OCN OCN General 3 — Questions and Answers
Question 1: A patient receiving doxorubicin reports shortness of breath and a new nonproductive cough. Which complication should the nurse suspect first?
- Pulmonary embolism
- Cardiotoxicity with heart failure (Correct answer)
- Anaphylaxis
- Pneumonia from neutropenia
Correct answer: Cardiotoxicity with heart failure
Doxorubicin causes cumulative dose-dependent cardiotoxicity that can lead to dilated cardiomyopathy and heart failure, presenting with dyspnea and cough.
Question 2: Which assessment finding in a patient with cancer indicates hypercalcemia of malignancy requiring urgent intervention?
- Serum calcium of 9.0 mg/dL with muscle cramps
- Serum calcium of 13.5 mg/dL with confusion and polyuria (Correct answer)
- Serum calcium of 10.1 mg/dL with mild fatigue
- Serum calcium of 8.8 mg/dL with paresthesias
Correct answer: Serum calcium of 13.5 mg/dL with confusion and polyuria
A serum calcium above 12 mg/dL with neurological symptoms (confusion) and polyuria represents severe hypercalcemia of malignancy requiring urgent IV hydration and bisphosphonate therapy.
Question 3: The nurse is assessing oral mucositis in a chemotherapy patient using the NCI grading scale. Which finding corresponds to Grade 3 mucositis?
- Asymptomatic with mild erythema
- Symptomatic but able to eat a modified diet
- Severe symptoms preventing adequate oral intake (Correct answer)
- Life-threatening requiring urgent intervention
Correct answer: Severe symptoms preventing adequate oral intake
NCI Grade 3 mucositis is characterized by severe symptoms that prevent adequate oral intake, requiring enteral or parenteral nutritional support.
Question 4: A cancer patient is receiving high-dose methotrexate. What is the primary antidote used to rescue normal cells?
- Mesna
- Leucovorin (folinic acid) (Correct answer)
- Amifostine
- Dexrazoxane
Correct answer: Leucovorin (folinic acid)
Leucovorin (folinic acid) rescue bypasses the dihydrofolate reductase blockade caused by methotrexate, protecting normal cells from folate depletion toxicity.
Question 5: Which type of cancer is most strongly associated with the Philadelphia chromosome (BCR-ABL translocation)?
- Acute myeloid leukemia (AML)
- Chronic myeloid leukemia (CML) (Correct answer)
- Hodgkin lymphoma
- Multiple myeloma
Correct answer: Chronic myeloid leukemia (CML)
The Philadelphia chromosome (translocation between chromosomes 9 and 22) creating the BCR-ABL fusion gene is the hallmark of chronic myeloid leukemia.
Question 6: When a patient with cancer develops spinal cord compression, which symptom requires the most urgent nursing assessment?
- Mild low back pain rated 3/10
- New onset urinary or bowel incontinence with back pain (Correct answer)
- Fatigue and generalized weakness
- Nausea and decreased appetite
Correct answer: New onset urinary or bowel incontinence with back pain
New bowel or bladder dysfunction combined with back pain signals potential spinal cord compression, an oncologic emergency requiring immediate imaging and intervention to prevent permanent paralysis.
Question 7: A patient receiving bevacizumab (a VEGF inhibitor) should be monitored most closely for which specific complication?
- Peripheral neuropathy
- Hypertension and wound healing impairment (Correct answer)
- Prolonged QT interval
- Severe ototoxicity
Correct answer: Hypertension and wound healing impairment
Bevacizumab inhibits vascular endothelial growth factor, leading to hypertension, impaired wound healing, and risk of arterial thromboembolism or GI perforation.
OCN OCN General 3
A patient receiving doxorubicin reports shortness of breath and a new nonproductive cough.
Which complication should the nurse suspect first?