Chapter 6 Cancer PrepU Questions

1. Which of the following does a nurse have to assess during the bone marrow transplant (BMT)
procedure?
Correct response: Psychological status
Explanation: During the BMT procedure, the nurse assesses the patient’s psychological status.
Patients experience many mood swings and need emotional support and help throughout this
process. Assessing the patient’s blood pressure, urine gravity, and electrolyte levels is important
for patients undergoing chemotherapy.

2. A nurse is caring for a client who is receiving chemotherapy and has a platelet count of
30,000/mm3. Which statement by the client indicates a need for additional teaching?
Correct response: "I floss my teeth every morning."
Explanation: A client with a platelet count of 30,000/mm3 is at risk for bleeding and shouldn't
floss his teeth. Flossing may increase the risk of bleeding in a client with a platelet count less
than 40,000/mm3.

3. What foods should the nurse suggest that the patient consume less of in order to reduce nitrate
intake because of the possibility of carcinogenic action?
Correct response: Ham and bacon
Explanation: Dietary substances that appear to increase the risk of cancer include fats, alcohol,
salt-cured or smoked meats, nitrate and nitrite-containing foods, and red and processed meats.
Nitrates are added to cured meats, such as ham and bacon.

4. A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks
the nurse why it takes so long. What is the best response by the nurse?
Correct response: “It will allow time for the repair of healthy tissue.”
Explanation: In external-beam radiation therapy (EBRT), the total radiation dose is delivered
over several weeks in daily doses called fractions. This allows healthy tissue to repair and
achieves greater cell kill by exposing more cells to the radiation as they begin active cell
division.

5. A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:

Correct response: Encourage fluid intake, if possible, to dilute the urine.
Explanation: To prevent renal damage, it is helpful to dilute the urine by increasing fluids as
tolerated.

6. The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides
that they are very depressed. The nurse recognizes depression as which of the following?
Correct response: A normal reaction to the diagnosis of cancer.
Explanation: Clients have many reactions, ranging from anxiety, fear, and depression to
feelings of guilt related to viewing cancer as a punishment for past actions or failure to practice a
healthy life-style.
7. A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion
according to the TNM staging system as follows: TIS, N0, M0. What does this classification
mean?
Correct response: Carcinoma in situ, no abnormal regional lymph nodes, and no evidence
of distant metastasis
Explanation: TIS, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and
no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph
nodes, and no evidence of distant metastasis is classified as T0, N0, M0.

8. A nurse is administering daunorubicin through a peripheral I.V. line when the client complains
of burning at the insertion site. The nurse notes no blood return from the catheter and redness at
the I.V. site. The client is most likely experiencing which complication?
Correct response: Extravasation
Explanation: The client is exhibiting signs of extravasation, which occurs when the medication
leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site.

9. Which is a growth-based classification of tumors?

Correct response: Malignancy
Explanation: Tumors classified on the basis of growth are described as benign or malignant.

10. The nurse is evaluating the client's risk for cancer and recommends changes when the client
states she
Correct response: eats red meat such as steaks or hamburgers every day
Explanation: Dietary substances such as nitrate–containing, nitrite–containing, and red meats
appear to increase the risk of cancer.

11. Which of the following does a nurse have to assess during the bone marrow transplant
(BMT) procedure?
Correct response: Psychological status
Explanation: During the BMT procedure, the nurse assesses the patient’s psychological status.
Patients experience many mood swings and need emotional support and help throughout this
process.

12. A nurse is caring for a client receiving chemotherapy. Which nursing action is most
appropriate for handling chemotherapeutic agents?
Correct response: Wear disposable gloves and protective clothing.
Explanation: A nurse must wear disposable gloves and protective clothing to prevent skin
contact with chemotherapeutic agents.

13. According to the TNM classification system, T0 means there is

Correct response: no evidence of primary tumor.
Explanation: T0 means that there is no evidence of primary tumor.
14. Which of the following is a term used to describe the process of programmed cell death?
Correct response: Apoptosis
Explanation: Apoptosis is the innate cellular process of programmed cell death. Mitosis is the
phase of the cell cycle in which cell division occurs. Carcinogenesis is the process by which
cancer arises. Angiogenesis is the process by which a new blood supply is formed.

15. Which oncologic emergency involves the failure in the negative feedback mechanism that
normally regulates the release of antidiuretic hormone (ADH)?
Correct response: Syndrome of inappropriate antidiuretic hormone release (SIADH)
Explanation: SIADH is a result of the failure in the negative feedback mechanism that
normally regulates the release of antidiuretic hormone (ADH). Cardiac tamponade is an
accumulation of fluid in the pericardial space. DIC is a complex disorder of coagulation and
fibrinolysis, which results in thrombosis and bleeding. Tumor lysis syndrome is a rapidly
developing oncologic emergency that results from the rapid release of intracellular contents as a
result of radiation- or chemotherapy-induced cell destruction of large or rapidly growing cancers
such as leukemia.

16. A patient with uterine cancer is being treated with internal radiation therapy. What would the
nurse’s priority responsibility be for this patient?
Correct response: Explain to the patient that she will continue to emit radiation while the
implant is in place.
Explanation: When the patient has a radioactive implant in place, the nurse and other health
care providers need to protect themselves, as well as the patient, from the effects of radiation.
Patients receiving internal radiation emit radiation while the implant is in place; therefore,
contact with the health care team is guided by principles of time, distance, and shielding to
minimize exposure of personnel to radiation.

17. A client receiving external radiation to the left thorax to treat lung cancer has a nursing
diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's
care plan?
Correct response: Avoiding using soap on the irradiated areas
Explanation: Because external radiation commonly causes skin irritation, the nurse should
wash the irradiated area with water only and leave the area open to air. No soaps, deodorants,
lotions, or powders should be applied.

18. While administering cisplatin (Platinol–AQ) to a client, the nurse assesses swelling at the
insertion site. The first action of the nurse is to
Correct response: Discontinue the intravenous medication.
Explanation: If extravasation of a chemotherapeutic medication is suspected, the nurse
immediately stops the medication.
19. The nurse working on a bone marrow unit knows that it is a priority to monitor which of the
following in a client who has just undergone a bone marrow transplant?
Correct response: Monitor the client closely to prevent infection.
Explanation: Until transplanted bone marrow begins to produce blood cells, these clients have
no physiologic means to fight infection, which makes them very prone to infection. They are at
high risk for dying from sepsis and bleeding before engraftment

20. You are an oncology nurse caring for a client who tells you that their tastes have changed.
They go on to say that “meat tastes bad”. What is a nursing intervention to increase protein
intake for a client with taste changes?
Correct response: Encourage cheese and sandwiches.
Explanation: The nurse encourages the clients with taste changes to eat cheese and
sandwiches.

21. After being seen in the oncology clinic, a client with severe bone marrow suppression is
admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy.
When developing the care plan for this client, which nursing diagnosis takes priority?
Correct response: Risk for infection
Explanation: Risk for infection takes highest priority in clients with severe bone marrow
depression because they have a decrease in the number of white blood cells, the cells that fight
infection.

22. What disadvantages of chemotherapy should the patient be informed about prior to starting
the regimen?
Correct response: It targets normal body cells as well as cancer cells.
Explanation: Chemotherapy agents affect both normal and malignant cells; therefore, their
effects are often widespread, affecting many body systems.

23. The client is scheduled for a breast lump excision and sentinel node biopsy. What should the
nurse know in planning care for the client with a negative biopsy report?
Correct response: A wide excision of lump will be performed.
Explanation: The sentinel node is the first node in which a tumor will drain; if no malignant
cells are found there, additional excision or radical removal will not be necessary.

24. For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should
include which intervention in the care plan?
Correct response: Inspecting the skin for petechiae once every shift
Explanation: Because thrombocytopenia impairs blood clotting, the nurse should inspect the
client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums.
The nurse should avoid administering aspirin because it may increase the risk of bleeding.
25. A client is receiving the cell cycle–nonspecific alkylating agent Thiotepa (Thioplex), 60 mg
weekly for 4 weeks by bladder instillation as part of chemotherapy regimen to treat bladder
cancer. The client asks the nurse how the drug works. How does Thiotepa exert its therapeutic
effects?
Correct response: It interferes with DNA replication and RNA transcription.
Explanation: Thiotepa interferes with DNA replication and RNA transcription. It doesn't
destroy the cell membrane.

26. The nurse is caring for a client newly diagnosed with cancer. Which of the following
therapies is used to treat something other than cancer?
Correct response: Electroconvulsive therapy
Explanation: Cancer is frequently treated with a combination of therapies using standardized
protocols. Three basic methods used to treat cancer are surgery, radiation therapy, and
chemotherapy. Electroconvulsive therapy (ECT) is a method of treatment for mental distress or
illness.

27. Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What
treatment mode will the nurse anticipate?
Correct response: Adjuvant therapy is likely.
Explanation: T3 indicates a large tumor size with N1 indicating regional lymph node
involvement. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or
radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to
other organs. The tumor staging of stage IV is indicative of palliative care.

28. The nurse is providing an educational presentation on dietary recommendations for reducing
the risk of cancer. Which of the following food selections would demonstrate a good
understanding of the information provided in the presentation? Select all that apply.
Correct response: Egg white omelet with spinach and mushrooms, Steamed broccoli and
carrots
Turkey breast on whole wheat bread
Explanation: Foods high in fat and those that are smoked or preserved with salt or nitrates are
associated with increased cancer risks. An omelet made of egg whites and vegetables is a healthy
low-fat selection as are steamed broccoli/carrots and turkey breast on whole grain bread. A salad
can be a healthy selection but Caesar salads contain much fat from the dressing and addition of
cheeses and fried chicken.

29. A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the
nurse provide for the care of this patient?
Correct response: Provide time for the patient to discuss her concerns.
Explanation: Patients who are undergoing surgery for the diagnosis or treatment of cancer may
be anxious about the surgical procedure, possible findings, postoperative limitations, changes in
normal body functions, and prognosis.
30. What does the nurse understand is the rationale for administering allopurinol for a patient
receiving chemotherapy?
Correct response: It lowers serum and uric acid levels.
Explanation: Adequate hydration, diuresis, alkalinization of the acid crystals, and
administration of allopurinol (Zyloprim) may be used to prevent renal toxicity.

31. A client is recovering from a craniotomy with tumor debulking. Which comment by the
client indicates to the nurse a correct understanding of what the surgery entailed?
Correct response: “I guess the doctor could not remove the entire tumor.”
Explanation: Debulking is a reference made when a tumor cannot be completely removed,
often due to its extension far into healthy tissue.

32. A client with cancer is being evaluated for possible metastasis. What is one of the most
common metastasis sites for cancer cells?
Correct response: Liver
Explanation: The liver is one of the five most common cancer metastasis sites. The others are
the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional
metastasis sites.

33. Which type of hematopoietic stem cell transplantation (HSCT) is characterized by cells from
a donor other than the patient?
Correct response: Allogeneic
Explanation: If the source of donor cells is from a donor other than the patient, it is termed
allogeneic. Autologous donor cells come from the patient. Syngeneic donor cells are from an
identical twin.

34. The nurse is caring for a thyroid cancer client following oral radioactive iodine treatment.
Which teaching point is most important?
Correct response: Flush the toilet twice after every use.
Explanation: Iodine 131 is a systemic internal radiation that is excreted through body fluids,
especially urine. Flushing the toilet twice after every use will avoid the exposure of others to
radioactive exposure.

35. Which of the following is a characteristic of a malignant tumor?

Correct response: It gains access to the blood and lymphatic channels.
Explanation: By this mechanism, the tumor metastasizes to other areas of the body. Cells of
malignant tumors are undifferentiated. Malignant tumors demonstrate variable rate of growth;
however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the
periphery and sends out processes that infiltrate and destroy surrounding tissues.

36. The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the
upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What
does this finding suggest?
Correct response: Malignant tumor
Explanation: A fast-growing lump is suggestive of a malignant tumor. Metastasis can only be
determined by cytology, not by palpation.