Nausea, bowel changes, neuropathy, skin, lymphedema, fatigue, nutrition and pain all fall under Symptom Management and Supportive Care, which carries 25% of the scored OCN questions under the 2026 outline, more than any other area. This page takes everything in that area except blood counts, which have their own page.
A patient with a tunneled pleural catheter for a recurrent malignant pleural effusion will drain it at home. Which statement shows the patient understood the teaching?
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The catheter opens into the pleural space, so tap water carries organisms straight in; a line that stops draining is reported to the team.
Straw-colored or blood-tinged fluid is common with a malignant effusion; cloudy or foul-smelling fluid, or a sudden change in color, is what gets reported.
Draining to the last drop removes fluid faster than the lung can adjust and risks re-expansion pulmonary edema and pain.
Tightness, pain, or coughing during drainage means the lung is re-expanding fast; stopping then, and keeping each session to about 1,000 mL, guards against re-expansion pulmonary edema.
Symptoms
A patient on opioids has recent falls and daytime somnolence. Which assessment best detects early opioid oversedation?
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Sedation rises before breathing slows, so scoring it with a tool such as the Pasero scale catches oversedation while there is still time to hold or reduce the next dose.
Saturation falls only after ventilation is already depressed, so an oximeter reading is a late warning, not an early one.
A rate checked once a shift misses the drowsy period that comes first; relying on breathing rate alone is how early oversedation gets missed.
Small pupils show opioid effect at almost any dose and do not track how sedated the patient is.
Symptoms
A patient with advanced cancer has mild persistent breathlessness at rest. Which simple nonpharmacologic measure should the nurse try first?
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When saturation is normal, oxygen relieves breathlessness no better than room air, so it is not the first measure to try.
Moving air over the face eases the sense of breathlessness through trigeminal pathways and is a first-line nondrug step in advanced cancer.
Warm, still air tends to make breathlessness feel worse; cool moving air is what helps.
Fast deep breaths raise the work of breathing and can cause lightheadedness; slow, controlled breathing is what is taught.
Symptoms
After the intensive phase of complete decongestive therapy for arm lymphedema, which measure maintains the reduction in limb volume?
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Immobilizing the limb removes the muscle pump that moves lymph, so swelling tends to return.
Heat draws more fluid into a limb whose lymph drainage is already damaged and does not hold the reduction.
In the maintenance phase, fitted compression worn during the day (with exercise and skin care) keeps the volume reduction gained by bandaging.
Lymphedema fluid is protein-rich; diuretics pull water from the blood, not lymph, and are not used to maintain reduction.
Symptoms
A patient receiving weekly paclitaxel reports numbness in the hands. Which finding is most important to report before the next dose?
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Mild tingling without loss of function is low-grade neuropathy to document and keep monitoring; it does not usually change the plan by itself.
Alopecia is expected with weekly paclitaxel and does not affect whether the dose is given.
Numbness that interferes with fine-motor tasks is neuropathy limiting daily activities; it is reported before the next paclitaxel dose because dose delay or reduction is considered at this level.
Short-lived aches a few days after a taxane are an expected arthralgia-myalgia effect managed with analgesics, not a reason to hold the drug.
Symptoms
A patient hospitalized for stem cell transplant is anxious and withdrawn. Which complementary intervention has the strongest evidence for reducing anxiety?
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Homeopathy has no evidence of benefit beyond placebo for anxiety or other cancer symptoms.
Music interventions have the most consistent trial evidence for reducing anxiety during cancer treatment, including during transplant hospital stays.
Reiki studies are small and poorly controlled, so evidence is too weak to recommend it over music therapy.
Valerian has not shown benefit in cancer trials, and an unregulated herb is a poor choice for a patient on transplant drugs.
Symptoms
A patient with hepatocellular carcinoma and refractory ascites had a transjugular intrahepatic portosystemic shunt (TIPS) placed yesterday. Which finding should the nurse report first?
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A shrinking girth is the expected result of decompressing portal pressure.
Better kidney perfusion after the shunt often raises urine output, which is a good sign.
The shunt is placed through the jugular vein, so mild soreness there is expected unless swelling or bleeding appears.
A shunt routes portal blood past the liver, so ammonia reaches the brain; new confusion with a flapping tremor signals hepatic encephalopathy and is reported first.
Symptoms
Hand-foot skin reaction from multikinase inhibitors such as sorafenib is best prevented by:
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Pyridoxine was tested for capecitabine hand-foot syndrome and did not prevent it; it has no role with sorafenib.
Urea-based cream on the soles and cushioned, well-fitting shoes reduce friction and callus, the measures with evidence for preventing reactions to sorafenib-type drugs.
Regional cooling is studied for liposomal doxorubicin, not for multikinase inhibitors taken by mouth every day.
Heat and friction worsen the reaction; patients are told to avoid hot water and pressure on the hands and feet.
Symptoms
A patient with constant bone pain takes immediate-release oxycodone only when the pain becomes severe. The nurse advocates:
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Spacing as-needed doses further apart leaves even longer gaps when constant pain is uncovered.
Constant pain does not stop at night; missed doses mean waking in severe pain.
A sleeping pill does not treat pain; the patient still wakes when the opioid level falls.
Constant pain needs scheduled long-acting or regular dosing so the drug level stays steady, with an as-needed dose kept for breakthrough pain.
Symptoms
Three days after starting morphine, a patient has constant mild nausea that is unrelated to movement. There is no constipation. Which antiemetic targets the likely mechanism?
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Opioid nausea without a movement trigger or constipation comes from the chemoreceptor trigger zone, which a dopamine antagonist such as prochlorperazine blocks.
Aprepitant blocks NK1 receptors as part of chemotherapy antiemetic prophylaxis; it is not the agent matched to this opioid mechanism.
Scopolamine targets vestibular input, which suits nausea set off by movement, the trigger this stem excludes.
Lorazepam is a sedating anxiolytic adjunct; it does not block the dopamine receptors behind opioid nausea and adds sedation to the opioid.
Symptoms
A patient with advanced cancer reports episodes of severe pain that occur without any trigger and are unrelated to activity or to the timing of scheduled doses. This type of breakthrough pain is best classified as:
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End-of-dose failure returns just before the next scheduled dose; here the episodes are unrelated to dose timing.
Procedural pain comes with a procedure such as a dressing change or line insertion.
Breakthrough pain with no trigger and no link to dose timing is called spontaneous (idiopathic) pain.
Incident pain has a predictable trigger such as moving, coughing or walking; this stem rules that out.
Symptoms
Three weeks after pelvic node dissection, a patient has new swelling of the right leg. Which finding most suggests lymphedema rather than DVT?
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Warmth and redness suggest DVT or cellulitis rather than lymphedema.
Lymphedema builds slowly and feels heavy or tight, usually without pain or warmth.
Both conditions usually affect one leg after pelvic surgery, so one-sided swelling does not tell them apart.
Swelling that appears quickly with calf pain points toward a clot and needs an ultrasound.
Symptoms
After IV metoclopramide, a patient develops sustained neck twisting and upward deviation of the eyes. The nurse anticipates:
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Giving more of the causative drug deepens the dopamine blockade.
Ondansetron does not reverse the dopamine blockade, so the dystonia that is happening now continues.
Twisting neck and upward-rolled eyes after metoclopramide are acute dystonia, which an anticholinergic such as diphenhydramine (or benztropine) reverses within minutes.
Haloperidol is another dopamine blocker and can worsen the reaction.
Symptoms
A patient with partial biliary obstruction and pruritus starts cholestyramine powder. Which teaching point is most important?
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Cholestyramine binds many drugs in the gut, so other medicines are taken about 1 hour before or 4 to 6 hours after it.
Relief from a bile acid binder builds over days, not within an hour.
Taking it with other pills is exactly what lets it bind and block them.
The powder must be mixed with liquid; dry powder can cause choking and irritation.
Symptoms
A man receiving androgen deprivation therapy starts venlafaxine for hot flashes. Which teaching point is most important?
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Stopping an SNRI suddenly can cause dizziness, irritability and flu-like symptoms, so venlafaxine is tapered when stopped.
Relief of hot flashes usually starts within 1 to 2 weeks, so a 3-month wait is not expected.
Doubling up raises blood pressure and side effects; a dose change is made by the prescriber.
Venlafaxine does not interact with androgen deprivation or change the PSA response.
Symptoms
Which agent is FDA-approved for chemotherapy-induced nausea and vomiting that has not responded to conventional antiemetic treatment?
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Ondansetron is itself one of the conventional 5-HT3 antiemetics; adding more of the same class does not rescue refractory nausea.
Hydroxyzine is an antihistamine for anxiety and itching with no approval for refractory chemotherapy nausea.
Meclizine is used for vertigo and motion sickness, not for nausea from chemotherapy.
Dronabinol, an oral cannabinoid, is labeled for chemotherapy nausea and vomiting in patients who have not responded adequately to conventional antiemetics.
Symptoms
A patient with mild oral mucositis asks about mouth care. Which instruction is appropriate?
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Bland rinses with saline or baking soda keep the mouth clean and moist without irritating the damaged mucosa.
Mouth care continues with a soft brush, because plaque and bacteria raise infection risk in damaged mucosa.
Alcohol dries and stings inflamed mucosa and can worsen mucositis.
Peroxide irritates and dries inflamed mucosa and can slow healing, so bland rinses are preferred.
Symptoms
After head and neck radiation, a patient with dysphagia has lost 7% of body weight in a month despite texture-modified meals. Which intervention should the nurse anticipate?
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An appetite stimulant does not fix a swallowing problem, so intake stays too low.
IV nutrition is reserved for a gut that cannot be used; it adds line infection risk without benefit here.
When dysphagia after head and neck radiation causes weight loss despite modified meals, enteral feeding through a gastrostomy uses the working gut and is preferred.
Clear liquids supply too few calories and protein and would speed the weight loss.
Symptoms
A patient with metastatic carcinoid tumor has episodes of flushing, watery diarrhea, and wheezing. Which drug controls these symptoms?
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A beta agonist acts only on the airway and can trigger more hormone release from the tumor, so flushing and diarrhea go on.
A somatostatin analog blocks the tumor's release of serotonin and other vasoactive substances, so it controls flushing, diarrhea and wheezing together.
An antidiarrheal slows the gut but leaves the flushing and bronchospasm untouched.
A nonselective beta blocker does not block the tumor's hormones and can worsen the wheezing.
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Outline lines in our words, with the examples this page covers; the weight belongs to the area as a whole.
IV.A Changes after surgery or site radiation: lymphedema after node removal, ostomies, and effects that depend on where the beam was aimed.
IV.B Vascular access devices: moved into this area from the treatment area in 2026.
IV.C Pharmacologic interventions: on this page, antiemetics, laxatives and antidiarrheals, adjuvant analgesics, and skin and mouth care products.
IV.D Complementary and integrative care: massage, acupuncture and herbal products, including what they interact with.
IV.E Effects on body systems: the gut, bladder, skin, lungs, heart, nerves and musculoskeletal system. The hematologic and immune lines of IV.E live on the blood counts page.
IV.F Nutrition: taste change, weight loss and cachexia.
IV.G Pain management: on this page, cancer pain during treatment and the opioid bowel plan.
Antiemetic plans follow the regimen's emetic risk
Prophylaxis for chemotherapy-induced nausea and vomiting (CINV) is chosen before the first dose, from the emetogenic risk of the most emetogenic drug in the regimen. The ASCO antiemetic guideline update (2020) and the NCCN Antiemesis guideline (version 2.2026) sort agents into four bands by the share of patients who would vomit without prophylaxis: high (over 90%), moderate (30–90%), low (10–30%) and minimal (under 10%).
a single dose of a 5-HT3 antagonist or dexamethasone
Minimal
most checkpoint inhibitors
none routinely
Timing is the second label. Acute CINV starts within 24 hours of the dose; delayed CINV comes after the first day and can run for several days; anticipatory nausea is a learned response that begins before the infusion, often in the car or the waiting room. Breakthrough nausea happens despite prophylaxis. Anticipatory nausea is easiest to prevent by controlling CINV fully from cycle 1, and once present it responds to anxiolytics and behavioral methods rather than to a stronger 5-HT3 antagonist.
Diarrhea, constipation and the opioid bowel plan
Diarrhea is graded by stools per day above the patient's baseline. In the NCI CTCAE version 6.0 (2025), grade 2 is an increase of 4–6 and grade 3 an increase of 7 or more, or a need for hospitalization or IV fluids, or a limit on self-care; grade 1 now covers any milder change in frequency or consistency, where version 5.0 (2017), still used by many trials, set it at an increase of fewer than 4. An ostomy is graded by the rise in output instead. Irinotecan has two patterns worth keeping apart: an early, cholinergic one during or shortly after the infusion, with cramping, sweating and salivation, and a late one more than 24 hours after the dose, which the Camptosar prescribing information (FDA label, 2024) treats with loperamide started at the first loose stool. Diarrhea on a checkpoint inhibitor raises the question of colitis, covered with immune-related toxicity.
Opioid-induced constipation does not fade with time the way opioid nausea and sedation usually do, so a scheduled bowel regimen starts with the scheduled opioid. The NCCN Adult Cancer Pain guideline (version 2.2026) builds it on a stimulant laxative such as senna, with an osmotic agent added as needed. When laxatives fail, a peripherally acting mu-opioid receptor antagonist (methylnaltrexone, naloxegol or naldemedine) blocks the opioid's effect on the gut without reversing analgesia. Their labels, such as the Relistor prescribing information (FDA label, 2024), rule them out when a bowel obstruction is known or suspected.
Nerves, skin and hair: who causes what
Peripheral neuropathy. Taxanes, platinum agents, vinca alkaloids and proteasome inhibitors cause most chemotherapy-induced peripheral neuropathy (CIPN). Oxaliplatin adds an acute, cold-triggered tingling of the hands, mouth and throat, during the infusion or in the days after it. The ASCO CIPN guideline (2020) recommends no drug for prevention; for painful established CIPN, duloxetine is the one agent it supports.
Hand-foot syndrome or hand-foot skin reaction. The first, from capecitabine or liposomal doxorubicin, is a diffuse redness and swelling of the palms and soles. The second, from multikinase inhibitors, forms thick, tender calluses over pressure points. Same body parts, different drugs, different look.
Rash from EGFR inhibitors. Cetuximab, panitumumab and erlotinib cause an acneiform rash on the face and upper trunk; despite the look, it is a drug effect, not acne.
Alopecia. Hair loss usually starts two to four weeks after treatment begins and is temporary for most regimens. The FDA clearance of the DigniCap system for solid tumors (2017) made scalp cooling an option for patients with solid tumors, not only breast cancer.
Lymphedema, ostomies, fatigue and weight loss
Lymphedema is staged on the scale of the International Society of Lymphology consensus document (2023), from 0 (impaired lymph flow, no visible swelling) through I (swelling that goes down with elevation) and II (elevation alone rarely reduces it; pitting may fade as tissue fibroses) to III (skin changes and hard, fibrotic tissue).
For ostomies, the stoma should look moist and red; a dusky, purple or black stoma is reported at once. An ileostomy puts out liquid stool and carries a higher risk of dehydration than a descending colostomy. A malignant pleural effusion that keeps coming back may be managed with an indwelling pleural catheter drained at home, so drainage teaching falls to the nurse as well.
The NCCN Cancer-Related Fatigue guideline (version 1.2027) asks for a 0–10 fatigue screen at regular intervals; physical activity is the intervention with the best evidence behind it, and treatable contributors such as anemia, pain, poor sleep, hypothyroidism and depression are checked first. Cachexia is weight loss of more than 5% in six months (or more than 2% with a BMI under 20 or with low muscle mass) by the Fearon et al. international consensus on cancer cachexia (2011), and unlike simple starvation it is not fully reversed by feeding.
Symptom answers that look right but aren't
Symptom mix-ups
Picking the antiemetic by how sick the patient looked last cycle. The plan follows the regimen's risk band; poor control last time moves the patient up a level, it does not replace the band.
Calling every early irinotecan reaction an allergy. Sweating, cramps and salivation during the infusion are cholinergic, not hypersensitivity.
Starting a PAMORA without asking about obstruction. Methylnaltrexone and its relatives are contraindicated if the bowel may be blocked.
Swapping the two hand-foot reactions. Ask which drug the patient is on before choosing the description.
Treating cachexia as a calorie gap. Feeding helps, but muscle loss driven by the tumor continues; that is why it has its own consensus definition.
Symptom topics with a page of their own
Blood counts, infection and bleeding: neutropenia and myelosuppression. Skin and mouth effects that depend on the radiation field: radiation, surgery and transplant. Body image and sexual effects of treatment: psychosocial care. Mucositis is still a sub-topic here: the MASCC/ISOO mucositis guideline (2020) supports oral cryotherapy during bolus 5-fluorouracil. Separate pages on mucositis, nutrition, cancer pain, vascular access devices and breast-specific care are planned.
Did the 2026 OCN outline change symptom management?
Yes. Area IV rose from 21% to 25% and was renamed from Symptom Management and Palliative Care to Symptom Management and Supportive Care. Palliative care considerations moved to the care continuum, and vascular access devices moved in from treatment.
Are pain questions on the OCN about hospice care?
Not only. Pain shows up twice in the outline: as pain management in area IV, and as comfort measures for the dying patient in area I, which the care continuum page covers.
Which side-effect grading system should I know?
NCI's CTCAE. It grades each toxicity from 1 (mild) to 5 (death). Version 6.0 came out in 2025; trials that started on version 5.0 keep reporting in it, so both versions are in use.
The topic after this
Oncologic emergencies: structural and treatment-related
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.
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.
05Radiation, surgery and transplantSurgical and procedural care, radiation principles and safety (time, distance, shielding; sealed and unsealed sources), common site effects, and an overview of autologous and allogeneic transplant.
Domain V · Oncologic Emergencies16%
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.