11.

A patient with relapsing Hodgkin s disease presents with weight gain, foot ulcers, vision problems, elevated blood sugar, oral candidiasis, and new onset of wildly swinging mood changes. What is the most likely etiology of this patient s psychiatric symptoms? (A) Adverse effects of bleomycin (B) Adverse effects of prednisone (C) Adverse effects of vincristine (D) Normal psychiatric response to having cancer 12. A 41-year-old pregnant woman sees her obstetrician because of new-onset vaginal bleeding. Although she is only 4 months pregnant, her doctor notes that her uterus is the size usually seen at 6 months of -human chorionic gonadotropinFgestation. Maternal blood works shows a -hCG) levelF( >5 times the upper limit of normal. If left untreated, what is a possible consequence of the patient s condition? (A) Choriocarcinoma (B) Coma (C) Fetal neural tube defects (D) Ovarian cancer 13. Oncology Nurse Test Questions about Hydrops fetalis that occurs in the setting of a certain type of thalassemia. What is the underlying mechanism leading to this event? -globin chains binding tighter to oxygenE(A) Excess -globin chains binding weaker to oxygenE(B) Excess -globin chains binding tighter to oxygenF(C) Excess (D) Excess gamma-globin chains binding tighter to oxygen 14. A 56-year-old man who is a health care worker presents to his physician with vague abdominal discomfort. A physical examination reveals a tender liver, palpable to 6 cm below the costal margin and scleral icterus. His laboratory studies are significant for an aspartate aminotransferase activity of 200 U/L and an alanine aminotransferase activity of 450 U/L. A CT scan of the abdomen shows a dominant solid nodule in the liver. The marker most likely to be elevated in this patient is also a good indicator of which of the following malignancies? (A) Choriocarcinoma (B) Colorectal carcinoma (C) Melanoma (D) Yolk sac carcinoma 15. A 57-year-old man presents to his physician with a 4-month history of worsening fatigue and

generalized weakness. Further questioning reveals that his clothes fit him more loosely now than they had in the past. Physical examination reveals generalized lymphadenopathy and hepatosplenomegaly. Lymph node biopsy specimens are sent to the pathologist with the presumptive diagnosis of lymphoma. Which of the following types of neoplastic cell is most common in non-Hodgkin s lymphoma? (A) B lymphocyte (B) Myeloblast (C) Plasma cell (D) Reed-Sternberg cell

11) B - Correct Rationale: This patient is presenting with some of the classic adverse effects of steroid therapy, which is often part of treatment for Hodgkins disease. These include the physical signs of Cushings syndrome (weight gain, moon facies, thin skin, muscle weakness, and brittle bones), along with cataracts, hypertension, increased appetite, elevated blood sugar, indigestion, insomnia, nervousness, restlessness, and immunosuppression. However, in addition, prednisone is known to produce profound mood changes known as glucocorticoid psychosis. A is Incorrect. Rationale: The typical adverse effects of bleomycin are pulmonary fibrosis, skin changes, and myelosuppression. Bleomycin is part of the ABVD cancer chemotherapy regimen against Hodgkins: Adriamycin (doxorubicin), Bleomycin, Vinblastine, and Dacarbazine. C is Incorrect. Oncology Nurse Test Questions Rationale: Common adverse effects of vincristine are areflexia and peripheral neuritis. Vincristine is part of the MOPP cancer chemotherapy regimen used against Hodgkins disease: Mechlorethamine, vincristine (Oncovin), Procarbazine, and Prednisone. D is Incorrect. Rationale: Wildly swinging mood is suggestive of cyclothymic disorders, which are common in patients with chronic medical illness. However, given that this disorder requires 2 years of symptoms before a definitive diagnosis can be made, the most likely cause is glucocorticoid psychosis. 12) A - Correct Oncology Nurse Test Questions Rationale: The patient has a hydatidiform mole. Hydatidiform moles are cystic swellings of the chorionic villi. They usually present in the fourth and fifth months of pregnancy with vaginal bleeding. On exam the uterus is -hCG level isFlarger than expected for gestational age and the serum much higher than normal. Moles can be either partial or complete and are caused by either fertilization of an egg that has lost its chromosomes or fertilization of a normal egg with two sperm. Partial moles may contain some fetal tissue but no viable fetus, and a complete mole contains no fetal tissue. Hydatidiform moles must be surgically removed because the chorionic villi may embolize to distant sites and because moles may lead to choriocarcinoma, an aggressive neoplasm that metastasizes early but is very responsive to

chemotherapy. B is Incorrect. Rationale: Coma is a possible outcome of eclampsia, not of a hydatidiform mole. Preeclampsia is the triad of hypertension, proteinuria, and edema. Eclampsia occurs when seizures accompany the symptoms of preeclampsia. This patient does not have any of these symptoms. C is Incorrect. Oncology Nurse Test Questions Rationale: Neural tube defects are usually detected in utero by increased -fetoprotein levels in amnioticE -hCG levelsFfluid and maternal serum; are normal in these patients. D is Incorrect. Rationale: Ovarian cancers are often accompanied by an increase in blood cancer -hCG levels. This patient has aFantigen 125 levels, not hydatidiform mole, not ovarian cancer. Hydatidiform moles do not predispose patients to ovarian cancer. 13) D - Correct Oncology Nurse Test Questions Rationale: When -globin genes are missing (as in the most severe type ofEthe -thalassemia), excess gamma-globin chains accumulate, leading to theE formation of tetramers known as hemoglobin Barts. These tetramers bind so strongly to oxygen that the fetal tissues are not oxygenated properly. This severe tissue anoxia leads to hydrops fetalis, an abnormal fluid accumulation in at least 2 fetal compartments. A is Incorrect. Rationale: -globin genes isE-Thalassemia occurs when one or more E deleted, leading to accumulation of other globin chains. For this reason, one -globin chains inEwould not expect to see accumulation of -globin chains would be expected inE-thalassemia. Excess E -thalassemiaF -Thalassemia usually does not haveFminor or major. negative effects on -chains are not expressed untilFthe fetus because after birth. B is Incorrect. -thalassemiaE-chains in ERationale: There is no excess of C is Incorrect. Excess Rationale: -globin chains would be seen in the case of hemoglobin HF (HbH) disease -globinEthalassemia), in which three E(another type of chains have -globin chains make tetramers known asFbeen deleted. Here, HbH. HbH does have a higher affinity for oxygen, and there is usually tissue hypoxia associated with this disease. However, hydrops fetalis is not associated with this condition because the hypoxia occurs in the adult -chains are expressed.Fwhen 14) D - Correct Oncology Nurse Test Questions Rationale: This vignette suggests a malignancy of the liver. Hepatomas are highly associated with chronic hepatitis B and C infections, which are often

found in health care workers due to needle stick injuries. Other risk factors for hepatomas include Wilsons disease, hemochromatosis, -1-antitrypsin deficiency, and carcinogens.Ealcoholic cirrhosis, -Fetoprotein is a marker for hepatomas but can also be elevated inE patients with germ cell tumors, such as yolk sac tumors. Tumor markers should not be used for primary diagnoses, but for confirmation and to monitor therapy. A is Incorrect. Rationale: -human chorionicFThe marker for choriocarcinoma is gonadotropin. This marker is also elevated with hydatidiform moles and gestational trophoblastic tumors. The presence of a hepatoma has no effect on this marker. B is Incorrect. Rationale: The marker for colorectal carcinoma is carcinoembryonic antigen. This marker is nonspecific and is also produced by pancreatic, gastric, and breast carcinomas. The presence of a hepatoma has no effect on this marker. C is Incorrect. Rationale: The marker for melanoma is S-100. This marker also is elevated with neural tumors and astrocytomas. The presence of a hepatoma has no effect on this marker. 15) A - Correct Oncology Nurse Test Questions Rationale: Neoplastic B lymphocytes are the cells of origin in most non-Hodgkins lymphomas (90% of cases), with the notable exception of lymphoblastic lymphoma, which is typically dominated by T lymphocytes. B is Incorrect. Rationale: Myeloblasts are the neoplastic cells in acute myelogenous leukemia. C is Incorrect. Rationale: Plasma cells are the neoplastic cells in multiple myeloma. Multiple myeloma also affects patients in their 50s and 60s. However, at presentation patients with multiple myeloma usually have pathologic fracture caused by lytic lesions, hypercalcemia because of bone resorption, and repeated infection because of decreased production of normal immunoglobulins. Urine analysis in patients with multiple myeloma shows Bence Jones proteinuria with a monoclonal spike on electrophoresis. D is Incorrect. Rationale: Reed-Sternberg cells are the neoplastic cells in Hodgkins disease. Under light microscopy, Reed-Sternberg cells appear as large binucleate cells with abundant cytoplasm and large owl-eye nucleoli.