COCN COCN Oncologic Emergencies 1 — Questions and Answers
Question 1: Superior vena cava (SVC) syndrome is most commonly caused by which malignancy in the United States?
- Colon cancer
- Lung cancer and lymphoma (Correct answer)
- Breast cancer only
- Prostate cancer
Correct answer: Lung cancer and lymphoma
Lung cancer (especially small cell and squamous cell) and lymphoma account for the majority of SVC syndrome cases.
Question 2: A patient with SVC syndrome presents with facial swelling, plethora, and dyspnea. The priority nursing intervention is:
- Position the patient flat with legs elevated
- Elevate the head of the bed to 45 degrees and administer oxygen (Correct answer)
- Restrict IV fluids to prevent fluid overload
- Administer aggressive diuretic therapy immediately
Correct answer: Elevate the head of the bed to 45 degrees and administer oxygen
Elevating the head reduces venous pressure in the upper body and supplemental oxygen addresses hypoxia in SVC syndrome.
Question 3: Spinal cord compression in a cancer patient most commonly presents with which early symptom?
- Complete paralysis
- Bowel and bladder incontinence
- Back pain that worsens with lying down or Valsalva maneuver (Correct answer)
- Sensory loss only
Correct answer: Back pain that worsens with lying down or Valsalva maneuver
Back pain is the earliest and most common presenting symptom of malignant spinal cord compression, often preceding neurologic deficits.
Question 4: Which of the following cancers has the highest incidence of hypercalcemia of malignancy?
- Ovarian cancer
- Squamous cell cancers and multiple myeloma (Correct answer)
- Colorectal cancer
- Bladder cancer
Correct answer: Squamous cell cancers and multiple myeloma
Squamous cell cancers (lung, head and neck) and multiple myeloma most frequently cause hypercalcemia through PTHrP or osteolytic mechanisms.
Question 5: A patient with lung cancer develops pulsus paradoxus, hypotension, and muffled heart sounds. The nurse recognizes this as:
- Congestive heart failure
- Cardiac tamponade (Correct answer)
- Pleural effusion
- Pulmonary embolism
Correct answer: Cardiac tamponade
Beck's triad (hypotension, muffled heart sounds, distended neck veins) plus pulsus paradoxus is classic for cardiac tamponade.
Question 6: Disseminated intravascular coagulation (DIC) in oncology patients is most associated with which malignancy?
- Renal cell carcinoma
- Acute promyelocytic leukemia (APL) (Correct answer)
- Thyroid cancer
- Melanoma
Correct answer: Acute promyelocytic leukemia (APL)
APL releases tissue factor from granules in promyelocytes, triggering the coagulation cascade and causing DIC.
COCN COCN Oncologic Emergencies 1
Superior vena cava (SVC) syndrome is most commonly caused by which malignancy in the United States?