AOCNP FINAL EXAM QUESTIONS WITH
VERIFIED ANSWERS
1. A 55-year-old female with a history of BRCA1 mutation presents for her annual screening.
Which of the following risk-reduction strategies offers the most significant reduction in breast
cancer incidence for this patient?
A. Bilateral prophylactic mastectomy
B. Annual breast MRI in addition to mammography
C. Bilateral salpingo-oophorectomy (BSO)
D. Chemoprevention with Tamoxifen
Answer: A
Conceptual Explanation: Bilateral prophylactic mastectomy reduces the risk of breast
cancer in BRCA1/2 mutation carriers by approximately 90-95%, which is the highest
reduction among the listed options. BSO reduces risk but to a lesser degree.
2. Which of the following laboratory findings is most characteristic of Tumor Lysis Syndrome
(TLS)?
A. Hypocalcemia, hyperkalemia, and hyperphosphatemia
,B. Hypercalcemia, hyperkalemia, and hypophosphatemia
C. Hypokalemia, hyponatremia, and hyperuricemia
D. Hypermagnesemia, hypocalcemia, and hyperuricemia
Answer: A
Conceptual Explanation: TLS is characterized by the release of intracellular contents,
leading to hyperkalemia, hyperphosphatemia, hyperuricemia, and secondary hypocalcemia
due to phosphorus binding to calcium.
3. An oncology nurse practitioner is managing a patient receiving pembrolizumab who
presents with Grade 2 diarrhea (4-6 stools per day above baseline). What is the most
appropriate initial management step?
A. Permanently discontinue pembrolizumab and start high-dose IV corticosteroids
B. Continue pembrolizumab and start Loperamide
C. Hold pembrolizumab and initiate oral corticosteroids (0.5-1 mg/kg/day)
D. Administer Infliximab immediately
Answer: C
Conceptual Explanation: According to ASCO/NCCN guidelines for immune-related
adverse events (irAEs), Grade 2 colitis/diarrhea requires holding the ICI and starting oral
corticosteroids. Grade 3-4 would require permanent discontinuation and potentially IV
steroids.
, 4. In the TNM staging system for lung cancer, a tumor that is 4 cm in size and involves the
main bronchus but is not involving the carina is classified as:
A. T1c
B. T2a
C. T3
D. T2b
Answer: D
Conceptual Explanation: T2b lung tumors are greater than 4 cm but less than or equal to
5 cm in greatest dimension. T2a is 3-4 cm. Involvement of the main bronchus regardless of
distance from carina (but not involving carina) is at least T2.
5. Which of the following agents is most likely to cause delayed nausea and vomiting
(occurring 24-120 hours after administration)?
A. Vincristine
B. Cyclophosphamide
C. Cisplatin
D. 5-Fluorouracil
Answer: C
VERIFIED ANSWERS
1. A 55-year-old female with a history of BRCA1 mutation presents for her annual screening.
Which of the following risk-reduction strategies offers the most significant reduction in breast
cancer incidence for this patient?
A. Bilateral prophylactic mastectomy
B. Annual breast MRI in addition to mammography
C. Bilateral salpingo-oophorectomy (BSO)
D. Chemoprevention with Tamoxifen
Answer: A
Conceptual Explanation: Bilateral prophylactic mastectomy reduces the risk of breast
cancer in BRCA1/2 mutation carriers by approximately 90-95%, which is the highest
reduction among the listed options. BSO reduces risk but to a lesser degree.
2. Which of the following laboratory findings is most characteristic of Tumor Lysis Syndrome
(TLS)?
A. Hypocalcemia, hyperkalemia, and hyperphosphatemia
,B. Hypercalcemia, hyperkalemia, and hypophosphatemia
C. Hypokalemia, hyponatremia, and hyperuricemia
D. Hypermagnesemia, hypocalcemia, and hyperuricemia
Answer: A
Conceptual Explanation: TLS is characterized by the release of intracellular contents,
leading to hyperkalemia, hyperphosphatemia, hyperuricemia, and secondary hypocalcemia
due to phosphorus binding to calcium.
3. An oncology nurse practitioner is managing a patient receiving pembrolizumab who
presents with Grade 2 diarrhea (4-6 stools per day above baseline). What is the most
appropriate initial management step?
A. Permanently discontinue pembrolizumab and start high-dose IV corticosteroids
B. Continue pembrolizumab and start Loperamide
C. Hold pembrolizumab and initiate oral corticosteroids (0.5-1 mg/kg/day)
D. Administer Infliximab immediately
Answer: C
Conceptual Explanation: According to ASCO/NCCN guidelines for immune-related
adverse events (irAEs), Grade 2 colitis/diarrhea requires holding the ICI and starting oral
corticosteroids. Grade 3-4 would require permanent discontinuation and potentially IV
steroids.
, 4. In the TNM staging system for lung cancer, a tumor that is 4 cm in size and involves the
main bronchus but is not involving the carina is classified as:
A. T1c
B. T2a
C. T3
D. T2b
Answer: D
Conceptual Explanation: T2b lung tumors are greater than 4 cm but less than or equal to
5 cm in greatest dimension. T2a is 3-4 cm. Involvement of the main bronchus regardless of
distance from carina (but not involving carina) is at least T2.
5. Which of the following agents is most likely to cause delayed nausea and vomiting
(occurring 24-120 hours after administration)?
A. Vincristine
B. Cyclophosphamide
C. Cisplatin
D. 5-Fluorouracil
Answer: C
