NCLEX Questions for Oncologic Disorders Answers and Rationale

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1.    Answer: B. Early detection of cancer is promoted by annual oral examination, monthly BSE from age 20, annual chest x-ray, yearly digital rectal examination for persons over age 40, annual Pap smear from age 40 and annual physical and blood examination. Letter B is wrong because it says Pap smear should be done yearly for sexually active women. All women should have an annual pap smear by age 40 and up whether sexually active or not.
2.    Answer: D. Halstead surgery also called radical mastectomy involves the removal of entire breast, pectoralis major and minor muscles and neck lymph nodes. It is followed by skin grafting. Removal of the entire breast, pectoralis major muscle and the axillary lymph nodes is a surgical procedure called modified radical mastectomy. Simple mastectomy is the removal of the entire breast but the pectoralis muscles and nipples remain intact.
3.    Answer: D. chemotherapy is contraindicated in cases of infection (chemotherapeutic agents are immunosuppressive), recent surgery (chemotherapeutic agent may retard the healing process), impaired renal and hepatic function (drugs are nephrotoxic and hepatotoxic), recent radiation therapy (immunosuppressive treatment), pregnancy (drugs can cause congenital defects) and bone marrow depression (chemo. Agents may aggravate the condition).
4.    Answer: A. The nurse should be corrected if she is only wearing mask and glove because gowns should also be worn in handling chemotherapeutic drugs. The vials should be vent after mixing to reduce the internal pressure. Air bubbles are expelled on wet cotton to prevent the spread of the chemotherapeutic agent particles.
5.    Answer: C.

6.    Answer: D. Unexplained sudden weight loss is a warning signal of cancer. Letter A is wrong because the sore in cancer does not heal. Nagging cough not dry cough and hoarseness of voice is a sign of cancer. Presence of lump is not limited to the breast only; it can grow elsewhere that is why letter C is wrong.
7.    Answer: B. TNM stands for tumor, node, and metastasis.
8.    Answer: B. This client needs further teaching as palpation in BSE should start at the periphery going to the center in a circular motion.
9.    Answer: C. Diarrhea not constipation is the side effect of radiation therapy.
10.    Answer: C. Radiation therapy makes the platelet count decrease. Thus, nursing responsibilities should be directed at promoting safety by avoiding episodes of hemorrhage or bleeding such as physical trauma and aspirin administration. Analgesics are given before meals to alleviate the pain caused by stomatitis. Bland diet and saline rinses every 2 hours should also be done to manage stomatitis.
11.    Answer: C. No soap should be used on the skin of the client undergoing radiation. Soap and irritants and may cause dryness of the patient’s skin. Only water should be used in washing the area.
12.    Answer A.  Metochlopramide (Metozol) – antiemetic. Succimer (Chemet) – chelating agent for lead poisoning. Anastrazole (Arimidex) – hormone regulator. Busulfan (Myleran) – alkylating agent
13.    Answer: A. The distance of at least 3 feet / 0.9 or 1 meter should be maintained when a nurse is not performing any nursing procedures.
14.    Answer: B. To promote safety to the personnel, the client will remain alone in the treatment room while the machine is in operation. The client may voice out any concern throughout the treatment because a technologist is just outside the room observing through a window or closed circuit TV. There is no residual radioactivity after radiation therapy. Safety precautions are necessary only during the time of actual irradiation. The client may resume normal activities of daily living afterwards.
15.    Answer C: Principles of Radiation protection follows the DTS system. Distance (D), Time (T) and Shielding (S). Distance – at least 3 feet should be maintained when a nurse is not performing any nursing procedures. Time – limit contact to 5 minutes each time. Shielding – use lead shield during contact with client.
16.    Answer: D. Hemorrhagic cystitis is the potentially fatal side effect of Cytoxan. Myeloma is an indication for giving this medication. Alopecia is a common side effect.
17.    Answer: D. Cytarabine syndrome includes fever, myalgia, bone pain, chest pain, rash, conjunctivitis and malaise. No diarrhea is included in this syndrome thus; letter D is the best choice.
18.    Answer: C. Steroids may be prescribed to promote relief from cytarabine syndrome. Allopurinol is given for hyperurecemia that will result from taking some chemotherapeutic agent.
19.    Answer: B. Fluorouracil (Adrucil) is an antimetabolite.
20.    Answer: B. Vincristine is a mitotic inhibitor
21.    Answer: B. Anstrazole (arimidex)- treatment of advanced breast cancer in post menopausal women following tamoxifen therapy. Estramustine (Emcyt) – palliative treatment of metastatic and progressive prostate cancer. Pclitaxel (Taxol) – treatment of ovarian cancer, breast cancer and AIDS related to Kaposi’s sarcoma. Irinotecan (Camptosar)- treatment of metastatic colon or rectal cancer after treatment with 5-FU.
22.    Answer: A. The client should prevent hot and spicy food because of the stomatitis side effect. The client should avoid people with infection but should not isolate himself in his room all the time. Fluid intake should be increased. Urine color change is normal.
23.    Answer B. Stage I – tumor size up to 2 cm. Stage II – tumor size up to 5 cm with axillary and neck lymph node involvement. Stage III – tumor size is more than 5 cm with axillary and neck lymph node involvement. Stage IV – metastasis to distant organs (liver, lungs, bone and brain).
24.    Answer A. Classic symptoms that define breast cancer includes:  Firm, nontender, nonmobile mass. Solitary, irregularly shaped mass. Adherence to muscle or skin causing dimpling effect. Involvement of the upper outer quadrant or central nipple portion. Asymmetry of the breasts. “Orange peel” skin. Retraction of nipple. Abnormal discharge from nipple.
25.    Answer: B. removal of the entire breast, pectoralis major muscle and the axillary lymph nodes is a surgical procedure called modified radical mastectomy. Simple mastectomy is the removal of the entire breast but the pectoralis muscles and nipples remain intact. Halstead surgery also called radical mastectomy involves the removal of entire breast, pectoralis major and minor muscles and neck lymph nodes. It is followed by skin grafting.

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