500 Oncology Nursing Answers And Rationale
imbalance of humoral elements, an obstruction of chi, a
1. D - Dyspnea, although a subjective observation, is a
general indication of inadequate respiration
2. D - Respiratory rate, oxygen saturation, and arterial
blood gas levels neither correlate with nor measure
dyspnea . The only reliable indicator of dyspnea in clinical
practice is patient self-support.
3. C - The success of a coping strategy is determined by its
outcome or intended outcome. The behaviour of denial
is value neutral, meaning that it is not inherently
adaptive or maladaptive.
4. C Loss and grief in the care of the cancer patient is
concerned with how to help patients die well. To do this
they must be aware of their losses first and then
embrace the impact of these losses in their life.
5. A The diagnosis of anxiety in healthy person is made
based on somatic symptoms, including anorexia, fatigue
and weight loss, which in cancer are often symptoms of
the disease itself and its treatment. The symptoms of
worry distract ability, restlessness, and fearfulness are
more important for diagnosing anxiety among cancer
patients.
6. B There is a wide range in estimate in prevalence for
anxiety in the cancer population. However, when
standardized psychiatric interviews and research
diagnostic criteria are used, the range is more typically
10-30%.
7. D TURP commonly causes erectile dysfunction(ED) in
50% of patients. Although radical prostatectomy has
been associated with a 90% risk of ED, nerve-sparing
radical prostatectomy has been reported to carry a risk
of ED as high as 75%, whereas, external beam radiation
therapy may be associated with up to a 60% risk.
8. A Chemotherapy agents affect actively growing
(anagen) hairs. Because anagen hair is most rapidly
proliferating cell population in the human body, alopecia
is a common toxicity
9. C- Chemotherapy agents associated with only mild hair
loss include uinorelbine, bleomycin, carmustine,
epirubicin, 5-FU, methotrexate and cepecitabine.
10. B- In southern Thailand cervical cancer accounts nearly
25% of all cases of cancer in women, and more than half
of patients are diagnosed at stage II or higher. The world
incidence rates average about 9%.
11. D- Among Asian groups, health is a state of harmony in
body, mind, and spirit with nature and the universe. A
balance between the hot (yang) and (yin) is essential for
good health. Other explanation for illness include an
curse a punishment for immoral behaviour, or an
imbalance in the body caused by exposure to wind or air.
12. A- National, state, and local governments have an impact
on cancer control through legislation. Cancer control
efforts are affected by the monies specifically
appropriated to cancer control in the national institutes
of health budget. The government can influence
advancement in this area by setting national goals for
cancer control, such as those in the Healthy People 2000
document.
13. C- An example of how chemoprevention may potentially
be applied to high risk population is the use of non-
steroidal anti-inflammatory drugs for the prevention of
colorectal cancer.
14. C- Individuals assume that the world is meaningful and
that they have worth. Traumatic events such as a cancer
diagnosis can shelter these assumptions. . When this
happen people work to reconstruct their world view so
that it includes assumptions the event that are wiser and
mature
15. D Sexual dysfunction in women is due to a threefold
assault on her sexual being: body image, sexual
functioning, and fertility.
16. C- Self concept is defined as the total self appraisal of
appearance, background and origins, abilities, resources,
attitudes and feelings. Most empirical studies dealing
with the relationship of cancer to self-concept have
focused on women with gynaecologic or breast cancer or
on men with testicular or prostate cancer
17. D- In a European multicenter-controlled clinical trial,
women receiving goserilin and goserilin plus tamoxifen
experienced significally higher levels of sexual
dysfunction at 1-2 year follow up compared with those
who received no endocrine treatment. Patients treated
with tamoxifen alone did not report significant sexual
side effects. In contrast, women treated with
chemotherapy had high and frequently increasing levels
of dysfunction even after 2 to 3 years independent
treatment.
18. A -Recent studies have indicated the effectiveness of
education and counselling as approaches to treatment of
changes in sexual health. One problem with respect to
such interventions is that effectiveness is often measured
in terms of resumption of sexual intercourse rather than
as the effect of the intervention on self concept or on
relationships with others.
 500 Oncology Nursing Answers And Rationale
19. A- Among the factors that affect a cancer patients
sexuality are those related to biologic/physiologic
process of cancer, the effects of treatment, the
alterations caused by cancer and treatment, and the
physiologic issues surrounding the patient and family.
Physiologic problems of infertility and sterility, changes in
body appearance, and the ability to have intercourse are
enhanced by psycho logic and psychosexual issues of
alteration in body image, fears of abandonment, loss of
self esteem, alterations in sexual identity and concerns
about self. Mutagenicity and psychosexual changes are
not closely related.
20. A Physical exam to document patterns of hair loss
include descriptions of patterns of hair loss on the scalp
and over entire body; density of remaining hair: shape of
the front hairline: length, texture and curl, color and
shine and condition of the scalp. A history of male
pattern baldness may be a factor in predicting hair loss
but is not an assessment criteria because it relates to the
timing of chemotherapy and hair loss.
21. B- Choices a, c and d although all associated with sexual
dysfunction resulting from gastrointestinal surgery,
primarily are psychosexual and not organic issue. For all
patients the removal of rectal tissue appears to be the
26. The correct answer is B.
(B) to a private room so she will not be infected by other
patients and health care workers CORRECT: protects
patient from exogenous bacteria, risk for developing
infection from others due to depressed WBC count,
alters ability to fight infection
27. The correct answer is A.
Question: What is the BEST way to prevent accidental
poisoning in children?
Strategy: Picture toddlers at play.
(A) Lock all medications in a cabinet CORRECT:
improper storage most common cause of
28. The correct answer is C.
Question: What is the correct universal precaution?
(C) Gloves, gown, mask, and goggles CORRECT: must
use universal precautions on ALL patients; prevent skin
and mucous membrane exposure when contact with
blood or other body fluids is anticipated
29. The correct answer is B.
(B) Side-lying CORRECT: most effective to facilitate
drainage of secretions from the mouth and pharynx;
reduces possibility of airway obstruction.
30. The correct answer is A.
most common denominator to organic sexual
dysfunction.
22. A- The most frequent addressed factors contributing to
cancer-related suicide or euthanasia are pain and other
symptoms distress
23. B- The cause of anemia frequently seen in patients with
cancer include decreased red cell production secondary
to myelosuppressive therapy (e.g Chemotherapy) and
the primary disease process.
24. C- The success of any cancer survival program depends
on the commitment of the health care team to provide
ongoing evaluation and planning for change in the lives
of survivors. Under such a dynamic program, preventive
and restorative goal setting become critical to a long
term survivorship trajectory that is characterized by
minimal debilitation and a wellness orientation.
Particular attention is also paid to the ongoing and long
range implications of financial burden imposed by
cancer.
25. D Severity of duration of disease is the factor most
closely related to cancer patients rehabilitation needs.
The physical needs frequently occurring with a variety of
cancers include general weakness, limited activities of
daily living, and issue related to limited mobility.
(A) A 72-year-old patient with diabetes who requires a
dressing change for a stasis ulcer CORRECT: stable
patient with an expected outcome
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 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.
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.
 500 Oncology Nursing Answers And Rationale
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. 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 second-degree burn in
histology, appearance, and sensation.
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.
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.
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 client more at risk for deep vein thrombosis or
thrombophleb
 500 Oncology Nursing Answers And Rationale
51. (2) This indicates denial of his illness. The question states
he has cancer. All of the other comments indicate an interest
in what is going to happen to him.
52. (1) Because taste buds are affected, increasing spices will
improve flavor.
53. (2) Fruits and vegetables will help the client to prevent
constipation, which could cause bleeding. All of the other
choices are appropriate for a low WBC but this WBC is
normal. The problem for this client is a low platelet count.
54. (3) Crowded places predispose to infection. #1 is related
to low platelet count. #4. The client should not eat fresh fruits
and vegetables even if they are washed.
55. (2) Stable weight indicates adequate nutritional status.
56. (3) This empathetic response will open communication.
#1 is really a why question which would put the client on
the defensive. #2 and #4 do not focus on the clients feelings.
57. (3) Yelling at the nurse would be typical of anger.
Projection is putting his feelings on the nurse You are angry
at me. Denial would be denying that he was terminally ill or
that he had cancer. A client who is depressed would be
apathetic and probably not have the energy to yell at the
nurse.
58. (3) The platelet count is very low normal is 150,000
500,000. Platelets clot blood. The client must be on bleeding
precautions. A WBC of 8000 is within the normal range so
neutropenic precautions and protective isolation and a
private room are not indicated.
59. (2) It is important that the client not wash off the marks
until after therapy is finished. The marks outline the tumor
and show where the radiation should be concentrated. The
client who is receiving external radiation is not radioactive
and should not put anything on the skin. The person who had
radioactive iodine to shrink the thyroid gland should double
flush the toilet after each use. There is no radioactivity in the
waste of a person who is receiving external radiation.
60. (3) Bone marrow biopsy is an invasive procedure that
requires a legal consent form to be signed. No iodine dye is
used. The usual site is the iliac crest; the client will not be
placed in fetal position. That is the position for a lumbar
puncture. There is no need for the client to be NPO. Only a
local anesthetic is used.
61. (2) Imferon is black and stains the skin and stings. The Z
track method of pulling the skin to one side before injecting
the medications prevents staining of the skin. Z track also
reduces pain. It does not prolong action or speed onset of
action or improve absorption rate.
62. (2) Beef, spinach and grape juice contains iron. Milk
contains no iron.
63. (4) Iron turns stool black. The other answers all indicate
compliance with the medication regime.
64. (2) A beefy red tongue is characteristic of pernicious
anemia. Easy bruising would be seen in a clotting disorder
such as hemophilia, in leukemia or in bone marrow
depression. Pruritus is characteristic of Hodgkins disease.
65. (2) Injections of Vit. B12 will be necessary because
without intrinsic factor her body cannot absorb Vit. B12 from
foods.
66. (4) Her symptoms suggest pernicious anemia. She would
not develop these symptoms if she took her medications
regularly.
67. (1) Dehydration causes sickling. Sickling causes clumping
and pain. First priority of care upon admission should be the
administration of fluids.
68. (4) Elevated fetal hemoglobin levels keep the oxygen
tension high so sickling does not occur.
69. (2) Fevers cause dehydration and sickling.
70. (3) Parents of children with hemophilia tend to over
protect them. A goal is to have the child lead as normal a life
as possible. #1 is correct. He should not receive aspirin, as it is
an anti-coagulant. #2 indicates good knowledge. Prophylactic
dental care is important so he will not need dental work or
extractions. #4 indicates good knowledge. He should always
wear a medic Alert bracelet in case he is injured.
71. (3) The Epstein-Barr virus is the causative organism for
infectious mononucleosis.
72. (4) The virus is spread through intimate oral contact. It is
called the kissing disease. It can also be spread by sharing
eating and drinking utensils.
73. (1) Leukemia causes a decrease in normal white cells.
White blood cells are the infection fighting cells. Infections
occur because of the decrease in normal WBCs due to
leukemia. Infections do not cause leukemia.
24. (4) Stomatitis is a frequent complication of chemotherapy
 500 Oncology Nursing Answers And Rationale
for leukemia. He has a tendency to bleed because of his
decreased platelets. Dental floss might cause bleeding. An
astringent mouthwash is too strong for his tender mouth. An
overbed cradle does not relate to stomatitis. Moistened
cotton swabs are a gentle means of cleaning the mouth.
75. (2) This answer indicates acceptance of hair loss a side
effect of chemotherapy. Choice 1 indicates denial. Choice 2
indicates lack of understanding. He will be very susceptible to
infections. Choice 4 is not correct. He may or may not go into
remission.
76. B. The 5th v/s is pain. Nurses should asssess and record
pain just as they would temperature, respirations, pulse, and
blood pressure. Answer A, C, and Dare included in the
charting but are not considered to be the 5th v/s and are,
therfore, incorrect.
77. C. Pain is a late sign of oral cancer. Answer A, B, and are
incorrect b'cos a feeling of warmth, odor, and a flat ulcer in
the mouth are all early occurences of oral cancer.
78. A. The best diagnostic tool for cancer is the biopsy. Other
assessment includes checking the lymph nodes. Answer B, C,
and D will not a diagnosis of oral cancer.
79. D. The v/s should be taken before any chemotherapy
agent. If it is an IV infusion of chemotherapy, the nurse
should check the IV site as well. Answer B and C are incorrect
b'cos it is not necessary to check the electrolyte or blood
gasses.
80. A. Crsytal in the solution are not normal and should be
administered to the client. Discard the bad solution
immediately. Answer B is incorrect b'cos warming the
solution will not help. Answer C, is incorrect, and answer D
requires a doctor's order.
81. C. The nurse should explore the cause for the lack of
motivation. The client might be anemic and lack energy, or
the client might be depressed. Alternating staff. as stated in
answer A, will prevent a bond from being formed with the
nurse. Answer B is not enough, and answer D is not
necessary.
82. D. Xerostomia is dry mouth, and offering the client a
saliva substitute will help the most. Eating hard candy in
answer A can further irritate the mucosa and cut the tongue
and lips. Administering an analgesic might not be necessary;
thus, answer B is incorrect. splinting swollen joints in answer
C, is not associated with xerostomia.
83. B. The best action at this time is to report the incident to
the charge nurse. Further action might be needed, but it will
be done by the charge nurse. Answer A, C, and D are not
correct b'cos notifying the police is over acting at this time,
and monitoring or ignoring the situation is an inadequate
response.
84. B. Cancer in situ means that the cancer is still localized to
the primary site. T stands for "Tumor" and the "IS" for "in
situ." Cancer is graded in terms of tumor, grdae, node
involvement, and mestatasis. Answer A, C and D pertain to
these other classifications.
85. B. The client is having an intravenous pyelogram will have
orders for laxatives or enemas, so asking the client to void
before the test is in order. A full bladder or bowel can
obscure the visualization of the kidney ureters and urethra.
Answer A is incorrect b'cos there is no need to force fluids
before the test. Answer C is incorrect b'cos there is no need
to with hold medication for 12 hours before the test. Answer
D is incorrect b'cos the client's reproductive organs should
not be covered.
86. A. The client wiht a lung resection will have chest tubes
and drainage-collection device. He probably will not have a
tracheostomy or medicastenal tube, and he will not have an
order for percussion, vibration, or drainage. Therefore,
answer B, C, and D are incorrect
87. C. The client with mouth and throat cancer will have all
the findings in answer A, B and D except the correct answer
of diarrhea.
88. D. The client with a perineal resection will have a perineal
incision. Drains will be used to facilitate wound drainage. This
will helpprevent infection of the surgical site. The client will
not have an illeostomy, as in answer A; he will have some
eletrolyte loss, but treatment is not focused on preventing
the loss, so answer B, is incorrect. A high fiber diet, in answer
C, is not ordered at this time.
89. D. Sarcoma is a type of bone cancer, therefore, bone pain
would be expected. Answer A, B, and C are not specific to this
type of cancer and are incorrect.
90. B. The only lab result that is abnormal is the potassium. A
potassium level of 1.9 indicates hypokalemia. The findings in
answer A, C, and D are not revealed in the serum.
91. A. Cancer of the liver frequently leads to severe nausea
and vomiting, thus the need for altering nutritional needs.
The problems in answers B, C, and D are of lesser concern
and, thus, are icorrect in this instance.
92. D. The client with neutropenia, or high white cell count,
should not have potted or cut flowers in the room. These
clients should not eat foods grown on or in the ground or eat
from the salad bar, in order to eliminate as many sources of
 500 Oncology Nursing Answers And Rationale
bacteria as possible. Cancer pt. are extremely susceptible to
bacterial infections. Answer A, B, and C will not help to
prevent bacterial invasions and, therefore, are incorrect.
93. C. A diet is high in fat and refined carbohydrates increase
the risk of colorectal cancer. High fat content results in an
increase in fecal bile acids, which facilitate carcinogenic
changes. Refined carbohydrates incease the transit time of
food through the gastrointestinal tract and increase the
exposure tome of the intestina mucosa to cancer causing
substance. Answer A, B, and D do not relate to the question;
therefore, they are incorrect.
94. D. A history of frequent alcohol and tobacco use is the
most significant factor in the development of the cancer of
the larynx. Answer A, B, and C, are also factors in the
development of laryngeal cancer but they are not the most
significant; therefore, they are not incorrect.
95. D. The nurse should not use water, soap, or lotion on the
area marked for radiation therapy. Answer A is incorrect
b'cos it would remove the marking . Answer B and C are not
necessary for the client receiving radiation; therefore, they
are incorrect.
96. C. The radioactive implant should be picked up with tongs
and returned to the lead-lined container.
97. A. A total mastectomy involves removal of the entire
breast and some or all of the axillary lymph nodes. Following
surgery, the client's right arm shloud be elevated on pillows
to facilitate lymph drainage.
98. C. Zofran is given before chemotherapy to prevent
nausea. Answer A, B, and D are not associated with the
mdication; therefore, they are incorrect.
99. A. Linear accelarator therapy is done in the radium
department and does not make the client radioactive.
100. B. The client with leukemia is at risk for infection and
often had recurrent respiratory in fections during the
previous 6 months.
101..Answer B. Antimetabolites act during the S phase of the
cell cycle, contributing to cell destruction or preventing cell
replication. Theyre most effective against rapidly
proliferating cancers. Miotic inhibitors interfere with cell
division or mitosis during the M phase of the cell cycle.
Alkylating agents affect all rapidly proliferating cells by
interfering with DNA; they may kill dividing cells in all phases
of the cell cycle and may also kill nondividing cells.
Antineoplastic antibiotic agents interfere with one or more
stages of the synthesis of RNA, DNA, or both, preventing
normal cell growth and reproduction.
102.Answer B. When following the ABCD method for
assessing skin lesions, the A stands for "asymmetry," the B for
"border irregularity," the C for "color variation," and the D for
"diameter."
103.Answer B. Tactile agnosia (inability to identify objects by
touch) is a sign of a parietal lobe tumor. Short-term memory
impairment occurs with a frontal lobe tumor. Seizures may
result from a tumor of the frontal, temporal, or occipital lobe.
Contralateral homonymous hemianopia suggests an occipital
lobe tumor.
104.Answer C. Presence of Bence Jones protein in the urine
almost always confirms the disease, but absence doesnt rule
it out. Serum calcium levels are elevated because calcium is
lost from the bone and reabsorbed in the serum. Serum
protein electrophoresis shows elevated globulin spike. The
serum creatinine level may also be increased.
105.Answer C. The tissue-destructive effects of cancer
chemotherapy typically cause stomatitis, resulting in ulcers
on the oral mucosa that appear as red, open sores. White,
cottage cheeselike patches on the tongue suggest a candidal
infection, another common adverse effect of chemotherapy.
Yellow tooth discoloration may result from antibiotic therapy,
not cancer chemotherapy. Rust-colored sputum suggests a
respiratory disorder, such as pneumonia.
106..Answer B. To decrease the pain of stomatitis, the nurse
should provide a solution of hydrogen peroxide and water for
the client to use as a mouth rinse. (Commercially prepared
mouthwashes contain alcohol and may cause dryness and
irritation of the oral mucosa.) The nurse also may administer
viscous lidocaine or systemic analgesics as prescribed.
Stomatitis occurs 7 to 10 days after chemotherapy begins;
thus, stopping chemotherapy wouldnt be helpful or practical.
Instead, the nurse should stay alert for this potential problem
to ensure prompt treatment. Monitoring platelet and
leukocyte counts may help prevent bleeding and infection but
wouldnt decrease pain in this highly susceptible client.
 500 Oncology Nursing Answers And Rationale
Checking for signs and symptoms of stomatitis also wouldnt
decrease the pain.
107..Answer A. The incidence of prostate cancer increases
after age 50. The digital rectal examination, which identifies
enlargement or irregularity of the prostate, and PSA test, a
tumor marker for prostate cancer, are effective diagnostic
measures that should be done yearly. Testicular self-
examinations wont identify changes in the prostate gland
due to its location in the body. A transrectal ultrasound, CBC,
and BUN and creatinine levels are usually done after
diagnosis to identify the extent of the disease and potential
metastases
108..Answer A. Anticipatory grieving is an appropriate nursing
diagnosis for this client because few clients with gallbladder
cancer live more than 1 year after diagnosis. Impaired
swallowing isnt associated with gallbladder cancer. Although
surgery typically is done to remove the gallbladder and,
possibly, a section of the liver, it isnt disfiguring and doesnt
cause Disturbed body image. Chronic low self-esteem isnt an
appropriate nursing diagnosis at this time because the
diagnosis has just been made.
109.Answer B. If a radioactive implant becomes dislodged,
the nurse should pick it up with long-handled forceps and
place it in a lead-lined container, then notify the radiation
therapy department immediately. The highest priority is to
minimize radiation exposure for the client and the nurse;
therefore, the nurse must not take any action that delays
implant removal. Standing as far from the implant as possible,
leaving the room with the implant still exposed, or
attempting to put it back in place can greatly increase the risk
of harm to the client and the nurse from excessive radiation
exposure.
110.Answer A. The client must report changes in visual acuity
immediately because this adverse effect may be irreversible.
Tamoxifen isnt associated with hearing loss. Although the
drug may cause anorexia, headache, and hot flashes, the
client need not report these adverse effects immediately
because they dont warrant a change in therapy.
111.Answer A. The liver is one of the five most common
cancer metastasis sites. The others are the lymph nodes,
lung, bone, and brain. The colon, reproductive tract, and
WBCs are occasional metastasis sites.
112.Answer B. A low-fat diet (one that maintains weight
within 20% of recommended body weight) has been found to
decrease a womans risk of breast cancer. A baseline
mammogram should be done between ages 30 and 40.
Monthly breast self-examinations should be done between
days 7 and 10 of the menstrual cycle. The client should
continue to perform monthly breast self-examinations even
when receiving yearly mammograms.
113.Answer C. Bone marrow suppression becomes noticeable
7 to 14 days after floxuridine administration. Bone marrow
recovery occurs in 21 to 28 days.
114.Answer D. During an MRI, the client should wear no
metal objects, such as jewelry, because the strong magnetic
field can pull on them, causing injury to the client and (if they
fly off) to others. The client must lie still during the MRI but
can talk to those performing the test by way of the
microphone inside the scanner tunnel. The client should hear
thumping sounds, which are caused by the sound waves
thumping on the magnetic field.
115.Answer D. Dysplasia refers to an alteration in the size,
shape, and organization of differentiated cells. The presence
of completely undifferentiated tumor cells that dont
resemble cells of the tissues of their origin is called anaplasia.
An increase in the number of normal cells in a normal
arrangement in a tissue or an organ is called hyperplasia.
Replacement of one type of fully differentiated cell by
another in tissues where the second type normally isnt found
is called metaplasia.
116..Answer A. Verbalizing feelings is the clients first step in
coping with the situational crisis. It also helps the health care
team gain insight into the clients feelings, helping guide
psychosocial care. Option B is inappropriate because
suppressing speculation may prevent the client from coming
to terms with the crisis and planning accordingly. Option C is
undesirable because some methods of reducing tension, such
as illicit drug or alcohol use, may prevent the client from
 500 Oncology Nursing Answers And Rationale
coming to terms with the threat of death as well as cause
physiologic harm. Option D isnt appropriate because seeking
information can help a client with cancer gain a sense of
control over the crisis.
117. .Answer C. A client with a cerebellar brain tumor may
suffer injury from impaired balance as well as disturbed gait
and incoordination. Visual field deficits, difficulty swallowing,
and psychomotor seizures may result from dysfunction of the
pituitary gland, pons, occipital lobe, parietal lobe, or temporal
lobe not from a cerebellar brain tumor. Difficulty
swallowing suggests medullary dysfunction. Psychomotor
seizures suggest temporal lobe dysfunction.
118.Answer C. Radiation therapy may cause fatigue, skin
toxicities, and anorexia regardless of the treatment site. Hair
loss, stomatitis, and vomiting are site-specific, not
generalized, adverse effects of radiation therapy.
119.Answer C. Fine needle aspiration and biopsy provide cells
for histologic examination to confirm a diagnosis of cancer. A
breast self-examination, if done regularly, is the most reliable
method for detecting breast lumps early. Mammography is
used to detect tumors that are too small to palpate. Chest X-
rays can be used to pinpoint rib metastasis.
120.Answer D. The nurse should instruct the client to keep
the stoma moist, such as by applying a thin layer of
petroleum jelly around the edges, because a dry stoma may
become irritated. The nurse should recommend placing a
stoma bib over the stoma to filter and warm air before it
enters the stoma. The client should begin performing stoma
care without assistance as soon as possible to gain
independence in self-care activities.
121.Answer D. Chemotherapy commonly causes nausea and
vomiting, which may lead to fluid and electrolyte imbalances.
Signs of fluid loss include dry oral mucous membranes,
cracked lips, decreased urine output (less than 40 ml/hour),
abnormally low blood pressure, and a serum potassium level
below 3.5 mEq/L.
122.Answer C. Women are instructed to examine themselves
to discover changes that have occurred in the breast. Only a
physician can diagnose lumps that are cancerous, areas of
thickness or fullness that signal the presence of a malignancy,
or masses that are fibrocystic as opposed to malignant.
123.Answer D. Like other viral and bacterial venereal
infections, human papillomavirus is a risk factor for cervical
cancer. Other risk factors for this disease include frequent
sexual intercourse before age 16, multiple sex partners, and
multiple pregnancies. A spontaneous abortion and pregnancy
complicated by eclampsia arent risk factors for cervical
cancer.
124.Answer D. Leucovorin is administered with methotrexate
to protect normal cells, which methotrexate could destroy if
given alone. Probenecid should be avoided in clients receiving
methotrexate because it reduces renal elimination of
methotrexate, increasing the risk of methotrexate toxicity.
Cytarabine and thioguanine arent used to treat osteogenic
carcinoma.
125.Answer D. Colorectal polyps are common with colon
cancer. Duodenal ulcers andhemorrhoids arent preexisting
conditions of colorectal cancer. Weight loss not gain is
an indication of colorectal cancer.
126.Answer B. The American Cancer Society guidelines state,
"Women older than age 40 should have a mammogram
annually and a clinical examination at least annually [not
every 2 years]; all women should perform breast self-
examination monthly [not annually]." The hormonal receptor
assay is done on a known breast tumor to determine whether
the tumor is estrogen- or progesterone-dependent.
127.Answer C. Indigestion, or difficulty swallowing, is one of
the seven warning signs of cancer. The other six are a change
in bowel or bladder habits, a sore that does not heal, unusual
bleeding or discharge, a thickening or lump in the breast or
elsewhere, an obvious change in a wart or mole, and a
nagging cough or hoarseness. Persistent nausea may signal
stomach cancer but isnt one of the seven major warning
signs. Rash and chronic ache or pain seldom indicate cancer.
128.Answer B. Because thrombocytopenia impairs blood
clotting, the nurse should inspect the client regularly for signs
of bleeding, such as petechiae, purpura, epistaxis, and
bleeding gums. The nurse should avoid administering aspirin
 500 Oncology Nursing Answers And Rationale
because it may increase the risk of bleeding. Frequent rest
periods are indicated for clients with anemia, not
thrombocytopenia. Strict isolation is indicated only for clients
who have highly contagious or virulent infections that are
spread by air or physical contact.
129.Answer A. The American Cancer Society recommends a
mammogram yearly for women over age 40. The other
statements are incorrect. Its recommended that women
between ages 20 and 40 have a professional breast
examination (not a mammogram) every 3 years.
130.Answer D. The nurse should obtain the clients baseline
blood pressure and pulse and respiratory rates before
administering the initial dose and then continue to monitor
vital signs throughout therapy. A naloxone challenge test may
be administered before using a narcotic antagonist, not a
narcotic agonist. The nurse shouldnt discontinue a narcotic
agonist abruptly because withdrawal symptoms may occur.
Morphine commonly is used as a continuous infusion in
clients with severe pain regardless of the ability to tolerate
fluids.
131.. Answer D. Men can develop breast cancer, although
they seldom do. The most reliable method for detecting
breast cancer is monthly self-examination, not
mammography. Lung cancer causes more deaths than breast
cancer in women of all ages. A mastectomy may not be
required if the tumor is small, confined, and in an early stage.
132. Answer D. Premenopausal women should do their self-
examination immediately after the menstrual period, when
the breasts are least tender and least lumpy. On the 1st and
last days of the cycle, the womans breasts are still very
tender. Postmenopausal women because their bodies lack
fluctuation of hormone levels, should select one particular
day of the month to do breast self-examination.
133. Answer A. Testicular cancer is highly curable,
particularly when its treated in its early stage. Self-
examination allows early detection and facilitates the early
initiation of treatment. The highest mortality rates from
cancer among men are in men with lung cancer. Testicular
cancer is found more commonly in younger men.
134. Answer C. Chlorambucil-induced alopecia occurs 2 to 3
weeks after therapy begins.
135. Answer C. Thiotepa interferes with DNA replication
and RNA transcription. It doesnt destroy the cell membrane.
136. Answer B. The testicular-self examination is
recommended monthly after a warm bath or shower when
the scrotal skin is relaxed. The client should stand to examine
the testicles. Using both hands, with fingers under the
scrotum and thumbs on top, the client should gently roll the
testicles, feeling for any lumps.
137. Answer C. Thrombocytopenia indicates a decrease in
the number of platelets in the circulating blood. A major
concern is monitoring for and preventing bleeding. Option A
elates to monitoring for infection, particularly if leukopenia is
present. Options B and D, although important in the plan of
care, are not related directly to thrombocytopenia.
138. Answer D. The breast self-examination should be
performed monthly 7 days after the onset of the menstrual
period. Performing the examination weekly is not
recommended. At the onset of menstruation and during
ovulation, hormonal changes occur that may alter breast
tissue.
139. Answer A. The client is at risk of deep vein thrombosis
or thrombophlebitis after this surgery, as for any other major
surgery. For this reason, the nurse implements measures that
will prevent this complication. Range-of-motion exercises,
antiembolism stockings, and pneumatic compression boots
are helpful. The nurse should avoid using the knee gatch in
the bed, which inhibits venous return, thus placing the client
more at risk for deep vein thrombosis or thrombophlebitis.
140.. Answer D. A pelvic ultrasound requires the ingestion
of large volumes of water just before the procedure. A full
bladder is necessary so that it will be visualized as such and
not mistaken for a possible pelvic growth. An abdominal
ultrasound may require that the client abstain from food or
fluid for several hours before the procedure. Option C is
unrelated to this specific procedure.
 500 Oncology Nursing Answers And Rationale
141. Answer A. A biopsy is done to determine whether a
tumor is malignant or benign. Magnetic resonance imaging,
computed tomography scan, and ultrasound will visualize the
presence of a mass but will not confirm a diagnosis of
malignancy.
142. Answer D. Multiple myeloma is a B-cell neoplastic
condition characterized by abnormal malignant proliferation
of plasma cells and the accumulation of mature plasma cells
in the bone marrow. Options A and B are not characteristics
of multiple myeloma. Option C describes the leukemic
process.
143.. Answer A. Findings indicative of multiple myeloma are
an increased number of plasma cells in the bone marrow,
anemia, hypercalcemia caused by the release of calcium from
the deteriorating bone tissue, and an elevated blood urea
nitrogen level. An increased white blood cell count may or
may not be present and is not related specifically to multiple
myeloma.
44. Answer A. Alopecia is not an assessment finding in
testicular cancer. Alopecia may occur, however, as a result of
radiation or chemotherapy. Options B, C, and D are
assessment findings in testicular cancer. Back pain may
indicate metastasis to the retroperitoneal lymph nodes.
145 Answer C. In general, only the area in the treatment
field is affected by the radiation. Skin reactions, fatigue,
nausea, and anorexia may occur with radiation to any site,
whereas other side effects occur only when specific areas are
involved in treatment. A client receiving radiation to the
larynx is most likely to experience a sore throat. Options B
and D may occur with radiation to the gastrointestinal tract.
Dyspnea may occur with lung involvement.
146. Answer B. The time that the nurse spends in a room of
a client with an internal radiation implant is 30 minutes per 8-
hour shift. The dosimeter badge must be worn when in the
clients room. Children younger than 16 years of age and
pregnant women are not allowed in the clients room.
147. Answer A. The client with a cervical radiation implant
should be maintained on bed rest in the dorsal position to
prevent movement of the radiation source. The head of the
bed is elevated to a maximum of 10 to 15 degrees for
comfort. The nurse avoids turning the client on the side. If
turning is absolutely necessary, a pillow is placed between
the knees and, with the body in straight alignment, the client
is logrolled.
148. Answer 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.
149. Answer C. In the neutropenic client, meticulous hand
hygiene education is implemented for the client, family,
visitors, and staff. Not all visitors are restricted, but the client
is protected from persons with known infections. Fluids
should be encouraged. Invasive measures such as an
indwelling urinary catheter should be avoided to prevent
infections.
150. Answer 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.
151. Answer: B. Early detection of cancer is promoted by
annual oral examination, monthly BSE from age 20, annual
chest x-ray, yearly digital rectal examination for persons over
age 40, annual Pap smear from age 40 and annual physical
and blood examination. Letter B is wrong because it says Pap
smear should be done yearly for sexually active women. All
women should have an annual pap smear by age 40 and up
whether sexually active or not.
152. Answer: D. Halstead surgery also called radical
mastectomy involves the removal of entire breast, pectoralis
major and minor muscles and neck lymph nodes. It is
followed by skin grafting. Removal of the entire breast,
pectoralis major muscle and the axillary lymph nodes is a
surgical procedure called modified radical mastectomy.
 500 Oncology Nursing Answers And Rationale
Simple mastectomy is the removal of the entire breast but
the pectoralis muscles and nipples remain intact.
153. Answer: D. chemotherapy is contraindicated in cases of
infection (chemotherapeutic agents are immunosuppressive),
recent surgery (chemotherapeutic agent may retard the
healing process), impaired renal and hepatic function (drugs
are nephrotoxic and hepatotoxic), recent radiation therapy
(immunosuppressive treatment), pregnancy (drugs can cause
congenital defects) and bone marrow depression (chemo.
Agents may aggravate the condition).
154. Answer: A. The nurse should be corrected if she is only
wearing mask and glove because gowns should also be worn
in handling chemotherapeutic drugs. The vials should be vent
after mixing to reduce the internal pressure. Air bubbles are
expelled on wet cotton to prevent the spread of the
chemotherapeutic agent particles.
155. Answer: C.
Benign Malignant
grows slowly, localized, Grows rapidly, infiltrates
encapsulated, well surrounding tissues, not
differentiated cells, no encapsulated, poorly
metastasis, not harmful to differentiated, metastasis
host present, always harmful
156. Answer: D. Unexplained sudden weight loss is a
warning signal of cancer. Letter A is wrong because the sore
in cancer does not heal. Nagging cough not dry cough and
hoarseness of voice is a sign of cancer. Presence of lump is
not limited to the breast only; it can grow elsewhere that is
why letter C is wrong.
157. Answer: B. TNM stands for tumor, node, and
metastasis.
158. Answer: B. This client needs further teaching as
palpation in BSE should start at the periphery going to the
center in a circular motion.
159. Answer: C. Diarrhea not constipation is the side effect
of radiation therapy.
160. Answer: C. Radiation therapy makes the platelet count
decrease. Thus, nursing responsibilities should be directed at
promoting safety by avoiding episodes of hemorrhage or
bleeding such as physical trauma and aspirin administration.
Analgesics are given before meals to alleviate the pain caused
by stomatitis. Bland diet and saline rinses every 2 hours
should also be done to manage stomatitis.
161. Answer: C. No soap should be used on the skin of the
client undergoing radiation. Soap and irritants and may cause
dryness of the patients skin. Only water should be used in
washing the area.
162. Answer A. Metochlopramide (Metozol) antiemetic.
Succimer (Chemet) chelating agent for lead poisoning.
Anastrazole (Arimidex) hormone regulator. Busulfan
(Myleran) alkylating agent
163. Answer: A. The distance of at least 3 feet / 0.9 or 1
meter should be maintained when a nurse is not performing
any nursing procedures.
164. Answer: B. To promote safety to the personnel, the
client will remain alone in the treatment room while the
machine is in operation. The client may voice out any concern
throughout the treatment because a technologist is just
outside the room observing through a window or closed
circuit TV. There is no residual radioactivity after radiation
therapy. Safety precautions are necessary only during the
time of actual irradiation. The client may resume normal
activities of daily living afterwards.
165. Answer C: Principles of Radiation protection follows
the DTS system. Distance (D), Time (T) and Shielding (S).
Distance at least 3 feet should be maintained when a nurse
is not performing any nursing procedures. Time limit
contact to 5 minutes each time. Shielding use lead shield
during contact with client.
166. Nurse Joy is caring for a client with an internal
radiation implant. When caring for the client, the nurse
should observe which of the following principles?
a. Limit the time with the client to 1 hour per shift
b. Do not allow pregnant women into the clients room
c. Remove the dosimeter badge when entering the clients
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
167. 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
168. A female client is hospitalized for insertion of an
internal cervical radiation implant. While giving care, the
 500 Oncology Nursing Answers And Rationale
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.
169. The nurse is caring for a female client experiencing
neutropenia as a result of chemotherapy and develops a plan
of care for the client. The nurse plans to:
a. Restrict all visitors
b. Restrict fluid intake
c. Teach the client and family about the need for hand
hygiene
d. Insert an indwelling urinary catheter to prevent skin
breakdown
170. 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
b. Nonverbal cues from the client
c. The nurses impression of the clients pain
d. Pain relief after appropriate nursing intervention
171. Nurse Mickey is caring for a client who is postoperative
following a pelvic exenteration and the physician changes the
clients 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
172. A male client is admitted to the hospital with a
suspected diagnosis of Hodgkins disease. Which assessment
findings would the nurse expect to note specifically in the
client?
a. Fatigue
b. Weakness
c. Weight gain
d. Enlarged lymph nodes
173. During the admission assessment of a 35 year old
client with advanced ovarian cancer, the nurse recognizes
which symptom as typical of the disease?
a. Diarrhea
b. Hypermenorrhea
c. Abdominal bleeding
d. Abdominal distention
174. Nurse Kate is reviewing the complications of
colonization with a client who has microinvasive cervical
cancer. Which complication, if identified by the client,
indicates a need for further teaching?
a. Infection
b. Hemorrhage
c. Cervical stenosis
d. Ovarian perforation
175. Mr. Miller has been diagnosed with bone cancer. You
know this type of cancer is classified as:
a. sarcoma.
b. lymphoma.
c. carcinoma.
d. melanoma.
176. A. aplastic anemia
Aplastic anemia is the result of a hypersensitivity reaction and
is often irreversible. It leads to pancytopenia, a severe
decrease in all cell types: red blood cells, white blood cells,
and platelets. A reduced number of red blood cells causes
hemoglobin to drop. A reduced number of white blood cells
makes the patient susceptible to infection. And, a reduced
number of platelets causes the blood not to clot as easily.
Treatment for mild cases is supportive. Transfusions may be
necessary. Severe cases require a bone marrow transplant.
Option 2 is an elevated platelet count. Option 3 is an elevated
white count. Option 4 is an elevated granulocyte count. A
granulocyte is a type of white blood cell.
177 A. tachycardia
Levothyroxine, especially in higher doses, can induce
hyperthyroid-like symptoms including tachycardia. An agent
that increases the basal metabolic rate would not be
expected to induce a slow heart rate. Hypotension would be
a side effect of bradycardia. Constipation is a symptom of
hypothyroid disease
178 A. cross-link DNA strands with covalent bonds between
alkyl groups on the drug and guanine bases on DNA.
Alkylating agents are highly reactive chemicals that introduce
alkyl radicals into biologically active molecules and thereby
prevent their proper functioning, replication, and
transcription. Alkylating agents have numerous side effects
including alopecia, nausea, vomiting, and myelosuppression.
Nitrogen mustards have a broad spectrum of activity against
chronic lymphocytic leukemia, non-Hodgkin's lymphoma, and
breast and ovarian cancer, but they are effective
 500 Oncology Nursing Answers And Rationale
chemotherapeutic agents because of DNA cross-linkage.
Alkylating agents are noncell cycle-specific agents.
179. C. estrogen antagonists to treat breast cancer.
Estrogen antagonists are used to treat estrogen hormone-
dependent cancer, such as breast carcinoma. A well-known
estrogen antagonist used in breast cancer therapy is
tamoxifen (Nolvadex). This drug, in combination with surgery
and other chemotherapeutic drugs reduces breast cancer
recurrence by 30 percent. Estrogen antagonists can also be
administered to prevent breast cancer in women who have a
strong family history of the disease. Thyroxine is a natural
thyroid hormone. It does not treat thyroid cancer. ACTH is an
anterior pituitary hormone, which stimulates the adrenal
glands to release glucocorticoids. It does not treat adrenal
cancer. Glucagon is a pancreatic alpha cell hormone, which
stimulates glycogenolysis and gluconeogenesis. It does not
treat pancreatic cancer.
180. B. red blood cells are affected first.
The time required to clear circulating cells before the effect
that chemotherapeutic drugs have on precursor cell
maturation in the bone marrow becomes evident.
Leukopenia is an abnormally low white blood cell count.
Answers 1-3 pertain to red blood cells.
181. A. Epoetin alfa (Epogen, Procrit).
Epoetin alfa (Epogen, Procrit) is a recombinant form of
endogenous erythropoietin, a hematopoietic growth factor
normally produced by the kidney that is used to induce red
blood cell production in the bone marrow and reduce the
need for blood transfusion. Glucagon is a pancreatic alpha
cell hormone, which cause glycogenolysis and
gluconeogenesis. Fenofibrate (Tricor) is an antihyperlipidemic
agent that lowers plasma triglycerides. Lamotrigine (Lamictal)
is an anticonvulsant.
182 A. prostate cancer.
Prostate tissue is stimulated by androgens and suppressed by
estrogens. Androgen antagonists will block testosterone
stimulation of prostate carcinoma cells. The types of cancer in
options 2-4 are not androgen dependent.
183. A. ondansetron (Zofran).
Chemotherapy often induces vomiting centrally by
stimulating the chemoreceptor trigger zone (CTZ) and
peripherally by stimulating visceral afferent nerves in the GI
tract. Ondansetron (Zofran) is a serotonin antagonist that
bocks the effects of serotonin and prevents and treats nausea
and vomiting. It is especially useful in single-day highly
emetogenic cancer chemotherapy (for example, cisplatin).
The agents in options 2-4 are selective serotonin reuptake
inhibitors. They increase the available levels of serotonin.
184. . C. intrathecally.
With intrathecal administration chemotherapy is injected
through the theca of the spinal cord and into the
subarachnoid space entering into the cerebrospinal fluid
surrounding the brain and spinal cord. The methods in
options 1, 2, and 4 are ineffective because the medication
cannot enter the CNS.
185B. consolidation therapy.
Leucovorin is used to save or "rescue" normal cells from the
damaging effects of chemotherapy allowing them to survive
while the cancer cells die. Therapy to rapidly reduce the
number of cancerous cells is the induction phase.
Consolidation therapy seeks to complete or extend the initial
remission and often uses a different combination of drugs
than that used for induction. Chemotherapy is often
administered in intermittent courses called pulse therapy.
Pulse therapy allows the bone marrow to recover function
before another course of chemotherapy is given.
186. B. gout and hyperuricemia.
Prevent uric acid nephropathy, uric acid lithiasis, and gout
during cancer therapy since chemotherapy causes the rapid
destruction of cancer cells leading to excessive purine
catabolism and uric acid formation. Allopurinol can induce
myelosuppression and pancytopenia. Allopurinol does not
have this function.
187. B. intravesical administration.
Medications administered intravesically are instilled into the
bladder. Intraventricular administration involves the
ventricles of the brain. Intravascular administration involves
blood vessels. Intrathecal administration involves the fluid
surrounding the brain and spinal cord.
188. . C. myelosuppression.
The overall goal of cancer chemotherapy is to give a dose
large enough to be lethal to the cancer cells, but small
 500 Oncology Nursing Answers And Rationale
enough to be tolerable for normal cells. Unfortunately, some
normal cells are affected including the bone marrow.
Myelosuppression limits the body's ability to prevent and
fight infection, produce platelets for clotting, and
manufacture red blood cells for oxygen portage. Even though
the effects in options 1, 2, and 4 are uncomfortable and
distressing to the patient, they do not have the potential for
lethal outcomes that myelosuppression has.
189. A. stimulating neuroreceptors in the medulla.
Vomiting (emesis) is initiated by a nucleus of cells located in
the medulla called the vomiting center. This center
coordinates a complex series of events involving pharyngeal,
gastrointestinal, and abdominal wall contractions that lead to
expulsion of gastric contents. Catecholamine inhibition does
not induce vomiting. Chemotherapy does not induce vomiting
from autonomic instability. Chemotherapy, especially oral
agents, may have an irritating effect on the gastric mucosa,
which could result in afferent messages to the solitary tract
nucleus, but these pathways do not project to the vomiting
center.
190. . B. it reduces the size of the cancer tumor.
Myelo comes from the Greek word myelos, which means
marrow. Ablation comes from the Latin word ablatio, which
means removal. Thus, myeloablative chemotherapeurtic
agents destroy the bone marrow. This procedure destroys
normal bone marrow as well as the cancerous marrow. The
patient's bone marrow will be replaced with a bone marrow
transplant. Myelocytes are not muscle cells Tumors are solid
masses typically located in organs. Surgery may be performed
to reduce tumor burden and require less chemotherapy
afterward.
191.. C. before chemotherapy administration.
Nausea and vomiting (N&V) are common side effects of
chemotherapy. Some patients are able to trigger these events
prior to actually receiving chemotherapy by anticipating, or
expecting, to have these effects. N&V occurring post-
chemotherapeutic administration is not an anticipatory event
but rather an effect of the drug. N&V occurring during the
administration of chemotherapy is an effect of the drug.
192. . A. it is chemically stable, nonallergenic, and can be
administered orally once a day.
It is safe and effective with virtually no side effects when
dosed properly. A single daily dose is possible because of the
long half-life. Levothyroxine tablets are available in a wide
range of concentrations to meet individual patient
requirements. Levothyroxine (T4) is a prodrug of T3.
Levothyroxine has a long half-life: 7 days.
193. . A. tolerance.
Repeated administration of an opioid agonist will lead to
pharmacodynamic tolerance of the drug. Tolerance is
primarily due to down-regulation of opioid receptors.
Potency is the degree of power or strength. Receptor agonists
are drugs that have both receptor affinity and intrinsic
activity (the ability to initiate a cellular effect). Efficacy is the
ability to produce a desired effect; effectiveness
194.. B. To treat malnutrition and optimize the surgical
outcome.
Patients with optimal nutritional status have improved
outcomes in fighting cancer, withstanding the surgical
procedure, healing after surgery, and maintaining
energy/activity levels. Option 1 is controversial and is under
investigation. Some oncologists recommend that patients not
take anti-oxidants that could counter the effect of some
chemotherapy. TPN will not cure depression. All surgeons do
not administer TPN prior to all surgeries.
195. B. promotes the excretion of bile.
High-fiber diets are recommended to reduce the risk of colon
cancer, because fiber promotes bile excretion and speeds up
intestinal transit time so that carcinogens are eliminated
quicker.
196. . B. be lowered.
There is potential for a lowered pain tolerance to exist with
diminished adaptative capacity.
197. A. BUN and creatinine
Older adults may be more at risk for gastric and renal toxicity,
which increases as adults age
198. . B. this combination treats pain both centrally and
peripherally.
Using a narcotic with a non-narcotic treats both central and
peripheral pain
199. . D. injectable pain reliever
 500 Oncology Nursing Answers And Rationale
Injectables act more quickly than other routes and can relieve
severe acute pain in one hour
200.. B. Antidepressants enhance the effect of analgesics.
Antidepressants are useful adjuncts to analgesia in the
management of cancer pain. The antidepressant potentiates
or enhances the analgesics medication.
201 .D Ill only eed chemotherapy treatment before
receiving my bone marrow transplant
Rationale : Most clients needs receice chemotherapy before
undergoing bone marrow transplantation. Most women older
than age 26 cant bear children after undergoing treatment
because they experience the early onset menopause. Clients
who undergo chemotherapy or radation must avoid all fresh
fruits and vegetables, and all foods should be cooked to avoid
bacterial contamination.
202. C
Rationale : Probenecid inhibits methotrexate excretion which
increases the risk of methorexate toxicity. Digonin ,
theophyline , and famotidine arent known to interact with
methotrexate.
203. B
Rationale : Lung cancer is the most deadly type of cancer in
both women and men. Breast cancer ranks second in women,
followed by colon and rectal cancer, pancreatic cancer,
ovarian cancer, uterine cancer, lymphoma, leukemia, liver
cancer, brain cancer, stomach cancer, and multiple myeloma.
204. A
Rationale: Anticipatory grieving is an appropriate nursing
diagnosis for this clients because few clients with gallbladder
cancer live more than 1 year after diagnosis. Impaired
swallowing isnt associated with gallbladder cancer. Although
surgery typically is done to remove the gallbladder and,
possibly, a section of the liver, it is isnt disfiguring and
doesnt cause Disturbed body image. Chronic low esteem
isnt appropriate nursing diagnosis at this time because the
diagnosis has just been made.
205. D
Rationale : The nurse should instruct the client to remain
supine for the time specified by the physician. Local
anesthetics used in a subrarachnoid block dont alter the gag
relax. No interactions between local anesthetics and food
oocur. Local anesthetics dont cause hematuria.
206. C
Rationale : When irrigating a colostomy, the client should
insert the catheter 2 to 4 into the stoma. Inserting it less
than 2 may cause leakage: inserting it more than 4 may
cause trauma to the intestinal mucosa.
207. B
Rationale : A fixed nodular mass with dimpling of the
overlying skin in common during late stages of breast cancer.
Many women have slightly asymmetrical breasts. Bloody
nipple discharge is a sign of intraductal papilloma, a benign
condition. Multiple firm, round, freely movable masses that
change with the menstrual cycle indicate fobrocystic breasts,
a benign condition.
208. C
Rationale: Administering an antiemetic, such as
metoclopramide, and an anti-inflammatory agent, such as
dexamethasone, may reduce the severity of chemotherapy
induced nausea and vomiting. This, in turn, helps prevent
dehydration, a common complication of chemotherapy. The
other options are less likely to achieve this outcome.
209. D
Rationale: Chemotherapy commonly causes nausea and
vomiting, which may lead to fluid and electrolyte imbalances.
Signs of fluid loss include dry oral mucous membranes,
cracked lips, decreased urine output( less than 40 ml/hour),
abnormally low blood pressure, and a serum potassium level
below 3.5 mEq/L.
210 D
Rationale: When caring for a client with multiple myeloma,
the nurse should focus on relieving pain, preventing bone
injury and infection, and maintaining hydration. Monitoring
respiratory status and balancing rest and activity are
appropriate interventions for any client. To prevent such
complications as pyelonephritis and rectal calculi, the nurse
should keep the client well hydrated- not restrict his fluid
intake.
211. D
 500 Oncology Nursing Answers And Rationale
Rationale: Men can develop breast cancer, although they
seldom do. The most reliable method for detecting breast
cancer is monthly self-examination, not mammography. Lung
cancer can causes more deaths than breast cancer in women
of all ages. A mastectomy may not be required if the tumor is
small , confined and in an early stage.
212. B
Rationale: Reviewing a persons life with his loved one is
therapeutic. Abnormal grief may manifest itself in
exaggerated or excessive expressions of normal grief
reactions, such as excessive anger, sadness, or depression.
Funcral planning can be therapeutic because it allows the
individual to do one last thing for his loved one. Sharing
treasured items with other family members is therapeutic.
213. B
Rationale: Intrevesical installation of BCG commonly causes
hematuria. Other common adverse effects of BCG include
urinary frequency and dysuria. Less commonly, BCG causes
cystitis, urinary urgency, urinary incontinence, urinary tract
infection (UTI), abdominal cramps or pain, decreased bladder
capacity, tissue in urine, local infection, renal toxicity, and
genital pain. BCG isnt associated with renal calculi, delayed,
ejaculation or impotence.
214. D
Rationale: A bleeding disorder is a contraindication for
thoracentesis because a hemorrhage may occur during or
after this procedure, possibly causing death. Although a
history of a seizure disorder, chronic obstructive pulmonary
disease, or anemia calls for caution, it doesnt contraindicate
thoracentesis.
215. C
Rationale: Thiotepa interferes with DNA replication and RNA
transcription. It doesnt destroy the cell membrane
216ANS: B
RATIONALES: In the clients with bone cancer,tumor
destruction of the bone commonly causes excessive calcium
release. When the calcium-excreting capacity of the kidneys
and GI tract is exceeded, the serum calcium level rises above
normal, leading to hypercalcemia. Hyperkalemia insn't caused
by bone cancer and seldom associated with chemotherapy.
Hyponatremia and hypomagnesemia are potential adverse
effect of chemotherapy; these electrolyte imbalances
disturbances don't results directly from bone cancer.
217.ANS: B
RATIONALES: After any invasive procedure, the nurse must
stay alert for complications in the affected region---in this
case, the abdomen. This client exhibits classic signs and
symptoms of perforated colon---severe abdominal pain,fever
and a decreasing level of consciousness. After detecting these
findings the nurse must notify the physician immediately the
client is experiencing a medical emergency and requires
abd.surgery and bowel resection. There is no reason to
suspectr bleeding resulting from the liver biopsy,although
this condition must be ruled out. Bleeding would cause
hypotension and signs of decreasing perfusion to major
organs, not severe pain. Liver biopsy doesn't involve the use
of contrast media.
218.ANS: A
RATIONALES: As a part of the multidiciplinary team, the nurse
is empowered to assist the client to better understand the
process, as long as the nurse has an understanding of the
treatment plan. The nurse shouldn't discourage the client
from participating in the research study. Providing
information to the client about the clinical trial isn't beyond
the scope of nursing practice. The information doesn't need
to come from the physician who originally presented the
material to the client.
219.ANS:C
RATIONALES: A normal platelet count is 140,000 to 400,000/u
in adults. Chemotherapeutic agents produce bone marrow
depression,reducing in reduced red blood cell
counts(anemia),reduced white blood cell counts(leukopenia),
and reduced platelet counts(thrombocytopenia).
Neutropenia is the presence of reduced number of
neutrophils in the blood and is caused by bone marrow
deppression induced by chemotherapeutic agents.
220.ANS:A
RATIONALES: Antiemetics are used to trear n/v.
Antihistamines and certain steroids are also used to treat n/v.
Antimetabolites and and tumor antibiotics are classes of
chemotherapeutic medication. Anticoagulants slow blood
clotting time, thereby helping prevent thrombi and emboli.
221.ANS:D
RATIONALES: The usual adult dose of morphine sulfate is
based on 10 mg/70kg of body weight when gives
parenterally.
 500 Oncology Nursing Answers And Rationale
222.ANS:A
RATIONALES: The American Cancer Society recommends a
mammogram for women over age 40. The other statements
are incorrect. It's recommended that women bet. Ages 2-0-40
have a profesional breast examination(not a mammogram)
every 3 years.
223.ANS:C
RATIONALES: The nurse should clean the prot with an alcohol
pad before administering I.V. Fluid through the catheter to
prevent microorganisms from entering the bloodstream.
Option 1 and 2 and 4 break sterile technique.
224.ANS:C
RATIONALES: Busulfan treatment should should resume when
the WBC count rises to 50,000/mm3. Hair growth and anemia
aren't appropriate markers for resumption of busulfan
treatment.
225. D. The other characteristics relate to malignant
neoplasms.
226. B. Relieving and/or managing stress may improve
the immune systems function. Chemotherapy may
be essential to treatment. Depression may weaken
the immune system, but antidepressants may not
been proven to strengthen the immune system.
227. C. An MRI uses radio frequency signals, not sound
waves. Radioactive substances and dyes are
generally not used for this procedure.
228. C. Responding by listening and giving support is the
most appropriate response by the nurse. The other
response minimize her experience and do not
convey warmth, caring, and respect.
229. A. Chemotherapy is not a local treatment, it is a
systemic treatment. The other statements are true
230. D. This is the only statement that relates to the cell-
kill hypothesis.
231. A. The Hickman is the only example of a tunneled
catheter. Mediports and port-a-caths are surgically
implanted port and PICC is a peripherally inserted
catheter.
232. B. Cardiac toxicity can occur when a client is taking
Adriamycin. It is not prevalent with the other listed
medications
233. B. Mrs. Morrison should avoid her school-aged
grandchildren while she is immune-compromised.
She may not have adequate protection against
childhood illnesses.
234. B. The nurse should arrange for Mrs. Nordant to
confer with the surgeon and oncologist so that she
fully understands treatment options. The nurse
should never try to persuade the client to accept any
option. The other answers are not appropriate in this
situation.
235. B. Brachytherapy involves placing radioactive
materials directly in the tumor site.
236. D. Body fluids are disposed in a specially marked
container. An abdominal apron is not required. The
client with internal radiation should not have a
roommate. Any dislodged implants should be moved
with long-handled forceps.
237. C. The client should protect the skin during and after
the treatment period. Heat or ice should not be
applied to the site. Clients receiving external
radiation can hane intimate physical contact.
Washing the skin with soap and hot water can dry
the skin and wash off treatment marks.
238. D. Fluids should be encouraged, not limited. The
other steps are appropriate, as confusion is a side
effect, the medication is given subcutaneously, and
flulike symptoms can occurs.
239. B. These symptoms are consistent with anxiety. The
other problems may be contributing to anxiety, but
are not directly related to the symptoms described.
240. D. Hair often grows back in after chemotherapy, but
the color and texture may be different. The other
statements are correct.
241. B. When the temperature is 101.5 F or higher, the
friend should call. The other situations would require
a call help
242. B. A positive PPD (5 mm or greater of induration and
redness) indicates immune-competence which is
consistent with improved nutrition. The other
findings are consistent with malnutrition
243. C. Dry foods are best tolerated by the nauseated
client. The other interventions may increase nausea.
244. B. Clients with leukemia should not floss, as it might
result in sepsis. The other interventions are
appropriate.
 500 Oncology Nursing Answers And Rationale
245. B. Mr. Rodriguez should be included in the funeral
planning if he wishes as it will provide him with a
sense of control. Keeping the information from Mr.
Rodriguez may be upsetting to him. Stating that
treatment might be still effective is inappropriate.
Waiting until death may add stress t an extremely
stressful time.
246. D. Warm spiced foods may be irritating to the oral
mucosa. The other interventions would be
appropriate
247. D. Facial and arm edema are early signs and
symptoms of superior vena cava syndrome.
248. B. Changes in neurologic function may be related to
spinal cord compression. Spinal cord compression is
an emergency as it can lead to irreversible
paraplegia.
249. .ANS:D
RATIONALES: The client isn't widthdraw and doesn't show
other signs of anxiety or depression. Therefore, the nurse can
probably safely approach her about talking with others who
have had similar experiences, either through Reach for
Recovery or another formal support grp. The nurse may
educate the clients spouse or partner and listen to his
concerns,but the shouldn't tell the client spouse what to do.
The client must consult with her physician and make her own
decision about further treatment. The client to express her
sadness, frustration and fear she can't be expected and
cheerful at all times.
250 C. Lung cancers may cause ectopic secretions of
insulin, which would decrease blood sugar.
251. B
Neomycin, an antibiotic will kill pathogens present in
the urinary tract.
252. C
To assess for bladder distention, the nurse should
percus and palpate the lower abdomen. A distended
bladder will produce a dull sound and may feel firm
when palpated
253. B
After thyroidectomy, bleeding occurs. The nurse
should slip his/her hands behind the clients neck to
assess for bleeding. Blood usually pools behind the
clients neck due to gravitational pull
254. D
Deep breathing will not increase the clients
intraocular pressure
255. B
Hemorrharge is one of the most common
complication of prostectomy
256. B
Palliative treatment involves the relief of the clients
pain and discomfort.
257. B
Enzyme-linked immunosorbent assay (ELISA) screen
the presence of HIV antibodies. Western blot
confirms the presence of antibodies that are found
in response to the presence of HIV
258. C
Hand washing will lesses the bacterial load present
in the skin which may possibly infect the client
259. C
Donating blood does not expose the client to
possible HIV infection as the equipment that is used
during blood donation is disposable
260. A
In a client with AIDS, diarrhea, weight loss, anorexia
and abdominal cramping occurs from the
development of enteric pathogens including
salmonella, shigella and entamoeba.
261. D
Army nay is a retracting instrument used to hold the
tissue of the preoperative site.
262. A
 500 Oncology Nursing Answers And Rationale
Straight needles are generally reserved for
superfacial surfaces including the skin.
263. B
The layers of the skin starting from the top are the
skin subcutaneous layer facia muscle and
peritoneum
264. C
The client may have difficulty in vision after cataract
surgery, therefore, the priority of the nurse should
be the clients safety.
265. B
Turning the client on the operative side drains the
secretions by gravity.
266. A
The normal range for Pa2O is 80-100mmHg.
267. C
Marking the fluid level will provide an accurate
estimate of the amount of drainage in the pleur
evac.
268. A
Swan ganz catheter has several lumens that are used
to monitor pulmonary artery pressure(normal: 20-
30mmHg) and pulmonary capillary wedge
pressure(normal: 6-13mmHg) A CVP catheter is used
for central venous pressure monitoring.
269. D
In acute renal failure, the increased aldosterone
level due to release of rennin angiotensin causes
fluid shifting which results in the inability to excrete
excess potassium and a decreased sodium level.
270. B
Pheochromicytoma, a tumor in the adrenal medulla
causes increased epinephrine and norepinephrine
secretion which produces hypertension and
hyperglycemia.
271. D
Maintaining the patency of continuous bladder
irrigation will prevent clots and fibrin from forming
which can obstruct the flow of drainage and cause
bladder distension in post TURP client.
272. A
In a client with continuous bladder irrigation the
urine output is the fluid output less the amount of
fluid infused.
273. C
Gross hematuria usually seen in the urinary drainage
is a signs of hemorrhage. generally, drainage should
be light pink with 24h after surgery.
274. B
securing the retention catheter to the clients leg
facilitate the application of pressure of the balloon
against the small blood vessels of the prostate
tissue. This leads to vasoconstriction preventing
bleeding.
275. B
Decreased urinary stream may indicate stricture
formation. burning on urination is expected due to
the trauma caused by catheterization. The urine of
the client is usually pink-tinged.A urine output of
30ml/h is normal.
276. D
In myocardial infarction, pain is due to necrosis
(permanent damage) of the cardiac muscles while in
angina the pain is due to decreased oxygen in the
heart nuscles due to insufficient oxygen.
277. C
Left sided heart failure occurs earlier than right sided
heart failure. In left sided heart failure, congestion
occurs mainly in the lungs from backing up of blood
into the pulmonary veins and capillaries leading to
dyspnea.
278. B.
One of the best way to judge the progressin of
activity in a client with myocardial infarction is to
determine the effect of activity on the degree of
fatigue.
 500 Oncology Nursing Answers And Rationale
279. B
Furosemide is a loop diuretic which will cause loss of
potassium.
280. D
Apples contains very loss amount of sodium.
281. D
Cholangiography allows direct visualization of
common bile duct, pancreatic duct and hepatic duct
with a flexible fiber optic endoscope inserted into
the esophagus and the duodenum.
282. C
Alcohol stimulates gastric secretion that can lead to
hyperacidity. Also the client should be instructed to
avoid other stimulants like cola coffee and tea.
283. C
Backflow of gastric contents can ppotentially cause
aspiration pneumonia
284. B
Tagamet (cimetidine) inhibits histamine at the h2
receptor in the gastric parietal cells, which inhibits
gastric acids secretion.
285. D
Hypokalemia is a common complication that result
from nasogastric tube irrigation. abdominal cramp
and decreased bowel sound are indicates of
hypokalemia.
286. D
Avoiding sudden inspiratory efforts by exhaling
deeply during chest tube removel will prevent
pneumothorax.
287. C
Among the option, nasal cannula is the best
equipment that can deliver oxygen in a hypoxic
client. a nasal cannula deliver 40% oxygen and it
does not interfere with the clients ability to eat and
talk.
288. D
A reading of 35-40mmHg indicates severe
pulmonary edema.
289. B
Recent literature suggest that the elderly client is at
most risk for tuberculosis.
290. C
Pursed-lip breathing promotes carbon dioxide
elimination by enabling tha client to control the rate
and depth of respiration.
291. D
Lethargy or difficulty in arousal indicates
accumulation of metabolic waste product in the
brain resulting in deterioration of mental function
from lethargy, delirium, coma and eventual death.
292. A
The priority for the client with cholecystitis is pain
relief or promotion of comfort.
293. B
Hypoglycemia, a blood level below 50mg/dl, is not
expected in a client with pancreatitis. In pancreatitis
hyperglycemia occurs.
294. A
An insulin pump provides continous infusion of
insulin in abdomen for 24h. it is suited for busy
people.
295. B
Tegamet (cimetidine) inhibits histamine at the H2
receptor site in the gastric parietal cells, which
inhibits gastric acids secretion.
296. B
The main role of the nurse when preparing a client
for surgery is to provide general formation.
297. B
The use of incentive spirometer requires complete
exhalation followed by slow deep breathing through
the mouthpiece of the spirometer.
298. B
The stage of anesthesia proceeds as follows: loss of
consciousness, excitement, surgical anesthesia then
danger stage
299. C
 500 Oncology Nursing Answers And Rationale

Hypotension is a common side effect of epidural 309. D

anesthesia. the nurse should monitor the clients
blood pressure in the post operative period. In Wernickes or receptive aphasia, the clients speak
readily but speech lacks clear content, information
300. C
and direction. The use of short sentences and simple
General anesthesia may tend to cause relaxation of words will allow the client to comprehend
the airway. Atelectasis may develop if coughing and what the nurse is saying.
deep breathing in not done by the client.
310. B
301. D
Elder abuse is an act or omission which results in
For several weeks, the wound will drain the clients harm or threatened harm to the health or welfare of
urine until healing takes place an elderly person. The cognitivelt impaired elderly
female client is prone to abuse. Recent literature
302. B
show that the family members of the elderly are the
The vermiform appendix is located in the right lower most frequent abusers of the elderly.
quadrant. It is also the space in which the new
311. D
kidney will be placed.
Lubricating the skin around the T-tube site decreases
303. B
excoriation. skin barriers reduce contact with bile
Manifestation of kidney transplant rejection includes and may decrease skin breakdown.
decreased urine output, elevated blood pressure,
312. C
flank pain, weight gain, and elevated temperature.
To prevent the backflow of fluids in the clients
304. B
chest, the collection device must be kept below the
Leukopenia, a descrease in WBC count, occurs with level of the clients level.
the administration of anti transplant rejection
313. C
medications. The normal WBC count is 5000-
10,000/mm3 The usual amount of T-tube drainage in a 24h period
is 300-500ml. An excessive amount of drainage
305. C
indicates obstruction of the T-tube. A decrease in
The creatinine clearance provides a reasonable rate the amount of drainage may be related to kinks in
of glomerular filtration, more sensitive than the the tubing.
blood urea nitrogen (BUN)
314. D
306. A
The depressant effects of the anesthesia used during
Oseltamivir ( tamiflu) shortens the duration of the surgery causes the absence of intestinal
influenza, if taken within 24 hour or 48 after the peristalsis in the first 2-3 days after the surgery.
onset of manifestations.
315. C
307. C
The pain associated with gallbladder disease is
The priority goal of care for a client with COPD is to usually steady, severe aching pain or sensation of
promotes adequate ventilation. pressure which radiates to the right scapular area or
right shoulder.
308. D
316. B
Yogurt is rich in calcium
 500 Oncology Nursing Answers And Rationale
The baroreceptors found in the clients neck respond
to the carbon dioxide level. The response is turned
of by increased oxygen that decrease the clients
urge to breath.
317. B
Inhaling through the nose and holding breath for 1-
2s before the client exhales prevents are trpping,
improves oxygenation and removes excess CO2.
318. A
Cor pulmonale refers to a heart condition that
develops as a complication of lung disorder like
COPD which cause right ventricular hypertrophy
leading to heart failure and liver enlargement.
319. B
Frquent small meals mill minimize exertion to
prevent exhaustion of the client,
320. C
Noisy breathing in a client with tracheostomy
indicates accumulation of secretions. Tracheal
suctioning is performed when adventitious (
abnormal ) breathing sounds are detected.
321. D
Coffee contains caffeine which acts as a stimulant.
Prior to electroencephalogram ( EEG), mind altering
substances such as those with caffeine should not
given to the client 2-3 days before the rest.
322. D
The function of the optic nerve, cranial nerve II is
usually evaluated with a Snellens chart or by asking
the client to read aprinted material to assess visual
acuity.
323. D
A Glasgow coma scale score or less than 7 indicates
that the client is in come and is therefore
unresponsive.
324. C
In electroencephalography, electrodes are attached
to the scalp to provide a recording of brain activity
that is generated in the serebral cortex. It isnon-
invasive.
325. D
A client with pierced ear can undergo MRI as long as
earing and metallic objects are removed. Clients with
metal object in the body with unstable vital signs,
claustrophobia and those who weight exceeds
300lbs are not allowed to undergo the test. MRI
make use of high degree of electromagnetic field
which may dislodge metal objects. Clients who are
obese and beyond 300lbs may not fit into the MRI
scan.
326. B
Data collection is the means by which research
purpose are achieved and research question
answered
327. B
Compliance is the dependent or outcome variable
while educational status is the independent or
predictor variable.
328. A
This could be done because there is a registry of TB
clients going through DOTS ( sampling frame)
329. C
reflicatiom studies are acceptable, and in fact
needed in nursing
330. C
Multistage or cluster sampling is the most
appropriate if the area being covered is big.
331. D
Hyperglycemia is defined as an elevation of blood
sugar above is normal value of 12omg/dl
332. D
After surgery, the inflammatory process may limit
the conduction of sound
 500 Oncology Nursing Answers And Rationale
333. A
Removing the catheter slowly ensures the remaining
urine is fully drained to get accurate reading
334. B
A tumor in the adrenal medulla causes increased
epinephrine and norepinephrine secretion which
produces hypertension and hyperglycemia
335. C
The pain associated with gallbladder disease is
usually steady, severe, aching pain or sensation of
pressure which radiates to the right scapular area or
right shoulder
336. B
th
A needle is used to assess the 5 cranial nerve on
the skin of the clients face. A wisp of cotton may
also be used to assess cranial nerve V and the
corneal reflex.
337. C
Clients with myasthenia gravis suffer from
dysarthria and dysphagia from weakness of laryngeal
and pharyngeal muscles. The highest priority of the
nurse is the maintenance of a patent airway.
338. A
Bradycardia and muscle weakness in a client with
myasthenia gravis indicates cholinergic crisis.
Atropine is an anticholinergic drug used for
cholinergic crisis.
339. D
Steroid reduce the inflammatory process in the optic
nerve, thereby decreasing diplopia, a common sign
of multiple sclerosis.
340. C
A client in Parkinsons crisis is at risk for aspiration
due to excessive drooling.
341. B
If an object appears to be embedded into the clients
eye, medical intervention is required. Local
anesthetic, antibiotic and clinical expertise in using
other instrument to remove the object are needed
to prevent damage to the structure of the eye.
342. B
Addisons crisis a severe form af addisons disease is
precipitated y stress, surgery ,infection and trauma.
343. B
A liter of 5% dextrose contains 50g of sugar that
yields 4kal/g. 50x4=200 calories.
344. C
Osteoporosis is accompanied bu pain and
deterioration of articular movement and neurologic
deficits with spinal involvement that increase the
clients risk for injury.
345. C
An open-ended question provides the client more
opportunity to freely describe their pain
experienced.
346.*B. Cancer occurs when abnormal cells become tumor
cells
347. *C. malignant melanomas have increased by 80%
since 1973
348. *D. Cancer is described as a disease of aging, with 66%
of cancer deaths occurring after 65.
349. *B. The impairment of the immune system applies to all
present theories about the etiology of cancer
350. *D. Some cancers such as cervical cancer may have viral
etiology. Option A is incorrect as this instance a viral etiology
is high probability. Option B is incorrect because not all
cancers have a viral etiology. Option C is incorrect because
the nurse can respond to this clients question.
351*D. Breast and colon cancers and melanomas have been
demonstrate to have a familial association
 500 Oncology Nursing Answers And Rationale
352.*D. An English teacher should have the lowest theoretical
risk for an occupational exposure. Miners, c3onstruction
workers, and health care workers are exposed to possible
carcinogens.
353.*D. The other characteristics relate to other malignant
neoplasm
354.B. Relieving and/or managing stress may improve the
immune systems function. Chemotherapy maybe essential to
treatment. Depression may weaken the immune system, but
antidepressants may not be indicated. Herbal remedies have
not been proven to strengthen the immune system.
355.*D. Aggressive therapy may kill the cancer cells.
Metastasis is not consistent with a death sentence. If cancer
is in the lymph system it may have spread to other organs.
Chemotherapy and radiation may results in a cure.
356.*C. Lung cancer may cause ectopic secretion insulin,
which would decrease blood sugar
357.*D
358.*D. Papilloma is a benign tumor. It is not related to
cancer, malignancy or metastatic lesion
359.*B
360.*C. An MRI uses radio frequency signals, not sound
waves. Radiopaque substances and dyes are generally not
used for this procedure
361.*B
362.*C. Responding by listening and giving support is the
most appropriate response by the nurse. The other
r3esponses minimize her experience and do not convey
warmth, caring, and respect
363.*A. Chemotherapy is not a local treatment, it is a
systemic treatment. The other statements are true
364.*D. This is the only statement that relates to the cell-kill
hypothesis
365*A. The Hickman is the only example of a tunneled
catheter. Mediports and Porth-a-caths are surgically
implanted ports and a PICC is a peripherally inserted catheter
366.*C. Fluids should be encouraged during chemotherapy.
The other interventions are appropriate.
367. *B. Cardiac toxicity can occur when a client is taking
Adriamycin. It is not prevalent with the other listed
medications
368. *C. wearing gloves, mask, and gowns are the
appropriate safety measures . chemotherapeutic agents are
not given through peripheral veins
369. *B. Mrs. Morrison should avoid her school-aged
grandchildren while she is immune-compromised. She may
not have adequate protection against childhood illnesses
370. *B. The nurse should arrange for Mrs. Nordant to confer
with the surgeon and oncologist so that she fully understands
treatment options. The nurse should never try to persuade
the client to accept any option. The other answers are not
appropriate in this situation.
371. Answer A. The client must report changes in visual acuity
immediately because this adverse effect may be irreversible.
Tamoxifen isnt associated with hearing loss. Although the
drug may cause anorexia, headache, and hot flashes, the
client need not report these adverse effects immediately
because they dont warrant a change in therapy.
372. Answer A. The liver is one of the five most common
cancer metastasis sites. The others are the lymph nodes,
lung, bone, and brain. The colon, reproductive tract, and
WBCs are occasional metastasis sites.
373. Answer B. A low-fat diet (one that maintains weight
within 20% of recommended body weight) has been found to
decrease a womans risk of breast cancer. A baseline
mammogram should be done between ages 30 and 40.
Monthly breast self-examinations should be done between
days 7 and 10 of the menstrual cycle. The client should
continue to perform monthly breast self-examinations even
when receiving yearly mammograms.
374. Answer C. Bone marrow suppression becomes
noticeable 7 to 14 days after floxuridine administration. Bone
marrow recovery occurs in 21 to 28 days.
375. D
376. C
377. Answer D. During an MRI, the client should wear no
metal objects, such as jewelry, because the strong magnetic
 500 Oncology Nursing Answers And Rationale
field can pull on them, causing injury to the client and (if they
fly off) to others. The client must lie still during the MRI but
can talk to those performing the test by way of the
microphone inside the scanner tunnel. The client should hear
thumping sounds, which are caused by the sound waves
thumping on the magnetic field.
378. Answer D. Men can develop breast cancer, although
they seldom do. The most reliable method for detecting
breast cancer is monthly self-examination, not
mammography. Lung cancer causes more deaths than breast
cancer in women of all ages. A mastectomy may not be
required if the tumor is small, confined, and in an early stage.
379. Answer D. Premenopausal women should do their self-
examination immediately after the menstrual period, when
the breasts are least tender and least lumpy. On the 1st and
last days of the cycle, the womans breasts are still very
tender. Postmenopausal women because their bodies lack
fluctuation of hormone levels, should select one particular
day of the month to do breast self-examination.
380. Answer A. Testicular cancer is highly curable, particularly
when its treated in its early stage. Self-examination allows
early detection and facilitates the early initiation of
treatment. The highest mortality rates from cancer among
men are in men with lung cancer. Testicular cancer is found
more commonly in younger men.
381. Answer C. Chlorambucil-induced alopecia occurs 2 to 3
weeks after therapy begins.
382. A
383A
384. Answer C. Thiotepa interferes with DNA replication and
RNA transcription. It doesnt destroy the cell membrane.
385. Answer B. The testicular-self examination is
recommended monthly after a warm bath or shower when
the scrotal skin is relaxed. The client should stand to examine
the testicles. Using both hands, with fingers under the
scrotum and thumbs on top, the client should gently roll the
testicles, feeling for any lumps.
386. Answer C. Thrombocytopenia indicates a decrease in the
number of platelets in the circulating blood. A major concern
is monitoring for and preventing bleeding. Option A elates to
monitoring for infection, particularly if leukopenia is present.
Options B and D, although important in the plan of care, are
not related directly to thrombocytopenia.
387. C
388. C
389. c
390. Answer D. The breast self-examination should be
performed monthly 7 days after the onset of the menstrual
period. Performing the examination weekly is not
recommended. At the onset of menstruation and during
ovulation, hormonal changes occur that may alter breast
tissue.
391. Answer A. The client is at risk of deep vein thrombosis or
thrombophlebitis after this surgery, as for any other major
surgery. For this reason, the nurse implements measures that
will prevent this complication. Range-of-motion exercises,
antiembolism stockings, and pneumatic compression boots
are helpful. The nurse should avoid using the knee gatch in
the bed, which inhibits venous return, thus placing the client
more at risk for deep vein thrombosis or thrombophlebitis.
392. Answer D. A pelvic ultrasound requires the ingestion of
large volumes of water just before the procedure. A full
bladder is necessary so that it will be visualized as such and
not mistaken for a possible pelvic growth. An abdominal
ultrasound may require that the client abstain from food or
fluid for several hours 393. C
394. D
395. a
396. Answer A. A biopsy is done to determine whether a
tumor is malignant or benign. Magnetic resonance imaging,
computed tomography scan, and ultrasound will visualize the
presence of a mass but will not confirm a diagnosis of
malignancy.
397Answer 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.
398. Answer A. Findings indicative of multiple myeloma are
an increased number of plasma cells in the bone marrow,
anemia, hypercalcemia caused by the release of calcium from
the deteriorating bone tissue, and an elevated blood urea
nitrogen level. An increased white blood cell count may or
may not be present and is not related specifically to multiple
myeloma.
399. Answer A. Alopecia is not an assessment finding in
testicular cancer. Alopecia may occur, however, as a result of
radiation or chemotherapy. Options B, C, and D are
assessment findings in testicular cancer. Back pain may
indicate metastasis to the retroperitoneal lymph nodes.
 500 Oncology Nursing Answers And Rationale
400Answer 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.
401. Answer B. The time that the nurse spends in a room of a
client with an internal radiation implant is 30 minutes per 8-
hour shift. The dosimeter badge must be worn when in the
clients room. Children younger than 16 years of age and
pregnant women are not allowed in the clients room.
402. B. Bradytherapy involves placing radioactive
material directly in tumor site.
403. D. Body fluids are disposed in an specially
remarked container. An abdominal apron is not
required. The client with internal radiation should
not have a roommate. Any dislodged implants
should be moved with long-handled forceps
404. C. The client should protect the skin during and
after the treatment period. Heat or ice should not
be applied to the site. Clients receiving external
radiation can have intimate physical contact.
Washing the skin with soap and hot water can dry
the skin and wash off treatment marks.
405. D. Fluids should be encourage, not limited. The
other steps are appropriate, as confusion is a side
effect, the medication is given subcutaneously, and
flulike symptoms can occur.
406. C
407. B. this is an indicator of poor nutrition. The
other findings do not support a diagnosis of poor
nutrition.
408. B. These symptoms are consistent with anxiety.
The other problems may contributing to anxiety,
but are not directly to the symptoms described.
409. D. hair often grows back in after chemotherapy,
but the color and texture may be different. The
other statement is correct.
410. This immunosuppressed client with cancer may
not have a fever when infection is present. The
nurse should expect that the pulse and respiratory
rate would increase with infection. An elevated
blood pressure may indicated uncontrolled pain.
411. When the temperature is 101.5 For higher, the
friend should call. The other situations would
require a call for help.
412. B. a positive PPD(5 mm or greater in induration
or redness)indicates immunocompetencewhich is
consistent with improved nutrition. The other
findings are consistent with malnutrition
413. C. Dry foods are best tolerated by the
nauseated client. The other interventions are
appropriate.
414. B. Clients with leukemia should not floss, as it
might results in sepsis. The other interventions are
appropriate.
415. B. If the client refuses to acknowledge the
change in body image, allow the client to engage in
denial as it is a protective mechanism. The other
intervention are not appropriate as they are not
empathetic and do not convey respect for the
clients experience.
416. B. Mr. Rodriguez should be included in the
funeral planning if he wishes as it will provide him
with a sense of control. Keeping the information
from Mr. Rodriguez may be upsetting to him.
Starting that treatment might be effected is
inappropriate. Waiting until death may add stress
at an extremely stressful time.
417. D. warm spiced foods may be irritating to the
oral mucosa. The other intervention would be
appropriate.
418. D. The ACS recommends a high-fiber, low-fat
diet, not a high-fat diet. The ACS recommends
minimal use of salt-cured foods and using foods
high in vitamins, not supplements.
419. B. Changes in neurologic function may be
related to spinal cord compression. Spinal cord is an
emergency as it can lead to irreversible paraplegia.
420. B. Cancer occurs when abnormal cells become tumor
cells
421. Answer A. The client with a cervical radiation implant
should be maintained on bed rest in the dorsal position to
prevent movement of the radiation source. The head of the
bed is elevated to a maximum of 10 to 15 degrees for
comfort. The nurse avoids turning the client on the side. If
turning is absolutely necessary, a pillow is placed between
 500 Oncology Nursing Answers And Rationale
the knees and, with the body in straight alignment, the client
is logrolled.
422. Answer 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.
423. Answer C. In the neutropenic client, meticulous hand
hygiene education is implemented for the client, family,
visitors, and staff. Not all visitors are restricted, but the client
is protected from persons with known infections. Fluids
should be encouraged. Invasive measures such as an
indwelling urinary catheter should be avoided to prevent
infections.
424. Answer 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.
425. Answer D. Colorectal polyps are common with colon
cancer. Duodenal ulcers and hemorrhoids arent preexisting
conditions of colorectal cancer. Weight loss not gain is
an indication of colorectal cancer.
426. Answer B. The American Cancer Society guidelines state,
"Women older than age 40 should have a mammogram
annually and a clinical examination at least annually [not
every 2 years]; all women should perform breast self-
examination monthly [not annually]." The hormonal receptor
assay is done on a known breast tumor to determine whether
the tumor is estrogen- or progesterone-dependent.
427. Answer C. Indigestion, or difficulty swallowing, is one of
the seven warning signs of cancer. The other six are a change
in bowel or bladder habits, a sore that does not heal, unusual
bleeding or discharge, a thickening or lump in the breast or
elsewhere, an obvious change in a wart or mole, and a
nagging cough or hoarseness. Persistent nausea may signal
stomach cancer but isnt one of the seven major warning
signs. Rash and chronic ache or pain seldom indicate cancer.
428. Answer B. Because thrombocytopenia impairs blood
clotting, the nurse should inspect the client regularly for signs
of bleeding, such as petechiae, purpura, epistaxis, and
bleeding gums. The nurse should avoid administering aspirin
because it may increase the risk of bleeding. Frequent rest
periods are indicated for clients with anemia, not
thrombocytopenia. Strict isolation is indicated only for clients
who have highly contagious or virulent infections that are
spread by air or physical contact.
429Answer A. The American Cancer Society recommends a
mammogram yearly for women over age 40. The other
statements are incorrect. Its recommended that women
between ages 20 and 40 have a professional breast
examination (not a mammogram) every 3 years.
430. Answer B. If a radioactive implant becomes dislodged,
the nurse should pick it up with long-handled forceps and
place it in a lead-lined container, then notify the radiation
therapy department immediately. The highest priority is to
minimize radiation exposure for the client and the nurse;
therefore, the nurse must not take any action that delays
implant removal. Standing as far from the implant as possible,
leaving the room with the implant still exposed, or
attempting to put it back in place can greatly increase the risk
of harm to the client and the nurse from excessive radiation
exposure.
431. Answer: B
Rationale: The most common risk factor associated with
laryngeal cancer is cigarette smoking. Heavy alcohol use and
the combined use o
432. Correct Answer:A
a. Mother affected by cancer before 60 years of age
Rationale:
Risk for breast cancer increases twofold if first-degree female
relatives (sister, mother, or daughter) had breast cancer.
433. Correct Answer:A
a. women at higher risk for benign proliferative breast
disease.
Rationale:
Performed in the doctors office, a microcatheter is inserted
through the nipple while instilling saline and retrieving the
fluid for analysis. It has been shown to identify atypical cells
in this population and has been found to be adept at
detecting cellular changes within the breast tissue.
434. Correct Answer:A
a. Mother affected by cancer before 60 years of age
Rationale:
Risk for breast cancer increases twofold if first-degree female
relatives (sister, mother, or daughter) had breast cancer.
 500 Oncology Nursing Answers And Rationale
443. Answer: C
Rationale: Stage I lymphoma presents with no symptoms; for
this reason, clients are usually not diagnosed until the later
stages of lymphoma.
444. Answer: A
Rationale: Clients in late stages of Hodgkins disease
experience drenching diaphoresis, especially at night; fever
without chills; and unintentional weight loss. Early-stage
disease is indicated by a painless enlargement of a lymph
node on one side of the neck (cervical area). Pruritus is also a
comm
445. Answer: C
Rationale: Assessment of a client with Hodgkins disease
most often reveals enlarged, painless lymph node, fever,
malaise and night sweats
446. Answer: A
Rationale: The client will have jaundice, clay-colored stools,
and tea-colored urine resulting from blockage of the bile
drainage.
447. Answer: C
Rationale: Limiting the intake of meat and fats in the diet
would be an example of primary interventions. Risk factors
for the development of cancer of the pancreas are cigarette
smoking and eating a high-fat diet that is high in animal
protein. By changing these behaviors the client could possibly
prevent the development of cancer of the pancreas. Other
risk factors include genetic predisposition and exposure to
industrial chemicals.
448. Answer: B
Rationale: A high-fat diet plays a role in the development of
cancer of the pancreas. Options 1, 3, and 4 are risk factors
related to gastric cancer.
449. Answer: B
Rationale: Cruciferous vegetables, such as broccoli,
cauliflower, and cabbage, are high in fiber.
One of the risks for cancer of the colon is a high-fat, low-fiber,
and high-protein diet.
The longer the transit time (the time from ingestion of the
food to the elimination of the waste products) the greater the
chance of developing cancer of the colon.
450. Answer: A
Rationale: Barium enema is the radiologic visualization of the
colon using a die. To obtain accurate results in this procedure,
the bowels must be emptied of fecal material thus the need
for laxative and enema.
451. Answer: B
Rationale: The perfusion of the surgical site is compromised
as a result of the surgical incision, especially when a graft is
used.
452. Answer: C
Rationale: 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.
453. Answer: C
Rationale: The most common symptom of colon cancer is a
change in bowel habits, specifically diarrhea alternating with
constipation.
454. Answer: D
Rationale: 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.
455. Answer: D
Rationale: A side effect specific to vincristine is peripheral
neuropathy, which occurs in almost every client. Peripheral
neuropathy can be manifested as numbness and tingling in
the fingers and toes. Depression of the Achilles tendon reflex
may be the first clinical sign indicating peripheral neuropathy.
Constipation rather than diarrhea is most likely to occur with
this medication, although diarrhea may occur occasionally.
Hair loss occurs with nearly all the antineoplastic
medications. Chest Pain is unrelated to this medication.
456. Answer: D
Rationale: A side effect specific to etoposide is orthostatic
hypotension. Etoposide should be administered slowly over
30 to 60 minutes to avoid hypotension. The clients blood
pressure is monitored during the infusion. Hair loss occurs
with nearly all the antineoplastic medications. Chest Pain and
pulmonary fibrosis are unrelated to this medication.
457. Answer: D
Rationale: Alopecia (hair loss) can occur following the
administration of many antineoplastic medications. Alopecia
 500 Oncology Nursing Answers And Rationale
is reversible, but new hair growth may have a different color
and texture.
458. Answer: C
Rationale: Radiation therapy to the head and scalp area is the
treatment of choice for central nervous system involvement
of any cancer.
Radiation therapy has longer-lasting side effects than
chemotherapy. If the radiation therapy destroys the hair
follicle, the hair will not grow back.
459. Answer: B
Rationale: The marks made by the radiation oncologist guide
the technician in configuring the external beam to irradiate
the area in question without causing damage to other tissues.
These marks must remain in place and should not be washed
off. Ointments, which are petroleum-based, could cause a
radiation burn to the area. The client should be encouraged
to use a hat or scarf when in the sun to prevent damage to
the scalp skin and at night to prevent loss of body heat
through the scalp; hats and scarves also help to foster a
positive body image
460. Answer: D
Rationale: Acute Lymphocytic Leukemia (ALL) does not cause
gastric distention. It does invade the central nervous system,
and clients experience headaches and vomiting from
meningeal irritation.
461. Answer: B
Rationale: Leukemiaany of several types of cancer in which
there is a disorganized proliferation of white blood cells in the
bone marrow; acute lymphatic leukemia (ALL) has as
symptomsfever, bleeding, enlarged lymph nodes, fatigue,
weakness, symptoms of blast crisis; treatment includes
chemotherapy with combinations of asparaginase
(Elspar), prednisone, and others; Nursingencourage
walking, hydration (measure fluid intake and output), rest,
close medical care, teaching, emotional support.
462. Answer: D
Rationale: In this form of leukemia the cells seem to escape
apoptosis (programmed cell death), which results in many
thousands of mature cells clogging the body. Because the
cells are mature, the client may be asymptomatic in the early
stages.
463 Answer: A
Rationale: A left shift indicates that immature white blood
cells are being produced and released into the circulating
blood volume. This should be investigated for the malignant
process of leukemia
464. Answer: A
Rationale: Fever and Infection are hallmark symptoms of
leukemia. They occur because the bone marrow is unable to
produce white blood cells of the number and maturity
needed to fight Infection.
465. Answer: C
Rationale: Because of the granulocytopenia associated with
AML, these patients are at high risk for development of
Infection. Infection is the major cause of death in patient with
leukemia, and therefore the slightest indications of Infection
must be assessed and treated at once; weakness and fatigue
occur in patient with AML as a result of anemia caused by
defective erythropoiesis; bruising occurs in patient with AML
as a result of thrombocytopenia. Bleeding tendencies are
usually associated with fever or Infection.
466.Answer: (C) Handle him gently when assisting with
required care
Patients with cancer and bone metastasis experience severe
pain especially when moving. Bone tumors weaken the bone
to appoint at which normal activities and even position
changes can lead to fracture. During nursing care, the patient
needs to be supported and handled gently.
467. .Answer: (C) Blood pressure
Pheochromocytoma is a tumor of the adrenal medulla that
causes an increase secretion of catecholamines that can
elevate the blood pressure.
468..Answer: (B) it affects both normal and tumor cells
Chemotherapeutic agents are given to destroy the actively
proliferating cancer cells. But these agents cannot
differentiate the abnormal actively proliferating cancer cells
from those that are actively proliferating normal cells like the
cells of the bone marrow, thus the effect of bone marrow
depression.
469.Answer: (C) CT scanning uses magnetic fields and radio
frequencies to provide cross-sectional view of tumor
CT scan uses narrow beam x-ray to provide cross-sectional
view. MRI uses magnetic fields and radio frequencies to
detect tumors.
470. . Answer: (D) frequently elevating the arm of the
affected side above the level of the heart.
 500 Oncology Nursing Answers And Rationale
Elevating the arm above the level of the heart promotes good
venous return to the heart and good lymphatic drainage thus
preventing swelling
471. Answer: (B) My 7 year old twins should not come to
visit me while Im receiving treatment.
472.Answer: (D) Use a soft toothbrush and electric razor
Suppression of red bone marrow increases bleeding
susceptibility associated with thrombocytopenia, decreased
platelets. Anemia and leucopenia are the two other problems
noted with bone marrow depression.
473. Answer: (C) A hemolytic transfusion reaction
This results from a recipients antibodies that are
incompatible with transfused RBCs; also called type II
hypersensitivity; these signs result from RBC hemolysis,
agglutination, and capillary plugging that can damage renal
function, thus the flank pain and hematuria and the other
manifestations.
474..Answer: (D) Does it help you to joke about your
illness?
This non-judgmentally on the part of the nurse points out the
clients behavior.
475.Answer: (C) Allow the denial but be available to discuss
death
This does not take away the clients only way of coping, and it
permits future movement through the grieving process when
the client is ready. Dying clients move through the different
stages of grieving and the nurse must be ready to intervene in
all these stages.
476.. Answer: (B) Urinary drainage will be dependent on a
urethral catheter for 24 hours
An indwelling urethral catheter is used, because surgical
trauma can cause urinary retention leading to further
complications such as bleeding.
477..Answer: (C) Maintaining patency of a three-way Foley
catheter for cystoclysis
Patency of the catheter promotes bladder decompression,
which prevents distention and bleeding. Continuous flow of
fluid through the bladder limits clot formation and promotes
hemostasis
478..Answer: (B) Hemorrhage
After transurethral surgery, hemorrhage is common because
of venous oozing and bleeding from many small arteries in
the prostatic bed.
479..Answer: (B) Provide hemostasis
The pressure of the balloon against the small blood vessels of
the prostate creates a tampon-like effect that causes them to
constrict thereby preventing bleeding.
480..Answer: (B) Milk the catheter tubing
Milking the tubing will usually dislodge the plug and will not
harm the client. A physicians order is not necessary for a
nurse to check catheter patency.
481. . Answer: (B) Call the physician if my urinary stream
decreases
Urethral mucosa in the prostatic area is destroyed during
surgery and strictures my form with healing that causes
partial or even complete urinary obstruction.
482. B - This patient is presenting with some of the classic
adverse effects of steroid therapy, which is often part of
treatment for Hodgkins disease. These include the physical
signs of Cushings syndrome (weight gain, moon facies, thin
skin, muscle weakness, and brittle bones), along with
cataracts, hypertension, increased appetite, elevated blood
sugar, indigestion, insomnia, nervousness, restlessness, and
immunosuppression. However, in addition, prednisone is
known to produce profound mood changes known as
glucocorticoid psychosis.
483. A - Oncology Nurse Test Questions Rationale: The
patient has a hydatidiform mole. Hydatidiform moles are
cystic swellings of the chorionic villi. They usually present in
the fourth and fifth months of pregnancy with vaginal
bleeding. On exam the uterus is larger than expected for
gestational age and the serum -hCG level is much higher
than normal. Moles can be either partial or complete and are
caused by either fertilization of an egg that has lost its
chromosomes or fertilization of a normal egg with two sperm.
Partial moles may contain some fetal tissue but no viable
fetus, and a complete mole contains no fetal tissue.
Hydatidiform moles must be surgically removed because the
chorionic villi may embolize to distant sites and because
moles may lead to choriocarcinoma, an aggressive neoplasm
that metastasizes early but is very responsive to
chemotherapy.
484 D - Oncology Nurse Test Questions Rationale: When the
-globin genes are missing (as in the most severe type of -
 500 Oncology Nursing Answers And Rationale
thalassemia), excess gamma-globin chains accumulate,
leading to the formation of tetramers known as hemoglobin
Barts. These tetramers bind so strongly to oxygen that the
fetal tissues are not oxygenated properly. This severe tissue
anoxia leads to hydrops fetalis, an abnormal fluid
accumulation in at least 2 fetal compartments.
485. ) D - Oncology Nurse Test Questions Rationale: This
vignette suggests a malignancy of the liver. Hepatomas are
highly associated with chronic hepatitis B and C infections,
which are often found in health care workers due to needle
stick injuries. Other risk factors for hepatomas include
Wilsons disease, hemochromatosis, alcoholic cirrhosis, -1-
antitrypsin deficiency, and carcinogens. -Fetoprotein is a
marker for hepatomas but can also be elevated in patients
with germ cell tumors, such as yolk sac tumors. Tumor
markers should not be used for primary diagnoses, but for
confirmation and to monitor therapy.
486. A -Oncology Nurse Test Questions Rationale: Neoplastic
B lymphocytes are the cells of origin in most non-Hodgkins
lymphomas (90% of cases), with the notable exception of
lymphoblastic lymphoma, which is typically dominated by T
lymphocytes.
487 D -The testes begin life high in the abdomen and descend
to their final resting place in the scrotum. The lymphatic
drainage from the testes, therefore, is to the para-aortic
lymph nodes in the lumbar region just inferior to the renal
arteries.
488. A - This woman suffers from von Willebrands disease,
the most common inherited bleeding disorder; it results from
a defective form or overall deficiency of vWF. vWF has two
functions: it serves as the ligand for platelet adhesion to a
damaged vessel wall, and it also is the plasma carrier of factor
VIII. Due to platelet dysfunction and lack of a carrier for factor
VIII, the unique lab finding in this disease consists of an
increased bleeding time and an increased partial
thromboplastin time. Cryoprecipitate is the precipitate that
remains when fresh frozen plasma is thawed. It contains
sufficient normal vWF to correct the bleeding dyscrasia. In
addition to prolonged bleeding from mucosal surfaces as in
this patient, other symptoms include easy bleeding and skin
bleeding.
489. A - DIC can occur in the setting of obstetric
complications, sepsis, malignancy, and other conditions. It is
described as a thrombohemorrhagic process because there
are microthrombi throughout the body, and coagulation
factors and platelets are consumed actively. The active
conversion of fibrinogen to fibrin as part of the convergence
of both clotting cascades leads to decreased levels of
fibrinogen. At the same time, anticoagulation factors such as
plasmin and protein C are being activated, leading to
fibrinolysis and increased levels of D-dimers in the circulation.
490. D - The patient has a prolonged prothrombin time, likely
indicating a deficiency in one of the factors involved with the
extrinsic pathway. Vitamin K is a fat-soluble vitamin that is a
cofactor for the -carboxylation of glutamate residues of
prothrombin; factors VII, IX, and X; and proteins C and S.
Vitamin K deficiency is uncommon; however, it can occur in
the setting of oral broad-spectrum antibiotics, which suppress
the flora of the bowel and interfere with the absorption and
synthesis of this vitamin. It can also be associated with other
conditions related to fat malabsorption and diffuse liver
disease, or in the neonatal period when the intestinal flora
have not developed and the liver reserves of vitamin K are
small. Vitamin K deficiency usually presents with bleeding
diathesis, hematuria, melena, bleeding gums, and
ecchymoses.
491. B. low intake of dietary fiber.
Feedback: inflammatory bowel disease is associated with an
increased risk of colorectal cancer but there is no association
with irritable bowel symdrome.
492.. D. commonly arises from pre-existing adenomas.
rd
Feedback: colorectal cancer is the 3 most common cancer in
UK and affects male and female equally.
493. A. acute large bowel obstruction.
Feedback: acute large bowel obstruction is a characteristic
presenting feature of left sided tumours.
anemia finding of an abdominal mass are associated with
right sided tumours.
494.C. presence of involved lymph nodes.
Feedback: mucinous rather than adenocarcinoma cell type,
presence of involved lymph nodes and lack of lymphocytic
response to tumour are features associated with poor
prognosis.
495 C.associated wth 16-10% 5 year survival.
Feedback: surgery for liver metastases from colorectal cancer
is associated with a 2% mortality, can be performed if more
than 1 lesion is present and is associated with 16-40% 5 year
survival.
 500 Oncology Nursing Answers And Rationale

496. D. improves 5years survival rates for patients with Diann Sloan
Dukes C Tumours by approximately 7%. Clara Hurd
Mosbys Essential Concept of Philippine Nurse
Feedback: 5fluoracil (5FU) based chemotherapy improves 5yr Licensure Exam
survival rates for patients with Dukes tumours by NCLEX-RN Practice Questionnaires by Wilda rinehart
approximately 7%. NCLEX Reviewer
Saunders Test for self- evaluation of Nursing
497. A. In DukeS 90% patients are cured by surgery alone. Competency by Gilles & Alyn
Medical-Surgical by: Lemoun Bouf
Feedback: in Dukes A disease 90% patients are cured by
surgery alone whereas in Dukes C disease 5yr survival is 30-
40%. There is demonstrated survival advantage for 5FU based
chemotherapy for patients with both Dukes C and metastatic
disease.

498. A. Is a monoclonal antibody that targets vascular

endothelial growth factor (VEGF).

Feedback: Bevacizumab is a monoclonal antibody that targets

vascular endothelial growth factor (VEGF)

499. C. Liver capsular pain usally responds well to non-

steroidal anti-inflammatory drugs.
st
Feedback: the liver is usually the 1 site of disease
progression in patients who develop metastases and may

Cause capsular pain which usually responds well to non-

steroidal anti-inflammatory drugs.

500. D .Should be treated with using a syringe driver

containing a mixture of anti-emetics, analgesics and anti-
spasmodics.

Feedback: bowel obstruction in advanced colorectal cancer

presents commonly with vomiting, constipation and crampy
abdominal pain. there are frequently sitesof obstruction and
surgery is not useful in this situation.

References:
Oncology Nursing Review 4th Edition
By: Connie Henke Yabro
Margaret Hansen Frogge
Michelle Goodman
EXAM CRAM NCLEX-RN Practice Question
Author:Wilda Rinehart