OCC OCC Oncology Emergencies & Complications 2 — Questions and Answers
Question 1: A patient with multiple myeloma develops confusion, polyuria, constipation, and a serum calcium of 13.5 mg/dL. What is the initial treatment priority?
- Administer oral calcium supplements to correct the imbalance
- Begin aggressive IV normal saline hydration to promote calciuresis (Correct answer)
- Administer loop diuretics without IV fluids
- Initiate bisphosphonate therapy as the first intervention
Correct answer: Begin aggressive IV normal saline hydration to promote calciuresis
Aggressive IV hydration with normal saline is the first-line treatment for hypercalcemia of malignancy, promoting renal calcium excretion before adding bisphosphonates.
Question 2: Which chemotherapy agent is MOST associated with anaphylaxis during infusion, requiring premedication?
- Fluorouracil
- Paclitaxel (Correct answer)
- Methotrexate
- Ifosfamide
Correct answer: Paclitaxel
Paclitaxel, formulated in Cremophor EL, frequently causes hypersensitivity reactions and requires premedication with corticosteroids, diphenhydramine, and H2 blockers.
Question 3: A patient with lung cancer on opioids develops progressive confusion, hyperreflexia, and seizures. Labs show serum sodium of 118 mEq/L. What is occurring?
- Hypercalcemia of malignancy
- Syndrome of inappropriate antidiuretic hormone (SIADH) (Correct answer)
- Tumor lysis syndrome
- Opioid toxicity
Correct answer: Syndrome of inappropriate antidiuretic hormone (SIADH)
SIADH causes dilutional hyponatremia with neurological manifestations; it is common in small cell lung cancer due to ectopic ADH secretion.
Question 4: What is the nurse's FIRST action when a patient on chemotherapy develops signs of anaphylaxis (urticaria, bronchospasm, hypotension)?
- Slow the infusion rate and administer diphenhydramine
- Stop the infusion immediately, call for help, and prepare epinephrine (Correct answer)
- Administer corticosteroids IV and observe for 15 minutes
- Document the reaction and notify the provider after stabilizing the patient
Correct answer: Stop the infusion immediately, call for help, and prepare epinephrine
Anaphylaxis is a life-threatening emergency requiring immediate infusion cessation, activation of emergency response, and administration of epinephrine.
Question 5: A patient with prostate cancer metastatic to the spine develops sudden onset of lower extremity weakness and urinary retention. What emergency should the nurse suspect?
- Leptomeningeal carcinomatosis
- Spinal cord compression from epidural metastasis (Correct answer)
- Deep vein thrombosis
- Chemotherapy-induced peripheral neuropathy
Correct answer: Spinal cord compression from epidural metastasis
New neurological deficits and urinary retention in a cancer patient with spinal metastases indicate malignant spinal cord compression, a neurological emergency requiring immediate intervention.
Question 6: Which finding indicates a patient with cancer-associated hypercoagulability has developed a pulmonary embolism (PE)?
- Gradual onset of bilateral leg edema over 3 days
- Sudden dyspnea, pleuritic chest pain, and tachycardia (Correct answer)
- Fever and productive cough with purulent sputum
- Abdominal pain and flank tenderness
Correct answer: Sudden dyspnea, pleuritic chest pain, and tachycardia
Sudden dyspnea, pleuritic chest pain, and tachycardia are the classic triad of pulmonary embolism, a common life-threatening complication in cancer patients due to hypercoagulability.
OCC OCC Oncology Emergencies & Complications 2
A patient with multiple myeloma develops confusion, polyuria, constipation, and a serum calcium of 13.5 mg/dL.
What is the initial treatment priority?