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Practice Test

Cancer and Oncology Nursing NCLEX Practice Quiz #1

(56 Questions)
By Matt Vera - February 18, 2014

Neonatal Nurse Designed

The Innovative babyLance™ Offers a Family of
Sizes, Precision Targeting & Safety Features

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This is a 56-item examination all about Oncology Nursing and Cancer. Oncology nurses are challenged on a
daily basis to deal with the numerous symptoms patients with cancer and their families encounter as a
result of their cancer or its treatment. So it is very important to be updated on the current variety of roles
and settings that were unheard of 10 years ago, but are now increasingly commonplace. These NCLEX style
questions can help you review for your local boards. Good luck!

Success seems to be connected with action. Successful people keep moving. They make mistakes, but
they donʼt quit.
~ Conrad Hilton

Topics

Neonatal Nurse Designed

The Innovative babyLance™ Offers a Family of Sizes, Precision Targeting
& Safety Features

Included topics in this practice quiz are:

Oncology Nursing
Hodgkinʼs Disease
Lung Cancer
Chemotherapy
Brachytherapy

Guidelines
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 are given below. Be sure to read them.
If you need more clarifications, please direct them to the comments section.

Questions

⋆ EXAM MODE ! PRACTICE MODE " TEXT MODE

In Exam Mode: All questions are shown in random and the results, answers and rationales (if any) will
only be given after youʼve finished the quiz. You are given 1 minute per question, a total of 56
minutes for this exam.

NCLEX Exam: Cancer and Oncology Nursing (56 Items)

48c46

Congratulations - you have completed NCLEX Exam: Cancer and Oncology Nursing (56 Items).

You scored 7 out of 56.

Your performance has been rated as Need more practice!

Your answers are highlighted below.

Question 1 CORRECT

A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how
the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is
which of the following?

“Chemotherapy affects all rapidly dividing cells.”

“The molecular structure of the DNA is altered.”

“Cancer cells are susceptible to drug toxins.”

“Chemotherapy encourages cancer cells to divide.”

Question 1 Explanation:

There are many mechanisms of action for chemotherapeutic agents, but most affect the
rapidly dividing cells—both cancerous and noncancerous. Cancer cells are characterized
by rapid cell division. Chemotherapy slows cell division. Not all chemotherapeutic agents
affect molecular structure. All cells are susceptible to drug toxins, but not all
chemotherapeutic agents are toxins.

Question 2 WRONG

A client with leukemia has neutropenia. Which of the following functions must be frequently
assessed?

Blood pressure

Bowel sounds

Heart sounds

Breath sounds

Question 2 Explanation:

Pneumonia, both viral and fungal, is a common cause of death in clients with
neutropenia, so frequent assessment of respiratory rate and breath sounds is required.
Although assessing blood pressure, bowel sounds, and heart sounds is important, it
wonʼt help detect pneumonia.

Question 3 WRONG

A pneumonectomy is a surgical procedure sometimes indicated for treatment of non-small-

cell lung cancer. A pneumonectomy involves removal of:

An entire lung field

A small, wedge-shaped lung surface

One lobe of a lung

One or more segments of a lung lobe

Question 3 Explanation:

A pneumonectomy is the removal of an entire lung field. A wedge resection refers to

removal of a wedge-shaped section of lung tissue. A lobectomy is the removal of one
lobe. Removal of one or more segments of a lung lobe is called a partial lobectomy.

Question 4 WRONG

The nurse is caring for a client following a modified radical mastectomy. Which assessment
finding would indicate that the client is experiencing a complication related to this surgery?

Sanguineous drainage in the Jackson-Pratt drain

Pain at the incisional site

Complaints of decreased sensation near the operative site

Arm edema on the operative side

Question 4 Explanation:

Arm edema on the operative side (lymphedema) is a complication following mastectomy

and can occur immediately postoperatively or may occur months or even years after
surgery. The other options are expected occurrences.

Question 5 WRONG

The oncology nurse specialist provides an educational session to nursing staff regarding the
characteristics of Hodgkinʼs disease. The nurse determines that further education is needed
if a nursing staff member states that which of the following is characteristic of the disease?

Presence of Reed-Sternberg cells

Involvement of lymph nodes, spleen, and liver

Occurs most often in the older client

Prognosis depends on the stage of the disease

Question 5 Explanation:

Hodgkinʼs disease is a disorder of young adults. Options 1, 2, and 4 are characteristics of

this disease.

Question 6 WRONG

In the client with terminal lung cancer, the focus of nursing care is on which of the following
nursing interventions?

Provide emotional support

Provide nutritional support

Provide pain control

Prepare the clientʼs will

Question 6 Explanation:

The client with terminal lung cancer may have extreme pleuritic pain and should be
treated to reduce his discomfort. Preparing the client and his family for the impending
death and providing emotional support is also important but shouldnʼt be the primary
focus until the pain is under control. Nutritional support may be provided, but as the
terminal phase advances, the clientʼs nutritional needs greatly decrease. Nursing care
doesnʼt focus on helping the client prepare the will.

Question 7 CORRECT

Which of the following nursing interventions would be most helpful in making the respiratory
effort of a client with metastatic lung cancer more efficient?

Teaching the client diaphragmatic breathing techniques

Administering cough suppressants as ordered

Teaching and encouraging pursed-lip breathing

Placing the client in a low semi-Fowlers position

Question 7 Explanation:

For clients with obstructive versus restrictive disorders, extending exhalation through
pursed-lip breathing will make the respiratory effort more efficient. The usual position of
choice for this client is the upright position, leaning slightly forward to allow greater lung
expansion. Teaching diaphragmatic breathing techniques will be more helpful to the
client with a restrictive disorder. Administering cough suppressants will not help
respiratory effort. A low semi-Fowlers position does not encourage lung expansion. Lung
expansion is enhanced in the upright position.

Question 8 CORRECT

Which of the following statements is correct about the rate of cell growth in relation to
chemotherapy?

Faster growing cells are less susceptible to chemotherapy.

Non-dividing cells are more susceptible to chemotherapy

Faster growing cells are more susceptible to chemotherapy

Slower growing cells are more susceptible to chemotherapy.

Question 8 Explanation:

The faster the cell grows, the more susceptible it is to chemotherapy and radiation
therapy. Slow-growing and non-dividing cells are less susceptible to chemotherapy.
Repeated cycles of chemotherapy are used to destroy nondividing cells as they begin
active cell division.

Question 9 CORRECT

The community nurse is conducting a health promotion program at a local school and is
discussing the risk factors associated with cancer. Which of the following, if identified by the
client as a risk factor, indicates a need for further instructions?

Viral factors

Stress

Low-fat and high-fiber diets

Exposure to radiation

Question 9 Explanation:

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. A diet high in fat may be a factor in the development of
breast, colon, and prostate cancers. High-fiber diets may reduce the risk of colon cancer.

Question 10 WRONG

Which of the following clients is most at risk for developing multiple myeloma?

A 20-year-old Asian woman

A 30-year-old White man

A 50-year-old Hispanic woman

A 60-year-old Black man

Question 10 Explanation:

Multiple myeloma is more common in middle-aged and older clients (the median age at
diagnosis is 60 years) and is twice as common in Blacks as Whites. It occurs most often
in Black men.

Question 11 WRONG

Which of the following represents the most appropriate nursing intervention for a client with
pruritis caused by cancer or the treatments?

Administration of antihistamines

Steroids

Silk sheets

Medicated cool baths

Question 11 Explanation:

Nursing interventions to decrease the discomfort of pruitus include those that prevent
vasodilation, decrease anxiety, and maintain skin integrity and hydration. Medicated
baths with salicyclic acid or colloidal oatmeal can be soothing as a temporary relief. The
use of antihistamines or topical steroids depends on the cause of pruritus, and these
agents should be used with caution. Using silk sheets is not a practical intervention for
the hospitalized client with pruritis.

Question 12 PARTIAL-CREDIT

When caring for a client with a central venous line, which of the following nursing actions
should be implemented in the plan of care for chemotherapy administration? Select all that
apply.

Verify patency of the line by the presence of a blood return at regular

intervals.

Inspect the insertion site for swelling, erythema, or drainage.

Administer a cytotoxic agent to keep the regimen on schedule even if blood

return is not present.

If unable to aspirate blood, reposition the client and encourage the client to
cough.

Contact the health care provider about verifying placement if the status is
questionable.

Question 12 Explanation:

A major concern with intravenous administration of cytotoxic agents is vessel irritation or

extravasation. The Oncology Nursing Society and hospital guidelines require frequent
evaluation of blood return when administering vesicant or nonvesicant chemotherapy
due to the risk of extravasation. These guidelines apply to peripheral and central venous
lines. In addition, central venous lines may be long-term venous access devices. Thus,
difficulty drawing or aspirating blood may indicate the line is against the vessel wall or
may indicate the line has occlusion. Having the client cough or move position may
change the status of the line if it is temporarily against a vessel wall. Occlusion warrants
more thorough evaluation via x-ray study to verify placement if the status is questionable
and may require a declotting regimen.

Question 13 WRONG

Which of the following substances has abnormal values early in the course of multiple
myeloma (MM)?

Immunoglobulins

Platelets

Red blood cells

White blood cells

Question 13 Explanation:

MM is characterized by malignant plasma cells that produce an increased amount of

immunoglobulin that isnʼt functional. As more malignant plasma cells are produced,
thereʼs less space in the bone marrow for RBC production. In late stages, platelets and
WBCʼs are reduced as the bone marrow is infiltrated by malignant plasma cells.

Question 14 CORRECT

Which of the following interventions is the key to increasing the survival rates of clients with
lung cancer?

Early bronchoscopy

Early detection

High-dose chemotherapy

Smoking cessation

Question 14 Explanation:

Early detection of cancer when the cells may be premalignant and potentially curable
would be most beneficial. However, a tumor must be 1 cm in diameter before itʼs
detectable on a chest x-ray, so this is difficult. A bronchoscopy may help identify cell
type but may not increase survival rate. High-dose chemotherapy has minimal effect on
long-term survival. Smoking cessation wonʼt reverse the process but may help prevent
further decompensation.

Question 15 WRONG

The nurse is developing a plan of care for the client with multiple myeloma. The nurse
includes which priority intervention in the plan of care?

Coughing and deep breathing

Encouraging fluids

Monitoring red blood cell count

Providing frequent oral care

Question 15 Explanation:

Hypercalcemia caused by bone destruction is a priority concern in the client with

multiple myeloma. The nurse should administer fluids in adequate amounts to maintain
and output of 1.5 to 2 L a day. Clients require about 3 L of fluid pre day. The fluid is
needed not only to dilute the calcium overload but also to prevent protein from
precipitating in renal tubules. Options 1, 3, and 4 may be components in the plan of care
but are not the priority in this client.

Question 16 CORRECT

A client with stomach cancer is admitted to the oncology unit after vomiting for 3 days.
Physical assessment findings include irregular pulse, muscle twitching, and complaints of
prickling sensations in the fingers and hands. Laboratory results include a potassium level of
2.9 mEq/L, a pH of 7.46, and a bicarbonate level of 29 mEq/L. The client is experiencing:

Respiratory alkalosis

Respiratory acidosis

Metabolic alkalosis

Metabolic acidosis

Question 16 Explanation:

The client is experiencing metabolic alkalosis caused by loss of hydrogen and chloride
ions from excessive vomiting. This is shown by a pH of 7.46 and elevated bicarbonate
level of 29 mEq/L.

Question 17 WRONG

Which of the following is the primary goal for surgical resection of lung cancer?

To remove the tumor and all surrounding tissue.

To remove the tumor and as little surrounding tissue as possible.

To remove all of the tumor and any collapsed alveoli in the same region.

To remove as much as the tumor as possible, without removing any alveoli.

Question 17 Explanation:

The goal of surgical resection is to remove the lung tissue that has a tumor in it while
saving as much surrounding tissue as possible. It may be necessary to remove alveoli
and bronchioles, but care is taken to make sure only whatʼs absolutely necessary is
removed.

Question 18 WRONG

The client with which of the following types of lung cancer has the best prognosis?

Adenocarcinoma

Oat cell

Squamous cell

Small cell

Question 18 Explanation:

Squamous cell carcinoma is a slow-growing, rarely metastasizing type of cancer.

Adenocarcinoma is the next best lung cancer to have in terms of prognosis. Oat cell and
small cell carcinoma are the same. Small cell carcinoma grows rapidly and is quick to
metastasize.

Question 19 CORRECT

Warning signs and symptoms of lung cancer include persistent cough, bloody sputum,
dyspnea, and which of the other following symptoms?

Dizziness

Generalized weakness

Hypotension

Recurrent pleural effusion

Question 19 Explanation:

Recurring episodes of pleural effusions can be caused by the tumor and should be
investigated. Dizziness, generalized weakness, and hypotension arenʼt typically
considered warning signals, but may occur in advanced stages of cancer.

Question 20 WRONG

A client is diagnosed with multiple myeloma. The client asks the nurse about the diagnosis.
The nurse bases the response on which of the following descriptions of this disorder?

Malignant exacerbation in the number of leukocytes.

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Altered production of lymph nodes

Malignant proliferation of plasma cells and tumors within the bone.

Question 20 Explanation:

Multiple myeloma is a B cell neoplastic condition characterized by abnormal malignant

proliferation of plasma cells and the accumulation of mature plasma cells in the bone
marrow. Option 1 describes the leukemic process. Options 2 and 3 are not characteristics
of multiple myeloma.

Question 21 WRONG

Parents of pediatric clients who undergo irradiation involving the central nervous system
should be warned about postirradiation somnolence. When does this neurologic syndrome
usually occur?