ATI Learning System RN 3.0: Med Surg Oncology Practice Test

c. Pancytopenia Pancytopenia, a deficiency of WBCs, RBCs, and platelet counts, is an expected adverse effect of chemotherapy. Gingival hyperplasia, or overgrowth of gingival tissue in the mouth, is caused by poor oral hygiene and can lead to bacterial plaque and tartar accumulation, but it is not an adverse effect of chemotherapy. Hirsutism, or excessive body or facial hair, is generally caused by Cushing syndrome, especially in women. The nurse should expect to see alopecia, or hair loss, in a client who is receiving chemotherapy. The client might have an inability or lack of desire to eat, causing weight loss due to the adverse effects of chemotherapy, such as a metallic taste in the mouth, nausea, and vomiting.

A nurse is caring for a client who is receiving chemotherapy to treat cancer. Which of the following adverse effects should the nurse anticipate from the chemotherapy? a. Gingival hyperplasia b. Hirsutism c. Pancytopenia d. Weight gain

A nurse is providing teaching to a client who has cancer and is receiving external radiation therapy. Which of the following statements by the client indicates an understanding of the teaching? a. "I need to protect the area from sunlight." b. "I'm going to apply a heating pad to the area after each treatment." c. "I'll massage the area once per day." d. "I'll wash the markings off after each therapy treatment."

a. "I need to protect the area from sunlight." To prevent skin irritation and subsequent breakdown, the nurse should instruct the client to protect areas of skin from sunlight that receive radiation. The nurse should instruct the client to avoid heat exposure to the radiated area, which might lead to skin breakdown. The nurse should instruct the client that massage can cause friction to the radiated skin, which might lead to skin breakdown. The nurse should instruct the client that external radiation sites are marked to indicate the exact area to receive the radiation therapy. Washing off the markings is contraindicated.

A nurse on an oncology unit is providing discharge teaching to an adolescent female client who received a bone marrow transplant for leukemia. Which of the following info should the nurse include in the teaching? a. "Take your temperature twice each day." b. "You may return to school if you feel strong enough." c. "It is important to always wear shoes." d. "Clean your toothbrush weekly with isopropyl alcohol." e. "Avoid using tampons."

a. "Take your temperature twice each day." c. "It is important to always wear shoes." e. "Avoid using tampons." "Take your temperature twice each day" is correct. Clients who are postoperative bone marrow transplants are immunosuppressed and should continually monitor for manifestations of infection. A temperature that is greater than 38° C (100° F) should be reported immediately to the provider. "You may return to school if you feel strong enough" is incorrect. Clients who have had a bone marrow transplant are immunosuppressed. They should avoid crowds, such as those encountered at school, a mall, or a movie theater. They will also require time at home to recover and should limit their visitors to individuals who are healthy. "It is important to always wear shoes" is correct. A client who had a bone marrow transplant is immunosuppressed and should wear shoes to prevent injury and decrease the risk for infection. "Clean your toothbrush weekly with isopropyl alcohol" is incorrect. Alcohol can cause trauma and irritation to the gums and tissues. Rinsing the toothbrush in a weak bleach solution or placing in it in the dishwasher weekly are safer alternatives. "Avoid using tampons" is correct. The use of tampons is discouraged because they can disrupt the mucosal layer of the vagina and, if left in too long, can support the growth of bacteria

A nurse is providing postop discharge teaching to a client following a panhysterectomy for uterine cancer. Which of the following info should the nurse include in the teaching? a. "You might experience manifestations of menopause." b. "You will need to continue to use some form of birth control for 6 months." c. "Do not lift anything heavier than 15 pounds." d. "Pain or burning on urination is an expected outcome of this surgery."

a. "You might experience manifestations of menopause." The nurse should inform the client that a panhysterectomy includes the removal of the uterus and the ovaries that might cause manifestations of menopause to occur. Manifestations of menopause include hot flashes, night sweats, and vaginal dryness. The nurse should inform the client that, following a panhysterectomy, pregnancy is not possible and birth control is no longer required. The nurse should inform the client to not lift anything heavier than 5 to 10 lbs. The nurse should inform the client that pain or burning on urination is not an expected outcome of a panhysterectomy and to report these manifestations to the provider. Such manifestations can indicate a urinary tract infection.

A nurse is caring for a client who has breast cancer and is receiving a combination of chemotherapy medications. The client expresses confusion about the therapy. Which of the following explanations should the nurse provide? a. "the chemotherapy medications act at different stages of cell division so more tumor cells are destroyed." b. "The risk of renal toxicity is lessened when a combination of chemotherapy medications are used." c. "The use of more chemotherapy medications will shorten the time you have to be in treatment." d. "The combination of chemotherapy medications will eliminate the potential for bone marrow suppression."

a. "the chemotherapy medications act at different stages of cell division so more tumor cells are destroyed." Different chemotherapeutic agents act at various stages of cellular mitosis (division). By combining agents, medication therapy is more effective in stopping or slowing the growth of cancerous cells by interfering with their ability to multiply. A combination of chemotherapeutic agents does not lessen the incidence of renal toxicity. A combination of chemotherapeutic agents does not ensure a shorter duration of treatment. It is not entirely possible to eliminate the suppression of bone marrow caused by chemotherapeutic medications. The extent of bone marrow suppression is dependent on the specific medications being administered.

A nurse is collecting a health history from a client. Which of the following findings is the highest risk factor for the client developing bladder cancer? a. The client uses tobacco b. The client is a hairdresser c. The client is over 60 years of age d. The client has frequent UTIs

a. The client uses tobacco The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. Therefore, the nurse should identify the client's tobacco use as being the greatest risk factor for developing bladder cancer. The nurse should recognize that being over the age of 60 is a risk factor for developing bladder cancer; however, there is a greater risk to the client than age. The nurse should recognize that a history of UTIs is a risk factor for developing bladder cancer; however, there is a greater risk to the client than frequent UTIs. The nurse should recognize that exposure to chemicals, such as those used in hairdressing, is a risk factor for developing bladder cancer; however, there is a greater risk to the client than chemical exposure.

A nurse is providing discharge teaching to a client following open radical prostatectomy. The client is going home with an indwelling urinary catheter. Which of the following statements by the client indicates an understanding of the teaching? a. "I will be able to take a tub bath in 1 week." b. "I will change the catheter drainage bag once each week." c. "I will use suppositories to prevent constipation." d. "I will regain my bladder control once the catheter is removed."

b. "I will change the catheter drainage bag once each week." The nurse should teach the client how to change the catheter drainage bag and to change the bag at least once each week. The nurse should instruct the client to shower rather than take a tub bath for 2 to 3 weeks following an open radical prostatectomy. The nurse should instruct the client to use stool softeners, rather than suppositories, to control constipation. The nurse should inform the client that bladder control might not return immediately and to practice Kegel exercises, which can help with incontinence. Urinary incontinence can last for 1 to 2 years following surgery.

A nurse in an oncology clinic is assessing a client who has early stage Hodgkin's lymphoma. Which of the following findings should the nurse expect? a. Bone and joint pain b. Enlarged lymph nodes c. Intermittent hematuria d. Productive cough

b. Enlarged lymph nodes Hodgkin's lymphoma is a malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow. The first manifestation of this cancer is often an enlarged painless lymph node, or nodes, which appear without a known cause. Other early manifestations include night sweats, unexplained weight loss, fever, and pruritus. The disease can spread to adjacent lymph nodes and later might spread outside the lymph nodes to the lungs, liver, bones, or bone marrow. The spread of Hodgkin's lymphoma is usually in an ordered pattern. Bone and joint pain are early manifestations of leukemia and multiple myeloma, not Hodgkin's lymphoma. Intermittent blood in the client's urine might indicate the manifestation of bladder cancer. A nonproductive cough might occur because of narrowed airways from swollen lymph glands. A productive cough might be an indication of lung cancer.

A nurse is planning care for a client who has cancer and has developed thrombocytopenia following chemotherapy. Which of the following precautions should the nurse offer to minimize the adverse effects of thrombocytopenia? a. Monitor visitors for manifestations of infection. b. Remind the client to use an electric razor. c. Encourage frequent rest periods. d. Instruct the client to rinse mouth daily with normal saline.

b. Remind the client to use an electric razor. Thrombocytopenia is a decrease in the client's blood platelet count, which places the client at an increased risk of bleeding due to the blood's inability to clot. Therefore, the nurse should institute bleeding precautions, which includes the use of an electric razor. The client has thrombocytopenia, not neutropenia. Neutropenia, a decreased WBC count, places a client at risk for infection, and the nurse should monitor for visitors who are ill. The client has thrombocytopenia, a decrease in the number of circulating RBCs, not iron-deficiency anemia. Iron-deficiency anemia necessitates the encouragement of frequent rest periods secondary to fatigue. Stomatitis, an inflammation of the mucous membranes of the mouth, is not a manifestation of thrombocytopenia. The client who has stomatitis should use bland rinses and avoid commercial mouthwashes that contain alcohol, which might cause further breakdown to the oral tissue.

A nurse is caring for a client who has testicular cancer and is experiencing peripheral neuropathy as an adverse effect of chemotherapy. Which of the following client manifestations is an expected finding of peripheral neuropathy? a. Thinning of the scalp hair b. Tingling of the hands and feet c. Reduced ability to concentrate d. Sores in the mucous membranes

b. Tingling of the hands and feet Several chemotherapeutic agents might cause peripheral neuropathy. One of the major manifestations of peripheral neuropathy is numbness and tingling of an extremity. Thinning of the scalp hair is alopecia, a known adverse effect of chemotherapy. This manifestation is not related to peripheral neuropathy. The reduced ability to concentrate reflects cognitive changes, a known adverse effect of chemotherapy. This manifestation is not related to peripheral neuropathy. Sores in the mucous membranes is mucositis, a known adverse effect of chemotherapy. This manifestation is not related to peripheral neuropathy.

A nurse is providing preoperative teaching for a client who has colorectal cancer and is to undergo placement of a colostomy with a perineal wound. Which of the following statements by the client indicates an understanding of the teaching? a. "It will be a relief to not have any further rectal pain." b. "I will need to sit on a rubber donut when I am out of bed in the chair." c. "I can have only liquids for 2 days before the surgery." d. "The colostomy will start working about 7 days after the surgery."

c. "I can have only liquids for 2 days before the surgery." The client should consume a full or clear liquid diet for 24 to 48 hr before the surgery to decrease bulk. The client should consume a low-residue diet for several days prior to surgery to decrease peristalsis. Following placement of a colostomy with a perineal wound, rectal sensations such as pain and itching might occur even after healing of the client's surgical wound. The client should sit on foam pads or soft pillows and avoid the use of rubber donut devices, which increase pressure to the incisional site. Following surgery, the client's colostomy should begin to function within 2 to 4 days.

A nurse is providing discharge teaching to a client who is postop following a right mastectomy for breast cancer. The client will be discharged with two Jackson-Pratt drains. Which of the following info should the nurse include in the teaching? a. "Empty the drainage tubes once per day." b. "Showering is permitted before the drainage tubes are removed." c. "The drainage tubes often are removed at the same time as the stitches." d. "Do not begin exercising the arm until the provider removes the drainage tubes."

c. "The drainage tubes often are removed at the same time as the stitches." The nurse should instruct the client that the provider will remove the drainage tubes at the same time the stitches are removed, usually within 7 to 10 days. The nurse should instruct the client to empty the drainage tubes and record the amount of drainage twice each day. The nurse should instruct the client to take baths until the provider removes the drainage tubes and stitches. The nurse should instruct the client that normal use and nonstrenuous exercise is appropriate before the provider removes the drainage tubes. More strenuous exercise can begin following the removal of the drains.

A nurse is caring for a client who is postoperative following a urinary diversion to treat bladder cancer. Which of the following interventions should the nurse include in the plan of care? a. Empty the collection pouch when it is 2/3 full. b. Expect urine outflow into pouch to begin 1 to 2 days following surgery. c. Change the collection pouch in the early morning. d. Place an aspirin in the collection pouch to control odor.

c. Change the collection pouch in the early morning. The nurse should plan to change the urinary collection pouch in the early morning when urine output is reduced. The nurse should empty the collection pouch when it is 1/3 full to prevent the excess weight of the urine causing the pouch to separate from the skin. The nurse should expect no delay in urinary output following surgery. The nurse should monitor hourly urine output in the immediate postoperative period. Monitoring is then every 4 to 8 hr. The nurse should not use an aspirin in the collection pouch to control odor, as this can cause an ulceration to the stoma.

A nurse is monitoring a client who has cancer and is receiving chemotherapy by peripheral IV infusion. The client reports pain at the insertion site and the nurse notes fluid leaking around the catheter. Which of the following actions should the nurse take first? a. Take a photograph of the peripheral IV site. b. Obtain and record the client's vital signs. c. Stop the infusion. d. Identify all medications administered through the IV site for the past 24 hr.

c. Stop the infusion The nurse should apply the urgent versus nonurgent priority-setting framework. Using this framework, the nurse should consider urgent needs the priority need because they pose more of a threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. Many chemotherapy medications are vesicants that can cause extensive tissue damage if extravasation occurs; therefore, the nurse's first action should be to stop the infusion immediately. The nurse should take a photograph of the IV site for documentation of potential harm from extravasation; however, there is another action that is the priority. The nurse should take and record the client's vital signs following extravasation of a chemotherapy agent; however, there is another action that is the priority. The nurse should identify all medications administered through the IV site for the past 24 hr; however, there is another action that is the priority.

A nurse is obtaining a health history from a client who has cancer of the cervix. Which of the following manifestations should the nurse expect? a. Weight gain b. Oliguria c. Vaginal bleeding d. Back pain

c. Vaginal bleeding The most common manifestation of cancer of the cervix is painless vaginal bleeding. Unexplained weight loss is a manifestation of cancer of the cervix. Dysuria is a manifestation of cancer of the cervix. Pelvic and chest pain are manifestations of cancer of the cervix.

A hospice nurse is providing education about pallative care to the partner of a client who has end-stage liver cancer. Which of the following statements by the partner indicates an understanding of teaching? a. "I will do my best to try to get him to eat something." b. "I will lay him flat if his breathing becomes shallow." c. "I will use an electric blanket to keep him warm." d. "I will continue to talk to him even when he's sleeping."

d. "I will continue to talk to him even when he's sleeping." The nurse should reinforce to the partner that the client's hearing is thought to be the last sense to leave when in the dying process. Therefore, continue to softly communicate with the client. The nurse should reinforce to the partner that the client who is approaching death should be positioned with the head elevated or on the side. The nurse should reinforce to the partner that the client who is approaching death often refuses nourishment and should not be forced to eat or drink. The nurse should reinforce to the partner that the client should be covered with a blanket to keep the extremities warm, but not with an electric blanket.

A nurse is admitting a client who has multiple myeloma and a white blood cell count of 2200. Which of the following foods should the nurse prohibit the family members from bringing to the client? a. Fried chicken from a fast food restaurant b. A case of canned nutritional supplements c. A factory-sealed box of chocolates d. A fresh fruit basket

d. A fresh fruit basket Raw fruits and vegetables are contraindicated for a client who has neutropenia, as the skin might harbor bacteria that can cause an infection. The nurse should prohibit these foods from entering the client's room. Thoroughly cooked food products should not harbor bacteria that could be a potential source of infection for a client who has neutropenia. Canned nutritional supplements are permissible for the client. The nurse should dispose of any amount leftover to prevent bacterial growth from contamination. A sealed box of candy should not harbor bacteria that could be a potential source of infection for a client who has neutropenia.

A nurse is caring for a client who has lung cancer that has metastasized. Which of the following findings indicates the client is developing superior vena cava syndrome? a. Irregular cardiac rhythm b. Numbness in the hands c. Muscle cramps d. Facial edema

d. Facial edema Superior vena cava syndrome is a medical emergency resulting from a partial occlusion of the superior vena cava, leading to a decreased blood flow through the vein. Most cases of superior vena cava syndrome are associated with cancers involving the client's upper chest, such as advanced lung and breast cancers and lymphoma. The earliest manifestations of superior vena cava syndrome are facial and upper extremity edema. Death can result if the compression is not corrected. It leads to alterations in client's vascular flow, not cardiac arrhythmias. Numbness in the client's hands is a manifestation of spinal cord compression that can result if cancer spreads to the spinal cord. Muscle cramps might indicate the client has syndrome of inappropriate antidiuretic hormone (SIADH) and might occur with cancer metastasis to the brain.

A nurse is collecting a health history from a female client who is undergoing screening for breast cancer. Which of the following factors should the nurse identify for placing the client at the greatest risk for developing breast cancer? a. Obesity b. Oral contraceptive use c. Alcohol use d. Over 50 years of age

d. Over 50 years of age A female client whose age is over 50 years has a high increased risk for developing breast cancer. Obesity places a client at a low but increased risk for developing breast cancer. Oral contraceptive use places a client at a low but increased risk of developing breast cancer. The risk from alcohol use is dose dependent. Consumption of 3 to 14 drinks a week causes a slight risk for developing breast cancer.

A nurse is collecting a health history from a client. Which of the following findings is the highest risk factor for the client developing skin cancer? a. Age over 60 b. Genetic predisposition c. Light-skinned race d. Overexposure to sun light

d. Overexposure to sun light The nurse should apply the safety and risk reduction priority-setting framework when caring for this client. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. Therefore, the nurse should identify the client's overexposure to sun as being the greatest risk factor for developing skin cancer. The nurse should recognize that the client being over the age of 60 is a risk factor for skin cancer. The nurse should recognize that the client having a genetic predisposition is a risk factor for skin cancer. The nurse should recognize that the client being of a light-skinned race is a risk factor for skin cancer.