Title: Exam 3
Course: NUR 1210C Adult Health

Q: The client tells the nurse that even though it has been 4 months since her sister’s death, she frequently finds herself crying uncontrollably. The client is afraid that she is “losing her mind.” What is the nurse’s best response?
- “Most people move on within a few months. You should see a grief counselor.”
- “Whenever you start to cry, distract yourself from thoughts of your sister.”
- “You should try not to cry. I’m sure your sister is in a better place now.”
- “Your feelings are completely normal and may continue for a long time.”
A: “Your feelings are completely normal and may continue for a long time.”
If right: Frequent crying is not an abnormal response. The nurse should let the client know that this is normal and okay. Although the client may benefit from talking with a grief counselor, it is not unusual for her to still be grieving after a few months. The other responses are not as therapeutic because they justify or minimize the client’s response.
If wrong: Frequent crying is not an abnormal response. The nurse should let the client know that this is normal and okay. Although the client may benefit from talking with a grief counselor, it is not unusual for her to still be grieving after a few months. The other responses are not as therapeutic because they justify or minimize the client’s response.

Q: The nurse is discussing advance directives with a client. Which statement by the client indicates good understanding of the purpose of an advance directive?
- “An advance directive will keep my children from selling my home when I’m old.”
- “An advance directive will be completed as soon as I’m incapacitated and can’t think for myself.”
- “An advance directive will specify what I want done when I can no longer make decisions about health care.”
- “An advance directive will allow me to keep my money out of the reach of my family.”
A: “An advance directive will specify what I want done when I can no longer make decisions about health care.”
If right: An advance directive is a written document prepared by a competent individual that specifies what, if any, extraordinary actions a person would want taken when he or she can no longer make decisions about personal health care. It does not address issues such as the client’s residence in his or her own home.
If wrong: An advance directive is a written document prepared by a competent individual that specifies what, if any, extraordinary actions a person would want taken when he or she can no longer make decisions about personal health care. It does not address issues such as the client’s residence in his or her own home.

Q: The nurse is caring for a client who is considering being admitted to hospice. What is the nurse’s best response?
- “Hospice admission has specific criteria. You may not be a viable candidate, so we will look at alternative plans for your discharge.”
- “Hospice care focuses on a holistic approach to health care. It is designed not to hasten death, but rather to relieve symptoms.”
- “Hospice care will not help with your symptoms of depression. I will refer you to the facility’s counseling services instead.”
- “You seem to be experiencing some difficulty with this stage of the grieving process. Let’s talk about your feelings.”
A: “Hospice care focuses on a holistic approach to health care. It is designed not to hasten death, but rather to relieve symptoms.”
If right: As both a philosophy and a system of care, hospice care uses an interdisciplinary approach to assess and address the holistic needs of clients and families to facilitate quality of life and a peaceful death. This holistic approach neither hastens nor postpones death but provides relief of symptoms experienced by the dying client.
If wrong: As both a philosophy and a system of care, hospice care uses an interdisciplinary approach to assess and address the holistic needs of clients and families to facilitate quality of life and a peaceful death. This holistic approach neither hastens nor postpones death but provides relief of symptoms experienced by the dying client.

Q: A hospitalized American Indian client is approaching death. Family members who are standing vigil in the client’s room begin to divide up his possessions among themselves as his symptoms progress. What is the nurse’s most important intervention?
- Ask the family members to step outside the room so the client cannot hear them.
- Tell the family that they are being insensitive and their behavior is inappropriate.
- Recognize that this is a culturally appropriate activity and document it in the chart.
- Report these activities to the client’s physician and the nursing supervisor.
A: Recognize that this is a culturally appropriate activity and document it in the chart.
If right: American Indians often disperse material possessions before or after death to friends and family members. Recognizing this culturally appropriate activity would not be consistent with removing the family, stopping the activity, or reporting the client’s family’s behaviors.
If wrong: American Indians often disperse material possessions before or after death to friends and family members. Recognizing this culturally appropriate activity would not be consistent with removing the family, stopping the activity, or reporting the client’s family’s behaviors.

Q: The spouse of a dying client states that she is concerned that her husband is choking to death. What is the nurse’s best response?
- “Do not worry. The choking sound is normal during the dying process.”
- “I will administer more morphine to keep your husband comfortable.”
- “I can ask the respiratory therapist to suction secretions out through his nose.”
- “I will have another nurse assist me to turn your husband on his side.”
A: “I will have another nurse assist me to turn your husband on his side.”
If right: The choking sound or “death rattle” is common in dying clients. The nurse should acknowledge the spouse’s concerns and provide interventions that will reduce the choking sounds. Repositioning the client onto one side with a towel under the mouth to collect secretions is the best intervention. Morphine will assist with comfort but will not decrease the choking sounds. Nasal tracheal suctioning is not appropriate in a dying client. The nurse should not minimize the spouse’s concerns.
If wrong: The choking sound or “death rattle” is common in dying clients. The nurse should acknowledge the spouse’s concerns and provide interventions that will reduce the choking sounds. Repositioning the client onto one side with a towel under the mouth to collect secretions is the best intervention. Morphine will assist with comfort but will not decrease the choking sounds. Nasal tracheal suctioning is not appropriate in a dying client. The nurse should not minimize the spouse’s concerns.

Q: The terminally ill client is prescribed morphine to help cope with increasing discomfort. A family member expresses concern that the client is on “too much morphine.” What is the nurse’s best response?
- “What has the physician told you about your family member’s illness?”
- “Don’t worry about that. We’re following the physician’s plan of care.”
- “Tell me more about what you mean by too much morphine.”
- “You should talk with your physician about this when he makes rounds.”
A: “Tell me more about what you mean by too much morphine.”
If right: Asking family members to explain what they mean by “too much morphine” serves to gain more information for the nurse. The other questions will not help the nurse obtain more information about the client’s care or the family’s concerns.
If wrong: Asking family members to explain what they mean by “too much morphine” serves to gain more information for the nurse. The other questions will not help the nurse obtain more information about the client’s care or the family’s concerns.

Q: The nurse is teaching a family member about various types of complementary therapies that might be effective for relieving the dying client’s anxiety and restlessness. Which statement by the family member indicates understanding of the nurse’s teaching?
- “Maybe we should just hire a round-the-clock sitter to stay with Grandmother.”
- “I have some of her favorite hymns on a CD that I could bring for music therapy.”
- “I don’t think that she’ll need pain medication along with her herbal treatments.”
- “I will burn therapeutic incense in the room so we can stop the anxiety pills.”
A: “I have some of her favorite hymns on a CD that I could bring for music therapy.”
If right: Music therapy is a complementary therapy that may produce relaxation by quieting the mind and removing a client’s inner restlessness. Complementary therapies are used in conjunction with traditional therapy. The complementary therapy would not replace pain or anxiety medication but may help decrease the need for these medications. Hiring an around-the-clock sitter does not demonstrate that the client’s family understands complementary therapies.
If wrong: Music therapy is a complementary therapy that may produce relaxation by quieting the mind and removing a client’s inner restlessness. Complementary therapies are used in conjunction with traditional therapy. The complementary therapy would not replace pain or anxiety medication but may help decrease the need for these medications. Hiring an around-the-clock sitter does not demonstrate that the client’s family understands complementary therapies.

Q: A terminally ill client has just died in a hospital setting with family members at the bedside. The health care provider is also present. What should be the nurse’s priority intervention as postmortem care begins?
- Call for emergency assistance so that resuscitation procedures can begin.
- Ask the family members if they would like to spend time alone with the client.
- Ensure that a death certificate has been completed by the physician.
- Request family members to prepare the client’s body for the funeral home.
A: Ask the family members if they would like to spend time alone with the client.
If right: Before moving the client’s body to the funeral home, the nurse should ask family members if they would like to be alone with the client. Emergency assistance will not be necessary. Although it is important to ensure that a death certificate has been completed before the client is moved to the mortuary, the nurse first should ask family members if they would like to be alone with the client. The client’s family should not be expected to prepare the body for the funeral home.
If wrong: Before moving the client’s body to the funeral home, the nurse should ask family members if they would like to be alone with the client. Emergency assistance will not be necessary. Although it is important to ensure that a death certificate has been completed before the client is moved to the mortuary, the nurse first should ask family members if they would like to be alone with the client. The client’s family should not be expected to prepare the body for the funeral home.

Q: The nurse is providing care for a hospice client who is in the last stages of the dying process. The client develops a pressure ulcer on her sacrum, and family members tell the nurse that they would like a specialist consulted to treat the ulcer. When the nurse discusses this with the client, the client states that the ulcer does not bother her, that it is not causing her pain, and that she’d rather not have additional caregivers at this time. What should the hospice nurse do next?
- Tell the family the wound care specialist will be consulted and treatment will begin.
- Ask the social worker and the chaplain to talk with family members about the dying process.
- Explain the client’s desires to the family, emphasizing that the client will be made as comfortable as possible.
- Ask the agency mental health nurse to speak with the client about refusing treatment.
A: Explain the client’s desires to the family, emphasizing that the client will be made as comfortable as possible.
If right: When palliative care is provided to the dying client, symptoms will be actively treated only if they are causing the client distress. In this case, the client has stated that the pressure ulcer is not causing her distress, and she does not want further intervention.
If wrong: When palliative care is provided to the dying client, symptoms will be actively treated only if they are causing the client distress. In this case, the client has stated that the pressure ulcer is not causing her distress, and she does not want further intervention.

Q: The nurse is being trained in hospice care. Which intervention by the nurse is most compatible with the goals of end-of-life care for the client?
- Administer influenza and pneumococcal vaccinations.
- Prevent the client with chronic obstructive pulmonary disease from smoking.
- Perform passive range-of-motion exercises to prevent contractures.
- Permit the client with diabetes mellitus to have a serving of ice cream.
A: Permit the client with diabetes mellitus to have a serving of ice cream.
If right: When a client is near the end of life, nursing interventions should be focused toward facilitating peaceful death by granting the client’s wishes and identifying his or her needs. Allowing a client who wishes to have something that is not permitted in the diet can be comforting if he or she has a craving or a desire for that food. There is no reason to withhold it at this time.
If wrong: When a client is near the end of life, nursing interventions should be focused toward facilitating peaceful death by granting the client’s wishes and identifying his or her needs. Allowing a client who wishes to have something that is not permitted in the diet can be comforting if he or she has a craving or a desire for that food. There is no reason to withhold it at this time.

Q: The nurse is assessing the dying client. Which manifestations of a dying client should the nurse assess to determine whether the client is near death?
- Level of consciousness
- Respiratory rate
- Bowel sounds
- Pain level on a 0 to 10 scale
A: Respiratory rate
If right: All of these assessments should be performed during the dying process. As the peripheral circulation decreases, the client’s level of consciousness and bowel sounds decrease. The client is unable to provide a numeric number on a pain scale. The nurse should continue to assess respiratory rate throughout the dying process. As the rate drops significantly and breathing becomes agonal, death is near.
If wrong: All of these assessments should be performed during the dying process. As the peripheral circulation decreases, the client’s level of consciousness and bowel sounds decrease. The client is unable to provide a numeric number on a pain scale. The nurse should continue to assess respiratory rate throughout the dying process. As the rate drops significantly and breathing becomes agonal, death is near.

Q: The wife is concerned because her terminally ill husband does not want to eat. What is the nurse’s best response?
- “Let him know that food is available if he wants it, but do not insist that he eat.”
- “A feeding tube can be placed in the nose to provide important nutrients.”
- “Force him to eat even if he does not feel hungry, or he will die sooner.”
- “He is getting all the nutrients he needs through his intravenous catheter.”
A: “Let him know that food is available if he wants it, but do not insist that he eat.”
If right: When family members understand that the client is not suffering from hunger and is not “starving to death,” they may allow the client to determine when, what, or if to eat. Often, as death approaches, metabolic needs decrease and clients do not feel the sensation of hunger. Forcing them to eat frustrates the client and the family.
If wrong: When family members understand that the client is not suffering from hunger and is not “starving to death,” they may allow the client to determine when, what, or if to eat. Often, as death approaches, metabolic needs decrease and clients do not feel the sensation of hunger. Forcing them to eat frustrates the client and the family.

Q: The family members of a client with a terminal illness tell a nurse that the client keeps asking if she is dying. What is the nurse’s best response?
- “Whenever she asks about dying, change the subject.”
- “Tell her the truth in as gentle a way as possible.”
- “Tell her that she will get better eventually.”
- “Ask her if she is afraid to die.”
A: “Tell her the truth in as gentle a way as possible.”
If right: Being honest and truthful at such a time is important. It helps the client develop trust in those caring for her. Changing the subject will frustrate the client and may make her distrustful. Providing false hope is not a realistic intervention. Asking a pointed question often will not elicit the information that you want from the client. It is better to ask open-ended questions.
If wrong: Being honest and truthful at such a time is important. It helps the client develop trust in those caring for her. Changing the subject will frustrate the client and may make her distrustful. Providing false hope is not a realistic intervention. Asking a pointed question often will not elicit the information that you want from the client. It is better to ask open-ended questions.

Q: The client’s family members are concerned that the client should have a urinary catheter placed because of her decreasing urinary output. What is the hospice nurse’s best response?
- “A Foley catheter is inserted only if she is taking medications that affect output.”
- “I will insert a Foley catheter if her urinary output drops below 500 mL/day.”
- “A Foley catheter will be inserted if her bladder becomes distended.”
- “I will insert a Foley catheter if she becomes incontinent of urine.”
A: “A Foley catheter will be inserted if her bladder becomes distended.”
If right: Insertion of an indwelling catheter is acceptable if the client is unable to void, has a distended bladder, and would be more comfortable not moving. The other statements are not appropriate uses for an indwelling catheter in a hospice setting.
If wrong: Insertion of an indwelling catheter is acceptable if the client is unable to void, has a distended bladder, and would be more comfortable not moving. The other statements are not appropriate uses for an indwelling catheter in a hospice setting.

Q: The health care provider suggests inpatient hospice for a client. The family members are concerned that their loved one will receive only custodial care. What is the nurse’s best response?
- “The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person enjoy whatever time is left.”
- “Palliative care will release you from the burden of having to care for someone in the home. It does not mean that curative treatment will stop.”
- “A palliative care facility is like a nursing home and costs less than a hospital because only pain medications are given.”
- “Your relative is unaware of her surroundings and will not notice the difference between her home and a palliative care facility.”
A: “The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person enjoy whatever time is left.”
If right: Palliative care provides an increased level of personal care designed to manage symptom distress. The focus is on pain control and helping the relative die with dignity.
If wrong: Palliative care provides an increased level of personal care designed to manage symptom distress. The focus is on pain control and helping the relative die with dignity.

Q: A dying client’s family members are spending time with the client. What instruction is best to give to family members regarding noise in the client’s room?
- “Remember that she cannot hear you.”
- “Try to get her to talk or respond to you.”
- “Avoid making any noise when you are with her.”
- “Talk in your normal speaking voice.”
A: “Talk in your normal speaking voice.”
If right: The sense of hearing may remain intact, even when it appears that the client is totally unresponsive to any sort of stimuli. The family member should speak to the client as if she were fully aware.
If wrong: The sense of hearing may remain intact, even when it appears that the client is totally unresponsive to any sort of stimuli. The family member should speak to the client as if she were fully aware.

Q: A client who is near death appears to be having difficulty breathing. What is the nurse’s highest-priority intervention?
- Teach the family how to perform nasotracheal suctioning.
- Request that the physician order morphine sulfate.
- Document the finding in the client’s chart.
- Call a respiratory therapist to intubate the client.
A: Request that the physician order morphine sulfate.
If right: Morphine sulfate is the standard treatment for dyspnea near death; it relieves the psychological and physiologic distress that accompanies breathlessness. Suctioning or intubation may cause the client discomfort. Documentation is important, but it is not the priority intervention because it does nothing to relieve the client’s distress.
If wrong: Morphine sulfate is the standard treatment for dyspnea near death; it relieves the psychological and physiologic distress that accompanies breathlessness. Suctioning or intubation may cause the client discomfort. Documentation is important, but it is not the priority intervention because it does nothing to relieve the client’s distress.

Q: The nurse is caring for a dying client who becomes very agitated. What is the nurse’s best response?
- Use music therapy to promote relaxation.
- Increase the dose of intravenous opioids.
- Provide a second antipsychotic medication.
- Assess the client for urinary retention.
A: Assess the client for urinary retention.
If right: Dying clients become agitated when they are in pain or have some discomfort. Before administering medications or other therapies to decrease discomfort, the nurse should assess for potential causes of discomfort including urinary retention.
If wrong: Dying clients become agitated when they are in pain or have some discomfort. Before administering medications or other therapies to decrease discomfort, the nurse should assess for potential causes of discomfort including urinary retention.

Q: An experienced hospice nurse is training a new nurse in the practices of palliative care. What statement by the new nurse indicates understanding about drug therapy for end-of-life care?
- “I can administer as much pain medication as I want because the client is dying.”
- “The administration of these medications will hasten the client’s death.”
- “I can administer medication per the protocol to relieve the client’s symptoms.”
- “The purpose of palliative sedation is to relieve family members’ distress.”
A: “I can administer medication per the protocol to relieve the client’s symptoms.”
If right: Palliative care nurses follow protocols when administering medications. These protocols are standing prescriptions from the provider that identify the appropriate medication, dose, and situation for administration. The nurse cannot administer more than is prescribed. The medications are given to promote comfort and if administered per protocol will not hasten death.
If wrong: Palliative care nurses follow protocols when administering medications. These protocols are standing prescriptions from the provider that identify the appropriate medication, dose, and situation for administration. The nurse cannot administer more than is prescribed. The medications are given to promote comfort and if administered per protocol will not hasten death.

Q: An older client was admitted to hospice owing to impending death in approximately 6 weeks. After 2 months, the family remains at the bedside but is becoming increasingly impatient and irritable. What is the best nursing intervention?
- Ask the family to leave and not return until they are calmer.
- Sit with the family and listen to their concerns and fears.
- Tell the family members not to worry, the client will die soon.
- Consult the chaplain to come and pray with the client’s family.
A: Sit with the family and listen to their concerns and fears.
If right: Death cannot be accurately predicted. The nurse should sit with the family and listen to their concerns. The nurse should not provide false hope or reassurance. Family members should remain with the client as long as they would like. The chaplain should be consulted if the family requests.
If wrong: Death cannot be accurately predicted. The nurse should sit with the family and listen to their concerns. The nurse should not provide false hope or reassurance. Family members should remain with the client as long as they would like. The chaplain should be consulted if the family requests.

Q: An intensive care nurse is discussing withdrawal of care with a client’s family. The family expresses concerns related to discontinuation of therapy. What is the nurse’s best response?
- “I understand your concerns, but in this state, discontinuation of care is not a form of active euthanasia.”
- “You will need to talk to the provider because I am not legally allowed to participate in the withdrawal of life support.”
- “I realize this is a difficult decision. Discontinuation of therapy will allow the client to die a natural death.”
- “There is no need to worry. Most religious organizations support the client’s decision to stop medical treatment.”
A: “I realize this is a difficult decision. Discontinuation of therapy will allow the client to die a natural death.”
If right: The nurse should validate the family’s concerns and provide accurate information about the discontinuation of therapy. The other statements address specific issues related to the withdrawal of care but do not provide appropriate information about its purpose. If the client’s family asks for specific information about euthanasia, legal, or religious issues, the nurse should provide unbiased information about these topics.
If wrong: The nurse should validate the family’s concerns and provide accurate information about the discontinuation of therapy. The other statements address specific issues related to the withdrawal of care but do not provide appropriate information about its purpose. If the client’s family asks for specific information about euthanasia, legal, or religious issues, the nurse should provide unbiased information about these topics.

Q: The nurse includes which information about benign tumors when presenting an in-service on cancer?
- They can wander far throughout the body.
- They are smaller than 2 cm.
- They retain a small nuclear-to-cytoplasmic ratio.
- They look different from the tissue they arose from.
A: They retain a small nuclear-to-cytoplasmic ratio.
If right: Benign tumors are made up of normal cells growing in the wrong place or growing when they are not needed. Benign tumors retain the characteristics of normal cells in that they do not migrate in the body, they retain a small nuclear-to-cytoplasmic ratio, and they look similar to the tissue from which they arose. Size is not related to malignancy or to being benign.
If wrong: Benign tumors are made up of normal cells growing in the wrong place or growing when they are not needed. Benign tumors retain the characteristics of normal cells in that they do not migrate in the body, they retain a small nuclear-to-cytoplasmic ratio, and they look similar to the tissue from which they arose. Size is not related to malignancy or to being benign.

Q: In reviewing the pathophysiology of a particular type of cancer, the nurse correlates the generation time for cancer development with which description?
- The rate at which cancer cells are able to migrate and metastasize to different sites
- How long it takes for a malignant tumor to double in size by mitotic cell divisions
- The period of time needed for one cell to divide into two cells by mitosis
- The period of time between cell damage and expression of a malignancy
A: The period of time needed for one cell to divide into two cells by mitosis
If right: Generation time is defined as the period of time necessary for one cell to complete a round of cell division.
If wrong: Generation time is defined as the period of time necessary for one cell to complete a round of cell division.

Q: Which biologic characteristic is specific to normal differentiated adult cells but not to cancer cells?
- Anaplasia
- Hypertrophy
- Aneuploidy
- Loose adherence
A: Hypertrophy
If right: Some normal tissues increase in size by having individual cells get larger, a process called hypertrophy. Cancer cells tend to grow by hyperplasia. The other characteristics are associated with cancer cells.
If wrong: Some normal tissues increase in size by having individual cells get larger, a process called hypertrophy. Cancer cells tend to grow by hyperplasia. The other characteristics are associated with cancer cells.

Q: A client states that his brain tumor is benign and does not need to be removed. What is the nurse’s best response?
- “As your tumor grows, it can damage your brain, so it should be removed.”
- “Benign tumors consist of normal cells, so removal is only for cosmetic purposes.”
- “Benign tumors turn into cancer, so they should be removed as soon as possible.”
- “Because benign tumors can migrate, they should be removed before they spread.”
A: “As your tumor grows, it can damage your brain, so it should be removed.”
If right: Even though benign tumors do not migrate (metastasize) or become cancerous, they can compromise or even destroy surrounding normal tissue. This is particularly a problem when a benign tumor arises in a location that does not expand to accommodate growth, such as in the skull.
If wrong: Even though benign tumors do not migrate (metastasize) or become cancerous, they can compromise or even destroy surrounding normal tissue. This is particularly a problem when a benign tumor arises in a location that does not expand to accommodate growth, such as in the skull.

Q: Which comment made by a client with breast cancer indicates a need for clarification regarding cancer causes and prevention?
- “I will eat a low-fat, high-fiber diet from now on.”
- “Probably nothing I did or didn’t do caused this cancer.”
- “I hope my daughter doesn’t develop breast cancer.”
- “Regular mammograms on my other breast will prevent cancer.”
A: “Regular mammograms on my other breast will prevent cancer.”
If right: Regular mammography can help detect breast cancer at an early stage, but it does not prevent breast cancer. For the most part, the specific cause of many cancers is unknown. Some associations have been noted with dietary habits. High fat, low fiber, high intake of red meat, and eating food with preservatives and other additives all have been suspected to contribute to carcinogenesis. Breast cancer has familial and hereditary forms.
If wrong: Regular mammography can help detect breast cancer at an early stage, but it does not prevent breast cancer. For the most part, the specific cause of many cancers is unknown. Some associations have been noted with dietary habits. High fat, low fiber, high intake of red meat, and eating food with preservatives and other additives all have been suspected to contribute to carcinogenesis. Breast cancer has familial and hereditary forms.

Q: Malignant cell growth is uncontrolled because of which action?
- Cancer cells always divide more rapidly than normal cells.
- Mitosis of malignant cells usually produces more than two daughter cells.
- Malignant cells bypass one or more phases of the cell cycle during cell division.
- Malignant cells enter the cell cycle frequently, making cell division continuous.
A: Malignant cells enter the cell cycle frequently, making cell division continuous.
If right: Malignant cells have bypassed the normal control mechanisms that restrict entry into the cell cycle, so they re-enter the cell cycle as soon as they finish a round of cell division. Thus, cancer cell division is relentless.
If wrong: Malignant cells have bypassed the normal control mechanisms that restrict entry into the cell cycle, so they re-enter the cell cycle as soon as they finish a round of cell division. Thus, cancer cell division is relentless.

Q: A client has known lung cancer and has been admitted for abdominal pain and jaundice. A computed tomography (CT) scan reveals tumors in the client’s liver. The client is distraught and says, “So now I have liver cancer too?” Which response by the nurse is most appropriate?
- “Yes, liver cancer is common in people who already have lung cancer.”
- “Yes, your chemotherapy left you vulnerable to a virus that causes liver cancer.”
- “No, the tumors are actually from your lung cancer, which has metastasized.”
- “No, having tumors in two different organs is rare; you probably have hepatitis.”
A: “No, the tumors are actually from your lung cancer, which has metastasized.”
If right: When a cancer metastasizes to another organ, it is still the same cancer from the original spot. This client has lung cancer that has metastasized to the liver.
If wrong: When a cancer metastasizes to another organ, it is still the same cancer from the original spot. This client has lung cancer that has metastasized to the liver.

Q: An occupational health nurse is working with management in a firm that provides commercial building restoration, including asbestos removal. Which action does the nurse recommend to management?
- Provide annual screening chest x-rays for those exposed to asbestos.
- Purchase protective gear and develop policies mandating its use.
- Offer “stop smoking” programs on site several times a year.
- Routinely distribute testing kits for occult fecal blood.
A: Purchase protective gear and develop policies mandating its use.
If right: Asbestos is a powerful carcinogen. Chronic exposure, even to small amounts of loose asbestos fibers, increases the risk for development of lung cancer. Employees should wear personal protective gear when working with asbestos. Management should provide this gear and should develop policies requiring employees to use it. Stop-smoking programs would not be as beneficial in preventing cancer in this group of people as would limiting asbestos exposure. Routine chest x-rays and fecal occult blood testing will not prevent cancer.
If wrong: Asbestos is a powerful carcinogen. Chronic exposure, even to small amounts of loose asbestos fibers, increases the risk for development of lung cancer. Employees should wear personal protective gear when working with asbestos. Management should provide this gear and should develop policies requiring employees to use it. Stop-smoking programs would not be as beneficial in preventing cancer in this group of people as would limiting asbestos exposure. Routine chest x-rays and fecal occult blood testing will not prevent cancer.

Q: The nurse correlates “initiation” in cancer development with which action?
- Inflicting mutations that lead to excessive cell division
- Increasing the capacity of the transformed cell for error-free DNA repair
- Stimulating contact inhibition in cells damaged by a carcinogen
- Making cancer cells appear more normal to escape immune surveillance
A: Inflicting mutations that lead to excessive cell division
If right: The process of initiation induces changes in the genes that allow proto-oncogenes to be activated to oncogene status and to be expressed.
If wrong: The process of initiation induces changes in the genes that allow proto-oncogenes to be activated to oncogene status and to be expressed.

Q: The middle-aged client with lung cancer asks whether his adult children are at increased risk for this cancer. What is the nurse’s best response?
- “This disease is a random event and there is no way to prevent it.”
- “This disease is inherited, so your children have a 50% risk for developing it.”
- “Smoking is the main cause. Helping your children not smoke decreases their risk.”
- “They can avoid cancer by decreasing the fat they eat and by exercising more.”
A: “Smoking is the main cause. Helping your children not smoke decreases their risk.”
If right: Long-term cigarette smoking is the major risk factor for lung cancer. Not smoking is the best way to prevent it.
If wrong: Long-term cigarette smoking is the major risk factor for lung cancer. Not smoking is the best way to prevent it.

Q: An adult client who has a suspicious mammogram says that her mother died of bone cancer when she was around the same age. Which is the most important question for the nurse to ask this client?
- “Have any other members of your family had bone cancer?”
- “Did your mother ever have any other type of cancer?”
- “How old were you when you started your periods?”
- “Did your mother have regular mammograms?”
A: “Did your mother ever have any other type of cancer?”
If right: Breast cancer often spreads to the bone. Many laypersons do not understand that breast cancer in the bone is still breast cancer. It would be very important to know whether this client’s mother had breast cancer because a genetic component is associated with it. Asking about other family members who have had bone cancer may give the nurse useful information but would not be as important as finding out about other cancers. Menstrual cycle and mammogram information also would not provide as relevant information as inquiring about other types of cancer, specifically breast cancer.
If wrong: Breast cancer often spreads to the bone. Many laypersons do not understand that breast cancer in the bone is still breast cancer. It would be very important to know whether this client’s mother had breast cancer because a genetic component is associated with it. Asking about other family members who have had bone cancer may give the nurse useful information but would not be as important as finding out about other cancers. Menstrual cycle and mammogram information also would not provide as relevant information as inquiring about other types of cancer, specifically breast cancer.

Q: A client with prostate cancer says that he is now having a lot of pain in his lower back and legs. The nurse educates the client about which intervention?
- X-rays of the spine and legs
- Administering ibuprofen (Motrin) for pain
- Referral to the pain control specialist
- Referral to physical therapy
A: X-rays of the spine and legs
If right: The primary site of metastasis for prostate cancer is the bone of the spine and legs. Pain in these areas in a client with prostate cancer is highly suggestive of cancer progression and metastasis. The client needs x-rays to assess for metastasis.
If wrong: The primary site of metastasis for prostate cancer is the bone of the spine and legs. Pain in these areas in a client with prostate cancer is highly suggestive of cancer progression and metastasis. The client needs x-rays to assess for metastasis.

Q: A middle-aged client is having a physical examination and is worried about cancer risk. Which question is most important for the nurse to ask?
- “How much time do you spend in the sun?”
- “How many servings of fruits and vegetables do you eat every day?”
- “How often do you eat processed meats like bologna?”
- “Do you smoke cigarettes or have you ever used tobacco products?”
A: “Do you smoke cigarettes or have you ever used tobacco products?”
If right: Tobacco is related to about 30% of all cancers in North America and is the most important source of preventable carcinogen exposure. The other questions are related to carcinogenesis, but not to the degree that tobacco is.
If wrong: Tobacco is related to about 30% of all cancers in North America and is the most important source of preventable carcinogen exposure. The other questions are related to carcinogenesis, but not to the degree that tobacco is.

Q: The nurse is counseling a client who smokes and drinks heavily about cancer risk. The client is adamant that he or she will never stop smoking. Which question by the nurse is most appropriate?
- “Would you be willing to stop drinking alcohol?”
- “Have you ever tried the nicotine patch?”
- “Why are you so determined to continue smoking?”
- “Do you understand that smoking is the leading cause of cancer?”
A: “Would you be willing to stop drinking alcohol?”
If right: Both tobacco and alcohol are carcinogenic, but their effects are multiplied when ingested together. Because the client is refusing to stop smoking, the nurse could help him or her reduce cancer risk by not drinking. Although it is not as beneficial as avoiding tobacco, this could at least decrease the risk. The client does not want to stop smoking, so asking about the nicotine patch, the reasons behind continued smoking, and knowledge regarding cancer risk might only serve to make the client more resolved to continue the habit or might make the client angry.
If wrong: Both tobacco and alcohol are carcinogenic, but their effects are multiplied when ingested together. Because the client is refusing to stop smoking, the nurse could help him or her reduce cancer risk by not drinking. Although it is not as beneficial as avoiding tobacco, this could at least decrease the risk. The client does not want to stop smoking, so asking about the nicotine patch, the reasons behind continued smoking, and knowledge regarding cancer risk might only serve to make the client more resolved to continue the habit or might make the client angry.

Q: A client’s cancer is staged by the TNM classification as T1, N3, M1. What is the nurse’s interpretation of this classification?
- The client has a large tumor involving the lymph nodes, but no distant metastasis.
- The client has a tumor, and metastasis cannot be determined by the staging method.
- The client has a 2-cm tumor, one involved lymph node, and local metastasis.
- The client has a small tumor, many involved lymph nodes, and distant metastasis.
A: The client has a small tumor, many involved lymph nodes, and distant metastasis.
If right: T = primary tumor. T1 indicates that a primary tumor is detectable but still relatively small. N = regional lymph nodes. N3 indicates that several regional lymph nodes are involved. M = distant metastasis. M1 indicates that distant metastasis is evident in at least one site.
If wrong: T = primary tumor. T1 indicates that a primary tumor is detectable but still relatively small. N = regional lymph nodes. N3 indicates that several regional lymph nodes are involved. M = distant metastasis. M1 indicates that distant metastasis is evident in at least one site.

Q: A client says that she has heard that the origin of most cancers is genetic and wants “genetic testing because of a family history of cancer.” What is the nurse’s best response?
- “I will ask your physician about a referral for genetic testing.”
- “Let’s look at your family history back to your grandparents’ generation.”
- “Genetic testing is so expensive; let’s talk about reducing your risk instead.”
- “Inherited cancers are much more common in males than in females.”
A: “Let’s look at your family history back to your grandparents’ generation.”
If right: Genetic testing for the risk of developing a few specific cancers is available but is expensive. The nurse should first assess the client’s family cancer history by creating a three-generation family tree. If the client actually does have a strong family history of cancers with a genetic component, the nurse can facilitate testing for the client. Teaching the client to reduce risk is always important, but simply telling the client about the expense involved in testing belittles the client’s concerns. Genetically related cancers are not more prevalent in men than in women, and again, this response belittles the client’s concerns.
If wrong: Genetic testing for the risk of developing a few specific cancers is available but is expensive. The nurse should first assess the client’s family cancer history by creating a three-generation family tree. If the client actually does have a strong family history of cancers with a genetic component, the nurse can facilitate testing for the client. Teaching the client to reduce risk is always important, but simply telling the client about the expense involved in testing belittles the client’s concerns. Genetically related cancers are not more prevalent in men than in women, and again, this response belittles the client’s concerns.

Q: In preparing a community teaching program, which information does the nurse plan to present to address secondary cancer prevention?
- Receiving cancer treatment with chemotherapy
- Annual measurement of prostate-specific antigen levels
- Avoiding known cancer-causing substances or conditions
- Having adolescent children receive the Gardasil vaccination
A: Annual measurement of prostate-specific antigen levels
If right: Secondary prevention focuses on screening and early diagnosis. Annual prostate-specific antigen (PSA) levels are a screening tool for prostate cancer. Chemotherapy is tertiary prevention (treatment and rehabilitation). Both avoiding carcinogens and receiving the Gardasil vaccination are primary preventions.
If wrong: Secondary prevention focuses on screening and early diagnosis. Annual prostate-specific antigen (PSA) levels are a screening tool for prostate cancer. Chemotherapy is tertiary prevention (treatment and rehabilitation). Both avoiding carcinogens and receiving the Gardasil vaccination are primary preventions.

Q: The nurse correlates the role of suppressor genes in cancer development with which action?
- The presence of suppressor genes increases risks for gene damage by carcinogens.
- People with a greater number of suppressor genes are at increased risk for getting cancer.
- Suppressor genes enhance immune function, suppressing cancer development.
- Suppressor genes limit cell division, reducing risks for developing cancer.
A: Suppressor genes limit cell division, reducing risks for developing cancer.
If right: Suppressor genes are responsible for ensuring that cell division occurs only when needed. Cancer cells lose this inhibition and re-enter the cell cycle frequently, leading to rapid growth.
If wrong: Suppressor genes are responsible for ensuring that cell division occurs only when needed. Cancer cells lose this inhibition and re-enter the cell cycle frequently, leading to rapid growth.

Q: The nurse most likely would construct a three-generation pedigree for a client who had a relative treated for which cancer?
- Lung cancer
- Prostate cancer
- Cervical cancer
- Bone cancer
A: Prostate cancer
If right: Prostate cancer has a sporadic form and a familial form. If a client has relatives diagnosed with prostate cancer, the nurse should assess for a genetic risk because the risk for this cancer can be inherited. The place to start this assessment is with a family tree.
If wrong: Prostate cancer has a sporadic form and a familial form. If a client has relatives diagnosed with prostate cancer, the nurse should assess for a genetic risk because the risk for this cancer can be inherited. The place to start this assessment is with a family tree.