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NCLEX Practice Test for Oncology 1

1. 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?
a. Presence of completely undifferentiated tumor cells that dont resemble cells of the tissues of
their origin
b. Increase in the number of normal cells in a normal arrangement in a tissue or an organ
c. Replacement of one type of fully differentiated cell by another in tissues where the second
type normally isnt found
d. Alteration in the size, shape, and organization of differentiated cells

2. 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?
a. Client verbalizes feelings of anxiety.
b. Client doesnt guess at prognosis.
c. Client uses any effective method to reduce tension.
d. Client stops seeking information.

3. 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?
a. Related to visual field deficits
b. Related to difficulty swallowing
c. Related to impaired balance
d. Related to psychomotor seizures

4. 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:
a. hair loss.
b. stomatitis.
c. fatigue.
d. vomiting.

5. 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:
a. breast self-examination.
b. mammography.
c. fine needle aspiration.
d. chest X-ray.

6. 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?
a. Keep the stoma uncovered.
b. Keep the stoma dry.
c. Have a family member perform stoma care initially until you get used to the procedure.
d. Keep the stoma moist.

7. A female client is receiving chemotherapy to treat breast cancer. Which assessment finding
indicates a fluid and electrolyte imbalance induced by chemotherapy?
a. Urine output of 400 ml in 8 hours
b. Serum potassium level of 3.6 mEq/L
c. Blood pressure of 120/64 to 130/72 mm Hg
d. Dry oral mucous membranes and cracked lips

8. 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:
a. cancerous lumps.
b. areas of thickness or fullness.
c. changes from previous self-examinations.
d. fibrocystic masses.

9. A client, age 41, visits the gynecologist. After examining her, the physician suspects cervical
cancer. The nurse reviews the clients history for risk factors for this disease. Which history
finding is a risk factor for cervical cancer?
a. Onset of sporadic sexual activity at age 17
b. Spontaneous abortion at age 19
c. Pregnancy complicated with eclampsia at age 27
d. Human papillomavirus infection at age 32

10. 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?
a. probenecid (Benemid)
b. cytarabine (ara-C, cytosine arabinoside [Cytosar-U])
c. thioguanine (6-thioguanine, 6-TG)
d. leucovorin (citrovorum factor or folinic acid [Wellcovorin])

11. 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?
a. Duodenal ulcers
b. Hemorrhoids
c. Weight gain
d. Polyps

12. 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:
a. perform breast self-examination annually.
b. have a mammogram annually.
c. have a hormonal receptor assay annually.
d. have a physician conduct a clinical examination every 2 years.

13. 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
a. Persistent nausea
b. Rash
c. Indigestion
d. Chronic ache or pain

14. For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse
should include which intervention in the plan of care?
a. Administering aspirin if the temperature exceeds 102 F (38.8 C)
b. Inspecting the skin for petechiae once every shift
c. Providing for frequent rest periods
d. Placing the client in strict isolation

15. Nurse Lucia is providing breast cancer education at a community facility. The American
Cancer Society recommends that women get mammograms:
a. yearly after age 40.
b. after the birth of the first child and every 2 years thereafter.
c. after the first menstrual period and annually thereafter.
d. every 3 years between ages 20 and 40 and annually thereafter.

16. Which intervention is appropriate for the nurse caring for a male client in severe pain
receiving a continuous I.V. infusion of morphine?
a. Assisting with a naloxone challenge test before therapy begins
b. Discontinuing the drug immediately if signs of dependence appear
c. Changing the administration route to P.O. if the client can tolerate fluids
d. Obtaining baseline vital signs before administering the first dose

17. 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
a. cell division or mitosis during the M phase of the cell cycle.
b. normal cellular processes during the S phase of the cell cycle.
c. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA
molecules (cell cyclenonspecific).
d. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cycle

18. The ABCD method offers one way to assess skin lesions for possible skin cancer. What does
the A stand for?
a. Actinic
b. Asymmetry
c. Arcus
d. Assessment

19. When caring for a male client diagnosed with a brain tumor of the parietal lobe, the nurse
expects to assess:
a. short-term memory impairment.
b. tactile agnosia.
c. seizures.
d. contralateral homonymous hemianopia.

20. A female client is undergoing tests for multiple myeloma. Diagnostic study findings in
multiple myeloma include:
a. a decreased serum creatinine level.
b. hypocalcemia.
c. Bence Jones protein in the urine.
d. a low serum protein level.

21. 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)?
a. White, cottage cheeselike patches on the tongue
b. Yellow tooth discoloration
c. Red, open sores on the oral mucosa
d. Rust-colored sputum

22. 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
a. Recommending that the client discontinue chemotherapy
b. Providing a solution of hydrogen peroxide and water for use as a mouth rinse
c. Monitoring the clients platelet and leukocyte counts
d. Checking regularly for signs and symptoms of stomatitis

23. What should a male client over age 52 do to help ensure early identification of prostate
a. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.
b. Have a transrectal ultrasound every 5 years.
c. Perform monthly testicular self-examinations, especially after age 50.
d. Have a complete blood count (CBC) and blood urea nitrogen (BUN) and creatinine levels
checked yearly.

24. 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?
a. Anticipatory grieving
b. Impaired swallowing
c. Disturbed body image
d. Chronic low self-esteem

25. 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
a. Stand as far away from the implant as possible and call for help.
b. Pick up the implant with long-handled forceps and place it in a lead-lined container.
c. Leave the room and notify the radiation therapy department immediately.
d. Put the implant back in place, using forceps and a shield for self-protection, and call for help.

26. 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?
a. Vision changes
b. Hearing loss
c. Headache
d. Anorexia

27. 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?
a. Liver
b. Colon
c. Reproductive tract
d. White blood cells (WBCs)

28. A 34-year-old female client is requesting information about mammograms and breast cancer.
She isnt considered at high risk for breast cancer. What should the nurse tell this client?
a. She should have had a baseline mammogram before age 30.
b. She should eat a low-fat diet to further decrease her risk of breast cancer.
c. She should perform breast self-examination during the first 5 days of each menstrual cycle.
d. When she begins having yearly mammograms, breast self-examinations will no longer be

29. 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?
a. 24 hours
b. 2 to 4 days
c. 7 to 14 days
d. 21 to 28 days

30. 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?
a. The client lies still.
b. The client asks questions.
c. The client hears thumping sounds.
d. The client wears a watch and wedding band.

1.Answer D. Dysplasia refers to an alteration in the size, shape, and organization of
differentiated cells. The presence of completely undifferentiated tumor cells that dont
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 isnt found is called metaplasia.

2.Answer A. Verbalizing feelings is the clients first step in coping with the situational crisis.
It also helps the health care team gain insight into the clients 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 isnt appropriate because seeking information can help a client
with cancer gain a sense of control over the crisis.

3.Answer C. 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

4.Answer C. 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.

5.Answer C. 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.

6.Answer D. 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.

7.Answer D. 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.

8.Answer C. 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.

9.Answer D. 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 arent risk factors for cervical cancer.

10.Answer D. 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 arent used to treat osteogenic

11.Answer D. Colorectal polyps are common with colon cancer. Duodenal ulcers and
hemorrhoids arent preexisting conditions of colorectal cancer. Weight loss not gain is
an indication of colorectal cancer.

12.Answer B. 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.

13.Answer C. 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 isnt one of the seven major warning signs. Rash and chronic ache or
pain seldom indicate cancer.

14.Answer B. 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.

15.Answer A. The American Cancer Society recommends a mammogram yearly for women
over age 40. The other statements are incorrect. Its recommended that women between
ages 20 and 40 have a professional breast examination (not a mammogram) every 3

16.Answer D. The nurse should obtain the clients 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 shouldnt 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.

17.Answer B. Antimetabolites act during the S phase of the cell cycle, contributing to cell
destruction or preventing cell replication. Theyre 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.

18.Answer B. 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

19.Answer B. 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.

20.Answer C. Presence of Bence Jones protein in the urine almost always confirms the
disease, but absence doesnt 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.

21.Answer C. The tissue-destructive effects of cancer chemotherapy typically cause
stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White,
cottage cheeselike patches on the tongue suggest a candidal infection, another common
adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic
therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder,
such as pneumonia.

22.Answer B. To decrease the pain of stomatitis, the nurse should provide a solution of
hydrogen peroxide and water for the client to use as a mouth rinse. (Commercially prepared
mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The
nurse also may administer viscous lidocaine or systemic analgesics as prescribed. Stomatitis
occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldnt be
helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure
prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and
infection but wouldnt decrease pain in this highly susceptible client. Checking for signs and
symptoms of stomatitis also wouldnt decrease the pain.

23.Answer A. The incidence of prostate cancer increases after age 50. The digital rectal
examination, which identifies enlargement or irregularity of the prostate, and PSA test, a
tumor marker for prostate cancer, are effective diagnostic measures that should be done
yearly. Testicular self-examinations wont identify changes in the prostate gland due to its
location in the body. A transrectal ultrasound, CBC, and BUN and creatinine levels are
usually done after diagnosis to identify the extent of the disease and potential metastases

24.Answer A. Anticipatory grieving is an appropriate nursing diagnosis for this client
because few clients with gallbladder cancer live more than 1 year after diagnosis. Impaired
swallowing isnt associated with gallbladder cancer. Although surgery typically is done to
remove the gallbladder and, possibly, a section of the liver, it isnt disfiguring and doesnt
cause Disturbed body image. Chronic low self-esteem isnt an appropriate nursing diagnosis
at this time because the diagnosis has just been made.

25.Answer B. If a radioactive implant becomes dislodged, the nurse should pick it up with
long-handled forceps and place it in a lead-lined container, then notify the radiation therapy
department immediately. The highest priority is to minimize radiation exposure for the client
and the nurse; therefore, the nurse must not take any action that delays implant removal.
Standing as far from the implant as possible, leaving the room with the implant still
exposed, or attempting to put it back in place can greatly increase the risk of harm to the
client and the nurse from excessive radiation exposure.

26.Answer A. The client must report changes in visual acuity immediately because this
adverse effect may be irreversible. Tamoxifen isnt associated with hearing loss. Although
the drug may cause anorexia, headache, and hot flashes, the client need not report these
adverse effects immediately because they dont warrant a change in therapy.

27.Answer A. The liver is one of the five most common cancer metastasis sites. The others
are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are
occasional metastasis sites.

28.Answer B. A low-fat diet (one that maintains weight within 20% of recommended body
weight) has been found to decrease a womans risk of breast cancer. A baseline
mammogram should be done between ages 30 and 40. Monthly breast self-examinations
should be done between days 7 and 10 of the menstrual cycle. The client should continue to
perform monthly breast self-examinations even when receiving yearly mammograms.

29.Answer C. Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine
administration. Bone marrow recovery occurs in 21 to 28 days.

30.Answer D. During an MRI, the client should wear no metal objects, such as jewelry,
because the strong magnetic field can pull on them, causing injury to the client and (if they
fly off) to others. The client must lie still during the MRI but can talk to those performing the
test by way of the microphone inside the scanner tunnel. The client should hear thumping
sounds, which are caused by the sound waves thumping on the magnetic field.

NCLEX Practice Test for Oncology 2

1. Nina, an oncology nurse educator is speaking to a womens 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?
a. Mammography is the most reliable method for detecting breast cancer.
b. Breast cancer is the leading killer of women of childbearing age.
c. Breast cancer requires a mastectomy.
d. Men can develop breast cancer.

2. Nurse Meredith is instructing a premenopausal woman about breast self-examination. The
nurse should tell the client to do her self-examination:
a. at the end of her menstrual cycle.
b. on the same day each month.
c. on the 1st day of the menstrual cycle.
d. immediately after her menstrual period.

3. Nurse Kent is teaching a male client to perform monthly testicular self-examinations. Which
of the following points would be appropriate to make?
a. Testicular cancer is a highly curable type of cancer.
b. Testicular cancer is very difficult to diagnose.
c. Testicular cancer is the number one cause of cancer deaths in males.
d. Testicular cancer is more common in older 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?
a. Immediately
b. 1 week
c. 2 to 3 weeks
d. 1 month

5. A male client is receiving the cell cyclenonspecific 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?
a. It interferes with deoxyribonucleic acid (DNA) replication only.
b. It interferes with ribonucleic acid (RNA) transcription only.
c. It interferes with DNA replication and RNA transcription.
d. It destroys the cell membrane, causing lysis.

6. The nurse is instructing the 35 year old client to perform a testicular self-examination. The
nurse tells the client:
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 testicular self-examination should be done at least every 6 months

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?
a. Monitoring temperature
b. Ambulation three times daily
c. Monitoring the platelet count
d. Monitoring for pathological fractures

8. Gian, a community health nurse is instructing a group of female clients about breast self-
examination. The nurse instructs the client to perform the examination:
a. At the onset of menstruation
b. Every month during ovulation
c. Weekly at the same time of day
d. 1 week after menstruation begins

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?
a. Elevating the knee gatch on the bed
b. Assisting with range-of-motion leg exercises
c. Removal of antiembolism stockings twice daily
d. Checking placement of pneumatic compression boots

10. Mina, who is suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse
provides which preprocedure instruction to the client?
a. Eat a light breakfast only
b. Maintain an NPO status before the procedure
c. Wear comfortable clothing and shoes for the procedure
d. Drink six to eight glasses of water without voiding before the test

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?
a. Biopsy of the tumor
b. Abdominal ultrasound
c. Magnetic resonance imaging
d. Computerized tomography scan

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?
a. Altered red blood cell production
b. Altered production of lymph nodes
c. Malignant exacerbation in the number of leukocytes
d. Malignant proliferation of plasma cells within the bone

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?
a. Increased calcium
b. Increased white blood cells
c. Decreased blood urea nitrogen level
d. Decreased number of plasma cells in the bone marrow

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?
a. Alopecia
b. Back pain
c. Painless testicular swelling
d. Heavy sensation in the scrotum

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:
a. Dyspnea
b. Diarrhea
c. Sore throat
d. Constipation

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?
a. Limit the time with the client to 1 hour per shift
b. Do not allow pregnant women into the clients room
c. Remove the dosimeter badge when entering the clients room
d. Individuals younger than 16 years old may be allowed to go in the room as long as they are 6
feet away from the client

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?
a. Bed rest
b. Out of bed ad lib
c. Out of bed in a chair only
d. Ambulation to the bathroom only

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:
a. Call the physician
b. Reinsert the implant into the vagina immediately
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.

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:
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

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 clients pain would include
which of the following?
a. The clients pain rating
b. Nonverbal cues from the client
c. The nurses impression of the clients pain
d. Pain relief after appropriate nursing intervention

21. Nurse Mickey is caring for a client who is postoperative following a pelvic exenteration and
the physician changes the clients diet from NPO status to clear liquids. The nurse makes which
priority assessment before administering the diet?
a. Bowel sounds
b. Ability to ambulate
c. Incision appearance
d. Urine specific gravity

22. A male client is admitted to the hospital with a suspected diagnosis of Hodgkins disease.
Which assessment findings would the nurse expect to note specifically in the client?
a. Fatigue
b. Weakness
c. Weight gain
d. Enlarged lymph nodes

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?
a. Diarrhea
b. Hypermenorrhea
c. Abdominal bleeding
d. Abdominal distention

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?
a. Infection
b. Hemorrhage
c. Cervical stenosis
d. Ovarian perforation

25. Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is classified
a. sarcoma.
b. lymphoma.
c. carcinoma.
d. melanoma.

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 daughters graduation, Ill be ready to
die. Which phrase of coping is this client experiencing?
a. Anger
b. Denial
c. Bargaining
d. Depression

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?
a. Pain at the incisional site
b. Arm edema on the operative side
c. Sanguineous drainage in the Jackson-Pratt drain
d. Complaints of decreased sensation near the operative site

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?
a. Alcohol abuse
b. Cigarette smoking
c. Use of chewing tobacco
d. Exposure to air 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
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

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:
a. Nausea
b. Alopecia
c. Vomiting
d. Hyperuricemia
1. Answer D. 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. Answer D. 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 womans 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. Answer A. Testicular cancer is highly curable, particularly when its 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. Answer C. Chlorambucil-induced alopecia occurs 2 to 3 weeks after therapy begins.

5. Answer C. Thiotepa interferes with DNA replication and RNA transcription. It doesnt
destroy the cell membrane.

6. Answer B. 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. Answer C. 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. Answer D. 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. Answer A. 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. Answer D. 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. Answer A. 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. Answer D. 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. Answer A. 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

14. Answer A. 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. Answer C. 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

16. Answer B. 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 clients room. Children younger than 16 years of age and pregnant women are not
allowed in the clients room.

17. Answer A. 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. Answer D. A lead container and long-handled forceps should be kept in the clients
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. Answer C. 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

20. Answer A. The clients 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 clients
words used to describe the pain. The nurses impression of the clients pain is not
appropriate in determining the clients 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. Answer A. 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. Answer D. Hodgkins 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. Answer D. 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. Answer D. 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. Answer A. Tumors that originate from bone,muscle, and other connective tissue are
called sarcomas.

26. Answer C. 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. Answer B. 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. Answer B. 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. Answer B. 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 clients
complaint is not associated with options A, C, and D.

30. Answer D. 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.


Exam Prep Questions
1. Which nursing intervention is most important when administering the chemotherapeutic drug
Platinol (cisplatin)?

A. Administration of an IV bolus of fluid before and after the drug is given

B. Performing deep tendon reflex assessment every two hours after the infusion

C. Assessing the clients food intake

D. Auscultating breath sounds every four hours

2. A client diagnosed with metastatic cancer of the bone is exhibiting mental confusion and a BP
of 160/100. Which laboratory value would correlate with the clients symptoms reflecting a
common complication with this diagnosis?

A. Potassium 5.2 mEq/l

B. Calcium 13 mg/dl

C. Inorganic phosphorus 1.7 mEq/l

D. Sodium 138 mEq/l

3. A client with cancer has been placed on TPN. The nurse notes air entering the client via the
central line. Which initial action is most appropriate?

A. Notify the physician.

B. Elevate the head of the bed.

C. Place the client in the left Trendelenburg position.

D. Stop the TPN and hang D51/2 NS.

4. The nurse is preparing a client for cervical uterine radiation implant insertion. Which will be
included in the teaching plan?

A. TV or telephone use will not be allowed while the implant is in place.

B. A Foley catheter is usually inserted.

C. A high fiber diet is recommended.

D. Excretions will be considered radioactive.

5. The nurse is caring for a client with leukemia who is receiving the drug doxorubicin
(Adriamycin). Which, if occurred, would be reported to the physician immediately due to the
toxic effects of this drug?

A. Rales and distended neck veins

B. Red discoloration of the urine and an output of 75 ml the previous hour

C. Nausea and vomiting

D. Elevated BUN and dry, flaky skin

6. A client with cancer received platelet infusions 24 hours ago. Which of the following
assessment findings would indicate the most therapeutic effect from the transfusions?

A. A Hgb level decrease from 8.9 to 8.7

B. A temperature reading of 99.4

C. A white blood cell count of 11,000

D. A decrease in oozing of blood from the IV site

7. The nurse is caring for a client receiving chemotherapy who is experiencing neutropenia.
Which intervention would be most appropriate to include in the clients plan of care?

A. Assess the clients temperature every four hours due to risk of hypothermia.

B. Instruct the client to avoid large crowds and people who are sick.

C. Instruct the client in the use of a soft toothbrush.

D. Assess the client for hematuria.

8. A client with cancer becomes emaciated, requiring TPN to provide adequate nutrition. The
nurse finds the TPN bag empty. Which fluid would the nurse select to hang until another bag is
prepared in the pharmacy?

A. Lactated Ringers

B. Normal saline

C. D10W

D. Normosol R

9. The nurse is caring for a client with possible cervical cancer. What clinical data would the
nurse most expect to find in the clients history?

A. Postcoital vaginal bleeding

B. Nausea and vomiting

C. Foul-smelling vaginal discharge

D. Hyperthermia

10. A client is scheduled to undergo a bone marrow aspiration. Which position would the nurse
assist the client into for this procedure?

A. Dorsal recumbent

B. Supine

C. High Fowlers

D. Lithotomy

Answer Rationales
1. Answer A is correct. Fluid administration is important to flush the drug through the renal
system to prevent damage. Cisplatin can cause renal damage. Answers B, C, and D would not
be important interventions with the drug administration, so they are incorrect.
2. Answer B is correct. Hypercalcemia is a common occurrence with cancer of the bone. The
potassium level is elevated but does not relate to the diagnosis, so answer A is incorrect.
Answers C and D are both normal levels, so they are incorrect.
3. Answer C is correct. The client is at risk for an air embolus. Placing the client in this position
displaces air away from the right ventricle. Answers B and D would not help, so they are
incorrect, and answer A would not be done first, so its incorrect.
4. Answer B is correct. A catheter allows urine elimination without possible disruption of the
implant. There is usually no restriction on TV or phone use, so answer A is incorrect. The
client is placed on a low residue diet, so answer C is incorrect. The clients radiation is not
internal; therefore, there are no special precautions with excretions, making answer D
5. Answer A is correct. This drug can cause cardiotoxicity exhibited by changes in the ECG and
congestive heart failure. Rales and distended neck veins are clinical manifestations of
congestive heart failure, so answer A is correct. A reddish discoloration to the urine is a
harmless side effect, so answer B is incorrect. An elevated BUN and dry, flaky skin are not
specific to this drug, so answers C and D are incorrect.
6. Answer D is correct. Platelets deal with the clotting of blood. Lack of platelets can cause
bleeding. Answers A, B, and C do not directly relate to platelets, so they are incorrect.
7. Answer B is correct. With neutropenia, the client is at risk for infection; therefore, he would
need to avoid crowds and people who are ill. Answer A would not be appropriate. Answers C
and D would correlate with a risk for bleeding, so they are incorrect.
8. Answer C is correct. D10W is the preferred solution to prevent complications from a sudden
lack of glucose. Answers A, B, and D do not have glucose, so they are incorrect.
9. Answer A is correct. Vaginal bleeding or spotting is a common symptom of cervical cancer.
Nausea and vomiting and foul-smelling discharge are not specific or common to cervical
cancer, so B and C are incorrect. Hyperthermia does not relate to the diagnosis, so answer D
is incorrect.
10. Answer C is correct. This procedure is usually done by the physician with specimens obtained
from the sternum or the iliac crest. The high Fowlers position would be the best position of the
ones listed to obtain a specimen from the clients sternum. Answers A, B, and D would be
inappropriate positions for getting a biopsy from the sites indicated.