ONCC ONCC Hematologic Malignancies 2 — Questions and Answers
Question 1: A patient undergoing induction chemotherapy for acute lymphoblastic leukemia (ALL) develops tumor lysis syndrome. Which electrolyte abnormality combination is expected?
- Hypernatremia, hypercalcemia, hypokalemia
- Hyperkalemia, hyperphosphatemia, hypocalcemia, and elevated uric acid (Correct answer)
- Hypokalemia, hyponatremia, and metabolic alkalosis
- Hypercalcemia, hypophosphatemia, and hypomagnesemia
Correct answer: Hyperkalemia, hyperphosphatemia, hypocalcemia, and elevated uric acid
Tumor lysis syndrome causes hyperkalemia, hyperphosphatemia, hypocalcemia (from phosphate binding), and hyperuricemia as massive cell death releases intracellular contents.
Question 2: Which intervention is the cornerstone of tumor lysis syndrome prevention in high-risk hematologic malignancies?
- Prophylactic platelet transfusions
- Aggressive IV hydration and allopurinol or rasburicase administration (Correct answer)
- Immediate red blood cell transfusion
- Prophylactic broad-spectrum antibiotics
Correct answer: Aggressive IV hydration and allopurinol or rasburicase administration
Vigorous IV hydration promotes renal uric acid and phosphate excretion, while allopurinol or rasburicase reduces uric acid production or degradation, preventing TLS.
Question 3: A patient with multiple myeloma is started on bortezomib. The nurse should educate the patient about which commonly expected side effect?
- Hypertension and edema
- Peripheral neuropathy, fatigue, and thrombocytopenia (Correct answer)
- Severe hepatotoxicity and jaundice
- Pulmonary fibrosis requiring oxygen
Correct answer: Peripheral neuropathy, fatigue, and thrombocytopenia
Bortezomib (a proteasome inhibitor) commonly causes peripheral neuropathy, fatigue, thrombocytopenia, and GI side effects, which patients must be educated to recognize and report.
Question 4: The Ann Arbor staging system is used for which malignancies?
- Breast and colorectal cancer
- Hodgkin and non-Hodgkin lymphoma (Correct answer)
- Acute leukemias
- Multiple myeloma
Correct answer: Hodgkin and non-Hodgkin lymphoma
The Ann Arbor staging system classifies Hodgkin and non-Hodgkin lymphoma by the number and location of lymph node regions involved and presence of extranodal disease.
Question 5: Which finding is most consistent with neutropenic fever in a patient with hematologic malignancy receiving chemotherapy?
- Temperature of 37.5°C (99.5°F) with an ANC of 2,500/µL
- Single oral temperature ≥38.3°C (101°F) or ≥38°C (100.4°F) sustained, with ANC <500/µL (Correct answer)
- Temperature of 39°C with normal ANC and positive blood cultures only
- Chills without fever with ANC of 1,000/µL
Correct answer: Single oral temperature ≥38.3°C (101°F) or ≥38°C (100.4°F) sustained, with ANC <500/µL
Neutropenic fever is defined as a single temperature ≥38.3°C or sustained ≥38°C with ANC <500/µL (or expected to fall below 500), requiring immediate broad-spectrum antibiotics.
Question 6: A patient with chronic lymphocytic leukemia (CLL) asks why they keep getting infections despite having a high white blood cell count. The nurse's best explanation is:
- Their immune system is overactive and attacking normal cells
- CLL cells are functionally defective and do not provide normal immune protection (Correct answer)
- The high WBC is consuming all available nutrients, leaving the immune system depleted
- Infections are caused by the chemotherapy, not the CLL itself
Correct answer: CLL cells are functionally defective and do not provide normal immune protection
In CLL, malignant B lymphocytes are functionally incompetent and crowd out normal immune cells, resulting in hypogammaglobulinemia and immunodeficiency despite elevated WBC.
ONCC ONCC Hematologic Malignancies 2
A patient undergoing induction chemotherapy for acute lymphoblastic leukemia (ALL) develops tumor lysis syndrome.
Which electrolyte abnormality combination is expected?