QUIZ 13.

Breast Cancer, Lung Cancer, Colon Cancer, Multiple Myeloma,

Hodgkin’s and Non-Hodgkin’s

Name: _______________________ Section: ___________ Date: ___________

Multiple Choice.

1. A diagnosis of Hodgkin’s disease was made to a 58- year old man and is
admitted for the initial cycle of chemotherapy. During the hospitalization, the
nurse should watch out for the following complication, except?
A. Fertility problems
B. Benign prostatic hyperplasia
C. Secondary cancer
D. Infection

RATIONALE: B. Hodgkin’s disease (Hodgkin’s lymphoma) is a type of

cancer that affects the lymphatic system (bone marrow, spleen, liver, and
lymph node tissue. Symptoms include painless swelling of a lymph node,
recurrent fever, night sweats, pruritus, and unexplained weight loss.
Prostate involvement is rare in Hodgkin’s disease. Options A, C, and D:
Complications of the disease would lead to a weakened immune system
resulting in various infections, It can also result in fertility problems
related to chemotherapy, and a probability of secondary cancers in the
future.

2. The nurse is interviewing a male client about his past medical history. Which
preexisting condition may lead the nurse to suspect that a client has
colorectal cancer?
A. Polyps
B. Weight gain
C. Hemorrhoids
D. Duodenal ulcers

RATIONALE: A. Colorectal polyps are common with colon cancer. These

polyps can develop into cancer over time depending on the type of polyps
such as adenomatous polyps and sessile serrated polyps. Option B:
Weight loss — not gain — is an indication of colorectal cancer. Options C
and D: Duodenal ulcers and hemorrhoids aren’t preexisting conditions of
colorectal cancer.

3. Nurse Andrei is caring for a client with multiple myeloma. During the review
of the laboratory results. The nurse will monitor the client for which of the
following conditions?
A. Hypermagnesemia
B. Hyperkalemia
C. Hypernatremia
D. Hypercalcemia

RATIONALE: D. Patients with multiple myeloma develop a bone disease

that causes bone destruction. Calcium is released during this, causing an
increase in serum calcium levels.

4. A nurse assesses clients at a community health center. Which client is at

highest risk for the development of colorectal cancer?
A. A 37-year-old who drinks eight cups of coffee daily
B. A 44-year-old with irritable bowel syndrome (IBS)
C. A 60-year-old lawyer who works 65 hours per week
D. A 72-year-old who eats fast food frequently

RATIONALE: D. Colon cancer is rare before the age of 40, but its incidence
increases rapidly with advancing age. Fast food tends to be high in fat and
low in fiber, increasing the risk for colon cancer. Coffee intake, IBS, and a
heavy workload do not increase the risk for colon cancer.

5. A 70-year-old male patient has multiple myeloma. His wife calls to report
that he sleeps most of the day, is confused when awake, and complains of
nausea and constipation. Which complication of cancer is this most likely
caused by?
A. Hypercalcemia
B. Tumor lysis syndrome
C. Spinal cord compression
D. Superior vena cava syndrome"

Rationale: A. Hypercalcemia can occur with multiple myeloma; immobility

and dehydration can contribute to or exacerbate hypercalcemia. The
primary manifestations of hypercalcemia include apathy, depression,
fatigue, muscle weakness, electrocardiographic changes, polyuria and
nocturia, anorexia, nausea, and vomiting."

6. A male client is admitted to the hospital with a suspected diagnosis of

Hodgkin’s disease. Which assessment findings would the nurse expect to note
specifically in the client?
A. Fatigue
B. Weakness
C. Weight gain
D. Enlarged lymph nodes

RATIONALE: D. Hodgkin’s disease is a chronic progressive neoplastic

disorder of lymphoid tissue characterized by the painless enlargement of
lymph nodes with progression to extra lymphatic sites, such as the spleen
and liver. Options A and B: Fatigue and weakness may occur but are not
related significantly to the disease. Option C: Weight loss is most likely to
be noted.

7. Which nursing action will be included in the plan of care for a patient
admitted with multiple myeloma?
A. Monitor fluid intake and output.
B. Administer calcium supplements.
C. Assess lymph nodes for enlargement.
D. Limit weight-bearing and ambulation.

RATIONALE: A. A high fluid intake and urine output helps prevent the
complications of kidney stones caused by hypercalcemia and renal failure
caused by deposition of Bence-Jones protein in the renal tubules. Weight
bearing and ambulation are encouraged to help bone retain calcium.
Lymph nodes are not enlarged with multiple myeloma. Calcium
supplements will further increase the patient's calcium level and are not
used.

8. A nurse assessing a client with colorectal cancer auscultates high-pitched

bowel sounds and notes the presence of visible peristaltic waves. Which
action should the nurse take?
A. Ask if the client is experiencing pain in the right shoulder.
B. Perform a rectal examination and assess for polyps.
C. Contact the provider and recommend computed tomography.
D. Administer a laxative to increase bowel movement activity.

RATIONALE: C. The presence of visible peristaltic waves, accompanied by

high-pitched or tingling bowel sounds, is indicative of partial obstruction
caused by the tumor. The nurse should contact the provider with these
results and recommend a computed tomography scan for further
diagnostic testing. This assessment finding is not associated with right
shoulder pain; peritonitis and cholecystitis are associated with referred
pain to the right shoulder. The registered nurse is not qualified to
complete a rectal examination for polyps, and laxatives would not help
this client.

9. A patient with multiple myeloma is complaining about pain. What instructions

will the nurse give the patient to help to reduce pain during activity?
A. Stay in bed until symptoms pass
B. Limit activity to once a day.
C. Limit fluids to prevent going to the bathroom.
D. Do not lift more than 10 pounds.
RATIONALE: D. The patient with multiple myeloma needs education about
activity instructions such as lifting no more than 10 pounds and using
proper body mechanics. Braces may be needed. The patient should have
activity and would not be instructed to stay in bed or limit activity as he
or she would become very stiff. Limiting fluids would be contraindicated.
The patient needs to remain well hydrated.

10.When assessing a patient’s needs for psychologic support after the patient
has been diagnosed with stage I cancer of the colon, which question by the
nurse will provide the most information?
A. "How do you feel about having a possibly terminal illness?"
B. "How long ago were you diagnosed with this cancer?"
C. "Are you familiar with the stages of emotional adjustment to a diagnosis
like cancer of the colon?"
D. "Can you tell me what has been helpful to you in the past when coping
with stressful events?"

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

11.Warning signs and symptoms of lung cancer include persistent cough, bloody
sputum, dyspnea, and which of the other following symptoms?
A. Generalized weakness
B. Recurrent pleural effusion
C. Dizziness
D. Hypotension

RATIONALE: B. If cancer is suspected in the lungs, it can cause fluid

accumulation in the pleura called pleural effusion. This fluid build-up takes
up space and fills the pleural cavity resulting in the compression of the
lungs making it hard for the client to breathe properly. Options A, C, and
D: Dizziness, generalized weakness, and hypotension aren’t typically
considered warning signals, but may occur in advanced stages of cancer.
12.Maria was recently diagnosed with Hodgkin’s lymphoma. Upon the early
diagnosis, the nurse will expect which of the following areas is often
involved?
A. Chest
B. Neck
C. Groin
D. Pelvis

RATIONALEB: B. A common early sign of Hodgkin lymphoma is swelling in

one or more lymph nodes, which is often seen in the neck. Options A, C,
and D: Lymph nodes can also be found in the chest, groin, and pelvis but
aren’t yet involved in the earliest stage of the disease.

13.A nurse prepares a client for a colonoscopy scheduled for tomorrow. The
client states, "My doctor told me that the fecal occult blood test was negative
for colon cancer. I don't think I need the colonoscopy and would like to cancel
it." How should the nurse respond?
A. Your doctor should not have given you that information prior to the
colonoscopy.
B. The colonoscopy is required due to the high percentage of false negatives
with the blood test.
C. A negative fecal occult blood test does not rule out the possibility of colon
cancer.
D. I will contact your doctor so that you can discuss your concerns about the
procedure.

RATIONALE: C. A negative result from a fecal occult blood test does not
completely rule out the possibility of colon cancer. To determine whether
the client has colon cancer, a colonoscopy should be performed so the
entire colon can be visualized and a tissue sample taken for biopsy. The
client may want to speak with the provider, but the nurse should address
the clients concerns prior to contacting the provider.

14.A pneumonectomy is a surgical procedure sometimes indicated for treatment

of non-small-cell lung cancer. A pneumonectomy involves removal of:
A. One lobe of a lung
B. An entire lung field
C. One or more segments of a lung lobe
D. A small, wedge-shaped lung surface

RATIONALE: B. A pneumonectomy is the removal of an entire lung field

indicated for the treatment of non-small cell lung cancer that has not
spread outside of the lung tissue. It is performed on patients who will
have adequate lung function in the unaffected lung. Option D: A wedge
resection refers to the removal of a wedge-shaped section of lung tissue.
It may be used to remove a tumor and a small amount of normal tissue
around it. Option A: A lobectomy is the removal of one lobe. Option C:
Removal of one or more segments of a lung lobe is called a partial
lobectomy.

15.A nurse cares for a client newly diagnosed with colon cancer who has become
withdrawn from family members. Which action should the nurse take?
A. Contact the provider and recommend a psychiatric consult for the client.
B. Encourage the client to verbalize feelings about the diagnosis.
C. Provide education about new treatment options with successful outcomes.
D. Ask family and friends to visit the client and provide emotional support.

RATIONALE: B. The nurse recognizes that the client may be expressing

feelings of grief. The nurse should encourage the client to verbalize
feelings and identify fears to move the client through the phases of the
grief process. A psychiatric consult is not appropriate for the client. The
nurse should not brush aside the client's feelings with discussions related
to cancer prognosis and treatment. The nurse should not assume that the
client desires family or friends to visit or provide emotional support.

16.During a routine physical examination, a firm mass is palpated in the right

breast of a 35-year-old woman. Which of the following findings or client
history would suggest cancer of the breast as opposed to fibrocystic disease?
A. Increased vascularity of the breast
B. History of anovulatory cycles
C. Cyclic changes in mass size
D. History of early menarche

RATIONALE: A. An increase in breast size or vascularity indicates the

growth of a tumor and is consistent with cancer of the breast.

17.A nurse cares for a client with colon cancer who has a new colostomy. The
client states, "I think it would be helpful to talk with someone who has had a
similar experience." How should the nurse respond?
A. I have a good friend with a colostomy who would be willing to talk with
you.
B. The enterostomal therapist will be able to answer all of your questions.
C. I will make a referral to the United Ostomy Associations of America.
D. You'll find that most people with colostomies don't want to talk about
them.

RATIONALE: C. Nurses need to become familiar with community-based

resources to better assist clients. The local chapter of the United Ostomy
Associations of America has resources for clients and their families,
including Ostomates (specially trained visitors who also have ostomies).
The nurse should not suggest that the client speak with a personal contact
of the nurse. Although the enterostomal therapist is an expert in ostomy
care, talking with him or her is not the same as talking with someone who
actually has had a colostomy. The nurse should not brush aside the
client's request by saying that most people with colostomies do not want
to talk about them. Many people are willing to share their ostomy
experience in the hope of helping others.

18.The nurse is reviewing the laboratory results of a client diagnosed with

multiple myeloma. Which of the following would the nurse expect to note
specifically in this disorder?
A. Increased WBC’s
B. Increased calcium levels
C. Decreased blood urea nitrogen
D. Decreased number of plasma cells in the bone marrow.

RATIONALE: B. Hypercalcemia (increased calcium level) is caused by the

release of calcium from the deteriorating bone tissue in multiple myeloma.
This may cause symptoms of excessive thirst, constipation, dehydration,
nausea, frequent urination, dizziness, confusion, and eventually to coma.
Options A and C: Findings indicative of multiple myeloma are an increased
number of plasma cells in the bone marrow and elevated uric acid levels.
Option D: An increased white blood cell count may or may not be present
and is not related specifically to multiple myeloma.

19.A nurse assesses a client who is prescribed 5-fluorouracil (5-FU)

chemotherapy intravenously for the treatment of colon cancer. Which
assessment finding should alert the nurse to contact the health care
provider?
A. White blood cell (WBC) count of 1500/mm3
B. Fatigue
C. Nausea and diarrhea
D. Mucositis and oral ulcers

RATIONALE: A. Common side effects of 5-FU include fatigue, leukopenia,

diarrhea, mucositis, mouth ulcers & peripheral neuropathy. However, the
client's WBC count is very low (normal range is 5000 to 10,000/mm3), so
the provider should be notified. She may want to delay chemotherapy by
a day or two. Certainly the client is at high risk for infection. The other
assessment findings are consistent with common side effects of 5-FU that
would not need to be reported immediately.
20.Which of the following is the primary goal for surgical resection of lung
cancer?
A. To remove all of the tumor and any collapsed alveoli in the same region
B. To remove as much as the tumor as possible, without removing any
alveoli
C. To remove the tumor and as little surrounding tissue as possible
D. To remove the tumor and all surrounding tissue

RATIONALE: C. 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. There is a possibility of cancer cells remaining in the body after
the operation so additional treatment modalities such as chemotherapy
and radiation therapy are done.

21.A 56-year-old woman is currently receiving radiation therapy to the chest

wall for recurrent breast cancer. She calls her health care provider to report
that she has pain while swallowing and burning and tightness in her chest.
Which of the following complications of radiation therapy is A. Radiation
enteritislikely responsible for her symptoms?
A. Radiation enteritis
B. Stomatitis
C. Esophagitis
D. Hiatal hernia

RATIONALE: C. Difficulty in swallowing, pain, and tightness in the chest

are signs of esophagitis, which is a common complication of radiation
therapy of the chest wall. Option A: Radiation enteritis is a damage to the
intestinal lining caused by radiation therapy. Symptoms include diarrhea,
rectal pain, and bleeding or mucus from the rectum. Option B: Stomatitis
results from the local effects of radiation to the oral mucosa. Symptoms
include mouth ulcers, red patches, swelling, and oral dysaesthesia. Option
D: Hiatal hernia may also cause symptoms of dysphagia and chest pain
but is not related to radiation therapy.

22.A nurse teaches a client who is recovering from a colon resection. Which
statement should the nurse include in this clients plan of care?
A. You may experience nausea and vomiting for the first few weeks.
B. Carbonated beverages can help decrease acid reflux from anastomosis
sites.
C. Take a stool softener to promote softer stools for ease of defecation.
D. You may return to your normal workout schedule, including weight lifting.

RATIONALE: C. Clients recovering from a colon resection should take a

stool softener as prescribed to keep stools a soft consistency for ease of
passage. Nausea and vomiting are symptoms of intestinal obstruction and
perforation and should be reported to the provider immediately. The client
should be advised to avoid gas-producing foods and carbonated
beverages, and avoid lifting heavy objects or straining on defecation.

23.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?
A. Encouraging fluids
B. Providing frequent oral care
C. Coughing and deep breathing
D. Monitoring red blood cell count

RATIONALE: A. 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 an output of 1.5 to 2 L a day.
Clients require about 3 L of fluid per day. The fluid is needed not only to
dilute the calcium overload but also to prevent protein from precipitating
in renal tubules. Options B, C, and D: These are components in the plan
of care but are not the priority in this client.

24.A nurse teaches a client who is at risk for colon cancer. Which dietary
recommendation should the nurse teach this client?
A. Eat low-fiber and low-residual foods.
B. White rice and bread are easier to digest.
C. Add vegetables such as broccoli and cauliflower to your new diet.
D. Foods high in animal fat help to protect the intestinal mucosa.

RATIONALE: C. The client should be taught to modify his or her diet to

decrease animal fat and refined carbohydrates. The client should also
increase high-fiber foods and Brassica vegetables, including broccoli and
cauliflower, which help to protect the intestinal mucosa from colon cancer.

25.The client with which of the following types of lung cancer has the best
prognosis?
A. Squamous cell
B. Oat cell
C. Small cell
D. Adenocarcinoma

RATIONALE: A. Squamous cell carcinoma is a slow-growing, rarely

metastasizing type of cancer. Options B and C: Oat cell and small cell
carcinoma are the same. Small cell carcinoma grows rapidly and is quick
to metastasize. Option D: Adenocarcinoma is the next best lung cancer to
have in terms of prognosis.
26.A nurse cares for a client who has a family history of colon cancer. The client
states, "My father & brother had colon cancer. What is the chance that I will
get cancer?" How should the nurse respond?
A. If you eat a low-fat and low-fiber diet, your chances decrease significantly.
B. You are safe. This is an autosomal dominant disorder that skips
generations.
C. Preemptive surgery and chemotherapy will remove cancer cells and
prevent cancer.
D. You should have a colonoscopy more frequently to identify abnormal
polyps early.

RATIONALE: D. The nurse should encourage the client to have frequent

colonoscopies to identify abnormal polyps and cancerous cells early. The
abnormal gene associated with colon cancer is an autosomal dominant
gene mutation that does not skip a generation and places the client at
high risk for cancer. Changing the client's diet, preemptive chemotherapy,
and removal of polyps will decrease the client's risk but will not prevent
cancer. However, a client at risk for colon cancer should eat a low-fat and
high-fiber diet.

27.A female client is undergoing tests for multiple myeloma. Diagnostic study
findings in multiple myeloma include:
A. A decreased serum creatinine level
B. A low serum protein level
C. Hypocalcemia
D. Bence Jones protein in the urine

RATIONALE: D. Bence-Jones protein is an antibody fragment called a light

chain that is not detectable in the urine. A presence of Bence Jones may
indicate excess light chain production of a single type of antibody by the
bone marrow cells. Option A: The serum creatinine level may also be
increased. Option B: Serum protein electrophoresis shows elevated
globulin spike. Option C: Serum calcium levels are elevated because
calcium is lost from the bone and reabsorbed in the serum.

28.Which diet is associated with an increased risk of colorectal cancer?

A. High protein, simple carbohydrates
B. Low carbohydrates, complex proteins
C. Low protein, complex carbohydrates
D. High fat, refined carbohydrates

RATIONALE: D. A diet that is high in fat and refined carbohydrates

increases the risk of colorectal cancer. High fat content results in an
increase in fecal bile acids, which facilitate carcinogenic changes. Refined
carbohydrates increase the transit time of food through the
gastrointestinal tract and increase the exposure time of the intestinal
mucosa to cancer-causing substances.

29.A client is being evaluated for cancer of the colon. In preparing the client for
barium enema, the nurse should:
A. Render an oil retention enema and give laxative the night before
B. Give laxative the night before and a cleansing enema in the morning
before the test
C. Place the client on CBR a day before the study
D. Instruct the client to swallow 6 radiopaque tablets the evening before the
study

RATIONALE: B. Barium enema is the radiologic visualization of the colon

using a die. To obtain accurate results in this procedure, the bowels must
be emptied of fecal material thus the need for laxative and enema.

30.The oncology nurse specialist provides an educational session to nursing staff

regarding the characteristics of Hodgkin’s disease. The nurse determines that
further education is needed if a nursing staff member states which of the
following is characteristic of the disease?
A. Prognosis depends on the stage of the disease
B. Occurs most often in the older client
C. Presence of Reed-Sternberg cells
D. Involvement of lymph nodes, spleen, and liver

RATIONALE: B: Hodgkin’s disease is a disorder of young people up to age

40 and among adults. It is more common in adolescents between the
ages of 15 and 19. Option A: Hodgkin’s lymphoma prognosis depends on
the stage of the disease. It is treatable in the early stages of the stages.
Option C: Hodgkin’s disease is marked by the presence of Reed-Sternberg
cells which are the abnormal B lymphocytes (WBC that produces
antibodies that are essential in combating infections). Option D: The
disease spread through the lymph vessels from lymph node to lymph
node. It can also travel to other parts such as the lung, liver, and spleen.

31.When teaching a client about the signs of colorectal cancer, Nurse Trish
stresses that the most common complaint of persons with colorectal cancer
is:
A. Change in caliber of stools
B. Change in bowel habits
C. Hemorrhoids
D. Abdominal pain
RATIONALE: B. Constipation, diarrhea, and/or constipation alternating
with diarrhea are the most common symptoms of colorectal cancer.

32.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?
A. “Cancer cells are susceptible to drug toxins.”
B. “Chemotherapy affects all rapidly dividing cells.”
C. “Chemotherapy encourages cancer cells to divide.”
D. “The molecular structure of the DNA is altered.”

RATIONALE: B: 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. Option A: All cells are susceptible to drug toxins, but not all
chemotherapeutic agents are toxins. Options C and D: Chemotherapy
slows cell division. Not all chemotherapeutic agents affect the molecular
structure.

33.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. Mammography
C. Fine needle aspiration
D. Chest X-ray

RATIONALE: C. Fine needle aspiration and biopsy provide cells for

histologic examination to confirm a diagnosis of cancer. During the
procedure, a needle is inserted into the lump and a sample of tissue is
taken for examination. Option A: A breast self-examination, if done
regularly, is the most reliable method for detecting breast lumps early.
Option B: Mammography is used to detect tumors that are too small to
palpate. Option D: Chest X-rays can be used to pinpoint rib metastasis.

34.Which of the following characteristics are risk factors for colorectal cancer?
A. Age younger than 40
B. History of skin cancer
C. Low fat, low protein, high fiber diet
D. Familial polyposis

RATIONALE: D. Family history of colon cancer or familial polyposis is a risk

factor for colorectal cancer.
35.The client with a benign lung tumor is treated in which of the following ways?
A. The tumor is removed, involving the least possible amount of tissue
B. The tumor is left alone unless symptoms are present
C. The tumor is treated with radiation only
D. The tumor is treated with chemotherapy only

RATIONALE: A. The tumor is removed to prevent further compression of

the lung tissue as the tumor grows, which could lead to respiratory
decompensation. Options B, C, and D: If for some reason it can’t be
removed, then radiation or chemotherapy may be used to try to shrink
the tumor.

36.A temporary colostomy is performed on the client with colon cancer. The
nurse is aware that the proximal end of a double barrel colostomy:
A. Is the opening on the client’s left side
B. Is the opening on the client’s right side
C. Is the opening on the distal end on the client’s left side
D. Is the opening on the distal right side
RATIONALE: B. The proximal end of the double-barrel colostomy is the
end toward the small intestines. This end is on the client’s right side.

37.According to a standard staging classification of Hodgkin’s disease, which of

the following criteria reflects stage III?
A. Involvement of lymph node regions or structures on both sides of the
diaphragm
B. Involvement of two or more lymph node regions or structures
C. Involvement of single lymph node region or structure
D. Involvement of extralymphatic organs or tissues

RATIONALE: A. Hodgkin lymphoma is classified into stages to determine

the state of the disease and where it has already spread. Stage III
involves nodes on both sides of the diaphragm.

38.A 34-year-old female client is requesting information about mammograms

and breast cancer. She isn’t considered at high risk for breast cancer. What
should the nurse tell this client?
A. She should have had a baseline mammogram before age 30
B. When she begins having yearly mammograms, breast self-examinations
will no longer be necessary
C. She should perform breast self-examination during the first 5 days of each
menstrual cycle
D. She should eat a low-fat diet to further decrease her risk of breast cancer
RATIONALE: D. A low-fat diet (one that maintains weight within 20% of
recommended body weight) has been found to decrease a woman’s risk of
breast cancer. Option A: A baseline mammogram should be done between
ages 30 and 40. Option B: The client should continue to perform monthly
breast self-examinations even when receiving yearly mammograms.
Option C: Monthly breast self-examinations should be done between days
7 and 10 of the menstrual cycle.

39.In the client with terminal lung cancer, the focus of nursing care is on which
of the following nursing interventions?
A. Prepare the client’s will
B. Provide pain control
C. Provide nutritional support
D. Provide emotional support

RATIONALE: B. The client with terminal lung cancer may have extreme
pleuritic pain and should be treated to reduce his discomfort therefore
improving the quality of life of the patient. Examples of pain medication
used with advanced cancer are opioids such as morphine, oxycodone,
fentanyl, or methadone. Option A: Nursing care doesn’t focus on helping
the client prepare the will. Option D: Preparing the client and his family
for the impending death and providing emotional support is also important
but shouldn’t be the primary focus until the pain is under control. Option
C: Nutritional support may be provided, but as the terminal phase
advances, the client’s nutritional needs greatly decrease.

40.A female client is receiving chemotherapy to treat breast cancer. Which

assessment finding indicates a fluid and electrolyte imbalance induced by
chemotherapy?
A. Serum potassium level of 3.6 mEq/L
B. Blood pressure of 120/64 to 130/72 mm Hg
C. Dry oral mucous membranes and cracked lips
D. Urine output of 400 ml in 8 hours

RATIONALE: C. Chemotherapy commonly causes nausea and vomiting,

which may lead to fluid and electrolyte imbalances. Signs of fluid loss
include dry oral mucous membranes, cracked lips, decreased urine output
(less than 40 ml/hour), abnormally low blood pressure, and a serum
potassium level below 3.5 mEq/L. Options A, B, and D: These values are
within the normal limits.

41.A client has been diagnosed with lung cancer and requires a wedge resection.
How much of the lung is removed?
A. A segment of the lung, including a bronchiole and its alveoli
B. One entire lung
C. A lobe of the lung
D. A small, localized area near the surface of the lung

RATIONALE: D. A wedge resection is a surgical procedure that involves

the removal of a small area of tissue close to the surface of the lung. It is
indicated for clients with certain types of lung cancer such as non-small
cell lung cancer (NSCLC). It is done in combination with chemotherapy
and radiation therapy.

42.The removal of entire breast, pectoralis major and minor muscles and neck
lymph nodes which is followed by skin grafting is a procedure called:
A. Radiation therapy
B. Halstead surgery
C. Modified radical mastectomy
D. Simple mastectomy

RATIONALE: B. Halstead surgery also called radical mastectomy involves

the removal of the entire breast, pectoralis major and minor muscles, and
neck lymph nodes. It is followed by skin grafting. Option A: Radiation
therapy uses high doses radiation to kill cancer cells and their ability to
grow and divide. Option C: Removal of the entire breast, pectoralis major
muscle and the axillary lymph nodes is a surgical procedure called
modified radical mastectomy. Option D: Simple mastectomy is the
removal of the entire breast but the pectoralis muscles and nipples remain
intact.

43.If the client with lung cancer also has preexisting pulmonary disease, which
of the following statements best describes the extent of a surgery that can be
performed?
A. It doesn’t affect it
B. It may require a whole lung to be removed
C. The entire tumor may not be able to be removed
D. It may prevent surgery if the client can’t tolerate lung tissue removal

RATIONALE: D. It may prevent surgery if the client can’t tolerate lung

tissue removal. Option D: If the client’s preexisting pulmonary disease is
restrictive and advanced, it may be impossible to remove the tumor, and
the client may have to be treated with chemotherapy and radiation.

44.Which of the following clients is most at risk for developing multiple

myeloma?
A. A 60-year-old African-American man
B. A 52-year-old Hispanic woman
C. A 35-year-old White man
D. A 25-year-old Asian woman

RATIONALE: A. 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.

45.Before discharge, the nurse scheduled the client who had a colostomy for
colorectal cancer for discharge instruction about resuming activities. The
nurse should plan to help the client understands that:
A. Most sports activities, except for swimming, can be resumed based on the
client’s overall physical condition.
B. With counseling and medical guidance, a near normal lifestyle, including
complete sexual function is possible.
C. Activities of daily living should be resumed as quickly as possible to avoid
depression and further dependency.
D. After surgery, changes in activities must be made to accommodate for the
physiologic changes caused by the operation.

RATIONALE: B. There are few physical restraints on activity

postoperatively, but the client may have emotional problems resulting
from the body image changes.

46.A 37-year-old client with uterine cancer asks the nurse, "Which is the most
common type of cancer in women?" The nurse replies that it's breast cancer.
Which type of cancer causes the most deaths in women?
A. Lung cancer
B. Colon and rectal cancer
C. Brain cancer
D. Breast cancer

RATIONALE: A. Lung cancer is the most deadly type of cancer in both

women and men. Breast cancer ranks second in women, followed (in
descending order) by colon and rectal cancer, pancreatic cancer, ovarian
cancer, uterine cancer, lymphoma, leukemia, liver cancer, brain cancer,
stomach cancer, and multiple myeloma.

47.Which of the following substances has abnormal values early in the course of
multiple myeloma (MM)?
A. Red blood cells
B. Immunoglobulins
C. White blood cells
D. Platelets
RATIONALE: B. MM is characterized by malignant plasma cells that
produce an increased amount of immunoglobulin that isn’t functional.

48.Breast self examination (BSE) is one of the ways to detect breast cancer
earlier. The nurse is conducting health teaching to female clients in a clinic.
During evaluation the clients are asked to state what they learned. Which of
the following statements made by a client needs further teaching about BSE?
A. “BSE is done after menstruation.”
B. “BSE palpation is done by starting at the center going to the periphery in
a circular motion.”
C. “BSE can be done in a lying position.”
D. “BSE should start from age 20.”

RATIONALE: B. This client needs further teaching as palpation in BSE

should start at the periphery going to the center in a circular motion.
Option A: BSE is performed 7-10 days after menstruation when the breast
are less tender and lumpy. Option C: The breast can be examined in a
lying position since this position flattens the breast and makes it easier to
examine. Option D: All women age 20 and older must do self-breast
exams where breast tumors can be easily detected at this age.

49. Which of the following interventions is the key to increasing the survival
rates of clients with lung cancer?
A. High-dose chemotherapy
B. Early bronchoscopy
C. Smoking cessation
D. Early Detection

RATIONALE: D. 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 it’s detectable on a chest x-ray, so
this is difficult.

50.A 32-year-old male patient is to undergo radiation therapy to the pelvic area
for Hodgkin’s lymphoma. He expresses concern to the nurse about the effect
of chemotherapy on his sexual function. The best response by the nurse to
the patient’s concerns is
A. "Radiation does not cause the problems with sexual functioning that occur
with chemotherapy or surgical procedures used to treat cancer."
B. "It is possible you may have some changes in your sexual function, and
you may want to consider pretreatment harvesting of sperm if you want
children."
C. "The radiation will make you sterile, but your ability to have sexual
intercourse will not be changed by the treatment."
D. "You may have some temporary impotence during the course of the
radiation, but normal sexual function will return."

RATIONALE: B. The impact on sperm count and erectile function depend

on the patient’s pretreatment status and on the amount of exposure to
radiation. The patient should consider sperm donation before radiation.
Options A, C, and D: Radiation (like chemotherapy or surgery) may affect
both sexual function and fertility either temporarily or permanently.

Prepared by: Dr. Jhonnifer A. Abarao,

DHCM, MAN, USRN, RN, LPT, CHA,

“Not all angels have wings … some have scrubs.” —Unknown