Answers and rationales
1. D. Tumor cells that enter the bone marrow reduce the
production of healthy white blood cells (WBCs), which are
needed for normal immune function. Therefore clients who
have cancer, especially leukemia, are at an increased risk for
infection. Other people are not at risk for becoming infected
as a result of contact with a person who has lung cancer.
Lung cancer that has spread to the bone is still lung cancer;
it is not a bone marrow malignancy. It is true that the person
with lung cancer may produce more mucus, which can
harbor microorganisms, but this is not the main reason why
the client should avoid crowds and people who are ill.
2. C. Radiation therapy that is directed in or around the oral
cavity has a variety of actions that increase the risk for
dental caries (cavities) and tooth decay. The salivary glands
are affected, which changes the composition of the person's
saliva and often causes "dry mouth." This result allows rapid
bacterial overgrowth, which leads to cavity formation. In
addition, the radiation damages the integrity of the enamel
and also damages some of the living cells in the tooth. All
contribute to an increased risk for dental infections and
cavities.
3. C. Epoetin alfa and other erythropoiesis-stimulating agents
(ESAs) such as darbepoetin alfa (Aranesp) and epoetin alfa
(Epogen, Procrit) increase the production of many blood cell
types, not just erythrocytes, which increases the client's risk
for hypertension, blood clots, strokes, and heart attacks,
especially among older adults. Dosing is based on individual
client hemoglobin and hematocrit levels to ensure that just
enough red blood cells are produced to avoid the need for
transfusion but not to bring hemoglobin or hematocrit levels
up to normal. The increased blood pressure is an indication
to stop this therapy immediately.
4. B. When emetogenic chemotherapy drugs are prescribed,
the client should receive antiemetic drugs before the
chemotherapy drugs are administered. This allows time for
prevention of chemotherapy-associated nausea and
vomiting; however, the antiemetic therapy cannot stop until
all risks for nausea and vomiting have passed. Clients
become nauseated and vomit even if they are NPO.
5. C. The client's swollen face indicates possible superior vena
cava syndrome, which is an oncologic emergency.
Manifestations result from the blockage of venous return
from the head, neck, and upper trunk. Early manifestations
occur when the client arises after a night's sleep and include
edema of the face, especially around the eyes, and tightness
of the shirt or blouse collar. As the compression worsens,
the client develops engorged blood vessels and erythema of
the upper body, edema in the arms and hands, dyspnea, and
epistaxis. Interventions at this stage are more likely to be
successful. Late manifestations include hemorrhage,
cyanosis, mental status changes, decreased cardiac output,
and hypotension. Death results if compression is not
relieved.
6. A. A strong family history of breast cancer indicates a risk for
breast cancer. Annual screening may be indicated for a
strong family history. The client may perform a self-breast
examination monthly; a clinical examination by a health care
provider is indicated annually. An annual mammography is
performed after age 40 or in younger clients with a strong
family history.
7. D. Pain in the back of the legs could indicate prostate cancer
in an older man.
8. D. Advancing age is the single most important risk factor for
cancer. As a person ages, immune protection decreases.
9. B. T1 means that the tumor is increasing in size to about 2
cm, and that no regional lymph nodes are present in the
brain. M0 means that no distant metastasis has occurred.
10. a-c, e. as well as the pancreas.
11. A. Testing of stool specimens for occult blood is done
according to a standardized protocol and can be delegated
to nursing assistants.
12. B-D. Eating cruciferous vegetables such as broccoli,
cauliflower, brussels sprouts, and cabbage may reduce
cancer risk.
13. D. Tobacco is the single most important source of
preventable carcinogenesis.
14. B,C,E: The heart does not contain cells that divide; therefore
cardiac cancer is unlikely.
15. B. Typical sites of breast cancer metastasis include bone,
manifested by back pain, lung, liver, and brain. Signs of
metastasis to the spine may include numbness, pain,
paresthesias and tingling, and loss of bowel and bladder
control.
16. A. Hepatitis B and C are risk factors for primary liver cancer.
Consuming a diet high in animal fat may predispose to colon
or breast cancer. Exposure to radon is a risk factor for lung
cancer. Familial polyposis is a risk factor for colorectal
cancer.
17. B. Dyspnea is a sign of lung cancer, as are cough,
hoarseness, shortness of breath (SOB), bloody sputum, arm
or chest pain, and dysphagia.Night sweats is a symptom of
the lymphomas.
18. B. Primary prevention involves avoiding exposure to known
causes of cancer; education assists clients with this strategy.
all the other options are secondary levels of prevention.
19. C. Providing truthful information addresses the client's
concern.
20. A. Use of immune suppressant medications to prevent organ
rejection increases the risk for cancer. Immune suppressant
 Answers and rationales
medications must be taken for the life of the organ; the risk
for developing cancer remains.
21. D. Clients taking immune suppressive drugs to prevent
rejection are at increased risk for development of cancer;
any lump should be reported to the physician.
22. C. Numbness and weakness should be reported to the
physician because paralysis caused by spinal cord
compression can occur.
23. A. Although all of these are risk factors for lung cancer, the
client's tobacco use is the only factor that he can change.
24. B. These promoters increase cell division. If cell division is
halted, this does not lead to cancer development in the
initiation phase.In the initiation phase, carcinogens invade
the DNA of the nucleus of a single cell. A 1-cm tumor
consists of 1 billion cells. The latent phase occurs between
initiation and tumor formation. promotion phase consists of
progression when the blood supply changes from diffusion
to TAF.
25. D. The prefix "glio-" is used when cancers of the brain are
named.
26. B. The focus of palliative surgery is to improve quality of life
during the survival time.
27. C. Brachytherapy refers to short-term insertion of a
radiation source.
28. a,c,d,e: Radiation therapy to any site produces fatigue,may
cause clients to report changes in taste. Radiation side
effects are site specific; the larynx is in this area, therefore
changes in the skin may occur and dysphagia may occur
from radiation to the throat area. Chemotherapy, which
causes alopecia, may cause changes in the color or texture
of hair.
29. C. The lowest point of bone marrow function is referred to
as the nadir. The peak of bone marrow function occurs when
the client's blood levels are at their highest.Trough, which
means low, is typically used in reference to drug levels.
30. D. Intraperitoneal chemotherapy is placed in the peritoneal
cavity or the abdominal cavity.