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26. A patient starting chemotherapy asks why the nurse obtains frequent CBCs. The best explanation is:
A. “To check for dehydration.”
B. “Chemotherapy often suppresses bone marrow, so we monitor for neutropenia, anemia, and thrombocytopenia.”
C. “It’s routine but not related to chemo.”
D. “Only to monitor liver function.”
Answer: B.
Rationale: Bone marrow suppression is a dose-limiting toxicity; CBC monitoring is essential.
Which is the priority nursing action for a patient who has a temperature of 38.3°C (101°F) and neutropenia after chemotherapy?
A. Encourage fluids and rest.
B. Notify the provider immediately — start neutropenic precautions and follow orders for blood cultures and empiric antibiotics.
C. Give aspirin to lower the fever.
D. Obtain a chest x-ray only.
Answer: B.
Rationale: Fever with neutropenia is an oncologic emergency; prompt cultures and empiric IV antibiotics per protocol are critical.
Methotrexate therapy requires monitoring of which labs most closely?
A. Renal and hepatic function tests and CBC.
B. Only blood glucose.
C. Serum potassium.
D. Lipid panel.
Answer: A.
Rationale: Methotrexate is hepatotoxic and can be nephrotoxic and myelosuppressive; monitor LFTs, renal function, CBC.
33. A patient receiving cisplatin (an alkylating-like agent) has tinnitus and decreased hearing. The nurse recognizes this as:
A. Expected sign of improvement.
B. Ototoxicity — notify provider; may require dose adjustment.
C. An isolated symptom unrelated to chemo.
D. A sign of anxiety.
Answer: B.
Rationale: Certain chemo agents (e.g., cisplatin) are ototoxic; assess and report.
A patient notes severe nausea and vomiting after chemotherapy. Which intervention is priority?
A. Administer prescribed antiemetics before chemo and as scheduled per protocol.
B. Offer herbal teas only.
C. Withhold antiemetic until vomiting occurs.
D. Encourage a high-fat meal immediately after chemo.
Answer: A.
Rationale: Preventive antiemetics given before chemo reduce incidence/severity of nausea/vomiting.