Immunotherapy and Targeted Therapy Practice Questions
20 free Immunotherapy and Targeted Therapy practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
Which statement best describes the primary mechanism of action of cancer immunotherapy?
- A Directly killing cancer cells through DNA alkylation
- B Enabling the immune system to recognise and attack cancer
- C Preventing new blood-vessel growth in tumour tissue
- D Replacing defective tumour-suppressor genes directly
Correct answer: Enabling the immune system to recognise and attack cancer
Immunotherapy works by enhancing or enabling the immune system to detect and destroy cancer cells.
The therapy described as a “precision medicine” that targets specific proteins in cancer cells is called:
- A Traditional chemotherapy
- B Radiation therapy
- C Targeted therapy
- D Hormone therapy
Correct answer: Targeted therapy
Targeted therapy specifically focuses on proteins or pathways in cancer cells (the “molecular target”) rather than indiscriminately affecting all rapidly dividing cells.
Which statement about monoclonal antibodies used in targeted therapy is correct?
- A They always enter cancer cells to inhibit intracellular proteins
- B They are lab-made proteins that bind specific targets on cancer cells
- C They cannot be combined with any other cancer therapies
- D They act like chemotherapy by killing all rapidly dividing cells
Correct answer: They are lab-made proteins that bind specific targets on cancer cells
Monoclonal antibodies are engineered proteins that bind to specific antigens on cancer cells and can either mark them for immune destruction or interfere with their function.
An example of an immune checkpoint inhibitor used in cancer is:
- A A small-molecule drug that inhibits the BCR-ABL kinase
- B A monoclonal antibody that blocks PD-1/PD-L1 signalling
- C A small molecule that blocks VEGF receptor signalling
- D A cytotoxic alkylating chemotherapy agent
Correct answer: A monoclonal antibody that blocks PD-1/PD-L1 signalling
Immune checkpoint inhibitors block inhibitory receptors like PD-1/PD-L1 to enhance T-cell mediated immune activity against cancer.
When combining immunotherapy and targeted therapy, one major rationale is:
- A They reliably cancel out each other's therapeutic effects
- B To exploit synergy by attacking cancer via different mechanisms
- C Immunotherapy works only after targeted therapy has failed
- D Targeted therapy alone always produces a complete cure
Correct answer: To exploit synergy by attacking cancer via different mechanisms
Combining immunotherapy and targeted therapy may improve outcomes by using immune-mediated attack plus inhibition of cancer growth pathways.
Which scenario best illustrates adoptive cell transfer immunotherapy (such as CAR T-cell therapy)?
- A A patient takes an oral pill that blocks the EGFR receptor
- B A patient is infused with engineered T-cells targeting tumour antigen
- C A patient receives a preventive vaccine against papillomavirus
- D A patient gets high-dose chemotherapy then stem-cell transplant
Correct answer: A patient is infused with engineered T-cells targeting tumour antigen
Adoptive cell transfer involves extracting a patient’s immune cells, modifying or selecting them ex vivo, and infusing them back to attack cancer.
For a patient receiving checkpoint inhibitor immunotherapy, which of the following side-effects should the nurse monitor for?
- A Isolated neutropenia is the only concern
- B Immune-mediated colitis, pneumonitis, or thyroiditis
- C Hair loss is the only expected adverse effect
- D No adverse effects, since immunotherapy is always safe
Correct answer: Immune-mediated colitis, pneumonitis, or thyroiditis
Because immunotherapy enhances immune activity, it can cause immune-mediated damage to healthy tissues (eg. colitis, pneumonitis, endocrine dysfunction).
Which statement about monoclonal antibodies used in targeted therapy is correct?
- A They always enter cancer cells to inhibit intracellular proteins
- B They are lab-made proteins that bind specific targets on cancer cells
- C They cannot be combined with any other cancer therapies
- D They act like chemotherapy by killing all rapidly dividing cells
Correct answer: They are lab-made proteins that bind specific targets on cancer cells
Monoclonal antibodies are engineered proteins that bind to specific antigens on cancer cells and can either mark them for immune destruction or interfere with their function.
A small-molecule targeted therapy differs from a monoclonal antibody because:
- A Small molecules cannot enter cells and act only outside them
- B Small molecules are large proteins binding extracellular antigens
- C Small molecules enter cells and inhibit intracellular targets
- D Small molecules are used only for infections, not for cancer
Correct answer: Small molecules enter cells and inhibit intracellular targets
Small-molecule targeted therapies are designed to penetrate cells and inhibit intracellular proteins or signalling pathways; monoclonal antibodies usually target extracellular or cell-surface molecules.
Which of the following is true regarding patient selection for targeted therapy?
- A Every cancer responds automatically to targeted agents
- B Targeted therapy requires no biomarker testing at all
- C Only patients whose tumours express the target benefit
- D Targeted therapy is first line regardless of mutation status
Correct answer: Only patients whose tumours express the target benefit
The efficacy of targeted therapy depends on the presence of the target; therefore only those patients whose tumours express the target are likely to benefit.
The term “durable response” in cancer immunotherapy means:
- A The cancer shrinks for only a few days before regrowing
- B A short-lived response that needs frequent re-treatment
- C A long-lasting remission persisting after therapy ends
- D The therapy produces no measurable anti-cancer effect
Correct answer: A long-lasting remission persisting after therapy ends
A hallmark of immunotherapy is that some patients achieve long-lasting responses because the immune system continues to act against cancer after treatment ends.
Which of the following is a potential limitation of targeted therapy?
- A It works irrespective of the cancer’s molecular profile
- B Cancer may develop resistance to the targeted agent over time
- C It has zero side-effects
- D It is cheaper than all other therapies
Correct answer: Cancer may develop resistance to the targeted agent over time
A known problem with targeted therapies is the development of drug resistance when cancer cells adapt or find alternative pathways.
Which of the following best describes “on-target off-tumour” toxicity in targeted therapy?
- A A drug that affects only the intended tumour target
- B A drug harming healthy cells that share the tumour's target
- C A drug that misses its intended molecular target entirely
- D A side-effect unrelated to where the target is expressed
Correct answer: A drug harming healthy cells that share the tumour's target
“On-target off-tumour” toxicity occurs when the molecular target is present on both tumour and some normal cells, causing unintended damage to healthy tissue.
A patient being considered for targeted therapy should have which of the following performed?
- A A random therapeutic trial without testing
- B Biomarker/mutation testing of the tumour
- C Only a physical exam without imaging
- D An assessment of hair and skin only
Correct answer: Biomarker/mutation testing of the tumour
Before starting targeted therapy, tumour tissue is often tested to detect whether a molecular target is present (eg. EGFR mutation, ALK rearrangement) to ensure the therapy is appropriate.
A nurse monitors a patient on immunotherapy for signs of “cytokine release syndrome” (CRS). This adverse effect is most often associated with which therapy type?
- A A small-molecule kinase inhibitor
- B Traditional cytotoxic chemotherapy
- C Adoptive cell transfer such as CAR T-cells
- D Standard endocrine hormone therapy
Correct answer: Adoptive cell transfer such as CAR T-cells
CRS is a known complication particularly of adoptive cell therapies (eg. CAR T-cells) when a large number of activated immune cells release cytokines rapidly.
In immunotherapy, the term “checkpoint” refers to:
- A A surgical pause to verify clear tumour margins
- B Regulatory pathways that inhibit or modulate immune responses
- C A blood test that monitors a patient's lab values during therapy
- D A scheduled interruption between chemotherapy cycles
Correct answer: Regulatory pathways that inhibit or modulate immune responses
Immune checkpoints are inhibitory pathways in the immune system that maintain self-tolerance and modulate immune response; cancer cells can exploit them to evade immune attack.
One major difference between targeted therapy and traditional chemotherapy is:
- A Targeted therapy affects healthy and cancer cells to an equal degree
- B Chemotherapy generally produces fewer side-effects than targeted therapy
- C Targeted therapy acts on specific molecular abnormalities in cancer cells
- D Chemotherapy is largely free of acquired drug resistance
Correct answer: Targeted therapy acts on specific molecular abnormalities in cancer cells
Targeted therapy is designed to affect specific molecular abnormalities associated with the cancer, whereas chemotherapy is less selective.
Targeted therapy may fail over time due to:
- A Increased stability of the target protein over time
- B The cancer carrying no driver mutations at all
- C Resistance via secondary mutations or alternative signalling pathways
- D Rapid and complete cure in most treated patients
Correct answer: Resistance via secondary mutations or alternative signalling pathways
One limitation of targeted therapy is that cancer cells may develop resistance by activating alternative pathways or mutating the target, reducing long-term efficacy.
Which of the following statements about immunotherapy is accurate?
- A It produces immediate tumour shrinkage in nearly all patients
- B It works mainly by directly damaging tumour-cell DNA
- C It may take longer to show clinical benefit than chemotherapy
- D It rarely produces any clinically important side-effects
Correct answer: It may take longer to show clinical benefit than chemotherapy
Immunotherapy often takes time because the immune system needs to mount an effective response; benefits may appear later compared to rapid cytotoxic effects of chemotherapy.
Which of the following best characterises a targeted therapy’s side-effect profile compared to chemotherapy?
- A It reliably produces no side-effects of any kind
- B It causes side-effects identical to those of chemotherapy
- C It often causes fewer off-target effects but real target-related toxicities
- D It causes only hair loss without any internal-organ effects
Correct answer: It often causes fewer off-target effects but real target-related toxicities
Targeted therapies often spare many normal rapidly-dividing cells compared with chemotherapy, resulting in fewer general side-effects; however, they can still cause serious toxicities especially if the target is also present in normal tissue.