Regular exposure to NCLEX RN Practice Questions prepares students to think critically and make sound clinical judgments in a time-sensitive environment.
NCLEX Oncology Questions - NCLEX Questions on Oncology
Oncology NCLEX Practice Questions
Question 1.
The nurse is evaluating an oncology patient's chart. They note that the patient is suffering from lung cancer and has a tumor about 4cm in size and associated pneumonitis. The tumor does not invade the entire lung and does not have lymph node involvement or distant metastasis. Using the TNM staging system, how would the nurse characterize this cancer patient's tumor?
(a) T3N3M1
(b) T2NOMO
(c) T1N1MO
(d) T2N1MO
Answer:
(b) T2NOMO
Explanation:
The TNM tumor staging method involves tumor size (T), node involvement (N), and distant metastasis (M). This patient has a tumor 4cm in size but locally contained in one section of the lung, giving it a rating of T2. Since there is no nodal involvement or metastasis, both N and M are O.
Rationale:
(a) is incorrect. T3 N3 Ml describes a tumor great than 7cm, metastasis in all contralateral lymph nodes, and distant metastasis.
(c) is incorrect. Ti Ni Ml describes a tumor that is self-contained and less than 3cm in size, some lymph node involvement, and no metastasis.
(d) is incorrect. T2 Ni MO indicates a tumor which is between 3 and 7cm in size, has some lymph node involvement, but no distant metastasis.
Question 2.
The incoming nurse is told in a report that their patient has been struggling with asymptomatic chemotherapy-induced anemia. The nurse understands that the patient will likely need a blood transfusion if:
(a) Hemoglobin drops below 8.0 g/dL
(b) Leukocytes drop below 4,000/mm3
(c) Hemoglobin drops below 10 g/dL
(d) Absolute neutrophil count is looo/mms
Answer:
(a) Hemoglobin drops below 8.0 g/dL
Explanation:
Hemoglobin levels are considered concerning and may require blood transfusions when below 8g/dL. Normal hemoglobin levels are 13.5 to 17.5 g/dL for men and 12 to 15.5 for women.
Rationale:
(b) is incorrect. While 4000/mm3 is on the low end of appropriate leukocyte levels, and this may be an effect of chemotherapy, this is not directly related to anemia, nor is it an indication for a blood transfusion.
(c) is incorrect. 10 g/dL is considered a low hemoglobin for both men and women, but since this patient is asymptomatic, they will not likely need a blood transfusion at this juncture.
(d) is incorrect. When ANC drops below 1ooo/mm3, this is called neutropenia. This is a side effect of chemotherapy and it increases the patient’s risk for infection, but this does not necessitate a blood transfusion.
Question 3.
The nurse is caring for a cancer patient who is undergoing chemotherapy. The patient is losing weight as a result of intermittent nausea and vomiting. The nurse encourages which of the following interventions to reduce nausea? (Select all that apply.)
(a) Encourage using hot sauce and flavorful herbs for unappetizing foods
(b) Consume small, frequent meals
(c) Provide meals that are served at room temperature
(d) Brush teeth midday rather than upon awakening in the morning
(e) Consume high-fat and high-protein foods
Answer:
(b) Consume small, frequent meals
(c) Provide meals that are served at room temperature
(d) Brush teeth midday rather than upon awakening in the morning
Explanation:
Serving small frequent meals served at room temperature and delaying teeth brushing till the midday may reduce nausea.
Rationale:
(a) is incorrect. Spicy foods and strong herbs may aggravate nausea in the patient receiving chemotherapy.
(e) is incorrect. High-fat foods are especially nauseating for those prone to upset stomach.
Question 4.
The nurse is discussing immunity with a student nurse. Which of the following statements by the student demonstrates an understanding about immunity?
(a) “The cell-mediated immune response is an example of adaptive immunity.”
(b) “An example of artificially acquired active immunity is when a mother passes antibodies through the placenta to the fetus.”
(c) Naturally acquired active immunity occurs after two or more exposures to a disease or foreign antigen.
(d) “The flu vaccine is naturally acquired active immunity.”
Answer:
(a) “The cell-mediated immune response is an example of adaptive immunity.”
Explanation:
Cell-mediated immunity is a good example of adaptive immunity. This type of immunity is spurred by cytokines and T-lymphocytes and doesn't involve antibodies.
Rationale:
(b) is incorrect. Antibodies passed from mother to baby via the placenta or breastmilk is naturally acquired passive immunity.
(c) is incorrect. In naturally acquired active immunity, the body produces specific antibodies during infection by a virus or bacterium, and memory cells remain in the bloodstream after recovery to give a faster secondary response if the same antigen is encountered again, making the individual immune to that pathogen.
(d) is incorrect. Vaccines are artificially acquired adaptive immunity. (An individual is given an injection of a small dose of weakened pathogen to stimulate the immune system to produce specific antibodies against that infection.)
Question 5.
While the nurse is caring for their patient with a large breast tumor, the patient reports some difficulty breathing. Upon examination, the nurse notes that the patient has a swollen face and neck, nasal congestion, and a hoarse voice. The nurse would most likely believe which of the following conditions is occurring in their patient?
(a) Spinal cord compression
(b) Hodgkin's lymphoma
(c) Superior vena cava syndrome
(d) Septic shock
Answer:
(c) Superior vena cava syndrome
Explanation:
Since this patient's cancerous tumor is located in the chest region, pressure from the tumor may result in the obstruction of flow to and/or from the superior vena cava. Common clinical presentations of Superior vena cava syndrome include blurred vision, hoarse voice, stridor, dyspnea, and nasal congestion. Patients may also experience a pleural effusion or light-headedness.
Rationale:
(a) is incorrect because spinal cord compression develops when the spinal cord is compressed by bone fragments from a vertebral fracture, a tumor, abscess, ruptured intervertebral disc or another lesion. Symptoms include back pain, paralysis, areas of increased or decreased sensation, and urinary or fecal incontinence.
(b) is incorrect because the symptoms of Hodgkin’s lymphoma include fever, night sweats, and weight loss. The patient may also have painless, enlarged lymph nodes near the next, axillae, or inguinal area.
(d) is incorrect because the symptoms of septic shock include organ injury related to infection along with low blood pressure, tachypnea, altered WBC (abnormally low or high), and tachycardia.
Question 6.
The nurse is caring for a patient with an epidural tumor. The patient reports new onset of inability to feel the lower extremities along with severe back pain. What is the priority action by the nurse?
(a) Evaluate and manage the patient's pain
(b) Observe for signs of urinary retention
(c) Aid the patient in performing personal hygiene care
(d) Maintain strict bed rest
Answer:
(d) Maintain strict bed rest
Explanation:
The patient is showing signs of spinal cord compression. Strict bed rest should be maintained while spinal stability is evaluated. Allowing the patient to ambulate or get out of bed increases the risk for paralysis or other permanent neurological damage.
Rationale:
(a) is incorrect because preventing paralysis by maintaining bed rest is a greater priority than pain control.
(b) is incorrect because although spinal cord compression can cause urinary retention, this is a non-life-threatening symptom which is not as important as maintaining bed rest.
(c) is incorrect because assistance with hygiene is not a priority when spinal cord compression is suspected.
Question 7.
When caring for a patient diagnosed with lung cancer, the nurse notes the patient will be receiving a wedge resection tomorrow. The nurse is aware that what part of the lung will be removed?
(a) A lung lobe
(b) A whole lung
(c) A small, localized segment near the superficial surface of the lung
(d) A segment of the lung containing bronchioles and alveoli
Answer:
(c) A small, localized segment near the superficial surface of the lung
Explanation:
During a wedge resection, a small, localized portion of the lung will be removed. This section will be close to the surface of the lung. A margin of healthy tissue around the sample will be removed as well. This is often done when removal of an entire lung lobe would impact respirations too much. A wedge resection is the smallest amount of lung tissue that can be removed in the treatment of lung cancer.
Rationale:
(a) is incorrect because this describes a lobectomy. Humans generally have five lung lobes: three on the right and two on the left. If a wedge resection or segmentectomy is not sufficient to remove the cancer or diseased portion of lung, a lobectomy will be performed.
(b) is incorrect because removal of an entire lung, a pneumonectomy, is a much larger procedure with greater risks than a wedge resection.
(d) is incorrect because it describes a segmentectomy.
Question 8.
The nurse is caring for a chemotherapy patient with an absolute neutrophil count (ANC) of 900. The patient has had poor nutritional intake over the past five days. The patient states, “All I want to eat is cheese, crackers, grapes, and pickles.” How should the nurse reply?
(a) “The goal is to increase your calorie intake, so I will order those foods for you.”
(b) “I can get you some crackers, but the other foods you requested are not safe because of your neutropenia.”
(c) “I can order you some crackers, but I suggest you also try the plain mashed potatoes and boiled, lightly-seasoned chicken.”
(d) “If we don’t boost your calorie intake you may need to start tube feeding.”
Answer:
(c) “I can order you some crackers, but I suggest you also try the plain mashed potatoes and boiled, lightly-seasoned chicken.”
Explanation:
Neutrophils make up the majority of circulating white blood cells and serve as the primary defense against infections by destroying bacteria and viruses in the blood. A normal absolute neutrophil count (ANC) is 1500-8000 cells/microliter. This patient has moderate neutropenia (ANC 1000-1500) and is at moderate risk for infection. Plain mashed potatoes and boiled, light-seasoned chicken are the best meal option for this neutropenic patient. Potatoes are easy to eat for patients with oral discomfort. Lightly seasoned, boiled chicken is fully cooked and poses no risk to the patient. Offering to order crackers, as well, is therapeutic because it acknowledges the patient’s wishes.
Rationale:
(a) is incorrect because some cheeses are unsafe to serve to the neutropenic patient as they may increase risk for infection. Fresh fruit, such as grapes, may contain bacteria, and should also be avoided on a neutropenic diet. Pickled foods can be irritating to the mouth, especially for chemotherapy patients who often experience stomatitis and sores in the mouth.
(b) is incorrect because (although it is a true statement) crackers alone will not meet the patient’s dietary needs.
(d) is incorrect because although it may be a true statement, the nurse should communicate therapeutically by acknowledging the patient’s wishes and making alternative, healthy suggestions.
Question 9.
A patient with an absolute neutrophil count of 750 is being transported from the hospital room for a procedure in a different hospital department. The patient has been complaining of chills and has had difficulty ambulating due to muscle weakness from chemotherapy. The nurse should ensure the patient uses which item at all times during transport?
(a) A gait belt to prevent falls
(b) Warmed blankets to maintain body heat
(c) Portable EKG monitor
(d) A face mask
Answer:
(d) A face mask
Explanation:
Neutropenic patients are at an increased risk of acquiring an infection. Extra steps, such as wearing a face mask, should be taken to prevent inhalation of airborne infectious agents, especially when being transported through the hospital, where chance for exposure is increased.
Rationale:
(a) is incorrect. When being transported from the unit to another area of the hospital, the patent should be transported in a wheelchair or on a stretcher, so a gait belt is unnecessary.
(b) is incorrect. Warm blankets provide comfort and do indeed help maintain patient heat. However, warmth is not as much of a priority as reducing risk for infection.
(c) is incorrect because continuous EKG monitoring is not required for a chemotherapy patient with neutropenia.
Question 10.
When preparing to discuss treatment options with a patient diagnosed with leukemia, which of the following will the nurse not anticipate to be included by the health care provider?
(a) Irradiated red blood cell transfusion
(b) Chemotherapy
(c) Hematopoietic stem cell transplantation
(d) Radioisotope therapy
Answer:
(a) Irradiated red blood cell transfusion
Explanation:
Leukemia is a neoplastic disease that affects blood-forming tissues of the bone marrow, spleen, and lymph nodes. Leukemia is characterized by destruction of at least one type of white blood cell and its precursors. The transfusion of irradiated red blood cells may be used to restore the RBC count in patients with compromised immune systems, but it is not used to treat leukemia.
Rationale:
(b) is incorrect because chemotherapy is commonly used to treat leukemia.
(c) is incorrect because hematopoietic stem cell transplantation can be used in addition to either chemotherapy or radiation for the treatment of leukemia.
(d) is incorrect because radioisotopes can be infused into the bloodstream to affect target tissues that are affected by leukemia.
Question 11.
The nurse is providing education to parents of a child receiving chemotherapy. Which of the following statements is appropriate for the nurse to include?
(a) “If your child develops a fever overnight, monitor it closely and bring your child to the clinic first thing in the morning.”
(b) “Be sure your child receives the MMR vaccine on schedule to prevent serious infection with the measles.”
(c) “Be sure to inspect your child’s feet daily to observe for cuts or infections.”
(d) “Regularly wash soft toys and security blankets in the washing machine.”
Answer:
(c) Sudden clumsiness of hands
Explanation:
Children receiving chemotherapy are at increased risk for infection, so parents should be taught about regularly washing items that the child uses frequently. The nurse should also teach the parents about keeping their child away from other children who are sick, avoiding playing with items other children have played with, and disinfecting other toys and surfaces frequently.
Rationale:
(a) is incorrect because a fever may be the only sign of infection in a child receiving chemotherapy. A fever should be treated as a medical emergency and the parents should be taught to call the healthcare provider on-call or bring the child to the ED immediately.
(b) is incorrect because a child receiving chemotherapy is immunocompromised and should not receive any live vaccines, such as the MMR vaccine.
(c) is incorrect because children receiving chemotherapy are not at increased risk specifically related to infections of the feet.
Question 12.
The nurse caring for a patient with myelosuppression anticipates performing all of the following nursing actions, except for:
(a) Monitor the patient for fever
(b) Observe for signs of neurological changes
(c) Initiate neutropenic precautions
(d) Administer antibiotics if prescribed
Answer:
(b) Observe for signs of neurological changes
Explanation:
While nurses should monitor all patients for level of consciousness changes, observing a patient with myelosuppression for neurological changes is not a priority action.
Rationale:
(a) is incorrect because patients with myelosuppression are at an increased risk of developing infections. The temperature should be monitored frequently, and any increase in temperature should be reported to the healthcare provider immediately.
(c) is incorrect because neutropenic precautions are generally initiated in patients with myelosuppression as a preventative measure against infection.
(d) is incorrect because antibiotics may be prescribed to patients with myelosuppression to aid their weakened immune systems in fighting off infection.
Question 13.
The nurse is assessing a client for Hodgkin's disease. Besides noting Reed-Sternberg cells on the lymph node biopsy specimen, what clinical feature will the nurse expect?
(a) Exophthalmos
(b) Urticaria
(c) Presenting age above 45
(d) Painless, enlarged lymph nodes
Answer:
(d) Painless, enlarged lymph nodes
Explanation:
Hodgkin’s disease is a type of lymphoma affecting lymphocyte white blood cells. Reeds- Sternberg cells observed in the biopsied lymph node specimen are a classic sign of Hodgkin's disease and are painless, enlarged lymph nodes and movable nodes in the supraclavicular area. Other symptoms include fever, night sweats, and weight loss.
Rationale:
(a) is incorrect because exophthalmos is an indication of thyroid dysfunction, not Hodgkin's disease.
(b) is incorrect because urticaria, or itching skin, is not a cardinal sign of Hodgkin's disease. Urticaria is more often seen in kidney disorders, gout, or allergic reactions.
(c) is incorrect because Hodgkin's lymphoma usually presents in mid-adolescence rather than in adults over 45 years old.
Question 14.
A four-year-old is being seen by the oncologist in the office. When the nurse assesses urinary frequency, an irregular mass along the midline of the abdomen, and pallor, the nurse would be most correct in considering which malignancy as the cause?
(a) Hodgkin's lymphoma
(b) Leukemia
(c) Pancreatic cancer
(d) Neuroblastoma
Answer:
(d) Neuroblastoma
Explanation:
This patient is displaying symptoms of a neuroblastoma. These adrenal gland or peritoneal tumors tend to occur in children under 10 years of age and result in urinary frequency and pallor. Tumors are generally located midline of the abdomen. Treatment depends on whether or not the tumor is localized and may include surgical removal along with chemotherapy. Neuroblastoma is the third most common cancer in children after leukemia and brain cancer.
Rationale:
(a) is incorrect because the patient is not presenting with symptoms of Hodgkin's lymphoma (fever, night sweats, weight loss, non-painful enlarged lymph nodes in the neck, groin, or axilla).
(b) is incorrect because signs of leukemia include bleeding, bruising, fatigue, fever, and increased risk for infection.
(c) is incorrect because characteristics of pancreatic cancer include yellow skin, abdominal or back pain, unexplained weight loss, loss of appetite, dark colored urine, and light-colored stool.
Question 15.
The nurse is providing pre-operative care for a patient with a brain tumor. Which assessment should be performed every four hours?
(a) Empty and replace the indwelling urinary catheter
(b) Provide a non-stimulating environment
(c) Assess the patient's neurological status
(d) Provide small, bland meals
Answer:
(c) Assess the patient's neurological status
Explanation:
A brain tumor frequently results in changes in the patient's level of consciousness. These early changes in LOC can be indicators of increasing intracranial pressure, which is a sign of worsening patient condition. The nurse should evaluate the patient's mental status using the Glascow Coma scale every four hours before surgery.
Rationale:
(a) is incorrect because while some patients with brain tumors may have problems with urination, a catheter is not generally needed preoperatively. If an indwelling urinary catheter is in place, the nurse should measure I and O every eight hours, or more frequently. Each time a urinary catheter is replaced, this increases risk for infection, so these should not be changed every four hours.
(b) is incorrect because providing a quiet environment is appropriate, but this does not need to be done every four hours and is not more important than assessing neurological status.
(d) is incorrect because NPO status is necessary pre-op before a brain surgery.
Question 16.
The pediatric nurse is providing a teaching session to new nurses on the oncology unit. When discussing an osteosarcoma, which of the following statements by a new RN indicates a need for further education?
(a) "At least the child won't experience any pain at the site of the osteosarcoma until after surgery."
(b) "Many parents attribute their children's pain to growing pains."
(c) "Patients may limp on their affected side."
(d) "Most commonly, the osteosarcoma forms in the patient's femur."
Answer:
(a) "At least the child won't experience any pain at the site of the osteosarcoma until after surgery."
Explanation:
The nurse must provide education to the new RN about the pain associated with osteosarcoma. This type of bone cancer often occurs in children and is found in the long bones, most commonly the femur.
Rationale:
(b) is incorrect because pain at the site of the bone cancer can often be misinterpreted as growing pains, or typical aches and pains of childhood. Often, by the time an osteosarcoma is diagnosed, it has spread to the lungs or secondary bones.
(c) is incorrect because children with an osteosarcoma in the leg often do limp on the affected side.
(d) is incorrect because the femur is the most common site of osteosarcoma, indicating understanding.
Question 17.
The pediatric oncology client is suspected of having developed a case of “Wilm's tumor." It is a priority for the nurse to ensure that which procedure is not performed on this child?
(a) Monitoring of the pediatric patient's blood pressure with an ankle cuff
(b) Taking rectal temperatures
(c) Palpating the abdomen for a mass
(d) Checking the patient's urine for bacteria
Answer:
(c) Palpating the abdomen for a mass
Explanation:
A Wilm’s tumor is a nephroblastoma (cancer of the kidneys), which occurs in children (500 cases annually in the U.S.) and rarely occurs in adults. The nurse should alert other members of the healthcare staff to avoid abdominal palpation. Palpation of Wilm's tumor may causing "seeding" or the spread of the cancerous cells. Symptoms include a painless abdominal mass, loss of appetite, abdominal pain, fever, nausea, and vomiting. Blood in the urine is seen in some cases, and high blood pressure is also seen on some occasions.
Rationale:
(a) is incorrect because this patient's vital signs should be evaluated per hospital policy. Blood pressure can be monitored on the arm for a patient with Wilm’s tumor. However, assessing BP on the ankle is not contraindicated.
(b) is incorrect because a patient with suspected Wilm’s tumor does not necessitate rectal temperatures, but this action is not specifically contraindicated in relation to the Wilm’s tumor.
(d) is incorrect because if a urinary tract infection is suspected, a lab test on urine should be performed. Assessment of this patient's urine is not contraindicated.
Question 18.
The oncology nurse notes that the patient is scheduled to receive syngeneic donor stem cells the following morning. The nurse understands that which of the following is true about these stem cells?
(a) There is no risk of graft-versus-host disease
(b) It is possible that the new cells will be cancerous as well
(c) The stem cells originated in the patient's body
(d) This type of stem cell donation cannot be used to treat testicular cancer
Answer:
(a) There is no risk of graft-versus-host disease
Explanation:
Syngeneic stem cells are taken from an identical twin (or triplet) of the patient who is to receive the donation. There is no risk of graft-vs-host disease because the patient’s body will recognize the donated cells as if they were the patient’s own.
Rationale:
(b) is incorrect because before donating stem cells, donors undergo rigorous medical testing to ensure than the donated cells are cancer-free.
(c) is incorrect because stem cells which originate in the patient's own body are autologous. Syngeneic stem cells are donated by an identical twin (or triplet) of the recipient.
(d) is incorrect because syngeneic stem cells donation can be used to treat the following types of cancers: testicular, Hodgkin’s and Non-Hodgkin’s lymphoma, multiple myeloma, leukemia, severe aplastic anemia, and myelodysplastic syndrome.
Question 19.
Following an engraftment procedure, the patient complains of right upper quadrant abdominal pain. The nurse assesses jaundice and palpates an enlarged liver. The nurse suspects which complication of engraftment procedures?
(a) Veno-occlusive disease of the liver
(b) Liver fibrosis
(c) Graft versus host disease
(d) Expected reactions to the procedure
Answer:
(a) Veno-occlusive disease of the liver
Explanation:
Occasionally, following an engraftment, the patient may experience veno-occlusive disease of the hepatic venules. This is a condition in which some of the small veins in the liver are obstructed. Characteristic findings include weight gain due to fluid retention, increased liver size, tenderness near the liver, and raised levels of bilirubin in the blood. The patient will need aggressive treatment via support fluids and symptomatic treatment.
Rationale:
(b) is incorrect because liver fibrosis is not a typical reaction from engraftment.
(c) is incorrect because graft versus host disease may occur after an engraftment procedure but is characterized by liver, skin (rash), and GI system damage.
(d) is incorrect because jaundice, abdominal pain, and a tender, enlarged liver are not expected finding after an engraftment procedure.
Question 20.
A female patient is expressing concern over the possibility of developing breast cancer. While providing breast self-examination instructions, which of the following instructions is appropriate?
(a) Perform the breast self-examination on the first day of her period
(b) If she is post-menopausal, breast self-examination can be performed once every two months
(c) Facing the mirror, examine breasts first with arms at sides, then with arms above head, and finally with hands on hips
(d) Perform the breast self-examination when menstrual bleeding is the heaviest
Answer:
(c) Facing the mirror, examine breasts first with arms at sides, then with arms above head, and finally with hands on hips
Explanation:
Women should exam their breasts at the same time each month, especially when they are soft. The woman should face a mirror and first examine breasts with both arms at her sides, then with both arms above the head, and lastly with her hands on her hips. Other instructions by the nurse should include use of the finger pads of the three middle fingers to palpate breasts to detect unusual growths while lying down, observation for dimpling or retractions on the skin of the breasts, and examination of nipples for discharge, changes or swelling.
Rationale:
(a) is incorrect because the best time to check breasts for lumps is one week after menstruation begins.
(b) is incorrect because even post-menopausal clients should be taught to perform the exam once a month, at the same time of the month.
(d) is incorrect because performing a breast self-examination during menses may be painful, as breasts are often enlarged and tender to the touch during this period.
Question 21.
The nurse is caring for a patient being treated for leukemia. Which of the following lab values causes the nurse to consider the patient may be experiencing tumor lysis syndrome?
(a) Potassium 3.3 mEq/L
(b) Hypophosphatemia
(c) Total serum calcium 8.5 mg/L
(d) BUN 8 mg/dL
Answer:
(c) Total serum calcium 8.5 mg/L
Explanation:
Tumor lysis syndrome (TLS) is a complication of cancer treatment in which numerous cancer cells are killed at a time and their contents are released into the bloodstream. TLS is characterized by hyperkalemia, hyperphosphatemia, hyperuricemia, and elevated BUN. Because calcium levels decrease when phosphate levels increase, the resultant hyperphosphatemia from TLS results in hypocalcemia. Normal total serum calcium is 8.6 - 10.2 mg/L. TLS occurs most commonly in the treatment of lymphomas and leukemias.
Rationale:
(a) is incorrect because TLS will present with elevated potassium. Normal potassium is 3.5-5.0 mEq/L.
(b) is incorrect because TLS is characterized by hyperphosphatemia (increased blood phosphate levels).
(d) is incorrect because BUN is elevated in TLS. Normal BUN is 10-20 mg/dL.
Question 22.
When the nurse is evaluating the labs of a patient with multiple myeloma, which finding would be expected?
(a) Proliferation of red blood cells
(b) Increased serum calcium
(c) Low number of circulating monoclonal proteins
(d) Decreased serum sodium
Answer:
(b) Increased serum calcium
Explanation:
Myeloma is cancer of plasma cells within the bone marrow. The abnormal cells multiply rapidly, crowding out normal WBCs and RBS, leading to fatigue and inability to fight infections. The cancerous cells also produce abnormal antibodies, called monoclonal proteins, which can build up in the body and cause kidney damage. Patients with multiple myeloma will have increased serum calcium levels due to the destruction of bone marrow and subsequent release of calcium.
Rationale:
(a) is incorrect because patients with multiple myeloma tend to have a decreased number of red blood cells, leading to anemia and fatigue.
(c) is incorrect because increased monoclonal proteins are characteristic of multiple myeloma.
(d) is incorrect because sodium levels are not relevant to multiple myeloma. In cases where kidney damage is present, hypernatremia may occur as a result of the kidneys’ inability to effectively excrete sodium and water from the circulation.
Question 23.
Hypercalcemia is an oncological emergency in patients with prostate cancer. Which of the following is a late sign of this condition?
(a) Thirst, sticky mucous membranes
(b) Seizures and increased neuromuscular irritability
(c) Diarrhea and dehydration
(d) EKG changes
Answer:
(d) EKG changes
Explanation:
Hypercalcemia is a calcium level greater than 10.2 mg/dL. This can cause a sedative effect on the central nervous system. Symptoms include muscle weakness, lack of coordination, decreased deep tendon reflexes, and EKG changes, such as cardiac dysrhythmias. When an excess of calcium is present in the bloodstream, the nurse may see a shortened ST segment and widened T wave.
Rationale:
(a) is incorrect because thirst and sticky mucous membranes are characteristic of hypernatremia, not hypercalcemia.
(b) is incorrect because seizures are a symptom of hypocalcemia, or total serum calcium less than 8.6 mg/dL.
(c) is incorrect because hypercalcemia will cause constipation.
Question 24.
The patient with squamous cell carcinoma is receiving intravenous bleomycin. The nurse expects which test to be ordered?
(a) Pulmonary function studies
(b) Lumbar puncture
(c) Renal computed tomography
(d) Abdominal radiography
Answer:
(a) Pulmonary function studies
Explanation:
Bleomycin is an antineoplastic antitumor antibiotic medication used to treat many cancers, including Hodgkin’s disease, non-Hodgkin’s lymphoma, and leukemia. Serious adverse reactions include pulmonary fibrosis and heart failure. Therefore, the patient's pulmonary function should be closely monitored.
Rationale:
(b) is incorrect because a lumbar puncture (LP) is not needed for a patient receiving bleomycin. An LP is a needle inserted into the subarachnoid space to inject medication or obtain a CSF specimen.
(c) is incorrect because bleomycin does not have an adverse reaction on the kidneys.
(d) is incorrect because abdominal radiography will not give any specific information about potential adverse effects of bleomycin.
Question 25.
The oncology patient is receiving megestrol acetate. The nurse should question this order if what medical history is noted in the patient’s record?
(a) Asthma since the age of five
(b) Gout with chronic joint pain and swelling
(c) Thrombophlebitis in left leg after previous surgery
(d) Recent weight loss and cachexia
Answer:
(c) Thrombophlebitis in left leg after previous surgery
Explanation:
Megestrol acetate is a hormonal antineoplastic agent used to treat breast, prostate, and endometrial cancers. Because this medication suppresses luteinizing hormone, cases of thrombophlebitis can be worse. The physician should be notified to address the appropriate course of action.
Rationale:
(a) is incorrect because asthma is not a contraindication for the use of megestrol acetate.
(b) is incorrect because the patient with gout can safely take megestrol acetate.
(d) is incorrect because megestrol acetate is actually beneficial for a patient who has been losing weight because it acts as an appetite stimulant and has been shown to help increase weight in cancer patients.
Question 26.
Upon entering the patient's room, the patient reports that her sealed radiation implant for cervical cancer has become dislodged and fallen out. Which of the following priority nursing actions should be performed first?
(a) Contact the radiation oncologist
(b) Document the dislodgment
(c) Encourage the client to lie still
(d) Retrieve the radioactive source with a long-handled pair of forceps and place in biohazard bucket
Answer:
(c) Encourage the client to lie still
Explanation:
This patient may have lost the sealed radiation device in her bed, or it may still be inside of her vagina. To prevent skin irritation or other hazards, the nurse should ask the patient to lie still until the implant has been located and retrieved. Once retrieved, the nurse should place the device in a lead bucket, contact the radiation oncologist, and document the occurrence and actions taken.
Rationale:
(a) is incorrect because locating the implant and properly sealing it in a lead bucket are priority actions that must be taken prior to calling the oncologist or nuclear medical specialist.
(b) is incorrect because documentation is not priority ahead of actual patient care at the bedside.
(d) is incorrect because instructing the patient to lie still is the priority until the nurse has located the implant. Once located, the item should be retrieved with long-handled forceps and placed in a lead bucket. A biohazard bucket is made of plastic and will not contain radiation.
Question 27.
The nurse is reviewing labs from a patient diagnosed with leukemia. The nurse knows that this patient is at risk of spontaneous bleeding when the platelet count falls below:
(a) 50,000 cells/mnD
(b) 150,000 cells/mm3
(c) 100,000 cells/mm3
(d) 20,000 cells/mm3
Answer:
(d) 20,000 cells/mm3
Explanation:
Normal platelet (thrombocyte) count is 150,000-450,ooo/mm3. Patients are at risk for spontaneous bleeding when the platelet count falls below 20,000 cells/mm3.
Rationale:
(a) is incorrect because patients are at risk of general bleeding (not spontaneous) when the platelet count falls below 50,000 cells/mm3.
(b) is incorrect because this platelet count is at the low end of normal and the risk for bleeding is not increased.
(c) is incorrect because the risk for spontaneous bleeding is when platelets fall below 20,000 cells/mm3.
Question 28.
The pre-operative nurse is providing patient education to a female client scheduled to have a right total breast mastectomy and lymph node removal. Which of the following patient statements would require the nurse to provide further education?
(a) "I should keep my right arm elevated after surgery."
(b) "I shouldn't carry anything heavy with my right arm when I go home."
(c) "I should wear snug-fitting sleeves, especially on the right side, to prevent blood clot formation."
(d) "I need to remind health care professionals to take my blood pressure on my left side."
Answer:
(c) "I should wear snug-fitting sleeves, especially on the right side, to prevent blood clot formation."
Explanation:
Tight-fitting clothing on the affected side can impede lymph drainage and adequate circulation to the surgical site. Rather, this patient should be encouraged to wear comfortable, loose-fitting clothing.
Rationale:
(a) is incorrect because it demonstrates understanding.
(b) is incorrect because the statement indicates that the patient understands the limitations after surgery.
(d) is incorrect because it is true that the patient must avoid blood pressure readings on the affected side after mastectomy.
Question 29.
The nurse is talking with a patient who has expressed that they are nervous about their family history of adenocarcinoma in the esophagus. Knowing the major risk factors involved with developing this disease, the nurse would instruct this patient to avoid or limit all of the following activities except:
(a) Smoking cigarettes
(b) Drinking alcohol
(c) Using antacids
(d) Chewing tobacco
Answer:
(c) Using antacids
Explanation:
Esophageal cancer is a malignancy in the esophageal mucosa. Antacids may reduce chronic acid reflux, preventing the development of an irritated esophagus. For those who suffer from acid reflux, taking a prescribed antacid may help.
Rationale:
(a) is incorrect because cigarette smoke can contribute to esophageal cancer and increases gastric acid production.
(b) is incorrect because it is a good nursing action to teach this patient to limit alcohol consumption to decrease the risk of esophageal cancer.
(d) is incorrect because and tobacco products increase the risk of many types of cancers.
Question 30.
While providing education to an oncology patient scheduled to start chemotherapy treatment, the nurse states that chemotherapy acts on rapidly dividing cells. Knowing this, the nurse would be correct in stating that which areas of the body are most likely to be affected?
(a) Spermatocytes, lining of the GI tract, and hair cells
(b) Skin cells, oocytes, and fat cells
(c) Fat cells, GI tract lining, and hair cells
(d) Alveoli of the lungs, taste buds, and cervical cells
Answer:
(a) Spermatocytes, lining of the GI tract, and hair cells
Explanation:
Chemotherapy acts on rapidly dividing cells such as spermatocytes, cells which line the GI tract (from the mouth to the anus) and skin and hair cells.
Rationale:
(b) is incorrect because while skin cells do indeed divide rapidly, oocytes and fat cells do not divide as rapidly and are not as affected by chemotherapy.
(c) is incorrect because fat cells are not as affected by chemotherapy as other more rapidly dividing cells.
(d) is incorrect because lung alveoli, taste buds, and cervical cells do not divide rapidly and are not primary target cells of chemotherapy treatment.
Question 31.
The nurse assesses four male patients. Which of the following is most likely suffering from testicular cancer?
(a) 60-year-old whose mother used diethylstilbestrol during her pregnancy with him
(b) 18-year-old, complains of pain while ejaculating
(c) 38-year-old reporting that one testis has become significantly smaller than the other during the past the weeks
(d) 22-year-old, complains of painless swelling of one testis
Answer:
(d) 22-year-old, complains of painless swelling of one testis
Explanation:
Testicular cancer is the most common cancer in men ages 15 to 35 years. Symptoms include painless swelling with or without a lump palpated in one or both testes.
Rationale:
(a) is incorrect because this patient has one risk factor for testicular cancer, but no symptoms are described. Women used diethylstilbestrol (DES) during the 1950s and 1960s to prevent miscarriage. Male babies born to women who used DES are at higher risk of developing testicular cancer.
(b) is incorrect because painful ejaculation is not a sign of testicular cancer.
(c) is incorrect because unilateral testicular atrophy is not a sign of testicular cancer.
Question 32.
The patient with gastric cancer is scheduled to undergo a Billroth I procedure. The nurse explains to the patient that this procedure will include:
(a) Removal of the entire stomach, attaching the esophagus to the jejunum or duodenum
(b) Removal of the stomach with the instillation of a Koch pouch
(c) Partial removal of the stomach with the remaining portion routed to the duodenum
(d) Removal of parts of the stomach with a routing to the jejunum
Answer:
(c) Partial removal of the stomach with the remaining portion routed to the duodenum
Explanation:
A Billroth I procedure is a type of bariatric surgery, also known as a gastro-duodenostomy. This procedure is performed by removing part of the stomach and rerouting the remaining portion to the duodenum.
Rationale:
(a) is incorrect because the removal of the entire stomach with an attachment to the jejunum or duodenum is known as a total gastrectomy.
(b) is incorrect because a Billroth procedure does not remove the entire stomach (known as a total gastrectomy).
(d) is incorrect because a Billroth I procedure routes to the duodenum rather than the jejunum. This variation is known as a gastro-jejunostomy, or a Billroth II procedure.
Question 33.
The oncological nurse is educating the student nurse about the phases of chemotherapy. Which of the following statements by the student nurse indicates an understanding of the induction phase?
(a) “Induction is the phase which decreases the tumor burden after initial treatment.”
(b) “The portion of chemotherapy which prevents further invasion by leukemic cells is known as induction.”
(c) “Induction includes the maintenance period of preventing and controlling remission.”
(d) “Induction is the phase which occurs before surgery or radiotherapy and attempts to reach full remission.”
Answer:
(d) “Induction is the phase which occurs before surgery or radiotherapy and attempts to reach full remission.”
Explanation:
The first phase of chemotherapy is called "induction" and aims to reach total remission or loss of leukemic cells. The patient may remain in the hospital for four weeks as high doses of chemotherapy are infused before surgery or radiation is attempted.
Rationale:
(a) is incorrect because the phase that decreases tumor burden after the initial treatment is known as intensification or consolidation therapy.
(b) is incorrect because central nervous system prophylactic therapy is the portion of chemotherapy that prevents further invasion by leukemic cells.
(c) is incorrect because the maintenance phase is responsible for controlling remission.
Question 34.
The oncology nurse is caring for a patient undergoing chemotherapy. Which of the following assessments indicate that the patient is experiencing nadir?
(a) The patient complains that bone pain is at its most extreme
(b) Platelet count reaches its lowest point
(c) White blood cells count begins to rise
(d) Nausea increases and becomes difficult to control.
Answer:
(b) Platelet count reaches its lowest point
Explanation:
The nadir is a period of time in which bone marrow suppression is at its greatest. Red blood cells, white blood cells, and platelets will be at the lowest at nadir, which usually occurs about 10 days after initial treatment.
Rationale:
(a) is incorrect because pain during cancer treatment varies depending on the site of the invasion and the type of therapy being employed. There is no term used to generalize the lowest point of pain, as this can be subjective.
(c) is incorrect because during the nadir, mature white blood cells will be much lower than normal. Cells counts begin to climb after the nadir period and may reach normal levels within three to four weeks.
(d) is incorrect because there is no term for the point of greatest nausea. Like pain, nausea can be subjective.
Question 35.
A 13-year-old child is being seen by the oncology service to be assessed for potential Hodgkin's disease. Which of the following positive test results would confirm this diagnosis?
(a) Elevated BUN levels
(b) The presence of Epstein-Barr virus in the blood
(c) Elevated immature white blood cells in the bone marrow
(d) The presence of Reed-Sternberg cells in the lymph
Answer:
(d) The presence of Reed-Sternberg cells in the lymph
Explanation:
Hodgkin’s disease is a type of lymphoma (cancer of the lymph system). The presence of Reed-Sternberg cells in the lymph is an indication of Hodgkin's disease. Hodgkin’s disease is much less common than Non-Hodgkin’s lymphoma. Treatment depends on the type of lymph cells affected by the cancer and may include both chemotherapy and radiation.
Rationale:
(a) is incorrect because elevated BUN levels do not indicate Hodgkin's disease. High BUN can be an indication of dehydration, renal damage, heart failure, or as an adverse reaction to fluoroquinolone antibiotics.
(b) is incorrect because the presence of the Epstein-Barr Virus in the blood indicates infectious mononucleosis.
(c) is incorrect because elevated immature white blood cells in the bone marrow often indicate leukemia, not Hodgkin's disease.
Question 36.
Which of the following antineoplastic medications is appropriately labeled according to its classification?
(a) Doxorubicin, an alkylating agent
(b) Tamoxifen, a hormonal antineoplastic agent
(c) Chlorambucil, an antimetabolite antineoplastic
(d) Methotrexate, an antibiotic antineoplastic
Answer:
(b) Tamoxifen, a hormonal antineoplastic agent
Explanation:
Tamoxifen is a hormonal medication used to treat breast cancer. It competes with estrogen to bind with estrogen receptor sites on malignant cells.
Rationale:
(a) is incorrect because doxorubicin is an antibiotic, antitumor antineoplastic (which can cause red urine) and is used to treat many cancers, including Hodgkin’s and non-Hodgkin’s lymphomas.
(c) is incorrect because chlorambucil is an alkylating agent that can be used to treat leukemia and multiple myeloma.
(d) is incorrect because methotrexate is an antimetabolite antineoplastic which can treat acute lymphatic leukemia and other cancers (colon, breast, stomach, and pancreas) and can also be used to treat psoriasis.
Question 37.
The nurse is helping a client prepare for magnetic resonance imaging (MRI). Which of the following requires additional assessment by the nurse?
(a) The client is allergic to mercury
(b)The client is wearing a wedding band
(c) The client complains of claustrophobia
(d) The client has advanced Parkinson’s disease
Answer:
(d) The client has advanced Parkinson’s disease
Explanation:
MRIs use magnets to develop detailed images of internal body structures. Patients with Parkinson’s disease may experience tremors which can impede the ability to achieve a clear image during the scan. The nurse must assess the patient for tremors and other involuntary muscular movements and determine if pre-medication is required before the procedure.
Rationale:
(a) is incorrect because gadolinium does not contain mercury.
(b) is incorrect because the wedding band can be removed before the MRI, no further assessment is needed.
(c) is incorrect because anti-anxiety medications are often given in preparation for an MRI to reduce nervousness and help the patient relax and lie still.
Question 38.
A client with cancer is being evaluated for the possibility of metastasis. Which of the following sites are most likely to be targeted by cancer cells?
(a) Urinary tract
(b) Spleen
(c) Liver
(d) White blood cells
Answer:
(c) Liver
Explanation:
The liver is one of the most common sites of metastasis along with the lung, bone, brain, and lymph nodes.
Rationale:
(a) is incorrect because cancer metastasizes to the urinary tract less commonly than the liver.
(b) is incorrect because of the answer choices, the liver is the most likely place for metastasis.
(d) is incorrect because cancer is more likely to spread to the liver than to white blood cells.
Question 39.
The nurse is preparing a patient for radiation therapy for gastric cancer. When teaching the patient about adverse effects of radiation therapy, the nurse should prepare the patient for which effect that is expected to occur?
(a) Hair loss from the scalp
(b) Generalized skin blotches on the extremities and trunk
(c) Abdominal discomfort and nausea
(d) Thyroid cancer
Answer:
(c) Abdominal discomfort and nausea
Explanation:
Side effects from radiation are specific to the area being irradiated. When irradiating the abdomen, the patient is likely to expect abdominal discomfort, nausea, vomiting, and diarrhea.
Rationale:
(a) is incorrect because scalp hair loss may occur as a side effect of chemotherapy or radiation to the head region.
(b) is incorrect because radiation to the abdomen may cause skin blotches to the area being radiated (the abdomen or trunk), not the extremities.
(d) is incorrect because although thyroid cancer is a potential long-term effect of treatment for lymphoma, it is not expected with abdominal radiation.
Question 40.
When caring for four patients with cervical cancer, which of the following findings is most concerning to the nurse?
(a) The patient reports she began sexual activity at age 15
(b) The patient had an abortion at age 19
(c) The patient is found to have unilateral leg edema
(d) The patient receiving cisplatin complains of nausea
Answer:
(c) The patient is found to have unilateral leg edema
Explanation:
Swelling in one leg can be a sign that cervical cancer is progressing, and this may be an indication for pelvic exenteration, a procedure in which portions of the pelvis are surgically removed to prevent the spread of the cancer.
Rationale:
(a) is incorrect because early sexual activity is a risk factor for cervical cancer. This gives the nurse information about prior risk factors, but this is not immediately concerning regarding a patient who has already been diagnosed with cervical cancer.
(b) is incorrect because history of abortion does not pose a major concern for a patient diagnosed with cervical cancer.
(d) is incorrect because nausea is a common side effect with cisplatin, an alkylating agent commonly used to treat cervical cancer.
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