AOCNP Hematologic Malignancies 3

Question 1

The CRAB criteria are used to define symptomatic multiple myeloma requiring treatment. What do the letters C-R-A-B represent?

Accepted Answer

Hypercalcemia, Renal insufficiency, Anemia, Bone lesions

Answer

CRAB stands for hyperCalcemia (>11 mg/dL), Renal insufficiency (creatinine >2 mg/dL), Anemia (Hgb <10 g/dL), and Bone lesions — end-organ damage that defines symptomatic myeloma requiring treatment.

Question 2

Which diagnostic test is most sensitive and specific for detecting and quantifying the monoclonal protein (M-protein) in multiple myeloma?

Accepted Answer

Serum protein electrophoresis (SPEP) combined with serum immunofixation electrophoresis (IFE)

Answer

SPEP quantifies the M-protein spike and immunofixation identifies its heavy and light chain type; together they are the gold standard for detecting and characterizing monoclonal immunoglobulins in myeloma.

Question 3

A patient with multiple myeloma develops sudden onset of severe back pain, bilateral lower extremity weakness, and urinary retention. What is the most urgent nursing priority?

Accepted Answer

Recognize spinal cord compression and initiate urgent evaluation with MRI and notify the oncology team immediately

Answer

Spinal cord compression from vertebral involvement is an oncologic emergency in myeloma; immediate MRI and emergent treatment (high-dose corticosteroids, radiation, or surgical decompression) are required to prevent permanent paralysis.

Question 4

Bortezomib is a key agent in multiple myeloma therapy. What is its mechanism of action?

Accepted Answer

Proteasome inhibitor that disrupts protein degradation and induces apoptosis in plasma cells

Answer

Bortezomib inhibits the 26S proteasome, preventing degradation of pro-apoptotic proteins and disrupting signaling pathways in myeloma cells, which are particularly dependent on proteasome function due to high immunoglobulin production.

Question 5

Myelodysplastic syndrome (MDS) is best characterized by which of the following?

Accepted Answer

Peripheral cytopenias with dysplastic morphologic changes in bone marrow cells despite adequate or hypercellular marrow cellularity

Answer

MDS is a clonal stem cell disorder characterized by ineffective hematopoiesis causing peripheral cytopenias, with morphologic dysplasia in ≥1 cell lineage in a normocellular or hypercellular bone marrow (by definition <20% blasts).

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP Hematologic Malignancies 3