N1120 Test Blueprint-Oncology

Oncology Test Questions/Blueprint

Question Course Step in the Cognitive Difficult Item Response Objective Nursing Level y Level Discrim Process (Blooms) . 1. Which statement regarding general cancer development is true? assess Remember 0.883 0.1 a. The risk for cancer development increases with age. b. Cancers usually develop in tissues that do not retain their ability to divide. c. Children born to older mothers have a greater risk for cancer development. d. Most mutations leading to cancer development occur in structural genes 2. By which process does “initiation” assist in the development of assess Remember 0.390 -0.1 MODIFY cancer? Understand

a. Carcinogen inflicts mutations at specific sites on the cell wall b. The initial tumor increases in size and causes metastasis c. Exposure to carcinogen results in division of mutated cells d. Making cancer cells appear more normal in order to escape immunosurveillance by the body

MODIFIED answer “A” 1120-VIII-3 By which process does “initiation” assist in the development of cancer?

a. Carcinogen inflicts damage to the cell wall b. The initial tumor increases in size and causes metastasis c. Exposure to carcinogen results in division of mutated cells d. Making cancer cells appear more normal in order to escape immunosurveillance by the body

©2011 Keith Rischer/www.KeithRN.com 3. Seeking to prevent cancer, nurses frequently counsel patients on Implement Understand 1.000 0.0 lifestyle choices related to dietary fat intake, tobacco use and Apply alcohol consumption. The goal of behavioral changes is to: a. minimize or reverse the promotion of cancer development

b. prevent metastasis of cancerous tumors

c. reverse cancer progression once it has been initiated

d. stimulate T cell production so the bodies immune system can be more effective

4. Your patient in clinic is a 61-year-old woman who is 5 feet, 4 Assess Understand 1.000 0.0 inches tall and weighs 125 pounds. She works for the post implement Apply office and has a 5-mile daily walking mail-delivery route. This Analyze is her first contact with the health care system in 20 years. Which of these topics will the nurse plan to include in patient teaching about cancer prevention for this patient? Need to increase physical activity and weight loss a.

Evaluate use of sunscreen and yearly Pap testing b.

c. Need for mammogram testing d. b & c e. a, b, c

5. Examples of carcinogens that can initiate or promote cancer assess Understand 0.857 0.2 development include: Apply

a. Smoking b. Ionizing and ultraviolet radiation c. Diet high in fiber and low in fat d. a & b e. a,b,c

6. While she is being prepared for a biopsy of a lump in her right implement Understand 1.000 0.0 breast, the patient asks the nurse what the difference is between a benign tumor and a malignant tumor. The nurse explains that a benign tumor differs from a malignant tumor in that benign tumors: ©2011 Keith Rischer/www.KeithRN.com a. are rapidly growing in size

b. are undifferentiated and do not resemble the tissue of origin

c. do not metastasize to other tissues and organs

d. metastasize to other tissues and organs

7. Which of the following diagnostic procedures can determine assess Understand 0.987 0.0 whether a tumor is benign or malignant? Apply

a. Positive Emission Tomography (PET) scan

b. Needle aspirated biopsy

c. Computed tomography (CT) scan

d. Magnetic resonance imaging (MRI)

8. A patient with breast cancer is told her cancer had assess Understand 0.974 0.0 metastasized to her lung. Which of the following Apply statements is correct?

a. The patient now has breast and lung cancer.

b. Breast cancer increases the risk of lung cancer.

c. The patient has breast cancer with metastasis to the lung.

d. The patient has experienced benign tumor activity.

9. Your patient with breast cancer has a small tumor with no assess Understand 0.922 0.1 spread or lymph node involvement. Using clinical staging, Apply this would be:

a. Stage I

b. Stage II

c. Stage III

d. Stage IV

©2011 Keith Rischer/www.KeithRN.com 10. The nurse closely monitors the CBC laboratory results of a assess Understand 0.779 0.4 patient receiving chemotherapy. The drug regimen may Apply need to be discontinued or modified if the results include: Analyze Evaluate a. Hemoglobin of 11 g/dl b. WBC count of 1200/mm3 c. platelets of 120,000/mm3 d. creatinine level of 1.2 mg/dl 11. Chemotherapy agents exert their physiologic influence to assess Understand 0.779 0.2 destroy cancer cells by: Apply

a. Damaging cellular DNA of only oncologic cells b. Damaging cellular DNA of all cells in the human body, especially those that are rapidly dividing c. Damaging the cell wall of all cells in the human body, especially those that are rapidly dividing d. Damaging the cell wall of all cells in the human body, especially those that are slow dividing 12. A hospitalized patient who has received chemotherapy for Assess Understand 0.948 0.1 leukemia develops neutropenia. Which observation by the implement Apply nurse caring for the patient indicates that they should intervene?

a. Groups of the patients coworkers visit each lunch hour.

b. Dietary staff do not do hand hygiene upon entering the room.

c. Dietary staff do not wear a gown upon entering the room.

d. Dietary staff do not wear a mask upon entering the room.

13. .When assessing a patient’s needs for psychological support Assess Understand 0.974 -0.1 after the patient has been diagnosed with stage IV cancer of implement Apply the colon, which question by the nurse will be the most meaningful?

a. “Can you tell me what has been helpful to you in the past when coping with stressful events?”

c. “Are you familiar with the stages of grief related to a diagnosis of cancer?”

d. “How do you feel about dying?”

14. What lab value will be elevated with your patient with lung assess Understand 0.818 0.4 cancer who now has suspected metastasis to the spine? Apply

a. Potassium

b. Calcium

c. Lactate

d. Magnesium

15. A patient with metastatic cancer of the colon experiences severe Assess Understand 0.961 0.0 vomiting following each administration of chemotherapy. implement Apply The most important nursing intervention for this patient is to: Evaluate

a. increase fluid intake before each chemotherapy treatment.

b. have the patient eat full meals when nausea is not present.

c. administer Prochlorperazine (Compazine) prn one hour before chemotherapy treatment.

d. offer dry crackers and carbonated fluid immediately following chemotherapy treatment.

16. Your patient is to receive Lorazepam (Ativan) to treat post Assess Understand 0.870 0.3 chemotherapy nausea. Because of your knowledge of the implement Apply mechanism of action of this drug after administration you Evaluate will need to closely assess for:

a. Drowsiness b. Tachycardia c. Insomnia d. Hypertension

©2011 Keith Rischer/www.KeithRN.com 17. 1120- A patient receiving head and neck radiation and systemic Assess Understand 0.805 0.2 chemotherapy has ulcerations over the oral mucosa and tongue. implement Apply An appropriate intervention for the nurse to perform is to:

a. remove food debris from the teeth and oral mucosa with a stiff toothbrush.

b. use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth.

c. gargle and rinse the mouth several times a day with an antiseptic mouthwash.

d. rinse the mouth before and after each meal and at bedtime with a saline solution.

18. In reviewing the labs and nursing assessment data for your assess Understand 0.818 0.0 patient receiving chemotherapy for cancer, all of the following Apply results are listed. Which findings should alert the nurse to the Analyze possibility of sepsis: evaluate

a. WBC 1000 mm3 and Neutrophils 50% for Absolute Neutrophil Count (ANC) of 500

b. Oral temperature of 99.5 F

c. Oral temperature of 100.5 F d. a & b

e. a & c

19. Your patient has just had radiation therapy to a tumor in their Assess Understand 0.506 0.4 right lung. You will include the following nursing interventions in your implement Apply plan of care EXCEPT:

a. Assess skin integrity regularly for any breakdown b. Keep chest covered and prevent exposure as much as possible c. Expose skin to air as much as possible d. Cleanse skin with normal saline 20. Your patient with lung cancer has had recent radiation therapy, assess Understand 0.974 0.0 and is now showing signs of sepsis/septic shock. You would expect Apply to see all of the following EXCEPT: Analyze Evaluate a.Decreasing blood pressure

c.Increased heart rate

d.Anxiety-restlessness

21. Surgery to bypass an intestinal obstruction due to widespread assess remember 0.987 0.1 metastasis in the abdomen would have as its major aim the: Understand

a. cure of the cancer.

b. palliation of symptoms.

c. prevention of further metastatic spread.

d. preparation of the patient for immunotherapy.

22. A 63-year-old man who has terminal cancer of the liver is cared Assess Understand 0.987 0.0 for by his wife at home. His abdominal pain has become Implement Apply increasingly severe, and he now states that the pain is intense most evaluate Evaluate of the time. The nurse recognizes that patient/family teaching regarding pain management with Oxycodone has been effective when the patient:

a. limits the use of opiate analgesics to prevent addiction.

b. resigns himself to the fact that pain is an inevitable consequence of cancer.

c. uses pain medication only when the pain becomes more than he can tolerate.

d. takes analgesics around the clock on a regular schedule, using additional

doses for breakthrough pain.

23. Your patient with breast cancer says that she is now having assess Remember 0.948 0.0 sudden onset of increased pain in her lower back. What problem Understand should the nurse suspect is related to this symptom?

a. Arthritis b. Urinary retention c. Metastasis to the bone ©2011 Keith Rischer/www.KeithRN.com d. Muscle atrophy from inactivity 24. 1124.MODIFIED N1120-VIII-4 The nurse is teaching a colon cancer implement Understand 0.740 0.3 MODIFY patient about the expected outcomes of her cancer treatment. Apply The nurse evaluates that the teaching has been effective when the patient states:

a. “After cancer has not recurred for 5 years, it is considered cured.”

b. “I will need to have follow-up examinations for ten years after I have treatment before I can be considered cured.”

c. “Cancer is considered cured if the entire tumor is surgically removed.”

d. “Cancer is never considered cured, but the tumor can be controlled with surgery, chemotherapy, and radiation.”

25. 1125. A patient returns to the surgical unit following a right Assess Understand 0.974 0.1 mastectomy with removal of axillary lymph nodes. The most implement Apply appropriate intervention for the nurse to include in implementing postoperative care for the patient includes:

a. teaching the patient to use the ordered patient-controlled analgesia (PCA) every 10 minutes and to use a timer to help her remember.

b. posting a sign at the bedside warning against blood pressures or venipunctures in the left arm.

c. posting a sign at the bedside warning against blood pressures or venipunctures in the right arm.

d. encouraging the patient to obtain a permanent breast prosthesis as soon as she is discharged from the hospital.

KEY: Cognitive Level: Item Discrimination = how well an item distinguishes between high and low scoring students. Remembering  0 is OK if it’s info that everyone absolutely needs to know, i.e. key content. Understanding  .2 to .3 is desirable for most Applying  .4 or higher is OK for just a few questions. If all were .4, most of our students would fail the test. Analyzing ©2011 Keith Rischer/www.KeithRN.com Evaluating  Negative discrimination means a problem, like a poorly written question, mis-speaking in lecture, not fully clarifying a Creating topic, or an error on the answer key.

Add the item analysis statistics to the blueprint after you administer the test. Use these stats for improving you test items.

1. What is the most effective intervention to teach your patient to decrease their likelihood of developing cancer? a. Monthly self-breast exams b. Smoking cessation c. Annual PAP exams d. Monthly testicular exams

2. Your oncology patient who just started assess Understand 0.810 0.3 chemotherapy spiked a temperature to 103 F, Apply what labs ordered by the physician will be Analyze relevant to closely monitor and trend: a. Total white blood cell count (WBC) b. Neutrophil differential percentage c. Serum lactate d. a & b e. a, b, c 3. The side effects commonly seen in a patient assess Understand 0.722 0.3 receiving chemotherapy are due to: apply a. impact on rapidly dividing cells in the body b. impact on only the cancerous cells in the tumor c. release of intracellular breakdown products d. a & c 4. When asked by a patient “how does someone assess Understand 0.937 0.2 get cancer?” the nurse’s reply is based on their apply knowledge that cancer can be associated with: a. genetic and hormonal factors b. environmental and dietary factors c. viruses d. a & b e. a, b & c 5. Your patient is newly diagnosed with cancer Assess Understand 1.000 0.0 and is scheduled to begin chemotherapy implement apply treatment. As part of your education plan, what

©2011 Keith Rischer/www.KeithRN.com is the most common side effect that you will prepare her for: a. Hyperkalemia b. Nausea and vomiting c. Altered glucose metabolism d. Increased appetite 6. Your oncology patient develops erythema Assess Understand 0.772 0.3 following radiation therapy. What should the implement apply nurse instruct the patient to do? a. Apply ice to the area. b. Keep the area cleanly shaven. c. Apply petroleum ointment to the affected area. d. Expose skin to air as much as possible 7. You are admitting an oncology patient to your assess Understand 0.848 0.4 unit prior to surgery. The patient has just apply finished radiation therapy. What is the most serious complication that this puts your patient at increased risk for? a. Nutritional deficit b. Infection/sepsis c. Cardiac tamponade d. Hypercalcemia