Caring for the Cancer Survivor

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 Kübler-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 client’s 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 client’s 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 client’s 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.

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 player’s chronic health issues do not present the greatest risk.

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 client’s chances of recovery
4.
The depression is a result of concerns about the cancer reoccurring

ANS: 3

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 survivor’s quality of life is:

1.
The client’s 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

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 client’s history of cancer surgery should direct you to the more related option.

While the client may prefer to protect her modesty and privacy, the client’s 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 client’s 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 provider’s 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 self-monitor (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 OBJ: Analysis

TOP: Nursing Process: Assessment

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.
Client’s 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 client’s 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 client’s 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.

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 client’s 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 client’s 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 client’s 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 wouldn’t jump to that conclusion. Let’s just see what your health care provider thinks.”

ANS: 2

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 client’s concern regarding reoccurring cancer.

Telling the client not to jump to conclusions minimizes the client’s concern.

DIF: C REF: 86 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Physiological Adaptation/Illness Management