FREE ONCC Oncology Certified Nurse Questions and Answers
A 20-year-old survivor of childhood brain cancer is now complaining of fatigue, weight gain, muscle weakness, dysmenorrhea, and depression. She underwent surgery and radiation therapy as treatment for her cancer fifteen years ago. Which of the following late effects is she probably experiencing?
Explanation:
Radiation of the head and neck during childhood is closely associated with the late development of hypothyroidism. Risk increases with radiation dose and being female gender. Hypothyroidism occurs when the thyroid produces inadequate levels of thyroid hormones. Associated thyroid conditions may range from mild to severe myxedema.
Symptoms may include chronic fatigue, menstrual disturbances, vocal hoarseness, cold intolerance, low pulse rate, weight gain, thinning hair, and thickened skin. Some dementia may occur with severe hypothyroidism.
A patient with ovarian cancer suddenly develops severe nausea. She is vomiting large volumes of fluid. Her abdomen is painful and rigid on palpation, and bowel sounds are diminished. She reports feeling short of breath. She is afebrile. She reports that she has had only very small bowel movements recently. The most likely diagnosis is:
Explanation:
These symptoms are consistent with an obstruction of the small intestines. Sudden and frequent nausea and vomiting in large volumes that occurs immediately after intake usually indicates a small bowel obstruction. An obstruction of the colon usually results in more delayed vomiting, with fecal emesis. If obstruction is partial or inoperable, dexamethasone may relieve some of the symptoms because it reduces inflammation and swelling, as well as providing relief of nausea.
A young man is undergoing a syngeneic, hematopoietic stem cell transplantation (HSCT). The donor tissue is coming from:
Explanation:
Syngenic: Donation is from an identical twin. Autologous: Donation is from the patient, but autologous purged transplant requires that malignant cells be removed through ex vivo treatment prior to transplantation so that malignant cells are not reintroduced.
Allogenic: Donation is from a family member, usually a sibling. Matched unrelated donor (MUD): Donation is obtained from a donor registry from an unrelated donor who has volunteered to provide stem cells for transplant.
During the intravenous administration of a chemotherapeutic agent, the patient has a sudden onset of dyspnea, wheezing, hypotension, and throat and facial edema. The nurse's initial action should be to:
Explanation:
Because these symptoms are consistent with anaphylaxis, the nurse should immediately discontinue the chemotherapeutic agent and then monitor the patient's respiratory and cardiovascular status. Epinephrine 1:1000 dilution is administered intramuscularly and may then be given in continuous IV infusion if symptoms are severe. Dyspnea is treated with a high concentration of oxygen. Once the patient is stabilized, antihistamines and corticosteroids may be administered to prevent recurrence and to treat hives and edema.
A patient has had persistent nausea and vomiting, despite receiving medication to control her symptoms. Which of the following measures may provide some relief?
Explanation:
Advising the patient to do deep breathing and controlled swallowing may help to control the gag/vomit reflex. Other measures include serving cold or room temperature foods, restricting intake of fluids during meals, and sitting or lying with head elevated for at least two hours after eating. Patients may benefit from five or six small meals per day rather than three large meals. Fluids should be sipped in small amounts throughout the day rather than drunk in a large volume.
A patient has been diagnosed with stage ll renal cell cancer (T2 NO MO). The nurse anticipates the treatment of choice will be:
Explanation:
Radical nephrectomy is the treatment of choice for Stage Il, and Stage Ill renal cell cancer. Stage I renal cell cancer may be treated with partial, simple, or radical nephrectomy. Renal cancer does not respond well to systemic therapy, so chemotherapy is not usually advised, although there are some current clinical trials studying new drugs. External beam radiation does not appear to improve survival rates, although it may be used for patients with diffuse renal cell cancer. In many cases, radical nephrectomy is curative.
Which of the following may be an indication of non-medical opioid use in a cancer patient being treated for pain?
Explanation:
Although most guidelines exempt cancer patients from limitations on the use of opioids, studies show that about 20% of cancer patients engage in non-medical opioid use, such as by increasing doses, using along with other drugs or alcohol, and sharing with other people. Signs of non-medical opioid use include repeatedly losing or misplacing medications, asking for early refills, increasing the dosage without discussing it with healthcare providers, refusing to change medication, and asking for opioids for non-pain issues such as insomnia.
Providing all patients with literature about the dangers of smoking, the steps to quitting, and the recommendation that all patients stop smoking, is an example of what type of preventive measure?
Explanation:
Primary prevention: Includes providing patients with educational materials and information, urging safe practices (smoking cessation), and providing immunizations.
Fluoridation of the water supply is also an example of primary prevention. Secondary prevention: Includes screening for those at high risk of disease (such as diabetes, high cholesterol, and hypertension) and instituting treatment to prevent negative outcomes and progression to disease. Tertiary prevention: Includes providing proper care to prevent further complications. Quaternary prevention: Includes intervening to prevent harm caused by medical treatment.
A patient receiving chemotherapy has developed oral mucositis, and the patient states that brushing her teeth with toothpaste increases her mouth pain. What should the patient use as an alternative?
Explanation:
The patient should be advised to use a soft-bristled toothbrush and salt water (about one-half teaspoon salt in 4 cups of water) to clean the teeth and soothe the mouth. Standard mouthwash will increase irritation. Lidocaine mouthwash is swished about the mouth to reduce pain and is not appropriate to use for brushing. Patients may also find relief with ice chips or Popsicles and some may need pain medications. If these measures aren't effective, "Magic mouthwash" and Gelclair can be prescribed to relieve mouth pain.
A patient who has received adjuvant chemotherapy is very distressed about cognitive impairment ("chemo brain"), which is interfering with her ability to work.
Which of the following techniques is likely to be most helpful initially?
Explanation:
While all of these techniques are valuable, maintaining a detailed daily planner may help the patient function most effectively at work. Additionally, the patient may need to make a ""to-do"" list and take notes with important dates or phone numbers. Brain exercises and physical exercise are both recommended to improve cognition. Patients may keep a memory diary to help determine contributing factors, such as inadequate sleep, depression, or medications. In most cases, cognitive impairment decreases within a few months after treatment stops, but it may persist indefinitely for some patients.
A patient is to begin treatment with Zometa for bone metastasis. Which laboratory tests or test is indicated prior to each dose of treatment?
Explanation:
Measuring serum creatinine and creatinine clearance is indicated prior to each dose of treatment, as Zometa may cause reduced renal function. Patients should also receive calcium supplements (500 mg) and vitamin D (400 IU) daily, although Zometa treatment should be withheld if the patient has hypocalcemia. Flu-like symptoms and fever are common side effects. Some people also develop nausea and vomiting and other Gl disturbances. Osteonecrosis of the jaw may develop, requiring discontinuation of therapy.