NCLEX-PN : Conditions and Treatments

Study concepts, example questions & explanations for NCLEX-PN

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Example Questions

Example Question #11 : Tumors And Cancer

What condition may look like eczema around the nipple but is actually a malignant skin change?

Possible Answers:

Invasive ductal carcinoma

Medullary carcinoma

Paget's disease of the breast

Invasive lobular carcinoma 

Correct answer:

Paget's disease of the breast

Explanation:

Paget's disease of the breast will often present as itchy, scaling, cracked, red lesions around the nipple. The other conditions mentioned are all forms of breast cancer, but all of them originate in tissues deeper to the breast and will generally present without a visible rash, though some skin changes such as redness or dimpling may occur.

Example Question #12 : Tumors And Cancer

Which of the following is a benign tumor? 

Possible Answers:

Chondrosarcoma

Adenocarcinoma

Fibroma

Osteosarcoma

Neuroblastoma

Correct answer:

Fibroma

Explanation:

A fibroma is considered a benign fibrous tissue tumor. The other tumor types are all malignant.

Example Question #13 : Tumors And Cancer

What is the most common soft tissue tumor in children?

Possible Answers:

Neuroblastoma

Rhabdomyosarcoma

Desmoid tumor

Epithelioid sarcoma

Correct answer:

Rhabdomyosarcoma

Explanation:

The most common soft tissue tumor in children is rhabdomyosarcoma. This generally presents on the face, neck, or extremities, with nearly one-third of cases presenting with orbital involvement. 90% of all cases of rhabdomyosarcoma are seen in children, most often seen in children under 10 years of age. Leiomyosarcoma, epithelioid sarcoma, and desmoid tumors are all relatively rare soft tissue tumors of childhood.

Example Question #14 : Tumors And Cancer

The nursing student prepares a report on acute versus chronic leukemia. Which of the following assessments is correct?

Possible Answers:

Acute leukemia has a gradual onset and often occurs among children and young adults; chronic leukemia has a rapid onset and often occurs among those aged 25 to 60

Acute leukemia has a gradual onset and often occurs among those aged 25 to 60; chronic leukemia has a rapid onset and often occurs among children and young adults

None of these

Acute leukemia has a rapid onset and often occurs among those aged 25 to 60; chronic leukemia has a gradual onset and often occurs among children and young adults

Acute leukemia has a rapid onset and often occurs among children and young adults; chronic leukemia has a gradual onset and often occurs among those aged 25 to 60

Correct answer:

Acute leukemia has a rapid onset and often occurs among children and young adults; chronic leukemia has a gradual onset and often occurs among those aged 25 to 60

Explanation:

To answer this question, it is essential to 1) identify the correct definition of acute conditions versus chronic conditions and 2) identify the age groups that experience acute leukemia versus chronic leukemia. Acute conditions such as acute leukemias have rapid onsets, while chronic conditions such as chronic leukemias have gradual onsets. Acute leukemias are more common among children and young adults, while chronic conditions are more common among adults aged 25 to 60.

Example Question #15 : Tumors And Cancer

Which of the following types of kidney tumors occurs most frequently in children?

Possible Answers:

Wilm's tumor

Renal oncocytoma

Chromophobe renal cell carcinoma

Metanephric adenoma

Correct answer:

Wilm's tumor

Explanation:

Wilm's tumor, also known as nephroblastoma, is a rare type of malignant tumor that occurs primarily in children. These tumors tend to be unilateral, and will present as an abdominal mass with abdominal pain or tenderness, nausea and vomiting, and fever. 20% of cases will also present with hematuria. 

Example Question #16 : Tumors And Cancer

With what co-infection is Burkitt lymphoma associated? 

Possible Answers:

Herpes simplex

Hepatitis B

Epstein-Barr virus (EBV)

Cytomegalovirus (CMV)

Correct answer:

Epstein-Barr virus (EBV)

Explanation:

EBV infection is common in Burkitt lymphoma. In malaria-endemic areas, it is thought that the cancer is actually caused by chronic malarial infection increasing a person's susceptibility to chronic EBV infection. The same is assumed about HIV co-infection with EBV in the United States.

None of the other infections listed are associated with Burkitt lymphoma.

Example Question #17 : Tumors And Cancer

A 55-year-old client presents to clinic for a small slowly enlarging papular skin lesion on the right aspect of his nose that has been present for less than 6 months. The nurse is aware that sun exposed skin is susceptible to lesions that may become cancerous. The appearance of the lesion is consistent with a basal cell carcinoma.

What is the best initial treatment for this type of lesion? 

Possible Answers:

Ultraviolet radiation

Wide excision of tissue down to fascia

No treatment is warranted at this time, the lesion should be observed for signs of overt changes.

Excisional surgery with possible use of topical chemotherapy agents

Radiation and systemic chemotherapy

Correct answer:

Excisional surgery with possible use of topical chemotherapy agents

Explanation:

The proper intervention for a lesion on the nose should include complete excision of the lesion to send for biopsy to discover the extent and type of skin lesion. It may require additional treatment in the form of topical chemotherapy drugs or further surgery depending on the pathological findings. Wide excision to fascia may be reserved for more invasive skin cancers such as malgnant melanoma after an initial biopsy has been performed. Lesions that have been present for longer than 6 months should be biopsied as a general rule, although some practitioners may biopsy sooner with increased suspicion of omnious looking lesions. 

Example Question #18 : Tumors And Cancer

A nurse is caring for a client newly diagnosed with chronic lymphocyctic leukemia (CLL). The nurse is aware that this type of malignancy is associated with certain factors and clinical manifestations. 

Which of these is not associated with CLL?

Possible Answers:

There is usually no symptoms seen in early disease, with later manifestations such as fatigue, splenomegaly, and night sweats.

The affected cells contain a distinctive genetic abnormality, known as the Philadelphia chromosome, used as a marker of the disease. 

CLL is the most common leukemia in adults, mostly affecting men between the ages of 50-70 years of age.

Some diagnostic findings include thrombocytopenia, with the presence of lymphocytes within the bone marrow. 

Treatments mostly include combination therapy of various chemotherapy agents, as well as radiation and splenectomy. 

Correct answer:

The affected cells contain a distinctive genetic abnormality, known as the Philadelphia chromosome, used as a marker of the disease. 

Explanation:

The Philadelphia chromosome is associated with chronic myelogenous leukemia.

Example Question #19 : Tumors And Cancer

A patient with a strong family history of cancer presents to your clinic with a new diagnosis of medullary thyroid cancer. You are concerned that the patient may have the familial cancer syndrome, MEN2A (Multiple Endocrine Neoplasia) Syndrome. Which of the following represents the malignancies encountered in MEN2A Syndrome?

Possible Answers:

Medullary thyroid cancer, parathyroid adenoma, islet cell tumor of the pancreas

Medullary thyroid cancer, head and neck cancer, esophageal cancer, anal cancer

Medullary thyroid cancer, pheochromocytoma, mucosal adenoma

Medullary thyroid cancer, colorectal cancer, uterine cancer, gastric cancer

Medullary thyroid cancer, pheochromocytoma, parathyroid adenoma

Correct answer:

Medullary thyroid cancer, pheochromocytoma, parathyroid adenoma

Explanation:

The correct answer is "Medullary thyroid cancer, pheochromocytoma, parathyroid adenoma," as these are the cancers most commonly associated with MEN2A (Multiple Endocrine Neoplasia) Syndrome, a familial cancer syndrome that predisposes to development of numerous cancers in patients generally at younger ages that would be expected. One should have an index of suspicion for such a familial cancer syndrome when evaluating a patient with a new cancer who has a family history of similar cancers that are known to be associated with familial cancer syndromes. 

Medullary thyroid cancer, pheochromocytoma, and mucosal adenomas are seen in patients with MEN2B Syndrome, not MEN2A.

Medullary thyroid cancer, parathyroid adenoma, and islet cell tumors of the pancreas are not seen together in a particular cancer syndrome. Parathyroid adenomas, islet cell tumors of the pancreas, and pituitary adenomas are seen in patients with MEN1 Syndrome though.

Medullary thyroid cancer, colorectal cancer, uterine cancer, and gastric cancer are not seen together in a particular cancer syndrome. Colorectal cancer, uterine cancer, and gastric cancer are known to be associated with Lynch Syndrome, also known as Hereditary Non-Polyposis Colorectal Cancer Syndrome though.

Medullary thyroid cancer, head and neck cancer, esophageal cancer, and anal cancer are not seen together in a particular cancer syndrome. Head and neck cancer, esophageal cancer (squamous cell carcinoma), and anal cancer are all known to be associated with alcohol and tobacco use among other risk factors.

Example Question #20 : Tumors And Cancer

You are the nurse taking care of a 20-year old patient who complains of palpitations, feelings of anxiety, headaches, and sweating for the last two months. You take the patient's vital signs, and find that they are tachycardic and hypertensive. Thyroid function tests and a urine drug screen are both within normal limits. 24-hour urine catecholamines and metanephrines are markedly elevated. Which of the following is the most likely diagnosis?

Possible Answers:

Amphetamine abuse

Pheochromocytoma

Cocaine abuse

Generalized anxiety disorder

Panic attack

Correct answer:

Pheochromocytoma

Explanation:

The most likely diagnosis in this patient is pheochromocytoma. A pheochromocytoma is a rare neuroendocrine neoplasm that arises within the chromaffin cells of the adrenal medulla. Pheochromocytomas can secrete norepinephrine and/or epinephrine, which can lead to symptoms of sympathetic activation. Patients with pheochromocytomas may experience palpitations, hypertension, headaches, fatigue, flushing, sweating, nausea, anxiety, and flank pain, among other symptoms. The workup for pheochromocytoma includes 24-hour urine catecholamines and metanephrines, as these would be elevated in a patient with a pheochromocytoma.

For the patient in this vignette, he/she complains of a number of symptoms that are consistent with a pheochromocytoma, and the elevated 24-hour urine catecholamines and metanephrines has a high sensitivity and specificity for pheochromocytoma, so this is the most likely diagnosis. 

Panic attacks and generalized anxiety disorder may present with similar symptoms to a pheochromocytoma, but would not account for the elevated urine catecholamines and metanephrines. 

Amphetamine abuse and cocaine abuse may present with some similar symptoms to a pheochromocytoma, but would not account account for the elevated urine catecholamines and metanephrines, and also would have appeared in the urine drug screen. The urine drug screen in this patient was within normal limits. 

 

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