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ONS ONCC CHEMO RENEWAL Exam |
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Neoadjuvant therapy does not increase survival when compared to 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 Correct Answer: Main benefit of neoadjuvant chemotherapy (breast cancer patient) A comprehensive geriatric assessment (CGA) is a multidisciplinary evaluation to assess life expectancy and risk of morbidity 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). Correct Answer: Due to Mrs. Turner's age and comorbidities, her oncologist performs a comprehensive geriatric assessment. You know that this assessment covers all but which of the following: 65
Correct Answer: 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 Two of the agents (docetaxel and carboplatin) that Mrs. Turner will receive are categorized as irritants. Docetaxel can cause a significant reaction if it extravasates. It can lead to edema, erythema, occasional pain and blister formation (ONS Chemo/Bio guidelines, 2014). That is the most likely reason that Mrs. Turner was given a port for her treatments. Some patients will receive their treatments through a peripheral IV without incident. Just because they are intravenous agents does not mean that a port is required and needing a port has nothing to do with her being older in age. Since none of these agents are vesicants, they likely could have been given safely via peripheral route but having a port placed is OK as well. Correct Answer: What is your best explanation for why Mrs. Turner was given a port to receive her chemotherapy? Irrirtants Correct Answer: _____________can cause inflammation, pain, and burning but rarely cause tissue necrosis comparable to a vesicant (unless a large amount or a very high concentration of the irritant is extravasated).
Vinblastine Vincristine Vindesine Vinorelbine Correct Answer: DNA Nonbinding vessicants Sodium thiosulfate 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. Correct Answer: Extravasciation Alkylating / Mechlorethamine tx Apply warm compresses. Dexamethasone 8 mg twice daily for 14 days Correct Answer: Extravasciation Alkylating: Oxaliplatin Totect
Apply ice pack (remove 15 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 Correct Answer: Extravasation Tx: Anthracyclines --- Daunorubicin, doxorubicin, epirubicin, idarubicin Hyaluronidase Apply warm pack for 15 - 20 minutes four times daily the next 24- 48 hours and keep extremity
Correct Answer: Most sources recommend the application of heat using _______________ to help reduce local discomfort and the restart of the peripheral IV in a larger vein (Polovich et al., 2014). irinotecan Correct Answer: 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 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). Correct Answer: Extravasation signs and symptoms can include Constipation is not a likely side effect with the agents that Mrs. Turner is to receive. Actually diarrhea is more likely when receiving both of the targeted therapies in this regimen. Correct Answer: Knowing the most common side effects of these agents (docetaxel, carboplatin, trastuzumab and pertuzumab), which of the following side effects will you not be covering in your patient teaching today since it is not usually seen with the chemotherapy agents Mrs. Turner is going to receive? ANC = (Neutrophils + Bands) x WBC / 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 Correct Answer: ANC Calculation Restriction of fresh fruits and vegetables is no longer necessary based on the evidence (ONS PEP resource Prevention of Infection https://www.ons.org/practice- resources/pep/prevention-infection/prevention-infection-general) Correct Answer: You meet with Mrs. Turner to discuss neutropenia and her increased risk of infections and to reinforce with her some ways that she can prevent infections. You are familiar with the ONS PEP resources including the resource Prevention of Infection.
Positive Expiratory Pressure and Self-Monitoring Pre-construction Planning Preoperative Antibiotics Correct Answer: Prevention of Infections: Practice Recommended Effectiveness Unlikely: Colony Stimulating Factors By 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 Correct Answer: Prevention on Infections: Practices No Long Recommended Per the NCCN Guidelines (http://www.nccn.org/professionals/physician_gls/pdf/myeloid_growth.pdf), because of Mrs. Turner's age ≥ 65 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.
Correct Answer: Which of the following do you feel will be done with the remaining cycles of chemotherapy to hopefully prevent Mrs. Turner from having additional problems with neutropenia? full dose Correct Answer: 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% Correct Answer: 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 = ____?_____ Per the prescribing information for Perjeta (http://www.gene.com/download/pdf/perjeta_prescribing.pdf) it states to assess LVEF
improved or has declined further, unless the benefits for the individual patient outweigh the risks. Correct Answer: You realize that since Mrs. Turner is on a regimen that includes pertuzumab that she should have her LVEF monitored every 6 weeks since she is receiving neoadjuvant therapy. You review Mrs. Turner's most recent MUGA scan and see that her LVEF is 48%. heart function Correct Answer: Two of the agents in the patients currecnt regimen, trastuzumab and pertuzumab, have the potential to cause a decline in _____________ 8.4% Correct Answer: 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 related to each drug. Understand the monitoring guidelines for each drug. Have knowledge of clinically significant signs and symptoms. Correct Answer: Key Points for Combination Therapy
Improved patient outcomes. Increased nurse satisfaction. Potential cost savings. Correct Answer: Evidence-based practice can have positive effects, such as: Smoking Increased age Alcohol intake History of Polyps Correct Answer: Risk factors for colon cancer 50 Correct Answer: 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. Racial and ethnic backgrounds (African Americans and Jews of Eastern European descent (Ashkenazi Jews) have highest incidence) Diet high in red and processed meats Physical inactivity, obesity Type 2 diabetes Family history of colon cancer or inflammatory bowel disease
Gabapentin and Opioid Combination Correct Answer: Effective treatments for peripheral neuropathy Per the ONS PEP resources for mucositis (https://www.ons.org/practice- 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. Correct Answer: Thinking that this is early mucositis, which of the following should the nurse instruct Mr. Patterson to do to help his symptoms? Risk factors for mucositis that are not from the agents themselves include the following: dental disease and 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. Correct Answer: Which of the following of Mr. Patterson's lifestyle factors put him at the most risk for developing mucositis? Recommended for Practice: 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 Correct Answer: Recommended and effective care in mucositis Single gown use with back closure Two pairs of chemotherapy gloves Correct Answer: Which of the following are recommended as standard PPE when there is any potential exposure for hazardous drugs? (select all that apply) Administering HDs by any route (PO, IV, IT, etc.) Handling any HD vials, ampules, or packaging materials Introducing or withdrawing needles or dispensing pins from HD vials
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. Correct Answer: Which of the following is of utmost importance to include in your education to Mr. Patterson since he will be receiving HDs at home (continuous 5-FU)? Serum Creatinine The estimated glomerular filtration 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. Correct Answer: Which of the following lab results must you have to review the dose calculation of Mrs. Kearns's carboplatin? Paclitaxel is mixed in a mineral-oil like solvent that can cause infusion related hypersensitivity reactions. Premedication should be given to prevent this from occurring. All patients should be pretreated with corticosteroids, diphenhydramine, and H 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. Correct Answer: Mrs. Kearns's orders seem appropriate and correct according to you and the other RNs calculations. She is a little nervous but ready to begin her first cycle of chemotherapy. Which of the following is true related to paclitaxel treatment? Although hypersensitivity and infusion reactions can occur at any time and potentially with any chemotherapy agent, there are certain agents that have a higher risk of causing a reaction. For some agents, the reaction is more likely to occur after they have received a few doses and have already been exposed to the same agent. On the other hand, there are agents where the hypersensitivity reactions can occur almost immediately on exposure. Reactions to platinum drugs (e.g., carboplatin, cisplatin, oxaliplatin) usually occur after multiple treatments. However, reactions caused by taxanes (e.g., paclitaxel, docetaxel) usually occur within the first hour of the first or second treatment. Reactions to monoclonal antibodies like rituximab and cetuximab usually occur with the first treatment as well. (Information from Zetka article) Correct Answer: Which of the following agents would you anticipate a hypersensitivity reaction more often occurring after the patient has already received several doses? Carboplatin's elimination by the kidneys occurs in a reliable manner that makes AUC the optimal method for dosing the drug. Basically, AUC is a method of expressing the
