ATI RN MEDICAL SURGICAL CANCER & ONCOLOGY
PRACTICE QUESTIONS 2026/2027 | Updated |
Correct Answers with Rationale | Pass Guaranteed -
A+ Graded
Section 1: Cancer Pathophysiology & Screening/Prevention (Q1-12)
Question 1 A 58-year-old client is diagnosed with colon cancer. The pathology
report states: "T3N1M0, moderately differentiated adenocarcinoma." Which
statement by the nurse demonstrates correct understanding of this staging?
A. The tumor has invaded through the muscularis propria into subserosa, with 1-3
positive regional lymph nodes, and no distant metastasis
B. The tumor is confined to the mucosa, with no lymph node involvement, and has
metastasized to the liver
C. The tumor is any size with distant metastasis to bone and more than 4 positive
lymph nodes
D. The tumor is in situ with extensive lymphovascular invasion and peritoneal spread
Rationale: T3 in colon cancer indicates invasion through the muscularis propria into
pericolorectal tissues/subserosa. N1 indicates 1-3 positive regional lymph nodes. M0
indicates no distant metastasis. "Moderately differentiated" refers to tumor grade
(how abnormal cells appear). Option B describes T1N0M1 which is contradictory.
Option C describes M1 disease. Option D describes in situ with metastasis which is
impossible. Correct Answer: A
Question 2 A nurse is reviewing tumor markers with a client recently diagnosed with
ovarian cancer. Which tumor marker is most specific for epithelial ovarian cancer
monitoring?
,A. CA 19-9
B. CA 125
C. AFP (alpha-fetoprotein)
D. PSA
Rationale: CA 125 is the primary tumor marker for epithelial ovarian cancer, used for
diagnosis monitoring, treatment response assessment, and recurrence detection. CA
19-9 is for pancreatic/GI cancers. AFP is for hepatocellular carcinoma and germ cell
tumors. PSA is for prostate cancer. Correct Answer: B
Question 3 A client asks the nurse about the USPSTF screening recommendation for
lung cancer. Which response is correct for a 62-year-old with a 35 pack-year smoking
history who quit 3 years ago?
A. Annual low-dose CT screening is recommended for adults aged 50-80 with a 20
pack-year history who currently smoke or quit within the past 15 years
B. Annual chest X-ray is the recommended screening modality
C. No screening is recommended because the client quit smoking
D. Screening begins at age 65 regardless of smoking history
Rationale: USPSTF 2021 lung cancer screening guidelines recommend annual low-
dose CT for adults 50-80 with ≥20 pack-year history who currently smoke or quit
within 15 years. This client (62 years, 35 pack-years, quit 3 years ago) meets criteria.
Chest X-ray (Option B) is insufficient. Option C is incorrect—quit within 15 years still
qualifies. Option D is incorrect—age alone does not determine eligibility. Correct
Answer: A
Question 4 A client with a family history of BRCA1 mutation asks about breast cancer
screening. Which recommendation is most appropriate?
A. Begin annual mammography at age 40 and consider breast MRI starting at age
25-30
B. Begin screening at age 50 with biennial mammography only
,C. No additional screening is needed beyond average-risk recommendations
D. BRCA1 carriers should undergo prophylactic mastectomy only, with no screening
Rationale: BRCA1 carriers have significantly elevated breast cancer risk. Guidelines
recommend enhanced screening beginning at age 25-30 with annual breast MRI plus
mammography (alternating every 6 months), or risk-reducing surgery. Option B
describes average-risk screening. Option C is incorrect—BRCA carriers require
enhanced surveillance. Option D is incorrect—screening is recommended even if
prophylactic surgery is deferred or in addition to surveillance. Correct Answer: A
Question 5 A nurse is teaching a client about the mechanism of carcinogenesis.
Which statement best describes the "two-hit hypothesis" for tumor suppressor
genes?
A. Both alleles of a tumor suppressor gene must be inactivated for cancer to develop
B. Only one mutated allele is needed to cause cancer
C. Tumor suppressor genes promote cell division when activated
D. The two-hit hypothesis applies only to oncogenes, not tumor suppressor genes
Rationale: The two-hit hypothesis (Knudson) states that both alleles of a tumor
suppressor gene (e.g., BRCA1, BRCA2, TP53, RB1) must be inactivated for cancer
development—unlike oncogenes where one mutated allele is sufficient. Option B
describes oncogenes. Option C is incorrect—tumor suppressor genes inhibit cell
division. Option D reverses the concept. Correct Answer: A
Question 6 A client is diagnosed with stage III colon cancer. Which characteristic best
defines stage III disease?
A. Tumor confined to mucosa and submucosa with no lymph node involvement
B. Tumor invasion through bowel wall with metastasis to distant organs
C. Tumor invasion into or through bowel wall with positive regional lymph nodes but
no distant metastasis
D. Tumor of any size with distant metastasis to liver and lungs
, Rationale: Stage III colon cancer is defined by regional lymph node involvement
(N1-N2) without distant metastasis (M0), regardless of T stage. Option A describes
stage I. Option B describes stage IV. Option D describes stage IV with distant
metastasis. Correct Answer: C
Question 7 A nurse is counseling a client about HPV vaccination for cancer
prevention. Which cancers are primarily prevented by the 9-valent HPV vaccine?
A. Breast, ovarian, and uterine cancers
B. Cervical, anal, oropharyngeal, vulvar, vaginal, and penile cancers
C. Lung, colon, and pancreatic cancers
D. Skin melanoma and basal cell carcinoma
Rationale: The 9-valent HPV vaccine prevents cancers caused by HPV types 6, 11, 16,
18, 31, 33, 45, 52, and 58, including cervical, anal, oropharyngeal, vulvar, vaginal, and
penile cancers. It does not prevent breast, lung, colon, pancreatic, or skin cancers.
Correct Answer: B
Question 8 A client with a history of ulcerative colitis asks about colon cancer risk.
Which statement by the nurse is correct?
A. Ulcerative colitis does not increase colon cancer risk
B. Colon cancer risk begins to increase significantly after 8-10 years of disease
duration, requiring surveillance colonoscopy every 1-2 years
C. Colon cancer screening should begin at age 50 regardless of disease duration
D. Only clients with Crohn's disease have increased colon cancer risk
Rationale: Ulcerative colitis (and Crohn's colitis) increases colon cancer risk after 8-
10 years of disease due to chronic inflammation. Surveillance colonoscopy with
random biopsies every 1-2 years is recommended beginning at 8 years post-
diagnosis. Option A is incorrect. Option C describes average-risk screening. Option D
is incorrect—both conditions increase risk. Correct Answer: B
PRACTICE QUESTIONS 2026/2027 | Updated |
Correct Answers with Rationale | Pass Guaranteed -
A+ Graded
Section 1: Cancer Pathophysiology & Screening/Prevention (Q1-12)
Question 1 A 58-year-old client is diagnosed with colon cancer. The pathology
report states: "T3N1M0, moderately differentiated adenocarcinoma." Which
statement by the nurse demonstrates correct understanding of this staging?
A. The tumor has invaded through the muscularis propria into subserosa, with 1-3
positive regional lymph nodes, and no distant metastasis
B. The tumor is confined to the mucosa, with no lymph node involvement, and has
metastasized to the liver
C. The tumor is any size with distant metastasis to bone and more than 4 positive
lymph nodes
D. The tumor is in situ with extensive lymphovascular invasion and peritoneal spread
Rationale: T3 in colon cancer indicates invasion through the muscularis propria into
pericolorectal tissues/subserosa. N1 indicates 1-3 positive regional lymph nodes. M0
indicates no distant metastasis. "Moderately differentiated" refers to tumor grade
(how abnormal cells appear). Option B describes T1N0M1 which is contradictory.
Option C describes M1 disease. Option D describes in situ with metastasis which is
impossible. Correct Answer: A
Question 2 A nurse is reviewing tumor markers with a client recently diagnosed with
ovarian cancer. Which tumor marker is most specific for epithelial ovarian cancer
monitoring?
,A. CA 19-9
B. CA 125
C. AFP (alpha-fetoprotein)
D. PSA
Rationale: CA 125 is the primary tumor marker for epithelial ovarian cancer, used for
diagnosis monitoring, treatment response assessment, and recurrence detection. CA
19-9 is for pancreatic/GI cancers. AFP is for hepatocellular carcinoma and germ cell
tumors. PSA is for prostate cancer. Correct Answer: B
Question 3 A client asks the nurse about the USPSTF screening recommendation for
lung cancer. Which response is correct for a 62-year-old with a 35 pack-year smoking
history who quit 3 years ago?
A. Annual low-dose CT screening is recommended for adults aged 50-80 with a 20
pack-year history who currently smoke or quit within the past 15 years
B. Annual chest X-ray is the recommended screening modality
C. No screening is recommended because the client quit smoking
D. Screening begins at age 65 regardless of smoking history
Rationale: USPSTF 2021 lung cancer screening guidelines recommend annual low-
dose CT for adults 50-80 with ≥20 pack-year history who currently smoke or quit
within 15 years. This client (62 years, 35 pack-years, quit 3 years ago) meets criteria.
Chest X-ray (Option B) is insufficient. Option C is incorrect—quit within 15 years still
qualifies. Option D is incorrect—age alone does not determine eligibility. Correct
Answer: A
Question 4 A client with a family history of BRCA1 mutation asks about breast cancer
screening. Which recommendation is most appropriate?
A. Begin annual mammography at age 40 and consider breast MRI starting at age
25-30
B. Begin screening at age 50 with biennial mammography only
,C. No additional screening is needed beyond average-risk recommendations
D. BRCA1 carriers should undergo prophylactic mastectomy only, with no screening
Rationale: BRCA1 carriers have significantly elevated breast cancer risk. Guidelines
recommend enhanced screening beginning at age 25-30 with annual breast MRI plus
mammography (alternating every 6 months), or risk-reducing surgery. Option B
describes average-risk screening. Option C is incorrect—BRCA carriers require
enhanced surveillance. Option D is incorrect—screening is recommended even if
prophylactic surgery is deferred or in addition to surveillance. Correct Answer: A
Question 5 A nurse is teaching a client about the mechanism of carcinogenesis.
Which statement best describes the "two-hit hypothesis" for tumor suppressor
genes?
A. Both alleles of a tumor suppressor gene must be inactivated for cancer to develop
B. Only one mutated allele is needed to cause cancer
C. Tumor suppressor genes promote cell division when activated
D. The two-hit hypothesis applies only to oncogenes, not tumor suppressor genes
Rationale: The two-hit hypothesis (Knudson) states that both alleles of a tumor
suppressor gene (e.g., BRCA1, BRCA2, TP53, RB1) must be inactivated for cancer
development—unlike oncogenes where one mutated allele is sufficient. Option B
describes oncogenes. Option C is incorrect—tumor suppressor genes inhibit cell
division. Option D reverses the concept. Correct Answer: A
Question 6 A client is diagnosed with stage III colon cancer. Which characteristic best
defines stage III disease?
A. Tumor confined to mucosa and submucosa with no lymph node involvement
B. Tumor invasion through bowel wall with metastasis to distant organs
C. Tumor invasion into or through bowel wall with positive regional lymph nodes but
no distant metastasis
D. Tumor of any size with distant metastasis to liver and lungs
, Rationale: Stage III colon cancer is defined by regional lymph node involvement
(N1-N2) without distant metastasis (M0), regardless of T stage. Option A describes
stage I. Option B describes stage IV. Option D describes stage IV with distant
metastasis. Correct Answer: C
Question 7 A nurse is counseling a client about HPV vaccination for cancer
prevention. Which cancers are primarily prevented by the 9-valent HPV vaccine?
A. Breast, ovarian, and uterine cancers
B. Cervical, anal, oropharyngeal, vulvar, vaginal, and penile cancers
C. Lung, colon, and pancreatic cancers
D. Skin melanoma and basal cell carcinoma
Rationale: The 9-valent HPV vaccine prevents cancers caused by HPV types 6, 11, 16,
18, 31, 33, 45, 52, and 58, including cervical, anal, oropharyngeal, vulvar, vaginal, and
penile cancers. It does not prevent breast, lung, colon, pancreatic, or skin cancers.
Correct Answer: B
Question 8 A client with a history of ulcerative colitis asks about colon cancer risk.
Which statement by the nurse is correct?
A. Ulcerative colitis does not increase colon cancer risk
B. Colon cancer risk begins to increase significantly after 8-10 years of disease
duration, requiring surveillance colonoscopy every 1-2 years
C. Colon cancer screening should begin at age 50 regardless of disease duration
D. Only clients with Crohn's disease have increased colon cancer risk
Rationale: Ulcerative colitis (and Crohn's colitis) increases colon cancer risk after 8-
10 years of disease due to chronic inflammation. Surveillance colonoscopy with
random biopsies every 1-2 years is recommended beginning at 8 years post-
diagnosis. Option A is incorrect. Option C describes average-risk screening. Option D
is incorrect—both conditions increase risk. Correct Answer: B
