1.

A diagnosis of Hodgkin’s disease was made to a 58- year old man and is admitted for
the initial cycle of chemotherapy. During the hospitalization, the nurse should watch out
for the following complication, except?
A. Fertility problems
B. Benign prostatic hyperplasia
C. Secondary cancer
D. Infection
Correct Answer: B. Benign prostatic hyperplasia
- Option B: Hodgkin’s disease (Hodgkin’s lymphoma) is a type of cancer that affects the
lymphatic system (bone marrow, spleen, liver, and lymph node tissue. Symptoms include
painless swelling of a lymph node, recurrent fever, night sweats, pruritus, and
unexplained weight loss. Prostate involvement is rare in Hodgkin’s disease.
- Options A, C, and D: Complications of the disease would lead to a weakened immune
system resulting in various infections, It can also result in fertility problems related to
chemotherapy, and a probability of secondary cancers in the future.

2. The nurse is reviewing the chart of a client who is newly diagnosed with chronic
lymphocytic leukemia. Which of the following laboratory values is expected to be seen?
A. Elevated aspartate aminotransferase and alanine aminotransferase levels
B. Thrombocytopenia and increased lymphocytes
C. Elevated sedimentation rate
D. Uncontrolled proliferation of granulocytes
Correct Answer: B. Thrombocytopenia and increased lymphocytes
- Option B: Chronic lymphocytic leukemia shows a proliferation of small abnormal mature
B lymphocytes and decreased antibody response. Thrombocytopenia also is often
present.
- Option A: Chronic lymphocytic leukemia often does not cause abnormal liver function
tests.
- Option C: An elevated ESR result is often seen with multiple myeloma and
Waldenstrom’s macroglobulinemia (a type of non-Hodgkin’s lymphoma that is
characterized by excessive production of white blood cells).
- Option D: Uncontrolled proliferation of granulocytes occurs in myelogenous leukemia.

3. Maria was recently diagnosed with Hodgkin’s lymphoma. Upon the early diagnosis, the
nurse will expect which of the following areas is often involved?
A. Chest
B. Neck
C. Groin
D. Pelvis
Correct Answer: B. Neck
- Option B: A common early sign of Hodgkin lymphoma is swelling in one or more lymph
nodes, which is often seen in the neck.
- Options A, C, and D: Lymph nodes can also be found in the chest, groin, and pelvis but
aren’t yet involved in the earliest stage of the disease.
 4. According to a standard staging classification of Hodgkin’s disease, which of the
following criteria reflects stage III?
A. Involvement of lymph node regions or structures on both sides of the diaphragm
B. Involvement of two or more lymph node regions or structures
C. Involvement of single lymph node region or structure
D. Involvement of extralymphatic organs or tissues
Correct Answer: A. Involvement of lymph node regions or structures on both sides of the
diaphragm
- Option A: Hodgkin lymphoma is classified into stages to determine the state of the
disease and where it has already spread. Stage III involves nodes on both sides of the
diaphragm
- Option B: Stage II involves two or more lymph node regions.
- Option C: Stage I only involves one lymph node region.
- Option D: Stage IV involves extra lymphatic organs or tissues.
5. Angela, a clinical instructor is conducting a lecture about chemotherapy. Which of the
following statements is correct about the rate of cell growth in relation to chemotherapy?
A. Faster growing cells are more susceptible to chemotherapy
B. Faster growing cells are less susceptible to chemotherapy
C. Slower growing cells are more susceptible to chemotherapy
D. Non-dividing cells are more susceptible to chemotherapy
Correct Answer: A. Faster growing cells are more susceptible to chemotherapy
- Option A: The faster the cell grows, the more susceptible it is to chemotherapy
and radiation therapy
- Options B, C, and D: Slow-growing and non-dividing cells are less susceptible to
chemotherapy. Repeated cycles of chemotherapy are used to destroy
nondividing cells as they begin active cell division.
6. 6. Question
A 40-year-old male diagnosed with acute lymphocytic leukemia finished his first cycle of
chemotherapy. Which of the following statements by the nurse is wrong?
○ A. “You can eat soft cheeses from pasteurized milk”
○ B. “You can enjoy the turkey on the day of thanksgiving party”
○ C. “Try eating sashimi in one of the famous Japanese restaurants around the
city”
○ D. “ A medium well steak is a good idea of a sumptuous meal”
7. Incorrect
Correct Answer: C. “Try eating sashimi in one of the famous Japanese restaurants
around the city”
○ Option C: A low bacteria diet would be indicated with excludes of raw or
undercooked fish such as sashimi due to the risk of exposure from harmful
bacteria.
○ Option A: Soft cheeses are allowed if they are made from pasteurized milk.
 ○ Options B and D: Cooked meat such as medium well steak and turkey are rich in
protein that can help the patient maintain strength and prevent weight and
muscle loss.
8. 7. Question
A client with leukemia has neutropenia. Which of the following functions must be
frequently assessed?
○ A. Heart sounds
○ B. Bowel sounds
○ C. Breath sounds
○ D. Blood pressure
9. Incorrect
Correct Answer: C. Breath sounds
○ Option C: Pneumonia, both viral and fungal, is a common cause of death in
clients with neutropenia, so frequent assessment of respiratory rate and breath
sounds is required.
○ Options A, B, and D: Although assessing blood pressure, bowel sounds, and
heart sounds is important, it won’t help detect pneumonia.
10. 8. Question
Which of the following clients is most at risk for developing multiple myeloma?
○ A. A 60-year-old African-American man
○ B. A 52-year-old Hispanic woman
○ C. A 35-year-old White man
○ D. A 25-year-old Asian woman
11. Incorrect
Correct Answer: A. A 60-year-old African-American man
○ Option A: Multiple myeloma is more common in middle-aged and older clients
(the median age at diagnosis is 60 years) and is twice as common in Blacks as
Whites. It occurs most often in Black men.
12. 9. Question
Which of the following substances has abnormal values early in the course of multiple
myeloma (MM)?
○ A. Red blood cells
○ B. Immunoglobulins
○ C. White blood cells
○ D. Platelets
13. Incorrect
Correct Answer: B. Immunoglobulins
○ Option B: MM is characterized by malignant plasma cells that produce an
increased amount of immunoglobulin that isn’t functional.
○ Option A: As more malignant plasma cells are produced, there’s less space in the
bone marrow for RBC production.
○ Options C and D: In the late stage of the disease, platelets and WBC’s are
reduced as the bone marrow is infiltrated by malignant plasma cells.
14. 10. Question
Nurse Andrei is caring for a client with multiple myeloma. During the review of the
laboratory results. The nurse will monitor the client for which of the following conditions?
○ A. Hypermagnesemia
○ B. Hyperkalemia
○ C. Hypernatremia
○ D. Hypercalcemia
15. Incorrect
Correct Answer: D. Hypercalcemia
○ Option D: Patients with multiple myeloma develop a bone disease that causes
bone destruction. Calcium is released during this, causing an increase in serum
calcium levels.
○ Options A, B, and C: MM doesn’t affect potassium, sodium, or magnesium levels.
16. 11. Question
Giving instructions for breast self-examination is particularly important for clients with
which of the following medical problems?
○ A. Ovarian cancer
○ B. Endometrial polyps
○ C. Cervical dysplasia
○ D. A dermoid cyst
17. Incorrect
Correct Answer: A. Ovarian cancer
○ Option A: Clients with ovarian cancer are at increased risk for breast cancer.
Breast self-examination supports early detection and treatment and is very
important.
○ Option B: Endometrial polyps are outgrowths in the endometrium that are mostly
non cancerous and the exact cause is unknown.
○ Option C: Cervical dysplasia is the abnormal cell growth in the lining of the cervix
that is related with human papillomavirus (HPV) infection.
○ Option D: Dermoid cysts are abnormal growth found in the ovary that usually
contain material such as skin, hari, teeth, nails, fat, and sweat glands that were
trapped during fetal development.
18. 12. Question
During a routine physical examination, a firm mass is palpated in the right breast of a
35-year-old woman. Which of the following findings or client history would suggest
cancer of the breast as opposed to fibrocystic disease?
○ A. Increased vascularity of the breast
○ B. History of anovulatory cycles
○ C. Cyclic changes in mass size
○ D. History of early menarche
19. Incorrect
Correct Answer: A. Increased vascularity of the breast
○ Option A: An increase in breast size or vascularity indicates the growth of a tumor
and is consistent with cancer of the breast.
 ○ Options B, C, and D: Early menarche, as well as late menopause or a history of
anovulatory cycles, are associated with fibrocystic disease. Masses associated
with fibrocystic disease of the breast are firm, most often located in the upper
outer quadrant of the breast, and increase in size prior to menstruation. They
may be bilateral in a mirror image and are typically well-demarcated and freely
moveable.
20. 13. Question
The client with which of the following types of lung cancer has the best prognosis?
○ A. Squamous cell
○ B. Oat cell
○ C. Small cell
○ D. Adenocarcinoma
21. Incorrect
Correct Answer: A. Squamous cell
○ Option A: Squamous cell carcinoma is a slow-growing, rarely metastasizing type
of cancer.
○ Options B and C: Oat cell and small cell carcinoma are the same. Small cell
carcinoma grows rapidly and is quick to metastasize.
○ Option D: Adenocarcinoma is the next best lung cancer to have in terms of
prognosis.
22. 14. Question
Warning signs and symptoms of lung cancer include persistent cough, bloody sputum,
dyspnea, and which of the other following symptoms?
○ A. Generalized weakness
○ B. Recurrent pleural effusion
○ C. Dizziness
○ D. Hypotension
23. Incorrect
Correct Answer: B. Recurrent pleural effusion
○ Option B: If cancer is suspected in the lungs, it can cause fluid accumulation in
the pleura called pleural effusion. This fluid build-up takes up space and fills the
pleural cavity resulting in the compression of the lungs making it hard for the
client to breathe properly.
○ Options A, C, and D: Dizziness, generalized weakness, and hypotension aren’t
typically considered warning signals, but may occur in advanced stages of
cancer.
24. 15. Question
A centrally located tumor would produce which of the following symptoms?
○ A. Shoulder pain
○ B. Pleuritic pain
○ C. Coughing
○ D. Hemoptysis
25. Incorrect
Correct Answer: C. Coughing
 ○ Option C: Centrally located pulmonary tumors are found in the upper airway
(vocal cords) and usually obstruct airflow, producing such symptoms as
coughing, wheezing, and stridor.
○ Option A: Pancoast tumors that occur in the apices may cause shoulder pain.
○ Option B: As the tumor invades the pleural space, it may cause pleuritic pain.
○ Option D: Small cell tumors tend to be located in the lower airways and often
cause hemoptysis.
26. 16. Question
Which of the following interventions is the key to increasing the survival rates of clients
with lung cancer?
○ A. High-dose chemotherapy
○ B. Early bronchoscopy
○ C. Smoking cessation
○ D. Early detection
27. Incorrect
Correct Answer: D. Early detection
○ Option D: Early detection of cancer when the cells may be premalignant and
potentially curable would be most beneficial. However, a tumor must be 1 cm in
diameter before it’s detectable on a chest x-ray, so this is difficult.
○ Option A: High-dose chemotherapy has minimal effect on long-term survival.
○ Option B: A bronchoscopy may help identify cell type but may not increase the
survival rate.
○ Option C: Smoking cessation won’t reverse the process but may help prevent
further decompensation.
28. 17. Question
A client has been diagnosed with lung cancer and requires a wedge resection. How
much of the lung is removed?
○ A. A segment of the lung, including a bronchiole and its alveoli
○ B. One entire lung
○ C. A lobe of the lung
○ D. A small, localized area near the surface of the lung
29. Incorrect
Correct Answer: D. A small, localized area near the surface of the lung
○ Option D: A wedge resection is a surgical procedure that involves the removal of
a small area of tissue close to the surface of the lung. It is indicated for clients
with certain types of lung cancer such as non-small cell lung cancer (NSCLC). It
is done in combination with chemotherapy and radiation therapy.
○ Options A and C: A segment of the lung is removed in a segmental resection and
a lobe is removed in a lobectomy.
○ Option B: An entire lung is removed in a pneumonectomy.
30. 18. Question
When a client has a lobectomy, what fills the space where the lobe was?
○ A. The remaining lobe or lobes over expand to fill the space
○ B. The lung space fills up with serous fluid
 ○ C. The space stays empty
○ D. The surgeon fills the space with gel
31. Incorrect
Correct Answer: A. The remaining lobe or lobes over expand to fill the space
○ Option A: The remaining lobe or lobes over expand slightly to fill the space
previously occupied by the removed tissue. The diaphragm is carried higher on
the operative side to further reduce the empty space.
○ Option C: The space can’t remain “empty” because truly empty would imply a
vacuum, which would interfere with the intrathoracic pressure changes that allow
breathing.
○ Option B: Serous fluid overproduction would compress the remaining lobes,
diminish their function and possibly, cause a mediastinal shift.
○ Option D: The surgeon doesn’t use a gel to fill the space.
32. 19. Question
Which of the following is the primary goal for surgical resection of lung cancer?
○ A. To remove all of the tumor and any collapsed alveoli in the same region
○ B. To remove as much as the tumor as possible, without removing any alveoli
○ C. To remove the tumor and as little surrounding tissue as possible
○ D. To remove the tumor and all surrounding tissue
33. Incorrect
Correct Answer: C. To remove the tumor and as little surrounding tissue as possible
○ Option C: The goal of surgical resection is to remove the lung tissue that has a
tumor in it while saving as much surrounding tissue as possible. There is a
possibility of cancer cells remaining in the body after the operation so additional
treatment modalities such as chemotherapy and radiation therapy are done.
○ Options A, B, and D: It may be necessary to remove alveoli and bronchioles, but
care is taken to make sure only what’s absolutely necessary is removed.
34. 20. Question
If the client with lung cancer also has preexisting pulmonary disease, which of the
following statements best describes the extent of a surgery that can be performed?
○ A. It doesn’t affect it
○ B. It may require a whole lung to be removed
○ C. The entire tumor may not be able to be removed
○ D. It may prevent surgery if the client can’t tolerate lung tissue removal
35. Incorrect
Correct Answer: D. It may prevent surgery if the client can’t tolerate lung tissue removal
○ Option D: If the client’s preexisting pulmonary disease is restrictive and
advanced, it may be impossible to remove the tumor, and the client may have to
be treated with chemotherapy and radiation.
○ Option A: A pre-existing pulmonary disease affects the ability of a client with lung
cancer to tolerate surgical therapy.
○ Option B: Removing the whole lung is recommended if the cancer is located in
the central area of the lung or if it cannot be fully removed with lobectomy.
 ○ Option C: A preexisting lung condition does not limit the option for the removal of
the entire tumor because a tumor that is not entirely removed poses a threat of
the spread of cancer cells to nearby tissues.
36. 21. Question
The client with a benign lung tumor is treated in which of the following ways?
○ A. The tumor is removed, involving the least possible amount of tissue
○ B. The tumor is left alone unless symptoms are present
○ C. The tumor is treated with radiation only
○ D. The tumor is treated with chemotherapy only
37. Incorrect
Correct Answer: A. The tumor is removed, involving the least possible amount of tissue
○ Option A: The tumor is removed to prevent further compression of the lung tissue
as the tumor grows, which could lead to respiratory decompensation.
○ Options B, C, and D: If for some reason it can’t be removed, then radiation or
chemotherapy may be used to try to shrink the tumor.
38. 22. Question
In the client with terminal lung cancer, the focus of nursing care is on which of the
following nursing interventions?
○ A. Prepare the client’s will
○ B. Provide pain control
○ C. Provide nutritional support
○ D. Provide emotional support
39. Incorrect
Correct Answer: B. Provide pain control
○ Option B: The client with terminal lung cancer may have extreme pleuritic pain
and should be treated to reduce his discomfort therefore improving the quality of
life of the patient. Examples of pain medication used with advanced cancer are
opioids such as morphine, oxycodone, fentanyl, or methadone.
○ Option A: Nursing care doesn’t focus on helping the client prepare the will.
○ Option D: Preparing the client and his family for the impending death and
providing emotional support is also important but shouldn’t be the primary focus
until the pain is under control.
○ Option C: Nutritional support may be provided, but as the terminal phase
advances, the client’s nutritional needs greatly decrease.
40. 23. Question
What are the three most important prognostic factors in determining long-term survival
for children with acute leukemia?
○ A. Histologic type of disease, initial WBC count, and client’s age at diagnosis
○ B. Progression of illness, WBC at the time of diagnosis, and client’s age at the
time of diagnosis
○ C. Histologic type of disease, initial platelet count, and type of treatment
○ D. Type of treatment and client’s sex
41. Incorrect
Correct Answer: A. Histologic type of disease, initial WBC count, and client’s age at
diagnosis
○ Option A: The factor whose prognostic value is considered to be of greatest
significance in determining the long-range outcome is the histologic type of
leukemia. Children with a normal or low WBC count appear to have a much
better prognosis than those with a high WBC count. Children diagnosed between
ages 2 and 10 have consistently demonstrated a better prognosis because of
age 2 or after 10.
42. 24. Question
Which of the following complications are three main consequences of leukemia?
○ A. Anemia, infection, and bleeding tendencies
○ B. Bone deformities, spherocytosis, and infection
○ C. Polycythemia, decreased clotting time, and infection
○ D. Lymphocytopoiesis, growth delays, and hirsutism
43. Incorrect
Correct Answer: A. Anemia, infection, and bleeding tendencies
○ Option A: The three main consequences of leukemia are anemia, caused by
decreased erythrocyte production; infection secondary to neutropenia; and
bleeding tendencies, from decreased platelet production.
○ Option B: Bone deformities don’t occur with leukemia although bones may
become painful because of the proliferation of cells in the bone marrow.
Spherocytosis refers to erythrocytes taking on a spheroid shape and isn’t a
feature in leukemia. Mature cells aren’t produced in adequate numbers.
○ Option C: Anemia, not polycythemia, occurs. Clotting times would be prolonged.
○ Option D: Hirsutism and growth delay can be a result of large doses of steroids
but isn’t common in leukemia.
44. 25. Question
A child is seen in the pediatrician’s office for complaints of bone and joint pain. Which of
the following other assessment findings may suggest leukemia?
○ A. Increased activity level
○ B. Increased appetite
○ C. Petechiae
○ D. Abdominal pain
45. Incorrect
Correct Answer: C. Petechiae
○ Option C: The most frequent signs and symptoms of leukemia are a result of
infiltration of the bone marrow. These include fever, pallor, fatigue, anorexia, and
petechiae, along with bone and joint pain. Petechiae is brought about by
damaged or broken blood vessels underneath the skin.
○ Option A: Leukemia increases inflammation in the body, which can make a
person feel tired and experience fatigue causing decreased activity level.
○ Option B: Increased appetite can occur but it usually isn’t a presenting symptom.
 ○ Option D: Abdominal pain may be caused by areas of inflammation from normal
flora within the GI tract or any number of other causes.
46. 26. Question
Which of the following assessment findings in a client with leukemia would indicate that
cancer has invaded the brain?
○ A. Hypervigilant and anxious behavior
○ B. Increased heart rate and decreased blood pressure
○ C. Headache and vomiting
○ D. Hypervigilant and anxious behavior
47. Incorrect
Correct Answer: C. Headache and vomiting
○ Option C: The usual effect of leukemic infiltration of the brain is increased
intracranial pressure. The proliferation of cells interferes with the flow of
cerebrospinal fluid in the subarachnoid space and at the base of the brain. The
increased fluid pressure causes dilation of the ventricles, which creates
symptoms of severe headache, vomiting, irritability, lethargy, and eventually,
coma.
○ Option B: Increasing intracranial pressure in brain metastasis would result in
symptoms of high blood pressure, decreased pulse rate, and abnormal
respirations known as Cushing triad.
○ Options A and D: Often children with a variety of illnesses are hypervigilant and
anxious when hospitalized.
48. 27. Question
Which of the following types of leukemia carries the best prognosis?
○ A. Basophilic leukemia
○ B. Acute lymphoblastic leukemia
○ C. Acute myelogenous leukemia
○ D. Eosinophilic leukemia
49. Incorrect
Correct Answer: B. Acute lymphoblastic leukemia
○ Option B: Acute lymphoblastic leukemia, which accounts for more than 85% of all
childhood cases, carries the best prognosis compared to adults. Survival rate
depends on the person’s age or white blood cell count at time of diagnosis and
individuals with cell subtypes such as pre-B also considered to have a higher
survival rate than those with mature B-cell leukemia.
○ Options A and D: Basophilic and eosinophilic leukemia are named for the specific
cells involved. These are much rarer and carry a poorer prognosis.
○ Option C: Acute myelogenous leukemia, with several subtypes, accounts for
most of the other leukemias affecting children.
50. 28. Question
Which of the following is the reason to perform a spinal tap on a client newly diagnosed
with leukemia?
○ A. To assess for central nervous system infiltration
○ B. To aid in classification of the leukemia
 ○ C. To rule out meningitis
○ D. To decrease intracranial pressure
51. Incorrect
Correct Answer: A. To assess for central nervous system infiltration
○ Option A: A spinal tap is performed to check if leukemia has infiltrated into the
central nervous system specifically to the cerebrospinal fluid (CSF).
○ Options B and D: It wouldn’t be done to decrease ICP nor does it aid in the
classification of leukemia. Spinal taps can result in brain stem herniation in cases
of ICP.
○ Option C: A spinal tap can be done to rule out meningitis but this isn’t the
indication for the test on a leukemic client.
52. 29. Question
Joseph who had a history of long-term smoking and alcoholism is diagnosed with
oropharyngeal cancer. He is admitted into the chemo unit for the initiation of
chemotherapy. Which of the following tests is performed before the infusion of
chemotherapeutic agents?
○ A. Complete blood count (CBC)
○ B. Peripheral blood smear
○ C. Lumbar puncture
○ D. Liver function test
53. Incorrect
Correct Answer: D. Liver function test
○ Option D: Liver and kidney function studies are done before the initiation of
chemotherapy to evaluate the client’s ability to metabolize the chemotherapeutic
agents.
○ Option A: A CBC is performed to assess for anemia and white blood cell count.
○ Option B: A peripheral blood smear is done to assess the maturity and
morphology of red blood cells.
○ Option C: A lumbar puncture is performed to assess for central nervous system
infiltration.
54. 30. Question
Which of the following immunizations should not be given to a 4-month-old sibling of a
client with leukemia?
○ A. Oral poliovirus vaccine (OPV)
○ B. Hepatitis B vaccine
○ C. Diphtheria and tetanus and pertussis (DPT) vaccine
○ D. Haemophilus influenzae type b vaccines (Hib)
55. Incorrect
Correct Answer: A. Oral poliovirus vaccine (OPV)
○ Option A: OPV is a live attenuated virus excreted in the stool. The excreted virus
can be communicated to the immunosuppressed child, resulting in an
overwhelming infection. Inactivated polio vaccine would be indicated because it
isn’t a live virus and wouldn’t pose the threat of infection.
 ○ Options B, C, and D: DTP, Hib, and hepatitis B vaccines can be given accordingly
to the recommended schedule.
56. 31. Question
Which of the following medications usually is given to a client with leukemia as
prophylaxis against P. carinii pneumonia?
○ A. Vincristine (Oncovin)
○ B. Prednisone (Deltasone)
○ C. Oral nystatin suspension
○ D. Sulfamethoxazole and trimethoprim (Bactrim)
57. Incorrect
Correct Answer: D. Sulfamethoxazole and trimethoprim (Bactrim)
○ Option D: The most frequent cause of death from leukemia is an overwhelming
infection. P. carinii infection is lethal to a child with leukemia. As prophylaxis
against P. carinii pneumonia, continuous low doses of co-trimoxazole (Bactrim)
are frequently prescribed.
○ Option A: Vincristine, an antineoplastic agent is used in the treatment for
leukemia but is not used as a prophylaxis against pneumonia.
○ Option B: Prednisone isn’t an antibiotic and increases susceptibility to infection.
○ Option C: Oral nystatin suspension would be indicated for the treatment of
thrush.
58. 32. Question
In which of the following diseases would bone marrow transplantation not be indicated in
a newly diagnosed client?
○ A. Severe aplastic anemia
○ B. Severe combined immunodeficiency
○ C. Acute lymphocytic leukemia
○ D. Chronic myeloid leukemia
59. Incorrect
Correct Answer: C. Acute lymphocytic leukemia
○ Option C: For the first episode of acute lymphocytic leukemia, conventional
therapy is superior to bone marrow transplantation. Treatment is usually
long-term chemotherapy and is composed of 3 phases (induction, consolidation,
and maintenance).
○ Options A and B: In severe combined immunodeficiency and in severe aplastic
anemia, bone marrow transplantation has been employed to replace abnormal
stem cells with healthy cells from the donor’s marrow.
○ Option D: In myeloid leukemia, bone marrow transplantation is done after
chemotherapy to infuse healthy marrow and to replace marrow stem cells ablated
during chemotherapy.
60. 33. Question
Which of the following treatment measures should be implemented for a child with
leukemia who has been exposed to the chickenpox?
○ A. Acyclovir (Zovirax) should be started on exposure
○ B. VZIG should be given within 72 hours of exposure
 ○ C. No treatment is indicated
○ D. Varicella-zoster immunoglobulin (VZIG) should be given with the evidence of
disease
61. Incorrect
Correct Answer: B. VZIG should be given within 72 hours of exposure
○ Option B: Varicella is a lethal organism to a child with leukemia. VZIG, given
within 72 hours, may favorably alter the course of the disease.
○ Option A: Acyclovir may be given if the child develops the disease but not if the
child has been exposed.
○ Option C: Chickenpox can cause severe complications in children afflicted with
leukemia if left untreated.
○ Option D: Giving the vaccine at the onset of symptoms wouldn’t likely decrease
the severity of the illness.
62. 34. Question
Nausea and vomiting are common adverse effects of radiation and chemotherapy. When
should a nurse administer antiemetics?
○ A. When therapy is completed
○ B. Immediately after nausea begins
○ C. With the administration of therapy
○ D. 30 minutes before the initiation of therapy
63. Incorrect
Correct Answer: D. 30 minutes before the initiation of therapy
○ Option D: Antiemetics are most beneficial when given before the onset of nausea
and vomiting. To calculate the optimum time for administration, the first dose is
given 30 minutes to 1 hour before nausea is expected, and then every 2, 4, or 6
hours for approximately 24 hours after chemotherapy.
○ Options A, B, and C: If the antiemetic was given with the medication or after the
medication, it could lose its maximum effectiveness when needed.
64. 35. Question
Parents of pediatric clients who undergo irradiation involving the central nervous system
should be warned about postirradiation somnolence. When does this neurologic
syndrome usually occur?
○ A. Immediately
○ B. Within 1 to 2 weeks
○ C. Within 5 to 8 weeks
○ D. Within 3 to 6 months
65. Incorrect
Correct Answer: C. Within 5 to 8 weeks
○ Option C: Postirradiation somnolence may develop 5 to 8 weeks after CNS
irradiation and may last 3 to 15 days. It’s characterized by somnolence with or
without fever, anorexia, nausea, and vomiting. Although the syndrome isn’t
thought to be clinically significant, parents should be prepared to expect such
symptoms and encourage the child to rest.
66. 36. Question
The nurse is instructing the client to perform a testicular self-examination. The nurse tells
the client:
○ A. That testicular examination should be done at least every 6 months
○ B. To gently feel the testicle with one finger to feel for a growth
○ C. To examine the testicles while lying down
○ D. The best time for the examination is after a shower
67. Incorrect
Correct Answer: D. The best time for the examination is after a shower
○ Option D: The testicular-self examination is recommended monthly after a warm
shower or bath when the scrotal skin is relaxed. The client should stand to
examine the testicles. Using both hands, with the fingers under the scrotum and
the thumbs on top, the client should gently roll the testicles, feeling for any lumps.
○ Option A: Testicular self-examination is done at least once a month.
○ Option B: Testicles are examined using both hands by placing the index and
middle fingers under the scrotum.
○ Option C: To do the exam, the patient should stand in front of a mirror.
68. 37. Question
The community nurse is conducting a health promotion program at a local school and is
discussing the risk factors associated with cancer. Which of the following, if identified by
the client as a risk factor, indicates a need for further instructions?
○ A. Stress
○ B. Exposure to radiation
○ C. Viral factors
○ D. Low-fat and high-fiber diet
69. Incorrect
Correct Answer: D. Low-fat and high-fiber diet
○ Option D: A diet high in fat may be a factor in the development of breast, colon,
and prostate cancers. High-fiber diets may reduce the risk of colon cancer.
○ Option A: Increased stress has been associated with causing the growth and
proliferation of cancer cells.
○ Option B: Two forms of radiation, ultraviolet and ionizing, can lead to cancer.
○ Option C: Viruses may be one of the multiple agents acting to initiate
carcinogenesis and have been associated with several types of cancer.
70. 38. Question
The client with cancer is receiving chemotherapy and develops thrombocytopenia. The
nurse identifies which intervention is the highest priority in the nursing plan of care?
○ A. Monitoring temperature
○ B. Monitoring for pathological factors
○ C. Ambulation three times a day
○ D. Monitoring the platelet count
71. Incorrect
Correct Answer: D. Monitoring the platelet count
 ○ Option D: Thrombocytopenia indicates a decrease in the number of platelets in
the circulating blood. A major concern is monitoring for and preventing bleeding.
○ Option A: Relates to monitoring for infection particularly if leukopenia is present.
○ Options B and C: Although monitoring the pathological factors and ambulation
are important in the plan of care. They are not related directly to
thrombocytopenia.
72. 39. Question
A client is diagnosed with multiple myeloma. The client asks the nurse about the
diagnosis. The nurse bases the response on which of the following descriptions of this
disorder?
○ A. Altered red blood cell production
○ B. Malignant proliferation of plasma cells and tumors within the bone
○ C. Altered production of lymph
○ D. Malignant exacerbation in the number of leukocytes
73. Incorrect
Correct Answer: B. Malignant proliferation of plasma cells and tumors within the bone
○ Option B: Multiple myeloma is a B cell neoplastic condition characterized by
abnormal malignant proliferation of plasma cells and the accumulation of mature
plasma cells in the bone marrow.
○ Option D: Malignant exacerbation in the number of leukocytes describes the
leukemic process.
○ Options A and C: Altered RBC and lymph production are not characteristics of
multiple myeloma.
74. 40. Question
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 WBC’s
○ B. Increased calcium levels
○ C. Decreased blood urea nitrogen
○ D. Decreased number of plasma cells in the bone marrow.
75. Incorrect
Correct Answer: B. Increased calcium levels
○ Option B: Hypercalcemia (increased calcium level) is caused by the release of
calcium from the deteriorating bone tissue in multiple myeloma. This may cause
symptoms of excessive thirst, constipation, dehydration, nausea, frequent
urination, dizziness, confusion, and eventually to coma.
○ Options A and C: Findings indicative of multiple myeloma are an increased
number of plasma cells in the bone marrow and elevated uric acid levels.
○ Option D: An increased white blood cell count may or may not be present and is
not related specifically to multiple myeloma.
76. 41. Question
The nurse is developing a plan of care for the client with multiple myeloma. The nurse
includes which priority intervention in the plan of care?
 ○ A. Encouraging fluids
○ B. Providing frequent oral care
○ C. Coughing and deep breathing
○ D. Monitoring red blood cell count
77. Incorrect
Correct Answer: A. Encouraging fluids
○ Option A: Hypercalcemia caused by bone destruction is a priority concern in the
client with multiple myeloma. The nurse should administer fluids in adequate
amounts to maintain an output of 1.5 to 2 L a day. Clients require about 3 L of
fluid per day. The fluid is needed not only to dilute the calcium overload but also
to prevent protein from precipitating in renal tubules.
○ Options B, C, and D: These are components in the plan of care but are not the
priority in this client.
78. 42. Question
The oncology nurse specialist provides an educational session to nursing staff regarding
the characteristics of Hodgkin’s disease. The nurse determines that further education is
needed if a nursing staff member states which of the following is characteristic of the
disease?
○ A. Prognosis depends on the stage of the disease
○ B. Occurs most often in the older client
○ C. Presence of Reed-Sternberg cells
○ D. Involvement of lymph nodes, spleen, and liver
79. Incorrect
Correct Answer: B. Occurs most often in the older client
○ Option B: Hodgkin’s disease is a disorder of young people up to age 40 and
among adults. It is more common in adolescents between the ages of 15 and 19.
○ Option A: Hodgkin’s lymphoma prognosis depends on the stage of the disease. It
is treatable in the early stages of the stages.
○ Option C: Hodgkin’s disease is marked by the presence of Reed-Sternberg cells
which are the abnormal B lymphocytes (WBC that produces antibodies that are
essential in combating infections).
○ Option D: The disease spread through the lymph vessels from lymph node to
lymph node. It can also travel to other parts such as the lung, liver, and spleen.
80. 43. Question
The nurse is reviewing the laboratory results of a client receiving chemotherapy. The
platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing
assessment is which of the following?
○ A. Assess skin turgor
○ B. Assess bowel sounds
○ C. Assess temperature
○ D. Assess level of consciousness
81. Incorrect
Correct Answer: D. Assess level of consciousness
 ○ Option D: A high risk of hemorrhage exists when the platelet count is fewer than
20,000. Fatal central nervous system hemorrhage or massive gastrointestinal
hemorrhage can occur when the platelet count is fewer than 10,000. The client
should be assessed for changes in levels of consciousness, which may be an
early indication of an intracranial hemorrhage.
○ Option A: Skin turgor will be assessed if there is a presence of dehydration in a
patient with low platelet count but it is not the priority.
○ Option B: Bowel sounds will be assessed when there is a presence of
gastrointestinal complications such as constipation, diarrhea, and radiation
enteritis.
○ Option C: Assessing the temperature is a priority nursing assessment when the
white blood cell count is low and the client is at risk for an infection.
82. 44. Question
Nurse Donald is caring for a client following a modified radical mastectomy. Which
assessment finding would indicate that the client is experiencing a complication related
to this surgery?
○ A. Pain at the incisional site
○ B. Complaints of decreased sensation near the operative site
○ C. Arm edema on the operative side
○ D. Sanguineous drainage in the Jackson-Pratt drain
83. Incorrect
Correct Answer: C. Arm edema on the operative side
○ Option C: Arm edema on the operative side (lymphedema) is a complication
following mastectomy and can occur immediately postoperatively or may occur
months or even years after surgery. The surgery damages some of the nodes
and vessels that lymph moves through resulting in a backup of fluid into the
body’s tissue.
○ Options A and B: Pain and decreased sensation in the chest area is normal and it
is caused by the damaged nerves in the armpit and chest during the surgery.
○ Option D: A sanguineous drainage in the Jackson-Pratt drain is normal
postoperatively. This output from the drain decreases each day and the color will
turn into light yellow or light pink.
84. 45. Question
A nurse is providing education in a community setting about general measures to avoid
excessive sun exposure. Which of the following recommendations is appropriate?
○ A. Wear loosely woven clothing for added ventilation
○ B. Apply sunscreen only after going in the water
○ C. Apply sunscreen with a sun protection factor (SPF) of 30 or more before sun
exposure
○ D. Avoid peak exposure hours from 9am to 1pm
85. Incorrect
Correct Answer: C. Apply sunscreen with a sun protection factor (SPF) of 30 or more
before sun exposure
 ○ Option C: According to The American Academy of Dermatology A sunscreen with
a SPF of 30 or higher should be worn on all sun-exposed skin surfaces is
recommended as a protection against ultraviolet A (UVA) and ultraviolet B (UVB)
rays.
○ Option A: Tightly woven clothing, protective hats, and sunglasses are
recommended to decrease sun exposure. Sun Tanning parlors should be
avoided.
○ Option B: It should be applied 15 to 30 minutes before sun exposure and
reapplied after being in the water.
○ Option D: Peak sun exposure usually occurs between 10 am to 2 pm.
86. 46. Question
Which of the following nursing interventions would be most helpful in making the
respiratory effort of a client with metastatic lung cancer more efficient?
○ A. Teaching the client diaphragmatic breathing techniques
○ B. Administering cough suppressants as ordered
○ C. Teaching and encouraging pursed-lip breathing
○ D. Placing the client in a low semi-Fowlers position
87. Incorrect
Correct Answer: C. Teaching and encouraging pursed-lip breathing
○ Option C: For clients with obstructive versus restrictive disorders, extending
exhalation through pursed-lip breathing will make the respiratory effort more
efficient. The usual position of choice for this client is the upright position, leaning
slightly forward to allow greater lung expansion.
○ Option A: Teaching diaphragmatic breathing techniques will be more helpful to
the client with a restrictive disorder.
○ Option B: Administering cough suppressants will not help the respiratory effort.
○ Option D: A low semi-Fowler’s position does not encourage lung expansion.
Lung expansion is enhanced in the upright position.
88. 47. Question
The nurse is teaching a 17-year old client and the client’s family about what to expect
with high-dose chemotherapy and the effects of neutropenia. What should the nurse
teach as the most reliable early indicator of infection in a neutropenic client?
○ A. Dyspnea
○ B. Fever
○ C. Tachycardia
○ D. Chills
89. Incorrect
Correct Answer: B. Fever
○ Option B: A patient with neutropenia has a decreased number of neutrophils.
These cells are responsible for fighting off bacteria once they enter the body. A
complication of neutropenia is infection. An early sign is a fever that requires
clinical intervention to identify potential causes.
○ Options A and D: Chills and dyspnea may or may not be observed.
 ○ Option C: Tachycardia can be an indicator in a variety of clinical situations when
associated with infection; it usually occurs in response to an elevated
temperature or change in cardiac function.
90. 48. Question
A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse
how the chemotherapeutic drugs will work. The most accurate explanation the nurse can
give is which of the following?
○ A. “Cancer cells are susceptible to drug toxins.”
○ B. “Chemotherapy affects all rapidly dividing cells.”
○ C. “Chemotherapy encourages cancer cells to divide.”
○ D. “The molecular structure of the DNA is altered.”
91. Incorrect
Correct Answer: B. “Chemotherapy affects all rapidly dividing cells.”
○ Option B: There are many mechanisms of action for chemotherapeutic agents,
but most affect the rapidly dividing cells—both cancerous and noncancerous.
Cancer cells are characterized by rapid cell division.
○ Option A: All cells are susceptible to drug toxins, but not all chemotherapeutic
agents are toxins.
○ Options C and D: Chemotherapy slows cell division. Not all chemotherapeutic
agents affect the molecular structure.
92. 49. Question
When caring for a client with a central venous line, which of the following nursing actions
should be implemented in the plan of care for chemotherapy administration? Select all
that apply.
○ A. Administer a cytotoxic agent to keep the regimen on schedule even if blood
return is not present.
○ B. If unable to aspirate blood, reposition the client and encourage the client to
cough.
○ C. Contact the health care provider about verifying placement if the status is
questionable.
○ D. Inspect the insertion site for swelling, erythema, or drainage.
○ E. Verify patency of the line by the presence of a blood return at regular
intervals.
93. Incorrect
Correct Answer: B, C, D, and E
○ A major concern with the intravenous administration of cytotoxic agents is vessel
irritation or extravasation. The Oncology Nursing Society and hospital guidelines
require frequent evaluation of blood return when administering vesicant or non
vesicant chemotherapy due to the risk of extravasation. These guidelines apply
to peripheral and central venous lines. In addition, central venous lines may be
long-term venous access devices. Thus, difficulty drawing or aspirating blood
may indicate the line is against the vessel wall or may indicate the line has
occlusion. Having the client cough or move position may change the status of the
line if it is temporarily against a vessel wall. Occlusion warrants more thorough
 evaluation via x-ray study to verify placement if the status is questionable and
may require a declotting regimen.
94. 50. Question
A client with stomach cancer is admitted to the oncology unit after vomiting for 3 days.
Physical assessment findings include irregular pulse, muscle twitching, and complaints
of prickling sensations in the fingers and hands. Laboratory results include a potassium
level of 2.9 mEq/L, a pH of 7.46, and a bicarbonate level of 29 mEq/L. The client is
experiencing:
○ A. Metabolic alkalosis
○ B. Respiratory acidosis
○ C. Metabolic acidosis
○ D.Respiratory alkalosis
95. Incorrect
Correct Answer: A. Metabolic alkalosis
○ The client is experiencing metabolic alkalosis caused by loss of hydrogen and
chloride ions from excessive vomiting. This is shown by a pH of 7.46 and
elevated bicarbonate level of 29 mEq/L
96. 1. Question
A 32-year-old woman meets with the nurse on her first office visit since undergoing a left
mastectomy. When asked how she is doing, the woman states her appetite is still not
good, she is not getting much sleep because she doesn’t go to bed until her husband is
asleep, and she is really anxious to get back to work. Which of the following nursing
interventions should the nurse explore to support the client’s current needs?
○ 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
97. Correct
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.
98. 2. 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
99. Incorrect
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.
100. 3. Question
A pneumonectomy is a surgical procedure sometimes indicated for 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
101. Incorrect
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.
102. 4. 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
103. Incorrect
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.
104. 5. 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
105. Incorrect
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.
106. 6. 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 enteritislikely responsible for her
symptoms?
○ A. Radiation enteritis
○ B. Stomatitis
○ C. Esophagitis
○ D. Hiatal hernia
107. Incorrect
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.
108. 7. 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
109. Incorrect
Correct 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.
110. 8. 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 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 feelings of anxiety.”
111. Incorrect
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.
112. 9. 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
113. Incorrect
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.
114. 10. 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
115. Incorrect
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.
116. 11. 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
117. Incorrect
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.
118. 12. 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.”
119. Incorrect
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.
120. 13. 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 mm Hg
○ C. Dry oral mucous membranes and cracked lips
 ○ D. Urine output of 400 ml in 8 hours
121. Incorrect
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.
122. 14. 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
123. Incorrect
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.
124. 15. 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
125. Incorrect
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.
126. 16. 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)
127. Incorrect
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.
128. 17. 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
129. Incorrect
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.
130. 18. 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-examination annually
○ C. Have a hormonal receptor assay annually
○ D. Have a physician conduct a clinical examination every 2 years
131. Incorrect
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.
132. 19. 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
133. Incorrect
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.
134. 20. 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° F (38.8°C)
135. Incorrect
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.
136. 21. 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
137. Incorrect
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.
138. 22. 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
139. Incorrect
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.
140. 23. 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, DNA synthesis, or
both (cell cycle–nonspecific)
141. Incorrect
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.
142. 24. 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
143. Incorrect
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.”
144. 25. 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
145. Incorrect
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.
146. 26. 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 Jones protein in the urine
147. Incorrect
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.
148. 27. 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
149. Incorrect
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.
150. 28. 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
151. Incorrect
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.
152. 29. 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 complete blood count (CBC) and blood urea nitrogen (BUN) and
creatinine levels checked yearly
153. Incorrect
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.
154. 30. 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
155. Incorrect
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.
156. 31. 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
157. Incorrect
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.
158. 32. 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
159. Incorrect
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.
160. 33. 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)
161. Incorrect
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.
162. 34. 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-examinations will
no longer be necessary
○ C. She should perform breast self-examination 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
163. Incorrect
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.
164. 35. 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
165. Incorrect
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.
166. 36. 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
167. Incorrect
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.
168. 37. 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
169. Incorrect
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.
170. 38. 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
171. Incorrect
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.
172. 39. 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
173. Incorrect
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.
174. 40. 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
175. Incorrect
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).
176. 41. Question
A male client is receiving the cell cycle–nonspecific alkylating agent Thioplex (thiotepa),
60 mg weekly for 4 weeks by bladder instillation as part of a chemotherapeutic regimen
to treat bladder cancer. The client asks the nurse how the drug works. How does
thiotepa exert its therapeutic effects?
○ A. It interferes with deoxyribonucleic acid (DNA) replication only
○ B. It interferes with ribonucleic acid (RNA) transcription only
○ C. It interferes with DNA replication and RNA transcription
○ D. It destroys the cell membrane, causing lysis
177. Incorrect
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.
178. 42. 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
179. Incorrect
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.
180. 43. 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 antiembolism 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
181. Incorrect
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.
182. 44. 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
183. Incorrect
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.
184. 45. 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
185. Incorrect
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.
186. 46. 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
187. Incorrect
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.
188. 47. 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
189. Incorrect
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.
190.
191. 48. 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. 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
○ C. Limit the time with the client to 1 hour per shift
○ D. Do not allow pregnant women into the client’s room
192. Incorrect
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.
193. 49. 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
194. Incorrect
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.
195. 50. 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
196. Incorrect
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.
197. 1. Question
The home health care nurse is caring for a male client with cancer and the client is
complaining of acute pain. The appropriate nursing assessment of the client’s pain would
include which of the following?
○ A. The client’s pain rating
○ B. The nurse’s impression of the client’s pain
○ C. Nonverbal cues from the client
○ D. Pain relief after appropriate nursing intervention
198. Incorrect
Correct Answer: A. The client’s pain rating
○ Option A: The client’s self-report is a critical component of pain assessment. The
nurse should ask the client about the description of the pain and listen carefully to
the client’s words used to describe the pain.
 ○ Option B: Nonverbal cues from the client are important but are not the most
appropriate pain assessment measure.
○ Option C: The nurse’s impression of the client’s pain is not appropriate in
determining the client’s level of pain.
○ Option D: Assessing pain relief is an important measure, but this option is not
related to the subject of the question.
199. 2. Question
Nurse Melinda 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. Ability to ambulate
○ B. Urine specific gravity
○ C. Bowel sounds
○ D. Incision appearance
200. Incorrect
Correct Answer: C. Bowel sounds
○ Option C: The client is kept NPO until peristalsis returns, usually in 4 to 6 days.
When signs of bowel function return, clear fluids are given to the client. If no
distention occurs, the diet is advanced as tolerated. The most important
assessment is to assess bowel sounds before feeding the client.
○ Options A, B, and D: These are unrelated to the subject of the question.
201. 3. Question
A male client is admitted to the hospital with a suspected diagnosis of Hodgkin’s
disease. Which assessment findings would the nurse expect to note specifically in the
client?
○ A. Fatigue
○ B. Weakness
○ C. Weight gain
○ D. Enlarged lymph nodes
202. Incorrect
Correct Answer: D. Enlarged lymph nodes
○ Option D: Hodgkin’s disease is a chronic progressive neoplastic disorder of
lymphoid tissue characterized by the painless enlargement of lymph nodes with
progression to extra lymphatic sites, such as the spleen and liver.
○ Options A and B: Fatigue and weakness may occur but are not related
significantly to the disease.
○ Option C: Weight loss is most likely to be noted.
203. 4. Question
During the admission assessment of a 35 year old client with advanced ovarian cancer,
the nurse recognizes which symptom as typical of the disease?
○ A. Abdominal distention
 ○ B. Abdominal bleeding
○ C. Diarrhea
○ D. Hypermenorrhea
204. Incorrect
Correct Answer: A. Abdominal distention
○ Option A: Clinical manifestations of ovarian cancer include abdominal distention,
urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure
caused by the growing tumor and the effects of urinary or bowel obstruction,
constipation, ascites with dyspnea, and ultimately general severe pain.
○ Options B and D: Abnormal bleeding, often resulting in hypermenorrhea, is
associated with uterine and endometrial cancer.
○ Option C: Diarrhea is often related to colon cancer, lymphoma, carcinoid
syndrome, and pancreatic cancer.
205. 5. Question
Nurse Kate is reviewing the complications of colonization with a client who has
microinvasive cervical cancer. Which complication, if identified by the client, indicates a
need for further teaching?
○ A. Hemorrhage
○ B. Ruptured ovarian cyst
○ C. Infection
○ D. Cervical stenosis
206. Incorrect
Correct Answer: B. Ruptured ovarian cyst
○ Option B: Ruptured ovarian cyst is not a complication. This usually occurs after
a strenuous exercise and after sexual intercourse.
○ Options A, C, and D: Conization procedure involves the removal of a
cone-shaped area of the cervix. Complications of the procedure include
hemorrhage, infection, and cervical stenosis.
207. 6. Question
Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is
classified as:
○ A. Carcinoma
○ B. Lymphoma
○ C. Melanoma
○ D. Sarcoma
208. Incorrect
Correct Answer: D. Sarcoma
○ Option D: Tumors that originate from bone, muscle, and other connective tissue
are called sarcomas.
○ Option A: Carcinoma is a malignancy that starts at the epithelial lining of an
organ, glands, or body structures.
 ○ Option B: Lymphoma is a cancer that begins in the nodes or glands of the
lymphatic system.
○ Option C: Melanoma is a type of skin cancer that originates in cells known as
melanocytes.
209. 7. Question
Sarah, a hospice nurse visits a client dying of ovarian cancer. During the visit, the client
expresses that “If I can just live long enough to attend my daughter’s graduation, I’ll be
ready to die.” Which phrase of coping is this client experiencing?
○ A. Anger
○ B. Denial
○ C. Bargaining
○ D. Depression
210. Incorrect
Correct Answer: C. Bargaining
○ Option C: Denial, bargaining, anger, depression, and acceptance are recognized
stages that a person facing a life-threatening illness experience. Bargaining
identifies a behavior in which the individual is willing to do anything to avoid loss
or change prognosis or fate.
○ Option A: Anger also may be the first response to upsetting news and the
predominant theme is “why me?” or the blaming of others.
○ Option B: Denial is expressed as shock and disbelief and may be the first
response to hearing bad news.
○ Option D: Depression may be manifested by hopelessness, weeping openly, or
remaining quiet or withdrawn.
211. 8. Question
The nurse is admitting a male client with laryngeal cancer to the nursing unit. The nurse
assesses for which most common risk factor for this type of cancer?
○ A. Alcohol abuse
○ B. Cigarette smoking
○ C. Use of chewing tobacco
○ D. Exposure to air pollutants
212. Incorrect
Correct Answer: B. Cigarette smoking
○ Option B: Cigarette use is the most common risk factor for head and neck
cancers such as laryngeal cancer. The smoke that comes from a cigarette
contains harmful chemicals such as nicotine, carbon monoxide, ammonia, and
hydrogen cyanide that passes through the larynx on its way to the lungs.
○ Options A and C: Combined use of alcohol and tobacco enhances the risk.
○ Option D: Another risk factor is exposure to environmental pollutants (e.g., paint
fumes, wood dust, coal dust) but cigarette smoking remains the most common.
213. 9. Question
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. Extreme stress caused by the diagnosis of cancer
○ B. Altered perineal sensation as a side effect of radiation therapy
○ C. Rupture of the bladder
○ D. The development of a vesicovaginal fistula
214. Incorrect
Correct Answer: D. The development of a vesicovaginal fistula
○ Option D: A vesicovaginal fistula is a genital fistula that occurs between the
bladder and vagina. The fistula is an abnormal opening between these two body
parts and, if this occurs, the client may experience drainage of urine through the
vagina.
○ Options A, B, and C: The client’s complaint is not associated.
215. 10. Question
The client with leukemia is receiving Myleran (busulfan) and Zyloprim (allopurinol). The
nurse tells the client that the purpose if the allopurinol is to prevent:
○ A. Mouth sores
○ B. Hyperuricemia
○ C. Nausea
○ D. Alopecia
216. Incorrect
Correct Answer: B. Hyperuricemia
○ Option B: Allopurinol decreases uric acid concentrations in serum and urine. In
the client receiving chemotherapy, uric acid levels increase as a result of the
massive cell destruction that occurs from the chemotherapy. This medication
prevents or treats hyperuricemia caused by chemotherapy.
○ Options A, C, and D: Allopurinol is not used to prevent alopecia, nausea, or
mouth sores.
217. 11. Question
A 25-year-old patient is inquiring about the methods or ways to detect cancer earlier. The
nurse least likely identifies this method by stating:
○ A. Yearly physical and blood examination
○ B. Annual digital rectal examination for persons over age 40
○ C. Annual Pap smear for sexually active women only
○ D. Annual chest x-ray
218. Incorrect
Correct Answer: C. Annual Pap smear for sexually active women only
○ Option C: Pap smear should be done yearly for sexually active women. All
women should have an annual pap smear by age 40 and up whether sexually
active or not.
 ○ Options A, B, and D: Early detection of cancer is promoted by annual oral
examination, monthly BSE from age 20, annual chest x-ray, yearly digital rectal
examination for persons over age 40, annual Pap smear from age 40 and annual
physical and blood examination.
219. 12. Question
The removal of entire breast, pectoralis major and minor muscles and neck lymph nodes
which is followed by skin grafting is a procedure called:
○ A. Radiation therapy
○ B. Halstead surgery
○ C. Modified radical mastectomy
○ D. Simple mastectomy
220. Incorrect
Correct Answer: B. Halstead surgery
○ Option B: Halstead surgery also called radical mastectomy involves the removal
of the entire breast, pectoralis major and minor muscles, and neck lymph nodes.
It is followed by skin grafting.
○ Option A: Radiation therapy uses high doses radiation to kill cancer cells and
their ability to grow and divide.
○ Option C: Removal of the entire breast, pectoralis major muscle and the axillary
lymph nodes is a surgical procedure called modified radical mastectomy.
○ Option D: Simple mastectomy is the removal of the entire breast but the
pectoralis muscles and nipples remain intact.
221. 13. Question
Chemotherapy is one of the therapeutic modalities for cancer. This treatment is
contraindicated to which of the following conditions?
○ A. Bone marrow depression
○ B. Recent surgery
○ C. Pregnancy
○ D. All of the above
222. Incorrect
Correct Answer: D. All of the above
○ Chemotherapy is contraindicated in cases of infection (chemotherapeutic agents
are immunosuppressive), recent surgery (chemotherapeutic agent may retard the
healing process), impaired renal and hepatic function (drugs are nephrotoxic and
hepatotoxic), recent radiation therapy (immunosuppressive treatment),
pregnancy (drugs can cause congenital defects) and bone marrow depression
(chemo. agents may aggravate the condition).
223. 14. Question
The nurse is preparing Cytoxan (cyclophosphamide). Safe handling of the drug should
be implemented to protect the nurse from injury. Which of the following actions by the
nurse should be corrected?
 ○ A. The nurse should wear a mask and gloves
○ B. Air bubbles should be expelled on wet cotton
○ C. Review order to check the rate, solution, and frequency of the drug
○ D. Vent vials after mixing
224. Incorrect
Correct Answer: A. The nurse should wear a mask and gloves
○ Option A: The nurse should be corrected if she is only wearing a mask and
glove because additional protective equipment (gown, goggles, and face shields)
should also be worn in handling chemotherapeutic drugs.
○ Option B: Air bubbles are expelled on wet cotton to prevent the spread of the
chemotherapeutic agent particles.
○ Option C: Ensures the IV chemotherapy solution is correct and helps avoid
medication error.
○ Option D: The vials should be vent after mixing to reduce the internal pressure.
225. 15. Question
Neoplasm can be classified as either benign or malignant. The following are
characteristics of malignant tumor apart from:
○ A. Encapsulated
○ B. Infiltrates surrounding tissues
○ C. Metastasis
○ D. Poorly differentiated cells
226. Incorrect
Correct Answer: A. Encapsulated
○ Option A: Benign: grows slowly, localized, encapsulated, well-differentiated cells,
no metastasis, not harmful to host.
○ Options B, C, and D: Malignant: Grows rapidly, infiltrate surrounding tissues, not
encapsulated, poorly differentiated, metastasis present, always harmful.
227. 16. Question
On a clinic visit a client who has a relative with cancer, is asking about the warning signs
that may relate to cancer. The nurse correctly identifies the warning signs of cancer by
responding:
○ A. “A lump located only in the breast area may suggest the presence of cancer.”
○ B. “Sudden weight loss of unexplained etiology can be a warning sign of cancer.”
○ C. “Presence of dry cough is one of the warning signs of cancer.”
○ D. “If a sore healing took a month or more to heal, cancer should be suspected.”
228. Incorrect
Correct Answer: B. “Sudden weight loss of unexplained etiology can be a warning
sign of cancer.”
 ○ Option B: Unexplained sudden weight loss of 10 pounds or more is a warning
signal of cancer. This is common among cancers of the esophagus, stomach,
and pancreas.
○ Option A: The presence of lump is not limited to the breast only; it can grow
elsewhere which is why this option is wrong.
○ Option C: Nagging cough not dry cough and hoarseness of voice is a sign of
cancer.
○ Option D: The sore in cancer does not heal.
229. 17. Question
In staging and grading neoplasm TNM systems is used. TNM stands for:
○ A. Tumor, neoplasm, mode of growth
○ B. Time, node, metastasis
○ C. Tumor, node, metastasis
○ D. Time, neoplasm, mode of growth
230. Incorrect
Correct Answer: C. Tumor, node, metastasis
○ TNM system is used to describe the amount and spread of cancer in a client’s
body. TNM stands for tumor (describes the original primary tumor), node
(describes whether the cancer has spread to the nearby lymph nodes), and
metastasis (describes whether the cancer has spread to other parts of the body).
231. 18. Question
Breast self examination (BSE) is one of the ways to detect breast cancer earlier. The
nurse is conducting health teaching to female clients in a clinic. During evaluation the
clients are asked to state what they learned. Which of the following statements made by
a client needs further teaching about BSE?
○ A. “BSE is done after menstruation.”
○ B. “BSE palpation is done by starting at the center going to the periphery in a
circular motion.”
○ C. “BSE can be done in a lying position.”
○ D. “BSE should start from age 20.”
232. Incorrect
Correct Answer: B. “BSE palpation is done by starting at the center going to the
periphery in a circular motion.”
○ Option B: This client needs further teaching as palpation in BSE should start at
the periphery going to the center in a circular motion.
○ Option A: BSE is performed 7-10 days after menstruation when the breast are
less tender and lumpy.
○ Option C: The breast can be examined in a lying position since this position
flattens the breast and makes it easier to examine.
○ Option D: All women age 20 and older must do self-breast exams where breast
tumors can be easily detected at this age.
233. 19. Question
A client had undergone radiation therapy (external). The expected side effects include
the following apart from:
○ A. Hair loss
○ B. Ulceration of oral mucous membranes
○ C. Constipation
○ D. Headache
234. Incorrect
Correct Answer: C. Constipation
○ Option C: Diarrhea, not constipation is the side effect of radiation therapy which
usually starts during or right after the treatment and may last for several weeks.
○ Options A, B, and D: These are common side effects of radiation therapy.
235. 20. Question
Nurse Janet is assigned in the oncology section of the hospital. Which of the following
orders should the nurse question if a client is on radiation therapy?
○ A. Bland diet
○ B. Aspirin every 4 hours
○ C. Saline rinses every 2 hours
○ D. Analgesics before meals
236. Incorrect
Correct Answer: B. Aspirin every 4 hours
○ Option B: Radiation therapy makes the platelet count decrease. Thus, nursing
responsibilities should be directed at promoting safety by avoiding episodes of
hemorrhage or bleeding such as physical trauma and aspirin administration.
○ Options A and C: Bland diet and saline rinses every 2 hours should also be
done to manage stomatitis, a complication of radiation therapy.
○ Option D: Analgesics are given before meals to alleviate the pain caused by
stomatitis.
237. 21. Question
Skin reactions are common in radiation therapy. Nursing responsibilities on promoting
skin integrity should be promoted apart from:
○ A. Avoiding the use of ointments, powders and lotion to the area
○ B. Using soft cotton fabrics for clothing
○ C. Washing the area with a bar of scented soap and water and patting it dry not
rubbing it
○ D. Avoiding direct sunshine or cold.
238. Incorrect
Correct Answer: C. Washing the area with a bar of scented soap and water and
patting it dry not rubbing it
 ○ Option C: A mild unscented soap should only be used on the skin of the client
undergoing radiation to decrease the occurrence of skin reactions.
○ Options A, and B: Soap and irritants may cause dryness of the patient’s skin.
○ Option D: Since the skin that is receiving radiation therapy may be burned from
the treatment, avoiding direct sunlight is helpful to prevent further damage.
239. 22. Question
Nausea and vomiting is an expected side effect of chemotherapeutic drug use. Which of
the following drugs should be administered to a client on chemotherapy to prevent
nausea and vomiting?
○ A. Myleran (busulfan)
○ B. Chemet (succimer)
○ C. Arimidex (anastrozole)
○ D. Metozol (metoclopramide)
240. Incorrect
Correct Answer: D. Metozol (metoclopramide)
○ Option D: Metoclopramide (Metozol) – an antiemetic is used before
chemotherapy to prevent nausea and vomiting.
○ Option A: Busulfan (Myleran) – alkylating agent that works by sticking to one of
the DNA strands of the cancer cells. It works also by inhibiting the growth of
cancer cells.
○ Option B: Succimer (Chemet) – chelating agent for lead poisoning.
○ Option C: Anastrozole (Arimidex) – hormone regulator that slows or inhibits the
growth of certain types of breast cancer cells that requires estrogen to grow.
○
241. 23. Question
Radiation protection is very important to implement when performing nursing
procedures. When the nurse is not performing any nursing procedures what distance
should be maintained from the client?
○ A. 1 feet
○ B. 2 feet
○ C. 2.5 feet
○ D. 3 feet
242. Incorrect
Correct Answer: D. 3 feet
○ Option D: The distance of at least 3 feet / 0.9 or 1 meter should be maintained
when a nurse is not performing any nursing procedures to decrease exposure
from the radiation.
243. 24. Question
The following are teaching guidelines regarding radiation therapy except:
○ A. The therapy is painless
 ○ B. To promote safety, the client is assisted by therapy personnel while the
machine is in operation
○ C. The client may communicate all his concerns or needs or discomforts while
the machine is operating
○ D. Safety precautions are necessary only during the time of actual irradiation
244. Incorrect
Correct Answer: B. To promote safety, the client is assisted by therapy personnel
while the machine is in operation
○ Option B: To promote safety to the personnel, the client will remain alone in the
treatment room while the machine is in operation.
○ Options A and D: There is no residual radioactivity after radiation therapy.
Safety precautions are necessary only during the time of actual irradiation. The
client may resume normal activities of daily living afterward.
○ Option C: The client may voice out any concern throughout the treatment
because a technologist is just outside the room observing through a window or
closed-circuit TV.
245. 25. Question
Contact of client on radiation therapy should be limited only to how many minutes to
promote safety of the therapy personnel?
○ A. 1 minute
○ B. 3 minutes
○ C. 5 minutes
○ D. 10 minutes
246. Incorrect
Correct Answer: C. 5 minutes
○ Option C: Principles of Radiation protection follows the DTS system. Distance
(D), Time (T), and Shielding (S). Distance – at least 3 feet should be maintained
when a nurse is not performing any nursing procedures. Time – limit exposure to
5 minutes each time. Shielding – use lead shield during contact with the client.
247. 26. Question
A client is taking Cyclophosphamide (Cytoxan) for the treatment of lymphoma. The nurse
is very cautious in administering the medication because this drug poses the fatal side
effect of:
○ A. Sterility
○ B. Hemorrhagic cystitis
○ C. Myeloma
○ D. Alopecia
248. Incorrect
Correct Answer: B. Hemorrhagic cystitis
 ○ Option B: Cyclophosphamide when broken down by the body into a substance
called acrolein which is excreted into the urine causing irritation in the lining of
the bladder (hemorrhagic cystitis).
○ Options A and D: Sterility and alopecia are common side effects of the drug but
is only temporary.
○ Option C: Myeloma is an indication for giving this medication.
249. 27. Question
Cytarabine (Ara-C) is an antimetabolite that can cause a common cytarabine syndrome
which includes the following, except:
○ A. Fever
○ B. Myalgia
○ C. Chest pain
○ D. Red-orange urine
250. Incorrect
Correct Answer: D. Red-orange urine
○ Option D: Cytarabine syndrome which occurs about 6 to 12 hours after taking
cytarabine. It is characterized by fever, myalgia, bone pain, chest pain, rash,
conjunctivitis, and malaise. Red-orange urine, a common side effect of
medications such as rifampin and phenazopyridine is not included in this
syndrome.
251. 28. Question
To provide relief from the cytarabine syndrome, which drug is given?
○ A. Dexamethasone
○ B. Allopurinol
○ C. Alka Seltzer
○ D. Aspirin
252. Incorrect
Correct Answer: A. Dexamethasone
○ Option A: Steroids such as dexamethasone may be prescribed to promote relief
from cytarabine syndrome.
○ Option B: Allopurinol is given for hyperuricemia that will result from taking some
chemotherapeutic agent.
○ Options C and D: Since cytarabine causes platelets to decrease, aspirin and
aspirin-containing products are not advised unless prescribed by the physician.
253. 29. Question
Chemotherapeutic agents have different specific classifications. The following
medications are antineoplastic antibiotics except:
○ A. Adriamycin (doxorubicin)B. Adrucil (fluorouracil)
○ B. Adrucil (fluorouracil)
○ C. Novantrone (mitoxantrone)
 ○ D. Blenoxane (bleomycin)
254. Incorrect
Correct Answer: B. Adrucil (fluorouracil)
○ Option B: Adrucil (fluorouracil) is an antimetabolite. Antimetabolites work by
acting as false metabolites that prevent DNA synthesis.
○ Options A, C, and D: Antineoplastic antibiotics such as doxorubicin,
mitoxantrone, and bleomycin are products of Streptomyces. These anticancer
drugs block cell growth by interfering with DNA.
255. 30. Question
Specific classification of the chemotherapeutic agent, Vincristine (Oncovin) is:
○ A. Hormone modulator
○ B. Mitotic inhibitor
○ C. Antineoplastic antibiotic
○ D. Antimetabolite
256. Incorrect
Correct Answer: B. Mitotic inhibitor
○ Option B: Vincristine is a mitotic inhibitor that inhibits mitosis or cell division.
Other examples of mitotic inhibitors are paclitaxel, docetaxel, and vinblastine.
○ Option A: Hormone modulators work by interfering with the activity of hormones.
A good example are the selective estrogen receptor modulators (Tamoxifen,
Raloxifene, and Ospemifene).
○ Option C: Antineoplastic antibiotic (e.g., doxorubicin, mitoxantrone, and
bleomycin) blocks cell growth by interfering with DNA.
○ Option D: Antimetabolites (such as Sulfanilamides) work by acting as false
metabolites that prevent DNA synthesis.
257. 31. Question
A client is diagnosed with progressive prostate cancer. The nurse expects which drug is
given?
○ A. Arimidex (anastrozole)
○ B. Emcyt (estramustine)
○ C. Taxol (paclitaxel)
○ D. Camptosar (irinotecan)
258. Incorrect
Correct Answer: B. Emcyt (estramustine)
○ Option B: Emcyt (estramustine)– is used as a palliative treatment of metastatic
and progressive prostate cancer.
○ Option A: Arimidex (anastrozole)- is used in the treatment of advanced breast
cancer in post-menopausal women following tamoxifen therapy.
○ Option C: Taxol (paclitaxel) is given as a treatment for ovarian cancer, breast
cancer, and AIDS-related to Kaposi’s sarcoma.
 ○ Option D: Camptosar (irinotecan) is indicated in the treatment of metastatic
colon or rectal cancer after treatment with 5-FU.
259. 32. Question
A client taking a chemotherapeutic agent understands the effects of therapy by stating:
○ A. “I should stay in my room all the time.”
○ B. “I will avoid eating hot and spicy foods.”
○ C. “I should limit my fluid intake to about 500 ml per day.”
○ D. “I should notify the physician immediately if a urine color change is observed.”
260. Incorrect
Correct Answer: B. “I will avoid eating hot and spicy foods.”
○ Option B: The client should prevent hot and spicy food because of the stomatitis
side effect. Spicy foods can further irritate the lining of the mouth causing more
ulcers.
○ Option A: The client should avoid people with infection but should not isolate
himself in his room all the time.
○ Option C: Fluid intake should be increased to help flush out the medication and
replace lost fluids caused by the other side effects of chemotherapy such as
nausea and vomiting.
○ Option D: Urine color change is normal.
261. 33. Question
A client is diagnosed with breast cancer. The tumor size is up to 5 cm with axillary and
neck lymph node involvement. The client is in what stage of breast cancer?
○ A. Stage I
○ B. Stage II
○ C. Stage III
○ D. Stage IV
262. Incorrect
Correct Answer: B. Stage II
○ Option B: The tumor in stage II measures between 2 cm to 5 cm or the cancer
has extended to the nearby lymph nodes.
○ Option A: Stage I – tumor size up to 2 cm. Stage II – tumor size up to 5 cm with
axillary and neck lymph node involvement.
○ Option C: Stage III – tumor size is more than 5 cm with axillary and neck lymph
node involvement.
○ Option D: Stage IV – metastasis to distant organs (liver, lungs, bone and brain).
263. 34. Question
The classic symptoms that define breast cancer includes the following except:
○ A. Solitary, irregularly shaped mass
○ B. “Pink peel” skin
○ C. Firm, nontender, nonmobile mass
 ○ D. Abnormal discharge from the nipple
264. Incorrect
Correct Answer: B. “Pink peel” skin
○ Options D: Pink peel skin is a symptom of breast cancer but it can also be seen
with other conditions such as eczema, contact dermatitis, or scarlet fever.
○ Options A, C, and D: Classic symptoms that define breast cancer include: Firm,
nontender, nonmobile mass. Solitary, irregularly shaped mass. Adherence to
muscle or skin causing dimpling effect. Involvement of the upper outer quadrant
or central nipple portion. Asymmetry of the breasts. “Orange peel” skin.
Retraction of nipple. Abnormal discharge from nipple.
265. 35. Question
Surgical procedure to treat breast cancer involves the removal of the entire breast,
pectoralis major muscle and the axillary lymph nodes is:
○ A. Simple mastectomy
○ B. Modified radical mastectomy
○ C. Halstead Surgery
○ D. Radical mastectomy
266. Incorrect
Correct Answer: B. Modified radical mastectomy
○ Option B: Removal of the entire breast, pectoralis major muscle and the axillary
lymph nodes is a surgical procedure called modified radical mastectomy.
○ Option A: Simple mastectomy is the removal of the entire breast but the
pectoralis muscles and nipples remain intact.
○ Options C and D: Halstead surgery also called radical mastectomy involves the
removal of the entire breast, pectoralis major and minor muscles and neck lymph
nodes. It is followed by skin grafting.
267. 36. Question
While being prepared for a biopsy of a lump in the right breast, the patient asks the
nurse what the difference is between a benign tumor and a malignant tumor. The nurse
explains that a benign tumor differs from a malignant tumor in that benign tumors
○ A. Do not cause damage to adjacent tissue
○ B. Do not spread to other tissues and organs
○ C. Are simply an overgrowth of normal cells
○ D. Frequently recur in the same site
268. Incorrect
Correct Answer: B. Do not spread to other tissues and organs
○ Option B: The major difference between benign and malignant tumors is that
malignant tumors invade adjacent tissues and spread to distant tissues and
benign tumors never metastasize.
○ Option A: Both types of tumors may cause damage to adjacent tissues.
○ Option C: The cells differ from normal in both benign and malignant tumors.
 ○ Option D: Benign tumors usually do not recur.
269. 37. Question
A patient who has been told by the health care provider that the cells in a bowel tumor
are poorly differentiated asks the nurse what is meant by “poorly differentiated.” Which
response should the nurse make?
○ A. "Your tumor cells look more like immature fetal cells than normal bowel cells."
○ B. "The cells in your tumor have mutated from the normal bowel cells."
○ C. "The cells in your tumor do not look very different from normal bowel cells."
○ D. "The tumor cells have DNA that is different from your normal bowel cells."
270. Incorrect
Correct Answer: A. “Your tumor cells look more like immature fetal cells than
normal bowel cells.”
○ Option A: An undifferentiated cell has an appearance more like a stem cell or
fetal cell and less like the normal cells of the organ or tissue.
○ Option B: All tumor cells are mutations from the normal cells of the tissue.
○ Options C and D: The DNA in cancer cells is always different from normal cells,
whether the cancer cells are well differentiated or not.
271. 38. Question
A patient who smokes tells the nurse, “I want to have a yearly chest x-ray so that if I get
cancer, it will be detected early.” Which response by the nurse is most appropriate?
○ A. "Insurance companies do not authorize yearly x-rays just to detect early lung
cancer."
○ B. "Annual x-rays will increase your risk for cancer because of exposure to
radiation."
○ C. "Chest x-rays do not detect cancer until tumors are already at least a half-inch
in size."
○ D. "Frequent x-rays damage the lungs and make them more susceptible to
cancer."
272. Incorrect
Correct Answer: C. “Chest x-rays do not detect cancer until tumors are already at
least a half-inch in size.”
○ Option C: A tumor must be at least 1 cm large before it is detectable by an x-ray
and may already have metastasized by that time.
○ Option A: Insurance companies do not usually authorize x-rays for this purpose,
but it would not be appropriate for the nurse to give this as the reason for not
doing an x-ray.
○ Options B and D: Radiographs have low doses of radiation, and an annual x-ray
alone is not likely to increase lung cancer risk.
273. 39. Question
In teaching about cancer prevention to a community group, the nurse stresses the
promotion of exercise, normal body weight, and a low-fat diet because
 ○ A. Obesity and lack of exercise cause cancer in susceptible people
○ B. People who exercise and eat healthy will make other lifestyle changes
○ C. Most people are willing to make these changes to avoid cancer
○ D. Dietary fat and obesity promote growth of many types of cancer
274. Incorrect
Correct Answer: D. Dietary fat and obesity promote growth of many types of
cancer
○ Option D: Obesity and dietary fat promote the growth of malignant cells, and
decreasing these risk factors can reduce the chance of cancer development.
○ Option A: Obesity and lack of exercise do not cause cancer, but they promote
the growth of altered cells.
○ Option B: Good diet and exercise habits are not a guarantee that other healthy
lifestyle changes will then occur.
○ Option C: Many people are not willing to make these changes.
275. 40. Question
During a routine health examination, a 30-year-old patient tells the nurse about a family
history of colon cancer. The nurse will plan to
○ A. Schedule a sigmoidoscopy to provide baseline data about the patient
○ B. Teach the patient about the need for a colonoscopy at age 50
○ C. Have the patient ask the doctor about specific tests for colon cancer
○ D. Ask the patient to bring in a stool specimen to test for occult blood
276. Incorrect
Correct Answer: C. Have the patient ask the doctor about specific tests for colon
cancer
○ Option C: The patient is at increased risk and should talk with the health care
provider about needed tests, which will depend on factors such as the exact type
of family history and any current symptoms.
○ Option A: The health care provider will take multiple factors into consideration
before determining whether a sigmoidoscopy is needed at age 30.
Option B: Colonoscopy at age 50 is used to screen for individuals without
symptoms or increased risk, but earlier testing may be needed for this patient
because of family history.
○ Option D: For fecal occult blood testing, patients use a take-home multiple
sample method rather than bring one specimen to the clinic.
277. 41. Question
When reviewing the chart for a patient with cervical cancer, the nurse notes that the
cancer is staged as Tis, N0, M0. The nurse will teach the patient that
○ A. The cancer cells are well-differentiated
○ B. It is difficult to determine the original site of cervical cancer
○ C. The cancer is localized to the cervix
 ○ D. Further testing is needed to determine the spread of the cancer
278. Incorrect
Correct Answer: C. The cancer is localized to the cervix
○ Option C: Cancer in situ indicates that the cancer is localized to the cervix and is
not invasive at this time.
○ Option A: Cell differentiation is not indicated by clinical staging.
○ Option B: Because the cancer is in situ, the origin is the cervix.
○ Option D: Further testing is not indicated given that the cancer has not spread.
279. 42. Question
Which statement by a patient who is scheduled for a needle biopsy of the prostate
indicates that the patient understands the purpose of a biopsy?
○ A. "The biopsy will tell the doctor whether the cancer has spread to my other
organs."
○ B. "The biopsy will help the doctor decide what treatment to use for my enlarged
prostate."
○ C. "The biopsy will determine how much longer I have to live."
○ D. "The biopsy will indicate the effect of the cancer on my life."
280. Incorrect
Correct Answer: B. “The biopsy will help the doctor decide what treatment to use
for my enlarged prostate.”
○ Option B: A biopsy is used to determine whether the prostate enlargement is
benign or malignant and determines the type of treatment that will be needed.
○ Options A, C, and D: Biopsy does not give information about metastasis, life
expectancy, or the impact of cancer on the patient’s life; the three remaining
statements indicate a need for patient teaching.
281. 43. Question
The nurse is teaching a postmenopausal patient with breast cancer about the expected
outcomes of her cancer treatment. The nurse evaluates that the teaching has been
effective when the patient says
○ A. "After cancer has not recurred for 5 years, it is considered cured."
○ B. "I will need to have follow-up examinations for many years after I have
treatment before I can be considered cured."
○ C. "Cancer is considered cured if the entire tumor is surgically removed."
○ D. "Cancer is never considered cured, but the tumor can be controlled with
surgery, chemotherapy, and radiation."
282. Incorrect
Correct Answer: B. “I will need to have follow-up examinations for many years
after I have treatment before I can be considered cured.”
○ Option B: The risk of recurrence varies by the type of cancer; for breast cancer
in postmenopausal women, the patient needs at least 20 disease-free years to be
considered cured.
 ○ Options A, C, and D: Some cancers (e.g., leukemia) are cured by nonsurgical
therapies such as radiation and chemotherapy.
283. 44. Question
A patient with a large stomach tumor that is attached to the liver is scheduled to have a
debulking procedure. The nurse explains that the expected outcome of this surgery is
○ A. Control of the tumor growth by removal of malignant tissue
○ B. Promotion of better nutrition by relieving the pressure in the stomach
○ C. Relief of pain by cutting sensory nerves in the stomach
○ D. Reduction of the tumor burden to enhance adjuvant therapy
284. Incorrect
Correct Answer: D. Reduction of the tumor burden to enhance adjuvant therapy
○ Option D: A debulking surgery reduces the size of the tumor and makes
radiation and chemotherapy more effective.
○ Option A: Debulking surgeries do not control tumor growth.
○ Option B: The tumor is debulked because it is attached to the liver, a vital organ
(not to relieve pressure on the stomach).
○ Option C: Debulking does not sever the sensory nerves, although pain may be
lessened by the reduction in pressure on the abdominal organs.
285. 45. Question
External-beam radiation is planned for a patient with endometrial cancer. The nurse
teaches the patient that an important measure to prevent complications from the effects
of the radiation is to
○ A. Test all stools for the presence of blood
○ B. Inspect the mouth and throat daily for the appearance of thrush
○ C. Perform perianal care with sitz baths and meticulous cleaning
○ D. Maintain a high-residue, high-fat diet
286. Incorrect
Correct Answer: C. Perform perianal care with sitz baths and meticulous cleaning
○ Option C: Radiation to the abdomen will affect organs in the radiation path, such
as the bowel, and cause frequent diarrhea.
○ Options A and B: Stools are likely to have occult blood from the inflammation
associated with radiation, so routine testing of stools for blood is not indicated.
Radiation to the abdomen will not cause stomatitis.
○ Option D: A low-residue diet is recommended to avoid irritation of the bowel
when patients receive abdominal radiation.
287. 46. Question
Which action by a nursing assistant (NA) caring for a patient with a temporary
radioactive cervical implant indicates that the RN should intervene?
○ A. The NA places the patient's bedding in the laundry container in the hallway
○ B. The NA gives the patient an alcohol-containing mouthwash for oral care
○ C. The NA stands by the patient's bed for an hour talking with the patient
 ○ D. The NA flushes the toilet once after emptying the patient's bedpan
288. Incorrect
Correct Answer: C. The NA stands by the patient’s bed for an hour talking with the
patient
○ Option C: Because patients with temporary implants emit radioactivity while the
implants are in place, exposure to the patient is limited.
○ Options A and D: Laundry and urine/feces do not have any radioactivity and do
not require special precautions.
○ Option B: Cervical radiation will not affect the oral mucosa, and alcohol-based
mouthwash is not contraindicated.
289. 47. Question
A patient with Hodgkin’s lymphoma is undergoing external radiation therapy on an
outpatient basis. After 2 weeks of treatment, the patient tells the nurse, “I am so tired I
can hardly get out of bed in the morning.” An appropriate intervention for the nurse to
plan with the patient is to
○ A. Consult with a psychiatrist for treatment of depression
○ B. Establish a time to take a short walk every day
○ C. Exercise vigorously when fatigue is not as noticeable
○ D. Maintain bed rest until the treatment is completed
290. Incorrect
Correct Answer: B. Establish a time to take a short walk every day
○ Option B: Walking programs are used to keep the patient active without
excessive fatigue.
○ Option A: Fatigue is expected during treatment and is not an indication of
depression.
○ Option C: Vigorous exercise when the patient is less tired may lead to increased
fatigue.
○ Option D: Bed rest will lead to weakness and other complications of immobility.
291. 48. Question
Which information obtained by the nurse about a patient with colon cancer who is
scheduled for external radiation therapy to the abdomen indicates a need for patient
teaching?
○ A. The patient showers with unscented mild soap daily
○ B. The patient eats frequently during the day
○ C. The patient swims a mile 5 days a week
○ D. The patient has a history of dental caries
292. Incorrect
Correct Answer: C. The patient swims a mile 5 days a week
○ Option C: The patient is instructed to avoid swimming in salt water or chlorinated
pools during the treatment period to prevent a skin reaction.
 ○ Options A and B: The patient does not need to change the habits of eating
frequently or showering with a mild soap.
○ Option D: A history of dental caries will not impact the patient who is scheduled
for abdominal radiation.
293. 49. Question
A patient undergoing external radiation has developed a dry desquamation of the skin in
the treatment area. The nurse knows that teaching about management of the skin
reaction has been effective when the patient says
○ A. "I can use ice packs to relieve itching in the treatment area."
○ B. "I can buy a steroid cream to use on the itching area."
○ C. "I will expose the treatment area to a sun lamp daily."
○ D. "I will scrub the area with warm water to remove the scales."
294. Incorrect
Correct Answer: B. “I can buy a steroid cream to use on the itching area
○ Option B: Steroid (over-the-counter [OTC] hydrocortisone) cream may be used
to reduce itching in the area.
○ Options A and C: Extreme heat or cold temperatures may injure the skin.
○ Option D: Treatment areas should be cleaned gently to avoid further injury.
295. 50. Question
A patient with metastatic cancer of the colon experiences severe vomiting following each
administration of chemotherapy. An important nursing intervention for the patient is to
○ A. Have the patient eat large meals when nausea is not present
○ B. Administer prescribed antiemetics 1 hour before the treatments
○ C. Teach about the importance of nutrition during treatment
○ D. Offer dry crackers and carbonated fluids during chemotherapy
296. Incorrect
Correct Answer: B. Administer prescribed antiemetics 1 hour before the
treatments
○ Option B: Treatment with antiemetics before chemotherapy may help to prevent
anticipatory nausea.
○ Option C: Although nausea may lead to poor nutrition, there is no indication that
the patient needs instruction about nutrition.
○ Option A: The patient should eat small, frequent meals.
○ Option D: Offering food and beverages during chemotherapy is likely to cause
nausea.
297. 1. Question
When the nurse is administering a vesicant chemotherapeutic agent intravenously, an
important consideration is to
○ A. Stop the infusion if swelling is observed at the site
○ B. Infuse the medication over a short period
○ C. Administer the chemotherapy through a small-bore catheter
 ○ D. Hold the medication unless a central venous line is available
298. Correct
Correct Answer: A. Stop the infusion if swelling is observed at the site
○ Option A: Swelling at the site may indicate extravasation, and the IV should be
stopped immediately.
○ Option B: The medication should generally be given slowly to avoid irritation of
the vein.
○ Option C: The size of the catheter is not as important as administration of
vesicants into a running IV line to allow dilution of the chemotherapy drug.
○ Option D: These medications can be given through peripheral lines, although
central vascular access devices (CVADs) are preferred.
299. 2. Question
A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To
maintain the patient’s self-esteem, the nurse plans to
○ A. Suggest that the patient limit social contacts until regrowth of the hair occurs
○ B. Encourage the patient to purchase a wig or hat and wear it once hair loss
begins
○ C. Have the patient wash the hair gently with a mild shampoo to minimize hair
loss
○ D. Inform the patient that hair loss will not be permanent and that the hair will
grow back
300. Incorrect
Correct Answer: B. Encourage the patient to purchase a wig or hat and wear it
once hair loss begins
○ Option B: The patient is taught to anticipate hair loss and to be prepared with
wigs, scarves, or hats.
○ Option A: Limiting social contacts is not appropriate at a time when the patient is
likely to need a good social support system.
○ Option C: The damage occurs at the hair follicle and will occur regardless of
gentle washing or use of a mild shampoo.
○ Option D: The information that the hair will grow back is not immediately helpful
in maintaining the patient’s self-esteem.
301. 3. Question
A patient with ovarian cancer tells the nurse, “I don’t think my husband cares about me
anymore. He rarely visits me.” On one occasion when the husband was present, he told
the nurse he just could not stand to see his wife so ill and never knew what to say to her.
An appropriate nursing diagnosis in this situation is
○ A. Risk for caregiver role strain related to burdens of caregiving responsibilities
○ B. Interrupted family processes related to the effect of illness on family members
○ C. Compromised family coping related to disruption in lifestyle and role changes
○ D. Impaired home maintenance related to perceived role changes
302. Incorrect
Correct Answer: B. Interrupted family processes related to the effect of illness on
family members
○ Option B: The data indicate that this diagnosis is most appropriate because the
family members are impacted differently by the patient’s cancer diagnosis.
○ Options A and C: There are no data to suggest a change in lifestyle or role as
an etiology.
○ Option D: The data do not support impairment in home maintenance or a burden
caused by caregiving responsibilities.
303. 4. Question
A patient receiving head and neck radiation and systemic chemotherapy has ulcerations
over the oral mucosa and tongue and thick, ropey saliva. An appropriate intervention for
the nurse to teach the patient is to
○ A. Rinse the mouth before and after each meal and at bedtime with a saline
solution
○ B. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth
○ C. Gargle and rinse the mouth several times a day with an antiseptic mouthwash
○ D. Remove food debris from the teeth and oral mucosa with a stiff toothbrush
304. Incorrect
Correct Answer: A. Rinse the mouth before and after each meal and at bedtime
with a saline solution
○ Option A: The patient should rinse the mouth with a saline solution frequently to
decrease the pain and to cleanse the wounds.
○ Option B: Hydrogen peroxide may damage tissues.
○ Option C: Antiseptic mouthwashes may irritate the oral mucosa and are not
recommended.
○ Option D: A soft toothbrush is used for oral care.
305. 5. Question
A patient who is receiving interleukin-2 (IL-2) therapy (Proleukin) complains to the nurse
about all of these symptoms. Which one is most important to report to the health care
provider?
○ A. Decreased appetite
○ B. Generalized aches
○ C. Dyspnea
○ D. Insomnia
306. Incorrect
Correct Answer: C. Dyspnea
○ Option C: Dyspnea may indicate capillary leak syndrome and pulmonary edema,
which requires rapid treatment.
○ Options A, B, and D: The other symptoms are common with IL-2 therapy, and
the nurse should teach the patient that these are common adverse effects that
will resolve at the end of the therapy.
307. 6. Question
A 32-year-old male patient is to undergo radiation therapy to the pelvic area for
Hodgkin’s lymphoma. He expresses concern to the nurse about the effect of
chemotherapy on his sexual function. The best response by the nurse to the patient’s
concerns is
○ A. "Radiation does not cause the problems with sexual functioning that occur
with chemotherapy or surgical procedures used to treat cancer."
○ B. "It is possible you may have some changes in your sexual function, and you
may want to consider pretreatment harvesting of sperm if you want children."
○ C. "The radiation will make you sterile, but your ability to have sexual intercourse
will not be changed by the treatment."
○ D. "You may have some temporary impotence during the course of the radiation,
but normal sexual function will return."
308. Incorrect
Correct Answer: B. “It is possible you may have some changes in your sexual
function, and you may want to consider pretreatment harvesting of sperm if you
want children.”
○ Option B: The impact on sperm count and erectile function depend on the
patient’s pretreatment status and on the amount of exposure to radiation. The
patient should consider sperm donation before radiation.
○ Options A, C, and D: Radiation (like chemotherapy or surgery) may affect both
sexual function and fertility either temporarily or permanently.
309. 7. Question
A 40-year-old divorced mother of four school-age children is hospitalized with metastatic
cancer of the ovary. The nurse finds the patient crying, and she tells the nurse that she
does not know what will happen to her children when she dies. The most appropriate
response by the nurse is
○ A. "Why don't we talk about the options you have for the care of your children?"
○ B. "Many patients with cancer live for a long time, so there is time to plan for
your children."
○ C. "For now you need to concentrate on getting well, not worry about your
children."
○ D. "Perhaps your ex-husband will take the children when you can't care for
them."
310. Incorrect
Correct Answer: A. “Why don’t we talk about the options you have for the care of
your children?”
○ Option A: This response expresses the nurse’s willingness to listen and
recognizes the patient’s concern.
○ Options B and C: The responses beginning “Many patients with cancer live for a
long time” and “For now you need to concentrate on getting well” close off
discussion of the topic and indicate that the nurse is uncomfortable with the topic.
 In addition, the patient with metastatic ovarian cancer may not have a long time
to plan.
○ Option D: Although it is possible that the patient’s ex-husband will take the
children, more assessment information is needed before making plans.
311. 8. Question
A patient who has terminal cancer of the liver and is cared for by family members at
home tells the nurse, “I have intense pain most of the time now.” The nurse recognizes
that teaching regarding pain management has been effective when the patient
○ A. States that nonopioid analgesics may be used when the maximal dose of the
opioid is reached without adequate pain relief
○ B. Uses the ordered opioid pain medication whenever the pain is greater than 5
on a 10-point scale
○ C. Agrees to take the medications by the IV route to improve effectiveness
○ D. Takes opioids around the clock on a regular schedule and uses additional
doses when breakthrough pain occurs
312. Incorrect
Correct Answer: D. Takes opioids around the clock on a regular schedule and
uses additional doses when breakthrough pain occurs
○ Option D: For chronic cancer pain, analgesics should be taken on a scheduled
basis, with additional doses as needed for breakthrough pain.
○ Option A: Although nonopioid analgesics may also be used, there is no
maximum dose of opioid. Opioids are given until pain control is achieved.
○ Option B: Taking the medications only when pain reaches a certain level does
not provide effective pain control.
○ Option C: The IV route is not more effective than the oral route and the oral
route is preferred.
313. 9. Question
Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell
carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is
to
○ A. Protect normal kidney cells from the damaging effects of chemotherapy
○ B. Enhance the patient's immunologic response to tumor cells
○ C. Stimulate malignant cells in the resting phase to enter mitosis
○ D. Prevent the bone marrow depression caused by chemotherapy
314. Incorrect
Correct Answer: B. Enhance the patient’s immunologic response to tumor cells
○ Option B: IL-2 is a naturally occurring protein that is made by a T-lymphocyte
which functions to enhance the growth and activity of other white blood cells. The
purpose of this therapy is to enhance the ability of the patient’s own immune
response to suppress tumor cells.
 ○ Options A, C, and D: IL-2 does not protect normal cells from damage caused by
chemotherapy, stimulate malignant cells to enter mitosis, or prevent bone marrow
depression.
315. 10. Question
The home health nurse is caring for a patient who has been receiving interferon therapy
for treatment of cancer. Which statement by the patient may indicate a need for a
change in treatment?
○ A. "I rarely have the energy to get out of bed."
○ B. "I experience chills after I inject the interferon."
○ C. "I take acetaminophen (Tylenol) every 4 hours."
○ D. "I have frequent muscle aches and pains."
316. Incorrect
Correct Answer: A. “I rarely have the energy to get out of bed.”
○ Option A: Fatigue can be dose-limiting toxicity for use of biologic therapies.
○ Options B and D: Flu-Like symptoms, such as muscle aches and chills, are
common side effects of interferon use.
○ Option D: Patients are advised to use Tylenol every 4 hours.
317. 11. Question
Which information noted by the nurse reviewing the laboratory results of a patient who is
receiving chemotherapy is most important to report to the health care provider?
○ A. WBC count of 1700/µl
○ B. Platelets of 65,000/µl
○ C. Hemoglobin of 10 g/L
○ D. Serum creatinine level of 1.2 mg/dl
318. Incorrect
Correct Answer: A. WBC count of 1700/µl
○ Option A: Neutropenia places the patient at risk for severe infection and is an
indication that the chemotherapy dose may need to be lower or that white blood
cell (WBC) growth factors such as filgrastim (Neupogen) are needed.
○ Options B, C, and D: The other laboratory data do not indicate any immediate
life-threatening adverse effects of the chemotherapy.
319. 12. Question
A bone marrow transplant is being considered for treatment of a patient with acute
leukemia that has not responded to chemotherapy. In discussing the treatment with the
patient, the nurse explains that
○ A. Donor bone marrow cells are transplanted immediately after an infusion of
chemotherapy
○ B. The transplant procedure takes place in a sterile operating room to minimize
the risk for infection
○ C. The transplant of the donated cells is painful because of the nerves in the
tissue lining the bone
 ○ D. Hospitalization will be required for several weeks after the hematopoietic stem
cell transplant (HSCT)
320. Incorrect
Correct Answer: D. Hospitalization will be required for several weeks after the
hematopoietic stem cell transplant (HSCT)
○ Option D: The patient requires strict protective isolation to prevent infection for 2
to 4 weeks after HSCT while waiting for the transplanted marrow to start
producing cells.
○ Option A: The HSCT takes place 1 or 2 days after chemotherapy to prevent
damage to the transplanted cells by the chemotherapy drugs.
○ Options B and C: The transplanted cells are infused through an IV line, so the
transplant is not painful, nor is an operating room required.
321. 13. Question
The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet
choices. Which snack choice by the patient indicates that the teaching has been
effective?
○ A. Fresh fruit salad
○ B. Orange sherbet
○ C. French fries
○ D. Strawberry yogurt
322. Incorrect
Correct Answer: D. Strawberry yogurt
○ Option D: Yogurt has high biologic value because of the protein and fat content.
○ Option A: Fruit salad does not have high amounts of protein or fat.
○ Option B: Orange sherbet is lower in fat and protein than yogurt.
○ Option C: French fries are high in calories from fat but low in protein.
323. 14. Question
The nurse has identified the nursing diagnosis of imbalanced nutrition: less than body
requirements related to altered taste sensation in a patient with lung cancer who has had
a 10% loss in weight. An appropriate nursing intervention that addresses the etiology of
this problem is to
○ A. Add strained baby meats to foods such as soups and casseroles
○ B. Provide foods that are highly spiced to stimulate the taste buds
○ C. Avoid presenting foods for which the patient has a strong dislike
○ D. Teach the patient to eat whatever is nutritious since food is tasteless
324. Incorrect
Correct Answer: C. Avoid presenting foods for which the patient has a strong
dislike
○ Option C: The patient will eat more if disliked foods are avoided and foods that
patient likes are included instead.
 ○ Option A: Adding baby meats to foods will increase calorie and protein levels,
but does not address the issue of taste.
○ Option B: Additional spice is not usually an effective way to enhance the taste.
○ Option D: Patients will not improve intake by eating foods that are beneficial but
have an unpleasant taste.
325. 15. Question
After the nurse has explained the purpose of and schedule for chemotherapy to a
23-year-old patient who recently received a diagnosis of acute leukemia, the patient asks
the nurse to repeat the information. Based on this assessment, which nursing diagnosis
is most likely for the patient?
○ A. Risk for ineffective health maintenance related to anxiety about new leukemia
diagnosis
○ B. Knowledge deficit: chemotherapy related to a lack of interest in learning about
treatment
○ C. Risk for ineffective adherence to treatment related to denial of need for
chemotherapy
○ D. Acute confusion related to infiltration of leukemia cells into the central nervous
system
326. Incorrect
Correct Answer: A. Risk for ineffective health maintenance related to anxiety
about new leukemia diagnosis
○ Option A: The patient who has a new cancer diagnosis is likely to have high
anxiety, which may impact learning and require that the nurse repeat and
reinforce information.
○ Options B and C: The patient asks for the information to be repeated, indicating
that lack of interest in learning and denial are not etiologic factors.
○ Option D: The patient’s history of a recent diagnosis suggests that infiltration of
the leukemia is not a likely cause of the confusion.
327. 16. Question
A hospitalized patient who has received chemotherapy for leukemia develops
neutropenia. Which observation by the RN caring for the patient indicates that the nurse
should take action?
○ A. The patient ambulates several times a day in the room
○ B. The patient's visitors bring in some fresh peaches from home
○ C. The patient uses soap and shampoo to shower every other day
○ D. The patient cleans with a warm washcloth after having a stool
328. Incorrect
Correct Answer: B. The patient’s visitors bring in some fresh peaches from home
○ Option B: Fresh, thinned-skin peaches are not permitted in a neutropenic diet
because of the risk of bacteria being present.
○ Option A: The patient should ambulate in the room rather than the hospital
hallway to avoid exposure to other patients or visitors.
 ○ Option C: Because overuse of soap can dry the skin and increase infection risk,
showering every other day is acceptable.
○ Option D: Careful cleaning after having a bowel movement will help to prevent
perineal skin breakdown and infection.
329. 17. Question
Which action by a nursing assistant (NA) when caring for a patient who has
pancytopenia indicates a need for the nurse to intervene?
○ A. The NA adds baking soda to the patient's saline oral rinses
○ B. The NA makes an oral rinse using 1 teaspoon of salt in a liter of water
○ C. The NA puts fluoride toothpaste on the patient's toothbrush
○ D. The NA assists the patient to use dental floss after eating
330. Incorrect
Correct Answer: D. The NA assists the patient to use dental floss after eating
○ Option D: The use of dental floss is avoided in patients with pancytopenia
because of the risk for infection and bleeding.
○ Options A, B, and C: The other actions are appropriate for oral care of a patient
with pancytopenia.
331. 18. Question
A with tumor lysis syndrome (TLS) is taking Zyloprim (allopurinol). Which laboratory
value should the nurse monitor to determine the effectiveness of the medication?
○ A. Blood urea nitrogen (BUN)
○ B. Serum phosphate
○ C. Serum potassium
○ D. Uric acid level
332. Incorrect
Correct Answer: D. Uric acid level
○ Option D: Allopurinol is used to decrease uric acid levels so a monitoring of
serum uric acid is essential.
○ Options A, B, and C: UN, potassium, and phosphate levels are also increased
in TLS but are not affected by allopurinol therapy.
333. 19. Question
When assessing a patient’s needs for psychologic support after the patient has been
diagnosed with stage I cancer of the colon, which question by the nurse will provide the
most information?
○ A. "How do you feel about having a possibly terminal illness?"
○ B. "How long ago were you diagnosed with this cancer?"
○ C. "Are you familiar with the stages of emotional adjustment to a diagnosis like
cancer of the colon?"
○ D. "Can you tell me what has been helpful to you in the past when coping with
stressful events?"
334. Incorrect
Correct Answer: D. “Can you tell me what has been helpful to you in the past
when coping with stressful events?”
○ Option D: Information about how the patient has coped with past stressful
situations helps the nurse determine usual coping mechanisms and their
effectiveness.
○ Option A: The patient with stage I cancer is not considered to have a terminal
illness at this time, and this question is likely to worry the patient unnecessarily.
○ Option B: The length of time since the diagnosis will not provide much
information about the patient’s need for support.
○ Option C: The patient’s knowledge of typical stages in adjustment to a critical
diagnosis does not provide insight into patient’s needs for assistance.
335. 20. Question
A 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg) tells the
nurse that she has a glass of wine two or three times a week. The patient works for the
post office and has a 5-mile mail-delivery route. This is her first contact with the health
care system in 20 years. Which of these topics will the nurse plan to include in patient
teaching about cancer? Select all that apply
○ A. Mammography
○ B. Physical activity
○ C. Body weight
○ D. Colorectal screening
○ E. Tobacco use
○ F. Alcohol use
○ G. Pap testing
○ H. Sunscreen use
336. Incorrect
Correct Answer: A, D, G, and H
○ Options A, D, G, and H: The patient’s age, gender, and history indicate a need
for teaching about or screening or both for colorectal cancer, mammography, Pap
smears, and sunscreen.
○ Options B, C, E, and F: The patient does not use excessive alcohol or tobacco,
she is physically active, and her body weight is healthy.