Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
Chapter 15: Cancer
Harding: Lewis’s Medical-Surgical Nursing, 11th Edition
MULTIPLE CHOICE
1. A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign
tumor and a malignant tumor. Which answer by the nurse is accurate?
a. “Benign tumors do not cause damage to other tissues.”
b. “Benign tumors are likely to recur in the same location.”
c. “Malignant tumors may spread to other tissues or organs.”
d. “Malignant cells reproduce more rapidly than normal cells.”
ANS: C
The major difference between benign and malignant tumors is that malignant tumors invade
adjacent tissues and spread to distant tissues and benign tumors do not metastasize. The other
statements are inaccurate. Both types of tumors may cause damage to adjacent tissues.
Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not
usually recur.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
2. The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse
should monitor for which adverse effect?
a. Nausea
b. Alopecia
NURSINGTB.COM
c. Hematuria
d. Xerostomia
ANS: C
The adverse effects of intravesical chemotherapy are confined to the bladder. The other
adverse effects are associated with systemic chemotherapy.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
3. The nurse is caring for a patient who smokes 2 packs/day. Which action by the nurse could
help reduce the patient’s risk of lung cancer?
a. Teach the patient about the seven warning signs of cancer.
b. Plan to monitor the patient’s carcinoembryonic antigen (CEA) level.
c. Teach the patient about annual chest x-rays for lung cancer screening.
d. Discuss risks associated with cigarettes during each patient encounter.
ANS: D
Teaching about the risks associated with cigarette smoking is recommended at every patient
encounter because cigarette smoking is associated with multiple health problems. The other
options may detect lung cancer that is already present but do not reduce the risk.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
4. The nurse should suggest which food choice for a patient scheduled to receive external-beam
radiation for abdominal cancer?
a. Fruit salad
b. Baked chicken
c. Creamed broccoli
d. Toasted wheat bread
ANS: B
Protein is needed for wound healing. To minimize the diarrhea that is associated with bowel
radiation, the patient should avoid foods high in roughage, such as fruits and whole grains.
Lactose intolerance may develop secondary to radiation, so dairy products should also be
avoided.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
5. During a routine health examination, a 40-yr-old patient tells the nurse about a family history
of colon cancer. Which action should the nurse take next?
a. Schedule a sigmoidoscopy to provide baseline data.
b. Obtain more information about the patient’s relatives.
c. Teach the patient about the need for a colonoscopy at age 50.
d. Teach the patient how to do home testing for fecal occult blood.
ANS: B
The patient may be at increased risk for colon cancer, but the nurse’s first action should be
further assessment. The other actions may be appropriate, depending on the information that is
obtained from the patient with further questioning.
NURSINGTB.COM
DIF: Cognitive Level: Analyze (analysis)
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
6. A patient who is diagnosed with cervical cancer classified as Tis, N0, M0 asks the nurse what
the letters and numbers mean. Which response by the nurse is accurate?
a. “The cancer involves only the cervix.”
b. “The cancer cells look like normal cells.”
c. “Further testing is needed to determine the spread of the cancer.”
d. “It is difficult to determine the original site of the cervical cancer.”
ANS: A
Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this
time. Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the
origin is the cervix. Further testing is not indicated given that the cancer has not spread.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
7. The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure.
Which statement by the patient indicates that teaching was effective?
a. “The biopsy will remove the cancer in my prostate gland.”
b. “The biopsy will determine how much longer I have to live.”
c. “The biopsy will help decide the treatment for my enlarged prostate.”
d. “The biopsy will indicate whether the cancer has spread to other organs.”
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
ANS: C
A biopsy is used to determine whether the prostate enlargement is benign or malignant and
determines the type of treatment that will be needed. A biopsy does not give information
about metastasis, life expectancy, or the impact of cancer on the patient’s life.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
8. The nurse teaches a postmenopausal patient with stage III breast cancer about the expected
outcomes of cancer treatment. Which patient statement indicates that the teaching has been
effective?
a. “After cancer has not recurred for 5 years, it is considered cured.”
b. “The cancer will be cured if the entire tumor is surgically removed.”
c. “I will need follow-up examinations for many years after treatment before I can be
considered cured.”
d. “Cancer is never cured, but the tumor can be controlled with surgery,
chemotherapy, and radiation.”
ANS: C
The risk of recurrence varies by the type of cancer. Some cancers are considered cured after a
shorter time span or after surgery, but stage III breast cancer will require additional therapies
and ongoing follow-up.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
9. A patient with a large stomach
to the
N tumor
R Iattached
G B.C
Mliver is scheduled for a debulking
U S
N theTpatientOabout the outcome of this procedure?
procedure. What should the nurse
teach
a. Pain will be relieved by cutting sensory nerves in the stomach.
b. Decreasing the tumor size will improve the effects of other therapy.
c. Relieving the pressure in the stomach will promote optimal nutrition.
d. Tumor growth will be controlled by removing all the cancerous tissue.
ANS: B
A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy
more effective. Debulking surgeries do not control tumor growth. The tumor is debulked
because it is attached to the liver, a vital organ (not to relieve pressure on the stomach).
Debulking does not sever the sensory nerves, although pain may be lessened by the reduction
in pressure on the abdominal organs.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
10. External-beam radiation is planned for a patient with cervical cancer. What instructions
should the nurse give to the patient to prevent complications from the effects of the radiation?
a. Test all stools for the presence of blood.
b. Maintain a high-residue, high-fiber diet.
c. Clean the perianal area carefully after every bowel movement.
d. Inspect the mouth and throat daily for the appearance of thrush.
ANS: C
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause
frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown
and infection. Stools are likely to have occult blood from the inflammation associated with
radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will
not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when
patients receive abdominal radiation.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
11. A patient with Hodgkin’s lymphoma who is undergoing external radiation therapy tells the
nurse, “I am so tired I can hardly get out of bed in the morning.” Which intervention should
the nurse add to the plan of care?
a. Minimize activity until the treatment is completed.
b. Establish time to take a short walk almost every day.
c. Consult with a psychiatrist for treatment of depression.
d. Arrange for delivery of a hospital bed to the patient’s home.
ANS: B
Walking programs are used to keep the patient active without excessive fatigue. Having a
hospital bed does not necessarily address the fatigue. The better option is to stay as active as
possible while combating fatigue. Fatigue is expected during treatment and is not an
indication of depression. Minimizing activity may lead to weakness and other complications
of immobility.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Planning
NURSINGTB.COM
12. The nurse is caring for a patient with colon cancer who is scheduled for external radiation
therapy to the abdomen. Which information obtained by the nurse would indicate a need for
patient teaching?
a. The patient has a history of dental caries.
b. The patient swims several days each week.
c. The patient snacks frequently during the day.
d. The patient showers each day with mild soap.
ANS: B
The patient is instructed to avoid swimming in salt water or chlorinated pools during the
treatment period. The patient does not need to change habits of eating frequently or showering
with a mild soap. A history of dental caries will not impact the patient who is scheduled for
abdominal radiation.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
13. A patient undergoing external radiation has developed a dry desquamation of the skin in the
treatment area. The nurse teaches the patient about the management of the skin reaction.
Which statement, if made by the patient, indicates the teaching was effective?
a. “I can use ice packs to relieve itching.”
b. “I will scrub the area with warm water.”
c. “I will expose my skin to a sun lamp each day.”
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
d. “I can buy some aloe vera gel to use on my skin.”
ANS: D
Aloe vera gel and cream may be used on the radiated skin area. Ice and sunlamps may injure
the skin. Treatment areas should be cleaned gently to avoid further injury.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
14. A patient with metastatic colon cancer has severe vomiting after each administration of
chemotherapy. Which action by the nurse is appropriate?
a. Have the patient eat large meals when nausea is not present.
b. Offer dry crackers and carbonated fluids during chemotherapy.
c. Administer prescribed antiemetics 1 hour before the treatments.
d. Give the patient a glass of a citrus fruit beverage during treatments.
ANS: C
Treatment with antiemetics before chemotherapy may help prevent nausea. The patient should
eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause
nausea. The acidity of citrus fruits may be further irritating to the stomach.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
15. The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is
most important for the nurse to take?
a. Infuse the medication over a short period of time.
b. Stop the infusion if swelling
is observed
at the site.
NUR
SINGTaB.C
OM catheter.
c. Administer the chemotherapy
through
small-bore
d. Hold the medication unless a central venous line is available.
ANS: B
Swelling at the site may indicate extravasation, and the IV should be stopped immediately.
The medication generally should be given slowly to avoid irritation of the vein. The size of
the catheter is not as important as administration of vesicants into a running IV line to allow
dilution of the chemotherapy drug. These medications can be given through peripheral lines,
although central vascular access devices are preferred.
DIF: Cognitive Level: Analyze (analysis)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
16. A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the
nurse take to support the patient’s self-esteem?
a. Suggest that the patient limit social contacts until hair regrowth occurs.
b. Encourage the patient to purchase a wig or hat to wear when hair loss begins.
c. Teach the patient to wash hair gently with mild shampoo to minimize hair loss.
d. Inform the patient that hair usually grows back once chemotherapy is complete.
ANS: B
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats.
Limiting social contacts is not appropriate at a time when the patient is likely to need a good
social support system. The damage occurs at the hair follicles and will occur regardless of
gentle washing or use of a mild shampoo. The information that the hair will grow back is not
immediately helpful in maintaining the patient’s self-esteem.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Psychosocial Integrity
TOP:
Nursing Process: Planning
17. A patient who has ovarian cancer is crying and tells the nurse, “My husband rarely visits. He
just doesn’t care.” The husband tells the nurse that he does not know what to say to his wife.
Which problem is appropriate for the nurse to address in the plan of care?
a. Anxiety
b. Death anxiety
c. Difficulty coping
d. Lack of knowledge
ANS: C
The data indicate that difficulty coping with the situation may be present reflected by the poor
communication among the family members. The data given does not suggest death anxiety,
anxiety, or lack of knowledge as an etiology.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Psychosocial Integrity
TOP:
Nursing Process: Analysis
18. A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral
mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this
NURSINGTB.COM
patient?
a. Remove food debris from the teeth and oral mucosa with a stiff toothbrush.
b. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth.
c. Gargle and rinse the mouth several times a day with an antiseptic mouthwash.
d. Rinse the mouth before and after each meal and at bedtime with a saline solution.
ANS: D
The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used
for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate
the oral mucosa and are not recommended.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
19. A patient has inadequate nutrition due to painful oral ulcers. Which nursing action will be
most effective in improving oral intake?
a. Offer the patient frequent small snacks between meals.
b. Assist the patient to choose favorite foods from the menu.
c. Apply prescribed anesthetic gel to oral lesions before meals.
d. Teach the patient about the importance of nutritional intake.
ANS: C
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
Because the cause of the patient’s poor nutrition is the painful oral ulcers, the best
intervention is to apply anesthetic gel to the lesions before the patient eats. The other actions
might be helpful for other patients with impaired nutrition but would not be as helpful for this
patient.
DIF: Cognitive Level: Analyze (analysis)
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Planning
20. A widowed mother of 4 school-age children is hospitalized with metastatic ovarian cancer.
The patient is crying and tells the nurse that she does not know what will happen to her
children when she dies. Which response by the nurse is most appropriate?
a. “Don’t you have any friends that will raise the children for you?”
b. “Would you like to talk about options for the care of your children?”
c. “For now you need to concentrate on getting well and not worrying about your
children.”
d. “Many patients with cancer live for a long time, so there is time to plan for your
children.”
ANS: B
This response expresses the nurse’s willingness to listen and recognizes the patient’s concern.
The responses beginning “Many patients with cancer live for a long time” and “For now you
need to concentrate on getting well” close off discussion of the topic and indicate that the
nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer
may not have a long time to plan. Although it is possible that the patient’s friends will raise
the children, more assessment information is needed before making plans.
DIF: Cognitive Level: Apply (application)
NURSINGMSC:
TOP: Nursing Process: Implementation
NCLEX:
TB.C
OM Psychosocial Integrity
21. A patient who has severe pain with terminal pancreatic cancer is being cared for at home by
family members. Which finding by the nurse indicates that teaching about pain management
has been effective?
a. The patient uses the ordered opioid pain medication whenever the pain is greater
than 5 (0 to 10 scale).
b. The patient agrees to take the medications by the IV route to improve analgesic
effectiveness.
c. The patient takes opioids around the clock on a regular schedule and uses
additional doses when breakthrough pain occurs.
d. The patient states that nonopioid analgesics may be used if the maximal dose of
the opioid is reached without adequate pain relief.
ANS: C
For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional
doses as needed for breakthrough pain. Taking the medications only when pain reaches a
certain level does not provide effective pain control. Although nonopioid analgesics may also
be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved.
The IV route is not more effective than the oral route, and usually the oral route is preferred.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
NURSINGTB.COM
Nursing Process: Evaluation
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
22. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell
carcinoma. Which information should the nurse include when explaining the purpose of this
therapy to the patient?
a. IL-2 enhances the body’s immunologic response to tumor cells.
b. IL-2 prevents bone marrow depression caused by chemotherapy.
c. IL-2 protects normal cells from harmful effects of chemotherapy.
d. IL-2 stimulates cancer cells in their resting phase to enter mitosis.
ANS: A
IL-2 enhances the ability of the patient’s own immune response to suppress tumor cells. IL-2
does not protect normal cells from damage caused by chemotherapy, stimulate cancer cells to
enter mitosis, or prevent bone marrow depression.
DIF: Cognitive Level: Understand (comprehension)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
23. The home health nurse is caring for a patient who has been receiving interferon therapy for
treatment of cancer. Which statement by the patient indicates a need for further assessment?
a. “I have frequent muscle aches and pains.”
b. “I rarely have the energy to get out of bed.”
c. “I experience chills after I inject the interferon.”
d. “I take acetaminophen (Tylenol) every 4 hours.”
ANS: B
Fatigue can be a dose-limiting toxicity for use of immunotherapy. Flu-like symptoms, such as
muscle aches and chills, are common side effects with interferon use. Patients are advised to
use acetaminophen every 4 hours.
NURSINGTB.COM
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
24. A patient with leukemia is considering whether to have hematopoietic stem cell
transplantation (HSCT). Which information should the nurse include in the patient’s teaching
plan?
a. Donor bone marrow is transplanted through a sternal or hip incision.
b. Hospitalization is required for several weeks after the stem cell transplant.
c. The transplant procedure takes place in a sterile operating room to decrease the
risk for infection.
d. Transplant of the donated cells can be very painful because of the nerves in the
tissue lining the bone.
ANS: B
The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT
while waiting for the transplanted marrow to start producing cells. The transplanted cells are
infused through an IV line so the transplant is not painful, nor is an operating room or incision
required.
DIF: Cognitive Level: Understand (comprehension)
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Planning
25. The nurse teaches a patient with liver cancer about high-protein, high-calorie diet choices.
Which snack choice by the patient indicates that the teaching has been effective?
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
a.
b.
c.
d.
Lime sherbet
Blueberry yogurt
Fresh strawberries
Cream cheese bagel
ANS: B
Yogurt has high biologic value because of the protein and fat content. Fruit salad does not
have high amounts of protein or fat. Lime sherbet is lower in fat and protein than yogurt.
Cream cheese is low in protein.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
26. A patient with cancer is eating very little due to altered taste sensation. Which nursing action
would address the cause of the patient problem?
a. Add protein powder to foods such as casseroles.
b. Tell the patient to eat foods that are high in nutrition.
c. Avoid giving the patient foods that are strongly disliked.
d. Add spices to enhance the flavor of foods that are served.
ANS: C
The patient will eat more if disliked foods are avoided and foods that the patient likes are
included instead. Additional spice is not usually an effective way to enhance taste. Adding
protein powder does not address the issue of taste. The patient’s poor intake is not caused by a
lack of information about nutrition.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
NCLEX:
N R I GMSC:
B.C
M Physiological Integrity
U S N T
O
27. During the teaching session for a patient who has a new diagnosis of acute leukemia, the
patient is restless and looks away without making eye contact. The patient asks the nurse to
repeat the information about the complications associated with chemotherapy. Based on this
assessment, which patient problem should the nurse identify?
a. Denial
b. Anxiety
c. Acute confusion
d. Ineffective adherence to treatment
ANS: B
The patient who has a new cancer diagnosis is likely to have high anxiety, which may affect
learning and require that the nurse repeat and reinforce information about health maintenance.
There is no evidence to support confusion. The patient asks for the information to be repeated,
indicating that denial is not present. The patient has recently been diagnosed, so adherence has
not yet been required.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Psychosocial Integrity
TOP:
Nursing Process: Analysis
28. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia.
Which observation by the nurse indicates a need for further teaching?
a. The patient ambulates around the room.
b. The patient’s visitors bring in fresh peaches.
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
c. The patient cleans with a warm washcloth after having a stool.
d. The patient uses soap and shampoo to shower every other day.
ANS: B
Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria
being present. The patient should ambulate in the room rather than the hospital hallway to
avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and
increase infection risk, showering every other day is acceptable. Careful cleaning after having
a bowel movement will help prevent skin breakdown and infection.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
Nursing Process: Evaluation
29. The nurse is caring for a patient diagnosed with stage I colon cancer. When assessing the need
for psychologic support, which question by the nurse will provide the most information?
a. “How long ago were you diagnosed with this cancer?”
b. “Do you have any concerns about body image changes?”
c. “Can you tell me what has been helpful when coping with past stressful events?”
d. “Are you familiar with the stages of emotional adjustment to cancer of the colon?”
ANS: C
Information about how the patient has coped with past stressful situations helps the nurse
determine usual coping mechanisms and their effectiveness. The length of time since the
diagnosis will not provide much information about the patient’s need for support. The
patient’s knowledge of typical stages in adjustment to a critical diagnosis does not provide
insight into patient needs for assistance. Because surgical interventions for stage I cancer of
the colon may not cause any body image changes, this question is not appropriate at this time.
NURSINGTB.COM
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
30. The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse
report immediately to the health care provider?
a. Generalized muscle aches
b. Crackles at the lung bases
c. Reports of nausea and anorexia
d. Oral temperature of 100.6° F (38.1° C)
ANS: B
Capillary leak syndrome and acute pulmonary edema are possible toxic effects of
interleukin-2. The patient may need oxygen and the nurse should rapidly notify the health care
provider. The other findings are common side effects of interleukin-2.
DIF: Cognitive Level: Analyze (analysis)
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Evaluation
31. The nurse obtains information about a hospitalized patient who is receiving chemotherapy for
colorectal cancer. Which information about the patient alerts the nurse to discuss a possible
change in cancer therapy with the health care provider?
a. Frequent loose stools
b. Nausea and vomiting
c. Elevated white blood count (WBC)
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
d. Increased carcinoembryonic antigen (CEA)
ANS: D
An increase in CEA indicates that the chemotherapy is not effective for the patient’s cancer
and may need to be modified. Gastrointestinal adverse effects are common with
chemotherapy. The nurse may need to address these, but they would not necessarily indicate a
need for a change in therapy. An elevated WBC may indicate infection but does not reflect the
effectiveness of the colorectal cancer therapy.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
32. The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which
laboratory result is most important to report to the health care provider?
a. Hematocrit 30%
b. Platelets 95,000/µL
c. Hemoglobin 10 g/L
d. White blood cells (WBC) 2700/µL
ANS: D
The low WBC count places the patient at risk for severe infection and is an indication that the
chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim
(Neupogen) are needed. Although the other laboratory data indicate decreased levels, they do
not indicate any immediate life-threatening adverse effects of the chemotherapy.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
N R I G B.C M
U S N T
O
33. When caring for a patient who is pancytopenic, which action by unlicensed assistive
personnel (UAP) indicates a need for the nurse to intervene?
a. The UAP assists the patient to use dental floss after eating.
b. The UAP adds baking soda to the patient’s saline oral rinses.
c. The UAP puts fluoride toothpaste on the patient’s toothbrush.
d. The UAP has the patient rinse after meals with a saline solution.
ANS: A
Use of dental floss is avoided in patients with pancytopenia because of the risk for infection
and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
34. The nurse supervises the care of a patient with a temporary radioactive cervical implant.
Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would
require an intervention?
a. The UAP flushes the toilet once after emptying the patient’s bedpan.
b. The UAP stands by the patient’s bed for 30 minutes talking with the patient.
c. The UAP places the patient’s bedding in the laundry container in the hallway.
d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
ANS: B
Because patients with temporary implants emit radioactivity while the implants are in place,
exposure to the patient is limited. Laundry and urine and feces do not have any radioactivity
and do not require special precautions. Cervical radiation will not affect the oral mucosa, and
alcohol-based mouthwash is not contraindicated.
DIF: Cognitive Level: Apply (application)
OBJ: Special Questions: Delegation
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
35. The nurse receives change-of-shift report on the oncology unit. Which patient should the
nurse assess first?
a. A 35-yr-old patient who has wet desquamation associated with abdominal
radiation
b. A 42-yr-old patient who is sobbing after receiving a new diagnosis of ovarian
cancer
c. A 24-yr-old patient who received neck radiation and has blood oozing from the
neck
d. A 56-yr-old patient who developed a new pericardial friction rub after chest
radiation
ANS: C
Because neck bleeding may indicate possible carotid artery rupture in a patient who is
receiving radiation to the neck, this patient should be seen first. The diagnoses and clinical
manifestations for the other patients are not immediately life threatening.
DIF: Cognitive Level: Analyze (analysis)
NURPatients
OBJ: Special Questions: Multiple
SINGTB.COM
MSC: NCLEX: Safe and Effective Care Environment
TOP: Nursing Process: Planning
36. Which action should the nurse take when caring for a patient who is receiving chemotherapy
and reports problems with concentration?
a. Suggest use of a daily planner and encourage adequate sleep.
b. Teach the patient to rest the brain by avoiding new activities.
c. Teach that “chemo-brain” is a short-term effect of chemotherapy.
d. Report patient symptoms immediately to the health care provider.
ANS: A
Use of tools to enhance memory and concentration such as a daily planner and adequate rest
are helpful for patients who develop “chemo-brain” while receiving chemotherapy. Patients
should be encouraged to exercise the brain through new activities. Chemo-brain may be short
or long term. There is no urgent need to report common chemotherapy side effects to the
provider.
DIF: Cognitive Level: Apply (application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
37. The nurse assesses a patient with non-Hodgkin’s lymphoma who is receiving an infusion of
rituximab (Rituxan). Which assessment finding would require the most rapid action by the
nurse?
a. Shortness of breath
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
b. Shivering and chills
c. Muscle aches and pains
d. Temperature of 100.2° F (37.9° C)
ANS: A
Rituximab (Rituxan) is a monoclonal antibody. Shortness of breath should be investigated
rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration. The
nurse will need to rapidly take actions such as stopping the infusion, assessing the patient
further, and notifying the health care provider. The other findings will also require action by
the nurse but are not indicative of life-threatening complications.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
38. A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back
pain. Which action should the nurse take first?
a. Give the patient the prescribed PRN opioid.
b. Assess for sensation and strength in the legs.
c. Notify the health care provider about the symptoms.
d. Teach the patient how to use relaxation to reduce pain.
ANS: B
Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the
epidural space. The nurse will need to assess the patient further for symptoms such as
decreased leg sensation and strength and then notify the health care provider. Administration
of opioids or the use of relaxation may be appropriate but only after the nurse has assessed for
possible spinal cord compression.
NURSINGTB.COM
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
39. The nurse is caring for a patient with left-sided lung cancer. Which finding would be most
important for the nurse to report to the health care provider?
a. Hematocrit of 32%
b. Pain with deep inspiration
c. Serum sodium of 126 mEq/L
d. Decreased breath sounds on left side
ANS: C
The syndrome of inappropriate antidiuretic hormone (and the resulting hyponatremia) is an
oncologic metabolic emergency and requires rapid treatment to prevent complications such as
seizures and coma. The other findings also require intervention but are common in patients
with lung cancer and not immediately life threatening.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
40. An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hr in
conjunction with the prescribed chemotherapy. Which finding by the nurse is most important
to report to the health care provider?
a. Patient reports having severe fatigue.
b. Patient voids every hour during the day.
c. Patient takes only 50% of meals and refuses snacks.
d. Patient has crackles up to the midline posterior chest.
ANS: D
Rapid fluid infusions may cause heart failure, especially in older patients. The other findings
are common in patients who have cancer or are receiving chemotherapy.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
41. After change-of-shift report on the oncology unit, which patient should the nurse assess first?
a. Patient who has a platelet count of 82,000/µL after chemotherapy.
b. Patient who has xerostomia after receiving head and neck radiation.
c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C).
d. Patient who is worried about getting the prescribed long-acting opioid on time.
ANS: C
Fever is an emergency in neutropenic patients because of the risk for rapid progression to
severe infections and sepsis. The other patients also require assessments or interventions but
do not need to be assessed as urgently. Patients with thrombocytopenia do not have
spontaneous bleeding until the platelets are 20,000/µL. Xerostomia does not require
immediate intervention. Although
breakthrough
NURS
INGTB.Cpain
OM needs to be addressed rapidly, the patient
does not appear to have breakthrough pain.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients
TOP: Nursing Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment
MULTIPLE RESPONSE
1. The nurse at the clinic is interviewing a 64-yr-old woman who is 5 feet, 3 inches tall and
weighs 125 lb (57 kg). The patient has not seen a health care provider for 20 years. She walks
5 miles most days and has a glass of wine 2 or 3 times a week. Which topics will the nurse
plan to include in patient teaching about cancer screening and decreasing cancer risk? (Select
all that apply.)
a. Pap testing
b. Tobacco use
c. Sunscreen use
d. Mammography
e. Colorectal screening
ANS: A, C, D, E
The patient’s age, gender, and history indicate a need for screening and teaching about
colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use
tobacco or excessive alcohol, she is physically active, and her body weight is healthy.
NURSINGTB.COM
Lewis's Medical Surgical Nursing 11th Edition Harding Test Bank
DIF: Cognitive Level: Analyze (analysis)
MSC: NCLEX: Health Promotion and Maintenance
TOP: Nursing Process: Planning
2. A patient develops neutropenia after receiving chemotherapy. Which information about ways
to prevent infection will the nurse include in the teaching plan? (Select all that apply.)
a. Cook food thoroughly before eating.
b. Choose low fiber, low residue foods.
c. Avoid public transportation such as buses.
d. Use rectal suppositories if needed for constipation.
e. Talk to the oncologist before having any dental work.
ANS: A, C, E
Eating only cooked food and avoiding public transportation will decrease infection risk. A
high-fiber diet is recommended for neutropenic patients to decrease constipation. Because
bacteria may enter the circulation during dental work or oral surgery, the patient may need to
postpone dental work or take antibiotics.
DIF: Cognitive Level: Apply (application)
MSC: NCLEX: Physiological Integrity
TOP:
NURSINGTB.COM
NURSINGTB.COM
Nursing Process: Planning