23

Chapter 23: Cancer Development
Test Bank
MULTIPLE CHOICE
1. 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.
b.
c.
d.
ANS: C
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.
DIF: Cognitive Level: Comprehension/Understanding
REF: p. 398
TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)
MSC: Integrated Process: Teaching/Learning
2. 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.
b.
c.
d.
ANS: C
Generation time is defined as the period of time necessary for one cell to complete a round of
cell division.
DIF: Cognitive Level: Knowledge/Remembering
REF: p. 397
MSC: Integrated Process: Nursing Process (Analysis)
3. Which biologic characteristic is specific to normal differentiated adult cells but not to cancer
cells?
a. Anaplasia
b. Hypertrophy
c. Aneuploidy
d. Loose adherence
ANS: B
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.
REF: p. 397

4. A client states that his brain tumor is benign and does not need to be removed. What is the
nurses 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.
b.
c.
d.
ANS: A
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.
DIF: Cognitive Level: Application/Applying or higher
REF: N/A
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for
Complications from Surgical Procedures and Health Alterations)
MSC: Integrated Process: Nursing Process (Implementation)
5. 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 didnt do caused this cancer.
I hope my daughter doesnt develop breast cancer.
Regular mammograms on my other breast will prevent cancer.
a.
b.
c.
d.
ANS: D
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.
REF: N/A
TOP: Client Needs Category: Health Promotion and Maintenance (Health and Wellness)
6. Malignant cell growth is uncontrolled because of which action?
a. Cancer cells always divide more rapidly than normal cells.
b. Mitosis of malignant cells usually produces more than two daughter cells.
c. Malignant cells bypass one or more phases of the cell cycle during cell division.
d. Malignant cells enter the cell cycle frequently, making cell division continuous.
ANS: D
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.
REF: p. 399
7. A client has known lung cancer and has been admitted for abdominal pain and jaundice. A
computed tomography (CT) scan reveals tumors in the clients liver. The client is distraught
and says, So now I have liver cancer too? Which response by the nurse is most appropriate?
a. Yes, liver cancer is common in people who already have lung cancer.
b. Yes, your chemotherapy left you vulnerable to a virus that causes liver cancer.
c. No, the tumors are actually from your lung cancer, which has metastasized.
d. No, having tumors in two different organs is rare; you probably have hepatitis.
ANS: C
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.
REF: N/A
MSC: Integrated Process: Communication and Documentation
8. 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?
a. Provide annual screening chest x-rays for those exposed to asbestos.
b. Purchase protective gear and develop policies mandating its use.
c. Offer stop smoking programs on site several times a year.
d. Routinely distribute testing kits for occult fecal blood.
ANS: B
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.
REF: N/A
Alterations in Body Systems)
9. The nurse correlates initiation in cancer development with which action?
a. Inflicting mutations that lead to excessive cell division
b. Increasing the capacity of the transformed cell for error-free DNA repair
c. Stimulating contact inhibition in cells damaged by a carcinogen
d. Making cancer cells appear more normal to escape immune surveillance
ANS: A
The process of initiation induces changes in the genes that allow proto-oncogenes to be
activated to oncogene status and to be expressed.
REF: p. 399
10. The middle-aged client with lung cancer asks whether his adult children are at increased risk
for this cancer. What is the nurses 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.
b.
c.
d.
ANS: C
Long-term cigarette smoking is the major risk factor for lung cancer. Not smoking is the best
way to prevent it.
REF: N/A
TOP: Client Needs Category: Health Promotion and Maintenance (High-Risk Behaviors)
11. 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?
a. Have any other members of your family had bone cancer?
b. Did your mother ever have any other type of cancer?
c. How old were you when you started your periods?
d. Did your mother have regular mammograms?
ANS: B
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 clients
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.
REF: N/A
MSC: Integrated Process: Nursing Process (Assessment)
12. 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.
b.
c.
d.
ANS: A
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.
REF: N/A
13. 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.
b.
c.
d.
ANS: D
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.
REF: N/A
14. 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?
a. Would you be willing to stop drinking alcohol?
b. Have you ever tried the nicotine patch?
c. Why are you so determined to continue smoking?
d. Do you understand that smoking is the leading cause of cancer?
ANS: A
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.
REF: N/A
15. A clients cancer is staged by the TNM classification as T1, N3, M1. What is the nurses
interpretation of this classification?

a. The client has a large tumor involving the lymph nodes, but no distant metastasis.
b. The client has a tumor, and metastasis cannot be determined by the staging method.
c. The client has a 2-cm tumor, one involved lymph node, and local metastasis.
d. The client has a small tumor, many involved lymph nodes, and distant metastasis.
ANS: D
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.
REF: N/A
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests)
MSC:
Integrated Process: Nursing Process (Analysis)
16. 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 nurses best response?
I will ask your physician about a referral for genetic testing.
Lets look at your family history back to your grandparents generation.
Genetic testing is so expensive; lets talk about reducing your risk instead.
Inherited cancers are much more common in males than in females.
a.
b.
c.
d.
ANS: B
Genetic testing for the risk of developing a few specific cancers is available but is expensive.
The nurse should first assess the clients 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 clients concerns. Genetically related cancers are not more prevalent in men than in
women, and again, this response belittles the clients concerns.
REF: N/A
17. 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.
b.
c.
d.
ANS: B
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.
REF: N/A
TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)
18. The nurse correlates the role of suppressor genes in cancer development with which action?
a. The presence of suppressor genes increases risks for gene damage by carcinogens.
b. People with a greater number of suppressor genes are at increased risk for getting
cancer.
c. Suppressor genes enhance immune function, suppressing cancer development.
d. Suppressor genes limit cell division, reducing risks for developing cancer.
ANS: D
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.
REF: p. 397

19. 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.
b.
c.
d.
ANS: B
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.
REF: N/A
20. The nurse counsels a woman who has a BRCA1 gene that she has what chance for developing
breast cancer during her lifetime?

None; this gene has a protective effect
Same as the general population
Lower than the general population
Higher than the general population
a.
b.
c.
d.
ANS: D
BRAC1 is a genetic mutation that increases risk for both breast and ovarian cancer.
REF: p. 407
21. The nurse wishes to present a cancer program to a group of people at high risk for cancer. In
planning the program, which group does the nurse consider the priority?
a. Older adults
b. People who smoke
c. Clients with family histories of cancer
d. People with poor immune function
ANS: A
Advancing age is the single most important risk factor for cancer because of age-related
decline in immune function and accumulated exposure to carcinogens. All of the people listed
are at some increased risk for cancer, but older adults have the highest risk overall.
REF: N/A
TOP: Client Needs Category: Health Promotion and Maintenance (Aging Process)
MSC: Integrated Process: Nursing Process (Planning)
22. The nurse is planning a cancer education event in an Asian community center. The nurse plans
to present information specifically on which types of cancer?

a. Breast and colorectal
b. Skin and lymphoma
c. Liver and stomach

d. Uterine and ovarian
ANS: A
Asians have higher rates of breast, colorectal, prostate, lung, and stomach cancers than are
seen in the general population.
REF: N/A
23. In preparing a cancer risk reduction pamphlet for African-American clients, it is most
important that the nurse include information on prevention and early detection for which types
of cancer?
a. Lung and prostate
b. Bone and leukemia
c. Skin and lymphoma
d. Stomach and esophageal
ANS: A
African Americans have higher incidences of lung, prostate, breast, colorectal, and uterine
cancers than are seen in the general population.
REF: N/A
24. The nurse is seeing clients in a clinic. Which client does the nurse assess further for the
development of cancer?
Client with a cough that has lasted for 4 months
Client whose mother died of lung cancer
Client with a 10-pound weight gain
Woman whose last mammogram was 3 years ago
a.
b.
c.
d.
ANS: A
The seven warning signs of cancer include changes in bowel/bladder habits, a sore that does
not heal, unusual bleeding or discharge, thickening or a lump in the breast or elsewhere,
indigestion or difficulty swallowing, obvious change in a wart/mole, and nagging
cough/hoarseness. The other clients do not have warning signs of cancer.
REF: N/A
TOP: Client Needs Category: Health Promotion and Maintenance (Health Screening)
25. It is most important that the nurse include which activity for the young adult client with Down
syndrome?
Encouraging more fruit and leafy green vegetables in the diet
Teaching him how to perform testicular self-examination
Assessing the skin for unusual bruises and petechiae
Testing the clients stool for occult blood
a.
b.
c.
d.
ANS: C
All screening and prevention activities are appropriate. However, people with Down
syndrome have an increased lifetime risk for the development of leukemia.
REF: N/A
26. The nurse is interested in primary prevention for cancer. Which activity does the nurse most
likely participate in?

Distributing occult fecal blood test kits to people at the shopping mall
Arranging transportation volunteers for clients undergoing radiation therapy
Teaching high school students the dangers of using tobacco
Educating adolescent girls about getting an annual Papanicolaou (PAP) smear
a.
b.
c.
d.
ANS: C
Primary prevention focuses on activities that occur before an illness, such as education and
vaccinations. Occult fecal blood testing and PAP smears are secondary prevention activities
designed for screening and early diagnosis. Arranging transportation for a client who is
undergoing radiation therapy is tertiary prevention.
REF: N/A
TOP: Client Needs Category: Health Promotion and Maintenance (Health Promotion/Disease
Prevention)
27. The nurse assesses which client most carefully for cancer development?
a. Young man receiving radiation therapy for a brain tumor
b. Young adult woman who recently had postpartum hemorrhage
c. Adolescent male recently diagnosed with acquired immune deficiency syndrome
(AIDS)
d. Older woman undergoing chemotherapy for bowel cancer
ANS: D
Age and immune suppression are two of the greatest risk factors for cancer development. The
young man with brain cancer and the adolescent are at increased risk, but their risk is not as
great as that of the older woman undergoing chemotherapy for bowel cancer. Postpartum
hemorrhage is not related to cancer development.
REF: N/A
MULTIPLE RESPONSE
1. A client has colorectal cancer. Which activities are especially important for the nurse to
conduct for this client? (Select all that apply.)

Monitor liver function studies.
Maintain accurate intake and output.
Obtain daily weight using the same scale.
Palpate lymph nodes at each clinic visit.
Ask the client about changes in belly size.
a.
b.
c.
d.
e.
ANS: A, D, E
Common sites of metastasis for colorectal cancer include the liver, lymph nodes, and adjacent
structures such as the abdominal cavity. Intake and output and daily weights would not
provide data related to possible metastases.
REF: N/A

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Chapter 23: Cancer Development

generation time for cancer development with which description?

MSC: Integrated Process: Nursing Process (Analysis)

nurses best response?

regarding cancer causes and prevention?

for this cancer. What is the nurses best response?

legs. The nurse educates the client about which intervention?

Which question is most important for the nurse to ask?

interpretation of this classification?

Integrated Process: Nursing Process (Analysis)

to address secondary cancer prevention?

Secondary prevention focuses on screening and early diagnosis. Annual prostate-specific

MSC: Integrated Process: Nursing Process (Analysis)

relative treated for which cancer?

breast cancer during her lifetime?

to present information specifically on which types of cancer?

c. Liver and stomach

likely participate in?

conduct for this client? (Select all that apply.)

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