Chapter 8: Caring for the Cancer Survivor

Test Bank
MULTIPLE CHOICE
1. The National Coalition for Cancer Survivorship has defined a cancer survivor as a person who
has
a
.
Been cancer free for 5 years after diagnosis.
b
.
Been cancer free for 3 years after diagnosis.
c
.
Had cancer until he or she dies.
d
.
Had cancer but is declared cancer free.
NS! C
The definition of a cancer survivor is the following! "n individual is considered a cancer
survivor fro# the ti#e of diagnosis through the balance of his or her life.$ Being cancer free
for any length of ti#e does not relate to the definition of a cancer survivor put forth by the
National Coalition for Cancer Survivorship.
%&'! (nowledge )*'! +, -B.! %iscuss the concept of cancer survivorship.
T-/! ssess#ent 0SC! Nursing /rocess
1. s nurses caring for cancer survivors2 it is i#portant to understand that
a
.
Caucasians have #ore post3treat#ent sy#pto#s than #inority patients.
b
.
Treat#ent outco#es are the sa#e regardless of ethnic bac4ground.
c
.
Cancer treat#ent is lifelong2 and follow3up ensures that needs are #et.
d
.
0any long3ter# cancer survivors suffer needlessly and die.
NS! %
%espite the incredible advances #ade in cancer care2 #any long3ter# survivors suffer
unnecessarily and die fro# delayed second cancer diagnoses or treat#ent3related chronic
disease. *vidence suggests that survivors a#ong racial and ethnic #inorities and other
underserved populations have #ore post3treat#ent sy#pto#s and poorer treat#ent outco#es
than Caucasians. -nce treat#ent is co#pleted2 contact with a cancer care provider often stops2
and survivors5 needs go unnoticed or untreated.
%&'! 6nderstand )*'! +, -B.! %iscuss the concept of cancer survivorship.
T-/! *valuation 0SC! Nursing /rocess
3. 7hen wor4ing with cancer survivors2 the nurse #ust understand that cancer survivors
a
.
'ace depression that is devastating and destroys one5s sense of life.
b
.
See4 a balance between independence and interdependence.
c
.
*8perience si#ilar long3ter# i#pact regardless of cultural beliefs.
d
.
re at #uch lower ris4 for developing a new cancer.
NS! B
9uality of life in cancer survivorship #eans having a balance between the e8perience of
increased dependence and see4ing both independence and interdependence. -f course there
are always e8ceptions with regard to the level of distress that survivors face. 'or so#e2 cancer
beco#es an e8perience of self3reflection and an enhanced sense of what life is about.
)egardless of each survivor5s :ourney with cancer2 having cancer affects each person5s
physical2 social2 psychological2 and spiritual well3being. lthough cancer survivors go
through si#ilar steps of cancer diagnosis and treat#ent2 they e8perience cancer and the long3
ter# i#pact differently based on their cultural beliefs. Cancer survivors are at increased ris4
for cancer ;either a recurrence of the cancer for which they were treated or a second cancer<.
%&'! 6nderstand )*'! +1
-B.! %escribe the influence of cancer survivorship on the patient5s =uality of life.
T-/! *valuation 0SC! Nursing /rocess
>. The nurse is caring for a cancer survivor who has been hospitali?ed in the intensive care unit
;&C6< for an unrelated and stable proble#. The &C6 has posted visiting hours2 but so#e of the
patient5s fa#ily is fro# out of town and would li4e to see her even though it is not ti#e. The
patient has also voiced a desire to see her fa#ily. The nurse allows the fa#ily to visit even
though it is not the "official$ visiting ti#e. 7hy would the nurse do this@
a
.
%isagrees with the established ti#e for visiting
b
.
)eali?es that the patient is dying because she is in the &C6
c
.
Believes that the visit will help relieve psychological stress
d
.
'eels there is no real reason to have li#ited visiting hours.
NS! C
Survivors who have social and e#otional support syste#s are li4ely to have less
psychological distress. )elationships are critical for cancer survivors. The nurse does not
necessarily have proble#s with the standard visiting hours. Not enough infor#ation is
provided to indicate that the patient is near death2 and not all patients in the &C6 are dying.
%&'! pply )*'! +3
-B.! %escribe the influence of cancer survivorship on the patient5s =uality of life.
T-/! &#ple#entation 0SC! Nursing /rocess
5. 7hy is cancer survivorship especially difficult for fa#ily #e#bers in the "sandwich
generation$@
a They are totally dependent on their parents who have cancer but are still the
. providers2 and hence2 "#a4e the sandwiches.$
b
.
They are the pri#ary caregivers of children with cancer2 and hence2 "#a4e their
sandwiches.$
c
.
They are cancer survivors who are in between ;"sandwiched$< treat#ents and
re=uire a great deal of support.
d
.
They are caught in the #iddle of caring for their own i##ediate fa#ily2 as well
as a parent with cancer.
NS! %
'or #e#bers of the "sandwich generation2$ caregivers who are 3, to 5, years old who are
often caught in the #iddle of caring for their own i##ediate fa#ily2 as well as a parent with
cancer2 the de#ands are #any2 fro# providing ongoing encourage#ent and support and
assisting with household chores to providing hands3on physical care when cancer is advanced.
%&'! (nowledge )*'! +> -B.! %iscuss the effects that cancer has on the fa#ily.
T-/! ssess#ent 0SC! Nursing /rocess
A. -ngoing concerns and proble#s facing cancer survivors and their fa#ilies are i#portant
deter#inants of ad:ust#ent and =uality of life. 'a#ilies generally find the#selves ill prepared
to deal with cancer because
a
.
*ducational progra#s are of no help in dealing with cancer issues.
b
.
Hiding cancer3related thoughts and concerns helps #aintain relationships.
c
.
Holding bac4 e#otions is an effort to shield others fro# true feelings.
d
.
Caregiving is predeter#ined and does not re=uire fa#ily decision3#a4ing s4ills.
NS! C
0any caregivers and cancer survivors atte#pt to hide cancer3related thoughts and concerns
fro# one another2 which increases adverse psychological outco#es. 0otivation for this
behavior is often to protect one another fro# the distress that is e8perienced by each #e#ber
of the fa#ily. Holding bac4 e#otions is so#eti#es a part of this effort to shield one another
fro# true thoughts and feelings. &f cancer survivors and their partners participated in an
educational progra# to teach the i#portance of disclosing feelings and then actually disclosed
the#2 relationships and inti#acy were i#proved. Caregiving also involves psychological
de#ands of co##unicating2 proble# solving2 and decision #a4ingB social de#ands of
re#aining active in the co##unity and wor4B and econo#ic de#ands of #eeting financial
obligations.
%&'! 6nderstand )*'! +> -B.! %iscuss the effects that cancer has on the fa#ily.
T-/! ssess#ent 0SC! Nursing /rocess
C. The nurse is caring for a young wo#an with breast cancer. The stress between the wo#an and
her husband is obvious2 as is an8iety a#ong the children. 7hat is the nurse5s best action in
this situation@
a Help find or develop an educational progra# for the patient and her husband.
.
b
.
*ncourage the patient to agree with her husband even if she disagrees.
c
.
Support the husband2 and e8plain that the husband 4nows what5s best.
d
.
Ta4e the children away and reco##end foster care.
NS!
&t has been found that if cancer survivors and their partners participated in an educational
progra# to teach the i#portance of disclosing feelings and then actually disclosed the#2
relationships and inti#acy were i#proved. *ncouraging honest co##unication within
fa#ilies is an i#portant intervention for the nurse to i#ple#ent to enhance fa#ily
relationships. Core fa#ily functions include #aintaining an e#otionally and physically safe
environ#ent2 interpreting and reducing the threat of stressful events ;including the cancer< for
fa#ily #e#bers2 and nurturing and supporting the develop#ent of individual fa#ily
#e#bers. &n childrearing fa#ilies2 this #eans providing an attentive parenting environ#ent
for children and infor#ation and support to children when their sense of well3being beco#es
threatened. Spouses often do not 4now what to do to support the survivor2 and they struggle
with how to help.
%&'! pply )*'! +> -B.! %iscuss the effects that cancer has on the fa#ily.
T-/! &#ple#entation 0SC! Nursing /rocess
D. The nurse is caring for a patient who is undergoing che#otherapy and radiation for cancer.
The patient says that he can5t wait until the therapy is done so that he can feel stronger2 and
as4s the nurse about the value of cancer screening when his course of therapy is over. The
nurse should infor# the patient that cancer screening
a
.
Should be done on an ongoing schedule.
b
.
/robably will not be needed because the patient has been cured.
c
.
6sually is not done even if reco##ended by the health care provider.
d
.
&s not so#ething that the health care provider should reco##end.
NS! B
Because survivors are at increased ris4 for developing a second cancer andEor chronic illness2
it is i#portant to educate the# about lifestyle behaviors and the i#portance of participating in
ongoing cancer screening and early detection practices. Fifelong cancer screening provides
the opportunity to identify new cancers in early stages. 7hen health care providers
reco##end follow3up screening in cancer survivors2 the li4elihood that the person will
actually undergo the screening test is increased.
%&'! pply )*'! +A
-B.! *8plain the nursing i#plications related to cancer survivorship.
T-/! &#ple#entation 0SC! Nursing /rocess
+. The nurse is caring for a patient diagnosed with cancer. The fa#ily of the patient as4s the
nurse for infor#ation. 7hat should the nurse do@
a
.
)efer fa#ily #e#bers to the physician because it is hisEher role to prescribe.
b
.
&nfor# the# that few options are available.
c
.
Tell the# to ta4e their fa#ily #e#ber to an NC& cancer center.
d
.
-ffer infor#ation about the different resources available.
NS! %
The nurse5s role is to tell patients and fa#ilies about the different resources available so they
can #a4e infor#ed choices. The physician is a resource2 but the nurse can educate as well.
NC&3designated cancer centers offer the #ost co#prehensive and up3to3date clinical care2 but
are only one of #any options. The nurse can refer fa#ily #e#bers to the NC& website2 where
a current list of NC&3designated co#prehensive cancer centers is provided.
%&'! pply )*'! +A
-B.! *8plain the nursing i#plications related to cancer survivorship.
T-/! &#ple#entation 0SC! Nursing /rocess
1,. The nurse is caring for a patient with 4nown coronary artery disease who has recently been
diagnosed with lung cancer. 7hat should the nurse do@
a
.
'ocus her assess#ent on the cancer diagnosis because it is the newer diagnosis.
b
.
s4 =uestions about cardiac sy#pto#s and their relationship to the cancer.
c
.
&gnore sy#pto# #anage#ent and focus on palliative care.
d
.
Say nothing because cancer survivors disli4e prying.
NS! B
The nurse needs to consider not only the effects of cancer and its treat#ent2 but how it will
affect any other #edical condition. 'or e8a#ple2 if a patient also has heart disease2 how will
the fatigue related to che#otherapy affect this individual@ &f cancer is secondary2 the nurse
does not want i#portant sy#pto#s to go unrecogni?ed. Given the sy#pto#s that a patient
identifies2 the nurse will e8plore each one to gain a co#plete picture of the patient5s health
status. /atients will appreciate the nurse5s sensitivity and interest in their well3being.
%&'! pply )*'! +>3+5
-B.! *8plain the nursing i#plications related to cancer survivorship.
T-/! &#ple#entation 0SC! Nursing /rocess
11. The patient has lung cancer and voices concerns about his cancer treat#ent. He wants to 4now
how che#otherapy will affect his se8uality. 7hat is the nurse5s best reply@
a
.
"Che#otherapy will wor4 in the lungs and should have no effect on your
se8uality.$
b
.
"That is so#ething that you should as4 your doctor. He can direct you.$
c
.
"Se8ual changes are co##on with cancer therapy. Fet #e get so#eone who can
answer your =uestions.$
d
.
"How cancer treat#ent affects se8uality depends on how active you are and your
age.$
NS! C
Cancer therapies have the potential to cause fatigue2 apathy2 nausea2 vo#iting2 #alaise2 and
sleep disturbances2 all of which interfere with a patient5s libido. &t helps if the nurse can
develop a co#fort level in ac4nowledging with patients that se8ual changes are co##on at
any age level. 7hen patients begin to discuss their se8ual proble#s2 4now the e8pert
resources in your institution ;e.g.2 psychologist2 social wor4er< who are available for patient
referral. The issue should not be pushed onto the physician. /atients appreciate the nurse5s
sensitivity and interest in their well3being.
%&'! pply )*'! +5
-B.! *8plain the nursing i#plications related to cancer survivorship.
T-/! &#ple#entation 0SC! Nursing /rocess
11. The nurse is caring for a patient who has successfully undergone cancer therapy and will be
discharged ho#e soon. The patient is concerned about going ho#e and not 4nowing what to
do. The nurse reassures the patient2 telling hi# that
a
.
She alone will develop a plan of care that will tell e8actly what needs to be done.
b
.
&f he has any issues2 he can call his doctor and the doctor will 4now what to do.
c
.
He has received the proper cancer treat#ent2 and he will need nothing else.
d
.
He will be part of a tea# that will provide any support and care that he #ay need.
NS! %
strong #ultidisciplinary approach that includes the patient2 nurses2 oncology specialists2
dietitians2 social wor4ers2 pastoral care2 and rehabilitation professionals is necessary to
provide support for the patient. Together2 the tea# will provide a plan of care that addresses
treat#ent3related proble#s and future health ris4s and offers a wellness focus to give patients
a sense of hope as they enter their survivor e8perience.
%&'! pply )*'! +C
-B.! %iscuss the essential co#ponents of survivorship care. T-/! &#ple#entation
0SC! Nursing /rocess
13. Nurses and other health care providers need to beco#e #ore vigilant in recogni?ing cancer
survivors and atte#pting to lin4 the# with the support and resources that they re=uire because
a
.
ll health care agencies provide survivorship care plans.
b
.
Survivorship care plans are reviewed with the patient after the patient goes ho#e.
c
.
0any survivors are discharged with no survivor plan.
d
.
The plan does not deal with future cancer care.
NS! C
*ven though &nternet guidelines for care plans are available2 #any survivors do not receive
care at NC&3designated cancer centers and are discharged with no survivor plan. Thus nurses
and other health care providers need to beco#e #ore vigilant in recogni?ing cancer survivors
and atte#pting to lin4 the# with the support and resources they re=uire. Survivor plans are
not always developed2 and health insurance co#panies do not routinely cover this type of
care. &deally2 the nurse reviews a survivorship care plan with a patient at the ti#e of discharge
fro# a treat#ent progra#. The plan beco#es a guide for any future cancer or cancer3related
care.
%&'! 6nderstand )*'! +C
-B.! %iscuss the essential co#ponents of survivorship care. T-/! *valuation
0SC! Nursing /rocess
MULTIPLE ESPO!SE
1. 7hich of the following are factors that help ease the psychological stress associated with
having cancer@ (Select all that apply.)
a
.
Hiewing cancer as a challenge
b
.
'e#ale gender
c
.
6sing proble#3oriented coping processes
d
.
Social support syste#
e
.
Being younger
NS! 2 C2 %
'actors have been identified that help ease the psychological stress associated with having
cancer. survivor who sees cancer as a challenging e8perience and a controllable threat will
have less stress. /atients who use proble#3oriented2 active2 and e#otionally e8pressive coping
processes also #anage stress well. Survivors who have social and e#otional support syste#s
and #aintain open co##unication with their treat#ent providers will also li4ely have less
psychological distress. Being fe#ale2 younger2 or less educated2 and having a lower inco#e
and less social and e#otional support increases the ris4 for post3trau#atic stress disorder
;/TS%<.
%&'! naly?e )*'! +3
-B.! %escribe the influence of cancer survivorship on the patient5s =uality of life.
T-/! *valuation 0SC! Nursing /rocess
1. The &nstitute of 0edicine ;&-0< has #ade reco##endations for four essential co#ponents of
survivorship care. 7hich of the following are actual reco##endations@ (Select all that apply.)
a
.
/revention and detection of new and recurrent cancers
b
.
Surveillance for cancer spread2 recurrence2 or second cancers
c
.
Cessation of noncancer follow3up and care
d
.
&ntervention for conse=uences of cancer and its treat#ent
e
.
Coordination between specialists and pri#ary care providers
NS! 2 B2 %2 *
The &nstitute of 0edicine ;&-0< has #ade reco##endations for four essential co#ponents of
survivorship care! ;1< prevention and detection of new cancers and recurrent cancerB ;1<
surveillance for cancer spread2 recurrence2 or second cancersB ;3< intervention for
conse=uences of cancer and its treat#ent ;e.g.2 #edical proble#s2 sy#pto#s2 psychological
distress<B and ;>< coordination between specialists and pri#ary care providers.
%&'! (nowledge )*'! +C
-B.! %iscuss the essential co#ponents of survivorship care. T-/! ssess#ent
0SC! Nursing /rocess