CANCER Although inquiry about food preferences is history

taking, it is not used in the standard nutritional status

assessment of the patient..
Situation: Aling Nena is a 60 year old woman with a malignant The information gained during nutritional status
tumor of the breast, who was admitted for modified radical assessment are:
mastectomy. • Anthropometric measurements: height, weight,
body mass index (BMI), circumferential
1. The physician has ordered 5 flourouracil, 700 mg IV once measurements
a week. When Aling Nena hears this, she says to the • Physical examination - clinical signs and symptoms
nurse, "Am I going to lose my hair?" Which is the best such as pallor, dry skin, brittle hair, mouth sores
response by the nurse? • Diet history - 24 hours diet recall to assess the
quality and quantity of food intake
• Diagnostic tests: hemoglobin, hematocrit,
a) 5-flourouracil usually does nit cause loss of hair transferring, serum protein, total lymphocyte count,
b) hair loss can occur but a wig can be worn until nitrogen balance, d-xylose absorption test, creatinine
your hair grows back excretion, serum levels
c) he physician will prescribe a medication to prevent 3. Which nursing action would best attain the goal of
this side effect from occurring providing and promoting coping for Aling Nena?
d) losing your hair is less traumatic than losing breast
a) telling Aling Nena for her strengths and progress
The drug can cause alopecia or hair loss but the hair b) planning experienced for her that are conclusive
will grow back after treatment. The nurse can advise the c) helping her to identify her problems and solutions
patient to wear a wig or other head accessories for d) giving her information on how to handle her problems
coverage. The patient should buy the wig before hair falls
out. 4. he nurse evaluates that zofran (ondansetron) is effective in
5-fluoroucacil or 5-FU is an antineoplastic drug that a client undergoing chemotherapy if which of the following
used for the cancers of the colon, rectum, breast, stomach is observed?
and pancreas.
The adverse side effects of this drug are: a) urine output is 1,500 ml/day
• Photosensitivity - advise to avoid prolonged b) the client can tolerate mechanically soft diet
exposure to sunlight and to use highly protective c) the client's anxiety is relieved
sunlight to prevent inflammatory erythematous d) the client was able to sleep
dermatitis
• advise patient she cannot get pregnant or Zofran is antiemetic. The drug is effective if the client
breastfeed while under medication because of its toxic is no longer experiencing nausea and vomiting. Therefore,
effect the client can already tolerate food.
• advise patient to discontinue drug and report to
physician if diarrhea occurs as it is a sign of toxicity 5. A client with cancer of the colon who is receiving
• Mouth sores (stomatitis) - apply topical anesthetics chemotherapy tells a nurse that some foods on the metal
for comfort, advise oral hygiene to prevent infection of tray taste bitter. The nurse would try ti limit which of the
the denuded oral mucosa following foods that is most likely to cause this taste for the
• Nausea, vomiting, and anorexia - give antiemetic client?
before administration
• Leukopenia, anemia, agranulocytosis - avoid a) cantaloupe
exposure to infection b) potatoes
• Scaling of the skin, pruritus, desquamative rash of c) beef
hands and feet, and nail changes - reversible after d) custard
medication, can be treated with pyridoxine 50-150 mg
for 7 days Meat is perceived as bitter by clients with cancer.
• Thrombocytopenia - avoid IM injections when
platelet count goes below 50,000 6. A client suspected of having lung tumor is scheduled for a
• if crystals form in the drug - redissolve by warming computerized tomography (CT) scan with dye injection. A
solution nurse tells the client that
• do not use cloudy solution, do not refrigirate, protect
a) the test may be painful
from sunlight, discard unused portion after 1 hour
b) the dye injected may cause a warm, flushing
• use plastic IV bags if to be infused by intravenous
sensation
route as the drug is more stable in plastic than glass
c) fluids will be restricted following the test
d) the test takes approximately 2 hours
2. Aling Nena is being assessed of her nutritional status. She
weigh 100 lbs and is 5'8 ft. tall. Her assessment would
Iodinated contrast medium causes warm, flushing
include the following except:
sensation as it is injected.
a) a diet history
7. Which of the following is a nursing responsibility for a
b) anthropometric measurements
client undergoing external radiation therapy?
c) food preferences
d) serum protein
a) wear gown, gloves and mask
b) observe time, distance, and shielding
 c) provide the client adequate rest and schedule
activity Each contact with the client undergoing internal
d) place the client in isolation for few days radiation therapy should last for 5 minutes only, a total of
30 minutes in an 8-hour shift, to minimize radiation
Fatigue is a side effect of external radiation therapy. contamination. The nurse should wear dosimeter badge to
Answers A, B, and D are practiced in internal radiation measure radiation exposure.
therapy.
13. A client is suspected of having pheochromocytoma. Which
8. Who among these clients is at high risk to develop of the following signs and symptoms would help support
testicular cancer? this diagnosis?

a) the client has undescended testes at birth a) abdominal pain

b) the client has human papilloma virus b) anuria
c) the client has recurrent urinary tract infection c) hypertension
d) the client is uncircumcised d) weight gain

History of undescended testes at birth is strongly
linked with testicular cancer.
9. A nursing assistant is taking care of a patient who had
undergone liver biopsy. When should the registered nurse
intervene?
Pheochromocytoma is a tumor in the adrenal medulla
that stimulates increased secretion of catecholamines
(epinephrine/norepinephrine). This causes hypertension.
14. Before uterine radioactive implant is inserted, which of the
following physician's orders does the nurse expect?

a) when the nursing assistant monitors the patient's vital a) administer analgesic
signs every 15 minutes for the 1st two hours after the b) administer sedative
procedure c) administer enema
b) when the nursing assistant tells the patient to remain d) administer antibiotic
in bed for several hours
c) when the nursing assistant positions the patient During uterine radioactive implant, the client should
on the left side be on bedrest. Defecation should be avoided during
d) when the nursing assistant checks the biopsy site for treatment to prevent dislodgement of the implant.
bleeding Therefore, enema is usually ordered by the physician
before the treatment.
The client should be turned to the right side after liver
biopsy, not on the left side. Turning the client on the right 15. The nurse is admitting a patient with jaundice, due to
side will apply pressure on the site and will prevent pancreatic cancer. Which of the following would the nurse
bleeding. give highest priority?

10. Which of the following is a risk factor to cancer of the a) body image
colon? b) nutrition
c) skin integrity
a) diabetes mellitus d) anticipatory grieving
b) peptic ulcer
c) abdominal hernia Give priority to physiologic before psychosocial
d) high fat, high calorie diet needs. Jaundice causes severe pruritus. Therefore,
maintaining skin integrity is a priority.
High fat, high protein and high carbohydrate diet
increase the risk of cancer in the colon. 16. After receiving chemotherapy for lung cancer, a client's
platelet count falls to 98,000/cu.mm. What term should the
11. Which of the following should the nurse assess prior to nurse use to describe this low platelet count?
administration of cisplatin?
Thrombocytopenia
a) hydration The normal thrombocyte count is 150,000 to 450,000/
b) hemoglobin cu.mm.
c) weight
d) ECG 17. Which of the following should the nurse include when
providing health teachings for patients at risk of developing
Cisplatin, a neoplastic agent is nephrotoxic. The client prostatic cancer?
should be adequately hydrated before administration of
the drug. a) participate in smoking cessation program
b) perform monthly self-testicular examination
12. The client is receiving internal radiation therapy. What is c) maintain daily walking exercise
the appropriate nursing action to minimize radiation d) undergo monthly digital rectal examination
contamination?
Smoking increases risk for prostatic cancer. Choice B
a) put the soiled linens in double bag is done to detect cancer of the testes. Choice D, digital
b) keep clients things close to her bedside rectal examination is recommended annually, not monthly.
c) always wear gloves when entering the client's room
d) minimize contact with the client
18. Which of the following questions should the nurse ask in a a) dark skin, black hair
client who is at risk for breast cancer? b) coarse skin, black hair
c) fair skin, blond hair
a) does your family have a history of multiple gestation? d) oily skin, brown hair
b) does your family have a history of ovarian Clients with fair skin, blond hair are prone to skin
cancer? cancer. This is because they have lesser melanin in their
c) does your family have a history of early menopause? skin, which serves as protection of the skin.
d) does your family have a history of late menarche?
24. Which of the following statements when made by the client
History of cancer of the reproductive system (cancer with implant radiation therapy needs intervention by the
of the uterus, cervix, and ovaries) increase risk for breast nurse?
cancer.
a) I will have to go to the toilet to void
19. Which of the following client history increases risk for b) my visitors are allowed to visit me for 30 minutes only
anorectal cancer? in a day
c) the nurse needs to wear a badge when caring for me
a) chronic constipation d) I need to remain in bed during the entire duration of
b) high fiber diet the treatment
c) alcohol abuse
d) chronic inflammatory bowel disease The client receiving internal radiation therapy should
be on complete bed rest to prevent dislodgement of the
Chronic inflammatory bowel disease are primarily implant. The client has 2-way foley catheter during the
associated with anorectal cancer. treatment.
Choices B, C, and D indicate correct understanding of
20. A client will be for uterine radium implant. Which of the the patient on internal radiation therapy, and do not need
following statement when made by the client indicates the intervention by the nurse.
need for further teaching?
25. Which of the following statements when made by the client
a) my sister is coming to stay with me today after with leukemia indicates that the client understands the
implant insertion health teachings given by the nurse? Select all that apply
b) I will be in bed for the duration of the treatment
c) I will have a foley catheter in place a) I am allowed to eat raw foods
d) I will have enema before the procedure b) I have to avoid raw fruits and vegetables
c) fresh flowers should not be allowed in my room
The client on internal radiation therapy should be on d) if I developed joint pains, I should apply cold
isolation to prevent radiation contamination of other compress to the area
people. e) if I developed high fever, I should take aspirin
f) I am allowed to watch baseball games
21. Which of the following nursing actions is most appropriate g) I should use soft-bristled toothbrush
when caring for a client with radium implant?
Indicates that the client with leukemia understands
a) wear gloves when entering the client's room health teachings. A client with leukemia has low resistance
b) wear masks and gloves when performing procedures to infection and bleeding tendencies.
to the client
c) avoid staying with the client for more than 30 26. A 40-year old woman is admitted to the hospital for a
minutes in a shift radiation implant therapy to treat recently diagnosed
d) place client's soiled gowns and linens in a plastic bag cervical cancer. The most important consideration when
planning care is her
The nurse must limit her exposure to the client having
internal radiation therapy to prevent contamination. The a) level of anxiety
nurse must observe DTS (distance, time, and shielding). b) loss of income due to inability to work
Time: 5 minutes/exposure; maximum of 30 minutes in an c) support system
8-hour shift. d) energy level to perform ADL's

22. A woman had been diagnosed to have breast cancer. Anxiety is the usual response to a change in life
Which of the following factors is most significant to her situation like undergoing treatment for cancer.
prognosis?
27. When the nurse is discussing risk factors for cervical
a) she had her menarche at age 12 years cancer, which of these women would be at greatest risk?
b) her sister died of breast cancer 5 years ago
c) she delivered her first born at age 25 years a) a 25-year old woman with family history of cancer and
d) she had her menopause at age 50 years using birth control pills
b) a 50-year old woman who has several exposures to
Positive family history plays vital role in the radiation and has chronic anemia
predisposition to cancer. c) a 19-year old woman who initiated sexual
intercourse early with multiple partners
23. Which of the following are characteristics of a client most d) a 60-year old woman who had smoked cigarettes for
susceptible to develop malignant melanoma? 5 years and used diaphragm for birth control
 Early sexual intercourse and having multiple sexual b) avoid creams and lotions
partners pose highest risk to cervical cancer. c) visitors are allowed to stay in the room
d) the client should remain in bed during the entire
28. Which of the following nursing diagnoses would rank as the duration of treatment
most important in the planning of care for a client in two
weeks after the chemotherapy has begun? The client with internal radiation implant should be on
bed rest. This is to prevent dislodgment of the implant.
a) potential for infection
b) activity intolerance 33. How often should a female who is above 40 years old, go
c) impaired skin integrity for cancer detection examination?
d) self-esteem disturbance
a) daily
Chemotherapy causes immunosuppression. b) weekly
Therefore, the patient is at risk to develop infection. c) monthly
d) yearly
29. During the administration of a chemotherapeutic drug, the
nurse observes that there is a lack of blood return from the Cancer screening for females who are above 40 years
intravenous catheter. The priority action by the nurse of age should be yearly.
would be to
34. The client is receiving internal radiation therapy. The nurse
a) stop the administration of the drug immediately should
b) reposition the client's arm and continue with the
administration of the drug a) remember to give the badge to the next-shift
c) apply a tourniquet to the patient's affected arm and nurse
notify the doctor b) maintain a 30-minute close contact with the patient in
d) continue to administer the drug and assess for edema a shift
at the IV site c) wear gloves, mask and gown when entering the
client's room
Chemotherapeutic agents are irritating to tissues. d) instruct relatives no to visit the client during the entire
Lack of blood return from the IV catheter indicates that it is duration of the treatment
out of vein. Therefore, administration of the drug should be
stopped immediately. Dosimeter badge is used to measure amount of
exposure to radiation. It should be endorsed to the next
30. A patient who is receiving chemotherapy develops shift.
stomatitis. Which of the following actions would be priority
for the nurse to incorporate into the plan of care? 35. A nurse is assessing a client with metastatic breast cancer
who reports nocturia, weakness, nausea and vomiting.
a) rinse the patient's mouth with full strength hydrogen The client's serum electrolytes include potassium 4.2
peroxide every 4 hours mEq/L, sodium 135 mEq/L, calcium 7.0 mEq/L, and
b) use a soft toothbrush after each meal magnesium 2.0 mEq/L. Based on the assessment
c) provide hot tea with honey to soothe the patient's findings, the priority action for the nurse is to:
painful oral mucosa
d) use dental floss only a) start client on fluid restriction
b) administer calcium gluconate
Use soft toothbrush in a client with stomatitis to c) increase the client's IV fluids
prevent further trauma and pain to the oral mucosa. Half- d) administer Allopurinol
strength hydrogen peroxide is recommended to relieve
stomatitis not full strength. Hot beverages will further Nocturia, nausea and vomiting cause dehydration.
cause irritation. Honey may support proliferation of Therefore, the correct nursing action is to increase the
microorganisms in the oral mucosa. Flossing may also client's IV fluids.
cause trauma to the mouth and gums of the patient with
stomatitis. 36. The nurse on the oncology unit enters the room of the
client with lung cancer. Which action is most appropriate
31. Which of these findings in the breast of a patient who is for the nurse to do first?
suspected of having breast cancer would support the
diagnosis? a) check the client's IV infusion pump and IV fluid rate
b) take the client's blood pressure and pulse
a) complaints of dull, achy, pain c) assess the client's mental status
b) palpation of a mobile mass d) elevate the client's head of the bed
c) presence of an inverted nipple
d) area of discoloration skin The client with lung cancer experiences difficulty of
breathing. Therefore, the first action by the nurse is to
Inversion of nipple is one of the manifestations of facilitate the client's breathing by elevating the head of the
breast cancer. A cancerous lesion is non-mobile. bed.

32. A nurse is caring for a client with an internal radiation 37. The nurse on the oncology unit is planning care for the
implant. Which of the following instructions is appropriate? client with colon cancer who is refusing a diagnostic test.
Which action is most appropriate for the nurse to take
a) allow the client to go to the bathroom first?

a) call the radiology department to let them know the
client will not be going to take the test
b) speak with the client to determine the reason for
refusing the test
c) inform the health care provider that the client is
refusing the test
d) ask the client's spouse why the client is refusing the
test
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. A nurse is admitting a 63-year old male reporting
hemoptysis and weight loss. The nurse identifies that the
highest priority risk factor for lung cancer for this client is:
a) family history of lung cancer
b) the client works in a chemical factory
c) the client lives in a coal mining area
d) the client uses chewing tobacco
The client who is exposed to chemicals for a long
period of time is at highest risk to develop lung cancer.
39. The nurse is caring for a client with a diagnosis of cancer
who is immunosuppressed. The nurse would consider
implementing neutropenic precautions if the client's white
blood cell count was which of the following?
a) 2,000 cells/mm3
b) 5,800 cells/mm3
c) 8,400 cells/mm3
d) 11,500 cells/mm3
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. A nurse is caring for a child after removal of a brain tumor.
The nurse assesses the child for which of the following
signs that would indicate that brainstem involvement
occurred during the surgical procedure?
a) inability to swallow
b) elevated temperature
c) altered hearing ability
d) orthostatic hypotension
Vital signs and neurological status are assessed
frequently. Special attention is given to the child’s
temperature, which may be elevated because of
hypothalamic or brainstem involvement during surgery. A
cooling blanket should be in place on the bed or readily
available if the child becomes hyperthermic. Options A and
C are related to functional deficits following surgery.
Orthostatic hypotension is not a common clinical
manifestation following brain surgery. An elevated blood
pressure and widened pulse pressure may be associated
with increased intracranial pressure, which is a
complication following brain surgery.
41. The health education nurse provides instructions to a
group of clients regarding measures that will assist in
preventing skin cancer. Which statement by a client
indicates a need for further instructions?
a) I will avoid sun exposure after 3 pm
b) I will use sunscreen when participating in outdoor
activities
c) I will wear a hat, opaque clothing, and sunglasses
when in the sun
d) I will examine my body monthly for any lesions that
may be suspicious
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. The client is undergoing radiation therapy to treat lung
cancer. Following treatment, the nurse notes erythema on
the client's chest and neck, and the client is complaining of
pain at the radiation site. The nurse interprets this
assessment data a(n):
a) allergic reaction to the radiation
b) superficial injury to tissue from the radiation
c) cutaneous reaction to products formed by the lysis of
the neoplastic cells
d) ischemic injury, much like pressure ulcer formation.
caused by pressure from the linear accelerator
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. The community nurse is conducting a health promotion
program at a local school and is discussing the risk factors
associated with cervical cancer. Which of the following, if
identified by the client as a risk factor to cervical cancer,
indicates a need for further teaching?
a) smoking
b) multiple sex partners
c) first intercourse after age 20
d) annual gynecological examinations
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. The client is diagnosed as having a bowel tumor and
several diagnostic tests are prescribed. The nurse
understands that which test will confirm the diagnosis of
malignancy?
a) biopsy of tumor
b) abdominal ultrasound
c) magnetic resonance imaging
 d) computed tomography scan
A 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. The nurse is reviewing the laboratory results of a client
diagnosed with multiple myeloma. Which of the following
would the nurse expect to note specifically in this
disorder?
a) increased calcium level
b) increased white blood cells
c) decreased blood urea nitrogen level
d) decreased number of plasma cells in the bone
marrow
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. The nurse is instructing the client to perform a testicular
self-examination. The nurse tells the client:
a) to examine the testicles while lying down that the best
time for the examination is after a shower
c) to gently feel the testicles with one finger to feel
for a growth
d) that testicular self-examinations should be done at
least every 6 months
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. The client with cancer is receiving chemotherapy and
develops thrombocytopenia. The nurse identifies which
intervention as the highest priority in the nursing plan of
care?
a) monitoring temperature
b) ambulation three times daily
c) monitoring the platelet count
d) monitoring for pathological fractures
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. The nurse is monitoring the laboratory results of a client
preparing to receive chemotherapy. The nurse determines
that the white blood cell count is normal if which of the
following results were present?
a) 2000 to 5000 cells/mm3
b) 3000 to 8000 cells/mm3
c) 5000 to 10000 cells/mm3
d) 7000 to 15000 cells/mm3
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. The community health nurse is instructing a group of
female clients about breast self-examination. The nurse
instructs the clients to perform the examination:
a) at the onset of menstruation
b) every month during ovulation
c) weekly at the same time of day
d) 1 week after menstruation begins
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. The nurse is caring for a client who has undergone vaginal
hysterectomy. The nurse avoids which of the following in
the care of this client?
a) elevating the knee on the bed
b) assisting with range-of-motion leg exercises
c) removal of antiembolism stockings twice a day
d) checking placement of pneumatic compression boots
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.
51. The client suspected of an ovarian tumor is scheduled for
a pelvic ultrasound. The nurse provides which pre-
procedure instruction to the client?
a) eat a light breakfast only
b) maintain an NPO before the procedure
c) wear comfortable clothing and shoes for the
procedure
d) drink six to eight glasses of water without voiding
before the test
A pelvic ultrasound requires the ingestion of large
volumes of water just before the procedure. A full bladder
is necessary so that it will be visualized as such and not
mistaken for a possible pelvic growth. An abdominal
ultrasound may require that the client abstain from food or
fluid for several hours before the procedure. Option 3 is
unrelated to this specific procedure.
52. A client is diagnosed with multiple myeloma and the client
asks the nurse about the diagnosis. The nurse bases the
response on which description of this disorder?
a) altered red blood cell production
b) altered production of lymph nodes
c) malignant exacerbation in the number of leukocytes
d) malignant proliferation of plasma cells within the
bone
 Multiple myeloma is a B-cell neoplastic condition
characterized by abnormal malignant proliferation of
plasma cells and the accumulation of mature plasma cells
in the bone marrow. Options A and B are not
characteristics of multiple myeloma. Option C describes
the leukemic process.
53. The oncology nurse specialist provides an educational
session to nursing staff regarding the characteristics of
Hodgkin's disease. The nurse determines that further
teaching is needed if a nursing staff member states that
which of the following is a characteristic of the disease?
a) presence of Reed-Sternberg cells
b) occurs most often in the older client
c) prognosis depending on the stage of the disease
d) involvement of lymph nodes, spleen, and liver
Hodgkin’s disease is a disorder of young adults.
Options A, C, and D are characteristics of this disease.
54. The community health nurse conducts a health promotion
program regarding testicular cancer to community
members. The nurse determines that further information
needs to be provided if a community member states that
which of the following is a sign of testicular cancer?
a) alopecia
b) back pain
c) painless testicular swelling
d) heavy sensation in the scrotum
Alopecia is not an assessment finding in testicular
cancer. Alopecia may occur, however, as a result of
radiation or chemotherapy. Options B, C, and D are
assessment findings in testicular cancer. Back pain may
indicate metastasis to the retroperitoneal lymph nodes.
55. The client is receiving external radiation to the neck for
cancer of the larynx. The most likely side effect to be
expected is:
a) dyspnea
b) diarrhea
c) sore throat
d) constipation
In general, only the area in the treatment field is
affected by the radiation. Skin reactions, fatigue, nausea,
and anorexia may occur with radiation to any site, whereas
other side effects occur only when specific areas are
involved in treatment. A client receiving radiation to the
larynx is most likely to experience a sore throat. Options B
and D may occur with radiation to the gastrointestinal tract.
Dyspnea may occur with lung involvement.
56. The nurse is caring for a client with an internal radiation
implant. When caring for the client, the nurse should
observe which of the following principles?
a) limit the time with the client to 1 hour per shift
b) do not allow pregnant women into the client's
room
c) remove the dosimeter badge when entering the
client's room
d) individuals younger than 16 years old may be allowed
to go in the room as long as they are 6 feet away from
the client
The time that the nurse spends in a room of a client
with an internal radiation implant is 30 minutes per 8-hour
shift. The dosimeter badge must be worn when in the
client’s room. Children younger than 16 years of age and
pregnant women are not allowed in the client’s room.
57. A cervical radiation implant is placed in the client for the
treatment of cervical cancer. The nurse initiates what most
appropriate activity order for this client?
a) bed rest
b) out of bed ad lib
c) out of bed in a chair only
d) ambulation to the bathroom only
The client with a cervical radiation implant should be
maintained on bed rest in the dorsal position to prevent
movement of the radiation source. The head of the bed is
elevated to a maximum of 10 to 15 degrees for comfort.
The nurse avoids turning the client on the side. If turning is
absolutely necessary, a pillow is placed between the
knees and, with the body in straight alignment, the client is
logrolled.
58. The client is hospitalized for insertion of an internal
cervical radiation implant. While giving care, the nurse
finds the radiation implant in the bed. The initial action by
the nurse is to:
a) call the physician
b) reinsert the implant into the vagina immediately
c) pick up the implant with gloved hands and flush it
down the toilet
d) pick up the implant with long-handled forceps and
place it in a lead container
A lead container and long-handled forceps should be
kept in the client’s room at all times during internal
radiation therapy. If the implant becomes dislodged, the
nurse should pick up the implant with long-handled forceps
and place it in the lead container. Options A, B, and C are
inaccurate interventions.
59. The nurse is caring for a client experiencing neutropenia
as a result of chemotherapy and develops a plan of care
for the client. The nurse plants to:
a) restrict all visitors
b) restrict fluid intake
c) teach the client and family about the need for
hand hygiene
d) insert an indwelling urinary catheter to prevent skin
breakdown
In the neutropenic client, meticulous hand hygiene
education is implemented for the client, family, visitors,
and staff. Not all visitors are restricted, but the client is
protected from persons with known infections. Fluids
should be encouraged. Invasive measures such as an
indwelling urinary catheter should be avoided to prevent
infections.
60. The nurse is reviewing the laboratory results of a client
receiving chemotherapy whose platelet count is 10,000
cells/mm3. based on this laboratory value, the priority
nursing assessment is which of the following?
a) assess skin turgor
b) assess temperature
 c) assess bowel sounds
d) assess level of consciousness
A high risk of hemorrhage exists when the platelet
count is less than 20,000 cells/mm3. Fatal central nervous
system hemorrhage or massive gastrointestinal
hemorrhage can occur when the platelet count is less than
10,000 cells/mm3. The client should be assessed for
changes in level of consciousness, which may be an early
indication of an intracranial hemorrhage. Option B is a
priority nursing assessment when the white blood cell
count is low and the client is at risk for an infection.
Although options A and C are important to assess, they
are not the priority in this situation.
61. The home health care nurse is caring for a client with
cancer and the client is complaining of acute pain. The
appropriate nursing assessment of the client's pain would
include which of the following?
a) the client's pain rating
b) nonverbal cues from the client
c) the nurse's impression of the client's pain
d) pain relief after appropriate nursing intervention
The client’s self-report is a critical component of pain
assessment. The nurse should ask the client about the
description of the pain and listen carefully to the client’s
words used to describe the pain. The nurse’s impression
of the client’s pain is not appropriate in determining the
client’s level of pain. Nonverbal cues from the client are
important but are not the most appropriate pain
assessment measure. Assessing pain relief is an
important measure, but this option is not related to the
subject of the question.
62. The nurse is caring for a client who is a pelvic exenteration
and the physician changes the client's diet from NPO
status to clear liquids. The nurse makes which priority
assessment before administering the diet?
a) bowel sounds
b) ability to ambulate
c) incision appearance
d) urine specific gravity
The client is kept NPO until peristalsis returns, usually
in 4 to 6 days. When signs of bowel function return, clear
fluids are given to the client. If no distention occurs, the
diet is advanced as tolerated. The most important
assessment is to assess bowel sounds before feeding the
client. Options B, C, and D are unrelated to the subject of
the question.
63. The client is admitted to the hospital with a suspected
diagnosis of Hodgkin's disease. Which assessment finding
would the nurse expect to note specifically in the client?
a) fatigue
b) weakness
c) weight gain
d) enlarged lymph nodes
Hodgkin’s disease is a chronic progressive neoplastic
disorder of lymphoid tissue characterized by the painless
enlargement of lymph nodes with progression to
extralymphatic sites, such as the spleen and liver. Weight
loss is most likely to be noted. Fatigue and weakness may
occur but are not related significantly to the disease.
64. During the admission assessment of a client with
advanced ovarian cancer, the nurse recognizes which
symptom as typical of the disease?
a) diarrhea
b) hypermenorrhea
c) abnormal bleeding
d) abdominal distention
Clinical manifestations of ovarian cancer include
abdominal distention, urinary frequency and urgency,
pleural effusion, malnutrition, pain from pressure caused
by the growing tumor and the effects of urinary or bowel
obstruction, constipation, ascites with dyspnea, and
ultimately general severe pain. Abnormal bleeding, often
resulting in hypermenorrhea, is associated with uterine
cancer.
65. The nurse is reviewing the complications of conization with
a client who has microinvasive cervical cancer. Which
complication, if identified by the client, indicates a need for
further teaching?
a) infection
b) hemorrhage
c) cervical stenosis
d) ovarian perforation
Conization procedure involves removal of a cone-
shaped area of the cervix. Complications of the procedure
include hemorrhage, infection, and cervical stenosis.
Ovarian perforation is not a complication.
66. When assessing the laboratory results of the client with
bladder cancer and bone metastasis, the nurse notes a
calcium level of 12 mg/dl. The nurse recognizes that this is
consistent with which oncological emergency?
a) hyperkalemia
b) hypercalemia
c) spinal cord compression
d) superior vena cava syndrome
Hypercalcemia is a serum calcium level higher than
10 mg/dL, most often occurs in clients who have bone
metastasis, and is a late manifestation of extensive
malignancy. The presence of cancer in the bone causes
the bone to release calcium into the bloodstream.
67. The client reports to the nurse that when performing
testicular self-examination, he found a lump the size and
shape of a pea. The appropriate response to the client is
which of the following?
a) lumps like that are normal, don't worry
b) let me know if it gets bigger next month
c) that could be cancer. I'll ask the doctor to examine
you
d) that's important to report even though it might not
be serious
Testicular cancer almost always occurs in only one
testicle and is usually a pea-sized painless lump. The
cancer is highly curable when found early. The finding
should be reported to the physician.
68. The hospice nurse visits a client dying of ovarian cancer.
During the visit, the client expresses that "If I can just live
 long enough to attend my daughter's graduation, I'll be
ready to die." Which phase of coping is this client
experiencing?
a) anger
b) denial
c) bargaining
d) depression
Denial, bargaining, anger, depression, and
acceptance are recognized stages that a person facing a
life-threatening illness experiences. Bargaining identifies a
behavior in which the individual is willing to do anything to
avoid loss or change prognosis or fate. Denial is
expressed as shock and disbelief and may be the first
response to hearing bad news. Depression may be
manifested by hopelessness, weeping openly, or
remaining quiet or withdrawn. Anger also may be a first
response to upsetting news and the predominant theme is
“why me?” or the blaming of others.
69. The nurse is caring for a client following mastectomy.
Which assessment finding indicates that the client is
experiencing a complication related to the surgery?
a) pain at the incisional site
b) arm edema on the operative side
c) sanguineous drainage in the Jackson-Pratt drain
d) complaints of decreased sensation near the operative
side
Arm edema on the operative side (lymphedema) is a
complication following mastectomy and can occur
immediately postoperatively or may occur months or even
years after surgery. Options A, C and D are expected
occurrences following mastectomy and do not indicate a
complication.
70. The nurse is admitting a client with laryngeal cancer to the
nursing unit. The nurse assesses for which most common
risk factor for this type of cancer?
a) alcohol abuse
b) cigarette smoking
c) use of chewing tobacco
d) exposure to air pollutants
The most common risk factor associated with
laryngeal cancer is cigarette smoking. Heavy alcohol use
and the combined use of tobacco increase the risk.
Another risk factor is exposure to environmental pollutants.
71. The female client who has been receiving radiation
therapy for bladder cancer tells the nurse that it feels as if
she is voiding through the vagina. The nurse interprets
that the client may be experiencing:
a) rupture of the bladder
b) the development of a vesicovaginal fistula
c) extreme stress caused by the diagnosis of cancer
d) altered personal sensation as the side effect of
radiation therapy
A vesicovaginal fistula is a genital fistula that occurs
between the bladder and vagina. The fistula is an
abnormal opening between these two body parts and, if
this occurs, the client may experience drainage of urine
through the vagina. The client’s complaint is not
associated with options A, C, and D.
72. The client with leukemia is receiving busulfan (Myleran)
and allupurinol (Zyloprim) is prescribed for the client. The
nurse tells the client that the purpose of the allupurinol is
to prevent:
a) nausea
b) alopecia
c) vomiting
d) hyperuricemia
Allopurinol decreases uric acid production and
reduces uric acid concentrations in serum and urine. In the
client receiving chemotherapy, uric acid levels increase as
a result of the massive cell destruction that occurs from
the chemotherapy. This medication prevents or treats
hyperuricemia caused by chemotherapy. Allopurinol is not
used to prevent alopecia, nausea, or vomiting.
73. The client receiving chemotherapy is experiencing
mucositis. The nurse advises the client to use which of the
following as the best substance to rinse the mouth?
a) alcohol-based mouthwash
b) hydrogen peroxide mixture
c) lemon-flavored mouthwash
d) weak salt and bicarbonate mouth rinse
An acidic environment in the mouth is favorable for
bacterial growth, particularly in an area already
compromised from chemotherapy. Therefore, the client is
advised to rinse the mouth before every meal and at
bedtime with a weak salt and sodium bicarbonate mouth
rinse. This lessens the growth of bacteria and limits plaque
formation. The other substances are irritating to oral
tissue. If hydrogen peroxide must be used because of
severe plaque, it should be a weak solution because it
dries the mucous membranes.
74. The community nurse is conducting a health promotion
program and the topic of the discussion relates to the risk
factors for gastric cancer. Which risk factor, if identified by
a client, indicates a need for further discussion?
a) smoking
b) a high-fat diet
c) foods containing nitrates
d) a diet of smoked, highly salted, and spiced food
A high-fat diet plays a role in the development of
cancer of the pancreas. Options A, C, and D are risk
factors related to gastric cancer.
75. A gastrectomy is performed on a client with gastric cancer.
In the immediate postoperative period, the nurse notes
bloody drainage from the nasogastric tube. Which of the
following is the appropriate nursing intervention?
a) notify the physician
b) measure abdominal girth
c) irrigate the nasogastric tube
d) continue to monitor the drainage
Following gastrectomy, drainage from the nasogastric
tube is normally bloody for 24 hours postoperatively,
changes to brown-tinged, and is then to yellow or clear.
Because bloody drainage is expected in the immediate
postoperative period, the nurse should continue to monitor
the drainage. The nurse does not need to notify the
 physician at this time. Measuring abdominal girth is
performed to detect the development of distention.
Following gastrectomy, a nasogastric tube should not be
irrigated unless there are specific physician orders to do
so.
76. The nurse is teaching a client about the risk factors
associated with colorectal cancer. The nurse determines
that further teaching related to colorectal cancer is
necessary if the client identifies which of the following as
an associated risk factor?
a) age younger than 50 years
b) history of colorectal polyps
c) family history of colorectal cancer
d) chronic inflammatory bowel disease
Colorectal cancer risk factors include age older than
50 years, a family history of the disease, colorectal polyps,
and chronic inflammatory bowel disease.
77. The nurse is performing an admission assessment on a
client diagnosed with a right colon tumor. The nurse asks
the client about which characteristic symptom of this type
of tumor?
a) rectal bleeding
b) flat, ribbon-like stool
c) crampy, colicky abdominal pain
d) alternating constipation and diarrhea
Vague abdominal discomfort or crampy, colicky
abdominal pain is a characteristic symptom of a right colon
tumor. Options A, B, and D are symptoms associated with
left colon tumors.
78. The nurse is reviewing the preoperative orders of a client
with a colon tumor who is scheduled for abdominal
perineal resection and notes that the physician has
prescribed neomycin (Mycifradin) for the client. The nurse
determines that this medication has been prescribed
primarily:
a) to prevent immune dysfunction
b) because the client has an infection
c) to decrease the bacteria in the bowel
d) because the client is allergic to penicillin
To reduce the risk of contamination at the time of
surgery, the bowel is emptied and cleansed. Laxatives and
enemas are given to empty the bowel. Intestinal anti-
infectives such as neomycin or kanamycin (Kantrex) are
administered to decrease the bacteria in the bowel.
79. The nurse is assessing the perineal wound in a client who
has returned from the operating room following an
abdominal perineal resection and notes serosanguineous
drainage from the wound. Which nursing intervention is
most appropriate?
a) notify the physician
b) clamp the penrose drain
c) change the dressing as prescribed
d) remove and replace the perineal packing
Immediately after surgery, profuse serosanguineous
drainage from the perineal wound is expected. The nurse
does not need to notify the physician at this time. A
Penrose drain should not be clamped because this action
will cause the accumulation of drainage within the tissue.
Penrose drains and packing are removed gradually over a
period of 5 to 7 days as prescribed. The nurse should not
remove the perineal packing.
80. The nurse is assessing the colostomy of a client who has
had an abdominal perineal resection for a bowel tumor.
Which of the following assessment findings indicates that
the colostomy is beginning to function?
a) absent bowel sounds
b) the passage of flatus
c) the client's ability to tolerate food
d) bloody drainage from the colostomy
Following abdominal perineal resection, the nurse
would expect the colostomy to begin to function within 72
hours after surgery, although it may take up to 5 days. The
nurse should assess for a return of peristalsis, listen for
bowel sounds, and check for the passage of flatus. Absent
bowel sounds would not indicate the return of peristalsis.
The client would remain NPO until bowel sounds return
and the colostomy is functioning. Bloody drainage is not
expected from a colostomy.
81. The nurse is caring for a client following a radical neck
dissection and creation of a tracheostomy performed for
laryngeal cancer and is providing discharge instructions to
the client. Which statement by the client indicates a need
for further instructions?
a) I will protect the stoma from water
b) I need to keep powders and sprays away from the
stoma
c) I need to use an air conditioner to provide cool air
to assist in breathing
d) I need to apply a thin layer of petrolatum to the skin
around the stoma to prevent cracking
Air conditioners need to be avoided to protect from
excessive coldness. A humidifier in the home should be
used if excessive dryness is a problem. Options A, B, and
D are appropriate interventions regarding stoma care
following radical neck dissection and creation of a
tracheotomy.
82. What is the purpose of cytoreductive ("debulking") surgery
for ovarian cancer?
a) cancer control by reducing the size of the tumor
b) cancer prevention by removal of precancerous tissue
c) cancer cure by removing all gross and microscopic
tumor cells
d) cancer rehabilitation by improving the appearance of
a previously treated body part
Cytoreductive or “debulking” surgery may be used if a
large tumor cannot be completely removed as is often the
case with late-stage ovarian cancer (e.g., the tumor is
attached to a vital organ or spread throughout the
abdomen). When this occurs, as much tumor as possible
is removed and adjuvant chemotherapy or radiation may
be prescribed.
83. Hormone therapy is prescribed as the mode of treatment
for a client with prostate cancer. The nurse understands
that the goal of this form of treatment is to:
a) increase testosterone levels
 b) increase prostaglandin levels
c) limit the amount of circulating androgens
d) increase the amount of circulating androgens
Hormone therapy (androgen deprivation) is a mode of
treatment for prostatic cancer. The goal is to limit the
amount of circulating androgens because prostate cells
depend on androgen for cellular maintenance. Deprivation
of androgen often can lead to regression of disease and
improvement of symptoms.
84. The nurse is caring for a client with cancer of the prostate
following a prostatectomy. The nurse provides discharge
instructions to the client and tells the client to:
a) avoid driving the car for 1 week
b) restrict fluid intake to prevent incontinence
c) avoid lifting objects heavier than 20 lb for at least
6 weeks
d) notify the physician if small blood clots are noticed
during urination
Small pieces of tissue or blood clots can be passed
during urination for up to 2 weeks after surgery. Driving a
car and sitting for long periods of time are restricted for at
least 3 weeks. A high daily fluid intake should be
maintained to limit clot formation and prevent infection.
Option C is an accurate discharge instruction following
prostatectomy.
85. The oncology nurse is providing a teaching session to
group of nursing students regarding the risks and causes
of bladder cancer. Which statement by a student indicates
a need for further teaching?
a) bladder cancer most often occurs in women
b) using cigarettes and coffee drinking can increase the
risk
c) bladder cancer generally is seen in client older than
40
d) environmental health hazards have been attributed as
a cause
The incidence of bladder cancer is greater in men
than in women and affects the white population twice as
often as blacks. Options B, C, and D are associated with
the incidence of bladder cancer.
86. The nurse is reviewing the history of a client with bladder
cancer. The nurse expects to note documentation of which
most common symptom of this type of cancer?
a) dysuria
b) hematuria
c) urgency on urination
d) frequency of urination
The most common symptom in clients with cancer of
the bladder is hematuria. The client also may experience
irritative voiding symptoms such as frequency, urgency,
and dysuria, and these symptoms often are associated
with carcinoma in situ.
87. The nurse is caring for a client following intravesical
instillation of an alkylating chemotherapeutic agent into the
bladder for the treatment of bladder cancer. Following the
instillation, the nurse should instruct the client to:
a) urinate immediately
b) maintain strict bed rest
c) change position every 15 minutes
d) retain the instillation fluid for 30 minutes
Normally, the medication is injected into the bladder
through a urethral catheter, the catheter is clamped or
removed, and the client is asked to retain the fluid for 2
hours. The client changes position every 15 to 30 minutes
from side to side and from supine to prone or resumes all
activity immediately. The client then voids and is instructed
to drink water to flush the bladder.
88. The nurse is assessing the stoma of a client following a
ureterostomy. Which of the following should the nurse
expect to note?
a) a dry stoma
b) a pale stoma
c) a dark-colored stoma
d) a red and moist stoma
Following ureterostomy, the stoma should be red and
moist. A pale stoma may indicate an inadequate amount of
vascular supply. A dry stoma may indicate a body fluid
deficit. Any sign of darkness or duskiness in the stoma
may indicate a loss of vascular supply and must be
reported immediately or necrosis can occur.
89. The nurse is caring for a client following a mastectomy.
Which nursing intervention would assist in preventing
lymphedema of the affected arm?
a) placing cool compresses on the affected arm
b) elevating the affected arm on a pillow above heart
level
c) avoiding arm exercises in the immediate
postoperative period
d) maintaining an intravenous site below the antecubital
area on the affected site
Following mastectomy, the arm should be elevated
above the level of the heart. Simple arm exercises should
be encouraged. No blood pressure readings, injections,
intravenous lines, or blood draws should be performed on
the affected arm. Cool compresses are not a suggested
measure to prevent lymphedema from occurring.
90. The nurse is preparing a client for a mammography. The
nurse tells the client:
a ) that mammography takes about 1 hour
b) that there is no discomfort associated with the
procedure
c) to maintain an NPO status on the day of the test
d) to avoid the use of deodorants, powders, or creams
on the day of the test
Mammography takes about 15 to 30 minutes to
complete. Some discomfort may be experienced because
of the breast compression required to obtain a clear
image. There is no reason to maintain an NPO status
before the procedure. Option D is an accurate instruction.
91. A nurse is monitoring a client for signs and symptoms
related to superior vena cava syndrome. Which of the
following is an early sign of this oncological emergency?
a) cyanosis
b) arm edema
 c) periorbital edema
d) mental status changes
Superior vena cava syndrome occurs when the
superior vena cava is compressed or obstructed by tumor
growth. Early signs and symptoms generally occur in the
morning and include edema of the face, especially around
the eyes, and client complaints of tightness of a shirt or
blouse collar. As the compression worsens the client
experiences edema of the hands and arms. Mental status
changes and cyanosis are late signs.
92. A nurse manager is teaching the nursing staff about signs
and symptoms related to hypercalcemia in a client with
metastatic prostate cancer and tells the staff that which of
the following is a serious late sign of this oncological
emergency?
a) headache
b) dysphagia
c) constipation
d) electrocardiographic changes
Hypercalcemia is a late manifestation of bone
metastasis in late-stage cancer. Headache and dysphagia
are not associated with hypercalcemia. Constipation may
occur early in the process. Electrocardiogram changes
include shortened ST segment and a widened T wave.
93. As part of chemotherapy education, the nurse teaches a
female client about the risk for bleeding and self-care
during the period of the greatest bone marrow suppression
(the nadir). The nurse understands that further teaching is
needed when the client states:
a) I should avoid blowing my nose
b) I may need a platelet transfusion if my platelet count
is too low
c) I'm going to take aspirin for my headache as soon
as I get home
d) I will count the number of pads and tampons I use
when menstruating
During the period of greatest bone marrow
suppression (the nadir), the platelet count may be low,
less than 20,000 cells/mm3. Option C describes an
incorrect statement by the client. Aspirin and nonsteroidal
anti-inflammatory drugs and products that contain aspirin
should be avoided because of their antiplatelet activity,
thus further teaching is needed. Options A, B, and D are
correct statements by the client to prevent and monitor
bleeding.
94. A client with carcinoma of the lung develops syndrome of
inappropriate antidiuretic hormone (SIADH) as a
complication of the cancer. The nurse anticipates that
which of the following may be prescribed? Select all that
apply
a) radiation
b) chemotherapy
c) increased fluid intake
d) serum sodium levels
e) decreased oral sodium intake
f) medication that is antagonistic to antidiuretic
hormone
Cancer is a common cause of syndrome of
inappropriate antidiuretic hormone (SIADH). In SIADH,
excessive amounts of water are reabsorbed by the kidney
and put into the systemic circulation. The increased water
causes hyponatremia (decreased serum sodium levels)
and some degree of fluid retention. The syndrome is
managed by treating the condition and cause and usually
includes fluid restriction, increased sodium intake, and
medication with a mechanism of action that is antagonistic
to antidiuretic hormone. Sodium levels are monitored
closely because hypernatremia can develop suddenly as a
result of treatment. The immediate institution of
appropriate cancer therapy, usually radiation or
chemotherapy, can cause tumor regression so that
antidiuretic hormone synthesis and release processes
return to normal.
95. The client has undergone mastectomy. The nurse
interprets that the client is making the best adjustment to
the loss of the breast if which of the following behaviors is
observed?
a) participating in the care of the surgical drain
b) reading the postoperative care booklet
c) refusing to look at the wound
d) asking for pain medication when needed
The client demonstrates the best adaptation by
participating in her own care. This would include care of
surgical drains that would be in place for a short time after
discharge. Asking for pain medication is also an action-
oriented option, but it does not relate to acceptance of the
loss of the breast. Reading the postoperative care booklet
is useful, but is not the best of the options presented here.
Refusing to look at the wound indicates no adaptation to
the loss.
96. The client is preparing for discharge from the hospital after
radical vulvectomy. The nurse plans to teach this client
that which of the following activities is acceptable after
discharge because it will no precipitate complications?
a) sexual activity
b) walking
c) sitting for lengthy periods
d) driving a car
The client should resume activity slowly, but walking
is a beneficial activity. The client should know to rest when
fatigued. Activities to be avoided include driving, heavy
housework, wearing tight clothing, crossing the legs, and
prolonged standing or sitting. Sexual activity is prohibited
for 4 to 6 weeks after surgery.
97. The nurse has admitted a client to the clinical nursing unit
following a modified right radical mastectomy for the
treatment of breast cancer. The nurse plans to place the
right arm in which of the following positions?
a) elevated above shoulder level
b) elevated on a pillow
c) level with the right atrium
d) dependent to the right atrium
The client’s operative arm should be positioned so
that it is elevated on a pillow, and not exceeding shoulder
elevation. This promotes optimal drainage from the limb,
without impairing the circulation to the arm. If the arm is
positioned flat (option C) or dependent (option D), this
could increase the edema in the arm, which is
 contraindicated because of lymphatic disruption caused by
surgery.
98. The nurse instructs the client in breast self-examination
(BSE). The nurse tells the client to lie down and to
examine the left breast. The nurse instructs the client that
while examining the left breast, she should place a pillow
under the :
a) right shoulder
b) left shoulder
c) small of the back
d) right scapula
The nurse would instruct the client to lie down and
place a towel or pillow under the shoulder on the side of
the breast to be examined. If the left breast is to be
examined, the pillow would be placed under the left
shoulder.
99. The nurse is teaching breast self-examination (BSE) to a
client who has had a hysterectomy. The appropriate
instruction regarding when the BSE should be performed
is:
a) 7 to 10 days after menses
b) just before menses begins
c) at ovulation time
d) at a specific day of the month and on that same
day every month thereafter
If the client has had a hysterectomy or is no longer
menstruating, the breast self-examination (BSE) should be
performed on the same day every month. Options A and B
are inappropriate because the client who had a
hysterectomy would not be menstruating. It is best not to
perform the BSE at ovulation time because of the
hormonal changes that occur.
100. The 32 y/o female client has a history of fibrocyctic
disorder of the breasts. The nurse interviewing the client
asks whether the breast lumps are more noticeable:
a) in the spring months
b) in the autumn
c) after menses
d) before menses
The nurse assesses the client with fibrocystic breast
disorder for worsening of symptoms (breast lumps, painful
breasts, and possible nipple discharge) before the onset of
menses. This is associated with cyclical hormone
changes.
101.The nurse is teaching the client who has had a
laryngectomy for laryngeal cancer how to use an artificial
larynx. The nurse tells the client to:
a) insert the device into the tracheostomy
b) hold the device alongside the neck
c) hold the device over the upper
The artificial larynx is an electronic device that assists
the client after laryngectomy to produce speech. There are
two types—one is held at the side of the neck and the
other is inserted into the mouth. The vibration produces a
mechanical sounding speech that is monotone in quality
but is intelligible.
102. A client is scheduled for a Papanicolaou (Pap) smear at
the next scheduled clinic visit. The nurse provides
instructions to the client regarding preparation for this test.
The nurse tells the client that:
a) the test can be performed during menstruation
b) fluids are restricted on the day of the test
c) the test is painless
d) vaginal douching is required 2 hours before the test
A Pap smear is usually painless. The test cannot be
performed during menstruation. The client needs to be
instructed to avoid douching for at least 24 hours prior to
the test. There is no reason to restrict fluids on the day of
the test.
103.The client has been hospitalized for a cervical implant. The
implant is removed and the nurse provides home care
instructions to the client. Which statement made by the
client indicates a need for further instructions?
a) cream may be used to relieve dryness or itching
b) foul-smelling vaginal discharge is a sign of an
infection
c) sexual intercourse may be resumed after 7 to 10
months
d) some vaginal bleeding is expected for 1 to 3 months
Foul-smelling vaginal discharge is expected and will
occur for some time following removal of a cervical
radiation implant. Options A, C and D are accurate
discharge instructions.
104.The nurse teaches skin care to the client receiving external
radiation therapy. Which of the following statements, if
made by the client, would indicate the need for further
instruction?
a) I will handle the area gently
b) I will avoid the use of deodorants
c) I will limit sun exposure to 1 hour daily
d) I will wear loose-fitting clothing
The client needs to be instructed to avoid exposure to
the sun. Options A, B, and D are accurate measures in the
care of a client receiving external radiation therapy.
105.A community health nurse is preparing a poster for
educational session for a group of women and will be
discussing the risk factors associated with breast cancer.
Select the risk factors for breast cancer that the nurse will
list on the poster. Select all that apply.
a) family history of breast cancer
b) early menarche
c) early menopause
d) previous cancer of the breast, uterus, or ovaries
e) multiparity
f) high-dose radiation exposure to chest
Risk factors for breast cancer include family history of
breast cancer, age older than 40 years, early menarche,
late menopause, or both, previous cancer of the breast,
uterus, or ovaries, nulliparity or first child born after age 30
years, and high-dose radiation exposure to chest.
106.A nurse is preparing a list of home care instructions
regarding stoma and laryngectomy care to a client who
 had a laryngectomy. Select all instructions that would be
included in the list
a) avoid swimming and use care when showering
b) keep the humidity in the home low
c) avoid exposure to people with infections
d) restrict fluid intake
e) obtain a Medic-Alert bracelet
f) prevent debris from entering the stoma
The nurse would teach the client how to care for the
stoma, depending on the type of laryngectomy performed.
Most interventions focus on protection of the stoma and
the prevention of infection. Interventions include to avoid
swimming, use care when showering, avoid exposure to
people with infections, prevent debris from entering the
stoma, and obtain a Medic-Alert bracelet. Additional
interventions include wearing a stoma guard or high-
collared clothing to cover the stoma, increasing the
humidity in the home, and increasing fluid intake to 3000
mL/day to keep the secretions thin.
107.A client suspected of having an abdominal tumor is
scheduled for a computed tomography (CT) scan with dye
injection. The nurse tells the client that:
a) the test may be painful
b) the dye injected may cause a warm, flushing
sensation
c) fluids will be restricted following the test
d) the test takes approximately 2 hours
Women who are in the postmenopausal phase are
taught to do BSE on the same day of every month. Before
menopause, woman should do the procedure 7 days after
the start of the menstrual cycle when the breasts are less
tender. Options A, B, and D are incorrect regarding breast
cancer and BSE in a woman who is postmenopausal.
110.A community health nurse who is conducting a teaching
session about the risks of testicular cancer has reviewed a
list of instructions regarding testicular self-examination
(TSE) with the clients attending the session. Which
statement by a client indicates a need for further
instructions?
a) TSE is performed once a month
b) TSE should be performed on the same day of each
month
c) the scrotum is held in one hand and the testicle is
rolled between the thumb and forefinger of the other
hand
d) it is best to do TSE first thing in the morning
before a bath or shower
TSE is performed once a month and should be done
on the same day of each month, as an aid to help the
client remember to perform the exam. The scrotum is held
in one hand and the testicle is rolled between the thumb
and forefinger of the other hand. It is best to perform the
exam during or after a warm shower or bath when the
scrotum is most relaxed.

CT scanning causes no pain and can take 15 to 60

minutes to perform. The dye may cause a warm flushing
sensation when injected. Fluids are encouraged following
the procedure. If an iodine dye is used, the client should
be asked about allergies to seafood or iodine.

108.A client with liver cancer receiving chemotherapy tells the

nurse that some foods on the meal tray taste bitter. The
nurse would try to limit which food that is most likely to
cause this taste for the client?

a) beef
b) potatoes
c) custard
d) cantaloupe

Chemotherapy may cause distortion of taste. Often,

beef and pork are reported to taste bitter or metallic. The
nurse can promote client nutrition by helping the client
choose alternative sources of protein in the diet. Options
B, C, and D are not likely to cause distortion of taste.

109.The community health nurse is conducting a breast cancer

screening clinic in a local neighborhood and is providing
sessions regarding breast self-examination (BSE). A
postmenopausal woman arrives at the clinic for
information on BSE. Which of the following information
should the nurse give the client?

a) it is not necessary to do BSE because you are

postmenpausal
b) you are not at risk for breast cancer because you are
in the postmenopausal phase
c) you need to perform BSE on the same day of
every month
d) mammograms performed every 5 years are sufficient
in the postmenopausal phase