Mixed Deck — All OCC Topics Flashcards

What is the first procedural step in manufacturing autologous CAR-T cell therapy for a patient?

Answer: Perform leukapheresis to collect the patient's T cells

Leukapheresis to collect the patient's own T cells is the first manufacturing step; these cells are then genetically engineered to express the chimeric antigen receptor.

A patient with a new PICC line develops sudden onset of dyspnea, hypotension, and a 'sucking' sound during catheter manipulation. What complication is occurring?

Answer: Air embolism

Air embolism can occur during open central catheter manipulation and presents with sudden dyspnea, hypotension, and a mill-wheel murmur or sucking sound.

A nurse notes an unexpected serious adverse event in a patient on a clinical trial. What is the MOST important immediate action?

Answer: Document the event in the chart, report to the principal investigator immediately, and complete the adverse event report per protocol

Serious adverse events must be documented, immediately reported to the PI, and captured in the adverse event reporting system per the protocol's safety monitoring plan.

A patient's oncologist recommends a treatment listed as Category 1 in the NCCN Guidelines. What does this designation mean?

Answer: High-level evidence with uniform consensus that the recommendation is appropriate

NCCN Category 1 designations indicate high-level evidence (usually from RCTs) with uniform consensus among NCCN panel members supporting the recommendation.

Atezolizumab differs from pembrolizumab and nivolumab in that it targets which molecule?

Answer: PD-L1 on tumor and immune cells

Atezolizumab targets PD-L1 (the ligand) rather than PD-1 (the receptor), blocking the interaction from the antigen-presenting or tumor cell side.

Which factor MOST increases a patient's risk for chemotherapy extravasation injury?

Answer: Multiple prior IV attempts in the same vein and fragile veins

Fragile veins with multiple prior cannulation sites have compromised integrity, significantly increasing the risk of extravasation during chemotherapy infusion.

Which laboratory pattern is most consistent with checkpoint inhibitor-induced immune-related thyroiditis progressing to hypothyroidism?

Answer: Elevated TSH with low free T4

Checkpoint inhibitor-induced thyroiditis most commonly results in hypothyroidism (elevated TSH, low free T4), which typically requires lifelong levothyroxine replacement.

A patient receiving irinotecan develops profuse watery diarrhea 12 hours after infusion. What is the nurse's priority action?

Answer: Administer loperamide per protocol and monitor hydration status

Late-onset diarrhea from irinotecan (>24 hours post-infusion) is managed with loperamide and vigilant hydration monitoring per protocol.

A nurse wants to find the best evidence for managing chemotherapy-induced nausea. Which resource provides the MOST credible, peer-reviewed clinical practice guidelines?

Answer: ASCO, ONS, or NCCN clinical practice guidelines

Professional organization guidelines from ASCO, ONS, and NCCN are developed through systematic evidence review and expert consensus, providing the most credible clinical practice guidance.

The nurse is educating a patient with a tunneled Hickman catheter about home care. Which instruction is MOST important?

Answer: Change the cap and flush the catheter per the prescribed protocol, and report fever above 100.4°F

Fever above 100.4°F in a patient with a tunneled catheter is a red flag for catheter-related bloodstream infection requiring immediate reporting.

A patient on doxorubicin complains of mouth sores and is unable to eat. The nurse grades the mucositis as Grade 3. Which intervention is appropriate?

Answer: Initiate parenteral nutrition and notify the provider for dose modification

Grade 3 mucositis (inability to eat) requires nutritional support and provider notification for possible chemotherapy dose modification.

A patient with prostate cancer metastatic to the spine develops sudden onset of lower extremity weakness and urinary retention. What emergency should the nurse suspect?

Answer: Spinal cord compression from epidural metastasis

New neurological deficits and urinary retention in a cancer patient with spinal metastases indicate malignant spinal cord compression, a neurological emergency requiring immediate intervention.

Which type of IV access is preferred for vesicant chemotherapy drugs?

Answer: Central venous catheter

Vesicant chemotherapy drugs can cause severe tissue damage, including blistering, necrosis, and ulceration, if they extravasate (leak) into surrounding tissues. A central venous catheter (CVC) is preferred for these drugs because it provides direct access to a large vein. This minimizes the risk of extravasation and ensures safe and effective delivery of the medication.

Moderate to severe immune-related adverse events (irAEs) from checkpoint inhibitors are primarily managed with:

Answer: Holding the checkpoint inhibitor and initiating systemic corticosteroids

Moderate to severe irAEs require holding the checkpoint inhibitor and initiating high-dose systemic corticosteroids (e.g., prednisone 1-2 mg/kg/day) to suppress aberrant immune activation.

CDK 4/6 inhibitors such as palbociclib are approved in combination with endocrine therapy for which breast cancer subtype?

Answer: Hormone receptor-positive/HER2-negative breast cancer

CDK 4/6 inhibitors arrest cell cycle progression at the G1/S checkpoint and are approved for HR+/HER2- advanced breast cancer in combination with endocrine therapy.

A patient with advanced cancer is being discharged with a PCA pump for home pain management. Which education point is MOST critical for caregiver safety?

Answer: Only the patient should press the PCA button; caregiver-controlled dosing increases overdose risk

PCA is designed for patient-only activation; caregiver- or nurse-activated dosing bypasses the safety feature that prevents dosing while the patient is sedated, risking respiratory depression.

A nurse is implementing a new evidence-based protocol for central line care. Which approach BEST demonstrates integration of evidence-based practice (EBP)?

Answer: Combining current best evidence, clinical expertise, and patient preferences to guide implementation

Evidence-based practice integrates the best available research evidence with clinical expertise and individual patient values and preferences.

Why is regular oral assessment important during chemotherapy?

Answer: To detect signs of mucositis

Regular oral assessment is crucial during chemotherapy because many agents cause mucositis, an inflammation and ulceration of the mucous membranes lining the digestive tract, including the mouth. Early detection allows for timely interventions to manage pain, prevent infection, and maintain nutritional intake. This significantly improves patient comfort and outcomes.

Before administering chemotherapy through a port-a-cath, the nurse aspirates and gets no blood return. What is the MOST appropriate next step?

Answer: Hold the chemotherapy and notify the provider to assess catheter function

Lack of blood return from a port-a-cath before chemotherapy administration requires provider notification and catheter assessment to prevent extravasation of vesicant drugs.

Blinatumomab is a bispecific T-cell engager (BiTE) that simultaneously binds CD19 on B cells and which molecule on T cells?

Answer: CD3

Blinatumomab bridges CD19-expressing malignant B cells and CD3-expressing T cells, forcing T cells to recognize and destroy the B cell tumor targets.