NCLEX Practice Exam for Oncology 2

1. 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.

2. 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.

3. 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.

4. 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

5. 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.

6. 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

7. 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

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:

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

9. 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

10. 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

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?

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

12. 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

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?

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

14. 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

15. 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

16. 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

17. 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

18. 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.

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:

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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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.

26. 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

27. 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

28. The 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

29. 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

30. 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

31. A 25 year old patient is inquiring about the methods or ways to detect cancer earlier. The nurse least likely identify this method by stating:

1. Annual chest x-ray.
2. Annual Pap smear for sexually active women only.
3. Annual digital rectal examination for persons over age 40.
4. Yearly physical and blood examination

32. The removal of entire breast, pectoralis major and minor muscles and neck lymph nodes which is followed by skin grafting is a procedure called:

1. Simple mastectomy
2. Modified radical mastectomy
3. Radiation therapy
4. Radical mastectomy

33. Chemotherapy is one of the therapeutic modalities for cancer. This treatment is contraindicated to which of the following conditions?

1. Recent surgery
2. Pregnancy
3. Bone marrow depression
4. All of the above

34. The nurse is preparing Cyclophosphamide (Cytoxan). Safe handling of the drug should be implemented to protect the nurse from injury. Which of the following action by the nurse should be corrected?

1. The nurse should wear mask and gloves.
2. Air bubbles should be expelled on wet cotton.
3. Label the hanging IV bottle with “ANTINEOPLASTIC CHEMOTHERAPY” sign.
4. Vent vials after mixing.

35. Neoplasm can be classified as either benign or malignant. The following are characteristics of malignant tumor apart from:

1.  Metastasis
2. Infiltrates surrounding tissues
3. Encapsulated
4. Poorly differentiated cells

36. On a clinic visit a client who has a relative with cancer, is asking about the warning signs that may relate to cancer. The nurse correctly identifies the warning signs of cancer by responding:

1. “If a sore healing took a month or more to heal, cancer should be suspected.”
2. “Presence of dry cough is one of the warning signs of cancer.”
3. “A lump located only in the breast area may suggest the presence of cancer.”
4. “Sudden weight loss of unexplained etiology can be a warning sign of cancer.”

37. In staging and grading neoplasm TNM system is used. TNM stands for:

1. Time, neoplasm, mode of growth
2. Tumor, node, metastasis
3. Tumor, neoplasm, mode of growth
4. Time, node, metastasis

38. Breast self examination (BSE) is one of the ways to detect breast cancer earlier. The nurse is conducting a health teaching to female clients in a clinic. During evaluation the clients are asked to state what they learned. Which of the following statement made by a client needs further teaching about BSE?

1. “BSE is done after menstruation.”
2. “BSE palpation is done by starting at the center going to the periphery in a circular motion.”
3. “BSE can be done in either supine or standing position.”
4. “BSE should start from age 20.”

39. A client had undergone radiation therapy (external). The expected side effects include the following apart from:

1. Hair loss
2. Ulceration of oral mucous membranes
3. Constipation
4. Headache

40. Nurse Janet is assigned in the oncology section of the hospital. Which of the following orders should the nurse question if a client is on radiation therapy?

1. Analgesics before meals
2. Saline rinses every 2 hours
3. Aspirin every 4 hours
4. Bland diet

41. Skin reactions are common in radiation therapy. Nursing responsibilities on promoting skin integrity should be promoted apart from:

1. Avoiding the use of ointments, powders and lotion to the area
2. Using soft cotton fabrics for clothing
3. Washing the area with a mild soap and water and patting it dry not rubbing it.
4. Avoiding direct sunshine or cold.

42. Nausea and vomiting is an expected side effect of chemotherapeutic drug use. Which of the following drug should be administered to a client on chemotherapy to prevent nausea and vomiting?

1. Metochlopramide (Metozol)
2. Succimer (Chemet)
3. Anastrazole (Arimidex)
4. Busulfan (Myleran)

43. Radiation protection is very important to implement when performing nursing procedures. When the nurse is not performing any nursing procedures what distance should be maintained from the client?

1. 1 feet
2. 2 feet
3. 2.5 feet
4. 3 feet

44. The following are teaching guidelines regarding radiation therapy except:

1. The therapy is painless
2. To promote safety, the client is assisted by therapy personnel while the machine is in operation.
3.  The client may communicate all his concerns or needs or discomforts while the machine is operating.
4. Safety precautions are necessary only during the time of actual irradiation.

45. Contact of client on radiation therapy should be limited only to how many minutes to promote safety of the therapy personnel?

1. 1 minute
2. 3 minutes
3. 5 minutes
4. 10 minutes

46. A client is taking Cyclophosphamide (Cytoxan) for the treatment of lymphoma. The nurse is very cautious in administering the medication because this drug poses the fatal side effect of:

1. Alopecia
2. Myeloma
3. CNS toxicity
4. Hemorrhagic cystitis

47. Cytarabine (Ara-C) is an antimetabolite that can cause a common cytarabine syndrome which includes the following apart from:

1. Fever
2. Myalgia
3. Chest pain
4. Diarrhea

48. To provide relief from the cytarabine syndrome, which drug is given?

1. Analgesic
2. Aspirin
3. Steroids
4. Allopurinol

49. Chemotherapeutic agents have different specific classifications. The following medications are antineoplastic antibiotics except:

1. Doxorubicin (Adriamycin)
2. Fluorouracil (Adrucil)
3. Mitoxantrone (Novantrone)
4. Bleomycin (Blenoxane)

50. Specific classification of the chemotherapeutic agent, Vincristine (Oncovin) is:

1. Hormone modulator
2. Mitotic inhibitor
3. Antineoplastic antibiotic
4. Antimetabolite

51. A client is diagnosed with progressive prostate cancer. The nurse expects which drug is given?

1. Anstrazole (arimidex)
2. Estramustine (Emcyt)
3. Paclitaxel (Taxol)
4. Irinotecan (Camptosar)

52. A client taking a chemotherapeutic agent understands the effects of therapy by stating:

1. “I will avoid eating hot and spicy foods.”
2. “I should stay in my room all the time.”
3. “I should limit my fluid intake to about 500 ml per day.”
4. “I should notify the physician immediately if a urine color change is observed.”

53. A client is diagnosed with breast cancer. The tumor size is up to 5 cm with axillary and neck lymph node involvement. The client is in what stage of breast cancer?

1. Stage I
2. Stage II
3. Stage III
4. Stage IV

54. The classic symptoms that define breast cancer includes the following except:

1. “pink peel” skin
2. Solitary, irregularly shaped mass
3. Firm, nontender, nonmobile mass
4. Abnormal discharge from the nipple

55. Surgical procedure to treat breast cancer involves the removal of the entire breast, pectoralis major muscle and the axillary lymph nodes is:

1. Simple mastectomy
2. Modified radical mastectomy
3. Halstead Surgery
4. Radical mastectomy

Answers and Rationales

1. Answer D. 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.
   
2. Answer D. 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.
   
3. Answer A. 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.
   
4. Answer C. Chlorambucil-induced alopecia occurs 2 to 3 weeks after therapy begins.
   
5. Answer C. Thiotepa interferes with DNA replication and RNA transcription. It doesn’t destroy the cell membrane.
   
6. 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 the testicles, feeling for any lumps.
7. 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 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.
8. Answer D. 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.
9. Answer A. 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.
10. 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 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.
11. 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.
12. Answer 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. Options A and B are not characteristics of multiple myeloma. Option C describes the leukemic process.
13. Answer A. 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.
14. Answer A. 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.
15. 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 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.
    
16. Answer B. 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.
    
17. 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 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.
    
18. Answer D. 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.
    
19. Answer C. 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.
    
20. Answer A. 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.
    
21. Answer A. 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.
    
22. Answer D. 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.
    
23. Answer D. 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.
    
24. 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. Answer A. Tumors that originate from bone,muscle, and other connective tissue are called sarcomas.
    
26. Answer C. 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.
    
27. Answer B. 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. Options A, C, and D are expected occurrences following mastectomy and do not indicate a complication.
    
28. Answer B. 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.
    
29. Answer B. 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. The client’s complaint is not associated with options A, C, and D.
    
30. Answer D. 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.
31. Answer: B. Early detection of cancer is promoted by annual oral examination, monthly BSE from age 20, annual chest x-ray, yearly digital rectal examination for persons over age 40, annual Pap smear from age 40 and annual physical and blood examination. Letter B is wrong because it says Pap smear should be done yearly for sexually active women. All women should have an annual pap smear by age 40 and up whether sexually active or not.
32. Answer: D. Halstead surgery also called radical mastectomy involves the removal of entire breast, pectoralis major and minor muscles and neck lymph nodes. It is followed by skin grafting. Removal of the entire breast, pectoralis major muscle and the axillary lymph nodes is a surgical procedure called modified radical mastectomy. Simple mastectomy is the removal of the entire breast but the pectoralis muscles and nipples remain intact.
33. Answer: D. chemotherapy is contraindicated in cases of infection (chemotherapeutic agents are immunosuppressive), recent surgery (chemotherapeutic agent may retard the healing process), impaired renal and hepatic function (drugs are nephrotoxic and hepatotoxic), recent radiation therapy (immunosuppressive treatment), pregnancy (drugs can cause congenital defects) and bone marrow depression (chemo. Agents may aggravate the condition).
34. Answer: A. The nurse should be corrected if she is only wearing mask and glove because gowns should also be worn in handling chemotherapeutic drugs. The vials should be vent after mixing to reduce the internal pressure. Air bubbles are expelled on wet cotton to prevent the spread of the chemotherapeutic agent particles.
35. Answer: C. Benign: grows slowly, localized, encapsulated, well differentiated cells, no metastasis, not harmful to host. Malignant: Grows rapidly, infiltrates surrounding tissues, not encapsulated, poorly differentiated, metastasis present, always harmful
36. Answer: D. Unexplained sudden weight loss is a warning signal of cancer. Letter A is wrong because the sore in cancer does not heal. Nagging cough not dry cough and hoarseness of voice is a sign of cancer. Presence of lump is not limited to the breast only; it can grow elsewhere that is why letter C is wrong.
37. Answer: B. TNM stands for tumor, node, and metastasis.
38. Answer: B. This client needs further teaching as palpation in BSE should start at the periphery going to the center in a circular motion.
39. Answer: C. Diarrhea not constipation is the side effect of radiation therapy.
40. Answer: C. Radiation therapy makes the platelet count decrease. Thus, nursing responsibilities should be directed at promoting safety by avoiding episodes of hemorrhage or bleeding such as physical trauma and aspirin administration. Analgesics are given before meals to alleviate the pain caused by stomatitis. Bland diet and saline rinses every 2 hours should also be done to manage stomatitis.
41. Answer: C. No soap should be used on the skin of the client undergoing radiation. Soap and irritants and may cause dryness of the patient’s skin. Only water should be used in washing the area.
42. Answer A. Metochlopramide (Metozol) – antiemetic. Succimer (Chemet) – chelating agent for lead poisoning. Anastrazole (Arimidex) – hormone regulator. Busulfan (Myleran) – alkylating agent
43. Answer: D. The distance of at least 3 feet / 0.9 or 1 meter should be maintained when a nurse is not performing any nursing procedures.
44. Answer: B. To promote safety to the personnel, the client will remain alone in the treatment room while the machine is in operation. The client may voice out any concern throughout the treatment because a technologist is just outside the room observing through a window or closed circuit TV. There is no residual radioactivity after radiation therapy. Safety precautions are necessary only during the time of actual irradiation. The client may resume normal activities of daily living afterwards.
45. Answer C: Principles of Radiation protection follows the DTS system. Distance (D), Time (T) and Shielding (S). Distance – at least 3 feet should be maintained when a nurse is not performing any nursing procedures. Time – limit contact to 5 minutes each time. Shielding – use lead shield during contact with client.
46. Answer: D. Hemorrhagic cystitis is the potentially fatal side effect of Cytoxan. Myeloma is an indication for giving this medication. Alopecia is a common side effect.
47. Answer: D. Cytarabine syndrome includes fever, myalgia, bone pain, chest pain, rash, conjunctivitis and malaise. No diarrhea is included in this syndrome thus; diarrhea is the best choice.
48. Answer: C. Steroids may be prescribed to promote relief from cytarabine syndrome. Allopurinol is given for hyperurecemia that will result from taking some chemotherapeutic agent.
49. Answer: B. Fluorouracil (Adrucil) is an antimetabolite.
50. Answer: B. Vincristine is a mitotic inhibitor
51. Answer: B. Anstrazole (arimidex)- treatment of advanced breast cancer in post menopausal women following tamoxifen therapy. Estramustine (Emcyt) – palliative treatment of metastatic and progressive prostate cancer. Pclitaxel (Taxol) – treatment of ovarian cancer, breast cancer and AIDS related to Kaposi’s sarcoma. Irinotecan (Camptosar)- treatment of metastatic colon or rectal cancer after treatment with 5-FU.
52. Answer: A. The client should prevent hot and spicy food because of the stomatitis side effect. The client should avoid people with infection but should not isolate himself in his room all the time. Fluid intake should be increased. Urine color change is normal.
53. Answer B. Stage I – tumor size up to 2 cm. Stage II – tumor size up to 5 cm with axillary and neck lymph node involvement. Stage III – tumor size is more than 5 cm with axillary and neck lymph node involvement. Stage IV – metastasis to distant organs (liver, lungs, bone and brain).
54. Answer A. Classic symptoms that define breast cancer includes: Firm, nontender, nonmobile mass. Solitary, irregularly shaped mass. Adherence to muscle or skin causing dimpling effect. Involvement of the upper outer quadrant or central nipple portion. Asymmetry of the breasts. “Orange peel” skin. Retraction of nipple. Abnormal discharge from nipple.
55. Answer: B. removal of the entire breast, pectoralis major muscle and the axillary lymph nodes is a surgical procedure called modified radical mastectomy. Simple mastectomy is the removal of the entire breast but the pectoralis muscles and nipples remain intact. Halstead surgery also called radical mastectomy involves the removal of entire breast, pectoralis major and minor muscles and neck lymph nodes. It is followed by skin grafting.