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Potter & Perry: Fundamentals of Nursing, 7th Edition

Test Bank
Chapter 7: Caring for the Cancer Survivor
MULTIPLE CHOICE
1. The nurse recognizes that the client symptomatology typical of the acute cancer survival
phase includes:
1. Fear and anxiety
2. Despair and anger
3. Lethargy and alopecia
4. Dyspnea and tachycardia
ANS: 1
The acute survival phase starts with the diagnosis of cancer. Diagnostic and therapeutic
efforts dominate. Fear and anxiety are constant elements of this phase.
Despair and anger are more representative of the stages of grief and loss according to
Kbler-Ross.
Extended survival is the period during which a client has ended the basic, rigorous course
of treatment and is dealing with the physical side effects of the treatment, such as
lethargy and alopecia.
Dyspnea and tachycardia may represent a clients unique individualized symptomatology
but they are not recognized as general signs of the acute phase.
DIF: A
REF: 85
OBJ: Comprehension
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Physiological Adaptation/Illness Management
2. Since being treated for leukemia in her early twenties, a client has experienced bilateral
mastectomies and has been diagnosed with osteoporosis and hypothyroidism. This health
history best reflects the lifelong impact of:
1. Cancer on a clients health and wellness
2. Cancer treatments on future health status
3. Specific cancers on the health status of survivors
4. Genetic susceptibility on the reoccurrence of cancer
ANS: 2
The impact of cancer treatment on future health status is the correct response. The
increased risk for developing a second cancer is due to cancer treatment, genetic or other
susceptibility, or an interaction between treatment and susceptibility. The risk for
treatment related problems is associated with the complexity of the cancer itself (e.g.,
type of tumor and stage of disease); the type, variety, and intensity of treatments used;
and the age and underlying health status of the client.
While cancer itself affects the clients immediate health and wellness status, it is
secondary to the long-term effects of the cancer treatments used.
Although some health effects are related to specific forms of cancer, this is not the best
option available because it is much less likely to be the cause of lifelong health issues.
Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

7-2

While genetic predisposition is a factor in cancer development it is not the most likely
factor affecting lifelong health issues for the cancer survivor.
DIF: C
REF: 86
OBJ: Analysis
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Physiological Adaptation/Illness Management
3. In the geriatric population, the primary reason cancer is diagnosed in its later stage is:
1. Health care benefit coverage is often inadequate
2. Symptoms are often masked by the effects of aging
3. Clients are reluctant to seek help for the early symptoms
4. Symptoms are often attributed to the aging process
ANS: 4
Most cancer survivors (61%) are over the age of 65 (IOM, 2006). Often health care
providers wrongly attribute the symptoms of cancer or the symptoms from the side
effects of treatment to aging. This often leads to late diagnosis or a failure to provide
aggressive and effective treatment of symptoms.
While the geriatric population may have a problem with adequate health care coverage, it
is not the primary cause of delayed cancer diagnosis in that population.
While symptoms may be masked by the effects of aging, it is not the primary cause of
delayed cancer diagnosis in this population.
While symptoms can be attributed to the aging process for individual geriatric clients, it
is not the primary cause of delayed cancer diagnosis in this population.
DIF: C
REF: 86
OBJ: Comprehension
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Physiological Adaptation/Illness Management
4. Which of the following clients is most likely to experience cancer treatment-related
problems in the future?
1. A 73-year-old client with heart problems
2. An otherwise healthy 6-year-old child
3. A 25-year-old professional tennis player
4. A 39-year-old with a history of depression
ANS: 2
The risk for treatment-related problems is associated with the complexity of the cancer
itself (e.g., type of tumor and stage of disease); the type, variety, and intensity of
treatments used; and the age and underlying health status of the client. The 6-year-old
child is at greatest risk because the primary cancer occurred at such a young age and
during a critical physiological developmental stage.
Because the pivotal factors for cancer treatment-related problems are age and
development, the 73-year-old with heart problems does not present the greatest risk.
Because the pivotal factors for cancer treatment related problems are age and
development, 25-year-old professional tennis players chronic health issues do not
present the greatest risk.

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

7-3

While depression may have a negative health effect, a 39-year-old with a history of
depression does not present the greatest risk for cancer treatment related problems since
the pivotal factors are age and developmental stage.
DIF: C
REF: 86-87
OBJ: Analysis
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Physiological Adaptation/Illness Management
5. Eleven months after being treated for breast cancer, a client reports difficulty sleeping
and the associated fatigue while denying any other signs/symptoms. The nurse recognizes
that the client may be experiencing:
1. Situational depression
2. Normal remission symptoms
3. Post-traumatic stress disorder
4. Delayed effects of chemotherapy drugs
ANS: 1
Survivors feelings of distress range along a continuum from sadness to disabling
depression (Vachon, 2006). The long-term presence of fatigue and sleep disturbances, for
example, is often associated with anxiety and depression in many cancer survivors
(Barton-Burke, 2006).
Sleep disorders and fatigue would not necessarily be expected at this point in the
remission stage.
Posttraumatic stress disorder (PTSD) is a psychiatric disorder characterized by an acute
emotional response to a traumatic event or situation. Cancer survivors experience
symptoms of PTSD (e.g., grief, nightmares, panic attacks, or fear) at a rate of 4% to 19%,
as a result of their diagnosis, treatment, or a past traumatic episode.
While chemotherapy drugs can produce side effects, sleep disorders are not a typical
complaint.
DIF: C
REF: 88
OBJ: Analysis
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Physiological Adaptation/Illness Management
6. A client, who recently completed treatment for cancer, shares with the nurse that she is,
a little depressed, but I guess I will be OK. The foremost reason the nurse encourages
the client to discuss this situation with her primary health care provider is that the nurse
realizes that:
1. The depression will not improve by itself
2. The medications can help resolve the depression
3. Depression can decrease the clients chances of recovery
4. The depression is a result of concerns about the cancer reoccurring
ANS: 3

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

7-4

Research has associated depression with decreased cancer survivorship. A study


conducted by Brown and colleagues (2003) suggested that a cancer diagnosis and its
effects predispose people to distress, which if maintained over time will enhance disease
progression.
While depression may not improve by itself, it is not the primary reason for the nurse to
encourage the client in cancer remission to seek medical advice. Chronic depression can
adversely affect the chances of long-term survivorship.
While medications can help resolve depression, it is not the primary reason for the nurse
to encourage the client in cancer remission to seek medical advice. Chronic depression
can adversely affect the chances of long-term survivorship.
While may be a result of concerns about the cancer reoccurring, it is not the primary
reason for the nurse to encourage the client in cancer remission to seek medical advice.
Chronic depression can adversely affect the chances of long-term survivorship.
DIF: C
REF: 87
OBJ: Analysis
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Physiological Adaptation/Illness Management
7. The nurse knows that the primary factor affecting a cancer survivors quality of life is:
1. The clients precancer physical and mental health status
2. The presence of a strong support system
3. The quality and type of cancer treatment received
4. The type and number of cancer-related risk factors the client possesses
ANS: 2
Mellon and colleagues (2006) interviewed cancer survivors and their family caregivers,
finding that two of the strongest predictors for cancer survivors quality of life
(enjoyment of life) were family stressors and social support.
Precancer physical and mental health status may affect the survivors physical recovery
regarding the treatment but not their quality of life (enjoyment of life).
The quality and type of cancer treatment received may affect the survivors chances of
survival but not their quality of life (enjoyment of life).
The type and number of cancer-related risk factors the client possesses may affect the
survivors chances of survival but not their quality of life (enjoyment of life).
DIF: C
REF: 85-86
OBJ: Analysis
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Physiological Adaptation/Illness Management
8. A client, who is a 7-year breast cancer survivor, tells the nurse, My husband will help
me bathe when he gets here. The nurse interprets this statement to mean that the client:
1. Is reluctant to have the staff see her chest scar
2. Prefers to protect her modesty and privacy
3. Has a healthy self-image regarding her husband
4. Is not comfortable with the care she is receiving
ANS: 3

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

7-5

Self-image and intimacy may be negatively affected after cancer surgery. It is a positive
sign that the client is comfortable having her husband perform this task for her.
Although the client may be reluctant to have staff see her chest scar, the clients history of
cancer surgery should direct you to the more related option.
While the client may prefer to protect her modesty and privacy, the clients history of
cancer surgery should direct you to the more related option.
Although the client may not be comfortable with the care she is receiving, it is not as
likely as the other options and the clients history of cancer surgery should direct you to
the more related option.
DIF: C
REF: 88
OBJ: Analysis
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Physiological Adaptation/Illness Management
9. The nurse understands the primary focus of education for a client who has just received a
diagnosis of cancer is to:
1. Introduce self-care measures to support health
2. Discuss the management of treatment-related side effects
3. Reinforce the explanation of the risks of proposed treatments
4. Formulate long-term lifestyle changes to minimize risk factors
ANS: 3
When caring for clients with an initial diagnosis of cancer, the immediate focus of client
education should be the reinforcement of their health care providers explanations of the
risks related to their cancer as well as the benefits and risks related to the proposed
treatment options. This should then be followed by instructions on what they need to selfmonitor (i.e., appetite and weight, effects of fatigue and sleeplessness), and what to
discuss with health care providers in the future. Potential for treatment effects; such as
pain, neuropathy, or cognitive change; also should be addressed since clients are more
likely to report their symptoms if they are educated on their likelihood. Survivors need to
learn how to manage problems related to persistent symptoms. Because survivors are at
an increased risk for developing a second cancer and/or chronic illness, it is important to
educate them about lifestyle behaviors that will improve the quality of their life.
While introducing self-care measures to support health is an appropriate topic for client
education, it should be addressed after the client is informed of the risks related to their
cancer as well as the benefits and risks related to the proposed treatment options.
Although discussing the management of treatment-related side effects is an appropriate
topic for client education, it should be addressed after the client is informed of the risks
related to their cancer as well as the benefits and risks related to the proposed treatment
options.
While formulating long-term lifestyle changes to minimize risk factors is an appropriate
topic for client education, it should be addressed after the client is informed of the risks
related to the cancer as well as the benefits and risks related to the proposed treatment
options.
DIF: C
REF: 91
TOP: Nursing Process: Assessment

OBJ: Analysis

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

7-6

MSC: NCLEX test plan designation: Safe, Effective Care Environment


10. Which of the following assessment data best confirms the possibility of cognitive
impairment in a client with a diagnosis of lung cancer?
1. Client is observed writing questions to ask his oncologist.
2. Client states, I seem to be a little more forgetful lately.
3. Clients wife states, I have to remind him of everything.
4. Client overheard asking son, Where did I put my glasses?
ANS: 2
Cognitive changes are a set of physical symptoms very common in survivors that develop
from their disease, treatment, the complications of treatment, underlying medical
conditions, and psychological responses to the diagnosis of cancer (Nail, 2006).
Cognitive changes can occur during all phases of the cancer experience, from small
deficits in information processing to acute delirium. Often the cognitive impairments
survivors experience are not evident to someone else but are apparent to the person
experiencing them, especially in relation to work performance with high cognitive
demands (Anderson-Hanley and others, 2003). The clients personal evaluation of his
memory is the best indicator of cognitive impairment.
While writing down questions to ask the oncologist may be motivated by poor memory, it
is not uncommon for clients to prepare a list of questions before a meeting with their
health care provider.
Although the clients spouse reminding the client of things may indicate impaired
cognitive ability, it is not as strong an indicator as a statement from the client.
Although not being able to locate an item may indicate impaired memory, it is not
uncommon for individuals to misplace personal items.
DIF: C
REF: 86-87
OBJ: Analysis
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Physiological Adaptation/Illness Management
11. Which of the following cancer survivors is at greatest risk for post-treatment symptoms
and poor treatment outcomes?
1. An Asian dishwasher
2. A Hispanic truck driver
3. A Caucasian factory worker
4. An African-American carpenter
ANS: 1
There is evidence to suggest that survivors among racial and ethnic minorities and other
underserved populations have more post-treatment symptoms and poorer treatment
outcomes than Caucasians (CDC, 2004). The disparities in health among ethnic groups
are related to a complex interplay of economic, social, and cultural factors, with poverty
being a key factor. The Asian dishwasher is both a member of a racial minority and likely
the poorest paid of the survivors.
While being a member of an ethnic group is a risk factor, a Hispanic truck driver is not
likely to be the poorest of the survivors.

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

7-7

The Caucasian factory worker has the least risk because he is not a member of an ethnic
or racial minority nor is there a likelihood of him being the poorest of the survivors.
While being a member of a racial minority is a risk factor, an African-American carpenter
is not likely to be the poorest of the survivors.
DIF: C
REF: 85
OBJ: Analysis
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Physiological Adaptation/Illness Management
12. When assessing cancer survivors regarding the stressors of cancer, the nurse should first
ask clients:
1. If they feel they are stressed by the cancer
2. How they believe cancer has affected their life
3. What they are doing to cope with the stress of having experienced cancer
4. What assistance they need to successfully manage the stressors of dealing with
cancer
ANS: 2
As a nurse, learn to assess the many ways in which cancer affects the lives of clients who
are survivors. It is through their perception of how cancer impacts their lives, that
therapeutic nursing interventions can be implemented.
Clients may not be comfortable identifying themselves as being stressed. An open-ended
question regarding the effects of cancer on the clients life is likely to be more
informative.
Asking a client what they are doing to cope with stress assumes the client is experiencing
stress, and it may be uncomfortable for the client to answer. An open-ended question
regarding the effects of cancer on the clients life is likely to be more informative.
Asking a client about assistance needed to manage stress assumes the client is
experiencing stress, and it may be uncomfortable for the client to answer. An open-ended
question regarding the effects of cancer on the clients life is likely to be more
informative.
DIF: C
REF: 91
OBJ: Analysis
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Physiological Adaptation/Illness Management
13. A 78-year-old woman presents at the emergency department with complaints of shortness
of breath. She has a history of radiation therapy for a lung mass 7 years ago. When the
client asks the nurse if it could be cancer again, the most therapeutic response would be:
1. At your age, shortness of breath could be a result of any number of things.
2. That is a possibility but it could also be a result of your radiation therapy.
3. What makes you think that? Shortness of breath can have many different causes.
4. I wouldnt jump to that conclusion. Lets just see what your health care provider
thinks.
ANS: 2

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

7-8

Cancer survivors are at increased risk for cancer (either a recurrence of the cancer for
which they were treated or a second cancer) and for a wide range of treatment-related
problems (IOM, 2006).
While shortness of breath could be caused by many things, it does not address the clients
concern regarding reoccurring cancer.
While shortness of breath could be caused by many things, it does not address the clients
concern regarding reoccurring cancer.
Telling the client not to jump to conclusions minimizes the clients concern.
DIF: C
REF: 86
OBJ: Analysis
TOP: Nursing Process: Implementation
MSC: NCLEX test plan designation: Physiological Adaptation/Illness Management

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.