Treatment Modalities is 20% of the scored OCN questions and has seven lettered sub-areas. This page takes the first three: surgery and procedures, blood and marrow transplant, and radiation. Systemic, localized, targeted and oral drug therapy are on chemotherapy, targeted therapy and immunotherapy.
Before Y-90 radioembolization, a patient has a mapping angiogram with a technetium-99m MAA scan. What is the purpose of this scan?
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FDG uptake is shown on PET, which plays no part in planning microsphere delivery.
Kidney function is checked with serum creatinine and eGFR, not with a nuclear scan.
Technetium-labeled albumin particles mimic the microspheres, so the scan shows how much would bypass the liver to the lungs or gut and lets the team cap or cancel the dose.
Bone metastases are looked for with a bone scan or PET, not with a hepatic arterial mapping study.
Radiation & transplant
A patient with ovarian cancer has tense malignant ascites causing dyspnea and early satiety. Which intervention provides the most effective relief?
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Limiting fluids does not shrink malignant ascites and risks dehydration.
Diuretics help mainly when portal pressure drives the ascites; peritoneal tumor fluid responds poorly and slowly.
Draining the fluid gives the fastest, most reliable relief of breathlessness and early fullness from tense malignant ascites.
A binder adds pressure on a tense abdomen and does not remove fluid.
Radiation & transplant
Which conditioning factor most increases the risk of hepatic veno-occlusive disease?
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High-dose busulfan injures the sinusoidal lining of the liver, making it one of the strongest conditioning risks for veno-occlusive disease.
Reduced-intensity regimens carry a much lower risk of liver sinusoidal injury.
Rituximab is not a conditioning agent and is not a recognized cause of the syndrome.
It is high-dose irradiation that raises the risk; low-dose irradiation adds little.
Radiation & transplant
Which approach before major cancer surgery best improves recovery for an older adult?
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Starting after the operation misses the chance to correct poor nutrition before the stress of surgery.
Combining exercise, nutrition support and anxiety reduction in the weeks before surgery improves functional reserve and recovery in older adults.
A teaching visit prepares the patient but does not build the physical and nutritional reserve that speeds recovery.
Enhanced recovery pathways allow clear fluids until about 2 hours before anesthesia; a long fast worsens insulin resistance and slows recovery.
Radiation & transplant
A patient receiving breast radiation develops mild pink erythema with dry, flaking skin and itching in the treatment field. The nurse recommends:
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Scrubbing and harsh soaps add friction and irritation; gentle washing with mild soap is advised.
A plain, fragrance-free moisturizer applied regularly soothes dry desquamation and keeps the skin barrier intact.
Adhesives can strip fragile irradiated skin, and a dressing is not needed for intact, dry skin.
Alcohol dries and stings irradiated skin even though the gel feels cool.
Radiation & transplant
After radical hysterectomy for cervical cancer, a patient has trouble sensing a full bladder and emptying it. The nurse explains that this is commonly due to:
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Infection causes urgency and burning, not a loss of the sense of a full bladder.
Extra fluid raises urine volume; it does not take away bladder sensation.
Radical hysterectomy removes tissue that carries the pelvic autonomic nerves to the bladder, so sensing fullness and emptying are impaired.
A blocked stent causes flank pain and kidney swelling, not trouble sensing or emptying the bladder.
Radiation & transplant
A patient asks why intraoperative electron radiation therapy (IOERT) is planned during her lumpectomy. Which response by the nurse is accurate?
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Pathology still checks the margins, and a positive margin still leads to further surgery.
A temporary implanted source describes brachytherapy, not an electron beam given once in the operating room.
Radiation and endocrine therapy treat different risks, so radiation does not take its place.
With the tissue open, electrons are aimed at the tumor bed once during surgery while normal tissue is moved aside.
Radiation & transplant
Two days after Yttrium-90 radioembolization for liver metastases, a patient reports fatigue, nausea, mild right upper quadrant discomfort, and a low-grade fever. Which explanation fits best?
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Veno-occlusive disease is a transplant complication that shows weight gain, jaundice and a tender enlarged liver, not this picture after radioembolization.
The microspheres stay lodged in the liver, so body fluids are not a meaningful radiation source.
Contrast injury shows as a rising creatinine and does not cause the liver-area pain and fever in this stem.
Fatigue, nausea, right upper quadrant discomfort and low fever in the first days after radioembolization are a common self-limited response treated with supportive care.
Radiation & transplant
Compared with peripheral blood stem cells, umbilical cord blood grafts are associated with:
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Cord units contain few stem cells, so neutrophil and platelet recovery take longer, which prolongs the infection risk.
The small cell dose makes graft failure more likely with cord blood, not less.
Cord blood is chosen because it tolerates more HLA mismatch; a perfect match is not typical.
Immature cord T cells cause less chronic GVHD than adult peripheral blood grafts.
Radiation & transplant
Weeks after BEAM conditioning and autologous transplant for lymphoma, a patient develops dry cough, dyspnea, and a falling DLCO. Which conditioning agent is most likely responsible?
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Carmustine (BCNU) causes delayed lung injury with cough, breathlessness and a falling diffusing capacity weeks to months after BEAM.
High-dose cytarabine is linked to cerebellar toxicity, conjunctivitis and fever; it is not the likely cause of this delayed lung picture.
Melphalan mainly causes mucositis and marrow suppression, not delayed pneumonitis.
Etoposide causes marrow suppression, mucositis and hypotension during infusion.
Radiation & transplant
Irreversible electroporation (IRE) is chosen for a locally advanced pancreatic tumor that encases major vessels. Why is IRE preferred over thermal ablation here?
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Electroporation uses electrical pulses, not radiation.
Electric pulses open pores in cell membranes without heat, so tumor cells die while the collagen frame of nearby vessels survives.
Large vessels carry heat away from thermal ablation; this method avoids heat altogether.
The strong pulses cause muscle contraction, so general anesthesia with full paralysis is needed.
Radiation & transplant
During radiation to the breast, which area should the nurse assess most closely for moist desquamation?
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The back sits outside the main breast field, although exit-dose redness can occur.
The other breast is outside the treatment field.
The sternal skin is flat and dry; breakdown there is less likely than in a fold.
Skin folds trap moisture and rub together, so the fold under the breast is where moist desquamation usually appears first.
Radiation & transplant
Six months after breast irradiation, a patient develops painful erythema and blistering sharply confined to the former treatment field days after starting docetaxel. The nurse recognizes this as:
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Stevens-Johnson syndrome involves mucous membranes and spreads widely; it does not respect a radiation field edge.
Cellulitis spreads with fever and does not stop at a field border or follow a new drug start.
Some drugs such as docetaxel can trigger inflammation sharply limited to an old radiation field, even months after radiation ended.
Fibrosis develops as slow skin and tissue hardening, not as sudden blistering after a drug.
Radiation & transplant
During infusion of cryopreserved autologous stem cells, the patient notices a strong garlic-like taste. The nurse explains this is caused by:
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Conditioning drugs are cleared before infusion and do not produce this taste.
Hemolysis causes fever, back pain and dark urine, not a garlic taste.
Dimethyl sulfoxide, used to protect frozen cells, is breathed out and gives a garlic taste and odor that can last a day or two.
Contamination causes fever and rigors, not a characteristic taste.
Radiation & transplant
Before each radium-223 injection for prostate cancer with bone metastases, which result determines whether the dose can be given?
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Radium-223 suppresses the marrow, so neutrophil and platelet counts are checked before every injection and the dose is held if they fall below set limits.
Radium acts like calcium in bone, but the serum calcium level does not set dosing.
PSA often does not fall even when radium is working, so it does not decide whether a dose is given.
Radium is not cleared by the liver and liver tests do not gate the dose.
Radiation & transplant
Ten days after mastectomy and a few days after drain removal, a patient has a soft, fluctuant swelling under the incision without redness or fever. This is most likely a:
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Fluid often gathers under the flap after the drain comes out, forming a soft, fluctuant swelling without signs of infection.
Lymphedema swells the arm or chest wall diffusely over time, not as a fluctuant pocket under the incision.
A hematoma usually appears within the first day or two as a firm, bruised, tender swelling.
An abscess causes redness, warmth, pain and often fever.
Radiation & transplant
On postoperative day 3 after tumor resection, the incision has mild erythema along the suture line and scant serosanguineous drainage; temperature and WBC are normal. The nurse should:
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Antibiotic ointment is not needed for a clean healing incision and can cause sensitization.
Mild redness along the sutures with a little serosanguineous drainage on day 3 is normal inflammation of healing when temperature and WBC are normal.
A culture without signs of infection invites treating skin colonizers.
IV antibiotics are for spreading infection or systemic signs, which are absent here.
Radiation & transplant
During simulation for stereotactic body radiation therapy (SBRT) of a lung tumor, a 4D-CT scan is obtained. What is its main purpose?
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A planning scan cannot confirm cancer; the diagnosis comes from tissue or prior workup.
Lung tumors move with respiration; scanning across the breathing cycle lets planners cover every tumor position while sparing healthy lung.
Staging for spread uses PET-CT and brain imaging, completed before simulation.
Lung function is measured with pulmonary function tests, not CT.
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Outline lines in our words, with the examples this page covers.
III.A Surgical and procedural interventions: on this page, biopsy, staging and curative surgery, debulking and palliative procedures, and image-guided ablation, with the nursing care before and after.
III.B Blood and marrow transplant: on this page, autologous and allogeneic transplant, conditioning, engraftment and recognizing graft-versus-host disease.
III.C Radiation therapy: on this page, external beam, sealed and unsealed sources, protection of staff and visitors, and effects that depend on the treatment field.
Time, distance and shielding at the bedside
Radiation protection follows the ALARA principle (as low as reasonably achievable) through three controls: keep the time close to the source short, increase the distance, and put shielding in between. Distance is the easiest to quantify, because exposure falls with the square of the distance: twice as far away means a quarter of the dose rate.
What the nurse has to manage depends on the kind of source:
Sealed, temporary (low-dose-rate implant in place)
Yes, while the implant is in
private room, timed visits, dosimeter badge; a lead container and long forceps at the bedside for a dislodged source
Sealed, high-dose-rate (remote afterloader)
No; the source returns to the machine after each fraction
positioning, catheter care
Sealed, permanent seeds (for example, prostate)
Low-level emission that decays over months
time-limited distance from children and pregnant contacts, per the discharge instructions
Unsealed (systemic radionuclides such as iodine-131 or lutetium-177)
Yes; body fluids carry the isotope for days
handling urine, sweat and saliva, laundry, toilet hygiene, discharge precautions
A dislodged sealed source is never picked up by hand; it goes into the lead container with the forceps, and radiation safety is called. The federal NRC rule 10 CFR 35.75 (patient release) lets a patient with radioactive material go home when no other person is likely to receive more than 5 mSv (0.5 rem) from them.
Field effects, acute and late
Radiation effects stay inside the treated field, with fatigue as the common exception. Under the convention of the RTOG/EORTC toxicity criteria (1995), effects in the first 90 days after the course starts are acute, and those after that are late.
Head and neck: mucositis, dry mouth, taste loss, trouble swallowing; later, dental decay and jaw necrosis, so a dental check comes before treatment.
Chest: esophagitis during treatment; radiation pneumonitis, typically one to six months after the course, which is an oncologic emergency in area V; heart effects years later.
Abdomen and pelvis: nausea, diarrhea, cystitis; later, bowel and bladder strictures, vaginal stenosis and infertility.
Brain: fatigue, hair loss in the field and swelling that may need dexamethasone.
Second cancers in the field and lymphedema are late effects that matter for survivorship.
Surgery in cancer care, from biopsy to palliation
Surgery does different jobs at different points: risk reduction (prophylactic mastectomy or salpingo-oophorectomy in carriers of BRCA1/2), diagnosis (fine-needle aspiration, core needle, incisional or excisional biopsy), staging (sentinel lymph node biopsy), cure, debulking to make other treatment work better, palliation of obstruction or bleeding, and reconstruction. Sentinel node biopsy carries less lymphedema risk than a full axillary dissection. Image-guided ablation (radiofrequency, microwave, cryoablation) treats small tumors in the liver, kidney or lung without open surgery.
Nursing care around these procedures is ordinary surgical nursing with oncology risks added: delayed wound healing after radiation or antiangiogenic drugs, higher clot risk, nutrition and infection risk in a patient with low counts.
Autologous or allogeneic, and what follows day 0
Feature
Autologous
Allogeneic
Stem cells from
the patient
a donor: matched related or unrelated, haploidentical, or umbilical cord blood
Why it is done
to rescue marrow after high-dose therapy (myeloma, lymphoma)
high-dose therapy plus a new immune system that attacks the cancer (graft-versus-tumor)
Graft-versus-host disease
not expected
the main risk; prophylaxis is standard
Immunosuppressive drugs after
none (no GVHD prophylaxis); immune recovery still takes months
months, often longer
The sequence is conditioning (myeloablative or reduced-intensity), stem cell infusion on day 0, a period of aplasia, and engraftment, conventionally dated to the first of three consecutive days with an ANC of at least 500/µL. Blood products for transplant recipients are irradiated to prevent transfusion-associated graft-versus-host disease.
Treating every radiation patient as radioactive. After external beam therapy and after a high-dose-rate fraction, the patient emits nothing; precautions belong to implants in place and unsealed isotopes.
Spending long stretches at the bedside of an implant patient. Care is planned to keep each visit short and as far from the source as the task allows.
Retrieving a dislodged seed with gloved hands. Forceps and the lead container, then radiation safety.
Dating chronic GVHD by day 100. Late acute GVHD and chronic GVHD are told apart by their features.
Expecting GVHD after an autologous transplant. The graft is the patient's own; infection, mucositis and engraftment problems are the concerns there.
Neighbors of the treatment pages
Skin, mouth and bowel effects from any cause, and lymphedema care, continue on symptom management. Protecting staff from hazardous drugs follows the same logic of exposure control; see safe chemotherapy administration. Radiation side effects and modalities such as SBRT or proton therapy, and transplant and cellular therapy in depth, belong to the ROCN™ and TCTCN™ exams, which will get pages of their own.
Day 0 is the day the stem cells are infused. Conditioning days before it count down (for example, day −7 to day −1), and days after it count up, so engraftment and later milestones such as day +100 are measured from the infusion.
How much of the OCN is radiation and transplant?
The weight belongs to the whole treatment area, 20%, which radiation, surgery and transplant share with systemic, localized, targeted and oral therapy.
The topic after this
Neutropenia and myelosuppression
Part of Domain IV · Symptom Management and Supportive Care (25%)
Domain IV · Symptom Management and Supportive Care25%
06Neutropenia and myelosuppressionAbsolute neutrophil count, neutropenic precautions, febrile neutropenia and the first hour of sepsis, growth factors, bleeding precautions, anemia and transfusion.
07Symptom management and supportive careNausea and vomiting, bowel changes, mucositis, neuropathy, fatigue, skin and hair changes, lymphedema and ostomies, nutrition and weight loss, pain, and complementary therapies.
Domain III · Treatment Modalities20%
03Chemotherapy, targeted therapy and immunotherapyDrug classes and how they work, checkpoint inhibitors, CAR T cells and bispecific antibodies, hormonal agents, oral therapy and adherence teaching, intrathecal and intravesical therapy, and recognizing immune-related toxicity.
04Safe chemotherapy administration and handlingOrder checks and independent double checks, dose and body surface area, hazardous drug handling and spills, protective equipment, infusion reactions, and first steps when a vesicant leaks.
08Oncologic emergencies: structural and treatment-relatedSuperior vena cava syndrome, spinal cord compression, cardiac tamponade, raised intracranial pressure, obstructions and pneumonitis, with a map of all sixteen Domain V emergencies.
09Tumor lysis syndrome and metabolic emergenciesTumor lysis syndrome, SIADH, hypercalcemia of malignancy, DIC and venous thromboembolism: who is at risk, the labs, and what the nurse does first.
Domain II · Oncology Nursing Practice15%
02Cancer biology, staging and practice standardsCarcinogenesis and immunology, genetic versus genomic testing, TNM staging and grading, performance status scales, clinical trial basics, ethics, advocacy and compassion fatigue.
Domain I · Care Continuum14%
01Care continuum: prevention, screening and survivorshipRisk factors, screening and prevention, navigation, survivorship care plans and late effects, advance care planning, and end-of-life and hospice care at the level the OCN exam tests.
Domain VI · Psychosocial Dimensions of Care10%
10Psychosocial care in oncologyDistress screening, coping, body image, sexuality and fertility, learning needs, cultural and spiritual care, caregiver strain, crises, and the cost of cancer care.