COCN COCN Oncologic Emergencies 2 — Questions and Answers
Question 1: The first-line pharmacologic treatment for malignant hypercalcemia, after IV hydration, is:
- Oral bisphosphonates
- IV zoledronic acid or pamidronate (Correct answer)
- Furosemide alone
- Calcitonin alone for sustained correction
Correct answer: IV zoledronic acid or pamidronate
IV bisphosphonates (zoledronic acid or pamidronate) are the drugs of choice for sustained lowering of serum calcium in malignancy.
Question 2: Which medication is the cornerstone of initial treatment for malignant spinal cord compression?
- Morphine sulfate
- High-dose corticosteroids (dexamethasone) (Correct answer)
- Warfarin
- Acetaminophen
Correct answer: High-dose corticosteroids (dexamethasone)
High-dose dexamethasone reduces perilesional edema, preserving neurologic function while definitive treatment is arranged.
Question 3: A patient develops syndrome of inappropriate antidiuretic hormone (SIADH) secondary to small cell lung cancer. The primary nursing concern is:
- Hypernatremia management
- Hyponatremia and fluid restriction (Correct answer)
- Hyperkalemia correction
- Dehydration prevention
Correct answer: Hyponatremia and fluid restriction
SIADH causes dilutional hyponatremia; fluid restriction is the primary treatment to reduce water retention.
Question 4: Which assessment finding indicates worsening cardiac tamponade requiring emergency pericardiocentesis?
- Mild ankle edema
- Increasing pulsus paradoxus (>10 mmHg) with hemodynamic instability (Correct answer)
- Mild tachycardia without blood pressure change
- Isolated JVD without other changes
Correct answer: Increasing pulsus paradoxus (>10 mmHg) with hemodynamic instability
Progressive pulsus paradoxus with hemodynamic compromise indicates critical tamponade physiology requiring immediate drainage.
Question 5: Neutropenic fever in an oncology patient is defined as a single temperature above 38.3°C (101°F) with an ANC below:
- 2000/mm³
- 1500/mm³
- 500/mm³ (Correct answer)
- 250/mm³
Correct answer: 500/mm³
Neutropenic fever requires ANC <500/mm³ (or <1000/mm³ expected to fall), combined with fever, as per IDSA guidelines.
Question 6: A patient with lymphoma develops rapid onset of elevated serum potassium, elevated phosphate, elevated uric acid, and decreased calcium. The nurse recognizes this as:
- Addisonian crisis
- Tumor lysis syndrome (TLS) (Correct answer)
- Hyperparathyroidism
- Septic shock
Correct answer: Tumor lysis syndrome (TLS)
The metabolic tetrad of hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia is diagnostic of tumor lysis syndrome.
COCN COCN Oncologic Emergencies 2
The first-line pharmacologic treatment for malignant hypercalcemia, after IV hydration, is: