NUR3795 PRINCIPLES OF ONCOLOGY
MIDTERM EXAM
2026
A patient with advanced colorectal cancer is receiving a combination chemotherapy regimen.
Which nursing intervention is most critical to prevent neutropenic complications?
a) Encourage oral hydration only
b) Administer prophylactic colony-stimulating factors as prescribed
c) Restrict all visitors during hospitalization
d) Monitor daily weight only
Answer: b) Administer prophylactic colony-stimulating factors as prescribed
Rationale: Colony-stimulating factors such as filgrastim reduce neutropenia duration and
prevent infections in chemotherapy patients, critical to minimize neutropenic complications.
A nurse is educating a patient about the potential side effects of immune checkpoint inhibitors.
Which adverse effect should the nurse emphasize as a priority for early detection?
a) Peripheral neuropathy
b) Immune-related pneumonitis
c) Alopecia
d) Hemorrhagic cystitis
Answer: b) Immune-related pneumonitis
Rationale: Immune checkpoint inhibitors can cause serious immune-related adverse events like
pneumonitis, requiring early recognition and prompt management.
A young adult patient with Hodgkin lymphoma reports severe fatigue during radiation therapy.
Which nursing diagnosis best addresses this problem?
a) Risk for infection related to immunosuppression
b) Activity intolerance related to radiation-induced fatigue
c) Acute pain related to skin irritation
d) Fluid volume deficit related to nausea
Answer: b) Activity intolerance related to radiation-induced fatigue
Rationale: Fatigue is a common side effect of radiation therapy, affecting patients' ability to
perform activities.
Which laboratory parameter is the most sensitive early indicator of tumor lysis syndrome in
oncology patients?
a) Elevated potassium
b) Elevated phosphate
c) Elevated uric acid
d) Reduced calcium
Answer: c) Elevated uric acid
Rationale: Uric acid elevation occurs early in tumor lysis syndrome as rapid tumor cell
destruction releases nucleic acids metabolized into uric acid.
,A patient receiving extravasation of doxorubicin at the IV site should be treated initially by:
a) Applying warm compresses
b) Administering dexrazoxane antidote
c) Elevating the limb and applying ice packs
d) Flushing the site with normal saline
Answer: b) Administering dexrazoxane antidote
Rationale: Doxorubicin is a vesicant and dexrazoxane is the specific antidote to limit tissue
damage from extravasation.
True/False
The presence of multidrug resistance proteins in tumor cells decreases the effectiveness of
chemotherapy.
Answer: True
Rationale: Multidrug resistance proteins pump chemotherapy agents out of cancer cells,
reducing drug concentration and effectiveness.
Late effects of cancer treatment can include cardiotoxicity, secondary malignancies, and
infertility.
Answer: True
Rationale: These late effects are well-documented consequences of certain chemotherapy and
radiation regimens.
Oncology nurses should avoid assessing pain in nonverbal cancer patients due to subjective
variability.
Answer: False
Rationale: Pain assessment is crucial regardless of verbal status; nurses use validated tools to
assess pain in nonverbal patients.
A patient with neutropenia should receive a live vaccine to prevent infections before discharge.
Answer: False
Rationale: Live vaccines are contraindicated in immunocompromised patients due to risk of
disseminated infection.
Targeted cancer therapies often cause alopecia more frequently than traditional chemotherapy.
Answer: False
Rationale: Targeted therapies generally cause less alopecia compared to cytotoxic
chemotherapy.
Fill in the Blank
The _______ score is commonly used to assess the risk of febrile neutropenia in chemotherapy
patients.
Answer: MASCC (Multinational Association for Supportive Care in Cancer)
Rationale: The MASCC score helps stratify risk for febrile neutropenia and guide outpatient vs
inpatient management.
Chemo-induced nausea and vomiting is primarily mediated through stimulation of the
___________ in the brainstem.
Answer: Chemoreceptor trigger zone (CTZ)
Rationale: CTZ activation leads to emesis reflex after chemotherapy administration.
, A nurse should monitor ___________ levels to assess for syndrome of inappropriate
antidiuretic hormone secretion (SIADH) in small cell lung cancer patients.
Answer: Sodium
Rationale: SIADH causes hyponatremia due to water retention.
The recommended initial treatment for hypercalcemia of malignancy includes administration of
__________ to promote renal calcium excretion.
Answer: Intravenous fluids (normal saline)
Rationale: Hydration with IV fluids aids calcium excretion by kidneys as first-line treatment.
_________ therapy uses monoclonal antibodies to target cancer cells expressing specific
antigens.
Answer: Immunotherapy
Rationale: Monoclonal antibodies as immunotherapy recognize tumor antigens and mediate cell
death.
Multiple Choice
During administration of cisplatin, which nursing action best prevents nephrotoxicity?
a) Restrict fluid intake
b) Administer antiemetics 30 minutes prior
c) Provide adequate IV hydration before and after infusion
d) Monitor liver enzymes
Answer: c) Provide adequate IV hydration before and after infusion
Rationale: Hydration minimizes cisplatin nephrotoxicity by promoting renal elimination.
Which clinical manifestation would most likely indicate superior vena cava syndrome in a
patient with lung cancer?
a) Leg edema
b) Facial swelling and dyspnea
c) Abdominal pain
d) Frequent headaches
Answer: b) Facial swelling and dyspnea
Rationale: Obstruction of the superior vena cava causes facial and upper extremity edema and
breathing difficulty.
A patient with hematologic malignancy is experiencing mucositis. Which intervention is most
effective to prevent secondary infection?
a) Routinely use chlorhexidine mouthwash
b) Encourage saline and baking soda rinses
c) Restrict oral intake of all food
d) Administer systemic antibiotics prophylactically
Answer: b) Encourage saline and baking soda rinses
Rationale: Gentle rinses reduce mucosal irritation and prevent infection better than harsh
antiseptics.
____ in oncology nursing refers to the intentional omission or delay of chemotherapy to
decrease toxicity.
a) Dose density
b) Dose reduction
c) Dose escalation
d) Dose intensity
MIDTERM EXAM
2026
A patient with advanced colorectal cancer is receiving a combination chemotherapy regimen.
Which nursing intervention is most critical to prevent neutropenic complications?
a) Encourage oral hydration only
b) Administer prophylactic colony-stimulating factors as prescribed
c) Restrict all visitors during hospitalization
d) Monitor daily weight only
Answer: b) Administer prophylactic colony-stimulating factors as prescribed
Rationale: Colony-stimulating factors such as filgrastim reduce neutropenia duration and
prevent infections in chemotherapy patients, critical to minimize neutropenic complications.
A nurse is educating a patient about the potential side effects of immune checkpoint inhibitors.
Which adverse effect should the nurse emphasize as a priority for early detection?
a) Peripheral neuropathy
b) Immune-related pneumonitis
c) Alopecia
d) Hemorrhagic cystitis
Answer: b) Immune-related pneumonitis
Rationale: Immune checkpoint inhibitors can cause serious immune-related adverse events like
pneumonitis, requiring early recognition and prompt management.
A young adult patient with Hodgkin lymphoma reports severe fatigue during radiation therapy.
Which nursing diagnosis best addresses this problem?
a) Risk for infection related to immunosuppression
b) Activity intolerance related to radiation-induced fatigue
c) Acute pain related to skin irritation
d) Fluid volume deficit related to nausea
Answer: b) Activity intolerance related to radiation-induced fatigue
Rationale: Fatigue is a common side effect of radiation therapy, affecting patients' ability to
perform activities.
Which laboratory parameter is the most sensitive early indicator of tumor lysis syndrome in
oncology patients?
a) Elevated potassium
b) Elevated phosphate
c) Elevated uric acid
d) Reduced calcium
Answer: c) Elevated uric acid
Rationale: Uric acid elevation occurs early in tumor lysis syndrome as rapid tumor cell
destruction releases nucleic acids metabolized into uric acid.
,A patient receiving extravasation of doxorubicin at the IV site should be treated initially by:
a) Applying warm compresses
b) Administering dexrazoxane antidote
c) Elevating the limb and applying ice packs
d) Flushing the site with normal saline
Answer: b) Administering dexrazoxane antidote
Rationale: Doxorubicin is a vesicant and dexrazoxane is the specific antidote to limit tissue
damage from extravasation.
True/False
The presence of multidrug resistance proteins in tumor cells decreases the effectiveness of
chemotherapy.
Answer: True
Rationale: Multidrug resistance proteins pump chemotherapy agents out of cancer cells,
reducing drug concentration and effectiveness.
Late effects of cancer treatment can include cardiotoxicity, secondary malignancies, and
infertility.
Answer: True
Rationale: These late effects are well-documented consequences of certain chemotherapy and
radiation regimens.
Oncology nurses should avoid assessing pain in nonverbal cancer patients due to subjective
variability.
Answer: False
Rationale: Pain assessment is crucial regardless of verbal status; nurses use validated tools to
assess pain in nonverbal patients.
A patient with neutropenia should receive a live vaccine to prevent infections before discharge.
Answer: False
Rationale: Live vaccines are contraindicated in immunocompromised patients due to risk of
disseminated infection.
Targeted cancer therapies often cause alopecia more frequently than traditional chemotherapy.
Answer: False
Rationale: Targeted therapies generally cause less alopecia compared to cytotoxic
chemotherapy.
Fill in the Blank
The _______ score is commonly used to assess the risk of febrile neutropenia in chemotherapy
patients.
Answer: MASCC (Multinational Association for Supportive Care in Cancer)
Rationale: The MASCC score helps stratify risk for febrile neutropenia and guide outpatient vs
inpatient management.
Chemo-induced nausea and vomiting is primarily mediated through stimulation of the
___________ in the brainstem.
Answer: Chemoreceptor trigger zone (CTZ)
Rationale: CTZ activation leads to emesis reflex after chemotherapy administration.
, A nurse should monitor ___________ levels to assess for syndrome of inappropriate
antidiuretic hormone secretion (SIADH) in small cell lung cancer patients.
Answer: Sodium
Rationale: SIADH causes hyponatremia due to water retention.
The recommended initial treatment for hypercalcemia of malignancy includes administration of
__________ to promote renal calcium excretion.
Answer: Intravenous fluids (normal saline)
Rationale: Hydration with IV fluids aids calcium excretion by kidneys as first-line treatment.
_________ therapy uses monoclonal antibodies to target cancer cells expressing specific
antigens.
Answer: Immunotherapy
Rationale: Monoclonal antibodies as immunotherapy recognize tumor antigens and mediate cell
death.
Multiple Choice
During administration of cisplatin, which nursing action best prevents nephrotoxicity?
a) Restrict fluid intake
b) Administer antiemetics 30 minutes prior
c) Provide adequate IV hydration before and after infusion
d) Monitor liver enzymes
Answer: c) Provide adequate IV hydration before and after infusion
Rationale: Hydration minimizes cisplatin nephrotoxicity by promoting renal elimination.
Which clinical manifestation would most likely indicate superior vena cava syndrome in a
patient with lung cancer?
a) Leg edema
b) Facial swelling and dyspnea
c) Abdominal pain
d) Frequent headaches
Answer: b) Facial swelling and dyspnea
Rationale: Obstruction of the superior vena cava causes facial and upper extremity edema and
breathing difficulty.
A patient with hematologic malignancy is experiencing mucositis. Which intervention is most
effective to prevent secondary infection?
a) Routinely use chlorhexidine mouthwash
b) Encourage saline and baking soda rinses
c) Restrict oral intake of all food
d) Administer systemic antibiotics prophylactically
Answer: b) Encourage saline and baking soda rinses
Rationale: Gentle rinses reduce mucosal irritation and prevent infection better than harsh
antiseptics.
____ in oncology nursing refers to the intentional omission or delay of chemotherapy to
decrease toxicity.
a) Dose density
b) Dose reduction
c) Dose escalation
d) Dose intensity
