ADVANCED ONCOLOGY CERTIFIED
NURSE PRACTITIONER (AOCNP)
COMPREHENSIVE EXAM STUDY GUIDE
1. Which of the following molecular mechanisms is primarily responsible for the development
of resistance to first-generation EGFR tyrosine kinase inhibitors, such as erlotinib, in non-
small cell lung cancer (NSCLC)?
A. KRAS G12C mutation
B. MET amplification
C. T790M mutation in exon 20
D. EML4-ALK rearrangement
Answer: C
Conceptual Explanation: The T790M mutation in exon 20 is the most common
mechanism of acquired resistance to first- and second-generation EGFR TKIs, occurring in
approximately 50-60% of cases.
,2. A patient undergoing treatment with an Immune Checkpoint Inhibitor (ICI) presents with
grade 3 immune-related colitis. What is the most appropriate initial management step?
A. Continue ICI and start loperamide
B. Hold ICI and initiate oral prednisone 0.5 mg/kg/day
C. Hold ICI and start infliximab immediately
D. Permanently discontinue ICI and initiate IV methylprednisolone 1-2 mg/kg/day
Answer: D
Conceptual Explanation: For Grade 3 immune-related colitis, management includes
permanent discontinuation of the ICI and initiation of high-dose systemic corticosteroids
(IV methylprednisolone). If no improvement occurs within 48-72 hours, biologics like
infliximab may be considered.
3. Tumor Lysis Syndrome (TLS) is characterized by which of the following metabolic
abnormalities?
A. Hypocalcemia, hyperkalemia, and hyperphosphatemia
B. Hypercalcemia, hyperkalemia, and hyperuricemia
C. Hypernatremia, hypokalemia, and hyperphosphatemia
D. Hypocalcemia, hypokalemia, and hypouricemia
Answer: A
, Conceptual Explanation: TLS involves the rapid release of intracellular contents, leading
to hyperkalemia, hyperphosphatemia, hyperuricemia, and secondary hypocalcemia due to
calcium-phosphate binding.
4. In a patient with suspected Spinal Cord Compression (SCC), what is the immediate
pharmacological intervention to reduce peritumoral edema?
A. Furosemide 40 mg IV
B. Zoledronic acid 4 mg IV
C. Morphine 2 mg IV
D. Dexamethasone 10-16 mg IV bolus
Answer: D
Conceptual Explanation: High-dose corticosteroids (specifically Dexamethasone) are the
standard immediate treatment to reduce edema and protect neurological function while
awaiting definitive therapy like radiation or surgery.
5. Which genetic syndrome is associated with a germline mutation in the TP53 gene,
increasing the risk for early-onset breast cancer, sarcomas, and adrenocortical carcinomas?
A. Lynch Syndrome
B. Cowden Syndrome
C. Von Hippel-Lindau Syndrome
D. Li-Fraumeni Syndrome
NURSE PRACTITIONER (AOCNP)
COMPREHENSIVE EXAM STUDY GUIDE
1. Which of the following molecular mechanisms is primarily responsible for the development
of resistance to first-generation EGFR tyrosine kinase inhibitors, such as erlotinib, in non-
small cell lung cancer (NSCLC)?
A. KRAS G12C mutation
B. MET amplification
C. T790M mutation in exon 20
D. EML4-ALK rearrangement
Answer: C
Conceptual Explanation: The T790M mutation in exon 20 is the most common
mechanism of acquired resistance to first- and second-generation EGFR TKIs, occurring in
approximately 50-60% of cases.
,2. A patient undergoing treatment with an Immune Checkpoint Inhibitor (ICI) presents with
grade 3 immune-related colitis. What is the most appropriate initial management step?
A. Continue ICI and start loperamide
B. Hold ICI and initiate oral prednisone 0.5 mg/kg/day
C. Hold ICI and start infliximab immediately
D. Permanently discontinue ICI and initiate IV methylprednisolone 1-2 mg/kg/day
Answer: D
Conceptual Explanation: For Grade 3 immune-related colitis, management includes
permanent discontinuation of the ICI and initiation of high-dose systemic corticosteroids
(IV methylprednisolone). If no improvement occurs within 48-72 hours, biologics like
infliximab may be considered.
3. Tumor Lysis Syndrome (TLS) is characterized by which of the following metabolic
abnormalities?
A. Hypocalcemia, hyperkalemia, and hyperphosphatemia
B. Hypercalcemia, hyperkalemia, and hyperuricemia
C. Hypernatremia, hypokalemia, and hyperphosphatemia
D. Hypocalcemia, hypokalemia, and hypouricemia
Answer: A
, Conceptual Explanation: TLS involves the rapid release of intracellular contents, leading
to hyperkalemia, hyperphosphatemia, hyperuricemia, and secondary hypocalcemia due to
calcium-phosphate binding.
4. In a patient with suspected Spinal Cord Compression (SCC), what is the immediate
pharmacological intervention to reduce peritumoral edema?
A. Furosemide 40 mg IV
B. Zoledronic acid 4 mg IV
C. Morphine 2 mg IV
D. Dexamethasone 10-16 mg IV bolus
Answer: D
Conceptual Explanation: High-dose corticosteroids (specifically Dexamethasone) are the
standard immediate treatment to reduce edema and protect neurological function while
awaiting definitive therapy like radiation or surgery.
5. Which genetic syndrome is associated with a germline mutation in the TP53 gene,
increasing the risk for early-onset breast cancer, sarcomas, and adrenocortical carcinomas?
A. Lynch Syndrome
B. Cowden Syndrome
C. Von Hippel-Lindau Syndrome
D. Li-Fraumeni Syndrome
