Ignatavicius: Medical-Surgical Nursing, 10th Edition
Chapter 19: Concepts of Cancer Development
Answer Key – NCLEX Examination Challenges, Clinical Judgment Challenges, and
Mastery Questions
Answer Key – NCLEX Examination Challenges
NCLEX Examination Challenge 19-1
Psychosocial Integrity
A client asks the nurse why his colorectal cancer is being tested for genetic mutations even though no one
else in the family has ever had cancer. What is the nurse’s best response?
A. “Colorectal cancer is rare and most cases are caused by a genetic mutation.”
B. “The results of this testing will indicate what caused your cancer so you can avoid further
exposure.”
C. “Many tumors have one or more genetic differences that can help determine the most effective
treatment options.”
D. “Genetic testing of tumor cells can help determine the stage of your cancer and whether it has
spread to other organs.”
Answer: C
Rationale:
Genetic testing of tumor cells (not the client with cancer) can indicate genetic mutations that would increase the
susceptibility of the tumor to being killed off or having its growth controlled by targeted therapy. It does not
indicate cause, stage, or degree of metastasis. Colorectal cancer is very common. Although some colorectal
cancers are caused by a genetic mutation, these cancers “run in families.”
Cognitive Level: Applying or higher
Client needs category:
Psychosocial Integrity
Nursing Process Step:
Intervention
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NCLEX Examination Challenge 19-2
Physiological Integrity
An older client reports all of the following changes since his last checkup. Which changes alerts the nurse to the
possibility of prostate cancer? Select all that apply.
A.
B.
C.
D.
E.
F.
Bloody urine
Constipation intermittent with diarrhea
Erectile dysfunction
Night sweats and fever
Persistent pain in the lower back and legs
Reduced urine stream
Correct Answers: D, E, F
Rationale:
Bloody urine is most associated with bladder cancer. Constipation/diarrhea and erectile dysfunction are not
common signs or symptoms of prostate cancer. Reduced urine stream is associated with both prostate cancer
and benign prostatic hyperplasia and is considered a red flag for prostate cancer when associated with other
prostate cancer symptoms. Persistent pain in the lower back and legs, as well as night sweats and fever are
associated with late stage prostate cancer.
Cognitive Level: Applying or higher
Client needs category:
Physiological Integrity
Nursing Process Step:
Assessment
NCLEX Examination Challenge 19-3
Physiological Integrity
Which specific cancer types have a higher rate of occurrence among the Hispanic/Latino population of the U.S.
compared with the nonHispanic white population? Select all that apply.
A.
B.
C.
D.
E.
F.
G.
Breast
Colorectal
Gall bladder
Liver
Lung
Prostate
Stomach
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Correct Answers:
C, D, G
Rationale:
The most common cancers in the United States among nonHispanic whites are breast, colorectal, lung, and
prostate cancers. These occur at lower rates among Hispanic/Latino adults living in the U.S. However, the
infection-associated cancers (gall bladder, liver, stomach) occur in this population at a higher rate.
Cognitive Level: Understanding
Client needs category:
Physiological Integrity
Nursing Process Step:
N/A
Answer Key – Clinical Judgment Challenges
None.
Answer Key – Mastery Questions
19-1.
How does a mutation is a suppressor gene, such as BRCA1, increase the risk for cancer development?
A.
Converting a proto-oncogene into an oncogene
B.
Removing the control over proto-oncogene expression
C.
Reducing the amount of cylins produced by the oncogenes
D.
Inhibiting the recognition of abnormal cells through immunosurveillance
Correct Answer: B
Rationale:
Suppressor genes make products that control proto-oncogenes and prevent them from being over expressed,
which would increase cell division. Thus when suppressor genes are mutated cellular regulation is lost and the
increased cell division can result in cancer development. Conversion of a proto-oncogene to an oncogene
requires a mutation in the proto-oncogene, not the suppressor gene. Health suppressor genes do control the
amount of cyclins produced by either oncogenes or proto-oncogenes, so a mutated suppressor gene would lose
this function. Suppressor genes do not interfere with the immunosurveillance performed by certain immune
system cells to detect the presence of abnormal cells.
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Cognitive Level: Understanding
Client needs category:
Physiological Integrity
Nursing Process Step:
N/A
19-2.
A client's cancer is staged as T1, N2, M1 by the TNM classification system. How does the nurse
interpret this report?
A.
The client has two tumors that are nonresponsive to treatment.
B.
The client has leukemia confined to the bone marrow.
C.
The client has a 2 cm tumor with one regional lymph node involved and no distant metastasis.
D.
The client has a small primary tumor extension into 3 lymph nodes and one site of
distant metastasis.
Correct Answer: D
Rationale:
T = primary tumor. A T1 indicates a primary tumor is detectable but still relatively small. N = regional lymph
nodes. An N2 indicates regional lymph nodes are involved. M = distant metastasis. M1 indicates there is
evidence of distant metastasis in at least one site.
Cognitive level:
Applying or higher
Client Needs Category:
Physiological integrity
Nursing Process Step:
Assessment
19-3.
Which statements made by a 62-year old client alerts the nurse to the possibility that the he may be at
increased genetic risk for cancer development? Select all that apply.
A.
An older aunt died from a brain tumor while she had breast cancer
B.
He had two benign colon polyps removed during his most recent routine colonoscopy
C.
His sister died from cancer of the appendix
D.
His brother is being treated for breast cancer
E.
His daughter 32-year-old daughter has been recently diagnosed with cervical cancer
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F.
One person in each of the previous three generations of his family has died from lung cancer
Correct Answers: C, D
Rationale:
Lung cancer and cervical cancers are considered environmentally-induced cancers and really do not have a
specific genetic predisposition. The fact that one person in each of three family generations developed lung
cancer is not considered excessive. Breast cancer in older women is common and often spreads to the brain.
Two benign colon polyps are common for the age group and do not indicate a genetic predisposition. The
brother has a cancer that is rare for the gender and the sister has an extremely rare cancer type. Both of these
cancers in first degree relatives are “red flags” for the possibility of an increased genetic risk for cancer.
Cognitive Level: Applying or higher
Client needs category:
Health Promotion and Maintenance
Nursing Process Step:
Assessment
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