Oncology Drills PDF

**ONCOLOGY DRILLS** DR. CZERWIN S. JUALES Course Instructor 1\. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief and he refuses to move. The nurse should plan to: a\. Reassure him that the nurses will not hurt him \ b. Let him...

**ONCOLOGY DRILLS** DR. CZERWIN S. JUALES Course Instructor 1\. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief and he refuses to move. The nurse should plan to: a\. Reassure him that the nurses will not hurt him \ b. Let him perform his own activities of daily living \ c. Handle him gently when assisting with required care \ d. Complete A.M. care quickly as possible when necessary 2\. A female client with breast cancer is currently receiving radiation therapy for treatment.  The client is complaining of apathy, hard to concentrate on something, and feeling tired despite of having time to rest and more sleep.  These complains suggest symptoms of\ a. Hypocalcemia\ b. radiation pneumonitis\ c. advanced breast cancer d\. fatigue 3\. A chemotherapeutic agent 5FU is ordered as an adjunct measure to surgery. Which of the ff. statements about chemotherapy is true? a\. it is a local treatment affecting only tumor cells \ b. it affects both normal and tumor cells \ c. it has been proven as a complete cure for cancer \ d. it is often used as a palliative measure. 4\. Which of the following signs and symptoms would Nurse Maureen include in teaching plan as an early manifestation of laryngeal cancer? a\. Stomatitis b\. Airway obstruction c\. Hoarseness d\. Dysphagia 5\. Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it: a\. Promotes the removal of antibodies that impair the transmission of impulses b\. Stimulates the production of acetylcholine at the neuromuscular junction. c\. Decreases the production of auto antibodies that attack the acetylcholine receptors. d\. Inhibits the breakdown of acetylcholine at the neuromuscular junction. 6\. Which of the following stage the carcinogen is irreversible? a\. Progression stage b\. Initiation stage c\. Regression stage d\. Promotion stage 7\. Nurse Anna is aware that early adaptation of client with renal carcinoma is: a\. Nausea and vomiting b\. flank pain c\. weight gain d\. intermittent hematuria 8\. A newly admitted client is diagnosed with Hodgkin's disease undergoes an excisional cervical lymph node biopsy under local anesthesia. What does the nurse assess first after the procedure? a\. Vital signs b\. Incision site c\. Airway d\. Level of consciousness 9\. Cancer patients have special nutrition needs and issues related to eating. The client receving chemotherapy refuses to eat the food that was delivered to him and said that the food tastes funny. The appropriate nursing intervention is: a\. Obtain an order for total parenteral nutrition b\. Keep the client on NPO c\. Administer anti-emetic as ordered by physician d\. Provide oral hygiene care 10\. A client with testicular cancer is scheduled for a right orchiectomy. The nurse knows that an orchiectomy is the a\. surgical removal of the entire scrotum b\. surgical removal of a testicle\ c. dissection of related lymph nodes\ d. partial surgical removal of the penis 11\. **A client is being evaluated for cancer of the colon. In preparing the client for barium enema, the nurse should:** a\. Give laxative the night before and a cleansing enema in the morning before the test \ b. Render an oil retention enema and give laxative the night before \ c. Instruct the client to swallow 6 radiopaque tablets the evening before the study \ d. Place the client on CBR a day before the study 12\. The client has a good understanding of the means to reduce the chances of colon cancer when he states: a\. "I will exercise daily." \ b. "I will include more red meat in my diet." \ c. "I will have an annual chest x-ray." \ d. "I will include more fresh fruits and vegetables in my diet." 13\. **A client, who is suspected of having Pheochromocytoma, complains of sweating, palpitation and headache. Which assessment is essential for the nurse to make first?** a\. Pupil reaction \ b. Hand grips \ c. Blood pressure \ d. Blood glucose 14\. **The nurse is conducting an education session for a group of smokers in a "stop smoking" class. Which finding would the nurse state as a common symptom of lung cancer? :** a\. Dyspnea on exertion \ b. Foamy, blood-tinged sputum \ c. Wheezing sound on inspiration \ d. Cough or change in a chronic cough 15\. A client admitted with newly diagnosed with Hodgkin's disease. Which of the following would the nurse expect the client to report? a. Lymph node pain b. Weight gain c. Night sweats d. Headache 16\. When teaching a client about the signs of colorectal cancer, Nurse Trish stresses that the most common complaint of persons with colorectal cancer is: a. Abdominal pain b. Hemorrhoids c. Change in caliber of stools d. Change in bowel habits 17\. A patient with a left frontal lobe tumor has a craniotomy. Four hours post surgery, which data indicates increased ICP? a\. BP 160/90 b\. Patient is difficult to arouse c\. Patient has a positive Babinski response d\. Patient has urinary incontinence 18\. The most common preferred treatment for cancer is a\. Chemotherapy b\. Radiation therapy c\. Surgery d\. Bone marrow transplant 19\. A client on chemotherapy has a platelet count of 26,000 mm. Which nursing intervention must be included in the client\'s care plan? a\. Having the client use an electric razor and soft-bristle toothbrush\ b. Premedicating the client 30 minutes before chemotherapy with an antiemetic\ c Preparing to administer leukocyte-poor packed red blood cells (RBCs)\ d. Screening all visitors and staff for infection prior to allowing them to enter the room 20\. Which intervention would be most appropriate for a client who is 12 days postchemotherapy and being admitted with shortness of breath, a dry hacking cough, and a temperature of 101° F? a\. Having the dietary department serve the meals as hot as possible\ b. Initiating the prescribed I.V. antibiotics after checking the white blood cell (WBC) count\ c. Limiting the protein and calories in the client\'s diet\ d. Reassuring the client that fatigue is a common occurrence after chemotherapy 21\. The nurse is planning the care for a client with cancer who is about to enter a hospice treatment program. Which nursing diagnosis and outcome would be appropriate for this client? a\. Imbalanced nutrition: The client will eat three meals/snacks a day\ b. Impaired social interaction: The client will attend one outing per week\ c. Anticipatory grieving: The client will participate in end-of-life care planning\ d. Deficient knowledge: The client will state three reasons for cancer therapy 22\. The nurse knows that a 28-year-old female client with Hodgkin\'s disease who is receiving chemotherapy understands the discharge teaching when the client says which statement? a\. \"I should begin to try to have a baby as soon as possible.\"\ b. \"If I begin to run a fever, I should call my doctor.\"\ c. \"If I feel tired, I should go to the gym and work out.\"\ d. \"If my mouth gets sore, I\'ll need to fast until it goes away.\" 23\. After chemotherapy, a client who is scheduled to begin treatment with a biologic response modifier (BRM) asks the nurse how this treatment will help him. The nurse bases the response on the knowledge that this type of treatment stimulates: a\. reproduction of cancer cells.\ b. the body\'s natural immune defenses.\ c. the liver to produce an anti-tumor hormone.\ d. the pancreas to produce an anti-cancer hormone. 24\. Larry is diagnosed as having myelocytic leukemia and is admitted to the hospital for chemotherapy. Larry discusses his recent diagnosis of leukemia by referring to statistical facts and figures. The nurse recognizes that Larry is using the defense mechanism known as: A. Reaction formation \ B. Sublimation \ C. Intellectualization \ D. Projection 25\. Which statement by the client indicates to the nurse that the patient understands precautions necessary during internal radiation therapy for cancer of the cervix? a\. "I should get out of bed and walk around in my room." \ b. "My 7 year old twins should not come to visit me while I'm receiving treatment." \ c. "I will try not to cough, because the force might make me expel the application." \ d. "I know that my primary nurse has to wear one of those badges like the people in the x-ray department, but they are not necessary for anyone else who comes in here." 26\. A post-operative complication of mastectomy is lymphedema. This can be prevented by a\. ensuring patency of wound drainage tube \ b. placing the arm on the affected side in a dependent position \ c. restricting movement of the affected arm \ d. frequently elevating the arm of the affected side above the level of the heart. 27\. **High uric acid levels may develop in clients who are receiving chemotherapy. This is caused by:** a\. The inability of the kidneys to excrete the drug metabolites \ b. Rapid cell catabolism \ c. Toxic effect of the antibiotic that are given concurrently \ d. The altered blood ph from the acid medium of the drugs 28\. **Maria Sison, 40 years old, single, was admitted to the hospital with a diagnosis of Breast Cancer. She was scheduled for radical mastectomy. Nursing care during the preoperative period should consist of:** a\. assuring Maria that she will be cured of cancer \ b. assessing Maria's expectations and doubts \ c. maintaining a cheerful and optimistic environment \ d. keeping Maria's visitors to a minimum so she can have time for herself 29\. **Maria refuses to acknowledge that her breast was removed. She believes that her breast is intact under the dressing. The nurse should** a\. call the MD to change the dressing so Kathy can see the incision \ b. recognize that Kathy is experiencing denial, a normal stage of the grieving process \ c. reinforce Kathy's belief for several days until her body can adjust to stress of surgery. \ d. remind Kathy that she needs to accept her diagnosis so that she can begin rehabilitation exercises. 30\. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy with the creation of an ileal conduit in the morning. He is wringing his hands and pacing the floor when the nurse enters his room. What is the best approach? a\. \"Good evening, Mr. Pablo. Wasn\'t it a pleasant day, today?\"\ b. \"Mr, Pablo, you must be so worried, I\'ll leave you alone with your thoughts.\ c. "Mr. Pablo, you\'ll wear out the hospital floors and yourself at this rate.\"\ d. \"Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow\'s surgery?\" 31\. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief and he refuses to move. The nurse should plan to: a\. Reassure him that the nurses will not hurt him\ b. Let him perform his own activities of daily living\ c. Handle him gently when assisting with required care\ d. Complete A.M. care quickly as possible when necessary 32\. A client, who is suspected of having Pheochromocytoma, complains of sweating, palpitation and headache. Which assessment is essential for the nurse to make first?\ a. Pupil reaction\ b. Hand grips\ c. Blood pressure\ d. Blood glucose\ \ 33. The client is admitted to the outpatient surgery center for removal of a malignant melanoma. Which assessment data indicate the lesion is a malignant melanoma? a\. The lesion is asymmetrical and has irregular borders. b\. The lesion has a waxy appearance with pearl-like borders. c\. The lesion has a thickened and scaly appearance. d\. The lesion appeared as a thickened area after an injury. 34\. The female client admitted for an unrelated diagnosis asks the nurse to check her back because "it itches all the time in that one spot." When the nurse assesses the client's back, the nurse notes an irregular-shaped lesion with some scabbed-over areas surrounding the lesion. Which action should the nurse implement first? a\. Notify the HCP to check the lesion on rounds. b\. Measure the lesion and note the color. c\. Apply lotion to the lesion. d\. Instruct the client to make sure the HCP checks the lesion. 35\. The nurse is caring for a client diagnosed with squamous cell skin cancer and writes a psychosocial problem of "fear." Which nursing interventions should be included in the plan of care? a\. Explain to the client that the fears are unfounded. b\. Encourage the client to verbalize the feeling of being afraid. c\. Have the HCP discuss the client's fear with the client. d\. Instruct the client regarding all planned procedures. 36\. The client has had a squamous cell carcinoma removed from the lip. Which discharge instructions should the nurse provide? a\. Notify the HCP if a lesion that does not heal develops around the mouth. b\. Squamous cell carcinoma tumors do not metastasize. c\. Limit foods to liquid or soft consistency for 1 month. d\. Apply heat to the area for 20 minutes every 4 hours. 37\. The nurse is caring for clients in an outpatient surgery clinic. Which client should be assessed first? a\. The client scheduled for a skin biopsy who is crying. b\. The client who had surgery three (3) hours ago and is sleeping. c\. The client who needs to void prior to discharge. d\. The client who has received discharge instructions and is ready to go home. 38\. The nurse and unlicensed assistive personnel are caring for clients in a dermatology clinic. Which task should not be delegated to the unlicensed assistant? a\. Stock the rooms with the equipment needed. b\. Weigh the clients and position the clients for the examination. c\. Discuss problems the client has experienced since the previous visit. d\. Take the biopsy specimens to the laboratory. 39\. Which client is at the greatest risk for the development of skin cancer? a\. The African American male who lives in the northeast. b\. The elderly Hispanic female who moved from Mexico as a child. c\. The client who has a family history of basal cell carcinoma. d\. The client with fair complexion who cannot get a tan. 40\. The nurse participating in a health fair is discussing malignant melanoma with a group of clients. Which information regarding the use of sunscreen is important to include? a\. Sunscreen is only needed during the hottest hours of the day. b\. Toddlers should not have sunscreen applied to their skin. c\. Sunscreen does not help prevent skin cancer. d\. The higher the number of the sunscreen, the more it blocks UV rays. 41\. The school nurse is preparing to teach a health promotion class to high school seniors. Which information regarding self-care should be included in the teaching? a\. Wear a sunscreen with a protection factor of 10 or less when in the sun. b\. Try to stay out of the sun between 0300 and 0500 daily. c\. Perform a thorough skin check monthly. d\. Remember that caps and long sleeves do not help prevent skin cancer. 42\. Which client physiological outcome (goal) is appropriate for a client diagnosed with skin cancer who has had surgery to remove the lesion? a\. The client will express feelings of fear. b\. The client will ask questions about the diagnosis. c\. The client will state a diminished level of pain. d\. The client will demonstrate care of operative site. 43\. The middle-aged client has had 2 lesions diagnosed as basal cell carcinoma removed. Which discharge instruction should the nurse include? a\. Teach the client that there is no more risk for cancer. b\. Refer the client to a prosthesis specialist for prosthesis. c\. Instruct the client how to apply sunscreen to the area. d\. Demonstrate care of the surgical site. 44\. The nurse is working on a renal surgery unit. After the afternoon report, which client should the nurse assess first? a\. The male client who just returned from a CT scan and states that he left his glasses in the x-ray department. b\. The client who is one (1) day post-op and has a moderate amount of serous drainage on the dressing. c\. The client who is scheduled for surgery in the morning and wants an explanation of the operative procedure before signing the permit. d\. The client who had ileal conduit surgery this morning and has not had any drainage in the drainage bag. 45\. Which is a modifiable risk factor for the development of cancer of the bladder? a\. Previous exposure to chemicals. b\. Pelvic radiation therapy. c\. Cigarette smoking. d\. Parasitic infections of the bladder. 46\. The client diagnosed with cancer of the bladder is scheduled to have a cutaneous urinary diversion procedure. Which preoperative teaching intervention specific to the procedure should be included? a\. Demonstrate turn, cough, and deep breathing. b\. Explain that a bag will drain the urine from now on. c\. Instruct the client on the use of a PCA pump. d\. Take the client to the ICD so that he or she can become familiar with it. 47\. The client diagnosed with cancer of the bladder is undergoing intravesical chemotherapy. Which instruction should the nurse provide the client about the pre-therapy routine? a\. Instruct the client to remain NPO after midnight before the procedure. b\. Explain the use of chemotherapy in bladder cancer. c\. Teach the client to administer Neupogen, a biologic response modifier. d\. Have the client take Tylenol, an analgesic, before coming to the clinic. 48\. The nurse is planning the care of a postoperative client with an ileal conduit. Which intervention should be included in the plan of care? 1\. Provide meticulous skin care and pouching. 2\. Apply sterile drainage bags daily. 3\. Monitor the pH of the urine weekly. 4\. Assess the stoma site every day. 49\. The nurse and a licensed practical nurse (LPN) are caring for a group of clients. Which intervention should be assigned to the LPN? a\. Assessment of the client who has had a Kock pouch procedure. b\. Monitoring of the post-op client with a WBC of 22,000 mm/dL. c\. Administration of the prescribed antineoplastic medications. d\. Care for the client going for a MRI of the kidneys. 50\. The male client diagnosed with metastatic cancer of the bladder is emaciated and refuses to eat. Which nursing action is an example of the ethical principle of paternalism? a\. The nurse allows the client to talk about not wanting to eat. b\. The nurse tells the client that if he does not eat, a feeding tube will be placed. c\. The nurse consults the dietitian about the client's nutritional needs. d\. The nurse asks the family to bring favorite foods for the client to eat. 51\. The client diagnosed with cancer of the bladder states, "I have young children. I am too young to die." Which statement is the nurse's best response? a\. "This cancer is treatable and you should not give up." b\. "Cancer occurs at any age. It is just one of those things." c\. "You are afraid of dying and what will happen to your children." d\. "Have you talked to your children about your dying?" 52\. The client with a continent urinary diversion is being discharged. Which discharge instructions should the nurse include in the teaching? a\. Have the client demonstrate catheterizing the stoma. b\. Instruct the client on how to pouch the stoma. c\. Explain the use of a bedside drainage bag at night. d\. Tell the client to call the HCP if the temperature is 99\_F or less. 53\. Which information regarding the care of a cutaneous ileal conduit should the nurse teach? a\. Teach the client to instill a few drops of vinegar into the pouch. b\. Tell the client that the stoma should be slightly dusky colored. c\. Inform the client that large clumps of mucus are expected. d\. Tell the client that it is normal for the urine to be pink or red in color. 54\. The client is 2 days post ureterosigmoidostomy for cancer of the bladder. Which assessment data warrant notification of the HCP by the nurse? a\. The client complains of pain at a "3," 30 minutes after being medicated. b\. The client complains that it hurts to cough and deep breathe. c\. The client ambulates to the end of the hall and back before lunch. d\. The client is lying in a fetal position and has a rigid abdomen. 55\. The female client diagnosed with bladder cancer with a cutaneous urinary diversion states, "Will I be able to have children now?" Which statement is the nurse's best response? a\. "Cancer does not make you sterile, but sometimes the therapy can." b\. "Are you concerned that you can't have children?" c\. "You will be able to have as many children as you want." d\. "Let me have the chaplain come to talk with you about this." 56\. 1. The nurse is instructing the client to perform a testicular self-examination. The nurse tells the client: a\. To examine the testicles while lying down b\. That the best time for the examination is after a shower c\. To gently feel the testicle with one finger to feel for a growth d\. That testicular self-examinations should be done at least every 6 months 57\. The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. Which of the following, if identified by the client as a risk factor for cervical cancer, indicates a need for further teaching? a\. Smoking b\. Multiple sex partners c\. First intercourse after age 20 d\. Annual gynecological examinations 58\. The community health nurse is instructing a group of female clients about breast self-examination. The nurse instructs the clients to perform the examination: a\. At the onset of menstruation b\. Every month during ovulation c\. Weekly at the same time of day d\. 1 week after menstruation begins 59\. The nurse is caring for a client who has undergone a vaginal hysterectomy. The nurse avoids which of the following in the care of this client? a\. Elevating the knee gatch on the bed b\. Assisting with range-of-motion leg exercises c\. Removal of antiembolism stockings twice daily d\. Checking placement of pneumatic compression boots 60\. The client is diagnosed as having a bowel tumor and several diagnostic tests are prescribed. The nurse understands that which test will confirm the diagnosis of malignancy? a\. Biopsy of the tumor b\. Abdominal ultrasound c\. Magnetic resonance imaging d\. Computed tomography scan 61\. A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder? a\. Altered red blood cell production b\. Altered production of lymph nodes c\. Malignant exacerbation in the number of leukocytes d\. Malignant proliferation of plasma cells within the bone 62\. 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? a\. Increased calcium level b\. Increased white blood cells c\. Decreased blood urea nitrogen level d\. Decreased number of plasma cells in the bone marrow 63\. The nurse is developing a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? a\. Encouraging fluids b\. Providing frequent oral care c\. Coughing and deep breathing d\. Monitoring the red blood cell count 64\. The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin\'s disease. The nurse determines that further teaching is needed if a nursing staff member states that which of the following is a characteristic of the disease? a\. Presence of Reed-Sternberg cells b\. Occurs most often in the older client c\. Prognosis depending on the stage of the disease d\. Involvement of lymph nodes, spleen, and liver 65\. The community health nurse conducts a health promotion program regarding testicular cancer to community members. The nurse determines that further information needs to be provided if a community member states that which of the following is a sign of testicular cancer? a\. Alopecia b\. Back pain c\. Painless testicular swelling d\. Heavy sensation in the scrotum 66\. The client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is: a\. Dyspnea b\. Diarrhea c\. Sore throat d\. Constipation 67\. The nurse is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles? a\. Limit the time with the client to 1 hour per shift. b\. Do not allow pregnant women into the client\'s room. 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 as long as they are 6 feet away from the client. 68\. A cervical radiation implant is placed in the client for treatment of cervical cancer. The nurse initiates what most appropriate activity order for this client? a\. Bed rest b\. Out of bed ad lib c\. Out of bed in a chair only d\. Ambulation to the bathroom only 69\. The client is hospitalized for insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. The initial action by the nurse is to: a\. Call the physician. b\. Reinsert the implant into the vagina immediately. c\. Pick up the implant with gloved hands and flush it down the toilet. d\. Pick up the implant with long-handled forceps and place it in a lead container. 70\. The nurse is caring for a client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plans to: a\. Restrict all visitors. b\. Restrict fluid intake. c\. Teach the client and family about the need for hand hygiene. d\. Insert an indwelling urinary catheter to prevent skin breakdown. 71\. The home health care nurse is caring for a client with cancer and the client is complaining of acute pain. The appropriate nursing assessment of the client\'s pain would include which of the following? a\. The client\'s pain rating b\. Nonverbal cues from the client c\. The nurse\'s impression of the client\'s pain d\. Pain relief after appropriate nursing intervention 72\. The nurse is caring for a client who is postoperative following a pelvic exenteration and the physician changes the client\'s diet from NPO status to clear liquids. The nurse makes which priority assessment before administering the diet? a\. Bowel sounds b\. Ability to ambulate c\. Incision appearance d\. Urine specific gravity 73\. The client is admitted to the hospital with a suspected diagnosis of Hodgkin\'s disease. Which assessment finding would the nurse expect to note specifically in the client? a\. Fatigue b\. Weakness c\. Weight gain d\. Enlarged lymph nodes 74\. During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? a\. Diarrhea b\. Hypermenorrhea c\. Abnormal bleeding d\. Abdominal distention 75\. When assessing the laboratory results of the client with bladder cancer and bone metastasis, the nurse notes a calcium level of 12 mg/dL. The nurse recognizes that this is consistent with which oncological emergency? a\. Hyperkalemia b\. Hypercalcemia c\. Spinal cord compression d\. Superior vena cava syndrome 76\. The client reports to the nurse that when performing testicular self-examination, he found a lump the size and shape of a pea. The appropriate response to the client is which of the following? a\. "Lumps like that are normal; don\'t worry." b\. "Let me know if it gets bigger next month." c\. "That could be cancer. I\'ll ask the doctor to examine you." d\. "That\'s important to report even though it might not be serious." 77\. The hospice nurse visits a client dying of ovarian cancer. During the visit, the client expresses that "If I can just live long enough to attend my daughter\'s graduation, I\'ll be ready to die." Which phase of coping is this client experiencing? a\. Anger b\. Denial c\. Bargaining d\. Depression 78\. The nurse is caring for a client following a mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery? a\. Pain at the incisional site b\. Arm edema on the operative side c\. Sanguineous drainage in the Jackson-Pratt drain d\. Complaints of decreased sensation near the operative site 79\. The nurse is admitting a 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 80\. 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 81\. The client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim) is prescribed for the client. The nurse tells the client that the purpose of the allopurinol is to: a\. Prevent nausea b\. Prevent alopecia c\. Prevent vomiting d\. Prevent hyperuricemia 82\. The client receiving chemotherapy is experiencing mucositis. The nurse advises the client to use which of the following as the best substance to rinse the mouth? a\. Alcohol-based mouthwash b\. Hydrogen peroxide mixture c\. Lemon-flavored mouthwash d\. Weak salt and bicarbonate mouth rinse 83\. The community nurse is conducting a health promotion program and the topic of the discussion relates to the risk factors for gastric cancer. Which risk factor, if identified by a client, indicates a need for further discussion? a\. Smoking b\. A high-fat diet c\. Foods containing nitrates d\. A diet of smoked, highly salted, and spiced food 84\. A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. Which of the following is the appropriate nursing intervention? a\. Notify the physician. b\. Measure abdominal girth. c\. Irrigate the nasogastric tube. d\. Continue to monitor the drainage. 85\. The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to colorectal cancer is necessary if the client identifies which of the following as an associated risk factor? 1\. Age younger than 50 years 2\. History of colorectal polyps 3\. Family history of colorectal cancer 4\. Chronic inflammatory bowel disease 86\. The nurse is reviewing the preoperative orders of a client with a colon tumor who is scheduled for abdominal perineal resection and notes that the physician has prescribed neomycin (Mycifradin) for the client. The nurse determines that this medication has been prescribed primarily: a\. To prevent an immune dysfunction b\. Because the client has an infection c\. To decrease the bacteria in the bowel d\. Because the client is allergic to penicillin 87\. The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is appropriate? a\. Notify the physician. b\. Clamp the Penrose drain. c\. Change the dressing as prescribed. d\. Remove and replace the perineal packing. 88\. The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which of the following assessment findings indicates that the colostomy is beginning to function? a\. Absent bowel sounds b\. The passage of flatus c\. The client\'s ability to tolerate food d\. Bloody drainage from the colostomy 89\. The nurse is caring for a client following a radical neck dissection and creation of a tracheostomy performed for laryngeal cancer and is providing discharge instructions to the client. Which statement by the client indicates a need for further instructions? a\. "I will protect the stoma from water." b\. "I need to keep powders and sprays away from the stoma site." c\. "I need to use an air conditioner to provide cool air to assist in breathing." d\. "I need to apply a thin layer of petrolatum to the skin around the stoma to prevent cracking." 90\. What is the purpose of cytoreductive ("debulking") surgery for ovarian cancer? a\. Cancer control by reducing the size of the tumor b\. Cancer prevention by removal of precancerous tissue c\. Cancer cure by removing all gross and microscopic tumor cells d\. Cancer rehabilitation by improving the appearance of a previously treated body part 91\. Hormone therapy is prescribed as the mode of treatment for a client with prostate cancer. The nurse understands that the goal of this form of treatment is to: a\. Increase testosterone levels. b\. Increase prostaglandin levels. c\. Limit the amount of circulating androgens. d\. Increase the amount of circulating androgens. 92\. The nurse is caring for a client with cancer of the prostate following a prostatectomy. The nurse provides discharge instructions to the client and tells the client to: a\. Avoid driving the car for 1 week. b\. Restrict fluid intake to prevent incontinence. c\. Avoid lifting objects heavier than 20 lb for at least 6 weeks. d\. Notify the physician if small blood clots are noticed during urination. 93\. The oncology nurse is providing a teaching session to a group of nursing students regarding the risks and causes of bladder cancer. Which statement by a student indicates a need for further teaching? a\. "Bladder cancer most often occurs in women." b\. "Using cigarettes and coffee drinking can increase the risk." c\. "Bladder cancer generally is seen in clients older than age 40." d\. "Environmental health hazards have been attributed as a cause." 94\. The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common symptom of this type of cancer? a\. Dysuria b\. Hematuria c\. Urgency on urination d\. Frequency of urination 95\. The nurse is caring for a client following intravesical instillation of an alkylating chemotherapeutic agent into the bladder for the treatment of bladder cancer. Following the instillation, the nurse should instruct the client to: a\. Urinate immediately. b\. Maintain strict bed rest. c\. Change position every 15 minutes. d\. Retain the instillation fluid for 30 minutes. 96\. The nurse is assessing the stoma of a client following an ureterostomy. Which of the following should the nurse expect to note? 1\. A dry stoma 2\. A pale stoma 3\. A dark-colored stoma 4\. A red and moist stoma 97\. The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? a\. Placing cool compresses on the affected arm b\. Elevating the affected arm on a pillow above heart level c\. Avoiding arm exercises in the immediate postoperative period d\. Maintaining an intravenous site below the antecubital area on the affected side 98\. A nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which of the following is an early sign of this oncological emergency? a\. Cyanosis b\. Arm edema c\. Periorbital edema d\. Mental status changes 99\. A nurse manager is teaching the nursing staff about signs and a symptom related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which of the following is a serious late sign of this oncological emergency? a\. Headache b\. Dysphagia c\. Constipation d\. Electrocardiographic changes 100\. As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of the greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed when the client states: a\. "I should avoid blowing my nose." b\. "I may need a platelet transfusion if my platelet count is too low." c\. "I\'m going to take aspirin for my headache as soon as I get home." d\. "I will count the number of pads and tampons I use when menstruating." 101\. The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by the intravenous route. The nurse plans to initiate bleeding precautions if which laboratory result is noted? a\. A clotting time of 10 minutes b\. An ammonia level of 20 mcg/dL c\. A platelet count of 50,000/mm3 d\. A white blood cell count of 5,000/mm3 102\. The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which of the following laboratory values would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? a\. Anemia b\. Decreased platelets c\. Increased uric acid level d\. Decreased leukocyte count 103\. The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide (Cytoxan, Neosar). The nurse tells the client to: a\. Take the medication with food. b\. Increase fluid intake to 2000 to 3000 mL daily. c\. Decrease sodium intake while taking the dedication. d\. Increase potassium intake while taking the medication. 104\. The client with non--Hodgkin\'s lymphoma is receiving daunorubicin (DaunoXome). Which of the following would indicate to the nurse that the client is experiencing a toxic effect related to the medication? a\. Fever b\. Diarrhea c\. Complaints of nausea and vomiting d\. Crackles on auscultation of the lungs 105\. Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to do which of the following before administering chemotherapy? a\. Measure abdominal girth. b\. Calculate body mass index. c\. Ask the client about his or her height and weight. d\. Weigh and measure the client on the day of drug administration. 106\. The client with squamous cell carcinoma of the larynx is receiving bleomycin (Blenoxane) intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? a\. Echocardiography b\. Electrocardiography c\. Cervical radiographphy d\. Pulmonary function studies 107\. Each chemotherapeutic agent has a specific nadir. The nurse administering a combination chemotherapy regimen understands the importance of: a\. Giving two agents from the same medication class b\. Giving two agents with like nadirs at the same time c\. Testing the client\'s knowledge about each agent\'s nadir d\. Avoid giving agents with the same nadirs and toxicities at the same time 108\. The clinic nurse prepares a teaching plan for the client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client: a\. To take aspirin (acetylsalicylic acid) as needed for headache b\. Drink beverages containing alcohol in moderate amounts each evening c\. Consult with health care providers before receiving immunizations d\. That it is not necessary to consult health care providers before receiving a flu vaccine at the local health fair 109\. The client with bladder cancer is receiving cisplatin (Platinol) and vincristine (Oncovin, Vincasar PFS). The nurse preparing to give the medication understands that the purpose of administering both these medications is to: a\. Prevent alopecia b\. Decrease the destruction of cells c\. Increase the therapeutic response d\. Prevent gastrointestinal side effects 110\. The client with lung cancer is receiving a high dose of methotrexate (Rheumatrex, Trexall). Leucovorin (citrovorum factor, folic acid) is also prescribed. The nurse caring for the client understands that the purpose of administering the leucovorin is to: a\. Preserve normal cells. b\. Promote DNA synthesis. c\. Promote medication excretion. d\. Promote the synthesis of nucleic acids. 111\. The client with ovarian cancer is being treated with vincristine (Oncovin, Vincasar PFS). The nurse monitors the client, knowing that which of the following indicates a side effect specific to this medication? a\. Diarrhea b\. Hair loss c\. Chest pain d\. Numbness and tingling in the fingers and toes 112\. The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse contacts the physician before administering the medication if which of the following is documented in the client\'s history? a\. Pancreatitis b\. Diabetes mellitus c\. Myocardial infarction d\. Chronic obstructive pulmonary disease 113\. Tamoxifen (Nolvadex) is prescribed for the client with metastatic breast carcinoma. The nurse administering the medication understands that the primary action of this medication is to: a\. Increase DNA and RNA synthesis. b\. Promote the biosynthesis of nucleic acids. c\. Increase estrogen concentration and estrogen response. d\. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors. 114\. The client with metastatic breast cancer is receiving tamoxifen (Nolvadex). The nurse specifically monitors which laboratory value while the client is taking this medication? a\. Glucose level b\. Calcium level c\. Potassium level d\. Prothrombin time 115\. Megestrol acetate (Megace), an antineoplastic medication, is prescribed for the client with metastatic endometrial carcinoma. The nurse reviews the client\'s history and contacts the physician if which of the following is documented in the client\'s history? a\. Gout b\. Asthma c\. Thrombophlebitis d\. Myocardial infarction 116\. A female client with carcinoma of the breast is admitted to the hospital for treatment with intravenously administered doxorubicin (Adriamycin). The client tells the nurse that she has been told by herfriends that she is going to lose all her hair. The appropriate nursing response is which of the following? a\. "Your friends are correct." b\. "You will not lose your hair." c\. "Hair loss may occur, but it will grow back just as it is now." d\. "Hair loss may occur, and it will grow back, but it may have a different color or texture." 117\. The clinic nurse prepares instructions for a client who developed stomatitis following the administration of a course of antineoplastic medications. The nurse tells the client to: a\. Rinse the mouth with baking soda or saline. b\. Avoid foods and fluids for the next 24 hours. c\. Swab the mouth daily with lemon and glycerin pads. d\. Brush the teeth and use waxed dental floss three times a day. 118\. The client with acute myelocytic leukemia is being treated with busulfan (Myleran, Busulfex). Which of the following laboratory values would the nurse specifically monitor during treatment with this medication? a\. Clotting time b\. Blood glucose level c\. Uric acid level d\. Potassium level 119\. The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse monitors the client during administration, knowing that which of the following indicates a side effect specific to this medication? a\. Alopecia b\. Chest pain c\. Pulmonary fibrosis d\. Orthostatic hypotension 120\. The nurse is assigned to care for several male and female clients who take estrogen or progestins. The nurse knows that this group of clients is a increased risk for which complication of the medication? a\. Sepsis b\. Dehydration c\. Deep vein thrombosis d\. Electrocardiographic changes 121\. The nurse has admitted a client to the clinical nursing unit following a modified right radical mastectomy for the treatment of breast cancer. The nurse plans to place the right arm in which of the following positions? a\. Elevated above shoulder level b\. Elevated on a pillow c\. Level with the right atrium d\. Dependent to the right atrium 122\. A 6-year-old child has just been diagnosed with localized Hodgkin\'s disease and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. The appropriate and supportive response to the mother is: a\. "I\'m not sure. I\'ll discuss it with the physician." b\. "The child is too young to have radiation therapy." c\. "It\'s very costly, and chemotherapy works just as well." d\. "The physician would prefer that you discuss treatment options with the oncologist." 123\. The nurse teaches skin care to the client receiving external radiation therapy. Which of the following statements, if made by the client, would indicate the need for further instruction? a\. "I will handle the area gently." b\. "I will avoid the use of deodorants." c\. "I will limit sun exposure to 1 hour daily." d\. "I will wear loose-fitting clothing." 124\. A 13-year-old child is diagnosed with Ewing\'s sarcoma of the femur. Following a course of radiation and chemotherapy, it has been decided that leg amputation is necessary. Following the amputation, the child becomes very frightened because of aching and cramping felt in the missing limb. Which nursing statement would be appropriate to assist in alleviating the child\'s fear? a\. "This aching and cramping is normal and temporary and will subside." b\. "This normally occurs after the surgery and we will teach you ways to deal with it." c\. "The pain medication that I give you will take these feelings away." d\. "This pain is not real pain and relaxation exercises will help it go away." 125\. A breast feeding mother develops mastitis in the left breast and is put on an antibiotic for seven days. She asks the nurse if she can continue breast feeding. The nurse\'s best answer would be: a\. \"Only breast feed from the right breast.\" b\. \"Do not breast feed or stimulate the breasts until the infection is resolved.\" c\. \"Continue breast feeding, this is not a contraindication.\" d\. \"Pump the breasts and discard the milk until the infection resolves.\" 126\. You are working in the Dermatology Clinic. A patient has a Basal Carcinoma In Situ removed from his left lower leg. When he returns for follow-up in one week, you note that the wound has healed with minimal scarring. Which type of healing process does this represent? a\. Primary intention b\. Secondary intention c\. Tertiary intention d\. Dehiscence 127\. A client receiving chemotherapy has developed sores in his mouth. He asks the nurse why\ this happened. What is the nurse's best response? a\. "It is a sign that the medication is working."\ b. "You need to have better oral hygiene."\ c. "The cells in the mouth are sensitive to the chemotherapy."\ d. "This always happens with chemotherapy." **The correct answer is C: "The cells in the mouth are sensitive to the chemotherapy."** 128\. Marco who was diagnosed with brain tumor was scheduled for craniotomy. In preventing the development of cerebral edema after surgery, the nurse should expect the use of: a. Diuretics b. Antihypertensive c. Steroids d. Anticonvulsants 129\. A high-fiber diet is thought to reduce the risk of colon cancer because it: **a.** absorbs water from the intestinal wall. **b.** promotes the excretion of bile. **c.** stops diarrhea. **d.** is low in kilocalories. 130\. Pain tolerance in an elderly patient with cancer would: **a.** stay the same. **b.** be lowered. **c.** be increased. **d.** no effect on pain tolerance. 131\. When administering a narcotic with a non-narcotic to relieve severe cancer pain, the nurse must remember: **a.** this combination enhances pain relief. **b.** this combination treats pain both centrally and peripherally. **c.** the narcotic potentiates action of the non-narcotic. **d.** each drug works in its own right. 132\. A cancer patient has had a resurgence of severe acute pain. Which of the following routes of medication is most appropriate for this patient? **a.** oral administration NSAIDS **b.** oral administration of narcotics **c.** rectal administration of NSAIDS **d.** injectable pain reliever 133\. Which of the following statements about the use of antidepressants with pain relief in cancer pain is true? **a.** Antidepressants have no effect. **b.** Antidepressants enhance the effect of analgesics. **c.** Antidepressants decrease the effect of analgesics. **d.** Antidepressants promote more rapid excretion of the medications. 134\. The use of radiation therapy in the care of a patient with abdominal cancer would be: **a.** to relive metastatic pain as well as symptoms from local extension of primary disease. **b.** to be a palliative treatment to relieve pain and maintain symptom control for the duration of the patient's life. **c.** to be used alone as a therapeutic agent. **d.** to help tissue to shrink and possible tumor eradication. 135\. In planning for pain control in a post-operative cancer patient, the nurse understands: **a.** radiation therapy alone will be used. **b.** noninvasive analgesic approaches should be tried before invasive palliative approaches. **c.** never use radiation therapy, unless you are sure the patient will die. **d.** radiation therapy is complementary to analgesic drug therapies. 136\. What considerations should be noted by the nurse when pharmacological support is given for cancer patients having procedures? **a.** The needs of the individual and the type of procedures to be done. **b.** All children and adults should have heavy dosages of drugs. **c.** All children no matter what age, should have hypnosis, distraction, imagery, and relaxation therapy. **d.** No special considerations are necessary. 137\. Cancer pain depends upon what? **a.** the age of the patient and how much fear and anxiety is present **b.** the type of cancer, the site of the cancer, and the time of the initial pain episode **c.** the type of cancer, the stage of the cancer, and the threshold (tolerance for pain) **d.** the psychosocial state of the client, how well they accept the diagnosis, and the sex of the patient 138\. A client received testing and was just informed she has leukemia. Which statement by the nurse is *most* therapeutic? **a.** "We have treatments for leukemia that are quite effective." **b.** "Don't worry, because your type of leukemia is treatable." **c.** "Lots of people have leukemia and are successfully treated." **d.** "How does it feel for you to hear you have leukemia?" 139\. Which of the following may be a complication of previous infection with human papilloma virus (HPV)? **a.** Cervical cancer **b.** Breast cancer **c.** Bone cancer **d.** Skin cancer 140\. A client has been treated for uterine cancer with internal radiation therapy. Which of the following complications may she develop later? **a.** cystitis **b.** arthritis **c.** hepatitis **d.** neuritis 141\. The client, aged 28, was recently diagnosed with Hodgkin's disease. After staging, therapy is planned to include combination radiation therapy and systemic chemotherapy with MOPP (nitrogen mustard, vincristine {Onconvin}, prednisone, and procarbazine). In planning care for the client, the nurse should anticipate which of the following effects to contribute to a sense of altered body image? **a.** cushingoid appearance **b.** alopecia **c.** temporary or permanent sterility **d.** pathologic fractures 142\. Which mnemonic is used to remember the seven warning signs of cancer? **a.** CAUTION **b.** DANGERS **c.** WARNING **d.** CANCERS 143\. Cancer is characterized by which of the following cell changes? **a.** Rapid proliferation **b.** Toxin production **c.** Increased differentiation **d.** Indiscriminate proliferation 144\. A client has a cancerous tumor on his tibia. What name is given this type of tumor? **1.** Adenoma **2.** Osteoma **3.** Fibroma **4.** Meningioma 145\. A 54-year-old man is admitted to the hospital for a colostomy related to a recent diagnosis of colon cancer. During the preoperative period, what is the most important aspect of this client's nursing care? **a.** Assure the client that he will be cured of cancer. **b.** Assess understanding of the procedure and expectation of bodily appearance after surgery. **c.** Maintain a cheerful and optimistic environment. **d.** Keep visitors to a minimum, so that he can have time to think things through. 146\. A client who is getting radiation asks the nurse why these sores developed in the client's mouth. What is the most appropriate response? **a.** "Don't worry; it always happens with radiation." **b.** "Your oral hygiene needs improvement." **c.** "It is a sign that the radiation is effective." **d.** "The sores result because the cells in the mouth are sensitive to the radiation." 147\. A client develops stomatitis during the course of radiation therapy. Nursing care for this problem should include: **a.** A soft, bland diet. **b.** Restricting fluids to decrease salivation. **c.** Rinsing the mouth every two hours with a dilute mouthwash. **d.** Encouraging the client to drink hot liquids. 148\. The chemotherapeutic agent 5-fluorourcacil (5-FU) is ordered for a client as an adjunct measure to surgery. Which statement about chemotherapy is true? **a.** It is a local treatment affecting only tumor cells. **b.** It is a systemic treatment affecting both tumor and normal cells. **c.** It has not yet been proved an effective treatment for cancer. **d.** It is often the drug of choice because it causes few if any side effects. 149\. Which instruction should be given in a health education class regarding testicular cancer? **a.** All males should perform a testicular exam after the age of 30. **b.** Testicular exams should be performed on a daily basis. **c**. Reddening or darkening of the scrotum is a normal finding. **d.** Testicular exams should be performed after a warm bath or shower. 150\. During surgery, it is found that a client with adenocarcinoma of the rectum has positive peritoneal lymph nodes. What is the next most likely site of metastasis? **a.** Brain **b.** Bone **c.** Liver **d.** Mediastinum 151\. Medical treatment for a client with cervical cancer will include a hysterectomy followed by internal radiation. Although she is 32 years old and has three children, the client tells the nurse that she is anxious regarding the impending treatment and loss of her femininity. Which interaction is most appropriate? **a.** Tell the client that now she does not have to worry about pregnancy. **b.** Provide the client with adequate information about the effects of treatment on sexual functioning. **c.** Refer her to the physician. **d.** Avoid the question. Nurses are not specialists in providing sexual counseling. 152\. When a client is having external radiation for lung cancer, what side effect is most likely to be experienced? **a.** Alopecia **b.** Bone marrow suppression **c.** Stomatitis **d.** Dyspnea 153\. A 25-year-old male client receiving external radiation treatments tells you that he fears he is radioactive and a danger to his family and friends. How would the nurse dispel his fears? **a.** Inform him that radiation machines are risk free. **b.** Explain that once the machine is off, radiation is no longer emitted. **c.** Avoid telling him that his fears are in fact true. **d.** Instruct him to spend short periods of time with his family and friends. 154\. The nurse assesses for findings of early cervical cancer by which of the following? **a.** A dark, foul-smelling vaginal discharge **b.** Pressure on the bladder or bowel, or both **c.** Back and leg pain and weight loss **d.** Vaginal discharge (leucorrhea) 155\. The nurse discusses with a client in the healthcare clinic the possibility of endometrial cancer. Which of the following statements is *incorrect* concerning endometrial cancer? **a.** Diagnosis is most frequently established by a dilation and curettage (D&C). **b.** Prolonged use of exogenous estrogen increases the occurrence. **c.** The first and most important symptom is abnormal bleeding. **d.** This malignancy tends to spread rapidly to other organs. 156\. The Pap smear reveals that a client has cancer of the cervix. The mode of treatment is an abdominal hysterectomy. The client voices concern about undergoing menopause. In counseling her, which statement would be most appropriate? **a.** A surgical menopause will occur, and treatment with estrogen therapy will be necessary. **b.** The ovaries will continue to function and produce estrogen, thus preventing menopause as a result of surgery. **c.** Ovarian hormone secretion ceases, but the hypothalamus will continue to secrete FSH, and this prevents menopause. **d.** The ovaries will cease functioning, and it will be necessary to take estrogen. 157\. Cancer of the lungs is caused by: **a.** Airway atrisia. **b.** Hepatitis A. **c.** Cigarette smoking. **d.** Congenital defects. 158\. A client begins a regimen of chemotherapy. Her platelet counts falls to 98,000. Which action is least necessary at this time? **a.** Test all excreta for occult blood. **b.** Use a soft toothbrush or foam cleaner for oral hygiene. **c.** Implement reverse isolation. **d.** Avoid IM injections. 159\. High uric acid levels may develop in clients who are receiving chemotherapy. This is caused by: **a.** The inability of the kidneys to excrete the drug metabolites. **b**. Rapid cell catabolism. **c.** Toxic effects of the prophylactic antibiotics that are given concurrently. **d.** The altered blood pH from the acid medium of the drugs. 160\. Which of the following statements, if made by a cancer patient with hair loss secondary to chemotherapy, indicates the goal for new coping patterns is being met? **a.** "I think I'll get some new barrettes for my hair." **b.** "I washed my wig today." **c.** "I asked my mom to bring my shampoo." **d.** "I'm thinking about changing my hair color." 161\. A patient with breast cancer is undergoing chemotherapy. She develops myelosuppression. Her discharge teaching should include: **a.** Manage sore throat with over-the-counter preparations. **b.** Wear a mask when going out to shop. **c.** You can babysit ill grandchildren. **d.** Avoid activities that may cause bleeding. 162\. Antimetabolites used for cancer treatment work by: **a.** Enhancing cell growth. **b.** Bone marrow ablation. **c.** Inhibiting cell growth and proliferation. **d.** Limiting the ability of the cancer to metastasize. 163\. The synthetic cannabis derivative dronabinol (Marinol) can be used to treat cancer patients for: **a.** Depression. **b.** Nausea. **c.** Pain. **d.** Mucositis. 164\. Which statement is incorrect regarding lung cancer? **a.** The 5-year survival rate depends on tumor histology and disease stage at the time treatment is initiated. **b.** Small-cell lung cancer has an excellent prognosis. **c.** The 5-year survival rate for lung cancer is less than 15 percent. **d.** Lung cancer is usually widespread by the time it is detected on chest x-ray. 165\. A client is scheduled for external radiation treatment for laryngeal cancer. Of the following, which is *not* a common systemic side effect of this treatment? **a.** Nausea **b.** Fatigue **c.** Malaise **d.** Dry desquamation of the skin 166\. When teaching the client about upcoming external radiation treatments, the nurse should stress the importance of: **a.** Massaging the area daily. **b.** Exposing the area to sunlight for 30 minutes each day. **c.** Not using soap on the treatment area and ink markings. **d.** Applying cosmetic creams over the area to conceal reddened areas. 167\. A recent diagnosis of cancer has caused a patient severe anxiety. The plan of care should include: **a.** Teaching the stages of grieving. **b.** Providing distraction during time of stress. **c.** Teaching chemotherapy aspects. **d.** Encouraging verbalization of concerns regarding diagnosis. 168\. A patient is undergoing chemotherapy following a laryngectomy for laryngeal cancer. The patient begins complaining of a sore mouth. The nurse should assess for: **a.** Xerostomia. **b.** Halatosis. **c.** Stomatitis. **d.** Dysgeusia. 169\. The main goal of cancer chemotherapy is to: **a.** Limit the toxic side effects. **b.** Attack the cancer as early as possible. **c.** Cure or provide palliation if the cancer is not curable. **d.** Provide the patient with a suitable quality of life. 170\. A client receiving radiation therapy for a cancer tumor asked the nurse, "How is the radiation treatments done?" The nurse replied that: **a.** The agents act on inhibiting DNA synthesis. **b.** The therapy can be either internal or external beam. **c.** The agents used kill all the cancer cells. **d.** The therapy of the beam of radiation is for the total body. 171\. A 67-year-old man is admitted to the hospital with a tentative diagnosis of bronchogenic carcinoma. His chief complaint is dyspnea and a chronic cough. The physician orders a sputum sample for cytologic testing. Important nursing implications involved with obtaining a sputum sample for cytology should include which of the following? **a.** Obtain the specimen in the evening hours. **b.** Collect the specimen in the morning before the client eats and drinks. **c.** Have the client brush his teeth before collection of the specimen. **d.** Keep the client NPO for 24 hours before collection of the specimen. 172\. A 4-year-old Mexican American client has recently been diagnosed with leukemia. What intervention would be appropriate when considering the client's culture? **a.** Limit all visitors, including extended family. **b.** Encourage visits from extended as well as immediate family. **c.** Ban all visits from alternative healers. **d.** Make diet selections for the child and family. 173\. An 85-year-old man with end-stage prostate cancer has a living will expressing his desire for a dignified death and comfort care measures without resuscitation measures. Advocate, your role is to: **a.** Support the daughter's decision. **b.** Encourage the patient to revoke his living will. **c.** Support the patient's decision and encourage him to discuss his feeling with his daughter. **d.** Ignore the patient's decision for non-resuscitation. 174\. Mr. Davis, an 80 year old, is being discharged from the hospital with a new diagnosis of lung cancer. The adult children have made arrangements for him to live with his youngest son. To promote optimal continuity of care, the nurse should: **a.** Immediately arrange for hospice care. **b.** Convince the family that institutionalized care would be better. **c.** Assist with the discharge as planned. **d.** Explore options for community health services with the family. 175\. A patient with advanced cancer of the stomach is undergoing surgery to take out part or debulk the tumor. This is known as \_\_\_\_\_\_ surgery. **a.** Tertiary **b.** Restorative **c.** Curative **d.** Palliative 176\. Which of the following primary precautions is aimed at reducing the risk of breast cancer in a female 50 years of age and older? **a.** Pap smear **b.** Colonoscopy **c.** Ultrasound **d.** Mammography 177\. Your patient is considering participating in a multi-site trial of a new cancer medication. According to the "Patient's Bill of Rights," it is important for the patient to know that: **a.** All costs of research are paid by the patient. **b.** He has the right to refuse to participate in research without fear of loss of care. **c.** The physicians will no longer be caring for him if he does not participate in the research. **d.** The research study is his only hope of treatment. 178\. Which of the following statements about cancer cachexia is true? **a.** It is no different than simple starvation because the metabolic rate declines in response to tumor growth. **b.** Cancer cachexia occurs as a result of chemotherapy but not radiation therapy. **c.** Cancer cachexia occurs as a result of tumorinduced changes. **d.** Cancer cachexia is only seen in clients who have limited caloric intake. 179\. A 52-year-old male client being treated for cancer doesn't understand why he is being given a "female hormone," megesterol acetate (Megace), as part of the treatment regimen. He is afraid that it will alter his appearance. How would you respond to the client's concern of altered body image? **a.** Tell the client that the physical changes are only temporary. **b.** Tell the client that this medication is used for its ability to stimulate appetite. **c.** Tell the client that you understand his concern and that he should not take it. **d.** Tell the client that the medication will be used for a short time and any effects will be self-limiting. 180\. What interventions would be appropriate for a client admitted to the oncology unit for chemotherapy and radiation therapy who is experiencing dysgeusia? **a.** Premedicate the client with an antiemetic. **b.** Observe the client for signs of dehydration. **c.** Use highly seasoned foods to stimulate taste buds. **d.** Obtain an order for zinc and give with food or milk to treat symptoms. 181\. Mr. Hart is your patient who has a new diagnosis of lung cancer who is deemed terminally ill. During your assessment of discharge needs, you find that he has no available caregiver in the home but will need assistance with ADLs. You discuss with the discharge planner: **a.** Home care. **b.** Adult day care. **c.** Long-term care with hospice services. **d.** Respite care. 182\. Which assessment finding would indicate to the nurse that an antitussive medication administered to a client with bronchogenic cancer is having the desired effect? a\. Dyspnea is relieved. b\. Coughing is decreased. c\. Expectoration is increased. d\. Wheezes and gurgles have diminished. 183\. Which assessment finding should the nurse interpret as indicative of impending spinal cord compression in a client with metastatic prostate cancer? a\. Increasing back pain, which is worse when standing than when lying down b\. Lower extremity weakness and/or paresthesias c\. Urgency accompanied by bladder spasms d\. Lower extremity muscle cramping 184\. A client having cryosurgery for removal of a squamous cell carcinoma asks if the procedure will hurt. Which is the correct answer for the nurse to give? a\. "You will not feel anything." b\. "There will be a brief tingling pain." c\. "There will be no pain but you may experience a slight odd smell." d\. "There will be a momentary, stabbing pain." 185\. When teaching at a health fair, the nurse is asked if there is really a relationship between tobacco smoke and lung cancer. Which information should serve as the basis for the nurse's response? a\. There is a relationship and it is between certain types of lung cancer and both smoking and being exposed to second-hand smoke. b\. Exposure to carcinogens such as asbestos and uranium account for a greater portion of lung cancer than does tobacco use. c\. Radon takes precedence over tobacco smoke as a factor responsible for lung cancer. d\. Tobacco smoking is associated with the majority of lung cancers of all types. 186\. What symptom reported in the health history of a 55- year-old woman should be interpreted by the nurse as requiring immediate follow-up evaluation for cancer of the right colon? a\. Black, tarry stools b\. Loose, frothy stool c\. Flat, ribbon-shaped stool d\. Mahogany-colored, formed stool 187\. When teaching a local club group about oral cancer, which comment by a participant indicates that the nurse needs to clarify the information presented? a."Most oral cancers occur on the tongue." b\. "The most rapidly spread oral cancer is on the floor of the mouth." c\. "Early oral cancers are generally asymptomatic." d\. "Smoking is a risk factor for cancer of the lip." 188\. Which symptom should the nurse interpret as requiring a check for endometrial cancer? a\. Postmenopausal bleeding b\. Persistent leukorrhea c\. Painful sexual intercourse d\. Intermittent amenorrhea 189\. How should the nurse interpret the leakage of fecal matter from the vagina of a client with advanced cancer? a\. Anal sphincter has been impaired b\. Cancer has metastasized to the GI tract c\. Rectovaginal fistula has developed d\. Rectum is being compressed by the tumor mass 190\. Which assessment finding is characteristic of advanced ovarian cancer? a\. Ascites b\. Purpura c\. Splenomegaly d\. Hypoactive DTRs 191\. Which client with breast cancer is a candidate for treatment with Tamoxifen? a\. A 32-year-old client with a lumpectomy for a small tumor and no sign of spread b\. A 58-year-old client with negative estrogen receptor (ER) status c\. A 41-year-old client with metastatic disease d\. A 66-year-old client with estrogen sensitive disease 192\. Which test confirms the diagnosis of prostate cancer? a\. PSA b\. Alkaline phosphatase c\. Ultrasound of the prostate d\. Prostate biopsy 193\. Lupron is prescribed for a client with prostate cancer. Which assessment data best indicates that the medication is having the desired effect? a\. Client reports pain is controlled b\. Vomiting has stopped c\. Urine is free of blood d\. PSA level has dropped 194\. Which condition can pain in young women with ovarian cancer mimic? a\. Appendicitis b\. Constipation c\. PMS d\. Urinary tract infection 195\. When caring for a client having radiation therapy the nurse receives a report that the client's laboratory values are normal and there are no signs of anemia, infection, or bleeding. Which conclusion should the nurse draw from this information? a\. Radiation has not yet reached a therapeutic level. b\. The client is free of side effects of radiation. c\. Nutritional status is normal. d\. Bone-marrow suppression is not a problem. 196\. When assessing skin of a client having external radiation therapy, which fact should the nurse keep in mind? a\. Skin damage is preceded by changes in oral mucous membranes. b\. Most skin changes occur 4--8 weeks after the start of radiation. c\. Skin areas with poor blood flow are at greatest risk for injury. d\. Intertriginous areas are at particular risk for skin reactions. 197\. How should the care of a client undergoing brachytherapy be assigned? a\. To male nurses whenever possible b\. On a rotating basis among nonpregnant nursing staff c\. Consistently to the same nurses d\. Never to a nurse with a history of cancer 198\. A client having radiation therapy asks the nurse if his blood cells are going to be affected. Which fact should form the basis of the nurse's answer? a\. Bone marrow and therefore blood cells are affected with almost all ports of radiation. b\. If radiation is delivered to the hip or leg, no effect should occur. c\. It depends on whether or not medications are being taken that sensitize blood cells to radiation. d\. Speed and volume of blood to tissues of the port will determine the effect. 199\. A client having chemotherapy for breast cancer reports a temperature of 101.4 F. How should the nurse interpret this fact? a\. Sign of infection, which needs to be reported right away b\. Side effect of chemotherapy, not requiring intervention c\. Sign of infection, which needs monitoring and reporting if it persists for 48 hours d\. Indicator of dehydration requiring client teaching regarding fluid intake 200\. A client who had a dose of chemotherapy at 8 a.m. calls the clinic at 2:30 p.m. complaining of nausea and vomiting despite having taken the prescribed medication. She asks how much worse the nausea and vomiting is going to get. On which fact should the nurse's answer be based? a\. Nausea and vomiting is totally unpredictable. b\. Nausea and vomiting typically peak in the first 12 hours. c\. Nausea and vomiting will ease on going to bed. d\. Vomiting should cease in about 36 hours but nausea may persist for 7--10 days. ANSWER KEY 1\. C 2\. D 3\. B 4\. C 5\. C 6\. A 7\. D 8\. C 9\. D 10\. B 11\. A 12\. D 13\. C 14\. D 15\. C 16\. D 17\. B 18\. C 19\. A 20\. B 21\. C 22\. B 23\. B 24\. C 25\. B 26\. D 27\. B 28\. B 29\. B 30\. D 31\. C 32\. C 33\. A 34\. B 35\. B 36\. A 37\. A 38\. C 39\. D 40\. D 41\. C 42\. C 43\. D 44\. D 45\. C 46\. B 47\. A 48\. A 49\. D 50\. B 51\. C 52\. A 53\. A 54\. D 55\. A 56\. B 57\. C 58\. D 59\. A 60\. A 61\. D 62\. A 63\. A 64\. B 65\. A 66\. C 67\. B 68\. A 69\. D 70\. C 71\. A 72\. A 73\. D 74\. D 75\. B 76\. D 77\. C 78\. B 79\. B 80\. B 81\. D 82\. D 83\. B 84\. D 85\. A 86\. C 87\. C 88\. B 89\. C 90\. A 91\. C 92\. D 93\. A 94\. B 95\. C 96\. D 97\. B 98\. C 99\. D 100\. C 101\. C 102\. C 103\. B 104\. D 105\. D 106\. D 107\. D 108\. C 109\. C 110\. A 111\. D 112\. A 113\. D 114\. B 115\. C 116\. D 117\. A 118\. C 119\. D 120\. C 121\. B 122\. B 123\. C 124\. A 125\. D 126\. A 127\. C 128\. C 129\. B 130\. B 131\. B 132\. D 133\. B 134\. B 135\. D 136\. A 137\. C 138\. D 139\. A 140\. A 141\. D 142\. A 143\. D 144\. B 145\. B 146\. D 147\. A 148\. B 149\. D 150\. C 151\. B 152\. 152. D 153\. 153. B 154\. 154. D 155\. 155. D 156\. 156. B 157\. 157. C 158\. 158. C 159\. 159. B 160\. 160. B 161\. 161. D 162\. 162. C 163\. 163. B 164\. 164. B 165\. 165. D 166\. 166. C 167\. 167. D 168\. 168. C 169\. 169. C 170\. 170. B 171\. 171. B 172\. 172. B 173\. 173. C 174\. 174. D 175\. 175. D 176\. 176. D 177\. 177. B 178\. 178. C 179\. 179. B 1. 180\. 180. D 2. 181\. 181. C 3. 182\. 182. B 4. 183\. 183. A 5. 184\. 184. B 6. 185\. 185. D 7. 186\. 186. D 8. 187\. 187. B 9. 188\. 188. A 10. 189\. 189. C 11. 190\. 190. A 12. 191\. 191. D 13. 192\. 192. D 14. 193\. 193. D 15. 194\. 194. A 16. 195\. 195. D 17. 196\. 196. D 18. 197\. 197. B 19. 198\. 198. A 20. 199\. 199. A 21. 200\. 200. B