Question: A 32-year-old woman meets with the nurse on her first official visit since undergoing a left mastectomy. When asked how she is doing, the woman states her appetite is still not good, she is not getting much sleep because she doesn't go to bed until her husband is asleep, and she is really anxious to get back to work. Which of the following nursing interventions should the nurse explore to support the client's current needs?
a) Ask open-ended questions about sexuality issues related to her mastectomy
b) Suggest that the client learn relaxation techniques to help with her insomnia
c) Call the physician to discuss allowing the client to return to work earlier
d) Perform a nutritional assessment to assess for anorexia

Answer: a) Ask open-ended questions about sexuality issues related to her mastectomy
- Correct Answer: A. Ask open-ended questions about sexuality issues related to her mastectomy
Option A: The content of the client's comments suggests that she is avoiding intimacy with her husband by waiting until he is asleep before going to bed. Addressing sexuality issues is appropriate for a client who has undergone a mastectomy.
Option B: Suggesting that she learn relaxation techniques to help her with her insomnia is appropriate; however, the nurse must first address the psychosocial and sexual issues that are contributing to her sleeping difficulties.
Option C: Rushing her return to work may debilitate her and add to her exhaustion.
Option D: A nutritional assessment may be useful, but there is no indication that she has anorexia.

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Question: One of the most serious blood coagulation complications for individuals with cancer and for those undergoing cancer treatments is disseminated intravascular coagulation (DIC). The most common cause of this bleeding disorder is:
a) Brain metastasis
b) Sepsis
c) Intravenous heparin therapy
d) underlying liver disease

Answer: b) Sepsis
- Correct Answer: B. Sepsis
Option B: Bacterial endotoxins released from gram-negative bacteria activate the Hageman factor or coagulation factor XII. This factor inhibits coagulation via the intrinsic pathway of homeostasis, as well as stimulating fibrinolysis.
Option D: Liver disease can cause multiple bleeding abnormalities resulting in chronic, subclinical DIC; however, sepsis is the most common cause.

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Question: A pneumonectomy is a surgical procedure sometimes indicated for the treatment of non-small-cell lung cancer. A pneumonectomy involves removal of:
a) One lobe of a lung
b) An entire lung field
c) One or more segments of a lung lobe
d) A small, wedge-shaped lung surface

Answer: b) An entire lung field
- Correct Answer: B. An entire lung field
Option B: A pneumonectomy is the removal of an entire lung field indicated for the treatment of non-small cell lung cancer that has not spread outside of the lung tissue. It is performed on patients who will have adequate lung function in the unaffected lung.
Option D: A wedge resection refers to the removal of a wedge-shaped section of lung tissue. It may be used to remove a tumor and a small amount of normal tissue around it/
Option A: A lobectomy is the removal of one lobe.
Option C: Removal of one or more segments of a lung lobe is called a partial lobectomy.

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Question: A 36-year-old man with lymphoma presents with signs of impending septic shock 9 days after chemotherapy. The nurse would expect which of the following to be present?
a) low-grade fever, chills, tachycardia
b) Elevated temperature, oliguria, hypotension
c) Flushing, decreased oxygen saturation, mild hypotension
d) High-grade fever, normal blood pressure, increased respirations

Answer: a) low-grade fever, chills, tachycardia
- Correct Answer: A. Low-grade fever, chills, tachycardia
Option A: Nine days after chemotherapy, one would expect the client to be immunocompromised. The clinical signs of shock reflect changes in cardiac function, vascular resistance, cellular metabolism, and capillary permeability. Low-grade fever, tachycardia, and flushing may be early signs of shock.
Option B: Oliguria and hypotension are late signs of shock. Urine output can be initially normal or increased.
Options C and D: The client with impending signs of septic shock may not have decreased oxygen saturation levels and normal blood pressure.

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Question: Which of the following represents the most appropriate nursing intervention for a client with pruritus caused by cancer or the treatments?
a) Silk sheets
b) Steroids
c) Medicated cool baths
d) Administration of antihistamines

Answer: c) Medicated cool baths
- Correct Answer: C. Medicated cool baths
Option C: Nursing interventions to decrease the discomfort of pruritus include those that prevent vasodilation, decrease anxiety, and maintain skin integrity and hydration. Medicated baths with salicylic acid or colloidal oatmeal can be soothing as a temporary relief.
Option A: Using silk sheets is not a practical intervention for the hospitalized client with pruritus.
Options B and D: The use of antihistamines or topical steroids depends on the cause of pruritus, and these agents should be used with caution.

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Question: A 56-year-old woman is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She calls her health care provider to report that she has pain while swallowing and burning and tightness in her chest. Which of the following complications of radiation therapy is A. Radiation enteritis likely responsible for her symptoms?
a) Radiation enteritis
b) Stomatitis
c) Esophagitis
d) Hiatal hernia

Answer: c) Esophagitis
- Correct Answer: C. Esophagitis
Option C: Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis, which is a common complication of radiation therapy of the chest wall.
Option A: Radiation enteritis is a damage to the intestinal lining caused by radiation therapy. Symptoms include diarrhea, rectal pain, and bleeding or mucus from the rectum.
Option B: Stomatitis results from the local effects of radiation to the oral mucosa. Symptoms include mouth ulcers, red patches, swelling, and oral dysaesthesia.
Option D: Hiatal hernia may also cause symptoms of dysphagia and chest pain but is not related to radiation therapy.

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Question: A male client has an abnormal result on a Papanicolaou test. After admitting, he read his chart while the nurse was out of the room, the client asked what dysplasia means. Which definition should the nurse provide?
a) Alteration in the size, shape, and organization of differentiated cells
b) Increase in the number of normal cells in a normal arrangement in a tissue or an organ
c) Presence of completely undifferentiated tumor cells that don't resemble cells of the tissues of their origin
d) Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn't found

Answer: a) Alteration in the size, shape, and organization of differentiated cells
- orrect Answer: A. Alteration in the size, shape, and organization of differentiated cells
Option A: Dysplasia refers to an alteration in the size, shape, and organization of differentiated cells.
Option B: An increase in the number of normal cells in a normal arrangement in a tissue or an organ is called hyperplasia.
Option C: The presence of completely undifferentiated tumor cells that don't resemble cells of the tissues of their origin is called anaplasia.
Option D: Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn't found is called metaplasia.

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Question: For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of anxiety related to the threat of death secondary to a cancer diagnosis. Which expected outcome would be appropriate for this client?
a) "Client stops seeking information."
b) "Client uses any effective method to reduce tension."
c) "Client doesn't guess at prognosis."
d) "Client verbalizes feeling of anxiety."

Answer: d) "Client verbalizes feeling of anxiety."
- Correct Answer: D. "Client verbalizes feelings of anxiety."
Option D: Verbalizing feelings is the client's first step in coping with the situational crisis. It also helps the health care team gain insight into the client's feelings, helping guide psychosocial care.
Option A: Seeking information can help a client with cancer gain a sense of control over the crisis.
Option B: This is undesirable because some methods of reducing tension, such as illicit drug or alcohol use, may prevent the client from coming to terms with the threat of death as well as cause physiological harm.
Option C: Suppressing speculation may prevent the client from coming to terms with the crisis and planning accordingly.

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Question: A male client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement?
a) Related to psychomotor seizures
b) Related to impaired balance
c) Related to visual field deficits
d) Related to difficulty swallowing

Answer: b) Related to impaired balance
- Correct Answer: B. Related to impaired balance
Option B: A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination.
Option A: Psychomotor seizures suggest temporal lobe dysfunction.
Option C: Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor.
Option D: Difficulty swallowing suggests medullary dysfunction.

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Question: A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect:
a) Fatigue
b) Vomiting
c) Hair loss
d) Stomatitis

Answer: a) Fatigue
- Correct Answer: A. Fatigue
Option A: Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the treatment site. Fatigue occurs when the treatment damages and destroys not only the healthy cells but also the cancer cells.
Options B, C, and D: Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse effects of radiation therapy.

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Question: Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:
a) Breast self-examination
b) Mammography
c) Fine needle aspiration
d) chest x-ray

Answer: c) Fine needle aspiration
- Correct Answer: C. Fine needle aspiration
Option C: Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. During the procedure, a needle is inserted into the lump and a sample of tissue is taken for examination.
Option A: A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early.
Option B: Mammography is used to detect tumors that are too small to palpate.
Option D: Chest X-rays can be used to pinpoint rib metastasis.

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Question: A male client undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to care for the neck stoma, the nurse should include which instruction?
a) "Keep the stoma dry."
b) "Keep the stoma moist."
c) "Keep the stoma uncovered."
d) "Have a family member perform stoma care initially until you get used to the procedure

Answer: b) "Keep the stoma moist."
- Correct Answer: B. "Keep the stoma moist."
Option B: The nurse should instruct the client to keep the stoma moist, such as by applying a thin layer of petroleum jelly around the edges, because a dry stoma may become irritated.
Option A: Moisture is needed by the stoma to keep the airway moist. The skin around the stoma is kept clean and dry instead.
Option C: The nurse should recommend placing a stoma bib over the stoma to filter and warm air before it enters the stoma.
Option D: The client should begin performing stoma care without assistance as soon as possible to gain independence in self-care activities.

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

Answer: c) Dry oral mucous membranes and cracked lips
- Correct Answer: C. Dry oral mucous membranes and cracked lips
Option C: Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L.
Options A, B, and D: These values are within the normal limits.

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Question: Nurse April is teaching a group of women to perform breast self-examination. The nurse should explain that the purpose of performing the examination is to discover:
a) Fibrocystic masses
b) Changes from previous self-examinations
c) Areas of thickness or fullness
d) Cancerous lumps

Answer: b) Changes from previous self-examinations
- Correct Answer: B. Changes from previous self-examinations
Option B: Women are instructed to examine themselves to discover changes that have occurred in the breast.
Options A, C, and D: Only a physician can diagnose lumps that are cancerous, areas of thickness or fullness that signal the presence of a malignancy, or masses that are fibrocystic as opposed to malignant.

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

Answer: d) Human papillomavirus infection at age 32
- Correct Answer: D. Human papillomavirus infection at age 32
Option D: Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include multiple sex partners, multiple pregnancies, long-term use of oral contraceptives and diethylstilbestrol (DES).
Options A and B: A spontaneous abortion and pregnancy complicated by eclampsia aren't risk factors for cervical cancer.
Option C: Risk factors for this disease include frequent sexual intercourse before age 16.

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Question: A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to treat osteogenic carcinoma. During methotrexate therapy, the nurse expects the client to receive which other drug to protect normal cells?
a) Tabloid (thioguanine)
b) Cytosar-U (cytarabine)
c) Wellcovorin (leucovorin or citrovorum factor or folinic acid)
d) Benemid (probenecid)

Answer: c) Wellcovorin (leucovorin or citrovorum factor or folinic acid)
- Correct Answer: C. Wellcovorin (leucovorin or citrovorum factor or folinic acid)
Option C: Leucovorin is administered with methotrexate to protect normal cells, which methotrexate could destroy if given alone.
Options A and B: Cytarabine and thioguanine aren't used to treat osteogenic carcinoma.
Option D: Probenecid should be avoided in clients receiving methotrexate because it reduces renal elimination of methotrexate, increasing the risk of methotrexate toxicity.

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Question: The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?
a) polyps
b) weight gain
c) Hemorrhoids
d) Duodenal ulcers

Answer: a) Polyps
- Correct Answer: A. Polyps
Option A: Colorectal polyps are common with colon cancer. These polyps can develop into cancer over time depending on the type of polyps such as adenomatous polyps and sessile serrated polyps.
Option B: Weight loss — not gain — is an indication of colorectal cancer.
Options C and D: Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer

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Question: Nurse Amy is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society guidelines, the nurse should recommend that the women:
a) Have a mammogram annually
b) Perform breast self-exams annually
c) Have a hormonal receptor assay annually
d) Have a physician conduct a clinical exam every 2 yrs

Answer: a) Have a mammogram annually
- Correct Answer: A. Have a mammogram annually
Option A: The American Cancer Society guidelines state, "Women older than age 40 should have a mammogram annually and a clinical examination at least annually [not every 2 years].
Option B: All women should perform breast self-examination monthly [not annually].
Option C: The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen- or progesterone-dependent.
Option D: A physician checkup every 2 years will not detect early signs of breast cancer

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Question: A male client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?
a) rash
b) Indigestion
c) chronic ache or pain
d) Persistent nausea

Answer: b) Indigestion
- Correct Answer: B. Indigestion
Option B: Indigestion, or difficulty swallowing, is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness.
Options A and C: Rash and chronic ache or pain seldom indicate cancer.
Option D: Persistent nausea may signal stomach cancer but isn't one of the seven major warning signs.

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

Answer: a) Inspecting the skin for petechiae once every shift
- Correct Answer: A. Inspecting the skin for petechiae once every shift
Option A: Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums.
Option B: Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.
Option C: Frequent rest periods are indicated for clients with anemia, not thrombocytopenia.
Option D: The nurse should avoid administering aspirin because it may increase the risk of bleeding.

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

Answer: b) Yearly after age 40
- Correct Answer: B. Yearly after age 40
Option B: Breast cancer is a common health problem for women ages 40-49 years old. The American Cancer Society recommends a mammogram yearly for women over age 40.
Options A, C, and D: The other statements are incorrect. It's recommended that women between ages 20 and 40 have a professional breast examination (not a mammogram) every 3 years.

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

Answer: c) Obtaining baseline vital signs before administering the first dose
- Correct Answer: C. Obtaining baseline vital signs before administering the first dose
Option C: The nurse should obtain the client's baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy.
Option A: The nurse shouldn't discontinue a narcotic agonist abruptly because withdrawal symptoms may occur.
Option B: A naloxone challenge test may be administered before using a narcotic antagonist, not a narcotic agonist.
Option D: Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the ability to tolerate fluids.

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Question: A 35 years old client with ovarian cancer is prescribed hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with:
a) Cell division or mitosis during the M phase of the cell cycle
b) Normal cellular processes during the S phase of the cell cycle
c) The chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle-nonspecific)
d) One or more stages of ribonucleic acid (RNA) synthesis, or both (cell cycle-nonspecific)

Answer: b) Normal cellular processes during the S phase of the cell cycle
- Correct Answer: B. Normal cellular processes during the S phase of the cell cycle
Option B: Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They're most effective against rapidly proliferating cancers.
Option A: Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle.
Option C: Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells.
Option D: Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.

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

Answer: d) Asymmetry
- Correct Answer: D. Asymmetry
Option D: When following the ABCD method for assessing skin lesions, the A stands for "asymmetry," the B for "border irregularity," the C for "color variation," and the D for "diameter."

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Question: When caring for a male client diagnosed with a brain tumor of the parietal lobe, the nurse expects to assess:
a) Seizures
b) Tactile agnosia
c) Short-term memory impairment
d) Contralateral homonymous hemianopia

Answer: b) Tactile agnosia
- Correct Answer: B. Tactile agnosia
Option B: Tactile agnosia (inability to identify objects by touch) is a sign of a parietal lobe tumor.
Option A: Seizures may result from a tumor of the frontal, temporal, or occipital lobe.
Option C: Short-term memory impairment occurs with a frontal lobe tumor.
Option D: Contralateral homonymous hemianopia suggests an occipital lobe tumor.

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

Answer: d) Bence Jones protein in the urine
- Correct Answer: D. Bence Jones protein in the urine
Option D: Bence-Jones protein is an antibody fragment called a light chain that is not detectable in the urine. A presence of Bence Jones may indicate excess light chain production of a single type of antibody by the bone marrow cells.
Option A: The serum creatinine level may also be increased.
Option B: Serum protein electrophoresis shows elevated globulin spike.
Option C: Serum calcium levels are elevated because calcium is lost from the bone and reabsorbed in the serum.

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Question: A 35-year-old client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis (inflammation of the mouth)?
a) Rust-colored sputum
b) Red, open sores on the oral mucosa
c) Yellow tooth discoloration
d) White, cottage cheese-like patches on the tongue

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

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Question: During chemotherapy, an oncology client has a nursing diagnosis of impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?
a) Monitoring the client's platelet and leukocyte counts
b) Checking regularly for signs and symptoms of stomatitis
c) Recommending that the client discontinue chemotherapy
d) Providing a solution of hydrogen peroxide and water for use as a mouth rinse

Answer: d) Providing a solution of hydrogen peroxide and water for use as a mouth rinse
- Correct Answer: D. Providing a solution of hydrogen peroxide and water for use as a mouth rinse
Option D: To decrease the pain of stomatitis, the nurse should provide a solution of hydrogen peroxide and water for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer viscous lidocaine or systemic analgesics as prescribed.
Option A: Monitoring platelet and leukocyte counts may help prevent bleeding and infection but wouldn't decrease pain in this highly susceptible client.
Option B: Checking for signs and symptoms of stomatitis also wouldn't decrease the pain.
Option C: Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn't be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment.

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

Answer: c) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly
- Correct Answer: C. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly
Option C: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly.
Options A and D: A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastases.
Option B: Testicular self-examinations won't identify changes in the prostate gland due to its location in the body.

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Question: A male client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis may be appropriate for this client?
a) Chronic low self-esteem
b) Disturbed body image
c) Anticipatory grieving
d) Impaired swallowing

Answer: c) Anticipatory grieving
- Correct Answer: C. Anticipatory grieving
Option C: Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients with gallbladder cancer live more than 1 year after diagnosis.
Option A: Chronic low self-esteem isn't an appropriate nursing diagnosis at this time because the diagnosis has just been made.
Option B: Although surgery typically is done to remove the gallbladder and, possibly, a section of the liver, it isn't disfiguring and doesn't cause Disturbed body image.
Option D: Impaired swallowing isn't associated with gallbladder cancer.

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Question: A male client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first?
a) Leave the room and notify the radiation therapy department immediately
b) Put the implant back in place, using forceps and a shield for self-protection, and call for help
c) Pick up the implant with long-handled forceps and place it in a lead-lined container
d) Stand as far away from the implant as possible and call for help

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

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Question: Jenny with an advanced breast cancer is prescribed Nolvadex (tamoxifen). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately?
a) Anorexia
b) Headache
c) Hearing loss
d) Vision changes

Answer: d) Vision changes
- Correct Answer: D. Vision changes
Option D: Tamoxifen, a selective estrogen receptor modulator (SERM) causes ocular side effects such as dryness, irritation, and cataracts. The client must report changes in visual acuity immediately because this adverse effect may be irreversible.
Options A and B: Although the drug may cause anorexia, headache, and hot flashes, the client need not report these adverse effects immediately because they don't warrant a change in therapy.
Option C: Tamoxifen isn't associated with hearing loss.

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Question: A female client with cancer is being evaluated for possible metastasis. Which of the following is one of the most common metastasis sites for cancer cells?
a) Colon
b) Liver
c) Reproductive tract
d) White blood cells (WBCs)

Answer: b) Liver
- Correct Answer: B. Liver
Option B: The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain.
Options A, C, and D: The colon, reproductive tract, and WBCs are occasional metastasis sites.

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Question: A 34-year-old female client is requesting information about mammograms and breast cancer. She isn't considered at high risk for breast cancer. What should the nurse tell this client?
a) She should have had a baseline mammogram before age 30
b) When she begins having yearly mammograms, breast self-exams will no longer be necessary
c) She should perform breast self-exam during the first 5 days of each menstrual cycle
d) She should eat a low-fat diet to further decrease her risk of breast cancer

Answer: d) She should eat a low-fat diet to further decrease her risk of breast cancer
- Correct Answer: D. She should eat a low-fat diet to further decrease her risk of breast cancer
Option D: A low-fat diet (one that maintains weight within 20% of recommended body weight) has been found to decrease a woman's risk of breast cancer.
Option A: A baseline mammogram should be done between ages 30 and 40.
Option B: The client should continue to perform monthly breast self-examinations even when receiving yearly mammograms.
Option C: Monthly breast self-examinations should be done between days 7 and 10 of the menstrual cycle.

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Question: Nurse Brian is developing a plan of care for marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable?
a) 24 hours
b) 2 to 4 days
c) 7 to 14 days
d) 21 to 28 days

Answer: c) 7 to 14 days
- Correct Answer: C. 7 to 14 days
Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.

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Question: The nurse is preparing for a female client for magnetic resonance imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which of the following would pose a threat to the client?
a) The client lies still
b) The client asks questions
c) The client hears thumping sounds
d) The client wears a watch and wedding band

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

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Question: Nina, an oncology nurse educator, is speaking to a women's group about breast cancer. Questions and comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the audience have made all of the following statements. Which one is accurate?
a) Breast cancer requires a mastectomy
b) Men can develop breast cancer
c) Breast cancer is the leading killer of women of childbearing age
d) Mammography is the most reliable method for detecting breast cancer

Answer: b) Men can develop breast cancer
- Correct Answer: B. Men can develop breast cancer
Option B: Men can develop breast cancer, although they seldom do. It is common among older men.
Option A: A mastectomy may not be required if the tumor is small, confined, and in an early stage.
Option C: Lung cancer causes more deaths than breast cancer in women of all ages.
Option D: The most reliable method for detecting breast cancer is monthly self-examination, not mammography.

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Question: Nurse Mary is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination:
a) On the 1st day of the menstrual cycle
b) On the same day each month
c) Immediately after her menstrual period
d) At the end of her menstrual cycle

Answer: c) Immediately after her menstrual period
- Correct Answer: C. Immediately after her menstrual period
Option C: Premenopausal women should do their self-examination immediately after the menstrual period, when the breasts are least tender and least lumpy.
Options A and D: On the 1st and last days of the cycle, the woman's breasts are still very tender.
Option B: Postmenopausal women because their bodies lack fluctuation of hormone levels, should select one particular day of the month to do breast self-examination.

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

Answer: a) Testicular cancer is a highly curable type of cancer
- Correct Answer: A. Testicular cancer is a highly curable type of cancer
Option A: Testicular cancer is highly curable, particularly when it's treated in its early stage. Stage I of the disease, a radical inguinal orchiectomy (removal of testicles) is performed first then followed by chemotherapy or radiation therapy.
Option B: Self-examination allows early detection and facilitates the early initiation of treatment.
Option C: The highest mortality rates from cancer among men are in men with lung cancer.
Option D: Testicular cancer is found more commonly in younger men.

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Question: Rhea has malignant lymphoma. As part of her chemotherapy, the physician prescribes chlorambucil (Leukeran), 10 mg by mouth daily. When caring for the client, the nurse teaches her about adverse reactions to chlorambucil, such as alopecia. How soon after the first administration of chlorambucil might this reaction occur?
a) Immediately
b) 1 week
c) 2 to 3 weeks
d) 1 month

Answer: c) 2 to 3 weeks
- Correct Answer: C. 2 to 3 weeks
Chlorambucil-induced alopecia occurs 2 to 3 weeks after therapy begins. The medication causes structural damage to the scalp hairs resulting in reduced hair growth and complete hair loss (alopecia).

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Question: A male client is receiving the cell cycle-nonspecific alkylating agent Thioplex (thiotepa), 60 mg weekly for 4 weeks by bladder installation as part of a chemotherapeutic regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects?
a) It interferes with deoxyribonucleic acid (DNA) replication only
b) It interferes with ribonucleic acid (RNA) transcription only
c) It interferes with DNA replication and RNA transcription
d) It destroys the cell membranes, causing lysis

Answer: c) It interferes with DNA replication and RNA transcription
- Correct Answer: C. It interferes with DNA replication and RNA transcription.
Option C: Thiotepa is an alkylating agent that works by crosslinking DNA strands by reacting with phosphate groups to stop protein synthesis, RNA, and DNA.
Options A, B, and D: Thiotepa interferes with DNA replication and RNA transcription. It doesn't destroy the cell membrane.

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

Answer: d) 1 week after menstruation begins
- Correct Answer: D. 1 week after menstruation begins
Option D: The breast self-examination should be performed monthly 7 days after the onset of the menstrual period when the breasts are less tender and lumpy.
Options A and B: At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.
Option C: Performing the examination weekly is not recommended.

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Question: Nurse Cindy 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) Removal of anti-embolism stockings twice daily
b) Checking placement of pneumatic compression boots
c) Elevating the knee gatch on the bed
d) Assisting with range-of-motion leg exercises

Answer: c) Elevating the knee gatch on the bed
- Correct Answer: C. Elevating the knee gatch on the bed
Option C: The nurse should avoid using the knee gatch in the bed, which inhibits venous return, thus placing the client more at risk for deep vein thrombosis or thrombophlebitis.
Options A, B, and D: The client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, as for any other major surgery. For this reason, the nurse implements measures that will prevent this complication. Range-of-motion exercises, anti-embolism stockings, and pneumatic compression boots are helpful.

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

Answer: c) Drink six to eight glasses of water without voiding before the test
- Correct Answer: C. Drink six to eight glasses of water without voiding before the test
Option C: A pelvic ultrasound requires the ingestion of large volumes of water just before the procedure. A full bladder is necessary so that it will be visualized as such and not mistaken for possible pelvic growth.
Option A: Comfortable shoes and clothing is unrelated to this specific procedure.
Option B: An abdominal ultrasound may require that the client abstain from food or fluid for several hours before the procedure.
Option D: A patient may eat and drink on the day of the exam regardless of quantity.

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Question: A male client is diagnosed as having a bowel tumor and several diagnostic tests are prescribed. The nurse understands which test will confirm the diagnosis of malignancy?
a) Magnetic resonance imaging
b) Computerized tomography scan
c) Abdominal ultrasound
d) Biopsy of the tumor

Answer: d) Biopsy of the tumor
- Correct Answer: D. Biopsy of the tumor
Option D: A biopsy is done to determine whether a tumor is malignant or benign through the examination of the sample of tissue taken into a body part.
Options A, B, and C: Magnetic resonance imaging, computed tomography scan, and ultrasound will visualize the presence of a mass but will not confirm a diagnosis of malignancy.

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Question: Vanessa, a community health nurse conducts a health promotion program regarding testicular cancer to community members. The nurse determines that further information needs to be provided if a community member states that which of the following is a sign of testicular cancer?
a) back pain
b) alopecia
c) Heavy sensation in the scrotum
d) Painless testicular swelling

Answer: b) Alopecia
- Correct Answer: B. Alopecia
Option B: Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as a result of radiation or chemotherapy.
Options A, C, and D: Back pain, heavy sensation in the scrotum, and painless testicular swelling are assessment findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes.

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Question: The male client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is:
a) Diarrhea
b) dyspnea
c) Constipation
d) Sore throat

Answer: d) Sore Throat
- Correct Answer: D. Sore throat
Option D: In general, only the area in the treatment field is affected by the radiation. Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side effects occur only when specific areas are involved in treatment. A client receiving radiation to the larynx is most likely to experience a sore throat.
Options A and C: May occur with radiation to the gastrointestinal tract.
Option B: Dyspnea may occur with lung involvement.

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Question: Nurse Joy is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles?
a) Remove the dosimeter badge when entering the client's room
b) Individual's younger than 16 yr may be allowed to go in the room as long as they are 6 feet away from the client
c) Limit the time with the client to 1 hour per shift
d) Do not allow pregnant women into the client's room

Answer: d) Do not allow pregnant women into the client's room
- Correct Answer: D. Do not allow pregnant women into the client's room
Options B and D: Children younger than 16 years of age and pregnant women are not allowed in the client's room to avoid radiation exposure that may harm the children and the developing baby.
Option A: The dosimeter badge must be worn when in the client's room.
Option C: The time that the nurse spends in a room of a client with an internal radiation implant is 30 minutes per 8-hour shift.

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Question: 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) Out of bed ad lib
b) Ambulation to the bathroom only
c) Bed rest
d) Out of bed in a chair only

Answer: c) Bed Rest
- Correct Answer: C. Bed rest
Option C: The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled.

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Question: The nurse is caring for a female client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plans to:
a) Teach the client and family about the need for hand hygiene
b) Insert an indwelling urinary catheter to prevent skin breakdown
c) Restrict fluid intake
d) Restrict all visitors

Answer: a) Teach the client and family about the need for hand hygiene
- Correct Answer: A. Teach the client and family about the need for hand hygiene
Option A: In the neutropenic client, meticulous hand hygiene education is implemented for the client, family, visitors, and staff to avoid transmission-based infection.
Option B: Invasive measures such as an indwelling urinary catheter should be avoided to prevent infections.
Option C: Fluids should be encouraged.
Option D: Not all visitors are restricted, but the client is protected from persons with known infections.

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