NCLEX questions Cancer older adult

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NUR 1024: NCLEX Questions for Ost...

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• When planning an educational program on cancer for a

group of older adults, the nurse incorporates information regarding racial and ethnic patterns of cancer in the United States that

includes evidence that:

• the incidence of cancer is highest among African

Americans.

• Native Americans have the highest overall incident

rates of cancer.

• incidence rates for lung cancer are lowest for white

women.

• Hispanic women have the lowest incidence rates of

cervical cancer.

ANS: A

Cancer affects Americans of all racial and ethnic groups; however, the incidence of cancer does demonstrate patterns according to racial and ethnic origins. African Americans have higher overall incidence rates than whites, whereas Hispanic Americans and Native Americans have lower incidence rates overall.DIF: Remembering (Knowledge) REF: Page 297 OBJ: 17-2 TOP: Teaching-Learning MSC: Physiologic Integrity

• An older adult patient asks the nurse why so many of

her friends are developing cancers. The

nurse responds best when answering:

• Cancer cells generally develop as a result of

prolonged exposure to external agents.

• The longer we live the more exposure we have to

environmental toxins.

• Aberrant growth seems to be the risk factor in the

older adult that is not well understood.

• As we age, our cells are less able to regulate

replication appropriately

ANS: D

The aging cell has a tendency toward aberration or abnormalcy as it replicates.Aberrant cell growth is related to failure of growth control mechanisms, which leads to less cell regulation during replication. Cancer occurs more commonly in replicating than in nonreplicating cell groups, which suggests that changes in internal cellular control mechanisms give rise to cancer.DIF: Understanding (Comprehension) REF: Page 299 OBJ: 17-1 TOP: Teaching-Learning MSC: Physiologic Integrity

• An older adult patient expresses concern about

developing cancer in the future and asks the nurse advice about cancer prevention. The nurse shares

that:

• Eating foods high in protein, such as chicken and fish,

promote cell growth and repair, thus minimizing the risk.

• Although there are some behaviors that can help

minimize your risk, the possibility of developing cancer is usually determined by age 65.

• Most cancers that develop after age 65 generally

respond well to cancer treatment modalities.

• Cancers that develop late in life are generally slow

growing, so they generally do not contribute to this groups mortality.

ANS: B

Most cancers are the result of a lifelong exposure, so the risk of developing malignant disease after age 65 is probably already determined by the time one reaches that age. If exposure to promoters can be avoided or reduced and antipromoters can be used, then cancerous transformation may not take place or may be delayed. The other statements are not accurate.DIF: Understanding (Comprehension) REF: Page 300 OBJ: 17-1 TOP: Teaching-Learning MSC: Physiologic Integrity

• An older adult patient has rheumatoid arthritis, which

limits her manual dexterity and ability to perform breast self-examinations. To address the patients need for breast health promotion, the

nurse teaches the patient to:

• use the palm of her hand to perform monthly breast

examinations.

• schedule a mammogram every 12 months.
• check each breast while in the shower if possible.
• visit her physician yearly for a breast examination.

ANS: A

Older women, while having the highest incidence of breast cancer, have been shown to have the least knowledge about the importance of breast examination. Modifying and encouraging selfbreast examination would be the most effective intervention to promote breast health. The other actions are good but not as helpful as adapting the technique of self-exam so the woman can accomplish it.DIF: Applying (Application) REF: N/A OBJ: 17-3 TOP: Teaching-Learning MSC: Health Promotion

• Which statement, if made by an older Caucasian adult

man, indicates the need for further teaching about prostate cancer and its prevention?

• Digital rectal examinations arent needed for screening.
• I should discuss having a yearly PSA test.
• Prostate cancer can look a lot like an enlarged

prostate.

• I am not in a high-risk category for prostate cancer.

ANS: A

The digital rectal exam and prostate-specific antigen (PSA) blood test are the two main screening methods for prostate cancer. Men should begin discussions about screening for this cancer when they are 50. The digital rectal exam is less costly than a blood test. The other statements show understanding.DIF: Evaluating (Evaluation) REF: N/A OBJ: 17-3 TOP: Nursing Process: Evaluation MSC: Health Promotion

• When obtaining a health history, the nurse recognizes

that an older adult patient has a risk

factor for colorectal cancer when he reports:

• that he is a vegetarian who eats soy products.
• that he often needs laxatives for constipation.
• a history of inflammatory bowel disease.
• that diarrhea occurs at least monthly

ANS: C

A personal or family history of colorectal cancer, polyps, or inflammatory bowel disease has been associated with increased colorectal cancer risk. The other options do not increase this patients risk.DIF: Remembering (Knowledge) REF: Page 305 OBJ: 17-1 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

• While awaiting the results of testing to determine a

diagnosis of cancer, an older adult patient asks a nurse to explain what happens when cancer

metastasizes. The nurse responds:

• It is the result of prolonged exposure to an external

agent.

• Cancer cells convert from transformed cells into small

clusters of clonal cells.

• Cell control mechanisms fail, giving rise to aberrant

cell growth.

• Cancer cells move from one location to another

unconnected location.

ANS: D

Metastasis involves a change in location of the cancer cells from one organ or part of the body to another that is not directly connected. The other statements are not correct.DIF: Understanding (Comprehension) REF: Page 299 OBJ: 17-1 TOP: Teaching-Learning MSC: Physiologic Integrity

• The family of an older adult diagnosed with cancer asks

the nurse to explain how gene therapy

might be beneficial. The nurse responds:

• The treatment decreases blood flow to the tumor and it

dies.

• A virus is injected into the tumor and then it cant grow.
• The cancer cells nucleus is destroyed and the cell

shrivels.

• Photosensitizers are introduced into the cells so lasers

can kill them.

ANS: B

Gene therapy involves the injection of a virus that makes the cancer cells incapable of reproducing.DIF: Understanding (Comprehension) REF: Page 308 OBJ: 17-1 TOP: Teaching-Learning MSC: Physiologic Integrity

• The nurse observes a suspicious mole on the back of

an older adult who is undergoing palliative radiotherapy for brain metastasis. The nurse

suspects that the mole:

• is a result of the radiation.
• is a secondary cancer.
• will not be screened.
• was the primary cancer.

ANS: C

Screening should not be conducted if there is no intent or ability to pursue findings with more complete evaluation and treatment. The goal of screening is to detect early cancer that is amenable to treatment; this patient is undergoing palliation, which means he or she is not expected to live but is getting the radiation for symptom control.DIF: Analyzing (Analysis) REF: N/A OBJ: 17-3 TOP: Nursing Process: Analysis MSC: Physiologic Integrity

• An older adult patient with breast cancer is reluctant

to agree to the suggested treatment plan because I have heard such horrible things about radiation

therapy. The nurse responds:

• Radiation therapy no longer causes such terrible side

effects.

• Your chances of recovery are best when radiation is

included.

• Ask the oncologist if there are alternative treatments.
• Actually there is very effective symptom control now.

ANS: A

Cancer care has changed dramatically over the years; however, many older adults remember friends or relatives who were treated with now outdated therapies that had devastating side effects. The other statements do not address the primary concern, which is side effects of the treatment.DIF: Understanding (Comprehension) REF: Page 309 OBJ: 17-4 TOP: Communication and Documentation MSC: Physiologic Integrity

• After a course of chemotherapy for cancer of the

throat, an older adult patient is admitted to the hospital with persistent nausea and vomiting. The

nurse should initially assess the patient for:

• weight loss and weak gag reflex.
• anemia and poor muscle tone.
• oral inflammation and ulceration.
• dehydration and infection.

ANS: D

Drug-induced nausea and vomiting can result in dehydration, decreased caloric intake, and weight loss. Chemotherapy in general will impact the immune systems ability to combat infections. All assessments are important, but dehydration and infection (or sepsis) need to be treated immediately.DIF: Applying (Application) REF: N/A OBJ: 17-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

• The daughter of an older adult woman who had a

colostomy as a result of colon cancer tells the nurse, Mom seems to be so withdrawn; she has stopped going out with her friends and Im really concerned. The most relevant nursing diagnosis for

the patients reaction is:

• Ineffective individual coping.
• Dysfunctional grieving.
• Social isolation.
• Hopelessness

ANS: C

Voluntary social isolation may result when an older adult with cancer no longer feels comfortable in social settings because of his or her situation, including, for example, changes in body image, energy levels, or interests. Older persons with cancer may withdraw because they perceive that others are uncomfortable in their presence and because they believe, rightly or wrongly, that others are avoiding them because of the cancer diagnosis. Coping may be disturbed in this patient as well. The patient may be grieving loss of her former healthy self, and she may feel hopeless. But social isolation fits the daughters data.DIF: Applying (Application) REF: N/A OBJ: 17-6 TOP: Nursing Process: Diagnosis MSC: Psychosocial Integrity

• An older adult patient diagnosed with colon cancer is

being evaluated for surgical removal of the tumor. The nurse explains that the primary

consideration is the:

• absence of any chronic disorders.
• absence of metastasis.
• tumors staging status.
• patients presurgical health status.

ANS: D

The curability of cancer in older adults is largely predicted by an individuals ability to tolerate major surgery. The absence of metastasis and the tumor stage will impact additional treatments.Absence of chronic illness is not a factor in and of itself.DIF: Understanding (Comprehension) REF: Page 309 OBJ: 17-4 TOP: Teaching-Learning MSC: Physiologic Integrity

• An older adult patient is undergoing palliative surgery

for colon cancer metastasis. The nurse

explains to the family that this intervention is intended to:

• prolong the patients life by several months.
• improve the effectiveness of the chemotherapy.
• relieve the pain associated with spread of the tumor.
• prevent further tumor growth.

ANS: C

Surgery may be indicated for palliative care in cases in which large primary or metastatic tumors can be reduced; the size or location of the tumor can create problems such as compression of surrounding tissues and organs, leading to pain, necrosis, or organ failure.Palliative procedures are designed to manage symptoms.DIF: Understanding (Comprehension) REF: Page 309 OBJ: 17-4 TOP: Teaching-Learning MSC: Physiologic Integrity