1.

Nurse observes shoulder drop postoperatively in a client who had a radical neck dissection for cancer 24
hours ago. What is the nurse's best action?
A. Reposition the client on the nonoperative side.
B. Document the observation as the only action.
C. Assess deep tendon reflexes.
D. Notify the physician

ANS: B
Cranial nerve XI (spinal accessory nerve) is removed during a radical neck dissection. The resulting
shoulder drop is an expected side effect. Physical therapy exercises are essential later in the recover period,
but no specific interventions are required at this postoperative stage.

2. What health promotion activity should the nurse stress to the client who has xerostomia as a result of
radiation therapy for head and neck cancer?
A. Carrying a medical alert card
B. Increasing carbohydrate and fat intake
C. Having a dental examination twice per year
D. Using only water soluble lubricants on the irradiated skin

ANS: C
Xerostomia is dry mouth. It is common after radiation therapy in which the salivary glands are in the
radiation path. The radiation damages theses glands and permanently reduces their function. The client
makes much lass saliva. Som of the functions of saliva are to maintain a specific pH of the mouth and
protect a gainst infection by the action of salivary enzymes and immunoglobulins. The reduction in the
protection provided by saliva changes the bacterial content of the mouth, increasing the risk for oral
infections and dental caries (tooth decay). A vertical laryngectomy allows one true cord, and most of the
tracheal rings to remain. Speech remains but voice quality is permanently changed because there will not be
full cord adduction. The result is a hoarse voice that has a "breathy" sound.

3. A client preparing to go home after a radical neck dissection for cancer is crying. When the nurse asks
why he is crying, the client writes, " I know I shouldn't cry because this surgery may well save my life, but I
can't believe how changed my appearance is."
What is the nurse's best response?
A. "It is all right to cry. Mourning this loss is important in getting past this point."
B. "You're right. :It is silly to carry on like this when the surgery may cure you."
C. "Would you like to talk to someone who also has had a laryngectomy?"
D. How have you coped with difficult situations in the past?"

ANS: A
Often, cancer surgery involves loss of a body part or a decrease in function. Mourning or grieving for a
body image alteration is a healthy part of adapting or adjusting to a new image.

4. Which clinical manifestation indicates that the client's superior vena cava syndrome is resolving?
A. The client's hands are less swollen.
B. Breath sounds are clear bilaterally.
C. The client's back pain is relieved.
D. Pedal edema is present.

ANS: A
With superior vena cava syndrome, blood flow through the vena cava is compromised as a result of tumor
growth. Blood backs up into the periphery and the client experiences upper body swelling, including the
hands.

5. The client receiving intravenous chemotherapy asks the nurse why the nurse is wearing a mask, gloves,
and gown when giving the drugs to the patient. What is the nurse's best response?
A. "These drugs will reduce your immune response and, with these coverings, I am protecting you from
getting an infection from me."
B. "Because your immunity is reduced by this therapy, I am preventing the spread of infection from you to
me or any other client here."
C. "The hospital policy is for any nurse giving these drugs to wear a gown, glove, and mask to prevent
other people from getting cancer."
D. "The drugs are powerful and I handle them every day. The clothing protects me from accidentally
absorbing these strong, cancer-killing drugs."

ANS: D
Most chemotherapy drugs are absorbed through the skin and mucous membranes. As a result, the health
care workers who prepare or give these drugs (especially nurses and pharmacists) are at risk for absorbing
them. Even at low doses, chronic exposure to chemotherapy drugs can affect health. The Oncology Nursing
Society and OSHA have specific guideline for using caution and wearing protective clothing whenever
preparing, giving, or disposing of chemotherapy drugs.

6. Upon entering the room of a 74-year-old client receiving brachytherapy for cervical cancer, the nurse
finds that the radiation implant and the position-holding devices are in the client's bed. What is the nurse's
first best action?
A. Assess the client's mental status.
B. Using tongs to place the implant into the radiation container.
C. Notify the physician and move the client to a different room.
D. Don gloves and attempt to reposition the implant and position holding device.

ANS: B
The implant does emit radiation and should be placed into the secure, lead-lined container in the client's
room. The nurse does not directly touch this implant, but uses long- handled tons for this purpose. If the
proper equipment is not available in the client's room, the radiation department must be notified.

7. For which type of cancer is chemotherapy most beneficial?
A. Brain tumors
B. Superficial cancers on the outside of the body
C. Cancers that are localized to one tissue or body area
D. Cancers that are large, with evidence of distant metastasis

ANS: D
Chemotherapy is considered systemic therapy and is used as primary therapy or adjuvant therapy for
cancers that may not be confined to a localized body area. Because chemotherapy is systemic, it circulates
through many body areas and can harm cancer cells that may be some distance from the primary tumor.
Many types of chemotherapy, however, are not able to cross the blood-brain barrier and are not useful for
tumors that either develop in the brain or metastasize to the brain.

8. The client who is receiving intravenous chemotherapy (into a peripheral line) with an agent that is an
irritant says that her arm burns terribly at and around the IV site. What is the nurse's best first action?
A. Check for a blood return.
B. Slow the rate of infusion.
C. Discontinue the infusion.
D. Apply a cold compress to the site.

ANS: C
Irritants and vesicants can both cause tissue damage. Even if the IV has a good blood return, some of the
chemotherapy can still be leaking into the tissues. Slowing the rate of infusion is not sufficient to prevent
further leakage and damage. Applying a cold compress may or may not be the correct action, depending on
the specific agent; however, the compress would only be applied after the infusion has been discontinued.

9. The client is experiencing lymphedema in the arm on the operative side after a modified radical
mastectomy. Which statement indicates correct understanding for managing this problem?
A. "I will reduce my intake of salt."
B. I will elevate my arm on a pillow at night."
C. "I will try to drink at least 3 L of water each day."
D. "I will wear long sleeves to prevent sun exposure to this arm."

ANS: B
The formation of edema is aggravated by having the arm in a position dependent to the heart. Elevating the
are as much as possible assists gravity to promote better venous and lymph return.

10. The family of a woman being treated with intracavitary radiation for endometrial cancer asks why the
client is in a private room. What is the nurse's best response?
A. "She needs quiet to recover from the fatigue associated with radiation therapy."
B. "She is less likely to become depressed if she doesn't have to tell a roommate that she has cancer."
C. "She has some radiation inside her for a few days, and a private room prevents radiation exposure to
others."
D. "She will become sick and lose her hair with is treatment, so it is best that she is not disturbed by
others."

ANS: C
Intracavitary radiation involves the temporary internal placement of the radiation source, causing radiation
emission within the client's room and posing a danger to other people.

11. The client is a 56-year-old woman receiving intracavitary radiation for cervical cancer. Which nurse
should be assigned to provide personal care to this client during the time the radiation source is within the
client?
A. 30-year-old nurse who is experienced with intracavity radiation and efficient in her work
B. 35-year-old male nurse who has nerver worked with a client receiving intracavitary radiation
C. 60-year-old nurse who is also assigned to provide care to another client receiving intracavitary radiation
D. 28-year-old pregnant nurse who has special expertise in radiation oncology

ANS: A
The client is emitting radioactivity and poses a radiation hazard as long as the intracavitary radiation source
is in place. Pregnant women should not enter the room. Individual care providers should wear a lead apron
and should not spend more than 30 min/day in the room with a client receiving intracavitary radiation.

12. The client receiving tamoxifen (Tamofen) asks how this therapy helps fight breast cancer. What is the
nurse's best response?
A. "The breast cancer cells need estrogen to continue growing. This agent decreases your circulating levels
of estrogen."
B. "The breast cancer cells need estrogen to continue growing. This agent causes you to secrete testosterone
instead of estrogen."
C. "The breast cancer cells need estrogen to continue growing. This agent kills off both the normal estrogen
secreting cells and the cancer cells."
D. "The breast cancer cells need estrogen to continue growing. This agent blocks the receptors for your
naturally occurring estrogen, reducing its availability to the cancer cells."

ANS: D
Tamoxifen is an estrogen antagonist-agonist. Its use in breast cancer is limited to cancers that express the
estrogen receptor. Tamoxifen binds to the estrogen receptors, inhibiting the binding of estrogen to the
receptors and therefore "starving" the cancer cells of an essential growth factor.

13. The client asks how soon after a mastectomy she can engage in sexual activity. What is the nurse's
best response?
A. "You many engage in sexual activity as soon as you are comfortable."
B. "You should wait until 3 months have passed before resuming sexual activity."
C. "You may safely engage in sexual activity as soon as the incision has healed completely."
D. "You should undergo counseling or therapy before you consider having sex again."

ANS: A
Sexual intercourse can be resumed whenever the client is comfortable. Until the incision is healed, clients
should be taught how to protect the incision and avoid contact with the surgical site during intercourse.

14. What exercise plan or activity should the nurse teach the client for the first postoperative day after a
modified radical mastectomy?
A. "Perform no movement or exercise today. Keep the arm supported, with the elbow flexed and as close to
your body as possible."
B. "Without moving your shoulder, straighten your elbow three times every hour and squeeze a small
sponge ball with your fingers."
C. "Face the wall and extend your arm straight out to the wall. Walk your fingers as far above your head as
your arm will reach and then walk them back down."
D. "Hold your operative arm straight out from the shoulder to the side. Use your nonoperative arm to pull
the operative arm completely straight above your head."

ANS: B
Mild exercise begins the first postoperative day. The exercise should not put stress on the incision and do
not involve the shoulder at this point. Full extension f the elbow, with support, is important, as is using grip
maneuvers for the hand on the affected side.

15. Which statement made by a client about breast cancer indicates correct understanding of disease?
A. "Breast cancer is the leading cause of cancer deaths among women in the United States."
B. "Breast cancer is the leading type of cancer among women in North America."
C. "Late onset of menses and early menopause increase the risk for breast cancer."
D. "The incidence of breast cancer decrease with age."

ANS: B
Breast cancer is the most common form of cancer diagnosed in women and is the second leading cause of
cancer deaths in woman in the United States.

16. The client who has just been diagnosed with invasive infiltrating ductal carcinoma asks this means.
What is the nurse's best response?
A. "The cancer has spread from the breast ducts into surrounding breast tissue."
B. "The cancer has spread from the breast into local lymph nodes and channels."
C. "The cancer has spread from the breast into surrounding tissues and organs."
D. "The cancer has spread from the breast into distant tissues and organs."

ANS: A
The term invasive when applied to infiltrating ductal carcinoma means that the cancer cells no longer
confined to ductal tissue but have spread into surrounding breast tissue. This term alone, however, does not
indicate that the disease has spread beyond the breast itself.

17. Which comment made by the client with breast cancer indicates correct understanding regarding cancer
causes and prevention?
A."I will cure my cancer by eating a low-fat diet from now on."
B."If I had breast-fed my children, this would not have happened to me."
C."I hope this doesn't increase my risk for bone cancer or lung cancer."
D."I will have regular mammograms on my other breast to detect cancer early."

ANS: D
Regular mammography can help detect breast cancer at an early stage. Women who have had breast cancer
have a greater risk of developing cancer in the other breast.

18. Which pathologic description of a breast cancer would the nurse interpret as being indicating of a better
prognosis for long-term survival?
A. Poorly differentiated; 20% of cells in S phase; estrogen receptor negative
B. Moderately differentiated; 50% of cells in S phase; estrogen receptor negative
C. Undiferentiated; 50% of cells in S phase, estrogen receptor positive
D. Highly differenctiated; 10% of cells in S phase; estrogen receptor positive

ANS: D
Lower grade malignancies are less aggressive and have a better change for long-term survival. Lower grade
malignancies are slower growing (have a smaller percentage of cells in the S phase and more closely
resemble the differentiated breast tissue from which they arose. Estrogen receptor-positive tumors respond
better to adjuvant therapy, and the client usually has a long survival rate. In addition, estrogen receptor-
positive tumors can be treated with hormonal manipulation techniques.

19. Which health problem or characteristic would exclude a client from receiving a lung transplant?
A. Being 45 years of age
B. Having a latex allergy
C. Having cystic fibrosis
D. Developing a systemic infection

ANS: D
Clients who receive a transplant must take immunosuppressive drugs for the rest of their lives to prevent
transplant rejection. Such medications, when given to a person with a systemic infection, could lead to
sepsis and death.

20. What is the primary cause for the increased incidence in lung cancer among women during the past 20
years?
A. Women now have a longer life expectancy than men.
B. Cigarette smoking among women increased dramatically 50 years ago.
C. More women now work in the industrial setting than in previous decades.
D. Increased use of oral contraceptives combined with air pollution hs driven the incidence of lung cancer
up in women.

ANS: B
Lung cancer is caused mainly by cigarette smoking and has a latency period of approximately 30 years or
more. The acceptance of smoking among women and its dramatic increase after World War II are the cause
of the increased incidence of lung cancer seen among women for the past 2 decades.

21. The client, a 63-year-old man who has smoked 2 packs of cigarettes per day for 45 years, has just had
his brother die of small cell lung cancer. Knowing that cancer is easier to cure in the early stages, the client
asks you about early symptoms of lung cancer. What is your best response?
A. "There are no early symptoms of lung cancer."
B. "Early symptoms of lung cancer include bloody sputum and nagging chest pain."
C. "Early symptoms are nonspecific, consisting of cough and shortness of breath on moderate exertion."
D. "Wheezing on exhalation should always be considered a positive sign of lung cancer until proven
otherwise."

ANS: C
The early symptoms of lung cancer are nonspecific (chronic cough, less endurance with heavy exercise,
more easily becoming short of breath) and could be associated with almost any acute or chronic pulmonary
problem. Pain, abnormal breath sounds, and blood sputum are late manifestations of some types of lung
cancer.

22. The client with a diagnosis of lung cancer is scheduled to have a liver scan and asks you why this
procedure is being done. What is your best response?
A. "Cigarette smoking can also cause liver cancer. The treatment for lung cancer is different if it has spread
to the liver than if it is only confined to the lungs."
B. The treatment for lung cancer is different if it has spread to the liver than if it is only confined to the
lungs."
C. "Some treatments are toxic to the liver and it is est to test liver function before these treatments are
started."
D. "An enlarged liver can interfere with cancer therapy, so the doctor wants to make certain of the liver's
size and position before therapy is started."

ANS: B
Surgery and radiation are considered local treatments for lung cancer confined to the chest. If cancer has
spread beyond the chest systemic therapy (chemotherapy) is required to control the disease.

23. The client with lung cancer is scheduled for surgery and is receiving oxygen for hypoxia.The client tells
you that the sensation of air hunger is worse. What is your best first action?
A. Notify the physician.
B. Increase the oxygen flow rate.
C. Document the observation as the only action.
D. Attempt to calm the client using guided imagery.

ANS: B
Depending on the location of the tumor, dyspnea can increase quickly. The client should be provided with
sufficient oxygen to reduce the hypoxia and its associated symptoms.

24. The client is receiving cyclophosphamide, doxorubicin, and vincristine as chemotherapy for lung cancer.
At the second round of therapy, the client tells you that a lot of blood was in the urine for 3 days after the
therapy. What is your best action?
A. Obtain a urine specimen for culture and sensitivity.
B. Document the information as the only action.
C. Check the client's platelet count.
D. Notify the physician.

ANS: D
Hemorrhagic cystitis is a frequent side effect of cyclophosphamide therapy. The physician should be
notified to prescribe increased hydration during therapy and the co-administration of a bladder-protecting
agent.

25. It is time for the client's third round of chemotherapy for lung cancer. After checking the client's white
blood count, the decision is made to delay the treatment for an additional week because of the low white
blood count and the increased risk for infection. The client is upset at the delay. What is your best response?
A."This extra time will give you hair a chance to grow back in."
B.."I will call the physician and request a prescription for something to calm your nerves."
C."Try not to worry. Your counts will probably be high enough next week and the chemotherapy will work
just as well then."
D."This delay is for the best because receiving the chemotherapy now would greatly increase your risks for
skin-related complications."

ANS: C
Many clients are concerned that a delay in treatment will mean that they are missing a treatment and that
the cancer cells will overgrow. Delayed treatments are not missing treatments and 1 week's additional
growth time for lung cancer is not significant.

26. The client with lung cancer who is receiving radiation therapy tells you that she has all the following
health problems. Which one is most likely a result of the radiation therapy?
A. Thinning scalp hair
B. Pain in the left shoulder
C. Difficulty swallowing solid food
D. Heart palpitations and night sweats

ANS: C
Radiation has the potential to damage the tissues directly in the radiation path only. The scalp is not in the
radiation path and scalp hair loss is not related to this therapy for this client. Pain in the left shoulder is
most likely related to disease progression. Although the heart is somewhat in the radiation path, this does
not result in palpitations or night sweats. The esophagus is in the radiation path and can become irritated as
the therapy continues (esophagitis). When esophagitis occurs, clients may have difficulty swallowing solid
foods and may experience "heartburn."

27. The client scheduled to undergo radiation therapy for lung cancer asks you why 6 weeks of daily
treatment are necessary. What is your best response?
A. "Your cancer is widespread and requires more than the usual amount of radiation treatments."
B. "The cost of giving larger doses of radiation for a shorter period of time is unjustified by the results."
C. "It is less likely that you will become anemic if the radiation is given in small doses over a longer time
period."
D. "Research has shown that more cancer cells are killed if the radiation is given in smaller doses over a
longer time period."

ANS: D
Because of the varying responses of all cancer cells within a given tumor, small doses of radiation are given
on a daily basis for a set period of time. This method allows multiple opportunities to destroy cancer cells
while minimizing damage to normal tissues.

28. Which statement made by the client concerning the risk of oral cancer indicates a need for further
teaching?
A. "I will brush my teeth and floss regularly."
B. "I will begin a smoking cessation program."
C. "I will limit my intake of alcoholic beverages."
D. I can still use chewing tobacco since I stopped smoking."

ANS: D
Tobacco in any form increases the risk of oral cancer. The client should be educated to eliminate all tobacco
products.

29. Which clinical manifestation would alert the nurse to the possibility of metastatic disease in a client
with oral cancer?
A. Thickening of the buccal mucosa
B. The presence of fixed cervical lymph nodes
C. Red or white patches appearing on the tongue
D. The presence of a sore on the lip that fails to heal

ANS: B
Cervical lymph nodes that become hardened, enlarged, and fixed in position are indications of metastatic
disease.

30. Which nursing diagnosis would be considered the priority for a client with oral cancer?
A. Ineffective Airway Clearance
B. Impaired Oral Mucus Membranes
C. Disturbed Body Image
D. Acute Pain

ANS: A
The priority nursing diagnosis for a client with oral cancer is Ineffective Airway Clearance. Airway
obstruction can result from the presence of a tumor, edema, or secretions and could be life threatening.

31. Which nursing intervention for oral care would be most appropriate for a client with oral cancer and a
platelet count of 30,000/mm3?
A. "Use only a disposable foam brush for oral care."
B. "Use only lemon-glycerin swabs for gentle oral care."
C. "Use an ultrasoft "chemobrush" for oral care."
D. "Use a firm tooth brush for oral care."

ANS: C

32. What postoperative nursing intervention would be a priority for the client who has undergone an
abdominal-perineal resection for a rectal tumor?
A. Monitoring of perineal wound drainage
B. Assisting the client with a bowel training program
C. Administering corticosteroids to prevent rectal itching
D. Providing a high-fiber diet to ease the passage of stools

ANS: A
Monitoring of drainage from the perineal wound and cavity is of primary importance in detecting infection
or abscess formation.

33. What medication should the nurse be prepared to administer for the client who is experiencing
transplant rejection?
A. Methylprednisolone
B. Cyclosporine
C. Azithromycin
D. Auranofin

ANS: A
Clients with transplant rejection may be treated with IV doses of methylprednisolone (Solu-Medrol).

34. Which of the following clients would be most at risk for the development of carcinoma of the liver?
A. 58-year-old client with a history of diabetes mellitus
B. 28-year-old client with a history of blunt liver trauma
C. 65-year-old client with a history of cirrhosis
D. 80-year-old client with malnutrition

ANS: C
The risk of contracting a primary carcinoma of the liver is 40 times higher in clients with cirrhosis.

35. A client who underwent liver transplantation 2 weeks ago reports a temperature of 101 F (38.3 C) and
right flank pain. What would be the nurse's best response?
A."The immunosuppressive drugs you are taking may make you susceptible to infections."
B."You may be rejecting the transplanted liver and should go to the hospital immediately."
C."You should take an additional dose of cyclosporine today."
D."Take acetaminophen every 4 hours until you feel better."

ANS: B

35. The client is 45 years old and has just been diagnosed with fibrocystic breast disease. She asks what this
means in terms of her health. What is the nurse's best response?
A. "This problem greatly increases your risk for breast cancer, so be sure to schedule yearly
mammograms."
B. "This problem progressively increases as you age, especially if you have never been pregnant."
C. "This problem will probably diminish with menopause if you don't take replacement hormones."
D. "This problem is genetic and you should teach your daughters about it."

ANS: C
Although the cause of fibrocystic breast changes is unknown, the condition seems to be related to normal
fluctuations in estrogen levels during the menstrual cycle. Symptoms usually resolve after menopause in the
absence of estrogen supplementation.

36. Which characteristic of a breast lump or mass is more associated with breast cancer than with benign
breast disease?
A. Lump or mass present in same area of both breasts
B. Pain or discomfort caused by palpation
C. Attached firmly to the chest wall
D. Appeared suddenly

ANS: C
Malignant tumors are usually nonmobile and often attached to the chest wall, rather than to breast tissue.

37. Which health problem is associated with large breasts?
A. Increased breast tenderness
B. Increased libido
C. Chest pain
D. Back pain

ANS: D
The added weight of large breasts and the altered center of gravity increase spinal pull and contribute to
back pain.

38. Which client should the nurse encourage to seek genetic counseling regarding ger risk for BRCA1 or
BRCA2 gene mutation-related breast cancer?
A. 55-year-old woman whose father had lung cancer and mother had leukemia, and whose two siblings
have had malignant melanoma.
B. 45-year-old woman whose brother and sister have breast cancer and whose mother has ovarian cancer
C. 65-year-old woman whose fraternal twin sister has breast cancer
D. 25-year-old woman who has bilateral benign breast disease

ANS: B
The most well-defined increased genetic risk for breast cancer is related to mutations in either the BRCA1
or BRCA2 genes. Families in which either of these genes is mutated have higher rates of breast and ovarian
cancer in first-degree relatives.

39. Which clinical manifestation in a client who smokes two packs of cigarettes per day should be explored
further for head and neck cancer?
A. Unplanned weight gain of 15 pounds
B. Decreased sense of taste
C. Difficulty swallowing
D. Persistent bad breath

ANS: C
One of the many common clinical manifestations of head and neck cancer is difficulty swallowing, or the
sensation of a "lump" in the throat.

40. Which conditions or factors in a 64-year-old man diagnosed with head and neck cancer are most likely
to have contributed to this health problem?
A. He quit school at age 16 and has worked in a butcher shop for over 40 years.
B. He uses chewing tobacco and drinks beer daily.
C. His father also had head and neck cancer.
D. His hobby is oil painting.

ANS: B
Many environmental risk factors contribute to the development of head and neck cancer, although the
actual cause is unknown. There does not appear to be a genetic predisposition to this type of cancer. The
two most important risk factors are tobacco and alcohol use, especially in combination. Other risk factors
include chewing tobacco, pipe smoking, marijuana, voice abuse, chronic laryngitis, exposure to industrial
chemicals or hardwood dust, and poor oral hygiene.

41. Which statement made by the client undergoing radiation treatment for laryngeal cancer indicates the
need for continued discussion regarding the effects of therapy?
A. "I will avoid exposing my skin to sunlight during treatment."
B. "I will purchase a wig so that my appearance will be close to normal."
C. "I will rest my voice and communicate by writing for the next two months."
D. "I will not shave until all the redness and peeling of the skin on my face and neck is gone."

ANS: B
Radiation only affects the tissues directly in the radiation path. Scalp hair loss will not occur as a side effect
of radiation therapy for cancer of the larynx.

42. What is the major cause of cancer deaths among men?
A. Skin ccancer
B. Prostate cancer
C. Colorectal cancer
D. Lung cancer

ANS: D
Although prostate cancer has a higher incidence among men than lung cancer, more cancer deaths occur
form lung cancer among men (about 90,000 per year) compared to deaths from prostate cancer (about
31,500 per year).

43. Which pathologic description of a tumor should the nurse interpret as a "very malignant" or
"high-grade" cancer?
A. Undifferentiated; mitotic index =50%
B. Poorly differentiated; mitotic index =40%
C. Moderately differentiated; mitotic index = 50%
D. Highly differentiated; mitotic index = 10%

ANS: A
Higher grade malignancies are rapid-growing, as indicated by a relatively high mitotic index, and have lost
so many differentiated features that they no longer resemble the tissue from which they arose.

44. The staging of the client's cancer by the TNM classification is T1, N3, M1. What is the correct
interpretation of this classification?
A. The client has two tumors that are nonresponsive to treatment.
B. The client has leukemia confined to the bone marrow.
C. The client has a 2 cm tumor with one regional lymph node involved and no distant metastasis.
D. The client has a small primary tumor, tumor extension into 3 lymph nodes, and one site of distant
metastasis.

ANS: D
T = primary tumor. T1 indicates that a primary tumor is detectable but still relatively small. N = regional
lymph nodes. N3 indicates that regional lymph nodes are involved M = distant metastasis. M1 indicates that
there is evidence of distant metastasis in at least one site.