Patient Care: Patient and Medical Record Management (9.5%)

ARRT-T · 29 questions

• A patient midway through a pelvic course reports looser stools and cramping at every visit and has been drinking less water because of the urgency. The symptoms have intensified over the past few days, and the radiation oncologist reviews the chart after the day's treatments are finished. How should this worsening bowel side effect be managed and recorded?
• The record-and-verify printout for a 30-fraction course already documents the prescribed dose, the daily fraction, the beam energy and the treated field arrangement for every session. During a documentation audit, the supervisor notes that how the patient was placed still has no per-fraction entry. Which treatment-record element should be added to each session's documentation?
• Before a patient's first fraction, the therapist reviews a lung cancer chart containing a chest CT describing a peripheral nodule, a bronchoscopic biopsy identifying adenocarcinoma, a PET report showing no uptake outside the chest, and surgical pathology reporting negative margins with every sampled lymph node negative. Which statement correctly attributes each finding to the report that establishes it?
• A patient in week three of pelvic radiation reports loose, crampy stools after meals and looser clothing at the weekly check-in. The nurse asks you to reinforce nutrition advice while the assessment note is open. Which dietary counseling point best controls the symptom pattern and protects the patient's weight?
• During simulation a patient mentions an aunt who had cancer, notes that she herself has never had a screening test, then asks what her family history means for her own risk. Which explanation of cancer risk factors and screening should the therapist give at this point?
• At the end of an evening shift, the therapist realizes one patient's treatment was delivered but was missing from the day's charge log, so the billing count is short by one session. Under the routine charge-capture process, which documentation step should happen first to capture that charge for the date?
• Before treatment planning, a therapist reviews the operative and pathology reports for a patient with colon cancer. The report describes a 5 cm adenocarcinoma invading through the muscularis propria into pericolonic fat, lymphovascular invasion present, all surgical margins clear, and 3 of 16 lymph nodes positive for metastasis. Which finding in the pathology report documents regional nodal involvement for this plan?
• During a weekly chart check, the record already documents the patient identifier, date, machine, energy, and the treated field. The therapist must confirm that the number of treatments delivered matches the physician's order before the next session. Which pair of record entries should be checked to verify that?
• During a consultation, a patient whose mother and sister both had breast cancer asks why she was told to begin screening earlier than friends of the same age. You want to document the discussion accurately for the record. Which explanation of cancer risk factors fits her situation?
• Yesterday a linac fault stopped treatment partway through the fraction; the beam was restored under departmental policy and the remaining monitor units were delivered, but the treatment note says only that the fraction was completed. Which entry best documents this interrupted fraction?
• At the weekly review for a prostate cancer patient, the record shows a hemoglobin that has drifted down to 11.2 g/dL, normal white cell and platelet counts, normal kidney studies, and a PSA that has fallen from 14 to 5 ng/mL across the treatment course. The patient reports mild tiredness but is eating and drinking well. Which laboratory finding is most directly related to the prostate cancer burden?
• A patient in the fourth week of treatment to the chest has weeping, tender skin in the fold beneath the breast where two skin surfaces rub together. The course must continue daily, and the team also needs to know when this finding should reach the nurse. Which care plan best manages this treatment side effect?
• Under department policy, a treatment variance must be documented during the same shift with the event timing, dose delivered, and everyone notified. After a pelvis fraction, verification imaging shows the patient was misaligned during part of the beam-on time, and the physician and physicist are both reachable right now. Which entry satisfies the policy?
• A patient in week three of treatment to a regional site reports pink, dry, itchy skin limited to the marked treatment area, with no blisters or open areas. The therapist documents the skin assessment before today's fraction, and the physician has directed that treatment continue. Which assessment finding and management note should be recorded?
• Before a first fraction, a therapist reviews a new chart holding a history and physical describing a right breast mass with a suspicious axillary node, a mammography report noting a 2.8 cm spiculated mass, a bone scan showing one sclerotic rib lesion, and a core biopsy pathology report reading invasive ductal carcinoma. Which document should confirm the histology listed on the treatment record?
• During the monthly billing reconciliation at a busy radiation oncology clinic, a therapist notices that the charge-capture system posted a cone-beam CT charge for every fraction of the past week. Cone-beam CT was used only on the first and last fractions, while planar portal images were taken on the other days, as confirmed by the daily imaging notes. Which correction to the posted charges should be made before the batch is released?
• A patient on pelvic radiation reports more gas and cramping since the last visit. You review their food diary together, suggest smaller meals and fewer gas-forming foods, and answer questions about eating around treatment times. The note must show both what you assessed and what you taught for the next therapist. Which entry best documents this dietary counseling?
• A patient receiving pelvic radiation reports new bruising and nosebleeds that started this week. Today's CBC shows white cells 5.8, hemoglobin 11.2, and platelets 64. Which laboratory finding should drive the therapist's action before today's fraction is delivered?
• During a new-patient evaluation, a person who has smoked for decades but feels completely well asks what a screening test is for, and mentions a parent who had a different cancer. The clinic tailors prevention advice to each person's history. Which explanation of cancer risk factors and screening is accurate?
• Before today's fraction, a patient on concurrent chemotherapy and pelvic radiation has labs showing white cells down from last week, platelets unchanged, hemoglobin steady at the patient's usual baseline, and a normal BUN. The patient now reports a sore throat and chills. Which result should be escalated to the oncology team right away?
• At the end of an evening shift, a therapist checks the treatment area's charge report before the midnight billing cut-off. Three fractions were delivered and documented, but the report shows one fraction posted twice and one fraction missing. Which reconciliation step best resolves these charge-capture errors?
• A patient being treated for a head and neck tumour reports painful mouth sores at today's review, is drinking less than usual, and has lost weight since the last visit. Which action completes the on-treatment assessment before today's fraction?
• During a quarterly chart audit, a lead therapist finds several fractions that record only the date, treatment machine, dose delivered, and fraction number, while the signed prescription and plan sheet are filed separately. Which additional treatment details best complete the documentation for each fraction?
• During week three of pelvic treatment, a patient reports four loose stools a day, cramping, little appetite for solid food, and a dry mouth by late afternoon. The therapist is documenting the daily side effect assessment and wants guidance that fits this bowel reaction. Which dietary advice should be recorded and given to the patient?
• A patient on thoracic radiation reports painful swallowing and has begun skipping meals, so the therapist counsels briefly before the fraction. Guidance must maintain calories and fluids, avoid foods that irritate the raw throat, keep food temperature mild, and be recorded with any change reported to the nurse. Which dietary counseling plan meets all four requirements?
• While reconciling charts at the end of shift, you find a record showing a completed fraction, but you remember the beam stopped partway through and was re-delivered after an unplanned restart. Your department’s written policy requires documenting treatment variances in the record and filing a variance report before shift end. Which entry and reporting action follows that policy?
• In week four of pelvic chemoradiation, a patient reports dizziness when standing and new bruising on both arms. The blood work shows hemoglobin 9.0 g/dL, a white cell count of 3,100 per microliter, and platelets of 95,000 per microliter, with the BUN inside the lab's reference range. Which interpretation best accounts for both symptoms using these results?
• A patient returns for simulation after breast-conserving surgery. The operative note records titanium clips around the cavity, pathology reports a 2.6 cm tumor with clear margins, and the preoperative film lists a 12 o'clock lesion. Which record element should guide identification of the boost target volume on the planning CT?
• During a new-patient evaluation, a woman tells you that her mother and maternal aunt were both diagnosed with breast cancer in their forties, and she asks what that means for her. She reports feeling well today. Which statement about her family history and screening plan belongs in the evaluation record?