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Cancer care includes addressing sexual health proactively. The PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy) framework provides a structured, evidence-based pathway. Begin by normalizing the topic and inviting discussion (Permission). Offer targeted education about treatment-related changes (Limited Information). Provide Specific Suggestions: water- or silicone-based lubricants for intercourse, regular vaginal moisturizers, graded vaginal dilator use to prevent stenosis, pelvic floor physical therapy, and strategies for communication with partners. If symptoms persist or are complex (pain disorders, significant body-image distress), coordinate Intensive Therapy via sexual medicine, gynecology, or psycho-oncology. Reassurance alone (Option A) risks worsening dysfunction. Automatic systemic estrogen (Option C) is inappropriate without individualized risk assessment, especially in hormone-sensitive tumors. Advising abstinence (Option D) can exacerbate anxiety and relationship strain. The APRN should assess for contraindications to local estrogen, screen for depression/anxiety, address menopausal symptoms, and provide culturally sensitive resources, ensuring follow-up to evaluate response and adjust the plan.

Neutropenic enterocolitis (typhlitis) is an oncologic emergency characterized by fever, abdominal pain (often RLQ), and bowel wall thickening—classically of the cecum—during profound neutropenia. Mortality is driven by sepsis, perforation, and hemorrhage. Evidence-based initial care includes hospital admission; aggressive IV fluids; broad-spectrum IV antibiotics that cover gram-negatives (including Pseudomonas), gram-positives, and anaerobes (e.g., piperacillin–tazobactam or cefepime plus metronidazole; carbapenem alternatives); and bowel rest with careful GI decompression as needed. Early surgical consultation is indicated for peritonitis, perforation, uncontrolled bleeding, or clinical deterioration, but routine emergent surgery is not indicated. Oral outpatient therapy (Option A) is unsafe. Delaying antibiotics (Option D) invites rapid progression to septic shock. G-CSF may be considered to shorten neutropenia in selected patients but never replaces immediate antimicrobials. The APRN coordinates serial exams, labs (lactate, blood cultures), imaging if worsening, and supportive measures (analgesia avoiding opiates that mask peritoneal signs, VTE prophylaxis). Careful nutrition planning and antifungal coverage are considered in persistent fever after 4–7 days.

Anthracyclines and HER2-targeted agents carry well-known cardiotoxic risks. Standard practice is to obtain a baseline assessment of left ventricular ejection fraction (LVEF), typically via transthoracic echocardiography, and to schedule periodic monitoring during and after therapy—more frequently when sequential anthracycline → trastuzumab is planned and when patient risk factors exist (hypertension, obesity, age). BP optimization, avoidance of cumulative doxorubicin doses above accepted thresholds, and attention to other cardiometabolic risks reduce events. Cardio-oncology collaboration is useful if LVEF is borderline or cardiac biomarkers (troponin/NT-proBNP) are abnormal. Amiodarone (Option C) is not cardioprotective and introduces toxicity. Switching to pertuzumab (Option D) does not remove the need for trastuzumab in standard regimens and does not eliminate HER2-therapy cardiac risk. Proceeding with only ECG (Option A) fails to quantify systolic function. The APRN ensures informed consent regarding cardiac risk, coordinates imaging schedules, counsels on symptom reporting (dyspnea, edema), and facilitates rapid evaluation for suspected cardiomyopathy with timely treatment modification and guideline-directed cardiac care if dysfunction occurs.

Universal screening of all new colorectal cancers using mismatch repair (MMR) immunohistochemistry and/or microsatellite instability (MSI) testing identifies patients with possible Lynch syndrome and those with dMMR/MSI-H tumors that have prognostic and therapeutic significance. Absent or weak IHC staining (MLH1, MSH2, MSH6, PMS2) or MSI-H prompts further evaluation: MLH1 loss often requires BRAF or MLH1 promoter methylation testing to distinguish sporadic from hereditary; if hereditary is suspected, refer for germline testing/counseling. dMMR/MSI-H tumors may benefit from immune checkpoint inhibitors in advanced disease and have different adjuvant considerations. Limiting germline testing to family history (Option A) misses many carriers. KRAS alone (Option C) guides anti-EGFR therapy but not Lynch risk. Waiting until recurrence (Option D) delays critical familial risk reduction and potential treatment choices. The APRN coordinates pathology, genetics referral, informs relatives about cascade testing, and documents results in survivorship plans for ongoing care.

Tumor lysis syndrome causes hyperuricemia, hyperphosphatemia, secondary hypocalcemia, and AKI. The priorities are to protect the kidneys and prevent calcium phosphate precipitation. Immediate, high-rate isotonic IV fluids increase renal perfusion and solute clearance; diuretics are considered only after euvolemia is achieved and urine output is adequate. Rasburicase rapidly degrades existing uric acid and should be continued/initiated for elevated levels. Hyperphosphatemia is addressed with dietary restriction and non–calcium-based binders (e.g., sevelamer) to reduce intestinal phosphate absorption; adding calcium can worsen calcium phosphate deposition unless the patient has symptomatic hypocalcemia (tetany, seizures, arrhythmia). Routine urine alkalinization is no longer recommended because it can promote calcium phosphate crystallization and complicate rasburicase efficacy. Dialysis (hemodialysis or CRRT) is indicated for refractory electrolyte abnormalities, fluid overload, or worsening uremia despite medical care. APRN tasks include TLS order set activation, Q6–8h labs (K, Ca, Phos, uric acid, creatinine), telemetry, medication review to avoid nephrotoxins, and early nephrology consultation with clear thresholds for escalation.