NURS 223 EXAM 2-COMPLETED A with Elaborate Answers and responses

NURS 223 EXAM 2 1. The student nurse learning about cellular regulation understands that which process occurs during the S phase of the cell cycle? a. Actual division (mitosis) b. Doubling of DNA c. Growing extra membrane d. No reproductive activity ANS: B During the S phase, the cell must double its DNA content through DNA synthesis. Actual division, or mitosis, occurs during the M phase. Growing extra membrane occurs in the G1 phase. During the G0 phase, the cell is working but is not involved in any reproductive activity. 2. A student nurse asks the nursing instructor what “apoptosis” means. What response by the instructor is best? a. Growth by cells enlarging b. Having the normal number of chromosomes c. Inhibition of cell growth d. Programmed cell death ANS: D Apoptosis is programmed cell death. With this characteristic, organs and tissues function with cells that are at their peak of performance. Growth by cells enlarging is hyperplasia. Having the normal number of chromosomes is euploidy. Inhibition of cell growth is contact inhibition. 3. The nursing instructor explains the difference between normal cells and benign tumor cells. What information does the instructor provide about these cells? a. Benign tumors grow through invasion of other tissue. b. Benign tumors have lost their cellular regulation from contact inhibition. c. Growing in the wrong place or time is typical of benign tumors. d. The loss of characteristics of the parent cells is called anaplasia. ANS: C Benign tumors are basically normal cells growing in the wrong place or at the wrong time. Benign cells grow through hyperplasia, not invasion. Benign tumor cells retain contact inhibition. Anaplasia is a characteristic of cancer cells. 4. A group of nursing students has entered a futuristic science contest in which they have “developed” a cure for cancer. Which treatment would most likely be the winning entry? a. Artificial fibronectin infusion to maintain tight adhesion of cells b. Chromosome repair kit to halt rapid division of cancer cells c. Synthetic enzyme transfusion to allow rapid cellular migration d. Telomerase therapy to maintain chromosomal immortality ANS: A Cancer cells do not have sufficient fibronectin and so do not maintain tight adhesion with other cells. This is part of the mechanism of metastasis. Chromosome alterations in cancer cells (aneuploidy) consist of having too many, too few, or altered chromosome pairs. This does not necessarily lead to rapid cellular division. Rapid cellular migration is part of metastasis. Immortality is a characteristic of cancer cells due to too much telomerase. 5. Which statement about carcinogenesis is accurate? a. An initiated cell will always become clinical cancer. b. Cancer becomes a health problem once it is 1 cm in size. c. Normal hormones and proteins do not promote cancer growth. d. Tumor cells need to develop their own blood supply. ANS: D Tumors need to develop their own blood supply through a process called angiogenesis. An initiated cell needs a promoter to continue its malignant path. Normal hormones and proteins in the body can act as promoters. A 1-cm tumor is a detectable size, but other events have to occur for it to become a health problem. 6. The nurse caring for oncology clients knows that which form of metastasis is the most common? a. Bloodborne b. Direct invasion c. Lymphatic spread d. Via bone marrow ANS: A Bloodborne metastasis is the most common way for cancer to metastasize. Direct invasion and lymphatic spread are other methods. Bone marrow is not a medium in which cancer spreads, although cancer can occur in the bone marrow. 7. A nurse is assessing a client with glioblastoma. What assessment is most important? a. Abdominal palpation b. Abdominal percussion c. Lung auscultation d. Neurologic examination ANS: D A glioblastoma arises in the brain. The most important assessment for this client is the neurologic examination. 8. A nurse has taught a client about dietary changes that can reduce the chances of developing cancer. What statement by the client indicates the nurse needs to provide additional teaching? a. “Foods high in vitamin A and vitamin C are important.” b. “I’ll have to cut down on the amount of bacon I eat.” c. “I’m so glad I don’t have to give up my juicy steaks.” d. “Vegetables, fruit, and high-fiber grains are important.” ANS: C To decrease the risk of developing cancer, one should cut down on the consumption of red meats and animal fat. The other statements are correct. 9. A client is in the oncology clinic for a first visit since being diagnosed with cancer. The nurse reads in the client’s chart that the cancer classification is TISN0M0. What does the nurse conclude about this client’s cancer? a. The primary site of the cancer cannot be determined. b. Regional lymph nodes could not be assessed. c. There are multiple lymph nodes involved already. d. There are no distant metastases noted in the report. ANS: D TIS stands for carcinoma in situ; N0 stands for no regional lymph node metastasis; and M0 stands for no distant metastasis. 10. A client asks the nurse if eating only preservative- and dye-free foods will decrease cancer risk. What response by the nurse is best? a. “Maybe; preservatives, dyes, and preparation methods may be risk factors.” b. “No; research studies have never shown those things to cause cancer.” c. “There are other things you can do that will more effectively lower your risk.” d. “Yes; preservatives and dyes are well known to be carcinogens.” ANS: A Dietary factors related to cancer development are poorly understood, although dietary practices are suspected to alter cancer risk. Suspected dietary risk factors include low fiber intake and a high intake of red meat or animal fat. Preservatives, preparation methods, and additives (dyes, flavorings, sweeteners) may have cancer-promoting effects. It is correct to say that other things can lower risk more effectively, but this does not give the client concrete information about how to do so, and also does not answer the client’s question. 1. The nursing student learning about cancer development remembers characteristics of normal cells. Which characteristics does this include? (Select all that apply.) a. Differentiated function b. Large nucleus-to-cytoplasm ratio c. Loose adherence d. Nonmigratory e. Specific morphology ANS: A, D, E Normal cells have the characteristics of differentiated function, nonmigratory, specific morphology, a smaller nucleus-to-cytoplasm ratio, tight adherence, and orderly and well-regulated growth. 2. The nurse working with oncology clients understands that interacting factors affect cancer development. Which factors does this include? (Select all that apply.) a. Exposure to carcinogens b. Genetic predisposition c. Immune function d. Normal doubling time e. State of euploidy ANS: A, B, C The three interacting factors needed for cancer development are exposure to carcinogens, genetic predisposition, and immune function. 3. A nurse is participating in primary prevention efforts directed against cancer. In which activities is this nurse most likely to engage? (Select all that apply.) a. Demonstrating breast self-examination methods to women b. Instructing people on the use of chemoprevention c. Providing vaccinations against certain cancers d. Screening teenage girls for cervical cancer e. Teaching teens the dangers of tanning booths ANS: B, C, E Primary prevention aims to prevent the occurrence of a disease or disorder, in this case cancer. Secondary prevention includes screening and early diagnosis. Primary prevention activities include teaching people about chemoprevention, providing approved vaccinations to prevent cancer, and teaching teens the dangers of tanning beds. Breast examinations and screening for cervical cancer are secondary prevention methods. 4. A nurse is providing community education on the seven warning signs of cancer. Which signs are included? (Select all that apply.) a. A sore that does not heal b. Changes in menstrual patterns c. Indigestion or trouble swallowing d. Near-daily abdominal pain e. Obvious change in a mole ANS: A, B, C, E The seven warning signs for cancer can be remembered with the acronym CAUTION: changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart or mole, and nagging cough or hoarseness. Abdominal pain is not a warning sign. Chapter 22: Care of Patients with Cancer 1. A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best? a. Call the client at home the next day to review teaching. b. Give the client information about a cancer support group. c. Provide all the preoperative instructions in writing. d. Reassure the client that surgery will be over soon. ANS: A Clients are often overwhelmed at a sudden diagnosis of cancer and may be more overwhelmed at the idea of a major operation so soon. This stress significantly impacts the client’s ability to understand, retain, and recall information. The nurse should call the client at home the next day to review the teaching and to answer questions. The client may or may not be ready to investigate a support group, but this does not help with teaching. Giving information in writing is important (if the client can read it), but in itself will not be enough. Telling the client that surgery will be over soon is giving false reassurance and does nothing for teaching. 2. A nurse reads on a hospitalized client’s chart that the client is receiving teletherapy. What action by the nurse is best? a. Coordinate continuation of the therapy. b. Place the client on radiation precautions. c. No action by the nurse is needed at this time. d. Restrict visitors to only adults over age 18. ANS: A The client needs to continue with radiation therapy, and the nurse can coordinate this with the appropriate department. The client is not radioactive, so radiation precautions and limiting visitors are not necessary. 3. A new nurse has been assigned a client who is in the hospital to receive iodine-131 treatment. Which action by the nurse is best? a. Ensure the client is placed in protective isolation. b. Hand off a pregnant client to another nurse. c. No special action is necessary to care for this client. d. Read the policy on handling radioactive excreta. ANS: D This type of radioisotope is excreted in body fluids and excreta (urine and feces) and should not be handled directly. The nurse should read the facility’s policy for handling and disposing of this type of waste. The other actions are not warranted. 4. A client in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate? a. “Are you getting adequate rest and sleep each day?” b. “It is normal to be fatigued even for years afterward.” c. “This is not normal and I’ll let the provider know.” d. “Try adding more vitamins B and C to your diet.” ANS: B Regardless of the cause, radiation-induced fatigue can be debilitating and may last for months or years after treatment has ended. Rest and adequate nutrition can affect fatigue, but it is most important that the client understands this is normal. 5. A client tells the oncology nurse about an upcoming vacation to the beach to celebrate completing radiation treatments for cancer. What response by the nurse is most appropriate? a. “Avoid getting salt water on the radiation site.” b. “Do not expose the radiation area to direct sunlight.” c. “Have a wonderful time and enjoy your vacation!” d. “Remember you should not drink alcohol for a year.” ANS: B The skin overlying the radiation site is extremely sensitive to sunlight after radiation therapy has been completed. The nurse should inform the client to avoid sun exposure to this area. This advice continues for 1 year after treatment has been completed. The other statements are not appropriate. 6. A client is receiving chemotherapy through a peripheral IV line. What action by the nurse is most important? a. Assessing the IV site every hour b. Educating the client on side effects c. Monitoring the client for nausea d. Providing warm packs for comfort ANS: A Intravenous chemotherapy can cause local tissue destruction if it extravasates into the surrounding tissues. Peripheral IV lines are more prone to this than centrally placed lines. The most important intervention is prevention, so the nurse should check hourly to ensure the IV site is patent, or frequently depending on facility policy. Education and monitoring for side effects such as nausea are important for all clients receiving chemotherapy. Warm packs may be helpful for comfort, but if the client reports that an IV site is painful, the nurse needs to assess further. 7. A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the client’s oral chemotherapy medications. What action by the nurse is most appropriate? a. Crush the medications if the client cannot swallow them. b. Give one medication at a time with a full glass of water. c. No special precautions are needed for these medications. d. Wear personal protective equipment when handling the medications. ANS: D During the administration of oral chemotherapy agents, nurses must take the same precautions that are used when administering IV chemotherapy. This includes using personal protective equipment. These medications cannot be crushed, split, or chewed. Giving one at a time is not needed. 8. The nurse working with oncology clients understands that which age-related change increases the older client’s susceptibility to infection during chemotherapy? a. Decreased immune function b. Diminished nutritional stores c. Existing cognitive deficits d. Poor physical reserves ANS: A As people age, there is an age-related decrease in immune function, causing the older adult to be more susceptible to infection than other clients. Not all older adults have diminished nutritional stores, cognitive dysfunction, or poor physical reserves. 9. After receiving the hand-off report, which client should the oncology nurse see first? a. Client who is afebrile with a heart rate of 108 beats/min b. Older client on chemotherapy with mental status changes c. Client who is neutropenic and in protective isolation d. Client scheduled for radiation therapy today ANS: B Older clients often do not exhibit classic signs of infection, and often mental status changes are the first observation. Clients on chemotherapy who become neutropenic also often do not exhibit classic signs of infection. The nurse should assess the older client first. The other clients can be seen afterward. 10. A client has a platelet count of 9800/mm3. What action by the nurse is most appropriate? a. Assess the client for calf pain, warmth, and redness. b. Instruct the client to call for help to get out of bed. c. Obtain cultures as per the facility’s standing policy. d. Place the client on protective isolation precautions. ANS: B A client with a platelet count this low is at high risk for serious bleeding episodes. To prevent injury, the client should be instructed to call for help prior to getting out of bed. Calf pain, warmth, and redness might indicate a deep vein thrombosis, not associated with low platelets. Cultures and isolation relate to low white cell counts. 11. A client hospitalized for chemotherapy has a hemoglobin of 6.1 mg/dL. What medication should the nurse prepare to administer? a. Epoetin alfa (Epogen) b. Filgrastim (Neupogen) c. Mesna (Mesnex) d. Oprelvekin (Neumega) ANS: A The client’s hemoglobin is low, so the nurse should prepare to administer epoetin alfa, a colony-stimulating factor that increases production of red blood cells. Filgrastim is for neutropenia. Mesna is used to decrease bladder toxicity from some chemotherapeutic agents. Oprelvekin is used to increase platelet count. 12. A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority? a. Helping clients adjust to their appearance b. Reassuring clients that this change is temporary c. Referring clients to a reputable wig shop d. Teaching measures to prevent scalp injury ANS: D All of the actions are appropriate for clients with alopecia. However, the priority is client safety, so the nurse should first teach ways to prevent scalp injury. 13. A client is receiving interleukins along with chemotherapy. What assessment by the nurse takes priority? a. Blood pressure b. Lung assessment c. Oral mucous membranes d. Skin integrity ANS: A Interleukins can cause capillary leak syndrome and fluid shifting, leading to intravascular volume depletion. Although all assessments are important in caring for clients with cancer, blood pressure and other assessments of fluid status take priority. 14. A client is receiving rituximab (Rituxan) and asks how it works. What response by the nurse is best? a. “It causes rapid lysis of the cancer cell membranes.” b. “It destroys the enzymes needed to create cancer cells.” c. “It prevents the start of cell division in the cancer cells.” d. “It sensitizes certain cancer cells to chemotherapy.” ANS: C Rituxan prevents the initiation of cancer cell division. The other statements are not accurate. 15. Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients should the nurse assess first? a. Client with dry, itchy, peeling skin b. Client with a serum calcium of 9.2 mg/dL c. Client with a serum potassium of 2.8 mEq/L d. Client with a weight gain of 0.5 pound (1.1 kg) in 1 day ANS: C TKIs can cause electrolyte imbalances. This potassium level is very low, so the nurse should assess this client first. Dry, itchy, peeling skin can be a problem in clients receiving biologic response modifiers, and the nurse should assess that client next because of the potential for discomfort and infection. This calcium level is normal. TKIs can also cause weight gain, but the client with the low potassium level is more critical. 16. A nurse is assessing a female client who is taking progestins. What assessment finding requires the nurse to notify the provider immediately? a. Irregular menses b. Edema in the lower extremities c. Ongoing breast tenderness d. Red, warm, swollen calf ANS: D All clients receiving progestin therapy are at risk for thromboembolism. A red, warm, swollen calf is a manifestation of deep vein thrombosis and should be reported to the provider. Irregular menses, edema in the lower extremities, and breast tenderness are common side effects of the therapy. 17. A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important? a. Assess the client’s gait and balance. b. Ask the client about the ease of urine flow. c. Document the report completely. d. Inquire about the client’s job risks. ANS: A This client has manifestations of spinal cord compression, which can be seen with prostate cancer. This may affect both gait and balance and urinary function. For client safety, assessing gait and balance is the priority. Documentation should be complete. The client may or may not have occupational risks for low back pain, but with his history of prostate cancer, this should not be where the nurse starts investigating. 18. The nurse has taught a client with cancer ways to prevent infection. What statement by the client indicates that more teaching is needed? a. “I should take my temperature daily and when I don’t feel well.” b. “I will wash my toothbrush in the dishwasher once a week.” c. “I won’t let anyone share any of my personal items or dishes.” d. “It’s alright for me to keep my pets and change the litter box.” ANS: D Clients should wash their hands after touching their pets and should not empty or scoop the cat litter box. The other statements are appropriate for self-management. 19. A client has received a dose of ondansetron (Zofran) for nausea. What action by the nurse is most important? a. Assess the client for a headache. b. Assist the client in getting out of bed. c. Instruct the client to reduce salt intake. d. Weigh the client daily before the client eats. ANS: B Ondansetron side effects include postural hypotension, vertigo, and bradycardia, all of which increase the client’s risk for injury. The nurse should assist the client when getting out of bed. Headache and fluid retention are not side effects of this drug. 20. A nurse working with clients who experience alopecia knows that which is the best method of helping clients manage the psychosocial impact of this problem? a. Assisting the client to pre-plan for this event b. Reassuring the client that alopecia is temporary c. Teaching the client ways to protect the scalp d. Telling the client that there are worse side effects ANS: A Alopecia does not occur for all clients who have cancer, but when it does, it can be devastating. The best action by the nurse is to teach the client about the possibility and to give the client multiple choices for preparing for this event. Not all clients will have the same reaction, but some possible actions the client can take are buying a wig ahead of time, buying attractive hats and scarves, and having a hairdresser modify a wig to look like the client’s own hair. Teaching about scalp protection is important but does not address the psychosocial impact. Reassuring the client that hair loss is temporary and telling him or her that there are worse side effects are both patronizing and do not give the client tools to manage this condition. 21. A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate? a. Administer a dose of allopurinol (Aloprim). b. Assess the client’s serum potassium level. c. Gently inquire about advance directives. d. Prepare the client for emergency surgery. ANS: C Superior vena cava syndrome is often a late-stage manifestation. After the client is stabilized and comfortable, the nurse should initiate a conversation about advance directives. Allopurinol is used for tumor lysis syndrome. Potassium levels are important in tumor lysis syndrome, in which cell destruction leads to large quantities of potassium being released into the bloodstream. Surgery is rarely done for superior vena cava syndrome. 22. A client is having a catheter placed in the femoral artery to deliver yttrium-90 beads into a liver tumor. What action by the nurse is most important? a. Assessing the client’s abdomen beforehand b. Ensuring that informed consent is on the chart c. Marking the client’s bilateral pedal pulses d. Reviewing client teaching done previously ANS: B This is an invasive procedure requiring informed consent. The nurse should ensure that consent is on the chart. The other actions are also appropriate but not the priority. 23. A nurse works on an oncology unit and delegates personal hygiene to an unlicensed assistive personnel (UAP). What action by the UAP requires intervention from the nurse? a. Allowing a very tired client to skip oral hygiene and sleep b. Assisting clients with washing the perianal area every 12 hours c. Helping the client use a soft-bristled toothbrush for oral care d. Reminding the client to rinse the mouth with water or saline ANS: A Even though clients may be tired, they still need to participate in hygiene to help prevent infection. The other options are all appropriate. 24. A client with cancer has anorexia and mucositis, and is losing weight. The client’s family members continually bring favorite foods to the client and are distressed when the client won’t eat them. What action by the nurse is best? a. Explain the pathophysiologic reasons behind the client not eating. b. Help the family show other ways to demonstrate love and caring. c. Suggest foods and liquids the client might be willing to try to eat. d. Tell the family the client isn’t able to eat now no matter what they bring. ANS: B Families often become distressed when their loved ones won’t eat. Providing food is a universal sign of caring, and to some people the refusal to eat signifies worsening of the condition. The best option for the nurse is to help the family find other ways to demonstrate caring and love, because with treatment-related anorexia and mucositis, the client is not likely to eat anything right now. Explaining the rationale for the problem is a good idea but does not suggest to the family anything that they can do for the client. Simply telling the family the client is not able to eat does not give them useful information and is dismissive of their concerns. 25. A client in the emergency department reports difficulty breathing. The nurse assesses the client’s appearance as depicted below: What action by the nurse is the priority? a. Assess blood pressure and pulse. b. Attach the client to a pulse oximeter. c. Have the client rate his or her pain. d. Start high-dose steroid therapy. ANS: A This client has superior vena cava syndrome, in which venous return from the head, neck, and trunk is blocked. Decreased cardiac output can occur. The nurse should assess indicators of cardiac output, including blood pressure and pulse, as the priority. The other actions are also appropriate but are not the priority. 1. The student nurse caring for clients who have cancer understands that the general consequences of cancer include which client problems? (Select all that apply.) a. Clotting abnormalities from thrombocythemia b. Increased risk of infection from white blood cell deficits c. Nutritional deficits such as early satiety and cachexia d. Potential for reduced gas exchange e. Various motor and sensory deficits ANS: B, C, D, E The general consequences of cancer include reduced immunity and blood-producing functions, altered GI structure and function, decreased respiratory function, and motor and sensory deficits. Clotting problems often occur due to thrombocytopenia (not enough platelets), not thrombocythemia (too many platelets). 2. A nurse is preparing to administer IV chemotherapy. What supplies does this nurse need? (Select all that apply.) a. “Chemo” gloves b. Facemask c. Isolation gown d. N95 respirator e. Shoe covers ANS: A, B, C The Occupational Safety and Health Administration (OSHA) and the Oncology Nurses Society have developed safety guidelines for those preparing or administering IV chemotherapy. These include double gloves (or “chemo” gloves), a facemask, and a gown. An N95 respirator and shoe covers are not required. 3. A client on interferon therapy is reporting severe skin itching and irritation. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply moisturizers to dry skin. b. Apply steroid creams to the skin. c. Bathe the client using mild soap. d. Help the client with a hot water bath. e. Teach the client to avoid sunlight. ANS: A, C The nurse can delegate applying unscented moisturizer and using mild soap for bathing. Steroid creams are not used for this condition. Hot water will worsen the irritation. Client teaching is a nursing function. 4. A client has thrombocytopenia. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply the client’s shoes before getting the client out of bed. b. Assist the client with ambulation. c. Shave the client with a safety razor only. d. Use a lift sheet to move the client up in bed. e. Use the Waterpik on a low setting for oral care. ANS: A, B, D Clients with thrombocytopenia are at risk of significant bleeding even with minor injuries. The nurse instructs the UAP to put the client’s shoes on before getting the client out of bed, assist with ambulation, shave the client with an electric razor, use a lift sheet when needed to reposition the client, and use a soft-bristled toothbrush for oral care. 5. A client has mucositis. What actions by the nurse will improve the client’s nutrition? (Select all that apply.) a. Assist with rinsing the mouth with saline frequently. b. Encourage the client to eat room-temperature foods. c. Give the client hot liquids to hold in the mouth. d. Provide local anesthetic medications to swish and spit. e. Remind the client to brush teeth gently after each meal. ANS: A, B, D, E Mucositis can interfere with nutrition. The nurse can help with rinsing the mouth frequently with water or saline; encouraging the client to eat cool, slightly warm, or room-temperature foods; providing swish-and-spit anesthetics; and reminding the client to keep the mouth clean by brushing gently after each meal. Hot liquids would be painful for the client. 6. A client’s family members are concerned that telling the client about a new finding of cancer will cause extreme emotional distress. They approach the nurse and ask if this can be kept from the client. What actions by the nurse are most appropriate? (Select all that apply.) a. Ask the family to describe their concerns more fully. b. Consult with a social worker, chaplain, or ethics committee. c. Explain the client’s right to know and ask for their assistance. d. Have the unit manager take over the care of this client and family. e. Tell the family that this secret will not be kept from the client. ANS: A, B, C The client’s right of autonomy means that the client must be fully informed as to his or her diagnosis and treatment options. The nurse cannot ethically keep this information from the client. The nurse can ask the family to explain their concerns more fully so everyone understands the concerns. A social worker, chaplain, or ethics committee can become involved to assist the nurse, client, and family. The nurse should explain the client’s right to know and ask the family how best to proceed. The nurse should not abdicate responsibility for this difficult situation by transferring care to another nurse. Simply telling the family that he or she will not keep this secret sets up an adversarial relationship. Explaining this fact along with the concept of autonomy would be acceptable, but this by itself is not. 7. A client receiving chemotherapy has a white blood cell count of 1000/mm3. What actions by the nurse are most appropriate? (Select all that apply.) a. Assess all mucous membranes every 4 to 8 hours. b. Do not allow the client to eat meat or poultry. c. Listen to lung sounds and monitor for cough. d. Monitor the venous access device appearance with vital signs. e. Take and record vital signs every 4 to 8 hours. ANS: A, C, D, E Depending on facility protocol, the nurse should assess this client for infection every 4 to 8 hours by assessing all mucous membranes, listening to lung sounds, monitoring for cough, monitoring the appearance of the venous access device, and recording vital signs. Eating meat and poultry is allowed. Chapter 7: End-of-Life Care Ignatavicius: Medical-Surgical Nursing, 8th Edition MULTIPLE CHOICE 1. A nurse cares for a dying client. Which manifestation of dying should the nurse treat first? a. Anorexia b. Pain c. Nausea d. Hair loss ANS: B Only symptoms that cause distress for a dying client should be treated. Such symptoms include pain, nausea and vomiting, dyspnea, and agitation. These problems interfere with the client’s comfort. Even when symptoms, such as anorexia or hair loss, disturb the family, they should be treated only if the client is distressed by their presence. The nurse should treat the client’s pain first. 2. A nurse plans care for a client who is nearing end of life. Which question should the nurse ask when developing this client’s plan of care? a. “Is your advance directive up to date and notarized?” b. “Do you want to be at home at the end of your life?” c. “Would you like a physical therapist to assist you with range-of-motion activities?” d. “Have your children discussed resuscitation with your health care provider?” ANS: B When developing a plan of care for a dying client, consideration should be given for where the client wants to die. Advance directives do not need to be notarized. A physical therapist would not be involved in end-of-life care. The client should discuss resuscitation with the health care provider and children; do-not-resuscitate status should be the client’s decision, not the family’s decision. 3. A nurse is caring for a client who has lung cancer and is dying. Which prescription should the nurse question? a. Morphine 10 mg sublingual every 6 hours PRN for pain level greater than 5 b. Albuterol (Proventil) metered dose inhaler every 4 hours PRN for wheezes c. Atropine solution 1% sublingual every 4 hours PRN for excessive oral secretions d. Sodium biphosphate (Fleet) enema once a day PRN for impacted stool ANS: A Pain medications should be scheduled around the clock to maintain comfort and prevent reoccurrence of pain. The other medications are appropriate for this client. 4. A client tells the nurse that, even though it has been 4 months since her sister’s death, she frequently finds herself crying uncontrollably. How should the nurse respond? a. “Most people move on within a few months. You should see a grief counselor.” b. “Whenever you start to cry, distract yourself from thoughts of your sister.” c. “You should try not to cry. I’m sure your sister is in a better place now.” d. “Your feelings are completely normal and may continue for a long time.” ANS: D Frequent crying is not an abnormal response. The nurse should let the client know that this is normal and okay. Although the client may benefit from talking with a grief counselor, it is not unusual for her to still be grieving after a few months. The other responses are not as therapeutic because they justify or minimize the client’s response. 5. After teaching a client about advance directives, a nurse assesses the client’s understanding. Which statement indicates the client correctly understands the teaching? a. “An advance directive will keep my children from selling my home when I’m old.” b. “An advance directive will be completed as soon as I’m incapacitated and can’t think for myself.” c. “An advance directive will specify what I want done when I can no longer make decisions about health care.” d. “An advance directive will allow me to keep my money out of the reach of my family.” ANS: C An advance directive is a written document prepared by a competent individual that specifies what, if any, extraordinary actions a person would want taken when he or she can no longer make decisions about personal health care. It does not address issues such as the client’s residence or financial matters. 6. A nurse teaches a client who is considering being admitted to hospice. Which statement should the nurse include in this client’s teaching? a. “Hospice admission has specific criteria. You may not be a viable candidate, so we will look at alternative plans for your discharge.” b. “Hospice care focuses on a holistic approach to health care. It is designed not to hasten death, but rather to relieve symptoms.” c. “Hospice care will not help with your symptoms of depression. I will refer you to the facility’s counseling services instead.” d. “You seem to be experiencing some difficulty with this stage of the grieving process. Let’s talk about your feelings.” ANS: B As both a philosophy and a system of care, hospice care uses an interdisciplinary approach to assess and address the holistic needs of clients and families to facilitate quality of life and a peaceful death. This holistic approach neither hastens nor postpones death but provides relief of symptoms experienced by the dying client. 7. A nurse is caring for a dying client. The client’s spouse states, “I think he is choking to death.” How should the nurse respond? a. “Do not worry. The choking sound is normal during the dying process.” b. “I will administer more morphine to keep your husband comfortable.” c. “I can ask the respiratory therapist to suction secretions out through his nose.” d. “I will have another nurse assist me to turn your husband on his side.” ANS: D The choking sound or “death rattle” is common in dying clients. The nurse should acknowledge the spouse’s concerns and provide interventions that will reduce the choking sounds. Repositioning the client onto one side with a towel under the mouth to collect secretions is the best intervention. The nurse should not minimize the spouse’s concerns. Morphine will assist with comfort but will not decrease the choking sounds. Nasotracheal suctioning is not appropriate in a dying client. 8. The nurse is teaching a family member about various types of complementary therapies that might be effective for relieving the dying client’s anxiety and restlessness. Which statement made by the family member indicates understanding of the nurse’s teaching? a. “Maybe we should just hire an around-the-clock sitter to stay with Grandmother.” b. “I have some of her favorite hymns on a CD that I could bring for music therapy.” c. “I don’t think that she’ll need pain medication along with her herbal treatments.” d. “I will burn therapeutic incense in the room so we can stop the anxiety pills.” ANS: B Music therapy is a complementary therapy that may produce relaxation by quieting the mind and removing a client’s inner restlessness. Hiring an around-the-clock sitter does not demonstrate that the client’s family understands complementary therapies. Complementary therapies are used in conjunction with traditional therapy. Complementary therapy would not replace pain or anxiety medication but may help decrease the need for these medications. 9. A nurse is caring for a terminally ill client who has just died in a hospital setting with family members at the bedside. Which action should the nurse take first? a. Call for emergency assistance so that resuscitation procedures can begin. b. Ask family members if they would like to spend time alone with the client. c. Ensure that a death certificate has been completed by the physician. d. Request family members to prepare the client’s body for the funeral home. ANS: B Before moving the client’s body to the funeral home, the nurse should ask family members if they would like to be alone with the client. Emergency assistance will not be necessary. Although it is important to ensure that a death certificate has been completed before the client is moved to the mortuary, the nurse first should ask family members if they would like to be alone with the client. The client’s family should not be expected to prepare the body for the funeral home. 10. A nurse assesses a client who is dying. Which manifestation of a dying client should the nurse assess to determine whether the client is near death? a. Level of consciousness b. Respiratory rate c. Bowel sounds d. Pain level on a 0-to-10 scale ANS: B Although all of these assessments should be performed during the dying process, periods of apnea and Cheyne-Strokes respirations indicate death is near. As peripheral circulation decreases, the client’s level of consciousness and bowel sounds decrease, and the client would be unable to provide a numeric number on a pain scale. Even with these other symptoms, the nurse should continue to assess respiratory rate throughout the dying process. As the rate drops significantly and breathing becomes agonal, death is near. 11. A nurse is caring for a client who is terminally ill. The client’s spouse states, “I am concerned because he does not want to eat.” How should the nurse respond? a. “Let him know that food is available if he wants it, but do not insist that he eat.” b. “A feeding tube can be placed in the nose to provide important nutrients.” c. “Force him to eat even if he does not feel hungry, or he will die sooner.” d. “He is getting all the nutrients he needs through his intravenous catheter.” ANS: A When family members understand that the client is not suffering from hunger and is not “starving to death,” they may allow the client to determine when, what, or if to eat. Often, as death approaches, metabolic needs decrease and clients do not feel the sensation of hunger. Forcing them to eat frustrates the client and the family. 12. A nurse discusses inpatient hospice with a client and the client’s family. A family member expresses concern that her loved one will receive only custodial care. How should the nurse respond? a. “The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person enjoy whatever time is left.” b. “Palliative care will release you from the burden of having to care for someone in the home. It does not mean that curative treatment will stop.” c. “A palliative care facility is like a nursing home and costs less than a hospital because only pain medications are given.” d. “Your relative is unaware of her surroundings and will not notice the difference between her home and a palliative care facility.” ANS: A Palliative care provides an increased level of personal care designed to manage symptom distress. The focus is on pain control and helping the relative die with dignity. 13. An intensive care nurse discusses withdrawal of care with a client’s family. The family expresses concerns related to discontinuation of therapy. How should the nurse respond? a. “I understand your concerns, but in this state, discontinuation of care is not a form of active euthanasia.” b. “You will need to talk to the provider because I am not legally allowed to participate in the withdrawal of life support.” c. “I realize this is a difficult decision. Discontinuation of therapy will allow the client to die a natural death.” d. “There is no need to worry. Most religious organizations support the client’s decision to stop medical treatment.” ANS: C The nurse should validate the family’s concerns and provide accurate information about the discontinuation of therapy. The other statements address specific issues related to the withdrawal of care but do not provide appropriate information about their purpose. If the client’s family asks for specific information about euthanasia, legal, or religious issues, the nurse should provide unbiased information about these topics. 14. A hospice nurse is caring for a variety of clients who are dying. Which end-of-life and death ritual is paired with the correct religion? a. Roman Catholic – Autopsies are not allowed except under special circumstances. b. Christian – Upon death, a religious leader should perform rituals of bathing and wrapping the body in cloth. c. Judaism – A person who is extremely ill and dying should not be left alone. d. Islam – An ill or dying person should receive the Sacrament of the Sick. ANS: C According to Jewish law, a person who is extremely ill or dying should not be left alone. Orthodox Jews do not allow autopsies except under special circumstances. The Islamic faith requires a religious leader to perform rituals of bathing and wrapping the body in cloth upon death. A Catholic priest performs the Sacrament of the Sick for ill or dying people. 1. A hospice nurse is caring for a dying client and her family members. Which interventions should the nurse implement? (Select all that apply.) a. Teach family members about physical signs of impending death. b. Encourage the management of adverse symptoms. c. Assist family members by offering an explanation for their loss. d. Encourage reminiscence by both client and family members. e. Avoid spirituality because the client’s and the nurse’s beliefs may not be congruent. ANS: A, B, D The nurse should teach family members about the physical signs of death, because family members often become upset when they see physiologic changes in their loved one. Palliative care includes management of symptoms so that the peaceful death of the client is facilitated. Reminiscence will help both the client and family members cope with the dying process. The nurse is not expected to explain why this is happening to the family’s loved one. The nurse can encourage spirituality if the client is agreeable, regardless of whether the client’s religion is the same. 2. A nurse admits an older adult client to the hospital. Which criterion should the nurse use to determine if the client can make his own medical decisions? (Select all that apply.) a. Can communicate his treatment preferences b. Is able to read and write at an eighth-grade level c. Is oriented enough to understand information provided d. Can evaluate and deliberate information e. Has completed an advance directive ANS: A, C, D To have decision-making ability, a person must be able to perform three tasks: receive information (but not necessarily oriented ´ 4); evaluate, deliberate, and mentally manipulate information; and communicate a treatment preference. The client does not have to read or write at a specific level. Education can be provided at the client’s level so that he can make the necessary decisions. The client does not need to complete an advance directive to make his own medical decisions. An advance directive will be necessary if he wants to designate someone to make medical decisions when he is unable to. 3. A hospice nurse plans care for a client who is experiencing pain. Which complementary therapies should the nurse incorporate in this client’s pain management plan? (Select all that apply.) a. Play music that the client enjoys. b. Massage tissue that is tender from radiation therapy. c. Rub lavender lotion on the client’s feet. d. Ambulate the client in the hall twice a day. e. Administer intravenous morphine. ANS: A, C Complementary therapies for pain management include massage therapy, music therapy, Therapeutic Touch, and aromatherapy. Nurses should not massage over sites of tissue damage from radiation therapy. Ambulation and intravenous morphine are not complementary therapies for pain management. 4. A nurse teaches a client’s family members about signs and symptoms of approaching death. Which manifestations should the nurse include in this teaching? (Select all that apply.) a. Warm and flushed extremities b. Long periods of insomnia c. Increased respiratory rate d. Decreased appetite e. Congestion and gurgling ANS: D, E Common physical signs and symptoms of approaching death including coolness of extremities, increased sleeping, irregular and slowed breathing rate, a decrease in fluid and food intake, congestion and gurgling, incontinence, disorientation, and restlessness. Chapter 23: Cancer Development 1. The nurse includes which information about benign tumors when presenting an in-service on cancer? a. They can wander far throughout the body. b. They are smaller than 2 cm. c. They retain a small nuclear-to-cytoplasmic ratio. d. They look different from the tissue they arose from. ANS: C Benign tumors are made up of normal cells growing in the wrong place or growing when they are not needed. Benign tumors retain the characteristics of normal cells in that they do not migrate in the body, they retain a small nuclear-to-cytoplasmic ratio, and they look similar to the tissue from which they arose. Size is not related to malignancy or to being benign. 2. In reviewing the pathophysiology of a particular type of cancer, the nurse correlates the generation time for cancer development with which description? a. The rate at which cancer cells are able to migrate and metastasize to different sites b. How long it takes for a malignant tumor to double in size by mitotic cell divisions c. The period of time needed for one cell to divide into two cells by mitosis d. The period of time between cell damage and expression of a malignancy ANS: C Generation time is defined as the period of time necessary for one cell to complete a round of cell division. 3. Which biologic characteristic is specific to normal differentiated adult cells but not to cancer cells? a. Anaplasia b. Hypertrophy c. Aneuploidy d. Loose adherence ANS: B Some normal tissues increase in size by having individual cells get larger, a process called hypertrophy. Cancer cells tend to grow by hyperplasia. The other characteristics are associated with cancer cells. 4. A client states that his brain tumor is benign and does not need to be removed. What is the nurse’s best response? a. “As your tumor grows, it can damage your brain, so it should be removed.” b. “Benign tumors consist of normal cells, so removal is only for cosmetic purposes.” c. “Benign tumors turn into cancer, so they should be removed as soon as possible.” d. “Because benign tumors can migrate, they should be removed before they spread.” ANS: A Even though benign tumors do not migrate (metastasize) or become cancerous, they can compromise or even destroy surrounding normal tissue. This is particularly a problem when a benign tumor arises in a location that does not expand to accommodate growth, such as in the skull. 5. Which comment made by a client with breast cancer indicates a need for clarification regarding cancer causes and prevention? a. “I will eat a low-fat, high-fiber diet from now on.” b. “Probably nothing I did or didn’t do caused this cancer.” c. “I hope my daughter doesn’t develop breast cancer.” d. “Regular mammograms on my other breast will prevent cancer.” ANS: D Regular mammography can help detect breast cancer at an early stage, but it does not prevent breast cancer. For the most part, the specific cause of many cancers is unknown. Some associations have been noted with dietary habits. High fat, low fiber, high intake of red meat, and eating food with preservatives and other additives all have been suspected to contribute to carcinogenesis. Breast cancer has familial and hereditary forms. 6. Malignant cell growth is uncontrolled because of which action? a. Cancer cells always divide more rapidly than normal cells. b. Mitosis of malignant cells usually produces more than two daughter cells. c. Malignant cells bypass one or more phases of the cell cycle during cell division. d. Malignant cells enter the cell cycle frequently, making cell division continuous. ANS: D Malignant cells have bypassed the normal control mechanisms that restrict entry into the cell cycle, so they re-enter the cell cycle as soon as they finish a round of cell division. Thus, cancer cell division is relentless. 7. A client has known lung cancer and has been admitted for abdominal pain and jaundice. A computed tomography (CT) scan reveals tumors in the client’s liver. The client is distraught and says, “So now I have liver cancer too?” Which response by the nurse is most appropriate? a. “Yes, liver cancer is common in people who already have lung cancer.” b. “Yes, your chemotherapy left you vulnerable to a virus that causes liver cancer.” c. “No, the tumors are actually from your lung cancer, which has metastasized.” d. “No, having tumors in two different organs is rare; you probably have hepatitis.” ANS: C When a cancer metastasizes to another organ, it is still the same cancer from the original spot. This client has lung cancer that has metastasized to the liver. 8. An occupational health nurse is working with management in a firm that provides commercial building restoration, including asbestos removal. Which action does the nurse recommend to management? a. Provide annual screening chest x-rays for those exposed to asbestos. b. Purchase protective gear and develop policies mandating its use. c. Offer “stop smoking” programs on site several times a year. d. Routinely distribute testing kits for occult fecal blood. ANS: B Asbestos is a powerful carcinogen. Chronic exposure, even to small amounts of loose asbestos fibers, increases the risk for development of lung cancer. Employees should wear personal protective gear when working with asbestos. Management should provide this gear and should develop policies requiring employees to use it. Stop-smoking programs would not be as beneficial in preventing cancer in this group of people as would limiting asbestos exposure. Routine chest x-rays and fecal occult blood testing will not prevent cancer. 9. The nurse correlates “initiation” in cancer development with which action? a. Inflicting mutations that lead to excessive cell division b. Increasing the capacity of the transformed cell for error-free DNA repair c. Stimulating contact inhibition in cells damaged by a carcinogen d. Making cancer cells appear more normal to escape immune surveillance ANS: A The process of initiation induces changes in the genes that allow proto-oncogenes to be activated to oncogene status and to be expressed. 10. The middle-aged client with lung cancer asks whether his adult children are at increased risk for this cancer. What is the nurse’s best response? a. “This disease is a random event and there is no way to prevent it.” b. “This disease is inherited, so your children have a 50% risk for developing it.” c. “Smoking is the main cause. Helping your children not smoke decreases their risk.” d. “They can avoid cancer by decreasing the fat they eat and by exercising more.” ANS: C Long-term cigarette smoking is the major risk factor for lung cancer. Not smoking is the best way to prevent it. 11. An adult client who has a suspicious mammogram says that her mother died of bone cancer when she was around the same age. Which is the most important question for the nurse to ask this client? a. “Have any other members of your family had bone cancer?” b. “Did your mother ever have any other type of cancer?” c. “How old were you when you started your periods?” d. “Did your mother have regular mammograms?” ANS: B Breast cancer often spreads to the bone. Many laypersons do not understand that breast cancer in the bone is still breast cancer. It would be very important to know whether this client’s mother had breast cancer because a genetic component is associated with it. Asking about other family members who have had bone cancer may give the nurse useful information but would not be as important as finding out about other cancers. Menstrual cycle and mammogram information also would not provide as relevant information as inquiring about other types of cancer, specifically breast cancer. 12. A client with prostate cancer says that he is now having a lot of pain in his lower back and legs. The nurse educates the client about which intervention? a. X-rays of the spine and legs b. Administering ibuprofen (Motrin) for pain c. Referral to the pain control specialist d. Referral to physical therapy ANS: A The primary site of metastasis for prostate cancer is the bone of the spine and legs. Pain in these areas in a client with prostate cancer is highly suggestive of cancer progression and metastasis. The client needs x-rays to assess for metastasis. 13. A middle-aged client is having a physical examination and is worried about cancer risk. Which question is most important for the nurse to ask? a. “How much time do you spend in the sun?” b. “How many servings of fruits and vegetables do you eat every day?” c. “How often do you eat processed meats like bologna?” d. “Do you smoke cigarettes or have you ever used tobacco products?” ANS: D Tobacco is related to about 30% of all cancers in North America and is the most important source of preventable carcinogen exposure. The other questions are related to carcinogenesis, but not to the degree that tobacco is. 14. The nurse is counseling a client who smokes and drinks heavily about cancer risk. The client is adamant that he or she will never stop smoking. Which question by the nurse is most appropriate? a. “Would you be willing to stop drinking alcohol?” b. “Have you ever tried the nicotine patch?” c. “Why are you so determined to continue smoking?” d. “Do you understand that smoking is the leading cause of cancer?” ANS: A Both tobacco and alcohol are carcinogenic, but their effects are multiplied when ingested together. Because the client is refusing to stop smoking, the nurse could help him or her reduce cancer risk by not drinking. Although it is not as beneficial as avoiding tobacco, this could at least decrease the risk. The client does not want to stop smoking, so asking about the nicotine patch, the reasons behind continued smoking, and knowledge regarding cancer risk might only serve to make the client more resolved to continue the habit or might make the client angry. 15. A client’s cancer is staged by the TNM classification as T1, N3, M1. What is the nurse’s interpretation of this classification? a. The client has a large tumor involving the lymph nodes, but no distant metastasis. b. The client has a tumor, and metastasis cannot be determined by the staging method. c. The client has a 2-cm tumor, one involved lymph node, and local metastasis. d. The client has a small tumor, many involved lymph nodes, and distant metastasis. ANS: D T = primary tumor. T1 indicates that a primary tumor is detectable but still relatively small. N = regional lymph nodes. N3 indicates that several regional lymph nodes are involved. M = distant metastasis. M1 indicates that distant metastasis is evident in at least one site. 16. A client says that she has heard that the origin of most cancers is genetic and wants “genetic testing because of a family history of cancer.” What is the nurse’s best response? a. “I will ask your physician about a referral for genetic testing.” b. “Let’s look at your family history back to your grandparents’ generation.” c. “Genetic testing is so expensive; let’s talk about reducing your risk instead.” d. “Inherited cancers are much more common in males than in females.” ANS: B Genetic testing for the risk of developing a few specific cancers is available but is expensive. The nurse should first assess the client’s family cancer history by creating a three-generation family tree. If the client actually does have a strong family history of cancers with a genetic component, the nurse can facilitate testing for the client. Teaching the client to reduce risk is always important, but simply telling the client about the expense involved in testing belittles the client’s concerns. Genetically related cancers are not more prevalent in men than in women, and again, this response belittles the client’s concerns. 17. In preparing a community teaching program, which information does the nurse plan to present to address secondary cancer prevention? a. Receiving cancer treatment with chemotherapy b. Annual measurement of prostate-specific antigen levels c. Avoiding known cancer-causing substances or conditions d. Having adolescent children receive the Gardasil vaccination ANS: B Secondary prevention focuses on screening and early diagnosis. Annual prostate-specific antigen (PSA) levels are a screening tool for prostate cancer. Chemotherapy is tertiary prevention (treatment and rehabilitation). Both avoiding carcinogens and receiving the Gardasil vaccination are primary preventions. 18. The nurse correlates the role of suppressor genes in cancer development with which action? a. The presence of suppressor genes increases risks for gene damage by carcinogens. b. People with a greater number of suppressor genes are at increased risk for getting cancer. c. Suppressor genes enhance immune function, suppressing cancer development. d. Suppressor genes limit cell division, reducing risks for developing cancer. ANS: D Suppressor genes are responsible for ensuring that cell division occurs only when needed. Cancer cells lose this inhibition and re-enter the cell cycle frequently, leading to rapid growth. 19. The nurse most likely would construct a three-generation pedigree for a client who had a relative treated for which cancer? a. Lung cancer b. Prostate cancer c. Cervical cancer d. Bone cancer ANS: B Prostate cancer has a sporadic form and a familial form. If a client has relatives diagnosed with prostate cancer, the nurse should assess for a genetic risk because the risk for this cancer can be inherited. The place to start this assessment is with a family tree. 20. The nurse counsels a woman who has a BRCA1 gene that she has what chance for developing breast cancer during her lifetime? a. None; this gene has a protective effect b. Same as the general population c. Lower than the general population d. Higher than the general population ANS: D BRAC1 is a genetic mutation that increases risk for both breast and ovarian cancer. 21. The nurse wishes to present a cancer program to a group of people at high risk for cancer. In planning the program, which group does the nurse consider the priority? a. Older adults b. People who smoke c. Clients with family histories of cancer d. People with poor immune function ANS: A Advancing age is the single most important risk factor for cancer because of age-related decline in immune function and accumulated exposure to carcinogens. All of the people listed are at some increased risk for cancer, but older adults have the highest risk overall. 22. The nurse is planning a cancer education event in an Asian community center. The nurse plans to present information specifically on which types of cancer? a. Breast and colorectal b. Skin and lymphoma c. Liver and stomach d. Uterine and ovarian ANS: A Asians have higher rates of breast, colorectal, prostate, lung, and stomach cancers than are seen in the general population. 23. In preparing a cancer risk reduction pamphlet for African-American clients, it is most important that the nurse include information on prevention and early detection for which types of cancer? a. Lung and prostate b. Bone and leukemia c. Skin and lymphoma d. Stomach and esophageal ANS: A African Americans have higher incidences of lung, prostate, breast, colorectal, and uterine cancers than are seen in the general population. 24. The nurse is seeing clients in a clinic. Which client does the nurse assess further for the development of cancer? a. Client with a cough that has lasted for 4 months b. Client whose mother died of lung cancer c. Client with a 10-pound weight gain d. Woman whose last mammogram was 3 years ago ANS: A The seven warning signs of cancer include changes in bowel/bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or a lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart/mole, and nagging cough/hoarseness. The other clients do not have warning signs of cancer. 25. It is most important that the nurse include which activity for the young adult client with Down syndrome? a. Encouraging more fruit and leafy green vegetables in the diet b. Teaching him how to perform testicular self-examination c. Assessing the skin for unusual bruises and petechiae d. Testing the client’s stool for occult blood ANS: C All screening and prevention activities are appropriate. However, people with Down syndrome have an increased lifetime risk for the development of leukemia. 26. The nurse is interested in primary prevention for cancer. Which activity does the nurse most likely participate in? a. Distributing occult fecal blood test kits to people at the shopping mall b. Arranging transportation volunteers for clients undergoing radiation therapy c. Teaching high school students the dangers of using tobacco d. Educating adolescent girls about getting an annual Papanicolaou (PAP) smear ANS: C Primary prevention focuses on activities that occur before an illness, such as education and vaccinations. Occult fecal blood testing and PAP smears are secondary prevention activities designed for screening and early diagnosis. Arranging transportation for a client who is undergoing radiation therapy is tertiary prevention. 27. The nurse assesses which client most carefully for cancer development? a. Young man receiving radiation therapy for a brain tumor b. Young adult woman who recently had postpartum hemorrhage c. Adolescent male recently diagnosed with acquired immune deficiency syndrome (AIDS) d. Older woman undergoing chemotherapy for bowel cancer ANS: D Age and immune suppression are two of the greatest risk factors for cancer development. The young man with brain cancer and the adolescent are at increased risk, but their risk is not as great as that of the older woman undergoing chemotherapy for bowel cancer. Postpartum hemorrhage is not related to cancer development. 1. A client has colorectal cancer. Which activities are especially important for the nurse to conduct for this client? (Select all that apply.) a. Monitor liver function studies. b. Maintain accurate intake and output. c. Obtain daily weight using the same scale. d. Palpate lymph nodes at each clinic visit. e. Ask the client about changes in belly size. ANS: A, D, E Common sites of metastasis for colorectal cancer include the liver, ly