AOCNP Cancer and Oncology Nursing 4 — Questions and Answers
Question 1: A patient is receiving intrathecal methotrexate. Which neurotoxicity symptom requires the nurse to stop the infusion and alert the provider?
- Mild headache rated 2/10 immediately post-injection
- Sudden leg weakness, bladder dysfunction, and back pain suggesting myelopathy (Correct answer)
- Temporary nausea lasting 30 minutes
- Low-grade fever of 37.8°C
Correct answer: Sudden leg weakness, bladder dysfunction, and back pain suggesting myelopathy
Signs of myelopathy (leg weakness, bowel/bladder changes) after intrathecal chemotherapy represent a serious neurotoxic complication requiring urgent evaluation.
Question 2: When educating a patient on granulocyte colony-stimulating factor (G-CSF) self-injection, which statement by the patient indicates understanding?
- 'I should inject it the same day I receive chemotherapy.'
- 'I should start the injection 24 hours after chemotherapy and not inject in bruised areas.' (Correct answer)
- 'I should skip doses if my white blood cell count is normal.'
- 'I should store the medication at room temperature indefinitely.'
Correct answer: 'I should start the injection 24 hours after chemotherapy and not inject in bruised areas.'
G-CSF should be started 24–72 hours after chemotherapy completion, not on the same day, and injected into unaffected skin sites.
Question 3: A cancer patient develops grade 3 peripheral neuropathy (severe symptoms limiting self-care). What is the most appropriate nursing action?
- Continue current chemotherapy and reassess in 2 weeks
- Document findings and notify the oncologist for possible dose reduction or discontinuation (Correct answer)
- Recommend over-the-counter vitamin B6 supplements only
- Apply heating pads to affected extremities
Correct answer: Document findings and notify the oncologist for possible dose reduction or discontinuation
Grade 3 peripheral neuropathy is severe and limits daily activities, warranting immediate provider notification for dose modification or treatment discontinuation.
Question 4: Which statement best describes the rationale for using combination chemotherapy regimens in oncology?
- To reduce total drug costs for the healthcare system
- To target multiple mechanisms, reduce drug resistance, and allow lower individual doses to minimize toxicity (Correct answer)
- To shorten infusion time for patient convenience
- To eliminate the need for supportive care medications
Correct answer: To target multiple mechanisms, reduce drug resistance, and allow lower individual doses to minimize toxicity
Combination chemotherapy targets different cell-cycle phases and mechanisms, which reduces resistance, improves efficacy, and allows dose reduction of individual agents.
Question 5: A patient with lung cancer reports severe dyspnea, distended neck veins, hypotension, and muffled heart sounds. Which emergency condition does the nurse suspect?
- Pulmonary embolism
- Cardiac tamponade (Correct answer)
- Tension pneumothorax
- Superior vena cava syndrome
Correct answer: Cardiac tamponade
Beck's triad (hypotension, distended neck veins, muffled heart sounds) is classic for cardiac tamponade, a life-threatening oncologic emergency.
Question 6: Which cancer is most strongly associated with the BRCA1 gene mutation?
- Colorectal and stomach cancer
- Breast and ovarian cancer (Correct answer)
- Prostate and thyroid cancer
- Lung and bladder cancer
Correct answer: Breast and ovarian cancer
BRCA1 mutations significantly increase lifetime risk for breast cancer (~70%) and ovarian cancer (~40–45%).
Question 7: A nurse is providing end-of-life education to a family whose cancer patient is transitioning to comfort-focused care. Which statement is most appropriate?
- 'We will continue all curative treatments alongside palliative measures.'
- 'Our goal shifts to maximizing comfort, dignity, and quality of life while supporting your family.' (Correct answer)
- 'Hospice care means we are giving up on your loved one.'
- 'Pain medications will be limited to prevent addiction even at this stage.'
Correct answer: 'Our goal shifts to maximizing comfort, dignity, and quality of life while supporting your family.'
Hospice and comfort-focused care prioritize symptom control, dignity, and quality of life; reframing this positively helps families understand the compassionate goals of care.
AOCNP Cancer and Oncology Nursing 4
A patient is receiving intrathecal methotrexate.
Which neurotoxicity symptom requires the nurse to stop the infusion and alert the provider?