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WorksheetsCancer, Leukemia & Lymphoma – NCLEX-Style Exam
Total questions: 50
Worksheet time: 25mins
The nurse understands that the hallmark feature of all cancers is:
Slow, regulated cell division
Abnormal and unregulated cellular proliferation
Controlled cell differentiation
Excessive apoptosis
Which characteristic best differentiates malignant from benign neoplasms?
Benign tumors invade surrounding tissues
Malignant cells metastasize and lose normal function
Benign cells are undifferentiated
Malignant tumors grow slowly and symmetrically
A nurse teaching about cancer risk factors includes which as modifiable?
Gender
Age
Tobacco and alcohol use
Family history
A patient receiving chemotherapy reports fatigue and pallor. Which lab result should the nurse monitor first?
Hemoglobin and hematocrit
Sodium and potassium
Calcium and phosphate
BUN and creatinine
A nurse caring for a leukemia patient understands that this disease involves:
Increased platelet production
Overproduction of abnormal white blood cells
Destruction of lymphocytes
Metastasis from solid tumors
Which clinical manifestation is most likely in leukemia due to bone marrow suppression?
Bradycardia
Hypertension
Fatigue, infection, and bleeding tendencies
Weight gain and edema
The nurse recognizes that neutropenia in a cancer patient primarily increases the risk for:
Bleeding
Infection
Anemia
Dehydration
A leukemia patient’s ANC is 480. Which action is priority?
Encourage ambulation
Monitor blood glucose
Report fever ≥100.4°F immediately
Provide high-fiber diet
Which isolation precaution is appropriate for a neutropenic patient?
Contact isolation
Airborne isolation
Protective isolation with hand hygiene and no live plants
Standard precautions only
Which finding in a leukemia patient with platelets of 50,000/mL requires immediate attention?
Gingival bleeding
Petechiae on legs
New confusion and headache
Ecchymosis on arms
A patient receiving chemotherapy asks why Filgrastim (Neupogen) is prescribed. The nurse responds:
It boosts red blood cell production.
It stimulates white blood cell (neutrophil) production.
Which lab findings indicate aplastic anemia secondary to chemotherapy?
Elevated WBC and low Hgb
Decreased RBCs, WBCs, and platelets
Elevated platelets and WBCs
Low MCV and high MCHC
When teaching about thrombocytopenia precautions, which statement indicates further teaching is needed?
I’ll use a soft toothbrush.
I’ll avoid contact sports.
I’ll take aspirin for mild pain.
I’ll use an electric razor.
Hodgkin lymphoma is characterized by which diagnostic finding?
Presence of Reed–Sternberg cells
High reticulocyte count
Decreased ferritin
Absence of lymphadenopathy
Which symptom commonly occurs in Hodgkin lymphoma?
Tender, fixed lymph nodes
Moveable, non-tender lymph node enlargement
Petechiae and purpura
Splenectomy required
Which cause is most strongly associated with Hodgkin lymphoma?
Epstein–Barr virus
Human papillomavirus
Radiation therapy
Vitamin deficiency
A patient with non-Hodgkin lymphoma is more likely to present with which pattern?
Localized, early-stage disease
Painless, widespread lymph node enlargement
Rapid regression without therapy
Night sweats without lymph involvement
Which symptom may indicate widespread involvement in non-Hodgkin lymphoma?
Hyperpigmented skin
Hepatomegaly and neurologic symptoms
Tinnitus
Hematuria
Which diagnostic test confirms leukemia or lymphoma?
Serum electrolytes
Bone marrow biopsy
Chest x-ray
Liver ultrasound
A patient with advanced cancer develops weakness, poor appetite, and significant weight loss. This syndrome is known as:
Anorexia nervosa
Cancer cachexia
Addison crisis
Hypoglycemia
Which statement by a patient receiving chemotherapy indicates correct understanding of infection prevention?
I’ll take my temperature once a day.
I’ll avoid raw fruits and vegetables unless they’re well washed.
I should limit fluid intake to avoid edema.
I’ll skip my flu shot to protect my immune system.
A nurse recognizes which sign as the earliest indicator of infection in a neutropenic patient?
Productive cough
Low-grade fever
Purulent drainage
Tachycardia
The nurse is teaching a patient with leukemia about diet. Which instruction is most appropriate?
Avoid foods high in protein.
You may eat unpasteurized dairy.
Avoid undercooked meats and wash produce well.
Increase your fiber intake with raw salads.
Which blood component is primarily affected in leukemia?
Erythrocytes
Platelets
Leukocytes
Plasma
During chemotherapy, a patient reports tingling in fingers and toes. The nurse documents this as:
Peripheral neuropathy
Paresthesia from anemia
Tumor lysis syndrome
Myelosuppression
A patient receiving chemotherapy complains of painful mouth ulcers. Which intervention is most appropriate?
Provide lemon-glycerin swabs
Offer spicy foods to stimulate appetite
Rinse mouth with saline or sodium-bicarbonate solution
Use alcohol-based mouthwash after meals
Which activity is safe for a patient with thrombocytopenia?
Flossing daily
Walking in the hall twice a day
Playing contact sports
Using straight-edge razor
Which statement by a cancer patient on radiation therapy requires intervention?
I will use mild soap and water on the treatment area.
I'll apply lotion before my radiation session.
I'll wear loose cotton clothing.
I should protect the area from sunlight.
A patient receiving chemotherapy develops mucositis. The nurse should prioritize which nursing diagnosis?
Risk for fluid volume deficit
Impaired gas exchange
Risk for falls
Impaired urinary elimination
Which blood value places the patient at highest risk for bleeding?
WBC = 9,000
Platelets = 40,000
Hgb = 13 g/dL
Hct = 38 %
The nurse knows that oncologic emergencies can include which finding?
Bradycardia
Hypercalcemia
Hyponatremia
Hypokalemia
Which intervention reduces hypercalcemia in metastatic cancer?
Encourage bed rest
Administer loop diuretics and IV fluids
Restrict fluids
Administer potassium supplements
Which description best explains 'angiogenesis'?
Spread of cancer to distant sites
Formation of new blood vessels feeding a tumor
Programmed cell death
Activation of tumor-suppressor genes
The nurse suspects a patient may have cancer when they report:
Rapid weight gain
Change in bowel or bladder habits
Cold intolerance
Decreased thirst
What is the primary goal of chemotherapy?
Eliminate localized tumors
Destroy rapidly dividing cells systemically
Increase immune tolerance
Prevent angiogenesis
A patient receiving combination chemotherapy asks why more than one drug is used. The nurse explains:
It’s to shorten your hospital stay.
Different drugs attack cancer cells at different stages.
It prevents allergic reactions.
It reduces nausea.
Which assessment finding suggests tumor lysis syndrome?
Hypokalemia
Hyperuricemia
Hypophosphatemia
Metabolic alkalosis
A nurse caring for a patient post–bone-marrow transplant should:
Limit oral fluids
Place the patient in protective isolation
Provide fresh flowers for comfort
Administer live vaccines
The nurse knows that biologic therapy (immunotherapy) for cancer works by:
Directly destroying DNA of cancer cells
Stimulating the patient’s own immune system
A nurse recognizes that “cachexia” refers to:
Abdominal fluid accumulation
Severe tissue wasting and weight loss
Increased muscle mass
Elevated hemoglobin
Which finding indicates possible metastasis of lymphoma?
Local lymph node swelling only
Hepatomegaly and splenomegaly
Petechiae
Cough with hemoptysis
The nurse caring for a patient with leukemia notes Hgb 8 g/dL, Hct 25 %, WBC 2,000, and platelets 30,000. Which intervention is priority?
Encourage ambulation
Maintain neutropenic and bleeding precautions
Provide high-fiber diet
Administer aspirin for pain
During induction chemotherapy, which goal is most important?
Induce remission
Maintain nutrition
Prevent nausea
Encourage exercise
The nurse monitors for tumor lysis syndrome in leukemia because cell destruction can cause:
A. Hypocalcemia and hyperkalemia
B. Hypercalcemia and hypokalemia
C. Hyponatremia
D. Hypophosphatemia
Which lab value indicates the patient with leukemia is responding to Filgrastim (Neupogen)?
Increased ANC
Decreased Hgb
Decreased WBC
Increased platelet count only
A nurse teaching about Hodgkin lymphoma emphasizes which classic symptom cluster?
Cough, fever, tachycardia
Fever, night sweats, and weight loss
Edema, pallor, and petechiae
Painful, tender lymph nodes
Which assessment finding requires immediate follow-up in a patient with lymphoma?
Fatigue
Shortness of breath and stridor
Mild nausea
Dry skin
Which statement by a patient with Hodgkin lymphoma receiving chemotherapy indicates a need for more teaching?
I will report any fever over 100.4°F.
I’ll avoid crowded places.
I can receive my live shingles vaccine next week.
I’ll wash my hands often.
A patient receiving radiation develops erythema at the treatment site. The nurse should:
Mark the area with permanent ink
Apply thick moisturizer before treatment
Use ice packs frequently
Cover with adhesive dressings
The nurse evaluates teaching for a patient with non-Hodgkin lymphoma. Which statement shows understanding?
A. “This disease often involves several organs when it’s found.”
B. “It usually stays in one lymph node area.”
