Part 1 is to discover:

1.    A male client has an abnormal result on a a.    cancerous lumps.

Papanicolaou test. After admitting, he read his chart b.    areas of thickness or fullness.
while the nurse was out of the room, the client asks c.    changes from previous self-examinations.
what dysplasia means. Which definition should the d.    fibrocystic masses.
nurse provide?
a.    Presence of completely undifferentiated tumor cells 9.    A client, age 41, visits the gynecologist. After
that don’t resemble cells of the tissues of their origin examining her, the physician suspects cervical cancer.
b.    Increase in the number of normal cells in a normal The nurse reviews the client’s history for risk factors
arrangement in a tissue or an organ for this disease. Which history finding is a risk factor
c.    Replacement of one type of fully differentiated cell by for cervical cancer?
another in tissues where the second type normally isn’t a.    Onset of sporadic sexual activity at age 17
found b.    Spontaneous abortion at age 19
d.    Alteration in the size, shape, and organization of c.    Pregnancy complicated with eclampsia at age 27
differentiated cells d.    Human papillomavirus infection at age 32

2.    For a female client with newly diagnosed cancer, 10.    A female client is receiving methotrexate (Mexate),
the nurse formulates a nursing diagnosis of Anxiety 12 g/m2 I.V., to treat osteogenic carcinoma. During
related to the threat of death secondary to cancer methotrexate therapy, the nurse expects the client to
diagnosis. Which expected outcome would be receive which other drug to protect normal cells?
appropriate for this client? a.    probenecid (Benemid)
a.    “Client verbalizes feelings of anxiety.” b.    cytarabine (ara-C, cytosine arabinoside [Cytosar-U])
b.    “Client doesn’t guess at prognosis.” c.    thioguanine (6-thioguanine, 6-TG)
c.    “Client uses any effective method to reduce tension.” d.    leucovorin (citrovorum factor or folinic acid
d.    “Client stops seeking information.” [Wellcovorin])

3.    A male client with a cerebellar brain tumor is 11.    The nurse is interviewing a male client about his
admitted to an acute care facility. The nurse formulates past medical history. Which preexisting condition may
a nursing diagnosis of Risk for injury. Which “related- lead the nurse to suspect that a client has colorectal
to” phrase should the nurse add to complete the nursing cancer?
diagnosis statement? a.    Duodenal ulcers
a.    Related to visual field deficits b.    Hemorrhoids
b.    Related to difficulty swallowing c.    Weight gain
c.    Related to impaired balance d.    Polyps
d.    Related to psychomotor seizures
12.    Nurse Amy is speaking to a group of women about
4.    A female client with cancer is scheduled for early detection of breast cancer. The average age of the
radiation therapy. The nurse knows that radiation at women in the group is 47. Following the American
any treatment site may cause a certain adverse effect. Cancer Society guidelines, the nurse should recommend
Therefore, the nurse should prepare the client to that the women:
expect: a.    perform breast self-examination annually.
a.    hair loss. b.    have a mammogram annually.
b.    stomatitis. c.    have a hormonal receptor assay annually.
c.    fatigue. d.    have a physician conduct a clinical examination every
d.    vomiting. 2 years.

5.    Nurse April is teaching a client who suspects that 13.    A male client with a nagging cough makes an
she has a lump in her breast. The nurse instructs the appointment to see the physician after reading that this
client that a diagnosis of breast cancer is confirmed by: symptom is one of the seven warning signs of cancer.
a.    breast self-examination. What is another warning sign of cancer?
b.    mammography. a.    Persistent nausea
c.    fine needle aspiration. b.    Rash
d.    chest X-ray. c.    Indigestion
d.    Chronic ache or pain
6.    A male client undergoes a laryngectomy to treat
laryngeal cancer. When teaching the client how to care 14.    For a female client newly diagnosed with
for the neck stoma, the nurse should include which radiation-induced thrombocytopenia, the nurse should
instruction? include which intervention in the plan of care?
a.    “Keep the stoma uncovered.” a.    Administering aspirin if the temperature exceeds 102°
b.    “Keep the stoma dry.” F (38.8° C)
c.    “Have a family member perform stoma care initially b.    Inspecting the skin for petechiae once every shift
until you get used to the procedure.” c.    Providing for frequent rest periods
d.    “Keep the stoma moist.” d.    Placing the client in strict isolation

7.    A female client is receiving chemotherapy to treat 15.    Nurse Lucia is providing breast cancer education
breast cancer. Which assessment finding indicates a at a community facility. The American Cancer Society
fluid and electrolyte imbalance induced by recommends that women get mammograms:
chemotherapy? a.    yearly after age 40.
a.    Urine output of 400 ml in 8 hours b.    after the birth of the first child and every 2 years
b.    Serum potassium level of 3.6 mEq/L thereafter.
c.    Blood pressure of 120/64 to 130/72 mm Hg c.    after the first menstrual period and annually thereafter.
d.    Dry oral mucous membranes and cracked lips d.    every 3 years between ages 20 and 40 and annually
thereafter.
8.    Nurse April is teaching a group of women to
perform breast self-examination. The nurse should
explain that the purpose of performing the examination
16.    Which intervention is appropriate for the nurse 23.    What should a male client over age 52 do to help
caring for a male client in severe pain receiving a ensure early identification of prostate cancer?
continuous I.V. infusion of morphine? a.    Have a digital rectal examination and prostate-specific
a.    Assisting with a naloxone challenge test before therapy antigen (PSA) test done yearly.
begins b.    Have a transrectal ultrasound every 5 years.
b.    Discontinuing the drug immediately if signs of c.    Perform monthly testicular self-examinations,
dependence appear especially after age 50.
c.    Changing the administration route to P.O. if the client d.    Have a complete blood count (CBC) and blood urea
can tolerate fluids nitrogen (BUN) and creatinine levels checked yearly.
d.    Obtaining baseline vital signs before administering the
first dose 24.    A male client complains of sporadic epigastric
pain, yellow skin, nausea, vomiting, weight loss, and
17.    A 35 years old client with ovarian cancer is fatigue. Suspecting gallbladder disease, the physician
prescribed hydroxyurea (Hydrea), an antimetabolite orders a diagnostic workup, which reveals gallbladder
drug. Antimetabolites are a diverse group of cancer. Which nursing diagnosis may be appropriate
antineoplastic agents that interfere with various for this client?
metabolic actions of the cell. The mechanism of action a.    Anticipatory grieving
of antimetabolites interferes with: b.    Impaired swallowing
a.    cell division or mitosis during the M phase of the cell c.    Disturbed body image
cycle. d.    Chronic low self-esteem
b.    normal cellular processes during the S phase of the cell
cycle. 25.    A male client is in isolation after receiving an
c.    the chemical structure of deoxyribonucleic acid (DNA) internal radioactive implant to treat cancer. Two hours
and chemical binding between DNA molecules (cell cycle– later, the nurse discovers the implant in the bed linens.
nonspecific). What should the nurse do first?
d.    one or more stages of ribonucleic acid (RNA) a.    Stand as far away from the implant as possible and call
synthesis, DNA synthesis, or both (cell cycle–nonspecific). for help.
b.    Pick up the implant with long-handled forceps and
18.    The ABCD method offers one way to assess skin place it in a lead-lined container.
lesions for possible skin cancer. What does the A stand c.    Leave the room and notify the radiation therapy
for? department immediately.
a.    Actinic d.    Put the implant back in place, using forceps and a
b.    Asymmetry shield for self-protection, and call for help.
c.    Arcus
d.    Assessment 26.    Jeovina, with advanced breast cancer is prescribed
tamoxifen (Nolvadex). When teaching the client about
19.    When caring for a male client diagnosed with a this drug, the nurse should emphasize the importance of
brain tumor of the parietal lobe, the nurse expects to reporting which adverse reaction immediately?
assess: a.    Vision changes
a.    short-term memory impairment. b.    Hearing loss
b.    tactile agnosia. c.    Headache
c.    seizures. d.    Anorexia
d.    contralateral homonymous hemianopia.
27.    A female client with cancer is being evaluated for
20.    A female client is undergoing tests for multiple possible metastasis. Which of the following is one of the
myeloma. Diagnostic study findings in multiple most common metastasis sites for cancer cells?
myeloma include: a.    Liver
a.    a decreased serum creatinine level. b.    Colon
b.    hypocalcemia. c.    Reproductive tract
c.    Bence Jones protein in the urine. d.    White blood cells (WBCs)
d.    a low serum protein level.
28.    A 34-year-old female client is requesting
21.    A 35 years old client has been receiving information about mammograms and breast cancer.
chemotherapy to treat cancer. Which assessment She isn’t considered at high risk for breast cancer.
finding suggests that the client has developed stomatitis What should the nurse tell this client?
(inflammation of the mouth)? a.    She should have had a baseline mammogram before
a.    White, cottage cheese–like patches on the tongue age 30.
b.    Yellow tooth discoloration b.    She should eat a low-fat diet to further decrease her
c.    Red, open sores on the oral mucosa risk of breast cancer.
d.    Rust-colored sputum c.    She should perform breast self-examination during the
first 5 days of each menstrual cycle.
22.    During chemotherapy, an oncology client has a d.    When she begins having yearly mammograms, breast
nursing diagnosis of impaired oral mucous membrane self-examinations will no longer be necessary.
related to decreased nutrition and immunosuppression
secondary to the cytotoxic effects of chemotherapy. 29.    Nurse Brian is developing a plan of care for
Which nursing intervention is most likely to decrease marrow suppression, the major dose-limiting adverse
the pain of stomatitis? reaction to floxuridine (FUDR). How long after drug
a.    Recommending that the client discontinue administration does bone marrow suppression become
chemotherapy noticeable?
b.    Providing a solution of hydrogen peroxide and water a.    24 hours
for use as a mouth rinse b.    2 to 4 days
c.    Monitoring the client’s platelet and leukocyte counts c.    7 to 14 days
d.    Checking regularly for signs and symptoms of d.    21 to 28 days
stomatitis
30.    The nurse is preparing for a female client for 8.Answer C. Women are instructed to examine themselves
magnetic resonance imaging (MRI) to confirm or rule to discover changes that have occurred in the breast. Only a
out a spinal cord lesion. During the MRI scan, which of physician can diagnose lumps that are cancerous, areas of
the following would pose a threat to the client? thickness or fullness that signal the presence of a
a.    The client lies still. malignancy, or masses that are fibrocystic as opposed to
b.    The client asks questions. malignant.
c.    The client hears thumping sounds.
d.    The client wears a watch and wedding band. 9.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
1.Answer D. Dysplasia refers to an alteration in the size, and pregnancy complicated by eclampsia aren’t risk factors
shape, and organization of differentiated cells. The for cervical cancer.
presence of completely undifferentiated tumor cells that
don’t resemble cells of the tissues of their origin is called 10.Answer D. Leucovorin is administered with
anaplasia. An increase in the number of normal cells in a methotrexate to protect normal cells, which methotrexate
normal arrangement in a tissue or an organ is called could destroy if given alone. Probenecid should be avoided
hyperplasia. Replacement of one type of fully differentiated in clients receiving methotrexate because it reduces renal
cell by another in tissues where the second type normally elimination of methotrexate, increasing the risk of
isn’t found is called metaplasia. methotrexate toxicity. Cytarabine and thioguanine aren’t
used to treat osteogenic carcinoma.
2.Answer A. Verbalizing feelings is the client’s first step in
coping with the situational crisis. It also helps the health 11.Answer D. Colorectal polyps are common with colon
care team gain insight into the client’s feelings, helping cancer. Duodenal ulcers and hemorrhoids aren’t preexisting
guide psychosocial care. Option B is inappropriate because conditions of colorectal cancer. Weight loss — not gain —
suppressing speculation may prevent the client from is an indication of colorectal cancer.
coming to terms with the crisis and planning accordingly.
Option C is undesirable because some methods of reducing 12.Answer B. The American Cancer Society guidelines
tension, such as illicit drug or alcohol use, may prevent the state, "Women older than age 40 should have a
client from coming to terms with the threat of death as well mammogram annually and a clinical examination at least
as cause physiologic harm. Option D isn’t appropriate annually [not every 2 years]; all women should perform
because seeking information can help a client with cancer breast self-examination monthly [not annually]." The
gain a sense of control over the crisis. hormonal receptor assay is done on a known breast tumor
to determine whether the tumor is estrogen- or
3.Answer C. A client with a cerebellar brain tumor may progesterone-dependent.
suffer injury from impaired balance as well as disturbed
gait and incoordination. Visual field deficits, difficulty 13.Answer C. Indigestion, or difficulty swallowing, is one
swallowing, and psychomotor seizures may result from of the seven warning signs of cancer. The other six are a
dysfunction of the pituitary gland, pons, occipital lobe, change in bowel or bladder habits, a sore that does not heal,
parietal lobe, or temporal lobe — not from a cerebellar unusual bleeding or discharge, a thickening or lump in the
brain tumor. Difficulty swallowing suggests medullary breast or elsewhere, an obvious change in a wart or mole,
dysfunction. Psychomotor seizures suggest temporal and a nagging cough or hoarseness. Persistent nausea may
lobe dysfunction. signal stomach cancer but isn’t one of the seven major
warning signs. Rash and chronic ache or pain seldom
4.Answer C. Radiation therapy may cause fatigue, skin indicate cancer.
toxicities, and anorexia regardless of the treatment site.
Hair loss, stomatitis, and vomiting are site-specific, not 14.Answer B. Because thrombocytopenia impairs blood
generalized, adverse effects of radiation therapy. clotting, the nurse should inspect the client regularly for
signs of bleeding, such as petechiae, purpura, epistaxis, and
5.Answer C. Fine needle aspiration and biopsy provide bleeding gums. The nurse should avoid administering
cells for histologic examination to confirm a diagnosis of aspirin because it may increase the risk of bleeding.
cancer. A breast self-examination, if done regularly, is the Frequent rest periods are indicated for clients with anemia,
most reliable method for detecting breast lumps early. not thrombocytopenia. Strict isolation is indicated only for
Mammography is used to detect tumors that are too small clients who have highly contagious or virulent infections
to palpate. Chest X-rays can be used to pinpoint rib that are spread by air or physical contact.
metastasis.
15.Answer A. The American Cancer Society recommends a
6.Answer D. The nurse should instruct the client to keep mammogram yearly for women over age 40. The other
the stoma moist, such as by applying a thin layer of statements are incorrect. It’s recommended that women
petroleum jelly around the edges, because a dry stoma may between ages 20 and 40 have a professional breast
become irritated. The nurse should recommend placing a examination (not a mammogram) every 3 years.
stoma bib over the stoma to filter and warm air before it
enters the stoma. The client should begin performing stoma 16.Answer D. The nurse should obtain the client’s baseline
care without assistance as soon as possible to gain blood pressure and pulse and respiratory rates before
independence in self-care activities. administering the initial dose and then continue to monitor
vital signs throughout therapy. A naloxone challenge test
7.Answer D. Chemotherapy commonly causes nausea and may be administered before using a narcotic antagonist, not
vomiting, which may lead to fluid and electrolyte a narcotic agonist. The nurse shouldn’t discontinue a
imbalances. Signs of fluid loss include dry oral mucous narcotic agonist abruptly because withdrawal symptoms
membranes, cracked lips, decreased urine output (less than may occur. Morphine commonly is used as a continuous
40 ml/hour), abnormally low blood pressure, and a serum infusion in clients with severe pain regardless of the ability
potassium level below 3.5 mEq/L. to tolerate fluids.
17.Answer B. Antimetabolites act during the S phase of the diagnosis at this time because the diagnosis has just been
cell cycle, contributing to cell destruction or preventing cell made.
replication. They’re most effective against rapidly
proliferating cancers. Miotic inhibitors interfere with cell 25.Answer B. If a radioactive implant becomes dislodged,
division or mitosis during the M phase of the cell cycle. the nurse should pick it up with long-handled forceps and
Alkylating agents affect all rapidly proliferating cells by place it in a lead-lined container, then notify the radiation
interfering with DNA; they may kill dividing cells in all therapy department immediately. The highest priority is to
phases of the cell cycle and may also kill nondividing cells. minimize radiation exposure for the client and the nurse;
Antineoplastic antibiotic agents interfere with one or more therefore, the nurse must not take any action that delays
stages of the synthesis of RNA, DNA, or both, preventing implant removal. Standing as far from the implant as
normal cell growth and reproduction. possible, leaving the room with the implant still exposed, or
attempting to put it back in place can greatly increase the
18.Answer B. When following the ABCD method for risk of harm to the client and the nurse from excessive
assessing skin lesions, the A stands for "asymmetry," the B radiation exposure.
for "border irregularity," the C for "color variation," and the
D for "diameter." 26.Answer A. The client must report changes in visual
acuity immediately because this adverse effect may be
19.Answer B. Tactile agnosia (inability to identify objects irreversible. Tamoxifen isn’t associated with hearing loss.
by touch) is a sign of a parietal lobe tumor. Short-term Although the drug may cause anorexia, headache, and hot
memory impairment occurs with a frontal lobe tumor. flashes, the client need not report these adverse effects
Seizures may result from a tumor of the frontal, temporal, immediately because they don’t warrant a change in
or occipital lobe. Contralateral homonymous hemianopia therapy.
suggests an occipital lobe tumor.
27.Answer A. The liver is one of the five most common
20.Answer C. Presence of Bence Jones protein in the urine cancer metastasis sites. The others are the lymph nodes,
almost always confirms the disease, but absence doesn’t lung, bone, and brain. The colon, reproductive tract, and
rule it out. Serum calcium levels are elevated because WBCs are occasional metastasis sites.
calcium is lost from the bone and reabsorbed in the serum.
Serum protein electrophoresis shows elevated globulin 28.Answer B. A low-fat diet (one that maintains weight
spike. The serum creatinine level may also be increased. within 20% of recommended body weight) has been found
to decrease a woman’s risk of breast cancer. A baseline
21.Answer C. The tissue-destructive effects of cancer mammogram should be done between ages 30 and 40.
chemotherapy typically cause stomatitis, resulting in ulcers Monthly breast self-examinations should be done between
on the oral mucosa that appear as red, open sores. White, days 7 and 10 of the menstrual cycle. The client should
cottage cheese–like patches on the tongue suggest a continue to perform monthly breast self-examinations even
candidal infection, another common adverse effect of when receiving yearly mammograms.
chemotherapy. Yellow tooth discoloration may result from
antibiotic therapy, not cancer chemotherapy. Rust-colored 29.Answer C. Bone marrow suppression becomes
sputum suggests a respiratory disorder, such as pneumonia. noticeable 7 to 14 days after floxuridine administration.
Bone marrow recovery occurs in 21 to 28 days.
22.Answer B. To decrease the pain of stomatitis, the nurse
should provide a solution of hydrogen peroxide and water 30.Answer D. During an MRI, the client should wear no
for the client to use as a mouth rinse. (Commercially metal objects, such as jewelry, because the strong magnetic
prepared mouthwashes contain alcohol and may cause field can pull on them, causing injury to the client and (if
dryness and irritation of the oral mucosa.) The nurse also they fly off) to others. The client must lie still during the
may administer viscous lidocaine or systemic analgesics as MRI but can talk to those performing the test by way of the
prescribed. Stomatitis occurs 7 to 10 days after microphone inside the scanner tunnel. The client should
chemotherapy begins; thus, stopping chemotherapy hear thumping sounds, which are caused by the sound
wouldn’t be helpful or practical. Instead, the nurse should waves thumping on the magnetic field.
stay alert for this potential problem to ensure prompt
treatment. Monitoring platelet and leukocyte counts may
help prevent bleeding and infection but wouldn’t decrease Part 2
pain in this highly susceptible client. Checking for signs 1.    Nina, an oncology nurse educator is speaking to a
and symptoms of stomatitis also wouldn’t decrease the women’s group about breast cancer. Questions and
pain. comments from the audience reveal a misunderstanding
of some aspects of the disease. Various members of the
23.Answer A. The incidence of prostate cancer increases audience have made all of the following statements.
after age 50. The digital rectal examination, which Which one is accurate? 
identifies enlargement or irregularity of the prostate, and a.    Mammography is the most reliable method for
PSA test, a tumor marker for prostate cancer, are effective detecting breast cancer. 
diagnostic measures that should be done yearly. Testicular b.    Breast cancer is the leading killer of women of
self-examinations won’t identify changes in the prostate childbearing age. 
gland due to its location in the body. A transrectal c.    Breast cancer requires a mastectomy. 
ultrasound, CBC, and BUN and creatinine levels are d.    Men can develop breast cancer.
usually done after diagnosis to identify the extent of the
disease and potential metastases 2.    Nurse Meredith is instructing a premenopausal
woman about breast self-examination. The nurse should
24.Answer A. Anticipatory grieving is an appropriate tell the client to do her self-examination: 
nursing diagnosis for this client because few clients with a.    at the end of her menstrual cycle. 
gallbladder cancer live more than 1 year after diagnosis. b.    on the same day each month. 
Impaired swallowing isn’t associated with gallbladder c.    on the 1st day of the menstrual cycle. 
cancer. Although surgery typically is done to remove the d.    immediately after her menstrual period.
gallbladder and, possibly, a section of the liver, it isn’t
disfiguring and doesn’t cause Disturbed body image.
Chronic low self-esteem isn’t an appropriate nursing
3.    Nurse Kent is teaching a male client to perform 10.    Mina, who is suspected of an ovarian tumor is
monthly testicular self-examinations. Which of the scheduled for a pelvic ultrasound. The nurse provides
following points would be appropriate to make?  which preprocedure instruction to the client? 
a.    Testicular cancer is a highly curable type of cancer.  a.    Eat a light breakfast only 
b.    Testicular cancer is very difficult to diagnose.  b.    Maintain an NPO status before the procedure 
c.    Testicular cancer is the number one cause of cancer c.    Wear comfortable clothing and shoes for the
deaths in males.  procedure 
d.    Testicular cancer is more common in older men. d.    Drink six to eight glasses of water without voiding
before the test
4.    Rhea, has malignant lymphoma. As part of her
chemotherapy, the physician prescribes chlorambucil 11.    A male client is diagnosed as having a bowel
(Leukeran), 10 mg by mouth daily. When caring for the tumor and several diagnostic tests are prescribed. The
client, the nurse teaches her about adverse reactions to nurse understands that which test will confirm the
chlorambucil, such as alopecia. How soon after the first diagnosis of malignancy? 
administration of chlorambucil might this reaction a.    Biopsy of the tumor 
occur?  b.    Abdominal ultrasound 
a.    Immediately  c.    Magnetic resonance imaging 
b.    1 week  d.    Computerized tomography scan
c.    2 to 3 weeks 
d.    1 month 12.    A female client diagnosed with multiple myeloma
and the client asks the nurse about the diagnosis. The
5.    A male client is receiving the cell cycle–nonspecific nurse bases the response on which description of this
alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 disorder? 
weeks by bladder instillation as part of a a.    Altered red blood cell production 
chemotherapeutic regimen to treat bladder cancer. The b.    Altered production of lymph nodes 
client asks the nurse how the drug works. How does c.    Malignant exacerbation in the number of leukocytes 
thiotepa exert its therapeutic effects?  d.    Malignant proliferation of plasma cells within the bone
a.    It interferes with deoxyribonucleic acid (DNA)
replication only.  13.     Nurse Bea is reviewing the laboratory results of a
b.    It interferes with ribonucleic acid (RNA) transcription client diagnosed with multiple myeloma. Which of the
only.  following would the nurse expect to note specifically in
c.    It interferes with DNA replication and RNA this disorder? 
transcription.  a.    Increased calcium 
d.    It destroys the cell membrane, causing lysis. b.    Increased white blood cells 
c.    Decreased blood urea nitrogen level 
6.    The nurse is instructing the 35 year old client to d.    Decreased number of plasma cells in the bone marrow
perform a testicular self-examination. The nurse tells
the client:  14.    Vanessa, a community health nurse conducts a
a.    To examine the testicles while lying down  health promotion program regarding testicular cancer
b.    That the best time for the examination is after a to community members. The nurse determines that
shower  further information needs to be provided if a
c.    To gently feel the testicle with one finger to feel for a community member states that which of the following is
growth  a sign of testicular cancer? 
d.    That testicular self-examination should be done at least a.    Alopecia 
every 6 months b.    Back pain 
c.    Painless testicular swelling 
7.    A female client with cancer is receiving d.    Heavy sensation in the scrotum
chemotherapy and develops thrombocytopenia. The
nurse identifies which intervention as the highest 15.    The male client is receiving external radiation to
priority in the nursing plan of care?  the neck for cancer of the larynx. The most likely side
a.    Monitoring temperature  effect to be expected is: 
b.    Ambulation three times daily  a.    Dyspnea 
c.    Monitoring the platelet count  b.    Diarrhea 
d.    Monitoring for pathological fractures c.    Sore throat 
d.    Constipation
8.    Gian, a community health nurse is instructing a
group of female clients about breast self-examination. 16.    Nurse Joy is caring for a client with an internal
The nurse instructs the client to perform the radiation implant. When caring for the client, the nurse
examination:  should observe which of the following principles? 
a.    At the onset of menstruation  a.    Limit the time with the client to 1 hour per shift 
b.    Every month during ovulation  b.    Do not allow pregnant women into the client’s room 
c.    Weekly at the same time of day  c.    Remove the dosimeter badge when entering the client’s
d.    1 week after menstruation begins room 
d.    Individuals younger than 16 years old may be allowed
9.    Nurse Cecilia is caring for a client who has to go in the room as long as they are 6 feet away from the
undergone a vaginal hysterectomy. The nurse avoids client
which of the following in the care of this client? 
a.    Elevating the knee gatch on the bed  17.    A cervical radiation implant is placed in the client
b.    Assisting with range-of-motion leg exercises  for treatment of cervical cancer. The nurse initiates
c.    Removal of antiembolism stockings twice daily  what most appropriate activity order for this client? 
d.    Checking placement of pneumatic compression boots a.    Bed rest 
b.    Out of bed ad lib 
c.    Out of bed in a chair only 
d.    Ambulation to the bathroom only
18.    A female client is hospitalized for insertion of an 26.    Sarah, a hospice nurse visits a client dying of
internal cervical radiation implant. While giving care, ovarian cancer. During the visit, the client expresses
the nurse finds the radiation implant in the bed. The that “If I can just live long enough to attend my
initial action by the nurse is to:  daughter’s graduation, I’ll be ready to die.” Which
a.    Call the physician  phrase of coping is this client experiencing? 
b.    Reinsert the implant into the vagina immediately  a.    Anger 
c.    Pick up the implant with gloved hands and flush it b.    Denial 
down the toilet  c.    Bargaining 
d.    Pick up the implant with long-handled forceps and d.    Depression
place it in a lead container.
27.    Nurse Farah is caring for a client following a
19.    The nurse is caring for a female client mastectomy. Which assessment finding indicates that
experiencing neutropenia as a result of chemotherapy the client is experiencing a complication related to the
and develops a plan of care for the client. The nurse surgery? 
plans to:  a.    Pain at the incisional site 
a.    Restrict all visitors  b.    Arm edema on the operative side 
b.    Restrict fluid intake  c.    Sanguineous drainage in the Jackson-Pratt drain 
c.    Teach the client and family about the need for hand d.    Complaints of decreased sensation near the operative
hygiene  site
d.    Insert an indwelling urinary catheter to prevent skin
breakdown 28.    The nurse is admitting a male client with laryngeal
cancer to the nursing unit. The nurse assesses for which
20.    The home health care nurse is caring for a male most common risk factor for this type of cancer? 
client with cancer and the client is complaining of acute a.    Alcohol abuse 
pain. The appropriate nursing assessment of the client’s b.    Cigarette smoking 
pain would include which of the following?  c.    Use of chewing tobacco 
a.    The client’s pain rating  d.    Exposure to air pollutants
b.    Nonverbal cues from the client 
c.    The nurse’s impression of the client’s pain  29.    The female client who has been receiving radiation
d.    Pain relief after appropriate nursing intervention therapy for bladder cancer tells the nurse that it feels as
if she is voiding through the vagina. The nurse
21.    Nurse Mickey is caring for a client who is interprets that the client may be experiencing: 
postoperative following a pelvic exenteration and the a.    Rupture of the bladder 
physician changes the client’s diet from NPO status to b.    The development of a vesicovaginal fistula 
clear liquids. The nurse makes which priority c.    Extreme stress caused by the diagnosis of cancer 
assessment before administering the diet?  d.    Altered perineal sensation as a side effect of radiation
a.    Bowel sounds  therapy
b.    Ability to ambulate 
c.    Incision appearance  30.    The client with leukemia is receiving busulfan
d.    Urine specific gravity (Myleran) and allopurinol (Zyloprim). The nurse tells
the client that the purpose if the allopurinol is to
22.    A male client is admitted to the hospital with a prevent: 
suspected diagnosis of Hodgkin’s disease. Which a.    Nausea 
assessment findings would the nurse expect to note b.    Alopecia 
specifically in the client?  c.    Vomiting 
a.    Fatigue  d.    Hyperuricemia
b.    Weakness 
c.    Weight gain 
d.    Enlarged lymph nodes 1.    Answer D. Men can develop breast cancer, although
they seldom do. The most reliable method for detecting
23.    During the admission assessment of a 35 year old breast cancer is monthly self-examination, not
client with advanced ovarian cancer, the nurse mammography. Lung cancer causes more deaths than
recognizes which symptom as typical of the disease?  breast cancer in women of all ages. A mastectomy may not
a.    Diarrhea  be required if the tumor is small, confined, and in an early
b.    Hypermenorrhea  stage.
c.    Abdominal bleeding 
d.    Abdominal distention 2.    Answer D. Premenopausal women should do their self-
examination immediately after the menstrual period, when
24.    Nurse Kate is reviewing the complications of the breasts are least tender and least lumpy. On the 1st and
colonization with a client who has microinvasive last days of the cycle, the woman’s breasts are still very
cervical cancer. Which complication, if identified by the tender. Postmenopausal women because their bodies lack
client, indicates a need for further teaching?  fluctuation of hormone levels, should select one particular
a.    Infection  day of the month to do breast self-examination.
b.    Hemorrhage 
c.    Cervical stenosis  3.    Answer A. Testicular cancer is highly curable,
d.    Ovarian perforation particularly when it’s treated in its early stage. Self-
examination allows early detection and facilitates the early
25.    Mr. Miller has been diagnosed with bone cancer. initiation of treatment. The highest mortality rates from
You know this type of cancer is classified as:  cancer among men are in men with lung cancer. Testicular
a.    sarcoma.  cancer is found more commonly in younger men.
b.    lymphoma. 
c.    carcinoma.  4.    Answer C. Chlorambucil-induced alopecia occurs 2 to
d.    melanoma. 3 weeks after therapy begins.
5.    Answer C. Thiotepa interferes with DNA replication larynx is most likely to experience a sore throat. Options B
and RNA transcription. It doesn’t destroy the cell and D may occur with radiation to the gastrointestinal tract.
membrane. Dyspnea may occur with lung involvement.

6.    Answer B. The testicular-self examination is 16.    Answer B. The time that the nurse spends in a room
recommended monthly after a warm bath or shower when of a client with an internal radiation implant is 30 minutes
the scrotal skin is relaxed. The client should stand to per 8-hour shift. The dosimeter badge must be worn when
examine the testicles. Using both hands, with fingers under in the client’s room. Children younger than 16 years of age
the scrotum and thumbs on top, the client should gently roll and pregnant women are not allowed in the client’s room.
the testicles, feeling for any lumps.
17.    Answer A. The client with a cervical radiation
7.    Answer C. Thrombocytopenia indicates a decrease in implant should be maintained on bed rest in the dorsal
the number of platelets in the circulating blood. A major position to prevent movement of the radiation source. The
concern is monitoring for and preventing bleeding. Option head of the bed is elevated to a maximum of 10 to 15
A elates to monitoring for infection, particularly if degrees for comfort. The nurse avoids turning the client on
leukopenia is present. Options B and D, although important the side. If turning is absolutely necessary, a pillow is
in the plan of care, are not related directly to placed between the knees and, with the body in straight
thrombocytopenia. alignment, the client is logrolled.

8.    Answer D. The breast self-examination should be 18.    Answer D. A lead container and long-handled forceps
performed monthly 7 days after the onset of the menstrual should be kept in the client’s room at all times during
period. Performing the examination weekly is not internal radiation therapy. If the implant becomes
recommended. At the onset of menstruation and during dislodged, the nurse should pick up the implant with long-
ovulation, hormonal changes occur that may alter breast handled forceps and place it in the lead container. Options
tissue. A, B, and C are inaccurate interventions.

9.    Answer A. The client is at risk of deep vein thrombosis 19.    Answer C.  In the neutropenic client, meticulous hand
or thrombophlebitis after this surgery, as for any other hygiene education is implemented for the client, family,
major surgery. For this reason, the nurse implements visitors, and staff. Not all visitors are restricted, but the
measures that will prevent this complication. Range-of- client is protected from persons with known infections.
motion exercises, antiembolism stockings, and pneumatic Fluids should be encouraged. Invasive measures such as an
compression boots are helpful. The nurse should avoid indwelling urinary catheter should be avoided to prevent
using the knee gatch in the bed, which inhibits venous infections.
return, thus placing the client more at risk for deep vein
thrombosis or thrombophlebitis. 20.    Answer A. The client’s self-report is a critical
component of pain assessment. The nurse should ask the
10.    Answer D.  A pelvic ultrasound requires the ingestion client about the description of the pain and listen carefully
of large volumes of water just before the procedure. A full to the client’s words used to describe the pain. The nurse’s
bladder is necessary so that it will be visualized as such and impression of the client’s pain is not appropriate in
not mistaken for a possible pelvic growth. An abdominal determining the client’s level of pain. Nonverbal cues from
ultrasound may require that the client abstain from food or the client are important but are not the most appropriate
fluid for several hours before the procedure. Option C is pain assessment measure. Assessing pain relief is an
unrelated to this specific procedure. important measure, but this option is not related to the
subject of the question.
11.    Answer A. A biopsy is done to determine whether a
tumor is malignant or benign. Magnetic resonance imaging, 21.    Answer A. The client is kept NPO until peristalsis
computed tomography scan, and ultrasound will visualize returns, usually in 4 to 6 days. When signs of bowel
the presence of a mass but will not confirm a diagnosis of function return, clear fluids are given to the client. If no
malignancy. distention occurs, the diet is advanced as tolerated. The
most important assessment is to assess bowel sounds before
12.    Answer D. Multiple myeloma is a B-cell neoplastic feeding the client. Options B, C, and D are unrelated to the
condition characterized by abnormal malignant subject of the question.
proliferation of plasma cells and the accumulation of
mature plasma cells in the bone marrow. Options A and B 22.    Answer D. Hodgkin’s disease is a chronic progressive
are not characteristics of multiple myeloma. Option C neoplastic disorder of lymphoid tissue characterized by the
describes the leukemic process. painless enlargement of lymph nodes with progression to
extralymphatic sites, such as the spleen and liver. Weight
13.    Answer A. Findings indicative of multiple myeloma loss is most likely to be noted. Fatigue and weakness may
are an increased number of plasma cells in the bone occur but are not related significantly to the disease.
marrow, anemia, hypercalcemia caused by the release of
calcium from the deteriorating bone tissue, and an elevated 23.    Answer D. Clinical manifestations of ovarian cancer
blood urea nitrogen level. An increased white blood cell include abdominal distention, urinary frequency and
count may or may not be present and is not related urgency, pleural effusion, malnutrition, pain from pressure
specifically to multiple myeloma. caused by the growing tumor and the effects of urinary or
bowel obstruction, constipation, ascites with dyspnea, and
14.    Answer A. Alopecia is not an assessment finding in ultimately general severe pain. Abnormal bleeding, often
testicular cancer. Alopecia may occur, however, as a result resulting in hypermenorrhea, is associated with uterine
of radiation or chemotherapy. Options B, C, and D are cancer.
assessment findings in testicular cancer. Back pain may
indicate metastasis to the retroperitoneal lymph nodes. 24.    Answer D. Conization procedure involves removal of
a cone-shaped area of the cervix. Complications of the
15.    Answer C. In general, only the area in the treatment procedure include hemorrhage, infection, and cervical
field is affected by the radiation. Skin reactions, fatigue, stenosis. Ovarian perforation is not a complication.
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
25.    Answer A. Tumors that originate from bone,muscle,
and other connective tissue are called sarcomas.

26.    Answer C. Denial, bargaining, anger, depression, and

acceptance are recognized stages that a person facing a life-
threatening illness experiences. Bargaining identifies a
behavior in which the individual is willing to do anything
to avoid loss or change prognosis or fate. Denial is
expressed as shock and disbelief and may be the first
response to hearing bad news. Depression may be
manifested by hopelessness, weeping openly, or remaining
quiet or withdrawn. Anger also may be a first response to
upsetting news and the predominant theme is “why me?” or
the blaming of others.

27.    Answer B. Arm edema on the operative side

(lymphedema) is a complication following mastectomy and
can occur immediately postoperatively or may occur
months or even years after surgery. Options A, C, and D
are expected occurrences following mastectomy and do not
indicate a complication.

28.    Answer B. The most common risk factor associated

with laryngeal cancer is cigarette smoking. Heavy alcohol
use and the combined use of tobacco increase the risk.
Another risk factor is exposure to environmental pollutants.

29.    Answer B. A vesicovaginal fistula is a genital fistula

that occurs between the bladder and vagina. The fistula is
an abnormal opening between these two body parts and, if
this occurs, the client may experience drainage of urine
through the vagina. The client’s complaint is not associated
with options A, C, and D.

30.    Answer D. Allopurinol decreases uric acid production

and reduces uric acid concentrations in serum and urine. In
the client receiving chemotherapy, uric acid levels increase
as a result of the massive cell destruction that occurs from
the chemotherapy. This medication prevents or treats
hyperuricemia caused by chemotherapy. Allopurinol is not
used to prevent alopecia, nausea, or vomiting.