1.

While being prepared for a biopsy of a lump in the right breast, the patient asks the nurse
what the difference is between a benign tumor and a malignant tumor. The nurse explains that
a benign tumor differs from a malignant tumor in that benign tumors
A. do not cause damage to adjacent tissue.
B. do not spread to other tissues and organs.
C. are simply an overgrowth of normal cells.
D. frequently recur in the same site.
2. A patient who has been told by the health care provider that the cells in a bowel tumor are
poorly differentiated asks the nurse what is meant by poorly differentiated. Which response
should the nurse make?
A. The cells in your tumor do not look very different from normal bowel cells.
B. The tumor cells have DNA that is different from your normal bowel cells.
C. Your tumor cells look more like immature fetal cells than normal bowel cells.
D. The cells in your tumor have mutated from the normal bowel cells.
3. A patient who smokes tells the nurse, I want to have a yearly chest x-ray so that if I get
cancer, it will be detected early. Which response by the nurse is most appropriate?
A. Chest x-rays do not detect cancer until tumors are already at least a half-inch in size.
B. Annual x-rays will increase your risk for cancer because of exposure to radiation.
C. Insurance companies do not authorize yearly x-rays just to detect early lung cancer.
D. Frequent x-rays damage the lungs and make them more susceptible to cancer.
4. In teaching about cancer prevention to a community group, the nurse stresses promotion of
exercise, normal body weight, and low-fat diet because
A. most people are willing to make these changes to avoid cancer.
B. dietary fat and obesity promote growth of many types of cancer.
C. people who exercise and eat healthy will make other lifestyle changes.
D. obesity and lack of exercise cause cancer in susceptible people.
5. During a routine health examination, a 30-year-old patient tells the nurse about a family
history of colon cancer. The nurse will plan to

A. teach the patient about the need for a colonoscopy at age 50.
B. ask the patient to bring in a stool specimen to test for occult blood.
C. schedule a sigmoidoscopy to provide baseline data about the patient.
D. have the patient ask the doctor about specific tests for colon cancer.
6. When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer
is staged as Tis, N0, M0. The nurse will teach the patient that
A. the cancer cells are well-differentiated.
B. it is difficult to determine the original site of the cervical cancer.
C. further testing is needed to determine the spread of the cancer.
D. the cancer is localized to the cervix.
7. Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates
that the patient understands the purpose of a biopsy?
A. The biopsy will tell the doctor whether the cancer has spread to my other organs.
B. The biopsy will help the doctor decide what treatment to use for my enlarged prostate.
C. The biopsy will determine how much longer I have to live.
D. The biopsy will indicate the effect of the cancer on my life.
8. The nurse is teaching a postmenopausal patient with breast cancer about the expected
outcomes of her cancer treatment. The nurse evaluates that the teaching has been effective
when the patient says
A. After cancer has not recurred for 5 years, it is considered cured.
B. I will need to have follow-up examinations for many years after I have treatment before I can be
considered cured.
C. Cancer is considered cured if the entire tumor is surgically removed.
D. Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy,
and radiation.
9. A patient with a large stomach tumor that is attached to the liver is scheduled to have a
debulking procedure. The nurse explains that the expected outcome of this surgery is

A. control of the tumor growth by removal of malignant tissue.

B. promotion of better nutrition by relieving the pressure in the stomach.
C. relief of pain by cutting sensory nerves in the stomach.
D. reduction of the tumor burden to enhance adjuvant therapy.
10. External-beam radiation is planned for a patient with endometrial cancer. The nurse
teaches the patient that an important measure to prevent complications from the effects of the
radiation is to
A. test all stools for the presence of blood.
B. inspect the mouth and throat daily for the appearance of thrush.
C. perform perianal care with sitz baths and meticulous cleaning.
D. maintain a high-residue, high-fat diet.
11. Which action by a nursing assistant (NA) caring for a patient with a temporary radioactive
cervical implant indicates that the RN should intervene?
A. The NA places the patients bedding in the laundry container in the hallway.
B. The NA flushes the toilet once after emptying the patients bedpan.
C. The NA stands by the patients bed for an hour talking with the patient.
D. The NA gives the patient an alcohol-containing mouthwash for oral care.
12. A patient with Hodgkins lymphoma is undergoing external radiation therapy on an
outpatient basis. After 2 weeks of treatment, the patient tells the nurse, I am so tired I can
hardly get out of bed in the morning. An appropriate intervention for the nurse to plan with
the patient is to
A. exercise vigorously when fatigue is not as noticeable.
B. consult with a psychiatrist for treatment of depression.
C. establish a time to take a short walk every day.
D. maintain bed rest until the treatment is completed.
13. Which information obtained by the nurse about a patient with colon cancer who is
scheduled for external radiation therapy to the abdomen indicates a need for patient teaching?

A. The patient swims a mile 5 days a week.

B. The patient eats frequently during the day.
C. The patient showers with Dove soap daily.
D. The patient has a history of dental caries.
14. A patient undergoing external radiation has developed a dry desquamation of the skin in
the treatment area. The nurse knows that teaching about management of the skin reaction has
been effective when the patient says
A. I can use ice packs to relieve itching in the treatment area.
B. I can buy a steroid cream to use on the itching area.
C. I will expose the treatment area to a sun lamp daily.
D. I will scrub the area with warm water to remove the scales.
15. A patient with metastatic cancer of the colon experiences severe vomiting following each
administration of chemotherapy. An important nursing intervention for the patient is to
A. teach about the importance of nutrition during treatment.
B. have the patient eat large meals when nausea is not present.
C. administer prescribed antiemetics 1 hour before the treatments.
D. offer dry crackers and carbonated fluids during chemotherapy.
16. When the nurse is administering a vesicant chemotherapeutic agent intravenously, an
important consideration is to
A. stop the infusion if swelling is observed at the site.
B. infuse the medication over a short period.
C. administer the chemotherapy through small-bore catheter.
D. hold the medication unless a central venous line is available.
17. A chemotherapeutic agent known to cause alopecia is prescribed for a patient. To maintain
the patients self-esteem, the nurse plans to
A. suggest that the patient limit social contacts until regrowth of the hair occurs.
B. encourage the patient to purchase a wig or hat and wear it once hair loss begins.

C. have the patient wash the hair gently with a mild shampoo to minimize hair loss.
D. inform the patient that hair loss will not be permanent and that the hair will grow back.
18. A patient with ovarian cancer tells the nurse, I dont think my husband cares about me
anymore. He rarely visits me. On one occasion when the husband was present, he told the
nurse he just could not stand to see his wife so ill and never knew what to say to her. An
appropriate nursing diagnosis in this situation is
A. compromised family coping related to disruption in lifestyle and role changes.
B. impaired home maintenance related to perceived role changes.
C. risk for caregiver role strain related to burdens of caregiving responsibilities.
D. interrupted family processes related to effect of illness on family members.
19. A patient receiving head and neck radiation and systemic chemotherapy has ulcerations
over the oral mucosa and tongue and thick, ropey saliva. An appropriate intervention for the
nurse to teach the patient is to
A. remove food debris from the teeth and oral mucosa with a stiff toothbrush.
B. use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth.
C. gargle and rinse the mouth several times a day with an antiseptic mouthwash.
D. rinse the mouth before and after each meal and at bedtime with a saline solution.
20. A patient who is receiving interleukin-2 (IL-2) therapy (Proleukin) complains to the nurse
about all of these symptoms. Which one is most important to report to the health care
provider?
A. Generalized aches
B. Dyspnea
C. Decreased appetite
D. Insomnia

Answers and Rationale

1. Answer: B. do not spread to other tissues and organs.

The major difference between benign and malignant tumors is that malignant tumors invade adjacent
tissues and spread to distant tissues and benign tumors never metastasize. Both types of tumors may
cause damage to adjacent tissues. The cells differ from normal in both benign and malignant tumors.
Benign tumors usually do not recur.
2. Answer: C. Your tumor cells look more like immature fetal cells than normal bowel cells.
An undifferentiated cell has an appearance more like a stem cell or fetal cell and less like the normal
cells of the organ or tissue. The DNA in cancer cells is always different from normal cells, whether
the cancer cells are well differentiated or not. All tumor cells are mutations form the normal cells of
the tissue.
3. Answer: A. Chest x-rays do not detect cancer until tumors are already at least a half-inch in
size.
A tumor must be at least 1 cm large before it is detectable by an x-ray and may already have
metastasized by that time. Radiographs have low doses of radiation, and an annual x-ray alone is not
likely to increase lung cancer risk. Insurance companies do not usually authorize x-rays for this
purpose, but it would not be appropriate for the nurse to give this as the reason for not doing an x-ray.
A yearly x-ray is not a risk factor for lung cancer.
4. Answer: B. dietary fat and obesity promote growth of many types of cancer.
Obesity and dietary fat promote the growth of malignant cells, and decreasing these risk factors can
reduce the chance of cancer development. Many people are not willing to make these changes. Good
diet and exercise habits are not a guarantee that other healthy lifestyle changes will then occur.
Obesity and lack of exercise do not cause cancer, but they promote the growth of altered cells.
5. Answer: D. have the patient ask the doctor about specific tests for colon cancer.
The patient is at increased risk and should talk with the health care provider about needed tests,
which will depend on factors such as the exact type of family history and any current symptoms.
Colonoscopy at age 50 is used to screen for individuals without symptoms or increased risk, but
earlier testing may be needed for this patient because of family history. For fecal occult blood testing,
patients use a take-home multiple sample method rather than bring one specimen to the clinic. The

health care provider will take multiple factors into consideration before determining whether a
sigmoidoscopy is needed at age 30.
6. Answer: D. the cancer is localized to the cervix.
Cancer in situ indicates that the cancer is localized to the cervix and is not invasive at this time. Cell
differentiation is not indicated by clinical staging. Because the cancer is in situ, the origin is the
cervix. Further testing is not indicated given that the cancer has not spread.
7. Answer: B. The biopsy will help the doctor decide what treatment to use for my enlarged
prostate.
A biopsy is used to determine whether the prostate enlargement is benign or malignant and
determines the type of treatment that will be needed. Biopsy does not give information about
metastasis, life expectancy, or the impact of cancer on the patients life; the three remaining
statements indicate a need for patient teaching.
8. Answer: B. I will need to have follow-up examinations for many years after I have
treatment before I can be considered cured.
The risk of recurrence varies by the type of cancer; for breast cancer in postmenopausal women, the
patient needs at least 20 disease-free years to be considered cured. Some cancers (e.g., leukemia) are
cured by nonsurgical therapies such as radiation and chemotherapy.
9. Answer: D. reduction of the tumor burden to enhance adjuvant therapy.
A debulking surgery reduces the size of the tumor and makes radiation and chemotherapy more
effective. Debulking surgeries do not control tumor growth. The tumor is debulked because it is
attached to the liver, a vital organ (not to relieve pressure on the stomach). Debulking does not sever
the sensory nerves, although pain may be lessened by the reduction in pressure on the abdominal
organs.
10. Answer: C. perform perianal care with sitz baths and meticulous cleaning.
Radiation to the abdomen will affect organs in the radiation path, such as the bowel, and cause
frequent diarrhea. Stools are likely to have occult blood from the inflammation associated with

radiation, so routine testing of stools for blood is not indicated. Radiation to the abdomen will not
cause stomatitis. A low-residue diet is recommended to avoid irritation of the bowel when patients
receive abdominal radiation.
11. Answer: C. The NA stands by the patients bed for an hour talking with the patient.
Because patients with temporary implants emit radioactivity while the implants are in place,
exposure to the patient is limited. Laundry and urine/feces do not have any radioactivity and do not
require special precautions. Cervical radiation will not affect the oral mucosa, and alcohol-based
mouthwash is not contraindicated.
12. Answer: C. establish a time to take a short walk every day.
Walking programs are used to keep the patient active without excessive fatigue. Vigorous exercise
when the patient is less tired may lead to increased fatigue. Fatigue is expected during treatment and
is not an indication of depression. Bed rest will lead to weakness and other complications of
immobility.
13. Answer: A. The patient swims a mile 5 days a week.
The patient is instructed to avoid swimming in salt water or chlorinated pools during the treatment
period. The patient does not need to change the habits of eating frequently or showering with a mild
soap. A history of dental caries will not impact the patient who is scheduled for abdominal radiation.
14. Answer: B. I can buy a steroid cream to use on the itching area.
Steroid (over-the-counter [OTC] hydrocortisone) cream may be used to reduce itching in the area. Ice
and sunlamps may injure the skin. Treatment areas should be cleaned gently to avoid further injury.
15. Answer: C. administer prescribed antiemetics 1 hour before the treatments.
Treatment with antiemetics before chemotherapy may help to prevent anticipatory nausea. Although
nausea may lead to poor nutrition, there is no indication that the patient needs instruction about
nutrition. The patient should eat small, frequent meals. Offering food and beverages during
chemotherapy is likely to cause nausea.

16. Answer: A. stop the infusion if swelling is observed at the site.

Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The
medication should generally be given slowly to avoid irritation of the vein. The size of the catheter is
not as important as administration of vesicants into a running IV line to allow dilution of the
chemotherapy drug. These medications can be given through peripheral lines, although central
vascular access devices (CVADs) are preferred.
17. Answer: B. encourage the patient to purchase a wig or hat and wear it once hair loss begins.
The patient is taught to anticipate hair loss and to be prepared with wigs, scarves, or hats. Limiting
social contacts is not appropriate at a time when the patient is likely to need a good social support
system. The damage occurs at the hair follicle and will occur regardless of gentle washing or use of a
mild shampoo. The information that the hair will grow back is not immediately helpful in
maintaining the patients self-esteem.
18. Answer: D. interrupted family processes related to effect of illness on family members.
The data indicate that this diagnosis is most appropriate because the family members are impacted
differently by the patients cancer diagnosis. There are no data to suggest a change in lifestyle or role
as an etiology. The data do not support impairment in home maintenance or a burden caused by
caregiving responsibilities.
19. Answer: D. rinse the mouth before and after each meal and at bedtime with a saline
solution.
The patient should rinse the mouth with a saline solution frequently. A soft toothbrush is used for oral
care. Hydrogen peroxide may damage tissues. Antiseptic mouthwashes may irritate the oral mucosa
and are not recommended.
20. Answer: B. Dyspnea
Dyspnea may indicate capillary leak syndrome and pulmonary edema, which requires rapid
treatment. The other symptoms are common with IL-2 therapy, and the nurse should teach the patient
that these are common adverse effects that will resolve at the end of the therapy.