NS 2 QUIZ 13 ONCO 6.

The client is diagnosed as having a bowel tumor and several

diagnostic tests are prescribed. The nurse understands that
1. The community nurse is conducting a health promotion which test will confirm the diagnosis of malignancy?
program at a local school and is discussing the risk factors a. Biopsy of the tumor
associated with cervical cancer. Which of the following, if b. Abdominal ultrasound
identified by the client as a risk factor for cervical cancer, c. Magnetic resonance imaging
indicates a need for further teaching? d. Computed tomography scan
a. Smoking
b. Multiple sex partners ANSWER A. A biopsy is done to determine whether a tumor is
c. First intercourse after age 20 malignant or benign. Magnetic resonance imaging, computed
d. Annual gynecological examinations tomography scan, and ultrasound will visualize the presence of a
mass but will not confirm a diagnosis of malignancy.
ANSWER C. Risk factors for cervical cancer include human
papillomavirus (HPV) infection, active and passive cigarette smoking, 7. A client is diagnosed with multiple myeloma and the client
certain high-risk sexual activities (first intercourse before 17 years of asks the nurse about the diagnosis. The nurse bases the
age, multiple sex partners, or male partners with multiple sex response on which description of this disorder?
partners). Screening via regular gynecological exams and a. Altered red blood cell production
Papanicolaou smear (Pap test) with treatment of precancerous b. Altered production of lymph nodes
abnormalities decrease the incidence and mortality of cervical c. Malignant exacerbation in the number of leukocytes
cancer. d. Malignant proliferation of plasma cells within the bone

2. The client with cancer is receiving chemotherapy and ANSWER D. Multiple myeloma is a B-cell neoplastic condition
develops thrombocytopenia. The nurse identifies which characterized by abnormal malignant proliferation of plasma cells
intervention as the highest priority in the nursing plan of and the accumulation of mature plasma cells in the bone marrow.
care? Options 1 and 2 are not characteristics of multiple myeloma. Option
a. Monitoring temperature 3 describes the leukemic process.
b. Ambulation three times daily
c. Monitoring the platelet count 8. The nurse is reviewing the laboratory results of a client
d. Monitoring for pathological fractures diagnosed with multiple myeloma. Which of the following
would the nurse expect to note specifically in this disorder?
ANSWER C. Thrombocytopenia indicates a decrease in the number a. Increased calcium level
of platelets in the circulating blood. A major concern is monitoring b. Increased white blood cells
for and preventing bleeding. Option 1 relates to monitoring for c. Decreased blood urea nitrogen level
infection, particularly if leukopenia is present. Options 2 and 4, d. Decreased number of plasma cells in the bone marrow
although important in the plan of care, are not related directly to
thrombocytopenia. ANSWER A. Findings indicative of multiple myeloma are an increased
number of plasma cells in the bone marrow, anemia, hypercalcemia
3. The community health nurse is instructing a group of female caused by the release of calcium from the deteriorating bone tissue,
clients about breast self-examination. The nurse instructs the and an elevated blood urea nitrogen level. An increased white blood
clients to perform the examination: cell count may or may not be present and is not related specifically
a. At the onset of menstruation to multiple myeloma.
b. Every month during ovulation
c. Weekly at the same time of day 9. The nurse is developing a plan of care for the client with
d. 1 week after menstruation begins multiple myeloma and includes which priority intervention in
the plan?
ANSWER D. The breast self-examination should be performed a. Encouraging fluids
monthly 7 days after the onset of the menstrual period. Performing b. Providing frequent oral care
the examination weekly is not recommended. At the onset of c. Coughing and deep breathing
menstruation and during ovulation, hormonal changes occur that d. Monitoring the red blood cell count
may alter breast tissue.
ANSWER A. Hypercalcemia caused by bone destruction is a priority
4. The nurse is caring for a client who has undergone a vaginal concern in the client with multiple myeloma. The nurse should
hysterectomy. The nurse avoids which of the following in the administer fluids in adequate amounts to maintain a urine output of
care of this client? 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The
a. Elevating the knee gatch on the bed fluid is needed not only to dilute the calcium overload but also to
b. Assisting with range-of-motion leg exercises prevent protein from precipitating in the renal tubules. Options 2, 3,
c. Removal of antiembolism stockings twice daily and 4 may be components of the plan of care but are not the
d. Checking placement of pneumatic compression boots priority in this client.

ANSWER A. The client is at risk of deep vein thrombosis or 10. The oncology nurse specialist provides an educational session
thrombophlebitis after this surgery, as for any other major surgery. to nursing staff regarding the characteristics of Hodgkin’s
For this reason, the nurse implements measures that will prevent disease. The nurse determines that further teaching is needed
this complication. Range-of-motion exercises, antiembolism if a nursing staff member states that which of the following is
stockings, and pneumatic compression boots are helpful. The nurse a characteristic of the disease?
should avoid using the knee gatch in the bed, which inhibits venous a. Presence of Reed-Sternberg cells
return, thus placing the client more at risk for deep vein thrombosis b. Occurs most often in the older client
or thrombophlebitis. c. Prognosis depending on the stage of the disease
d. Involvement of lymph nodes, spleen, and liver
5. The client suspected of an ovarian tumor is scheduled for a
pelvic ultrasound. The nurse provides which preprocedure ANSWER B. Hodgkin’s disease is a disorder of young adults. Options
instruction to the client? 1, 3, and 4 are characteristics of this disease.
a. Eat a light breakfast only.
b. Maintain an NPO status before the procedure. 11. The community health nurse conducts a health promotion
c. Wear comfortable clothing and shoes for the procedure. program regarding testicular cancer to community members.
d. Drink six to eight glasses of water without voiding before The nurse determines that further information needs to be
the test. provided if a community member states that which of the
following is a sign of testicular cancer?
ANSWER D. A pelvic ultrasound requires the ingestion of large a. Alopecia
volumes of water just before the procedure. A full bladder is b. Back pain
necessary so that it will be visualized as such and not mistaken for a c. Painless testicular swelling
possible pelvic growth. An abdominal ultrasound may require that d. Heavy sensation in the scrotum
the client abstain from food or fluid for several hours before the
procedure. Option 3 is unrelated to this specific procedure. ANSWER A. Alopecia is not an assessment finding in testicular
cancer. Alopecia may occur, however, as a result of radiation or
chemotherapy. Options 2, 3, and 4 are assessment findings in Invasive measures such as an indwelling urinary catheter should be
testicular cancer. Back pain may indicate metastasis to the avoided to prevent infections.
retroperitoneal lymph nodes.
17. The nurse is reviewing the laboratory results of a client
12. The client is receiving external radiation to the neck for cancer receiving chemotherapy whose platelet count is 10,000
of the larynx. The most likely side effect to be expected is: cells/mm³. Based on this laboratory value, the
a. Dyspnea priority nursing assessment is which of the following?
b. Diarrhea a. Assess skin turgor.
c. Sore throat b. Assess temperature.
d. Constipation c. Assess bowel sounds.
d. Assess level of consciousness.
ANSWER C. In general, only the area in the treatment field is
affected by the radiation. Skin reactions, fatigue, nausea, and ANSWER D. A high risk of hemorrhage exists when the platelet count
anorexia may occur with radiation to any site, whereas other side is less than 20,000 cells/mm³. Fatal central nervous
effects occur only when specific areas are involved in treatment. A system hemorrhage or massive gastrointestinal hemorrhage can
client receiving radiation to the larynx is most likely to experience a occur when the platelet count is less than 10,000
sore throat. Options 2 and 4 may occur with radiation to the cells/mm³. The client should be assessed for changes in
gastrointestinal tract. Dyspnea may occur with lung involvement. level of consciousness, which may be an early indication of an
intracranial hemorrhage. Option 2 is a priority nursing assessment
13. The nurse is caring for a client with an internal radiation when the white blood cell count is low and the client is at risk for an
implant. When caring for the client, the nurse should observe infection. Although options 1 and 3 are important to assess, they are
which of the following principles? not the priority in this situation.
a. Limit the time with the client to 1 hour per shift.
b. Do not allow pregnant women into the client’s room. 18. The nurse is caring for a client who is postoperative following
c. Remove the dosimeter badge when entering the client’s a pelvic exenteration and the physician changes the client’s
room. diet from NPO status to clear liquids. The nurse makes which
d. Individuals younger than 16 years old may be allowed to priority assessment before administering the diet?
go in the room as long as they are 6 feet away from the a. Bowel sounds
client. b. Ability to ambulate
c. Incision appearance
ANSWER B. The time that the nurse spends in a room of a client with d. Urine specific gravity
an internal radiation implant is 30 minutes per 8-hour shift. The
dosimeter badge must be worn when in the client’s room. Children ANSWER A. The client is kept NPO until peristalsis returns, usually in
younger than 16 years of age and pregnant women are not allowed 4 to 6 days. When signs of bowel function return, clear fluids are
in the client’s room. given to the client. If no distention occurs, the diet is advanced as
tolerated. The most important assessment is to assess bowel sounds
14. A cervical radiation implant is placed in the client for before feeding the client. Options 2, 3, and 4 are unrelated to the
treatment of cervical cancer. The nurse initiates what most subject of the question.
appropriate activity order for this client?
a. Bed rest 19. During the admission assessment of a client with advanced
b. Out of bed ad lib ovarian cancer, the nurse recognizes which symptom as
c. Out of bed in a chair only typical of the disease?
d. Ambulation to the bathroom only a. Diarrhea
b. Hypermenorrhea
ANSWER A. The client with a cervical radiation implant should be c. Abnormal bleeding
maintained on bed rest in the dorsal position to prevent movement d. Abdominal distention
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 ANSWER D. Clinical manifestations of ovarian cancer include
the client on the side. If turning is absolutely necessary, a pillow is abdominal distention, urinary frequency and urgency, pleural
placed between the knees and, with the body in straight alignment, effusion, malnutrition, pain from pressure caused by the growing
the client is logrolled. tumor and the effects of urinary or bowel obstruction, constipation,
ascites with dyspnea, and ultimately general severe pain. Abnormal
15. The client is hospitalized for insertion of an internal cervical bleeding, often resulting in hypermenorrhea, is associated with
radiation implant. While giving care, the nurse finds the uterine cancer.
radiation implant in the bed. The initial action by the nurse is
to: 20. The nurse is reviewing the complications of conization with a
a. Call the physician. client who has microinvasive cervical cancer. Which
b. Reinsert the implant into the vagina immediately. complication, if identified by the client, indicates a need for
c. Pick up the implant with gloved hands and flush it down further teaching?
the toilet. a. Infection
d. Pick up the implant with long-handled forceps and place it b. Hemorrhage
in a lead container. c. Cervical stenosis
d. Ovarian perforation
ANSWER D. A lead container and long-handled forceps should be
kept in the client’s room at all times during internal radiation ANSWER D. Conization procedure involves removal of a cone-shaped
therapy. If the implant becomes dislodged, the nurse should pick up area of the cervix. Complications of the procedure include
the implant with long-handled forceps and place it in the lead hemorrhage, infection, and cervical stenosis. Ovarian perforation is
container. Options 1, 2, and 3 are inaccurate interventions. not a complication.

16. The nurse is caring for a client experiencing neutropenia as a 21. When assessing the laboratory results of the client with
result of chemotherapy and develops a plan of care for the bladder cancer and bone metastasis, the nurse notes a
client. The nurse plans to: calcium level of 12 mg/dL. The nurse recognizes that this is
a. Restrict all visitors. consistent with which oncological emergency?
b. Restrict fluid intake. a. Hyperkalemia
c. Teach the client and family about the need for hand b. Hypercalcemia
hygiene. c. Spinal cord compression
d. Insert an indwelling urinary catheter to prevent skin d. Superior vena cava syndrome
breakdown.
ANSWER B. Hypercalcemia is a serum calcium level higher than 10
ANSWER C. In the neutropenic client, meticulous hand hygiene mg/dL, most often occurs in clients who have bone metastasis, and
education is implemented for the client, family, visitors, and staff. is a late manifestation of extensive malignancy. The presence of
Not all visitors are restricted, but the client is protected from cancer in the bone causes the bone to release calcium into the
persons with known infections. Fluids should be encouraged. bloodstream.
 22. The client reports to the nurse that when performing chemotherapy. Therefore, the client is advised to rinse the mouth
testicular self-examination, he found a lump the size and before every meal and at bedtime with a weak salt and sodium
shape of a pea. The appropriate response to the client is bicarbonate mouth rinse. This lessens the growth of bacteria and
which of the following? limits plaque formation. The other substances are irritating to oral
a. Lumps like that are normal; don’t worry. tissue. If hydrogen peroxide must be used because of severe plaque,
b. Let me know if it gets bigger next month. it should be a weak solution because it dries the mucous
c. That could be cancer. I’ll ask the doctor to examine you. membranes.
d. That’s important to report even though it might not be
serious. 28. The community nurse is conducting a health promotion
program and the topic of the discussion relates to the risk
ANSWER D. Testicular cancer almost always occurs in only one factors for gastric cancer. Which risk factor, if identified by a
testicle and is usually a pea-sized painless lump. The cancer is highly client, indicates a need for further discussion?
curable when found early. The finding should be reported to the a. Smoking
physician. b. A high-fat diet
c. Foods containing nitrates
23. The nurse is caring for a client following a mastectomy. Which d. A diet of smoked, highly salted, and spiced food
assessment finding indicates that the client is experiencing a
complication related to the surgery? ANSWER B. A high-fat diet plays a role in the development of cancer
a. Pain at the incisional site of the pancreas. Options 1, 3, and 4 are risk factors related to gastric
b. Arm edema on the operative side cancer.
c. Sanguineous drainage in the Jackson-Pratt drain
d. Complaints of decreased sensation near the operative site 29. A gastrectomy is performed on a client with gastric cancer. In
the immediate postoperative period, the nurse notes bloody
ANSWER B. Arm edema on the operative side (lymphedema) is a drainage from the nasogastric tube. Which of the following is
complication following mastectomy and can occur immediately the appropriate nursing intervention?
postoperatively or may occur months or even years after surgery. a. Notify the physician.
Options 1, 3, and 4 are expected occurrences following mastectomy b. Measure abdominal girth.
and do not indicate a complication. c. Irrigate the nasogastric tube.
d. Continue to monitor the drainage.
24. The nurse is admitting a client with laryngeal cancer to the
nursing unit. The nurse assesses for which most common risk ASNWER D. Following gastrectomy, drainage from the nasogastric
factor for this type of cancer? tube is normally bloody for 24 hours postoperatively, changes to
a. Alcohol abuse brown-tinged, and is then to yellow or clear. Because bloody
b. Cigarette smoking drainage is expected in the immediate postoperative period, the
c. Use of chewing tobacco nurse should continue to monitor the drainage. The nurse does not
d. Exposure to air pollutants need to notify the physician at this time. Measuring abdominal girth
is performed to detect the development of distention. Following
ANSWER B. The most common risk factor associated with laryngeal gastrectomy, a nasogastric tube should not be irrigated unless there
cancer is cigarette smoking. Heavy alcohol use and the combined are specific physician orders to do so.
use of tobacco increase the risk. Another risk factor is exposure to
environmental pollutants. 30. The nurse is teaching a client about the risk factors associated
with colorectal cancer. The nurse determines that further
25. The female client who has been receiving radiation therapy teaching related to colorectal cancer is necessary if the client
for bladder cancer tells the nurse that it feels as if she is identifies which of the following as an associated risk factor?
voiding through the vagina. The nurse interprets that the a. Age younger than 50 years
client may be experiencing: b. History of colorectal polyps
a. Rupture of the bladder c. Family history of colorectal cancer
b. The development of a vesicovaginal fistula d. Chronic inflammatory bowel disease
c. Extreme stress caused by the diagnosis of cancer
d. Altered perineal sensation as a side effect of radiation ANSWER A. Colorectal cancer risk factors include age older than 50
therapy years, a family history of the disease, colorectal polyps, and chronic
inflammatory bowel disease.
ANSWER B. A vesicovaginal fistula is a genital fistula that occurs
between the bladder and vagina. The fistula is an abnormal opening 31. The nurse is performing an admission assessment on a client
between these two body parts and, if this occurs, the client may diagnosed with a right colon tumor. The nurse asks the client
experience drainage of urine through the vagina. The client’s about which characteristic symptom of this type of a tumor?
complaint is not associated with options 1, 3, and 4. a. Rectal bleeding
b. Flat, ribbon-like stools
26. The client with leukemia is receiving busulfan (Myleran) and c. Crampy, colicky abdominal pain
allopurinol (Zyloprim) is prescribed for the client. The nurse d. Alternating constipation and diarrhea
tells the client that the purpose of the allopurinol is to
prevent: ANSWER C. Vague abdominal discomfort or crampy, colicky
a. Nausea abdominal pain is a characteristic symptom of a right colon tumor.
b. Alopecia Options 1, 2, and 4 are symptoms associated with left colon tumors.
c. Vomiting
d. Hyperuricemia 32. The nurse is assessing the perineal wound in a client who has
returned from the operating room following an abdominal
ANSWER D. Allopurinol decreases uric acid production and reduces perineal resection and notes serosanguineous drainage from
uric acid concentrations in serum and urine. In the client receiving the wound. Which nursing intervention is most appropriate?
chemotherapy, uric acid levels increase as a result of the massive a. Notify the physician.
cell destruction that occurs from the chemotherapy. This medication b. Clamp the Penrose drain.
prevents or treats hyperuricemia caused by chemotherapy. c. Change the dressing as prescribed.
Allopurinol is not used to prevent alopecia, nausea, or vomiting. d. Remove and replace the perineal packing.

27. The client receiving chemotherapy is experiencing mucositis. ANSWER C. Immediately after surgery, profuse serosanguineous
The nurse advises the client to use which of the following as drainage from the perineal wound is expected. The nurse does not
the best substance to rinse the mouth? need to notify the physician at this time. A Penrose drain should not
a. Alcohol-based mouthwash be clamped because this action will cause the accumulation of
b. Hydrogen peroxide mixture drainage within the tissue. Penrose drains and packing are removed
c. Lemon-flavored mouthwash gradually over a period of 5 to 7 days as prescribed. The nurse
d. Weak salt and bicarbonate mouth rinse should not remove the perineal packing.

ANSWER D. An acidic environment in the mouth is favorable for 33. The nurse is assessing the colostomy of a client who has had
bacterial growth, particularly in an area already compromised from an abdominal perineal resection for a bowel tumor. Which of
 the following assessment findings indicates that the a. Dysuria
colostomy is beginning to function? b. Hematuria
a. Absent bowel sounds c. Urgency on urination
b. The passage of flatus d. Frequency of urination
c. The client’s ability to tolerate food
d. Bloody drainage from the colostomy ANSWER B. The most common symptom in clients with cancer of
the bladder is hematuria. The client also may experience irritative
ANSWER B. Following abdominal perineal resection, the nurse would voiding symptoms such as frequency, urgency, and dysuria, and
expect the colostomy to begin to function within 72 hours after these symptoms often are associated with carcinoma in situ.
surgery, although it may take up to 5 days. The nurse should assess
for a return of peristalsis, listen for bowel sounds, and check for the 39. The nurse is caring for a client following intravesical
passage of flatus. Absent bowel sounds would not indicate the instillation of an alkylating chemotherapeutic agent into the
return of peristalsis. The client would remain NPO until bowel bladder for the treatment of bladder cancer. Following the
sounds return and the colostomy is functioning. Bloody drainage is instillation, the nurse should instruct the client to:
not expected from a colostomy. a. Urinate immediately.
b. Maintain strict bed rest.
34. The nurse is caring for a client following a radical neck c. Change position every 15 minutes.
dissection and creation of a tracheostomy performed for d. Retain the instillation fluid for 30 minutes.
laryngeal cancer and is providing discharge instructions to the
client. Which statement by the client indicates a need for ANSWER C. Normally, the medication is injected into the bladder
further instructions? through a urethral catheter, the catheter is clamped or removed,
a. I will protect the stoma from water.  and the client is asked to retain the fluid for 2 hours. The client
b. I need to keep powders and sprays away from the stoma changes position every 15 to 30 minutes from side to side and from
site.  supine to prone or resumes all activity immediately. The client then
c. I need to use an air conditioner to provide cool air to assist voids and is instructed to drink water to flush the bladder.
in breathing. 
d. I need to apply a thin layer of petrolatum to the skin 40. The nurse is assessing the stoma of a client following a
around the stoma to prevent cracking.  ureterostomy. Which of the following should the nurse expect
to note?
ANSWER C. Air conditioners need to be avoided to protect from a. A dry stoma
excessive coldness. A humidifier in the home should be used if b. A pale stoma
excessive dryness is a problem. Options 1, 2, and 4 are appropriate c. A dark-colored stoma
interventions regarding stoma care following radical neck dissection d. A red and moist stoma
and creation of a tracheotomy.
ANSWERD D. Following ureterostomy, the stoma should be red and
35. What is the purpose of cytoreductive ( debulking ) surgery moist. A pale stoma may indicate an inadequate amount of vascular
for ovarian cancer? supply. A dry stoma may indicate a body fluid deficit. Any sign of
a. Cancer control by reducing the size of the tumor darkness or duskiness in the stoma may indicate a loss of vascular
b. Cancer prevention by removal of precancerous tissue supply and must be reported immediately or necrosis can occur.
c. Cancer cure by removing all gross and microscopic tumor
cells 41. The nurse is caring for a client following a mastectomy. Which
d. Cancer rehabilitation by improving the appearance of a nursing intervention would assist in preventing lymphedema
previously treated body part of the affected arm?
a. Placing cool compresses on the affected arm
ANSWER A. Cytoreductive or debulking  surgery may be used if a b. Elevating the affected arm on a pillow above heart level
large tumor cannot be completely removed as is often the case with c. Avoiding arm exercises in the immediate postoperative
late-stage ovarian cancer (e.g., the tumor is attached to a vital organ period
or spread throughout the abdomen). When this occurs, as much d. Maintaining an intravenous site below the antecubital area
tumor as possible is removed and adjuvant chemotherapy or on the affected side
radiation may be prescribed.
ANSWER B. Following mastectomy, the arm should be elevated
36. Hormone therapy is prescribed as the mode of treatment for above the level of the heart. Simple arm exercises should be
a client with prostate cancer. The nurse understands that the encouraged. No blood pressure readings, injections, intravenous
goal of this form of treatment is to: lines, or blood draws should be performed on the affected arm. Cool
a. Increase testosterone levels. compresses are not a suggested measure to prevent lymphedema
b. Increase prostaglandin levels. from occurring.
c. Limit the amount of circulating androgens.
d. Increase the amount of circulating androgens. 42. The nurse is preparing a client for a mammography. The nurse
tells the client:
ANSWER C. Hormone therapy (androgen deprivation) is a mode of a. That mammography takes about 1 hour
treatment for prostatic cancer. The goal is to limit the amount of b. That there is no discomfort associated with the procedure
circulating androgens because prostate cells depend on androgen c. To maintain an NPO status on the day of the test
for cellular maintenance. Deprivation of androgen often can lead to d. To avoid the use of deodorants, powders, or creams on
regression of disease and improvement of symptoms. the day of the test

37. The nurse is caring for a client with cancer of the prostate ANSWER D. Mammography takes about 15 to 30 minutes to
following a prostatectomy. The nurse provides discharge complete. Some discomfort may be experienced because of the
instructions to the client and tells the client to: breast compression required to obtain a clear image. There is no
a. Avoid driving the car for 1 week. reason to maintain an NPO status before the procedure. Option 4 is
b. Restrict fluid intake to prevent incontinence. an accurate instruction.
c. Avoid lifting objects heavier than 20 lb for at least 6 weeks.
d. Notify the physician if small blood clots are noticed during 43. A nurse is monitoring a client for signs and symptoms related
urination. to superior vena cava syndrome. Which of the following is an
early sign of this oncological emergency?
ANSWER C. Small pieces of tissue or blood clots can be passed a. Cyanosis
during urination for up to 2 weeks after surgery. Driving a car and b. Arm edema
sitting for long periods of time are restricted for at least 3 weeks. A c. Periorbital edema
high daily fluid intake should be maintained to limit clot formation d. Mental status changes
and prevent infection. Option 3 is an accurate discharge instruction
following prostatectomy. ANSWER C. Superior vena cava syndrome occurs when the superior
vena cava is compressed or obstructed by tumor growth. Early signs
38. The nurse is reviewing the history of a client with bladder and symptoms generally occur in the morning and include edema of
cancer. The nurse expects to note documentation of which the face, especially around the eyes, and client complaints of
most common symptom of this type of cancer? tightness of a shirt or blouse collar. As the compression worsens the
client experiences edema of the hands and arms. Mental status c. Esophagitis
changes and cyanosis are late signs. d. Hiatal hernia

44. A nurse manager is teaching the nursing staff about signs and
symptoms related to hypercalcemia in a client with metastatic ANSWER C. Difficulty in swallowing, pain, and tightness in the chest
prostate cancer and tells the staff that which of the following are signs of esophagitis, which is a common complication of
is a serious late sign of this oncological emergency? radiation therapy of the chest wall. Option A: Radiation enteritis is a
a. Headache damage to the intestinal lining caused by radiation therapy.
b. Dysphagia Symptoms include diarrhea, rectal pain, and bleeding or mucus from
c. Constipation the rectum. Option B: Stomatitis results from the local effects of
d. Electrocardiographic changes radiation to the oral mucosa. Symptoms include mouth ulcers, red
patches, swelling, and oral dysaesthesia. Option D: Hiatal hernia may
ANSWER D. Hypercalcemia is a late manifestation of bone
also cause symptoms of dysphagia and chest pain but is not related
metastasis in late-stage cancer. Headache and dysphagia are not
to radiation therapy.
associated with hypercalcemia. Constipation may occur early in the
process. Electrocardiogram changes include shortened ST segment
and a widened T wave.
49. A nurse teaches a client who is recovering from a colon
resection. Which statement should the nurse include in
45. As part of chemotherapy education, the nurse teaches a
this clients plan of care?
female client about the risk for bleeding and self-care during
a. You may experience nausea and vomiting for the first
the period of the greatest bone marrow suppression (the
nadir). The nurse understands that further teaching is needed few weeks.
when the client states: b. Carbonated beverages can help decrease acid reflux
a. I should avoid blowing my nose.  from anastomosis sites.
b. I may need a platelet transfusion if my platelet count is too c. Take a stool softener to promote softer stools for
low.  ease of defecation.
c. I’m going to take aspirin for my headache as soon as I get d. You may return to your normal workout schedule,
home.  including weight lifting.
d. I will count the number of pads and tampons I use when
menstruating. 
ANSWER C. During the period of greatest bone marrow suppression ANSWER C. Clients recovering from a colon resection should take a
(the nadir), the platelet count may be low, less than 20,000 stool softener as prescribed to keep stools a soft consistency for
cells/mm³. Option 3 describes an incorrect statement ease of passage. Nausea and vomiting are symptoms of intestinal
by the client. Aspirin and nonsteroidal anti-inflammatory drugs and obstruction and perforation and should be reported to the provider
products that contain aspirin should be avoided because of their immediately. The client should be advised to avoid gas-producing
antiplatelet activity, thus further teaching is needed. Options 1, 2, foods and carbonated beverages, and avoid lifting heavy objects or
and 4 are correct statements by the client to prevent and monitor
straining on defecation.
bleeding.

46. The nurse is analyzing the laboratory results of a client with 50. The nurse is developing a plan of care for the client with
leukemia who has received a regimen of chemotherapy. multiple myeloma. The nurse includes which priority
Which of the following laboratory values would the nurse intervention in the plan of care?
specifically note as a result of the massive cell destruction
a. Encouraging fluids
that occurred from the chemotherapy?
b. Providing frequent oral care
a. Anemia
b. Decreased platelet c. Coughing and deep breathing
c. Increased ueic acid level d. Monitoring red blood cell count
d. Decereased Leukocyte count
ANSWER A. Hypercalcemia caused by bone destruction is a priority
ANSWER C. Hyperuricemia is especially common following
treatment for leukemias and lymphomas because chemotherapy concern in the client with multiple myeloma. The nurse should
results in massive cell kill. Although options 1, 2, and 4 also may be administer fluids in adequate amounts to maintain an output of 1.5
noted, an increased uric acid level is related specifically to cell to 2 L a day. Clients require about 3 L of fluid per day. The fluid is
destruction needed not only to dilute the calcium overload but also to prevent
protein from precipitating in renal tubules. Options B, C, and D:
These are components in the plan of care but are not the priority in
47. Which of the following is the primary goal for surgical this client.
resection of lung cancer?
a. To remove all of the tumor and any collapsed alveoli in the
same region
b. To remove as much as the tumor as possible, without
removing any alveoli
c. To remove the tumor and as little surrounding tissue as
possible
d. To remove the tumor and all surrounding tissue

ANSWER C. The goal of surgical resection is to remove the lung

tissue that has a tumor in it while saving as much surrounding tissue
as possible. There is a possibility of cancer cells remaining in the
body after the operation so additional treatment modalities such as
chemotherapy and radiation therapy are done.

48. A 56-year-old woman is currently receiving radiation

therapy to the chest wall for recurrent breast cancer. She
calls her health care provider to report that she has pain
while swallowing and burning and tightness in her chest.
Which of the following complications of radiation therapy
is A. Radiation enteritis likely responsible for her
symptoms?
a. Radiation enteritis
b. Stomatitis