AOCNP EXAM 2025 QUESTIONS AND CORRECT ANSWERS., Exams of Nursing

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AOCNP EXAM QUESTIONS AND CORRECT

ANSWERS

the risk for significant bone marrow suppression (8) - 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) - 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 - ANSWER>>melanoma, cancer of the breast, lung, kidney and prostate

Nitrosoureas (Carmustine, Lomustine) - 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) - ANSWER>>1. treatment field involves marrow producing tissue or with dose greater than 15 Gy

CD 4 counts < 500/mm3 - ANSWER>>significant risk factor for oopotunisitic infections

Cyclosphosphamide - myelosuppression risk - ANSWER>>moderate

Paclitaxel - myelosuppression risk - ANSWER>>moderate

Doxorubicin (Adriamycin) - myelosuppression risk - ANSWER>>alkylating agnet, may produce severe myelosuppression, the duration only about 21 days

Myelosupression secondary to radiation therapy peaks at - 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? - ANSWER>>Alkylating agent, especially with high doses or cumulative doses of antimetabolites Antitumor antibiotics Corticosteroids Epipodophyllotoxins (i.e Etoposide)

Second malignancy : Bladder cancer- potential etiologic factor? - ANSWER>>radiation therapy for prostate cancer

Second malignancy : Brain tumors - potential etiologic factor? - ANSWER>>therapeutic radiation for other cancer

Second malignancy : hepatoma- potential etiologic factor? - ANSWER>>Androgen therapy

Second malignancy : Kidney cancer - potential etiologic factor? - ANSWER>>Brain tumor therapies Cisplatin, especially in treatment for testicular cancer

Second malignancy : Leukemia - potential etiologic factor? - ANSWER>>Antitumor antibiotics Brest cancer treatment Lymphoma treatment

production suspected, which test should be performed? - ANSWER>>Bone marrow aspirations and biopsy with peripheral smear

Gail model best use for - 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 - ANSWER>>hereditary colon cancer

Claus model estimates - ANSWER>>breast cancer risk based on first -and second -degree relatives with breast or ovarian cancer.

Primary cancer prevention (definition) - ANSWER>>aims to reverse or inhibit cancer by modification of a person's environment or behaviors or through pharmacologic mechanisms

Primary cancer prevention : example - ANSWER>>tabacco use, smoking cessation, Sun Exposure, Diet exercise, chemoprevention, HPV vaccine

Secondary prevention - ANSWER>>screening and early detection

Chemoprevention : negative trial - 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 - 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, high risk pre and post menopausal women.

Lung cancer screening - 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 - 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 - ANSWER>>age 21-

• PAP test q3 years, no HPV testing age 30-
• PAP test and HPV testing every 5 years (preferred ) or PAP test alone q 3 yeras

HNPCC syndrome (Lynch syndrome) screening/risk - 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- 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 - ANSWER>>diagnosed with a hereditary mutation but does not have a cancer diagnosis

Plain radiographs （Indications） - ANSWER>>quick and inexpensive option

• Purely lytic bone metastasis (such as multiple myeloma)
• pneumonias and intestinal obstructions in patient with peripheral lung lesion

St. John's wort should be discontinued more than 24 hours, why - ANSWER>>The concentration of active ingredients in herbal products varies wildly among preparations. Adverse reactions of St. John's wort include an anti platelet effects. Abrupt cessation of this alternative medication may initiate withdrawal symptoms. Should be discontinued two weeks before the surgery.

Post-mastectomy pain syndrome - ANSWER>>occurs in 25-60% of mastectomy patients postoperative radiation and extensive axillary dissection are risk factors symptoms: tight, burning pain in mastectomy site, axilla and back of arm, paresthesia, dysesthesia, allodynia(異痛症), hyperalgesia, or loss of shoulder function, neuropatic pain and phantom breast pain.

Paclitaxel vs paclitaxel protein-bound particles AE: peripheral neuropathy - 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 - ANSWER>>St. John's wort decrease the effectiveness of the active betabolites SN-38 of irinotecan by almost 50%

Surveillance - breast - ANSWER>>H&P every 4-6 months for 5 years then annually Mammogram yearly

Surveillance - Lymphoma (varies among specific lymphoma types) - 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 - 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 - ANSWER>>H&P with CT Chest +/- contrast every 6- months for 2 years then annually PET/MRI not routinely recommended

Surveillance - Prostate after initial definitive treatment - 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 - ANSWER>>H&P every 2-4 months for 2 years, then 3- months for 3 years, then annually for a total of 5 years. CA-125 - optional, every visit if initially elevated

Beneficience definition - ANSWER>>the principle of doing no harm and maximizing benefits while minimizing harm

Justice means - ANSWER>>giving each person an equal share and according to need, individual effort, societal contribution or or merit.

Respect describes.... - ANSWER>>the need to treat individual effort and their decisions as autonomous and if that autonomy is compromised, the obligation to protect that individual.

CHOP regimen - ANSWER>>cyclophosphamide, doxorubicin, vincristine, prednisone

CHOP regimen two drugs cause myelosupressive side effects - ANSWER>>The myelosuppression with cyclophosphamide occurs in 7-10 days, whereas that of doxorubicin occurs in 10-14 days.

vincristine side effects - ANSWER>>neurotoxicity

Trastuzumab (Herceptin) should be held for - ANSWER>>at least 4 weeks for a) 16 % or greater absolute decrease in LVEF from pretreatment values b) an KVEF below institutional limits of normal and 10 % or greater absolute decrease in LVEF from pretreatment values. Resume drug if, within four to eight weeks, the LVEF returns to within normal limits and the absolute decrease from baseline is 15% or less.

Monoclonal antibodies

1. -umab
2. -zumab
3. -ximab
4. -momab - ANSWER>>1) antibodies a re made to be totally human
5. mostly human and wonly a small part mouse
6. some mouse and some human
7. entirely mouse protein

SSRI for cancer related depression (side effects) - ANSWER>>agitation, gastrointestinal disturbance, sexual dysfunction

symptoms of drug induced liver injury - ANSWER>>edema, muscle and joint aches, pruritus, ecchymosis, headache, low grade fever

Dementia Criteria - ANSWER>>impairment in memory, orientation and personality of chronic nature

delirium is defined as - 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 - ANSWER>>dilated superficial blood vessels

The most common sings and symptoms relate to superior vena cava syndrome(SVCS) - 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 - ANSWER>>Carmustine and Lomustine (lipid soluble) cross the brain barrier. Temozolomide

Carmustine - 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 - 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 - 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.

Graft versus host disease - 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

Sulfonamides use for prophylactically in patients undergoing stem cell transplantation to prevent ----- , what is the sulfonamides - ANSWER>>pneumocystis jiroveci pneumonia sulfonamides - pentamidine, dapsone

BCR ABL test - ANSWER>>is most often used to diagnose or rule out chronic myeloid leukemia (CML) called Philadelphia chromosome positive treatment of CML wit hphiladephia chromasone positive involves a tyrosine kinase inhibitor (TKI)

Pt with chemo shows visible sings of mucositis - ANSWER>>4-5 days after initial treatment and peaks within 2 weeks.

A patient with recurrent breast cancer is preparing to receive additional Adriamycin. Her MUG scan showed decreased LVF. The APN prepare to prescribe - ANSWER>>Dexrazoxane -to reduce the incidence and severity of heart problems associated with the chemotherapy agent doxorubicin in women being treated for metastatic breast cancer.

A patient with a undergoing HSCT and having large amounts of persistent watery stools. what type of diarrhea ??? - ANSWER>>Secretory diarrehea

A 40 years old patient with terminal cancder is noted to have a chloroma on the spine with relapsed leukemia. What action would be appropriate to help relieve pain - ANSWER>>Radiation, epidural infusion of pain medication, nerve block

Doxorubicin liposomal - the cumulative lifetime dose of doxorubicin liposomal reaching - ANSWER>>500 -550 mg/m2; 450-500 mg/m2 if receiving RT to the meiastinum or administration of other cardiotoxic agent such as cyclophosphamide

Doxorubicin - Adriamycin -the cumulative lifetime dose of doxorubicin reaching

• ANSWER>>550 mg/m2, 400 mg/,2 if prior radiation therapy including heart

Dexrazoxone - ANSWER>>cardioprotective agent indicated for patients with metastatic breast cancer who have received a cumulative dose of 300mg/m2 of doxorubicin or more; reduces the severity and incidence of doxorubicin- associated cardiomyopathy (though some evidence exists that is may decrease anticancer effects of doxorubicin).

Cord Blood transplant (3 disadvantages ) - ANSWER>>another source of stem cells; disadvantages include the limited number of cells, delayed time to engraftment, higher risk of infection.

Cord blood transplant (3 advantages) - ANSWER>>low rate of viral contamination, lower rate of GVDH, and ready availability of units

Amifostine - ANSWER>>reduces cumulative nephrotoxicity associated with cisplatin

Diuretics: - ANSWER>>hasten elimination of cisplatin

Leucovorin - ANSWER>>hasten elimination and lessen systemic toxicity of high- dose METHOTREXATE

Mesna - ANSWER>>inactivates metabolites of ifosfamide (or high-dose cyclophosphamide) to prevent hemorrhagic cystitis

Mild neutropenia - ANSWER>>ANC of less than 1500 per mm

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 - 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 - ANSWER>>Agency for Healthcare Research and Quality

Autologous HSCT - 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 - ANSWER>>Hodgkins lymphoma, NHL, multiple myeloma, some solid tumors

Four phases of autologous transplantation - ANSWER>>o Induction o Mobilization/ harvesting

o Conditioning o Engraftment

Allogenic HSCT - ANSWER>>Hematopoeitic cells are donated by an immunologically related healthy donor; allogenic nonmyeloablative transplants use low doses of total body irradiation or chemotherapy to suppress the immune system, then the patient receives an infusion of stem cells from the donor.

GVHD can be prevented with - ANSWER>>classic immunosuppressives including cyclosporine, methotrexate, prednisone; polyclonal or monoclonals Abs, phototherapy.

Allogenic HSCT- Three phases: - ANSWER>>o Donor matching o Conditioning o Engraftment

Syngeneic HSCT - ANSWER>>donor is an identical twin, which produces a perfect human leukocyte antigen match so that immunosuppression is not needed. There is a higher risk of relapse due to lack of graft-vs-disease effect.

Nonmyeloablative HSCT: aka "mini"-HSCT - ANSWER>>Patient receives lower doses of chemo or total body irradiation and followed by receipt of donor stem cells.

Mobilization - ANSWER>>procedure to stimulate bone marrow to make and move pluripotent stem cells and progenitor cells into peripheral blood. Mobilization can be done with hematopoietic growth factors alone, or with chemotherapy (cyclophosphamide) or chemokine antagonists (plerixafor).

Conditioning - ANSWER>>needed to eliminate remaining disease and wipe out the bone marrow in anticipation of new donor marrow/ stem cells. It also suppresses the immune system to prevent GVHD. If the patient is having an

Post HSCT: supportive care - 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. - ANSWER>>FDA MedWatch

Germline mutations p 16 (CDKN2A) gene - 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 - ANSWER>>Ann Arbor Classification System

Leukemia Classification System - ANSWER>>Rai or Binet Classification System FAB Classification System WHO Classification System

Acute DIC is associated with - ANSWER>>more bleeding

Chronic DIC is associated with - ANSWER>>thrombus formation

DIC

1. Prolonged
2. Decreased
3. Elevated - ANSWER>>1. PT, APTT, INR
4. PLT, ATIII, protein C, Fibrinogen,
5. 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? - ANSWER>>MBL

ACS 2017 recommends: mammogram - 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

The main risk factor of development of testicular cancer is A and other risk factors includes B - ANSWER>>A. Cryptorchidism B. Being Caucasian

Melphalan (Alkeran) - indication and AE - ANSWER>>treatment of multiple myeloma and ovarian cancer. weight loss, loss of appetite, weakness, blistering skin or acne, nausea, vomiting, diarrhea, white patches or sores inside your mouth or on your lips, temporary hair loss, or skin itching and rash

What treatment modality has been established as effective for mucositis - ANSWER>>Cyotherapy, palifermin, sodium bicarbonate