NCLEX Practice Exam for Oncology 3

1. Which of the following conditions is not a complication of Hodgkin’s disease?

1. Anemia
2. Infection
3. Myocardial Infarction
4. Nausea

2.     Which of the following laboratory values is expected for a client just diagnosed with chronic lymphocytic leukemia?

1. Elevated sedimentation rate
2. Uncontrolled proliferation of granulocytes
3. Thrombocytopenia and increased lymphocytes
4. Elevated aspartate aminotransferase and alanine aminotransferase levels.

3.     At the time of diagnosis of Hodgkin’s lymphoma, which of the following areas is often involved?

1. Back
2. Chest
3. Groin
4. Neck

4.     According to a standard staging classification of Hodgkin’s disease, which of the following criteria reflects stage II?

1. Involvement of extralymphatic organs or tissues
2. Involvement of single lymph node region or structure
3. Involvement of two or more lymph node regions or structures.
4. Involvement of lymph node regions or structures on both sides of the diaphragm.

5.     Which of the following statements is correct about the rate of cell growth in relation to chemotherapy?

1. Faster growing cells are less susceptible to chemotherapy.
2. Non-dividing cells are more susceptible to chemotherapy
3. Faster growing cells are more susceptible to chemotherapy
4. Slower growing cells are more susceptible to chemotherapy.

6.      Which of the following foods should a client with leukemia avoid?

1. White bread
2. Carrot sticks
3. Stewed apples
4. Medium rare steak

7.      A client with leukemia has neutropenia. Which of the following functions must be frequently assessed?

1. Blood pressure
2. Bowel sounds
3. Heart sounds
4. Breath sounds

8.     Which of the following clients is most at risk for developing multiple myeloma?

1. A 20-year-old Asian woman
2. A 30-year-old White man
3. A 50-year-old Hispanic woman
4. A 60-year-old Black man

9.     Which of the following substances has abnormal values early in the course of multiple myeloma (MM)?

1. Immunoglobulins
2. Platelets
3. Red blood cells
4. White blood cells

10.  For which of the following conditions is a client with multiple myeloma (MM) monitored?

1. Hypercalcemia
2. Hyperkalemia
3. Hypernatremia
4. Hypermagnesemia

11.  Giving instructions for breast self-examination is particularly important for clients with which of the following medical problems?

1. Cervical dysplasia
2. A dermoid cyst
3. Endometrial polyps
4. Ovarian cancer

12.  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?

1. History of early menarche
2. Cyclic changes in mass size
3. History of anovulatory cycles
4. Increased vascularity of the breast

13.  The client with which of the following types of lung cancer has the best prognosis?

1. Adenocarcinoma
2. Oat cell
3. Squamous cell
4. Small cell

14.  Warning signs and symptoms of lung cancer include persistent cough, bloody sputum, dyspnea, and which of the other following symptoms?

1. Dizziness
2. Generalized weakness
3. Hypotension
4. Recurrent pleural effusion

15.  A centrally located tumor would produce which of the following symptoms?

1. Coughing
2. Hemoptysis
3. Pleuritic pain
4. Shoulder pain

16.  Which of the following interventions is the key to increasing the survival rates of clients with lung cancer?

1. Early bronchoscopy
2. Early detection
3. High-dose chemotherapy
4. Smoking cessation

17.  A client has been diagnosed with lung cancer and requires a wedge resection. How much of the lung is removed?

1. One entire lung
2. A lobe of the lung
3. A small, localized area near the surface of the lung.
4. A segment of the lung, including a bronchiole and its alveoli.

18.  When a client has a lobectomy, what fills the space where the lobe was?

1. The space stays empty.
2. The surgeon fills the space with gel
3. The lung space fills up with serous fluid
4. The remaining lobe or lobes overexpand to fill the space.

19.  Which of the following is the primary goal for surgical resection of lung cancer?

1. To remove the tumor and all surrounding tissue.
2. To remove the tumor and as little surrounding tissue as possible.
3. To remove all of the tumor and any collapsed alveoli in the same region.
4. To remove as much as the tumor as possible, without removing any alveoli.

20.  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?

1. It doesn’t affect it.
2. It may require a whole lung to be removed.
3. The entire tumor may not be able to be removed
4. It may prevent surgery if the client can’t tolerate lung tissue removal.

21.  The client with a benign lung tumor is treated in which of the following ways?

1. The tumor is treated with radiation only.
2. The tumor is treated with chemotherapy only.
3. The tumor is left alone unless symptoms are present.
4. The tumor is removed, involving the least possible amount of tissue.

22.  In the client with terminal lung cancer, the focus of nursing care is on which of the following nursing interventions?

1. Provide emotional support
2. Provide nutritional support
3. Provide pain control
4. Prepare the client’s will

23.  What are the three most important prognostic factors in determining long-term survival for children with acute leukemia?

1. Histologic type of disease, initial platelet count, and type of treatment
2. Type of treatment and client’s sex
3. Histologic type of disease, initial WBC count, and client’s age at diagnosis
4. Progression of illness, WBC at the time of diagnosis, and client’s age at the time of diagnosis.

24.  Which of the following complications are three main consequences of leukemia?

1. Bone deformities, spherocytosis, and infection.
2. Anemia, infection, and bleeding tendencies
3. Lymphocytopoesis, growth delays, and hirsutism
4. Polycythemia, decreased clotting time, and infection.

25.  A child is seen in the pediatrician’s office for complaints of bone and joint pain. Which of the following other assessment findings may suggest leukemia?

1. Abdominal pain
2. Increased activity level
3. Increased appetite
4. Petechiae

26.  Which of the following assessment findings in a client with leukemia would indicate that the cancer has invaded the brain?

1. Headache and vomiting.
2. Restlessness and tachycardia
3. Hypervigilant and anxious behavior
4. Increased heart rate and decreased blood pressure.

27.  Which of the following types of leukemia carries the best prognosis?

1. Acute lymphoblastic leukemia
2. Acute myelogenous leukemia
3. Basophillic leukemia
4. Eosinophillic leukemia

28.  Which of the following is the reason to perform a spinal tap on a client newly diagnosed with leukemia?

1. To rule out meningitis
2. To decrease intracranial pressure
3. To aid in classification of the leukemia
4. To assess for central nervous system infiltration

29.  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?

1. Lumbar puncture
2. Liver function studies
3. Complete blood count (CBC)
4. Peripheral blood smear

30.  Which of the following immunizations should not be given to a 4-month-old sibling of a client with leukemia?

1. Diphtheria and tetanus and pertussis (DPT) vaccine.
2. Hepatitis B vaccine
3. Haemophilus influenza type b vaccines (Hib)
4. Oral poliovirus vaccine (OPV)

31.  Which of the following medications usually is given to a client with leukemia as prophylaxis against P. carinii pneumonia?

1. Bactrim
2. Oral nystatin suspension
3. Prednisone
4. Vincristine (Oncovin)

32.  In which of the following diseases would bone marrow transplantation not be indicated in a newly diagnosed client?

1. Acute lymphocytic leukemia
2. Chronic myeloid leukemia
3. Severe aplastic anemia
4. Severe combined immunodeficiency

33.  Which of the following treatment measures should be implemented for a child with leukemia who has been exposed to the chickenpox?

1. No treatment is indicated.
2. Acyclovir (Zovirax) should be started on exposure
3. Varicella-zoster immune globin (VZIG) should be given with the evidence of disease
4. VZIG should be given within 72 hours of exposure.

34.  Nausea and vomiting are common adverse effects of radiation and chemotherapy. When should a nurse administer antiemetics?

1. 30 minutes before the initiation of therapy.
2. With the administration of therapy.
3. Immediately after nausea begins.
4. When therapy is completed.

35.  Parents of pediatric clients who undergo irradiation involving the central nervous system should be warned about postirradiation somnolence. When does this neurologic syndrome usually occur?

1. Immediately
2. Within 1 to 2 weeks
3. Within 5 to 8 weeks
4. Within 3 to 6 months

36.  The nurse is instructing the client to perform a testicular self-examination. The nurse tells the client:

1. To examine the testicles while lying down.
2. 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 examination should be done at least every 6 months.

37.  The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cancer. Which of the following, if identified by the client as a risk factor, indicates a need for further instructions?

1. Viral factors
2. Stress
3. Low-fat and high-fiber diets
4. Exposure to radiation

38.  The 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. Ambulation three times a day
2. Monitoring temperature
3. Monitoring the platelet count
4. Monitoring for pathological factors

39.  A client is diagnosed with multiple myeloma. The client asks the nurse about the diagnosis. The nurse bases the response on which of the following descriptions of this disorder?

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

40.  The nurse 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. Decreased number of plasma cells in the bone marrow.
2. Increased WBC’s
3. Increased calcium levels
4. Decreased blood urea nitrogen

41.  The nurse is developing a plan of care for the client with multiple myeloma. The nurse includes which priority intervention in the plan of care?

1. Coughing and deep breathing
2. Encouraging fluids
3. Monitoring red blood cell count
4. Providing frequent oral care

42.  The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin’s disease. The nurse determines that further education is needed if a nursing staff member states that which of the following is characteristic of the disease?

1. Presence of Reed-Sternberg cells
2. Involvement of lymph nodes, spleen, and liver
3. Occurs most often in the older client
4. Prognosis depends on the stage of the disease

43.  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?

1. Assess level of consciousness
2. Assess temperature
3. Assess bowel sounds
4. Assess skin turgor

44.  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?

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

45.  A nurse is providing education in a community setting about general measures to avoid excessive sun exposure. Which of the following recommendations is appropriate?

1. Apply sunscreen only after going in the water.
2. Avoid peak exposure hours from 9am to 1pm
3. Wear loosely woven clothing for added ventilation
4. Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure.

46.  Which of the following nursing interventions would be most helpful in making the respiratory effort of a client with metastatic lung cancer more efficient?

1. Teaching the client diaphragmatic breathing techniques
2. Administering cough suppressants as ordered
3. Teaching and encouraging pursed-lip breathing
4. Placing the client in a low semi-Fowlers position

47.  The nurse is teaching a 17-year old client and the client’s family about what to expect with high-dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client?

1. Fever
2. Chills
3. Tachycardia
4. Dyspnea

48.  A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following?

1. “Chemotherapy affects all rapidly dividing cells.”
2. “The molecular structure of the DNA is altered.”
3. “Cancer cells are susceptible to drug toxins.”
4. “Chemotherapy encourages cancer cells to divide.”

49.  When caring for a client with a central venous line, which of the following nursing actions should be implemented in the plan of care for chemotherapy administration? Select all that apply.

1. Verify patency of the line by the presence of a blood return at regular intervals.
2. Inspect the insertion site for swelling, erythema, or drainage.
3. Administer a cytotoxic agent to keep the regimen on schedule even if blood return is not present.
4. If unable to aspirate blood, reposition the client and encourage the client to cough.
5. Contact the health care provider about verifying placement if the status is questionable.

50.  A client with stomach cancer is admitted to the oncology unit after vomiting for 3 days. Physical assessment findings include irregular pulse, muscle twitching, and complaints of prickling sensations in the fingers and hands. Laboratory results include a potassium level of 2.9 mEq/L, a pH of 7.46, and a bicarbonate level of 29 mEq/L. The client is experiencing:

1. Respiratory alkalosis
2. Respiratory acidosis
3. Metabolic alkalosis
4. Metabolic acidosis

51.  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?

1. Call the physician to discuss allowing the client to return to work earlier.
2. Suggest that the client learn relaxation techniques to help with her insomnia
3. Perform a nutritional assessment to assess for anorexia
4. Ask open-ended questions about sexuality issues related to her mastectomy

52.  One of the most serious blood coagulation complications for individuals with cancer and for those undergoing cancer treatments is disseminated intravascular coagulation (DIC). The most common cause of this bleeding disorder is:

1. Underlying liver disease
2. Brain metastasis
3. Intravenous heparin therapy
4. Sepsis

53.  A pneumonectomy is a surgical procedure sometimes indicated for treatment of non-small-cell lung cancer. A pneumonectomy involves removal of:

1. An entire lung field
2. A small, wedge-shaped lung surface
3. One lobe of a lung
4. One or more segments of a lung lobe

54.  A 36-year-old man with lymphoma presents with signs of impending septic shock 9 days after chemotherapy. The nurse could expect which of the following to be present?

1. Flushing, decreased oxygen saturation, mild hypotension
2. Low-grade fever, chills, tachycardia
3. Elevated temperature, oliguria, hypotension
4. High-grade fever, normal blood pressure, increased respirations

55.  Which of the following represents the most appropriate nursing intervention for a client with pruritis caused by cancer or the treatments?

1. Administration of antihistamines
2. Steroids
3. Silk sheets
4. Medicated cool baths

56.  A 56-year-old woman is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She calls her health care provider to report that she has pain while swallowing and burning and tightness in her chest. Which of the following complications of radiation therapy is most likely responsible for her symptoms?

1. Hiatal hernia
2. Stomatitis
3. Radiation enteritis
4. Esophagitis

Answers and Rationales

1. C. Complications of Hodgkin’s are pancytopenia, nausea, and infection. Cardiac involvement usually doesn’t occur.
2. C. Chronic lymphocytic leukemia shows a proliferation of small abnormal mature B lymphocytes and decreased antibody response. Thrombocytopenia also is often present. Uncontrolled proliferation of granulocytes occurs in myelogenous leukemia.
3. D. At the time of diagnosis, a painless cervical lesion is often present. The back, chest, and groin areas aren’t involved.
4. C. Stage II involves two or more lymph node regions. Stage I only involves one lymph node region; stage III involves nodes on both sides of the diaphragm; and stage IV involves extralymphatic organs or tissues.
5. C. The faster the cell grows, the more susceptible it is to chemotherapy and radiation therapy. Slow-growing and non-dividing cells are less susceptible to chemotherapy. Repeated cycles of chemotherapy are used to destroy nondividing cells as they begin active cell division.
6. B. A low-bacteria diet would be indicated with excludes raw fruits and vegetables.
7. D. Pneumonia, both viral and fungal, is a common cause of death in clients with neutropenia, so frequent assessment of respiratory rate and breath sounds is required. Although assessing blood pressure, bowel sounds, and heart sounds is important, it won’t help detect pneumonia.
8. D. 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.
9. A. MM is characterized by malignant plasma cells that produce an increased amount of immunoglobin that isn’t functional. As more malignant plasma cells are produced, there’s less space in the bone marrow for RBC production. In late stages, platelets and WBC’s are reduced as the bone marrow is infiltrated by malignant plasma cells.
10. A. Calcium is released when the bone is destroyed. This causes an increase in serum calcium levels. MM doesn’t affect potassium, sodium, or magnesium levels.
11. D. Clients with ovarian cancer are at increased risk for breast cancer. Breast self-examination supports early detection and treatment and is very important.
12. D. 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.
13. C. Squamous cell carcinoma is a slow-growing, rarely metastasizing type of cancer. Adenocarcinoma is the next best lung cancer to have in terms of prognosis. Oat cell and small cell carcinoma are the same. Small cell carcinoma grows rapidly and is quick to metastasize.
14. D. Recurring episodes of pleural effusions can be caused by the tumor and should be investigated. Dizziness, generalized weakness, and hypotension aren’t typically considered warning signals, but may occur in advanced stages of cancer.
15. A. 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.
16.  B. Early detection of cancer when the cells may be premalignant and potentially curable would be most beneficial. However, a tumor must be 1 cm in diameter before it’s detectable on a chest x-ray, so this is difficult. A bronchoscopy may help identify cell type but may not increase survival rate. High-dose chemotherapy has minimal effect on long-term survival. Smoking cessation won’t reverse the process but may help prevent further decompensation.
17. C. A small area of tissue close to the surface of the lung is removed in a wedge resection. An entire lung is removed in a pneumonectomy. A segment of the lung is removed in a segmental resection and a lobe is removed in a lobectomy.
18. D. The remaining lobe or lobes overexpand slightly to fill the space previously occupied by the removed tissue. The diaphragm is carried higher on the operative side to further reduce the empty space. The space can’t remain “empty” because truly empty would imply a vacuum, which would interfere with the intrathoracic pressure changes that allow breathing. The surgeon doesn’t use a gel to fill the space. Serous fluid overproduction would compress the remaining lobes, diminish their function and possibly, cause a mediastinal shift.
19. B. 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.
20. D. 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.
21. D. The tumor is removed to prevent further compression of the lung tissue as the tumor grows, which could lead to respiratory decompensation. If for some reason it can’t be removed, then radiation or chemotherapy may be used to try to shrink the tumor.
22. C. The client with terminal lung cancer may have extreme pleuritic pain and should be treated to reduce his discomfort. Preparing the client and his family for the impending death and providing emotional support is also important but shouldn’t be the primary focus until the pain is under control. Nutritional support may be provided, but as the terminal phase advances, the client’s nutritional needs greatly decrease. Nursing care doesn’t focus on helping the client prepare the will.
23. C. The factor whose prognostic value is considered to be of greatest significance in determining the long-range outcome is the histologic type of leukemia. Children with a normal or low WBC count appear to have a much better prognosis than those with a high WBC count. Children diagnosed between ages 2 and 10 have consistently demonstrated a better prognosis because age 2 or after 10.
24. B. The three main consequences of leukemia are anemia, caused by decreased erythrocyte production; infection secondary to neutropenia; and bleeding tendencies, from decreased platelet production. Bone deformities don’t occur with leukemia although bones may become painful because of the proliferation of cells in the bone marrow. Spherocytosis refers to erythrocytes taking on a spheroid shape and isn’t a feature in leukemia. Mature cells aren’t produced in adequate numbers. Hirsutism and growth delay can be a result of large doses of steroids but isn’t common in leukemia. Anemia, not polycythemia, occurs. Clotting times would be prolonged.
25. D. The most frequent signs and symptoms of leukemia are a result of infiltration of the bone marrow. These include fever, pallor, fatigue, anorexia, and petechiae, along with bone and joint pain. Increased appetite can occur but it usually isn’t a presenting symptom. Abdominal pain may be caused by areas of inflammation from normal flora within the GI tract or any number of other causes.
26. A. The usual effect of leukemic infiltration of the brain is increased intracranial pressure. The proliferation of cells interferes with the flow of cerebrospinal fluid in the subarachnoid space and at the base of the brain. The increased fluid pressure causes dilation of the ventricles, which creates symptoms of severe headache, vomiting, irritability, lethargy, increased blood pressure, decreased heart rate, and eventually, coma. Often children with a variety of illnesses are hypervigilant and anxious when hospitalized.
27. A. 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. Basophillic and eosinophillic leukemia are named for the specific cells involved. These are much rarer and carry a poorer prognosis.
28. D. A spinal tap is performed to assess for central nervous system infiltration. It wouldn’t be done to decrease ICP nor does it aid in the classification of the leukemia. Spinal taps can result in brain stem herniation in cases of ICP. A spinal tap can be done to rule out meningitis but this isn’t the indication for the test on a leukemic client.
29. B. 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.
30. D. 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.
31. A. 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. cariniipneumonia, 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.
32. A. 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.
33. D. Varicella is a lethal organism to a child with leukemia. VZIG, given within 72 hours, may favorably alter the course of the disease. Giving the vaccine at the onset of symptoms wouldn’t likely decrease the severity of the illness. Acyclovir may be given if the child develops the disease but not if the child has been exposed.
34. A. 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.
35. C. Postirradiation somnolence may develop 5 to 8 weeks after CNS irradiation and may last 3 to 15 days. It’s characterized by somnolence with or without fever, anorexia, nausea, and vomiting. Although the syndrome isn’t thought to be clinically significant, parents should be prepared to expect such symptoms and encourage the child needed rest.
36. B. The testicular-self examination is recommended monthly after a warm shower or bath when the scrotal skin is relaxed. The client should stand to examine the testicles. Using both hands, with the fingers under the scrotum and the thumbs on top, the client should gently roll the testicles, feeling for any lumps.
37. C. Viruses may be one of multiple agents acting to initiate carcinogenesis and have been associated with several types of cancer. Increased stress has been associated with causing the growth and proliferation of cancer cells. Two forms of radiation, ultraviolet and ionizing, can lead to cancer. A diet high in fat may be a factor in the development of breast, colon, and prostate cancers. High-fiber diets may reduce the risk of colon cancer.
38. C. Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option B relates to monitoring for infection particularly if leukopenia is present. Options A and D, although important in the plan of care are not related directly to thrombocytopenia.
39. D. 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. Option A describes the leukemic process. Options B and C are not characteristics of multiple myeloma.
40. C. 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.
41. B. Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain and output of 1.5 to 2 L a day. Clients require about 3 L of fluid pre day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in renal tubules. Options A, C, and D may be components in the plan of care but are not the priority in this client.
42. C. Hodgkin’s disease is a disorder of young adults. Options A, B, and D are characteristics of this disease.
43. A. 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 B is a priority nursing assessment when the white blood cell count is low and the client is at risk for an infection.
44. D. 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.
45. D. A sunscreen with a SPF of 15 or higher should be worn on all sun-exposed skin surfaces. It should be applied before sun exposure and reapplied after being in the water. Peak sun exposure usually occurs between 10am to 2pm. Tightly woven clothing, protective hats, and sunglasses are recommended to decrease sun exposure. Suntanning parlors should be avoided.
46. C. For clients with obstructive versus restrictive disorders, extending exhalation through pursed-lip breathing will make the respiratory effort more efficient. The usual position of choice for this client is the upright position, leaning slightly forward to allow greater lung expansion. Teaching diaphragmatic breathing techniques will be more helpful to the client with a restrictive disorder. Administering cough suppressants will not help respiratory effort. A low semi-Fowlers position does not encourage lung expansion. Lung expansion is enhanced in the upright position.
47. A. Fever is an early sign requiring clinical intervention to identify potential causes. Chills and dyspnea may or may not be observed. Tachycardia can be an indicator in a variety of clinical situations when associated with infection; it usually occurs in response to an elevated temperature or change in cardiac function.
48. A. There are many mechanisms of action for chemotherapeutic agents, but most affect the rapidly dividing cells—both cancerous and noncancerous. Cancer cells are characterized by rapid cell division. Chemotherapy slows cell division. Not all chemotherapeutic agents affect molecular structure. All cells are susceptible to drug toxins, but not all chemotherapeutic agents are toxins.
49. A, B, D, E. A major concern with intravenous administration of cytotoxic agents is vessel irritation or extravasation. The Oncology Nursing Society and hospital guidelines require frequent evaluation of blood return when administering vesicant or nonvesicant chemotherapy due to the risk of extravasation. These guidelines apply to peripheral and central venous lines. In addition, central venous lines may be long-term venous access devices. Thus, difficulty drawing or aspirating blood may indicate the line is against the vessel wall or may indicate the line has occlusion. Having the client cough or move position may change the status of the line if it is temporarily against a vessel wall. Occlusion warrants more thorough evaluation via x-ray study to verify placement if the status is questionable and may require a declotting regimen.
50. C. The client is experiencing metabolic alkalosis caused by loss of hydrogen and chloride ions from excessive vomiting. This is shown by a pH of 7.46 and elevated bicarbonate level of 29 mEq/L.
51. D. 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.
52. D. Bacterial endotoxins released from gram-negative bacteria activate the Hageman factor or coagulation factor XII. This factor inhibits coagulation via the intrinsic pathway of homeostasis, as well as stimulating fibrinolysis. Liver disease can cause multiple bleeding abnormalities resulting in chronic, subclinic DIC; however, sepsis is the most common cause.
53. A. A pneumonectomy is the removal of an entire lung field. A wedge resection refers to removal of a wedge-shaped section of lung tissue. A lobectomy is the removal of one lobe. Removal of one or more segments of a lung lobe is called a partial lobectomy.
54. B. Nine days after chemotherapy, one would expect the client to be immunocompromised. The clinical signs of shock reflect changes in cardiac function, vascular resistance, cellular metabolism, and capillary permeability. Low-grade fever, tachycardia, and flushing may be early signs of shock. The client with impending signs of septic shock may not have decreased oxygen saturation levels. Oliguria and hypotension are late signs of shock. Urine output can be initially normal or increased.
55. D. 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.
56.  D. Difficulty in swallowing, pain, and tightness in the chest are signs of esophagitis, which is a common complication of radiation therapy of the chest wall.