Tumor Lysis Syndrome and Oncologic Emergencies Practice Questions
20 free Tumor Lysis Syndrome and Oncologic Emergencies practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
Which lab finding most supports a diagnosis of Tumor Lysis Syndrome in a patient with high-grade lymphoma undergoing chemotherapy?
- A Hypouricemia and hypophosphatemia
- B Hyperuricemia and hyperphosphatemia
- C Hypokalemia and hypercalcemia
- D Hypermagnesemia and metabolic alkalosis
Correct answer: Hyperuricemia and hyperphosphatemia
Tumor Lysis Syndrome is characterized by hyperuricemia and hyperphosphatemia due to massive tumor cell lysis.
Which scenario presents the highest risk for the development of Tumor Lysis Syndrome?
- A Slow-growing prostate cancer treated with hormonal therapy
- B Large tumor burden Burkitt lymphoma receiving cytotoxic chemotherapy
- C Early-stage breast cancer treated with surgery only
- D Adjuvant therapy for localized colon cancer with low tumor burden
Correct answer: Large tumor burden Burkitt lymphoma receiving cytotoxic chemotherapy
Tumor Lysis Syndrome is more likely in cases of large tumor burden malignancies receiving cytotoxic therapy.
What is the most critical nursing intervention for prevention of Tumor Lysis Syndrome?
- A Restrict all oral fluids for 24 hours before therapy
- B Give isotonic IV fluids before and after chemotherapy
- C Hold all antihypertensive medications during therapy
- D Administer high-dose IV potassium supplements
Correct answer: Give isotonic IV fluids before and after chemotherapy
The critical intervention for TLS prevention is aggressive IV hydration with isotonic fluids before, during, and after therapy.
When a patient with TLS has serum potassium of 6.8 mEq/L and peaked T-waves on ECG, what treatment would the nurse anticipate?
- A Intravenous calcium gluconate
- B Oral magnesium oxide
- C Intravenous sodium bicarbonate only
- D Oral phosphate binder alone
Correct answer: Intravenous calcium gluconate
Elevated potassium in TLS can cause cardiac arrhythmias, and administering intravenous calcium gluconate can stabilize cardiac membranes.
Which electrolyte pattern is characteristic of Tumor Lysis Syndrome?
- A Hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia
- B Hypokalemia, hypophosphatemia, hypercalcemia, hypouricemia
- C Hyperkalemia, hypophosphatemia, hypercalcemia, hyperuricemia
- D Hypokalemia, hyperphosphatemia, hypocalcemia, hypouricemia
Correct answer: Hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia
Tumor lysis causes spillage of intracellular contents, leading to hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia.
In hypercalcemia of malignancy, which initial therapy is most appropriate for a patient with calcium level of 15 mg/dL?
- A IV saline, loop diuretic, and a bisphosphonate
- B Fluid restriction with digoxin and observation
- C Oral calcium supplements together with vitamin D
- D Immediate hemodialysis as the sole intervention
Correct answer: IV saline, loop diuretic, and a bisphosphonate
Hypercalcemia of malignancy is treated with hydration, loop diuretics, and bisphosphonates to reduce resorption.
What oncologic emergency is most likely in a patient presenting with facial swelling, dyspnea, and dilated veins in the upper chest and neck?
- A Tumor lysis syndrome
- B Superior Vena Cava Syndrome
- C Hypercalcemia of malignancy
- D Spinal cord compression
Correct answer: Superior Vena Cava Syndrome
Superior Vena Cava Syndrome occurs due to compression of SVC, leading to facial and neck symptoms.
Which structure releases intracellular nucleic acids during Tumor Lysis Syndrome, contributing to elevated uric acid levels?
- A Mitochondria
- B Cytoskeleton
- C Nucleus
- D Ribosome
Correct answer: Nucleus
During tumor cell lysis, the nucleus releases nucleic acids that convert to uric acid in the liver.
When is the use of Rasburicase particularly indicated in managing TLS?
- A Uric acid levels remain normal before treatment
- B Known pre-existing G6PD deficiency is present
- C High-risk lymphoma with elevated uric acid and renal impairment
- D Moderate-risk patient with fully intact renal function
Correct answer: High-risk lymphoma with elevated uric acid and renal impairment
Rasburicase is indicated in high-risk TLS patients with elevated uric acid and renal impairment due to its rapid action on uric acid breakdown.
In a patient with TLS and oliguria, what intervention may be required with persistent hyperphosphatemia?
- A Peritoneal dialysis used as the only modality
- B Continuous cardiac monitoring without dialysis
- C Hemodialysis for refractory hyperphosphatemia and uremia
- D Oral hydration with watchful observation only
Correct answer: Hemodialysis for refractory hyperphosphatemia and uremia
Hemodialysis is recommended in TLS when there is acute kidney injury with persistent hyperphosphatemia.
Which symptom in a patient with malignancy should prompt urgent evaluation for hypercalcemia?
- A New-onset constipation, polyuria, and confusion
- B Mild fatigue reported as the only symptom
- C Occasional headache relieved by acetaminophen
- D Mild intermittent dependent peripheral edema
Correct answer: New-onset constipation, polyuria, and confusion
Symptoms like constipation, polyuria, and confusion are signs of hypercalcemia that require immediate attention.
What nursing measure best helps reduce the risk of TLS in a patient with acute lymphoblastic leukemia and high WBC count starting induction chemo?
- A Delay all hydration until after chemotherapy
- B Start allopurinol prophylactically before therapy
- C Administer potassium-rich maintenance fluids
- D Monitor a complete blood count only once daily
Correct answer: Start allopurinol prophylactically before therapy
Allopurinol given prophylactically helps prevent hyperuricemia and TLS before cytotoxic therapy.
Which ECG change is most likely in hyperkalemia associated with Tumor Lysis Syndrome?
- A Flattened T-waves
- B Peaked T-waves
- C Shortened QT interval
- D Prolonged PR interval
Correct answer: Peaked T-waves
Hyperkalemia in TLS often presents with peaked T-waves on ECG.
In a patient with bone metastases and severe hypercalcemia, what does calcium level of 16 mg/dL indicate?
- A Within the normal reference range
- B Mild elevation needing no intervention
- C Moderate elevation managed with oral fluids
- D Severe hypercalcemic crisis needing urgent treatment
Correct answer: Severe hypercalcemic crisis needing urgent treatment
Serum calcium level beyond 14 mg/dL indicates severe hypercalcemia requiring immediate intervention.
Why does hyperphosphatemia in Tumor Lysis Syndrome cause hypocalcemia?
- A Phosphate stimulates PTH release and lowers calcium
- B Calcium shifts intracellularly during cell lysis
- C Calcium and phosphate precipitate in renal tubules
- D Calcium binds albumin and becomes biologically inactive
Correct answer: Calcium and phosphate precipitate in renal tubules
Elevated phosphate binds to calcium, leading to formation of calcium-phosphate precipitates in kidneys, causing hypocalcemia.
Which oncologic emergency should be suspected in a lung cancer patient with sudden back pain, difficulty walking, and sensory changes in legs?
- A Tumor lysis syndrome
- B Spinal cord compression
- C Superior Vena Cava Syndrome
- D Hypercalcemia of malignancy
Correct answer: Spinal cord compression
Symptoms like back pain and neurological deficits suggest spinal cord compression, an oncologic emergency.
What laboratory monitoring frequency is recommended for a high-risk TLS patient during the first 24-48 hours after chemotherapy?
- A Once-daily routine laboratory panels only
- B Every 6-12 hours for electrolytes, uric acid, and creatinine
- C Every 72 hours unless the patient deteriorates
- D No laboratory monitoring until symptoms appear
Correct answer: Every 6-12 hours for electrolytes, uric acid, and creatinine
High-risk TLS patients should undergo lab monitoring every 6–12 hours to detect early derangements.
Why is bisphosphonate therapy indicated in hypercalcemia of malignancy?
- A It increases bone resorption and calcium release
- B It decreases osteoclast activity and calcium release
- C It acutely raises serum calcium levels
- D It has no measurable effect on bone metabolism
Correct answer: It decreases osteoclast activity and calcium release
Bisphosphonates reduce bone resorption by inhibiting osteoclast activity, lowering serum calcium levels.
When TLS occurs before chemotherapy in patients with high tumor burden, what is this scenario called?
- A Spontaneous tumor lysis syndrome
- B Delayed tumor lysis syndrome
- C Secondary chemotherapy syndrome
- D Tumor rebound syndrome
Correct answer: Spontaneous tumor lysis syndrome
Spontaneous TLS can occur prior to therapy in cases of high tumor burden, known as spontaneous tumor lysis syndrome.
Which symptom should a nurse prioritize for immediate assessment in a patient with suspected oncologic metabolic emergency?
- A Mild intermittent headache lasting a few minutes
- B Facial swelling first noticed after a long flight
- C Severe muscle cramps, oliguria, and ECG changes
- D Chronic generalized fatigue over several weeks
Correct answer: Severe muscle cramps, oliguria, and ECG changes
Severe muscle cramps, oliguria, and ECG changes suggest an acute metabolic oncologic emergency requiring urgent evaluation.