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OCN practice questions

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Question 1Care Continuum

Under the Medicare hospice benefit, a patient with cancer is eligible when the prognosis is which of the following if the disease runs its usual course?

  1. 24 months or less
  2. 12 months or less
  3. 3 months or less
  4. 6 months or less Correct answer.

Explanation

Medicare hospice eligibility requires the physician to certify a prognosis of 6 months or less if the terminal illness follows its normal course, along with the patient's election of comfort-focused care. The benefit can be re-certified beyond 6 months if the criteria continue to be met.

Question 2Care Continuum

Which elements are essential components of a survivorship care plan for a patient completing primary cancer treatment?

  1. A list of the patient's insurance benefits
  2. Copies of all original pathology slides
  3. A signed consent for future research
  4. A treatment summary plus follow-up plan Correct answer.

Explanation

A survivorship care plan summarizes the diagnosis and treatments received and outlines surveillance, late-effect monitoring, health promotion, and coordination with the primary care clinician. It is given at the completion of primary treatment and shared with the clinicians who will follow the patient.

Question 3Care Continuum

Which statement best describes palliative care for a patient with cancer?

  1. It can be given alongside cancer treatment Correct answer.
  2. It is limited to patients with a 6-month prognosis
  3. It begins only after cancer treatment has stopped
  4. It is another name for hospice care

Explanation

Palliative care addresses symptom burden, psychosocial needs, and quality of life from the time of diagnosis and can be delivered concurrently with curative or disease-directed therapy. Hospice is a distinct insurance benefit defined by prognosis-based eligibility.

Question 4Care Continuum

What is the purpose of a durable power of attorney for health care?

  1. It names a surrogate decision-maker Correct answer.
  2. It is completed only when death is imminent
  3. It is a physician order limiting resuscitation
  4. It lists the patient's financial assets

Explanation

A durable power of attorney for health care designates a health care agent who speaks for the patient if decision-making capacity is lost. It is completed while the patient still has capacity and takes effect only when capacity is lost.

Question 5Care Continuum

Medicare requires hospice programs to offer bereavement support to the family for how long after the patient's death?

  1. No defined period
  2. 6 weeks
  3. Up to 1 year Correct answer.
  4. 30 days

Explanation

Hospice programs must provide bereavement services to the family and caregivers for up to 1 year following the death under the Medicare hospice benefit. Bereavement support is a required hospice service, not an optional add-on.

Question 6Care Continuum

According to national oncology standards, psychosocial distress screening should occur at which time points?

  1. At the initial visit and at intervals Correct answer.
  2. Only if there is a psychiatric history
  3. Only when the patient asks for help
  4. Only at the end of treatment

Explanation

Distress is treated as the sixth vital sign, and standards require screening of all patients at the initial visit and at appropriate intervals or transitions in care, with referral when distress is identified. Screening only on request or only in patients with prior psychiatric history misses substantial distress.

Question 7Care Continuum

A patient with metastatic pancreatic cancer says, "Just tell me straight, how long do I have?" What is the nurse's best initial response?

  1. Ask what he understands first Correct answer.
  2. Reassure him that everything will be fine
  3. Give the median survival figure right away
  4. Defer the discussion to the oncologist

Explanation

Before offering prognostic information, the nurse should assess what the patient already understands and how much detail he wants, then respond honestly in a way that is consistent with the team's plan. This respects autonomy and avoids giving more information than the patient is seeking.

Question 8Care Continuum

A patient enrolled in hospice has painful bone metastases, and the family fears that radiation will end hospice eligibility. What should the nurse explain?

  1. Hospice must be revoked to receive any radiation
  2. Radiation therapy is never covered under hospice
  3. Radiation is covered only if the tumor shrinks
  4. Palliative radiation for comfort is covered Correct answer.

Explanation

Hospice covers therapies directed at comfort, including palliative radiation for pain, bleeding, or obstruction, as long as the goal is symptom relief rather than cure. The patient does not need to revoke the hospice benefit to receive palliative treatment.

Question 9Care Continuum

A spouse caring for a patient with advanced cancer reports exhaustion, poor sleep, and feeling trapped. What is the nurse's best action?

  1. Refer the spouse to a bereavement support group
  2. Encourage the spouse to stay at the bedside
  3. Suggest reducing the patient's pain medication
  4. Assess caregiver strain and arrange respite care Correct answer.

Explanation

Caregiver burden should be formally assessed, with respite services, home health support, and counseling offered to protect the caregiver's health and sustain care at home. Bereavement services address grief after death rather than current caregiving strain.

Question 10Care Continuum

A patient starting an expensive oral chemotherapy agent tells the nurse he is not sure he can afford the copay. What is the most appropriate initial action?

  1. Suggest he consider hospice instead
  2. Substitute a less effective oral agent
  3. Screen for hardship and refer to social work Correct answer.
  4. Advise him to skip doses when money is short

Explanation

Financial toxicity is a recognized consequence of cancer treatment and should be screened for routinely; social work, financial counselors, and manufacturer assistance programs can lower cost barriers. Skipping doses or substituting less effective therapy without team discussion jeopardizes outcomes.

Question 11Care Continuum

A patient with advanced cancer has a completed POLST form stating Do Not Resuscitate. On admission, the family says, "Do everything." What should the nurse do?

  1. Ignore the form until a physician arrives
  2. Honor the patient's documented wishes Correct answer.
  3. Tear up the form because the family objects
  4. Ask the family to sign a new consent form

Explanation

A POLST is a portable medical order reflecting the patient's own treatment preferences and remains in effect across settings until changed by the patient or an authorized decision-maker. The patient's documented wishes take precedence over family disagreement, which is best addressed through a goals-of-care conversation.

Question 12Care Continuum

A patient receiving chemotherapy reports persistent fatigue and asks what can help. What is the best evidence-based recommendation?

  1. Complete bed rest until treatment ends
  2. Avoid all activity to conserve energy
  3. Start a stimulant as first-line therapy
  4. Encourage moderate exercise most days Correct answer.

Explanation

Physical activity, including moderate aerobic exercise, is the best-supported intervention for cancer-related fatigue, together with energy conservation and sleep hygiene. Inactivity and bed rest promote deconditioning and worsen fatigue over time.

Question 13Care Continuum

What is the primary purpose of a multidisciplinary tumor board?

  1. To review hospital billing and coding
  2. To assign nursing shifts and workloads
  3. To agree on a coordinated treatment plan Correct answer.
  4. To verify each patient's insurance coverage

Explanation

A tumor board brings surgery, medical and radiation oncology, pathology, radiology, and nursing together to agree on a coordinated, guideline-concordant plan for each case. Administrative, staffing, and financial functions are handled outside the clinical case conference.

Question 14Care Continuum

A survivor treated with doxorubicin five years ago is now followed in a survivorship clinic. Which late effect requires ongoing surveillance?

  1. Cardiomyopathy Correct answer.
  2. Hemorrhagic cystitis
  3. Sensorineural hearing loss
  4. Pulmonary fibrosis

Explanation

Anthracyclines such as doxorubicin are cardiotoxic, so survivors need periodic assessment of cardiac function and management of cardiovascular risk factors. Hearing loss is linked to platinum agents, pulmonary fibrosis to bleomycin, and hemorrhagic cystitis to cyclophosphamide or ifosfamide.

Question 15Care Continuum

A patient with metastatic cancer is actively dying. What is the most appropriate nursing action?

  1. Increase blood draws to track organ function
  2. Begin tube feedings to prevent weight loss
  3. Focus care on comfort; stop routine labs Correct answer.
  4. Maintain full code status until the family agrees

Explanation

When death is imminent, care shifts to comfort: discontinuing non-beneficial laboratory draws and routine vital signs, aggressively managing symptoms, and supporting the family. Artificial nutrition generally does not benefit the actively dying patient and may cause aspiration, edema, and distress.

Question 16Care Continuum

A patient with advanced cancer reports refractory dyspnea and is not hypoxic. What is the recommended first-line pharmacologic management?

  1. Benzodiazepines as first-line therapy
  2. Nebulized saline treatments
  3. High-flow oxygen for all patients
  4. Low-dose opioids titrated to dyspnea Correct answer.

Explanation

Systemic opioids are first-line for refractory dyspnea in advanced illness because they reduce the sensation of breathlessness. Oxygen is indicated only for documented hypoxemia, and benzodiazepines are adjuncts for anxiety-associated breathlessness.

Question 17Care Continuum

A patient receiving hospice care for metastatic cancer asks to enroll in a phase I clinical trial at an academic center. What should the nurse explain?

  1. Hospice agencies are required to pay for trial costs
  2. The trial may begin only after a 6-month waiting period
  3. Hospice must be revoked before the trial Correct answer.
  4. Hospice can continue while traveling for the trial

Explanation

Electing the Medicare hospice benefit requires waiving coverage for curative or investigational treatment directed at the terminal diagnosis. A patient who chooses a phase I trial revokes hospice and may re-elect it later if eligibility criteria are still met.

Question 18Care Continuum

A 28-year-old woman with newly diagnosed breast cancer wants to preserve fertility. Which statement should guide the nurse's response?

  1. Fertility preservation waits until chemotherapy ends
  2. Ovarian failure is rare under age 35
  3. Refer before starting gonadotoxic therapy Correct answer.
  4. Pregnancy is contraindicated for all survivors

Explanation

Fertility counseling and referral to a reproductive specialist should occur as early as possible, before gonadotoxic chemotherapy begins, because oocyte or embryo cryopreservation may require a delay in starting treatment. Younger age lowers but does not eliminate the risk of treatment-related gonadal failure.

Question 19Care Continuum

Which discharge intervention is most likely to reduce 30-day readmissions for a patient with cancer?

  1. Scheduling follow-up 8 weeks after discharge
  2. Teach-back plus a 48-hour follow-up call Correct answer.
  3. Providing written instructions without discussion
  4. Discharging late on a Friday afternoon

Explanation

Structured discharge teaching using teach-back, combined with early post-discharge contact, identifies problems before they escalate and supports continuity of care. Long gaps before follow-up and weekend discharges without outpatient support raise readmission risk.

Question 20Care Continuum

An unresponsive patient with no advance directive has a legally authorized surrogate. Which standard should guide the surrogate's decisions?

  1. What the patient would have wanted Correct answer.
  2. The physician's recommendation alone
  3. The surrogate's own treatment preferences
  4. The cost of care to the family

Explanation

Surrogates are asked to use substituted judgment, deciding as the patient would have decided based on the patient's values and prior statements. When the patient's wishes are unknown, the best-interests standard is applied instead.

Question 21Oncology Nursing Practice

A client receiving myelosuppressive chemotherapy asks when the white blood cell count is expected to be at its lowest. The nurse explains that the nadir usually occurs:

  1. 3 to 5 days after treatment
  2. 7 to 14 days after treatment Correct answer.
  3. 28 days after treatment
  4. within 24 hours of treatment

Explanation

Myelosuppression after cytotoxic chemotherapy follows a predictable pattern, with the white cell nadir typically falling 7 to 14 days after the dose is given. Clients are taught to monitor for fever and signs of infection during that window, when neutropenia is most profound.

Question 22Oncology Nursing Practice

During intravenous administration of a vesicant, a client reports burning at the site and the nurse observes swelling around the catheter. The nurse's first action is to:

  1. stop the infusion and aspirate residual drug through the catheter Correct answer.
  2. slow the rate and reassess the site in 15 minutes
  3. remove the catheter at once and apply a warm compress to the site
  4. flush the line rapidly with a large volume of normal saline to dilute the drug

Explanation

When extravasation is suspected, the infusion is stopped immediately, the catheter remains in place so residual drug can be aspirated, and the prescribed antidote and local measures are then applied per protocol. Prompt cessation limits the volume of vesicant that reaches the tissue.

Question 23Oncology Nursing Practice

A nurse is assigned to care for a client with a sealed radioactive implant. Which approach reflects the principles of radiation protection?

  1. limit visits to pregnant staff and visitors only
  2. ask the client to hold the implant when it must be repositioned
  3. wear a lead apron and remain in the room during all client care activities
  4. organize care to limit time near the source and use shielding Correct answer.

Explanation

Protection from an internal sealed source relies on time, distance, and shielding: care is clustered so exposure time is short, staff step back whenever possible, and lead shields are used as appropriate. Pregnant staff and visitors are not the only people who need dose limitation.

Question 24Oncology Nursing Practice

A client with chemotherapy-induced neutropenia is admitted to a private room. Which instruction should the nurse include in the plan of care?

  1. keep the room door open so staff can observe the client
  2. eat only raw fruits and vegetables that are peeled at the bedside
  3. check an oral temperature whenever chills occur
  4. avoid fresh flowers and standing water in the room Correct answer.

Explanation

Fresh flowers, dried flowers, and standing water can harbor gram-negative organisms and fungi, so they are removed from the environment of a deeply neutropenic client. Protective measures focus on reducing exposure to environmental pathogens while preserving scrupulous hand hygiene.

Question 25Oncology Nursing Practice

A client is starting an oral chemotherapy agent at home. Which instruction should the nurse give about handling the medication?

  1. crush the tablets to make them easier to swallow
  2. wear gloves when handling tablets and wash hands afterward Correct answer.
  3. store the medication in the bathroom cabinet next to other medicines
  4. double the next dose if a dose was vomited

Explanation

Oral cytotoxic agents are hazardous drugs, so clients and caregivers should avoid direct contact with tablets or capsules and wash hands after any handling. Storage should be in a dry, secure place away from other medications and out of reach of children and pets.

Question 26Oncology Nursing Practice

Which measure should the nurse teach a client receiving chemotherapy to help prevent and manage oral mucositis?

  1. scrub the tongue with a firm brush to remove plaques
  2. use an alcohol-based mouthwash after every meal and at bedtime
  3. apply lemon and glycerin swabs to keep the mouth moist
  4. rinse with saline or bicarbonate and use a soft toothbrush Correct answer.

Explanation

Frequent rinsing with saline or sodium bicarbonate and gentle oral hygiene with a soft brush reduce mucosal irritation and remove debris without further trauma. Alcohol-containing and acidic products are avoided because they dry and irritate damaged mucosa.

Question 27Oncology Nursing Practice

A client receiving chemotherapy has a platelet count of 22,000/mm3. Which instruction should the nurse include in client teaching?

  1. use a straight razor and avoid over-the-counter laxatives
  2. use an electric razor and a soft-bristled toothbrush Correct answer.
  3. take a daily aspirin to help prevent small-vessel clotting
  4. floss the teeth after every meal to prevent infection

Explanation

With severe thrombocytopenia, the goal is to prevent trauma to capillary-rich tissue, so electric shavers and soft toothbrushes replace sharp implements and vigorous flossing. Aspirin and other antiplatelet drugs are avoided because they further impair clotting.

Question 28Oncology Nursing Practice

A client is scheduled for a highly emetogenic chemotherapy regimen. To manage chemotherapy-induced nausea and vomiting most effectively, the nurse should:

  1. use a single antiemetic agent for all emetogenic regimens
  2. wait until the client reports nausea, then give the drug promptly
  3. give the scheduled antiemetic before the chemotherapy begins Correct answer.
  4. give antiemetics only after the infusion is completed

Explanation

Antiemetics given on a scheduled basis before the chemotherapy dose prevent the emetic cascade rather than reacting to it, and guideline-based regimens combine agents from different classes for highly emetogenic drugs. Rescue medication is added for breakthrough symptoms but does not replace prophylaxis.

Question 29Oncology Nursing Practice

A client receiving oxaliplatin reports numbness and tingling in both hands and new difficulty buttoning clothing. The nurse should:

  1. report the findings, because dose reduction or delay may be needed Correct answer.
  2. document the finding as an expected effect that requires no action
  3. reassure the client that this effect is permanent and untreatable
  4. apply warm compresses to the hands and continue the regimen

Explanation

Worsening paresthesias and loss of fine motor dexterity suggest chemotherapy-induced peripheral neuropathy that is interfering with function, which must be reported so the regimen can be modified. Early dose reduction or delay can prevent progression to irreversible deficits and reduces fall risk.

Question 30Oncology Nursing Practice

A client receiving chemotherapy has a temperature of 38.4 C and an absolute neutrophil count of 400/mm3. The nurse should:

  1. start antiviral therapy and place the client in a private room with positive pressure
  2. wait for the culture results before starting antibiotic therapy
  3. give acetaminophen and reassess the temperature in 4 hours
  4. obtain cultures and give the first antibiotic dose within 60 minutes Correct answer.

Explanation

Febrile neutropenia is an emergency in which infection can progress to sepsis within hours, so blood cultures are drawn and empiric broad-spectrum antibiotics are started promptly, generally within 60 minutes. Therapy is never delayed while awaiting culture results.

Question 31Oncology Nursing Practice

Which chemotherapy agent is classified as a vesicant?

  1. doxorubicin Correct answer.
  2. methotrexate
  3. cytarabine
  4. asparaginase

Explanation

Vesicants such as the anthracyclines, vinca alkaloids, and mechlorethamine cause severe tissue necrosis if they leak into surrounding tissue, so they require careful site assessment and blood return verification. Methotrexate, cytarabine, and asparaginase are not classified as vesicants.

Question 32Oncology Nursing Practice

Which agent is the recommended antidote for extravasation of doxorubicin?

  1. sodium thiosulfate
  2. dimethyl sulfoxide
  3. dexrazoxane Correct answer.
  4. hyaluronidase

Explanation

Dexrazoxane is the specific antidote for anthracycline extravasation and is most effective when given as soon as possible after the event. Sodium thiosulfate is used for mechlorethamine extravasation and hyaluronidase for vinca alkaloids and taxanes.

Question 33Oncology Nursing Practice

Which precaution is most important when a vesicant is administered through a central venous catheter?

  1. use a smaller syringe to increase pressure when the catheter is sluggish
  2. confirm blood return before each dose and stop for any resistance Correct answer.
  3. check for blood return only at the time of initial placement
  4. flush the catheter with sterile water if the client reports discomfort

Explanation

A central catheter must demonstrate blood return before each vesicant dose, and any resistance, pain, or change in flow signals possible malposition or infiltration and requires stopping the infusion. Catheter position can change over time, so a single confirmation at insertion is insufficient.

Question 34Oncology Nursing Practice

During a first infusion of rituximab, a client develops facial flushing, dyspnea, and a feeling of throat tightness. The nurse should:

  1. stop the infusion and assess the airway while keeping the line patent Correct answer.
  2. slow the infusion and give oral diphenhydramine as ordered
  3. continue the infusion at a slower rate and apply supplemental oxygen
  4. document the reaction and reassess at the next set of vital signs

Explanation

These findings suggest an infusion-related or anaphylactoid reaction, and the first priority is to stop the drug and assess airway, breathing, and circulation while keeping venous access available for emergency medications. Restarting at a slower rate may be considered later only after the reaction is controlled and the provider is consulted.

Question 35Oncology Nursing Practice

A client receiving ipilimumab reports five watery stools a day with abdominal cramping. The nurse's priority action is to:

  1. give a bulk-forming laxative and encourage oral fluids
  2. hold the drug, notify the provider, and anticipate corticosteroids Correct answer.
  3. reassure the client that this diarrhea is expected and will resolve on its own
  4. obtain a stool culture and wait for the results before any action

Explanation

Diarrhea during immune checkpoint inhibitor therapy may represent immune-mediated colitis, which can progress to perforation, so the drug is held and corticosteroids are started promptly after the provider is notified. Infectious causes are ruled out in parallel but do not justify delaying treatment of a suspected immune-related adverse event.

Question 36Oncology Nursing Practice

Which instruction should the nurse give a client about skin care in a radiation treatment field?

  1. keep the area covered with an occlusive dressing at all times
  2. scrub the area daily with an alcohol-based cleanser
  3. apply a thick layer of petroleum-based ointment before each treatment
  4. wash the area gently with mild soap and lukewarm water, then pat dry Correct answer.

Explanation

The irradiated field is washed gently with mild soap and lukewarm water and patted dry, avoiding rubbing, heat, and tight clothing. Topical products must be cleared with the radiation oncology team because metallic or heavy creams can alter dose delivery to the skin.

Question 37Oncology Nursing Practice

A client starting long-acting morphine for cancer pain asks how to prevent constipation. The nurse's best response is:

  1. rely on a high-fiber diet alone as the primary prevention
  2. give a bulk-forming laxative only after the client becomes constipated
  3. wait until there has been no bowel movement for 3 days
  4. start a scheduled stimulant laxative when the opioid is begun Correct answer.

Explanation

Opioids reduce gut motility through mu-receptor activity, so a stimulant laxative is started prophylactically and continued for as long as the opioid is taken, with a stool softener often added. Fiber and fluids help but cannot overcome opioid-induced slowing of peristalsis on their own.

Question 38Oncology Nursing Practice

A client with metastatic prostate cancer reports new mid-back pain and progressive leg weakness. The nurse should:

  1. give an NSAID and encourage ambulation to relieve the pain
  2. schedule a routine outpatient MRI in the next two weeks
  3. apply heat to the back and reassess at the next visit
  4. notify the provider and anticipate dexamethasone plus urgent MRI Correct answer.

Explanation

New back pain with neurologic deficit in a client with bone metastases suggests spinal cord compression, which requires immediate provider notification, corticosteroids to reduce cord edema, and urgent imaging. Neurologic function can be preserved only when decompression and radiation or surgery occur before deficits become fixed.

Question 39Oncology Nursing Practice

A client with acute leukemia develops tumor lysis syndrome. Which laboratory pattern is most consistent with this condition?

  1. hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia Correct answer.
  2. hypokalemia, hypophosphatemia, hypouricemia, hypercalcemia
  3. hyperkalemia, hypophosphatemia, hyperuricemia, hypercalcemia
  4. hypokalemia, hyperphosphatemia, hypouricemia, hypocalcemia

Explanation

Rapid lysis of tumor cells releases intracellular potassium, phosphate, and nucleic acids, producing hyperkalemia, hyperphosphatemia, and hyperuricemia. Phosphate binds calcium, so serum calcium falls, causing hypocalcemia with neuromuscular irritability and possible dysrhythmias.

Question 40Oncology Nursing Practice

Which practice best prevents a fatal error when vincristine is prepared for administration?

  1. requiring a physician rather than a nurse to administer the dose at the bedside
  2. labeling the syringe with a purple cap and storing it in the refrigerator
  3. dispensing the drug in an intravenous minibag rather than in a syringe Correct answer.
  4. drawing the drug up in a syringe with a spinal needle attached for the procedure

Explanation

Vinca alkaloids are fatal if given intrathecally, so they are dispensed in minibags for intravenous infusion and are never supplied in syringes that could be mistaken for intrathecal preparations. Syringes intended for spinal use must be prepared and labeled separately and delivered only by trained personnel.

Question 41Oncology Nursing Practice

Five days after receiving CAR T-cell therapy, a client has a temperature of 39.2 C, blood pressure of 84/52 mm Hg, and new oxygen requirement. Which action is the priority?

  1. begin broad-spectrum antibiotics and hold all other medications
  2. give acetaminophen and reassess the temperature in one hour
  3. notify the provider and anticipate administration of tocilizumab Correct answer.
  4. obtain blood cultures and wait for results before any treatment

Explanation

Fever with hypotension and hypoxia after CAR T-cell infusion suggests cytokine release syndrome, for which tocilizumab, an interleukin-6 receptor antagonist, is the first-line therapy along with supportive care. Recognition and treatment within hours prevents progression to severe capillary leak and organ dysfunction.

Question 42Oncology Nursing Practice

A client considering enrollment in a phase I oncology trial asks the nurse what this phase involves. The nurse's best response is that phase I trials primarily:

  1. confirm the drug's effectiveness in a large population
  2. test the drug in laboratory cell lines and animal models
  3. compare the new drug with the current standard treatment
  4. identify the safe dose range and dose-limiting toxicities Correct answer.

Explanation

Phase I trials are dose-finding studies that establish the maximum tolerated dose, the recommended phase II dose, and the toxicity profile, usually in a small number of participants. Efficacy compared with standard therapy is assessed in later-phase trials.

Question 43Oncology Nursing Practice

A 24-year-old man is about to begin a highly gonadotoxic chemotherapy regimen. The nurse should:

  1. discuss sperm banking and refer before the first dose is given Correct answer.
  2. recommend oral contraceptives to protect the ovaries
  3. reassure him that fertility is rarely affected at this age
  4. defer the discussion until treatment has been completed

Explanation

Fertility counseling and referral for preservation must occur before the first dose of gonadotoxic therapy, because options such as sperm banking are only useful if completed beforehand. Discussion afterward cannot restore gametes already destroyed by treatment.

Question 44Oncology Nursing Practice

A client who received doxorubicin three months ago now has a painful, red rash confined to a previously irradiated area after starting gemcitabine. The nurse recognizes this as:

  1. radiation recall dermatitis triggered by the new drug Correct answer.
  2. an acute allergic reaction to the chemotherapy infusion
  3. a radiation-induced second malignancy
  4. a recurrence of the original tumor within the field

Explanation

Radiation recall is an inflammatory reaction in a previously irradiated area provoked by a subsequently administered drug, most often an anthracycline or gemcitabine. The reaction is limited to the prior radiation port, which distinguishes it from a drug allergy or tumor recurrence.

Question 45Oncology Nursing Practice

A client who is about to start doxorubicin asks the nurse when hair loss will occur. Which response by the nurse is accurate?

  1. Hair thinning occurs only after six cycles of therapy are completed.
  2. Hair loss happens only if the scalp is exposed to sunlight during treatment.
  3. Loss typically starts 2 to 3 weeks after the first dose. Correct answer.
  4. Hair loss occurs within 24 to 48 hours of the first dose and is permanent.

Explanation

Anagen hair follicles are highly sensitive to cytotoxic drugs, so alopecia usually begins about 2 to 3 weeks after the first dose, when the damaged hairs are shed. Hair typically regrows after the regimen is completed, although texture or color may change.

Question 46Oncology Nursing Practice

A client receiving myelosuppressive chemotherapy asks when the blood counts will be at their lowest. How should the nurse respond?

  1. Only after the final cycle is completed
  2. Within 24 hours of treatment
  3. About 7 to 14 days after treatment Correct answer.
  4. About 4 to 6 weeks after treatment

Explanation

The nadir, or lowest point of blood counts, generally occurs 7 to 14 days after administration of a myelosuppressive regimen, depending on the drugs used. Clients are at greatest risk for infection and bleeding during this period.

Question 47Oncology Nursing Practice

A client is scheduled to receive high-dose cyclophosphamide. Which nursing action best helps prevent hemorrhagic cystitis?

  1. Encourage frequent voiding and generous fluid intake Correct answer.
  2. Insert an indwelling catheter for the duration of therapy
  3. Restrict fluids for 4 hours after the infusion
  4. Administer the drug as a rapid IV push over 1 minute

Explanation

Cyclophosphamide produces acrolein, a bladder-irritating metabolite, so hydration and frequent emptying dilute the urine and reduce contact time with the bladder mucosa. Mesna may also be given to bind acrolein when high doses are used.

Question 48Oncology Nursing Practice

A client taking capecitabine reports tingling and redness of the palms. Which instruction should the nurse give?

  1. Stop taking the drug permanently and do not notify the provider until the next visit
  2. Wear snug gloves throughout the day to protect the skin from friction and dryness
  3. Continue the drug and apply a heating pad to both hands for 20 minutes four times daily
  4. Moisturize the skin, avoid tight footwear, and report blistering Correct answer.

Explanation

These findings suggest hand-foot syndrome, a dose-related effect of capecitabine that can progress to blistering and desquamation. The nurse should teach skin protection and prompt reporting so the provider can adjust the dose before severe injury occurs.

Question 49Oncology Nursing Practice

Which assessment is most important for the nurse to review before each dose of doxorubicin?

  1. Left ventricular ejection fraction and cardiac status Correct answer.
  2. Pulmonary function tests and oxygen saturation
  3. Audiometry results and tinnitus rating
  4. Serum creatinine and hourly urine output

Explanation

Doxorubicin is an anthracycline with cumulative dose-related cardiotoxicity, so ventricular function is monitored at baseline and periodically during therapy. A falling ejection fraction or new heart failure symptoms may prompt stopping or altering treatment.

Question 50Oncology Nursing Practice

A client with cancer reports fatigue that limits daily activities. Which recommendation by the nurse is most appropriate?

  1. Skip meals on days when the fatigue is most severe
  2. Drink caffeinated beverages to maintain energy through the day
  3. Rest in bed for most of the day until energy returns
  4. Engage in light-to-moderate activity such as short daily walks Correct answer.

Explanation

Cancer-related fatigue is best managed with a balance of rest and regular light-to-moderate activity, which preserves strength and reduces deconditioning. Prolonged bed rest tends to worsen fatigue.