NCLEX Oncology Care questions
The PrepScore bank has 61 Oncology Care questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Recognize cues and Analyze cues, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Neutropenic precautions, tumor lysis syndrome, SIADH from chemo, spinal cord compression, cancer pain management, stomatitis + chemo GI side effects, BMT + GVHD, radiation safety, hospice transition, oncologic emergencies priority.
Three worked questions
Q1. A 30-year-old male with Burkitt lymphoma 24 hours after starting chemo. The ED nurse evaluates for TLS. Which findings SUGGEST TUMOR LYSIS SYNDROME after chemo initiation? Select all that apply.
- A. Hyperkalemia (intracellular K released)
- B. Hyperphosphatemia + hypocalcemia (P binds Ca → hypoCa)
- C. Hyperuricemia + AKI (rapid nucleic acid breakdown)
- D. Hypoglycemia (NOT TLS feature)
- E. Cardiac arrhythmias (from hyperK + hypoCa)
- F. Hypotension only (incomplete characterization)
Show answer and rationale
Answer: Hyperkalemia (intracellular K released)Hyperphosphatemia + hypocalcemia (P binds Ca → hypoCa)Hyperuricemia + AKI (rapid nucleic acid breakdown)Cardiac arrhythmias (from hyperK + hypoCa)
TLS = rapid lysis releases intracellular contents: hyperK + hyperP + hypoCa + hyperuricemia + AKI + arrhythmias. Hypoglycemia and hypotension alone don't characterize TLS.
Q2. An oncology nurse takes report on 4 patients with possible emergencies. The nurse identifies the priority. Which oncology emergency requires IMMEDIATE radiation therapy?
- A. Anemia of chronic disease (NOT emergent radiation — supportive)
- B. Spinal cord compression (oncologic emergency — IMMEDIATE radiation oncology consultation + urgent radiation therapy + dexamethasone + neurosurgery if indicated; treatment within hours preserves neurologic function)
- C. Nausea after chemo (NOT — antiemetic management)
- D. Hair loss (NOT — supportive)
Show answer and rationale
Answer: Spinal cord compression (oncologic emergency — IMMEDIATE radiation oncology consultation + urgent radiation therapy + dexamethasone + neurosurgery if indicated; treatment within hours preserves neurologic function)
Spinal cord compression = oncologic emergency requiring immediate radiation oncology + radiation therapy + dexamethasone + neurosurgery if indicated.
Q3. A new RN orientation includes a session on chemotherapy terminology. The educator presents 4 options. Pre-op chemotherapy is termed:
- A. Adjuvant (POST-op chemo to reduce recurrence)
- B. Neoadjuvant (PRE-op chemo to shrink tumor and improve surgical resection)
- C. Palliative (symptom-focused)
- D. Curative (intent to eradicate; not timing-specific)
Show answer and rationale
Answer: Neoadjuvant (PRE-op chemo to shrink tumor and improve surgical resection)
Chemo terminology: NEOadjuvant = pre-op (shrink + improve resection); adjuvant = post-op (reduce recurrence); palliative = symptom-focused; curative = intent.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
ANC < 500 + single oral T ≥ 38.3 OR sustained ≥ 38.0 × 1 hr = neutropenic fever emergency. Workup: pan-cultures (blood per lumen + peripheral, urine, sputum if productive). Empirical broad-spectrum IV antibiotic (e.g., piperacillin-tazobactam ± vancomycin) within 1 hr — do NOT wait for cultures. Protective precautions: private room, hand hygiene, no fresh fruits/flowers/raw foods. Hold routine antipyretics that mask fever.
Cell lysis releases K + phos + uric acid; calcium falls (binds with phos). Aggressive hydration (1.5-2x maintenance, NO K + NO phos). Rasburicase for active treatment of high uric acid; allopurinol for prophylaxis. Treat hyperK first (ECG → calcium gluconate → insulin/D50 → Kayexalate; HD if refractory). Caution IV calcium with hyperphos (Ca-phos precipitation, AKI). Monitor labs q4-6h × 48-72 hr.
SIADH = hyponatremia + low serum osm + INAPPROPRIATELY concentrated urine osm + euvolemia + urine Na > 30. Treat with fluid restriction (800-1000 mL/day), salt tabs, tolvaptan. Severe symptoms (seizure, coma) = hypertonic 3% saline carefully. Correct Na slowly — no more than 6-8 mEq/L per 24 hr; faster = osmotic demyelination syndrome (CPM).
Cancer (especially breast, lung, prostate, MM, lymphoma) + new back pain + neuro deficit (motor weakness, sensory loss, saddle anesthesia, bowel/bladder dysfunction) = malignant spinal cord compression. STAT IV high-dose dexamethasone + STAT MRI of complete spine + radiation oncology / neurosurgery consult. Spine precautions. Pre-treatment ambulatory status predicts outcome — hours matter.
Chronic cancer pain = scheduled long-acting opioid + immediate-release short-acting for breakthrough (10-15% of total daily dose q1h PRN). Always scheduled bowel regimen with opioid (senna + docusate ± PEG). Multimodal: NSAID/steroid for bone, gabapentin/pregabalin for neuropathic, bisphosphonate for skeletal. Tolerance + dependence ≠ addiction. Don't hold scheduled dose just because patient sleeping (use sedation + RR criteria).
Stomatitis care: soft toothbrush + saline / sodium bicarbonate rinses 4-6×/day + magic mouthwash before meals; nystatin if candidal. AVOID alcohol-based mouthwash + glycerin/lemon swabs (drying). Bland soft cool diet. Highly emetogenic chemo: scheduled 5HT3 + dexamethasone + NK1 + olanzapine; lorazepam for anticipatory. PRN alone is inadequate.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Oncology Care questions does the bank have?
61 multiple-choice items, plus 10 unfolding cases in the Oncology Care pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Recognize cues and Analyze cues, though every step appears.
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