Exam for the Non-Cancer Chemotherapy/Biotherapy Course
1. Potential side effects of monoclonal antibodies include:
a. Cardiac toxicity
b. Anaphylactic reaction
c. Mucositis
d. Renal toxicity
Rationale: Slide #32
2. Patients receiving cyclophosphamide are at risk for the following complication
a. Hemorrhagic cystitis
b. Mucositis
c. Flu – like syndrome
d. Hepatic toxicity
Rationale: Slide #4
3. Hypertension is a common side effect to many immunosuppressive drugs.
a. True
b. False
Rationale: Slide #44-48
4. PTLD many occur after any solid organ or blood and marrow transplant.
a. True
b. False
Rationale: Slide #2
5. Treatment for PTLD may include the following
a. Immunosuppressive therapy
b. Chemotherapy
c. Biotherapy
d. All of the above
Rationale: Slide #10
6. PTLD is most commonly seen after
a. Liver transplant
b. Intestinal transplant
c. Stem cell transplant
d. Heart transplant
Rationale: Slide #4
7. When comparing pediatric multiple sclerosis to adult multiple sclerosis, pediatric
multiple sclerosis:
a. progresses faster
b. causes a later onset of disabilities
c. progresses slower, however permanent disability occurs at a younger age
d. has a more predictable course
Rationale: C - MS progresses at a slower rate in children, however diability is
present at a younger age.
8. The most common form of multiple sclerosis is:
a. Relapsed-Remitting
b. Primary Progressive
c. Secondary Progressive
d. Progressive-Relapsing
Rationale: A - The most common form of MS is relapse remitting , accounting
for 93-95% of cases in children and 85% of cases in adults
9. The diagnostic workup for a pediatric patient with a suspected diagnosis of
multiple sclerosis would include the following in addition to complete history
and physical:
a. neurological exam, spinal tap, and electroencephalogram
b. neurological exam, CAT scan and spinal tap
c. neurological exam, electroencephalogram and MRI
d. neurological exam, MRI, evoked potential tests and spinal tap
Rationale: D - A complete work up for MS includes a neurological exam, MRI,
evoked potential tests and spinal tap
10. The hypothesized goal of rituximab in a newly diagnosed diabetic patient is:
a. prevention of further destruction of beta cells
b. replication of beta cells
c. patient will be able to produce normal amounts of insulin
d. the patient will no longer require insulin injections
Rationale: A - The hypothesized goal of rituximab in a newly diagnosed
diabetic patient is prevention of further destruction of beta cells.
11. In order to be eligible for a study drug which will decrease the destruction of
beta cells in patients diagnosed with type I diabetes, the patient:
a. must be diagnosed with type I diabetes within the past 6-9 months
b. agree to check their glucose level 1 time daily
c. have blood work which reveals the presence of functioning beta cells
d. must not require insulin injections
Rationale: C -Study paticipats will be required to have blood work which
reveals the presence of functioning beta cells.
12. Relatives of people with type I diabetes are at a:
a. lower risk of developing diabetes
b. 10-15% greater risk for developing diabetes
c. 20-30% greater risk for developing diabetes
d. 30-50% greater risk for developing diabetes
Rationale: A - Relatives of people with type I diabetes are at a 10-15%
greater risk for developing diabetes
13. Personal protective equipment is required when:
a. Caring for patients within 36 hours after administration of
chemotherapy
b. Entering a patient room where chemotherapy was administered
c. Pre-medicating a patient for chemotherapy administration
d. There is the possibility of releasing the drug into the environment
14. Which one of the following actions should the nurse perform first when a
chemotherapy spill occurs?
a. Report the spill to the biohazard department of the institution
b. Call the pharmacy to replace the spilled chemotherapy
c. Post a sign that warns others and secure the area
d. Clean the spill according to spill kit directions
15. Which is the MOST appropriate safe-handling practice when caring for a
child who received chemotherapy within the last 24hours?
a. No precautions are necessary after the infusion is complete
b. Discard leak-proof pads and diapers in the trash
c. Document the amount of urine voided at least every 2 hours
d. Institute universal precautions when handling the patient’s body fluids
16. Why are immunosuppressive therapies effective in treating a child with
idiopathic nephrology syndrome?
a. T cell involvement
b. B cell involvement
c. interlukine involvement
d. a and c only
e. b and c only
Answer: D-Possible therories point to role of lymphkines and T cells
17. Which CD 20 antibody is used in treating membraneous nephropathies?
a. chlorambucil
b. cyclosporine
c. rituximab
d. cellcept
e. prograf
Answer: C-CD 20 antibodies have shown remission and reversal of pathological
changes.
18. Why are antithymocyte globulin, monoclonal anti CD25 antibodies, prograf
and cellcept effective in preventing/treating rejection related to kidney
transplants?
a. they all mitigate the T cell proliferation or depletion
b. they all have the same mode of action
c. they all activate the inflammatory mediator system
d. a and b only
e. none of the above
Answer: A-T8 cells are predominant cells involved in kidney rejection
19. When are immunomodulators and biotherapy added to treatment for IBD?
a. fistula/stricture formation
b. to achieve a steroid sparing effect
c. unresponsive to aminosaclicyclates, steroids, and antibiotics
d. a and c only
e. all of the above
Answer: E-All are indications for use when there has been a lack of response or
manifestation of side effects/toxicities
20. The immunomodulator that is chemically similar to 6-MP is:
a. Mexate
b. Mercaptopurine
c. Immuran
d. Methotrexate
e. Humira
Answer: C-Prodrug that is converted to 6-MP and is used to mediate immune
response for maintenance therapy
21. What are nursing assessment/interventions are important when administering
Remicade?
a. titrate to avoid acute infusion reactions
b. verify CXR and skin PPD for latent or active TB
c. have anaphylaxis kit available
d. a and c only
e. all of the above
Answer: E-Derived from murine and human components. Also, side effects
include respiratory complications
22. List 3 side effects of steroids?
Hunger, Slows bone growth, weight gain, cushingoid effect, acne, mood
swings, elevations in blood pressure
Answer: These are all possible answers of common side effects of taking
prednisone
23. What is the minimum number of criteria patients must have to be diagnosed
with Lupus?
a. 11
b. 4
c. 2
d. none of the above
Answer: B- any patient diagnosed with SLE must have at least 4 of the 11 criteria
24. Which of the following biotherapies are used to treat Juvenile Arthritis in
Children?
a. Enbrel
b. Humira
c. Remicade
d. All of the above
Answer D-all three of these biotherapies are used to treat Juvenile Arthritis
25. The most common clinical manifestation of HSP is
a. palpable purpura
b. oral ulcers
c. pulmonary hemorrhage
d. none of the above
Answer: A-the most common clinical manifestation of HSP is palpable purpura
26. Dermatomyositis can cause a skin rash and truncal weakness in the
extremities.
True
False
Answer: True both skin rash and truncal weakness are common in
Dermatomyositis
27.Systemic Scleroderma can lead to death.
True
False
Answer: True Sytemic Scleroderma though a slow disease is progressive and life
threatening
28. Uveitis is inflammation of
a. eye
b. heart
c. lungs
d. kidneys
Answer A: Uveitis is inflammation within the eye
29. Wegener’s Granulomatosis is characterized by granulomatous vasculitis in the
upper and lower respiratory track.
True
False
Answer: True, granulomatous vasculitis is the upper and/or lower respiratory
track is commonly seen in Wegeners
30. Takaysu’s Arteritis has been treated with
a. glucocorticosteroids
b. cyclophosphamide
c. naprosyn
d. a and b
Answer: D: Takyasus’s has been treated with glucocorticosteroids and
cyclophosphamide
31. The following report addresses the eithical principles of
respect for persons, beneficence, and justice:
A.
B.
C.
D.
The Nuremberg Code
The Belmont Report
The Helsinki Declaration
The Code of Federal Regulation
Answer: B. The Belmont Report
32. The following is true regarding Informed Consent:
A. It is a one time process initiated at the beginning of treatment
B. It is a one time process initiated after treatment has started
C. It is an on-going process that continues throughout the duration of
treatment.
Answer: C It is an on-going process. Informed consent continues throughout the
duration of the treatment process, is voluntary and includes a discussion of risks,
benefits and alternative therapies.
33.In the fetus, the process of normal hematopoeisis occurs in the:
A. Kidneys
B. Liver and Spleen
C. Spleen only
D. Bone Marrow
Answer: B. Liver and spleen. The liver and spleen are responsible for the normal
hematopeisis process in the fetus. After birth, this process occurs primarily in the
bone marrow.
34. The immune system has 3 lines of defense. The line of defense that addresses
specific types of immunity is:
A. First Line (Protective)
B. Second Line (Inflammatory)
C. Third Line (Immunity)
Answer: C. Third Line of Defense. This is is responsible for the "specific type of
immunity", through lymphocyte responsed to specific antigens. The First Line of
Defense is the protective response done primarily through barriers of skin and
mucous membranes. The Second Line of Defense in responsible for the
inflammatory response which is mediated by neutrophils and macrophages. Both
the First and Second Line of Defense are Nonspecific Immunity.
35. Immune Thrombocytopenia Purpura (ITP) often follows:
A.
B.
C.
D.
Bacterial Infection
Immunizations
Viral Infection
Fungal Infection
Answer: C. Viral Illness. ITP usually follows approximately 2-3 weeks after a
viral illness.
36. Paroxysmal Nocturnal Hematuria (PNH) is an acquired life threatening
disorder that may present with the following symptoms: (choose all that appy)
A. Fatigue
B. Abdominal Pain
C. Hematuria
D. Alopecia
Answer: Answers A, B, and C. Fatigue, abdominal pain and hematuria are
hallmark symptoms for PNH. Alopecia is a side effect of chemotherapy
treatments that may be used to treat this condition.
37. One mechanism of action monoclonal antibodies is to enhance the patient’s
own immune system (Kline, N. 2007). One agent used in the treatment of the
non-cancer patient is alemtuzumab (Campath®). What is the most important
nursing implication in caring for the patient receiving this monoclonal
antibody?
a. Administer infusion slowly over one hour
b. Assess patient regularly, obtaining vital signs prior to, during, and post
infusion, monitoring for side effects
c. Premedicate with appropriate medications, as this will decrease severity of
side effects
d. Obtain physician order for the alemtuzumab
Answer: b
Rationale: Biotherapy is known to cause moderate to severe reactions, and in some
cases, anaphylaxis. It is the responsibility of the nurse to complete a thorough
assessment of the patient prior to, during, and after the completion of the infusion to
monitor for such side effects (Kline, N. 2007)
38. Following the administration of cyclophosphamide, an Alkylating agent, the
patient develops an increase in nausea and vomiting six hours post
administration of his therapy. Which of the following interventions is the most
appropriate at this time?
a. Notify physician on patient’s nausea/vomiting
b. Administer Mesna IV over 15 minutes
c. Administer appropriate anti-emetic, assessing that appropriate anti-emetics
are scheduled for up to 24 hours, noting that delayed nausea/vomiting can
occur
d. Encourage patient and family to decrease noxious stimuli to decrease
nausea/vomiting
Answer: c
Rationale: Administering appropriate anti-emetics is important when administering
Alkylating agents, as these agents have a high incidence of causing nausea and
vomiting. Administering the appropriate anti-emetic prior to the infusion, and at
scheduled intervals for up to 24 hours post-infusion, helps to decrease the nausea and
vomiting.
39. Components of safe preparation for chemotherapy administration include the
following: 1) verification of chemotherapy orders, 2) verification of
chemotherapy roadmap, 3) preparation of the setting, and 4) an independent
verification and calculation by a second RN. If a discrepancy is found, what is
the correct measure taken by the RN administering the chemotherapy
a. Call Pharmacy to prepare the chemotherapy for administration
b. Notify the Physician of the discrepancy and obtain clarification orders
c. Have the second RN verify chemotherapy anyways, as to deliver
chemotherapy on time.
Answer: b
Rationale: Principles of safe preparation include verifying each step in the process of
administering chemotherapy. Double-checking chemotherapy with a second RN ensures
appropriateness and accuracy of all orders and roadmaps, identifying discrepancies, and
has shown to decrease medication errors. The RN must notify the Physician to clarify any
discrepancies prior to administering the chemotherapy (Kline, N. 2007).
40. Chronic complications for Sickle Cell Anemia may include which of the
following (check all that apply)
a.
b.
c.
d.
Cholelithiasis
Delayed Growth and Maturation
Cataracts
Avascular Necrosis
Answer: A, B, and D. These complications occur due to the sickle shaped red blood cell
becoming trapped in the microvasculature of various organs in the body.
41. Sickle Cell Anemia is a genetic disease.
True or False
Answer: True. Sickle Cell Anemia is the most common Genetic Disorder in the United
States. There are approximately 72,000 new cases diagnosed a year.
42. Autoimmune Hemolytic Anemia is an anemia caused by the destruction of red
blood cells due to an immune mediated response.
True or False
Answer: True. Its origin can be intravscular or extravascular.
43. Autoimmune Hemolytic Anemia is an anemia often associate with other
genetic diseases.
True or False
Answer: False. Autoimmune Hemolytic Anemia is thought to be an autoimmune
condition. It is often associated with other autoimmune conditions such as lupus. (SLE)
Reference:
Kline, N. (Ed.). (2007). The Pediatric Chemotherapy and Biotherapy Curriculum (2nd
edition). Glenview, IL: Association of Pediatric Hematology and Oncology
Nurses.