Cancer and Oncology Nursing NCLEX Practice Quiz #1 (56 Questions)
Answers and Rationale
1. Answer: 3. Myocardial Infarction
Complications of Hodgkin’s are pancytopenia, nausea, and
infection. Cardiac involvement usually doesn’t occur.
2. Answer: 3. Thrombocytopenia and
increased lymphocytes
Chronic lymphocytic leukemia shows a proliferation of small
abnormal mature B lymphocytes and decreased antibody
response. Thrombocytopenia also is often present.
Uncontrolled proliferation of granulocytes occurs in
myelogenous leukemia.
3. Answer: 4. Neck
At the time of diagnosis, a painless cervical lesion is often
present. The back, chest, and groin areas aren’t involved.
4. Answer: 3. Involvement of two or more lymph node
regions or structures.
Stage II involves two or more lymph node regions. Stage I
only involves one lymph node region; stage III involves nodes
on both sides of the diaphragm; and stage IV involves
extralymphatic organs or tissues.
5. Answer: 3. Faster growing cells are more susceptible to
chemotherapy
The faster the cell grows, the more susceptible it is to
chemotherapy and radiation therapy. Slow-growing and non-
dividing cells are less susceptible to chemotherapy. Repeated
cycles of chemotherapy are used to destroy nondividing cells
as they begin active cell division.
6. Answer: 2. Carrot sticks
A low-bacteria diet would be indicated with excludes raw
fruits and vegetables.
7. Answer: 4. Breath sounds
Pneumonia, both viral and fungal, is a common cause of death
in clients with neutropenia, so frequent assessment of
respiratory rate and breath sounds is required. Although
assessing blood pressure, bowel sounds, and heart sounds is
important, it won’t help detect pneumonia.
8. Answer: 4. A 60-year-old Black man
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.
9. Answer: 1. Immunoglobulins
MM is characterized by malignant plasma cells that produce
an increased amount of immunoglobulin that isn’t functional.
As more malignant plasma cells are produced, there’s less
space in the bone marrow for RBC production. In late
stages, platelets and WBC’s are reduced as the bone marrow
is infiltrated by malignant plasma cells.
10. Answer: 1. Hypercalcemia
Calcium is released when the bone is destroyed. This causes
an increase in serum calcium levels. MM doesn’t
affect potassium, sodium, or magnesium levels.
11. Answer: 4. Ovarian cancer
Clients with ovarian cancer are at increased risk for breast
cancer. Breast self-examination supports early detection and
treatment and is very important.
12. Answer: 4. Increased vascularity of the breast
Increase in breast size or vascularity is consistent with cancer
of the breast. Early menarche as well as late menopause or a
history of anovulatory cycles are associated with fibrocystic
disease. Masses associated with fibrocystic disease of the
breast are firm, most often located in the upper outer
quadrant of the breast, and increase in size prior
to menstruation. They may be bilateral in a mirror image and
are typically well demarcated and freely moveable.
13. Answer: 3. Squamous cell
Squamous cell carcinoma is a slow-growing, rarely
metastasizing type of cancer. Adenocarcinoma is the next best
lung cancer to have in terms of prognosis. Oat cell and small
cell carcinoma are the same. Small cell carcinoma grows
rapidly and is quick to metastasize.
14. Answer: 4. Recurrent pleural effusion
Recurring episodes of pleural effusions can be caused by the
tumor and should be investigated. Dizziness, generalized
weakness, and hypotension aren’t typically considered
warning signals, but may occur in advanced stages of cancer.
15. Answer: 1. Coughing
Centrally located pulmonary tumors are found in the upper
airway (vocal cords) and usually obstruct airflow, producing
such symptoms as coughing, wheezing, and stridor. Small cell
tumors tend to be located in the lower airways and often
cause hemoptysis. As the tumor invades the pleural space, it
may cause pleuritic pain. Pancoast tumors that occur in the
apices may cause shoulder pain.
16. Answer: 2. Early detection
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
 Cancer and Oncology Nursing NCLEX Practice Quiz #1 (56 Questions)
chest x-ray, so this is difficult. A bronchoscopy may help
identify cell type but may not increase survival rate. High-
dose chemotherapy has minimal effect on long-term survival.
Smoking cessation won’t reverse the process but may help
prevent further decompensation.
17. Answer: 3. A small, localized area near the surface of
the lung.
A small area of tissue close to the surface of the lung is
removed in a wedge resection. An entire lung is removed in a
pneumonectomy. A segment of the lung is removed in a
segmental resection and a lobe is removed in a lobectomy.
18. Answer: 4. The remaining lobe or lobes overexpand to
fill the space.
The remaining lobe or lobes overexpand slightly to fill the
space previously occupied by the removed tissue.
The diaphragm is carried higher on the operative side to
further reduce the empty space. The space can’t remain
“empty” because truly empty would imply a vacuum, which
would interfere with the intrathoracic pressure changes that
allow breathing. The surgeon doesn’t use a gel to fill the
space. Serous fluid overproduction would compress the
remaining lobes, diminish their function and possibly, cause a
mediastinal shift.
19. Answer: 2. To remove the tumor and as little
surrounding tissue as possible.
The goal of surgical resection is to remove the lung tissue that
has a tumor in it while saving as much surrounding tissue as
possible. It may be necessary to remove alveoli
and bronchioles, but care is taken to make sure only what’s
absolutely necessary is removed.
20. Answer: 4. It may prevent surgery if the client can’t
tolerate lung tissue removal.
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 on;t chemotherapy and
radiation.
21. Answer: 4. The tumor is removed, involving the least
possible amount of tissue.
The tumor is removed to prevent further compression of the
lung tissue as the tumor grows, which could lead to
respiratory decompensation. If for some reason it can’t be
removed, then radiation or chemotherapy may be used to try
to shrink the tumor.
22. Answer: 3. Provide pain control
The client with terminal lung cancer may have extreme
pleuritic pain and should be treated to reduce his discomfort.
Preparing the client and his family for the impending death
and providing emotional support is also important but
shouldn’t be the primary focus until the pain is under control.
Nutritional support may be provided, but as the terminal
phase advances, the client’s nutritional needs greatly
decrease. Nursing care doesn’t focus on helping the client
prepare the will.
23. Answer: 3. Histologic type of disease, initial WBC
count, and client’s age at diagnosis
The factor whose prognostic value is considered to be of
greatest significance in determining the long-range outcome
is the histologic type of leukemia. Children with a normal or
low WBC count appear to have a much better prognosis than
those with a high WBC count. Children diagnosed between
ages 2 and 10 have consistently demonstrated a better
prognosis because age 2 or after 10.
24. Answer: 2. Anemia, infection, and bleeding tendencies
The three main consequences of leukemia are anemia, caused
by decreased erythrocyte production; infection secondary to
neutropenia; and bleedingtendencies, from decreased platelet
production. Bone deformities don’t occur with leukemia
although bones may become painful because of the
proliferation of cells in the bone marrow. Spherocytosis refers
to erythrocytes taking on a spheroid shape and isn’t a feature
in leukemia. Mature cells aren’t produced in adequate
numbers. Hirsutism and growth delay can be a result of large
doses of steroids but isn’t common in leukemia. Anemia, not
polycythemia, occurs. Clotting times would be prolonged.
25. Answer: 4. Petechiae
The most frequent signs and symptoms of leukemia are a
result of infiltration of the bone marrow. These include fever,
pallor, fatigue, anorexia, and petechiae, along with bone and
joint pain. Increased appetite can occur but it usually isn’t a
presenting symptom. Abdominal pain may be caused by areas
of inflammation from normal flora within the GI tract or any
number of other causes.
26. Answer: 1. Headache and vomiting.
The usual effect of leukemic infiltration of the brain is
increased intracranial pressure. The proliferation of cells
interferes with the flow of cerebrospinal fluid in the
subarachnoid space and at the base of the brain. The
increased fluid pressure causes dilation of the ventricles,
which creates symptoms of severe headache, vomiting,
irritability, lethargy, increased blood pressure, decreased
heart rate, and eventually, coma. Often children with a variety
of illnesses are hypervigilant and anxious when hospitalized.
27. Answer: 1. Acute lymphoblastic leukemia
Acute lymphoblastic leukemia, which accounts for more than
80% of all childhood cases, carries the best prognosis. Acute
myelogenous leukemia, with several subtypes, accounts for
most of the other leukemias affecting children. Basophilic and
 Cancer and Oncology Nursing NCLEX Practice Quiz #1 (56 Questions)
eosinophilic leukemia are named for the specific cells
involved. These are much rarer and carry a poorer prognosis.
28. Answer: 4. To assess for central nervous system
infiltration
A spinal tap is performed to assess for central nervous system
infiltration. It wouldn’t be done to decrease ICP nor does it aid
in the classification of the leukemia. Spinal taps can result
in brain stem herniation in cases of ICP. A spinal tap can be
done to rule out meningitis but this isn’t the indication for the
test on a leukemic client.
29. Answer: 2. Liver function studies
Liver and kidney function studies are done before initiation of
chemotherapy to evaluate the child’s ability to metabolize the
chemotherapeutic agents. A CBC is performed to assess for
anemia and white blood cell count. A peripheral blood smear
is done to assess the maturity and morphology of red blood
cells. A lumbar puncture is performed to assess for central
nervous system infiltration.
30. Answer: 4. Oral poliovirus vaccine (OPV)
OPV is a live attenuated virus excreted in the stool. The
excreted virus can be communicated to the
immunosuppressed child, resulting in an overwhelming
infection. Inactivated polio vaccine would be indicated
because it isn’t a live virus and wouldn’t pose the threat of
infection. DTP, Hib, and hepatitis B vaccines can be given
accordingly to the recommended schedule.
31. Answer: 1. Bactrim
The most frequent cause of death from leukemia is
overwhelming infection. P. carinii infection is lethal to a child
with leukemia. As prophylaxis against P. carinii pneumonia,
continuous low doses of co-trimoxazole (Bactrim) are
frequently prescribed. Oral nystatin suspension would be
indicated for the treatment of thrush. Prednisone isn’t
an antibiotic and increases susceptibility to
infection. Vincristine is an antineoplastic agent.
32. Answer: 1. Acute lymphocytic leukemia
For the first episode of acute lymphocytic anemia,
conventional therapy is superior to bone marrow
transplantation. In severe combined immunodeficiency and in
severe aplastic anemia, bone marrow transplantation has
been employed to replace abnormal stem cells with healthy
cells from the donor’s marrow. In myeloid leukemia, bone
marrow transplantation is done after chemotherapy to infuse
healthy marrow and to replace marrow stem cells ablated
during chemotherapy.
33. Answer: 4. VZIG should be given within 72 hours of
exposure.
Varicella is a lethal organism to a child with leukemia. VZIG,
given within 72 hours, may favorably alter the course of the
disease. Giving the vaccine at the onset of symptoms wouldn’t
likely decrease the severity of the illness. Acyclovirmay be
given if the child develops the disease but not if the child has
been exposed.
34. Answer: 1. 30 minutes before the initiation of therapy.
Antiemetics are most beneficial when given before the onset
of nausea and vomiting. To calculate the optimum time for
administration, the first dose is given 30 minutes to 1 hour
before nausea is expected, and then every 2, 4, or 6 hours for
approximately 24 hours after chemotherapy. If the antiemetic
was given with the medication or after the medication, it
could lose its maximum effectiveness when needed.
35. Answer: 3. Within 5 to 8 weeks
Postirradiation somnolence may develop 5 to 8 weeks after
CNS irradiation and may last 3 to 15 days. It’s characterized
by somnolence with or without fever, anorexia, nausea, and
vomiting. Although the syndrome isn’t thought to be clinically
significant, parents should be prepared to expect such
symptoms and encourage the child needed rest.
36. Answer: 2. The best time for the examination is after a
shower
The testicular-self examination is recommended monthly
after a warm shower or bath when the scrotal skin is relaxed.
The client should stand to examine the testicles. Using both
hands, with the fingers under the scrotum and the thumbs on
top, the client should gently roll the testicles, feeling for any
lumps.
37. Answer: 3. Low-fat and high-fiber diets
Viruses may be one of multiple agents acting to initiate
carcinogenesis and have been associated with several types of
cancer. Increased stress has been associated with causing the
growth and proliferation of cancer cells. Two forms of
radiation, ultraviolet and ionizing, can lead to cancer. A diet
high in fat may be a factor in the development of breast, colon,
and prostate cancers. High-fiber diets may reduce the risk
of colon cancer.
38. Answer: 3. Monitoring the platelet count
Thrombocytopenia indicates a decrease in the number
of platelets in the circulating blood. A major concern is
monitoring for and preventing bleeding. Option 2 relates to
monitoring for infection particularly if leukopenia is present.
Options 1 and 4, although important in the plan of care are
not related directly to thrombocytopenia.
39. Answer: 4. Malignant proliferation of plasma cells and
tumors within the bone.
 Cancer and Oncology Nursing NCLEX Practice Quiz #1 (56 Questions)
Multiple myeloma is a B cell neoplastic condition
characterized by abnormal malignant proliferation of plasma
cells and the accumulation of mature plasma cells in the bone
marrow. Option 1 describes the leukemic process. Options 2
and 3 are not characteristics of multiple myeloma.
40. Answer: 3. Increased calcium levels
Findings indicative of multiple myeloma are an increased
number of plasma cells in the bone marrow,
anemia, hypercalcemia caused by the release of calcium from
the deteriorating bone tissue, and an elevated blood urea
nitrogen level. An increased white blood cell count may or
may not be present and is not related specifically to multiple
myeloma.
41. Answer: 2. Encouraging fluids
Hypercalcemia caused by bone destruction is a priority
concern in the client with multiple myeloma. The nurse
should administer fluids in adequate amounts to maintain and
output of 1.5 to 2 L a day. Clients require about 3 L of fluid pre
day. The fluid is needed not only to dilute the calcium
overload but also to prevent protein from precipitating in
renal tubules. Options 1, 3, and 4 may be components in the
plan of care but are not the priority in this client.
42. Answer: 3. Occurs most often in the older client
Hodgkin’s disease is a disorder of young adults. Options 1, 2,
and 4 are characteristics of this disease.
43. Answer: 1. Assess level of consciousness
A high risk of hemorrhage exists when the platelet count is
fewer than 20,000. Fatal central nervous system hemorrhage
or massive gastrointestinal hemorrhage can occur when the
platelet count is fewer than 10,000. The client should be
assessed for changes in levels of consciousness, which may be
an early indication of an intracranial hemorrhage. Option 2 is
a priority nursing assessment when the white blood cell count
is low and the client is at risk for an infection.
44. Answer: 4. Arm edema on the operative side
Arm edema on the operative side (lymphedema) is a
complication following mastectomy and can occur
immediately postoperatively or may occur months or even
years after surgery. The other options are expected
occurrences.
45. Answer: 4. Apply sunscreen with a sun protection
factor (SPF) of 15 or more before sun exposure.
A sunscreen with a SPF of 15 or higher should be worn on all
sun-exposed skin surfaces. It should be applied before sun
exposure and reapplied after being in the water. Peak sun
exposure usually occurs between 10am to 2pm. Tightly
woven clothing, protective hats, and sunglasses are
recommended to decrease sun exposure. Suntanning parlors
should be avoided.
46. Answer: 3. Teaching and encouraging pursed-lip
breathing
For clients with obstructive versus restrictive disorders,
extending exhalationthrough pursed-lip breathing will make
the respiratory effort more efficient. The usual position of
choice for this client is the upright position, leaning slightly
forward to allow greater lung expansion. Teaching
diaphragmatic breathing techniques will be more helpful to
the client with a restrictive disorder. Administering cough
suppressants will not help respiratory effort. A low semi-
Fowlers position does not encourage lung expansion. Lung
expansion is enhanced in the upright position.
47. Answer: 1. Fever
Fever is an early sign requiring clinical intervention to
identify potential causes. Chills and dyspnea may or may not
be observed. Tachycardia can be an indicator in a variety of
clinical situations when associated with infection; it usually
occurs in response to an elevated temperature or change in
cardiac function.
48. Answer: 1. “Chemotherapy affects all rapidly dividing
cells.”
There are many mechanisms of action for chemotherapeutic
agents, but most affect the rapidly dividing cells—both
cancerous and noncancerous. Cancer cells are characterized
by rapid cell division. Chemotherapy slows cell division. Not
all chemotherapeutic agents affect molecular structure. All
cells are susceptible to drug toxins, but not all
chemotherapeutic agents are toxins.
49. Answer: 1, 2, 4, 5.
A major concern with intravenous administration of cytotoxic
agents is vessel irritation or extravasation. The Oncology
Nursing Society and hospital guidelines require frequent
evaluation of blood return when administering vesicant or
nonvesicant chemotherapy due to the risk of extravasation.
These guidelines apply to peripheral and central venous lines.
In addition, central venous lines may be long-term venous
access devices. Thus, difficulty drawing or aspirating blood
may indicate the line is against the vessel wall or may indicate
the line has occlusion. Having the client cough or move
position may change the status of the line if it is temporarily
against a vessel wall. Occlusion warrants more thorough
evaluation via x-ray study to verify placement if the status is
questionable and may require a declotting regimen.
50. Answer: 3. Metabolic alkalosis
The client is experiencing metabolic alkalosis caused by loss
of hydrogen and chloride ions from excessive vomiting. This is
shown by a pH of 7.46 and elevated bicarbonate level of 29
mEq/L.
 Cancer and Oncology Nursing NCLEX Practice Quiz #1 (56 Questions)
51. Answer: 4. Ask open-ended questions about sexuality Difficulty in swallowing, pain, and tightness in the chest are
issues related to her mastectomy signs of esophagitis, which is a common complication of
radiation therapy of the chest wall.
The content of the client’s comments suggests that she is
avoiding intimacy with her husband by waiting until he is
asleep before going to bed. Addressing sexuality issues is
appropriate for a client who has undergone a mastectomy.
Rushing her return to work may debilitate her and add to her
exhaustion. Suggesting that she learn relaxation techniques to
help her with her insomnia is appropriate; however, the nurse
must first address the psychosocial and sexual issues that are
contributing to her sleeping difficulties. A nutritional
assessment may be useful, but there is no indication that she
has anorexia.

52. Answer: 4. Sepsis

Bacterial endotoxins released from gram-negative bacteria

activate the Hageman factor or coagulation factor XII. This
factor inhibits coagulation via the intrinsic pathway
of homeostasis, as well as stimulating fibrinolysis. Liver
disease can cause multiple bleeding abnormalities resulting in
chronic, subclinical DIC; however, sepsis is the most common
cause.

53. Answer: 1. An entire lung field

A pneumonectomy is the removal of an entire lung field. A

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

54. Answer: 2. Low-grade fever, chills, tachycardia

Nine days after chemotherapy, one would expect the client to

be immunocompromised. The clinical signs of shock reflect
changes in cardiac function, vascular resistance, cellular
metabolism, and capillary permeability. Low-grade fever,
tachycardia, and flushing may be early signs of shock. The
client with impending signs of septic shock may not have
decreased oxygen saturation levels. Oliguria
and hypotension are late signs of shock. Urine output can be
initially normal or increased.

55. Answer: 4. Medicated cool baths

Nursing interventions to decrease the discomfort of pruitus

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

56. Answer: 4. Esophagitis