Download CSO Exam| 172 questions| 2024| with complete solutions and more Exams Nursing in PDF only on Docsity!
A cancer patient is unable to provide self-care. His disease is progressing rapidly and prognosis is poor. Which number likely represents his Karnofsky Performance Status? A. 100 B. 70 C. 40 D. 0 - correct answerC. 40 Disabled; requires special care & assistance.
0 - DEAD 100 - no evidence of disease A cancer patient is fully active and able to carry on all pre-disease activities without restrictions. Which Eastern Cooperative Oncology Group (ECOG) grade is appropriate? A. Grade 0 B. Grade 1 C. Grade 2 D. Grade 3 - correct answerA. Grade 0 is fully active and able to carry on all pre- disease activities without restrictions. (KS 90-100) For Cancer Prevention: The American Institute for Cancer Research (AICR) recommends that Americans stay physically active for at least ______minutes every day - correct answerFor Cancer Prevention: The American Institute for Cancer Research (AICR) recommends that Americans are physically active for at least 30 minutes every day. Limit sedentary behavior like watching TV. If the pyloric valve (located at the base of the stomach) was removed or manipulated during surgery, the patient is at risk for _______________________________ - correct answerDUMPING SYNDROME If the pyloric valve (located at the base of the stomach) was removed or manipulated during surgery, the patient is at risk for DUMPING SYNDROME True or False A patient with a new ileostomy should avoid both soluble and insoluble fiber after surgery - correct answerTRUE Patients should avoid SOLUBLE fiber until the surgeon confirms the intestine has healed. Nestle Health Science suggests limiting MCT oil to _____mL/day - correct answerNestle Health Science suggests limiting MCT oil to 100 mL/day (~6.5 TBSP) =760 kcals True or False The ketogenic diet limits carbohydrate intake to 5-10% of the total diet, typically between 15-50 grams daily - correct answerTrue
The ketogenic diet limits carbohydrate intake to 5-10% of the total diet, typically between 15-50 grams daily Generally, the Macrobiotic diet is made up of these foods: - correct answerThe Macrobiotic diet is made up of: •organic whole grains (50% of food intake) •locally grown, organic fruits/vegs (25% of diet) •soups made with vegetables, seaweed, beans, fermented soy (miso) (up to 25% food intake) Generally, the Macrobiotic diet does NOT include A. Dairy, eggs, poultry, red meat B. Artificial flavors, processed foods or chemical additives C. Mango, pineapple and papaya D. Both A & B E. Answers A, B & C - correct answerAnswer: E Zoledronic acid (Zometa®) is a supportive care drug in the category of bisphosphonates that can be used to decrease complications produced by metastasis to the: A. Brain B. Bone C. Liver D. Kidney - correct answerZoledronic acid (Zometa®) is a supportive care drug in the category of bisphosphonates to decrease complications produced by metastasis to the: B. BONE Which dietary supplements should be recommended when a patient is prescribed Zoledronic acid for stage IV breast cancer with bone metastasis? - correct answerCo- administer oral calcium 500 mg and a multiple vitamin containing 400 IU Vit D daily. Reference: https://www.pharma.us.novartis.com/sites/www.pharma.us.novartis.com/ files/Zometa.pdf St. John's Wort may ______________________ the drug activity of Vinblastine (Velban) & Vincristine (Oncovin) - correct answerDECREASE St. John's Wort may DECREASE the drug activity of Vinblastine (Velban) & Vincristine (Oncovin) by INDUCING Cytochrome P450 3A4 (CYP3A4). CYP3A4 is an important enzyme in the body, mainly found in the liver and in the intestine. It oxidizes xenobiotics, such as toxins or drugs, so that they can be removed from the body. TRUE or FALSE
The antiemetic Ondansetron (Zofran) may cause constipation or diarrhea in cancer patients - correct answerTRUE •Constipation -- in up to 9% of patients •Diarrhea -- in up to 7 % of patients Anticipatory nausea and vomiting (ANV) - correct answerAnticipatory nausea and vomiting (ANV), also is widely believed to be a learned response to chemotherapy that 25% of patients develop by the 4th treatment cycle List some risk factors for anticipatory nausea and vomiting - correct answer1. Age younger than 50 years.
- N&V after the last chemotherapy session.
- Post-treatment nausea OR vomiting described as moderate, severe, or intolerable.
- Susceptibility to motion sickness.
- Female gender.
- High-state anxiety
- Patient expectations of chemotherapy-related nausea before beginning treatment.
- Emetogenic potential of various chemotherapeutic agents. Patients receiving drugs with a moderate to severe potential for post-treatment N&V are more likely to develop ANV.
- History of morning sickness during pregnancy. The American Society of Clinical Oncology (ASCO) provides a summary of IV chemotherapeutic agents and their respective risk of acute and delayed emesis. •High risk: Emesis that has been documented to occur in more than 90% of patients: - correct answer•Anthracycline/cyclophosphamide combination. •Carmustine (BiCNU®) •Cisplatin (Platinol®) •Cyclophosphamide (Cytoxan) (≥1,500 mg/m2). •Dacarbazine •Dactinomycin. •Mechlorethamine (Mustargen®) •Streptozotocin (Zanosar®) Streptozotocin (Zanosar®) alters __________________________ metabolism in some patients causing ________________________ - correct answerStreptozotocin (Zanosar®) alters glucose metabolism in some patients causing hypoglycemia
Women should not take this OTC medicine within 2 hours of taking Tamoxifen - correct answerAntacids- Avoid antacids within 2 hours of taking Tamoxifen In order for a patient to receive TF he needs ______cm jejunum and ___ ___cm ileum w/ileocecal valve for adequate GI absorption of nutrients - correct answerIn order for a patient to receive TF he needs 100 cm jejunum and 150 cm ileum w/ileocecal valve for adequate GI absorption of nutrients The initiation rate of bolus or gravity feedings should be _____- ______ mL for the first 1-2 feedings and increase by ______ - _____ mL every 8-12 hours or every 1- feedings - correct answerThe initiation rate of a bolus or gravity feeding should be 60- 120 mL for the first 1-2 feedings and increase by 60-120 mL every 8-12 hours or every 1-2 feedings Refeeding syndrome is characterized by severe electrolyte abnormalities such as... - correct answerhypophosphatemia hypokalemia hypomagnesemia Once electrolytes are restored to the normal range, EN should start with 25% of estimated energy needs and advance over 3-5 days to feeding goals Avoid holding EN for gastric residual volumes of <__________ mL in the absence of other signs of intolerance - correct answerAvoid holding EN for gastric residual volumes of <500mL in the absence of other signs of intolerance If Gastric Residual Volume (GRV) is >/= _________ mL , HOLD EN and perform a physical assessment, evaluate glycemic control, consider a promotility agent (metoclopramide or erythromycin) and consider narcotic alternatives - correct answerIf Gastric Residual Volume (GRV) is >/= 500 mL , HOLD EN List 3 possible causes of hyponatremia on EN - correct answerH20 retention/fluid overload Sodium Losses (GI) SIADH If refeeding syndrome is suspected in a patient receiving EN, the RD should recommend: - correct answerMonitor fluid status Decrease nutrition delivery to 25% of goal, replace phosphorus & potassium monitor labs, vitals and fluid balance FACTS: Dextrose is the primary energy substrate in TPN and provides ___________ kcals/gram. Amino acids provide ____________ kcals/gm
A. Calorie and protein intake B. Maintain anthropometric measurements C. Improve Quality of Life D. All of the above - correct answerD. All of the above RATING: STRONG, IMPERATIVE Evidence Based Oncology Nutrition Practice Guidelines- MNT in Colorectal Cancer: RDNs should provide WEEKLY MNT that includes an individualized nutrition prescription and counseling for patients with colorectal cancer on pelvic radiation. Individualized counseling may improve: A. Calorie and protein intake B. Nutritional Status C. Quality of Life D. All of the above And reduce symptoms of anorexia, N/V/D - correct answerD. All of the above RATING: FAIR, IMPERATIVE Evidence Based Oncology Nutrition Practice Guidelines: Esophageal ca patients on concurrent chemo/xrt should receive MNT consisting of a PRETREATMENT evaluation and weekly visits x 6 weeks during treatment to improve outcomes. - correct answerRATING: WEAK, IMPERATIVE For the Nutrition Diagnosis of adult malnutrition in the context of chronic illness, a patient must have 2 of these 6 characteristics. - correct answer1. Intake <75% of estimated energy needs for >30 days
/= 5% weight loss in 1 month
- Loss of muscle mass
- Loss of body fat
- Fluid accumulation
- Diminished functional status as measure by hand grip strength Consequences of malnutrition for patients with cancer include: A. Reduced response and tolerance to the prescribed cancer treatment B. Impaired wound healing & immune response C. Reduced muscle strength and quality of life D. Increased Fatigue E. A & B are correct F. C & D are correct G. All of the above - correct answerG. All of the above The following are the ONLY criteria validated as indicators of nutritional status. SELECT TWO: A. Unintentional Weight Change B. Decreased appetite/intake C. Alterations in chewing/swallowing
D. GI distress E. Low albumin/prealbumin F. BMI <18 - correct answerAnswer: A & B Reference: Page 19 in the pocket guide to the NCP and Cancer List the FOUR valid & reliable Nutrition Screening Tools for adult patients with cancer. All FOUR may be used in the INPATIENT setting. Which TWO should be used in the ambulatory/outpatient setting - correct answer1. Malnutrition Universal Screening Tool (MUST)
- Malnutrition Screening Tool for Cancer patients (MSTC)
- Malnutrition Screening Tool (MST) ** outpatient
- Scored Patient-Generated Subjective Global Assessment (PG-SGA) ** outpatient Candidates for PROPHYLACTIC FEEDING TUBE with a DIAGNOSIS OF H&N CANCER: - correct answerElderly patients H&N flap reconstruction Cancer of BOT Weight Loss before cancer treatment Smoking >20 cigarettes daily Stage III or IV cancer Reference: Page 22 in the pocket guide to the NCP and Cancer Suggested High Risk Nutrition Screening Criteria for use in Cancer Centers with one or more FT RDNs. List 5 criteria based on cancer site or stage: - correct answer1. Esophageal Ca
- Gastric Cancer
- Lung Cancer
- Colorectal Ca
- Any stage III or IV cancer Reference: Page 23 in the pocket guide to the NCP and Cancer ??? why isn't H&N on this list ?! Suggested High Risk Nutrition Screening Criteria for use in Cancer Centers with one or more FT RDNs. List 10 criteria based on nutrition impact symptoms: - correct answer1. Unable to maintain usual food intake
- No appetite
- dysphagia resulting in NPO > 2 days
- Any of these: N/V/C/D
- Problems with TPN
- Stomatitis or Odynophagia
TRUE or FALSE All adult patients should be screened for malnutrition risk on entry into oncology services & rescreening should be repeated routinely throughout treatment - correct answerAnswer: TRUE Rating: Consensus, Imperative Which drug is prescribed as an antidote to methotrexate? - correct answerAnswer: Leucovorin Leucovorin is a reduced folic acid. Leucovorin is given to lessen the side effects of methotrexate Leucovorin is used in combination with other chemotherapy drugs to either enhance effectiveness, or as a "chemoprotectant." This drug _________________________is given in combination with fluorouracil (5-FU) causing the side effects of fluorouracil to be more _________________________ - correct answerLeucovorin SEVERE Methotrexate exerts its chemotherapeutic effect by being able to counteract and compete with ____________________ in cancer cells resulting in _____________________deficiency in the cells and causing their death. - correct answerMethotrexate exerts its chemotherapeutic effect by being able to counteract and compete with FOLIC ACID in cancer cells resulting in FOLIC ACID deficiency in the cells and causing their death. An oral prodrug that is converted to 5-FU in the body - correct answercapecitabine (Xeloda) The first and only antidote for a chemotherapy overdose appears to be a safe and effective life-saving emergency treatment. The product_____________________________________________ increased the chances of recovery from severe and rapid-onset toxicity related to a 5-fluorouracil (5- FU) infusion, or an overdose of 5-FU. - correct answeruridine triacetate (Vistogard) List some of the possible nutrition impact symptoms r/t gastrectomy - correct answerDumping Syndrome Dehydration Early Satiety Gastroparesis Fat malabsorption Malabsorption of Vit B12, Vit D calcium and iron If a cancer patient needs surgery r/t cancer of the gallbladder &/or bile duct he may experience these nutrition problems: - correct answerGastroparesis
Hyperglycemia Fluid & electrolyte imbalance Fat malabsorption Malabsorption of Vitamins A, D, E, K; MAGNESIUM, calcium, zinc & iron List some of the possible nutrition problems r/t surgery affecting the colon &/or rectum: - correct answerIncreased transit time Diarrhea Dehydration Bloating, cramping, gas Fluid & electrolyte imbalance Vit/Mineral malabsorption (B12, Na, K+, Mg, Ca) Some of the possible nutrition problems r/t surgery affecting the small bowel: - correct answerChyle leak lactose intolerance Bile acid depletion Diarrhea Fluid & electrolyte imbalance Vit/Mineral malabsorption. Vitamins A, D, E, K; B12, calcium, zinc & iron Possible nutrition problems r/t surgery affecting the pancreas: - correct answerGastroparesis Hyperglycemia Fluid & electrolyte imbalance Fat malabsorption Malabsorption of Vitamins A, D, E, K; Vit B12, calcium, zinc & iron The primary goals of nutritional management of chyle leaks are to:
- Decrease production of chyle fluid
- Replace fluid and electrolytes; and
- Maintain or replete nutritional status and prevent malnutrition. Describe the possible Nutritional Mgmt of Chyle Leaks: - correct answer* Fat free diet (FF);
- FF diet with medium chain triglycerides
- Specialized enteral feeding (fat free, MCT based or very low fat); or total parenteral nutrition (TPN). **************Adequate protein intake***************
- Chyle contains significant amounts of protein (22-60 g/L). Recommendations should account for such losses
- 2%-4% of total calories from EFA required to avoid essential fatty acid deficiency (EFAD).
Common anti-nausea medications: - correct answerAprepitant (Emend®) Dolasetron (Anzemet®) Granisetron (Kytril®) Ondansetron (Zofran®) Palonosetron (Aloxi®) Proclorperazine (Compazine®) Promethazine (Anergan®), (Phenergan®) Netupitant-Palonosetron (Akyzeo®) Rolapitant (Varubi®) Lorazepam (Ativan®) Metoclopramide (Reglan®) Dexamethasone (Decadron®) Famotidine (Pepcid®) Ranitidine (Zantac®) Medications for Treatment of Lack of Appetite: - correct answerMegestrol acetate are forms of the progesterone hormone that can improve appetite and weight gain. Steroid medications, which can increase appetite, improve a person's sense of well- being, and help with nausea, weakness, or pain. Metoclopramide (Reglan), which helps move food out of the stomach and can prevent feeling full before eating enough food. Dronabinol (Marinol), a cannabinoid made in the laboratory, which may stimulate appetite. TRUE or FALSE Reglan (metoclopramide) is a dopamine antagonist that can be used as an antiemetic agent, and/or prescribed for loss of appetite, early satiety and heartburn - correct answerTRUE When is a cancer patient most susceptible to increased risk for infection, anemia and/or bleeding? - correct answerAnswer: When the patient has low blood counts- Myelosuppression Nadir: Meaning low point, Nadir is the point in time between chemotherapy cycles in which you experience low blood counts. What is Myelosuppression? - correct answerMyelosuppression is a condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets. It is a side effect of some cancer treatments. Side effects that are common for patients taking cyclophosphamide (Cytoxan): - correct answerLow blood counts
Nausea and vomiting: more common with larger doses, usually beginning 6-10 hours after therapy. Poor appetite The following are less common side effects: Diarrhea Mouth sores Tumor lysis syndrome can lead to _____________________failure - correct answerTumor lysis syndrome can lead to kidney failure and other sudden health problems within 24 - 48 hours of therapy People about to receive chemotherapy for a cancer with a high cell turnover rate, especially lymphomas and leukemias, should receive prophylactic oral or IV allopurinol as well as adequate IV hydration to maintain high urine output (> 2.5 L/day) to prevent which condition? - correct answerTumor lysis syndrome WHAT changes in electrolytes and metabolites are expected in tumor lysis syndrome?
- correct answerHyperkalemia Hyperphosphatemia LOW calcium (hypocalcemia), High uric acid (hyperuricemia), and higher than normal levels of blood urea nitrogen (BUN) and other nitrogen- containing compounds (azotemia)
