Chapter 25: The Patient With Cancer: Multiple Choice

Chapter 25: The Patient with Cancer
MULTIPLE CHOICE
1. Which statement reflects useful information to include in a teaching plan for a cancer
patient?
1. Cancer is a group of diseases. The cancer cells are different from the cells in the
tissue of origin in growth and the spreading of abnormal cells.
2. Cancer is the third leading cause of death in the United States. Many hospitals
have the highest number of patients with this diagnosis.
3. Americans who have a diagnosis of cancer die within a year or less.
4. When a person is genetically predisposed to a type of cancer, there is nothing that
can be done to prevent its occurrence.
ANS: 1
Information about the disease and disease process is helpful to allay anxiety as well as to
instruct about the pathophysiology.
PTS: 1 DIF: Cognitive Level: Application REF: 369-370

OBJ: 4 TOP: Morbidity and Mortality of Cancer
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance
2. Helpful sources of information that the nurse may use in beginning to develop a teaching
plan for patients having cancer diagnostic testing include:
1. other patients, visitors, or hospital workers who have been associated with
someone who has had cancer.
2. analysis of what the patient and family already know about prevention, detection,
treatment, and outcomes.
3. American Cancer Society (ACS), National Cancer Institute, Oncology Nursing
Society, VFW, or DAV.
4. supermarket tabloids or public books from the local library.
ANS: 2
Effective teaching starts with the level of knowledge of the learner. That content is then
analyzed for specific information that needs to be corrected or added.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 374

OBJ: 5
TOP: Knowledge of Approved Resources to Use in Developing a Nursing Care Plan
3. Identification of cancer risks is part of every nurse’s assessment skills. Some of the most
common of these signs and symptoms include:
1. appearance of recent skin area changes that look markedly unlike surrounding
tissues.
2. exposure to street repairs by smoothing newly laid concrete.
3. coughs and colds that respond quickly to ampicillin and tea with honey.
4. frequently forgetting monthly breast self-examination.
ANS: 1
Health promotion through self-knowledge and teaching of the public may lead to application
measures of early detection and treatment.

OBJ: 3 TOP: Cancer Risks per American Cancer Society (ACS)
KEY: Nursing Process Step: Assessment
4. A patient is receiving another course of chemotherapy as his cancer treatment after some
previous radiation treatments. He asks about several cancer words, which he has heard
referring to him. Correct interpretation of these words for this patient are that:
1. alopecia refers to the darkening of the skin over his cancer area.
2. carcinogen refers to some of the materials in his environment such as cigarettes,
asbestos, and mercury.
3. biotherapy refers to special diet foods and specific vitamins that he will need to
take on a regular basis now.
4. antineoplastic refers to drugs that increase the spread of his cancer.
ANS: 2
Correct definitions are important when the patient overhears someone using words about
himself and his disease.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 372

OBJ: 5 TOP: Cancer Glossary
MSC: NCLEX: Physiological Integrity and Psychological Integrity
5. The nurse includes in the teaching plan that malignant tumors are similar to benign tumors
because both:
1. contain cells that closely resemble those in the tissue of origin.
2. travel quickly to invade and destroy other tissues and organs.
3. always grow and multiply very rapidly, competing for space and nutrients and
causing severe pain.
4. may press on nearby surrounding tissues, such as nerves and blood vessels, causing
pain.
ANS: 4
This question requires interpretation of primary concepts of differences and similarities of
benign and malignant tumor cells.

OBJ: 1 TOP: Characteristics of Benign and Malignant Cells
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
6. The nurse explains that tumors that originate from tissues in the skin are:
1. carcinomas.
2. lymphomas.
3. melanomas.
4. sarcomas.
ANS: 3
Tumors are classified by anatomic site and tissue of origin. Carcinomas include the skin.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 371, Table 25-3

OBJ: 4 TOP: Cancer Terminology
KEY: Nursing Process Step: N/A MSC: NCLEX: Physiologic Integrity
7. A patient has a cancer that has been staged as T3 N2 M3. He has a PRN order of morphine,
4 mg, IM q3-4hr. He requests another pain shot about hours after the last one. An
appropriate nursing action would be to:
1. inform the patient that this narcotic may be given only every 4 hours to prevent
addiction.
2. ignore the call bell for 20 minutes, and then take at least 10 minutes to prepare and
administer the injection.
3. give the morphine; evaluate the results of pain relief. Arrange for the physician to
evaluate for breakthrough pain.
4. ask the family to assist in helping the patient accept waiting longer to receive an
addicting medication such as morphine.
ANS: 3
Terminal care does not include concerns about morphine addiction. Medication may be
given 15 minutes before or after an allotted time. The occurrence of breakthrough pain is a
real concern for this patient.
PTS: 1 DIF: Cognitive Level: Application REF: 371, Table 25-3

OBJ: 7 TOP: Nursing Care of the Terminal Patient in Pain
8. A patient is scheduled for a chemotherapy treatment in about 30 minutes. Breakfast trays

have arrived and are being served on the unit. The nurse’s best intervention would be to:
1. encourage the patient to eat all his breakfast to keep up his strength to fight the
cancer. Remind the patient that breakfast is about one third of daily intake.
2. listen attentively to any concerns that the patient voices regarding the treatment.
Offer to hold his tray until after the treatment.
3. offer to call the family to come and be present after the treatment. Encourage the
patient to drink at least all of orange juice and coffee.
4. suggest that the patient request a dose of strong analgesic instead of eating,
because this treatment is very painful.
ANS: 2
Chemotherapy causes nausea and vomiting. Holding the tray until later provides for better
intake and for holding the food in the stomach for digestion.
PTS: 1 DIF: Cognitive Level: Application

REF: 385, Nursing Care Plan OBJ: 6
TOP: Care of the Patient Undergoing Chemotherapy Treatment
MSC: NCLEX: Psychosocial Integrity
9. The nurse explains that drugs such as cannabinoids, Benadryl, and Vistaril are frequently
ordered for cancer patients to help:
1. promote amnesia to dampen the fears of dying and loss of financial income.
2. maintain fluid retention to prevent dehydration.
3. control nausea, vomiting, and taste disorders caused by therapy.
4. control bouts of diarrhea or uncomfortable constipation.
ANS: 3
This question requires the demonstration of concept application for specific drugs to patients
and expected results.
PTS: 1 DIF: Cognitive Level: Knowledge

REF: 390, Drug Therapy table OBJ: 5, 6
TOP: Drugs Commonly Ordered for Cancer Patients
10. During a gentle bathing, several new bruises are noted on the cancer patient’s upper arms
and thighs. An understanding of the possible causes and correct nurse’s actions for these
findings are that:
1. the patient must have fallen last night walking to the bathroom. Teach the patient to
use the call bell when assistance is needed.
2. the patient may have disseminated intravascular coagulation. Size, shape, location,
color, and tenderness must be reported and recorded fully.
3. an intravascular fluid overload is occurring because of the chemotherapy. Place the
patient on strict I/O and limit fluids.
4. the patient must have had a drug-induced seizure, which caused arm and leg
thrashing and the bruises. Chart findings and pad the side rails.
ANS: 2
Nurses are the health care providers most often physically closer to the patient. They are
frequently better able to assess the skin totally and to monitor the patient’s responses to
treatments and potential risks. Serious signs need to be reported in a timely manner and fully
described.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 388, Table 25-4

OBJ: 6 TOP: Physical Findings, Evaluation
KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity
11. The nurse closely monitors for an oncologic emergency consisting of a blood calcium
concentration that is too high. This may be manifested by:
1. hypertension and bradycardia.
2. fatigue, confusion, and weakness.
3. laboratory test results of potassium 2.5 mEq/L, sodium 143 mEq/L
4. urine output less than 30 mL/hr.
ANS: 2
This is the application of previous learned information in a new situation.
PTS: 1 DIF: Cognitive Level: Application REF: 394

OBJ: 6 TOP: Oncologic Emergencies
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
12. A senior female college student has had a melanoma of the forehead surgically removed and
given a course of chemotherapy. Which of the following comments that she has made
demonstrate her appropriate understanding of the treatments and prognosis?
1. “Why did you bring me this shampoo? You guys took all my hair, so I don’t have
anything to wash or fix.”
2. “Why don’t my friends from school come to visit? Did you tell them to stay
away?”
3. “My spring dance is only 3 weeks away. Do you think I could find a wig to cover
my head where the hair fell out from the chemo?”
4. “Well, this looks like the end of the problem for me, thank goodness! I won’t have
to bother that doctor again until I graduate in a couple of years because all my
shots must be up to date now.”
ANS: 3
Acceptance of the diagnosis, treatments, side effects, and prognosis by the patient are
important so that the nurse can judge their understanding and acceptance by the patient.
PTS: 1 DIF: Cognitive Level: Analysis REF: 387

OBJ: 6
TOP: Acceptance of the Results of Therapy, Understanding the Significance of the
Treatments KEY: Nursing Process Step: Assessment
13. A patient whose cancer has been staged at T4 N2 M2 has been assigned for care. What is the
best interpretation of this staging information in planning care for this patient?
1. The primary tumor has shrunken, although some lymph nodes remain involved.
Teach the patient that this is good news.
2. The primary tumor has now responded to a combination of chemotherapy and
radiation. The patient should now receive much less analgesic medication.
3. The primary tumor is quite large and has extended to lymph glands and distant
areas. Gentle touch and therapeutic listening will be especially helpful.
4. After the series of radiation treatments, the distant metastases are still present.
Prepare the patient to accept only the cure of the primary tumor.
ANS: 3
Correct interpretation and differentiating components of staging data are used to plan
effective nursing care.
PTS: 1 DIF: Cognitive Level: Analysis REF: 371, Table 29-5

OBJ: 7 TOP: Tumor Staging Used to Plan Care
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
14. The nurse assesses the patient on Adriamycin very carefully when the patient complains of:
1. nausea.
2. visual disturbances.
3. headache and dizziness.
4. rapid heart beat.
ANS: 4
Adriamycin is cardiotoxic and can cause heart failure.
PTS: 1 DIF: Cognitive Level: Application REF: 380-381

OBJ: 6 TOP: Complication of Adriamycin
15. An addition that should be made in the nursing care plan when a diagnosis of breast cancer
is first made at stage T1 N0 M0 is:
1. “risk for disturbed body image related to threats of anticipated changes.”
2. “risk of anxiety related to outcome of treatments.”
3. “risk for infection related to decreased white blood cell count.”
4. “risk for ineffective coping related to husband’s expectations regarding anticipated
treatments.”
ANS: 2
Early stages of cancer create anxiety about the outcome of treatments for the patient.

OBJ: 4, 6 TOP: Nursing Diagnosis
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
16. The nurse counsels that the most common site of cancer in adult women is the:
1. breast.
2. lung.
3. kidney.
4. uterus.
ANS: 1
The gender of the person determines the risk for some cancers and the need for early
detection.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 369, Figure 25-1

OBJ: 2 TOP: Common Sites of Cancer in Women
KEY: Nursing Process Step: N/A
17. An appropriate cancer warning sign to teach the public would be:
1. intense pain in an area such as a hip or groin after carrying several gallons of paint
up a ladder and painting the garage.
2. a mole on the calf of the leg that enlarges over a month and lifts up after 2 weeks
of being in the sun at the beach.
3. diarrhea that lasts 2 days after an all-day picnic at the beach.
4. a painful lump under the umbilicus that recedes when pushed, but comes out again
with a sneeze or hard cough.
ANS: 2
An obvious change in a wart or mole is an American Cancer Society (ACS) published risk
for a cancerous sign.

OBJ: 3 TOP: Warning Signs of Cancer
MSC: NCLEX: Health Promotion and Prevention
18. The nurse cautions that the most common site of cancer in adult men is the:
1. colon.
2. lung.
3. pancreas.
4. prostate.
ANS: 4
Gender defines some of the potential risks for cancer.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 369, Figure 25-1

OBJ: 3 TOP: Cancer Sites in Men
KEY: Nursing Process Step: N/A
19. The nurse assesses beginning acceptance of the diagnosis of cancer when the patient:
1. begins to act in a cheerful manner.
2. inquires about support groups.
3. cries over loss of health.
4. actively interacts with his or her family.
ANS: 2
Directed planning for support for the diagnosis is indicative of acceptance. Crying and a
cheerful manner are not necessarily positive. Interaction with the family is not indicative of
acceptance.

OBJ: 7 TOP: Acceptance of Cancer Diagnosis
20. The family is concerned about the possibility of addiction due to the frequent doses of
Roxanol. The nurse’s best response is:
1. “At this stage, addiction is the least of our worries.”
2. “This is a low-dose drug and controls pain without the problems of addiction.”
3. “Addiction is rare, but we have drugs that can counteract the effect of this
narcotic.”
4. “You may want to share your concerns with the doctor. He can order another drug
that is not addictive.”
ANS: 2
Roxanol is a low-dose narcotic with very little potential for addiction.

OBJ: 6 TOP: Radiation Teaching, Coping, and Family Involvement
21. The nurse explains that the most common cytologic test, usually performed in outpatient
settings, and that suggests the probability of a need for further testing for cancer cells, is a:
1. chest x-ray.
2. Koch test.
3. Pap test.
4. tine test.
ANS: 3
Preventive testing (Pap test) and screening reduce risks and increase chances of early
treatment.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 374, Table 25-1

OBJ: 3 TOP: Knowledge of Diagnostic Tests
22. Assisting the health care team to prepare a terminal cancer nursing care plan includes which
of the following?
1. Assessment of hyponatremia, hypotension, or cough, all of which must be
alleviated by appropriate medications before treatments can begin
2. Preplanning, which includes acceptance by the nurse that it is the patient who is
dying (nurse’s personal feelings about death are not considered)
3. Acceptance that late-stage cancer needs management of severe continual pain, and
acceptance of anxieties related to patient’s physical deterioration and to personal
grieving
4. Helping the patient or family to contact the social worker (no use at this point)
ANS: 3
Pain and anxiety management are within the expected scope of underlying principles and
concepts as nursing implementations for terminal cancer patients.

OBJ: 7 TOP: Care Planning for the Terminal Patient
KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity
23. The best menu choice for a patient who is undergoing radiation treatments every other day
is:
1. a bowl of vegetable soup, chopped egg and pickle sandwich on wheat bread, apple,
8 oz. orange juice.
2.
pinto beans, strained, with rice; 1-oz. slice of plain American cheese; cup
spinach; ripe banana; 8 oz. milk.
3.
Spanish rice, cup mixed green salad, cup canned peaches, 8 oz. Coke.
4. spaghetti with tomato sauce, cheddar cheese toast strips, six celery sticks with
peanut butter, 8 oz. whole milk.
ANS: 2
The relationship between concepts of proper nutrition, (normal versus during cancer
treatments), the special needs of the patient, and adequate nutrition are differentiated to
reduce digestive side effects of certain food groups.

OBJ: 6 TOP: Nutrition During Radiation Treatments
24. A patient is close to death with terminal liver cancer. He has widespread metastases. The
nurse decides that the patient’s frequent call bell summons need to be analyzed and an
appropriate action plan implemented. In selecting the best choice, nursing action(s) should
be based on which of the following judgments?
1. Encourage and insist that the family requests a transfer to hospice care, because the
general hospital does not have enough staff to keep responding to the patient’s end-
stage frequent calling and requests for minor help.
2. Use fixed interval and cocktail medication administration. Frequently evaluate for
breakthrough pain and anxieties. Answer the call bell quickly on the intercom or in
person.
3. Tell the family that as of this afternoon, all the patient’s questions, comments, and
expressed fears of dying and financial worries will be referred to the social worker,
physician, or clergy. Otherwise, one of them can come in and sit beside the bed.
4. Plan to limit the time spent with the patient strictly, because there is not much that
the nurse can do that could be beneficial at this point.
ANS: 2
Therapeutic touch, the nurse’s presence, and sufficient pain medication to make the patient
comfortable are appropriate nursing actions.

OBJ: 7
TOP: Terminal Care Planning and Implementations for the Cancer Patient
25. The patient is scheduled for a colonoscopy at 10 AM today. The effectiveness of the nurse’s
teaching for this procedure is verified by the following statement by the patient:
1. “I know that the lighted tube he will use will help the doctor look at my tumor and
he might take a small piece of tissue to look at in the lab.”
2. “I know that light on the tube will help to cure my cancer for me.”
3. “I know colonoscopy is very painful and embarrassing and I hope no one sees me
in that position.”
4. “My daughter is coming in to see me today. I am glad to be looking forward to
something pleasant.”
ANS: 1
Effective teaching may be evaluated by patient statements referring to correct concepts.
PTS: 1 DIF: Cognitive Level: Application

REF: 374, Diagnostic Tests and Procedures table OBJ: 7
TOP: Care of Patient Undergoing Colonoscopy
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Safe, Effective Care Environment
MULTIPLE RESPONSE
1. The nurse cautions a group of middle-aged persons that conditions that promote the
formation of malignant cells are (select all that apply):
1. general emotional health.
2. increasing age.
3. hormonal changes.
4. chronic irritation of tissue.
5. diet.
ANS: 1, 2, 3, 4, 5
All options mentioned are possible sources of increased incidence of cancer in middle-aged
persons.

OBJ: 1 TOP: Conditions That Increase Incidence of Cancer
2. The nurse reminds a visitor to a patient who has an internal radiation implant to (select all
that apply):
1. avoid visitation if you are pregnant.
2. take off all metals, such as your watch and belt.
3. limit visitation time.
4. wear a protective lead apron.
5. stay at least 6 feet away from bedside.
ANS: 1, 3, 5
Visitors are important to reduce the isolation of the radiation patient, but pregnant women
should not visit. The visits of all persons should be limited to a few minutes and they should
be at least 6 feet from the bedside. Removing metal objects and wearing protective devices
are not necessary.

OBJ: 5 TOP: Radiation Precautions
MSC: NCLEX: Safe, Effective Care Environment
3. The nurse explains that adjuvant therapy is given to cancer patients who are free of signs of
the disease to (select all that apply):
1. ensure eradication of undetected cells.
2. stabilize normal cells.
3. diminish recurrence of breast cancer.
4. reduce the extent of the tumor before surgery or radiation.
5. change the pH of the system to inhibit cell growth.
ANS: 1, 3
Adjuvant therapy is given to symptom-free cancer victims to eradicate undetected cells and
to diminish the recurrence of breast cancer. Administration prior to surgery or radiation to
reduce tumor bulk is call neoadjuvant therapy. The therapy does not stabilize normal cells or
alter the pH.

OBJ: 3 TOP: Adjuvant Therapy
4. When the nurse sees that an IV vesicant cancer drug has extravasated, the nurse should
(select all that apply):
1. place a warm compress on the area.
2. chill the area with an ice pack.
3. raise the patient’s arm above the level of the heart.
4. stop the infusion.
5. notify the charge nurse.
ANS: 4, 5
The LPN should stop the infusion and notify the charge nurse so that specially trained
personnel can intervene.

OBJ: 5 TOP: Extravasation
COMPLETION
1. The nurse clarifies that cells that change from their tissues of origin and have multiple nuclei
are categorized as ____________________.
ANS: Undifferentiated

OBJ: 1 TOP: Undifferentiated Cells

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Chapter 25: The Patient with Cancer

PTS: 1 DIF: Cognitive Level: Application REF: 369-370

PTS: 1 DIF: Cognitive Level: Comprehension REF: 374

PTS: 1 DIF: Cognitive Level: Comprehension REF: 371

PTS: 1 DIF: Cognitive Level: Knowledge REF: 372

PTS: 1 DIF: Cognitive Level: Comprehension REF: 370

PTS: 1 DIF: Cognitive Level: Comprehension REF: 371, Table 25-3

PTS: 1 DIF: Cognitive Level: Application REF: 371, Table 25-3

8. A patient is scheduled for a chemotherapy treatment in about 30 minutes. Breakfast trays

PTS: 1 DIF: Cognitive Level: Application

PTS: 1 DIF: Cognitive Level: Knowledge

PTS: 1 DIF: Cognitive Level: Comprehension REF: 388, Table 25-4

PTS: 1 DIF: Cognitive Level: Application REF: 394

PTS: 1 DIF: Cognitive Level: Analysis REF: 387

PTS: 1 DIF: Cognitive Level: Analysis REF: 371, Table 29-5

PTS: 1 DIF: Cognitive Level: Application REF: 380-381

PTS: 1 DIF: Cognitive Level: Application REF: 386

PTS: 1 DIF: Cognitive Level: Comprehension REF: 369, Figure 25-1

PTS: 1 DIF: Cognitive Level: Comprehension REF: 372

PTS: 1 DIF: Cognitive Level: Knowledge REF: 369, Figure 25-1

PTS: 1 DIF: Cognitive Level: Analysis REF: 391

PTS: 1 DIF: Cognitive Level: Application REF: 394

PTS: 1 DIF: Cognitive Level: Knowledge REF: 374, Table 25-1

PTS: 1 DIF: Cognitive Level: Analysis REF: 392

PTS: 1 DIF: Cognitive Level: Analysis REF: 389

PTS: 1 DIF: Cognitive Level: Analysis REF: 392

PTS: 1 DIF: Cognitive Level: Application

PTS: 1 DIF: Cognitive Level: Analysis REF: 370

PTS: 1 DIF: Cognitive Level: Application REF: 376

PTS: 1 DIF: Cognitive Level: Application REF: 376

PTS: 1 DIF: Cognitive Level: Application REF: 381

PTS: 1 DIF: Cognitive Level: Comprehension REF: 369

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