Oncological and Hematological Problems of the Adult Client
1. The nurse is reviewing the laboratory results of a
client diagnosed with multiple myeloma. Which
would the nurse expect to note specifically in this
disorder?
a. Increased calcium level
b. Increased white blood cells
c. Decreased blood urea nitrogen level
d. Decreased number of plasma cells in the
bone marrow
2. The nurse is creating a plan of care for the client
with multiple myeloma and includes which
priority intervention in the plan?
a. Encouraging fluids
b. Providing frequent oral care
c. Coughing and deep breathing
d. Monitoring the red blood cell count
3. When caring for a client with an internal radiation
implant, the nurse should observe which 3? Select
all that apply.
a. Limiting the time with the client to 1 hour
per shift.
b. Keeping pregnant women out of the
client’s room.
c. Placing the client in a private room with a
private bath.
d. Wearing a lead shield when providing
direct client care.
e. Removing the dosimeter film badge when
entering the client’s room.
f. Allowing individuals younger than 16
years old in the room as long as they are 6
feet away from the client.
4. While giving care to a client with an internal
cervical radiation implant, the nurse finds the
implant in the bed. The nurse should take which
initial action?
a. Call the primary health care provider
(PHCP).
b. Reinsert the implant into the vagina.
c. Pick up the implant with gloved hands and
flush it down the toilet.
d. Pick up the implant with long-handled
forceps and place it in a lead container.
5. The nurse should plan to implement which
intervention in the care of a client experiencing
neutropenia as a result of chemotherapy?
a. Restrict all visitors.
b. Restrict fluid intake.
c. Teach the client and family about the need
for hand hygiene.
d. Insert an indwelling urinary catheter to
prevent skin breakdown.
6. The home health care nurse is caring for a client
with cancer who is complaining of acute pain. The
most appropriate determination of the client’s pain
should include which assessment?
a. The client’s pain rating
b. Nonverbal cues from the client
c. The nurse’s impression of the client’s pain
d. Pain relief after appropriate nursing
intervention
7. The nurse is caring for a client who is
postoperative following a pelvic exenteration, and
the surgeon changes the client’s diet from NPO
(nothing by mouth) status to clear liquids. The
nurse should check which priority item before
administering the diet?
a. Bowel sounds
b. Ability to ambulate
c. Incision appearance
d. Urine specific gravity
8. A client is admitted to the hospital with a
suspected diagnosis of Hodgkin’s disease. Which
assessment finding would the nurse expect to note
specifically in the client?
a. Fatigue
b. Weakness
c. Weight gain
d. Enlarged lymph nodes
9. During the admission assessment of a client with
advanced ovarian cancer, the nurse recognizes
which manifestation as typical of the disease?
a. Diarrhea
b. Hypermenorrhea
c. Abnormal bleeding
d. Abdominal distention
10. The nurse is caring for a client with lung cancer
and bone metastasis. What signs and symptoms
would the nurse recognize as indications of a
possible oncological emergency? Select all that
apply.
a. Facial edema in the morning
b. Weight loss of 20 lb (9 kg) in 1 month
c. Serum calcium level of 12 mg/dL (3.0
mmol/L)
d. Serum sodium level of 136 mg/dL (136
mmol/L)
e. Serum potassium level of 3.4 mg/dL (3.4
mmol/L)
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 Oncological and Hematological Problems of the Adult Client
f. Numbness and tingling of the lower
extremities
11. A client who has been receiving radiation therapy
for bladder cancer tells the nurse that it feels as if
she is voiding through the vagina. The nurse
interprets that the client may be experiencing
which condition?
a. Rupture of the bladder
b. The development of a vesicovaginal fistula
c. Extreme stress caused by the diagnosis of
cancer
d. Altered perineal sensation as a side effect
of radiation therapy
12. The nurse is instructing a client to perform a
testicular self-examination (TSE). The nurse
should provide the client with which information
about the procedure?
a. To examine the testicles while lying down
b. That the best time for the examination is
after a shower
c. To gently feel the testicle with one finger
to feel for a growth
d. That TSEs should be done at least every 6
months
13. The nurse is conducting a history and monitoring
laboratory values on a client with multiple
myeloma. What assessment findings should the
nurse expect to note? Select all that apply.
a. Pathological fracture
b. Urinalysis positive for Bence Jones protein
c. Hemoglobin level of 15.5 g/dL (155
mmol/L)
d. Calcium level of 8.6 mg/dL (2.15 mmol/L)
5. Serum creatinine level of 2.0 mg/dL
(176.6 mcmol/L)
14. A gastrectomy is performed on a client with gastric
cancer. In the immediate postoperative period, the
nurse notes bloody drainage from the nasogastric
tube. The nurse should take which most
appropriate action?
a. Measure abdominal girth.
b. Irrigate the nasogastric tube.
c. Continue to monitor the drainage.
d. Notify the primary health care provider
(PHCP).
15. The nurse is teaching a client about the risk
factors associated with colorectal cancer. The
nurse determines that further teaching is necessary
related to colorectal cancer if the client identifies
which item as an associated risk factor?
a. Age younger than 50 years
b. History of colorectal polyps
c. Family history of colorectal cancer
d. Chronic inflammatory bowel disease
16. The nurse is assessing the perineal wound in a
client who has returned from the operating room 1
an abdominal perineal resection and notes
serosanguineous drainage from the wound. Which
nursing intervention is most appropriate?
a. Clamp the surgical drain.
b. Change the dressing as prescribed.
c. Notify the surgeon.
d. Remove and replace the perineal packing.
17. The nurse is assessing the colostomy of a client
who has had an abdominal perineal resection for a
bowel tumor. Which assessment finding indicates
that the colostomy is beginning to function?
a. The passage of flatus
b. Absent bowel sounds
c. The client’s ability to tolerate food
d. Bloody drainage from the colostomy
18. The nurse is reviewing the history of a client with
bladder cancer. The nurse expects to note
documentation of which most common sign or
symptom of this type of cancer?
a. Dysuria
b. Hematuria
c. Urgency on urination
d. Frequency of urination
19. The nurse is assessing a client who has a new
ureterostomy. Which statement by the client
indicates the need for more education about
urinary stoma care?
a. “I change my pouch every week.”
b. “I change the appliance in the morning.”
c. “I empty the urinary collection bag when it
is two-thirds full.”
d. “When I’m in the shower I direct the flow
of water away from my stoma.”
20. A client with carcinoma of the lung develops
syndrome of inappropriate antidiuretic hormone
(SIADH) as a complication of the cancer. The
nurse anticipates that the primary health care
provider will request which prescriptions? Select
all that apply.
a. Radiation
b. Chemotherapy
c. Increased fluid intake
d. Decreased oral sodium intake
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 Oncological and Hematological Problems of the Adult Client
e. Serum sodium level determination 6.
Medication that is antagonistic to
antidiuretic hormone
21. The nurse is monitoring a client for signs and
symptoms related to superior vena cava syndrome.
Which is an early sign of this oncological
emergency?
a. Cyanosis
b. Arm edema
c. Periorbital edema
d. Mental status changes
22. The nurse manager is teaching the nursing staff
about signs and symptoms related to
hypercalcemia in a client with metastatic prostate
cancer and tells the staff that which is a late sign or
symptom of this oncological emergency?
a. Headache
b. Dysphagia
c. Constipation
d. Electrocardiographic changes
23. As part of chemotherapy education, the nurse
teaches a female client about the risk for bleeding
and self-care during the period of greatest bone
marrow suppression (the nadir). The nurse
understands that further teaching is needed if the
client makes which statement?
a. “I should avoid blowing my nose.”
b. “I may need a platelet transfusion if my
platelet count is too low.”
c. “I’m going to take aspirin for my headache
as soon as I get home.”
d. “I will count the number of pads and
tampons I use when menstruating.”
24. The community health nurse is instructing a group
of young female clients about breast self-
examination. The nurse should instruct the clients
to perform the examination at which time?
a. At the onset of menstruation
b. Every month during ovulation
c. Weekly at the same time of day
d. One week after menstruation begins
25. A client is diagnosed as having a intestinal tumor.
The nurse should monitor the client for which
complications of this type of tumor? Select all that
apply.
a. Flatulence
b. Peritonitis
c. Hemorrhage
d. Fistula formation
e. Bowel perforation
f. Lactose intolerance
26. The nurse is caring for a client following a
mastectomy. Which nursing intervention would
assist in preventing lymphedema of the affected
arm?
a. Placing cool compresses on the affected
arm
b. Elevating the affected arm on a pillow
above heart level
c. Avoiding arm exercises in the immediate
postoperative period
d. Maintaining an intravenous site below the
antecubital area on the affected side
27. The nurse is providing dietary teaching for a client
with a diagnosis of chronic gastritis. The nurse
instructs the client to include which foods rich in
vitamin B12 in the diet? Select all that apply.
a. Nuts
b. Corn
c. Liver
d. Apples
e. Lentils
f. Bananas
28. The nurse is instructing a client with iron
deficiency anemia regarding the administration of
a liquid oral iron supplement. Which instruction
should the nurse tell the client?
a. Administer the iron at mealtimes.
b. Administer the iron through a straw.
c. Mix the iron with cereal to administer.
d. Add the iron to apple juice for easy
administration.
29. Laboratory studies are performed for a client
suspected to have iron deficiency anemia. The
nurse reviews the laboratory results, knowing that
which result indicates this type of anemia?
a. Elevated hemoglobin level
b. Decreased reticulocyte count
c. Elevated red blood cell count
d. Red blood cells that are microcytic and
hypochromic
30. Chemotherapy dosage is frequently based on total
body surface area (BSA), so it is important for the
nurse to perform which assessment before
administering chemotherapy?
a. Measure the client’s abdominal girth.
b. Calculate the client’s body mass index.
c. Measure the client’s current weight and
height.
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 Oncological and Hematological Problems of the Adult Client
d. Ask the client about his or her weight and
height.
31. A client with squamous cell carcinoma of the
larynx is receiving bleomycin intravenously. The
nurse caring for the client anticipates that which
diagnostic study will be prescribed?
a. Echocardiography
b. Electrocardiography
c. Cervical radiography
d. Pulmonary function studies
32. A client with acute myelocytic leukemia is being
treated with busulfan. Which laboratory value
would the nurse specifically monitor during
treatment with this medication?
a. Clotting time
b. Uric acid level
c. Potassium level
d. Blood glucose level
33. A client with small cell lung cancer is being treated
with etoposide. The nurse monitors the client
during administration, knowing that which adverse
effect is specifically associated with this
medication?
a. Alopecia
b. Chest pain
c. Pulmonary fibrosis
d. Orthostatic hypotension
34. A clinic nurse prepares a teaching plan for a client
receiving an antineoplastic medication. When
implementing the plan, the nurse should make
which statement to the client?
a. “You can take aspirin as needed for
headache.”
b. “You can drink beverages containing
alcohol in moderate amounts each
evening.”
c. “You need to consult with the primary
health care provider (PHCP) before
receiving immunizations.”
d. “It is fine to receive a flu vaccine at the
local health fair without PHCP approval
because the flu is so contagious.”
35. A client with ovarian cancer is being treated with
vincristine. The nurse monitors the client, knowing
that which manifestation indicates an adverse
effect specific to this medication?
a. Diarrhea
b. Hair loss
c. Chest pain
d. Peripheral neuropathy
36. The nurse is reviewing the history and physical
examination of a client who will be receiving
asparaginase, an antineoplastic agent. The nurse
contacts the primary health care provider before
administering the medication if which disorder is
documented in the client’s history?
a. Pancreatitis
b. Diabetes mellitus
c. Myocardial infarction
d. Chronic obstructive pulmonary disease
37. Tamoxifen citrate is prescribed for a client with
metastatic breast carcinoma. The client asks the
nurse if her family member with bladder cancer
can also take this medication. The nurse most
appropriately responds by making which
statement?
a. “This medication can be used only to treat
breast cancer.”
b. “Yes, your family member can take this
medication for bladder cancer as well.”
c. “This medication can be taken to prevent
and treat clients with breast cancer.”
d. “This medication can be taken by anyone
with cancer as long as their health care
provider approves it.”
38. A client with metastatic breast cancer is receiving
tamoxifen. The nurse specifically monitors which
laboratory value while the client is taking this
medication?
a. Glucose level
b. Calcium level
c. Potassium level
d. Prothrombin time
39. Megestrol acetate, an antineoplastic medication, is
prescribed for a client with metastatic endometrial
carcinoma. The nurse reviews the client’s history
and should contact the primary health care
provider if which diagnosis is documented in the
client’s history?
a. Gout
b. Asthma
c. Myocardial infarction
d. Venous thromboembolism
40. The nurse is monitoring the intravenous (IV)
infusion of an antineoplastic medication. During
the infusion, the client complains of pain at the
insertion site. On inspection of the site, the nurse
notes redness and swelling and that the infusion of
the medication has slowed in rate. The nurse
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 Oncological and Hematological Problems of the Adult Client

suspects extravasation and should take which c. A platelet count of 50,000 mm3 (50 × 10 9
actions? Select all that apply. /L)
a. Stop the infusion. d. A white blood cell count of 5000 mm3
b. Prepare to apply ice or heat to the site. (5.0 × 10 9 /L)
c. Restart the IV at a distal part of the same
vein.
d. Notify the primary health care provider
(PHCP).
e. Prepare to administer a prescribed antidote
into the site. 6. Increase the flow rate of
the solution to flush the skin and
subcutaneous tissue.
41. The nurse is analyzing the laboratory results of a
client with leukemia who has received a regimen
of chemotherapy. Which laboratory value would
the nurse specifically note as a result of the
massive cell destruction that occurred from the
chemotherapy?
a. Anemia
b. Decreased platelets
c. Increased uric acid level
d. Decreased leukocyte count
42. The nurse is providing medication instructions to a
client with breast cancer who is receiving
cyclophosphamide. The nurse should tell the client
to take which action?
a. Take the medication with food.
b. Increase fluid intake to 2000 to 3000 mL
daily.
c. Decrease sodium intake while taking the
medication.
d. Increase potassium intake while taking the
medication.
43. A client with non-Hodgkin’s lymphoma is
receiving daunorubicin. Which finding would
indicate to the nurse that the client is experiencing
an adverse effect related to the medication?
a. Fever
b. Sores in the mouth and throat
c. Complaints of nausea and vomiting
d. Crackles on auscultation of the lungs
44. The nurse is monitoring the laboratory results of a
client receiving an antineoplastic medication by
the intravenous route. The nurse plans to initiate
bleeding precautions if which laboratory result is
noted?
a. A clotting time of 10 minutes
b. An ammonia level of 10 mcg/dL (6
mcmol/L).

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 Oncological and Hematological Problems of the Adult Client

ANSWERS should ask the client to describe the pain and listen
carefully to the words the client uses to describe
1. Answer: A Rationale: Findings indicative of
the pain. Nonverbal cues from the client are
multiple myeloma are an increased number of
important but are not the most appropriate pain
plasma cells in the bone marrow, anemia,
assessment measure. The nurse’s impression of the
hypercalcemia caused by the release of calcium
client’s pain is not appropriate in determining the
from the deteriorating bone tissue, and an elevated
client’s level of pain. Assessing pain relief is an
blood urea nitrogen level. An increased white
important measure, but this option is not related to
blood cell count may or may not be present and is
the subject of the question.
not related specifically to multiple myeloma.
7. Answer: A Rationale: The client is kept NPO until
2. Answer: A Rationale: Hypercalcemia caused by
peristalsis returns, usually in 4 to 6 days. When
bone destruction is a priority concern in the client
signs of bowel function return, clear fluids are
with multiple myeloma. The nurse should
given to the client. If no distention occurs, the diet
administer fluids in adequate amounts to maintain
is advanced as tolerated. The most important
a urine output of 1.5 to 2 L/day; this requires about
assessment is to assess bowel sounds before
3 L of fluid intake per day. The fluid is needed not
feeding the client. Options 2, 3, and 4 are unrelated
only to dilute the calcium overload but also to
to the data in the question.
prevent protein from precipitating in the renal
8. Answer: D Rationale: Hodgkin’s disease is a
tubules. Options 2, 3, and 4 may be components of
chronic progressive neoplastic disorder of
the plan of care but are not the priority in this
lymphoid tissue characterized by the painless
client.
enlargement of lymph nodes with progression to
3. Answer: B, C, D Rationale: The time that the nurse
extralymphatic sites, such as the spleen and liver.
spends in the room of a client with an internal
Weight loss is most likely to be noted. Fatigue and
radiation implant is 30 minutes per shift. The client
weakness may occur but are not related
must be placed in a private room with a private
significantly to the disease.
bath. Lead shielding can be used to reduce the
9. Answer: D Rationale: Clinical manifestations of
transmission of radiation. The dosimeter film
ovarian cancer include abdominal distention,
badge must be worn when in the client’s room.
urinary frequency and urgency, pleural effusion,
Children younger than 16 years of age and
malnutrition, pain from pressure caused by the
pregnant women are not allowed in the client’s
growing tumor and the effects of urinary or bowel
room.
obstruction, constipation, ascites with dyspnea,
4. Answer: D Rationale: In the event that a radiation
and ultimately general severe pain. Abnormal
source becomes dislodged, the nurse would first
bleeding, often resulting in hypermenorrhea, is
encourage the client to lie still until the radioactive
associated with uterine cancer.
source has been placed in a safe, closed container.
10. Answer: A, C, F Rationale: Oncological
The nurse would use long-handled forceps to place
emergencies include sepsis, disseminated
the source in the lead container that should be in
intravascular coagulation, syndrome of
the client’s room. The nurse should then call the
inappropriate antidiuretic hormone, spinal cord
radiation oncologist and document the event and
compression, hypercalcemia, superior vena cava
the actions taken. It is not within the scope of
syndrome, and tumor lysis syndrome. Blockage of
nursing practice to insert a radiation implant.
blood flow to the venous system of the head
5. Answer: C Rationale: In the neutropenic client,
resulting in facial edema is a sign of superior vena
meticulous hand hygiene education is implemented
cava syndrome. A serum calcium level of 12
for the client, family, visitors, and staff. Not all
mg/dL (3.0 mmol/L) indicates hypercalcemia.
visitors are restricted, but the client is protected
Numbness and tingling of the lower extremities
from persons with known infections. Fluids should
could be a sign of spinal cord compression. Mild
be encouraged. Invasive measures such as an
hypokalemia and weight loss are not oncological
indwelling urinary catheter should be avoided to
emergencies. A sodium level of 136 mg/dL (136
prevent infections.
mmol/L) is a normal level.
6. Answer: A Rationale: The client’s self-report is a
critical component of pain assessment. The nurse
6
 Oncological and Hematological Problems of the Adult Client
11. Answer: B Rationale: A vesicovaginal fistula is a
genital fistula that occurs between the bladder and
vagina. The fistula is an abnormal opening
between these two body parts, and if this occurs,
the client may experience drainage of urine
through the vagina. The client’s complaint is not
associated with options 1, 3, or 4.
12. Answer: B Rationale: The TSE is recommended
monthly after a warm bath or shower when the
scrotal skin is relaxed. The client should stand to
examine the testicles. Using both hands, with
fingers under the scrotum and thumbs on top, the
client should gently roll the testicles, feeling for
any lumps.
13. Answer: A, B, E Rationale: Multiple myeloma is a
B cell neoplastic condition characterized by
abnormal malignant proliferation of plasma cells
and the accumulation of mature plasma cells in the
bone marrow. The client with multiple myeloma
may experience pathological fractures,
hypercalcemia, anemia, recurrent infections, and
renal failure. In addition, Bence Jones proteinuria
is a finding. A serum calcium level of 8.6 mg/dL
(2.15 mmol/L) and a hemoglobin level of 15.5
g/dL (155 mmol/L) are normal values. A serum
creatinine level of 2.0 mg/dL (176.6 mcmol/L) is
elevated indicating a renal problem.
14. Answer: C Rationale: Following gastrectomy,
drainage from the nasogastric tube is normally
bloody for 24 hours postoperatively, changes to
brown-tinged, and is then yellow or clear. Because
bloody drainage is expected in the immediate
postoperative period, the nurse should continue to
monitor the drainage. The nurse does not need to
notify the PHCP (surgeon) at this time. Abdominal
girth is measured to detect the development of
distention. Following gastrectomy, a nasogastric
tube should not be irrigated unless there are
specific surgeon prescriptions to do so.
15. Answer: A Rationale: Colorectal cancer risk
factors include age older than 50 years, a family
history of the disease, colorectal polyps, and
chronic inflammatory bowel disease.
16. Answer: B Rationale: Immediately after surgery,
profuse serosanguineous drainage from the
perineal wound is expected. Therefore, the nurse
should change the dressing as prescribed. A
surgical drain should not be clamped, because this
action will cause the accumulation of drainage
within the tissue. The nurse does not need to notify
the surgeon at this time. Drains and packing are
removed gradually over a period of 5 to 7 days as
prescribed. The nurse should not remove the
perineal packing.
17. Answer: A Rationale: Following abdominal
perineal resection, the nurse would expect the
colostomy to begin to function within 72 hours
after surgery, although it may take up to 5 days.
The nurse should assess for a return of peristalsis,
listen for bowel sounds, and check for the passage
of flatus. Absent bowel sounds would not indicate
the return of peristalsis. The client would remain
NPO (nothing by mouth) until bowel sounds return
and the colostomy is functioning. Bloody drainage
is not expected from a colostomy.
18. Answer: B Rationale: The most common sign in
clients with cancer of the bladder is hematuria. The
client also may experience irritative voiding
symptoms such as frequency, urgency, and dysuria,
and these symptoms often are associated with
carcinoma in situ. Dysuria, urgency, and frequency
of urination are also symptoms of a bladder
infection.
19. Answer: C Rationale: The urinary collection bag
should be changed when it is one-third full to
prevent pulling of the appliance and leakage. The
remaining options identify correct statements
about the care of a urinary stoma.
20. Answer: A, B, E, F Rationale: Cancer is a common
cause of SIADH. In SIADH, excessive amounts of
water are reabsorbed by the kidney and put into the
systemic circulation. The increased water causes
hyponatremia (decreased serum sodium levels) and
some degree of fluid retention. The syndrome is
managed by treating the condition and cause and
usually includes fluid restriction, increased sodium
intake, and medication with a mechanism of action
that is antagonistic to antidiuretic hormone.
Sodium levels are monitored closely because
hypernatremia can develop suddenly as a result of
treatment. The immediate institution of appropriate
cancer therapy, usually radiation or chemotherapy,
can cause tumor regression so that antidiuretic
hormone synthesis and release processes return to
normal.
21. Answer: C Rationale: Superior vena cava
syndrome occurs when the superior vena cava is
compressed or obstructed by tumor growth. Early
signs and symptoms generally occur in the
morning and include edema of the face, especially
7
 Oncological and Hematological Problems of the Adult Client
around the eyes, and client complaints of tightness
of a shirt or blouse collar. As the compression
worsens, the client experiences edema of the hands
and arms. Cyanosis and mental status changes are
late signs.
22. Answer: D Rationale: Hypercalcemia is a
manifestation of bone metastasis in late-stage
cancer. Headache and dysphagia are not associated
with hypercalcemia. Constipation may occur early
in the process. Electrocardiogram changes include
shortened ST segment and a widened T wave.
23. Answer: C Rationale: During the period of greatest
bone marrow suppression (the nadir), the platelet
count may be low, less than 20,000 cells mm3
(20.0 × 10 9 /L). The correct option describes an
incorrect statement by the client. Aspirin and
nonsteroidal antiinflammatory drugs and products
that contain aspirin should be avoided because of
their antiplatelet activity. Options 1, 2, and 4 are
correct statements by the client to prevent and
monitor bleeding.
24. Answer: D Rationale: The breast self-examination
should be performed regularly, 7 days after the
onset of the menstrual period. Performing the
examination weekly is not recommended. At the
onset of menstruation and during ovulation,
hormonal changes occur that may alter breast
tissue.
25. Answer: B, C, D, E Rationale: Complications of
intestinal tumors include bowel perforation, which
can result in hemorrhage and peritonitis. Other
complications include bowel obstruction and
fistula formation. Flatulence can occur but is not a
complication; lactose intolerance also is not a
complication of intestinal tumor.
26. Answer: B Rationale: Following mastectomy, the
arm should be elevated above the level of the
heart. Simple arm exercises should be encouraged.
No blood pressure readings, injections, intravenous
lines, or blood draws should be performed on the
affected arm. Cool compresses are not a suggested
measure to prevent lymphedema from occurring.
27. Answer: A, C, E Rationale: Chronic gastritis
causes deterioration and atrophy of the lining of
the stomach, leading to the loss of function of the
parietal cells. The source of intrinsic factor is lost,
which results in an inability to absorb vitamin
B12 , leading to development of pernicious
anemia. Clients must increase their intake of
vitamin B12 by increasing consumption of foods
rich in this vitamin, such as nuts, organ meats,
dried beans, citrus fruits, green leafy vegetables,
and yeast.
28. Answer: B Rationale: In iron deficiency anemia,
iron stores are depleted, resulting in a decreased
supply of iron for the manufacture of hemoglobin
in red blood cells. An oral iron supplement should
be administered through a straw or medicine
dropper placed at the back of the mouth, because
the iron stains the teeth. The client should be
instructed to brush or wipe their teeth after
administration. Iron is administered between
meals, because absorption is decreased if there is
food in the stomach. Iron requires an acid
environment to facilitate its absorption in the
duodenum. Iron is not mixed with cereal or other
food items.
29. Answer: D Rationale: In iron deficiency anemia,
iron stores are depleted, resulting in a decreased
supply of iron for the manufacture of hemoglobin
in red blood cells. The results of a complete blood
cell count in clients with iron deficiency anemia
show decreased hemoglobin levels and microcytic
and hypochromic red blood cells. The red blood
cell count is decreased. The reticulocyte count is
usually normal or slightly elevated.
30. Answer: C Rationale: To ensure that the client
receives optimal doses of chemotherapy, dosing is
usually based on the total BSA, which requires a
current accurate height and weight for BSA
calculation (before each medication
administration). Asking the client about his or her
height and weight may lead to inaccuracies in
determining a true BSA and dosage. Calculating
body mass index and measuring abdominal girth
will not provide the data needed.
31. Answer: D Rationale: Bleomycin is an
antineoplastic medication that can cause interstitial
pneumonitis, which can progress to pulmonary
fibrosis. Pulmonary function studies along with
hematological, hepatic, and renal function tests
need to be monitored. The nurse needs to monitor
lung sounds for dyspnea and crackles, which
indicate pulmonary toxicity. The medication needs
to be discontinued immediately if pulmonary
toxicity occurs. Options 1, 2, and 3 are unrelated to
the specific use of this medication.
32. Answer: B Rationale: Busulfan can cause an
increase in the uric acid level. Hyperuricemia can
produce uric acid nephropathy, renal stones, and
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 Oncological and Hematological Problems of the Adult Client
acute kidney injury. Options 1, 3, and 4 are not
specifically related to this medication.
33. Answer: D Rationale: An adverse effect specific to
etoposide is orthostatic hypotension. Etoposide
should be administered slowly over 30 to 60
minutes to avoid hypotension. The client’s blood
pressure is monitored during the infusion. Hair
loss occurs with nearly all antineoplastic
medications. Chest pain and pulmonary fibrosis
are unrelated to this medication.
34. Answer: C Rationale: Because antineoplastic
medications lower the resistance of the body,
clients must be informed not to receive
immunizations without the PHCP’s approval.
Clients also need to avoid contact with individuals
who have recently received a live virus vaccine.
Clients need to avoid aspirin and aspirin-
containing products to minimize the risk of
bleeding, and they need to avoid alcohol to
minimize the risk of toxicity and side/adverse
effects.
35. Answer: D Rationale: An adverse effect specific to
vincristine is peripheral neuropathy, which occurs
in almost every client. Peripheral neuropathy can
be manifested as numbness and tingling in the
fingers and toes. Depression of the Achilles tendon
reflex may be the first clinical sign indicating
peripheral neuropathy. Constipation rather than
diarrhea is most likely to occur with this
medication, although diarrhea may occur
occasionally. Hair loss occurs with nearly all
antineoplastic medications. Chest pain is unrelated
to this medication.
36. Answer: A Rationale: Asparaginase is
contraindicated if hypersensitivity exists, in
pancreatitis, or if the client has a history of
pancreatitis. The medication impairs pancreatic
function, and pancreatic function tests should be
performed before therapy begins and when a week
or more has elapsed between dose administrations.
The client needs to be monitored for signs of
pancreatitis, which include nausea, vomiting, and
abdominal pain. The conditions noted in options 2,
3, and 4 are not contraindicated with this
medication.
37. Answer: C Rationale: Tamoxifen is an
antineoplastic medication that competes with
estradiol for binding to estrogen in tissues
containing high concentrations of receptors.
Tamoxifen is used to treat metastatic breast
carcinoma in women and men. Tamoxifen is also
effective in delaying the recurrence of cancer
following mastectomy and for preventing breast
cancer in those that are at high risk.
38. Answer: B Rationale: Tamoxifen may increase
calcium, cholesterol, and triglyceride levels.
Before the initiation of therapy, a complete blood
count, platelet count, and serum calcium level
should be assessed. These blood levels, along with
cholesterol and triglyceride levels, should be
monitored periodically during therapy. The nurse
should assess for hypercalcemia while the client is
taking this medication. Signs of hypercalcemia
include increased urine volume, excessive thirst,
nausea, vomiting, constipation, hypotonicity of
muscles, and deep bone and flank pain.
39. Answer: D Rationale: Megestrol acetate
suppresses the release of luteinizing hormone from
the anterior pituitary by inhibiting pituitary
function and regressing tumor size. Megestrol is
used with caution if the client has a history of
venous thromboembolism. Options 1, 2, and 3 are
not contraindications for this medication.
40. Answer: A, B, D, E Rationale: Redness and
swelling and a slowed infusion indicate signs of
extravasation. If the nurse suspects extravasation
during the IV administration of an antineoplastic
medication, the infusion is stopped and the PHCP
is notified. Ice or heat may be prescribed for
application to the site, and an antidote may be
prescribed to be administered into the site.
Increasing the flow rate can increase damage to the
tissues. Restarting an IV in the same vein can
increase damage to the site and vein.
41. Answer: C Rationale: Hyperuricemia is especially
common following treatment for leukemias and
lymphomas, because chemotherapy results in
massive cell kill. Although options 1, 2, and 4 also
may be noted, an increased uric acid level is
related specifically to cell destruction.
42. Answer: B Rationale: Hemorrhagic cystitis is an
adverse effect that can occur with the use of
cyclophosphamide. The client needs to be
instructed to drink copious amounts of fluid during
the administration of this medication. Clients also
should monitor urine output for hematuria. The
medication should be taken on an empty stomach,
unless gastrointestinal upset occurs. Hyperkalemia
can result from the use of the medication;
therefore, the client would not be told to increase
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 Oncological and Hematological Problems of the Adult Client

potassium intake. The client would not be

instructed to alter sodium intake.
43. Answer: D Rationale: Cardiotoxicity noted by
abnormal electrocardiographic findings or
cardiomyopathy manifested as heart failure (lung
crackles) is an adverse effect of daunorubicin.
Bone marrow depression is also an adverse effect.
Fever is a frequent side effect, and sores in the
mouth and throat can occur occasionally. Nausea
and vomiting is a frequent side effect associated
with the medication that begins a few hours after
administration and lasts 24 to 48 hours. Options 1,
2, and 3 are not adverse effects.
44. Answer: C Rationale: Bleeding precautions need
to be initiated when the platelet count decreases.
The normal platelet count is 150,000 to 450,000
mm3 (150 to 400 × 10 9 /L). When the platelet
count decreases, the client is at risk for bleeding.
The normal white blood cell count is 5000 to
10,000 mm3 (5.0 to 10.0 × 10 9 /L). When the
white blood cell count drops, neutropenic
precautions need to be implemented. The normal
clotting time is 8 to 15 minutes. The normal
ammonia value is 10 to 80 mcg/dL (6 to 47
mcmol/L).

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