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OCN Practice Tests 70 Questions with Verified Answers
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. - CORRECT 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. 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. - CORRECT ANSWER C. hypersensitivity reaction 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. 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. - CORRECT 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. 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. - CORRECT 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. 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. - CORRECT 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
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). 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. - CORRECT ANSWER B. I do not want to get an influenza shot until all my chemotherapy is finished 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. 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. - CORRECT ANSWER D. call for an ambulance. 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. 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. - CORRECT ANSWER D. suggest ways for the patient to participate in the treatment plan. 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. 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. - CORRECT ANSWER B. tumor lysis syndrome 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. 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:
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. 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. - CORRECT ANSWER C. tailor treatment approaches to the individual patient. 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. 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. - CORRECT ANSWER C. Have an interpreter translate with the grandson present 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. 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. - CORRECT ANSWER D. ask the patient to further explain his feelings 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. 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. - CORRECT ANSWER D. stop the infusion and flush the line with saline. 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. 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 mm C. White blood cell count, 2960 mm D. Absolute neutrophil count, 1700/mm3 - CORRECT ANSWER A. Hemoglobin level, 7.9 g/dl
distention, correcting the fluid imbalances, and removing the source of the obstruction. During counseling, a patient with breast cancer asks the nurse, "After I finish chemotherapy, how long should I wait to get pregnant?" The nurse's best response is: A. "Infertility is a permanent side effect of your therapy." B. "Pregnancy will increase your chance of recurrence." C. "You should wait at least one year." D. "No delay in necessary." - CORRECT ANSWER C. "You should wait at least one year." There appears to be no decrease in survival for women who become pregnant following treatment. Further pregnancy may actually protect against recurrence. For those desiring future pregnancies, it is recommended to wait one to five years following cessation of all treatment. The nurse informs a patient that a required premedication may cause drowsiness. The patient requests that treatment be delayed so he can be alert enough to pray at sunset. The nurse should: A. assess to determine if a delay is permissible. B. inform that the treatment cannot be delayed. C. require that a waiver be signed to delay treatment. D. delay the treatment for 24 hours. - CORRECT ANSWER A. assess to determine if a delay is permissible Nursing should support spiritual or cultural practices that are not detrimental to the patient's health. Which of the following actions must be performed first when developing an educational program? A. Formulate criteria for evaluation B. Select educational methods C. Assess learning needs
D. Determine educational objectives - CORRECT ANSWER C. Assess learning needs The initial key component in the nursing process when developing an educational program is to obtain a thorough assessment of learning needs. This is the first step in determining educational objectives, selecting educational methods, and then formulating criteria for evaluation. The adult children of a patient who has just died approach the nurse expressing feelings of sadness, helplessness, and numbness. The nurse can provide support to this family by: A. encouraging a family conference. B. validating needs for counseling for these feelings. C. encouraging discussion with the physician. D. validating these as normal feelings of grief. - CORRECT ANSWER D. Validating these as normal feelings of grief. Grief is a normal and expected reaction to a loss. Family members will grieve the loss of their loved ones. Nurses need to validate as normal the manifestations that the bereaved experience. Normal manifestations of grief include: sadness, anger, guilt, anxiety, loneliness, fatigue, helplessness, yearning, emancipation, relief, and numbness. When assessing the level of pain, the primary source of information is the patient's: A. vital signs. B. self-report. C. medical diagnosis. D. current pain medications. - CORRECT ANSWER B. Self Reporting Guidelines for cancer pain treatment from the Agency for Health Care Policy and Research, the American Pain Society, the National Comprehensive Cancer Network, and the World Health Organization (WHO) all use assessment of pain intensity through patient report as the most important consideration in determining treatment.
Nursing interventions for the management of nausea include encouraging patients to: A. use sauces and gravies. B. eat foods that are cold or at room temperature. C. eat high-protein and high-potassium foods. D. avoid brushing their teeth when they are nauseated - CORRECT ANSWER B. eat foods that are cold or at room temperature Nausea may be caused by cancer treatment or the disease itself. In addition to pharmacological management, patients should be taught self-care strategies to minimize nausea, such as consumption of foods that are cold or at room temperature. The smells from hot foods many increase nausea. Prostate cancer most frequently metastasizes to the: A. bone. B. brain. C. liver. D. lung. - CORRECT ANSWER A. bone The most common site of metastasis in prostate cancer is the bone. Rare sites of metastatic spread include the liver and lungs. An abnormal finding on the third postoperative day following a bowel resection with a colostomy for colon cancer is: A. a dull, gray stoma. B. a moist, bright pink stoma. C. slight bleeding from the stoma. D. air in the ostomy appliance. - CORRECT ANSWER A. a dull, grey stoma A healthy stoma should be reddish-pink and moist. A gray colored stoma indicates lack of blood flow, ischemia, or necrosis, and should be immediately reported to the physician.
Which of the following is prescribed for a patient diagnosed with surgically unresectable renal cell carcinoma that has metastasized to the liver? A. Fluorouracil B. Temsirolimus C. Nilotinib D. Cetuximab - CORRECT ANSWER B. temsirolimus About 30% of individuals with renal cell cancer present with metastasis at the time of diagnosis. Chemotherapy has not demonstrated a response in renal cell carcinoma, but various biological therapies have, including temsiroliums. A patient receiving doxorubicin through a peripheral IV catheter reports burning at the site, but there is no notable swelling. The nurse's first action is to: A. stop the administration of the drug. B. flush with 10ml of 0.9% normal saline. C. reposition the patient's arm. D. continue the administration while observing the site. - CORRECT ANSWER A. stop the administration of the drug. Doxorubicin is a vesicant, meaning it can cause tissue damage. Pain and burning at the IV site is an immediate manifestation of extravasation. Administration of the drug should be stopped at the first sign of infiltration. When considering general principles of rehabilitation in a patient with cancer, the nurse should: A. focus on disabilities. B. develop group goals. C. emphasize capabilities. D. encourage more frequent rest periods. - CORRECT ANSWER C. emphasize capabilities General principles of rehabilitative care include the emphasis of function versus dysfunction, and capability versus disability. Then, it should include a balance of activity and rest as well as provide an environment conducive to encouraging
Cancer is the predominant etiology for superior vena cava syndrome. Superior vena cava syndrome refers to signs and symptoms that occur when blood flow through the superior vena cava is compromised, resulting in venous congestion proximal to the occlusion and restricted cardiac output. Patients are frequently anxious and relief of symptoms is important. Many are orthopneic and most comfortable when sitting up. A chest x-ray will be positive in approximately 80- 85% of cases, and will be the first diagnostic measure. A patient with colon mesothelioma is scheduled for chemotherapy to be administered in the peritoneal space. The nurse expects the patient to have which type of access for this treatment? A. Ommaya reservoir B. Peripherally inserted central catheter C. Implanted, large diameter silicone port D. Arterial catheter - CORRECT ANSWER C. implanted, large diameter silicone port Intraperitoneal catheters or implanted ports are the type of devices indicated for delivery of high concentrations of chemotherapy to disease in the peritoneal cavity. Client selection criteria includes patients with metastatic cancer into the abdomen and peritoneum; diagnosis of cancers of the ovary or colon mesotheliomas; or malignant ascites. After a physician discusses the need for a descending colostomy with a patient who has colorectal cancer, the nurse informs the patient that the stoma site will be located: A. just below the waistline. B. in the right upper quadrant. C. in the right lower quadrant. D. in the left lower quadrant. - CORRECT ANSWER D. In the left lower quadrant The location of a transverse colostomy is just below the waistline. An ascending colostomy is located in the right upper quadrant. A sigmoid colostomy is located in the right lower quadrant. The descending colostomy is located in the left lower quadrant.
In addition to decreasing inflammation, corticosteroids: A. improve muscle tone. B. stimulate weight loss. C. stimulate the appetite. D. reduce anxiety. - CORRECT ANSWER C. stimulate the appetite Corticosteroids, such as dexamethasone and prednisone can stimulate the appetite. Additionally, this class of medications can create a sense of well-being, and may cause weight gain. A patient is ordered opiates around the clock for pain control. Prior to initiating opioid therapy, the nurse anticipates an order for: A. bulk laxatives. B. suppositories. C. stimulant laxatives. D. oral mineral oil. - CORRECT ANSWER C. stimulant laxatives Opioids can delay gastric emptying, slow bowel motility, decrease peristalsis, and reduce secretions from the colonic mucosa. Constipation is the most common side effect of opioids and the only one for which individuals do not develop tolerance. Prevention, rather than treatment, of opioid side effects is important. Stimulant laxatives plus a stool softener is recommended when initiating opioid therapy. In order to assist in resolving the patient's spiritual pain during end-stage disease, the priority nursing intervention is to: A. encourage random reflection of life events. B. mobilize the patient's support system. C. acknowledge the legitimacy of the patient's pain. D. encourage the patient to avoid focusing on the issues. - CORRECT ANSWER C. acknowledge the legitimacy of the patient's pain Spirituality, a part of every human being, is the connection to self , others, the environment, and a "higher power". Clients who have been alienated from their
When errors occur that could cause a possible injury to the patient, explanation of the error and possible long and short term effects should be explained. It is important that the nurse offer full disclosure of the event, and the steps to be taken. A 21-year-old patient recently withdrew from college classes secondary to cancer recurrence. His parents report that the patient is moody and is no longer seeing friends and classmates. The nurse initiates strategies aimed at achieving which of the following patient outcomes? A. Participation in a clinical trial B. Maintenance of open communication C. Re-enrollment in college courses D. Recognition of self-destructive behaviors - CORRECT ANSWER B. Maintenance of open communication Providing open communication between the patient and parents facilitates support and validation of feelings. To reduce the risk of complications from thrombocytopenia, patients are taught to avoid: A. using a soft-bristled toothbrush. B. getting a haircut. C. consuming high-fiber foods. D. walking barefoot. - CORRECT ANSWER D. walking barefoot Thrombocytopenia is a decrease in the number of circulating platelets below 100,000/mm3. Interventions to minimize the occurrence of bleeding include encouraging the patient to wear shoes during ambulation to maintain skin integrity and avoid injury. A patient in remission complains of dysthymic behaviors for the past several weeks. The nurse knows to assess for: A. recurrence of disease. B. cognitive learning.
C. bowel habits. D. depression. - CORRECT ANSWER D. depression Evidence suggests 25% of people with cancer have depression, and depressed people have poorer outcomes. Therefore, nurses need to assess for depression. Initial treatment of a patient in early septic shock includes the administration of: A. vasopressors. B. IV antibiotics. C. IV antifungals. D. high-dose corticosteroids. - CORRECT ANSWER B. IV antibiotics The hallmark of progressive septic shock is profound hypotension. The goals of treatment are to maintain blood pressure and tissue perfusion while treating underlying pathogens. Broad-spectrum antibiotics should be initiated within one hour of drawing blood cultures. The choice of empiric antibiotic therapy is based on the suspected site of infection and most likely causative pathogen. A patient has signed a consent form prior to beginning chemotherapy, and has questions regarding treatment. The nurse: A. addresses the patient's concerns prior to initiating treatment. B. asks the healthcare provider to discuss the treatment with the patient. C. ensures that the consent is signed and begins the treatment. D. begins administration while discussing the treatment with the patient. - CORRECT ANSWER A. addresses the patient's concerns prior to initiating treatment As a patient advocate, the nurse should encourage the patient to ask questions and provide the patient with information needed to make decisions. Informed consent involves ensuring a thorough understanding of the treatment by a patient and includes the right to withdraw consent at anytime. One of the roles of the nurse in the informed consent process is to reinforce and clarify info already presented. The first step in using evidence-based practice in the oncology clinical setting is to:
