ADVANCED ONCOLOGY CERTIFIED
NURSE PRACTITIONER (AOCNP)
PRACTICE EXAM QUESTIONS AND
ANSWERS
1. A patient with metastatic non-small cell lung cancer (NSCLC) progresses on first-line
osimertinib. Which molecular resistance mechanism is most likely to be identified upon re-
biopsy?
A. T790M mutation
B. MET amplification
C. KRAS G12C mutation
D. EGFR C797S mutation
Answer: D
Conceptual Explanation: Osimertinib is a third-generation EGFR TKI. While T790M is a
resistance mechanism for first-generation TKIs, C797S is the most common tertiary
mutation mediating resistance to third-generation TKIs in the ATP-binding site.
,2. In the management of Grade 3 Immune-related Adverse Events (irAEs) secondary to
pembrolizumab, what is the recommended first-line intervention?
A. Immediate permanent discontinuation and observation
B. Administer prophylactic infliximab before the next dose
C. Switch to an alternative checkpoint inhibitor class
D. Hold immunotherapy and initiate high-dose corticosteroids (1-2 mg/kg/day)
Answer: D
Conceptual Explanation: For Grade 3 toxicities, current ASCO/NCCN guidelines
recommend holding the immunotherapy and initiating high-dose systemic corticosteroids,
tapering over at least 4-6 weeks.
3. Which pharmacogenetic marker is associated with an increased risk of severe, life-
threatening toxicity (diarrhea and neutropenia) when administering irinotecan?
A. DPYD*2A
B. TPMT
C. CYP2D6 *4
D. UGT1A1*28
Answer: D
, Conceptual Explanation: Polymorphisms in the UGT1A1 gene (specifically the *28 allele)
lead to reduced glucuronidation of SN-38, the active metabolite of irinotecan, increasing
the risk of severe toxicity.
4. A patient with breast cancer is undergoing treatment with trastuzumab. Which monitoring
parameter is most critical to prevent long-term morbidity?
A. Serum Creatinine
B. Liver Function Tests
C. Pulmonary Function Tests
D. Left Ventricular Ejection Fraction (LVEF)
Answer: D
Conceptual Explanation: HER2-targeted therapies like trastuzumab are associated with
cardiotoxicity, typically manifested as an asymptomatic decrease in LVEF. Periodic cardiac
monitoring is essential.
5. According to the MASCC risk index, which score indicates a ‘low-risk’ patient with febrile
neutropenia who might be eligible for outpatient management?
A. < 15
B. >= 21
C. 15-20
D. Exactly 10
NURSE PRACTITIONER (AOCNP)
PRACTICE EXAM QUESTIONS AND
ANSWERS
1. A patient with metastatic non-small cell lung cancer (NSCLC) progresses on first-line
osimertinib. Which molecular resistance mechanism is most likely to be identified upon re-
biopsy?
A. T790M mutation
B. MET amplification
C. KRAS G12C mutation
D. EGFR C797S mutation
Answer: D
Conceptual Explanation: Osimertinib is a third-generation EGFR TKI. While T790M is a
resistance mechanism for first-generation TKIs, C797S is the most common tertiary
mutation mediating resistance to third-generation TKIs in the ATP-binding site.
,2. In the management of Grade 3 Immune-related Adverse Events (irAEs) secondary to
pembrolizumab, what is the recommended first-line intervention?
A. Immediate permanent discontinuation and observation
B. Administer prophylactic infliximab before the next dose
C. Switch to an alternative checkpoint inhibitor class
D. Hold immunotherapy and initiate high-dose corticosteroids (1-2 mg/kg/day)
Answer: D
Conceptual Explanation: For Grade 3 toxicities, current ASCO/NCCN guidelines
recommend holding the immunotherapy and initiating high-dose systemic corticosteroids,
tapering over at least 4-6 weeks.
3. Which pharmacogenetic marker is associated with an increased risk of severe, life-
threatening toxicity (diarrhea and neutropenia) when administering irinotecan?
A. DPYD*2A
B. TPMT
C. CYP2D6 *4
D. UGT1A1*28
Answer: D
, Conceptual Explanation: Polymorphisms in the UGT1A1 gene (specifically the *28 allele)
lead to reduced glucuronidation of SN-38, the active metabolite of irinotecan, increasing
the risk of severe toxicity.
4. A patient with breast cancer is undergoing treatment with trastuzumab. Which monitoring
parameter is most critical to prevent long-term morbidity?
A. Serum Creatinine
B. Liver Function Tests
C. Pulmonary Function Tests
D. Left Ventricular Ejection Fraction (LVEF)
Answer: D
Conceptual Explanation: HER2-targeted therapies like trastuzumab are associated with
cardiotoxicity, typically manifested as an asymptomatic decrease in LVEF. Periodic cardiac
monitoring is essential.
5. According to the MASCC risk index, which score indicates a ‘low-risk’ patient with febrile
neutropenia who might be eligible for outpatient management?
A. < 15
B. >= 21
C. 15-20
D. Exactly 10
