AOCNP Advance Oncology Nursing 3 — Questions and Answers
Question 1: A patient undergoing allogeneic hematopoietic stem cell transplant develops a diffuse erythematous rash, diarrhea, and elevated bilirubin on day 25. What condition is MOST likely?
- Engraftment syndrome
- Acute graft-versus-host disease (aGVHD) (Correct answer)
- Veno-occlusive disease (VOD/SOS)
- Cytomegalovirus (CMV) colitis
Correct answer: Acute graft-versus-host disease (aGVHD)
Rash, diarrhea, and liver dysfunction appearing within 100 days post-allogeneic SCT are the classic triad of acute graft-versus-host disease.
Question 2: Which of the following best describes the mechanism of action of trastuzumab (Herceptin)?
- It inhibits BCR-ABL tyrosine kinase to block cell proliferation
- It binds HER2 receptors and inhibits downstream PI3K/Akt signaling (Correct answer)
- It blocks programmed death-ligand 1 (PD-L1) to restore T-cell activity
- It intercalates DNA and inhibits topoisomerase II
Correct answer: It binds HER2 receptors and inhibits downstream PI3K/Akt signaling
Trastuzumab is a monoclonal antibody that binds the extracellular domain of HER2, inhibiting HER2-mediated signaling and promoting antibody-dependent cellular cytotoxicity.
Question 3: An oncology NP reviews a patient's opioid regimen and calculates a total daily oral morphine equivalent of 320 mg. The patient reports moderate breakthrough pain every 2 hours. What is the appropriate breakthrough dose range?
- 5–10 mg oral morphine equivalent every 4 hours as needed
- 10–15% of total daily dose (32–48 mg) every 1–4 hours as needed (Correct answer)
- 25% of the total daily dose every 6 hours
- A fixed dose of 15 mg morphine regardless of total daily dose
Correct answer: 10–15% of total daily dose (32–48 mg) every 1–4 hours as needed
Breakthrough opioid doses are typically 10–15% of the total daily opioid dose, administered every 1–4 hours as needed for acute pain flares.
Question 4: Which lab finding is MOST indicative of tumor lysis syndrome (TLS) requiring immediate intervention?
- Serum sodium 128 mEq/L
- Serum potassium 6.8 mEq/L with peaked T-waves on ECG (Correct answer)
- Serum calcium 10.5 mg/dL
- Serum phosphorus 4.5 mg/dL
Correct answer: Serum potassium 6.8 mEq/L with peaked T-waves on ECG
Hyperkalemia with ECG changes (peaked T-waves) in TLS indicates life-threatening cardiac risk requiring emergency treatment.
Question 5: A patient receiving FOLFOX for colorectal cancer reports cold-induced paresthesias when touching cold surfaces. This is MOST characteristic of toxicity from which agent in the regimen?
- Fluorouracil (5-FU)
- Leucovorin
- Oxaliplatin (Correct answer)
- Bevacizumab
Correct answer: Oxaliplatin
Cold-induced dysesthesia and paresthesias are hallmark acute neurotoxicity symptoms of oxaliplatin, distinct from the cumulative peripheral neuropathy it also causes.
Question 6: When assessing spiritual distress in a patient with advanced cancer, which tool is MOST appropriate for a structured clinical assessment?
- GAD-7 (Generalized Anxiety Disorder scale)
- FICA Spiritual History Tool (Correct answer)
- Edmonton Symptom Assessment System (ESAS)
- Patient Health Questionnaire-9 (PHQ-9)
Correct answer: FICA Spiritual History Tool
The FICA tool assesses Faith, Importance, Community, and Address in care, and is validated for spiritual history-taking in oncology and palliative settings.
Question 7: A patient with stage IV pancreatic cancer asks about transitioning to hospice care. The oncology NP explains that hospice eligibility typically requires a prognosis of:
- Less than 3 months if the disease follows its expected course
- Less than 6 months if the disease follows its expected course (Correct answer)
- Less than 12 months regardless of treatment status
- Inability to perform any activities of daily living
Correct answer: Less than 6 months if the disease follows its expected course
In the US, Medicare hospice benefit eligibility requires a physician-certified prognosis of 6 months or less if the disease runs its expected course.
AOCNP Advance Oncology Nursing 3
A patient undergoing allogeneic hematopoietic stem cell transplant develops a diffuse erythematous rash, diarrhea, and elevated bilirubin on day 25.
What condition is MOST likely?