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12. (2) Beef, spinach and grape juice contains iron. Milk 1. The nurse is instructing the client to perform a testicular
contains no iron. self-examination. The nurse tells the client:
13. (4) Iron turns stool black. The other answers all indicate 1. To examine the testicles while lying down
compliance with the medication regime. 2. That the best time for the examination is after a shower
14. (2) A beefy red tongue is characteristic of pernicious 3. To gently feel the testicle with one finger to feel for a
anemia. Easy bruising would be seen in a clotting disorder growth
such as hemophilia, in leukemia or in bone marrow 4. That testicular self-examinations should be done at least
depression. Pruritus is characteristic of Hodgkin’s disease. every 6
15. (2) Injections of Vit. B12 will be necessary because months
without intrinsic factor her body cannot absorb Vit. B12
from foods. 2. The community nurse is conducting a health promotion
16. (4) Her symptoms suggest pernicious anemia. She program at a local school and is discussing the risk factors
would not develop these symptoms if she took her associated with cervical cancer. Which of the following, if
medications regularly. identified by the client as a risk factor for cervical cancer,
17. (1) Dehydration causes sickling. Sickling causes indicates a need for further teaching?
clumping and pain. First priority of care upon admission 1. Smoking
should be the administration of fluids. 2. Multiple sex partners
18. (4) Elevated fetal hemoglobin levels keep the oxygen 3. First intercourse after age 20
tension high so sickling does not occur. 4. Annual gynecological examinations
19. (2) Fevers cause dehydration and sickling.
20. (3) Parents of children with hemophilia tend to over 3. The community health nurse is instructing a group of
protect them. A goal is to have the child lead as normal a female clients about breast self-examination. The nurse
life as possible. #1 is correct. He should not receive instructs the clients to perform the examination:
aspirin, as it is an anti-coagulant. #2 indicates good 1. At the onset of menstruation
knowledge. Prophylactic dental care is important so he will 2. Every month during ovulation
not need dental work or extractions. #4 indicates good 3. Weekly at the same time of day
knowledge. He should always wear a medic Alert bracelet 4. 1 week after menstruation begins
in case he is injured.
21. (3) The Epstein-Barr virus is the causative organism for 4. The nurse is caring for a client who has undergone a
infectious mononucleosis. vaginal hysterectomy. The nurse avoids which of the
22. (4) The virus is spread through intimate oral contact. It following in the care of this client?
is called the “kissing disease.” It can also be spread by 1. Elevating the knee gatch on the bed
sharing eating and drinking utensils. 2. Assisting with range-of-motion leg exercises
23. (1) Leukemia causes a decrease in normal white cells. 3. Removal of antiembolism stockings twice daily
White blood cells are the infection fighting cells. Infections 4. Checking placement of pneumatic compression boots
occur because of the decrease in normal WBCs due to
leukemia. Infections do not cause leukemia. 5. The client is diagnosed as having a bowel tumor and
24. (4) Stomatitis is a frequent complication of several diagnostic tests are prescribed. The nurse
chemotherapy for leukemia. He has a tendency to bleed understands that which test will confirm the diagnosis of
because of his decreased platelets. Dental floss might malignancy?
cause bleeding. An astringent mouthwash is too strong for 1. Biopsy of the tumor
his tender mouth. An overbed cradle does not relate to 2. Abdominal ultrasound
stomatitis. Moistened cotton swabs are a gentle means of 3. Magnetic resonance imaging
cleaning the mouth. 4. Computed tomography scan
25. (2) This answer indicates acceptance of hair loss a side
effect of chemotherapy. Choice 1 indicates denial. Choice 2 6. A client is diagnosed with multiple myeloma and the
indicates lack of understanding. He will be very susceptible client asks the nurse about the diagnosis. The nurse bases
to infections. Choice 4 is not correct. He may or may not go the response on which description of this disorder?
into remission. 1. Altered red blood cell production
26. (1) Bone marrow aspiration on adult clients is obtained 2. Altered production of lymph nodes
from the sternum or iliac crest. Because there is a slight 3. Malignant exacerbation in the number of leukocytes
risk of hemorrhage, firm pressure is applied over the site of 4. Malignant proliferation of plasma cells within the bone
aspiration for approximately 5 minutes.
27. (4) Difficulty holding a crayon and forgetting things 7. The nurse is reviewing the laboratory results of a client
sounds like a neurological problem. He would be unlikely to diagnosed with multiple myeloma. Which of the following
exhibit these symptoms at this point in his illness. #1, #2, would the nurse expect to note specifically in this disorder?
and #3 are all typically seen in the child with leukemia. 1. Increased calcium level
Bruises are the result of platelet depression. Bumps on the 2. Increased white blood cells
sides of the neck and in the groin are probably swollen 3. Decreased blood urea nitrogen level
lymph nodes. Sores in the mouth are frequent and may be 4. Decreased number of plasma cells in the bone marrow
a result of decreased normal white cells. Fatigue is
common and a result of decreased red blood cells. 8. The nurse is developing a plan of care for the client with
28. (1) Pale and apathetic in a child who has leukemia is a multiple myeloma and includes which priority intervention
result of the anemia or decrease in red cells that occurs in in the plan?
leukemia. 1. Encouraging fluids
29. (3) Explaining that the delay did not have any effect 2. Providing frequent oral care
upon the course of the disease is realistic. There is no way 3. Coughing and deep breathing
to predict that the child had leukemia when he first had a 4. Monitoring the red blood cell count
cold. The reason for the persistence of the cold was the
leukemia. The cold did not cause leukemia to develop. 9. The oncology nurse specialist provides an educational
Leukemia could not have been prevented by earlier session to nursing staff regarding the characteristics of
treatment of the cold. The nurse should carefully explain Hodgkin's disease. The nurse determines that further
this to the parents to reduce the guilt they may place upon teaching is needed if a nursing staff member states that
themselves. which of the following is a characteristic of the disease?
30. (1) In order to have a child, the husband would have to 1. Presence of Reed-Sternberg cells
be exposed to the virus. This answer indicates a need for 2. Occurs most often in the older client
more instruction. The other responses all indicate 3. Prognosis depending on the stage of the disease
understanding. 4. Involvement of lymph nodes, spleen, and liver
4. Weak salt and bicarbonate mouth rinse previously treated body part
28. The community nurse is conducting a health promotion 36. Hormone therapy is prescribed as the mode of
program and the topic of the discussion relates to the risk treatment for a client with prostate cancer. The nurse
factors for gastric cancer. Which risk factor, if identified by understands that the goal of this form of treatment is to:
a client, indicates a need for further discussion? 1. Increase testosterone levels.
1. Smoking 2. Increase prostaglandin levels.
2. A high-fat diet 3. Limit the amount of circulating androgens.
3. Foods containing nitrates 4. Increase the amount of circulating androgens.
4. A diet of smoked, highly salted, and spiced food
37. The nurse is caring for a client with cancer of the
29. A gastrectomy is performed on a client with gastric prostate following a prostatectomy. The nurse provides
cancer. In the immediate postoperative period, the nurse discharge instructions to the client and tells the client to:
notes bloody drainage from the nasogastric tube. Which of 1. Avoid driving the car for 1 week.
the following is the appropriate nursing intervention? 2. Restrict fluid intake to prevent incontinence.
1. Notify the physician. 3. Avoid lifting objects heavier than 20 lb for at least 6
2. Measure abdominal girth. weeks.
3. Irrigate the nasogastric tube. 4. Notify the physician if small blood clots are noticed
4. Continue to monitor the drainage. during
urination.
30. The nurse is teaching a client about the risk factors
associated with colorectal cancer. The nurse determines 38. The oncology nurse is providing a teaching session to a
that further teaching related to colorectal cancer is group of nursing students regarding the risks and causes of
necessary if the client identifies which of the following as bladder cancer. Which statement by a student indicates a
an associated risk factor? need for further teaching?
1. Age younger than 50 years 1. “Bladder cancer most often occurs in women.”
2. History of colorectal polyps 2. “Using cigarettes and coffee drinking can increase the
3. Family history of colorectal cancer risk.”
4. Chronic inflammatory bowel disease 3. “Bladder cancer generally is seen in clients older than
age 40.”
31. The nurse is reviewing the preoperative orders of a 4. “Environmental health hazards have been attributed as
client with a colon tumor who is scheduled for abdominal a cause.”
perineal resection and notes that the physician has
prescribed neomycin (Mycifradin) for the client. The nurse 39. The nurse is reviewing the history of a client with
determines that this medication has been prescribed bladder cancer. The nurse expects to note documentation
primarily: of which most common symptom of this type of cancer?
1. To prevent an immune dysfunction 1. Dysuria
2. Because the client has an infection 2. Hematuria
3. To decrease the bacteria in the bowel 3. Urgency on urination
4. Because the client is allergic to penicillin 4. Frequency of urination
32. The nurse is assessing the perineal wound in a client 40. The nurse is caring for a client following intravesical
who has returned from the operating room following an instillation of an alkylating chemotherapeutic agent into
abdominal perineal resection and notes serosanguineous the bladder for the treatment of bladder cancer. Following
drainage from the wound. Which nursing intervention is the instillation, the nurse should instruct the client to:
appropriate? 1. Urinate immediately.
1. Notify the physician. 2. Maintain strict bed rest.
2. Clamp the Penrose drain. 3. Change position every 15 minutes.
3. Change the dressing as prescribed. 4. Retain the instillation fluid for 30 minutes.
4. Remove and replace the perineal packing.
41. The nurse is assessing the stoma of a client following a
33. The nurse is assessing the colostomy of a client who ureterostomy. Which of the following should the nurse
has had an abdominal perineal resection for a bowel expect to note?
tumor. Which of the 1. A dry stoma
following assessment findings indicates that the colostomy 2. A pale stoma
is 3. A dark-colored stoma
beginning to function? 4. A red and moist stoma
1. Absent bowel sounds
2. The passage of flatus 42. The nurse is caring for a client following a mastectomy.
3. The client's ability to tolerate food Which nursing intervention would assist in preventing
4. Bloody drainage from the colostomy lymphedema of the affected arm?
1. Placing cool compresses on the affected arm
34. The nurse is caring for a client following a radical neck 2. Elevating the affected arm on a pillow above heart level
dissection and creation of a tracheostomy performed for 3. Avoiding arm exercises in the immediate postoperative
laryngeal cancer and is providing discharge instructions to period
the client. Which statement by the client indicates a need 4. Maintaining an intravenous site below the antecubital
for further instructions? area on the affected side
1. “I will protect the stoma from water.”
2. “I need to keep powders and sprays away from the 43. A nurse is monitoring a client for signs and symptoms
stoma site.” related to superior vena cava syndrome. Which of the
3. “I need to use an air conditioner to provide cool air to following is an early sign of this oncological emergency?
assist in 1. Cyanosis
breathing.” 2. Arm edema
4. “I need to apply a thin layer of petrolatum to the skin 3. Periorbital edema
around the stoma to prevent cracking.” 4. Mental status changes
35. What is the purpose of cytoreductive (“debulking”) 44. A nurse manager is teaching the nursing staff about
surgery for ovarian cancer? signs and
1. Cancer control by reducing the size of the tumor symptoms related to hypercalcemia in a client with
2. Cancer prevention by removal of precancerous tissue metastatic prostate cancer and tells the staff that which of
3. Cancer cure by removing all gross and microscopic the following is a serious late sign of this oncological
tumor cells emergency?
4. Cancer rehabilitation by improving the appearance of a 1. Headache
6
25. 2 Rationale: A vesicovaginal fistula is a genital fistula 35. 1 Rationale: Cytoreductive or “debulking” surgery
that occurs between the bladder and vagina. The fistula is may be used if a large tumor cannot be completely
an abnormal opening between these two body parts and, if removed as is often the case with late-stage ovarian
this occurs, the client may experience drainage of urine cancer (e.g., the tumor is attached to a vital organ or
through the vagina. The client's complaint is not associated spread throughout the abdomen). When this occurs, as
with options 1, 3, and 4. much tumor as possible is removed and
26. 4 Rationale: Allopurinol decreases uric acid 36. 3 Rationale: Hormone therapy (androgen deprivation)
production and reduces uric acid concentrations in serum is a mode of treatment for prostatic cancer. The goal is to
and urine. In the client receiving chemotherapy, uric acid limit the amount of circulating androgens because prostate
levels increase as a result of the massive cell destruction cells depend on androgen for cellular maintenance.
that occurs from the chemotherapy. This medication Deprivation of androgen often can lead to regression of
prevents or treats hyperuricemia caused by chemotherapy. disease and improvement of symptoms.
Allopurinol is not used to prevent alopecia, nausea, or
vomiting. 37. 4 Rationale: Small pieces of tissue or blood clots can
be passed during urination for up to 2 weeks after surgery.
27. 4 Rationale: An acidic environment in the mouth is Driving a car and sitting for long periods of time are
favorable for bacterial growth, particularly in an area restricted for at least 3 weeks. A high daily fluid intake
already compromised from chemotherapy. Therefore, the should be maintained to limit clot formation and prevent
8
7. A female client is receiving chemotherapy to treat breast cancer. Which 14. For a female client newly diagnosed with radiation-induced
assessment finding indicates a fluid and electrolyte imbalance induced by thrombocytopenia, the nurse should include which intervention in the plan of
chemotherapy? care?
a. Urine output of 400 ml in 8 hours a. Administering aspirin if the temperature exceeds 102° F (38.8° C)
b. Serum potassium level of 3.6 mEq/L b. Inspecting the skin for petechiae once every shift
c. Blood pressure of 120/64 to 130/72 mm Hg c. Providing for frequent rest periods
d. Dry oral mucous membranes and cracked lips d. Placing the client in strict isolation
7.Answer D. Chemotherapy commonly causes nausea and vomiting, 14.Answer B. Because thrombocytopenia impairs blood clotting, the
which may lead to fluid and electrolyte imbalances. Signs of fluid loss nurse should inspect the client regularly for signs of bleeding, such as
include dry oral mucous membranes, cracked lips, decreased urine petechiae, purpura, epistaxis, and bleeding gums. The nurse should
output (less than 40 ml/hour), abnormally low blood pressure, and a avoid administering aspirin because it may increase the risk of
serum potassium level below 3.5 mEq/L. bleeding. Frequent rest periods are indicated for clients with anemia,
not thrombocytopenia. Strict isolation is indicated only for clients who
8. Nurse April is teaching a group of women to perform breast self- have highly contagious or virulent infections that are spread by air or
examination. The nurse should explain that the purpose of performing the physical contact.
examination is to discover:
a. cancerous lumps. 15. Nurse Lucia is providing breast cancer education at a community
b. areas of thickness or fullness. facility. The American Cancer Society recommends that women get
c. changes from previous self-examinations. mammograms:
d. fibrocystic masses. a. yearly after age 40.
8.Answer C. Women are instructed to examine themselves to discover b. after the birth of the first child and every 2 years thereafter.
changes that have occurred in the breast. Only a physician can c. after the first menstrual period and annually thereafter.
diagnose lumps that are cancerous, areas of thickness or fullness that d. every 3 years between ages 20 and 40 and annually thereafter.
signal the presence of a malignancy, or masses that are fibrocystic as 15.Answer A. The American Cancer Society recommends a
opposed to malignant. mammogram yearly for women over age 40. The other statements are
incorrect. It’s recommended that women between ages 20 and 40 have
9. A client, age 41, visits the gynecologist. After examining her, the a professional breast examination (not a mammogram) every 3 years.
physician suspects cervical cancer. The nurse reviews the client’s history for
risk factors for this disease. Which history finding is a risk factor for cervical 16. Which intervention is appropriate for the nurse caring for a male client
cancer? in severe pain receiving a continuous I.V. infusion of morphine?
a. Onset of sporadic sexual activity at age 17 a. Assisting with a naloxone challenge test before therapy begins
b. Spontaneous abortion at age 19 b. Discontinuing the drug immediately if signs of dependence appear
c. Pregnancy complicated with eclampsia at age 27 c. Changing the administration route to P.O. if the client can tolerate fluids
d. Human papillomavirus infection at age 32 d. Obtaining baseline vital signs before administering the first dose
9.Answer D. Like other viral and bacterial venereal infections, human 16.Answer D. The nurse should obtain the client’s baseline blood
papillomavirus is a risk factor for cervical cancer. Other risk factors pressure and pulse and respiratory rates before administering the
for this disease include frequent sexual intercourse before age 16, initial dose and then continue to monitor vital signs throughout
multiple sex partners, and multiple pregnancies. A spontaneous therapy. A naloxone challenge test may be administered before using
abortion and pregnancy complicated by eclampsia aren’t risk factors a narcotic antagonist, not a narcotic agonist. The nurse shouldn’t
for cervical cancer. discontinue a narcotic agonist abruptly because withdrawal
symptoms may occur. Morphine commonly is used as a continuous
10. A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to infusion in clients with severe pain regardless of the ability to tolerate
treat osteogenic carcinoma. During methotrexate therapy, the nurse expects fluids.
the client to receive which other drug to protect normal cells?
a. probenecid (Benemid) 17. A 35 years old client with ovarian cancer is prescribed hydroxyurea
b. cytarabine (ara-C, cytosine arabinoside [Cytosar-U]) (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of
c. thioguanine (6-thioguanine, 6-TG) antineoplastic agents that interfere with various metabolic actions of the cell.
d. leucovorin (citrovorum factor or folinic acid [Wellcovorin]) The mechanism of action of antimetabolites interferes with:
10.Answer D. Leucovorin is administered with methotrexate to protect a. cell division or mitosis during the M phase of the cell cycle.
normal cells, which methotrexate could destroy if given alone. b. normal cellular processes during the S phase of the cell cycle.
Probenecid should be avoided in clients receiving methotrexate c. the chemical structure of deoxyribonucleic acid (DNA) and chemical
because it reduces renal elimination of methotrexate, increasing the binding between DNA molecules (cell cycle–nonspecific).
risk of methotrexate toxicity. Cytarabine and thioguanine aren’t used d. one or more stages of ribonucleic acid (RNA) synthesis, DNA
to treat osteogenic carcinoma. synthesis, or both (cell cycle–nonspecific).
17.Answer B. Antimetabolites act during the S phase of the cell cycle,
11. The nurse is interviewing a male client about his past medical history. contributing to cell destruction or preventing cell replication. They’re
Which preexisting condition may lead the nurse to suspect that a client has most effective against rapidly proliferating cancers. Miotic inhibitors
colorectal cancer? interfere with cell division or mitosis during the M phase of the cell
a. Duodenal ulcers cycle. Alkylating agents affect all rapidly proliferating cells by
b. Hemorrhoids interfering with DNA; they may kill dividing cells in all phases of the
c. Weight gain cell cycle and may also kill nondividing cells. Antineoplastic antibiotic
d. Polyps agents interfere with one or more stages of the synthesis of RNA,
11.Answer D. Colorectal polyps are common with colon cancer. DNA, or both, preventing normal cell growth and reproduction.
Duodenal ulcers and hemorrhoids aren’t preexisting conditions of
colorectal cancer. Weight loss — not gain — is an indication of 18. The ABCD method offers one way to assess skin lesions for possible
colorectal cancer. skin cancer. What does the A stand for?
a. Actinic
12. Nurse Amy is speaking to a group of women about early detection of b. Asymmetry
breast cancer. The average age of the women in the group is 47. Following c. Arcus
the American Cancer Society guidelines, the nurse should recommend that d. Assessment
the women: 18.Answer B. When following the ABCD method for assessing skin
a. perform breast self-examination annually. lesions, the A stands for "asymmetry," the B for "border irregularity,"
b. have a mammogram annually. the C for "color variation," and the D for "diameter."
c. have a hormonal receptor assay annually.
d. have a physician conduct a clinical examination every 2 years. 19. When caring for a male client diagnosed with a brain tumor of the
12.Answer B. The American Cancer Society guidelines state, "Women parietal lobe, the nurse expects to assess:
older than age 40 should have a mammogram annually and a clinical a. short-term memory impairment.
examination at least annually [not every 2 years]; all women should b. tactile agnosia.
perform breast self-examination monthly [not annually]." The c. seizures.
hormonal receptor assay is done on a known breast tumor to d. contralateral homonymous hemianopia.
determine whether the tumor is estrogen- or progesterone-dependent. 19.Answer B. Tactile agnosia (inability to identify objects by touch) is
a sign of a parietal lobe tumor. Short-term memory impairment occurs
13. A male client with a nagging cough makes an appointment to see the with a frontal lobe tumor. Seizures may result from a tumor of the
physician after reading that this symptom is one of the seven warning signs frontal, temporal, or occipital lobe. Contralateral homonymous
of cancer. What is another warning sign of cancer? hemianopia suggests an occipital lobe tumor.
a. Persistent nausea
b. Rash 20. A female client is undergoing tests for multiple myeloma. Diagnostic
c. Indigestion study findings in multiple myeloma include:
d. Chronic ache or pain a. a decreased serum creatinine level.
13.Answer C. Indigestion, or difficulty swallowing, is one of the seven b. hypocalcemia.
warning signs of cancer. The other six are a change in bowel or c. Bence Jones protein in the urine.
bladder habits, a sore that does not heal, unusual bleeding or d. a low serum protein level.
discharge, a thickening or lump in the breast or elsewhere, an obvious 20.Answer C. Presence of Bence Jones protein in the urine almost
change in a wart or mole, and a nagging cough or hoarseness. always confirms the disease, but absence doesn’t rule it out. Serum
Persistent nausea may signal stomach cancer but isn’t one of the calcium levels are elevated because calcium is lost from the bone and
seven major warning signs. Rash and chronic ache or pain seldom reabsorbed in the serum. Serum protein electrophoresis shows
indicate cancer. elevated globulin spike. The serum creatinine level may also be
increased.
10
c. Headache
21. A 35 years old client has been receiving chemotherapy to treat d. Anorexia
cancer. Which assessment finding suggests that the client has developed 26.Answer A. The client must report changes in visual acuity
stomatitis (inflammation of the mouth)? immediately because this adverse effect may be irreversible.
a. White, cottage cheese–like patches on the tongue Tamoxifen isn’t associated with hearing loss. Although the drug may
b. Yellow tooth discoloration cause anorexia, headache, and hot flashes, the client need not report
c. Red, open sores on the oral mucosa these adverse effects immediately because they don’t warrant a
d. Rust-colored sputum change in therapy.
21.Answer C. The tissue-destructive effects of cancer chemotherapy
typically cause stomatitis, resulting in ulcers on the oral mucosa that 27. A female client with cancer is being evaluated for possible metastasis.
appear as red, open sores. White, cottage cheese–like patches on the Which of the following is one of the most common metastasis sites for
tongue suggest a candidal infection, another common adverse effect cancer cells?
of chemotherapy. Yellow tooth discoloration may result from antibiotic a. Liver
therapy, not cancer chemotherapy. Rust-colored sputum suggests a b. Colon
respiratory disorder, such as pneumonia. c. Reproductive tract
d. White blood cells (WBCs)
22. During chemotherapy, an oncology client has a nursing diagnosis of 27.Answer A. The liver is one of the five most common cancer
impaired oral mucous membrane related to decreased nutrition and metastasis sites. The others are the lymph nodes, lung, bone, and
immunosuppression secondary to the cytotoxic effects of chemotherapy. brain. The colon, reproductive tract, and WBCs are occasional
Which nursing intervention is most likely to decrease the pain of stomatitis? metastasis sites.
a. Recommending that the client discontinue chemotherapy
b. Providing a solution of hydrogen peroxide and water for use as a mouth 28. A 34-year-old female client is requesting information about
rinse mammograms and breast cancer. She isn’t considered at high risk for
c. Monitoring the client’s platelet and leukocyte counts breast cancer. What should the nurse tell this client?
d. Checking regularly for signs and symptoms of stomatitis a. She should have had a baseline mammogram before age 30.
22.Answer B. To decrease the pain of stomatitis, the nurse should b. She should eat a low-fat diet to further decrease her risk of breast
provide a solution of hydrogen peroxide and water for the client to use cancer.
as a mouth rinse. (Commercially prepared mouthwashes contain c. She should perform breast self-examination during the first 5 days of
alcohol and may cause dryness and irritation of the oral mucosa.) The each menstrual cycle.
nurse also may administer viscous lidocaine or systemic analgesics d. When she begins having yearly mammograms, breast self-
as prescribed. Stomatitis occurs 7 to 10 days after chemotherapy examinations will no longer be necessary.
begins; thus, stopping chemotherapy wouldn’t be helpful or practical. 28.Answer B. A low-fat diet (one that maintains weight within 20% of
Instead, the nurse should stay alert for this potential problem to recommended body weight) has been found to decrease a woman’s
ensure prompt treatment. Monitoring platelet and leukocyte counts risk of breast cancer. A baseline mammogram should be done
may help prevent bleeding and infection but wouldn’t decrease pain in between ages 30 and 40. Monthly breast self-examinations should be
this highly susceptible client. Checking for signs and symptoms of done between days 7 and 10 of the menstrual cycle. The client should
stomatitis also wouldn’t decrease the pain. continue to perform monthly breast self-examinations even when
receiving yearly mammograms.
23. What should a male client over age 52 do to help ensure early
identification of prostate cancer? 29. Nurse Brian is developing a plan of care for marrow suppression, the
a. Have a digital rectal examination and prostate-specific antigen (PSA) major dose-limiting adverse reaction to floxuridine (FUDR). How long after
test done yearly. drug administration does bone marrow suppression become noticeable?
b. Have a transrectal ultrasound every 5 years. a. 24 hours
c. Perform monthly testicular self-examinations, especially after age 50. b. 2 to 4 days
d. Have a complete blood count (CBC) and blood urea nitrogen (BUN) c. 7 to 14 days
and creatinine levels checked yearly. d. 21 to 28 days
23.Answer A. The incidence of prostate cancer increases after age 50. 29.Answer C. Bone marrow suppression becomes noticeable 7 to 14
The digital rectal examination, which identifies enlargement or days after floxuridine administration. Bone marrow recovery occurs in
irregularity of the prostate, and PSA test, a tumor marker for prostate 21 to 28 days.
cancer, are effective diagnostic measures that should be done yearly.
Testicular self-examinations won’t identify changes in the prostate 30. The nurse is preparing for a female client for magnetic resonance
gland due to its location in the body. A transrectal ultrasound, CBC, imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI
and BUN and creatinine levels are usually done after diagnosis to scan, which of the following would pose a threat to the client?
identify the extent of the disease and potential metastases a. The client lies still.
b. The client asks questions.
24. A male client complains of sporadic epigastric pain, yellow skin, c. The client hears thumping sounds.
nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, d. The client wears a watch and wedding band.
the physician orders a diagnostic workup, which reveals gallbladder cancer.
Which nursing diagnosis may be appropriate for this client? 30.Answer D. During an MRI, the client should wear no metal objects,
a. Anticipatory grieving such as jewelry, because the strong magnetic field can pull on them,
b. Impaired swallowing causing injury to the client and (if they fly off) to others. The client
c. Disturbed body image must lie still during the MRI but can talk to those performing the test
d. Chronic low self-esteem by way of the microphone inside the scanner tunnel. The client should
24.Answer A. Anticipatory grieving is an appropriate nursing hear thumping sounds, which are caused by the sound waves
diagnosis for this client because few clients with gallbladder cancer thumping on the magnetic field.
live more than 1 year after diagnosis. Impaired swallowing isn’t
associated with gallbladder cancer. Although surgery typically is done 1. Nina, an oncology nurse educator is speaking to a women’s group
to remove the gallbladder and, possibly, a section of the liver, it isn’t about breast cancer. Questions and comments from the audience reveal a
disfiguring and doesn’t cause Disturbed body image. Chronic low self- misunderstanding of some aspects of the disease. Various members of the
esteem isn’t an appropriate nursing diagnosis at this time because the audience have made all of the following statements. Which one is
diagnosis has just been made. accurate?
a. Mammography is the most reliable method for detecting breast cancer.
25. A male client is in isolation after receiving an internal radioactive b. Breast cancer is the leading killer of women of childbearing age.
implant to treat cancer. Two hours later, the nurse discovers the implant in c. Breast cancer requires a mastectomy.
the bed linens. What should the nurse do first? d. Men can develop breast cancer.
a. Stand as far away from the implant as possible and call for help. 1. Answer D. Men can develop breast cancer,
b. Pick up the implant with long-handled forceps and place it in a lead- although they seldom do. The most reliable method
lined container.
for detecting breast cancer is monthly self-
c. Leave the room and notify the radiation therapy department
immediately. examination, not mammography. Lung cancer
d. Put the implant back in place, using forceps and a shield for self- causes more deaths than breast cancer in women of
protection, and call for help. all ages. A mastectomy may not be required if the
25.Answer B. If a radioactive implant becomes dislodged, the nurse tumor is small, confined, and in an early stage.
should pick it up with long-handled forceps and place it in a lead-lined
container, then notify the radiation therapy department immediately. 2. Nurse Meredith is instructing a premenopausal woman about breast
The highest priority is to minimize radiation exposure for the client self-examination. The nurse should tell the client to do her self-examination:
and the nurse; therefore, the nurse must not take any action that a. at the end of her menstrual cycle.
delays implant removal. Standing as far from the implant as possible, b. on the same day each month.
leaving the room with the implant still exposed, or attempting to put it c. on the 1st day of the menstrual cycle.
back in place can greatly increase the risk of harm to the client and d. immediately after her menstrual period.
the nurse from excessive radiation exposure. 2. Answer D. Premenopausal women should do
26. Jeovina, with advanced breast cancer is prescribed tamoxifen
their self-examination immediately after the
(Nolvadex). When teaching the client about this drug, the nurse should menstrual period, when the breasts are least tender
emphasize the importance of reporting which adverse reaction immediately? and least lumpy. On the 1st and last days of the
a. Vision changes cycle, the woman’s breasts are still very tender.
b. Hearing loss Postmenopausal women because their bodies lack
11
fluctuation of hormone levels, should select one c. Removal of antiembolism stockings twice daily
particular day of the month to do breast self- d. Checking placement of pneumatic compression boots
examination. 9. Answer A. The client is at risk of deep vein
thrombosis or thrombophlebitis after this surgery,
3. Nurse Kent is teaching a male client to perform monthly testicular self- as for any other major surgery. For this reason, the
examinations. Which of the following points would be appropriate to make? nurse implements measures that will prevent this
a. Testicular cancer is a highly curable type of cancer. complication. Range-of-motion exercises,
b. Testicular cancer is very difficult to diagnose.
antiembolism stockings, and pneumatic
c. Testicular cancer is the number one cause of cancer deaths in males.
d. Testicular cancer is more common in older men. compression boots are helpful. The nurse should
3. Answer A. Testicular cancer is highly curable, avoid using the knee gatch in the bed, which
particularly when it’s treated in its early stage. Self- inhibits venous return, thus placing the client more
examination allows early detection and facilitates at risk for deep vein thrombosis or
the early initiation of treatment. The highest thrombophlebitis.
mortality rates from cancer among men are in men
10. Mina, who is suspected of an ovarian tumor is scheduled for a pelvic
with lung cancer. Testicular cancer is found more ultrasound. The nurse provides which preprocedure instruction to the
commonly in younger men. client?
a. Eat a light breakfast only
4. Rhea, has malignant lymphoma. As part of her chemotherapy, the b. Maintain an NPO status before the procedure
physician prescribes chlorambucil (Leukeran), 10 mg by mouth daily. When c. Wear comfortable clothing and shoes for the procedure
caring for the client, the nurse teaches her about adverse reactions to d. Drink six to eight glasses of water without voiding before the test
chlorambucil, such as alopecia. How soon after the first administration of 10. Answer D. A pelvic ultrasound requires the
chlorambucil might this reaction occur?
ingestion of large volumes of water just before the
a. Immediately
b. 1 week procedure. A full bladder is necessary so that it will
c. 2 to 3 weeks be visualized as such and not mistaken for a
d. 1 month possible pelvic growth. An abdominal ultrasound
4. Answer C. Chlorambucil-induced alopecia occurs may require that the client abstain from food or
2 to 3 weeks after therapy begins. fluid for several hours before the procedure. Option
C is unrelated to this specific procedure.
5. A male client is receiving the cell cycle–nonspecific alkylating agent
thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part 11. A male client is diagnosed as having a bowel tumor and several
of a chemotherapeutic regimen to treat bladder cancer. The client asks the diagnostic tests are prescribed. The nurse understands that which test will
nurse how the drug works. How does thiotepa exert its therapeutic effects? confirm the diagnosis of malignancy?
a. It interferes with deoxyribonucleic acid (DNA) replication only. a. Biopsy of the tumor
b. It interferes with ribonucleic acid (RNA) transcription only. b. Abdominal ultrasound
c. It interferes with DNA replication and RNA transcription. c. Magnetic resonance imaging
d. It destroys the cell membrane, causing lysis. d. Computerized tomography scan
5. Answer C. Thiotepa interferes with DNA 11. Answer A. A biopsy is done to determine
replication and RNA transcription. It doesn’t destroy whether a tumor is malignant or benign. Magnetic
the cell membrane. resonance imaging, computed tomography scan,
and ultrasound will visualize the presence of a mass
6. The nurse is instructing the 35 year old client to perform a testicular
self-examination. The nurse tells the client:
but will not confirm a diagnosis of malignancy.
a. To examine the testicles while lying down
12. A female client diagnosed with multiple myeloma and the client asks
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 the nurse about the diagnosis. The nurse bases the response on which
description of this disorder?
d. That testicular self-examination should be done at least every 6 months
a. Altered red blood cell production
6. Answer B. The testicular-self examination is b. Altered production of lymph nodes
recommended monthly after a warm bath or shower c. Malignant exacerbation in the number of leukocytes
when the scrotal skin is relaxed. The client should d. Malignant proliferation of plasma cells within the bone
stand to examine the testicles. Using both hands, 12. Answer D. Multiple myeloma is a B-cell
with fingers under the scrotum and thumbs on top, neoplastic condition characterized by abnormal
the client should gently roll the testicles, feeling for malignant proliferation of plasma cells and the
any lumps. accumulation of mature plasma cells in the bone
marrow. Options A and B are not characteristics of
7. A female client with cancer is receiving chemotherapy and develops multiple myeloma. Option C describes the leukemic
thrombocytopenia. The nurse identifies which intervention as the highest
priority in the nursing plan of care?
process.
a. Monitoring temperature
13. Nurse Bea is reviewing the laboratory results of a client diagnosed
b. Ambulation three times daily
c. Monitoring the platelet count with multiple myeloma. Which of the following would the nurse expect to
note specifically in this disorder?
d. Monitoring for pathological fractures
a. Increased calcium
7. Answer C. Thrombocytopenia indicates a b. Increased white blood cells
decrease in the number of platelets in the c. Decreased blood urea nitrogen level
circulating blood. A major concern is monitoring for d. Decreased number of plasma cells in the bone marrow
and preventing bleeding. Option A elates to 13. Answer A. Findings indicative of multiple
monitoring for infection, particularly if leukopenia is myeloma are an increased number of plasma cells in
present. Options B and D, although important in the the bone marrow, anemia, hypercalcemia caused by
plan of care, are not related directly to the release of calcium from the deteriorating bone
thrombocytopenia. tissue, and an elevated blood urea nitrogen level.
An increased white blood cell count may or may not
8. Gian, a community health nurse is instructing a group of female clients be present and is not related specifically to multiple
about breast self-examination. The nurse instructs the client to perform the
examination:
myeloma.
a. At the onset of menstruation
14. Vanessa, a community health nurse conducts a health promotion
b. Every month during ovulation
c. Weekly at the same time of day program regarding testicular cancer to community members. The nurse
determines that further information needs to be provided if a community
d. 1 week after menstruation begins
member states that which of the following is a sign of testicular cancer?
8. Answer D. The breast self-examination should a. Alopecia
be performed monthly 7 days after the onset of the b. Back pain
menstrual period. Performing the examination c. Painless testicular swelling
weekly is not recommended. At the onset of d. Heavy sensation in the scrotum
menstruation and during ovulation, hormonal 14. Answer A. Alopecia is not an assessment
changes occur that may alter breast tissue. finding in testicular cancer. Alopecia may occur,
however, as a result of radiation or chemotherapy.
9. Nurse Cecilia is caring for a client who has undergone a vaginal Options B, C, and D are assessment findings in
hysterectomy. The nurse avoids which of the following in the care of this testicular cancer. Back pain may indicate metastasis
client?
a. Elevating the knee gatch on the bed
to the retroperitoneal lymph nodes.
b. Assisting with range-of-motion leg exercises
12
15. The male client is receiving external radiation to the neck for cancer of ask the client about the description of the pain and
the larynx. The most likely side effect to be expected is: listen carefully to the client’s words used to
a. Dyspnea
describe the pain. The nurse’s impression of the
b. Diarrhea
c. Sore throat client’s pain is not appropriate in determining the
d. Constipation client’s level of pain. Nonverbal cues from the client
15. Answer C. In general, only the area in the are important but are not the most appropriate pain
treatment field is affected by the radiation. Skin assessment measure. Assessing pain relief is an
reactions, fatigue, nausea, and anorexia may occur important measure, but this option is not related to
with radiation to any site, whereas other side the subject of the question.
effects occur only when specific areas are involved
in treatment. A client receiving radiation to the 21. Nurse Mickey is caring for a client who is postoperative following a
pelvic exenteration and the physician changes the client’s diet from NPO
larynx is most likely to experience a sore throat. status to clear liquids. The nurse makes which priority assessment before
Options B and D may occur with radiation to the administering the diet?
gastrointestinal tract. Dyspnea may occur with lung a. Bowel sounds
involvement. b. Ability to ambulate
c. Incision appearance
16. Nurse Joy is caring for a client with an internal radiation implant. When d. Urine specific gravity
caring for the client, the nurse should observe which of the following 21. Answer A. The client is kept NPO until
principles? peristalsis returns, usually in 4 to 6 days. When
a. Limit the time with the client to 1 hour per shift signs of bowel function return, clear fluids are given
b. Do not allow pregnant women into the client’s room
to the client. If no distention occurs, the diet is
c. Remove the dosimeter badge when entering the client’s room
d. Individuals younger than 16 years old may be allowed to go in the room advanced as tolerated. The most important
as long as they are 6 feet away from the client assessment is to assess bowel sounds before
16. Answer B. The time that the nurse spends in a feeding the client. Options B, C, and D are unrelated
room of a client with an internal radiation implant is to the subject of the question.
30 minutes per 8-hour shift. The dosimeter badge
must be worn when in the client’s room. Children 22. A male client is admitted to the hospital with a suspected diagnosis of
Hodgkin’s disease. Which assessment findings would the nurse expect to
younger than 16 years of age and pregnant women note specifically in the client?
are not allowed in the client’s room. a. Fatigue
b. Weakness
17. A cervical radiation implant is placed in the client for treatment of c. Weight gain
cervical cancer. The nurse initiates what most appropriate activity order for d. Enlarged lymph nodes
this client? 22. Answer D. Hodgkin’s disease is a chronic
a. Bed rest
progressive neoplastic disorder of lymphoid tissue
b. Out of bed ad lib
c. Out of bed in a chair only characterized by the painless enlargement of lymph
d. Ambulation to the bathroom only nodes with progression to extralymphatic sites,
17. Answer A. The client with a cervical radiation such as the spleen and liver. Weight loss is most
implant should be maintained on bed rest in the likely to be noted. Fatigue and weakness may occur
dorsal position to prevent movement of the but are not related significantly to the disease.
radiation source. The head of the bed is elevated to
a maximum of 10 to 15 degrees for comfort. The 23. During the admission assessment of a 35 year old client with
advanced ovarian cancer, the nurse recognizes which symptom as typical of
nurse avoids turning the client on the side. If the disease?
turning is absolutely necessary, a pillow is placed a. Diarrhea
between the knees and, with the body in straight b. Hypermenorrhea
alignment, the client is logrolled. c. Abdominal bleeding
d. Abdominal distention
18. A female client is hospitalized for insertion of an internal cervical 23. Answer D. Clinical manifestations of ovarian
radiation implant. While giving care, the nurse finds the radiation implant in cancer include abdominal distention, urinary
the bed. The initial action by the nurse is to: frequency and urgency, pleural effusion,
a. Call the physician
malnutrition, pain from pressure caused by the
b. Reinsert the implant into the vagina immediately
c. Pick up the implant with gloved hands and flush it down the toilet growing tumor and the effects of urinary or bowel
d. Pick up the implant with long-handled forceps and place it in a lead obstruction, constipation, ascites with dyspnea, and
container. ultimately general severe pain. Abnormal bleeding,
18. Answer D. A lead container and long-handled often resulting in hypermenorrhea, is associated
forceps should be kept in the client’s room at all with uterine cancer.
times during internal radiation therapy. If the
implant becomes dislodged, the nurse should pick 24. Nurse Kate is reviewing the complications of colonization with a client
up the implant with long-handled forceps and place who has microinvasive cervical cancer. Which complication, if identified by
the client, indicates a need for further teaching?
it in the lead container. Options A, B, and C are a. Infection
inaccurate interventions. b. Hemorrhage
c. Cervical stenosis
19. The nurse is caring for a female client experiencing neutropenia as a d. Ovarian perforation
result of chemotherapy and develops a plan of care for the client. The nurse 24. Answer D. Conization procedure involves
plans to:
removal of a cone-shaped area of the cervix.
a. Restrict all visitors
b. Restrict fluid intake Complications of the procedure include hemorrhage,
c. Teach the client and family about the need for hand hygiene infection, and cervical stenosis. Ovarian perforation
d. Insert an indwelling urinary catheter to prevent skin breakdown is not a complication.
19. Answer C. In the neutropenic client,
meticulous hand hygiene education is implemented 25. Mr. Miller has been diagnosed with bone cancer. You know this type
for the client, family, visitors, and staff. Not all of cancer is classified as:
a. sarcoma.
visitors are restricted, but the client is protected b. lymphoma.
from persons with known infections. Fluids should c. carcinoma.
be encouraged. Invasive measures such as an d. melanoma.
indwelling urinary catheter should be avoided to 25. Answer A. Tumors that originate from
prevent infections. bone,muscle, and other connective tissue are called
sarcomas.
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 26. Sarah, a hospice nurse visits a client dying of ovarian cancer. During
of the client’s pain would include which of the following? the visit, the client expresses that “If I can just live long enough to attend my
a. The client’s pain rating daughter’s graduation, I’ll be ready to die.” Which phrase of coping is this
b. Nonverbal cues from the client client experiencing?
c. The nurse’s impression of the client’s pain a. Anger
d. Pain relief after appropriate nursing intervention b. Denial
20. Answer A. The client’s self-report is a critical c. Bargaining
component of pain assessment. The nurse should d. Depression
13
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
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. The female client who has been receiving radiation therapy for bladder
cancer tells the nurse that it feels as if she is voiding through the vagina.
The nurse interprets that the client may be experiencing:
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
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 client’s complaint is not associated with options
A, C, and D.