Brunner: Medical-Surgical Nursing, 11th Edition

Test Bank

Chapter 16: Oncology: Nursing Management in Cancer Care

Multiple Choice

1. The school health nurse is presenting a health promotion class to a group of high school
students. Which intervention addresses health promotion strategies related to the leading cause of
cancer deaths in North America?
A) Monthly breast self-exams
B) Smoking cessation
C) Annual colonoscopies
D) Monthly testicular exams

Ans: B
Chapter: 16
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 4
Patient Needs: B-2
Feedback: Lung cancer is the leading cause of death for men and women in North America, so
smoking cessation is the health promotion initiative directly related to lung cancer.

2. The patient arrives in clinic for a 2-month follow-up appointment following chemotherapy.
The nurse notes that the patient's skin appears yellow. What blood tests should be done to further
explore this clinical sign?
A) Liver function test
B) CBC
C) Platelet count
D) Electrolytes

Ans: A
Chapter: 16
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 7
Patient Needs: D-4
Feedback: Yellow skin is a sign of jaundice. The liver is a common organ affected by metastatic
disease. A liver function test should be done to determine if the liver is functioning.

3. A patient tells the nurse that he has heard that certain foods can increase the incidence of
cancer. The nurse informs the patient that certain foods appear to increase the risk of cancer.
Which of the following menu selections would be the best choice for reducing the risk of cancer?
A) Smoked salmon and green beans
B) Pork chops and fried green tomatoes
C) Baked apricot chicken and steamed broccoli
D) Liver, onions, and steamed peas

Ans: C
Chapter: 16
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 3
Patient Needs: B-2
Feedback: High-fiber foods, cruciferous vegetables (such as broccoli, cauliflower, and spinach),
and carotenoids (such as apricots and peaches) appear to reduce cancer risk. Salt-cured foods,
such as ham and processed luncheon meats, should be avoided.

4. Which of the following would be an example of primary prevention?

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

Ans: C
Chapter: 16
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 4
Patient Needs: B-2
Feedback: Primary prevention is concerned with reducing the risks of cancer in healthy people
through practices such as use of sunscreen. Secondary prevention involves detection and
screening to achieve early diagnosis, as demonstrated by Papanicolaou tests, mammograms, and
testicular exams.

5. The patient is a 39-year-old woman with a family history of breast cancer. A breast-tumor
marking test is done, and the results are positive. The patient is requesting a bilateral
mastectomy. This surgery is an example of which of the following?
A) Salvage surgery
B) Palliative surgery
C) Prophylactic surgery
D) Reconstructive surgery

Ans: C
Chapter: 16
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 5
Patient Needs: D-3
Feedback: Prophylactic surgery is used when there is an extensive family history and non-vital
tissues are removed.

6. The patient is receiving external radiation for a malignant tumor of the head and neck. For
which of the following side effects should the nurse assess from the radiation treatment?
A) Impaired nutritional status
B) Pink oral mucosa
C) Diarrhea
D) Alopecia

Ans: A
Chapter: 16
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 6
Patient Needs: D-4
Feedback: Alterations in oral mucosa, change/loss of taste, pain, and dysphasia often occur as a
result of radiotherapy to the head and neck. The patient is at an increased risk of impaired
nutritional status.
7. While a patient is receiving intravenous doxorubicin hydrochloride, the nurse observes that
there is swelling and pain at the IV site. The nurse should:
A) Stop the administration of the drug immediately.
B) Notify the patient's physician.
C) Continue to administer but decrease the rate of infusion.
D) Apply a warm compress to the site.

Ans: A
Chapter: 16
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 7
Patient Needs: D-2
Feedback: Doxorubicin hydrochloride is a chemotherapeutic vesicant that can cause severe
tissue damage. The nurse should stop the administration of the drug immediately and then notify
the patient's physician. Ice can be applied to the site once the drug therapy has stopped.

8. A patient scheduled to receive chemotherapy for cancer asks the nurse what the most common
side effect of chemotherapy is. The nurse informs the patient that the most common side effect of
chemotherapy is:
A) Alopecia
B) Nausea and vomiting
C) Altered glucose metabolism
D) Increased appetite

Ans: B
Chapter: 16
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 7
Patient Needs: D-2
Feedback: One of the most common side effects of chemotherapy is nausea and vomiting;
antiemetic drugs are frequently prescribed for these patients. Other side effects include bone
marrow suppression, anorexia, vaginal dryness, and hair loss. Less common side effects include
altered glucose metabolism and jaundice.
9. The patient is receiving carmustine, a chemotherapy agent. A side effect of this medication is
thrombocytopenia. What symptom will the nurse likely assess in the patient with
thrombocytopenia?
A) Interrupted sleep pattern
B) Hot flashes
C) Nosebleed
D) Increased weight

Ans: C
Chapter: 16
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 7
Patient Needs: D-4
Feedback: Patients with thrombocytopenia are at risk for bleeding due to decreased platelet
counts. A priority goal for this patient is to prevent trauma related to the decreased platelet count.
A soft toothbrush or an electric razor can be used. No invasive procedures should be performed.

10. When preparing to administer an antineoplastic agent to a hospitalized patient, the nurse
should:
A) Administer only pre-packaged agents from the manufacturer.
B) Wash hands and arms following administration.
C) Use gloves and a lab coat.
D) Dispose of the antineoplastic wastes in the hazardous waste receptacle.

Ans: D
Chapter: 16
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 7
Patient Needs: A-2
Feedback: The nurse should use surgical gloves and disposable long-sleeved gowns when
administering antineoplastic agents. The antineoplastic wastes are disposed of as hazardous
materials.

11. What information will the nurse provide to the visitors of a patient who is to receive a bone
marrow transplant?
A) Bring plants to improve air quality.
B) Take the patient to the cafeteria for meals.
C) Wear hospital scrubs when entering the patient's room.
D) Do not visit if you have had a recent infection.

Ans: D
Chapter: 16
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 6
Patient Needs: A-2
Feedback: Before engraftment, patients are at a high risk for infection, sepsis, and bleeding.
Visitors should not visit if they've had a recent illness or vaccination.

12. The nurse is aware that infection is a significant consideration when providing care to an
oncology patient. The leading cause of death in an oncology patient is infection caused by which
of the following?
A) Malnutrition
B) Impaired skin integrity
C) Poor hygiene
D) Broken oral mucosa

Ans: B
Chapter: 16
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 7
Patient Needs: A-2
Feedback: For oncology patients, infection is the leading cause of death due to impaired skin
integrity and the suppression of bone marrow caused by many treatments for cancer.

13. A nurse who is caring for an adult patient who develops a mild oral yeast infection following
chemotherapy should encourage the patient to:
A) Avoid the use of a lip lubricant.
B) Scrub the tongue with a firm-bristled toothbrush.
C) Avoid the use of dental floss until the stomatitis is resolved.
D) Rinse the mouth with normal saline.
Ans: D
Chapter: 16
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Teaching/Learning
Objective: 7
Patient Needs: D-1
Feedback: Stomatitis is an inflammation of the oral cavity. The patient should be encouraged to
brush the teeth with a soft toothbrush after meals, use dental floss every 24 hours, rinse with
normal saline, and use a lip lubricant. Mouthwashes and hot foods should be avoided.

14. A priority nursing diagnosis for the nurse caring for a patient with cancer who is preparing
for engraftment for a bone marrow transplant is:
A) Fatigue and activity intolerance
B) Altered nutrition: less than body requirements due to anorexia
C) Risk for infection related to altered immunologic response
D) Body image disturbance related to weight loss and anorexia

Ans: C
Chapter: 16
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 8
Patient Needs: D-2
Feedback: A priority nursing diagnosis for this patient is risk for infection related to altered
immunologic response. Because the patient's immunity is suppressed, he or she will be at a high
risk for infection.

15. A nurse caring for an oncology patient who develops erythema following radiation therapy
should instruct the patient to:
A) Apply ice to the area.
B) Keep the area cleanly shaven.
C) Apply petroleum ointment to the affected area.
D) Avoid using soap on the area of treatment.

Ans: D
Chapter: 16
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 6
Patient Needs: D-3
Feedback: Care to the affected area must focus on preventing further skin irritation, drying, and
damage. Soaps, petroleum ointment, and shaving the area could worsen the erythema. Ice is also
contraindicated.

16. A patient has been given a 6-month prognosis and would like to die at home. The patient's
care needs are unable to be met in a home environment. What might the nurse suggest as an
alternative?
A) A rehabilitation hospital
B) A personal care home
C) Acute care
D) Hospice care

Ans: D
Chapter: 16
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Caring
Objective: 10
Patient Needs: D-1
Feedback: Hospice care can be provided in several settings. Because of the high cost associated
with free-standing hospices, care is often delivered by coordinating services provided by both
hospitals and the community. The primary goal of hospice care is to provide support to the
patient and family. Patients who are referred to hospice care generally have less than 6 months to
live.

17. A 42-year-old male complains of extreme fatigue and weakness after his first week of
radiation therapy. Which of the following responses by the nurse would best reassure him?
A) "These symptoms usually result from radiation therapy; however, we will continue to
monitor your laboratory and x-ray studies."
B) "These symptoms are part of your disease and can't be helped."
C) "Don't be concerned about these symptoms. Everybody feels this way after having radiation
therapy."
D) "This is a good sign. It means that only the cancer cells are dying."

Ans: A
Chapter: 16
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 6
Patient Needs: D-4
Feedback: Fatigue and weakness result from radiation treatment and usually don't represent
deterioration or disease progression. The symptoms associated with radiation therapy usually
decrease after therapy ends, but they may concern the patient and shouldn't be belittled.
Radiation destroys both cancerous and normal cells.

18. A female patient experiences alopecia resulting from chemotherapy, prompting the nursing
diagnoses of disturbed body image and situational low self-esteem. Which of the following
actions best indicates that the patient is meeting the goal of improved body image and self-
esteem?
A) The patient requests that her family bring her makeup and wig.
B) The patient begins to discuss the future with her family.
C) The patient reports less disruption from pain and discomfort.
D) The patient cries openly when discussing her disease.

Ans: A
Chapter: 16
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 7
Patient Needs: C-1
Feedback: Requesting her wig and makeup indicates that the patient with alopecia is becoming
interested in looking her best and that her body image and self-esteem may be improving. The
other options may indicate that other nursing goals are being met, but they don't assess improved
body image and self-esteem.

19. Patients receiving chemotherapy are at risk for adverse effects related to the therapy. To
combat the most common adverse effects of chemotherapy, the nurse would administer an:
A) Antiemetic
B) Antimetabolite
C) Tumor antibiotic
D) Anticoagulant

Ans: A
Chapter: 16
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 7
Patient Needs: D-2
Feedback: Antiemetics are used to treat nausea and vomiting. Antihistamines and certain
steroids are also used to treat nausea and vomiting. Antimetabolites and tumor antibiotics are
classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby
helping to prevent thrombi and emboli.

20. A 58-year-old male is hospitalized for a wedge resection of the left lower lung lobe. A
routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which of
the following statements by the nurse would be most therapeutic?
A) "Smoking is the reason you're here."
B) "The doctor left orders for you not to smoke."
C) "You're anxious about the surgery. Do you see smoking as helping?"
D) "Smoking is OK right now, but after your surgery it's contraindicated."

Ans: C
Chapter: 16
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication/Documentation
Objective: 3
Patient Needs: C-1
Feedback: This acknowledges the patient's feelings and encourages him to assess his previous
behavior. Option A belittles the patient. Option B doesn't address the patient's anxiety. Option D
would be highly detrimental to this patient.