OCC OCC Oncology Emergencies & Complications 1 — Questions and Answers
Question 1: A patient 48 hours post-chemotherapy develops fever of 101.5°F, chills, and an ANC of 300/mm³. What is the nurse's IMMEDIATE priority?
- Administer acetaminophen and reassess in 2 hours
- Obtain blood cultures and initiate broad-spectrum antibiotics within 60 minutes per protocol (Correct answer)
- Isolate the patient and await the provider's morning rounds
- Increase oral fluid intake and monitor temperature every 4 hours
Correct answer: Obtain blood cultures and initiate broad-spectrum antibiotics within 60 minutes per protocol
Febrile neutropenia is a life-threatening emergency; blood cultures must be obtained and broad-spectrum antibiotics initiated within 60 minutes of fever onset.
Question 2: Which clinical findings are characteristic of superior vena cava (SVC) syndrome in an oncology patient?
- Hypotension, bradycardia, and peripheral edema
- Facial plethora, upper extremity edema, and distended neck veins (Correct answer)
- Severe hypercalcemia, constipation, and confusion
- Bilateral leg edema and dyspnea on exertion
Correct answer: Facial plethora, upper extremity edema, and distended neck veins
SVC syndrome presents with facial plethora, upper extremity and facial edema, and distended neck veins due to obstruction of venous return from the upper body.
Question 3: A patient undergoing aggressive chemotherapy for leukemia develops hyperkalemia, hyperphosphatemia, hypocalcemia, and elevated uric acid. What syndrome is occurring?
- Hypercalcemia of malignancy
- Tumor lysis syndrome (Correct answer)
- Disseminated intravascular coagulation
- Syndrome of inappropriate antidiuretic hormone
Correct answer: Tumor lysis syndrome
Tumor lysis syndrome results from rapid destruction of cancer cells releasing intracellular contents, causing the classic electrolyte pattern of hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia.
Question 4: Which intervention is the MOST critical in preventing tumor lysis syndrome in high-risk patients?
- Restricting dietary potassium
- Aggressive IV hydration and allopurinol or rasburicase administration before chemotherapy (Correct answer)
- Administering calcium gluconate prophylactically
- Placing the patient on continuous telemetry only
Correct answer: Aggressive IV hydration and allopurinol or rasburicase administration before chemotherapy
Aggressive IV hydration dilutes metabolites and promotes renal excretion, while allopurinol or rasburicase prevents uric acid accumulation before chemotherapy initiation.
Question 5: A cancer patient on opioids and vincristine develops abdominal distension, absence of bowel sounds, and no bowel movement in 5 days. What complication is suspected?
- Ileus/bowel obstruction from vincristine-induced neurotoxicity (Correct answer)
- Chemotherapy-induced diarrhea
- Bowel perforation
- Peritoneal carcinomatosis
Correct answer: Ileus/bowel obstruction from vincristine-induced neurotoxicity
Vincristine causes autonomic neuropathy leading to paralytic ileus, particularly when combined with opioids, presenting with absent bowel sounds and obstipation.
Question 6: A patient receiving high-dose cyclophosphamide reports severe bladder pain, urinary frequency, and grossly bloody urine. What complication has occurred?
- Urinary tract infection
- Hemorrhagic cystitis from acrolein metabolite accumulation (Correct answer)
- Renal failure from drug nephrotoxicity
- Bladder cancer as a late effect
Correct answer: Hemorrhagic cystitis from acrolein metabolite accumulation
Hemorrhagic cystitis is caused by acrolein, a toxic metabolite of cyclophosphamide that accumulates in the bladder, causing mucosal damage and bleeding.
OCC OCC Oncology Emergencies & Complications 1
A patient 48 hours post-chemotherapy develops fever of 101.5°F, chills, and an ANC of 300/mm³.
What is the nurse's IMMEDIATE priority?