# 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. Place the actions in the safest sequence.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522594&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.

Place the actions in the safest sequence.

Interrupt blinatumomab and activate urgent oncology and rapid-response assistance.

Administer authorized corticosteroid and other syndrome-directed supportive treatment based on severity.

Repeat vital signs and structured neurologic assessments and clarify whether treatment remains withheld, is modified, or is discontinued.

Obtain ordered cultures, metabolic studies, and focused neurologic evaluation without delaying stabilization.

Assess and support airway, breathing, circulation, oxygenation, and immediate neurologic safety.

## Explanation

The sequence stops the causal exposure, stabilizes vital functions, evaluates overlapping causes, delivers authorized syndrome-directed treatment, and verifies a durable response before any treatment decision.

## In-depth explanation

Quick answer
Sequence interrupt, stabilize, investigate, treat, and reassess.

Why this is correct
Laboratory evaluation and infection workup proceed rapidly but never delay support for shock, hypoxemia, seizure, or declining consciousness.

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.

## Related questions

- [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en)
- [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=en)
- [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=en)
- [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. Before the next do…](https://mymerci.kr/pages/nclex_q.php?qn_id=362833&lang=en)
- [A client with bipolar disorder has been taking lithium carbonate 600 mg orally three times…](https://mymerci.kr/pages/nclex_q.php?qn_id=362894&lang=en)
- [A nurse is monitoring a client receiving a continuous IV heparin infusion for pulmonary em…](https://mymerci.kr/pages/nclex_q.php?qn_id=363988&lang=en)
- [A nurse is preparing to initiate a weight-based continuous IV unfractionated heparin infus…](https://mymerci.kr/pages/nclex_q.php?qn_id=364107&lang=en)
- [A nurse is providing discharge teaching to a 65-year-old client newly prescribed warfarin …](https://mymerci.kr/pages/nclex_q.php?qn_id=364872&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=522594&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=522594&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=522594&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=522594&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=522594&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._