NCLEX PN Review: Oncology

The nurse is caring for a client who just returned from the initial external beam radiation therapy (EBRT) session for lung cancer. Which statement by the client indicates the need for further clarification by the nurse regarding EBRT?

"I'm worried I will expose my family members to radiation."

A client with newly diagnosed breast cancer asks the nurse, "Why me? I've always been a good person. What have I done to deserve this?" Which response by the nurse would be most therapeutic?

"Please tell me more about how you are feeling."

A nurse walks into the room of a client who has had surgery for testicular cancer. The client becomes quiet and tearful after telling the nurse, "I'm afraid that now I will be undesirable to my wife." Which response by the nurse is most appropriate?

"Tell me more about how you are feeling."

The nurse is caring for a client who detected a lump in her right breast. The client asks the nurse " How do I find out if it's cancer?" Which statement by the nurse would be most appropriate?

"The physician will need to perform a fine needle aspiration and biopsy to confirm the diagnosis."

As part of a primary cancer prevention program, an oncology nurse speaks to the public at a health fair. When someone asks about laryngeal cancer, which statement by the nurse would be most helpful?

"To reduce the risk of developing laryngeal cancer you shouldn't smoke or drink alcohol."

The nurse is teaching a group of men about prostate health. Which of the following would be most important for the nurse to tell the men?

"You should discuss PSA testing with a health care provider to decide whether testing is the right choice for you."

A client with suspected lung cancer is scheduled for thoracentesis as part of the diagnostic workup. The nurse reviews the client's history for conditions that might contraindicate this procedure. Which condition is a contraindication for thoracentesis?

A bleeding disorder

During a breast examination, which finding most strongly suggests that the client has breast cancer?

A fixed nodular mass with dimpling of the overlying skin

The nurse is caring for a client admitted for treatment of dehydration who has an infusion of 5% dextrose in 0.45% saline at 125 ml/hr. The client has a history of breast cancer, left radical mastectomy, and lymphedema. The client is wearing a compression sleeve on the left arm. The nurse notes the sleeve has bulging areas in the upper arm and swelling is evident in the anterior axilla area. Which action(s) does the nurse take?

Ask the client how long the current compression sleeve has been in use. Remove the sleeve immediately by gently peeling from top to bottom. Perform a focused integumentary and neurological assessment of the left arm.

A client has radiation seeds implanted into the prostate gland. Which action should the nurse take to safely provide care to this client?

Learn the safe distance from the client. Identify the safest amount of time to be at the bedside. Obtain the necessary shielding when providing care.

A client with cancer is being evaluated for possible metastasis. Which of the following is a common metastasis site for cancer cells?

Liver

The nurse is caring for a client with bronchogenic carcinoma. Which nursing interventions are essential in the care of the client receiving a chemotherapeutic regimen?

Maintain a patent airway. Alleviate anxiety by explaining procedures and care delivery. Instruct the client on signs and symptoms of infection.

A 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?

Pick up the implant with long-handled forceps and place it in a lead-lined container.

After a transsphenoidal adenohypophysectomy, a client is likely to undergo hormone replacement therapy. A transsphenoidal adenohypophysectomy is performed to treat which type of cancer?

Pituitary carcinoma

A nurse receives a client assignment and is to care for a client who has terminal lung cancer. The nurse's father died two months ago from the same disease, and the nurse is having difficulty interacting with the client and family due to being overwhelmed with emotion. Which action should the nurse take?

Speak to the nurse in charge about the emotional reaction and explore options.

A client with metastatic cancer is experiencing neuropathic pain. Which alternative therapy is most beneficial in treating this type of pain?

Transcutaneous electrical nerve stimulation (TENS)

A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for this client?

Wearing personal protective equipment when handling blood, body fluids, or feces

A client with supraglottic cancer undergoes a partial laryngectomy. Postoperatively, a cuffed tracheostomy tube is in place. When removing secretions that pool above the cuff, the nurse should instruct the client to:

cough as the cuff is being deflated.

Which nurse should be assigned to a client receiving brachytherapy for the treatment of cervical cancer?

female nurse with 3 years' experience working in oncology

A nurse is reinforcing education with the parent of an ill child about childhood immunizations. The nurse should tell the parent that only inactivated virus vaccines should be administered to children with which disorder?

leukemia

A client is undergoing a left modified radical mastectomy for breast cancer. Postoperatively, blood pressure should be obtained from the client's right arm, and the left arm and hand should be elevated as much as possible to prevent which condition?

lymphedema

A client receives a sealed radiation implant to treat cervical cancer. When caring for this client, the nurse should:

maintain the client on complete bed rest with bathroom privileges only.

A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, the nurse should assign highest priority to:

maintaining a patent airway.

A client is undergoing chemotherapy without responding to three different rounds of agents. The client proposes testing for specific serum metal levels based on a review of the history of symptoms and Internet research. The nurse recognizes that the client is demonstrating:

self-advocacy.

On discharge, a client who underwent a left mastectomy expresses relief that "the cancer" has been treated. When discussing this issue with the client, the nurse should stress that she:

should continue to perform breast self-examination on her right breast.

The nurse is providing breast cancer education at a community facility. The American Cancer Society (Canadian Cancer Society) recommends that women get mammograms:

yearly after age 40.

The nurse is preparing a client for magnetic resonance imaging (MRI) to confirm or rule out a spinal cord lesion. Which question would the nurse ask the client to assess for the greatest risk in the MRI scan room?

"Are you wearing a wedding band?"

The nurse reinforces instructions for a client diagnosed with acute lymphocytic leukemia (ALL) who is preparing for allogeneic bone marrow transplant. Which statement made by the client indicates to the nurse that the client understands the instructions?

"Before undergoing the bone marrow transplant, I will receive chemotherapy."

For a client with newly diagnosed cancer, the nurse assists in formulating a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client?

"Client verbalizes feelings of anxiety." Explanation: 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. Suppressing speculation is inappropriate and may prevent the client from coming to terms with the crisis and planning accordingly. Using any tension-reducing method available 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 physiologic harm. The client shouldn't stop seeking information because doing so can help a client with cancer gain a sense of control over the crisis.

A young adult client received her first chemotherapy treatment for breast cancer. Which statement by the client requires further exploration by the nurse?

"I don't care about the adverse effects of the drugs."

The nurse is interviewing a client suspected of having colon cancer about his past medical history. Which statement by the client should the nurse report to the physician?

"I had some polyps removed last time I had a colonoscopy."

A client becomes neutropenic 11 days after his last chemotherapy cycle. It's obvious that the client understands his condition when he states:

"I'll monitor my temperature frequently and go to the nearest emergency department if my temperature rises above 38° C (100.4° F)."

A client with uterine cancer asks the nurse, "Which type of cancer causes the most deaths in women?" How should the nurse respond?

"Lung cancer."

A client with cancer tells the nurse, "I found out about this new herbal treatment for breast cancer that I would really like to try." Which nursing response is appropriate?

"We should share this information with your health care provider."

The nurse is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47 years. Following the American Cancer Society guidelines, what information would be the most important for the nurse to give the women?

"Women older than age 40 should have a mammogram and clinical examination every year."

A nurse is working with a client who is afraid of dying after a biopsy result came back positive for cancer. What is the best reflective response by the nurse to enhance client communication?

"You are afraid to die."

A client recruited to participate in a clinical trial to treat non-Hodgkin's lymphoma voices concerns about the adverse effects of the treatment preventing the completion of the trial. What will the nurse tell the client to protect the principle of autonomy?

"You may withdraw at any time."

A client is ordered a dose of epoetin alfa to treat anemia related to chemotherapy. The recommended dose is 150 units/kg. The client weighs 60 kg. The vial is labeled 10,000 units/mL. How many milliliters of epoetin alfa should the nurse administer?

0.9 mL

On a visit to the gynecologist, a client reports urinary frequency, pelvic discomfort, and weight loss. After a complete physical examination, blood studies, and a pelvic examination with a Papanicolaou test, the physician diagnoses stage IV ovarian cancer. The nurse expects to prepare the client for which initial treatment?

Major surgery

In assessing a postmastectomy client, the nurse determines that the client is in denial. The nurse can best respond by:

Accepting the denial.

A client has an abnormal result on a Papanicolaou test. After admitting that she read her chart while the nurse was out of the room, the client asks what dysplasia means. Which definition should the nurse provide?

Alteration in the size, shape, and organization of differentiated cells

To combat the most common adverse effects of chemotherapy, the nurse would administer an:

Antiemetic

A 45-year-old client receiving radiation therapy for thyroid cancer reports mouth and throat pain. While inspecting the mouth and throat, the nurse notices white patches and ulcerations in the oral mucosa. What do these findings suggest?

Candidiasis

The nurse 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:

Changes from previous self-examinations

A client diagnosed with acute myelocytic leukemia (AML) has been receiving chemotherapy. During the last two cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia?

Closely observe the client's skin for petechiae and bruising.

The nurse is caring for a client who was admitted with rectal bleeding. The client is at high risk for having colorectal cancer. The nurse anticipates the physician will order which diagnostic test to confirm this suspicion?

Colonoscopy

A client has been receiving chemotherapy for cancer treatment. The client is competent and has been actively involved in decisions regarding care; however, the client has now decided to refuse treatment. What should the nurse do when the client refuses the next dose of chemotherapy?

Document the client's choice and offer to discuss feelings about the chemotherapy.

A client is receiving chemotherapy to treat breast cancer. Which data collection finding indicates a fluid and electrolyte imbalance induced by chemotherapy?

Dry oral mucous membranes and cracked lips

A client with a diagnosis of ovarian cancer is receiving chemotherapy with cisplatin and reports nausea and loss of appetite resulting in decreased food intake. What should the nurse recommend to improve nutrition?

Eat small meals high in protein and calories throughout the day.

A client is admitted to the hospital with severe bone marrow depression related to chemotherapy. What does the nurse include when assisting with the development of the plan of care to decrease the risk of infection in this client?

Ensure the use of protective isolation protocol. Wash hands before administering care. Request that family members not bring flowers to the client's room.

The nurse is caring for a client recently diagnosed with gastric cancer. Which bacteria does the nurse anticipate may be present?

Helicobacter pylori

A client with metastatic brain cancer is admitted to the oncology floor. According to the Patient Self-Determination Act of 1991 (PSDA), what is the hospital required to do concerning the execution of advance directives?

Inform the client or legal guardian of his right to execute an advance directive.

A 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?

Keep the stoma moist.

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 statement is accurate?

Men can develop breast cancer.

Which finding is an early indicator of bladder cancer?

Painless, intermittent hematuria

The nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for:

Pathologic bone fractures

The nurse is caring for a client diagnosed with cancer of the cervix. When reinforcing education on intracavitary radiation, which explanation best explains the importance of emptying the bowel?

Pressure changes in the pelvis associated with bowel movements can alter the position of the applicator and the radiation source.

Which nursing intervention is most appropriate for a client with multiple myeloma?

Preventing bone injury

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?

Providing a solution of hydrogen peroxide and water for use as a mouth rinse

The nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction. She's in her 30s and has two young children. Although she's worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to support her coping?

Refer the client to the American Cancer Society's (Canadian Cancer Society's) Reach for Recovery program or another support program.

A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse assists with formulating a nursing diagnosis of Risk for injury. Which "related- to" phrase is appropriate for the nurse to add to complete the nursing diagnosis statement?

Related to impaired balance

The nurse is teaching a session on cancer prevention to a group of young adults. Which nutrition information will the nurse share?

Strive to maintain a healthy weight.

A nurse is caring for a client with end-stage testicular cancer who has been referred to hospice care. Which criterion excludes the client from hospice care?

The client entered a clinical trial through the National Cancer Institute

A nurse is preparing a client for magnetic resonance imaging (MRI) scan to confirm or rule out a spinal cord lesion. Which action would pose a threat to the client during the procedure?

The client wears a watch and wedding band

A client who is receiving the first dose of chemotherapy expresses concern at the thought of losing their hair. What would be the most appropriate response by the nurse?

Your hair loss will be temporary. Tell me about your concerns."`

A nurse is participating in a cancer-screening program for colorectal cancer. Which client presents the fewest risk factors for colon cancer?

a 60-year-old client who follows a diet low in fat and high in fiber

A few minutes after beginning a blood transfusion, the nurse notes that the client has chills, dyspnea, and urticaria. The nurse reports this to the physician immediately because the client probably is experiencing:

a hemolytic allergic reaction caused by an antigen reaction.

A multidisciplinary oncology team notes that a client who has been undergoing chemotherapy is now experiencing pancytopenia. When reviewing the laboratory data, which values support this diagnosis?

decreased white blood cells decreased platelets decreased red blood cells

A home care nurse assesses for disease complications in a client with bone cancer. The nurse knows that bone cancer may cause which electrolyte disturbance?

hypercalcemia

The client is receiving an infusion of cytarabine through a peripheral IV catheter when he reports burning at the insertion site. The nurse notes no blood return from the catheter, but she sees redness at the IV site. The client is most likely experiencing which complication?

extravasation

A client suspected of having gallbladder cancer is admitted to the hospital for a series of diagnostic testing. What objective data collected by the nurse would be indicative of gallbladder cancer?

jaundice weight loss of 10 kg in 2 months

The nurse on the oncology unit is caring for a client with a total white blood cell (WBC) count equal to 2000/µL (2.0 ×109/L). Which intervention is most important to include in the plan of care?

perform proper hand hygiene

The nurse is caring for a male client who reports difficulty urinating. Which laboratory test does the nurse anticipate may be administered?

prostate-specific antigen (PSA)

A client in the terminal stage of cancer is receiving a continuous infusion of morphine for pain management. Which data collection finding suggests that the client is experiencing an adverse effect of this medication?

respiratory rate of 8 breaths/minute

A client with advanced breast cancer is prescribed tamoxifen. When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately?

vision changes