Oncology and Pain Jomel R. Mina, R.

Situation: Aling Nena is a 60 year old woman with a malignant tumor of the breast, who was admitted for modified radical mastectomy. 1. The physician has ordered 5 flourouracil, 700 mg IV once a week. When Aling Nena hears this, she says to the nurse, "Am I going to lose my hair?" Which is the best response by the nurse? a) 5-flourouracil usually does nit cause loss of hair b) hair loss can occur but a wig can be worn until your hair grows back c) the physician will prescribe a medication to prevent this side effect from occurring d) losing your hair is less traumatic than losing breast 2. Aling Nena is being assessed of her nutritional status. She weigh 100 lbs and is 5'8 ft. tall. Her assessment would include the following except: a) a diet history b) anthropometric measurements c) food preferences d) serum protein 3. Which nursing action would best attain the goal of providing and promoting coping for Aling Nena? a) telling Aling Nena for her strengths and progress b) planning experienced for her that are conclusive c) helping her to identify her problems and solutions d) giving her information on how to handle her problems

4. The nurse evaluates that zofran (ondansetron) is effective in a client undergoing chemotherapy if which of the following is observed? a) urine output is 1,500 ml/day b) the client can tolerate mechanically soft diet c) the client's anxiety is relieved d) the client was able to sleep 5. A client with cancer of the colon who is receiving chemotherapy tells a nurse that some foods on the metal tray taste bitter. The nurse would try ti limit which of the following foods that is most likely to cause this taste for the client? a) cantaloupe b) potatoes c) beef d) custard

6. A client suspected of having lung tumor is scheduled for a computerized tomography (CT) scan with dye injection. A nurse tells the client that a) the test may be painful b) the dye injected may cause a warm, flushing sensation c) fluids will be restricted following the test d) the test takes approximately 2 hours

7. Which of the following is a nursing responsibility for a client undergoing external radiation therapy? a) wear gown, gloves and mask b) observe time, distance, and shielding c) provide the client adequate rest and schedule activity d) place the client in isolation for few days 8. Who among these clients is at high risk to develop testicular cancer? a) the client has undescended testes at birth b) the client has human papilloma virus c) the client has recurrent urinary tract infection d) the client is uncircumcised 9. A nursing assistant is taking care of a patient who had undergone liver biopsy. When should the registered nurse intervene? a) when the nursing assistant monitors the patient's vital signs every 15 minutes for the 1st two hours after the procedure b) when the nursing assistant tells the patient to remain in bed for several hours c) when the nursing assistant positions the patient on the left side d) when the nursing assistant checks the biopsy site for bleeding 10. Which of the following is a risk factor to cancer of the colon? a) diabetes mellitus b) peptic ulcer c) abdominal hernia d) high fat, high calorie diet 11. Which of the following should the nurse assess prior to administration of cisplatin? a) hydration b) hemoglobin c) weight d) ECG 12. The client is receiving internal radiation therapy. What is the appropriate nursing action to minimize radiation contamination? a) put the soiled linens in double bag b) keep clients things close to her bedside c) always wear gloves when entering the client's room d) minimize contact with the client 13. A client is suspected of having pheochromocytoma. Which of the following signs and symptoms would help support this diagnosis? a) abdominal pain b) anuria c) hypertension d) weight gain 14. Before uterine radioactive implant is inserted, which of the following physician's orders does the nurse expect? a) administer analgesic b) administer sedative c) administer enema

d) administer antibiotic 15. The nurse is admitting a patient with jaundice, due to pancreatic cancer. Which of the following would the nurse give highest priority? a) body image b) nutrition c) skin integrity d) anticipatory grieving

16. a. b. c. d.

The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A Actinic Asymmetry Arcus Assessment

stand for?

17. Which of the following should the nurse include when providing health teachings for patients at risk of developing prostatic cancer? a) participate in smoking cessation program b) perform monthly self-testicular examination c) maintain daily walking exercise d) undergo monthly digital rectal examination 18. Which of the following questions should the nurse ask in a client who is at risk for breast cancer? a) does your family have a history of multiple gestation? b) does your family have a history of ovarian cancer? c) does your family have a history of early menopause? d) does your family have a history of late menarche?

19. A nurse has prepared a client for an intravenous pyelogram. The nurse determines that the client understands the procedure if the client states to expect which sensation during the procedure? a. nausea b. Difficulty of breathing c. cold clammy skin d. salty taste in the mouth 20. A client will be for uterine radium implant. Which of the following statement when made by the client indicates the need for further teaching? a) my sister is coming to stay with me today after implant insertion b) I will be in bed for the duration of the treatment c) I will have a foley catheter in place d) I will have enema before the procedure

21. Which of the following nursing actions is most appropriate when caring for a client with radium implant? a) wear gloves when entering the client's room b) wear masks and gloves when performing procedures to the client

c) avoid staying with the client for more than 30 minutes in a shift d) place client's soiled gowns and linens in a plastic bag

22. A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean? a. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis b. Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis c. Cant assess tumor or regional lymph nodes and no evidence of metastasis d. Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis

23. Which of the following are characteristics of a client most susceptible to develop malignant melanoma? a) dark skin, black hair b) coarse skin, black hair c) fair skin, blond hair d) oily skin, brown hair 24. Which of the following statements when made by the client with implant radiation therapy needs intervention by the nurse? a) I will have to go to the toilet to void b) my visitors are allowed to visit me for 30 minutes only in a day c) the nurse needs to wear a badge when caring for me d) I need to remain in bed during the entire duration of the treatment 25. Which of the following statements when made by the client with leukemia indicates that the client understands the health teachings given by the nurse? Select all that apply a) I am allowed to eat raw foods b) I have to avoid raw fruits and vegetables c) fresh flowers should not be allowed in my room d) if I developed joint pains, I should apply cold compress to the area e) if I developed high fever, I should take aspirin f) I am allowed to watch baseball games g) I should use soft-bristled toothbrush

26. A 40-year old woman is admitted to the hospital for a radiationimplant therapy to treat recently diagnosed cervical cancer. The most important consideration when planning care is her a) level of anxiety b) loss of income due to inability to work c) support system d) energy level to perform ADL's 27. When the nurse is discussing risk factors for cervical cancer, which of these women would be at greatest risk? a) a 25-year old woman with family history of cancer and using birth control pills b) a 50-year old woman who has several exposures to radiation and has chronic anemia c) a 19-year old woman who initiated sexual intercourse early with multiple partners d) a 60-year old woman who had smoked cigarettes for 5 years and used diaphragm for birth control

28. Which of the following nursing diagnoses would rank as the most important in the planning of care for a client in two weeks after the chemotherapy has begun? a) potential for infection b) activity intolerance c) impaired skin integrity d) self-esteem disturbance 29. During the administration of a chemotherapeutic drug, the nurse observes that there is a lack of blood return from the intravenous catheter. The priority action by the nurse would be to a) stop the administration of the drug immediately b) reposition the client's arm and continue with the administration of the drug c) apply a tourniquet to the patient's affected arm and notify the doctor d) continue to administer the drug and assess for edema at the IV site 30. A patient who is receiving chemotherapy develops stomatitis. Which of the following actions would be priority for the nurse to incorporate into the plan of care? a) rinse the patient's mouth with full strength hydrogen peroxide every 4 hours b) use a soft toothbrush after each meal c) provide hot tea with honey to soothe the patient's painful oral mucosa d) use dental floss only

31. Which of these findings in the breast of a patient who is suspected of having breast cancer would support the diagnosis? a) complaints of dull, achy, pain b) palpation of a mobile mass c) presence of an inverted nipple d) area of discoloration skin 32. A nurse is caring for a client with an internal radiation implant. Which of the following instructions is appropriate? a) allow the client to go to the bathroom b) avoid creams and lotions c) visitors are allowed to stay in the room d) the client should remain in bed during the entire duration of treatment 33. a. b. c. d. When caring for a male client diagnosed with a brain tumor of the parietal lobe, the nurse expects short-term memory impairment. tactile agnosia. seizures. contralateral homonymous hemianopia.

to assess:

34. The client is receiving internal radiation therapy. The nurse should a) remember to give the badge to the next-shift nurse

b) maintain a 30-minute close contact with the patient in a shift c) wear gloves, mask and gown when entering the client's room d) instruct relatives no to visit the client during the entire duration of the treatment

35. A nurse is assessing a client with metastatic breast cancer who reports nocturia, weakness, nausea and vomiting. The client's serum electrolytes include potassium 4.2 mEq/L, sodium 135 mEq/L, calcium 7.0 mEq/L, and magnesium 2.0 mEq/L. Based on the assessment findings, the priority action for the nurse is to: a) start client on fluid restriction b) administer calcium gluconate c) increase the client's IV fluids d) administer Allopurinol

36. The nurse on the oncology unit enters the room of the client with lung cancer. Which action is most appropriate for the nurse to do first? a) check the client's IV infusion pump and IV fluid rate b) take the client's blood pressure and pulse c) assess the client's mental status d) elevate the client's head of the bed

37. The nurse on the oncology unit is planning care for the client with colon cancer who is refusing a diagnostic test. Which action is most appropriate for the nurse to take first? a) call the radiology department to let them know the client will not be going to take the test b) speak with the client to determine the reason for refusing the test c) inform the health care provider that the client is refusing the test d) ask the client's spouse why the client is refusing the test

38. A nurse is caring for a patient with prostate cancer, all but one are signs of prostate cancer? a. Rectal pain b. Urinary incontinence c. Hematuria d. Low back pain

39. The nurse is caring for a client with a diagnosis of cancer who is immunosuppressed. The nurse would consider implementing neutropenic precautions if the client's white blood cell count was which of the following? a) 2,000 cells/mm3 b) 5,800 cells/mm3 c) 8,400 cells/mm3 d) 11,0 00 cells/mm3 40. A nurse is caring for a child after removal of a brain tumor. The nurse assesses the child for which of the following signs that would indicate that brainstem involvement occurred during the surgical procedure?

a) inability to swallow b) elevated temperature c) altered hearing ability d) orthostatic hypotension

41. The health education nurse provides instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which statement by a client indicates a need for further instructions? a) I will avoid sun exposure after 3 pm b) I will use sunscreen when participating in outdoor activities c) I will wear a hat, opaque clothing, and sunglasses when in the sun d) I will examine my body monthly for any lesions that may be suspicious 42. The client is undergoing radiation therapy to treat lung cancer. Following treatment, the nurse notes erythema on the client's chest and neck, and the client is complaining of pain at the radiation site. The nurse interprets this assessment data a(n): a) allergic reaction to the radiation b) superficial injury to tissue from the radiation c) cutaneous reaction to products formed by the lysis of the neoplastic cells d) ischemic injury, much like pressure ulcer formation. caused by pressure from the linear accelerator

43. The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cervical cancer. Which of the following, if identified by the client as a risk factor to cervical cancer, indicates a need for further teaching? a) smoking b) multiple sex partners c) first intercourse after age 20 d) annual gynecological examinations 44. The client is diagnosed as having a bowel tumor and several diagnostic tests are prescribed. The nurse understands that which test will confirm the diagnosis of malignancy? a) biopsy of tumor b) abdominal ultrasound c) magnetic resonance imaging d) computed tomography scan 45. The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder? a) increased calcium level b) increased white blood cells c) decreased blood urea nitrogen level d) decreased number of plasma cells in the bone marrow

46. The nurse is instructing the client to perform a testicular self-examination. The nurse tells the client: a) to examine the testicles while lying down b)that the best time for the examination is after a shower c) to gently feel the testicles with one finger to feel for a growth d) that testicular self-examinations should be done at least every 6 months

47. The client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention as the highest priority in the nursing plan of care? a) monitoring temperature b) ambulation three times daily c) monitoring the platelet count d) monitoring for pathological fractures

48. The nurse is monitoring the laboratory results of a client preparing to receive chemotherapy. The nurse determines that the white blood cell count is normal if which of the following results were present? a) 2000 to 5000 cells/mm3 b) 3000 to 8000 cells/mm3 c) 4,000 to 11,000 cells/mm3 d) 7000 to 15000 cells/mm3

49. The community health nurse is instructing a group of female clients about breast self-examination. The nurse instructs the clients to perform the examination: a) at the onset of menstruation b) every month during ovulation c) weekly at the same time of day d) 1 week after menstruation begins

50. The nurse is caring for a client who has undergone vaginal hysterectomy. The nurse avoids which of the following in the care of this client? a) elevating the knee on the bed b) assisting with range-of-motion leg exercises c) removal of antiembolism stockings twice a day d) checking placement of pneumatic compression boots

51. The client suspected of an ovarian tumor is scheduled for a pelvic ultrasound. The nurse provides which pre-procedure instruction to the client? a) eat a light breakfast only b) maintain an NPO before the procedure c) wear comfortable clothing and shoes for the procedure d) drink six to eight glasses of water without voiding before the test 52. A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder? a) altered red blood cell production b) altered production of lymph nodes c) malignant exacerbation in the number of leukocytes d) malignant proliferation of plasma cells within the bone

53. The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further teaching is needed if a nursing staff member states that which of the following is a characteristic of the disease? a) presence of Reed-Sternberg cells b) occurs most often in the older client c) prognosis depending on the stage of the disease d) involvement of lymph nodes, spleen, and liver 54. The community health nurse conducts a health promotion program regarding testicular cancer to community members. The nurse determines that further information needs to be provided if a community member states that which of the following is a sign of testicular cancer? a) alopecia b) back pain c) painless testicular swelling d) heavy sensation in the scrotum 55. The client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is: a) dyspnea b) diarrhea c) sore throat d) constipation

56. A male client has an abnormal result on a Papanicolaou test. After admitting, he read his chart while the nurse was out of the room, the client asks what dysplasia means. Which definition should the nurse provide? a. Presence of completely undifferentiated tumor cells that dont resemble cells of the tissues of their origin b. Increase in the number of normal cells in a normal arrangement in a tissue or an organ c. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isnt found d. Alteration in the size, shape, and organization of differentiated cells

57. A cervical radiation implant is placed in the client for the treatment of cervical cancer. The nurse initiates what most appropriate activity order for this client? a) bed rest b) out of bed ad lib c) out of bed in a chair only d) ambulation to the bathroom only

58. The client is hospitalized for insertion of an internal cervical radiationimplant. While giving care, the nurse finds the radiation implant in the bed. The initial action by the nurse is to: a) call the physician b) reinsert the implant into the vagina immediately c) pick up the implant with gloved hands and flush it down the toilet d) pick up the implant with long-handled forceps and place it in a lead container 59. The nurse is caring for a client experiencing neutropenia as a result of chemotherapy and develops a

plan of care for the client. The nurse plants to: a) restrict all visitors b) restrict fluid intake c) teach the client and family about the need for hand hygiene d) insert an indwelling urinary catheter to prevent skin breakdown 60. The nurse is reviewing the laboratory results of a client receiving chemotherapy whose platelet count is 10,000 cells/mm3. based on this laboratory value, the priority nursing assessment is which of the following? a) assess skin turgor b) assess temperature c) assess bowel sounds d) assess level of consciousness

61. The home health care nurse is caring for a client with cancer and the client is complaining of acute pain. The appropriate nursing assessment of the client's pain would include which of the following? a) the client's pain rating b) nonverbal cues from the client c) the nurse's impression of the client's pain d) pain relief after appropriate nursing intervention 62. The nurse is caring for a client who is a pelvic exenteration and thephysician changes the client's diet from NPO status to clear liquids. The nurse makes which priority assessment before administering the diet? a) bowel sounds b) ability to ambulate c) incision appearance d) urine specific gravity

63. The client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note specifically in the client? a) fatigue b) weakness c) weight gain d) enlarged lymph nodes 64. During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease? a) diarrhea b) hypermenorrhea c) abnormal bleeding d) abdominal distention

65. The nurse is reviewing the complications of conization with a client who has microinvasive cervical cancer. Which complication, if identified by the client, indicates a need for further teaching? a) infection b) hemorrhage

c) cervical stenosis d) ovarian perforation

66.When assessing the laboratory results of the client with bladder cancerand bone metastasis, the nurse notes a calcium level of 12 mg/dl. The nurse recognizes that this is consistent with which oncological emergency? a) hyperkalemia b) hypercalemia c) spinal cord compression d) superior vena cava syndrome 67. The client reports to the nurse that when performing testicular self-examination, he found a lump the size and shape of a pea. The appropriate response to the client is which of the following? a) lumps like that are normal, don't worry b) let me know if it gets bigger next month c) that could be cancer. I'll ask the doctor to examine you d) that's important to report even though it might not be serious

68. A 19-year-old college student reports to the health service with a sore throat, malaise, and fever of four days duration. Examination shows cervical lymphadenopathy and splenomegaly. Temperature is 103oF. Blood is positive for heterophil antibody agglutination test. The nurse knows thatinfectious mononucleosis is caused by a. Cytomegalovirus. b. Beta hemolytic streptococcus. c. Epstein-Barr virus. d. Herpes simplex virus I.

69. The nurse is caring for a client following mastectomy. Which assessment finding indicates that the client is experiencing a complication related to the surgery? a) pain at the incisional site b) arm edema on the operative side c) sanguineous drainage in the Jackson-Pratt drain d) complaints of decreased sensation near the operative side

70. The nurse is admitting a client with laryngeal cancer to the nursing unit. The nurse assesses for which most common risk factor for this type of cancer? a) alcohol abuse b) cigarette smoking c) use of chewing tobacco d) exposure to air pollutants

71. The female client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing: a) rupture of the bladder b) the development of a vesicovaginal fistula c) extreme stress caused by the diagnosis of cancer d) altered personal sensation as the side effect of radiation therapy 72. The client with leukemia is receiving busulfan (Myleran) and allupurinol (Zyloprim) is prescribed for the client. The nurse tells the client that the purpose of the allupurinol is to prevent: a) nausea b) alopecia c) vomiting d) hyperuricemia

73. The client receiving chemotherapy is experiencing mucositis. The nurse advises the client to use which of the following as the best substance to rinse the mouth? a) alcohol-based mouthwash b) hydrogen peroxide mixture c) lemon-flavored mouthwash d) weak salt and bicarbonate mouth rinse

74. The community nurse is conducting a health promotion program and the topic of the discussion relates to the risk factors for gastric cancer. Which risk factor, if identified by a client, indicates a need for further discussion? a) smoking b) a high-fat diet c) foods containing nitrates d) a diet of smoked, highly salted, and spiced food

75. A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. Which of the following is the appropriate nursing intervention? a) notify the physician b) measure abdominal girth c) irrigate the nasogastric tube d) continue to monitor the drainage 76. The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to colorectal cancer is necessary if the client identifies which of the following as an associated risk factor? a) age younger than 50 years b) history of colorectal polyps c) family history of colorectal cancer d) chronic inflammatory bowel disease 77. The nurse is performing an admission assessment on a client diagnosed with a right colon tumor. The nurse asks the client about which characteristic symptom of this type of tumor? a) rectal bleeding b) flat, ribbon-like stool c) crampy, colicky abdominal pain d) alternating constipation and diarrhea

78. The nurse is reviewing the preoperative orders of a client with a colon tumor who is scheduled for abdominal perineal resection and notes that the physician has prescribed neomycin (Mycifradin) for the client. The nurse determines that this medication has been prescribed primarily: a) to prevent immune dysfunction b) because the client has an infection c) to decrease the bacteria in the bowel d) because the client is allergic to penicillin 79. The nurse is assessing the perineal wound in a client who has returned from the operating room following an abdominal perineal resection and notes serosanguineous drainage from the wound. Which nursing intervention is most appropriate? a) notify the physician b) clamp the penrose drain c) change the dressing as prescribed d) remove and replace the perineal packing 80. The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which of the following assessment findings indicates that the colostomy is beginning to function? a) absent bowel sounds b) the passage of flatus c) the client's ability to tolerate food d) bloody drainage from the colostomy

81. The nurse is caring for a client following a radical neck dissection and creation of a tracheostomy performed for laryngeal cancer and is providing discharge instructions to the client. Which statement by the client indicates a need for further instructions? a) I will protect the stoma from water b) I need to keep powders and sprays away from the stoma c) I need to use an air conditioner to provide cool air to assist in breathing d) I need to apply a thin layer of petrolatum to the skin around the stoma to prevent cracking 82. What is the purpose of cytoreductive ("debulking") surgery for ovarian cancer? a) cancer control by reducing the size of the tumor b) cancer prevention by removal of precancerous tissue c) cancer cure by removing all gross and microscopic tumor cells d) cancer rehabilitation by improving the appearance of a previously treated body part

83. Hormone therapy is prescribed as the mode of treatment for a client with prostate cancer. The nurse understands that the goal of this form of treatment is to: a) increase testosterone levels b) increase prostaglandin levels c) limit the amount of circulating androgens d) increase the amount of circulating androgens 84. The nurse is caring for a client with cancer of the prostate following a prostatectomy. The nurse provides discharge instructions to the client and tells the client to: a) avoid driving the car for 1 week b) restrict fluid intake to prevent incontinence c) avoid lifting objects heavier than 20 lb for at least 6 weeks d) notify the physician if small blood clots are noticed during urination

85. The oncology nurse is providing a teaching session to group of nursing students regarding the risks and causes of bladder cancer. Which statement by a student indicates a need for further teaching? a) bladder cancer most often occurs in women b) using cigarettes and coffee drinking can increase the risk c) bladder cancer generally is seen in client older than 40 d) environmental health hazards have been attributed as a cause

86. The nurse is reviewing the history of a client with bladder cancer. The nurse expects to note documentation of which most common symptom of this type of cancer? a) dysuria b) hematuria c) urgency on urination d) frequency of urination 87. The nurse is caring for a client following intravesical instillation of an alkylating chemotherapeutic agent into the bladder for the treatment ofbladder cancer. Following the instillation, the nurse should instruct the client to: a) urinate immediately b) maintain strict bed rest c) change position every 15 minutes d) retain the instillation fluid for 30 minutes 88. The nurse is assessing the stoma of a client following a ureterostomy. Which of the following should the nurse expect to note? a) a dry stoma b) a pale stoma c) a dark-colored stoma d) a red and moist stoma 89. The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm? a) placing cool compresses on the affected arm b) elevating the affected arm on a pillow above heart level c) avoiding arm exercises in the immediate postoperative period d) maintaining an intravenous site below the antecubital area on the affected site 90. The nurse is preparing a client for a mammography. The nurse tells the client: a ) that mammography takes about 1 hour b) that there is no discomfort associated with the procedure c) to maintain an NPO status on the day of the test d) to avoid the use of deodorants, powders, or creams on the day of the test

91. A nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which of the following is an early sign of this oncological emergency? a) cyanosis b) arm edema c) periorbital edema d) mental status changes

92. A nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which of the following is a serious late sign of this oncological emergency? a) headache b) dysphagia c) constipation d) electrocardiographic changes

93. As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of the greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed when the client states: a) I should avoid blowing my nose b) I may need a platelet transfusion if my platelet count is too low c) I'm going to take aspirin for my headache as soon as I get home I will count the number of pads and tampons I use when menstruating 94. A client with carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which of the following may be prescribed? Select all that apply a) radiation b) chemotherapy c) increased fluid intake d) serum sodium levels e) decreased oral sodium intake f) medication that is antagonistic to antidiuretic hormone

95. The client has undergone mastectomy. The nurse interprets that the client is making the best adjustment to the loss of the breast if which of the following behaviors is observed? a ) participating in the care of the surgical drain b) reading the postoperative care booklet c) refusing to look at the wound d) asking for pain medication when needed

96. The client is preparing for discharge from the hospital after radical vulvectomy. The nurse plans to teach this client that which of the following activities is acceptable after discharge because it will no precipitate complications? a) sexual activity b) walking c) sitting for lengthy periods d) driving a car 97. The nurse has admitted a client to the clinical nursing unit following a modified right radical mastectomy for the treatment of breast cancer. The nurse plans to place the right arm in which of the following positions? a) elevated above shoulder level b) elevated on a pillow c) level with the right atrium d) dependent to the right atrium

98. The nurse instructs the client in breast self-examination (BSE). The nurse tells the client to lie down and to examine the left breast. The nurse instructs the client that while examining the left breast, she should place a pillow under the : a) right shoulder b) left shoulder c) small of the back d) right scapula 99. The nurse is teaching breast self-examination (BSE) to a client who has had a hysterectomy. The appropriate instruction regarding when the BSE should be performed is: a) 7 to 10 days after menses b) just before menses begins c) at ovulation time d) at a specific day of the month and on that same day every month thereafter 100. The 32 y/o female client has a history of fibrocyctic disorder of the breasts. The nurse interviewing the client asks whether the breast lumps are more noticeable: a) in the spring months b) in the autumn c) after menses d) before menses

101. The nurse is teaching the client who has had a laryngectomy for laryngeal cancer how to use an artificial larynx. The nurse tells the client to: a) insert the device into the tracheostomy b) hold the device alongside the neck c) hold the device over the upper d.)insert the device into the nose 102. A client is scheduled for a Papanicolaou (Pap) smear at the next scheduled clinic visit. The nurse provides instructions to the client regarding preparation for this test. The nurse tells the client that: a) the test can be performed during menstruation b) fluids are restricted on the day of the test c) the test is painless d) vaginal douching is required 2 hours before the test

103. The client has been hospitalized for a cervical implant. The implant is removed and the nurse provides home care instructions to the client. Which statement made by the client indicates a need for further instructions? a) cream may be used to relieve dryness or itching b) foul-smelling vaginal discharge is a sign of an infection c) sexual intercourse may be resumed after 7 to 10 months d) some vaginal bleeding is expected for 1 to 3 months

104. The nurse teaches skin care to the client receiving external radiation therapy. Which of the following statements, if made by the client, would indicate the need for further instruction? a) I will handle the area gently b) I will avoid the use of deodorants c) I will limit sun exposure to 1 hour daily d) I will wear loose-fitting clothing 105. A community health nurse is preparing a poster for educational session for a group of women and will be discussing the risk factors associated with breast cancer. Select the risk factors for breast cancer that the nurse will list on the poster. Select all that apply. a) family history of breast cancer b) early menarche c) early menopause d) previous cancer of the breast, uterus, or ovaries e) multiparity f) high-dose radiation exposure to chest

106. A nurse is preparing a list of home care instructions regarding stoma and laryngectomy care to a client who had a laryngectomy. Select all instructions that would be included in the list a) avoid swimming and use care when showering b) keep the humidity in the home low c) avoid exposure to people with infections d) restrict fluid intake e) obtain a Medic-Alert bracelet f) prevent debris from entering the stoma 107. A client suspected of having an abdominal tumor is scheduled for a computed tomography (CT) scan with dye injection. The nurse tells the client that: a) the test may be painful b) the dye injected may cause a warm, flushing sensation c) fluids will be restricted following the test d) the test takes approximately 2 hours

108. A client with liver cancer receiving chemotherapy tells the nurse that some foods on the meal tray taste bitter. The nurse would try to limit which food that is most likely to cause this taste for the client? a) beef b) potatoes c) custard d) cantaloupe 109. The community health nurse is conducting a breast cancer screening clinic in a local neighborhood and is providing sessions regarding breast self-examination (BSE). A postmenopausal woman arrives at the clinic for information on BSE. Which of the following information should the nurse give the client? a) it is not necessary to do BSE because you are postmenpausal b) you are not at risk for breast cancer because you are in thepostmenopausal phase c) you need to perform BSE on the same day of every month d) mammograms performed every 5 years are sufficient in thepostmenopausal phase 110. A community health nurse who is conducting a teaching session about the risks of testicular cancer

has reviewed a list of instructions regarding testicular self-examination (TSE) with the clients attending the session. Which statement by a client indicates a need for further instructions? a) TSE is performed once a month b) TSE should be performed on the same day of each month c) the scrotum is held in one hand and the testicle is rolled between the thumb and forefinger of the other hand d) it is best to do TSE first thing in the morning before a bath or shower

111. A chronic pain client reports to you, the charge nurse, that the nurse have not been responding to requests for pain medication. What is your initial action? a. Check the MARs and nurses notes for the past several days. b. Ask the nurse educator to give an in-service about pain management. c. Perform a complete pain assessment and history on the client. d. Have a conference with the nurses responsible for the care of this client 112. Family members are encouraging your client to tough it out rather than run the risk of becoming addicted to narcotics. The client is stoically abiding by the familys wishes. Priority nursing interventions for this client should target which dimension of pain? a. Sensory b. Affective c. Sociocultural d. Behavioral e. Cognitive 113. A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain? a. Amitriptyline (Elavil) b. Corticosteroids c. Methylphenidate (Ritalin) d. Lorazepam (Ativan) 114. Which client is most likely to receive opioids for extended periods of time? a. A client with fibrolyalgia b. A client with phantom limb pain c. A client with progressive pancreatic cancer d. A client with trigeminal neuralgia 115. As the charge nurse, you are reviewing the charts of clients who were assigned to a newly graduated RN. The RN has correctly charted dose and time of medication, but there is no documentation regarding non-pharmaceutical measures. What action should you take first? a. Make a note in the nurses file and continue to observe clinical performance b. Refer the new nurse to the in-service education department. c. Quiz the nurse about knowledge of pain management d. Give praise for the correct dose and time and discuss the deficits in charting. 116. In caring for a young child with pain, which assessment tool is the most useful? a. Simple description pain intensity scale b. 0-10 numeric pain scale c. Faces pain-rating scale d. McGill-Melzack pain questionnaire

117. In applying the principles of pain treatment, what is the first consideration? a. Treatment is based on client goals. b. A multidisciplinary approach is needed. c. The client must be believed about perceptions of own pain. d. Drug side effects must be prevented and managed. 118. Which route of administration is preferred if immediate analgesia and rapid titration are necessary? a. Intraspinal b. Patient-controlled analgesia (PCA) c. Intravenous (IV) d. Sublingual 119. When titrating an analgesic to manage pain, what is the priority goal? a. Administer smallest dose that provides relief with the fewest side effects. b. Titrate upward until the client is pain free. c. Titrate downwards to prevent toxicity. d. Ensure that the drug is adequate to meet the clients subjective needs. 10.In educating clients about non-pharmaceutical alternatives, which topic could you delegate to an experienced LPN/LVN, who will function under your continued support and supervision? a. Therapeutic touch b. Use of heat and cold applications c. Meditation d. Transcutaneous electrical nerve stimulation (TENS) 121.Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder. a. Morphine, hydromorphone, acetaminophen and lorazepam b. NSAIDs and corticosteroids c. Codeine, oxycodone and diphenhydramine _____, _____, _____ 122.Which client is at greater risk for respiratory depression while receiving opioids for analgesia? a. An elderly chronic pain client with a hip fracture b. A client with a heroin addiction and back pain c. A young female client with advanced multiple myeloma d. A child with an arm fracture and cystic fibrosis 123.A client appears upset and tearful, but denies pain and refuses pain medication, because my sibling is a drug addict and has ruined out lives. What is the priority intervention for this client? a. Encourage expression of fears on past experiences b. Provide accurate information about use of pain medication c. Explain that addiction is unlikely among acute care clients. d. Seek family assistance in resolving this problem. 124.A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal? a. Fever b. Nausea c. Diaphoresis d. Abdominal cramps

125.In caring for clients with pain and discomfort, which task is most appropriate to delegate to the nursing assistant? a. Assist the client with preparation of a sitz bath. b. Monitor the client for signs of discomfort while ambulating c. Coach the client to deep breathe during painful procedures d. Evaluate relief after applying a cold application. 126.The physician has ordered a placebo for a chronic pain client. You are newly hired nurse and you feel very uncomfortable administering the medication. What is the first action that you should take? a. Prepare the medication and hand it to the physician b. Check the hospital policy regarding use of the placebo. c. Follow a personal code of ethics and refuse to give it. d. Contact the charge nurse for advice. 127.For a cognitively impaired client who cannot accurately report pain, what is the first action that you should take? a. Closely assess for nonverbal signs such as grimacing or rocking. b. Obtain baseline behavioral indicators from family members. c. Look at the MAR and chart, to note the time of the last dose and response. d. Give the maximum PRS dose within the minimum time frame for relief. 128.Which route of administration is preferable for administration of daily analgesics (if all body systems are functional)? a. IV b. IM or subcutaneous c. Oral d. Transdermal e. PCA 129.A first day post-operative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take? a. Deliver the bolus dose per standing order. b. Contact the physician to increase the dose. c. Try non-pharmacological comfort measures. d. Assess the pain for location, quality, and intensity. 130.Which non-pharmacological measure is particularly useful for a client with acute pancreatitis? a. Diversional therapy, such as playing cards or board games b. Massage of back and neck with warmed lotion c. Side-lying position with knees to chest and pillow against abdomen d. Transcutaneous electrical nerve stimulation (TENS) 131.What is the best way to schedule medication for a client with constant pain? a. PRN at the clients request b. Prior to painful procedures c. IV bolus after pain assessment d. Around-the-clock 132.Which client(s) are appropriate to assign to the LPN/LVN, who will function under the supervision of the RN or team leader? (Choose all that apply.) a. A client who needs pre-op teaching for use of a PCA pump b. A client with a leg cast who needs neurologic checks and PRN hydrocodone c. A client post-op toe amputation with diabetic neuropathic pain d. A client with terminal cancer and severe pain who is refusing medication

133.For a client who is taking aspirin, which laboratory value should be reported to the physician? a. Potassium 3.6 mEq/L b. Hematocrit 41% c. PT 14 seconds d. BUN 20 mg/dL 134.Which client(s) would be appropriate to assign to a newly graduated RN, who has recently completed orientation? (Choose all that apply.) a. An anxious, chronic pain client who frequently uses the call button b. A client second day post-op who needs pain medication prior to dressing changes c. A client with HIV who reports headache and abdominal and pleuritic chest pain d. A client who is being discharged with a surgically implanted catheter 135.A family member asks you, Why cant you give more medicine? He is still having a lot of pain. What is your best response? a. The doctor ordered the medicine to be given every 4 hours. b. If the medication is given too frequently he could suffer ill effects. c. Please tell him that I will be right there to check of him. d. Lets wait about 30-40 minutes. If there is no relief Ill call the doctor. 136. A physiologic response to moderate pain is a. Increased blood pressure b. Restlessness c. Decreased pulse rate d. Protection of the painful area 137. Which statement reflects development of tolerance to opioids? Larger doses of opioids are needed to control pain than were needed several weeks earlier. Stimulants are needed to counteract the sedating effects of opioids. The patient becomes anxious about knowing the exact time of the next dose of opioid. The patient no longer experiences constipation from the usual dose of opioid. 138. The pain management nurse notices a male patient grimacing as he moves from the bed to a chair. The patient tells the nurse that he is not experiencing any pain. The nurse: clarifies the patient's report by stating the patient's nonverbal behavior. confronts the patient's denial of pain. obtains an order for pain medication from the physician. supports the patient's stoic behavior. 139. A focused exam for fibromyalgia includes assessment for: autonomic changes, peripheral neuropathy, and skin fold tenderness. morning fatigue, widespread body pain, and focal tenderness. skin rashes, edema, and constipation. unilateral weakness, hyperesthesia, and allodynia.

140. An 85-year-old male patient with a history of prostate cancer and metastasis to the lumbar spine is receiving current treatment of methadone (Dolophine) 10 mg 3 times a day. The patient is seen in the clinic for re-evaluation. The patient's wife tells the pain management nurse that her husband exhibits a lack of motivation, loss of appetite, and inability to get out of bed. The nurse initially focuses on the: assessment of pain. need for antidepressants. physical therapy evaluation. psychological evaluation. 141. The family of an older male patient is concerned that the patient's arthritic pain has increased and his pain medication is not working. When questioned by the pain management nurse, the patient states that he has no pain. A focused exam produces no evidence of a change in condition. The pain management nurse is uncertain that the patient's pain has increased. The nurse's next action is to: assess activities of daily living. call the health care provider for more pain medication. pursue a psychiatric evaluation. reassure the family that the patient's pain has not increased. 142. The pain management nurse is caring for a patient with paraplegia and central pain syndrome. In developing a self-care plan for pain management, the nurse assesses the patient's: ability to use an electronic wheelchair. confidence in managing pain. home environment for safety. understanding of nutritional diet habits. 143. A 35-year-old male patient with testicular cancer is conversing and joking while playing cards with his roommate. When assessed by the pain management nurse, the patient rates his pain as 7 on a numeric pain scale of 0 to 10. The nurse concludes that the patient's behavior: is an emotional reaction to the anticipated pain. is in anticipation of future pain. is more indicative of the need for pain medication than the pain rating. may be in conflict with the pain rating, and the report of pain should be accepted. 144. Which statement about the administration of acetaminophen to children is correct? Acetaminophen affects platelet aggregation. Acetaminophen causes gastric irritation. Acetaminophen does not have an analgesic ceiling. Acetaminophen has an analgesic ceiling. 145. Biofeedback is a therapy used to: develop psycho-physiologic self-regulation. enhance drug delivery. increase release of serotonin. promote neuronal regeneration.

146. An 86-year-old patient with chronic low back pain is being started on a new nonsteroidal antiinflamatory drug. The pain management nurse expects the starting dose to be: the usual recommended dose. 50% or less of the usual recommended dose. 75% of the usual recommended dose. 90% of the usual recommended dose. 147. When assessing a patient for possible side effects related to acetaminophen, the pain management nurse asks the patient about the use of: alcohol. marijuana. opioids. tobacco. 148. An older patient is discharged from the hospital with nortriptyline (Pamelor) for neuropathic pain. Which statement indicates the patient's need for additional education? I will chew sugarless gum and mints. I will drink carbonated beverages. I will take my medication at breakfast. I will use a humidifier at bedtime. 149. A 62-year-old woman is receiving sustained-release morphine (MS Contin) 15 mg twice a day for the management of pain. The pain management nurse knows that this patient understands the use of the medication when the patient says: I am going away on vacation next month and the doctor can just call my medication in to the pharmacy. I know I can take a few extra doses during the day if my pain gets really bad. I understand that by taking this medication, I am now an addict. I will make my next appointment a week before I need a refill on my prescription. 150. A 72-year-old man with severe scoliosis is undergoing staging procedures to straighten his neck. The physician ordered acetaminophen with codeine (Tylenol #3), 1 tablet by mouth every 6 hours as needed for pain. Two hours after receiving a Tylenol #3 tablet, the patient reports a neck pain neck which he rates as 8 on a numeric pain scale of 0 to 10. The nurse: calls the physician to increase the dose to 2 tablets. contacts the physician to discuss modifications to the treatment plan. explains to the patient that the next dose of analgesic is not due for 4 hours. immediately administers a second dose of Tylenol #3.