Question 1

Question 1
WRONG
Which of the following treatment measures should be implemented for a child with
leukemia who has been exposed to the chickenpox?
No treatment is indicated.
Acyclovir (Zovirax) should be started on exposure
Varicella-zoster immunoglobulin (VZIG) should be given with the evidence of

disease
VZIG should be given within 72 hours of exposure.
Question 1 Explanation:
Varicella is a lethal organism to a child with leukemia. VZIG, given within 72 hours,
may favorably alter the course of the disease. Giving the vaccine at the onset of
symptoms wouldn’t likely decrease the severity of the illness. Acyclovir may be
given if the child develops the disease but not if the child has been exposed.
Question 2
WRONG
In the client with terminal lung cancer, the focus of nursing care is on which of the
following nursing interventions?
Provide emotional support
Provide nutritional support
Provide pain control
Prepare the client’s will

The client with terminal lung cancer may have extreme pleuritic pain and should be
treated to reduce his discomfort. 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. Nutritional support may be
provided, but as the terminal phase advances, the client’s nutritional needs greatly
decrease. Nursing care doesn’t focus on helping the client prepare the will.
Question 3
WRONG
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 that which of the
following is characteristic of the disease?
Presence of Reed-Sternberg cells
Involvement of lymph nodes, spleen, and liver
Occurs most often in the older client
Prognosis depends on the stage of the disease
Hodgkin’s disease is a disorder of young adults. Options 1, 2, and 4 are
characteristics of this disease.
Question 4
WRONG
Which of the following foods should a client with leukemia avoid?
White bread
Carrot sticks
Stewed apples
Medium rare steak
A low-bacteria diet would be indicated with excludes raw fruits and vegetables.
Question 5
WRONG
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:
Respiratory alkalosis
Respiratory acidosis
Metabolic alkalosis
Metabolic acidosis
The 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.
Question 6
WRONG
When a client has a lobectomy, what fills the space where the lobe was?
The space stays empty.

The surgeon fills the space with gel
The lung space fills up with serous fluid
The remaining lobe or lobes overexpand to fill the space.
The remaining lobe or lobes overexpand 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. The space can’t remain “empty” because
truly empty would imply a vacuum, which would interfere with the intrathoracic
pressure changes that allow breathing. The surgeon doesn’t use a gel to fill the
space. Serous fluid overproduction would compress the remaining lobes, diminish
their function and possibly, cause a mediastinal shift.
Question 7
WRONG
According to a standard staging classification of Hodgkin’s disease, which of the

following criteria reflects stage II?
Involvement of extralymphatic organs or tissues
Involvement of single lymph node region or structure
Involvement of two or more lymph node regions or structures.
Involvement of lymph node regions or structures on both sides of the diaphragm.
Stage II involves two or more lymph node regions. Stage I only involves one lymph
node region; stage III involves nodes on both sides of the diaphragm; and stage IV
involves extralymphatic organs or tissues.
Question 8
WRONG
The nurse is instructing the client to perform a testicular self-examination. The

nurse tells the client:
To examine the testicles while lying down.
The best time for the examination is after a shower
To gently feel the testicle with one finger to feel for a growth
That testicular examination should be done at least every 6 months.
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.
Question 9
WRONG
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?
Abdominal pain
Increased activity level
Increased appetite
Petechiae
The 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. Increased appetite can occur but it usually isn’t a
presenting symptom. Abdominal pain may be caused by areas of inflammation
from normal flora within the GI tract or any number of other causes.
Question 10
WRONG
At the time of diagnosis of Hodgkin’s lymphoma, which of the following areas is

often involved?
Back
Chest
Groin
Neck
At the time of diagnosis, a painless cervical lesion is often present. The back, chest,
and groin areas aren’t involved.
Question 11
WRONG
Which of the following tests in performed on a client with leukemia before initiation
of therapy to evaluate the child’s ability to metabolize chemotherapeutic agents?
Lumbar puncture
Liver function studies
Complete blood count (CBC)
Peripheral blood smear

Liver and kidney function studies are done before initiation of chemotherapy to
evaluate the child’s ability to metabolize the chemotherapeutic agents. A CBC is
performed to assess for anemia and white blood cell count. A peripheral blood
smear is done to assess the maturity and morphology of red blood cells. A lumbar
puncture is performed to assess for central nervous system infiltration.
Question 12
WRONG
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?
History of early menarche
Cyclic changes in mass size
History of anovulatory cycles
Increased vascularity of the breast
Increase in breast size or vascularity is consistent with cancer of the breast. 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.
Question 13
WRONG
The client with a benign lung tumor is treated in which of the following ways?
The tumor is treated with radiation only.

The tumor is treated with chemotherapy only.
The tumor is left alone unless symptoms are present.
The tumor is removed, involving the least possible amount of tissue.
The tumor is removed to prevent further compression of the lung tissue as the
tumor grows, which could lead to respiratory decompensation. If for some reason it
can’t be removed, then radiation or chemotherapy may be used to try to shrink the
tumor.
Question 14
WRONG
A nurse is providing education in a community setting about general measures to

avoid excessive sun exposure. Which of the following recommendations is
appropriate?
Apply sunscreen only after going in the water.
Avoid peak exposure hours from 9am to 1pm
Wear loosely woven clothing for added ventilation
Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun
exposure.
A sunscreen with a SPF of 15 or higher should be worn on all sun-exposed skin
surfaces. It should be applied before sun exposure and reapplied after being in the
water. Peak sun exposure usually occurs between 10am to 2pm. Tightly woven
clothing, protective hats, and sunglasses are recommended to decrease sun
exposure. Suntanning parlors should be avoided.
Question 15
WRONG
A pneumonectomy is a surgical procedure sometimes indicated for treatment of

non-small-cell lung cancer. A pneumonectomy involves removal of:
An entire lung field
A small, wedge-shaped lung surface
One lobe of a lung
One or more segments of a lung lobe
A pneumonectomy is the removal of an entire lung field. A wedge resection refers
to removal of a wedge-shaped section of lung tissue. A lobectomy is the removal of
one lobe. Removal of one or more segments of a lung lobe is called a partial
lobectomy.
Question 16
WRONG
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
Chills
Tachycardia
Dyspnea
Fever is an early sign requiring clinical intervention to identify potential causes.
Chills and dyspnea may or may not be observed. 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.
Question 17
WRONG
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?
Immediately
Within 1 to 2 weeks
Within 5 to 8 weeks
Within 3 to 6 months
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 needed rest.
Question 18
WRONG
A centrally located tumor would produce which of the following symptoms?
Coughing
Hemoptysis
Pleuritic pain
Shoulder pain
Centrally located pulmonary tumors are found in the upper airway (vocal cords)
and usually obstruct airflow, producing such symptoms as coughing, wheezing, and
stridor. Small cell tumors tend to be located in the lower airways and often cause
hemoptysis. As the tumor invades the pleural space, it may cause pleuritic pain.
Pancoast tumors that occur in the apices may cause shoulder pain.
Question 19
WRONG
A 56-year-old woman is currently receiving radiation therapy to the chest wall for
recurrent breast cancer. She calls her health care provider to report that she has
pain while swallowing and burning and tightness in her chest. Which of the
following complications of radiation therapy is most likely responsible for her
symptoms?
Hiatal hernia
Stomatitis
Radiation enteritis
Esophagitis
Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis,
which is a common complication of radiation therapy of the chest wall.
Question 20
WRONG
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?
Decreased number of plasma cells in the bone marrow.
Increased WBC’s
Increased calcium levels
Decreased blood urea nitrogen
Findings indicative of multiple myeloma are an increased number of plasma cells in
the bone marrow, anemia, hypercalcemia caused by the release of calcium from
the deteriorating bone tissue, and an elevated blood urea nitrogen level. An
increased white blood cell count may or may not be present and is not related
specifically to multiple myeloma.
Question 21
WRONG
If the client with lung cancer also has preexisting pulmonary disease, which of the
following statements best describes how the extent of that can be performed?
It doesn’t affect it.
It may require a whole lung to be removed.
The entire tumor may not be able to be removed
It may prevent surgery if the client can’t tolerate lung tissue removal.
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 on;t
chemotherapy and radiation.
Question 22
WRONG
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
Assess temperature
Assess bowel sounds
Assess skin turgor
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 2 is a priority nursing assessment when the white
blood cell count is low and the client is at risk for an infection.
Question 23
WRONG
Warning signs and symptoms of lung cancer include persistent cough, bloody
sputum, dyspnea, and which of the other following symptoms?
Dizziness
Generalized weakness
Hypotension
Recurrent pleural effusion
Recurring episodes of pleural effusions can be caused by the tumor and should be
investigated. Dizziness, generalized weakness, and hypotension aren’t typically
considered warning signals, but may occur in advanced stages of cancer.
Question 24
WRONG
Which of the following immunizations should not be given to a 4-month-old sibling

of a client with leukemia?
Diphtheria and tetanus and pertussis (DPT) vaccine.
Hepatitis B vaccine
Haemophilus influenzae type b vaccines (Hib)
Oral poliovirus vaccine (OPV)
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. DTP, Hib, and hepatitis B vaccines can be
given accordingly to the recommended schedule.
Question 25
WRONG
Nausea and vomiting are common adverse effects of radiation and chemotherapy.
When should a nurse administer antiemetics?
30 minutes before the initiation of therapy.
With the administration of therapy.
Immediately after nausea begins.
When therapy is completed.
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. If the antiemetic was given with the
medication or after the medication, it could lose its maximum effectiveness when
needed.
Question 26
WRONG
For which of the following conditions is a client with multiple myeloma (MM)
monitored?
Hypercalcemia
Hyperkalemia
Hypernatremia
Hypermagnesemia
Calcium is released when the bone is destroyed. This causes an increase in serum
calcium levels. MM doesn’t affect potassium, sodium, or magnesium levels.
Question 27
WRONG
Which of the following interventions is the key to increasing the survival rates of
clients with lung cancer?
Early bronchoscopy
Early detection
High-dose chemotherapy
Smoking cessation
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. A bronchoscopy may help
identify cell type but may not increase survival rate. High-dose chemotherapy has
minimal effect on long-term survival. Smoking cessation won’t reverse the process
but may help prevent further decompensation.
Question 28
WRONG
A client has been diagnosed with lung cancer and requires a wedge resection. How
much of the lung is removed?
One entire lung
A lobe of the lung
A small, localized area near the surface of the lung

A segment of the lung, including a bronchiole and its alveoli
A small area of tissue close to the surface of the lung is removed in a wedge
resection. An entire lung is removed in a pneumonectomy. A segment of the lung is
removed in a segmental resection and a lobe is removed in a lobectomy.
Question 29
WRONG
Giving instructions for breast self-examination is particularly important for clients

with which of the following medical problems?
Cervical dysplasia
A dermoid cyst
Endometrial polyps
Ovarian cancer
Clients with ovarian cancer are at increased risk for breast cancer. Breast self-
examination supports early detection and treatment and is very important.
Question 30
WRONG
In which of the following diseases would bone marrow transplantation not be

indicated in a newly diagnosed client?
Acute lymphocytic leukemia
Chronic myeloid leukemia

Severe aplastic anemia
Severe combined immunodeficiency
For the first episode of acute lymphocytic anemia, conventional therapy is superior
to bone marrow transplantation. 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. In myeloid
leukemia, bone marrow transplantation is done after chemotherapy to infuse
healthy marrow and to replace marrow stem cells ablated during chemotherapy.
Question 31
WRONG
A 32-year-old woman meets with the nurse on her first office visit since undergoing
a left mastectomy. When asked how she is doing, the woman states her appetite is
still not good, she is not getting much sleep because she doesn’t go to bed until her
husband is asleep, and she is really anxious to get back to work. Which of the
following nursing interventions should the nurse explore to support the client’s
current needs?
Call the physician to discuss allowing the client to return to work earlier.
Suggest that the client learn relaxation techniques to help with her insomnia
Perform a nutritional assessment to assess for anorexia
Ask open-ended questions about sexuality issues related to her mastectomy
The content of the client’s comments suggests that she is avoiding intimacy with
her husband by waiting until he is asleep before going to bed. Addressing sexuality
issues is appropriate for a client who has undergone a mastectomy. Rushing her
return to work may debilitate her and add to her exhaustion. Suggesting that she
learn relaxation techniques to help her with her insomnia is appropriate; however,
the nurse must first address the psychosocial and sexual issues that are
contributing to her sleeping difficulties. A nutritional assessment may be useful, but
there is no indication that she has anorexia.
Question 32
WRONG
Which of the following medications usually is given to a client with leukemia as

prophylaxis against P. carinii pneumonia?
Bactrim
Oral nystatin suspension
Prednisone
Vincristine (Oncovin)
The most frequent cause of death from leukemia is 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. Oral nystatin suspension would be indicated for the treatment of
thrush. Prednisone isn’t an antibiotic and increases susceptibility to infection.
Vincristine is an antineoplastic agent.
Question 33
WRONG
Which of the following clients is most at risk for developing multiple myeloma?
A 20-year-old Asian woman
A 30-year-old White man

A 50-year-old Hispanic woman
A 60-year-old Black man
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.
Question 34
WRONG
What are the three most important prognostic factors in determining long-term
survival for children with acute leukemia?
Histologic type of disease, initial platelet count, and type of treatment
Type of treatment and client’s sex
Histologic type of disease, initial WBC count, and client’s age at diagnosis
Progression of illness, WBC at the time of diagnosis, and client’s age at the time
of 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 age 2 or after 10.
Question 35
WRONG
One of the most serious blood coagulation complications for individuals with
cancer and for those undergoing cancer treatments is disseminated intravascular
coagulation (DIC). The most common cause of this bleeding disorder is:
Underlying liver disease
Brain metastasis
Intravenous heparin therapy
Sepsis
Bacterial endotoxins released from gram-negative bacteria activate the Hageman
factor or coagulation factor XII. This factor inhibits coagulation via the intrinsic
pathway of homeostasis, as well as stimulating fibrinolysis. Liver disease can cause
multiple bleeding abnormalities resulting in chronic, subclinical DIC; however,
sepsis is the most common cause.
Question 36
WRONG
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 the client diaphragmatic breathing techniques
Administering cough suppressants as ordered
Teaching and encouraging pursed-lip breathing
Placing the client in a low semi-Fowlers position
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. Teaching diaphragmatic breathing
techniques will be more helpful to the client with a restrictive disorder.
Administering cough suppressants will not help respiratory effort. A low semi-
Fowlers position does not encourage lung expansion. Lung expansion is enhanced
in the upright position.
Question 37
WRONG
The client with which of the following types of lung cancer has the best prognosis?
Adenocarcinoma
Oat cell
Squamous cell
Small cell
Squamous cell carcinoma is a slow-growing, rarely metastasizing type of cancer.
Adenocarcinoma is the next best lung cancer to have in terms of prognosis. Oat cell
and small cell carcinoma are the same. Small cell carcinoma grows rapidly and is
quick to metastasize.
Question 38
WRONG
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.
Verify patency of the line by the presence of a blood return at regular intervals.
Inspect the insertion site for swelling, erythema, or drainage.

Administer a cytotoxic agent to keep the regimen on schedule even if blood
return is not present.
If unable to aspirate blood, reposition the client and encourage the client to
cough.
Contact the health care provider about verifying placement if the status is
questionable.
A major concern with 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
nonvesicant 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.
Question 39
WRONG
Which of the following substances has abnormal values early in the course of
multiple myeloma (MM)?
Immunoglobulins
Platelets
Red blood cells
White blood cells

MM is characterized by malignant plasma cells that produce an increased amount
of immunoglobulin that isn’t functional. As more malignant plasma cells are
produced, there’s less space in the bone marrow for RBC production. In late stages,
platelets and WBC’s are reduced as the bone marrow is infiltrated by malignant
plasma cells.
Question 40
WRONG
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?
Coughing and deep breathing
Encouraging fluids
Monitoring red blood cell count
Providing frequent oral care
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 and output of 1.5 to 2 L a day. Clients require about 3 L of fluid pre day.
The fluid is needed not only to dilute the calcium overload but also to prevent
protein from precipitating in renal tubules. Options 1, 3, and 4 may be components
in the plan of care but are not the priority in this client.
Question 41
WRONG
Which of the following assessment findings in a client with leukemia would indicate
that the cancer has invaded the brain?
Headache and vomiting.

Restlessness and tachycardia
Hypervigilant and anxious behavior
Increased heart rate and decreased blood pressure.
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, increased blood pressure, decreased heart rate, and
eventually, coma. Often children with a variety of illnesses are hypervigilant and
anxious when hospitalized.
Question 42
WRONG
Which of the following laboratory values is expected for a client just diagnosed with
chronic lymphocytic leukemia?
Elevated sedimentation rate
Uncontrolled proliferation of granulocytes
Thrombocytopenia and increased lymphocytes
Elevated aspartate aminotransferase and alanine aminotransferase levels.
Chronic lymphocytic leukemia shows a proliferation of small abnormal mature B
lymphocytes and decreased antibody response. Thrombocytopenia also is often
present. Uncontrolled proliferation of granulocytes occurs in myelogenous
leukemia.
Question 43
WRONG
Which of the following represents the most appropriate nursing intervention for a
client with pruritis caused by cancer or the treatments?
Administration of antihistamines
Steroids
Silk sheets
Medicated cool baths
Nursing interventions to decrease the discomfort of pruitus include those that
prevent vasodilation, decrease anxiety, and maintain skin integrity and hydration.
Medicated baths with salicyclic acid or colloidal oatmeal can be soothing as a
temporary relief. The use of antihistamines or topical steroids depends on the
cause of pruritus, and these agents should be used with caution. Using silk sheets is
not a practical intervention for the hospitalized client with pruritis.
Question 44
WRONG
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.”
“The molecular structure of the DNA is altered.”
“Cancer cells are susceptible to drug toxins.”

“Chemotherapy encourages cancer cells to divide.”
There 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. Chemotherapy slows cell division. Not all
chemotherapeutic agents affect molecular structure. All cells are susceptible to
drug toxins, but not all chemotherapeutic agents are toxins.
Question 45
WRONG
A 36-year-old man with lymphoma presents with signs of impending septic shock 9
days after chemotherapy. The nurse could expect which of the following to be
present?
Flushing, decreased oxygen saturation, mild hypotension
Low-grade fever, chills, tachycardia
Elevated temperature, oliguria, hypotension
High-grade fever, normal blood pressure, increased respirations
Nine days after chemotherapy, one would expect the client to be
immunocompromised. The clinical signs of shock reflect changes in cardiac
function, vascular resistance, cellular metabolism, and capillary permeability. Low-
grade fever, tachycardia, and flushing may be early signs of shock. The client with
impending signs of septic shock may not have decreased oxygen saturation levels.
Oliguria and hypotension are late signs of shock. Urine output can be initially
normal or increased.
Question 46
WRONG
Which of the following conditions is not a complication of Hodgkin’s disease?
Anemia
Infection
Myocardial Infarction
Nausea
Complications of Hodgkin’s are pancytopenia, nausea, and infection. Cardiac
involvement usually doesn’t occur.
Question 47
WRONG
A client with leukemia has neutropenia. Which of the following functions must be
frequently assessed?
Blood pressure
Bowel sounds
Heart sounds
Breath sounds
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. Although assessing blood pressure, bowel sounds, and heart sounds is
important, it won’t help detect pneumonia.
Question 48
WRONG
Which of the following types of leukemia carries the best prognosis?
Acute lymphoblastic leukemia
Acute myelogenous leukemia
Basophilic leukemia
Eosinophilic leukemia
Acute lymphoblastic leukemia, which accounts for more than 80% of all childhood
cases, carries the best prognosis. Acute myelogenous leukemia, with several
subtypes, accounts for most of the other leukemias affecting children. Basophilic
and eosinophilic leukemia are named for the specific cells involved. These are much
rarer and carry a poorer prognosis.
Question 49
WRONG
Which of the following complications are three main consequences of leukemia?
Bone deformities, spherocytosis, and infection.
Anemia, infection, and bleeding tendencies
Lymphocytopoiesis, growth delays, and hirsutism
Polycythemia, decreased clotting time, and infection.
The three main consequences of leukemia are anemia, caused by decreased
erythrocyte production; infection secondary to neutropenia; and bleeding
tendencies, from decreased platelet production. 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. Hirsutism and growth delay can be a result of large doses of steroids but
isn’t common in leukemia. Anemia, not polycythemia, occurs. Clotting times would
be prolonged.
Question 50
WRONG
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 exacerbation in the number of leukocytes.
Altered red blood cell production.
Altered production of lymph nodes
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 1 describes the leukemic process. Options 2 and 3
are not characteristics of multiple myeloma.
Question 51
WRONG
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?
Viral factors
Stress
Low-fat and high-fiber diets
Exposure to radiation
Viruses may be one of multiple agents acting to initiate carcinogenesis and have
been associated with several types of cancer. Increased stress has been associated
with causing the growth and proliferation of cancer cells. Two forms of radiation,
ultraviolet and ionizing, can lead to cancer. 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.
Question 52
WRONG
The client with cancer is receiving chemotherapy and develops thrombocytopenia.

The nurse identifies which intervention as the highest priority in the nursing plan of
care?
Ambulation three times a day
Monitoring temperature
Monitoring the platelet count
Monitoring for pathological factors
Thrombocytopenia indicates a decrease in the number of platelets in the circulating
blood. A major concern is monitoring for and preventing bleeding. Option 2 relates
to monitoring for infection particularly if leukopenia is present. Options 1 and 4,
although important in the plan of care are not related directly to
thrombocytopenia.
Question 53
WRONG
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.
Non-dividing cells are more susceptible to chemotherapy
Faster growing cells are more susceptible to chemotherapy
Slower growing cells are more susceptible to chemotherapy.
The faster the cell grows, the more susceptible it is to chemotherapy and radiation
therapy. 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.
Question 54
WRONG
The nurse 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?
Sanguineous drainage in the Jackson-Pratt drain
Pain at the incisional site
Complaints of decreased sensation near the operative site
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 other options are expected occurrences.
Question 55
WRONG
Which of the following is the reason to perform a spinal tap on a client newly
diagnosed with leukemia?
To rule out meningitis
To decrease intracranial pressure
To aid in classification of the leukemia
To assess for central nervous system infiltration
A spinal tap is performed to assess for central nervous system infiltration. It
wouldn’t be done to decrease ICP nor does it aid in the classification of the
leukemia. Spinal taps can result in brain stem herniation in cases of ICP. A spinal
tap can be done to rule out meningitis but this isn’t the indication for the test on a
leukemic client.
Question 56
WRONG
Which of the following is the primary goal for surgical resection of lung cancer?
To remove the tumor and all surrounding tissue.
To remove the tumor and as little surrounding tissue as possible.

To remove all of the tumor and any collapsed alveoli in the same region.
To remove as much as the tumor as possible, without removing any alveoli.
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. It may be necessary to
remove alveoli and bronchioles, but care is taken to make sure only what’s
absolutely necessary is removed.
1. Which of the following conditions is not a complication of Hodgkin’s

disease?
1. Anemia
2. Infection
3. Myocardial Infarction
4. Nausea
2. Which of the following laboratory values is expected for a client just

diagnosed with chronic lymphocytic leukemia?
1. Elevated sedimentation rate

2. Uncontrolled proliferation of granulocytes
3. Thrombocytopenia and increased lymphocytes
4. Elevated aspartate aminotransferase and alanine aminotransferase levels.
3. At the time of diagnosis of Hodgkin’s lymphoma, which of the following

areas is often involved?
1. Back
2. Chest
3. Groin
4. Neck
4. According to a standard staging classification of Hodgkin’s disease, which of

the following criteria reflects stage II?
1. Involvement of extralymphatic organs or tissues
2. Involvement of single lymph node region or structure
3. Involvement of two or more lymph node regions or structures.
4. Involvement of lymph node regions or structures on both sides of
the diaphragm.
5. Which of the following statements is correct about the rate of cell growth in
relation to chemotherapy?
1. Faster growing cells are less susceptible to chemotherapy.

2. Non-dividing cells are more susceptible to chemotherapy
3. Faster growing cells are more susceptible to chemotherapy
4. Slower growing cells are more susceptible to chemotherapy.
6. Which of the following foods should a client with leukemia avoid?
1. White bread
2. Carrot sticks
3. Stewed apples
4. Medium rare steak
7. A client with leukemia has neutropenia. Which of the following functions
must be frequently assessed?
1. Blood pressure
2. Bowel sounds
3. Heart sounds
4. Breath sounds
8. Which of the following clients is most at risk for developing multiple

myeloma?
1. A 20-year-old Asian woman

2. A 30-year-old White man
3. A 50-year-old Hispanic woman
4. A 60-year-old African-American man
9. Which of the following substances has abnormal values early in the course
of multiple myeloma (MM)?
1. Immunoglobulins
2. Platelets
3. Red blood cells
4. White blood cells
10. For which of the following conditions is a client with multiple myeloma
(MM) monitored?
1. Hypercalcemia
2. Hyperkalemia
3. Hypernatremia
4. Hypermagnesemia
11. Giving instructions for breast self-examination is particularly important

for clients with which of the following medical problems?
1. Cervical dysplasia
2. A dermoid cyst
3. Endometrial polyps
4. Ovarian cancer
12. 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?
1. History of early menarche

2. Cyclic changes in mass size
3. History of anovulatory cycles
4. Increased vascularity of the breast
13. The client with which of the following types of lung cancer has the best
prognosis?
1. Adenocarcinoma
2. Oat cell
3. Squamous cell
4. Small cell
14. Warning signs and symptoms of lung cancer include persistent cough,

bloody sputum, dyspnea, and which of the other following symptoms?
1. Dizziness
2. Generalized weakness
3. Hypotension
4. Recurrent pleural effusion
15. A centrally located tumor would produce which of the following

symptoms?
1. Coughing
2. Hemoptysis
3. Pleuritic pain
4. Shoulder pain
16. Which of the following interventions is the key to increasing the survival
rates of clients with lung cancer?
1. Early bronchoscopy
2. Early detection
3. High-dose chemotherapy
4. Smoking cessation
17. A client has been diagnosed with lung cancer and requires a wedge
resection. How much of the lung is removed?
1. One entire lung

2. A lobe of the lung
3. A small, localized area near the surface of the lung.
4. A segment of the lung, including a bronchiole and its alveoli.
18. When a client has a lobectomy, what fills the space where the lobe was?
1. The space stays empty.

2. The surgeon fills the space with gel
3. The lung space fills up with serous fluid
4. The remaining lobe or lobes overexpand to fill the space.
19. Which of the following is the primary goal for surgical resection of lung
cancer?
1. To remove the tumor and all surrounding tissue.

2. To remove the tumor and as little surrounding tissue as possible.
3. To remove all of the tumor and any collapsed alveoli in the same region.
4. To remove as much as the tumor as possible, without removing any alveoli.
20. If the client with lung cancer also has preexisting pulmonary disease,
which of the following statements best describes how the extent of that can
be performed?
1. It doesn’t affect it.

2. It may require a whole lung to be removed.
3. The entire tumor may not be able to be removed
4. It may prevent surgery if the client can’t tolerate lung tissue removal.
21. The client with a benign lung tumor is treated in which of the following
ways?
1. The tumor is treated with radiation only.

2. The tumor is treated with chemotherapy only.
3. The tumor is left alone unless symptoms are present.
4. The tumor is removed, involving the least possible amount of tissue.
22. In the client with terminal lung cancer, the focus of nursing care is on
which of the following nursing interventions?
1. Provide emotional support

2. Provide nutritional support
3. Provide pain control
4. Prepare the client’s will
23. What are the three most important prognostic factors in determining
long-term survival for children with acute leukemia?
1. Histologic type of disease, initial platelet count, and type of treatment

2. Type of treatment and client’s sex
3. Histologic type of disease, initial WBC count, and client’s age at diagnosis
4. Progression of illness, WBC at the time of diagnosis, and client’s age at the time
of diagnosis.
24. Which of the following complications are three main consequences of

leukemia?
1. Bone deformities, spherocytosis, and infection.

2. Anemia, infection, and bleeding tendencies
3. Lymphocytopoiesis, growth delays, and hirsutism
4. Polycythemia, decreased clotting time, and infection.
25. 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?
1. Abdominal pain
2. Increased activity level
3. Increased appetite
4. Petechiae
26. Which of the following assessment findings in a client with leukemia

would indicate that the cancer has invaded the brain?
1. Headache and vomiting.
2. Restlessness and tachycardia
3. Hypervigilant and anxious behavior
4. Increased heart rate and decreased blood pressure.
27. Which of the following types of leukemia carries the best prognosis?
1. Acute lymphoblastic leukemia

2. Acute myelogenous leukemia
3. Basophilic leukemia
4. Eosinophilic leukemia
28. Which of the following is the reason to perform a spinal tap on a client
newly diagnosed with leukemia?
1. To rule out meningitis
2. To decrease intracranial pressure
3. To aid in classification of the leukemia
4. To assess for central nervous system infiltration
29. Which of the following tests in performed on a client with leukemia

before initiation of therapy to evaluate the child’s ability to metabolize
chemotherapeutic agents?
1. Lumbar puncture
2. Liver function studies
3. Complete blood count (CBC)
4. Peripheral blood smear
30. Which of the following immunizations should not be given to a 4-month-

old sibling of a client with leukemia?
1. Diphtheria and tetanus and pertussis (DPT) vaccine.

2. Hepatitis B vaccine
3. Haemophilus influenzae type b vaccines (Hib)
4. Oral poliovirus vaccine (OPV)
31. Which of the following medications usually is given to a client with leukemia as
prophylaxis against P. carinii pneumonia?
1. Bactrim
2. Oral nystatin suspension
3. Prednisone
4. Vincristine (Oncovin)
32. In which of the following diseases would bone marrow transplantation

not be indicated in a newly diagnosed client?
1. Acute lymphocytic leukemia

2. Chronic myeloid leukemia
3. Severe aplastic anemia
4. Severe combined immunodeficiency
33. Which of the following treatment measures should be implemented for a

child with leukemia who has been exposed to the chickenpox?
1. No treatment is indicated.
2. Acyclovir (Zovirax) should be started on exposure
3. Varicella-zoster immunoglobulin (VZIG) should be given with the evidence of
disease
4. VZIG should be given within 72 hours of exposure.
34. Nausea and vomiting are common adverse effects of radiation and
chemotherapy. When should a nurse administer antiemetics?
1. 30 minutes before the initiation of therapy.

2. With the administration of therapy.
3. Immediately after nausea begins.
4. When therapy is completed.
35. 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?
1. Immediately
2. Within 1 to 2 weeks
3. Within 5 to 8 weeks
4. Within 3 to 6 months
36. The nurse is instructing the client to perform a testicular self-
examination. The nurse tells the client:
1. To examine the testicles while lying down.

2. The best time for the examination is after a shower
3. To gently feel the testicle with one finger to feel for a growth
4. That testicular examination should be done at least every 6 months.
37. 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?
1. Viral factors
2. Stress
3. Low-fat and high-fiber diets
4. Exposure to radiation
38. The client with cancer is receiving chemotherapy and develops

thrombocytopenia. The nurse identifies which intervention as the highest
priority in the nursing plan of care?
1. Ambulation three times a day

2. Monitoring temperature
3. Monitoring the platelet count
4. Monitoring for pathological factors
39. 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?
1. Malignant exacerbation in the number of leukocytes.

2. Altered red blood cell production.
3. Altered production of lymph nodes
4. Malignant proliferation of plasma cells and tumors within the bone.
40. 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?
1. Decreased number of plasma cells in the bone marrow.

2. Increased WBC’s
3. Increased calcium levels
4. Decreased blood urea nitrogen
41. 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?
1. Coughing and deep breathing

2. Encouraging fluids
3. Monitoring red blood cell count
4. Providing frequent oral care
42. 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 that which
of the following is characteristic of the disease?
1. Presence of Reed-Sternberg cells

2. Involvement of lymph nodes, spleen, and liver
3. Occurs most often in the older client
4. Prognosis depends on the stage of the disease
43. 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?
1. Assess level of consciousness

2. Assess temperature
3. Assess bowel sounds
4. Assess skin turgor
44. The nurse 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?
1. Sanguineous drainage in the Jackson-Pratt drain

2. Pain at the incisional site
3. Complaints of decreased sensation near the operative site
4. Arm edema on the operative side
45. A nurse is providing education in a community setting about general

measures to avoid excessive sun exposure. Which of the following
recommendations is appropriate?
1. Apply sunscreen only after going in the water.

2. Avoid peak exposure hours from 9am to 1pm
3. Wear loosely woven clothing for added ventilation
4. Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun
exposure.
46. Which of the following nursing interventions would be most helpful in

making the respiratory effort of a client with metastatic lung cancer more
efficient?
1. Teaching the client diaphragmatic breathing techniques

2. Administering cough suppressants as ordered
3. Teaching and encouraging pursed-lip breathing
4. Placing the client in a low semi-Fowlers position
47. 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?
1. Fever
2. Chills
3. Tachycardia
4. Dyspnea
48. 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?
1. “Chemotherapy affects all rapidly dividing cells.”

2. “The molecular structure of the DNA is altered.”
3. “Cancer cells are susceptible to drug toxins.”
4. “Chemotherapy encourages cancer cells to divide.”
49. 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.
1. Verify patency of the line by the presence of a blood return at regular intervals.
2. Inspect the insertion site for swelling, erythema, or drainage.
3. Administer a cytotoxic agent to keep the regimen on schedule even if blood
return is not present.
4. If unable to aspirate blood, reposition the client and encourage the client to
cough.
5. Contact the health care provider about verifying placement if the status is
questionable.
50. 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:
1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic alkalosis
4. Metabolic acidosis
51. A 32-year-old woman meets with the nurse on her first office visit since
undergoing a left mastectomy. When asked how she is doing, the woman
states her appetite is still not good, she is not getting much sleep because she
doesn’t go to bed until her husband is asleep, and she is really anxious to get
back to work. Which of the following nursing interventions should the nurse
explore to support the client’s current needs?
1. Call the physician to discuss allowing the client to return to work earlier.
2. Suggest that the client learn relaxation techniques to help with her insomnia
3. Perform a nutritional assessment to assess for anorexia
4. Ask open-ended questions about sexuality issues related to her mastectomy
52. One of the most serious blood coagulation complications for individuals
with cancer and for those undergoing cancer treatments is disseminated
intravascular coagulation (DIC). The most common cause of this bleeding
disorder is:
1. Underlying liver disease

2. Brain metastasis
3. Intravenous heparin therapy
4. Sepsis
53. A pneumonectomy is a surgical procedure sometimes indicated for

treatment of non-small-cell lung cancer. A pneumonectomy involves removal
of:
1. An entire lung field

2. A small, wedge-shaped lung surface
3. One lobe of a lung
4. One or more segments of a lung lobe
54. A 36-year-old man with lymphoma presents with signs of impending

septic shock 9 days after chemotherapy. The nurse could expect which of the
following to be present?
1. Flushing, decreased oxygen saturation, mild hypotension

2. Low-grade fever, chills, tachycardia
3. Elevated temperature, oliguria, hypotension
4. High-grade fever, normal blood pressure, increased respirations
55. Which of the following represents the most appropriate nursing

intervention for a client with pruritis caused by cancer or the treatments?
1. Administration of antihistamines
2. Steroids
3. Silk sheets
4. Medicated cool baths
56. A 56-year-old woman is currently receiving radiation therapy to the chest

wall for recurrent breast cancer. She calls her health care provider to report
that she has pain while swallowing and burning and tightness in her chest.
Which of the following complications of radiation therapy is most likely
responsible for her symptoms?
1. Hiatal hernia
2. Stomatitis
3. Radiation enteritis
4. Esophagitis
Answers and Rationale

1. Answer: 3. Myocardial Infarction
Complications of Hodgkin’s are pancytopenia, nausea, and infection. Cardiac

involvement usually doesn’t occur.
2. Answer: 3. Thrombocytopenia and increased lymphocytes
Chronic lymphocytic leukemia shows a proliferation of small abnormal mature B

lymphocytes and decreased antibody response. Thrombocytopenia also is often
present. Uncontrolled proliferation of granulocytes occurs in myelogenous
leukemia.
3. Answer: 4. Neck
At the time of diagnosis, a painless cervical lesion is often present. The back, chest,
and groin areas aren’t involved.
4. Answer: 3. Involvement of two or more lymph node regions or structures.

Stage II involves two or more lymph node regions. Stage I only involves one lymph
node region; stage III involves nodes on both sides of the diaphragm; and stage IV
involves extralymphatic organs or tissues.
5. Answer: 3. Faster growing cells are more susceptible to chemotherapy
The faster the cell grows, the more susceptible it is to chemotherapy and radiation
therapy. 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.
6. Answer: 2. Carrot sticks
A low-bacteria diet would be indicated with excludes raw fruits and vegetables.
7. Answer: 4. Breath sounds
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. Although assessing blood pressure, bowel sounds, and heart sounds is
important, it won’t help detect pneumonia.
8. Answer: 4. A 60-year-old Black man
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.
9. Answer: 1. Immunoglobulins
MM is characterized by malignant plasma cells that produce an increased amount

of immunoglobulin that isn’t functional. As more malignant plasma cells are
produced, there’s less space in the bone marrow for RBC production. In late stages,
platelets and WBC’s are reduced as the bone marrow is infiltrated by malignant
plasma cells.
10. Answer: 1. Hypercalcemia

Calcium is released when the bone is destroyed. This causes an increase in serum
calcium levels. MM doesn’t affect potassium, sodium, or magnesium levels.
11. Answer: 4. Ovarian cancer
Clients with ovarian cancer are at increased risk for breast cancer. Breast self-
examination supports early detection and treatment and is very important.
12. Answer: 4. Increased vascularity of the breast
Increase in breast size or vascularity is consistent with cancer of the breast. 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.
13. Answer: 3. Squamous cell
Squamous cell carcinoma is a slow-growing, rarely metastasizing type of cancer.

Adenocarcinoma is the next best lung cancer to have in terms of prognosis. Oat cell
and small cell carcinoma are the same. Small cell carcinoma grows rapidly and is
quick to metastasize.
14. Answer: 4. Recurrent pleural effusion
Recurring episodes of pleural effusions can be caused by the tumor and should be
investigated. Dizziness, generalized weakness, and hypotension aren’t typically
considered warning signals, but may occur in advanced stages of cancer.
15. Answer: 1. Coughing
Centrally located pulmonary tumors are found in the upper airway (vocal cords)
and usually obstruct airflow, producing such symptoms as coughing, wheezing, and
stridor. Small cell tumors tend to be located in the lower airways and often cause
hemoptysis. As the tumor invades the pleural space, it may cause pleuritic pain.
Pancoast tumors that occur in the apices may cause shoulder pain.
16. Answer: 2. Early detection
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. A bronchoscopy may help
identify cell type but may not increase survival rate. High-dose chemotherapy has
minimal effect on long-term survival. Smoking cessation won’t reverse the process
but may help prevent further decompensation.
17. Answer: 3. A small, localized area near the surface of the lung.
A small area of tissue close to the surface of the lung is removed in a wedge
resection. An entire lung is removed in a pneumonectomy. A segment of the lung is
removed in a segmental resection and a lobe is removed in a lobectomy.
18. Answer: 4. The remaining lobe or lobes overexpand to fill the space.
The remaining lobe or lobes overexpand 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. The space can’t remain “empty” because
truly empty would imply a vacuum, which would interfere with the intrathoracic
pressure changes that allow breathing. The surgeon doesn’t use a gel to fill the
space. Serous fluid overproduction would compress the remaining lobes, diminish
their function and possibly, cause a mediastinal shift.
19. Answer: 2. To remove the tumor and as little surrounding tissue as
possible.
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. It may be necessary to
remove alveoli and bronchioles, but care is taken to make sure only what’s
absolutely necessary is removed.
20. Answer: 4. It may prevent surgery if the client can’t tolerate lung tissue
removal.
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 on;t
chemotherapy and radiation.
21. Answer: 4. The tumor is removed, involving the least possible amount of
tissue.
The tumor is removed to prevent further compression of the lung tissue as the
tumor grows, which could lead to respiratory decompensation. If for some reason it
can’t be removed, then radiation or chemotherapy may be used to try to shrink the
tumor.
22. Answer: 3. Provide pain control
The client with terminal lung cancer may have extreme pleuritic pain and should be
treated to reduce his discomfort. 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. Nutritional support may be
provided, but as the terminal phase advances, the client’s nutritional needs greatly
decrease. Nursing care doesn’t focus on helping the client prepare the will.
23. Answer: 3. 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 age 2 or after 10.
24. Answer: 2. 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. 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. Hirsutism and growth delay can be a result of large doses of steroids but
isn’t common in leukemia. Anemia, not polycythemia, occurs. Clotting times would
be prolonged.
25. Answer: 4. Petechiae
The 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. Increased appetite can occur but it usually isn’t a
presenting symptom. Abdominal pain may be caused by areas of inflammation
from normal flora within the GI tract or any number of other causes.
26. Answer: 1. Headache and vomiting.
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, increased blood pressure, decreased heart rate, and
eventually, coma. Often children with a variety of illnesses are hypervigilant and
anxious when hospitalized.
27. Answer: 1. Acute lymphoblastic leukemia
Acute lymphoblastic leukemia, which accounts for more than 80% of all childhood
cases, carries the best prognosis. Acute myelogenous leukemia, with several
subtypes, accounts for most of the other leukemias affecting children. Basophilic
and eosinophilic leukemia are named for the specific cells involved. These are much
rarer and carry a poorer prognosis.
28. Answer: 4. To assess for central nervous system infiltration
A spinal tap is performed to assess for central nervous system infiltration. It

wouldn’t be done to decrease ICP nor does it aid in the classification of the
leukemia. Spinal taps can result in brain stem herniation in cases of ICP. A spinal
tap can be done to rule out meningitis but this isn’t the indication for the test on a
leukemic client.
29. Answer: 2. Liver function studies
Liver and kidney function studies are done before initiation of chemotherapy to

evaluate the child’s ability to metabolize the chemotherapeutic agents. A CBC is
performed to assess for anemia and white blood cell count. A peripheral blood
smear is done to assess the maturity and morphology of red blood cells. A lumbar
puncture is performed to assess for central nervous system infiltration.
30. Answer: 4. Oral poliovirus vaccine (OPV)
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. DTP, Hib, and hepatitis B vaccines can be
given accordingly to the recommended schedule.
31. Answer: 1. Bactrim
The most frequent cause of death from leukemia is 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. Oral nystatin suspension would be indicated for the treatment of
thrush. Prednisone isn’t an antibiotic and increases susceptibility to infection.
Vincristine is an antineoplastic agent.
32. Answer: 1. Acute lymphocytic leukemia
For the first episode of acute lymphocytic anemia, conventional therapy is superior
to bone marrow transplantation. 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. In myeloid
leukemia, bone marrow transplantation is done after chemotherapy to infuse
healthy marrow and to replace marrow stem cells ablated during chemotherapy.
33. Answer: 4. VZIG should be given within 72 hours of exposure.

Varicella is a lethal organism to a child with leukemia. VZIG, given within 72 hours,
may favorably alter the course of the disease. Giving the vaccine at the onset of
symptoms wouldn’t likely decrease the severity of the illness. Acyclovir may be
given if the child develops the disease but not if the child has been exposed.
34. Answer: 1. 30 minutes before the initiation of therapy.
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. If the antiemetic was given with
the medication or after the medication, it could lose its maximum effectiveness
when needed.
35. Answer: 3. 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 needed rest.
36. Answer: 2. 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.
37. Answer: 3. Low-fat and high-fiber diets
Viruses may be one of multiple agents acting to initiate carcinogenesis and have
been associated with several types of cancer. Increased stress has been associated
with causing the growth and proliferation of cancer cells. Two forms of radiation,
ultraviolet and ionizing, can lead to cancer. 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.
38. Answer: 3. 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 2 relates
to monitoring for infection particularly if leukopenia is present. Options 1 and 4,
although important in the plan of care are not related directly to
thrombocytopenia.
39. Answer: 4. 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 1 describes the leukemic process. Options 2 and 3
are not characteristics of multiple myeloma.
40. Answer: 3. Increased calcium levels
Findings indicative of multiple myeloma are an increased number of plasma cells in

the bone marrow, anemia, hypercalcemia caused by the release of calcium from
the deteriorating bone tissue, and an elevated blood urea nitrogen level. An
increased white blood cell count may or may not be present and is not related
specifically to multiple myeloma.
41. Answer: 2. Encouraging fluids
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 and output of 1.5 to 2 L a day. Clients require about 3 L of fluid pre day.
The fluid is needed not only to dilute the calcium overload but also to prevent
protein from precipitating in renal tubules. Options 1, 3, and 4 may be components
in the plan of care but are not the priority in this client.
42. Answer: 3. Occurs most often in the older client
Hodgkin’s disease is a disorder of young adults. Options 1, 2, and 4 are

characteristics of this disease.
43. Answer: 1. 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 2 is a priority nursing assessment when the white
blood cell count is low and the client is at risk for an infection.
44. Answer: 4. 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 other options are expected occurrences.
45. Answer: 4. Apply sunscreen with a sun protection factor (SPF) of 15 or

more before sun exposure.
A sunscreen with a SPF of 15 or higher should be worn on all sun-exposed skin

surfaces. It should be applied before sun exposure and reapplied after being in the
water. Peak sun exposure usually occurs between 10am to 2pm. Tightly woven
clothing, protective hats, and sunglasses are recommended to decrease sun
exposure. Suntanning parlors should be avoided.
46. Answer: 3. 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. Teaching diaphragmatic breathing
techniques will be more helpful to the client with a restrictive disorder.
Administering cough suppressants will not help respiratory effort. A low semi-
Fowlers position does not encourage lung expansion. Lung expansion is enhanced
in the upright position.
47. Answer: 1. Fever

Fever is an early sign requiring clinical intervention to identify potential causes.
Chills and dyspnea may or may not be observed. 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.
48. Answer: 1. “Chemotherapy affects all rapidly dividing cells.”
There 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. Chemotherapy slows cell division. Not all
chemotherapeutic agents affect molecular structure. All cells are susceptible to
drug toxins, but not all chemotherapeutic agents are toxins.
49. Answer: 1, 2, 4, 5.
A major concern with 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
nonvesicant 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.
50. Answer: 3. Metabolic alkalosis
The 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.
51. Answer: 4. Ask open-ended questions about sexuality issues related to her
mastectomy
The content of the client’s comments suggests that she is avoiding intimacy with
her husband by waiting until he is asleep before going to bed. Addressing sexuality
issues is appropriate for a client who has undergone a mastectomy. Rushing her
return to work may debilitate her and add to her exhaustion. Suggesting that she
learn relaxation techniques to help her with her insomnia is appropriate; however,
the nurse must first address the psychosocial and sexual issues that are
contributing to her sleeping difficulties. A nutritional assessment may be useful, but
there is no indication that she has anorexia.
52. Answer: 4. Sepsis
Bacterial endotoxins released from gram-negative bacteria activate the Hageman

factor or coagulation factor XII. This factor inhibits coagulation via the intrinsic
pathway of homeostasis, as well as stimulating fibrinolysis. Liver disease can cause
multiple bleeding abnormalities resulting in chronic, subclinical DIC; however,
sepsis is the most common cause.
53. Answer: 1. An entire lung field
A pneumonectomy is the removal of an entire lung field. A wedge resection refers

to removal of a wedge-shaped section of lung tissue. A lobectomy is the removal of
one lobe. Removal of one or more segments of a lung lobe is called a partial
lobectomy.
54. Answer: 2. Low-grade fever, chills, tachycardia
Nine days after chemotherapy, one would expect the client to be

immunocompromised. The clinical signs of shock reflect changes in cardiac
function, vascular resistance, cellular metabolism, and capillary permeability. Low-
grade fever, tachycardia, and flushing may be early signs of shock. The client with
impending signs of septic shock may not have decreased oxygen saturation levels.
Oliguria and hypotension are late signs of shock. Urine output can be initially
normal or increased.
55. Answer: 4. Medicated cool baths
Nursing interventions to decrease the discomfort of pruitus include those that

prevent vasodilation, decrease anxiety, and maintain skin integrity and hydration.
Medicated baths with salicyclic acid or colloidal oatmeal can be soothing as a
temporary relief. The use of antihistamines or topical steroids depends on the
cause of pruritus, and these agents should be used with caution. Using silk sheets is
not a practical intervention for the hospitalized client with pruritus.
56. Answer: 4. Esophagitis
Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis,
which is a common complication of radiation therapy of the chest wall.

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Acyclovir (Zovirax) should be started on exposure

Varicella-zoster immunoglobulin (VZIG) should be given with the evidence of

VZIG should be given within 72 hours of exposure.

Provide emotional support

Provide nutritional support

Provide pain control

Prepare the client’s will

The oncology nurse specialist provides an educational session to nursing staff

Presence of Reed-Sternberg cells

Involvement of lymph nodes, spleen, and liver

Occurs most often in the older client

Prognosis depends on the stage of the disease

Which of the following foods should a client with leukemia avoid?

Medium rare steak

The space stays empty.

The lung space fills up with serous fluid

The remaining lobe or lobes overexpand to fill the space.

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

Involvement of extralymphatic organs or tissues

Involvement of single lymph node region or structure

Involvement of two or more lymph node regions or structures.

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

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

To examine the testicles while lying down.

The best time for the examination is after a shower

That testicular examination should be done at least every 6 months.

Increased activity level

At the time of diagnosis of Hodgkin’s lymphoma, which of the following areas is

Liver function studies

Complete blood count (CBC)

Peripheral blood smear

History of early menarche

Cyclic changes in mass size

History of anovulatory cycles

Increased vascularity of the breast

The tumor is treated with radiation only.

The tumor is left alone unless symptoms are present.

The tumor is removed, involving the least possible amount of tissue.

A nurse is providing education in a community setting about general measures to

Apply sunscreen only after going in the water.

Avoid peak exposure hours from 9am to 1pm

Wear loosely woven clothing for added ventilation

A pneumonectomy is a surgical procedure sometimes indicated for treatment of

An entire lung field

A small, wedge-shaped lung surface

One lobe of a lung

One or more segments of a lung lobe

A centrally located tumor would produce which of the following symptoms?

Decreased number of plasma cells in the bone marrow.

Increased calcium levels

Decreased blood urea nitrogen

It doesn’t affect it.

It may require a whole lung to be removed.

The entire tumor may not be able to be removed

The nurse is reviewing the laboratory results of a client receiving chemotherapy.

Assess level of consciousness

Assess bowel sounds

Assess skin turgor

Recurrent pleural effusion

Which of the following immunizations should not be given to a 4-month-old sibling

Diphtheria and tetanus and pertussis (DPT) vaccine.

Haemophilus influenzae type b vaccines (Hib)

Oral poliovirus vaccine (OPV)