Oncc Practice Tests

Front 1

A patient expresses anger about his diagnosis of cancer and the need to receive his first chemotherapy treatment. The nurse's best response is to:

A. initiate a referral to a social worker.
B. call the physician and ask for the treatment to be delayed.
C. explain to the patient that the doctor ordered treatment to start today.
D. suggest ways for the patient to participate in the treatment plan.

Back 1

D.

Rational: Loss of personal control is perceived as lacking the ability to control events that affect life style and goals. Both disease and treatment are considered risk factors for a loss of personal control. Personal control can be maintained through verbalization of feelings and participation in care.

Front 2

A patient has the following laboratory values: white blood cell count 2100 mm3; neutrophils, segmented 23%; neutrophils, band 6%; hemoglobin 8.9 g/dl; and, platelets 100,000 mm 3. The nurse's initial patient teaching includes:

A. washing hands frequently.
B. using an electric razor.
C. avoiding trauma.
D. taking daily stool softeners

Back 2

A.
Rational: There are many nonpharmacologic interventions for the prevention of infection. Handwashing remains the single most important intervention to prevent infection.

Front 3

A 69-year-old patient who received chemotherapy seven days ago calls the nurse to report a temperature of 101°F (38.3°C) and lightheadedness. The nurse determines the patient is dyspneic and diaphoretic. The nurse's initial response is to instruct the patient to:

A. take acetaminophen.
B. recheck his temperature in two hours.
C. report to the emergency department.
D. call for an ambulance.

Back 3

D.
Rational: The time at which chemotherapy exerts its maximum effect on the bone marrow and the white blood count reaches its lowest point is the nadir. This usually occurs within 7 to 10 days after administration. Patients are most susceptible to infections at this time due to neutropenia. In a neutropenic patient, infection may rapidly progress to sepsis, a systemic inflammatory response to microorganisms in the blood. Early signs of sepsis include fever, chills, and tachypnea. Patients over the age of 65 are at greater risk. Untreated sepsis can result in septic shock and death. Immediate reporting of symptoms and medical management is necessary.

Front 4

A survivor of colon cancer expresses his desire to change jobs. He is concerned that he will be unable to obtain health insurance at a new job due to his history of cancer. The nurse's best intervention is to:

A. encourage him to speak with his attorney.
B. refer him to a support group.
C. inform him about the Americans with Disabilities Act of 1990.
D. provide him with the phone number of the National Coalition of Cancer Survivorship.

Back 4

C.

Rationale:
Some survivors may avoid changing jobs because they fear the loss of health insurance. Survivors and their family members are protected at the workplace by the Americans with Disabilities Act (ADA). Cancer is considered a disability under the ADA. The act requires employers to treat all employees the same, including the provision of benefits. If insurance coverage is offered to all employees, it must be offered to the cancer survivor or the employer is in violation of the ADA.

Front 5

A patient who completed treatment for malignant melanoma one year ago complains of still feeling tired. The nurse anticipates an order for:

A. darbepoetin.
B. methylphenidate.
C. lorazepam.
D. pegfilgrastim.
Please select an answer.

Back 5

B.
Rationale:
Psychostimulants such as methylphenidate have been tested in certain populations including patients with malignant melanoma as well as in patients with advanced cancer. Patients reported improvement in symptoms of cancer-related fatigue with the use of methylphenidate but it remains an area where more research is needed.

Front 6

A patient is receiving the first dose of paclitaxel. The nurse should be prepared to treat the patient for:

A. shaking chills.
B. projectile vomiting.
C. hypersensitivity reaction.
D. urinary retention.

Back 6

C.

A side effect associated with paclitaxel is hypersensitivity reaction. Hypersensitivity is an exaggerated or inappropriate immune response that may be localized or systemic. Pretreatment to prevent the reaction includes administering cimetidine, diphenhydramine, and if not contraindicated, dexamethasone.

Front 7

During the initial evaluation of a patient, the treatment plan is outlined and includes amputation of the right leg. The patient begins to scream and cry, stating, "But I have small children. I need to be able to run, walk, and play with them." The nurse's best response is:

A. It sounds like you fear your treatment plan, tell me what you know about it.
B. Many patients feel better after they are fitted with a prosthesis.
C. If you do not receive the amputation, your chance of dying is great.
D. The psychiatric nurse will help you cope with the amputation.

Back 7

A.

Rationale:
Anger as part of the mourning process often is felt most profoundly in those who experience disfiguring surgery, loss of body parts, and loss of control of the body. Nurses can address the underlying feelings with reflective statements. A reflective statement will help patients to gain control and focus on the real issues.

Front 8

A patient newly diagnosed with cancer experiences restlessness, insomnia, diarrhea, heart palpitations, and irritability. The patient states he is nervous and jittery and requests something for nerves. The nurse's best response is to:

A. tell the patient that treatment will begin at once.
B. instruct the patient to ask the physician for a sedative.
C. assure the patient that his reaction is typical to a diagnosis of cancer.
D. ask the patient to further explain his feelings.

Back 8

D.

Rationale:
There are several risk factors that are related to the development of anxiety. Before treating anxiety, it is important to determine those situations that cause it. The nurse should help the patient to identify the situations that cause the anxiety.

Front 9

Which of the following statements by a patient most likely indicates the need for further education about preventing infection?

A. I need to be very diligent about washing my hands after working in the garden.
B. I do not want to get an influenza shot until all my chemotherapy is finished.
C. I keep my wound dressing supplies in a closed storage container.
D. I will not permit my grandchildren to visit me if they are sick.

Back 9

B.

Because a percentage of patients will achieve protection from the influenza vaccination and the risks for adverse effects are low, all patients with cancer and their household contacts should receive annual vaccination. NCCN recommends vaccination at least two weeks prior to cytotoxic or immunosuppressive. If this is not possible, patients can be vaccinated during treatment and revaccinated at least three months after therapy.

Front 10

A patient with a history of cardiac disease is being evaluated for chronic leukemia. The patient reports tachycardia and dyspnea. A complete blood cell count with differential is obtained. Which of the following findings would most likely indicate the cause?

A. Hemoglobin level, 7.9 g/dl
B. Platelet count, 1000,000 mm3
C. White blood cell count, 2960 mm3
D. Absolute neutrophil count, 1700/mm3
Please select an answer.

Back 10

A.

Anemia is defined as a reduction in the normal concentration of hemoglobin (Hgb) or red blood cells in the blood. Severe anemia is defined as an Hgb level below 8 g/dl. Clinical signs of severe anemia include: tachycardia, dyspnea at rest, angina, headache, and dizzyness.

Front 11

Which of the following is a complication that can occur after a percutaneous lung biopsy is performed?

A. Pleural effusion
B. Atelectasis
C. Pneumothorax
D. Pneumonia

Back 11

C.

A lung biopsy is performed by inserting a spinal type needle into the chest cavity to obtain tissue for examination. Air can be introduced into the chest cavity during the procedure and can cause a pneumothorax.

Front 12

A patient receiving 10 mg of sustained-release oxycodone every 12 hours requires 5 mg of immediate-release oxycodone five to six times daily. The best adjustment in the pain medication regimen is to request an order for:

A. 5 mg of immediate-release oxycodone every 3 hours.
B. 10 mg of immediate-release oxycodone every 6 hours.
C. 10 mg of sustained-release oxycodone every 8 hours.
D. 30 mg of sustained-release oxycodone every 12 hours.

Back 12

D.

The first sign that an increase in opioid dose is needed is a decrease in the duration of analgesia for a given opioid dose. Patients may report the need for an increased number of rescue doses. Sustained release doses plus immediate-release (rescue) doses should be calculated. When slight improvement in analgesia is needed, a 25% increase in opioid dose may be sufficient; for a moderate improvement, 50%; and for a strong effect, 100% increase may be needed.

Front 13

A patient with lymphoma reports persistent nausea, muscle cramps, weakness, and paresthesia of the fingers two days after receiving the first cycle of chemotherapy. The patient most likely is experiencing:

A. hypercalcemia.
B. tumor lysis syndrome.
C. disseminated intravasular coagulation.
D. syndrome of inappropriate antidiuretic hormone secretion.

Back 13

B.

Tumor lysis syndrome involves a metabolic imbalance that occurs with the rapid release of intracellular potassium, phosphorus, and nucleic acid into the blood as a result of tumor cell kill. Early signs and symptoms of tumor lysis syndrome include the following: muscle cramps, weakness, nausea and vomiting, diarrhea, lethargy, and paresthesia.

Front 14

The severe pain associated with post-herpetic neuropathy is most effectively treated by:

A. propoxyphene.
B. hydromorphone.
C. amitriptyline.
D. extra-strength acetaminophen.

Back 14

C.

Pain associated with herpes zoster is severe and can be debilitating. The pain is described as continuous, deep and burning. Opioids are used to treat acute herpes zoster. Tricyclic antidepressants are used to treat post-herpetic neuralgia.

Front 15

It is important to assess attitudes about illness and care-seeking in a patient from different racial and ethnic groups in order to:

A. effectively change attitudes.
B. identify the socioeconomic status of the patient.
C. tailor treatment approaches to the individual patient.
D. determine where early interventions will be ineffective.

Back 15

C.

Rational: The aim of transcultural nursing is to understand and assist diverse cultural groups with their nursing and health care needs. Assessing the cultural aspects of an individual's lifestyle, health beliefs, and health practices will enhance the nurse's decision making and judgment when providing care, thereby tailoring care to the individual.

Front 16

An oncology nurse teaching a cancer biology class explains that a proto-oncogene's role is to:

A. stimulate angiogenesis.
B. cause apoptosis.
C. inhibit tumor growth.
D. promote cell division.

Back 16

D.

Rational: Proto-oncogenes promote the specialization and division of normal cells. A change in a proto-oncogenes genetic sequence can result in uncontrolled cell growth, ultimately causing the formation of a cancerous tumor. Proto-oncogenes can be transformed into oncogenes in three ways: point mutation (alteration of a single nucleotide base pair), translocation (in which a segment of the chromosome breaks off and attaches to another chromosome), or amplification (increase in the number of copies of the proto-oncogene).

Front 17

While administering doxorubicin peripherally, a patient complains of itching at the infusion site. The nurse observes red streaking along the vein with a blood return. The nurse's initial response is to:

A. change the IV site.
B. continue administering the drug.
C. stop the infusion and instill an antidote.
D. stop the infusion and flush the line with saline.

Back 17

D.

rational: A flare reaction is a local venous inflammatory response with subsequent histamine release manifested by streaking or red blotches along the vein, but without pain. If it is determined that the drug administered has not extravasated, then the infusion should stop and the line should be flushed with saline, while watching for resolution of the flare.

Front 18

A patient who does not speak English is eligible to participate in a phase II clinical trial. The patient's grandson wishes to translate to obtain informed consent. Which of the following actions would be most appropriate?

A. Allow the grandson to act as the interpreter.
B. Have an interpreter translate without the grandson present.
C. Have an interpreter translate with the grandson present.
D. Disallow the patient's participation because of the language barrier.

Back 18

C.

Rational: Without an interpreter present, obtaining an informed consent would be deemed inappropriate. The literal meaning of the communication may not be ensured when using a family member to interpret the information. It is recommended a professional interpreter be used to facilitate the process.

Front 19

Which terms are associated with malignant tumors originating in the epithelial tissue?

A. Osteo and chondra
B. Lympho and myelo
C. Adeno and squamous
D. Lipo and rhabdo

Back 19

C.

Rational: Tumors are classified by the tissue of origin. The malignancies that arise from the epithelium are squamous cell, adenocarcinoma, basal cell, and choriocarcinoma.

Front 20

A patient with prostate cancer is taking oxycodone orally every four hours as needed for pain. At a home visit, the nurse learns the patient is experiencing constant, dull back pain and he has not moved his bowels for three days. These symptoms most likely indicate:

A. ascites.
B. hypercalcemia.
C. impending spinal cord compression.
D. an adverse effect of the oxycodone.

Back 20

C.

Rational: Spinal cord compression may result from tumor invasion into the vertebrae causing a collapse on the spinal cord. Patients at high risk for cord compression include those with prostate cancer. Dull back pain is an early symptom of spinal cord compression.