OCN Practice Tests 70 Questions with Verified Answers
A patient has the following laboratory values: white blood cell count 2100 mm3; neutrophils,
... [Show More] segmented 23%; neutrophils, band 6%; hemoglobin 8.9 g/dl; and, platelets 100,000 mm 3. The nurse's initial patient teaching includes:
A. washing hands frequently.
B. using an electric razor.
C. avoiding trauma.
D. taking daily stool softeners. - CORRECT ANSWER A. washing hands frequently
There are many nonpharmacologic interventions for the prevention of infection. Handwashing remains the single most important intervention to prevent infection.
A patient is receiving the first dose of paclitaxel. The nurse should be prepared to treat the patient for:
A. shaking chills.
B. projectile vomiting.
C. hypersensitivity reaction.
D. urinary retention. - CORRECT ANSWER C. hypersensitivity reaction
A side effect associated with paclitaxel is hypersensitivity reaction. Hypersensitivity is an exaggerated or inappropriate immune response that may be localized or systemic. Pretreatment to prevent the reaction includes administering cimetidine, diphenhydramine, and if not contraindicated, dexamethasone.
A patient who completed treatment for malignant melanoma one year ago complains of still feeling tired. The nurse anticipates an order for:
A. darbepoetin.
B. methylphenidate.
C. lorazepam.
D. pegfilgrastim. - CORRECT ANSWER B. methylphenidate
Psychostimulants such as methylphenidate have been tested in certain populations including patients with malignant melanoma as well as in patients with advanced cancer. Patients reported improvement in symptoms of cancer-related fatigue with the use of methylphenidate but it remains an area where more research is needed.
A patient receiving 10 mg of sustained-release oxycodone every 12 hours requires 5 mg of immediate-release oxycodone five to six times daily. The best adjustment in the pain medication regimen is to request an order for:
A. 5 mg of immediate-release oxycodone every 3 hours.
B. 10 mg of immediate-release oxycodone every 6 hours.
C. 10 mg of sustained-release oxycodone every 8 hours.
D. 30 mg of sustained-release oxycodone every 12 hours. - CORRECT ANSWER D. 30 mg of sustained-release oxycodone every 12 hours
The first sign that an increase in opioid dose is needed is a decrease in the duration of analgesia for a given opioid dose. Patients may report the need for an increased number of rescue doses. Sustained release doses plus immediate-release (rescue) doses should be calculated. When slight improvement in analgesia is needed, a 25% increase in opioid dose may be sufficient; for a moderate improvement, 50%; and for a strong effect, 100% increase may be needed.
A patient with prostate cancer is taking oxycodone orally every four hours as needed for pain. At a home visit, the nurse learns the patient is experiencing constant, dull back pain and he has not moved his bowels for three days. These symptoms most likely indicate:
A. ascites.
B. hypercalcemia.
C. impending spinal cord compression.
D. an adverse effect of the oxycodone. - CORRECT ANSWER C. impending spinal cord compression
Spinal cord compression may result from tumor invasion into the vertebrae causing a collapse on the spinal cord. Patients at high risk for cord compression include those with prostate cancer. Dull back pain is an early symptom of spinal cord compression.
Which terms are associated with malignant tumors originating in the epithelial tissue?
A. Osteo and chondra
B. Lympho and myelo
C. Adeno and squamous
D. Lipo and rhabdo - CORRECT ANSWER C. Adeno and squamous
Tumors are classified by the tissue of origin. The malignancies that arise from the epithelium are squamous cell, adenocarcinoma, basal cell, and choriocarcinoma.
The severe pain associated with post-herpetic neuropathy is most effectively treated by:
A. propoxyphene.
B. hydromorphone.
C. amitriptyline.
D. extra-strength acetaminophen. - CORRECT ANSWER C. amitriptyline.
Pain associated with herpes zoster is severe and can be debilitating. The pain is described as continuous, deep and burning. Opioids are used to treat acute herpes zoster. Tricyclic antidepressants are used to treat post-herpetic neuralgia.
An oncology nurse teaching a cancer biology class explains that a proto-oncogene's role is to:
A. stimulate angiogenesis.
B. cause apoptosis.
C. inhibit tumor growth.
D. promote cell division. - CORRECT ANSWER D. promote cell division
Proto-oncogenes promote the specialization and division of normal cells. A change in a proto-oncogenes genetic sequence can result in uncontrolled cell growth, ultimately causing the formation of a cancerous tumor. Proto-oncogenes can be transformed into oncogenes in three ways: point mutation (alteration of a single nucleotide base pair), translocation (in which a segment of the chromosome breaks off and attaches to another chromosome), or amplification (increase in the number of copies of the proto-oncogene).
Which of the following statements by a patient most likely indicates the need for further education about preventing infection?
A. I need to be very diligent about washing my hands after working in the garden.
B. I do not want to get an influenza shot until all my chemotherapy is finished.
C. I keep my wound dressing supplies in a closed storage container.
D. I will not permit my grandchildren to visit me if they are sick. - CORRECT ANSWER B. I do not want to get an influenza shot until all my chemotherapy is finished
Because a percentage of patients will achieve protection from the influenza vaccination and the risks for adverse effects are low, all patients with cancer and their household contacts should receive annual vaccination. NCCN recommends vaccination at least two weeks prior to cytotoxic or immunosuppressive. If this is not possible, patients can be vaccinated during treatment and revaccinated at least three months after therapy.
A 69-year-old patient who received chemotherapy seven days ago calls the nurse to report a temperature of 101°F (38.3°C) and lightheadedness. The nurse determines the patient is dyspneic and diaphoretic. The nurse's initial response is to instruct the patient to:
A. take acetaminophen.
B. recheck his temperature in two hours.
C. report to the emergency department.
D. call for an ambulance. - CORRECT ANSWER D. call for an ambulance.
The time at which chemotherapy exerts its maximum effect on the bone marrow and the white blood count reaches its lowest point is the nadir. This usually occurs within 7 to 10 days after administration. Patients are most susceptible to infections at this time due to neutropenia. In a neutropenic patient, infection may rapidly progress to sepsis, a systemic inflammatory response to microorganisms in the blood. Early signs of sepsis include fever, chills, and tachypnea. Patients over the age of 65 are at greater risk. Untreated sepsis can result in septic shock and death. Immediate reporting of symptoms and medical management is necessary.
A patient expresses anger about his diagnosis of cancer and the need to receive his first chemotherapy treatment. The nurse's best response is to:
A. initiate a referral to a social worker.
B. call the physician and ask for the treatment to be delayed.
C. explain to the patient that the doctor ordered treatment to start today.
D. suggest ways for the patient to participate in the treatment plan. - CORRECT ANSWER D. suggest ways for the patient to participate in the treatment plan.
Loss of personal control is perceived as lacking the ability to control events that affect life style and goals. Both disease and treatment are considered risk factors for a loss of personal control. Personal control can be maintained through verbalization of feelings and participation in care.
A patient with lymphoma reports persistent nausea, muscle cramps, weakness, and paresthesia of the fingers two days after receiving the first cycle of chemotherapy. The patient most likely is experiencing:
A. hypercalcemia.
B. tumor lysis syndrome.
C. disseminated intravasular coagulation.
D. syndrome of inappropriate antidiuretic hormone secretion. - CORRECT ANSWER B. tumor lysis syndrome
Tumor lysis syndrome involves a metabolic imbalance that occurs with the rapid release of intracellular potassium, phosphorus, and nucleic acid into the blood as a result of tumor cell kill. Early signs and symptoms of tumor lysis syndrome include the following: muscle cramps, weakness, nausea and vomiting, diarrhea, lethargy, and paresthesia.
During the initial evaluation of a patient, the treatment plan is outlined and includes amputation of the right leg. The patient begins to scream and cry, stating, "But I have small children. I need to be able to run, walk, and play with them." The nurse's best response is:
A. It sounds like you fear your treatment plan, tell me what you know about it.
B. Many patients feel better after they are fitted with a prosthesis.
C. If you do not receive the amputation, your chance of dying is great.
D. The psychiatric nurse will help you cope with the amputation. - CORRECT ANSWER A. It sounds like you fear your treatment plan, tell me what you know about it.
Anger as part of the mourning process often is felt most profoundly in those who experience disfiguring surgery, loss of body parts, and loss of control of the body. Nurses can address the underlying feelings with reflective statements. A reflective statement will help patients to gain control and focus on the real issues.
Which of the following is a complication that can occur after a percutaneous lung biopsy is performed?
A. Pleural effusion
B. Atelectasis
C. Pneumothorax
D. Pneumonia - CORRECT ANSWER C. Pneumothorax
A lung biopsy is performed by inserting a spinal type needle into the chest cavity to obtain tissue for examination. Air can be introduced into the chest cavity during the procedure and can cause a pneumothorax.
A survivor of colon cancer expresses his desire to change jobs. He is concerned that he will be unable to obtain health insurance at a new job due to his history of cancer. The nurse's best intervention is to:
A. encourage him to speak with his attorney.
B. refer him to a support group.
C. inform him about the Americans with Disabilities Act of 1990.
D. provide him with the phone number of the National Coalition of Cancer Survivorship. - CORRECT ANSWER C. inform him about the Americans with Disabilities Act of 1990.
Some survivors may avoid changing jobs because they fear the loss of health insurance. Survivors and their family members are protected at the workplace by the Americans with Disabilities Act (ADA). Cancer is considered a disability under the ADA. The act requires employers to treat all employees the same, including the provision of benefits. If insurance coverage is offered to all employees, it must be offered to the cancer survivor or the employer is in violation of the ADA.
It is important to assess attitudes about illness and care-seeking in a patient from different racial and ethnic groups in order to:
A. effectively change attitudes.
B. identify the socioeconomic status of the patient.
C. tailor treatment approaches to the individual patient.
D. determine where early interventions will be ineffective. - CORRECT ANSWER C. tailor treatment approaches to the individual patient.
The aim of transcultural nursing is to understand and assist diverse cultural groups with their nursing and health care needs. Assessing the cultural aspects of an individual's lifestyle, health beliefs, and health practices will enhance the nurse's decision making and judgment when providing care, thereby tailoring care to the individual.
A patient who does not speak English is eligible to participate in a phase II clinical trial. The patient's grandson wishes to translate to obtain informed consent. Which of the following actions would be most appropriate?
A. Allow the grandson to act as the interpreter.
B. Have an interpreter translate without the grandson present.
C. Have an interpreter translate with the grandson present.
D. Disallow the patient's participation because of the language barrier. - CORRECT ANSWER C. Have an interpreter translate with the grandson present
Without an interpreter present, obtaining an informed consent would be deemed inappropriate. The literal meaning of the communication may not be ensured when using a family member to interpret the information. It is recommended a professional interpreter be used to facilitate the process.
A patient newly diagnosed with cancer experiences restlessness, insomnia, diarrhea, heart palpitations, and irritability. The patient states he is nervous and jittery and requests something for nerves. The nurse's best response is to:
A. tell the patient that treatment will begin at once.
B. instruct the patient to ask the physician for a sedative.
C. assure the patient that his reaction is typical to a diagnosis of cancer.
D. ask the patient to further explain his feelings. - CORRECT ANSWER D. ask the patient to further explain his feelings
There are several risk factors that are related to the development of anxiety. Before treating anxiety, it is important to determine those situations that cause it. The nurse should help the patient to identify the situations that cause the anxiety.
While administering doxorubicin peripherally, a patient complains of itching at the infusion site. The nurse observes red streaking along the vein with a blood return. The nurse's initial response is to:
A. change the IV site.
B. continue administering the drug.
C. stop the infusion and instill an antidote.
D. stop the infusion and flush the line with saline. - CORRECT ANSWER D. stop the infusion and flush the line with saline.
A flare reaction is a local venous inflammatory response with subsequent histamine release manifested by streaking or red blotches along the vein, but without pain. If it is determined that the drug administered has not extravasated, then the infusion should stop and the line should be flushed with saline, while watching for resolution of the flare.
A patient with a history of cardiac disease is being evaluated for chronic leukemia. The patient reports tachycardia and dyspnea. A complete blood cell count with differential is obtained. Which of the following findings would most likely indicate the cause?
A. Hemoglobin level, 7.9 g/dl
B. Platelet count, 1000,000 mm3
C. White blood cell count, 2960 mm3
D. Absolute neutrophil count, 1700/mm3 - CORRECT ANSWER A. Hemoglobin level, 7.9 g/dl
Anemia is defined as a reduction in the normal concentration of hemoglobin (Hgb) or red blood cells in the blood. Severe anemia is defined as an Hgb level below 8 g/dl. Clinical signs of severe anemia include: tachycardia, dyspnea at rest, angina, headache, and dizzyness.
A patient with lung cancer is scheduled to receive her fourth dose of chemotherapy. The patient tells the nurse that she has begun to experience nausea when driving to her appointments. Which of the following types of nausea is the patient experiencing?
A. Acute
B. Delayed
C. Anticipatory
D. Breakthrough - CORRECT ANSWER C. Anticipatory
Patterns of nausea and vomiting range in etiology and duration. Acute nausea and vomiting occurs within several minutes to several hours after drug administration. Delayed nausea and vomiting develops after more than 24 hours after drug administration. Breakthrough nausea and vomiting occurs when preventative regimens fail. Anticipatory nausea and vomiting is a conditioned response that occurs prior to the administration of chemotherapy.
A patient with a history of ovarian cancer reports being bloated and feeling full and vomiting after eating small amounts of food. The patient has noticed a 10 pound weight gain over the last week and states she is eating less. The nurse instructs the patient to:
A. come to the clinic.
B. call if her ankles swell.
C. eat small, frequent meals.
D. report any further weight gain. - CORRECT ANSWER A. Come to the Clinic
The incidence of bowel obstruction is reported between 5.5% and 42% of patients with ovarian cancer. Signs and symptoms of bowel obstruction depend on the location of the obstruction, and include vomiting, distention, colicky pain, and diarrhea. Medical treatment of an intestinal obstruction consists of relieving the distention, correcting the fluid imbalances, and removing the source of the obstruction.
During counseling, a patient with breast cancer asks the nurse, "After I finish chemotherapy, how long should I wait to get pregnant?" The nurse's best response is:
A. "Infertility is a permanent side effect of your therapy."
B. "Pregnancy will increase your chance of recurrence."
C. "You should wait at least one year."
D. "No delay in necessary." - CORRECT ANSWER C. "You should wait at least one year."
There appears to be no decrease in survival for women who become pregnant following treatment. Further pregnancy may actually protect against recurrence. For those desiring future pregnancies, it is recommended to wait one to five years following cessation of all treatment.
The nurse informs a patient that a required premedication may cause drowsiness. The patient requests that treatment be delayed so he can be alert enough to pray at sunset. The nurse should:
A. assess to determine if a delay is permissible.
B. inform that the treatment cannot be delayed.
C. require that a waiver be signed to delay treatment.
D. delay the treatment for 24 hours. - CORRECT ANSWER A. assess to determine if a delay is permissible
Nursing should support spiritual or cultural practices that are not detrimental to the patient's health.
Which of the following actions must be performed first when developing an educational program?
A. Formulate criteria for evaluation
B. Select educational methods
C. Assess learning needs
D. Determine educational objectives - CORRECT ANSWER C. Assess learning needs
The initial key component in the nursing process when developing an educational program is to obtain a thorough assessment of learning needs. This is the first step in determining educational objectives, selecting educational methods, and then formulating criteria for evaluation.
The adult children of a patient who has just died approach the nurse expressing feelings of sadness, helplessness, and numbness. The nurse can provide support to this family by:
A. encouraging a family conference.
B. validating needs for counseling for these feelings.
C. encouraging discussion with the physician.
D. validating these as normal feelings of grief. - CORRECT ANSWER D. Validating these as normal feelings of grief.
Grief is a normal and expected reaction to a loss. Family members will grieve the loss of their loved ones. Nurses need to validate as normal the manifestations that the bereaved experience. Normal manifestations of grief include: sadness, anger, guilt, anxiety, loneliness, fatigue, helplessness, yearning, emancipation, relief, and numbness.
When assessing the level of pain, the primary source of information is the patient's:
A. vital signs.
B. self-report.
C. medical diagnosis.
D. current pain medications. - CORRECT ANSWER B. Self Reporting
Guidelines for cancer pain treatment from the Agency for Health Care Policy and Research, the American Pain Society, the National Comprehensive Cancer Network, and the World Health Organization (WHO) all use assessment of pain intensity through patient report as the most important consideration in determining treatment.
Palliative care is focused on the patient and family to:
A. preserve the patient's life based solely on clinical technology and scientific advances.
B. provide relief from suffering only during the last six months of life expectancy.
C. treat each patient uniformly to meet his or her needs, expectations, and cultural beliefs.
D. attend to the needs of those who love and care for the dying person. - CORRECT ANSWER D. attend to the needs of those who love and care for the dying person.
Palliative care is focused on the patient and family to attend to the needs of those who love and care for the dying person. The patient and family are supported through the active dying phase, and survivors are provided with bereavement resources following the patient's death.
Long-term exposure to radon has been associated with which of the following cancers?
A. Colorectal
B. Lung
C. Bladder
D. Breast - CORRECT ANSWER B. Lung
Research confirms a link between radon exposure and lung cancer. There is no documented link between radon and colorectal, bladder, or breast cancer.
A patient receiving thalidomide is requesting an adjunct treatment option for neuropathy. Based on current evidence, the nurse suggests:
A. fish oil.
B. acupuncture.
C. lamatrigine.
D. glutathione. - CORRECT ANSWER B. acupuncture
Evidence-based research reports that a treatment option for neuropathy incudes the use of acupuncture as an effective adjunct treatment.
Nursing interventions for the management of nausea include encouraging patients to:
A. use sauces and gravies.
B. eat foods that are cold or at room temperature.
C. eat high-protein and high-potassium foods.
D. avoid brushing their teeth when they are nauseated - CORRECT ANSWER B. eat foods that are cold or at room temperature
Nausea may be caused by cancer treatment or the disease itself. In addition to pharmacological management, patients should be taught self-care strategies to minimize nausea, such as consumption of foods that are cold or at room temperature. The smells from hot foods many increase nausea.
Prostate cancer most frequently metastasizes to the:
A. bone.
B. brain.
C. liver.
D. lung. - CORRECT ANSWER A. bone
The most common site of metastasis in prostate cancer is the bone. Rare sites of metastatic spread include the liver and lungs.
An abnormal finding on the third postoperative day following a bowel resection with a colostomy for colon cancer is:
A. a dull, gray stoma.
B. a moist, bright pink stoma.
C. slight bleeding from the stoma.
D. air in the ostomy appliance. - CORRECT ANSWER A. a dull, grey stoma
A healthy stoma should be reddish-pink and moist. A gray colored stoma indicates lack of blood flow, ischemia, or necrosis, and should be immediately reported to the physician.
Which of the following is prescribed for a patient diagnosed with surgically unresectable renal cell carcinoma that has metastasized to the liver?
A. Fluorouracil
B. Temsirolimus
C. Nilotinib
D. Cetuximab - CORRECT ANSWER B. temsirolimus
About 30% of individuals with renal cell cancer present with metastasis at the time of diagnosis. Chemotherapy has not demonstrated a response in renal cell carcinoma, but various biological therapies have, including temsiroliums.
A patient receiving doxorubicin through a peripheral IV catheter reports burning at the site, but there is no notable swelling. The nurse's first action is to:
A. stop the administration of the drug.
B. flush with 10ml of 0.9% normal saline.
C. reposition the patient's arm.
D. continue the administration while observing the site. - CORRECT ANSWER A. stop the administration of the drug.
Doxorubicin is a vesicant, meaning it can cause tissue damage. Pain and burning at the IV site is an immediate manifestation of extravasation. Administration of the drug should be stopped at the first sign of infiltration.
When considering general principles of rehabilitation in a patient with cancer, the nurse should:
A. focus on disabilities.
B. develop group goals.
C. emphasize capabilities.
D. encourage more frequent rest periods. - CORRECT ANSWER C. emphasize capabilities
General principles of rehabilitative care include the emphasis of function versus dysfunction, and capability versus disability. Then, it should include a balance of activity and rest as well as provide an environment conducive to encouraging rehabilitative efforts. In addition, rehabilitation is an individual process with a focus on the value of independence.
A patient with lymphoma reports numbness in the feet, weakness when ambulating and dribbling urine. The nurse suspects:
A. type I diabetes.
B. spinal cord compression.
C. peripheral neuropathy.
D. hormonal disruption. - CORRECT ANSWER B. spinal cord compression
Lymphoma is a risk for spinal cord compression. Classic signs include leg weakness (one or both) that may include loss of sensation, and the possibility of urinary or bowel incontinence.
A patient with stage I non-small cell lung cancer has impaired pulmonary function. The nurse anticipates the treatment of choice will be:
A. platinum-based chemotherapy.
B. external beam radiation.
C. lobectomy.
D. pneumonectomy. - CORRECT ANSWER B. external beam radiation
Patients who are not surgical candidates due to impaired lung function or other comorbid conditions can receive radiation therapy, which can be curative in some patients with stage I or II disease.
A patient scheduled for chemotherapy complains of shortness of breath, fatigue, and facial swelling. Physical assessment reveals neck vein distention, edema of the hands, tachycardia, and cyanosis. The nurse calls the physician and instructs the patient to:
A. sit up and anticipates an order for a chest x-ray.
B. lie flat and prepares the patient for an echocardiogram.
C. lie flat and prepares the patient for a thoracostomy.
D. sit up and begins the chemotherapy infusion. - CORRECT ANSWER A. sit up and anticipates an order for a chest-x-ray
Cancer is the predominant etiology for superior vena cava syndrome. Superior vena cava syndrome refers to signs and symptoms that occur when blood flow through the superior vena cava is compromised, resulting in venous congestion proximal to the occlusion and restricted cardiac output. Patients are frequently anxious and relief of symptoms is important. Many are orthopneic and most comfortable when sitting up. A chest x-ray will be positive in approximately 80-85% of cases, and will be the first diagnostic measure.
A patient with colon mesothelioma is scheduled for chemotherapy to be administered in the peritoneal space. The nurse expects the patient to have which type of access for this treatment?
A. Ommaya reservoir
B. Peripherally inserted central catheter
C. Implanted, large diameter silicone port
D. Arterial catheter - CORRECT ANSWER C. implanted, large diameter silicone port
Intraperitoneal catheters or implanted ports are the type of devices indicated for delivery of high concentrations of chemotherapy to disease in the peritoneal cavity. Client selection criteria includes patients with metastatic cancer into the abdomen and peritoneum; diagnosis of cancers of the ovary or colon mesotheliomas; or malignant ascites.
After a physician discusses the need for a descending colostomy with a patient who has colorectal cancer, the nurse informs the patient that the stoma site will be located:
A. just below the waistline.
B. in the right upper quadrant.
C. in the right lower quadrant.
D. in the left lower quadrant. - CORRECT ANSWER D. In the left lower quadrant
The location of a transverse colostomy is just below the waistline. An ascending colostomy is located in the right upper quadrant. A sigmoid colostomy is located in the right lower quadrant. The descending colostomy is located in the left lower quadrant.
In addition to decreasing inflammation, corticosteroids:
A. improve muscle tone.
B. stimulate weight loss.
C. stimulate the appetite.
D. reduce anxiety. - CORRECT ANSWER C. stimulate the appetite
Corticosteroids, such as dexamethasone and prednisone can stimulate the appetite. Additionally, this class of medications can create a sense of well-being, and may cause weight gain.
A patient is ordered opiates around the clock for pain control. Prior to initiating opioid therapy, the nurse anticipates an order for:
A. bulk laxatives.
B. suppositories.
C. stimulant laxatives.
D. oral mineral oil. - CORRECT ANSWER C. stimulant laxatives
Opioids can delay gastric emptying, slow bowel motility, decrease peristalsis, and reduce secretions from the colonic mucosa. Constipation is the most common side effect of opioids and the only one for which individuals do not develop tolerance. Prevention, rather than treatment, of opioid side effects is important. Stimulant laxatives plus a stool softener is recommended when initiating opioid therapy.
In order to assist in resolving the patient's spiritual pain during end-stage disease, the priority nursing intervention is to:
A. encourage random reflection of life events.
B. mobilize the patient's support system.
C. acknowledge the legitimacy of the patient's pain.
D. encourage the patient to avoid focusing on the issues. - CORRECT ANSWER C. acknowledge the legitimacy of the patient's pain
Spirituality, a part of every human being, is the connection to self , others, the environment, and a "higher power". Clients who have been alienated from their religious or spiritual community may suffer from spiritual distress. Acknowledge the client's spiritual pain, encourage verbalization, and use a family genogram to elicit relationships, fears, hopes, and unfinished business.
An example of adaptive or specific immunity is:
A. inflammatory response.
B. acute-phase protein production.
C. large lymphocyte production.
D. cell-mediated response. - CORRECT ANSWER D. cell-mediated response
An example of adaptive or specific immunity is cell-mediated immunity. Cell-mediated immunity is mediated by T-cells and their cytokine products. This type of immunity does not involve an antibody.
A patient with acute lymphoid leukemia experiences hyperkalemia, hyperphosphatemia, and hypocalcemia within a week of initiating chemotherapy. These symptoms are most likely indicative of:
A. disseminated intravascular coagulation.
B. syndrome of inappropriate antidiuretic hormone.
C. septic shock.
D. tumor lysis syndrome. - CORRECT ANSWER D. tumor lysis syndrome
Tumor lysis syndrome is common in acute lymphocytic leukemia. Metabolic abnormalities associated with tumor lysis syndrome are hyperkalemia, Hyperuricemia, hyperphosphatemia, and hypocalcemia.
A nurse mistakenly administers a long-acting morphine tablet instead of the prescribed long-acting oxycodone. What is the nurse's next step?
A. Continue to monitor the patient closely for the next eight hours.
B. Hold all further medications for the patient.
C. Notify the patient and physician of the error.
D. Call the risk management department to guide documentation. - CORRECT ANSWER C. Notify the patient and physician of the error.
When errors occur that could cause a possible injury to the patient, explanation of the error and possible long and short term effects should be explained. It is important that the nurse offer full disclosure of the event, and the steps to be taken.
A 21-year-old patient recently withdrew from college classes secondary to cancer recurrence. His parents report that the patient is moody and is no longer seeing friends and classmates. The nurse initiates strategies aimed at achieving which of the following patient outcomes?
A. Participation in a clinical trial
B. Maintenance of open communication
C. Re-enrollment in college courses
D. Recognition of self-destructive behaviors - CORRECT ANSWER B. Maintenance of open communication
Providing open communication between the patient and parents facilitates support and validation of feelings.
To reduce the risk of complications from thrombocytopenia, patients are taught to avoid:
A. using a soft-bristled toothbrush.
B. getting a haircut.
C. consuming high-fiber foods.
D. walking barefoot. - CORRECT ANSWER D. walking barefoot
Thrombocytopenia is a decrease in the number of circulating platelets below 100,000/mm3. Interventions to minimize the occurrence of bleeding include encouraging the patient to wear shoes during ambulation to maintain skin integrity and avoid injury.
A patient in remission complains of dysthymic behaviors for the past several weeks. The nurse knows to assess for:
A. recurrence of disease.
B. cognitive learning.
C. bowel habits.
D. depression. - CORRECT ANSWER D. depression
Evidence suggests 25% of people with cancer have depression, and depressed people have poorer outcomes. Therefore, nurses need to assess for depression.
Initial treatment of a patient in early septic shock includes the administration of:
A. vasopressors.
B. IV antibiotics.
C. IV antifungals.
D. high-dose corticosteroids. - CORRECT ANSWER B. IV antibiotics
The hallmark of progressive septic shock is profound hypotension. The goals of treatment are to maintain blood pressure and tissue perfusion while treating underlying pathogens. Broad-spectrum antibiotics should be initiated within one hour of drawing blood cultures. The choice of empiric antibiotic therapy is based on the suspected site of infection and most likely causative pathogen.
A patient has signed a consent form prior to beginning chemotherapy, and has questions regarding treatment. The nurse:
A. addresses the patient's concerns prior to initiating treatment.
B. asks the healthcare provider to discuss the treatment with the patient.
C. ensures that the consent is signed and begins the treatment.
D. begins administration while discussing the treatment with the patient. - CORRECT ANSWER A. addresses the patient's concerns prior to initiating treatment
As a patient advocate, the nurse should encourage the patient to ask questions and provide the patient with information needed to make decisions. Informed consent involves ensuring a thorough understanding of the treatment by a patient and includes the right to withdraw consent at anytime. One of the roles of the nurse in the informed consent process is to reinforce and clarify info already presented.
The first step in using evidence-based practice in the oncology clinical setting is to:
A. use a medical practice model to define the problem.
B. define a patient outcome prior to conducting a literature search.
C. incorporate changes into the plan of care to evaluate the outcome.
D. assess the patient's needs to define the problem. - CORRECT ANSWER D. assess the patient's needs to define the problem
Translating evidence into practice requires assessing patient needs, identifying appropriate resources, and selecting interventions. Practices based upon strong evidence are used to enhance and support quality patient care.
A survivor of breast cancer tearfully states, "I knew lymphedema could happen, but I never thought it would happen to me." The nurse's priority intervention is to:
A. allow the patient to express her feelings.
B. assure the patient that the lymphedema will resolve quickly.
C. take a recent history to identify the cause of the lymphedema.
D. teach the patient ways to reduce the risk of recurrence of the lymphedema. - CORRECT ANSWER A. allow the patient to express her feelings
Because the impact of disease upon body image is closely bound to psychological symptoms and the physical effects of the illness and its treatment, nurses must be able to address body image dysfunction with timely interventions. An appropriate intervention is to acknowledge the patient's loss and encourage her expression.
A patient receiving interleukin-2 has persistent fever and chills and an absolute neutrophil count of 1500/mm 3. The nurse knows that these symptoms represent:
A. tumor lysis syndrome.
B. a viral infection.
C. a drug-induced reaction.
D. septic shock. - CORRECT ANSWER C. a drug-induced reaction
Interleukin-2's effectiveness is based on stimulation of the host's own cytotoxic, immunological response. The most common side effect occurring with all methods of interleukin-2 administration is flu-like symptoms.
A patient newly diagnosed with prostate cancer states, "I have quit going to all my community activities since my diagnosis." The nurse's best initial response is:
A. "It is a good idea to concentrate on your disease."
B. "Your friends could hinder your coping with your diagnosis."
C. "When you complete your treatments, you can return to your activities."
D. "Tell me which activities you enjoyed before beginning treatments." - CORRECT ANSWER D. "Tell me which activities you enjoyed before beginning treatments"
Successful adjustment to living with cancer is characterized by the ability to minimize disruptions to established social roles, regulate the experience of emotional distress, and maintain active engagement in meaningful life activities. Interventions aimed at promoting a successful adjustment include the opportunity to safely discuss thoughts and feelings with an attentive, empathetic, and professional listener.
A patient is to begin temozolomide. The nurse instructs the patient that:
A. nausea and vomiting are uncommon side effects.
B. weekly monitoring of urine for protein is necessary.
C. diarrhea is a common side effect.
D. neutropenia occurs 22 to 29 days after completion. - CORRECT ANSWER D. neutropenia occurs 22 to 28 days after completion
The dose-limiting toxicities of temozolomide are leukopenia and thrombocytopenia. These toxicities are not cumulative. Nadir counts occur late in the treatment cycle, generally between days 22 and 29 and recover in 14 days.
Which of the following ethnic groups in the United States has the highest incidence and mortality for prostate cancer?
A. Asian American
B. African American
C. Hispanic American
D. Non-Hispanic Caucasian - CORRECT ANSWER B. African America
Prostate cancer is the most commonly diagnosed solid tumor in American males. African American males have the highest incidence; with mortality rates twice that for Caucasian males in the United States.
A patient with cancer who is taking opioids for pain complains of pruritus. This may be managed with:
A. nonsteroidal anti-inflammatory agents.
B. antihistamines.
C. antipyretics.
D. selective serotonin reuptake inhibitors. - CORRECT ANSWER B. antihistamines
Pruritus, or itching, is a commonly reported side effect of opioids taken systemically. This is often causes by release of histamine, and can be accompanied by flushing. Administration of antihistamines may be helpful in managing this side effect.
A 20-year-old woman with a family history of BRCA1 and BRCA2 breast cancer asks when she should have a mammogram. The nurse recommends:
A. talking with her doctor about the benefits and limitations of starting screening early.
B. having a yearly mammogram beginning at the age of 35.
C. having a breast ultrasound after the birth of her first child.
D. screening to begin at the age of her family member's diagnosis. - CORRECT ANSWER A. talking with her doctor about the benefits and limitations of starting screening early.
Yearly mammograms are recommended starting at age 40. Women at increased risk (e.g., family history, genetic tendency, past history of breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests, or having more frequent exams.
A patient with testicular cancer who is scheduled for a unilateral orchiectomy asks the nurse about reproduction. The nurse responds with the understanding that he is likely to have:
A. no change in fertility.
B. 50% reduction in fertility.
C. oligospermia.
D. azoospermia. - CORRECT ANSWER A. no change in fertility
The loss of one testicle does not alter fertility in a person with cancer who undergoes a unilateral orchiectomy for testicular cancer.
A patient newly diagnosed with cancer tells the nurse, "The doctor ordered all of these tests for clinical staging. What does that mean?" The nurse's best response is based on the knowledge that staging:
A. predicts response to treatment.
B. compares treatment results across populations.
C. assesses the usual patterns of spread of specific cancers.
D. evaluates the extent of local and potential metastatic disease. - CORRECT ANSWER D. evaluates the extent of local and potential metastatic disease.
The primary purpose for staging is to provide optimal treatment selection and planning for each individual patient. Staging systems include clinical, surgical, pathology and biochemical determinants to define the extent of disease and direct treatment of the individual. Staging does not directly predict response to treatment, assess patterns of spread, nor compare results across a population.
A patient with small cell lung cancer has a four-pound weight gain, headache, and excessive thirst. These symptoms indicate:
A. tumor lysis syndrome.
B. hemolytic uremic syndrome.
C. neoplastic cardiac tamponade.
D. syndrome of inappropriate antidiuretic hormone. - CORRECT ANSWER D. syndrome of inappropriate antidiuretic hormone
Small cell lung cancer accounts for 80% of syndrome of inappropriate antidiuretic hormone syndrome (SIADH) cases. Signs and symptoms include thirst, weight gain, lethargy, headache, anorexia, muscle cramps, and weakness.
A 62-year-old patient with CD33-positive acute myeloid leukemia in first relapse presents with a left ejection fraction of 40%. The nurse anticipates an order for:
A. gemtuzumab ozogamicin.
B. all-trans retinoic acid.
C. cytarabine.
D. rituximab. - CORRECT ANSWER A. gemtuzumab ozogamicin
Gemtuzumab ozogamicin is used for the treatment of relapsed CD33-positive acute myeloid leukemia in patients greater than or equal to 60 years of age, who would not be considered candidates for cytotoxic chemotherapy.
Which of the following medications can cause increased sedation when administered with opioids?
A. Chlorpromazine
B. Ibuprofen
C. Naloxone
D. Prednisone - CORRECT ANSWER A. Chlorpromazine
Phenothiazines can potentiate the sedative effects of opiates. Nonsteriodal anti-inflammatory agents (NSAIDs) such as ibuprofen do not cause sedation. Naloxone antagonizes opioids, and prednisone can cause hyperexcitability and insomnia.
A patient recently diagnosed with liver cancer presents with mild ascites and complaints of early satiety and bloating. Which of the following increases the risk of developing malignant ascites?
A. Diabetes
B. Diverticulitis
C. Renal disease
D. Pulmonary disease - CORRECT ANSWER C. Renal disease
Patients at risk for developing malignant ascites include those with primary tumors of the liver and comorbid conditions such as renal and cardiac disease.
An 85-year-old patient's physician recommends major surgery and chemotherapy for his cancer. His family advocates palliative care. The patient asks the nurse to help him decide what to do. The most appropriate initial nursing action would be to:
A. help the patient to complete an advance directive.
B. support and document the family's preference.
C. assess the patient's values and basis for his preference.
D. consult the hospital ethics committee. - CORRECT ANSWER C. assess the patient's values and basis for his preference
The initial key component in the nursing process when evaluating psychosocial issues is to obtain a thorough assessment. This should include presence of risk factors, pattern of emotional distress, and perceptions as well as understanding of his situation.
A patient receiving hospice care is refusing to take prescribed opiates and tells the nurse "pain is a part of life." The initial step the nurse takes is to:
A. explore the meaning of pain with the patient.
B. refer the patient to the chaplain.
C. schedule a visit with a CanSurmount volunteer.
D. request an evaluation from the pain service. - CORRECT ANSWER A. explore the meaning of pain with the patient
It is useful to assess the meaning of the pain to the patient and family. Pain may be perceived as a punishment, and the nurse needs to help reframe this perception to provide comfort.
A patient with lymphedema is seen in the outpatient clinic and reports using reflexology to improve circulation in the affected arm. The nurse's best response is:
A. "This method has shown promise in clinical trials."
B. "Can you give me more information on this technique?"
C. "Your lymphedema will subside over time."
D. "I recommend that you use only the compression sleeve." - CORRECT ANSWER B. " Can you give me more information on this technique"
Encourage open communication about conventional therapy options and complementary or alternative medicine. Support an informal dialogue initiated by nurses, clients, and/or their families. Success depends upon building rapport, ensuring a culturally sensitive and nonjudgmental social and professional environment.
Following surgery for cancer, a patient has been told that adjuvant chemotherapy is needed. The nurse explains that adjuvant chemotherapy refers to:
A. immunotherapy used to boost the body's immune system.
B. drugs given to target minimal disease or micrometastases.
C. investigational drugs used in combination with surgery.
D. regimens given to patients who cannot tolerate aggressive therapies. - CORRECT ANSWER B. drugs given to target minimal disease or micrometastases
Adjuvant therapy follows a primary treatment modality such as surgery or radiation. The primary goal of adjuvant chemotherapy is the use of chemotherapy to target any minimal disease or micrometastases for those at risk. [Show Less]