Chapter 15 Cancer

Cancer: Prevention and Detection

1. The nurse is developing a program for a population with a high incidence of cancer and
determines that the male population would benefit. What form of cancer for males should
the nurse focus on?
Prostate cancer
Rationale
Among all the cancers in men, prostate cancer has the highest incidence (29%). Lung cancer has
the highest death rate among men (29%). The incidence of colon cancer in males is 9%. Thyroid
cancer is more common in women than men.
p. 231

2. The nurse is preparing a patient to have a biopsy. What documentation on the surgical
permit does the nurse ensure is correct that will improve tissue localization during the
procedure?
Rationale
Computed tomography is a diagnostic procedure that can be performed in combination with
biopsy to improve tissue localization; this technique helps to visualize the tumor. Craniotomy
and thoracotomy are surgical procedures that are performed when the tumor is not easily
accessible. Sigmoidoscopy is an endoscopic examination, which is useful to diagnose cancer, but
it does not help in tumor localization.
p. 243
3. Which cancer diagnosis for a female patient is most likely to cause death?
Rationale
A lung cancer diagnosis has a 26% death rate for women. Uterine, breast, and pancreatic cancers
have death rates of 15%, 4%, and 7%, respectively.
p. 235
4. A patient is suspected of having ovarian cancer. What oncofetal antigen does the nurse
anticipate seeing when the laboratory results return?
CA-125
Rationale
Oncofetal antigens are a type of tumor antigens. They are found on both the surfaces and the
inside of cancer cells and fetal cells. These antigens are an expression of the shift of cancerous
cells to a more immature pathway, which is associated with fetal periods of life. CA-125 is the
oncofetal antigen found in ovarian carcinoma. CA-15-3 is the oncofetal antigen found in breast
cancer. CA-19-9 is the oncofetal antigen found in pancreatic and gall bladder cancers. CA-27-29
is found in breast cancer.
p. 243
5. When discussing cancer diagnoses with a patient, which should the nurse identify as the
only definitive method?
Pathologic evaluation
Rationale
Pathologic examinations are the only definitive method for cancer diagnosis. Genetic markers,
radiographic studies, and endoscopic examinations may all be used in the diagnostic process, but
these methods are not definitive for the diagnosis of cancer on their own.
p. 243
6. The nurse is conducting a teaching session within the community regarding cancer
prevention and detection. Which type of cancer should the nurse include based on
the highest incidence among both men and women?
Lung cancer
Rationale
Aside from prostate cancer for men and breast cancer for women, lung cancer has the highest
incidence among both men and women. Thyroid cancer affects 7% of women but is not ranked
for men. Colorectal cancer is the third most common cancer; however, it ranks below lung
cancer. Non-Hodgkin lymphoma affects 5% of men and 4% of women; it also ranks below lung
cancer for both sexes.
p. 235
7. A patient has a grade IV histologic tumor. What condition does the nurse determine this
patient has?
Anaplasia
Rationale
Grade IV of histologic classification of tumors is associated with anaplasia. The grade I
histologic classification is associated mild dysplasia. The grade III histologic classification of
tumors indicates severe dysplasia. The grade II histologic classification of tumors is associated
with moderate dysplasia.
p. 241

8. The nurse is educating a student nurse about the seven warning signs of cancer. Which
warning sign stated by the student nurse indicates the student requires further education?
Severe headache
Rationale
Severe headache is not a warning sign of cancer. Severe headache may indicate a stroke.
Indigestion may indicate stomach cancer. Unusual bleeding may indicate uterine cancer.
Difficulty in swallowing may indicate esophageal cancer.
p. 242

9. Which diagnostic tool should the nurse include in the plan of care when determining the
needs of a patient who is suspected of having leukemia?
 Bone marrow aspiration
Rationale
Bone marrow examinations, such as a bone marrow aspiration, is a diagnostic tool for leukemia.
BRAC studies are conducted for a patient suspected of having breast cancer. Liver function
testing is conducted for a patient suspected of having liver cancer. Estrogen and progesterone
status checks are performed for patients suspected of having uterine cancer.
p. 243
10. A patient is diagnosed with carcinoma in situ. What tumor classification does the nurse
observe on the medication record?
T is
Rationale
The TNM classification system is used to determine the anatomic extent of the disease
involvement according to three parameters: tumor size and invasiveness, presence or absence of
regional spread to lymph nodes, and metastases. Carcinoma in situ (CIS) has its own designation
in the system (T is) because it has all the histologic characteristics of cancer except invasion,
which is a primary feature of the TNM staging system. T 0 is the designation used when there is
no evidence of a primary tumor. T X is the designation used for tumors that cannot be found or
measured. T 1-4 is the designation used for tumors that ascend in degrees and increase in size.
p. 236
11. The nurse is preparing a patient for diagnostic testing for a suspected malignancy.
What is the most appropriate statement by the nurse?
"Here is information about the biopsy."
Rationale
Providing the patient with easily understandable information regarding the process of diagnostic
testing is an appropriate response by the nurse. The nurse should avoid communication patterns
that may hinder exploration of feelings and meaning, such as providing false reassurances (for
example, "There is probably nothing wrong"), redirecting the discussion (for example, "Let’s
discuss that later"), generalizing (for example, "Everyone feels this way"), and using overly
technical language.
p. 242
12. Which data collected by the nurse indicates the patient has a complete carcinogen risk
factor for the development of cancer?
Cigarette smoking
Rationale
Cigarette smoke is a complete carcinogen because it is capable of both initiating and promoting
the development of cancer. Although alcohol consumption, dietary fat, and obesity are all
promoting factors for cancer, they are not considered complete carcinogens.
p. 238

Cancer Treatment and Care

1. The laboratory report reveals that the cells from the patient's tumor biopsy are Grade
II. What should the nurse know about this histologic grading?
Cells are abnormal and moderately differentiated
Rationale
Grade II cells are more abnormal than Grade I and moderately differentiated. Grade III cells are
very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and
undifferentiated; the cell origin is difficult to determine. Grade I cells differ slightly from normal
cells and are well differentiated.
p. 241
2. A patient is having whole brain radiation for brain metastasis and is concerned about
how they will look when hair loss occurs. What is the best response by the nurse to this
patient?
 "You can get a wig now to match your hair so you will not look different."
Rationale
Hair loss with radiation usually is permanent. The best response by the nurse is to suggest getting
a wig before the patient loses her hair so they will not look or feel so different. When hair grows
back after chemotherapy, it is frequently a different color or texture. Avoiding use of electric hair
dryers, curlers, and curling irons may slow the hair loss, but will not answer the patient's
concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but
this response is avoiding the patient's immediate concern.
p. 256
3. The nurse is caring for a patient with anorexia secondary to chemotherapy. Which
strategy would be most appropriate for the nurse to use to increase the patient's nutritional
intake?
Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods
Rationale
The nurse can increase the nutritional density of foods by adding items high in protein or calories
(such as peanut butter, skim milk powder, cheese, or honey) to foods the patient will eat.
Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat.
Small frequent meals are tolerated best. Supplements can be helpful to promote improved
nutritional status so should not be avoided.
p. 254
4. A patient undergoes modified radical mastectomy with axillary node dissection. After the
surgical incision is sufficiently healed, the patient is to undergo radiation therapy. What
instruction should the nurse give the patient regarding care of the skin at the site of
radiation therapy?
Wash the area gently with lukewarm water and lightly pat it dry
Rationale
The area undergoing radiation therapy may safely be washed with lukewarm water if it is done
gently and if care is taken not to injure the skin. A patient undergoing radiation therapy should
avoid anything that may be irritating to the skin, such as sunlight, lotions, ointments, or talcum
powder.
p. 255
5. The nurse is caring for a patient with Hodgkin’s disease who has developed
thrombocytopenia after receiving chemotherapy. What is the outcome of highest priority in
the nursing plan of care?
Controlling bleeding
Rationale
Thrombocytopenia is a low platelet count that leaves the patient at high risk for life-threatening
spontaneous hemorrhage. Diarrhea and infection are not symptoms associated with
thrombocytopenia. Hypotension may be seen if hemorrhagic or hypovolemic shock develops as a
result of blood loss stemming from thrombocytopenia.
p. 253
6. A nurse is caring for a patient with cancer of the neck. While assessing the vital signs of
the patient, the nurse notices bleeding in the cancerous area. Which nursing action is
a priority?
Apply pressure on the site
Rationale
Carotid artery rupture is a common complication in cancers of the head and neck. The artery can
rupture due to invasion of the blood vessel wall by the tumor. It can also be caused by erosion of
the arterial wall following surgery or radiation therapy. In the case of bleeding at the carotid
artery, the nurse should immediately apply pressure on the bleeding site to stop bleeding.
Intravenous fluids should be administered to maintain the intravascular volume; however, this
intervention is not the priority. A blood transfusion may be necessary; however, it is not a
priority. The primary health care provider should be informed after pressure is applied to the site
of the bleeding.
p. 264
7. The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a
rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for
tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality
associated with this oncologic emergency?
Hypocalcemia
Rationale
TLS is a metabolic complication characterized by rapid release of intracellular components in
response to chemotherapy. This can lead rapidly to acute renal injury. The hallmark signs of TLS
are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.
p. 263
8. The patient is being treated with brachytherapy for cervical cancer. What factors of
protection must the nurse be aware of when caring for this patient?
The time the nurse spends with the patient and at what distance
Rationale
The principles of ALARA (as low as reasonably achievable) and time, distance, and shielding
are essential to maintain the nurse's safety when the patient is a source of internal radiation. The
patient's medications, nutritional supplements, and time needed to complete care will not protect
the nurse caring for a patient with brachytherapy for cervical cancer.
p. 250
9. The patient with breast cancer is having teletherapy radiation treatments after surgery. What
should the nurse teach the patient about the care of the skin?
Avoid heat and cold to the treatment area
Rationale
Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented,
nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid
wearing tight-fitting clothing, such as a bra, over the treatment field and will want to expose the
area to air as often as possible.
p. 255
10. The patient is receiving an intravenous (IV) vesicant chemotherapy drug. The nurse
notices swelling and redness at the site. What should the nurse do first?
Turn off the chemotherapy infusion
Rationale
Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with
any sign of extravasation the infusion first should be stopped, then the protocol for the drug-
specific extravasation procedures should be followed to minimize further tissue damage. The site
of extravasation usually hurts, but it may not. It is more important to stop the infusion
immediately. The health care provider may be notified by another nurse while the patient's nurse
starts the drug-specific extravasation procedures, which may or may not include sterile saline.
p. 246
11. A patient undergoing outpatient chemotherapy reports feeling lonely and isolated and
expresses the desire to resume normal activities, such as socialization with friends. Which
precaution should the nurse recommend when allowing the patient to resume these
activities?
Avoiding crowds
Rationale
The nurse needs to teach the patient measures that will protect against infection, such as
maintaining adequate nutrition and fluid intake and avoiding crowds, people with infections, and
others who have been recently vaccinated with live or attenuated vaccines. Drinking bottled
water, eating only at home, and using the bathroom only at home are unnecessary precautions.
p. 253
12. The patient is receiving biologic and targeted therapy for ovarian cancer. What
medication should the nurse expect to administer before therapy to combat
the most common side effects of these medications?
Acetaminophen
Rationale
Acetaminophen is administered before therapy and every four hours after to prevent or decrease
the intensity of the severe flu-like symptoms, especially with interferon, which frequently is used
for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms.
Ondansetron is an antiemetic, but not used first to combat flu-like symptoms such as headache,
fever, chills, and myalgias.
p. 259
13. The nurse is reviewing the role of the immune system in cancer development. Which of
these statements explains the primary protective role of the immune system related to
malignant cells?
The immune system provides surveillance for cells with tumor-associated antigens
(TAAs).
Rationale
It is believed that one of the functions of the immune system is to respond to TAAs, which are
altered cell-surface antigens that occur on a cancer cell as a result of malignant transformation.
This immune function is known as immunologic surveillance. Immune cells do not bind with
free antigens released by malignant cells, nor do they produce blocking factors that immobilize
cancer cells. The immune system does not produce antibodies to attack cancer cells.
p. 238

Complications of Cancer
1. What is an oncogene?
A tumor-inducing gene
Rationale
An oncogene is a tumor-inducing gene. A tumor-suppressing gene regulates cell growth. A
carcinogen is a cancer-causing agent capable of producing cell alterations. A protooncogene is a
normal cell gene that regulates cell processes.
p. 236
2. What does the term "malignant" describe when referring to the anatomic classification
of a tumor?
Behavior
Rationale
The behavior of the tumor is described as either malignant or benign. The anatomic site describes
the location of tumor. A neoplasm is an abnormal growth of tissue. The tissue of origin is the site
where the tumor originated.
p. 240
3. A patient has peripheral neuropathy since taking chemotherapy. What medication does
the nurse anticipate educating the patient regarding?
Gabapentin
Rationale
Other adjuvant therapies, such as antidepressant and antiseizure drugs such as gabapentin, may
be beneficial in the treatment of neuropathic pain, which is often resistant to opiods. Furosemide
is a diuretic and therefore is not a treatment option for neuropathic pain. Metoclopramide is an
antiemetic and would not be used to treat neuropathic pain. Morphine sulfate is an analgesic and
would not be used to treat neuropathic pain.

Test-Taking Tip: Identifying content and what is being asked about that content is critical to
your choosing the correct response. Be alert for words in the stem of the item that are the same or
similar in nature to those in one or two of the options.
p. 264
4. What does the letter "A" represent in the acronym "CAUTION," which describes the
seven warning signs of cancer?
A sore that does not heal
Rationale
The letter "A" represents "A sore that will not go away." Pressure, pain, and itching are not
included in the seven warning signs of cancer.
p. 242
5. Which type of radiation therapy involves the oral administration of radioactive sources?
Radiopharmaceutical
Rationale
Radiopharmaceutical therapy involves the oral administration of radioactive sources. Teletherapy
involves exposing the patient to external radiation. A patient who undergoes brachytherapy is
exposed to internal radiation. Particulate radiation is a type of ionizing radiation used to treat
cancer.
p. 250
6. What is the anatomic classification of a malignant bone tumor?
Osteosarcoma
Rationale
An osteosarcoma is a malignancy found in bones. A carcinoma is a malignancy found in tissues.
A chondrosarcoma is a malignancy found in cartilage. A neuroblastoma is a malignancy found in
nerve cells.
p. 240
7. Melanomas, squamous cell carcinomas, and basal cell carcinomas are associated with
which type of carcinogen?
Ultraviolet radiation
Rationale
Melanomas, squamous cell carcinomas, and basal cell carcinoma are types of skin cancer, which
are associated with ultraviolet radiation. Viral carcinomas are associated with oncogenic viruses.
Inherited genetic mutations are passed on from a parent. Chemical carcinogens are cancer-
causing agents capable of producing cell alterations.
p. 237
8. Which type of kidney damage is due to the adverse effects of chemotherapy?
Chronic toxicity
Rationale
Chemotherapy-related damage to the kidneys is classified as a chronic toxicity. Chronic
toxicities can be either long-term effects that develop during or immediately after treatment and
persist, or late effects that are absent during treatment and manifest later. Acute toxicity occurs
during and immediately after drug administration. Delayed effects are many and include delayed
nausea and vomiting, mucositis, alopecia, skin rashes, bone marrow suppression, altered bowel
function (diarrhea or constipation), and a variety of cumulative neurotoxicity’s. Prolonged
toxicity is not a classification of the adverse effects of chemotherapy.
p. 248
9. The nurse is educating a patient about cancer prevention and early detection. Which
instructions should the nurse include in the discussion? Select all that apply.
1 Limit alcohol consumption.
2 Cut down on cigarette smoking.
3 Get regular physical examinations.
4 Obtain adequate rest (6-8 hours a night).
5 Know the seven warning signs of cancer.
6 Exercise for 20 minutes three times a week.
Rationale
Regular physical examinations, adequate consistent rest for at least 6-8 hours a night,
understanding the seven warning signs of cancer, and limiting alcohol intake are all educational
topics about cancer prevention. Cigarette smoking should be avoided completely, and the
recommendation for exercise is 30 minutes of moderate exercise five times a week.

Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify
a wrong answer.
p. 242
10. The nurse is developing a plan of care for a patient with cancer that is experiencing
pain. Which is the most important parameter the nurse should use to develop an effective
pain management plan for this patient?
Assessing the type of pain
Rationale
Assessing the type of pain (whether it is visceral, neuropathic, or bone) will help a nurse devise
an effective pain management plan. Vital signs, sleep cycles, and patient behavior do not provide
reliable data about the pain and its progression.
p. 264
11. Which type of chemotherapy drug will cause severe local tissue breakdown and necrosis
if inadvertently infiltrated into the skin?
Vesicant
Rationale
A vesicant will cause severe local tissue breakdown and necrosis if it is inadvertently infiltrated
into the skin. An irritant will damage the intima of the vein and cause phlebitis and sclerosis;
however, it will not damage the skin. Extravasation is the process by which drugs are infiltrated
into the tissues surrounding the infusion site. Intraarterial chemotherapy is a route used to deliver
drugs to the tumor via the arteries that supply it.
p. 246
12. Which cells have the most rapid rate of proliferation?
Bone marrow stem cells
Rationale
Bone marrow stem cells have a 6- to 24-hour generation time; these have the most rapid rate of
proliferation. The cells of the hair follicles have a 24-hour generation time. The epithelial cells
that line the gastrointestinal tract have a 12- to 24-hour generation time. Ova and sperm cells
have a 24- to 36-hour generation time.
p. 248
13. The patient with cancer is scheduled to have epidural analgesia. What should the nurse
educate the patient regarding the administration of this medication?
It will minimize the use of opioid drugs.
Rationale
Epidural analgesia minimizes the use of opioids in patients with cancer to relieve pain. Hydration
therapy increases urine production and reduces the risk of hyperurecimia. Furosemide is not
dependent on analgesic drugs. Low albumin levels in the blood cause false calcium levels; these
levels will not be reduced by epidural analgesia.
pp. 264-265
14. The nurse is caring for a patient diagnosed with superior vena cava syndrome. What clinical
manifestations does the nurse assess for? Select all that apply.
1. Seizures
2. Periorbital edema
3. Reports of headache
4. Distention of veins of head, neck, chest
5. Bruit auscultated bilateral carotid arteries
Rationale
Clinical manifestations of superior vena cava syndrome are facial edema; periorbital edema;
distention of veins of head, neck, and chest; headache; seizures; and a mediastinal mass is
observed on chest x-ray. A bruit is not diagnostic related to this syndrome.
p. 263