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ONCOLOGY BOARD EXAM

1. Nina, an oncology nurse educator is speaking to a women’s group about breast cancer.
Questions and comments from the audience reveal a misunderstanding of some aspects of the
disease. Various members of the audience have made all of the following statements. Which one
is accurate?
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 self-examination. 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 woman’s breasts are still very tender. Postmenopausal women because their bodies
lack fluctuation of hormone levels, should select one particular day of the month to do breast
self-examination.

3. Nurse Kent is teaching a male client to perform monthly testicular self-examinations. 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 it’s treated in its early
stage. Self-examination allows early detection and facilitates the early initiation of treatment.
The highest mortality rates from cancer among men are in men with lung cancer. Testicular
cancer is found more commonly in younger men.

4. 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 cycle–nonspecific alkylating agent thiotepa (Thioplex), 60
mg weekly for 4 weeks by bladder instillation as part of a chemotherapeutic regimen to treat
bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its
therapeutic effects?
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 doesn’t
destroy the cell membrane.

6. The nurse is instructing the 35 year old client to perform a testicular self-examination. 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

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. Abdominal ultrasound
c. Magnetic resonance imaging
d. 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 male client is receiving external radiation to the neck for cancer of the larynx. The
most likely side effect to be expected is:
a. Dyspnea
b. Diarrhea
c. Sore throat
d. 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 client’s room
c. Remove the dosimeter badge when entering the client’s 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 client’s
room. Children younger than 16 years of age and pregnant women are not allowed in the client’s
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 client’s room
at all times during internal radiation therapy. If the implant becomes dislodged, the nurse should
pick up the implant with long-handled forceps and place it in the lead container. Options A, B,
and C are inaccurate interventions.

19. 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 client’s pain would include
which of the following?
a. The client’s pain rating
b. Nonverbal cues from the client
c. The nurse’s impression of the client’s pain
d. Pain relief after appropriate nursing intervention

Answer A. The client’s self-report is a critical component of pain assessment. The nurse
should ask the client about the description of the pain and listen carefully to the client’s words
used to describe the pain. The nurse’s impression of the client’s pain is not appropriate in
determining the client’s level of pain. Nonverbal cues from the client are important but are not
the most appropriate pain assessment measure. Assessing pain relief is an important measure, but
this option is not related to the subject of the question.

21. Nurse Mickey is caring for a client who is postoperative following a pelvic exenteration
and the physician changes the client’s diet from NPO status to clear liquids. The nurse makes
which priority assessment before administering the diet?
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 Hodgkin’s 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. Hodgkin’s disease is a chronic progressive neoplastic disorder of lymphoid
tissue characterized by the painless enlargement of lymph nodes with progression to
extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue
and weakness may occur but are not related significantly to the disease.

23. 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. Infection
b. Hemorrhage
c. Cervical stenosis
d. 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 daughter’s graduation, I’ll 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 client’s 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.

Source/ Reference: http://nclexreviewers.com/nclex-review/oncology/nclex-review-oncology-


questions-part-2.html

31. Which of these findings in the breast of a patient who is suspected of having breast cancer
would support the diagnosis?

a. complaints of dull, achy, pain


b. palpation of a mobile mass
c. presence of an inverted nipple
d. area of discoloration skin

Answer C. Inversion of nipple is one of the manifestations of breast cancer. A cancerous


lesion is non-mobile.

32. A nurse is caring for a client with an internal radiation implant. Which of the following
instructions is appropriate?

a. allow the client to go to the bathroom


b. avoid creams and lotions
c. visitors are allowed to stay in the room
d. the client should remain in bed during the entire duration of treatment

Answer D. The client with internal radiation implant should be on bed rest. This is to
prevent dislodgment of the implant.

33. How often should a female who is above 40 years old, go for cancer detection examination?

a. daily
b. weekly
c. monthly
d. yearly
Answer D. Cancer screening for females who are above 40 years of age should be yearly.

34. The client is receiving internal radiation therapy. The nurse should

a. remember to give the badge to the next-shift nurse


b. maintain a 30-minute close contact with the patient in a shift
c. wear gloves, mask and gown when entering the client's room
d. instruct relatives no to visit the client during the entire duration of the treatment

Answer A. Dosimeter badge is used to measure amount of exposure to radiation. It


should be endorsed to the next shift.

35. A nurse is assessing a client with metastatic breast cancer who reports nocturia, weakness,
nausea and vomiting. The client's serum electrolytes include potassium 4.2 mEq/L, sodium 135
mEq/L, calcium 7.0 mEq/L, and magnesium 2.0 mEq/L. Based on the assessment findings, the
priority action for the nurse is to:

a. start client on fluid restriction


b. administer calcium gluconate
c. increase the client's IV fluids
d. administer Allopurinol

Answer C. Nocturia, nausea and vomiting cause dehydration. Therefore, the correct
nursing action is to increase the client's IV fluids.

Source: http://www.blogcatalog.com/blog/nclex-and-local-board-prc-sample-
exam/5ec63aeeb3953955c859a0cc6b6c00eb

36. The nurses assesses that the client with cancer is not ready for teaching when the client asks:

a. “Am I going to loose my hair?”


b. “Should I get a second opinion?”
c. “Will this make me really sick?”
d. “Will I have to stop exercising at the gym?”

Answer B. This indicates denial of his illness. The question states he has cancer. All of
the other comments indicate an interest in what is going to happen to him.

37. Knowing that chemotherapy affects the taste buds, the nurse would have the client

a. Increase the amount of spices in the food.


b. Avoid red meats.
c. Medicate with Compazine before meals.
d. Eat foods that are hot in temperature.

Answer A. Because taste buds are affected, increasing spices will improve flavor.
38. In evaluating the client with cancer what best indicates that nutritional status is adequate?

a. Calorie intake
b. Weight is stable
c. Amount of nausea and vomiting
d. Serum protein levels

Answer B. Stable weight indicates adequate nutritional status.


39. An adult client with newly diagnosed cancer says, “I’m really afraid of dying. Who’s going
to take care of my children?” What is the best initial response for the nurse to make?
a. “What makes you think you are going to die?”
b. “How old are your children?”
c. “This must be a difficult time for you.”
d. “Most people with your kind of cancer live a long time.”
Answer C. This empathetic response will open communication. #1 is really a “why”
question which would put the client on the defensive. #2 and #4 do not focus on the client’s
feelings.
40. A client with terminal cancer yells at the nurse and says, “I don’t need your help. I can bathe
myself.” Which stage of grief is the client most likely experiencing?
a. Projection
b. Denial
c. Anger
d. Depression
Answer C. Yelling at the nurse would be typical of anger. Projection is putting his
feelings on the nurse “You are angry at me.” Denial would be denying that he was terminally ill
or that he had cancer. A client who is depressed would be apathetic and probably not have the
energy to yell at the nurse.
Source: http://nurse.nonoy.net/2010/06/nclex-review-cancer-hematology/