Mixed Deck — All AOCNP Topics Flashcards

Tobacco cessation counseling is a primary prevention intervention most critically indicated for which cancer risk reduction?

Answer: Lung, head and neck, bladder, esophageal, and pancreatic cancers

Tobacco is carcinogenic across multiple organ systems — smoking causes 30% of all cancer deaths and cessation reduces risk for at least 12 different cancer types.

A colorectal cancer survivor who completed curative resection should receive which surveillance study at 1 year post-surgery?

Answer: Colonoscopy at 1 year post-resection (if not done preoperatively), then per findings

ASCO/NCCN guidelines for colorectal cancer surveillance recommend colonoscopy at 1 year after surgery (or within 3–6 months if preoperative colonoscopy was incomplete). If normal, repeat at 3 years, then every 5 years, along with CEA monitoring every 3–6 months for 5 years and CT chest/abdomen/pelvis annually for 3–5 years.

A patient with metastatic colorectal cancer has a KRAS wild-type, RAS/RAF wild-type tumor. Which targeted therapy is most appropriate?

Answer: Cetuximab or panitumumab (anti-EGFR)

Anti-EGFR monoclonal antibodies (cetuximab, panitumumab) are only effective in metastatic colorectal cancer patients with RAS/RAF wild-type tumors. KRAS mutations cause downstream EGFR-independent activation, rendering anti-EGFR therapy ineffective in mutant patients.

A clinical instructor named Barbara is giving a presentation on chemotherapy. Which of the following claims regarding the pace of cell growth and chemotherapy is true?

Answer: Faster growing cells are more susceptible to chemotherapy

Chemotherapy and radiation therapy are more effective against cells that are growing more quickly.

For a patient with head and neck cancer undergoing concurrent chemoradiation who cannot maintain adequate oral intake due to mucositis, which nutritional support route is most appropriate?

Answer: Enteral nutrition via nasogastric or gastrostomy tube

When the GI tract is functional, enteral nutrition (via NG tube or prophylactic PEG/RIG) is the preferred route and is supported by ASPEN, ESPEN, and ASCO guidelines for patients who cannot maintain adequate oral intake. Enteral feeding maintains gut integrity, reduces infection risk, and is more physiologic than parenteral nutrition. TPN is reserved for patients with a non-functional GI tract. Oral supplements alone are insufficient if mucositis prevents adequate intake. IV dextrose provides calories but no protein or micronutrients.

Dump syndrome following gastric surgery or esophagectomy is characterized by which symptom cluster?

Answer: Nausea, diarrhea, diaphoresis, palpitations after eating (early) or hypoglycemia (late)

Dumping syndrome results from rapid gastric emptying of hyperosmolar contents into the small bowel. Early dumping (within 30 min) causes GI symptoms (nausea, cramping, diarrhea) and vasomotor symptoms (flushing, diaphoresis, tachycardia). Late dumping (1–3 h) causes reactive hypoglycemia. Management includes dietary modifications and small frequent meals.

Which taxane is approved for albumin-bound nanoparticle formulation to reduce hypersensitivity and improve delivery?

Answer: Nab-paclitaxel (Abraxane)

Nab-paclitaxel encapsulates paclitaxel in albumin nanoparticles, eliminating the Cremophor solvent that causes hypersensitivity reactions.

Which first-line intervention is indicated for hypercalcemia of malignancy with corrected serum calcium > 14 mg/dL?

Answer: Aggressive IV normal saline hydration followed by bisphosphonate

Aggressive IV normal saline rehydration is the immediate priority, followed by a bisphosphonate such as zoledronic acid to lower calcium.

Which intervention has the strongest evidence base for reducing cancer-related fatigue (CRF) in patients who have completed active treatment?

Answer: Aerobic exercise and physical activity

Multiple systematic reviews and RCTs support aerobic exercise as the most effective intervention for cancer-related fatigue in survivors, improving both fatigue severity and quality of life. Corticosteroids are used short-term in palliative contexts. Methylphenidate has modest evidence and is typically reserved for specific populations with severe fatigue. Prolonged rest paradoxically worsens CRF by reducing physical conditioning and disrupting sleep architecture.

EGFR-mutated non-small cell lung cancer (NSCLC) is most effectively treated with which class of targeted agents?

Answer: EGFR tyrosine kinase inhibitors (e.g., osimertinib)

EGFR TKIs, particularly third-generation osimertinib, are first-line standard of care for EGFR-mutated (exon 19 deletion or L858R) NSCLC. Osimertinib also covers T790M resistance mutations and has better CNS penetration compared to first/second-generation TKIs.

A patient on venetoclax for AML develops tumor lysis syndrome (TLS). Which lab finding is NOT a feature of TLS?

Answer: Hypercalcemia

TLS causes hypocalcemia (not hypercalcemia) because phosphate released from lysed cells binds calcium, lowering serum levels.

An AOCNP is managing a patient on tamoxifen who is also prescribed paroxetine for depression. What is the primary concern?

Answer: Paroxetine inhibits CYP2D6, reducing conversion of tamoxifen to its active metabolite endoxifen

Paroxetine is a potent CYP2D6 inhibitor that significantly reduces conversion of tamoxifen to endoxifen, potentially reducing efficacy of hormonal therapy.

Protocol deviation vs. protocol violation in clinical trials: which is more serious and requires immediate reporting?

Answer: Protocol violation — deviations that affect participant safety, data integrity, or rights, requiring immediate IRB and sponsor reporting

Protocol violations (also called serious deviations) are departures that have potential to affect participant safety, rights, or welfare, or to significantly impact data integrity or trial conduct. These require prompt reporting to the IRB/IEC, sponsor, and regulatory authorities. Minor deviations without impact are documented but have lower reporting urgency.

A male patient completes prostate radiation therapy and reports erectile dysfunction 18 months later. The MOST likely etiology of this late effect is:

Answer: Radiation-induced fibrosis of the neurovascular bundles and penile vasculature

Late radiation-induced erectile dysfunction is primarily caused by damage to the neurovascular bundles lateral to the prostate and radiation arteritis affecting penile blood flow.

Which nursing intervention is most important for patients receiving pelvic radiation to prevent vaginal stenosis?

Answer: Use of vaginal dilators beginning 2–4 weeks after radiation completion

Vaginal dilators are recommended beginning 2–4 weeks after pelvic radiation completion (or sooner as tolerated) to prevent fibrosis and stenosis. Regular sexual activity or dilator use maintains vaginal patency and reduces scar tissue formation, preserving quality of life and facilitating follow-up gynecologic exams.

The USPSTF recommends against which cancer screening test due to insufficient evidence of benefit in average-risk asymptomatic adults?

Answer: Annual CA-125 for ovarian cancer screening in average-risk women

The USPSTF gives a D recommendation (recommend against) for ovarian cancer screening with CA-125 and transvaginal ultrasound in average-risk asymptomatic women, as evidence shows it does not reduce mortality and leads to harmful false-positive surgical interventions.

All of these symptoms are reported by a patient who is getting interleukin-2 (IL-2) therapy (Proleukin). Which one needs to be reported to the healthcare provider first?

Answer: Dyspnea

Dyspnea may be a sign of pulmonary edema and capillary leak syndrome, both of which need prompt medical attention.

At what age does the USPSTF recommend initiating annual low-dose CT (LDCT) screening for lung cancer in high-risk individuals?

Answer: 50 years

The USPSTF (2021 update) recommends annual LDCT screening beginning at age 50 for adults with a 20-pack-year history who currently smoke or quit within the past 10 years.

Chemotherapy-induced peripheral neuropathy (CIPN) most commonly occurs with which drug class?

Answer: Platinum compounds (oxaliplatin, cisplatin) and taxanes (paclitaxel)

CIPN predominantly affects the peripheral sensory (and less commonly motor) nerves and most commonly results from platinums (particularly oxaliplatin causing acute cold dysesthesia and chronic sensory loss) and taxanes (paclitaxel causing dose-dependent sensory neuropathy). Vinca alkaloids primarily cause motor neuropathy.

Prehabilitation in the preoperative period for cancer surgery focuses on which intervention?

Answer: Optimizing physical fitness, nutrition, and psychological readiness before surgery

Prehabilitation is a multimodal preoperative program including aerobic and resistance exercise, nutritional optimization (protein supplementation, addressing deficiencies), and anxiety management. It has been shown to reduce postoperative complications, shorten length of stay, and improve functional recovery particularly for major abdominal and thoracic cancer surgeries.