Cancer NCLEX style questions
The nurse has provided teaching for an adult client about screening for colon cancer. Which statement by the client indicates that education was *effective*? A) "I should have an annual fecal occult blood test." B) "I should have an annual colonoscopy when I become 60." C) "I will have a colonoscopy before the fecal occult blood test." D) "I will not need to have further fecal occult blood tests after a colonoscopy."
A) "I should have an annual fecal occult blood test." (Fecal occult blood testing for colorectal cancer should be done annually for both men and women. Less invasive diagnostic testing such as a fecal occult blood test will be performed first. Colonoscopy is done at age 50 and then every 10 years)
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? A) "It is all right to use a straight razor to shave under my arms." B) "I must be sure to use thick potholders when I am cooking." C) "I must be sure not to have blood pressures taken or blood drawn from my right arm." D) "I should inform all of my other health care providers that I have had this surgical procedure."
A) "It is all right to use a straight razor to shave under my arms." (After mastectomy with axillary lymph node dissection, the client is at risk for arm edema and infection. The client should be instructed regarding home care measures to prevent these complications. The client should be told to avoid activities such as carrying heavy objects or having blood pressure measurements taken on the affected arm. The client also should be instructed in the techniques to avoid trauma to the affected arm, such as using an electric razor to shave under the arms, using gloves when working in the garden, and using or wearing thick potholders when cooking)
The nurse is caring for a client with a diagnosis of breast cancer who is immunosuppressed. The nurse would consider implementing neutropenic precautions if the client's white blood cell count was which value? A) 2000 mm3 (2.0 × 109/L) B) 5800 mm3 (5.8 × 109/L) C) 8400 mm3 (8.4 × 109/L) D) 11,500 mm3 (11.5 × 109/L)
A) 2000 mm3 (2.0 × 109/L) (The normal WBC count ranges from 5000 to 10,000 mm3 (5 to 10 × 109/L). The client who has a decrease in the number of circulating WBCs is immunosuppressed. The nurse implements neutropenic precautions when the client's values fall sufficiently below the normal level. The specific value for implementing neutropenic precautions usually is determined by agency policy. The remaining options are normal values)
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? A) Age younger than 50 years B) History of colorectal polyps C) Family history of colorectal cancer D) Chronic inflammatory bowel disease
A) Age younger than 50 years (Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease)
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. A) Avoid contact sports. B) Wash hands frequently. C) Increase intake of fresh fruits and vegetables. D) Avoid crowded places such as shopping malls. E) Treat a sore throat with over-the-counter products. F) Avoid people who have received live attenuated vaccines.
A) Avoid contact sports. B) Wash hands frequently. D) Avoid crowded places such as shopping malls. F) Avoid people who have received live attenuated vaccines. (Effective measures should be used to protect the client from infection and bleeding. A variety of interventions are essential to keep the client who is receiving chemotherapy safe. Live attenuated vaccines can easily infect clients with myelosuppression, and crowded places usually have people who are sick and coughing and sneezing, which can easily cause illness in myelosuppressed clients. Contact sports can result in injury or bleeding, and hand washing is the mainstay of asepsis and protection from infection. The client with myelosuppression should not eat fresh fruits and vegetables because of the risk of contamination or infection. All foods should be thoroughly cooked. Option 5 is incorrect because many over-the-counter products contain acetaminophen or aspirin, which could potentially mask an elevated temperature. Additionally, aspirin is an antiplatelet and can cause bleeding. Clients receiving chemotherapy should not take any other medications without direction from the primary health care provider)
A) Review side effects of chemotherapy and treatment with the client. B) Teach the client how to resolve specific concerns of her personal life. C) Teach the client to pace activities with rest so as to maintain strength. D) Offer information on available counseling services and support groups. E) Tell the client about some other clients who have had breast cancer treatment. F) Inquire how the cancer diagnosis and treatment affect the client's normal routine.
A) Review side effects of chemotherapy and treatment with the client. C) Teach the client to pace activities with rest so as to maintain strength. D) Offer information on available counseling services and support groups. F) Inquire how the cancer diagnosis and treatment affect the client's normal routine. (It is not therapeutic nor is it the nurse's role to teach the client how to resolve specific concerns of her personal life. The nurse should determine how the cancer diagnosis and treatment are affecting the client's normal routine, and the client should be aware of potential side effects of treatment so as to cope with the events with medications or other measures. It is important for the nurse to inform clients about support groups available (e.g., Reach for Recovery) so the client does not feel isolated. Teaching clients to pace activities even when they feel well will conserve energy so they ultimately feel stronger and less fatigued. It is a breach of confidentiality and the Health Insurance Portability and Accountability Act (HIPAA) laws for the nurse to discuss other clients and their medical problems)
The nurse is caring for a client on the oncology unit who has developed stomatitis during chemotherapy for treatment of breast cancer. The nurse should plan which measure to treat this complication? A) Rinse the mouth with diluted baking soda or saline. B) Use lemon and glycerin swabs liberally on painful oral lesions. C) Brush the teeth and use non-waxed dental floss at least twice a day. D) Place the client on NPO (nothing by mouth) status for 12 hours, and then resume liquids.
A) Rinse the mouth with diluted baking soda or saline (Stomatitis, or mouth ulcerations, occurs with the administration of many antineoplastic medications. The client's mouth should be examined daily for signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with baking soda or saline. Lemon and glycerin swabs may cause pain and further irritation. The client should avoid brushing the teeth and flossing when stomatitis is severe. Food and fluids are important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet. Instruct the client to avoid spicy foods and foods with hard crusts or edges)
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? A) Under the left scapula B) Under the left shoulder C) Under the right shoulder D) Under the small of the back
C) Under the right shoulder (The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the right breast is to be examined, the pillow would be placed under the right shoulder and vice versa. Therefore, options 1, 2, and 4 are incorrect)
The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication to treat breast cancer. During the infusion, the client complains of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and should take which actions? Select all that apply. A) Stop the infusion. B) Prepare to apply ice or heat to the site. C) Notify the primary health care provider (PHCP). D) Restart the IV at a distal part of the same vein. E) Prepare to administer a prescribed antidote into the site. F) Increase the flow rate of the solution to flush the skin and subcutaneous tissue.
A) Stop the infusion. B) Prepare to apply ice or heat to the site. C) Notify the primary health care provider (PHCP). E) Prepare to administer a prescribed antidote into the site. (Redness and swelling and a slowed infusion indicate signs of extravasation. If the nurse suspects extravasation during the IV administration of an antineoplastic medication, the infusion is stopped and the PHCP is notified. Ice or heat may be prescribed for application to the site and an antidote may be prescribed to be administered into the site. Increasing the flow rate can increase damage to the tissues. Restarting an IV in the same vein can increase damage to the site and vein)
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? A) The client looks at the surgical site. B) The client performs the prescribed arm exercises. C) The client takes the pain medication as prescribed. D) The client has read all of the postoperative materials provided by the hospital nurse.
A) The client looks at the surgical site. (Of the options provided, the client behavior in the correct option demonstrates the greatest adaptation or adjustment (looking at the surgical site). This indicates that the client has acknowledged and is beginning to cope with the loss of the breast. Reading postoperative care booklets and performing prescribed exercises indicate an interest in self-care and are positive signs indicating adjustment. Taking pain medication is not related to adjustment to the loss of the breast)
A woman has just been told by the primary 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? A) fear B) rage C) denial D) anxiety
A) fear (The woman's reaction is one of fear. The woman has verbalized the object of fear (dying), which makes anxiety incorrect. There is no evidence of rage or denial in the woman's statement)
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. A) A high-fiber diet B) A diet high in fats C) Minimal alcohol intake D) A diet high in carbohydrates E) A history of inflammatory bowel disease F) A maternal grandfather who had a history of heart disease
B) A diet high in fats D) A diet high in carbohydrates E) A history of inflammatory bowel disease (A high-fiber diet actually lessens the chances of developing colorectal cancer. This type of cancer most often occurs in populations with diets low in fiber and high in refined carbohydrates, fats, and meats. Other risk factors include a family history of the disease, rectal polyps, and active inflammatory disease of at least 10 years' duration)
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? A) After menses B) Before menses C) During menses D) At any time, regardless of the menstrual cycle
B) Before menses (The nurse assesses the client with fibrocystic breast disorder for worsening of symptoms (breast lumps, painful breasts, and possible nipple discharge) before the onset of menses. This is associated with cyclical hormone changes. Therefore, the other options are incorrect)
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. A) Multiparity B) Early menarche C) Early menopause D) Family history of breast cancer E) High-dose radiation exposure to chest F) Previous cancer of the breast, uterus, or ovaries
B) Early menarche D) Family history of breast cancer E) High-dose radiation exposure to chest F) Previous cancer of the breast, uterus, or ovaries (Risk factors for breast cancer include nulliparity or first child born after age 30 years; early menarche; late menopause; family history of breast cancer; high-dose radiation exposure to the chest; and previous cancer of the breast, uterus, or ovaries. In addition, specific inherited mutations in BReast CAncer (BRCA)1 and BRCA2 increase the risk of female breast cancer; these mutations are also associated with an increased risk for ovarian cancer)
The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? A) Placing cool compresses on the affected arm B) Elevating the affected arm on a pillow above heart level C) Avoiding arm exercises in the immediate postoperative period D) Maintaining an intravenous site below the antecubital area on the affected side
B) Elevating the affected arm on a pillow above heart level (Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring)
The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide (cytotoxic medication). The nurse should tell the client to take which action? A) Take the medication with food. B) Increase fluid intake to 2000 to 3000 mL daily. C) Decrease sodium intake while taking the medication. D) Increase potassium intake while taking the medication.
B) Increase fluid intake to 2000 to 3000 mL daily. (Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake)
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? A) Older women are more likely to get mammograms. B) Treatment decisions are based on a woman's overall health. C) Women younger than age 65 are more likely to get breast cancer. D) A woman's age is the main factor used to decide which screening methods to use.
B) Treatment decisions are based on a woman's overall health. (Breast cancer occurs most often in women who are 65 years of age or older, and older women are less likely to have mammograms. Rather than using the woman's age to decide on screening and treatment measures, the woman's overall health is used to make these determinations, since health status has a greater influence on tolerance to treatment)
A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? A) glucose level B) calcium level C) potassium level D) prothrombin time
B) calcium level (Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium level should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain)
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? A) "Good job performing your BSE. I am sure that is nothing to be concerned about." B) "Make sure you tell the primary health care provider about your finding at the next regularly scheduled visit." C) "I am glad you called to report this finding. Can you come to the clinic to see your primary health care provider tomorrow?" D) "Do you have a thermometer? You need to take your temperature and call back if you have a fever over 101º F (38.3º C)."
C) "I am glad you called to report this finding. Can you come to the clinic to see your primary health care provider tomorrow?" (Peau d'orange or orange peel appearance of the skin over the breast is associated with late breast cancer. Therefore, the nurse would arrange for the client to come to the clinic as soon as possible. Peau d'orange is not indicative of an infection)
Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement? A) "This medication can be used only to treat breast cancer." B) "Yes, your family member can take this medication for bladder cancer as well." C) "This medication can be taken to prevent and treat clients with breast cancer." D) "This medication can be taken by anyone with cancer as long as their health care provider approves it."
C) "This medication can be taken to prevent and treat clients with breast cancer." (Tamoxifen is an *antineoplastic medication* that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy and for preventing breast cancer in those that are at high risk)
A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication to treat breast cancer. When implementing the plan, the nurse should make which statement to the client? A) "You can take aspirin as needed for headache." B) "You can drink beverages containing alcohol in moderate amounts each evening." C) "You need to consult with the primary health care provider (PHCP) before receiving immunizations." D) "It is fine to receive a flu vaccine at the local health fair without PHCP approval because the flu is so contagious."
C) "You need to consult with the primary health care provider (PHCP) before receiving immunizations." (Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without the PHCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side/adverse effects)
A client with colon cancer has received a course of chemotherapy with fluorouracil (antimetabolite). The nurse should tell the client to report which finding immediately? A) Alopecia B) Headache C) Stomatitis and diarrhea D) Changes in color vision
C) Stomatitis and diarrhea (Fluorouracil should be discontinued as soon as reactions (stomatitis, diarrhea) occur. Dosage can also be limited by palmar-plantar erythrodysesthesia syndrome (also called hand-foot syndrome), characterized by tingling, burning, redness, flaking, swelling, and blistering of the palms and soles. Alopecia is common and would not require immediate reporting. Headache and vision changes are not associated with fluorouracil)
The nurse in the primary 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? A) These sensations are signs of a complication. B) These sensations probably will be permanent. C) These sensations dissipate over several months and usually resolve after 1 year. D) It is nothing to worry about because most women who have this type of surgery experience this problem.
C) These sensations dissipate over several months and usually resolve after 1 year. (Numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow occurs in most women after mastectomy. It is a result of injury to the nerves that provide sensation to the skin in those areas. These sensations may be described as heaviness, pain, tingling, burning, or "pins and needles." These sensations dissipate over several months and usually resolve by 1 year after surgery. These sensations are not a sign of a complication and are not permanent. The nurse would not tell the client that a complaint is nothing to worry about because this is nontherapeutic and avoids the client's concern)
A female client with carcinoma of the breast is admitted to the hospital for treatment with intravenously administered doxorubicin. The client tells the nurse that she has been told by her friends that she is going to lose all her hair. What is the most appropriate nursing response? A) "Your friends are correct." B) "You will not lose your hair." C) "Hair loss may occur, but it will grow back just as it is now." D) "Hair loss may occur, and it will grow back, but it may have a different color or texture."
D) "Hair loss may occur, and it will grow back, but it may have a different color or texture." (Alopecia (hair loss) can occur after the administration of many antineoplastic medications. Alopecia is reversible, but the new hair growth may have a different color and texture. Therefore, options 1, 2, and 3 are incorrect)
The nurse is giving client instructions over the telephone about preparing for a mammography. The nurse should make which statement to the client? A) "Wear metal jewelry as desired." B) "Consume clear liquids only on the day of the test." C) "Use only lanolin-based skin lotions on the day of the test." D) "If possible, avoid using underarm deodorant on the day of the test."
D) "If possible, avoid using underarm deodorant on the day of the test." (The client should avoid the use of lotions or underarm deodorant on the day of mammography because this can affect breast and axilla positioning and obtaining clear mammography pictures. At the mammography suite, the client may also be asked to clean the underarms with the provided wipes. Mammography is a type of radiographic procedure. Therefore, the client is advised not to wear jewelry or metal objects on the day of the test. No special dietary preparation is needed)
The nurse is caring for a client diagnosed with breast cancer receiving combination chemotherapy. Which nursing intervention is the *most appropriate*? A) Give 2 agents from the same medication class. B) Give 2 agents with like nadirs at the same time. C) Test the client's knowledge about each agent's nadir. D) Avoid giving agents with the same nadirs and toxicities at the same time.
D) Avoid giving agents with the same nadirs and toxicities at the same time. (Each chemotherapeutic agent has a specific nadir. Chemotherapy agents are usually given in combinations (also called regimens or protocols). The goal of administering combination chemotherapy in cycles or specific sequences is to produce additive or synergistic therapeutic effects. Administering several medications with different mechanisms of action and different onsets of nadirs and toxicities enhances tumor cell destruction while minimizing medication resistance and overlapping toxicities)
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? A) Keep suction drains fully inflated to provide adequate suction. B) Perform venipunctures and blood pressures on the operative side only. C) Inform the client that drains will be removed on the second postoperative day. D) Maintain head of the bed elevation at 30 degrees with the right arm elevated on a pillow
D) Maintain head of the bed elevation at 30 degrees with the right arm elevated on a pillow (The client should have the head of the bed elevated at least 30 degrees with the affected arm elevated on a pillow. Keeping the affected arm elevated promotes lymphatic fluid return after removal of lymph nodes and channels. Gentle suction must be maintained on the drain bulb to prevent fluid accumulation at the operative site. With short hospital stays, drainage tubes are usually removed about 1 to 3 weeks after hospital discharge when the client returns for an office visit. All staff must avoid using the affected arm for measuring blood pressure, giving injections, or drawing blood)
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? A) Document the findings. B) Administer pain medication. C) Place a heating pad on the client's back. D) Notify the primary health care provider (PHCP)
D) Notify the primary health care provider (PHCP) (*Spinal cord compression* should be suspected in a client with metastatic disease, particularly with sudden onset of new back pain. Spinal cord compression causes back pain before neurological changes occur. Spinal cord compression constitutes an *oncological emergency*, so the PHCP should be notified. Although the nurse would document this finding, this is not the priority action. The nurse would not administer pain medication or place a heating pad on the client unless the cause of the new pain has been determined. In addition, a prescription from the PHCP is needed for the use of a heating pad)
The community health nurse is instructing a group of young female clients about breast self-examination. The nurse should instruct the clients to perform the examination at which time? A) At the onset of menstruation B) Every month during ovulation C) Weekly at the same time of day D) One week after menstruation begins
D) One week after menstruation begins (The breast self-examination should be performed regularly, 7 days after the onset of the menstrual period. Performing the examination weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue)
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? A) Refusing to look at the wound B) Reading the postoperative care booklet C) Asking for pain medication when needed D) Participating in the care of the surgical drain
D) Participating in the care of the surgical drain (The client demonstrates the best adaptation by participating in her own care. This would include care of surgical drains that are in place for a short time after discharge. Refusing to look at the wound indicates no adaptation to the loss. Reading the postoperative care booklet is useful but is not the best of the options presented here. Asking for pain medication is an action-oriented option, but it does not relate to acceptance of the loss of the breast)
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? A) Empties the drain to prevent infection B) Elevates the arm when lying and sitting C) Applies lotion to the area after the incision heals D) Performs full range-of-motion exercises to the upper arm
D) Performs full range-of-motion exercises to the upper arm (The client should be instructed to limit upper arm range-of-motion exercises to the level of the shoulder only. Once the suction drain has been removed, the client can begin full range-of-motion exercises to the upper arm as prescribed. The client should elevate the arm while sitting down or lying, and the client will be able to apply lotion to the incision once it has healed. The drain is emptied as needed)
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? A) High-fiber, low-fat diet B) Age older than 30 years C) Distant relative with colorectal cancer D) Personal history of ulcerative colitis or gastrointestinal polyps
D) Personal history of ulcerative colitis or gastrointestinal polyps (Common risk factors for colorectal cancer include age older than 40 years; first-degree relative with colorectal cancer; high-fat, low-fiber diet; and history of bowel problems, such as ulcerative colitis or familial polyposis)
