D. STANDARDS OF PROFESSIONAL PERFORMANCE

138. The four-accepted fundamental ethical principles that guide medical decision-making are:

1. Autonomy, maleficence, beneficence, and justice
2. Autonomy, maleficence, beneficence, and judgment
3. Autonomy, nonmaleficence, beneficence, and judgment
4. Autonomy, nonmaleficence, beneficence, and justice

139. The patient has the right to make medical decisions regarding their care even when medical professionals disagree with that decision. In the field of genetics, it is especially important to ensure informed consent. Informed consent is a central focus of which fundamental ethical principle that guides medical decision-making?

1. Autonomy
2. Nonmaleficence
3. Beneficence
4. Justice

140. The patient had a biopsy with negative results. However, the team knows that the biopsy material can be negative while another part of the tumor mass may be positive for cancer. Which fundamental ethical principle that guides medical decision-making serves as an ethical principle in determining what to tell the patient?

1. Autonomy
2. Nonmaleficence
3. Beneficence
4. Justice

141. The ethical principle of justice is applied in which section of the informed consent document?

1. Eligibility
2. Risks/benefits
3. Cost to the patient
4. Procedures

142. Following World War II, the Nuremberg Code was established to delineate legal responsibility for patient education in informed consent. Content central to this code includes which of the following?

1. The use of voluntary consent to protect human subjects in experimentation
2. The use of coercion as deemed necessary to provide quality care
3. The individual or their spouse can provide consent.
4. An understanding of what costs are covered by the study

143. The first step a nurse should take when addressing someone from another culture is:

1. Addressing the person formally, such as using “Mr.” or “Mrs.”
2. Direct them to the educational kiosk in your center.
3. Determine the preferred language and learning process.
4. Determine the decision-making patterns.

144. When providing education for patients who do not speak English, you should use which of the following?

1. Over-the-telephone interpretation service or professional interpreters of the same tribe, state, region, or nation
2. Nonfamily members of the same age and gender
3. Family members
4. Only staff members who are bilingual

145. The most important information to include when providing education for patients receiving radiation is:

1. Treatment plan and expected outcomes
2. Sensory and procedural information
3. Myths and misinformation that family members may provide
4. Side effect management

146. In planning a smoking cessation program, the nurse knows that the most successful strategy for tobacco cessation is:

1. Increased taxes on tobacco products
2. The smoker’s desire and readiness to quit
3. Pharmaceutical interventions
4. Nonpharmaceutical interventions

147. The nurse practitioner (NP) is a registered nurse who has advanced education and clinical training in a specialty area. The primary difference between an adult, family, pediatric, or acute care NP is which of the following?

1. Educational requirements are essentially the same.
2. A family NP is more general and not considered “advanced” compared to the other practitioner roles.
3. A family NP requires a clinical doctorate in nursing.
4. A master’s degree is common but not a baseline requirement for an adult NP.

148. The three interacting domains of competencies of the Oncology Clinical Nurse Specialist (OCNS) practice are which of the following?

1. Patient/client, nurses and nursing practice, and organizations/systems
2. Patient/family, professional nursing practice, and institutional practice
3. Patient/client, evidence-based practice, and organizational quality initiatives
4. Patient/family, nurses and nursing practice, and institutional practice

149. According to the Oncology Nursing Society (ONS) the primary difference between an Oncology Clinical Nurse Specialist (OCNS) and a nurse practitioner (NP) is which of the following?

1. There is no significant difference between these terms.
2. An NP is a nurse who has completed an NP program at the master’s or doctorate level.
3. OCNSs deliver direct care to patients, whereas NPs are more like doctor’s assistants.
4. All OCNSs are NPs, whereas not all NPs are considered OCNSs.

150. Specialty certification among healthcare providers has concentrated on which of the following avenues of inquiry?

1. Education characteristics that differentiate certified and noncertified providers
2. Describing similarities in practice between certified and noncertified providers
3. Describing the role of labor unions and demands for certification among healthcare providers
4. Linking provider certification to patient outcomes

151. Terrence is an oncology advanced practice nurse (OAPN) who chooses to work as a consultant rather than as a direct care provider. The OAPN in secondary care may be most helpful in:

1. Discussing the treatment plan and expected outcomes with the patients and family
2. Planning and implementing initiatives aimed at preventing provider compassion fatigue
3. Triaging patient calls for symptom support
4. Establishing standards for oncology practice and developing critical pathways

152. Which of the following is required for use of the designation “oncology certified nurse”?

1. A minimum of 1-year experience as a registered nurse within the last 3 years
2. A baccalaureate degree with credits toward a master’s degree
3. A minimum of 2,000 hours of cancer nursing practice within the last 2.5 years
4. A score of 90% or higher on the Oncology Nursing Certification Corporation certification examination

153. Karen is a nurse practitioner (NP) working in a collaborative practice. In general, in a collaborative practice:

1. NPs function independently in caring for a caseload of patients in the ambulatory setting only.
2. NPs function independently in caring for a caseload of patients in the ambulatory or acute care setting.
3. The skills of the NP are matched with those of the MD partner patient.
4. The physician ultimately makes the final decision regarding patient management.

154. The Oncology Nursing Society (ONS) Putting Evidence into Practice Weight of Evidence Rules use:

1. 6 levels of effectiveness for grading nursing and medical interventions
2. 4 categories from low- to high-level evidence
3. 6 levels of higher or lower strength
4. 4 grades of recommendations from very low to high

155. When reviewing a research survey, it is important to ensure whether the survey has been validated for reliability. Which of the following is a type of research reliability measure?

1. Question and answer format
2. Test and control reliability
3. Internal consistency testing
4. Connect–disconnect analysis

156. One of the statistical methods used to determine reliability is Cronbach’s coefficient alpha. Which of the following best describes what this statistical measure refers to?

1. It is a measure of the strength of the internal consistency of a set of survey questions.
2. It is a measure of the likeness of individuals being surveyed.
3. It is a predictive measure of the sameness of the findings as they relate to similar research findings.
4. It is a measure of whether two observers agree.

157. Pilot studies are best used to:

1. Compare a new intervention with an existing intervention
2. Assess the feasibility of a research design and pretest an instrument
3. Evaluate the side effects and management of a new treatment toxicity
4. Determining effectiveness of an intervention

158. In the process of evidence-based practice, the PICOT acronym is useful to clarify the specific question/problem. In the acronym, P stands for:

1. Practice
2. Population
3. Patient
4. Patient or population

159. In the process of evidence-based practice, the PICOT acronym is useful to clarify the specific question/problem. In the acronym, C stands for:

1. Comparison intervention or group
2. Context
3. Cancer
4. Complex

160. When assessing evidence for practice, the strongest evidence useful for practice is:

1. Level IV
2. Level II
3. Level III
4. Level I

161. The Oncology Nursing Society Putting Evidence into Practice (PEP) rating system has six levels that are color coded for easy interpretation. Interventions for which effectiveness has been demonstrated from a single rigorously conducted controlled trial, consistent supportive evidence from well-designed controlled trials using small samples, or guidelines developed from evidence and support by expert opinion would be considered:

1. Green, likely to be effective
2. Yellow, effectiveness not established
3. Green, recommended for practice
4. Yellow, benefits balanced with harm

162. You recently attended a program on nutritional supplements presented by nationally known oncology specialists and heard about a recommendation that you wanted to share with your patient. You discussed it with the advanced practice nurse on your unit who asked you to provide some evidence to support the option. Even though you could not find a randomized controlled study that supported the use of the recommended nutrient, you did find this practice supported by an expert in a peer reviewed publication. You agreed that this was a low-risk intervention with which level of recommendation?

1. Effectiveness unlikely
2. Not recommended for practice
3. Effectiveness not established
4. Expert opinion

163. The Oncology Nursing Society (ONS) Putting Evidence into Practice (PEP) is used for evaluating evidence-based research. Which of the following is the best description of the process for evaluating the evidence?

1. Teams review all literature on 20 symptoms annually to ensure the recommendations are current and accurate.
2. Teams search for relevant literature, create summaries of the intervention research, and rank each intervention.
3. Teams of nurses, physicians, and pharmacists review the literature on 20 symptoms to ensure a comprehensive approach.
4. ONS staff select nurse experts to develop the PEP summaries then turn them into practical PEP cards.

164. Failure mode and effect analysis (FMEA) is a risk analysis technique that is used to examine which of the following?

1. Root-cause analysis
2. Pharmacy errors in drug dispensing
3. Risk analysis technique to examine the chemotherapy administration process
4. Errors in drug administration as it relates to method of administration

165. The major difference between root-cause analysis and failure mode and effect analysis (FMEA) as it relates to chemotherapy administration is which of the following?

1. They are the same process where root-cause analysis follows FMEA.
2. FMEA is designed to prevent chemotherapy errors.
3. Root-cause analysis is a prospective risk analysis.
4. Both FMEA and root-cause analysis provide a “fail-safe” process in drug administration.

166. Which of the following chemotherapeutic agents is lethal if injected intrathecally, and to assure patient safety it has special United States Pharmacopeia (USP) labeling and packaging that must be removed before administration?

1. Cytarabine
2. Methotrexate
3. Vincristine
4. Interferon

167. You are caring for a patient who was recently diagnosed with acute leukemia. The patient begins asking you questions regarding his prognosis and is expressing difficulty in deciding about being evaluated for transplantation. Which of the following statements is the best example of effective communication?

1. I know you are feeling afraid to make a decision regarding transplantation? Did your doctor tell you that you will likely be cured with transplantation?
2. Your disease is progressing rapidly, so you should make a decision soon.
3. It sounds like you are concerned about how to make this decision. Would it be ok if we discussed some of the goals you have for care?
4. I will refer you to the social worker to discuss your concerns.

168. When the nurse is assessing the spouse’s response to the death of his wife, which of the following factors can influence the grieving process?

1. History of previous loss
2. Number of children
3. Length of the illness of the spouse
4. Health of the surviving spouse

169. To demonstrate therapeutic understanding at the time of diagnosis, the nurse may ask the patient “how are you feeling.” If the patient states that he is not sleeping well, the best response would be:

1. Asking the patient what measures they have tried followed by attentive listening
2. Telling the patient you will request a sleeping medication be ordered
3. Asking the patient if he is anxious about his diagnosis
4. Asking the patient if he has ever been treated for anxiety

170. Cognitive techniques may help patients reduce anxiety, manage symptoms, and increase feelings of self-control. Which are cognitive techniques?

1. Hypnosis, cognitive distraction, passive relaxation
2. Biofeedback, music therapy, cognitive focusing
3. Progressive muscle relaxation, systematic desensitization
4. Mindfulness-based stress reduction, hypnosis, therapeutic touch

171. Behavioral techniques may help patients reduce anxiety, manage symptoms, and increase feelings of self-control. Which are behavioral techniques?

1. Passive relaxation, progressive muscle relaxation, and systematic desensitization
2. Biofeedback, music therapy, cognitive focusing
3. Mindfulness-based stress reduction, hypnosis
4. Self-monitoring and biofeedback

172. What nursing interventions are useful when patients use information seeking to cope with their cancer:

1. Shared decision-making interventions
2. Psychoeducational interventions
3. Adult learning interventions
4. Multimedia interventions including web resources, videos, and print materials

173. Cognitive rehabilitation is used for patients with mild cognitive impairments. Which of the following best describes a cognitive rehabilitation technique?

1. Teaching compensatory mechanisms to develop alternative ways to achieve behavioral tasks
2. Retraining to create new cognitive abilities that may have been lost
3. Holistic methods to address social, emotional, and functional issues related to cognitive impairment
4. A combination of medications, physical therapy, and cognitive challenges

174. The most important reason for multidisciplinary collaboration in determining cancer risk is:

1. Individual healthcare providers always include family history in the patient assessment.
2. Individual and family risk are the same and should be shared among the care providers.
3. Although preliminary risk assessment can be done by all healthcare providers, full assessment and testing should be provided by trained genetic counselors.
4. Only physicians can refer patients and families for genetic risk assessment.

175. Professional barriers to successful palliative care have been identified as inadequate knowledge, lack of cultural awareness and sensitivity, difficulty with issues related to death and dying, and delays in referral for hospice services. To best overcome these barriers, palliative care should be:

1. Provided only in dedicated inpatient palliative care units
2. Provided only in combined hospital/palliative care units with or without a community-based hospice program
3. Provided by trained providers both in inpatient and outpatient settings
4. Provided by trained providers in the setting that is most appropriate for the patient and family

176. Patients with head and neck cancer receive multimodality therapy. Coordination of therapy may be complicated by which of the following?

1. Timing of consultations with radiation, surgery, and medical oncologists; dentists; and nutritionists
2. Timing of consultations with radiation, surgery, and medical oncologists; nutritionists; and financial counselors
3. Presence of side effects from various therapies
4. Inability to swallow oral targeted therapies and/or liquids and solids

177. Guidelines for handling antineoplastic agents have been established by:

1. The U.S. Food and Drug Administration, the Occupational Safety and Health Administration, and the Oncology Nursing Society
2. The Occupational Safety and Health Administration, the Oncology Nursing Society, American Society of Clinical Oncology, and the American Society of Hospital Pharmacists
3. The National Cancer Institute, the Oncology Nursing Society, and the American Society of Clinical Oncology
4. The Oncology Nursing Society, the U.S. Food and Drug Administration, and the Occupational Safety and Health Administration

178. Examples of useful cancer-related websites recommended for patients and families include:

1. http://www.cancer.org; http://www.ons.org
2. http://www.livestrong.org; http://www.cancercare.org
3. http://www.canceranswers.org; http://www.cancercaregivers.org
4. http://www.cancercare.org; http://www.nccn.org

179. Which of the following does the federal government insist on before a drug can be marketed?

1. The safety of the drug only
2. The efficacy of the drug only
3. The safety and the efficacy of the drug only
4. The safety, efficacy, and long-term value of the drug

180. Safe delivery of patient care is supported by oncology nurses who are aware of which of the following?

1. Professional licensing requirements, use of medical equipment, institutional procedures, personal practices, use of personal protective equipment
2. Accreditation requirements, use of medical equipment, institutional safety committees
3. Staffing ratios, professional licensing requirements, market value of nurses
4. Use of medical equipment, institutional procedures, amount of liability insurance carried by the institution

181. Oncology nurses work in high-risk environments. Which response best describes the challenges oncology nurses face:

1. Inadequate staffing to care for increasing numbers of patients at risk for falls
2. Increased documentation requirements, individualized treatment dosing
3. Inadequate staffing to support safe administration of vesicants
4. Medication errors, patients at risk for falls, infusion reactions, or extravasation

182. The best strategy to decrease risk of exposure to hazardous drugs is:

1. Limit the nurse’s daily assignment to two patients receiving treatment.
2. Provide personal protective equipment
3. Education and use of personal protective equipment
4. Mandatory education on safe administration on an annual basis

183. Medical surveillance of workers who handle hazardous drugs recommended by the National Institute for Safety and Health includes which of the following?

1. Observation of the nurse administering chemotherapy
2. Hazard identification program with baseline assessment and annual monitoring
3. Semi-annual monitoring of health status including laboratory studies
4. Regular review of medical history and biological monitoring

184. In addition to occupational exposure to hazardous drugs, oncology nurses are at risk for which of the following safety hazards?

1. Back injury and respiratory infection
2. Back and neck injury when lifting patients
3. Influenza and other infections
4. Violent patients

185. According to the groundbreaking 2000 Institute of Medicine report, To Err is Human: Building a Safer Health System, medical errors caused 44,000 to 98,000 deaths per year. An updated estimate from 2008 to 2011 estimates which of the following is the number of preventable deaths per year?

1. 50,000
2. 100,000
3. 200,000
4. 400,000

186. An adverse event is described as a sentinel event only if:

1. Patient death occurs.
2. Serious injury or death occurs.
3. Staff were negligent.
4. The event causes psychological injury.

187. The definition of a sentinel event was expanded in 2013 to include:

1. Visitors
2. Staff, family, and vendors
3. Anyone in the institution at the time of an event
4. Staff, family, and volunteers

188. The American Society of Clinical Oncology and the Oncology Nursing Society have developed safety standards for:

1. The prescription, preparation, and administration of antineoplastic agents
2. Staffing ratios to ensure safe care for oncology patients
3. Assessment and management of cancer treatment side effects
4. The preparation and administration of antineoplastic agents

189. In recent years, what condition has prompted litigation for nurses?

1. Medication errors
2. Inadequate pain management
3. Violations of the Health Insurance Portability and Accountability Act
4. Hypersensitivity reactions

190. To avoid litigation when using electronic communication with patients, which response describes best practice?

1. Electronic communication for nonurgent matters, a set turnaround time for responses, and following Health Insurance Portability and Accountability Act (HIPAA) regulations
2. Delineating which types of requests will be permitted such as appointments and narcotic refills
3. Use of phones with cameras to assist in assessment of patients
4. Use protocol-driven, and computer-supported telephone systems

191. Which of the following is true about the Health Insurance Portability and Accountability Act (HIPAA)?

1. HIPAA provides comprehensive protection against inappropriate or unintended disclosure of personal health information.
2. Patients have control over who can see their health information but not the use of their health information.
3. The Privacy Rule became effective 10 years after HIPAA.
4. The Privacy Rule preempts state laws regarding privacy.

Answer Rationales

Please note: All page numbers referenced in the Answer Rationales sections refer to the textbook Cancer Nursing: Principles and Practice, Eighth Edition, by Connie Henke Yarbro, Debra Wujcik, and Barbara Holmes Gobel (Jones & Bartlett Learning, © 2018) and Cancer Symptom Management (CSM), Fourth Edition by Connie Henke Yarbro, Debra Wujcik, and Barbara Holmes Gobel (Jones & Bartlett Learning, © 2014).