ONCC ONCC Hematologic Malignancies 1 — Questions and Answers
Question 1: A patient with acute myeloid leukemia (AML) has a WBC of 120,000/µL. The nurse should prioritize assessment for which life-threatening complication?
- Tumor lysis syndrome and leukostasis (Correct answer)
- Hyponatremia and fluid overload
- Hypoglycemia and adrenal insufficiency
- Deep vein thrombosis and pulmonary embolism
Correct answer: Tumor lysis syndrome and leukostasis
Extreme leukocytosis in AML can cause leukostasis (vascular sludging) and places patients at high risk for tumor lysis syndrome, both of which are oncologic emergencies.
Question 2: Which laboratory finding is most characteristic of chronic myeloid leukemia (CML)?
- Presence of Reed-Sternberg cells on biopsy
- Philadelphia chromosome (BCR-ABL fusion) detected by cytogenetics or PCR (Correct answer)
- Monoclonal immunoglobulin spike on serum protein electrophoresis
- Hypercalcemia with lytic bone lesions
Correct answer: Philadelphia chromosome (BCR-ABL fusion) detected by cytogenetics or PCR
The Philadelphia chromosome (BCR-ABL translocation) is the hallmark genetic abnormality of CML and is the target of tyrosine kinase inhibitor therapy.
Question 3: A patient with multiple myeloma presents with back pain, fatigue, and a calcium level of 12.5 mg/dL. The nurse recognizes these findings as consistent with:
- Hypocalcemia from bisphosphonate therapy
- The CRAB criteria (hypercalcemia, renal failure, anemia, bone lesions) indicating end-organ damage (Correct answer)
- Side effects of proteasome inhibitor therapy
- Neutropenic fever requiring immediate antibiotics
Correct answer: The CRAB criteria (hypercalcemia, renal failure, anemia, bone lesions) indicating end-organ damage
The CRAB criteria define myeloma-related organ damage: hyperCalcemia, Renal insufficiency, Anemia, and Bone lesions — guiding treatment initiation.
Question 4: Which medication class is the first-line targeted therapy for CML and works by inhibiting the BCR-ABL tyrosine kinase?
- Monoclonal antibodies (e.g., rituximab)
- Tyrosine kinase inhibitors (e.g., imatinib) (Correct answer)
- Proteasome inhibitors (e.g., bortezomib)
- Checkpoint inhibitors (e.g., pembrolizumab)
Correct answer: Tyrosine kinase inhibitors (e.g., imatinib)
Tyrosine kinase inhibitors such as imatinib, dasatinib, and nilotinib directly inhibit the BCR-ABL oncoprotein driving CML proliferation.
Question 5: A patient with non-Hodgkin lymphoma is receiving rituximab. The nurse should monitor for which infusion-related reaction most closely during the FIRST infusion?
- Severe hypertension and bradycardia
- Fever, chills, hypotension, and bronchospasm (cytokine release syndrome) (Correct answer)
- Anaphylaxis to the diluent only
- Delayed hypersensitivity occurring 48 hours after infusion
Correct answer: Fever, chills, hypotension, and bronchospasm (cytokine release syndrome)
Rituximab commonly causes cytokine release syndrome during the first infusion, manifesting as fever, chills, hypotension, and bronchospasm, requiring close monitoring and rate adjustments.
Question 6: Hodgkin lymphoma is distinguished from non-Hodgkin lymphoma by the presence of which pathognomonic cell type?
- Blast cells
- Reed-Sternberg cells (Correct answer)
- Plasma cells
- Auer rods
Correct answer: Reed-Sternberg cells
Reed-Sternberg cells — large binucleate or multinucleate cells with prominent 'owl-eye' nucleoli — are the pathognomonic finding in Hodgkin lymphoma.
ONCC ONCC Hematologic Malignancies 1
A patient with acute myeloid leukemia (AML) has a WBC of 120,000/µL.
The nurse should prioritize assessment for which life-threatening complication?