INTERMEDIATE MED-SURG 201 EXAM 1 QUESTIONS And ANSWERS (Latest Update)

INTERMEDIATE MED-SURG 201 EXAM 1 QUESTIONS 1. While being prepared for a biopsy of a lump in the right breast, the patient asks the nurse what the difference is between a benign tumor and a malignant tumor. The nurse explains that a benign tumor differs from a malignant tumor in that benign tumors. a. do not cause damage to adjacent tissue. b. do not spread to other tissues and organs. c. are simply an overgrowth of normal cells. d. frequently recur in the same site. 2. A patient who has been told by the health care provider that the cells in a bowel tumor are poorly differentiated asks the nurse what is meant by "poorly differentiated." Which response should the nurse make? a. "The cells in your tumor do not look very different from normal bowel cells." b. "The tumor cells have DNA that is different from your normal bowel cells." c. "Your tumor cells look more like immature fetal cells than normal bowel cells." d. "The cells in your tumor have mutated from the normal bowel cells." 3. A patient who smokes tells the nurse, "I want to have a yearly chest x-ray so that if I get cancer, it will be detected early." Which response by the nurse is most appropriate? a. "Chest x-rays do not detect cancer until tumors are already at least a half-inch in size." b. "Annual x-rays will increase your risk for cancer because of exposure to radiation." c. "Insurance companies do not authorize yearly x-rays just to detect early lung cancer." d. "Frequent x-rays damage the lungs and make them more susceptible to cancer." 4. In teaching about cancer prevention to a community group, the nurse stresses promotion of exercise, normal body weight, and low-fat diet because a. most people are willing to make these changes to avoid cancer. b. dietary fat and obesity promote growth of many types of cancer. c. people who exercise and eat healthy will make other lifestyle changes. d. obesity and lack of exercise cause cancer in susceptible people. 5. During a routine health examination, a 30-year-old patient tells the nurse about a family history of colon cancer. The nurse will plan to a. teach the patient about the need for a colonoscopy at age 50. b. ask the patient to bring in a stool specimen to test for occult blood. c. schedule a sigmoidoscopy to provide baseline data about the patient. d. have the patient ask the doctor about specific tests for colon cancer. 6. When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer is staged as Tis, N0, M0. The nurse will teach the patient that a. the cancer cells are well-differentiated. b. it is difficult to determine the original site of the cervical cancer. c. further testing is needed to determine the spread of the cancer. d. the cancer is localized to the cervix. 7. Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates that the patient understands the purpose of a biopsy? a. "The biopsy will tell the doctor whether the cancer has spread to my other organs." b. "The biopsy will help the doctor decide what treatment to use for my enlarged prostate." c. "The biopsy will determine how much longer I have to live." d. "The biopsy will indicate the effect of the cancer on my life." 8. The nurse is teaching a postmenopausal patient with breast cancer about the expected outcomes of her cancer treatment. The nurse evaluates that the teaching has been effective when the patient says a. "After cancer has not recurred for 5 years, it is considered cured." b. "I will need to have follow-up examinations for many years after I have treatment before I can be considered cured." c. "Cancer is considered cured if the entire tumor is surgically removed." d. "Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation." 9. A patient with a large stomach tumor that is attached to the liver is scheduled to have a debulking procedure. The nurse explains that the expected outcome of this surgery is a. control of the tumor growth by removal of malignant tissue. b. promotion of better nutrition by relieving the pressure in the stomach. c. relief of pain by cutting sensory nerves in the stomach. d. reduction of the tumor burden to enhance adjuvant therapy. 10. External-beam radiation is planned for a patient with endometrial cancer. The nurse teaches the patient that an important measure to prevent complications from the effects of the radiation is to a. test all stools for the presence of blood. b. inspect the mouth and throat daily for the appearance of thrush. c. perform perianal care with sitz baths and meticulous cleaning. d. maintain a high-residue, high-fat diet. 11. Which action by a nursing assistant (NA) caring for a patient with a temporary radioactive cervical implant indicates that the RN should intervene? a. The NA places the patient's bedding in the laundry container in the hallway. b. The NA flushes the toilet once after emptying the patient's bedpan. c. The NA stands by the patient's bed for an hour talking with the patient. d. The NA gives the patient an alcohol-containing mouthwash for oral care. 12. A patient with Hodgkin's lymphoma is undergoing external radiation therapy on an outpatient basis. After 2 weeks of treatment, the patient tells the nurse, "I am so tired I can hardly get out of bed in the morning." An appropriate intervention for the nurse to plan with the patient is to a. exercise vigorously when fatigue is not as noticeable. b. consult with a psychiatrist for treatment of depression. c. establish a time to take a short walk every day. d. maintain bed rest until the treatment is completed. 13. Which information obtained by the nurse about a patient with colon cancer who is scheduled for external radiation therapy to the abdomen indicates a need for patient teaching? a. The patient swims a mile 5 days a week. b. The patient eats frequently during the day. c. The patient showers with Dove soap daily. d. The patient has a history of dental caries. 14. A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse knows that teaching about management of the skin reaction has been effective when the patient says a. "I can use ice packs to relieve itching in the treatment area." b. "I can buy a steroid cream to use on the itching area." c. "I will expose the treatment area to a sun lamp daily." d. "I will scrub the area with warm water to remove the scales." 15. A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. An important nursing intervention for the patient is to a. teach about the importance of nutrition during treatment. b. have the patient eat large meals when nausea is not present. c. administer prescribed antiemetics 1 hour before the treatments. d. offer dry crackers and carbonated fluids during chemotherapy. 16. When the nurse is administering a vesicant chemotherapeutic agent intravenously, an important consideration is to a. stop the infusion if swelling is observed at the site. b. infuse the medication over a short period. c. administer the chemotherapy through small-bore catheter. d. hold the medication unless a central venous line is available. 17. A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To maintain the patient's self-esteem, the nurse plans to a. suggest that the patient limit social contacts until regrowth of the hair occurs. b. encourage the patient to purchase a wig or hat and wear it once hair loss begins. c. have the patient wash the hair gently with a mild shampoo to minimize hair loss. d. inform the patient that hair loss will not be permanent and that the hair will grow back. 18. A patient with ovarian cancer tells the nurse, "I don't think my husband cares about me anymore. He rarely visits me." On one occasion when the husband was present, he told the nurse he just could not stand to see his wife so ill and never knew what to say to her. An appropriate nursing diagnosis in this situation is a. compromised family coping related to disruption in lifestyle and role changes. b. impaired home maintenance related to perceived role changes. c. risk for caregiver role strain related to burdens of caregiving responsibilities. d. interrupted family processes related to effect of illness on family members. 19. A patient receiving head and neck radiation and systemic chemotherapy has ulcerations over the oral mucosa and tongue and thick, ropey saliva. An appropriate intervention for the nurse to teach the patient is to 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. 20. A patient who is receiving interleukin-2 (IL-2) therapy (Proleukin) complains to the nurse about all of these symptoms. Which one is most important to report to the health care provider? a. Generalized aches b. Dyspnea c. Decreased appetite d. Insomnia 21. A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin's lymphoma. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the nurse to the patient's concerns is a. "Radiation does not cause the problems with sexual functioning that occur with chemotherapy or surgical procedures used to treat cancer." b. "It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children." c. "The radiation will make you sterile, but your ability to have sexual intercourse will not be changed by the treatment." d. "You may have some temporary impotence during the course of the radiation, but normal sexual function will return." 22. A 40-year-old divorced mother of four school-age children is hospitalized with metastatic cancer of the ovary. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is a. "Why don't we talk about the options you have for the care of your children?" b. "Many patients with cancer live for a long time, so there is time to plan for your children." c. "For now you need to concentrate on getting well, not worry about your children." d. "Perhaps your ex-husband will take the children when you can't care for them." 23. A patient who has terminal cancer of the liver and is cared for by family members at home tells the nurse, "I have intense pain most of the time now." The nurse recognizes that teaching regarding pain management has been effective when the patient a. uses the ordered opioid pain medication whenever the pain is greater than 5 on a 10-point scale. b. states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief. c. agrees to take the medications by the IV route to improve effectiveness. d. takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. 24. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is to a. protect normal kidney cells from the damaging effects of chemotherapy. b. enhance the patient's immunologic response to tumor cells. c. stimulate malignant cells in the resting phase to enter mitosis. d. prevent the bone marrow depression caused by chemotherapy. 25. The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient may indicate a need for a change in treatment? a. "I have frequent muscle aches and pains." b. "I rarely have the energy to get out of bed." c. "I take acetaminophen (Tylenol) every 4 hours." d. "I experience chills after I inject the interferon." 26. Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider? a. Hemoglobin of 10 g/L b. WBC count of 1700/µl c. Platelets of 65,000/µl d. Serum creatinine level of 1.2 mg/dl 27. A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not responded to chemotherapy. In discussing the treatment with the patient, the nurse explains that a. hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT). b. the transplant of the donated cells is painful because of the nerves in the tissue lining the bone. c. donor bone marrow cells are transplanted immediately after an infusion of chemotherapy. d. the transplant procedure takes place in a sterile operating room to minimize the risk for infection. 28. The nurse teaches a patient with cancer of the liver about high- protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective? a. Fresh fruit salad b. Orange sherbet c. Strawberry yogurt d. French fries 29. The nurse has identified the nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation in a patient with lung cancer who has had a 10% loss in weight. An appropriate nursing intervention that addresses the etiology of this problem is to a. provide foods that are highly spiced to stimulate the taste buds. b. avoid presenting foods for which the patient has a strong dislike. c. add strained baby meats to foods such as soups and casseroles. d. teach the patient to eat whatever is nutritious since food is tasteless. 30. After the nurse has explained the purpose of and schedule for chemotherapy to a 23-year-old patient who recently received a diagnosis of acute leukemia, the patient asks the nurse to repeat the information. Based on this assessment, which nursing diagnosis is most likely for the patient? a. Acute confusion related to infiltration of leukemia cells into the central nervous system b. Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment c. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis d. Risk for ineffective adherence to treatment related to denial of need for chemotherapy 31. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the RN caring for the patient indicates that the nurse should take action? a. The patient's visitors bring in some fresh peaches from home. b. The patient ambulates several times a day in the room. c. The patient uses soap and shampoo to shower every other day. d. The patient cleans with a warm washcloth after having a stool. 32. Which action by a nursing assistant (NA) when caring for a patient who is pancytopenic indicates a need for the nurse to intervene? a. The NA assists the patient to use dental floss after eating. b. The NA makes an oral rinse using 1 teaspoon of salt in a liter of water. c. The NA adds baking soda to the patient's saline oral rinses. d. The NA puts fluoride toothpaste on the patient's toothbrush. 33. A with tumor lysis syndrome (TLS) is taking allopurinol (Xyloprim). Which laboratory value should the nurse monitor to determine the effectiveness of the medication? a. Blood urea nitrogen (BUN) b. Serum phosphate c. Serum potassium d. Uric acid level 34. When assessing a patient's needs for psychologic support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information? a. "Can you tell me what has been helpful to you in the past when coping with stressful events?" b. "How long ago were you diagnosed with this cancer?" c. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?" d. "How do you feel about having a possibly terminal illness?" MULTIPLE RESPONSE 1. A 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg) tells the nurse that she has a glass of wine two or three times a week. The patient works for the post office and has a 5-mile mail-delivery route. This is her first contact with the health care system in 20 years. Which of these topics will the nurse plan to include in patient teaching about cancer? (Select all that apply.) a. Alcohol use b. Physical activity c. Body weight d. Colorectal screening e. Tobacco use f. Mammography g. Pap testing h. Sunscreen use