AOCNP exam test bank
TABLE OF CONTENTS
Chapter 1: Oncologic Emergencies — Questions 1–15
Chapter 2: Chemotherapy Toxicities and Symptom Management — Questions 16–30
Chapter 3: Immunotherapy and Targeted Therapy — Questions 31–40
Chapter 4: Cancer Pain and Supportive Care — Questions 41–50
CHAPTER 1: ONCOLOGIC EMERGENCIES (Questions 1–15)
Q1. Which electrolyte pattern is most consistent with tumor lysis syndrome?
A. Hyperkalemia and hyperuricemia
B. Hypokalemia and hypophosphatemia
C. Hypernatremia and hypocalcemia
D. Hypouricemia and hypercalcemia
Correct Answer: Hyperkalemia and hyperuricemia ✅
Rationale: Tumor lysis syndrome results from the rapid breakdown of malignant cells, which
releases intracellular potassium, phosphate, and nucleic acids that are metabolized into uric acid,
producing hyperkalemia and hyperuricemia. Option B is incorrect because TLS causes potassium and
phosphate to rise, not fall, so hypokalemia and hypophosphatemia are the opposite of the expected
pattern. Option C is incorrect because sodium is not the characteristic electrolyte disturbed in TLS,
and while calcium does fall, the sodium abnormality listed is not part of the syndrome. Option D is
incorrect because TLS raises uric acid rather than lowering it, and it lowers calcium rather than
raising it. The key concept is that TLS is a metabolic emergency defined by hyperkalemia,
hyperphosphatemia, hyperuricemia, and hypocalcemia, and it requires aggressive hydration,
monitoring, and often rasburicase or allopurinol.
Q2. A client with neutropenic fever has an absolute neutrophil count of 400. Which action should the
nurse take first?
,A. Administer prescribed intravenous antibiotics
B. Obtain a chest radiograph
C. Apply a cooling blanket
D. Wait for blood culture results
Correct Answer: Administer prescribed intravenous antibiotics ✅
Rationale: Neutropenic fever is a medical emergency, and intravenous antibiotics must be
administered within one hour because infection can progress rapidly when neutrophils are
profoundly low. Option B is incorrect because imaging is supportive but must never delay antibiotic
administration in this time-sensitive situation. Option C is incorrect because external cooling does
not address the underlying infection and is not a priority intervention. Option D is incorrect because
waiting for culture results delays treatment and increases the risk of sepsis and death. The key
concept is that febrile neutropenia requires empiric broad-spectrum antibiotics within one hour, with
cultures drawn promptly but never allowed to postpone therapy.
Q3. A client with lung cancer reports new back pain and leg weakness. Which complication should
the nurse suspect?
A. Spinal cord compression
B. Superior vena cava syndrome
C. Hypercalcemia
D. Pericardial tamponade
Correct Answer: Spinal cord compression ✅
Rationale: New back pain accompanied by leg weakness in a client with cancer strongly
suggests spinal cord compression, which is an oncologic emergency requiring immediate imaging and
steroids. Option B is incorrect because superior vena cava syndrome presents with facial swelling,
distended neck veins, and upper body edema rather than leg weakness. Option C is incorrect
because hypercalcemia causes confusion, constipation, and polyuria rather than focal weakness with
back pain. Option D is incorrect because pericardial tamponade presents with hypotension, muffled
heart sounds, and distended neck veins. The key concept is that spinal cord compression is a time-
,critical emergency in which neurologic function can be preserved only if treatment begins before
deficits become fixed.
Q4. Which finding is an early sign of superior vena cava syndrome?
A. Facial swelling in the morning
B. Pedal edema
C. Hematuria
D. Jaundice
Correct Answer: Facial swelling in the morning ✅
Rationale: Superior vena cava syndrome results from obstruction of venous return from the
upper body, producing facial and neck swelling that is often most pronounced in the morning after
lying flat overnight. Option B is incorrect because pedal edema reflects lower extremity or systemic
fluid retention rather than upper body venous obstruction. Option C is incorrect because hematuria
indicates urinary tract or renal pathology, not SVC obstruction. Option D is incorrect because
jaundice reflects hepatobiliary disease and is unrelated to SVC syndrome. The key concept is that SVC
syndrome is caused by compression or thrombosis of the superior vena cava, and early recognition of
facial and upper extremity swelling allows timely intervention before airway compromise develops.
Q5. A client with breast cancer has a calcium level of 13.2 mg/dL. Which finding should the nurse
expect?
A. Confusion and constipation
B. Tetany and seizures
C. Bradycardia and hypertension
D. Polyphagia and weight gain
Correct Answer: Confusion and constipation ✅
Rationale: Hypercalcemia of malignancy typically produces neurologic and gastrointestinal
symptoms such as confusion, lethargy, constipation, and polyuria as calcium rises. Option B is
incorrect because tetany and seizures are signs of hypocalcemia, not hypercalcemia. Option C is
, incorrect because hypercalcemia more commonly causes hypotension and cardiac arrhythmias
rather than bradycardia with hypertension. Option D is incorrect because hypercalcemia causes
anorexia and weight loss rather than polyphagia and weight gain. The key concept is that
hypercalcemia of malignancy is managed with aggressive intravenous hydration and agents such as
bisphosphonates or calcitonin, and neurologic changes should prompt immediate calcium
measurement.
Q6. Which condition is characterized by hypotension, muffled heart sounds, and distended neck
veins?
A. Pericardial tamponade
B. Superior vena cava syndrome
C. Tumor lysis syndrome
D. Spinal cord compression
Correct Answer: Pericardial tamponade ✅
Rationale: Pericardial tamponade impairs ventricular filling, producing the classic triad of
hypotension, muffled heart sounds, and distended neck veins known as Beck triad. Option B is
incorrect because SVC syndrome causes facial and upper body swelling without muffled heart
sounds. Option C is incorrect because TLS is a metabolic derangement with electrolyte abnormalities
rather than this hemodynamic triad. Option D is incorrect because spinal cord compression presents
with pain and neurologic deficits rather than cardiac findings. The key concept is that pericardial
tamponade is a cardiac emergency requiring prompt pericardiocentesis, and Beck triad should be
recognized immediately.
Q7. A client receiving chemotherapy has a uric acid level of 11 mg/dL. Which medication should the
nurse anticipate?
A. Rasburicase
B. Leucovorin
C. Mesna
D. Dexrazoxane
Correct Answer: Rasburicase ✅
TABLE OF CONTENTS
Chapter 1: Oncologic Emergencies — Questions 1–15
Chapter 2: Chemotherapy Toxicities and Symptom Management — Questions 16–30
Chapter 3: Immunotherapy and Targeted Therapy — Questions 31–40
Chapter 4: Cancer Pain and Supportive Care — Questions 41–50
CHAPTER 1: ONCOLOGIC EMERGENCIES (Questions 1–15)
Q1. Which electrolyte pattern is most consistent with tumor lysis syndrome?
A. Hyperkalemia and hyperuricemia
B. Hypokalemia and hypophosphatemia
C. Hypernatremia and hypocalcemia
D. Hypouricemia and hypercalcemia
Correct Answer: Hyperkalemia and hyperuricemia ✅
Rationale: Tumor lysis syndrome results from the rapid breakdown of malignant cells, which
releases intracellular potassium, phosphate, and nucleic acids that are metabolized into uric acid,
producing hyperkalemia and hyperuricemia. Option B is incorrect because TLS causes potassium and
phosphate to rise, not fall, so hypokalemia and hypophosphatemia are the opposite of the expected
pattern. Option C is incorrect because sodium is not the characteristic electrolyte disturbed in TLS,
and while calcium does fall, the sodium abnormality listed is not part of the syndrome. Option D is
incorrect because TLS raises uric acid rather than lowering it, and it lowers calcium rather than
raising it. The key concept is that TLS is a metabolic emergency defined by hyperkalemia,
hyperphosphatemia, hyperuricemia, and hypocalcemia, and it requires aggressive hydration,
monitoring, and often rasburicase or allopurinol.
Q2. A client with neutropenic fever has an absolute neutrophil count of 400. Which action should the
nurse take first?
,A. Administer prescribed intravenous antibiotics
B. Obtain a chest radiograph
C. Apply a cooling blanket
D. Wait for blood culture results
Correct Answer: Administer prescribed intravenous antibiotics ✅
Rationale: Neutropenic fever is a medical emergency, and intravenous antibiotics must be
administered within one hour because infection can progress rapidly when neutrophils are
profoundly low. Option B is incorrect because imaging is supportive but must never delay antibiotic
administration in this time-sensitive situation. Option C is incorrect because external cooling does
not address the underlying infection and is not a priority intervention. Option D is incorrect because
waiting for culture results delays treatment and increases the risk of sepsis and death. The key
concept is that febrile neutropenia requires empiric broad-spectrum antibiotics within one hour, with
cultures drawn promptly but never allowed to postpone therapy.
Q3. A client with lung cancer reports new back pain and leg weakness. Which complication should
the nurse suspect?
A. Spinal cord compression
B. Superior vena cava syndrome
C. Hypercalcemia
D. Pericardial tamponade
Correct Answer: Spinal cord compression ✅
Rationale: New back pain accompanied by leg weakness in a client with cancer strongly
suggests spinal cord compression, which is an oncologic emergency requiring immediate imaging and
steroids. Option B is incorrect because superior vena cava syndrome presents with facial swelling,
distended neck veins, and upper body edema rather than leg weakness. Option C is incorrect
because hypercalcemia causes confusion, constipation, and polyuria rather than focal weakness with
back pain. Option D is incorrect because pericardial tamponade presents with hypotension, muffled
heart sounds, and distended neck veins. The key concept is that spinal cord compression is a time-
,critical emergency in which neurologic function can be preserved only if treatment begins before
deficits become fixed.
Q4. Which finding is an early sign of superior vena cava syndrome?
A. Facial swelling in the morning
B. Pedal edema
C. Hematuria
D. Jaundice
Correct Answer: Facial swelling in the morning ✅
Rationale: Superior vena cava syndrome results from obstruction of venous return from the
upper body, producing facial and neck swelling that is often most pronounced in the morning after
lying flat overnight. Option B is incorrect because pedal edema reflects lower extremity or systemic
fluid retention rather than upper body venous obstruction. Option C is incorrect because hematuria
indicates urinary tract or renal pathology, not SVC obstruction. Option D is incorrect because
jaundice reflects hepatobiliary disease and is unrelated to SVC syndrome. The key concept is that SVC
syndrome is caused by compression or thrombosis of the superior vena cava, and early recognition of
facial and upper extremity swelling allows timely intervention before airway compromise develops.
Q5. A client with breast cancer has a calcium level of 13.2 mg/dL. Which finding should the nurse
expect?
A. Confusion and constipation
B. Tetany and seizures
C. Bradycardia and hypertension
D. Polyphagia and weight gain
Correct Answer: Confusion and constipation ✅
Rationale: Hypercalcemia of malignancy typically produces neurologic and gastrointestinal
symptoms such as confusion, lethargy, constipation, and polyuria as calcium rises. Option B is
incorrect because tetany and seizures are signs of hypocalcemia, not hypercalcemia. Option C is
, incorrect because hypercalcemia more commonly causes hypotension and cardiac arrhythmias
rather than bradycardia with hypertension. Option D is incorrect because hypercalcemia causes
anorexia and weight loss rather than polyphagia and weight gain. The key concept is that
hypercalcemia of malignancy is managed with aggressive intravenous hydration and agents such as
bisphosphonates or calcitonin, and neurologic changes should prompt immediate calcium
measurement.
Q6. Which condition is characterized by hypotension, muffled heart sounds, and distended neck
veins?
A. Pericardial tamponade
B. Superior vena cava syndrome
C. Tumor lysis syndrome
D. Spinal cord compression
Correct Answer: Pericardial tamponade ✅
Rationale: Pericardial tamponade impairs ventricular filling, producing the classic triad of
hypotension, muffled heart sounds, and distended neck veins known as Beck triad. Option B is
incorrect because SVC syndrome causes facial and upper body swelling without muffled heart
sounds. Option C is incorrect because TLS is a metabolic derangement with electrolyte abnormalities
rather than this hemodynamic triad. Option D is incorrect because spinal cord compression presents
with pain and neurologic deficits rather than cardiac findings. The key concept is that pericardial
tamponade is a cardiac emergency requiring prompt pericardiocentesis, and Beck triad should be
recognized immediately.
Q7. A client receiving chemotherapy has a uric acid level of 11 mg/dL. Which medication should the
nurse anticipate?
A. Rasburicase
B. Leucovorin
C. Mesna
D. Dexrazoxane
Correct Answer: Rasburicase ✅
