1. Answer: 3.

Myocardial Infarction
Complications of Hodgkins are pancytopenia, nausea, and infection. Cardiac involvement usually doesnt
occur.
2. Answer: 3. Thrombocytopenia and increased lymphocytes
Chronic lymphocytic leukemia shows a proliferation of small abnormal mature B lymphocytes and decreased
antibody response. Thrombocytopenia also is often present. Uncontrolled proliferation of granulocytes
occurs in myelogenous leukemia.
3. Answer: 4. Neck
At the time of diagnosis, a painless cervical lesion is often present. The back, chest, and groin areas arent
involved.
4. Answer: 3. Involvement of two or more lymph node regions or structures.
Stage II involves two or more lymph node regions. Stage I only involves one lymph node region; stage III
involves nodes on both sides of the diaphragm; and stage IV involves extralymphatic organs or tissues.
5. Answer: 3. Faster growing cells are more susceptible to chemotherapy
The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy. Slow-growing
and non-dividing cells are less susceptible to chemotherapy. Repeated cycles of chemotherapy are used to
destroy nondividing cells as they begin active cell division.
6. Answer: 2. Carrot sticks
A low-bacteria diet would be indicated with excludes raw fruits and vegetables.
7. Answer: 4. Breath sounds
Pneumonia, both viral and fungal, is a common cause of death in clients with neutropenia, so frequent
assessment of respiratory rate and breath sounds is required. Although assessing blood pressure, bowel
sounds, and heart sounds is important, it wont help detect pneumonia.
8. Answer: 4. A 60-year-old Black man

Multiple myeloma is more common in middle-aged and older clients (the median age at diagnosis is 60
years) and is twice as common in Blacks as Whites. It occurs most often in Black men.
9. Answer: 1. Immunoglobulins
MM is characterized by malignant plasma cells that produce an increased amount of immunoglobulin that
isnt functional. As more malignant plasma cells are produced, theres less space in the bone marrow for
RBC production. In late stages, platelets and WBCs are reduced as the bone marrow is infiltrated by
malignant plasma cells.
10. Answer: 1. Hypercalcemia
Calcium is released when the bone is destroyed. This causes an increase in serum calcium levels. MM
doesnt affect potassium, sodium, or magnesium levels.
11. Answer: 4. Ovarian cancer
Clients with ovarian cancer are at increased risk for breast cancer. Breast self-examination supports early
detection and treatment and is very important.
12. Answer: 4. Increased vascularity of the breast
Increase in breast size or vascularity is consistent with cancer of the breast. Early menarche as well as
late menopause or a history of anovulatory cycles are associated with fibrocystic disease. Masses
associated with fibrocystic disease of the breast are firm, most often located in the upper outer quadrant of
the breast, and increase in size prior to menstruation. They may be bilateral in a mirror image and are
typically well demarcated and freely moveable.
13. Answer: 3. Squamous cell
Squamous cell carcinoma is a slow-growing, rarely metastasizing type of cancer. Adenocarcinoma is the
next best lung cancer to have in terms of prognosis. Oat cell and small cell carcinoma are the same. Small
cell carcinoma grows rapidly and is quick to metastasize.
14. Answer: 4. Recurrent pleural effusion

Recurring episodes of pleural effusions can be caused by the tumor and should be investigated. Dizziness,
generalized weakness, and hypotension arent typically considered warning signals, but may occur in
advanced stages of cancer.
15. Answer: 1. Coughing
Centrally located pulmonary tumors are found in the upper airway (vocal cords) and usually obstruct airflow,
producing such symptoms as coughing, wheezing, and stridor. Small cell tumors tend to be located in the
lower airways and often cause hemoptysis. As the tumor invades the pleural space, it may cause pleuritic
pain. Pancoast tumors that occur in the apices may cause shoulder pain.
16. Answer: 2. Early detection
Early detection of cancer when the cells may be premalignant and potentially curable would be most
beneficial. However, a tumor must be 1 cm in diameter before its detectable on a chest x-ray, so this is
difficult. A bronchoscopy may help identify cell type but may not increase survival rate. High-dose
chemotherapy has minimal effect on long-term survival. Smoking cessation wont reverse the process but
may help prevent further decompensation.
17. Answer: 3. A small, localized area near the surface of the lung.
A small area of tissue close to the surface of the lung is removed in a wedge resection. An entire lung is
removed in a pneumonectomy. A segment of the lung is removed in a segmental resection and a lobe is
removed in a lobectomy.
18. Answer: 4. The remaining lobe or lobes overexpand to fill the space.
The remaining lobe or lobes overexpand slightly to fill the space previously occupied by the removed tissue.
The diaphragm is carried higher on the operative side to further reduce the empty space. The space cant
remain empty because truly empty would imply a vacuum, which would interfere with the intrathoracic
pressure changes that allow breathing. The surgeon doesnt use a gel to fill the space. Serous fluid
overproduction would compress the remaining lobes, diminish their function and possibly, cause a
mediastinal shift.
19. Answer: 2. To remove the tumor and as little surrounding tissue as possible.

The goal of surgical resection is to remove the lung tissue that has a tumor in it while saving as much
surrounding tissue as possible. It may be necessary to remove alveoli and bronchioles, but care is taken to
make sure only whats absolutely necessary is removed.
20. Answer: 4. It may prevent surgery if the client cant tolerate lung tissue removal.
If the clients preexisting pulmonary disease is restrictive and advanced, it may be impossible to remove the
tumor, and the client may have to be treated with on;t chemotherapy and radiation.
21. Answer: 4. The tumor is removed, involving the least possible amount of tissue.
The tumor is removed to prevent further compression of the lung tissue as the tumor grows, which could lead
to respiratory decompensation. If for some reason it cant be removed, then radiation or chemotherapy may
be used to try to shrink the tumor.
22. Answer: 3. Provide pain control
The client with terminal lung cancer may have extreme pleuritic pain and should be treated to reduce his
discomfort. Preparing the client and his family for the impending death and providing emotional support is
also important but shouldnt be the primary focus until the pain is under control. Nutritional support may be
provided, but as the terminal phase advances, the clients nutritional needs greatly decrease. Nursing care
doesnt focus on helping the client prepare the will.
23. Answer: 3. Histologic type of disease, initial WBC count, and clients age at diagnosis
The factor whose prognostic value is considered to be of greatest significance in determining the long-range
outcome is the histologic type of leukemia. Children with a normal or low WBC count appear to have a much
better prognosis than those with a high WBC count. Children diagnosed between ages 2 and 10 have
consistently demonstrated a better prognosis because age 2 or after 10.
24. Answer: 2. Anemia, infection, and bleeding tendencies
The three main consequences of leukemia are anemia, caused by decreased erythrocyte production;
infection secondary to neutropenia; and bleeding tendencies, from decreased platelet production. Bone
deformities dont occur with leukemia although bones may become painful because of the proliferation of
cells in the bone marrow. Spherocytosis refers to erythrocytes taking on a spheroid shape and isnt a feature
in leukemia. Mature cells arent produced in adequate numbers. Hirsutism and growth delay can be a result

of large doses of steroids but isnt common in leukemia. Anemia, not polycythemia, occurs. Clotting times
would be prolonged.
25. Answer: 4. Petechiae
The most frequent signs and symptoms of leukemia are a result of infiltration of the bone marrow. These
include fever, pallor, fatigue, anorexia, and petechiae, along with bone and joint pain. Increased appetite can
occur but it usually isnt a presenting symptom. Abdominal pain may be caused by areas of inflammation
from normal flora within the GI tract or any number of other causes.
26. Answer: 1. Headache and vomiting.
The usual effect of leukemic infiltration of the brain is increased intracranial pressure. The proliferation of
cells interferes with the flow of cerebrospinal fluid in the subarachnoid space and at the base of the brain.
The increased fluid pressure causes dilation of the ventricles, which creates symptoms of severe headache,
vomiting, irritability, lethargy, increased blood pressure, decreased heart rate, and eventually, coma. Often
children with a variety of illnesses are hypervigilant and anxious when hospitalized.
27. Answer: 1. Acute lymphoblastic leukemia
Acute lymphoblastic leukemia, which accounts for more than 80% of all childhood cases, carries the best
prognosis. Acute myelogenous leukemia, with several subtypes, accounts for most of the other leukemias
affecting children. Basophilic and eosinophilic leukemia are named for the specific cells involved. These are
much rarer and carry a poorer prognosis.
28. Answer: 4. To assess for central nervous system infiltration
A spinal tap is performed to assess for central nervous system infiltration. It wouldnt be done to decrease
ICP nor does it aid in the classification of the leukemia. Spinal taps can result in brain stem herniation in
cases of ICP. A spinal tap can be done to rule out meningitis but this isnt the indication for the test on a
leukemic client.
29. Answer: 2. Liver function studies
Liver and kidney function studies are done before initiation of chemotherapy to evaluate the childs ability to
metabolize the chemotherapeutic agents. A CBC is performed to assess for anemia and white blood cell
count. A peripheral blood smear is done to assess the maturity and morphology of red blood cells. A lumbar
puncture is performed to assess for central nervous system infiltration.

30. Answer: 4. Oral poliovirus vaccine (OPV)

OPV is a live attenuated virus excreted in the stool. The excreted virus can be communicated to the
immunosuppressed child, resulting in an overwhelming infection. Inactivated polio vaccine would be
indicated because it isnt a live virus and wouldnt pose the threat of infection. DTP, Hib, and hepatitis B
vaccines can be given accordingly to the recommended schedule.
31. Answer: 1. Bactrim
The most frequent cause of death from leukemia is overwhelming infection. P. carinii infection is lethal to a
child with leukemia. As prophylaxis against P. carinii pneumonia, continuous low doses of co-trimoxazole
(Bactrim) are frequently prescribed. Oral nystatin suspension would be indicated for the treatment of thrush.
Prednisone isnt an antibiotic and increases susceptibility to infection. Vincristine is an antineoplastic agent.
32. Answer: 1. Acute lymphocytic leukemia
For the first episode of acute lymphocytic anemia, conventional therapy is superior to bone marrow
transplantation. In severe combined immunodeficiency and in severe aplastic anemia, bone marrow
transplantation has been employed to replace abnormal stem cells with healthy cells from the donors
marrow. In myeloid leukemia, bone marrow transplantation is done after chemotherapy to infuse healthy
marrow and to replace marrow stem cells ablated during chemotherapy.
33. Answer: 4. VZIG should be given within 72 hours of exposure.
Varicella is a lethal organism to a child with leukemia. VZIG, given within 72 hours, may favorably alter the
course of the disease. Giving the vaccine at the onset of symptoms wouldnt likely decrease the severity of
the illness. Acyclovir may be given if the child develops the disease but not if the child has been exposed.
34. Answer: 1. 30 minutes before the initiation of therapy.
Antiemetics are most beneficial when given before the onset of nausea and vomiting. To calculate the
optimum time for administration, the first dose is given 30 minutes to 1 hour before nausea is expected, and
then every 2, 4, or 6 hours for approximately 24 hours after chemotherapy. If the antiemetic was given with
the medication or after the medication, it could lose its maximum effectiveness when needed.
35. Answer: 3. Within 5 to 8 weeks

Postirradiation somnolence may develop 5 to 8 weeks after CNS irradiation and may last 3 to 15 days. Its
characterized by somnolence with or without fever, anorexia, nausea, and vomiting. Although the syndrome
isnt thought to be clinically significant, parents should be prepared to expect such symptoms and encourage
the child needed rest.
36. Answer: 2. The best time for the examination is after a shower
The testicular-self examination is recommended monthly after a warm shower or bath when the scrotal skin
is relaxed. The client should stand to examine the testicles. Using both hands, with the fingers under the
scrotum and the thumbs on top, the client should gently roll the testicles, feeling for any lumps.
37. Answer: 3. Low-fat and high-fiber diets
Viruses may be one of multiple agents acting to initiate carcinogenesis and have been associated with
several types of cancer. Increased stress has been associated with causing the growth and proliferation of
cancer cells. Two forms of radiation, ultraviolet and ionizing, can lead to cancer. A diet high in fat may be a
factor in the development of breast, colon, and prostate cancers. High-fiber diets may reduce the risk of
colon cancer.
38. Answer: 3. Monitoring the platelet count
Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern
is monitoring for and preventing bleeding. Option 2 relates to monitoring for infection particularly if
leukopenia is present. Options 1 and 4, although important in the plan of care are not related directly to
thrombocytopenia.
39. Answer: 4. Malignant proliferation of plasma cells and tumors within the bone.
Multiple myeloma is a B cell neoplastic condition characterized by abnormal malignant proliferation of
plasma cells and the accumulation of mature plasma cells in the bone marrow. Option 1 describes the
leukemic process. Options 2 and 3 are not characteristics of multiple myeloma.
40. Answer: 3. Increased calcium levels
Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow,
anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated
blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related
specifically to multiple myeloma.

41. Answer: 2. Encouraging fluids

Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The
nurse should administer fluids in adequate amounts to maintain and output of 1.5 to 2 L a day. Clients
require about 3 L of fluid pre day. The fluid is needed not only to dilute the calcium overload but also to
prevent protein from precipitating in renal tubules. Options 1, 3, and 4 may be components in the plan of
care but are not the priority in this client.
42. Answer: 3. Occurs most often in the older client
Hodgkins disease is a disorder of young adults. Options 1, 2, and 4 are characteristics of this disease.
43. Answer: 1. Assess level of consciousness
A high risk of hemorrhage exists when the platelet count is fewer than 20,000. Fatal central nervous system
hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is fewer than 10,000.
The client should be assessed for changes in levels of consciousness, which may be an early indication of
an intracranial hemorrhage. Option 2 is a priority nursing assessment when the white blood cell count is low
and the client is at risk for an infection.
44. Answer: 4. Arm edema on the operative side
Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur
immediately postoperatively or may occur months or even years after surgery. The other options are
expected occurrences.
45. Answer: 4. Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun
exposure.
A sunscreen with a SPF of 15 or higher should be worn on all sun-exposed skin surfaces. It should be
applied before sun exposure and reapplied after being in the water. Peak sun exposure usually occurs
between 10am to 2pm. Tightly woven clothing, protective hats, and sunglasses are recommended to
decrease sun exposure. Suntanning parlors should be avoided.
46. Answer: 3. Teaching and encouraging pursed-lip breathing
For clients with obstructive versus restrictive disorders, extending exhalation through pursed-lip breathing will
make the respiratory effort more efficient. The usual position of choice for this client is the upright position,

leaning slightly forward to allow greater lung expansion. Teaching diaphragmatic breathing techniques will be
more helpful to the client with a restrictive disorder. Administering cough suppressants will not help
respiratory effort. A low semi-Fowlers position does not encourage lung expansion. Lung expansion is
enhanced in the upright position.
47. Answer: 1. Fever
Fever is an early sign requiring clinical intervention to identify potential causes. Chills and dyspnea may or
may not be observed. Tachycardia can be an indicator in a variety of clinical situations when associated with
infection; it usually occurs in response to an elevated temperature or change in cardiac function.
48. Answer: 1. Chemotherapy affects all rapidly dividing cells.
There are many mechanisms of action for chemotherapeutic agents, but most affect the rapidly dividing cells
both cancerous and noncancerous. Cancer cells are characterized by rapid cell division. Chemotherapy
slows cell division. Not all chemotherapeutic agents affect molecular structure. All cells are susceptible to
drug toxins, but not all chemotherapeutic agents are toxins.
49. Answer: 1, 2, 4, 5.
A major concern with intravenous administration of cytotoxic agents is vessel irritation or extravasation. The
Oncology Nursing Society and hospital guidelines require frequent evaluation of blood return when
administering vesicant or nonvesicant chemotherapy due to the risk of extravasation. These guidelines apply
to peripheral and central venous lines. In addition, central venous lines may be long-term venous access
devices. Thus, difficulty drawing or aspirating blood may indicate the line is against the vessel wall or may
indicate the line has occlusion. Having the client cough or move position may change the status of the line if
it is temporarily against a vessel wall. Occlusion warrants more thorough evaluation via x-ray study to verify
placement if the status is questionable and may require a declotting regimen.
50. Answer: 3. Metabolic alkalosis
The client is experiencing metabolic alkalosis caused by loss of hydrogen and chloride ions from excessive
vomiting. This is shown by a pH of 7.46 and elevated bicarbonate level of 29 mEq/L.
51. Answer: 4. Ask open-ended questions about sexuality issues related to her mastectomy
The content of the clients comments suggests that she is avoiding intimacy with her husband by waiting until
he is asleep before going to bed. Addressing sexuality issues is appropriate for a client who has undergone

a mastectomy. Rushing her return to work may debilitate her and add to her exhaustion. Suggesting that she
learn relaxation techniques to help her with her insomnia is appropriate; however, the nurse must first
address the psychosocial and sexual issues that are contributing to her sleeping difficulties. A nutritional
assessment may be useful, but there is no indication that she has anorexia.
52. Answer: 4. Sepsis
Bacterial endotoxins released from gram-negative bacteria activate the Hageman factor or coagulation factor
XII. This factor inhibits coagulation via the intrinsic pathway of homeostasis, as well as stimulating
fibrinolysis. Liver disease can cause multiple bleeding abnormalities resulting in chronic, subclinical DIC;
however, sepsis is the most common cause.
53. Answer: 1. An entire lung field
A pneumonectomy is the removal of an entire lung field. A wedge resection refers to removal of a wedgeshaped section of lung tissue. A lobectomy is the removal of one lobe. Removal of one or more segments of
a lung lobe is called a partial lobectomy.
54. Answer: 2. Low-grade fever, chills, tachycardia
Nine days after chemotherapy, one would expect the client to be immunocompromised. The clinical signs of
shock reflect changes in cardiac function, vascular resistance, cellular metabolism, and capillary
permeability. Low-grade fever, tachycardia, and flushing may be early signs of shock. The client with
impending signs of septic shock may not have decreased oxygen saturation levels. Oliguria and hypotension
are late signs of shock. Urine output can be initially normal or increased.
55. Answer: 4. Medicated cool baths
Nursing interventions to decrease the discomfort of pruitus include those that prevent vasodilation, decrease
anxiety, and maintain skin integrity and hydration. Medicated baths with salicyclic acid or colloidal oatmeal
can be soothing as a temporary relief. The use of antihistamines or topical steroids depends on the cause of
pruritus, and these agents should be used with caution. Using silk sheets is not a practical intervention for
the hospitalized client with pruritis.
56. Answer: 4. Esophagitis
Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis, which is a common
complication of radiation therapy of the chest wall.

1. Answer: B. Annual Pap smear for sexually active women only.

Early detection of cancer is promoted by annual oral examination, monthly BSE from age 20, annual chest xray, yearly digital rectal examination for persons over age 40, annual Pap smear from age 40 and annual
physical and blood examination. Letter B is wrong because it says Pap smear should be done yearly for
sexually active women. All women should have an annual pap smear by age 40 and up whether sexually
active or not.
2. Answer: D. Radical mastectomy
Halstead surgery also called radical mastectomy involves the removal of entire breast, pectoralis major and
minor muscles and neck lymph nodes. It is followed by skin grafting. Removal of the entire breast, pectoralis
major muscle and the axillary lymph nodes is a surgical procedure called modified radical mastectomy.
Simple mastectomy is the removal of the entire breast but the pectoralis muscles and nipples remain intact.
3. Answer: D. All of the above
chemotherapy is contraindicated in cases of infection (chemotherapeutic agents are immunosuppressive),
recent surgery (chemotherapeutic agent may retard the healing process), impaired renal and hepatic
function (drugs are nephrotoxic and hepatotoxic), recent radiation therapy (immunosuppressive treatment),
pregnancy (drugs can cause congenital defects) and bone marrow depression (chemo. Agents may
aggravate the condition).
4. Answer: A. The nurse should wear mask and gloves.
The nurse should be corrected if she is only wearing mask and glove because gowns should also be worn in
handling chemotherapeutic drugs. The vials should be vent after mixing to reduce the internal pressure. Air
bubbles are expelled on wet cotton to prevent the spread of the chemotherapeutic agent particles.
5. Answer: C. Encapsulated
Benign: grows slowly, localized, encapsulated, well differentiated cells, no metastasis, not harmful to host.
Malignant: Grows rapidly, infiltrates surrounding tissues, not encapsulated, poorly differentiated, metastasis
present, always harmful

6. Answer: D. Sudden weight loss of unexplained etiology can be a warning sign of cancer.
Unexplained sudden weight loss is a warning signal of cancer. Letter A is wrong because the sore in cancer
does not heal. Nagging cough not dry cough and hoarseness of voice is a sign of cancer. Presence of lump
is not limited to the breast only; it can grow elsewhere that is why letter C is wrong.
7. Answer: B. Tumor, node, metastasis
TNM stands for tumor, node, and metastasis.
8. Answer: B. BSE palpation is done by starting at the center going to the periphery in a circular
motion.
This client needs further teaching as palpation in BSE should start at the periphery going to the center in a
circular motion.
9. Answer: C. Constipation
Diarrhea not constipation is the side effect of radiation therapy.
10. Answer: C. Aspirin every 4 hours
Radiation therapy makes the platelet count decrease. Thus, nursing responsibilities should be directed at
promoting safety by avoiding episodes of hemorrhage or bleeding such as physical trauma and aspirin
administration. Analgesics are given before meals to alleviate the pain caused by stomatitis. Bland diet and
saline rinses every 2 hours should also be done to manage stomatitis.
11. Answer: C. Washing the area with a mild soap and water and patting it dry not rubbing it.
No soap should be used on the skin of the client undergoing radiation. Soap and irritants and may cause
dryness of the patients skin. Only water should be used in washing the area.
12. Answer A. Metochlopramide (Metozol)
Metochlopramide (Metozol) antiemetic. Succimer (Chemet) chelating agent for lead poisoning.
Anastrazole (Arimidex) hormone regulator. Busulfan (Myleran) alkylating agent
13. Answer: D. 3 feet

The distance of at least 3 feet / 0.9 or 1 meter should be maintained when a nurse is not performing any
nursing procedures.
14. Answer: B. To promote safety, the client is assisted by therapy personnel while the machine is in
operation.
To promote safety to the personnel, the client will remain alone in the treatment room while the machine is in
operation. The client may voice out any concern throughout the treatment because a technologist is just
outside the room observing through a window or closed circuit TV. There is no residual radioactivity after
radiation therapy. Safety precautions are necessary only during the time of actual irradiation. The client may
resume normal activities of daily living afterwards.
15. Answer C: 5 minutes
Principles of Radiation protection follows the DTS system. Distance (D), Time (T) and Shielding (S). Distance
at least 3 feet should be maintained when a nurse is not performing any nursing procedures. Time limit
contact to 5 minutes each time. Shielding use lead shield during contact with client.
16. Answer: D. Hemorrhagic cystitis
Hemorrhagic cystitis is the potentially fatal side effect of Cytoxan. Myeloma is an indication for giving this
medication. Alopecia is a common side effect.
17. Answer: D. Diarrhea
Cytarabine syndrome includes fever, myalgia, bone pain, chest pain, rash, conjunctivitis and malaise. No
diarrhea is included in this syndrome thus; letter D is the best choice.
18. Answer: C. Steroids
Steroids may be prescribed to promote relief from cytarabine syndrome. Allopurinol is given for
hyperurecemia that will result from taking some chemotherapeutic agent.
19. Answer: B. Fluorouracil (Adrucil)
Fluorouracil (Adrucil) is an antimetabolite.
20. Answer: B. Mitotic inhibitor

Vincristine is a mitotic inhibitor

21. Answer: B. Estramustine (Emcyt)
Anstrazole (arimidex)- treatment of advanced breast cancer in post menopausal women following tamoxifen
therapy. Estramustine (Emcyt) palliative treatment of metastatic and progressive prostate cancer. Pclitaxel
(Taxol) treatment of ovarian cancer, breast cancer and AIDS related to Kaposis sarcoma. Irinotecan
(Camptosar)- treatment of metastatic colon or rectal cancer after treatment with 5-FU.
22. Answer: A. I will avoid eating hot and spicy foods.
The client should prevent hot and spicy food because of the stomatitis side effect. The client should avoid
people with infection but should not isolate himself in his room all the time. Fluid intake should be increased.
Urine color change is normal.
23. Answer B. Stage II
Stage I tumor size up to 2 cm. Stage II tumor size up to 5 cm with axillary and neck lymph node
involvement. Stage III tumor size is more than 5 cm with axillary and neck lymph node involvement. Stage
IV metastasis to distant organs (liver, lungs, bone and brain).
24. Answer A. pink peel skin
Classic symptoms that define breast cancer includes: Firm, nontender, nonmobile mass. Solitary, irregularly
shaped mass. Adherence to muscle or skin causing dimpling effect. Involvement of the upper outer quadrant
or central nipple portion. Asymmetry of the breasts. Orange peel skin. Retraction of nipple. Abnormal
discharge from nipple.
25. Answer: B. Modified radical mastectomy
Removal of the entire breast, pectoralis major muscle and the axillary lymph nodes is a surgical procedure
called modified radical mastectomy. Simple mastectomy is the removal of the entire breast but the pectoralis
muscles and nipples remain intact. Halstead surgery also called radical mastectomy involves the removal of
entire breast, pectoralis major and minor muscles and neck lymph nodes. It is followed by skin grafting.
1. Answer: B. It is possible you may have some changes in your sexual function, and you may want
to consider pretreatment harvesting of sperm if you want children.

The impact on sperm count and erectile function depends on the patients pretreatment status and on the
amount of exposure to radiation. The patient should consider sperm donation before radiation. Radiation
(like chemotherapy or surgery) may affect both sexual function and fertility either temporarily or permanently.
2. Answer: A. Why dont we talk about the options you have for the care of your children?
This response expresses the nurses willingness to listen and recognizes the patients concern. The
responses beginning Many patients with cancer live for a long time and For now you need to concentrate
on getting well close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In
addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible
that the patients ex-husband will take the children, more assessment information is needed before making
plans.
3. Answer: D. takes opioids around the clock on a regular schedule and uses additional doses when
breakthrough pain occurs.
For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed
for breakthrough pain. Taking the medications only when pain reaches a certain level does not provide
effective pain control. Although nonopioid analgesics may also be used, there is no maximum dose of opioid.
Opioids are given until pain control is achieved. The IV route is not more effective than the oral route and the
oral route is preferred.
4. Answer: B. enhance the patients immunologic response to tumor cells.
IL-2 enhances the ability of the patients own immune response to suppress tumor cells. IL-2 does not protect
normal cells from damage caused by chemotherapy, stimulate malignant cells to enter mitosis, or prevent
bone marrow depression.
5. Answer: B. I rarely have the energy to get out of bed.
Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms, such as muscle aches
and chills, are common side effects with interferon use. Patients are advised to use Tylenol every 4 hours.
6. Answer: B. WBC count of 1700/l
Neutropenia places the patient at risk for severe infection and is an indication that the chemotherapy dose
may need to be lower or that white blood cell (WBC) growth factors such as filgrastim (Neupogen) are

needed. The other laboratory data do not indicate any immediate life-threatening adverse effects of the
chemotherapy.
7. Answer: A. hospitalization will be required for several weeks after the hematopoietic stem cell
transplant (HSCT).
The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting
for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so
the transplant is not painful, nor is an operating room required. The HSCT takes place 1 or 2 days after
chemotherapy to prevent damage to the transplanted cells by the chemotherapy drugs.
8. Answer: C. Strawberry yogurt
Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high
amounts of protein or fat. Orange sherbet is lower in fat and protein than yogurt. French fries are high in
calories from fat but low in protein.
9. Answer: B. avoid presenting foods for which the patient has a strong dislike.
The patient will eat more if disliked foods are avoided and foods that patient likes are included instead.
Additional spice is not usually an effective way to enhance taste. Adding baby meats to foods will increase
calorie and protein levels, but does not address the issue of taste. Patients will not improve intake by eating
foods that are beneficial but have unpleasant taste.
10. Answer: C. Risk for ineffective health maintenance related to anxiety about new leukemia
diagnosis
The patient who has a new cancer diagnosis is likely to have high anxiety, which may impact learning and
require that the nurse repeat and reinforce information. The patients history of a recent diagnosis suggests
that infiltration of the leukemia is not a likely cause of the confusion. The patient asks for the information to
be repeated, indicating that lack of interest in learning and denial are not etiologic factors.
11. Answer: A. The patients visitors bring in some fresh peaches from home.
Fresh, thinned-skin peaches are not permitted in a neutropenic diet because of the risk of bacteria being
present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other
patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every

other day is acceptable. Careful cleaning after having a bowel movement will help to prevent perineal skin
breakdown and infection.
12. Answer: A. The NA assists the patient to use dental floss after eating.
Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding.
The other actions are appropriate for oral care of a pancytopenic patient.
13. Answer: D. Uric acid level
Allopurinol is used to decrease uric acid levels. BUN, potassium, and phosphate levels are also increased in
TLS but are not affected by allopurinol therapy.
14. Answer: A. Can you tell me what has been helpful to you in the past when coping with stressful
events?
Information about how the patient has coped with past stressful situations helps the nurse determine usual
coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much
information about the patients need for support. The patients knowledge of typical stages in adjustment to a
critical diagnosis does not provide insight into patient needs for assistance. The patient with stage I cancer is
not considered to have a terminal illness at this time, and this question is likely to worry the patient
unnecessarily.
15. Answer: D, F, G, H
The patients age, gender, and history indicate a need for teaching about or screening or both for colorectal
cancer, mammography, Pap smears, and sunscreen. The patient does not use excessive alcohol or tobacco,
she is physically active, and her body weight is healthy.