Silvestri Chapter 42 Ed#566

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 042 (edited file)—"Oncological Disorders" 10/14/08, Page 1 of 26, 2 Figure(s), 0 Table(s), 23 Box(es)

42: Oncological Disorders PRACTICE QUESTIONS 1. A nurse is instructing a client to perform a testicular self-examination (TSE). Which instruction would the nurse provide to the client? 1. Examine the testicles while lying down. 2. The best time for the examination is after a shower. 3. Gently feel the testicle with one finger to feel for a growth. 4. Testicular examinations should be done at least every 6 months. Answer: 2 Rationale: The TSE 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. Test-Taking Strategy: Use the process of elimination. Eliminate option 4 first because of the words “6 months.” Next, eliminate option 3 because of the word “one.” From the remaining options, eliminate option 1 by trying to visualize the process of the self-examination. If you had difficulty with this question, review this self-examination. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Oncology Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 752. 2. A nurse is assisting in conducting a health promotion program at a local school. The nurse determines that additional teaching is needed if a student identifies which of the following as a risk factor associated with cancer? 1. Viral factors 2. Stress 3. Low-fat and high-fiber diets 4. Exposure to radiation Answer: 3 Rationale: Viruses may be one of multiple agents acting to initiate carcinogenesis and have been associated with several types of cancer. Increased stress has been associated with causing the growth and proliferation of cancer cells. Two forms of radiation, ultraviolet and ionizing, can lead to cancer. High-fiber diets may reduce the risk of colon cancer. A diet high in fat may increase the risk of developing some cancers. Test-Taking Strategy: Note the key words, additional teaching is needed. These words indicate a false response question and that you need to select the incorrect client statement. Read each option carefully, using the process of elimination. Recalling the risk factors related to cancer will direct you to option 3. Review these risk factors if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance

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Integrated Process: Teaching/Learning Content Area: Adult Health/Oncology Reference: Lewis, S., Heitkemper, M., & Dirksen, S. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed.). St. Louis: Mosby, p. 299. 3. A client with cancer is receiving chemotherapy and develops thrombocytopenia. Which intervention is the priority in the nursing plan of care? 1. Ambulate the client three times daily. 2. Monitor the client’s temperature. 3. Monitor the client for bleeding. 4. Monitor the client for pathological fractures. Answer: 3 Rationale: Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Option 2 relates to monitoring for infection particularly if leukopenia is present. Options 1 and 4, although important in the plan of care, are not directly related to thrombocytopenia. Test-Taking Strategy: Use the process of elimination and note the key word, thrombocytopenia. Recalling that this condition places the client at risk of bleeding will assist in eliminating options 1, 2, and 4. If you are unfamiliar with the nursing interventions related to this disorder, review this content. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, pp. 339, 526. 4. A nurse inspects the oral cavity of a client with cancer and notes white patches on the mucous membranes. The nurse determines that this occurrence: 1. Is common 2. Is characteristic of a thrush infection 3. Is indicative that oral hygiene needs to be improved 4. Suggests that the client is anemic Answer: 2 Rationale: Candidiasis is a fungal infection caused by Candida albicans. When it occurs in the mouth, it is called thrush, and appears as white plaques. Although it can occur in an immunocompromised client, it is not considered to be common. Options 3 and 4 are not accurate regarding this infection. Test-Taking Strategy: Use the process of elimination. Options 1 and 3 can be eliminated first. Recalling that the anemic client is more likely to exhibit pallor will assist in eliminating option 4 and will direct you to option 2. If you are unfamiliar with the manifestations associated with thrush, review this content. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection

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Content Area: Adult Health/Oncology References: Christensen, B., & Kockrow, E. (2003). Foundations of nursing (4th ed). St. Louis: Mosby, p. 880. Lewis, S., Heitkemper, M., & Dirksen, S. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed.). St. Louis: Mosby, p. 1008. 5. A nurse is monitoring the laboratory results of a client preparing to receive chemotherapy. The nurse determines that the white blood cell count (WBC) is normal if which of the following results were present? 1. 2000 to 5000/mm3 2. 3000 to 6000/mm3 3. 4000 to 9000/mm3 4. 7,000 to 15,000/mm3 Answer: 3 Rationale: The normal WBC count ranges from 4,500 to 11,000/mm3. Options 1 and 2 identify values lower than normal. Option 4 identifies a value higher than normal. Test-Taking Strategy: Recalling the normal WBC count will direct you to the correct option. Review the normal WBC count if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Pagana, K., & Pagana, T. (2003). Mosby’s diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, p. 940. 6. A nurse is instructing a group of female clients about breast self-examination (BSE). The nurse would instruct the clients to perform the examination: 1. At the onset of menstruation 2. One week after menstruation begins 3. Every month during ovulation 4. Weekly at the same time of day Answer: 2 Rationale: The BSE should be performed monthly about 7 days after the menstrual period begins. It is not recommended to perform the examination weekly. At the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue. Test-Taking Strategy: Use the process of elimination. Option 4 can be eliminated first because of the word “weekly.” Eliminate options 1 and 3 next because of the similarity that exists in regard to the hormonal changes that occur during these times. If you are unfamiliar with the procedure for performing BSE, review this self-examination. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Oncology Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 736.

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7. A nurse instructs the client in breast self-examination (BSE). The nurse instructs the client to lie down and to examine the left breast. The nurse instructs the client that while examining the left breast, to place a pillow: 1. Under the right shoulder 2. Under the left shoulder 3. Under the small of the back 4. Under the right scapula Answer: 2 Rationale: The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the left breast it to be examined, the pillow would be placed under the left shoulder. Options 3 and 4 are incorrect. Test-Taking Strategy: Visualize this procedure to select the correct option. Remember, to examine the left breast, the pillow is placed under the left breast; to examine the right breast, the pillow is placed under the right breast. If you are unfamiliar with the procedure for performing BSE, review this self-examination. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Oncology Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 736. 8. A nurse is teaching breast self-examination (BSE) to a client who has had a hysterectomy. The nurse tells the client to perform the BSE: 1. 7 to 10 days after menses 2. Just before the menses begins 3. At ovulation time 4. At a specific day of the month and on that same day every month thereafter Answer: 4 Rationale: If the client has had a hysterectomy or is no longer menstruating, the BSE should be performed on the same day every month. Options 1 and 2 are inappropriate because the client who had a hysterectomy would not be menstruating. It is best not to perform the BSE at ovulation time because of the hormonal changes that occur. Test-Taking Strategy: Use the process of elimination and note the key word. hysterectomy. Options 1 and 2 can be easily eliminated. Eliminate option 3 because of the hormonal changes that occur at this time. If you are unfamiliar with the procedure for performing BSE, review this self-examination. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Oncology Reference: Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St. Louis: Mosby, p. 737.

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9. A client suspected of having an abdominal tumor is scheduled for a computerized tomography (CT) scan with dye injection. The nurse tells the client which of the following about the test? 1. The test may be painful. 2. The dye injected may cause a warm, flushing sensation. 3. Fluids will be restricted following the test. 4. The test takes approximately 2 to 3 hours. Answer: 2 Rationale: The CT scan causes no pain and takes about 15 to 60 minutes to perform. The dye may cause a warm flushing sensation when injected. Fluids are encouraged following the procedure. If an iodine dye is used, the client should be asked about allergies to seafood or iodine. Test-Taking Strategy: Use the process of elimination and note the key words, dye injection. Noting the relationship between these key words and option 2 will assist in answering the question. Review this diagnostic test if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Oncology Reference: Pagana, K., & Pagana, T. (2003). Mosby’s diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, p. 281. 10. A 32-year-old female client has a history of fibrocystic disorder of the breasts. The nurse gathering data from the client asks whether the breast lumps are more noticeable: 1. In the spring months 2. In the autumn 3. After menses 4. Before menses Answer: 4 Rationale: The nurse asks the client with fibrocystic breast disorder about worsening of symptoms (breast lumps, painful breasts, and possible nipple discharge) before the onset of menses. This is associated with cyclical hormone changes. Options 1, 2, and 3 do not provide significant data regarding this disorder. Test-Taking Strategy: Note the key words, more noticeable. This implies that there is a predictable variation in symptoms. Use knowledge of the effects of various hormones in the body to analyze the options and choose correctly. Review fibrocystic disorder, if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed). St. Louis: Mosby, p. 528. 11. A client has undergone mastectomy. The nurse interprets that the client is making the best adjustment to the loss of the breast if which of the following behaviors is observed?

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1. Participating in the care of the surgical drain 2. Reading postoperative care booklet 3. Refusing to look at wound 4. Asking for pain medication when needed Answer: 1 Rationale: The client demonstrates the best adjustment by participating in his or her own care. This would include care of surgical drains that would be in place for a short time after discharge. Asking for pain medication is also an action-oriented option, but it does not relate to acceptance of the loss of the breast. Reading the postoperative care booklet is useful, but is not the best of the options presented. Refusing to look at the wound indicates a lack of adjustment to the loss. Test-Taking Strategy: Note the key words, best adjustment. This tells you that more than one or all of the options may be partially or totally correct. Use prioritizing skills, noting that option 1 is the most action oriented behavior. Review the psychosocial needs of the client following mastectomy if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Evaluation Content Area: Adult Health/Oncology References: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed). St. Louis: Mosby, pp. 534-536. Phipps, W., Monahan, F., Sands, J., Marek, J., & Neighbors, M. (2003). Medical-surgical nursing: Health and illness perspectives (7th ed.). St. Louis: Mosby, p. 1809. 12. A client is preparing for discharge after undergoing a radical vulvectomy. The nurse plans to tell the client that which activity is acceptable after discharge because it will not precipitate complications? 1. Sexual activity 2. Walking 3. Sitting for lengthy periods 4. Driving a car Answer: 2 Rationale: The client should resume activity slowly, and walking is a beneficial activity. The client should be instructed to rest when fatigue occurs. Activities to be avoided include driving, heavy housework, wearing tight clothing, crossing the legs, and prolonged standing or sitting. Sexual activity is prohibited for 4 to 6 weeks after surgery. Test-Taking Strategy: Use the process of elimination and note the key words, not precipitate complications. With this in mind, evaluate each of the options in terms of the stress or harm it could cause to the perineal area. This will direct you to option 2. Review home care measures following vulvectomy if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Oncology Reference: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 1087.

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13. A client has undergone vaginal hysterectomy. The nurse avoids which of the following in the care of this client? 1. Removal of antiembolism stockings twice daily 2. Assisting with range-of-motion leg exercises 3. Elevating the knee on the Gatch bed 4. Checking placement of pneumatic compression boots Answer: 3 Rationale: 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 all 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. Test-Taking Strategy: Use the process of elimination and note the key word, avoids. This word indicates a false response question and that you need to select the incorrect intervention. Recalling the complications following this type of surgery and the interventions that will prevent these complications will direct you to option 3. Review these postoperative nursing interventions if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 947. 14. A client suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse plans to tell the client that preparation for the ultrasound includes which of the following? 1. NPO prior to the procedure 2. A light breakfast only 3. Drinking six to eight glasses of water without voiding before the test 4. Wearing comfortable clothing and shoes for the procedure Answer: 3 Rationale: A pelvic ultrasound requires the ingestion of large volumes of water just prior to the procedure. A full bladder is necessary so that this organ will be visualized as such and not mistaken as a possible pelvic growth. An abdominal ultrasound may require that the client abstain from food or fluid for several hours before the procedure. Option 4 is unrelated to this specific procedure. Test-Taking Strategy: Use the process of elimination. Noting the key word, pelvic, will assist in directing you to option 3. Review preparation for a pelvic ultrasound if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Oncology

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Reference: Pagana, K., & Pagana, T. (2003). Mosby’s diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, p. 661. 15. A 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? 1. Magnetic resonance imaging (MRI) 2. Computerized tomography (CT) scan 3. Abdominal ultrasound 4. Biopsy of the tumor Answer: 4 Rationale: A biopsy is done to determine whether a tumor is malignant or benign. An MRI, CT scan, and ultrasound will visualize the presence of a mass but will not confirm a diagnosis of malignancy. Test-Taking Strategy: Use the process of elimination and note the key word, confirm. This key word will direct you to option 4. Review the purpose of the tests if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed). St. Louis: Mosby, p. 720. 16. A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which characteristic of the disorder? 1. Malignant exacerbation in the number of leukocytes 2. Altered red blood cell production 3. Altered production of lymph nodes 4. Malignant proliferation of plasma cells and tumors within the bone Answer: 4 Rationale: Multiple myeloma is a neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Option 1 describes the leukemic process. Options 2 and 3 are not characteristics of multiple myeloma. Test-Taking Strategy: Use the process of elimination and knowledge regarding the pathophysiology associated with this disorder to answer the question. Focusing on the name of the diagnosis will assist in directing you to option 4. Review this information if you are unfamiliar with this oncological disorder. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 552.

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17. A nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to specifically note with this diagnosis? 1. Decreased number of plasma cells in the bone marrow 2. Increased white blood cells 3. Increased calcium level 4. Decreased blood urea nitrogen (BUN) level Answer: 3 Rationale: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia as a result of the release of calcium from the deteriorating bone tissue, and an elevated BUN level. An increased white blood cell count may or may not be present and is not specifically related to multiple myeloma. Test-Taking Strategy: Knowledge regarding the pathophysiology associated with this disorder and the effects it produces on the body is required to answer the question. Remember, hypercalcemia occurs as a result of the release of calcium from the deteriorating bone tissue. Review this information if you are unfamiliar with this oncological disorder. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Lewis, S., Heitkemper, M., & Dirksen, S. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed.). St. Louis: Mosby, p. 745. 18. A nurse is assisting in developing a plan of care for the client with multiple myeloma. A priority nursing intervention for a client with multiple myeloma is which of the following? 1. Coughing and deep breathing 2. Encouraging fluids 3. Monitoring the red blood cell count 4. Providing frequent oral care Answer: 2 Rationale: Hypercalcemia secondary to bone destruction is a priority concern in the client with multiple myeloma. The nurse should encourage fluids in adequate amounts to maintain an output of 1.5 to 2.0 L/day. Clients require about 3 L of fluid per day. The fluid is needed not only to dilute the calcium, but also to prevent protein from precipitating in the renal tubules. Options 1, 3, and 4 may be a component of the plan of care, but are not the priority in this client. Test-Taking Strategy: Knowledge regarding the clinical manifestations that occur in multiple myeloma is required to answer the question. Recalling that encouraging fluids is specific to the care of a client with this disorder will direct you to option 2. Review the specific manifestations of this disorder if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Oncology Reference: Lewis, S., Heitkemper, M., & Dirksen, S. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed.). St. Louis: Mosby, p. 746.

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19. A nursing instructor asks a nursing student about the characteristics of Hodgkin's disease. The instructor determines that the student needs to read about the characteristics of this disease if the student states that which of the following is an associated characteristic? 1. Presence of Reed-Sternberg cells 2. Involvement of lymph nodes, spleen, and liver 3. Occurs most often in older adults 4. Prognosis depends on the stage of the disease Answer: 3 Rationale: Hodgkin's disease is a disorder of young adults and primarily occurs between the ages of 20 to 40. Options 1, 2, and 4 are characteristics of this disease. Test-Taking Strategy: Use the process of elimination and note the key words, needs to read about the characteristics of this disease. Recalling that Hodgkin’s disease occurs in the young adult will direct you to option 3. Review the characteristics of this disorder if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Oncology Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed). St. Louis: Mosby, p. 279. 20. A nurse is assisting in conducting a health promotion program regarding testicular cancer to community members. The nurse determines that further teaching is needed if a community member states that which of the following is a sign of testicular cancer? 1. Painless testicular swelling 2. Heavy sensation in the scrotum 3. Alopecia 4. Back pain Answer: 3 Rationale: Alopecia is not a finding in testicular cancer. It may however occur as a result of radiation or chemotherapy. Options 1, 2, and 4 are findings in testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes. Test-Taking Strategy: Note the key words, further teaching is needed. These words indicate a false response question and that you need to select the incorrect sign. Use the process of elimination, remembering that alopecia occurs as a result of chemotherapy rather than from the disease. Review the manifestations associated with testicular cancer if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Oncology Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed). St. Louis: Mosby, p. 541. 21. A nurse is reviewing the laboratory results of a client with leukemia who has received a

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regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurs with the chemotherapy? 1. Anemia 2. Decreased platelets 3. Decreased leukocyte count 4. Increased uric acid level Answer: 4 Rationale: Hyperuricemia is especially common following treatment for leukemias and lymphomas, because the therapy results in massive cell destruction. Although options 1, 2, and 3 may also be noted, an increased uric acid level is specifically related to cell destruction. Test-Taking Strategy: Note the key words, specifically note and massive cell destruction. Recalling the cell response to destruction will assist in directing you to option 4. Review this concept if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, pp. 2405-2406. 22. A nurse is preparing a client with a bowel tumor for surgery. The physician has informed the client that the surgery is palliative in the treatment of the tumor. The nurse understands that this type of surgery is performed to: 1. Restore maximal function and appearance. 2. Eliminate high-risk factors. 3. Reduce pain. 4. Cure the client. Answer: 3 Rationale: Palliative surgery that can benefit the client with cancer and improve quality of life includes procedures that reduce pain, relieve airway obstructions, relieve obstruction in the gastrointestinal and urinary tracts, relieve pressure on the brain and spinal cord, and prevent hemorrhage. Options 1, 2, and 4 do not describe palliative surgery. Test-Taking Strategy: Note the key word, palliative. Knowledge of the definition of this word will assist in directing you to option 3. Review the various types of surgery if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Oncology Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed). St. Louis: Mosby, p. 20. 23. A client is receiving external radiation to the neck for cancer of the larynx. The nurse plans care knowing that the most likely side effect to be expected is: 1. Constipation

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2. Dyspnea 3. Sore throat 4. Diarrhea Answer: 3 Rationale: 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 1 and 4 may occur with radiation to the gastrointestinal (GI) tract. Dyspnea may occur with lung involvement. Test-Taking Strategy: Use the process of elimination and note the key words, most likely. Eliminate options 1 and 4 first because they are similar and GI related. Consider the anatomical location of the radiation therapy to assist in directing you to option 3. Review the effects of radiation therapy if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 330. 24. A nurse inspects the skin of a client receiving external radiation therapy and documents a finding noted as moist desquamation. The nurse understands that moist desquamation is best described as which of the following? 1. Reddened skin 2. A rash 3. Weeping of the skin 4. Dermatitis Answer: 3 Rationale: Moist desquamation occurs when the basal cells of the skin are destroyed. The dermal level is exposed, which results in the leakage of serum. Reddened skin, a rash, and dermatitis may occur with external radiation but is not described as a moist desquamation. Test-Taking Strategy: Use the process of elimination. Noting the key word, moist, will direct you to option 3. Options 1, 2, and 4 are eliminated because they are similar and describe a dry rather than a moist skin alteration. Review the signs associated with a moist desquamation if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Thompson, J., McFarland, G., Hirsch, J., & Tucker, S. (2002). Mosby’s clinical nursing (5th ed.). St. Louis: Mosby, pp. 1230-1231. 25. A nurse is providing instructions to a client receiving external radiation therapy. The nurse determines that the client needs further instructions if the client states an intention to: 1. Avoid exposure to sunlight.

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2. Wash the skin with a mild soap and pat dry. 3. Apply pressure on the radiated area to prevent bleeding. 4. Eat a high-protein diet. Answer: 3 Rationale: The client should avoid pressure on the radiated area and should wear loose-fitting clothing. Options 1, 2, and 4 are accurate instructions regarding radiation therapy. Test-Taking Strategy: Use the process of elimination and note the key words, needs further instructions. These words indicate a false response question and that you need to select the incorrect client statement. The word “pressure” in option 3 should be an indication that this is an inappropriate measure. Review client teaching points related to skin care and radiation therapy if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 342. 26. A nurse is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which principle? 1. Limit the time with the client to 1 hour per shift. 2. Do not allow pregnant women into the client's room. 3. Individuals under 16 years may be allowed to go in the room as long as they are 6 feet away from the client. 4. Remove dosimeter badge when entering the client's room. Answer: 2 Rationale: 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 client’s room. Children younger than 16 years of age and pregnant women are not allowed in the client’s room. Test-Taking Strategy: Use the process of elimination. Option 4 can be eliminated first. Knowledge of the time frame related to exposure to the client will assist in eliminating option 1. From the remaining options, select option 2 because of the possible risks associated with exposure to the mother and fetus. Review these principles if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Oncology Reference: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 363. 27. A client was hospitalized for a cervical radiation implant for the treatment of cervical cancer. The implant is removed, the client is to be discharged, and the nurse reinforces discharge instructions. Which statement by the client indicates the need for further instructions? 1. “Cream may be used to relieve dryness or itching.”

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2. “Foul-smelling vaginal discharge is a sign of an infection.” 3. “Sexual intercourse may be resumed after 7 to 10 days.” 4. “Some vaginal bleeding is expected for 1 to 3 months.” Answer: 2 Rationale: Foul-smelling vaginal discharge is expected and will occur for some time following removal of a radiation implant from the cervix. It is not a sign of an infection. Options 1, 3, and 4 are accurate discharge instructions. Test-Taking Strategy: Note the key words, need for further instructions. These words indicate a false response question and that you need to select the incorrect client statement. Recalling that foul-smelling vaginal discharge is expected will direct you to option 2. Review these points if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, pp. 962-963. 28. A cervical radiation implant is placed in the client for treatment of cervical cancer. What activity order would the nurse most likely expect to note in the physician’s orders? 1. Out of bed in a chair only 2. Ambulate to the bathroom only 3. Bed rest 4. Out of bed ad lib Answer: 3 Rationale: 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. Avoid turning the client on the side. If the client needs to be turned, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled. Test-Taking Strategy: Consider the anatomical location of the implant and the risk of dislodgement to answer the question. Additionally, note that options 1, 2, and 4 are similar. If you had difficulty with this question, review care of the client with a radiation implant. Level of Cognitive Ability: Comprehension Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Planning Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 962. 29. A nurse teaches skin care to the client receiving external radiation therapy. Which of the following statements, if made by the client, would indicate the need for further instruction? 1. “I will handle the area gently.” 2. “I will avoid the use of deodorants.” 3. “I will limit sun exposure to 1 hour daily.”

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4. “I will wear loose-fitting clothing.” Answer: 3 Rationale: The client needs to be instructed to avoid exposure to the sun. Options 1, 2, and 4 are accurate measures in the care of a client receiving external radiation therapy. Test-Taking Strategy: Note the key words, need for further instruction. These words indicate a false response question and that you need to select the incorrect client statement. Eliminate option 1 because of the word “gently’ and option 4 because of the word “loose.” From the remaining options, recalling that sun exposure is to be avoided will assist in answering the question. Review skin care measures for the client receiving external radiation if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 342. 30. A client is hospitalized for insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. The nurse would immediately: 1. Call the physician. 2. Pick up the implant with gloved hands and flush down the toilet. 3. Reinsert the implant into the vagina immediately. 4. Pick up the implant with long-handled forceps and place into a lead container. Answer: 4 Rationale: A lead container and long-handled forceps should be kept in the client’s 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 into the lead container. Options 1, 2, and 3 are inaccurate interventions. Test-Taking Strategy: Use the process of elimination. Note the key word, immediately. Option 3 is not an appropriate action. Eliminate option 2 next because the implant would not be discarded. Although the physician would be notified, the initial action is option 4. Review the measures related to a dislodged implant if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Oncology Reference: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 362. 31. A nurse is assisting in developing a plan of care for a client experiencing hematological toxicity as a result of chemotherapy. The nurse suggests including which of the following in the plan of care? 1. Restricting all visitors 2. Restricting fluid intake 3. Inserting an indwelling urinary catheter to prevent skin breakdown

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4. Restricting fresh fruits and vegetables in the diet Answer: 4 Rationale: In a client experiencing hematological toxicity, a low-bacteria diet is implemented. This includes avoiding fresh fruits and vegetables and thorough cooking of all foods. Not all visitors are restricted, but the client is protected from people with known infections. Fluids should be encouraged. Invasive measures such as an indwelling urinary catheter should be avoided to prevent infections. Test-Taking Strategy: Use the process of elimination. Eliminate option 1 because of the word “all.” Next, eliminate option 2 because it is not reasonable to restrict fluids in a client receiving chemotherapy who is already at risk for fluid and electrolyte imbalances. Eliminate option 3 because of the risk of infection that exists with this measure. Review interventions for the client with hematological toxicity if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Planning Content Area: Adult Health/Oncology References: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed). St. Louis: Mosby, p. 732. Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 340. 32. A nurse is reviewing the laboratory results of a client receiving chemotherapy and notes that the platelet count is 10,000/mm3. Based on this laboratory value, the priority action is to monitor which of the following? 1. Level of consciousness 2. Temperature 3. Bowel sounds 4. Skin turgor Answer: 1 Rationale: A high risk of hemorrhage exists when the platelet count is lower than 20,000/mm3. Fatal central nervous system (CNS) hemorrhage or massive gastrointestinal (GI) hemorrhage can occur when the platelet count is lower than 10,000/mm3. The client should be monitored for changes in level of consciousness, which may be an early indication of an intracranial hemorrhage. Option 2 is a priority when the WBC count is low and the client is at risk for an infection. Although options 3 and 4 are important, they are not the priority in this situation. Test-Taking Strategy: Use the process of elimination and note the key word, priority. Recalling the normal platelet count and determining that a low count places the client at risk for bleeding will assist in eliminating options 2, 3, and 4. Review the normal platelet count and the nursing interventions for a client with a low count if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Oncology References: Lewis, S., Heitkemper, M., & Dirksen, S. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed.). St. Louis: Mosby, p. 700.

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Pagana, K., & Pagana, T. (2003). Mosby’s diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, p. 679. 33. A nurse is caring for a postoperative client who had a pelvic exenteration. The physician has changed the client's diet from NPO to clear liquids. The nurse checks which of the following before administering the clear liquids? 1. Ability to ambulate 2. Specific gravity of the urine 3. Incision appearance 4. Bowel sounds Answer: 4 Rationale: The client is kept NPO until peristalsis returns, usually in 4 to 6 days postoperatively. When signs of bowel function return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. It is most important to monitor for bowel sounds prior to feeding the client. Options 1, 2, and 3 are unrelated to the issue of the question. Test-Taking Strategy: Use the process of elimination. Note the key words, priority and NPO to clear liquids. Option 4 is the only option that relates to GI function, which is the issue of the question. Review care of the client following abdominal surgery if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Oncology Reference: Lewis, S., Heitkemper, M., & Dirksen, S. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed.). St. Louis: Mosby, p. 1062. 34. A client is admitted to the hospital with a diagnosis of suspected Hodgkin's disease. Which of the following findings would the nurse most likely expect to note documented in the client’s record? 1. Weakness 2. Fatigue 3. Weight gain 4. Enlarged lymph nodes Answer: 4 Rationale: Hodgkin’s 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 is not significantly related to the disease. Test-Taking Strategy: Use the process of elimination and note the key words, most likely. Option 3 can be eliminated first because in such a disorder, weight loss is most likely to occur. Options 1 and 2 are similar and rather vague symptoms that can occur in many disorders. Also, recalling that Hodgkin’s disease affects the lymph nodes will direct you to option 4. Review the manifestations associated with Hodgkin’s disease if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity

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Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed). St. Louis: Mosby, p. 279. 35. When reviewing the health care record of a client with ovarian cancer, the nurse recognizes which symptom as typical of the disease? 1. Hypermenorrhea 2. Abdominal distention 3. Diarrhea 4. Abnormal bleeding Answer: 2 Rationale: Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, pain from pressure caused by the growing tumor and the effects of urinary or bowel obstruction, and constipation. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer. Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 4 first because they are similar. From the remaining options, consider the anatomical location of the diagnosis. This will assist in directing you to option 2. Review the manifestations associated with ovarian cancer if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 960. 36. A nurse is reviewing the complications of conization with a client who has microinvasive cervical cancer. The nurse determines that the client needs additional information about the complications of the procedure if the client states that which of the following is a complication? 1. Infection 2. Infertility 3. Ovarian perforation 4. Hemorrhage Answer: 3 Rationale: Conization is generally not performed on women who desire to bear children because it can lead to incompetence of the cervix or infertility. Other complications of the procedure include hemorrhage, infection and, less frequently cervical stenosis. Test-Taking Strategy: Use the process of elimination. Note the key words needs additional information and the words “cervical cancer.” Select option 3 because this option addresses an “ovarian” condition, not a cervical one. Review the complications associated with this procedure if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation

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Content Area: Adult Health/Oncology Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed). St. Louis: Mosby, p. 524. 37. A nurse is caring for a client dying of ovarian cancer. During care, the client states, "If I can just live long enough to attend my daughter's graduation, I'll be ready to die." Which phase of coping is this client experiencing? 1. Denial 2. Bargaining 3. Depression 4. Anger Answer: 2 Rationale: Denial, bargaining, anger, depression, and acceptance are recognized stages that a person facing a life-threatening illness experiences. The client’s statement is indicative of bargaining. 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 may also be a first response to upsetting news and the predominant theme is “Why me?” or the blaming of others. Test-Taking Strategy: Focus on the client’s statement as identified in the question to assist in selecting the correct option. From this point, you should be able to eliminate options 1, 3, and 4. Review these stages if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed). St. Louis: Mosby, pp. 931-933. 38. A nurse is caring for a client following a modified radical mastectomy. Which of the following findings would indicate that the client is experiencing a complication related to the surgery? 1. Sanguineous drainage in the drainage tube 2. Pain at the incisional site 3. Complaints of decreased sensation near the operative site 4. Arm edema on the operative side Answer: 4 Rationale: Arm edema on the operative side (lymphedema) is a complication following mastectomy and can occur immediately postoperatively, months, or even years after surgery. Options 1, 2, and 3 are expected occurrences following mastectomy and are not indicative of a complication. Test-Taking Strategy: Use the process of elimination, considering the normal expected occurrences following a mastectomy. This will direct you to the correct option. If you had difficulty with this question, review the complications following mastectomy. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity

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Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, pp. 957; 959. 39. A nurse is reviewing the health record of a client with laryngeal cancer. The nurse would expect to note which most common risk factor for this type of cancer as documented in the record? 1. Use of chewing tobacco 2. Cigarette smoking 3. Urban living 4. Alcohol abuse Answer: 2 Rationale: The most common risk factor associated with laryngeal cancer is cigarette smoking. Approximately 75% of those diagnosed with this form of cancer smoke, either currently or in the past. Alcohol abuse may have a synergistic effect with cigarette smoking. Air pollution is also a contributing cause, as well as chronic laryngitis and voice abuse. Test-Taking Strategy: Use the process of elimination and note the key words, most common. Begin to answer this question by eliminating options 3 and 4. Because cancer of the upper and lower airway is most often related to tobacco, these are the options that are most likely correct. From the remaining options, recalling that cigarettes are the most harmful, guides you to choose this option over the option of chewing tobacco. Review these risk factors if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 1111. 40. A 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: 1. Extreme stress due to the diagnosis of cancer 2. Altered perineal sensation as a side effect of radiation therapy 3. The development of a vesicovaginal fistula 4. Rupture of the bladder Answer: 3 Rationale: A vesicovaginal fistula is a genital fistula that occurs between the bladder and the 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 client’s complaint is not associated with options 1, 2, and 4. Test-Taking Strategy: Use the process of elimination. Noting the key words, voiding through the vagina, should direct you to option 3. Review the symptoms associated with vesicovaginal fistula if you had difficulty with this question.

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Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Phipps, W., Monahan, F., Sands, J., Marek, J., & Neighbors, M. (2003). Medicalsurgical nursing: Health and illness perspectives (7th ed.). St. Louis: Mosby, pp. 1758-1759. 41. A client with leukemia is receiving busulfan (Myleran). Allopurinol (Zyloprim) is prescribed for the client. The nurse understands that the purpose of the allopurinol (Zyloprim) is to: 1. Prevent gouty arthritis. 2. Prevent hyperuricemia. 3. Prevent stomatitis. 4. Prevent diarrhea. Answer: 2 Rationale: Allopurinol decreases uric acid production and reduces uric acid concentrations in both 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 secondary to chemotherapy. Although the medication is used to treat gout, it is not the purpose in this client’s situation. This medication is not used to prevent stomatitis or diarrhea. Test-Taking Strategy: Use the process of elimination. Recalling that hyperuricemia occurs as a result of chemotherapy will assist in directing you to option 2. If you had difficulty with this question or are unfamiliar with the action of this medication, review this content. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Oncology Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, pp. 686-687. 42. A client receiving chemotherapy is experiencing stomatitis. The nurse advises the client to use which of the following as the best substance to rinse the mouth? 1. Hydrogen peroxide mixture 2. Weak salt and bicarbonate mouth rinse 3. Lemon-flavored mouthwash 4. Alcohol-based mouthwash Answer: 2 Rationale: An acidic environment in the mouth is favorable for bacterial growth. Therefore, the client is advised to rinse the mouth at least before every meal and at bedtime with a weak salt and sodium bicarbonate mouth rinse. This lessens the growth of bacteria and limits plaque formation. The other substances are irritating to oral tissue, which is already at risk. If hydrogen peroxide must be used, it should be a very weak solution, because it dries the mucous membranes. Test-Taking Strategy: Use the process of elimination. Options 3 and 4 can be eliminated first

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because of the irritating effects of these solutions. From the remaining options, note the word “weak” in the correct option. Review the treatment measures for stomatitis if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Oncology Reference: Phipps, W., Monahan, F., Sands, J., Marek, J., & Neighbors, M. (2003). Medicalsurgical nursing: Health and illness perspectives (7th ed.). St. Louis: Mosby, p. 353. 43. A nurse is assisting in conducting a health promotion program and the topic of the discussion relates to the risk factors of gastric cancer. The nurse determines that a client attending the program needs additional teaching if the client states that which of the following is associated with the incidence of this type of cancer? 1. History of gastric polyps 2. History of pernicious anemia 3. A diet of smoked, highly salted, and spiced food 4. High meat and carbohydrate consumption Answer: 4 Rationale: High meat and carbohydrate consumption plays a role in the development of cancer of the pancreas. Options 1, 2, and 3 are risk factors related to gastric cancer. Test-Taking Strategy: Use the process of elimination. Note that the question asks about the risk factors associated with gastric cancer, and note the key words, needs additional teaching. Eliminate options 1 and 2 because they are directly related to gastric disorders. Eliminate option 3 knowing that spicy foods cause gastric irritation. Review the risk factors associated with gastric cancer if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Oncology Reference: Phipps, W., Monahan, F., Sands, J., Marek, J., & Neighbors, M. (2003). Medicalsurgical nursing: Health and illness perspectives (7th ed.). St. Louis: Mosby, p. 1046. 44. A nurse is reviewing the preoperative orders of a client with a colon tumor who is scheduled for abdominal perineal resection. The nurse notes that the physician has prescribed neomycin sulfate (Mycifradin) for the client. The nurse determines that this medication has been prescribed: 1. Because the client has an infection 2. To prevent an infection 3. To decrease the bacteria in the bowel 4. Because the client is allergic penicillin Answer: 3 Rationale: To reduce the risk of contamination at the time of surgery, the bowel is emptied and cleansed. Laxatives and enemas are given to empty the bowel. Intestinal antiinfectives such as neomycin are administered to decrease the bacteria in the bowel.

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Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 4 first because there is no reference made to this information in the question. Recalling the concepts related to the flora of the intestinal tract will assist in directing you to option 3 as the primary purpose of this medication. Review this preoperative intervention if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Oncology Reference: Phipps, W., Monahan, F., Sands, J., Marek, J., & Neighbors, M. (2003). Medicalsurgical nursing: Health and illness perspectives (7th ed.). St. Louis: Mosby, p. 1108. 45. A nurse caring for a client following a radical neck dissection and creation of a tracheostomy performed for laryngeal cancer is reinforcing discharge instructions to the client. Which statement by the client indicates the need for additional instructions regarding care to the stoma? 1. “I need to apply a thin layer of petrolatum to the skin around the stoma to prevent cracking.” 2. “I need to protect the stoma from water.” 3. “I need to use an air conditioner to provide cool air to assist in breathing.” 4. “I need to keep powders and sprays away from the stoma site.” Answer: 3 Rationale: Air conditioners need to be avoided to protect from excessive coldness. A humidifier in the home should be used if excessive dryness is a problem. Options 1, 2, and 4 are appropriate interventions regarding stoma care following radical neck dissection and creation of a tracheotomy. Test-Taking Strategy: Use the process of elimination. Noting the key words, need for additional instructions, will assist in eliminating options 2 and 4. From the remaining options, recalling that a humidifier rather than an air conditioner is recommended will assist in selecting the correct option. If you had difficulty with this question, review discharge instructions following radical neck dissection. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Oncology Reference: Phipps, W., Monahan, F., Sands, J., Marek, J., & Neighbors, M. (2003). Medicalsurgical nursing: Health and illness perspectives (7th ed.). St. Louis: Mosby, p. 509. 46. A nurse is caring for a client with cancer of the prostate following a prostatectomy. The nurse reinforces discharge instructions and plans to include which of the following? 1. Notify the physician if small blood clots are noticed during urination. 2. Driving a car may be resumed in 1 week. 3. Restrict fluid intake to prevent incontinence. 4. Avoid lifting objects heavier than 20 pounds for at least 6 weeks. Answer: 4 Rationale: Small pieces of tissue or blood clots can be passed during urination for up to 2 weeks after surgery. Driving a car and sitting for long periods of time are restricted for at least 3 weeks. A daily fluid intake of 2 to 2.5 L/day should be maintained to limit clot formation and prevent

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infection. Option 4 is an accurate discharge instruction following prostatectomy. Test-Taking Strategy: Use the process of elimination. Option 3 can be easily eliminated first. Eliminate option 2 next, because 1 week is a rather short time period. Recalling that blood clots are expected following this type of surgery will assist in directing you to option 4. Review client teaching points following prostatectomy if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Oncology Reference: Phipps, W., Monahan, F., Sands, J., Marek, J. & Neighbors, M. (2003). Medicalsurgical nursing: health and illness perspectives (7th ed.). St. Louis: Mosby, p. 1846. 47. A nurse is assisting in providing a teaching session to a community group regarding the risks and causes of bladder cancer. The nurse determines that additional teaching is needed if a member of the community group states that which of the following is associated with this type of cancer? 1. It most often occurs in women 2. It is generally seen in clients older than age 40 3. Environmental health hazards have been attributed as a cause 4. Using cigarettes, artificial sweeteners, and coffee drinking can increase the risk Answer: 1 Rationale: The incidence of bladder cancer is three times greater in men than in women and affects the white population twice as often as the black population. Options 2, 3, and 4 are associated with the incidence of bladder cancer. Test-Taking Strategy: Use the process of elimination and note the key words, additional teaching is needed. Basic information regarding the risks associated with cancer will assist in eliminating options 3 and 4. From the remaining options, knowledge regarding the risk factors associated with bladder cancer will direct you to option 1. If you had difficulty with this question, review these risks. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Oncology Reference: Lewis, S., Heitkemper, M., & Dirksen, S. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed.). St. Louis: Mosby, p. 1194. 48. A nurse is reviewing the history of a client with bladder cancer. The nurse would expect to note which most common symptom of this type of cancer documented in the record? 1. Frequency of urination 2. Urgency on urination 3. Hematuria 4. Dysuria Answer: 3 Rationale: The most common symptom in clients with cancer of the bladder is hematuria. The client may also experience irritative voiding symptoms such as frequency, urgency, and dysuria

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and these symptoms are often associated with cancer in situ. Test-Taking Strategy: Use the process of elimination and note the key words, most common. Options 1, 2, and 4 are symptoms that are also associated with bladder infection. Review the clinical manifestations associated with bladder cancer if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Phipps, W., Monahan, F., Sands, J., Marek, J., & Neighbors, M. (2003). Medicalsurgical nursing: Health and illness perspectives (7th ed.). St. Louis: Mosby, p. 1226. 49. A nurse is inspecting the stoma of a client following a ureterostomy. Which of the following would the nurse expect to note? 1. A pale stoma 2. A red and moist stoma 3. A dry stoma 4. A dark-colored stoma Answer: 2 Rationale: After ureterostomy, the stoma should be red and moist. A pale stoma may indicate an inadequate amount of vascular supply. A dry stoma may indicate body fluid deficit. Any sign of darkness or duskiness in the stoma may mean loss of vascular supply and must be corrected immediately or necrosis can occur. Test-Taking Strategy: Use the process of elimination. You should easily be able to eliminate options 1 and 4. From the remaining options, note the key word, moist, in option 2. This should indicate that this is an expected and positive finding. If you had difficulty with this question, review expected and unexpected findings following ureterostomy. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 363. 50. A nurse is caring for a client following a radical mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? 1. Placing cool compresses on the affected arm 2. Elevating the affected arm on a pillow above heart level 3. Maintaining an IV site below the antecubital area on the affected side 4. Avoiding arm exercises in the immediate postoperative period Answer: 2 Rationale: After mastectomy, the arm should be elevated above the level of the heart. Arm exercises should be encouraged. No blood pressure readings, injections, IV line insertions, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure to prevent lymphedema from occurring. Test-Taking Strategy: Note the key words, assist in preventing. Use the process of elimination

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and note the relationship between the words lymphedema in the question and elevating in the correct option. Review these measures if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Oncology Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 959. 51. A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which of the following may be prescribed? ____Increased fluid intake ____Decreased sodium intake ____Monitoring of serum sodium blood levels ____Medication that is antagonistic to antidiuretic hormone (ADH) ____Radiation or chemotherapy Answers: Monitoring of serum sodium blood levels Medication that is antagonistic to antidiuretic hormone (ADH) Radiation or chemotherapy Rationale: Cancer is a common cause of SIADH. In SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. SIADH is managed by treating the condition and cause and usually includes fluid restriction, increased sodium intake, and medication with a mechanism of action that is antagonistic to ADH. Sodium levels are monitored closely because hypernatremia can suddenly develop as a result of treatment. The immediate institution of appropriate cancer therapy, usually either radiation or chemotherapy, can cause such tumor regression that ADH synthesis and release processes return to normal. Test-Taking Strategy: Focusing on the client’s diagnosis and recalling that, in SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation will assist in answering this question. Review the treatment for SIADH if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs : Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Oncology Reference: Ignatavicius, D., & Workman, M. (2006). Medical surgical nursing: Critical thinking for collaborative care (5th ed.). Philadelphia: W.B. Saunders, pp. 501-502.