AOCNP Advance Oncology Nursing 4 — Questions and Answers
Question 1: A patient with cervical cancer is receiving concurrent cisplatin and radiation therapy. She reports decreased urine output and her creatinine has risen from 0.9 to 2.4 mg/dL. The BEST immediate intervention is:
- Hold cisplatin, ensure aggressive IV hydration, and consult nephrology (Correct answer)
- Continue cisplatin at a reduced dose of 50%
- Switch to carboplatin and continue radiation
- Administer furosemide to increase urine output
Correct answer: Hold cisplatin, ensure aggressive IV hydration, and consult nephrology
Acute cisplatin nephrotoxicity requires immediate drug hold, aggressive IV hydration to restore renal perfusion, and nephrology consultation.
Question 2: Which test result is REQUIRED before initiating treatment with PARP inhibitors (e.g., olaparib) in ovarian cancer?
- KRAS mutation status via liquid biopsy
- BRCA1/BRCA2 germline or somatic mutation testing (Correct answer)
- HER2 amplification by FISH
- PD-L1 combined positive score (CPS)
Correct answer: BRCA1/BRCA2 germline or somatic mutation testing
PARP inhibitors exploit homologous recombination deficiency; BRCA1/2 mutation status determines eligibility and expected magnitude of benefit.
Question 3: An oncology NP is caring for a patient who develops stridor, facial swelling, and hypotension within 10 minutes of starting a paclitaxel infusion. The FIRST intervention is:
- Slow the infusion rate and administer diphenhydramine IV
- Stop the infusion immediately and administer epinephrine 0.3 mg IM (Correct answer)
- Administer IV dexamethasone 20 mg and monitor closely
- Call the oncologist and await further orders before acting
Correct answer: Stop the infusion immediately and administer epinephrine 0.3 mg IM
These signs indicate anaphylaxis; the infusion must be stopped immediately and epinephrine 0.3 mg IM administered as the first-line life-saving intervention.
Question 4: A patient with diffuse large B-cell lymphoma on R-CHOP develops a fever of 38.5°C on day 10 post-chemotherapy with an ANC of 200 cells/µL. According to MASCC criteria, what is the PRIORITY action?
- Order blood cultures and begin empiric broad-spectrum IV antibiotics within 1 hour (Correct answer)
- Prescribe oral ciprofloxacin and levofloxacin and discharge home
- Wait for culture results before starting antibiotics
- Administer G-CSF and recheck ANC in 24 hours before starting antibiotics
Correct answer: Order blood cultures and begin empiric broad-spectrum IV antibiotics within 1 hour
Febrile neutropenia (ANC <500 with fever ≥38.3°C) requires blood cultures and empiric broad-spectrum IV antibiotics within 60 minutes of presentation.
Question 5: Which dietary modification is MOST important to counsel a patient receiving warfarin for cancer-associated thrombosis?
- Avoid all grapefruit to prevent CYP3A4 interaction
- Maintain consistent vitamin K intake rather than eliminating it (Correct answer)
- Eliminate all leafy green vegetables from the diet
- Increase calcium-rich foods to counteract bone density loss
Correct answer: Maintain consistent vitamin K intake rather than eliminating it
Patients on warfarin should maintain consistent, not zero, vitamin K intake because dramatic fluctuations destabilize INR more than a steady moderate intake.
Question 6: A 58-year-old man with prostate cancer on androgen deprivation therapy (ADT) is at highest risk for which long-term complication requiring proactive screening?
- Pulmonary fibrosis
- Osteoporosis and pathologic fracture (Correct answer)
- Hepatic veno-occlusive disease
- Peripheral arterial disease
Correct answer: Osteoporosis and pathologic fracture
ADT causes hypogonadism leading to accelerated bone loss; DEXA scanning and calcium/vitamin D supplementation are guideline-recommended for fracture prevention.
Question 7: When explaining a clinical trial's Phase I design to a patient considering enrollment, the oncology NP should communicate that the primary goal is to:
- Confirm the treatment is more effective than standard of care in a large population
- Determine the maximum tolerated dose and characterize the safety profile (Correct answer)
- Compare two treatments head-to-head in a randomized blinded design
- Evaluate quality of life outcomes in a specific cancer subtype
Correct answer: Determine the maximum tolerated dose and characterize the safety profile
Phase I trials primarily assess safety, dose escalation, pharmacokinetics, and maximum tolerated dose, not efficacy.
AOCNP Advance Oncology Nursing 4
A patient with cervical cancer is receiving concurrent cisplatin and radiation therapy.
She reports decreased urine output and her creatinine has risen from 0.9 to 2.4 mg/dL.
The BEST immediate intervention is: