NCLEX : NCLEX

Study concepts, example questions & explanations for NCLEX

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Example Questions

Example Question #851 : Nclex

The oncology nurse cares for a patient newly diagnosed with breast cancer. What are common risk factors for this type of cancer? 

Possible Answers:

Immunosuppression, advancing age, genetic predisposition

Pharmaceutical use, alcohol, radiation

Stress, advancing age, chronic irritation

Radiation, chronic irritation, smoking

Smoking, advanced age, genetic disposition

Correct answer:

Immunosuppression, advancing age, genetic predisposition

Explanation:

All of these may be factors in the diagnosis of cancer. The operative word in the question is ‘risk.’ Common risk factors for breast cancer include previous immunosuppression, advancing age, and genetic predisposition. Common causative factors include smoking, alcohol use, radiation,  chronic irritation, consumption of food additives, exposure to industrial chemicals such as asbestos, exposure to dangerous pharmaceuticals such as stillbesterol, previous viral infection such as Epstein-Barr, and stress (when combined with other causative factors).

Example Question #46 : Conditions And Treatments

You are the nurse taking care of a patient newly diagnosed with ovarian cancer. Which of the following biomarkers is typically followed to assess the progress of disease (or response to treatment) in ovarian cancer patients?

Possible Answers:

BCR/ABL

Prostate specific antigen (PSA)

Cancer antigen 19-9 (CA 19-9)

Cancer antigen 125 (CA-125)

c-KIT

Correct answer:

Cancer antigen 125 (CA-125)

Explanation:

The correct answer is "Cancer antigen (CA-125)" because CA-125, also known as mucin 16, is a glycoprotein that is found to have elevated serum levels in patients with a variety of cancers (including ovarian cancer) and benign conditions, as compared to patients without such conditions. As a result, monitoring CA-125 levels can be used as a method of tracking disease progression or response to treatment based upon what the initial CA-125 level is at the time of diagnosis. 

On the other hand, the other choices are incorrect. Cancer antigen 19-9 (CA 19-9) is incorrect as this is a biomarker in pancreatic cancer, not ovarian cancer.Prostate specific antigen (PSA) is incorrect as this is a biomarker in prostate cancer (and other prostate conditions), not ovarian cancer. c-KIT is incorrect as this is a biomarker in gastrointestinal stromal tumors, not ovarian cancer. BCR/ABL is incorrect as this is the translocation found in the Philadelphia Chromosome implicated in chronic myelogenous leukemia, not ovarian cancer.

Example Question #5 : Symptoms And Tests For Tumors

You are the nurse taking care of a patient newly diagnosed with pancreatic cancer. Which of the following biomarkers is typically followed to assess the progress of disease (or response to treatment) in pancreatic cancer patients?

Possible Answers:

BRAF

CD20 antigen

Cancer antigen 19-9 (CA 19-9)

Cancer antigen 125 (CA-125)

CD30

Correct answer:

Cancer antigen 19-9 (CA 19-9)

Explanation:

The correct answer is "Cancer antigen 19-9 (CA 19-9)" because CA 19-9 is often elevated in patients who have pancreatic cancer (or certain types of colon cancers), and can be used to assess response to treatment and/or disease progression. 

On the other hand, the other choices are incorrect. Cancer antigen-125 (CA-125) is incorrect as this is a tumor marker used to track ovarian cancer, not pancreatic cancer. CD20 antigen is a tumor marker for B-cell lymphomas and leukemias, not pancreatic cancer. CD30 antigen is a tumor marker for anaplastic large cell lymphoma, not pancreatic cancer. BRAF is a tumor marker for melanoma, not pancreatic cancer.

Example Question #851 : Nclex

Which of the following image modalities would be best suited to diagnose a suspected lung cancer?

Possible Answers:

CT scan

Chest x-ray

EKG

EEG

Correct answer:

CT scan

Explanation:

A CT scan is the preferred imaging modality to view a tumor in the lung tissue. A chest x-ray might initially find a nodule or abnormal marking in the lungs, but it must be followed up with a CT scan to be diagnostic. EKG looks at the heart and EEG looks at the brain. 

Example Question #42 : Tumors And Cancer

You are the nurse taking care of a patient in an oncology clinic who was treated with chemotherapy and radiation therapy for anal cancer. The patient finished treatment two weeks ago. Which of the following treatment side effects would you expect to see?

Possible Answers:

Fever

Headache

Rectal bleeding

Pupil dilation 

Eye redness

Correct answer:

Rectal bleeding

Explanation:

The correct answer is "rectal bleeding." This answer is correct, as the patient is being treated with chemotherapy and radiation therapy for anal cancer, and is multiple weeks removed from treatment. Rectal bleeding is a very common side effect in patients who recently received radiation therapy to the anus, as numerous blood vessels are treated by the radiation therapy, and the body's immunologic response to radiation therapy also promotes vascular permeability. Rectal bleeding, unless profuse and uncontrolled is often a self-limiting phenomenon in the setting of radiation and while troublesome for the patient, does not pose much of an acute threat to the patient's stability.

Fever is something that should be taken seriously in any cancer patient, especially one receiving chemotherapy. However, it should not necessarily be expected. It should always be assessed for.

Headache is a common side effect in patients actively receiving chemotherapy, often either directly due to the chemotherapy drug itself, or to dehydration as a side effect of treatment/lack of appetite. This patient is multiple weeks removed from chemotherapy though, so headache would not be expected as a treatment side effect at this time.

Pupil dilation and eye redness are not typical side effects of chemotherapy or radiation therapy for anal cancer.

Example Question #852 : Nclex

You are the nurse at an oncology practice taking care of an otherwise healthy 22-year old male being treated with chemotherapy and radiation for Hodgkin's lymphoma. His chemotherapy regimen consists of doxorubicin, bleomycin, vinblastine, and dacarbazine. He is not receiving any other medications. He reports feeling well aside from fatigue, and numbness and tingling of his hands and feet. Which of the following is the most likely cause of the hand and foot numbness and tingling?

Possible Answers:

Bleomycin-induced neuropathy

Vinblastine-induced neuropathy

Diabetic neuropathy

Posterior spinal cord degeneration

Selective serotonin reuptake inhibitor discontinuation syndrome

Correct answer:

Vinblastine-induced neuropathy

Explanation:

The correct answer is "Vinblastine-induced neuropathy." 

This is the most likely explanation for this patient's peripheral neuropathy, as the patient is described as being healthy aside from Hodgkin's lymphoma, and on no medications aside from his chemotherapy regimen. As a result, diabetic neuropathy and selective serotonin reuptake inhibitor discontinuation syndrome can each be ruled out as etiologies. Similarly, given that he is otherwise healthy and not complaining of any additional neurological symptoms (and given that he is young and actively receiving chemotherapy) it is unlikely that he is experiencing posterior spinal cord degeneration. 

Thus, in a young patient with lymphoma who is receiving chemotherapy and experiencing peripheral neuropathy, the most likely etiology is one of the chemotherapy medications that he is receiving. In this patient's case, he is receiving doxorubicin, bleomycin, vinblastine, and dacarbazine. Of these medications, vinblastine is the most strongly associated with peripheral neuropathy, as this is a fairly common side effect of vinblastine and other agents in the same class (vinca alkaloids). As such, vinblastine-induced neuropathy is the most likely etiology.

Example Question #852 : Nclex

You are a nurse at an oncology clinic taking care of a 65-year old male with stage one non-small cell lung cancer (NSCLC) who is one year removed from a wedge resection and chemotherapy. Which of the following tests would be best to assess treatment response in this patient?

Possible Answers:

CT (without PET)

X-ray

PET-CT

MRI

Pulmonary function tests

Correct answer:

PET-CT

Explanation:

The correct answer is "PET-CT." This is the correct answer because a PET-CT shows not only spatial information from the serial slices taken on CT imaging, which would include the size and location of any potential tumor, scarring, or nodal involvement, but also the FDG-avidity or uptake of the contents of the image, which would help correlate the spatial findings with possible disease activity. Nodules observed on a CT scan can be non-descript, ranging from malignant, to indeterminate, to benign (which may still be infectious or inflammatory). The addition of PET to a CT allows the observer to see which nodules, nodes, or lesions are more likely to be indicative of disease burden, as tumors and infections will have greater FDG uptake since they are more metabolically active than surrounding tissues. 

MRI is not typically used to assess treatment in lung cancer as CT coupled with PET is more commonly used. X-ray does not provide enough resolution to adequately assess response to cancer treatment. Pulmonary function tests, while a useful measure of lung functionality, do not give a specific picture of the lung cancer burden and as such are not the best treatment response assessment tool.

Example Question #51 : Tumors And Cancer

You are the nurse in an oncology clinic taking care of a patient with a glioblastoma who has been receiving chemotherapy and radiation therapy. You want to assess response to treatment. Which of the following images should would best assess treatment response?

Possible Answers:

CT Head without contrast

MRI Head

X-ray Head

CT Head with contrast

PET-CT

Correct answer:

MRI Head

Explanation:

The correct answer is "MRI Head." This is the correct answer because in evaluating brain parenchyma, which is relatively soft tissue, MRI provides the greatest degree of spatial resolution, which would best allow assessment of any residual, recurrent, or new tumor burden within the brain. CT imaging is commonly used to assess the brain when evaluating for bleeds or fractures, among other conditions, as it is far more expedient than MRI. However, it does not visualize the soft tissue of the brain parenchyma as well as MRI, and treatment response MRI scans are often not emergent, and therefore MRI would be preferred. PET-CT, while often highly useful in oncologic assessments is of limited value in evaluating the brain for cancer response, because the entire brain is highly metabolically active in nearly all patients, and therefore the entire brain typically has a great deal of FDG uptake uniformly, limiting the value of the scan.

Example Question #1 : Respiratory Conditions

A client had just undergone a total right knee replacement and has just returned from the operating room. Later that evening, the client suddenly begins to complain of shortness or breath and chest pain on inspiration. The nurse caring for this client further notes the coughing up of blood and that he is sweating profusely.

Which of the following nursing interventions should the nurse perform first? 

Possible Answers:

Place in Fowler's position

Draw blood for arterial blood gasses (ABG's)

Auscultate for breath sounds

Give oxygen

Assess the client's mental status

Correct answer:

Place in Fowler's position

Explanation:

The priority for this client is to ensure a patent airway by placing him the Fowler's or semi upright seated position. Giving oxygen is warranted but will be given after the client is positioned correctly. ABG's would be helpful in this situation but it not the priority. Auscultation of breath sounds and assessment of mental status are not indicated.

Example Question #1 : Respiratory Conditions

What is the final stage of a pertussis infection?

Possible Answers:

The post-infectious stage

The convalescent stage

The recovery phase

The paroxysmal stage

Correct answer:

The convalescent stage

Explanation:

The final stage of a pertussis infection is known as the convalescent phase. This occurs for 2-6 weeks, after the paroxysmal stage of the disease. During this time coughing decreases, and paroxysms are less severe. The infected individual may experience increased susceptibility to upper and lower respiratory conditions for as much as 6 months after resolution of the infection.

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