OCN OCN MCQ 2 — Questions and Answers
Question 1: A patient receiving carboplatin reports ringing in the ears and decreased hearing. Which action should the oncology nurse take first?
- Administer an antiemetic as ordered
- Notify the provider and document the findings (Correct answer)
- Reassure the patient this is expected and temporary
- Increase oral fluid intake to flush the drug
Correct answer: Notify the provider and document the findings
Ototoxicity is a serious adverse effect that requires prompt provider notification and documentation before treatment continues.
Question 2: Which laboratory value is most critical to assess before administering methotrexate?
- Serum potassium
- Serum creatinine (Correct answer)
- Platelet count
- Serum sodium
Correct answer: Serum creatinine
Methotrexate is renally excreted, and impaired renal function can lead to toxic drug accumulation.
Question 3: A patient with multiple myeloma develops sudden severe back pain and lower extremity weakness. The priority nursing action is to:
- Administer scheduled opioid analgesics
- Apply a heating pad to the lumbar area
- Notify the physician immediately for spinal cord compression evaluation (Correct answer)
- Encourage ambulation to prevent deconditioning
Correct answer: Notify the physician immediately for spinal cord compression evaluation
Sudden back pain with neurological deficits in a myeloma patient suggests spinal cord compression, an oncologic emergency.
Question 4: Which dietary instruction is most appropriate for a neutropenic patient?
- Eat fresh fruits and vegetables washed under running water
- Consume only commercially canned or well-cooked foods (Correct answer)
- Increase intake of yogurt containing live cultures for gut health
- Follow a high-fiber diet including raw grains and sprouts
Correct answer: Consume only commercially canned or well-cooked foods
Neutropenic patients follow a low-microbial diet, avoiding raw or undercooked foods that harbor pathogens.
Question 5: A patient's ANC is 450 cells/mm³. Based on this value, the nurse understands the patient is at:
- No increased infection risk
- Mild risk and standard precautions are sufficient
- Moderate to severe risk requiring neutropenic precautions (Correct answer)
- Low risk requiring only hand hygiene reinforcement
Correct answer: Moderate to severe risk requiring neutropenic precautions
An ANC below 500 cells/mm³ indicates severe neutropenia and high infection risk requiring protective precautions.
Question 6: Which statement best describes the mechanism of action of monoclonal antibodies such as trastuzumab?
- They alkylate DNA strands to prevent cell replication
- They target specific antigens on cancer cells to inhibit growth or trigger immune destruction (Correct answer)
- They interfere with microtubule polymerization during mitosis
- They inhibit topoisomerase enzymes causing DNA strand breaks
Correct answer: They target specific antigens on cancer cells to inhibit growth or trigger immune destruction
Monoclonal antibodies bind to specific cell surface antigens, blocking signaling pathways or flagging cells for immune-mediated destruction.
Question 7: A patient is prescribed leucovorin rescue therapy following high-dose methotrexate. The nurse explains that leucovorin works by:
- Enhancing renal clearance of methotrexate
- Providing folate to rescue normal cells from methotrexate toxicity (Correct answer)
- Neutralizing the alkaline properties of methotrexate in the bloodstream
- Stimulating bone marrow recovery after drug-induced suppression
Correct answer: Providing folate to rescue normal cells from methotrexate toxicity
Leucovorin (folinic acid) bypasses the methotrexate block on dihydrofolate reductase, rescuing normal cells while cancer cells remain sensitive.
OCN OCN MCQ 2
A patient receiving carboplatin reports ringing in the ears and decreased hearing.
Which action should the oncology nurse take first?