Cancer And Oncology | NCLEX Quiz 154 - Quiz, Flashcards & Trivia

1. A hospitalized patient who has received chemotherapy for leukemia develops neutropenia. Which observation by the RN caring for the patient indicates that the nurse should take action?

The patient’s visitors bring in some fresh peaches from home.

The patient ambulates several times a day in the room.

The patient uses soap and shampoo to shower every other day.

The patient cleans with a warm washcloth after having a stool.

Fresh. thinned-skin peaches are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk. showering every other day is acceptable. Careful cleaning after having a bowel movement will help to prevent perineal skin breakdown and infection.

Explanation

Fresh. thinned-skin peaches are not permitted in a neutropenic diet because of the risk of bacteria being present. The patient should ambulate in the room rather than the hospital hallway to avoid exposure to other patients or visitors. Because overuse of soap can dry the skin and increase infection risk. showering every other day is acceptable. Careful cleaning after having a bowel movement will help to prevent perineal skin breakdown and infection.

2. A with tumor lysis syndrome (TLS) is taking allopurinol (Zyloprim). Which laboratory value should the nurse monitor to determine the effectiveness of the medication?

Blood urea nitrogen (BUN)

Serum phosphate

Serum potassium

Uric acid level

Allopurinol is used to decrease uric acid levels. BUN. potassium. and phosphate levels are also increased in TLS but are not affected by allopurinol therapy.

Explanation

Allopurinol is used to decrease uric acid levels. BUN. potassium. and phosphate levels are also increased in TLS but are not affected by allopurinol therapy.

3. Which of the following conditions is not a complication of Hodgkin's disease?

Anemia

Infection

Myocardial Infarction

Nausea

Complications of Hodgkin’s are pancytopenia. nausea. and infection. Cardiac involvement usually doesn’t occur.

Explanation

Complications of Hodgkin’s are pancytopenia. nausea. and infection. Cardiac involvement usually doesn’t occur.

4. When assessing a patient's needs for psychologic support after the patient has been diagnosed with stage I cancer of the colon. which question by the nurse will provide the most information?

“Can you tell me what has been helpful to you in the past when coping with stressful events?”

“How long ago were you diagnosed with this cancer?”

“Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?”

“How do you feel about having a possibly terminal illness?”

Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient’s need for support. The patient’s knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. The patient with stage I cancer is not considered to have a terminal illness at this time. and this question is likely to worry the patient unnecessarily.

Explanation

Information about how the patient has coped with past stressful situations helps the nurse determine usual coping mechanisms and their effectiveness. The length of time since the diagnosis will not provide much information about the patient’s need for support. The patient’s knowledge of typical stages in adjustment to a critical diagnosis does not provide insight into patient needs for assistance. The patient with stage I cancer is not considered to have a terminal illness at this time. and this question is likely to worry the patient unnecessarily.

5. Which action by a nursing assistant (NA) when caring for a patient who is pancytopenic indicates a need for the nurse to intervene?

The NA assists the patient to use dental floss after eating.

The NA makes an oral rinse using 1 teaspoon of salt in a liter of water.

The NA adds baking soda to the patient’s saline oral rinses.

The NA puts fluoride toothpaste on the patient’s toothbrush.

Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.

Explanation

Use of dental floss is avoided in patients with pancytopenia because of the risk for infection and bleeding. The other actions are appropriate for oral care of a pancytopenic patient.

6. At the time of diagnosis of Hodgkin's lymphoma. which of the following areas is often involved?

Back

Chest

Groin

Neck

At the time of diagnosis. a painless cervical lesion is often present. The back. chest. and groin areas aren’t involved.

Explanation

At the time of diagnosis. a painless cervical lesion is often present. The back. chest. and groin areas aren’t involved.

7. After the nurse has explained the purpose of and schedule for chemotherapy to a 23-year-old patient who recently received a diagnosis of acute leukemia. the patient asks the nurse to repeat the information. Based on this assessment. which nursing diagnosis is most likely for the patient?

Acute confusion related to infiltration of leukemia cells into the central nervous system

Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment

Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis

Risk for ineffective adherence to treatment related to denial of need for chemotherapy

The patient who has a new cancer diagnosis is likely to have high anxiety. which may impact learning and require that the nurse repeat and reinforce information. The patient’s history of a recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the confusion. The patient asks for the information to be repeated. indicating that lack of interest in learning and denial are not etiologic factors.

Explanation

The patient who has a new cancer diagnosis is likely to have high anxiety. which may impact learning and require that the nurse repeat and reinforce information. The patient’s history of a recent diagnosis suggests that infiltration of the leukemia is not a likely cause of the confusion. The patient asks for the information to be repeated. indicating that lack of interest in learning and denial are not etiologic factors.

8. According to a standard staging classification of Hodgkin's disease. which of the following criteria reflects stage II?

Involvement of extralymphatic organs or tissues

Involvement of single lymph node region or structure

Involvement of two or more lymph node regions or structures.

Involvement of lymph node regions or structures on both sides of the diaphragm.

Stage II involves two or more lymph node regions. Stage I only involves one lymph node region; stage III involves nodes on both sides of the diaphragm; and stage IV involves extralymphatic organs or tissues.

Explanation

Stage II involves two or more lymph node regions. Stage I only involves one lymph node region; stage III involves nodes on both sides of the diaphragm; and stage IV involves extralymphatic organs or tissues.

9. A 61-year-old woman who is 5 feet. 3 inches tall and weighs 125 pounds (57 kg) tells the nurse that she has a glass of wine two or three times a week. The patient works for the post office and has a 5-mile mail-delivery route. This is her first contact with the health care system in 20 years. Which of these topics will the nurse plan to include in patient teaching about cancer? (Select all that apply.)

Alcohol use

Physical activity

Body weight

Colorectal screening

Tobacco use

Mammography

Pap testing

Sunscreen use

The patient’s age. gender. and history indicate a need for teaching about or screening or both for colorectal cancer. mammography. Pap smears. and sunscreen. The patient does not use excessive alcohol or tobacco. she is physically active. and her body weight is healthy.

Explanation

The patient’s age. gender. and history indicate a need for teaching about or screening or both for colorectal cancer. mammography. Pap smears. and sunscreen. The patient does not use excessive alcohol or tobacco. she is physically active. and her body weight is healthy.

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10. During a routine physical examination. a firm mass is palpated in the right breast of a 35-year-old woman. Which of the following findings or client history would suggest cancer of the breast as opposed to fibrocystic disease?

History of early menarche

Cyclic changes in mass size

History of anovulatory cycles

Increased vascularity of the breast

Increase in breast size or vascularity is consistent with cancer of the breast. Early menarche as well as late menopause or a history of anovulatory cycles are associated with fibrocystic disease. Masses associated with fibrocystic disease of the breast are firm. most often located in the upper outer quadrant of the breast. and increase in size prior to menstruation. They may be bilateral in a mirror image and are typically well demarcated and freely moveable.

Explanation

Increase in breast size or vascularity is consistent with cancer of the breast. Early menarche as well as late menopause or a history of anovulatory cycles are associated with fibrocystic disease. Masses associated with fibrocystic disease of the breast are firm. most often located in the upper outer quadrant of the breast. and increase in size prior to menstruation. They may be bilateral in a mirror image and are typically well demarcated and freely moveable.