OCN OCN General 5 — Questions and Answers
Question 1: A patient with non-Hodgkin lymphoma is receiving rituximab. Which pre-infusion assessment finding should cause the nurse to withhold the drug and notify the provider?
- Blood pressure of 118/76 mmHg
- Temperature of 37.8°C (100°F) with suspected active infection (Correct answer)
- Heart rate of 82 beats per minute
- Serum creatinine of 0.9 mg/dL
Correct answer: Temperature of 37.8°C (100°F) with suspected active infection
Rituximab can cause fatal infusion reactions and reactivation of infections; active infection warrants holding the drug and consulting the oncologist before proceeding.
Question 2: Which clinical feature differentiates superior vena cava (SVC) syndrome from other oncologic emergencies?
- Severe lower extremity edema and ascites
- Facial and upper extremity edema, venous distension of the neck and chest, and dyspnea (Correct answer)
- Sudden onset chest pain radiating to the jaw
- Bilateral lower extremity weakness with saddle anesthesia
Correct answer: Facial and upper extremity edema, venous distension of the neck and chest, and dyspnea
SVC syndrome presents with facial/arm edema, visible chest and neck vein distension, and dyspnea due to obstruction of venous return from the upper body to the right atrium.
Question 3: A patient's caregiver asks about the purpose of a 'nadir' blood count check after chemotherapy. The nurse's best explanation is:
- It checks for drug resistance to predict the next cycle dose
- It identifies the point of lowest bone marrow function to monitor for infection and bleeding risk (Correct answer)
- It measures tumor marker levels to assess treatment response
- It determines when the patient can resume a normal diet
Correct answer: It identifies the point of lowest bone marrow function to monitor for infection and bleeding risk
The nadir is the lowest point of blood cell counts after chemotherapy (typically 7–14 days), representing the period of greatest vulnerability to infection and bleeding complications.
Question 4: When caring for a patient with malignant pleural effusion, which intervention provides the most immediate relief of dyspnea?
- Administering a diuretic such as furosemide
- Positioning in high Fowler's and assisting with thoracentesis (Correct answer)
- Applying supplemental oxygen via nasal cannula at 2 L/min
- Encouraging incentive spirometry every hour
Correct answer: Positioning in high Fowler's and assisting with thoracentesis
Thoracentesis to drain the effusion provides immediate relief of dyspnea by re-expanding the compressed lung; high Fowler's positioning aids breathing while preparing for the procedure.
Question 5: A patient undergoing allogeneic stem cell transplant develops a skin rash, profuse diarrhea, and elevated bilirubin. The nurse recognizes these as signs of:
- Cytomegalovirus (CMV) reactivation
- Graft-versus-host disease (GVHD) (Correct answer)
- Veno-occlusive disease of the liver
- Engraftment syndrome
Correct answer: Graft-versus-host disease (GVHD)
The classic triad of skin rash, diarrhea, and liver dysfunction (elevated bilirubin) in an allogeneic transplant recipient indicates acute graft-versus-host disease caused by donor T-cells attacking host tissues.
Question 6: Which nursing intervention best supports a patient's autonomy during the informed consent process for a clinical trial?
- Telling the patient to trust the oncologist's recommendation
- Ensuring the patient has adequate time to ask questions and understands they may withdraw at any time (Correct answer)
- Witnessing the signature promptly to avoid treatment delays
- Explaining only the benefits to encourage enrollment
Correct answer: Ensuring the patient has adequate time to ask questions and understands they may withdraw at any time
True informed consent requires that patients fully understand risks, benefits, and alternatives and know they can withdraw without penalty; the nurse's role is to ensure comprehension and protect autonomy.
Question 7: A patient with advanced cancer has a DNR order. They develop a bowel obstruction and severe pain. What is the nurse's priority action?
- Withhold all medications since resuscitation is not desired
- Focus on aggressive symptom management and comfort measures (Correct answer)
- Contact surgery to reverse the obstruction despite the DNR
- Notify the family and await further orders before acting
Correct answer: Focus on aggressive symptom management and comfort measures
A DNR order applies only to cardiopulmonary resuscitation; all other treatments, especially aggressive pain and symptom management, remain appropriate and are the priority in palliative care.
OCN OCN General 5
A patient with non-Hodgkin lymphoma is receiving rituximab.
Which pre-infusion assessment finding should cause the nurse to withhold the drug and notify the provider?