NSG 3850 Exam 4 Final
Comprehensive Hematology and Oncology Nursing
Exam 2026
Section 1: Acute vs Chronic Conditions and Metastasis
Question 1
A nursing student is learning about the differences between acute and chronic
conditions. Which statement by the student indicates correct understanding?
A. "Acute conditions have a slow onset and develop gradually over time"
B. "Chronic conditions present with abrupt onset and severe symptoms"
C. "Acute conditions have an abrupt onset while chronic conditions develop slowly"
D. "Both acute and chronic conditions present with the same onset pattern"
ANSWER: C
Rationale for Option A: This statement is incorrect because acute conditions are
characterized by abrupt, sudden onset, not slow development. This is a fundamental
characteristic that distinguishes acute from chronic conditions.
Rationale for Option B: This statement is incorrect because it reverses the
characteristics. Chronic conditions develop slowly over time, not abruptly. Acute
conditions are the ones with abrupt onset.
Rationale for Option C: This is the correct ANSWER. Acute conditions are characterized
by abrupt, sudden onset with rapid development of symptoms, while chronic conditions
develop slowly over an extended period. This is a key distinguishing feature between
the two types of conditions.
Rationale for Option D: This statement is incorrect because acute and chronic
conditions have distinctly different onset patterns. Acute conditions present abruptly
while chronic conditions develop gradually.
Question 2
A patient with cancer asks the nurse to explain how metastasis occurs through the
vascular system. Which explanation by the nurse is most accurate?
A. "Cancer cells remain in their original location and do not spread"
,B. "Cancer cells escape from the cell of origin through vascular/lymphatic flow and
create new colonies"
C. "Metastasis only occurs through direct extension to adjacent tissues"
D. "Cancer cells can only spread through the nervous system"
ANSWER: B
Rationale for Option A: This statement is incorrect. The defining characteristic of
malignant cancer is its ability to metastasize - to spread from the original site to other
parts of the body. Benign tumors remain in their original location.
Rationale for Option B: This is the correct ANSWER. Metastasis occurs when cancer
cells escape from the primary tumor through vascular (blood) or lymphatic flow, travel
through the circulation, and establish new tumor colonies at distant sites. This is the
fundamental mechanism of cancer spread.
Rationale for Option C: This statement is incorrect because while direct extension can
occur, metastasis specifically refers to spread through vascular or lymphatic systems to
distant sites, not just adjacent tissue invasion.
Rationale for Option D: This statement is incorrect. Cancer does not spread through the
nervous system as a primary mechanism. The main routes of metastasis are vascular
(hematogenous) and lymphatic spread.
Question 3
The nurse is teaching about the lymphatic system's role in metastasis. Which statement
accurately describes why the lymphatic system is particularly significant in cancer
spread?
A. "The lymphatic system has fewer pathways than the vascular system"
B. "The lymphatic system has more pathways and can build its own blood supply,
allowing it to go to atypical sites"
C. "The lymphatic system only drains fluid and has no role in cancer metastasis"
D. "Cancer cells cannot survive in the lymphatic system"
ANSWER: B
Rationale for Option A: This statement is incorrect. The lymphatic system actually has
MORE pathways compared to the vascular system, which is one reason why it's such
an effective route for cancer metastasis.
Rationale for Option B: This is the correct ANSWER. The lymphatic system has
extensive pathways throughout the body and tumors can induce lymphangiogenesis
(formation of new lymphatic vessels), essentially building their own drainage system.
,This allows cancer cells to reach atypical sites and contributes to widespread
metastasis.
Rationale for Option C: This statement is incorrect. While the lymphatic system does
drain fluid, it also plays a crucial role in cancer metastasis. Many cancers, particularly
breast cancer and melanoma, commonly spread through lymphatic channels.
Rationale for Option D: This statement is incorrect. Cancer cells not only survive in the
lymphatic system but often use lymph nodes as waystations to establish secondary
tumors before spreading further.
Question 4
A patient with breast cancer is found to have cancer cells in the axillary lymph nodes.
The nurse understands this represents which type of spread?
A. Direct extension
B. Lymphatic metastasis
C. Hematogenous metastasis only
D. Transcoelomic spread
ANSWER: B
Rationale for Option A: This is incorrect. Direct extension refers to cancer spreading by
direct invasion into adjacent tissues, not through lymphatic channels to lymph nodes.
Rationale for Option B: This is the correct ANSWER. The presence of cancer cells in
axillary lymph nodes indicates lymphatic metastasis, where cancer cells have traveled
through lymphatic vessels from the primary breast tumor to regional lymph nodes.
Rationale for Option C: This is incorrect. While hematogenous (blood-borne) metastasis
can occur, involvement of lymph nodes specifically indicates lymphatic spread.
Hematogenous metastasis would more likely result in distant organ involvement like
lungs, liver, or bone.
Rationale for Option D: This is incorrect. Transcoelomic spread refers to cancer
spreading through body cavities (like peritoneal or pleural cavities), not through
lymphatic channels.
Question 5
Which characteristic distinguishes chronic myeloid leukemia (CML) from other types of
leukemia?
A. Presence of Reed-Sternberg cells
B. High granulocyte count on CBC with differential and presence of Philadelphia
chromosome
, C. Exclusive involvement of lymphoid tissue
D. Absence of bone marrow involvement
ANSWER: B
Rationale for Option A: This is incorrect. Reed-Sternberg cells are characteristic of
Hodgkin's lymphoma, not CML. These are large, abnormal lymphocytes with a
distinctive appearance.
Rationale for Option B: This is the correct ANSWER. CML is characterized by a high
granulocyte count on complete blood count (CBC) with differential, and the presence of
the Philadelphia chromosome (Ph+), which is a specific genetic abnormality resulting
from translocation between chromosomes 9 and 22, creating the BCR-ABL fusion gene.
Rationale for Option C: This is incorrect. CML is a myeloid (not lymphoid) leukemia,
meaning it involves the myeloid cell line (granulocytes, monocytes, erythrocytes,
platelets) rather than lymphoid cells.
Rationale for Option D: This is incorrect. CML definitely involves the bone marrow. In
fact, bone marrow aspiration is one of the confirmatory diagnostic tests for CML.
Question 6
A patient is diagnosed with chronic myeloid leukemia. Which diagnostic test would the
nurse prepare the patient for to confirm the diagnosis?
A. Lymph node biopsy
B. Bone marrow aspiration
C. Lumbar puncture
D. CT scan of the abdomen
ANSWER: B
Rationale for Option A: This is incorrect. Lymph node biopsy is primarily used for
diagnosing lymphomas (Hodgkin's and Non-Hodgkin's), not leukemia. Leukemia is a
disease of the bone marrow and blood.
Rationale for Option B: This is the correct ANSWER. Bone marrow aspiration is the
confirmatory diagnostic test for CML and other leukemias. It allows examination of the
bone marrow cells, identification of the Philadelphia chromosome, and assessment of
the disease phase.
Rationale for Option C: This is incorrect. Lumbar puncture is used to check for central
nervous system involvement, particularly in ALL (Acute Lymphocytic Leukemia), but it is
not the primary confirmatory test for CML.
Comprehensive Hematology and Oncology Nursing
Exam 2026
Section 1: Acute vs Chronic Conditions and Metastasis
Question 1
A nursing student is learning about the differences between acute and chronic
conditions. Which statement by the student indicates correct understanding?
A. "Acute conditions have a slow onset and develop gradually over time"
B. "Chronic conditions present with abrupt onset and severe symptoms"
C. "Acute conditions have an abrupt onset while chronic conditions develop slowly"
D. "Both acute and chronic conditions present with the same onset pattern"
ANSWER: C
Rationale for Option A: This statement is incorrect because acute conditions are
characterized by abrupt, sudden onset, not slow development. This is a fundamental
characteristic that distinguishes acute from chronic conditions.
Rationale for Option B: This statement is incorrect because it reverses the
characteristics. Chronic conditions develop slowly over time, not abruptly. Acute
conditions are the ones with abrupt onset.
Rationale for Option C: This is the correct ANSWER. Acute conditions are characterized
by abrupt, sudden onset with rapid development of symptoms, while chronic conditions
develop slowly over an extended period. This is a key distinguishing feature between
the two types of conditions.
Rationale for Option D: This statement is incorrect because acute and chronic
conditions have distinctly different onset patterns. Acute conditions present abruptly
while chronic conditions develop gradually.
Question 2
A patient with cancer asks the nurse to explain how metastasis occurs through the
vascular system. Which explanation by the nurse is most accurate?
A. "Cancer cells remain in their original location and do not spread"
,B. "Cancer cells escape from the cell of origin through vascular/lymphatic flow and
create new colonies"
C. "Metastasis only occurs through direct extension to adjacent tissues"
D. "Cancer cells can only spread through the nervous system"
ANSWER: B
Rationale for Option A: This statement is incorrect. The defining characteristic of
malignant cancer is its ability to metastasize - to spread from the original site to other
parts of the body. Benign tumors remain in their original location.
Rationale for Option B: This is the correct ANSWER. Metastasis occurs when cancer
cells escape from the primary tumor through vascular (blood) or lymphatic flow, travel
through the circulation, and establish new tumor colonies at distant sites. This is the
fundamental mechanism of cancer spread.
Rationale for Option C: This statement is incorrect because while direct extension can
occur, metastasis specifically refers to spread through vascular or lymphatic systems to
distant sites, not just adjacent tissue invasion.
Rationale for Option D: This statement is incorrect. Cancer does not spread through the
nervous system as a primary mechanism. The main routes of metastasis are vascular
(hematogenous) and lymphatic spread.
Question 3
The nurse is teaching about the lymphatic system's role in metastasis. Which statement
accurately describes why the lymphatic system is particularly significant in cancer
spread?
A. "The lymphatic system has fewer pathways than the vascular system"
B. "The lymphatic system has more pathways and can build its own blood supply,
allowing it to go to atypical sites"
C. "The lymphatic system only drains fluid and has no role in cancer metastasis"
D. "Cancer cells cannot survive in the lymphatic system"
ANSWER: B
Rationale for Option A: This statement is incorrect. The lymphatic system actually has
MORE pathways compared to the vascular system, which is one reason why it's such
an effective route for cancer metastasis.
Rationale for Option B: This is the correct ANSWER. The lymphatic system has
extensive pathways throughout the body and tumors can induce lymphangiogenesis
(formation of new lymphatic vessels), essentially building their own drainage system.
,This allows cancer cells to reach atypical sites and contributes to widespread
metastasis.
Rationale for Option C: This statement is incorrect. While the lymphatic system does
drain fluid, it also plays a crucial role in cancer metastasis. Many cancers, particularly
breast cancer and melanoma, commonly spread through lymphatic channels.
Rationale for Option D: This statement is incorrect. Cancer cells not only survive in the
lymphatic system but often use lymph nodes as waystations to establish secondary
tumors before spreading further.
Question 4
A patient with breast cancer is found to have cancer cells in the axillary lymph nodes.
The nurse understands this represents which type of spread?
A. Direct extension
B. Lymphatic metastasis
C. Hematogenous metastasis only
D. Transcoelomic spread
ANSWER: B
Rationale for Option A: This is incorrect. Direct extension refers to cancer spreading by
direct invasion into adjacent tissues, not through lymphatic channels to lymph nodes.
Rationale for Option B: This is the correct ANSWER. The presence of cancer cells in
axillary lymph nodes indicates lymphatic metastasis, where cancer cells have traveled
through lymphatic vessels from the primary breast tumor to regional lymph nodes.
Rationale for Option C: This is incorrect. While hematogenous (blood-borne) metastasis
can occur, involvement of lymph nodes specifically indicates lymphatic spread.
Hematogenous metastasis would more likely result in distant organ involvement like
lungs, liver, or bone.
Rationale for Option D: This is incorrect. Transcoelomic spread refers to cancer
spreading through body cavities (like peritoneal or pleural cavities), not through
lymphatic channels.
Question 5
Which characteristic distinguishes chronic myeloid leukemia (CML) from other types of
leukemia?
A. Presence of Reed-Sternberg cells
B. High granulocyte count on CBC with differential and presence of Philadelphia
chromosome
, C. Exclusive involvement of lymphoid tissue
D. Absence of bone marrow involvement
ANSWER: B
Rationale for Option A: This is incorrect. Reed-Sternberg cells are characteristic of
Hodgkin's lymphoma, not CML. These are large, abnormal lymphocytes with a
distinctive appearance.
Rationale for Option B: This is the correct ANSWER. CML is characterized by a high
granulocyte count on complete blood count (CBC) with differential, and the presence of
the Philadelphia chromosome (Ph+), which is a specific genetic abnormality resulting
from translocation between chromosomes 9 and 22, creating the BCR-ABL fusion gene.
Rationale for Option C: This is incorrect. CML is a myeloid (not lymphoid) leukemia,
meaning it involves the myeloid cell line (granulocytes, monocytes, erythrocytes,
platelets) rather than lymphoid cells.
Rationale for Option D: This is incorrect. CML definitely involves the bone marrow. In
fact, bone marrow aspiration is one of the confirmatory diagnostic tests for CML.
Question 6
A patient is diagnosed with chronic myeloid leukemia. Which diagnostic test would the
nurse prepare the patient for to confirm the diagnosis?
A. Lymph node biopsy
B. Bone marrow aspiration
C. Lumbar puncture
D. CT scan of the abdomen
ANSWER: B
Rationale for Option A: This is incorrect. Lymph node biopsy is primarily used for
diagnosing lymphomas (Hodgkin's and Non-Hodgkin's), not leukemia. Leukemia is a
disease of the bone marrow and blood.
Rationale for Option B: This is the correct ANSWER. Bone marrow aspiration is the
confirmatory diagnostic test for CML and other leukemias. It allows examination of the
bone marrow cells, identification of the Philadelphia chromosome, and assessment of
the disease phase.
Rationale for Option C: This is incorrect. Lumbar puncture is used to check for central
nervous system involvement, particularly in ALL (Acute Lymphocytic Leukemia), but it is
not the primary confirmatory test for CML.
