OCN Oncologic Emergencies 2 — Questions and Answers
Question 1: Neutropenic fever in a cancer patient is defined as a single oral temperature ≥38.3°C (101°F) or ≥38°C (100.4°F) for 1 hour AND an ANC of:
- < 1500 cells/mm³
- < 1000 cells/mm³
- < 500 cells/mm³ (Correct answer)
- < 100 cells/mm³
Correct answer: < 500 cells/mm³
IDSA guidelines define neutropenic fever as fever with an ANC <500 cells/mm³, or <1000 cells/mm³ with expected decline to <500.
Question 2: A neutropenic patient with fever should receive empiric broad-spectrum antibiotics within:
- 6 hours of presentation
- 4 hours of presentation
- 1 hour of presentation (Correct answer)
- 24 hours of presentation
Correct answer: 1 hour of presentation
Current guidelines recommend initiating empiric IV antibiotics within 1 hour of presentation in febrile neutropenia to reduce morbidity and mortality.
Question 3: Disseminated intravascular coagulation (DIC) in cancer is most commonly associated with which malignancy?
- Chronic lymphocytic leukemia
- Acute promyelocytic leukemia (APL) (Correct answer)
- Multiple myeloma
- Breast cancer
Correct answer: Acute promyelocytic leukemia (APL)
APL (AML-M3) is classically associated with DIC due to release of procoagulant granules from malignant promyelocytes.
Question 4: A patient with known lung cancer develops distant heart sounds, jugular venous distension, and hypotension. The nurse suspects:
- Pulmonary embolism
- Cardiac tamponade (Correct answer)
- Myocardial infarction
- Heart failure exacerbation
Correct answer: Cardiac tamponade
Beck's triad (muffled heart sounds, JVD, hypotension) is classic for cardiac tamponade, which can result from malignant pericardial effusion.
Question 5: Which of the following best prevents tumor lysis syndrome in high-risk patients starting chemotherapy?
- Restricting IV fluids to prevent fluid overload
- Allopurinol or rasburicase plus aggressive IV hydration (Correct answer)
- Prophylactic potassium supplementation
- Immediate plasmapheresis
Correct answer: Allopurinol or rasburicase plus aggressive IV hydration
Allopurinol (or rasburicase for very high-risk cases) combined with aggressive IV hydration is the standard prophylaxis for TLS in high-risk patients.
Question 6: Hyperviscosity syndrome is most commonly associated with which cancer?
- Colon cancer
- Waldenström macroglobulinemia or multiple myeloma (Correct answer)
- Pancreatic cancer
- Cervical cancer
Correct answer: Waldenström macroglobulinemia or multiple myeloma
Hyperviscosity syndrome results from excess paraproteins (IgM in Waldenström, or IgG/IgA in myeloma) thickening the blood and impairing flow.
OCN Oncologic Emergencies 2
Neutropenic fever in a cancer patient is defined as a single oral temperature ≥38.3°C (101°F) or ≥38°C (100.4°F) for 1 hour AND an ANC of: