Oncology Drills 003

8/3/2019 Oncology Drills 003

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1. Nina, an oncology nurse educator is speaking to a womens group about breast cancer.Questions and comments from the audience reveal a misunderstanding of some aspects of thedisease. Various members of the audience have made all of the following statements. Which one

is accurate?a. Mammography is the most reliable method for detecting breast cancer. b. Breast cancer is the leading killer of women of childbearing age.c. Breast cancer requires a mastectomy.d. Men can develop breast cancer.

Answer D. Men can develop breast cancer, although they seldom do. The most reliablemethod for detecting breast cancer is monthly self-examination, not mammography. Lung cancer causes more deaths than breast cancer in women of all ages. A mastectomy may not be requiredif the tumor is small, confined, and in an early stage.

2. Nurse Meredith is instructing a premenopausal woman about breast self-examination. Thenurse should tell the client to do her self-examination:a. at the end of her menstrual cycle.

b. on the same day each month.c. on the 1st day of the menstrual cycle.d. immediately after her menstrual period.

Answer D. Premenopausal women should do their self-examination immediately after themenstrual period, when the breasts are least tender and least lumpy. On the 1st and last days of the cycle, the womans breasts are still very tender. Postmenopausal women because their bodieslack fluctuation of hormone levels, should select one particular day of the month to do breast

self-examination.

3. Nurse Kent is teaching a male client to perform monthly testicular self-examinations. Whichof the following points would be appropriate to make?a. Testicular cancer is a highly curable type of cancer.

b. Testicular cancer is very difficult to diagnose.c. Testicular cancer is the number one cause of cancer deaths in males.d. Testicular cancer is more common in older men.

Answer A. Testicular cancer is highly curable, particularly when its treated in its earlystage. Self-examination allows early detection and facilitates the early initiation of treatment.

The highest mortality rates from cancer among men are in men with lung cancer. Testicular cancer is found more commonly in younger men.

4. Rhea, has malignant lymphoma. As part of her chemotherapy, the physician prescribeschlorambucil (Leukeran), 10 mg by mouth daily. When caring for the client, the nurse teachesher about adverse reactions to chlorambucil, such as alopecia. How soon after the firstadministration of chlorambucil might this reaction occur?a. Immediately


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b. 1 week c. 2 to 3 weeksd. 1 month

Answer C. Chlorambucil-induced alopecia occurs 2 to 3 weeks after therapy begins.

5. A male client is receiving the cell cyclenonspecific alkylating agent thiotepa (Thioplex), 60mg weekly for 4 weeks by bladder instillation as part of a chemotherapeutic regimen to treat

bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert itstherapeutic effects?a. It interferes with deoxyribonucleic acid (DNA) replication only.

b. It interferes with ribonucleic acid (RNA) transcription only.c. It interferes with DNA replication and RNA transcription.d. It destroys the cell membrane, causing lysis.

Answer C. Thiotepa interferes with DNA replication and RNA transcription. It doesnt

destroy the cell membrane.

6. The nurse is instructing the 35 year old client to perform a testicular self-examination. Thenurse tells the client:a. To examine the testicles while lying down

b. That the best time for the examination is after a shower c. To gently feel the testicle with one finger to feel for a growthd. That testicular self-examination should be done at least every 6 months

Answer B. The testicular-self examination is recommended monthly after a warm bath or shower when the scrotal skin is relaxed. The client should stand to examine the testicles. Using

both hands, with fingers under the scrotum and thumbs on top, the client should gently roll thetesticles, feeling for any lumps.

7. A female client with cancer is receiving chemotherapy and develops thrombocytopenia. Thenurse identifies which intervention as the highest priority in the nursing plan of care?a. Monitoring temperature

b. Ambulation three times dailyc. Monitoring the platelet countd. Monitoring for pathological fractures

Answer C. Thrombocytopenia indicates a decrease in the number of platelets in the

circulating blood. A major concern is monitoring for and preventing bleeding. Option A elates tomonitoring for infection, particularly if leukopenia is present. Options B and D, althoughimportant in the plan of care, are not related directly to thrombocytopenia.

8. Gian, a community health nurse is instructing a group of female clients about breast self-examination. The nurse instructs the client to perform the examination:a. At the onset of menstruation

b. Every month during ovulation


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c. Weekly at the same time of dayd. 1 week after menstruation begins

Answer D. The breast self-examination should be performed monthly 7 days after theonset 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.

9. Nurse Cecilia is caring for a client who has undergone a vaginal hysterectomy. The nurseavoids which of the following in the care of this client?a. Elevating the knee gatch on the bed

b. Assisting with range-of-motion leg exercisesc. Removal of antiembolism stockings twice dailyd. Checking placement of pneumatic compression boots

Answer A. The client is at risk of deep vein thrombosis or thrombophlebitis after thissurgery, as for any other major surgery. For this reason, the nurse implements measures that will

prevent this complication. Range-of-motion exercises, antiembolism stockings, and pneumaticcompression boots are helpful. The nurse should avoid using the knee gatch in the bed, whichinhibits venous return, thus placing the client more at risk for deep vein thrombosis or thrombophlebitis.

10. Mina, who is suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse provides which preprocedure instruction to the client?a. Eat a light breakfast only

b. Maintain an NPO status before the procedurec. Wear comfortable clothing and shoes for the procedured. Drink six to eight glasses of water without voiding before the test

Answer D. A pelvic ultrasound requires the ingestion of large volumes of water just before the procedure. A full bladder is necessary so that it will be visualized as such and notmistaken for a possible pelvic growth. An abdominal ultrasound may require that the clientabstain from food or fluid for several hours before the procedure. Option C is unrelated to thisspecific procedure.

11. A male client is diagnosed as having a bowel tumor and several diagnostic tests are prescribed. The nurse understands that which test will confirm the diagnosis of malignancy?a. Biopsy of the tumor

b. Abdominal ultrasound

c. Magnetic resonance imagingd. Computerized tomography scan

Answer A. A biopsy is done to determine whether a tumor is malignant or benign.Magnetic resonance imaging, computed tomography scan, and ultrasound will visualize the

presence of a mass but will not confirm a diagnosis of malignancy.


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12. A female client diagnosed with multiple myeloma and the client asks the nurse about thediagnosis. The nurse bases the response on which description of this disorder?a. Altered red blood cell production

b. Altered production of lymph nodesc. Malignant exacerbation in the number of leukocytes

d. Malignant proliferation of plasma cells within the bone

Answer D. Multiple myeloma is a B-cell neoplastic condition characterized by abnormalmalignant proliferation of plasma cells and the accumulation of mature plasma cells in the bonemarrow. Options A and B are not characteristics of multiple myeloma. Option C describes theleukemic process.

13. 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?a. Increased calcium

b. Increased white blood cells

c. Decreased blood urea nitrogen leveld. Decreased number of plasma cells in the bone marrow

Answer A. Findings indicative of multiple myeloma are an increased number of plasmacells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from thedeteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white bloodcell count may or may not be present and is not related specifically to multiple myeloma.

14. Vanessa, a community health nurse conducts a health promotion program regardingtesticular cancer to community members. The nurse determines that further information needs to

be provided if a community member states that which of the following is a sign of testicular

cancer?a. Alopecia b. Back painc. Painless testicular swellingd. Heavy sensation in the scrotum

Answer A. Alopecia is not an assessment finding in testicular cancer. Alopecia mayoccur, however, as a result of radiation or chemotherapy. Options B, C, and D are assessmentfindings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymphnodes.

15. The male client is receiving external radiation to the neck for cancer of the larynx. Themost likely side effect to be expected is:a. Dyspnea

b. Diarrheac. Sore throatd. Constipation


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Answer C. In general, only the area in the treatment field is affected by the radiation.Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side effects occur only when specific areas are involved in treatment. A client receiving radiationto the larynx is most likely to experience a sore throat. Options B and D may occur withradiation to the gastrointestinal tract. Dyspnea may occur with lung involvement.

16. Nurse Joy is caring for a client with an internal radiation implant. When caring for theclient, the nurse should observe which of the following principles?a. Limit the time with the client to 1 hour per shift

b. Do not allow pregnant women into the clients roomc. Remove the dosimeter badge when entering the clients roomd. Individuals younger than 16 years old may be allowed to go in the room as long as they are 6feet away from the client

Answer B. The time that the nurse spends in a room of a client with an internal radiationimplant is 30 minutes per 8-hour shift. The dosimeter badge must be worn when in the clients

room. Children younger than 16 years of age and pregnant women are not allowed in the clientsroom.

17. A cervical radiation implant is placed in the client for treatment of cervical cancer. Thenurse initiates what most appropriate activity order for this client?a. Bed rest

b. Out of bed ad libc. Out of bed in a chair onlyd. Ambulation to the bathroom only

Answer A. The client with a cervical radiation implant should be maintained on bed rest

in the dorsal position to prevent movement of the radiation source. The head of the bed iselevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client onthe side. If turning is absolutely necessary, a pillow is placed between the knees and, with the

body in straight alignment, the client is logrolled.

18. A female client is hospitalized for insertion of an internal cervical radiation implant. Whilegiving care, the nurse finds the radiation implant in the bed. The initial action by the nurse is to:a. Call the physician

b. Reinsert the implant into the vagina immediatelyc. Pick up the implant with gloved hands and flush it down the toiletd. Pick up the implant with long-handled forceps and place it in a lead container.

Answer D. A lead container and long-handled forceps should be kept in the clients roomat all times during internal radiation therapy. If the implant becomes dislodged, the nurse should

pick up the implant with long-handled forceps and place it in the lead container. Options A, B,and C are inaccurate interventions.

19. The nurse is caring for a female client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plans to:


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a. Restrict all visitors b. Restrict fluid intakec. Teach the client and family about the need for hand hygiened. Insert an indwelling urinary catheter to prevent skin breakdown

Answer C. In the neutropenic client, meticulous hand hygiene education is implementedfor the client, family, visitors, and staff. Not all visitors are restricted, but the client is protectedfrom persons with known infections. Fluids should be encouraged. Invasive measures such as anindwelling urinary catheter should be avoided to prevent infections.

20. The home health care nurse is caring for a male client with cancer and the client iscomplaining of acute pain. The appropriate nursing assessment of the clients pain would includewhich of the following?a. The clients pain rating

b. Nonverbal cues from the clientc. The nurses impression of the clients pain

d. Pain relief after appropriate nursing intervention

Answer A. The clients self-report is a critical component of pain assessment. The nurseshould ask the client about the description of the pain and listen carefully to the clients wordsused to describe the pain. The nurses impression of the clients pain is not appropriate indetermining the clients level of pain. Nonverbal cues from the client are important but are notthe most appropriate pain assessment measure. Assessing pain relief is an important measure, butthis option is not related to the subject of the question.

21. Nurse Mickey is caring for a client who is postoperative following a pelvic exenterationand the physician changes the clients diet from NPO status to clear liquids. The nurse makes

which priority assessment before administering the diet?a. Bowel sounds b. Ability to ambulatec. Incision appearanced. Urine specific gravity

Answer A. The client is kept NPO until peristalsis returns, usually in 4 to 6 days. Whensigns of bowel function return, clear fluids are given to the client. If no distention occurs, the dietis advanced as tolerated. The most important assessment is to assess bowel sounds beforefeeding the client. Options B, C, and D are unrelated to the subject of the question.

22. A male client is admitted to the hospital with a suspected diagnosis of Hodgkins disease.Which assessment findings would the nurse expect to note specifically in the client?a. Fatigue

b. Weaknessc. Weight gaind. Enlarged lymph nodes


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Answer D. Hodgkins disease is a chronic progressive neoplastic disorder of lymphoidtissue characterized by the painless enlargement of lymph nodes with progression toextralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigueand weakness may occur but are not related significantly to the disease.

23. During the admission assessment of a 35 year old client with advanced ovarian cancer, thenurse recognizes which symptom as typical of the disease?a. Diarrhea

b. Hypermenorrheac. Abdominal bleedingd. Abdominal distention

Answer D. Clinical manifestations of ovarian cancer include abdominal distention,urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by thegrowing tumor and the effects of urinary or bowel obstruction, constipation, ascites withdyspnea, and ultimately general severe pain. Abnormal bleeding, often resulting in

hypermenorrhea, is associated with uterine cancer.

24. Nurse Kate is reviewing the complications of colonization with a client who hasmicroinvasive cervical cancer. Which complication, if identified by the client, indicates a needfor further teaching?a. Infection

b. Hemorrhagec. Cervical stenosisd. Ovarian perforation

Answer D. Conization procedure involves removal of a cone-shaped area of the cervix.

Complications of the procedure include hemorrhage, infection, and cervical stenosis. Ovarian perforation is not a complication.

25. Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is classifiedas:a. sarcoma.

b. lymphoma.c. carcinoma.d. melanoma.

Answer A. Tumors that originate from bone,muscle, and other connective tissue are

called sarcomas.26. Sarah, a hospice nurse visits a client dying of ovarian cancer. During the visit, the clientexpresses that If I can just live long enough to attend my daughters graduation, Ill be ready todie. Which phrase of coping is this client experiencing?a. Anger

b. Denial


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30. The client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim). Thenurse tells the client that the purpose if the allopurinol is to prevent:a. Nausea

b. Alopeciac. Vomiting

d. Hyperuricemia

Answer D. Allopurinol decreases uric acid production and reduces uric acidconcentrations in serum and urine. In the client receiving chemotherapy, uric acid levels increaseas a result of the massive cell destruction that occurs from the chemotherapy. This medication

prevents or treats hyperuricemia caused by chemotherapy. Allopurinol is not used to preventalopecia, nausea, or vomiting.

Source/ Reference: http://nclexreviewers.com/nclex-review/oncology/nclex-review-oncology-questions-part-2.html

31. Which of these findings in the breast of a patient who is suspected of having breast cancer would support the diagnosis?

a. complaints of dull, achy, pain b. palpation of a mobile massc. presence of an inverted nippled. area of discoloration skin

Answer C. Inversion of nipple is one of the manifestations of breast cancer. A cancerous

lesion is non-mobile.

32. A nurse is caring for a client with an internal radiation implant. Which of the followinginstructions is appropriate?

a. allow the client to go to the bathroom b. avoid creams and lotionsc. visitors are allowed to stay in the roomd. the client should remain in bed during the entire duration of treatment

Answer D. The client with internal radiation implant should be on bed rest. This is to

prevent dislodgment of the implant.33. How often should a female who is above 40 years old, go for cancer detection examination?

a. daily b. weeklyc. monthlyd. yearly


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Answer D. Cancer screening for females who are above 40 years of age should be yearly.

34. The client is receiving internal radiation therapy. The nurse should

a. remember to give the badge to the next-shift nurse

b. maintain a 30-minute close contact with the patient in a shiftc. wear gloves, mask and gown when entering the client's roomd. instruct relatives no to visit the client during the entire duration of the treatment

Answer A. Dosimeter badge is used to measure amount of exposure to radiation. Itshould be endorsed to the next shift.

35. A nurse is assessing a client with metastatic breast cancer who reports nocturia, weakness,nausea and vomiting. The client's serum electrolytes include potassium 4.2 mEq/L, sodium 135mEq/L, calcium 7.0 mEq/L, and magnesium 2.0 mEq/L. Based on the assessment findings, the

priority action for the nurse is to:

a. start client on fluid restriction b. administer calcium gluconatec. increase the client's IV fluidsd. administer Allopurinol

Answer C. Nocturia, nausea and vomiting cause dehydration. Therefore, the correctnursing action is to increase the client's IV fluids.

Source: http://www.blogcatalog.com/blog/nclex-and-local-board-prc-sample-exam/5ec63aeeb3953955c859a0cc6b6c00eb

36. The nurses assesses that the client with cancer is not ready for teaching when the client asks:

a. Am I going to loose my hair? b. Should I get a second opinion?c. Will this make me really sick?d. Will I have to stop exercising at the gym?

Answer B. This indicates denial of his illness. The question states he has cancer. All of the other comments indicate an interest in what is going to happen to him.

37. Knowing that chemotherapy affects the taste buds, the nurse would have the client

a. Increase the amount of spices in the food. b. Avoid red meats.c. Medicate with Compazine before meals.d. Eat foods that are hot in temperature.

Answer A. Because taste buds are affected, increasing spices will improve flavor.


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38. In evaluating the client with cancer what best indicates that nutritional status is adequate?

a. Calorie intake b. Weight is stablec. Amount of nausea and vomiting

d. Serum protein levels

Answer B. Stable weight indicates adequate nutritional status.

39. An adult client with newly diagnosed cancer says, Im really afraid of dying. Whos goingto take care of my children? What is the best initial response for the nurse to make?

a. What makes you think you are going to die? b. How old are your children?c. This must be a difficult time for you.d. Most people with your kind of cancer live a long time.

Answer C. This empathetic response will open communication. #1 is really a whyquestion which would put the client on the defensive. #2 and #4 do not focus on the clientsfeelings.

40. A client with terminal cancer yells at the nurse and says, I dont need your help. I can bathemyself. Which stage of grief is the client most likely experiencing?

a. Projection b. Denialc. Anger d. Depression

Answer C. Yelling at the nurse would be typical of anger. Projection is putting hisfeelings on the nurse You are angry at me. Denial would be denying that he was terminally illor that he had cancer. A client who is depressed would be apathetic and probably not have theenergy to yell at the nurse.

Source: http://nurse.nonoy.net/2010/06/nclex-review-cancer-hematology/

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Oncology Drills 003