Republic of the Philippines

N A V A L S T A T E U N I V ER S I T Y
College of Arts & Sciences
NURSING & HEALTH SCIENCES DEPARTMENT
Naval, Biliran

NCM 417: CARE OF CLIENTS WITH CELLULAR ABERRATION, in ACUTE BIOLOGIC CRISIS,
Including EMERGENCY AND DISASTER NURSING
MIDTERM EXAM

INSTRUCTION: Select the correct answer for each of the following questions. Mark only one answer for each
item by shading the corresponding letter of your choice on the answer sheet provided. STRICTLY NO
ERASURES ALLOWED. Use pencil #1 only.

Situation 1: A 51-year old post-menopausal woman came to the oncology unit because of vaginal bleeding.
It started as watery, blood-streaked flow that gradually contains more blood. She got panicked and rushed
immediately to the hospital.

1. During assessment, the patient asks “What could be the possible cause of my disease? I can’t recall any of
my relatives having cancer.” What is the appropriate response by Nurse Castro?
a. “The exact cause is unknown. Did you take pills lately?”
b. “One of the causes is estrogen replacement therapy.”
c. “You ask the doctor because he is more knowledgeable than me.”
d. “The cause is similar to that of lung cancer.”

2. Nurse Castro is developing a plan of care for marrow suppression, the major dose-limiting adverse reaction
to floxuridine (FUDR). How long after drug administration does bone marrow suppression become
noticeable?
a. 24 hours b. 7 to 14 days c. 2 to 4 days d. 21 to 28 days 

3. Ms. Castro is newly-promoted as the head nurse of the oncology unit. She updates her knowledge on the
theories in management and leadership in order to become effective in her new role. She learns that some
managers have low concern for services and high concern for staff. Which style of management refers to this? 
a. Organization of Man Management 
b. Country Club Management 
c. Impoverished Management 
d. Team Management

4. After undergoing chemotherapy, the nurse formulated the diagnosis of impaired oral mucous membranes
related to decreased nutrition and immunosuppression. Nurse Castro can delegate which of the following
interventions to the nursing assistant?
a. Recommending that the patient discontinues chemotherapy
b. Monitoring the patient’s platelet and leukocyte counts
c. Providing a solution of hydrogen peroxide and water for use as a mouth rinse
d. Checking the vital signs regularly 

Situation 2: An oncology unit caters all patients suffering from cancer. A 27-year old male client with
cerebellar brain tumor is admitted to the facility.

5. Based on initial assessment, a nursing diagnosis of Risk for Injury has been formulated. The diagnosis can
be related to:
a. visual field deficits. b. impaired balance. c. difficulty swallowing. d. psychomotor
seizures. 

6. Morphine drip has been prescribed to the client. Which of these findings indicate that a pump to deliver a
basal rate of 10 ml per hour plus PRN for breakthrough pain of morphine drip is not working to the client?
a. The client complains of discomfort at the IV insertion site.
b. The level of drug is 100 ml at 8 AM and is 80 ml at noon.
c. The client states "I just can’t get relief from my pain."
d. The level of the drug is 100 ml at 8 AM and is 50 ml at noon.
7. The nurse in charge of the unit has been assigned to Patient X diagnosed with brain tumor, parietal lobe.
The nurse expects to assess for:
a. short-term memory impairment. c. seizures.
b. tactile agnosia. d. contralateral homonymous hemianopia. 

8. Patient X with brain tumor underwent craniectomy. From the recovery room, the patient has been
transferred to the unit with the following vital signs: blood pressure of 90/50 mmHg, pulse 132 bpm, and
respirations 30 cpm. Which action by the nurse should receive priority? Safe and Quality Care
a. Continuing to monitor the vital signs  c. Asking the client how he feels 
b. Contacting the physician  d. Asking the LPN to continue the post-op care 

9. Which of the following can Nurse A delegate the assignment to the licensed practical nurse? 
a. Inserting a Foley catheter  c. Obtaining a sputum specimen 
b. Discontinuing a nasogastric tube  d. Starting a blood transfusion

10. The staff nurse is suspected of charting a medication that he did not give. After talking to the nurse, Ms.
Castro should:
a. Call the Board of Nursing 
b. Terminate the nurse 
c. File a formal reprimand 
d. Charge the nurse with a tort
 
Situation 3: Breast Cancer Awareness is an effort to  raise awareness and reduce the stigma of breast
cancer through education on symptoms and treatment. Supporters hope that greater knowledge will lead to
earlier detection of breast cancer, which is associated with higher long-term survival rates and will produce
a reliable, permanent cure.

11. Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the
client that a diagnosis of breast cancer is confirmed by:
a. breast self-examination. b. fine needle aspiration. c. mammography. d. chest X-ray. 

12. Nurse Kay is teaching a group of women to perform breast self-examination. The nurse should explain that
the purpose of performing the examination is to discover:
a. cancerous lumps. c. changes from previous self-examinations.
b. areas of thickness or fullness. d. fibrocystic masses. 

13. Nurse Amy is speaking to a group of women about early detection of breast cancer. The average age of the
women in the group is 47. Following the American Cancer Society guidelines, the nurse should recommend
that the women:
a. perform breast self-examination annually.
b. have a hormonal receptor assay annually.
c. have a mammogram annually.
d. have a physician conduct a clinical examination every 2 years. 

14. Nurse Lucia is providing breast cancer education at a community facility. The American Cancer Society
recommends that women get mammograms:
a. yearly after age 40.
b. after the first menstrual period and annually thereafter.
c. after the birth of the first child and every 2 years thereafter.
d. every 3 years between ages 20 and 40 and annually thereafter. 

15. Nina, an oncology nurse educator is speaking to a women’s group about breast cancer. Questions and
comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of
the audience have made all of the following statements. Which one is accurate?
a. “Mammography is the most reliable method for detecting breast cancer.” 
b. “Breast cancer is the leading killer of women of childbearing age.” 
c. “Breast cancer requires a mastectomy.” 
d. “Men can develop breast cancer.”

Situation 4: Tina, a 41-year old client, visits the gynecologist. Based on the findings of the initial physical
exam, the physician suspects cervical cancer.
16. The nurse reviews Tina’s history for risk factors of the disease. Based on research studies, one of the risk
factors for cervical cancer is:
a. onset of sporadic sexual activity at age 17.
b. pregnancy complicated with eclampsia at age 27.
c. spontaneous abortion at age 19.
d. human papillomavirus infection at age 32. 

17. Tina is for insertion of an internal cervical radiation implant. While giving care, the nurse finds the
radiation implant in the bed. The initial action by the nurse is to:
a. call the physician. 
b. reinsert the implant into the vagina immediately. 
c. pick up the implant with long-handled forceps and place it in a lead container. 
d. pick up the implant with gloved hands and flush it down the toilet. 

18. Tina’s husband asks the nurse if he can spend the night with his wife. The nurse’s response would be: 
a. “Overnight stay by family members is against hospital policy.” 
b. “Yes. Your wife will fell rested knowing that you are present.” 
c. “There is no need for you to stay because staff nurses are adequate.” 
d. “No. You can only visit your wife for 30 minutes when the implant is in place.” 

19. What is the MOST appropriate activity for Tina post-radiation therapy? 
a. Bed rest  b. Out of bed in a chair only  c. Out of bed ad lib  d. Ambulation to the bathroom only 

20. Tina is also receiving methotrexate (Mexate), 12 g/m2 I.V. as an adjunct therapy to treat cervical cancer.
During methotrexate therapy, what drug is being given to Tina to protect the normal cells of her body?
a. Probenecid (Benemid)
b. Thioguanine (6-thioguanine)
c. Cytarabine (Cytosine)
d. Leucovorin (Citrovorum Factor) 

Situation 5: A 32-year old male client went to the hospital for his check-up.

21. Routine assessment was done. When Nurse B conducted the interview with the client about his past
medical history, which preexisting condition may lead the nurse to suspect that he has colorectal cancer?
a. Duodenal ulcers b. Weight gain c. Hemorrhoids d. Polyps 

22. The client with a suspected colorectal cancer will MOST likely report that his abdominal pain lessens
when he:
a. skips a meal.
b. take analgesic.
c. rests in recumbent position.
d. sits upright after eating.

23. During assessment, the nurse knows that the type of diet the client has increases his risk of colorectal
cancer. Which of the following diets is the nurse referring to?
a. Low protein, complex carbohydrates
b. High protein, simple carbohydrates
c. High fat, refined carbohydrate
d. Low carbohydrates, complex proteins

24. Series of diagnostic tests were done to confirm the suspicion. After undergoing fiberoptic colonoscopy, the
client reports increasing abdominal pain, fever, and chills. Which of the following conditions poses the MOST
immediate concern? 
a. Bowel perforation b. Colon cancer  c. Viral gastroenteritis d. Diverticulitis

25. The client was further advised to undergo other diagnostic tests. The nurse understands that which test will
confirm the diagnosis of the malignancy? 
a. Biopsy of the tumor 
b. Magnetic resonance imaging 
c. Abdominal ultrasound 
d. Computerized tomography scan
Situation 6: A child is admitted to the hospital with a diagnosis of Wilm's tumor, stage II.

26. Which of the following statements MOST accurately describes this stage? 
a. The tumor is less than 3 cms in size and requires no chemotherapy. 
b. The tumor extended beyond the kidney but was completely resected. 
c. The tumor did not extend beyond the kidney and was completely resected. 
d. The tumor has spread into the abdominal cavity and cannot be resected. 

27. The nurse caring for the child is planning to delegate tasks to the nursing aide. Which of the following
tasks can the registered nurse safely assign to a nursing aide? 
a. Administering analgesics as prescribed.
b. Administering antipyretics as indicated.
c. Assisting with position changes every 2 hours for 2-3 days.
d. Administering antiemetics as ordered.

28. The nurse is finishing her shift on the pediatric oncology unit. Because her shift is ending, which
intervention takes top priority?
a. Changing the linens on the patient’s bed
b. Emptying trash cans in the nurse’s station
c. Restocking bedside supplies needed for the upcoming shift
d. Dusting the furniture found in the round

29. Child is undergoing chemotherapy. The nurse assigned to the child administers adult-strength dose of the
chemotherapeutic drug. As a result of her actions, the patient suffers irreversible brain damage. The nurse can
be charged with: 
a. negligence.  b. assault.  c. tort.  d. malpractice. 

30. Another child in the pediatric oncology unit is ordered to undergo chemotherapy. During the therapy, a
wrong dose of drug is administered by the nurse. The nurse is responsible to whom?
a. Client b. Society c. Physician who ordered the drug d. All of these

Situation 7: Mario, a 45-year old client, has been a cigarette smoker since high school. Recently, he
experienced cough for almost a month, sudden weight loss, and fatigue.

31. The nurse is preparing Mario for magnetic resonance imaging (MRI) to rule out the presence of lung
tumor. During the MRI scan, which of the following would pose a threat to Mario?
a. Mario lies still.
b. Mario hears thumping sounds.
c. Mario asks questions.
d. Mario wears a watch and a wedding band.

32. It was confirmed that Mario has lung cancer. To determine metastasis to the liver, a biopsy was scheduled.
Before the biopsy was done, the nurse taught the patient to assume what position after the procedure? 
a. Left side-lying, with the bed flat. 
b. Left side-lying, with the bed in semi-Fowler’s position. 
c. Right side-lying, with the bed flat. 
d. Right side-lying, with the bed in semi-Fowler’s position. 

33. Accounts for 90% of all cases of Lung Cancer:

a. radon exposure b. tobacco smoking c. asbestos exposure d. family history

34. Which of the following BEST describes Non-Small Cell Lung Cancer (NSCLC)?
a. Spreads more quickly and aggressively
b. About 80-85% of Lung Cancer cases
c. Found mostly in heavy smokers
d. All of the above

Situation 8: An 11-year old African-American child is diagnosed with acute lymphoblastic leukemia (ALL).

35. Which of the following is the MOST likely period of occurrence of ALL? 
a. Chilhood   b. Young Adulthood  c. Middle Adulthood  d. Old age

36. Which of the following would the nurse inquire as part of the assessment of the child? 
a. The client collects stamps as a hobby. 
b. The client had radiation for treatment of Hodgkin’s disease. 
c. The client recently quitted school. 
d. The client’s brother had leukemia as a child. 

37. The nurse is performing assessment to monitor signs and symptoms of bleeding. Where is the best site for
examining for the presence of petechiae? 
a. The abdomen  b. The earlobes  c. The thorax  d. The soles of the feet 

38. The nurse will administer blood to the child because he has low hemoglobin count. The child’s mother
asks, “How long will the red blood cells (RBCs} last in my son’s body?” The correct response of the nurse is:
a. “The life span of RBC is 45 days.”  c. “The life span of RBC is 90 days.” 
b. “The life span of RBC is 60 days.”  d. “The life span of RBC is 120 days.”

39. Which of the following is the MOST accurate statement that will describe the administration of packed
red blood cells (PRBCs) as management for anemia secondary to leukemia? 
a. Transfusion reaction is most likely immediately after the infusion is completed. 
b. PRBCs should be flushed with a 5% dextrose solution. 
c. PRBCs are best infused slowly through a 20g. IV catheter. 
d. A nurse should remain in the room during the first 15 minutes of infusion. 

40. The mother of the child stated that they have a relative who wants to donate blood for transfusion. Which
of the following donor medical conditions would prevent this? 
a. A history of hepatitis C five years previously
b. Asymptomatic diverticulosis 
c. Cholecystitis requiring cholecystectomy one year previously 
d. Crohn's disease in remission 

41. Moreover, the child is given an injection of Epoetin. Which of the following should reflect the findings in
a complete blood count (CBC) drawn several days later? 
a. An increase in neutrophil count.  c . An increase in platelet count. 
b. An increase in hematocrit.  d. An increase in serum iron. 

Situation 9: A patient with leukemia is receiving chemotherapy that is known to depress bone marrow.

42. Complete Blood Count (CBC) reveals a platelet count of 25,000/microliter. Which of the following actions
related specifically to the platelet count should be included in the nursing care plan? 
a. Monitor for fever every 4 hours. 
b. Consider transfusion of packed red blood cells. 
c. Require visitors to wear respiratory masks and protective clothing. 
d. Check for signs of bleeding, including examination of urine and stool for blood. 
43. In caring for the patient who has underwent sessions of chemotherapy, which can be delegated to a nursing
assistant?
a. Observe for evidence of spontaneous bleeding and document. 
b. Limit visitors to family only and visiting time is only 30 minutes. 
c. Give aspirin in case of headaches. 
d. Conduct stem cell therapy. 

44. Kim refuses to take the drug given by the nurse because she is going to die anyway. Despite the refusal,
the nurse on duty injected the drug to Kim. The nurse is held liable for:
a. battery. b. negligence. c. defamation. d. malpractice.

45. The physician has ordered a minimal-bacteria diet for Kim with neutropenia. Kim should be taught to
avoid eating: 
a. fruits.  b. pepper.  c. salt.  d. ketchup.

46. The nurse in-charge of the oncology unit is the sole health care provider who was on duty that day. In an extreme situation
and when no other resident or intern is available, should the nurse receive telephone orders, the order has to be
correctly written and signed by the physician within:
a. 12 hours b. 36 hours c. 24 hours d. 48 hours

47. Kim, experiencing thrombocytopenia secondary to chemotherapy should be placed in:

a. a private room so she will not infect other patients and health care workers. 
b. a private room so she will not be infected by other patients and health care workers. 
c. a semiprivate room so she will have stimulation during her hospitalization. 
d. a semiprivate room so she will have the opportunity to express her feelings about her illness. 

48. The nurse, who attended a seminar on topics related to Leukemia, was tasked to conduct an echo-seminar
to his fellow staff nurses. Based on his acquired knowledge, which of the following will he include in his
lecture?
a. Leukemia is caused by benzene.
b. The only treatment is bone marrow transplant.
c. Among the four (4) types of leukemia, the chronic types are the most serious.
d. According to research studies, leukemia has a high percentage of survival rate.

49. Aiken once read an article in the newspaper about cancer. She asked the nurse “Is it true that the origin of
most cancer is genetics?” What is the nurse’s appropriate response?
a. “The development of most cancers is predetermined and not affected by environmental factors.” c. “No.
Majority of cancers are inherited.”
b. “Yes. Cancers arise in cells that have alterations in genes.” d. “No. Cancer
is determined by the person’s gender.”

50. Mickey arrived in the unit with an appointment to see the physician after reading that his symptom is one
of the seven warning signs of cancer which is:
a. persistent nausea. b. thickening or lump. c. rash. d. chronic ache or pain. 

Time is like a river.

You cannot touch
the same water
twice because the
flow that has passed
will never passed again…..