F.L.

VARGAS COLLEGE College of Health Sciences Bagay Road, Caritan Centro Tuguegarao City, 3500 Telephone Number: (078)844-6368

MIDTERM EXAM NCM 106

1. A male client has an abnormal result on a Papanicolaou test. After admitting, he read his chart while the nurse was out of the room, the client asks what dysplasia means. Which definition should the nurse provide? a. Presence of completely undifferentiated tumor cells that dont resemble cells of the tissues of their origin b. Increase in the number of normal cells in a normal arrangement in a tissue or an organ c. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isnt found d. Alteration in the size, shape, and organization of differentiated cells 2. For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client? a. Client verbalizes feelings of anxiety. b. Client doesnt guess at prognosis. c. Client uses any effective method to reduce tension. d. Client stops seeking information.

3. Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by: a. breast self-examination. c. fine needle aspiration. b. mammography. d. chest X-ray. 4. A male client undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to care for the neck stoma, the nurse should include which instruction? a. Keep the stoma uncovered. stoma care initially until you get used b. Keep the stoma dry. to the procedure. c. Have a family member perform d. Keep the stoma moist. 5. A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy?

a. Urine output of 400 ml in 8 hours mm Hg b. Serum potassium level of 3.6 mEq/L d. Dry oral mucous membranes and c. Blood pressure of 120/64 to 130/72 cracked lips 6. Nurse April is teaching a group of women to perform breast self-examination. The nurse should explain that the purpose of performing the examination is to discover: a. cancerous lumps. examinations. b. areas of thickness or fullness. d. fibrocystic masses. c. changes from previous self7. The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? a. Duodenal ulcers b. Hemorrhoids 8. A male client with a nagging cough makes after reading that this symptom is one of the another warning sign of cancer? c. Weight gain d. Polyps an appointment to see the physician seven warning signs of cancer. What is

a. Persistent nausea c. Indigestion b. Rash d. Chronic ache or pain 9. A 35 years old client with ovarian cancer is prescribed hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with: a. cell division or mitosis during the M phase of the cell cycle. b. normal cellular processes during the S phase of the cell cycle. c. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cyclenonspecific). d. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cyclenonspecific). 10. During chemotherapy, an oncology client has a nursing diagnosis of impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis? a. Recommending that the client c. Monitoring the clients platelet and discontinue chemotherapy leukocyte counts b. Providing a solution of hydrogen d. Checking regularly for signs and peroxide and water for use as a mouth symptoms of stomatitis rinse 11. A female client with cancer is being evaluated for possible metastasis. Which of the following is one of the most common metastasis sites for cancer cells? a. Liver b. Colon c. Reproductive tract d. White blood cells (WBCs)

12. Warning signs and symptoms of lung cancer include persistent cough, bloody sputum, dyspnea, and which of the other following symptoms?

a. Dizziness b. Generalized weakness

c. Hypotension d. Recurrent pleural effusion

13. Which of the following interventions is the key to increasing the survival rates of clients with lung cancer? a. Early bronchoscopy b. Early detection c. High-dose chemotherapy d. Smoking cessation

14. A client has been diagnosed with lung cancer and requires a wedge resection. How much of the lung is removed? a. One entire lung b. A lobe of the lung c. A small, localized area near the surface of the lung. d. A segment of the lung, including a bronchiole and its alveoli. 15. Nausea and vomiting are common adverse effects of radiation and chemotherapy. When should a nurse administer antiemetics? a. 30 minutes before the initiation of therapy. b. With the administration of therapy. c. Immediately after nausea begins. d. When therapy is completed

16. 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. b. The best time for the examination is after a shower c. To gently feel the testicle with one finger to feel for a growth d. That testicular examination should be done at least every 6 months

17. The nurse is caring for a client following a modified radical mastectomy. Which assessment finding would indicate that the client is experiencing a complication related to this surgery? a. Sanguineous drainage in the Jackson-Pratt drain b. Pain at the incisional site c. Complaints of decreased sensation near the operative site d. Arm edema on the operative side

18. The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing assessment is which of the following? a. Assess level of consciousness b. Assess temperature c. Assess bowel sounds d. Assess skin turgor 19. The nurse is caring for a client following a modified radical mastectomy. Which assessment finding would indicate that the client is experiencing a complication related to this surgery? a. Sanguineous drainage in the Jackson-Pratt drain b. Pain at the incisional site c. Complaints of decreased sensation near the operative site d. Arm edema on the operative side 20. A nurse is providing education in a community setting about general measures to avoid excessive sun exposure. Which of the following recommendations is appropriate? a. Apply sunscreen only after going in the water. b. Avoid peak exposure hours from 9am to 1pm c. Wear loosely woven clothing for added ventilation d. Apply sunscreen with a sun protection factor (SPF) of 15 or more before sun exposure.

21. The nurse is teaching a 17-year old client and the clients family about what to expect with high-dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client? a. Fever b. Chills c. Tachycardia d. Dyspnea

22. A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following? a. Chemotherapy affects all rapidly dividing cells. b. The molecular structure of the DNA is altered. c. Cancer cells are susceptible to drug toxins. d. Chemotherapy encourages cancer cells to divide.

23. A client with stomach cancer is admitted to the oncology unit after vomiting for 3 days. Physical assessment findings include irregular pulse, muscle twitching, and complaints of prickling sensations in the fingers and hands. Laboratory results include a potassium level of 2.9 mEq/L, a pH of 7.46, and a bicarbonate level of 29 mEq/L. The client is experiencing: a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic alkalosis d. Metabolic acidosis

24. A 32-year-old woman meets with the nurse on her first office visit since undergoing a left mastectomy. When asked how she is doing, the woman states her appetite is still not good, she is not getting much sleep because she doesnt go to bed until her husband is asleep, and she is really anxious to get back to work. Which of the following nursing interventions should the nurse explore to support the clients current needs? a. Call the physician to discuss allowing the client to return to work earlier. b. Suggest that the client learn relaxation techniques to help with her insomnia c. Perform a nutritional assessment to assess for anorexia d. Ask open-ended questions about sexuality issues related to her mastectomy

25. A pneumonectomy is a surgical procedure sometimes indicated for treatment of non-small-cell lung cancer. A pneumonectomy involves removal of: a. An entire lung field b. A small, wedge-shaped lung surface c. One lobe of a lung d. One or more segments of a lung lobe

26. Which of the following represents the most appropriate nursing intervention for a client with pruritis caused by cancer or the treatments? a. Administration of antihistamines b. Steroids c. Silk sheets d. Medicated cool baths

27. Which set of classification values indicates the most extensive and progressed cancer? a. T1 N0 M0 b. Tis N0 M0 c. T1 N1 M0 d. T4 N3 M1

28. What do you tell patients is the most important risk factor for lung cancer when you are teaching about lung cancer prevention?

a. Cigarette smoking b. Exposure environmental/occupational carcinogens to

c. Exposure to environmental tobacco smoke (ETS) d. Pipe or cigar smoking

29. Nina, an oncology nurse educator is speaking to a womens group about breast cancer. Questions and comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the audience have made all of the following statements. Which one is accurate? a. Mammography is the most reliable c. Breast cancer requires a method for detecting breast cancer. mastectomy. b. Breast cancer is the leading killer of d. Men can develop breast cancer. women of childbearing age. 30. Nurse Meredith is instructing a premenopausal woman about breast selfexamination. The nurse should tell the client to do her self-examination: a. at the end of her menstrual cycle. cycle. b. on the same day each month. d. immediately after her menstrual c. on the 1st day of the menstrual period. 31. A male client is receiving the cell cyclenonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of a chemotherapeutic regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects? a. It interferes with deoxyribonucleic c. It interferes with DNA replication acid (DNA) replication only. and RNA transcription. b. It interferes with ribonucleic acid d. It destroys the cell membrane, (RNA) transcription only. causing lysis. 32. A female client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care? a. Monitoring temperature c. Monitoring the platelet count b. Ambulation three times daily d. Monitoring for pathological fractures 33. Nurse Joy is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles? a. Limit the time with the client to 1 entering the clients room hour per shift d. Individuals younger than 16 years b. Do not allow pregnant women into old may be allowed to go in the room the clients room as long as they are 6 feet away from c. Remove the dosimeter badge when the client 34. A cervical radiation implant is placed in the client for treatment of cervical cancer. The nurse initiates what most appropriate activity order for this client? a. Bed rest b. Out of bed ad lib c. Out of bed in a chair only d. Ambulation to the bathroom only

35. A female client is hospitalized for insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. The initial action by the nurse is to: a. Call the physician hands and flush it down the toilet b. Reinsert the implant into the vagina d. Pick up the implant with longimmediately handled forceps and place it in a lead c. Pick up the implant with gloved container 36. The nurse is caring for a female client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plans to: a. Restrict all visitors the need for hand hygiene b. Restrict fluid intake d. Insert an indwelling urinary catheter c. Teach the client and family about to prevent skin breakdown 37. The home health care nurse is caring for a male client with cancer and the client is complaining of acute pain. The appropriate nursing assessment of the clients pain would include which of the following? a. The clients pain rating clients pain b. Nonverbal cues from the client d. Pain relief after appropriate nursing c. The nurses impression of the intervention 38. The female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing: a. Rupture of the bladder b. The development of a vesicovaginal fistula c. Extreme stress caused by the diagnosis of cancer d. Altered perineal sensation as a side effect of radiation therapy Aling Nena is a 60 year old woman with a malignant tumor of the breast, who was admitted for modified radical mastectomy. 39. 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? 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 40. 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

41. 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

42. 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

43. 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

44. 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

45. 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? 46. 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?

47. 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 47. 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 48. 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 49. 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 50. 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 51. 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 52. 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 53. 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 54. How often should a female who is above 40 years old, go for cancer detection examination? a) daily b) weekly c) monthly d) yearly 55. 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 56. 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

57. 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 58. 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 59. 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 60. The client is undergoing radiation therapy 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 61. 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

A female client with breast cancer is currently receiving radiation therapy for treatment. The client is complaining of apathy, hard to concentrate on something, and feeling tired despite of having time to rest and more sleep. These complain suggest symptoms of a. Hypocalcemia b. radiation pneumonitis c. advanced breast cancer d. fatigue A chemotherapeutic agent 5FU is ordered as an adjunct measure to surgery. Which of the ff. statements about chemotherapy is true? a. it is a local treatment affecting only tumor cells b. it affects both normal and tumor cells c. it has been proven as a complete cure for cancer d. it is often used as a palliative measure. A client is being evaluated for cancer of the colon. In preparing the client for barium enema, the nurse should: a. Give laxative the night before and a cleansing enema in the morning before the test b. Render an oil retention enema and give laxative the night before c. Instruct the client to swallow 6 radiopaque tablets the evening before the study d. Place the client on CBR a day before the study The client has a good understanding of the means to reduce the chances of colon cancer when he states: a. I will exercise daily. b. I will include more red meat in my diet. c. I will have an annual chest x-ray. d. I will include more fresh fruits and vegetables in my diet.