1 Blood Disorders 1. The nurses assesses that the client with cancer is not ready for teaching when the client asks: 1. “Am I going to loose my hair?” 2. “Should I get a second opinion?” 3. “Will this make me really sick?” 4. “Will I have to stop exercising at the gym?” 2. Knowing that chemotherapy affects the taste buds, the nurse would have the client 1. Increase the amount of spices in the food. 2. Avoid red meats. 3. Medicate with Compazine before meals. 4. Eat foods that are hot in temperature.
1. Prolong the action of the drug. 2. Prevent staining of the skin. 3. Improve the absorption rate. 4. Increase the speed of onset of action 12. The nurse is discussing dietary sources of iron with a client who has iron deficiency anemia. The nurse knows the client can select a diet high in iron when she selects which menu? 1. Milkshake, hot dog, beets. 2. Beef steak, spinach, grape juice. 3. Chicken salad, green peas, coffee. 4. Macaroni and cheese, coleslaw, lemonade.
3. In planning care for a client with a platelet count of 8000 and a WBC of 8000 the nurse can expect to: 1. Remove flowers from the room. 2. Encourage fruits and vegetables. 3. Use strict hand washing technique. 4. Take temperature frequently.
13. A client with iron deficiency anemia is to take ferrous sulfate. She returns to clinic in two weeks. Which assessment by the nurse indicates the client has NOT been taking iron as ordered? 1. The client’s cheeks are flushed. 2. The client reports having more energy. 3. The client complains of nausea. 4. The client’s stools are light brown.
4. The nurse is teaching a client with a WBC of 2000. Which statement the client makes indicates indicates an understanding understanding of the teaching? 1. “I will eat fresh fruits and vegetables to avoid constipation.” 2. “I will stay away from my cat.” 3. “I will avoid crowded places.” 4. “I will wash all my fruits and vegetables before I eat them.”
14. A 66-year-old woman is being evaluated for pernicious anemia. What signs and symptoms would the nurse expect to assess in a client with pernicious anemia? 1. Easy bruising. 2. Beefy red tongue. 3. Fine red rash on the extremities. 4. Pruritus.
5. In evaluating the client with cancer what best indicates that nutritional status is adequate? 1. Calorie intake 2. Weight is stable 3. Amount of nausea and vomiting 4. Serum protein levels 6. An adult client with newly diagnosed cancer says, “I’m really afraid of dying. Who’s going to take care of my children?” What is the best initial response for the nurse to make? 1. “What makes you think you are going to die?” 2. “How old are your children?” 3. “This must be a difficult time for you.” 4. “Most people with your kind of cancer live a long time.” 7. A client with terminal cancer yells at the nurse and says, “I don’t need your help. I can bathe myself.” Which stage of grief is the client most likely experiencing? 1. Projection 2. Denial 3. Anger 4. Depression 8. The nurse can expect a client with a platelet count of 8000 and WBC count of 8000 to be placed: 1. In a private room. 2. On protective isolation. 3. On bleeding precautions. 4. On neutropenic precautions. 9. Which statement the client makes indicates to the nurse that the client understands external radiation? 1. “I’ll stay away from small children since I am radioactive.” 2. “I won’t wash these marks off until after my therapy.” 3. “I’ll put lotion on my skin to keep it moist.” 4. “I will double flush the toilet each time I use the bathroom.” 10. When teaching and preparing a client for a bone marrow biopsy, the nurse would 1. Check for iodine allergy. 2. Position the client in fetal position with back curved. 3. Have the client sign the consent form. 4. Have the client remain NPO. 11. A 28-year-old woman is diagnosed as having iron deficiency anemia. Imferon IM is ordered. The nurse administers administers it using the Z track technique. The primary reason for administering Imferon via Z track is to:
15. The nurse is caring for a client who is newly diagnosed with pernicious anemia. The client asks why she must receive vitamin shots. What is the best answer for the nurse to give? 1. “Shots work faster than pills.” 2. “Your body can not absorb Vitamin B12 from the stomach.” 3. “Vitamins are necessary to make the blood cells.” 4. “You can get more vitamins in a shot than a pill.” 16. A woman who has had pernicious anemia for several years is seen in the clinic. She tells the nurse that she has a tingling in her arms and legs. What question should the nurse ask initially? 1. “Has your activity level changed lately?” 2. “Has your diet changed recently?” 3. “Have you been sitting more than usual?” 4. “Have you been taking your medicine regularly?” 17. A one-year-old is admitted to the hospital with sickle cell anemia in crisis. Upon admission which therapy will assume priority? 1. Fluid administration. 2. Exchange transfusion. 3. Anticoagulant. 4. IM administration of iron and folic acid. 18. The nurse is caring for a 15-month-old child who is newly diagnosed with sickle cell anemia. The mother asks why the child has not had any symptoms before now. The nurse’s response is based on which knowledge? 1. Maternal antibodies have protected the child during the first year of life. 2. Breast milk is a deterrent to sickle cell anemia. 3. The disease does not manifest until the child begins to walk. 4. Elevated fetal hemoglobin levels prevent sickling of red cells. 19. Which statement is essential for the nurse to include in discharge teaching to the parents of a young child who has sickle cell anemia? 1. Do not let her bump into things. She will bruise easily. 2. Notify the physician immediately if she develops a fever. 3. She will need special help with feeding. 4. Observe her frequently for difficulty breathing. 20. The nurse has been teaching the mother of a child with hemophilia about the care he will need. Which statement the mother makes indicates a need for more instruction? 1. “If he needs something for pain or a fever, I will give him acetaminophen instead of aspirin.”
2 2. “I will take him to the dentist for regular checkups.” 3. “I will keep him in the house most of the time.” 4. “His medical identification bracelet arrived.” 21. A 19-year-old college student reports to the health service with a sore throat, malaise, and fever of four days duration. Examination shows cervical lymphadenopathy and splenomegaly. Temperature is 103oF. Blood is positive for heterophil antibody agglutination test. The nurse knows that infectious mononucleosis is caused by 1. Cytomegalovirus. 2. Beta hemolytic streptococcus. 3. Epstein-Barr virus. 4. Herpes simplex virus I. 22. A client who is diagnosed with infectious mononucleosis asks how he got this disease. The nurse’s response is based on the knowledge that the usual mode of transmission is through 1. Contact with an open wound in the skin. 2. Genital contact. 3. Contaminated water. 4. Intimate oral contact. 23. An 8-year-old is admitted to the unit with a diagnosis of acute lymphocytic leukemia. He was receiving a physical exam prior to playing Little League baseball. Numerous ecchymotic areas were noted on his body. His mother reported that he had been more tired than usual lately. The child’s mother says that he has had a cold for the last several weeks. She asks if this is related to his leukemia. The nurse’s response is based on the knowledge that 1. Leukemia causes a decrease in the number of normal white blood cells in the body. 2. A chronic infection such as he has had predisposes a child to the development of leukemia. 3. The virus responsible for colds has been implicated as a possible etiologic agent in leukemia. 4. Having an infection prior to the onset of leukemia is merely a coincidence. 24. A child who is receiving chemotherapy for leukemia has stomatitis. Which of the following nursing care measures is essential? 1. Using dental floss to clean the teeth. 2. Frequent cleaning of the mouth with an astringent mouthwash. 3. Use of an overbed cradle. 4. Swabbing the mouth with moistened cotton swabs. 25. A school age child is receiving chemotherapy for leukemia. Which statement he makes indicates the best understanding and acceptance of what is happening to him? 1. “I hope I won’t loose my hair like the other kids.” 2. “See my new red hat. I like to wear it.” 3. “I want to go see my friend Harold who is in the hospital with meningitis.” 4. “When I’m finished with the chemotherapy, the leukemia will be gone forever.” 26. An adult client has had a bone marrow aspiration. What should the nurse do immediately following this procedure? 1. Apply firm pressure to the site of the aspiration for at least 5 minutes. 2. Place a plain adhesive bandage directly over the aspiration site. 3. Apply a topical antibiotic on the aspiration site and leave open. 4. Apply an ice pack to the aspiration site for at least 10 minutes. 27. A five-year-old boy is admitted with a diagnosis of acute leukemia. The nurse is taking a nursing history from the child’s mother. Which statement she makes is least likely to be related to the diagnosis of acute leukemia? 1. “He has been so pale lately and has these little bruises and black and blue marks all over his skin.” 2. “He has bumps I can feel on the sides of his neck and in his groin.” 3. “He has sores in his mouth and feels so tired.” 4. “He is having difficulty holding a crayon and forgets things.”
28. The mother of a child with leukemia describes him as being pale and apathetic. The nurse interprets these symptoms as being an indication of 1. Anemia. 2. Poor nutrition. 3. Renal disease. 4. Infection. 29. The mother of a child newly diagnosed with leukemia reports that her son had a cold that persisted for several weeks. She is concerned that she did not take him to the doctor when his cold first appeared. She asks the nurse if taking him to the doctor would have prevented him from getting leukemia. What is the best reply for the nurse to make? 1. “It is too late to look back.” 2. “Perhaps you should discuss this with the doctor.” 3. “The delay did not have any effect on the course of the disease.” 4. “We’ll never know what could have happened if he had been treated sooner.” 30. The nurse is teaching person who has been diagnosed as HIV positive. Which comment by the person indicates a need for more instruction? 1. “My husband and I should have a child now before the condition gets worse.” 2. “I know several people who are HIV positive and they have not gotten sick yet.” 3. “I hope I can swallow all those pills every day.” 4. “I’m sorry I can’t donate blood any more.” NCLEX Review: Cancer and Blood Disorders Answers and Rationales 1. (2) This indicates denial of his illness. The question states he has cancer. All of the other comments indicate an interest in what is going to happen to him. 2. (1) Because taste buds are affected, increasing spices will improve flavor. 3. (2) Fruits and vegetables will help the client to prevent constipation, which could cause bleeding. All of the other choices are appropriate for a low WBC but this WBC is normal. The problem for this client is a low platelet count. 4. (3) Crowded places predispose to infection. #1 is related to low platelet count. #4. The client should not eat fresh fruits and vegetables even if they are washed. 5. (2) Stable weight indicates adequate nutritional status. 6. (3) This empathetic response will open communication. #1 is really a “why” question which would put the client on the defensive. #2 and #4 do not focus on the client’s feelings. 7. (3) Yelling at the nurse would be typical of anger. Projection is putting his feelings on the nurse “You are angry at me.” Denial would be denying that he was terminally ill or that he had cancer. A client who is depressed would be apathetic and probably not have the energy to yell at the nurse. 8. (3) The platelet count is very low – normal is 150,000 – 500,000. Platelets clot blood. The client must be on bleeding precautions. A WBC of 8000 is within the normal range so neutropenic precautions and protective isolation and a private room are not indicated. 9. (2) It is important that the client not wash off the marks until after therapy is finished. The marks outline the tumor and show where the radiation should be concentrated. The client who is receiving external radiation is not radioactive and should not put anything on the skin. The person who had radioactive iodine to shrink the thyroid gland should double flush the toilet after each use. There is no radioactivity in the waste of a person who is receiving external radiation. 10. (3) Bone marrow biopsy is an invasive procedure that requires a legal consent form to be signed. No iodine dye is used. The usual site is the iliac crest; the client will not be placed in fetal position. That is the position for a lumbar puncture. There is no need for the client to be NPO. Only a local anesthetic is used. 11. (2) Imferon is black and stains the skin and stings. The Z track method of pulling the skin to one side before injecting the medications prevents staining of the skin. Z track also reduces pain. It does not prolong action or speed onset of action or improve absorption rate.
3 12. (2) Beef, spinach and grape juice contains iron. Milk contains no iron. 13. (4) Iron turns stool black. The other answers all indicate compliance with the medication regime. 14. (2) A beefy red tongue is characteristic of pernicious anemia. Easy bruising would be seen in a clotting disorder such as hemophilia, in leukemia or in bone marrow depression. Pruritus is characteristic of Hodgkin’s disease. 15. (2) Injections of Vit. B12 will be necessary because without intrinsic factor her body cannot absorb Vit. B12 from foods. 16. (4) Her symptoms suggest pernicious anemia. She would not develop these symptoms if she took her medications regularly. 17. (1) Dehydration causes sickling. Sickling causes clumping and pain. First priority of care upon admission should be the administration of fluids. 18. (4) Elevated fetal hemoglobin levels keep the oxygen tension high so sickling does not occur. 19. (2) Fevers cause dehydration and sickling. 20. (3) Parents of children with hemophilia tend to over protect them. A goal is to have the child lead as normal a life as possible. #1 is correct. He should not receive aspirin, as it is an anti-coagulant. #2 indicates good knowledge. Prophylactic dental care is important so he will not need dental work or extractions. #4 indicates good knowledge. He should always wear a medic Alert bracelet in case he is injured. 21. (3) The Epstein-Barr virus is the causative organism for infectious mononucleosis. 22. (4) The virus is spread through intimate oral contact. It is called the “kissing disease.” It can also be spread by sharing eating and drinking utensils. 23. (1) Leukemia causes a decrease in normal white cells. White blood cells are the infection fighting cells. Infections occur because of the decrease in normal WBCs due to leukemia. Infections do not cause leukemia. 24. (4) Stomatitis is a frequent complication of chemotherapy for leukemia. He has a tendency to bleed because of his decreased platelets. Dental floss might cause bleeding. An astringent mouthwash is too strong for his tender mouth. An overbed cradle does not relate to stomatitis. Moistened cotton swabs are a gentle means of cleaning the mouth. 25. (2) This answer indicates acceptance of hair loss a side effect of chemotherapy. Choice 1 indicates denial. Choice 2 indicates lack of understanding. He will be very susceptible to infections. Choice 4 is not correct. He may or may not go into remission. 26. (1) Bone marrow aspiration on adult clients is obtained from the sternum or iliac crest. Because there is a slight risk of hemorrhage, firm pressure is applied over the site of aspiration for approximately 5 minutes. 27. (4) Difficulty holding a crayon and forgetting things sounds like a neurological problem. He would be unlikely to exhibit these symptoms at this point in his illness. #1, #2, and #3 are all typically seen in the child with leukemia. Bruises are the result of platelet depression. Bumps on the sides of the neck and in the groin are probably swollen lymph nodes. Sores in the mouth are frequent and may be a result of decreased normal white cells. Fatigue is common and a result of decreased red blood cells. 28. (1) Pale and apathetic in a child who has leukemia is a result of the anemia or decrease in red cells that occurs in leukemia. 29. (3) Explaining that the delay did not have any effect upon the course of the disease is realistic. There is no way to predict that the child had leukemia when he first had a cold. The reason for the persistence of the cold was the leukemia. The cold did not cause leukemia to develop. Leukemia could not have been prevented by earlier treatment of the cold. The nurse should carefully explain this to the parents to reduce the guilt they may place upon themselves. 30. (1) In order to have a child, the husband would have to be exposed to the virus. This answer indicates a need for more instruction. The other responses all indicate understanding.
PRACTICE QUESTIONS
1. The nurse is instructing the client to perform a testicular self-examination. The nurse tells the client: 1. To examine the testicles while lying down 2. That the best time for the examination is after a shower 3. To gently feel the testicle with one finger to feel for a growth 4. That testicular self-examinations should be done at least every 6 months 2. 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? 1. Smoking 2. Multiple sex partners 3. First intercourse after age 20 4. Annual gynecological examinations 3. The community health nurse is instructing a group of female clients about breast self-examination. The nurse instructs the clients to perform the examination: 1. At the onset of menstruation 2. Every month during ovulation 3. Weekly at the same time of day 4. 1 week after menstruation begins 4. 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? 1. Elevating the knee gatch on the bed 2. Assisting with range-of-motion leg exercises 3. Removal of antiembolism stockings twice daily 4. Checking placement of pneumatic compression boots 5. 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? 1. Biopsy of the tumor 2. Abdominal ultrasound 3. Magnetic resonance imaging 4. Computed tomography scan 6. 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? 1. Altered red blood cell production 2. Altered production of lymph nodes 3. Malignant exacerbation in the number of leukocytes 4. Malignant proliferation of plasma cells within the bone 7. The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder? 1. Increased calcium level 2. Increased white blood cells 3. Decreased blood urea nitrogen level 4. Decreased number of plasma cells in the bone marrow 8. The nurse is developing a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? 1. Encouraging fluids 2. Providing frequent oral care 3. Coughing and deep breathing 4. Monitoring the red blood cell count 9. 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? 1. Presence of Reed-Sternberg cells 2. Occurs most often in the older client 3. Prognosis depending on the stage of the disease 4. Involvement of lymph nodes, spleen, and liver 10. 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
4 states that which of the following is a sign of testicular cancer? 1. Alopecia 2. Back pain 3. Painless testicular swelling 4. Heavy sensation in the scrotum 11. The client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is: 1. Dyspnea 2. Diarrhea 3. Sore throat 4. Constipation 12. 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? 1. Limit the time with the client to 1 hour per shift. 2. Do not allow pregnant women into the client's room. 3. Remove the dosimeter badge when entering the client's room. 4. 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. 13. 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? 1. Bed rest 2. Out of bed ad lib 3. Out of bed in a chair only 4. Ambulation to the bathroom only 14. 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: 1. Call the physician. 2. Reinsert the implant into the vagina immediately. 3. Pick up the implant with gloved hands and flush it down the toilet. 4. Pick up the implant with long-handled forceps and place it in a lead container. 15. 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: 1. Restrict all visitors. 2. Restrict fluid intake. 3. Teach the client and family about the need for hand hygiene. 4. Insert an indwelling urinary catheter to prevent skin breakdown. 16. 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? 1. The client's pain rating 2. Nonverbal cues from the client 3. The nurse's impression of the client's pain 4. Pain relief after appropriate nursing intervention 17. The nurse is caring for a client who is postoperative following a pelvic exenteration and the physician changes the client's diet from NPO status to clear liquids. The nurse makes which priority assessment before administering the diet? 1. Bowel sounds 2. Ability to ambulate 3. Incision appearance 4. Urine specific gravity 18. 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? 1. Fatigue 2. Weakness 3. Weight gain 4. Enlarged lymph nodes
19. During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? 1. Diarrhea 2. Hypermenorrhea 3. Abnormal bleeding 4. Abdominal distention 20. 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? 1. Hyperkalemia 2. Hypercalcemia 3. Spinal cord compression 4. Superior vena cava syndrome 21. 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? 1. “Lumps like that are normal; don't worry.” 2. “Let me know if it gets bigger next month.” 3. “That could be cancer. I'll ask the doctor to examine you.” 4. “That's important to report even though it might not be serious.” 22. 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? 1. Anger 2. Denial 3. Bargaining 4. Depression 23. 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? 1. Pain at the incisional site 2. Arm edema on the operative side 3. Sanguineous drainage in the Jackson-Pratt drain 4. Complaints of decreased sensation near the operative site 24. 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? 1. Alcohol abuse 2. Cigarette smoking 3. Use of chewing tobacco 4. Exposure to air pollutants 25. 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: 1. Rupture of the bladder 2. The development of a vesicovaginal fistula 3. Extreme stress caused by the diagnosis of cancer 4. Altered perineal sensation as a side effect of radiation therapy 26. 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: 1. Prevent nausea 2. Prevent alopecia 3. Prevent vomiting 4. Prevent hyperuricemia 27. 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? 1. Alcohol-based mouthwash 2. Hydrogen peroxide mixture 3. Lemon-flavored mouthwash
5 4. Weak salt and bicarbonate mouth rinse
previously treated body part
28. 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? 1. Smoking 2. A high-fat diet 3. Foods containing nitrates 4. A diet of smoked, highly salted, and spiced food
36. 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: 1. Increase testosterone levels. 2. Increase prostaglandin levels. 3. Limit the amount of circulating androgens. 4. Increase the amount of circulating androgens.
29. 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? 1. Notify the physician. 2. Measure abdominal girth. 3. Irrigate the nasogastric tube. 4. Continue to monitor the drainage. 30. 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 31. 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: 1. To prevent an immune dysfunction 2. Because the client has an infection 3. To decrease the bacteria in the bowel 4. Because the client is allergic to penicillin 32. 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? 1. Notify the physician. 2. Clamp the Penrose drain. 3. Change the dressing as prescribed. 4. Remove and replace the perineal packing. 33. 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? 1. Absent bowel sounds 2. The passage of flatus 3. The client's ability to tolerate food 4. Bloody drainage from the colostomy 34. 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? 1. “I will protect the stoma from water.” 2. “I need to keep powders and sprays away from the stoma site.” 3. “I need to use an air conditioner to provide cool air to assist in breathing.” 4. “I need to apply a thin layer of petrolatum to the skin around the stoma to prevent cracking.” 35. What is the purpose of cytoreductive (“debulking”) surgery for ovarian cancer? 1. Cancer control by reducing the size of the tumor 2. Cancer prevention by removal of precancerous tissue 3. Cancer cure by removing all gross and microscopic tumor cells 4. Cancer rehabilitation by improving the appearance of a
37. 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: 1. Avoid driving the car for 1 week. 2. Restrict fluid intake to prevent incontinence. 3. Avoid lifting objects heavier than 20 lb for at least 6 weeks. 4. Notify the physician if small blood clots are noticed during urination. 38. 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? 1. “Bladder cancer most often occurs in women.” 2. “Using cigarettes and coffee drinking can increase the risk.” 3. “Bladder cancer generally is seen in clients older than age 40.” 4. “Environmental health hazards have been attributed as a cause.” 39. 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? 1. Dysuria 2. Hematuria 3. Urgency on urination 4. Frequency of urination 40. 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: 1. Urinate immediately. 2. Maintain strict bed rest. 3. Change position every 15 minutes. 4. Retain the instillation fluid for 30 minutes. 41. The nurse is assessing the stoma of a client following a 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 42. The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? 1. Placing cool compresses on the affected arm 2. Elevating the affected arm on a pillow above heart level 3. Avoiding arm exercises in the immediate postoperative period 4. Maintaining an intravenous site below the antecubital area on the affected side 43. 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? 1. Cyanosis 2. Arm edema 3. Periorbital edema 4. Mental status changes 44. A nurse manager is teaching the nursing staff about signs and symptoms 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? 1. Headache
6 2. Dysphagia 3. Constipation 4. Electrocardiographic changes 45. 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: 1. “I should avoid blowing my nose.” 2. “I may need a platelet transfusion if my platelet count is too low.” 3. “I'm going to take aspirin for my headache as soon as I get home.” 4. “I will count the number of pads and tampons I use when menstruating.” ALTERNATE ITEM FORMAT: MULTIPLE RESPONSE A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which of the following may be prescribed? ▪1. Radiation ▪2. Chemotherapy ▪3. Increased fluid intake ▪4. Serum sodium levels ▪5. Decreased oral sodium intake ▪6. Medication that is antagonistic to antidiuretic hormone ANSWERS 1. 2 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. 2. 3 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). Screening via regular gynecological exams and Papanicolaou smear (Pap test) with treatment of precancerous abnormalities decrease the incidence and mortality of cervical cancer. 3. 4 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. 4. 1 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 this complication. Range-of-motion exercises, antiembolism stockings, and pneumatic compression boots are helpful. The nurse should avoid using the knee gatch in the bed, which inhibits venous return, thus placing the client more at risk for deep vein thrombosis or thrombophlebitis. 5. 1 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. 6. 4 Rationale: Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow.
Options 1 and 2 are not characteristics of multiple myeloma. Option 3 describes the leukemic process. 7. 1 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. 8. 1 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. Options 2, 3, and 4 may be components of the plan of care but are not the priority in this client. 9. 2 Rationale: Hodgkin's disease is a disorder of young adults. Options 1, 3, and 4 are characteristics of this disease. 10. 1 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. 11. 3 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. Options 2 and 4 may occur with radiation to the gastrointestinal tract. Dyspnea may occur with lung involvement. 12. 2 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. 13. 1 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 knees and, with the body in straight alignment, the client is logrolled. 14. 4 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 longhandled forceps and place it in the lead container. Options 1, 2, and 3 are inaccurate interventions. 15. 3 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. 16. 1 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 client are important but are not the most appropriate pain assessment measure. Assessing pain relief is an important measure, but this option is not related to the subject of the question.
7 17. 1 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. Options 2, 3, and 4 are unrelated to the subject of the question. 18. 4 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. 19. 4 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. 20. 2 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. . 21. 4 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. Test-Taking Strategy: Use the process of elimination. Eliminate 22. 3 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. 23. 2 Rationale: Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. Options 1, 3, and 4 are expected occurrences following mastectomy and do not indicate a complication.
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 28. 2 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. 29. 4 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. 30. 1 Rationale: Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease. 31. 3 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 anti-infectives such as neomycin or kanamycin (Kantrex) are administered to decrease the bacteria in the bowel. 32. 3 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. . 33. 2 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 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.
24. 2 Rationale: The most common risk factor associated with laryngeal cancer is cigarette smoking. Heavy alcohol use and the combined use of tobacco increases the risk. Another risk factor is exposure to environmental pollutants.
34. 3 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. Options 1, 2, and 4 are appropriate interventions regarding stoma care following radical neck dissection and creation of a tracheotomy. Test-Taking Strategy: Use the process of elimination and note the
25. 2 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. The client's complaint is not associated with options 1, 3, and 4.
35. 1 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
26. 4 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.
36. 3 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.
27. 4 Rationale: An acidic environment in the mouth is favorable for bacterial growth, particularly in an area already compromised from chemotherapy. Therefore, the
37. 4 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
8 infection. Option 3 is an accurate discharge instruction following prostatectomy. 38. 1 Rationale: The incidence of bladder cancer is greater in men than in women and affects the white population twice as often as blacks. Options 2, 3, and 4 are associated with the incidence of bladder cancer. 39. 2 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. 40. 3 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. 41. 4 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. 42. 2 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. 43. 3 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. 44. 4 Rationale: Hypercalcemia is a late manifestation of bone metastasis in late-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. 45. 3 Rationale: During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000 cells/mm3. Option 3 describes an incorrect statement by the client. Aspirin and nonsteroidal anti-inflammatory drugs and product that contain aspirin should be avoided because of their antiplatelet activity, thus further teaching is needed. Options 1, 2 and 4 are correct statements by the client to prevent and monitor bleeding. ALTERNATE ITEM FORMAT: MULTIPLE RESPONSE Answer: 1, 2, 4, 6 Rationale: Cancer is a common cause of syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal.
ONCOLOGY 1. A male client has an abnormal result on a Papanicolaou test. After admitting, he read his chart while the nurse was out of the room, the client asks what dysplasia means. Which definition should the nurse provide? a. Presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin b. Increase in the number of normal cells in a normal arrangement in a tissue or an organ c. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn’t found d. Alteration in the size, shape, and organization of differentiated cells 1.Answer D. Dysplasia refers to an alteration in the size, shape, and organization of differentiated cells. The presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin is called anaplasia. An increase in the number of normal cells in a normal arrangement in a tissue or an organ is called hyperplasia. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn’t found is called metaplasia. 2. For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client? a. “Client verbalizes feelings of anxiety.” b. “Client doesn’t guess at prognosis.” c. “Client uses any effective method to reduce tension.” d. “Client stops seeking information.” 2.Answer A. Verbalizing feelings is the client’s first step in coping with the situational crisis. It also helps the health care team gain insight into the client’s feelings, helping guide p sychosocial care. Option B is inappropriate because suppressing speculation may prevent the client from coming to terms with the crisis and planning accordingly. Option C is undesirable because some methods of reducing tension, such as illicit drug or alcohol use, may prevent the client from coming to terms with the threat of death as well as cause physiologic harm. Option D isn’t appropriate because seeking information can help a client with cancer gain a sense of control over the crisis. 3. A male client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis o f Risk for injury. Which “related-to” phrase should the nurse add to complete the nursing diagnosis statement? a. Related to visual field deficits b. Related to difficulty swallowing c. Related to impaired balance d. Related to psychomotor seizures 3.Answer C. A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction. 4. A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect: a. hair loss. b. stomatitis. c. fatigue. d. vomiting. 4.Answer C. Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the treatment site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse effects of radiation therapy. 5. Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by: a. breast self-examination. b. mammography. c. fine needle aspiration. d. chest X-ray. 5.Answer C. Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self- examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis. 6. A male client undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to care for the neck stoma, the nurse should include which instruction? a. “Keep the stoma uncovered.” b. “Keep the stoma dry.” c. “Have a family member perform stoma care initially until you get used to the procedure.” d. “Keep the stoma moist.” 6.Answer D. The nurse should instruct the client to keep the stoma moist, such as by applying a thin layer of petroleum jelly around the edges, because a dry stoma may become irritated. The nurse should recommend placing a stoma bib over the stoma to filter and warm air before it enters the stoma. The client should begin performing stoma care without assistance as soon as possible to gain independence in self-care activities.
9 7. A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy? a. Urine output of 400 ml in 8 hours b. Serum potassium level of 3.6 mEq/L c. Blood pressure of 120/64 to 130/72 mm Hg d. Dry oral mucous membranes and cracked lips 7.Answer D. Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L. 8. Nurse April is teaching a group of women to perform breast selfexamination. The nurse should explain that the purpose of performing the examination is to discover: a. cancerous lumps. b. areas of thickness or fullness. c. changes from previous self-examinations. d. fibrocystic masses. 8.Answer C. Women are instructed to examine themselves to discover changes that have occurred in the breast. Only a physician can diagnose lumps that are cancerous, areas of thickness or fullness that signal the presence of a malignancy, or masses that are fibrocystic as opposed to malignant. 9. A client, age 41, visits the gynecologist. After examining her, the physician suspects cervical cancer. The nurse reviews the client’s history for risk factors for this disease. Which history finding i s a risk factor for cervical cancer? a. Onset of sporadic sexual activity at age 17 b. Spontaneous abortion at age 19 c. Pregnancy complicated with eclampsia at age 27 d. Human papillomavirus infection at age 32 9.Answer D. Like other v iral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 16, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren’t risk factors for cervical cancer. 10. A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to treat osteogenic carcinoma. During methotrexate therapy, the nurse expects the client to receive which other drug to protect normal cells? a. probenecid (Benemid) b. cytarabine (ara-C, cytosine arabinoside [Cytosar-U]) c. thioguanine (6-thioguanine, 6-TG) d. leucovorin (citrovorum factor or folinic acid [Wellcovorin]) 10.Answer D. Leucovorin is administered with methotrexate to protect normal cells, which methotrexate could destroy if given alone. Probenecid should be avoided in clients receiving methotrexate because it reduces renal elimination of methotrexate, increasing the risk of methotrexate toxicity. Cytarabine and thioguanine aren’t used to treat osteogenic carcinoma. 11. The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? a. Duodenal ulcers b. Hemorrhoids c. Weight gain d. Polyps 11.Answer D. Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren’t preexisting conditions of colorectal cancer. Weight loss not gain is an indication of colorectal cancer. 12. Nurse Amy is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society guidelines, the nurse should recommend that the women: a. perform breast self-examination annually. b. have a mammogram annually. c. have a hormonal receptor assay annually. d. have a physician conduct a clinical examination every 2 years. 12.Answer B. The American Cancer Society guidelines state, "Women older than age 40 should have a mammogram annually and a clinical examination at least annually [not every 2 years]; all women should perform breast self-examination monthly [not annually]." The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen- or progesterone-dependent. 13. A male client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer? a. Persistent nausea b. Rash c. Indigestion d. Chronic ache or pain 13.Answer C. Indigestion, or difficulty swallowing, is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but isn’t one of the seven major warning signs. Rash and chronic ache or pain seldom indicate cancer.
14. For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care? a. Administering aspirin if the temperature exceeds 102° F (38.8° C) b. Inspecting the skin for petechiae once every shift c. Providing for frequent rest periods d. Placing the client in strict isolation 14.Answer B. Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air o r physical contact. 15. Nurse Lucia is providing breast cancer education at a community facility. The American Cancer Society recommends that women get mammograms: a. yearly after age 40. b. after the birth of the first child and every 2 years thereafter. c. after the first menstrual period and annually thereafter. d. every 3 years between ages 20 and 40 and annually thereafter. 15.Answer A. The American Cancer Society recommends a mammogram yearly for women over age 40. The other statements are incorrect. It’s recommended that women between ages 20 and 40 have a professional breast examination (not a mammogram) every 3 years. 16. Which intervention is appropriate for the nurse caring for a male client in severe pain receiving a continuous I.V. infusion of morphine? a. Assisting with a naloxone challenge test before therapy begins b. Discontinuing the drug immediately if signs of dependence appear c. Changing the administration route to P.O. if the client can tolerate fluids d. Obtaining baseline vital signs before administering the first dose 16.Answer D. The nurse should obtain the client’s baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy. A naloxone challenge test may be administered before using a narcotic antagonist, not a narcotic agonist. The nurse shouldn’t discontinue a narcotic agonist abruptly because withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the ability to tolerate fluids. 17. A 35 years old client with ovarian cancer is prescribed hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with: a. cell division or mitosis during the M phase of the cell cycle. b. normal cellular processes during the S phase of the cell cycle. c. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle–nonspecific). d. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cycle–nonspecific). 17.Answer B. Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They’re most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may a lso kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction. 18. The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for? a. Actinic b. Asymmetry c. Arcus d. Assessment 18.Answer B. When following the ABCD method for assessing skin lesions, the A stands for "asymmetry," the B for "border irregularity," the C for "color variation," and the D for "diameter." 19. When caring for a male client diagnosed with a brain tumor of the parietal lobe, the nurse expects to assess: a. short-term memory impairment. b. tactile agnosia. c. seizures. d. contralateral homonymous hemianopia. 19.Answer B. Tactile agnosia (inability to identify objects by touch) is a sign of a parietal lobe tumor. Short-term memory impairment occurs with a frontal lobe tumor. Seizures may result from a tumor of the frontal, temporal, or occipital lobe. Contralateral homonymous hemianopia suggests an occipital lobe tumor. 20. A female client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include: a. a decreased serum creatinine level. b. hypocalcemia. c. Bence Jones protein in the urine. d. a low serum protein level. 20.Answer C. Presence of Bence Jones protein in the urine almost always confirms the disease, but absence doesn’t rule it out. Serum calcium levels are elevated because calcium is lost from the bone and reabsorbed in the serum. Serum protein electrophoresis shows elevated globulin spike. The serum creatinine level may also be increased.
10 21. A 35 years old client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis (inflammation of the mouth)? a. White, cottage cheese–like patches on the tongue b. Yellow tooth discoloration c. Red, open sores on the oral mucosa d. Rust-colored sputum 21.Answer C. The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese–like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia. 22. During chemotherapy, an oncology client has a nursing diagnosis of impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis? a. Recommending that the client discontinue chemotherapy b. Providing a solution of hydrogen peroxide and water for use as a mouth rinse c. Monitoring the client’s platelet and leukocyte counts d. Checking regularly for signs and symptoms of stomatitis 22.Answer B. To decrease the pain of stomatitis, the nurse should provide a solution of hydrogen peroxide and water for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer viscous lidocaine or systemic analgesics as prescribed. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn’t be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection but wouldn’t decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn’t decrease the pain. 23. What should a male client over age 52 do to help ensure early identification of prostate cancer? a. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. b. Have a transrectal ultrasound every 5 years. c. Perform monthly testicular self-examinations, especially after age 50. d. Have a complete blood count (CBC) and blood urea nitrogen (BUN) and creatinine levels checked yearly. 23.Answer A. The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won’t identify changes in the prostate gland due to its location in the body. A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastases 24. A male client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis may be a ppropriate for this client? a. Anticipatory grieving b. Impaired swallowing c. Disturbed body image d. Chronic low self-esteem 24.Answer A. Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isn’t associated with gallbladder cancer. Although surgery typically is done to remove the gallbladder and, possibly, a section of the liver, it isn’t disfiguring and doesn’t cause Disturbed body image. Chronic low self- esteem isn’t an appropriate nursing diagnosis at this time because the diagnosis has just been made. 25. A male client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours l ater, the nurse discovers the implant in the bed linens. What should the nurse do first? a. Stand as far away from the implant as possible and call for help. b. Pick up the implant with long-handled forceps and place it in a leadlined container. c. Leave the room and notify the radiation therapy department immediately. d. Put the implant back in place, using forceps and a shield for selfprotection, and call for help. 25.Answer B. If a radioactive implant becomes dislodged, the nurse should pick it up with long-handled forceps and place it in a lead-lined container, then notify the radiation therapy department immediately. The highest priority is to minimize radiation exposure for the client and the nurse; therefore, the nurse must not take any action that delays implant removal. Standing as far from the implant as possible, leaving the room with the implant still exposed, or attempting to put it back in place can greatly increase the risk of harm to the client and the nurse from excessive radiation exposure. 26. Jeovina, with advanced breast cancer is prescribed tamoxifen (Nolvadex). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately? a. Vision changes b. Hearing loss
c. Headache d. Anorexia 26.Answer A. The client must report changes in visual acuity immediately because this adverse effect may be irreversible. Tamoxifen isn’t associated with hearing loss. Although the drug may cause anorexia, headache, and hot flashes, the client need not report these adverse effects immediately because they don’t warrant a change in therapy. 27. A female client with cancer is being evaluated for possible metastasis. Which of the following i s one of the most common metastasis sites for cancer cells? a. Liver b. Colon c. Reproductive tract d. White blood cells (WBCs) 27.Answer A. The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites. 28. A 34-year-old female client is requesting information about mammograms and breast cancer. She isn’t considered at high risk for breast cancer. What should the nurse tell this client? a. She should have had a baseline mammogram before age 30. b. She should eat a low-fat diet to further decrease her risk of breast cancer. c. She should perform breast self-examination during the first 5 days of each menstrual cycle. d. When she begins having yearly mammograms, breast selfexaminations will no longer be necessary. 28.Answer B. A low-fat diet (one that maintains weight within 20% of recommended body weight) has been found to decrease a woman’s risk of breast cancer. A baseline mammogram should be done between ages 30 and 40. Monthly breast self-examinations should be done between days 7 and 10 of the menstrual cycle. The client should continue to perform monthly breast self-examinations even when receiving yearly mammograms. 29. Nurse Brian is developing a plan of care for marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable? a. 24 hours b. 2 to 4 days c. 7 to 14 days d. 21 to 28 days 29.Answer C. Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days. 30. The nurse is preparing for a female client for magnetic resonance imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which of the following would pose a threat to the client? a. The client lies still. b. The client asks questions. c. The client hears thumping sounds. d. The client wears a watch and wedding band. 30.Answer D. During an MRI, the client should wear no metal objects, such as jewelry, because the strong magnetic field can pull on them, causing injury to the client and (if they fly off) to others. The client must lie still during the MRI but can talk to those performing the test by way of the microphone inside the scanner tunnel. The client should hear thumping sounds, which are caused by the sound waves thumping on the magnetic field. 1. Nina, an oncology nurse educator is speaking to a women’s group about breast cancer. Questions and comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the audience have made all of the following statements. Which one is accurate? a. Mammography is the most reliable method for detecting breast cancer. b. Breast cancer is the leading killer of women of childbearing age. c. Breast cancer requires a mastectomy. d. Men can develop breast cancer.
1. Answer D. Men can develop breast cancer , although they seldom do. The most reliable method for detecting breast cancer is monthly selfexamination, not mammography. Lung cancer causes more deaths than breast cancer in women of all ages. A mastectomy may not be required if the tumor is small, confined, and in an early stage. 2. Nurse Meredith is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination: a. at the end of her menstrual cycle. b. on the same day each month. c. on the 1st day of the menstrual cycle. d. immediately after her menstrual period.
2. Answer D. Premenopausal women should do their self-examination immediately after the menstrual period, when the breasts are least tender and least lumpy. On the 1st and last days of the cycle, the woman’s breasts are still very tender. Postmenopausal women because their bodies lack
11 fluctuation of hormone levels, should select one particular day of the month to do breast selfexamination. 3. Nurse Kent is teaching a male client to perform monthly testicular selfexaminations. Which of the following points would be appropriate to make? a. Testicular cancer is a highly curable type of cancer. b. Testicular cancer is very difficult to diagnose. c. Testicular cancer is the number one cause of cancer deaths in males. d. Testicular cancer is more common in older men.
3. Answer A. Testicular cancer is highly curable, particularly when it’s treated in its early stage. Selfexamination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are in men with lung cancer. Testicular cancer is found more commonly in younger men. 4. Rhea, has malignant lymphoma. As part of her chemotherapy, the physician prescribes chlorambucil (Leukeran), 10 mg by mouth daily. When caring for the client, the nurse teaches her about adverse reactions to chlorambucil, such as alopecia. How soon after the first administration of chlorambucil might this reaction occur? a. Immediately b. 1 week c. 2 to 3 weeks d. 1 month
4. Answer C. Chlorambucil-induced alopecia occurs 2 to 3 weeks after therapy begins. 5. A male client is receiving the cell cycle–nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of a chemotherapeutic regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects? a. It interferes with deoxyribonucleic acid (DNA) replication only. b. It interferes with ribonucleic acid (RNA) transcription only. c. It interferes with DNA replication and RNA transcription. d. It destroys the cell membrane, causing lysis.
5. Answer C. Thiotepa interferes with DNA replication and RNA transcription. It doesn’t destroy the cell membrane. 6. The nurse is instructing the 35 year old client to perform a testicular self-examination. The nurse tells the client: a. To examine the testicles while lying down b. That the best time for the examination is after a shower c. To gently feel the testicle with one finger to feel for a growth d. That testicular self-examination should be done at least every 6 months
6. Answer B. 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. 7. A female client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care? a. Monitoring temperature b. Ambulation three times daily c. Monitoring the platelet count d. Monitoring for pathological fractures
7. Answer C. Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option A elates to monitoring for infection, particularly if leukopenia is present. Options B and D, although important in the plan of care, are not related directly to thrombocytopenia. 8. Gian, a community health nurse is instructing a group of female clients about breast self-examination. The nurse instructs the client to perform the examination: a. At the onset of menstruation b. Every month during ovulation c. Weekly at the same time of day d. 1 week after menstruation begins
8. Answer D. 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. 9. Nurse Cecilia 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. d.
Removal of antiembolism stockings twice daily Checking placement of pneumatic compression boots
9. Answer A. The client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, as for any other major surgery. For this reason, the nurse implements measures that will prevent this complication. Range-of-motion exercises, antiembolism stockings, and pneumatic compression boots are helpful. The nurse should avoid using the knee gatch in the bed, which inhibits venous return, thus placing the client more at risk for deep vein thrombosis or thrombophlebitis. 10. Mina, who is suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse provides which preprocedure instruction to the client? a. Eat a light breakfast only b. Maintain an NPO status before the procedure c. Wear comfortable clothing and shoes for the procedure d. Drink six to eight glasses of water without voiding before the test
10. Answer D. A pelvic ultrasound requires the ingestion of large volumes of water just before the procedure. A full bladder is necessary so that it will be visualized as such and not mistaken for a possible pelvic growth. An abdominal ultrasound may require that the client abstain from food or fluid for several hours before the procedure. Option C is unrelated to this specific procedure. 11. A male client is diagnosed as having a bowel tumor and several diagnostic tests are prescribed. The nurse understands that which test will confirm the diagnosis of malignancy? a. Biopsy of the tumor b. Abdominal ultrasound c. Magnetic resonance imaging d. Computerized tomography scan
11. Answer A. 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. 12. A female client diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder? a. Altered red blood cell production b. Altered production of lymph nodes c. Malignant exacerbation in the number of leukocytes d. Malignant proliferation of plasma cells within the bone
12. Answer D. Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Options A and B are not characteristics of multiple myeloma. Option C describes the leukemic process. 13. Nurse Bea is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder? a. Increased calcium b. Increased white blood cells c. Decreased blood urea nitrogen level d. Decreased number of plasma cells in the bone marrow
13. Answer A. 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. 14. Vanessa, a community health nurse conducts a health promotion program regarding testicular cancer to community members. The nurse determines that further information needs to be provided if a community member states that which of the following i s a sign o f testicular cancer? a. Alopecia b. Back pain c. Painless testicular swelling d. Heavy sensation in the scrotum
14. Answer A. Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as a result of radiation or chemotherapy. Options B, C, and D are assessment findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes.
12 15. The male client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is: a. Dyspnea b. Diarrhea c. Sore throat d. Constipation
15. Answer C. In general, only the area in the treatment field is affected by the radiation. Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side effects occur only when specific areas are involved in treatment. A client receiving radiation to the larynx is most likely to experience a sore throat. Options B and D may occur with radiation to the gastrointestinal tract. Dyspnea may occur with lung involvement. 16. Nurse Joy is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles? a. Limit the time with the client to 1 hour per shift b. Do not allow pregnant women into the 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
16. Answer B. 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. 17. 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
17. Answer A. The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled. 18. A female client is hospitalized for insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. The initial action by the nurse is to: a. Call the physician b. Reinsert the implant into the vagina immediately c. Pick up the implant with gloved hands and flush it down the toilet d. Pick up the implant with long-handled forceps and place it in a lead container.
18. Answer D. 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. Options A, B, and C are inaccurate interventions. 19. The nurse is caring for a female client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plans to: a. Restrict all visitors b. Restrict fluid intake c. Teach the client and family about the need for hand hygiene d. Insert an indwelling urinary catheter to prevent skin breakdown
19. Answer C. 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. 20. The home health care nurse is caring for a male client with cancer and the client is complaining of acute pain. The appropriate nursing assessment of the 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
20. Answer A. 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 client are important but are not the most appropriate pain assessment measure. Assessing pain relief is an important measure, but this option is not related to the subject of the question. 21. Nurse Mickey is caring for a client who is postoperative following a pelvic exenteration and the physician changes the client’s diet from NPO status to clear liquids. The nurse makes which priority assessment before administering the diet? a. Bowel sounds b. Ability to ambulate c. Incision appearance d. Urine specific gravity
21. Answer A. The client is kept NPO until peristalsis returns, usually in 4 to 6 days. When signs of bowel function return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. The most important assessment is to assess bowel sounds before feeding the client. Options B, C, and D are unrelated to the subject of the question. 22. A male client is admitted to the hospital with a suspected diagnosis of Hodgkin’s disease. Which assessment findings would the nurse expect to note specifically in the client? a. Fatigue b. Weakness c. Weight gain d. Enlarged lymph nodes
22. Answer D. 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. 23. During the admission assessment of a 35 year old client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? a. Diarrhea b. Hypermenorrhea c. Abdominal bleeding d. Abdominal distention
23. Answer D. 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. 24. Nurse Kate is reviewing the complications of colonization with a client who has microinvasive cervical cancer. Which complication, if identified by the client, indicates a need for further teaching? a. Infection b. Hemorrhage c. Cervical stenosis d. Ovarian perforation
24. Answer D. Conization procedure involves removal of a cone-shaped area of the cervix. Complications of the procedure include hemorrhage, infection, and cervical stenosis. Ovarian perforation is not a complication. 25. Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is classified as: a. sarcoma. b. lymphoma. c. carcinoma. d. melanoma.
25. Answer A. Tumors that originate from bone,muscle, and other connective tissue are called sarcomas. 26. Sarah, a hospice nurse visits a client dying of ovarian cancer. During the visit, the client expresses that “If I can just live long enough to attend my daughter’s graduation, I’ll be ready to die.” Which phrase of coping is this client experiencing? a. Anger b. Denial c. Bargaining d. Depression
13 26. Answer C. 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. 27. Nurse Farah is caring for a client following a mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery? a. Pain at the incisional site b. Arm edema on the operative side c. Sanguineous drainage in the Jackson-Pratt drain d. Complaints of decreased sensation near the operative site
27. Answer B. Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. Options A, C, and D are expected occurrences following mastectomy and do not indicate a complication. 28. The nurse is admitting a male client with laryngeal cancer to the nursing unit. The nurse assesses for which most common risk factor for this type of cancer? a. Alcohol abuse b. Cigarette smoking c. Use of chewing tobacco d. Exposure to air pollutants
28. Answer B. 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. 29. 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
29. Answer B. A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina. The client’s complaint is not associated with options A, C, and D. 30. The client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim). The nurse tells the client that the purpose if the allopurinol is to prevent: a. Nausea b. Alopecia c. Vomiting d. Hyperuricemia
30. Answer D. 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.
