Question 1
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.
ANSWER
A. washing hands frequently
There are many nonpharmacologic interventions for the prevention of infection.
Handwashing remains the single most important intervention to prevent infection.
Question 2
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.
ANSWER
C. hypersensitivity reaction
1
,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.
Question 3
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.
ANSWER
B. methylphenidate
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.
Question 4
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.
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,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.
ANSWER
D. 30 mg of sustained-release oxycodone every 12 hours
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.
Question 5
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.
ANSWER
C. impending spinal cord compression
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.
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, Question 6
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
ANSWER
C. Adeno and squamous
Tumors are classified by the tissue of origin. The malignancies that arise from the epithelium
are squamous cell, adenocarcinoma, basal cell, and choriocarcinoma.
Question 7
The severe pain associated with post-herpetic neuropathy is most effectively treated by:
A. propoxyphene.
B. hydromorphone.
C. amitriptyline.
D. extra-strength acetaminophen.
ANSWER
C. amitriptyline.
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.
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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.
ANSWER
A. washing hands frequently
There are many nonpharmacologic interventions for the prevention of infection.
Handwashing remains the single most important intervention to prevent infection.
Question 2
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.
ANSWER
C. hypersensitivity reaction
1
,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.
Question 3
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.
ANSWER
B. methylphenidate
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.
Question 4
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.
2
,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.
ANSWER
D. 30 mg of sustained-release oxycodone every 12 hours
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.
Question 5
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.
ANSWER
C. impending spinal cord compression
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.
3
, Question 6
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
ANSWER
C. Adeno and squamous
Tumors are classified by the tissue of origin. The malignancies that arise from the epithelium
are squamous cell, adenocarcinoma, basal cell, and choriocarcinoma.
Question 7
The severe pain associated with post-herpetic neuropathy is most effectively treated by:
A. propoxyphene.
B. hydromorphone.
C. amitriptyline.
D. extra-strength acetaminophen.
ANSWER
C. amitriptyline.
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.
4
