AOCNP Surgical Oncology and Perioperative Care 4

Question 1

A patient undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) develops hypotension and tachycardia intraoperatively. Which factor is MOST likely contributing to hemodynamic instability during HIPEC?

Accepted Answer

Vasodilation from hyperthermia and cytokine release

Answer

HIPEC causes significant vasodilation and third-spacing due to hyperthermia and systemic cytokine release, leading to hemodynamic instability requiring aggressive fluid management.

Question 2

A patient with locally advanced rectal cancer is scheduled for abdominoperineal resection (APR). Which preoperative bowel preparation practice is currently supported by enhanced recovery after surgery (ERAS) protocols?

Accepted Answer

Mandatory mechanical bowel preparation plus oral antibiotics

Answer

Current ERAS evidence for colorectal surgery supports combined mechanical bowel preparation with oral antibiotics to reduce surgical site infection rates.

Question 3

Which sentinel lymph node biopsy technique uses a combination of radioisotope and blue dye to achieve the highest identification rate in breast cancer surgery?

Accepted Answer

Dual-agent technique combining radioisotope and blue dye

Answer

The dual-agent technique combining radiolabeled colloid and blue dye achieves sentinel node identification rates exceeding 95%, superior to either agent used alone.

Question 4

A patient 48 hours post-esophagectomy develops fever, tachycardia, and increased chest tube output with turbid fluid. Which complication is MOST likely?

Accepted Answer

Anastomotic leak

Answer

Anastomotic leak post-esophagectomy typically presents 48–72 hours postoperatively with fever, tachycardia, and chest tube drainage changes, representing the most feared early complication.

Question 5

When performing intraoperative frozen section analysis of surgical margins in a patient with oral cavity squamous cell carcinoma, a finding of 'close margin' (<1mm) should prompt the surgeon to:

Accepted Answer

Take additional tissue to achieve clear margins intraoperatively

Answer

Intraoperative frozen section provides real-time guidance, and close or positive margins should be addressed immediately by re-excision to optimize local control.

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP Surgical Oncology and Perioperative Care 4