AOCNP EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS, Exams of Nursing

Download AOCNP EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS and more Exams Nursing in PDF only on Docsity! AOCNP EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS the risk for significant bone marrow suppression (8) - Precise Answer ✔✔advanced age (>65),poor nutritional status, preexisting autoimmune disease, DM, GI disorders, liver disease, or hematopoietic disease, and substance abuse. Cancer-induced bone marrow suppression (3) - Precise Answer ✔✔a) dysfunctional hematopoietic cell within the bone marrow, b) bone marrow infiltration with tumor c)general exhaustion of bone marrow reserves solid tumor malignancies with the highest propensity to infiltrate the bone marrow in the course of metastasis - Precise Answer ✔✔melanoma, cancer of the breast, lung, kidney and prostate Nitrosoureas (Carmustine, Lomustine) - Precise Answer ✔✔affect the pluripotent stem cell (affecting all cell lines/cell cycle nonspecific agent) use for glioblastoma multiforme severe myelosuppression may last up to 85 days, nadir of carmustine occurs in 26-60 days Radiation induced bone marrow suppression occurs when (2) - Precise Answer ✔✔1. treatment field involves marrow producing tissue or with dose greater than 15 Gy CD 4 counts < 500/mm3 - Precise Answer ✔✔significant risk factor for oopotunisitic infections Cyclosphosphamide - myelosuppression risk - Precise Answer ✔✔moderate Paclitaxel - myelosuppression risk - Precise Answer ✔✔moderate Doxorubicin (Adriamycin) - myelosuppression risk - Precise Answer ✔✔alkylating agnet, may produce severe myelosuppression, the duration only about 21 days Myelosupression secondary to radiation therapy peaks at - Precise Answer ✔✔week 3 Suppression may occur in all cell lines simultaneously rather than sequentially as seen with chemotherapy The recovery period also may be less predictable. Second malignancy : Acute leukemia - potential etiologic factor ? - Precise Answer ✔✔Alkylating agent, especially with high doses or cumulative doses of antimetabolites Antitumor antibiotics Corticosteroids Epipodophyllotoxins (i.e Etoposide) In a patient with an abnormal complete blood count with all cell line diminished and without evidence for a specific disorder and in whom an eorror in cell production suspected, which test should be performed ? - Precise Answer ✔✔Bone marrow aspirations and biopsy with peripheral smear Gail model best use for - Precise Answer ✔✔general breast cancer risk assessment estimate 5 years risk and overall lifetime risk for breast cancer risk factor : age, age at monarch, age at first live birth race, number of first degree relatives with breast cancer the MMR pro model best use for - Precise Answer ✔✔hereditary colon cancer Claus model estimates - Precise Answer ✔✔breast cancer risk based on first -and second -degree relatives with breast or ovarian cancer. Primary cancer prevention (definition) - Precise Answer ✔✔aims to reverse or inhibit cancer by modification of a person's environment or behaviors or through pharmacologic mechanisms Primary cancer prevention : example - Precise Answer ✔✔tabacco use, smoking cessation, Sun Exposure, Diet exercise, chemoprevention, HPV vaccine Secondary prevention - Precise Answer ✔✔screening and early detection Chemoprevention : negative trial - Precise Answer ✔✔Beta-caroten cancer prevention trial (ATBC) trial the Beta-Caroten and retinol efficacy trial (CARET) (NCI,2003) No benefit was seen from supplements in the men at risk for lung cancers were diagnosed 17 % more death occurred in participants taking beta-caroten and Vitamin A than in thoese taking placeboes. Chemoprevention: positive trial - Precise Answer ✔✔Tamoxifen and Raloxifen the prevention of invasive breast cancer after result from the breast cancer prevention trial (49 % reduction in invasive breast cancer in more than 13,000 high risk pre and post menopausal women. Lung cancer screening - Precise Answer ✔✔annual LDCT in patients age 55-74 who are current or former smokers (> or + to 30 packs years) and otherwise in good health. Colon cancer screening - Precise Answer ✔✔Age> 59 Colonoscopy q 10 years or FOBT or FIT annually and flexible sigmoidoscopy q5 years (per NCCN, annual FOBT/FIT only per ACS) flexible sigmoidoscopy q 5 years Cervical cancer screening - Precise Answer ✔✔age 21-29 - PAP test q3 years, no HPV testing age 30-65 - PAP test and HPV testing every 5 years (preferred ) or PAP test alone q 3 yeras HNPCC syndrome (Lynch syndrome) screening/risk - Precise Answer ✔✔80 % lifetime risk of developing colon cancer (compared with 6% risk in general population) - yearly 60 % lifetime risk of developing endometrial cancer 12 % lifetime risk of developing ovarian cancer --> bianual pelvic exam at age 25, transvaginal ultrasounds at age 30-35 q 6-12 months, Ca 125 every 6-12 months 1-13 of lifetime risk of developing gastric cancer ---> EGD every A previvor is a person who is - Precise Answer ✔✔diagnosed with a hereditary mutation but does not have a cancer diagnosis Plain radiographs （Indications） - Precise Answer ✔✔quick and inexpensive option - Purely lytic bone metastasis (such as multiple myeloma) - pneumonias and intestinal obstructions in patient with peripheral lung lesion Paclitaxel vs paclitaxel protein-bound particles AE: peripheral neuropathy - Precise Answer ✔✔The incidence of arthralgia is equal for both drugs, but protein-bound paclitaxel neuropahties are more quickly reversible. Paclitaxel- protein bound particles does not use Cremophor to deliver the drug to the cancer which increases the neurotoxicity. However, the higher incidence of neurotoxicity with paclitaxel protein boudn particles occurs because higher doses (71% vs 56%) can be used. This side effects is more quickly reversible but if the toxicity exceeds grade 3, dose interruption is required. St.John's wort for depression while on irinotecan - Precise Answer ✔✔St. John's wort decrease the effectiveness of the active betabolites SN-38 of irinotecan by almost 50% Surveillance - breast - Precise Answer ✔✔H&P every 4-6 months for 5 years then annually Mammogram yearly Surveillance - Lymphoma (varies among specific lymphoma types) - Precise Answer ✔✔H&P with CBCD, LDH - every 3-6 months for 5 years then annually. CT, PET/CT (No more than every 6 months for 2 years annually for a total of 5 years, then as clinically indicated. Surveillance - colorectal - Precise Answer ✔✔H&P every 3-6 months for 2 years then every 6 months for total of 6 years colonoscopy - 1 year after completion of treatment CT CAP every 6-12 months for 2 years then annually PET-CT not routinely recommended Surveillance- Lung NSCC - Precise Answer ✔✔H&P with CT Chest +/- contrast every 6-12 months for 2 years then annually PET/MRI not routinely recommended Surveillance - Prostate after initial definitive treatment - Precise Answer ✔✔H&P with PSA every 6-1 2months for 5 years the annually DRE every year but may be omitted if PSA is undetectable Surveillance - Ovarian - Precise Answer ✔✔H&P every 2-4 months for 2 years, then 3-6 months for 3 years, then annually for a total of 5 years. CA-125 - optional, every visit if initially elevated Beneficience definition - Precise Answer ✔✔the principle of doing no harm and maximizing benefits while minimizing harm Justice means - Precise Answer ✔✔giving each person an equal share and according to need, individual effort, societal contribution or or merit. Respect describes.... - Precise Answer ✔✔the need to treat individual effort and their decisions as autonomous and if that autonomy is compromised, the obligation to protect that individual. Heart disease risk for patients who received radiation to the left breast - Precise Answer ✔✔It remains greater than for women who had radiation therapy to the right breast at 20 years after treatment. Reversible Posterior Leukoencephalopathy Syndrome (RPLS) - Precise Answer ✔✔- The incidence of RPLS in patient receiving bevacizumab is less than 0.5% - The signs of RPLS include headache, seizure, lethargy, confusion, blindness, or other visual and neurologic disturbances. - A MRI is used to confirm a diagnosis. - Symptoms begin from 16 hours to once year after start of bevacizumab weekly docetaxel therapy; expected side effects with a cumulative dose of ----- and management - Precise Answer ✔✔400 mg/m2. ==, epiphora (流涙症) Docetaxel is secreted in tears, causing irritation of the eye and may cause canalicular inflammation and blockage of tear ducts with epiphora. Pts on weekly docetaxel should be see n by an opthalmologist at baseline then every 4-6 weeks or more often as needed. Topixal antibiotics and dexamethasone may be helpful. disenfranchised grief - Precise Answer ✔✔A situation in which certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions. delirium is defined as - Precise Answer ✔✔disturbance in attention and awareness that represents a change from baseline. It also must be accompanied by an additional disturbance in cognition (e.g. memory, orientation, language, visuospatial ability, perception) telangiectasia - Precise Answer ✔✔dilated superficial blood vessels The most common sings and symptoms relate to superior vena cava syndrome(SVCS) - Precise Answer ✔✔face or neck swelling (82 %), upper extremity swelling (68%),dyspnea (66%), cough (50%) and dilated chest vein collateral (38%). Symptoms are worsen in the morning because the patient has been lying spine during the night. Chemotherapy drug cross the blood brain barrier - Precise Answer ✔✔Carmustine and Lomustine (lipid soluble) cross the brain barrier. Temozolomide Carmustine - Precise Answer ✔✔a parenterally administered alkylating agent used alone and in combination with other antineoplastic agents in the treatment of several forms of cancer including leukemias, lymphomas, and breast, testicular, ovarian Lomustine - Precise Answer ✔✔- an orally administered alkylating agent used alone and in combination with other antineoplastic agents in the treatment of several malignancies including Hodgkin disease, lymphoma, and brain cancer. - can cause a severe decrease in the number of blood cells in your bone marrow Radiation therapy for SVCS - Precise Answer ✔✔may notice improvement in venous congestion within 3-4 days of treatment as result of improved venous blood flow. The RT provides maximum symptoms relief within 3-4 weeks in 70 % of patients with lung cancer and 95 % of patient with lymphoma. The pts with Acute Promyelocytic Leukemia (APL) are at risk for - Precise Answer ✔✔Increased intracranial pressure due to a high blast cell count. Increased ICP may assciated with leukemia also may be result of hemorrhage caused by coagulopathy or thrombocytopenia tumor lysis syndrome (metabolic disturbance) - Precise Answer ✔✔Hyperkalemia Hyperuricemia Hyperphosphatemia Hypocalcemia (phosphorus binds to calcium in the circulation which causes hypocalcemia) TLS risk - Precise Answer ✔✔TLS occurs most frequently in patient with lymphoproliferative malignancies or in patient with elevagted white blood cell counts such as high grade lymphomas or acute leukemias TLS prevention - Precise Answer ✔✔Prophylactic hydration to maitain a urine out put greater than 150-200 ml/hour and prophylactic rasburicase. Hypercalcimia symptoms and management - Precise Answer ✔✔weakness and confusion can progress to coma and obtundation Fluid intake/hydration and strict fall precautions Sources of hematopoietic stem cells (HSCs) for allogeneic transplantation - Precise Answer ✔✔umbilical cord blood, marched sibling donor, matched unrelated donor How long must a transplant recipient be monitored for a delayed immune hemolysis response after receiving marrow from an ABO mismatched donor - Precise Answer ✔✔approximately four months after transplant because the life span of red blood cells is approximately 120 days . Graft versus host disease - Precise Answer ✔✔complication that occurs following a stem cell or bone marrow transplant in which the transplant produces antibodies against recipient's organs that can be severe enough to cause death an immune reaction that occurs between the recipient cells and the immunologically competent donor T lymphocytes Diuretics: - Precise Answer ✔✔hasten elimination of cisplatin Leucovorin - Precise Answer ✔✔hasten elimination and lessen systemic toxicity of high-dose METHOTREXATE Mesna - Precise Answer ✔✔inactivates metabolites of ifosfamide (or high-dose cyclophosphamide) to prevent hemorrhagic cystitis Mild neutropenia - Precise Answer ✔✔ANC of less than 1500 per mm3 Moderate neutropenia with increased risk of infection - Precise Answer ✔✔ANC of less than 1000 per mm3 Severe neutropenia with high risk of infection - Precise Answer ✔✔ANC less than 500 per mm3 Agents with higher risk of grade 3 (10-50K) and grade 4 (<10K) thrombocytopenia include: - Precise Answer ✔✔Topotecan - 52-58 % MOPP - 52 % ESHAP - 50 % Gemcitabine & Ciplatin 50-57% PCDE - 78% Osmotic diarrhea - Precise Answer ✔✔o Caused by mechanical disturbance o Results from ingestion of hyperosmolar substances, such as non- absorbable solutes (sorbitol) or enteral feeding solutions or intestinal hemorrhage o Occurs when large volume of fluids/electrolytes enter the intestinal lumen and overwhelm the absorptive capacity of the bowel o Characterized by watery & voluminous stools o Resolves when the causative agent is withdrawn Secretory diarrhea - Precise Answer ✔✔o Caused by intestinal hypersecretion o Results from biochemical disturbance causing a mechanical response; the principal producers of the biochemical disturbance are enterotoxin- producing pathogens such as C.diff, and endocrine tumors o Occurs when pathogens irritate and damage the epithelial cells of the bowel wall; or when NETs produce large quantities of peptide secretagogues o Persistent, watery, voluminous stools DESPITE FASTING Exudative diarrhea - Precise Answer ✔✔o Caused by inflammation and ulceration of the bowel mucosa o Often related to radiation to the bowel mucosa, causing depletion of crypt stem cells, mucosal atrophy, fibrosis o Characterized by high-frequency stools with mucus, serum protein, and blood with varying volumes (usually less than 1L per day) Malabsorptive diarrhea - Precise Answer ✔✔- o Caused by mechanical and biochemical disturbances o Can be result of enzyme deficiency, lactose intolerance, pancreatic insufficiency o Can be caused by chemotherapy (5FU, irinotecan) as biochemical direct effect on the bowel mucosa o Can be related to surgical resection of the intestine and dysmotility, peristaltic dysfunction, and IBS o Results in changes in mucosal integrity or membrane permeability and leads to abnormal enterohepatic circulation of bile salts o Osmotically active substances enter the colon and directly stimulate the bowel o Results in rapid transit of stool through large & small intestines o Characterized by voluminous, foul-smelling, steatorrhea-type stools. Agency is designed to improve health care quality, decrease cost and create more access to essential services - Precise Answer ✔✔Agency for Healthcare Research and Quality Autologous HSCT - Precise Answer ✔✔the patient donates the hematopoietic cells, virtually no risk of GVHD. High potential for relapse due to contamination by residual tumor cells and lack of immunologic graft vs tumor effect. Autologous HSCT used for hem malignancies including - Precise Answer ✔✔Hodgkins lymphoma, NHL, multiple myeloma, some solid tumors Graft-vs-Host Disease (GVHD) can occur acutely or chronically is one of the most difficult problems associated with - Precise Answer ✔✔ALLOGENIC transplants; acute GVHD usually occur 2-5 weeks after transplantation Chronic or late GVHD: - Precise Answer ✔✔o Most common late complication and usually occurs within first 2 years after transplantation o Treated with cyclosporine and prednisone, alternating doses every other day o Infection is the most common cause of death in patients with chronic GVHD Infection: - Precise Answer ✔✔- One of the most common causes of death in transplant recipients - Recovery of the cellular and humoral immune systems can occur 3-6 months after autologous transplantation and 6-12 months after allogenic transplantation; if GVHD occurs, recovery could be delayed. - Prophylactic antibiotics and antifungals may be prescribed. Graft failure: - Precise Answer ✔✔Usually recognized during the expected engraftment phase when a specific number of days with an ANC higher than 500 does not occur. In some cases, graft failure is quickly recognized. In other cases, the engraftment process occurs but is not sustained, leading to graft failure. Post HSCT: supportive care - Precise Answer ✔✔- Treatment with hematopoietic growth factors to reduce pancytopenia, and transfusion of red cells are usually required - Blood products should be irradiated and leuko-reduced to reduce the likelihood of transfusion reactions, alloimmunizations, and infection. voluntary program where professionals can report adverse reactions or safety concerns with medications, medical devices, cosmetics or infant formula. - Precise Answer ✔✔FDA MedWatch Germline mutations p 16 (CDKN2A) gene - Precise Answer ✔✔Account for 10 % of all melanomas, and 25-40 % of hereditary melanomas associate with pancreatic cancer Melanoma lifetime risk 60% pancreatic Ca lifetime risk 17 % Lymphoma classification system - Precise Answer ✔✔Ann Arbor Classification System Leukemia Classification System - Precise Answer ✔✔Rai or Binet Classification System FAB Classification System WHO Classification System Acute DIC is associated with - Precise Answer ✔✔more bleeding Chronic DIC is associated with - Precise Answer ✔✔thrombus formation DIC 1. Prolonged 2. Decreased 3. Elevated - Precise Answer ✔✔1. PT, APTT, INR 2. PLT, ATIII, protein C, Fibrinogen, 3. Thrombin time, Fibrin Degradation peoducts, D-dimer Individual patient differences in ability to fight sepsis and response to intervention may be dependent on underlying genetic factors. Which collectin (Collagen containing C-type lectins) plays an important role in innate immune defense? - Precise Answer ✔✔MBL ACS 2017 recommends: mammogram - Precise Answer ✔✔· Women ages 40-44 should have the choice to begin annual breast cancer screening with mammogram · Women ages 45-54 should get annual mammograms · Women 55+ should have mammograms every 2 years or the choice to continue annual mammogram · Screening should continue as long as a woman is in good health and expected to live 10+ years CLL is classified as Stage 0 if - Precise Answer ✔✔the patient has an absolute lymphocytosis (>15,000), without adenopathy, without hepatosplenomegaly, without anemia or thrombocytopenia. NCI targeted prevention strategies: - Precise Answer ✔✔increased consumption of fruits/ veggies/ fiber, decreased fat intake, decreased tobacco use, decreased red meat consumption, increase use of sunscreen, regular exercise. Signs and symptoms of lung cancer related to intrathoracic extrapulmonary spread include ------ , imaging diagnosis - Precise Answer ✔✔Horner syndrome (ptosis, miosis, and anhidrosis), weight loss and fatigue. A chest x-ray is the most cost-effective imaging study to determine the presence of a chest mass. Which of the following assessment findings is most concerning for the diagnosis of a head and neck malignancy? - Precise Answer ✔✔Enlarged jugular lymph node chains *The patient with a head and neck malignancy may present with painless and enlarged lymph nodes in the neck Which of the following Gleason scores indicate the most poorly differentiated cells? - Precise Answer ✔✔5 Aggressive tumors defined as - Precise Answer ✔✔PSA greater than 20 and Gleason score greater than 7 5-year survival of prostate cancer is - Precise Answer ✔✔100% for local/ regional disease, 99% for all patients; 15-year survival 82% and many patients die of other causes. Treatment for leukocytosis, when accompanied by neurologic or respiratory symptoms - Precise Answer ✔✔leukapheresis. A supraglottic laryngectomy affects - Precise Answer ✔✔swallowing, decreasing protection of the glottis and increasing the risk for aspiration. Trismus - Precise Answer ✔✔Inability to open the jaw due to pain xerostomia. - Precise Answer ✔✔dry mouth The management for abdominal distention and pain during intraperitoneal chemotherapy is - Precise Answer ✔✔to slow the infusion until the discomfort stops and administer pain medication as needed. Capecitabine & warfarine - Precise Answer ✔✔increase PT Sepsis causes - Precise Answer ✔✔a large scale release of cytokines resulting in massive vasodilation, increased capillary permeability, decreased vascular resistance, and hypotension. A patient with cancer reports they have been fired so the employer can avoid providing benefits. The APRN understands this is a violation of the: - Precise Answer ✔✔Employee Retirement and Income Security Act. cancer risk due to arsenic exposure in well water - Precise Answer ✔✔Exposure to arsenic increases the risk of bladder, lung and skin cancer. Colorectal cancer T staging - Precise Answer ✔✔T1 invades submucosa T2 invades muscularis propria T3 invades through the muscularis propria into pericolorectal tissue T4 penetrates to the surface of the visceral peritoneum Which type of biopsy will best determine the Breslow thickness? - Precise Answer ✔✔Excisional biopsies are best able to determine Breslow depths for skin cancers. Which of the following findings from a bone marrow biopsy is a favorable prognostic indicator for acute myeloid leukemia? - Precise Answer ✔✔Translocation of chromosomes 8 and 21 In AML, 5q deletion - prognosis - Precise Answer ✔✔usually associated with a complex karyotype. Prognosis of AML with 5q-/-5 is generally unfavorable, associated with rapid disease progression and poor outcome and survival, especially when it is seen as a part of complex karyotype. Sinusoidal obstruction syndrome - Precise Answer ✔✔occur following allogeneic transplant and is characterized by hepatomegaly, fluid retention and increased liver enzyme levels. Most likely to occur within 4 to 12 weeks of receiving treatment with symptoms including cough, temperature, rales and a pleural friction rub - Precise Answer ✔✔Radiation-induced pneumonitis non-pharmacologic interventions for lymphedema - Precise Answer ✔✔1. Elevation of extremity for 45 minutes two to three times a day 2. Regular, light aerobic exercise daily or several times weekly 3. Elastic garment (requires measuring by a physical or occupational therapist) to compress fluid 4. Elevation of extremity or wearing a well-fitted garment when traveling by air 5. Weight management counseling 6. Massage therapy to affected extremity or manual lymphedema drainage; massage therapy is contraindicated in the following situations. a) Active cellulitis b) Active neoplasia c) Acute DVT d) CHF e) Local massage over irradiated soft tissue 7. Intermittent pneumatic compression devices 8. Complete decongestive physiotherapy (e.g., manual lymphedema drainage) 9. Use of compression sleeve while flying 10. Meticulous skin hygiene and nail care Look Good Feel Better is a program that - Precise Answer ✔✔works to improve the self-image of patients receiving treatment. Which of the following reimbursement coding systems is most closely associated with the types of products and supplies used for care? - Precise Answer ✔✔The Level II Healthcare Common Procedure Coding System The APRN delegates a staff member to audit the accuracy of tumor registry data to comply with accreditation standards from the: - Precise Answer ✔✔The American College of Surgeons Content validation should be conducted with - Precise Answer ✔✔a panel of subject matter experts to identify any issues related to relevance, balance, and comprehension. Describes fidelity as an ethical principle? - Precise Answer ✔✔the obligation to keep one's promise and commitments. A phase 4 clinical trial occurs - Precise Answer ✔✔after the medication receives U.S. FDA approval for the proposed indication and assesses the effectiveness and long term effects. Helicobacter pylori - Precise Answer ✔✔an infectious agent that is carcinogenic to humans and could lead to the development of gastric lymphoma. capecitabine education - Precise Answer ✔✔Soiled linens should be washed separately two times with regular detergent. Obinutuzumab binds to what? - Precise Answer ✔✔binds to CD20, causing cell death. The APRN is reviewing the urinalysis results for a patient with lung cancer and a pulmonary embolism who is experiencing worsening renal function. The APRN expects to find a: - Precise Answer ✔✔Pulmonary emboli may cause prerenal states. Prerenal state is associated with a urine osmolality greater than 500 mOsm/kg. Which medication is likely to be effective for chemotherapy-induced diarrhea that is refractory to loperamide. - Precise Answer ✔✔Octreotide A patient with small cell lung cancer presents with a headache, irritability, fatigue, and muscle cramps. A complete metabolic panel reveals a serum sodium of 131 mEq/L. What should the APRN do next? - Precise Answer ✔✔A patient with mild hyponatremia should initially restrict fluid intake to a maximum of 1,000 mL each day. an emotional response to grief. - Precise Answer ✔✔Sense of helplessness a cognitive response to grief - Precise Answer ✔✔Inability to concentrate behavioral response to grief. - Precise Answer ✔✔crying and withdrawal