Recipe for success: Study while others are sleeping; work while others are loafing; prepare while others are playing; and dream while others are wishing.
~ William A. Ward
Topics or concepts included in this exam are:
- Oncology Nursing
Follow the guidelines below to make the most out of this exam:
- Read each question carefully and choose the best answer.
- You are given one minute per question. Spend your time wisely!
- Answers and rationales (if any) are given below. Be sure to read them.
- If you need more clarifications, please direct them to the comments section.
In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz. You are given 1 minute per question.
NCLEX Exam: Cancer and Oncology Nursing 5 (15 Items)
Practice Mode: This is an interactive version of the Text Mode. All questions are given in a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. No time limit for this exam.
NCLEX Exam: Cancer and Oncology Nursing 5 (15 Items)
In Text Mode: All questions and answers are given for reading and answering at your own pace. You can also copy this exam and make a print out.
1. A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin’s lymphoma. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the nurse to the patient’s concerns is
A. “Radiation does not cause the problems with sexual functioning that occur with chemotherapy or surgical procedures used to treat cancer.”
B. “It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children.”
C. “The radiation will make you sterile, but your ability to have sexual intercourse will not be changed by the treatment.”
D. “You may have some temporary impotence during the course of the radiation, but normal sexual function will return.”
2. A 40-year-old divorced mother of four school-age children is hospitalized with metastatic cancer of the ovary. The nurse finds the patient crying, and she tells the nurse that she does not know what will happen to her children when she dies. The most appropriate response by the nurse is
A. “Why don’t we talk about the options you have for the care of your children?”
B. “Many patients with cancer live for a long time, so there is time to plan for your children.”
C. “For now you need to concentrate on getting well, not worry about your children.”
D. “Perhaps your ex-husband will take the children when you can’t care for them.”
3. A patient who has terminal cancer of the liver and is cared for by family members at home tells the nurse, “I have intense pain most of the time now.” The nurse recognizes that teaching regarding pain management has been effective when the patient
A. uses the ordered opioid pain medication whenever the pain is greater than 5 on a 10-point scale.
B. states that nonopioid analgesics may be used when the maximal dose of the opioid is reached without adequate pain relief.
C. agrees to take the medications by the IV route to improve effectiveness.
D. takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.
4. Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. The nurse teaches the patient that the purpose of therapy with this agent is to
A. protect normal kidney cells from the damaging effects of chemotherapy.
B. enhance the patient’s immunologic response to tumor cells.
C. stimulate malignant cells in the resting phase to enter mitosis.
D. prevent the bone marrow depression caused by chemotherapy.
5. The home health nurse is caring for a patient who has been receiving interferon therapy for treatment of cancer. Which statement by the patient may indicate a need for a change in treatment?
A. “I have frequent muscle aches and pains.”
B. “I rarely have the energy to get out of bed.”
C. “I take acetaminophen (Tylenol) every 4 hours.”
D. “I experience chills after I inject the interferon.”
6. Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider?
7. A bone marrow transplant is being considered for treatment of a patient with acute leukemia that has not responded to chemotherapy. In discussing the treatment with the patient, the nurse explains that
A. hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT).
B. the transplant of the donated cells is painful because of the nerves in the tissue lining the bone.
C. donor bone marrow cells are transplanted immediately after an infusion of chemotherapy.
D. the transplant procedure takes place in a sterile operating room to minimize the risk for infection.
8. The nurse teaches a patient with cancer of the liver about high-protein, high-calorie diet choices. Which snack choice by the patient indicates that the teaching has been effective?
A. Fresh fruit salad
B. Orange sherbet
C. Strawberry yogurt
D. French fries
9. The nurse has identified the nursing diagnosis of imbalanced nutrition: less than body requirements related to altered taste sensation in a patient with lung cancer who has had a 10% loss in weight. An appropriate nursing intervention that addresses the etiology of this problem is to
A. provide foods that are highly spiced to stimulate the taste buds.
B. avoid presenting foods for which the patient has a strong dislike.
C. add strained baby meats to foods such as soups and casseroles.
D. teach the patient to eat whatever is nutritious since food is tasteless.
10. 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?
A. Acute confusion related to infiltration of leukemia cells into the central nervous system
B. Knowledge deficit: chemotherapy related to a lack of interest in learning about treatment
C. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis
D. Risk for ineffective adherence to treatment related to denial of need for chemotherapy
11. 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?
A. The patient’s visitors bring in some fresh peaches from home.
B. The patient ambulates several times a day in the room.
C. The patient uses soap and shampoo to shower every other day.
D. The patient cleans with a warm washcloth after having a stool.
12. Which action by a nursing assistant (NA) when caring for a patient who is pancytopenic indicates a need for the nurse to intervene?
A. The NA assists the patient to use dental floss after eating.
B. The NA makes an oral rinse using 1 teaspoon of salt in a liter of water.
C. The NA adds baking soda to the patient’s saline oral rinses.
D. The NA puts fluoride toothpaste on the patient’s toothbrush.
13. A with tumor lysis syndrome (TLS) is taking allopurinol (Zyloprim). Which laboratory value should the nurse monitor to determine the effectiveness of the medication?
14. 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?
A. “Can you tell me what has been helpful to you in the past when coping with stressful events?”
B. “How long ago were you diagnosed with this cancer?”
C. “Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?”
D. “How do you feel about having a possibly terminal illness?”
15. 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.)
A. Alcohol use
B. Physical activity
C. Body weight
D. Colorectal screening
E. Tobacco use
G. Pap testing
H. Sunscreen use
Answers and Rationale
1. Answer: B. “It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children.”
The impact on sperm count and erectile function depends on the patient’s pretreatment status and on the amount of exposure to radiation. The patient should consider sperm donation before radiation. Radiation (like chemotherapy or surgery) may affect both sexual function and fertility either temporarily or permanently.
2. Answer: A. “Why don’t we talk about the options you have for the care of your children?”
This response expresses the nurse’s willingness to listen and recognizes the patient’s concern. The responses beginning “Many patients with cancer live for a long time” and “For now you need to concentrate on getting well” close off discussion of the topic and indicate that the nurse is uncomfortable with the topic. In addition, the patient with metastatic ovarian cancer may not have a long time to plan. Although it is possible that the patient’s ex-husband will take the children, more assessment information is needed before making plans.
3. Answer: D. takes opioids around the clock on a regular schedule and uses additional doses when breakthrough pain occurs.
For chronic cancer pain, analgesics should be taken on a scheduled basis, with additional doses as needed for breakthrough pain. Taking the medications only when pain reaches a certain level does not provide effective pain control. Although nonopioid analgesics may also be used, there is no maximum dose of opioid. Opioids are given until pain control is achieved. The IV route is not more effective than the oral route and the oral route is preferred.
4. Answer: B. enhance the patient’s immunologic response to tumor cells.
IL-2 enhances the ability of the patient’s own immune response to suppress tumor cells. IL-2 does not protect normal cells from damage caused by chemotherapy, stimulate malignant cells to enter mitosis, or prevent bone marrow depression.
5. Answer: B. “I rarely have the energy to get out of bed.”
Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use. Patients are advised to use Tylenol every 4 hours.
6. Answer: B. WBC count of 1700/µl
Neutropenia places the patient at risk for severe infection and is an indication that the chemotherapy dose may need to be lower or that white blood cell (WBC) growth factors such as filgrastim (Neupogen) are needed. The other laboratory data do not indicate any immediate life-threatening adverse effects of the chemotherapy.
7. Answer: A. hospitalization will be required for several weeks after the hematopoietic stem cell transplant (HSCT).
The patient requires strict protective isolation to prevent infection for 2 to 4 weeks after HSCT while waiting for the transplanted marrow to start producing cells. The transplanted cells are infused through an IV line, so the transplant is not painful, nor is an operating room required. The HSCT takes place 1 or 2 days after chemotherapy to prevent damage to the transplanted cells by the chemotherapy drugs.
8. Answer: C. Strawberry yogurt
Yogurt has high biologic value because of the protein and fat content. Fruit salad does not have high amounts of protein or fat. Orange sherbet is lower in fat and protein than yogurt. French fries are high in calories from fat but low in protein.
9. Answer: B. avoid presenting foods for which the patient has a strong dislike.
The patient will eat more if disliked foods are avoided and foods that patient likes are included instead. Additional spice is not usually an effective way to enhance taste. Adding baby meats to foods will increase calorie and protein levels, but does not address the issue of taste. Patients will not improve intake by eating foods that are beneficial but have unpleasant taste.
10. Answer: C. Risk for ineffective health maintenance related to anxiety about new leukemia diagnosis
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.
11. Answer: A. The patient’s visitors bring in some fresh peaches from home.
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.
12. Answer: A. The NA assists the patient to use dental floss after eating.
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.
13. Answer: D. 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.
14. Answer: A. “Can you tell me what has been helpful to you in the past when coping with stressful events?”
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.
15. Answer: D, F, G, H
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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Selected NCLEX-RN review books:
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- Saunders Strategies for Success for the NCLEX – An invaluable guide that will help you master what matters most in passing nursing school and the NCLEX.
- Mosby's Comprehensive Review of Nursing for NCLEX-RN – This book has helped nurses pass the NCLEX exam for over 60 years. Practice with over 600 alternative item question formats.
- Lippincott Q&A Review for NCLEX-RN – A different approach to NCLEX-RN review.
- Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX Examination – An NCLEX review book that focuses on prioritization, delegation, and patient assignment.