OCN Exam Prep 10-Week Study Plan

Week 1 — Part 1: Oncology Nursing Practice

Difficulty: Moderate

What it covers:

• The oncology nurse's role across the full care continuum: prevention, screening, diagnosis, treatment, survivorship, and end of life

• ONS standards and scope of practice, the six competency domains, and OCN certification

• Legal and ethical frameworks: informed consent, confidentiality, advocacy, advance directives, and DNR orders

• Cultural competence and spiritual care, including structured tools (FICA, LEARN, ETHNIC)

• Patient and caregiver education tailored to literacy, learning style, and language

• Survivorship care plans and late-effects surveillance

• The distinction between palliative care, hospice, and end-of-life care, and when each applies

Print: 1 Mind Map, 2 Comparison Charts, 2 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first, completing the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read, following the Made Easy Highlighting System

☐ Lock in the four core ethical principles before anything else: autonomy (the foundation of informed consent), beneficence, non-maleficence, and justice. The OCN tests these as scenarios that pit two principles against each other and ask which should guide the response.

☐ Build a clean one-page comparison of palliative care versus hospice. The single most-tested distinction: palliative care is appropriate at any stage and can run alongside curative treatment with no prognosis requirement, while hospice requires a prognosis of six months or less and a shift to comfort-focused care.

☐ Memorize the survivorship essentials: the Institute of Medicine recommends every survivor receive a survivorship care plan, and the nurse coordinates late-effects surveillance, recurrence and secondary-malignancy screening, and health promotion.

☐ Review your Part 1 flashcards (Anki or printable). Tag anything you miss for daily repetition.

☐ Complete the Practice Questions for Part 1 in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Oncology Nursing Practice. Main branches: Role Across the Continuum → ONS Standards & Scope of Practice → OCN Certification → Legal & Ethical Principles (autonomy, beneficence, non-maleficence, justice) → Informed Consent & Advance Directives → Cultural Competence & Spiritual Care → Patient & Caregiver Education → Survivorship Care → Palliative vs. Hospice vs. End-of-Life Care.

Comparison Charts:

☐ Chart 1 — Palliative Care vs. Hospice Care: Timing, goal, whether curative treatment can continue, eligibility/prognosis requirement, care setting, and the nurse's role in each.

☐ Chart 2 — Adjustment Reaction vs. Pathologic Distress (intro level): Proportionality to the stressor, impact on function, expected time course, and when a referral is triggered.

Cornell Notes:

☐ Page 1 — Cue questions: What are the four core ethical principles, and which one is the legal foundation of informed consent? What are the five steps of the nursing process applied to oncology care?

☐ Page 2 — Cue questions: What is the difference between palliative care and hospice in timing and eligibility? Why should a professional medical interpreter, not a family member, be used for complex medical discussions?

Week 2 — Part 2: Cancer Pathophysiology

Difficulty: Heavy

What it covers:

• The cell cycle (G1, S, G2, M, G0), checkpoints, and the cyclin/CDK regulatory machinery

• Carcinogenesis as a three-stage process: initiation, promotion (reversible), and progression

• Tumor classification (carcinoma, sarcoma, leukemia/lymphoma, glioma), benign versus malignant behavior, TNM staging, and histologic grading

• Cancer genetics: oncogenes, tumor suppressor genes, DNA repair genes, Knudson's two-hit hypothesis, and hereditary syndromes (BRCA1/2, Lynch, FAP, Li-Fraumeni)

• Immunosurveillance and the mechanisms of immune evasion (MHC-I downregulation, PD-L1, immunosuppressive cytokines)

• The metastatic cascade, EMT, and the seed-and-soil hypothesis

• Cancer epidemiology, modifiable versus non-modifiable risk factors, and screening principles (sensitivity, specificity, current guidelines)

Print: 1 Mind Map, 4 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first, completing the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read using the six-color Made Easy system (Blue = cancer science, Green = nursing actions, Red = emergencies, Yellow = drugs/agents, Orange = symptoms/complications, Pink = psychosocial/ethical). This Part will be mostly Blue.

☐ Master the carcinogenesis sequence cold: initiation is an irreversible carcinogen-induced mutation, promotion is reversible clonal expansion, and progression adds genetic instability plus invasive and metastatic capability. Knowing which stage is reversible is a frequent test point.

☐ Lock in TNM and grading. T = tumor size/invasion, N = nodal involvement, M = distant metastasis. Stage 0 = carcinoma in situ, Stage IV = distant metastasis. Grade reflects differentiation (higher grade = more undifferentiated = more aggressive). Do not confuse staging with grading.

☐ Build a hereditary-syndrome card: BRCA1/2 (breast/ovarian), Lynch (mismatch repair, colorectal/endometrial), FAP (APC gene). Anchor the two-hit hypothesis to tumor suppressor genes specifically.

☐ Memorize the high-yield screening guidelines: mammography (ages 40 to 74), Pap plus HPV co-test (ages 21 to 65), colonoscopy (beginning age 45), low-dose CT for lung (ages 50 to 80 with a 20+ pack-year history), and PSA via shared decision-making.

☐ Review your Part 2 flashcards, then re-cycle any Part 1 cards you missed.

☐ Complete the Practice Questions for Part 2 in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Cancer Pathophysiology. Main branches: Cell Cycle & Checkpoints → Carcinogenesis (initiation/promotion/progression) → Tumor Classification & TNM Staging & Grading → Cancer Genetics (oncogenes, tumor suppressors, two-hit, hereditary syndromes) → Cancer Immunology & Immune Evasion → Metastatic Cascade & EMT → Epidemiology & Risk Factors → Screening & Early Detection.

Comparison Charts:

☐ Chart 1 — Oncogene vs. Tumor Suppressor Gene: Normal function, type of mutation (gain vs. loss of function), dominant vs. recessive at the cellular level, two-hit applicability, and an example gene for each.

☐ Chart 2 — Benign vs. Malignant Tumor: Encapsulation, growth rate, invasion, metastatic potential, differentiation, and clinical significance.

☐ Chart 3 — TNM Staging vs. Histologic Grading: What each measures, the scale used, what drives the score, and how each informs prognosis versus treatment.

☐ Chart 4 — Sensitivity vs. Specificity: Definition, which error each minimizes (false negatives vs. false positives), clinical consequence of a low value, and a screening example.

Cornell Notes:

☐ Page 1 — Cue questions: What are the three stages of carcinogenesis, and which stage is reversible? What is Knudson's two-hit hypothesis, and which gene class does it apply to?

☐ Page 2 — Cue questions: What do T, N, and M represent, and how does staging differ from grading? What are three mechanisms tumors use to evade the immune system?

☐ Page 3 — Cue questions: What are the five steps of the metastatic cascade in order? What are the current screening age thresholds for breast, cervical, colorectal, and lung cancer?

Week 3 — Part 3: Treatment Modalities — Chemotherapy

Difficulty: Heavy, High-Yield

What it covers:

• Chemotherapy principles: the log-kill hypothesis, cell-cycle specificity, the Gompertzian growth model, and drug resistance

• Alkylating agents and antitumor antibiotics: mechanisms, key agents, and signature toxicities (including doxorubicin cardiomyopathy and bleomycin pulmonary fibrosis)

• Antimetabolites and plant-derived agents (vinca alkaloids, taxanes, topoisomerase inhibitors), including leucovorin rescue

• Safe handling per NIOSH: PPE, double-verification, spill management, and ONS provider certification

• Dosing math: BSA-based dosing and the Calvert formula for carboplatin, plus dose adjustments for organ impairment

• Vesicants versus irritants and the step-by-step extravasation response (warm vs. cold compresses are agent-specific)

• The rationale and naming of combination regimens

Print: 1 Mind Map, 4 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first, completing the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read using the six-color Made Easy system (Yellow will dominate 

this Part for the drug classes; Red for extravasation; Orange for myelosuppression).

☐ Memorize the cell-cycle classification before the quiz bank: alkylating agents and antitumor antibiotics are cell-cycle non-specific; antimetabolites are S-phase specific; vinca alkaloids and taxanes are M-phase specific. Match each class to its hallmark toxicity (anthracyclines = cumulative cardiomyopathy at 450 to 550 mg/m², bleomycin = pulmonary fibrosis, vincristine = peripheral neuropathy).

☐ Practice the two dosing methods until they are automatic. Most agents: dose = mg/m² × BSA. Carboplatin only: the Calvert formula, dose (mg) = AUC × (GFR + 25). Do not move past this Part until you can run both from memory.

☐ Drill the extravasation response in order: stop the infusion, leave the catheter in place, aspirate residual drug, mark the area, apply the agent-specific antidote, and document. Anchor the compress rule: cold for anthracyclines, warm for vinca alkaloids.

☐ Memorize the pre-treatment lab floors: ANC at least 1,500/mm³ and platelets at least 100,000/mm³, plus two-nurse double-verification of drug, dose, patient, and route.

☐ Review your Part 3 flashcards, then re-cycle missed cards from Parts 1 and 2.

☐ Complete the Practice Questions for Part 3 in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Chemotherapy. Main branches: Principles (log-kill, cell-cycle specificity, Gompertzian, resistance) → Alkylating Agents → Antitumor Antibiotics → Antimetabolites → Plant-Derived Agents (vinca, taxanes, topoisomerase inhibitors) → Safe Handling (NIOSH, PPE, verification, spills) → Dosing (BSA, Calvert/AUC, organ-impairment adjustments) → Vesicants/Irritants & Extravasation → Combination Regimens.

Comparison Charts:

☐ Chart 1 — Cell-Cycle Specific vs. Cell-Cycle Non-Specific Agents: Definition, example classes, effectiveness against resting cells, and clinical implication for slow- 

vs. fast-growing tumors.

☐ Chart 2 — Vesicant vs. Irritant: Tissue outcome on extravasation, onset of damage, example high-risk agents, antidotes, and compress (warm vs. cold).

☐ Chart 3 — Vinca Alkaloids vs. Taxanes: Mechanism on microtubules (prevent assembly vs. prevent disassembly), cell-cycle phase, signature toxicity, and an example agent for each.

☐ Chart 4 — BSA Dosing vs. Calvert (AUC) Dosing: What drives the calculation, which agents use each, the variables required, and the organ function each depends on.

Cornell Notes:

☐ Page 1 — Cue questions: What is the log-kill hypothesis, and why does it require multiple cycles? Which classes are cell-cycle non-specific, and why does that matter for slow-growing tumors?

☐ Page 2 — Cue questions: What is the full Calvert formula, and which single agent is dosed this way? What are the cumulative-dose ceilings and target organs for doxorubicin and bleomycin?

☐ Page 3 — Cue questions: What are the six steps of the extravasation response in order, and which compress applies to anthracyclines versus vinca alkaloids? What two lab values must be met before administration?

Week 4 — Part 4: Treatment Modalities — Targeted & Immunotherapy

Difficulty: Heavy

What it covers:

• Tyrosine kinase inhibitors: mechanism, major target classes (BCR-ABL, EGFR, HER2, VEGFR, BRAF), and common toxicities (rash, hand-foot reaction, QTc prolongation, hypertension)

• Monoclonal antibodies: naked versus conjugated, the naming convention (-omab, -ximab, -zumab, -umab), key agents, and infusion-reaction risk

• Checkpoint inhibitors (anti-PD-1, anti-PD-L1, anti-CTLA-4) and the grading and management of immune-related adverse events (irAEs)

• CAR-T cell therapy from leukapheresis to infusion, plus the two life-threatening toxicities, CRS and ICANS

• Hormonal therapy: SERMs, aromatase inhibitors, SERDs, and androgen deprivation, with bone-loss and cardiovascular concerns

• Hematopoietic stem cell transplantation (autologous vs. allogeneic), engraftment, GVHD, and the graft-versus-tumor effect

Print: 1 Mind Map, 4 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first, completing the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read using the six-color Made Easy system (Yellow for the agents, Red for CRS/ICANS, Orange for irAEs).

☐ Learn the monoclonal antibody naming convention as a memory hook: -omab (mouse), -ximab (chimeric), -zumab (humanized), -umab (fully human). Fully human antibodies carry the lowest infusion-reaction risk, which is itself a test point.

☐ Build a checkpoint-inhibitor map: anti-PD-1 (pembrolizumab, nivolumab) blocks the T-cell side, anti-PD-L1 (atezolizumab, durvalumab) blocks the tumor side, anti-CTLA-4 (ipilimumab) acts earlier in the lymph node. Then drill irAE management by grade: Grade 1 continue with monitoring, Grade 2 hold and start prednisone, Grade 3 to 4 discontinue and high-dose IV steroids.

☐ Memorize the CAR-T toxicity pair cold. CRS = fever, hypotension, hypoxia from cytokine release, first-line tocilizumab plus steroids. ICANS = confusion, aphasia, seizures, cerebral edema, managed with steroids and ICU-level neuro monitoring. Note tocilizumab is the IL-6 receptor antagonist used first for CRS.

☐ Distinguish autologous from allogeneic HSCT: autologous has no GVHD risk but no graft-versus-tumor benefit; allogeneic provides the GVT effect but carries GVHD, graft failure, and infection risk during engraftment (typically 2 to 4 weeks).

☐ Review your Part 4 flashcards, then re-cycle missed cards from Parts 1 through 3.

☐ Complete the Practice Questions for Part 4 in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Targeted & Immunotherapy. Main branches: Tyrosine Kinase Inhibitors → Monoclonal Antibodies (naming, naked vs. conjugated/ADC) → Checkpoint Inhibitors (PD-1/PD-L1/CTLA-4, irAEs) → CAR-T Therapy (leukapheresis → lymphodepletion → infusion → CRS/ICANS) → Hormonal Therapy (SERM, AI, SERD, ADT) → HSCT (autologous vs. allogeneic, GVHD, GVT, engraftment).

Comparison Charts:

☐ Chart 1 — TKIs vs. Monoclonal Antibodies: Molecule size, intracellular vs. extracellular target, route (oral vs. infusion), signature toxicities, and infusion-reaction risk.

☐ Chart 2 — CRS vs. ICANS: Onset, hallmark signs, grading tool, first-line management, and monitoring priority.

☐ Chart 3 — Autologous vs. Allogeneic HSCT: Stem cell source, GVHD risk, graft-versus-tumor benefit, conditioning intensity, and representative disease indication.

☐ Chart 4 — SERM vs. Aromatase Inhibitor: Mechanism, menopausal-status eligibility, signature toxicity (endometrial/VTE vs. arthralgia/bone loss), and monitoring required.

Cornell Notes:

☐ Page 1 — Cue questions: What does each monoclonal antibody suffix encode, and which carries the lowest infusion-reaction risk? How is irAE management escalated across CTCAE grades 1 through 4?

☐ Page 2 — Cue questions: What are the hallmark signs and first-line treatment of CRS versus ICANS? What is the sequence of the CAR-T process from leukapheresis to infusion?

☐ Page 3 — Cue questions: How do autologous and allogeneic HSCT differ in GVHD risk and GVT benefit? Which hormonal agents require a baseline DEXA scan and why?

Week 5 — Part 5: Treatment Modalities — Radiation & Surgery

Difficulty: Moderate–Heavy

What it covers:

• Radiobiology: direct versus indirect (free-radical) DNA damage, fractionation rationale, and the five Rs (Repair, Repopulation, Redistribution, Reoxygenation, Radiosensitivity)

• External beam radiation therapy techniques and the nursing priorities of skin care, fatigue management, and education

• Brachytherapy: HDR versus LDR, and the very different radiation-safety precautions each requires

• Acute versus late radiation side effects by treatment site

• Surgical oncology goals: curative, cytoreductive, prophylactic, diagnostic/staging, and palliative, plus the meaning of R0/R1/R2 margins

• Pre- and postoperative oncology nursing care, including ERAS protocols, VTE prophylaxis, and anastomotic-leak recognition

Print: 1 Mind Map, 3 Comparison Charts, 2 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first, completing the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read using the six-color Made Easy system (Blue for radiobiology, Green for nursing care, Orange for site-specific side effects).

☐ Memorize the five Rs of radiobiology and why fractionation works: normal cells repair sublethal damage between fractions better than tumor cells. Note that indirect, free-radical-mediated damage accounts for roughly 70% of radiation cell kill.

☐ Lock in the brachytherapy safety distinction, because it changes how you provide bedside care. LDR permanent implants emit radiation continuously (apply distance, shielding, time, and visitor restrictions, no pregnant visitors or children). HDR patients are NOT radioactive between sessions because the source is mechanically retracted.

☐ Build a site-specific side-effect card splitting acute from late: head and neck (mucositis, xerostomia, then osteoradionecrosis); thoracic (esophagitis, pneumonitis, then fibrosis); pelvic (diarrhea, cystitis, then fistula); brain (edema, then cognitive decline).

☐ Memorize the five surgical goals and the margin definitions: R0 = negative margin, R1 = microscopic residual, R2 = gross residual. Positive margins raise local recurrence risk.

☐ Review your Part 5 flashcards, then re-cycle missed cards from earlier Parts.

☐ Complete the Practice Questions for Part 5 in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Radiation & Surgery. Main branches: Radiobiology (direct/indirect damage, five Rs, fractionation) → EBRT (techniques, skin care, fatigue, education) → Brachytherapy (HDR vs. LDR, safety) → Radiation Side Effects (acute vs. late by site) → Surgical Goals (curative/cytoreductive/prophylactic/diagnostic/palliative, R0–R2) → Perioperative Nursing (ERAS, VTE prophylaxis, anastomotic leak, lymphedema).

Comparison Charts:

☐ Chart 1 — HDR vs. LDR Brachytherapy: Source and dose rate, treatment duration, whether the patient is radioactive between sessions, nursing safety precautions, and a representative clinical use.

☐ Chart 2 — Acute vs. Late Radiation Effects: Time course, tissues affected (rapidly vs. slowly renewing), reversibility, and a site-specific example of each.

☐ Chart 3 — Surgical Goals in Oncology: Curative vs. cytoreductive vs. prophylactic vs. diagnostic vs. palliative, what each aims to accomplish, and a clinical example.

Cornell Notes:

☐ Page 1 — Cue questions: What are the five Rs of radiobiology, and which one is the basis for fractionation? What is the critical safety difference between HDR and LDR brachytherapy at the bedside?

☐ Page 2 — Cue questions: What do R0, R1, and R2 margins mean, and how do they affect recurrence risk? What are the highest-risk VTE and anastomotic-leak findings in the postoperative oncology patient, and on which post-op days do leaks classically present?

Week 6 — Part 6: Symptom Management

Difficulty: Heavy, High-Yield

What it covers:

• Chemotherapy-induced nausea and vomiting (CINV) by timing and emetogenic risk, with risk-matched antiemetic regimens

• Oral mucositis grading, prevention (including cryotherapy), and treatment

• Cancer-related fatigue and the evidence for aerobic exercise as first-line management

• Comprehensive pain assessment, the WHO analgesic ladder, opioid principles, and adjuvant analgesics

• Chemotherapy-induced peripheral neuropathy (CIPN) and cancer-related cognitive impairment

• Alopecia and treatment-related skin changes (EGFR rash, hand-foot syndrome)

• Anorexia-cachexia, nutrition screening (PG-SGA), and support interventions

• Chemotherapy-induced diarrhea, opioid-induced constipation, lymphedema staging and care, and sexual health and fertility

Print: 1 Mind Map, 4 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first, completing the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read using the six-color Made Easy system (Orange will dominate this Part; Yellow for antiemetics and analgesics).

☐ Match antiemetic regimens to emetogenic risk before the quiz bank. Highly emetogenic chemotherapy needs three drugs (5-HT3 antagonist plus NK1 antagonist plus dexamethasone); moderately emetogenic needs at least a 5-HT3 antagonist plus dexamethasone. Anticipatory CINV is a conditioned response managed with lorazepam and prevented by controlling early cycles.

☐ Lock in the opioid and pain rules: around-the-clock dosing plus breakthrough PRN, a standing bowel regimen from day one (opioid-induced constipation does not develop tolerance), and the right adjuvant for the pain type (gabapentinoids or duloxetine for neuropathic, NSAIDs or bisphosphonates for bone pain).

☐ Memorize the two evidence anchors examiners love: aerobic exercise is the single most evidence-based intervention for cancer-related fatigue, and duloxetine has the strongest evidence for painful CIPN (no agent reliably prevents CIPN).

☐ Build a grading-threshold card for mucositis (Grade 3 = confluent ulcers, cannot eat solids) and diarrhea (Grade 3 = 7 or more stools/day above baseline, IV hydration). Note cryotherapy (ice chips) is recommended to reduce mucositis with high-dose chemotherapy.

☐ Learn lymphedema staging (ISL Stage 0 subclinical through Stage III fibrotic) and that Complete Decongestive Therapy is the standard treatment.

☐ Review your Part 6 flashcards, then re-cycle missed cards from earlier Parts.

☐ Complete the Practice Questions for Part 6 in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Symptom Management. Main branches: CINV (timing, emetogenic risk, antiemetics) → Mucositis (grading, cryotherapy, oral care) → Cancer-Related Fatigue (exercise first-line) → Pain (WHO ladder, opioids, adjuvants) → CIPN & Cognitive Impairment → Alopecia & Skin Changes (EGFR rash, hand-foot) → Anorexia-Cachexia & Nutrition (PG-SGA) → Diarrhea & Constipation → Lymphedema (ISL staging, CDT) → Sexual Health & Fertility.

Comparison Charts:

☐ Chart 1 — CINV by Type: Acute vs. delayed vs. anticipatory vs. breakthrough, timing, mechanism, and management for each.

☐ Chart 2 — Nociceptive vs. Neuropathic Pain: Source, descriptors, example in oncology, and the preferred adjuvant analgesic for each.

☐ Chart 3 — Chemotherapy-Induced Diarrhea vs. Opioid-Induced Constipation: Cause, grading or hallmark, first-line management, and prophylaxis strategy.

☐ Chart 4 — Lymphedema Stages (ISL 0 to III): Pitting vs. non-pitting, reversibility with elevation, skin changes, and treatment intensity at each stage.

Cornell Notes:

☐ Page 1 — Cue questions: What three-drug regimen prevents CINV from highly emetogenic chemotherapy, and what manages anticipatory CINV? What is the single most evidence-based intervention for cancer-related fatigue?

☐ Page 2 — Cue questions: What are the steps of the WHO analgesic ladder, and what bowel-regimen rule applies to every opioid order? Which agent has the strongest evidence for painful CIPN?

☐ Page 3 — Cue questions: What are the grade-3 thresholds for mucositis and chemotherapy-induced diarrhea? What are the four ISL lymphedema stages, and what is the standard treatment?

Week 7 — Part 7: Hematological Complications

Difficulty: Heavy

What it covers:

• Myelosuppression and neutropenia, ANC calculation, the chemotherapy nadir window, and neutropenic precautions

• Febrile neutropenia as an oncologic emergency, the diagnostic criteria, the cultures-before-antibiotics-within-60-minutes rule, and MASCC risk stratification

• Anemia grading, transfusion thresholds, and the restricted indications for erythropoiesis-stimulating agents

• Thrombocytopenia grading, platelet transfusion thresholds, and bleeding precautions

• Disseminated intravascular coagulation (DIC): pathophysiology, labs, and management

• Colony-stimulating factors (G-CSF, GM-CSF, ESAs, TPO-RAs), including pegfilgrastim timing rules

Print: 1 Mind Map, 3 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first, completing the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read using the six-color Made Easy system (Red for febrile neutropenia and DIC, Orange for the cytopenias, Yellow for the growth factors).

☐ Memorize the febrile-neutropenia definition and response cold, because it is the most tested item in this Part. Criteria: ANC under 500 (or under 1,000 with predicted decline) plus a single temperature of 38.3°C or sustained 38.0°C for an hour. Response: blood cultures BEFORE antibiotics, then broad-spectrum anti-pseudomonal IV antibiotics within 60 minutes. Every minute of delay raises mortality.

☐ Build a threshold table you can reproduce from memory: ANC neutropenia under 1,500, severe under 500, profound under 100; platelet prophylactic transfusion under 10,000, under 50,000 before an invasive procedure, under 100,000 before neurosurgery; ESAs are only for non-curative-intent chemotherapy anemia, capped at Hgb 12.

☐ Lock in DIC's paradox: simultaneous microvascular clotting and hemorrhage from consumed platelets and factors. Labs: low platelets, low fibrinogen, elevated PT/PTT, elevated D-dimer. There is no antidote, treat the underlying cause and give hemostatic support.

☐ Memorize the pegfilgrastim timing rule: give it 24 to 72 hours after chemotherapy, and never within 14 days before the next cycle. Note the most common side effect is bone pain.

☐ Review your Part 7 flashcards, then re-cycle missed cards from earlier Parts.

☐ Complete the Practice Questions for Part 7 in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Hematological Complications. Main branches: Myelosuppression & Neutropenia (ANC, nadir, precautions) → Febrile Neutropenia (criteria, emergency response, MASCC) → Anemia (grading, transfusion, ESAs) → Thrombocytopenia (grading, transfusion thresholds, bleeding precautions) → DIC (pathophysiology, labs, management) → Colony-Stimulating Factors (G-CSF, GM-CSF, ESAs, TPO-RAs).

Comparison Charts:

☐ Chart 1 — Neutropenia vs. Severe vs. Profound: ANC value, infection risk, and the precaution bundle that applies.

☐ Chart 2 — Platelet Transfusion Thresholds: Prophylactic (stable), with fever/bleeding, before an invasive procedure, and before neurosurgery, with the rationale for each cutoff.

☐ Chart 3 — G-CSF vs. ESA vs. TPO-RA: Cell line stimulated, indication, timing rules, and key nursing consideration or restriction.

Cornell Notes:

☐ Page 1 — Cue questions: How is ANC calculated, and what are the neutropenia, severe, and profound thresholds? When does the neutrophil nadir typically occur after chemotherapy?

☐ Page 2 — Cue questions: What are the exact diagnostic criteria for febrile neutropenia, and what are the first three nursing actions in order? What MASCC score identifies a low-risk patient?

☐ Page 3 — Cue questions: What are the laboratory hallmarks of DIC, and why does the patient bleed and clot at the same time? What is the pegfilgrastim timing rule relative to chemotherapy?

Week 8 — Part 8: Oncologic Emergencies

Difficulty: Heavy, High-Yield

What it covers:

• Structural emergencies: superior vena cava syndrome (SVCS), spinal cord compression (SCC), increased intracranial pressure, and cardiac tamponade (Beck's triad, pulsus paradoxus)

• Metabolic emergencies: hypercalcemia of malignancy (PTHrP), tumor lysis syndrome (Cairo-Bishop criteria), and SIADH (euvolemic hyponatremia)

• Septic emergencies, including neutropenic sepsis and Sepsis-3 criteria

• The pathophysiology linking each emergency to its underlying malignancy or treatment

• Priority nursing actions, pharmacologic and fluid strategies, and escalation criteria

• Patient and caregiver education on early warning signs requiring immediate reporting

Print: 1 Mind Map, 4 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first, completing the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read using the six-color Made Easy system. This Part is heavily Red; use Blue only for the underlying pathophysiology.

☐ Sort the emergencies into structural, metabolic, and septic before memorizing details, because the OCN tests your ability to recognize the category and act fast. Structural = SVCS, SCC, IICP, tamponade. Metabolic = hypercalcemia, TLS, SIADH.

☐ Memorize the signature recognition cues: SVCS = facial and upper-extremity edema worse when bending forward, with distended neck/chest veins; SCC = back pain plus new motor or sensory deficit (treat immediately to preserve function); cardiac tamponade = Beck's triad (hypotension, muffled heart sounds, JVD) plus pulsus paradoxus.

☐ Lock in tumor lysis syndrome. It follows rapid tumor cell death, most often in highly chemosensitive hematologic malignancies. Cairo-Bishop labs: high potassium, high phosphate, high uric acid, low calcium. Management centers on aggressive hydration and rasburicase or allopurinol.

☐ Pin down SIADH versus hypercalcemia as the two metabolic-sodium-and-calcium pictures: SIADH = euvolemic hyponatremia with concentrated urine; hypercalcemia of malignancy = calcium over 10.5, most often PTHrP-driven, treated with hydration and bisphosphonates.

☐ Review your Part 8 flashcards, then re-cycle missed cards from earlier Parts.

☐ Complete the Practice Questions for Part 8 in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Oncologic Emergencies. Main branches: Structural (SVCS, SCC, IICP, cardiac tamponade) → Metabolic (hypercalcemia/PTHrP, TLS/Cairo-Bishop, SIADH) → Septic (neutropenic sepsis, Sepsis-3) → Recognition Cues → Priority Nursing Actions → Patient Warning-Sign Education.

Comparison Charts:

☐ Chart 1 — Structural vs. Metabolic vs. Septic Emergencies: Defining mechanism, representative emergencies, hallmark presentation, and first nursing priority for each category.

☐ Chart 2 — SVCS vs. Spinal Cord Compression: Most common underlying cancer, classic signs, diagnostic step, and the time-sensitivity of intervention.

☐ Chart 3 — Tumor Lysis Syndrome vs. Hypercalcemia of Malignancy: Trigger, the four (TLS) or one (hypercalcemia) key lab abnormalities, mechanism, and first-line management.

☐ Chart 4 — Cardiac Tamponade vs. SIADH: Pathophysiology, hallmark findings (Beck's triad/pulsus paradoxus vs. euvolemic hyponatremia), diagnostic clue, and intervention.

Cornell Notes:

☐ Page 1 — Cue questions: How do you sort the major oncologic emergencies into structural, metabolic, and septic? What is the classic presentation and most common cause of SVCS?

☐ Page 2 — Cue questions: What are the Cairo-Bishop laboratory criteria for tumor lysis syndrome, and what is the cornerstone of management? What distinguishes the sodium picture of SIADH from a normal patient?

☐ Page 3 — Cue questions: What are the three components of Beck's triad and the definition of pulsus paradoxus? Why is spinal cord compression an emergency, and what is the priority nursing action?

Week 9 — Part 9: Disease-Specific Oncology Nursing

Difficulty: Heavy

• What it covers:

• Breast cancer subtypes (HR+, HER2+, TNBC), targeted treatments, and nursing priorities (lymphedema, trastuzumab cardiac monitoring, tamoxifen and AI toxicities, BRCA counseling)

• Lung cancer (NSCLC vs. SCLC), driver mutations (EGFR, ALK, ROS1, KRAS), and biomarker-directed therapy

• Colorectal cancer and Lynch syndrome, prostate cancer (PSA, androgen deprivation therapy), and gynecologic cancers (FIGO staging)

• Hematologic malignancies: leukemia (blast crisis), lymphoma (Reed-Sternberg cells), and multiple myeloma (CRAB criteria, M-protein)

• CNS tumors including glioblastoma and the Stupp protocol

• Pediatric oncology: family-centered care, common childhood cancers, and late effects

Print: 1 Mind Map, 4 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first, completing the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read using the six-color Made Easy system (Yellow for the targeted agents, Green for disease-specific nursing priorities, Blue for biomarkers and staging).

☐ Build a one-line card for each major cancer: subtype or biomarker, first-line targeted treatment, and the single most important nursing priority. For breast, anchor the three subtypes to their drivers (HR+ to endocrine therapy, HER2+ to trastuzumab with LVEF monitoring, TNBC to chemotherapy and PARP inhibitors if BRCA-mutated).

☐ Memorize the lung-cancer biomarker map: EGFR (osimertinib), ALK/ROS1 (alectinib, entrectinib), KRAS G12C (sotorasib), PD-L1 at or above 50% (pembrolizumab). Note SCLC gets platinum plus etoposide and prophylactic cranial irradiation for limited stage.

☐ Lock in the hematologic and myeloma mnemonics: Reed-Sternberg "owl-eye" cells signal Hodgkin lymphoma, blast crisis is over 20% blasts in CML transformation, and CRAB defines symptomatic myeloma (hyperCalcemia, Renal insufficiency, Anemia, Bone lesions) with M-protein monitored via SPEP/UPEP.

☐ Pin the pediatric late-effects list: anthracycline cardiomyopathy, cranial-radiation growth impairment and neurocognitive deficits, secondary malignancies, and infertility.

☐ Review your Part 9 flashcards, then re-cycle missed cards from earlier Parts.

☐ Complete the Practice Questions for Part 9 in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Disease-Specific Oncology Nursing. Main branches: Breast (HR+/HER2+/TNBC) → Lung (NSCLC/SCLC, biomarkers) → Colorectal (Lynch) → Prostate (PSA, ADT) → Gynecologic (FIGO) → Hematologic (leukemia/lymphoma/myeloma) → CNS (glioblastoma, Stupp) → Pediatric (late effects, family-centered care).

Comparison Charts:

☐ Chart 1 — Breast Cancer Subtypes (HR+/HER2−, HER2+, TNBC): Driver, first-line treatment, key targeted agents, and signature nursing monitoring.

☐ Chart 2 — NSCLC vs. SCLC: Frequency, behavior, biomarker-directed options, and the role of prophylactic cranial irradiation.

☐ Chart 3 — Leukemia vs. Lymphoma vs. Multiple Myeloma: Defining cell or marker (blasts, Reed-Sternberg, M-protein/CRAB), hallmark presentation, and a nursing priority for each.

☐ Chart 4 — Adult vs. Pediatric Oncology Nursing: Family-centered care emphasis, common tumor types, late-effects surveillance, and developmental considerations.

Cornell Notes:

☐ Page 1 — Cue questions: What are the three breast cancer subtypes by receptor status, and what is the first-line treatment and key monitoring for each? Which monoclonal antibody requires LVEF monitoring every three months?

☐ Page 2 — Cue questions: What is the lung cancer biomarker-to-drug map for EGFR, ALK/ROS1, KRAS G12C, and PD-L1? How does SCLC management differ from NSCLC?

☐ Page 3 — Cue questions: What do the Reed-Sternberg cell, blast crisis, and CRAB criteria each identify? What are four common late effects in childhood cancer survivors?

Week 10 — Part 10: Psychosocial & Supportive Care

Difficulty: Moderate

What it covers:

• Psychosocial assessment using validated tools (NCCN Distress Thermometer, PHQ-9, GAD-7, ESAS, FACT-G) and distress as the sixth vital sign

• Differentiating normal adjustment from anxiety disorders and major depression in oncology

• Body image and self-concept changes and evidence-based communication

• Caregiver burden and family support strategies

• Financial toxicity and resource navigation

• The Kubler-Ross stages of grief and distinguishing normal bereavement from complicated/prolonged grief

• Complementary and integrative therapies, safety and evidence, and advance care planning (advance directives, POLST, goals of care)

Print: 1 Mind Map, 2 Comparison Charts, 2 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first, completing the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read using the six-color Made Easy system. This Part is heavily Pink; use Green for the nurse's screening and referral actions.

☐ Memorize the screening cutoffs examiners use: NCCN Distress Thermometer score of 4 or above triggers referral; PHQ-9 of 10 to 14 is moderate depression; GAD-7 of 10 or above is moderate-to-severe anxiety. Note distress is screened as the sixth vital sign.

☐ Distinguish adjustment disorder from major depression. Adjustment disorder is the most common psychosocial diagnosis in oncology, proportionate but impairing, and resolves with the stressor. MDD requires two weeks of depressed mood or anhedonia, and the challenge is that somatic symptoms overlap with treatment side effects.

☐ Pin down the grief distinction: complicated/prolonged grief lasts beyond 12 months with persistent yearning and inability to re-engage, and requires specialist intervention, unlike normal bereavement.

☐ Learn the advance care planning hierarchy: an advance directive records wishes, while a POLST is a portable physician order for the seriously ill, and a goals-of-care conversation aligns care with the patient's values.

☐ Review your Part 10 flashcards, then re-cycle missed cards from earlier Parts.

☐ Complete the Practice Questions for Part 10 in your quiz bank. Review every rationale, correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Psychosocial & Supportive Care. Main branches: Psychosocial Assessment (Distress Thermometer, PHQ-9, GAD-7, ESAS, FACT-G) → Anxiety/Depression/Adjustment → Body Image & Self-Concept → Caregiver Burden → Financial Toxicity → Grief & Bereavement (Kubler-Ross, complicated grief) → Integrative Oncology → Advance Care Planning (advance directive, POLST, goals of care).

Comparison Charts:

☐ Chart 1 — Adjustment Disorder vs. Major Depressive Disorder: Trigger, proportionality, duration, the somatic-symptom overlap challenge, and treatment approach.

☐ Chart 2 — Advance Directive vs. POLST: Legal nature (directive vs. medical order), who signs, the appropriate patient population, and what each documents.

Cornell Notes:

☐ Page 1 — Cue questions: What are the referral cutoffs for the NCCN Distress Thermometer, PHQ-9, and GAD-7? Why is screening for depression in oncology complicated by somatic symptoms?

☐ Page 2 — Cue questions: How does complicated grief differ from normal bereavement, and when is specialist referral indicated? What is the difference between an advance directive and a POLST?

Week 11 — Full Review & Exam Simulation

Your final week is not about learning new material, it is about consolidating everything you have built and proving it under exam conditions.

Review Tasks

☐ Re-draw one Mind Map from memory for each Part you feel least confident about. Check it against your original.

☐ Work through your Cornell Notes cue columns for every Part, covering the right-hand notes and answering from memory.

☐ Do a full flashcard pass across all ten Parts, prioritizing every card you have ever missed.

☐ Re-do any quiz bank questions you got wrong across all Parts. Focus on the rationales.

☐ Review the Rapid Review and Self-Assessment sections for your two or three weakest Parts.

Exam Simulation

☐ Take the full-length OCN practice exam using the QR code in the back matter of this book. Complete it in one sitting, timed, as close to real exam conditions as possible.

☐ Review your emailed score report. Identify which Parts you missed most and spend your remaining time on those Parts' Rapid Review and clinical scenarios only.