Oncology

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Sample questions from Oncology

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 54-year-old client receiving chemotherapy for acute leukemia calls the oncology clinic reporting chills. The client's temperature is 38.3 C (100.9 F), and yesterday's absolute neutrophil count was 320/mm3. Which instruction should the nurse give first?

   • A.Take acetaminophen and check the temperature again in 1 hour.
   • B.Go immediately to the designated emergency department for evaluation.
   • C.Increase oral fluids and contact the clinic if a cough develops.
   • D.Avoid visitors and return for the scheduled laboratory appointment tomorrow.

   Rationale: Fever with severe neutropenia is an oncologic emergency requiring immediate evaluation and prompt empiric antibiotics. Acetaminophen may mask fever and must not delay treatment, while increased fluids do not address potentially life-threatening infection. Avoiding visitors is preventive but is not an adequate response to an existing fever. The exam takeaway is to treat even an isolated fever during neutropenia as urgent.

2. 2.A 47-year-old client with lymphoma is admitted with febrile neutropenia. Temperature is 39.0 C (102.2 F), heart rate is 118/min, blood pressure is 106/64 mm Hg, and the absolute neutrophil count is 180/mm3. Blood cultures have been collected, and a prescribed broad-spectrum IV antibiotic is available. What should the nurse do next?

   • A.Wait for the chest radiograph result before administering the antibiotic.
   • B.Repeat the complete blood count to confirm the neutrophil level.
   • C.Administer the prescribed IV antibiotic promptly.
   • D.Give an antipyretic and reassess before starting the antibiotic.

   Rationale: Prompt empiric broad-spectrum antibiotics are essential for febrile neutropenia once cultures have been obtained without delaying therapy. Neither a chest radiograph nor a repeat blood count should postpone the first dose. An antipyretic improves comfort but does not treat the infection. The exam takeaway is that diagnostic clarification must not delay time-sensitive treatment.

3. 3.A 63-year-old client on an oncology unit has a platelet count of 16,000/mm3 after chemotherapy. The client is alert, has scattered petechiae, and has no active bleeding. Which nursing care plan is most appropriate?

   • A.Use an electric razor, avoid rectal procedures, and apply prolonged pressure after venipuncture.
   • B.Use a soft toothbrush, administer prescribed ibuprofen for pain, and encourage daily walking.
   • C.Avoid intramuscular injections, floss vigorously, and restrict all activity.
   • D.Check stool for blood, obtain rectal temperatures, and use a manual razor carefully.

   Rationale: An electric razor, avoidance of rectal procedures, and prolonged pressure after venipuncture reduce bleeding risk. Ibuprofen impairs platelet function and is inappropriate without specific evaluation in this setting. Vigorous flossing can injure gums, and complete activity restriction is not routinely required for an otherwise stable client. Rectal temperatures and manual razors can cause trauma; the exam takeaway is to minimize invasive procedures and tissue injury with severe thrombocytopenia.

4. 4.A 39-year-old client receiving doxorubicin through a peripheral IV reports burning at the insertion site. The nurse observes swelling and loss of blood return. Which action should the nurse take first?

   • A.Slow the infusion and apply a warm compress.
   • B.Flush the catheter with normal saline to assess patency.
   • C.Remove the catheter immediately and apply firm pressure.
   • D.Stop the infusion and leave the catheter in place for aspiration.

   Answer and rationale are in the full material.

5. 5.A 28-year-old client with Burkitt lymphoma develops nausea and weakness 18 hours after starting chemotherapy. Laboratory results show potassium 6.2 mEq/L, phosphate 6.5 mg/dL, calcium 7.0 mg/dL, and uric acid 11 mg/dL. Which action is the priority?

   • A.Administer an oral calcium supplement for the low calcium level.
   • B.Initiate continuous cardiac monitoring and notify the provider immediately.
   • C.Restrict IV fluids because the phosphate level is elevated.
   • D.Encourage high-potassium foods to replace nutritional losses.

   Answer and rationale are in the full material.