NCLEX 3000-Oncology

A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis may be appropriate for this client?

Anticipatory grieving

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

Antiemetic.

The nurse is caring for a client receiving the fentanyl transdermal system (Duragesic-50) for pain management. When applying a new system, the nurse should:

Apply the system immediately after removal from a package.

The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for?

Asymmetry

A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's plan of care?

Avoiding using soap on the irradiated areas

A client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include:

Bence Jones protein in the urine.

A client is admitted to an acute care facility with esophageal cancer. The incidence of esophageal cancer is highest in:

Black males.

(SELECT ALL THAT APPLY) A client receiving chemotherapy for breast cancer develops myelosuppression. Which instructions should the nurse include in the discharge teaching plan?

(1) Avoid people who have recently received attenuated vaccines. (2) Avoid activities that may cause bleeding. (3) Wash hands frequently. (5) Avoid crowded places, such as shopping malls.

(SELECT ALL THAT APPLY) A client in the terminal stage of cancer is being transferred to hospice care. Which information should the nurse include in the teaching plan regarding hospice care?

(1) Care focuses on controlling symptoms and relieving pain. (2) A multidisciplinary team provides care. (5) Bereavement care is provided to the family.

(SELECT ALL THAT APPLY) After having a lobectomy for lung cancer, a client receives a chest tube connected to a three-chamber chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes which of the following?

(1) Fluctuations in the water-seal chamber occur when the client breathes. (3) Intermittent bubbling occurs in the water-seal chamber. (4) Gentle bubbling occurs in the suction control chamber. (5) Drainage is collecting in the drainage chamber

(SELECT ALL THAT APPLY) What diagnostic studies are recommended to be performed annually on all women older than age 40?

(1) Mammography (4) Clinical breast examination

(SELECT ALL THAT APPLY) After undergoing chemotherapy to treat breast cancer, a client has a white blood cell (WBC) count of 1,300/microliter. Which nursing interventions should be used with this client?

(1) Monitor the client's temperature and vital signs; report temperature higher than 101.3° F (38.5° C). (2) Make sure no one with a viral or bacterial infection enters the client's room. (3) Administer hematopoietic growth factors as prescribed. (4) Reinforce good hand-washing techniques to anyone entering the client's room.

(SELECT ALL THAT APPLY) A client with laryngeal cancer has undergone laryngectomy and is receiving radiation therapy to the head and neck. The nurse should monitor the client for which adverse effects of external radiation?

(1) Xerostomia (2) Stomatitis (5) Dysgeusia

(SELECT ALL THAT APPLY) A client with bladder cancer undergoes surgical removal of the bladder and construction of an ileal conduit. Which data collection findings indicate that the client is developing complications?

(2) The stoma appears dusky. (3) The stoma protrudes from the skin. (6) The client experiences sharp abdominal pain and rigidity.

A client is hospitalized with lung cancer. To manage severe pain, the physician prescribes a continuous I.V. infusion of morphine. Which formula should the nurse use to check that the morphine dose is appropriate for the client?

10 mg/70 kg of body weight

A client with a history of colon cancer has a permanent colostomy. The nurse must irrigate the colostomy to prepare the client for diagnostic testing. When irrigating, how far into the stoma should the nurse insert the lubricated catheter?

2" to 4"

Which client has the highest risk of ovarian cancer?

45-year-old woman who has never been pregnant

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

A registered nurse (RN) on the oncology floor is busy with one client, so she delegates care of another client to her coworker, a licensed practical nurse (LPN). The client that the LPN begins caring for requires a 3-hour chemotherapy infusion. Which of the following actions is in accordance with her state's nurse practice act?

A chemotherapy-certified RN must begin the chemotherapy infusion; then the LPN may monitor the client.

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

"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.

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

Accepting the denial.

A nurse is working with a dying client and his family. Which communication technique is most important to use?

Active listening

"A client is prescribed tamoxifen (Nolvadex), 20 mg by mouth twice per day for treatment of breast cancer. The client complains to the nurse that she has worsening bone pain. How should the nurse respond?

Acute worsening of bone pain commonly indicates that the drug will produce a good response.

Which of the following is a risk factor associated with prostate cancer?

Age older than 40

"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

"A 45-year-old client receiving radiation therapy for thyroid cancer complains of 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

"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.

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.

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.

"A client suspected of having colorectal cancer will require which diagnostic study to confirm the diagnosis?

Colonoscopy

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

A client is undergoing a diagnostic workup for suspected testicular cancer. When obtaining the client's history, the nurse checks for known risk factors for this type of cancer. Testicular cancer has been linked to?

Cryptorchidism (failure of one or both testes to descend into the scrotum)

How can breast cancer prevention programs best serve women who are at risk and come from lower socioeconomic backgrounds?

Develop screening and educational programs.

"A client seeks care for hoarseness that has lasted for 1 month. To elicit the most appropriate information about this problem, the nurse should ask which question?

Do you smoke cigarettes, cigars, or a pipe?

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

The client is receiving an infusion of cytarabine (Cytosar-U) through a peripheral I.V. catheter when he complains of burning at the insertion site. The nurse notes no blood return from the catheter, but she sees redness at the I.V. site. The client is most likely experiencing which complication?

Extravasation

A client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expec

Fatigue

The nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:

Fine needle aspiration and biopsy.

A staff nurse on the oncology unit must teach a new unit assistant about infection control practices on the unit. The nurse should explain that the most important measure to prevent the spread of infection is what?

Frequent hand washing

What should a male client older than age 50 do to help ensure early identification of prostate cancer?

Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.

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. Following the American Cancer Society guidelines, the nurse should recommend that the women:

Have a mammogram annually.

Which of the following actions displayed by a grieving husband over his dying wife would cause the nurse to suggest counseling?

He refuses to acknowledge his wife's family and blames them for her current health problems.

A client, age 42, visits the gynecologist. After examining her, the physician suspects cervical cancer. The nurse reviews the client's history for risk factors for this disease. Which history finding is a risk factor for cervical cancer?

Human papillomavirus infection at age 32

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

An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates an understanding of the nurse's teaching?

I clean my teeth gently several times a day.

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 100.4° F."

The nurse is caring for a recently married, 29-year-old female client, who was diagnosed with acute lymphocytic leukemia (ALL). The client is preparing for an allogeneic bone marrow transplant. Which statement by the client demonstrates an understanding of the physician's description of the diagnosis and treatment?

I'll only need chemotherapy therapy before receiving my bone marrow transplant.

"A client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which statement by the client indicates an understanding of appropriate ways to deal with this deficit?

I'll play card games with my friends.

Which statement by a client undergoing external radiation therapy indicates the need for further teaching?

I'm afraid I'll expose my family members to radiation.

"A client recently diagnosed with metastatic liver cancer is admitted for hospice care. An acquaintance of the client calls the nurse to ask how the client is doing. Which response by the nurse is most appropriate?

I'm not permitted to give you any information about his condition for confidentiality reasons; I'll tell him you were asking about him.

The nurse is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination:

Immediately after her menses

A client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the warning signs of cancer. What is another warning sign of cancer?

Indigestion

The nurse is caring for a client with bronchogenic carcinoma. Which nursing diagnosis takes highest priority?

Ineffective airway clearance related to obstruction by a tumor or secretions

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.

Several days before admission, a client reports finding a small lump in the left breast near the nipple. What should the nurse tell the client to do?

Inform the physician immediately.

"For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?

Inspecting the skin for petechiae once every shift

"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.

"A client who underwent surgery 2 days ago is unable to tolerate anything by mouth and is experiencing mild to moderate cancer pain. Which nonsteroidal anti-inflammatory drug (NSAID) can the nurse safely administer by the I.M. route?

Ketorolac (Toradol)

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

Liver

"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 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 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.

On a visit to the gynecologist, a client complains of 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

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 drug should be prescribed with nonsteroidal inflammatory drugs (NSAIDs) in elderly cancer clients to reduce the risk of GI adverse effects?

Misoprostol (Cytotec)

According to the World Health Organization's analgesic ladder, which drugs would likely be used first to treat mild pain?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

At a health fair, an oncology nurse answers questions about risk factors for various types of cancer. One person with a family history of colon cancer asks the nurse to identify risk factors for this type of cancer. The nurse should identify

Obesity

"Which intervention is appropriate for the nurse caring for a client in severe pain receiving a continuous I.V. infusion of morphine?

Obtaining baseline vital signs before administering the first dose

"A 30-year-old client whose mother died of breast cancer at age 44 and whose sister has ovarian cancer is concerned about developing cancer. A nurse who is a member of the oncology multidisciplinary team should suggest that the client ask the physician about which of the following actions?

Obtaining genetic counseling

Which finding is an early indicator of bladder cancer?

Painless, intermittent hematuria

A client is undergoing a diagnostic workup for suspected thyroid cancer. What is the most common form of thyroid cancer in adults?

Papillary carcinoma

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.

After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. The physician orders a blind liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain and rigidity, and seems increasingly confused. The nurse suspects that these findings result from:

Perforation of the colon caused by the liver biopsy.

"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

The nurse is interviewing a client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?

Polyps

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

Preventing bone injury

A client with a cancerous tumor must undergo a modified radical mastectomy, which includes axillary node removal and immediate breast reconstruction. The nurse explains to the client that the axillary nodes will be removed in order to:

Provide prognostic information.

After a physician explains the risks and benefits of a clinical trial to a client, the client agrees to participate. Later that day, the client requests clarification of the process involved in the clinical trial. As a member of the multidisciplinary team, how should the nurse respond?

Provide the information requested.

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

A client with vaginal cancer asks the nurse, "What is the usual treatment for this type of cancer?" Which treatment should the nurse name?

Radiation therapy

A client has been receiving chemotherapy to treat cancer. Which data collection finding suggests that the client has developed stomatitis (inflammation of the mouth)?

Red, open sores on the oral mucosa

"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 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

What is the most important postoperative instruction the nurse must give a client who has just returned from the operating room after receiving a subarachnoid block?

Remain supine for the time specified by the physician.

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

Respiratory rate of 8 breaths/minute

After being seen in the oncology clinic, a client is admitted to the hospital with severe bone marrow depression. The client's cancer therapy consisted of radiation and chemotherapy. Which nursing diagnosis takes priority when developing this client's plan of care?

Risk for infection

"A client with stage II ovarian cancer undergoes a total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, and lymphadenectomy. During the second postoperative day, which data collection finding would raise concern in the nurse?

Shallow breathing and increasing lethargy

A 35-year-old female client is requesting information about mammograms and breast cancer. She isn't considered at high risk for breast cancer. What should the nurse tell this client?

She should eat a low-fat diet to further decrease her risk of breast cancer.

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

A nurse is preparing a client for discharge after a prolonged hospitalization in which the client had a colon resection and colostomy formation for treatment of colon cancer. The client's family has concerns about managing his care at home. Which factor is most important in ensuring successful home care?

Support from friends and family

A client was recently enrolled in a clinical trial for lung cancer. The client's health insurance provider asks the nurse caring for the client about the client's status, treatment regimen, and possible adverse effects of the medication she is taking. How can the nurse best respond?

Tell the provider that a Certificate of Confidentiality was issued; therefore, no information can be released.

The nurse is teaching a male client to perform monthly testicular self-examinations. Which of the following points would be appropriate to make?

Testicular cancer is a highly curable type of cancer.

A 65-year-old client is scheduled for a right lower lobectomy for lung cancer. During the admission assessment, the client asks for information about a living will and advance directive. The nurse knows that the client understands her teaching about the living will when he says:

The advance directive allows me to state my health care wishes while I'm still able to do so.

"A nurse is caring for a 25-year-old client with end-stage testicular cancer who has been referred to hospice care. Which of the following criteria excludes the client from hospice care?

The client entered a clinical trial through the National Cancer Institute

To treat cervical cancer, a client has had an applicator of radioactive material placed in the vagina. Which observation by the nurse indicates a radiation hazard?

The client receives a complete bed bath each morning.

The nurse is preparing a client for magnetic resonance imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which of the following would pose a threat to the client?

The client wears a watch and wedding band

After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/μl. What term should the nurse use to refer to this drop in the platelet count?

Thrombocytopenia

A client diagnosed with leukemia asks the nurse why he must undergo bone marrow aspiration. Which response by the nurse is best?

To determine what type of leukemia you have; your physician will explain the procedure to you in more detail.

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)

The spouse of a client with gastric cancer expresses concern that the couple's children may develop this type of cancer when they're older. When reviewing risk factors for gastric cancer with the client and family, the nurse explains that a certain blood type increases the risk by 10%. The nurse is referring to:

Type A.

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

Vision changes

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

Before a cancer client receiving total parenteral nutrition (TPN) resumes a normal diet, the nurse teaches him about dietary sources of minerals. Which foods are good sources of zinc?

Whole grains and meats

A client in the final stages of terminal cancer tells his nurse: ""I wish I could just be allowed to die. I'm tired of fighting this illness. I have lived a good life. I only continue my chemotherapy and radiation treatments because my family wants me to."" What is the nurse's best response?

Would you like to meet with your family and your physician about this matter?

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

Yearly after age 40.

"A 43-year-old black client without a family history of prostate cancer asks the nurse when he should have a prostate-specific antigen (PSA) test and a digital rectal examination (DRE) performed. Which response by the nurse is appropriate?

You should start undergoing prostate cancer screening at age 45.

As part of a primary cancer prevention program, an oncology nurse answers questions from the public at a health fair. When someone asks about laryngeal cancer, the nurse should explain that:

laryngeal cancer is one of the most preventable types of cancer.

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.