ATI RN MEDICAL SURGICAL: CANCER & ONCOLOGY
PRACTICE QUESTIONS
Updated for 2026/2027 | Correct Answers & Rationales
SECTION 1: Cancer Biology & Prevention (Questions 1-10)
Q1: A 52-year-old female with a strong family history of breast cancer (mother and
sister diagnosed pre-menopause) asks about her screening options. According to
NCCN 2026 guidelines, what is the recommended screening for her?
A. Annual clinical breast exam only
B. Annual mammography starting at age 40
C. Annual mammography and annual breast MRI starting now [CORRECT]
D. No screening until age 50, then biennial mammography
Correct Answer: C
Rationale: C is correct. [CORRECT] Guideline Application: NCCN 2026 guidelines
recommend enhanced screening with both annual mammogram and annual breast MRI
for women with a >20% lifetime risk of breast cancer, which is indicated by a first-degree
family history of pre-menopausal breast cancer in multiple relatives. This approach
increases early detection sensitivity through complementary imaging (MRI detects more
cancers in dense breast tissue). Screening should begin at age 30 or 10 years before
the youngest affected relative's diagnosis, whichever is earlier, but not before age 25.
Distractor Analysis:
, ● A: Clinical breast exam alone has poor sensitivity for early-stage detection and is
insufficient for high-risk patients.
● B: Mammography alone is appropriate for average-risk women; this patient's
genetic/familial risk profile requires enhanced surveillance.
● D: USPSTF biennial screening starting at 50 applies only to average-risk women;
delaying screening in this high-risk patient could miss early, curable disease.
Q2: A nurse is educating a community group about colorectal cancer prevention. Which
statement by a participant indicates understanding of primary prevention strategies?
A. "I should get a colonoscopy every 10 years starting at age 45."
B. "If I have polyps removed, I won't get colon cancer."
C. "Eating a diet high in fiber and low in red meat can reduce my risk of developing colon
cancer." [CORRECT]
D. "The fecal immunochemical test can detect cancer early."
Correct Answer: C
Rationale: C is correct. [CORRECT] Cancer Prevention Hierarchy: Primary prevention
aims to prevent cancer from occurring through risk reduction (lifestyle,
chemoprevention, vaccines). Dietary modification (high fiber, low red/processed meat)
reduces colorectal cancer incidence by 20-30% through mechanisms including reduced
intestinal transit time and decreased inflammation. Secondary prevention (options A, D)
involves early detection through screening. Tertiary prevention (option B) involves
preventing recurrence/progression.
Distractor Analysis:
● A/D: These describe secondary prevention (screening/early detection), not
primary prevention.
, ● B: Polypectomy prevents progression of existing lesions (secondary/tertiary
prevention), not primary prevention; also, not all polyps are precancerous, and
new polyps can form.
Q3 (SATA): Which factors are classified as carcinogens that increase cancer risk
through direct DNA damage? Select all that apply.
A. Tobacco smoke (polycyclic aromatic hydrocarbons) [CORRECT]
B. Ultraviolet B radiation [CORRECT]
C. Aflatoxin B1 (Aspergillus-contaminated food) [CORRECT]
D. Human papillomavirus (HPV) type 16
E. Ionizing radiation [CORRECT]
Correct Answer: A, B, C, E
Rationale: A, B, C, and E are correct. [CORRECT] Carcinogenesis Mechanisms: These are
direct-acting carcinogens or complete carcinogens that cause direct DNA damage
through formation of DNA adducts (A, C), thymine dimer formation (B), or double-strand
breaks (E). They do not require metabolic activation and act through genotoxic
mechanisms.
Why D is incorrect: HPV is an indirect-acting carcinogen (biological carcinogen). It
causes cancer through viral oncogene integration (E6, E7 proteins inactivating p53 and
Rb), not direct DNA damage. This is an epigenetic/epigenetic mechanism rather than
direct genotoxicity.
, Q4: A 45-year-old male with a 30-pack-year smoking history asks about lung cancer
screening. He is currently smoking and has no symptoms. According to the 2026
USPSTF guidelines, which recommendation is appropriate?
A. Annual low-dose CT (LDCT) screening [CORRECT]
B. Annual chest X-ray
C. Sputum cytology every 6 months
D. No screening recommended until age 50
Correct Answer: A
Rationale: A is correct. [CORRECT] Screening Guidelines: The 2026 USPSTF
recommends annual LDCT screening for adults aged 50-80 with ≥20 pack-year smoking
history who currently smoke or quit within the past 15 years. LDCT reduces lung cancer
mortality by 20% compared to chest X-ray through detection of early, resectable Stage I
disease. Screening should discontinue once a person has not smoked for 15 years or
develops health problems limiting life expectancy or curative treatment.
Distractor Analysis:
● B: Chest X-ray has poor sensitivity for early lung cancer and is not recommended
for screening.
● C: Sputum cytology has low sensitivity for peripheral lesions and is not a
screening tool.
● D: Age threshold was lowered to 50 in 2021 updates; this patient meets criteria.
Q5: A nurse is counseling a patient about chemoprevention for breast cancer risk
reduction. The patient has a 5-year projected breast cancer risk of 3.5% (Gail model)
and is postmenopausal. Which agent is FDA-approved for this indication?
PRACTICE QUESTIONS
Updated for 2026/2027 | Correct Answers & Rationales
SECTION 1: Cancer Biology & Prevention (Questions 1-10)
Q1: A 52-year-old female with a strong family history of breast cancer (mother and
sister diagnosed pre-menopause) asks about her screening options. According to
NCCN 2026 guidelines, what is the recommended screening for her?
A. Annual clinical breast exam only
B. Annual mammography starting at age 40
C. Annual mammography and annual breast MRI starting now [CORRECT]
D. No screening until age 50, then biennial mammography
Correct Answer: C
Rationale: C is correct. [CORRECT] Guideline Application: NCCN 2026 guidelines
recommend enhanced screening with both annual mammogram and annual breast MRI
for women with a >20% lifetime risk of breast cancer, which is indicated by a first-degree
family history of pre-menopausal breast cancer in multiple relatives. This approach
increases early detection sensitivity through complementary imaging (MRI detects more
cancers in dense breast tissue). Screening should begin at age 30 or 10 years before
the youngest affected relative's diagnosis, whichever is earlier, but not before age 25.
Distractor Analysis:
, ● A: Clinical breast exam alone has poor sensitivity for early-stage detection and is
insufficient for high-risk patients.
● B: Mammography alone is appropriate for average-risk women; this patient's
genetic/familial risk profile requires enhanced surveillance.
● D: USPSTF biennial screening starting at 50 applies only to average-risk women;
delaying screening in this high-risk patient could miss early, curable disease.
Q2: A nurse is educating a community group about colorectal cancer prevention. Which
statement by a participant indicates understanding of primary prevention strategies?
A. "I should get a colonoscopy every 10 years starting at age 45."
B. "If I have polyps removed, I won't get colon cancer."
C. "Eating a diet high in fiber and low in red meat can reduce my risk of developing colon
cancer." [CORRECT]
D. "The fecal immunochemical test can detect cancer early."
Correct Answer: C
Rationale: C is correct. [CORRECT] Cancer Prevention Hierarchy: Primary prevention
aims to prevent cancer from occurring through risk reduction (lifestyle,
chemoprevention, vaccines). Dietary modification (high fiber, low red/processed meat)
reduces colorectal cancer incidence by 20-30% through mechanisms including reduced
intestinal transit time and decreased inflammation. Secondary prevention (options A, D)
involves early detection through screening. Tertiary prevention (option B) involves
preventing recurrence/progression.
Distractor Analysis:
● A/D: These describe secondary prevention (screening/early detection), not
primary prevention.
, ● B: Polypectomy prevents progression of existing lesions (secondary/tertiary
prevention), not primary prevention; also, not all polyps are precancerous, and
new polyps can form.
Q3 (SATA): Which factors are classified as carcinogens that increase cancer risk
through direct DNA damage? Select all that apply.
A. Tobacco smoke (polycyclic aromatic hydrocarbons) [CORRECT]
B. Ultraviolet B radiation [CORRECT]
C. Aflatoxin B1 (Aspergillus-contaminated food) [CORRECT]
D. Human papillomavirus (HPV) type 16
E. Ionizing radiation [CORRECT]
Correct Answer: A, B, C, E
Rationale: A, B, C, and E are correct. [CORRECT] Carcinogenesis Mechanisms: These are
direct-acting carcinogens or complete carcinogens that cause direct DNA damage
through formation of DNA adducts (A, C), thymine dimer formation (B), or double-strand
breaks (E). They do not require metabolic activation and act through genotoxic
mechanisms.
Why D is incorrect: HPV is an indirect-acting carcinogen (biological carcinogen). It
causes cancer through viral oncogene integration (E6, E7 proteins inactivating p53 and
Rb), not direct DNA damage. This is an epigenetic/epigenetic mechanism rather than
direct genotoxicity.
, Q4: A 45-year-old male with a 30-pack-year smoking history asks about lung cancer
screening. He is currently smoking and has no symptoms. According to the 2026
USPSTF guidelines, which recommendation is appropriate?
A. Annual low-dose CT (LDCT) screening [CORRECT]
B. Annual chest X-ray
C. Sputum cytology every 6 months
D. No screening recommended until age 50
Correct Answer: A
Rationale: A is correct. [CORRECT] Screening Guidelines: The 2026 USPSTF
recommends annual LDCT screening for adults aged 50-80 with ≥20 pack-year smoking
history who currently smoke or quit within the past 15 years. LDCT reduces lung cancer
mortality by 20% compared to chest X-ray through detection of early, resectable Stage I
disease. Screening should discontinue once a person has not smoked for 15 years or
develops health problems limiting life expectancy or curative treatment.
Distractor Analysis:
● B: Chest X-ray has poor sensitivity for early lung cancer and is not recommended
for screening.
● C: Sputum cytology has low sensitivity for peripheral lesions and is not a
screening tool.
● D: Age threshold was lowered to 50 in 2021 updates; this patient meets criteria.
Q5: A nurse is counseling a patient about chemoprevention for breast cancer risk
reduction. The patient has a 5-year projected breast cancer risk of 3.5% (Gail model)
and is postmenopausal. Which agent is FDA-approved for this indication?
