Cancer NCLEX style questions

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1. A nurse cares for a client who ANS: C

has a genetic mutation that in- This situation represents an ethical dilem-
creases the risk for colon can- ma. It is the client's decision whether to
cer. The client states that he disclose the information. However, the in-
does not want any family to formation can affect others in the client's
know about this result. How family. The law does not require the client to
should the nurse respond? tell family members about the results, nor
a. "It is required by law that you can the client be held liable for not telling
inform your siblings and chil- them. The nurse may consider it ethically
dren about this result so that correct for the client to tell family members
they also can be tested and so that they can take action to prevent the
monitored for colon cancer." development of cancer, but the nurse must
b. "It is not necessary to tell respect the client's decision.
your siblings because they are
adults, but you should tell your
children so that they can be
tested before they decide to
have children of their own."
c. "It is not required that you tell
anyone about this result. How-
ever, your siblings and chil-
dren may also be at risk for
colon cancer and this informa-
tion might help them."

2. A nurse cares for a client ANS: A, B, E

who recently completed genet- The medical-surgical nurse can assess the
ic testing that revealed that client's response to the test results, discuss
she has a BRCA1 gene muta- potential risks for other family members,
tion. Which actions should the encourage genetic counseling, and assist
nurse take next? (Select all that the client to make a plan for prevention, risk
apply.) reduction, and early detection. For some
positive genetic test results, such as having
a. Discuss potential risks for a BRCA1 gene mutation, the risk for de-
other members of her family. veloping breast cancer is high but is not a
b. Assist the client to make a certainty. Because the risk is high, the client
plan for prevention and risk re- should have a plan for prevention and risk
duction. reduction. One form of prevention is early
c. Disclose the information to detection. Breast self-examinations may be
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 Cancer NCLEX style questions
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the medical insurance compa- helpful when performed monthly, but those
ny. performed every week may not be useful,
d. Recommend the client com- especially around the time of menses. A
plete weekly breast self-exami- client who tests positive for a BRCA1 mu-
nations. tation should have at least yearly mammo-
e. Assess the client's response grams and ovarian ultrasounds to detect
to the test results. cancer at an early stage, when it is more
f. Encourage support by shar- easily cured.
ing the results with family
members.

3. A nurse obtains health histo- ANS: A

ries when admitting clients to A client with a family history of breast can-
a medical-surgical unit. With cer should be provided information about
which client should the nurse predisposition testing. Predisposition test-
discuss predisposition genetic ing should be discussed with clients who
testing? are at high risk of hereditary breast, ovari-
a. Middle-aged woman whose an, and colorectal cancers so that the client
mother died at age 48 of breast can engage in heightened screening activ-
cancer ities or interventions that reduce risk.
b. Young man who has all
the symptoms of rheumatoid
arthritis
c. Pregnant woman whose fa-
ther has sickle cell disease
d. Middle-aged man of Eastern
European Jewish ancestry

4. The nursing instructor explains ANS: C

the difference between normal Benign tumors are basically normal cells
cells and benign tumor cells. growing in the wrong place or at the wrong
What information does the in- time. Benign cells grow through hyperpla-
structor provide about these sia, not invasion. Benign tumor cells retain
cells? contact inhibition. Anaplasia is a character-
a. Benign tumors grow through istic of cancer cells
invasion of other tissue. **Benign has smaller than normal nucle-
b. Benign tumors have lost us**
their cellular regulation from
contact inhibition.

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c. Growing in the wrong place
or time is typical of benign tu-
mors.
d. The loss of characteristics
of the parent cells is called
anaplasia.

5. A nurse has taught a client ANS: C

about dietary changes that can To decrease the risk of developing cancer,
reduce the chances of develop- one should cut down on the consumption of
ing cancer. What statement by red meats and animal fat. The other state-
the client indicates the nurse ments are correct.
needs to provide additional
teaching?
a. "Foods high in vitamin A and
vitamin C are important."
b. "I'll have to cut down on the
amount of bacon I eat."
c. "I'm so glad I don't have to
give up my juicy steaks."
d. "Vegetables, fruit, and
high-fiber grains are impor-
tant."

6. A nurse is participating in pri- ANS: B, C, E

mary prevention efforts direct- Primary prevention aims to prevent the
ed against cancer. In which ac- occurrence of a disease or disorder, in
tivities is this nurse most likely this case cancer. Secondary prevention in-
to engage? (Select all that ap- cludes screening and early diagnosis. Pri-
ply.) mary prevention activities include teaching
a. Demonstrating breast people about chemoprevention, providing
self-examination methods to approved vaccinations to prevent cancer,
women and teaching teens the dangers of tanning
b. Instructing people on the use beds. Breast examinations and screening
of chemoprevention for cervical cancer are secondary preven-
c. Providing vaccinations tion methods.
against certain cancers
d. Screening teenage girls for
cervical cancer

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e. Teaching teens the dangers
of tanning booths

7. A client receiving intravenous ANS: D

chemotherapy asks the nurse Most chemotherapy drugs are absorbed
the reason for wearing a mask, through the skin and mucous membranes.
gloves, and gown while ad- As a result, health care workers who pre-
ministering drugs to the client. pare or give these drugs, especially nurses
What is the nurse's best re- and pharmacists, are at risk for absorbing
sponse? them. Even at low doses, chronic exposure
to chemotherapy drugs can affect health.
a."These coverings protect you The Oncology Nursing Society and the Oc-
from getting an infection from cupational Safety and Health Administra-
me." tion (OSHA) have specific guidelines for us-
ing caution and wearing protective clothing
b."I am preventing the spread whenever preparing, giving, or disposing of
of infection from you to me or chemotherapy drugs.
any other client here."

c."The policy is for any nurse

giving these drugs to wear a
gown, gloves, and mask."

d."The clothing protects me

from accidentally absorbing
these drugs."

8. A client is on chemotherapy ANS: C

and has a platelet count of
25,000. Which intervention is This client has thrombocytopenia, which
most important to teach this is a common side effect of chemothera-
client? py. This increases the client's risk for pro-
longed bleeding in response to even minor
a. injury, especially from highly vascular areas
such as the gums. The client should be
taught to use a soft toothbrush. A low-bac-
"Eat a low-bacteria diet." teria diet and daily temperature monitor-
ing would be used in a client who is neu-
b. tropenic.

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"Take your temperature daily."

c.

"Use a soft-bristled tooth-

brush."

9. A client with chemotherapy-in- ANS: D

duced bone marrow suppres-
sion has received filgrastim Filgrastim is a single-lineage growth factor
(Neupogen). Which laboratory that stimulates the maturation and release
finding indicates that this ther- of only segmented neutrophils. This drug
apy is effective for the client? is not given unless the neutrophil count is
dangerously low. The near-normal range of
a.Hematocrit is 28%. neutrophils indicates effective therap

b.Hematocrit is 38%.

c.Segmented neutrophil count

is 2500/mm3.

d.Segmented neutrophil count

is 3500/mm3.

10. A nurse is reviewing the white ANS: C

blood cell count with dif-
ferential for a client receiv- Normally, mature segmented neutrophils
ing chemotherapy for cancer. ("segs") are the major population of cir-
Which finding alerts the nurse culating leukocytes, constituting 55% to
to the possibility of sepsis? 70% of the total white blood cell count.
Less than 3% to 5% of circulating white
a.Total white blood cell count is blood cells should be the less mature band
9000/mm3. neutrophils. A left shift occurs when the
bone marrow releases more immature neu-
b.Lymphocytes outnumber ba- trophils than mature neutrophils. This con-
sophils.

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dition indicates severe infection with possi-
c."Bands" outnumber "segs." ble sepsis and must be explored further.

d.Monocyte count is
1800/mm3.

11. Why is sepsis an oncological Can trigger disseminated Intravascular co-

emergency? agulation (DIC)
It is life-threatening

12. Why is SIADH an ocological Causes fluid retention, hyponatremia. Left

emergency? untreated can progress to seizure, coma,
and death.

13. A client has small cell lung can- ANS: B

cer. Which laboratory result re-
quires immediate intervention In the syndrome of inappropriate antidiuret-
by the nurse? ic hormone hypersecretion (SIADH), secre-
tion of antidiuretic hormone (ADH) from the
a. posterior pituitary gland is increased, caus-
ing the client to reabsorb water from the
distal convoluted tubule and collecting duct.
Serum potassium of 5.1 mEq/L As a result, weight increases, and serum
sodium and hematocrit levels are diluted.
b. Potassium is slightly high, but very low
sodium places the client at risk for seizures
and even death
Serum sodium of 118 mEq/L

14. Compare normal and cancer Normal: Large cytoplasm, single nucleus,
cells. single nucleolus, fine chromatin.
Cancer: Small cytoplasm, multiple nuclei,
multiple and large nucleoli, coarse chro-
matin.
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15. The nurse is administering a ANS: B

combination of three differ-
ent antineoplastic drugs to a Because drug-resistant cells commonly de-
patient who has metastatic velop, exposure to multiple drugs with mul-
breast cancer. Which statement tiple mechanisms and sites of action will
best describes the rationale for destroy more subpopulations of cells. The
combination therapy? other options are incorrect.

a. There will be less nausea and

vomiting.

b.Increased cancer-cell killing

will occur.

c.The drugs will prevent metas-

tasis.

d.Combination therapy re-

duces the need for radiation
therapy.

16. When giving chemotherapy as ANS: A, C, E

cancer treatment, the nurse Chemotherapy toxicities generally stem
recognizes that toxicity to from the fact that chemotherapy drugs
rapidly growing normal cells affect rapidly dividing cells—both harm-
also occurs. Which rapidly ful cancer cells and healthy, normal cells.
growing normal cells are also Three types of rapidly dividing human cells
harmed by chemotherapy? (Se- are the cells of hair follicles, GI tract cells,
lect all that apply.) and bone marrow cells. The other options
are incorrect.
a.Bone marrow cells

b.Retinal cells

c.Hair follicle cells

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d.Nerve myelin cells

e. Gastrointestinal (GI) mucous

membrane cells

17. One patient has cancer of the ANS: A

bone; another has cancer in the
connective tissues of the thigh Sarcomas are malignant tumors that arise
muscles; a third patient has from connective tissues. These tissues can
cancer in the vascular tissues. be found in bone, cartilage, muscle, blood,
These patients have a type of lymphatic, and vascular tissues. The other
tumor referred to as a options are incorrect.

a.sarcoma.

b.leukemia.

c.carcinoma.

d.lymphoma.

18. A patient who has cancer is ANS: B

about to begin chemotherapy. Using two or more chemotherapeutic
The patient asks the nurse why agents can have a synergistic effect. Com-
two chemotherapeutic agents bination therapy typically uses two drugs
are being used instead of just with different dose-limiting toxicities, but the
one. Which response by the use of more than one drug does not al-
nurse is correct? low for using less toxic doses. Combination
a. "The drugs may be given in therapy allows cell kill in all phases of the
less toxic doses if two drugs cell cycle. Combination therapy does not
are used." shorten the length of time chemotherapy is
b. "Two agents used together needed.
can have synergistic effects."
c. "Use of two drugs will in-
crease tumorcidal activity in
the G0 phase of the cell."
d. "Using two agents will

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shorten the length of time
chemotherapy is needed."

19. The nurse is teaching a patient ANS: C

who will begin receiving target- Targeted therapy differs from traditional
ed therapy for cancer. The pa- cancer chemotherapy by taking advantage
tient asks how targeted thera- of biologic features particular to cancer
py differs from other types of cells and targeting specific mechanisms.
chemotherapies. The nurse will They block the growth and spread of cancer
explain that targeted therapy by interfering with specific molecules with-
a. damages cancer cell DNA to in the cancer cells. Traditional chemothera-
prevent cell replication. peutic agents damage cell DNA of cancer
b. directly kills or damages can- cells as well as normal cells. Targeted ther-
cerous cells. apies do not directly kill or damage cancer
c. interferes with specific mole- cells or prevent metastasis.
cules in cancer cells.
d. prevents metastasis of can-
cer cells.

20. Rituximab (Rituxan) has been Do you have any history of heart disease or
prescribed for a patient irregular heart rhythms
who has chronic lymphocyte
leukemia. When assessing the
patient prior to the treatment,
what assessment question is
the nurse's priority?

21. A patient with acute lym- daily weights

phoblastic leukemia (ALL) is
receiving imatinib on an inpa-
tient basis. When planning the
care of this patient, what as-
sessment should be specified
in the patient's plan of nursing
care?

22. what do you watch during the respiratory and cardiac status
1st infusion with Rituximab

23. Subclavian vien

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The use of which venous site
reduces risk of extravasation
during chemo treatments?

24. A client with vaginal cancer is D. Visitation is limited to 30 minutes when

being treated with a radioactive the implant is in place.
vaginal implant. The client's
husband asks the nurse if he
can spend the night with his
wife. The nurse should explain
that:

A. Overnight stays by family

members is against hospital
policy.
B. There is no need for him to
stay because staffing is ade-
quate.
C. His wife will rest much better
knowing that he is at home.
D. Visitation is limited to 30
minutes when the implant is in
place.

25. A client has cancer of the A.Alteration in nutrition

pancreas. The nurse should be
most concerned about which
nursing diagnosis?

A.Alteration in nutrition

B.Alteration in bowel elimina-

tion

C. Alteration in skin integrity

D. Ineffective individual coping

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26. The registered nurse is making A.The client with HIV
assignments for the day. Which
client should be assigned to
the pregnant nurse?
A.The client with HIV
B. The client with a radium im-
plant for cervical cancer
C. The client with RSV (respira-
tory synctial virus)
D.The client with cy-
tomegalovirus

27. Which health care worker The Nursing Assistant who is pregnant
should not be assigned to care
for the client with a radium im-
plant for vaginal cancer?
A.The doctor who is six months
postpartum
B.The Nursing Assistant who is
pregnant
C.The RN who is allergic to io-
dine
D.The RN with a three-year-old
at home

28. A client is admitted with a D. Bone Pain

Ewing's sarcoma. which symp-
toms would be expected due to why?
this tumor's location?
Sarcoma is a type of bone cancer, therefor,
A. Hemiplegia bone pain would be expected
B. Aphasia
C. Nausea
D. Bone Pain

29. A client with acute leukemia de- D. Provide foods in seal single serving
velops a low white blood cell packages
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count. In addition to the in-
stitute of isolation the nurse why?
should:
Because the client is immune-suppressed,
A. Request that food be served foods should be served in sealed contain-
with disposable utensils ers, to avoid food contaminants.
B. Ask the client to wear a mask
when visitors are present
C. Prep IV with mild soap, wa-
ter, and alcohol
D. Provide foods in seal single
serving packages

30. A client with leukemia is re- Answer D is correct. Leucovorin is the an-
ceiving Trimetrexate. After re- tidote for Methotrexate and Trimetrexate
viewing the client's chart, the which are folic acid antagonists. Leucov-
physician orders Wellcovorin orin is a folic acid derivative. Answers A,
(leucovorin calcium). The ratio- B, and C are incorrect because Leucovorin
nale for administering leucov- does not treat iron deficiency, increase neu-
orin calcium to a client receiv- trophils, or have a synergistic effect.
ing Trimetrexate is to:
A. Treat iron-deficiency anemia
caused by chemotherapeutic
agents
B. Create a synergistic effect
that shortens treatment time
C. Increase the number of cir-
culating neutrophils
D. Reverse drug toxicity and
prevent tissue damage

31. A 33-year-old male is being Answer C is correct. Radiation treatment

evaluated for possible acute for other types of cancer can result in
leukemia. Which of the follow- leukemia. Some hobbies and occupations
ing would the nurse inquire involving chemicals are linked to leukemia,
about as a part of the assess- but not the ones in these answers; there-
ment? fore, answers A and B are incorrect. Answer
A. The client collects stamps as D is incorrect because the incidence of
a hobby. leukemia is higher in twins than in siblings.

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B. The client recently lost his
job as a postal worker.
C. The client had radiation for
treatment of Hodgkin's disease
as a teenager.
D. The client's brother had
leukemia as a child.

32. An African American client is Answer D is correct. Petechiae are not usu-
admitted with acute leukemia. ally visualized on dark skin. The soles of
The nurse is assessing for the feet and palms of the hand provide a
signs and symptoms of bleed- lighter surface for assessing the client for
ing. Where is the best site for petichiae. Answers A, B, and C are incor-
examining for the presence of rect because the skin might be too dark to
petechiae? make an assessment.
A. The abdomen
B. The thorax
C. The earlobes
D. The soles of the feet

33. A client with acute leukemia is Answer B is correct. The client with
admitted to the oncology unit. leukemia is at risk for infection and has
Which of the following would often had recurrent respiratory infections
be most important for the nurse during the previous 6 months. Insomno-
to inquire? lence, weight loss, and a decrease in alert-
A. "Have you noticed a change ness also occur in leukemia, but bleeding
in sleeping habits recently?" tendencies and infections are the primary
B. "Have you had a respiratory clinical manifestations; therefore, answers
infection in the last 6 months?" A, C, and D are incorrect.
C. "Have you lost weight re-
cently?"
D. "Have you noticed changes
in your alertness?"

34. Which of the following would Answer B is correct. The client with acute
be the priority nursing diag- leukemia has bleeding tendencies due to
nosis for the adult client with decreased platelet counts, and any injury
acute leukemia? would exacerbate the problem. The client
A. Oral mucous membrane, al- would require close monitoring for hemor-

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tered related to chemotherapy rhage, which is of higher priority than the
B. Risk for injury related to diagnoses in answers A, C, and D, which
thrombocytopenia are incorrect.
C. Fatigue related to the dis-
ease process
D. Interrupted family process-
es related to life-threatening ill-
ness of a family member

35. A client being treated for ad- C. Examines the client's neck and chest for
vanced breast cancer with edema and engorged veins
chemotherapy reports that she Rationale:
must be allergic to one of her The client's swollen face indicates possi-
drugs because her entire face ble superior vena cava syndrome, which
is swollen. What assessment is an oncologic emergency. Manifestations
does the nurse perform? result from the blockage of venous return
from the head, neck, and upper trunk. Early
manifestations occur when the client arises
after a night's sleep and include edema of
A. Asks whether the client has the face, especially around the eyes, and
other known allergies tightness of the shirt or blouse collar. As
B. Checks the capillary refill on the compression worsens, the client de-
fingernails bilaterally velops engorged blood vessels and ery-
C. Examines the client's neck thema of the upper body, edema in the
and chest for edema and en- arms and hands, dyspnea, and epistaxis.
gorged veins Interventions at this stage are more likely
D. Compares blood pressure to be successful. Late manifestations in-
measured in the right arm with clude hemorrhage, cyanosis, mental status
that in the left arm changes, decreased cardiac output, and
hypotension. Death results if compression
is not relieved.

36. A client receiving high-dose C. Blood pressure change from 130/90 mm

chemotherapy who has bone Hg to 148/98 mm Hg
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marrow suppression has been
receiving daily injections of Rationale
epoetin alfa (Procrit). Which as- Epoetin alfa and other erythropoiesis-stim-
sessment finding indicates to ulating agents (ESAs) such as darbepoetin
the nurse that today's dose alfa (Aranesp) and epoetin alfa (Epogen,
should be held and the health Procrit) increase the production of many
care provider notified? blood cell types, not just erythrocytes,
which increases the client's risk for hyper-
tension, blood clots, strokes, and heart at-
tacks, especially among older adults. Dos-
A. Hematocrit of 28% ing is based on individual client hemoglobin
B. Total white blood cell count and hematocrit levels to ensure that just
of 6200 cells/mm3 enough red blood cells are produced to
C. Blood pressure change from avoid the need for transfusion but not to
130/90 mm Hg to 148/98 mm Hg bring hemoglobin or hematocrit levels up to
D. Temperature change from normal. The increased blood pressure is an
99° F (37.2° C) to 100° F (37.8° indication to stop this therapy immediately.
C)

37. Which statement made by the C. "I will have a radioactive device in my
client allows the nurse to rec- body for a short time."
ognize whether the client who
is receiving brachytherapy for Rationale
ovarian cancer understands
the treatment plan? A. Side effects of radiation therapy are site
specific.
B. The client undergoing teletherapy (ex-
ternal beam radiation) must be positioned
A. "I may lose my hair during precisely in the same position each time.
this treatment." C. Brachytherapy refers to short-term inser-
B. "I must be positioned in the tion of a radiation source.
same way during each treat- D. The client who is receiving brachythera-
ment." py must be in a private room.
C. "I will have a radioactive de-
vice in my body for a short
time."
D. "I will be placed in a semipri-
vate room for company."

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38. The client receiving C. Nadir
chemotherapy will experience
the lowest level of bone marrow Rationale
activity and neutropenia during
which period? A. The peak of bone marrow function oc-
curs when the client's blood levels are at
their highest.
B. Trough, which means low, is typically
A. Peak used in reference to drug levels.
B. Trough C. The lowest point of bone marrow func-
C. Nadir tion is referred to as the nadir.
D. Adjuvant D. Adjuvant refers to use of radiation ther-
apy or surgery along with chemotherapy in
cancer treatment.

39. The registered nurse is teach- A. Client with hemoglobin of 7.4 and hema-
ing a nursing student about the tocrit of 21.8
importance of observing for Rationale
bone marrow suppression dur-
ing chemotherapy. Select the Bone marrow suppression causes ane-
person who displays bone mar- mia, leukopenia, and thrombocytopenia;
row suppression. this client has anemia demonstrated by low
hemoglobin and hematocrit.

A. Client with hemoglobin of

7.4 and hematocrit of 21.8
B. Client with diarrhea and
potassium level of 2.9 mEq/L
C. Client with 250,000 platelets
D. Client with 5000 white blood
cells/mm3

40. Which client problem does the B. Risk for Injury related to sensory and
nurse set as the priority for the motor deficits
client experiencing chemother-
apy-induced peripheral neu- Rationale
ropathy?
A. Although this information may be helpful,

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the priority is the client's safety because of
lack of sensation or innervation.
A. Potential for lack of under- B. The highest priority is safety.
standing related to side effects C. The nurse should address the client's
of chemotherapy coping, after providing for safety.
B. Risk for Injury related to sen- D. Erectile dysfunction may be a manifesta-
sory and motor deficits tion of peripheral neuropathy, but the prior-
C. Potential for ineffective cop- ity is the client's safety.
ing strategies related to loss of
motor control
D. Altered sexual function relat-
ed to erectile dysfunction

41. The nurse is caring for a client Allergy is the most common side effect.
who is receiving rituximab (Rit-
uxan) for treatment of lym-
phoma. It is essential for the
nurse to observe for which side
effect?

42. Which intervention will be most C. Using strict aseptic technique to prevent
helpful in preventing dissem- infection
inated intravascular coagula- **Sepsis is a major cause of DIC, especially
tion (DIC)? in the oncology client. ***

A. Monitoring platelets
B. Administering packed red
blood cells
C. Using strict aseptic tech-
nique to prevent infection
D. Administering low-dose he-
parin therapy for clients on
bedrest

43. When caring for a client with A. Hyponatremia

suspected syndrome of inap-
propriate antidiuretic hormone
secretions (SIADH), the nurse
reviews the medical record

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to uncover which signs and B. Mental status changes
symptoms consistent with this
syndrome?
(SATA)

A. Hyponatremia E. Weakness
B. Mental status changes
C. Azotemia
D. Bradycardia
E. Weakness

44. The nurse anticipates admin- B. Allopurinol (Zyloprim)

istering which medication to Rationale
treat hyperuricemia associat-
ed with tumor lysis syndrome A. Tumor lysis syndrome results in hy-
(TLS)? peruricemia (elevation of uric acid in the
blood), hyperkalemia, and other electrolyte
imbalances; Procrit is used to increase red
blood cell (RBC) production and is not a
A. Recombinant erythropoietin treatment for hyperuricemia.
(Procrit) B. Tumor lysis syndrome results in hype-
B. Allopurinol (Zyloprim) ruricemia, Allopurinol decreases uric acid
C. Potassium chloride production and is indicated in TLS.
D. Radioactive iodine 131 C. Tumor lysis syndrome results in hype-
ruricemia, hyperkalemia, and other elec-
trolyte imbalances; administering addition-
al potassium is dangerous.
D. Radioactive iodine 131 is indicated in the
treatment of thyroid cancer, not TLS

45. Which manifestation of an on- B. Edema of arms and hands

cologic emergency requires
the nurse to contact the health Rationale
care provider immediately? Edema of the arms and hands indicates
worsening compression of the superior
vena cava consistent with superior vena
A. New onset of fatigue cava syndrome. The compression must be
B. Edema of arms and hands relieved immediately, often with radiation

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C. Dry cough therapy, because death can result without
D. Weight gain timely intervention.

46. Which precaution is most im- C. See your dentist twice yearly for the rest
portant for the nurse to teach a of your life.
client receiving radiation thera- Rationale:
py for head and neck cancer? Radiation therapy that is directed in or
around the oral cavity has a variety of ac-
tions that increase the risk for dental caries
(cavities) and tooth decay. The salivary
A. Avoid eating red meat during glands are affected, which changes the
treatment. composition of the person's saliva and of-
B. Pace your leisure activities ten causes "dry mouth." This result allows
to prevent fatigue. rapid bacterial overgrowth, which leads to
C. See your dentist twice yearly cavity formation. In addition, the radiation
for the rest of your life. damages the integrity of the enamel and
D. Avoid using headphones or also damages some of the living cells in the
headsets until your hair grows tooth. All contribute to an increased risk for
back. dental infections and cavities.

47. How would the nurse define the Nadir refers to the average number of days
term nadir to a client? it takes for a chemotherapeutic drug to
have its peak effect on the bone marrow,
which would coincide with the client's low-
est white blood count and highest risk for
infection or bleeding.

48. The nurse would anticipate ad- Leucovorin is given to block the systemic
ministering which medication toxic effect of high-dose methotrexate. It
to clients receiving high-dose is a form of folic acid that does not re-
methotrexate? quire dihydrofolate reductase to produce
folic acid. Therefore, it is used to prevent
or treat toxicity induced by methotrexate, a
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folic acid antagonist. All of the other options
are chemotherapeutic drugs, which are not
specifically associated with methotrexate.

49. The nurse should teach the Filgrastim increases the production of
client about which expected WBCs in the bone marrow, triggering
adverse effect of filgrastim (Ne- the common adverse effect of bone pain.
upogen)? (Cranking up the bone marrow=BONE
PAIN)

50. The nurse anticipates a client Oprelvekin stimulates the production of

with low platelets will be pre- platelets that results from chemo induced
scribed which drug to stimu- thrombocytopenia.
late platelet production?

51. When providing education to The client must contact the health care
a client undergoing antineo- provider immediately if any of the listed
plastic drug therapy, the nurse signs or symptoms occur:
instructs the client to imme- · Fever or chills with a temperature higher
diately notify the health care than 100.5° F (38.1° C)
provider for which signs and · New sores or white patches in the mouth
symptoms? or throat
(Lilley Chapter 46) · Swollen tongue with or without cracks and
bleeding
· Bleeding gums
· Dry, burning, "scratchy," or "swollen"
throat
· A cough that is new and persistent
· Changes in bladder function or patterns
· Blood in the urine
· Changes in gastrointestinal or bowel
patterns, including "heartburn" or nausea,
vomiting, constipation, or diarrhea lasting
longer than 2 or 3 days
· Blood in the stools

52. When teaching a client receiv- Myalgias and arthralgia (joint pain) are
ing paclitaxel (Taxol), the nurse common adverse effects of paclitaxel that
should instruct the client about the client should be prepared to expect.
which common adverse effect?
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53. Which are general adverse ef- Bone marrow suppression leads to
fects of chemotherapy? leukopenia, neutropenia, and thrombocy-
topenia.
Alopecia is a common adverse reaction to
antineoplastic drugs.

54. The nurse is discussing the They alter the chemical structure of the
use of alkylating drugs with a deoxyribonucleic acid (DNA).
client. What is the best way for The alkylating drugs work by preventing
the nurse to describe the action cancer cells from reproducing. Specifical-
of alkylating drugs on cancer ly, they alter the chemical structure of the
cells? cells' DNA, which is essential to the repro-
duction of any cell. This stops the cancer
from reproducing or spreading.

55. What is considered a major Clients receiving doxorubicin need to be

dose-limiting adverse effect of monitored for cardiac toxicity. There is a
doxorubicin (Adriamycin)? lifetime limited dose that clients are allowed
to receive to minimize the occurrence of
Hepatoxicity cardiomyopathy.
Nephrotoxicity *monitor EKGs before and after can cause
Cardiomyopathy CHF*
Hemorrhagic cystitis

56. When a client is receiving cy- Hemorrhagic cystitis

clophosphamide (Cytoxan), the (Clients receiving cyclophosphamide
nurse should advise the client should drink at least 2 to 3 L of fluid before,
to drink plenty of fluids to pre- during, and after administration to prevent
vent which condition? hemorrhagic cystitis)

57. Combinations of antineoplas- A, D, E

tic drugs are frequently used Administering a combination of antineo-
for which purpose? (Select all plastic drugs allows for smaller doses of
that apply.) each, which can minimize the severity of
A Prevent drug resistance adverse effects and help prevent drug re-
B Lower cost of treatment sistance. Additionally, there is a synergistic
C Decrease drug tolerance action between some of the medications.
D Provide a synergistic action Decreasing cost is not a benefit of combi-
nation therapy
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E Decrease the severity of ad-
verse effects.

58. The client receives nolvadex Correct Answer: 1

(tamoxifen) for treatment of
breast cancer. She asks the Rationale 1: Breast cancer is dependent on
nurse why the medicine works. estrogen for growth. nolvadex (Tamoxifen)
What is the best response by acts by blocking estrogen receptors; the
the nurse? tumor is deprived of estrogen.

1. "Tamoxifen works by block-

ing estrogen receptors on
breast tissue."

2. "Tamoxifen works by in-

hibiting the cellular mitosis of
breast cancer."

3. "Tamoxifen works by inhibit-

ing the metabolism of breast
cancer cells."

4. "Tamoxifen works by bind-

ing to the DNA of breast cancer
cells."

59. grows slowly, localized, en- Benign

capsulated, well differentiated
cells, no metastasis, not harm-
ful to host.

60. Grows rapidly, infiltrates sur- Malignant

rounding tissues, not encap-
sulated, poorly differentiated,
metastasis present, always
harmful

61. In staging and grading neo- B. TNM stands for tumor, node, and metas-
plasm TNM system is used. tasis.
TNM stands for:
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A Time, neoplasm, mode of
growth
B. Tumor, node, metastasis
C Tumor, neoplasm, mode of
growth
D Time, node, metastasis

62. Breast self examination (BSE) B-This client needs further teaching as pal-
is one of the ways to de- pation in BSE SHOULD start at the periph-
tect breast cancer earlier. The ery going to the center in a circular motion.
nurse is conducting a health
teaching to female clients in
a clinic. During evaluation the
clients are asked to state what
they learned. Which of the
following statement made by
a client needs further teach-
ing about BSE? (FURTHER IN-
STRUCTION key words)
A "BSE is done after menstrua-
tion."
B. "BSE palpation is done by
starting at the center going to
the periphery in a circular mo-
tion."
C "BSE can be done in either
supine or standing position."
D "BSE should start from age
20."

63. Which of the following clients D A 60-year-old Black man-

is most at risk for developing Multiple myeloma is more common in mid-
multiple myeloma? dle-aged and older clients (the median age
A A 20-year-old Asian woman at diagnosis is 60 years) and is twice as
B A 30-year-old White man common in Blacks as Whites. It occurs
C A 50-year-old Hispanic most often in Black men.
woman
D A 60-year-old Black man

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64. For which of the following con- Hypercalcemia-
ditions is a client with multiple Calcium is released when the bone is de-
myeloma (MM) monitored? stroyed. This causes an increase in serum
Hypercalcemia calcium levels. MM doesn't affect potassi-
Hyperkalemia um, sodium, or magnesium levels.
Hypernatremia
Hypermagnesemia

65. An elderly female patient is ANS: C

receiving the drug megestrol
(Megace). Which is the most Megestrol can cause appetite stimulation
likely reason megestrol is or- and weight gain, and therefore is used in
dered for this patient? the management of anorexia, cachexia, or
a.Migraine headaches unexplained substantial weight loss in pa-
tients with acquired immunodeficiency syn-
b.Osteoporosis drome (AIDS) and in patients with cancer.
The other options are incorrect.
c.Appetite stimulant

66. he patient, 69 years old, Doxorubicin

is receiving cyclophosphamide
(Cytoxan), doxorubicin (Adri-
amycin), and methotrexate
(Trexall) (CAM) for the treat-
ment of prostate cancer. Dur-
ing morning rounds, the pa-
tient complains of feeling short
of breath. Physical assessment
reveals crackles in both lungs.
What is the most likely cause of
this clinical manifestation?

67. The nurse is reviewing the A-A high risk of hemorrhage exists when
laboratory results of a client the platelet count is fewer than 20,000. Fa-
receiving chemotherapy. The tal central nervous system hemorrhage or
platelet count is 10,000 massive gastrointestinal hemorrhage can
cells/mm. Based on this labora- occur when the platelet count is fewer than
tory value, the priority nursing 10,000. The client should be assessed for
assessment is which of the fol- changes in levels of consciousness, which

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lowing? may be an early indication of an intracranial
A Assess level of conscious- hemorrhage. Option 2 is a priority nurs-
ness ing assessment when the white blood cell
B Assess temperature count is low and the client is at risk for an
C Assess bowel sounds infection.
D Assess skin turgor

68. A 56-year-old woman is cur- Esophagitis

rently receiving radiation ther- Question 56 Explanation:
apy to the chest wall for re- Difficulty in swallowing, pain, and tightness
current breast cancer. She calls in the chest are signs of esophagitis, which
her health care provider to re- is a common complication of radiation ther-
port that she has pain while apy of the chest wall
swallowing and burning and
tightness in her chest. Which of
the following complications of
radiation therapy is most likely
responsible for her symptoms?
A Hiatal hernia
B Stomatitis
C Radiation enteritis
D Esophagitis

69. The nurse is caring for of D Increase level of uric acid (Hyper-
a client who is receiving a uricemia) in the body is common follow-
chemotherapy. Which of the fol- ing the treatment for leukemias and lym-
lowing would be expected as phomas because chemotherapy results in
a result of the massive cell massive cell destruction. Options A, B, and
destruction that occurred from C are usually noted, but an increase uric
the chemotherapy? acid level is specifically related to massive
A Leukopenia. cell destruction.
B Anemia.
C Thrombocytopenia.
D Hyperuricemia.

70. The client with non-Hodgkin's B:

lymphoma is being managed A side effect specific to this medication is
with vincristine (Vincasar). peripheral neuropathy. It can be manifested
Which of the following indi- as numbness and tingling sensation in the

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cates a side effect specific to finger and toes. Option A: Alopecia occurs
this medication? nearly with all the neoplastic medications.
A Alopecia. Options C and D are not related to this
B Numbness in the toes. medication.
C Chest heaviness.
D Weight gain.

71. A patient is receiving B. 8 days.

chemotherapy for the treat- **Nadir is when the bone marrow and WBC
ment of cancer. The nurse an- are at their lowest**
ticipates nadir to occur in
A. 2 days.
B. 8 days.
C. 15 days.
D. 30 days

72. The oncologist has told the 3 "Benign tumors do not invade and spread
patient that he or she has to other organs."
a benign tumor in the liver. The ability of malignant tumor cells to in-
The patient asks the nurse, vade and metastasize is the major differ-
"What is the main difference ence between benign and malignant neo-
between benign and malignant plasms. Benign tumors usually are encap-
tumors?" Which answer by the sulated; metastasis is absent, and recur-
nurse is correct? rence is rare. Malignant tumors rarely are
1 "Malignant tumors usually encapsulated, are capable of metastasis,
are encapsulated." and are capable of recurring.
2 "Malignant tumors have a
rare recurrence rate."
3 "Benign tumors do not invade
and spread to other organs."
4 "Malignant tumors require
less nutrients for their cells
than benign tumors."

73. The nurse providing care for a 2 Only a biopsy is a definitive means of di-
patient with suspected cancer agnosing cancer, because it actually identi-
recalls that the only diagnostic fies the pathological cells. Many tests, such
procedure that is definitive for as MRI, CT scan, and tumor markers, are
a diagnosis of cancer is: indicative of cancer, but they do not con-

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1 firm the presence of cancer cells as exam-
MRI ination of a specimen obtained by biopsy
2 does.
Biopsy
3
CT scan
4
Tumor marker

74. Seven Warning Signs of Cancer C:hange in bowel or bladder habits

(CAUTION) A: sore throat that doesn't heal
U:nusual bleeding or discharge
T:hickening or lump in breast or elsewhere
I:ndigestion or difficulty swallowing
O:obvious change in wart or mole
N:agging cough or hoarseness

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