Principles And Practice Of Radiation Therapy 4th Edition By Charles M. – Test Bank

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Chapter 05: Detection and Diagnosis

Washington & Leaver: Principles and Practice of Radiation Therapy, 4th Edition

 

MULTIPLE CHOICE

 

  1. A subjective indication of a disease or a change in condition as perceived by the patient is a ________.
a. sign
b. symptom
c. syndrome
d. screening

 

 

ANS:  B

A symptom is a “subjective indication of a disease or a change in condition as perceived by a patient.” A sign is an objective finding by the examiner. A syndrome is a set of signs and symptoms arising from a common cause.

 

REF:   p. 88

 

  1. Making a fist and pounding gently onto the posterior abdomen, over a kidney area, is an example of which of the following physician’s exam?
a. Percussion
b. Auscultation
c. Palpation
d. Inspection

 

 

ANS:  A

Percussion differs from palpation in that it is the act of striking or tapping the patient gently. Pounding one’s fist gently over one’s kidney area would not produce pain. If that patient has an underlying kidney infection, percussion could cause more severe pain.

 

REF:   p. 91

 

  1. Which of the following is not considered one of the four senses?
a. Sight
b. Touch
c. Taste
d. Smell

 

 

ANS:  C

The four senses are sight, touch, hearing, and smell. The sense of smell is one of the most valuable tools in assessing a patient. Examples related to smell consist of breath, sputum, vomitus, feces, urine, and pus.

 

REF:   pp. 90-91

 

  1. The chance of developing invasive breast cancer at some time in a woman’s life is approximately 1 out of every ______ women.
a. 5
b. 7
c. 8
d. 10

 

 

ANS:  C

Breast cancer is the most common cancer among American women, except for skin cancer. The chance of developing invasive breast cancer at some time in a woman’s life is 1 in 8 (20%).

 

REF:   p. 98

 

  1. Which of the following is a normal white blood count?
a. 3.9 to 5.4 million/mm3
b. 3,900 to 10,800/mm3
c. 12 to 16 million/mm3
d. 150,000 to 425.000/mm3

 

 

ANS:  B

Normal ranges for white blood cells are 3,900 to 10,800/mm3.

 

REF:   p. 101, table 5-8

 

  1. Examples of facilitating verbal responses include all except which of the following?
a. “I understand.”
b. “This is just part of the aging process.”
c. “How much did it hurt?”
d. “I see you are very angry.”

 

 

ANS:  B

Some of the verbal responses that can facilitate the interview are minimal responses, reflecting feelings, and seeking clarification. Responses that may hinder the interview are the use of social clichés, imposition of the interviewer’s own values, and devaluing or minimizing the patient’s feelings or responses. In addition, the interviewer should present himself or herself as unhurried, interested, and sympathetic to the patient.

 

REF:   p. 90, table 5-2

 

  1. In the TNM staging system, what does the “T” indicate?
a. Metastases
b. Nodal status
c. Primary tumor
d. Grade of the tumor

 

 

ANS:  C

In the TNM clinical classification (Table 5-10), T indicates the primary tumor, size, and extent; N indicates the involved region lymph nodes that are assessable; and M indicates distant metastasis.

 

REF:   p. 103, table 5-9

 

  1. What was the leading site of new cancer cases in females in 2013?
a. Lung
b. Colon
c. Cervix
d. Breast

 

 

ANS:  D

The American Cancer Society, Inc., Surveillance Research, 2013, indicates that breast cancer is still the estimated leading site of new cancers in women. The estimated leading cause of death is cancer of the lung and bronchus.

 

REF:   p. 90

 

  1. Most screening studies can be grouped into which of the following major categories?
  2. Laboratory studies
  3. Imaging studies

III.  Vital signs

  1. Observation
a. I and II
b. II and III
c. II and IV
d. III and IV

 

 

ANS:  A

Most screening studies can be grouped into two major categories: (1) laboratory studies and (2) medical imaging. Observation and vital signs fall under the physical examination information that the physician may be gathering to detect variations of the normal state of the patient. Specific screening is performed for patients who are symptomatic, undergoing treatment, or being followed.

 

REF:   pp. 93-94

 

  1. What is the leading site of cancer resulting in deaths in males and females from studies in 2013?
a. Lung and bronchus
b. Colon and rectum
c. Brain
d. Head and neck

 

 

ANS:  A

The leading site of cancer resulting in deaths for 2013, according to the American Cancer Society, was lung and bronchus.

 

REF:   p. 88, call out

 

  1. The American Cancer Society strongly recommends mass screening for all except which of the following?
a. Breast cancer
b. Lung cancer
c. Prostate cancer
d. Colorectal cancer

 

 

ANS:  B

At present, no organization recommends testing for early lung cancer detection in asymptomatic individuals at risk for lung cancer. However, the growth of spiral computed tomography (CT) to test for lung cancer detection of former and current smokers led the American Cancer Society to update its 2001 narrative on lung cancer testing, emphasizing the importance of decisions among individuals at risk seeking testing.

 

REF:   pp. 93-96|p. 99

 

  1. Which of the following statements are incorrect?
a. Ultrasonography uses high-frequency sound waves.
b. CT scans have a higher resolution than radiographs.
c. Magnetic resonance imaging (MRI) scans use ionizing radiation.
d. Most invasive procedures provide some risk to the patient.

 

 

ANS:  C

Unlike CT, the MRI scanner does not use ionizing radiation to produce an image. The MRI creates images of the body by using a combination of radiofrequency waves and a strong magnetic field. Ultrasonography images are produced by high-frequency sound waves, and any invasive procedure would put a patient at some risk.

 

REF:   pp. 101-102

 

  1. One part of the staging by the American Joint Committee on Cancer (AJCC) is called histologic type; this refers to which of the following?
a. Staging of the cell
b. Cell type
c. Differentiation of the cell
d. Grading of the cell

 

 

ANS:  B

Histologic type indicates the type of cell making up the tumor. Surgical/pathologic staging offers the most accurate information about the tumor and the extent of disease spread. A biopsy is often obtained during surgical staging.

 

REF:   p. 103

 

  1. Which of the following are parts of the medical record?
  2. Lab results
  3. Medical history

III. Simulation and treatment related images

a. I and II
b. I and III
c. II and III
d. I, II, and III

 

 

ANS:  D

The medical record contains the medical history, results of laboratory tests and medical procedures, progress notes, copies of consent forms, correspondence, and even images produced in the radiation therapy department. Images in the radiation department would include simulation and treatment-related images.

 

REF:   pp. 89-90

 

  1. Mass screening is based on all except which of the following?
a. Specific results obtained
b. Cost-effectiveness
c. Risk to the patient
d. Geographic location

 

 

ANS:  D

Cancer screening is part of the second level of health promotion. The determination to perform mass screening is based on the results obtained, cost-effectiveness, and risk to the patient.

 

REF:   pp. 93-94

 

  1. A physician used auscultation, the act of listening to sounds within the body. The instrument often used in this procedure is the ____________.
a. sphygmomanometer
b. stethoscope
c. pulse oximeter
d. flowmeter

 

 

ANS:  B

With a stethoscope, a physician or nurse performs auscultation to listen to sounds of the lungs, heart, arteries, stomach, and bowel.

 

REF:   p. 91

 

  1. Vital signs include all except which of the following?
a. Temperature
b. Pulse
c. Oxygen analysis
d. Blood pressure

 

 

ANS:  C

Vital signs include temperature, pulse, respirations, blood pressure, and (now by The Joint Commission) pain.

 

REF:   p. 92

 

  1. The diastolic norm would be within a range of which of the following?
a. 40 to 50 mm Hg
b. 60 to 80 mm Hg
c. 110 to 140 mm Hg
d. 140 to 160 mm Hg

 

 

ANS:  B

The normal diastolic range for blood pressure is 60 to 80 mm Hg.

 

REF:   p. 92, table 5-4

 

  1. Which of the following is an advantage of digital mammography over conventional mammography with x-ray film?
  2. Images are displayed on a computer monitor.
  3. Images can be manipulated (lightened or darkened) by the radiologist.

III. Images can be stored and retrieved.

a. I and II
b. II and III
c. I and III
d. I, II, and III

 

 

ANS:  D

Digital mammography can be very advantageous over conventional mammography. Images are displayed on a computer monitor and can be manipulated by the radiologist by lightening or darkening, as well as by zooming in on suspicious areas for more careful inspection. They also can be stored and retrieved electronically, which makes it easier for long-distance consultation.

 

REF:   pp. 95-96

 

  1. Which of the following factors would not be observed when assessing respiration?
  2. Rate
  3. Rhythm

III. Character

a. I and II
b. II and III
c. I and III
d. I, II, and III

 

 

ANS:  D

All of these factors are observed during the evaluation of respiration. Rate is the breaths per minute, depth refers to shallow or deep breathing, and rhythm refers to the regularity of the breathing.

 

REF:   p. 92

 

  1. Which of the following is a more widely accepted procedure for assessing axillary node status once the primary breast tumor has been identified?
a. Specificity testing
b. Predictive value testing
c. Sentinel lymph node
d. Axillary node surgery

 

 

ANS:  C

The sentinel lymph node procedure focuses on finding lymph nodes that are the first to receive draining fluid from breast tumor and, therefore, the first to collect cancer cells. A blue dye or radioactive substance is injected near the tumor site and is then absorbed locally through the lymph system traveling to the sentinel node(s).

 

REF:   p. 96

 

  1. In which of the following modalities might the patient be injected with a radionuclide, making the patient radioactive for an image?
a. Medical radiography
b. Nuclear medicine
c. Ultrasonography
d. CT

 

 

ANS:  B

Nuclear medicine imaging introduces a special radionuclide (radioactive substance) into the patient. It is a radioisotope that undergoes radioactive decay. After injection into the patient, it follows a specific metabolic pathway in the body. Then the patient undergoes imaging.

 

REF:   pp. 101-102

 

  1. An example of an exfoliative cytologic study could be demonstrative in which of the following?
  2. Cervix
  3. Lung

III. Brain

a. I and II
b. II and III
c. I and III
d. I, II, and III

 

 

ANS:  A

Exfoliative cells are usually scraped off or sloughed off naturally. They are found in the urine, sputum, feces, and mucus. They are extremely helpful in identifying neoplastic disease, especially in cases of cervical and lung cancer.

 

REF:   p. 102

 

  1. Which of the following indicates a hematocrit value within normal limits for a healthy 40-year-old woman?
a. 20%
b. 30%
c. 40%
d. 50%

 

 

ANS:  C

Normal range for women is 37% to 47%. At certain times, women run a slightly lower hematocrit due to the menstrual cycle.

 

REF:   p. 101, table 5-8

 

  1. Lymphadenopathy in the axilla area could be an indication of cancer spread from which of the following?
a. Breast
b. Larynx
c. Lung
d. Thyroid

 

 

ANS:  A

Lymphadenopathy is defined as swelling of any lymph nodes, particularly superficial lymph nodes, which can be palpated by a physician during a physical exam. Lymph node status is the most important prognostic indicator and is a significant aspect of staging.

 

REF:   pp. 95-96

 

 

 

 

Chapter 26: Electronic Charting and Image Management

Washington & Leaver: Principles and Practice of Radiation Therapy, 4th Edition

 

MULTIPLE CHOICE

 

  1. Which of the following is the most important step in the implementation of an electronic medical chart?
a. Staff education
b. Configuration
c. Problem-solving
d. Data gathering

 

 

ANS:  A

The most important step in implementing an electronic medical chart is educating the staff. The benefits of the system will be lost if not optimally used by the staff. Ongoing staff education is essential to the success of electronic medical charting.

 

REF:   p. 550

 

  1. What communication standards are shaped by a joint committee of the National Electronic Manufacturers Association (NEMA) and the American College of Radiology (ACR)?
a. Data entry
b. HIPAA
c. DICOM
d. HL7

 

 

ANS:  C

Digital imaging and communications in medicine standards are produced by the joint committee of the NEMA and the ACR. The committee provides communication standards for sharing imaging information.

 

REF:   p. 559

 

  1. Electronic medical records (EMRs) provide which benefits over paper-based records?
  2. Improved efficiency
  3. Enhanced patient privacy and security

III. Improved accessibility to medical information

a. I and II
b. I and III
c. II and III
d. I, II, and III

 

 

ANS:  B

Data from EMRs are more easily accessed and sorted. The accessibility of electronic records aid caregivers but pose a risk to patient privacy and security.

 

REF:   pp. 550-551

 

  1. HIPAA provides guidelines and regulations for which of the following?
a. Computerizing medical records
b. Patients’ right and responsibilities
c. Standards of care
d. Use and disclosure of patient information

 

 

ANS:  D

HIPAA guidelines and regulations require security precautions to not only restrict access but also keep records of who is accessing information.

 

REF:   p. 556

 

  1. HL7 is responsible for developing standards for which of the following?
a. Exchanging clinical data
b. Sharing image information
c. Security and privacy
d. Data entry

 

 

ANS:  A

HL7 is an American National Standards Institute accredited organization that develops standards for exchanging clinical and administrative data.

 

REF:   p. 559

 

  1. What are standards of care?
a. Set of education standards for a profession
b. Compilation of the customs and behaviors of a profession
c. Set of moral and religious conduct
d. All of the above

 

 

ANS:  B

Standards of care derive from compiling the customs and behavior of the members of the profession.

 

REF:   p. 554

 

  1. What is an information system designed for the collection, management, and analysis of data on a person with a malignant disease?
a. Data gathering
b. DICOM
c. Cancer registry
d. PACS

 

 

ANS:  C

A cancer registry is an information system designed for the collection, management, and analysis of data on persons with a malignant disease.

 

REF:   p. 555

 

  1. Which is information gathered during initial patient examinations?
  2. Chief complaint
  3. History and physical examination

III. Review of systems

a. I and II
b. I and III
c. I only
d. I, II, and III

 

 

ANS:  D

Initial presentation and plan for assessment and treatment are described in the history and physical examination. The chief complaint or reason for the visit is recorded. The review of systems includes signs and symptoms leading a person to the doctor.

 

REF:   pp. 551-552

 

  1. Which communication standards are routinely applied in radiation therapy EMRs?
  2. HL7
  3. DICOM

III. PACS

a. I and II
b. II and III
c. I and III

 

 

ANS:  A

Two communication standards routinely applied in radiation therapy EMRs are HL7 and DICOM.

 

REF:   p. 559

 

  1. All of the following except which personnel provide support for EMRs?
a. System analyst
b. Network specialist
c. Engineers
d. Information systems specialist

 

 

ANS:  C

The system analyst, network specialist, hardware specialist, and members of the information systems team manage an array of requirements from supporting the system infrastructure to ensuring that it is used efficiently by clinicians and staff.

 

REF:   p. 551

 

  1. _______ is a computer network covering a small geographic area.
a. A local area network (LAN)
b. WAN
c. PACS
d. DICOM

 

 

ANS:  A

A LAN is geographically confined to an area in which a common communication service may be used.

 

REF:   p. 557

 

  1. What is the most common method for restricting unauthorized access to EMRs?
a. Passwords
b. Fingerprints
c. Retinal scans
d. Both a and b

 

 

ANS:  A

Passwords are currently the most common method of restricting access to the electronic chart and in conjunction with security privileges.

 

REF:   p. 556

 

  1. The complexity of linear accelerators needs the integration of which of the following to guide and monitor the physical settings required for the delivery of complex treatment plans?
a. Verification and record systems
b. IMRT
c. DICOM
d. PACS

 

 

ANS:  A

The complexity of linear accelerators increasingly necessitates the integration of verification and record systems to guide and monitor the physical settings required for the delivery of complex treatment plans.

 

REF:   p. 557

 

  1. Centralization of patient medical history in the EMR does which of the following?
a. Enhances patient privacy
b. Improves safety and efficiency
c. Improves the decision-making process
d. Both b and c

 

 

ANS:  D

Centralization of patient medical history in the EMR provides the foundation for improved safety and efficiency resulting from fully informed decision making.

 

REF:   pp. 551-553

 

  1. Quality and accuracy in documenting medical records are governed by which of the following?
a. Professional guidelines
b. Hospital guidelines
c. Regulatory boards
d. The health department

 

 

ANS:  A

Caregivers follow professional guidelines to ensure that medical record keeping maintains community standards of quality and accuracy.

 

REF:   p. 560

 

  1. Who is responsible for the quality of the EMR?
a. Patients
b. Hospital administrators
c. Information systems personnel
d. Caregivers

 

 

ANS:  D

Errors or poor documentation are potential sources of harm; therefore, each caregiver is responsible for the character of the record.

 

REF:   p. 560

 

  1. All except which of the following medical personnel are involved in the radiation oncology record?
a. Radiation therapists
b. Radiation oncologists
c. Nurses
d. Physical therapists

 

 

ANS:  D

Within a radiation oncology department, many clinical and administrative staff members use the patient’s chart. These may include physicians, radiation therapists, physicists, medical dosimetrists, nurses, tumor registrars, and administrative staff.

 

REF:   p. 559

 

  1. Each member of the radiation oncology team contributes documentation for which of the following?
  2. Treatment plan
  3. Treatment delivery

III. Follow-up care

a. I only
b. I and II
c. I, II, and III
d. I and III

 

 

ANS:  C

The compilation of each team member’s contribution comprises a radiation oncology record documenting the rationale, plan, delivery, and follow-up care given the patient in the specialty clinic.

 

REF:   p. 559

 

  1. Which of the following does not describe EMR?
a. Digital
b. Paperless
c. Easy accessibility
d. Requires little or no training

 

 

ANS:  D

Education and training need to occur prior to the initial use of the software and then continue over time. Staff development is typically included with the purchase of complex systems and may be delivered through a variety of methods.

 

REF:   p. 559

 

  1. _______ facilitate the use of wireless PDAs, laptops, and other pervasive computing devices at the point of care.
a. LANs
b. WLANs
c. ASPs
d. Mans

 

 

ANS:  B

Wireless local area networks (WLANs) are increasingly popular in clinical settings because they facilitate the use of wireless PDAs, laptops, and other pervasive computing devices at the point of care.

 

REF:   p. 557

 

  1. _______ refers to the graphic, textual, and auditory information the program presents to the user and the input methods the user employs to control the program.
a. Data entry
b. Proprietary interface
c. User interface (UI)
d. Standards-based interface

 

 

ANS:  C

The UI of the EMR refers to the graphic, textual, and auditory information the program presents to the user and the input methods the user employs to control the program.

 

REF:   p. 559

 

  1. The design of the interface affects the amount of the time the user spends to perform which of the following?
a. Input information
b. Interpret the output
c. Neither a nor b
d. Both a and b

 

 

ANS:  D

The design of a user interface affects the amount of effort the user must expend to input information into the system, interpret the output of the system, and learn how to do both of these things.

 

REF:   pp. 558-559

 

  1. _______ is the degree to which the design of a particular user interface takes into account how that piece of the software fits into the overall patient visit and the logic that is required by the user to figure out how to use it.
a. Usability
b. User interface
c. Standards-based interface
d. Proprietary interface

 

 

ANS:  A

Usability is the degree to which the design of a particular user interface takes into account how that piece of the software fits into the overall patient visit and the logic that is required by the user to figure out how to use it.

 

REF:   p. 561

 

  1. Which communication systems can be wasteful of time and resources during development and add difficulty for users?
a. HL7
b. Proprietary interfaces
c. User interfaces
d. Standards-based interfaces

 

 

ANS:  B

Proprietary systems can waste time and resources during development as well as add difficulty for users who must understand the variety of capabilities and operating procedures of resulting systems.

 

REF:   p. 558

 

  1. ________ can be defined as an assembly of tasks performed to accomplish a goal.
a. Input methods
b. Workflow
c. Medical record
d. Decision making

 

 

ANS:  B

Workflow can be defined as an assembly of tasks performed to accomplish a goal. The tasks range from the very high level, such as the general path a patient takes moving through the clinic, to the specific procedures that define when the therapist tattoos a patient.

 

REF:   p. 551

 

  1. ________ is (are) online management of the entire order tracking and documentation process from order entry to return of results.
a. EMR
b. Computerized physician order entry (CPOE)
c. Medical imaging
d. All of the above

 

 

ANS:  B

CPOE is online management of the entire order tracking and documentation process from order entry to return of results and is a standard workflow component of an electronic chart.

 

REF:   p. 552

 

  1. Which medical personnel are interested in records and verify systems for the transfer of information between the treatment planning and treatment delivery systems?
a. Physicists
b. Radiation therapists
c. Radiation oncologists
d. Nurses

 

 

ANS:  A

The physicist is interested in accurate transfer of these same settings from the treatment planning to the delivery system and confirmation that they were applied at treatment.

 

REF:   p. 552

 

  1. Treatment planning and delivery systems are rapidly evolving to accomplish all except which of the following?
a. Increase tumor effects
b. Reduce normal tissue damage
c. Improve patient safety
d. Decrease patient care

 

 

ANS:  D

Treatment planning and delivery systems incorporate rapidly changing technology to increase tumor effects while reducing normal tissue damage.

 

REF:   p. 552

 

  1. What series of events does a patient referred to radiation oncology typically follow?
  2. Consultation
  3. Treatment delivery

III. Simulation

a. I and II
b. I, III, and II
c. I, II, and III
d. I and III

 

 

ANS:  B

Looking specifically at a patient who has been referred to radiation oncology, the typical series of events is consultation, decision to treat, simulation, verification of treatment plan, treatment delivery, monitoring of response, and follow-up.

 

REF:   p. 554, figure 26-3

 

  1. What is the most widely used mechanism for data entry?
a. Voice recognition systems
b. Keyboard and mouse
c. Scanners
d. Signature pads

 

 

ANS:  B

The most widely used mechanism for data entry has been, and continues to be, the keyboard and mouse.

 

REF:   p. 550

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