NEW
Font size
WorksheetsUnit 4 Study Guide
Total questions: 74
Worksheet time: 37mins
Which action is priority in the first 24 hours after esophageal cancer surgery?
Maintain Fowler’s or semi-Fowler’s positioning
Clamp the chest tube to limit drainage
Encourage oral fluids to promote hydration
Reinsert the nasogastric tube if dislodged
After esophagectomy, the nasogastric drainage is expected to appear how during the first 5–7 days?
Bloody then greenish-yellow later
Clear and odorless throughout
Milky and frothy immediately
Brown and thick from day one
Which finding should be reported immediately in a post-esophagectomy patient with a chest tube?
Minimal fluctuation with quiet respirations
No bubbling in the water seal chamber
Serous drainage totaling 50 mL in 12 hours
Drainage greater than 400–600 mL in 8 hours
For head and neck cancer post-op care with a tracheostomy, which intervention is essential?
Removal of the trach within 24 hours
Covering skin flaps with bulky dressings
Routine manipulation of the nasogastric tube
Frequent trach suctioning and airway management
A patient with a new neck skin flap after surgery requires which nursing approach?
Ambulation only after 72 hours post-op
Hourly checks and avoiding pressure on tissue
Continuous heat packs over the flap site
Firm dressing to reduce edema formation
Which measure helps prevent respiratory complications after stomach cancer surgery?
Splint the incision with coughing and deep breathing
Avoid incentive spirometry during early recovery
Restrict ambulation until pain fully resolves
Limit repositioning to once every 12 hours
Following gastrectomy, what nasogastric tube observation requires provider notification?
Drainage exceeding 75 mL and persistent blood
Thin yellow-green fluid after 48 hours
Small air bubbles with minimal output
Decreased edema and reduced aspirate
Which set of signs is most concerning for an anastomotic leak after stomach surgery?
Transient anxiety relieved by reassurance
Clear serous drainage and stable vital signs
Mild nausea, passing flatus, and hunger return
Tachycardia, dyspnea, fever, and abdominal pain
In pancreatic cancer post-op care, which ongoing need is commonly required?
Strict bedrest without ambulation
Continuous IV insulin infusion
Routine NPO for seven full days
Pancreatic enzyme replacement for digestion
Which urine output threshold after pancreatic surgery should be reported promptly?
About 90 mL per hour
Exactly 50 mL per hour
Greater than 60 mL per hour
Less than 30 mL per hour
For colon cancer surgery with a new colostomy, which early finding is normal?
Stoma pink to red with mild swelling
Stoma pale and dusky with no bleeding
Stoma black with firm crusting tissue
Stoma white to gray without moisture
Which instruction is appropriate for a patient with a new colostomy regarding gas and drainage?
Ignore drainage amount because it is unpredictable
Clamp the pouch to retain gas and reduce odor
Report any gas immediately as a surgical emergency
Expect excess gas for about two weeks temporarily
Which exposure is a major risk factor for head and neck cancers?
Long-term probiotic use
Persistent HPV infection
High-fiber diet intake
Chronic calcium deficiency
Which behavior most increases risk for lung cancer?
Cigarette smoking
Daily multivitamins
High water intake
Regular stretching
Which environmental agent is linked with lung cancer risk?
Radon and asbestos
Silica and sodium
Ozone and helium
Neon and argon
Which is a modifiable risk factor for stomach cancer?
Dietary smoked foods
Advanced patient age
Male biological sex
Blood type O status
Which combination is a recognized risk factor set for pancreatic cancer?
Iron deficiency and anemia
Low-fat diet and exercise
Smoking and chronic pancreatitis
Viral hepatitis A infection
Which virus pair is most associated with liver cancer in the United States?
EBV and VZV
HIV and CMV
HPV and HSV
HBV and HCV
Which patient history most increases colorectal cancer risk?
Tonsillectomy in adolescence
Seasonal allergies history
Appendectomy in childhood
First-degree relative with CRC
Which dietary pattern raises colorectal cancer risk?
Mediterranean low red meat intake
Strict low-sodium DASH pattern
Daily legumes and leafy greens
More than seven red meat servings weekly
A patient starting chemotherapy develops hyperuricemia. Which nursing action is appropriate?
Monitor uric acid levels
Restrict all dietary protein
Apply cold packs to joints
Schedule daily chest X‑rays
During anthracycline therapy, which monitoring best detects cardiotoxicity?
ECG and ejection fraction
Peak expiratory flow
Glucose tolerance test
Serum amylase level
A patient post-radiation presents months later with dyspnea and chest discomfort. Which complication is most likely?
Pericarditis or myocarditis
Clostridioides difficile colitis
Acute pulmonary embolism
Autoimmune thyroiditis
A nurse notes declining ejection fraction during chemotherapy. What is the best immediate action?
Notify provider to adjust drug therapy
Increase patient fluid boluses now
Start empiric broad antibiotics
Switch to high-intensity exercise
Which intervention best supports anorexia during chemotherapy?
Encourage prolonged fasting to stimulate appetite
Restrict intake to two large balanced meals daily
Prioritize low-protein low-calorie bland snacks
Offer small frequent high-protein high-calorie meals
A patient on chemotherapy reports four loose stools daily. What initial diet teaching is most appropriate?
Choose low fiber low residue foods and hydrate
Increase insoluble fiber and raw vegetables intake
Adopt ketogenic high fat very low carb meals
Use dairy-rich smoothies with extra lactose
For stomatitis prevention in chemotherapy, which routine is recommended?
Daily alcohol-based mouthwash gargles
Frequent saline or salt-soda mouth rinses
Sucking lemon candies to stimulate saliva
Toothbrushing once daily with hard bristles
Which statement shows correct teaching for nausea and vomiting after highly emetogenic therapy?
Take prescribed antiemetics on schedule for 2–3 days
Stop fluids for 24 hours to rest the stomach
Avoid antiemetics unless vomiting starts repeatedly
Use PRN antiemetics only at bedtime for sleep
Which lab should be monitored for suspected hepatotoxicity during chemotherapy?
Serum amylase and lipase levels
Urinalysis for protein and glucose
Liver function tests including transaminases
Arterial blood gas with lactate
Which instruction supports constipation prevention in a chemotherapy patient?
Reduce fluids to minimize abdominal cramping
Use stool softeners as needed and increase fiber
Take daily stimulant laxatives regardless
Avoid fiber and limit walking to prevent strain
Key nursing priority in leukopenia management is to:
Delay reporting of low-grade fevers
Encourage gardening and soil exposure
Teach to avoid crowds and sick contacts
Discontinue all growth factors promptly
A patient with thrombocytopenia needs which precaution?
Administer aspirin for mild headaches
Use firm flossing to clean the gums
Encourage intramuscular injections routinely
Observe for bleeding and monitor platelets
Which measure is appropriate for hemorrhagic cystitis risk?
Restrict hydration to avoid bladder distension
Avoid reporting hematuria unless painful
Delay voiding to concentrate cytoprotectants
Increase fluid intake for 24–72 hours post-treatment
To reduce nephrotoxicity during chemotherapy, which action is indicated?
Focus only on electrolytes while continuing NSAIDs
Alkalinize serum pH using oral vinegar intake
Monitor BUN and creatinine and avoid nephrotoxic drugs
Hold allopurinol to prevent uric acid reduction
Which counseling is essential before starting therapy with gonadotoxic risk?
Reassure that fertility will return within months
Discuss fertility risks and options for gamete banking
Delay conversations until after first treatment
Recommend herbal agents to preserve fertility
Best advice to manage alopecia distress during chemotherapy is to:
Explore wigs scarves and hairpieces before hair loss
Shave scalp immediately without discussion
Schedule tight braids to retain hair follicles
Increase daily hot blow-drying for scalp health
Which set describes common chemotherapy-induced skin changes?
Acneiform eruptions acral erythema hyperpigmentation photosensitivity
Hives scabies psoriasis dermatophyte infection
Vitiligo petechiae livedo reticularis frostbite
Necrosis varicose ulcers keloid hypertrophy
For radiation skin reaction with dry to moist desquamation, which step is appropriate?
Cover tightly with plastic wrap all day
Apply strong perfume lotions for fragrance
Scrub vigorously with loofah and hot water
Gently cleanse with mild soap soft cloth pat dry
Which topical product may reduce pruritus in irradiated skin if approved?
Over-the-counter hydrocortisone cream
High-potency fluorinated steroids daily
Antibiotic ointment for routine use
Alcohol rubs to dry the area
What environmental advice protects irradiated skin during healing?
Use tanning beds briefly to thicken skin
Soak daily in hot chlorinated pools
Avoid sun exposure and excessive heat sources
Apply heating pads to improve circulation
Which cognitive support strategy is recommended during chemotherapy-related brain fog?
Use a detailed daily planner and rest adequately
Rely on memory rather than writing plans
Multitask constantly to train working memory
Avoid all exercise to reduce fatigue burden
A patient develops distal paresthesias and weakness from chemotherapy. Initial management may include:
Begin anticoagulation to improve nerve perfusion
Start daily corticosteroids for lifelong therapy
Increase dose to speed tumor response quickly
Temporarily reduce or interrupt dose and consider gabapentin
Which finding during bone marrow suppression typically occurs 7–10 days after starting therapy?
Immediate thrombocytosis within two days
Stable platelets with isolated lymphocytosis
Nadir of WBC platelets and RBC counts
Peak hemoglobin with neutrophil recovery
Which instruction for oral mucositis pain control is appropriate?
Limit rinses to once daily with strong alcohol
Use topical anesthetics and choose moist soft foods
Prefer spicy acidic foods to stimulate saliva
Talk extensively during meals to distract pain
Which TNM designation indicates no evidence of a primary tumor?
T1 indicates no primary tumor evidence
Tx indicates no primary tumor evidence
T0 indicates no primary tumor evidence
Tis indicates no primary tumor evidence
A patient’s regional lymph nodes cannot be clinically assessed. Which N category applies?
N0 indicates no nodal disease detected
N4 indicates extensive nodal involvement
N1 indicates mild nodal involvement present
Nx indicates lymph nodes not assessable
Which statement best describes M1 in the TNM system?
M1 means metastases cannot be determined
M1 means distant metastases are present
M1 means local lymph nodes are positive
M1 means no distant metastases found
Chemotherapy most commonly causes the first nadir in which cell line, and when does it occur?
Platelets with nadir at 24–48 hours
Neutrophils with nadir at 7–10 days
Lymphocytes with nadir at 3–4 months
Erythrocytes with nadir at 2 weeks
At what absolute neutrophil count (ANC) is chemotherapy typically held due to infection risk?
ANC below 1,500 cells per mm3
ANC below 50 cells per mm3
ANC below 500 cells per mm3
ANC below 5,000 cells per mm3
When is platelet transfusion generally considered during chemotherapy-induced thrombocytopenia?
When platelets are under 20,000 per µL
When platelets are under 50,000 per µL
When platelets are under 150,000 per µL
When platelets are under 5,000 per µL
Why does red blood cell recovery after chemotherapy take longer than other lines?
RBCs lack any marrow precursors
RBC lifespan is about 120 days
RBCs are destroyed by neutrophil toxins
RBCs are sequestered in lymph nodes
Which normal hemoglobin range is correct for adult males?
36–46% in males
12–16 g/dL in males
13.5–17.5 g/dL in males
11–13 g/dL in males
Which step best describes the purpose of high-dose chemotherapy in the stem cell transplant process?
Stimulate graft T cells to attack host organs quickly
Eradicate diseased marrow components before infusion
Prime umbilical cord blood to increase platelet counts
Reduce pain perception before anesthesia is administered
A patient develops a pruritic rash and liver dysfunction after allogeneic transplant. Which mechanism most likely explains this complication?
Neutrophils attack infused stem cells directly
Macrophages destroy prophylactic antibiotics
Donor T cells recognize host tissues as foreign
Host T cells reject donor red blood cells
Which source can be used for hematopoietic stem cells besides bone marrow?
Synovial fluid aspirate from large joints
Umbilical cord blood or peripheral blood
Cerebrospinal fluid from lumbar puncture
Peritoneal fluid from paracentesis
During cancer pain assessment, which principle should guide the nurse's decision-making?
Patient self-report is the primary pain source
Opioid need is proven by imaging studies
Objective vital signs outweigh patient self-report
Family report replaces patient verbal ratings
Which regimen best reflects appropriate pharmacologic cancer pain management?
Short trial of antibiotics for neuropathic pain
Around-the-clock dosing with rescue doses
As-needed dosing only without baseline analgesia
Exclusive use of nonpharmacologic measures
A clinician worries about addiction and therefore withholds opioids from a patient with severe cancer pain. What is the most appropriate critique of this decision?
Reasonable because addiction risk is always high
Not valid because under-medication is harmful
Not valid only when using spinal anesthesia
Reasonable if nonsteroidal drugs are available
Which post-transplant complication is most commonly prevented with prophylactic antibiotics?
Bacterial, viral, and fungal infections
Chemotherapy-induced cardiomyopathy
Autoimmune hemolysis after transfusion reactions
Immediate graft failure due to anemia
Which finding most strongly suggests Superior Vena Cava syndrome in a patient with lung cancer?
Painless jaundice with dark urine
Unilateral leg swelling after long airplane travel
Facial and periorbital edema with venous distention
Diffuse abdominal tenderness without guarding
A patient starts chemotherapy and 24 hours later develops weakness, diarrhea, and seizures. Which laboratory pattern best supports Tumor Lysis syndrome?
Hypouricemia, hyperphosphatemia, hyperkalemia, hypercalcemia
Hypouricemia, hypophosphatemia, hypokalemia, hypercalcemia
Hyperuricemia, hypophosphatemia, hypokalemia, hypercalcemia
Hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia
Which immediate management is most appropriate for a suspected Superior Vena Cava syndrome caused by a mediastinal tumor?
Urgent radiation to the obstruction site or chemotherapy
Elective surgical resection after outpatient evaluation
Empiric broad-spectrum antibiotics for seven days
High-dose corticosteroids for long-term monotherapy
Paraneoplastic syndrome from small-cell lung cancer most likely presents with which endocrine or electrolyte abnormality?
Addison disease with chronic hypotension
Graves disease with ophthalmopathy
Primary hyperparathyroidism with low phosphate levels
Syndrome of inappropriate antidiuretic hormone secretion
Which nursing action best reduces infection risk during chemotherapy-induced bone marrow suppression?
Encourage daily jogging in public parks
Teach to avoid large crowds and active infections
Recommend probiotic supplements every morning
Advise high-protein diet without restrictions
A patient on induction chemotherapy has rising potassium and phosphate with decreasing calcium. What complication should you prioritize and what supportive measure helps prevent renal injury?
Tumor Lysis syndrome; aggressive hydration to maintain output
Septic shock; early diuresis with loop diuretics
Adrenal crisis; fluid restriction to prevent edema
SIADH; hypertonic saline for sodium correction
Which factor increases the risk for Superior Vena Cava syndrome aside from tumor burden?
Daily use of low-dose aspirin for prevention
Presence of a central venous catheter in the SVC
High-altitude travel within the last month
Prior appendectomy in early adulthood
Why should electrolytes be closely monitored 6–48 hours after starting cytotoxic therapy in high-tumor-burden cancers?
Drug-induced pancreatitis peaks during the first 48 hours
Delayed neutropenia masks early bacteremia during this period
Rapid cell lysis can cause life-threatening electrolyte derangements
Radiation recall dermatitis is most common at this interval
Which statement best describes video-assisted thoracoscopic surgery (VATS)?
Minimally invasive thoracic procedure using a video scope
Noninvasive imaging test without any incisions
Abdominal laparoscopic operation for gastric cancers
Open thoracic surgery with large rib spreaders used
Primary purpose of a double lumen tracheal tube during thoracic surgery is to
Deliver inhaled chemotherapeutics to both lung fields
Measure airway pressures more accurately during anesthesia
Enable one-lung ventilation and isolate the operative lung
Provide routine postoperative oxygen therapy to both lungs
Targeted cancer therapy most directly aims to
Interact with specific receptors and signaling pathways
Enhance nonspecific immune activation against infections
Increase general cytotoxicity across all dividing cells
Replace damaged tumor DNA with healthy donor sequences
Herceptin (trastuzumab) exerts its antitumor effect primarily by
Inhibiting androgen synthesis in adrenal cortical cells
Stabilizing microtubules to arrest metaphase progression
Alkylating DNA bases to prevent strand separation
Blocking HER2 receptor signaling with a monoclonal antibody
Cisplatin’s principal mechanism of action involves
Neutralizing circulating VEGF to prevent angiogenesis
Forming DNA adducts that miscode and block replication
Inducing apoptosis by blocking estrogen receptors
Inhibiting tyrosine kinase activity at HER2 receptors
Which scenario best justifies selecting a double lumen tracheal tube?
Diagnostic bronchoscopy performed under local anesthesia
Percutaneous nephrolithotomy with limited respiratory impact
Elective hernia repair requiring short general anesthesia only
Thoracoscopic lobectomy requiring isolation of the nonoperative lung
A patient’s tumor is hormone-sensitive and causes inflammatory symptoms. Which combined approach is most appropriate?
Avoid targeted agents because hormones drive all cancers
Switch to nonsteroidal antiandrogens without any adjuncts
Start cisplatin alone to avoid endocrine adverse reactions
Use hormone therapy plus glucocorticoids to reduce side effects
