AOCNP Advance Oncology Nursing 5 — Questions and Answers
Question 1: A patient with metastatic melanoma on ipilimumab develops diarrhea with 7 stools above baseline per day and cramping. The MOST appropriate management is:
- Administer loperamide and continue ipilimumab at the same dose
- Hold ipilimumab and initiate high-dose systemic corticosteroids (prednisone 1–2 mg/kg/day) (Correct answer)
- Reduce ipilimumab dose by 50% and add bismuth subsalicylate
- Discontinue ipilimumab permanently and start infliximab immediately
Correct answer: Hold ipilimumab and initiate high-dose systemic corticosteroids (prednisone 1–2 mg/kg/day)
Grade 3 immune-mediated colitis (≥7 stools above baseline) requires drug hold and high-dose systemic corticosteroids; infliximab is reserved for steroid-refractory cases.
Question 2: The oncology NP is reviewing a patient's DECIPHER genomic risk score after radical prostatectomy. This score MOST directly informs decisions about:
- Eligibility for PARP inhibitor therapy
- The need for adjuvant or salvage radiation therapy (Correct answer)
- Initiation of androgen deprivation therapy duration
- Chemoprevention with finasteride
Correct answer: The need for adjuvant or salvage radiation therapy
The DECIPHER score predicts metastasis risk after radical prostatectomy and guides shared decision-making about adjuvant or salvage radiation.
Question 3: A patient with head and neck cancer completing radiation therapy reports severe odynophagia and is unable to maintain adequate oral intake. Which intervention is MOST appropriate to address nutritional needs?
- Initiate total parenteral nutrition (TPN) via central line
- Place a percutaneous endoscopic gastrostomy (PEG) tube for enteral feeding (Correct answer)
- Prescribe oral nutritional supplements and reassess in 2 weeks
- Start low-dose corticosteroids to reduce mucosal inflammation only
Correct answer: Place a percutaneous endoscopic gastrostomy (PEG) tube for enteral feeding
A PEG tube provides reliable enteral nutrition for patients with severe radiation-induced mucositis-related dysphagia and is preferred over TPN when the gut is functional.
Question 4: Which nursing assessment finding would MOST strongly suggest superior vena cava (SVC) syndrome in a patient with lung cancer?
- Bilateral lower extremity pitting edema and ascites
- Facial plethora, neck vein distension, and worsening dyspnea when supine (Correct answer)
- Sudden onset chest pain radiating to the left arm
- New jugular venous pulsation with a split S2 heart sound
Correct answer: Facial plethora, neck vein distension, and worsening dyspnea when supine
SVC syndrome causes impaired venous return from the upper body, resulting in facial plethora, neck vein distension, and positional dyspnea (worse when lying flat).
Question 5: A patient asks about the difference between adjuvant and neoadjuvant chemotherapy. The BEST explanation is:
- Adjuvant is given to shrink the tumor before surgery; neoadjuvant is given after surgery to kill residual disease
- Neoadjuvant is given before primary treatment to downstage disease; adjuvant is given after to reduce recurrence risk (Correct answer)
- Both terms refer to chemotherapy given concurrently with radiation therapy
- Neoadjuvant refers to chemotherapy for metastatic disease; adjuvant refers to localized disease only
Correct answer: Neoadjuvant is given before primary treatment to downstage disease; adjuvant is given after to reduce recurrence risk
Neoadjuvant chemotherapy is administered before primary treatment (surgery/radiation) to reduce tumor size, while adjuvant chemotherapy is given afterward to eliminate micrometastatic disease.
Question 6: Which assessment best evaluates a cancer patient's functional capacity to tolerate intensive chemotherapy?
- Serum albumin and pre-albumin levels alone
- Comprehensive geriatric assessment (CGA) including functional status, comorbidities, and polypharmacy (Correct answer)
- Eastern Cooperative Oncology Group (ECOG) performance status alone
- PET-CT scan metabolic activity score
Correct answer: Comprehensive geriatric assessment (CGA) including functional status, comorbidities, and polypharmacy
A comprehensive geriatric assessment captures multiple domains that ECOG alone misses, including cognitive function, fall risk, social support, and comorbidities that affect treatment tolerance.
Question 7: A patient with newly diagnosed acute myeloid leukemia (AML) undergoes induction chemotherapy. On day 15 the bone marrow biopsy shows <5% blasts. This finding indicates:
- Partial remission requiring immediate re-induction chemotherapy
- Complete remission (CR), and consolidation therapy planning should begin (Correct answer)
- Refractory disease requiring allogeneic transplant evaluation immediately
- Minimal residual disease positivity mandating maintenance therapy
Correct answer: Complete remission (CR), and consolidation therapy planning should begin
Complete remission in AML is defined as bone marrow blasts <5%, with recovery of peripheral blood counts; this triggers consolidation therapy planning.
AOCNP Advance Oncology Nursing 5
A patient with metastatic melanoma on ipilimumab develops diarrhea with 7 stools above baseline per day and cramping.
The MOST appropriate management is: