# Clinical context An adult with B-cell precursor acute lymphoblastic leukemia develops fever, hypotension, hypoxemia, confusion, word-finding difficulty, and tremor 18 hours after a continuous blinatumomab infusion begins, raising concern for concurrent cytokine release syndrome and neurologic toxicity. Highlight the new findings that support simultaneous cytokine release syndrome and neurologic toxicity during blinatumomab therapy. Do not select stable baseline or unrelated findings.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522590&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Clinical context
An adult with B-cell precursor acute lymphoblastic leukemia develops fever, hypotension, hypoxemia, confusion, word-finding difficulty, and tremor 18 hours after a continuous blinatumomab infusion begins, raising concern for concurrent cytokine release syndrome and neurologic toxicity.

Highlight the new findings that support simultaneous cytokine release syndrome and neurologic toxicity during blinatumomab therapy. Do not select stable baseline or unrelated findings.

Infusion Record\nA 46-year-old client with B-cell precursor acute lymphoblastic leukemia with normal orientation and language before treatment began continuous blinatumomab infusion 18 hours ago. The client now has temperature 39.3 C, blood pressure 82/48 mm Hg, oxygen saturation 89% on room air, new confusion, difficulty naming common objects, and a new hand tremor. The blood glucose is 104 mg/dL, and the pupils are equal and reactive.

## Explanation

High fever, hypotension, hypoxemia, new confusion, a speech disturbance, and a new tremor after blinatumomab begins are urgent cues for cytokine release syndrome with neurologic toxicity.

## In-depth explanation

Quick answer
Recognize systemic inflammation and new neurologic dysfunction together.

Why this is correct
Blinatumomab can cause life-threatening cytokine release syndrome and serious neurologic toxicity, including ICANS. Both syndromes require prompt recognition and interruption or discontinuation according to severity.

Easy analogy or mental picture
Use a closed medication-safety loop: identify the immune or cytotoxic exposure, connect the new findings, interrupt further harm, stabilize the client, and verify the response over time.

Memory hook
Exposure, immune effect, organ toxicity, infection risk, immediate action, and serial reassessment.

NCLEX decision rule
Choose the action that reduces the most immediate medication-related risk while preserving diagnostic evaluation and authorized treatment.

Why the other choices are wrong
Options that continue the exposure, treat only one symptom, or delay reassessment leave the toxic or infectious process active.References
1DailyMed: BLINCYTO (blinatumomab)Cytokine release syndrome, neurologic toxicity including ICANS, interruption, corticosteroid treatment, and monitoring

## Clinical scenario

Clinical context
An adult with B-cell precursor acute lymphoblastic leukemia develops fever, hypotension, hypoxemia, confusion, word-finding difficulty, and tremor 18 hours after a continuous blinatumomab infusion begins, raising concern for concurrent cytokine release syndrome and neurologic toxicity.

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