MSN Exam for Lung Cancer

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1) Which of the following types of lung cancer is the most prevalent carcinoma of the lung for both men and women?

  1. Adenocarcinoma
  2. Large cell carcinoma
  3. Squamous cell carcinoma
  4. Small cell carcinoma

2) A 37-year-old client with uterine cancer asks the nurse, “Which is the most common type of cancer in women?” The nurse replies that it’s breast cancer. Which type of cancer causes the most deaths in women?

  1. Breast cancer
  2. Lung cancer
  3. Brain cancer
  4. Colon and rectal cancer

3) A 64-year-old woman returns to your clinic for continued evaluation of a chronic cough, which she has been experiencing for the past 2 months. A chest x-ray obtained yesterday shows a spiculated right middle lobe mass with mediastinal lymphadenopathy. In addition, today the patient reports right leg pain of new onset. You are concerned about metastatic disease.

For this patient, which of the following approaches to diagnostic imaging would be most appropriate for the evaluation of possible metastatic disease?

  1. CT scan of the chest
  2. CT scan of the chest, head, and adrenal glands
  3. CT scan of the chest, head, and adrenal glands, and a bone scan
  4. CT scan of the chest and head, and a bone scan

4) Which of the following types of lung cancer is characterized as fast growing and tending to arise peripherally?

  1. Large cell carcinoma
  2. Bronchioalveolar carcinoma
  3. Adenocarcinoma
  4. Squamous cell carcinoma

5) A patient is scheduled for a magnetic resonance imaging (MRI) scan for suspected lung cancer. Which of the following is a contraindication to the study for this patient?

  1. The patient is allergic to shellfish.
  2. The patient has a pacemaker.
  3. The patient suffers from claustrophobia.
  4. The patient takes anti-psychotic medication.

6) A 67-year-old client who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. While you are taking the admission history, the client makes these statements. Which statement is of most concern?

  1. “I’ve noticed that I bruise more easily since the chemotherapy started.”
  2. “My bowel movements are soft and dark brown in color.”
  3. “I take one aspirin every morning because of my history of angina.”
  4. “My appetite has decreased since the chemotherapy strated.”

7) What is true about interventional pulmonology?

  1. Looks at reasons for shortness of breath. This is not only used for lung cancer; it can be used for breast cancer, colon cancer, renal cancer and melanoma.
  2. This increases the likelihood for cure by 29%.
  3. CTCA was the first to combine interventional pulmonology with various treatments.

8) Gina, a home health nurse is visiting a home care client with advanced lung cancer. Upon assessing the client, the nurse discovers wheezing, bradycardia, and a respiratory rate of 10 breaths/minute. These signs are associated with which condition?

  1. Hypoxia
  2. Delirium
  3. Hyperventilation
  4. Semiconsciousness

9) What percentage of lung cancer is caused by smoking?

  1. 50%
  2. 63%
  3. 87%
  4. 94%

10) What is the benefit of a navigational bronchoscopy?

  1. Performs biopsies
  2. Delivers High Dose Radiation (HDR)
  3. Explains the distance that the bronchoscope can travel into the lung.
  4. All of the above

11) Of the four basic cell types of lung cancer listed below, which is always associated with smoking?

  1. adenocarcinoma
  2. squamous cell carcinoma (epidermoid)
  3. undifferenciated carcinoma
  4. bronchoalveolar carcinoma

12) In terms of lung cancer, what is intratumoral chemotherapy used for?

  1. Small Cell Lung Cancer
  2. Non-Small Cell Lung Cancer

13) When a patient in the terminal stages of lung cancer begins to exhibit loss of consciousness, a major nursing priority is to:

  1. Protect the patient from injury
  2. Insert an airway
  3. Elevate the head of the bed
  4. Withdraw all pain medications

14) What is an autofluorescence bronchoscopy?

  1. This shows where treatment is being delivered to within the lung.
  2. This lights up cancer cells and it can show cells that haven’t grown into a tumor yet.
  3. This lights up the path that a bronchoscope can follow.

15) Which of the following is the most common type of lung cancer?

  1. Large cell
  2. Adenocarcinoma
  3. Oat cell
  4. Squamous cell

16) Chemotherapy may be used in combination with surgery in the treatment of lung cancer. Special nursing considerations with chemotherapy include all but which of the following?

  1. Helping the client deal with depression secondary to the diagnosis and its treatment
  2. Explaining that the reactions to chemotherapy are minimal
  3. Careful observation of the IV site of the administration of the drugs
  4. Careful attention to blood count results

17) A 56-year-old man is worried about his risk of developing lung cancer. He has no medical problems, but he does report having smoked one pack of cigarettes a day for 4 years while in college. He stopped smoking more than 30 years ago.

Of the following which is the most accurate statement regarding this patient’s risk of developing lung cancer?

  1. It is equal to someone who has never smoked
  2. In any age group, the risk of developing lung cancer declines after stopping smoking
  3. The annual lung cancer mortality of smokers is 10 times that of nonsmokers
  4. His risk of developing lung cancer is only slightly greater than that of a nonsmoker

18) Lung cancer is the top killer of cancer.

  1. True
  2. False

19) A client with lung cancer has received oxycodone 10 mg orally for pain. When the student nurse assesses the client, which finding should you instruct the student to report immediately?

  1. Respiratory rate of 8 to 10 per minute
  2. Pain level decreased from 6/10 to 2/10
  3. Client requests room door be closed.
  4. Heart rate 90-100 per minute

20) A 62-year-old woman presents to your clinic for a regularly scheduled examination. She has no new complaints, but she is concerned about her risk of developing lung cancer. She has smoked one pack of cigarettes a day since she was 18 years old. She asks whether she should be given any tests to screen for lung cancer.

For this patient, which of the following statements is true?

  1. Chest x-rays are a cost-effective and accurate way to screen for lung cancer
  2. Spiral computed tomography scanning is currently recommended for screening in asymptomatic patients
  3. Benign nodules are rarely seen on spiral CT, making it ideal for cancer screening
  4. At present, there are no recommended radiographic studies to screen for lung cancer

21) A client with lung cancer is admitted in the nursing care unit. The husband wants to know the condition of his wife. How should the nurse respond to the husband?

  1. Find out what information he already has.
  2. Suggest that he discuss it with his wife.
  3. Refer him to the doctor.
  4. Refer him to the nurse in charge.

22) The nurse is conducting an education session for a group of smokers in a “stop smoking” class. Which finding would the nurse state as a common symptom of lung cancer? :

  1. Dyspnea on exertion
  2. Foamy, blood-tinged sputum
  3. Wheezing sound on inspiration
  4. Cough or change in a chronic cough

23) Which of the following symptoms is most characteristic of a client with a cancer of the lung?

  1. air hunger
  2. exertional dyspnea
  3. cough with night sweats
  4. persistent changing cough

24) What does an Endobronchial Ultrasound help do and how does it work?

  1. An Endobronchial Ultrasound helps with the staging of a tumor. A bronchoscope is inserted into the lung with an ultrasound on the tip. There is a slot that houses a needle to biopsy the lymph nodes.
  2. An Endobronchial Ultrasound helps take images of the lung. A long scope is inserted directly into the chest cavity. The scope takes 30 images with a 360 degree rotation. The images are sent to a computer where the oncologist is able to examine the images.
  3. An Endobronchial Ultrasound helps with the placement of fiducial markers. An x-ray is taken of the lung and lymph nodes, the endobronchial ultrasound is then inserted in the area of the tumor(s) for implantation of fiducial markers.

25) The most common lethal cancer in males between their fifth and seventh decades is:

  1. cancer of the prostate
  2. cancer of the lung
  3. cancer of the pancreas
  4. cancer of the bowel

26) What is the most common reason for bronchoscopes not being able to reach a tumor within the lung?

  1. Scar tissue
  2. Malformations of the lung
  3. The tumor is too small
  4. Due to small bronchi

27) Antonio with lung cancer develops Horner’s syndrome when the tumor invades the ribs and affects the sympathetic nerve ganglia. When assessing for signs and symptoms of this syndrome, the nurse should note:

  1. miosis, partial eyelid ptosis, and anhidrosis on the affected side of the face.
  2. chest pain, dyspnea, cough, weight loss, and fever.
  3. arm and shoulder pain and atrophy of arm and hand muscles, both on the affected side.
  4. hoarseness and dysphagia.
Answers and Rationales
  1. A. Adenocarcinoma . Adenocarcinoma presents more peripherally as peripheral masses or nodules and often metastasizes.
  2. B. Lung cancer . Lung cancer is the most deadly type of cancer in both women and men. Breast cancer ranks second in women, followed (in descending order) by colon and rectal cancer, pancreatic cancer, ovarian cancer, uterine cancer, lymphoma, leukemia, liver cancer, brain cancer, stomach cancer, and multiple myeloma.
  3. C. CT scan of the chest, head, and adrenal glands, and a bone scan . For patients with suspected metastatic disease in whom the results of the clinical examination and chest x-ray are abnormal, the standard imaging evaluation has included a chest CT scan with images through the adrenal glands, a bone scan, and a CT or magnetic resonance imaging scan of the brain. The role of positron emission tomography (PET) scanning has become a standard part of the evaluation of lung cancer patients. F-18 fluorodeoxyglucose (FDG) uptake is greater in malignant cells than in normal, benign cells. Several series have suggested that FDG-PET imaging can be very useful in determining whether abnormalities seen on CT particularly in the adrenal gland and bone likely represent metastatic disease. PET scans are also useful for evaluation of solitary pulmonary nodules, with a sensitivity of 90% to 95% and a specificity of 80% to 100% for the detection of cancer. Because PET imaging can detect unsuspected metastatic disease in 11% to 14% of patients and thus help avoid futile surgery in these cases, in the United States, Medicare provides coverage for FDG-PET for the staging of NSCLC. PET technology is evolving rapidly, and its sensitivity for the detection of smaller lesions is improving. Although PET scanning can detect lesions measuring between 0.5 and 1.0 cm, most series have limited the analysis to lesions greater than 1.0 cm. In addition, techniques that incorporate simultaneous CT and PET image analysis appear to be most useful.
  4. A. Large cell carcinoma. Large cell carcinoma is a fast-growing tumor that tends to arise peripherally.
  5. B. The patient has a pacemaker. The implanted pacemaker will interfere with the magnetic fields of the MRI scanner and may be deactivated by them. Shellfish/iodine allergy is not a contraindication because the contrast used in MRI scanning is not iodine-based. Open MRI scanners and anti-anxiety medications are available for patients with claustrophobia. Psychiatric medication is not a contraindication to MRI scanning.
  6. C. “I take one aspirin every morning because of my history of angina.” Because aspiring will decrease platelet aggregation, clients with thrombocytopenia should not use aspirin routinely. Client teaching about his should be included in the care plan. Bruising is consistent with the client’s admission problem of thrombocytopenia. Soft, dark brown stools indicate that there is no frank blood in the bowel movements. A decrease in appetite is common with chemotherapy, and more assessment is indicated. Focus: Prioritization
  7. A. Looks at reasons for shortness of breath. This is not only used for lung cancer; it can be used for breast cancer, colon cancer, renal cancer and melanoma.
  8. A. Hypoxia. As the respiratory center in the brain becomes depressed, hypoxia occurs, producing wheezing, bradycardia, and a decreased respiratory rate. Delirium is a state of mental confusion characterized by disorientation to time and place. Hyperventilation (respiratory rate greater than that metabolically necessary for gas exchange) is marked by an increased respiratory rate or tidal volume, or both. Semiconsciousness is a state of impaired consciousness characterized by limited motor and verbal responses and decreased orientation.
  9. C. 87% 
  10. D. All of the above
  11. B. squamous cell carcinoma (epidermoid) . Textbooks of medicine and nursing classify primary pulmonary carcinoma somewhat differently. However most agree that sqaumous cell or epidermoid carcinoma is always associated with cigarette smoking.
  12. B. Non-Small Cell Lung Cancer 
  13. A. Protect the patient from injury . Ensuring the patient’s safety is the most essential action at this time. The other nursing actions may be necessary but are not a major priority.
  14. B. This lights up cancer cells and it can show cells that haven’t grown into a tumor yet.
  15. D. Squamous cell 
  16. B. Explaining that the reactions to chemotherapy are minimal . There ar enumerous severe reactions to chemotherapy such as stomatitis, alopecia, bone marrow depression, nausea and vomiting. Options A, B and D are important nursing considerations.
  17. D. His risk of developing lung cancer is only slightly greater than that of a nonsmoker. Cigarette smoking continues to contribute to the risk of lung cancer long after a person has stopped smoking. The American Cancer Society evaluated this relationship in a 6-year prospective study involving more than 900,000 persons. This study included persons who had never smoked, current smokers, and former smokers. As expected, the risk of dying of lung cancer was lower in patients who had quit smoking early in life than in those who quit later on, and the risk was significantly lower in those who quit than in those who did not. In a person who smoked 26 cigarettes a day starting at 17 years of age and stopped smoking between the ages of 30 and 49, the risk of death from lung cancer is slightly greater than that of persons who never smoked. For a person who started smoking at 17 years of age and quit smoking between the ages of 50 and 64, the risk of death from lung cancer plateaus at the risk level at the time of quitting and remains level until about the age of 75, at which time the risk appears to increase further. In this model, the annual lung cancer mortality for current smokers at age 75 is 1% for men and 0.5% for women, which is approximately 20 times higher than that of nonsmokers.
  18. A. True 
  19. A. Respiratory rate of 8 to 10 per minute. A decreased respiratory rate indicates respiratory depression which also puts the client at risk for respiratory acidosis, All of the other findings are important and should be reported to the RN, but the respiratory rate is urgent.
  20. D. At present, there are no recommended radiographic studies to screen for lung cancer . Most patients with lung cancer present with advanced inoperable disease. Screening for lung cancer at an earlier stage is therefore an attractive idea, especially because persons at high risk for lung cancer can be readily identified by a smoking history. Early studies of screening produced disappointing results. Randomized trials of screening suggested that chest x-ray alone was not a satisfactory screening tool for the detection of early lung cancer tumors. Curable tumors are often too small or indistinct to be detected on a standard chest x-ray. Spiral CT scanning is a more sensitive technique for lung cancer screening. With this technique, radiologists obtain a low-resolution image of the entire thorax in a single breath-hold; this approach is associated with low radiation exposure and relatively rapid throughput, as compared with standard CT scans. A number of studies have demonstrated the feasibility of spiral CT scanning in screening for lung cancer. In the Early Lung Cancer Action Project (ELCAP), 1,000 asymptomatic persons older than 60 years who had a smoking history of 10 or more pack-years underwent both spiral CT and chest x-ray. CT detected malignant nodules in 2.7% of the patients, compared with 0.6% by chest x-ray. Benign nodules were detected at a rate of 20.6% by CT, compared with 6.1% by chest x-ray; consequently, careful follow-up is critical for avoiding unnecessary biopsy. A Mayo Clinic study of spiral CT also demonstrated enhanced detection of malignant nodules, most of which were early-stage lung cancer; however, the high yield of benign nodules (60%) detected on spiral CT emphasizes the potential drawback of this technique. At present, no data from randomized trials exist to allow an evidence-based recommendation either for or against lung cancer screening.
  21. A. Find out what information he already has. It is best to establish baseline information first.
  22. D. Cough or change in a chronic cough . Cigarette smoke is a carcinogen that irritates and damages the respiratory epithelium. The irritation causes the cough which initially maybe dry, persistent and unproductive. As the tumor enlarges, obstruction of the airways occurs and the cough may become productive due to infection.
  23. D. persistent changing cough . The most common sign of lung cancer is a persistent cough that changes. Other signs are dyspnea, bloody sputum and long term pulmonary infection.
  24. A. An Endobronchial Ultrasound helps with the staging of a tumor. A bronchoscope is inserted into the lung with an ultrasound on the tip. There is a slot that houses a needle to biopsy the lymph nodes. 
  25. B. cancer of the lung . The incidence of lung cancer is also rapidly rising in women.
  26. D. Due to small bronchi 
  27. A. miosis, partial eyelid ptosis, and anhidrosis on the affected side of the face. Horner’s syndrome, which occurs when a lung tumor invades the ribs and affects the sympathetic nerve ganglia, is characterized by miosis, partial eyelid ptosis, and anhidrosis on the affected side of the face. Chest pain, dyspnea, cough, weight loss, and fever are associated with pleural tumors. Arm and shoulder pain and atrophy of the arm and hand muscles on the affected side suggest Pancoast’s tumor, a lung tumor involving the first thoracic and eighth cervical nerves within the brachial plexus. Hoarseness in a client with lung cancer suggests that the tumor has extended to the recurrent laryngeal nerve; dysphagia suggests that the lung tumor is compressing the esophagus.

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