NCLEX- RN Oncology & Cancer Practice Exam Questions

1. C. Muscle spasm

Rationale: Complications of multiple myeloma most commonly affect the chest, lower back, or legs, and the symptoms may include odd sensations like numbness and tingling, pain, or muscle weakness. Occasionally, neurologic symptoms occur because plasma cells grow within the spinal canal and press on the spinal cord.

• Option A: Neurological complications in multiple myeloma most frequently occur in the spinal cord, not the brain. Multiple myeloma weakens the bones in the spine, then they collapse and press on the spinal nerves. This can cause severe back pain and numbness and weakness in the lower extremities.
• Option B: Renal dysfunction is not a complication of multiple myeloma, rather, it is one of the symptoms. Myeloma protein can damage the kidneys. As the kidneys start to fail, they lose the ability to get rid of excess salt, fluid, and body waste products.
• Option D: Direct damage to the heart tissue is a potential short-term or long-term complication from the ant-cancer therapy, but not a direct complication of multiple myeloma itself. The type of drug, how much it is taken over time, the frequency and route of administration, the drug-to-drug interactions, and the client’s age can all play a role in causing complications.

• Bloom’s Taxonomy: Understanding
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Rajkumar et al. (2020); American Cancer Society (2018); International Myeloma Foundation (2019)

2. C. Leukopenia

Rationale: Leukopenia refers to a decrease in the number of white blood cells (WBCs) in the blood. The mechanism of leukopenia caused by drugs is mainly mediated by the immune system itself. Some agents like cancer chemotherapy drugs cause leukopenia by suppressing the bone marrow, leading to immunosuppression or weakened immunity.

• Option A: Nystagmus is a complication of platinum-based chemotherapy, which causes cochlear toxicity. Given that the auditory and vestibular organs of the inner ear share the same blood, nerve, and fluid supplies, it is possible that vestibular function loss may occur. Symptoms such as vertigo, dizziness, double vision (nystagmus), and light-headedness have been reported by clients diagnosed with bilateral vestibular impairment due to platinum-based chemotherapy.
• Option B: Ascites are not a side effect of chemotherapy. Ascites are common in some cancers that have reached the advanced stages and spread in the abdominal area, including cancer of the ovary, liver, colon, stomach, or pancreas. Sometimes chemotherapy might help manage ascites.
• Option D: Drug-induced polycythemia can be seen with excess use of rHuEPO or anabolic steroids. abuse of both types of agents by athletes may be associated with increased thrombotic risk.

• Bloom’s Taxonomy: Remembering
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Mandal (2019); Prayuenyong et al (2018); American Cancer Society (2021); Mintzer et al (2009)

3. B. “One of the late symptoms to manifest is stomach pain.”

Rationale: The most common presenting symptoms of gastric cancer are non-specific weight loss, persistent abdominal pain, dysphagia, hematemesis, anorexia, nausea, early satiety, and dyspepsia. Clients presenting with a locally-advanced or metastatic disease usually present with significant abdominal pain, potential ascites, weight loss, fatigue, and have visceral metastasis on scans. Most clients in the United States have symptoms of an advanced stage at the time of presentation.

• Option A: Treatment modality for gastric cancer depends on accurate preoperative staging. Although recent advances in chemotherapy have achieved considerable tumor shrinkage in many cases of gastric cancer, these responses have not ultimately led to a cure. The current goal of chemotherapy is to delay the manifestation of, or ameliorate, the disease-related symptoms and to prolong survival.
• Option C: TPN may enhance the growth of cancer. The literature contains few scattered anecdotal reports showing the benefits or deleterious effects of enteral or parenteral feeding on tumor progression. eight of 12 studies reported that nutritional support appeared to stimulate tumor cell proliferation.
• Option D: The main goal of surgery is complete resection with adequate margins (more than 4 cm), and only 50% of clients will obtain R0. Only clients with localized, resectable gastric cancer have the best chance of long-term survival with surgery alone.

• Bloom’s Taxonomy: Applying
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Farci et al. (2021); Japanese Gastric Cancer Association (2020); Bozzetti & Stanga (2020)

4. B. Determine the client’s knowledge about colostomies.

Rationale: Colorectal cancer surgery can trigger anxiety episodes of varying intensities. Preoperative anxiety in elective surgery clients is highly prevalent, with rates of 60-70%. Assessing the client’s knowledge of the procedure may help the nurse create a teaching plan for the client. Understanding the procedure and its risks and benefits may allay the client’s fear and anxiety.

• Options A and C: Using teaching materials such as photos and written materials may enhance the client’s understanding of the procedure and decrease their anxiety. However, determining the client’s knowledge may be needed first to help in creating the teaching plan.
• Option D: Support and counseling should be tackled along with the introduction of surgery as a treatment option. Social support is one of the most important resources for people dealing with cancer-related stress; this type of support refers to the perceived caring, assistance, and esteem individuals receive in their supportive social networks. Social support has been widely confirmed to improve quality of life.

• Bloom’s Taxonomy: Applying
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Turrado et al. (2021); Yang et al. (2019)

5. A. Red

In a study, bloody drainage from the nasogastric tube was observed several hours after the surgery. Minor bleeding of the anastomosis is usually self-limited and can be treated conservatively. However, fresh bloody drainage that increases within a short time may indicate hemorrhage and should be reported to the healthcare provider.

• Options B and C: Cloudy, pale-yellowish drainage is characteristic when the tube is in the stomach; bile-colored or greenish drainage is characteristic when the tube is in the duodenum.
• Option D: In gastrointestinal drainage, blood varies in color. It may be fresh, dark brown, or in brown particles (“coffee ground” drainage if it has been partially digested.

• Bloom’s Taxonomy: Analyzing
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Brookside Associates (2015); Tanizawa et al. (2010)

6. B. An older adult male with a low-fat, high-fiber diet.

The ingestion of a high-fiber diet may be protective against colorectal cancer. fiber causes the formation of a soft, bulky stool that dilutes carcinogens; it also decreases colonic transit time. allowing less time for harmful substances to contact the mucosa. The decreased incidence of colorectal cancer in Africans is attributed to their high-fiber, low-animal-fat diet.

• Option A: Having a family health history of colorectal cancer makes the client more likely to get colorectal cancer themselves. Lynch syndrome is an inherited genetic condition that predisposes a client to colorectal cancer. However, not all inherited colorectal cancers are due to Lynch syndrome, and not everyone with Lynch syndrome will get colorectal cancer.
• Option C: Clients with previous breast cancer are actually 5% less likely to develop colon cancer and 13% less likely to develop rectal cancer than clients in the general population. Nevertheless, the risk of colon cancer is still greater in these clients than in clients who consume a high-fiber, low fat diet.
• Option D: Inflammatory bowel disease (IBD), mainly ulcerative colitis, has a well-known association with Cca, with an estimated incidence 0.5% per year between 10 and 20 years after the time of IBD diagnosis and 1% per year after that reaching a 30% risk probability by the fourth decade of patients with pancolitis.

• Bloom’s Taxonomy: Remembering
• QSEN: Evidence-based Practice
• Content Area: Adult Health- Oncology
• References: Centers for Disease Control and Prevention (2022); Cagir & Espat (2021); Newschaffer et al. (2001); Farci (2022)

7. D. Serum glucose

Diabetes is both a risk factor and a complication of pancreatic cancer. Indeed, prediabetes and long-term diabetes are associated with an increased risk of pancreatic cancer, and early-stage pancreatic cancer causes new-onset diabetes. a systematic review showed that elevated fasting blood glucose levels are associated with an increased risk of pancreatic cancer.

• Option A: Creatine phosphokinase (CPK), also known by the name creatine kinase (CK), is the enzyme that catalyzes the reaction of creatine and adenosine triphosphate (ATP) to phosphocreatine and adenosine diphosphate (ADP). Many conditions can cause derangement in CPK levels, including rhabdomyolysis, heart disease, kidney disease, or even certain medications.
• Option B: The serum level of CEA is increased in 30%–60% of pancreatic cancer clients. Thus, elevated CEA levels have been established as an independent predictor of poor survival of pancreatic cancer clients.
• Option C: Enzyme-linked immunosorbent assay and radioimmunoassay are two common platforms for the detection of biomarkers; however, they suffer from some limitations. Measuring the levels of these biomarkers in pancreatic cancer clients, pancreatitis clients, and healthy individuals reveals the unique expression pattern of these markers in pancreatic cancer clients, suggesting the great potential of using this approach for early diagnostics of pancreatic cancer.
• Bloom’s Taxonomy: Applying
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Zhang et al. (2021); Rodriguez, (2021); Meng et al.(2017); Banaei et al. (2017)

8. C. Left nephrectomy

Nephrotoxicity with the use of aminoglycoside antibiotics occurs mainly through renal tubular toxicity. Additional mechanisms include a decrease in glomerular filtration and a reduction of blood flow to the kidneys. If discontinued, this damage is usually temporary.

• Option A: Peripheral neuropathy is a chronic complication of diabetes mellitus. It is not contraindicated for neomycin administration. Neomycin should not be utilized in individuals with bowel obstruction or inflammatory bowel disease.
• Option B: MI is not affected by neomycin. The use of other analgesic agents, such as nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in clients diagnosed with MI if at all possible, as the use of these agents has been associated with adverse cardiovascular events.
• Option D: Glaucoma is not contraindicated in the use of neomycin. Several different drugs have the potential to cause the elevation of intraocular pressure (IOP), which can occur via an open-angle mechanism or a closed-angle mechanism. A steroid-induced glaucoma is a form of open-angle glaucoma that usually is associated with topical steroid use, but it may develop with inhaled, oral, intravenous, periocular, or intravitreal steroid administration.

• Bloom’s Taxonomy: Remembering
• QSEN: Safety
• Content Area: Adult Health- Oncology
• References: Veirup & Kyriakopoulos (2021); Zafari (2019); Greenwood & Roy (2020)

9. C.  Visitation is limited to 30 minutes when the implant is in place.

Clients with radium implants should have close contact limited to 30 minutes per visit. The client should do simple things to minimize exposure to family members, especially children, and pregnant women, who may be more sensitive to radiation. Minimizing direct contact for prolonged periods of time, especially for the first few weeks or months after an implant, should be practiced.

• Option A: Family members are allowed to stay in the room with the client for a limited time only. the client may also hold a child but should restrict activities such as allowing the child to sit on the lap for many hours on multiple occasions.
• Option B: Immediately after the brachytherapy procedure, exposure from the client is surveyed at one meter. However, visitors are still allowed provided that they are 18 years old and above and not pregnant.
• Option D: Radiation exposure to family and household members from a client receiving a radioactive brachytherapy implant is very low and should be a minor factor in the decision-making process for the primary therapy. Nevertheless, precautions should still be taken whenever visiting a client undergoing brachytherapy.

• Bloom’s Taxonomy: Applying
• QSEN: Safety
• Content Area: Adult Health- Oncology
• References: Michalski et al. (2003)

10. B. “It reverses drug toxicity and prevents tissue damage.”

Leucovorin is FDA indicated after high dose methotrexate therapy in osteosarcoma to decrease the toxic effects of methotrexate or counter the toxic effects of folate antagonists. When used as a part of chemotherapeutic regimens, leucovorin is not administered along with methotrexate. It is usually administered 24 hours after a course of methotrexate. Tissue toxicity may be permanent if leucovorin therapy gets delayed beyond 40 hours.

• Option A: Leucovirin does not increase the number of circulating neutrophils. Off-label uses include neoadjuvant treatment in bladder cancer, as a cofactor in methanol toxicity, in the treatment of advanced esophageal cancer, advanced gastric cancer, advanced pancreatic cancer, prevention of hematological toxicity of pyrimethamine in patients with AIDS, and the treatment of ectopic pregnancy (along with methotrexate)
• Option C: Leucovorin does not treat iron deficiency. Leucovorin is occasionally an alternative agent used in the treatment of megaloblastic anemia when oral intake of folic acid is not possible.
• Option D: Leucovirin does not create a synergistic effect that shortens treatment time. n the setting of methotrexate toxicity, intravenous dosing is preferred and should start immediately. Methotrexate becomes increasingly polyglutamated; the longer it stays in the cell, the polyglutamated methotrexate stays in the nucleus and is less susceptible to reversal with leucovorin.

• Bloom’s Taxonomy: Analyzing
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Hegde & Nagalli (2021)

11. A, B, C, and D.

Chemotherapeutic agents have a narrow therapeutic index and as a result, these agents have the potential for detrimental adverse events. Cytotoxic chemotherapy may result in severe complications that can lead to reversible or irreversible adverse events and even death.

• Option A: Check on the infusion regularly and the IV site. Extravasation is a well-recognized complication of IV chemotherapy administration. It is the non-intentional leakage of substances/solutions into the perivascular or subcutaneous space that can result in significant tissue damage. The client is monitored for pain, which is usually described as mild to severe burning radiating along the vein. The site is examined for erythema or swelling.
• Option B: Having the client cough or move position may change the status of the line if it is temporarily against a vessel wall. Veins to be used for drug administration may be distended by using a heat compress, asking the client to dangle hand and arm over the side of the bed, or the use of a blood pressure cuff inflated to 40 to 50 mm Hg on the upper arm.
• Option C: The client is urged to report immediately any sensation of pain or burning. In case of any doubt, the infusion should be stopped, and one should consider changing the infusion site or notifying the healthcare provider so they can evaluate the placement.
• Option D: Blood return should be verified before, during continuous infusions, and after administration. Ensure the central venous catheter is properly functioning before administering hazardous chemotherapy agents, and if the client is alert and oriented, instruct them to call the nurse if they notice any problems with the infusion.
• Option E: Vein integrity and flow may be pretested with 10 mL of saline or dextrose. Good blood return and patency are established by gently drawing back blood before starting to administer the drug through the tubing.

• Bloom’s Taxonomy: Applying
• QSEN: Safety
• Content Area: Adult Health- Oncology
• References: Pitello et al. (2010); Goolsby & Lombardo (2006)

12. B. Night sweats

Clients diagnosed with Hodgkin lymphoma manifest B symptoms including unexplained profound weight loss, high fevers, and drenching night sweats. B symptoms are evident in up to 30% of patients and are generally more common in stages 3 to 4 of the disease, mixed cellularity, and lymphocyte depleted HL subtypes.

• Option A: Headache is not a symptom of Hodgkin lymphoma. Chest pain may occur as caused by the mass effect of significant mediastinal node enlargement.
• Option C: Clients diagnosed with Hodgkin lymphoma frequently present with painless supra-diaphragmatic lymphadenopathy (one to two lymph node areas) that can be seen in the cervical area, axilla, and the inguinal area.
• Option D: Unexplained profound weight loss is one of the B symptoms commonly found with Hodgkin lymphoma. Cancer cells can burn up the body’s energy resources as the body tries to eliminate these cells. This results in sudden weight loss especially because lymphomas grow rapidly.

• Bloom’s Taxonomy: Remembering
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Kaseb & Baker (2021); Kiefer (2019)

13. A. Change in bowel habits

In the UK, a ‘change in bowel habit’ specifically in the context of CRC refers to the passage of loose stool or increased frequency of defecation persisting for 6 weeks, especially in those over 60 years. These studies showed that a change to looser stool and/or increased frequency of defecation occurred in 60– 91% of clients with a distal and in 40–61% of clients with proximal cancer.

• Option B: A total of 15–30% of the general population have experienced abdominal pain in the past year. This may be part of irritable bowel syndrome, which is more common in younger age groups and is usually associated with diarrhea at the outset.
• Option C: Hemorrhoids are not symptoms of colorectal cancer. Rectal bleeding, however, is one of the most common symptoms of colorectal cancer, but most often, it is because of a benign pathology. It is generally regarded as an early symptom of colorectal cancer.
• Option D: The client with colorectal cancer may have changes in stool consistency, as they may experience either constipation or diarrhea. Although constipation is not described as a high-risk symptom by the Department of Health Guidelines, recent work in primary care suggests that this symptom had to be a criterion for referral either alone or in combination with other symptoms.

• Bloom’s Taxonomy: Remembering
• QSEN: Evidence-based Practice
• Content Area: Adult Health- Oncology
• References: John et al. (2010)

14. C. Sexual dysfunction related to radiation therapy

Radiotherapy may result in impotence and testicular dysfunction in males. Clients undergoing radiotherapy should be offered sperm or egg cryopreservation options before undergoing RT.

• Option A: Grieving is also an appropriate nursing diagnosis for the client, however, the presence of the client’s fiancee may provide a support system that can help him through his grief.
• Option B: The client is not on bedrest, therefore, impaired skin integrity will not be applicable. As radiation therapy progresses, long-term radiation injury to the skin may occur involving erythema, inflammation, and desquamation of dry and moist skin surfaces.
• Option D: Fatigue is a common side effect of radiotherapy but is not a priority. The nurse may help the client plan rest and activity periods to conserve their energy appropriately.

• Bloom’s Taxonomy: Analyzing
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Majeed & Gupta (2021)

15. B, C, D, and F.

A cancer diagnosis may disrupt the normal development of independence, complicate role expectations, and create fragmented support.

• Options A and C: Illness in one family member can affect all family members, even children. Previous research suggests that for adolescents, parents are the main source of support, but for older clients, spouses and partners are often the primary supporters involved in cancer caregiving and decision-making.
• Option B: Given the developmental stages of the clients and the changing nature of their relationships, there is a need to understand how clients, parents, and partners expect to and enact support for the client. Qualitative accounts of cancer survivors diagnosed with cancer as young adults reveal common domains of everyday life that become disrupted, such as having to drop out of high school or college, missing social activities with friends, and not being able to work resulting in loss of financial independence.
• Option D: Having well-defined expectations within the family regarding roles and responsibilities for decision-making and care may be important for reducing conflict and improving support. Families described support provided by caregivers as largely focused on emotional support, transportation assistance, and the general presence of all caregivers at all stages of the experience.
• Option E: There are some unique roles taken on by parents and/or partners based on their strengths or the situation. For example, caregivers with medical backgrounds often become translators during doctor appointments, those with better financial situations helped more with bills, and those who were queasy around hospitals spent more time helping in the home. There should often be coordination among family members to determine who has the best ability to do particular tasks.
• Option F: As with other life stressors, a cancer diagnosis is likely to intensify existing patterns of behavior. Research on family resilience has outlined factors for family protection from stress, including flexibility, communication, and connectedness, as well as risks for vulnerability, such as conflict, change in family role, and cumulative effects of multiple stressors. This resilience may be important to protect clients from the frustration of poorly-executed attempts at support as caregivers acclimate to their role.

• Bloom’s Taxonomy: Applying
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Reblin et al. (2019)

16. C. Alteration in the size, shape, and organization of differentiated cells

Dysplasia refers to an alteration in the size, shape, and organization of differentiated cells. dysplasia is not cancer, but it may sometimes become one. It can be mild, moderate, or severe, depending on how abnormal the cells look under the microscope and how much of the tissue or organ is affected.

• Option A: Metaplasia refers to the process of cells transforming from one differentiated cell type to another, effectively changing the cell from its original state into a new one.
• Option B: The presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin is called anaplasia. Anaplasia cells divide rapidly and do not look or function like normal cells.
• Option D: In hyperplasia, there is an increase in the number of cells in an organ or tissue that appear normal under a microscope.

• Bloom’s Taxonomy: Understanding
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: National Cancer Institute; Gentle Cure (2021); Canadian Cancer Society (2014)

17. C. Night sweat

The Ann Arbor classification is used most often for Hodgkin lymphoma, and stage 1 involves a single lymph node area or single extranodal site with clinical manifestations of B symptoms such as drenching night sweats are present in 40% of clients.

• Option A: Splenomegaly and/or hepatomegaly may be present but are usually asymptomatic.
• Option B: Constitutional symptoms include unexplained fever >38℃, not hypothermia. Intermittent fever is observed in approximately 35% of cases; infrequently, the classic Pel-Ebstein fever is observed (high fever for 1-2 wk, followed by an afebrile period of 1-2 wk).
• Option D: Pericarditis isn’t associated with Hodgkin lymphoma. Chest pain, cough, shortness of breath, or a combination of those may be present due to a large mediastinal mass or lung involvement; rarely, hemoptysis occurs.

• Bloom’s Taxonomy: Remembering
• QSEN: Evidence-based Practice
• Content Area: Adult Health- Oncology
• References: Lash & Besa (2021)

18. C, D, and E.

Pediatric brain tumors are the most common type of solid childhood cancer and are only second to leukemia as a cause of pediatric malignancies. Postnatally, common presentations are hydrocephalus, macrocrania, and localizing neurological signs. In neonates and older children, the clinical presentation depends on the site of tumor involvement.

• Option A: Primary polydipsia is a condition where there is excess consumption of fluids leading to polyuria with diluted urine and, ultimately, hyponatremia. The main differential diagnosis for primary polydipsia is diabetes insipidus (DI).
• Option B: Bradycardia in neurosurgery is almost always assumed to be secondary to intracranial conditions, specifically raised intracranial pressure causing Cushing’s reflex, the trigemino-cardiac reflex, or brainstem lesions. Bradycardia occurring from lesions arising from intrinsic brainstem lesions, especially at the ponto-medullary junction, is usually associated with other significant morbid symptomatologies.
• Option C: The client diagnosed with a brain tumor in the occipital area may cause a stiff neck and develop a head tilt. This occurs when the client holds their head or neck in an unusual way, such as at an awkward angle or in a twisted position. The client may develop a ‘wry neck’, which refers to difficulty in turning their head from side to side.
• Option D: Nausea and vomiting are two common signs of the flu or flu-like illnesses. However, in rare instances, these symptoms can be due to a brain tumor causing increased pressure inside the brain.
• Option E: Supratentorial tumors may present with limb weakness, convulsions, and altered level of consciousness. Infratentorial tumors commonly present with signs of raised intracranial pressure (HCP) and imbalance.
• Option F: In the first few years of life, other symptoms of tumors can include loss of appetite. Tumors in the cerebellum (the lower, back part of the brain that controls coordination) can cause problems in swallowing, further decreasing the client’s eating ability.

• Bloom’s Taxonomy: Analyzing
• QSEN: Evidence-based Practice
• Content Area: Adult Health- Oncology
• References: Kotagiri & Sridharan (2021); Dadlani et al. (2010); The Brain Tumor Charity (2022); John Hopkins Medicine (2022); American Cancer Society (2018)

19. B. Breath sounds

Pneumonia is common during induction chemotherapy for acute leukemia and is associated with increased morbidity, mortality, and health care resource utilization. There is an association between the type of leukemia and the incidence of pneumonia even after adjustment for neutropenia. Assessing for breath sounds aids the nurse in identifying the presence of pneumonia earlier.

• Option A: Cardiovascular events are the leading non-malignant cause of death among survivors of childhood cancers, and are responsible for a seven-fold higher risk of death among such clients compared with age-matched peers. Both chemotherapy and radiation therapy are cardiotoxic. Cardiac dysfunction resulting in congestive heart failure (CHF) may be progressive and fatal [9], and negatively impact the quality of life.
• Option C: Neutropenia occurs following chemotherapy (eg, in cancer). Hypotension occurs in this group in the context of fever and infection, however, a small drop in blood pressure may be missed in the clinical setting in the absence of other symptoms.
• Option D: Assessing bowel sounds is unnecessary with neutropenia. Leukemia may affect the small and large bowel and they are usually hemorrhagic or infiltrative.

• Bloom’s Taxonomy: Applying
• QSEN: Safety
• Content Area: Adult Health- Oncology
• References: Garcia et al. (2013); Chellapandian et al. (2019); Morton et al. (2008)

20. D. “If my child continues to vomit and has diarrhea, I will call the provider.”

Nausea and vomiting are serious side effects of cancer chemotherapy that can cause significant negative impacts on clients’ quality of life and on their ability to tolerate and comply with therapy. Also, nausea and vomiting can result in anorexia, decreased performance status, metabolic imbalance, wound dehiscence, esophageal tears, and nutritional deficiency

• Option A: Feeling weakness or fatigue is common in clients diagnosed with cancer, but it’s different for each person. Feeling weak is often one part of having fatigue. It is important to remember that fatigue might get better after treatment ends for some, but last many months to years after treatment for others.
• Option B: Hair is lost when chemotherapy drugs damage hair follicles, making hair fall out. It can be hard to predict which clients will lose their hair and which ones won’t, even when they take the same drugs. Some drugs can cause hair thinning or hair loss only on the scalp. Others can also cause the thinning or loss of pubic hair, arm, and leg hair, eyebrows, and eyelashes.
• Option C: Sleep problems (sometimes called sleep disturbances or sleep-wake disturbances) can happen for many reasons, and clients diagnosed with cancer often have an increased risk for them.

• Bloom’s Taxonomy: Applying
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Rao & Faso (2012); American Cancer Society (2020)

21. A, C, D, G, and H.

Dr. Elizabeth Kubler-Ross introduced the most commonly taught system for understanding the process of dying in her 1969 book, On Death and Dying. The book explored the experience of dying through interviews with terminally ill patients and described the Five Stages of Dying: Denial, Anger, Bargaining, Depression, and Acceptance (DABDA). The stages provide a heuristic for patterns of thought and behavior, common in the setting of terminal illness, which may otherwise seem atypical.

• Option A: Acceptance describes recognizing the reality of a difficult diagnosis while no longer protesting or struggling against it. It is often portrayed as the last of Kubler-Ross’s stages and a sort of goal of the dying or grieving process.
• Options B, E, and F: Fear, anxiety, and panic are not included in the stages of grief by Kübler-Ross. However, these emotions are inherently present in those who are undergoing grief.
• Option C: When bargaining starts to take place, the client may often direct their requests to a higher power or something bigger that may be able to influence a different outcome. The feeling of helplessness can cause the client to react in protest by bargaining, which gives them a perceived sense of control over something that feels so out of control.
• Option D: It is common to experience anger after the loss of a loved one. The client is trying to adjust to a new reality and is likely experiencing extreme emotional discomfort. There is so much to process that anger may feel like it allows us an emotional outlet.
• Option G: The first stage in this theory, denial helps clients minimize the overwhelming pain of loss. Denial is not only an attempt to pretend that the loss does not exist. The client is also trying to absorb and understand what is happening.
• Option H: Although this is a very natural stage of grief, dealing with depression after the loss of a loved one can be extremely isolating. As the panic begins to subside, the emotional fog begins to clear and the loss feels more present and unavoidable.

• Bloom’s Taxonomy: Remembering
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Clarke (2021); Tyrrell et al. (2021)

22. C. “Hair loss is temporary. You may regrow your hair after 3-6 months.”

Hair is lost when chemotherapy drugs damage hair follicles, making hair fall out. It can be hard to predict which clients will lose their hair and which ones won’t, even when they take the same drugs. Some drugs can cause hair thinning or hair loss only on the scalp. Others can also cause the thinning or loss of pubic hair, arm, and leg hair, eyebrows, and eyelashes.

• Option A: Reassuring the client is non-therapeutic. Additionally, telling the client not to worry may belittle and invalidate their feelings and they may tend to hide their feelings later on.
• Option B: Providing facts regarding the client’s condition may help the client accept the side effect more therapeutically. It may also help the client plan interventions if they would want to cover up the hair loss.
• Option D: Suggesting options like using a hat can be helpful, but the nurse should initially provide information regarding the side effect so that the client can make decisions based on it.

• Bloom’s Taxonomy: Applying
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: American Cancer Society (2020)

23. B, D, and E.

The term ‘protective isolation’ describes a range of practices used to protect highly susceptible hospital clients from infection. The most common reason for placing a client in protective isolation is if his or her blood neutrophil count falls, or is expected to fall, below 0.5 x 109/l. This is due to high-dose chemotherapy and occurs particularly in clients with hematological malignancies who are given bone marrow or hematopoietic stem cell transplants. In these situations it is common for the period of neutropenia to be prolonged, lasting more than seven days.

• Option A: The immunocompromised client is at increased risk of food-borne illness and the acquisition of harmful micro-organisms from some food and drink. Therefore immunocompromised individuals are advised to avoid certain high-risk foods, for example, soft cheeses and foods made with raw eggs, such as mayonnaise.
• Option B: Hand hygiene is fundamental to the prevention of infection in all situations. All persons should cleanse their hands before any contact with an immunocompromised individual or their immediate environment as well as before any handling of invasive devices or contact with wounds or other breaks in the skin.
• Option C: Not all visitors need to be restricted. Staff and visitors with known or suspected infections or communicable diseases should be excluded from contact with immunocompromised persons.
• Option D: Medical devices and other equipment should be decontaminated according to existing guidance. Items labelled as ‘single-use’ must never be re-used or re-processed. The use of aseptic technique is a must, especially during invasive procedures.
• Option E: A low-bacteria diet does not have foods that are most likely to have bacteria or other infection-causing microorganisms. Bacteria and other harmful microorganisms are most likely to be in raw or fresh foods. These microorganisms are destroyed when you cook food well. For example, fresh veggies should be cooked until tender, meats should be cooked until well-done, and eggs should be cooked until the yolk is firm.
• Option F: Although flowers and plants have not been directly linked to infection in immunocompromised patients, they are normally not permitted in protective isolation rooms, as they may be a reservoir for Gram-negative bacteria or fungal spores.

• Bloom’s Taxonomy: Applying
• QSEN: Safety
• Content Area: Adult Health- Oncology
• References: Wigglesworth (2003); Winchester Hospital (2021)

24. B and F.

Depending on the extent of surgery and immediate postoperative condition, the client who underwent supratentorial craniotomy may start mobilizing the following day, depending on age, but sitting up, sitting in a chair, standing, and eventually walking if able. Complications of positioning include decubitus ulcers, skull fractures, and CSF leaks.

• Options A, C, and D: Specifically, positioning of the head and neck requires special attention. Hyperflexion, hyperextension, lateral flexion or rotation should be avoided. Hyperflexion of the head and neck may decrease blood flow in vertebral and carotid arteries, leading to the brain stem and cervical spine ischemia, resulting in quadriparesis and quadriplegia.
• Option B: The client is positioned to avoid extreme hip or neck flexion, and the head is maintained in a midline, neutral position.
• Option E: If a large tumor has been removed, the client should be placed on the non-operative side to prevent the displacement of the cranial contents.
• Option F: The HOB after supratentorial craniotomy should be at least at 30 degrees. Avoidance of prolonged pressure directly on the incision will prevent breakdown or added discomfort.

• Bloom’s Taxonomy: Applying
• QSEN: Safety
• Content Area: Adult Health- Oncology
• References: International Society for Pediatric Neurosurgery (2022); Vavilala & Rozet (2007)

25. A, B & C.

Hyponatremia may be encountered in several hematological diseases, both benign and malignant. Hyponatremia was significantly related both to neurologic complications and the existence of obvious central nervous system leukemia at diagnosis. In a single-center analysis of 140 pediatric clients, hyponatremia was observed in 40% of clients following hematopoietic stem cell transplantation (HSCT).

• Options A and B: Clients with clinical signs of volume depletion (e.g. orthostatic decreases in blood pressure and increases in pulse rate, dry mucus membranes, decreased skin turgor) should be considered hypovolemic. When available, direct hemodynamic measurements can provide corroboration of the clinical impression.
• Option C: A frequent cause of postural lightheadedness is acute, gravitational shifts in blood pressure with standing called orthostatic hypotension. Several studies have demonstrated that higher sodium intake stabilizes blood pressure with standing and reduces postural lightheadedness. This is thought to be related to an increased intravascular volume that accompanies higher sodium intake.
• Option D: Given that the ability for water excretion is sufficient in normal states, retention of water resulting in reduced serum sodium concentration occurs only in the presence of impaired renal excretion of water. Primary polydipsia represents an exception to this rule, in which the disproportionate water intake can overwhelm the normal excretory capacity (acute water intoxication).
• Option E: Reduced dietary sodium intake (sodium reduction) increases heart rate in some studies of animals and humans. Compensating physiological mechanisms, like increases in renin and aldosterone and noradrenalin and adrenalin during reduced sodium intake may contribute not only to maintaining BP but also to increasing heart rate (HR).

• Bloom’s Taxonomy: Analyzing
• QSEN: Evidence-based Practice
• Content Area: Adult Health- Oncology
• References: Koumpis et al. (2020); Peng et al. (2019); Sahay (2014); Baltatu & Branco (2016)

26. B. High corticotropin and high cortisol levels

Pituitary adenomas are tumors of the anterior pituitary. Most pituitary tumors are slow-growing and benign. They are classified based on size or cell of origin. Early morning fasting cortisol levels can be useful in assessing the hypothalamic-pituitary-adrenal (HPA) axis insufficiency. AM cortisol level of greater than 14 mcg/dl is suggestive of a normal HPA axis. The goal of treatment is to decrease cortisol levels rapidly and to reduce the associated complications and mortality.

• Option A: Low ACTH and high cortisol levels may mean Cushing’s syndrome or a tumor of the adrenal gland. Cushing’s syndrome is a disorder in which the adrenal gland makes too much cortisol. It may be caused by a tumor in the pituitary gland or the use of steroid medicines. Steroids are used to treat inflammation but can have side effects that affect cortisol levels.
• Option C: Low ACTH and low cortisol levels may mean hypopituitarism. Hypopituitarism is a disorder in which the pituitary gland does not make enough of some or all of its hormones.
• Option D: The screening tests for Cushing disease include checking late-night salivary cortisol (around midnight), 24-hour urine free cortisol, or dexamethasone suppression test (DST). Late-night salivary cortisol has a greater than 90% sensitivity and specificity if done accurately. A cortisol level of 1.8 mcg/dl or higher suggests hypercortisolemia.

• Bloom’s Taxonomy: Analyzing
• QSEN: Evidence-based Practice
• Content Area: Adult Health- Oncology
• References: Russ et al. (2021); Medline Plus (2021)

27. A. Immediately discontinue the infusion

The initial step for managing suspected vesicant extravasation is to stop the infusion. The IV tube should be disconnected, but the needle should not be removed in an attempt to prevent further release of the vesicant.

• Option B: After discontinuing the infusion, the nurse will notify the healthcare provider. If an antidote is available, an appropriate amount should be instilled through the existing IV, and then the IV is discontinued. An antidote may prevent tissue necrosis.
• Option C: Compresses may be given as indicated by the healthcare provider. The affected extremity is kept elevated, and a warm or cold compress is applied as indicated.
• Option D: The nurse may attempt to aspirate residual drug from the IV site using a small (1 to 3 mL) syringe to help lower the concentration of the drug in the area.

• Bloom’s Taxonomy: Applying
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Goolsby & Lombardo (2006)

28. C, D, E, & F.

Syndrome of inappropriate antidiuretic hormone (SIADH) is often associated with cancer. Approximately 67% of SIADH cases are reported to be caused by cancer, the majority of which (70%) are linked to small cell carcinoma of the lung.

• Option A: Hyponatremia is often caused by SIADH in cancer patients. Several studies were identified that explored the impact of a low serum sodium level on survival outcomes in clients with malignancies other than small cell lung carcinoma. Hyponatremia was identified as a negative prognostic factor in both univariate and multivariate analyses in two of three studies of non-small cell lung cancer.
• Option B: Asymptomatic clients with euvolemic or hypervolemic hyponatremia are usually managed initially by fluid restriction, with the goal of achieving a negative water balance. Fluid (but not sodium) should be restricted to approximately 500 ml below the average daily urine output, and any drug known to cause SIADH should be discontinued whenever possible and replaced with another agent that does not cause hyponatremia.
• Options C and D: A second option is to treat cancer first (radiation or chemotherapy) —which could also yield improvement in the sodium status—while monitoring carefully for hyponatremia (a likely scenario if cancer therapy is deemed to be more urgent). The approach to these clients should be dictated by the specific clinical scenario and by the treating provider’s best medical judgment.
• Option E: Three vasopressin antagonists (conivaptan, tolvaptan, mozavaptan) have been introduced into clinical practice and others (e.g., lixivaptan, satavaptan) have undergone clinical testing.
• Option F: Hyponatremia may be detected incidentally on routine laboratory testing before or during cancer treatment, or it may be suggested by the presence of mostly neurological symptoms (e.g., headache, nausea, vomiting, muscle cramps, lethargy, disorientation, depressed reflexes).

• Bloom’s Taxonomy: Applying
• QSEN: Evidence-based Practice
• Content Area: Adult Health- Oncology
• References: Yoo (2008); Castillo et al. (2012)

29. A, B, & D.

Good communication can help allay fears, minimize pain and suffering, and enable clients and their families to experience a “peaceful death.” Poor communication can result in suboptimal care, and clients and their families may be subjected to undue mental or physical anguish.

• Option A: Early discussions may also provide opportunities to elicit general thoughts about end-of-life care. Clients and families often require repeated explanations in order to understand a medical problem. Comprehension is enhanced with each repetition. With all medical discussions, it is best to use simple, everyday language and avoid technical wording.
• Option B: By encouraging a client or significant other to speak openly, the subject of death can become less of a taboo. Clients and families may feel comfortable continuing conversations outside the clinics. When the client becomes sicker, all parties find it easier to reopen the discussion.
• Option C: This statement is devoid of empathy, thereby limiting the nurse-client alliance. Undue emphasis is placed on possible interventions while ignoring the mention of the ongoing care that will be provided. The burden of decision-making is thrust on the patient and family—the nurse does not guide in addressing these complicated issues.
• Option D: Clients and families speak more openly and are more trusting when they feel their caregiver’s empathy and compassion. A caring connection can be enhanced by recognizing the stresses that illness imposes on a client and family.
• Option E: As death nears, most clients share similar goals: maximizing time with family and friends, avoiding hospitalization and unnecessary procedures, maintaining functionality, and minimizing pain. Some clients have special requests, such as important visits, desired conversations, or the wish to involve hospice or religious counsel in their final care.

• Bloom’s Taxonomy: Applying
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Balaban (2000)

30. A B, C, & D.

Pituitary tumors, which account for 15–20% of all brain tumors, are benign tumors arising from anterior pituitary cells. Pituitary tumors cause a variety of clinical signs and symptoms due to the metabolic and endocrinological effects of the hormones they secrete, and due to compression on surrounding structures depending on the tumor size. The nurse, with multiple roles in the team, handles individual needs uniquely and holistically and cares for the patient in a systematic approach.

• Option A: In the treatment of clients who develop hyponatremia, restriction in fluid intake to 800–1000 ml/day is applied to prevent possible dilution of plasma sodium level. The reason for fluid restriction should be explained to the client and his family
• Options B and C: Monitor intake and output. Signs and findings of fluid overload due to hypernatremia such as an increase in blood pressure, tachycardia, increase in body weight, thirst, and edema are also closely monitored.
• Option D: Laboratory results including serum levels of anterior pituitary gland hormones and electrolytes such as sodium, and urinalyses are monitored, causative and affecting factors are followed, and fluid balance is monitored.
• Option E: Caffeine and related methylxanthine compounds are recognized as having a diuretic action, and consumers are often advised to avoid beverages containing these compounds in situations where fluid balance may be compromised.

• Bloom’s Taxonomy: Applying
• QSEN: Patient-centered Care
• Content Area: Adult Health- Oncology
• References: Melikoglu & Ozakgul (2018); Maughan & Griffin (2003)