OCC OCC Supportive Care & Symptom Management 2 — Questions and Answers
Question 1: Which intervention is MOST effective for managing cancer-related depression in oncology patients?
- Opioid dose reduction
- Combined pharmacotherapy (antidepressants) and psychotherapy (CBT or supportive counseling) (Correct answer)
- Increasing physical activity without any pharmacotherapy
- Administering corticosteroids to improve mood
Correct answer: Combined pharmacotherapy (antidepressants) and psychotherapy (CBT or supportive counseling)
The combination of antidepressant pharmacotherapy with psychotherapy (especially CBT) has the strongest evidence for treating cancer-related depression.
Question 2: A patient receiving chemotherapy reports moderate-to-severe cancer-related fatigue. Which assessment finding would indicate a potentially treatable contributing cause?
- Mild insomnia reported by the patient
- Hemoglobin of 7.5 g/dL with symptoms of dyspnea on exertion (Correct answer)
- ANC of 2,000/mm³ at end of cycle
- Weight loss of 2 lbs over 3 weeks
Correct answer: Hemoglobin of 7.5 g/dL with symptoms of dyspnea on exertion
Anemia (Hgb 7.5 g/dL) with symptomatic dyspnea is a directly treatable cause of cancer-related fatigue, warranting evaluation for RBC transfusion or erythropoiesis-stimulating agents.
Question 3: Which sleep hygiene strategy has the STRONGEST evidence for managing insomnia in cancer patients?
- Long-term benzodiazepine use as first-line therapy
- Cognitive behavioral therapy for insomnia (CBT-I) (Correct answer)
- Daytime naps of 3+ hours to compensate for nighttime sleep loss
- Melatonin supplementation as the only non-pharmacologic intervention
Correct answer: Cognitive behavioral therapy for insomnia (CBT-I)
CBT-I is the first-line, evidence-based treatment for insomnia in cancer patients, with sustained benefits that outlast pharmacologic interventions.
Question 4: A patient with advanced cancer and dyspnea at rest has oxygen saturation of 94% on room air. Which intervention is MOST evidence-based for managing refractory dyspnea?
- High-flow oxygen regardless of saturation level
- Low-dose oral or IV opioids to reduce the sensation of breathlessness (Correct answer)
- Anxiolytics as first-line therapy
- Pursed-lip breathing exercises as the sole intervention
Correct answer: Low-dose oral or IV opioids to reduce the sensation of breathlessness
Low-dose opioids are the most evidence-based pharmacologic intervention for refractory dyspnea in cancer patients, regardless of oxygen saturation.
Question 5: A cancer patient receiving corticosteroids long-term for symptom management is at risk for which complication requiring prophylactic management?
- Thrombocytopenia and bleeding
- Osteoporosis, hyperglycemia, and Pneumocystis jirovecii pneumonia (PCP) (Correct answer)
- Peripheral neuropathy and cardiac arrhythmias
- Renal failure and electrolyte wasting
Correct answer: Osteoporosis, hyperglycemia, and Pneumocystis jirovecii pneumonia (PCP)
Long-term corticosteroid use in cancer patients risks osteoporosis, steroid-induced hyperglycemia, immunosuppression, and PCP, often requiring prophylactic calcium/vitamin D, glucose monitoring, and TMP-SMX.
Question 6: A hospice patient with cancer develops the death rattle (noisy breathing). What is the MOST appropriate nursing intervention?
- Perform aggressive oral suctioning to clear the airway
- Reposition the patient, explain the sound to family, and administer anticholinergic medications if ordered (Correct answer)
- Initiate mechanical ventilation support
- Administer high-dose diuretics to reduce secretions
Correct answer: Reposition the patient, explain the sound to family, and administer anticholinergic medications if ordered
The death rattle results from secretions the patient can no longer clear; repositioning helps drainage, family education reduces distress, and anticholinergics (glycopyrrolate/hyoscine) reduce secretion production.
OCC OCC Supportive Care & Symptom Management 2
Which intervention is MOST effective for managing cancer-related depression in oncology patients?