NCLEX Cancer Practice Questions

2. A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan (select all that apply)? a. Cook food thoroughly before eating. b. Choose low fiber, low residue foods. c. Avoid public transportation such as buses. d. Use rectal suppositories if needed for constipation. e. Talk to the oncologist before having any dental work.

ANS: A, C, E Eating only cooked food and avoiding public transportation will decrease infection risk. A high-fiber diet is recommended for neutropenic patients to decrease constipation. Because bacteria may enter the circulation during dental work or oral surgery, the patient may need to postpone dental work or take antibiotics. DIF: Cognitive Level: Apply (application) REF: 253 TOP: Nursing Process: Planning MSC: NCLEX:

15. The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a. Infuse the medication over a short period of time. b. Stop the infusion if swelling is observed at the site. c. Administer the chemotherapy through a small-bore catheter. d. Hold the medication unless a central venous line is available.

ANS: B Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication generally should be given slowly to avoid irritation of the vein. 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. These medications can be given through peripheral lines, although central vascular access devices are preferred. DIF: Cognitive Level: Analyze (analysis) REF: 246 TOP: Nursing Process: Implementation MSC: NCLEX:

25. 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. Lime sherbet c. Fresh strawberries b. Blueberry yogurt d. Cream cheese bagel

ANS: B Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Lime sherbet is lower in fat and protein than yogurt. Cream cheese is low in protein. DIF: Cognitive Level: Apply (application) REF: 261 TOP: Nursing Process: Evaluation MSC: NCLEX:

13. A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about the management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective? a. "I can use ice packs to relieve itching." b. "I will scrub the area with warm water." c. "I can buy aloe vera gel to use on my skin." d. "I will expose my skin to a sun lamp each day."

ANS: C Aloe vera gel and cream may be used on the radiated skin area. Ice and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury. DIF: Cognitive Level: Apply (application) REF: 255 TOP: Nursing Process: Evaluation MSC: NCLEX:

2. The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect? a. Nausea c. Hematuria b. Alopecia d. Xerostomia

ANS: C The adverse effects of intravesical chemotherapy are confined to the bladder. The other adverse effects are associated with systemic chemotherapy. DIF: Cognitive Level: Apply (application) REF: 252 TOP: Nursing Process: Evaluation MSC: NCLEX:

1. A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is correct? a. "Benign tumors do not cause damage to other tissues." b. "Benign tumors are likely to recur in the same location." c. "Malignant tumors may spread to other tissues or organs." d. "Malignant cells reproduce more rapidly than normal cells."

ANS: C The major difference between benign and malignant tumors is that malignant tumors invade adjacent tissues and spread to distant tissues and benign tumors do not metastasize. The other statements are inaccurate. Both types of tumors may cause damage to adjacent tissues. Malignant cells do not reproduce more rapidly than normal cells. Benign tumors do not usually recur. DIF: Cognitive Level: Understand (comprehension) REF: 240 TOP: Nursing Process: Implementation MSC: NCLEX:

40. An older adult patient who has colorectal cancer is receiving IV fluids at 175 mL/hr in conjunction with the prescribed chemotherapy. Which finding by the nurse is most important to report to the health care provider? a. Patient complains of severe fatigue. b. Patient voids every hour during the day. c. Patient takes only 50% of meals and refuses snacks. d. Patient has crackles up to the midline posterior chest.

ANS: D Rapid fluid infusions may cause heart failure, especially in older patients. The other findings are common in patients who have cancer or are receiving chemotherapy. DIF: Cognitive Level: Analyze (analysis) REF: 266 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX:

36. Which action should the nurse take when caring for a patient who is receiving chemotherapy and complains of problems with concentration? a. Teach the patient to rest the brain by avoiding new activities. b. Teach that "chemo-brain" is a short-term effect of chemotherapy. c. Report patient symptoms immediately to the health care provider. d. Suggest use of a daily planner and encourage adequate rest and sleep.

ANS: D Use of tools to enhance memory and concentration such as a daily planner and adequate rest are helpful for patients who develop "chemo-brain" while receiving chemotherapy. Patients should be encouraged to exercise the brain through new activities. Chemo-brain may be short or long term. There is no urgent need to report common chemotherapy side effects to the provider. DIF: Cognitive Level: Apply (application) REF: 252 TOP: Nursing Process: Implementation MSC: NCLEX:

5. You are assigned a client who is to be treated with a cobalt implant for intracavity irradiation for cervical cancer. Her treatment will be completed in 72 hours. Which protective measures are indicated for personnel and visitors? List all of the numbers that apply _________. 1. Place a "Radiation Treatment" sign on the door to the client's room and on the front of the client's chart. 2. All nurses and visitors must wear a protective shield. (Keep a lead shield at the client's doorway.) 3. Complete care of the client as fast as possible and leave the room quickly. 4. Do not allow pregnant women to visit or to be assigned as staff for this client, but children under age 18 may visit. 5. Visitors must limit exposure to 1 hour/day and keep a distance from the client.

Answers are (1), (2), and (5). (3) and (4) are incorrect. Completing care as soon as possible is not the point— limiting exposure to 15 minutes/day is the advised protocol. It is true that pregnant women cannot be exposed; anyone under 18 also cannot be admitted.

6. A patient who is diagnosed with cervical cancer classified as Tis, N0, M0 asks the nurse what the letters and numbers mean. Which response by the nurse is accurate? a. "The cancer involves only the cervix." b. "The cancer cells look like normal cells." c. "Further testing is needed to determine the spread of the cancer." d. "It is difficult to determine the original site of the cervical cancer."

ANS: A Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time. Cell differentiation is not indicated by clinical staging. Because the cancer is in situ, the origin is the cervix. Further testing is not indicated given that the cancer has not spread. DIF: Cognitive Level: Apply (application) REF: 241 TOP: Nursing Process: Implementation MSC: NCLEX:

15. To educate clients, the nurse should understand that the most common site of cancer for a female is the 1. Uterine cervix. 2. Uterine body. 3. Vagina. 4. Fallopian tubes.

(1) Cervical cancer is the most common site and squamous cell cancer is the most common cell type.

23. Which nursing diagnosis should receive highest priority in a client who is receiving the chemotherapeutic agent that causes bone marrow suppression? 1. Risk of infection. 2. Activity intolerance. 3. Altered oral mucous membranes. 4. Altered nutrition: less than body requirements.

(1) Chemotherapeutic drugs that depress the bone marrow interfere with the production of WBCs. The resultant leukopenia can be life-threatening; therefore, risk of infection is the highest priority. The other nursing diagnoses, although appropriate for this client, would be of lower priority.

3. A client has just received a report from her physician that describes a tumor that was recently biopsied. If the result she receives is listed as "T0, N0, M0," the client will know that she has 1. No evidence of a primary tumor, lymph node involvement, and metastasis. 2. No primary tumor, but evidence of a degree of distant metastasis. 3. A primary tumor and regional nodes involved. 4. Carcinoma in situ

(1) The staging of the cancer according to cancer classification means that there is no evidence of a primary tumor (T0), regional lymph nodes are not abnormal (N0), and there is no evidence of distant metastasis (M0).

16. A 45-year-old client has just been admitted to the hospital for an abdominal hysterectomy following a diagnosis of uterine cancer. Results of lab tests indicate that the client's WBC is 9800/mm3. The nursing intervention is to 1. Call the operating room and cancel the surgery. 2. Notify the surgeon immediately. 3. Take no action as this is a normal value. 4. Call the lab and have the test repeated.

(3) The normal WBC count is 5000 to 10,000/mm3. If the results were abnormally high or low, the surgeon would have to be notified (2) and the surgery may be canceled (1). Tests with abnormal results are not routinely repeated (4) unless the results are grossly abnormal.

6. The nurse is assessing a client with a radiation implant and observes that the implant has been dislodged. The nurse cannot immediately locate the implant. The first nursing action is to 1. Search for the implant in the bed covers and place it in a lead container. 2. Call the physician and bar all visitors from the room. 3. Pick up the source with a foot-long applicator. 4. Notify the radiation safety team.

6. (2) The first nursing action is to bar all visitors from the room and notify the physician. It is important not to contaminate yourself by searching for the implant (1). The physician will notify the radiation team and make decisions about reimplanting the radiation source in the client.

2. Of the following screening methods for prevention of cancer, the most important one for the client to be aware of is 1. Magnetic resonance imaging (MRI). 2. Breast self-examination. 3. Risk assessment. 4. Sigmoidoscopy

(2) Breast self-examination (BSE) is the most important method to instruct the client about because it is a primary prevention method. It is performed every month (whereas a mammogram is done every year after age 50), and many breast lumps are first found by the woman when she is examining her breasts. An MRI (1) would be done for diagnosis. Risk assessment (3) and sigmoidoscopy (4) are also important preventive measures, but in priority fall below a BSE.

A client has been receiving chemotherapy for the treatment of breast cancer. She is now to start receiving daily injections of Neupogen (filgrastim). The nurse would assess for a therapeutic response to this drug by monitoring which laboratory test result? 1. Blood urea nitrogen (BUN). 2. Potassium. 3. Platelets. 4. White blood cell count (WBC).

(4) Neupogen stimulates the production of WBCs. It is given to clients experiencing bone marrow depression with leukopenia secondary to cancer chemotherapy.

13. Alkylating drugs are used as chemotherapeutic agents in cancer therapy. The nurse understands that these drugs stop cancer growth by 1. Damaging DNA in the cell nucleus. 2. Interrupting the production of necessary cellular metabolites. 3. Creating a hormonal imbalance. 4. Destroying messenger RNA.

. (1) Alkylating agents affect production of DNA, which, in turn, disrupts cell growth and division.

24. A client is experiencing diarrhea as a side effect of chemotherapy. Which nursing diagnosis should receive the highest priority? 1. Fluid volume deficit. 2. Impaired skin integrity. 3. Body image disturbance. 4. Activity intolerance.

. (1) Although all of these nursing diagnoses could apply to a client with diarrhea, fluid volume deficit is the priority diagnosis because it is potentially life-threatening

22. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient? a. IL-2 enhances the body's immunologic response to tumor cells. b. IL-2 prevents bone marrow depression caused by chemotherapy. c. IL-2 protects normal cells from harmful effects of chemotherapy. d. IL-2 stimulates malignant cells in the resting phase to enter mitosis.

ANS: A IL-2 enhances the ability of the patient's own immune response to suppress tumor cells. IL-2 does not protect normal cells from damage caused by chemotherapy, stimulate malignant cells to enter mitosis, or prevent bone marrow depression. DIF: Cognitive Level: Understand (comprehension) REF: 258 TOP: Nursing Process: Implementation MSC: NCLEX:

37. The nurse assesses a patient with non-Hodgkin's lymphoma who is receiving an infusion of rituximab (Rituxan). Which assessment finding would require the most rapid action by the nurse? a. Shortness of breath b. Shivering and chills c. Muscle aches and pains d. Temperature of 100.2° F (37.9° C)

ANS: A Rituximab (Rituxan) is a monoclonal antibody. Shortness of breath should be investigated rapidly because anaphylaxis is a possible reaction to monoclonal antibody administration. The nurse will need to rapidly take actions such as stopping the infusion, assessing the patient further, and notifying the health care provider. The other findings will also require action by the nurse, but are not indicative of life-threatening complications. DIF: Cognitive Level: Analyze (analysis) REF: 258 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX:

5. During a routine health examination, a 40-yr-old patient tells the nurse about a family history of colon cancer. Which action should the nurse take next? a. Obtain more information about the family history. b. Schedule a sigmoidoscopy to provide baseline data. c. Teach the patient about the need for a colonoscopy at age 50. d. Teach the patient how to do home testing for fecal occult blood.

ANS: A The patient may be at increased risk for colon cancer, but the nurse's first action should be further assessment. The other actions may be appropriate, depending on the information that is obtained from the patient with further questioning. DIF: Cognitive Level: Analyze (analysis) REF: 241 TOP: Nursing Process: Implementation MSC: NCLEX:

MULTIPLE RESPONSE 1. The nurse at the clinic is interviewing a 64-yr-old woman who is 5 feet, 3 inches tall and weighs 125 lb (57 kg). The patient has not seen a health care provider for 20 years. She walks 5 miles most days and has a glass of wine two or three times a week. Which topics will the nurse plan to include in patient teaching about cancer screening and decreasing cancer risk (select all that apply)? a. Pap testing b. Tobacco use c. Sunscreen use d. Mammography e. Colorectal screening

ANS: A, C, D, E The patient's age, gender, and history indicate a need for screening and teaching about colorectal cancer, mammography, Pap smears, and sunscreen. The patient does not use tobacco or excessive alcohol, she is physically active, and her body weight is healthy. DIF: Cognitive Level: Analyze (analysis) REF: 235 TOP: Nursing Process: Planning MSC: NCLEX:

34. The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require an intervention? a. The UAP flushes the toilet once after emptying the patient's bedpan. b. The UAP stands by the patient's bed for 30 minutes talking with the patient. c. The UAP places the patient's bedding in the laundry container in the hallway. d. The UAP gives the patient an alcohol-containing mouthwash to use for oral care.

ANS: B Because patients with temporary implants emit radioactivity while the implants are in place, exposure to the patient is limited. Laundry and urine and feces do not have any radioactivity and do not require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based mouthwash is not contraindicated. DIF: Cognitive Level: Apply (application) REF: 250 OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation MSC: NCLEX:

30. The nurse assesses a patient who is receiving interleukin-2. Which finding should the nurse report immediately to the health care provider? a. Generalized muscle aches b. Crackles heard at the lung bases c. Complaints of nausea and anorexia d. Oral temperature of 100.6° F (38.1° C)

ANS: B Capillary leak syndrome and acute pulmonary edema are possible toxic effects of interleukin-2. The patient may need oxygen and the nurse should rapidly notify the health care provider. The other findings are common side effects of interleukin-2. DIF: Cognitive Level: Analyze (analysis) REF: 257 TOP: Nursing Process: Evaluation MSC: NCLEX:

23. The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient indicates a need for further assessment? a. "I have frequent muscle aches and pains." b. "I rarely have the energy to get out of bed." c. "I experience chills after I inject the interferon." d. "I take acetaminophen (Tylenol) every 4 hours."

ANS: B Fatigue can be a dose-limiting toxicity for use of immunotherapy. Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use acetaminophen every 4 hours. DIF: Cognitive Level: Apply (application) REF: 258 TOP: Nursing Process: Assessment MSC: NCLEX:

28. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the nurse would indicate a need for further teaching? a. The patient ambulates around the room. b. The patient's visitors bring in fresh peaches. c. The patient cleans with a warm washcloth after having a stool. d. The patient uses soap and shampoo to shower every other day.

ANS: B Fresh, thinned-skin fruits are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk, showering every other day is acceptable. Careful cleaning after having a bowel movement will help prevent skin breakdown and infection. DIF: Cognitive Level: Apply (application) REF: 253 TOP: Nursing Process: Evaluation MSC: NCLEX:

4. The nurse should suggest which food choice when providing dietary teaching for a patient scheduled to receive external-beam radiation for abdominal cancer? a. Fruit salad c. Creamed broccoli b. Baked chicken d. Toasted wheat bread

ANS: B Protein is needed for wound healing. To minimize the diarrhea that is commonly associated with bowel radiation, the patient should avoid foods high in roughage, such as fruits and whole grains. Lactose intolerance may develop secondary to radiation, so dairy products should also be avoided. DIF: Cognitive Level: Apply (application) REF: 254 TOP: Nursing Process: Implementation MSC: NCLEX:

38. A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first? a. Give the patient the prescribed PRN opioid. b. Assess for sensation and strength in the legs. c. Notify the health care provider about the symptoms. d. Teach the patient how to use relaxation to reduce pain.

ANS: B Spinal cord compression, an oncologic emergency, can occur with invasion of tumor into the epidural space. The nurse will need to assess the patient further for symptoms such as decreased leg sensation and strength and then notify the health care provider. Administration of opioids or the use of relaxation may be appropriate but only after the nurse has assessed for possible spinal cord compression. DIF: Cognitive Level: Analyze (analysis) REF: 264 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX:

7. The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was effective? a. "The biopsy will remove the cancer in my prostate gland." b. "The biopsy will determine how much longer I have to live." c. "The biopsy will help decide the treatment for my enlarged prostate." d. "The biopsy will indicate whether the cancer has spread to other organs."

ANS: C A biopsy is used to determine whether the prostate enlargement is benign or malignant and determines the type of treatment that will be needed. A biopsy does not give information about metastasis, life expectancy, or the impact of cancer on the patient's life. DIF: Cognitive Level: Apply (application) REF: 238 TOP: Nursing Process: Evaluation MSC: NCLEX:

35. The nurse receives change-of-shift report on the oncology unit. Which patient should the nurse assess first? a. A 35-yr-old patient who has wet desquamation associated with abdominal radiation b. A 42-yr-old patient who is sobbing after receiving a new diagnosis of ovarian cancer c. A 24-yr-old patient who received neck radiation and has blood oozing from the neck d. A 56-yr-old patient who developed a new pericardial friction rub after chest radiation

ANS: C Because neck bleeding may indicate possible carotid artery rupture in a patient who is receiving radiation to the neck, this patient should be seen first. The diagnoses and clinical manifestations for the other patients are not immediately life threatening. DIF: Cognitive Level: Analyze (analysis) REF: 263 OBJ: Special Questions: Multiple Patients TOP: Nursing Process: Planning MSC: NCLEX:

10. External-beam radiation is planned for a patient with cervical cancer. What instructions should the nurse give to the patient to prevent complications from the effects of the radiation? a. Test all stools for the presence of blood. b. Maintain a high-residue, high-fiber diet. c. Clean the perianal area carefully after every bowel movement. d. Inspect the mouth and throat daily for the appearance of thrush.

ANS: C Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause frequent diarrhea. Careful cleaning of this area will help decrease the risk for skin breakdown and infection. Stools are likely to have occult blood from the inflammation associated with radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients receive abdominal radiation. DIF: Cognitive Level: Apply (application) REF: 251 TOP: Nursing Process: Implementation MSC: NCLEX:

26. A patient with cancer has a nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation. Which nursing action would address the cause of the patient problem? a. Add protein powder to foods such as casseroles. b. Tell the patient to eat foods that are high in nutrition. c. Avoid giving the patient foods that are strongly disliked. d. Add spices to enhance the flavor of foods that are served.

ANS: C The patient will eat more if disliked foods are avoided and foods that the patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding protein powder does not address the issue of taste. The patient's poor intake is not caused by a lack of information about nutrition. DIF: Cognitive Level: Apply (application) REF: 262 TOP: Nursing Process: Implementation MSC: NCLEX:

8. The nurse teaches a postmenopausal patient with stage III breast cancer about the expected outcomes of cancer treatment. Which patient statement indicates that the teaching has been effective? a. "After cancer has not recurred for 5 years, it is considered cured." b. "The cancer will be cured if the entire tumor is surgically removed." c. "I will need follow-up examinations for many years after treatment before I can be considered cured." d. "Cancer is never cured, but the tumor can be controlled with surgery, chemotherapy, and radiation."

ANS: C The risk of recurrence varies by the type of cancer. Some cancers are considered cured after a shorter time span or after surgery, but stage III breast cancer will require additional therapies and ongoing follow-up. DIF: Cognitive Level: Apply (application) REF: 243 TOP: Nursing Process: Evaluation MSC: NCLEX:

3. The nurse is caring for a patient who smokes two packs/day. Which action by the nurse could help reduce the patient's risk of lung cancer? a. Teach the patient about the seven warning signs of cancer. b. Plan to monitor the patient's carcinoembryonic antigen (CEA) level. c. Teach the patient about annual chest x-rays for lung cancer screening. d. Discuss risks associated with cigarette smoking during each patient encounter.

ANS: D Teaching about the risks associated with cigarette smoking is recommended at every patient encounter because cigarette smoking is associated with multiple health problems. The other options may detect lung cancer that is already present but do not reduce the risk. DIF: Cognitive Level: Apply (application) REF: 237 TOP: Nursing Process: Implementation MSC: NCLEX:

17. A patient who has ovarian cancer is crying and tells the nurse, "My husband rarely visits. He just doesn't care." The husband indicates to the nurse that he does not know what to say to his wife. Which nursing diagnosis is appropriate for the nurse to add to the plan of care? a. Compromised family coping related to disruption in lifestyle b. Impaired home maintenance related to perceived role changes c. Risk for caregiver role strain related to burdens of caregiving responsibilities d. Dysfunctional family processes related to effect of illness on family members

ANS: D The data indicate that this diagnosis is most appropriate because poor communication among the family members is affecting family processes. No data suggest a change in lifestyle or its role as an etiology. The data do not support impairment in home maintenance or a burden caused by caregiving responsibilities. DIF: Cognitive Level: Apply (application) REF: 265 TOP: Nursing Process: Diagnosis MSC: NCLEX:

17. While the nurse is orienting a client scheduled for surgery, the client states she is afraid of what will happen the next day. What is the most appropriate response? 1. Assure her that the surgery is very safe and problems are rare. 2. Encourage her to talk about her fears as much as she wishes. 3. Explain that her physician is one of the best and she has nothing to worry about. 4. Explain that worrying will only prolong her hospitalization.

(2) Allowing the client to express her fears results in a decrease in anxiety and a more realistic and knowledgeable reaction to the situation. Studies have shown that the less anxiety the client has about the surgery, the more positive the postoperative results. (1) and (3) are false reassurances and nontherapeutic.

14. Antineoplastic drugs are dangerous because they affect normal tissue as well as cancer tissue. Normal cells that divide and proliferate rapidly are more at risk. Which of the following areas of the body would be least at risk? 1. Bone marrow. 2. Nervous tissue. 3. Hair follicles. 4. Lining of the GI tract.

(2) Nervous tissue is least at risk. Bone marrow (1), hair follicles (3), and the lining of the GI tract (4) are the cells that are most vulnerable because they have rapid cell division and proliferation similar to cancer cells. The nervous tissue cells do not have rapid cell division.

7. A client with cancer that has metastasized to the liver is started on chemotherapy. His physician has specified divided doses of the antimetabolite. In discharge planning, the nurse instructs the client to take the drug in divided doses. What is the rationale for this instruction? 1. "There really is no reason; your doctor just wrote the orders that way." 2. "This schedule will reduce the side effects of the drug." 3. "Divided doses produce greater cytotoxic effects on the diseased cells." 4. "Because these drugs prevent cell division, they are more effective in divided doses."

(3) Because not all cells will be in the same phase at the same time, divided doses will produce greater cytotoxic effects. This schedule will not reduce the side effects of the drug. Even though the drugs may prevent cell division (4), divided doses will not affect this characteristic.

33. When caring for a patient who is pancytopenic, which action by unlicensed assistive personnel (UAP) indicates a need for the nurse to intervene? a. The UAP assists the patient to use dental floss after eating. b. The UAP adds baking soda to the patient's saline oral rinses. c. The UAP puts fluoride toothpaste on the patient's toothbrush. d. The UAP has the patient rinse after meals with a saline solution.

ANS: A Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient. DIF: Cognitive Level: Apply (application) REF: 261 OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation MSC: NCLEX:

12. The nurse is caring for a patient with colon cancer who is scheduled for external radiation therapy to the abdomen. Which information obtained by the nurse would indicate a need for patient teaching? a. The patient has a history of dental caries. b. The patient swims several days each week. c. The patient snacks frequently during the day. d. The patient showers each day with mild soap.

ANS: B The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment period. The patient does not need to change habits of eating frequently or showering with a mild soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation. DIF: Cognitive Level: Apply (application) REF: 255 TOP: Nursing Process: Assessment MSC: NCLEX:

9. A patient with a large stomach tumor attached to the liver is scheduled for a debulking procedure. Which information should the nurse teach the patient about the outcome of this procedure? a. Pain will be relieved by cutting sensory nerves in the stomach. b. Relief of pressure in the stomach will promote better nutrition. c. Decreasing the tumor size will improve the effects of other therapy. d. Tumor growth will be controlled by the removal of malignant tissue.

ANS: C A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more effective. Debulking surgeries do not control tumor growth. The tumor is debulked because it is attached to the liver, a vital organ (not to relieve pressure on the stomach). Debulking does not sever the sensory nerves, although pain may be lessened by the reduction in pressure on the abdominal organs. DIF: Cognitive Level: Understand (comprehension) REF: 245 TOP: Nursing Process: Implementation MSC: NCLEX:

31. The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patient alerts the nurse to discuss a possible change in cancer therapy with the health care provider? a. Frequent loose stools b. Nausea and vomiting c. Elevated white blood count (WBC) d. Increased carcinoembryonic antigen (CEA)

ANS: D An increase in CEA indicates that the chemotherapy is not effective for the patient's cancer and may need to be modified. Gastrointestinal adverse effects are common with chemotherapy. The nurse may need to address these, but they would not necessarily indicate a need for a change in therapy. An elevated WBC may indicate infection but does not reflect the effectiveness of the colorectal cancer therapy. DIF: Cognitive Level: Apply (application) REF: 236 TOP: Nursing Process: Assessment MSC: NCLEX:

19. A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake? a. Offer the patient frequent small snacks between meals. b. Assist the patient to choose favorite foods from the menu. c. Provide teaching about the importance of nutritional intake. d. Apply prescribed anesthetic gel to oral lesions before meals.

ANS: D Because the etiology of the patient's poor nutrition is the painful oral ulcers, the best intervention is to apply anesthetic gel to the lesions before the patient eats. The other actions might be helpful for other patients with impaired nutrition but would not be as helpful for this patient. DIF: Cognitive Level: Analyze (analysis) REF: 254 TOP: Nursing Process: Planning MSC: NCLEX:

32. The nurse reviews the laboratory results of a patient who is receiving chemotherapy. Which laboratory result is most important to report to the health care provider? a. Hematocrit 30% b. Platelets 95,000/µL c. Hemoglobin 10 g/L d. White blood cells (WBC) 2700/µL

ANS: D The low WBC count places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that WBC growth factors such as filgrastim (Neupogen) are needed. Although the other laboratory data indicate decreased levels, they do not indicate any immediate life-threatening adverse effects of the chemotherapy. DIF: Cognitive Level: Apply (application) REF: 235 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX:

18. A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva. Which instructions should the nurse give to this patient? a. Remove food debris from the teeth and oral mucosa with a stiff toothbrush. 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. Rinse the mouth before and after each meal and at bedtime with a saline solution.

ANS: D The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used for oral care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate the oral mucosa and are not recommended. DIF: Cognitive Level: Apply (application) REF: 251 TOP: Nursing Process: Implementation MSC: NCLEX:

27. During the teaching session for a patient who has a new diagnosis of acute leukemia, the patient is restless and looks away without making eye contact. The patient asks the nurse to repeat the information about the complications associated with chemotherapy. Based on this assessment, which nursing diagnosis is appropriate for the patient? a. Risk for ineffective adherence to treatment related to denial of need for chemotherapy b. Acute confusion related to infiltration of leukemia cells into the central nervous system c. Deficient knowledge: chemotherapy related to a lack of interest in learning about treatment d. Risk for ineffective health maintenance related to possible anxiety about leukemia diagnosis

ANS: D 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. The patient's history of a recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the confusion. The patient asks for the information to be repeated, indicating that lack of interest in learning and denial are not etiologic factors. DIF: Cognitive Level: Apply (application) REF: 265 TOP: Nursing Process: Diagnosis MSC: NCLEX:

16. A chemotherapy drug that causes alopecia is prescribed for a patient. Which action should the nurse take to support the patient's self-esteem? a. Encourage the patient to purchase a wig or hat to wear when hair loss begins. b. Suggest that the patient limit social contacts until regrowth of the hair occurs. c. Teach the patient to wash hair gently with mild shampoo to minimize hair loss. d. Inform the patient that hair usually grows back once chemotherapy is complete.

ANS: A The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting social contacts is not appropriate at a time when the patient is likely to need a good social support system. The damage occurs at the hair follicles and will occur regardless of gentle washing or use of a mild shampoo. The information that the hair will grow back is not immediately helpful in maintaining the patient's self-esteem. DIF: Cognitive Level: Apply (application) REF: 256 TOP: Nursing Process: Planning MSC: NCLEX:

24. A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). The nurse will include which information in the patient's teaching plan? a. Donor bone marrow is transplanted through a sternal or hip incision. b. Hospitalization is required for several weeks after the stem cell transplant. c. The transplant procedure takes place in a sterile operating room to minimize the risk for infection. d. Transplant of the donated cells can be very painful because of the nerves in the tissue lining the bone.

ANS: B 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. The transplanted cells are infused through an IV line so the transplant is not painful, nor is an operating room or incision required. DIF: Cognitive Level: Understand (comprehension) REF: 261 TOP: Nursing Process: Planning MSC: NCLEX:

29. The nurse is caring for a patient diagnosed with stage I colon cancer. When assessing the need for psychologic support, which question by the nurse will provide the most information? a. "How long ago were you diagnosed with this cancer?" b. "Do you have any concerns about body image changes?" c. "Can you tell me what has been helpful to you in the past when coping with stressful events?" d. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?"

ANS: C Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient's need for support. The patient's knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. Because surgical interventions for stage I cancer of the colon may not cause any body image changes, this question is not appropriate at this time. DIF: Cognitive Level: Apply (application) REF: 265 TOP: Nursing Process: Assessment MSC: NCLEX:

41. After change-of-shift report on the oncology unit, which patient should the nurse assess first? a. Patient who has a platelet count of 82,000/µL after chemotherapy b. Patient who has xerostomia after receiving head and neck radiation c. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C) d. Patient who is worried about getting the prescribed long-acting opioid on time

ANS: C Temperature elevation is an emergency in neutropenic patients because of the risk for rapid progression to severe infections and sepsis. The other patients also require assessments or interventions but do not need to be assessed as urgently. Patients with thrombocytopenia do not have spontaneous bleeding until the platelets are 20,000/µL. Xerostomia does not require immediate intervention. Although breakthrough pain needs to be addressed rapidly, the patient does not appear to have breakthrough pain. DIF: Cognitive Level: Analyze (analysis) REF: 253 OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients TOP: Nursing Process: Assessment MSC: NCLEX:

39. The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider? a. Hematocrit of 32% b. Pain with deep inspiration c. Serum sodium of 126 mEq/L d. Decreased breath sounds on left side

ANS: C The syndrome of inappropriate antidiuretic hormone (and the resulting hyponatremia) is an oncologic metabolic emergency and requires rapid treatment to prevent complications such as seizures and coma. The other findings also require intervention but are common in patients with lung cancer and not immediately life threatening. DIF: Cognitive Level: Analyze (analysis) REF: 263 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX:

. For a client who has received a diagnosis of skin cancer, the type that has the poorest prognosis because it metastasizes so rapidly and extensively via the lymph system is 1. Basal cell epithelioma. 2. Squamous cell epithelioma. 3. Malignant melanoma. 4. Sebaceous cyst.

(3) Malignant melanoma has the poorest prognosis. Basal cell epithelioma (1) and squamous cell epithelioma (2) are both superficial, easily excised, slowgrowing tumors. A sebaceous cyst (4) is a benign (nonmalignant) growth.

Intravenous is the most common route for the administration of chemotherapy drugs because it provides for better absorption. When a client is receiving drugs via this route, one of the most important assessments the nurse will perform is for the complication(s) of 1. Catheter clotting. 2. Infection and phlebitis. 3. Malposition of the needle. 4. Sepsis.

(2) Infection and phlebitis are two of the most common complications of receiving chemotherapy drugs via IV. The other complications are seen with central venous catheter insertion, used for continuous infusions.

21. A client has just learned that he has a diagnosis of cancer of the lung. His physician has recommended that the lung be removed. The client says to the nurse that he is sure the doctor made a mistake because he can breathe just fine. The nurse interprets this response as 1. Depression. 2. Denial. 3. Avoidance. 4. Reaction formation.

(2) The first phase of psychological adaptation to terminal illness is denial. It is important for the nurse to recognize this as a natural reaction and support the client until he can deal with the reality of the diagnosis.

1. When the nurse is counseling a client about preventive measures for cancer, one of the most important behaviors to emphasize is to 1. Decrease fat intake. 2. Avoid exposure to the sun. 3. Avoid smoking. 4. Obtain adequate rest and avoid stress.

(3) Avoiding smoking is a primary cancer preventive behavior. Smoking is believed to be the cause of 75% of lung cancers in the United States. All of the other behaviors are also important preventive measures, but tobacco is a known carcinogen.

19. A client has had a partial colectomy and is 2 days postop. During a 6:00 pm assessment, the nurse observed all of the following. A priority concern that would require the earliest intervention is a 1. Dressing that is moderately saturated with serosanguineous drainage. 2. Warm and reddened area on the client's left calf. 3. Distended bladder that is firm to palpation. 4. Decrease in breath sounds on the right side

(3) Inability to void after the Foley catheter has been removed is a common problem resulting from anesthesia or pain medication and requires an early intervention. It is important to be aware of the client's output for several reasons: to ensure adequate intake, to detect renal problems, and to assess for blood pressure problems. The solution to this problem is catheterization, based on a physician's order. The dressing should be closely observed but is not presently a problem (1). The area on the calf may be developing thrombophlebitis (2) and should be reported to the physician immediately. The breath sounds (4) can be improved by turning, coughing, and deep-breathing.

20. A client has possible malignancy of the colon, and surgery is scheduled. The rationale for administering neomycin preoperatively is to 1. Prevent infection postoperatively. 2. Eliminate the need for preoperative enemas. 3. Decrease and retard the growth of normal bacteria in the intestines. 4. Treat cancer of the colon.

(3) Neomycin suppresses normal bacterial flora, thereby "sterilizing" the bowel preoperatively to decrease the possibility of postoperative infection. It cannot prevent infection (1). Neomycin does not influence the need for preoperative enemas (2) or treat cancer of the colon (4).

22. A female client is to be discharged following a simple mastectomy of the right breast for cancer. Discharge instructions should include 1. Follow-up visits with a physical therapist. 2. Referral to a Reach for Recovery group. 3. Returning to her physician for monthly breast exams. 4. How to perform a breast self-exam monthly

(4) It is most important for the client to perform a breast self-exam monthly at a regular time because she would not make monthly visits to her physician. Telling her how to contact a support group (2) would also be helpful.

25. A female client with a diagnosis of cancer of the cervix has a radon seed implanted. Which data would it be important for the nurse to assess every few hours? 1. Presence of nausea and vomiting. 2. Hydration status. 3. Ability of the client to change position. 4. Dislodging of radiation source.

(4) Frequently checking that the radiation source has not become dislodged is the most important assessment. The seed may get lost in the linen or dressing. If the radiation source is dislodged, it must be placed in a lead container for safety. The other assessment parameters are important, but do not have to be done every few hours.

4. A client has just completed a course in radiation therapy and is experiencing radiodermatitis. The most effective method of treating the skin is to 1. Wash the area with soap and warm water. 2. Apply a cream or lotion to the area. 3. Leave the skin alone until it is clear. 4. Avoid applying creams or lotions to the area.

(4) Irradiated areas are very sensitive; all creams and lotions, which would serve to irritate the skin, should be avoided. The area should be washed with lukewarm water; a mild soap may be used, but most physicians prefer clear water.

A client experiencing severe, intractable pain from cancer complains that the pain medication is not handling the pain at all. The nurse has given the client all the medicine she can receive. The next nursing action is to 1. Emotionally support the client and tell her she will receive the next dose of medication as soon as possible. 2. Contact the physician immediately and intervene on the client's behalf to increase the pain dose or change the medication. 3. Suggest the client try breathing or other alternative techniques to cope with the pain. 4. Explore the nature of the pain and help the client perceive it in a different way.

(2) It is the nurse's responsibility to intervene with the physician and report that the pain medication is not providing adequate pain relief. Undertreatment with analgesics has been identified as a major problem for cancer clients, and studies have shown that physicians frequently underprescribe. The other responses will help support the client, but they will not be effective enough to relieve severe pain.

18. A 52-year-old client has had a lobectomy for cancer of the left lower lobe of the lung. He is 18 hours postoperative. The nurse understands that for this client the most appropriate position immediately postoperatively is 1. Flat bed rest. 2. Turned to the unoperative side only. 3. Turned to the operative side only. 4. Semi-Fowler's position, turned to either side.

(4) Postoperatively, the client can be turned to both sides to increase full expansion of lung tissue. It is best to place him in semi-Fowler's position when his vital signs are stable to ensure full lung expansion.

Cancer is the second major cause of death in the United States. What is the first step toward effective cancer control? 1. Increasing government control of potential carcinogens. 2. Changing habits and customs that predispose the individual to cancer. 3. Conducting more mass-screening programs. 4. Educating public and professional people about cancer.

(4) The most important step in controlling cancer is educating the public about cancer and its warning signs. Education will have an effect on early diagnosis and treatment.

20. A widowed mother of four school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate? a. "Don't you have any friends that will raise the children for you?" b. "Would you like to talk about options for the care of your children?" c. "For now you need to concentrate on getting well and not worrying about your children." d. "Many patients with cancer live for a long time, so there is time to plan for your children."

ANS: B This response expresses the nurse's willingness to listen and recognizes the patient's concern. 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. Although it is possible that the patient's friends will raise the children, more assessment information is needed before making plans. DIF: Cognitive Level: Apply (application) REF: 265 TOP: Nursing Process: Implementation MSC: NCLEX:

11. A patient with Hodgkin's lymphoma who is undergoing external radiation therapy tells the nurse, "I am so tired I can hardly get out of bed in the morning." Which intervention should the nurse add to the plan of care? a. Minimize activity until the treatment is completed. b. Establish time to take a short walk almost every day. c. Consult with a psychiatrist for treatment of depression. d. Arrange for delivery of a hospital bed to the patient's home.

ANS: B Walking programs are used to keep the patient active without excessive fatigue. Having a hospital bed does not necessarily address the fatigue. The better option is to stay as active as possible while combating fatigue. Fatigue is expected during treatment and is not an indication of depression. Minimizing activity may lead to weakness and other complications of immobility. DIF: Cognitive Level: Apply (application) REF: 253 TOP: Nursing Process: Planning MSC: NCLEX:

21. A patient who has severe pain associated with terminal pancreatic cancer is being cared for at home by family members. Which finding by the nurse indicates that teaching regarding pain management has been effective? a. The patient uses the ordered opioid pain medication whenever the pain is greater than 5 (0 to 10 scale). b. The patient agrees to take the medications by the IV route in order to improve analgesic effectiveness. c. The patient takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs. d. The patient states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief.

ANS: C For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain. Taking the medications only when pain reaches a certain level does not provide effective pain control. Although nonopioid analgesics may also be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved. The IV route is not more effective than the oral route, and usually the oral route is preferred. DIF: Cognitive Level: Apply (application) REF: 264 TOP: Nursing Process: Evaluation MSC: NCLEX:

14. A patient with metastatic cancer of the colon experiences severe vomiting after each administration of chemotherapy. Which action, if taken by the nurse, is appropriate? a. Have the patient eat large meals when nausea is not present. b. Offer dry crackers and carbonated fluids during chemotherapy. c. Administer prescribed antiemetics 1 hour before the treatments. d. Give the patient a glass of a citrus fruit beverage during treatments.

ANS: C Treatment with antiemetics before chemotherapy may help prevent nausea. The patient should eat small, frequent meals. Offering food and beverages during chemotherapy is likely to cause nausea. The acidity of citrus fruits may be further irritating to the stomach. DIF: Cognitive Level: Apply (application) REF: 251 TOP: Nursing Process: Implementation MSC: NCLEX: