NRS 300 EXAM 3-CARE OF THE ONCOLOGY PATIENT PRACTICE
QUESTIONS AND ANSWERS–COMPLETE STUDY GUIDE |
PRACTICE QUESTIONS AND ANSWERS-RATIONALES | EXAM
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LATEST EXAM 2026-2027
1. A 58-year-old patient with stage III non-small cell lung cancer is receiving concurrent
chemotherapy and radiation therapy. During the second week of treatment, the patient
reports a mild, dry cough and slight shortness of breath upon exertion. Auscultation
reveals clear lung fields bilaterally. What is the nurse's best initial action?
A. Administer prescribed rescue inhalers and notify the provider immediately of acute
bronchospasm
B. Document the findings, reassure the patient that mild radiation pneumonitis can occur, and
monitor closely
C. Withhold all scheduled chemotherapy and radiation sessions until a formal pulmonary
function test is completed
D. Prepare the patient for emergency endotracheal intubation due to impending acute respiratory
distress syndrome
Answer: B
This clinical presentation reflects early, low-grade radiation pneumonitis, a common and
expected inflammatory reaction during thoracic radiation. Because the symptoms are mild and
breath sounds are clear, immediate discontinuation of therapy or emergency intervention is
unnecessary, but vigilant ongoing monitoring is essential to catch progression early.
2. A patient receiving high-dose cisplatin therapy for ovarian cancer exhibits a serum
creatinine increase from 0.8 mg/dL to 2.1 mg/dL and a blood urea nitrogen (BUN) rise to
35 mg/dL within 48 hours of infusion. Which proactive nursing measure should have been
prioritized to mitigate this nephrotoxic effect?
A. Administering concentrated oral potassium supplements alongside every chemotherapy cycle
B. Enforcing strict fluid restriction to prevent systemic volume overload and pulmonary edema
C. Implementing aggressive pre- and post-hydration regimens utilizing normal saline and
diuretics
D. Co-administering potent nephrotoxic aminoglycosides to synergistic therapeutic advantage
Answer: C
Cisplatin is notoriously nephrotoxic due to direct tubular injury. Standard clinical prevention
protocols rely heavily on aggressive IV hydration (often with normal saline) and sometimes
,mannitol-induced diuresis to maintain high urine output, thereby reducing drug concentration
in the renal tubules.
3. An oncology nurse is reviewing laboratory results for a patient scheduled to receive the
third cycle of adjuvant chemotherapy. The absolute neutrophil count (ANC) returns at
450/mm3, and the patient reports a current oral temperature of 38.5°C (101.3°F). What is
the immediate priority intervention?
A. Apply a cooling blanket to aggressively lower the patient's core body temperature
B. Administer a dose of oral acetaminophen and re-evaluate the temperature in 60 minutes
C. Draw blood cultures from all lumen ports, initiate broad-spectrum IV antibiotics, and notify
the provider
D. Place the patient in strict negative-pressure isolation and restrict all family visitations
Answer: C
An ANC below 500/mm3 combined with a fever defines febrile neutropenia, an absolute
medical emergency. Immediate blood cultures followed by the rapid administration of broad-
spectrum intravenous empiric antibiotics within one hour are critical to prevent fatal septic
shock.
4. A patient diagnosed with acute myeloid leukemia (AML) undergoes induction
chemotherapy. On day four post-infusion, telemetry monitors note a sudden onset of wide
QRS complexes, tall peaked T-waves, and prolonged PR intervals. Laboratory results
reveal a potassium level of 6.8 mEq/L, uric acid of 12.5 mg/dL, and a phosphorus of 7.2
mg/dL. Which oncologic emergency is unfolding?
A. Superior vena cava syndrome
B. Tumor lysis syndrome
C. Cardiac tamponade
D. Hypercalcemia of malignancy
Answer: B
Tumor lysis syndrome occurs when massive numbers of cancer cells are destroyed rapidly,
releasing their intracellular contents (potassium, phosphorus, and nucleic acids converted to
uric acid) into the bloodstream. This leads to life-threatening hyperkalemia,
hyperphosphatemia, hyperuricemia, and secondary hypocalcemia.
5. A patient with metastatic breast cancer receiving bone-targeting bisphosphonates
reports a persistent, dull ache in the right jaw alongside localized gum swelling and a small
area of exposed bone. What is the most likely diagnosis associated with these symptoms?
A. Osteonecrosis of the jaw (ONJ)
B. Periodontal abscess secondary to poor oral hygiene
C. Metastatic bone lesion invasion of the mandible
,D. Radiation-induced osteoradionecrosis
Answer: A
Bisphosphonate-related osteonecrosis of the jaw (ONJ) is a well-documented long-term
complication of bone-modifying agents used in oncology. It presents with exposed necrotic
bone in the maxillofacial region that fails to heal over several weeks, particularly following
dental trauma or invasive dental procedures.
6. A patient receiving doxorubicin experiences accidental extravasation during the
peripheral infusion of the medication. The nurse immediately stops the infusion,
disconnects the tubing, and leaves the cannula in place. What is the next specific action the
nurse should take?
A. Apply an immediate warm compress to the site for 20 minutes every four hours
B. Aspirate any residual drug from the cannula, then gently remove it and administer the
specific antidote
C. Flush the remaining line aggressively with 10 mL of normal saline to clear the vein
D. Elevate the affected upper extremity above the level of the heart to promote venous return
Answer: B
Doxorubicin is a potent vesicant that causes severe tissue necrosis. When extravasation
occurs, the nurse should attempt to aspirate a small amount of blood and residual drug
through the existing cannula before removing it, followed by the immediate application of the
specific neutralizing agent (such as dexrazoxane) and appropriate cold or warm compresses
depending on institutional guidelines.
7. A patient with advanced lung cancer develops facial edema, distended jugular veins, and
prominent chest wall collateral veins over a 48-hour period. The nurse recognizes these
clinical signs as indicative of which medical emergency?
A. Deep vein thrombosis of the upper extremities
B. Superior vena cava syndrome
C. Cardiac tamponade
D. Pulmonary embolism
Answer: B
Superior vena cava syndrome is caused by compression of the superior vena cava by tumor
mass or mediastinal lymphadenopathy, resulting in impaired venous return from the head,
neck, and upper torso. Classic signs include facial and periorbital edema, engorged neck
veins, and upper extremity swelling.
8. An oncology patient undergoing active radiation therapy to the head and neck develops
severe, painful erythematous ulcerations throughout the oral cavity and oropharynx,
, severely limiting oral intake. Which nursing diagnosis is most appropriate for this clinical
scenario?
A. Impaired Oral Mucous Membrane related to the cytotoxic effects of radiation therapy
B. Deficient Fluid Volume related to decreased vascular permeability
C. Imbalanced Nutrition: More than body requirements related to altered metabolic demand
D. Risk for Infection related to systemic immunosuppression and neutropenia
Answer: A
Radiation-induced oral mucositis causes intense inflammation and painful ulceration of the
mucosal lining of the GI tract. This diagnosis directly targets the localized tissue destruction,
pain, and functional impairment caused by radiation toxicity.
9. A patient with multiple myeloma is admitted with generalized muscle weakness,
lethargy, nausea, constipation, and an electrocardiogram showing shortened QT intervals.
The serum calcium level returns at 13.2 mg/dL. Which initial collaborative intervention is
indicated?
A. Immediate administration of oral calcium supplements and vitamin D
B. Aggressive intravenous normal saline hydration coupled with loop diuretics
C. Infusion of concentrated potassium chloride via a central venous catheter
D. Initiation of high-dose sodium bicarbonate infusions to correct metabolic acidosis
Answer: B
Severe hypercalcemia of malignancy requires immediate intervention to rehydrate the
intravascular space and promote renal calcium excretion via aggressive normal saline
infusion combined with a loop diuretic such as furosemide once volume status is stable.
10. A nurse is evaluating a patient with colorectal cancer who is receiving oxaliplatin
therapy. The patient reports a sudden onset of intense, painful dysesthesia in the hands and
throat immediately upon drinking a cold beverage. What patient education should the
nurse provide?
A. Advise the patient to permanently discontinue all fluid intake immediately after
chemotherapy
B. Reassure the patient that oxaliplatin-induced peripheral neuropathy can be triggered by cold
exposure and to avoid cold drinks and ice
C. Prepare the patient for immediate surgical intervention due to acute esophageal rupture
D. Instruct the patient to take high-dose oral iron supplements to combat cold intolerance
Answer: B
Oxaliplatin uniquely causes acute, transient, cold-triggered peripheral neurotoxicity
characterized by paresthesias or dysesthesias in the extremities and throat. Educating the
QUESTIONS AND ANSWERS–COMPLETE STUDY GUIDE |
PRACTICE QUESTIONS AND ANSWERS-RATIONALES | EXAM
PREP | DOWNLOAD INSTANT PDF | GUARANTEED PASS ||
LATEST EXAM 2026-2027
1. A 58-year-old patient with stage III non-small cell lung cancer is receiving concurrent
chemotherapy and radiation therapy. During the second week of treatment, the patient
reports a mild, dry cough and slight shortness of breath upon exertion. Auscultation
reveals clear lung fields bilaterally. What is the nurse's best initial action?
A. Administer prescribed rescue inhalers and notify the provider immediately of acute
bronchospasm
B. Document the findings, reassure the patient that mild radiation pneumonitis can occur, and
monitor closely
C. Withhold all scheduled chemotherapy and radiation sessions until a formal pulmonary
function test is completed
D. Prepare the patient for emergency endotracheal intubation due to impending acute respiratory
distress syndrome
Answer: B
This clinical presentation reflects early, low-grade radiation pneumonitis, a common and
expected inflammatory reaction during thoracic radiation. Because the symptoms are mild and
breath sounds are clear, immediate discontinuation of therapy or emergency intervention is
unnecessary, but vigilant ongoing monitoring is essential to catch progression early.
2. A patient receiving high-dose cisplatin therapy for ovarian cancer exhibits a serum
creatinine increase from 0.8 mg/dL to 2.1 mg/dL and a blood urea nitrogen (BUN) rise to
35 mg/dL within 48 hours of infusion. Which proactive nursing measure should have been
prioritized to mitigate this nephrotoxic effect?
A. Administering concentrated oral potassium supplements alongside every chemotherapy cycle
B. Enforcing strict fluid restriction to prevent systemic volume overload and pulmonary edema
C. Implementing aggressive pre- and post-hydration regimens utilizing normal saline and
diuretics
D. Co-administering potent nephrotoxic aminoglycosides to synergistic therapeutic advantage
Answer: C
Cisplatin is notoriously nephrotoxic due to direct tubular injury. Standard clinical prevention
protocols rely heavily on aggressive IV hydration (often with normal saline) and sometimes
,mannitol-induced diuresis to maintain high urine output, thereby reducing drug concentration
in the renal tubules.
3. An oncology nurse is reviewing laboratory results for a patient scheduled to receive the
third cycle of adjuvant chemotherapy. The absolute neutrophil count (ANC) returns at
450/mm3, and the patient reports a current oral temperature of 38.5°C (101.3°F). What is
the immediate priority intervention?
A. Apply a cooling blanket to aggressively lower the patient's core body temperature
B. Administer a dose of oral acetaminophen and re-evaluate the temperature in 60 minutes
C. Draw blood cultures from all lumen ports, initiate broad-spectrum IV antibiotics, and notify
the provider
D. Place the patient in strict negative-pressure isolation and restrict all family visitations
Answer: C
An ANC below 500/mm3 combined with a fever defines febrile neutropenia, an absolute
medical emergency. Immediate blood cultures followed by the rapid administration of broad-
spectrum intravenous empiric antibiotics within one hour are critical to prevent fatal septic
shock.
4. A patient diagnosed with acute myeloid leukemia (AML) undergoes induction
chemotherapy. On day four post-infusion, telemetry monitors note a sudden onset of wide
QRS complexes, tall peaked T-waves, and prolonged PR intervals. Laboratory results
reveal a potassium level of 6.8 mEq/L, uric acid of 12.5 mg/dL, and a phosphorus of 7.2
mg/dL. Which oncologic emergency is unfolding?
A. Superior vena cava syndrome
B. Tumor lysis syndrome
C. Cardiac tamponade
D. Hypercalcemia of malignancy
Answer: B
Tumor lysis syndrome occurs when massive numbers of cancer cells are destroyed rapidly,
releasing their intracellular contents (potassium, phosphorus, and nucleic acids converted to
uric acid) into the bloodstream. This leads to life-threatening hyperkalemia,
hyperphosphatemia, hyperuricemia, and secondary hypocalcemia.
5. A patient with metastatic breast cancer receiving bone-targeting bisphosphonates
reports a persistent, dull ache in the right jaw alongside localized gum swelling and a small
area of exposed bone. What is the most likely diagnosis associated with these symptoms?
A. Osteonecrosis of the jaw (ONJ)
B. Periodontal abscess secondary to poor oral hygiene
C. Metastatic bone lesion invasion of the mandible
,D. Radiation-induced osteoradionecrosis
Answer: A
Bisphosphonate-related osteonecrosis of the jaw (ONJ) is a well-documented long-term
complication of bone-modifying agents used in oncology. It presents with exposed necrotic
bone in the maxillofacial region that fails to heal over several weeks, particularly following
dental trauma or invasive dental procedures.
6. A patient receiving doxorubicin experiences accidental extravasation during the
peripheral infusion of the medication. The nurse immediately stops the infusion,
disconnects the tubing, and leaves the cannula in place. What is the next specific action the
nurse should take?
A. Apply an immediate warm compress to the site for 20 minutes every four hours
B. Aspirate any residual drug from the cannula, then gently remove it and administer the
specific antidote
C. Flush the remaining line aggressively with 10 mL of normal saline to clear the vein
D. Elevate the affected upper extremity above the level of the heart to promote venous return
Answer: B
Doxorubicin is a potent vesicant that causes severe tissue necrosis. When extravasation
occurs, the nurse should attempt to aspirate a small amount of blood and residual drug
through the existing cannula before removing it, followed by the immediate application of the
specific neutralizing agent (such as dexrazoxane) and appropriate cold or warm compresses
depending on institutional guidelines.
7. A patient with advanced lung cancer develops facial edema, distended jugular veins, and
prominent chest wall collateral veins over a 48-hour period. The nurse recognizes these
clinical signs as indicative of which medical emergency?
A. Deep vein thrombosis of the upper extremities
B. Superior vena cava syndrome
C. Cardiac tamponade
D. Pulmonary embolism
Answer: B
Superior vena cava syndrome is caused by compression of the superior vena cava by tumor
mass or mediastinal lymphadenopathy, resulting in impaired venous return from the head,
neck, and upper torso. Classic signs include facial and periorbital edema, engorged neck
veins, and upper extremity swelling.
8. An oncology patient undergoing active radiation therapy to the head and neck develops
severe, painful erythematous ulcerations throughout the oral cavity and oropharynx,
, severely limiting oral intake. Which nursing diagnosis is most appropriate for this clinical
scenario?
A. Impaired Oral Mucous Membrane related to the cytotoxic effects of radiation therapy
B. Deficient Fluid Volume related to decreased vascular permeability
C. Imbalanced Nutrition: More than body requirements related to altered metabolic demand
D. Risk for Infection related to systemic immunosuppression and neutropenia
Answer: A
Radiation-induced oral mucositis causes intense inflammation and painful ulceration of the
mucosal lining of the GI tract. This diagnosis directly targets the localized tissue destruction,
pain, and functional impairment caused by radiation toxicity.
9. A patient with multiple myeloma is admitted with generalized muscle weakness,
lethargy, nausea, constipation, and an electrocardiogram showing shortened QT intervals.
The serum calcium level returns at 13.2 mg/dL. Which initial collaborative intervention is
indicated?
A. Immediate administration of oral calcium supplements and vitamin D
B. Aggressive intravenous normal saline hydration coupled with loop diuretics
C. Infusion of concentrated potassium chloride via a central venous catheter
D. Initiation of high-dose sodium bicarbonate infusions to correct metabolic acidosis
Answer: B
Severe hypercalcemia of malignancy requires immediate intervention to rehydrate the
intravascular space and promote renal calcium excretion via aggressive normal saline
infusion combined with a loop diuretic such as furosemide once volume status is stable.
10. A nurse is evaluating a patient with colorectal cancer who is receiving oxaliplatin
therapy. The patient reports a sudden onset of intense, painful dysesthesia in the hands and
throat immediately upon drinking a cold beverage. What patient education should the
nurse provide?
A. Advise the patient to permanently discontinue all fluid intake immediately after
chemotherapy
B. Reassure the patient that oxaliplatin-induced peripheral neuropathy can be triggered by cold
exposure and to avoid cold drinks and ice
C. Prepare the patient for immediate surgical intervention due to acute esophageal rupture
D. Instruct the patient to take high-dose oral iron supplements to combat cold intolerance
Answer: B
Oxaliplatin uniquely causes acute, transient, cold-triggered peripheral neurotoxicity
characterized by paresthesias or dysesthesias in the extremities and throat. Educating the
