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ANSWERS ( LATEST UPDATE)
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 Answers ✅C. 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 Answers ✅A. Grade 0 is fully active and able to carry on all pre-disease activities without restrictions. (KS 90-100)
ANSWERS ( LATEST UPDATE)
For Cancer Prevention: The American Institute for Cancer Research (AICR) recommends that Americans stay physically active for at least ______minutes every day - Correct Answers ✅For 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 Answers ✅DUMPING 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 Answers ✅TRUE Patients should avoid SOLUBLE fiber until the surgeon confirms the intestine has healed. Nestle Health Science suggests limiting MCT oil to _____mL/day - Correct Answers ✅Nestle Health Science suggests limiting MCT oil to 100 mL/day (~6.5 TBSP) =760 kcals
ANSWERS ( LATEST UPDATE)
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 Answers ✅Zoledronic 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 Answers ✅Co-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.c om/files/Zometa.pdf St. John's Wort may ______________________ the drug activity of Vinblastine (Velban) & Vincristine (Oncovin) - Correct Answers ✅DECREASE
ANSWERS ( LATEST UPDATE)
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 Grapefruit juice (GFJ) can INCREASE a drugs' activity by INHIBITING the enzyme responsible for the drug's metabolism - Correct Answers ✅TRUE Example: Concomitant use of GFJ and docetaxel resulted in a reduction of clearance greater than 15% Name 3-4 foods that can alter the CYP3A4 metabolizing enzyme- thus altering a drugs' efficacy/toxicity - Correct Answers ✅Possible food & drug interactions occur with: • grapefruit and GFJ ••pomegranate •star fruit *citrus juice/ seville oranges (In the USA, Seville oranges are grown on a limited scale by small farmers)
ANSWERS ( LATEST UPDATE)
A patient with newly diagnosed pancreatic cancer completes the Scored Patient-Generated Subjective Global Assessment (PG-SGA©) with information regarding weight, food intake, symptoms and activities/functional status. The additive score is 10. What does this score mean? A. No intervention is required at this time. B. Requires intervention by RD with RN or MD C. Indicates a critical need for improved symptom management &/or nutrient intervention options - Correct Answers ✅>/= 9 Indicates a critical need for improved symptom management &/or nutrient intervention options TRUE or FALSE The antiemetic Ondansetron (Zofran) may cause constipation or diarrhea in cancer patients - Correct Answers ✅TRUE •Constipation -- in up to 9% of patients •Diarrhea -- in up to 7 % of patients Anticipatory nausea and vomiting (ANV) - Correct Answers ✅Anticipatory 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
ANSWERS ( LATEST UPDATE)
List some risk factors for anticipatory nausea and vomiting - Correct Answers ✅1. 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 Answers ✅•Anthracycline/cyclophosphamide combination.
ANSWERS ( LATEST UPDATE)
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 Answers ✅In 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 1-2 feedings - Correct Answers ✅The initiation rate of a bolus or gravity feeding should be 60-120 mL for the first 1- feedings and increase by 60-120 mL every 8-12 hours or every 1- feedings Refeeding syndrome is characterized by severe electrolyte abnormalities such as... - Correct Answers ✅hypophosphatemia 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 Answers ✅Avoid
ANSWERS ( LATEST UPDATE)
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 Answers ✅If Gastric Residual Volume (GRV) is >/= 500 mL , HOLD EN List 3 possible causes of hyponatremia on EN - Correct Answers ✅H retention/fluid overload Sodium Losses (GI) SIADH If refeeding syndrome is suspected in a patient receiving EN, the RD should recommend: - Correct Answers ✅Monitor 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.
ANSWERS ( LATEST UPDATE)
phosphorus, copper, selenium, many B vitamins, are all absorbed in the duodenum. Where are Vitamin B12 and bile salts absorbed? - Correct Answers ✅In the terminal ileum. Vitamin B12 is absorbed in the ileum and must be bound to intrinsic factor, a protein secreted in the stomach, in order to be absorbed. If intrinsic factor is missing, then Vitamin B12 is not absorbed and pernicious anemia results. Pernicious anemia is a form of megaloblastic anemia. Megaloblastic anemia refers to an abnormally large type of red blood cell (megaloblast). Megaloblasts are produced in the bone marrow when vitamin ____________________or ___________________levels are low - Correct Answers ✅Megaloblasts are produced in the bone marrow when vitamin B-12 or folic acid levels are low Evidence Based Oncology Nutrition Practice Guidelines- MNT & pretreatment evaluation in H&N Cancer: RDNs should provide MNT consisting of a PRETREATMENT evaluation and weekly visits during radiation for H&N ca to improve outcomes - Correct Answers ✅RATING: STRONG, IMPERATIVE RDNs should provide MNT consisting of a pretreatment evaluation and weekly visits during radiation for H&N ca to improve outcomes
ANSWERS ( LATEST UPDATE)
Evidence Based Oncology Nutrition Practice Guidelines-MNT and Radiation Therapy in H&N Cancer. MNT has been shown to improve: A. Calorie and protein intake B. Maintain anthropometric measurements C. Improve Quality of Life D. All of the above - Correct Answers ✅D. 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
ANSWERS ( LATEST UPDATE)
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 Answers ✅G. 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 Answers ✅Answer: 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.
ANSWERS ( LATEST UPDATE)
Which TWO should be used in the ambulatory/outpatient setting - Correct Answers ✅1. 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 Answers ✅Elderly 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 Answers ✅1. Esophageal Ca
ANSWERS ( LATEST UPDATE)
Suggested High Risk Nutrition Screening Criteria for use in Cancer Centers with one or more FT RDNs. List 4 criteria based on cancer treatment: - Correct Answers ✅1. XRT to the GI tract or affecting the GI tract (such as esophagitis from lung radiation).
- Concurrent chemo/xrt
- All new cancer patients prescribed chemotherapy, biotherapy (monoclonal antibodies, growth factors, and vaccines) or targeted therapy
- Resumption of chemo or biotherapy after cessation for > 6 months Biotherapy is a treatment to ... - Correct Answers ✅Biotherapy is a treatment to boost or restore the ability of the immune system to fight cancer, infections, and other diseases. It is also used to lessen certain side effects that may be caused by some cancer treatments. Biological therapy helps your immune system fight cancer where chemotherapy attacks the cancer cells directly. Targeted therapy works by targeting specific genes or proteins to help stop cancer from growing and spreading. These genes and proteins are found in cancer cells or in cells related to cancer growth, like blood vessel cells. There are 2 main types of targeted therapy: - Correct Answers ✅1. Monoclonal antibodies
- Small-molecule drugs
ANSWERS ( LATEST UPDATE)
Examples: cetuximab (Erbitux) and panitumumab (Vectibix), trastuzumab (Herceptin), Suggested High Risk Nutrition Screening Criteria for use in Cancer Centers with one or more FT RDNs. Criteria based on h/o medical conditions or diseases- List 10 high risk medical conditions or diseases: - Correct Answers ✅1. Short Bowel Syndrome
- PCM
- Renal failure
- IBD or Celiac
- HIV
- Bariatric Surgery
- Open wounds or pressure ulcers
- Psychiatric Disorders
- DM
- Enteral/Parenteral support
- Cancer Recurrence Criteria for the rating of evidence -based nutrition recommendations: - Correct Answers ✅STRONG, FAIR, WEAK, CONSENSUS, INSUFFICIENT EVIDENCE
