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Medical-Surgical Nursing b. Stimulates the production of acetylcholine


ONCOLOGY at the neuromuscular junction.
c. Decreases the production of auto
1. Mr. Perez is in continuous pain from cancer antibodies that attack the acetylcholine
that has metastasized to the bone. Pain receptors.
medication provides little relief and he d. Inhibits the breakdown of acetylcholine at
refuses to move. The nurse should plan to: the neuromuscular junction.
a. Reassure him that the nurses will not hurt
him
b. Let him perform his own activities of daily 6. Which of the following stage the
living carcinogen is irreversible?
c. Handle him gently when assisting with a. Progression stage
required care b. Initiation stage
d. Complete A.M. care quickly as possible c. Regression stage
when necessary d. Promotion stage

2. A female client with breast cancer is 7. Nurse Anna is aware that early adaptation
currently receiving radiation therapy for of
treatment. The client is complaining of client with renal carcinoma is:
apathy, hard to concentrate on something, a. Nausea and vomiting
and feeling tired despite of having time to b. flank pain
rest and more sleep. These complains c. weight gain
suggest symptoms of d. intermittent hematuria
a. Hypocalcemia
b. radiation pneumonitis 8. A newly admitted client is diagnosed with
c. advanced breast cancer Hodgkin’s disease undergoes an excisional
d. fatigue cervical lymph node biopsy under local
anesthesia. What does the nurse assess first
3. A chemotherapeutic agent 5FU is ordered after the procedure?
as an adjunct measure to surgery. Which of a. Vital signs
the ff. statements about chemotherapy is b. Incision site
true? c. Airway
a. it is a local treatment affecting only tumor d. Level of consciousness
cells
b. it affects both normal and tumor cells 9. Cancer patients have special nutrition
c. it has been proven as a complete cure for needs and issues related to eating. The client
cancer receving chemotherapy refuses to eat the
d. it is often used as a palliative measure. food that was delivered to him and said that
the food tastes funny. The appropriate
4. Which of the following signs and symptoms nursing intervention is:
would Nurse Maureen include in teaching plan a. Obtain an order for total parenteral
as an early manifestation of laryngeal cancer? nutrition
a. Stomatitis b. Keep the client on NPO
b. Airway obstruction c. Administer anti-emetic as ordered by
c. Hoarseness physician
d. Dysphagia d. Provide oral hygiene care

5. Karina a client with myasthenia gravis is to 10. A client with testicular cancer is
receive immunosuppressive therapy. The scheduled for a right orchiectomy. The nurse
nurse understands that this therapy is knows that an orchiectomy is the
effective because it: a. surgical removal of the entire scrotum
a. Promotes the removal of antibodies that
impair the transmission of impulses
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b. surgical removal of a testicle c. Night sweats
c. dissection of related lymph nodes d. Headache
d. partial surgical removal of the penis
16. When teaching a client about the signs of
colorectal cancer, Nurse Trish stresses that
11. A client is being evaluated for cancer of the most common complaint of persons with
the colon. In preparing the client for barium colorectal cancer is:
enema, the nurse should: a. Abdominal pain
a. Give laxative the night before and a b. Hemorrhoids
cleansing enema in the morning before the c. Change in caliber of stools
test d. Change in bowel habits
b. Render an oil retention enema and give
laxative the night before 17. A patient with a left frontal lobe tumor has
c. Instruct the client to swallow 6 radiopaque a craniotomy. Four hours post surgery, which
tablets the evening before the study data indicates increased ICP?
d. Place the client on CBR a day before the a. BP 160/90
study b. Patient is difficult to arouse
c. Patient has a positive Babinski response
d. Patient has urinary incontinence

12. The client has a good understanding of


the means to reduce the chances of colon
cancer when he states: 18. The most common preferred treatment
a. “I will exercise daily.” for cancer is
b. “I will include more red meat in my diet.” a. Chemotherapy
c. “I will have an annual chest x-ray.” b. Radiation therapy
d. “I will include more fresh fruits and c. Surgery
vegetables in my diet.” d. Bone marrow transplant

13. A client, who is suspected of having 19. A client on chemotherapy has a platelet
Pheochromocytoma, complains of sweating, count of 26,000 mm. Which nursing
palpitation and headache. Which assessment intervention must be included in the client's
is essential for the nurse to make first? care plan?
a. Pupil reaction a. Having the client use an electric razor and
b. Hand grips soft-bristle toothbrush
c. Blood pressure b. Premedicating the client 30 minutes before
d. Blood glucose chemotherapy with an antiemetic
c Preparing to administer leukocyte-poor
14. The nurse is conducting an education packed red blood cells (RBCs)
session for a group of smokers in a “stop d. Screening all visitors and staff for infection
smoking” class. Which finding would the prior to allowing them to enter the room
nurse state as a common symptom of lung
cancer? : 20. Which intervention would be most
a. Dyspnea on exertion appropriate for a client who is 12 days
b. Foamy, blood-tinged sputum postchemotherapy and being admitted with
c. Wheezing sound on inspiration shortness of breath, a dry hacking cough, and
d. Cough or change in a chronic cough a temperature of 101° F?
a. Having the dietary department serve the
15. A client admitted with newly diagnosed meals as hot as possible
with Hodgkin’s disease. Which of the following b. Initiating the prescribed I.V. antibiotics
would the nurse expect the client to report? after checking the white blood cell (WBC)
a. Lymph node pain count
b. Weight gain c. Limiting the protein and calories in the
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client's diet A. Reaction formation
d. Reassuring the client that fatigue is a B. Sublimation
common occurrence after chemotherapy C. Intellectualization
D. Projection
21. The nurse is planning the care for a client
with cancer who is about to enter a hospice 25. Which statement by the client indicates to
treatment program. Which nursing diagnosis the nurse that the patient understands
and outcome would be appropriate for this precautions necessary during internal
client? radiation therapy for cancer of the cervix?
a. Imbalanced nutrition: The client will eat a. “I should get out of bed and walk around in
three meals/snacks a day my room.”
b. Impaired social interaction: The client will b. “My 7 year old twins should not come to
attend one outing per week visit me while I’m receiving treatment.”
c. Anticipatory grieving: The client will c. “I will try not to cough, because the force
participate in end-of-life care planning might make me expel the application.”
d. Deficient knowledge: The client will state d. “I know that my primary nurse has to wear
three reasons for cancer therapy one of those badges like the people in the x-
ray department, but they are not necessary
22. The nurse knows that a 28-year-old for anyone else who comes in here.”
female client with Hodgkin's disease who is
receiving chemotherapy understands the 26. A post-operative complication of
discharge teaching when the client says mastectomy is lymphedema. This can be
which statement? prevented by
a. "I should begin to try to have a baby as a. ensuring patency of wound drainage tube
soon as possible." b. placing the arm on the affected side in a
b. "If I begin to run a fever, I should call my dependent position
doctor." c. restricting movement of the affected arm
c. "If I feel tired, I should go to the gym and d. frequently elevating the arm of the
work out." affected side above the level of the heart.
d. "If my mouth gets sore, I'll need to fast
until it goes away." 27. High uric acid levels may develop in
clients who are receiving chemotherapy. This
23. After chemotherapy, a client who is is caused by:
scheduled to begin treatment with a biologic a. The inability of the kidneys to excrete the
response modifier (BRM) asks the nurse how drug metabolites
this treatment will help him. The nurse bases b. Rapid cell catabolism
the response on the knowledge that this type c. Toxic effect of the antibiotic that are given
of treatment stimulates: concurrently
a. reproduction of cancer cells. d. The altered blood ph from the acid medium
b. the body's natural immune defenses. of the drugs
c. the liver to produce an anti-tumor
hormone. 28. Maria Sison, 40 years old, single, was
d. the pancreas to produce an anti-cancer admitted to the hospital with a diagnosis of
hormone. Breast Cancer. She was scheduled for radical
mastectomy. Nursing care during the
24. Larry is diagnosed as having myelocytic preoperative period should consist of:
leukemia and is admitted to the hospital for a. assuring Maria that she will be cured of
chemotherapy. Larry discusses his recent cancer
diagnosis of leukemia by referring to b. assessing Maria’s expectations and doubts
statistical facts and figures. The nurse c. maintaining a cheerful and optimistic
recognizes that Larry is using the defense environment
mechanism known as: d. keeping Maria’s visitors to a minimum so
she can have time for herself
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33. The client is admitted to the outpatient
29. Maria refuses to acknowledge that her surgery center for removal of a malignant
breast was removed. She believes that her melanoma. Which assessment data indicate
breast is intact under the dressing. The nurse the lesion is a malignant melanoma?
should a. The lesion is asymmetrical and has
a. call the MD to change the dressing so irregular borders.
Kathy can see the incision b. The lesion has a waxy appearance with
b. recognize that Kathy is experiencing pearl-like borders.
denial, a normal stage of the grieving c. The lesion has a thickened and scaly
process appearance.
c. reinforce Kathy’s belief for several days d. The lesion appeared as a thickened area
until her body can adjust to stress of surgery. after an injury.
d. remind Kathy that she needs to accept her
diagnosis so that she can begin rehabilitation 34. The female client admitted for an
exercises. unrelated diagnosis asks the nurse to check
her back because “it itches all the time in that
30. Mr. Pablo, diagnosed with Bladder Cancer, one spot.” When the nurse assesses the
is scheduled for a cystectomy with the client’s back, the nurse notes an irregular-
creation of an ileal conduit in the morning. He shaped lesion with some scabbed-over areas
is wringing his hands and pacing the floor surrounding the lesion. Which action should
when the nurse enters his room. What is the the nurse implement first?
best approach? a. Notify the HCP to check the lesion on
a. "Good evening, Mr. Pablo. Wasn't it a rounds.
pleasant day, today?" b. Measure the lesion and note the color.
b. "Mr, Pablo, you must be so worried, I'll c. Apply lotion to the lesion.
leave you alone with your thoughts. d. Instruct the client to make sure the HCP
c. “Mr. Pablo, you'll wear out the hospital checks the lesion.
floors and yourself at this rate."
d. "Mr. Pablo, you appear anxious to me. How 35. The nurse is caring for a client diagnosed
are you feeling about tomorrow's surgery?" with squamous cell skin cancer and writes a
psychosocial problem of “fear.” Which nursing
31. Mr. Perez is in continuous pain from interventions should be included in the plan
cancer that has metastasized to the bone. of care?
Pain medication provides little relief and he a. Explain to the client that the fears are
refuses to move. The nurse should plan to: unfounded.
a. Reassure him that the nurses will not hurt b. Encourage the client to verbalize the
him feeling of being afraid.
b. Let him perform his own activities of daily c. Have the HCP discuss the client’s fear with
living the client.
c. Handle him gently when assisting with d. Instruct the client regarding all planned
required care procedures.
d. Complete A.M. care quickly as possible
when necessary 36. The client has had a squamous cell
carcinoma removed from the lip. Which
32. A client, who is suspected of having discharge instructions should the nurse
Pheochromocytoma, complains of sweating, provide?
palpitation and headache. Which assessment a. Notify the HCP if a lesion that does not heal
is essential for the nurse to make first? develops around the mouth.
a. Pupil reaction b. Squamous cell carcinoma tumors do not
b. Hand grips metastasize.
c. Blood pressure c. Limit foods to liquid or soft consistency for
d. Blood glucose 1 month.
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d. Apply heat to the area for 20 minutes every 41. The school nurse is preparing to teach a
4 hours. health promotion class to high school seniors.
Which information regarding self-care should
37. The nurse is caring for clients in an be included in the teaching?
outpatient surgery clinic. Which client should a. Wear a sunscreen with a protection factor
be assessed first? of 10 or less when in the sun.
a. The client scheduled for a skin biopsy who b. Try to stay out of the sun between 0300
is crying. and 0500 daily.
b. The client who had surgery three (3) hours c. Perform a thorough skin check monthly.
ago and is sleeping. d. Remember that caps and long sleeves do
c. The client who needs to void prior to not help prevent skin cancer.
discharge.
d. The client who has received discharge 42. Which client physiological outcome (goal)
instructions and is ready to go home. is appropriate for a client diagnosed with skin
cancer who has had surgery to remove the
38. The nurse and unlicensed assistive lesion?
personnel are caring for clients in a a. The client will express feelings of fear.
dermatology clinic. Which task should not be b. The client will ask questions about the
delegated to the unlicensed assistant? diagnosis.
a. Stock the rooms with the equipment c. The client will state a diminished level of
needed. pain.
b. Weigh the clients and position the clients d. The client will demonstrate care of
for the examination. operative site.
c. Discuss problems the client has
experienced since the previous visit. 43. The middle-aged client has had 2 lesions
d. Take the biopsy specimens to the diagnosed as basal cell carcinoma removed.
laboratory. Which discharge instruction should the nurse
include?
39. Which client is at the greatest risk for the a. Teach the client that there is no more risk
development of skin cancer? for cancer.
a. The African American male who lives in the b. Refer the client to a prosthesis specialist
northeast. for prosthesis.
b. The elderly Hispanic female who moved c. Instruct the client how to apply sunscreen
from Mexico as a child. to the area.
c. The client who has a family history of basal d. Demonstrate care of the surgical site.
cell carcinoma.
d. The client with fair complexion who cannot 44. The nurse is working on a renal surgery
get a tan. unit. After the afternoon report, which client
should the nurse assess first?
40. The nurse participating in a health fair is a. The male client who just returned from a
discussing malignant melanoma with a group CT scan and states that he left his glasses in
of clients. Which information regarding the the x-ray department.
use of sunscreen is important to include? b. The client who is one (1) day post-op and
a. Sunscreen is only needed during the has a moderate amount of serous drainage on
hottest hours of the day. the dressing.
b. Toddlers should not have sunscreen c. The client who is scheduled for surgery in
applied to their skin. the morning and wants an explanation of the
c. Sunscreen does not help prevent skin operative procedure before signing the
cancer. permit.
d. The higher the number of the sunscreen, d. The client who had ileal conduit surgery
the more it blocks UV rays. this morning and has not had any drainage in
the drainage bag.
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45. Which is a modifiable risk factor for the c. Administration of the prescribed
development of cancer of the bladder? antineoplastic medications.
a. Previous exposure to chemicals. d. Care for the client going for a MRI of the
b. Pelvic radiation therapy. kidneys.
c. Cigarette smoking.
d. Parasitic infections of the bladder. 50. The male client diagnosed with metastatic
cancer of the bladder is emaciated and
46. The client diagnosed with cancer of the refuses to eat. Which nursing action is an
bladder is scheduled to have a cutaneous example of the ethical principle of
urinary diversion procedure. Which paternalism?
preoperative teaching intervention specific to a. The nurse allows the client to talk about
the procedure should be included? not wanting to eat.
a. Demonstrate turn, cough, and deep b. The nurse tells the client that if he does not
breathing. eat, a feeding tube will be placed.
b. Explain that a bag will drain the urine from c. The nurse consults the dietitian about the
now on. client’s nutritional needs.
c. Instruct the client on the use of a PCA d. The nurse asks the family to bring favorite
pump. foods for the client to eat.
d. Take the client to the ICD so that he or she
can become familiar with it. 51. The client diagnosed with cancer of the
bladder states, “I have young children. I am
47. The client diagnosed with cancer of the too young to die.” Which statement is the
bladder is undergoing intravesical nurse’s best response?
chemotherapy. a. “This cancer is treatable and you should
Which instruction should the nurse provide not give up.”
the client about the pre-therapy routine? b. “Cancer occurs at any age. It is just one of
a. Instruct the client to remain NPO after those things.”
midnight before the procedure. c. “You are afraid of dying and what will
b. Explain the use of chemotherapy in bladder happen to your children.”
cancer. d. “Have you talked to your children about
c. Teach the client to administer Neupogen, a your dying?”
biologic response modifier.
d. Have the client take Tylenol, an analgesic, 52. The client with a continent urinary
before coming to the clinic. diversion is being discharged. Which
discharge instructions should the nurse
48. The nurse is planning the care of a include in the teaching?
postoperative client with an ileal conduit. a. Have the client demonstrate catheterizing
Which intervention should be included in the the stoma.
plan of care? b. Instruct the client on how to pouch the
1. Provide meticulous skin care and pouching. stoma.
2. Apply sterile drainage bags daily. c. Explain the use of a bedside drainage bag
3. Monitor the pH of the urine weekly. at night.
4. Assess the stoma site every day. d. Tell the client to call the HCP if the
temperature is 99_F or less.

49. The nurse and a licensed practical nurse 53. Which information regarding the care of a
(LPN) are caring for a group of clients. cutaneous ileal conduit should the nurse
Which intervention should be assigned to the teach?
LPN? a. Teach the client to instill a few drops of
a. Assessment of the client who has had a vinegar into the pouch.
Kock pouch procedure. b. Tell the client that the stoma should be
b. Monitoring of the post-op client with a WBC slightly dusky colored.
of 22,000 mm/dL.
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c. Inform the client that large clumps of d. Annual gynecological examinations
mucus are expected.
d. Tell the client that it is normal for the urine 58. The community health nurse is instructing
to be pink or red in color. a group of female clients about breast self-
examination. The nurse instructs the clients
54. The client is 2 days post to perform the examination:
ureterosigmoidostomy for cancer of the a. At the onset of menstruation
bladder. Which assessment data warrant b. Every month during ovulation
notification of the HCP by the nurse? c. Weekly at the same time of day
a. The client complains of pain at a “3,” 30 d. 1 week after menstruation begins
minutes after being medicated.
b. The client complains that it hurts to cough 59. The nurse is caring for a client who has
and deep breathe. undergone a vaginal hysterectomy. The nurse
c. The client ambulates to the end of the hall avoids which of the following in the care of
and back before lunch. this client?
d. The client is lying in a fetal position and a. Elevating the knee gatch on the bed
has a rigid abdomen. b. Assisting with range-of-motion leg
exercises
55. The female client diagnosed with bladder c. Removal of antiembolism stockings twice
cancer with a cutaneous urinary diversion daily
states, “Will I be able to have children now?” d. Checking placement of pneumatic
Which statement is the nurse’s best compression boots
response?
a. “Cancer does not make you sterile, but 60. The client is diagnosed as having a bowel
sometimes the therapy can.” tumor and several diagnostic tests are
b. “Are you concerned that you can’t have prescribed. The nurse understands that which
children?” test will confirm the diagnosis of malignancy?
c. “You will be able to have as many children a. Biopsy of the tumor
as you want.” b. Abdominal ultrasound
d. “Let me have the chaplain come to talk c. Magnetic resonance imaging
with you about this.” d. Computed tomography scan

56. 1. The nurse is instructing the client to


perform a testicular self-examination. The 61. A client is diagnosed with multiple
nurse tells the client: myeloma and the client asks the nurse about
a. To examine the testicles while lying down the diagnosis. The nurse bases the response
b. That the best time for the examination is on which description of this disorder?
after a shower a. Altered red blood cell production
c. To gently feel the testicle with one finger to b. Altered production of lymph nodes
feel for a growth c. Malignant exacerbation in the number of
d. That testicular self-examinations should be leukocytes
done at least every 6 months d. Malignant proliferation of plasma cells
within the bone
57. The community nurse is conducting a
health promotion program at a local school 62. The nurse is reviewing the laboratory
and is discussing the risk factors associated results of a client diagnosed with multiple
with cervical cancer. Which of the following, myeloma. Which of the following would the
if identified by the client as a risk factor for nurse expect to note specifically in this
cervical cancer, indicates a need for further disorder?
teaching? a. Increased calcium level
a. Smoking b. Increased white blood cells
b. Multiple sex partners c. Decreased blood urea nitrogen level
c. First intercourse after age 20
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d. Decreased number of plasma cells in the c. Remove the dosimeter badge when
bone marrow entering the client's room.
d. Individuals younger than 16 years old may
63. The nurse is developing a plan of care for be allowed to go in the room as long as they
the client with multiple myeloma and includes are 6 feet away from the client.
which priority intervention in the plan?
a. Encouraging fluids 68. A cervical radiation implant is placed in
b. Providing frequent oral care the client for treatment of cervical cancer.
c. Coughing and deep breathing The nurse initiates what most appropriate
d. Monitoring the red blood cell count activity order for this client?
a. Bed rest
64. The oncology nurse specialist provides an b. Out of bed ad lib
educational session to nursing staff regarding c. Out of bed in a chair only
the characteristics of Hodgkin's disease. The d. Ambulation to the bathroom only
nurse determines that further teaching is
needed if a nursing staff member states that 69. The client is hospitalized for insertion of
which of the following is a characteristic of an internal cervical radiation implant. While
the disease? giving care, the nurse finds the radiation
a. Presence of Reed-Sternberg cells implant in the bed. The initial action by the
b. Occurs most often in the older client nurse is to:
c. Prognosis depending on the stage of the a. Call the physician.
disease b. Reinsert the implant into the vagina
d. Involvement of lymph nodes, spleen, and immediately.
liver c. Pick up the implant with gloved hands and
flush it down the toilet.
65. The community health nurse conducts a d. Pick up the implant with long-handled
health promotion program regarding forceps and place it in a lead container.
testicular cancer to community members. The
nurse determines that further information 70. The nurse is caring for a client
needs to be provided if a community member experiencing neutropenia as a result of
states that which of the following is a sign of chemotherapy and develops a plan of care for
testicular cancer? the client. The nurse plans to:
a. Alopecia a. Restrict all visitors.
b. Back pain b. Restrict fluid intake.
c. Painless testicular swelling c. Teach the client and family about the need
d. Heavy sensation in the scrotum for hand hygiene.
d. Insert an indwelling urinary catheter to
66. The client is receiving external radiation prevent skin breakdown.
to the neck for cancer of the larynx. The most
likely side effect to be expected is: 71. The home health care nurse is caring for a
a. Dyspnea client with cancer and the client is
b. Diarrhea complaining of acute pain. The appropriate
c. Sore throat nursing assessment of the client's pain would
d. Constipation include which of the following?
a. The client's pain rating
67. The nurse is caring for a client with an b. Nonverbal cues from the client
internal radiation implant. c. The nurse's impression of the client's pain
When caring for the client, the nurse should d. Pain relief after appropriate nursing
observe which of the following principles? intervention
a. Limit the time with the client to 1 hour per
shift. 72. The nurse is caring for a client who is
b. Do not allow pregnant women into the postoperative following a pelvic exenteration
client's room. and the physician changes the client's diet
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from NPO status to clear liquids. The nurse ready to die.” Which phase of coping is this
makes which priority assessment before client experiencing?
administering the diet? a. Anger
a. Bowel sounds b. Denial
b. Ability to ambulate c. Bargaining
c. Incision appearance d. Depression
d. Urine specific gravity
78. The nurse is caring for a client following a
73. The client is admitted to the hospital with mastectomy. Which assessment finding
a suspected diagnosis of Hodgkin's disease. indicates that the client is experiencing a
Which assessment finding would the nurse complication related to the surgery?
expect to note specifically in the client? a. Pain at the incisional site
a. Fatigue b. Arm edema on the operative side
b. Weakness c. Sanguineous drainage in the Jackson-Pratt
c. Weight gain drain
d. Enlarged lymph nodes d. Complaints of decreased sensation near
the operative site
74. During the admission assessment of a
client with advanced ovarian cancer, the 79. The nurse is admitting a client with
nurse recognizes which symptom as typical of laryngeal cancer to the nursing unit. The
the disease? nurse assesses for which most common risk
a. Diarrhea factor for this type of cancer?
b. Hypermenorrhea a. Alcohol abuse
c. Abnormal bleeding b. Cigarette smoking
d. Abdominal distention c. Use of chewing tobacco
d. Exposure to air pollutants
75. When assessing the laboratory results of
the client with bladder cancer and bone 80. The female client who has been receiving
metastasis, the nurse notes a calcium level of radiation therapy for bladder cancer tells the
12 mg/dL. The nurse recognizes that this is nurse that it feels as if she is voiding through
consistent with which oncological the vagina. The nurse interprets that the
emergency? client may be experiencing:
a. Hyperkalemia a. Rupture of the bladder
b. Hypercalcemia b. The development of a vesicovaginal fistula
c. Spinal cord compression c. Extreme stress caused by the diagnosis of
d. Superior vena cava syndrome cancer
d. Altered perineal sensation as a side effect
76. The client reports to the nurse that when of radiation therapy
performing testicular self-examination, he
found a lump the size and shape of a pea. The 81. The client with leukemia is receiving
appropriate response to the client is which of busulfan (Myleran) and allopurinol (Zyloprim)
the following? is prescribed for the client. The nurse tells the
a. “Lumps like that are normal; don't worry.” client that the purpose of the allopurinol is to:
b. “Let me know if it gets bigger next month.” a. Prevent nausea
c. “That could be cancer. I'll ask the doctor to b. Prevent alopecia
examine you.” c. Prevent vomiting
d. “That's important to report even though it d. Prevent hyperuricemia
might not be serious.”
82. The client receiving chemotherapy is
77. The hospice nurse visits a client dying of experiencing mucositis. The nurse advises the
ovarian cancer. During the visit, the client client to use which of the following as the
expresses that “If I can just live long enough best substance to rinse the mouth?
to attend my daughter's graduation, I'll be a. Alcohol-based mouthwash
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b. Hydrogen peroxide mixture perineal resection and notes
c. Lemon-flavored mouthwash serosanguineous drainage from the wound.
d. Weak salt and bicarbonate mouth rinse Which nursing intervention is appropriate?
a. Notify the physician.
83. The community nurse is conducting a b. Clamp the Penrose drain.
health promotion program and the topic of c. Change the dressing as prescribed.
the discussion relates to the risk factors for d. Remove and replace the perineal packing.
gastric cancer.
Which risk factor, if identified by a client, 88. The nurse is assessing the colostomy of a
indicates a need for further discussion? client who has had an abdominal perineal
a. Smoking resection for a bowel tumor. Which of the
b. A high-fat diet following assessment findings indicates that
c. Foods containing nitrates the colostomy is beginning to function?
d. A diet of smoked, highly salted, and spiced a. Absent bowel sounds
food b. The passage of flatus
c. The client's ability to tolerate food
84. A gastrectomy is performed on a client d. Bloody drainage from the colostomy
with gastric cancer. In the immediate
postoperative period, the nurse notes bloody 89. The nurse is caring for a client following a
drainage from the nasogastric tube. Which of radical neck dissection and creation of a
the following is the appropriate nursing tracheostomy performed for laryngeal cancer
intervention? and is providing discharge instructions to the
a. Notify the physician. client. Which statement by the client
b. Measure abdominal girth. indicates a need for further instructions?
c. Irrigate the nasogastric tube. a. “I will protect the stoma from water.”
d. Continue to monitor the drainage. b. “I need to keep powders and sprays away
from the stoma site.”
85. The nurse is teaching a client about the c. “I need to use an air conditioner to provide
risk factors associated with colorectal cancer. cool air to assist in breathing.”
The nurse determines that further teaching d. “I need to apply a thin layer of petrolatum
related to colorectal cancer is necessary if the to the skin around the stoma to prevent
client identifies which of the following as an cracking.”
associated risk factor?
1. Age younger than 50 years 90. What is the purpose of cytoreductive
2. History of colorectal polyps (“debulking”) surgery for ovarian cancer?
3. Family history of colorectal cancer a. Cancer control by reducing the size of the
4. Chronic inflammatory bowel disease tumor
b. Cancer prevention by removal of
86. The nurse is reviewing the preoperative precancerous tissue
orders of a client with a colon tumor who is c. Cancer cure by removing all gross and
scheduled for abdominal perineal resection microscopic tumor cells
and notes that the physician has prescribed d. Cancer rehabilitation by improving the
neomycin (Mycifradin) for the client. The appearance of a previously treated body part
nurse determines that this medication has
been prescribed primarily: 91. Hormone therapy is prescribed as the
a. To prevent an immune dysfunction mode of treatment for a client with prostate
b. Because the client has an infection cancer. The nurse understands that the goal
c. To decrease the bacteria in the bowel of this form of treatment is to:
d. Because the client is allergic to penicillin a. Increase testosterone levels.
b. Increase prostaglandin levels.
87. The nurse is assessing the perineal wound c. Limit the amount of circulating androgens.
in a client who has returned from the d. Increase the amount of circulating
operating room following an abdominal androgens.
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2. A pale stoma
92. The nurse is caring for a client with cancer 3. A dark-colored stoma
of the prostate following a prostatectomy. The 4. A red and moist stoma
nurse provides discharge instructions to the
client and tells the client to: 97. The nurse is caring for a client following a
a. Avoid driving the car for 1 week. mastectomy. Which nursing intervention
b. Restrict fluid intake to prevent would assist in preventing lymphedema of the
incontinence. affected arm?
c. Avoid lifting objects heavier than 20 lb for a. Placing cool compresses on the affected
at least 6 weeks. arm
d. Notify the physician if small blood clots are b. Elevating the affected arm on a pillow
noticed during urination. above heart level
c. Avoiding arm exercises in the immediate
93. The oncology nurse is providing a postoperative period
teaching session to a group of nursing d. Maintaining an intravenous site below the
students regarding the risks and causes of antecubital area on the affected side
bladder cancer.
Which statement by a student indicates a 98. A nurse is monitoring a client for signs
need for further teaching? and symptoms related to superior vena cava
a. “Bladder cancer most often occurs in syndrome.
women.” Which of the following is an early sign of this
b. “Using cigarettes and coffee drinking can oncological emergency?
increase the risk.” a. Cyanosis
c. “Bladder cancer generally is seen in clients b. Arm edema
older than age 40.” c. Periorbital edema
d. “Environmental health hazards have been d. Mental status changes
attributed as a cause.”
99. A nurse manager is teaching the nursing
94. The nurse is reviewing the history of a staff about signs and a symptom related to
client with bladder cancer. The nurse expects hypercalcemia in a client with metastatic
to note documentation of which most prostate cancer and tells the staff that which
common symptom of this type of cancer? of the following is a serious late sign of this
a. Dysuria oncological emergency?
b. Hematuria a. Headache
c. Urgency on urination b. Dysphagia
d. Frequency of urination c. Constipation
d. Electrocardiographic changes
95. The nurse is caring for a client following
intravesical instillation of an 100. As part of chemotherapy education, the
alkylating chemotherapeutic agent into the nurse teaches a female client about the risk
bladder for the treatment of bladder cancer. for bleeding and self-care during the period of
Following the instillation, the nurse should the greatest bone marrow suppression (the
instruct the client to: nadir). The nurse understands that further
a. Urinate immediately. teaching is needed when the client states:
b. Maintain strict bed rest. a. “I should avoid blowing my nose.”
c. Change position every 15 minutes. b. “I may need a platelet transfusion if my
d. Retain the instillation fluid for 30 minutes. platelet count is too low.”
c. “I'm going to take aspirin for my headache
96. The nurse is assessing the stoma of a as soon as I get home.”
client following an ureterostomy. Which of d. “I will count the number of pads and
the following should the nurse expect to tampons I use when menstruating.”
note?
1. A dry stoma
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101. The nurse is monitoring the laboratory c. Ask the client about his or her height and
results of a client receiving an antineoplastic weight.
medication by the intravenous route. The d. Weigh and measure the client on the day of
nurse plans to initiate bleeding precautions if drug administration.
which laboratory result is noted?
a. A clotting time of 10 minutes 106. The client with squamous cell carcinoma
b. An ammonia level of 20 mcg/dL of the larynx is receiving
c. A platelet count of 50,000/mm3 bleomycin (Blenoxane) intravenously. The
d. A white blood cell count of 5,000/mm3 nurse caring for the client anticipates that
which diagnostic study will be prescribed?
102. The nurse is analyzing the laboratory a. Echocardiography
results of a client with leukemia who has b. Electrocardiography
received a regimen of chemotherapy. Which c. Cervical radiographphy
of the following laboratory values would the d. Pulmonary function studies
nurse specifically note as a result of the
massive cell destruction that occurred from 107. Each chemotherapeutic agent has a
the chemotherapy? specific nadir. The nurse administering a
a. Anemia combination chemotherapy regimen
b. Decreased platelets understands the importance of:
c. Increased uric acid level a. Giving two agents from the same
d. Decreased leukocyte count medication class
b. Giving two agents with like nadirs at the
103. The nurse is providing medication same time
instructions to a client with breast cancer who c. Testing the client's knowledge about each
is receiving cyclophosphamide (Cytoxan, agent's nadir
Neosar). The nurse tells the client to: d. Avoid giving agents with the same nadirs
a. Take the medication with food. and toxicities at the same time
b. Increase fluid intake to 2000 to 3000 mL
daily. 108. The clinic nurse prepares a teaching plan
c. Decrease sodium intake while taking the for the client receiving an antineoplastic
dedication. medication. When implementing the plan, the
d. Increase potassium intake while taking the nurse tells the client:
medication. a. To take aspirin (acetylsalicylic acid) as
needed for headache
104. The client with non–Hodgkin's lymphoma b. Drink beverages containing alcohol in
is receiving daunorubicin moderate amounts each evening
(DaunoXome). Which of the following would c. Consult with health care providers before
indicate to the nurse that the client is receiving immunizations
experiencing a toxic effect related to the d. That it is not necessary to consult health
medication? care providers before receiving a flu vaccine
a. Fever at the local health fair
b. Diarrhea
c. Complaints of nausea and vomiting 109. The client with bladder cancer is
d. Crackles on auscultation of the lungs receiving cisplatin (Platinol) and vincristine
(Oncovin, Vincasar PFS). The nurse preparing
105. Chemotherapy dosage is frequently to give the medication understands that the
based on total body surface area purpose of administering both these
(BSA), so it is important for the nurse to do medications is to:
which of the following before administering a. Prevent alopecia
chemotherapy? b. Decrease the destruction of cells
a. Measure abdominal girth. c. Increase the therapeutic response
b. Calculate body mass index. d. Prevent gastrointestinal side effects
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110. The client with lung cancer is receiving a b. Calcium level
high dose of methotrexate (Rheumatrex, c. Potassium level
Trexall). Leucovorin (citrovorum factor, folic d. Prothrombin time
acid) is also prescribed. The nurse caring for
the client understands that the purpose of 115. Megestrol acetate (Megace), an
administering the leucovorin is to: antineoplastic medication, is prescribed for
a. Preserve normal cells. the client with metastatic endometrial
b. Promote DNA synthesis. carcinoma. The nurse reviews the client's
c. Promote medication excretion. history and contacts the physician if which of
d. Promote the synthesis of nucleic acids. the following is documented in the client's
history?
111. The client with ovarian cancer is being a. Gout
treated with vincristine (Oncovin, Vincasar b. Asthma
PFS). The nurse monitors the client, knowing c. Thrombophlebitis
that which of the following indicates a side d. Myocardial infarction
effect specific to this medication?
a. Diarrhea 116. A female client with carcinoma of the
b. Hair loss breast is admitted to the hospital for
c. Chest pain treatment with intravenously administered
d. Numbness and tingling in the fingers and doxorubicin (Adriamycin). The client tells the
toes nurse that she has been told by herfriends
that she is going to lose all her hair. The
112. The nurse is reviewing the history and appropriate nursing response is which of the
physical examination of a client who will be following?
receiving asparaginase (Elspar), an a. “Your friends are correct.”
antineoplastic agent. b. “You will not lose your hair.”
The nurse contacts the physician before c. “Hair loss may occur, but it will grow back
administering the medication if which of the just as it is now.”
following is documented in the client's d. “Hair loss may occur, and it will grow back,
history? but it may have a different color or texture.”
a. Pancreatitis
b. Diabetes mellitus 117. The clinic nurse prepares instructions for
c. Myocardial infarction a client who developed stomatitis following
d. Chronic obstructive pulmonary disease the administration of a course of
antineoplastic medications. The nurse tells
113. Tamoxifen (Nolvadex) is prescribed for the client to:
the client with metastatic breast carcinoma. a. Rinse the mouth with baking soda or saline.
The nurse administering the medication b. Avoid foods and fluids for the next 24
understands that the primary action of this hours.
medication is to: c. Swab the mouth daily with lemon and
a. Increase DNA and RNA synthesis. glycerin pads.
b. Promote the biosynthesis of nucleic acids. d. Brush the teeth and use waxed dental floss
c. Increase estrogen concentration and three times a day.
estrogen response.
d. Compete with estradiol for binding to 118. The client with acute myelocytic
estrogen in tissues containing high leukemia is being treated with busulfan
concentrations of receptors. (Myleran, Busulfex). Which of the following
laboratory values would the nurse specifically
114. The client with metastatic breast cancer monitor during treatment with this
is receiving tamoxifen (Nolvadex). The nurse medication?
specifically monitors which laboratory value a. Clotting time
while the client is taking this medication? b. Blood glucose level
a. Glucose level c. Uric acid level
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d. Potassium level 123. The nurse teaches skin care to the client
receiving external radiation therapy. Which of
119. The client with small cell lung cancer is the following statements, if made by the
being treated with etoposide (VePesid). The client, would indicate the need for further
nurse monitors the client during instruction?
administration, knowing that which of the a. “I will handle the area gently.”
following indicates a side effect specific to b. “I will avoid the use of deodorants.”
this medication? c. “I will limit sun exposure to 1 hour daily.”
a. Alopecia d. “I will wear loose-fitting clothing.”
b. Chest pain
c. Pulmonary fibrosis 124. A 13-year-old child is diagnosed with
d. Orthostatic hypotension Ewing's sarcoma of the femur.
Following a course of radiation and
120. The nurse is assigned to care for several chemotherapy, it has been decided that leg
male and female clients who take estrogen or amputation is necessary. Following the
progestins. The nurse knows that this group amputation, the child becomes very
of clients is a increased risk for which frightened because of aching and cramping
complication of the medication? felt in the missing limb. Which nursing
a. Sepsis statement would be appropriate to assist in
b. Dehydration alleviating the child's fear?
c. Deep vein thrombosis a. “This aching and cramping is normal and
d. Electrocardiographic changes temporary and will subside.”
b. “This normally occurs after the surgery and
121. The nurse has admitted a client to the we will teach you ways to deal with it.”
clinical nursing unit following a modified right c. “The pain medication that I give you will
radical mastectomy for the treatment of take these feelings away.”
breast cancer. The nurse plans to place the d. “This pain is not real pain and relaxation
right arm in which of the following positions? exercises will help it go away.”
a. Elevated above shoulder level
b. Elevated on a pillow 125. A breast feeding mother develops
c. Level with the right atrium mastitis in the left breast and is put on an
d. Dependent to the right atrium antibiotic for seven days. She asks the nurse
if she can continue breast feeding. The
nurse's best answer would be:
122. A 6-year-old child has just been a. "Only breast feed from the right breast."
diagnosed with localized Hodgkin's disease b. "Do not breast feed or stimulate the
and chemotherapy is planned to begin breasts until the infection is resolved."
immediately. The mother of the child asks the c. "Continue breast feeding, this is not a
nurse why radiation therapy was not contraindication."
prescribed as a part of the treatment. The d. "Pump the breasts and discard the milk
appropriate and supportive response to the until the infection resolves."
mother is:
a. “I'm not sure. I'll discuss it with the 126. You are working in the Dermatology
physician.” Clinic. A patient has a Basal Carcinoma In
b. “The child is too young to have radiation Situ removed from his left lower leg. When
therapy.” he returns for follow-up in one week, you note
c. “It's very costly, and chemotherapy works that the wound has healed with minimal
just as well.” scarring. Which type of healing process does
d. “The physician would prefer that you this represent?
discuss treatment options with the a. Primary intention
oncologist.” b. Secondary intention
c. Tertiary intention
d. Dehiscence
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b. oral administration of narcotics
127. A client receiving chemotherapy has c. rectal administration of NSAIDS
developed sores in his mouth. He asks the d. injectable pain reliever
nurse why
this happened. What is the nurse’s best 133. Which of the following statements about
response? the use of antidepressants with pain relief in
a. “It is a sign that the medication is cancer pain is true?
working.” a. Antidepressants have no effect.
b. “You need to have better oral hygiene.” b. Antidepressants enhance the effect of
c. “The cells in the mouth are sensitive to the analgesics.
chemotherapy.” c. Antidepressants decrease the effect of
d. “This always happens with chemotherapy.” analgesics.
The correct answer is C: “The cells in the d. Antidepressants promote more rapid
mouth are sensitive to the chemotherapy.” excretion of the medications.

128. Marco who was diagnosed with brain 134. The use of radiation therapy in the care
tumor was scheduled for craniotomy. In of a patient with abdominal cancer would be:
preventing the development of cerebral a. to relive metastatic pain as well as
edema after surgery, the nurse should expect symptoms from local extension of primary
the use of: disease.
a. Diuretics b. to be a palliative treatment to relieve pain
b. Antihypertensive and maintain symptom control for the
c. Steroids duration of the patient’s life.
d. Anticonvulsants c. to be used alone as a therapeutic agent.
d. to help tissue to shrink and possible tumor
129. A high-fiber diet is thought to reduce the eradication.
risk of colon cancer because it:
a. absorbs water from the intestinal wall. 135. In planning for pain control in a post-
b. promotes the excretion of bile. operative cancer patient, the nurse
c. stops diarrhea. understands:
d. is low in kilocalories. a. radiation therapy alone will be used.
b. noninvasive analgesic approaches should
130. Pain tolerance in an elderly patient with be tried before invasive palliative approaches.
cancer would: c. never use radiation therapy, unless you are
a. stay the same. sure the patient will die.
b. be lowered. d. radiation therapy is complementary to
c. be increased. analgesic drug therapies.
d. no effect on pain tolerance.
136. What considerations should be noted by
131. When administering a narcotic with a the nurse when pharmacological support is
non-narcotic to relieve severe cancer pain, given for cancer patients having procedures?
the nurse must remember: a. The needs of the individual and the type of
a. this combination enhances pain relief. procedures to be done.
b. this combination treats pain both centrally b. All children and adults should have heavy
and peripherally. dosages of drugs.
c. the narcotic potentiates action of the non- c. All children no matter what age, should
narcotic. have hypnosis, distraction, imagery, and
d. each drug works in its own right. relaxation therapy.
132. A cancer patient has had a resurgence of d. No special considerations are necessary.
severe acute pain. Which of the following
routes of medication is most appropriate for 137. Cancer pain depends upon what?
this patient? a. the age of the patient and how much fear
a. oral administration NSAIDS and anxiety is present
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b. the type of cancer, the site of the cancer, 142. Which mnemonic is used to remember
and the time of the initial pain episode the seven warning signs of cancer?
c. the type of cancer, the stage of the cancer, a. CAUTION
and the threshold (tolerance for pain) b. DANGERS
d. the psychosocial state of the client, how c. WARNING
well they accept the diagnosis, and the sex of d. CANCERS
the patient
143. Cancer is characterized by which of the
138. A client received testing and was just following cell changes?
informed she has leukemia. Which statement a. Rapid proliferation
by the nurse is most therapeutic? b. Toxin production
a. “We have treatments for leukemia that are c. Increased differentiation
quite effective.” d. Indiscriminate proliferation
b. “Don’t worry, because your type of
leukemia is treatable.” 144. A client has a cancerous tumor on his
c. “Lots of people have leukemia and are tibia. What name is given this type of tumor?
successfully treated.” 1. Adenoma
d. “How does it feel for you to hear you have 2. Osteoma
leukemia?” 3. Fibroma
4. Meningioma
139. Which of the following may be a
complication of previous infection with human 145. A 54-year-old man is admitted to the
papilloma virus (HPV)? hospital for a colostomy related to a recent
a. Cervical cancer diagnosis of colon cancer.
b. Breast cancer During the preoperative period, what is the
c. Bone cancer most important aspect of this client’s nursing
d. Skin cancer care?
a. Assure the client that he will be cured of
140. A client has been treated for uterine cancer.
cancer with internal radiation therapy. Which b. Assess understanding of the procedure and
of the following complications may she expectation of bodily appearance after
develop later? surgery.
a. cystitis c. Maintain a cheerful and optimistic
b. arthritis environment.
c. hepatitis d. Keep visitors to a minimum, so that he can
d. neuritis have time to think things through.

141. The client, aged 28, was recently 146. A client who is getting radiation asks the
diagnosed with Hodgkin’s disease. After nurse why these sores developed in the
staging, therapy is planned to include client’s mouth. What is the most appropriate
combination radiation therapy and systemic response?
chemotherapy with MOPP (nitrogen mustard, a. “Don’t worry; it always happens with
vincristine {Onconvin}, prednisone, and radiation.”
procarbazine). In planning care for the client, b. “Your oral hygiene needs improvement.”
the nurse should anticipate which of the c. “It is a sign that the radiation is effective.”
following effects to contribute to a sense of d. “The sores result because the cells in the
altered body image? mouth are sensitive to the radiation.”
a. cushingoid appearance
b. alopecia 147. A client develops stomatitis during the
c. temporary or permanent sterility course of radiation therapy. Nursing care for
d. pathologic fractures this problem should include:
a. A soft, bland diet.
b. Restricting fluids to decrease salivation.
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c. Rinsing the mouth every two hours with a d. Avoid the question. Nurses are not
dilute mouthwash. specialists in providing sexual counseling.
d. Encouraging the client to drink hot liquids.
152. When a client is having external
148. The chemotherapeutic agent 5- radiation for lung cancer, what side effect is
fluorourcacil (5-FU) is ordered for a client as most likely to be experienced?
an adjunct measure to surgery. Which a. Alopecia
statement about chemotherapy is true? b. Bone marrow suppression
a. It is a local treatment affecting only tumor c. Stomatitis
cells. d. Dyspnea
b. It is a systemic treatment affecting both
tumor and normal cells. 153. A 25-year-old male client receiving
c. It has not yet been proved an effective external radiation treatments tells you that he
treatment for cancer. fears he is radioactive and a danger to his
d. It is often the drug of choice because it family and friends. How would the nurse
causes few if any side effects. dispel his fears?
a. Inform him that radiation machines are risk
149. Which instruction should be given in a free.
health education class regarding testicular b. Explain that once the machine is off,
cancer? radiation is no longer emitted.
a. All males should perform a testicular exam c. Avoid telling him that his fears are in fact
after the age of 30. true.
b. Testicular exams should be performed on a d. Instruct him to spend short periods of time
daily basis. with his family and friends.
c. Reddening or darkening of the scrotum is a
normal finding. 154. The nurse assesses for findings of early
d. Testicular exams should be performed after cervical cancer by which of the following?
a warm bath or shower. a. A dark, foul-smelling vaginal discharge
b. Pressure on the bladder or bowel, or both
150. During surgery, it is found that a client c. Back and leg pain and weight loss
with adenocarcinoma of the rectum has d. Vaginal discharge (leucorrhea)
positive peritoneal lymph nodes. What is the
next most likely site of metastasis? 155. The nurse discusses with a client in the
a. Brain healthcare clinic the possibility of endometrial
b. Bone cancer. Which of the following statements is
c. Liver incorrect concerning endometrial cancer?
d. Mediastinum a. Diagnosis is most frequently established by
a dilation and curettage (D&C).
151. Medical treatment for a client with b. Prolonged use of exogenous estrogen
cervical cancer will include a hysterectomy increases the occurrence.
followed by internal radiation. Although she is c. The first and most important symptom is
32 years old and has three children, the client abnormal bleeding.
tells the nurse that she is anxious regarding d. This malignancy tends to spread rapidly to
the impending treatment and loss of her other organs.
femininity. Which interaction is most
appropriate? 156. The Pap smear reveals that a client has
a. Tell the client that now she does not have cancer of the cervix. The mode of treatment
to worry about pregnancy. is an abdominal hysterectomy. The client
b. Provide the client with adequate voices concern about undergoing menopause.
information about the effects of treatment on In counseling her, which statement would be
sexual functioning. most appropriate?
c. Refer her to the physician.
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a. A surgical menopause will occur, and Her discharge teaching should include:
treatment with estrogen therapy will be a. Manage sore throat with over-the-counter
necessary. preparations.
b. The ovaries will continue to function and b. Wear a mask when going out to shop.
produce estrogen, thus preventing c. You can babysit ill grandchildren.
menopause as a result of surgery. d. Avoid activities that may cause bleeding.
c. Ovarian hormone secretion ceases, but the
hypothalamus will continue to secrete FSH, 162. Antimetabolites used for cancer
and this prevents menopause. treatment work by:
d. The ovaries will cease functioning, and it a. Enhancing cell growth.
will be necessary to take estrogen. b. Bone marrow ablation.
c. Inhibiting cell growth and proliferation.
157. Cancer of the lungs is caused by: d. Limiting the ability of the cancer to
a. Airway atrisia. metastasize.
b. Hepatitis A.
c. Cigarette smoking. 163. The synthetic cannabis derivative
d. Congenital defects. dronabinol
(Marinol) can be used to treat cancer patients
158. A client begins a regimen of for:
chemotherapy. Her platelet counts falls to a. Depression.
98,000. Which action is least necessary at b. Nausea.
this time? c. Pain.
a. Test all excreta for occult blood. d. Mucositis.
b. Use a soft toothbrush or foam cleaner for
oral hygiene. 164. Which statement is incorrect regarding
c. Implement reverse isolation. lung cancer?
d. Avoid IM injections. a. The 5-year survival rate depends on tumor
histology and disease stage at the time
159. High uric acid levels may develop in treatment is initiated.
clients who are receiving chemotherapy. This b. Small-cell lung cancer has an excellent
is caused by: prognosis.
a. The inability of the kidneys to excrete the c. The 5-year survival rate for lung cancer is
drug metabolites. less than 15 percent.
b. Rapid cell catabolism. d. Lung cancer is usually widespread by the
c. Toxic effects of the prophylactic antibiotics time it is detected on chest x-ray.
that are given concurrently.
d. The altered blood pH from the acid medium 165. A client is scheduled for external
of the drugs. radiation treatment for laryngeal cancer. Of
the following, which is not a common
160. Which of the following statements, if systemic side effect of this treatment?
made by a cancer patient with hair loss a. Nausea
secondary to chemotherapy, indicates the b. Fatigue
goal for new coping patterns is being met? c. Malaise
a. “I think I’ll get some new barrettes for my d. Dry desquamation of the skin
hair.”
b. “I washed my wig today.” 166. When teaching the client about
c. “I asked my mom to bring my shampoo.” upcoming external radiation treatments, the
d. “I’m thinking about changing my hair nurse should stress the importance of:
color.” a. Massaging the area daily.
b. Exposing the area to sunlight for 30
161. A patient with breast cancer is minutes each day.
undergoing chemotherapy. She develops c. Not using soap on the treatment area and
myelosuppression. ink markings.
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d. Applying cosmetic creams over the area to c. Have the client brush his teeth before
conceal reddened areas. collection of the specimen.
d. Keep the client NPO for 24 hours before
167. A recent diagnosis of cancer has caused collection of the specimen.
a patient severe anxiety. The plan of care
should include: 172. A 4-year-old Mexican American client
a. Teaching the stages of grieving. has recently been diagnosed with leukemia.
b. Providing distraction during time of stress. What intervention would be appropriate when
c. Teaching chemotherapy aspects. considering the client’s culture?
d. Encouraging verbalization of concerns a. Limit all visitors, including extended family.
regarding diagnosis. b. Encourage visits from extended as well as
immediate family.
168. A patient is undergoing chemotherapy c. Ban all visits from alternative healers.
following a laryngectomy for laryngeal d. Make diet selections for the child and
cancer. The patient begins complaining of a family.
sore mouth. The nurse should assess for:
a. Xerostomia. 173. An 85-year-old man with end-stage
b. Halatosis. prostate cancer has a living will expressing
c. Stomatitis. his desire for a dignified death and comfort
d. Dysgeusia. care measures without resuscitation
measures. Advocate, your role is to:
169. The main goal of cancer chemotherapy a. Support the daughter’s decision.
is to: b. Encourage the patient to revoke his living
a. Limit the toxic side effects. will.
b. Attack the cancer as early as possible. c. Support the patient’s decision and
c. Cure or provide palliation if the cancer is encourage him to discuss his feeling with his
not curable. daughter.
d. Provide the patient with a suitable quality d. Ignore the patient’s decision for non-
of life. resuscitation.

170. A client receiving radiation therapy for a 174. Mr. Davis, an 80 year old, is being
cancer tumor asked the nurse, “How is the discharged from the hospital with a new
radiation treatments done?” The nurse replied diagnosis of lung cancer. The adult children
that: have made arrangements for him to live with
a. The agents act on inhibiting DNA synthesis. his youngest son. To promote optimal
b. The therapy can be either internal or continuity of care, the nurse should:
external beam. a. Immediately arrange for hospice care.
c. The agents used kill all the cancer cells. b. Convince the family that institutionalized
d. The therapy of the beam of radiation is for care would be better.
the total body. c. Assist with the discharge as planned.
d. Explore options for community health
171. A 67-year-old man is admitted to the services with the family.
hospital with a tentative diagnosis of
bronchogenic carcinoma. His chief complaint 175. A patient with advanced cancer of the
is dyspnea and a chronic cough. The stomach is undergoing surgery to take out
physician orders a sputum sample for part or debulk the tumor. This is known as
cytologic testing. Important nursing ______ surgery.
implications involved with obtaining a sputum a. Tertiary
sample for cytology should include which of b. Restorative
the following? c. Curative
a. Obtain the specimen in the evening hours. d. Palliative
b. Collect the specimen in the morning before
the client eats and drinks.
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176. Which of the following primary 180. What interventions would be appropriate
precautions is aimed at reducing the risk of for a client admitted to the oncology unit for
breast cancer in a female 50 years of age and chemotherapy and radiation therapy who is
older? experiencing dysgeusia?
a. Pap smear a. Premedicate the client with an antiemetic.
b. Colonoscopy b. Observe the client for signs of dehydration.
c. Ultrasound c. Use highly seasoned foods to stimulate
d. Mammography taste buds.
d. Obtain an order for zinc and give with food
177. Your patient is considering participating or milk to treat symptoms.
in a multi-site trial of a new cancer
medication. According to the “Patient’s Bill of 181. Mr. Hart is your patient who has a new
Rights,” it is important for the patient to know diagnosis of lung cancer who is deemed
that: terminally ill. During your assessment of
a. All costs of research are paid by the discharge needs, you find that he has no
patient. available caregiver in the home but will need
b. He has the right to refuse to participate in assistance with ADLs. You discuss with the
research without fear of loss of care. discharge planner:
c. The physicians will no longer be caring for a. Home care.
him if he does not participate in the research. b. Adult day care.
d. The research study is his only hope of c. Long-term care with hospice services.
treatment. d. Respite care.

178. Which of the following statements about 182. Which assessment finding would indicate
cancer cachexia is true? to the nurse that an antitussive medication
a. It is no different than simple starvation administered to a client with bronchogenic
because the metabolic rate declines in cancer is having the desired effect?
response to tumor growth. a. Dyspnea is relieved.
b. Cancer cachexia occurs as a result of b. Coughing is decreased.
chemotherapy but not radiation therapy. c. Expectoration is increased.
c. Cancer cachexia occurs as a result of d. Wheezes and gurgles have diminished.
tumorinduced changes.
d. Cancer cachexia is only seen in clients who 183. Which assessment finding should the
have limited caloric intake. nurse interpret as indicative of impending
spinal cord compression in a client with
179. A 52-year-old male client being treated metastatic prostate cancer?
for cancer doesn’t understand why he is a. Increasing back pain, which is worse when
being given a “female hormone,” megesterol standing than when lying down
acetate (Megace), as part of the treatment b. Lower extremity weakness and/or
regimen. He is afraid that it will alter his paresthesias
appearance. How would you respond to the c. Urgency accompanied by bladder spasms
client’s concern of altered body image? d. Lower extremity muscle cramping
a. Tell the client that the physical changes are
only temporary. 184. A client having cryosurgery for removal
b. Tell the client that this medication is used of a squamous cell carcinoma asks if the
for its ability to stimulate appetite. procedure will hurt. Which is the correct
c. Tell the client that you understand his answer for the nurse to give?
concern and that he should not take it. a. “You will not feel anything.”
d. Tell the client that the medication will be b. “There will be a brief tingling pain.”
used for a short time and any effects will be c. “There will be no pain but you may
self-limiting. experience a slight odd smell.”
d. “There will be a momentary, stabbing
pain.”
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b. Cancer has metastasized to the GI tract
185. When teaching at a health fair, the nurse c. Rectovaginal fistula has developed
is asked if there is really a relationship d. Rectum is being compressed by the tumor
between tobacco smoke and lung cancer. mass
Which information should serve as the basis
for the nurse’s response? 190. Which assessment finding is
a. There is a relationship and it is between characteristic of advanced ovarian cancer?
certain types of lung cancer and both a. Ascites
smoking and being exposed to second-hand b. Purpura
smoke. c. Splenomegaly
b. Exposure to carcinogens such as asbestos d. Hypoactive DTRs
and uranium account for a greater portion of
lung cancer than does tobacco use. 191. Which client with breast cancer is a
c. Radon takes precedence over tobacco candidate for treatment with Tamoxifen?
smoke as a factor responsible for lung cancer. a. A 32-year-old client with a lumpectomy for
d. Tobacco smoking is associated with the a small tumor and no sign of spread
majority of lung cancers of all types. b. A 58-year-old client with negative estrogen
receptor
186. What symptom reported in the health (ER) status
history of a 55- year-old woman should be c. A 41-year-old client with metastatic disease
interpreted by the nurse as requiring d. A 66-year-old client with estrogen sensitive
immediate follow-up evaluation for cancer of disease
the right colon?
a. Black, tarry stools 192. Which test confirms the diagnosis of
b. Loose, frothy stool prostate cancer?
c. Flat, ribbon-shaped stool a. PSA
d. Mahogany-colored, formed stool b. Alkaline phosphatase
c. Ultrasound of the prostate
187. When teaching a local club group about d. Prostate biopsy
oral cancer, which comment by a participant
indicates that the nurse needs to clarify the 193. Lupron is prescribed for a client with
information presented? prostate cancer. Which assessment data best
a.“Most oral cancers occur on the tongue.” indicates that the medication is having the
b. “The most rapidly spread oral cancer is on desired effect?
the floor of the mouth.” a. Client reports pain is controlled
c. “Early oral cancers are generally b. Vomiting has stopped
asymptomatic.” c. Urine is free of blood
d. “Smoking is a risk factor for cancer of the d. PSA level has dropped
lip.”
194. Which condition can pain in young
women with ovarian cancer mimic?
188. Which symptom should the nurse a. Appendicitis
interpret as requiring a check for endometrial b. Constipation
cancer? c. PMS
a. Postmenopausal bleeding d. Urinary tract infection
b. Persistent leukorrhea
c. Painful sexual intercourse 195. When caring for a client having
d. Intermittent amenorrhea radiation therapy the nurse receives a report
that the client’s laboratory values are normal
189. How should the nurse interpret the and there are no signs of anemia, infection, or
leakage of fecal matter from the vagina of a bleeding. Which conclusion should the nurse
client with advanced cancer? draw from this information?
a. Anal sphincter has been impaired
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a. Radiation has not yet reached a 200. A client who had a dose of
therapeutic level. chemotherapy at 8 a.m. calls the clinic at
b. The client is free of side effects of 2:30 p.m. complaining of nausea and
radiation. vomiting despite having taken the prescribed
c. Nutritional status is normal. medication. She asks how much worse the
d. Bone-marrow suppression is not a problem. nausea and vomiting is going to get. On
which fact should the nurse’s answer be
196. When assessing skin of a client having based?
external radiation therapy, which fact should a. Nausea and vomiting is totally
the nurse keep in mind? unpredictable.
a. Skin damage is preceded by changes in b. Nausea and vomiting typically peak in the
oral mucous membranes. first 12 hours.
b. Most skin changes occur 4–8 weeks after c. Nausea and vomiting will ease on going to
the start of radiation. bed.
c. Skin areas with poor blood flow are at d. Vomiting should cease in about 36 hours
greatest risk for injury. but nausea may persist for 7–10 days.
d. Intertriginous areas are at particular risk
for skin reactions.

197. How should the care of a client


undergoing brachytherapy be assigned?
a. To male nurses whenever possible ANSWER AND RATIONALE
b. On a rotating basis among nonpregnant ONCOLOGIC
nursing staff
c. Consistently to the same nurses 1. Answer: C
d. Never to a nurse with a history of cancer Rationale: Patients with cancer and bone
metastasis experience severe pain especially
198. A client having radiation therapy asks when moving. Bone tumors weaken the bone
the nurse if his blood cells are going to be to appoint at which normal activities and
affected. Which fact should form the basis of even position changes can lead to fracture.
the nurse’s answer? During nursing care, the patient needs to be
a. Bone marrow and therefore blood cells are supported and handled gently.
affected with almost all ports of radiation.
b. If radiation is delivered to the hip or leg, no 2. Answer: D
effect should occur. Rationale: Fatigue is a common complaint of
c. It depends on whether or not medications individuals receiving medication therapy.
are being taken that sensitize blood cells to
radiation. 3. Answer: B
d. Speed and volume of blood to tissues of Rationale: Chemotherapeutic agents are
the port will determine the effect. given to destroy the actively proliferating
cancer cells. But these agents cannot
199. A client having chemotherapy for breast differentiate the abnormal actively
cancer reports a temperature of 101.4 F. How proliferating cancer cells from those that are
should the nurse interpret this fact? actively proliferating normal cells like the
a. Sign of infection, which needs to be cells of the bone marrow, thus the effect of
reported right away bone marrow depression.
b. Side effect of chemotherapy, not requiring
intervention 4. Answer: C
c. Sign of infection, which needs monitoring Rationale: Early warning signs of laryngeal
and reporting if it persists for 48 hours cancer can vary depending on tumor location.
d. Indicator of dehydration requiring client Hoarseness lasting 2 weeks should be
teaching regarding fluid intake evaluated because it is one of the most
common warning signs.
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bowels must be emptied of fecal material
5. Answer: C thus the need for laxative and enema.
Rationale: Steroids decrease the body’s
immune response thus decreasing the 12. Answer: D
production of antibodies that attack the Rationale: Numerous aspects of diet and
acetylcholine receptors at the neuromuscular nutrition may contribute to the development
junction of cancer. A low-fiber diet, such as when fresh
fruits and vegetables are minimal or lacking
6. Answer: A in the diet, slows transport of materials
Rationale: Progression stage is the change of through the gut which has been linked to
tumor from the preneoplastic state or low colorectal cancer.
degree of malignancy to a fast growing tumor
that cannot be reversed.
13. Answer: C
7. Answer: D Rationale: Blood pressure.
Rationale: Intermittent pain is the classic sign Pheochromocytoma is a tumor of the adrenal
of renal carcinoma. It is primarily due to medulla that causes an increase secretion of
capillary erosion by the cancerous growth. catecholamines that can elevate the blood
pressure.
8. Answer: C
Rationale: Assessing for an open airway is the 14. Answer: D
priority. The procedure involves the neck, the Rationale: Cigarette smoke is a carcinogen
anesthesia may have affected the swallowing that irritates and damages the respiratory
reflex or the inflammation may have closed in epithelium. The irritation causes the cough
on the airway leading to ineffective air which initially maybe dry, persistent and
exchange. unproductive. As the tumor enlarges,
obstruction of the airways occurs and the
cough may become productive due to
9. Answer: D infection.

Rationale: Gentle oral hygiene is essential to 15. Answer: C


remove debris, prevent irritation and promote Rationale: Assessment of a client with
healing. Oral hygiene before meal time often Hodgkin’s disease most often reveals
makes meals more pleasant. The best enlarged, painless lymph node, fever, malaise
and night sweats
solution for oral care is normal saline.
Commercial mouthwashes are irritating to the 16. Answer: D
oral mucosa therefore they are Rationale: Constipation, diarrhea, and/or
contraindicated. An anti-emetic is not constipation alternating with diarrhea are the
necessary in this situation as well as keeping most common symptoms of colorectal cancer.
the client on NPO and administering the food
via TPN. 17. Answer: B
Rationale: The earliest and most sensitive
10. Answer: B sign of increased ICP is a change in the level
Rationale: Orchiectomy is the surgical of consciousness. Elevated BP + positive
removal of a testicle. The affected testicle is Babinski reflex due to damage to the
surgically removed along with its tunica and corticospinal tract are both late signs. Urinary
spermatic cord incontinence` is not diagnostic of increased
ICP.
11. Answer: A
Rationale: Barium enema is the radiologic 18. Answer: C
visualization of the colon using a die. To Rationale: If the cancer is treatable by
obtain accurate results in this procedure, the surgery, it is preferred over other treatments
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that have multiple side effects such as for periods of rest to avoid fatigue and
chemotherapy and radiation therapy. Bone overexertion.
marrow transplant is a specific treatment for
leukemia that is not applicable to other types
of cancer. 23. Answer: B
Rationale: Biologic response modifiers are
19. Answer: A naturally or genetically engineered agents
Rationale: The client's platelet count is that can alter the immunologic relationship
severely depressed, placing him at risk for between the tumor and the client with cancer
bleeding secondary to thrombocytopenia. in an attempt to destroy or stop the
Bleeding precautions should be instituted, malignant growth by stimulating the body's
including the use of an electric razor and soft natural immune defenses. Destroying or
toothbrush, minimizing injections, avoiding stopping malignant growth, not stimulating
aspirin, and observing for petechiae and the production of cancer cells, is the goal of
ecchymosis. Typically, chemotherapy would therapy when using BRMs.
be held if the client developed
thrombocytopenia. 24. Answer: C
Rationale: Intellectualization. People use
20. Answer: B defense mechanisms to cope with stressful
Rationale: The client is probably neutropenic events. Intellectualization is the use of
due to a low neutrophil count on the WBC reasoning and thought processes to avoid the
count. This occurs as a result of emotional upsets.
myelosuppressive activity of the
chemotherapy and is further confirmed by the 25. Answer: B
client's symptoms of infection. Even though Rationale: Children have cells that are
infection control is the top priority, meals normally actively dividing in the process of
should be served at room temperature to cold growth. Radiation acts not only against the
to minimize food odors, which can cause abnormally actively dividing cells of cancer
nausea. A client receiving chemotherapy and but also on the normally dividing cells thus
having developed an infection should be affecting the growth and development of the
served a high-protein, high-calorie diet to child and even causing cancer itself.
ensure adequate nutrients and calories for
the body to mount a response to the 26. Answer: D
infection. Rationale: Elevating the arm above the level
of the heart promotes good venous return to
21. Answer: C the heart and good lymphatic drainage thus
Rationale: Hospice programs are designed to preventing swelling.
help with symptom control and maintain
quality of life for the client who has 6 months 27. Answer: B
or less to live; they also assist the client with Rationale: One of the oncologic emergencies,
the anticipation of loss and plans for end-of- the tumor lysis syndrome, is caused by the
life care, such as funerals. rapid destruction of large number of tumor
cells. . Intracellular contents are released,
22. Answer: B including potassium and purines, into the
Rationale: The client receiving chemotherapy bloodstream faster than the body can
is at risk for infection secondary to bone eliminate them. The purines are converted in
marrow suppression. A fever indicates the the liver to uric acid and released into the
possibility of an infection that could be life- blood causing hyperuricemia. They can
threatening, so she should notify her health precipitate in the kidneys and block the
care provider immediately. The client should tubules causing acute renal failure.
be taught to use birth control for at least 2
years after chemotherapy to prevent possible 28. Answer: B
birth defects and to pace herself and to allow
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Rationale: Assessing the client’s expectations reddish purple? 4) Diameter—A diameter
and doubts will help lessen her fears and exceeding 4–6 mm is considered suspicious.
anxieties. The nurse needs to encourage the
client to verbalize and to listen and correctly 35. Answer: B
provide explanations when needed. Rationale: This is the most commonly written
therapeutic communication goal. This
addresses the client’s concerns.
29. Answer: B
Rationale: A person grieves to a loss of a 36. Answer: A
significant object. The initial stage in the Rationale: The client should be aware of
grieving process is denial, then anger, symptoms that indicate development of
followed by bargaining, depression and last another skin cancer. Squamous cell
acceptance. The nurse should show carcinoma can develop
acceptance of the patient’s feelings and
encourage verbalization. 37. Answer: A
Rationale: This client has an unexpected
30. Answer: D situation occurring and should be assessed
Rationale: The client is showing signs of before any stable client.
anxiety reaction to a stressful event.
Recognizing the client’s anxiety conveys 38. Answer: C
acceptance of his behavior and will allow for Rationale: This is part of assessing the client
verbalization of feelings and concerns. and cannot be delegated.

31. Answer: C 39. Answer: D


Rationale: Patients with cancer and bone Rationale: Clients with very little melanin in
metastasis experience severe pain especially the skin (fair-skinned) have an increased risk
when moving. Bone tumors weaken the bone as a result of the UV damage to the
to appoint at which normal activities and underlying membranes. Damage to the
even position changes can lead to fracture. underlying membranes never completely
During nursing care, the patient needs to be reverses itself; a lifetime of damage causes
supported and handled gently. changes at the cellular level that can result in
the development of cancer.
32. Answer: C
Rationale: Pheochromocytoma is a tumor of
the adrenal medulla that causes an increase
secretion of catecholamines that can elevate 40. Answer: D
the blood pressure. Rationale: Sunscreen products range in
numerical value from 4 to 50; the higher the
33. Answer: A number of the sunscreen, the greater the UV
Rationale: Malignant melanomas are the most protection.
deadly of the skin cancers. Asymmetry,
irregular borders, variegated color, and rapid 41. Answer: C
growth are characteristic of them. Rationale: The American Cancer Society
recommends a monthly skin check using
34. Answer: B mirrors to identify any suspicious skin lesion
Rationale: This is part of assessing the lesion for early detection.
and should be completed. The ABCDs of skin
cancer detection include the following: 1) 42. Answer: C
Asymmetry—Is the lesion balanced on both Rationale: Pain is a physiological problem;
sides with an even surface? 2) Borders—are this is an appropriate physiological goal.
the borders rounded and smooth or notched
and indistinct? 3) Color—Is the color a uniform 43. Answer: D
light brown or is it variegated and darker or
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Rationale: On discharge, all clients should a feeding tube, without the client wishing to
receive instructions in the care of surgical eat is paternalism.
incisions.
51. Answer: C
44. Answer: D Rationale: This is an example of restating, a
Rationale: An ileal conduit is a procedure that therapeutic technique used to clarify the
diverts urine from the bladder and provides client’s feelings and encourage a discussion
an alternate cutaneous pathway for urine to of those feelings.
exit the body. Urinary output should always
be at least 30 mL per hour. This client should 52. Answer: A
be assessed to make sure that the stents Rationale: A continent urinary diversion is a
placed in the ureters have not become surgical procedure in which a reservoir is
dislodged or to ensure that edema of the created that will hold urine until the client can
ureters is not occurring. selfcatheterize the stoma. The nurse should
observe the client’s technique before
45. Answer: C discharge.
Rationale: Cigarette smoke contains more
than 400 chemicals, 17 of which are known to 53. Answer: A
cause cancer. The risk is directly proportional Rationale: Vinegar will act as a deodorizing
to the amount of smoking. agent in the pouch and help prevent a strong
urine smell.
46. Answer: B
Rationale: A urinary diversion procedure 54. Answer: D
involves the removal of the bladder. In a Rationale: The client is drawn up in a position
cutaneous procedure the ureters are that takes pressure off the abdomen; a rigid
implanted in some way to allow for stoma abdomen is an indicator of peritonitis, a
formation on the abdominal wall, and the medical emergency.
urine then drains into a pouch. There are
numerous methods used for creating the 55. Answer: A
stoma. Rationale: This client is asking for information
and should be given factual information. The
47. Answer: A surgery will not make the client sterile, but
Rationale: The client will have medication chemotherapy can induce menopause and
instilled in the bladder that must remain in radiation therapy to the pelvis can render a
the bladder for a prescribed length of time. client sterile.
For this reason, the client must remain NPO
before the procedure.
56. Answer: B
48. Answer: A Rationale: The testicular-self examination is
Rationale: Urine is acidic and the abdominal recommended monthly after a warm bath or
wall tissue is not designed to tolerate acidic shower when the scrotal skin is relaxed. The
environments. The stoma is pouched so that client should stand to examine the testicles.
urine will not touch the skin. Using both hands, with fingers under the
scrotum and thumbs on top, the client should
49. Answer: D gently roll the testicles, feeling for any lumps.
Rationale: It is in the scope of practice for the
LPN to care for this client. 57. Answer: C
Rationale: Risk factors for cervical cancer
50. Answer: B include human papillomavirus (HPV) infection,
Rationale: Paternalism is deciding for the active and passive cigarette smoking, certain
client what is best, such as a parent making high-risk sexual activities (first intercourse
decisions for a child. Feeding a client, as with before 17 years of age, multiple sex partners,
or male partners with multiple sex partners).
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Screening via regular gynecological exams
and Papanicolaou smear (Pap test) with 63. Answer: A
treatment of precancerous abnormalities Rationale: Hypercalcemia caused by bone
decrease the incidence and mortality of destruction is a priority concern in the client
cervical cancer. with multiple myeloma. The nurse should
administer fluids in adequate amounts to
58. Answer: D maintain a urine output of 1.5 to 2 L/day; this
Rationale: The breast self-examination should requires about 3 L of fluid intake per day. The
be performed monthly 7 days after the onset fluid is needed not only to dilute the calcium
of the menstrual period. Performing the overload but also to prevent protein from
examination weekly is not recommended. At precipitating in the renal tubules
the onset of menstruation and during
ovulation, hormonal changes occur that may 64. Answer: B
alter breast tissue. Rationale: Hodgkin's disease is a disorder of
young adults.
59. Answer: A
Rationale: The client is at risk of deep vein 65. Answer: A
thrombosis or thrombophlebitis after this Rationale: Alopecia is not an assessment
surgery, as for any other major surgery. For finding in testicular cancer.
this reason, the nurse implements measures Alopecia may occur, however, as a result of
that will prevent thiscomplication. Range-of- radiation or chemotherapy. Options 2, 3, and
motion exercises, antiembolism stockings, 4 are assessment findings in testicular
and pneumatic compression boots are cancer. Back pain may indicate metastasis to
helpful. The nurse should avoid using the the retroperitoneal lymph nodes.
knee gatch in the bed, which inhibits venous
return, thus placing the client more at risk for 66. Answer: C
deep vein thrombosis or thrombophlebitis. Rationale: In general, only the area in the
treatment field is affected by the radiation.
60. Answer: A Skin reactions, fatigue, nausea, and anorexia
Rationale: A biopsy is done to determine may occur with radiation to any site, whereas
whether a tumor is malignant or benign. other side effects occur only when specific
Magnetic resonance imaging, computed areas are involved in treatment. A client
tomography scan, and ultrasound will receiving radiation to the larynx is most likely
visualize the presence of a mass but will not to experience a sore throat.
confirm a diagnosis of malignancy.
67. Answer: B
61. Answer: D Rationale: The time that the nurse spends in
Rationale: Rationale: Multiple myeloma is a B- a room of a client with an internal radiation
cell neoplastic condition characterized by implant is 30 minutes per 8-hour shift. The
abnormal malignant proliferation of plasma dosimeter badge must be worn when in the
cells and the accumulation of mature plasma client's room. Children younger than 16 years
cells in the bone marrow. of age and pregnant women are not allowed
in the client's room.
62. Answer: A
Rationale: Findings indicative of multiple 68. Answer: A
myeloma are an increased number of plasma Rationale: The client with a cervical radiation
cells in the bone marrow, anemia, implant should be maintained on bed rest in
hypercalcemia caused by the release of the dorsal position to prevent movement of
calcium from the deteriorating bone tissue, the radiation source. The head of the bed is
and an elevated blood urea nitrogen level. An elevated to a maximum of 10 to 15 degrees
increased white blood cell count may or may for comfort. The nurse avoids turning the
not be present and is not related specifically client on the side. If turning is absolutely
to multiple myeloma. necessary, a pillow is placed between the
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knees and, with the body in straight and liver. Weight loss is most likely to be
alignment, the client is log rolled. noted. Fatigue and weakness may occur but
are not related significantly to the disease.
69. Answer: D
Rationale: A lead container and long-handled 74. Answer: D
forceps should be kept in the client's room at Rationale: Clinical manifestations of ovarian
all times during internal radiation therapy. If cancer include abdominal distention, urinary
the implant becomes dislodged, the nurse frequency and urgency, pleural effusion,
should pick up the implant with long-handled malnutrition, pain from pressure caused by
forceps and place it in the lead container. the growing tumor and the effects of urinary
or bowel obstruction, constipation,
70. Answer: C ascites with dyspnea, and ultimately general
Rationale: In the neutropenic client, severe pain. Abnormal bleeding, often
meticulous hand hygiene education is resulting in hypermenorrhea, is associated
implemented for the client, family, visitors, with uterine cancer.
and staff.
Not all visitors are restricted, but the client is 75. Answer: B
protected from persons with known Rationale: Hypercalcemia is a serum calcium
infections. Fluids should be encouraged. level higher than 10 mg/dL, most often occurs
Invasive measures such as an indwelling in clients who have bone metastasis, and is a
urinary catheter should be avoided to prevent late manifestation of extensive malignancy.
infections. The presence of cancer in the bone causes
the bone to release calcium into the
71. Answer: A bloodstream.
Rationale: Rationale: The client's self-report is
a critical component of pain assessment. The 76. Answer: D
nurse should ask the client about the Rationale: Testicular cancer almost always
description of the pain and listen carefully to occurs in only one testicle and is usually a
the client's words used to describe the pain. pea-sized painless lump. The cancer is highly
The nurse's impression of the client's pain is curable when found early. The finding should
not appropriate in determining the client's be reported to the physician.
level of pain. Nonverbal cues from the
clientare important but are not the most 77. Answer: C
appropriate pain assessment measure. Rationale: Denial, bargaining, anger,
Assessing pain relief is an important measure, depression, and acceptance are recognized
but this option is not related to the subject of stages that a person facing a life-threatening
the question. illness experiences. Bargaining identifies a
behavior in which the individual is willing to
72. Answer: A do anything to avoid loss or change prognosis
Rationale: Rationale: The client is kept NPO or fate. Denial is expressed as shock and
until peristalsis returns, usually in 4 to 6 days. disbelief and may be the first response to
When signs of bowel function return, clear hearing bad news. Depression may be
fluids are given to the client. If no distention manifested by hopelessness, weeping openly,
occurs, the diet is advanced as tolerated. The or remaining quiet or withdrawn.
most important assessment is to assess Anger also may be a first response to
bowel sounds before feeding the client. upsetting news and the predominant theme is
“why me?” or the blaming of others.
73. Answer: D
Rationale: Hodgkin's disease is a chronic 78. Answer: B
progressive neoplastic disorder of lymphoid Rationale: Arm edema on the operative side
tissue characterized by the painless (lymphedema) is a complication following
enlargement of lymph nodes with progression mastectomy and can occur immediately
to extralymphatic sites, such as the spleen
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postoperatively or may occur months or even
years after surgery. 84. Answer: D
Rationale: Following gastrectomy, drainage
from the nasogastric tube is normally bloody
79. Answer: B for 24 hours postoperatively, changes to
Rationale: The most common risk factor brown-tinged, and is then to yellow or clear.
associated with laryngeal cancer is cigarette Because bloody drainage is expected in the
smoking. Heavy alcohol use and the immediate postoperative period, the nurse
combined use of tobacco increase the risk. should continue to monitor the drainage. The
Another risk factor is exposure to nurse does not need to notify the physician at
environmental pollutants. this time. Measuring abdominal girth is
performed to detect the development of
80. Answer: B distention. Following gastrectomy, a
Rationale: A vesicovaginal fistula is a genital nasogastric tube should not be irrigated
fistula that occurs between the bladder and unless there are specific physician orders to
vagina. The fistula is an abnormal opening do so.
between these two body parts and, if this
occurs, the client may experience drainage of 85. Answer: A
urine through the vagina. Rationale: Colorectal cancer risk factors
include age older than 50 years, a family
81. Answer: D history of the disease, colorectal polyps, and
Rationale: Allopurinol decreases uric acid chronic inflammatory bowel disease.
production and reduces uric acid
concentrations in serum and urine. In the 86. Answer: C
client receiving chemotherapy, uric acid Rationale: To reduce the risk of contamination
levels increase as a result of the massive cell at the time of surgery, the bowel is emptied
destruction that occurs from the and cleansed. Laxatives and enemas are
chemotherapy. This medication prevents or given to empty the bowel. Intestinal anti-
treats hyperuricemia caused by infectives such as neomycin or kanamycin
chemotherapy. (Kantrex) are administered to decrease the
Allopurinol is not used to prevent alopecia, bacteria in the bowel.
nausea, or vomiting.
87. Answer: C
82. Answer: D Rationale: Immediately after surgery, profuse
Rationale: An acidic environment in the serosanguineous drainage from the perineal
mouth is favorable for bacterial growth, wound is expected. The nurse does not need
particularly in an area already compromised to notify the physician at this time. A Penrose
from chemotherapy. Therefore, the client is drain should not be clamped because this
advised to rinse the mouth before every meal action will cause the accumulation of
and at bedtime with a weak salt and sodium drainage within the tissue. Penrose drains and
bicarbonate mouth rinse. This lessens the packing are removed gradually over a period
growth of bacteria and limits plaque of 5 to 7 days as prescribed. The nurse should
formation. The other substances are irritating not remove the perineal packing.
to oral tissue. If hydrogen peroxide must be
used because of severe plaque, it should be a
weak solution because it dries the mucous 88. Answer: B
membranes. Rationale: Following abdominal perineal
resection, the nurse would expect the
83. Answer: B colostomy to begin to function within 72
Rationale: A high-fat diet plays a role in the hours after surgery, although it may take up
development of cancer of the pancreas. to 5 days. The nurse should assess for a
Options 1, 3, and 4 are risk factors related to return of peristalsis, listen for bowel sounds,
gastric cancer. and check for the passage of flatus. Absent
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bowel sounds would not indicate the return of frequency, urgency, and dysuria, and these
peristalsis. The client would remain NPO until symptoms often are associated with
bowel sounds return and the colostomy is carcinoma in situ.
functioning. Bloody drainage is not expected
from a colostomy. 95. Answer: C
Rationale: Normally, the medication is
89. Answer: C injected into the bladder through a urethral
Rationale: Air conditioners need to be avoided catheter, the catheter is clamped or removed,
to protect from excessive coldness. A and the client is asked to retain the fluid for 2
humidifier in the home should be used if hours. The client changes position every 15 to
excessive dryness is a problem. 30 minutes from side to side and from supine
. to prone or resumes all activity immediately.
90. Answer: A The client then voids and is instructed to
Rationale: Cytoreductive or “debulking” drink water to flush the bladder.
surgery may be used if a large tumor cannot
be completely removed as is often the case 96. Answer: D
with late-stage ovarian cancer (e.g., the Rationale: Following ureterostomy, the stoma
tumor is attached to a vital organ or spread should be red and moist. A pale stoma may
throughout the abdomen). When this occurs, indicate an inadequate amount of vascular
as much tumor as possible is removed and supply. A dry stoma may indicate a body fluid
adjuvant chemotherapy or radiation may be deficit. Any sign of darkness or duskiness in
prescribed. the stoma may indicate a loss of vascular
supply and must be reported immediately or
91. Answer: C necrosis can occur.
Rationale: Hormone therapy (androgen
deprivation) is a mode of treatment for
prostatic cancer. The goal is to limit the 97. Answer: B
amount of circulating androgens because Rationale: Following mastectomy, the arm
prostate cells depend on androgen for cellular should be elevated above the level of the
maintenance. Deprivation of androgen often heart. Simple arm exercises should be
can lead to regression of disease and encouraged.
improvement of symptoms. No blood pressure readings, injections,
intravenous lines, or blood draws should be
92. Answer: D performed on the affected arm. Cool
Rationale: Small pieces of tissue or blood compresses are not a suggested measure to
clots can be passed during urination for up to prevent lymphedema from occurring.
2 weeks after surgery. Driving a car and
sitting for long periods of time are restricted 98. Answer: C
for at least 3 weeks. A high daily fluid intake Rationale: Superior vena cava syndrome
should be maintained to limit clot formation occurs when the superior vena cava is
and prevent infection. Option 3 is an accurate compressed or obstructed by tumor growth.
discharge instruction following prostatectomy. Early signs and symptoms generally occur in
the morning and include edema of the face,
93. Answer: A especially around the eyes, and client
Rationale: The incidence of bladder cancer is complaints of tightness of a shirt or blouse
greater in men than in women and affects the collar. As the compression worsens, the client
white population twice as often as blacks. experiences edema of the hands and arms.
Mental status changes and cyanosis are late
94. Answer: B signs.
Rationale: The most common symptom in
clients with cancer of the bladder is 99. Answer: D
hematuria. The client also may experience Rationale: Rationale: Hypercalcemia is a late
irritative voiding symptoms such as manifestation of bone metastasis in late-
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stage cancer. Headache and dysphagia are increase potassium intake. The client would
not associated with not be instructed to alter sodium intake.
hypercalcemia. Constipation may occur early
in the process. Electrocardiogram changes 104. Answer: D
include shortened ST segment and a widened Rationale: Cardiotoxicity noted by abnormal
T wave. electrocardiographic findings or
cardiomyopathy manifested as congestive
100. Answer: C heart failure is a toxic effect of daunorubicin.
Rationale: During the period of greatest bone Bone marrow depression is also a toxic effect.
marrow suppression (the nadir), the platelet Nausea and vomiting is a frequent side effect
count may be low, less than 20,000 associated with the medication that begins a
cells/mm3. Aspirin and nonsteroidal anti- few hours after administration and lasts 24 to
inflammatory drugs and product that contain 48 hours. Fever is a frequent side effect and
aspirin should be avoided because of their diarrhea can occur occasionally.
antiplatelet activity, thus further teaching is
needed. 105. Answer: D
Rationale: To ensure that the client receives
101. Answer: C optimal doses of chemotherapy, dosing is
Rationale: Bleeding precautions need to be usually based on the total body surface area
initiated when the platelet count decreases. (BSA), which requires a current accurate
The normal platelet count is 150,000 to height and weight for BSA calculation (before
450,000/mm3. When the platelets are lower each medication administration). Asking the
than 50,000 /mm3, any small trauma can client about his or her height and weight may
lead to episodes of prolonged bleeding. The lead to inaccuracies in determining a true BSA
normal white blood cell count is 5,000 to and dosage. Calculating body mass index and
10,000/mm3. When the white blood cell count measuring abdominal girth will not provide
drops, neutropenic precautions need to be the data needed.
implemented. The normal clotting time is 8 to
15 minutes. The normal ammonia value is 15 106. Answer: D
to 45 mcg/dL. Rationale: Bleomycin (Blenoxane) is an
antineoplastic medication that can cause
102. Answer: C interstitial pneumonitis, which can progress to
Rationale: Hyperuricemia is especially pulmonary fibrosis. Pulmonary function
common following treatment for leukemias studies along with hematological, hepatic,
and lymphomas because chemotherapy and renal function tests need to be
results in massive cell kill. Although options 1, monitored. The nurse needs to monitor lung
2, and 4 also may be noted, an increased uric sounds for dyspnea and crackles, which
acid level is related specifically to cell indicate pulmonary toxicity. The medication
destruction. needs to be discontinued immediately if
pulmonary toxicity occurs.
103. Answer: B
Rationale: Hemorrhagic cystitis is a toxic 107. Answer: D
effect that can occur with the use of Rationale: Chemotherapy agents are usually
cyclophosphamide (Cytoxan, Neosar). The given in combinations (also called regimens
client needs to be instructed to drink copious or protocols). The goal of administering
amounts of fluid during the administration of combination chemotherapy in cycles or
this medication. Clients also should monitor specific sequences is to produce additive or
urine output for hematuria. The medication synergistic therapeutic effects. Administering
should be taken on an empty stomach, unless combination therapy by administering several
gastrointestinal upset occurs. Hyperkalemia medications with different mechanisms of
can result from the use of the medication; action and differents onsets of nadirs and
therefore, the client would not be told to toxicities enhances tumor cell destruction
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while minimizing medication resistance and
overlapping toxicities. 112. Answer: A
Rationale: Asparaginase (Elspar) is
108. Answer: C contraindicated if hypersensitivity exists, in
Rationale: Because antineoplastic pancreatitis, or if the client has a history of
medications lower the resistance of the body, pancreatitis. The medication impairs
clients must be informed not to receive pancreatic function and pancreatic function
immunizations without a physician's or health tests should be performed before therapy
care provider's approval. Clients also need to begins and when a week or more has elapsed
avoid contact with individuals who have between administration of the doses. The
recently received a live virus vaccine. Clients client needs to be monitored for signs of
need to avoid aspirin and aspirin-containing pancreatitis, which include nausea, vomiting,
products to minimize the risk of bleeding, and and abdominal pain.
they need to avoid alcohol to minimize the
risk of toxicity and side effects. 113. Answer: D
Rationale: Tamoxifen (Nolvadex) is an
109. Answer: C antineoplastic medication that competes with
Rationale: Cisplatin (Platinol) is an alkylating estradiol for binding to estrogen in tissues
type of medication and vincristine (Oncovin, containing high concentrations of receptors.
Vincasar PFS) is a vinca (plant) alkaloid. Tamoxifen is used to treat metastatic breast
Alkylating medications are cell cycle phase- carcinoma in women and men. Tamoxifen is
nonspecific. Vinca alkaloids are cell cycle also effective in delaying the recurrence of
phase-specific and act on the M phase. cancer following mastectomy. Tamoxifen
Combinations of medications are used to reduces DNA synthesis and estrogen
enhance tumoricidal effects and increase the response.
therapeutic response.
114. Answer: B
110. Answer: A Rationale: Tamoxifen (Nolvadex) may
Rationale: High concentrations of increase calcium, cholesterol, and triglyceride
methotrexate harm and damage normal cells. levels. Before the initiation of therapy, a
To save normal cells, leucovorin is given, complete blood count, platelet count, and
which is known as leucovorin rescue. serum calcium levels should be assessed.
Leucovorin bypasses the metabolic block These blood levels, along with cholesterol and
caused by methotrexate, thereby permitting triglyceride levels, should be monitored
normal cells to synthesize. Note that periodically during therapy. The nurse should
leucovorin rescue is potentially hazardous. assess for hypercalcemia while the client is
Failure to administer leucovorin in the right taking this medication. Signs of
dose at the right time can be fatal. hypercalcemia include increased urine
volume, excessive thirst, nausea, vomiting,
111. Answer: D constipation, hypotonicity of muscles, deep
Rationale: A side effect specific to vincristine bone, and flank pain.
is peripheral neuropathy, which occurs in
almost every client. Peripheral neuropathy 115. Answer: C
can be manifested as numbness and tingling Rationale: Megestrol acetate (Megace)
in the fingers and toes. Depression of the suppresses the release of luteinizing hormone
Achilles tendon reflex may be the first clinical from the anterior pituitary by inhibiting
sign indicating peripheral neuropathy. pituitary function and regressing tumor size.
Constipation rather than diarrhea is most Megestrol is used with caution if the client has
likely to occur with this medication, although a history of thrombophlebitis.
diarrhea may occur occasionally. Hair loss
occurs with nearly all the antineoplastic 116. Answer: D
medications. Chest pain is unrelated to this Rationale: Alopecia (hair loss) can occur
medication. following the administration of many
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antineoplastic medications. Alopecia is This promotes optimal drainage from the
reversible, but new hair growth may have a limb, without impairing the circulation to the
different color and texture. arm.

117. Answer: A 122. Answer: B


Rationale: Stomatitis (ulceration in the Rationale: Radiation therapy is usually
mouth) can result from the administration of delayed until a child is 8 years of age,
antineoplastic medications. The client should whenever possible, to prevent retardation of
be instructed to examine her or his mouth bone growth and soft tissue development.
daily and to report any signs of ulceration. If
stomatitis occurs, the client should be 123. Answer: C
instructed to rinse the mouth with baking Rationale: The client needs to be instructed
soda or saline. Food and fluid is important to avoid exposure to the sun the sun. Other
and should not be restricted. If chewing and options are accurate measures in the care of
swallowing are painful, the client may switch a client receiving external radiation therapy.
to a liquid diet that includes milk shakes and
ice cream. Instruct the client to avoid spicy 124. Answer: A
foods and foods with hard crusts or edges. Rationale: Following amputation, phantom
The client should avoid limb pain is a temporary condition that some
toothbrushing and flossing when stomatitis is children may experience. This sensation of
severe. Lemon and glycerin swabs may cause burning, aching, or cramping in the missing
pain and further irritation. limb is most distressing to the child. The child
needs to be reassured that the condition is
118. Answer: C normal and only temporary.
Rationale: Busulfan (Myleran, Busufex) can
cause an increase in the uric acid level. 125. Answer: D
Hyperuricemia can produce uric acid Rationale: Unless the antibiotic is safe for the
nephropathy, renal stones, and acute renal infant, it is best not to feed the baby, but in
failure. order to continue establishment of milk flow,
the breasts must be stimulated.
119. Answer: D
Rationale: A side effect specific to etoposide 126. Answer: A
is orthostatic hypotension. Etoposide should Rationale: Surgical incisions, and small
be administered slowly over 30 to 60 minutes sutured incisions usually heal by what is
to avoid hypotension. The client's blood called Primary Intention. In surgical incisions
pressure is monitored during the infusion. and the like where the edges of the wound
Hair loss occurs with nearly all the can be approximated, healing takes place in
antineoplastic medications. Chest pain and this way. In larger wounds, when the edges
pulmonary fibrosis are unrelated to this cannot be approximated Secondary Intention
medication. is the usual manner of healing, the Tertiary
intention occurs when there is an extended
120. Answer: C period of time between the wound and when
Rationale: Male and female clients who take it is sutured.
estrogen or progestins are at increased risk
for deep vein thrombosis (DVT). Women 127. Answer: C
receiving estrogens or progestins have Rationale: The epithelial cells in the mouth
irregular but heavy menses, fluid retention, are very sensitive to chemotherapy due to
and breast tenderness. their high rate of cell turnover.

121. Answer: B 128. Answer: C


Rationale: The client's operative arm should Rationale: Glucocorticoids (steroids) are used
be positioned so that it is elevated on a for their anti-inflammatory action, which
pillow, and not exceeding shoulder elevation. decreases the development of edema.
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the stage of cancer, and the pain tolerance of
129. Answer: B the individual.
Rationale: High-fiber diets are recommended
to reduce the risk of colon cancer, because 138. Answer: D
fiber promotes bile excretion and speeds up Rationale: This statement is most
intestinal transit time so that carcinogens are therapeutic, as it allows the client to ventilate
eliminated quicker. her feelings. The ability of the nurse to be
present with the client during this difficult
130. Answer: B time demonstrates caring for the client. The
Rationale: There is potential for a lowered other statements may offer false hope and do
pain tolerance to exist with diminished not give the client the opportunity to share
adaptative capacity. her feelings.

131. Answer: B 139. Answer: A


Rationale: Using a narcotic with a non- Rationale: Certain types of HPV infection may
narcotic treats both central and peripheral predispose a woman to developing cervical
pain. cancer later in life. The other cancers do not
have a direct link to HPV infection.
132. Answer: D
Rationale: Injectables act more quickly than 140. Answer: A
other routes and can relieve severe acute Rationale: A client who has been treated for
pain in one hour. uterine cancer with internal radiation therapy
may later develop cystitis. The other options
133. Answer: B are not associated with internal radiation
Rationale: Antidepressants are useful therapy.
adjuncts to analgesia in the management of
cancer pain. The antidepressant potentiates 141. Answer: D
or enhances the analgesics medication. Rationale: Pathologic fractures are not
common to the disease process or its
134. Answer: B treatment, although osteoporosis may be
Rationale: Radiation therapy is a palliative potential complication of steroid use;
treatment to relieve pain quickly, and Hodgkin’s disease most commonly affects
treatment is tailored to the patient’s clinical young adults (males) and is spread through
condition and prognosis (duration of life). lymphatic channels to contiguous nodes. It
also may spread via hematogenous route to
135. Answer: D extradal sites (GI, bone marrow, skin, and
Rationale: Both radiation therapy and other organs); a working “staging”
analgesic drug therapies can be used classification is done for clinical use and care.
together to enhance the effectiveness as they
directly target the cause of pain. 142. Answer: A
Rationale: C: Change in bowel or bladder
136. Answer: A habits; A: A sore that does not heal; U:
Rationale: The needs of the individual and the Unusual bleeding or discharge from anybody
type of procedure to be done shape the orifice; T: Thickening or a lump in the breast
pharmacological approach to managing or elsewhere; I: Indigestion or difficulty
procedure-related pain. Because children swallowing; O: Obvious change in a wart or
have special needs, the nurse’s expertise and mole; N: Nagging cough or hoarseness. The
experience with children are key to successful other options are not mnemonics relating to
therapy. cancer.

137. Answer: C 143. Answer: D


Rationale: Most cancer publications state the
pain aspect as falling into the type of cancer,
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Rationale: Cancer cells are characterized by
indiscriminate proliferation, not the other 149. Answer: D
options. Rationale: Testicular exams should be
performed after a warm shower or bath to
144. Answer: B relax the scrotum. Testicular exams should be
Rationale: An osteoma is a tumor on bone done by all men beginning at age 15 on a
tissue. The other options are other types of monthly basis. Reddening or darkening of the
tumors. scrotum is not normal finding and should be
reported to a physician.
145. Answer: B
Rationale: False reassurance that everything 150. Answer: C
will be all right is inappropriate. It is a block to Rationale: Colon tumors tend to spread
therapeutic communication and it discounts through the lymphatics and portal vein to the
the client’s feelings. The client should liver. Although metastasis to the other sites
understand the extent of surgery and type listed is possible, the liver is most likely the
and care of the ostomy. Although a cheerful, first to be affected.
optimistic environment is important, it is
essential that the client understand the 151. Answer: B
proposed surgical treatment. Visitors should Rationale: Many women with cervical cancer
not be restricted. Family and friends can fear a loss of femininity. It is important to
provide valuable social support to the client. discuss the effects of treatment to enable the
client to prepare for changes in sexual
146. Answer: D functioning. Although telling the client that
Rationale: Epithelial cells are extremely she does not have to worry about pregnancy
sensitive to radiation therapy, because of is accurate, it is not a therapeutic response.
their normally high rate of cell turnover. The Nurses are capable of answering questions
client deserves an honest, supportive answer. regarding sexuality. The client will need to be
referred to other resources if the client’s
147. Answer: A concerns cannot be addressed by the nurse;
Rationale: Bland foods of moderate the physician should be notified of the client’s
temperature facilitate swallowing and concerns, but not necessarily as a referral.
decrease pain. Fluids should be encouraged
to keep oral membranes moist and to 152. Answer: D
decrease side effects of chemotherapy. Rationale: The majority of side effects of
Commercial mouthwashes should be avoided external radiation are dependent on the
because of their alcohol content. The mouth specific site being radiated. Because the
should be rinsed with dilute H2O2 or normal client’s cancer site is the lung, radiation will
saline solution. Lemon-glycerin swabs should result in irritation of the lung mucosa,
be avoided to prevent excessive drying of the resulting in dyspnea.
oral mucosa.
153. Answer: B
148. Answer: B Rationale: It is important to understand the
Rationale: 5-Fluorouracil (5-FU) is an difference between external and internal
antineoplastic, antimetabolic drug that radiation so that the nurse can be accurate
inhibits DNA synthesis and interferes with cell when correcting the client’s misconceptions.
replication. It is given intravenously and acts He is not radioactive and does not need to
systemically. It affects all rapidly growing limit contact with others.
cells, both malignant and normal. It is used as
adjunct therapy for treating cancer of the 154. Answer: D
colon, rectum, stomach, breast, and Rationale: The two chief symptoms of cancer
pancreas. This drug has many side effects, of the cervix are metrorrhagia (vaginal
including bone marrow depression, anorexia, bleeding or spotting at irregular intervals and
stomatitis, and nausea and vomiting.
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between periods) and a watery vaginal 161. Answer: D
discharge. Rationale: Myelosuppression describes a
deficit of cells produced by the bone marrow:
155. Answer: D RBC, WBC, and platelets.
Rationale: Cancer of the endometrium tends The patient will have increased risk for
to be slow spreading. After it has spread to bleeding, infections, and anemia. There will
the cervix, invaded the myometrium, or be difficulty healing with myelosuppression
spread outside the uterus, the prognosis is
poor. 162. Answer: C
Rationale: Antimetabolites are structural
156. Answer: B analogues of folic acid, purine, or pyrimidine
Rationale: Menstruation will cease after a bases found in DNA. They inhibit cell growth
hysterectomy, but as long as the ovaries are and proliferation by inhibiting enzymes
left in place, they will continue to function, required for DNA base synthesis. This limits
and surgical menopause will not occur. A the chemical and physical processes of the
hysterectomy is removal of the uterus and cell. Antimetobolites do not promote cell
usually the cervix. growth. Antimetabolites do not destroy the
bone marrow. Antimetabolites may have
some limitation on cancer metastasis but it is
an indirect effect caused by inhibition of cell
157. Answer: C growth and proliferation.
Rationale: Lung cancer is a malignant tumor
of lung tissue. Causes are cigarette smoking, 163. Answer: B
air pollution, arsenic, asbestos, and Rationale: The active ingredient in this agent
radioactive dust. Cancer of the lungs can be is Δ9 -tetrahydrocannabinol or THC. THC
diagnosed with chest radiography, modulates the activity of acetylcholine,
bronchoscopy, tissue biopsy, or dopamine, and serotonin. Dopamine and
mediastinoseph. serotonin activate the chemoreceptor trigger
zone which activates the vomiting center in
158. Answer: C the medulla. Dronabinol can induce mild
Rationale: It is not necessary because it will stimulation followed by depression.
not affect the risk of hemorrhage. Dronabinol has no pain relief properties.
Dronabinol does not reduce or treat
159. Answer: B inflammation of the oral mucosa.
Rationale: When chemotherapy is initiated,
there is a breakdown of many cancer cells. 164. Answer: B
Uric acid is a cell metabolite. Rationale: Small-cell lung cancer has a poor
prognosis because it is rarely diagnosed in a
160. Answer: B limited and localized state. Even with
Rationale: One of the two indicators that the treatment the client has only a 20 percent
goal for implementing new coping patterns chance for 2-year survival. At advanced
has been met is a willingness and ability to stages most clients die within 6 months. The
resume self-care responsibilities. Statement 2 5-year survival rate depends on the type of
shows that the client is taking care of their lung cancer (non-small-cell cancer has a
wig, a new self-care responsibility. Statement somewhat better 5-year survival rate) and
1 shows denial that there has been hair loss stage (cancer is easier to treat in an earlier
and inappropriate self-care goals exist. stage when the cancer is localized). Usually
Statements 3 and 4 also deny hair loss. The by the time a lung tumor is detected on x-ray,
statements denying hair loss are evidence of about 75 percent of the disease course has
the minor defining characteristics of body elapsed. Eighty-seven percent of lung cancer
image disturbance still existing and the goal clients die within 5 years.
not being met.
165. Answer: D
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Rationale: Dry desquamation of the skin; Rationale: Sputum samples should be
external radiation therapy side effects are: collected early in the morning before the
nausea, fatigue, malaise, skin irritation, wet client eats or drinks. The client is not required
desquamation, diarrhea.. to be NPO for 24 hours before the procedure.
The client needs to be well hydrated to
166. Answer: C facilitate coughing up tenacious secretions.
Rationale: Skin markings over the treatment Using toothpaste or mouthwash should be
area should not be washed off for the avoided because they can affect the sample.
duration of the therapy unless special The sample should be coughed up from deep
permission is given because they are within the lungs. Saliva should not be
important reference marks for the radiation collected.
beams. The area should be left open to air,
but sunlight should be avoided. The skin 172. Answer: B
should not be massaged, and lotions, Rationale: The extended family is considered
cosmetics, and powder should not be applied. a source of strength, support, and emotional
These interventions will reduce the problems stability for the Mexican- American family.
associated with dry desquamation of the skin. Alternative healers and specific foods also
may be important to the state of health.
167. Answer: D
Rationale: Verbalizing concerns elicits 173. Answer: C
information about the disease, giving the Rationale: The nurse advocate will explore
patient a sense of control and helps the the patient’s decision with him, support his
patient face the unknown. decision-making authority, and encourage a
discussion between the patient and his
168. Answer: C daughter regarding his wishes in order for
Rationale: One of the earliest side-effects of these wishes to be honored.
chemotherapy is stomatitis.
174. Answer: D
169. Answer: C Rationale: In exploring options for assistance
Rationale: Ideally, a cancer cure will be to the family from the available community
elicited. If no cure is possible, cancer health services, the nurse is facilitating the
palliation prolongs useful life and reduces family’s caregiving and assisting them in
incapacitating symptoms. Limiting toxic meeting the patient’s needs at home. As
chemotherapy side effects is a secondary terminal illness has not been established,
goal of treatment. Early recognition and hospice is not yet an appropriate option.
treatment of cancer enhances the cure rate. A Institutionalized care may be needed later,
cure is part of the main goal of therapy. A but for now the family should be assisted in
suitable quality of life is part of the main goal their desire to care for the patient at home.
of cancer chemotherapy and is related to
palliation. 175. Answer: D
Rationale: Debulking of a tumor is done to
170. Answer: B decrease the symptoms of the disease or is
Rationale: Radiation therapy—clients can known as palliative surgery. It does not affect
receive external-beam radiation therapy a cure.
(EBRT), or internal radiation therapy
(brachytherapy) with implanted isotopes; it 176. Answer: D
damages rapidly replicating local normal host Rationale: Mammography is suggested for
cells along with cancerous cells; it is used to every female over age 50 or greater as a
treat tumors that cannot be surgically primary preventative measure.
removed and are sensitive to radiation
exposure. 177. Answer: B
Rationale: The “Patient’s Bill of Rights”
171. Answer: B describes the right of the patient to refuse to
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participate in research without the fear of loss or an unexplained, significant weight loss in
of care by the healthcare team. He will still be clients with a diagnosis of AIDS.
cared for by physicians and nurses on the
team, and other treatment options may be
offered. The costs of research are commonly 180. Answer: D
at least partially paid by the research study. Rationale: Elemental zinc taken with food or
milk will help correct alterations in taste
178. Answer: C (dysgeuisa); Dygeusia— impairment or
Rationale: Cancer cachexia is a syndrome perversion of the gustatory sense so that
that occurs in clients with cancer normal tastes are interpreted as being
(malignancy) that leads to a loss of muscle, unpleasant or completely different from the
fat, and body weight. It is thought to occur characteristic taste of a particular food or
due to tumor-induced changes that cause chemical compound; associated nutritional
profound effects on metabolism, nutrient problems—clients receiving radiation therapy
losses, and anorexia. A cycle of wasting is are at risk to develop muscositis of the oral
established because alterations in nutrient cavity, xerostomia, nausea and vomiting,
requirements and intake lead to high cell diarrhea, dental caries, esophagitis,
turnover in body organs, affecting the GI tract dysphagia, and anorexia; clients receiving
and bone marrow. Alterations in digestion chemotherapy are at risk to develop anorexia,
occur along with decreased immune nausea and vomiting, altered elimination
response; in simple starvation the body pattern (diarrhea or constipation), mucositis,
adapts to a lower metabolic rate. The and altered liver function (jaundice) as a
metabolic rate can be normal, decreased, or consequence of impaired drug clearance;
increased; cachexia occurs in the presence of associated weight loss and accompanying
both chemotherapy and radiation; cancer malnutrition correlate with impaired immunity
cachexia can be seen in clients who have and affect response to therapy and survival.
adequate caloric intake because it is not
calorie dependent; cachexia—general ill 181. Answer: C
health and malnutrition, marked by weakness Rationale: Home care alone without a
and emaciation, usually associated with caregiver in a patient requiring ADL
serious disease as cancer. assistance may not be sufficient to maintain
function and safety. Adult day care provides
179. Answer: B care for a limited time period daily and so
Rationale: Megesterol acetate (Megace) is would not meet the patient’s need for full
oral progesterone that is used for both male time caregiver assistance. Respite care is
and female clients to boost appetite and short-term care while caregivers rest, and so
promote weight gain. It is important that all is not a long-term option for the patient. The
clients receive accurate information about most appropriate referral choice for
prescribed medications and are aware of the suggestion is therefore long term care with
indication for the drug, potential side effects, the option of hospice services in the facility.
and expected response to treatment. The
nurse should respond to the client’s concern 182. Answer: B
initially with factual information because the Rationale: An antitussive stops coughing.
client does not seem to understand the effect Antitussives are used for nonproductive
of the medication; Megace has an coughs and to prevent exhaustion from
antineoplastic activity due to suppression of coughing. Antitussives are not typically used
gonadotropine (Antiluteinizing effect); the for productive coughs because the secretions
appetite-enhancing properties (mechanism need to be raised.
unknown); pulliative treatment of advanced Secretions that are not raised will be pulled
endometrial or breast cancer (not used in by gravity deep into the lung where the
place of chemotherapy, radiation, or surgery); warm, dark, moist environment is supportive
use for the treatment of anorexia, cachexia, of bacterial growth. Antitussives do not
relieve dyspnea. Antitussives do not increase
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expectoration rather they decrease it because 187. Answer: B
they suppress coughing. Rationale: The most rapidly spread oral
Wheezes and gurgles are caused by narrowed cancer is not cancer of the floor of the mouth
airways and presence of secretions. Since but the cancer of the tongue because of its
antitussives do not act on either of these rich blood and lymph supply.
problems, their decrease is not reflective of
the desired effect of an antitussive. 188. Answer: A
Rationale: Postmenopausal bleeding is the
183. Answer: A primary symptom of endometrial cancer.
Rationale: Escalating back pain with or Persistent leukorrhea occurs with a variety of
without bladder symptoms, worse on lying vaginal and cervical infections. Painful
down and improved on standing is the intercourse
warning sign of impending spinal cord (dyspareunia) occurs with uterine prolapse.
compression. Sudden loss of sensation and Amenorrhea has a variety of causes. The
motor function in the lower extremities occurs most frequent is pregnancy but endocrine
with compression. Loss of bowel or bladder disturbances, poor diet, excessive exercise,
control may or may not occur. emotional shock, change in climate, etc., are
other causes.
184. Answer: B
Rationale: A brief tingling pain is felt with 189. Answer: C
cryosurgery. An unpleasant odor can occur Rationale: Leakage of fecal matter from the
when electrocautery is used to burn abnormal vagina is a sign of rectovaginal fistula.
tissue as in cases of cervical dysplasia or
genital warts. 190. Answer: A
Rationale: Ascites develops late in the course
185. Answer: D of ovarian cancer. Another sign of advanced
Rationale: Tobacco smoking has been shown ovarian cancer is pleural effusion, which is
to be related to the development of all types common with metastases to the lung.
of lung cancer, not just certain types. Second- Purpura, splenomegaly, and hypoactive DTRs
hand smoke is also a risk factor as is are not related symptoms.
exposure to chemicals including asbestos,
uranium, and radon but they do not account 191. Answer: D
for more cases of lung cancer than tobacco Rationale: Tamoxifen is adjuvant therapy for
use. early stage ER—positive breast cancer.
Tamoxifen is an estrogen antagonist that
186. Answer: D blocks the ER sites on the tumor cells thus
Rationale: A symptom of right-sided cancer blocking tumor growth. It decreases the risk
of the colon is mahoganycolored stool due to of metastasis or prolongs survival once
the presence of blood from the tumor being metastasis occurs.
mixed with the stool and exposed to digestive
tract secretions as it progresses through the 192. Answer: D
remaining colon. Rationale: Diagnosis of cancer can only be
Black, tarry stools are indicative of blood from confirmed by microscopic examination of
the upper GI tract which has been in the GI tissue. PSA is used for screening for prostate
tract long enough to be completely digested. cancer but elevated levels (over 4 ng/ml) can
Loose, frothy stool is indicative of high fat be due to a variety of factors including benign
content and is associated with malabsorptive prostatic hypertrophy and prostatitis; they are
disorders. not specific to prostate cancer. Ultrasound of
Flat, ribbon-shaped stool is consistent with a the prostate is used for follow- up when PSA
tumor which alters the shape of the left colon levels are suspicious but its effectiveness is
and prevents formation and passage of controversial. Alkaline phosphatase is an
normally formed stool. enzyme whose serum level is elevated in
hepatobiliary and bone disease.
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depends on the port. This is different from
193. Answer: D chemotherapy, which is administered
Rationale: Lupron is a gonadotropin-releasing systemically. Acute skin reactions consist of
hormone agonist analog (GnRH), which erythema which increases over 2–3 weeks
suppresses pituitary release of LH and and then either fades or progresses to dry or
reduces serum testosterone levels. Since moist desquamation. Areas of poor bloodflow
prostatic cancers require testosterone, are less well-oxygenated and hypoxic tissues
reducing testosterone levels causes tumors to are resistant to radiation not at greater risk
regress. Because the concentration of PSA in for injury.
the blood is proportional to the total prostatic
mass as the tumor regresses, PSA level drops. 197. Answer: B
If a client has pain from metastases and these Rationale: To limit exposure to specific
shrink in response to Lupron, pain can be individuals, care of clients undergoing
relieved. However, this is not the best brachytherapy should be rotated among staff
measure of Lupron’s effectiveness since not members with the exception of those who are
all tumors are necessarily causing pain. pregnant because of the risk of damage to
Vomiting is not common with prostate cancer the developing fetus. Male gender or cancer
and hematuria is a late sign. Concentration of history is not considered influencing factors.
PSA in the blood is proportional to the total Assigning the same nurses would support
prostatic mass. consistency and efficiency of care but these
benefits do not outweigh the risk of exposure.
194. Answer: A
Rationale: Ovarian cancer can present in 198. Answer: A
young women with pain similar to that of Rationale: Radiation therapy exerts its
appendicitis. If pain accompanies constipation greatest effect on well-oxygenated, actively
it is usually crampy pain or a sense of rectal dividing cells. As a result, bone-marrow cells
discomfort. are almost always affected. The hip and long
Urinary tract infection causes burning on bones of the leg contain large amounts of
urination or suprapubic discomfort from the bone marrow so effects on the blood from
bladder. radiation to these areas do occur. The effect
on the blood occurs because the active cells
195. Answer: D in the bone marrow are affected, not because
Rationale: Some effect on bone marrow of any sensitizing drug.
occurs with almost all radiation therapy
regardless of port. Bone-marrow suppression 199. Answer: A
becomes a significant problem when RBC and Rationale: Any temperature over 101 F is
WBC counts and platelet count drop below considered a sign of infection and needs to be
critical levels. This drop is seen in laboratory reported right away. Clients having radiation
values and can result in the development of therapy are immunosuppressed because of
anemia, infection, or bleeding. Therefore, the effect of the radiation on the bone
normal laboratory values and the absence of marrow and so infection poses a particular
signs/symptoms of anemia, infection, and risk for this population.
bleeding indicate that bone-marrow
suppression is not a problem at this time. 200. Answer: B
Rationale: Nausea and vomiting typically
196. Answer: D peak in the first 12 hours so in this case the
Rationale: Skin fold areas are at particular nausea and vomiting should begin to subside
risk for developing a reaction to radiation after 8 p.m. The degree of nausea and
therapy. vomiting can vary from person to person and
It is important to keep these areas clean, dry, with different types of chemotherapy but
and free of irritation to help decrease the risk. broad patterns are evident; it is not totally
Changes in oral mucous membranes do not unpredictable. Going to bed does not ease
always occur with radiation therapy; it
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nausea and vomiting and its absolute
duration is not known.