AOCNP Cancer and Oncology Nursing 5 — Questions and Answers
Question 1: A patient receiving immunotherapy with a PD-1 inhibitor develops a new rash and diarrhea. What should the nurse suspect first?
- Disease progression requiring new chemotherapy
- Immune-related adverse events (irAEs) requiring immune-modulating treatment (Correct answer)
- Infectious colitis requiring broad-spectrum antibiotics
- Drug-drug interaction from a new supplement
Correct answer: Immune-related adverse events (irAEs) requiring immune-modulating treatment
Rash and diarrhea are common immune-related adverse events (irAEs) from checkpoint inhibitors and must be distinguished from infection to guide appropriate treatment with corticosteroids.
Question 2: Which blood count threshold typically prompts platelet transfusion in a non-bleeding oncology patient per standard guidelines?
- Platelet count below 50,000/mm³
- Platelet count below 10,000/mm³ (Correct answer)
- Platelet count below 100,000/mm³
- Platelet count below 75,000/mm³
Correct answer: Platelet count below 10,000/mm³
Current guidelines recommend prophylactic platelet transfusion at <10,000/mm³ in non-bleeding, hemodynamically stable patients to reduce spontaneous hemorrhage risk.
Question 3: A patient undergoing radiation to the pelvis asks why they were instructed to drink water before each treatment. What is the best explanation?
- It increases tumor sensitivity to radiation
- A full bladder displaces the small bowel out of the radiation field, reducing bowel toxicity (Correct answer)
- It prevents radiation-induced cystitis
- It improves image quality on CT simulation only
Correct answer: A full bladder displaces the small bowel out of the radiation field, reducing bowel toxicity
Bladder filling displaces small bowel superiorly and out of the pelvic radiation field, significantly reducing radiation dose to bowel and decreasing gastrointestinal toxicity.
Question 4: Which assessment finding would most concern the nurse in a patient 48 hours post-stem cell transplant?
- Mild fatigue and decreased appetite
- Temperature of 38.6°C with ANC of 50/mm³ (Correct answer)
- Hair loss beginning on the scalp
- Nausea controlled by ondansetron
Correct answer: Temperature of 38.6°C with ANC of 50/mm³
Febrile neutropenia with profound neutropenia in the early post-transplant period is life-threatening and requires immediate empiric broad-spectrum antibiotic therapy.
Question 5: A patient with prostate cancer on androgen deprivation therapy (ADT) is at increased risk for which long-term complication?
- Hyperthyroidism and weight loss
- Osteoporosis and increased fracture risk (Correct answer)
- Polycythemia and thrombosis
- Hyperandrogenism and hirsutism
Correct answer: Osteoporosis and increased fracture risk
ADT suppresses testosterone, causing accelerated bone loss leading to osteoporosis and increased fracture risk; bone density monitoring and bisphosphonates may be needed.
Question 6: Which nursing action best supports an oncology patient's autonomy regarding treatment decisions?
- Informing the family first so they can prepare the patient
- Ensuring the patient receives complete, unbiased information and their questions are answered before consent is obtained (Correct answer)
- Deferring all treatment discussions to the physician only
- Withholding negative prognosis information to maintain hope
Correct answer: Ensuring the patient receives complete, unbiased information and their questions are answered before consent is obtained
Oncology nurses advocate for patient autonomy by ensuring informed consent is truly informed, with all questions answered and information presented in an unbiased manner.
Question 7: A patient taking tamoxifen for hormone receptor-positive breast cancer asks about side effects. Which response is most accurate?
- 'Tamoxifen has no significant side effects since it is not chemotherapy.'
- 'Tamoxifen increases the risk of endometrial cancer, blood clots, and hot flashes.' (Correct answer)
- 'The main side effect is hair loss and immunosuppression.'
- 'You will need monthly blood transfusions while on this medication.'
Correct answer: 'Tamoxifen increases the risk of endometrial cancer, blood clots, and hot flashes.'
Tamoxifen's known risks include endometrial cancer, venous thromboembolism, and vasomotor symptoms such as hot flashes due to its mixed estrogenic/antiestrogenic activity.
AOCNP Cancer and Oncology Nursing 5
A patient receiving immunotherapy with a PD-1 inhibitor develops a new rash and diarrhea.
What should the nurse suspect first?