Question 1

While she is being prepared for a biopsy of a lump in her right breast, the patient asks the nurse what the difference is between a benign tumour and a malignant tumour. Which of the following explanations about benign tumours best describes the difference from malignant tumours? a. Benign tumours frequently recur in the same site. b. Benign tumours do not cause damage to adjacent tissue. c. Benign tumours do not spread to other tissues and organs. d. Benign tumours are simply an overgrowth of normal cells.

Accepted Answer

ANS: C The major difference between malignant and benign tumours is that benign tumours never metastasize, whereas malignant tumours invade adjacent tissues and spread to distant tissues.

Question 2

A patient has been told by his physician that the tumour in his bowel is poorly differentiated. He asks the nurse what is meant by “poorly differentiated.” On what knowledge should the nurse base the response to the patient’s question? a. Cancer cells develop a new gene, called an oncogene, which promotes continuous, immature reproduction of cells. b. Poorly differentiated cells are fetal cells that do not have time to mature as a result of the rapid division of malignant cells. c. Normal cells revert to a more fetal appearance and function, probably because of mutation of cellular genes called proto-oncogenes. d. Normal mature cells with specific functions become immature, nonfunctioning cells when chemical agents, such as oncogenes, cause cell mutation.

Accepted Answer

ANS: C An undifferentiated cell has an appearance more like that of a stem cell or a fetal cell and less like that of a normal cell of the organ or tissue. The DNA in cancer cells is always different from that of normal cells.

Question 3

A patient tells the nurse that he read that asbestos is a carcinogen and asks whether that means it causes cancer. Which of the following explains what a carcinogen is? a. Any agent or condition that can promote the proliferation of altered, mutated cells b. Any chemical, physical, or genetic agent that can irreversibly alter cellular DNA, causing abnormal cells to be produced c. Any agent or condition that causes chronic irritation and stimulation of tissue, resulting in uncontrolled overgrowth of tissue d. A specific, known chemical or physical agent that can start uncontrolled cellular proliferation by fracturing cellular DNA

Accepted Answer

ANS: B Carcinogens are cancer-causing agents capable of producing cellular alterations and may be chemical, radioactive, or viral in nature.

Question 4

When teaching a patient who smokes about the relationship of smoking to the development of cancer, how should the nurse explain tobacco smoke as a “complete” carcinogen? a. Exposure to the smoke always causes cellular changes. b. Tobacco smoke is capable of both initiating and promoting cancer growth. c. Cancer will always develop when people who smoke are exposed to other carcinogens. d. Tobacco smoke serves as a vehicle for the spread of cancer cells during the progression stage of cancer.

Accepted Answer

``` ANS: B Some carcinogens (called complete carcinogens) are capable of both initiating and promoting the development of cancer. Tobacco is an example of a complete carcinogen, capable of initiating and promoting cancer. ```

Question 5

In teaching about cancer prevention, why does the nurse stress promotion of exercise, normal body weight, and a low-fat diet? a. General aerobic health is an important defence against cellular mutation. b. Obesity is a factor that promotes cancer growth; if it is reversed, the risk of cancer can be decreased. c. People who are overweight usually consume large amounts of fat, which is a chemical carcinogen. d. The development of fatty tumours, such as lipomas, is increased when fatty tissue is abundant.

Accepted Answer

ANS: B Promoting factors include dietary fat, obesity, cigarette smoking, and alcohol consumption. The withdrawal of or reduction in these factors can reduce the risk of cancer development.

Question 6

During a routine health examination, the patient tells the nurse that she has a family history of colon cancer. What should the nurse advise the patient to do? a. Schedule a sigmoidoscopy every year after the age of 40. b. Schedule a digital rectal examination every 6 months after the age of 45. c. Have a sigmoidoscopy for baseline at the age of 50 and every 5 years afterward. d. Discuss specific testing with her doctor because her risk for colon cancer is increased.

Accepted Answer

ANS: D If the patient has a higher known risk (a first-degree relative with colorectal cancer or a history of inflammatory bowel disease or benign polyps), then screening should be individualized and started before the age of 50.

Question 7

A 58-year-old woman has breast cancer that has metastasized to the liver. On which fact about metastatic cells does the nurse understand that the treatment plan for the patient is based? a. They become more unlike the cells of the primary site as mutations occur in the tumour cells at both sites. b. They are identical to the cells in the breast, having passively been spread through blood and lymph vessels. c. They do not proliferate as rapidly as the malignant cells in the primary site and are therefore less sensitive to treatment. d. They retain the characteristics of the malignant cells in the breast and have the same response to treatment as the primary tumour does.

Accepted Answer

ANS: A As the primary and metastatic sites develop, the cells quickly become more heterogeneous as they repeatedly undergo spontaneous genetic mutations.

Question 8

A patient undergoes a needle biopsy of the prostate. What type of tumour classification can be provided from a needle biopsy? a. Clinical status of the patient with cancer b. Staging of the extent and spread of the tumour c. Appearance of cells and degree of differentiation d. TNM staging with size, node involvement, and presence of metastasis

Accepted Answer

ANS: C This examination will determine whether the tissue is benign or malignant, the anatomic tissue from which the tumour arises, and the degree of cellular differentiation (i.e., how closely the specimen cells resemble the normal cells of the tissue).

Question 9

The nurse is teaching a postmenopausal patient with breast cancer about the expected outcomes of her cancer treatment. The nurse evaluates that the teaching has been effective when the patient makes which of the following statements? a. “If I have no recurrence in the tumour for 5 years after treatment, I will be cured of my cancer.” b. “Because my tumour is slow-growing, it will be many years before I can be considered cured of cancer.” c. “Cancer can be cured only with surgery, and other treatments are used to control the symptoms cancer causes.” d. “Cancer is never considered cured, and the goal of treatment is control of tumour growth over a long period of time.”

Accepted Answer

ANS: B The patient with a tumour that has a slower mitotic rate (e.g., postmenopausal breast cancer) needs 20 or more disease-free years before she can be considered cured of cancer.

Question 10

A patient with a large stomach tumour that is attached to the liver is scheduled to have a debulking procedure. What should the nurse explain that the expected outcome for this surgery will be? a. Relief of pain by cutting sensory nerves in the stomach b. Reduction of the tumour burden to enhance adjuvant therapy c. Control of the tumour growth by removal of malignant tissue d. Promotion of better nutrition by relieving the pressure in his stomach

Accepted Answer

ANS: B A debulking or cytoreductive procedure may be used if the tumour cannot be completely removed (e.g., is attached to a vital organ). When this occurs, as much tumour as possible is removed, and the patient may be given chemotherapy or radiation therapy.

Question 11

External beam radiation is planned for a patient with cancer of the colon. Because the treatment area is in the lower abdomen and pelvic area, which of the following measures should the nurse teach the patient is important to prevent complications from the effects of the radiation? a. Maintain a high-residue, high-fat diet. b. Test all stools for the presence of blood. c. Inspect the mouth and throat daily for the appearance of thrush. d. Perform perianal care with sitz baths and meticulous cleaning.

Accepted Answer

ANS: D Radiation to the lower abdomen will affect organs in the radiation path, such as the bowel. Nausea, vomiting, and diarrhea are early responses to irradiation of the gastrointestinal tissue and may occur immediately following the first treatment.

Question 12

Approximately what percentage of Canadians will develop cancer during their lifetimes? a. 12% b. 27% c. 43% d. 55%

Accepted Answer

ANS: C Approximately 43% of Canadians will develop cancer during their lifetimes.

Question 13

A patient with Hodgkin’s disease is undergoing external radiation therapy on an outpatient basis. After 2 weeks of treatment, he tells the nurse that he is so tired he can hardly get out of bed in the morning. What is an appropriate goal for the nurse to plan with this patient? a. Establish a daily walking program. b. Exercise vigorously when fatigue is not as noticeable. c. Consult with a psychiatrist for treatment of depression. d. Maintain bed rest until the radiation treatment is completed.

Accepted Answer

ANS: A Mild physical activity programs are usually within the abilities of patients undergoing external radiation therapy and have been found to improve symptoms of fatigue, lessen anxiety, and facilitate sleep in cancer patients.

Question 14

After 3 weeks of radiation therapy, a patient has lost 4.5 kg and does not eat well because nothing tastes good. What is an appropriate nursing diagnosis for the patient? a. Risk for infection related to poor nutrition b. Ineffective therapeutic regimen management related to refusal to eat c. Imbalanced nutrition: less than body requirements related to anorexia d. Ineffective health maintenance related to lack of knowledge of nutritional requirements during radiation therapy

Accepted Answer

ANS: B The patient is not eating; therefore, the nurse needs to encourage small, frequent meals of high-protein, high-calorie foods (e.g., Ensure or other supplements) to achieve an effective therapeutic regimen management and avoid weight loss.

Question 15

A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. Which of the following statements by the patient indicates to the nurse that the teaching about management of the skin reaction has been effective? a. “I can use ice packs to relieve itching and scaling in the treatment area.” b. “I can lubricate the area with a nonmedicated, nonperfumed moisturizing lotion.” c. “I will expose the treatment area to a sun lamp daily to increase blood supply to the area.” d. “I should scrub the area with warm water to remove the scales and apply alcohol to toughen the skin.”

Accepted Answer

ANS: B Dry skin should be lubricated with a nonirritating lotion or solution that contains no metal, alcohol, perfume, or additives that irritate the skin.

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LA#8 ( Cancer) Chaps 18, 30, 45, 54, 57 in Med Surg Flashcards

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