NCLEX Practice Exam for Oncology 1

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1. A female client has an abnormal result on a Papanicolaou test. After admitting, she read his chart while the nurse was out of the room, the client asks what dysplasia means. Which definition should the nurse provide?

  1. Presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin
  2. Increase in the number of normal cells in a normal arrangement in a tissue or an organ
  3. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn’t found
  4. Alteration in the size, shape, and organization of differentiated cells

2. For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client?

  1. “Client verbalizes feelings of anxiety.”
  2. “Client doesn’t guess at prognosis.”
  3. “Client uses any effective method to reduce tension.”
  4. “Client stops seeking information.”

3. A male client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which “related-to” phrase should the nurse add to complete the nursing diagnosis statement?

  1. Related to visual field deficits
  2. Related to difficulty swallowing
  3. Related to impaired balance
  4. Related to psychomotor seizures

4. A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect:

  1. hair loss.
  2. stomatitis.
  3. fatigue.
  4. vomiting.

5. Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:

  1. breast self-examination.
  2. mammography.
  3. fine needle aspiration.
  4. chest X-ray.

6. A male client undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to care for the neck stoma, the nurse should include which instruction?

  1. “Keep the stoma uncovered.”
  2. “Keep the stoma dry.”
  3. “Have a family member perform stoma care initially until you get used to the procedure.”
  4. “Keep the stoma moist.”

7. A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy?

  1. Urine output of 400 ml in 8 hours
  2. Serum potassium level of 3.6 mEq/L
  3. Blood pressure of 120/64 to 130/72 mm Hg
  4. Dry oral mucous membranes and cracked lips

8. Nurse April is teaching a group of women to perform breast self-examination. The nurse should explain that the purpose of performing the examination is to discover:

  1. cancerous lumps.
  2. areas of thickness or fullness.
  3. changes from previous self-examinations.
  4. fibrocystic masses.

9. A client, age 41, visits the gynecologist. After examining her, the physician suspects cervical cancer. The nurse reviews the client’s history for risk factors for this disease. Which history finding is a risk factor for cervical cancer?

  1. Onset of sporadic sexual activity at age 17
  2. Spontaneous abortion at age 19
  3. Pregnancy complicated with eclampsia at age 27
  4. Human papillomavirus infection at age 32

10. A female client is receiving methotrexate (Mexate), 12 g/m2 I.V., to treat osteogenic carcinoma. During methotrexate therapy, the nurse expects the client to receive which other drug to protect normal cells?

  1. probenecid (Benemid)
  2. cytarabine (ara-C, cytosine arabinoside [Cytosar-U])
  3. thioguanine (6-thioguanine, 6-TG)
  4. leucovorin (citrovorum factor or folinic acid [Wellcovorin])

11. The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?

  1. Duodenal ulcers
  2. Hemorrhoids
  3. Weight gain
  4. Polyps

12. Nurse Amy is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society guidelines, the nurse should recommend that the women:

  1. perform breast self-examination annually.
  2. have a mammogram annually.
  3. have a hormonal receptor assay annually.
  4. have a physician conduct a clinical examination every 2 years.

13. A male client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?

  1. Persistent nausea
  2. Rash
  3. Indigestion
  4. Chronic ache or pain

14. For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?

  1. Administering aspirin if the temperature exceeds 102° F (38.8° C)
  2. Inspecting the skin for petechiae once every shift
  3. Providing for frequent rest periods
  4. Placing the client in strict isolation

15. Nurse Lucia is providing breast cancer education at a community facility. The American Cancer Society recommends that women get mammograms:

  1. yearly after age 40.
  2. after the birth of the first child and every 2 years thereafter.
  3. after the first menstrual period and annually thereafter.
  4. every 3 years between ages 20 and 40 and annually thereafter.

16. Which intervention is appropriate for the nurse caring for a male client in severe pain receiving a continuous I.V. infusion of morphine?

  1. Assisting with a naloxone challenge test before therapy begins
  2. Discontinuing the drug immediately if signs of dependence appear
  3. Changing the administration route to P.O. if the client can tolerate fluids
  4. Obtaining baseline vital signs before administering the first dose

17. A 35 years old client with ovarian cancer is prescribed hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with:

  1. cell division or mitosis during the M phase of the cell cycle.
  2. normal cellular processes during the S phase of the cell cycle.
  3. the chemical structure of deoxyribonucleic acid (DNA) and chemical binding between DNA molecules (cell cycle–nonspecific).
  4. one or more stages of ribonucleic acid (RNA) synthesis, DNA synthesis, or both (cell cycle–nonspecific).

18. The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for?

  1. Actinic
  2. Asymmetry
  3. Arcus
  4. Assessment

19. When caring for a male client diagnosed with a brain tumor of the parietal lobe, the nurse expects to assess:

  1. short-term memory impairment.
  2. tactile agnosia.
  3. seizures.
  4. contralateral homonymous hemianopia.

20. A female client is undergoing tests for multiple myeloma. Diagnostic study findings in multiple myeloma include:

  1. a decreased serum creatinine level.
  2. hypocalcemia.
  3. Bence Jones protein in the urine.
  4. a low serum protein level.

21. A 35 years old client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis (inflammation of the mouth)?

  1. White, cottage cheese–like patches on the tongue
  2. Yellow tooth discoloration
  3. Red, open sores on the oral mucosa
  4. Rust-colored sputum

22. During chemotherapy, an oncology client has a nursing diagnosis of impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis?

  1. Recommending that the client discontinue chemotherapy
  2. Providing a solution of hydrogen peroxide and water for use as a mouth rinse
  3. Monitoring the client’s platelet and leukocyte counts
  4. Checking regularly for signs and symptoms of stomatitis

23. What should a male client over age 52 do to help ensure early identification of prostate cancer?

  1. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.
  2. Have a transrectal ultrasound every 5 years.
  3. Perform monthly testicular self-examinations, especially after age 50.
  4. Have a complete blood count (CBC) and blood urea nitrogen (BUN) and creatinine levels checked yearly.

24. A male client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis may be appropriate for this client?

  1. Anticipatory grieving
  2. Impaired swallowing
  3. Disturbed body image
  4. Chronic low self-esteem

25. A male client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first?

  1. Stand as far away from the implant as possible and call for help.
  2. Pick up the implant with long-handled forceps and place it in a lead-lined container.
  3. Leave the room and notify the radiation therapy department immediately.
  4. Put the implant back in place, using forceps and a shield for self-protection, and call for help.

26. Jeovina, with advanced breast cancer is prescribed tamoxifen (Nolvadex). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately?

  1. Vision changes
  2. Hearing loss
  3. Headache
  4. Anorexia

27. A female client with cancer is being evaluated for possible metastasis. Which of the following is one of the most common metastasis sites for cancer cells?

  1. Liver
  2. Colon
  3. Reproductive tract
  4. White blood cells (WBCs)

28. A 34-year-old female client is requesting information about mammograms and breast cancer. She isn’t considered at high risk for breast cancer. What should the nurse tell this client?

  1. She should have had a baseline mammogram before age 30.
  2. She should eat a low-fat diet to further decrease her risk of breast cancer.
  3. She should perform breast self-examination during the first 5 days of each menstrual cycle.
  4. When she begins having yearly mammograms, breast self-examinations will no longer be necessary.

29. Nurse Brian is developing a plan of care for marrow suppression, the major dose-limiting adverse reaction to floxuridine (FUDR). How long after drug administration does bone marrow suppression become noticeable?

  1. 24 hours
  2. 2 to 4 days
  3. 7 to 14 days
  4. 21 to 28 days

30. The nurse is preparing for a female client for magnetic resonance imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which of the following would pose a threat to the client?

  1. The client lies still.
  2. The client asks questions.
  3. The client hears thumping sounds.
  4. The client wears a watch and wedding band.
Answers and Rationales
  1. Answer D. Dysplasia refers to an alteration in the size, shape, and organization of differentiated cells. The presence of completely undifferentiated tumor cells that don’t resemble cells of the tissues of their origin is called anaplasia. An increase in the number of normal cells in a normal arrangement in a tissue or an organ is called hyperplasia. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn’t found is called metaplasia.
  2. Answer A. Verbalizing feelings is the client’s first step in coping with the situational crisis. It also helps the health care team gain insight into the client’s feelings, helping guide psychosocial care. Option B is inappropriate because suppressing speculation may prevent the client from coming to terms with the crisis and planning accordingly. Option C is undesirable because some methods of reducing tension, such as illicit drug or alcohol use, may prevent the client from coming to terms with the threat of death as well as cause physiologic harm. Option D isn’t appropriate because seeking information can help a client with cancer gain a sense of control over the crisis.
  3. Answer C. A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction.
  4. Answer C. Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the treatment site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse effects of radiation therapy.
  5. Answer C. Fine needle aspiration and biopsy provide cells for histologic examination to confirm a diagnosis of cancer. A breast self-examination, if done regularly, is the most reliable method for detecting breast lumps early. Mammography is used to detect tumors that are too small to palpate. Chest X-rays can be used to pinpoint rib metastasis.
  6. Answer D. The nurse should instruct the client to keep the stoma moist, such as by applying a thin layer of petroleum jelly around the edges, because a dry stoma may become irritated. The nurse should recommend placing a stoma bib over the stoma to filter and warm air before it enters the stoma. The client should begin performing stoma care without assistance as soon as possible to gain independence in self-care activities.
  7. Answer D. Chemotherapy commonly causes nausea and vomiting, which may lead to fluid and electrolyte imbalances. Signs of fluid loss include dry oral mucous membranes, cracked lips, decreased urine output (less than 40 ml/hour), abnormally low blood pressure, and a serum potassium level below 3.5 mEq/L.
  8. Answer C. Women are instructed to examine themselves to discover changes that have occurred in the breast. Only a physician can diagnose lumps that are cancerous, areas of thickness or fullness that signal the presence of a malignancy, or masses that are fibrocystic as opposed to malignant.
  9. Answer D. Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 16, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren’t risk factors for cervical cancer.
  10. Answer D. Leucovorin is administered with methotrexate to protect normal cells, which methotrexate could destroy if given alone. Probenecid should be avoided in clients receiving methotrexate because it reduces renal elimination of methotrexate, increasing the risk of methotrexate toxicity. Cytarabine and thioguanine aren’t used to treat osteogenic carcinoma.
  11. Answer D. Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren’t preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.
  12. Answer B. The American Cancer Society guidelines state, “Women older than age 40 should have a mammogram annually and a clinical examination at least annually [not every 2 years]; all women should perform breast self-examination monthly [not annually].” The hormonal receptor assay is done on a known breast tumor to determine whether the tumor is estrogen- or progesterone-dependent.
  13. Answer C. Indigestion, or difficulty swallowing, is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but isn’t one of the seven major warning signs. Rash and chronic ache or pain seldom indicate cancer.
  14. Answer B. Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.
  15. Answer A. The American Cancer Society recommends a mammogram yearly for women over age 40. The other statements are incorrect. It’s recommended that women between ages 20 and 40 have a professional breast examination (not a mammogram) every 3 years.
  16. Answer D. The nurse should obtain the client’s baseline blood pressure and pulse and respiratory rates before administering the initial dose and then continue to monitor vital signs throughout therapy. A naloxone challenge test may be administered before using a narcotic antagonist, not a narcotic agonist. The nurse shouldn’t discontinue a narcotic agonist abruptly because withdrawal symptoms may occur. Morphine commonly is used as a continuous infusion in clients with severe pain regardless of the ability to tolerate fluids.
  17. Answer B. Antimetabolites act during the S phase of the cell cycle, contributing to cell destruction or preventing cell replication. They’re most effective against rapidly proliferating cancers. Miotic inhibitors interfere with cell division or mitosis during the M phase of the cell cycle. Alkylating agents affect all rapidly proliferating cells by interfering with DNA; they may kill dividing cells in all phases of the cell cycle and may also kill nondividing cells. Antineoplastic antibiotic agents interfere with one or more stages of the synthesis of RNA, DNA, or both, preventing normal cell growth and reproduction.
  18. Answer B. When following the ABCD method for assessing skin lesions, the A stands for “asymmetry,” the B for “border irregularity,” the C for “color variation,” and the D for “diameter.”
  19. Answer B. Tactile agnosia (inability to identify objects by touch) is a sign of a parietal lobe tumor. Short-term memory impairment occurs with a frontal lobe tumor. Seizures may result from a tumor of the frontal, temporal, or occipital lobe. Contralateral homonymous hemianopia suggests an occipital lobe tumor.
  20. Answer C. Presence of Bence Jones protein in the urine almost always confirms the disease, but absence doesn’t rule it out. Serum calcium levels are elevated because calcium is lost from the bone and reabsorbed in the serum. Serum protein electrophoresis shows elevated globulin spike. The serum creatinine level may also be increased.
  21. Answer C. The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese–like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.
  22. Answer B. To decrease the pain of stomatitis, the nurse should provide a solution of hydrogen peroxide and water for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer viscous lidocaine or systemic analgesics as prescribed. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn’t be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection but wouldn’t decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn’t decrease the pain.
  23. Answer A. The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won’t identify changes in the prostate gland due to its location in the body. A transrectal ultrasound, CBC, and BUN and creatinine levels are usually done after diagnosis to identify the extent of the disease and potential metastases
  24. Answer A. Anticipatory grieving is an appropriate nursing diagnosis for this client because few clients with gallbladder cancer live more than 1 year after diagnosis. Impaired swallowing isn’t associated with gallbladder cancer. Although surgery typically is done to remove the gallbladder and, possibly, a section of the liver, it isn’t disfiguring and doesn’t cause Disturbed body image. Chronic low self-esteem isn’t an appropriate nursing diagnosis at this time because the diagnosis has just been made.
  25. Answer B. If a radioactive implant becomes dislodged, the nurse should pick it up with long-handled forceps and place it in a lead-lined container, then notify the radiation therapy department immediately. The highest priority is to minimize radiation exposure for the client and the nurse; therefore, the nurse must not take any action that delays implant removal. Standing as far from the implant as possible, leaving the room with the implant still exposed, or attempting to put it back in place can greatly increase the risk of harm to the client and the nurse from excessive radiation exposure.
  26. Answer A. The client must report changes in visual acuity immediately because this adverse effect may be irreversible. Tamoxifen isn’t associated with hearing loss. Although the drug may cause anorexia, headache, and hot flashes, the client need not report these adverse effects immediately because they don’t warrant a change in therapy.
  27. Answer A. The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites.
  28. Answer B. A low-fat diet (one that maintains weight within 20% of recommended body weight) has been found to decrease a woman’s risk of breast cancer. A baseline mammogram should be done between ages 30 and 40. Monthly breast self-examinations should be done between days 7 and 10 of the menstrual cycle. The client should continue to perform monthly breast self-examinations even when receiving yearly mammograms.
  29. Answer C. Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.
  30. Answer D. During an MRI, the client should wear no metal objects, such as jewelry, because the strong magnetic field can pull on them, causing injury to the client and (if they fly off) to others. The client must lie still during the MRI but can talk to those performing the test by way of the microphone inside the scanner tunnel. The client should hear thumping sounds, which are caused by the sound waves thumping on the magnetic field.