1. Which of the following conditions is not a complication of Hodgkins disease?

1. Anemia
2. Infection
3. Myocardial Infarction
4. Nausea
2. Which of the following laboratory values is expected for a client just diagnosed
with chronic lymphocytic leukemia?
1. Elevated sedimentation rate
2. Uncontrolled proliferation of granulocytes
3. Thrombocytopenia and increased lymphocytes
4. Elevated aspartate aminotransferase and alanine aminotransferase levels.
3. At the time of diagnosis of Hodgkins lymphoma, which of the following areas is
often involved?
1. Back
2. Chest
3. Groin
4. Neck
4. According to a standard staging classification of Hodgkins disease, which of the
following criteria reflects stage II?
1. Involvement of extralymphatic organs or tissues
2. Involvement of single lymph node region or structure
3. Involvement of two or more lymph node regions or structures.
4. Involvement of lymph node regions or structures on both sides of the diaphragm.
5. Which of the following statements is correct about the rate of cell growth in
relation to chemotherapy?
1. Faster growing cells are less susceptible to chemotherapy.
2. Non-dividing cells are more susceptible to chemotherapy
3. Faster growing cells are more susceptible to chemotherapy
4. Slower growing cells are more susceptible to chemotherapy.
6. Which of the following foods should a client with leukemia avoid?
1. White bread
2. Carrot sticks
3. Stewed apples
4. Medium rare steak
7. A client with leukemia has neutropenia. Which of the following functions must
be frequently assessed?
1. Blood pressure
2. Bowel sounds
3. Heart sounds
4. Breath sounds
8. Which of the following clients is most at risk for developing multiple myeloma?
1. A 20-year-old Asian woman
2. A 30-year-old White man
3. A 50-year-old Hispanic woman
4. A 60-year-old African-American man
9. Which of the following substances has abnormal values early in the course of
multiple myeloma (MM)?
1. Immunoglobulins
2. Platelets
3. Red blood cells
4. White blood cells
10. For which of the following conditions is a client with multiple myeloma (MM)
monitored?
1. Hypercalcemia
2. Hyperkalemia
3. Hypernatremia
4. Hypermagnesemia
11. Giving instructions for breast self-examination is particularly important for
clients with which of the following medical problems?
1. Cervical dysplasia
2. A dermoid cyst
3. Endometrial polyps
4. Ovarian cancer
12. During a routine physical examination, a firm mass is palpated in the right
breast of a 35-year-old woman. Which of the following findings or client history
would suggest cancer of the breast as opposed to fibrocystic disease?
1. History of early menarche
2. Cyclic changes in mass size
3. History of anovulatory cycles
4. Increased vascularity of the breast
13. The client with which of the following types of lung cancer has the best
prognosis?
1. Adenocarcinoma
2. Oat cell
3. Squamous cell
4. Small cell
14. Warning signs and symptoms of lung cancer include persistent cough, bloody
sputum, dyspnea, and which of the other following symptoms?
1. Dizziness
2. Generalized weakness
3. Hypotension
4. Recurrent pleural effusion
15. A centrally located tumor would produce which of the following symptoms?
1. Coughing
2. Hemoptysis
3. Pleuritic pain
4. Shoulder pain
16. Which of the following interventions is the key to increasing the survival rates
of clients with lung cancer?
1. Early bronchoscopy
2. Early detection
3. High-dose chemotherapy
4. Smoking cessation
17. A client has been diagnosed with lung cancer and requires a wedge resection.
How much of the lung is removed?
1. One entire lung
2. A lobe of the lung
3. A small, localized area near the surface of the lung.
4. A segment of the lung, including a bronchiole and its alveoli.
18. When a client has a lobectomy, what fills the space where the lobe was?
1. The space stays empty.
2. The surgeon fills the space with gel
3. The lung space fills up with serous fluid
4. The remaining lobe or lobes overexpand to fill the space.
19. Which of the following is the primary goal for surgical resection of lung
cancer?
1. To remove the tumor and all surrounding tissue.
2. To remove the tumor and as little surrounding tissue as possible.
3. To remove all of the tumor and any collapsed alveoli in the same region.
4. To remove as much as the tumor as possible, without removing any alveoli.
20. If the client with lung cancer also has preexisting pulmonary disease, which
of the following statements best describes how the extent of that can be
performed?
1. It doesnt affect it.
2. It may require a whole lung to be removed.
3. The entire tumor may not be able to be removed
4. It may prevent surgery if the client cant tolerate lung tissue removal.
21. The client with a benign lung tumor is treated in which of the following ways?
1. The tumor is treated with radiation only.
2. The tumor is treated with chemotherapy only.
3. The tumor is left alone unless symptoms are present.
4. The tumor is removed, involving the least possible amount of tissue.
22. In the client with terminal lung cancer, the focus of nursing care is on which
of the following nursing interventions?
1. Provide emotional support
2. Provide nutritional support
3. Provide pain control
4. Prepare the clients will
23. What are the three most important prognostic factors in determining long-
term survival for children with acute leukemia?
1. Histologic type of disease, initial platelet count, and type of treatment
2. Type of treatment and clients sex
3. Histologic type of disease, initial WBC count, and clients age at diagnosis
4. Progression of illness, WBC at the time of diagnosis, and clients age at the time of
diagnosis.
24. Which of the following complications are three main consequences
of leukemia?
1. Bone deformities, spherocytosis, and infection.
2. Anemia, infection, and bleeding tendencies
3. Lymphocytopoiesis, growth delays, and hirsutism
4. Polycythemia, decreased clotting time, and infection.
25. A child is seen in the pediatricians office for complaints of bone and
joint pain. Which of the following other assessment findings may
suggest leukemia?
1. Abdominal pain
2. Increased activity level
3. Increased appetite
4. Petechiae
26. Which of the following assessment findings in a client with leukemia would
indicate that the cancer has invaded the brain?
1. Headache and vomiting.
2. Restlessness and tachycardia
3. Hypervigilant and anxious behavior
4. Increased heart rate and decreased blood pressure.
27. Which of the following types of leukemia carries the best prognosis?
1. Acute lymphoblastic leukemia
2. Acute myelogenous leukemia
3. Basophilic leukemia
4. Eosinophilic leukemia
28. Which of the following is the reason to perform a spinal tap on a client newly
diagnosed with leukemia?
1. To rule out meningitis
2. To decrease intracranial pressure
3. To aid in classification of the leukemia
4. To assess for central nervous system infiltration
29. Which of the following tests in performed on a client with leukemia before
initiation of therapy to evaluate the childs ability to metabolize chemotherapeutic
agents?
1. Lumbar puncture
2. Liver function studies
3. Complete blood count (CBC)
4. Peripheral blood smear
30. Which of the following immunizations should not be given to a 4-month-old
sibling of a client with leukemia?
1. Diphtheria and tetanus and pertussis (DPT) vaccine.
2. Hepatitis B vaccine
3. Haemophilus influenzae type b vaccines (Hib)
4. Oral poliovirus vaccine (OPV)
31. Which of the following medications usually is given to a client with leukemia as
prophylaxis against P. carinii pneumonia?
1. Bactrim
2. Oral nystatin suspension
3. Prednisone
4. Vincristine (Oncovin)
32. In which of the following diseases would bone marrow transplantation not be
indicated in a newly diagnosed client?
1. Acute lymphocytic leukemia
2. Chronic myeloid leukemia
3. Severe aplastic anemia
4. Severe combined immunodeficiency
33. Which of the following treatment measures should be implemented for a child
with leukemia who has been exposed to the chickenpox?
1. No treatment is indicated.
2. Acyclovir (Zovirax) should be started on exposure
3. Varicella-zoster immunoglobulin (VZIG) should be given with the evidence of disease
4. VZIG should be given within 72 hours of exposure.
34. Nausea and vomiting are common adverse effects of radiation and
chemotherapy. When should a nurse administer antiemetics?
1. 30 minutes before the initiation of therapy.
2. With the administration of therapy.
3. Immediately after nausea begins.
4. When therapy is completed.
35. Parents of pediatric clients who undergo irradiation involving the central
nervous system should be warned about postirradiation somnolence. When does
this neurologic syndrome usually occur?
1. Immediately
2. Within 1 to 2 weeks
3. Within 5 to 8 weeks
4. Within 3 to 6 months
36. The nurse is instructing the client to perform a testicular self-examination.
The nurse tells the client:
1. To examine the testicles while lying down.
2. The best time for the examination is after a shower
3. To gently feel the testicle with one finger to feel for a growth
4. That testicular examination should be done at least every 6 months.
37. The community nurse is conducting a health promotion program at a local
school and is discussing the risk factors associated with cancer. Which of the
following, if identified by the client as a risk factor, indicates a need for further
instructions?
1. Viral factors
2. Stress
3. Low-fat and high-fiber diets
4. Exposure to radiation
38. The client with cancer is receiving chemotherapy and develops
thrombocytopenia. The nurse identifies which intervention as the highest priority
in the nursing plan of care?
1. Ambulation three times a day
2. Monitoring temperature
3. Monitoring the platelet count
4. Monitoring for pathological factors
39. A client is diagnosed with multiple myeloma. The client asks the nurse about
the diagnosis. The nurse bases the response on which of the following descriptions
of this disorder?
1. Malignant exacerbation in the number of leukocytes.
2. Altered red blood cell production.
3. Altered production of lymph nodes
4. Malignant proliferation of plasma cells and tumors within the bone.
40. The nurse is reviewing the laboratory results of a client diagnosed with
multiple myeloma. Which of the following would the nurse expect to note
specifically in this disorder?
1. Decreased number of plasma cells in the bone marrow.
2. Increased WBCs
3. Increased calcium levels
4. Decreased blood urea nitrogen
41. The nurse is developing a plan of care for the client with multiple myeloma.
The nurse includes which priority intervention in the plan of care?
1. Coughing and deep breathing
2. Encouraging fluids
3. Monitoring red blood cell count
4. Providing frequent oral care
42. The oncology nurse specialist provides an educational session to nursing staff
regarding the characteristics of Hodgkins disease. The nurse determines that
further education is needed if a nursing staff member states that which of the
following is characteristic of the disease?
1. Presence of Reed-Sternberg cells
2. Involvement of lymph nodes, spleen, and liver
3. Occurs most often in the older client
4. Prognosis depends on the stage of the disease
43. The nurse is reviewing the laboratory results of a client receiving
chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory
value, the priority nursing assessment is which of the following?
1. Assess level of consciousness
2. Assess temperature
3. Assess bowel sounds
4. Assess skin turgor
44. The nurse is caring for a client following a modified radical mastectomy.
Which assessment finding would indicate that the client is experiencing a
complication related to this surgery?
1. Sanguineous drainage in the Jackson-Pratt drain
2. Pain at the incisional site
3. Complaints of decreased sensation near the operative site
4. Arm edema on the operative side
45. A nurse is providing education in a community setting about general measures
to avoid excessive sun exposure. Which of the following recommendations is
appropriate?
1. Apply sunscreen only after going in the water.
2. Avoid peak exposure hours from 9am to 1pm
3. Wear loosely woven clothing for added ventilation
4. Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure.
46. Which of the following nursing interventions would be most helpful in making
the respiratory effort of a client with metastatic lung cancer more efficient?
1. Teaching the client diaphragmatic breathing techniques
2. Administering cough suppressants as ordered
3. Teaching and encouraging pursed-lip breathing
4. Placing the client in a low semi-Fowlers position
47. The nurse is teaching a 17-year old client and the clients family about what to
expect with high-dose chemotherapy and the effects of neutropenia. What should
the nurse teach as the most reliable early indicator of infection in a neutropenic
client?
1. Fever
2. Chills
3. Tachycardia
4. Dyspnea
48. A 58-year-old man is going to have chemotherapy for lung cancer. He asks the
nurse how the chemotherapeutic drugs will work. The most accurate explanation
the nurse can give is which of the following?
1. Chemotherapy affects all rapidly dividing cells.
2. The molecular structure of the DNA is altered.
3. Cancer cells are susceptible to drug toxins.
4. Chemotherapy encourages cancer cells to divide.
49. When caring for a client with a central venous line, which of the following
nursing actions should be implemented in the plan of care for chemotherapy
administration? Select all that apply.
1. Verify patency of the line by the presence of a blood return at regular intervals.
2. Inspect the insertion site for swelling, erythema, or drainage.
3. Administer a cytotoxic agent to keep the regimen on schedule even if blood return is not
present.
4. If unable to aspirate blood, reposition the client and encourage the client to cough.
5. Contact the health care provider about verifying placement if the status is questionable.
50. A client with stomach cancer is admitted to the oncology unit after vomiting
for 3 days. Physical assessment findings include irregular pulse, muscle twitching,
and complaints of prickling sensations in the fingers and hands. Laboratory results
include a potassium level of 2.9 mEq/L, a pH of 7.46, and a bicarbonate level of 29
mEq/L. The client is experiencing:
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic alkalosis
4. Metabolic acidosis
51. A 32-year-old woman meets with the nurse on her first office visit since
undergoing a left mastectomy. When asked how she is doing, the woman states
her appetite is still not good, she is not getting much sleep because she doesnt go
to bed until her husband is asleep, and she is really anxious to get back to work.
Which of the following nursing interventions should the nurse explore to support
the clients current needs?
1. Call the physician to discuss allowing the client to return to work earlier.
2. Suggest that the client learn relaxation techniques to help with her insomnia
3. Perform a nutritional assessment to assess for anorexia
4. Ask open-ended questions about sexuality issues related to her mastectomy
52. One of the most serious blood coagulation complications for individuals with
cancer and for those undergoing cancer treatments is disseminated intravascular
coagulation (DIC). The most common cause of this bleedingdisorder is:
1. Underlying liver disease
2. Brain metastasis
3. Intravenous heparin therapy
4. Sepsis
53. A pneumonectomy is a surgical procedure sometimes indicated for treatment
of non-small-cell lung cancer. A pneumonectomy involves removal of:
1. An entire lung field
2. A small, wedge-shaped lung surface
3. One lobe of a lung
4. One or more segments of a lung lobe
54. A 36-year-old man with lymphoma presents with signs of impending septic
shock 9 days after chemotherapy. The nurse could expect which of the following to
be present?
1. Flushing, decreased oxygen saturation, mild hypotension
2. Low-grade fever, chills, tachycardia
3. Elevated temperature, oliguria, hypotension
4. High-grade fever, normal blood pressure, increased respirations
55. Which of the following represents the most appropriate nursing intervention
for a client with pruritis caused by cancer or the treatments?
1. Administration of antihistamines
2. Steroids
3. Silk sheets
4. Medicated cool baths
56. A 56-year-old woman is currently receiving radiation therapy to the chest wall
for recurrent breast cancer. She calls her health care provider to report that she
has pain while swallowing and burning and tightness in her chest. Which of the
following complications of radiation therapy is most likely responsible for her
symptoms?
1. Hiatal hernia
2. Stomatitis
3. Radiation enteritis
4. Esophagitis
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, plateletsand 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 coloncancer.
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 cellsboth 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, sepsisis 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 wedge-shaped 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 pruritus.
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. A male client has an abnormal result on a Papanicolaou test. After admitting, he
read his chart while the nurse was out of the room, the client asks what dysplasia
means. Which definition should the nurse provide?
A. Presence of completely undifferentiated tumor cells that dont resemble cells of the
tissues of their origin
B. Increase in the number of normal cells in a normal arrangement in a tissue or an organ
C. Replacement of one type of fully differentiated cell by another in tissues where the
second type normally isnt found
D. Alteration in the size, shape, and organization of differentiated cells
2. For a female client with newly diagnosed cancer, the nurse formulates a nursing
diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis.
Which expected outcome would be appropriate for this client?
A. Client verbalizes feelings of anxiety.
B. Client doesnt guess at prognosis.
C. Client uses any effective method to reduce tension.
D. Client stops seeking information.
3. A male client with a cerebellar brain tumor is admitted to an acute care facility.
The nurse formulates a nursing diagnosis of Risk for injury. Which related-to
phrase should the nurse add to complete the nursing diagnosis statement?
A. Related to visual field deficits
B. Related to difficulty swallowing
C. Related to impaired balance
D. Related to psychomotor seizures
4. A female client with cancer is scheduled for radiation therapy. The nurse knows
that radiation at any treatment site may cause a certain adverse effect. Therefore,
the nurse should prepare the client to expect:
A. hair loss.
B. stomatitis.
C. fatigue.
D. vomiting.
5. Nurse April is teaching a client who suspects that she has a lump in her breast.
The nurse instructs the client that a diagnosis of breast cancer is confirmed by:
A. breast self-examination.
B. mammography.
C. fine needle aspiration.
D. chest X-ray.
6. A male client undergoes a laryngectomy to treat laryngeal cancer. When
teaching the client how to care for the neck stoma, the nurse should include which
instruction?
A. Keep the stoma uncovered.
B. Keep the stoma dry.
C. Have a family member perform stoma care initially until you get used to the procedure.
D. Keep the stoma moist.
7. A female client is receiving chemotherapy to treat breast cancer. Which
assessment finding indicates a fluid and electrolyte imbalance induced
by chemotherapy?
A. Urine output of 400 ml in 8 hours
B. Serum potassium level of 3.6 mEq/L
C. Blood pressure of 120/64 to 130/72 mm Hg
D. Dry oral mucous membranes and cracked lips
8. Nurse April is teaching a group of women to perform breast self-examination.
The nurse should explain that the purpose of performing the examination is to
discover:
A. cancerous lumps.
B. areas of thickness or fullness.
C. changes from previous self-examinations.
D. fibrocystic masses.
9. A client, age 41, visits the gynecologist. After examining her, the physician
suspects cervical cancer. The nurse reviews the clients history for risk factors for
this disease. Which history finding is a risk factor for cervical cancer?
A. Onset of sporadic sexual activity at age 17
B. Spontaneous abortion at age 19
C. Pregnancy complicated with eclampsia at age 27
D. Human papillomavirus infection at age 32
10. A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to treat
osteogenic carcinoma. During methotrexate therapy, the nurse expects the client
to receive which other drug to protect normal cells?
A. probenecid (Benemid)
B. cytarabine (ara-C, cytosine arabinoside [Cytosar-U])
C. thioguanine (6-thioguanine, 6-TG)
D. leucovorin (citrovorum factor or folinic acid [Wellcovorin])
11. The nurse is interviewing a male client about his past medical history. Which
preexisting condition may lead the nurse to suspect that a client has colorectal
cancer?
A. Duodenal ulcers
B. Hemorrhoids
C. Weight gain
D. Polyps
12. Nurse Amy is speaking to a group of women about early detection of breast
cancer. The average age of the women in the group is 47. Following the American
Cancer Society guidelines, the nurse should recommend that the women:
A. perform breast self-examination annually.
B. have a mammogram annually.
C. have a hormonal receptor assay annually.
D. have a physician conduct a clinical examination every 2 years.
13. A male client with a nagging cough makes an appointment to see the physician
after reading that this symptom is one of the seven warning signs of cancer. What
is another warning sign of cancer?
A. Persistent nausea
B. Rash
C. Indigestion
D. Chronic ache or pain
14. For a female client newly diagnosed with radiation-induced thrombocytopenia,
the nurse should include which intervention in the plan of care?
A. Administering aspirin if the temperature exceeds 102 F (38.8 C)
B. Inspecting the skin for petechiae once every shift
C. Providing for frequent rest periods
D. Placing the client in strict isolation
15. Nurse Lucia is providing breast cancer education at a community facility. The
American Cancer Society recommends that women get mammograms:
A. yearly after age 40.
B. after the birth of the first child and every 2 years thereafter.
C. after the first menstrual period and annually thereafter.
D. every 3 years between ages 20 and 40 and annually thereafter.
16. Which intervention is appropriate for the nurse caring for a male client in
severe pain receiving a continuous I.V. infusion of morphine?
A. Assisting with a naloxone challenge test before therapy begins
B. Discontinuing the drug immediately if signs of dependence appear
C. Changing the administration route to P.O. if the client can tolerate fluids
D. Obtaining baseline vital signs before administering the first dose
17. A 35 years old client with ovarian cancer is prescribed hydroxyurea(Hydrea),
an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic
agents that interfere with various metabolic actions of the cell. The mechanism of
action of antimetabolites interferes with:
A. cell division or mitosis during the M phase of the cell cycle.
B. normal cellular processes during the S phase of the cell cycle.
C. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA
molecules (cell cyclenonspecific).
D. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell
cyclenonspecific).
18. The ABCD method offers one way to assess skin lesions for possible skin
cancer. What does the A stand for?
A. Actinic
B. Asymmetry
C. Arcus
D. Assessment
19. When caring for a male client diagnosed with a brain tumor of the parietal
lobe, the nurse expects to assess:
A. short-term memory impairment.
B. tactile agnosia.
C. seizures.
D. contralateral homonymous hemianopia.
20. A female client is undergoing tests for multiple myeloma. Diagnostic study
findings in multiple myeloma include:
A. a decreased serum creatinine level.
B. hypocalcemia.
C. Bence Jones protein in the urine.
D. a low serum protein level.
21. A 35 years old client has been receiving chemotherapy to treat cancer. Which
assessment finding suggests that the client has developed stomatitis
(inflammation of the mouth)?
A. White, cottage cheeselike patches on the tongue
B. Yellow tooth discoloration
C. Red, open sores on the oral mucosa
D. Rust-colored sputum
22. During chemotherapy, an oncology client has a nursing diagnosis of impaired
oral mucous membrane related to decreased nutrition and immunosuppression
secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is
most likely to decrease the pain of stomatitis?
A. Recommending that the client discontinue chemotherapy
B. Providing a solution of hydrogen peroxide and water for use as a mouth rinse
C. Monitoring the clients platelet and leukocyte counts
D. Checking regularly for signs and symptoms of stomatitis
23. What should a male client over age 52 do to help ensure early identification of
prostate cancer?
A. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.
B. Have a transrectal ultrasound every 5 years.
C. Perform monthly testicular self-examinations, especially after age 50.
D. Have a complete blood count (CBC) and blood urea nitrogen (BUN) and creatinine levels
checked yearly.
24. A male client complains of sporadic epigastric pain, yellow skin, nausea,
vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician
orders a diagnostic workup, which reveals gallbladder cancer. Which nursing
diagnosis may be appropriate for this client?
A. Anticipatory grieving
B. Impaired swallowing
C. Disturbed body image
D. Chronic low self-esteem
25. A male client is in isolation after receiving an internal radioactive implant to
treat cancer. Two hours later, the nurse discovers the implant in the bed linens.
What should the nurse do first?
A. Stand as far away from the implant as possible and call for help.
B. Pick up the implant with long-handled forceps and place it in a lead-lined container.
C. Leave the room and notify the radiation therapy department immediately.
D. Put the implant back in place, using forceps and a shield for self-protection, and call for
help.
26. Jenny, with advanced breast cancer is prescribed tamoxifen (Nolvadex). When
teaching the client about this drug, the nurse should emphasize the importance of
reporting which adverse reaction immediately?
A. Vision changes
B. Hearing loss
C. Headache
D. Anorexia
27. A female client with cancer is being evaluated for possible metastasis. Which
of the following is one of the most common metastasis sites for cancer cells?
A. Liver
B. Colon
C. Reproductive tract
D. White blood cells (WBCs)
28. A 34-year-old female client is requesting information about mammograms and
breast cancer. She isnt considered at high risk for breast cancer. What should the
nurse tell this client?
A. She should have had a baseline mammogram before age 30.
B. She should eat a low-fat diet to further decrease her risk of breast cancer.
C. She should perform breast self-examination during the first 5 days of each menstrual
cycle.
D. When she begins having yearly mammograms, breast self-examinations will no longer be
necessary.
29. Nurse Brian is developing a plan of care for marrow suppression, the major
dose-limiting adverse reaction to floxuridine (FUDR). How long after drug
administration does bone marrow suppression become noticeable?
A. 24 hours
B. 2 to 4 days
C. 7 to 14 days
D. 21 to 28 days
30. The nurse is preparing for a female client for magnetic resonance imaging
(MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which of
the following would pose a threat to the client?
A. The client lies still.
B. The client asks questions.
C. The client hears thumping sounds.
D. The client wears a watch and wedding band.
31. Nina, an oncology nurse educator, is speaking to a womens group about
breast cancer. Questions and comments from the audience reveal a
misunderstanding of some aspects of the disease. Various members of the
audience have made all of the following statements. Which one is accurate?
A. Mammography is the most reliable method for detecting breast cancer.
B. Breast cancer is the leading killer of women of childbearing age.
C. Breast cancer requires a mastectomy.
D. Men can develop breast cancer.
32. Nurse Mary is instructing a premenopausal woman about breast self-
examination. The nurse should tell the client to do her self-examination:
A. at the end of her menstrual cycle.
B. on the same day each month.
C. on the 1st day of the menstrual cycle.
D. immediately after her menstrual period.
33. Nurse Kent is teaching a male client to perform monthly testicular self-
examinations. Which of the following points would be appropriate to make?
A. Testicular cancer is a highly curable type of cancer.
B. Testicular cancer is very difficult to diagnose.
C. Testicular cancer is the number one cause of cancer deaths in males.
D. Testicular cancer is more common in older men.
34. Rhea, has malignant lymphoma. As part of her chemotherapy, the physician
prescribes chlorambucil (Leukeran), 10 mg by mouth daily. When caring for the
client, the nurse teaches her about adverse reactions to chlorambucil, such as
alopecia. How soon after the first administration of chlorambucil might this
reaction occur?
A. Immediately
B. 1 week
C. 2 to 3 weeks
D. 1 month
35. A male client is receiving the cell cyclenonspecific alkylating agent thiotepa
(Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of a
chemotherapeutic regimen to treat bladder cancer. The client asks the nurse how
the drug works. How does thiotepa exert its therapeutic effects?
A. It interferes with deoxyribonucleic acid (DNA) replication only.
B. It interferes with ribonucleic acid (RNA) transcription only.
C. It interferes with DNA replication and RNA transcription.
D. It destroys the cell membrane, causing lysis.
36. The nurse is instructing the 35 year old client to perform a testicular self-
examination. The nurse tells the client:
A. To examine the testicles while lying down
B. That the best time for the examination is after a shower
C. To gently feel the testicle with one finger to feel for a growth
D. That testicular self-examination should be done at least every 6 months
37. A female client with cancer is receiving chemotherapy and develops
thrombocytopenia. The nurse identifies which intervention as the highest priority
in the nursing plan of care?
A. Monitoring temperature
B. Ambulation three times daily
C. Monitoring the platelet count
D. Monitoring for pathological fractures
38. Gio, a community health nurse, is instructing a group of female clients about
breast self-examination. The nurse instructs the client to perform the
examination:
A. At the onset of menstruation
B. Every month during ovulation
C. Weekly at the same time of day
D. 1 week after menstruation begins
39. Nurse Cindy is caring for a client who has undergone a vaginal hysterectomy.
The nurse avoids which of the following in the care of this client?
A. Elevating the knee gatch on the bed
B. Assisting with range-of-motion leg exercises
C. Removal of antiembolism stockings twice daily
D. Checking placement of pneumatic compression boots
40. Mina, who is suspected of an ovarian tumor is scheduled for a pelvic
ultrasound. The nurse provides which preprocedure instruction to the client?
A. Eat a light breakfast only
B. Maintain an NPO status before the procedure
C. Wear comfortable clothing and shoes for the procedure
D. Drink six to eight glasses of water without voiding before the test
41. A male client is diagnosed as having a bowel tumor and several diagnostic
tests are prescribed. The nurse understands that which test will confirm the
diagnosis of malignancy?
A. Biopsy of the tumor
B. Abdominal ultrasound
C. Magnetic resonance imaging
D. Computerized tomography scan
42. A female client diagnosed with multiple myeloma and the client asks the nurse
about the diagnosis. The nurse bases the response on which description of this
disorder?
A. Altered red blood cell production
B. Altered production of lymph nodes
C. Malignant exacerbation in the number of leukocytes
D. Malignant proliferation of plasma cells within the bone
43. Nurse Bea is reviewing the laboratory results of a client diagnosed with
multiple myeloma. Which of the following would the nurse expect to note
specifically in this disorder?
A. Increased calcium
B. Increased white blood cells
C. Decreased blood urea nitrogen level
D. Decreased number of plasma cells in the bone marrow
44. Vanessa, a community health nurse conducts a health promotion program
regarding testicular cancer to community members. The nurse determines that
further information needs to be provided if a community member states that
which of the following is a sign of testicular cancer?
A. Alopecia
B. Back pain
C. Painless testicular swelling
D. Heavy sensation in the scrotum
45. The male client is receiving external radiation to the neck for cancer of
the larynx. The most likely side effect to be expected is:
A. Dyspnea
B. Diarrhea
C. Sore throat
D. Constipation
46. Nurse Joy is caring for a client with an internal radiation implant. When caring
for the client, the nurse should observe which of the following principles?
A. Limit the time with the client to 1 hour per shift
B. Do not allow pregnant women into the clients room
C. Remove the dosimeter badge when entering the clients room
D. Individuals younger than 16 years old may be allowed to go in the room as long as they
are 6 feet away from the client
47. A cervical radiation implant is placed in the client for treatment of cervical
cancer. The nurse initiates what most appropriate activity order for this client?
A. Bed rest
B. Out of bed ad lib
C. Out of bed in a chair only
D. Ambulation to the bathroom only
48. A female client is hospitalized for insertion of an internal cervical radiation
implant. While giving care, the nurse finds the radiation implant in the bed. The
initial action by the nurse is to:
A. Call the physician
B. Reinsert the implant into the vagina immediately
C. Pick up the implant with gloved hands and flush it down the toilet
D. Pick up the implant with long-handled forceps and place it in a lead container.
49. The nurse is caring for a female client experiencing neutropenia as a result of
chemotherapy and develops a plan of care for the client. The nurse plans to:
A. Restrict all visitors
B. Restrict fluid intake
C. Teach the client and family about the need for hand hygiene
D. Insert an indwelling urinary catheter to prevent skin breakdown
50. The home health care nurse is caring for a male client with cancer and the
client is complaining of acute pain. The appropriate nursing assessment of the
clients pain would include which of the following?
A. The clients pain rating
B. Nonverbal cues from the client
C. The nurses impression of the clients pain
D. Pain relief after appropriate nursing intervention
51. Nurse Melinda is caring for a client who is postoperative following a pelvic
exenteration and the physician changes the clients diet from NPO status to clear
liquids. The nurse makes which priority assessment before administering the diet?
A. Bowel sounds
B. Ability to ambulate
C. Incision appearance
D. Urine specific gravity
52. A male client is admitted to the hospital with a suspected diagnosis of
Hodgkins disease. Which assessment findings would the nurse expect to note
specifically in the client?
A. Fatigue
B. Weakness
C. Weight gain
D. Enlarged lymph nodes
53. During the admission assessment of a 35 year old client with advanced ovarian
cancer, the nurse recognizes which symptom as typical of the disease?
A. Diarrhea
B. Hypermenorrhea
C. Abdominal bleeding
D. Abdominal distention
54. Nurse Kate is reviewing the complications of colonization with a client who has
microinvasive cervical cancer. Which complication, if identified by the client,
indicates a need for further teaching?
A. Infection
B. Hemorrhage
C. Cervical stenosis
D. Ovarian perforation
55. Mr. Miller has been diagnosed with bone cancer. You know this type of cancer
is classified as:
A. sarcoma.
B. lymphoma.
C. carcinoma.
D. melanoma.
56. Sarah, a hospice nurse visits a client dying of ovarian cancer. During the visit,
the client expresses that If I can just live long enough to attend my daughters
graduation, Ill be ready to die. Which phrase of coping is this client
experiencing?
A. Anger
B. Denial
C. Bargaining
D. Depression
57. Nurse Farah is caring for a client following a mastectomy. Which assessment
finding indicates that the client is experiencing a complication related to the
surgery?
A. Pain at the incisional site
B. Arm edema on the operative side
C. Sanguineous drainage in the Jackson-Pratt drain
D. Complaints of decreased sensation near the operative site
58. The nurse is admitting a male client with laryngeal cancer to the nursing unit.
The nurse assesses for which most common risk factor for this type of cancer?
A. Alcohol abuse
B. Cigarette smoking
C. Use of chewing tobacco
D. Exposure to air pollutants
59. The female client who has been receiving radiation therapy for bladdercancer
tells the nurse that it feels as if she is voiding through the vagina. The nurse
interprets that the client may be experiencing:
A. Rupture of the bladder
B. The development of a vesicovaginal fistula
C. Extreme stress caused by the diagnosis of cancer
D. Altered perineal sensation as a side effect of radiation therapy
60. The client with leukemia is receiving busulfan (Myleran) and allopurinol
(Zyloprim). The nurse tells the client that the purpose if the allopurinol is to
prevent:
A. Nausea
B. Alopecia
C. Vomiting
D. Hyperuricemia
Answers and Rationale
1. Answer: D. Alteration in the size, shape, and organization of differentiated cells
Dysplasia refers to an alteration in the size, shape, and organization of differentiated cells.
The presence of completely undifferentiated tumor cells that dont resemble cells of the
tissues of their origin is called anaplasia. An increase in the number of normal cells in a
normal arrangement in a tissue or an organ is called hyperplasia. Replacement of one type
of fully differentiated cell by another in tissues where the second type normally isnt found is
called metaplasia.
2. Answer: A. Client verbalizes feelings of anxiety.
Verbalizing feelings is the clients first step in coping with the situational crisis. It also helps
the health care team gain insight into the clients feelings, helping guide psychosocial care.
Option B is inappropriate because suppressing speculation may prevent the client from
coming to terms with the crisis and planning accordingly. Option C is undesirable because
some methods of reducing tension, such as illicit drug or alcohol use, may prevent the client
from coming to terms with the threat of death as well as cause physiologic harm. Option D
isnt appropriate because seeking information can help a client with cancer gain a sense of
control over the crisis.
3. Answer: C. Related to impaired balance
A client with a cerebellar brain tumor may suffer injury from impaired balance as well as
disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and
psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital
lobe, parietal lobe, or temporal lobe not from a cerebellar brain tumor. Difficulty
swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe
dysfunction.
4. Answer: C. fatigue
Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the
treatment site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse
effects of radiation therapy.
5. Answer: C. fine needle aspiration.
Fine needle aspiration and biopsy provide cells for histologic examination to confirm a
diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method
for detecting breast lumps early. Mammography is used to detect tumors that are too small
to palpate. Chest X-rays can be used to pinpoint rib metastasis.
6. Answer: D. Keep the stoma moist.
The nurse should instruct the client to keep the stoma moist, such as by applying a thin
layer of petroleum jelly around the edges, because a dry stoma may become irritated. The
nurse should recommend placing a stoma bib over the stoma to filter and warm air before it
enters the stoma. The client should begin performing stoma care without assistance as soon
as possible to gain independence in self-care activities.
7. Answer: D. Dry oral mucous membranes and cracked lips
Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and
electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips,
decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a
serum potassium level below 3.5 mEq/L.
8. Answer: C. changes from previous self-examinations.
Women are instructed to examine themselves to discover changes that have occurred in the
breast. Only a physician can diagnose lumps that are cancerous, areas of thickness or
fullness that signal the presence of a malignancy, or masses that are fibrocystic as opposed
to malignant.
9. Answer: D. Human papillomavirus infection at age 32
Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for
cervical cancer. Other risk factors for this disease include frequent sexual intercourse before
age 16, multiple sex partners, and multiple pregnancies. A spontaneous abortion and
pregnancy complicated by eclampsia arent risk factors for cervical cancer.
10. Answer: D. leucovorin (citrovorum factor or folinic acid [Wellcovorin])
Leucovorin is administered with methotrexate to protect normal cells, which methotrexate
could destroy if given alone. Probenecid should be avoided in clients receiving methotrexate
because it reduces renal elimination of methotrexate, increasing the risk of methotrexate
toxicity. Cytarabine and thioguanine arent used to treat osteogenic carcinoma.
11. Answer: D. Polyps
Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids arent
preexisting conditions of colorectal cancer. Weight loss not gain is an indication of
colorectal cancer.
12. Answer: B. have a mammogram annually.
The American Cancer Society guidelines state, Women older than age 40 should have a
mammogram annually and a clinical examination at least annually [not every 2 years]; all
women should perform breast self-examination monthly [not annually]. The hormonal
receptor assay is done on a known breast tumor to determine whether the tumor
is estrogen or progesterone-dependent.
13. Answer: C. Indigestion
Indigestion, or difficulty swallowing, is one of the seven warning signs of cancer. The other
six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or
discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or
mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but
isnt one of the seven major warning signs. Rash and chronic ache or pain seldom indicate
cancer.
14. Answer: B. Inspecting the skin for petechiae once every shift
Because thrombocytopenia impairs blood clotting, the nurse should inspect the client
regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleedinggums.
The nurse should avoid administering aspirin because it may increase the risk of bleeding.
Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict
isolation is indicated only for clients who have highly contagious or virulent infections that
are spread by air or physical contact.
15. Answer: A. yearly after age 40.
The American Cancer Society recommends a mammogram yearly for women over age 40.
The other statements are incorrect. Its recommended that women between ages 20 and 40
have a professional breast examination (not a mammogram) every 3 years.
16. Answer: D. Obtaining baseline vital signs before administering the first dose
The nurse should obtain the clients baseline blood pressure and pulse and respiratory rates
before administering the initial dose and then continue to monitor vital signs throughout
therapy. A naloxone challenge test may be administered before using a narcotic antagonist,
not a narcotic agonist. The nurse shouldnt discontinue a narcotic agonist abruptly because
withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in
clients with severe pain regardless of the ability to tolerate fluids.
17. Answer: B.normal cellular processes during the S phase of the cell cycle.
Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or
preventing cell replication. Theyre most effective against rapidly proliferating cancers.
Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle.
Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill
dividing cells in all phases of the cell cycle and may also kill nondividing cells.
Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA,
DNA, or both, preventing normal cell growth and reproduction.
18. Answer: B. Asymmetry
When following the ABCD method for assessing skin lesions, the A stands for asymmetry,
the B for border irregularity, the C for color variation, and the D for diameter.
19. Answer: B. tactile agnosia.
Tactile agnosia (inability to identify objects by touch) is a sign of a parietal lobe tumor.
Short-term memory impairment occurs with a frontal lobe tumor. Seizures may result from
a tumor of the frontal, temporal, or occipital lobe. Contralateral homonymous hemianopia
suggests an occipital lobe tumor.
20. Answer: C. Bence Jones protein in the urine.
Presence of Bence Jones protein in the urine almost always confirms the disease, but
absence doesnt rule it out. Serum calcium levels are elevated because calcium is lost from
the bone and reabsorbed in the serum. Serum protein electrophoresis shows elevated
globulin spike. The serum creatinine level may also be increased.
21. Answer: C. Red, open sores on the oral mucosa
The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in
ulcers on the oral mucosa that appear as red, open sores. White, cottage cheeselike
patches on the tongue suggest a candidal infection, another common adverse effect of
chemotherapy. Yellow tooth discoloration may result from antibiotictherapy, not cancer
chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.
22. Answer: B. Providing a solution of hydrogen peroxide and water for use as a
mouth rinse
To decrease the pain of stomatitis, the nurse should provide a solution of hydrogen peroxide
and water for the client to use as a mouth rinse. (Commercially prepared mouthwashes
contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also
may administer viscous lidocaine or systemic analgesics as prescribed. Stomatitis occurs 7
to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldnt be helpful or
practical. Instead, the nurse should stay alert for this potential problem to ensure prompt
treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and
infection but wouldnt decrease pain in this highly susceptible client. Checking for signs and
symptoms of stomatitis also wouldnt decrease the pain.
23. Answer: A. Have a digital rectal examination and prostate-specific antigen
(PSA) test done yearly.
The incidence of prostate cancer increases after age 50. The digital rectal examination,
which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker
for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular
self-examinations wont identify changes in the prostate gland due to its location in the
body. A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after
diagnosis to identify the extent of the disease and potential metastases
24. Answer: A. Anticipatory grieving
Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients
with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isnt
associated with gallbladder cancer. Although surgery typically is done to remove the
gallbladder and, possibly, a section of the liver, it isnt disfiguring and doesnt
cause Disturbed body image. Chronic low self-esteem isnt an appropriate nursing diagnosis
at this time because the diagnosis has just been made.
25. Answer: B. Pick up the implant with long-handled forceps and place it in a
lead-lined container.
If a radioactive implant becomes dislodged, the nurse should pick it up with long-handled
forceps and place it in a lead-lined container, then notify the radiation therapy department
immediately. The highest priority is to minimize radiation exposure for the client and the
nurse; therefore, the nurse must not take any action that delays implant removal. Standing
as far from the implant as possible, leaving the room with the implant still exposed, or
attempting to put it back in place can greatly increase the risk of harm to the client and the
nurse from excessive radiation exposure.
26. Answer: A. Vision changes
The client must report changes in visual acuity immediately because this adverse effect may
be irreversible. Tamoxifen isnt associated with hearing loss. Although the drug may cause
anorexia, headache, and hot flashes, the client need not report these adverse effects
immediately because they dont warrant a change in therapy.
27. Answer: A. Liver
The liver is one of the five most common cancer metastasis sites. The others are the lymph
nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional
metastasis sites.
28. Answer: B. She should eat a low-fat diet to further decrease her risk of breast
cancer.
A low-fat diet (one that maintains weight within 20% of recommended body weight) has
been found to decrease a womans risk of breast cancer. A baseline mammogram should be
done between ages 30 and 40. Monthly breast self-examinations should be done between
days 7 and 10 of the menstrual cycle. The client should continue to perform monthly breast
self-examinations even when receiving yearly mammograms.
29. Answer: C. 7 to 14 days
Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration.
Bone marrow recovery occurs in 21 to 28 days.
30. Answer: D. The client wears a watch and wedding band.
During an MRI, the client should wear no metal objects, such as jewelry, because the strong
magnetic field can pull on them, causing injury to the client and (if they fly off) to others.
The client must lie still during the MRI but can talk to those performing the test by way of
the microphone inside the scanner tunnel. The client should hear thumping sounds, which
are caused by the sound waves thumping on the magnetic field.
31. Answer: D. Men can develop breast cancer.
Men can develop breast cancer, although they seldom do. The most reliable method for
detecting breast cancer is monthly self-examination, not mammography. Lung cancer
causes more deaths than breast cancer in women of all ages. A mastectomy may not be
required if the tumor is small, confined, and in an early stage.
32. Answer: D. immediately after her menstrual period.
Premenopausal women should do their self-examination immediately after the menstrual
period, when the breasts are least tender and least lumpy. On the 1st and last days of the
cycle, the womans breasts are still very tender. Postmenopausal women because their
bodies lack fluctuation of hormone levels, should select one particular day of the month to
do breast self-examination.
33. Answer: A. Testicular cancer is a highly curable type of cancer.
Testicular cancer is highly curable, particularly when its treated in its early stage. Self-
examination allows early detection and facilitates the early initiation of treatment. The
highest mortality rates from cancer among men are in men with lung cancer. Testicular
cancer is found more commonly in younger men.
34. Answer: C. 2 to 3 weeks
Chlorambucil-induced alopecia occurs 2 to 3 weeks after therapy begins.
35. Answer: C. It interferes with DNA replication and RNA transcription.
Thiotepa interferes with DNA replication and RNA transcription. It doesnt destroy the cell
membrane.
36. Answer: B. That the best time for the examination is after a shower
The testicular-self examination is recommended monthly after a warm bath or shower when
the scrotal skin is relaxed. The client should stand to examine the testicles. Using both
hands, with fingers under the scrotum and thumbs on top, the client should gently roll the
testicles, feeling for any lumps.
37. Answer: C. 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 A elates to monitoring for
infection, particularly if leukopenia is present. Options B and D, although important in the
plan of care, are not related directly to thrombocytopenia.
38. Answer: D. 1 week after menstruation begins
The breast self-examination should be performed monthly 7 days after the onset of the
menstrual period. Performing the examination weekly is not recommended. At the onset
of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.
39. Answer: A. Elevating the knee gatch on the bed
The client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, as for
any other major surgery. For this reason, the nurse implements measures that will prevent
this complication. Range-of-motion exercises, antiembolism stockings, and pneumatic
compression boots are helpful. The nurse should avoid using the knee gatch in the bed,
which inhibits venous return, thus placing the client more at risk for deep vein
thrombosis or thrombophlebitis.
40. Answer: D. Drink six to eight glasses of water without voiding before the test
A pelvic ultrasound requires the ingestion of large volumes of water just before the
procedure. A full bladder is necessary so that it will be visualized as such and not mistaken
for a possible pelvic growth. An abdominal ultrasound may require that the client abstain
from food or fluid for several hours before the procedure. Option C is unrelated to this
specific procedure.
41. Answer: A. Biopsy of the tumor
A biopsy is done to determine whether a tumor is malignant or benign. Magnetic resonance
imaging, computed tomography scan, and ultrasound will visualize the presence of a mass
but will not confirm a diagnosis of malignancy.
42. Answer: D. Malignant proliferation of plasma cells 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. Options A and B are not characteristics of multiple myeloma. Option C describes
the leukemic process.
43. Answer: A. Increased calcium
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.
44. Answer: A. Alopecia
Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as
a result of radiation or chemotherapy. Options B, C, and D are assessment findings in
testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes.
45. Answer: C. Sore throat
In general, only the area in the treatment field is affected by the radiation. Skin
reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other
side effects occur only when specific areas are involved in treatment. A client receiving
radiation to the larynx is most likely to experience a sore throat. Options B and D may occur
with radiation to the gastrointestinal tract. Dyspnea may occur with lung involvement.
46. Answer: B. Do not allow pregnant women into the clients room
The time that the nurse spends in a room of a client with an internal radiation implant is 30
minutes per 8-hour shift. The dosimeter badge must be worn when in the clients room.
Children younger than 16 years of age and pregnant women are not allowed in the clients
room.
47. Answer: A. Bed rest
The client with a cervical radiation implant should be maintained on bed rest in the dorsal
position to prevent movement of the radiation source. The head of the bed is elevated to a
maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side.
If turning is absolutely necessary, a pillow is placed between the knees and, with the body
in straight alignment, the client is logrolled.
48. Answer: D. Pick up the implant with long-handled forceps and place it in a lead
container.
A lead container and long-handled forceps should be kept in the clients room at all times
during internal radiation therapy. If the implant becomes dislodged, the nurse should pick
up the implant with long-handled forceps and place it in the lead container. Options A, B,
and C are inaccurate interventions.
49. Answer: C. Teach the client and family about the need for hand hygiene
In the neutropenic client, meticulous hand hygiene education is implemented for the client,
family, visitors, and staff. Not all visitors are restricted, but the client is protected from
persons with known infections. Fluids should be encouraged. Invasive measures such as an
indwelling urinary catheter should be avoided to prevent infections.
50. Answer: A. The clients pain rating
The clients self-report is a critical component of pain assessment. The nurse should ask the
client about the description of the pain and listen carefully to the clients words used to
describe the pain. The nurses impression of the clients pain is not appropriate in
determining the clients level of pain. Nonverbal cues from the client are important but are
not the most appropriate pain assessment measure. Assessing pain relief is an important
measure, but this option is not related to the subject of the question.
51. Answer: A. Bowel sounds
The client is kept NPO until peristalsis returns, usually in 4 to 6 days. When signs of bowel
function return, clear fluids are given to the client. If no distention occurs, the diet is
advanced as tolerated. The most important assessment is to assess bowel sounds before
feeding the client. Options B, C, and D are unrelated to the subject of the question.
52. Answer: D. Enlarged lymph nodes
Hodgkins disease is a chronic progressive neoplastic disorder of lymphoid tissue
characterized by the painless enlargement of lymph nodes with progression to
extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be
noted. Fatigue and weakness may occur but are not related significantly to the disease.
53. Answer: D. Abdominal distention
Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency
and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing
tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea,
and ultimately general severe pain. Abnormal bleeding, often resulting in hypermenorrhea,
is associated with uterine cancer.
54. Answer: D. Ovarian perforation
Conization procedure involves removal of a cone-shaped area of the cervix. Complications of
the procedure include hemorrhage, infection, and cervical stenosis. Ovarian perforation is
not a complication.
55. Answer: A. sarcoma.
Tumors that originate from bone,muscle, and other connective tissue are called sarcomas.
56. Answer: C. Bargaining
Denial, bargaining, anger, depression, and acceptance are recognized stages that a person
facing a life-threatening illness experiences. Bargaining identifies a behavior in which the
individual is willing to do anything to avoid loss or change prognosis or fate. Denial is
expressed as shock and disbelief and may be the first response to hearingbad news.
Depression may be manifested by hopelessness, weeping openly, or remaining quiet or
withdrawn. Anger also may be a first response to upsetting news and the predominant
theme is why me? or the blaming of others.
57. Answer: B. 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. Options A, C, and D are expected occurrences following mastectomy and do not
indicate a complication.
58. Answer: B. Cigarette smoking
The most common risk factor associated with laryngeal cancer is cigarette smoking. Heavy
alcohol use and the combined use of tobacco increase the risk. Another risk factor is
exposure to environmental pollutants.
59. Answer: B. The development of a vesicovaginal fistula
A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The
fistula is an abnormal opening between these two body parts and, if this occurs, the client
may experience drainage of urine through the vagina. The clients complaint is not
associated with options A, C, and D.
60. Answer: D. Hyperuricemia
Allopurinol decreases uric acid production and reduces uric acid concentrations in serum and
urine. In the client receiving chemotherapy, uric acid levels increase as a result of the
massive cell destruction that occurs from the chemotherapy. This medication prevents or
treats hyperuricemia caused by chemotherapy. Allopurinol is not used to prevent alopecia,
nausea, or vomiting.
1. A 25 year old patient is inquiring about the methods or ways to
detect cancer earlier. The nurse least likely identify this method by stating:
A. Annual chest x-ray.
B. Annual Pap smear for sexually active women only.
C. Annual digital rectal examination for persons over age 40.
D. Yearly physical and blood examination
2. The removal of entire breast, pectoralis major and minor muscles and
neck lymph nodes which is followed by skin grafting is a procedure called:
A. Simple mastectomy
B. Modified radical mastectomy
C. Radiation therapy
D. Radical mastectomy
3. Chemotherapy is one of the therapeutic modalities for cancer. This treatment is
contraindicated to which of the following conditions?
A. Recent surgery
B. Pregnancy
C. Bone marrow depression
D. All of the above
4. The nurse is preparing Cyclophosphamide (Cytoxan). Safe handling of the drug
should be implemented to protect the nurse from injury. Which of the following
action by the nurse should be corrected?
A. The nurse should wear mask and gloves.
B. Air bubbles should be expelled on wet cotton.
C. Label the hanging IV bottle with ANTINEOPLASTIC CHEMOTHERAPY sign.
D. Vent vials after mixing.
5. Neoplasm can be classified as either benign or malignant. The following are
characteristics of malignant tumor apart from:
A. Metastasis
B. Infiltrates surrounding tissues
C. Encapsulated
D. Poorly differentiated cells
6. On a clinic visit a client who has a relative with cancer, is asking about the
warning signs that may relate to cancer. The nurse correctly identifies the warning
signs of cancer by responding:
A. If a sore healing took a month or more to heal, cancer should be suspected.
B. Presence of dry cough is one of the warning signs of cancer.
C. A lump located only in the breast area may suggest the presence of cancer.
D. Sudden weight loss of unexplained etiology can be a warning sign of cancer.
7. In staging and grading neoplasm TNM system is used. TNM stands for:
A. Time, neoplasm, mode of growth
B. Tumor, node, metastasis
C. Tumor, neoplasm, mode of growth
D. Time, node, metastasis
8. Breast self examination (BSE) is one of the ways to detect breast cancerearlier.
The nurse is conducting a health teaching to female clients in a clinic. During
evaluation the clients are asked to state what they learned. Which of the following
statement made by a client needs further teaching about BSE?
A. BSE is done after menstruation.
B. BSE palpation is done by starting at the center going to the periphery in a circular
motion.
C. BSE can be done in either supine or standing position.
D. BSE should start from age 20.
9. A client had undergone radiation therapy (external). The expected side effects
include the following apart from:
A. Hair loss
B. Ulceration of oral mucous membranes
C. Constipation
D. Headache
10. Nurse Janet is assigned in the oncology section of the hospital. Which of the
following orders should the nurse question if a client is on radiation therapy?
A. Analgesics before meals
B. Saline rinses every 2 hours
C. Aspirin every 4 hours
D. Bland diet
11. Skin reactions are common in radiation therapy. Nursing responsibilities on
promoting skin integrity should be promoted apart from:
A. Avoiding the use of ointments, powders and lotion to the area
B. Using soft cotton fabrics for clothing
C. Washing the area with a mild soap and water and patting it dry not rubbing it.
D. Avoiding direct sunshine or cold.
12. Nausea and vomiting is an expected side effect of chemotherapeutic drug use.
Which of the following drug should be administered to a client on chemotherapy to
prevent nausea and vomiting?
A. Metochlopramide (Metozol)
B. Succimer (Chemet)
C. Anastrazole (Arimidex)
D. Busulfan (Myleran)
13. Radiation protection is very important to implement when performing nursing
procedures. When the nurse is not performing any nursing procedures what
distance should be maintained from the client?
A. 1 feet
B. 2 feet
C. 2.5 feet
D. 3 feet
14. The following are teaching guidelines regarding radiation therapy except:
A. The therapy is painless
B. To promote safety, the client is assisted by therapy personnel while the machine is in
operation.
C. The client may communicate all his concerns or needs or discomforts while the machine
is operating.
D. Safety precautions are necessary only during the time of actual irradiation.
15. Contact of client on radiation therapy should be limited only to how many
minutes to promote safety of the therapy personnel?
A. 1 minute
B. 3 minutes
C. 5 minutes
D. 10 minutes
16. A client is taking Cyclophosphamide (Cytoxan) for the treatment of lymphoma.
The nurse is very cautious in administering the medication because this drug
poses the fatal side effect of:
A. Alopecia
B. Myeloma
C. CNS toxicity
D. Hemorrhagic cystitis
17. Cytarabine (Ara-C) is an antimetabolite that can cause a
common cytarabine syndrome which includes the following apart from:
A. Fever
B. Myalgia
C. Chest pain
D. Diarrhea
18. To provide relief from the cytarabine syndrome, which drug is given?
A. Analgesic
B. Aspirin
C. Steroids
D. Allopurinol
19. Chemotherapeutic agents have different specific classifications. The following
medications are antineoplastic antibiotics except:
A. Doxorubicin (Adriamycin)
B. Fluorouracil (Adrucil)
C. Mitoxantrone (Novantrone)
D. Bleomycin (Blenoxane)
20. Specific classification of the chemotherapeutic agent, Vincristine(Oncovin) is:
A. Hormone modulator
B. Mitotic inhibitor
C. Antineoplastic antibiotic
D. Antimetabolite
21. A client is diagnosed with progressive prostate cancer. The nurse expects
which drug is given?
A. Anstrazole (arimidex)
B. Estramustine (Emcyt)
C. Pclitaxel (Taxol)
D. Irinotecan (Camptosar)
22. A client taking a chemotherapeutic agent understands the effects of therapy
by stating:
A. I will avoid eating hot and spicy foods.
B. I should stay in my room all the time.
C. I should limit my fluid intake to about 500 ml per day.
D. I should notify the physician immediately if a urine color change is observed.
23. A client is diagnosed with breast cancer. The tumor size is up to 5 cm with
axillary and neck lymph node involvement. The client is in what stage of breast
cancer?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
24. The classic symptoms that define breast cancer includes the following except:
A. pink peel skin
B. Solitary, irregularly shaped mass
C. Firm, nontender, nonmobile mass
D. Abnormal discharge from the nipple
25. Surgical procedure to treat breast cancer involves the removal of the entire
breast, pectoralis major muscle and the axillary lymph nodes is:
A. Simple mastectomy
B. Modified radical mastectomy
C. Halstead Surgery
D. Radical mastectomy
Answers and Rationale
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 x-ray, 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. While being prepared for a biopsy of a lump in the right breast, the patient asks
the nurse what the difference is between a benign tumor and a malignant tumor.
The nurse explains that a benign tumor differs from a malignant tumor in that
benign tumors
A. do not cause damage to adjacent tissue.
B. do not spread to other tissues and organs.
C. are simply an overgrowth of normal cells.
D. frequently recur in the same site.
2. A patient who has been told by the health care provider that the cells in a
bowel tumor are poorly differentiated asks the nurse what is meant by poorly
differentiated. Which response should the nurse make?
A. The cells in your tumor do not look very different from normal bowel cells.
B. The tumor cells have DNA that is different from your normal bowel cells.
C. Your tumor cells look more like immature fetal cells than normal bowel cells.
D. The cells in your tumor have mutated from the normal bowel cells.
3. A patient who smokes tells the nurse, I want to have a yearly chest x-ray so
that if I get cancer, it will be detected early. Which response by the nurse is most
appropriate?
A. Chest x-rays do not detect cancer until tumors are already at least a half-inch in size.
B. Annual x-rays will increase your risk for cancer because of exposure to radiation.
C. Insurance companies do not authorize yearly x-rays just to detect early lung cancer.
D. Frequent x-rays damage the lungs and make them more susceptible to cancer.
4. In teaching about cancer prevention to a community group, the nurse stresses
promotion of exercise, normal body weight, and low-fat diet because
A. most people are willing to make these changes to avoid cancer.
B. dietary fat and obesity promote growth of many types of cancer.
C. people who exercise and eat healthy will make other lifestyle changes.
D. obesity and lack of exercise cause cancer in susceptible people.
5. During a routine health examination, a 30-year-old patient tells the nurse about
a family history of colon cancer. The nurse will plan to
A. teach the patient about the need for a colonoscopy at age 50.
B. ask the patient to bring in a stool specimen to test for occult blood.
C. schedule a sigmoidoscopy to provide baseline data about the patient.
D. have the patient ask the doctor about specific tests for colon cancer.
6. When reviewing the chart for a patient with cervical cancer, the nurse notes
that the cancer is staged as Tis, N0, M0. The nurse will teach the patient that
A. the cancer cells are well-differentiated.
B. it is difficult to determine the original site of the cervical cancer.
C. further testing is needed to determine the spread of the cancer.
D. the cancer is localized to the cervix.
7. Which statement by a patient who is scheduled for a needle biopsy of the
prostate indicates that the patient understands the purpose of a biopsy?
A. The biopsy will tell the doctor whether the cancer has spread to my other organs.
B. The biopsy will help the doctor decide what treatment to use for my enlarged prostate.
C. The biopsy will determine how much longer I have to live.
D. The biopsy will indicate the effect of the cancer on my life.
8. The nurse is teaching a postmenopausal patient with breast cancer about the
expected outcomes of her cancer treatment. The nurse evaluates that the teaching
has been effective when the patient says
A. After cancer has not recurred for 5 years, it is considered cured.
B. I will need to have follow-up examinations for many years after I have treatment before
I can be considered cured.
C. Cancer is considered cured if the entire tumor is surgically removed.
D. Cancer is never considered cured, but the tumor can be controlled
with surgery, chemotherapy, and radiation.
9. A patient with a large stomach tumor that is attached to the liver is scheduled
to have a debulking procedure. The nurse explains that the expected outcome of
this surgery is
A. control of the tumor growth by removal of malignant tissue.
B. promotion of better nutrition by relieving the pressure in the stomach.
C. relief of pain by cutting sensory nerves in the stomach.
D. reduction of the tumor burden to enhance adjuvant therapy.
10. External-beam radiation is planned for a patient with endometrial cancer. The
nurse teaches the patient that an important measure to prevent complications
from the effects of the radiation is to
A. test all stools for the presence of blood.
B. inspect the mouth and throat daily for the appearance of thrush.
C. perform perianal care with sitz baths and meticulous cleaning.
D. maintain a high-residue, high-fat diet.
11. Which action by a nursing assistant (NA) caring for a patient with a temporary
radioactive cervical implant indicates that the RN should intervene?
A. The NA places the patients bedding in the laundry container in the hallway.
B. The NA flushes the toilet once after emptying the patients bedpan.
C. The NA stands by the patients bed for an hour talking with the patient.
D. The NA gives the patient an alcohol-containing mouthwash for oral care.
12. A patient with Hodgkins lymphoma is undergoing external radiation therapy
on an outpatient basis. After 2 weeks of treatment, the patient tells the nurse, I
am so tired I can hardly get out of bed in the morning. An appropriate
intervention for the nurse to plan with the patient is to
A. exercise vigorously when fatigue is not as noticeable.
B. consult with a psychiatrist for treatment of depression.
C. establish a time to take a short walk every day.
D. maintain bed rest until the treatment is completed.
13. Which information obtained by the nurse about a patient with coloncancer who
is scheduled for external radiation therapy to the abdomen indicates a need for
patient teaching?
A. The patient swims a mile 5 days a week.
B. The patient eats frequently during the day.
C. The patient showers with Dove soap daily.
D. The patient has a history of dental caries.
14. A patient undergoing external radiation has developed a dry desquamation of
the skin in the treatment area. The nurse knows that teaching about management
of the skin reaction has been effective when the patient says
A. I can use ice packs to relieve itching in the treatment area.
B. I can buy a steroid cream to use on the itching area.
C. I will expose the treatment area to a sun lamp daily.
D. I will scrub the area with warm water to remove the scales.
15. A patient with metastatic cancer of the colon experiences severe vomiting
following each administration of chemotherapy. An important nursing intervention
for the patient is to
A. teach about the importance of nutrition during treatment.
B. have the patient eat large meals when nausea is not present.
C. administer prescribed antiemetics 1 hour before the treatments.
D. offer dry crackers and carbonated fluids during chemotherapy.
16. When the nurse is administering a vesicant chemotherapeutic agent
intravenously, an important consideration is to
A. stop the infusion if swelling is observed at the site.
B. infuse the medication over a short period.
C. administer the chemotherapy through small-bore catheter.
D. hold the medication unless a central venous line is available.
17. A chemotherapeutic agent known to cause alopecia is prescribed for a patient.
To maintain the patients self-esteem, the nurse plans to
A. suggest that the patient limit social contacts until regrowth of the hair occurs.
B. encourage the patient to purchase a wig or hat and wear it once hair loss begins.
C. have the patient wash the hair gently with a mild shampoo to minimize hair loss.
D. inform the patient that hair loss will not be permanent and that the hair will grow back.
18. A patient with ovarian cancer tells the nurse, I dont think my husband cares
about me anymore. He rarely visits me. On one occasion when the husband was
present, he told the nurse he just could not stand to see his wife so ill and never
knew what to say to her. An appropriate nursing diagnosis in this situation is
A. compromised family coping related to disruption in lifestyle and role changes.
B. impaired home maintenance related to perceived role changes.
C. risk for caregiver role strain related to burdens of caregiving responsibilities.
D. interrupted family processes related to effect of illness on family members.
19. A patient receiving head and neck radiation and systemic chemotherapy has
ulcerations over the oral mucosa and tongue and thick, ropey saliva. An
appropriate intervention for the nurse to teach the patient is to
A. remove food debris from the teeth and oral mucosa with a stiff toothbrush.
B. use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth.
C. gargle and rinse the mouth several times a day with an antiseptic mouthwash.
D. rinse the mouth before and after each meal and at bedtime with a saline solution.
20. A patient who is receiving interleukin-2 (IL-2) therapy (Proleukin) complains
to the nurse about all of these symptoms. Which one is most important to report
to the health care provider?
A. Generalized aches
B. Dyspnea
C. Decreased appetite
D. Insomnia
Answers and Rationale
1. Answer: B. do not spread to other tissues and organs.
The major difference between benign and malignant tumors is that malignant tumors invade
adjacent tissues and spread to distant tissues and benign tumors never metastasize. Both
types of tumors may cause damage to adjacent tissues. The cells differ from normal in both
benign and malignant tumors. Benign tumors usually do not recur.
2. Answer: C. Your tumor cells look more like immature fetal cells than normal
bowel cells.
An undifferentiated cell has an appearance more like a stem cell or fetal cell and less like
the normal cells of the organ or tissue. The DNA in cancer cells is always different from
normal cells, whether the cancer cells are well differentiated or not. All tumor cells are
mutations form the normal cells of the tissue.
3. Answer: A. Chest x-rays do not detect cancer until tumors are already at least
a half-inch in size.
A tumor must be at least 1 cm large before it is detectable by an x-ray and may already
have metastasized by that time. Radiographs have low doses of radiation, and an annual x-
ray alone is not likely to increase lung cancer risk. Insurance companies do not usually
authorize x-rays for this purpose, but it would not be appropriate for the nurse to give this
as the reason for not doing an x-ray. A yearly x-ray is not a risk factor for lung cancer.
4. Answer: B. dietary fat and obesity promote growth of many types of cancer.
Obesity and dietary fat promote the growth of malignant cells, and decreasing these risk
factors can reduce the chance of cancer development. Many people are not willing to make
these changes. Good diet and exercise habits are not a guarantee that other healthy
lifestyle changes will then occur. Obesity and lack of exercise do not cause cancer, but they
promote the growth of altered cells.
5. Answer: D. have the patient ask the doctor about specific tests for coloncancer.
The patient is at increased risk and should talk with the health care provider about needed
tests, which will depend on factors such as the exact type of family history and any current
symptoms. Colonoscopy at age 50 is used to screen for individuals without symptoms or
increased risk, but earlier testing may be needed for this patient because of family history.
For fecal occult blood testing, patients use a take-home multiple sample method rather than
bring one specimen to the clinic. The health care provider will take multiple factors into
consideration before determining whether a sigmoidoscopy is needed at age 30.
6. Answer: D. the cancer is localized to the cervix.
Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this
time. Cell differentiation is not indicated by clinical staging. Because the cancer is in situ,
the origin is the cervix. Further testing is not indicated given that the cancer has not spread.
7. Answer: B. The biopsy will help the doctor decide what treatment to use for my
enlarged prostate.
A biopsy is used to determine whether the prostate enlargement is benign or malignant and
determines the type of treatment that will be needed. Biopsy does not give information
about metastasis, life expectancy, or the impact of cancer on the patients life; the three
remaining statements indicate a need for patient teaching.
8. Answer: B. I will need to have follow-up examinations for many years after I
have treatment before I can be considered cured.
The risk of recurrence varies by the type of cancer; for breast cancer in postmenopausal
women, the patient needs at least 20 disease-free years to be considered cured. Some
cancers (e.g., leukemia) are cured by nonsurgical therapies such as radiation and
chemotherapy.
9. Answer: D. reduction of the tumor burden to enhance adjuvant therapy.
A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy
more effective. Debulking surgeries do not control tumor growth. The tumor is debulked
because it is attached to the liver, a vital organ (not to relieve pressure on the stomach).
Debulking does not sever the sensory nerves, although pain may be lessened by the
reduction in pressure on the abdominal organs.
10. Answer: C. perform perianal care with sitz baths and meticulous cleaning.
Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and
cause frequent diarrhea. Stools are likely to have occult blood from the inflammation
associated with radiation, so routine testing of stools for blood is not indicated. Radiation to
the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation
of the bowel when patients receive abdominal radiation.
11. Answer: C. The NA stands by the patients bed for an hour talking with the
patient.
Because patients with temporary implants emit radioactivity while the implants are in place,
exposure to the patient is limited. Laundry and urine/feces do not have any radioactivity
and do not require special precautions. Cervical radiation will not affect the oral mucosa,
and alcohol-based mouthwash is not contraindicated.
12. Answer: C. establish a time to take a short walk every day.
Walking programs are used to keep the patient active without excessive fatigue. Vigorous
exercise when the patient is less tired may lead to increased fatigue. Fatigueis expected
during treatment and is not an indication of depression. Bed rest will lead to weakness and
other complications of immobility.
13. Answer: A. The patient swims a mile 5 days a week.
The patient is instructed to avoid swimming in salt water or chlorinated pools during the
treatment period. The patient does not need to change the habits of eating frequently or
showering with a mild soap. A history of dental caries will not impact the patient who is
scheduled for abdominal radiation.
14. Answer: B. I can buy a steroid cream to use on the itching area.
Steroid (over-the-counter [OTC] hydrocortisone) cream may be used to reduce itching in
the area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently
to avoid further injury.
15. Answer: C. administer prescribed antiemetics 1 hour before the treatments.
Treatment with antiemetics before chemotherapy may help to prevent anticipatory nausea.
Although nausea may lead to poor nutrition, there is no indication that the patient needs
instruction about nutrition. The patient should eat small, frequent meals. Offering food and
beverages during chemotherapy is likely to cause nausea.
16. Answer: A. stop the infusion if swelling is observed at the site.
Swelling at the site may indicate extravasation, and the IV should be stopped immediately.
The medication should generally be given slowly to avoid irritation of the vein. The size of
the catheter is not as important as administration of vesicants into a running IV line to allow
dilution of the chemotherapy drug. These medications can be given through peripheral lines,
although central vascular access devices (CVADs) are preferred.
17. Answer: B. encourage the patient to purchase a wig or hat and wear it once
hair loss begins.
The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats.
Limiting social contacts is not appropriate at a time when the patient is likely to need a good
social support system. The damage occurs at the hair follicle and will occur regardless of
gentle washing or use of a mild shampoo. The information that the hair will grow back is not
immediately helpful in maintaining the patients self-esteem.
18. Answer: D. interrupted family processes related to effect of illness on family
members.
The data indicate that this diagnosis is most appropriate because the family members are
impacted differently by the patients cancer diagnosis. There are no data to suggest a
change in lifestyle or role as an etiology. The data do not support impairment in home
maintenance or a burden caused by caregiving responsibilities.
19. Answer: D. rinse the mouth before and after each meal and at bedtime with a
saline solution.
The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is
used for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may
irritate the oral mucosa and are not recommended.
20. Answer: B. Dyspnea
Dyspnea may indicate capillary leak syndrome and pulmonary edema, which requires rapid
treatment. The other symptoms are common with IL-2 therapy, and the nurse should teach
the patient that these are common adverse effects that will resolve at the end of the
therapy.
1. A 32-year-old male patient is to undergo radiation therapy to the pelvic area for
Hodgkins lymphoma. He expresses concern to the nurse about the effect
of chemotherapy on his sexual function. The best response by the nurse to the
patients concerns is
A. Radiation does not cause the problems with sexual functioning that occur
with chemotherapy or surgical procedures used to treat cancer.
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.
C. The radiation will make you sterile, but your ability to have sexual intercourse will not
be changed by the treatment.
D. You may have some temporary impotence during the course of the radiation, but normal
sexual function will return.
2. A 40-year-old divorced mother of four school-age children is hospitalized with
metastatic cancer of the ovary. The nurse finds the patient crying, and she tells
the nurse that she does not know what will happen to her children when she dies.
The most appropriate response by the nurse is
A. Why dont we talk about the options you have for the care of your children?
B. Many patients with cancer live for a long time, so there is time to plan for your
children.
C. For now you need to concentrate on getting well, not worry about your children.
D. Perhaps your ex-husband will take the children when you cant care for them.
3. A patient who has terminal cancer of the liver and is cared for by family
members at home tells the nurse, I have intense pain most of the time now. The
nurse recognizes that teaching regarding pain management has been effective
when the patient
A. uses the ordered opioid pain medication whenever the pain is greater than 5 on a 10-
point scale.
B. states that nonopioid analgesics may be used when the maximal dose of the opioid is
reached without adequate pain relief.
C. agrees to take the medications by the IV route to improve effectiveness.
D. takes opioids around the clock on a regular schedule and uses additional doses when
breakthrough pain occurs.
4. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic
renal cell carcinoma. The nurse teaches the patient that the purpose of therapy
with this agent is to
A. protect normal kidney cells from the damaging effects of chemotherapy.
B. enhance the patients immunologic response to tumor cells.
C. stimulate malignant cells in the resting phase to enter mitosis.
D. prevent the bone marrow depression caused by chemotherapy.
5. The home health nurse is caring for a patient who has been
receiving interferon therapy for treatment of cancer. Which statement by the
patient may indicate a need for a change in treatment?
A. I have frequent muscle aches and pains.
B. I rarely have the energy to get out of bed.
C. I take acetaminophen (Tylenol) every 4 hours.
D. I experience chills after I inject the interferon.
6. Which information noted by the nurse reviewing the laboratory results of a
patient who is receiving chemotherapy is most important to report to the health
care provider?
A. Hemoglobin of 10 g/L
B. WBC count of 1700/l
C. Platelets of 65,000/l
D. Serum creatinine level of 1.2 mg/dl
7. A bone marrow transplant is being considered for treatment of a patient with
acute leukemia that has not responded to chemotherapy. In discussing the
treatment with the patient, the nurse explains that
A. hospitalization will be required for several weeks after the hematopoietic stem cell
transplant (HSCT).
B. the transplant of the donated cells is painful because of the nerves in the tissue lining the
bone.
C. donor bone marrow cells are transplanted immediately after an infusion of
chemotherapy.
D. the transplant procedure takes place in a sterile operating room to minimize the risk for
infection.
8. The nurse teaches a patient with cancer of the liver about high-protein, high-
calorie diet choices. Which snack choice by the patient indicates that the teaching
has been effective?
A. Fresh fruit salad
B. Orange sherbet
C. Strawberry yogurt
D. French fries
9. The nurse has identified the nursing diagnosis of imbalanced nutrition: less than
body requirements related to altered taste sensation in a patient with
lung cancer who has had a 10% loss in weight. An appropriate nursing
intervention that addresses the etiology of this problem is to
A. provide foods that are highly spiced to stimulate the taste buds.
B. avoid presenting foods for which the patient has a strong dislike.
C. add strained baby meats to foods such as soups and casseroles.
D. teach the patient to eat whatever is nutritious since food is tasteless.
10. After the nurse has explained the purpose of and schedule for chemotherapy
to a 23-year-old patient who recently received a diagnosis of acute leukemia, the
patient asks the nurse to repeat the information. Based on this assessment, which
nursing diagnosis is most likely for the patient?
A. Acute confusion related to infiltration of leukemia cells into the central nervous system
B. Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment
C. Risk for ineffective health maintenance related to anxiety about new leukemiadiagnosis
D. Risk for ineffective adherence to treatment related to denial of need for chemotherapy
11. A hospitalized patient who has received chemotherapy for leukemiadevelops
neutropenia. Which observation by the RN caring for the patient indicates that the
nurse should take action?
A. The patients visitors bring in some fresh peaches from home.
B. The patient ambulates several times a day in the room.
C. The patient uses soap and shampoo to shower every other day.
D. The patient cleans with a warm washcloth after having a stool.
12. Which action by a nursing assistant (NA) when caring for a patient who is
pancytopenic indicates a need for the nurse to intervene?
A. The NA assists the patient to use dental floss after eating.
B. The NA makes an oral rinse using 1 teaspoon of salt in a liter of water.
C. The NA adds baking soda to the patients saline oral rinses.
D. The NA puts fluoride toothpaste on the patients toothbrush.
13. A with tumor lysis syndrome (TLS) is taking allopurinol (Zyloprim). Which
laboratory value should the nurse monitor to determine the effectiveness of the
medication?
A. Blood urea nitrogen (BUN)
B. Serum phosphate
C. Serum potassium
D. Uric acid level
14. When assessing a patients needs for psychologic support after the patient has
been diagnosed with stage I cancer of the colon, which question by the nurse will
provide the most information?
A. Can you tell me what has been helpful to you in the past when coping with stressful
events?
B. How long ago were you diagnosed with this cancer?
C. Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of
the colon?
D. How do you feel about having a possibly terminal illness?
15. A 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57
kg) tells the nurse that she has a glass of wine two or three times a week. The
patient works for the post office and has a 5-mile mail-deliveryroute. This is her
first contact with the health care system in 20 years. Which of these topics will the
nurse plan to include in patient teaching about cancer? (Select all that apply.)
A. Alcohol use
B. Physical activity
C. Body weight
D. Colorectal screening
E. Tobacco use
F. Mammography
G. Pap testing
H. Sunscreen use
Answers and Rationale
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 tumorcells. 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 anxietyabout
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.