1.
Nina, an oncology nurse educator is speaking to a women’s group
about breast cancer. Questions and comments from the audience reveal a
misunderstanding of some aspects of the disease. Various members of the
audience have made all of the following statements. Which one is
accurate?
Correct Answer
D. Men can develop breast cancer.
Explanation
Men can develop breast cancer, although they seldom do. The most reliable method for detecting breast cancer is monthly self-examination, not mammography. Lung cancer causes more deaths than breast cancer in women of all ages. A mastectomy may not be required if the tumor is small, confined, and in an early stage.
2.
Nurse Meredith is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination:
Correct Answer
D. Immediately after her menstrual period.
Explanation
Premenopausal women should do their self-examination immediately after the menstrual period, when the breasts are least tender and least lumpy. On the 1st and last days of the cycle, the woman’s breasts are still very tender. Postmenopausal women because their bodies lack fluctuation of hormone levels, should select one particular day of the month to do breast self-examination.
3.
Nurse Kent is teaching a male client to perform monthly testicular self-examinations. Which of the following points would be appropriate to make?
Correct Answer
A. Testicular cancer is a highly curable type of cancer
Explanation
Testicular cancer is highly curable, particularly when it’s treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are in men with lung cancer. Testicular cancer is found more commonly in younger men
4.
Rhea, has malignant lymphoma. As part of her chemotherapy, the physician prescribes chlorambucil (Leukeran), 10 mg by mouth daily. When caring for the client, the nurse teaches her about adverse reactions to chlorambucil, such as alopecia. How soon after the first administration of chlorambucil might this reaction occur?
Correct Answer
C. 2 to 3 weeks
Explanation
Chlorambucil-induced alopecia occurs 2 to 3 weeks after therapy begins.
5.
A male client is receiving the cell cycle–nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of a chemotherapeutic regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects?
Correct Answer
C. It interferes with DNA replication and RNA transcription.
Explanation
Thiotepa interferes with DNA replication and RNA transcription. It doesn’t destroy the cell membrane.
6.
The nurse is instructing the 35 year old client to perform a testicular self-examination. The nurse tells the client:
Correct Answer
B. That the best time for the examination is after a shower
Explanation
The testicular-self examination is recommended monthly after a warm bath or shower when the scrotal skin is relaxed. The client should stand to examine the testicles. Using both hands, with fingers under the scrotum and thumbs on top, the client should gently roll the testicles, feeling for any lumps.
7.
A female client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care?
Correct Answer
C. Monitoring the platelet count
Explanation
Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option A elates to monitoring for infection, particularly if leukopenia is present. Options B and D, although important in the plan of care, are not related directly to thrombocytopenia.
8.
Ian, a community health nurse is instructing a group of female clients about breast self-examination. The nurse instructs the client to perform the examination:
Correct Answer
D. 1 week after menstruation begins
Explanation
The breast self-examination should be performed monthly 7 days after the onset of the menstrual period. Performing the examination weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.
9.
Nurse Cecilia is caring for a client who has undergone a vaginal hysterectomy. The nurse avoids which of the following in the care of this client?
Correct Answer
A. Elevating the knee gatch on the bed
Explanation
The client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, as for any other major surgery. For this reason, the nurse implements measures that will prevent this complication. Range-of-motion exercises, antiembolism stockings, and pneumatic compression boots are helpful. The nurse should avoid using the knee gatch in the bed, which inhibits venous return, thus placing the client more at risk for deep vein thrombosis or thrombophlebitis.
10.
Mina, who is suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse provides which preprocedure instruction to the client?
Correct Answer
D. Drink six to eight glasses of water without voiding before the test
Explanation
A pelvic ultrasound requires the ingestion of large volumes of water just before the procedure. A full bladder is necessary so that it will be visualized as such and not mistaken for a possible pelvic growth. An abdominal ultrasound may require that the client abstain from food or fluid for several hours before the procedure. Option C is unrelated to this specific procedure.
11.
A male client is diagnosed as having a bowel tumor and several diagnostic tests are prescribed. The nurse understands that which test will confirm the diagnosis of malignancy?
Correct Answer
A. Biopsy of the tumor
Explanation
A biopsy is done to determine whether a tumor is malignant or benign. Magnetic resonance imaging, computed tomography scan, and ultrasound will visualize the presence of a mass but will not confirm a diagnosis of malignancy.
12.
A female client diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder?
Correct Answer
D. Malignant proliferation of plasma cells within the bone
Explanation
Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Options A and B are not characteristics of multiple myeloma. Option C describes the leukemic process.
13.
Nurse Bea is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder?
Correct Answer
A. Increased calcium
Explanation
Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.
14.
Vanessa, a community health nurse conducts a health promotion program regarding testicular cancer to community members. The nurse determines that further information needs to be provided if a community member states that which of the following is a sign of testicular cancer?
Correct Answer
A. Alopecia
Explanation
Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as a result of radiation or chemotherapy. Options B, C, and D are assessment findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes.
15.
The male client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is:
Correct Answer
C. Sore throat
Explanation
In general, only the area in the treatment field is affected by the radiation. Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side effects occur only when specific areas are involved in treatment. A client receiving radiation to the larynx is most likely to experience a sore throat. Options B and D may occur with radiation to the gastrointestinal tract. Dyspnea may occur with lung involvement.
16.
Nurse Joy is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles?
Correct Answer
B. Do not allow pregnant women into the client’s room
Explanation
The time that the nurse spends in a room of a client with an internal radiation implant is 30 minutes per 8-hour shift. The dosimeter badge must be worn when in the client’s room. Children younger than 16 years of age and pregnant women are not allowed in the client’s room.
17.
A cervical radiation implant is placed in the client for treatment of cervical cancer. The nurse initiates what most appropriate activity order for this client?
Correct Answer
A. Bed rest
Explanation
The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled.
18.
A female client is hospitalized for insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. The initial action by the nurse is to:
Correct Answer
D. Pick up the implant with long-handled forceps and place it in a lead container.
Explanation
A lead container and long-handled forceps should be kept in the client’s room at all times during internal radiation therapy. If the implant becomes dislodged, the nurse should pick up the implant with long-handled forceps and place it in the lead container. Options A, B, and C are inaccurate interventions.
19.
The nurse is caring for a female client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plans to:
Correct Answer
C. Teach the client and family about the need for hand hygiene
Explanation
In the neutropenic client, meticulous hand hygiene education is implemented for the client, family, visitors, and staff. Not all visitors are restricted, but the client is protected from persons with known infections. Fluids should be encouraged. Invasive measures such as an indwelling urinary catheter should be avoided to prevent infections.
20.
The home health care nurse is caring for a male client with cancer and the client is complaining of acute pain. The appropriate nursing assessment of the client’s pain would include which of the following?
Correct Answer
A. The client’s pain rating
Explanation
The client’s self-report is a critical component of pain assessment. The nurse should ask the client about the description of the pain and listen carefully to the client’s words used to describe the pain. The nurse’s impression of the client’s pain is not appropriate in determining the client’s level of pain. Nonverbal cues from the client are important but are not the most appropriate pain assessment measure. Assessing pain relief is an important measure, but this option is not related to the subject of the question.
21.
Nurse Mickey is caring for a client who is postoperative following a pelvic exenteration and the physician changes the client’s diet from NPO status to clear liquids. The nurse makes which priority assessment before administering the diet?
Correct Answer
A. Bowel sounds
Explanation
The client is kept NPO until peristalsis returns, usually in 4 to 6 days. When signs of bowel function return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. The most important assessment is to assess bowel sounds before feeding the client. Options B, C, and D are unrelated to the subject of the question
22.
A male client is admitted to the hospital with a suspected diagnosis of Hodgkin’s disease. Which assessment findings would the nurse expect to note specifically in the client?
Correct Answer
D. Enlarged lympH nodes
Explanation
Hodgkin’s disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.
23.
During the admission assessment of a 35 year old client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease?
Correct Answer
D. Abdominal distention
Explanation
Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.
24.
Nurse Kate is reviewing the complications of colonization with a client who has microinvasive cervical cancer. Which complication, if identified by the client, indicates a need for further teaching?
Correct Answer
D. Ovarian perforation
Explanation
Conization procedure involves removal of a cone-shaped area of the cervix. Complications of the procedure include hemorrhage, infection, and cervical stenosis. Ovarian perforation is not a complication.
25.
Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is classified as:
Correct Answer
A. Sarcoma
Explanation
Tumors that originate from bone,muscle, and other connective tissue are called sarcomas.
26.
Sarah, a hospice nurse visits a client dying of ovarian cancer. During the visit, the client expresses that “If I can just live long enough to attend my daughter’s graduation, I’ll be ready to die.” Which phrase of coping is this client experiencing?
Correct Answer
C. Bargaining
Explanation
Denial, bargaining, anger, depression, and acceptance are recognized stages that a person facing a life-threatening illness experiences. Bargaining identifies a behavior in which the individual is willing to do anything to avoid loss or change prognosis or fate. Denial is expressed as shock and disbelief and may be the first response to hearing bad news. Depression may be manifested by hopelessness, weeping openly, or remaining quiet or withdrawn. Anger also may be a first response to upsetting news and the predominant theme is “why me?” or the blaming of others.
27.
Nurse Farah is caring for a client following a mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery?
Correct Answer
B. Arm edema on the operative side
Explanation
Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. Options A, C, and D are expected occurrences following mastectomy and do not indicate a complication.
28.
The nurse is admitting a male client with laryngeal cancer to the nursing unit. The nurse assesses for which most common risk factor for this type of cancer?
Correct Answer
B. Cigarette smoking
Explanation
The most common risk factor associated with laryngeal cancer is cigarette smoking. Heavy alcohol use and the combined use of tobacco increase the risk. Another risk factor is exposure to environmental pollutants.
29.
The female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing:
Correct Answer
B. The development of a vesicovaginal fistula
Explanation
A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina. The client’s complaint is not associated with options A, C, and D.
30.
The client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim). The nurse tells the client that the purpose if the allopurinol is to prevent:
Correct Answer
D. Hyperuricemia
Explanation
Allopurinol decreases uric acid production and reduces uric acid concentrations in serum and urine. In the client receiving chemotherapy, uric acid levels increase as a result of the massive cell destruction that occurs from the chemotherapy. This medication prevents or treats hyperuricemia caused by chemotherapy. Allopurinol is not used to prevent alopecia, nausea, or vomiting.
31.
A male client has an abnormal result on a Papanicolaou test. After
admitting, he read his chart while the nurse was out of the room, the
client asks what dysplasia means. Which definition should the nurse
provide?
Correct Answer
D. Alteration in the size, shape, and organization of differentiated cells
Explanation
Dysplasia refers to an alteration in the size, shape, and organization of differentiated cells. The presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin is called anaplasia. An increase in the number of normal cells in a normal arrangement in a tissue or an organ is called hyperplasia. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn’t found is called metaplasia.
32.
For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client?
Correct Answer
A. “Client verbalizes feelings of anxiety.”
Explanation
Verbalizing feelings is the client’s first step in coping with the situational crisis. It also helps the health care team gain insight into the client’s feelings, helping guide psychosocial care. Option B is inappropriate because suppressing speculation may prevent the client from coming to terms with the crisis and planning accordingly. Option C is undesirable because some methods of reducing tension, such as illicit drug or alcohol use, may prevent the client from coming to terms with the threat of death as well as cause physiologic harm. Option D isn’t appropriate because seeking information can help a client with cancer gain a sense of control over the crisis.
33.
A male client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which “related-to” phrase should the nurse add to complete the nursing diagnosis statement?
Correct Answer
C. Related to impaired balance
Explanation
A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction.
34.
A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect:
Correct Answer
C. Fatigue
Explanation
Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the treatment site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse effects of radiation therapy.
35.
Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:
Correct Answer
C. Fine needle aspiration.
Explanation
Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.
36.
A male client undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to care for the neck stoma, the nurse should include which instruction?
Correct Answer
D. “Keep the stoma moist.”
Explanation
The nurse should instruct the client to keep the stoma moist, such as by applying a thin layer of petroleum jelly around the edges, because a dry stoma may become irritated. The nurse should recommend placing a stoma bib over the stoma to filter and warm air before it enters the stoma. The client should begin performing stoma care without assistance as soon as possible to gain independence in self-care activities.
37.
A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy?
Correct Answer
D. Dry oral mucous membranes and cracked lips
Explanation
Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L.
38.
Nurse April is teaching a group of women to perform breast self-examination. The nurse should explain that the purpose of performing the examination is to discover:
Correct Answer
C. Changes from previous self-examinations.
Explanation
Women are instructed to examine themselves to discover changes that have occurred in the breast. Only a physician can diagnose lumps that are cancerous, areas of thickness or fullness that signal the presence of a malignancy, or masses that are fibrocystic as opposed to malignant.
39.
A client, age 41, visits the gynecologist. After examining her, the physician suspects cervical cancer. The nurse reviews the client’s history for risk factors for this disease. Which history finding is a risk factor for cervical cancer?
Correct Answer
D. Human papillomavirus infection at age 32
Explanation
Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 16, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren’t risk factors for cervical cancer.
40.
A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to treat osteogenic carcinoma. During methotrexate therapy, the nurse expects the client to receive which other drug to protect normal cells?
Correct Answer
D. Leucovorin (citrovorum factor or folinic acid [Wellcovorin])
Explanation
Leucovorin is administered with methotrexate to protect normal cells, which methotrexate could destroy if given alone. Probenecid should be avoided in clients receiving methotrexate because it reduces renal elimination of methotrexate, increasing the risk of methotrexate toxicity. Cytarabine and thioguanine aren’t used to treat osteogenic carcinoma.
41.
The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?
Correct Answer
D. Polyps
Explanation
Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren’t preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.
42.
Nurse Amy is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society guidelines, the nurse should recommend that the women:
Correct Answer
B. Have a mammogram annually.
Explanation
The American Cancer Society guidelines state, "Women older than age 40 should have a mammogram annually and a clinical examination at least annually [not every 2 years]; all women should perform breast self-examination monthly [not annually]." The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen- or progesterone-dependent.
43.
A male client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?
Correct Answer
C. Indigestion
Explanation
Indigestion, or difficulty swallowing, is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but isn’t one of the seven major warning signs. Rash and chronic ache or pain seldom indicate cancer.
44.
For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?
Correct Answer
B. Inspecting the skin for petechiae once every shift
Explanation
Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.
45.
Nurse Lucia is providing breast cancer education at a community facility. The American Cancer Society recommends that women get mammograms:
Correct Answer
A. Yearly after age 40.
Explanation
The American Cancer Society recommends a mammogram yearly for women over age 40. The other statements are incorrect. It’s recommended that women between ages 20 and 40 have a professional breast examination (not a mammogram) every 3 years.
46.
Which intervention is appropriate for the nurse caring for a male client in severe pain receiving a continuous I.V. infusion of morphine?
Correct Answer
D. Obtaining baseline vital signs before administering the first dose
Explanation
The nurse should obtain the client’s baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy. A naloxone challenge test may be administered before using a narcotic antagonist, not a narcotic agonist. The nurse shouldn’t discontinue a narcotic agonist abruptly because withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the ability to tolerate fluids.
47.
A 35 years old client with ovarian cancer is prescribed hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with:
Correct Answer
B. Normal cellular processes during the S pHase of the cell cycle.
Explanation
Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They’re most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.
48.
The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for?
Correct Answer
B. Asymmetry
Explanation
When following the ABCD method for assessing skin lesions, the A stands for "asymmetry," the B for "border irregularity," the C for "color variation," and the D for "diameter."
49.
When caring for a male client diagnosed with a brain tumor of the parietal lobe, the nurse expects to assess:
Correct Answer
B. Tactile agnosia.
Explanation
Tactile agnosia (inability to identify objects by touch) is a sign of a parietal lobe tumor. Short-term memory impairment occurs with a frontal lobe tumor. Seizures may result from a tumor of the frontal, temporal, or occipital lobe. Contralateral homonymous hemianopia suggests an occipital lobe tumor.
50.
A female client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include:
Correct Answer
C. Bence Jones protein in the urine.
Explanation
Presence of Bence Jones protein in the urine almost always confirms the disease, but absence doesn’t rule it out. Serum calcium levels are elevated because calcium is lost from the bone and reabsorbed in the serum. Serum protein electrophoresis shows elevated globulin spike. The serum creatinine level may also be increased.