AOCNP Advance Oncology Nursing 2 — Questions and Answers
Question 1: A patient receiving cisplatin-based chemotherapy develops tinnitus and decreased high-frequency hearing. Which intervention is most appropriate?
- Reduce the cisplatin dose by 25% and continue
- Discontinue cisplatin and notify the oncologist immediately (Correct answer)
- Administer amifostine prophylactically before the next cycle
- Document the finding and reassess at the next scheduled visit
Correct answer: Discontinue cisplatin and notify the oncologist immediately
Tinnitus and high-frequency hearing loss are signs of cisplatin-induced ototoxicity, which requires immediate discontinuation and oncologist notification.
Question 2: Which grading tool is most appropriate for evaluating chemotherapy-induced peripheral neuropathy (CIPN) severity in clinical oncology practice?
- Karnofsky Performance Scale
- NCI Common Terminology Criteria for Adverse Events (CTCAE) (Correct answer)
- Eastern Cooperative Oncology Group (ECOG) scale
- Functional Assessment of Cancer Therapy (FACT-G)
Correct answer: NCI Common Terminology Criteria for Adverse Events (CTCAE)
The NCI CTCAE provides standardized grading (1–4) for peripheral neuropathy and is the standard tool used in oncology clinical trials and practice.
Question 3: A patient on pembrolizumab develops a skin rash covering 35% of body surface area with mucosal involvement. What is the FIRST priority action?
- Apply topical corticosteroids and continue pembrolizumab
- Hold pembrolizumab and initiate systemic corticosteroids
- Permanently discontinue pembrolizumab and initiate IV corticosteroids (Correct answer)
- Reduce pembrolizumab dose by 50%
Correct answer: Permanently discontinue pembrolizumab and initiate IV corticosteroids
Grade 3 immune-mediated dermatitis with mucosal involvement requires permanent discontinuation of the checkpoint inhibitor and systemic high-dose corticosteroids.
Question 4: When counseling a premenopausal woman with hormone receptor-positive breast cancer about fertility preservation, which option is safest prior to chemotherapy?
- Oral contraceptive pills to suppress ovarian function
- Embryo or oocyte cryopreservation before chemotherapy (Correct answer)
- Immediate chemotherapy initiation to avoid tumor progression
- GnRH agonist therapy started concurrently with chemotherapy
Correct answer: Embryo or oocyte cryopreservation before chemotherapy
Embryo or oocyte cryopreservation before chemotherapy is the most established and effective fertility preservation method for premenopausal women.
Question 5: A patient with multiple myeloma receiving bortezomib develops new-onset tingling and burning pain in bilateral feet. The MOST appropriate next step is to:
- Switch to carfilzomib and initiate gabapentin (Correct answer)
- Increase bortezomib dose to achieve faster response
- Administer IV magnesium sulfate for 24 hours
- Order an MRI of the lumbar spine only
Correct answer: Switch to carfilzomib and initiate gabapentin
Bortezomib causes peripheral neuropathy; switching to subcutaneous carfilzomib (less neurotoxic) and initiating neuropathic pain management with gabapentin is appropriate.
Question 6: Which parameter is MOST critical to monitor in a patient receiving high-dose methotrexate therapy?
- Serum creatinine and urine pH (Correct answer)
- Complete blood count and platelet count only
- Serum potassium and sodium levels
- Liver function tests and bilirubin
Correct answer: Serum creatinine and urine pH
Methotrexate is renally cleared and crystallizes in acidic urine; monitoring renal function and maintaining urine pH above 7 prevents nephrotoxicity and delayed clearance.
Question 7: A patient with non-small cell lung cancer develops new-onset confusion, hypercalcemia (Ca 13.5 mg/dL), and polyuria. This presentation is MOST consistent with which oncologic emergency?
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Hypercalcemia of malignancy (Correct answer)
- Tumor lysis syndrome
- Adrenal insufficiency
Correct answer: Hypercalcemia of malignancy
Confusion, elevated serum calcium, and polyuria (nephrogenic diabetes insipidus from hypercalcemia) are classic features of hypercalcemia of malignancy.
AOCNP Advance Oncology Nursing 2
A patient receiving cisplatin-based chemotherapy develops tinnitus and decreased high-frequency hearing.
Which intervention is most appropriate?