AOCNP Surgical Oncology and Perioperative Care 3

Question 1

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

Accepted Answer

Optimizing physical fitness, nutrition, and psychological readiness before surgery

Answer

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.

Question 2

A patient undergoes abdominoperineal resection (APR) for rectal cancer and requires a permanent colostomy. Postoperative colostomy education should emphasize which priority?

Accepted Answer

Proper pouching system management, skin care, and expected output characteristics

Answer

Postoperative ostomy education is a critical nursing responsibility. Key teaching includes proper pouch application and changing (every 3–5 days or when leaking), peristomal skin assessment and protection, expected stool output, dietary modifications to manage odor/gas/consistency, and return to normal activities.

Question 3

In breast-conserving surgery (lumpectomy) for breast cancer, which additional procedure is performed to assess locoregional lymph node involvement with minimal morbidity?

Accepted Answer

Sentinel lymph node biopsy (SLNB)

Answer

SLNB is the standard nodal staging procedure for clinically node-negative breast cancer patients undergoing lumpectomy. By mapping lymphatic drainage to identify the first (sentinel) node(s), SLNB accurately predicts axillary nodal status while avoiding the lymphedema risk of complete ALND.

Question 4

Milking or stripping surgical drains placed after oncologic surgery is now generally discouraged because:

Accepted Answer

It creates excessive negative pressure that can damage healing tissue and increase drainage volume

Answer

Research has shown that aggressive milking/stripping of surgical drains creates excessive negative pressure (up to -300 mmHg) that can damage delicate healing tissue, disrupt lymphatic sealing, and paradoxically increase drainage volume. Current evidence-based guidelines recommend gentle stripping only to clear clots when drains are not functioning.

Question 5

Which lab value change in the immediate postoperative period after major cancer surgery most warrants notification of the surgical team?

Accepted Answer

Serum lactate >2 mmol/L with tachycardia and hypotension

Answer

Elevated serum lactate (>2 mmol/L) combined with tachycardia and hypotension in the postoperative period suggests tissue hypoperfusion and may indicate hemorrhage, sepsis, anastomotic leak, or other major complications requiring immediate intervention. This constellation represents a surgical emergency.

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP Surgical Oncology and Perioperative Care 3