Mesna is given with cyclophosphamide or ifosfamide to prevent which adverse effect?
Hemorrhagic cystitis
✓
Cardiotoxicity
Pulmonary fibrosis
Peripheral neuropathy
Correct Answer
Hemorrhagic cystitis
Toxic metabolites of cyclophosphamide and ifosfamide irritate the bladder lining, and mesna binds them in the urine to protect the bladder; good hydration and frequent voiding also help. Cardiotoxicity is the classic concern with anthracyclines such as doxorubicin. Pulmonary fibrosis is linked to bleomycin. Peripheral neuropathy is typical of vinca alkaloids and taxanes.
Category: Alkylating and Antimetabolite Drugs
Question 2
Alkylating agents such as cyclophosphamide kill cancer cells by which mechanism?
Blocking estrogen receptors
Cross-linking DNA strands
✓
Disrupting microtubules
Mimicking folic acid
Correct Answer
Cross-linking DNA strands
Alkylating agents attach to DNA and cross-link its strands so the cell cannot replicate, and they act in any phase of the cell cycle. Blocking estrogen receptors is how tamoxifen works. Disrupting microtubules is the action of taxanes and vinca alkaloids. Mimicking folic acid describes antimetabolites such as methotrexate.
Category: Alkylating and Antimetabolite Drugs
Question 3
Before doxorubicin therapy begins, which baseline assessment is essential?
Pulmonary function tests
Hearing test
Cardiac ejection fraction
✓
Bone density scan
Correct Answer
Cardiac ejection fraction
Doxorubicin and other anthracyclines can cause cumulative, dose-related heart damage and heart failure, so left ventricular function is measured before treatment and the lifetime cumulative dose is recorded. Pulmonary function tests are the key baseline for bleomycin. A hearing test is important with drugs such as cisplatin, not doxorubicin. A bone density scan is relevant to aromatase inhibitors.
Category: Antitumor and Plant Drugs
Question 4
Which antitumor antibiotic is best known for causing pulmonary fibrosis?
Doxorubicin
Vincristine
Fluorouracil
Bleomycin
✓
Correct Answer
Bleomycin
Bleomycin can cause lung inflammation and fibrosis, so pulmonary function is monitored and patients report cough or shortness of breath. Doxorubicin is known for cardiotoxicity. Vincristine is a vinca alkaloid known for neurotoxicity. Fluorouracil is an antimetabolite known for mucositis, diarrhea and hand-foot syndrome.
Category: Antitumor and Plant Drugs
Question 5
Which chemotherapy drug is fatal if given intrathecally, so it is dispensed only in an IV bag and never in a syringe?
Vincristine
✓
Methotrexate
Cytarabine
Cyclophosphamide
Correct Answer
Vincristine
Vinca alkaloids such as vincristine cause fatal neurotoxicity if injected into the spinal canal, so safety rules require them to be prepared in IV bags. Methotrexate is routinely given intrathecally to treat cancer in the central nervous system. Cytarabine is also given by the intrathecal route. Cyclophosphamide is not the drug this safety rule targets.
Category: Antitumor and Plant Drugs
Question 6
A patient receiving a vinca alkaloid is started on a bowel regimen because the drug can cause which effect?
Hemorrhagic cystitis
Severe constipation
✓
Red-orange urine
Hand-foot syndrome
Correct Answer
Severe constipation
Vinca alkaloids damage autonomic nerves to the gut, causing constipation that can progress to paralytic ileus, so stool softeners and laxatives are used and bowel function is assessed. Hemorrhagic cystitis is caused by cyclophosphamide and ifosfamide. Red-orange urine follows anthracyclines such as doxorubicin. Hand-foot syndrome is linked to pyrimidine antimetabolites such as fluorouracil and capecitabine.
Category: Antitumor and Plant Drugs
Question 7
Methotrexate is an antimetabolite that interferes with the use of which nutrient?
Vitamin K
Iron
Folic acid
✓
Vitamin D
Correct Answer
Folic acid
Methotrexate blocks the enzyme that activates folate, which cells need to make DNA, so rapidly dividing cells cannot replicate. Vitamin K is involved in clotting, not methotrexate's action. Iron is needed for hemoglobin, not targeted by methotrexate. Vitamin D regulates calcium and is unrelated to this mechanism.
Category: Alkylating and Antimetabolite Drugs
Question 8
Before paclitaxel, patients receive a corticosteroid, an antihistamine and an H2 blocker to prevent which complication?
Tumor lysis syndrome
Hemorrhagic cystitis
Peripheral neuropathy
A hypersensitivity reaction
✓
Correct Answer
A hypersensitivity reaction
Taxanes, and the solvent paclitaxel is dissolved in, can trigger severe hypersensitivity reactions, so premedication is given and the patient is watched closely during the infusion. Tumor lysis syndrome is prevented with hydration and uric acid lowering drugs. Hemorrhagic cystitis is prevented with mesna. Peripheral neuropathy is a taxane effect, but this premedication does not prevent it.
Category: Antitumor and Plant Drugs
Question 9
Paclitaxel halts cell division by acting on which cell structure?
Microtubules
✓
Ribosomes
Cell membrane
Mitochondria
Correct Answer
Microtubules
Taxanes bind microtubules and stabilize them so the mitotic spindle cannot function, stopping cells in M phase. Ribosomes are the target of many antibacterial drugs, not taxanes. The cell membrane is not the site of taxane action. Mitochondria are not the target of paclitaxel.
Category: Antitumor and Plant Drugs
Question 10
In chemotherapy, the term nadir refers to which event?
The highest drug level after a dose
The lowest blood cell count after a dose
✓
The time to complete remission
The first sign of hair loss
Correct Answer
The lowest blood cell count after a dose
After chemotherapy, blood counts fall and reach a low point before recovering; this nadir is when the risk of infection and bleeding is greatest, and its timing differs by drug. The highest drug level after a dose is called the peak. The time to complete remission is unrelated to blood count timing. The first sign of hair loss is not what nadir describes.
Category: Chemotherapy Toxicity
Question 11
Ten days after chemotherapy, a patient has a temperature of 101 F (38.3 C) and a very low neutrophil count. What should the nurse do first?
Give acetaminophen and recheck later
Encourage oral fluids and rest
Notify the provider immediately
✓
Recheck the blood count next week
Correct Answer
Notify the provider immediately
Febrile neutropenia is an emergency: the provider is notified at once so blood cultures can be drawn and broad-spectrum antibiotics started without delay. Giving acetaminophen and rechecking later masks the fever and delays treatment. Encouraging oral fluids and rest does not address a possible life-threatening infection. Rechecking the blood count next week leaves the infection untreated.
Category: Chemotherapy Toxicity
Question 12
A patient with chemotherapy-induced thrombocytopenia should be taught to do which of these?
Floss vigorously twice daily
Use an alcohol-based mouthwash
Take aspirin for minor aches
Use a soft toothbrush or tooth sponge
✓
Correct Answer
Use a soft toothbrush or tooth sponge
With a low platelet count, gentle mouth care with a soft brush or sponge reduces gum bleeding. Flossing vigorously twice daily can make the gums bleed. Using an alcohol-based mouthwash irritates fragile oral tissue. Taking aspirin for minor aches impairs platelet function and raises bleeding risk.
Category: Chemotherapy Toxicity
Question 13
Filgrastim is given after chemotherapy for which purpose?
To stimulate neutrophil production
✓
To stimulate red blood cell production
To prevent nausea and vomiting
To protect the bladder lining
Correct Answer
To stimulate neutrophil production
Filgrastim and pegfilgrastim are colony-stimulating factors that speed neutrophil recovery and lower the risk of infection. To stimulate red blood cell production is the role of epoetin alfa and darbepoetin. To prevent nausea and vomiting is the role of antiemetics such as ondansetron. To protect the bladder lining is the role of mesna.
Category: Chemotherapy Toxicity
Question 14
Chemotherapy given before surgery to shrink a tumor is called which type of therapy?
Adjuvant therapy
Neoadjuvant therapy
✓
Salvage therapy
Maintenance therapy
Correct Answer
Neoadjuvant therapy
Neoadjuvant therapy is given first so the tumor is smaller and easier to remove. Adjuvant therapy is given after surgery to destroy remaining cancer cells. Salvage therapy is second-line treatment after first-line therapy fails. Maintenance therapy is given after remission to prevent recurrence.
Category: Treatment Approaches
Question 15
Tumor lysis syndrome produces which electrolyte change?
Hypokalemia
Hypophosphatemia
Hyperkalemia
✓
Hypercalcemia
Correct Answer
Hyperkalemia
When large numbers of cancer cells are destroyed, they release potassium, phosphate and nucleic acids, causing high potassium, high phosphate, high uric acid and low calcium. Hypokalemia is the opposite of what occurs. Hypophosphatemia is also the opposite, since phosphate rises. Hypercalcemia is wrong because calcium falls as it binds the released phosphate.
Category: Cancer Basics
Question 16
Tamoxifen slows the growth of hormone receptor-positive breast cancer by which action?
Blocking the aromatase enzyme
Blocking androgen receptors
Blocking the PD-1 protein
Blocking estrogen receptors
✓
Correct Answer
Blocking estrogen receptors
Tamoxifen is an antiestrogen that occupies estrogen receptors on breast cancer cells, so estrogen cannot stimulate their growth. Blocking the aromatase enzyme is how anastrozole and exemestane lower estrogen. Blocking androgen receptors is the action of flutamide and bicalutamide in prostate cancer. Blocking the PD-1 protein is how pembrolizumab works.
Category: Hormonal Therapy
Question 17
A patient taking anastrozole should be monitored for which long-term adverse effect?
Loss of bone density
✓
Hearing loss
Hemorrhagic cystitis
Pulmonary fibrosis
Correct Answer
Loss of bone density
Aromatase inhibitors lower estrogen levels, which speeds bone loss and raises the risk of osteoporosis; joint and muscle pain are also common. Hearing loss is linked to drugs such as cisplatin. Hemorrhagic cystitis is linked to cyclophosphamide and ifosfamide. Pulmonary fibrosis is linked to bleomycin.
Category: Hormonal Therapy
Question 18
Pembrolizumab can cause which type of serious adverse effect as a result of its action on T cells?
Hemorrhagic cystitis
Immune-mediated organ inflammation
✓
Hand-foot syndrome
Red-orange urine
Correct Answer
Immune-mediated organ inflammation
PD-1 inhibitors release a brake on T lymphocytes, and the more active immune system can attack healthy organs, causing conditions such as colitis, hepatitis, pneumonitis or thyroid problems. Hemorrhagic cystitis is caused by cyclophosphamide. Hand-foot syndrome is linked to fluorouracil and capecitabine. Red-orange urine follows anthracyclines.
Category: Biologic Response Modifiers
Question 19
Which practice is part of the safe handling of chemotherapy drugs?
Preparing doses on an open counter
Recapping needles after use
Wearing two pairs of chemotherapy-rated gloves
✓
Disposing of waste in regular trash
Correct Answer
Wearing two pairs of chemotherapy-rated gloves
Cytotoxic drugs can harm staff and caregivers, so they are handled with double chemotherapy-rated gloves, prepared in a biological safety cabinet and discarded as hazardous waste. Preparing doses on an open counter exposes staff to the drug. Recapping needles after use risks needlestick injury. Disposing of waste in regular trash violates hazardous drug disposal standards.
Category: Treatment Approaches
Question 20
During a doxorubicin infusion, the nurse sees swelling and the patient reports burning at the IV site. What is the nurse's first action?
Increase the infusion rate
Apply pressure and continue
Flush the line forcefully
Stop the infusion
✓
Correct Answer
Stop the infusion
Doxorubicin is a vesicant, and suspected extravasation requires stopping the infusion at once, notifying the provider and following the facility's extravasation protocol. Increasing the infusion rate pushes more drug into the tissue. Applying pressure and continuing still allows the vesicant to leak. Flushing the line forcefully spreads the drug further into the tissue.
Category: Chemotherapy Toxicity