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Post-treatment surveillance aims to detect resectable recurrence and metachronous neoplasia. Standard follow-up includes interval history/physical and CEA testing every 3–6 months for the first 2 years (highest recurrence risk), then every 6 months to year 5. Cross-sectional imaging (CT chest/abdomen/pelvis) is typically performed annually for at least 3 years (some programs use every 6–12 months for higher risk), tailored to comorbidity and relapse risk. PET/CT (Option A) is not routine due to cost and false positives; reserve for equivocal findings. Colonoscopy should be performed at 1 year post-resection (or 3–6 months if the pre-op colon was not fully visualized), then at 3 years, and every 5 years thereafter if normal—shorter intervals for advanced adenomas. Limiting CEA to symptoms (Option C) or omitting surveillance (Option D) misses opportunities for early, potentially curable recurrence. APRNs coordinate scheduling, reinforce symptom awareness (weight loss, pain, bowel habit change), ensure lifestyle counseling, and document a survivorship care plan shared with primary care.

Tumor lysis syndrome (TLS) risk is high with Burkitt lymphoma due to rapid cell turnover. Laboratory abnormalities here (hyperuricemia, hyperkalemia, hyperphosphatemia, rising creatinine) with oliguria indicate evolving TLS. Immediate management includes vigorous IV hydration to enhance renal clearance, rasburicase to rapidly degrade uric acid (preferred over allopurinol in high-risk or established TLS), strict electrolyte control (treat hyperkalemia, manage hyperphosphatemia with binders, avoid nephrotoxic agents), and continuous cardiac/telemetry monitoring. Avoid potassium and phosphate in IV fluids and diet. Allopurinol (Option A) prevents new uric acid formation but does not reduce existing levels promptly. Hemodialysis (Option C) is reserved for refractory electrolyte disturbances, persistent acidosis/uremia, or fluid overload despite optimal medical therapy. Fluid restriction (Option D) is inappropriate; careful hydration with monitoring of urine output and diuretics as needed is standard. Initiate cytoreduction once stabilized, and use established TLS criteria (Cairo-Bishop) to guide diagnosis and severity grading.

Smoking cessation improves treatment tolerance, reduces complications, and lowers recurrence and second primary risks in head and neck cancer. The most effective strategy pairs pharmacotherapy with behavioral support. Varenicline, a partial α4β2 nicotinic receptor agonist, demonstrates superior quit rates compared with bupropion or single-form NRT in many settings. Combining varenicline with structured counseling (individual or group), setting a quit date, addressing triggers, and scheduling proactive follow-ups enhances adherence and relapse prevention. E-cigarettes (Option C) are not first-line due to variable nicotine delivery and uncertain long-term safety; they may be considered harm reduction in select cases when approved therapies fail. Brief advice or PRN gum alone (Options A/D) yields lower sustained quit rates than combination approaches. APRNs should assess neuropsychiatric history, discuss common adverse effects (nausea, vivid dreams), consider combination NRT if varenicline is contraindicated or not tolerated, and integrate cessation plans into oncology pathways, leveraging institutional programs and quitlines for ongoing support.

ICI-related adrenal insufficiency (primary or central) is a time-sensitive emergency when hypotension, hyponatremia, hyperkalemia, and hypoglycemia coexist. Do not delay therapy for lab confirmation. Administer stress-dose corticosteroids—hydrocortisone 100 mg IV bolus followed by 50 mg IV every 6 hours (or continuous infusion)—plus rapid isotonic fluids and dextrose as needed. Draw cortisol and ACTH first if it won’t delay treatment; cosyntropin testing can occur later. Hold the checkpoint inhibitor during the acute phase. If primary adrenal failure is confirmed, add mineralocorticoid (fludrocortisone) after stabilization. Thyroid replacement must NOT precede glucocorticoid replacement (Option A) because it can precipitate adrenal crisis. Waiting for labs (Option B) risks shock. Sympathomimetics (midodrine) without steroids (Option D) ignore the pathophysiology. APRNs should educate patients on sick-day rules, provide a steroid card/bracelet, and coordinate endocrinology follow-up and a slow steroid taper once improved, while reassessing whether/when to resume ICI based on grade and response.

Primary prophylaxis with a long-acting granulocyte colony-stimulating factor (G-CSF), such as pegfilgrastim, is recommended when the overall risk of febrile neutropenia (FN) is ≥20% or when patient-specific risk factors (e.g., advanced age, comorbidities like diabetes, poor performance status, prior FN) elevate risk to a clinically meaningful threshold. Administering pegfilgrastim at least 24 hours after cytotoxic chemotherapy supports neutrophil recovery during the expected nadir without antagonizing cytotoxic effect. Waiting for ANC decline (Option C) fails to prevent first-cycle FN, which is associated with dose reductions, delays, hospitalizations, and mortality. Routine antibiotic prophylaxis (Option A) is not indicated for most solid-tumor regimens and carries risks of resistance and C. difficile. Deferring G-CSF until after an FN event (Option D) ignores clear indications for primary prophylaxis. APRNs should educate patients on FN symptoms, reinforce the importance of prompt reporting, and coordinate supportive pathways including vaccination, growth factor timing, and dose intensity preservation when clinically appropriate.