OCC Patient Assessment & Monitoring 1 — Questions and Answers

Question 1: Before starting chemotherapy, which baseline assessment is most critical?

Liver function tests
Electrocardiogram
Complete blood count (CBC) (Correct answer)
Urinalysis

Correct answer: Complete blood count (CBC)

A Complete Blood Count (CBC) is the most critical baseline assessment before chemotherapy because many chemotherapy drugs are myelosuppressive, meaning they can suppress bone marrow function. This assessment provides vital information about the patient's white blood cells, red blood cells, and platelets, which helps determine if the patient can safely receive treatment and guides dose adjustments.

Question 2: Which symptom requires immediate attention during chemotherapy infusion?

Fatigue
Shortness of breath (Correct answer)
Mild nausea
Loss of appetite

Correct answer: Shortness of breath

Shortness of breath during chemotherapy infusion can indicate a serious adverse reaction, such as an allergic reaction, pulmonary toxicity, or fluid overload, which requires immediate medical intervention. While fatigue, mild nausea, and loss of appetite are common side effects, shortness of breath signals a potentially life-threatening emergency that demands prompt assessment and action.

Question 3: What should be closely monitored in a patient receiving high-dose methotrexate?

Vision changes
Renal function (Correct answer)
Hearing loss
Weight gain

Correct answer: Renal function

High-dose methotrexate is primarily excreted by the kidneys, making renal function monitoring absolutely critical to prevent severe toxicity. Impaired kidney function can lead to delayed drug clearance, resulting in dangerously high methotrexate levels. These elevated levels can cause severe myelosuppression, mucositis, and liver damage, necessitating careful monitoring.

Question 4: A patient on chemotherapy reports a fever of 101.5°F. What should the nurse do first?

Administer acetaminophen
Encourage fluid intake
Notify the healthcare provider (Correct answer)
Apply cooling blankets

Correct answer: Notify the healthcare provider

A fever in a chemotherapy patient, especially one over 100.4°F (38°C), is a medical emergency and should be treated as neutropenic fever until proven otherwise. The nurse's first action must be to notify the healthcare provider immediately. Prompt evaluation and initiation of broad-spectrum antibiotics are crucial to prevent life-threatening sepsis in these immunocompromised patients.

Question 5: Which lab value is most concerning in a chemotherapy patient?

Platelet count of 150,000/mm³
Hemoglobin of 11 g/dL
Absolute neutrophil count (ANC) of 400 (Correct answer)
White blood cell count of 5,000/mm³

Correct answer: Absolute neutrophil count (ANC) of 400

An Absolute Neutrophil Count (ANC) of 400 (or 0.4 x 10^9/L) indicates severe neutropenia, a critical side effect of chemotherapy that significantly compromises the patient's immune system. This level puts the patient at extreme risk for serious, life-threatening infections. It requires immediate medical attention and protective measures to prevent complications.

Question 6: Why is regular oral assessment important during chemotherapy?

To evaluate hydration status
To detect signs of mucositis (Correct answer)
To check for tooth decay
To assess speech clarity

Correct answer: To detect signs of mucositis

Regular oral assessment is crucial during chemotherapy because many agents cause mucositis, an inflammation and ulceration of the mucous membranes lining the digestive tract, including the mouth. Early detection allows for timely interventions to manage pain, prevent infection, and maintain nutritional intake. This significantly improves patient comfort and outcomes.

OCC Patient Assessment & Monitoring 1

Before starting chemotherapy, which baseline assessment is most critical?