1.

The nurse is preparing an educational program on breast cancer for women at an African
American community center. What information is important for the nurse to consider for the
discussion?
■ African American women have the lowest rate of breast cancer.
■ Most African American women are diagnosed early in the disease process.
■ Breast cancer concerns vary between socioeconomic levels of African American women.
■ African American women believe breast cancer is inevitable.

2. Which of the following clients is at highest risk for colorectal cancer?

■ The client who smokes.
■ The client who eats a vegetarian diet.
■ The client who has been treated for Crohn’s disease for 20 years.
■ The client who has a family history of lung cancer.

3. A 21-year-old client undergoes bone marrow aspiration at the clinic to establish a diagnosis of
possible lymphoma. Which statement made by the client demonstrates proper understanding of
discharge teaching? Select all that apply.
■ “I will take Tylenol for pain.”
■ “I do not need to inspect the puncture site.”
■ “I will not be able to play basketball for the next 2 days.”
■ “I will take aspirin if I have pain.”
■ “I can apply an ice pack or a cold compress to the puncture site.”

4. A nurse is conducting a cancer risk screening program. Which of the following clients is at greatest
risk for skin cancer?
■ 45-year-old physician.
■ 15-year-old high school student.
■ 30-year-old butcher.
■ 60-year-old mountain biker.

5. A client diagnosed with testicular cancer expresses concerns about fertility. The couple
desires to eventually have a family and the nurse discusses the option of sperm banking. The nurse
should inform the couple that sperm banking would need to be performed:
■ Before treatment is started.
■ Once the client is tolerating the treatment.
■ Upon completion of treatment.
■ When tumor markers drop to normal levels.

6. Carcinogenesis is irreversible in which of the following stages?

■ Progression stage.
■ Promotion stage.
■ Initiation stage.
■ Regression stage.

7. Cancer prevalence is defi ned as:

■ The likelihood cancer will occur in a lifetime.
■ The number of persons with cancer at a given point in time.
■ The number of new cancers in a year.
■ All cancer cases more than 5 years old

8. Which of the following groups would benefi t most from education regarding potential risk factors
for melanoma?
■ Adults older than age 35.
■ Senior citizens who have been repeatedly exposed to the effects of ultraviolet A and ultraviolet B
rays.
■ Parents with children.
■ Employees of a chemical factory.

9. A nurse is providing education in a community setting about general measures to avoid excessive
sun exposure. Which of the following recommendations is appropriate?
■ Apply sunscreen only after going into the water.
■ Avoid peak exposure hours from 9 a.m. to 1 p.m.
■ Wear loosely woven clothing for added ventilation.
■ Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure.

10. A 29-year-old woman is concerned about her personal risk factors for malignant melanoma. She
is upset because her 49-year-old sister was recently diagnosed with the disease. After gatherin g
information about the client’s history of sun exposure, the nurse’s best response would be to
explain that:
■ Some melanomas have a familial component and she should seek medical advice.
■ Her personal risk is low because most melanomas occur at age 60 or later.
■ Her personal risk is low because melanoma does not have a familial component.
■She should not worry because she did not experience severe sunburn as a child.

12. A 17-year-old, sexually active female client is seen in the family planning clinic and requests
hormonal contraceptives. Before examination, the nurse should explain the importance of regular
Papanicolaou (Pap) smears. This recommendation is based on the current screening guidelines of the
American Cancer Society for Pap smears, which state that:
■ Pap smears are recommended every other year.
■ If four consecutive annual Pap smears are negative, the client should schedule repeat Pap smears
every 3 years.
■ The initial Pap smear should be done at age 21 or earlier if the woman is sexually active.
■ If four consecutive smears are negative, the client should request a colposcopy.

13. A client with a family history of cancer asks the nurse what the single most important risk factor
is for cancer. Which of the following risk factors should the nurse discuss?
■ Family history.
■ Lifestyle choices.
■ Age.
■ Menopause or hormonal events.
14. Experimental and epidemiologic evidence suggests that a high-fat diet increases the risk of
several cancers. Which of the following cancers is linked to a high-fat diet?
■ Ovarian.
■ Lung.
■ Colon.
■ Liver.
15. A 42-year-old female highway construction worker is concerned about her cancer risks. She
reveals that she has been married for 18 years, has two children, smokes one pack of cigarettes per
day, and drinks one to two beers with her husband after work almost every day. She is 30 lb
overweight, eats fast food often, and rarely eats fresh fruits and vegetables. Her mother was
diagnosed with breast cancer 2 years ago. Her father and an aunt both died of lung
cancer. She had a basal cell carcinoma removed from her cheek 3 years earlier. What combination
of behavioral changes should the nurse instruct this client to make first?
■ Decrease fat in the diet, decrease alcohol consumption, and use sunscreen every day.
■ Decrease intake of salt-cured food, lose weight, and stop smoking.
■ Stop drinking beer, decrease fi ber in the diet, and use sun protection.
■ Stop smoking, use sun protection, and lose weigh

16. The incidence and risk of cancer increase when smoking is combined with:
■ Asbestos exposure and alcohol consumption.
■ Ultraviolet radiation exposure and alcohol consumption.
■ Asbestos exposure and ultraviolet radiation exposure.
■ Alcohol consumption and human papillomavirus (HPV) infection.

17. The nurse is assessing a 60-year-old male who has hoarseness. The nurse should conduct a
focused assessment to determine:
■ Patterns of medication use and history of alcohol consumption.
■ Exposure to sun and family history of head and neck cancers.
■ Exposure to wood dust and a high-fat diet.
■ History of tobacco use and alcohol consumption.

18. A 42-year-old female is interested in making dietary changes to reduce her risk of colon cancer.
What dietary selections should the nurse suggest?
■ Croissant, granola and peanut butter squares, whole milk.
■ Bran muffin, skim milk, stir-fried broccoli.
■ Granola, bagel with cream cheese, cauliflower salad.
■ Oatmeal, raisin cookies, baked potato with sour cream, turkey sandwich.

19. Which of the following is an environmental factor that increases the risk of cancer?
■ Gender.
■ Nutrition.
■ Immunologic status.
■ Age.
20. A client at risk for lung cancer asks why he is scheduled for a computed tomography (CT) scan as
part of his initial workup. The nurse’s best response is which of the following?
■ “CT is far superior to magnetic resonance imaging for evaluating lymph node metastasis.”
■ “CT is noninvasive and readily available.”
■ “CT is useful for distinguishing small differences in tissue density and detecting nodal involvement.”
■ “CT can distinguish a malignant from a nonmalignant adenopathy.”

21. Lifestyle influences that are considered risk factors for colorectal cancer include:
■ A diet low in vitamin C.
■ A high dietary intake of artificial sweeteners (Aspartame).
■ A high-fat, low fiber diet.
■ Multiple sex partners.

22. A client with pancreatic cancer is receiving morphine via a subcutaneous pump. The client is
developing drug tolerance. The nurse understands that the client is:
■ Tolerating the medication well.
■ Showing addiction to morphine.
■ Requiring an increased dose.
■ Experiencing physical dependence.

23. A client with advanced ovarian cancer takes 150 mg of long-acting morphine orally every 12 hours
for abdominal pain. When the client develops a small bowel obstruction, the physician discontinues
the oral morphine and begins morphine 6 mg/ hour I.V. After calculating the
equianalgesic conversion from oral to intravenous morphine, the nurse should:
■ Continue the oral morphine for one more dose after the I.V. morphine is started.
■ Contact the physician to suggest a higher equianalgesic dose of I.V. morphine.
■ Administer the morphine I.V. as ordered.
■ Clarify the order to recommend the initial morphine dose of 4 mg/hour.
24. A 62-year-old female is taking long-acting morphine 120 mg every 12 hours for pain from
metastatic breast cancer. She can have 20 mg of immediate-release morphine every 3 to 4 hours as
needed for breakthrough pain. The physician should be notifi ed if the client uses more than how
many breakthrough doses of morphine in 24 hours?
■ Seven.
■ Four.
■ Two.
■One.

25. A 52-year-old male was discharged from the hospital for cancer-related pain. His pain appeared
to be well controlled on the I.V. morphine. He was switched to oral morphine when discharged 2
days ago. He now reports his pain as an 8 on a 10-point scale and wants the I.V. morphine. Which of
the following represents the most likely explanation for the client’s reports of inadequate pain
control?
■ He is addicted to the I.V. morphine.
■ He is going through withdrawal from the I.V. opioid.
■ He is physically dependent on the I.V. morphine.
■ He is undermedicated on the oral opioid.

26. A nurse is assessing a client with bone cancer pain. Which of the following components of a
thorough pain assessment is most significant for this client?
■ Intensity.
■ Cause.
■ Aggravating factors.
■ Location.
27. A 48-year-old client with cancer has been receiving 10 mg of I.V. morphine while hospitalized.
In order to give an equivalent dose of oral morphine, the nurse should be sure the physician has
ordered which of the following doses?
■ 25 mg.
■ 30 mg.
■40 mg.
■ 10 mg.

28. Which of the following reasons explains why meperidine (Demerol) is not recommended for
chronic cancer-related pain?
■ It has a high potential for abuse.
■ It has agonist-antagonist properties.
■ It must be given intramuscularly to be effective.
■ It contains a metabolite that causes seizures.
29. A 60-year-old female with chronic cancer pain has been receiving opiates for 4 months. She
rated her pain as an 8 on a 10-point scale before starting the opioid medication. She has just had
a thorough examination with no new evidence of increased disease, yet her pain is close to 8 again.
The most likely explanation for her increasing pain is:
■ Development of an addiction to the opioids.
■ Tolerance to the opioid.
■ Withdrawal from the opioid.
■ Placebo effect has decreased.

30. A 68-year-old male has been receiving monthly doses of chemotherapy for treatment of
stage III colon cancer. He comes to the clinic for his fourth monthly dose. Which laboratory result(s)
should be reported to the oncologist before the next dose of chemotherapy is administered? Select
all that apply.
■ Hemoglobin of 14.5 g/dL.
■ Platelet count of 40,000/mm3
■ Blood urea nitrogen (BUN) level of 12 mg/dL.
■ White blood cell count of 2,300/mm3
■ Temperature of 101.2° F (38.4° C).
■ Urine specifi c gravity of 1.020

31. Doxorubicin (Adriamycin) is prescribed for a female client with breast cancer. The client is
distressed about hair loss. The nurse should do which of the following?
■ Have the client wash and massage the scalp daily to stimulate hair growth.
■ Explain that hair loss is temporary and will quickly grow back to its original appearance.
■ Provide resources for a wig selection before hair loss begins.
■ Recommend that the client limit social contacts until hair regrows

32. The nurse is caring for a 78-year-old male with lung cancer who is receiving chemotherapy.
The client states he is not eating well but otherwise feels healthy. Which meal suggestion would be
best for this client?
■ 1. Cereal with milk and strawberries.
■ 2. Toast, gelatin dessert, and cookies.
■ 3. Broiled chicken, green beans, and cottage cheese.
■ 4. Steak and french fries.

33. A nurse is assessing a female who is receiving her second administration of chemotherapy for
breast cancer. When obtaining this client’s health history, what is the most important information
the nurse should obtain?
■ 1. “Has your hair been falling out in clumps?”
■ 2. “Have you had nausea or vomiting?”
■ 3. “Have you been sleeping at night?”
■ 4. “Do you have your usual energy level?

34.. A client who is scheduled for an open cholecystectomy has a 20-pack-year history of smoking.
For which postoperative complication is the client most at risk?
■Deep vein thrombosis.
■ Atelectasis and pneumonia.
■ Delayed wound healing.
■ Prolonged immobility.

35. A client has undergone a laparoscopic cholecystectomy. Which of the following instructions
should the nurse include in the discharge teaching?
■ Empty the bile bag daily.
■ If you become nauseated, breathe deeply into a paper bag.
■ Keep adhesive dressings in place for 6 weeks.
■ Report bile-colored drainage from any incision.

36. A 40-year-old client is admitted to the hospital with a diagnosis of acute cholecystitis. The nurse
should contact the physician to question which of the following orders?
■I.V. fl uid therapy of normal saline solution to be infused at 100 mL/hour until further orders.
■ Administer morphine sulfate 10 mg I.M. every 4 hours as needed for severe abdominal
pain.
■ Nothing by mouth (NPO) until further orders.
■ Insert a nasogastric tube and connect to low intermittent suction.

37. A client is admitted to the hospital with a diagnosis of cholecystitis from cholelithiasis. The
client has severe abdominal pain, nausea, and has vomited several times. Based on these data, which
nursing diagnosis would have the highest priority for intervention at this time?
■ 1. Anxiety related to severe abdominal discomfort.
■ 2. Deficient fluid volume related to vomiting.
■ 3. Pain related to gallbladder inflammation.
■ 4. Imbalanced nutrition: Less than body requirements related to vomiting.

38. A client has an amylase level of 450 units/L and lipase level of 659 units/L. The client has
mid-epigastric pain with nausea. What assessment helps the nurse to determine severity of the
client’s condition?
■ Ranson’s criteria.
■ Vital signs.
■Urine output.
■ Glasgow Coma Scale

39. The nurse notes that a client with acute pancreatitis occasionally experiences muscle twitching
and jerking. How should the nurse interpret the significance of these symptoms?
■The client may be developing hypocalcemia.
■ The client is experiencing a reaction to meperidine (Demerol).
■ The client has a nutritional imbalance.
■ The client needs a muscle relaxant to help him rest.

40. A client with acute pancreatitis has a blood pressure of 88/40, heart rate of 128 beats per minute,
respirations of 28 per minute, and Grey Turner’s sign. What action should the nurse perform first?
■ Assess the urine output.
■ Place an intravenous line.
■ Position on the left side.
■ Insert a nasogastric tube

41. The nurse should monitor the client with acute pancreatitis for which of the following
complications?
■Heart failure.
■ Duodenal ulcer.
■ Cirrhosis.
■ Pneumonia.

42. Which of the following dietary instructions would be appropriate for the nurse to give a client
who is recovering from acute pancreatitis?
■ Avoid crash dieting.
■ 2. Restrict carbohydrate intake.
■ Eat six small meals a day.
■ Decrease sodium in the diet.

43. Pancreatic enzyme replacements are ordered for the client with chronic pancreatitis. When
should the nurse instruct the client to take them to obtain the most therapeutic effect?
■Three times daily between meals.
■ With each meal and snack.
■ In the morning and at bedtime.
■ Every 4 hours, at specifi ed times.

44. The nurse is assessing a client with hepatitis and notices that the AST and ALT lab values have
increased. Which of the following statements by the client requires further instruction by the nurse?
■ “I require increased periods of rest.”
■ “I follow a low-fat, high carbohydrate diet.”
■ “I eat dry toast to relieve my nausea.”
■ “I take acetaminophen (Tylenol) for arthritis pain.

45. Which of the following is normal for a client during the icteric phase of viral hepatitis?
■ Tarry stools.
■ Yellowed sclera.
■ Shortness of breath.
■ Light, frothy urine.
46. The nurse is planning a home visit for a client with hepatitis. In order to prevent transmission the
nurse should focus teaching on:
■ Proper food handling.
■ Insulin syringe disposal.
■ Alpha-interferon.
■Use of condoms.

47. The nurse should teach the client with viral hepatitis to:
■ Limit caloric intake and reduce weight.
■ Increase carbohydrates and protein in the diet.
■ Avoid contact with others and live separately.
■ Intensify routine exercise and increase strength.

48. The nurse develops a teaching plan for the client about how to prevent the transmission of
hepatitis A. Which of the following discharge instructions is appropriate for the client?
■ Spray the house to eliminate infected insects.
■ Tell family members to try to stay away from the client.
■ Tell family members to wash their hands frequently.
■ Disinfect all clothing and eating utensils.

49. The nurse is assessing a client with cirrhosis who has developed hepatic encephalopathy. The
nurse should notify the physician of a decrease in which lab serum that is a potential precipitating
factor for hepatic encephalopathy?
■ Aldosterone.
■ Creatinine.
■ Potassium.
■ Protein.

50. The nurse is providing discharge instructions for a client with cirrhosis. Which of the following
statements best indicates that the client has understood the teaching?
■ “I should eat a high-protein, high-carbohydrate diet to provide energy.”
■ “It is safer for me to take acetaminophen (Tylenol) for pain instead of aspirin.”
■ “I should avoid constipation to decrease chances of bleeding.”
■ “If I get enough rest and follow my diet, it is possible for my cirrhosis to be cured.”