AOCNP Advanced oncology nurse practitioner
certification emphasizing diagnosis, treatment
planning, and management of cancer patients.
Question 1
A 48-year-old woman with a family history of breast cancer (mother diagnosed at
age 44, sister diagnosed at age 38) is referred for genetic counseling. Which of the
following is the MOST appropriate recommendation for hereditary cancer risk
assessment?
A. BRCA1/BRCA2 genetic testing only if she has Ashkenazi Jewish ancestry
B. Multigene panel testing that includes BRCA1/BRCA2, PALB2, and CHEK2
C. Annual mammography starting at age 50 only
D. BRCA1/BRCA2 testing followed by prophylactic mastectomy regardless of
results
Answer: B. Multigene panel testing that includes BRCA1/BRCA2, PALB2,
and CHEK2
Rationale: For a patient with a strong family history of breast cancer meeting
criteria for hereditary breast and ovarian cancer syndrome, multigene panel testing
is preferred over BRCA testing alone. This allows identification of mutations in
other high-risk genes (PALB2, CHEK2, ATM, etc.) that may influence
management. Genetic testing should be offered regardless of ancestry, and results
guide individualized risk management rather than mandating prophylactic surgery.
Question 2
A 62-year-old patient with a 40-pack-year smoking history presents for a wellness
visit. According to current lung cancer screening guidelines, which of the
following is the MOST appropriate recommendation?
A. Annual chest X-ray
B. Low-dose computed tomography (LDCT) annually
C. Sputum cytology every 6 months
D. No screening is indicated at this time
,Answer: B. Low-dose computed tomography (LDCT) annually
Rationale: Annual LDCT screening is recommended for individuals aged 50-80
years with a ≥20 pack-year smoking history who currently smoke or have quit
within the past 15 years. This patient meets the criteria. Chest X-ray and sputum
cytology are not recommended for lung cancer screening. LDCT has been shown
to reduce lung cancer mortality in high-risk populations.
Question 3
A 45-year-old patient of average risk presents for colorectal cancer screening.
Which of the following is the MOST appropriate screening recommendation
according to current guidelines?
A. Colonoscopy every 10 years starting at age 45
B. Fecal immunochemical test (FIT) annually starting at age 50
C. Colonoscopy every 5 years starting at age 45
D. Carcinoembryonic antigen (CEA) blood test annually
Answer: A. Colonoscopy every 10 years starting at age 45
Rationale: Current guidelines recommend colorectal cancer screening beginning
at age 45 for average-risk individuals. Colonoscopy every 10 years is the preferred
screening modality. FIT annually is an alternative but typically recommended
starting at age 45. CEA is a tumor marker used for monitoring known colorectal
cancer, not for screening.
Question 4
A patient is diagnosed with stage IIA breast cancer (T2N0M0). The pathology
report shows estrogen receptor-positive (ER+), progesterone receptor-positive
(PR+), HER2-negative status. The APRN should recommend which of the
following as the INITIAL treatment approach?
A. Neoadjuvant chemotherapy followed by surgery
B. Surgery (breast-conserving surgery or mastectomy) with sentinel lymph node
biopsy
C. Adjuvant trastuzumab and chemotherapy
D. Palliative radiation therapy only
,Answer: B. Surgery (breast-conserving surgery or mastectomy) with sentinel
lymph node biopsy
Rationale: For early-stage, hormone receptor-positive, HER2-negative breast
cancer, the initial treatment is surgical resection with sentinel lymph node biopsy.
Adjuvant systemic therapy (endocrine therapy, possibly chemotherapy) is
determined based on genomic testing (e.g., Oncotype DX) and clinical factors.
Neoadjuvant therapy is not typically first-line for this presentation. Trastuzumab is
not indicated for HER2-negative disease.
Question 5
A patient with newly diagnosed non-small cell lung cancer (NSCLC) is found to
have an EGFR exon 19 deletion mutation. Which of the following targeted
therapies is MOST appropriate as first-line treatment?
A. Pembrolizumab
B. Osimertinib
C. Crizotinib
D. Carboplatin and pemetrexed
Answer: B. Osimertinib
Rationale: Osimertinib is a third-generation EGFR tyrosine kinase inhibitor (TKI)
and is the preferred first-line treatment for patients with EGFR-mutant NSCLC
(exon 19 deletion or L858R mutation). It has demonstrated superior efficacy and
CNS penetration compared to earlier-generation TKIs. Pembrolizumab is for PD-
L1-positive tumors without targetable mutations. Crizotinib is for ALK
rearrangements.
Question 6
A 52-year-old patient with metastatic colon cancer is found to have a KRAS exon
2 mutation. Which of the following therapies would be INEFFECTIVE and should
be avoided?
A. FOLFOX chemotherapy
B. Cetuximab
C. Bevacizumab
D. FOLFIRI chemotherapy
, Answer: B. Cetuximab
Rationale: Cetuximab is an EGFR inhibitor that is ineffective in patients with
KRAS (exon 2, 3, 4) or NRAS mutations. These mutations confer primary
resistance to anti-EGFR therapies. FOLFOX, FOLFIRI, and bevacizumab (anti-
VEGF) remain effective options regardless of KRAS status. Molecular testing is
essential before initiating anti-EGFR therapy in colorectal cancer.
Question 7
A patient is diagnosed with stage III melanoma. The APRN should order which of
the following tests to guide further treatment decisions?
A. BRAF V600 mutation testing
B. CA-125 level
C. Alpha-fetoprotein (AFP) level
D. Human chorionic gonadotropin (hCG) level
Answer: A. BRAF V600 mutation testing
Rationale: BRAF V600 mutations are present in approximately 50% of
melanomas and predict response to BRAF/MEK targeted therapy. Testing is
essential for treatment planning in stage III and IV melanoma. CA-125 is used for
ovarian cancer monitoring, AFP for hepatocellular carcinoma, and hCG for germ
cell tumors.
Question 8
A 55-year-old woman presents with postmenopausal bleeding. Transvaginal
ultrasound reveals an endometrial thickness of 12 mm. Which of the following is
the MOST appropriate next step?
A. Endometrial biopsy
B. Repeat transvaginal ultrasound in 3 months
C. Hysterectomy
D. Observation with annual follow-up
Answer: A. Endometrial biopsy
Rationale: Postmenopausal bleeding with endometrial thickness >4-5 mm requires
tissue sampling. An endometrial thickness of 12 mm is abnormal and warrants
certification emphasizing diagnosis, treatment
planning, and management of cancer patients.
Question 1
A 48-year-old woman with a family history of breast cancer (mother diagnosed at
age 44, sister diagnosed at age 38) is referred for genetic counseling. Which of the
following is the MOST appropriate recommendation for hereditary cancer risk
assessment?
A. BRCA1/BRCA2 genetic testing only if she has Ashkenazi Jewish ancestry
B. Multigene panel testing that includes BRCA1/BRCA2, PALB2, and CHEK2
C. Annual mammography starting at age 50 only
D. BRCA1/BRCA2 testing followed by prophylactic mastectomy regardless of
results
Answer: B. Multigene panel testing that includes BRCA1/BRCA2, PALB2,
and CHEK2
Rationale: For a patient with a strong family history of breast cancer meeting
criteria for hereditary breast and ovarian cancer syndrome, multigene panel testing
is preferred over BRCA testing alone. This allows identification of mutations in
other high-risk genes (PALB2, CHEK2, ATM, etc.) that may influence
management. Genetic testing should be offered regardless of ancestry, and results
guide individualized risk management rather than mandating prophylactic surgery.
Question 2
A 62-year-old patient with a 40-pack-year smoking history presents for a wellness
visit. According to current lung cancer screening guidelines, which of the
following is the MOST appropriate recommendation?
A. Annual chest X-ray
B. Low-dose computed tomography (LDCT) annually
C. Sputum cytology every 6 months
D. No screening is indicated at this time
,Answer: B. Low-dose computed tomography (LDCT) annually
Rationale: Annual LDCT screening is recommended for individuals aged 50-80
years with a ≥20 pack-year smoking history who currently smoke or have quit
within the past 15 years. This patient meets the criteria. Chest X-ray and sputum
cytology are not recommended for lung cancer screening. LDCT has been shown
to reduce lung cancer mortality in high-risk populations.
Question 3
A 45-year-old patient of average risk presents for colorectal cancer screening.
Which of the following is the MOST appropriate screening recommendation
according to current guidelines?
A. Colonoscopy every 10 years starting at age 45
B. Fecal immunochemical test (FIT) annually starting at age 50
C. Colonoscopy every 5 years starting at age 45
D. Carcinoembryonic antigen (CEA) blood test annually
Answer: A. Colonoscopy every 10 years starting at age 45
Rationale: Current guidelines recommend colorectal cancer screening beginning
at age 45 for average-risk individuals. Colonoscopy every 10 years is the preferred
screening modality. FIT annually is an alternative but typically recommended
starting at age 45. CEA is a tumor marker used for monitoring known colorectal
cancer, not for screening.
Question 4
A patient is diagnosed with stage IIA breast cancer (T2N0M0). The pathology
report shows estrogen receptor-positive (ER+), progesterone receptor-positive
(PR+), HER2-negative status. The APRN should recommend which of the
following as the INITIAL treatment approach?
A. Neoadjuvant chemotherapy followed by surgery
B. Surgery (breast-conserving surgery or mastectomy) with sentinel lymph node
biopsy
C. Adjuvant trastuzumab and chemotherapy
D. Palliative radiation therapy only
,Answer: B. Surgery (breast-conserving surgery or mastectomy) with sentinel
lymph node biopsy
Rationale: For early-stage, hormone receptor-positive, HER2-negative breast
cancer, the initial treatment is surgical resection with sentinel lymph node biopsy.
Adjuvant systemic therapy (endocrine therapy, possibly chemotherapy) is
determined based on genomic testing (e.g., Oncotype DX) and clinical factors.
Neoadjuvant therapy is not typically first-line for this presentation. Trastuzumab is
not indicated for HER2-negative disease.
Question 5
A patient with newly diagnosed non-small cell lung cancer (NSCLC) is found to
have an EGFR exon 19 deletion mutation. Which of the following targeted
therapies is MOST appropriate as first-line treatment?
A. Pembrolizumab
B. Osimertinib
C. Crizotinib
D. Carboplatin and pemetrexed
Answer: B. Osimertinib
Rationale: Osimertinib is a third-generation EGFR tyrosine kinase inhibitor (TKI)
and is the preferred first-line treatment for patients with EGFR-mutant NSCLC
(exon 19 deletion or L858R mutation). It has demonstrated superior efficacy and
CNS penetration compared to earlier-generation TKIs. Pembrolizumab is for PD-
L1-positive tumors without targetable mutations. Crizotinib is for ALK
rearrangements.
Question 6
A 52-year-old patient with metastatic colon cancer is found to have a KRAS exon
2 mutation. Which of the following therapies would be INEFFECTIVE and should
be avoided?
A. FOLFOX chemotherapy
B. Cetuximab
C. Bevacizumab
D. FOLFIRI chemotherapy
, Answer: B. Cetuximab
Rationale: Cetuximab is an EGFR inhibitor that is ineffective in patients with
KRAS (exon 2, 3, 4) or NRAS mutations. These mutations confer primary
resistance to anti-EGFR therapies. FOLFOX, FOLFIRI, and bevacizumab (anti-
VEGF) remain effective options regardless of KRAS status. Molecular testing is
essential before initiating anti-EGFR therapy in colorectal cancer.
Question 7
A patient is diagnosed with stage III melanoma. The APRN should order which of
the following tests to guide further treatment decisions?
A. BRAF V600 mutation testing
B. CA-125 level
C. Alpha-fetoprotein (AFP) level
D. Human chorionic gonadotropin (hCG) level
Answer: A. BRAF V600 mutation testing
Rationale: BRAF V600 mutations are present in approximately 50% of
melanomas and predict response to BRAF/MEK targeted therapy. Testing is
essential for treatment planning in stage III and IV melanoma. CA-125 is used for
ovarian cancer monitoring, AFP for hepatocellular carcinoma, and hCG for germ
cell tumors.
Question 8
A 55-year-old woman presents with postmenopausal bleeding. Transvaginal
ultrasound reveals an endometrial thickness of 12 mm. Which of the following is
the MOST appropriate next step?
A. Endometrial biopsy
B. Repeat transvaginal ultrasound in 3 months
C. Hysterectomy
D. Observation with annual follow-up
Answer: A. Endometrial biopsy
Rationale: Postmenopausal bleeding with endometrial thickness >4-5 mm requires
tissue sampling. An endometrial thickness of 12 mm is abnormal and warrants
