NCLEX: ONCOLOGY

The nurse has admitted a client to the clinical nursing unit after undergoing a right mastectomy. The nurse should plan to place the right arm in which position?

1. Elevated on a pillow

The nurse is reviewing a plan of care for a client with cancer of the cervix who is undergoing treatment with a cesium (radiation) implant. Which nursing interventions are most appropriate for this client? Select all that apply.

1. Maintain the client on bed rest. 2. Place the client on a low-fiber diet. 5. Stand at the entrance of the room to communicate with the client when possible.

The nurse is conducting a history and monitoring laboratory values on a client with multiple myeloma. What assessment findings should the nurse expect to note? Select all that apply.

1. Pathological fracture 2. Urinalysis positive for nitrites 5. Serum creatinine level of 2.0 mg/dL (176.6 mcmol/L)

The home health care nurse is visiting a client who has undergone a mastectomy. The nurse determines that the client demonstrates greatest adjustment to the loss of the breast if which behavior is noted?

1. The client looks at the surgical site.

The nurse is creating a plan of care for the client with multiple myeloma and includes which priority intervention in the plan?

1. Encouraging fluids

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder?

1. Increased calcium level

A 27-year-old client is undergoing evaluation of lumps in her breasts. In determining whether the client could have fibrocystic breast disorder, the nurse should ask her whether the breast lumps seem to become more prominent or troublesome at which time?

2. Before menses

The nurse is caring for a client with leukemia. In assessing the client for signs of leukemia, the nurse determines that what should be monitored?

2. Bone marrow biopsy

For the client with stomatitis resulting from chemotherapy, the care plan should include which intervention?

2. Encourage foods with neutral or cool temperatures.

A client is diagnosed as having a bowel tumor. The nurse should monitor the client for which complications of this type of tumor? Select all that apply.

2. Peritonitis 3. Hemorrhage 4. Fistula formation 5. Bowel perforation

The nurse is caring for a client with leukemia who is receiving intravenous chemotherapy. The nurse reviews the laboratory results and notes that the white blood cell count is 2000 mm3 (2 × 109/L), the platelet count is 150,000 mm3 (150 × 109/L), the clotting time is 10 minutes, and the ammonia level is 20 mcg/dL (12 mcmol/L). Which nursing action would be appropriate?

2. Place the client on neutropenic precautions.

A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which condition?

2. The development of a vesicovaginal fistula

A client has undergone abdominal perineal resection for a bowel tumor. The nurse interprets that the client's colostomy is beginning to function if which sign is noted?

2. The passage of flatus

The nurse is assessing a client who has a new ureterostomy. Which statement by the client indicates the need for more education about urinary stoma care?

3. "I empty the urinary collection bag when it is two-thirds full."

As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement?

3. "I'm going to take aspirin for my headache as soon as I get home."

The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency?

3. Periorbital edema

The nurse monitoring an oncological client assesses for which early sign of vena cava syndrome?

3. Periorbital edema

A client is receiving external radiation to the neck for cancer of the larynx. Which is the most likely expected effect?

3. Sore throat

The nurse in the health care provider's office is performing a postoperative assessment of a client who underwent mastectomy of her right breast 2 weeks ago. The client tells the nurse that she is very concerned because she has numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow. The nurse should provide which information to the client about her complaint?

3. These sensations dissipate over several months and usually resolve after 1 year.

The nurse has instructed the client in the correct technique for breast self-examination (BSE). For a portion of the examination, the client will lie down. The nurse should teach the client to put the pillow in which location for self-examination of the right breast?

3. Under the right shoulder

The client has undergone mastectomy. The nurse determines that the client is making the best adjustment to the loss of the breast if which behavior is observed?

4. Participating in the care of the surgical drain

A client receiving chemotherapy is experiencing mucositis. The nurse should advise the client to use which item as the best substance to rinse the mouth?

4. Weak salt and bicarbonate mouth rinse

The nurse is counseling a woman about decreasing her risk for cervical cancer. Which statement by the client indicates a need for further counseling?

2. "Condoms are needed only if I do not trust a new partner."

The nurse teaches skin care to a client receiving external radiation therapy. Which client statement indicates the need for further instruction?

4. "I will limit sun exposure to 1 hour daily."

The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching is necessary related to colorectal cancer if the client identifies which item as an associated risk factor?

1. Age younger than 50 years

The nurse has provided teaching for an adult client about screening for a colon cancer. Which statement by the client indicates that education was effective?

1. "I should have an annual fecal occult blood test."

The nurse has provided discharge instructions to a client who underwent a right mastectomy with axillary lymph node dissection. Which statement made by the client indicates a need for further instruction regarding home care measures?

1. "It is all right to use a straight razor to shave under my arms."

The nurse has conducted an educational session about risk factors for bladder cancer with clients in the ambulatory care center. Which statements by the clients indicate that teaching was effective? Select all that apply.

1. "Quitting smoking will help to reduce my risk." 2. "I have to consider natural alternatives to dye my hair." 5. "I have to consult with my health care provider about long-term use of cyclophosphamide medications."

The nurse is taking a history from a client suspected of having testicular cancer. Which data will be most helpful in determining the risk factors for this type of cancer?

1. Age and race

The community health nurse conducts a health promotion program for community members regarding testicular cancer. The nurse determines that further information needs to be provided if a community member states that which is a sign of testicular cancer?

1. Alopecia

The nurse is performing a skin assessment on a client diagnosed with malignant melanoma. The nurse should expect to note which characteristic of this type of skin lesion?

1. An irregularly shaped lesion

A client who is receiving chemotherapy for breast cancer develops myelosuppression. Which instructions should the nurse include in the client's discharge teaching plan? Select all that apply.

1. Avoid contact sports. 2. Wash hands frequently. 4. Avoid crowded places such as shopping malls. 6. Avoid people who have received live attenuated vaccines.

A cervical radiation implant is placed in a client who is undergoing treatment of cervical cancer. The nurse should initiate which activity prescription as the most appropriate for this client?

1. Bed rest

The nurse is reviewing the laboratory test results for a client with bladder cancer with bone metastasis. The nurse should contact the health care provider (HCP) if which finding is noted?

1. Calcium level of 15 mg/dL (3.75 mmol/L)

The nurse is monitoring a client with chronic lymphocytic leukemia (CLL). Which sign should the nurse specifically monitor for and report to the health care provider?

4. Lymphadenopathy

The nurse has provided instructions to a client regarding testicular self-examination (TSE). Which client statement indicates the need for further teaching regarding TSE?

2. "I examine myself every 2 months."

The ambulatory care nurse is providing discharge instructions to a female client who underwent cryosurgery with laser therapy because of a positive Papanicolaou test. Which statement by the client indicates an understanding of the instructions?

2. "I should expect the vaginal discharge to be clear and watery."

Which statement made by a client who will undergo cytoreductive (debulking) surgery for ovarian cancer indicates that teaching by the nurse was effective?

2. "The surgery will help to reduce the size of the tumor."

The nurse is teaching a group of adults about the warning signs of cancer. Which signs and symptoms should the nurse mention to the group? Select all that apply.

2. Sores that do not heal 3. Nagging cough or hoarseness 4. Indigestion or difficulty swallowing 5. Change in bowel or bladder habits

A client with laryngeal cancer has undergone laryngectomy and is now receiving external radiation therapy to the head and neck. The nurse should monitor the client for which side and adverse effects of external radiation? Select all that apply.

2. Stomatitis 3. Dysgeusia 5. Xerostomia

The nurse is preparing to care for a client with a diagnosis of metastatic cancer. The nurse notes documentation in the client's chart that the client is experiencing cachexia. Which should the nurse expect to note on assessment of the client?

2. Sunken eyes and a hollow cheek appearance

The community health nurse is preparing an educational session for a group of women and will be discussing the primary prevention strategies and treatment measures for breast cancer. What information should the nurse include in the educational session?

2. Treatment decisions are based on a woman's overall health.

The nurse is providing discharge instructions to a client who has undergone treatment of cervical cancer with a radiation (cesium) implant. Which instruction should the nurse provide to the client?

2. Use a vaginal dilator 3 times a week.

The nurse is participating in a health screening clinic and is preparing teaching materials about colorectal cancer. Which risk factor for colorectal cancer should the nurse include?

4. Personal history of ulcerative colitis or gastrointestinal polyps

The nurse is caring for a client with metastatic breast cancer. The client describes a new and sudden sharp pain in the back. Based on this assessment finding, which is the priority nursing intervention?

3. Notify the health care provider (HCP).

The nurse is providing care to a client who has undergone modified right mastectomy for the treatment of breast cancer. Which activity should the nurse incorporate into the plan of care?

4. Maintain head of the bed elevation at 30 degrees with the right arm elevated on a pillow.

A client calls the ambulatory care clinic and tells the nurse that she found an area that looks like the peel of an orange when performing breast self-examination (BSE) but found no other changes. What is the nurse's best response to this client?

3. "I am glad you called to report this finding. Can you come to the clinic to see your health care provider tomorrow?"

The nurse is providing instructions to the client who is receiving external radiation therapy. Which statement, if made by the client, indicates the need for further instruction?

3. "I will use a washcloth to wash the affected area."

The home care nurse visits a client who has just returned home from the hospital after a mastectomy with a suction drain in place. Which observed client behavior requires a need for further teaching?

4. Performs full range-of-motion exercises to the upper arm

A client has been hospitalized for removal of a cervical radiation implant used to treat cancer. The implant is removed, and the nurse provides home care instructions to the client. Which statement made by the client indicates a need for further instruction?

4. "Foul-smelling vaginal discharge is a sign of an infection."

The nurse has provided instructions to a client receiving external radiation therapy. Which client statement would indicate a need for further instruction regarding self-care related to the radiation therapy?

4. "I need to apply pressure on the irritated area by wearing snug clothing to prevent bleeding."

The nurse is caring for a client with prostate cancer who is being treated with a hormone therapy. What should the nurse monitor for in order to evaluate the effect of this treatment?

4. A decline in the amount of circulating androgens

During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which manifestation as typical of the disease?

4. Abdominal distention

The nurse is performing an admission assessment of a client with a possible right colon tumor. Which sign or symptom should the nurse anticipate the client may report?

4. Dull abdominal pain exacerbated by walking

The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer, and tells the staff that which is a late sign or symptom of this oncological emergency?

4. Electrocardiographic changes

A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client?

4. Enlarged lymph nodes

The nurse is reviewing the medical record for a client who has been diagnosed with Hodgkin's disease. The nurse should check which diagnostic test noted in the client's record to determine the stage of the disease?

4. Positron emission topography (PET) scan

A 67-year-old man is receiving outpatient radiation treatments for carcinoma of the oropharynx and has developed dysphagia. The nurse develops a teaching plan regarding dysphagia and includes which interventions in the plan? Select all that apply.

4. Teach the man to examine his oral mucosa daily. 5. Encourage the man to use artificial saliva to manage dryness.

The oncology nurse specialist provides an educational session for nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further teaching is needed if a nursing staff member states that which is a characteristic of the disease?

4. The disease occurs most often in those older than 75 years of age.

A client with liver cancer who is receiving chemotherapy tells the nurse that some foods taste bitter. The nurse would try to limit which food that is most likely to cause this bitter taste for the client?

1. Pork

The nurse should include which intervention in the care of a client who has undergone a vaginal hysterectomy for the treatment of cancer? Select all that apply.

2. Encourage ambulation as prescribed. 3. Remove antiembolism stockings twice daily. 4. Assist with range-of-motion (ROM) leg exercises. 5. Check placement of pneumatic compression boots.

The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common sign or symptom of this type of cancer?

2. Hematuria

A client is admitted to the hospital with suspected bladder cancer. The nurse assesses the client for which early signs and symptoms of the disease?

2. Hematuria and absence of pain

The nurse is preparing a list of home care instructions regarding stoma and laryngectomy care for a client with laryngeal cancer who had a laryngectomy. Which instructions should be included in the list? Select all that apply.

2. Obtain a MedicAlert bracelet. 4. Prevent debris from entering the stoma. 5. Avoid exposure to people with infections. 6. Avoid swimming and use care when showering.

The nurse is reviewing the laboratory test results for a client with a diagnosis of leukemia who is receiving chemotherapy. The nurse notes that the client's platelet count is 20,000 mm3 (200 × 109/L). The nurse should prepare to implement which action based on this finding?

2. Remove the rectal thermometer from the client's room.

A client with leukemia is receiving busulfan and allopurinol. The nurse should tell the client that the purpose of the allopurinol is to prevent which symptom?

4. Hyperuricemia

The oncology nurse is providing a teaching session for a group of nursing students regarding the risks and causes of bladder cancer. Which statement by a student would indicate a need for further teaching?

1. "Bladder cancer most often occurs in women."

The community health nurse has conducted a teaching session for community members about the risk factors for laryngeal cancer. Which statement by a person attending the session indicates that teaching was effective?

1. "Exposure to airborne carcinogens can cause this type of cancer."

The nurse is reviewing the record of a client who was admitted to the hospital with a diagnosis of ovarian cancer. A client has received an unsealed radioactive isotope for treatment of thyroid cancer. Which instruction is essential for the nurse to provide the client?

1. "Flush the toilet at least 3 times after use."

The nurse is teaching a client who has had a laryngectomy for laryngeal cancer how to use an artificial larynx. Which statement should the nurse include in the teaching?

1. "Hold the device alongside the neck."

The nurse is doing preoperative teaching with a client newly diagnosed with a stage I cervical cancer. Which statement by the client indicates that education was effective?

1. "I have carcinoma that is just in the cervix."

A client is admitted to the nursing unit after undergoing radical prostatectomy for cancer. The nurse anticipates that which problem would be of most concern to the client in the immediate postoperative period?

1. Concern about the outcome of surgery

A client with bladder cancer has undergone surgical removal of the bladder with creation of an ileal conduit. Which assessment findings indicate that the client is developing complications? Select all that apply.

1. Dusky appearance of the stoma 2. Stoma protrusion from the skin 3. Sharp abdominal pain with rigidity

The nurse is caring for a client with lung cancer and bone metastasis. What signs and symptoms would the nurse recognize as indications of a possible oncological emergency? Select all that apply.

1. Facial edema in the morning 3. Serum calcium level of 12 mg/dL (3.0 mmol/L) 6. Numbness and tingling of the lower extremities

A woman has just been told by the health care provider that she has breast cancer. The woman responds, "Oh, no! Does this mean I'm going to die?" The nurse interprets the woman's initial reaction as which response?

1. Fear

The nurse is reviewing the record of a client admitted to the hospital with a diagnosis of Hodgkin's disease. Which assessment findings noted in the client's record are associated with this diagnosis? Select all that apply.

1. Fever 2. Weight loss 3. Night sweats 5. Enlarged, painless lymph nodes

The nurse is caring for a client who has undergone a radical neck dissection and creation of a tracheostomy because of laryngeal cancer and is providing discharge instructions to the client. Which should be included in the instructions? Select all that apply.

1. Protect the stoma from water. 2. Use a humidifier if dryness is a problem. 3. Keep powders and sprays away from the stoma site. 5. Apply a thin layer of non-oil-based ointment to the skin around the stoma to prevent cracking.

A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that the health care provider will request which prescriptions? Select all that apply.

1. Radiation 2. Chemotherapy 5. Serum sodium level determination 6. Medication that is antagonistic to antidiuretic hormone

A client with a medical diagnosis of breast cancer is undergoing chemotherapy. The client complains to the nurse about losing her hair and severe fatigue from the treatment. Which interventions should the nurse implement for this client? Select all that apply.

1. Review side effects of chemotherapy and treatment with the client. 3. Teach the client to pace activities with rest so as to maintain strength. 4. Offer information on available counseling services and support groups. 6. Inquire how the cancer diagnosis and treatment affect the client's normal routine.

The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. Which are risk factors for cervical cancer? Select all that apply.

1. Smoking 2. Multiple sex partners 3. Human papillomavirus infection 5. First intercourse before 17 years of age

The client is preparing for discharge from the hospital after radical vulvectomy. The nurse should include which activity as appropriate for the client immediately after discharge?

1. Walking

The nurse is reviewing the preoperative prescriptions for a client with a colon tumor who is scheduled for abdominal perineal resection and notes that the health care provider has prescribed neomycin for the client. After discussing a prescription for neomycin with the nursing student who is caring for the client, the nurse determines that the student understands the rationale for administration if which statement is made?

2. "It will help to decrease the bacteria in the bowel."

A client is having a diagnostic workup for colorectal cancer. Which factors in the client's history place the client at increased risk for this type of cancer? Select all that apply.

2. A diet high in fats 4. A diet high in carbohydrates 5. A history of inflammatory bowel disease

The community nurse is conducting a health promotion program, and the topic of the discussion relates to the risk factors for gastric cancer. Which item, if identified as a risk factor by a client, indicates a need for further discussion?

2. A low-fat diet

The clinic nurse has conducted a health screening clinic to identify clients who are at risk for cervical cancer. The nurse is reviewing the assessment findings in the records of the clients who attended the clinic. Which client is at lowest risk for developing this type of cancer?

2. A single white client

The nurse has conducted a cancer prevention seminar for clients in an ambulatory setting. The nurse determines that teaching was effective if the clients select which food item on the menu?

2. Broccoli, baked fish, mashed potato

The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is most appropriate?

2. Change the dressing as prescribed.

The nurse is admitting a client with laryngeal cancer to the nursing unit. What should the nurse assess for as the most common risk factor for this type of cancer?

2. Cigarette smoking

The community health nurse is creating a poster for an educational session for a group of women and will be discussing the risk factors associated with breast cancer. Which risk factors for breast cancer should the nurse list on the poster? Select all that apply.

2. Early menarche 4. Family history of breast cancer 5. High-dose radiation exposure to chest 6. Previous cancer of the breast, uterus, or ovaries

The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm?

2. Elevating the affected arm on a pillow above heart level

The nurse is reviewing the laboratory test results for a client receiving chemotherapy. The nurse notes that the white blood cell count is extremely low and places the client on neutropenic precautions. Which interventions are components of these types of precautions? Select all that apply.

2. Removing fresh-cut flowers from the client's room 4. Instructing family members on the proper technique for hand washing 5. Instructing family members to wear a mask when entering the client's room

The nurse conducted discharge teaching for the client diagnosed with melanoma. Which statement by a client indicates that education was effective?

3. "It is highly metastatic."

The home health care nurse is providing instructions to a client after a vulvectomy. Which instruction should the nurse provide to the client?

3. "Resume activities slowly, keeping in mind that walking is a beneficial activity."

The client reports to the nurse that while performing testicular self-examination, he found a lump the size and shape of a pea. Which statement is the most appropriate response to the client?

3. "That's important to report even though it might not be serious."

The nurse is caring for a client undergoing external radiation. The client has developed a dry desquamation of the skin in the treatment area, and the nurse is teaching about management of the skin reaction. Which comment made by the client suggests understanding of the instructions?

3. "When bathing I will use lukewarm water on the affected area."

The nurse is caring for a client with cancer of the prostate who has undergone a prostatectomy. Which action should the nurse include in discharge instructions?

3. Avoid lifting objects heavier than 20 lb (9 kg) for at least 6 weeks.

The nurse is caring for a client after intravesical instillation of an alkylating chemotherapeutic agent for the treatment of bladder cancer. What should the nurse instruct the client to do after the instillation?

3. Change position every 15 minutes.

Which interventions are the most appropriate for a client who is experiencing thrombocytopenia? Select all that apply.

3. Check secretions for frank or occult blood. 5. Encourage fluid intake to avoid constipation. 6. Provide oral sponges or a soft toothbrush for oral care.

A community health nurse is providing an educational session on cancer of the cervix for women living in the community. The nurse informs the community residents that which is an early sign of this type of cancer?

3. Irregular vaginal bleeding or spotting

A client seeks treatment in an ambulatory clinic for a complaint of hoarseness that has lasted for 6 weeks. On the basis of this symptom, the nurse should consider developing a plan of care for which possible medical diagnosis?

3. Laryngeal cancer