ONCOLOGIC NURSING

Compiled by. Zudota

1.Nina, an oncology nurse educator is speaking to a womens group about
breast cancer. Questions and comments from the audience reveal a
misunderstanding of some aspects of the disease. Various members of the
audience have made all of the following statements. Which one is accurate?
a. Mammography is the most reliable method for detecting breast cancer.
b. Breast cancer is the leading killer of women of childbearing age.
c. Breast cancer requires a mastectomy.
d. Men can develop breast cancer.
Answer D. Men can develop breast cancer, although they seldom do. The
most 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. Nurse Meredith is instructing a premenopausal woman about breast selfexamination. The nurse should tell the client to do her self-examination:
a. at the end of her menstrual cycle.
b. on the same day each month.
c. on the 1st day of the menstrual cycle.
d. immediately after her menstrual period.
Answer D. Premenopausal women should do their self-examination
immediately after the menstrual period, when the breasts are least tender
and least lumpy. On the 1st and last days of the cycle, the womans breasts
are still very tender. Postmenopausal women because their bodies lack
fluctuation of hormone levels, should select one particular day of the month
to do breast self-examination.
3.
Nurse Kent is teaching a male client to perform monthly testicular selfexaminations. Which of the following points would be appropriate to make?
a. Testicular cancer is a highly curable type of cancer.
b. Testicular cancer is very difficult to diagnose.
c. Testicular cancer is the number one cause of cancer deaths in males.
d. Testicular cancer is more common in older men.
Answer A. Testicular cancer is highly curable, particularly when its treated
in its 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. 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?
a. Immediately
b. 1 week
c. 2 to 3 weeks
d. 1 month
Answer C. Chlorambucil-induced alopecia occurs 2 to 3 weeks after therapy
begins
5.A male client is receiving the cell cyclenonspecific alkylating agent
thiotepa (Thioplex), 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?
a. It interferes with deoxyribonucleic acid (DNA) replication only.
b. It interferes with ribonucleic acid (RNA) transcription only.
c. It interferes with DNA replication and RNA transcription.
d. It destroys the cell membrane, causing lysis.
Answer C. Thiotepa interferes with DNA replication and RNA transcription. It
doesnt destroy the cell membrane.
6. The nurse is instructing the 35 year old client to perform a testicular selfexamination. The nurse tells the client:
a. To examine the testicles while lying down
b. That the best time for the examination is after a shower
c. To gently feel the testicle with one finger to feel for a growth
d. That testicular self-examination should be done at least every 6 months
Answer B. The testicular-self examination is recommended monthly after a
warm bath or shower when the scrotal skin is relaxed. The client should stand
to examine the testicles. Using both hands, with fingers under the scrotum
and thumbs on top, the client should gently roll the testicles, feeling for any
lumps.
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?
a. Monitoring temperature
b. Ambulation three times daily
c. Monitoring the platelet count
d. Monitoring for pathological fractures
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. Gian, a community health nurse is instructing a group of female clients

about breast self-examination. The nurse instructs the client to perform the
examination:
a. At the onset of menstruation
b. Every month during ovulation
c. Weekly at the same time of day
d. 1 week after menstruation begins
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.
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?
a. Elevating the knee gatch on the bed
b. Assisting with range-of-motion leg exercises
c. Removal of antiembolism stockings twice daily
d. Checking placement of pneumatic compression boots
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. Mina, who is suspected of an ovarian tumor is scheduled for a pelvic
ultrasound. The nurse provides which preprocedure instruction to the client?
a. Eat a light breakfast only
b. Maintain an NPO status before the procedure
c. Wear comfortable clothing and shoes for the procedure
d.
Drink six to eight glasses of water without voiding before the
test
Answer D. A pelvic ultrasound requires the ingestion of large volumes of
water just before the procedure. A full bladder is necessary so that it will be
visualized as such and 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.
A male client is diagnosed as having a bowel tumor and several
diagnostic tests are prescribed. The nurse understands that which test will
confirm the diagnosis of malignancy?
a. Biopsy of the tumor

b.
c.
d.

Abdominal ultrasound
Magnetic resonance imaging
Computerized tomography scan

Answer A. A biopsy is done to determine whether a tumor is malignant or

benign. Magnetic resonance imaging, computed tomography scan, and
ultrasound will visualize the presence of a mass but will not confirm a
diagnosis of malignancy.
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?
a. Altered red blood cell production
b. Altered production of lymph nodes
c. Malignant exacerbation in the number of leukocytes
d. Malignant proliferation of plasma cells within the bone
Answer D. Multiple myeloma is a B-cell neoplastic condition characterized
by 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.
Nurse Bea is reviewing the laboratory results of a client diagnosed with
multiple myeloma. Which of the following would the nurse expect to note
specifically in this disorder?
a. Increased calcium
b. Increased white blood cells
c. Decreased blood urea nitrogen level
d. Decreased number of plasma cells in the bone marrow
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.
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?
a. Alopecia
b. Back pain
c. Painless testicular swelling
d. Heavy sensation in the scrotum
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.
the
a.
b.
c.
d.

The male client is receiving external radiation to the neck for cancer of
larynx. The most likely side effect to be expected is:
Dyspnea
Diarrhea
Sore throat
Constipation

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. 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?
a. Limit the time with the client to 1 hour per shift
b. Do not allow pregnant women into the clients room
c. Remove the dosimeter badge when entering the clients room
d. 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
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 clients room. Children younger than 16 years of
age and pregnant women are not allowed in the clients room.
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?
a. Bed rest
b. Out of bed ad lib
c. Out of bed in a chair only
d. Ambulation to the bathroom only
Answer A. The client with a cervical radiation implant should be maintained
on bed rest in the dorsal position to prevent movement of the radiation
source. The head of the bed 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.
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:
a. Call the physician
b. Reinsert the implant into the vagina immediately
c. Pick up the implant with gloved hands and flush it down the toilet
d.
Pick up the implant with long-handled forceps and place it in a
lead container.
Answer D. A lead container and long-handled forceps should be kept in the
clients 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.
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:
a. Restrict all visitors
b. Restrict fluid intake
c. Teach the client and family about the need for hand hygiene
d. Insert an indwelling urinary catheter to prevent skin breakdown
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. 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 clients pain would include which of the following?
a. The clients pain rating
b. Nonverbal cues from the client
c. The nurses impression of the clients pain
d. Pain relief after appropriate nursing intervention
Answer A. The clients self-report is a critical component of pain
assessment. The nurse should ask the client about the description of the pain
and listen carefully to the clients words used to describe the pain. The
nurses impression of the clients pain is not appropriate in determining the
clients 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.
Nurse Mickey is caring for a client who is postoperative following a
pelvic exenteration and the physician changes the clients diet from NPO
status to clear liquids. The nurse makes which priority assessment before
administering the diet?
a. Bowel sounds
b. Ability to ambulate
c. Incision appearance
d. Urine specific gravity
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.
A male client is admitted to the hospital with a suspected diagnosis of
Hodgkins disease. Which assessment findings would the nurse expect to
note specifically in the client?
a. Fatigue
b. Weakness
c. Weight gain
d. Enlarged lymph nodes
Answer D. Hodgkins 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. During the admission assessment of a 35 year old client with advanced
ovarian cancer, the nurse recognizes which symptom as typical of the
disease?
a. Diarrhea
b. Hypermenorrhea
c. Abdominal bleeding
d. Abdominal distention
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.
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?

a.
b.
c.
d.

Infection
Hemorrhage
Cervical stenosis
Ovarian perforation

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

the cervix. Complications of the procedure include hemorrhage, infection, and
cervical stenosis. Ovarian perforation is not a complication
25.
Mr. Miller has been diagnosed with bone cancer. You know this type of
cancer is classified as:
a. sarcoma.
b. lymphoma.
c. carcinoma.
d. melanoma.
Answer A. Tumors that originate from bone,muscle, and other connective
tissue are called sarcomas.
26. Sarah, a hospice nurse visits a client dying of ovarian cancer. During the
visit, the client expresses that If I can just live long enough to attend my
daughters graduation, Ill Ill be ready to die. Which phrase of coping is this
client experiencing?
a. Anger
b. Denial
c. Bargaining
d. Depression
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.
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?
a. Pain at the incisional site
b. Arm edema on the operative side
c. Sanguineous drainage in the Jackson-Pratt drain
d. Complaints of decreased sensation near the operative site

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.
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?
a. Alcohol abuse
b. Cigarette smoking
c. Use of chewing tobacco
d. Exposure to air pollutants
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. 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:
a. Rupture of the bladder
b. The development of a vesicovaginal fistula
c. Extreme stress caused by the diagnosis of cancer
d. Altered perineal sensation as a side effect of radiation therapy
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 clients complaint is not associated with options A, C,
and D.
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:
a. Nausea
b. Alopecia
c. Vomiting
d. Hyperuricemia
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.

1.
A male client has an abnormal result on a Papanicolaou test. After
admitting, he read his chart while the nurse was out of the room, the client
asks what dysplasia means. Which definition should the nurse provide?
a.
Presence of completely undifferentiated tumor cells that dont resemble
cells of the tissues of their origin
b.
Increase in the number of normal cells in a normal arrangement in a
tissue or an organ
c. Replacement of one type of fully differentiated cell by another in tissues
where the second type normally isnt found
d. Alteration in the size, shape, and organization of differentiated cells
Answer D. Dysplasia refers to an alteration in the size, shape, and
organization of differentiated cells. The presence of completely
undifferentiated tumor cells that dont resemble cells of the tissues of their
origin is called anaplasia. An increase in the number of normal cells in a
normal arrangement in a tissue or an organ is called hyperplasia.
Replacement of one type of fully differentiated cell by another in tissues
where the second type normally isnt found is called metaplasia.
2. For a female client with newly diagnosed cancer, the nurse formulates a
nursing diagnosis of Anxiety related to the threat of death secondary to
cancer diagnosis. Which expected outcome would be appropriate for this
client?
a. Client verbalizes feelings of anxiety.
b. Client doesnt guess at prognosis.
c. Client uses any effective method to reduce tension.
d. Client stops seeking information.
Answer A. Verbalizing feelings is the clients first step in coping with the
situational crisis. It also helps the health care team gain insight into the
clients feelings, helping guide psychosocial care. Option B is inappropriate
because suppressing speculation may prevent the client from coming to
terms with the crisis and planning accordingly. Option C is undesirable
because some methods of reducing tension, such as illicit drug or alcohol use,
may prevent the client from coming to terms with the threat of death as well
as cause physiologic harm. Option D isnt appropriate because seeking
information can help a client with cancer gain a sense of control over the
crisis.
3.
A male client with a cerebellar brain tumor is admitted to an acute care
facility. The nurse formulates a nursing diagnosis of Risk for injury. Which
related-to phrase should the nurse add to complete the nursing diagnosis
statement?
a. Related to visual field deficits
b. Related to difficulty swallowing
c. Related to impaired balance
d. Related to psychomotor seizures

Answer C. A client with a cerebellar brain tumor may suffer injury from
impaired balance as well as disturbed gait and incoordination. Visual field
deficits, difficulty swallowing, and psychomotor seizures may result from
dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or
temporal lobe not from a cerebellar brain tumor. Difficulty swallowing
suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe
dysfunction.
4. A female client with cancer is scheduled for radiation therapy. The nurse
knows that radiation at any treatment site may cause a certain adverse
effect. Therefore, the nurse should prepare the client to expect:
a. hair loss.
b. stomatitis.
c. fatigue.
d. vomiting.
Answer C. Radiation therapy may cause fatigue, skin toxicities, and anorexia
regardless of the treatment site. Hair loss, stomatitis, and vomiting are sitespecific, not generalized, adverse effects of radiation therapy.

5.
Nurse April is teaching a client who suspects that she has a lump in her
breast. The nurse instructs the client that a diagnosis of breast cancer is
confirmed by:
a. breast self-examination.
b. mammography.
c. fine needle aspiration.
d. chest X-ray.
Answer C. Fine needle aspiration and biopsy provide cells for histologic
examination to confirm a diagnosis of cancer. A breast self-examination, if
done regularly, is the most reliable method for detecting breast lumps early.
Mammography is used to detect tumors that are too small to palpate. Chest
X-rays can be used to pinpoint rib metastasis.
6. A male client undergoes a laryngectomy to treat laryngeal cancer. When
teaching the client how to care for the neck stoma, the nurse should include
which instruction?
a. Keep the stoma uncovered.
b. Keep the stoma dry.
c. Have a family member perform stoma care initially until you get used to
the procedure.
d. Keep the stoma moist.
Answer D. The nurse should instruct the client to keep the stoma moist,
such as by applying a thin layer of petroleum jelly around the edges, because
a dry stoma may become irritated. The nurse should recommend placing a
stoma bib over the stoma to filter and warm air before it enters the stoma.

The client should begin performing stoma care without assistance as soon as
possible to gain independence in self-care activities
7.
A female client is receiving chemotherapy to treat breast cancer. Which
assessment finding indicates a fluid and electrolyte imbalance induced by
chemotherapy?
a. Urine output of 400 ml in 8 hours
b. Serum potassium level of 3.6 mEq/L
c. Blood pressure of 120/64 to 130/72 mm Hg
d. Dry oral mucous membranes and cracked lips
Answer D. Chemotherapy commonly causes nausea and vomiting, which
may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry
oral mucous membranes, cracked lips, decreased urine output (less than 40
ml/hour), abnormally low blood pressure, and a serum potassium level below
3.5 mEq/L.
8.
Nurse April is teaching a group of women to perform breast selfexamination. The nurse should explain that the purpose of performing the
examination is to discover:
a. cancerous lumps.
b. areas of thickness or fullness.
c. changes from previous self-examinations.
d. fibrocystic masses.
Answer C. Women are instructed to examine themselves to discover
changes that have occurred in the breast. Only a physician can diagnose
lumps that are cancerous, areas of thickness or fullness that signal the
presence of a malignancy, or masses that are fibrocystic as opposed to
malignant.
9.
A client, age 41, visits the gynecologist. After examining her, the
physician suspects cervical cancer. The nurse reviews the clients history for
risk factors for this disease. Which history finding is a risk factor for cervical
cancer?
a. Onset of sporadic sexual activity at age 17
b. Spontaneous abortion at age 19
c. Pregnancy complicated with eclampsia at age 27
d. Human papillomavirus infection at age 32
Answer D. Like other viral and bacterial venereal infections, human
papillomavirus is a risk factor for cervical cancer. Other risk factors for this
disease include frequent sexual intercourse before age 16, multiple sex
partners, and multiple pregnancies. A spontaneous abortion and pregnancy
complicated by eclampsia arent risk factors for cervical cancer.
10.
A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to
treat osteogenic carcinoma. During methotrexate therapy, the nurse expects
the client to receive which other drug to protect normal cells?

a.
b.
c.
d.

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

Answer D. Leucovorin is administered with methotrexate to protect normal

cells, which methotrexate could destroy if given alone. Probenecid should be
avoided in clients receiving methotrexate because it reduces renal
elimination of methotrexate, increasing the risk of methotrexate toxicity.
Cytarabine and thioguanine arent used to treat osteogenic carcinoma.
11.
The nurse is interviewing a male client about his past medical history.
Which preexisting condition may lead the nurse to suspect that a client has
colorectal cancer?
a. Duodenal ulcers
b. Hemorrhoids
c. Weight gain
d. Polyps
Answer D. Colorectal polyps are common with colon cancer. Duodenal ulcers
and hemorrhoids arenarent preexisting conditions of colorectal cancer.
Weight loss not gain is an indication of colorectal cancer.
12.
Nurse Amy is speaking to a group of women about early detection of
breast cancer. The average age of the women in the group is 47. Following
the American Cancer Society guidelines, the nurse should recommend that
the women:
a. perform breast self-examination annually.
b. have a mammogram annually.
c. have a hormonal receptor assay annually.
d. have a physician conduct a clinical examination every 2 years.
Answer B. The American Cancer Society guidelines state, "Women older
than age 40 should have a mammogram annually and a clinical examination
at least annually [not every 2 years]; all women should perform breast selfexamination monthly [not annually]." The hormonal receptor assay is done on
a known breast tumor to determine whether the tumor is estrogen- or
progesterone-dependent.
13.
A male client with a nagging cough makes an appointment to see the
physician after reading that this symptom is one of the seven warning signs
of cancer. What is another warning sign of cancer?
a. Persistent nausea
b. Rash
c. Indigestion
d. Chronic ache or pain
Answer C. Indigestion, or difficulty swallowing, is one of the seven warning
signs of cancer. The other six are a change in bowel or bladder habits, a sore

that does not heal, unusual bleeding or discharge, a thickening or lump in the
breast or elsewhere, an obvious change in a wart or mole, and a nagging
cough or hoarseness. Persistent nausea may signal stomach cancer but isnt
one of the seven major warning signs. Rash and chronic ache or pain seldom
indicate cancer.
14.
For a female client newly diagnosed with radiation-induced
thrombocytopenia, the nurse should include which intervention in the plan of
care?
a. Administering aspirin if the temperature exceeds 102 F (38.8 C)
b. Inspecting the skin for petechiae once every shift
c. Providing for frequent rest periods
d. Placing the client in strict isolation
Answer B. Because thrombocytopenia impairs blood clotting, the nurse
should inspect the client regularly for signs of bleeding, such as petechiae,
purpura, epistaxis, and bleeding gums. The nurse should avoid administering
aspirin because it may increase the risk of bleeding. Frequent rest periods are
indicated for clients with anemia, not thrombocytopenia. Strict isolation is
indicated only for clients who have highly contagious or virulent infections
that are spread by air or physical contact.
15.
Nurse Lucia is providing breast cancer education at a community
facility. The American Cancer Society recommends that women get
mammograms:
a. yearly after age 40.
b. after the birth of the first child and every 2 years thereafter.
c. after the first menstrual period and annually thereafter.
d. every 3 years between ages 20 and 40 and annually thereafter.
Answer A. The American Cancer Society recommends a mammogram yearly
for women over age 40. The other statements are incorrect. Its
recommended that women between ages 20 and 40 have a professional
breast examination (not a mammogram) every 3 years.
16.
Which intervention is appropriate for the nurse caring for a male client
in severe pain receiving a continuous I.V. infusion of morphine?
a. Assisting with a naloxone challenge test before therapy begins
b. Discontinuing the drug immediately if signs of dependence appear
c. Changing the administration route to P.O. if the client can tolerate fluids
d. Obtaining baseline vital signs before administering the first dose
Answer D. The nurse should obtain the clients baseline blood pressure and
pulse and respiratory rates before administering the initial dose and then
continue to monitor vital signs throughout therapy. A naloxone challenge test
may be administered before using a narcotic antagonist, not a narcotic
agonist. The nurse shouldnt discontinue a narcotic agonist abruptly because
withdrawal symptoms may occur. Morphine commonly is used as a
continuous infusion in clients with severe pain regardless of the ability to
tolerate fluids.

17.
A 35 years old client with ovarian cancer is prescribed hydroxyurea
(Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of
antineoplastic agents that interfere with various metabolic actions of the cell.
The mechanism of action of antimetabolites interferes with:
a. cell division or mitosis during the M phase of the cell cycle.
b. normal cellular processes during the S phase of the cell cycle.
c.
the chemical structure of deoxyribonucleic acid (DNA) and chemical
binding between DNA molecules (cell cyclenonspecific).
d. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or
both (cell cyclenonspecific).
Answer B. Antimetabolites act during the S phase of the cell cycle,
contributing to cell destruction or preventing cell replication. Theyre most
effective against rapidly proliferating cancers. Miotic inhibitors interfere with
cell division or mitosis during the M phase of the cell cycle. Alkylating agents
affect all rapidly proliferating cells by interfering with DNA; they may kill
dividing cells in all phases of the cell cycle and may also kill nondividing cells.
Antineoplastic antibiotic agents interfere with one or more stages of the
synthesis of RNA, DNA, or both, preventing normal cell growth and
reproduction.
18. The ABCD method offers one way to assess skin lesions for possible skin
cancer. What does the A stand for?
a. Actinic
b. Asymmetry
c. Arcus
d. Assessment
Answer B. When following the ABCD method for assessing skin lesions, the A
stands for "asymmetry," the B for "border irregularity," the C for "color
variation," and the D for "diameter."
19.
When caring for a male client diagnosed with a brain tumor of the
parietal lobe, the nurse expects to assess:
a. short-term memory impairment.
b. tactile agnosia.
c. seizures.
d. contralateral homonymous hemianopia.
Answer B. Tactile agnosia (inability to identify objects by touch) is a sign of a
parietal lobe tumor. Short-term memory impairment occurs with a frontal lobe
tumor. Seizures may result from a tumor of the frontal, temporal, or occipital
lobe. Contralateral homonymous hemianopia suggests an occipital lobe
tumor

20.
A female client is undergoing tests for multiple myeloma. Diagnostic
study findings in multiple myeloma include:
a. a decreased serum creatinine level.
b. hypocalcemia.
c. Bence Jones protein in the urine.
d. a low serum protein level.
Answer C. Presence of Bence Jones protein in the urine almost always
confirms the disease, but absence doesnt rule it out. Serum calcium levels
are elevated because calcium is lost from the bone and reabsorbed in the
serum. Serum protein electrophoresis shows elevated globulin spike. The
serum creatinine level may also be increased.
21. A 35 years old client has been receiving chemotherapy to treat cancer.
Which assessment finding suggests that the client has developed stomatitis
(inflammation of the mouth)?
a. White, cottage cheeselike patches on the tongue
b. Yellow tooth discoloration
c. Red, open sores on the oral mucosa
d. Rust-colored sputum
Answer C. The tissue-destructive effects of cancer chemotherapy typically
cause stomatitis, resulting in ulcers on the oral mucosa that appear as red,
open sores. White, cottage cheeselike patches on the tongue suggest a
candidal infection, another common adverse effect of chemotherapy. Yellow
tooth discoloration may result from antibiotic therapy, not cancer
chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as
pneumonia.
22.
During chemotherapy, an oncology client has a nursing diagnosis of
impaired oral mucous membrane related to decreased nutrition and
immunosuppression secondary to the cytotoxic effects of chemotherapy.
Which nursing intervention is most likely to decrease the pain of stomatitis?
a. Recommending that the client discontinue chemotherapy
b.
Providing a solution of hydrogen peroxide and water for use as
a mouth rinse
c. Monitoring the clients platelet and leukocyte counts
d. Checking regularly for signs and symptoms of stomatitis
Answer B. To decrease the pain of stomatitis, the nurse should provide a
solution of hydrogen peroxide and water for the client to use as a mouth
rinse. (Commercially prepared mouthwashes contain alcohol and may cause
dryness and irritation of the oral mucosa.) The nurse also may administer
viscous lidocaine or systemic analgesics as prescribed. Stomatitis occurs 7 to
10 days after chemotherapy begins; thus, stopping chemotherapy wouldnt
be helpful or practical. Instead, the nurse should stay alert for this potential
problem to ensure prompt treatment. Monitoring platelet and leukocyte

counts may help prevent bleeding and infection but wouldnt decrease pain in
this highly susceptible client. Checking for signs and symptoms of stomatitis
also wouldnt decrease the pain.
23.
What should a male client over age 52 do to help ensure early
identification of prostate cancer?
a.
Have a digital rectal examination and prostate-specific antigen
(PSA) test done yearly.
b. Have a transrectal ultrasound every 5 years.
c. Perform monthly testicular self-examinations, especially after age 50.
d.
Have a complete blood count (CBC) and blood urea nitrogen (BUN) and
creatinine levels checked yearly.
Answer A. The incidence of prostate cancer increases after age 50. The
digital rectal examination, which identifies enlargement or irregularity of the
prostate, and PSA test, a tumor marker for prostate cancer, are effective
diagnostic measures that should be done yearly. Testicular self-examinations
wont identify changes in the prostate gland due to its location in the body. A
transrectal ultrasound, CBC, and BUN and creatinine levels are usually done
after diagnosis to identify the extent of the disease and potential metastases
24. A male client complains of sporadic epigastric pain, yellow skin, nausea,
vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the
physician orders a diagnostic workup, which reveals gallbladder cancer.
Which nursing diagnosis may be appropriate for this client?
a. Anticipatory grieving
b. Impaired swallowing
c. Disturbed body image
d. Chronic low self-esteem
Answer A. Anticipatory grieving is an appropriate nursing diagnosis for this
client because few clients with gallbladder cancer live more than 1 year after
diagnosis. Impaired swallowing isnt associated with gallbladder cancer.
Although surgery typically is done to remove the gallbladder and, possibly, a
section of the liver, it isnt disfiguring and doesnt cause Disturbed body
image. Chronic low self-esteem isnt an appropriate nursing diagnosis at this
time because the diagnosis has just been made.
25.
A male client is in isolation after receiving an internal radioactive
implant to treat cancer. Two hours later, the nurse discovers the implant in
the bed linens. What should the nurse do first?
a. Stand as far away from the implant as possible and call for help.
b.
Pick up the implant with long-handled forceps and place it in a
lead-lined container.
c. Leave the room and notify the radiation therapy department immediately.
d.
Put the implant back in place, using forceps and a shield for selfprotection, and call for help.

Answer B. If a radioactive implant becomes dislodged, the nurse should pick

it up with long-handled forceps and place it in a lead-lined container, then
notify the radiation therapy department immediately. The highest priority is
to minimize radiation exposure for the client and the nurse; therefore, the
nurse must not take any action that delays implant removal. Standing as far
from the implant as possible, leaving the room with the implant still exposed,
or attempting to put it back in place can greatly increase the risk of harm to
the client and the nurse from excessive radiation exposure.
26.
Jeovina, with advanced breast canc cancer is prescribed tamoxifen
(Nolvadex). When teaching the client about this drug, the nurse should
emphasize the importance of reporting which adverse reaction immediately?
a. Vision changes
b. Hearing loss
c. Headache
d. Anorexia
Answer A. The client must report changes in visual acuity immediately
because this adverse effect may be irreversible. Tamoxifen isnt associated
with hearing loss. Although the drug may cause anorexia, headache, and hot
flashes, the client need not report these adverse effects immediately because
they dont warrant a chang in therapy.
27.
A female client with cancer is being evaluated for possible metastasis.
Which of the following is one of the most common metastasis sites for cancer
cells?
a. Liver
b. Colon
c. Reproductive tract
d. White blood cells (WBCs)
Answer A. The liver is one of the five most common cancer metastasis sites.
The others are the lymph nodes, lung, bone, and brain. The colon,
reproductive tract, and WBCs are occasional metastasis sites.
28.
A 34-year-old female client is requesting information about
mammograms and breast cancer. She isnt considered at high risk for breast
cancer. What should the nurse tell this client?
a. She should have had a baseline mammogram before age 30.
b.
She should eat a low-fat diet to further decrease her risk of
breast cancer.
c.
She should perform breast self-examination during the first 5 days of
each menstrual cycle.
d.
When she begins having yearly mammograms, breast self-examinations
will no longer be necessary.

Answer B. A low-fat diet (one that maintains weight within 20% of

recommended body weight) has been found to decrease a womans risk of
breast cancer. A baseline mammogram should be done between ages 30 and
40. Monthly breast self-examinations should be done between days 7 and 10
of the menstrual cycle. The client should continue to perform monthly breast
self-examinations even when receiving yearly mammograms.
29.
Nurse Brian is developing a plan of care for marrow suppression, the
major dose-limiting adverse reaction to floxuridine (FUDR). How long after
drug administration does bone marrow suppression become noticeable?
a. 24 hours
b. 2 to 4 days
c. 7 to 14 days
d. 21 to 28 days
Answer C. Bone marrow suppression becomes noticeable 7 to 14 days after
floxuridine administration. Bone marrow recovery occurs in 21 to 28
days.Bone marrow suppression becomes noticeable 7 to 14 days after
floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.
30.
The nurse is preparing for a female client for magnetic resonance
imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI scan,
which of the following would pose a threat to the client?
a. The client lies still.
b. The client asks questions.
c. The client hears thumping sounds.
d. The client wears a watch and wedding band.
Answer D. During an MRI, the client should wear no metal objects, such as
jewelry, because the strong magnetic field can pull on them, causing injury to
the client and (if they fly off) to others. The client must lie still during the MRI
but can talk to those performing the test by way of the microphone inside the
scanner tunnel. The client should hear thumping sounds, which are caused by
the sound waves thumping on the magnetic field.

During the breast exam, the nurse palpates a series of lymph nodes. Why is
this a part of the breast exam?
a. It's not. It's done because the chest area is exposed.
b. To review the integrity of the skin.
c. To assess the deep lymph nodes which drain the mammary
lobules.
d. To assess shoulder range of motion.
Answe C.To assess the deep lymph nodes which drain the mammary
lobules.

A client asks the nurse, "Why do I need to examine my armpits when I do my

monthly breast exam?" Which of the following would be an appropriate
response for the nurse to make to this client?
a. This is the hardest area to feel for changes.
b. Who told you that you have to do that?
c. I'm not sure why that is important, but it sounds like it is.
d. Breast tissue extends into the axilla.
ANSWER D Breast tissue extends into the axilla.
A client with fibrocystic breast disease says she has increased breast pain
and tenderness with menses. Which of the following can help this client?
a. Nothing can be done to help this client.
b. Discuss how this can be a precursor to breast cancer.
c. Review how reducing caffeine and salt and wearing a support bra
might help.
d. Explain how a breast biopsy is indicated.
ANSWER C. Review how reducing caffeine and salt and wearing a
support bra might help.
a postmenopausal client has difficulty remembering to complete a monthly
breast exam. What can be done to help this client?
a. Nothing. This client doesn't need to do self examinations.
b. Suggest the client plan to conduct the exam the first day of every month.
c. Schedule the client to come into the clinic every month for the
exam.
d. Schedule the client to receive a monthly phone call from the clinic as a
reminder.
ANSWER C Schedule the client to come into the clinic every month
for the exam.
Remind the client to use a calendar to keep a record of when she performs
the breast examination. Teach clients to perform the exam at the same time
each month.
A pregnant client is upset and thinks she has breast disease because she has
a thick white discharge coming from her left breast. What can the nurse say
or do for this client?
a. Nothing. This client needs a mammogram as soon as possible.
b. A thick yellow discharge from the breasts during pregnancy is
normal.
c. Call the physician. This information is not normal.
d. Help the client understand that she might not be able to breastfeed her
infant.
ANSWER B. A thick yellow discharge from the breasts during
pregnancy is normal.

A 14-year-old female client is upset because her breast development is not

equal. What can the nurse say to this client?
a. Don't worry about that!
b. They look equal to me.
c. Maybe you should talk with your mother about breast surgery?
d. Breast tissue growth is uneven but will even out as you get older.
ANSWER D. Breast tissue growth is uneven but will even out as you
get older.