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Private Practice Implements Prostate Cancer Navigation Program
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2/28/2016   Post a comment
Your private practice has decided to implement a patient navigation program specifically for high-volume patients with numerous needs across the cancer trajectory. You are interested in the position of Prostate Cancer Nurse Navigator.
Nurse Provides Education on Cancer-Related Fatigue
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1/31/2016   Post a comment
An expectation of staff nurse attendance at conferences and continuing education offerings is that you will present a “brown bag” lunch upon your return on a topic you found interesting. One of the most informative presentations was a lunch session on the pathobiology of cancer-related fatigue.
Nurse Gives Lecture on Pancreatic Cancer Risk Factors
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12/31/2015   Post a comment
As a component of your clinical ladder application, you must make a presentation to your colleagues on a topic of relevance to your work group. You have decided to provide a lecture on pancreatic cancer since you have noted an increased number of patients with this malignancy in your infusion clinic setting.
Oncology NP Treats Cancer Patient With Depression
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11/30/2015   Post a comment
As the oncology nurse practitioner, you are treating a 72-year-old man with head and neck cancer for depression. You are aware that antidepressants can have toxicities associated with their use and also that some of them are effective in managing other symptoms associated with the cancer.
Nurse Attends Education Session on Radiation-Induced Toxicities
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10/30/2015   Post a comment
As the most experienced nurse in the radiation therapy department at your cancer center, you have been chosen to attend an international symposium on the management of radiation-related toxicities. You are particularly interested in attending the session on radiation cystitis due to the large population of men you treat with prostate cancer.
Psychiatric NP Educates Staff on Cancer-Related PTSD
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9/16/2015   Post a comment
You are a member of a novel nurse practitioner-led survivorship program at your cancer center. Recently, a psychiatric nurse practitioner has joined your team. Having worked in a veteran’s administration medical center previously, one of her areas of expertise focuses on patients’ reactions to trauma.
Understanding the Characteristics of Targeted Therapies
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8/11/2015   Post a comment
You are studying for the OCN exam and are reading information on targeted therapies. When you read a sample exam question, you identify which of the options below to be incorrect?
NP Provides Education on Opioid Use in the AYA Population
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7/16/2015   1 comment
Your department has recently hired a psychiatric nurse practitioner to work with the adolescents and young adults in your leukemia/lymphoma clinic on aberrant opioid-associated behavior.
Assessing the Suicide Risk in Cancer Patients
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6/23/2015   Post a comment
As one of the more tenured oncology nurses in your hematology/oncology office practice, you are chairing a committee to revise the initial intake assessment for new patients. At a recent conference, you heard a presentation on suicide and its risk factors in oncology patients, and want to include a screening question in the new document.
Male Patient Presents to the ED With Increasing Shortness of Breath
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3/10/2015   Post a comment
Mr. J is a 67-year-old male who has a long history of smoking, approximately 40 packs per year. He arrived at the emergency department due to increased shortness of breath for the past 2 weeks. He was evaluated for a possible pulmonary embolism, and the CT angiogram of the chest revealed a 13 mm semi-solid mass in the left upper lobe and pneumonia. Bronchoscopy and pathology confirmed small cell lung cancer with neuroendocrine histology.
Elderly Male With a History of MDS is Admitted to the Hospital With Complications
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2/26/2015   Post a comment
Mr. S is a 76-year-old Iranian patient with severe myelodysplastic syndrome (MDS) who has been requiring weekly transfusions is admitted to the hospital for worsening congestive heart failure and C-difficle. Mr. S’s wife, who does not speak English, stays in her husband’s room most of the day. While the patient is competent, he has made his wishes clear that all decisions about his care will be made by his oldest son. After a family discussion with the palliative care team, Mr. S will remain a Full Code.
Nursing Student Learns More About Chemotherapy-Induced Taste Alterations
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2/11/2015   Post a comment
In your oncology nursing graduate program, you must write a scholarly paper on a problematic symptom you experienced in clinical practice. You decide to focus your paper on taste alterations in patients receiving chemotherapy as you remember the prominence of this patient complaint when you worked in the infusion clinic.
Male Patient With a History of Lung Cancer Presents With Neurocognitive Changes
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1/30/2015   1 comment
Mr. L is a 79-year-old Korean man recently diagnosed with metastatic lung cancer. He had previously received palliative radiation therapy to his chest, hip, and lumbosacral spine lesions three months ago. Currently he is mid-way through his course of palliative radiation therapy for his brain metastases, but is now experiencing cognitive issues.
Male Patient With a History of Colorectal Cancer Presents With GI Distress
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1/8/2015   Post a comment
As one of the day shift nurses working in the urgent care clinic at your comprehensive cancer center, you are assigned to assess Mr. F, a 69-year-old man with a diagnosis of colorectal cancer (CRC). He tells you he completed his treatment nearly a year ago and is now experiencing vomiting and abdominal pain.
Assessing the Risk of Cognitive Impairment in Elderly Breast Cancer Patient
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12/3/2014   Post a comment
Gerri is an oncology nurse who has traveled home to attend her grandmother's consultation with a medical oncologist following her recent diagnosis of breast cancer. Due to her grandmother's age (83 years) and a history of dementia in her family, Gerri is concerned about the effects of potential chemotherapy on her grandmother's cognitive function.
Oncology NP Assesses the Medication Regimen of a Prostate Cancer Patient
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11/18/2014   Post a comment
A major component of your role is to assess all new patients and provide symptom management during treatment. Today you meet an 81-year-old man recently diagnosed with prostate cancer who is receiving external beam radiation therapy. You inquire about his existing comorbidities and medications.
Female Widow Is Experiencing Symptoms of Intense Grief
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10/23/2014   Post a comment
Jennie has been a widow for six months following the death of her husband from lymphoma. She has sought help from a counselor as she has not been able to return to work since his death.
Clinical Nurse Specialist Lectures on Pain in Patients With Chronic GVHD
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10/3/2014   Post a comment
As the oncology clinical nurse specialist in your regional cancer center, you have been asked to lecture on the problem of pain in cancer survivors. You are aware that chronic graft-versus-host disease (cGVHD) in hematopoietic stem cell transplant survivors is a major etiology of chronic pain syndromes.
Female Patient With a History of DCIS Presents With a Fungating Breast Lesion & Lymphedema
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9/18/2014   1 comment
A 75-year-old patient presents with a fungating, exophytic lesion of her right breast. She tells you that she was diagnosed 15 years ago with DCIS, but decided against treatment. Her concerns now include pain and swelling of her right arm, difficulty sleeping, and wound management.
Female Patient Presents With a Large Breast Mass & Facial Paralysis
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9/4/2014   Post a comment
A 45-year-old patient presented to a primary care physician with multiple breast nodules. Breast imaging turned out to be negative. Several months later, she presented with symptoms of facial paralysis and numbness. A further work-up after the MRI revealed a meningeal mass in the lower half of the brain; a large mass (15 cm) in the right breast was also identified. Pathology of the breast mass revealed a high Ki-67 antigen level and lymphoproliferative disordered cells.
Oncology Nurse Educates Staff on Effective Pain Management in Cancer Patients
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8/21/2014   1 comment
As an oncology staff nurse pursuing advancement through your institution’s clinical ladder program, you plan to offer a series of in-services on pain management to your colleagues.
Cancer Care Team Discusses Treatment Options for Newly Diagnosed Elderly Breast Cancer Patient
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8/6/2014   Post a comment
Your patient is a 97-year-old woman who had not had a mammogram in over 20 years, but decided this year to have a screening done. A mammogram abnormality was noted and a biopsy was performed. Results of that pathology revealed an invasive mammary carcinoma, so the multidisciplinary tumor board conference spent some time on how to manage this elderly breast cancer patient.
Oncology NP Looks to Update Clinical Practice Guidelines for Peripheral Neuropathy
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7/23/2014   2 comments
As one of the oncology nurse practitioners in your three medical oncology practices, you have been charged with ensuring your group’s symptom management algorithms remain up to date with the latest evidence. The peripheral neuropathy guidelines are due for a critique this quarter.
Female Newly Diagnosed With Breast Cancer Requires Neoadjuvant Treatment
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7/10/2014   Post a comment
You are the oncology nurse about to treat a newly diagnosed patient with stage IIIB (T4cN1M0) breast cancer. She had undergone only one biopsy, which revealed hormone receptor negative, HER2/neu positive breast cancer. Her treatment today will be administered in the neoadjuvant setting.
Oncology Nurse Specialist Provides Education on Multiple Myeloma
Quick Quiz  
6/25/2014   1 comment
You have been asked to give a lecture on multiple myeloma to nurse practitioner students. Which statement would not be included in your lecture?
Female Patient With a History of Dwarfism & Breast Cancer Needs Radiation Treatment
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6/11/2014   1 comment
Sharon is a 42-year-old patient with locally advanced breast cancer. She is generally in good health, with no prior family history of breast cancer. Significant to her personal history is that she has achondroplasia dwarfism. After definitive surgery of a mastectomy and axillary node dissection, it was determined that she will need radiation therapy.
Male Patient Experiences New Onset Vision Issues & Headaches
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5/28/2014   1 comment
Mr. B is a 57-year-old male who is complaining about not being able to read and is having trouble with his vision. He noticed the issue with reading and vision about a month ago, but dismissed it. However, over the past week it has become increasingly worse, and even his co-workers and family have noticed changes in his behavior. He has new onset tension headaches, but they improve most of the time when he takes ibuprofen.
An Oncology Nurse Presents the Most Recent Statistics on Cancer Survivorship
Quick Quiz  
5/14/2014   2 comments
You have been asked to make a presentation at a regional conference on cancer survivorship. The planning committee has asked you to present the most recent statistics on this topic.
Oncology Nurse Looks to Improve Patient Care Through Evidence-Based Practice
Quick Quiz  
4/30/2014   1 comment
Carrie is an oncology nurse who has worked on the inpatient oncology unit for three years. As part of her application for clinical ladder advancement, she must address an evidence-based practice change to improve patient care.
Female Patient With a History of Cervical Cancer Presents With Inguinal Pain
Quick Quiz  
4/23/2014   2 comments
A 50-year-old patient presented to her Ob/Gyn physician with vague left inguinal pain for the last 3 weeks. Her surgical history is significant for a vaginal hysterectomy 9 years ago due to a high-grade cervical cancer caused by HPV-16. Her most recent pap smear of the cervical cuff was normal, and the pelvic exam was negative. An MRI and PET scan were ordered to further explore the nature of the pain.
Elderly Patient With a History of CLL & Intermittent Confusion Requires a Blood Transfusion
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4/16/2014   2 comments
A 90-year-old patient with CLL has had periods of intermittent confusion during his hospital stay. The doctor comes into the room to determine if the patient can make his own decision to consent to a blood transfusion.
Elderly Female Presents to an Oncologist With Low Hemoglobin & Splenomegaly
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4/10/2014   1 comment
An 83-year-old woman is referred to a medical oncologist with a hemoglobin level of 7.0 and an enlarged spleen. Her history is notable for atrial fibrillation with mild CHF, and she is on multiple medications for these conditions. She complains of vague fatigue and mild upper left abdominal discomfort. She is otherwise healthy, vital signs are stable, and she is a non-smoker.
Female Patient With a History of MDS Presents With SOB & Fatigue
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4/2/2014   Post a comment
A 78-year-old woman with myelodysplastic syndrome (MDS) initiates treatment with lenalidomide (Revlimid). She presents to your office three weeks later with shortness of breath and worsening fatigue. Her oxygen saturation is 99%, and her CBC results are: WBC = 3.6; hemoglobin = 10.5; Platelets = 27,000. She reports a recent fever as high as 100.7. Her past medical history is significant for hyperlipidemia and hypertension.
Male Patient With a History of Colorectal Cancer Is Concerned About Follow-Up Care
Quick Quiz  
3/19/2014   1 comment

As the oncology nurse practitioner in your practice setting, you see you are scheduled this morning to see Mr. G, a 63-year-old man who recently completed his FOLFOX chemotherapy for Stage III colorectal cancer. During his examination he tells you that he has decided to take an early retirement and that he and his wife will be moving to a rural part of the state to a new retirement community. Mr. G says his major concern is his ongoing follow-up. He says he wants to be sure his new team is aware of necessary screening tests that need to be performed. You offer to communicate with the new team who will be following Mr. G, and share with them the recent American Society of Clinical Oncology follow-up guidelines for colorectal cancer.1

Male Patient Presents With Weight Loss & Shortness of Breath
Quick Quiz  
3/12/2014   3 comments
A 64-year-old healthy male presents to the medical oncologist with a 30-pound weight loss within the last few months. He has no history of smoking or alcohol use, and no major comorbidities that could account for this sudden drop in weight. The medical oncologist orders a PET/CT and it is noted that his liver is enlarged with many small nodules. A biopsy is ordered. The immunostains illustrate positivity for CD5 and CK5/6.
Male Patient With Brain Metastasis Is at an Increased Risk for Falls
Quick Quiz  
3/5/2014   2 comments
As the oncology nurse responsible for monitoring falls on your unit, in your review of incidents for the past month, you analyze the case of Mr. S, a 78-year-old man with widely metastatic lung cancer who was admitted from the ED for pain control. He recently completed a course of radiation to treat brain metastases and has just started receiving palliative home care.
Male Patient Receiving Erlotinib Experiences Rash & Swelling Involving the Face
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2/26/2014   5 comments
Your patient with non-small cell lung cancer is found to have an EGFR mutation and is started on erlotinib (Tarceva) 150mg daily. You see him two weeks later for a follow-up and he presents with severe skin toxicity. He is noted to have an erythemic papulopustular rash involving the face; swelling of the nose, eyes, and ears; and palpable heat radiating from his scalp. He reports painful throbbing of his scalp, especially when lying down, and is complaining of vertigo.
Male With a History of Metastatic Prostate Cancer Shows Signs of Depression
Quick Quiz  
2/20/2014   2 comments
Mr. L is a 74-year-old retired Air Force colonel whom you meet on his last day of radiation therapy for bilateral bone metastases in his hips related to advanced prostate cancer. When you ask him about his pain, he says it is better but he is worried that "It's going to pop up someplace else." You talk to him about the common fear of recurrence and then plan to address his activity level and functional status in the coming weeks.
Pediatric Patient With a History of AML Seeks Out Home Palliative Care
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2/12/2014   3 comments
Your 11-year-old patient diagnosed with AML is being discharged home with TPN, chemotherapy, blood transfusions, and pain management. The prognosis is poor but hope to prolong the patient’s life is the goal. The family is considering home palliative care.
Male With Metastatic Prostate Cancer Is Admitted for Pain Control & Confusion
Quick Quiz  
2/5/2014   1 comment
As the night-shift charge nurse, you are called by one of the oncology unit staff nurses to assist with the management of Mr. G, a 78-year-old man with widely metastatic prostate cancer (liver and bones) admitted late afternoon for pain control. At the beginning of your shift, Mr. G was joking with you and seemed appropriate in answering your questions; yet he seemed a bit restless. His daughter informs you that he has also been experiencing some intermittent confusion.
Male Patient With a History of AML Is Admitted to the ICU With Sepsis & Renal Failure
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1/29/2014   2 comments
Dr. T is a 76-year-old retired pediatrician with a history of myelodysplastic syndrome, which recently converted to acute myelogenous leukemia. He opted to try one course of induction chemotherapy but had only a partial response. Yesterday, he was admitted to the ICU with severe neutropenia, sepsis, and renal failure. As the clinical nurse specialist, you have been consulted to assist with care discussions and emotional support.
Male Patient With a History of Myelofibrosis Presents With Neurological Issues & Vomiting
Quick Quiz  
1/22/2014   1 comment
A 74-year-old male with myelofibrosis presents to your clinic reporting a one-week course of progressive illness. He initially developed mouth sores, which were not responsive to oral fluconazole. He then began experiencing dizziness with vomiting, and now right-sided deafness, facial paralysis, and inability to close the right eye in the last two days. You inspect the patient and find a thick coating along the right side of the tongue extending to the posterior oropharynx.
Male Patient Presents With New-Onset Hypertension, Headaches & Hyperglycemia
Quick Quiz  
1/15/2014   1 comment
Mr. M is a 47-year-old male who was admitted to the hospital due to refractory high blood pressure, headache, diaphoresis, and hyperglycemia. Prior to admission, Mr. M was relatively healthy with a recent history of having blood pressure issues about two weeks ago that required a visit to his physician. He was put on a beta-blocker, but it seemed that things became worse for Mr. M after that.
Male Lung Cancer Patient Experiences GI Symptoms During Treatment Phase
Quick Quiz  
1/8/2014   1 comment

Mr. G is a 58-year-old reformed smoker who was diagnosed three months ago with widely metastatic non-small cell lung cancer. He decided to receive single agent doxorubin for palliation. Up until this point, he has done well without significant toxicity. He comes in today for his treatment and to your surprise tells you, "I can't take this chemo anymore. The nausea and diarrhea are too much for me."

Older Female With a History of Breast Cancer Experiences Anxiety
Quick Quiz  
1/2/2014   1 comment
Mrs. G is a 71-year-old woman who is one year post completion of therapy for early-stage breast cancer. She has made an appointment in your office to be seen for ongoing surveillance. As the nurse practitioner, the first thing you observe is Mrs. G’s restlessness, and you begin to explore further.
Woman Having Difficulty Coping From Loss of Her Mother Due to Cancer
Quick Quiz  
12/18/2013   2 comments
Martha is a 55-year-old librarian who has been having increasing difficulty coping over the past 13 months since her mother’s death from colon cancer. Her supervisor encourages her to go to her doctor when Martha tells him of her insomnia, poor concentration, overwhelming sadness, and overall loss of interest in her work.
Female With Metastatic Cancer Is Admitted to Rule Out a Bowel Obstruction
Quick Quiz  
12/11/2013   2 comments
Mrs. P is a 60-year-old female with metastatic pancreatic cancer who has been admitted to the oncology unit to rule out obstruction. It has been confirmed that she is impacted with stool and the palliative care consult team has been asked to assist with recommendations for pharmacologic disimpaction and future constipation prophylaxis.
Elderly Woman With a History of Breast Cancer Experiences Psychosocial Issues
Quick Quiz  
12/4/2013   3 comments
Mrs. G is a 75-year-old woman, recently diagnosed with stage 2B breast cancer, who underwent breast conservation surgery with radiation and is currently on an estrogen modulating agent. She declined chemotherapy after extended discussions with her oncologist. She is recently widowed, retired from a sales position that she loved just before her cancer diagnosis, and has two adult sons living nearby and one adult daughter out of state. She has a small circle of friends who she sees regularly and were very supportive throughout her diagnosis and radiation. Today she returns for a three-month follow-up appointment and expresses concerns regarding a lack of appetite, insomnia, feeling “scattered,” and social isolation.
Female Patient Is Admitted to the Hospital With Bleeding Gums & Lower Extremity Rash
Quick Quiz  
11/25/2013   2 comments
Ms. S is a 47-year-old female who last week went to the dentist to have her teeth cleaned and since then she says her gums have been bleeding and look swollen but no pain. She also complains of fatigue and a rash on her lower extremities. She went to her primary care physician who obtained a CBC and found the patient to have pancytopenia and admitted her to the hospital.
Female With a History of Advanced Breast Cancer Complains of Increasing Somnolence
Quick Quiz  
11/12/2013   8 comments
Mrs. H is a 58-year-old assistant professor in anthropology at the local university. She has metastatic breast cancer with bone and liver involvement. As the oncology nurse practitioner in your office, you have been following her to manage her symptom distress. She has had stable disease for six months with no further lytic lesions or worsening liver function. For her pain management, she has been well controlled on oxycodone but now complains of increasing somnolence.
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Webinar Series
Tuesday, October 29, 2013 12:00 PM EDT

Presented by Ellen T. Matloff, MS, CGC , this webinar will highlight:

  • How to determine which patients require genetic counseling
  • How to help prepare your patients for the genetic counseling process
  • Testing options that are now available
  • How you can utilize this data in managing your patients and their family members

Participants will also be able to ask questions during a live question and answer period with speaker Ellen T. Matloff, MS, CGC .

Wednesday, August 28, 2013 12:00 PM EDT
Wednesday, June 26, 2013 12:00 PM EDT
Wednesday, April 10, 2013 12:00 PM EDT
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FDA Approves Onivyde for Advanced Pancreatic Cancer
Marijke Vroomen Durning, RN,
10/27/2015  3
On October 22, 2015, the US Food and Drug Administration (FDA) approved Onivyde (irinotecan liposome injection, Merrimack Pharmaceuticals, Inc.), in combination with fluorouracil ...
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