ONCC Practice Tests (OCN - Care Continuum)
What is the nurse's best response to a patient who asks about the risk of lymphedema following breast-conservation surgery with a sentinel node biopsy and radiation? "Although your risk is low; precautions still need to be taken." "If you do not develop lymphedema within the first year, you will not develop it later." "There is no risk of lymphedema with sentinel node biopsy." "If you follow the lymphedema guidelines for prevention, you will not develop it."
"Although your risk is low; precautions still need to be taken." Answer: Lymphedema rates are 0% to 5% for women after a sentinel lymph node procedure and 10%-30% after axillary lymph node dissection. Reference: Mahon, S.M. (Ed.). (2011). Site-specific cancer series: Breast cancer (2nd ed.). Pittsburgh, PA: Oncology Nursing Society, pp. 84-85.
Within which timeframe will chemotherapy-induced alopecia normally begin after receiving a first treatment? 2 weeks 24 hours 1 month 3 months
2 weeks Answer: Hair loss from chemotherapy usually begins two weeks after beginning treatment. Reference: Eggert, J. (Ed.). (2017). Cancer basics (2nd ed.). Pittsburgh, PA: Oncology Nursing Society, p. 360.
A patient with lung cancer will be discharged after receiving etoposide and cisplatin. Discharge instructions should include what information? A fever should be reported immediately to the physician. Ringing in the ears is due to the etoposide and will improve in a few days. Observe the urine carefully for the next two days for blood and immediately report its presence. Hiccups that develops should be reported immediately to the physician.
A fever should be reported immediately to the physician. Answer: Patient teaching after receiving chemotherapy includes follow-up care and symptom management. The risks and symptoms of infection are most important. Reference: Polovich, M., Olsen, M., & LeFebvre, K. (Eds.). (2014). Chemotherapy and biotherapy guidelines and recommendations for practice (4th ed.). Pittsburgh, PA: Oncology Nursing Society, p. 140.
What should a cancer education program for adults with low-literacy levels include? Multiple forms of the same message and repetition Medical terms so people become familiar with these words Frequent use of scored quizzes on new material Cartoon-type illustrations to explain concepts
Answer: Repetition of concepts and using multiple ways to convey a message is recommended, including the use of pictures and demonstrations. Reference: Bastable, S.B. (Ed.). (2019). Nurse as educator: Principles of teaching and learning for nursing practice (5th ed.). Burlington, MA: Jones and Bartlett, p. 299.
Which of the following is the most appropriate nursing intervention for a patient with cancer who has been informed that treatment has failed? Asking the patient to share feelings about hearing the news Offering the patient some time alone to process the news Reviewing further treatment possibilities offered by the physician Calling the family in to be with the patient
Asking the patient to share feelings about hearing the news Answer: When treatment fails, the nurse should explore the patient's feelings about hearing the news rather than focusing on the treatment possibilities discussed with the physician. Reference: Burke, C.C. (Ed.). (2009). Psychosocial dimensions of oncology nursing care (2nd ed.). Pittsburgh, PA: Oncology Nursing Society, p. 41.
Advance directives are based upon which of the following principles? Autonomy Beneficience Veracity Justice
Autonomy Answer: Advance directives are based on the principle of autonomy. Reference: Eggert, J. (Ed.). (2017). Cancer basics (2nd ed.). Pittsburgh, PA: Oncology Nursing Society, p. 653.
What information should the nurse provide to a patient following a loop electrosurgical excision procedure? Avoid inserting anything into the vagina for four weeks. Begin an exercise program to decrease weight gain. Sit upright the majority of the day. Expect extreme fatigue for several months.
Avoid inserting anything into the vagina for four weeks. Answer: It is recommended that the patient avoid inserting anything into the vagina for four weeks following a loop electrosurgical excision procedure. Reference: Yarbro, C.H., Wujcik, D., & Gobel, B.H. (Eds.). (2018). Cancer nursing: Principles and practice (8th ed.). Burlington, MA: Jones and Bartlett, p. 1407.
Which of the following is the best intervention to increase a patient's adherence to taking oral chemotherapy at home? Calling the patient periodically to monitor for side effects and ask questions Intructing the patient to double the next dose if a dose is missed Telling the patient to take over-the-counter medications as needed for nausea Having the patient pick up a refill at the next appointment if the supply runs out
Calling the patient periodically to monitor for side effects and ask questions Answer: Follow-up telephone calls are known to help with medication adherence. Reference: Polovich, M., Olsen, M., & LeFebvre, K. (Eds.). (2014). Chemotherapy and biotherapy guidelines and recommendations for practice (4th ed.). Pittsburgh, PA: Oncology Nursing Society, p. 130.
Which of the following is an advantage of an implanted vascular access device over a tunneled central venous catheter? Decreased risk of infection Short-term use Low cost of insertion Unlimited ability to access
Decreased risk of infection Answer: Implanted ports have a lower risk of infection than tunneled central venous catheters. Reference: Camp-Sorrell, D., & Matey, L. (Eds.). (2017). Access device standards of practice for oncology nursing. Pittsburgh, PA: Oncology Nursing Society, p. 67.
Which of the following factors play a major role in the prevention of colon cancer? Diet Acetaminophen Vitamins Exercise
Diet Answer: It is estimated that 80% of colon cancers can be prevented by dietary change. Reference: Yarbro, C.H., Wujcik, D., & Gobel, B.H. (Eds.). (2018). Cancer nursing: Principles and practice (8th ed.). Burlington, MA: Jones and Bartlett, p. 143.
A patient expresses a desire to return back to work following treatment, but still reports significant fatigue. What is the nurse's most appropriate suggestion? Discussing a flexible work schedule with the employer Encouraging a delay for an additional year before returning to work Reflecting on changed roles at home before making a decision Instructing to avoid discussion of the illness with coworkers
Discussing a flexible work schedule with the employer Answer: The possibility of reduced work schedules, and support from coworkers are factors that can facilitate a smoother transition into the workforce following treatment. Reference: Lester, J.L., & Schmitt, P. (Eds.). (2011). Cancer rehabilitation and survivorship: Transdisciplinary approaches to personalized care. Pittsburgh, PA: Oncology Nursing Society, p. 252.
A patient with intractable dyspnea at the end of life has not experienced any relief with traditional interventions. Which of the following should the nurse next consider? Discussing the initiating of palliative sedation with the team Asking the physician to increase the doses of all medications Calling anesthesia to intubate the patient Informing the patient that there is nothing else left to give them
Discussing the initiating of palliative sedation with the team Answer: When therapies such as IV opioids, oxygen, diuretics, and benzodiazepines fail to improve intractable dyspnea, palliative sedation is considered in end-of-life care. Reference: Brown, C.G. (Ed.). (2015). A guide to oncology symptom management (2nd ed.). Pittsburgh, PA: Oncology Nursing Society, p. 373.
Which population is most at risk for the undertreatment of pain at the end of life? Elderly Men Obese adults Young adults
Elderly Answer: Individuals at particular risk for undertreatment of pain symptoms at the end of life are the elderly, minorities, and women. Reference: Ferrell, B.R., Coyle, N. & Paice, J. (Eds.). (2015). Oxford textbook of palliative nursing (4th ed.). New York, NY: Oxford University Press, p. 135.
During a home visit, the nurse discovers that a patient has lost 20 pounds since beginning chemotherapy four months ago. What should the nurse do first? Investigate the cause of weight loss Arrange for Meals on Wheels services Recommend a high-protein, high-calorie supplement Consult with the physician
Investigate the cause of weight loss Answer: The extent of nutrition intervention depends on the cause of weight loss and overall goals of the patient and healthcare team. Reference: Polovich, M., Olsen, M., & LeFebvre, K. (Eds.). (2014). Chemotherapy and biotherapy guidelines and recommendations for practice (4th ed.). Pittsburgh, PA: Oncology Nursing Society, pp. 222-225.
Excessive use of smokeless tobacco and alcohol increases the risk for developing which type of cancer? Laryngeal Hepatocellular Lung Gastric
Laryngeal Answer: The combined use of alcohol and tobacco synergistically increases the risk of laryngeal cancer by about 50%. Reference: Newton, S., Hickey, M., & Brant, J. (2017). Mosby's oncology nursing advisor: A comprehensive guide to clinical practice (2nd ed.). St. Louis, MO: Elsevier Mosby, p. 93.
Which of the following medications requires mandatory enrollment in a program to ensure teaching about risks to a fetus is provided? Lenalidomide Sorafenib Capecitabine Everolimus
Lenalidomide Answer: Lenalidomide is only available under the REVAssist® program to ensure patients are properly informed of fetal risks. Reference: Polovich, M., Olsen, M., & LeFebvre, K. (Eds.). (2014). Chemotherapy and biotherapy guidelines and recommendations for practice (4th ed.). Pittsburgh, PA: Oncology Nursing Society, p. 68.
A patient with Hodgkin lymphoma is most likely to develop which of the following secondary malignancies? Leukemia Colorectal Melanoma Ovarian
Leukemia Answer: Patients with Hodgkin lymphoma have an increased risk of secondary malignacy including leukemia and myelodysplastic syndrome, non-Hodgkin lymphoma, breast, lung and thyroid. Reference: Yarbro, C.H., Wujcik, D., & Gobel, B.H. (2018). Cancer nursing: Principles and practice (8th ed.). Burlington, MA: Jones and Bartlett, p 2036(t).
A patient with head and neck cancer who has completed treatment is at risk for which secondary malignancy? Lung cancer Glioblastoma Gastric cancer Breast cancer
Lung cancer Answer: A secondary malignancy affecting the skin and mucosa after treatment for head and neck cancer can be an oral/buccal cancer or lung cancer. Reference: Lester, J.L., & Schmitt, P. (Eds.). (2011). Cancer rehabilitation and survivorship: Transdisciplinary approaches to personalized care. Pittsburgh, PA: Oncology Nursing Society, p. 61.
Which of the following risk factors will most significantly increase the risk of developing breast cancer? Mother diagnosed before age 60 Menopause occuring at age 54 First pregnancy at age 31 Menarche at age 13
Mother diagnosed before age 60 Answer: Having a mother who was diagnosed with breast cancer before the age of 60 years has an associated relative risk of 2 to 4 times of those without this risk factor. Reference: Newton, S., Hickey, M., & Marrs, J. (2017). Mosby's oncology nursing advisor: A comprehensive guide to clinical practice (2nd ed.). St. Louis, MO: Elsevier Mosby, p. 4.
A patient with ovarian cancer is most likely to be diagnosed with which of the following secondary malignancies? Ocular melanoma Leiomyosarcoma Gastric carcinoma Hodgkin lymphoma
Ocular melanoma Answer: A patient with ovarian cancer is at risk for the development of a secondary melanoma of the eye. Reference: Yarbro, C.H., Wujcik, D., & Gobel, B.H. (Eds.). (2018). Cancer nursing: Principles and practice (8th ed.). Burlington, MA: Jones and Bartlett, p. 2036(t).
The use of oral contraceptives for more than five years may provide protection from developing which of the following cancers? Ovarian Endometrial Cervical Breast
Ovarian Answer: Oral contraceptives are recommended to aid in prevention of ovarian cancer families with Lynch syndrome, not genetically at risk for breast cancer. Reference: Yarbro, C.H., Wujcik, D., & Gobel, B.H. (Eds.). (2018). Cancer nursing: Principles and practice (8th ed.). Burlington, MA: Jones and Bartlett, p. 62.
Neglecting to address a patient's quality of life at the end of life can lead to which of the following? Premature death A sense of peace Hope for recovery Adequate pain control
Premature death Answer: Neglecting the quality of life can lead to premature death either by suicide or passive surrender. Reference: Yarbro, C.H., Wujcik, D., & Gobel, B.H. (Eds.). (2018). Cancer nursing: Principles and practice (8th ed.). Burlington, MA: Jones and Bartlett, p. 220
What is the most likely cause of palmar-plantar erythrodysesthesia? Rupture of capillaries from pressure and friction Overexposure of fast-growing skin cells Increased circulation during infusion Decreased circulation after infusion
Rupture of capillaries from pressure and friction Answer: Palmar-plantar erythrodysesthesia changes to skin can be related to capillary rupture occurring while walking or during other weight-bearing activities. Reference: Eggert, J. (Ed.). (2017). Cancer basics (2nd ed.). Pittsburgh, PA: Oncology Nursing Society, p. 399.
A 19-year-old patient with testicular cancer who will receive cisplatin and pelvic radiation asks if he will be able to conceive children. What should the nurse suggest? Sperm banking prior to beginning treatment Sexual counseling throughout treatment Cryopreservation after completing cisplatin treatment Sildenafil prior to engaging in sexual activity following the completion of treatment
Sperm banking prior to beginning treatment Answer: Chemotherapy, especially with cisplatin and alkylating agents can cause permanent infertility (azoospermia). Sperm banking is recommended prior to the start of treatment if the patient is interested in future paternity. Reference: Burke, C.C. (Ed.). (2009). Psychosocial dimensions of oncology nursing care (2nd ed.). Pittsburgh, PA: Oncology Nursing Society, pp. 93-94, 115.
Which of the following is a primary cancer prevention measure? Sunscreen use Testicular self-examination Guaiac stool test Postmenopausal estrogen therapy
Sunscreen use Answer: Primary prevention refers to measures for the prevention of the disease such as immunization, avoiding tobacco or reducing exposure to ultraviolet rays. Reference: Eggert, J. (Ed.). (2017). Cancer basics (2nd ed.). Pittsburgh, PA: Oncology Nursing Society, p. 44.
A patient's adolescent son approaches the nurse about screening for himself. The nurse most appropriately recommends which of the following? Testicular self-examination CA 19-9 testing Prostate-specific antigen testing Colonoscopy
Testicular self-examination Answer: Teaching about risk factors and the importance of testicular self-examination beginning in the teen years is the most important prevention method. Reference: Newton, S., Hickey, M., & Marrs, J. (2017). Mosby's oncology nursing advisor: A comprehensive guide to clinical practice (2nd ed.). St. Louis, MO: Elsevier Mosby, pp. 77-78.
Which of the folllowing offers the best explanation as to why a patient with metastatic breast cancer would experience pain at the site of metastasis with the initiation of tamoxifen? The patient is experiencing: a common, temporary reaction to initial tamoxifen therapy. an awkward sleeping position. further progression of the disease. a psychosomatic reaction to the diagnosis of metastasis.
a common, temporary reaction to initial tamoxifen therapy. Answer: Initiation of tamoxifen can result in a tumor flare. This is transient and usually resolves even with continued therapy. Reference: Deglin, J.H., Vallerand, A.H., & Sanoski, C.A. (2011). Davis's drug guide for nurses (12th ed.). Philadelphia, PA: F.A. Davis, p. 1163.
A patient with breast cancer who received cyclophospamide five years ago reports a new onset of bruising and fatigue. The nurse suspects: a secondary leukemia. liver failure. leukoencephalopathy. cardiomyopathy.
a secondary leukemia. Answer: The risk of secondary leukemia increases with the use of alkylating agents. Reference: Polovich, M., Olsen, M., & LeFebvre, K. (Eds.). (2014). Chemotherapy and biotherapy guidelines and recommendations for practice (4th ed.). Pittsburgh, PA: Oncology Nursing Society, p. 446(t).
The nurse with the ability to recognize and respect differences in beliefs, values, and lifestyles of all patients demonstrates: cultural competence. nonmaleficence. presencing. protective buffering.
cultural competence. Answer: Cultural competence suggests that healthcare professionals demonstrate the ability to recognize the cultural differences in society and respect those differences in the treatment of all patients that they encounter. Reference: Burke, C.C. (Ed.). (2009). Psychosocial dimensions of oncology nursing care (2nd ed.). Pittsburgh, PA: Oncology Nursing Society, p. 22.
Prior to a fourth dose of cisplatin, a patient reports difficulty manipulating a toothbrush and silverware. The nurse's initial intervention is to: document the findings and report them to the physician. instruct the patient to seek assistance with meals and oral hygiene. arrange for an occupational therapy consultation. reassure the patient that these problems are temporary side effects of the chemotherapy.
document the findings and report them to the physician. Answer: Cisplatin can cause neurotoxicity, particularly at cumulative doses of more than 300-500mg/m2. Numbness and pain will generally begin in the fingers and toes and continue proximally. Reference: Polovich, M., Olsen, M., & LeFebvre, K. (Eds.). (2014). Chemotherapy and biotherapy guidelines and recommendations for practice (4th ed.). Pittsburgh, PA: Oncology Nursing Society, p. 341.
The nurse teaches a patient that the purpose of a living will is to: establish the patient's desires for care prior to a life-threatening illness. make final decisions regarding treatment until disease progression. acknowledge the risks and limitations of recommended therapies. appoint a surrogate to make medical decisions.
establish the patient's desires for care prior to a life-threatening illness. Answer: Living wills are designed to determine the care that a patient is agreeable to receive or not receive in the event of a terminal illness. Reference: Eggert, J. (Ed.). (2017). Cancer basics (2nd ed.). Pittsburgh, PA: Oncology Nursing Society, p. 655(t).
A patient receiving docetaxel asks why dexamethasone is prescribed. The nurse's best response is that it prevents: fluid retention. seizures. fatigue. anorexia.
fluid retention. Answer: Docetaxel is associated with fluid retention and associated alveolar permeability and pulmonary infiltrates that may be prevented with corticosteroids premedication. Reference: Polovich, M., Olsen, M., & LeFebvre, K. (Eds.). (2014). Chemotherapy and biotherapy guidelines and recommendations for practice (4th ed.). Pittsburgh, PA: Oncology Nursing Society, p. 45.
A 64-year-old African American patient with prostate cancer asks if there is any advice he should give his grown sons regarding prostate screening. The nurse's best response is to recommend shared-decision making for: prostate-specific antigen testing beginning at age 45. a transrectal ultrasound beginning at age 45. an ultrasound-guided biopsy of the prostate beginning at age 45. prostatic acid phosphatase testing beginning at age 45.
prostate-specific antigen testing beginning at age 45. Answer: The American Cancer Society recommends a shared-decision making conversation about prostate-specific antigen testing and digital rectal examination beginning at age 45 for men with a high risk of developing prostate cancer. Reference: American Cancer Society (2018). Cancer facts and figures. Retrieved from: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2018.html., p. 22.
The nurse teaches a patient that the survivorship care plan is used to: provide clear direction for ongoing care and surveillance following treatment. provide instructions to the employer to make accomodations upon the return to work. take the place of discussions with their oncologist following the completion of treatment. replace the patient's electronic medical record.
provide clear direction for ongoing care and surveillance following treatment. Answer: A survivorship care plan is provided to a patient upon the completion of treatment to provide information on the treatments received, possible long term effects, and healthy lifestyle choices and screenings throughout a patient's lifetime. Reference: Newton, S., Hickey, M., & Marrs, J. (2017). Mosby's oncology nursing advisor: A comprehensive guide to clinical practice (2nd ed.). St. Louis, MO: Elsevier Mosby, p. 403.
A patient with a permanent colostomy expresses concern about engaging in sexual intercourse. The nurse first recommends: tracking bowel habits to best schedule sexual intercourse. eating immediately before engaging in sexual intercourse. having further discussions with a therapist prior to having sexual intercourse. replacing the ostomy appliance just before engaging in sexual intercourse.
tracking bowel habits to best schedule sexual intercourse. Answer: By being aware of their bowel habits, a patient will be able to better plan sexual activities around expected bowel movements. Reference: Newton, S., Hickey, M., & Marrs, J. (2017). Mosby's oncology nursing advisor: A comprehensive guide to clinical practice (2nd ed.). St. Louis, MO: Elsevier Mosby, p. 349.