ONCC Hematologic Malignancies Flashcards

A patient undergoing induction chemotherapy for acute lymphoblastic leukemia (ALL) develops tumor lysis syndrome. Which electrolyte abnormality combination is expected?

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.

Which intervention is the cornerstone of tumor lysis syndrome prevention in high-risk hematologic malignancies?

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.

A patient with multiple myeloma is started on bortezomib. The nurse should educate the patient about which commonly expected side effect?

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.

The Ann Arbor staging system is used for which malignancies?

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.

Which finding is most consistent with neutropenic fever in a patient with hematologic malignancy receiving chemotherapy?

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.

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:

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.