OCC Patient Assessment & Monitoring 2 — Questions and Answers
Question 1: A patient receiving cisplatin develops tinnitus and decreased hearing. Which assessment action should the oncology nurse prioritize?
- Obtain an audiogram and notify the oncologist (Correct answer)
- Administer antiemetics to relieve associated nausea
- Reassure the patient this is a temporary side effect
- Increase IV fluid rate to promote renal clearance
Correct answer: Obtain an audiogram and notify the oncologist
Cisplatin is ototoxic, and new tinnitus or hearing changes require audiometric evaluation and immediate oncologist notification to consider dose modification.
Question 2: When assessing a patient's performance status before initiating chemotherapy, which tool uses a 0–4 scale where 0 indicates fully active?
- Karnofsky Performance Scale
- ECOG Performance Status (Correct answer)
- Functional Assessment of Cancer Therapy (FACT)
- Edmonton Symptom Assessment Scale
Correct answer: ECOG Performance Status
The ECOG (Eastern Cooperative Oncology Group) Performance Status scale ranges from 0 (fully active) to 4 (completely disabled), guiding chemotherapy eligibility decisions.
Question 3: A patient on methotrexate presents with a serum creatinine that has doubled from baseline. What is the nurse's primary concern?
- Increased risk of peripheral neuropathy
- Delayed methotrexate clearance and toxicity accumulation (Correct answer)
- Reduced efficacy of the chemotherapy regimen
- Hypokalemia from proximal tubular damage
Correct answer: Delayed methotrexate clearance and toxicity accumulation
Methotrexate is renally cleared, so impaired kidney function delays drug elimination and significantly increases the risk of severe toxicity including mucositis and myelosuppression.
Question 4: Which electrolyte imbalance is most commonly monitored in patients receiving oxaliplatin-based chemotherapy?
- Hyperkalemia
- Hypomagnesemia (Correct answer)
- Hypernatremia
- Hypercalcemia
Correct answer: Hypomagnesemia
Oxaliplatin-based regimens commonly cause hypomagnesemia, which must be monitored and corrected to prevent neuromuscular and cardiac complications.
Question 5: During a physical assessment, a nurse notices a patient on paclitaxel has absent deep tendon reflexes in bilateral lower extremities. This finding most likely indicates:
- Spinal cord compression requiring urgent imaging
- Taxane-induced peripheral neuropathy (Correct answer)
- Electrolyte imbalance secondary to vomiting
- Paraneoplastic syndrome progression
Correct answer: Taxane-induced peripheral neuropathy
Absent deep tendon reflexes are a classic sign of peripheral neuropathy, a dose-limiting toxicity of paclitaxel and other taxanes.
Question 6: A patient's absolute neutrophil count (ANC) is 450 cells/mm³ before the scheduled chemotherapy infusion. What is the most appropriate action?
- Administer chemotherapy as scheduled with close monitoring
- Hold chemotherapy and notify the oncologist per protocol (Correct answer)
- Administer G-CSF and proceed with the infusion
- Reduce the chemotherapy dose by 25% and administer
Correct answer: Hold chemotherapy and notify the oncologist per protocol
An ANC below 500 cells/mm³ typically meets the threshold to hold chemotherapy; the oncologist must be notified to determine the appropriate plan.
Question 7: When monitoring a patient for tumor lysis syndrome after initiating chemotherapy, which laboratory combination is most consistent with this complication?
- Hypernatremia, hypokalemia, hypocalcemia, low uric acid
- Hyperkalemia, hyperphosphatemia, hypocalcemia, elevated uric acid (Correct answer)
- Hypokalemia, hypophosphatemia, hypercalcemia, elevated creatinine
- Hyponatremia, hyperkalemia, hypermagnesemia, low phosphorus
Correct answer: Hyperkalemia, hyperphosphatemia, hypocalcemia, elevated uric acid
Tumor lysis syndrome classically presents with hyperkalemia, hyperphosphatemia, hypocalcemia, and elevated uric acid due to massive cell destruction releasing intracellular contents.
OCC Patient Assessment & Monitoring 2
A patient receiving cisplatin develops tinnitus and decreased hearing.
Which assessment action should the oncology nurse prioritize?