OCN OCN General 4 — Questions and Answers
Question 1: A patient asks the nurse what BRCA1 gene mutation means for their cancer risk. Which response is most accurate?
- It guarantees development of breast cancer by age 40
- It significantly increases lifetime risk of breast and ovarian cancers (Correct answer)
- It only affects ovarian cancer risk, not breast cancer
- It has no impact if no family history of cancer exists
Correct answer: It significantly increases lifetime risk of breast and ovarian cancers
BRCA1 mutations significantly elevate lifetime risk for both breast cancer (55–72%) and ovarian cancer (44%), guiding decisions about enhanced surveillance and risk-reduction strategies.
Question 2: Which intervention is most appropriate when a patient develops chemotherapy extravasation of a vesicant agent?
- Apply warm compresses and continue the infusion at a slower rate
- Stop the infusion immediately, aspirate residual drug, and apply cold compresses for most vesicants (Correct answer)
- Flush the IV line with normal saline and apply a warm compress
- Discontinue the IV and massage the affected area vigorously
Correct answer: Stop the infusion immediately, aspirate residual drug, and apply cold compresses for most vesicants
For vesicant extravasation, the infusion must be stopped immediately, residual drug aspirated, the IV removed, and cold compresses applied (except for vinca alkaloids which require warmth).
Question 3: Which statement best describes the mechanism of action of checkpoint inhibitors such as pembrolizumab?
- They directly kill cancer cells by binding to tumor antigens
- They block inhibitory signals that cancer cells use to evade T-cell immune surveillance (Correct answer)
- They stimulate bone marrow production of neutrophils
- They prevent cancer cell DNA replication by cross-linking DNA strands
Correct answer: They block inhibitory signals that cancer cells use to evade T-cell immune surveillance
Pembrolizumab (anti-PD-1) blocks the PD-1/PD-L1 pathway that tumors exploit to suppress T-cell activity, restoring the immune system's ability to recognize and destroy cancer cells.
Question 4: A nurse notes that a patient's absolute neutrophil count (ANC) is 450 cells/mm³. Which classification and action is correct?
- Normal range; no special precautions needed
- Severe neutropenia (< 500); initiate neutropenic precautions and notify provider (Correct answer)
- Mild neutropenia; encourage handwashing only
- Critical value; administer packed red blood cells immediately
Correct answer: Severe neutropenia (< 500); initiate neutropenic precautions and notify provider
An ANC below 500 cells/mm³ is severe neutropenia, placing the patient at very high infection risk and requiring immediate neutropenic precautions, provider notification, and possible filgrastim therapy.
Question 5: A patient with cancer reports a pain level of 7/10 currently on acetaminophen alone. According to the WHO analgesic ladder, what is the next appropriate step?
- Add a non-opioid adjuvant like gabapentin only
- Add a weak opioid such as tramadol or codeine (Step 2) (Correct answer)
- Initiate strong opioids such as morphine immediately (Step 3)
- Refer the patient to a pain specialist before changing therapy
Correct answer: Add a weak opioid such as tramadol or codeine (Step 2)
The WHO three-step analgesic ladder recommends adding a weak opioid (Step 2) when a non-opioid alone provides inadequate pain control before escalating to strong opioids.
Question 6: Which patient situation is the most appropriate indication for a peripherally inserted central catheter (PICC) rather than a peripheral IV?
- Single dose of IV acetaminophen for fever
- Long-term vesicant chemotherapy requiring reliable venous access (Correct answer)
- One-time IV contrast for a CT scan
- Rapid IV fluid bolus in an emergency
Correct answer: Long-term vesicant chemotherapy requiring reliable venous access
PICC lines are indicated for patients requiring prolonged IV therapy with vesicant chemotherapy, reducing the risk of extravasation and preserving peripheral veins.
Question 7: Which early sign of increased intracranial pressure (ICP) from brain metastases should the oncology nurse recognize?
- Bradycardia with widened pulse pressure
- Morning headache that improves upon sitting upright (Correct answer)
- Decreased deep tendon reflexes bilaterally
- Tachycardia with narrowed pulse pressure
Correct answer: Morning headache that improves upon sitting upright
Headache that is worst in the morning and improves when upright is a classic early sign of elevated ICP from brain metastases due to positional changes in cerebrospinal fluid pressure.
OCN OCN General 4
A patient asks the nurse what BRCA1 gene mutation means for their cancer risk.
Which response is most accurate?