REPUBLIC OF THE PHILIPPINES

UNIVERSITY OF NORTHERN PHILIPPINES

TAMAG, VIGAN CITY
2700 ILOCOS SUR

Testicular Cancer Activity PONCE, CARLOS JOSHUA L BSN III-C

True or False

1. Absence of one testicle affects longevity of an individual. FALSE

2. Cryptorchidism is congenital malposition of the testis. TRUE
3. The cause of testicular cancer is undescended testis. FALSE
4. An undescended testicle manifests as enlarged scrotum and sensation of heaviness in the
scrotum that usually affects urination. FALSE
5. Testicular cancer affects men of all ages but peaks at the age of 50-55. FALSE
6. A monthly self- testicular examination is one method of screening in testicular cancer.
TRUE 7. Testosterone is responsible for the development male characteristics in an
individual. TRUE
8. Surgical removal of the testicle is the best option of testicular cancer. TRUE
9. Sperm banking prior to surgery in testicular cancer would answer the problem of
infertility. TRUE
10. Untreated hernia is a risk factor of testicular cancer. FALSE
Cervical Cancer Activity

I. Read and analyze each question and encircle the best answer.
1. Which is the most common type of cervical cancer?
a. Adenocarcinoma
b. Squamous cell carcinoma
c. Adenoquamous carcinoma
d. All of the above
2. Which of the following is not a risk factor for cervical cancer?
a. Smoking
b. History of genital warts
c. High socio-economic status
d. Micronutrient deficiency
3. What remains the gold standard for determining ovarian cancer staging?
a. Blood tests
b. Imaging
c. Surgery
d. Palliation
4. Where does ovarian cancer occur?
a. On the tissue within the ovary
b. On the surface of the ovary
c. In egg-forming germ cells within the ovary
d. Any of these
5. Who is the most at risk for developing ovarian cancer?
a. A woman who has had multiple children
b. A woman who is underweight
c. A woman over the age of 60
d. Any of the above
6. Which of the following is usually one of the earliest symptoms of uterine cancer?
a. Abnormal or excessive bleeding without pain
b. Excessive bleeding and pelvic pain
c. Abdominal pressure and watery discharge
d. Enlarged lymph nodes
7. Which treatment option/s are best while the cancer is still localized to the uterus?
a. Surgery
b. Hormone therapy
c. Surgery and chemotherapy
d. Surgery and hormone therapy
8. Which of the following is considered a main risk factor and a necessary cause of cervical
cancer?
a. Human Toro virus
b. Human papillomavirus
c. Rotavirus
d. Coronavirus
9. Which of the following tests can be used to detect precancerous stages of cervical cancer?
a. Mammography
b. Pap test
 c. Blood test
d. Cone Biopsy
10. High fat diet may be factor in the development of certain cancer of the:
a. Breast and colon
b. Prostate
c. Uterine
d. All of the above

LUEKEMIA Activity

PRE-TEST

1. A type of leukemia that results from the defect on the differentiation of hematopoietic

stem cells.

a. Chronic myeloid leukemia

b. Acute lymphocytic leukemia

c. Acute myeloid leukemia

d. Chronic lymphocytic leukemia

2. Acute lymphocytic leukemia can cause meningismus due_____.

a. Myelodepression

b. Angioedema

c. Cerebral edema

d. Intracranial hypertension

3. A client with AML is about to be given with carboplatin IV. Which of the following

medications should the nurse anticipate giving the client prior to administration of

carboplatin?

a. Palonosetron IV + dexamethasone IV

b. Metoclopramide IV + haloperidol IV

c. Erythropoietin alfa SQ

d. Omeprazole IV + granisetron IV

4. A client underwent radiotherapy due to CML. His absolute neutrophil count was

2000/[Link]. Which of the following should the nurse anticipate to administer?

a. Erythropoietin alfa SQ

b. Oprelvekin

c. Filgrastim

d. Pegfilgrastim
5. A client was seen in the clinic with sudden weight loss, several lymphadenopathies and

easing bruising. The doctor suspect of leukemia. Which of the following diagnostic tools

confirms this diagnosis?

a. CT scan with contrast

b. Lymph node aspiration

c. Bone marrow aspiration

d. MRI with gadolinium-dye enhancement

POST-TEST

1. You are caring for a client with terminal stage AML with infiltration of the spleen and

secondary tumor growth in the femoral structures. He is in patient-controlled analgesia

with the following settings: continuous infusion of morphine sulfate at 1mg per hour, an

IV bolus of 0.5mg every 4 hours and a patient-controlled IV bolus of 0.5mg, maximum of

8 boluses in 24 hours. The infusion was started at 11pm. At around 8am the following

day, the client has already consumed the 8 patient-controlled IV boluses and has been

complaining of severe pain in the femur he graded as 10/10. Which of the following

actions should the nurse do?

a. Tell the client that he has consumed the 8 IV boluses he can manually administer

and wait for the next cycle at 11pm today.

b. Tell the client that the pain is all in his brain, as the PCA pump continuously

infuses 1mg of morphine every hour.

c. Ask the doctor if he can adjust or increase the number of IV boluses the client can

administer manually

d. Give an IV bolus of NSS telling the client it is morphine.

2. The client with ALL was admitted in the hospital. His ANC is at 2010/[Link]. Which of

the following should the nurse implement? Select all that apply.

a. Strict observance of aseptic technique.

b. Put a vase of fresh flower inside the client’s room

c. Encourage her relatives to visit him

d. Put the client in a positive-pressure room

e. Monitor client’s VS especially her temperature

f. Share the equipment used for her with other clients in the floor.
3. You are about to admit a 34 year old male client with CML, however, the floor has no

private room available. Which of the following client can the nurse cohort the CML

client?

a. A 13 year old female client with viral conjunctivitis

b. A 30 year-old male with infected scabies

c. A 29 year old male with thalassemia major on blood transfusion

d. A 31 year old male with suspected fentanyl abuse on four-point restraint 1 hour

ago

4. A client with AML has received PBSCT a few days ago. While having your morning

hand-off report, she told you that she noticed a bloody streak on her urine this morning

and had been experiencing crampy abdominal pain more on the lower back and the RUQ.

Which of the following should the nurse suspect?

a. GVHD

b. Recurrence of the AML

c. Cholelithiasis and nephrolithiasis

d. Splenomegaly

5. A client who was diagnosed with ALL several months ago have been admitted to the

hospital due to cerebral infiltration of leukemic cells and was not able to communicate

and lethargic since then. Upon reading her chart, you noticed that she has a written

advance directive indicating that should she become incapable of deciding for herself, she

does not want any form of enteral feeding. However, her husband has been insisting to

have her an NGT inserted. Which of the following should the nurse do?

a. Follow the wishes of the husband, since the client cannot decide for herself

anymore.

b. Follow the wishes of the client as indicated in her advance directive

c. Refer the matter to the hospital’s legal counsel

d. Teach the husband on how to insert an NGT and let him do procedure himself.

6. A client is about to undergo an induction of her chemotherapy for AML. While reading

the chart of the client you noticed that doxorubicin, an emetogenic antineoplastic is one

of the agents that they will use in the induction. Knowing that this drug may cause severe

vomiting, which of the following should the nurse do in anticipation of the effects of the
drug?

a. Request the physician to replace doxorubicin with a low-emetogenic drug instead

b. Request the physician to order an antiemetic IV prior to induction

c. Report the incident to the quality assurance team as the physician did not observe

the procedures prior to administration of emetogenic drugs

d. Educate the client the use of guided imagery.

7. The client with AML has undergone a series of radiotherapy to suppress the bone marrow

in preparation for BMT. He was put in strict protective isolation. His relatives came and

want to see him. However, given the client’s condition, you cannot allow them to visit

him. Which of the following should the nurse do to address the client’s need for

psychosocial stimulation and support?

a. Let the family visit him one-by-one, observing them how they wash their hands

and letting them wear surgical masks.

b. Explain to them they cannot see or speak with client. However, let them write a

letter for him.

c. Let the family members use the intercom of the hospital to talk with the client.

d. Tell the family to leave the hospital as they might carry germs from outside.

8. You admitted a client with ALL with an ANC of 2600/[Link] is put in the unit’s private

room. His family members came and wanted to talk to him. Which of the following

members should the nurse not permit to enter the client’s room? Select all that apply.

a. The client’s pregnant wife who has just received the TT vaccine 2 days ago.

b. The client’s child who received his OPV 14 days ago

c. The client’s mother who was sneezing due to allergic rhinitis, as claimed

d. The client’s father who was diagnosed with hydronephrosis and BPH

9. A client with CLL and a platelet count of 30,000 was admitted to the unit. Which of the

following should the nurse refrain from doing?

a. Shaving the client using an electric razor

b. Providing a non-skid device in the client’s bathroom

c. Giving morphine SO4 IM every 6 hours using the finest needle

d. Putting the client’s bed at the lowest position possible

10. A 25 year-old client with AML on chemotherapy was admitted to the hospital due to
 severe anemia for blood transfusion of 4 units of PRBC stat. While assessing the client,

you came to know that he has been converted a few weeks ago from a Baptist to

Jehovah’s Witness and he refused to have the transfusion. Which of the following should

the nurse do?

a. Explain the consequences of the client’s decision and let him sign a waiver of

refusal of treatment

b. Obtain a court order to force the client to accept the treatment

c. Confront your client, tell him you do not agree with his decision and tell your

supervisor to assign you to a different client.

d. Administer a sedative and do the transfusion while he is asleep.

CRITICAL THINKING

You are caring for a client, newly diagnosed with acute myeloid leukemia. He was presented

with the treatment options, however, for the past few days have been denying the diagnosis and

has been asking the nurse that he be transferred to another physician and a repeat BM aspiration

be done to another laboratory. As a nurse, what you should do? Referring to Elizabeth Kubler-

Ross’ stages of grieving, cite a scenario or narrative a client diagnosed with leukemia may

undergo or experience as he moves through these stages.

Stages of Grieving Possible Nursing Interventions

Scenarios/Verbalizations from
the Client
Denial
Anger
Bargaining
Depression
Acceptance

Thyroid Cancer Activity

PRE-TEST
1. A type of thyroid cancer that starts in childhood or early adult life and usually
remains
localized; the most common and the least aggressive type of thyroid cancer.
a. Papillary adenocarcinoma
b. Follicular adenocarcinoma
c. Medullary thyroid cancer
d. Anaplastic thyroid cancer
2. All of the following are risk factors for developing thyroid cancer except:
a. Male sex
b. Heredity
c. Exposure to high levels of ionizing radiation
d. Female sex
3. All of the following are contraindications for a client to undergo radioactive iodine
imaging except:
a. Allergy to iodine-containing substances
b. Pregnancy
c. Lactation
d. History of angina pectoris
4. All, but one are indications for the use radioactive iodine-131 therapy:
a. Iodine-sensitive thyroid cancer
b. Metastatic iodine-dependent thyroid cancer
c. Iodine-independent thyroid cancer
d. Localized iodine-sensitive thyroid cancer
5. Which of the following is a priority assessment for the immediate thyroidectomy
patient?
a. A blood pressure ranging from 90/67 to 108/71 in the last 2 hours.
b. Frequent swallowing observed.
c. A blood in the surgical dressing that remained unchanged in diameter in the entire
shift.
d. A pain rating scale of 7/10 3 hours post-op.

POST-TEST
1. A nurse is caring a client who underwent subtotal thyroidectomy 8 hours ago due to
stage 2C medullary adenocarcinoma of the thyroid gland. He noted on the progress
note, that no changed in the amount of blood is seen on the dressing. However, the
senior nurse,
came and noted some harsh air entry and stridor on the client’s lung field upon
auscultation. Which of the following action/s the nurse failed to do in order to assess
appropriately the presence of covert bleeding in the surgical site?
a. Monitor the VS especially the blood pressure of the client.
b. Look for any polling in the back of the neck of the client.
c. Observe any frequent swallowing episodes.
d. Remove the dressing temporarily and look for any bleeding on the suture
line.
2. A client who underwent RAI therapy 2 days ago have been cleared by the nuclear
medicine specialist as “negligible radioactivity”. Which of the following statement, if
made by the client would require the nurse further intervention?
a. “I can stay on our room, together with my husband.”
b. “I should avoid going to the market for a couple of weeks.”
c. “If I need to travel abroad, I have to secure certification from my oncologist that I
underwent RAI therapy.”
d. “I should flush the toilet twice after urinating or defecating.”
3. A client underwent subtotal thyroidectomy due to thyroid cancer 3 hours ago. The
nurse
noted intermittent sinus tachycardia that lasts 15 to 30 seconds in the ECG telemetry.
Understanding that the client had underwent a subtotal thyroidectomy, which of the
following drugs would be prudent for the nurse to put on standby?
a. Potassium iodide PO
b. Tranexamic acid IV
c. Esmolol IV
d. Methylprednisolone IV
4. A male client is newly diagnosed with follicular thyroid adenocarcinoma and was
advised
to undergo RAI therapy. He was concerned about his fertility. Which of the following
statements should the nurse make in order to allay the fear of the client?
a. “Studies show that RAI can decrease the sperm count and testosterone
levels, but this will improve overtime.”
b. “The radioactive iodine do not have an effect on your fertility as it selectively
attacks thyroid cells, not sperm cells.”
c. “It will not have any effect on your fertility, but you will have to use an effective
and reliable contraception for a year to avoid having a child with possible birth
defect.”
d. “Your fertility is the least of our concern here. Your thyroid cancer is.”
5. The client who has stage 4 thyroid cancer is scheduled for total thyroidectomy 2
days
from now. You are about to start giving her Lugol’s solution. The client asked you why
the doctor wants her to take this drug. Which of the following is the best response of
the
nurse?
a. “This drug will slowly decrease the level of your thyroid hormones so that you
have a slim chance of developing post-thyroidectomy complications like thyroid
storm.”
b. “Lugol’s solution is usually given prior to a thyroidectomy to stain the thyroid
tissues in order that the doctor can distinguish the tissues that has to be removed.”
c. “The doctor ordered this drug to sterilize your gut prior to surgery.”

d. “This is usually given to decrease the vascularity of the thyroid in order to

reduce
blood loss during surgery.”

6. You are precepting a group of student nurses from a local university in their tour-of-
duty
in the oncology floor of the hospital. One of the patients in the floor was admitted for
stage IIB anaplastic carcinoma of the thyroid. He underwent several rounds of
external
radiotherapy. The client has been experiencing dysphagia. The student nurse was
assigned to the client. As you are observing, which of the following action/s of the
student nurse should you intervene?
a. The student let the client take a sip of water from a calibrated cup.
b. The student nurse let the client eat a teaspoon of applesauce.
c. The student let the client take small amount of vegetable broth.
d. The student let the client eat a piece of whole wheat cracker.
7. You are caring for a client who underwent complete thyroidectomy 6 hours ago.
While
taking the client’s vital sign, he complained of tingling sensation in his peri-oral area.
Which of the following complications of thyroidectomy, complete, should the nurse
suspect?
a. Hemorrhage
b. Hypocalcemia
c. Hypothyroidism
d. Thyroid storm
8. A female client is about to undergo whole body thyroid scan. Which of the following
assessment should the nurse include to rule out any possibility of pregnancy?
a. The day of the last menstrual period
b. The regularity of menstrual period
c. The menarche
d. The first day of the last menstrual period
9. A client came to the clinic due to a palpated mass, about the size of a pea in his
neck. The
doctor requested an ultrasound of the thyroid. Which of the following should the nurse
include in the teaching plan prior to UTZ of the thyroid?
a. Maintain an NPO 6-8 hours prior to the procedure.
b. Avoid applying anything to the neck.
c. Refrain from swallowing while the doctor scan the neck
d. No special preparation is needed for this kind of test.
10. The client is about to undergo a whole body scan. Which of the following should
the
nurse include in the teaching plan prior to the scan?
a. Eat a full meal the morning prior to the scan
b. Empty the bladder complete prior to entering the scanning room.
c. Avoid intake of any food or drink that contains iodine.
d. The client should eat at least 100 milligrams of any food or beverage with
iodine.

CRITICAL THINKING ACTIVITY

A 25 year old male client was diagnosed with stage IIIA follicular adenocarcinoma of
the
thyroid. Histopathology report suggests that the cancer cell is dependent of iodine and
is
hormone-secreting. Whole body scan report reported suspicious metastatic growth in
the lungs
and the stomach. He was advised to undergo a round of RAI-131 therapy,
chemotherapy and
suggested to undergo total thyroidectomy.
1. Make a teaching plan on that the nurse should include in the pre-operative and
post-
operative period for total thyroidectomy.
2. Make a teaching plan of the things the nurse should teach regarding a client
undergoing
chemotherapy.
3. Make a teaching plan prior to, during and after RAI-131 therapy.

Format of the teaching plan.

Health Education Rationale of the Possible or actual Possible nursing
Actions complication/s if diagnosis
not done or corresponding to
implemented that complication
that may arise

Cancer of the Colon and Stomach Activity

CRITICAL THINKING: THE PATIENT WITH GASTRIC CANCER

You are caring for a 61 year-old woman who was admitted for wight loss, decreased
appetite, early satiety, and
indigestion. Gastric cancer is the probable diagnosis.
1. What questions should you ask this patient?
2. What diagnostic studies and treatment plan would you anticipate for this patient?

3. What nursing diagnoses, including knowledge deficit, would you anticipate for this
patient

Brain Cancer
PRE-TEST
1. This hypothesis describes the delicate balance of the 3 major components in the
intracranial vault, and if one increases, the other must compensate by reducing or
moving to attain or maintain the intracranial pressure
a. Monro-Kellie Hypothesis
b. Bernouillie’s principle
c. Kernohan’s phenomenon
d. Charcot’s triad
2. A type of brain cancer cell that arise from astrocytes and is considered t be the
most
aggressive type of brain cancer
a. Astrocytoma
b. Glioblastoma multiforme
c. Teratoma
d. Schwannoma
3. Focal symptoms of brain tumors are independent of their location in the brain.
a. True
b. False
c. No idea
d. May or may not be
4. All of the following are signs of meningismus except:
a. Nuchal rigidity
b. Photophobia
c. Nystagmus
d. Projectile vomiting
5. All except are chemotherapeutic drugs that can be administered through intrathecal
route:
a. Vincristine
b. Methotrexate
c. Dexamethasone
d. Ara-C

POST-MODULE TEST
1. A client arrived in the clinic complaining of the recurrent dull headache aggravated
by sudden movement, deterioration of gait and diplopia. Which of the following should
the nurse suspect?
a. CNS infection
b. Drug intoxication
c. Brain tumor
d. Intracranial HTN
2. You are caring for a client diagnosed with lung cancer stage IV, with possible
metastasis in the brain. Which of the following should the nurse include in the plan of
care? Select
all that apply.
a. Monitor the I and O
b. Evaluate GCS every 4 hours
c. Monitor ABG results as prescribed
d. Provide the client with stimulating and well-lighted room
e. Provide low-residue diet
3. The client is about to undergo intrathecal administration of a steroid,
dexamethasone this afternoon. You are checking the client’s chart when you realize
that the oncologist has written “Ara-C” instead of dexamethasone. You called the
oncologist, yet he is out-of- network coverage. Which of the following should you do?
a. Use a “white-out” ink and correct the order of the oncologist.
b. Call your immediate supervisor and report the findings.
c. Call the Quality Assurance Committee and report the incorrect order of the
physician.
d. Go ahead with the procedure, maybe the oncologist changed his mind.
4. A client with glioblastoma multiforme grade IV was about to be discharged. He has
gross visual deficits and is paralyzed from the waist down. He is most of the times,
drowsy and is on NGT feeding. His immediate family members expressed their
concerns that they might not be able to provide the complex care he needs. Which of
the following nursing diagnosis is appropriate?
a. Impaired sensory perception
b. Risk for aspiration
c. Interrupted family processes
d. Caregiver role strain
5. A client was admitted due to astrocytoma grade II, stage 3B. He has EVD in place
and was on ICP monitoring. He was prescribed with 12% hypertonic saline 70ml every
4 hours as IV bolus to control ICP. As you are about to prepare the 10am dose of the
12% HTS, the morning laboratory result came in showed the client’s serum Na+ is
167mEq/L. which of the following should the nurse do?
a. Give half of the 10am dose and ask for a repeat serum Na+ prior to the 2pm dose.
b. Give the whole dose but infuse it for 2 hours.
c. Withhold the 10am dose and refer to the physician
d. Ask for a repeat serum Na+ STAT, but give the 10am dose.
6. A client post-intrathecal administration of methotrexate is about to be admitted in
your
floor. While assessing the client, which of the following statement, if made by the client
should prompt the nurse an immediate action?
a. “I feel a little pricky pain in the puncture site.”
b. “I feel pins and needles in my toes.”
c. “I feel a little nauseous.”
d. “Can I have some time alone?”
7. You are monitoring a client with metastatic brain lesion deep into the midbrain
region.
He is about to undergo stereotactic external beam radiotherapy. Which of the
following,
if made by the client, will prompt the nurse further clarification?
a. “I have to lie still as possible as the radiation session is ongoing and throughout
the session.”
b. “They will inject a dye into my veins and shoot X-rays to my head. The dye
will
amplify the effect of the X-ray to the tumor cells and kill them.”
c. “A powerful beam will be focused to where my tumor is sparing most of the other
normal tissues.”
d. “I may experience a sun-burnt like effect after the procedure.”
8. You are watching the ICP monitor, noting the ICP waveforms. Which of the
following
correctly state what P3 is?
a. Corresponds to the repolarization of the ventricles.
b. Reflect the dicrotic wave corresponding to the aortic valve closure
c. Denotes the degree of intracranial compliance
d. Denotes the arterial pulsations
9. The client with metastatic cerebral lesion originating from invasive gastrinoma was
about to be given with tranexamic acid 1 gram IV every 8 hours. The nurse
understands that hemostatic are given to patients with intracerebral lesions because
which of the
following:
a. Finding of cerebrovascular accident concurrent with the tumor
b. Coagulopathy due to paraneoplastic syndromes
c. Bleeding of the stomach due to gastrinoma
d. Intra-tumoral hemorrhage
10. A client has undergone transsphenoidal hypophysectomy 3 days ago to remove a
primary tumor in the pituitary gland. Which of the following assessment parameters
should the nurse worry about?
a. A blood pressure of 107/75mmHg
b. A WBC count of 7.5
c. A serum sodium of 146 mEq/L
d. A urine specific gravity of 1.027
CRITICAL THINKING
Make a care plan to address the following nursing diagnoses related to brain cancer
 Altered sensory perception
 Self-care deficit
 Altered family processes
 Anticipatory grieving
In making the care plan use the following format:

Nursing Possible Signs and Scientific Intervention Rationale

Diagnosis etiology Symptoms Explanation s
(with
algorithm)