TEST BANK

Chapter 08: Care of Patients with Cancer

PTS: 1 DIF: Cognitive Level: Application REF: 145

PTS: 1 DIF: Cognitive Level: Comprehension REF: 146

PTS: 1 DIF: Cognitive Level: Analysis REF: 147

PTS: 1 DIF: Cognitive Level: Analysis REF: 148

PTS: 1 DIF: Cognitive Level: Application REF: 148

PTS: 1 DIF: Cognitive Level: Application REF: 148, Table 8-1

PTS: 1 DIF: Cognitive Level: Application

PTS: 1 DIF: Cognitive Level: Comprehension REF: 156, Box 8-1

PTS: 1 DIF: Cognitive Level: Application REF: 156, Box 8-2

PTS: 1 DIF: Cognitive Level: Analysis REF: 163, Table 8-4

PTS: 1 DIF: Cognitive Level: Analysis REF: 164, Table 8-5

PTS: 1 DIF: Cognitive Level: Application REF: 165

PTS: 1 DIF: Cognitive Level: Knowledge REF: 166

PTS: 1 DIF: Cognitive Level: Application REF: 168

MSC: NCLEX: Health Promotion and Maintenance

PTS: 1 DIF: Cognitive Level: Application REF: 170

PTS: 1 DIF: Cognitive Level: Application REF: 161, Box 8-3

PTS: 1 DIF: Cognitive Level: Analysis REF: 172

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

PTS: 1 DIF: Cognitive Level: Application REF: 158

PTS: 1 DIF: Cognitive Level: Analysis REF: 175

PTS: 1 DIF: Cognitive Level: Application REF: 156, Box 8-2

PTS: 1 DIF: Cognitive Level: Application REF: 156

PTS: 1 DIF: Cognitive Level: Application REF: 173

PTS: 1 DIF: Cognitive Level: Comprehension REF: 145

PTS: 1 DIF: Cognitive Level: Comprehension REF: 146

PTS: 1 DIF: Cognitive Level: Comprehension REF: 146

PTS: 1 DIF: Cognitive Level: Comprehension REF: 149

OBJ: 2 (theory) TOP: Causative Factors

PTS: 1 DIF: Cognitive Level: Comprehension REF: 166

The immune system can be suppressed by prolonged stress.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 150

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