Oncology Drills With Answers and Rationales

NTCS FREE NURSING ONLINE REVIEW Medical-Surgical Nursing ONCOLOGY 1. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief and he refuses to move. The nurse should plan to: a. Reassure him that the nurses will not hurt him b. Let him perform his own activities of daily living c. Handle him gently when assisting with required care d. Complete A.M. care quickly as possible when necessary 2. A female client with breast cancer is currently receiving radiation therapy for treatment. The client is complaining of apathy, hard to concentrate on something, and feeling tired despite of having time to rest and more sleep. These complains suggest symptoms of a. Hypocalcemia b. radiation pneumonitis c. advanced breast cancer d. fatigue 3. A chemotherapeutic agent 5FU is ordered as an adjunct measure to surgery. Which of the ff. statements about chemotherapy is true? a. it is a local treatment affecting only tumor cells b. it affects both normal and tumor cells c. it has been proven as a complete cure for cancer d. it is often used as a palliative measure. 4. Which of the following signs and symptoms would Nurse Maureen include in teaching plan as an early manifestation of laryngeal cancer? a. Stomatitis b. Airway obstruction c. Hoarseness d. Dysphagia 5. Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it: a. Promotes the removal of antibodies that impair the transmission of impulses

b. Stimulates the production of acetylcholine at the neuromuscular junction. c. Decreases the production of auto antibodies that attack the acetylcholine receptors. d. Inhibits the breakdown of acetylcholine at the neuromuscular junction. 6. Which of the following stage the carcinogen is irreversible? a. Progression stage b. Initiation stage c. Regression stage d. Promotion stage 7. Nurse Anna is aware that early adaptation of client with renal carcinoma is: a. Nausea and vomiting b. flank pain c. weight gain d. intermittent hematuria 8. A newly admitted client is diagnosed with Hodgkin’s disease undergoes an excisional cervical lymph node biopsy under local anesthesia. What does the nurse assess first after the procedure? a. Vital signs b. Incision site c. Airway d. Level of consciousness 9. Cancer patients have special nutrition needs and issues related to eating. The client receving chemotherapy refuses to eat the food that was delivered to him and said that the food tastes funny. The appropriate nursing intervention is: a. Obtain an order for total parenteral nutrition b. Keep the client on NPO c. Administer anti-emetic as ordered by physician d. Provide oral hygiene care 10. A client with testicular cancer is scheduled for a right orchiectomy. The nurse knows that an orchiectomy is the a. surgical removal of the entire scrotum

NTCS FREE NURSING ONLINE REVIEW b. surgical removal of a testicle c. dissection of related lymph nodes d. partial surgical removal of the penis 11. A client is being evaluated for cancer of the colon. In preparing the client for barium enema, the nurse should: a. Give laxative the night before and a cleansing enema in the morning before the test b. Render an oil retention enema and give laxative the night before c. Instruct the client to swallow 6 radiopaque tablets the evening before the study d. Place the client on CBR a day before the study

12. The client has a good understanding of the means to reduce the chances of colon cancer when he states: a. “I will exercise daily.” b. “I will include more red meat in my diet.” c. “I will have an annual chest x-ray.” d. “I will include more fresh fruits and vegetables in my diet.” 13. A client, who is suspected of having Pheochromocytoma, complains of sweating, palpitation and headache. Which assessment is essential for the nurse to make first? a. Pupil reaction b. Hand grips c. Blood pressure d. Blood glucose 14. The nurse is conducting an education session for a group of smokers in a “stop smoking” class. Which finding would the nurse state as a common symptom of lung cancer? : a. Dyspnea on exertion b. Foamy, blood-tinged sputum c. Wheezing sound on inspiration d. Cough or change in a chronic cough 15. A client admitted with newly diagnosed with Hodgkin’s disease. Which of the following would the nurse expect the client to report? a. Lymph node pain b. Weight gain

c. Night sweats d. Headache 16. When teaching a client about the signs of colorectal cancer, Nurse Trish stresses that the most common complaint of persons with colorectal cancer is: a. Abdominal pain b. Hemorrhoids c. Change in caliber of stools d. Change in bowel habits 17. A patient with a left frontal lobe tumor has a craniotomy. Four hours post surgery, which data indicates increased ICP? a. BP 160/90 b. Patient is difficult to arouse c. Patient has a positive Babinski response d. Patient has urinary incontinence

18. The most common preferred treatment for cancer is a. Chemotherapy b. Radiation therapy c. Surgery d. Bone marrow transplant 19. A client on chemotherapy has a platelet count of 26,000 mm. Which nursing intervention must be included in the client's care plan? a. Having the client use an electric razor and soft-bristle toothbrush b. Premedicating the client 30 minutes before chemotherapy with an antiemetic c Preparing to administer leukocyte-poor packed red blood cells (RBCs) d. Screening all visitors and staff for infection prior to allowing them to enter the room 20. Which intervention would be most appropriate for a client who is 12 days postchemotherapy and being admitted with shortness of breath, a dry hacking cough, and a temperature of 101° F? a. Having the dietary department serve the meals as hot as possible b. Initiating the prescribed I.V. antibiotics after checking the white blood cell (WBC) count c. Limiting the protein and calories in the

NTCS FREE NURSING ONLINE REVIEW client's diet d. Reassuring the client that fatigue is a common occurrence after chemotherapy 21. The nurse is planning the care for a client with cancer who is about to enter a hospice treatment program. Which nursing diagnosis and outcome would be appropriate for this client? a. Imbalanced nutrition: The client will eat three meals/snacks a day b. Impaired social interaction: The client will attend one outing per week c. Anticipatory grieving: The client will participate in end-of-life care planning d. Deficient knowledge: The client will state three reasons for cancer therapy 22. The nurse knows that a 28-year-old female client with Hodgkin's disease who is receiving chemotherapy understands the discharge teaching when the client says which statement? a. "I should begin to try to have a baby as soon as possible." b. "If I begin to run a fever, I should call my doctor." c. "If I feel tired, I should go to the gym and work out." d. "If my mouth gets sore, I'll need to fast until it goes away." 23. After chemotherapy, a client who is scheduled to begin treatment with a biologic response modifier (BRM) asks the nurse how this treatment will help him. The nurse bases the response on the knowledge that this type of treatment stimulates: a. reproduction of cancer cells. b. the body's natural immune defenses. c. the liver to produce an anti-tumor hormone. d. the pancreas to produce an anti-cancer hormone. 24. Larry is diagnosed as having myelocytic leukemia and is admitted to the hospital for chemotherapy. Larry discusses his recent diagnosis of leukemia by referring to statistical facts and figures. The nurse recognizes that Larry is using the defense mechanism known as:

A. Reaction formation B. Sublimation C. Intellectualization D. Projection 25. Which statement by the client indicates to the nurse that the patient understands precautions necessary during internal radiation therapy for cancer of the cervix? a. “I should get out of bed and walk around in my room.” b. “My 7 year old twins should not come to visit me while I’m receiving treatment.” c. “I will try not to cough, because the force might make me expel the application.” d. “I know that my primary nurse has to wear one of those badges like the people in the xray department, but they are not necessary for anyone else who comes in here.” 26. A post-operative complication of mastectomy is lymphedema. This can be prevented by a. ensuring patency of wound drainage tube b. placing the arm on the affected side in a dependent position c. restricting movement of the affected arm d. frequently elevating the arm of the affected side above the level of the heart. 27. High uric acid levels may develop in clients who are receiving chemotherapy. This is caused by: a. The inability of the kidneys to excrete the drug metabolites b. Rapid cell catabolism c. Toxic effect of the antibiotic that are given concurrently d. The altered blood ph from the acid medium of the drugs 28. Maria Sison, 40 years old, single, was admitted to the hospital with a diagnosis of Breast Cancer. She was scheduled for radical mastectomy. Nursing care during the preoperative period should consist of: a. assuring Maria that she will be cured of cancer b. assessing Maria’s expectations and doubts c. maintaining a cheerful and optimistic environment d. keeping Maria’s visitors to a minimum so she can have time for herself

NTCS FREE NURSING ONLINE REVIEW 29. Maria refuses to acknowledge that her breast was removed. She believes that her breast is intact under the dressing. The nurse should a. call the MD to change the dressing so Kathy can see the incision b. recognize that Kathy is experiencing denial, a normal stage of the grieving process c. reinforce Kathy’s belief for several days until her body can adjust to stress of surgery. d. remind Kathy that she needs to accept her diagnosis so that she can begin rehabilitation exercises. 30. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy with the creation of an ileal conduit in the morning. He is wringing his hands and pacing the floor when the nurse enters his room. What is the best approach? a. "Good evening, Mr. Pablo. Wasn't it a pleasant day, today?" b. "Mr, Pablo, you must be so worried, I'll leave you alone with your thoughts. c. “Mr. Pablo, you'll wear out the hospital floors and yourself at this rate." d. "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?" 31. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief and he refuses to move. The nurse should plan to: a. Reassure him that the nurses will not hurt him b. Let him perform his own activities of daily living c. Handle him gently when assisting with required care d. Complete A.M. care quickly as possible when necessary 32. A client, who is suspected of having Pheochromocytoma, complains of sweating, palpitation and headache. Which assessment is essential for the nurse to make first? a. Pupil reaction b. Hand grips c. Blood pressure d. Blood glucose

33. The client is admitted to the outpatient surgery center for removal of a malignant melanoma. Which assessment data indicate the lesion is a malignant melanoma? a. The lesion is asymmetrical and has irregular borders. b. The lesion has a waxy appearance with pearl-like borders. c. The lesion has a thickened and scaly appearance. d. The lesion appeared as a thickened area after an injury. 34. The female client admitted for an unrelated diagnosis asks the nurse to check her back because “it itches all the time in that one spot.” When the nurse assesses the client’s back, the nurse notes an irregularshaped lesion with some scabbed-over areas surrounding the lesion. Which action should the nurse implement first? a. Notify the HCP to check the lesion on rounds. b. Measure the lesion and note the color. c. Apply lotion to the lesion. d. Instruct the client to make sure the HCP checks the lesion. 35. The nurse is caring for a client diagnosed with squamous cell skin cancer and writes a psychosocial problem of “fear.” Which nursing interventions should be included in the plan of care? a. Explain to the client that the fears are unfounded. b. Encourage the client to verbalize the feeling of being afraid. c. Have the HCP discuss the client’s fear with the client. d. Instruct the client regarding all planned procedures. 36. The client has had a squamous cell carcinoma removed from the lip. Which discharge instructions should the nurse provide? a. Notify the HCP if a lesion that does not heal develops around the mouth. b. Squamous cell carcinoma tumors do not metastasize. c. Limit foods to liquid or soft consistency for 1 month.

NTCS FREE NURSING ONLINE REVIEW d. Apply heat to the area for 20 minutes every 4 hours. 37. The nurse is caring for clients in an outpatient surgery clinic. Which client should be assessed first? a. The client scheduled for a skin biopsy who is crying. b. The client who had surgery three (3) hours ago and is sleeping. c. The client who needs to void prior to discharge. d. The client who has received discharge instructions and is ready to go home. 38. The nurse and unlicensed assistive personnel are caring for clients in a dermatology clinic. Which task should not be delegated to the unlicensed assistant? a. Stock the rooms with the equipment needed. b. Weigh the clients and position the clients for the examination. c. Discuss problems the client has experienced since the previous visit. d. Take the biopsy specimens to the laboratory. 39. Which client is at the greatest risk for the development of skin cancer? a. The African American male who lives in the northeast. b. The elderly Hispanic female who moved from Mexico as a child. c. The client who has a family history of basal cell carcinoma. d. The client with fair complexion who cannot get a tan. 40. The nurse participating in a health fair is discussing malignant melanoma with a group of clients. Which information regarding the use of sunscreen is important to include? a. Sunscreen is only needed during the hottest hours of the day. b. Toddlers should not have sunscreen applied to their skin. c. Sunscreen does not help prevent skin cancer. d. The higher the number of the sunscreen, the more it blocks UV rays.

41. The school nurse is preparing to teach a health promotion class to high school seniors. Which information regarding self-care should be included in the teaching? a. Wear a sunscreen with a protection factor of 10 or less when in the sun. b. Try to stay out of the sun between 0300 and 0500 daily. c. Perform a thorough skin check monthly. d. Remember that caps and long sleeves do not help prevent skin cancer. 42. Which client physiological outcome (goal) is appropriate for a client diagnosed with skin cancer who has had surgery to remove the lesion? a. The client will express feelings of fear. b. The client will ask questions about the diagnosis. c. The client will state a diminished level of pain. d. The client will demonstrate care of operative site. 43. The middle-aged client has had 2 lesions diagnosed as basal cell carcinoma removed. Which discharge instruction should the nurse include? a. Teach the client that there is no more risk for cancer. b. Refer the client to a prosthesis specialist for prosthesis. c. Instruct the client how to apply sunscreen to the area. d. Demonstrate care of the surgical site. 44. The nurse is working on a renal surgery unit. After the afternoon report, which client should the nurse assess first? a. The male client who just returned from a CT scan and states that he left his glasses in the x-ray department. b. The client who is one (1) day post-op and has a moderate amount of serous drainage on the dressing. c. The client who is scheduled for surgery in the morning and wants an explanation of the operative procedure before signing the permit. d. The client who had ileal conduit surgery this morning and has not had any drainage in the drainage bag.

NTCS FREE NURSING ONLINE REVIEW 45. Which is a modifiable risk factor for the development of cancer of the bladder? a. Previous exposure to chemicals. b. Pelvic radiation therapy. c. Cigarette smoking. d. Parasitic infections of the bladder. 46. The client diagnosed with cancer of the bladder is scheduled to have a cutaneous urinary diversion procedure. Which preoperative teaching intervention specific to the procedure should be included? a. Demonstrate turn, cough, and deep breathing. b. Explain that a bag will drain the urine from now on. c. Instruct the client on the use of a PCA pump. d. Take the client to the ICD so that he or she can become familiar with it. 47. The client diagnosed with cancer of the bladder is undergoing intravesical chemotherapy. Which instruction should the nurse provide the client about the pre-therapy routine? a. Instruct the client to remain NPO after midnight before the procedure. b. Explain the use of chemotherapy in bladder cancer. c. Teach the client to administer Neupogen, a biologic response modifier. d. Have the client take Tylenol, an analgesic, before coming to the clinic. 48. The nurse is planning the care of a postoperative client with an ileal conduit. Which intervention should be included in the plan of care? 1. Provide meticulous skin care and pouching. 2. Apply sterile drainage bags daily. 3. Monitor the pH of the urine weekly. 4. Assess the stoma site every day. 49. The nurse and a licensed practical nurse (LPN) are caring for a group of clients. Which intervention should be assigned to the LPN? a. Assessment of the client who has had a Kock pouch procedure. b. Monitoring of the post-op client with a WBC of 22,000 mm/dL.

c. Administration of the prescribed antineoplastic medications. d. Care for the client going for a MRI of the kidneys. 50. The male client diagnosed with metastatic cancer of the bladder is emaciated and refuses to eat. Which nursing action is an example of the ethical principle of paternalism? a. The nurse allows the client to talk about not wanting to eat. b. The nurse tells the client that if he does not eat, a feeding tube will be placed. c. The nurse consults the dietitian about the client’s nutritional needs. d. The nurse asks the family to bring favorite foods for the client to eat. 51. The client diagnosed with cancer of the bladder states, “I have young children. I am too young to die.” Which statement is the nurse’s best response? a. “This cancer is treatable and you should not give up.” b. “Cancer occurs at any age. It is just one of those things.” c. “You are afraid of dying and what will happen to your children.” d. “Have you talked to your children about your dying?” 52. The client with a continent urinary diversion is being discharged. Which discharge instructions should the nurse include in the teaching? a. Have the client demonstrate catheterizing the stoma. b. Instruct the client on how to pouch the stoma. c. Explain the use of a bedside drainage bag at night. d. Tell the client to call the HCP if the temperature is 99_F or less. 53. Which information regarding the care of a cutaneous ileal conduit should the nurse teach? a. Teach the client to instill a few drops of vinegar into the pouch. b. Tell the client that the stoma should be slightly dusky colored.

NTCS FREE NURSING ONLINE REVIEW c. Inform the client that large clumps of mucus are expected. d. Tell the client that it is normal for the urine to be pink or red in color. 54. The client is 2 days post ureterosigmoidostomy for cancer of the bladder. Which assessment data warrant notification of the HCP by the nurse? a. The client complains of pain at a “3,” 30 minutes after being medicated. b. The client complains that it hurts to cough and deep breathe. c. The client ambulates to the end of the hall and back before lunch. d. The client is lying in a fetal position and has a rigid abdomen. 55. The female client diagnosed with bladder cancer with a cutaneous urinary diversion states, “Will I be able to have children now?” Which statement is the nurse’s best response? a. “Cancer does not make you sterile, but sometimes the therapy can.” b. “Are you concerned that you can’t have children?” c. “You will be able to have as many children as you want.” d. “Let me have the chaplain come to talk with you about this.” 56. 1. The nurse is instructing the 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-examinations should be done at least every 6 months 57. The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. Which of the following, if identified by the client as a risk factor for cervical cancer, indicates a need for further teaching? a. Smoking b. Multiple sex partners c. First intercourse after age 20

d. Annual gynecological examinations 58. The community health nurse is instructing a group of female clients about breast selfexamination. The nurse instructs the clients 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 59. The nurse 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 60. The 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. Computed tomography scan 61. A client is 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 62. 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? a. Increased calcium level b. Increased white blood cells c. Decreased blood urea nitrogen level

NTCS FREE NURSING ONLINE REVIEW d. Decreased number of plasma cells in the bone marrow 63. The nurse is developing a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? a. Encouraging fluids b. Providing frequent oral care c. Coughing and deep breathing d. Monitoring the red blood cell count 64. The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further teaching is needed if a nursing staff member states that which of the following is a characteristic of the disease? a. Presence of Reed-Sternberg cells b. Occurs most often in the older client c. Prognosis depending on the stage of the disease d. Involvement of lymph nodes, spleen, and liver 65. The 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 66. The 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 67. The nurse 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 client's room.

c. Remove the dosimeter badge when entering the client's 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. 68. 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 69. The 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. 70. The nurse is caring for a 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. 71. The home health care nurse is caring for a client with cancer and the client is complaining of acute pain. The appropriate nursing assessment of the client's pain would include which of the following? a. The client's pain rating b. Nonverbal cues from the client c. The nurse's impression of the client's pain d. Pain relief after appropriate nursing intervention 72. The nurse is caring for a client who is postoperative following a pelvic exenteration and the physician changes the client's diet

NTCS FREE NURSING ONLINE REVIEW 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 73. The client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client? a. Fatigue b. Weakness c. Weight gain d. Enlarged lymph nodes 74. During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? a. Diarrhea b. Hypermenorrhea c. Abnormal bleeding d. Abdominal distention 75. When assessing the laboratory results of the client with bladder cancer and bone metastasis, the nurse notes a calcium level of 12 mg/dL. The nurse recognizes that this is consistent with which oncological emergency? a. Hyperkalemia b. Hypercalcemia c. Spinal cord compression d. Superior vena cava syndrome 76. The client reports to the nurse that when performing testicular self-examination, he found a lump the size and shape of a pea. The appropriate response to the client is which of the following? a. “Lumps like that are normal; don't worry.” b. “Let me know if it gets bigger next month.” c. “That could be cancer. I'll ask the doctor to examine you.” d. “That's important to report even though it might not be serious.” 77. The 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 daughter's graduation, I'll be

ready to die.” Which phase of coping is this client experiencing? a. Anger b. Denial c. Bargaining d. Depression 78. The nurse 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 79. The nurse is admitting a 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 80. The female client who has been receiving radiation therapy for bladder cancer 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 81. The client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim) is prescribed for the client. The nurse tells the client that the purpose of the allopurinol is to: a. Prevent nausea b. Prevent alopecia c. Prevent vomiting d. Prevent hyperuricemia 82. The client receiving chemotherapy is experiencing mucositis. The nurse advises the client to use which of the following as the best substance to rinse the mouth? a. Alcohol-based mouthwash

NTCS FREE NURSING ONLINE REVIEW b. Hydrogen peroxide mixture c. Lemon-flavored mouthwash d. Weak salt and bicarbonate mouth rinse 83. The community nurse is conducting a health promotion program and the topic of the discussion relates to the risk factors for gastric cancer. Which risk factor, if identified by a client, indicates a need for further discussion? a. Smoking b. A high-fat diet c. Foods containing nitrates d. A diet of smoked, highly salted, and spiced food 84. A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. Which of the following is the appropriate nursing intervention? a. Notify the physician. b. Measure abdominal girth. c. Irrigate the nasogastric tube. d. Continue to monitor the drainage. 85. The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to colorectal cancer is necessary if the client identifies which of the following as an associated risk factor? 1. Age younger than 50 years 2. History of colorectal polyps 3. Family history of colorectal cancer 4. Chronic inflammatory bowel disease 86. The nurse is reviewing the preoperative orders of a client with a colon tumor who is scheduled for abdominal perineal resection and notes that the physician has prescribed neomycin (Mycifradin) for the client. The nurse determines that this medication has been prescribed primarily: a. To prevent an immune dysfunction b. Because the client has an infection c. To decrease the bacteria in the bowel d. Because the client is allergic to penicillin 87. The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal

perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is appropriate? a. Notify the physician. b. Clamp the Penrose drain. c. Change the dressing as prescribed. d. Remove and replace the perineal packing. 88. The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which of the following assessment findings indicates that the colostomy is beginning to function? a. Absent bowel sounds b. The passage of flatus c. The client's ability to tolerate food d. Bloody drainage from the colostomy 89. The nurse is caring for a client following a radical neck dissection and creation of a tracheostomy performed for laryngeal cancer and is providing discharge instructions to the client. Which statement by the client indicates a need for further instructions? a. “I will protect the stoma from water.” b. “I need to keep powders and sprays away from the stoma site.” c. “I need to use an air conditioner to provide cool air to assist in breathing.” d. “I need to apply a thin layer of petrolatum to the skin around the stoma to prevent cracking.” 90. What is the purpose of cytoreductive (“debulking”) surgery for ovarian cancer? a. Cancer control by reducing the size of the tumor b. Cancer prevention by removal of precancerous tissue c. Cancer cure by removing all gross and microscopic tumor cells d. Cancer rehabilitation by improving the appearance of a previously treated body part 91. Hormone therapy is prescribed as the mode of treatment for a client with prostate cancer. The nurse understands that the goal of this form of treatment is to: a. Increase testosterone levels. b. Increase prostaglandin levels. c. Limit the amount of circulating androgens. d. Increase the amount of circulating androgens.

NTCS FREE NURSING ONLINE REVIEW 92. The nurse is caring for a client with cancer of the prostate following a prostatectomy. The nurse provides discharge instructions to the client and tells the client to: a. Avoid driving the car for 1 week. b. Restrict fluid intake to prevent incontinence. c. Avoid lifting objects heavier than 20 lb for at least 6 weeks. d. Notify the physician if small blood clots are noticed during urination. 93. The oncology nurse is providing a teaching session to a group of nursing students regarding the risks and causes of bladder cancer. Which statement by a student indicates a need for further teaching? a. “Bladder cancer most often occurs in women.” b. “Using cigarettes and coffee drinking can increase the risk.” c. “Bladder cancer generally is seen in clients older than age 40.” d. “Environmental health hazards have been attributed as a cause.” 94. The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common symptom of this type of cancer? a. Dysuria b. Hematuria c. Urgency on urination d. Frequency of urination 95. The nurse is caring for a client following intravesical instillation of an alkylating chemotherapeutic agent into the bladder for the treatment of bladder cancer. Following the instillation, the nurse should instruct the client to: a. Urinate immediately. b. Maintain strict bed rest. c. Change position every 15 minutes. d. Retain the instillation fluid for 30 minutes. 96. The nurse is assessing the stoma of a client following an ureterostomy. Which of the following should the nurse expect to note? 1. A dry stoma

2. A pale stoma 3. A dark-colored stoma 4. A red and moist stoma 97. The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? a. Placing cool compresses on the affected arm b. Elevating the affected arm on a pillow above heart level c. Avoiding arm exercises in the immediate postoperative period d. Maintaining an intravenous site below the antecubital area on the affected side 98. A nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which of the following is an early sign of this oncological emergency? a. Cyanosis b. Arm edema c. Periorbital edema d. Mental status changes 99. A nurse manager is teaching the nursing staff about signs and a symptom related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which of the following is a serious late sign of this oncological emergency? a. Headache b. Dysphagia c. Constipation d. Electrocardiographic changes 100. As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of the greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed when the client states: a. “I should avoid blowing my nose.” b. “I may need a platelet transfusion if my platelet count is too low.” c. “I'm going to take aspirin for my headache as soon as I get home.” d. “I will count the number of pads and tampons I use when menstruating.”

NTCS FREE NURSING ONLINE REVIEW 101. The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by the intravenous route. The nurse plans to initiate bleeding precautions if which laboratory result is noted? a. A clotting time of 10 minutes b. An ammonia level of 20 mcg/dL c. A platelet count of 50,000/mm3 d. A white blood cell count of 5,000/mm3 102. The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which of the following laboratory values would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? a. Anemia b. Decreased platelets c. Increased uric acid level d. Decreased leukocyte count 103. The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide (Cytoxan, Neosar). The nurse tells the client to: a. Take the medication with food. b. Increase fluid intake to 2000 to 3000 mL daily. c. Decrease sodium intake while taking the dedication. d. Increase potassium intake while taking the medication. 104. The client with non–Hodgkin's lymphoma is receiving daunorubicin (DaunoXome). Which of the following would indicate to the nurse that the client is experiencing a toxic effect related to the medication? a. Fever b. Diarrhea c. Complaints of nausea and vomiting d. Crackles on auscultation of the lungs 105. Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to do which of the following before administering chemotherapy? a. Measure abdominal girth. b. Calculate body mass index.

c. Ask the client about his or her height and weight. d. Weigh and measure the client on the day of drug administration. 106. The client with squamous cell carcinoma of the larynx is receiving bleomycin (Blenoxane) intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? a. Echocardiography b. Electrocardiography c. Cervical radiographphy d. Pulmonary function studies 107. Each chemotherapeutic agent has a specific nadir. The nurse administering a combination chemotherapy regimen understands the importance of: a. Giving two agents from the same medication class b. Giving two agents with like nadirs at the same time c. Testing the client's knowledge about each agent's nadir d. Avoid giving agents with the same nadirs and toxicities at the same time 108. The clinic nurse prepares a teaching plan for the client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client: a. To take aspirin (acetylsalicylic acid) as needed for headache b. Drink beverages containing alcohol in moderate amounts each evening c. Consult with health care providers before receiving immunizations d. That it is not necessary to consult health care providers before receiving a flu vaccine at the local health fair 109. The client with bladder cancer is receiving cisplatin (Platinol) and vincristine (Oncovin, Vincasar PFS). The nurse preparing to give the medication understands that the purpose of administering both these medications is to: a. Prevent alopecia b. Decrease the destruction of cells c. Increase the therapeutic response d. Prevent gastrointestinal side effects

NTCS FREE NURSING ONLINE REVIEW 110. The client with lung cancer is receiving a high dose of methotrexate (Rheumatrex, Trexall). Leucovorin (citrovorum factor, folic acid) is also prescribed. The nurse caring for the client understands that the purpose of administering the leucovorin is to: a. Preserve normal cells. b. Promote DNA synthesis. c. Promote medication excretion. d. Promote the synthesis of nucleic acids. 111. The client with ovarian cancer is being treated with vincristine (Oncovin, Vincasar PFS). The nurse monitors the client, knowing that which of the following indicates a side effect specific to this medication? a. Diarrhea b. Hair loss c. Chest pain d. Numbness and tingling in the fingers and toes 112. The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse contacts the physician before administering the medication if which of the following is documented in the client's history? a. Pancreatitis b. Diabetes mellitus c. Myocardial infarction d. Chronic obstructive pulmonary disease 113. Tamoxifen (Nolvadex) is prescribed for the client with metastatic breast carcinoma. The nurse administering the medication understands that the primary action of this medication is to: a. Increase DNA and RNA synthesis. b. Promote the biosynthesis of nucleic acids. c. Increase estrogen concentration and estrogen response. d. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors. 114. The client with metastatic breast cancer is receiving tamoxifen (Nolvadex). The nurse specifically monitors which laboratory value while the client is taking this medication? a. Glucose level

b. Calcium level c. Potassium level d. Prothrombin time 115. Megestrol acetate (Megace), an antineoplastic medication, is prescribed for the client with metastatic endometrial carcinoma. The nurse reviews the client's history and contacts the physician if which of the following is documented in the client's history? a. Gout b. Asthma c. Thrombophlebitis d. Myocardial infarction 116. A female client with carcinoma of the breast is admitted to the hospital for treatment with intravenously administered doxorubicin (Adriamycin). The client tells the nurse that she has been told by herfriends that she is going to lose all her hair. The appropriate nursing response is which of the following? a. “Your friends are correct.” b. “You will not lose your hair.” c. “Hair loss may occur, but it will grow back just as it is now.” d. “Hair loss may occur, and it will grow back, but it may have a different color or texture.” 117. The clinic nurse prepares instructions for a client who developed stomatitis following the administration of a course of antineoplastic medications. The nurse tells the client to: a. Rinse the mouth with baking soda or saline. b. Avoid foods and fluids for the next 24 hours. c. Swab the mouth daily with lemon and glycerin pads. d. Brush the teeth and use waxed dental floss three times a day. 118. The client with acute myelocytic leukemia is being treated with busulfan (Myleran, Busulfex). Which of the following laboratory values would the nurse specifically monitor during treatment with this medication? a. Clotting time b. Blood glucose level c. Uric acid level

NTCS FREE NURSING ONLINE REVIEW d. Potassium level 119. The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse monitors the client during administration, knowing that which of the following indicates a side effect specific to this medication? a. Alopecia b. Chest pain c. Pulmonary fibrosis d. Orthostatic hypotension 120. The nurse is assigned to care for several male and female clients who take estrogen or progestins. The nurse knows that this group of clients is a increased risk for which complication of the medication? a. Sepsis b. Dehydration c. Deep vein thrombosis d. Electrocardiographic changes 121. The nurse has admitted a client to the clinical nursing unit following a modified right radical mastectomy for the treatment of breast cancer. The nurse plans to place the right arm in which of the following positions? a. Elevated above shoulder level b. Elevated on a pillow c. Level with the right atrium d. Dependent to the right atrium 122. A 6-year-old child has just been diagnosed with localized Hodgkin's disease and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. The appropriate and supportive response to the mother is: a. “I'm not sure. I'll discuss it with the physician.” b. “The child is too young to have radiation therapy.” c. “It's very costly, and chemotherapy works just as well.” d. “The physician would prefer that you discuss treatment options with the oncologist.”

123. The nurse teaches skin care to the client receiving external radiation therapy. Which of the following statements, if made by the client, would indicate the need for further instruction? a. “I will handle the area gently.” b. “I will avoid the use of deodorants.” c. “I will limit sun exposure to 1 hour daily.” d. “I will wear loose-fitting clothing.” 124. A 13-year-old child is diagnosed with Ewing's sarcoma of the femur. Following a course of radiation and chemotherapy, it has been decided that leg amputation is necessary. Following the amputation, the child becomes very frightened because of aching and cramping felt in the missing limb. Which nursing statement would be appropriate to assist in alleviating the child's fear? a. “This aching and cramping is normal and temporary and will subside.” b. “This normally occurs after the surgery and we will teach you ways to deal with it.” c. “The pain medication that I give you will take these feelings away.” d. “This pain is not real pain and relaxation exercises will help it go away.” 125. A breast feeding mother develops mastitis in the left breast and is put on an antibiotic for seven days. She asks the nurse if she can continue breast feeding. The nurse's best answer would be: a. "Only breast feed from the right breast." b. "Do not breast feed or stimulate the breasts until the infection is resolved." c. "Continue breast feeding, this is not a contraindication." d. "Pump the breasts and discard the milk until the infection resolves." 126. You are working in the Dermatology Clinic. A patient has a Basal Carcinoma In Situ removed from his left lower leg. When he returns for follow-up in one week, you note that the wound has healed with minimal scarring. Which type of healing process does this represent? a. Primary intention b. Secondary intention c. Tertiary intention d. Dehiscence

NTCS FREE NURSING ONLINE REVIEW 127. A client receiving chemotherapy has developed sores in his mouth. He asks the nurse why this happened. What is the nurse’s best response? a. “It is a sign that the medication is working.” b. “You need to have better oral hygiene.” c. “The cells in the mouth are sensitive to the chemotherapy.” d. “This always happens with chemotherapy.” The correct answer is C: “The cells in the mouth are sensitive to the chemotherapy.” 128. Marco who was diagnosed with brain tumor was scheduled for craniotomy. In preventing the development of cerebral edema after surgery, the nurse should expect the use of: a. Diuretics b. Antihypertensive c. Steroids d. Anticonvulsants 129. A high-fiber diet is thought to reduce the risk of colon cancer because it: a. absorbs water from the intestinal wall. b. promotes the excretion of bile. c. stops diarrhea. d. is low in kilocalories. 130. Pain tolerance in an elderly patient with cancer would: a. stay the same. b. be lowered. c. be increased. d. no effect on pain tolerance. 131. When administering a narcotic with a non-narcotic to relieve severe cancer pain, the nurse must remember: a. this combination enhances pain relief. b. this combination treats pain both centrally and peripherally. c. the narcotic potentiates action of the nonnarcotic. d. each drug works in its own right. 132. A cancer patient has had a resurgence of severe acute pain. Which of the following routes of medication is most appropriate for this patient? a. oral administration NSAIDS

b. oral administration of narcotics c. rectal administration of NSAIDS d. injectable pain reliever 133. Which of the following statements about the use of antidepressants with pain relief in cancer pain is true? a. Antidepressants have no effect. b. Antidepressants enhance the effect of analgesics. c. Antidepressants decrease the effect of analgesics. d. Antidepressants promote more rapid excretion of the medications. 134. The use of radiation therapy in the care of a patient with abdominal cancer would be: a. to relive metastatic pain as well as symptoms from local extension of primary disease. b. to be a palliative treatment to relieve pain and maintain symptom control for the duration of the patient’s life. c. to be used alone as a therapeutic agent. d. to help tissue to shrink and possible tumor eradication. 135. In planning for pain control in a postoperative cancer patient, the nurse understands: a. radiation therapy alone will be used. b. noninvasive analgesic approaches should be tried before invasive palliative approaches. c. never use radiation therapy, unless you are sure the patient will die. d. radiation therapy is complementary to analgesic drug therapies. 136. What considerations should be noted by the nurse when pharmacological support is given for cancer patients having procedures? a. The needs of the individual and the type of procedures to be done. b. All children and adults should have heavy dosages of drugs. c. All children no matter what age, should have hypnosis, distraction, imagery, and relaxation therapy. d. No special considerations are necessary. 137. Cancer pain depends upon what? a. the age of the patient and how much fear and anxiety is present

NTCS FREE NURSING ONLINE REVIEW b. the type of cancer, the site of the cancer, and the time of the initial pain episode c. the type of cancer, the stage of the cancer, and the threshold (tolerance for pain) d. the psychosocial state of the client, how well they accept the diagnosis, and the sex of the patient 138. A client received testing and was just informed she has leukemia. Which statement by the nurse is most therapeutic? a. “We have treatments for leukemia that are quite effective.” b. “Don’t worry, because your type of leukemia is treatable.” c. “Lots of people have leukemia and are successfully treated.” d. “How does it feel for you to hear you have leukemia?” 139. Which of the following may be a complication of previous infection with human papilloma virus (HPV)? a. Cervical cancer b. Breast cancer c. Bone cancer d. Skin cancer 140. A client has been treated for uterine cancer with internal radiation therapy. Which of the following complications may she develop later? a. cystitis b. arthritis c. hepatitis d. neuritis 141. The client, aged 28, was recently diagnosed with Hodgkin’s disease. After staging, therapy is planned to include combination radiation therapy and systemic chemotherapy with MOPP (nitrogen mustard, vincristine {Onconvin}, prednisone, and procarbazine). In planning care for the client, the nurse should anticipate which of the following effects to contribute to a sense of altered body image? a. cushingoid appearance b. alopecia c. temporary or permanent sterility d. pathologic fractures

142. Which mnemonic is used to remember the seven warning signs of cancer? a. CAUTION b. DANGERS c. WARNING d. CANCERS 143. Cancer is characterized by which of the following cell changes? a. Rapid proliferation b. Toxin production c. Increased differentiation d. Indiscriminate proliferation 144. A client has a cancerous tumor on his tibia. What name is given this type of tumor? 1. Adenoma 2. Osteoma 3. Fibroma 4. Meningioma 145. A 54-year-old man is admitted to the hospital for a colostomy related to a recent diagnosis of colon cancer. During the preoperative period, what is the most important aspect of this client’s nursing care? a. Assure the client that he will be cured of cancer. b. Assess understanding of the procedure and expectation of bodily appearance after surgery. c. Maintain a cheerful and optimistic environment. d. Keep visitors to a minimum, so that he can have time to think things through. 146. A client who is getting radiation asks the nurse why these sores developed in the client’s mouth. What is the most appropriate response? a. “Don’t worry; it always happens with radiation.” b. “Your oral hygiene needs improvement.” c. “It is a sign that the radiation is effective.” d. “The sores result because the cells in the mouth are sensitive to the radiation.” 147. A client develops stomatitis during the course of radiation therapy. Nursing care for this problem should include: a. A soft, bland diet. b. Restricting fluids to decrease salivation.

NTCS FREE NURSING ONLINE REVIEW c. Rinsing the mouth every two hours with a dilute mouthwash. d. Encouraging the client to drink hot liquids. 148. The chemotherapeutic agent 5fluorourcacil (5-FU) is ordered for a client as an adjunct measure to surgery. Which statement about chemotherapy is true? a. It is a local treatment affecting only tumor cells. b. It is a systemic treatment affecting both tumor and normal cells. c. It has not yet been proved an effective treatment for cancer. d. It is often the drug of choice because it causes few if any side effects. 149. Which instruction should be given in a health education class regarding testicular cancer? a. All males should perform a testicular exam after the age of 30. b. Testicular exams should be performed on a daily basis. c. Reddening or darkening of the scrotum is a normal finding. d. Testicular exams should be performed after a warm bath or shower. 150. During surgery, it is found that a client with adenocarcinoma of the rectum has positive peritoneal lymph nodes. What is the next most likely site of metastasis? a. Brain b. Bone c. Liver d. Mediastinum 151. Medical treatment for a client with cervical cancer will include a hysterectomy followed by internal radiation. Although she is 32 years old and has three children, the client tells the nurse that she is anxious regarding the impending treatment and loss of her femininity. Which interaction is most appropriate? a. Tell the client that now she does not have to worry about pregnancy. b. Provide the client with adequate information about the effects of treatment on sexual functioning. c. Refer her to the physician.

d. Avoid the question. Nurses are not specialists in providing sexual counseling. 152. When a client is having external radiation for lung cancer, what side effect is most likely to be experienced? a. Alopecia b. Bone marrow suppression c. Stomatitis d. Dyspnea 153. A 25-year-old male client receiving external radiation treatments tells you that he fears he is radioactive and a danger to his family and friends. How would the nurse dispel his fears? a. Inform him that radiation machines are risk free. b. Explain that once the machine is off, radiation is no longer emitted. c. Avoid telling him that his fears are in fact true. d. Instruct him to spend short periods of time with his family and friends. 154. The nurse assesses for findings of early cervical cancer by which of the following? a. A dark, foul-smelling vaginal discharge b. Pressure on the bladder or bowel, or both c. Back and leg pain and weight loss d. Vaginal discharge (leucorrhea) 155. The nurse discusses with a client in the healthcare clinic the possibility of endometrial cancer. Which of the following statements is incorrect concerning endometrial cancer? a. Diagnosis is most frequently established by a dilation and curettage (D&C). b. Prolonged use of exogenous estrogen increases the occurrence. c. The first and most important symptom is abnormal bleeding. d. This malignancy tends to spread rapidly to other organs. 156. The Pap smear reveals that a client has cancer of the cervix. The mode of treatment is an abdominal hysterectomy. The client voices concern about undergoing menopause. In counseling her, which statement would be most appropriate?

NTCS FREE NURSING ONLINE REVIEW a. A surgical menopause will occur, and treatment with estrogen therapy will be necessary. b. The ovaries will continue to function and produce estrogen, thus preventing menopause as a result of surgery. c. Ovarian hormone secretion ceases, but the hypothalamus will continue to secrete FSH, and this prevents menopause. d. The ovaries will cease functioning, and it will be necessary to take estrogen. 157. Cancer of the lungs is caused by: a. Airway atrisia. b. Hepatitis A. c. Cigarette smoking. d. Congenital defects. 158. A client begins a regimen of chemotherapy. Her platelet counts falls to 98,000. Which action is least necessary at this time? a. Test all excreta for occult blood. b. Use a soft toothbrush or foam cleaner for oral hygiene. c. Implement reverse isolation. d. Avoid IM injections. 159. High uric acid levels may develop in clients who are receiving chemotherapy. This is caused by: a. The inability of the kidneys to excrete the drug metabolites. b. Rapid cell catabolism. c. Toxic effects of the prophylactic antibiotics that are given concurrently. d. The altered blood pH from the acid medium of the drugs. 160. Which of the following statements, if made by a cancer patient with hair loss secondary to chemotherapy, indicates the goal for new coping patterns is being met? a. “I think I’ll get some new barrettes for my hair.” b. “I washed my wig today.” c. “I asked my mom to bring my shampoo.” d. “I’m thinking about changing my hair color.” 161. A patient with breast cancer is undergoing chemotherapy. She develops myelosuppression.

Her discharge teaching should include: a. Manage sore throat with over-the-counter preparations. b. Wear a mask when going out to shop. c. You can babysit ill grandchildren. d. Avoid activities that may cause bleeding. 162. Antimetabolites used for cancer treatment work by: a. Enhancing cell growth. b. Bone marrow ablation. c. Inhibiting cell growth and proliferation. d. Limiting the ability of the cancer to metastasize. 163. The synthetic cannabis derivative dronabinol (Marinol) can be used to treat cancer patients for: a. Depression. b. Nausea. c. Pain. d. Mucositis. 164. Which statement is incorrect regarding lung cancer? a. The 5-year survival rate depends on tumor histology and disease stage at the time treatment is initiated. b. Small-cell lung cancer has an excellent prognosis. c. The 5-year survival rate for lung cancer is less than 15 percent. d. Lung cancer is usually widespread by the time it is detected on chest x-ray. 165. A client is scheduled for external radiation treatment for laryngeal cancer. Of the following, which is not a common systemic side effect of this treatment? a. Nausea b. Fatigue c. Malaise d. Dry desquamation of the skin 166. When teaching the client about upcoming external radiation treatments, the nurse should stress the importance of: a. Massaging the area daily. b. Exposing the area to sunlight for 30 minutes each day. c. Not using soap on the treatment area and ink markings.

NTCS FREE NURSING ONLINE REVIEW d. Applying cosmetic creams over the area to conceal reddened areas. 167. A recent diagnosis of cancer has caused a patient severe anxiety. The plan of care should include: a. Teaching the stages of grieving. b. Providing distraction during time of stress. c. Teaching chemotherapy aspects. d. Encouraging verbalization of concerns regarding diagnosis. 168. A patient is undergoing chemotherapy following a laryngectomy for laryngeal cancer. The patient begins complaining of a sore mouth. The nurse should assess for: a. Xerostomia. b. Halatosis. c. Stomatitis. d. Dysgeusia. 169. The main goal of cancer chemotherapy is to: a. Limit the toxic side effects. b. Attack the cancer as early as possible. c. Cure or provide palliation if the cancer is not curable. d. Provide the patient with a suitable quality of life. 170. A client receiving radiation therapy for a cancer tumor asked the nurse, “How is the radiation treatments done?” The nurse replied that: a. The agents act on inhibiting DNA synthesis. b. The therapy can be either internal or external beam. c. The agents used kill all the cancer cells. d. The therapy of the beam of radiation is for the total body. 171. A 67-year-old man is admitted to the hospital with a tentative diagnosis of bronchogenic carcinoma. His chief complaint is dyspnea and a chronic cough. The physician orders a sputum sample for cytologic testing. Important nursing implications involved with obtaining a sputum sample for cytology should include which of the following? a. Obtain the specimen in the evening hours. b. Collect the specimen in the morning before the client eats and drinks.

c. Have the client brush his teeth before collection of the specimen. d. Keep the client NPO for 24 hours before collection of the specimen. 172. A 4-year-old Mexican American client has recently been diagnosed with leukemia. What intervention would be appropriate when considering the client’s culture? a. Limit all visitors, including extended family. b. Encourage visits from extended as well as immediate family. c. Ban all visits from alternative healers. d. Make diet selections for the child and family. 173. An 85-year-old man with end-stage prostate cancer has a living will expressing his desire for a dignified death and comfort care measures without resuscitation measures. Advocate, your role is to: a. Support the daughter’s decision. b. Encourage the patient to revoke his living will. c. Support the patient’s decision and encourage him to discuss his feeling with his daughter. d. Ignore the patient’s decision for nonresuscitation. 174. Mr. Davis, an 80 year old, is being discharged from the hospital with a new diagnosis of lung cancer. The adult children have made arrangements for him to live with his youngest son. To promote optimal continuity of care, the nurse should: a. Immediately arrange for hospice care. b. Convince the family that institutionalized care would be better. c. Assist with the discharge as planned. d. Explore options for community health services with the family. 175. A patient with advanced cancer of the stomach is undergoing surgery to take out part or debulk the tumor. This is known as ______ surgery. a. Tertiary b. Restorative c. Curative d. Palliative

NTCS FREE NURSING ONLINE REVIEW 176. Which of the following primary precautions is aimed at reducing the risk of breast cancer in a female 50 years of age and older? a. Pap smear b. Colonoscopy c. Ultrasound d. Mammography 177. Your patient is considering participating in a multi-site trial of a new cancer medication. According to the “Patient’s Bill of Rights,” it is important for the patient to know that: a. All costs of research are paid by the patient. b. He has the right to refuse to participate in research without fear of loss of care. c. The physicians will no longer be caring for him if he does not participate in the research. d. The research study is his only hope of treatment. 178. Which of the following statements about cancer cachexia is true? a. It is no different than simple starvation because the metabolic rate declines in response to tumor growth. b. Cancer cachexia occurs as a result of chemotherapy but not radiation therapy. c. Cancer cachexia occurs as a result of tumorinduced changes. d. Cancer cachexia is only seen in clients who have limited caloric intake. 179. A 52-year-old male client being treated for cancer doesn’t understand why he is being given a “female hormone,” megesterol acetate (Megace), as part of the treatment regimen. He is afraid that it will alter his appearance. How would you respond to the client’s concern of altered body image? a. Tell the client that the physical changes are only temporary. b. Tell the client that this medication is used for its ability to stimulate appetite. c. Tell the client that you understand his concern and that he should not take it. d. Tell the client that the medication will be used for a short time and any effects will be self-limiting.

180. What interventions would be appropriate for a client admitted to the oncology unit for chemotherapy and radiation therapy who is experiencing dysgeusia? a. Premedicate the client with an antiemetic. b. Observe the client for signs of dehydration. c. Use highly seasoned foods to stimulate taste buds. d. Obtain an order for zinc and give with food or milk to treat symptoms. 181. Mr. Hart is your patient who has a new diagnosis of lung cancer who is deemed terminally ill. During your assessment of discharge needs, you find that he has no available caregiver in the home but will need assistance with ADLs. You discuss with the discharge planner: a. Home care. b. Adult day care. c. Long-term care with hospice services. d. Respite care. 182. Which assessment finding would indicate to the nurse that an antitussive medication administered to a client with bronchogenic cancer is having the desired effect? a. Dyspnea is relieved. b. Coughing is decreased. c. Expectoration is increased. d. Wheezes and gurgles have diminished. 183. Which assessment finding should the nurse interpret as indicative of impending spinal cord compression in a client with metastatic prostate cancer? a. Increasing back pain, which is worse when standing than when lying down b. Lower extremity weakness and/or paresthesias c. Urgency accompanied by bladder spasms d. Lower extremity muscle cramping 184. A client having cryosurgery for removal of a squamous cell carcinoma asks if the procedure will hurt. Which is the correct answer for the nurse to give? a. “You will not feel anything.” b. “There will be a brief tingling pain.” c. “There will be no pain but you may experience a slight odd smell.” d. “There will be a momentary, stabbing pain.”

NTCS FREE NURSING ONLINE REVIEW 185. When teaching at a health fair, the nurse is asked if there is really a relationship between tobacco smoke and lung cancer. Which information should serve as the basis for the nurse’s response? a. There is a relationship and it is between certain types of lung cancer and both smoking and being exposed to second-hand smoke. b. Exposure to carcinogens such as asbestos and uranium account for a greater portion of lung cancer than does tobacco use. c. Radon takes precedence over tobacco smoke as a factor responsible for lung cancer. d. Tobacco smoking is associated with the majority of lung cancers of all types. 186. What symptom reported in the health history of a 55- year-old woman should be interpreted by the nurse as requiring immediate follow-up evaluation for cancer of the right colon? a. Black, tarry stools b. Loose, frothy stool c. Flat, ribbon-shaped stool d. Mahogany-colored, formed stool 187. When teaching a local club group about oral cancer, which comment by a participant indicates that the nurse needs to clarify the information presented? a.“Most oral cancers occur on the tongue.” b. “The most rapidly spread oral cancer is on the floor of the mouth.” c. “Early oral cancers are generally asymptomatic.” d. “Smoking is a risk factor for cancer of the lip.” 188. Which symptom should the nurse interpret as requiring a check for endometrial cancer? a. Postmenopausal bleeding b. Persistent leukorrhea c. Painful sexual intercourse d. Intermittent amenorrhea 189. How should the nurse interpret the leakage of fecal matter from the vagina of a client with advanced cancer? a. Anal sphincter has been impaired

b. Cancer has metastasized to the GI tract c. Rectovaginal fistula has developed d. Rectum is being compressed by the tumor mass 190. Which assessment finding is characteristic of advanced ovarian cancer? a. Ascites b. Purpura c. Splenomegaly d. Hypoactive DTRs 191. Which client with breast cancer is a candidate for treatment with Tamoxifen? a. A 32-year-old client with a lumpectomy for a small tumor and no sign of spread b. A 58-year-old client with negative estrogen receptor (ER) status c. A 41-year-old client with metastatic disease d. A 66-year-old client with estrogen sensitive disease 192. Which test confirms the diagnosis of prostate cancer? a. PSA b. Alkaline phosphatase c. Ultrasound of the prostate d. Prostate biopsy 193. Lupron is prescribed for a client with prostate cancer. Which assessment data best indicates that the medication is having the desired effect? a. Client reports pain is controlled b. Vomiting has stopped c. Urine is free of blood d. PSA level has dropped 194. Which condition can pain in young women with ovarian cancer mimic? a. Appendicitis b. Constipation c. PMS d. Urinary tract infection 195. When caring for a client having radiation therapy the nurse receives a report that the client’s laboratory values are normal and there are no signs of anemia, infection, or bleeding. Which conclusion should the nurse draw from this information?

NTCS FREE NURSING ONLINE REVIEW a. Radiation has not yet reached a therapeutic level. b. The client is free of side effects of radiation. c. Nutritional status is normal. d. Bone-marrow suppression is not a problem. 196. When assessing skin of a client having external radiation therapy, which fact should the nurse keep in mind? a. Skin damage is preceded by changes in oral mucous membranes. b. Most skin changes occur 4–8 weeks after the start of radiation. c. Skin areas with poor blood flow are at greatest risk for injury. d. Intertriginous areas are at particular risk for skin reactions. 197. How should the care of a client undergoing brachytherapy be assigned? a. To male nurses whenever possible b. On a rotating basis among nonpregnant nursing staff c. Consistently to the same nurses d. Never to a nurse with a history of cancer 198. A client having radiation therapy asks the nurse if his blood cells are going to be affected. Which fact should form the basis of the nurse’s answer? a. Bone marrow and therefore blood cells are affected with almost all ports of radiation. b. If radiation is delivered to the hip or leg, no effect should occur. c. It depends on whether or not medications are being taken that sensitize blood cells to radiation. d. Speed and volume of blood to tissues of the port will determine the effect. 199. A client having chemotherapy for breast cancer reports a temperature of 101.4 F. How should the nurse interpret this fact? a. Sign of infection, which needs to be reported right away b. Side effect of chemotherapy, not requiring intervention c. Sign of infection, which needs monitoring and reporting if it persists for 48 hours d. Indicator of dehydration requiring client teaching regarding fluid intake

200. A client who had a dose of chemotherapy at 8 a.m. calls the clinic at 2:30 p.m. complaining of nausea and vomiting despite having taken the prescribed medication. She asks how much worse the nausea and vomiting is going to get. On which fact should the nurse’s answer be based? a. Nausea and vomiting is totally unpredictable. b. Nausea and vomiting typically peak in the first 12 hours. c. Nausea and vomiting will ease on going to bed. d. Vomiting should cease in about 36 hours but nausea may persist for 7–10 days.

ANSWER AND RATIONALE ONCOLOGIC 1. Answer: C Rationale: Patients with cancer and bone metastasis experience severe pain especially when moving. Bone tumors weaken the bone to appoint at which normal activities and even position changes can lead to fracture. During nursing care, the patient needs to be supported and handled gently. 2. Answer: D Rationale: Fatigue is a common complaint of individuals receiving medication therapy. 3. Answer: B Rationale: Chemotherapeutic agents are given to destroy the actively proliferating cancer cells. But these agents cannot differentiate the abnormal actively proliferating cancer cells from those that are actively proliferating normal cells like the cells of the bone marrow, thus the effect of bone marrow depression. 4. Answer: C Rationale: Early warning signs of laryngeal cancer can vary depending on tumor location. Hoarseness lasting 2 weeks should be evaluated because it is one of the most common warning signs.

NTCS FREE NURSING ONLINE REVIEW 5. Answer: C Rationale: Steroids decrease the body’s immune response thus decreasing the production of antibodies that attack the acetylcholine receptors at the neuromuscular junction 6. Answer: A Rationale: Progression stage is the change of tumor from the preneoplastic state or low degree of malignancy to a fast growing tumor that cannot be reversed. 7. Answer: D Rationale: Intermittent pain is the classic sign of renal carcinoma. It is primarily due to capillary erosion by the cancerous growth. 8. Answer: C Rationale: Assessing for an open airway is the priority. The procedure involves the neck, the anesthesia may have affected the swallowing reflex or the inflammation may have closed in on the airway leading to ineffective air exchange. 9. Answer: D Rationale: Gentle oral hygiene is essential to remove debris, prevent irritation and promote healing. Oral hygiene before meal time often makes meals more pleasant. The best solution for oral care is normal saline. Commercial mouthwashes are irritating to the oral mucosa therefore they are contraindicated. An anti-emetic is not necessary in this situation as well as keeping the client on NPO and administering the food via TPN. 10. Answer: B Rationale: Orchiectomy is the surgical removal of a testicle. The affected testicle is surgically removed along with its tunica and spermatic cord 11. Answer: A Rationale: Barium enema is the radiologic visualization of the colon using a die. To obtain accurate results in this procedure, the

bowels must be emptied of fecal material thus the need for laxative and enema. 12. Answer: D Rationale: Numerous aspects of diet and nutrition may contribute to the development of cancer. A low-fiber diet, such as when fresh fruits and vegetables are minimal or lacking in the diet, slows transport of materials through the gut which has been linked to colorectal cancer. 13. Answer: C Rationale: Blood pressure. Pheochromocytoma is a tumor of the adrenal medulla that causes an increase secretion of catecholamines that can elevate the blood pressure. 14. Answer: D Rationale: Cigarette smoke is a carcinogen that irritates and damages the respiratory epithelium. The irritation causes the cough which initially maybe dry, persistent and unproductive. As the tumor enlarges, obstruction of the airways occurs and the cough may become productive due to infection. 15. Answer: C Rationale: Assessment of a client with Hodgkin’s disease most often reveals enlarged, painless lymph node, fever, malaise and night sweats 16. Answer: D Rationale: Constipation, diarrhea, and/or constipation alternating with diarrhea are the most common symptoms of colorectal cancer. 17. Answer: B Rationale: The earliest and most sensitive sign of increased ICP is a change in the level of consciousness. Elevated BP + positive Babinski reflex due to damage to the corticospinal tract are both late signs. Urinary incontinence` is not diagnostic of increased ICP. 18. Answer: C Rationale: If the cancer is treatable by surgery, it is preferred over other treatments

NTCS FREE NURSING ONLINE REVIEW that have multiple side effects such as chemotherapy and radiation therapy. Bone marrow transplant is a specific treatment for leukemia that is not applicable to other types of cancer. 19. Answer: A Rationale: The client's platelet count is severely depressed, placing him at risk for bleeding secondary to thrombocytopenia. Bleeding precautions should be instituted, including the use of an electric razor and soft toothbrush, minimizing injections, avoiding aspirin, and observing for petechiae and ecchymosis. Typically, chemotherapy would be held if the client developed thrombocytopenia. 20. Answer: B Rationale: The client is probably neutropenic due to a low neutrophil count on the WBC count. This occurs as a result of myelosuppressive activity of the chemotherapy and is further confirmed by the client's symptoms of infection. Even though infection control is the top priority, meals should be served at room temperature to cold to minimize food odors, which can cause nausea. A client receiving chemotherapy and having developed an infection should be served a high-protein, high-calorie diet to ensure adequate nutrients and calories for the body to mount a response to the infection. 21. Answer: C Rationale: Hospice programs are designed to help with symptom control and maintain quality of life for the client who has 6 months or less to live; they also assist the client with the anticipation of loss and plans for end-oflife care, such as funerals. 22. Answer: B Rationale: The client receiving chemotherapy is at risk for infection secondary to bone marrow suppression. A fever indicates the possibility of an infection that could be lifethreatening, so she should notify her health care provider immediately. The client should be taught to use birth control for at least 2 years after chemotherapy to prevent possible birth defects and to pace herself and to allow

for periods of rest to avoid fatigue and overexertion. 23. Answer: B Rationale: Biologic response modifiers are naturally or genetically engineered agents that can alter the immunologic relationship between the tumor and the client with cancer in an attempt to destroy or stop the malignant growth by stimulating the body's natural immune defenses. Destroying or stopping malignant growth, not stimulating the production of cancer cells, is the goal of therapy when using BRMs. 24. Answer: C Rationale: Intellectualization. People use defense mechanisms to cope with stressful events. Intellectualization is the use of reasoning and thought processes to avoid the emotional upsets. 25. Answer: B Rationale: Children have cells that are normally actively dividing in the process of growth. Radiation acts not only against the abnormally actively dividing cells of cancer but also on the normally dividing cells thus affecting the growth and development of the child and even causing cancer itself. 26. Answer: D Rationale: Elevating the arm above the level of the heart promotes good venous return to the heart and good lymphatic drainage thus preventing swelling. 27. Answer: B Rationale: One of the oncologic emergencies, the tumor lysis syndrome, is caused by the rapid destruction of large number of tumor cells. . Intracellular contents are released, including potassium and purines, into the bloodstream faster than the body can eliminate them. The purines are converted in the liver to uric acid and released into the blood causing hyperuricemia. They can precipitate in the kidneys and block the tubules causing acute renal failure. 28. Answer: B

NTCS FREE NURSING ONLINE REVIEW Rationale: Assessing the client’s expectations and doubts will help lessen her fears and anxieties. The nurse needs to encourage the client to verbalize and to listen and correctly provide explanations when needed. 29. Answer: B Rationale: A person grieves to a loss of a significant object. The initial stage in the grieving process is denial, then anger, followed by bargaining, depression and last acceptance. The nurse should show acceptance of the patient’s feelings and encourage verbalization. 30. Answer: D Rationale: The client is showing signs of anxiety reaction to a stressful event. Recognizing the client’s anxiety conveys acceptance of his behavior and will allow for verbalization of feelings and concerns. 31. Answer: C Rationale: Patients with cancer and bone metastasis experience severe pain especially when moving. Bone tumors weaken the bone to appoint at which normal activities and even position changes can lead to fracture. During nursing care, the patient needs to be supported and handled gently. 32. Answer: C Rationale: Pheochromocytoma is a tumor of the adrenal medulla that causes an increase secretion of catecholamines that can elevate the blood pressure. 33. Answer: A Rationale: Malignant melanomas are the most deadly of the skin cancers. Asymmetry, irregular borders, variegated color, and rapid growth are characteristic of them. 34. Answer: B Rationale: This is part of assessing the lesion and should be completed. The ABCDs of skin cancer detection include the following: 1) Asymmetry—Is the lesion balanced on both sides with an even surface? 2) Borders—are the borders rounded and smooth or notched and indistinct? 3) Color—Is the color a uniform light brown or is it variegated and darker or

reddish purple? 4) Diameter—A diameter exceeding 4–6 mm is considered suspicious. 35. Answer: B Rationale: This is the most commonly written therapeutic communication goal. This addresses the client’s concerns. 36. Answer: A Rationale: The client should be aware of symptoms that indicate development of another skin cancer. Squamous cell carcinoma can develop 37. Answer: A Rationale: This client has an unexpected situation occurring and should be assessed before any stable client. 38. Answer: C Rationale: This is part of assessing the client and cannot be delegated. 39. Answer: D Rationale: Clients with very little melanin in the skin (fair-skinned) have an increased risk as a result of the UV damage to the underlying membranes. Damage to the underlying membranes never completely reverses itself; a lifetime of damage causes changes at the cellular level that can result in the development of cancer.

40. Answer: D Rationale: Sunscreen products range in numerical value from 4 to 50; the higher the number of the sunscreen, the greater the UV protection. 41. Answer: C Rationale: The American Cancer Society recommends a monthly skin check using mirrors to identify any suspicious skin lesion for early detection. 42. Answer: C Rationale: Pain is a physiological problem; this is an appropriate physiological goal. 43. Answer: D

NTCS FREE NURSING ONLINE REVIEW Rationale: On discharge, all clients should receive instructions in the care of surgical incisions. 44. Answer: D Rationale: An ileal conduit is a procedure that diverts urine from the bladder and provides an alternate cutaneous pathway for urine to exit the body. Urinary output should always be at least 30 mL per hour. This client should be assessed to make sure that the stents placed in the ureters have not become dislodged or to ensure that edema of the ureters is not occurring. 45. Answer: C Rationale: Cigarette smoke contains more than 400 chemicals, 17 of which are known to cause cancer. The risk is directly proportional to the amount of smoking. 46. Answer: B Rationale: A urinary diversion procedure involves the removal of the bladder. In a cutaneous procedure the ureters are implanted in some way to allow for stoma formation on the abdominal wall, and the urine then drains into a pouch. There are numerous methods used for creating the stoma. 47. Answer: A Rationale: The client will have medication instilled in the bladder that must remain in the bladder for a prescribed length of time. For this reason, the client must remain NPO before the procedure. 48. Answer: A Rationale: Urine is acidic and the abdominal wall tissue is not designed to tolerate acidic environments. The stoma is pouched so that urine will not touch the skin. 49. Answer: D Rationale: It is in the scope of practice for the LPN to care for this client. 50. Answer: B Rationale: Paternalism is deciding for the client what is best, such as a parent making decisions for a child. Feeding a client, as with

a feeding tube, without the client wishing to eat is paternalism. 51. Answer: C Rationale: This is an example of restating, a therapeutic technique used to clarify the client’s feelings and encourage a discussion of those feelings. 52. Answer: A Rationale: A continent urinary diversion is a surgical procedure in which a reservoir is created that will hold urine until the client can selfcatheterize the stoma. The nurse should observe the client’s technique before discharge. 53. Answer: A Rationale: Vinegar will act as a deodorizing agent in the pouch and help prevent a strong urine smell. 54. Answer: D Rationale: The client is drawn up in a position that takes pressure off the abdomen; a rigid abdomen is an indicator of peritonitis, a medical emergency. 55. Answer: A Rationale: This client is asking for information and should be given factual information. The surgery will not make the client sterile, but chemotherapy can induce menopause and radiation therapy to the pelvis can render a client sterile. 56. Answer: B Rationale: 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. 57. Answer: C Rationale: Risk factors for cervical cancer include human papillomavirus (HPV) infection, active and passive cigarette smoking, certain high-risk sexual activities (first intercourse before 17 years of age, multiple sex partners, or male partners with multiple sex partners).

NTCS FREE NURSING ONLINE REVIEW Screening via regular gynecological exams and Papanicolaou smear (Pap test) with treatment of precancerous abnormalities decrease the incidence and mortality of cervical cancer. 58. Answer: D Rationale: 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. 59. Answer: A Rationale: 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 thiscomplication. Range-ofmotion 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. 60. Answer: A Rationale: 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. 61. Answer: D Rationale: Rationale: Multiple myeloma is a Bcell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. 62. Answer: A Rationale: 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.

63. Answer: A Rationale: 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 a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules 64. Answer: B Rationale: Hodgkin's disease is a disorder of young adults. 65. Answer: A Rationale: Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as a result of radiation or chemotherapy. Options 2, 3, and 4 are assessment findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes. 66. Answer: C Rationale: 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. 67. Answer: B Rationale: 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 client's room. Children younger than 16 years of age and pregnant women are not allowed in the client's room. 68. Answer: A Rationale: 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

NTCS FREE NURSING ONLINE REVIEW knees and, with the body in straight alignment, the client is log rolled. 69. Answer: D Rationale: A lead container and long-handled forceps should be kept in the client's 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. 70. Answer: C Rationale: 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. 71. Answer: A Rationale: Rationale: The client's 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 client's words used to describe the pain. The nurse's impression of the client's pain is not appropriate in determining the client's level of pain. Nonverbal cues from the clientare 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. 72. Answer: A Rationale: Rationale: 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. 73. Answer: D Rationale: Hodgkin's 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. 74. Answer: D Rationale: 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. 75. Answer: B Rationale: Hypercalcemia is a serum calcium level higher than 10 mg/dL, most often occurs in clients who have bone metastasis, and is a late manifestation of extensive malignancy. The presence of cancer in the bone causes the bone to release calcium into the bloodstream. 76. Answer: D Rationale: Testicular cancer almost always occurs in only one testicle and is usually a pea-sized painless lump. The cancer is highly curable when found early. The finding should be reported to the physician. 77. Answer: C Rationale: 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 hearing bad 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. 78. Answer: B Rationale: Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately

NTCS FREE NURSING ONLINE REVIEW postoperatively or may occur months or even years after surgery. 79. Answer: B Rationale: 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. 80. Answer: B Rationale: 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. 81. Answer: D Rationale: 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. 82. Answer: D Rationale: An acidic environment in the mouth is favorable for bacterial growth, particularly in an area already compromised from chemotherapy. Therefore, the client is advised to rinse the mouth before every meal and at bedtime with a weak salt and sodium bicarbonate mouth rinse. This lessens the growth of bacteria and limits plaque formation. The other substances are irritating to oral tissue. If hydrogen peroxide must be used because of severe plaque, it should be a weak solution because it dries the mucous membranes. 83. Answer: B Rationale: A high-fat diet plays a role in the development of cancer of the pancreas. Options 1, 3, and 4 are risk factors related to gastric cancer.

84. Answer: D Rationale: Following gastrectomy, drainage from the nasogastric tube is normally bloody for 24 hours postoperatively, changes to brown-tinged, and is then to yellow or clear. Because bloody drainage is expected in the immediate postoperative period, the nurse should continue to monitor the drainage. The nurse does not need to notify the physician at this time. Measuring abdominal girth is performed to detect the development of distention. Following gastrectomy, a nasogastric tube should not be irrigated unless there are specific physician orders to do so. 85. Answer: A Rationale: Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease. 86. Answer: C Rationale: To reduce the risk of contamination at the time of surgery, the bowel is emptied and cleansed. Laxatives and enemas are given to empty the bowel. Intestinal antiinfectives such as neomycin or kanamycin (Kantrex) are administered to decrease the bacteria in the bowel. 87. Answer: C Rationale: Immediately after surgery, profuse serosanguineous drainage from the perineal wound is expected. The nurse does not need to notify the physician at this time. A Penrose drain should not be clamped because this action will cause the accumulation of drainage within the tissue. Penrose drains and packing are removed gradually over a period of 5 to 7 days as prescribed. The nurse should not remove the perineal packing. 88. Answer: B Rationale: Following abdominal perineal resection, the nurse would expect the colostomy to begin to function within 72 hours after surgery, although it may take up to 5 days. The nurse should assess for a return of peristalsis, listen for bowel sounds, and check for the passage of flatus. Absent

NTCS FREE NURSING ONLINE REVIEW bowel sounds would not indicate the return of peristalsis. The client would remain NPO until bowel sounds return and the colostomy is functioning. Bloody drainage is not expected from a colostomy. 89. Answer: C Rationale: Air conditioners need to be avoided to protect from excessive coldness. A humidifier in the home should be used if excessive dryness is a problem. . 90. Answer: A Rationale: Cytoreductive or “debulking” surgery may be used if a large tumor cannot be completely removed as is often the case with late-stage ovarian cancer (e.g., the tumor is attached to a vital organ or spread throughout the abdomen). When this occurs, as much tumor as possible is removed and adjuvant chemotherapy or radiation may be prescribed. 91. Answer: C Rationale: Hormone therapy (androgen deprivation) is a mode of treatment for prostatic cancer. The goal is to limit the amount of circulating androgens because prostate cells depend on androgen for cellular maintenance. Deprivation of androgen often can lead to regression of disease and improvement of symptoms. 92. Answer: D Rationale: Small pieces of tissue or blood clots can be passed during urination for up to 2 weeks after surgery. Driving a car and sitting for long periods of time are restricted for at least 3 weeks. A high daily fluid intake should be maintained to limit clot formation and prevent infection. Option 3 is an accurate discharge instruction following prostatectomy. 93. Answer: A Rationale: The incidence of bladder cancer is greater in men than in women and affects the white population twice as often as blacks. 94. Answer: B Rationale: The most common symptom in clients with cancer of the bladder is hematuria. The client also may experience irritative voiding symptoms such as

frequency, urgency, and dysuria, and these symptoms often are associated with carcinoma in situ. 95. Answer: C Rationale: Normally, the medication is injected into the bladder through a urethral catheter, the catheter is clamped or removed, and the client is asked to retain the fluid for 2 hours. The client changes position every 15 to 30 minutes from side to side and from supine to prone or resumes all activity immediately. The client then voids and is instructed to drink water to flush the bladder. 96. Answer: D Rationale: Following ureterostomy, the stoma should be red and moist. A pale stoma may indicate an inadequate amount of vascular supply. A dry stoma may indicate a body fluid deficit. Any sign of darkness or duskiness in the stoma may indicate a loss of vascular supply and must be reported immediately or necrosis can occur. 97. Answer: B Rationale: Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring. 98. Answer: C Rationale: Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Mental status changes and cyanosis are late signs. 99. Answer: D Rationale: Rationale: Hypercalcemia is a late manifestation of bone metastasis in late-

NTCS FREE NURSING ONLINE REVIEW stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave. 100. Answer: C Rationale: During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000 cells/mm3. Aspirin and nonsteroidal antiinflammatory drugs and product that contain aspirin should be avoided because of their antiplatelet activity, thus further teaching is needed. 101. Answer: C Rationale: Bleeding precautions need to be initiated when the platelet count decreases. The normal platelet count is 150,000 to 450,000/mm3. When the platelets are lower than 50,000 /mm3, any small trauma can lead to episodes of prolonged bleeding. The normal white blood cell count is 5,000 to 10,000/mm3. When the white blood cell count drops, neutropenic precautions need to be implemented. The normal clotting time is 8 to 15 minutes. The normal ammonia value is 15 to 45 mcg/dL. 102. Answer: C Rationale: Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction. 103. Answer: B Rationale: Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide (Cytoxan, Neosar). The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to

increase potassium intake. The client would not be instructed to alter sodium intake. 104. Answer: D Rationale: Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as congestive heart failure is a toxic effect of daunorubicin. Bone marrow depression is also a toxic effect. Nausea and vomiting is a frequent side effect associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Fever is a frequent side effect and diarrhea can occur occasionally. 105. Answer: D Rationale: To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total body surface area (BSA), which requires a current accurate height and weight for BSA calculation (before each medication administration). Asking the client about his or her height and weight may lead to inaccuracies in determining a true BSA and dosage. Calculating body mass index and measuring abdominal girth will not provide the data needed. 106. Answer: D Rationale: Bleomycin (Blenoxane) is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. 107. Answer: D Rationale: Chemotherapy agents are usually given in combinations (also called regimens or protocols). The goal of administering combination chemotherapy in cycles or specific sequences is to produce additive or synergistic therapeutic effects. Administering combination therapy by administering several medications with different mechanisms of action and differents onsets of nadirs and toxicities enhances tumor cell destruction

NTCS FREE NURSING ONLINE REVIEW while minimizing medication resistance and overlapping toxicities. 108. Answer: C Rationale: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without a physician's or health care provider's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side effects. 109. Answer: C Rationale: Cisplatin (Platinol) is an alkylating type of medication and vincristine (Oncovin, Vincasar PFS) is a vinca (plant) alkaloid. Alkylating medications are cell cycle phasenonspecific. Vinca alkaloids are cell cycle phase-specific and act on the M phase. Combinations of medications are used to enhance tumoricidal effects and increase the therapeutic response. 110. Answer: A Rationale: High concentrations of methotrexate harm and damage normal cells. To save normal cells, leucovorin is given, which is known as leucovorin rescue. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Note that leucovorin rescue is potentially hazardous. Failure to administer leucovorin in the right dose at the right time can be fatal. 111. Answer: D Rationale: A side effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.

112. Answer: A Rationale: Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between administration of the doses. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. 113. Answer: D Rationale: Tamoxifen (Nolvadex) is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response. 114. Answer: B Rationale: Tamoxifen (Nolvadex) may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, deep bone, and flank pain. 115. Answer: C Rationale: Megestrol acetate (Megace) suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of thrombophlebitis. 116. Answer: D Rationale: Alopecia (hair loss) can occur following the administration of many

NTCS FREE NURSING ONLINE REVIEW antineoplastic medications. Alopecia is reversible, but new hair growth may have a different color and texture.

This promotes optimal drainage from the limb, without impairing the circulation to the arm.

117. Answer: A Rationale: Stomatitis (ulceration in the mouth) can result from the administration of antineoplastic medications. The client should be instructed to examine her or his mouth daily and to report any signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with baking soda or saline. Food and fluid is important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet that includes milk shakes and ice cream. Instruct the client to avoid spicy foods and foods with hard crusts or edges. The client should avoid toothbrushing and flossing when stomatitis is severe. Lemon and glycerin swabs may cause pain and further irritation.

122. Answer: B Rationale: Radiation therapy is usually delayed until a child is 8 years of age, whenever possible, to prevent retardation of bone growth and soft tissue development.

118. Answer: C Rationale: Busulfan (Myleran, Busufex) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute renal failure. 119. Answer: D Rationale: A side effect specific to etoposide is orthostatic hypotension. Etoposide should be administered slowly over 30 to 60 minutes to avoid hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication. 120. Answer: C Rationale: Male and female clients who take estrogen or progestins are at increased risk for deep vein thrombosis (DVT). Women receiving estrogens or progestins have irregular but heavy menses, fluid retention, and breast tenderness. 121. Answer: B Rationale: The client's operative arm should be positioned so that it is elevated on a pillow, and not exceeding shoulder elevation.

123. Answer: C Rationale: The client needs to be instructed to avoid exposure to the sun the sun. Other options are accurate measures in the care of a client receiving external radiation therapy. 124. Answer: A Rationale: Following amputation, phantom limb pain is a temporary condition that some children may experience. This sensation of burning, aching, or cramping in the missing limb is most distressing to the child. The child needs to be reassured that the condition is normal and only temporary. 125. Answer: D Rationale: Unless the antibiotic is safe for the infant, it is best not to feed the baby, but in order to continue establishment of milk flow, the breasts must be stimulated. 126. Answer: A Rationale: Surgical incisions, and small sutured incisions usually heal by what is called Primary Intention. In surgical incisions and the like where the edges of the wound can be approximated, healing takes place in this way. In larger wounds, when the edges cannot be approximated Secondary Intention is the usual manner of healing, the Tertiary intention occurs when there is an extended period of time between the wound and when it is sutured. 127. Answer: C Rationale: The epithelial cells in the mouth are very sensitive to chemotherapy due to their high rate of cell turnover. 128. Answer: C Rationale: Glucocorticoids (steroids) are used for their anti-inflammatory action, which decreases the development of edema.

NTCS FREE NURSING ONLINE REVIEW 129. Answer: B Rationale: High-fiber diets are recommended to reduce the risk of colon cancer, because fiber promotes bile excretion and speeds up intestinal transit time so that carcinogens are eliminated quicker. 130. Answer: B Rationale: There is potential for a lowered pain tolerance to exist with diminished adaptative capacity. 131. Answer: B Rationale: Using a narcotic with a nonnarcotic treats both central and peripheral pain. 132. Answer: D Rationale: Injectables act more quickly than other routes and can relieve severe acute pain in one hour. 133. Answer: B Rationale: Antidepressants are useful adjuncts to analgesia in the management of cancer pain. The antidepressant potentiates or enhances the analgesics medication. 134. Answer: B Rationale: Radiation therapy is a palliative treatment to relieve pain quickly, and treatment is tailored to the patient’s clinical condition and prognosis (duration of life). 135. Answer: D Rationale: Both radiation therapy and analgesic drug therapies can be used together to enhance the effectiveness as they directly target the cause of pain. 136. Answer: A Rationale: The needs of the individual and the type of procedure to be done shape the pharmacological approach to managing procedure-related pain. Because children have special needs, the nurse’s expertise and experience with children are key to successful therapy. 137. Answer: C Rationale: Most cancer publications state the pain aspect as falling into the type of cancer,

the stage of cancer, and the pain tolerance of the individual. 138. Answer: D Rationale: This statement is most therapeutic, as it allows the client to ventilate her feelings. The ability of the nurse to be present with the client during this difficult time demonstrates caring for the client. The other statements may offer false hope and do not give the client the opportunity to share her feelings. 139. Answer: A Rationale: Certain types of HPV infection may predispose a woman to developing cervical cancer later in life. The other cancers do not have a direct link to HPV infection. 140. Answer: A Rationale: A client who has been treated for uterine cancer with internal radiation therapy may later develop cystitis. The other options are not associated with internal radiation therapy. 141. Answer: D Rationale: Pathologic fractures are not common to the disease process or its treatment, although osteoporosis may be potential complication of steroid use; Hodgkin’s disease most commonly affects young adults (males) and is spread through lymphatic channels to contiguous nodes. It also may spread via hematogenous route to extradal sites (GI, bone marrow, skin, and other organs); a working “staging” classification is done for clinical use and care. 142. Answer: A Rationale: C: Change in bowel or bladder habits; A: A sore that does not heal; U: Unusual bleeding or discharge from anybody orifice; T: Thickening or a lump in the breast or elsewhere; I: Indigestion or difficulty swallowing; O: Obvious change in a wart or mole; N: Nagging cough or hoarseness. The other options are not mnemonics relating to cancer. 143. Answer: D

NTCS FREE NURSING ONLINE REVIEW Rationale: Cancer cells are characterized by indiscriminate proliferation, not the other options. 144. Answer: B Rationale: An osteoma is a tumor on bone tissue. The other options are other types of tumors. 145. Answer: B Rationale: False reassurance that everything will be all right is inappropriate. It is a block to therapeutic communication and it discounts the client’s feelings. The client should understand the extent of surgery and type and care of the ostomy. Although a cheerful, optimistic environment is important, it is essential that the client understand the proposed surgical treatment. Visitors should not be restricted. Family and friends can provide valuable social support to the client. 146. Answer: D Rationale: Epithelial cells are extremely sensitive to radiation therapy, because of their normally high rate of cell turnover. The client deserves an honest, supportive answer. 147. Answer: A Rationale: Bland foods of moderate temperature facilitate swallowing and decrease pain. Fluids should be encouraged to keep oral membranes moist and to decrease side effects of chemotherapy. Commercial mouthwashes should be avoided because of their alcohol content. The mouth should be rinsed with dilute H2O2 or normal saline solution. Lemon-glycerin swabs should be avoided to prevent excessive drying of the oral mucosa. 148. Answer: B Rationale: 5-Fluorouracil (5-FU) is an antineoplastic, antimetabolic drug that inhibits DNA synthesis and interferes with cell replication. It is given intravenously and acts systemically. It affects all rapidly growing cells, both malignant and normal. It is used as adjunct therapy for treating cancer of the colon, rectum, stomach, breast, and pancreas. This drug has many side effects, including bone marrow depression, anorexia, stomatitis, and nausea and vomiting.

149. Answer: D Rationale: Testicular exams should be performed after a warm shower or bath to relax the scrotum. Testicular exams should be done by all men beginning at age 15 on a monthly basis. Reddening or darkening of the scrotum is not normal finding and should be reported to a physician. 150. Answer: C Rationale: Colon tumors tend to spread through the lymphatics and portal vein to the liver. Although metastasis to the other sites listed is possible, the liver is most likely the first to be affected. 151. Answer: B Rationale: Many women with cervical cancer fear a loss of femininity. It is important to discuss the effects of treatment to enable the client to prepare for changes in sexual functioning. Although telling the client that she does not have to worry about pregnancy is accurate, it is not a therapeutic response. Nurses are capable of answering questions regarding sexuality. The client will need to be referred to other resources if the client’s concerns cannot be addressed by the nurse; the physician should be notified of the client’s concerns, but not necessarily as a referral. 152. Answer: D Rationale: The majority of side effects of external radiation are dependent on the specific site being radiated. Because the client’s cancer site is the lung, radiation will result in irritation of the lung mucosa, resulting in dyspnea. 153. Answer: B Rationale: It is important to understand the difference between external and internal radiation so that the nurse can be accurate when correcting the client’s misconceptions. He is not radioactive and does not need to limit contact with others. 154. Answer: D Rationale: The two chief symptoms of cancer of the cervix are metrorrhagia (vaginal bleeding or spotting at irregular intervals and

NTCS FREE NURSING ONLINE REVIEW between periods) and a watery vaginal discharge. 155. Answer: D Rationale: Cancer of the endometrium tends to be slow spreading. After it has spread to the cervix, invaded the myometrium, or spread outside the uterus, the prognosis is poor. 156. Answer: B Rationale: Menstruation will cease after a hysterectomy, but as long as the ovaries are left in place, they will continue to function, and surgical menopause will not occur. A hysterectomy is removal of the uterus and usually the cervix.

157. Answer: C Rationale: Lung cancer is a malignant tumor of lung tissue. Causes are cigarette smoking, air pollution, arsenic, asbestos, and radioactive dust. Cancer of the lungs can be diagnosed with chest radiography, bronchoscopy, tissue biopsy, or mediastinoseph. 158. Answer: C Rationale: It is not necessary because it will not affect the risk of hemorrhage. 159. Answer: B Rationale: When chemotherapy is initiated, there is a breakdown of many cancer cells. Uric acid is a cell metabolite. 160. Answer: B Rationale: One of the two indicators that the goal for implementing new coping patterns has been met is a willingness and ability to resume self-care responsibilities. Statement 2 shows that the client is taking care of their wig, a new self-care responsibility. Statement 1 shows denial that there has been hair loss and inappropriate self-care goals exist. Statements 3 and 4 also deny hair loss. The statements denying hair loss are evidence of the minor defining characteristics of body image disturbance still existing and the goal not being met.

161. Answer: D Rationale: Myelosuppression describes a deficit of cells produced by the bone marrow: RBC, WBC, and platelets. The patient will have increased risk for bleeding, infections, and anemia. There will be difficulty healing with myelosuppression 162. Answer: C Rationale: Antimetabolites are structural analogues of folic acid, purine, or pyrimidine bases found in DNA. They inhibit cell growth and proliferation by inhibiting enzymes required for DNA base synthesis. This limits the chemical and physical processes of the cell. Antimetobolites do not promote cell growth. Antimetabolites do not destroy the bone marrow. Antimetabolites may have some limitation on cancer metastasis but it is an indirect effect caused by inhibition of cell growth and proliferation. 163. Answer: B Rationale: The active ingredient in this agent is Δ9 -tetrahydrocannabinol or THC. THC modulates the activity of acetylcholine, dopamine, and serotonin. Dopamine and serotonin activate the chemoreceptor trigger zone which activates the vomiting center in the medulla. Dronabinol can induce mild stimulation followed by depression. Dronabinol has no pain relief properties. Dronabinol does not reduce or treat inflammation of the oral mucosa. 164. Answer: B Rationale: Small-cell lung cancer has a poor prognosis because it is rarely diagnosed in a limited and localized state. Even with treatment the client has only a 20 percent chance for 2-year survival. At advanced stages most clients die within 6 months. The 5-year survival rate depends on the type of lung cancer (non-small-cell cancer has a somewhat better 5-year survival rate) and stage (cancer is easier to treat in an earlier stage when the cancer is localized). Usually by the time a lung tumor is detected on x-ray, about 75 percent of the disease course has elapsed. Eighty-seven percent of lung cancer clients die within 5 years. 165. Answer: D

NTCS FREE NURSING ONLINE REVIEW Rationale: Dry desquamation of the skin; external radiation therapy side effects are: nausea, fatigue, malaise, skin irritation, wet desquamation, diarrhea.. 166. Answer: C Rationale: Skin markings over the treatment area should not be washed off for the duration of the therapy unless special permission is given because they are important reference marks for the radiation beams. The area should be left open to air, but sunlight should be avoided. The skin should not be massaged, and lotions, cosmetics, and powder should not be applied. These interventions will reduce the problems associated with dry desquamation of the skin. 167. Answer: D Rationale: Verbalizing concerns elicits information about the disease, giving the patient a sense of control and helps the patient face the unknown. 168. Answer: C Rationale: One of the earliest side-effects of chemotherapy is stomatitis. 169. Answer: C Rationale: Ideally, a cancer cure will be elicited. If no cure is possible, cancer palliation prolongs useful life and reduces incapacitating symptoms. Limiting toxic chemotherapy side effects is a secondary goal of treatment. Early recognition and treatment of cancer enhances the cure rate. A cure is part of the main goal of therapy. A suitable quality of life is part of the main goal of cancer chemotherapy and is related to palliation. 170. Answer: B Rationale: Radiation therapy—clients can receive external-beam radiation therapy (EBRT), or internal radiation therapy (brachytherapy) with implanted isotopes; it damages rapidly replicating local normal host cells along with cancerous cells; it is used to treat tumors that cannot be surgically removed and are sensitive to radiation exposure. 171. Answer: B

Rationale: Sputum samples should be collected early in the morning before the client eats or drinks. The client is not required to be NPO for 24 hours before the procedure. The client needs to be well hydrated to facilitate coughing up tenacious secretions. Using toothpaste or mouthwash should be avoided because they can affect the sample. The sample should be coughed up from deep within the lungs. Saliva should not be collected. 172. Answer: B Rationale: The extended family is considered a source of strength, support, and emotional stability for the Mexican- American family. Alternative healers and specific foods also may be important to the state of health. 173. Answer: C Rationale: The nurse advocate will explore the patient’s decision with him, support his decision-making authority, and encourage a discussion between the patient and his daughter regarding his wishes in order for these wishes to be honored. 174. Answer: D Rationale: In exploring options for assistance to the family from the available community health services, the nurse is facilitating the family’s caregiving and assisting them in meeting the patient’s needs at home. As terminal illness has not been established, hospice is not yet an appropriate option. Institutionalized care may be needed later, but for now the family should be assisted in their desire to care for the patient at home. 175. Answer: D Rationale: Debulking of a tumor is done to decrease the symptoms of the disease or is known as palliative surgery. It does not affect a cure. 176. Answer: D Rationale: Mammography is suggested for every female over age 50 or greater as a primary preventative measure. 177. Answer: B Rationale: The “Patient’s Bill of Rights” describes the right of the patient to refuse to

NTCS FREE NURSING ONLINE REVIEW participate in research without the fear of loss of care by the healthcare team. He will still be cared for by physicians and nurses on the team, and other treatment options may be offered. The costs of research are commonly at least partially paid by the research study. 178. Answer: C Rationale: Cancer cachexia is a syndrome that occurs in clients with cancer (malignancy) that leads to a loss of muscle, fat, and body weight. It is thought to occur due to tumor-induced changes that cause profound effects on metabolism, nutrient losses, and anorexia. A cycle of wasting is established because alterations in nutrient requirements and intake lead to high cell turnover in body organs, affecting the GI tract and bone marrow. Alterations in digestion occur along with decreased immune response; in simple starvation the body adapts to a lower metabolic rate. The metabolic rate can be normal, decreased, or increased; cachexia occurs in the presence of both chemotherapy and radiation; cancer cachexia can be seen in clients who have adequate caloric intake because it is not calorie dependent; cachexia—general ill health and malnutrition, marked by weakness and emaciation, usually associated with serious disease as cancer. 179. Answer: B Rationale: Megesterol acetate (Megace) is oral progesterone that is used for both male and female clients to boost appetite and promote weight gain. It is important that all clients receive accurate information about prescribed medications and are aware of the indication for the drug, potential side effects, and expected response to treatment. The nurse should respond to the client’s concern initially with factual information because the client does not seem to understand the effect of the medication; Megace has an antineoplastic activity due to suppression of gonadotropine (Antiluteinizing effect); the appetite-enhancing properties (mechanism unknown); pulliative treatment of advanced endometrial or breast cancer (not used in place of chemotherapy, radiation, or surgery); use for the treatment of anorexia, cachexia,

or an unexplained, significant weight loss in clients with a diagnosis of AIDS. 180. Answer: D Rationale: Elemental zinc taken with food or milk will help correct alterations in taste (dysgeuisa); Dygeusia— impairment or perversion of the gustatory sense so that normal tastes are interpreted as being unpleasant or completely different from the characteristic taste of a particular food or chemical compound; associated nutritional problems—clients receiving radiation therapy are at risk to develop muscositis of the oral cavity, xerostomia, nausea and vomiting, diarrhea, dental caries, esophagitis, dysphagia, and anorexia; clients receiving chemotherapy are at risk to develop anorexia, nausea and vomiting, altered elimination pattern (diarrhea or constipation), mucositis, and altered liver function (jaundice) as a consequence of impaired drug clearance; associated weight loss and accompanying malnutrition correlate with impaired immunity and affect response to therapy and survival. 181. Answer: C Rationale: Home care alone without a caregiver in a patient requiring ADL assistance may not be sufficient to maintain function and safety. Adult day care provides care for a limited time period daily and so would not meet the patient’s need for full time caregiver assistance. Respite care is short-term care while caregivers rest, and so is not a long-term option for the patient. The most appropriate referral choice for suggestion is therefore long term care with the option of hospice services in the facility. 182. Answer: B Rationale: An antitussive stops coughing. Antitussives are used for nonproductive coughs and to prevent exhaustion from coughing. Antitussives are not typically used for productive coughs because the secretions need to be raised. Secretions that are not raised will be pulled by gravity deep into the lung where the warm, dark, moist environment is supportive of bacterial growth. Antitussives do not relieve dyspnea. Antitussives do not increase

NTCS FREE NURSING ONLINE REVIEW expectoration rather they decrease it because they suppress coughing. Wheezes and gurgles are caused by narrowed airways and presence of secretions. Since antitussives do not act on either of these problems, their decrease is not reflective of the desired effect of an antitussive. 183. Answer: A Rationale: Escalating back pain with or without bladder symptoms, worse on lying down and improved on standing is the warning sign of impending spinal cord compression. Sudden loss of sensation and motor function in the lower extremities occurs with compression. Loss of bowel or bladder control may or may not occur. 184. Answer: B Rationale: A brief tingling pain is felt with cryosurgery. An unpleasant odor can occur when electrocautery is used to burn abnormal tissue as in cases of cervical dysplasia or genital warts. 185. Answer: D Rationale: Tobacco smoking has been shown to be related to the development of all types of lung cancer, not just certain types. Secondhand smoke is also a risk factor as is exposure to chemicals including asbestos, uranium, and radon but they do not account for more cases of lung cancer than tobacco use. 186. Answer: D Rationale: A symptom of right-sided cancer of the colon is mahoganycolored stool due to the presence of blood from the tumor being mixed with the stool and exposed to digestive tract secretions as it progresses through the remaining colon. Black, tarry stools are indicative of blood from the upper GI tract which has been in the GI tract long enough to be completely digested. Loose, frothy stool is indicative of high fat content and is associated with malabsorptive disorders. Flat, ribbon-shaped stool is consistent with a tumor which alters the shape of the left colon and prevents formation and passage of normally formed stool.

187. Answer: B Rationale: The most rapidly spread oral cancer is not cancer of the floor of the mouth but the cancer of the tongue because of its rich blood and lymph supply. 188. Answer: A Rationale: Postmenopausal bleeding is the primary symptom of endometrial cancer. Persistent leukorrhea occurs with a variety of vaginal and cervical infections. Painful intercourse (dyspareunia) occurs with uterine prolapse. Amenorrhea has a variety of causes. The most frequent is pregnancy but endocrine disturbances, poor diet, excessive exercise, emotional shock, change in climate, etc., are other causes. 189. Answer: C Rationale: Leakage of fecal matter from the vagina is a sign of rectovaginal fistula. 190. Answer: A Rationale: Ascites develops late in the course of ovarian cancer. Another sign of advanced ovarian cancer is pleural effusion, which is common with metastases to the lung. Purpura, splenomegaly, and hypoactive DTRs are not related symptoms. 191. Answer: D Rationale: Tamoxifen is adjuvant therapy for early stage ER—positive breast cancer. Tamoxifen is an estrogen antagonist that blocks the ER sites on the tumor cells thus blocking tumor growth. It decreases the risk of metastasis or prolongs survival once metastasis occurs. 192. Answer: D Rationale: Diagnosis of cancer can only be confirmed by microscopic examination of tissue. PSA is used for screening for prostate cancer but elevated levels (over 4 ng/ml) can be due to a variety of factors including benign prostatic hypertrophy and prostatitis; they are not specific to prostate cancer. Ultrasound of the prostate is used for follow- up when PSA levels are suspicious but its effectiveness is controversial. Alkaline phosphatase is an enzyme whose serum level is elevated in hepatobiliary and bone disease.

NTCS FREE NURSING ONLINE REVIEW 193. Answer: D Rationale: Lupron is a gonadotropin-releasing hormone agonist analog (GnRH), which suppresses pituitary release of LH and reduces serum testosterone levels. Since prostatic cancers require testosterone, reducing testosterone levels causes tumors to regress. Because the concentration of PSA in the blood is proportional to the total prostatic mass as the tumor regresses, PSA level drops. If a client has pain from metastases and these shrink in response to Lupron, pain can be relieved. However, this is not the best measure of Lupron’s effectiveness since not all tumors are necessarily causing pain. Vomiting is not common with prostate cancer and hematuria is a late sign. Concentration of PSA in the blood is proportional to the total prostatic mass. 194. Answer: A Rationale: Ovarian cancer can present in young women with pain similar to that of appendicitis. If pain accompanies constipation it is usually crampy pain or a sense of rectal discomfort. Urinary tract infection causes burning on urination or suprapubic discomfort from the bladder. 195. Answer: D Rationale: Some effect on bone marrow occurs with almost all radiation therapy regardless of port. Bone-marrow suppression becomes a significant problem when RBC and WBC counts and platelet count drop below critical levels. This drop is seen in laboratory values and can result in the development of anemia, infection, or bleeding. Therefore, normal laboratory values and the absence of signs/symptoms of anemia, infection, and bleeding indicate that bone-marrow suppression is not a problem at this time. 196. Answer: D Rationale: Skin fold areas are at particular risk for developing a reaction to radiation therapy. It is important to keep these areas clean, dry, and free of irritation to help decrease the risk. Changes in oral mucous membranes do not always occur with radiation therapy; it

depends on the port. This is different from chemotherapy, which is administered systemically. Acute skin reactions consist of erythema which increases over 2–3 weeks and then either fades or progresses to dry or moist desquamation. Areas of poor bloodflow are less well-oxygenated and hypoxic tissues are resistant to radiation not at greater risk for injury. 197. Answer: B Rationale: To limit exposure to specific individuals, care of clients undergoing brachytherapy should be rotated among staff members with the exception of those who are pregnant because of the risk of damage to the developing fetus. Male gender or cancer history is not considered influencing factors. Assigning the same nurses would support consistency and efficiency of care but these benefits do not outweigh the risk of exposure. 198. Answer: A Rationale: Radiation therapy exerts its greatest effect on well-oxygenated, actively dividing cells. As a result, bone-marrow cells are almost always affected. The hip and long bones of the leg contain large amounts of bone marrow so effects on the blood from radiation to these areas do occur. The effect on the blood occurs because the active cells in the bone marrow are affected, not because of any sensitizing drug. 199. Answer: A Rationale: Any temperature over 101 F is considered a sign of infection and needs to be reported right away. Clients having radiation therapy are immunosuppressed because of the effect of the radiation on the bone marrow and so infection poses a particular risk for this population. 200. Answer: B Rationale: Nausea and vomiting typically peak in the first 12 hours so in this case the nausea and vomiting should begin to subside after 8 p.m. The degree of nausea and vomiting can vary from person to person and with different types of chemotherapy but broad patterns are evident; it is not totally unpredictable. Going to bed does not ease

NTCS FREE NURSING ONLINE REVIEW nausea and vomiting and its absolute duration is not known.