Contributors: Casey L Long BSN RN CPON, Anita Max MSN RN CPON
Practice test questions are listed below. Beneath the question is the correct answer with references below the answer when available.
1. Which of the following agents is most effective when administered in divided doses or by continuous infusion?
Answer C: Cell-cycle specific drugs include plant alkaloids and antimetabolites. These agents have their most cytotoxic effects during the active S and M phases of the cell cycle. Cytatabine is an antimetabolite.
Kline, N. E. (2007). The pediatric chemotherapy and biotherapy curriculum (2nd ed.). Glenview, IL: APHON, pg. 7
2. Which of the following is true of a tumor suppressor gene?
A. Allows unrestricted cell growth and proliferation.
B. Promotes different phases of the cell cycle.
C. Produces proteins that block the activity of cyclins.
D. Regulates cell growth and repair.
Answer C: Progress through each phase of the cell cycle is controlled tightly by a group of proteins called cyclins. Tumor suppressor genes produce proteins that block the activity of cyclins, thereby inhibiting cell growth and division.
Kline, N. E. (2007). The pediatric chemotherapy and biotherapy curriculum (2nd ed.). Glenview, IL: APHON, pg. 5
3. When reviewing the chemistry panel of a newly diagnosed patient with AML who is lethargic, complaining of flank pain, and experiencing nausea and vomiting, the nurse would expect to see which of the following:
A. Potassium 4.5, Phosphorus 8, Uric Acid 7, Calcium 9.0, BUN 12
B. Potassium 6.5, Phosphorus 8, Uric Acid 9, Calcium 10, BUN 14
C. Potassium 4, Phosphorus 9, Uric Acid 10, Calcium 10, BUN 10
D. Potassium 7, Phosphorus 12, Uric Acid 10, Calcium 7, BUN 25
Answer D: Lethargy, flank pain, and nausea and/or vomiting are symptoms of tumor lysis syndrome. Patients with ALL, AML, and NHL are at risk for TLS. In TLS, abnormal lab findings include elevated WBC, phosphorus, uric acid, potassium, BUN, creatinine, and LDH and decreased calcium.
Kline, N. E. (2008). Essentials of pediatric hematology/oncology nursing: A core curriculum. (3rd ed.). Glenview, IL: APHON, pg 154
4. A patient with pulmonary fibrosis, seen as a late effect of chemotherapy received as a child, would most likely have received which of the following chemotherapeutic agents?
Answer A: Carmustine: A common side effect of Carmustine is late pulmonary dysfunction.
Kline, N. E. (2007). The pediatric chemotherapy and biotherapy curriculum (2nd ed.). Glenview, IL: APHON, pg. 42
5. The single-best predictor of favorable outcome in AML is the presence of which of the following?
A. Ataxia Telangiectasia
B. Fanconi anemia
C. Myelodyplastic syndrome
D. Trisomy 21
Answer D: The presence of Trisomy 21 (Down Syndrome) is the single-best predictor of favorable outcome in AML.
Kline, N. E. (2008). Essentials of pediatric hematology/oncology nursing: A core curriculum. (3rd ed.). Glenview, IL: APHON, pg 16
6. You are taking care of a 15 year old patient with Medulloblastoma who is being admitted for his second round of chemotherapy. The patient states that he became nauseated as he walked into the hospital lobby. Given this information, the nurse should:
A. Administer the ordered Ondansetron immediately.
B. Advise the parents to give Ondansetron prior to coming to the hospital before the next course of chemotherapy.
C. Check the orders for Lorazepam and if not ordered, obtain an order for it.
D. Encourage the patient to drink a carbonated beverage and eat some crackers.
Answer C: Lorazepam is indicated for the prevention of anticipatory nausea and vomiting.
Polovich, M., White, J. M., Kelleher, L. O. (2005). Chemotherapy and biotherapy guidelines and recommendations for practice. Pennsylvania: ONS, pg 116
7. Which of the following is a non-profit organization that provides information about the legal rights of cancer survivors?
A. American Cancer Survivors Foundation
B. Candlelighters Childhood Cancer Foundation
C. Light the Lamp Foundation
D. Young Adult Cancer Survivors of America
Answer B: Candlelighter’s Childhood Cancer Foundation is a non-profit organization
that provides information about the legal rights of cancer survivors.
Kline, N. E. (2008). Essentials of pediatric hematology/oncology nursing: A core curriculum. (3rd ed.). Glenview, IL: APHON, pg 277
8. Your patient’s hemoglobin is 7.5. He has a history of severe transfusion reactions. The blood bank calls to tell you that his packed red blood cells are ready and that they are in a syringe. When you call to inform his mother she asks if they can return later that evening. What is the best response?
A. “No, the packed red blood cells must be given now because they are irradiated.”
B. “No, the packed red blood cells had to be washed and will expire in four hours.”
C. “Yes, the packed red blood cells will not expire for 24 hours.”
D. “Yes, because his hemoglobin is higher than 7 it will be okay to wait.”
Answer B: Patients who have had severe transfusion reactions to PRBC’s receive PRBC’s that have to be washed. This process reduces the amount of WBC’s, protein, and cellular waste in the unit. PRBC’s expire 4 hours after they have been washed and placed in a syringe.
Kline, N. E. (2008). Essentials of pediatric hematology/oncology nursing: A core curriculum. (3rd ed.). Glenview, IL: APHON, pg 179
9. A three year old male day two post surgical resection of a primary tumor in the posterior fossa region stops speaking and develops increased irritability and generalized hypotonia. The parents are concerned that his conditioning is worsening. The nurse should:
A. Immediately call the physician, this is a sign of increased intracranial pressure.
B. Immediately call the physician, this is a sign of complex seizure activity.
C. Reassure the family that this is a sign of mutism and can happen after the type of surgery that he had and most often occurs in the first week, then report this change to the physician.
D. Inform the family that this often happens after this type of surgery and is indicative of the child’s anger and withdrawal in response to what he has gone through.
Answer- C: Mutism can occur after surgery in the posterior fossa region of the brain and may be present immediately after surgery or it may be delayed. Most often mutism occurs during the first week. It can last from 6 days to 52 months.
10. Transretinoic acid (Tretinoin) used to induce remission in patients with acute promyelocitic leukemia (APL) works by:
A. Inducing normal differentiation and decreasing proliferation of APL retinoid cells
B. Mounting an immune response that stimulates the IgA antibodies to increase their ability to attack the APL retinoid cells
C. Destroying the nucleus of the DNA in the APL retinoid cells
D. Attacking the fast growing APL retinoid cells and causing them to lose their outer proteins
Answer- A: Transretinoic acid drives the APL retinoid cells to develop into functional cells and prevents the rapid proliferation and differentiation of immature cells into mature cells that result in cell death.
11. The most urgent complication in a patient with Non-Hodgkin’s Lymphoma that needs to be evaluated at diagnosis and followed closely is:
A. An elevated WBC > 50,000
B. A uric acid of 5.0
C. A mediastinal mass
D. Complaints of left flank pain
Answer-C: The presence of a mediastinal mass should be ruled out with all new patients with Non-Hodgkin’s lymphoma. Approximately 25% of patients with NHL have a mediastinal mass and present with a cough, wheezing, and malaise. This can rapidly progress to respiratory distress, tracheal compression and superior vena cava syndrome which constitute a medical emergency.
12. A two year female has recently been diagnosed with a Wilms tumor. Her presenting signs and symptoms likely included:
A. A soft mass in the left lower quadrant, pain, dysuria and peri-umbilical petechiae
B. An abdominal mass, hematuria, hypertension and fever
C. Enlarged abdomen detected by her parents, decreased ambulation, fatigue, and hyperglycemia
D. A firm left lower quadrant mass, hyponatremia, constipation, and polyuria
Answer-B: A firm flank mass is present that can be seen as an abdominal enlargement. Hematuria, malaise, fever, and hypertension are often present. Wilms tumor presentation may also include nausea and vomiting, anorexia, anemia, and hypotension.
13. Wilm’s tumor has been recognized for its association with a number of congenital malformations that include cryptorchidism, hypospadias, and hemihypertrophy. Another congenital malformation that has also been associated with Wilms tumor is:
B. Tetralogy of fallot
C. Club foot
Answer-A: Aniridia is the congenital absence of the iris of the eye and has been identified as a congenital malformation associated with Wilms tumor. Hemihypertrophy and “horsehoe” kidney have also been linked with Wilms tumor.
14. Prognostic indicators at diagnosis in acute lymphoblastic leukemia (ALL) include age and biologic properties of the leukemic blasts. Which of the following is another prognostic indicator at diagnosis for ALL?
B. The presence of Down syndrome
C. The presence of fever
D. Initial white blood cell count
Answer-D: A higher WBC at diagnosis is considered to be an unfavorable risk factor.
15. Auer rods are typically seen with which form of leukemia?
A. Acute lymphoblastic leukemia
B. Acute myeloid leukemia
C. Chronic lymphocytic leukemia
D. Burkitt’s leukemia
Answer-B: Auer rods are often present in acute myeloblastic or monoblastic leukemia.
16. “B” symptoms in Hodgkin’s disease include:
A. Body odor, boils, bad mood, and big ears
B. Enlarged cervical lymph nodes, weight loss, and cold intolerance
C. Fever, weight loss, and night sweats
D. Weight loss, headaches, and night sweats
Answer-C: “B” symptoms in Hodgkin’s disease presentation include unexplained weight loss of ≥ 10%, unexplained persistent, recurrent fever with temperatures greater than 380 C in the last month, and recurrent drenching night sweats during the last month. “A” symptoms simply implies the absence of “B” symptoms.
17. The antidote for Versed is:
A. Flumazenil (Romazicon)
B. Naloxone Hydrochloride
C. Methelyn blue
Answer-A: Flumazenil 0.01mg/kg every minute for up to five doses (max 0.2mg/dose up to 1 mg total dose).
18. Syndrome of Inappropriate Diuretic Hormone (SIADH), which leads to salt wasting, can be a side effect of which chemotherapeutic agents?
A. Vincristine and Adriamycin
B. Vinblastine and Cytarabine
C. Cyclophosphamide and Vincristine
D. L-Aparaginase and Cyclophosphamide
Answer-C: SIADH is a known side effect of Cyclophosphamide and Vincristine
19. Which of the following has the most negative prognostic outcome in a patient diagnosed with Neuroblastoma?
A. High-TrkA expression of the tumor
B. The patient is considered to be Stage 2 according to the INSS
C. The patient is six months of age
D. The tumor expresses N-myc amplification.
Answer D: N-myc amplification regardless of age or stage is associated with advanced disease, rapid tumor progression, and a poor prognosis.
Kline, N. E. (2008). Essentials of pediatric hematology/oncology nursing: A core curriculum. (3rd ed.). Glenview, IL: APHON, pg 33
20. What is the primary goal of Phase II trials?
A. To determine the maximum tolerated dose of an investigational drug
B. To determine the value of a new agent in relation to existing treatments
C. To determine the efficacy of a new agent
D. To identify dose-limiting toxicities
Answer C: The primary goals of Phase II trials are to determine the efficacy of a new agent in the treatment of specific types of cancer and to validate toxicity and dosage data.
Kline, N. E. (2007). The pediatric chemotherapy and biotherapy curriculum (2nd ed.). Glenview, IL: APHON, pg. 25
21. What is the leading cause of death in children with Sickle-Cell Disease?
A. Acute Chest Syndrome
B. Cerebral Vascular Accident
D. Splenic Sequestration
Answer C: Streptococcus pneumonia sepsis is the leading cause of death in children with Sickle-Cell Disease.
Kline, N. E. (2008). Essentials of pediatric hematology/oncology nursing: A core curriculum. (3rd ed.). Glenview, IL: APHON, pg 289
22. Why is the radioisotope marker 1-metaiodobenzylguanidine (MIBG) used to diagnose and monitor patients with neuroblastoma?
A) MIBG is picked up only by active tumor and not bone growth/re-growth as occurs with a routine bone scan
B) MIBG is done in one day and saves time
C) No sedation is required for children undergoing a MIBG
D) MIBG is picked up by both active tumor and bone growth/re-growth and is therefore more useful than a routine bone scan
Answer: A- Routine bone scans are often used with MIBG but they pick up any area of bone activity and the MIBG only picks up active tumor.
23. What can a total body bone scan show at diagnosis in a patient with osteosarcoma?
A) Star shaped lesions in the long bones if tumor is present
B) Skip lesions and metastatic pulmonary nodules if present
C) Mediastinal mass if present
D) The elimination of Ewing’s Sarcoma as a differential diagnosis
Answer: B- An open biopsy is needed to confirm osteo or Ewings sarcoma. The presence of metastases is important at diagnosis to determine treatment and prognosis. This is done with a chest CT and a total body bone scan.
24. A common presenting sign with retinoblastoma is:
A) Cat’s eye coloring
D) Sclera erythema
Answer: D- Leukokoria is white pupil seen at certain angles and is also known as “cat’s eye” reflex.
25. The tumor markers a-fetoprotein (AFP) and B subunit of human chorionic gonadotropin (B-hCG) are very important in the diagnosis of:
A. Wilm’s tumor
C. Germ cell tumors
Answer: C- Both of these tumor markers (AFP and B-hCG) are elevated in germ cell tumors.
26. Why are blood products for transfusion irradiated?
A. To prevent human immunodeficiency virus (HIV) transmission
B. To facilitate uptake by the recipient’s bone marrow
C. To eliminate the amount of plasma transfused
D. To prevent transfusion associated graft versus host disease (TA-GVHD)
Answer: D- Irradiation is the safest and most cost effective way to prevent TA-GVHD.
27. How does granulocyte colony stimulating factor G-CSF work?
A. This biologic hematopoetic growth factor stimulates the late proliferation and differentiation of granulocytic progenitor cells, while at the same time increases neutrophil phagocytosis
B. This biologic response modifier stimulates the production of macrophages
C. This biologic agent stimulates the production of white blood cells through direct action on the eosinophil
D. G-CSF works by indirectly causing the hematopoetic system to produce immature agranulocytes
Answer: A- GCSF is lineage specific to the granulocyte lineage
28. A phase II clinical trial is used to determine:
A. Maximum tolerated dose
B. Evaluation of quality of life
C. Anti-tumor activity against a certain disease
D. To compare experimental treatment with the best results of the current phase III trial
Answer: D- The goal of phase II trials is to determine if the treatment is effective against a specific disease.
29. The risk of pancreatitis is increased with the use of which chemotherapeutic agent?
Answer: A- Asparaginase has been linked with an increased risk of pancreatitis in a child with cancer
30. Which chemotherapeutic agents readily cross the blood-brain barrier?
B. Nitrosureas - Carmustine (BCNU) and Lomustine (CCNU)
Answer: B- Carmustine/Nitrosureas cross the blood brain barrier.
31. Ototoxicity which is sometimes presented as tinnitus is associated with which chemotherapeutic agent?
Answer: D- Cisplatin (Platinol) is a heavy metal alkylating agent and is commonly associated with high frequency hearing loss and less frequently normal range hearing. Tinnitus may also occur.