Oncology NCLEX Questions
A client taking a chemotherapeutic agent understands the effects of therapy by stating:
"I will avoid eating hot and spicy foods."
During the admission assessment of a 35 year old client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease?
Abdominal distention
Nausea and vomiting are common adverse effects of radiation and chemotherapy. When should a nurse administer antiemetics?
30 minutes before the initiation of therapy. Antiemetics are most beneficial when given before the onset of nausea and vomiting. To calculate the optimum time for administration, the first dose is given 30 minutes to 1 hour before nausea is expected, and then every 2, 4, or 6 hours for approximately 24 hours after chemotherapy. If the antiemetic was given with the medication or after the medication, it could lose its maximum effectiveness when needed.
Which of the following clients is most at risk for developing multiple myeloma?
A 60-year-old Black man. Multiple myeloma is more common in middle-aged and older clients (the median age at diagnosis is 60 years) and is twice as common in Blacks as Whites. It occurs most often in Black men.
Which of the following types of leukemia carries the best prognosis?
Acute lymphoblastic leukemia. Acute lymphoblastic leukemia, which accounts for more than 80% of all childhood cases, carries the best prognosis. Acute myelogenous leukemia, with several subtypes, accounts for most of the other leukemias affecting children. Basophilic and eosinophilic leukemia are named for the specific cells involved. These are much rarer and carry a poorer prognosis.
In which of the following diseases would bone marrow transplantation not be indicated in a newly diagnosed client?
Acute lymphocytic leukemia. For the first episode of acute lymphocytic anemia, conventional therapy is superior to bone marrow transplantation. In severe combined immunodeficiency and in severe aplastic anemia, bone marrow transplantation has been employed to replace abnormal stem cells with healthy cells from the donor's marrow. In myeloid leukemia, bone marrow transplantation is done after chemotherapy to infuse healthy marrow and to replace marrow stem cells ablated during chemotherapy.
Nurse Farah is caring for a client following a mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery?
Arm edema on the operative side. Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery.
Nurse Janet is assigned in the oncology section of the hospital. Which of the following orders should the nurse question if a client is on radiation therapy?
Aspirin every 4 hours
A client had undergone radiation therapy (external). The expected side effects include the following apart from:
Constipation
A centrally located tumor would produce which of the following symptoms?
Coughing. Centrally located pulmonary tumors are found in the upper airway (vocal cords) and usually obstruct airflow, producing such symptoms as coughing, wheezing, and stridor. Small cell tumors tend to be located in the lower airways and often cause hemoptysis. As the tumor invades the pleural space, it may cause pleuritic pain. Pancoast tumors that occur in the apices may cause shoulder pain.
In teaching about cancer prevention to a community group, the nurse stresses promotion of exercise, normal body weight, and low-fat diet because
Dietary fat and obesity promote growth of many types of cancer.
While being prepared for a biopsy of a lump in the right breast, the patient asks the nurse what the difference is between a benign tumor and a malignant tumor. The nurse explains that a benign tumor differs from a malignant tumor in that benign tumors
Do not spread to other tissues and organs
Neoplasm can be classified as either benign or malignant. The following are characteristics of malignant tumor apart from:
Encapsulated
What should a male client over age 52 do to help ensure early identification of prostate cancer?
Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.
A client, age 41, visits the gynecologist. After examining her, the physician suspects cervical cancer. The nurse reviews the client's history for risk factors for this disease. Which history finding is a risk factor for cervical cancer?
Human papillomavirus infection at age 32
Nurse Mary is instructing a pre-menopausal woman about breast self-examination. The nurse should tell the client to do her self-examination:
Immediately after her menstrual period
Which of the following represents the most appropriate nursing intervention for a client with pruritis caused by cancer or the treatments?
Medicated cool baths. Nursing interventions to decrease the discomfort of pruitus include those that prevent vasodilation, decrease anxiety, and maintain skin integrity and hydration. Medicated baths with salicyclic acid or colloidal oatmeal can be soothing as a temporary relief. The use of antihistamines or topical steroids depends on the cause of pruritus, and these agents should be used with caution. Using silk sheets is not a practical intervention for the hospitalized client with pruritis.
A female client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care?
Monitoring the platelet count. Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding.
Which of the following conditions is not a complication of Hodgkin's disease?
Myocardial Infarction. Complications of Hodgkin's are pancytopenia, nausea, and infection. Cardiac involvement usually doesn't occur.
At the time of diagnosis of Hodgkin's lymphoma, which of the following areas is often involved?
Neck. At the time of diagnosis, a painless cervical lesion is often present. The back, chest, and groin areas aren't involved.
Which of the following immunizations should not be given to a 4-month-old sibling of a client with leukemia?
Oral poliovirus vaccine (OPV). OPV is a live attenuated virus excreted in the stool. The excreted virus can be communicated to the immunosuppressed child, resulting in an overwhelming infection. Inactivated polio vaccine would be indicated because it isn't a live virus and wouldn't pose the threat of infection. DTP, Hib, and hepatitis B vaccines can be given accordingly to the recommended schedule.
A 35 years old client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis (inflammation of the mouth)?
Red, open sores on the oral mucosa
Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is classified as:
Sarcoma
A 34-year-old female client is requesting information about mammograms and breast cancer. She isn't considered at high risk for breast cancer. What should the nurse tell this client?
She should eat a low-fat diet to further decrease her risk of breast cancer.
The male client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is:
Sore throat
Which of the following is the reason to perform a spinal tap on a client newly diagnosed with leukemia?
To assess for central nervous system infiltration.
Nurse April is teaching a group of women to perform breast self-examination. The nurse should explain that the purpose of performing the examination is to discover:
changes from previous self-examinations
Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:
fine needle aspiration.
Nurse Amy is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society guidelines, the nurse should recommend that the women:
have a mammogram annually
When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer is staged as Tis, N0, M0. The nurse will teach the patient that
the cancer is localized to the cervix
The nurse is caring for a client following a modified radical mastectomy. Which assessment finding would indicate that the client is experiencing a complication related to this surgery?
Arm edema on the operative side. Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively or may occur months or even years after surgery. The other options are expected occurrences.
A 32-year-old woman meets with the nurse on her first office visit since undergoing a left mastectomy. When asked how she is doing, the woman states her appetite is still not good, she is not getting much sleep because she doesn't go to bed until her husband is asleep, and she is really anxious to get back to work. Which of the following nursing interventions should the nurse explore to support the client's current needs?
Ask open-ended questions about sexuality issues related to her mastectomy. The content of the client's comments suggests that she is avoiding intimacy with her husband by waiting until he is asleep before going to bed. Addressing sexuality issues is appropriate for a client who has undergone a mastectomy. Rushing her return to work may debilitate her and add to her exhaustion. Suggesting that she learn relaxation techniques to help her with her insomnia is appropriate; however, the nurse must first address the psychosocial and sexual issues that are contributing to her sleeping difficulties. A nutritional assessment may be useful, but there is no indication that she has anorexia.
The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing assessment is which of the following?
Assess level of consciousness. A high risk of hemorrhage exists when the platelet count is fewer than 20,000. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is fewer than 10,000. The client should be assessed for changes in levels of consciousness, which may be an early indication of an intracranial hemorrhage. Option 2 is a priority nursing assessment when the white blood cell count is low and the client is at risk for an infection.
Which of the following medications usually is given to a client with leukemia as prophylaxis against P. carinii pneumonia?
Bactrim. The most frequent cause of death from leukemia is overwhelming infection. P. carinii infection is lethal to a child with leukemia. As prophylaxis against P. carinii pneumonia, continuous low doses of co-trimoxazole (Bactrim) are frequently prescribed. Oral nystatin suspension would be indicated for the treatment of thrush. Prednisone isn't an antibiotic and increases susceptibility to infection. Vincristine is an antineoplastic agent.
Nurse Bea is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder?
Increased calcium
During a routine physical examination, a firm mass is palpated in the right breast of a 35-year-old woman. Which of the following findings or client history would suggest cancer of the breast as opposed to fibrocystic disease?
Increased vascularity of the breast. Increase in breast size or vascularity is consistent with cancer of the breast. Early menarche as well as late menopause or a history of anovulatory cycles are associated with fibrocystic disease. Masses associated with fibrocystic disease of the breast are firm, most often located in the upper outer quadrant of the breast, and increase in size prior to menstruation. They may be bilateral in a mirror image and are typically well demarcated and freely moveable.
A male client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?
Indigestion
For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?
Inspecting the skin for petechiae once every shift Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.
If the client with lung cancer also has preexisting pulmonary disease, which of the following statements best describes how the extent of that can be performed?
It may prevent surgery if the client can't tolerate lung tissue removal. If the client's preexisting pulmonary disease is restrictive and advanced, it may be impossible to remove the tumor, and the client may have to be treated with on;t chemotherapy and radiation.
A female client with cancer is being evaluated for possible metastasis. Which of the following is one of the most common metastasis sites for cancer cells?
Liver
Which of the following tests in performed on a client with leukemia before initiation of therapy to evaluate the child's ability to metabolize chemotherapeutic agents?
Liver function studies. Liver and kidney function studies are done before initiation of chemotherapy to evaluate the child's ability to metabolize the chemotherapeutic agents. A CBC is performed to assess for anemia and white blood cell count. A peripheral blood smear is done to assess the maturity and morphology of red blood cells. A lumbar puncture is performed to assess for central nervous system infiltration.
A female client diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder?
Malignant proliferation of plasma cells within the bone. Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow.
Nurse Kate is reviewing the complications of colonization with a client who has microinvasive cervical cancer. Which complication, if identified by the client, indicates a need for further teaching?
Ovarian perforation
Which of the following is the primary goal for surgical resection of lung cancer?
To remove the tumor and as little surrounding tissue as possible. The goal of surgical resection is to remove the lung tissue that has a tumor in it while saving as much surrounding tissue as possible. It may be necessary to remove alveoli and bronchioles, but care is taken to make sure only what's absolutely necessary is removed.
In staging and grading neoplasm TNM system is used. TNM stands for:
Tumor, node, metastasis
