Cancer & Oncology Nursing NCLEX Practice Quiz 4
The home health nurse is caring for a patient who has been receiving interferon therapy for the treatment of cancer. Which statement by the patient may indicate a need for a change in treatment? a) "I rarely have the energy to get out of bed." b) "I experience chills after I inject the interferon." c) "I take acetaminophen (Tylenol) every 4 hours." d) "I have frequent muscle aches and pains."
a) "I rarely have the energy to get out of bed." - Correct Answer: A. "I rarely have the energy to get out of bed." Option A: Fatigue can be dose-limiting toxicity for use of biologic therapies. Options B and D: Flu-Like symptoms, such as muscle aches and chills, are common side effects of interferon use. Option D: Patients are advised to use Tylenol every 4 hours.
A 40-year-old divorced mother of four school-age children is hospitalized with metastatic cancer of the ovary. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is a) "Why don't we talk about the options you have for the care of your children?" b) "Many patients with cancer live for along time, so there is time to plan for your children." c) "For now you need to concentrate on getting well, not worry about your children." d) "Perhaps your ex-husband will take the children when you can't care for them."
a) "Why don't we talk about the options you have for the care of your children?" - Correct Answer: A. "Why don't we talk about the options you have for the care of your children?" Option A: This response expresses the nurse's willingness to listen and recognizes the patient's concern. Options B and C: The responses beginning "Many patients with cancer live for a long time" and "For now you need to concentrate on getting well" close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Option D: Although it is possible that the patient's ex-husband will take the children, more assessment information is needed before making plans.
A 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg) tells the nurse that she has a glass of wine two or three times a week. The patient works for the post office and has a 5-mile mail-delivery route. This is her first contact with the health care system in 20 years. Which of these topics will the nurse plan to include in patient teaching about cancer? Select all that apply a) Mammography b) Physical activity c) Body weight d) Colorectal screening e) Tobacco use f) Alcohol use g) Pap testing h) sunscreen use
a) Mammography d) Colorectal screening g) Pap testing h) Sunscreen use - Correct Answer: A, D, G, and H Options A, D, G, and H: The patient's age, gender, and history indicate a need for teaching about or screening or both for colorectal cancer, mammography, Pap smears, and sunscreen. Options B, C, E, and F: The patient does not use excessive alcohol or tobacco, she is physically active, and her body weight is healthy
A patient receiving head and neck radiation and systemic chemotherapy has ulcerations over the oral mucosa and tongue and thick, ropey saliva. An appropriate intervention for the nurse to teach the patient is to a) Rinse the mouth before and after each meal and at bedtime with a saline solution b) Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth c) Gargle and rinse the mouth several times a day with an antiseptic mouthwash d) Remove food debris from the teeth and oral mucosa with a stiff toothbrush
a) Rinse the mouth before and after each meal and at bedtime with a saline solution - Correct Answer: A. Rinse the mouth before and after each meal and at bedtime with a saline solution Option A: The patient should rinse the mouth with a saline solution frequently to decrease the pain and to cleanse the wounds. Option B: Hydrogen peroxide may damage tissues. Option C: Antiseptic mouthwashes may irritate the oral mucosa and are not recommended. Option D: A soft toothbrush is used for oral care.
After the nurse has explained the purpose of and schedule for chemotherapy to a 23-year-old patient who recently received a diagnosis of acute leukemia, the patient asks the nurse to repeat the information. Based on this assessment, which nursing diagnosis is most likely for the patient? a) Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis b) Knowledge deficit: chemotherapy-related to a lack of interest in learning about treatment c) Risk for ineffective adherence to treatment related to denial of the need for chemotherapy d) Acute confusion related to infiltration of leukemia cells into the central nervous system
a) Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis - Correct Answer: A. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis Option A: The patient who has a new cancer diagnosis is likely to have high anxiety, which may impact learning and require that the nurse repeat and reinforce information. Options B and C: The patient asks for the information to be repeated, indicating that lack of interest in learning and denial are not etiologic factors. Option D: The patient's history of a recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the confusion.
When the nurse is administering a vesicant chemotherapeutic agent intravenously, an important consideration is to a) Stop the infusion if swelling is observed at the site b) Infuse the medication over a short period c) Administer the chemotherapy through a small-bore catheter d) Hold the medication unless a central venous line is available
a) Stop the infusion if swelling is observed at the site - Correct Answer: A. Stop the infusion if swelling is observed at the site Option A: Swelling at the site may indicate extravasation, and the IV should be stopped immediately. Option B: The medication should generally be given slowly to avoid irritation of the vein. Option C: The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapy drug. Option D: These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred.
Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider? a) WBC count of 1700/ul b) Platelets of 65,000/ul c) Hemoglobin of 10 g/L d) Serum creatinine level of 1.2 mg/dL
a) WBC count of 1700/ul - Correct Answer: A. WBC count of 1700/µl Option A: Neutropenia places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that white blood cell (WBC) growth factors such as filgrastim (Neupogen) are needed. Options B, C, and D: The other laboratory data do not indicate any immediate life-threatening adverse effects of the chemotherapy.
A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin's lymphoma. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the nurse to the patient's concerns is a) "Radiation does not cause the problems with sexual functioning that occur with chemotherapy or surgical procedures used to treat cancer." b) "It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children." c) "The radiation will make you sterile, but your ability to have sexual intercourse will not be changed by the treatment." d) "You may have some temporary impotence during the course of the radiation but normal sexual function will return."
b) "It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children." - Correct Answer: B. "It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children." Option B: The impact on sperm count and erectile function depend on the patient's pretreatment status and on the amount of exposure to radiation. The patient should consider sperm donation before radiation. Options A, C, and D: Radiation (like chemotherapy or surgery) may affect both sexual function and fertility either temporarily or permanently.
A chemotherapeutic agent is known to cause alopecia is prescribed for a patient. To maintain the patient's self-esteem, the nurse plans to a) Suggest that the patient limit social contacts until regrowth of the hair occurs b) Encourage the patient to purchase a wig or hat and wear it once hair loss begins c) Have the patient was the hair gently with a mild shampoo to minimize hair loss d) Inform the patient that hair loss will not be permanent and that the hair will grow back
b) Encourage the patient to purchase a wig or hat and wear it once hair loss begins - Correct Answer: B. Encourage the patient to purchase a wig or hat and wear it once hair loss begins Option B: The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Option A: Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. Option C: The damage occurs at the hair follicle and will occur regardless of gentle washing or use of a mild shampoo. Option D: The information that the hair will grow back is not immediately helpful in maintaining the patient's self-esteem.
Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is to a) Protect normal kidney cells from the damaging effects of chemotherapy b) Enhance the pt's immunologic response to tumor cells c) Stimulate malignant cells in the resting phase to enter mitosis d) Prevent the bone marrow depression caused by chemotherapy
b) Enhance the pt's immunologic response to tumor cells - Correct Answer: B. Enhance the patient's immunologic response to tumor cells Option B: IL-2 is a naturally occurring protein that is made by a T-lymphocyte which functions to enhance the growth and activity of other white blood cells. The purpose of this therapy is to enhance the ability of the patient's own immune response to suppress tumor cells. Options A, C, and D: IL-2 does not protect normal cells from damage caused by chemotherapy, stimulate malignant cells to enter mitosis, or prevent bone marrow depression.
A patient with ovarian cancer tells the nurse, "I don't think my husband cares about me anymore. He rarely visits me." On one occasion when the husband was present, he told the nurse he just could not stand to see his wife so ill and never knew what to say to her. An appropriate nursing diagnosis in this situation is a) Risk for caregiver role strain related to burdens of caregiving responsibilities b) Interrupted family process related to the effect of illness on family members c) Compromised family coping related to disruption in lifestyle and role changes d) Impaired home maintenance related to perceived role changes
b) Interrupted family process related to the effect of illness on family members - Correct Answer: B. Interrupted family processes related to the effect of illness on family members Option B: The data indicate that this diagnosis is most appropriate because the family members are impacted differently by the patient's cancer diagnosis. Options A and C: There are no data to suggest a change in lifestyle or role as an etiology. Option D: The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities.
A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the RN caring for the patient indicates that the nurse should take action? a) The patient ambulates several times a day in the room b) The patient's visitors bring in some fresh peaches from home c) The patient uses soap and shampoo to shower every other day d) The patient cleans with a warm washcloth after having a stool
b) The patient's visitors bring in some fresh peaches from home - Correct Answer: B. The patient's visitors bring in some fresh peaches from home Option B: Fresh, thinned-skin peaches are not permitted in a neutropenic diet because of the risk of bacteria being present. Option A: The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Option C: Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Option D: Careful cleaning after having a bowel movement will help to prevent perineal skin breakdown and infection.
The nurse has identified the nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation in a patient with lung cancer who has had a 10% loss in weight. An appropriate nursing intervention that addresses the etiology of this problem is to a) Add strained baby meats to foods such as soups and casseroles b) Provide foods that are highly spiced to stimulate the taste buds c) Avoid presenting foods for which the patient has a strong dislike d) Teach the patient to eat whatever is nutritious since food is tasteless
c) Avoid presenting foods for which the patient has a strong dislike - Correct Answer: C. Avoid presenting foods for which the patient has a strong dislike Option C: The patient will eat more if disliked foods are avoided and foods that patient likes are included instead. Option A: Adding baby meats to foods will increase calorie and protein levels, but does not address the issue of taste. Option B: Additional spice is not usually an effective way to enhance the taste. Option D: Patients will not improve intake by eating foods that are beneficial but have an unpleasant taste.
A patient who is receiving interleukin-2 (IL-2) therapy (Proleukin) complains to the nurse about all of these symptoms. Which one is most important to report to the health care provider? a) Decreased appetite b) Generalized aches c) Dyspnea d) Insomnia
c) Dyspnea - Correct Answer: C. Dyspnea Option C: Dyspnea may indicate capillary leak syndrome and pulmonary edema, which requires rapid treatment. Options A, B, and D: The other symptoms are common with IL-2 therapy, and the nurse should teach the patient that these are common adverse effects that will resolve at the end of the therapy.
When assessing a patient's needs for psychologic support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information? a) "How do you feel about having a possibly terminal illness?" b) "How long ago were you diagnosed with this cancer?" c) "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?" d) "Can you tell me what has been helpful to you in the past when coping with stressful events?"
d) "Can you tell me what has been helpful to you in the past when coping with stressful events?" - Correct Answer: D. "Can you tell me what has been helpful to you in the past when coping with stressful events?" Option D: Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. Option A: The patient with stage I cancer is not considered to have a terminal illness at this time, and this question is likely to worry the patient unnecessarily. Option B: The length of time since the diagnosis will not provide much information about the patient's need for support. Option C: The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient's needs for assistance.
A bone marrow transplant is being considered for the treatment of a patient with acute leukemia that has not responded to chemotherapy. In discussing the treatment with the patient, the nurse explains that a) Donor bone marrow cells are transplanted immediately after an infusion of chemotherapy b) The transplant procedure takes place in a sterile operating room to minimize the risk for infection c) The transplant of the donated cells is painful because of the nerves in the tissue lining the bone d) Hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT)
d) Hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT) - Correct Answer: D. Hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT) Option D: The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. Option A: The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to the transplanted cells by the chemotherapy drugs. Options B and C: The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room required.
The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective? a) Fresh fruit salad b) Orange sherbet c) French fries d) Strawberry yogurt
d) Strawberry yogurt - Correct Answer: D. Strawberry yogurt Option D: Yogurt has high biologic value because of the protein and fat content. Option A: Fruit salad does not have high amounts of protein or fat. Option B: Orange sherbet is lower in fat and protein than yogurt. Option C: French fries are high in calories from fat but low in protein.
A patient who has terminal cancer of the liver and is cared for by family members at home tells the nurse, "I have intense pain most of the time now." The nurse recognizes that teaching regarding pain management has been effective when the patient a) States that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief b) Uses the ordered opioid pain medication whenever the pain is greater than 5 on a 10-point scale c) Agrees to take the medications by the IV route to improve the effectiveness d) Takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs
d) Takes opioids around the clock on a regular schedule and uses additional doses when breaththrough pain occurs - Correct Answer: D. Takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs Option D: For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain. Option A: Although nonopioid analgesics may also be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved. Option B: Taking the medications only when pain reaches a certain level does not provide effective pain control. Option C: The IV route is not more effective than the oral route and the oral route is preferred.
Which action by a nursing assistant (NA) when caring for a patient who has pancytopenia indicates a need for the nurse to intervene? a) The NA adds baking soda to the patient's saline oral rinses b) The NA makes an oral rinse using 1 teaspoon of salt in a liter of water c) The NA puts fluoride toothpaste on the patient's toothbrush d) The NA assists the patient to use dental floss after eating
d) The NA assists the patient to use dental floss after eating - Correct Answer: D. The NA assists the patient to use dental floss after eating Option D: The use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. Options A, B, and C: The other actions are appropriate for oral care of a patient with pancytopenia.
A with tumor lysis syndrome (TLS) is taking Zyloprim (allopurinol). Which laboratory value should the nurse monitor to determine the effectiveness of the medication? a) Blood urea nitrogen (BUN) b) Serum phosphate c) Serum potassium d) Uric Acid Level
d) Uric Acid Level - Correct Answer: D. Uric acid level Option D: Allopurinol is used to decrease uric acid levels so a monitoring of serum uric acid is essential. Options A, B, and C: UN, potassium, and phosphate levels are also increased in TLS but are not affected by allopurinol therapy.
