Oncology Practice Test - Answers and Rationale
1. ANSWER: D
For a breast self-examination, placing a pillow or towel under the shoulder of the side being examined elevates the chest wall while the woman lies flat on her back. This positioning allows for better breast tissue distribution over the chest wall and the most thorough examination of tissues by palpation.
1. ANSWER: D
For a breast self-examination, placing a pillow or towel under the shoulder of the side being examined elevates the chest wall while the woman lies flat on her back. This positioning allows for better breast tissue distribution over the chest wall and the most thorough examination of tissues by palpation.
A: Sitting is not the desired position for palpating the breasts.
B: A standing position, facing a mirror, is used to inspect the breasts for changes in size and shape, skin dimpling, and nipple changes, but not for palpation.
C: This is not a recommended position as it cannot expose the tissue better than raising only one arm with a pillow under the shoulder.
2. ANSWER:
A-C-D-E-F
A. Maintain the
child in a private room
C. Reduce exposure to environmental organisms
D. Ensure that anyone entering the child's room wears a mask
E. Use strict aseptic technique for all procedures
F. Maintain frequent and thorough hand washing. A common complication of treatment for leukemia is overwhelming infection secondary to neutropenia. Measures to prevent infection include the use of a private room, strict aseptic technique, restriction of visitors and health care personnel with active infection, strict hand washing, ensuring that anyone entering the child\'s room wears a mask, and reducing exposure to environmental organisms by eliminating raw fruits and vegetables and fresh flowers and by not leaving standing water in the child\'s room. The other interventions listed are measures to prevent bleeding.
3. ANSWER: C
The most common cause of death in children with leukemia is infection. The child should be monitored for any signs of infection, including temperature.
The most common cause of death in children with leukemia is infection. The child should be monitored for any signs of infection, including temperature.
A: Preventing injury is a concern because of the bleeding that can result.
B: Bleeding, although a common problem, is not the most common cause of death.
D: Increasing fluids is necessary when a fever is present.
4. ANSWER: A
Testicular cancer, although not common in general, is the most common cancer in males aged 15-34 years.
Testicular cancer, although not common in general, is the most common cancer in males aged 15-34 years.
B: Testicular self-exam should be taught for use at this age.
C: Even though it can be a beneficial way to get the client to discuss sexual issues, this is not the primary reason for teaching testicular self-examination.
D: Although it can be a beneficial way to help the client become familiar with his own sexuality, this is not the primary reason for teaching testicular self-examination.
5. ANSWER: D
This is the treatment of choice; a variety of drugs affects rapidly dividing cells at different stages of cell division.
This is the treatment of choice; a variety of drugs affects rapidly dividing cells at different stages of cell division.
A: Although this may be done, it is not the primary treatment.
B: Although this may be used to alleviate pain and treat acute vertebral lesions, it is not the primary approach.
C: Multiple
myeloma is a diffuse disorder of the bone and no single lesion can be removed.
6. ANSWER: D
Acute lymphoblastic leukemia and its treatment cause immunosuppression. Thorough hand washing is the single most effective way to prevent infection in an immunosuppressed client. Reverse isolation doesn't significantly reduce the incidence of infection in immunosuppressed clients; furthermore, isolation may cause psychological stress. Standard precautions are intended mainly to protect caregivers from contact with infectious matter, not to reduce the client's risk of infection. Staff and others need not wear masks when visiting because most infections are transmitted by direct contact. Instead of relying on masks and other barrier methods, the nurse should keep persons with known infections out of the client's room.
Acute lymphoblastic leukemia and its treatment cause immunosuppression. Thorough hand washing is the single most effective way to prevent infection in an immunosuppressed client. Reverse isolation doesn't significantly reduce the incidence of infection in immunosuppressed clients; furthermore, isolation may cause psychological stress. Standard precautions are intended mainly to protect caregivers from contact with infectious matter, not to reduce the client's risk of infection. Staff and others need not wear masks when visiting because most infections are transmitted by direct contact. Instead of relying on masks and other barrier methods, the nurse should keep persons with known infections out of the client's room.
7. ANSWER: A
A bone marrow aspiration or biopsy confirms the diagnosis and type of leukemia based on an examination of the actual cells.
A bone marrow aspiration or biopsy confirms the diagnosis and type of leukemia based on an examination of the actual cells.
B: Although a CBC may suggest leukemia (such as normal, elevated, or decreased WBC count with immature cells, decreased RBC, and decreased platelet count), it does not confirm the diagnosis.
C: A lumbar puncture is performed to rule out spread of leukemia cells to the central nervous system once the diagnosis has been established.
D: Even though the peripheral blood smear is used to note immature blood cells, it is not the definitive diagnostic test.
8. ANSWER: D
If a child is severely thrombocytopenic and has a platelet count less than 20,000 cells/µl, precautions need to be taken because of the increased risk of bleeding. The precautions include limiting activity that could result in head injury, using soft toothbrushes or Toothettes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. In addition, suppositories and rectal temperatures are avoided. Options A, B, and C are related to the prevention of infection rather than bleeding.
If a child is severely thrombocytopenic and has a platelet count less than 20,000 cells/µl, precautions need to be taken because of the increased risk of bleeding. The precautions include limiting activity that could result in head injury, using soft toothbrushes or Toothettes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. In addition, suppositories and rectal temperatures are avoided. Options A, B, and C are related to the prevention of infection rather than bleeding.
9. ANSWER: C
Blood tests indicate response to therapy; if the WBC count drops severely, therapy may be temporarily halted.
Blood tests indicate response to therapy; if the WBC count drops severely, therapy may be temporarily halted.
A: These children receive therapy for extended periods, and prolonged isolation from their peers may lead to destructive social isolation.
B: This is a very painful procedure and is not done weekly.
D: Nausea commonly occurs with this therapy; although antiemetic measures are instituted, the drug is not withdrawn.
10. ANSWER: D
Cranial radiation destroys leukemic cells in the brain because chemotherapeutic agents are poorly absorbed through the blood-brain barrier.
Cranial radiation destroys leukemic cells in the brain because chemotherapeutic agents are poorly absorbed through the blood-brain barrier.
A: This is not the primary reason for the treatment; it is a curative measure.
B: This is not the reason for cranial radiation.
C: This is inaccurate; leukemia is an abnormality of the bone marrow and lymphatic system.
11. ANSWER: B
When the child is nauseated, offering cool, clear liquids is best because they are soothing and better tolerated. One should not offer favorite foods when the child is nauseated because foods eaten during times of nausea will be associated with being sick. Supportive nutritional measures also should include oral supplements with high-protein and high- calorie foods.
When the child is nauseated, offering cool, clear liquids is best because they are soothing and better tolerated. One should not offer favorite foods when the child is nauseated because foods eaten during times of nausea will be associated with being sick. Supportive nutritional measures also should include oral supplements with high-protein and high- calorie foods.
12. ANSWER: A
Painless hematuria is the most common symptom associated with bladder cancer. Bleeding from the lesions occurs fairly early in the disease process, but bladder cancer is basically asymptomatic in early stages.
Painless hematuria is the most common symptom associated with bladder cancer. Bleeding from the lesions occurs fairly early in the disease process, but bladder cancer is basically asymptomatic in early stages.
B: Bladder cancer is not related to renal function.
C: Burning on urination is associated with urinary tract infections.
D: Bladder cancer is not related to infection.
13. ANSWER: C
Antineoplastic drugs depress bone marrow, which causes leukopenia; the client must be protected from infection, which could cause death.
Antineoplastic drugs depress bone marrow, which causes leukopenia; the client must be protected from infection, which could cause death.
A: These may decrease as rapidly but complications can be limited with infusions of platelets.
B: RBCs diminish slowly and can be easily replaced with a transfusion of packed cells.
D: RBCs diminish slowly and can be easily replaced with a transfusion of packed cells.
14. ANSWER: B
Radiodermatitis occurs 3 to 6 weeks after the start of treatment.
Radiodermatitis occurs 3 to 6 weeks after the start of treatment.
A: The word burn should be avoided because it may increase anxiety.
C: This response does not address the client's concern.
D: Emollients are contraindicated; they may alter the calculated x-ray route and injure normal tissue.
15. ANSWER: C
The client should be taught to elevate the affected arm on a pillow to promote venous return and lymphatic drainage of the area.
The client should be taught to elevate the affected arm on a pillow to promote venous return and lymphatic drainage of the area.
A: Applying an elastic bandage is inappropriate because constriction of the extremity should be avoided.
B: Range-of-motion exercising is not limited. Rather, it is encouraged.
D: Diuretics are not used to control lymphedema.
16. ANSWER: B
Individuals with cancer pain have a right to obtain optimal pain relief. Nurses caring for terminally ill patients with metastatic cancer have an ethical obligation to provide pain relief. A goal is to assist the patient to achieve as comfortable a death as possible.
Individuals with cancer pain have a right to obtain optimal pain relief. Nurses caring for terminally ill patients with metastatic cancer have an ethical obligation to provide pain relief. A goal is to assist the patient to achieve as comfortable a death as possible.
A: While constipation may be a problem secondary to pain medications, it is not the priority intervention in the terminally ill cancer patient.
C: A goal in the care of a terminally ill cancer patient is not to prolong life, but to provide comfort.Preventing respiratory arrest would prolong life.
D: Many terminally ill patients no longer receive chemotherapy. Managing chemotherapy is the role of an oncologist.
17. ANSWER: C
Clinical manifestations specifically associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular area. Hepatosplenomegaly also is noted. Although fever, malaise, anorexia, and weight loss are associated with Hodgkin's disease, these manifestations are seen in many disorders.
Clinical manifestations specifically associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular area. Hepatosplenomegaly also is noted. Although fever, malaise, anorexia, and weight loss are associated with Hodgkin's disease, these manifestations are seen in many disorders.
18. ANSWER: C
Oxygen should be humidified to assure that irritation of the mucosa doesn't occur. This teen's platelet level is decreased, so she's at risk for bleeding. The nose is a vascular region that can bleed easily if the mucosa is dried by the oxygen. A sign to remind others to avoid needle sticks and to not give anything via the rectum, the presence of two peripheral I.V.s, and the use of a tympanic temperature device are all aspects of care that would decrease the client's risk of bleeding.
Oxygen should be humidified to assure that irritation of the mucosa doesn't occur. This teen's platelet level is decreased, so she's at risk for bleeding. The nose is a vascular region that can bleed easily if the mucosa is dried by the oxygen. A sign to remind others to avoid needle sticks and to not give anything via the rectum, the presence of two peripheral I.V.s, and the use of a tympanic temperature device are all aspects of care that would decrease the client's risk of bleeding.
19. ANSWER: A
Unexplained bleeding is the answer because, although bleeding is a cardinal sign in adults, it is not a cardinal sign in children.
Unexplained bleeding is the answer because, although bleeding is a cardinal sign in adults, it is not a cardinal sign in children.
B: Persistent localized pain may be the initial sign in bone tumors.
C: Sudden vision changes are a cardinal sign, possibly indicating solid tumors of the eye.
D: An unusual mass or swelling, especially in the abdomen, may indicate cancer in children.
20. ANSWER: D
Alopecia, which can occur with the administration of some chemotherapeutic agents, is psychologically disturbing for many clients even though the loss is temporary. Clients should be reassured that their hair will grow back. The nurse should encourage the client to discuss any concerns and should explore the various options available to the client (eg, wigs, scarves, turbans).
Alopecia, which can occur with the administration of some chemotherapeutic agents, is psychologically disturbing for many clients even though the loss is temporary. Clients should be reassured that their hair will grow back. The nurse should encourage the client to discuss any concerns and should explore the various options available to the client (eg, wigs, scarves, turbans).
A: This comment trivializes the client's concerns.
B: This answer conveys negativity and harsh judgment and is likely to demoralize the client.
C: This response ignores the client's concerns.
21. ANSWER: A
The decreased hemoglobin and hematocrit levels and RBC count may be a result of malnutrition; also, cancer of the esophagus can cause dysphagia and anorexia.
The decreased hemoglobin and hematocrit levels and RBC count may be a result of malnutrition; also, cancer of the esophagus can cause dysphagia and anorexia.
B: There are no data given related to airway obstruction or metastasis.
C: There are no data given related to pressure on surrounding structures producing pain.
D: There are no data given related to airway obstruction or injury.
22. ANSWER: B
A protocol consisting of three or four chemotherapeutic agents that attack the dividing cells at various phases of development is the therapy of choice at this stage; alternating courses of different protocols may be used.
A protocol consisting of three or four chemotherapeutic agents that attack the dividing cells at various phases of development is the therapy of choice at this stage; alternating courses of different protocols may be used.
A: Radiation, alone or in combination with chemotherapy, is used in stages IA, IB, IIA, IIB, and IIIA.
C: This is recommended for use in stage IIIA.
D: This is not a therapy for Hodgkin's disease at any stage; nodes may be removed for biopsy; nodes may be irradiated as part of therapy.
23. ANSWER: A
The child’s neutrophil count is low (normal range is 3,000 to 5,000 cells/mm3), predisposing the child to infection. If an infection occurs, the child will have difficulty combating it. Therefore, staff and visitors are restricted to those without an active infection.
The child’s neutrophil count is low (normal range is 3,000 to 5,000 cells/mm3), predisposing the child to infection. If an infection occurs, the child will have difficulty combating it. Therefore, staff and visitors are restricted to those without an active infection.
B: Typically neutropenic precautions, not strict isolation would be used to protect the child from exposure to infection. The hospitalized child would be placed in a private room with visitors and staff screened for illnesses. Temperature would be monitored every 4 hours.
C: Low neutrophil counts do not increase the likelihood of vomiting; therefore, an antiemetic is not needed.
D: Increasing the child’s oral fluid intake may be necessary; however, doing so is unrelated to the child’s neutrophil count.
24. ANSWER: A
A whitish appearance (cat's eye reflex or leukokoria) is symptomatic of retinoblastoma. The coloring is due to the visualization of the tumor as the light momentarily falls on the mass.
A whitish appearance (cat's eye reflex or leukokoria) is symptomatic of retinoblastoma. The coloring is due to the visualization of the tumor as the light momentarily falls on the mass.
B: Protruding eyes are seen in children with hyperthyroid/goiter.
C: Blindness is a late sign of retinoblastoma.
D: An inflamed conjunctiva is seen in various forms of conjunctivitis, not retinoblastoma
25. ANSWER: D
Mechanical obstruction is most often caused by obliteration of the lumen of the intestine by malignant cells.
Mechanical obstruction is most often caused by obliteration of the lumen of the intestine by malignant cells.
A: In the early stages, symptoms of cancer of the colon are vague or absent.
B: This is untrue; localized tumors are usually benign.
C: Cancer of the lower bowel is more common in men than women.
26. ANSWER: D
The child is never placed in the Trendelenburg's position because it increases intracranial pressure (ICP) and the risk of bleeding. In the event of shock, the physician is notified immediately before changing the child's position or increasing intravenous fluids. Increasing intravenous fluids can cause an increase in ICP.
The child is never placed in the Trendelenburg's position because it increases intracranial pressure (ICP) and the risk of bleeding. In the event of shock, the physician is notified immediately before changing the child's position or increasing intravenous fluids. Increasing intravenous fluids can cause an increase in ICP.
27. ANSWER: D
An appropriate expected outcome is for the client to maintain nutrition either through oral or total parenteral feedings. Oral and total parenteral nutrition may also be used concurrently.
An appropriate expected outcome is for the client to maintain nutrition either through oral or total parenteral feedings. Oral and total parenteral nutrition may also be used concurrently.
A: It is not realistic to expect the client to regain weight loss within 4 weeks of surgery.
B: After surgery, it is recommended that the client eat six small meals a day rather than three full meals to decrease symptoms of dumping syndrome.
C: Enteral feedings are not part of the expected outcome for gastric surgery.
28. ANSWER: A
The radioactivity comes from a radioactive material such as radium or cesium. Radioactivity affects tissues but does not make them radioactive. Once the radioactive source is removed, no radioactivity remains. Accurate information can help alleviate ungrounded fears.
The radioactivity comes from a radioactive material such as radium or cesium. Radioactivity affects tissues but does not make them radioactive. Once the radioactive source is removed, no radioactivity remains. Accurate information can help alleviate ungrounded fears.
B: The time required for a radioactive substance to be half-dissipated is called its half-life, but this does not determine discharge time. The client receiving sealed internal radiotherapy is not discharged until the radioactive source is removed.
C: Nightmares probably indicate the client's concern about the therapy.
D: With cervical implants, there is no way to shield the area above the waist from radiation.
29. ANSWER: C
The most important component of pain assessment is the client's self-report of the pain. The nurse should have the client describe the quality, location, and intensity of the pain; the client's response to the pain; and any alleviating or aggravating factors affecting the pain.
The most important component of pain assessment is the client's self-report of the pain. The nurse should have the client describe the quality, location, and intensity of the pain; the client's response to the pain; and any alleviating or aggravating factors affecting the pain.
A: The physical assessment should follow the pain assessment and should be delayed if the client is uncomfortable.
B: This is an important component of the pain assessment, but it is meaningless without the client’s self-report of the pain and the effectiveness of the pain therapy.
D: The family’s response to the client’s illness casts light on the amount of support the client has and alerts the nurse to potential problems. With care, however, these concerns are secondary to the issue of pain control.
30. ANSWER: A
The child with a very low platelet count (normal platelet count after the newborn period---150,00 to 400,000) is at risk for bleeding. Since epistaxis is common, especially after nose-blowing, the child is discouraged from blowing his or her nose.
The child with a very low platelet count (normal platelet count after the newborn period---150,00 to 400,000) is at risk for bleeding. Since epistaxis is common, especially after nose-blowing, the child is discouraged from blowing his or her nose.
B: Infection control precautions are heightened for low WBC counts, not platelet counts, and, even then, strict isolation is usually not warranted.
C: Pain medication will not help a lowered platelet count. Aspirin is contraindicated because of its antiplatelet properties.
D: Iron rich foods are not useful for low platelet counts. However, they are helpful for the associated anemia.
21. ANSWER: A
As cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria. (Pain is a late symptom of bladder cancer.) The remaining findings aren't associated with bladder cancer. Occasional polyuria is associated with diabetes or increased alcohol or caffeine intake. Nocturia frequently accompanies benign prostatic hypertrophy. Dysuria may indicate urinary tract infection.
As cancer cells destroy normal bladder tissue, bleeding occurs and causes painless hematuria. (Pain is a late symptom of bladder cancer.) The remaining findings aren't associated with bladder cancer. Occasional polyuria is associated with diabetes or increased alcohol or caffeine intake. Nocturia frequently accompanies benign prostatic hypertrophy. Dysuria may indicate urinary tract infection.
32. ANSWER: D
The client with a cervical implant is kept on strict bed rest, flat in bed. Limitation of movement is designed to prevent accidental displacement or implant dislodgment. Client knowledge and understanding are critical to compliance with these restrictions.
The client with a cervical implant is kept on strict bed rest, flat in bed. Limitation of movement is designed to prevent accidental displacement or implant dislodgment. Client knowledge and understanding are critical to compliance with these restrictions.
A: The client will not be allowed out of bed while the implant is in.
B: The client will not be allowed out of bed while the implant is in.
C: Assuming various positions while in bed can dislodge the implant.
33. ANSWER: C
A rectal probe could be traumatic to delicate rectal tissue weakened by the effects of leukemia and chemotherapeutic agents.
A rectal probe could be traumatic to delicate rectal tissue weakened by the effects of leukemia and chemotherapeutic agents.
A: This is true, but it is not the primary reason to avoid rectal temperatures in children with leukemia.
B: Oral temperatures are accurate, provided the child can hold the thermometer in the mouth correctly and comfortably.
D: This is inaccurate; tympanic temperatures are frequently used.
34. ANSWER: C
The best time to do breast self-examination is after your period, when breasts are not swollen or tender.
The best time to do breast self-examination is after your period, when breasts are not swollen or tender.
A: Breast self-examination should be done after menstruation. If the patient does not have regular periods or sometimes skip a month, breast self-examination should be done on the same day every month.
B: The finger pads or the top third of each finger should be used to do breast self-examination. It recommended that the patient do breast self-examination while bathing so that the soapy hands will glide over the wet skin.
D: The finger pads or the top third of each finger should be used to do breast self-examination.
35. ANSWER: C
Tamoxifen is an estrogen blocker used to treat both premenopausal and postmenopausal breast cancer and to prevent breast cancer in certain women who are at high risk. Acetaminophen is a nonnarcotic analgesic. Dopamine is a vasoconstrictor used to treat hypotension. Progesterone is a hormone used to treat amenorrhea or dysfunctional uterine bleeding.
Tamoxifen is an estrogen blocker used to treat both premenopausal and postmenopausal breast cancer and to prevent breast cancer in certain women who are at high risk. Acetaminophen is a nonnarcotic analgesic. Dopamine is a vasoconstrictor used to treat hypotension. Progesterone is a hormone used to treat amenorrhea or dysfunctional uterine bleeding.
36. ANSWER: A
Autologous transplants use the client's own marrow, collected from disease-free tissue, and therefore is the least likely to result in GVHD.
Autologous transplants use the client's own marrow, collected from disease-free tissue, and therefore is the least likely to result in GVHD.
B: Allogenic transplants involve the matching of a histocompatible donor, usually a sibling, with the client, and may result in GVHD.
C: Syngeneic transplants use marrow from an identical twin and still may result in GVHD.
D: HLA system complexes are the histocompatibility antigens that are present on the cell membrane of almost all body cells used for tissue matching.
37. ANSWER: A
Platelets are rapidly administered to avoid destruction after being hung.
Platelets are rapidly administered to avoid destruction after being hung.
B: Platelets should not hang for a long time because of their fragility.
C: This is too long an interval; during the infusion of a blood derivative, the vital signs are
more closely monitored.
D: Dextrose solution is not appropriate for flushing a blood derivative line because it may clog the tubing.
38. ANSWER: A
Suppression of bone marrow increases bleeding susceptibility associated with decreased platelets.
Suppression of bone marrow increases bleeding susceptibility associated with decreased platelets.
B: This will not affect the bone marrow; citrus juices should be avoided by the client receiving chemotherapy because of the side effects of stomatitis.
C: With bone marrow suppression the red blood cells are decreased in number and there is a decreased O2 carrying capacity of the blood; this position will not increase the number of red blood cells.
D: With bone marrow depression there would be a decrease in red blood cells; rest should be encouraged.
39. ANSWER: A
Cystitis is a potentially serious adverse reaction to Cytoxan, which can sometimes be prevented by increased hydration because the fluid flushes the bladder.
Cystitis is a potentially serious adverse reaction to Cytoxan, which can sometimes be prevented by increased hydration because the fluid flushes the bladder.
B: Irritability may be present but is not necessarily a result of Cytoxan administration.
C: This is an expected but not serious side effect of Cytoxan.
D: This is unrelated to Cytoxan administration; it occurs with Dilantin therapy.
40. ANSWER: B
The area should be kept dry and open to the air.
The area should be kept dry and open to the air.
A: Lotions, creams, and powders may increase skin irritation and should be avoided.
C: The area should be kept dry and open to the air. The client should seek guidance from the nurse or the radiologist about specific treatment measures.
D: Radiated skin is temperature-sensitive. A hot-water bottle could cause a burn.
41. ANSWER: D
Premenopausal women should do their self-examination immediately after the menstrual period, when the breasts are least tender and least lumpy. On the 1st and last days of the cycle, the woman's breasts are still very tender. Postmenopausal women, because their bodies lack fluctuation of hormone levels, should select one particular day of the month to do breast self-examination.
Premenopausal women should do their self-examination immediately after the menstrual period, when the breasts are least tender and least lumpy. On the 1st and last days of the cycle, the woman's breasts are still very tender. Postmenopausal women, because their bodies lack fluctuation of hormone levels, should select one particular day of the month to do breast self-examination.
42. ANSWER: C
Uncontrolled vaginal bleeding is the priority concern during the first 24 hours after conization of the cervix. This is best monitored by keeping an accurate pad count which assesses the extent of bleeding.
Uncontrolled vaginal bleeding is the priority concern during the first 24 hours after conization of the cervix. This is best monitored by keeping an accurate pad count which assesses the extent of bleeding.
A: Hourly vital signs are unnecessary unless complications develop.
B: Strict bed rest is unnecessary unless complications develop.
D: Electrolyte imbalance is not anticipated with this procedure.
43. ANSWER: D
The Whipple procedure leads to malabsorption because of impaired delivery of bile to the intestine; fat metabolism is interfered with, causing dyspepsia.
A: These clients are anorexic; require small, frequent meals; and should eat high-calorie, high-protein, low-fat diets.
The Whipple procedure leads to malabsorption because of impaired delivery of bile to the intestine; fat metabolism is interfered with, causing dyspepsia.
A: These clients are anorexic; require small, frequent meals; and should eat high-calorie, high-protein, low-fat diets.
B: High-calorie meals are needed for energy and to promote use of protein for tissue repair.
C: High protein is required for tissue building; there is no problem with the liver in clients with cancer of the pancreas unless direct extension occurs.
44. ANSWER: A
A stool softener would assist in preventing damage to the rectal mucosa due to hard stool, thereby decreasing the chances of rectal bleeding.
A stool softener would assist in preventing damage to the rectal mucosa due to hard stool, thereby decreasing the chances of rectal bleeding.
B: Placing the child in protective isolation would be appropriate for the child if the neutrophil count was low.
C: The use of heparin is contraindicated in situations in which there is a possibility of increased bleeding due to low platelets.
D: Avoiding raw vegetables or fruits would be indicated if the child’s neutrophil count were low.
45. ANSWER: A
For a child with Wilms' tumor, frequent abdominal palpation is avoided because palpation of the mass may cause dissemination of cancer cells to adjacent and distant sites.
For a child with Wilms' tumor, frequent abdominal palpation is avoided because palpation of the mass may cause dissemination of cancer cells to adjacent and distant sites.
B: Asking about the child's blood pressure is appropriate because some children with Wilms' tumor experience hypertension, probably caused by the tumor secreting excess renin.
C: Discussing alopecia after surgery is appropriate because radiotherapy and chemotherapy, which are usually done immediately after surgery, result in alopecia.
D: Typically, the child will be anxious due to hospitalization, impending surgery, and the child's level of understanding about the diagnosis and reaction to sensing his/her parents’ apprehension.
46. ANSWER: B
Sores in the mouth are not a presenting sign but often result from chemotherapy.
Sores in the mouth are not a presenting sign but often result from chemotherapy.
A: Anorexia is a presenting symptom of leukemia and may be the result of enlarged lymph nodes and areas of inflammation in the intestinal tract.
C: Pallor is a presenting sign of leukemia and reflects the anemia present because of decreased erythrocytes.
D: Decreased platelet production with petechiae and bleeding is a presenting sign of leukemia.
47. ANSWER: B
The client should not skip his dosages of pain medication to prevent addiction. Clients with cancer pain do not become psychologically dependent on the medication and should not fear becoming addicted. The nurse should allow the client and family members to verbalize their concerns about drug addiction.
The client should not skip his dosages of pain medication to prevent addiction. Clients with cancer pain do not become psychologically dependent on the medication and should not fear becoming addicted. The nurse should allow the client and family members to verbalize their concerns about drug addiction.
A,C & D: This statement indicates an appropriate understanding of pain therapy.
48. ANSWER: C
A common priority problem for clients receiving chemotherapy is infection because chemotherapeutic agents may suppress formation of white blood cells and their components, leading to increased risk of infection. Careful monitoring of white blood cell levels is warranted in clients receiving immunosuppressive drugs.
A: Deficient
Fluid Volume is more typical than Excess Fluid Volume.
B: Impaired Physical Mobility is not necessarily a problem encountered during chemotherapy.
D: Disturbed Body Image is a possible diagnosis; however, the risk for infection and its physiologic consequences (overwhelming infection) are of greater importance.
49. ANSWER: B
A family history of breast cancer, early onset of menstruation, delayed onset of menopause, and childlessness all appear to increase a woman's risk of breast cancer.
A family history of breast cancer, early onset of menstruation, delayed onset of menopause, and childlessness all appear to increase a woman's risk of breast cancer.
A: A woman's lifetime exposure to estrogen is implicated in breast cancer development. Therefore, early menopause, which decreases exposure, is not a risk factor for breast cancer.
C: An increased risk of breast cancer is associated with not bearing children or delaying childbearing until late in life.
D: Because menstruation is delayed until breast-feeding ceases, which limits a woman’s exposure to estrogen, breast-feeding may reduce, not increase, risk.
50. ANSWER: B
A mask, not gloves, may be helpful for protecting the child from contracting infections transmitted by the airborne route.
A mask, not gloves, may be helpful for protecting the child from contracting infections transmitted by the airborne route.
A: The normal neutrophil count range is 3,000 to 5,000 cells/mm³. An absolute neutrophil count of 900/mm³ is low, placing the child at high risk for infection. Therefore, the nurse should instruct the mother to have the child avoid crowds because of the risk of exposure to infection. Additionally, siblings and others who have an active infection should stay away from the child.
C: The child's absolute neutrophil count is high enough that a mask, gown, and isolation are not necessary.
D: Raw fruits and vegetables contain bacteria and fungi. If ingested by a child with a low neutrophil count, the risk for infection increases. Therefore, their ingestion should be avoided.
51. ANSWER: B
Elevated uric acid levels from destroyed cells may lead to renal problems; increased fluid intake helps dilute urine.
Elevated uric acid levels from destroyed cells may lead to renal problems; increased fluid intake helps dilute urine.
A, C & D: This will have to be monitored, but it is not of primary importance at this time.
52. ANSWER: C
Hodgkin's disease most often strikes young adults usually between ages 21 and 40 years.
53. ANSWER: B
Hoarseness occurs early in the course of most laryngeal cancers because the tumor prevents accurate approximation of the vocal cords during phonation.
Hoarseness occurs early in the course of most laryngeal cancers because the tumor prevents accurate approximation of the vocal cords during phonation.
A: Large tumors eventually produce difficulty and pain in swallowing, but this is not an early sign.
C: Foul breath and expectoration of blood are late symptoms.
D: A nagging cough has no direct relationship to laryngeal cancer.
54. ANSWER: A
Cranial enlargement, possibly significant in a much younger child, is unlikely in a child such as a four-year-old whose fontanelles and sutures have closed.
Cranial enlargement, possibly significant in a much younger child, is unlikely in a child such as a four-year-old whose fontanelles and sutures have closed.
B: Behavioral changes are highly significant because they are early signs of increased intracranial pressure in children.
C: Projectile vomiting, especially in the early morning, is a key sign of increased intracranial pressure in children.
D: Headaches are early signs of increased intracranial pressure in children.
55. ANSWER: A
The platelet count is reduced as a result of the bone marrow depression associated with leukemia.
The platelet count is reduced as a result of the bone marrow depression associated with leukemia.
B: The uric acid level affects urinary output, not blood clotting.
C: Prothrombin time is influenced by vitamin K factors, not lack of platelets.
D: The red blood cell count will indicate the hematocrit and hemoglobin levels, which would neither provide the reason for nor cause the bleeding.
56. ANSWER: B
On a continuous around-the-clock schedule. Pain seen in malignancies may require pain¬relieving medications routinely. Patients experiencing pain due to cancer may require routine pain-relieving medications. Pain for cancer patients is given on a regular schedule to prevent exacerbations.
On a continuous around-the-clock schedule. Pain seen in malignancies may require pain¬relieving medications routinely. Patients experiencing pain due to cancer may require routine pain-relieving medications. Pain for cancer patients is given on a regular schedule to prevent exacerbations.
A: Management of cancer pain is in contrast to medications being taken at the time of pain or prn
C&D: Predictable and chronic pain is managed more effectively if the patient maintains a therapeutic blood level of analgesia.
57. ANSWER: A
In leukemia, megakaryocytes, from which platelets are derived, are decreased. Normal platelet counts range from 150 to 300 x 10³/mm³. A platelet count of 80 x 10³/mm³ is low, predisposing the child to bruising and bleeding easily.
In leukemia, megakaryocytes, from which platelets are derived, are decreased. Normal platelet counts range from 150 to 300 x 10³/mm³. A platelet count of 80 x 10³/mm³ is low, predisposing the child to bruising and bleeding easily.
B: Although the serum calcium level is decreased, low serum calcium levels are not related to bleeding and bruising in a child with leukemia or any aspect of leukemia.
C: Normal fibrinogen level ranges from 200 to 400 mg/dL. However, insufficient fibrinogen concentration is not related to bleeding and bruising in a child with leukemia or any aspect of leukemia.
D: PTT, a measurement of clotting factors (except factor XIII), normally ranges from 25 to 40 seconds. The child’s PTT is within the normal range.
58. ANSWER: B
Once the drugs that interfere with cell division are stopped, the hair will grow back; sometimes the hair will be a different color or texture.
Once the drugs that interfere with cell division are stopped, the hair will grow back; sometimes the hair will be a different color or texture.
A: Alopecia is a common side effect of chemotherapy.
C: Hair loss persists while the drugs are being received; once the drugs are withdrawn, the hair grows back.
D: Although ice caps on the head and rubber bands around the scalp have been used to try to limit alopecia, they have not been particularly effective.
59. ANSWER: C
Colorless drainage on the dressing would indicate the presence of cerebrospinal fluid and should be reported to the physician immediately. Options A, B, and D are inaccurate nursing interventions.
Colorless drainage on the dressing would indicate the presence of cerebrospinal fluid and should be reported to the physician immediately. Options A, B, and D are inaccurate nursing interventions.
60. ANSWER: D
The radiated skin should be protected from sunlight and extreme cold. The nurse should instruct the patient to keep the skin dry; not apply lotions, powders, creams, alcohol or deodorants; wear loose-fitting garments; not apply tape, shave with an electric razor; and protect the skin from direct sunlight, chlorinated pools and temperature extremes.
The radiated skin should be protected from sunlight and extreme cold. The nurse should instruct the patient to keep the skin dry; not apply lotions, powders, creams, alcohol or deodorants; wear loose-fitting garments; not apply tape, shave with an electric razor; and protect the skin from direct sunlight, chlorinated pools and temperature extremes.
A: The dark ink markings that outline the radiation field should be left intact. They should not be washed off.
B: Applying any lotions, perfumes, deodorants or powder to the treatment area is contraindicated.
C: Non-restrictive cotton clothing should be worn over the treatment area.
61. ANSWER: C
The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy.
The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy.
A: The white blood cell count may be normal, high, or low in leukemia.
B: A lumbar puncture may be done to look for blast cells in the spinal fluid that indicate central nervous system disease.
D: An altered platelet count occurs as a result of the disease but also may occur as a result of chemotherapy and does not confirm the diagnosis.
62. ANSWER: A
The nurse's first action would be to assess the child's lower extremities for possible deficits suggesting that the tumor may be causing spinal cord compression, resulting in paralysis or paresis.
The nurse's first action would be to assess the child's lower extremities for possible deficits suggesting that the tumor may be causing spinal cord compression, resulting in paralysis or paresis.
B: At this point in time, the patient is just being evaluated to rule out neuroblastoma and, therefore, would not be on any chemotherapeutic agents.
C: Providing reassurance that everything may be okay is inappropriate because it may be faulty reassurance if the child does have a neuroblastoma.
D: There is no evidence to demonstrate that raising the foot of the bed is helpful. The nurse's priority here is to investigate the possible etiology.
63. ANSWER: B
Predisposing factors for laryngeal cancer include chronic irritants such as alcohol, tobacco, and exposure to noxious fumes. About 75% of people who develop laryngeal cancer are smokers. The combination of smoking and heavy alcohol intake is even more strongly implicated as a causative agent in the laryngeal cancer.
Predisposing factors for laryngeal cancer include chronic irritants such as alcohol, tobacco, and exposure to noxious fumes. About 75% of people who develop laryngeal cancer are smokers. The combination of smoking and heavy alcohol intake is even more strongly implicated as a causative agent in the laryngeal cancer.
A: Epidemiologic studies indicate that a high-fat diet may be a major factor in the development of cancer of the breast, prostate, and colon.
C: Low socioeconomic status is a predisposing factor in cervical cancer but not laryngeal cancer.
D: Artificial sweeteners have been related to the incidence of bladder cancer.
64. ANSWER: B
Wilms' tumor, or nephroblastoma, is the most common renal tumor in children. Arising from the renal parenchyma of the kidney, this tumor grows rapidly. The tumor may be present unilaterally and localized or bilaterally, sometimes with metastasis to other organs. Options A, C, and D are incorrect.
Wilms' tumor, or nephroblastoma, is the most common renal tumor in children. Arising from the renal parenchyma of the kidney, this tumor grows rapidly. The tumor may be present unilaterally and localized or bilaterally, sometimes with metastasis to other organs. Options A, C, and D are incorrect.
65. ANSWER: B
Clients with Hodgkin's disease are extremely vulnerable to infection because of the defective immune responses caused by the tumor as well as the bone-marrow depression and low white blood cell count that result from radiation therapy. Fever is the most sensitive indicator of infection and should be reported immediately so that treatment can be initiated.
Clients with Hodgkin's disease are extremely vulnerable to infection because of the defective immune responses caused by the tumor as well as the bone-marrow depression and low white blood cell count that result from radiation therapy. Fever is the most sensitive indicator of infection and should be reported immediately so that treatment can be initiated.
A: Measuring neck circumference is not related to any major complications associated with Hodgkin’s disease and radiation therapy.
C: Loss of hair is unusual with radiation therapy to the neck.
D: Upper extremity circulation is not related to any major complication associated with Hodgkin’s disease and radiation therapy.
66. ANSWER: A
Women in the childbearing years should be informed of all options available to preserve ovarian function.
Women in the childbearing years should be informed of all options available to preserve ovarian function.
B: This is an incorrect statement; always is too absolute.
C: This is an incorrect statement because radiation can influence or destroy ovarian functioning.
D: Once ova have been destroyed, they cannot regenerate.
67. ANSWER: A
The onset of puberty may start as early as age eight, with development possibly beginning unilaterally.
The onset of puberty may start as early as age eight, with development possibly beginning unilaterally.
B: Precocious thelarche occurs before the onset of the pubertal period, which can start as young as age eight.
C: Gynecomastia is the development of breast tissue in males.
D: Precocious pseudo puberty is a precocity that develops with no early secretion of gonadotropin.
68. ANSWER: B
The risk of injury to fragile mucous membranes is so great in the child with leukemia that only oral or axillary temperatures should be taken. Rectal abscesses can occur easily to damaged rectal tissue. No rectal temperatures should be taken. In addition, oral temperatures should be avoided if the child has oral ulcers. Options A, C, and D are appropriate measures to prevent infection.
The risk of injury to fragile mucous membranes is so great in the child with leukemia that only oral or axillary temperatures should be taken. Rectal abscesses can occur easily to damaged rectal tissue. No rectal temperatures should be taken. In addition, oral temperatures should be avoided if the child has oral ulcers. Options A, C, and D are appropriate measures to prevent infection.
69. ANSWER: B
Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the hallmark of this disease. The presence of blast cells in the bone marrow indicates leukemia. The Epstein-Barr virus is associated with infectious mononucleosis. Elevated levels of vanillylmandelic acid in the urine may be found in children with neuroblastoma.
Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the hallmark of this disease. The presence of blast cells in the bone marrow indicates leukemia. The Epstein-Barr virus is associated with infectious mononucleosis. Elevated levels of vanillylmandelic acid in the urine may be found in children with neuroblastoma.
70. ANSWER: A
Based on experimental research that is controversial, breast cancer is not thought to be associated with high dietary fat intake. Current research indicates that high-fat diets are associated with colon, prostate, and rectal cancers.
Based on experimental research that is controversial, breast cancer is not thought to be associated with high dietary fat intake. Current research indicates that high-fat diets are associated with colon, prostate, and rectal cancers.
B,C&D: Current research indicates that high-fat diets are associated with colon, prostate, and rectal cancers.
71. ANSWER: D
In leukemia, normal bone marrow is replaced by malignant blast cells. As the blast cells take over the bone marrow, eventually red blood cell and platelet production is affected and the child becomes anemic and thrombocytopenic. The Reed-Sternberg cell is found in Hodgkin's disease.
In leukemia, normal bone marrow is replaced by malignant blast cells. As the blast cells take over the bone marrow, eventually red blood cell and platelet production is affected and the child becomes anemic and thrombocytopenic. The Reed-Sternberg cell is found in Hodgkin's disease.
72. ANSWER: D
A clinical manifestation of osteogenic sarcoma is progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor. Options A, B, and C are accurate regarding osteogenic sarcoma.
A clinical manifestation of osteogenic sarcoma is progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor. Options A, B, and C are accurate regarding osteogenic sarcoma.
73. ANSWER: A
When receiving chemotherapy, hair usually starts to regrow in 3 to 6 months, not 1 year.
When receiving chemotherapy, hair usually starts to regrow in 3 to 6 months, not 1 year.
B: The client should use protection in the sun since natural protection is lost.
C: Alopecia is usually less severe with a second treatment of chemotherapy.
D: Adolescents are encouraged to use scarves and wigs to improve their appearance and body image.
74. ANSWER: C
Constipation, diarrhea, and/or constipation alternating with diarrhea are the most common symptoms of colorectal cancer.
Constipation, diarrhea, and/or constipation alternating with diarrhea are the most common symptoms of colorectal cancer.
A: Pain is reported as a symptom in less than 25% of clients; also it is a late sign after other organs are invaded, intestinal obstruction occurs, or tissue necrosis develops.
B: This is the second most common complaint that results from destruction of the epithelial lining of the intestine.
D: This is a later sign that only becomes evident when the lumen of the intestine narrows as a result of the enlarging mass.
75. ANSWER: C
Depression of the bone marrow interferes with hemopoiesis and results in anemia.
Depression of the bone marrow interferes with hemopoiesis and results in anemia.
A: There is a decrease in the number of cells and therefore a decrease in viscosity.
B: Pathologic fractures result from the disease, not the treatment.
D: Radiation causes increased susceptibility to infection as a result of the decreased number of white blood cells.
76. ANSWER: A
Meperidine, useful for short-term treatment of acute pain, is inappropriate for use with clients experiencing chronic pain, such as that associated with cancer, because of the drug’s short duration of action. Meperidine also can be toxic in clients with impaired renal function or the elderly.
Meperidine, useful for short-term treatment of acute pain, is inappropriate for use with clients experiencing chronic pain, such as that associated with cancer, because of the drug’s short duration of action. Meperidine also can be toxic in clients with impaired renal function or the elderly.
B: To treat cancer pain, the World Health Organization recommends a three-step analgesic ladder approach involving nonopiod (nonnarcotic) analgesics, opioid analgesics, and adjuvant drugs such as antidepressants and antiemetics. Opioid drugs of choice include morphine, the most commonly used opioid drug used for the treatment of cancer pain; hydromorphone (Dilaudid); and codeine.
C: To treat cancer pain, the World Health Organization recommends a three-step analgesic ladder approach involving nonopiod (non-narcotic) analgesics, opioid analgesics, and adjuvant drugs such as antidepressants and antiemetics. Common nonopiod analgesics include acetaminophen (Tylenol), salicylates, and nonsteroidal anti-inflammatory drugs (NSAIDS).
D: To treat cancer pain, the World Health Organization recommends a three-step analgesic ladder approach involving nonopiod (non-narcotic) analgesics, opioid analgesics, and adjuvant drugs such as antidepressants and antiemetics. Opioid drugs of choice include morphine, the most commonly used opioid drug used for the treatment of cancer pain; hydromorphone (Dilaudid); and codeine.
77. ANSWER: A
This is the most accurate and age-appropriate response to the question.
This is the most accurate and age-appropriate response to the question.
B: This is inaccurate; not being truthful interferes with the development of trust.
C: This is inaccurate and may instill more fear.
D: This response is insensitive to the question and does not provide any explanation.
78. ANSWER: D
The most important principle related to the management of cancer pain is to individualize the therapy to the client.
The most important principle related to the management of cancer pain is to individualize the therapy to the client.
A: Fear of client addiction to pain medication is unfounded.
B: Medications should not be given on an as-needed basis. They should be given on a regular, around-the-clock schedule to maintain a therapeutic blood level and analgesic effect.
C: Medications should not be discontinued. They should be given in increasing dosages as drug tolerance develops.
79. ANSWER: A
Since vincristine is neurotoxic, the nurse must monitor for neurologic impairment, such as foot drop.
Since vincristine is neurotoxic, the nurse must monitor for neurologic impairment, such as foot drop.
B: The chemotherapeutic agent most likely to cause hemorrhagic cystitis is cyclophosphamide (Cytoxan).
C: Pharmacologic agents most commonly associated with moon face are corticosteroids.
D: The most common chemotherapeutic agent associated with causing cardiac abnormalities is doxorubicin (Adriamycin).
80. ANSWER: A
Reducing barriers to mammography is the best way to improve adherence with screening.
Reducing barriers to mammography is the best way to improve adherence with screening.
B: Mammography can detect breast cancer in the early stages but cannot prevent it.
C: Mammography is not a low-cost approach for all clients. In fact, it may cost the client a significant amount of money.
D: The client is not at high risk for developing breast cancer at this point.
81. ANSWER: B
Leucovorin calcium limits toxicity of folic acid antagonists, such as methotrexate sodium, by competing for transport into cells.
Leucovorin calcium limits toxicity of folic acid antagonists, such as methotrexate sodium, by competing for transport into cells.
A: This is not the action of leucovorin calcium.
C: This is the purpose of antiemetics such as prochlorperazine maleate (Compazine).
D: Leucovorin calcium does not interfere with cell division; this is the purpose of a multiple drug protocol.
82. ANSWER: D
Neurotoxicity is a specific common side effect to this drug; the client can become numb and ataxic.
Neurotoxicity is a specific common side effect to this drug; the client can become numb and ataxic.
A: Vincristine causes adynamic ileus, resulting in constipation; diarrhea occurs with other antineoplastics and radiation therapy.
B: Alopecia is an expected side effect rather than a toxic response; it is not considered serious, and hair will regrow.
C: This is not a side effect of this drug but a toxic response to Cytoxan.
83. ANSWER: D
Immunocompromised children are unable to fight varicella adequately. Chickenpox can be deadly to the immunocompromised child. If an immunocompromised child who has not had chickenpox is exposed to someone with varicella, the child should receive varicella zoster immune globulin within 96 hours of exposure. Options A, B, and C are incorrect.
Immunocompromised children are unable to fight varicella adequately. Chickenpox can be deadly to the immunocompromised child. If an immunocompromised child who has not had chickenpox is exposed to someone with varicella, the child should receive varicella zoster immune globulin within 96 hours of exposure. Options A, B, and C are incorrect.
84. ANSWER: A
Although respiratory complications may occur, the respiratory system is not one of the four systems that have complications unique to children.
Although respiratory complications may occur, the respiratory system is not one of the four systems that have complications unique to children.
B: Radiation therapy administered to children may affect growth hormone and cause delayed or stunted growth.
C: Radiation therapy and the use of alkalating agents cause decreased fertility and sterility.
D: Irradiation to bones and cartilage causes defects and possible osteoporosis.
85. ANSWER: A
Bone marrow aspiration is the definitive diagnostic tool in confirming or ruling out leukemic cells. Blood cultures and acid or alkaline phosphatase wouldn't supply the needed data.
Bone marrow aspiration is the definitive diagnostic tool in confirming or ruling out leukemic cells. Blood cultures and acid or alkaline phosphatase wouldn't supply the needed data.
86. ANSWER: A
The nurse should notify the physician of extreme amounts of emesis because further treatment may be warranted.
The nurse should notify the physician of extreme amounts of emesis because further treatment may be warranted.
B: Placing the client on a liquid diet is the physician's decision.
C: The client needs intervention now to provide basic comfort (relief of nausea) and to prevent problems associated with excessive fluid loss through emesis (electrolyte imbalance, dehydration).
D: Administering anti-emetic medication is important but the severity of the client's nausea and amount of vomiting are important information to share with the physician for additional intervention.
87. ANSWER: C
Because the I.V. route doesn't allow chemotherapeutic agents to reach all areas invaded by leukemic cells, this medication is administered intrathecally to ensure the entire body receives treatment. Although this medication may be given by mouth, I.M., or I.V., these routes would be inappropriate in this situation.
Because the I.V. route doesn't allow chemotherapeutic agents to reach all areas invaded by leukemic cells, this medication is administered intrathecally to ensure the entire body receives treatment. Although this medication may be given by mouth, I.M., or I.V., these routes would be inappropriate in this situation.
88. ANSWER: A
The massive cell destruction resulting from chemotherapy may place the client at risk for developing renal calculi; adding allopurinol decreases this risk. Allopurinol doesn't act in the manner described in B, C, or D.
The massive cell destruction resulting from chemotherapy may place the client at risk for developing renal calculi; adding allopurinol decreases this risk. Allopurinol doesn't act in the manner described in B, C, or D.
89. ANSWER: A
Fatigue is one of the most common problems associated with radiotherapy. It persists during therapy and for varying periods after therapy ends. Extra rest and a reduction in normal activity are often necessary to maintain a reasonable energy level.
Fatigue is one of the most common problems associated with radiotherapy. It persists during therapy and for varying periods after therapy ends. Extra rest and a reduction in normal activity are often necessary to maintain a reasonable energy level.
B: Fatigue persists during therapy and for varying periods after therapy ends. It is not a transient problem that resolves with the continuation of treatment.
C: Fatigue is one of the most common problems associated with radiotherapy.
D: Fatigue is one of the most common problems associated with radiotherapy. It is unrelated to the extent of disease present.
90. ANSWER: A
One of the many effects associated with the use of steroids is mood swings.
One of the many effects associated with the use of steroids is mood swings.
B: Allopurinol is typically associated with rash, nausea and vomiting, renal failure, and bone marrow depression, not mood swings.
C: Adverse effects of granulocyte colony-stimulating factor include bone pain, fever, rash, and malaise, but not mood swings.
D: L-asparaginase may cause allergic reactions, fever, nausea and vomiting, anorexia, and liver toxicity, but not mood swings.
91. ANSWER: A
If Wilms' tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Fever, hematuria, and hypertension are clinical manifestations associated with Wilms' tumor.
If Wilms' tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Fever, hematuria, and hypertension are clinical manifestations associated with Wilms' tumor.
92. ANSWER: B
For the hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas, to which these children are susceptible. in addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count rises.
For the hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas, to which these children are susceptible. in addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count rises.
93. ANSWER: D
Collect additional information to determine potential causes of the weight loss. Information derived from interviewing and observing the patient will guide the nurse in the application of her knowledge regarding nutrition. The nurse will need to explore the patient's dietary patterns to discover the unique reasons for the patient's eating behaviors. Assessment is the first step of the nursing process.
Collect additional information to determine potential causes of the weight loss. Information derived from interviewing and observing the patient will guide the nurse in the application of her knowledge regarding nutrition. The nurse will need to explore the patient's dietary patterns to discover the unique reasons for the patient's eating behaviors. Assessment is the first step of the nursing process.
A: A nutritional assessment should be completed before recommendations are made.
B: The nurse needs to assess the patient's eating habits before planning calorie distribution.
C: The patient's plan of care should be individualized. An assessment needs to be completed prior to the institution of a care plan.
94. ANSWER: A
Vital signs and neurological status are assessed frequently. Special attention is paid to the child's temperature which may be elevated because of hypothalamus or brainstem involvement during surgery. A cooling blanket should be in place on the bed or readily available if the child becomes hyperthermic. Options C and D are related to functional deficits following surgery. An elevated blood pressure and a widened pulse pressure may be associated with increased intracranial pressure.
Vital signs and neurological status are assessed frequently. Special attention is paid to the child's temperature which may be elevated because of hypothalamus or brainstem involvement during surgery. A cooling blanket should be in place on the bed or readily available if the child becomes hyperthermic. Options C and D are related to functional deficits following surgery. An elevated blood pressure and a widened pulse pressure may be associated with increased intracranial pressure.
95. ANSWER: C
The most important component of pain assessment is the client's self-report of the pain. The nurse should have the client describe the quality, location, and intensity of the pain; the client's response to the pain; and any alleviating or aggravating factors affecting the pain.
The most important component of pain assessment is the client's self-report of the pain. The nurse should have the client describe the quality, location, and intensity of the pain; the client's response to the pain; and any alleviating or aggravating factors affecting the pain.
A: The physical
assessment should follow the pain assessment and should be delayed if the
client is uncomfortable.
B: This is an
important component of the pain assessment, but it is meaningless without the
client’s self-report of the pain and the effectiveness of the pain therapy.
D: The family’s
response to the client’s illness casts light on the amount of support the
client has and alerts the nurse to potential problems. With care, however,
these concerns are secondary to the issue of pain control.
96. ANSWER: A
The signs and symptoms stated in this case are all found in the client with low self-esteem. The diagnosis of neglect occurs in neurologic illness or trauma when the client shows a lack of awareness of a body part. This client is at risk for social isolation and loneliness, but there is no indication in the case study that these diagnoses are present.
The signs and symptoms stated in this case are all found in the client with low self-esteem. The diagnosis of neglect occurs in neurologic illness or trauma when the client shows a lack of awareness of a body part. This client is at risk for social isolation and loneliness, but there is no indication in the case study that these diagnoses are present.
97. ANSWER: D
Complication of
procedure is hypotension (hypovolemic shock due to fluid shift); also check for
tachycardia, oliguria, pallor
A: not most
important; will decrease
B: not most
important; will lose weight (3)
C: not most
important
ADDITIONAL INFO: Paracentesis: removal of fluid from the peritoneal cavity. Prep: informed consent, void, sit on side of bed. Take vital signs, measure abdominal girth, weigh pt. During procedure: take vital signs q 15 min. After procedure: document amount, color, characteristics of drainage obtained, assess pressure dressing for drainage, position in bed till vital signs stable. 2 - 3 L may be removed
98. ANSWER: C
The client should be taught to elevate the affected arm on a pillow to promote venous return and lymphatic drainage of the area.
The client should be taught to elevate the affected arm on a pillow to promote venous return and lymphatic drainage of the area.
A: Applying an
elastic bandage is inappropriate because constriction of the extremity should
be avoided.
B: Range-of-motion
exercising is not limited. Rather, it is encouraged.
D: Diuretics are not
used to control lymphedema.
99. ANSWER: D
The client with a cervical implant is kept on strict bed rest, flat in bed. Limitation of movement is designed to prevent accidental displacement or implant dislodgment. Client knowledge and understanding are critical to compliance with these restrictions.
The client with a cervical implant is kept on strict bed rest, flat in bed. Limitation of movement is designed to prevent accidental displacement or implant dislodgment. Client knowledge and understanding are critical to compliance with these restrictions.
A&B: The
client will not be allowed out of bed while the implant is in.
C: Assuming
various positions while in bed can dislodge the implant.
100. ANSWER: A
This helps flush
the kidneys and prevent nephrotoxicity, especially during the early phase of
treatment.
B: Reconstituted
solution can be stored in the refrigerator for 1 month.
C: Confusion,
dizziness, and hallucinations are side effects of this drug; the client should
avoid hazardous tasks, such as driving or using machinery.
D: Activity may
have to be altered because fatigue and other flulike symptoms are common with
this drug.
101. ANSWER: C
Fine-needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis.
Fine-needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis.
A: A breast
self-examination, if done regularly, is the most reliable method for detecting
breast lumps early.
B: Mammography is
used to detect tumors that are too small to palpate.
D: Chest X-rays
can be used to pinpoint rib metastasis.
102. ANSWER: C
The sun is the
best known and most common cause of basal cell epithelioma. Immunosuppression,
radiation, and burns are less common causes.
103. ANSWER: B
The nurse
shouldn't invite his clergyman to visit the client, unless the client
specifically asks to see that member of the clergy.
A: Acknowledging the client's spiritual distress
may help the nurse build a therapeutic relationship with the client.
C: Encouraging the
client to discuss religious beliefs and practices is a first step in developing
a plan for the client.
D: Encouraging the
client to discuss his concerns with the clergy is also appropriate.
104. ANSWER: A
The American
Cancer Society recommends a mammogram yearly for women over age 40. The other
statements are incorrect. It's recommended that women between ages 20 and 40
have a professional breast examination (not a mammogram) every 3 years.
105. ANSWER: C
Administration of
an antiemetic, such as metoclopramide, and an anti-inflammatory, such as
dexamethasone, can reduce the severity of chemotherapy-induced nausea and
vomiting. This in turn, helps prevent dehydration, a common complication of
chemotherapy. The remaining options are unlikely to be as successful in achieving
this outcome.
106. ANSWER: C
Normal activity
must be limited so that the implant will not become dislodged.
A: While the
client is receiving therapy, alpha, beta, and gamma rays will be emitted.
Therefore the nurse should employ the principles of time and distance when
providing care. The extent of exposure to the client must be monitored and kept
within safe limits depending on the type and amount of rays emitted.
B: This is not
necessary; adherence to principles of time and distance will protect the nurse
from excessive exposure.
D: This is not
necessary; however, all bed linens must be examined carefully for dislodged
radium prior to sending to the laundry.
107. ANSWER: A
Congestive heart
failure and dysrhythmias are the only life-threatening toxic effects unique to
Adriamycin.
B: When bone
marrow is depressed to precarious levels, the dose is altered and/or blood
components administered.
C: This is not a
side effect of Adriamycin nor of any of the other antineoplastic agents.
D: This is a very
uncomfortable side effect but is not life threatening.
108. ANSWER: C
Clients with
multiple myeloma are at risk for pathologic bone fractures secondary to diffuse
osteoporosis and osteolytic lesions. Also, clients are at risk for renal
failure secondary to myeloma proteins by causing renal tubular obstruction.
A&B: Liver
failure and heart failure aren't usually sequelae of multiple myeloma.
D: Hypoxemia isn't
usually related to multiple myeloma.
109. ANSWER: A
Treatment for
breast cancer depends on the disease stage and type, the client's age and menopausal
status, and the disfiguring effects of the surgery. For this client, lumpectomy
is the most likely option. Lumpectomy involves a small incision with removal of
the surrounding tissue and, possibly, the nearby lymph nodes. The client
usually undergoes radiation therapy afterward. In a partial mastectomy, the
tumor is removed along with a wedge of normal tissue, skin, and possibly
axillary lymph nodes. In a total (simple) mastectomy, the entire breast is
removed.
110. ANSWER: B
Breast cancer
tumors are fixed, hard, and poorly delineated with irregular edges.
111. ANSWER: D
When advance
directives state that a client doesn't want life-prolonging interventions,
nursing care focuses on providing emotional and spiritual support and comfort
measures.
A: The client
still needs to be checked regularly. The client and family shouldn't feel as if
they've been abandoned.
B: Providing mouth
and skin care makes the client more comfortable.
C: Turning the
client provides comfort and prevents potentially painful complications such as
pressure ulcers.
112. ANSWER: C
Breast surgery can
be psychologically traumatic to a woman, especially if she closely links her
womanhood and sexuality to her breasts.
A: With this in
mind, the nurse must ask proactive questions regarding the client's feelings
about her own breasts.
B: Listing
accomplishments or describing ambitions will give the nurse a general
impression of the client's self-concept; however, at this point, the
breast-related question is more valuable because of the nature of the illness
and the proposed surgery.
D: Eliciting
information about the husband's comments doesn't focus on the nurse's
assessment of the client's perception of herself.
113. ANSWER: D
D: Because of bone
erosion, pathologic fractures are a common complication of multiple myeloma.
A: Although this
would be done, the priority is to prevent injury.
B: Although this
is an adaptation to the associated anemia, it is not life threatening.
C: Although this
is important, preventing pathologic fractures is the priority.)
114. ANSWER: C
Pain in the
epigastric area is associated with gastric ulcer disease.
A&B: Pain
below or at the umbilicus is associated with appendicitis.
D: Abdominal pain
that occurs after a high-fat meal is associated with cholecystitis.
115. ANSWER: D
A bone scan
reflects the uptake of a bone-seeking radioactive isotope; an increased uptake
is seen in metastatic bone disease, osteosarcoma, osteomyelitis, and certain
fractures.
A: A bone scan
measures the uptake of radioactive material, not the absence of calcium, which
would be seen in an x-ray examination of bone.
B: This is a bone
marrow aspiration, in which a small amount of marrow is examined to determine
the presence of abnormal cells in diseases such as leukemia.
C: A bone scan
involves a small diagnostic dosage of a radioactive substance; it is not
therapeutic.
116. ANSWER: A
Cystitis is the
most common adverse reaction associated with radiation therapy; symptoms
include dysuria, frequency, urgency, and nocturia. Clients with radiation
implants require a private room. Urine of clients with radiation implants for
bladder cancer should be sent to the radioisotopes laboratory for monitoring.
It's recommended that fluid intake be increased.
117. ANSWER: B
Malignant melanoma
may indeed spread through the lymphatic system and the bloodstream.
A: This disorder
can spread to every organ in the body.
C: Men usually
have an area on the back involved, while women have an area on their lower legs
involved.
D: The most common
skin cancer is basal cell carcinoma.
118. ANSWER: D
Objective data are
measurable. Increased urinary frequency is measurable data that is related to
anxiety. Independence of ADLs and distraction aren't measurable quantities.
119. ANSWER: D
Leukemia is manifested by an abnormal overproduction of immature leukocytes in
the bone marrow.
120. ANSWER: B
The client will
receive an enema before the procedure because bowel motility during cervical
radiation implant therapy can disrupt or dislodge the implants.
A: The client will
be in a private room, and activities will be restricted in order to keep the implants
in place.
C: To keep the
bladder empty, an indwelling catheter will be used.
D: Positioning in
bed shouldn't exceed a 20-degree elevation because sitting up can cause the
implants to move from their intended locations. Semi-Fowler's position is 45
degrees.
121. ANSWER: D
Colorectal polyps
are common with colon cancer. Duodenal ulcers and hemorrhoids aren't a
preexisting condition of colorectal cancer. IT should be weight loss.
122. ANSWER: C
The nurse's main
concern following a circular skin punch procedure is to monitor for bleeding.
A&D: Infection
is a later possible consequence of a skin punch, and swelling is a normal
reaction associated with any event that traumatizes the skin.
B: Dehiscence is
more likely in larger wounds such as surgical wounds of the abdomen or thorax.
123. ANSWER: D
Radiated skin is
sensitive to the sun and cold temperatures so it should be protected.
A: Heat should not
be applied; the irradiated area should be protected from temperature extremes.
B: Only mild soaps
should be used.
C: No lotions,
perfumes, or oils should be applied to the area without the consent of the
radiologist. Such preparations can increase the skin irritation that results
from radiation treatments.
124. ANSWER: A
The normal white
blood cell count ranges from 4500 to 11,000 cells/µL. The client who is
immunosuppressed has a decrease in the number of circulating white blood cells.
The nurse implements neutropenic precautions when the client's values fall
sufficiently below the normal level. The specific value for implementing
neutropenic precautions usually is determined by agency policy. Options B, C,
and D are normal values.
125. ANSWER: B
Because
thrombocytopenia impairs blood clotting, the nurse should assess the client
regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and
bleeding gums.
A: The nurse
should avoid administering aspirin because it can increase the risk of
bleeding.
C: Frequent rest
periods are indicated for clients with anemia, not thrombocytopenia.
D: Strict
isolation is indicated only for clients who have highly contagious or virulent
infections that are spread by air or physical contact.
126. ANSWER: D
Testicular cancer
commonly occurs in men between ages 20 and 30. A male client should be taught
how to perform testicular self-examination before age 20, preferably when he
enters his teens.
127. ANSWER: C
Immunosuppressed
clients — for example, clients receiving chemotherapy — are at risk for
infection with C. difficile, which causes "horse barn"
smelling diarrhea. Successful treatment begins with an accurate diagnosis,
which includes a stool test.
A: The ELISA test
is diagnostic for human immunodeficiency virus and isn't indicated in this
case.
B: An electrolyte
panel and hemogram may be useful in the overall evaluation of a client but
aren't diagnostic for specific causes of diarrhea.
D: A flat plate
X-ray of the abdomen may provide useful information about bowel function but
isn't indicated in the case of "horse barn" smelling diarrhea.
128. ANSWER: C
HCG is one of the
tumor markers for testicular cancer. The HCG level won't identify the site of
an infection or evaluate prostatic function or testosterone level.
129. ANSWER: D
The client who
avoids conversation may be denying his condition, which can interfere with
treatment.
A: Crying is a
normal response to his disease.
B&C: Asking
questions about his prognosis is a normal coping response, as is showing concern
for his family.
130. ANSWER: A
An NG tube that
fails to drain during the postoperative period after gastrectomy should be
reported to the physician immediately. The tube may be occluded, which could
increase pressure on the suture line because fluid isn't draining adequately.
B&C: Repositioning
or irrigating the tube in a client who has had gastric surgery can disrupt the
anastamosis.
D: Increasing the
level of suction may cause trauma to GI mucosa or the suture line.
For practice test please click the link below:
http://ilovenurselouie.blogspot.com/2014/12/oncology-practice-test.html
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