Situation: Aling Nena is a 60 year old woman with a malignant tumor of the breast, who was admitted for

modified radical mastectomy. 1. The physician has ordered 5 flourouracil, 700 mg IV once a week. When Aling Nena hears this, she says to the nurse, "Am I going to lose my hair?" Which is the best response by the nurse?

advise patient she cannot get pregnant or breastfeed while under medication because of its toxic effect

advise patient to discontinue drug and report to physician if diarrhea occurs as it is a sign of toxicity

a) 5-flourouracil usually does nit cause loss of hair b) hair loss can occur but a wig can be worn until your hair grows back c) the physician will prescribe a medication to prevent this side effect from occurring d) losing your hair is less traumatic than losing breast 2. Aling Nena is being assessed of her nutritional status. She weigh 100 lbs and is 5'8 ft. tall. Her assessment would include the following except: a) a diet history b) anthropometric measurements c) food preferences d) serum protein 3. Which nursing action would best attain the goal of providing and promoting coping for Aling Nena? a) telling Aling Nena for her strengths and progress b) planning experienced for her that are conclusive c) helping her to identify her problems and solutions d) giving her information on how to handle her problems

Mouth sores (stomatitis) - apply topical anesthetics for comfort, advise oral hygiene to prevent infection of the denuded oral mucosa

Nausea, vomiting, and anorexia - give antiemetic before administration

Leukopenia, anemia, agranulocytosis avoid exposure to infection

Scaling of the skin, pruritus, desquamative rash of hands and feet, and nail changes - reversible after medication, can be treated with pyridoxine 50-150 mg for 7 days

Thrombocytopenia - avoid IM injections when platelet count goes below 50,000

if crystals form in the drug - redissolve by warming solution

do not use cloudy solution, do not refrigirate, protect from sunlight, discard unused portion after 1 hour

use plastic IV bags if to be infused by intravenous route as the drug is more

1) B - the drug can cause alopecia or hair loss but the hair will grow back after treatment. The nurse can advise the patient to wear a wig or other head accessories for coverage. The patient should buy the wig before hair falls out. 5-fluoroucacil or 5-FU is an antineoplastic drug that used for the cancers of the colon, rectum, breast, stomach and pancreas. The adverse side effects of this drug are:

stable in plastic than glass 2) C - although inquiry about food preferences is history taking, it is not used in the standard nutritional status assessment of the patient. The information gained during nutritional status assessment are:

Anthropometric measurements: height, weight, body mass index (BMI), circumferential measurements

Photosensitivity - advise to avoid prolonged exposure to sunlight and to use highly protective sunlight to prevent inflammatory erythematous dermatitis

Physical examination - clinical signs and symptoms such as pallor, dry skin, brittle hair, mouth sores

Diet history - 24 hours diet recall to assess the quality and quantity of food intake

9. A nursing assistant is taking care of a patient who had undergone liver biopsy. When should the registered nurse intervene? a) when the nursing assistant monitors the patient's vital signs every 15 minutes for the 1st two hours after the procedure b) when the nursing assistant tells the patient to remain in bed for several hours c) when the nursing assistant positions the patient on the left side d) when the nursing assistant checks the biopsy site for bleeding 10. Which of the following is a risk factor to cancer of the colon? a) diabetes mellitus b) peptic ulcer c) abdominal hernia d) high fat, high calorie diet 4) B - zofran is antiemetic. The drug is effective if the client is no longer experiencing nausea and vomiting. Therefore, the client can already tolerate food. 5) C - meat is perceived as bitter by clients with cancer 6) B - iodinated contrast medium causes warm, flushing sensation as it is injected. 7) C - fatigue is a side effect of external radiation therapy. Answers A, B, and D are practiced in internal radiation therapy. 8) A - history of undescended testes at birth is strongly linked with testicular cancer. 9) C - the client should be turned to the right side after liver biopsy, not on the left side. Turning the client on the right side will apply pressure on the site and will prevent bleeding. 10) D - high fat, high protein and high carbohydrate diet increase the risk of cancer in the colon.

Diagnostic tests: hemoglobin, hematocrit, transferring, serum protein, total lymphocyte count, nitrogen balance, d-xylose absorption test, creatinine excretion, serum levels

3) C 4. The nurse evaluates that zofran (ondansetron) is effective in a client undergoing chemotherapy if which of the following is observed? a) urine output is 1,500 ml/day b) the client can tolerate mechanically soft diet c) the client's anxiety is relieved d) the client was able to sleep 5. A client with cancer of the colon who is receiving chemotherapy tells a nurse that some foods on the metal tray taste bitter. The nurse would try ti limit which of the following foods that is most likely to cause this taste for the client? a) cantaloupe b) potatoes c) beef d) custard 6. A client suspected of having lung tumor is scheduled for a computerized tomography (CT) scan with dye injection. A nurse tells the client that a) the test may be painful b) the dye injected may cause a warm, flushing sensation c) fluids will be restricted following the test d) the test takes approximately 2 hours 7. Which of the following is a nursing responsibility for a client undergoing external radiation therapy? a) wear gown, gloves and mask b) observe time, distance, and shielding c) provide the client adequate rest and schedule activity d) place the client in isolation for few days 8. Who among these clients is at high risk to develop testicular cancer? a) the client has undescended testes at birth b) the client has human papilloma virus c) the client has recurrent urinary tract infection d) the client is uncircumcised

11. Which of the following should the nurse assess prior to administration of cisplatin? a) hydration b) hemoglobin c) weight d) ECG

12. The client is receiving internal radiation therapy. What is the appropriate nursing action to minimize radiation contamination? a) put the soiled linens in double bag b) keep clients things close to her bedside c) always wear gloves when entering the client's room d) minimize contact with the client 13. A client is suspected of having pheochromocytoma. Which of the following signs and symptoms would help support this diagnosis? a) abdominal pain b) anuria c) hypertension d) weight gain 14. Before uterine radioactive implant is inserted, which of the following physician's orders does the nurse expect? a) administer analgesic b) administer sedative c) administer enema d) administer antibiotic 15. The nurse is admitting a patient with jaundice, due to pancreatic cancer. Which of the following would the nurse give highest priority? a) body image b) nutrition c) skin integrity d) anticipatory grieving 11) A - cisplatin, a neoplastic agent is nephrotoxic. The client should be adequately hydrated before administration of the drug. 12) D - Each contact with the client undergoing internal radiation therapy should last for 5 minutes only, a total of 30 minutes in an 8-hour shift, to minimize radiation contamination. The nurse should wear dosimeter badge to measure radiation exposure. 13) C - pheochromocytoma is a tumor in the adrenal medulla that stimulates increased secretion of catecholamines (epinephrine/norepinephrine). This causes hypertension. 14) C - during uterine radioactive implant, the client should be on bedrest. Defecation should be avoided during treatment to prevent dislodgement of the implant. Therefore, enema is usually ordered by the physician before the treatment.

15) C - give priority to physiologic before psychosocial needs. Jaundice causes severe pruritus. Therefore, maintaining skin integrity is a priority. 16. After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/cu.mm. What term should the nurse use to describe this low platelet count? 17. Which of the following should the nurse include when providing health teachings for patients at risk of developing prostatic cancer? a) participate in smoking cessation program b) perform monthly self-testicular examination c) maintain daily walking exercise d) undergo monthly digital rectal examination 18. Which of the following questions should the nurse ask in a client who is at risk for breast cancer? a) does your family have a history of multiple gestation? b) does your family have a history of ovarian cancer? c) does your family have a history of early menopause? d) does your family have a history of late menarche? 19. Which of the following client history increases risk for anorectal cancer? a) chronic constipation b) high fiber diet c) alcohol abuse d) chronic inflammatory bowel disease 20. A client will be for uterine radium implant. Which of the following statement when made by the client indicates the need for further teaching? a) my sister is coming to stay with me today after implant insertion b) I will be in bed for the duration of the treatment c) I will have a foley catheter in place d) I will have enema before the procedure

16) thrombocytopenia - the normal thrombocyte count is 150,000 to 450,000/ cu.mm. 17) A - smoking increases risk for prostatic cancer. Choice B is done to detect cancer of the testes. Choice D, digital rectal examination is recommended annually, not monthly. 18) B

- history of cancer of the reproductive system (cancer of the uterus, cervix, and ovaries) increase risk for breast cancer. 19) D - chronic inflammatory bowel disease are primarily associated with anorectal cancer. 20) A - the client on internal radiation therapy should be on isolation to prevent radiation contamination of other people. 1. Which of the following nursing actions is most appropriate when caring for a client with radium implant? a) wear gloves when entering the client's room b) wear masks and gloves when performing procedures to the client c) avoid staying with the client for more than 30 minutes in a shift d) place client's soiled gowns and linens in a plastic bag 22. A woman had been diagnosed to have breast cancer. Which of the following factors is most significant to her prognosis? a) she had her menarche at age 12 years b) her sister died of breast cancer 5 years ago c) she delivered her first born at age 25 years d) she had her menopause at age 50 years 23. Which of the following are characteristics of a client most susceptible to develop malignant melanoma? a) dark skin, black hair b) coarse skin, black hair c) fair skin, blond hair d) oily skin, brown hair 24. Which of the following statements when made by the client with implant radiation therapy needs intervention by the nurse? a) I will have to go to the toilet to void b) my visitors are allowed to visit me for 30 minutes only in a day c) the nurse needs to wear a badge when caring for me d) I need to remain in bed during the entire duration of the treatment 25. Which of the following statements when made by the client with leukemia indicates that the client understands the health teachings given by the nurse? Select all that apply a) I am allowed to eat raw foods b) I have to avoid raw fruits and vegetables c) fresh flowers should not be allowed in my room d) if I developed joint pains, I should apply cold

compress to the area e) if I developed high fever, I should take aspirin f) I am allowed to watch baseball games g) I should use soft-bristled toothbrush

21) C - the nurse must limit her exposure to the client having internal radiation therapy to prevent contamination. The nurse must observe DTS (distance, time, and shielding). Time: 5 minutes/exposure; maximum of 30 minutes in an 8-hour shift. 22) B - positive family history plays vital role in the predisposition to cancer. 23) C - clients with fair skin, blond hair are prone to skin cancer. This is because they have lesser melanin in their skin, which serves as protection of the skin. 24) A - the client receiving internal radiation therapy should be on complete bed rest to prevent dislodgement of the implant. The client has 2way foley catheter during the treatment. Choices B, C, and D indicate correct understanding of the patient on internal radiation therapy, and do not need intervention by the nurse. 25) B, C, D, G - indicates that the client with leukemia understands health teachings. A client with leukemia has low resistance to infection and bleeding tendencies. 26. A 40-year old woman is admitted to the hospital for a radiation implant therapy to treat recently diagnosed cervical cancer. The most important consideration when planning care is her a) level of anxiety b) loss of income due to inability to work c) support system d) energy level to perform ADL's 27. When the nurse is discussing risk factors for cervical cancer, which of these women would be at greatest risk? a) a 25-year old woman with family history of cancer and using birth control pills b) a 50-year old woman who has several exposures to radiation and has chronic anemia c) a 19-year old woman who initiated sexual intercourse early with multiple partners d) a 60-year old woman who had smoked cigarettes for 5 years and used diaphragm for birth control

28. Which of the following nursing diagnoses would rank as the most important in the planning of care for a client in two weeks after the chemotherapy has begun? a) potential for infection b) activity intolerance c) impaired skin integrity d) self-esteem disturbance 29. During the administration of a chemotherapeutic drug, the nurse observes that there is a lack of blood return from the intravenous catheter. The priority action by the nurse would be to a) stop the administration of the drug immediately b) reposition the client's arm and continue with the administration of the drug c) apply a tourniquet to the patient's affected arm and notify the doctor d) continue to administer the drug and assess for edema at the IV site 30. A patient who is receiving chemotherapy develops stomatitis. Which of the following actions would be priority for the nurse to incorporate into the plan of care? a) rinse the patient's mouth with full strength hydrogen peroxide every 4 hours b) use a soft toothbrush after each meal c) provide hot tea with honey to soothe the patient's painful oral mucosa d) use dental floss only

strength. Hot beverages will further cause irritation. Honey may support proliferation of microorganisms in the oral mucosa. Flossing may also cause trauma to the mouth and gums of the patient with stomatitis.

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 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 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 34. The client is receiving internal radiation therapy. The nurse should a) remember to give the badge to the nextshift 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 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 : 31) C - inversion of nipple is one of the manifestations of breast cancer. A cancerous lesion is non-mobile. 32) D - the client with internal radiation implant should be on bed rest. This is to prevent

26) A - anxiety is the usual response to a change in life situation like undergoing treatment for cancer. 27) C - early sexual intercourse and having multiple sexual partners pose highest risk to cervical cancer. 28) A - chemotherapy causes immunosuppression. Therefore, the patient is at risk to develop infection. 29) A - chemotherapeutic agents are irritating to tissues. Lack of blood return from the IV catheter indicates that it is out of vein. Therefore, administration of the drug should be stopped immediately. 30) B - use soft toothbrush in a client with stomatitis to prevent further trauma and pain to the oral mucosa. Half-strength hydrogen peroxide is recommended to relieve stomatitis not full

dislodgment of the implant. 33) D - cancer screening for females who are above 40 years of age should be yearly. 34) A - dosimeter badge is used to measure amount of exposure to radiation. It should be endorsed to the next shift. 35) C - nocturia, nausea and vomiting cause dehydration. Therefore, the correct nursing action is to increase the client's IV fluids. a) inability to swallow b) elevated temperature c) altered hearing ability d) orthostatic hypotension

36) D - the client with lung cancer experiences difficulty of breathing. Therefore, the first action by the nurse is to facilitate the client's breathing by elevating the head of the bed. 37) B - the first nursing action when a client refuses a test or treatment is to assess the reason for refusal. Assessment is the first phase of the nursing process. 38) B - the client who is exposed to chemicals for a long period of time is at highest risk to develop lung cancer. 39) A - the normal white blood cell count ranges from 4,500 to 11,000/mm3. 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 sufficiency 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. 40) B - Vital signs and neurological status are assessed frequently. Special attention is given to the childs temperature, which may be elevated because of hypothalamic or brainstem involvement during surgery. A cooling blanket should be in place on the bed or readily available if the child becomes hyperthermic. Options A and C are related to functional deficits following surgery. Orthostatic hypotension is not a common clinical manifestation following brain surgery. An elevated blood pressure and widened pulse pressure may be associated with increased intracranial pressure, which is a complication following brain surgery. 41. The health education nurse provides instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which statement by a client indicates a need for further instructions? a) I will avoid sun exposure after 3 pm b) I will use sunscreen when participating in outdoor activities c) I will wear a hat, opaque clothing, and sunglasses when in the sun d) I will examine my body monthly for any lesions that may be suspicious 42. The client is undergoing radiation therapy

36. The nurse on the oncology unit enters the room of the client with lung cancer. Which action is most appropriate for the nurse to do first? a) check the client's IV infusion pump and IV fluid rate b) take the client's blood pressure and pulse c) assess the client's mental status d) elevate the client's head of the bed 37. The nurse on the oncology unit is planning care for the client with colon cancer who is refusing a diagnostic test. Which action is most appropriate for the nurse to take first? a) call the radiology department to let them know the client will not be going to take the test b) speak with the client to determine the reason for refusing the test c) inform the health care provider that the client is refusing the test d) ask the client's spouse why the client is refusing the test

38. A nurse is admitting a 63-year old male reporting hemoptysis and weight loss. The nurse identifies that the highest priority risk factor for lung cancer for this client is: a) family history of lung cancer b) the client works in a chemical factory c) the client lives in a coal mining area d) the client uses chewing tobacco 39. The nurse is caring for a client with a diagnosis of cancer who is immunosuppressed. The nurse would consider implementing neutropenic precautions if the client's white blood cell count was which of the following? a) 2,000 cells/mm3 b) 5,800 cells/mm3 c) 8,400 cells/mm3 d) 11,500 cells/mm3 40. A nurse is caring for a child after removal of a brain tumor. The nurse assesses the child for which of the following signs that would indicate that brainstem involvement occurred during the surgical procedure?

to treat lung cancer. Following treatment, the nurse notes erythema on the client's chest and neck, and the client is complaining of pain at the radiation site. The nurse interprets this assessment data a(n): a) allergic reaction to the radiation b) superficial injury to tissue from the radiation c) cutaneous reaction to products formed by the lysis of the neoplastic cells d) ischemic injury, much like pressure ulcer formation. caused by pressure from the linear accelerator

43) C - Risk factors for cervical cancer include human papillomavirus (HPV) infection, active and passive cigarette smoking, certain high-risk sexual activities (first intercourse before 17 years of age, multiple sex partners, or male partners with multiple sex partners). Screening via regular gynecological exams and Papanicolaou smear (Pap test) with treatment of precancerous abnormalities decrease the incidence and mortality of cervical cancer. 44) 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. 45) 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.

43. The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. Which of the following, if identified by the client as a risk factor to cervical cancer, indicates a need for further teaching? a) smoking b) multiple sex partners c) first intercourse after age 20 d) annual gynecological examinations 44. The 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 tumor b) abdominal ultrasound c) magnetic resonance imaging d) computed tomography scan 45. The nurse 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 level b) increased white blood cells c) decreased blood urea nitrogen level d) decreased number of plasma cells in the bone marrow 41) A - The client should be instructed to avoid sun exposure between the hours of 11 AM and 3 PM. Sunscreen, a hat, opaque clothing, and sunglasses should be worn for outdoor activities. The client should be instructed to examine the body monthly for the appearance of any possible cancerous or any precancerous lesions. 42) B - Superficial injury from radiation can manifest with erythema (probably caused by capillary damage), hyperpigmentation (from stimulation of melanocytes), dry desquamation (caused by basal cell destruction), or moist desquamation (also caused by basal cell destruction). Moist desquamation is comparable to a seconddegree burn in histology, appearance, and sensation.

6. The nurse is instructing the client to perform a testicular self-examination. The nurse tells the client: a) to examine the testicles while lying down that the best time for the examination is after a shower c) to gently feel the testicles with one finger to feel for a growth d) that testicular self-examinations should be done at least every 6 months 47. The 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

48. The nurse is monitoring the laboratory results of a client preparing to receive chemotherapy. The nurse determines that the white blood cell count is normal if which of the following results were present? a) 2000 to 5000 cells/mm3 b) 3000 to 8000 cells/mm3 c) 5000 to 10000 cells/mm3 d) 7000 to 15000 cells/mm3 49. The community health nurse is instructing

a group of female clients about breast selfexamination. The nurse instructs the clients 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 50. The nurse is caring for a client who has undergone vaginal hysterectomy. The nurse avoids which of the following in the care of this client? a) elevating the knee on the bed b) assisting with range-of-motion leg exercises c) removal of antiembolism stockings twice a day d) checking placement of pneumatic compression boots

client more at risk for deep vein thrombosis or thrombophlebitis.

51. The client suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse provides which pre-procedure instruction to the client? a) eat a light breakfast only b) maintain an NPO 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 52. A client is 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

46) 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. 47) 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 relates 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.

53. The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further teaching is needed if a nursing staff member states that which of the following is a characteristic of the disease? a) presence of Reed-Sternberg cells b) occurs most often in the older client c) prognosis depending on the stage of the disease d) involvement of lymph nodes, spleen, and liver 54. The 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 55. The 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

48) C - The normal white blood cell count ranges from 5000 to 10,000 cells/mm3. Options A and B indicate low values. Option D indicates an elevated value. 49) 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. 50) 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

51) 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 3 is unrelated to this specific procedure. 52) 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. 53) B - Hodgkins disease is a disorder of young adults. Options A, C, and D are characteristics of this disease. 54) 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. 55) 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. 56. The nurse 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 57. A cervical radiation implant is placed in the client for the 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

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 59. The nurse is caring for a client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plants 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 60. The nurse is reviewing the laboratory results of a client receiving chemotherapy whose platelet count is 10,000 cells/mm3. based on this laboratory value, the priority nursing assessment is which of the following? a) assess skin turgor b) assess temperature c) assess bowel sounds d) assess level of consciousness

NCLEX Review Questions on Cancer: ANSWERS AND RATIONALE 56) B - The time that the nurse spends in a room of a client with an internal radiation implant is 30 minutes per 8-hour shift. The dosimeter badge must be worn when in the clients room. Children younger than 16 years of age and pregnant women are not allowed in the clients room. 57) 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. 58) D - A lead container and long-handled forceps should be kept in the clients room at all times during internal radiation therapy. If the implant becomes dislodged, the nurse should pick up the implant with long-handled forceps and place it in the lead container. Options A, B, and C are inaccurate interventions. 59) C

58. The client is hospitalized for insertion of an

- 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. 60) D - A high risk of hemorrhage exists when the platelet count is less than 20,000 cells/mm3. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is less than 10,000 cells/mm3. The client should be assessed for changes in level of consciousness, which may be an early indication of an intracranial hemorrhage. Option B is a priority nursing assessment when the white blood cell count is low and the client is at risk for an infection. Although options A and C are important to assess, they are not the priority in this situation.

65. The nurse is reviewing the complications of conization 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

NCLEX Review Questions on Cancer: ANSWERS AND RATIONALE 61) A - The clients self-report is a critical component of pain assessment. The nurse should ask the client about the description of the pain and listen carefully to the clients words used to describe the pain. The nurses impression of the clients pain is not appropriate in determining the clients level of pain. Nonverbal cues from the client are important but are not the most appropriate pain assessment measure. Assessing pain relief is an important measure, but this option is not related to the subject of the question. 62) 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. 63) D - Hodgkins disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease. 64) 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. 65) 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.

61. The home health care nurse is caring for a 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 62. The nurse is caring for a client who is 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

63. The client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client? a) fatigue b) weakness c) weight gain d) enlarged lymph nodes 64. During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? a) diarrhea b) hypermenorrhea c) abnormal bleeding d) abdominal distention

early. The finding should be reported to the physician. 66.When assessing the laboratory results of the client with bladder cancer and bone metastasis, the nurse notes a calcium level of 12 mg/dl. The nurse recognizes that this is consistent with which oncological emergency? a) hyperkalemia b) hypercalemia c) spinal cord compression d) superior vena cava syndrome 67. The client reports to the nurse that when performing testicular self-examination, he found a lump the size and shape of a pea. The appropriate response to the client is which of the following? a) lumps like that are normal, don't worry b) let me know if it gets bigger next month c) that could be cancer. I'll ask the doctor to examine you d) that's important to report even though it might not be serious 68) 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. 69) 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. 70) 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. 71. 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 personal sensation as the side effect of radiation therapy 72. The client with leukemia is receiving busulfan (Myleran) and allupurinol (Zyloprim) is prescribed for the client. The nurse tells the client that the purpose of the allupurinol is to prevent: a) nausea b) alopecia c) vomiting d) hyperuricemia

68. The 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 phase of coping is this client experiencing? a) anger b) denial c) bargaining d) depression 69. The nurse is caring for a client following 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 side 70. The nurse is admitting a 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 pollution 66) B - Hypercalcemia is a serum calcium level higher than 10 mg/dL, most often occurs in clients who have bone metastasis, and is a late manifestation of extensive malignancy. The presence of cancer in the bone causes the bone to release calcium into the bloodstream. 67) D - Testicular cancer almost always occurs in only one testicle and is usually a pea-sized painless lump. The cancer is highly curable when found

73. The client receiving chemotherapy is experiencing mucositis. The nurse advises the client to use which of the following as the best substance to rinse the mouth? a) alcohol-based mouthwash b) hydrogen peroxide mixture c) lemon-flavored mouthwash d) weak salt and bicarbonate mouth rinse

74. The community nurse is conducting a health promotion program and the topic of the discussion relates to the risk factors for gastric cancer. Which risk factor, if identified by a client, indicates a need for further discussion? a) smoking b) a high-fat diet c) foods containing nitrates d) a diet of smoked, highly salted, and spiced food 75. A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. Which of the following is the appropriate nursing intervention? a) notify the physician b) measure abdominal girth c) irrigate the nasogastric tube d) continue to monitor the drainage

hours postoperatively, changes to browntinged, and is then to yellow or clear. Because bloody drainage is expected in the immediate postoperative period, the nurse should continue to monitor the drainage. The nurse does not need to notify the physician at this time. Measuring abdominal girth is performed to detect the development of distention. Following gastrectomy, a nasogastric tube should not be irrigated unless there are specific physician orders to do so.

76. The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to colorectal cancer is necessary if the client identifies which of the following as an associated risk factor? a) age younger than 50 years b) history of colorectal polyps c) family history of colorectal cancer d) chronic inflammatory bowel disease 77. The nurse is performing an admission assessment on a client diagnosed with a right colon tumor. The nurse asks the client about which characteristic symptom of this type of tumor? a) rectal bleeding b) flat, ribbon-like stool c) crampy, colicky abdominal pain d) alternating constipation and diarrhea

71) B - A vesicovaginal fistula is a genital fistula that occurs between the bladder and vagina. The fistula is an abnormal opening between these two body parts and, if this occurs, the client may experience drainage of urine through the vagina. The clients complaint is not associated with options A, C, and D. 72) 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.

78. The nurse is reviewing the preoperative orders of a client with a colon tumor who is scheduled for abdominal perineal resection and notes that the physician has prescribed neomycin (Mycifradin) for the client. The nurse determines that this medication has been prescribed primarily: a) to prevent immune dysfunction b) because the client has an infection c) to decrease the bacteria in the bowel d) because the client is allergic to penicillin 79. The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is most appropriate? a) notify the physician b) clamp the penrose drain c) change the dressing as prescribed d) remove and replace the perineal packing 80. The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which of the following assessment findings indicates that the colostomy is beginning to function? a) absent bowel sounds b) the passage of flatus

73) D - An acidic environment in the mouth is favorable for bacterial growth, particularly in an area already compromised from chemotherapy. Therefore, the client is advised to rinse the mouth before every meal and at bedtime with a weak salt and sodium bicarbonate mouth rinse. This lessens the growth of bacteria and limits plaque formation. The other substances are irritating to oral tissue. If hydrogen peroxide must be used because of severe plaque, it should be a weak solution because it dries the mucous membranes. 74) B - A high-fat diet plays a role in the development of cancer of the pancreas. Options A, C, and D are risk factors related to gastric cancer. 75) D - Following gastrectomy, drainage from the nasogastric tube is normally bloody for 24

c) the client's ability to tolerate food d) bloody drainage from the colostomy

76) A - Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease. 77) C - Vague abdominal discomfort or crampy, colicky abdominal pain is a characteristic symptom of a right colon tumor. Options A, B, and D are symptoms associated with left colon tumors. 78) C - To reduce the risk of contamination at the time of surgery, the bowel is emptied and cleansed. Laxatives and enemas are given to empty the bowel. Intestinal anti-infectives such as neomycin or kanamycin (Kantrex) are administered to decrease the bacteria in the bowel. 79) C - Immediately after surgery, profuse serosanguineous drainage from the perineal wound is expected. The nurse does not need to notify the physician at this time. A Penrose drain should not be clamped because this action will cause the accumulation of drainage within the tissue. Penrose drains and packing are removed gradually over a period of 5 to 7 days as prescribed. The nurse should not remove the perineal packing. 80) B - Following abdominal perineal resection, the nurse would expect the colostomy to begin to function within 72 hours after surgery, although it may take up to 5 days. The nurse should assess for a return of peristalsis, listen for bowel sounds, and check for the passage of flatus. Absent bowel sounds would not indicate the return of peristalsis. The client would remain NPO until bowel sounds return and the colostomy is functioning. Bloody drainage is not expected from a colostomy.

a) cancer control by reducing the size of the tumor b) cancer prevention by removal of precancerous tissue c) cancer cure by removing all gross and microscopic tumor cells d) cancer rehabilitation by improving the appearance of a previously treated body part

83. Hormone therapy is prescribed as the mode of treatment for a client with prostate cancer. The nurse understands that the goal of this form of treatment is to: a) increase testosterone levels b) increase prostaglandin levels c) limit the amount of circulating androgens d) increase the amount of circulating androgens 84. The nurse is caring for a client with cancer of the prostate following a prostatectomy. The nurse provides discharge instructions to the client and tells the client to: a) avoid driving the car for 1 week b) restrict fluid intake to prevent incontinence c) avoid lifting objects heavier than 20 lb for at least 6 weeks d) notify the physician if small blood clots are noticed during urination 85. The oncology nurse is providing a teaching session to group of nursing students regarding the risks and causes of bladder cancer. Which statement by a student indicates a need for further teaching? a) bladder cancer most often occurs in women b) using cigarettes and coffee drinking can increase the risk c) bladder cancer generally is seen in client older than 40 d) environmental health hazards have been attributed as a cause 81) C - Air conditioners need to be avoided to protect from excessive coldness. A humidifier in the home should be used if excessive dryness is a problem. Options A, B, and D are appropriate interventions regarding stoma care following radical neck dissection and creation of a tracheotomy.

81. The nurse is caring for a client following a radical neck dissection and creation of a tracheostomy performed for laryngeal cancer and is providing discharge instructions to the client. Which statement by the client indicates a need for further instructions? a) I will protect the stoma from water b) I need to keep powders and sprays away from the stoma c) I need to use an air conditioner to provide cool air to assist in breathing d) I need to apply a thin layer of petrolatum to the skin around the stoma to prevent cracking 82. What is the purpose of cytoreductive ("debulking") surgery for ovarian cancer?

82) A - Cytoreductive or debulking surgery may be used if a large tumor cannot be completely removed as is often the case with late-stage ovarian cancer (e.g., the tumor is attached to a vital organ or spread throughout the abdomen). When this occurs, as much tumor as possible is removed and adjuvant chemotherapy or radiation may be prescribed. 83) C - Hormone therapy (androgen deprivation) is a mode of treatment for prostatic cancer. The goal is to limit the amount of circulating

androgens because prostate cells depend on androgen for cellular maintenance. Deprivation of androgen often can lead to regression of disease and improvement of symptoms. 84) C - Small pieces of tissue or blood clots can be passed during urination for up to 2 weeks after surgery. Driving a car and sitting for long periods of time are restricted for at least 3 weeks. A high daily fluid intake should be maintained to limit clot formation and prevent infection. Option C is an accurate discharge instruction following prostatectomy. 85) A - The incidence of bladder cancer is greater in men than in women and affects the white population twice as often as blacks. Options B, C, and D are associated with the incidence of bladder cancer.

a ) that mammography takes about 1 hour b) that there is no discomfort associated with the procedure c) to maintain an NPO status on the day of the test d) to avoid the use of deodorants, powders, or creams on the day of the test 86) B - The most common symptom in clients with cancer of the bladder is hematuria. The client also may experience irritative voiding symptoms such as frequency, urgency, and dysuria, and these symptoms often are associated with carcinoma in situ. 87) C - Normally, the medication is injected into the bladder through a urethral catheter, the catheter is clamped or removed, and the client is asked to retain the fluid for 2 hours. The client changes position every 15 to 30 minutes from side to side and from supine to prone or resumes all activity immediately. The client then voids and is instructed to drink water to flush the bladder. 88) D - Following ureterostomy, the stoma should be red and moist. A pale stoma may indicate an inadequate amount of vascular supply. A dry stoma may indicate a body fluid deficit. Any sign of darkness or duskiness in the stoma may indicate a loss of vascular supply and must be reported immediately or necrosis can occur. 89) B - Following mastectomy, the arm should be elevated above the level of the heart. Simple arm exercises should be encouraged. No blood pressure readings, injections, intravenous lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring. 90) D - Mammography takes about 15 to 30 minutes to complete. Some discomfort may be experienced because of the breast compression required to obtain a clear image. There is no reason to maintain an NPO status before the procedure. Option D is an accurate instruction.

86. The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common symptom of this type of cancer? a) dysuria b) hematuria c) urgency on urination d) frequency of urination 87. The nurse is caring for a client following intravesical instillation of an alkylating chemotherapeutic agent into the bladder for the treatment of bladder cancer. Following the instillation, the nurse should instruct the client to: a) urinate immediately b) maintain strict bed rest c) change position every 15 minutes d) retain the instillation fluid for 30 minutes

88. The nurse is assessing the stoma of a client following a ureterostomy. Which of the following should the nurse expect to note? a) a dry stoma b) a pale stoma c) a dark-colored stoma d) a red and moist stoma 89. The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? a) placing cool compresses on the affected arm b) elevating the affected arm on a pillow above heart level c) avoiding arm exercises in the immediate postoperative period d) maintaining an intravenous site below the antecubital area on the affected site 90. The nurse is preparing a client for a mammography. The nurse tells the client:

1. A nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which of the following is an early sign of this oncological emergency? a) cyanosis b) arm edema c) periorbital edema d) mental status changes

92. A nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which of the following is a serious late sign of this oncological emergency? a) headache b) dysphagia c) constipation d) electrocardiographic changes

hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave. 93) C - During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000 cells/mm3. Option C describes an incorrect statement by the client. Aspirin and nonsteroidal anti-inflammatory drugs and products that contain aspirin should be avoided because of their antiplatelet activity, thus further teaching is needed. Options A, B, and D are correct statements by the client to prevent and monitor bleeding. 94) A, B, D, F - Cancer is a common cause of syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. The syndrome is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are monitored closely because hypernatremia can develop suddenly as a result of treatment. The immediate institution of appropriate cancer therapy, usually radiation or chemotherapy, can cause tumor regression so that antidiuretic hormone synthesis and release processes return to normal. 95) A - The client demonstrates the best adaptation by participating in her own care. This would include care of surgical drains that would be in place for a short time after discharge. Asking for pain medication is also an action-oriented option, but it does not relate to acceptance of the loss of the breast. Reading the postoperative care booklet is useful, but is not the best of the options presented here. Refusing to look at the wound indicates no adaptation to the loss.

93. As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of the greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed when the client states: a) I should avoid blowing my nose b) I may need a platelet transfusion if my platelet count is too low c) I'm going to take aspirin for my headache as soon as I get home I will count the number of pads and tampons I use when menstruating 94. A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which of the following may be prescribed? Select all that apply a) radiation b) chemotherapy c) increased fluid intake d) serum sodium levels e) decreased oral sodium intake f) medication that is antagonistic to antidiuretic hormone 95. The client has undergone mastectomy. The nurse interprets that the client is making the best adjustment to the loss of the breast if which of the following behaviors is observed? a ) participating in the care of the surgical drain b) reading the postoperative care booklet c) refusing to look at the wound d) asking for pain medication when needed

91) C - Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens the client experiences edema of the hands and arms. Mental status changes and cyanosis are late signs.

96. The client is preparing for discharge from the hospital after radical vulvectomy. The nurse plans to teach this client that which of the following activities is acceptable after discharge because it will no precipitate complications? a) sexual activity b) walking c) sitting for lengthy periods d) driving a car 97. The nurse has admitted a client to the clinical nursing unit following a modified right radical mastectomy for the treatment of breast cancer. The nurse plans to place the right arm

92) D - Hypercalcemia is a late manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with

in which of the following positions? a) elevated above shoulder level b) elevated on a pillow c) level with the right atrium d) dependent to the right atrium 98. The nurse instructs the client in breast selfexamination (BSE). The nurse tells the client to lie down and to examine the left breast. The nurse instructs the client that while examining the left breast, she should place a pillow under the : a) right shoulder b) left shoulder c) small of the back d) right scapula 99. The nurse is teaching breast selfexamination (BSE) to a client who has had a hysterectomy. The appropriate instruction regarding when the BSE should be performed is: a) 7 to 10 days after menses b) just before menses begins c) at ovulation time d) at a specific day of the month and on that same day every month thereafter 100. The 32 y/o female client has a history of fibrocyctic disorder of the breasts. The nurse interviewing the client asks whether the breast lumps are more noticeable: a) in the spring months b) in the autumn c) after menses d) before menses 96) B - The client should resume activity slowly, but walking is a beneficial activity. The client should know to rest when fatigued. Activities to be avoided include driving, heavy housework, wearing tight clothing, crossing the legs, and prolonged standing or sitting. Sexual activity is prohibited for 4 to 6 weeks after surgery. 97) B - The clients operative arm should be positioned so that it is elevated on a pillow, and not exceeding shoulder elevation. This promotes optimal drainage from the limb, without impairing the circulation to the arm. If the arm is positioned flat (option C) or dependent (option D), this could increase the edema in the arm, which is contraindicated because of lymphatic disruption caused by surgery. 98) B - The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the left breast is to be examined, the pillow would be placed under the left shoulder. 99) D

- If the client has had a hysterectomy or is no longer menstruating, the breast selfexamination (BSE) should be performed on the same day every month. Options A and B are inappropriate because the client who had a hysterectomy would not be menstruating. It is best not to perform the BSE at ovulation time because of the hormonal changes that occur. 100) D - The nurse assesses the client with fibrocystic breast disorder for worsening of symptoms (breast lumps, painful breasts, and possible nipple discharge) before the onset of menses. This is associated with cyclical hormone changes. 101. The nurse is teaching the client who has had a laryngectomy for laryngeal cancer how to use an artificial larynx. The nurse tells the client to: a) insert the device into the tracheostomy b) hold the device alongside the neck c) hold the device over the upper 102. A client is scheduled for a Papanicolaou (Pap) smear at the next scheduled clinic visit. The nurse provides instructions to the client regarding preparation for this test. The nurse tells the client that: a) the test can be performed during menstruation b) fluids are restricted on the day of the test c) the test is painless d) vaginal douching is required 2 hours before the test

103. The client has been hospitalized for a cervical implant. The implant is removed and the nurse provides home care instructions to the client. Which statement made by the client indicates a need for further instructions? a) cream may be used to relieve dryness or itching b) foul-smelling vaginal discharge is a sign of an infection c) sexual intercourse may be resumed after 7 to 10 months d) some vaginal bleeding is expected for 1 to 3 months 104. The nurse teaches skin care to the client receiving external radiation therapy. Which of the following statements, if made by the client, would indicate the need for further instruction? a) I will handle the area gently b) I will avoid the use of deodorants c) I will limit sun exposure to 1 hour daily d) I will wear loose-fitting clothing 105. A community health nurse is preparing a poster for educational session for a group of women and will be discussing the risk factors associated with breast cancer. Select the risk factors for breast cancer that the nurse will list on the poster. Select all that apply.

a) family history of breast cancer b) early menarche c) early menopause d) previous cancer of the breast, uterus, or ovaries e) multiparity f) high-dose radiation exposure to chest

b) the dye injected may cause a warm, flushing sensation c) fluids will be restricted following the test d) the test takes approximately 2 hours

101) B - The artificial larynx is an electronic device that assists the client after laryngectomy to produce speech. There are two typesone is held at the side of the neck and the other is inserted into the mouth. The vibration produces a mechanical sounding speech that is monotone in quality but is intelligible. 102) C - A Pap smear is usually painless. The test cannot be performed during menstruation. The client needs to be instructed to avoid douching for at least 24 hours prior to the test. There is no reason to restrict fluids on the day of the test. 103) B - Foul-smelling vaginal discharge is expected and will occur for some time following removal of a cervical radiation implant. Options A, C and D are accurate discharge instructions. 104) C - The client needs to be instructed to avoid exposure to the sun. Options A, B, and D are accurate measures in the care of a client receiving external radiation therapy. 105) A, B, D, F - Risk factors for breast cancer include family history of breast cancer, age older than 40 years, early menarche, late menopause, or both, previous cancer of the breast, uterus, or ovaries, nulliparity or first child born after age 30 years, and high-dose radiation exposure to chest. 106. A nurse is preparing a list of home care instructions regarding stoma and laryngectomy care to a client who had a laryngectomy. Select all instructions that would be included in the list a) avoid swimming and use care when showering b) keep the humidity in the home low c) avoid exposure to people with infections d) restrict fluid intake e) obtain a Medic-Alert bracelet f) prevent debris from entering the stoma 107. A client suspected of having an abdominal tumor is scheduled for a computed tomography (CT) scan with dye injection. The nurse tells the client that: a) the test may be painful

108. A client with liver cancer receiving chemotherapy tells the nurse that some foods on the meal tray taste bitter. The nurse would try to limit which food that is most likely to cause this taste for the client? a) beef b) potatoes c) custard d) cantaloupe 109. The community health nurse is conducting a breast cancer screening clinic in a local neighborhood and is providing sessions regarding breast self-examination (BSE). A postmenopausal woman arrives at the clinic for information on BSE. Which of the following information should the nurse give the client? a) it is not necessary to do BSE because you are postmenpausal b) you are not at risk for breast cancer because you are in the postmenopausal phase c) you need to perform BSE on the same day of every month d) mammograms performed every 5 years are sufficient in the postmenopausal phase 110. A community health nurse who is conducting a teaching session about the risks of testicular cancer has reviewed a list of instructions regarding testicular selfexamination (TSE) with the clients attending the session. Which statement by a client indicates a need for further instructions? a) TSE is performed once a month b) TSE should be performed on the same day of each month c) the scrotum is held in one hand and the testicle is rolled between the thumb and forefinger of the other hand d) it is best to do TSE first thing in the morning before a bath or shower 106) A, C, E, F - The nurse would teach the client how to care for the stoma, depending on the type of laryngectomy performed. Most interventions focus on protection of the stoma and the prevention of infection. Interventions include to avoid swimming, use care when showering, avoid exposure to people with infections, prevent debris from entering the stoma, and obtain a Medic-Alert bracelet. Additional interventions include wearing a stoma guard or high-collared clothing to cover the stoma, increasing the humidity in the home, and increasing fluid intake to 3000 mL/day to keep

the secretions thin. 107) B - CT scanning causes no pain and can take 15 to 60 minutes to perform. The dye may cause a warm flushing sensation when injected. Fluids are encouraged following the procedure. If an iodine dye is used, the client should be asked about allergies to seafood or iodine. 108) A - Chemotherapy may cause distortion of taste. Often, beef and pork are reported to taste bitter or metallic. The nurse can promote client nutrition by helping the client choose alternative sources of protein in the diet. Options B, C, and D are not likely to cause distortion of taste. 109) C - Women who are in the postmenopausal phase are taught to do BSE on the same day of every month. Before menopause, woman should do the procedure 7 days after the start of the menstrual cycle when the breasts are less tender. Options A, B, and D are incorrect regarding breast cancer and BSE in a woman who is postmenopausal. 110) D - TSE is performed once a month and should be done on the same day of each month, as an aid to help the client remember to perform the exam. The scrotum is held in one hand and the testicle is rolled between the thumb and forefinger of the other hand. It is best to perform the exam during or after a warm shower or bath when the scrotum is most relaxed.