Q.1 Which of the following is the most common oncological emergency associated with tumor lysis syndrome?
Hyperkalemia
Hypokalemia
Hyponatremia
Hypocalcemia
Explanation - Tumor lysis syndrome releases intracellular potassium, phosphate, and nucleic acids into the blood, causing hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia.
Correct answer is: Hyperkalemia
Q.2 Superior vena cava (SVC) syndrome in oncology patients is most commonly caused by:
Lung cancer
Breast cancer
Colorectal cancer
Leukemia
Explanation - SVC syndrome is usually caused by extrinsic compression of the superior vena cava by mediastinal tumors, most commonly lung cancer, particularly small cell lung carcinoma.
Correct answer is: Lung cancer
Q.3 A patient with acute spinal cord compression from a tumor is experiencing which early symptom?
Severe back pain
Urinary retention
Paralysis
Respiratory distress
Explanation - Acute spinal cord compression often presents first with severe, localized back pain, followed by neurological deficits such as weakness, sensory loss, or bladder/bowel dysfunction.
Correct answer is: Severe back pain
Q.4 Which electrolyte abnormality is a hallmark of tumor lysis syndrome?
Hyperuricemia
Hypomagnesemia
Hypernatremia
Hypokalemia
Explanation - Rapid lysis of tumor cells releases nucleic acids, which are metabolized to uric acid, causing hyperuricemia—a hallmark of tumor lysis syndrome.
Correct answer is: Hyperuricemia
Q.5 Febrile neutropenia is considered an oncologic emergency primarily because it can lead to:
Sepsis
Anemia
Thrombocytopenia
Electrolyte imbalance
Explanation - Febrile neutropenia compromises the immune system, making patients highly susceptible to infections that can rapidly progress to sepsis.
Correct answer is: Sepsis
Q.6 Hypercalcemia in a cancer patient is most commonly caused by:
Bone metastasis
Liver metastasis
Renal failure
Splenic enlargement
Explanation - Bone metastasis leads to increased osteoclastic activity, releasing calcium into the bloodstream, causing hypercalcemia—a common oncological emergency.
Correct answer is: Bone metastasis
Q.7 Which of the following is a first-line intervention for superior vena cava syndrome?
Elevate the head of the bed
Administer diuretics
Immediate surgery
Radiation therapy
Explanation - Initial management of SVC syndrome includes supportive measures such as elevating the head to reduce venous pressure, along with corticosteroids or radiotherapy depending on the cause.
Correct answer is: Elevate the head of the bed
Q.8 A patient presents with sudden dyspnea, chest pain, and hypotension after chemotherapy. The nurse suspects:
Pulmonary embolism
Pneumothorax
Asthma attack
Anaphylaxis
Explanation - Cancer patients have a high risk of thromboembolic events; sudden dyspnea, chest pain, and hypotension after chemotherapy can indicate a pulmonary embolism.
Correct answer is: Pulmonary embolism
Q.9 Which laboratory marker is most indicative of tumor lysis syndrome?
Elevated uric acid
Low hemoglobin
High albumin
Low creatinine
Explanation - Tumor lysis syndrome causes rapid cell breakdown, releasing nucleic acids metabolized to uric acid, leading to hyperuricemia.
Correct answer is: Elevated uric acid
Q.10 In a patient with neutropenic sepsis, the nurse’s priority action is:
Administer broad-spectrum antibiotics
Give analgesics
Check blood pressure once daily
Apply cold compress
Explanation - Neutropenic sepsis can progress rapidly to septic shock. Immediate administration of broad-spectrum antibiotics is critical to reduce mortality.
Correct answer is: Administer broad-spectrum antibiotics
Q.11 Which of the following is the most common cause of hypercalcemia in cancer patients?
Paraneoplastic syndrome
Kidney failure
Excess vitamin D intake
Hypoparathyroidism
Explanation - Many cancers secrete parathyroid hormone-related protein (PTHrP), leading to hypercalcemia as a paraneoplastic phenomenon.
Correct answer is: Paraneoplastic syndrome
Q.12 What is the first-line treatment for spinal cord compression caused by cancer?
Corticosteroids
Surgical resection immediately
Chemotherapy only
Radiation therapy only
Explanation - Corticosteroids reduce edema and inflammation around the spinal cord, providing immediate symptom relief while definitive treatment (surgery/radiation) is planned.
Correct answer is: Corticosteroids
Q.13 Which of the following is a hallmark feature of superior vena cava syndrome?
Facial and upper extremity edema
Lower limb edema
Abdominal distension
Jaundice
Explanation - SVC obstruction leads to impaired venous return from the head, neck, and upper limbs, causing edema and prominent veins.
Correct answer is: Facial and upper extremity edema
Q.14 A 55-year-old patient with leukemia develops sudden hematuria, oliguria, and elevated creatinine. This is most likely due to:
Tumor lysis syndrome
Hypercalcemia
Febrile neutropenia
SVC syndrome
Explanation - Tumor lysis syndrome causes renal failure due to uric acid and phosphate deposition, leading to oliguria, hematuria, and elevated creatinine.
Correct answer is: Tumor lysis syndrome
Q.15 The classic triad of neutropenic sepsis includes fever, neutropenia, and:
Hypotension
Hypercalcemia
Dyspnea
Bradycardia
Explanation - Neutropenic sepsis can rapidly progress to septic shock, characterized by fever, neutropenia, and hypotension.
Correct answer is: Hypotension
Q.16 Which of the following is the priority nursing intervention in hypercalcemia of malignancy?
Hydration with IV saline
Administering analgesics
Restricting fluids
Applying cold therapy
Explanation - IV hydration helps to promote renal calcium excretion and is the first-line intervention in hypercalcemia management.
Correct answer is: Hydration with IV saline
Q.17 Which symptom is an early indicator of pulmonary embolism in cancer patients?
Sudden dyspnea
Fever
Back pain
Abdominal swelling
Explanation - Sudden onset of shortness of breath is a classic early sign of pulmonary embolism, especially in patients at high risk such as those with cancer.
Correct answer is: Sudden dyspnea
Q.18 A patient with mediastinal tumor develops facial swelling and dyspnea. Which emergency is suspected?
Superior vena cava syndrome
Spinal cord compression
Hypercalcemia
Tumor lysis syndrome
Explanation - Mediastinal tumors can compress the SVC, causing facial and upper body swelling, dyspnea, and venous distension.
Correct answer is: Superior vena cava syndrome
Q.19 Which electrolyte imbalance is most life-threatening in tumor lysis syndrome?
Hyperkalemia
Hypophosphatemia
Hypokalemia
Hypernatremia
Explanation - Hyperkalemia can cause life-threatening cardiac arrhythmias in tumor lysis syndrome and requires immediate intervention.
Correct answer is: Hyperkalemia
Q.20 In a cancer patient with neutropenic fever, blood cultures should be obtained:
Before starting antibiotics
After 48 hours of antibiotics
After fever resolves
Only if hypotension develops
Explanation - Blood cultures are obtained prior to antibiotic therapy to identify causative organisms while not delaying treatment.
Correct answer is: Before starting antibiotics
Q.21 Which of the following is a sign of impending spinal cord compression?
Progressive limb weakness
Fever
Jaundice
Cough
Explanation - Progressive motor weakness in the limbs is an early sign of spinal cord compression due to tumor growth or metastasis.
Correct answer is: Progressive limb weakness
Q.22 What is the first-line pharmacologic therapy in acute hypercalcemia of malignancy?
IV bisphosphonates
Loop diuretics
ACE inhibitors
Corticosteroids
Explanation - IV bisphosphonates inhibit osteoclast-mediated bone resorption and are the mainstay treatment for acute hypercalcemia of malignancy.
Correct answer is: IV bisphosphonates
Q.23 A patient receiving chemotherapy develops sudden confusion, muscle cramps, and tetany. The nurse suspects:
Hypocalcemia
Hypercalcemia
Hyperkalemia
Hyponatremia
Explanation - Symptoms like tetany, muscle cramps, and confusion are classic for hypocalcemia, which may occur in tumor lysis syndrome or as a treatment side effect.
Correct answer is: Hypocalcemia
Q.24 Which clinical intervention reduces the risk of complications in tumor lysis syndrome?
Aggressive hydration
Bed rest only
Analgesics only
Low-sodium diet
Explanation - Aggressive IV hydration helps maintain renal perfusion and prevents uric acid and phosphate crystal deposition, reducing complications of tumor lysis syndrome.
Correct answer is: Aggressive hydration