A diagnosis of Hodgkin’s disease was made to a 58- year old man and is admitted for the

initial cycle of chemotherapy. During the hospitalization, the nurse should watch out for
the following complication, except?

 B. Benign prostatic hyperplasia

 Option B: Hodgkin’s disease (Hodgkin’s lymphoma) is a type of cancer that

affects the lymphatic system (bone marrow, spleen, liver, and lymph node
tissue. Symptoms include painless swelling of a lymph node, recurrent
fever, night sweats, pruritus, and unexplained weight loss. Prostate
involvement is rare in Hodgkin’s disease.
 Options A, C, and D: Complications of the disease would lead to a
weakened immune system resulting in various infections, It can also result
in fertility problems related to chemotherapy, and a probability of
secondary cancers in the future.

The nurse is reviewing the chart of a client who is newly diagnosed with chronic
lymphocytic leukemia. Which of the following laboratory values is expected to be seen?

. Thrombocytopenia and increased lymphocytes

 Option B: Chronic lymphocytic leukemia shows a proliferation of small

abnormal mature B lymphocytes and decreased antibody response.
Thrombocytopenia also is often present.
 Option A: Chronic lymphocytic leukemia often does not cause abnormal
liver function tests.
 Option C: An elevated ESR result is often seen with multiple myeloma and
Waldenstrom’s macroglobulinemia (a type of non-Hodgkin’s lymphoma
that is characterized by excessive production of white blood cells).
 Option D: Uncontrolled proliferation of granulocytes occurs in
myelogenous leukemia.

Maria was recently diagnosed with Hodgkin’s lymphoma. Upon the early diagnosis, the
nurse will expect which of the following areas is often involved?

Neck

 Option B: A common early sign of Hodgkin lymphoma is swelling in one

or more lymph nodes, which is often seen in the neck.
  Options A, C, and D: Lymph nodes can also be found in the chest, groin,
and pelvis but aren’t yet involved in the earliest stage of the disease.

According to a standard staging classification of Hodgkin’s disease, which of the following

criteria reflects stage III?

 Involvement of lymph node regions or structures on both sides of the diaphragm

 Option A: Hodgkin lymphoma is classified into stages to determine the

state of the disease and where it has already spread. Stage III involves
nodes on both sides of the diaphragm.
 Option B: Stage II involves two or more lymph node regions.
 Option C: Stage I only involves one lymph node region.
 Option D: Stage IV involves extra lymphatic organs or tissues.

Angela, a clinical instructor is conducting a lecture about chemotherapy. Which of

the following statements is correct about the rate of cell growth in relation to
chemotherapy?

Faster growing cells are less susceptible to chemotherapy

 Option B: The faster the cell grows, the more susceptible it is to

chemotherapy and radiation therapy.
 Options A, C, and D: Slow-growing and non-dividing cells are less
susceptible to chemotherapy. Repeated cycles of chemotherapy are used
to destroy nondividing cells as they begin active cell division.
A 40 year old male diagnosed with acute lymphocytic leukemia finished his first cycle of
chemotherapy. Which of the following statements by the patient warrants further teaching
by the nurse?

“Try eating sashimi in one of the famous Japanese restaurants around the city”

 Option C: A low bacteria diet would be indicated with excludes of raw or
undercooked fish such as sashimi due to the risk of exposure from
harmful bacteria.
 Option A: Soft cheeses are allowed if they are made from pasteurized
milk.
  Options B and D: Cooked meat such as medium well steak and turkey are
rich in protein that can help the patient maintain strength and prevent
weight and muscle loss.
A client with leukemia has neutropenia. Which of the following functions must be
frequently assessed?

Breath sounds

 Option C: Pneumonia, both viral and fungal, is a common cause of death

in clients with neutropenia, so frequent assessment of respiratory rate
and breath sounds is required.
 Options A, B, and D: Although assessing blood pressure, bowel sounds,
and heart sounds is important, it won’t help detect pneumonia.
Which of the following clients is most at risk for developing multiple myeloma?

A 60-year-old African-American man

 Option A: Multiple myeloma is more common in middle-aged and older

clients (the median age at diagnosis is 60 years) and is twice as common in
Blacks as Whites. It occurs most often in Black men.
Which of the following substances has abnormal values early in the course of multiple
myeloma (MM)?

Immunoglobulins

 Option B: MM is characterized by malignant plasma cells that produce an

increased amount of immunoglobulin that isn’t functional.
 Option A: As more malignant plasma cells are produced, there’s less
space in the bone marrow for RBC production.
 Options C and D: In the late stage of the disease, platelets and WBC’s are
reduced as the bone marrow is infiltrated by malignant plasma cells.
Nurse Andrei is caring for a client with multiple myeloma. During the review of the
laboratory results. The nurse will monitor the client for which of the following conditions?

Hypercalcemia

 Option D: Patients with multiple myeloma develop a bone disease that

causes bone destruction. Calcium is released during this, causing an
increase in serum calcium levels.
  Options A, B, and C: MM doesn’t affect potassium, sodium, or
magnesium levels.
Giving instructions for breast self-examination is particularly important for clients with
which of the following medical problems?

Ovarian cancer

 Option A: Clients with ovarian cancer are at increased risk for breast
cancer. Breast self-examination supports early detection and treatment
and is very important.
 Option B: Endometrial polyps are outgrowths in the endometrium that
are mostly non cancerous and the exact cause is unknown.
 Option C: Cervical dysplasia is the abnormal cell growth in the lining of
the cervix that is related with human papillomavirus (HPV) infection.
 Option D: Dermoid cysts are abnormal growth found in the ovary that
usually contain material such as skin, hari, teeth, nails, fat, and sweat
glands that were trapped during fetal development.
During a routine physical examination, a firm mass is palpated in the right breast of a 35-
year-old woman. Which of the following findings or client history would suggest cancer of
the breast as opposed to fibrocystic disease?

Increased vascularity of the breast

 Option A: An increase in breast size or vascularity indicates the growth of

a tumor and is consistent with cancer of the breast.
 Options B, C, and D: Early menarche, as well as late menopause or a
history of anovulatory cycles, are associated with fibrocystic disease.
Masses associated with fibrocystic disease of the breast are firm, most
often located in the upper outer quadrant of the breast, and increase in
size prior to menstruation. They may be bilateral in a mirror image and
are typically well-demarcated and freely moveable.
The client with which of the following types of lung cancer has the best prognosis?

 Squamous cell

 Option A: Squamous cell carcinoma is a slow-growing, rarely

metastasizing type of cancer.
 Options B and C: Oat cell and small cell carcinoma are the same. Small
cell carcinoma grows rapidly and is quick to metastasize.
  Option D: Adenocarcinoma is the next best lung cancer to have in terms
of prognosis.
Warning signs and symptoms of lung cancer include persistent cough, bloody sputum,
dyspnea, and which of the other following symptoms?

Recurrent pleural effusion

 Option B: If cancer is suspected in the lungs, it can cause fluid

accumulation in the pleura called pleural effusion. This fluid build-up takes
up space and fills the pleural cavity resulting in the compression of the
lungs making it hard for the client to breathe properly.
 Options A, C, and D: Dizziness, generalized weakness, and hypotension
aren’t typically considered warning signals, but may occur in advanced
stages of cancer.
A centrally located tumor would produce which of the following symptoms?

Coughing

 Option C: Centrally located pulmonary tumors are found in the upper

airway (vocal cords) and usually obstruct airflow, producing such
symptoms as coughing, wheezing, and stridor.
 Option A: Pancoast tumors that occur in the apices may cause shoulder
pain.
 Option B: As the tumor invades the pleural space, it may cause pleuritic
pain.
 Option D: Small cell tumors tend to be located in the lower airways and
often cause hemoptysis.
Which of the following interventions is the key to increasing the survival rates of clients
with lung cancer?

Early detection

 Option D: Early detection of cancer when the cells may be premalignant

and potentially curable would be most beneficial. However, a tumor must
be 1 cm in diameter before it’s detectable on a chest x-ray, so this is
difficult.
 Option A: High-dose chemotherapy has minimal effect on long-term
survival.
  Option B: A bronchoscopy may help identify cell type but may not
increase the survival rate.
 Option C: Smoking cessation won’t reverse the process but may help
prevent further decompensation.
A client has been diagnosed with lung cancer and requires a wedge resection. How much
of the lung is removed?

A small, localized area near the surface of the lung

 Option D: A wedge resection is a surgical procedure that involves the

removal of a small area of tissue close to the surface of the lung. It is
indicated for clients with certain types of lung cancer such as non-small
cell lung cancer (NSCLC). It is done in combination with chemotherapy and
radiation therapy.
 Options A and C: A segment of the lung is removed in a segmental
resection and a lobe is removed in a lobectomy.
 Option B: An entire lung is removed in a pneumonectomy.
When a client has a lobectomy, what fills the space where the lobe was?

The remaining lobe or lobes over expand to fill the space

 Option A: The remaining lobe or lobes over expand slightly to fill the
space previously occupied by the removed tissue. The diaphragm is
carried higher on the operative side to further reduce the empty space.
 Option C: The space can’t remain “empty” because truly empty would
imply a vacuum, which would interfere with the intrathoracic pressure
changes that allow breathing.
 Option B: Serous fluid overproduction would compress the remaining
lobes, diminish their function and possibly, cause a mediastinal shift.
 Option D: The surgeon doesn’t use a gel to fill the space.
Which of the following is the primary goal for surgical resection of lung cancer?

To remove the tumor and as little surrounding tissue as possible

 Option C: The goal of surgical resection is to remove the lung tissue that
has a tumor in it while saving as much surrounding tissue as possible.
There is a possibility of cancer cells remaining in the body after the
 operation so additional treatment modalities such as chemotherapy and
radiation therapy are done.
 Options A, B, and D: It may be necessary to remove alveoli and
bronchioles, but care is taken to make sure only what’s absolutely
necessary is removed.
If the client with lung cancer also has preexisting pulmonary disease, which of the following
statements best describes the extent of a surgery that can be performed?

It may prevent surgery if the client can’t tolerate lung tissue removal

 Option D: If the client’s preexisting pulmonary disease is restrictive and

advanced, it may be impossible to remove the tumor, and the client may
have to be treated with chemotherapy and radiation.
 Option A: A pre-existing pulmonary disease affects the ability of a client
with lung cancer to tolerate surgical therapy.
 Option B: Removing the whole lung is recommended if the cancer is
located in the central area of the lung or if it cannot be fully removed with
lobectomy.
 Option C: A preexisting lung condition does not limit the option for the
removal of the entire tumor because a tumor that is not entirely removed
poses a threat of the spread of cancer cells to nearby tissues.
The client with a benign lung tumor is treated in which of the following ways?
The tumor is removed, involving the least possible amount of tissue

 Option A: The tumor is removed to prevent further compression of the

lung tissue as the tumor grows, which could lead to respiratory
decompensation.
 Options B, C, and D: If for some reason it can’t be removed, then
radiation or chemotherapy may be used to try to shrink the tumor.
In the client with terminal lung cancer, the focus of nursing care is on which of the
following nursing interventions?
Provide pain control

 Option B: The client with terminal lung cancer may have extreme pleuritic
pain and should be treated to reduce his discomfort therefore improving
the quality of life of the patient. Examples of pain medication used with
advanced cancer are opioids such as morphine, oxycodone, fentanyl, or
methadone.
  Option A: Nursing care doesn’t focus on helping the client prepare the
will.
 Option D: Preparing the client and his family for the impending death and
providing emotional support is also important but shouldn’t be the
primary focus until the pain is under control.
 Option C: Nutritional support may be provided, but as the terminal phase
advances, the client’s nutritional needs greatly decrease.
What are the three most important prognostic factors in determining long-term survival
for children with acute leukemia?

Histologic type of disease, initial WBC count, and client’s age at diagnosis

The factor whose prognostic value is considered to be of greatest significance in

determining the long-range outcome is the histologic type of leukemia. Children with a
normal or low WBC count appear to have a much better prognosis than those with a high
WBC count. Children diagnosed between ages 2 and 10 have consistently demonstrated a
better prognosis because of age 2 or after 10.

Which of the following complications are three main consequences of leukemia?

Anemia, infection, and bleeding tendencies

 The three main consequences of leukemia are anemia, caused by

decreased erythrocyte production; infection secondary to neutropenia;
and bleeding tendencies, from decreased platelet production.
 Option B: Bone deformities don’t occur with leukemia although bones
may become painful because of the proliferation of cells in the bone
marrow. Spherocytosis refers to erythrocytes taking on a spheroid shape
and isn’t a feature in leukemia. Mature cells aren’t produced in adequate
numbers.
 Option C: Anemia, not polycythemia, occurs. Clotting times would be
prolonged.
 Option D: Hirsutism and growth delay can be a result of large doses of
steroids but isn’t common in leukemia.
A child is seen in the pediatrician’s office for complaints of bone and joint pain. Which of
the following other assessment findings may suggest leukemia?

 Petechiae
  he most frequent signs and symptoms of leukemia are a result of
infiltration of the bone marrow. These include fever, pallor, fatigue,
anorexia, and petechiae, along with bone and joint pain. Petechiae is
brought about by damaged or broken blood vessels underneath the skin.
 Option A: Leukemia increases inflammation in the body, which can make
a person feel tired and experience fatigue causing decreased activity level.
 Option B: Increased appetite can occur but it usually isn’t a presenting
symptom.
 Option D: Abdominal pain may be caused by areas of inflammation from
normal flora within the GI tract or any number of other causes.
Which of the following assessment findings in a client with leukemia would indicate that
cancer has invaded the brain?

Headache and vomiting

 b The usual effect of leukemic infiltration of the brain is increased

intracranial pressure. The proliferation of cells interferes with the flow of
cerebrospinal fluid in the subarachnoid space and at the base of the brain.
The increased fluid pressure causes dilation of the ventricles, which
creates symptoms of severe headache, vomiting, irritability, lethargy, and
eventually, coma.
 Option B: Increasing intracranial pressure in brain metastasis would
result in symptoms of high blood pressure, decreased pulse rate, and
abnormal respirations known as Cushing triad.
 Options A and D: Often children with a variety of illnesses are
hypervigilant and anxious when hospitalized.
Which of the following types of leukemia carries the best prognosis?

Acute lymphoblastic leukemia

 Option B: Acute lymphoblastic leukemia, which accounts for more than

85% of all childhood cases, carries the best prognosis compared to adults.
Survival rate depends on the person’s age or white blood cell count at
time of diagnosis and individuals with cell subtypes such as pre-B also
considered to have a higher survival rate than those with mature B-cell
leukemia.
 Options A and D: Basophilic and eosinophilic leukemia are named for the
specific cells involved. These are much rarer and carry a poorer prognosis.
  Option C: Acute myelogenous leukemia, with several subtypes, accounts
for most of the other leukemias affecting children.
Which of the following is the reason to perform a spinal tap on a client newly diagnosed
with leukemia?

To assess for central nervous system infiltration

 Option A: A spinal tap is performed to check if leukemia has infiltrated

into the central nervous system specifically to the cerebrospinal fluid
(CSF).
 Options B and D: It wouldn’t be done to decrease ICP nor does it aid in
the classification of leukemia. Spinal taps can result in brain stem
herniation in cases of ICP.
 Option C: A spinal tap can be done to rule out meningitis but this isn’t the
indication for the test on a leukemic client.
Joseph who had a history of long-term smoking and alcoholism is diagnosed with
oropharyngeal cancer. He is admitted into the chemo unit for the initiation of
chemotherapy. Which of the following tests is performed before the infusion of
chemotherapeutic agents?

Liver function test

  Liver and kidney function studies are done before the initiation of
chemotherapy to evaluate the client’s ability to metabolize the
chemotherapeutic agents.
 Option A: A CBC is performed to assess for anemia and white blood cell
count.
 Option B: A peripheral blood smear is done to assess the maturity and
morphology of red blood cells.
 Option C: A lumbar puncture is performed to assess for central nervous
system infiltration.
Which of the following immunizations should not be given to a 4-month-old sibling of a
client with leukemia?

Oral poliovirus vaccine (OPV)

 Option A: OPV is a live attenuated virus excreted in the stool. The

excreted virus can be communicated to the immunosuppressed child,
resulting in an overwhelming infection. Inactivated polio vaccine would be
 indicated because it isn’t a live virus and wouldn’t pose the threat of
infection.
 Options B, C, and D: DTP, Hib, and hepatitis B vaccines can be given
accordingly to the recommended schedule.
Which of the following medications usually is given to a client with leukemia as prophylaxis
against P. carinii pneumonia?

 Sulfamethoxazole and trimethoprim (Bactrim)

 ption D: The most frequent cause of death from leukemia is an

overwhelming infection. P. carinii infection is lethal to a child with
leukemia. As prophylaxis against P. carinii pneumonia, continuous low
doses of co-trimoxazole (Bactrim) are frequently prescribed.
 Option A: Vincristine, an antineoplastic agent is used in the treatment for
leukemia but is not used as a prophylaxis against pneumonia.
 Option B: Prednisone isn’t an antibiotic and increases susceptibility to
infection.
 Option C: Oral nystatin suspension would be indicated for the treatment
of thrush.
In which of the following diseases would bone marrow transplantation not be indicated in a
newly diagnosed client?

Acute lymphocytic leukemia

 Option C: For the first episode of acute lymphocytic leukemia,

conventional therapy is superior to bone marrow transplantation.
Treatment is usually long-term chemotherapy and is composed of 3
phases (induction, consolidation, and maintenance).
 Options A and B: In severe combined immunodeficiency and in severe
aplastic anemia, bone marrow transplantation has been employed to
replace abnormal stem cells with healthy cells from the donor’s marrow.
 Option D: In myeloid leukemia, bone marrow transplantation is done
after chemotherapy to infuse healthy marrow and to replace marrow
stem cells ablated during chemotherapy.
Which of the following treatment measures should be implemented for a child with
leukemia who has been exposed to the chickenpox?

VZIG should be given within 72 hours of exposure

  Option B: Varicella is a lethal organism to a child with leukemia. VZIG,
given within 72 hours, may favorably alter the course of the disease.
 Option A: Acyclovir may be given if the child develops the disease but not
if the child has been exposed.
 Option C: Chickenpox can cause severe complications in children afflicted
with leukemia if left untreated.
 Option D: Giving the vaccine at the onset of symptoms wouldn’t likely
decrease the severity of the illness.
Nausea and vomiting are common adverse effects of radiation and chemotherapy. When
should a nurse administer antiemetics?

 30 minutes before the initiation of therapyOption D: Antiemetics are most

beneficial when given before the onset of nausea and vomiting. To
calculate the optimum time for administration, the first dose is given 30
minutes to 1 hour before nausea is expected, and then every 2, 4, or 6
hours for approximately 24 hours after chemotherapy.
 Options A, B, and C: If the antiemetic was given with the medication or
after the medication, it could lose its maximum effectiveness when
needed.
Parents of pediatric clients who undergo irradiation involving the central nervous system
should be warned about postirradiation somnolence. When does this neurologic syndrome
usually occur?

 Within 5 to 8 weeks

Postirradiation somnolence may develop 5 to 8 weeks after CNS irradiation and may last 3
to 15 days. It’s characterized by somnolence with or without fever, anorexia, nausea, and
vomiting. Although the syndrome isn’t thought to be clinically significant, parents should be
prepared to expect such symptoms and encourage the child to rest.

The nurse is instructing the client to perform a testicular self-examination. The nurse tells
the client:

. The best time for the examination is after a shower

 The testicular-self examination is recommended monthly after a warm

shower or bath when the scrotal skin is relaxed. The client should stand to
examine the testicles. Using both hands, with the fingers under the
scrotum and the thumbs on top, the client should gently roll the testicles,
feeling for any lumps.
  Option A: Testicular self-examination is done at least once a month.
 Option B: Testicles are examined using both hands by placing the index
and middle fingers under the scrotum.
 Option C: To do the exam, the patient should stand in front of a mirror.
The community nurse is conducting a health promotion program at a local school and is
discussing the risk factors associated with cancer. Which of the following, if identified by
the client as a risk factor, indicates a need for further instructions?

Low-fat and high-fiber diet

 Option D: A diet high in fat may be a factor in the development of breast,
colon, and prostate cancers. High-fiber diets may reduce the risk of colon
cancer.
 Option A: Increased stress has been associated with causing the growth
and proliferation of cancer cells.
 Option B: Two forms of radiation, ultraviolet and ionizing, can lead to
cancer.
 Option C: Viruses may be one of the multiple agents acting to initiate
carcinogenesis and have been associated with several types of cancer.
The client with cancer is receiving chemotherapy and develops thrombocytopenia. The
nurse identifies which intervention is the highest priority in the nursing plan of care?

Monitoring the platelet count

 Thrombocytopenia indicates a decrease in the number of platelets in the

circulating blood. A major concern is monitoring for and preventing
bleeding.
 Option A: Relates to monitoring for infection particularly if leukopenia is
present.
 Options B and C: Although monitoring the pathological factors and
ambulation are important in the plan of care. They are not related directly
to thrombocytopenia.
A client is diagnosed with multiple myeloma. The client asks the nurse about the diagnosis.
The nurse bases the response on which of the following descriptions of this disorder?

Malignant proliferation of plasma cells and tumors within the bone

  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.
 Option D: Malignant exacerbation in the number of leukocytes describes
the leukemic process.
 Options A and C: Altered RBC and lymph production are not
characteristics of multiple myeloma.
The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma.
Which of the following would the nurse expect to note specifically in this disorder?

 Increased calcium levels

 Option B: Hypercalcemia (increased calcium level) is caused by the

release of calcium from the deteriorating bone tissue in multiple
myeloma. This may cause symptoms of excessive thirst, constipation,
dehydration, nausea, frequent urination, dizziness, confusion, and
eventually to coma.
 Options A and C: Findings indicative of multiple myeloma are an
increased number of plasma cells in the bone marrow and elevated uric
acid levels.
 Option D: An increased white blood cell count may or may not be present
and is not related specifically to multiple myeloma.
The nurse is developing a plan of care for the client with multiple myeloma. The nurse
includes which priority intervention in the plan of care?

Encouraging fluids

 Option A: Hypercalcemia caused by bone destruction is a priority concern

in the client with multiple myeloma. The nurse should administer fluids in
adequate amounts to maintain an output of 1.5 to 2 L a day. Clients
require about 3 L of fluid per day. The fluid is needed not only to dilute the
calcium overload but also to prevent protein from precipitating in renal
tubules.
 Options B, C, and D: These are components in the plan of care but are
not the priority in this client.
The oncology nurse specialist provides an educational session to nursing staff regarding
the characteristics of Hodgkin’s disease. The nurse determines that further education is
needed if a nursing staff member states which of the following is characteristic of the
disease?

Occurs most often in the older client

 Option B: Hodgkin’s disease is a disorder of young people up to age 40

and among adults. It is more common in adolescents between the ages of
15 and 19.
 Option A: Hodgkin’s lymphoma prognosis depends on the stage of the
disease. It is treatable in the early stages of the stages.
 Option C: Hodgkin’s disease is marked by the presence of Reed-Sternberg
cells which are the abnormal B lymphocytes (WBC that produces
antibodies that are essential in combating infections).
 Option D: The disease spread through the lymph vessels from lymph
node to lymph node. It can also travel to other parts such as the lung,
liver, and spleen.
The nurse is reviewing the laboratory results of a client receiving chemotherapy. The
platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing
assessment is which of the following?

Assess level of consciousness

 A high risk of hemorrhage exists when the platelet count is fewer than
20,000. Fatal central nervous system hemorrhage or massive
gastrointestinal hemorrhage can occur when the platelet count is fewer
than 10,000. The client should be assessed for changes in levels of
consciousness, which may be an early indication of an intracranial
hemorrhage.
 Option A: Skin turgor will be assessed if there is a presence of
dehydration in a patient with low platelet count but it is not the priority.
 Option B: Bowel sounds will be assessed when there is a presence of
gastrointestinal complications such as constipation, diarrhea, and
radiation enteritis.
 Option C: Assessing the temperature is a priority nursing assessment
when the white blood cell count is low and the client is at risk for an
infection.
Nurse Donald is caring for a client following a modified radical mastectomy. Which
assessment finding would indicate that the client is experiencing a complication related to
this surgery?

Arm edema on the operative side

 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. The surgery damages some of
the nodes and vessels that lymph moves through resulting in a backup of
fluid into the body’s tissue.
 Options A and B: Pain and decreased sensation in the chest area is
normal and it is caused by the damaged nerves in the armpit and chest
during the surgery.
 Option D: A sanguineous drainage in the Jackson-Pratt drain is normal
postoperatively. This output from the drain decreases each day and the
color will turn into light yellow or light pink.
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 with a sun protection factor (SPF) of 30 or more before sun exposure

 According to The American Academy of Dermatology A sunscreen with a

SPF of 30 or higher should be worn on all sun-exposed skin surfaces is
recommended as a protection against ultraviolet A (UVA) and ultraviolet B
(UVB) rays.
 Option A: Tightly woven clothing, protective hats, and sunglasses are
recommended to decrease sun exposure. Sun Tanning parlors should be
avoided.
 Option B: It should be applied 15 to 30 minutes before sun exposure and
reapplied after being in the water.
 Option D: Peak sun exposure usually occurs between 10 am to 2 pm.
Which of the following nursing interventions would be most helpful in making the
respiratory effort of a client with metastatic lung cancer more efficient?

Teaching and encouraging pursed-lip breathing

 For clients with obstructive versus restrictive disorders, extending

exhalation through pursed-lip breathing will make the respiratory effort
 more efficient. The usual position of choice for this client is the upright
position, leaning slightly forward to allow greater lung expansion.
 Option A: Teaching diaphragmatic breathing techniques will be more
helpful to the client with a restrictive disorder.
 Option B: Administering cough suppressants will not help the respiratory
effort.
 Option D: A low semi-Fowler’s position does not encourage lung
expansion. Lung expansion is enhanced in the upright position.
The nurse is teaching a 17-year old client and the client’s family about what to expect with
high-dose chemotherapy and the effects of neutropenia. What should the nurse teach as
the most reliable early indicator of infection in a neutropenic client?

 Fever

 A patient with neutropenia has a decreased number of neutrophils. These

cells are responsible for fighting off bacteria once they enter the body. A
complication of neutropenia is infection. An early sign is a fever that
requires clinical intervention to identify potential causes.
 Options A and D: Chills and dyspnea may or may not be observed.
 Option C: Tachycardia can be an indicator in a variety of clinical situations
when associated with infection; it usually occurs in response to an
elevated temperature or change in cardiac function.
A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how
the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is
which of the following?

“Chemotherapy affects all rapidly dividing cells.”

 here are many mechanisms of action for chemotherapeutic agents, but

most affect the rapidly dividing cells—both cancerous and noncancerous.
Cancer cells are characterized by rapid cell division.
 Option A: All cells are susceptible to drug toxins, but not all
chemotherapeutic agents are toxins.
 Options C and D: Chemotherapy slows cell division. Not all
chemotherapeutic agents affect the molecular structure.
 When caring for a client with a central venous line, which of the following nursing actions
should be implemented in the plan of care for chemotherapy administration? Select all
that apply.

 B. If unable to aspirate blood, reposition the client and encourage the

client to cough.

  C. Contact the health care provider about verifying placement if the
status is questionable.

  D. Inspect the insertion site for swelling, erythema, or drainage.

  E. Verify patency of the line by the presence of a blood return at

regular intervals.
Correct
Correct Answer: B, C, D, and E

 A major concern with the intravenous administration of cytotoxic agents is

vessel irritation or extravasation. The Oncology Nursing Society and
hospital guidelines require frequent evaluation of blood return when
administering vesicant or non vesicant chemotherapy due to the risk of
extravasation. These guidelines apply to peripheral and central venous
lines. In addition, central venous lines may be long-term venous access
devices. Thus, difficulty drawing or aspirating blood may indicate the line
is against the vessel wall or may indicate the line has occlusion. Having the
client cough or move position may change the status of the line if it is
temporarily against a vessel wall. Occlusion warrants more thorough
evaluation via x-ray study to verify placement if the status is questionable
and may require a declotting regimen.
A client with stomach cancer is admitted to the oncology unit after vomiting for 3 days.
Physical assessment findings include irregular pulse, muscle twitching, and complaints of
prickling sensations in the fingers and hands. Laboratory results include a potassium level
of 2.9 mEq/L, a pH of 7.46, and a bicarbonate level of 29 mEq/L. The client is experiencing:

Metabolic alkalosis

he client is experiencing metabolic alkalosis caused by loss of hydrogen and chloride ions
from excessive vomiting. This is shown by a pH of 7.46 and elevated bicarbonate level of 29
mEq/L.
A 28 year old female patient asks you when it is best to perform a self breast
exam. Your response is the following:

 It is best to perform a self breast exam 7 to 10 days after menses.

 It is best to perform a self breast exam every 6 months on the 1st day of
bleeding.
 It is best to perform a self breast exam on the same time every month of the

day. 
 It is best to perform a self breast exam on the day after ovulation.
Self breast exams should be performed 7 to 10 day after the start of menses (the patient's
period...this is the first day of bleeding). Breast tissue is soft at this time due to hormone levels.

You are educating a group of young men on preventing testicular cancer. What is
a correct statement by a participant regarding a testicular exam?

 "The best time to perform a self exam is after a shower." 

 "The testicle should feel hard but firm."
 "The testicle may have minor lumps or swelling due to monthly hormonal
changes."
 "I perform a self testicular exam once every 6 months."
The best time to perform a self testicular exam is after a shower when the scrotum is
descended and the tissue is soft. This makes it easier to feel for lumps or masses. All
the other options are incorrect.

As a shift leader making out patient assignments for the oncoming shift, how
would you assign care of a patient that has had a sealed radiation source placed?

 You decide to rotate staff and assign a nurse who has not provided care for
the patient.
 You decide to assign the same nurse who had the patient yesterday to continue

providing quality care. 

 None of the options are correct. Sealed radiation therapy has no special staffing
restrictions.
 You decide to assign one nurse to care for all the patients undergoing sealed
radiation therapy to provide continum of care.
Sealed radiation therapy patients are radioactive for 4-8 hours. Staff should be rotated
out and never required to provide care for more than on patient at a time. This
decreases radiation exposure.

A patient who has underwent a bone marrow transplant is at most risk for what?

 Bleeding and infection 

 Congestive heart failure
 Liver failure
 HIV
Patients who have underwent a bone marrow transplant are at major risk for bleeding
and infection. The bone marrow is responsible for producing infection and bleeding
fighting agents such as WBCs and platelets. Therefore, when a patient receives this
from a donor it takes time for the body to build up normal levels.

A patient with leukemia is entering the period known as "the nadir". As the nurse,
you know the following about this period:
 The patient is at greatest risk for bleeding and the patient can experience a

platelet count of 50,000 or less during this period. 

 The patient is at greatest risk for blood clots and the patient may experience a
platelet count of 500,000 or more.
 The patient is at risk for elevated hgb and hct, therefore, are at risk for stroke.
 The patient will need to be placed in reverse isolation due to low WBC count.
During this period, bone marrow suppression is the greatest, therefore, the platelet
count may be extremely low. This is the nadir period.

On assessment of a patient with leukemia, how would the patient present

clinically?
 Decreased hgb and hct, decreased platelets, and elevated or normal WBCs

with enlarged lymph nodes. 

 Elevated hgb and hct, decreased platelets, decreased WBCs, and bradycardia.
 Normal hgb and hct, normal platelets, and increased WBCs.
 Decreased hgb and hct, increased platelets, and elevated WBCs.
Clinically the patient will present with the following: Decreased hgb and hct, decreased
platelets, and elevated or normal WBCs with enlarged lymph nodes. This is because
leukemia effects the bone marrow. The bone marrow is responsible for production of
platelets, WBCs, and RBCs.

You are teaching a group of new nurse graduates hired on your oncology unit
about oncological disorders. Which statement by a nursing graduate about
Hodgkin's Disease require re-education?

 This disease always presents with hallmark signs of bone pain in the ribs,
spine, and pelvis.
 Reed Stenberg cells are present in the nodes.
 A positive CT scan of liver and spleen presents.
 A positive biopsy of the lymph nodes with cervical nodes most often

affected. 
All the options are correct expect for "This disease always presents with hallmark signs of bone
pain in the ribs, spine, and pelvis." This is a hallmark of Multiple Myleoma

You are developing a plan of care for a patient with multiple myeloma. What
nursing intervention(s) would be included in their plan of care?
 Encourage at least 2 Liters of fluids per day and skeletal support during

moving. 
 Discuss infertility issues with the patient.
 Assist with coughing and deep breathing exercises.
 Apply antiembolic stockings as prescribed.
Multiple myeloma is proliferation of plasma cells. This causes increased uric acid and
calcium levels. This, therefore, increases the patient's risk for renal failure and bone
problems. Encourage fluids to keep the kidneys "flushed" and skeletal support for the
bones helps with further complications.

Which patient is at highest risk for cervical cancer?

 A 21 year old who reports first sexual partner at the age of 14 and that she
has had at least 10 sex partners.
 A 60 year old with a history of syphillis and cigarette smoking.

 A 32 year old in a monogamous relationship who declined the HPV vaccine. 

 None of the patients are at risk for cervical cancer.
Due to the patient's young age of a first sexual encounter (any age before 17 is
significant) and multiple sex partners, drastically increases a person risk of cervical
cancer.

As an oncological nurse, you know what finding is correct regarding breast

cancer?

 Masses are usually felt in the upper outer quadrant beneath the nipple or
axilla.
 Women who've had a late menarche and early menopause are at risk for breast

cancer. 
 Nipple retraction is never present.
 The mass is typically painful and red.
All options are incorrect expect for "Masses are usually felt in the upper outer quadrant
beneath the nipple or axilla."

Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is
classified as:

Sarcoma.

Lymphoma.

Carcinoma.

Melanoma
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?

Anger

Denial

Bargaining

Depression
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?

Pain at the incisional site

Arm edema on the operative side

Sanguineous drainage in the Jackson-Pratt drain

Complaints of decreased sensation near the operative site

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?
Alcohol abuse
Cigarette smoking
Use of chewing tobacco
Exposure to air pollutants

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:

Rupture of the bladder

The development of a vesicovaginal fistula

Extreme stress caused by the diagnosis of cancer

Altered perineal sensation as a side effect of radiation therapy

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:

Nausea
Alopecia

Vomiting

Hyperuricemia

A 25 year old patient is inquiring about the methods or ways to detect cancer
earlier. The nurse least likely identify this method by stating:

Annual chest x-ray.

Annual Pap smear for sexually active women only.

Annual digital rectal examination for persons over age 40.

Yearly physical and blood examination

The removal of entire breast. pectoralis major and minor muscles and neck
lymph nodes which is followed by skin grafting is a procedure called:

Simple mastectomy

Modified radical mastectomy

Radiation therapy

Radical mastectomy
Chemotherapy is one of the therapeutic modalities for cancer. This treatment
is contraindicated to which of the following conditions?

Recent surgery

Pregnancy

Bone marrow depression

All of the above

The nurse is preparing Cyclophosphamide (Cytoxan). Safe handling of the
drug should be implemented to protect the nurse from injury. Which of the
following action by the nurse should be corrected?

The nurse should wear mask and gloves.

Air bubbles should be expelled on wet cotton.

Label the hanging IV bottle with “ANTINEOPLASTIC CHEMOTHERAPY”

sign.

Vent vials after mixing

A female client is undergoing tests for multiple myeloma. Diagnostic study

findings in multiple myeloma include:

Bence Jones protein in the urine

A 35 years old client has been receiving chemotherapy to treat cancer. Which
assessment finding suggests that the client has developed stomatitis
(inflammation of the mouth)?

Red, open sores on the oral mucosa

A female client is receiving chemotherapy to treat breast cancer. Which

assessment finding indicates a fluid and electrolyte imbalance induced by
chemotherapy?

Dry oral mucous membranes and cracked lips

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:
changes from previous self-examinations

Which intervention is appropriate for the nurse caring for a male client in
severe pain receiving a continuous I.V. infusion of morphine?

Obtaining baseline vital signs before administering the first dose

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?

“Keep the stoma moist.

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?

Polyps

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?

leucovorin (citrovorum factor or folinic acid [Wellcovorin

Jeovina, with advanced breast cancer is prescribed tamoxifen (Nolvadex).

When teaching the client about this drug, the nurse should emphasize the
importance of reporting which adverse reaction immediately?

Vision changes
The nurse is preparing for a female client for magnetic resonance imaging
(MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which of
the following would pose a threat to the client?

The client wears a watch and wedding band

A 34-year-old female client is requesting information about mammograms

and breast cancer. She isn’t considered at high risk for breast cancer. What
should the nurse tell this client?

She should eat a low-fat diet to further decrease her risk of breast cancer.

For a female client newly diagnosed with radiation-induced thrombocytopenia,

the nurse should include which intervention in the plan of care?

Inspecting the skin for petechiae once every shift

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?

Human papillomavirus infection at age 32

Nurse Lucia is providing breast cancer education at a community facility. The

American Cancer Society recommends that women get mammograms:

yearly after age 40

Nurse Brian is developing a plan of care for marrow suppression, the major
dose-limiting adverse reaction to floxuridine (FUDR). How long after drug
administration does bone marrow suppression become noticeable?

7 to 14 days

A female client has an abnormal result on a Papanicolaou test. After

admitting, she read his chart while the nurse was out of the room, the client
asks what dysplasia means. Which definition should the nurse provide?

Alteration in the size, shape, and organization of differentiated cells

During chemotherapy, an oncology client has a nursing diagnosis of impaired
oral mucous membrane related to decreased nutrition and
immunosuppression secondary to the cytotoxic effects of chemotherapy.
Which nursing intervention is most likely to decrease the pain of stomatitis?

Providing a solution of hydrogen peroxide and water for use as a mouth rinse

When caring for a male client diagnosed with a brain tumor of the parietal
lobe, the nurse expects to assess:

tactile agnosia.

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?

Indigestion

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:

normal cellular processes during the S phase of the cell cycle.

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?

“Client verbalizes feelings of anxiety.

What should a male client over age 52 do to help ensure early identification of
prostate cancer?

Have a digital rectal examination and prostate-specific antigen (PSA) test

done yearly.
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:

fine needle aspiration

A male client is in isolation after receiving an internal radioactive implant to

treat cancer. Two hours later, the nurse discovers the implant in the bed
linens. What should the nurse do first?

Pick up the implant with long-handled forceps and place it in a lead-lined

container.

The ABCD method offers one way to assess skin lesions for possible skin
cancer. What does the A stand for?

Asymmetry

A male client complains of sporadic epigastric pain, yellow skin, nausea,

vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the
physician orders a diagnostic workup, which reveals gallbladder cancer.
Which nursing diagnosis may be appropriate for this client?

Anticipatory grieving

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?

Related to impaired balance

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:

Fatigue

A female client with cancer is being evaluated for possible metastasis. Which
of the following is one of the most common metastasis sites for cancer cells?
Liver

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:

have a mammogram annually

A client diagnosed with widespread lung cancer asks the nurse why he must be careful to avoid
crowds and people who are ill. What is the nurse's best response?
D. "When lung cancer is in the bones, it can prevent production of immune system cells, making
you less resistant to infection."