OCN Oncologic Emergencies 1 — Questions and Answers
Question 1: A patient with small cell lung cancer presents with facial swelling, venous distension of the neck and chest, and dyspnea. This presentation is most consistent with:
- Cardiac tamponade
- Superior vena cava (SVC) syndrome (Correct answer)
- Pulmonary embolism
- Tension pneumothorax
Correct answer: Superior vena cava (SVC) syndrome
SVC syndrome is caused by obstruction of the SVC, commonly by mediastinal tumors, leading to facial edema, neck vein distension, and dyspnea.
Question 2: Tumor lysis syndrome (TLS) is most likely to occur in which cancer type?
- Slow-growing solid tumors
- Highly proliferative tumors such as Burkitt lymphoma or ALL (Correct answer)
- Hormone-sensitive breast cancer
- Well-differentiated thyroid cancer
Correct answer: Highly proliferative tumors such as Burkitt lymphoma or ALL
TLS most commonly occurs with highly proliferative hematologic malignancies like Burkitt lymphoma or ALL due to rapid cell lysis releasing intracellular contents.
Question 3: Which laboratory finding is NOT consistent with tumor lysis syndrome?
- Hyperkalemia
- Hyperphosphatemia
- Hypercalcemia (Correct answer)
- Hyperuricemia
Correct answer: Hypercalcemia
TLS causes hypocalcemia (not hypercalcemia) because phosphate released from lysed cells binds calcium, lowering serum levels.
Question 4: A patient with multiple myeloma presents with confusion, polyuria, and constipation. Serum calcium is 13.5 mg/dL. The priority nursing intervention is:
- Administer IV bisphosphonates immediately
- Initiate aggressive IV hydration with normal saline (Correct answer)
- Restrict fluid intake
- Administer oral calcium supplements
Correct answer: Initiate aggressive IV hydration with normal saline
Aggressive IV hydration with normal saline is the first-line treatment for hypercalcemia of malignancy to dilute calcium and promote renal excretion.
Question 5: Spinal cord compression in oncology patients most commonly presents initially with:
- Bowel and bladder incontinence
- Back pain (Correct answer)
- Complete paralysis
- Sensory loss only
Correct answer: Back pain
Back pain is the earliest and most common presenting symptom of malignant spinal cord compression, often preceding neurologic deficits.
Question 6: Which treatment is the immediate priority for a patient with confirmed malignant spinal cord compression?
- Surgical decompression
- High-dose corticosteroids (dexamethasone) (Correct answer)
- Radiation therapy
- Chemotherapy
Correct answer: High-dose corticosteroids (dexamethasone)
High-dose dexamethasone is given immediately to reduce spinal cord edema while definitive treatment (radiation or surgery) is arranged.
OCN Oncologic Emergencies 1
A patient with small cell lung cancer presents with facial swelling, venous distension of the neck and chest, and dyspnea.
This presentation is most consistent with: