ONS ONCC CHEMO RENEWAL EXAM LATEST ACTUAL EXAM 60 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES|AGRADE

ONS ONCC CHEMO RENEWAL EXAM LATEST

2023-2024 ACTUAL EXAM 60 QUESTIONS AND

CORRECT DETAILED ANSWERS WITH

RATIONALES|AGRADE

Mr. Rylan is receiving doxorubicin as part of his chemotherapy regimen.

The patient's ejection fraction should be tested prior to starting

doxorubicin. Periodic monitoring is also suggested in addition to testing

ejection fraction one year post completion of therapy. Per the prescribing

information, one should assess left ventricular cardiac function (e.g.,

MUGA or echocardiogram) prior to initiation of doxorubicin, during

treatment to detect acute changes, and after treatment to detect delayed

cardiotoxicity - ANSWER- Since you know that Mr. Rylan is getting RCHOP, which of the following pretreatment test results do you feel is a

priority to review prior to starting his chemotherapy?

Lifetime cumulative dose of doxorubicin is 550 mg/m2 except when

patient has received prior chest irradiation or when receiving

concomitant cyclophosphamide where the cumulative dose decreases to

450 mg/m2. Mr. Rylan is receiving cyclophosphamide as part of

RCHOP regimen so therefore should not exceed 450 mg/m2. -

ANSWER- Mr. Rylan is receiving RCHOP. What is the lifetime

cumulative dose of doxorubicin that Mr. Rylan should not exceed?

The risk of cardiotoxicity is generally proportional to the cumulative

exposure of doxorubicin. The probability of developing cardiotoxicity is

estimated to be 1 to 2% at a total cumulative dose of 300 mg/m2 of

doxorubicin, 3 to 5% at a dose of 400 mg/m2, 5 to 8% at a dose of 450

mg/m2, and 6 to 20% at a dose of 500 mg/m2, when doxorubicin is

administered every 3 weeks. There is an additive or potentially

synergistic increase in the risk of cardiotoxicity in patients who have

received radiotherapy to the mediastinum or concomitant therapy with

other known cardiotoxic agents such as cyclophosphamide, taxanes, and

trastuzumab. Cardiotoxicity can occur at lower doses in patients who

have received mediastinal radiation or those that have underlying heart

disease. Coadministration of coenzyme Q10 has actually shown

potential benefit in decreasing cardiotoxicity. - ANSWER- Which of the

following offers the highest risk for developing cardiotoxicity?

Per the NCCN guidelines

(http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf) on

Antiemesis, the most likely classes of agents that would be used as

premedication for a moderately emetic risk regimen include: Steroids

usually dexamethasone, 5HT3 antagonists like palonosetron or

ondansetron, with or without neurokinin 1 antagonists like aprepitant or

fosaprepitant. Prokinetic agents like metoclopramide are sometimes used

PRN for low risk regimens and breakthrough CINV. Other classes of

agents like proton pump inhibitors, H2 blockers, and benzodiazepines

are utilized for CINV prevention and control as well and sometimes are

included as premedications prior to chemotherapy. - ANSWER- Which

of the following classes of agents would you not anticipate to be a part

of Mr. Rylan's orders for premedication to prevent CINV?

Avoiding fresh fruits and vegetables is no longer recommended to

prevent infection. Fresh fruits and vegetables can and should be eaten as

long as they are washed thoroughly. - ANSWER- The next thing you

discuss with Mr. Rylan is neutropenia and the risk for infection that goes

along with it. You state that you will monitor his blood counts closely

and that his physician may decide to use a colony-stimulating factor to

enhance his neutrophil count. You review some of the things that Mr.

Rylan can do to hopefully prevent getting an infection like good hand

washing.

Although all the other answers listed can happen with rituximab, you are

most concerned about the potential for a hypersensitivity reaction since

this is rituximab and it is the patient's first dose. - ANSWER- What is

the most important toxicity that you will monitor for with rituximab

especially since this is the patient's first dose of the agent?

Oncovin (vincristine) can cause neurotoxicity of the smooth muscle of

the GI tract which can lead to decreased peristalsis and paralytic ileus.

Constipation, abdominal pain, and paralytic ileus can be seen with

vincristine use. - ANSWER- Which of the following medications is the

likely cause of Mr. Rylan's constipation?

A dose-limiting toxicity of cyclophosphamide is hemorrhagic cystitis.

Although it is more commonly seen with high-dose therapy, it can still

occur in patients receiving R-CHOP. - ANSWER- Which of the agents

that Mr. Rylan is receiving in R-CHOP would be the likely culprit if this

is hemorrhagic cystitis?

The risk of developing anthracycline cardiotoxicity increases with the

total cumulative dose of doxorubicin. This is very important information

for Mr. Rylan to have and provide to his follow-up health care providers.

That way the appropriate monitoring can be performed. - ANSWERWhich of the following related to doxorubicin is most important to

include in Mr. Rylan's comprehensive care summary due to potential

late effects of this agent?