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ONS ONCC Chemo Renewal Exam Newest 2026
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Neoadjuvant therapy does not Main benefit of neoadjuvant chemotherapy (breast increase survival when compared to cancer patient) adjuvant therapy. It only changes the timing of treatment and can change surgical options if the tumor is shrunk enough. If this occurs, the patient may only require a lumpectomy plus radiation therapy instead of needing a mastectomy
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A comprehensive geriatric Due to Mrs. Turner's age and comorbidities, her assessment (CGA) is a oncologist performs a comprehensive geriatric multidisciplinary evaluation to assess assessment. You know that this assessment covers life expectancy and risk of morbidity all but which of the following: and mortality in the older patient. This assessment tool would evaluate and include the following areas: functional status, socioeconomic issues, psychosocial distress, comorbidities, cognitive function, nutritional status, polypharmacy, and a medication review (NCCN Older Adult Oncology Guidelines, version 1.2015).
65 The NCCN Older Adult Oncology Guidelines (version 1.2015) provides information on what is included in a comprehensive geriatric assessment. Currently, more than 60% of cancers in the United States occur in people age and older and as the oncology world ages, nearly half (46%) of cancer survivors are 70 years of age or older
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Non-DNA-binding solutions remain A further classification of an antineoplastic agent's in the local area of the extravasation, potential to cause damage is whether its which improves the possibility of mechanism of action includes DNA binding. drug deactivation. DNA-binding agents attach to DNA nucleic acids, causing the antagonist to be ingested cellularly, leading to progressive tissue destruction
Bendamustinea DNA Binding Irritants Dactinomycin Daunorubicin Doxorubicin Epirubicin Idarubicin Mechlorethamine Mitomycin
Amsacrine DNA Nonbinding vessicants Paclitaxel Vinblastine Vincristine Vindesine Vinorelbine
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Sodium thiosulfate Extravasciation Alkylating / Mechlorethamine tx
Inject 2 ml of sodium thiosulfate for each milligram of mechlorethamine extravasated. Inject subcutaneously into extravasation site using a 25 gauge or smaller needle (change needle with each injection). Monitor extravasation site according to the institution's policies and procedures.
Apply warm compresses. Extravasciation Alkylating: Oxaliplatin Dexamethasone 8 mg twice daily for 14 days
Totect Extravasation Tx: Anthracyclines --- Daunorubicin, doxorubicin, epirubicin, Apply ice pack (remove 15 idarubicin minutes prior to Totect treatment).
Infusion should be initiated within six hours of extravasation. Infused over 1-2 hours for three days in an area other than the extravasation site The dose recommended is based on the patients' body surface area.
- Day 1: 1,000 mg/m
- Day 2: 1,000 mg/m
- Day 3: 500 mg/m
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irinotecan The manufacturer of__________ recommends topical flushing of the skin with sterile water and application of ice in the event of extravasation of the drug (Pfizer Inc., 2012).
Burning, stinging pain around the Extravasation signs and symptoms can include administration site, although it is important to note that some patients do not experience any pain with vesicant extravasation and may in fact experience a feeling of coolness at the site (Polovich et al., 2014).
Constipation is not a likely side effect Knowing the most common side effects of these with the agents that Mrs. Turner is to agents (docetaxel, carboplatin, trastuzumab and receive. Actually diarrhea is more pertuzumab), which of the following side effects likely when receiving both of the will you not be covering in your patient teaching targeted therapies in this regimen. today since it is not usually seen with the chemotherapy agents Mrs. Turner is going to receive?
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ANC = (Neutrophils + Bands) x WBC / ANC Calculation 100
To calculate the ANC:
Find the WBC, the polys/neutrophils and bands on your CBC (neutrophils can be called many things in a differential including: polymorphonuclear cells or polys, PMNs, granulocytes, segmented neutrophils, or segs). WBC = 2.
Add the polys and bands (polys = 22%, bands = 4%). 22 + 4 = 26
Multiply the sum of the polys and bands by the WBC. 26 X 2.1 = 54.
Multiply the product by 10. 54.6 X 10 = 546
Mrs. Turner's ANC is 546
Restriction of fresh fruits and You meet with Mrs. Turner to discuss neutropenia vegetables is no longer necessary and her increased risk of infections and to reinforce based on the evidence (ONS PEP with her some ways that she can prevent infections. resource Prevention of Infection You are familiar with the ONS PEP resources https://www.ons.org/practice- including the resource Prevention of Infection. resources/pep/prevention- infection/prevention-infection- You review with Mrs. Turner what the evidence general) recommends to prevent infections. Which of the following is unlikely to be effective for infection prevention?
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Effectiveness Unlikely: Prevention on Infections: Practices No Long Colony Stimulating Factors By Recommended Intravenous Rather Than Subcutaneous Route Frequent IV Tubing and Component Changes Restriction of Fresh Fruits and Vegetables
Not Recommended for Practice: Extended Post-Operative Antibiotics Implantable Gentamycin Sponge Use of Live Attenuated Vaccines
Per the NCCN Guidelines Which of the following do you feel will be done (http://www.nccn.org/professionals/ with the remaining cycles of chemotherapy to physician_gls/pdf/myeloid_growth.pd hopefully prevent Mrs. Turner from having f), because of Mrs. Turner's age ≥ 65 additional problems with neutropenia? as well as a previous neutropenic episode, she would be a candidate to receive a GCSF. Her febrile neutropenic episode requiring hospitalization puts her at high risk for additional neutropenia.
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full dose Evidence shows that older patients with cancer can safely obtain the same treatment benefits as younger patients when they receive______ standard chemotherapy regimens. Many physicians are reluctant to give full-dose chemotherapy to older adults perhaps due to of fear of adverse events like febrile neutropenia. Suboptimal dosing from increasing the length of time between cycles or from dose reduction is a serious issue because large, randomized clinical trials have demonstrated that the delivery of lower doses or shorter courses of chemotherapy can reduce overall survival in older patients with breast cancer or lymphoma
85% Amgen (2007) defines RDI as "is a quantification of how closely an administered course of chemotherapy treatment adheres to a specific regimen." Three separate clinical trials evaluating outcomes in patients with breast cancer related to RDI have demonstrated improved overall survival and 10-year disease free survival in patients who receive a RDI > or = ____?_____
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Mrs. Turner's initial MUGA scan result You realize that since Mrs. Turner is on a regimen was 55% and is now decreased to that includes pertuzumab that she should have her 48% which is a > 10% decrease in her LVEF monitored every 6 weeks since she is LVEF. Per the prescribing information receiving neoadjuvant therapy. You review Mrs. for Perjeta, if the LVEF is 45%, or is Turner's most recent MUGA scan and see that her 45% to 49% with a 10% or greater LVEF is 48%. absolute decrease below the pretreatment value, withhold PERJETA and trastuzumab and repeat LVEF assessment within approximately 3 weeks (http://www.gene.com/download/pd f/perjeta_prescribing.pdf). You should call the doctor to provide the results of the MUGA scan compared to her initial MUGA scan and anticipate that the trastuzumab and pertuzumab will be held for this cycle of chemotherapy. Mrs. Turner should have a repeat MUGA scan prior to cycle #4 and based on those results, discontinue PERJETA and trastuzumab if the LVEF has not improved or has declined further, unless the benefits for the individual patient outweigh the risks.
heart function Two of the agents in the patients currecnt regimen, trastuzumab and pertuzumab, have the potential to cause a decline in _____________
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8.4% It is important that the nurse recognizes certain drugs that, when given together, may result in a higher risk of adverse events. For example, in neoadjuvant clinical trials using trastuzumab and pertuzumab, the incidence of decline in left ventricular ejection fraction (LVEF) was 1.9% in patients treated with trastuzumab and docetaxel, compared to___ of those treated with trastuzumab, docetaxel, and pertuzumab (Genentech, 2013).
Consider the potential toxicity Key Points for Combination Therapy related to each drug. Understand the monitoring guidelines for each drug. Have knowledge of clinically significant signs and symptoms.
Improved patient outcomes. Evidence-based practice can have positive effects, Increased nurse satisfaction. such as: Potential cost savings.
Smoking Risk factors for colon cancer Increased age Alcohol intake History of Polyps
50 The chance of developing colorectal cancer increases markedly after age___ . Roughly 9 out of 10 people diagnosed with colorectal cancer are at least__ years old.
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Duloxetine Effective treatments for peripheral neuropathy Gabapentin and Opioid Combination
Per the ONS PEP resources for Thinking that this is early mucositis, which of the mucositis following should the nurse instruct Mr. Patterson to (https://www.ons.org/practice- do to help his symptoms? resources/pep/mucositis), of the listed answers, oral care protocol would be what the nurse needs to ensure Mr. Patterson is doing at home for his early mucositis to prevent it from worsening.
Risk factors for mucositis that are not Which of the following of Mr. Patterson's lifestyle from the agents themselves include factors put him at the most risk for developing the following: dental disease and mucositis? poor oral hygiene, ill-fitting dentures, advanced age and youth age, history of alcohol and tobacco use, poor nutrition, intake of irritating foods (spicy or acidic foods), and dehydration (Information from the chemo/bio guidelines page 214-215). Mr. P. has both a poor diet and also uses tobacco (both chewing tobacco and cigarettes) and alcohol. The use of tobacco products is a big risk factor for development of mucositis.
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Recommended for Practice: Recommended and effective care in mucositis Cryotherapy Low Level Laser Therapy in Patients Undergoing Hematopoietic Cell Transplantation Low Level Laser Therapy in Patients With Head and Neck Cancer Oral Care Protocol Sodium Bicarbonate
Likely to Be Effective: Benzydamine for Patients Receiving Combination Chemotherapy and Radiation Therapy Benzydamine for Radiation-Related Mucositis Lactobacillus Lozenges Palifermin for Patients Receiving Chemotherapy and Radiation for Head and Neck Cancer Palifermin with High-Dose Chemotherapy and/or Hematopoietic Cell Transplantation
Single gown use with back closure Which of the following are recommended as Two pairs of chemotherapy gloves standard PPE when there is any potential exposure for hazardous drugs? (select all that apply)
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When receiving chemotherapy in the Which of the following is of utmost importance to home (in Mr. Patterson..'s case he is include in your education to Mr. Patterson since he getting continuous 5-FU) it is will be receiving HDs at home (continuous 5-FU)? recommended to send the patient home with and instruct them on the use of a spill kit (see Figure 13 from the Guidelines). Other important things to include in your education is that everyone, not just caregivers, should wear gloves when touching the chemotherapy or anything soiled by chemotherapy. Visitors are welcome and encouraged when patients are going through chemotherapy. Hugging and kissing are safe post chemotherapy. Sexual activity is usually considered safe as well with the use of barrier protection. However, it is recommended that patients discuss this issue with their physician or nurse first to discuss specific precautions that may be necessary.
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Serum Creatinine Which of the following lab results must you have to review the dose calculation of Mrs. Kearns's The estimated glomerular filtration carboplatin? rate (eGFR) is required for the carboplatin dose calculation. Serum creatinine is used to determine the eGFR. The eGFR is needed to calculate the carboplatin dose. To determine the eGFR the following is needed: age of patient, weight, gender, and serum creatinine. The most commonly used formula to calculate the GFR in the United States is the Cockcroft-Gault formula
. A 24-hour urine can also be used to determine GFR if the patient has one.
Paclitaxel is mixed in a mineral-oil Mrs. Kearns's orders seem appropriate and correct like solvent that can cause infusion according to you and the other RNs calculations. related hypersensitivity reactions. She is a little nervous but ready to begin her first Premedication should be given to cycle of chemotherapy. prevent this from occurring. All patients should be pretreated with Which of the following is true related to paclitaxel corticosteroids, diphenhydramine, treatment? and H2 antagonists. Paclitaxel is an irritant and potential vesicant. Therefore it is very important for patient to receive education about symptoms to report (i.e. pain, erythema, redness). To prevent severe myelosuppression, paclitaxel should always be given prior to platinum-containing medications. Paclitaxel should be administered via a 0.3 micron in-line filter using a glass bottle or non-PVC bag and tubing.
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