ADVANCED ONCOLOGY CERTIFIED
NURSE PRACTITIONER (AOCNP) FINAL
EXAM STUDY GUIDE QUESTIONS AND
ANSWERS
1. A 62-year-old male with small cell lung cancer (SCLC) presents with a serum sodium level of
122 mEq/L, low serum osmolality, and high urine osmolality. Which of the following is the
most appropriate initial management strategy?
A. Fluid restriction to 800-1000 mL per day
B. Intravenous administration of 3% hypertonic saline
C. Aggressive hydration with Normal Saline at 150 mL/hr
D. Administration of oral desmopressin (DDAVP)
Answer: A
Conceptual Explanation: The clinical picture is consistent with Syndrome of
Inappropriate Antidiuretic Hormone (SIADH), which is common in SCLC. The first-line
treatment for asymptomatic or mildly symptomatic hyponatremia in SIADH is fluid
restriction. Hypertonic saline is reserved for severe, life-threatening neurological
symptoms.
,2. When evaluating a patient for Tumor Lysis Syndrome (TLS), which set of biochemical
abnormalities is characteristic of the condition?
A. Hypokalemia, Hypophosphatemia, Hypercalcemia, Hyperuricemia
B. Hyperkalemia, Hypophosphatemia, Hypercalcemia, Hypouricemia
C. Hyperkalemia, Hyperphosphatemia, Hypocalcemia, Hyperuricemia
D. Hypokalemia, Hyperphosphatemia, Hypocalcemia, Hypouricemia
Answer: C
Conceptual Explanation: Tumor Lysis Syndrome is characterized by the rapid release of
intracellular contents, leading to high potassium, high phosphorus, and high uric acid. The
high phosphorus binds calcium, leading to secondary hypocalcemia.
3. A patient receiving Doxorubicin has reached a cumulative lifetime dose of 450 mg/m2.
What is the most appropriate next step in monitoring this patient?
A. Continuous ECG monitoring during the next infusion
B. Measurement of serum Troponin I and T levels
C. Evaluation of Left Ventricular Ejection Fraction (LVEF)
D. Pulmonary function tests with DLCO
Answer: C
, Conceptual Explanation: Anthracyclines like Doxorubicin have a known dose-dependent
cardiotoxicity. The risk of congestive heart failure increases significantly as the cumulative
dose exceeds 400-450 mg/m2, requiring regular LVEF assessment.
4. Which of the following monoclonal antibodies is associated with a risk of delayed wound
healing and arterial thromboembolism?
A. Rituximab
B. Trastuzumab
C. Cetuximab
D. Bevacizumab
Answer: D
Conceptual Explanation: Bevacizumab targets Vascular Endothelial Growth Factor
(VEGF), which is essential for angiogenesis. Inhibiting VEGF interferes with wound healing
and increases the risk of hemorrhage and arterial thrombosis.
5. A patient with metastatic melanoma is treated with ipilimumab and nivolumab. He
presents with severe diarrhea (Grade 3). What is the recommended management?
A. Administer loperamide 4mg followed by 2mg every 4 hours
B. Hold immunotherapy and initiate high-dose corticosteroids (1-2 mg/kg/day)
C. Discontinue nivolumab but continue ipilimumab with oral hydration
D. Switch to a different class of immunotherapy immediately
NURSE PRACTITIONER (AOCNP) FINAL
EXAM STUDY GUIDE QUESTIONS AND
ANSWERS
1. A 62-year-old male with small cell lung cancer (SCLC) presents with a serum sodium level of
122 mEq/L, low serum osmolality, and high urine osmolality. Which of the following is the
most appropriate initial management strategy?
A. Fluid restriction to 800-1000 mL per day
B. Intravenous administration of 3% hypertonic saline
C. Aggressive hydration with Normal Saline at 150 mL/hr
D. Administration of oral desmopressin (DDAVP)
Answer: A
Conceptual Explanation: The clinical picture is consistent with Syndrome of
Inappropriate Antidiuretic Hormone (SIADH), which is common in SCLC. The first-line
treatment for asymptomatic or mildly symptomatic hyponatremia in SIADH is fluid
restriction. Hypertonic saline is reserved for severe, life-threatening neurological
symptoms.
,2. When evaluating a patient for Tumor Lysis Syndrome (TLS), which set of biochemical
abnormalities is characteristic of the condition?
A. Hypokalemia, Hypophosphatemia, Hypercalcemia, Hyperuricemia
B. Hyperkalemia, Hypophosphatemia, Hypercalcemia, Hypouricemia
C. Hyperkalemia, Hyperphosphatemia, Hypocalcemia, Hyperuricemia
D. Hypokalemia, Hyperphosphatemia, Hypocalcemia, Hypouricemia
Answer: C
Conceptual Explanation: Tumor Lysis Syndrome is characterized by the rapid release of
intracellular contents, leading to high potassium, high phosphorus, and high uric acid. The
high phosphorus binds calcium, leading to secondary hypocalcemia.
3. A patient receiving Doxorubicin has reached a cumulative lifetime dose of 450 mg/m2.
What is the most appropriate next step in monitoring this patient?
A. Continuous ECG monitoring during the next infusion
B. Measurement of serum Troponin I and T levels
C. Evaluation of Left Ventricular Ejection Fraction (LVEF)
D. Pulmonary function tests with DLCO
Answer: C
, Conceptual Explanation: Anthracyclines like Doxorubicin have a known dose-dependent
cardiotoxicity. The risk of congestive heart failure increases significantly as the cumulative
dose exceeds 400-450 mg/m2, requiring regular LVEF assessment.
4. Which of the following monoclonal antibodies is associated with a risk of delayed wound
healing and arterial thromboembolism?
A. Rituximab
B. Trastuzumab
C. Cetuximab
D. Bevacizumab
Answer: D
Conceptual Explanation: Bevacizumab targets Vascular Endothelial Growth Factor
(VEGF), which is essential for angiogenesis. Inhibiting VEGF interferes with wound healing
and increases the risk of hemorrhage and arterial thrombosis.
5. A patient with metastatic melanoma is treated with ipilimumab and nivolumab. He
presents with severe diarrhea (Grade 3). What is the recommended management?
A. Administer loperamide 4mg followed by 2mg every 4 hours
B. Hold immunotherapy and initiate high-dose corticosteroids (1-2 mg/kg/day)
C. Discontinue nivolumab but continue ipilimumab with oral hydration
D. Switch to a different class of immunotherapy immediately
