NCLEX Practice Exam for Pharmacology: Antineoplastic Medications

Practice Mode – Questions and choices are randomly arranged, the answer is revealed instantly after each question, and there is no time limit for the exam.

Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam.

Text Mode – Text version of the exam

1. Chemotherapy dosing is usually based on the total body surface. What should the nurse do before administering chemotherapy?

1. Get the body mass index (BMI).
2. Ask the client about intake and output.
3. Weigh and measure the height of the patient on the day of administration.
4. Ask the client for the height and weight.

2. The nurse is caring for of a client who is receiving a chemotherapy. Which of the following would be expected as a result of the massive cell destruction that occurred from the chemotherapy?

1. Leukopenia.
2. Anemia.
3. Thrombocytopenia.
4. Hyperuricemia.

3. Mitomycin (Mutamycin) is prescribed to a client with colorectal cancer. All of which are the routes of administration, except?

1. Oral.
2. Intravenous.
3. Intravesical.
4. Intraarterial.

4. The client with a testicular cancer is being treated with Etoposide (Etopophos). Which of the following side effect is specifically associated with this medication?

1. Chest pain.
2. Edema.
3. Alopecia.
4. Orthostatic hypotension.

5. The clinic nurse provides instructions to a client receiving an antineoplastic medication. When implementing the plan, the nurse tells the client to?

1. To drink beverages containing alcohol in moderate amount during the evening.
2. To avoid hot foods and high fiber rich foods.
3. To take acetylsalicylic acid as needed for headache.
4. To consult with health care providers before receiving immunization.

6. The client with non-Hodgkin’s lymphoma is being managed with vincristine (Vincasar). Which of the following indicates a side effect specific to this medication?

1. Alopecia.
2. Numbness in the toes.
3. Chest heaviness.
4. Weight gain.

7. A client with a sarcoma is receiving Bleomycin (Blenoxane). The nurse in charge for the client expect the physician to order which diagnostic procedure?

1. Pulmonary function studies (PFT’s).
2. Stress test.
3. Cranial x-ray.
4. Electrocardiogram (ECG).

8. A male client with breast cancer is receiving Tamoxifen (Nolvadex). The nurse specifically monitors which laboratory value?

1. Activated partial thromboplastin time
2. Triglyceride level.
3. Fasting blood sugar.
4. Serum sodium and potassium.

9. The client with an ovarian cancer is receiving Tamoxifen (Nolvadex). Which of the following indicates a side effect specific to this medication?

1. Weak and brittle nails.
2. Facial twitching.
3. Convulsions.
4. Constipation.

10. The client with acute myelocytic leukemia is being treated with Busulfan (Myleran). The nurse specifically monitors which laboratory value while the client is taking this medication?

1. Serum calcium.
2. Uric acid level.
3. Prothrombin time.
4. Platelet count.

11. The nurse is evaluating the medical history of a client who will be receiving Asparaginase (Elspar). The nurse contacts the health care provider if which of the following is noted in the history?

1. Diabetes Mellitus type II.
2. Pancreatitis.
3. Asthma.
4. Ischemic heart disease.

12. Megestrol acetate (Megace) is prescribed for a client with advanced breast cancer. The nurse reviews the client’s history and contacts the physician if which of the following is documented in the client’s history?

1. Pulmonary embolism.
2. Gouty arthritis.
3. Bronchial asthma.
4. Ischemic heart disease.

13. The cliet with non-hodgkins lymphoma is receiving Idarubucin (Idamycin). Which of the following would indicate to the nurse that the client is experiencing an adverse effect related to the medication?

1. Dysrhythmia.
2. Weight loss.
3. Nausea and vomiting.
4. Peripheral neuropathy.

14. The client is receiving Cisplatin (Platinol-AQ). Which of the following side effect is related to the medication?

1. Depressed tendon reflexes.
2. Photosensitivity.
3. Tinnitus.
4. Ptosis.

15. The nurse is monitoring the laboratory results of a male client receiving antineoplastic medications. The nurse plans to initiate bleeding precautions if which laboratory is value is noted?

1. White blood cell count of 6,000/mm3.
2. Platelet count of 45,000 cells/mm3
3. Clotting time of 8 minutes.
4. Hemoglobin count of 15g/dl.

16. A client is receiving Methotrexate (Rheumatrex) for a series of chemotherapy. Which of the following medication should be readily available to avoid toxicity?

1. Mesna (Mesnex).
2. Vigabatrin (Sabril).
3. Leucovorin (Folinic acid).
4. Oseltamivir (Tamiflu).

17. The nurse is providing teachings to a client receiving cyclophosphamide (Cytoxan). The nurse tells the client to which of the following?

1. Eat foods rich in potassium.
2. Increase fluid intake to 2-3 liters per day.
3. Take the medication with food.
4. Eat foods rich in purine.

18. The nurse is monitoring a patient receiving an Iv infusion of an antineoplastic medication. During the infusion, the patient complains of pain and redness at the insertion site. The nurse should take which actions? Select all that apply.

1. Reinsert the IV at a distal part of the same vein.
2. Increase the flow rate of the medication.
3. Notify the physician.
4. Apply a heat or ice compress to the site.
5. Administer an antidote as prescribed.

19. The nurse is caring for a client receiving chemotherapy when an anaphylactic reaction occurs from the medication.  The nurse should take which actions? Select all that apply.

1. Stop the medication.
2. Remove the IV line.
3. Administer Oxygen.
4. Administer epinephrine.
5. Positioned the client in a reverse Trendelenburg position.

20. The nurse is caring for a client who is receiving Fluorouracil (Adrucil). Which of the following symptoms would necessitate the nurse to immediate discontinuation of the medication?

1. Palmar-plantar erythrodysesthesia.
2. Ataxia.
3. Constipation.
4. Insomnia.

Answers and Rationale

1. Answer: C. Weigh and measure the height of the patient on the day of administration. To assure that the client obtains optimal doses of chemotherapy, dosing is usually based on the total body surface (BSA), which requires an accurate current measurement of height and weight on the day of the administration.

• Options A and B will not provide the information needed.
• Option D will lead to inaccurate value in determining the true body total surface.

2. Answer: D. Hyperuricemia. Increase level of uric acid (Hyperuricemia)  in the body is common following the treatment for leukemias and lymphomas because chemotherapy results in massive cell destruction.

• Options A, B, and C are usually noted, but an increase uric acid level is specifically related to massive cell destruction.

3. Answer: A. Oral. Mitomycin (Mutamycin) is an antitumor antibiotic used in the treatment of anal, bladder, breast, cervical, colorectal, head and neck, and non-small cell lung cancer. There is no pill form of this medication.

• Options B, C, and D are the routes of medication.

4. Answer: D. Orthostatic hypotension. While on etoposide infusion, blood pressure is monitored throughout and it should be administered slowly over 30-60 minutes to avoid hypotension.

• Options A and B are not related to this medication.
• Option C: Alopecia happens nearly with all the neoplastic medications.

5. Answer: D. To consult with health care providers before receiving immunization. Because antineoplastic medications lower the resistance of the body, clients must be informed not to received immunizations without a health care provider’s approval.

• Option A: Clients need to avoid alcohol to minimize the risk of toxicity.
• Option B: Diarrhea as one of the common signs of antineoplastic medication needs to avoid spicy and high-fiber foods which can increase peristalsis.
• Option C: Clients need to avoid aspirin to minimize the risk of bleeding.

6. Answer: B. Numbness in the toes. A side effect specific to this medication is peripheral neuropathy. It can be manifested as numbness and tingling sensation in the finger and toes.

• Option A: Alopecia occurs nearly with all the neoplastic medications.
• Options C and D are not related to this medication.

7. Answer: A. Pulmonary function studies (PFT’s). Bleomycin (Blenoxane) is an antitumor antibiotic that can cause interstitial pulmonary fibrosis. Pulmonary function tests and chest x-ray are done while on this treatment.

• Options B, C, and D are not related to the specific use of this medication.

8. Answer: B. Triglyceride level. Tamoxifen (Nolvadex) is an antineoplastic medication that may increase cholesterol, triglyceride and calcium levels. Complete blood count, platelet count, serum calcium, cholesterol, and triglyceride level must be monitored periodically before the administration of this medication.

• Options A, C, and D are not monitored during the medication therapy.

9. Answer: D. Constipation. Tamoxifen (Nolvadex) is an antineoplastic medication that may increase calcium levels. Signs of hypercalcemia includes include constipation, abdominal pain, hypotonicity of muscle, nausea and vomiting.

• Options A, B, and C are signs of hypocalcemia.

10. Answer: B. Uric acid level. Busulfan (Myleran) is an antineoplastic medication that can cause an increase uric acid level in the body.

• Options A, C, and D are not related to this medication.

11. Answer: B. Pancreatitis. One of the major toxicities associated with asparaginase therapy is pancreatitis. Pancreatic function test should be performed before and during the administration of the medication.

• Options A, C, and D are not contraindicated with this medication.

12. A. Pulmonary embolism. Megestrol acetate (Megace) is an antineoplastic agent that treats breast and endometrial cancer. This medication is contraindicated for patients with a history of thrombophlebitis and pulmonary embolism.

• Options B, C, and D are not contraindicated with this medication.

13. A. Dysrhythmia. Idarubicin (Idamycin) and Daunorubicin (Daunoxome) may cause cardiotoxicity (such as dysrhythmia, fatigue, shortness of breath), cardiomyopathy and ECG changes.

• Option B: Weight gain not weight loss is a side effect.
• Option C is a usual side effect that can last for 2-3 days.
• Option D: is not a side effect related to this medication.

14. C. Tinnitus. Cisplatin (Platinol-AQ), an alkylating medication, may cause ototoxicity, tinnitus, hypokalemia, hypomagnesemia, hypocalcemia and nephrotoxicity.

• Option A is a sign of hypermagnesemia.
• Options B and D are side effects not related to this medication.

15. B. Platelet count of 45,000 cells/mm3. The normal value for platelet is 150,000 to 450,000 cells/mm3. When platelet count is less than 50,000 cells/mm3, minor trauma can lead to episodes of prolonged bleeding; when less than 20,000 cells/mm3, spontaneous and uncontrolled bleeding can occur.

• Option A: Normal white blood cell count is 4,000 to 11,000/mm3.
• Option C: Normal clotting time is 8-15 minutes.
• Option D: Normal hgb is 13.5-17.5 g/dl.

16. C. Leucovorin (Folinic acid). Large doses of Methotrexate (Rheumatrex) may lead to harmful effects in the body. Leucovorin is administered to prevent its toxicity.

• Option A: Mesna is given with ifosfamide to decrease the potential of ifosfamide induced cystitis.
• Option B is an anticonvulsant.
• Option D: is an influenza antiviral medication.

17. B. Increase fluid intake to 2-3 liters per day. Cyclophosphamide can cause hemorrhagic cystitis. Encourage the client to increase their fluid intake to 2- 3 liters per day, unless contraindicated.

• Option A: This medication can cause hyperkalemia.
• Option C: The medication is taken without food.
• Option D: Client must follow a low purine diet to alkalinize the urine and lowers the uric acid level.

18. C. Notify the physician., D. Apply a heat or ice compress to the site., E. Administer an antidote as prescribed. Extravasation may occur during the infusion of chemotherapy. Signs of which are pain, redness and swelling on the insertion site. The infusion must stop and the physician is notified. The physician may order the administration of an antidote and a heat or cold compress is done.

• Options A and B: Reinsertion on the same vein and increasing the flow rate may cause further damage to the site.

19. A. Stop the medication., C. Administer Oxygen., D. Contact the physician. During an anaphylactic reaction, the medication is immediately stopped. The nurse assesses the respiratory status and monitors the client vital signs. The physician is contacted immediately. and an emergency medication is given such as epinephrine.

• Option B: The IV line is not removed because IV access is required to administer emergency IV medications.
• Option E: The client’s head is not lowered but elevated to improve ventilation.

20. B. Ataxia. During the administration of Fluorouracil. Monitor for symptoms of dizziness, weakness, and ataxia which are signs of cerebral dysfunction that would immediately lead to the discontinuation of the medication.

• Option A is characterized by skin rash, swelling, redness, pain and/or peeling of the skin on the palms of hands and soles of feet. Is usually a mild symptom that would only require reduction of the dosage.
• Option C: Diarrhea is a related sign, not constipation.
• Option D: is not a related symptom of this medication.