Question 1

A provider orders tamoxifen for a premenopausal woman with ER-positive breast cancer. What rationale supports the provider's decision to prescribe tamoxifen over anastrozole?

Accepted Answer

Anastrozole is an aromatase inhibitor, which is not effective in premenopausal women because it works by inhibiting the synthesis of estrogen from androgens in peripheral tissues and the adrenal glands, a process that is minimal in premenopausal women due to the primary production of estrogen by the ovaries. Tamoxifen, on the other hand, is a selective estrogen receptor modulator (SERM) that blocks the effects of estrogen in the breast tissue and is effective in both premenopausal and postmenopausal women with ER-positive breast cancer.

Question 2

A provider considers cancer prophylaxis with tamoxifen for a 45-year-old patient with a family history of breast cancer. According to her health history, she had one child at age 35 and developed deep vein thrombosis (DVT) during the pregnancy. She has not had a hysterectomy. What information from the patient's history informs the provider's decision regarding tamoxifen?

Accepted Answer

Tamoxifen increases the risk of thromboembolic events, such as deep vein thrombosis (DVT), which the patient has a history of. This history makes the use of tamoxifen more risky for her.

Question 3

The provider can prescribe a monoclonal antibody medication for the patient with which condition?

Accepted Answer

Psoriatic arthritis is an autoimmune disease that affects the joints and skin. Monoclonal antibody medications are used to treat autoimmune diseases by targeting specific proteins involved in the disease process.

Question 4

A patient with cancer uses a fentanyl transdermal patch for pain relief. The patient reports having three or four episodes of severe pain lasting 30 minutes most days. What action will the provider take to address the patient's pain? .

Accepted Answer

The correct action is to prescribe a strong, short-acting opioid PRN (as needed) for break-through pain. This is because the patient is already on a long-acting opioid (fentanyl patch) for chronic pain, and the episodes of severe pain indicate the need for additional, immediate relief that a short-acting opioid can provide.

Question 5

A provider considers prescribing cancer prophylaxis with tamoxifen for a 43-year-old patient with a strong family history of breast cancer. Which assessment finding will the prescriber view as a possible contraindication?

Accepted Answer

Tamoxifen increases the risk of thromboembolic events, such as deep vein thrombosis (DVT), making a history of DVT a possible contraindication for its use.

Question 6

A patient with advanced renal carcinoma is prescribed aldesleukin as part of the treatment regimen. What adverse effect of this drug will be a concern for the provider?

Accepted Answer

Aldesleukin can cause capillary leakage syndrome, which leads to fluid and protein leakage from the capillaries into the surrounding tissues, potentially causing severe hypotension and organ damage.

Question 7

A provider teaches a patient about a vesicant chemotherapeutic agent. Which statement by the patient indicates a need for further teaching about this type of drug?

Accepted Answer

Vesicant chemotherapeutic agents are primarily administered intravenously due to their potential to cause severe tissue damage if they leak into the surrounding tissue. Oral administration of these agents is not common or recommended due to their high potential for causing severe side effects and tissue damage.

Question 8

A patient with cancer has taken oxycodone and a nonsteroidal anti-inflammatory drug (NSAID) for a year. At a follow-up visit, the patient reports an increase in pain intensity with a new "burning and shooting" pain. What prescription will the provider write to address the patient's current pain?

Accepted Answer

The patient's new "burning and shooting" pain suggests neuropathic pain, which is often treated with adjunctive analgesics (e.g., antidepressants, anticonvulsants) in addition to opioids like fentanyl and non-opioid analgesics such as acetaminophen.

Question 9

Which statement correctly informs a provider's decision regarding whether to order an antiestrogen drug or an aromatase inhibitor for treatment of breast cancer.

Accepted Answer

Antiestrogen drugs, such as tamoxifen, are known to increase the risk for endometrial cancer. This is a significant consideration for providers when choosing a treatment plan for breast cancer, especially in patients with a uterus.

Question 10

Which conditions may be treated with monoclonal antibody (mAb) therapy? (Select all that apply.)

Accepted Answer

The answer of Which conditions may be treated with monoclonal...

Question 11

A patient newly diagnosed with cancer reports having pain at a level of 7 to 8 on a scale of 10. Which type of pain management will be prescribed initially by the provider to manage this patient's pain?

Accepted Answer

For pain that is reported as 7 to 8 on a scale of 10, which is considered severe pain, opioid analgesics are typically prescribed initially to manage the patient's pain effectively. Non-opioid analgesics and nonpharmacologic measures may not be sufficient for this level of pain.

Question 12

A patient with cancer who has been taking an opioid analgesic reports new onset pain at a new location even though the previous pain is well controlled. What will the provider suspect is the cause of this latest report of pain?

Accepted Answer

The new onset of pain at a different location in a cancer patient, despite well-controlled previous pain, suggests a possible progression of the disease, such as infection or metastasis, rather than issues related to the analgesic therapy itself.

Question 13

A patient reports "burning and shooting" foot pain alternating with sensations of numbness. Which medication will the provider discuss with the patient?

Accepted Answer

Imipramine, a tricyclic antidepressant, is often used to treat neuropathic pain, which is characterized by burning, shooting, and numb sensations.

Question 14

A patient who takes hydrocodone and ibuprofen for cancer pain is admitted to the hospital for chemotherapy. What action will the prescriber take regarding the prescribed ibuprofen.

Accepted Answer

Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can increase the risk of bleeding, especially in patients undergoing chemotherapy, which can further compromise platelet function or decrease platelet counts. Therefore, discontinuing ibuprofen to minimize the risk of bleeding is a prudent action.

Question 15

A patient asks why a combination product containing an opioid analgesic and a nonsteroidal antiinflammatory drug (NSAID) has been prescribed to manage cancer pain. Which response will the provider give the patient?

Accepted Answer

The combination of an opioid analgesic and a nonsteroidal anti-inflammatory drug (NSAID) is prescribed to provide increased pain relief than when either product is used alone. This approach utilizes the different mechanisms of action of the two drug classes to achieve better pain control, often allowing for lower doses of the opioid and potentially reducing the risk of opioid-related side effects.

Question 16

Oxycodone is ordered every 4 to 6 hours PRN for a patient newly diagnosed with cancer who is admitted to the hospital. The patient requests pain medication whenever reporting pain as a 7 or 8 on a scale of 1 to 10 (10 being the worst pain), but then tells the nurse the medication is not working well. What action will the provider take when learning of this situation?

Accepted Answer

Prescribing a fixed dosing schedule for oxycodone can help maintain a consistent level of pain control, potentially preventing the peaks and troughs of pain that can occur with PRN (as needed) dosing, especially in the context of cancer pain which is often continuous.

Question 17

A patient diagnosed with C. difficile infection is considered a high risk for recurrence. Which medication will the provider prescribed?

Accepted Answer

Bezlotoxumab is specifically indicated to reduce the recurrence of Clostridium difficile infection (CDI) in patients who are at high risk for CDI recurrence. It is a monoclonal antibody that targets the C. difficile toxin B, preventing its effects. The other options are monoclonal antibodies used for different indications, not for C. difficile infection.

Quiz 19: Cancer Therapy