🎯 High-Yield Points
- Nadir: lowest point of WBC after chemotherapy — highest infection risk (typically 7-14 days post-chemo)
- Neutropenic precautions: avoid raw foods, fresh flowers, sick visitors; hand hygiene paramount
- Tumour lysis syndrome: after chemo — hyperkalaemia, hyperuricaemia, hyperphosphataemia, hypocalcaemia
- Superior vena cava syndrome: facial oedema + dyspnoea = oncology emergency
- Chemotherapy extravasation: STOP infusion immediately; do not flush; assess for vesicant damage
[Concept Map: Oncology NCLEX Questions — Clinical Manifestations, Nursing Interventions, Priority Actions]
Practice Questions
Question 1
A client receiving chemotherapy has an absolute neutrophil count (ANC) of 380 cells/mm³. Which nursing intervention is the PRIORITY?
✓ Correct: Implement neutropenic precautions and limit visitors with illness
ANC <500 cells/mm³ indicates severe neutropenia — a critical immunocompromised state with very high infection risk. The priority nursing action is implementing neutropenic precautions: strict hand hygiene, private room, limit visitors (especially those with illness), avoid fresh flowers/plants, avoid raw fruits and vegetables (cooked only), and monitor closely for signs of infection (fever ≥38°C is a medical emergency in neutropenic patients).
ANC <500 cells/mm³ indicates severe neutropenia — a critical immunocompromised state with very high infection risk. The priority nursing action is implementing neutropenic precautions: strict hand hygiene, private room, limit visitors (especially those with illness), avoid fresh flowers/plants, avoid raw fruits and vegetables (cooked only), and monitor closely for signs of infection (fever ≥38°C is a medical emergency in neutropenic patients).
Question 2
A nurse is caring for a client receiving IV chemotherapy. The client reports burning pain at the IV site. Which action is FIRST?
✓ Correct: Stop the infusion immediately and disconnect; do not flush the line
Burning pain at an IV site during chemotherapy administration indicates possible extravasation — leakage of vesicant chemotherapy into surrounding tissue. Vesicants cause severe tissue necrosis. Immediate action: STOP the infusion, do NOT flush the line (flushes more vesicant into tissue), disconnect (leave needle in place), aspirate residual drug from the line, and notify the provider and pharmacy immediately. Specific antidotes may be required depending on the chemotherapy agent.
Burning pain at an IV site during chemotherapy administration indicates possible extravasation — leakage of vesicant chemotherapy into surrounding tissue. Vesicants cause severe tissue necrosis. Immediate action: STOP the infusion, do NOT flush the line (flushes more vesicant into tissue), disconnect (leave needle in place), aspirate residual drug from the line, and notify the provider and pharmacy immediately. Specific antidotes may be required depending on the chemotherapy agent.
Question 3
A client with ovarian cancer receiving cisplatin-based chemotherapy develops nausea and vomiting, confusion, and muscle cramps 24 hours after treatment. Which laboratory finding is most expected?
✓ Correct: Decreased serum magnesium
Cisplatin is a highly nephrotoxic chemotherapy agent known to cause significant renal magnesium wasting, leading to hypomagnesaemia. Low magnesium causes nausea, vomiting, muscle cramps, and neurological symptoms (confusion, tremors). Cisplatin also causes significant nausea and nephrotoxicity. Magnesium levels must be monitored closely during and after cisplatin therapy.
Cisplatin is a highly nephrotoxic chemotherapy agent known to cause significant renal magnesium wasting, leading to hypomagnesaemia. Low magnesium causes nausea, vomiting, muscle cramps, and neurological symptoms (confusion, tremors). Cisplatin also causes significant nausea and nephrotoxicity. Magnesium levels must be monitored closely during and after cisplatin therapy.
Question 4
A nurse is caring for a client with end-stage cancer who requests assistance with advance directives. Which action is MOST appropriate?
✓ Correct: Provide information about advance directives and connect the client with the social worker or chaplain
Advance directive planning is an important component of end-of-life care for cancer patients. The nurse's role is to provide accurate information, support the client's autonomy in decision-making, and facilitate connection with the social worker, chaplain, and other resources. Advance directives (healthcare proxy, DNR, living will) are applicable to any serious medical condition, not just surgical situations. Every competent adult has the right to plan their care.
Advance directive planning is an important component of end-of-life care for cancer patients. The nurse's role is to provide accurate information, support the client's autonomy in decision-making, and facilitate connection with the social worker, chaplain, and other resources. Advance directives (healthcare proxy, DNR, living will) are applicable to any serious medical condition, not just surgical situations. Every competent adult has the right to plan their care.
Question 5
A client with cancer develops a blood pressure of 80/50 mmHg, facial oedema, and distended neck veins. Which oncological emergency does the nurse suspect?
✓ Correct: Superior vena cava syndrome
Superior vena cava (SVC) syndrome occurs when a tumour (most commonly lung cancer or lymphoma) compresses the SVC, obstructing venous return from the upper body. Classic signs: facial and neck oedema, dilated neck and chest veins, headache, dyspnoea, and upper extremity swelling. SVC syndrome is an oncological emergency requiring immediate radiation therapy or stenting. Septic shock causes fever and signs of infection. SVC syndrome does not cause fever.
Superior vena cava (SVC) syndrome occurs when a tumour (most commonly lung cancer or lymphoma) compresses the SVC, obstructing venous return from the upper body. Classic signs: facial and neck oedema, dilated neck and chest veins, headache, dyspnoea, and upper extremity swelling. SVC syndrome is an oncological emergency requiring immediate radiation therapy or stenting. Septic shock causes fever and signs of infection. SVC syndrome does not cause fever.
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