A man with a high-grade lymphoma is to start chemotherapy, and rasburicase is ordered to prevent tumour lysis syndrome. His record shows G6PD deficiency. What should the nurse do?

Hold the dose and inform the prescriber

Give half the dose and recheck uric acid

Give the dose with extra IV fluids

Give the dose after a paracetamol premedication

A patient receiving high-dose chemotherapy has painful oral mucositis. Which mouth care instruction should the nurse give?

Rinse with plain saline or bicarbonate several times a day

Suck lemon-glycerine swabs to keep the mouth moist

Brush firmly with a medium toothbrush to remove debris

Rinse with an alcohol-based mouthwash after each meal

A positive hepatitis B surface antigen (HBsAg) result means that the patient:

Has recovered from past infection

On day 3 after a total knee replacement, four findings are noted in the same patient. Which one needs the nurse's immediate action?

Sudden sharp chest pain with SpO2 88% on room air

Moderate knee swelling and bruising around the wound

Pain 5/10 during continuous passive motion

Temperature 37.6 degrees C with clear lung sounds

After a total hip replacement through a posterior approach, which movement should the patient avoid to prevent dislocation?

Bending the hip beyond 90 degrees

Sitting on a raised toilet seat

Keeping a pillow between the knees

Oncology, haematology, musculoskeletal and infectious disease

38 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Oncology, haematology, musculoskeletal and infectious disease, part of Adult Health Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A man with a high-grade lymphoma is to start chemotherapy, and rasburicase is ordered to prevent tumour lysis syndrome. His record shows G6PD deficiency. What should the nurse do?
1. AGive half the dose and recheck uric acid
2. BHold the dose and inform the prescriber
3. CGive the dose with extra IV fluids
4. DGive the dose after a paracetamol premedication
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Answer: B · Hold the dose and inform the prescriber
Rasburicase breaks down uric acid and produces hydrogen peroxide. People with G6PD deficiency cannot neutralise this oxidant, so rasburicase can cause severe haemolysis and methaemoglobinaemia, and it is contraindicated. The nurse withholds it and contacts the prescriber, who will usually choose allopurinol with aggressive hydration. G6PD deficiency is common in the Gulf, so screening before rasburicase matters.
- A: A reduced dose is still contraindicated and unsafe.
- C: Extra fluid does not prevent oxidative haemolysis.
- D: Paracetamol does not protect red cells from hydrogen peroxide.
Question 2 · Medium
A patient receiving high-dose chemotherapy has painful oral mucositis. Which mouth care instruction should the nurse give?
1. ASuck lemon-glycerine swabs to keep the mouth moist
2. BBrush firmly with a medium toothbrush to remove debris
3. CRinse with plain saline or bicarbonate several times a day
4. DRinse with an alcohol-based mouthwash after each meal
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Answer: C · Rinse with plain saline or bicarbonate several times a day
Mucositis leaves the oral lining thin and ulcerated, and it is a portal for infection in a patient who is often neutropenic. Frequent bland rinses with saline or sodium bicarbonate solution clean the mouth without irritation, and a soft toothbrush is used gently. Alcohol mouthwashes and lemon-glycerine swabs dry and sting the mucosa. Pain relief and soft, bland, cool foods help the patient keep eating.
- A: Lemon-glycerine is acidic and drying and worsens mucositis.
- B: Firm brushing traumatises fragile mucosa; a soft brush is used gently.
- D: Alcohol dries and irritates ulcerated mucosa.
Question 3 · Easy
A positive hepatitis B surface antigen (HBsAg) result means that the patient:
1. AIs currently infected
2. BHas recovered from past infection
3. CIs immune after vaccination
4. DHas never met the virus
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Answer: A · Is currently infected
HBsAg is a protein of the viral coat and is present in the blood whenever the virus is present, in acute or chronic infection. Its presence means the patient is infected and can transmit the virus. Persistence of HBsAg for more than six months defines chronic infection. Immunity is shown by anti-HBs, not by HBsAg.
- B: Recovery is shown by loss of HBsAg with anti-HBs and anti-HBc present.
- C: Vaccine immunity is shown by anti-HBs with a negative anti-HBc.
- D: A positive HBsAg proves exposure to the virus.
Question 4 · Hard
On day 3 after a total knee replacement, four findings are noted in the same patient. Which one needs the nurse's immediate action?
1. AModerate knee swelling and bruising around the wound
2. BPain 5/10 during continuous passive motion
3. CSudden sharp chest pain with SpO2 88% on room air
4. DTemperature 37.6 degrees C with clear lung sounds
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Answer: C · Sudden sharp chest pain with SpO2 88% on room air
Sudden pleuritic chest pain with low oxygen saturation after lower-limb joint replacement suggests pulmonary embolism, a leading cause of death after this surgery. The nurse stays with the patient, sits him up, gives oxygen and calls the rapid response team. Pain during continuous passive motion, a low-grade temperature in the first days and knee swelling with bruising are expected after a knee replacement. Prophylaxis with an anticoagulant and early mobilisation reduce the risk.
- A: Swelling and bruising are expected after knee replacement.
- B: Moderate pain with CPM is expected and treated with planned analgesia.
- D: A mild temperature with clear lungs is common in the first days after surgery.
Question 5 · Easy
After a total hip replacement through a posterior approach, which movement should the patient avoid to prevent dislocation?
1. ASitting on a raised toilet seat
2. BLying flat on the back in bed
3. CKeeping a pillow between the knees
4. DBending the hip beyond 90 degrees
Show answerHide answer
Answer: D · Bending the hip beyond 90 degrees
With a posterior approach, flexion beyond 90 degrees, adduction past the midline and internal rotation push the femoral head out of the back of the socket. Patients are taught not to bend forward, cross their legs or sit on low chairs. An abduction pillow or a pillow between the knees, a raised toilet seat and a high, firm chair keep the hip in a safe position. Precautions are usually kept for about six weeks or as the surgeon directs.
- A: A raised toilet seat limits hip flexion and is recommended.
- B: Lying supine keeps the hip extended and is a safe position.
- C: A pillow between the knees keeps the hip abducted, which protects it.
Question 6 · Medium
A newly diagnosed HIV patient has a CD4 count of 150 cells/microlitre. In addition to antiretroviral therapy, the nurse expects which medicine to be started to prevent Pneumocystis pneumonia?
1. AAciclovir
2. BIsoniazid
3. CFluconazole
4. DCo-trimoxazole
Answer and explanation in LearnFree account
Question 7 · Hard
Two days after starting chemotherapy for Burkitt lymphoma, a patient's results are: potassium 6.6 mmol/L (3.5-5.0), phosphate 2.4 mmol/L (0.8-1.5), calcium 1.8 mmol/L (2.2-2.6), uric acid 720 micromol/L, creatinine rising, urine output 20 mL/h. What is the nurse's priority?
1. ARestrict IV fluids because urine output is low
2. BGive an oral calcium supplement with the next meal
3. CStart cardiac monitoring and report urgently
4. DEncourage a high-potassium diet to replace losses
Answer and explanation in LearnFree account
Question 8 · Medium
A man on antiretroviral therapy asks whether he can infect his wife. His viral load has been undetectable on every test for the past year. Which response is accurate?
1. AHe can stop condoms only after his CD4 count reaches normal
2. BWith a sustained undetectable viral load, sexual transmission does not occur
3. CHe must stop ART first to check whether he is cured
4. DHe remains highly infectious until a cure is found
Answer and explanation in LearnFree account
Question 9 · Hard
A woman in Buck's traction for a hip fracture is checked: weights of 3 kg hanging freely, rope in the pulley groove, skin under the wrap pink and blanching, hip pain 4/10, and new numbness between the first and second toes with weak upward movement of the foot. Which finding needs urgent action?
1. APink, blanching skin under the traction wrap
2. BWeights of 3 kg hanging freely from the pulley
3. CHip pain of 4/10 while lying in traction
4. DNumbness of the toes with weak dorsiflexion
Answer and explanation in LearnFree account
Question 10 · Medium
A neutropenic patient on the oncology ward develops a temperature of 38.6 degrees C. Blood cultures have just been taken from the central line and a peripheral vein. The nurse's next priority is to:
1. AWait for the culture results before antibiotics
2. BGive paracetamol and recheck the temperature
3. CGive the first IV antibiotic dose at once
4. DSend a urine sample and await the result
Answer and explanation in LearnFree account
Question 11 · Easy
A young man with sickle cell disease plans to fast during Ramadan in the summer. Which factor most raises his risk of a vaso-occlusive crisis while fasting?
1. AA high intake of fresh fruit at iftar
2. BSleeping for a short time after iftar
3. CDehydration over the long fasting day
4. DTaking his folic acid tablet at suhoor
Answer and explanation in LearnFree account
Question 12 · Medium
A patient in skeletal traction has four pin sites. Which pin-site finding should the nurse report?
1. AMild tenderness when the pin is touched
2. BThick yellow drainage with spreading redness
3. CA small crust of dried serous fluid
4. DClear, thin fluid in the first 48 hours
Answer and explanation in LearnFree account
Question 13 · Easy
Hepatitis C is most often acquired through:
1. AContaminated food and water
2. BContact with infected blood
3. CRespiratory droplets
4. DCasual contact such as hugging
Answer and explanation in LearnFree account
Question 14 · Medium
A man with sickle cell disease is started on hydroxyurea (hydroxycarbamide). Which explanation of how it helps is correct?
1. AIt dissolves clots inside small blood vessels
2. BIt raises fetal haemoglobin to reduce sickling
3. CIt removes excess iron from the liver and heart
4. DIt replaces folic acid used up by haemolysis
Answer and explanation in LearnFree account
Question 15 · Easy
A woman with iron-deficiency anaemia is starting oral ferrous sulphate tablets. The nurse should teach her to take each tablet with:
1. AA cup of tea
2. BA glass of orange juice
3. CA glass of milk
4. DAn antacid tablet
Answer and explanation in LearnFree account
Question 16 · Easy
A patient with chemotherapy-induced neutropenia is in a protective-environment room. Which item brought by the family should the nurse ask them to take home?
1. AA sealed box of dates from a shop
2. BA freshly laundered cotton prayer mat
3. CA printed copy of the Holy Quran
4. DA vase of fresh flowers in water
Answer and explanation in LearnFree account
Question 17 · Medium
A man arrives at triage with fever, cough and shortness of breath. He works on a camel farm. The triage nurse's first action is to:
1. AMask him and move him to an isolation room
2. BSeat him in the main waiting area to await the doctor
3. CCollect a nasopharyngeal swab at the triage desk
4. DTake a full history before deciding on isolation
Answer and explanation in LearnFree account
Question 18 · Hard
An 80-year-old man with heart failure is receiving his second unit of red cells. After 90 minutes he becomes breathless. BP 172/98 mmHg (was 138/80), HR 112/min, temperature 37.0 degrees C, raised JVP, crackles in both lung bases, SpO2 89%. After stopping the transfusion, the nurse anticipates:
1. AIV adrenaline for anaphylaxis
2. BBroad-spectrum antibiotics for bacterial contamination
3. CRapid IV fluid boluses for hypotension
4. DSitting him upright, oxygen and an IV diuretic
Answer and explanation in LearnFree account
Question 19 · Medium
Pre-employment screening of a nurse shows HBsAg negative, anti-HBc positive and anti-HBs positive. How should the nurse's result be interpreted?
1. AImmune because of vaccination only
2. BImmune because of past natural infection
3. CChronic hepatitis B infection
4. DSusceptible and needs vaccination
Answer and explanation in LearnFree account
Question 20 · Medium
A woman's red cell transfusion began 10 minutes ago. She now has rigors, temperature 38.9 degrees C, lower back pain and BP 90/50 mmHg. What should the nurse do first?
1. AStop the transfusion and keep the vein open with saline
2. BSlow the transfusion rate and recheck all the vital signs
3. CGive paracetamol and continue the transfusion
4. DFlush the blood tubing with saline and restart it
Answer and explanation in LearnFree account
Question 21 · Medium
A 20-year-old man known to have G6PD deficiency comes to the emergency department with jaundice, tiredness and dark urine. Which item in his history is the most likely trigger?
1. AParacetamol taken at the usual dose
2. BA long shift in an air-conditioned office
3. CA meal of grilled chicken and rice
4. DA meal of ful made from fava beans
Answer and explanation in LearnFree account
Question 22 · Hard
A unit of packed red cells of 300 mL is to be given over 2 hours. The blood administration set delivers 15 drops/mL. What drip rate should the nurse set?
1. A150 drops/min
2. B38 drops/min
3. C25 drops/min
4. D75 drops/min
Answer and explanation in LearnFree account
Question 23 · Medium
After caring for a COVID-19 patient, the nurse removes personal protective equipment. Which item should be removed last?
1. AThe eye protection, before removing the gloves
2. BThe gown, after leaving the room
3. CThe N95 respirator, after leaving the room
4. DThe gloves, after removing the respirator
Answer and explanation in LearnFree account
Question 24 · Easy
The nurse is assisting with endotracheal intubation of a patient with confirmed COVID-19. The respiratory protection the nurse should wear is:
1. AA cloth face covering
2. BA surgical mask alone
3. CA face shield without a mask
4. DA fit-tested N95 or FFP2 respirator
Answer and explanation in LearnFree account
Question 25 · Easy
After receiving IV cyclophosphamide, a patient needs help to empty a urinal. For at least 48 hours after the dose, the nurse handling the urine should:
1. AWear chemotherapy-tested gloves and a gown
2. BAdd bleach to the urine before emptying it
3. CWear a surgical mask only
4. DUse clean hands without gloves
Answer and explanation in LearnFree account

13 more Oncology, haematology, musculoskeletal and infectious disease questions

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Oncology, haematology, musculoskeletal and infectious disease

A man with a high-grade lymphoma is to start chemotherapy, and rasburicase is ordered to prevent tumour lysis syndrome. His record shows G6PD deficiency. What should the nurse do?

A patient receiving high-dose chemotherapy has painful oral mucositis. Which mouth care instruction should the nurse give?

A positive hepatitis B surface antigen (HBsAg) result means that the patient:

On day 3 after a total knee replacement, four findings are noted in the same patient. Which one needs the nurse's immediate action?

After a total hip replacement through a posterior approach, which movement should the patient avoid to prevent dislocation?

A newly diagnosed HIV patient has a CD4 count of 150 cells/microlitre. In addition to antiretroviral therapy, the nurse expects which medicine to be started to prevent Pneumocystis pneumonia?

Two days after starting chemotherapy for Burkitt lymphoma, a patient's results are: potassium 6.6 mmol/L (3.5-5.0), phosphate 2.4 mmol/L (0.8-1.5), calcium 1.8 mmol/L (2.2-2.6), uric acid 720 micromol/L, creatinine rising, urine output 20 mL/h. What is the nurse's priority?

A man on antiretroviral therapy asks whether he can infect his wife. His viral load has been undetectable on every test for the past year. Which response is accurate?

A woman in Buck's traction for a hip fracture is checked: weights of 3 kg hanging freely, rope in the pulley groove, skin under the wrap pink and blanching, hip pain 4/10, and new numbness between the first and second toes with weak upward movement of the foot. Which finding needs urgent action?

A neutropenic patient on the oncology ward develops a temperature of 38.6 degrees C. Blood cultures have just been taken from the central line and a peripheral vein. The nurse's next priority is to:

A young man with sickle cell disease plans to fast during Ramadan in the summer. Which factor most raises his risk of a vaso-occlusive crisis while fasting?

A patient in skeletal traction has four pin sites. Which pin-site finding should the nurse report?

Hepatitis C is most often acquired through:

A man with sickle cell disease is started on hydroxyurea (hydroxycarbamide). Which explanation of how it helps is correct?

A woman with iron-deficiency anaemia is starting oral ferrous sulphate tablets. The nurse should teach her to take each tablet with:

A patient with chemotherapy-induced neutropenia is in a protective-environment room. Which item brought by the family should the nurse ask them to take home?

A man arrives at triage with fever, cough and shortness of breath. He works on a camel farm. The triage nurse's first action is to:

An 80-year-old man with heart failure is receiving his second unit of red cells. After 90 minutes he becomes breathless. BP 172/98 mmHg (was 138/80), HR 112/min, temperature 37.0 degrees C, raised JVP, crackles in both lung bases, SpO2 89%. After stopping the transfusion, the nurse anticipates:

Pre-employment screening of a nurse shows HBsAg negative, anti-HBc positive and anti-HBs positive. How should the nurse's result be interpreted?

A woman's red cell transfusion began 10 minutes ago. She now has rigors, temperature 38.9 degrees C, lower back pain and BP 90/50 mmHg. What should the nurse do first?

A 20-year-old man known to have G6PD deficiency comes to the emergency department with jaundice, tiredness and dark urine. Which item in his history is the most likely trigger?

A unit of packed red cells of 300 mL is to be given over 2 hours. The blood administration set delivers 15 drops/mL. What drip rate should the nurse set?

After caring for a COVID-19 patient, the nurse removes personal protective equipment. Which item should be removed last?

The nurse is assisting with endotracheal intubation of a patient with confirmed COVID-19. The respiratory protection the nurse should wear is:

After receiving IV cyclophosphamide, a patient needs help to empty a urinal. For at least 48 hours after the dose, the nurse handling the urine should: