AOCNP Radiation Oncology Nursing 5 — Questions and Answers
Question 1: Which grading system is most commonly used in clinical trials to document radiation therapy toxicities?
- NCI Common Terminology Criteria for Adverse Events (CTCAE) (Correct answer)
- WHO Performance Status Scale
- Radiation Therapy Oncology Group (RTOG) Karnofsky Scale
- Eastern Cooperative Oncology Group (ECOG) Toxicity Scale
Correct answer: NCI Common Terminology Criteria for Adverse Events (CTCAE)
The NCI CTCAE is the standardized grading system used to classify and document adverse events including radiation toxicities in clinical trials and practice.
Question 2: A patient receiving radiation to the thorax develops a dry cough and low-grade fever 6 weeks post-treatment. Which complication should the nurse suspect first?
- Radiation pneumonitis (Correct answer)
- Pulmonary embolism
- Bacterial pneumonia
- Radiation esophagitis recurrence
Correct answer: Radiation pneumonitis
Radiation pneumonitis typically presents 4–12 weeks after thoracic irradiation with dry cough, dyspnea, and low-grade fever.
Question 3: For a patient undergoing high-dose-rate (HDR) brachytherapy for cervical cancer, which nursing priority applies immediately after applicator removal?
- Assess for vaginal bleeding and monitor vital signs closely (Correct answer)
- Instruct the patient to resume full activity within 30 minutes
- Initiate radiation precautions because the patient remains radioactive
- Administer prophylactic anticoagulation to prevent DVT
Correct answer: Assess for vaginal bleeding and monitor vital signs closely
After HDR applicator removal, the source is no longer in the patient, so there is no radiation precaution needed, but bleeding risk from applicator trauma requires prompt assessment.
Question 4: Which factor most significantly increases a patient's risk for osteoradionecrosis of the jaw following head and neck radiation?
- Dental extractions performed after radiation therapy without prophylactic hyperbaric oxygen (Correct answer)
- Use of IMRT technique instead of 3D conformal radiation
- Concurrent use of antiemetics during chemoradiation
- Total radiation dose below 50 Gy to the mandible
Correct answer: Dental extractions performed after radiation therapy without prophylactic hyperbaric oxygen
Post-radiation dental extractions disrupt vascular integrity in irradiated bone, dramatically increasing osteoradionecrosis risk, especially without hyperbaric oxygen prophylaxis.
Question 5: A patient undergoing prostate brachytherapy with permanent iodine-125 seeds is being discharged. Which instruction is most important?
- Avoid prolonged close contact with pregnant women and young children for several months (Correct answer)
- Stay in the hospital for 72 hours until seeds lose all radioactivity
- Avoid sexual activity permanently following seed implantation
- Wear a lead apron at all times when around other people
Correct answer: Avoid prolonged close contact with pregnant women and young children for several months
I-125 seeds emit low-energy photons for months; precautions include limiting prolonged close contact with pregnant women and children, though risk to others is low.
Question 6: Which assessment finding in a patient receiving radiation to the cervical spine warrants immediate reporting to the radiation oncologist?
- Electric shock-like sensation radiating down the spine when the neck is flexed (Lhermitte's sign) (Correct answer)
- Mild fatigue and scalp tenderness in the treatment field
- Nausea occurring 2 hours after each treatment fraction
- Grade 1 mucositis with pain rating of 2/10
Correct answer: Electric shock-like sensation radiating down the spine when the neck is flexed (Lhermitte's sign)
Lhermitte's sign indicates transient radiation myelopathy from demyelination and should be promptly reported to differentiate it from more serious cord injury.
Question 7: A nurse is educating a patient about the purpose of daily image-guided radiation therapy (IGRT) before each treatment fraction. Which explanation is most accurate?
- IGRT uses daily imaging to verify tumor and organ position and adjust treatment delivery for accuracy (Correct answer)
- IGRT delivers a higher dose per fraction to shorten overall treatment time
- IGRT replaces the need for immobilization devices by tracking motion in real time
- IGRT is used only for brain tumors to achieve stereotactic precision
Correct answer: IGRT uses daily imaging to verify tumor and organ position and adjust treatment delivery for accuracy
IGRT acquires images immediately before or during treatment to detect and correct for positional variations, ensuring the radiation dose is delivered accurately to the target.
AOCNP Radiation Oncology Nursing 5
Which grading system is most commonly used in clinical trials to document radiation therapy toxicities?