NUR 6121 Exam 4 V3 | NUR 6121
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 4) | William Paterson
University
1. A 68-year-old patient with metastatic lung cancer presents with facial swelling, neck vein
distention, and dyspnea. Which oncologic emergency should the nurse practitioner suspect
first?
A. Tumor Lysis Syndrome
B. Superior Vena Cava Syndrome
C. Spinal Cord Compression
D. Hypercalcemia of Malignancy
Answer: B
Rationale: Superior Vena Cava (SVC) Syndrome is caused by the external compression of
the SVC by a tumor, common in lung cancer and lymphoma. The clinical hallmark includes
facial edema, periorbital edema, and venous distention in the neck and chest. Immediate
management involves airway protection, steroids, and potentially urgent radiation or
stenting to relieve the obstruction.
2. Which laboratory profile is most characteristic of a patient experiencing acute Tumor Lysis
Syndrome (TLS)?
A. Hypokalemia, hypouricemia, and hypercalcemia
,B. Hyperkalemia, hyperuricemia, and hypocalcemia
C. Hypernatremia, hypophosphatemia, and hypercalcemia
D. Hypokalemia, hyperuricemia, and hypercalcemia
Answer: B
Rationale: Tumor Lysis Syndrome results from the rapid destruction of a large number of
tumor cells, releasing intracellular contents into the systemic circulation. This leads to
hyperkalemia, hyperuricemia, and hyperphosphatemia, with the latter causing secondary
hypocalcemia due to calcium-phosphate binding. Monitoring renal function is critical as
these metabolic derangements can lead to acute kidney injury.
3. An 82-year-old patient with end-stage heart failure is being transitioned to hospice care.
The family asks what criteria must be met for this service. Which statement is correct?
A. The patient must have a life expectancy of 12 months or less.
B. The patient must agree to stop all medications, including those for comfort.
C. Hospice is only available for patients with a cancer diagnosis.
D. Two physicians must certify that the patient has a terminal illness with a prognosis of 6
months or less.
Answer: D
Rationale: To qualify for the Medicare Hospice Benefit, two physicians must certify that
the patient’s life expectancy is six months or less if the disease follows its normal course.
,The patient must also elect to waive curative treatments in favor of palliative and comfort-
focused care. Hospice services can be provided in various settings, including the home,
nursing facilities, or dedicated hospice centers.
4. A patient with Multiple Myeloma presents with increased confusion, constipation, and a
serum calcium level of 12.8 mg/dL. What is the priority pharmacological intervention?
A. Intravenous aggressive hydration with normal saline
B. Oral calcium supplements
C. High-dose loop diuretics without hydration
D. Immediate hemodialysis
Answer: A
Rationale: Hypercalcemia of malignancy is a common emergency in Multiple Myeloma due
to increased osteoclastic bone resorption. The first-line treatment is aggressive
intravenous hydration with 0.9% normal saline to increase glomerular filtration and
urinary calcium excretion. Bisphosphonates like zoledronic acid are typically administered
after hydration has started to inhibit further bone resorption.
5. A nurse practitioner is evaluating a peripheral blood smear that shows the presence of
Auer rods. This finding is most diagnostic of which condition?
A. Acute Lymphoblastic Leukemia (ALL)
B. Acute Myeloid Leukemia (AML)
C. Chronic Myeloid Leukemia (CML)
, D. Chronic Lymphocytic Leukemia (CLL)
Answer: B
Rationale: Auer rods are elongated, pink-purple staining needle-like inclusions seen in the
cytoplasm of myeloblasts. They are pathognomonic for Acute Myeloid Leukemia (AML) and
are not found in lymphoid leukemias. Their presence confirms a myeloid lineage and
assists the clinician in differentiating between acute leukemia types.
6. Which of the following is a primary difference between palliative care and hospice care?
A. Palliative care is only for the last weeks of life.
B. Palliative care can be initiated at any stage of a serious illness.
C. Hospice care allows for concurrent curative treatments.
D. Hospice care is focused purely on physical symptoms, excluding spiritual needs.
Answer: B
Rationale: Palliative care is a broad approach to improving the quality of life for patients
with serious illnesses and can be provided alongside curative or life-prolonging treatments.
In contrast, hospice is a specific type of palliative care for those with a terminal prognosis
of 6 months or less who have chosen to stop curative efforts. Both services address
physical, emotional, and spiritual needs through an interdisciplinary team.
7. A 45-year-old male with a history of HIV presents with a CD4 count of 150 cells/mm3.
Which opportunistic infection prophylaxis should be initiated immediately?
A. Fluconazole for Candidiasis
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 4) | William Paterson
University
1. A 68-year-old patient with metastatic lung cancer presents with facial swelling, neck vein
distention, and dyspnea. Which oncologic emergency should the nurse practitioner suspect
first?
A. Tumor Lysis Syndrome
B. Superior Vena Cava Syndrome
C. Spinal Cord Compression
D. Hypercalcemia of Malignancy
Answer: B
Rationale: Superior Vena Cava (SVC) Syndrome is caused by the external compression of
the SVC by a tumor, common in lung cancer and lymphoma. The clinical hallmark includes
facial edema, periorbital edema, and venous distention in the neck and chest. Immediate
management involves airway protection, steroids, and potentially urgent radiation or
stenting to relieve the obstruction.
2. Which laboratory profile is most characteristic of a patient experiencing acute Tumor Lysis
Syndrome (TLS)?
A. Hypokalemia, hypouricemia, and hypercalcemia
,B. Hyperkalemia, hyperuricemia, and hypocalcemia
C. Hypernatremia, hypophosphatemia, and hypercalcemia
D. Hypokalemia, hyperuricemia, and hypercalcemia
Answer: B
Rationale: Tumor Lysis Syndrome results from the rapid destruction of a large number of
tumor cells, releasing intracellular contents into the systemic circulation. This leads to
hyperkalemia, hyperuricemia, and hyperphosphatemia, with the latter causing secondary
hypocalcemia due to calcium-phosphate binding. Monitoring renal function is critical as
these metabolic derangements can lead to acute kidney injury.
3. An 82-year-old patient with end-stage heart failure is being transitioned to hospice care.
The family asks what criteria must be met for this service. Which statement is correct?
A. The patient must have a life expectancy of 12 months or less.
B. The patient must agree to stop all medications, including those for comfort.
C. Hospice is only available for patients with a cancer diagnosis.
D. Two physicians must certify that the patient has a terminal illness with a prognosis of 6
months or less.
Answer: D
Rationale: To qualify for the Medicare Hospice Benefit, two physicians must certify that
the patient’s life expectancy is six months or less if the disease follows its normal course.
,The patient must also elect to waive curative treatments in favor of palliative and comfort-
focused care. Hospice services can be provided in various settings, including the home,
nursing facilities, or dedicated hospice centers.
4. A patient with Multiple Myeloma presents with increased confusion, constipation, and a
serum calcium level of 12.8 mg/dL. What is the priority pharmacological intervention?
A. Intravenous aggressive hydration with normal saline
B. Oral calcium supplements
C. High-dose loop diuretics without hydration
D. Immediate hemodialysis
Answer: A
Rationale: Hypercalcemia of malignancy is a common emergency in Multiple Myeloma due
to increased osteoclastic bone resorption. The first-line treatment is aggressive
intravenous hydration with 0.9% normal saline to increase glomerular filtration and
urinary calcium excretion. Bisphosphonates like zoledronic acid are typically administered
after hydration has started to inhibit further bone resorption.
5. A nurse practitioner is evaluating a peripheral blood smear that shows the presence of
Auer rods. This finding is most diagnostic of which condition?
A. Acute Lymphoblastic Leukemia (ALL)
B. Acute Myeloid Leukemia (AML)
C. Chronic Myeloid Leukemia (CML)
, D. Chronic Lymphocytic Leukemia (CLL)
Answer: B
Rationale: Auer rods are elongated, pink-purple staining needle-like inclusions seen in the
cytoplasm of myeloblasts. They are pathognomonic for Acute Myeloid Leukemia (AML) and
are not found in lymphoid leukemias. Their presence confirms a myeloid lineage and
assists the clinician in differentiating between acute leukemia types.
6. Which of the following is a primary difference between palliative care and hospice care?
A. Palliative care is only for the last weeks of life.
B. Palliative care can be initiated at any stage of a serious illness.
C. Hospice care allows for concurrent curative treatments.
D. Hospice care is focused purely on physical symptoms, excluding spiritual needs.
Answer: B
Rationale: Palliative care is a broad approach to improving the quality of life for patients
with serious illnesses and can be provided alongside curative or life-prolonging treatments.
In contrast, hospice is a specific type of palliative care for those with a terminal prognosis
of 6 months or less who have chosen to stop curative efforts. Both services address
physical, emotional, and spiritual needs through an interdisciplinary team.
7. A 45-year-old male with a history of HIV presents with a CD4 count of 150 cells/mm3.
Which opportunistic infection prophylaxis should be initiated immediately?
A. Fluconazole for Candidiasis
