Cancer

Question: A nurse is reviewing the pathophysiology of cancer with a nursing student. Which statement best explains how a normal cell becomes malignant? Answer Choices: A) A normal cell temporarily increases its rate of mitosis in response to tissue injury but returns to normal after healing. B) Genetic mutations alter cellular growth regulation, allowing abnormal cells to proliferate and potentially invade surrounding tissues. C) A normal cell enlarges because of increased workload, resulting in permanent loss of its ability to divide. D) A normal cell undergoes apoptosis in response to DNA damage, producing uncontrolled growth in neighboring cells.

Option A is incorrect because temporary, regulated cell proliferation is a normal physiologic response to tissue repair. Option B is correct because carcinogenesis involves genetic alterations that disrupt normal cellular regulation, allowing abnormal cells to proliferate, acquire malignant characteristics, and potentially invade or metastasize. Option C is incorrect because cellular enlargement in response to workload describes hypertrophy, which is not synonymous with malignancy. Option D is incorrect because apoptosis is programmed cell death that helps eliminate damaged cells and generally protects against cancer development. Correct Answer: B

7. A provider obtains cells from a client's sputum to evaluate for possible malignancy. Which diagnostic approach does this represent?

Answer Choices:

A) Histologic examination
B) Cytologic examination
C) Tumor grading
D) Bone marrow aspiration

Rationales:

A) Incorrect. Histologic examination evaluates tissue architecture and cellular characteristics from a tissue specimen, commonly obtained through biopsy.

B) Correct. Cytologic examination evaluates individual cells. The PowerPoint identifies collected secretions, such as sputum, as potential specimens for cytologic evaluation.

C) Incorrect. Grading evaluates the degree of cellular differentiation and estimates tumor aggressiveness. It is not the name of the procedure used to collect sputum cells.

D) Incorrect. Bone marrow aspiration obtains marrow samples and is used in conditions such as leukemia and lymphoma.

Correct Answer: B

45. A nurse is reviewing the categories of chemotherapy agents with a nursing student. Which categories are listed in the PowerPoint? Select all that apply.

Answer Choices:

A) Alkylating agents
B) Antimetabolites
C) Antitumor antibiotics
D) Hormones and hormone antagonists
E) Biological response modifiers and targeted therapies
F) Natural products

Rationales:

A) Correct. Alkylating agents are one of the chemotherapy categories identified in the PowerPoint.

B) Correct. Antimetabolites are included among the chemotherapy categories.

C) Correct. Antitumor antibiotics are listed as a chemotherapy category.

D) Correct. Hormones and hormone antagonists are included among the listed categories.

E) Correct. Biological response modifiers and targeted therapies are identified as chemotherapy categories.

F) Correct. Natural products are also listed. The slides additionally mention miscellaneous antineoplastic drugs.

Correct Answers: A, B, C, D, E, F

Question: A nurse explains the difference between benign and malignant neoplasms to a client whose biopsy revealed a localized tumor. Which characteristic most strongly supports a benign neoplasm? Answer Choices: A) The tumor invades adjacent tissue but has not spread to distant organs. B) The tumor consists of poorly differentiated cells that divide rapidly. C) The tumor has well-defined borders, grows slowly, and remains localized. D) The tumor stimulates angiogenesis and spreads through lymphatic vessels.

Option A is incorrect because invasion of surrounding tissues is a characteristic of malignant neoplasms, even when distant metastasis has not occurred. Option B is incorrect because poor differentiation and rapid growth are associated with more aggressive malignant tumors. Option C is correct because benign neoplasms are generally localized, well circumscribed, slow growing, and frequently encapsulated. Option D is incorrect because angiogenesis supports tumor growth, while lymphatic dissemination is a mechanism of malignant metastasis. Correct Answer: C

Question: A client has a benign intracranial tumor that is compressing surrounding brain tissue. The client develops worsening headaches, vomiting, and altered level of consciousness. Which interpretation should guide the nurse's response? Answer Choices: A) The symptoms indicate that the tumor has necessarily become malignant. B) Benign tumors cannot produce serious complications unless metastasis occurs. C) The symptoms are expected because benign tumors always invade adjacent tissue. D) The tumor may threaten life by increasing intracranial pressure despite its benign classification.

Option A is incorrect because symptoms of compression do not establish malignant transformation. Option B is incorrect because a benign tumor can cause severe complications through compression or obstruction without metastasizing. Option C is incorrect because invasion is characteristic of malignancy, whereas benign tumors typically push against surrounding structures. Option D is correct because a benign intracranial mass can impair cerebral function by increasing intracranial pressure, potentially causing neurologic deterioration, coma, or death if not treated. Correct Answer: D

Question: A nurse reviews a biopsy report describing a malignant tumor with cells that closely resemble the normal cells from which the tumor originated. Which interpretation is most appropriate? Answer Choices: A) The tumor is highly differentiated, which generally indicates less aggressive cellular behavior than a comparable poorly differentiated tumor. B) The tumor is benign because its cells retain characteristics of the tissue of origin. C) The tumor has necessarily metastasized because the cells resemble normal tissue. D) The tumor has lost all capacity for proliferation because its cells maintain specialized functions.

Option A is correct because well-differentiated malignant cells retain more features of their tissue of origin and generally exhibit less aggressive behavior than poorly differentiated cells of the same tumor type. Option B is incorrect because differentiation alone does not determine whether a neoplasm is benign or malignant; malignant tumors can be well differentiated. Option C is incorrect because differentiation does not establish whether metastasis has occurred. Option D is incorrect because malignant cells can continue proliferating even when they retain some specialized cellular characteristics. Correct Answer: A

Question: A nurse is teaching a client about the three stages of carcinogenesis. Which sequence correctly describes the process? Answer Choices: A) Promotion, metastasis, initiation. B) Initiation, progression, promotion. C) Initiation, promotion, progression. D) Differentiation, apoptosis, progression.

Option A is incorrect because metastasis is a possible consequence of malignant progression rather than the second stage in the classic three-stage model. Option B is incorrect because promotion generally precedes progression. Option C is correct because initiation involves carcinogen-related DNA damage or mutation, promotion stimulates proliferation of altered cells, and progression involves additional changes that produce increasingly malignant characteristics. Option D is incorrect because differentiation and apoptosis are cellular processes but do not represent the three stages of carcinogenesis. Correct Answer: C

Question: A nurse is explaining the role of tumor suppressor genes to a client with a newly diagnosed malignancy. Which explanation is most accurate? Answer Choices: A) Tumor suppressor genes normally stimulate cell division and become protective when their activity increases. B) Tumor suppressor genes normally help restrain cell proliferation or repair DNA, and their inactivation can contribute to cancer. C) Tumor suppressor genes produce all tumor markers used to diagnose malignancy. D) Tumor suppressor genes prevent cancer exclusively by increasing the blood supply to normal tissues.

Option A is incorrect because tumor suppressor genes generally oppose uncontrolled proliferation rather than promote it. Option B is correct because these genes help regulate the cell cycle, maintain genomic integrity, or promote appropriate responses to cellular damage; loss of their function can permit malignant growth. Option C is incorrect because tumor markers may be produced by tumor cells or associated tissues and are not all products of tumor suppressor genes. Option D is incorrect because angiogenesis is the formation of new blood vessels and is not the exclusive mechanism of tumor suppression. Correct Answer: B

Question: A client asks why a family history of cancer increases concern but does not guarantee that the client will develop cancer. Which response by the nurse is best? Answer Choices: A) Inherited mutations always cause cancer, regardless of environmental exposures. B) Familial cancer patterns are unrelated to genes and reflect only shared lifestyle choices. C) A genetic predisposition may increase susceptibility, but cancer development often involves additional genetic, environmental, and behavioral factors. D) Hereditary risk matters only after a person develops symptoms of cancer.

Option A is incorrect because an inherited predisposition does not mean cancer is inevitable. Option B is incorrect because inherited variants can contribute to familial cancer risk, although shared exposures and behaviors may also matter. Option C is correct because hereditary susceptibility can interact with age, carcinogen exposure, lifestyle, and additional mutations to influence whether cancer develops. Option D is incorrect because family history can inform prevention, genetic counseling, and screening before symptoms occur. Correct Answer: C

Question: A nurse is developing a cancer-prevention teaching plan for an adult who smokes cigarettes and frequently uses tanning beds. Which intervention best addresses the client's modifiable risk factors? Answer Choices: A) Encourage smoking cessation, avoidance of tanning beds, and protection from excessive ultraviolet exposure. B) Recommend postponing preventive care until the client reaches an age when cancer is more common. C) Explain that inherited susceptibility makes behavioral prevention ineffective. D) Recommend annual tumor-marker testing as a substitute for reducing carcinogen exposure.

Option A is correct because tobacco smoke and ultraviolet radiation are modifiable carcinogenic exposures, and reducing these exposures can lower cancer risk. Option B is incorrect because risk-reduction measures should begin before symptoms develop and should be appropriate to the client's age and risk profile. Option C is incorrect because a genetic predisposition does not eliminate the benefits of reducing modifiable exposures. Option D is incorrect because tumor markers are not a universal screening substitute and do not prevent cancer. Correct Answer: A

Question: A nurse teaches a client about the relationship between human papillomavirus (HPV) and cancer. Which statement by the client demonstrates correct understanding? Answer Choices: A) HPV vaccination eliminates the need for all future cervical cancer screening. B) HPV is associated with certain cancers, and vaccination can prevent infection from HPV types responsible for many cervical cancers. C) HPV increases cancer risk only in individuals who have an inherited tumor suppressor mutation. D) HPV causes cancer by directly producing malignant cells without altering normal cellular processes.

Option A is incorrect because vaccination does not eliminate the need for recommended cervical cancer screening. Option B is correct because persistent infection with high-risk HPV types contributes to cervical and several other cancers, and vaccination helps prevent infection from important cancer-causing types. Option C is incorrect because HPV-associated cancer does not require a known inherited tumor suppressor mutation. Option D is incorrect because viral oncogenesis involves effects on host cellular regulation rather than viruses simply producing malignant human cells directly. Correct Answer: B

Question: A nurse assesses a client with cancer who reports progressive fatigue, unintended weight loss, reduced appetite, and loss of muscle mass. Which pathophysiologic process best explains this pattern? Answer Choices: A) Localized tissue compression without systemic metabolic effects. B) Increased appetite caused by reduced energy expenditure. C) Anorexia-cachexia syndrome involving altered metabolism and progressive wasting. D) Isolated thrombocytopenia that increases protein storage in skeletal muscle.

Option A is incorrect because localized compression alone does not adequately explain progressive systemic wasting. Option B is incorrect because cachexia commonly involves reduced intake and abnormal metabolism rather than increased appetite and reduced energy expenditure. Option C is correct because cancer-associated anorexia-cachexia syndrome involves weight and muscle loss related to altered metabolism, decreased intake, inflammation, and sometimes treatment effects. Option D is incorrect because thrombocytopenia increases bleeding risk and does not explain the characteristic metabolic wasting syndrome. Correct Answer: C

Question: A nurse evaluates a client with a rapidly growing abdominal malignancy who develops abdominal distention, vomiting, and absent passage of stool. Which mechanism best explains these findings? Answer Choices: A) Increased erythropoietin production stimulates excessive intestinal peristalsis. B) Tumor compression or invasion obstructs the intestinal lumen and disrupts normal bowel function. C) Reduced platelet production causes the bowel wall to become excessively permeable to water. D) Tumor differentiation restores normal motility but increases gastric acid secretion.

Option A is incorrect because increased erythropoietin can contribute to erythrocytosis in certain cancers but does not explain mechanical bowel obstruction. Option B is correct because a tumor can narrow or block the bowel lumen, producing distention, vomiting, constipation, and potentially serious complications such as ischemia or perforation. Option C is incorrect because thrombocytopenia increases bleeding risk rather than directly producing mechanical obstruction. Option D is incorrect because differentiation does not restore motility in the presence of a physical obstruction. Correct Answer: B

Question: A client with cancer develops new bruising, prolonged bleeding from venipuncture sites, and a markedly reduced platelet count after chemotherapy. Which mechanism most likely explains the findings? Answer Choices: A) Chemotherapy suppresses bone marrow production of platelets, impairing primary hemostasis. B) Increased red blood cell production prevents fibrin formation. C) Increased lymphocyte production directly consumes all circulating clotting factors. D) Reduced tumor vascularity causes platelets to become excessively adhesive.

Option A is correct because many chemotherapy agents suppress rapidly dividing bone marrow cells, decreasing platelet production and increasing bleeding risk. Option B is incorrect because erythrocyte production does not directly prevent fibrin formation. Option C is incorrect because lymphocyte production does not directly consume all clotting factors. Option D is incorrect because reduced tumor vascularity does not explain a markedly low platelet count after chemotherapy. Correct Answer: A

Question: A nurse reviews the laboratory results of a client receiving chemotherapy: hemoglobin 7.8 g/dL, hematocrit 24%, and a low red blood cell count. The client reports dyspnea on exertion and profound fatigue. Which interpretation is most appropriate? Answer Choices: A) The findings indicate isolated thrombocytopenia and a primary clotting disorder. B) The findings are consistent with anemia, which reduces the oxygen-carrying capacity of blood. C) The findings demonstrate neutropenia, which directly decreases platelet adhesion. D) The findings indicate tumor lysis syndrome because hemoglobin is below the expected range.

Option A is incorrect because thrombocytopenia involves reduced platelets and does not account for the low hemoglobin and hematocrit. Option B is correct because reduced red blood cell mass and hemoglobin decrease oxygen delivery to tissues, contributing to fatigue, pallor, tachycardia, and exertional dyspnea. Option C is incorrect because neutropenia is a reduction in neutrophils and primarily increases infection risk. Option D is incorrect because tumor lysis syndrome is associated with metabolic abnormalities from rapid tumor-cell destruction, not diagnosed by low hemoglobin alone. Correct Answer: B

Question: A nurse is caring for a client with leukemia whose white blood cell count is markedly elevated. The client develops a fever and has an absolute neutrophil count of 300 cells/mm³. Which interpretation is most accurate? Answer Choices: A) The elevated total white blood cell count confirms that the client can adequately fight infection. B) The client is protected from infection because malignant leukocytes circulate in large numbers. C) The client is severely neutropenic and at high risk for infection despite the elevated total white blood cell count. D) The client has thrombocytosis because malignant leukocytes increase the platelet count.

Option A is incorrect because the total white blood cell count can be elevated by abnormal, dysfunctional leukemic cells and does not establish effective immune function. Option B is incorrect because malignant leukocytes may be immature or ineffective, and a low absolute neutrophil count substantially increases infection risk. Option C is correct because an absolute neutrophil count of 300 cells/mm³ represents severe neutropenia, making fever a potentially life-threatening sign requiring urgent evaluation and treatment. Option D is incorrect because leukocyte elevation does not establish an elevated platelet count. Correct Answer: C

Question: A nurse reviews a client's biopsy and staging results. The report documents a primary tumor, regional lymph node involvement, and distant liver lesions. Which interpretation of the TNM classification is correct? Answer Choices: A) T describes tumor size or local extent, N describes regional lymph node involvement, and M describes distant metastasis. B) T describes treatment response, N describes nutritional status, and M describes the degree of cellular differentiation. C) T describes platelet count, N describes neutrophil count, and M describes bone marrow function. D) T describes tumor-marker concentration, N describes necrosis, and M describes mitotic rate.

Option A is correct because TNM staging characterizes the primary tumor, regional lymph node involvement, and distant metastatic disease. Option B is incorrect because these are not the meanings of the TNM categories. Option C is incorrect because TNM is used to classify solid tumors rather than blood cell counts. Option D is incorrect because tumor-marker levels, necrosis, and mitotic rate do not define the TNM categories. Correct Answer: A

Question: A nurse explains tumor grading to a client who asks how it differs from cancer staging. Which explanation is most accurate? Answer Choices: A) Grading determines whether cancer has spread to distant organs, whereas staging determines how closely cells resemble normal tissue. B) Grading evaluates cellular differentiation and features associated with aggressiveness, whereas staging evaluates tumor extent, lymph node involvement, and metastasis. C) Grading identifies the medication that will cure the cancer, whereas staging determines the patient's nutritional status. D) Grading and staging are interchangeable terms that describe the same pathologic finding.

Option A is incorrect because it reverses the main purposes of grading and staging. Option B is correct because grading evaluates the degree of differentiation and estimates biologic aggressiveness, whereas staging describes the anatomic extent of disease. Option C is incorrect because neither grading nor staging independently identifies a guaranteed curative medication or measures nutritional status. Option D is incorrect because grading and staging provide different, complementary information. Correct Answer: B

Question: A client asks why the oncologist recommends a biopsy after imaging identifies a suspicious lung mass. Which response by the nurse is best? Answer Choices: A) Imaging alone establishes the exact histologic type and cellular differentiation of every tumor. B) A biopsy is performed primarily to determine whether the client is experiencing chemotherapy-induced neutropenia. C) Tissue examination can identify cellular characteristics and help establish the type of malignancy, while imaging helps evaluate location and extent. D) A biopsy is unnecessary if a tumor marker is elevated above the reference range.

Option A is incorrect because imaging can locate and characterize a mass but generally cannot establish its exact histologic identity. Option B is incorrect because neutropenia is assessed through blood testing rather than tissue biopsy. Option C is correct because microscopic histologic examination helps establish the tumor's cellular origin and characteristics, while imaging contributes information about tumor location and spread. Option D is incorrect because elevated tumor markers are not definitive proof of cancer and do not replace appropriate tissue diagnosis when indicated. Correct Answer: C

Question: A nurse reviews a client's carcinoembryonic antigen (CEA) result, which is elevated above the laboratory reference range. Which interpretation is most appropriate? Answer Choices: A) The elevated result definitively proves colorectal cancer without further evaluation. B) The result may support assessment or monitoring in an appropriate clinical context but cannot independently establish a cancer diagnosis. C) The result confirms that the cancer has metastasized to the brain. D) The result rules out malignancy if subsequent imaging is normal.

Option A is incorrect because CEA can be elevated in conditions other than colorectal cancer and is not a definitive stand-alone diagnostic test. Option B is correct because tumor markers may help monitor treatment response, recurrence, or disease burden in selected cancers, but results must be interpreted alongside clinical findings and other diagnostic tests. Option C is incorrect because CEA does not identify the specific site of metastasis. Option D is incorrect because a normal imaging study or a subsequent marker result cannot categorically exclude all malignancy. Correct Answer: B

Question: A client with cancer is scheduled for an MRI to evaluate a suspected soft-tissue tumor. Which statement best describes MRI? Answer Choices: A) MRI uses ionizing radiation to produce images through repeated X-ray exposures. B) MRI measures tumor-derived proteins in the bloodstream without producing anatomic images. C) MRI uses a strong magnetic field and radiofrequency signals to produce detailed images of body structures. D) MRI directly identifies malignant cells under a microscope without obtaining a specimen.

Option A is incorrect because MRI does not use ionizing X-ray radiation to generate its images. Option B is incorrect because blood-based tumor-marker testing measures selected substances rather than producing anatomic images. Option C is correct because MRI uses magnetic fields and radiofrequency signals to create detailed images and can help evaluate soft tissues and tumor extent. Option D is incorrect because microscopic identification of malignant cells requires a tissue or cell specimen. Correct Answer: C

Question: A nurse prepares a client for an angiography procedure to evaluate the blood supply of a tumor before surgery. Which assessment is especially important because the procedure may involve contrast injection and vascular catheterization? Answer Choices: A) Assess for contrast-related risks, explain the procedure, and monitor the catheter insertion site for bleeding afterward. B) Restrict all oral and intravenous fluids for 48 hours after the procedure regardless of the client's condition. C) Encourage vigorous activity immediately after catheter removal to prevent clot formation. D) Explain that angiography is noninvasive and does not require monitoring for vascular complications.

Option A is correct because angiography involves vascular access and contrast administration; relevant preparation includes assessment for contrast-related risks and monitoring for bleeding and other complications after the procedure. Option B is incorrect because fluid management should be individualized rather than universally restricted for 48 hours. Option C is incorrect because activity restrictions may be needed after vascular catheterization to reduce bleeding risk. Option D is incorrect because angiography is invasive and requires appropriate monitoring. Correct Answer: A

Question: A nurse is caring for a client receiving chemotherapy who develops a temperature of 38.4°C (101.1°F) and has a recent absolute neutrophil count of 400 cells/mm³. Which action is the priority? Answer Choices: A) Administer an antipyretic and reassess the temperature in four hours before notifying the provider. B) Encourage oral fluids and wait for the next scheduled complete blood count. C) Initiate urgent evaluation for febrile neutropenia, obtain ordered cultures promptly, and facilitate immediate empiric antimicrobial treatment. D) Place the client in a warm environment because fever is expected after chemotherapy.

Option A is incorrect because delaying evaluation can allow a life-threatening infection to progress, and antipyretics may mask the fever. Option B is incorrect because hydration and repeat laboratory testing do not replace urgent assessment and treatment. Option C is correct because fever in a severely neutropenic client is an oncologic emergency; prompt cultures and empiric broad-spectrum antibiotics are critical, without delaying treatment unnecessarily. Option D is incorrect because fever should not be dismissed as an expected treatment effect in a severely neutropenic client. Correct Answer: C

Question: A client with a high-burden hematologic malignancy develops nausea, weakness, muscle cramps, and decreased urine output shortly after chemotherapy begins. Laboratory testing reveals hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. Which complication should the nurse suspect? Answer Choices: A) Superior vena cava syndrome. B) Tumor lysis syndrome. C) Paraneoplastic syndrome caused by ectopic hormone secretion. D) Isolated chemotherapy-induced anemia.

Option A is incorrect because superior vena cava syndrome typically causes impaired venous drainage, facial or upper-extremity swelling, and respiratory or neurologic symptoms. Option B is correct because rapid tumor-cell destruction releases intracellular potassium, phosphate, and nucleic acids, leading to hyperkalemia, hyperphosphatemia, hyperuricemia, secondary hypocalcemia, and possible acute kidney injury. Option C is incorrect because paraneoplastic syndromes result from tumor-related hormonal or immune effects and do not explain this characteristic cluster of metabolic abnormalities. Option D is incorrect because anemia does not cause the described electrolyte pattern. Correct Answer: B

Question: A nurse assesses a client with advanced lung cancer who develops facial swelling, distended neck veins, dyspnea, and difficulty lying flat. Which complication requires immediate recognition? Answer Choices: A) Superior vena cava syndrome caused by obstruction of venous return from the upper body. B) Tumor lysis syndrome caused by the rapid release of intracellular electrolytes. C) Anemia caused by decreased erythropoietin production. D) Chronic cancer-related cachexia caused by increased metabolic demand.

Option A is correct because superior vena cava obstruction impairs venous drainage from the head, neck, and upper extremities and may cause facial edema, distended veins, dyspnea, and potentially serious airway or neurologic compromise. Option B is incorrect because tumor lysis syndrome is characterized by metabolic abnormalities and possible renal and cardiac complications. Option C is incorrect because anemia can cause fatigue and dyspnea but does not explain facial swelling and distended neck veins. Option D is incorrect because cachexia causes wasting and weight loss rather than acute upper-body venous congestion. Correct Answer: A

Question: A client with metastatic cancer reports new severe back pain and develops bilateral leg weakness and urinary retention. Which nursing response is most appropriate? Answer Choices: A) Reassure the client that back pain is an expected consequence of advanced cancer and reassess the next day. B) Encourage ambulation to determine whether the weakness is caused by deconditioning. C) Administer the prescribed oral analgesic and postpone further assessment until it takes effect. D) Treat the findings as possible malignant spinal cord compression and initiate urgent evaluation.

Option A is incorrect because new neurologic deficits and urinary retention are not findings that should be attributed to routine cancer pain without evaluation. Option B is incorrect because ambulation may be unsafe and delays assessment of a potentially irreversible neurologic emergency. Option C is incorrect because pain relief is important but must not delay urgent evaluation for spinal cord compression. Option D is correct because tumor-related compression of the spinal cord can rapidly produce permanent neurologic deficits; urgent assessment and treatment are needed to preserve function. Correct Answer: D

Question: A nurse caring for a client with metastatic cancer notes sudden dyspnea, chest discomfort, tachycardia, and hypotension. The client has a known malignant pericardial effusion. Which complication is the greatest concern? Answer Choices: A) Uncomplicated chemotherapy-induced alopecia. B) Acute tumor-related cachexia. C) Cardiac tamponade caused by impaired cardiac filling from fluid accumulating in the pericardial sac. D) Chronic anemia without hemodynamic consequences.

Option A is incorrect because alopecia does not explain acute cardiovascular instability. Option B is incorrect because cachexia is a chronic wasting syndrome rather than a cause of sudden hypotension and dyspnea. Option C is correct because a malignant pericardial effusion can increase pressure around the heart, impair ventricular filling, and cause life-threatening cardiac tamponade. Option D is incorrect because anemia may cause fatigue and tachycardia but does not adequately explain the acute presentation in a client with a known pericardial effusion. Correct Answer: C

Question: A nurse is caring for a client with cancer who develops severe mucositis during chemotherapy. The client reports painful swallowing and is consuming very little food or fluid. Which nursing intervention best addresses the immediate concerns? Answer Choices: A) Encourage acidic foods to stimulate saliva and improve appetite. B) Assess hydration and nutritional status, provide prescribed oral care and symptom relief, and collaborate on tolerable nutrition and fluid intake. C) Withhold all oral hygiene until the mucosa has completely healed. D) Encourage the client to avoid reporting pain so the oncology team can accurately evaluate the chemotherapy response.

Option A is incorrect because acidic foods may irritate inflamed oral mucosa and worsen pain. Option B is correct because mucositis can impair oral intake and increase dehydration, malnutrition, and infection risk; symptom management, oral care, hydration assessment, and nutritional support are important. Option C is incorrect because appropriate gentle oral hygiene helps maintain mucosal integrity and reduce complications. Option D is incorrect because reporting and treating pain supports nutrition, comfort, and treatment adherence. Correct Answer: B

Question: A nurse reviews the treatment plan for a client with leukemia who is beginning intensive induction chemotherapy. Which statement best explains why the client may be at risk for tumor lysis syndrome? Answer Choices: A) Chemotherapy causes malignant cells to release intracellular contents rapidly, potentially overwhelming renal excretion and electrolyte regulation. B) Chemotherapy immediately increases the production of mature red blood cells, resulting in severe iron overload. C) Chemotherapy prevents all malignant cells from releasing potassium and phosphate. D) Chemotherapy selectively destroys tumor cells without affecting metabolic balance.

Option A is correct because rapid malignant-cell destruction can release potassium, phosphate, and nucleic acids, resulting in dangerous electrolyte disturbances and renal complications. Option B is incorrect because induction chemotherapy commonly suppresses bone marrow function rather than immediately increasing mature red blood cell production. Option C is incorrect because potassium and phosphate release is central to tumor lysis syndrome. Option D is incorrect because tumor destruction can significantly disrupt metabolic homeostasis and requires monitoring and prevention strategies. Correct Answer: A

Question: A nurse is reviewing the medication plan of a client receiving combination chemotherapy. Which explanation best describes a reason for using more than one antineoplastic agent? Answer Choices: A) Combination therapy guarantees that normal rapidly dividing cells will not be affected. B) Combination therapy is used only to treat nausea caused by cancer. C) Combination therapy prevents the need to monitor blood counts and organ function. D) Combining agents with different mechanisms or cellular targets may improve tumor control and reduce the likelihood of resistance.

Option A is incorrect because chemotherapy can affect normal rapidly dividing cells, including bone marrow and gastrointestinal mucosal cells. Option B is incorrect because combination chemotherapy is intended to treat malignancy, although supportive medications may be combined to manage symptoms. Option C is incorrect because blood counts and organ function must still be monitored for treatment toxicity. Option D is correct because agents that affect different stages or mechanisms of cellular growth may improve effectiveness and reduce the likelihood that resistant tumor-cell populations survive. Correct Answer: D

Question: A nurse is teaching a client about radiation therapy. Which statement most accurately describes its cellular effect? Answer Choices: A) Radiation stimulates tumor cells to differentiate into normal tissue. B) Radiation damages cellular DNA, impairing the ability of targeted cells to reproduce. C) Radiation eliminates all cancer cells without affecting surrounding healthy tissue. D) Radiation works exclusively by increasing circulating platelet counts.

Option A is incorrect because radiation does not treat cancer by reliably restoring normal differentiation. Option B is correct because radiation damages cellular DNA and interferes with cell division; rapidly dividing cells are particularly vulnerable, although normal tissues in the treatment field may also be injured. Option C is incorrect because radiation can damage surrounding normal tissue and does not guarantee complete tumor eradication. Option D is incorrect because increasing platelet counts is not the therapeutic mechanism of radiation. Correct Answer: B

Question: A nurse cares for a client receiving chemotherapy who has a low neutrophil count and painful oral ulcerations. Which intervention is most appropriate for reducing infection risk? Answer Choices: A) Encourage the client to share personal hygiene items to conserve supplies. B) Use rectal temperatures because they provide the most reliable measurement in neutropenic clients. C) Promote hand hygiene, gentle oral care, protection of skin and mucous membranes, and prompt reporting of fever. D) Discontinue all assessment of the oral cavity because manipulation can introduce infection.

Option A is incorrect because sharing personal hygiene items can increase exposure to infectious organisms. Option B is incorrect because rectal temperatures and rectal procedures may injure mucosa and introduce organisms in neutropenic clients. Option C is correct because hand hygiene, mucosal and skin protection, careful monitoring, and early reporting of infection help reduce complications in clients with compromised immunity. Option D is incorrect because gentle assessment of the oral cavity is important for identifying mucositis, infection, and tissue breakdown. Correct Answer: C

Question: A nurse is planning care for an older adult with cancer, chronic kidney disease, heart failure, and several prescribed medications. Which factor is most important when evaluating the proposed cancer treatment plan? Answer Choices: A) The client's chronological age alone should determine whether treatment is offered. B) The nurse should assume that all standard chemotherapy doses are equally safe in older adults. C) Chronic illnesses are unrelated to treatment tolerance when the cancer is potentially curable. D) Functional status, comorbidities, organ function, life expectancy, and potential medication interactions should be considered individually.

Option A is incorrect because chronological age alone does not adequately predict treatment tolerance or determine whether treatment is appropriate. Option B is incorrect because age-related physiologic changes, organ dysfunction, and drug interactions may require individualized treatment planning. Option C is incorrect because chronic illnesses can worsen treatment toxicity, interrupt therapy, and delay recovery. Option D is correct because treatment decisions should incorporate functional status, comorbidities, organ function, life expectancy, medication interactions, and the client's goals. Correct Answer: D

Question: A nurse is discussing childhood cancer survivorship with the parents of a child who received radiation to the head and neck. Which long-term complication should the nurse include in the teaching? Answer Choices: A) Permanent prevention of all future thyroid disorders. B) Reduced risk of dental and skeletal development problems. C) Hypothyroidism and possible impaired growth or development of bones and teeth. D) Increased bone growth caused by stimulation of normal tissue division.

Option A is incorrect because head and neck radiation can damage the thyroid and increase the risk of hypothyroidism. Option B is incorrect because radiation can impair the growth of bones and teeth rather than protect against developmental complications. Option C is correct because childhood radiation can cause long-term endocrine and developmental effects, including hypothyroidism and impaired skeletal or dental growth. Option D is incorrect because radiation damages cellular DNA and can impair normal tissue growth. Correct Answer: C

Question: A nurse is explaining leukemia to the parents of a child recently diagnosed with acute lymphoblastic leukemia (ALL). Which statement best describes the underlying problem? Answer Choices: A) Malignant immature white blood cells accumulate in the bone marrow, interfering with normal blood cell production. B) Mature red blood cells proliferate uncontrollably and replace all lymphatic tissue. C) Platelet destruction is the primary abnormality, with no effect on leukocyte development. D) A localized benign tumor develops in the bone marrow but cannot affect circulating blood cells.

Option A is correct because leukemia involves malignant white blood cells or their precursors, which accumulate in the marrow and can interfere with normal production of red blood cells, platelets, and functional leukocytes. Option B is incorrect because leukemia is a malignant disorder of white blood cell precursors rather than uncontrolled mature erythrocyte proliferation. Option C is incorrect because leukemia can impair multiple blood cell lines, not just platelets. Option D is incorrect because leukemia is a malignant hematologic disorder that affects marrow and circulating blood cells rather than a localized benign tumor. Correct Answer: A

Question: A nurse is assessing a child with newly diagnosed leukemia. The child has pallor, fatigue, recurrent infections, and petechiae. Which explanation best links these findings to the disease process? Answer Choices: A) Excessive production of normal blood cells improves oxygen delivery but causes temporary skin discoloration. B) Leukemic cells interfere with normal bone marrow function, producing anemia, impaired infection defense, and thrombocytopenia. C) Increased platelet production causes mucosal bleeding and recurrent infections. D) Normal marrow function is preserved, but circulating mature red blood cells become unable to carry carbon dioxide.

Option A is incorrect because leukemia does not improve oxygen delivery through excessive production of normal blood cells. Option B is correct because marrow replacement by malignant cells can decrease erythrocyte production, reduce functional immune defense, and lower platelet production, explaining fatigue, infections, and bleeding manifestations. Option C is incorrect because increased platelet production does not explain petechiae and recurrent infections. Option D is incorrect because leukemia can compromise normal marrow function, and the client's findings are not explained by impaired carbon dioxide transport alone. Correct Answer: B

Question: A nurse is reviewing the clinical patterns of leukemia with a student. Which statement best reflects the usual age-related distribution described in the course materials? Answer Choices: A) Acute myeloid leukemia is the most common childhood leukemia, while ALL occurs almost exclusively in older adults. B) Chronic lymphocytic leukemia is the most common leukemia in infants. C) ALL is common in children, while AML and CLL are important leukemia types in adults. D) All leukemia subtypes occur at the same frequency in every age group.

Option A is incorrect because ALL, not AML, is the most common childhood leukemia. Option B is incorrect because CLL is primarily an adult disease and is not the most common leukemia in infants. Option C is correct because acute lymphoblastic leukemia is the most common leukemia in children, whereas AML and CLL are important leukemia types among adults. Option D is incorrect because leukemia subtype distribution varies with age. Correct Answer: C

Question: A nurse is caring for a client with cancer who has severe pain associated with bone metastases. Which approach best supports individualized cancer pain management? Answer Choices: A) Delay analgesic administration until the pain becomes severe enough to interfere with sleep. B) Use a standardized analgesic dose for every client with the same cancer diagnosis. C) Focus exclusively on the tumor itself because treatment-related pain cannot be managed separately. D) Assess pain characteristics, severity, functional impact, and response to treatment, then collaborate on an individualized analgesic and supportive care plan.

Option A is incorrect because delaying analgesia can allow pain to intensify and unnecessarily increase suffering. Option B is incorrect because pain severity, opioid tolerance, organ function, and individual response vary among clients. Option C is incorrect because pain can result from tumor invasion, tissue compression, and treatment effects, all of which may require management. Option D is correct because comprehensive assessment and individualized treatment support comfort, function, quality of life, and adherence to cancer therapy. Correct Answer: D

Question: A nurse assesses a client with advanced cancer who reports persistent fatigue, anorexia, and progressive weight loss despite attempts to increase food intake. Which nursing intervention is most appropriate? Answer Choices: A) Assess nutritional intake, weight trends, symptoms affecting eating, and metabolic or treatment-related contributors while collaborating on individualized nutritional support. B) Explain that weight loss is inevitable and that nutritional interventions cannot improve comfort or function. C) Encourage the client to consume large meals regardless of nausea, early satiety, or fatigue. D) Restrict protein intake to reduce the metabolic activity of malignant cells.

Option A is correct because cancer-related wasting can result from altered metabolism, reduced intake, inflammation, malabsorption, and treatment effects; assessment and individualized symptom and nutrition management are appropriate. Option B is incorrect because supportive interventions can improve intake, comfort, hydration, and quality of life even when cachexia cannot be fully reversed. Option C is incorrect because large meals may worsen early satiety, nausea, and fatigue; smaller, frequent, nutrient-dense meals may be more tolerable. Option D is incorrect because unnecessary protein restriction can worsen muscle wasting and malnutrition. Correct Answer: A

Question: A nurse is reviewing laboratory results for a client with suspected bone metastases. Which result may support further investigation of bone involvement but cannot independently confirm the diagnosis? Answer Choices: A) A normal platelet count. B) An elevated alkaline phosphatase level. C) A normal serum sodium concentration. D) An isolated low eosinophil count.

Option A is incorrect because a normal platelet count does not establish or exclude bone metastases. Option B is correct because alkaline phosphatase can increase with increased bone turnover and may be elevated in bone metastases, although it is not specific to cancer. Option C is incorrect because sodium concentration does not independently identify bone metastases. Option D is incorrect because an isolated low eosinophil count is not a specific marker of bone involvement. Correct Answer: B

Question: A client with cancer develops confusion, constipation, nausea, excessive thirst, and generalized weakness. Laboratory results reveal a markedly elevated serum calcium concentration. Which complication should the nurse suspect? Answer Choices: A) Chemotherapy-induced thrombocytopenia. B) Tumor lysis syndrome characterized by hypocalcemia. C) Hypercalcemia of malignancy. D) Isolated neutropenic fever.

Option A is incorrect because thrombocytopenia primarily increases bleeding risk and does not explain the characteristic manifestations of hypercalcemia. Option B is incorrect because tumor lysis syndrome typically produces hyperphosphatemia and secondary hypocalcemia, not isolated marked hypercalcemia. Option C is correct because cancer-associated hypercalcemia can cause gastrointestinal symptoms, dehydration, weakness, altered mental status, and cardiac complications. Option D is incorrect because neutropenic fever is an infectious emergency characterized by fever in a client with reduced neutrophils, not this specific metabolic pattern. Correct Answer: C

Question: A nurse is reviewing a client's cancer diagnosis and learns that malignant cells have spread from the primary tumor to the liver. Which process best explains this finding? Answer Choices: A) Metaplasia, in which one differentiated cell type is replaced by another. B) Hypertrophy, in which existing cells increase in size. C) Hyperplasia, in which the number of normal cells increases in response to stimulation. D) Metastasis, in which malignant cells spread from the primary site and establish growth in a distant location.

Option A is incorrect because metaplasia is a change from one differentiated cell type to another and does not describe distant malignant spread. Option B is incorrect because hypertrophy is an increase in cell size. Option C is incorrect because hyperplasia is an increase in cell number and does not itself establish distant metastatic disease. Option D is correct because metastasis occurs when malignant cells disseminate through blood, lymphatic vessels, or body cavities and establish secondary tumors at other sites. Correct Answer: D

Question: A nurse is teaching a client why a malignant tumor can continue growing after it has reached a substantial size. Which process enables the tumor to obtain additional oxygen and nutrients? Answer Choices: A) Angiogenesis, in which the tumor stimulates the formation of new blood vessels. B) Apoptosis, in which damaged cells undergo programmed death. C) Contact inhibition, in which cells stop dividing after contacting neighboring cells. D) Differentiation, in which cells acquire specialized functions and stop all proliferation.

Option A is correct because angiogenesis allows a growing tumor to establish a blood supply that supports oxygen delivery, nutrient acquisition, and continued growth. Option B is incorrect because apoptosis eliminates cells rather than supplying a growing tumor. Option C is incorrect because malignant cells commonly lose normal contact inhibition. Option D is incorrect because differentiation does not automatically eliminate proliferative capacity, and it is not the mechanism that supplies a tumor's blood supply. Correct Answer: A

Question: A nurse is planning cancer screening education for an asymptomatic adult. Which principle should guide the nurse's teaching? Answer Choices: A) Screening should begin only after unexplained weight loss or bleeding occurs. B) Screening should be individualized according to age, risk factors, evidence-based recommendations, and the client's overall health. C) Every available tumor marker should be measured annually because this reliably detects all early cancers. D) Screening recommendations should be identical regardless of age, family history, or life expectancy.

Option A is incorrect because screening is intended to identify selected cancers before symptoms occur; waiting for symptoms may delay diagnosis. Option B is correct because appropriate screening depends on the cancer type, age, risk profile, available evidence, and the likelihood that the person will benefit. Option C is incorrect because tumor markers are not universal screening tests and can produce false-positive or false-negative results. Option D is incorrect because screening benefits and harms vary according to individual circumstances. Correct Answer: B

Question: A nurse is caring for a client who has just received a new cancer diagnosis and is expressing fear, anger, and uncertainty about the future. Which response best supports therapeutic communication? Answer Choices: A) Reassure the client that positive thinking will eliminate the cancer. B) Avoid discussing emotional concerns because the nurse should focus on physical symptoms. C) Invite the client to express concerns, acknowledge the emotions, and assess coping resources and support needs. D) Immediately correct the client's feelings by explaining that many cancers are curable.

Option A is incorrect because positive thinking cannot guarantee elimination of cancer and may invalidate the client's concerns. Option B is incorrect because emotional assessment is an important component of comprehensive cancer nursing care. Option C is correct because acknowledging emotions, listening without judgment, and assessing support needs help the nurse individualize psychosocial care. Option D is incorrect because immediately correcting or minimizing emotions may discourage the client from expressing legitimate fears and questions. Correct Answer: C

Question: A nurse is preparing a client for colonoscopy to investigate possible colorectal cancer. Which explanation best distinguishes direct visualization from imaging studies? Answer Choices: A) Colonoscopy allows direct visualization of the intestinal mucosa and can permit tissue sampling of suspicious lesions. B) Colonoscopy measures circulating tumor markers without entering the gastrointestinal tract. C) Colonoscopy determines the exact TNM stage without requiring additional diagnostic evaluation. D) Colonoscopy identifies malignant cells solely by measuring electrical activity in the bowel wall.

Option A is correct because colonoscopy permits direct inspection of the colonic mucosa and biopsy of suspicious lesions for histologic evaluation. Option B is incorrect because tumor markers are assessed using laboratory testing rather than colonoscopy. Option C is incorrect because complete staging may require additional imaging, pathology, and assessment of lymph nodes and distant disease. Option D is incorrect because electrical activity is not the basis of colonoscopic cancer diagnosis. Correct Answer: A

Question: A nurse is reviewing the care of a pregnant client newly diagnosed with cancer. Which principle should guide collaborative treatment planning? Answer Choices: A) All cancer treatment must be delayed until after delivery, regardless of the cancer type or stage. B) The same chemotherapy regimen is appropriate in every trimester because pregnancy does not affect treatment decisions. C) The nurse should advise the client to make treatment decisions without discussing fetal considerations. D) Treatment decisions require individualized collaboration that considers cancer type and urgency, gestational age, maternal needs, and potential fetal effects.

Option A is incorrect because delaying all treatment may endanger the mother, and management depends on the cancer and clinical circumstances. Option B is incorrect because the safety and appropriateness of therapies vary with the treatment and stage of pregnancy. Option C is incorrect because informed decisions require clear communication about maternal and fetal considerations, risks, and available options. Option D is correct because cancer during pregnancy requires coordinated, individualized planning involving oncology, obstetric, and other relevant specialists. Correct Answer: D

Question: A nurse is reviewing the treatment plan for a client with chronic lymphocytic leukemia (CLL) who has no significant symptoms and stable clinical findings. Which principle is most consistent with individualized management? Answer Choices: A) Every client with CLL must receive intensive chemotherapy immediately after diagnosis. B) Observation may be appropriate for selected asymptomatic clients, while treatment decisions depend on disease activity, symptoms, and individual factors. C) Treatment is unnecessary even if progressive marrow failure and serious symptoms develop. D) CLL is a benign condition that never affects normal blood cell production.

Option A is incorrect because immediate intensive chemotherapy is not necessary for every asymptomatic client with CLL. Option B is correct because selected asymptomatic clients may undergo observation with monitoring, while active or symptomatic disease may require treatment based on the client's condition and risk profile. Option C is incorrect because progressive or symptomatic disease may require treatment. Option D is incorrect because CLL is a malignant lymphoid disorder that can impair normal blood cell function and cause complications. Correct Answer: B

Question: A nurse is caring for a client whose cancer treatment causes immunosuppression, mucosal injury, and reduced nutritional intake. Which finding should the nurse recognize as a potential indicator of infection even when typical inflammatory signs are subtle? Answer Choices: A) A stable weight over the past month. B) Improved appetite and intact oral mucosa. C) New lethargy, declining functional status, or an unexplained change in vital signs. D) A normal platelet count in the absence of other symptoms.

Option A is incorrect because stable weight does not indicate infection, although weight trends remain useful in overall assessment. Option B is incorrect because improved appetite and intact mucosa do not suggest an active infection. Option C is correct because immunosuppressed clients may have subtle or atypical infection manifestations, so unexplained lethargy, deterioration, and vital-sign changes warrant prompt assessment. Option D is incorrect because platelet count alone does not reliably identify infection. Correct Answer: C

Question: A nurse is teaching a group of clients about cellular mechanisms that contribute to cancer development. Which statements accurately describe malignant cellular behavior? Select all that apply. Answer Choices: A) Malignant cells may lose normal regulation of the rate of mitosis. B) Malignant cells consistently undergo apoptosis whenever DNA damage occurs. C) Malignant cells may lose contact inhibition and invade surrounding tissues. D) Malignant cells may stimulate angiogenesis to support tumor growth. E) Malignant cells always retain the same size, shape, and differentiation as their parent cells. F) Malignant cells may acquire additional mutations as the tumor progresses.

Option A is correct because malignant cells may lose normal growth regulation, allowing excessive proliferation. Option B is incorrect because malignant cells may evade apoptosis and survive despite cellular damage. Option C is correct because loss of contact inhibition and altered cellular adhesion can facilitate invasion. Option D is correct because angiogenesis supplies oxygen and nutrients that support tumor growth. Option E is incorrect because malignant cells may exhibit abnormal size, shape, and differentiation. Option F is correct because additional genetic alterations may accumulate during tumor progression, contributing to increasingly aggressive behavior. Correct Answers: A, C, D, F

Question: A nurse is teaching a client about inherited and acquired cancer risk factors. Which factors can contribute to cancer development? Select all that apply. Answer Choices: A) Inherited mutations affecting tumor suppressor genes. B) Exposure to ultraviolet radiation. C) Tobacco smoke exposure. D) Persistent infection with certain cancer-associated viruses. E) Increasing age and accumulation of cellular damage. F) Effective DNA repair that corrects mutations before they are transmitted during cell division.

Option A is correct because inherited alterations in tumor suppressor genes can increase susceptibility to malignancy. Option B is correct because ultraviolet radiation can damage DNA and contribute to skin cancer. Option C is correct because tobacco contains carcinogens associated with multiple cancers. Option D is correct because persistent infection with certain viruses, including high-risk HPV, can contribute to carcinogenesis. Option E is correct because aging is associated with accumulated cellular damage and increased cancer incidence. Option F is incorrect because effective DNA repair helps preserve genomic integrity and generally reduces cancer risk. Correct Answers: A, B, C, D, E

Question: A nurse develops a health promotion plan for a client who wants to reduce the risk of cancer. Which interventions are appropriate? Select all that apply. Answer Choices: A) Encourage smoking cessation and avoidance of secondhand smoke. B) Recommend appropriate vaccination against cancer-associated viruses. C) Encourage protection from excessive ultraviolet exposure. D) Recommend evidence-based cancer screening based on age and individual risk. E) Explain that screening can replace all other cancer prevention measures. F) Encourage a balanced diet, regular physical activity, and maintenance of a healthy weight.

Option A is correct because avoiding tobacco reduces exposure to carcinogens. Option B is correct because HPV and hepatitis B vaccination can prevent infections associated with certain cancers. Option C is correct because limiting ultraviolet exposure reduces a modifiable skin cancer risk. Option D is correct because appropriate screening can identify selected cancers or precancerous changes before symptoms develop. Option E is incorrect because screening does not prevent every cancer and does not replace risk reduction. Option F is correct because healthy dietary patterns, physical activity, and weight management can reduce certain cancer risks and support overall health. Correct Answers: A, B, C, D, F

Question: A nurse compares benign and malignant neoplasms while reviewing a pathology report. Which characteristics are more consistent with benign neoplasms? Select all that apply. Answer Choices: A) Localized growth. B) Well-defined borders. C) Frequent invasion through surrounding tissue. D) Slow growth or long-term stability. E) Frequent encapsulation. F) Routine spread to distant organs through blood and lymph.

Option A is correct because benign neoplasms typically remain localized. Option B is correct because benign tumors commonly have well-defined borders. Option C is incorrect because invasion and destruction of adjacent tissue are characteristic of malignant neoplasms. Option D is correct because benign tumors often grow slowly or remain stable in size. Option E is correct because benign tumors are frequently encapsulated. Option F is incorrect because distant metastasis is a defining behavior of malignant tumors, not a usual feature of benign neoplasms. Correct Answers: A, B, D, E

Question: A nurse is reviewing how malignant cells spread from a primary tumor to distant organs. Which processes can contribute to metastasis? Select all that apply. Answer Choices: A) Invasion through the basement membrane and surrounding tissues. B) Entry of malignant cells into blood or lymphatic vessels. C) Survival of malignant cells during circulation. D) Exit from vessels and implantation in distant tissue. E) Permanent containment of all malignant cells within a capsule. F) Formation of a secondary tumor after malignant cells establish growth at a distant site.

Option A is correct because malignant cells must invade surrounding tissue to access routes of dissemination. Option B is correct because malignant cells may enter blood or lymphatic vessels to travel to other sites. Option C is correct because circulating malignant cells must survive immune defenses and other stresses to establish metastases. Option D is correct because extravasation and implantation allow malignant cells to enter distant tissues. Option E is incorrect because malignant tumors are generally nonencapsulated and invasive rather than permanently contained. Option F is correct because successful establishment and proliferation at a distant site produces a secondary tumor. Correct Answers: A, B, C, D, F

Question: A nurse is caring for a client receiving chemotherapy who has developed bone marrow suppression. Which findings or complications should the nurse monitor for? Select all that apply. Answer Choices: A) Fatigue and exertional dyspnea associated with anemia. B) Increased susceptibility to infection associated with neutropenia. C) Petechiae and mucosal bleeding associated with thrombocytopenia. D) Improved oxygen delivery because fewer red blood cells are circulating. E) Delayed recovery from infection because immune defenses are impaired. F) Spontaneous bleeding when platelet counts become severely reduced.

Option A is correct because anemia reduces oxygen-carrying capacity and can cause fatigue and dyspnea. Option B is correct because neutropenia increases the risk of serious infection. Option C is correct because thrombocytopenia can produce petechiae, bruising, and mucosal bleeding. Option D is incorrect because reduced red blood cell counts decrease rather than improve oxygen delivery. Option E is correct because impaired immune function can delay infection control and recovery. Option F is correct because severe thrombocytopenia can lead to spontaneous or life-threatening bleeding. Correct Answers: A, B, C, E, F

Question: A nurse assesses a client with cancer who has progressive weight loss, poor appetite, and loss of muscle mass. Which factors may contribute to cancer-associated anorexia-cachexia syndrome? Select all that apply. Answer Choices: A) Altered metabolism associated with tumor activity. B) Reduced food intake related to nausea, pain, or treatment effects. C) Increased nutritional requirements associated with metabolic changes. D) Malabsorption caused by certain gastrointestinal tumors or treatments. E) Guaranteed preservation of skeletal muscle despite inadequate intake. F) Early satiety and symptoms that interfere with eating.

Option A is correct because cancer can alter metabolism and promote catabolism. Option B is correct because symptoms and treatment effects can decrease nutritional intake. Option C is correct because some cancers increase metabolic demands and contribute to wasting. Option D is correct because gastrointestinal disease and certain treatments can impair nutrient absorption. Option E is incorrect because inadequate intake and altered metabolism can cause progressive muscle loss. Option F is correct because early satiety and other symptoms can limit the amount of food consumed. Correct Answers: A, B, C, D, F

Question: A nurse reviews diagnostic findings for a client with a suspected solid tumor. Which statements about cancer diagnostic procedures are accurate? Select all that apply. Answer Choices: A) Histologic examination of a tissue biopsy can help identify the type of malignant cells. B) Cytologic examination can evaluate cells obtained from body fluids or epithelial surfaces. C) Imaging studies can help assess the location and extent of a tumor. D) A single elevated tumor marker always confirms a specific cancer diagnosis. E) Lymph node biopsy may provide information about malignant involvement. F) A negative screening test excludes every possible malignancy.

Option A is correct because histology evaluates tissue architecture and cellular characteristics to help establish a diagnosis. Option B is correct because cytology can assess cells from specimens such as Pap tests, sputum, or aspirated fluids. Option C is correct because imaging helps identify tumors and assess possible spread. Option D is incorrect because tumor markers can be elevated in nonmalignant conditions and must be interpreted with other findings. Option E is correct because lymph node biopsy can establish whether malignant cells have spread to regional nodes. Option F is incorrect because screening tests have limitations and cannot exclude every cancer. Correct Answers: A, B, C, E

Question: A nurse is teaching a student about cancer grading and staging. Which statements are correct? Select all that apply. Answer Choices: A) Grading evaluates cellular differentiation and features related to tumor aggressiveness. B) Higher-grade tumors generally demonstrate less differentiation and more aggressive characteristics. C) TNM staging evaluates the primary tumor, regional lymph nodes, and distant metastasis. D) A tumor's grade and stage describe exactly the same characteristics. E) Stage information can help guide treatment planning and prognosis. F) A high-grade tumor automatically proves that distant metastasis has occurred.

Option A is correct because grading assesses how closely tumor cells resemble their normal tissue of origin and estimates aggressiveness. Option B is correct because poorly differentiated tumors generally have more aggressive characteristics. Option C is correct because TNM stands for tumor, nodes, and metastasis. Option D is incorrect because grading evaluates cellular characteristics, whereas staging evaluates disease extent. Option E is correct because stage is important in selecting treatment and estimating prognosis. Option F is incorrect because grade alone does not establish whether distant metastases are present. Correct Answers: A, B, C, E

Question: A nurse is reviewing tumor-marker testing with a client who has cancer. Which statements accurately describe the clinical use and limitations of tumor markers? Select all that apply. Answer Choices: A) Tumor markers may help monitor response to treatment in selected cancers. B) Some tumor markers may help identify recurrence or changes in disease activity. C) Tumor markers may be detected in blood, urine, or other body fluids. D) Every cancer produces a detectable tumor marker. E) Tumor-marker results must be interpreted alongside clinical and diagnostic findings. F) A tumor-marker result independently determines the exact anatomic stage of every cancer.

Option A is correct because selected markers can help assess treatment response. Option B is correct because changes in some markers can support surveillance for recurrence or progression. Option C is correct because tumor-associated substances may be measurable in different body fluids. Option D is incorrect because many cancers do not produce reliably detectable markers. Option E is correct because marker results have limitations and require clinical interpretation. Option F is incorrect because tumor markers alone do not determine the complete TNM stage of every cancer. Correct Answers: A, B, C, E

Question: A nurse cares for a client receiving chemotherapy who has an absolute neutrophil count of 350 cells/mm³. Which interventions are appropriate for reducing infection risk? Select all that apply. Answer Choices: A) Perform meticulous hand hygiene. B) Monitor for fever and subtle changes in clinical status. C) Encourage the client to avoid close contact with people who have contagious illnesses. D) Use rectal temperatures routinely to detect small temperature changes. E) Protect skin and mucous membranes from injury. F) Report fever promptly and facilitate urgent evaluation when indicated.

Option A is correct because hand hygiene reduces transmission of infectious organisms. Option B is correct because severe neutropenia can blunt typical inflammatory responses, making careful monitoring essential. Option C is correct because avoiding exposure to contagious illnesses reduces infection risk. Option D is incorrect because rectal temperatures can injure mucosa and increase infection risk in severely neutropenic clients. Option E is correct because damaged skin and mucous membranes provide potential entry points for pathogens. Option F is correct because fever in severe neutropenia may indicate a life-threatening infection and requires urgent evaluation. Correct Answers: A, B, C, E, F

Question: A nurse is assessing a client receiving chemotherapy who develops fever and chills. Which actions are appropriate when febrile neutropenia is suspected? Select all that apply. Answer Choices: A) Obtain ordered blood cultures promptly. B) Delay antibiotics until all culture results are finalized. C) Facilitate prompt administration of prescribed empiric broad-spectrum antibiotics. D) Assess vital signs and the client's overall clinical status. E) Assume that the absence of redness or pus excludes infection. F) Notify the appropriate provider or activate the urgent clinical response pathway.

Option A is correct because blood cultures can help identify the infectious organism and guide therapy. Option B is incorrect because antibiotic treatment should not be delayed while awaiting final culture results. Option C is correct because prompt empiric antimicrobial treatment is critical in suspected febrile neutropenia. Option D is correct because deterioration, hypotension, and other signs of sepsis must be recognized promptly. Option E is incorrect because severe neutropenia may reduce typical local inflammatory findings. Option F is correct because urgent clinical evaluation is necessary to facilitate timely treatment. Correct Answers: A, C, D, F

Question: A nurse is monitoring a client who is at risk for tumor lysis syndrome after starting chemotherapy. Which findings are consistent with this complication? Select all that apply. Answer Choices: A) Hyperkalemia. B) Hyperphosphatemia. C) Hyperuricemia. D) Hypocalcemia. E) Acute kidney injury. F) Persistent hypokalemia as the defining electrolyte abnormality.

Option A is correct because intracellular potassium is released during rapid tumor-cell destruction. Option B is correct because cellular phosphate release can cause hyperphosphatemia. Option C is correct because nucleic acid breakdown increases uric acid production. Option D is correct because phosphate binding can lower serum calcium. Option E is correct because uric acid and calcium-phosphate precipitation, together with other metabolic effects, can impair renal function. Option F is incorrect because hyperkalemia, rather than persistent hypokalemia, is a characteristic abnormality of tumor lysis syndrome. Correct Answers: A, B, C, D, E

Question: A nurse is caring for a client with advanced cancer who suddenly develops facial edema, neck vein distention, dyspnea, and worsening headache. Which findings or actions are relevant to suspected superior vena cava syndrome? Select all that apply. Answer Choices: A) Recognize that obstruction of the superior vena cava can impair venous drainage from the upper body. B) Assess respiratory status and neurologic changes promptly. C) Consider the syndrome an oncologic emergency when symptoms indicate significant compromise. D) Assume that facial edema always indicates nephrotic syndrome rather than cancer-related obstruction. E) Notify the oncology team promptly for urgent evaluation. F) Encourage the client to lie flat regardless of respiratory distress.

Option A is correct because obstruction of the superior vena cava impedes venous return from the head, neck, and upper extremities. Option B is correct because respiratory compromise and cerebral venous congestion may cause serious deterioration. Option C is correct because severe superior vena cava syndrome can threaten airway and neurologic function. Option D is incorrect because cancer-related venous obstruction is an important cause of facial edema in this clinical context. Option E is correct because prompt evaluation and management are needed. Option F is incorrect because lying flat may worsen symptoms in a client with respiratory distress; positioning should support breathing while urgent evaluation proceeds. Correct Answers: A, B, C, E

Question: A nurse is assessing a client with metastatic cancer who reports new severe back pain and has progressive lower-extremity weakness. Which findings increase concern for malignant spinal cord compression? Select all that apply. Answer Choices: A) New or progressive limb weakness. B) New sensory changes. C) New bowel or bladder dysfunction. D) New severe back or neck pain. E) Improvement in chronic pain after the prescribed analgesic. F) Sudden inability to ambulate normally.

Option A is correct because progressive weakness can indicate spinal cord or nerve-root compromise. Option B is correct because sensory changes may occur with cord compression. Option C is correct because bowel or bladder dysfunction is a serious warning sign. Option D is correct because new severe back or neck pain may precede neurologic deterioration. Option E is incorrect because improvement in chronic pain after analgesia alone does not establish spinal cord compression. Option F is correct because sudden loss of mobility can reflect serious neurologic compromise. Correct Answers: A, B, C, D, F

Question: A nurse is teaching a client receiving external-beam radiation therapy about expected tissue effects. Which statements are accurate? Select all that apply. Answer Choices: A) Radiation damages cellular DNA and interferes with the ability of targeted cells to reproduce. B) Rapidly dividing cells are generally more vulnerable to radiation-related injury. C) Normal tissues in the treatment field may also be affected. D) All radiation-related tissue damage is permanent. E) Adverse effects depend partly on the treatment site and the tissues exposed. F) Radiation guarantees complete elimination of all malignant cells.

Option A is correct because radiation damages DNA and limits cellular reproduction. Option B is correct because rapidly dividing cells are particularly susceptible to radiation-related injury. Option C is correct because normal tissues may be damaged along with malignant cells. Option D is incorrect because some normal tissues can recover after treatment, although certain effects may persist. Option E is correct because adverse effects vary with the anatomical treatment field and tissue sensitivity. Option F is incorrect because radiation does not guarantee complete eradication of cancer. Correct Answers: A, B, C, E

Question: A nurse is preparing a client to receive combination chemotherapy. Which principles should guide the nurse's care? Select all that apply. Answer Choices: A) Monitor blood counts for evidence of bone marrow suppression. B) Assess for nausea, mucositis, and nutritional problems. C) Monitor for medication-specific organ toxicity. D) Assume that all chemotherapy agents affect only malignant cells. E) Explain that combination therapy may use agents with different mechanisms of action. F) Assess for infection and bleeding when appropriate laboratory abnormalities develop.

Option A is correct because chemotherapy may suppress bone marrow function. Option B is correct because gastrointestinal toxicity and mucosal injury can compromise nutrition and hydration. Option C is correct because different antineoplastic agents can cause specific renal, cardiac, pulmonary, neurologic, or other toxicities. Option D is incorrect because chemotherapy can damage normal rapidly dividing cells and other susceptible tissues. Option E is correct because combination regimens may target different cellular processes and reduce the likelihood of resistance. Option F is correct because neutropenia and thrombocytopenia increase infection and bleeding risks, respectively. Correct Answers: A, B, C, E, F

Question: A nurse is planning care for a child receiving cancer treatment. Which interventions support the child's developmental, psychosocial, and physical needs? Select all that apply. Answer Choices: A) Include the child in care discussions at a level appropriate to developmental ability. B) Support age-appropriate contact with peers and family. C) Provide parents with information about treatment and available support resources. D) Assume that every child understands the diagnosis and treatment in the same way. E) Monitor for late effects such as impaired growth, endocrine dysfunction, and learning difficulties. F) Recognize that siblings may also require attention and emotional support.

Option A is correct because developmentally appropriate participation promotes understanding and a sense of control. Option B is correct because supportive relationships can reduce isolation and improve coping. Option C is correct because parents often need help coordinating care, obtaining resources, and making treatment decisions. Option D is incorrect because understanding and coping vary by developmental stage. Option E is correct because childhood cancer treatment can have long-term physical and neurocognitive effects. Option F is correct because siblings may experience fear, jealousy, sadness, or distress and also need support. Correct Answers: A, B, C, E, F

Question: A nurse is discussing childhood leukemia with the parents of a newly diagnosed child. Which statements are accurate? Select all that apply. Answer Choices: A) Acute lymphoblastic leukemia (ALL) is the most common childhood leukemia. B) Bone marrow involvement can impair red blood cell and platelet production. C) Chemotherapy is a major treatment approach for childhood leukemia. D) Children who complete treatment have no risk of long-term treatment-related complications. E) Age at diagnosis and the initial white blood cell count can contribute to prognosis. F) Selected children with higher-risk leukemia may be considered for stem cell transplantation.

Option A is correct because ALL is the most common childhood leukemia. Option B is correct because leukemic marrow replacement can cause anemia and thrombocytopenia. Option C is correct because chemotherapy is a major treatment modality, with regimen and phases depending on the leukemia subtype. Option D is incorrect because survivors may develop late effects involving cardiac, pulmonary, renal, endocrine, reproductive, auditory, or neurocognitive function. Option E is correct because age and initial white blood cell count are among the factors used in assessing prognosis. Option F is correct because stem cell transplantation may be considered for selected children with higher-risk disease. Correct Answers: A, B, C, E, F

Question: A nurse is teaching the parents of a child who has completed treatment for leukemia. Which late effects should be included in survivorship education? Select all that apply. Answer Choices: A) Cardiomyopathy. B) Hearing loss. C) Learning difficulties or neurocognitive changes. D) Infertility or impaired reproductive function. E) Secondary malignancies. F) Guaranteed lifelong protection against future cancer.

Option A is correct because certain chemotherapy agents can damage the myocardium and cause cardiomyopathy. Option B is correct because some chemotherapy drugs and radiation exposures can cause hearing loss. Option C is correct because childhood cancer and its treatment can affect learning and neurocognitive performance. Option D is correct because chemotherapy or radiation may impair reproductive function. Option E is correct because some cancer treatments increase the risk of secondary malignancies. Option F is incorrect because previous successful treatment does not eliminate the possibility of a new cancer. Correct Answers: A, B, C, D, E

Question: A nurse is planning cancer care for an older adult with multiple chronic conditions and several prescribed medications. Which considerations should be included in the individualized plan? Select all that apply. Answer Choices: A) Potential interactions between cancer medications and existing prescriptions. B) Baseline organ function and the client's ability to tolerate treatment. C) Whether treatment could worsen chronic health conditions. D) Functional status and the client's goals of care. E) Chronological age as the only factor determining treatment eligibility. F) Potential for delayed recovery or interruption of treatment due to comorbidities.

Option A is correct because medication interactions can increase toxicity or reduce treatment effectiveness. Option B is correct because age-associated physiologic changes and organ dysfunction may influence treatment safety. Option C is correct because cancer therapies may exacerbate existing chronic illnesses. Option D is correct because functional status and personal goals help guide appropriate care. Option E is incorrect because chronological age alone does not determine eligibility; individual clinical circumstances matter. Option F is correct because comorbidities may delay recovery or interrupt treatment. Correct Answers: A, B, C, D, F

Question: A nurse is performing an assessment for a client newly diagnosed with cancer. Which assessment components are important when developing an individualized nursing plan of care? Select all that apply. Answer Choices: A) Pain characteristics and their effect on daily functioning. B) Nutritional status and recent weight changes. C) Hydration status and ability to maintain oral intake. D) Psychosocial concerns, coping strategies, and available support. E) Treatment understanding and the client's ability to participate in decisions. F) Tumor location alone, because other assessments are unnecessary once cancer is diagnosed.

Option A is correct because pain assessment supports individualized symptom management. Option B is correct because weight loss and malnutrition can complicate cancer treatment and recovery. Option C is correct because poor intake, vomiting, and mucositis can contribute to dehydration. Option D is correct because cancer can affect emotional well-being, coping, family relationships, and access to support. Option E is correct because understanding and decision-making needs influence teaching and care planning. Option F is incorrect because cancer affects multiple systems and requires comprehensive assessment beyond tumor location. Correct Answers: A, B, C, D, E

Question: A nurse is planning interventions for a client with cancer who is at risk for impaired skin integrity and infection. Which actions are appropriate? Select all that apply. Answer Choices: A) Inspect skin and mucous membranes for breakdown or lesions. B) Encourage adequate nutrition and hydration as tolerated. C) Reposition clients with limited mobility and protect pressure-prone areas. D) Use appropriate aseptic technique for invasive procedures and dressing changes. E) Ignore small skin lesions unless the client develops a high fever. F) Monitor blood counts and report clinically significant neutropenia.

Option A is correct because early recognition of tissue breakdown permits timely intervention. Option B is correct because adequate nutrition and hydration support tissue integrity and recovery. Option C is correct because pressure relief reduces the risk of pressure injury in clients with limited mobility. Option D is correct because aseptic technique reduces the introduction of pathogens. Option E is incorrect because small lesions may become infection sources, particularly in immunocompromised clients. Option F is correct because neutropenia increases infection risk and may require additional precautions and urgent evaluation of symptoms. Correct Answers: A, B, C, D, F

Question: A nurse is teaching a client about paraneoplastic syndromes. Which statements accurately describe these syndromes? Select all that apply. Answer Choices: A) They may result from tumor production of hormones or other biologically active substances. B) They may result from abnormal immune responses associated with cancer. C) Their manifestations can occur in organs distant from the primary tumor. D) They are always caused by direct mechanical compression of adjacent tissue. E) They can produce systemic manifestations that may precede recognition of the primary cancer. F) They are identical to metastasis because both require malignant cells to establish a distant tumor.

Option A is correct because tumors can produce ectopic hormones or other substances that disrupt normal physiology. Option B is correct because abnormal immune responses may contribute to paraneoplastic manifestations. Option C is correct because the effects may occur away from the primary tumor and may involve multiple organ systems. Option D is incorrect because direct compression is a local effect, whereas paraneoplastic syndromes involve systemic hormonal or immune mechanisms. Option E is correct because systemic manifestations can occasionally precede diagnosis of the underlying malignancy. Option F is incorrect because paraneoplastic syndromes do not require malignant cells to establish a distant tumor. Correct Answers: A, B, C, E

Question: A nurse is evaluating a client with cancer who has new neurologic symptoms and possible increased intracranial pressure. Which mechanisms could explain serious complications from a tumor? Select all that apply. Answer Choices: A) Compression of adjacent brain tissue. B) Obstruction of cerebrospinal fluid pathways. C) Increased pressure within the cranial cavity. D) Destruction of surrounding tissue by invasive growth. E) Guaranteed improvement in cerebral perfusion as the tumor enlarges. F) Impaired function of structures compressed or invaded by the tumor.

Option A is correct because a growing mass can compress brain tissue and impair neurologic function. Option B is correct because obstruction of cerebrospinal fluid pathways may produce hydrocephalus and increased pressure. Option C is correct because an expanding intracranial mass can raise intracranial pressure and threaten cerebral perfusion. Option D is correct because invasive malignant growth can destroy normal tissue. Option E is incorrect because tumor enlargement can compromise rather than guarantee improvement in cerebral perfusion. Option F is correct because compression or invasion can impair the function of affected neural structures. Correct Answers: A, B, C, D, F

Question: A nurse is teaching a client about the potential consequences of cancer-related infection and hemorrhage. Which statements are accurate? Select all that apply. Answer Choices: A) Immunosuppression can allow infection to progress rapidly. B) Tumor invasion of blood vessels can cause bleeding. C) Severe hemorrhage may lead to hypovolemic shock. D) Infection is impossible when the total white blood cell count is elevated. E) Bone marrow suppression can increase the risk of infection and bleeding. F) Local tissue necrosis can contribute to infection risk.

Option A is correct because impaired immune defenses can permit infection to become severe quickly. Option B is correct because malignant invasion can damage blood vessels and cause hemorrhage. Option C is correct because substantial blood loss can reduce circulating volume and cause shock. Option D is incorrect because an elevated total white blood cell count may reflect abnormal leukemic cells and does not guarantee effective immune defense. Option E is correct because reduced neutrophils and platelets can increase infection and bleeding risks. Option F is correct because necrotic tissue can compromise local defenses and provide conditions that favor infection. Correct Answers: A, B, C, E, F

Question: A nurse is preparing a client for cancer treatment and discussing the importance of interprofessional collaboration. Which activities are appropriate components of collaborative cancer care? Select all that apply. Answer Choices: A) Coordinating diagnostic evaluation, treatment, and follow-up. B) Collaborating on symptom control, nutrition, and psychosocial support. C) Communicating clinically significant treatment complications to the appropriate team members. D) Developing care goals that reflect the client's needs and preferences. E) Making all decisions independently without involving the client. F) Coordinating supportive and palliative interventions when indicated.

Option A is correct because cancer diagnosis, treatment, and aftercare often require multiple specialties. Option B is correct because symptom control and psychosocial support are integral to comprehensive cancer care. Option C is correct because timely communication supports recognition and management of treatment complications. Option D is correct because individualized goals should reflect the client's condition, values, and preferences. Option E is incorrect because client participation and informed decision-making are essential components of patient-centered care. Option F is correct because supportive and palliative interventions can improve comfort and quality of life alongside disease-directed treatment when appropriate. Correct Answers: A, B, C, D, F

Question: A nurse is evaluating whether a client's cancer-related nursing plan of care is effective. Which findings indicate progress toward common care goals? Select all that apply. Answer Choices: A) The client reports improved pain control and demonstrates increased ability to perform desired activities. B) The client maintains adequate hydration and shows no new evidence of dehydration. C) The client and family describe coping strategies and identify available support resources. D) The client develops new fever and worsening confusion without further assessment. E) The client maintains or improves nutritional intake within the limits of the treatment plan. F) The client understands relevant warning signs and when to seek urgent medical evaluation.

Option A is correct because improved pain control and function indicate progress toward comfort and quality-of-life goals. Option B is correct because adequate hydration reduces the risk of complications associated with poor intake and fluid loss. Option C is correct because identifying coping strategies and support resources reflects psychosocial preparation. Option D is incorrect because fever and worsening confusion may indicate a serious complication requiring prompt assessment rather than evidence of effective care. Option E is correct because maintaining adequate nutritional intake supports strength and recovery. Option F is correct because understanding warning signs promotes timely recognition and management of complications. Correct Answers: A, B, C, E, F

Question: A nurse is teaching a client receiving chemotherapy about symptoms that require prompt reporting. Which symptoms should the nurse emphasize? Select all that apply. Answer Choices: A) Fever or chills during a period of neutropenia. B) New unexplained bruising or persistent bleeding. C) New severe back pain accompanied by weakness or bladder dysfunction. D) Sudden facial swelling with breathing difficulty. E) Mild temporary fatigue that is unchanged from the client's established baseline and has no associated warning signs. F) Markedly reduced urine output accompanied by weakness after chemotherapy begins.

Option A is correct because fever during neutropenia may signal a life-threatening infection. Option B is correct because unexplained bruising or persistent bleeding may indicate thrombocytopenia or another bleeding disorder. Option C is correct because severe back pain with neurologic or bladder symptoms raises concern for spinal cord compression. Option D is correct because facial swelling with respiratory difficulty may indicate serious venous obstruction or another emergency. Option E is incorrect because mild unchanged fatigue without additional warning signs does not carry the same urgency as the listed red flags, although persistent or worsening fatigue should still be discussed with the care team. Option F is correct because markedly reduced urine output and weakness after chemotherapy may indicate acute kidney injury or tumor lysis syndrome and require urgent evaluation. Correct Answers: A, B, C, D, F