Katherine Berliner
1. William Smith has been diagnosed with squamous cell carcinoma of the right
upper lobe of the lung. On physical assessment, it is noted that he has edema of the
face and neck vein distention. It is also noted that he cannot button the shirt on his
collar. Mr. Smith is exhibiting signs of: (pertains to question 1-3)
A. Tumor Lysis Syndrome
B. Disseminated intravascular coagulation
C. Superior vena cava syndrome
D. Brain metastases
(Answer C - Rationale: These signs are typical of superior vena cava syndrome. The
superior vena cava is being compressed or obstructed by tumor growth. Tumor lysis
syndrome and DIC are also oncologic emergencies but do not exhibit the above signs and
symptoms. Brain metastases is progression of disease and will exhibit neurological
symptoms such as headache, unsteady gate, cranial nerve abnormalities, etc.)
2. Because of the signs that Mr. Smith is exhibiting, what treatment will take 1st
priority in his treatment plan?
A. Chemotherapy
B. Immunotherapy
C. Diuretic therapy
D. Radiation therapy
(Answer D – Rationale: Emergent radiation therapy is started as soon as possible to
shrink the tumor and open up the superior vena cava. Chemotherapy may be given but it
will be later as they need to immediately shrink the tumor. Immunotherapy and diruetic
therapy are the #1 priority treatment in this case. )
3. Three months later, Mr. Smith was diagnosed by his physician with bone
metastases. He came to the emergency room with nausea, vomiting, polyuria and
confusion. His blood work showed the following: serum Potassium: 3.8 mg/dl,
serum Calcium 12.2mg/dl, blood ph 7.35, serum glucose , BUN of 15 and creatinine
of 1.1.
Mr Smith is exhibiting signs of :
A.
Renal failure
B.
Hyperkalemia
C.
Hyperglycemia
D.
Hypercalcemia
Katherine Berliner
(Answer D – Rationale: The presenting signs and symptoms along with the patient’s
history and well as the lab results are consistent with hypercalcemia. Hypercalcemia is
seen in patients with bone metastases and the number 1 histology is that of squamous cell
carcinoma. )
4. Mr. Billy Rubin is admitted to the Oncology unit following a hemicolectomy. His
diagnosis is Stage IV colon cancer. (pertains to question 4-7)
According to the stage of Mr. Rubin’s cancer, his disease is probably involving what
structure:
A.
Liver
B.
Pericolic lymph nodes
C.
Submucosa of the colon
D.
Muscularis propria of the colon
(Answer A – Rationale: Stage IV disease means the disease has progressed beyond the
primary tumor site and has metastasized to other organs such as liver, lung, bone, brain,
etc. The other answers do not demonstrate disease involving other organs. The pericolic
LN are regional and the other answers are still in the colon.
5. Mr. Rubin will begin his chemotherapy once he has recovered from his
hemicolectomy. He will receive 5-FU and leucovorin on an outpatient basis. Which
of the following side effects must the nurse educate the patient on?
A. Dysuria and polyuria
B. Mucositis and bone marrow suppression
C. Abdominal pain and diarrhea
D. Headaches and vomiting
(Answer A- Rationale: Mucositis and bone marrow suppression are two side effects
which chemotherapy patients may experience. The chemotherapy effects the bloodforming cells of the bone marrow leading to bone marrow suppression.
Chemotherapy also effects the mucous membranes as they are cells that undergo
frequent cell division.)
6. You are the RN in the Oncologist office where Mr. Rubin will be coming to
receive his chemotherapy. You are preparing his patient care plan. What is your
1st priority nursing diagnosis?
A. Disturbed Body Image
Katherine Berliner
B. Death Anxiety
C. Risk for Infection
D. Fatigue
(Answer C – Rationale: The risk for infection is your number one priority. Because the
bone marrow is depressed, their white blood counts are decreased which puts them at
higher risk for infection. If they do get infected, they have less reserve to fight with
putting them at extreme risk)
7. Mr. Rubin is admitted six months later with a small bowel obstruction. He
undergoes a small bowel resection to relieve the obstruction. What type of surgery
does this represent in Mr. Rubin’s case?
A. Palliative Surgery
B. Curative Surgery
C. Reconstructive Surgery
D. Supportive care Surgery
(Answer A – Rationale – this surgery is being done to promote the patient’s quality of
life. He has liver metastases so he will not be cured by this surgery. There is nothing
that is being reconstructed. Supportive care are things like insertion of therapeutic
devices.
8. Ms Sucrose was admitted to the emergency room with hypoglycemia. She is now
stable and ready for discharge. In discharge teaching, the RN should recommend
the following to control episodes of hypoglycemia: (pertains to question 8-10)
A. Eating a candy bar if lightheadedness occurs
B. Increasing intake of vitamins B and D and taking iron supplements.
C. Increasing saturated fat intake and fasting I the afternoon.
D. Consuming a low-carbohydrate diet, high-protein diet and avoid fasting.
(Answer D: Rationale: Low-carbohydrate and high-protein diet is the best diet for the
hypoglycemic patient. They should also avoid simple sugars. They also must not fast as
they need to keep their blood sugar at a more constant level.)
9. Ms. Sucrose is a Type I diabetic. She has been instructed by her physician to
take 15 units of Humulin 70/30. What does this type of insulin contain:
A. 70% regular insulin and 30% NPH insulin.
B. 70% NPH insulin and 30% regular insulin
Katherine Berliner
C. 70 units regular insulin and 30 units NPH
D. 70 units NPH and 30 units regular insulin
(Answer B – Rationale: Humulin 70/30 is a combination insulin and contains 70% NPH
and 30% regular insulin.)
10. Ms. Sucrose needs to be aware of the crucial role diet plays in managing her
diabetes. She is eating the right foods if her total daily caloric intake consists of:
A. 30% carbohydrates, 40% fat, and 30% protein
B. 60% carbohydrates, 20% fat, and 20% protein
C. 40% carbohydrates, 30% fat, and 30% protein
D. 50% carbohydrates, 30% fat and 20% protein.
(Answer B – Rationale: a person with diabetes should get 60% carbohydrates, 20% fats
and 20% proteins. A diet that has less carbohydrates will have a higher fat content than
recommended for a healthy diet. Diabetes is a risk factor for cardiovascular disease and
excessive fat will put the client at higher risk for cardiovascular disease. )