Name:_______________________________ Date: _______________________________

Section: _______________________________ Score:_________________________________

INSTRUCTION: Select the correct answer for each of the following questions. Mark only one answer for each item by shading the box corresponding to the letter of your choice on the answer sheet provided. STRICTLY NO ERASURES ALLOWED. Situation 1 (Questions 1-5) A 50 year old female is diagnosed with cervical cancer and is admitted in 3A ward for chemotherapy. 1. She asks the nurse if the chemotherapy will only affect the cancer cells in the body. Which of the following is the appropriate response by the nurse? a. The chemotherapy affects only the cancer cell. b. The chemotherapy affects both the normal as well as the cancer cells. c. It depends on the type of chemotherapy. d. The effect on cells is different in every client. RATIONALE: Chemotherapy drugs are effective in destroying cancer cells because they interfere directly or indirectly in with the synthesis or functions of nucleic acids. Chemotherapy also produce undesirable damage to the rapidly growing normal cells of the body such as hematologic suppression. Gastrointestinal tract lining inflammation and scalp hair loss. KEY AREA: SQC TAXONOMY: 2. A client asks the nurse what was meant when the physician stated, There has been a partial remission of the cancer. Which of the following is the appropriate response by the nurse? a. The cancer has regressed 50% or more. b. The cancer has progressed by 25%. c. The cancer has spread to lymph nodes. d. The cancer has disappeared. RATIONALE: The term remission is used by doctors to describe the shrinking of cancer. When a physician talks about the remission of cancer, he or she is referring to the category under which the extent of the shrinkage of the cancer has been placed. There are two types of remissions of the cancer, namely partial remission and complete remission. KEY AREA:SQC TAXONOMY: 3. The nurse evaluates chemotherapy to be most effective in which of the following clients? a. A client who is well nourished. b. A client who has had chemotherapy before. c. A 40-year-old male with lung cancer. d. A 30-year-old woman with breast cancer.

RATIONALE: Taken early, and as prescribed, chemotherapy has been shown to have a cure rate of 70% to 90% in low-risk choriocarcinoma, early Burkitt's lymphoma, stage II-III testicular cancer, childhood sarcomas and lymphomas. The more advanced your disease, the more difficult it becomes to treat your cancer. KEY AREA:SQC TAXONOMY: 4. Which of the following should the nurse consider before preparing to administer chemotherapy to a client? a. wears disposable gown, masks and gloves. b. wait for the chemotherapy to be prepared by the physician. c. do not assign a nurse who is pregnant to this client. d. prime the IV tubing with the chemotherapy agent.

Rationale: The doctor will give specific orders on drug preparation depending on the route of administration. Cytotoxic drugs are toxic compounds and are known to have carcinogenic, mutagenic and/or teratogenic potential. With direct contact they may cause irritation to the skin, eyes, and mucous membranes, and ulceration and necrosis of tissue. The toxicity of cytotoxic drugs dictates that the exposure of health-care personnel to these drugs should be minimized. At the same time, the requirement for maintenance of aseptic conditions must be satisfied. Pregnant nurses are not supposed to handle these kind of drugs. KEY AREA:SQC TAXONOMY: The nurse is planning to care for the adverse reactions in a client receiving chemotherapy. Which adverse reaction should take priority in this plan of care? a. Depression. b. Headache c. Fatigue. d. Rash. RATIONALE: The most common side effects of chemotherapy include fatigue, nausea and hair loss. KEY AREA:SQC TAXONOMY: Situation 2 (Questions 6-10) The client with bladder cancer is receiving Cisplatin (Platinol) and Vincristine (Oncovin). 6. The nurse preparing to give the medication understands that the purpose of administering both of these medications is to: a. prevent gastrointestinal side effects. b. prevent alopecia. c.decrease the destruction of cells. d. increase the therapeutic response. 5.

RATIONALE: The use of two or more drugs together often works better than a single drug for treating cancer. It achieves greater tumor kill thus, increases the therapeutic response. KEY AREA:SQC TAXONOMY:KNOWLEDGE Which of the following is a priority to include in this clients plan of care? a. monitor the BUN and creatinine. b. instruct the client to report tinnitus. c. maintain IV hydration. d. instruct the client to use a reliable method of birth control. RATIONALE: We know that some chemotherapy drugs affect women's ability to become pregnant. But because research in this area is limited, it is often difficult to give an individual woman an accurate idea of her chance of keeping her fertility. KEY AREA:SQC TAXONOMY:COMPREHENSION The client asks, Why will I lose my hair from chemotherapy? The appropriate response by the nurse is based on which of the following? a. It is difficult to predict. b. chemotherapy affects normal cell that divide often. c.all chemotherapy causes total alopecia. d.special shampoos can be used to prevent alopecia. RATIONALE: Most commonly, chemotherapy acts by killing cells that divide rapidly, one of the main properties of most cancer cells. This means that it also harms cells that divide rapidly under normal circumstances: cells in the bone marrow, digestive tract and hair follicles; this results in the most common side effects of chemotherapymyelosuppression (decreased production of blood cells), mucositis (inflammation of the lining of the digestive tract) and alopecia (hair loss). KEY AREA:COMMUNICATION TAXONOMY:COMPREHENSION The nurse is aware that the classification of Cisplatin (Platinol) is: a. Anti-neoplastic b. Antimetabolites c. Alkylating agent d. Antibiotics RATIONALE: Platinol is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "alkylating agent." KEYA AREA:SQC TAXONOMY:KNOWLEDGE 10. Which of the following is the priority nursing action when a client states, My IV sites hurts! during chemotherapy administration? a. reposition the needle. b. notify the physician. c. stop the infusion. d. apply a cold pack to the IV site. RATIONALE: In mild cases, extravasation can cause pain, reddening, or irritation on the arm with the infusion needle. In case it occurs, stop the infusion immediately then notify the physician. Cold or warm pack may be applied but only after you have stopped the infusion. Do not reposition the needle. KEY AREA: SQC TAXONOMY: APPLICATION Situation 3: (Questions 11-15) The client is hospitalized for insertion of an internal cervical radiation implant. She was diagnosed with cervical cancer 11. 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. Pick up the implant with gloved hands and flush it down the toilet. c. Reinsert the implant into the vagina immediately. d. Pick up the implant with long handled forceps and place it in a lead container. RATIONALE: In implant therapy, a sealed source of radioactive material is placed in a body cavity close to the tumor and left in place for a prescribed period of time. In the event a source becomes dislodged, do not touch it even w/ gloved hands. Pick up the implant with long handled forceps and place in a lead container and notify the Radiation Oncology resident on call immediately. Do not permit others to enter the room until the source is secured. KEY AREA: SQC TAXONOMY:APPLICATION 12. The nurse understands that the most common cause of cervical cancer is: a. Human Herpes Virus 4 (HHV4) b. Human Papilloma Virus (HPV) c. HIV d. Herpes Simplex RATIONALE: Human papillomavirus, or HPV for short, is the current leading cause of cervical. HPV has nothing to do with HIV and HHV4. Herpes simplex is a viral disease. KEY AREA:SQC TAXONOMY: KNOWLEDGE 13. When caring for the client, the nurse should observe which of the following principles? a. Limit the time with the client to 2 hours per shift. 9. 8. 7.

b. c. d.

Do not allow pregnant women into the client's room. Individuals less than 16 years old may be allowed to go in the room as long as they are 6 feet away from the client. Remove dosimeter badge when entering the client's room.

RATIONALE: While the implant is in place, women who are pregnant and children younger than 18 should not visit. Other visitors should sit at least 6 feet from the patients bed and limit their stay to 30 minutes or fewer each day. Wear dosimeter badge when entering the clients room. KEY AREA: SQC TAXONOMY: APPLICATION 14. The 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. Out of the bed in chair only. b. Ambulate to the bathroom only. c. Bedrest. d. Out of the bed ad lib. RATIONALE: Complete bedrest without bathroom priviledge should be ordered to patient undergoing internal radiation to prevent dislodge of the implant. KAY AREA: SQC TAXONOMY: APPLICATION 15. During the visit, the client express that if I can just live long enough to attend my daughters graduation, Ill be ready to die. Which phase of coping is this client experiencing? a. Denial b. Bargaining c. Depression d. Anger. RATIONALE: Bargaining often takes place before the loss. Attempting to make deals with the spouse who is leaving, or attempting to make deals with God to stop or change the loss. KEY AREA:COMMUNICATION TAXONOMY:ANALYSIS Situation 4: Questions 16-20 The nurse in the oncology ward is having her morning rounds. 16. A clients family asks the nurse, Why cant the chemotherapy be given once instead of in multiple cycles? The nurse response is based on which of the following? a. certain chemotherapy works best during certain phases of the cell cycle. b. No one could tolerate the entire dose in one administration. c. chemotherapy is only covered by insurance if given in small doses. d. most clients prefer several doses over one dose. RATIONALE: In order to achieve and maintain the optimal level of a given cancer drug in patients' bloodstream. Also, chemotherapy agents work best during certain phases of life cycle. KEY AREA: SQC TAXONOMY:APPLICATION 17. The client asks, Why do I need to receive all these chemotherapy medicines on the same day? The nurses response is based on the understanding that chemotherapy given in combination: a. is the only way it will be paid for by insurance. b. achieves the greatest tumor cell kill. c. shortens the length of administration. e. decreases the chance of allergic reaction. RATIONALE: The use of two or more drugs together often works better than a single drug for treating cancer. It achieves greater tumor kill thus, increases the therapeutic response. KEY AREA: SQC TAXONOMY: COMPREHENSION 18. Her third patient is diagnosed as having a bowel tumor. Several diagnostic tests are prescribed. The nurse understands that which of the following tests will confirm the diagnosis of malignancy? a. Computerized tomography scan b. Abdominal ultrasound c. Magnetic resonance imaging d. Biopsy of the tumor RATIONALE: A biopsy is a medical test involving the removal of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or absence of malignancies. The other tests mentioned are designed to view the image internal structures of the body. KEY AREA: SQC TAXONOMY: KNOWLEDGE 19. The nurse is monitoring the laboratory results of a patient preparing to receive chemotherapy. The nurse would determine that the white blood cell count is normal if which of the following results were present? a. 3000-8000 cells/mm b. 5000-10,000 cells/mm c. 7000-15000 cells/mm d. 2000-5000 cells/mm

RATIONALE: The normal range for WBC count is 4,300 to 10,800 cells per cubic millimeter (cmm) or 4.3 to 10.8 x 109 cells per liter. A range of 11 to 17 x 109/L may be considered mild to moderate leukocytosis, and a range of 3.0 to 5.0x10 9/L may be considered mild leukopenia. KEY AREA: SQC TAXONOMY: ANALYSIS 20. One of the patients develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing care plan of care? a. Ambulation 3 times daily b. Monitoring temperature c. Monitoring the platelet count d. Monitoring the pathological fractures RATIONALE: Thrombocytes are cells that play a key role in blood clotting. In mammals, thrombocytes are anucleated cell fragments called platelets. KEY AREA: TAXONOMY: Situation 5: Questions 21-25 The nurse is admitting a client with lung cancer to the nursing unit. 21. The nurse assesses for which most common risk factor for this type of cancer? a. Use of chewing tobacco. b. Cigarette smoking. c. Urban living. d. Alcohol abuse. RATIONALE: The most common cause of lung cancer is long-term exposure to tobacco smoke. The occurrence of lung cancer in nonsmokers, who account for as many as 15% of cases, [5] is often attributed to a combination of genetic factors, radon gas, asbestos, and air pollution including secondhand smoke. KEY AREA: SQC TAXONOMY:KNOWLEDGE 22. The nurse is preparing a client for surgery and notices that the client looks sad. The client says, I am scared of having cancer. Its so horrible and I brought it on myself. I should have quit smoking years ago. What would be the nurses best response to the client? a. Its okay to be scared. What is it about cancer that youre afraid of? b. Its normal to be scared. I would be, too. Well help you through it. c. Dont be so hard on yourself. You dont know if your smoking caused the cancer. d. Do you feel guilty because you smoked? RATIONALE: When dealing with patients emotions, communicate in an honest, open, clear and straightforward manner. Encourage verbalization of feeling. Options B, C&D are incorrect. KEY AREA: COMMUNICATION TAXONOMY: COMPREHENSION 23. The patient underwent a left lower lobectomy. He has been out of surgery for 48 hours. She is receiving morphine sulfate via a patient-controlled analgesia (PCA) system. She complains of moderately severe pain in her left thorax that worsens when she coughs. The nurse should: a. let the client rest, so that she is not stimulated to cough. b. encourage the client to take deep breaths to help control the pain. c. check the PCA device is functioning properly, and then reassure the client that the machine is working and will relieve her pain. d. Assess the pain systematically with the hospital approved scale. RATIONALE: Assessment should be done initially before any intervention would take place. Options A&B are interventions; C is incorrect assess the patient first before the machine KEY AREA: SQC TAXONOMY:APPLICATION 24.The client asks, Why do I need to receive all these chemotherapy medicines on the same day? The nurses response is based on the understanding that chemotherapy given in combination: a. is the only way it will be paid for by insurance. b. achieves the greatest tumor cell kill. c. shortens the length of administration. f. decreases the chance of allergic reaction. RATIONALE: The use of two or more drugs together often works better than a single drug for treating cancer. It achieves greater tumor kill thus, increases the therapeutic response. KEY AREA:SQC TAXONOMY: ANALYSIS 25. Which of the following would be a major intervention to help prevent lung cancer? a. Encourage cigarette smokers to have yearly chest radiographs. b. Instruct people about techniques for smoking cessation. c. Recommend that people have their houses and apartments checked for asbestos leakage. d. Encourage people to install central air cleaners in their homes. RATIONALE: Prevention is the most cost-effective means of fighting lung cancer. While in most countries industrial and domestic carcinogens has been identified and banned, tobacco smoking is still widespread. Eliminating tobacco smoking is a primary goal in the prevention of lung cancer, and smoking cessation is an important preventive tool in this process. KEY AREA: SQC TAXONOMY: ANALYSIS

Situation 6: Questions 26-30 The BSN 4 students just finished their lecture class on Oncologic Nursing. They are getting ready for their exposure at oncology ward the following week. The students understand that 26. The students understand that the nursing intervention to patients receiving chemotherapy is a. instructing the client to use a straight razor only when shaving and to self administer IM injections with with an 18-gauge needle b. instructing the client to avoid cuts, bruises and trauma to inspect the skin for bruises and petechiae c. instructing the client to report any skin burns and to apply lotion to burned areas d. instructing the client not to remove marks placed on the skin by the radiation therapist and to increase fluid intake during therapy RATIONALE: Chemotherapy can cause hematopoietic dysfunction. Patients should be taught how to minimize skin breakdown. Needle pricks must be avoided. Applying lotion or powder to burned areas is contraindicated. Option D talks about radiation therapy. KEY AREAS: COMMUNICATION TAXONOMY:APPLICATION 27. Student nurse Paolo was asked about the difference between Hodgkins Lymphoma with other types of lymphomas. His best response would be a. A massive proliferation of leukocytes in the bone marrow. b. Presence of Reed-Sternberg cells. c. An altered DNA molecular structure. d. Crowding out of normal bone marrow cells. RATIONALE: Reed-Sternberg cell is a pathognomonic sign at the same time differentiated the Hodgkins Lymphoma from other lymphomas. Options A & D are definition of leukemia disease. KEY AREAS:SQC TAXONOMY:COMPREHENSION 28. A 32 year old lady secretary asks student nurse Belinda, What can I do to make sure I dont get breast cancer like my mother and my sister? SN Belindas best reply would be: a. b. c. d. There is nothing you can do to make sure that you dont get breast cancer because of family history of cancer. You can detect cancer early by doing self-breast exams monthly and having a mammogram every year. You can detect cancer early by doing self-breast exams monthly and having a mammogram every 3 months. You can detect cancer early by doing self-breast exams monthly, a mammogram every 6 years.

RATIONALE: The goal of screening exams for early breast cancer detection is to find cancers before they start to cause symptoms. Early detection means using an approach that allows earlier diagnosis of breast cancer than otherwise might have occurred especially if genetic factor is highly suggestive. Breast self exam should be done every month after menstruation and a mammogram every year. KEY AREA: COMMUNICATION TAXONOMY: APPLICATION 29. The students are aware that secondary cancer prevention means a. Eating high fiber, low fat diet b. detection and screening efforts to achieve early diagnosis and prompt intervention c. prevention of genetic cancer inheritance d. avoiding smoking and sun exposure RATIONALE: Secondary prevention is that set of interventions leading to the discovery and control of cancerous or precancerous processes while localized, i.e., screening, early detection, and effective treatment. A&D options are primary cancer prevention. C option is incorrect. KEY AREA: SQC TAXONOMY:COMPREHENSION 30. A patient with history of cancer asks the student nurse about the risk of eating high fat diets for several cancers. To allay anxiety of the patient, the student nurse appropriately answers that such eating habit puts the patient at risk of cancer involving: a. Ovarian b. Lung c. Colon d. Liver RATIONALE: High in fat, low in fiber diet contributes to colonic cancer, though biggest risk factor is age above 40; (A) usually caused by genetic & hormones; (B) cigarette smoking can cause lung cancer; (D) chronic alcoholism and viral infection cause liver CA. KEY AREA:SQC TAXONOMY:COMPREHENSION Situation 7: Questions 31-35 You are the nurse in the clinic and is often asked about the prevention, screening and treatment of breast cancer. 31. A 20 year old G2P2 who breastfeeds her two months old baby worries that an indistinct, smooth, movable, painful 2 x 1 cm mass in her left breast is cancer. No lymph nodes are palpable. You should: a. Tell her not to worry and reassure her it is not cancer b. Refer to oncologist c. Reassure her that cancer is unlikely but repeat breast examination after 1 month d. Suggest to her to consult a surgeon to do excision biopsy. RATIONALE: A biopsy is a medical test involving the removal of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease; Options A & C are giving false reassurance to the patient; (B) referral to oncologist is done after the biopsy result. KEY AREA: SQC TAXONOMY: COMPREHENSION

32. Cancer is a name for a large group of diseases all of which are characterized by: a. cells that multiply rapidly, invading and destroying normal tissues b. death in a high percentage of cases c. a course of treatment lasting 4 5 years d. production of a toxin that causes a spread of abnormal tissues RATIONALE: Best option is A KEY AREA:SQC TAXONOMY:KNOWLEDGE 33. A 45 year old client weighing 66 kilograms approached you asking you about the significance of diet in the prevention of CA. The best response of the nurse would be: a. Dietary regimen does not play an important factor in developing CA b. Incidence of CA decreases to those who practice weight control and reduces intake of fats. c. Increasing consumption of high caloric intake does not affect its development. d. Age and weight is not a significant factor in the development of CA. RATIONALE: Proper diet and age are significant in cancer prevention and control. KEY AREA: COMMUNICATION TAXONOMY:COMPREHENSION 34. During the initial stage of adaptation to cancer and its treatment, the nurse can facilitate the clients adaptation by: a. Encouraging the client to maintain her usual role b. Facilitating family-related disagreements and conflicts c. Supporting the client in her use of denial as a coping strategy d. Arranging transportation and child care on treatment days RATIONALE: There are five stages of grief. If we get stuck in one stage or the other, the process of grieving is not complete, and cannot be complete. Thus there will be no healing. A person MUST go through the five stages to be well again, to heal. Denial is the initial stage in grieving process. Options A, B & D are not signs of person in denial. KEY AREA: SQC TAXONOMY: APPLICATION 35. While being educated by the nurse about how to perform breast self exam, a client asks the nurse what the rationale is for moving her arms in different positions while standing in front of a mirror. The nurse explains that these positions are used to: a. Increase the examiners comfort during the procedure b. Easily diagnose any masses c. Determine whether there is any nipple discharge with movement d. Emphasize any change in shape or contour of the breast RATIONALE: Several positions such as putting hand on the hip & then again w/ arms held overhead is designed to emphasize any change in the shape or contour of the breast. Chest muscles should tighten when doing this procedure. KEY AREA: SQC TAXONOMY: COMPREHENSION Situation 8: Questions 36-40 The nurse is caring for a client with experiencing hematologic toxicity as a result of chemotherapy. 36. The nurse develops a plan of care for the client. The nurse plans to: a. Restrict all visitors. b. Restrict fluid intake. c. Insert an indwelling urinary catheter to prevent skin breakdown. d. Restrict fresh fruits and vegetables in the diet RATIONALE: Chemotherapy side effect may cause hematopoietic dysfunction such as leukocytosis, anemia and thrombocytopenia. Fresh fruits and vegetables should be avoided in the diet because these may contain bacteria. Option C is wrong since any invasive procedures must be avoided for risk of bleeding. Option (A) is incorrect the patient may limit visitors. KEY AREA: SQC TAXONOMY: APPLICATION 37. An appropriate nursing intervention for a patient experiencing fatigue due to cancer treatment includes teaching the client to: a. Increase fluid intake b. Minimize naps or periods of rest during the day c. Conserve energy by prioritizing activities d. Limit dietary intake of high-fiber food RATIONALE: Devise a plan for how to accomplish certain tasks. Plan for all that needs to be done. Prioritize the list and what needs to be done first. Pace yourself as you go through your prioritized list. Options A, B & D are incorrect. KEY AREA: SQC TAXONOMY: COMPREHENSION 38. Clients who are newly diagnosed with cancer have many fears and concerns. Which of the following issue is of primary concern? a. Ability to perform in usual roles b. Cost of treatments c. Prognosis d. Pain RATIONALE: Cancer is quite common throughout the world. Many people each day have to grapple with the unwanted news of cancer particularly the prognosis. Nurses should focus on the patients reaction to her/his prognosis and should include in the plan of care. Options A, B & D are correct but not the primary concern. KEY AREA: SQC TAXONOMY: COMPREHENSION

39. A client is experiencing low WBC. The nurse should teach the client to avoid contact with which of the following family members? a. 34 year old nephew with fracture b. 68 year old husband with a history of exposure to TB as youth c. 9 year old grandchild with a recent exposure to chicken pox d. 31 year old daughter who is 6 mos. pregnant RATIONALE: Low WBC makes the patient immuno-compromised thus, susceptible to infection. The patient should avoid people who are contagious, like option C. Options A & D are not contagious; Option (C) not contagious anymore. KEY AREA: SQC TAXONOMY: COMPREHENSION 40. The nurse clearly understands thrombocytopenia when he states to the client that a. You should gargle with Listerine daily b. You need to gargle with weak salt and bicarbonate mouth rinse c. When you brush your teeth, you should brush vigorously and use a hard bristled toothbrush d. You should eat foods low in protein and drink only cold beverages not to cause pain. RATIONALE: Thrombocytopenia makes the patient susceptible to bleeding. (C) Brushing vigorously w/ hard bristled toothbrush might cause the gum to bleed. (A) & (D) are incorrect. Alcohol-based mouthwash and extreme hot & cold beverages should be avoided to prevent erosion of the oral mucosa which can lead to bleeding. KEY AREA: SQC TAXONOMY: COMPREHENSION Situation 9: Questions 41-50 General knowledge on oncology nursing 41. In assessing a very young pregnant woman, you are about to begin taking the clients health and sexual history. Utilizing proper communication techniques, one of the following is the appropriate statement to start the interview. a. Maam I hope you will not get offended but I have to ask you some personal sensitive questions. b. Maam, you have to answer the following questions honestly for us to be able to determine your problem. c. Maam the following questions are routinely asked from all patients for purposes of assessment. d. Maam please dont be ashamed to reveal your personal sexual practices. RATIONALE: When dealing with patients personal life, communicate in an honest, open, clear and straightforward manner to avoid embarrassment in the case of the patient. KEY AREA: COMMUNICATION TAXONOMY: APPLICATION 42. The nurse is instructing the client to perform a testicular 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 a growth. d. The testicular examination should be done at least every 6 months. RATIONALE: It's best to do a TSE during or right after a hot shower or bath. The scrotum (skin that covers the testicles) is most relaxed then, which makes it easier to examine the testicles. KEY AREA: SQC TAXONOMY: COMPREHENSION 43. The client reports to the nurse that when performing testicular self-examination, he found a lump the size and shape of a pea. The most appropriate response to the client is which of the following? a. Thats important to report even though it might not be serious. b. That could be cancer. Ill ask the doctor to examine you. c. Let me know if it gets bigger next month. d. Lumps like that are normal, dont worry. RATIONALE: Lumps or swelling may not be cancer, but they should be checked by your doctor as soon as possible. Testicular cancer is almost always curable if it is caught and treated early. KEY AREA: COMMUNICATION TAXONOMY: APPLICATION 44. A client is diagnosed with multiple myeloma. The client asks the nurse about the diagnosis. The nurse bases the response on which of the following descriptions of this disorder? a. Malignant exacerbation in the number of leukocytes. b. Altered red blood cell production. c. Altered production of lymph nodes. d. Malignant proliferation of plasma cells and tumors within the bone.

RATIONALE: Multiple myeloma is a type of cancer. Cancer is a group of many related diseases. Myeloma is a cancer that starts in plasma cells, a type of white blood cell. It's the most common type of plasma cell cancer.Most blood cells develop from cells in the bone marrow called stem cells. Bone marrow is the soft material in the center of most bones; Options A & B- leukemia; option C lymphoma KEY AREA: SQC TAXONOMY:COMPREHENSION 45. The client is admitted to the hospital with a suspected diagnosis of Hodgkins disease. Which of the following assessment signs would the nurse expect to note specifically in the client? a. Weakness. b. Fatigue. c. Weight gain. d. Enlarged lymph node.

RATIONALE: Because Hodgkin's disease does not cause pain during the initial stages, it can be difficult for patients to notice and doctors to diagnose. Since this disease affects the lymphatic system, one of the first major signs of this disease is that lymph nodes start to enlarge and become noticeable in the neck and underarm. Options A & B is not major clinical manifistattion of HD; (C) is incorrect, weight loss is a sign of cancer . KEY AREA:SQC TAXONOMY:KNOWLEDGE 46. After a thoracotomy, clients should be instructed to perform deep-breathing exercises for which of the following reasons? a. Deep breathing elevates the diaphragm. b. Deep breathing increases blood flow to the lungs. c. Deep breathing controls the rate of airflow to prevent hyperinflated lungs. d. Deep breathing expands the alveoli and increases the lung surface available for ventilation. RATIONALE: Deep breathing exercise to post operative clients promotes expansion of the alveoli and prevents post op complications such as atelectasis. KEY AREA: SQC TAXONOMY: COMPREHENSION 47. A woman reports all of the following data when giving her history to a nurse. Which one would indicate a risk factor for developing cancer of the cervix? a. Diet high in fat b. Exposure to pesticides c. Menses at age eleven d. Multiple sexual partners RATIONALE: One of the causes of cervical cancer is promiscuity or having multiple sexual partners. Option A may cause colon/colorectal CA; Option B lung cancer; Option C menarch at age 11 is normal and has nothing to do with cervical cancer. KEY AREA: SQC TAXONOMY: KNOWLEDGE 48. A client receiving intravenous chemotherapy is experiencing nausea. Which of the following would be the best intervention to lessen the severity of nausea? a. administer anti emetics when client complain of nausea b. offer warm liquid during chemotherapy c. administer anti emetics before chemotherapy d. encourage client to eat a full meal before receiving chemotherapy RATIONALE: Giving of anti emetics before chemotherapy to prevent nausea and vomiting. Common medications include Zofran, Anzemet, Kytril and Aloxi. KEY AREA: SQC TAXONOMY: APPLICATION 49. A woman loses most of her hair as a result of cancer chemotherapy. The nurse understands that which of the following is true about chemotherapy induce alopecia? a. New hair will be gray. b. She can use of wigs after 2 days c. The hair loss is temporary. d. Pre-chemo hair texture will return. RATIONALE: Chemotherapy often causes hair loss otherwise known as Alopecia. This is because the cells in the hair follicles grow fast and chemotherapy damages fast growing cells. Hair loss is not permanent and it will grow back once your treatment has ended. KEY AREA: SQC TAXONOMY: COMPREHENSION 50. The client is suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse provides which pre-procedure instructions to the client? a. Maintain an NPO status before the procedure. b. Eat a light breakfast only. c. Drink six to eight glasses of water without voiding before the test. d. Wear a comfortable clothing and shoes for the procedure. RATIONALE: Before undergoing a pelvic ultrasound, the patient may be asked to drink several glasses of water and to avoid urinating for about one hour prior to exam time. When the bladder is full, it forms a convenient path, called an acoustic window, for the ultrasonic waves. (a) NPO prior to the procedure is not necessary; (B) regular diet is allowed; (D) only the abdomen is exposed during the procedure. KEY AREA: SQC TAXONOMY: APPLICATION Good Luck!!!