AOCNP Exam Study Guide – 400+
Review Questions & Terms for
Advanced Oncology Certified Nurse
Practitioner (2026) Board Exam Prep
(PDF)
SECTION I: CANCER CONTINUUM (28%)
Domain I.1: Screening, Prevention, and Surveillance
Question 1
A 55-year-old woman with a 30-pack-year smoking history and no other risk factors
presents for her annual physical. She asks about lung cancer screening. According to
current USPSTF guidelines, which of the following is the most appropriate
recommendation?
A) Annual low-dose CT (LDCT) screening if she has a 30-pack-year history and is a
current smoker or quit within the last 15 years
B) Chest X-ray annually for all patients with a smoking history
C) No screening is recommended until she reaches age 65
D) LDCT screening only if she has additional risk factors
Correct Answer: A) Annual low-dose CT (LDCT) screening if she has a 30-pack-year
history and is a current smoker or quit within the last 15 years
,Rationale: Lung cancer screening with low-dose CT is recommended for adults aged
50-80 with a 20-pack-year smoking history who currently smoke or have quit within the
last 15 years. Chest X-ray is not recommended for screening. This patient meets criteria
and should be screened annually. Screening decisions should be shared and consider
the patient's overall health and willingness to undergo further evaluation if findings are
abnormal .
Question 2
A 62-year-old patient with no family history of colorectal cancer is due for colorectal
cancer screening. What is the recommended screening interval for a colonoscopy in
average-risk individuals?
A) Every 5 years
B) Every 10 years
C) Every 15 years
D) Every 3 years
Correct Answer: B) Every 10 years
Rationale: For average-risk individuals, colonoscopy is recommended every 10 years. If
other modalities are used (e.g., FIT, CT colonography), more frequent intervals apply.
Screening should generally begin at age 45. The key distinction is that average-risk
patients do not require more frequent surveillance unless polyps or other findings are
identified .
Question 3
A 48-year-old woman with a maternal aunt diagnosed with breast cancer at age 40
presents for risk assessment. She has no other family history of breast or ovarian cancer.
What is the most appropriate recommendation?
A) Begin annual mammography at age 50
B) Begin annual mammography at age 40
C) Refer for genetic counseling and consider BRCA testing
D) Begin mammography at age 45 and continue annually
Correct Answer: C) Refer for genetic counseling and consider BRCA testing
,Rationale: This patient has a family history suggestive of a hereditary cancer syndrome
(a first- or second-degree relative diagnosed with breast cancer at age ≤45). She should
be referred for genetic counseling and risk assessment. BRCA testing should be offered
based on the counseling. Mammography screening may also begin earlier based on risk,
but genetic counseling is the priority to guide all future management .
Domain I.2: Assessment and Diagnosis
Question 4
A 68-year-old patient with newly diagnosed non-small cell lung cancer has a tumor that
tests positive for a PD-L1 expression level of 70%. Which of the following is the most
appropriate initial treatment strategy based on this biomarker?
A) Immediate referral for surgical resection
B) Single-agent immunotherapy (pembrolizumab)
C) Platinum-based doublet chemotherapy
D) Targeted therapy based on EGFR mutation status
Correct Answer: B) Single-agent immunotherapy (pembrolizumab)
Rationale: For metastatic NSCLC with high PD-L1 expression (≥50%), pembrolizumab as
a single agent is a first-line treatment option. This immunotherapy approach has
demonstrated superior outcomes compared to chemotherapy in this biomarker-defined
population. Always check EGFR, ALK, and ROS1 mutations first, as targeted therapies
would be preferred if positive .
Question 5
A 62-year-old woman presents with a palpable right breast mass. A diagnostic
mammogram and ultrasound demonstrate a 2.5 cm irregular mass with spiculated
margins. Biopsy shows infiltrating ductal carcinoma that is ER-positive, PR-negative,
HER2-positive. Which staging workup is most appropriate before treatment planning?
A) Complete history and physical exam only
B) Complete history, physical exam, bilateral mammogram, and ultrasound
, C) Complete history, physical exam, bilateral mammogram, breast MRI,
chest/abdomen/pelvis CT, bone scan, and consideration of FDG PET/CT
D) Complete history, physical exam, and bone scan only
Correct Answer: C) Complete history, physical exam, bilateral mammogram, breast
MRI, chest/abdomen/pelvis CT, bone scan, and consideration of FDG PET/CT
Rationale: For a patient with newly diagnosed breast cancer who is HER2-positive and
has a palpable mass, staging should be comprehensive to rule out distant metastases.
HER2-positive and node-positive cancers have higher risk of metastatic spread. Workup
includes imaging of the chest, abdomen, and pelvis. FDG PET/CT may be considered if
there is suspicion for metastatic disease. All staging information is critical for treatment
planning, especially since this patient may benefit from neoadjuvant therapy .
SECTION II: CANCER TREATMENT AND SUPPORTIVE CARE
(45%)
Domain II.1: Systemic Therapy
Question 6
A 65-year-old patient with advanced colorectal cancer is started on FOLFOX
chemotherapy (fluorouracil, leucovorin, oxaliplatin). He develops cold-induced
dysesthesia in his hands and feet, perioral tingling, and throat discomfort. What is the
most likely cause of these symptoms?
A) Fluorouracil cardiotoxicity
B) Oxaliplatin-induced peripheral neuropathy
C) Leucovorin hypersensitivity
D) Tumor lysis syndrome
Correct Answer: B) Oxaliplatin-induced peripheral neuropathy
Rationale: Oxaliplatin causes a unique, acute peripheral neuropathy characterized by
cold-induced paresthesias (dysesthesia) in the hands, feet, and perioral region. Throat
discomfort can also occur with cold exposure. This is dose-limiting and may be
Review Questions & Terms for
Advanced Oncology Certified Nurse
Practitioner (2026) Board Exam Prep
(PDF)
SECTION I: CANCER CONTINUUM (28%)
Domain I.1: Screening, Prevention, and Surveillance
Question 1
A 55-year-old woman with a 30-pack-year smoking history and no other risk factors
presents for her annual physical. She asks about lung cancer screening. According to
current USPSTF guidelines, which of the following is the most appropriate
recommendation?
A) Annual low-dose CT (LDCT) screening if she has a 30-pack-year history and is a
current smoker or quit within the last 15 years
B) Chest X-ray annually for all patients with a smoking history
C) No screening is recommended until she reaches age 65
D) LDCT screening only if she has additional risk factors
Correct Answer: A) Annual low-dose CT (LDCT) screening if she has a 30-pack-year
history and is a current smoker or quit within the last 15 years
,Rationale: Lung cancer screening with low-dose CT is recommended for adults aged
50-80 with a 20-pack-year smoking history who currently smoke or have quit within the
last 15 years. Chest X-ray is not recommended for screening. This patient meets criteria
and should be screened annually. Screening decisions should be shared and consider
the patient's overall health and willingness to undergo further evaluation if findings are
abnormal .
Question 2
A 62-year-old patient with no family history of colorectal cancer is due for colorectal
cancer screening. What is the recommended screening interval for a colonoscopy in
average-risk individuals?
A) Every 5 years
B) Every 10 years
C) Every 15 years
D) Every 3 years
Correct Answer: B) Every 10 years
Rationale: For average-risk individuals, colonoscopy is recommended every 10 years. If
other modalities are used (e.g., FIT, CT colonography), more frequent intervals apply.
Screening should generally begin at age 45. The key distinction is that average-risk
patients do not require more frequent surveillance unless polyps or other findings are
identified .
Question 3
A 48-year-old woman with a maternal aunt diagnosed with breast cancer at age 40
presents for risk assessment. She has no other family history of breast or ovarian cancer.
What is the most appropriate recommendation?
A) Begin annual mammography at age 50
B) Begin annual mammography at age 40
C) Refer for genetic counseling and consider BRCA testing
D) Begin mammography at age 45 and continue annually
Correct Answer: C) Refer for genetic counseling and consider BRCA testing
,Rationale: This patient has a family history suggestive of a hereditary cancer syndrome
(a first- or second-degree relative diagnosed with breast cancer at age ≤45). She should
be referred for genetic counseling and risk assessment. BRCA testing should be offered
based on the counseling. Mammography screening may also begin earlier based on risk,
but genetic counseling is the priority to guide all future management .
Domain I.2: Assessment and Diagnosis
Question 4
A 68-year-old patient with newly diagnosed non-small cell lung cancer has a tumor that
tests positive for a PD-L1 expression level of 70%. Which of the following is the most
appropriate initial treatment strategy based on this biomarker?
A) Immediate referral for surgical resection
B) Single-agent immunotherapy (pembrolizumab)
C) Platinum-based doublet chemotherapy
D) Targeted therapy based on EGFR mutation status
Correct Answer: B) Single-agent immunotherapy (pembrolizumab)
Rationale: For metastatic NSCLC with high PD-L1 expression (≥50%), pembrolizumab as
a single agent is a first-line treatment option. This immunotherapy approach has
demonstrated superior outcomes compared to chemotherapy in this biomarker-defined
population. Always check EGFR, ALK, and ROS1 mutations first, as targeted therapies
would be preferred if positive .
Question 5
A 62-year-old woman presents with a palpable right breast mass. A diagnostic
mammogram and ultrasound demonstrate a 2.5 cm irregular mass with spiculated
margins. Biopsy shows infiltrating ductal carcinoma that is ER-positive, PR-negative,
HER2-positive. Which staging workup is most appropriate before treatment planning?
A) Complete history and physical exam only
B) Complete history, physical exam, bilateral mammogram, and ultrasound
, C) Complete history, physical exam, bilateral mammogram, breast MRI,
chest/abdomen/pelvis CT, bone scan, and consideration of FDG PET/CT
D) Complete history, physical exam, and bone scan only
Correct Answer: C) Complete history, physical exam, bilateral mammogram, breast
MRI, chest/abdomen/pelvis CT, bone scan, and consideration of FDG PET/CT
Rationale: For a patient with newly diagnosed breast cancer who is HER2-positive and
has a palpable mass, staging should be comprehensive to rule out distant metastases.
HER2-positive and node-positive cancers have higher risk of metastatic spread. Workup
includes imaging of the chest, abdomen, and pelvis. FDG PET/CT may be considered if
there is suspicion for metastatic disease. All staging information is critical for treatment
planning, especially since this patient may benefit from neoadjuvant therapy .
SECTION II: CANCER TREATMENT AND SUPPORTIVE CARE
(45%)
Domain II.1: Systemic Therapy
Question 6
A 65-year-old patient with advanced colorectal cancer is started on FOLFOX
chemotherapy (fluorouracil, leucovorin, oxaliplatin). He develops cold-induced
dysesthesia in his hands and feet, perioral tingling, and throat discomfort. What is the
most likely cause of these symptoms?
A) Fluorouracil cardiotoxicity
B) Oxaliplatin-induced peripheral neuropathy
C) Leucovorin hypersensitivity
D) Tumor lysis syndrome
Correct Answer: B) Oxaliplatin-induced peripheral neuropathy
Rationale: Oxaliplatin causes a unique, acute peripheral neuropathy characterized by
cold-induced paresthesias (dysesthesia) in the hands, feet, and perioral region. Throat
discomfort can also occur with cold exposure. This is dose-limiting and may be
