AOCNP Surgical Oncology and Perioperative Care 2 — Questions and Answers
Question 1: Which perioperative nursing assessment is most critical before major oncologic surgery involving general anesthesia?
- Administering prophylactic antibiotics 48 hours before surgery
- Comprehensive assessment of functional status, nutritional state, and comorbidities (Correct answer)
- Ensuring the patient has received chemotherapy within 2 weeks preoperatively
- Confirming the patient has fasted for less than 2 hours
Correct answer: Comprehensive assessment of functional status, nutritional state, and comorbidities
Preoperative assessment of functional status (ECOG/Karnofsky), nutritional status (weight loss, albumin/prealbumin), comorbidities, medication review, and psychosocial factors determines surgical risk, guides perioperative planning, and identifies need for prehabilitation to optimize outcomes.
Question 2: A patient post-Whipple procedure (pancreaticoduodenectomy) on day 2 develops significant drainage from the drain with amylase level >3× the serum amylase. This indicates which complication?
- Bile leak
- Postoperative pancreatic fistula (POPF) (Correct answer)
- Anastomotic hemorrhage
- Delayed gastric emptying
Correct answer: Postoperative pancreatic fistula (POPF)
Postoperative pancreatic fistula is defined by drain amylase >3× the upper limit of normal serum amylase on or after postoperative day 3. It is one of the most common serious complications after Whipple procedure, graded A (biochemical leak) to C (severe, requiring reoperation).
Question 3: Which complication is most commonly associated with total gastrectomy for gastric cancer and requires lifelong supplementation?
- Iron deficiency requiring IV iron infusion only
- Vitamin B12 deficiency due to loss of intrinsic factor (Correct answer)
- Calcium deficiency causing osteoporosis
- Vitamin D deficiency from malabsorption
Correct answer: Vitamin B12 deficiency due to loss of intrinsic factor
The stomach produces intrinsic factor, essential for vitamin B12 absorption in the terminal ileum. Total gastrectomy eliminates intrinsic factor production, causing pernicious anemia. Patients require lifelong vitamin B12 supplementation, typically by intramuscular injection since oral absorption is absent without intrinsic factor.
Question 4: Dump syndrome following gastric surgery or esophagectomy is characterized by which symptom cluster?
- Constipation, abdominal distension, weight gain
- Nausea, diarrhea, diaphoresis, palpitations after eating (early) or hypoglycemia (late) (Correct answer)
- Severe heartburn and regurgitation
- Obstipation and progressive vomiting
Correct 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.
Question 5: Venous thromboembolism (VTE) prophylaxis in cancer surgery patients typically involves which combination?
- Antiplatelet therapy (aspirin) alone
- Pharmacologic prophylaxis (LMWH) plus mechanical prophylaxis (sequential compression devices) (Correct answer)
- Warfarin anticoagulation starting immediately after surgery
- No prophylaxis — VTE risk is the same as general surgical patients
Correct answer: Pharmacologic prophylaxis (LMWH) plus mechanical prophylaxis (sequential compression devices)
Cancer patients have 2–6× higher VTE risk than non-cancer surgical patients due to hypercoagulability. Combined mechanical (SCDs) and pharmacologic (LMWH/heparin) prophylaxis beginning perioperatively, with extended prophylaxis for 28 days post-discharge for high-risk abdominal/pelvic cancer surgery, is standard of care.
Question 6: Which wound complication is most specifically associated with colorectal resection surgery and manifests as separation of abdominal fascial layers?
- Superficial surgical site infection
- Wound dehiscence (fascial separation) (Correct answer)
- Enterocutaneous fistula formation
- Anastomotic leak
Correct answer: Wound dehiscence (fascial separation)
Wound dehiscence (separation of fascial wound layers) is a serious complication of abdominal surgery, more common in patients who are immunocompromised, malnourished, obese, or received preoperative radiation/steroids. It requires urgent surgical consultation and may progress to evisceration if full-thickness.
AOCNP Surgical Oncology and Perioperative Care 2
Which perioperative nursing assessment is most critical before major oncologic surgery involving general anesthesia?