AOCNP Oncologic Emergencies 5

Question 1

A patient with lymphoma undergoing induction chemotherapy develops rising creatinine, oliguria, and uric acid of 12 mg/dL. Allopurinol was started 24 hours ago. Which agent should be added to address established hyperuricemia?

Accepted Answer

Rasburicase

Answer

Rasburicase is a recombinant urate oxidase that rapidly converts existing uric acid to allantoin (a soluble metabolite) and is preferred when hyperuricemia is already established, unlike allopurinol which only prevents new formation.

Question 2

Superior vena cava (SVC) syndrome with acute airway compromise and cerebral edema should be treated FIRST with which intervention?

Accepted Answer

Emergent SVC stenting or radiation therapy

Answer

Emergent endovascular SVC stenting provides the fastest relief of obstruction and is preferred for acute life-threatening SVC syndrome; radiation may follow once airway is stabilized.

Question 3

A patient with multiple myeloma develops acute flaccid paraplegia with urinary retention. MRI shows vertebral compression at T6 with epidural extension. Surgical evaluation is obtained. What is the PRIMARY factor determining eligibility for surgical decompression over radiation alone?

Accepted Answer

Patient's overall performance status and life expectancy

Answer

Patient performance status and prognosis (expected survival >3 months) are the primary determinants of whether surgical decompression is appropriate, as surgery offers no benefit to patients who cannot tolerate the procedure or have very limited life expectancy.

Question 4

Which statement about neutropenic enterocolitis (typhlitis) in oncology patients is CORRECT?

Accepted Answer

CT scan showing bowel wall thickening ≥4 mm supports the diagnosis

Answer

CT findings of bowel wall thickening ≥4 mm (particularly of the cecum/right colon) combined with neutropenia and abdominal pain support the diagnosis of typhlitis; initial management is usually conservative with bowel rest and broad-spectrum IV antibiotics.

Question 5

A patient with SCLC and SIADH has a serum sodium of 115 mEq/L with severe neurological symptoms (seizures). What is the appropriate rate of sodium correction?

Accepted Answer

Increase sodium by no more than 8-10 mEq/L per 24 hours

Answer

The safe rate of sodium correction is ≤8-10 mEq/L per 24 hours (up to 1-2 mEq/L/hr in acute symptomatic cases) to prevent osmotic demyelination syndrome while managing neurological symptoms.

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP Oncologic Emergencies 5