Homework Lance
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.
ANS: C
The definition of a cancer survivor is the following: “An individual is considered a cancer survivor from the time of diagnosis through the balance of his or her life.” Being cancer free for any length of time does not relate to the definition of a cancer survivor put forth by the National Coalition for Cancer Survivorship.
DIF: Knowledge REF: 90 OBJ: Discuss the concept of cancer survivorship.
TOP: Assessment MSC: Nursing Process
2. As nurses caring for cancer survivors, it is important to understand that
a.
Caucasians have more post-treatment symptoms than minority patients.
b.
Treatment outcomes are the same regardless of ethnic background.
c.
Cancer treatment is lifelong, and follow-up ensures that needs are met.
d.
Many long-term cancer survivors suffer needlessly and die.
ANS: D
Despite the incredible advances made in cancer care, many long-term survivors suffer unnecessarily and die from delayed second cancer diagnoses or treatment-related chronic disease. Evidence suggests that survivors among racial and ethnic minorities and other underserved populations have more post-treatment symptoms and poorer treatment outcomes than Caucasians. Once treatment is completed, contact with a cancer care provider often stops, and survivors’ needs go unnoticed or untreated.
DIF: Understand REF: 90 OBJ: Discuss the concept of cancer survivorship.
TOP: Evaluation MSC: Nursing Process
3. When working with cancer survivors, the nurse must understand that cancer survivors
a.
Face depression that is devastating and destroys one’s sense of life.
b.
Seek a balance between independence and interdependence.
c.
Experience similar long-term impact regardless of cultural beliefs.
d.
Are at much lower risk for developing a new cancer.
ANS: B
Quality of life in cancer survivorship means having a balance between the experience of increased dependence and seeking both independence and interdependence. Of course there are always exceptions with regard to the level of distress that survivors face. For some, cancer becomes an experience of self-reflection and an enhanced sense of what life is about. Regardless of each survivor’s journey with cancer, having cancer affects each person’s physical, social, psychological, and spiritual well-being. Although cancer survivors go through similar steps of cancer diagnosis and treatment, they experience cancer and the long-term impact differently based on their cultural beliefs. Cancer survivors are at increased risk for cancer (either a recurrence of the cancer for which they were treated or a second cancer).
DIF: Understand REF: 91
OBJ: Describe the influence of cancer survivorship on the patient’s quality of life.
TOP: Evaluation MSC: Nursing Process
4. The nurse is caring for a cancer survivor who has been hospitalized in the intensive care unit (ICU) for an unrelated and stable problem. The ICU has posted visiting hours, but some of the patient’s family is from out of town and would like to see her even though it is not time. The patient has also voiced a desire to see her family. The nurse allows the family to visit even though it is not the “official” visiting time. Why would the nurse do this?
a.
Disagrees with the established time for visiting
b.
Realizes that the patient is dying because she is in the ICU
c.
Believes that the visit will help relieve psychological stress
d.
Feels there is no real reason to have limited visiting hours.
ANS: C
Survivors who have social and emotional support systems are likely to have less psychological distress. Relationships are critical for cancer survivors. The nurse does not necessarily have problems with the standard visiting hours. Not enough information is provided to indicate that the patient is near death, and not all patients in the ICU are dying.
DIF: Apply REF: 93
OBJ: Describe the influence of cancer survivorship on the patient’s quality of life.
TOP: Implementation MSC: Nursing Process
5. Why is cancer survivorship especially difficult for family members in the “sandwich generation”?
a.
They are totally dependent on their parents who have cancer but are still the providers, and hence, “make the sandwiches.”
b.
They are the primary caregivers of children with cancer, and hence, “make their sandwiches.”
c.
They are cancer survivors who are in between (“sandwiched”) treatments and require a great deal of support.
d.
They are caught in the middle of caring for their own immediate family, as well as a parent with cancer.
ANS: D
For members of the “sandwich generation,” caregivers who are 30 to 50 years old who are often caught in the middle of caring for their own immediate family, as well as a parent with cancer, the demands are many, from providing ongoing encouragement and support and assisting with household chores to providing hands-on physical care when cancer is advanced.
DIF: Knowledge REF: 94 OBJ: Discuss the effects that cancer has on the family.
TOP: Assessment MSC: Nursing Process
6. Ongoing concerns and problems facing cancer survivors and their families are important determinants of adjustment and quality of life. Families generally find themselves ill prepared to deal with cancer because
a.
Educational programs are of no help in dealing with cancer issues.
b.
Hiding cancer-related thoughts and concerns helps maintain relationships.
c.
Holding back emotions is an effort to shield others from true feelings.
d.
Caregiving is predetermined and does not require family decision-making skills.
ANS: C
Many caregivers and cancer survivors attempt to hide cancer-related thoughts and concerns from one another, which increases adverse psychological outcomes. Motivation for this behavior is often to protect one another from the distress that is experienced by each member of the family. Holding back emotions is sometimes a part of this effort to shield one another from true thoughts and feelings. If cancer survivors and their partners participated in an educational program to teach the importance of disclosing feelings and then actually disclosed them, relationships and intimacy were improved. Caregiving also involves psychological demands of communicating, problem solving, and decision making; social demands of remaining active in the community and work; and economic demands of meeting financial obligations.
DIF: Understand REF: 94 OBJ: Discuss the effects that cancer has on the family.
TOP: Assessment MSC: Nursing Process
7. The nurse is caring for a young woman with breast cancer. The stress between the woman and her husband is obvious, as is anxiety among the children. What is the nurse’s best action in this situation?
a.
Help find or develop an educational program for the patient and her husband.
b.
Encourage the patient to agree with her husband even if she disagrees.
c.
Support the husband, and explain that the husband knows what’s best.
d.
Take the children away and recommend foster care.
ANS: A
It has been found that if cancer survivors and their partners participated in an educational program to teach the importance of disclosing feelings and then actually disclosed them, relationships and intimacy were improved. Encouraging honest communication within families is an important intervention for the nurse to implement to enhance family relationships. Core family functions include maintaining an emotionally and physically safe environment, interpreting and reducing the threat of stressful events (including the cancer) for family members, and nurturing and supporting the development of individual family members. In childrearing families, this means providing an attentive parenting environment for children and information and support to children when their sense of well-being becomes threatened. Spouses often do not know what to do to support the survivor, and they struggle with how to help.
DIF: Apply REF: 94 OBJ: Discuss the effects that cancer has on the family.
TOP: Implementation MSC: Nursing Process
8. The nurse is caring for a patient who is undergoing chemotherapy and radiation for cancer. The patient says that he can’t wait until the therapy is done so that he can feel stronger, and asks the nurse about the value of cancer screening when his course of therapy is over. The nurse should inform the patient that cancer screening
a.
Should be done on an ongoing schedule.
b.
Probably will not be needed because the patient has been cured.
c.
Usually is not done even if recommended by the health care provider.
d.
Is not something that the health care provider should recommend.
ANS: B
Because survivors are at increased risk for developing a second cancer and/or chronic illness, it is important to educate them about lifestyle behaviors and the importance of participating in ongoing cancer screening and early detection practices. Lifelong cancer screening provides the opportunity to identify new cancers in early stages. When health care providers recommend follow-up screening in cancer survivors, the likelihood that the person will actually undergo the screening test is increased.
DIF: Apply REF: 96
OBJ: Explain the nursing implications related to cancer survivorship.
TOP: Implementation MSC: Nursing Process
9. The nurse is caring for a patient diagnosed with cancer. The family of the patient asks the nurse for information. What should the nurse do?
a.
Refer family members to the physician because it is his/her role to prescribe.
b.
Inform them that few options are available.
c.
Tell them to take their family member to an NCI cancer center.
d.
Offer information about the different resources available.
ANS: D
The nurse’s role is to tell patients and families about the different resources available so they can make informed choices. The physician is a resource, but the nurse can educate as well. NCI-designated cancer centers offer the most comprehensive and up-to-date clinical care, but are only one of many options. The nurse can refer family members to the NCI website, where a current list of NCI-designated comprehensive cancer centers is provided.
DIF: Apply REF: 96
OBJ: Explain the nursing implications related to cancer survivorship.
TOP: Implementation MSC: Nursing Process
10. The nurse is caring for a patient with known coronary artery disease who has recently been diagnosed with lung cancer. What should the nurse do?
a.
Focus her assessment on the cancer diagnosis because it is the newer diagnosis.
b.
Ask questions about cardiac symptoms and their relationship to the cancer.
c.
Ignore symptom management and focus on palliative care.
d.
Say nothing because cancer survivors dislike prying.
ANS: B
The nurse needs to consider not only the effects of cancer and its treatment, but how it will affect any other medical condition. For example, if a patient also has heart disease, how will the fatigue related to chemotherapy affect this individual? If cancer is secondary, the nurse does not want important symptoms to go unrecognized. Given the symptoms that a patient identifies, the nurse will explore each one to gain a complete picture of the patient’s health status. Patients will appreciate the nurse’s sensitivity and interest in their well-being.
DIF: Apply REF: 94-95
OBJ: Explain the nursing implications related to cancer survivorship.
TOP: Implementation MSC: Nursing Process
11. The patient has lung cancer and voices concerns about his cancer treatment. He wants to know how chemotherapy will affect his sexuality. What is the nurse’s best reply?
a.
“Chemotherapy will work in the lungs and should have no effect on your sexuality.”
b.
“That is something that you should ask your doctor. He can direct you.”
c.
“Sexual changes are common with cancer therapy. Let me get someone who can answer your questions.”
d.
“How cancer treatment affects sexuality depends on how active you are and your age.”
ANS: C
Cancer therapies have the potential to cause fatigue, apathy, nausea, vomiting, malaise, and sleep disturbances, all of which interfere with a patient’s libido. It helps if the nurse can develop a comfort level in acknowledging with patients that sexual changes are common at any age level. When patients begin to discuss their sexual problems, know the expert resources in your institution (e.g., psychologist, social worker) who are available for patient referral. The issue should not be pushed onto the physician. Patients appreciate the nurse’s sensitivity and interest in their well-being.
DIF: Apply REF: 95
OBJ: Explain the nursing implications related to cancer survivorship.
TOP: Implementation MSC: Nursing Process
12. The nurse is caring for a patient who has successfully undergone cancer therapy and will be discharged home soon. The patient is concerned about going home and not knowing what to do. The nurse reassures the patient, telling him that
a.
She alone will develop a plan of care that will tell exactly what needs to be done.
b.
If he has any issues, he can call his doctor and the doctor will know what to do.
c.
He has received the proper cancer treatment, and he will need nothing else.
d.
He will be part of a team that will provide any support and care that he may need.
ANS: D
A strong multidisciplinary approach that includes the patient, nurses, oncology specialists, dietitians, social workers, pastoral care, and rehabilitation professionals is necessary to provide support for the patient. Together, the team will provide a plan of care that addresses treatment-related problems and future health risks and offers a wellness focus to give patients a sense of hope as they enter their survivor experience.
DIF: Apply REF: 97
OBJ: Discuss the essential components of survivorship care. TOP: Implementation
MSC: Nursing Process
13. Nurses and other health care providers need to become more vigilant in recognizing cancer survivors and attempting to link them with the support and resources that they require because
a.
All health care agencies provide survivorship care plans.
b.
Survivorship care plans are reviewed with the patient after the patient goes home.
c.
Many survivors are discharged with no survivor plan.
d.
The plan does not deal with future cancer care.
ANS: C
Even though Internet guidelines for care plans are available, many survivors do not receive care at NCI-designated cancer centers and are discharged with no survivor plan. Thus nurses and other health care providers need to become more vigilant in recognizing cancer survivors and attempting to link them with the support and resources they require. Survivor plans are not always developed, and health insurance companies do not routinely cover this type of care. Ideally, the nurse reviews a survivorship care plan with a patient at the time of discharge from a treatment program. The plan becomes a guide for any future cancer or cancer-related care.
DIF: Understand REF: 97
OBJ: Discuss the essential components of survivorship care. TOP: Evaluation
MSC: Nursing Process
MULTIPLE RESPONSE
1. Which of the following are factors that help ease the psychological stress associated with having cancer? (Select all that apply.)
a.
Viewing cancer as a challenge
b.
Female gender
c.
Using problem-oriented coping processes
d.
Social support system
e.
Being younger
ANS: A, C, D
Factors have been identified that help ease the psychological stress associated with having cancer. A survivor who sees cancer as a challenging experience and a controllable threat will have less stress. Patients who use problem-oriented, active, and emotionally expressive coping processes also manage stress well. Survivors who have social and emotional support systems and maintain open communication with their treatment providers will also likely have less psychological distress. Being female, younger, or less educated, and having a lower income and less social and emotional support increases the risk for post-traumatic stress disorder (PTSD).
DIF: Analyze REF: 93
OBJ: Describe the influence of cancer survivorship on the patient’s quality of life.
TOP: Evaluation MSC: Nursing Process
2. The Institute of Medicine (IOM) has made recommendations for four essential components of survivorship care. Which of the following are actual recommendations? (Select all that apply.)
a.
Prevention and detection of new and recurrent cancers
b.
Surveillance for cancer spread, recurrence, or second cancers
c.
Cessation of noncancer follow-up and care
d.
Intervention for consequences of cancer and its treatment
e.
Coordination between specialists and primary care providers
ANS: A, B, D, E
The Institute of Medicine (IOM) has made recommendations for four essential components of survivorship care: (1) prevention and detection of new cancers and recurrent cancer; (2) surveillance for cancer spread, recurrence, or second cancers; (3) intervention for consequences of cancer and its treatment (e.g., medical problems, symptoms, psychological distress); and (4) coordination between specialists and primary care providers.
DIF: Knowledge REF: 97
OBJ: Discuss the essential components of survivorship care. TOP: Assessment
MSC: Nursing Process
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