MSN Exam for Cancer II

1) 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:

1. breast self-examination.
2. mammography
3. fine needle aspiration.
4. chest X-ray.

2) A male client has an abnormal result on a Papanicolaou test. After admitting, he read his chart while the nurse was out of the room, the client asks what dysplasia means. Which definition should the nurse provide?

1. Presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin
2. Increase in the number of normal cells in a normal arrangement in a tissue or an organ
3. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn’t found
4. Alteration in the size, shape, and organization of differentiated cells

3) Nurse Lucia is providing breast cancer education at a community facility. The American Cancer Society recommends that women get mammograms:

1. yearly after age 40.
2. after the birth of the first child and every 2 years thereafter.
3. after the first menstrual period and annually thereafter
4. every 3 years between ages 20 and 40 and annually thereafter.

4) A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy?

1. Urine output of 400 ml in 8 hours
2. Serum potassium level of 3.6 mEq/L
3. Blood pressure of 120/64 to 130/72 mm Hg
4. Dry oral mucous membranes and cracked lips

5) 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)?

1. White, cottage cheese–like patches on the tongue
2. Yellow tooth discoloration
3. Red, open sores on the oral mucosa
4. Rust-colored sputum

6) What should a male client over age 52 do to help ensure early identification of prostate cancer?

1. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.
2. Have a transrectal ultrasound every 5 years.
3. Perform monthly testicular self-examinations, especially after age 50.
4. Have a complete blood count (CBC) and blood urea nitrogen (BUN) and creatinine levels checked yearly.

7) A male client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which “related-to” phrase should the nurse add to complete the nursing diagnosis statement?

1. Related to visual field deficits
2. Related to difficulty swallowing
3. Related to impaired balance
4. Related to psychomotor seizures

8) Mina, who is suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse provides which preprocedure instruction to the client?

1. Eat a light breakfast only
2. Maintain an NPO status before the procedure
3. Wear comfortable clothing and shoes for the procedure
4. Drink six to eight glasses of water without voiding before the test

9) 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?

1. Persistent nausea
2. Rash
3. Indigestion
4. Chronic ache or pain

10) The nurse is instructing the 35 year old client to perform a testicular self-examination. The nurse tells the client:

1. To examine the testicles while lying down
2. That the best time for the examination is after a shower
3. To gently feel the testicle with one finger to feel for a growth
4. That testicular self-examination should be done at least every 6 months

11) Nurse Kent is teaching a male client to perform monthly testicular self-examinations. Which of the following points would be appropriate to make?

1. Testicular cancer is a highly curable type of cancer
2. Testicular cancer is very difficult to diagnose.
3. Testicular cancer is the number one cause of cancer deaths in males.
4. Testicular cancer is more common in older men.

12) A male client undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to care for the neck stoma, the nurse should include which instruction?

1. “Keep the stoma uncovered.”
2. “Keep the stoma dry.”
3. “Have a family member perform stoma care initially until you get used to the procedure.”
4. “Keep the stoma moist.”

13) Rhea, has malignant lymphoma. As part of her chemotherapy, the physician prescribes chlorambucil (Leukeran), 10 mg by mouth daily. When caring for the client, the nurse teaches her about adverse reactions to chlorambucil, such as alopecia. How soon after the first administration of chlorambucil might this reaction occur?

1. Immediately
2. 1 week
3. 2 to 3 weeks
4. 1 month

14) A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect:

1. hair loss.
2. stomatitis
3. fatigue
4. vomiting

15) 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?

1. Pain at the incisional site
2. Arm edema on the operative side
3. Sanguineous drainage in the Jackson-Pratt drain
4. Complaints of decreased sensation near the operative site

16) A cervical radiation implant is placed in the client for treatment of cervical cancer. The nurse initiates what most appropriate activity order for this client?

1. Bed rest
2. Out of bed ad lib
3. Out of bed in a chair only
4. Ambulation to the bathroom only

17) 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:

1. perform breast self-examination annually.
2. have a mammogram annually.
3. have a hormonal receptor assay annually.
4. have a physician conduct a clinical examination every 2 years.

18) 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?

1. Infection
2. Hemorrhage
3. Cervical stenosis
4. Ovarian perforation

19) Nurse Mickey is caring for a client who is postoperative following a pelvic exenteration and the physician changes the client’s diet from NPO status to clear liquids. The nurse makes which priority assessment before administering the diet?

1. Bowel sounds
2. Ability to ambulate
3. Incision appearance
4. Urine specific gravity

20) For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client?

1. “Client verbalizes feelings of anxiety.”
2. “Client doesn’t guess at prognosis.”
3. “Client uses any effective method to reduce tension.”
4. “Client stops seeking information.”

21) The home health care nurse is caring for a male client with cancer and the client is complaining of acute pain. The appropriate nursing assessment of the client’s pain would include which of the following?

1. The client’s pain rating
2. Nonverbal cues from the client
3. The nurse’s impression of the client’s pain
4. Pain relief after appropriate nursing intervention

22) 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?

1. Monitoring temperature
2. Ambulation three times daily
3. Monitoring the platelet count
4. Monitoring for pathological fractures

23) A male client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first?

1. Stand as far away from the implant as possible and call for help.
2. Pick up the implant with long-handled forceps and place it in a lead-lined container.
3. Leave the room and notify the radiation therapy department immediately.
4. Put the implant back in place, using forceps and a shield for self-protection, and call for help.

24) A 35 years old client with ovarian cancer is prescribed hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with:

1. cell division or mitosis during the M phase of the cell cycle.
2. normal cellular processes during the S phase of the cell cycle.
3. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle–nonspecific)
4. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cycle–nonspecific).

25) For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?

1. Administering aspirin if the temperature exceeds 102° F (38.8° C)
2. Inspecting the skin for petechiae once every shift
3. Providing for frequent rest periods
4. Placing the client in strict isolation

26) Nurse Meredith is instructing a premenopausal woman about breast self-examination. The nurse should tell the client to do her self-examination:

1. at the end of her menstrual cycle.
2. on the same day each month.
3. on the 1st day of the menstrual cycle.
4. immediately after her menstrual period.

27) he nurse is admitting a male client with laryngeal cancer to the nursing unit. The nurse assesses for which most common risk factor for this type of cancer?

1. Alcohol abuse
2. Cigarette smoking
3. Use of chewing tobacco
4. Exposure to air pollutants

28) A male client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis may be appropriate for this client?

1. Anticipatory grieving
2. Impaired swallowing
3. Disturbed body image
4. Chronic low self-esteem

29) Nurse Brian is developing a plan of care for marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable?

1. 24 hours
2. 2 to 4 days
3. 7 to 14 days
4. 21 to 28 days

30) The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?

1. Duodenal ulcers
2. Hemorrhoids
3. Weight gain
4. Polyps

31) The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for?

1. Actinic
2. Asymmetry
3. Arcus
4. Assessment

32) 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?

1. Onset of sporadic sexual activity at age 17
2. Spontaneous abortion at age 19
3. Pregnancy complicated with eclampsia at age 27
4. Human papillomavirus infection at age 32

33) A female client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include:

1. a decreased serum creatinine level
2. hypocalcemia
3. Bence Jones protein in the urine.
4. a low serum protein level.

34) 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?

1. Increased calcium
2. Increased white blood cells
3. Decreased blood urea nitrogen level
4. Decreased number of plasma cells in the bone marrow

35) Jeovina, with advanced breast cancer is prescribed tamoxifen (Nolvadex). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately?

1. Vision changes
2. Hearing loss
3. Headache
4. Anorexia

36) 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?

1. She should have had a baseline mammogram before age 30.
2. She should eat a low-fat diet to further decrease her risk of breast cancer.
3. She should perform breast self-examination during the first 5 days of each menstrual cycle.
4. When she begins having yearly mammograms, breast self-examinations will no longer be necessary.

37) During chemotherapy, an oncology client has a nursing diagnosis of impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?

1. Recommending that the client discontinue chemotherapy
2. Providing a solution of hydrogen peroxide and water for use as a mouth rinse
3. Monitoring the client’s platelet and leukocyte counts
4. Checking regularly for signs and symptoms of stomatitis

38) When caring for a male client diagnosed with a brain tumor of the parietal lobe, the nurse expects to assess:

1. short-term memory impairment.
2. tactile agnosia.
3. seizures
4. contralateral homonymous hemianopia.

39) Vanessa, a community health nurse conducts a health promotion program regarding testicular 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?

1. Alopecia
2. Back pain
3. Painless testicular swelling
4. Heavy sensation in the scrotum

40) During the admission assessment of a 35 year old client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease?

1. Diarrhea
2. Hypermenorrhea
3. Abdominal bleeding
4. Abdominal distention

41) 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:

1. cancerous lumps.
2. areas of thickness or fullness.
3. changes from previous self-examinations.
4. fibrocystic masses.

42) A male client is receiving the cell cycle–nonspecific alkylating agent thiotepa (Thioplex), 60 mg 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 its therapeutic effects?

1. It interferes with deoxyribonucleic acid (DNA) replication only.
2. It interferes with ribonucleic acid (RNA) transcription only.
3. It interferes with DNA replication and RNA transcription.
4. It destroys the cell membrane, causing lysis.

43) A female client is hospitalized for insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. The initial action by the nurse is to:

1. Call the physician
2. Reinsert the implant into the vagina immediately
3. Pick up the implant with gloved hands and flush it down the toilet
4. Pick up the implant with long-handled forceps and place it in a lead container.

44) A male client is admitted to the hospital with a suspected diagnosis of Hodgkin’s disease. Which assessment findings would the nurse expect to note specifically in the client?

1. Fatigue
2. Weakness
3. Weight gain
4. Enlarged lymph nodes

45) 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?

1. Altered red blood cell production
2. Altered production of lymph nodes
3. Malignant exacerbation in the number of leukocytes
4. Malignant proliferation of plasma cells within the bone

46) 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?

1. Biopsy of the tumor
2. Abdominal ultrasound
3. Magnetic resonance imaging
4. Computerized tomography scan

47) The male client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is:

1. Dyspnea
2. Diarrhea
3. Sore throat
4. Constipation

48) Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is classified as:

1. sarcoma
2. lymphoma
3. carcinoma
4. melanoma

49) Nina, an oncology nurse educator is speaking to a women’s group about breast cancer. Questions and comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the audience have made all of the following statements. Which one is accurate?

1. Mammography is the most reliable method for detecting breast cancer.
2. Breast cancer is the leading killer of women of childbearing age.
3. Breast cancer requires a mastectomy.
4. Men can develop breast cancer.

50) 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:

1. At the onset of menstruation
2. Every month during ovulation
3. Weekly at the same time of day
4. 1 week after menstruation begins

51) The nurse is preparing for a female client for magnetic resonance imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which of the following would pose a threat to the client?

1. The client lies still.
2. The client asks questions.
3. The client hears thumping sounds.
4. The client wears a watch and wedding band.

52) A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to treat osteogenic carcinoma. During methotrexate therapy, the nurse expects the client to receive which other drug to protect normal cells?

1. probenecid (Benemid)
2. cytarabine (ara-C, cytosine arabinoside [Cytosar-U]
3. thioguanine (6-thioguanine, 6-TG)
4. leucovorin (citrovorum factor or folinic acid [Wellcovorin])

53) The female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing:

1. Rupture of the bladder
2. The development of a vesicovaginal fistula
3. Extreme stress caused by the diagnosis of cancer
4. Altered perineal sensation as a side effect of radiation therapy

54) 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?

1. Liver
2. Colon
3. Reproductive tract
4. White blood cells (WBCs)

55) Nurse Cecilia is caring for a client who has undergone a vaginal hysterectomy. The nurse avoids which of the following in the care of this client?

1. Elevating the knee gatch on the bed
2. Assisting with range-of-motion leg exercises
3. Removal of antiembolism stockings twice daily
4. Checking placement of pneumatic compression boots

56) Which intervention is appropriate for the nurse caring for a male client in severe pain receiving a continuous I.V. infusion of morphine?

1. Assisting with a naloxone challenge test before therapy begins
2. Discontinuing the drug immediately if signs of dependence appear
3. Changing the administration route to P.O. if the client can tolerate fluids
4. Obtaining baseline vital signs before administering the first dose

57) Sarah, a hospice nurse visits a client dying of ovarian cancer. During the visit, the client expresses that “If I can just live long enough to attend my daughter’s graduation, I’ll be ready to die.” Which phrase of coping is this client experiencing?

1. Anger
2. Denial
3. Bargaining
4. Depression

58) The client with leukemia is receiving busulfan (Myleran) and allopurinol (Zyloprim). The nurse tells the client that the purpose if the allopurinol is to prevent:

1. Nausea
2. Alopecia
3. Vomiting
4. Hyperuricemia

59) 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:

1. Restrict all visitors
2. Restrict fluid intake
3. Teach the client and family about the need for hand hygiene
4. Insert an indwelling urinary catheter to prevent skin breakdown

60) Nurse Joy is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles?

1. Limit the time with the client to 1 hour per shift
2. Do not allow pregnant women into the client’s room
3. Remove the dosimeter badge when entering the client’s room
4. Individuals younger than 16 years old may be allowed to go in the room as long as they are 6 feet away from the client

Answers and Rationales

1. C. fine needle aspiration. Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.
2. D. Alteration in the size, shape, and organization of differentiated cells . Dysplasia refers to an alteration in the size, shape, and organization of differentiated cells. The presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin is called anaplasia. An increase in the number of normal cells in a normal arrangement in a tissue or an organ is called hyperplasia. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn’t found is called metaplasia.
3. A. yearly after age 40. The American Cancer Society recommends a mammogram yearly for women over age 40. The other statements are incorrect. It’s recommended that women between ages 20 and 40 have a professional breast examination (not a mammogram) every 3 years.
4. D. Dry oral mucous membranes and cracked lips. Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L.
5. C. Red, open sores on the oral mucosa . The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese–like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.
6. A. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won’t identify changes in the prostate gland due to its location in the body. A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastases.
7. C. Related to impaired balance . A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction.
8. D. Drink six to eight glasses of water without voiding before the test . 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 not mistaken for a possible pelvic growth. An abdominal ultrasound may require that the client abstain from food or fluid for several hours before the procedure. Option C is unrelated to this specific procedure.
9. C. Indigestion . Indigestion, or difficulty swallowing, is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but isn’t one of the seven major warning signs. Rash and chronic ache or pain seldom indicate cancer.
10. B. That the best time for the examination is after a shower. 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 the testicles, feeling for any lumps.
11. A. Testicular cancer is a highly curable type of cancer . Testicular cancer is highly curable, particularly when it’s treated in its early stage. 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
12. D. “Keep the stoma moist.” . The nurse should instruct the client to keep the stoma moist, such as by applying a thin layer of petroleum jelly around the edges, because a dry stoma may become irritated. The nurse should recommend placing a stoma bib over the stoma to filter and warm air before it enters the stoma. The client should begin performing stoma care without assistance as soon as possible to gain independence in self-care activities.
13. C. 2 to 3 weeks . Chlorambucil-induced alopecia occurs 2 to 3 weeks after therapy begins.
14. C. fatigue . Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the treatment site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse effects of radiation therapy.
15. B. 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.
16. A. Bed rest. 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 is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled.
17. B. have a mammogram annually. The American Cancer Society guidelines state, “Women older than age 40 should have a mammogram annually and a clinical examination at least annually [not every 2 years]; all women should perform breast self-examination monthly [not annually].” The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen- or progesterone-dependent.
18. D. Ovarian perforation. 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.
19. A. Bowel sounds . The client is kept NPO until peristalsis returns, usually in 4 to 6 days. When signs of bowel function return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. The most important assessment is to assess bowel sounds before feeding the client. Options B, C, and D are unrelated to the subject of the question
20. A. “Client verbalizes feelings of anxiety.” Verbalizing feelings is the client’s first step in coping with the situational crisis. It also helps the health care team gain insight into the client’s feelings, helping guide psychosocial care. Option B is inappropriate because suppressing speculation may prevent the client from coming to terms with the crisis and planning accordingly. Option C is undesirable because some methods of reducing tension, such as illicit drug or alcohol use, may prevent the client from coming to terms with the threat of death as well as cause physiologic harm. Option D isn’t appropriate because seeking information can help a client with cancer gain a sense of control over the crisis.
21. A. The client’s pain rating. The client’s self-report is a critical component of pain assessment. The nurse should ask the client about the description of the pain and listen carefully to the client’s words used to describe the pain. The nurse’s impression of the client’s pain is not appropriate in determining the client’s level of pain. Nonverbal cues from the client are important but are not the most appropriate pain assessment measure. Assessing pain relief is an important measure, but this option is not related to the subject of the question.
22. C. 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. Option A elates to monitoring for infection, particularly if leukopenia is present. Options B and D, although important in the plan of care, are not related directly to thrombocytopenia.
23. B. Pick up the implant with long-handled forceps and place it in a lead-lined container. If a radioactive implant becomes dislodged, the nurse should pick it up with long-handled forceps and place it in a lead-lined container, then notify the radiation therapy department immediately. The highest priority is to minimize radiation exposure for the client and the nurse; therefore, the nurse must not take any action that delays implant removal. Standing as far from the implant as possible, leaving the room with the implant still exposed, or attempting to put it back in place can greatly increase the risk of harm to the client and the nurse from excessive radiation exposure.
24. B. normal cellular processes during the S phase of the cell cycle. Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They’re most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.
25. B. 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.
26. D. immediately after her menstrual period. Premenopausal women should do their self-examination immediately after the menstrual period, when the breasts are least tender and least lumpy. On the 1st and last days of the cycle, the woman’s breasts are still very tender. Postmenopausal women because their bodies lack fluctuation of hormone levels, should select one particular day of the month to do breast self-examination.
27. B. Cigarette smoking . The most common risk factor associated with laryngeal cancer is cigarette smoking. Heavy alcohol use and the combined use of tobacco increase the risk. Another risk factor is exposure to environmental pollutants.
28. A. Anticipatory grieving . Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isn’t associated with gallbladder cancer. Although surgery typically is done to remove the gallbladder and, possibly, a section of the liver, it isn’t disfiguring and doesn’t cause Disturbed body image. Chronic low self-esteem isn’t an appropriate nursing diagnosis at this time because the diagnosis has just been made.
29. C. 7 to 14 days . Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.
30. D. Polyps. Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren’t preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.
31. B. Asymmetry . When following the ABCD method for assessing skin lesions, the A stands for “asymmetry,” the B for “border irregularity,” the C for “color variation,” and the D for “diameter.”
32. D. Human papillomavirus infection at age 32 . Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 16, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren’t risk factors for cervical cancer.
33. C. Bence Jones protein in the urine. Presence of Bence Jones protein in the urine almost always confirms the disease, but absence doesn’t rule it out. Serum calcium levels are elevated because calcium is lost from the bone and reabsorbed in the serum. Serum protein electrophoresis shows elevated globulin spike. The serum creatinine level may also be increased.
34. A. Increased calcium . Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.
35. A. Vision changes . The client must report changes in visual acuity immediately because this adverse effect may be irreversible. Tamoxifen isn’t associated with hearing loss. Although the drug may cause anorexia, headache, and hot flashes, the client need not report these adverse effects immediately because they don’t warrant a change in therapy.
36. B. She should eat a low-fat diet to further decrease her risk of breast cancer. A low-fat diet (one that maintains weight within 20% of recommended body weight) has been found to decrease a woman’s risk of breast cancer. A baseline mammogram should be done between ages 30 and 40. Monthly breast self-examinations should be done between days 7 and 10 of the menstrual cycle. The client should continue to perform monthly breast self-examinations even when receiving yearly mammograms.
37. B. Providing a solution of hydrogen peroxide and water for use as a mouth rinse. To decrease the pain of stomatitis, the nurse should provide a solution of hydrogen peroxide and water for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer viscous lidocaine or systemic analgesics as prescribed. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn’t be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection but wouldn’t decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn’t decrease the pain.
38. B. tactile agnosia. Tactile agnosia (inability to identify objects by touch) is a sign of a parietal lobe tumor. Short-term memory impairment occurs with a frontal lobe tumor. Seizures may result from a tumor of the frontal, temporal, or occipital lobe. Contralateral homonymous hemianopia suggests an occipital lobe tumor.
39. A. Alopecia . Alopecia is not an assessment finding in testicular cancer. Alopecia may occur, however, as a result of radiation or chemotherapy. Options B, C, and D are assessment findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes.
40. D. Abdominal distention . Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and ultimately general severe pain. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.
41. C. changes from previous self-examinations. Women are instructed to examine themselves to discover changes that have occurred in the breast. Only a physician can diagnose lumps that are cancerous, areas of thickness or fullness that signal the presence of a malignancy, or masses that are fibrocystic as opposed to malignant.
42. C. It interferes with DNA replication and RNA transcription.Thiotepa interferes with DNA replication and RNA transcription. It doesn’t destroy the cell membrane.
43. D. Pick up the implant with long-handled forceps and place it in a lead container. A lead container and long-handled forceps should be kept in the client’s room at 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.
44. D. Enlarged lymph nodes. Hodgkin’s disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.
45. D. 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. Options A and B are not characteristics of multiple myeloma. Option C describes the leukemic process.
46. A. Biopsy of the tumor . 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.
47. C. Sore throat. 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 radiation to the larynx is most likely to experience a sore throat. Options B and D may occur with radiation to the gastrointestinal tract. Dyspnea may occur with lung involvement.
48. A. sarcoma . Tumors that originate from bone,muscle, and other connective tissue are called sarcomas.
49. D. Men can develop breast cancer. Men can develop breast cancer, although they seldom do. The most reliable method 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 required if the tumor is small, confined, and in an early stage.
50. D. 1 week after menstruation begins . The breast self-examination should be performed monthly 7 days after the onset of the menstrual period. Performing the examination weekly is not recommended. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.
51. D. The client wears a watch and wedding band. During an MRI, the client should wear no metal objects, such as jewelry, because the strong magnetic field can pull on them, causing injury to the client and (if they fly off) to others. The client must lie still during the MRI but can talk to those performing the test by way of the microphone inside the scanner tunnel. The client should hear thumping sounds, which are caused by the sound waves thumping on the magnetic field.
52. D. leucovorin (citrovorum factor or folinic acid [Wellcovorin]) . Leucovorin is administered with methotrexate to protect normal cells, which methotrexate could destroy if given alone. Probenecid should be avoided in clients receiving methotrexate because it reduces renal elimination of methotrexate, increasing the risk of methotrexate toxicity. Cytarabine and thioguanine aren’t used to treat osteogenic carcinoma.
53. B. The development of a vesicovaginal fistula . A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina.
54. A. Liver . The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites.
55. A. Elevating the knee gatch on the bed . The client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, 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 pneumatic compression boots are helpful. The nurse should avoid using the knee gatch in the bed, which inhibits venous return, thus placing the client more at risk for deep vein thrombosis or thrombophlebitis.
56. D. Obtaining baseline vital signs before administering the first dose. The nurse should obtain the client’s baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy. A naloxone challenge test may be administered before using a narcotic antagonist, not a narcotic agonist. The nurse shouldn’t discontinue a narcotic agonist abruptly because withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the ability to tolerate fluids.
57. C. Bargaining . Denial, bargaining, anger, depression, and acceptance are recognized stages that a person facing a life-threatening illness experiences. Bargaining identifies a behavior in which the individual is willing to do anything to avoid loss or change prognosis or fate. Denial is expressed as shock and disbelief and may be the first response to hearing bad news. Depression may be manifested by hopelessness, weeping openly, or remaining quiet or withdrawn. Anger also may be a first response to upsetting news and the predominant theme is “why me?” or the blaming of others.
58. D. Hyperuricemia . Allopurinol decreases uric acid production and reduces uric acid concentrations in serum and urine. In the client receiving chemotherapy, uric acid levels increase as 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 prevent alopecia, nausea, or vomiting.
59. C. Teach the client and family about the need for hand hygiene . In the neutropenic client, meticulous hand hygiene education is implemented for the client, family, visitors, and staff. Not all visitors are restricted, but the client is protected from persons with known infections. Fluids should be encouraged. Invasive measures such as an indwelling urinary catheter should be avoided to prevent infections.
60. B. Do not allow pregnant women into the client’s room. The time that the nurse spends in a room of a client with an internal radiation implant is 30 minutes per 8-hour shift. The dosimeter badge must be worn when in the client’s room. Children younger than 16 years of age and pregnant women are not allowed in the client’s room.