Evolve Cancer NCLEX Questions

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A 33-year-old patient has recently been diagnosed with stage
II cervical cancer. What should the nurse understand about the
patient's cancer?
It has spread locally.
It is in situ.
Stage II cancer is associated with limited local spread. Stage 0
denotes cancer in situ; stage I denotes tumor limited to the tissue
It has metastasized.
of origin with localized tumor growth. Stage III denotes extensive
local and regional spread. Stage IV denotes metastasis.
It has spread locally.

It has spread extensively.

The patient and his family are upset that the patient is going
through procedures to diagnose cancer. What nursing actions
should the nurse use first to facilitate their coping with this situation
(select all that apply)?
Select all that apply.
Maintain hope.
Exhibit a caring attitude.
Maintain hope.
Be available to listen to fears and concerns.
Exhibit a caring attitude.
Plan realistic long-term goals.
Give them antianxiety medications.
Be available to listen to fears and concerns.
Teach them about all the types of cancer that could be diagnosed.
The laboratory reports that the cells from the patient's tumor biop-
sy are Grade II. What should the nurse know about this histologic
grading? Cells are abnormal and moderately differentiated.

Cells are abnormal and moderately differentiated. Grade II cells are more abnormal than Grade I and moderately
differentiated. Grade I cells differ slightly from normal cells and are
Cells are very abnormal and poorly differentiated. well-differentiated. Grade III cells are very abnormal and poorly
differentiated. Grade IV cells are immature, primitive, and undif-
Cells are immature, primitive, and undifferentiated. ferentiated; the cell origin is difficult to determine.

Cells differ slightly from normal cells and are well-differentiated.

Immunologic surveillance
When caring for the patient with cancer, what does the nurse
understand as the response of the immune system to antigens
Immunologic surveillance is the process where lymphocytes
of the malignant cells?
check cell surface antigens and detect and destroy cells with
abnormal or altered antigenic determinants to prevent these cells
Metastasis
from developing into clinically detectable tumors. Metastasis is
increased growth rate of the tumor, increased invasiveness, and
Tumor angiogenesis
spread of the cancer to a distant site in the progression stage of
cancer development. Tumor angiogenesis is the process of blood
Immunologic escape
vessels forming within the tumor itself. Immunologic escape is the
cancer cells' evasion of immunologic surveillance that allows the
Immunologic surveillance
cancer cells to reproduce.
The patient was told that he would have intraperitoneal
chemotherapy. He asks the nurse when the IV will be started for
the chemotherapy. What should the nurse teach the patient about A Silastic catheter will be percutaneously placed into the peri-
this type of chemotherapy delivery? toneal cavity for chemotherapy administration.

It is delivered via an Ommaya reservoir and extension catheter. Intraperitoneal chemotherapy is delivered to the peritoneal cavity
via a temporary percutaneously inserted Silastic catheter and
It is instilled in the bladder via a urinary catheter and retained for drained from this catheter after the dwell time in the peritoneum.
1 to 3 hours. The Ommaya reservoir is used for intraventricular chemothera-
py. Intravesical bladder chemotherapy is delivered via a urinary
A Silastic catheter will be percutaneously placed into the peri- catheter. Intraarterial chemotherapy is delivered via a surgically
toneal cavity for chemotherapy administration. placed catheter that delivers chemotherapy via an external or
internal infusion pump.
The arteries supplying the tumor are accessed with surgical
placement of a catheter connected to an infusion pump.

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The female patient is having whole brain radiation for brain metas-
tasis. She is concerned about how she will look when she loses
her hair. What is the best response by the nurse to this patient?

"When your hair grows back it will be patchy."

"You can get a wig now to match your hair so you will not look
"Don't use your curling iron and that will slow down the loss."
different."
"You can get a wig now to match your hair so you will not look
different."

"You should contact "Look Good, Feel Better" to figure out what
to do about this."
What can the nurse do to facilitate cancer prevention for the
patient in the promotion stage of cancer development?

Teach the patient to exercise daily.

Teach the patient promoting factors to avoid.
Teach the patient promoting factors to avoid.

Tell the patient to have the cancer surgically removed now.

Teach the patient which vitamins will improve the immune system.
Previous administrations of chemotherapy agents to a cancer pa-
tient have resulted in diarrhea. Which dietary modification should
A bland, low-fiber diet
the nurse recommend?
Patients experiencing diarrhea secondary to chemotherapy and/or
A bland, low-fiber diet
radiation therapy often benefit from a diet low in seasonings and
roughage before the treatment. Foods should be easy to digest
A high-protein, high-calorie diet
and low in fat. Fresh fruits and vegetables are high in fiber and
should be minimized during treatment. Whole and organic foods
A diet high in fresh fruits and vegetables
do not prevent diarrhea.
A diet emphasizing whole and organic foods
The patient has been diagnosed with non-small cell lung cancer.
Which type of targeted therapy will most likely be used for this
patient to suppress cell proliferation and promote programmed
tumor cell death?

Proteasome inhibitors
Epidermal growth factor receptor-tyrosine kinase inhibitors
(EGFR-TK)
BCR-ABL tyrosine kinase inhibitors

CD20 monoclonal antibodies (MoAb)

Epidermal growth factor receptor-tyrosine kinase inhibitors

(EGFR-TK)
The nurse is caring for a patient suffering from anorexia secondary
to chemotherapy. Which strategy would be most appropriate for
the nurse to use to increase the patient's nutritional intake? Add items such as skim milk powder, cheese, honey, or peanut
butter to selected foods.
Increase intake of liquids at mealtime to stimulate the appetite.
The nurse can increase the nutritional density of foods by adding
Serve three large meals per day plus snacks between each meal. items high in protein and/or calories (such as peanut butter, skim
milk powder, cheese, honey, or brown sugar) to foods the patient
Avoid the use of liquid protein supplements to encourage eating will eat. Increasing fluid intake at mealtime fills the stomach with
at mealtime. fluid and decreases the desire to eat. Small frequent meals are
best tolerated. Supplements can be helpful.
Add items such as skim milk powder, cheese, honey, or peanut
butter to selected foods.

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The patient is receiving biologic and targeted therapy for ovarian
cancer. What medication should the nurse expect to administer
before therapy to combat the most common side effects of these Acetaminophen (Tylenol)
medications?
Acetaminophen is administered before therapy and every 4 hours
Morphine sulfate to prevent or decrease the intensity of the severe flu-like symp-
toms, especially with interferon which is frequently used for ovari-
Ibuprofen (Advil) an cancer. Morphine sulfate and ibuprofen will not decrease flu-like
symptoms. Ondansetron is an antiemetic, but not used first to
Ondansetron (Zofran) combat flu-like symptoms of headache, fever, chills, myalgias, etc.

Acetaminophen (Tylenol)
The patient has osteosarcoma of the right leg. The unlicensed
assistive personnel (UAP) reports that the patient's vital signs
are normal, but the patient says he still has pain in his leg and
it is getting worse. What assessment question should the nurse
ask the patient to determine treatment measures for this patient's
pain?
"What does the pain feel like?"
"Where is the pain?"

"Is the pain getting worse?"

"What does the pain feel like?"

"Do you use medications to relieve the pain?"

The patient is told that the adenoma tumor is not encapsulated but
has normally differentiated cells and that surgery will be needed.
The patient asks the nurse what this means. What should the
nurse tell the patient?
It is probably benign.
It will recur.
Benign tumors usually are encapsulated and have normally dif-
ferentiated cells. They do not metastasize and rarely recur as
It has metastasized.
malignant tumors do.
It is probably benign.

It is probably malignant.
The nurse is caring for a patient receiving an initial dose of
chemotherapy to treat a rapidly growing metastatic colon cancer.
The nurse is aware that this patient is at risk for tumor lysis
syndrome (TLS) and will monitor the patient closely for which Hypocalcemia
abnormality associated with this oncologic emergency?
TLS is a metabolic complication characterized by rapid release of
Hypokalemia intracellular components in response to chemotherapy. This can
rapidly lead to acute renal injury. The hallmark signs of TLS are
Hypouricemia hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocal-
cemia.
Hypocalcemia

Hypophosphatemia

The patient with breast cancer is having teletherapy radiation

treatments after her surgery. What should the nurse teach the
patient about the care of her skin?

Use Dial soap to feel clean and fresh. Avoid heat and cold to the treatment area.

Scented lotion can be used on the area.

Avoid heat and cold to the treatment area.

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Wear the new bra to comfort and support the area.

Which nursing diagnosis is most appropriate for a patient experi-
encing myelosuppression secondary to chemotherapy for cancer
treatment?

Acute pain
Risk for infection
Hypothermia

Powerlessness

Risk for infection

Which cellular dysfunction in the process of cancer development
Dynamic equilibrium
allows defective cell proliferation?
Dynamic equilibrium is the regulation of proliferation that usually
Proto-oncogenes
only occurs to equal cell degeneration or death or when the body
has a physiologic need for more cells. Cell differentiation is the or-
Cell differentiation
derly process that progresses a cell from a state of immaturity to a
state of differentiated maturity. Mutations that alter the expression
Dynamic equilibrium
of proto-oncogenes can activate them to function as oncogenes,
which are tumor-inducing genes and alter their differentiation.
Activation of oncogenes
The patient is being treated with brachytherapy for cervical cancer.
What factors must the nurse be aware of to protect herself when
The time the nurse spends at what distance from the patient
caring for this patient?
The principles of ALARA (as low as reasonably achievable) and
The medications the patient is taking
time, distance, and shielding are essential to maintain the nurse's
safety when the patient is a source of internal radiation. The
The nutritional supplements that will help the patient
patient's medications, nutritional supplements, and time needed
to complete care will not protect the nurse caring for a patient with
How much time is needed to provide the patient's care
brachytherapy for cervical cancer.
The time the nurse spends at what distance from the patient
A patient has been diagnosed with Burkitt's lymphoma. In the
initiation stage of cancer, the cells genetic structure is mutated.
Exposure to what may have functioned as a carcinogen for this Epstein-Barr virus
patient?
Burkitt's lymphoma consistently shows evidence of the presence
Bacteria of Epstein-Barr virus in vitro. Bacteria do not initiate cancer.
Sun exposure causes cell alterations leading to melanoma and
Sun exposure squamous and basal cell skin carcinoma. Long-term exposure to
certain chemicals (e.g., ethylene oxide, chloroform, benzene) is
Most chemicals known to initiate cancer.

Epstein-Barr virus
Which item would be most beneficial when providing oral care to
a patient with metastatic cancer who is at risk for oral tissue injury 1 tsp salt in 1 L water mouth rinse
secondary to chemotherapy?
A salt-water mouth rinse will not cause further irritation to oral
Firm-bristle toothbrush tissue that is fragile because of mucositis, which is a side ef-
fect of chemotherapy. A soft-bristle toothbrush will be used. One
Hydrogen peroxide rinse teaspoon of sodium bicarbonate may be added to the salt-water
solution to decrease odor, alleviate pain, and dissolve mucin.
Alcohol-based mouthwash Hydrogen peroxide and alcohol-based mouthwash are not used
because they would damage the oral tissue.
1 tsp salt in 1 L water mouth rinse

The patient is receiving an IV vesicant chemotherapy drug. The Turn off the chemotherapy infusion.
nurse notices swelling and redness at the site. What should the
nurse do first? Because extravasation of vesicants may cause severe local tissue
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breakdown and necrosis, with any sign of extravasation the infu-
Ask the patient if the site hurts. sion should first be stopped. Then the protocol for the drug-specific
extravasation procedures should be followed to minimize further
Turn off the chemotherapy infusion. tissue damage. The site of extravasation usually hurts, but it may
not. It is more important to stop the infusion immediately. The
Call the ordering health care provider. health care provider may be notified by another nurse while the
patient's nurse starts the drug-specific extravasation procedures,
Administer sterile saline to the reddened area. which may or may not include sterile saline.

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