Chapter 15
Cancer
Answer Keys for Questions
• Rationales for Bridge to NCLEX Examination Questions
1. Correct answer: c
Rationale: Cancer incidence and death rates are disproportionately higher among Blacks than
among other minority groups and white people.
2. Correct answers: a, c, e
Rationale: Cancer cells proliferate at the same rate as the normal cells of the tissue from
which they arise. However, cancer cells respond differently than normal cells to the intracellular
signals that regulate cell proliferation and death. The result is that the proliferation of the cancer
cells is indiscriminate and continuous. They lack contact inhibition. Cancer cells may have
altered cell-surface antigens because of malignant transformation. These antigens are termed
tumor-associated antigens. Normally the differentiated cell is stable and will not dedifferentiate.
Cancer cells can dedifferentiate. Abilities and properties that the cell had in fetal development
are again expressed.
3. Correct answer: d
Rationale: Progression is the last stage of cancer. This stage is characterized by increased
growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (e.g.,
metastasis). Progression occurs because of rapid proliferation and decreased cell adhesion.
4. Correct answer: a
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Rationale: Cancer cells may have altered cell surface antigens because of malignant
transformation. These antigens are called tumor-associated antigens (TAAs). One of the
functions of the immune system is to respond to TAAs.
5. Correct answer: d
Rationale: While the patient is waiting for diagnostic study results, you should be available to
actively listen to the patient’s concerns. You should be skilled in techniques that can engage the
patient and caregivers in a discussion about their cancer-related fears.
6. Correct answer: c
Rationale: The goals of cancer treatment are cure, control, and palliation. When cure is the goal,
treatment is offered that is expected to have the greatest chance of disease eradication. Curative
cancer therapy depends on the cancer being treated and may involve local therapies (e.g., surgery
or radiation) alone or in combination, with or without adjunctive systemic therapy (e.g.,
chemotherapy).
7. Correct answer: d
Rationale: Infusion with central venous access devices reduces the risk of infiltration of
chemotherapy agents that are vesicants. If vesicants are inadvertently infiltrated into the skin,
severe local tissue breakdown and necrosis may result.
8. Correct answer: b
Rationale: Brachytherapy consists of the implantation or insertion of radioactive materials
directly into the tumor or next to the tumor. It would not be possible to shield the ovaries during
therapy. Caring for the person undergoing brachytherapy requires the nurse to take special
precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance,
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and shielding are vital to health care professional safety. Simulation is a process by which
external radiation treatment fields are defined. Desquamation is an effect of external radiation.
9. Correct answer: c
Rationale: Neutropenia is more common in patients receiving chemotherapy than in those
receiving radiation. It can seriously increase the risk for life-threatening infection and sepsis.
Any sign of infection should be treated promptly because fever in the setting of neutropenia is a
medical emergency.
10. Correct answer: b
Rationale: Common side effects of rituximab include constitutional flu-like symptoms,
including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea.
The patient is often premedicated with acetaminophen to try to prevent or decrease the intensity
of these symptoms. Large amounts of fluids help decrease symptoms.
11. Correct answer: d
Rationale: Nausea and vomiting can usually be managed with antiemetic drugs, diet
modification, and other nondrug interventions. Some cancer survivors may continue to have
symptoms or functional impairment related to treatment for years after treatment. Others who
have successful treatment may not have any functional limitations. Maintaining activity within
tolerable limits is helpful in managing fatigue. Lifelong birth control is not necessary.
12. Correct answer: d
Rationale: Teach the patient to try different ways to mask the taste changes. Some find stronger
seasonings and spices effective. Others find it better to avoid strong flavors and eat more bland
foods. Avoiding strong smells, drinking more water with food, oral care before eating, eating
smaller amounts more often, and using plastic utensils may help.
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13. Correct answer: a
Rationale: Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can
contribute to or worsen hypercalcemia. The manifestations of hypercalcemia include apathy,
depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia,
anorexia, nausea, and vomiting.
14. Correct answer: a
Rationale: Maintain hope, which is the key to effective cancer care. Hope depends on the status
of the patient: hope that the symptoms are not serious, hope that the treatment is curative, hope
for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death.
Hope provides control over what is occurring and is the basis of a positive attitude toward cancer
and cancer care.
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