OCC Patient Assessment & Monitoring 3 — Questions and Answers
Question 1: A nurse is assessing a patient 10 days after initiation of a myelosuppressive chemotherapy regimen. Which symptom requires the most urgent intervention?
- Mild fatigue and decreased appetite
- Oral temperature of 38.5°C (101.3°F) (Correct answer)
- Grade 1 alopecia noted on scalp
- Mild constipation unrelieved by stool softeners
Correct answer: Oral temperature of 38.5°C (101.3°F)
Fever during the nadir period (days 7–14) is a medical emergency suggesting febrile neutropenia and requires immediate blood cultures, CBC, and broad-spectrum antibiotics.
Question 2: Which assessment finding in a patient receiving bevacizumab (Avastin) should be reported immediately to the oncologist?
- Grade 1 hypertension managed with oral antihypertensives
- Sudden severe headache with neurological changes (Correct answer)
- Mild proteinuria on dipstick urinalysis
- Fatigue rated 4/10 by the patient
Correct answer: Sudden severe headache with neurological changes
Sudden severe headache with neurological changes in a patient on bevacizumab may indicate hypertensive crisis or intracranial hemorrhage, a rare but life-threatening complication.
Question 3: A patient receiving anthracycline-based chemotherapy is scheduled for cycle 5. The nurse notes the cumulative doxorubicin dose is approaching 450 mg/m². What assessment is most critical?
- Pulmonary function testing to detect bleomycin toxicity
- Echocardiogram or MUGA scan to assess cardiac function (Correct answer)
- Bone marrow biopsy to evaluate myelosuppression
- Liver biopsy to assess hepatotoxicity
Correct answer: Echocardiogram or MUGA scan to assess cardiac function
Anthracyclines like doxorubicin cause cumulative cardiotoxicity; cardiac function must be assessed via echocardiogram or MUGA scan before exceeding lifetime dose thresholds.
Question 4: A patient on ifosfamide therapy reports hematuria and painful urination. Which targeted assessment finding confirms the suspected complication?
- Positive urinalysis for leukocyte esterase and nitrites
- Gross blood in urine with negative urine culture (Correct answer)
- Elevated serum creatinine with flank pain
- Urine specific gravity >1.030 with dysuria
Correct answer: Gross blood in urine with negative urine culture
Ifosfamide metabolizes to acrolein, which causes hemorrhagic cystitis presenting as gross hematuria with a negative urine culture, distinguishing it from infectious causes.
Question 5: When evaluating pain in oncology patients, which assessment approach best aligns with evidence-based practice?
- Assess pain only when the patient verbally reports discomfort
- Use a standardized tool and reassess within 30–60 minutes after intervention (Correct answer)
- Document pain as the fifth vital sign without reassessment
- Rely primarily on behavioral observation rather than self-report
Correct answer: Use a standardized tool and reassess within 30–60 minutes after intervention
Best practice requires using a validated pain scale, administering the intervention, and reassessing within 30–60 minutes to evaluate efficacy and guide further management.
Question 6: A nurse is monitoring a patient for capecitabine-related hand-foot syndrome (palmar-plantar erythrodysesthesia). Which Grade 3 finding warrants dose modification?
- Mild redness without pain affecting daily activities
- Blistering, ulceration, or severe pain preventing ambulation (Correct answer)
- Dry skin with mild peeling and minimal discomfort
- Moderate erythema with swelling but intact skin
Correct answer: Blistering, ulceration, or severe pain preventing ambulation
Grade 3 hand-foot syndrome includes blistering, ulceration, or severe pain that prevents normal activity and requires chemotherapy dose reduction or interruption.
Question 7: Which nutritional assessment parameter is most sensitive for detecting early malnutrition in chemotherapy patients?
- Body mass index (BMI) below 18.5
- Unintentional weight loss of >5% in one month (Correct answer)
- Serum albumin level below 3.5 g/dL
- Total lymphocyte count below 1500 cells/mm³
Correct answer: Unintentional weight loss of >5% in one month
Unintentional weight loss of >5% in one month is the most sensitive early indicator of malnutrition and nutritional risk in cancer patients receiving chemotherapy.
OCC Patient Assessment & Monitoring 3
A nurse is assessing a patient 10 days after initiation of a myelosuppressive chemotherapy regimen.
Which symptom requires the most urgent intervention?