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1. A male client has an abnormal result on a Papanicolaou test. After admitting, he
read his chart while the nurse was out of the room, the client asks what dysplasia
means. Which definition should the nurse provide?
A. Presence of completely undifferentiated tumor cells that dont resemble cells of the
tissues of their origin
B. Increase in the number of normal cells in a normal arrangement in a tissue or an organ
C. Replacement of one type of fully differentiated cell by another in tissues where the
second type normally isnt found
D. Alteration in the size, shape, and organization of differentiated cells
2. For a female client with newly diagnosed cancer, the nurse formulates a nursing
diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis.
Which expected outcome would be appropriate for this client?
A. Client verbalizes feelings of anxiety.
B. Client doesnt guess at prognosis.
C. Client uses any effective method to reduce tension.
D. Client stops seeking information.
3. A male client with a cerebellar brain tumor is admitted to an acute care facility. The
nurse formulates a nursing diagnosis of Risk for injury. Which related-to phrase
should the nurse add to complete the nursing diagnosis statement?
A. Related to visual field deficits
B. Related to difficulty swallowing
C. Related to impaired balance
D. Related to psychomotor seizures
4. A female client with cancer is scheduled for radiation therapy. The nurse knows
that radiation at any treatment site may cause a certain adverse effect. Therefore, the
nurse should prepare the client to expect:

A. hair loss.
B. stomatitis.
C. fatigue.
D. vomiting.
5. Nurse April is teaching a client who suspects that she has a lump in her breast.
The nurse instructs the client that a diagnosis of breast cancer is confirmed by:
A. breast self-examination.
B. mammography.
C. fine needle aspiration.
D. chest X-ray.
6. A male client undergoes a laryngectomy to treat laryngeal cancer. When teaching
the client how to care for the neck stoma, the nurse should include which
instruction?
A. Keep the stoma uncovered.
B. Keep the stoma dry.
C. Have a family member perform stoma care initially until you get used to the procedure.
D. Keep the stoma moist.
7. A female client is receiving chemotherapy to treat breast cancer. Which
assessment finding indicates a fluid and electrolyte imbalance induced by
chemotherapy?
A. Urine output of 400 ml in 8 hours
B. Serum potassium level of 3.6 mEq/L
C. Blood pressure of 120/64 to 130/72 mm Hg
D. Dry oral mucous membranes and cracked lips
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 is to discover:
A. cancerous lumps.
B. areas of thickness or fullness.

C. changes from previous self-examinations.

D. fibrocystic masses.
9. A client, age 41, visits the gynecologist. After examining her, the physician
suspects cervical cancer. The nurse reviews the clients history for risk factors for
this disease. Which history finding is a risk factor for cervical cancer?
A. Onset of sporadic sexual activity at age 17
B. Spontaneous abortion at age 19
C. Pregnancy complicated with eclampsia at age 27
D. Human papillomavirus infection at age 32
10. A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to treat
osteogenic carcinoma. During methotrexate therapy, the nurse expects the client to
receive which other drug to protect normal cells?
A. probenecid (Benemid)
B. cytarabine (ara-C, cytosine arabinoside [Cytosar-U])
C. thioguanine (6-thioguanine, 6-TG)
D. leucovorin (citrovorum factor or folinic acid [Wellcovorin])
11. The nurse is interviewing a male client about his past medical history. Which
preexisting condition may lead the nurse to suspect that a client has colorectal
cancer?
A. Duodenal ulcers
B. Hemorrhoids
C. Weight gain
D. Polyps
12. Nurse Amy is speaking to a group of women about early detection of breast
cancer. The average age of the women in the group is 47. Following the American
Cancer Society guidelines, the nurse should recommend that the women:
A. perform breast self-examination annually.
B. have a mammogram annually.

C. have a hormonal receptor assay annually.

D. have a physician conduct a clinical examination every 2 years.
13. A male client with a nagging cough makes an appointment to see the physician
after reading that this symptom is one of the seven warning signs of cancer. What is
another warning sign of cancer?
A. Persistent nausea
B. Rash
C. Indigestion
D. Chronic ache or pain
14. For a female client newly diagnosed with radiation-induced thrombocytopenia,
the nurse should include which intervention in the plan of care?
A. Administering aspirin if the temperature exceeds 102 F (38.8 C)
B. Inspecting the skin for petechiae once every shift
C. Providing for frequent rest periods
D. Placing the client in strict isolation
15. Nurse Lucia is providing breast cancer education at a community facility. The
American Cancer Society recommends that women get mammograms:
A. yearly after age 40.
B. after the birth of the first child and every 2 years thereafter.
C. after the first menstrual period and annually thereafter.
D. every 3 years between ages 20 and 40 and annually thereafter.
16. Which intervention is appropriate for the nurse caring for a male client in severe
pain receiving a continuous I.V. infusion of morphine?
A. Assisting with a naloxone challenge test before therapy begins
B. Discontinuing the drug immediately if signs of dependence appear
C. Changing the administration route to P.O. if the client can tolerate fluids
D. Obtaining baseline vital signs before administering the first dose

17. A 35 years old client with ovarian cancer is prescribed hydroxyurea (Hydrea), an
antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that
interfere with various metabolic actions of the cell. The mechanism of action of
antimetabolites interferes with:
A. cell division or mitosis during the M phase of the cell cycle.
B. normal cellular processes during the S phase of the cell cycle.
C. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between
DNA molecules (cell cyclenonspecific).
D. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell
cyclenonspecific).
18. The ABCD method offers one way to assess skin lesions for possible skin cancer.
What does the A stand for?
A. Actinic
B. Asymmetry
C. Arcus
D. Assessment
19. When caring for a male client diagnosed with a brain tumor of the parietal lobe,
the nurse expects to assess:
A. short-term memory impairment.
B. tactile agnosia.
C. seizures.
D. contralateral homonymous hemianopia.
20. A female client is undergoing tests for multiple myeloma. Diagnostic study
findings in multiple myeloma include:
A. a decreased serum creatinine level.
B. hypocalcemia.
C. Bence Jones protein in the urine.
D. a low serum protein level.

21. A 35 years old client has been receiving chemotherapy to treat cancer. Which
assessment finding suggests that the client has developed stomatitis (inflammation
of the mouth)?
A. White, cottage cheeselike patches on the tongue
B. Yellow tooth discoloration
C. Red, open sores on the oral mucosa
D. Rust-colored sputum
22. During chemotherapy, an oncology client has a nursing diagnosis of impaired
oral mucous membrane related to decreased nutrition and immunosuppression
secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is
most likely to decrease the pain of stomatitis?
A. Recommending that the client discontinue chemotherapy
B. Providing a solution of hydrogen peroxide and water for use as a mouth rinse
C. Monitoring the clients platelet and leukocyte counts
D. Checking regularly for signs and symptoms of stomatitis
23. What should a male client over age 52 do to help ensure early identification of
prostate cancer?
A. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.
B. Have a transrectal ultrasound every 5 years.
C. Perform monthly testicular self-examinations, especially after age 50.
D. Have a complete blood count (CBC) and blood urea nitrogen (BUN) and creatinine levels
checked yearly.
24. A male client complains of sporadic epigastric pain, yellow skin, nausea,
vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician
orders a diagnostic workup, which reveals gallbladder cancer. Which nursing
diagnosis may be appropriate for this client?
A. Anticipatory grieving
B. Impaired swallowing

C. Disturbed body image

D. Chronic low self-esteem
25. A male client is in isolation after receiving an internal radioactive implant to treat
cancer. Two hours later, the nurse discovers the implant in the bed linens. What
should the nurse do first?
A. Stand as far away from the implant as possible and call for help.
B. Pick up the implant with long-handled forceps and place it in a lead-lined container.
C. Leave the room and notify the radiation therapy department immediately.
D. Put the implant back in place, using forceps and a shield for self-protection, and call for
help.
26. Jenny, with advanced breast cancer is prescribed tamoxifen (Nolvadex). When
teaching the client about this drug, the nurse should emphasize the importance of
reporting which adverse reaction immediately?
A. Vision changes
B. Hearing loss
C. Headache
D. Anorexia
27. A female client with cancer is being evaluated for possible metastasis. Which of
the following is one of the most common metastasis sites for cancer cells?
A. Liver
B. Colon
C. Reproductive tract
D. White blood cells (WBCs)
28. A 34-year-old female client is requesting information about mammograms and
breast cancer. She isnt considered at high risk for breast cancer. What should the
nurse tell this client?
A. She should have had a baseline mammogram before age 30.
B. She should eat a low-fat diet to further decrease her risk of breast cancer.

C. She should perform breast self-examination during the first 5 days of each menstrual
cycle.
D. When she begins having yearly mammograms, breast self-examinations will no longer be
necessary.
29. Nurse Brian is developing a plan of care for marrow suppression, the major doselimiting adverse reaction to floxuridine (FUDR). How long after drug administration
does bone marrow suppression become noticeable?
A. 24 hours
B. 2 to 4 days
C. 7 to 14 days
D. 21 to 28 days
30. The nurse is preparing for a female client for magnetic resonance imaging (MRI)
to confirm or rule out a spinal cord lesion. During the MRI scan, which of the
following would pose a threat to the client?
A. The client lies still.
B. The client asks questions.
C. The client hears thumping sounds.
D. The client wears a watch and wedding band.
31. Nina, an oncology nurse educator, is speaking to a womens group about breast
cancer. Questions and comments from the audience reveal a misunderstanding of
some aspects of the disease. Various members of the audience have made all of the
following statements. Which one is accurate?
A. Mammography is the most reliable method for detecting breast cancer.
B. Breast cancer is the leading killer of women of childbearing age.
C. Breast cancer requires a mastectomy.
D. Men can develop breast cancer.
32. Nurse Mary is instructing a premenopausal woman about breast self-examination.
The nurse should tell the client to do her self-examination:

A. at the end of her menstrual cycle.

B. on the same day each month.
C. on the 1st day of the menstrual cycle.
D. immediately after her menstrual period.
33. Nurse Kent is teaching a male client to perform monthly testicular selfexaminations. Which of the following points would be appropriate to make?
A. Testicular cancer is a highly curable type of cancer.
B. Testicular cancer is very difficult to diagnose.
C. Testicular cancer is the number one cause of cancer deaths in males.
D. Testicular cancer is more common in older men.
34. Rhea, has malignant lymphoma. As part of her chemotherapy, the physician
prescribes chlorambucil (Leukeran), 10 mg by mouth daily. When caring for the
client, the nurse teaches her about adverse reactions to chlorambucil, such as
alopecia. How soon after the first administration of chlorambucil might this reaction
occur?
A. Immediately
B. 1 week
C. 2 to 3 weeks
D. 1 month
35. A male client is receiving the cell cyclenonspecific alkylating agent thiotepa
(Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of a
chemotherapeutic regimen to treat bladder cancer. The client asks the nurse how the
drug works. How does thiotepa exert its therapeutic effects?
A. It interferes with deoxyribonucleic acid (DNA) replication only.
B. It interferes with ribonucleic acid (RNA) transcription only.
C. It interferes with DNA replication and RNA transcription.
D. It destroys the cell membrane, causing lysis.
36. The nurse is instructing the 35 year old client to perform a testicular selfexamination. The nurse tells the client:

A. To examine the testicles while lying down

B. That the best time for the examination is after a shower
C. To gently feel the testicle with one finger to feel for a growth
D. That testicular self-examination should be done at least every 6 months
37. A female client with cancer is receiving chemotherapy and develops
thrombocytopenia. The nurse identifies which intervention as the highest priority in
the nursing plan of care?
A. Monitoring temperature
B. Ambulation three times daily
C. Monitoring the platelet count
D. Monitoring for pathological fractures
38. Gio, a community health nurse, is instructing a group of female clients about
breast self-examination. The nurse instructs the client 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
39. Nurse Cindy is caring for a client who has undergone a vaginal hysterectomy. The
nurse avoids which of the following in the care of this client?
A. Elevating the knee gatch on the bed
B. Assisting with range-of-motion leg exercises
C. Removal of antiembolism stockings twice daily
D. Checking placement of pneumatic compression boots
40. Mina, who is suspected of an ovarian tumor is scheduled for a pelvic ultrasound.
The nurse provides which preprocedure instruction to the client?
A. Eat a light breakfast only
B. Maintain an NPO status 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
41. A male 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 the tumor
B. Abdominal ultrasound
C. Magnetic resonance imaging
D. Computerized tomography scan
42. A female client 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
43. Nurse Bea 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
B. Increased white blood cells
C. Decreased blood urea nitrogen level
D. Decreased number of plasma cells in the bone marrow
44. Vanessa, a 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
45. The male 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
46. Nurse Joy is caring for a client with an internal radiation implant. When caring for
the client, the nurse should observe which of the following principles?
A. Limit the time with the client to 1 hour per shift
B. Do not allow pregnant women into the clients room
C. Remove the dosimeter badge when entering the clients room
D. Individuals younger than 16 years old may be allowed to go in the room as long as they
are 6 feet away from the client
47. A cervical radiation implant is placed in the client for treatment of cervical cancer.
The nurse initiates what most appropriate activity order for this client?
A. Bed rest
B. Out of bed ad lib
C. Out of bed in a chair only
D. Ambulation to the bathroom only
48. A female client is hospitalized for insertion of an internal cervical radiation
implant. While giving care, the nurse finds the radiation implant in the bed. The initial
action by the nurse is to:
A. Call the physician
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.
49. The nurse is caring for a female client experiencing neutropenia as a result of
chemotherapy and develops a plan of care for the client. The nurse plans to:
A. Restrict all visitors
B. Restrict fluid intake
C. Teach the client and family about the need for hand hygiene
D. Insert an indwelling urinary catheter to prevent skin breakdown
50. The home health care nurse is caring for a male client with cancer and the client
is complaining of acute pain. The appropriate nursing assessment of the clients pain
would include which of the following?
A. The clients pain rating
B. Nonverbal cues from the client
C. The nurses impression of the clients pain
D. Pain relief after appropriate nursing intervention
51. Nurse Melinda is caring for a client who is postoperative following a pelvic
exenteration and the physician changes the clients diet from NPO status to clear
liquids. The nurse makes which priority assessment before administering the diet?
A. Bowel sounds
B. Ability to ambulate
C. Incision appearance
D. Urine specific gravity
52. A male client is admitted to the hospital with a suspected diagnosis of Hodgkins
disease. Which assessment findings would the nurse expect to note specifically in
the client?
A. Fatigue
B. Weakness

C. Weight gain
D. Enlarged lymph nodes
53. During the admission assessment of a 35 year old client with advanced ovarian
cancer, the nurse recognizes which symptom as typical of the disease?
A. Diarrhea
B. Hypermenorrhea
C. Abdominal bleeding
D. Abdominal distention
54. Nurse Kate is reviewing the complications of colonization with a client who has
microinvasive cervical cancer. Which complication, if identified by the client,
indicates a need for further teaching?
A. Infection
B. Hemorrhage
C. Cervical stenosis
D. Ovarian perforation
55. Mr. Miller has been diagnosed with bone cancer. You know this type of cancer is
classified as:
A. sarcoma.
B. lymphoma.
C. carcinoma.
D. melanoma.
56. Sarah, a 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 daughters
graduation, Ill be ready to die. Which phrase of coping is this client experiencing?
A. Anger
B. Denial
C. Bargaining
D. Depression

57. Nurse Farah is caring for a client following a 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 site
58. The nurse is admitting a male 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
59. The female client who has been receiving radiation therapy for bladder cancer
tells the nurse that it feels as if she is voiding through the vagina. The nurse
interprets that the client may be experiencing:
A. Rupture of the bladder
B. The development of a vesicovaginal fistula
C. Extreme stress caused by the diagnosis of cancer
D. Altered perineal sensation as a side effect of radiation therapy
60. The client with leukemia is receiving busulfan (Myleran) and allopurinol
(Zyloprim). The nurse tells the client that the purpose if the allopurinol is to prevent:
A. Nausea
B. Alopecia
C. Vomiting
D. Hyperuricemia

Answers and Rationale

1. Answer D. Alteration in the size, shape, and organization of differentiated cells

Dysplasia refers to an alteration in the size, shape, and organization of differentiated cells.
The presence of completely undifferentiated tumor cells that dont resemble cells of the
tissues of their origin is called anaplasia. An increase in the number of normal cells in a
normal arrangement in a tissue or an organ is called hyperplasia. Replacement of one type
of fully differentiated cell by another in tissues where the second type normally isnt found is
called metaplasia.
2. Answer A. Client verbalizes feelings of anxiety.
Verbalizing feelings is the clients first step in coping with the situational crisis. It also helps
the health care team gain insight into the clients feelings, helping guide psychosocial care.
Option B is inappropriate because suppressing speculation may prevent the client from
coming to terms with the crisis and planning accordingly. Option C is undesirable because
some methods of reducing tension, such as illicit drug or alcohol use, may prevent the client
from coming to terms with the threat of death as well as cause physiologic harm. Option D
isnt appropriate because seeking information can help a client with cancer gain a sense of
control over the crisis.
3. Answer C. Related to impaired balance
A client with a cerebellar brain tumor may suffer injury from impaired balance as well as
disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor
seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal
lobe, or temporal lobe not from a cerebellar brain tumor. Difficulty swallowing suggests
medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction.
4. Answer C. fatigue
Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the
treatment site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse
effects of radiation therapy.
5. Answer C. fine needle aspiration.

Fine needle aspiration and biopsy provide cells for histologic examination to confirm a
diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method
for detecting breast lumps early. Mammography is used to detect tumors that are too small
to palpate. Chest X-rays can be used to pinpoint rib metastasis.
6. Answer D. Keep the stoma moist.
The nurse should instruct the client to keep the stoma moist, such as by applying a thin
layer of petroleum jelly around the edges, because a dry stoma may become irritated. The
nurse should recommend placing a stoma bib over the stoma to filter and warm air before it
enters the stoma. The client should begin performing stoma care without assistance as
soon as possible to gain independence in self-care activities.
7. Answer D. Dry oral mucous membranes and cracked lips
Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and
electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked
lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a
serum potassium level below 3.5 mEq/L.
8. Answer C. changes from previous self-examinations.
Women are instructed to examine themselves to discover changes that have occurred in the
breast. Only a physician can diagnose lumps that are cancerous, areas of thickness or
fullness that signal the presence of a malignancy, or masses that are fibrocystic as opposed
to malignant.
9. Answer D. Human papillomavirus infection at age 32
Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for
cervical cancer. Other risk factors for this disease include frequent sexual intercourse before
age 16, multiple sex partners, and multiple pregnancies. A spontaneous abortion and
pregnancy complicated by eclampsia arent risk factors for cervical cancer.
10. Answer D. leucovorin (citrovorum factor or folinic acid [Wellcovorin])

Leucovorin is administered with methotrexate to protect normal cells, which methotrexate

could destroy if given alone. Probenecid should be avoided in clients receiving methotrexate
because it reduces renal elimination of methotrexate, increasing the risk of methotrexate
toxicity. Cytarabine and thioguanine arent used to treat osteogenic carcinoma.
11. Answer D. Polyps
Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids arent
preexisting conditions of colorectal cancer. Weight loss not gain is an indication of
colorectal cancer.
12. Answer B. have a mammogram annually.
The American Cancer Society guidelines state, Women older than age 40 should have a
mammogram annually and a clinical examination at least annually [not every 2 years]; all
women should perform breast self-examination monthly [not annually]. The hormonal
receptor assay is done on a known breast tumor to determine whether the tumor
isestrogen or progesterone-dependent.
13. Answer C. Indigestion
Indigestion, or difficulty swallowing, is one of the seven warning signs of cancer. The other
six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or
discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or
mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer
but isnt one of the seven major warning signs. Rash and chronic ache or pain seldom
indicate cancer.
14. Answer B. Inspecting the skin for petechiae once every shift
Because thrombocytopenia impairs blood clotting, the nurse should inspect the client
regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums.
The nurse should avoid administering aspirin because it may increase the risk of bleeding.
Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict
isolation is indicated only for clients who have highly contagious or virulent infections that
are spread by air or physical contact.

15. Answer A. yearly after age 40.

The American Cancer Society recommends a mammogram yearly for women over age 40.
The other statements are incorrect. Its recommended that women between ages 20 and 40
have a professional breast examination (not a mammogram) every 3 years.
16. Answer D. Obtaining baseline vital signs before administering the first dose
The nurse should obtain the clients baseline blood pressure and pulse and respiratory rates
before administering the initial dose and then continue to monitor vital signs throughout
therapy. A naloxone challenge test may be administered before using a narcotic antagonist,
not a narcotic agonist. The nurse shouldnt discontinue a narcotic agonist abruptly because
withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in
clients with severe pain regardless of the ability to tolerate fluids.
17. Answer B.normal cellular processes during the S phase of the cell cycle.
Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or
preventing cell replication. Theyre most effective against rapidly proliferating cancers. Miotic
inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating
agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells
in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic
agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing
normal cell growth and reproduction.
18. Answer B. Asymmetry
When following the ABCD method for assessing skin lesions, the A stands for asymmetry,
the B for border irregularity, the C for color variation, and the D for diameter.
19. Answer B. tactile agnosia.
Tactile agnosia (inability to identify objects by touch) is a sign of a parietal lobe tumor. Shortterm memory impairment occurs with a frontal lobe tumor. Seizures may result from a tumor
of the frontal, temporal, or occipital lobe. Contralateral homonymous hemianopia suggests
an occipital lobe tumor.

20. Answer C. Bence Jones protein in the urine.

Presence of Bence Jones protein in the urine almost always confirms the disease, but
absence doesnt rule it out. Serum calcium levels are elevated because calcium is lost from
the bone and reabsorbed in the serum. Serum protein electrophoresis shows elevated
globulin spike. The serum creatinine level may also be increased.
21. Answer C. Red, open sores on the oral mucosa
The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in
ulcers on the oral mucosa that appear as red, open sores. White, cottage cheeselike
patches on the tongue suggest a candidal infection, another common adverse effect of
chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer
chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.
22. Answer B. Providing a solution of hydrogen peroxide and water for use as a
mouth rinse
To decrease the pain of stomatitis, the nurse should provide a solution of hydrogen peroxide
and water for the client to use as a mouth rinse. (Commercially prepared mouthwashes
contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also
may administer viscous lidocaine or systemic analgesics as prescribed. Stomatitis occurs 7
to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldnt be helpful or
practical. Instead, the nurse should stay alert for this potential problem to ensure prompt
treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection
but wouldnt decrease pain in this highly susceptible client. Checking for signs and
symptoms of stomatitis also wouldnt decrease the pain.
23. Answer A. Have a digital rectal examination and prostate-specific antigen (PSA)
test done yearly.
The incidence of prostate cancer increases after age 50. The digital rectal examination,
which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for
prostate cancer, are effective diagnostic measures that should be done yearly. Testicular
self-examinations wont identify changes in the prostate gland due to its location in the body.

A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after
diagnosis to identify the extent of the disease and potential metastases
24. Answer A. Anticipatory grieving
Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients
with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isnt
associated with gallbladder cancer. Although surgery typically is done to remove the
gallbladder and, possibly, a section of the liver, it isnt disfiguring and doesnt cause
Disturbed body image. Chronic low self-esteem isnt an appropriate nursing diagnosis at this
time because the diagnosis has just been made.
25. Answer B. Pick up the implant with long-handled forceps and place it in a leadlined container.
If a radioactive implant becomes dislodged, the nurse should pick it up with long-handled
forceps and place it in a lead-lined container, then notify the radiation therapy department
immediately. The highest priority is to minimize radiation exposure for the client and the
nurse; therefore, the nurse must not take any action that delays implant removal. Standing
as far from the implant as possible, leaving the room with the implant still exposed, or
attempting to put it back in place can greatly increase the risk of harm to the client and the
nurse from excessive radiation exposure.
26. Answer A. Vision changes
The client must report changes in visual acuity immediately because this adverse effect may
be irreversible. Tamoxifen isnt associated with hearing loss. Although the drug may cause
anorexia, headache, and hot flashes, the client need not report these adverse effects
immediately because they dont warrant a change in therapy.
27. Answer A. Liver
The liver is one of the five most common cancer metastasis sites. The others are the lymph
nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional
metastasis sites.

28. Answer B. She should eat a low-fat diet to further decrease her risk of breast
cancer.
A low-fat diet (one that maintains weight within 20% of recommended body weight) has
been found to decrease a womans risk of breast cancer. A baseline mammogram should be
done between ages 30 and 40. Monthly breast self-examinations should be done between
days 7 and 10 of the menstrual cycle. The client should continue to perform monthly breast
self-examinations even when receiving yearly mammograms.
29. Answer C. 7 to 14 days
Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration.
Bone marrow recovery occurs in 21 to 28 days.
30. Answer D. The client wears a watch and wedding band.
During an MRI, the client should wear no metal objects, such as jewelry, because the strong
magnetic field can pull on them, causing injury to the client and (if they fly off) to others. The
client must lie still during the MRI but can talk to those performing the test by way of the
microphone inside the scanner tunnel. The client should hear thumping sounds, which are
caused by the sound waves thumping on the magnetic field.
31. Answer D. Men can develop breast cancer.
Men can develop breast cancer, although they seldom do. The most reliable method for
detecting breast cancer is monthly self-examination, not mammography. Lung cancer
causes more deaths than breast cancer in women of all ages. A mastectomy may not be
required if the tumor is small, confined, and in an early stage.
32. Answer D. immediately after her menstrual period.
Premenopausal women should do their self-examination immediately after the menstrual
period, when the breasts are least tender and least lumpy. On the 1st and last days of the
cycle, the womans breasts are still very tender. Postmenopausal women because their
bodies lack fluctuation of hormone levels, should select one particular day of the month to
do breast self-examination.

33. Answer A. Testicular cancer is a highly curable type of cancer.

Testicular cancer is highly curable, particularly when its treated in its early stage. Selfexamination allows early detection and facilitates the early initiation of treatment. The
highest mortality rates from cancer among men are in men with lung cancer. Testicular
cancer is found more commonly in younger men.
34. Answer C. 2 to 3 weeks
Chlorambucil-induced alopecia occurs 2 to 3 weeks after therapy begins.
35. Answer C. It interferes with DNA replication and RNA transcription.
Thiotepa interferes with DNA replication and RNA transcription. It doesnt destroy the cell
membrane.
36. Answer B. That the best time for the examination is after a shower
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.
37. Answer C. Monitoring the platelet count
Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A
major concern is monitoring for and preventing bleeding. Option A elates to monitoring for
infection, particularly if leukopenia is present. Options B and D, although important in the
plan of care, are not related directly to thrombocytopenia.
38. Answer 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
ofmenstruation and during ovulation, hormonal changes occur that may alter breast tissue.

39. Answer A. Elevating the knee gatch on the bed

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.
40. Answer 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 C is unrelated to this
specific procedure.
41. Answer A. Biopsy of the tumor
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.
42. Answer 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.
43. Answer A. Increased calcium
Findings indicative of multiple myeloma are an increased number of plasma cells in the
bone marrow, anemia, hypercalcemia caused by the release of calcium from the
deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white

blood cell count may or may not be present and is not related specifically to multiple
myeloma.
44. Answer A. Alopecia
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.
45. Answer C. Sore throat
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.
46. Answer B. Do not allow pregnant women into the clients room
The time that the nurse spends in a room of a client with an internal radiation implant is 30
minutes per 8-hour shift. The dosimeter badge must be worn when in the clients room.
Children younger than 16 years of age and pregnant women are not allowed in the clients
room.
47. Answer A. Bed rest
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.
48. Answer 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 clients room at all times
during internal radiation therapy. If the implant becomes dislodged, the nurse should pick up
the implant with long-handled forceps and place it in the lead container. Options A, B, and C
are inaccurate interventions.
49. Answer C. Teach the client and family about the need for hand hygiene
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.
50. Answer A. The clients pain rating
The clients self-report is a critical component of pain assessment. The nurse should ask the
client about the description of the pain and listen carefully to the clients words used to
describe the pain. The nurses impression of the clients pain is not appropriate in
determining the clients level of pain. Nonverbal cues from the client are important but are
not the most appropriate pain assessment measure. Assessing pain relief is an important
measure, but this option is not related to the subject of the question.
51. Answer A. Bowel sounds
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.
52. Answer D. Enlarged lymph nodes
Hodgkins 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.
53. Answer 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.
54. Answer 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.
55. Answer A. sarcoma.
Tumors that originate from bone,muscle, and other connective tissue are called sarcomas.
56. Answer C. Bargaining
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.
57. Answer B. Arm edema on 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.
58. Answer B. Cigarette smoking

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.
59. Answer B. The development of a vesicovaginal fistula
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 clients complaint is not
associated with options A, C, and D.
60. Answer 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.