Radiation Therapy and Chemotherapy (19 Questions)

1. You are administering the first cycle of intravenous chemotherapy (Doxorubicin/Adriamycin) to Mrs. Tremblay, a 54-year-old patient with breast cancer. You are administering the medication via a peripheral IV line in her right forearm. Ten minutes into the infusion, Mrs. Tremblay complains of a stinging and burning sensation at the insertion site. You observe slight redness around the IV site, but there is still blood return.

Question:
What is your immediate priority nursing action? *
2. Mr. Gagnon, a 68-year-old patient with prostate cancer, is receiving internal radiation therapy (brachytherapy) via a temporary radioactive implant. He is placed in a private room with lead shielding. His 32-year-old pregnant daughter arrives on the unit and asks to visit her father for "a few hours" to keep him company.

Question:
Based on radiation safety principles (Time, Distance, and Shielding), what is the correct nursing response? *
3. Mrs. Roy, 45, is receiving external beam radiation therapy for lung cancer. During her third week of treatment, she shows you the skin over her chest wall. The area is red, dry, and itchy (dry desquamation). She asks for advice on how to care for her skin at home.

Question:
Which instruction should you provide to maintain skin integrity? *
4. You are reviewing the complete blood count (CBC) for Mr. Leblanc, a patient with leukemia who received chemotherapy 10 days ago. The results are: White Blood Cells (WBC) 1.2 x 10⁹/L, Neutrophils 0.5 x 10⁹/L, Hemoglobin 95 g/L, and Platelets 150 x 10⁹/L. Mr. Leblanc feels generally well but reports a temperature of 38.3°C (101°F).

Question:
Based on these lab results and the assessment, what is your interpretation and priority action? *
5. You are teaching Mr. Dubé, who has developed thrombocytopenia (Platelet count 40 x 10⁹/L) following chemotherapy, about home safety and bleeding precautions. He likes to garden and perform home repairs.

Question:
Which statement by the patient indicates that he has understood the teaching? *
6. Mrs. Fortin is receiving chemotherapy that is known to cause severe stomatitis (mucositis). She complains of painful sores in her mouth and difficulty eating. You are planning her diet and oral care.

Question:
Which intervention is appropriate to promote comfort and nutrition? *
7. You are the primary nurse for Mrs. Cote, who has a sealed radioactive implant (brachytherapy) for cervical cancer. While assisting her to turn in bed, the implant accidentally dislodges and falls onto the bed linens.

Question:
To ensure your safety and follow proper protocol, what is the immediate action? *
8. Mr. Lavoie is scheduled to receive Cisplatin, a chemotherapy agent known to be highly emetogenic (causing vomiting) and nephrotoxic. He is anxious about the nausea.

Question:
To best manage chemotherapy-induced nausea and vomiting (CINV), when should the anti-emetic medication (e.g., Ondansetron/Zofran) be administered? *
9. You are preparing to administer an oral chemotherapy agent (cytotoxic drug) to a patient on the oncology unit. You are wearing a single pair of gloves.

Question:
According to safe handling guidelines for hazardous drugs, what is the correct Personal Protective Equipment (PPE) requirement for this procedure? *
10. Mr. Talon, a 22-year-old male with a large tumor burden from non-Hodgkin’s lymphoma, has just started aggressive chemotherapy. Twenty-four hours later, he complains of muscle cramps, weakness, and nausea. His lab results show High Potassium (Hyperkalemia), High Uric Acid (Hyperuricemia), and High Phosphate.

Question:
These clinical signs are consistent with Tumor Lysis Syndrome. What is the priority collaborative intervention to prevent permanent renal damage? *
11. Mrs. Boucher, a 45-year-old mother of two young children, has just received her first cycle of chemotherapy (Cyclophosphamide and Fluorouracil) in the outpatient clinic. She is preparing for discharge home. You are providing education regarding safety precautions for handling body fluids, as chemotherapy drugs and their metabolites are excreted in urine and stool.

Question:
To prevent cross-contamination and exposure of her family members to hazardous drug residues, which instruction regarding bathroom use is essential for the next 48 to 72 hours? *
12. Mr. Morin, 63 years old, is on day 3 of high-dose Cyclophosphamide for relapsed multiple myeloma. His IV fluids are infusing at 150 mL/h. At 02:00 he rings the call bell and reports suprapubic discomfort and “burning” when he urinates. You note that his urine in the urinal is pink-tinged. Most recent vitals: BP 126/78, HR 92, Temp 36.9 °C.

Question:
What is the nurse’s PRIORITY intervention? *
14. Mr. Tremblay, 62, is currently undergoing external beam radiation therapy for throat cancer. During your assessment, he reports feeling extreme exhaustion. He states, "I sleep 10 hours a night, but I still feel too tired to do anything during the day." His blood work is within normal limits, and he is maintaining his weight.

Question:
What is the most appropriate nursing intervention to help the patient manage this common side effect? *
15. You are preparing Mr. Nguyen, 40, for today’s chemotherapy infusion via his implanted port-a-cath (right subclavian). On assessment you note a slight redness (1 cm) at the port site but no warmth, swelling, or tenderness. The dressing is dry and intact. Temperature is 37.4 °C. You flush the port with 10 mL normal saline and meet resistance; no blood return is obtained.

Question:
What is the BEST nursing action before deciding to withhold the chemotherapy? *
16. You are the nurse administering Doxorubicin (Adriamycin) to Mrs. Lemieux, a 55-year-old patient with breast cancer. This drug is an anthracycline known for its cumulative cardiotoxicity. Mrs. Lemieux is scheduled for her fourth cycle today.

Question:
Before administering the drug, which specific diagnostic result must you review to ensure it is safe to proceed? *
17. Mrs. Paquette, 50, is taking Tamoxifen, a hormonal therapy, following surgery for estrogen-receptor-positive breast cancer. She presents to the clinic for a follow-up visit. During the assessment, she mentions that her right calf feels "heavy," swollen, and tender to the touch.

Question:
Given the side effect profile of Tamoxifen, what is your interpretation of this finding and the priority action? *
18. Ms. Rousseau, 29, is beginning her first course of combination chemotherapy for Hodgkin’s lymphoma. She is distressed about potential total alopecia and asks what can be done to lessen hair loss.

Question:
Which nursing response is evidence-based and therapeutic? *
19. Mr. Roy is receiving radiation therapy to the head and neck area. He has developed xerostomia (severe dry mouth), which is affecting his ability to eat and speak. He asks if there is anything he can do to improve his comfort.

Question:
Which teaching point is appropriate for managing xerostomia? *