COCN Cheat Sheet 2026

The 30 highest-yield COCN facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. Which advance directive specifically designates a person to make healthcare decisions if the patient becomes incapacitated? → Durable power of attorney for healthcare (DPAHC)
2. The Philadelphia chromosome, resulting from a translocation between chromosomes 9 and 22, is the hallmark of which leukemia? → Chronic myeloid leukemia (CML)
3. Which reading material is most appropriate for evidence-based ostomy care guidelines? → WOCN clinical guidelines
4. What is the most common acute side effect of radiation therapy? → Skin reactions (radiation dermatitis) in the treatment field
5. What is the nadir period in chemotherapy treatment? → The point at which blood cell counts reach their lowest level after treatment
6. A nurse is providing discharge teaching to a patient who underwent sentinel lymph node biopsy for melanoma. Which instruction is most important to emphasize? → Notify the surgeon promptly if the incision site shows redness, swelling, or drainage
7. Which assessment finding in a postoperative oncology patient requires the most immediate nursing intervention? → Urine output of 25 mL/hr for 2 consecutive hours
8. What does recent literature recommend to reduce risk of peristomal moisture-associated dermatitis? → Proper fitting appliance and skin barrier
9. What are common coping mechanisms observed in cancer patients? → Problem-focused coping, emotion-focused coping, and meaning-making
10. Allopurinol is administered prophylactically before chemotherapy in high-risk hematologic malignancy patients primarily to prevent: → Uric acid nephropathy from tumor lysis syndrome
11. When a cancer patient's family asks if 'increasing the morphine will hasten death,' the nurse's best response is based on which ethical principle? → Doctrine of double effect — the intent is relief of suffering, not hastening death
12. What is the purpose of premedication before chemotherapy? → To prevent or reduce side effects such as nausea, allergic reactions, and hypersensitivity
13. Which Enhanced Recovery After Surgery (ERAS) protocol element is most effective in reducing postoperative ileus in cancer surgery patients? → Early ambulation within 24 hours of surgery
14. What is the difference between neoadjuvant and adjuvant chemotherapy? → Neoadjuvant is given before surgery; adjuvant is given after surgery
15. Which laboratory value is most critical to monitor before administering myelosuppressive chemotherapy? → Absolute neutrophil count (ANC)
16. Which material is typically used in ostomy skin barriers? → Hydrocolloid
17. Which of the following can contribute to peristomal candidiasis? → Excessive moisture
18. At what point on the NCCN Distress Thermometer should a referral for psychosocial support be considered? → A score of 4 or higher
19. A nurse is caring for a patient with multiple myeloma. Which lab finding is most indicative of disease activity? → Elevated serum protein electrophoresis (M-protein spike)
20. A myeloma patient receiving bortezomib is at risk for which notable peripheral neuropathy-related side effect? → Chemotherapy-induced peripheral neuropathy (CIPN)
21. A patient with lung cancer develops pulsus paradoxus, hypotension, and muffled heart sounds. The nurse recognizes this as: → Cardiac tamponade
22. Tumor lysis syndrome is most likely to occur in patients receiving treatment for which hematologic malignancy? → Bulky or rapidly proliferating lymphomas and acute leukemias
23. The nursing concept of 'total pain' in palliative care encompasses which dimensions? → Physical, psychological, social, and spiritual suffering
24. What is breakthrough pain in cancer patients? → Transient flares of pain that occur despite around-the-clock analgesic therapy
25. A patient is being discharged after total laryngectomy for laryngeal cancer. Which teaching point is most essential for patient safety? → Never allow water to enter the permanent stoma
26. Which of the following is a common complication of ostomies? → Peristomal skin irritation
27. What does the WOCN recommend regarding patient education? → Demonstrate care and allow patient practice
28. Which medication is specifically FDA-approved for opioid-induced constipation in cancer patients who have not responded to standard laxatives? → Methylnaltrexone (Relistor)
29. A cancer patient on chronic opioids develops constipation. The first-line treatment is: → Stimulant laxatives (senna) with or without stool softeners
30. According to best practices, what is the recommended frequency for assessing peristomal skin? → At every routine care session