AOCNP Advanced Oncology Certified Nurse Practitioner 4 — Questions and Answers
Question 1: A patient with colorectal cancer is found to have a RAS mutation. What is the implication for treatment?
- Eligible for cetuximab therapy
- Not eligible for anti-EGFR therapy (Correct answer)
- Requires immediate surgical resection
- Indicates sensitivity to bevacizumab
Correct answer: Not eligible for anti-EGFR therapy
RAS mutations (KRAS or NRAS) predict resistance to anti-EGFR antibodies such as cetuximab and panitumumab.
Question 2: Which pain scale is most appropriate for assessing pain in a cognitively impaired oncology patient who cannot self-report?
- Numerical Rating Scale (NRS)
- Visual Analog Scale (VAS)
- Pain Assessment in Advanced Dementia (PAINAD) (Correct answer)
- McGill Pain Questionnaire
Correct answer: Pain Assessment in Advanced Dementia (PAINAD)
The PAINAD scale uses behavioral observations to assess pain in non-verbal or cognitively impaired patients.
Question 3: A patient with diffuse large B-cell lymphoma (DLBCL) achieves complete remission after R-CHOP. Which finding on interim PET scan predicts better prognosis?
- Deauville score 4
- Deauville score 1-2 (Correct answer)
- SUVmax > 5
- New lesions on PET
Correct answer: Deauville score 1-2
Deauville scores of 1-2 indicate complete metabolic response and are associated with favorable prognosis in DLBCL treated with R-CHOP.
Question 4: What is the primary goal of palliative care in oncology?
- To hasten death when curative options are exhausted
- To improve quality of life by preventing and relieving suffering (Correct answer)
- To replace disease-directed therapy entirely
- To provide only end-of-life hospice care
Correct answer: To improve quality of life by preventing and relieving suffering
Palliative care focuses on improving quality of life for patients and families by addressing physical, emotional, and spiritual suffering at any disease stage.
Question 5: Which chemotherapy agent is associated with hemorrhagic cystitis, and what is the prophylactic agent used?
- Cisplatin — folinic acid
- Cyclophosphamide — mesna (Correct answer)
- Doxorubicin — dexrazoxane
- Bleomycin — amifostine
Correct answer: Cyclophosphamide — mesna
Cyclophosphamide and ifosfamide produce acrolein, a bladder-toxic metabolite; mesna binds acrolein in the urine to prevent hemorrhagic cystitis.
Question 6: A patient with CML has a BCR-ABL transcript level that increases 1-log after being on imatinib for 12 months. What is the most appropriate next step?
- Continue imatinib and recheck in 6 months
- Switch to a second-generation TKI such as dasatinib or nilotinib (Correct answer)
- Proceed to allogeneic stem cell transplant immediately
- Add hydroxyurea to imatinib
Correct answer: Switch to a second-generation TKI such as dasatinib or nilotinib
Loss of major molecular response or increasing BCR-ABL transcripts on imatinib indicates treatment failure, and switching to a second-generation TKI is recommended.
Question 7: What is the most appropriate route of opioid administration for a cancer patient who can no longer swallow and has uncontrolled pain at home?
- Intramuscular injection
- Subcutaneous infusion via syringe driver (Correct answer)
- Rectal suppository
- Intravenous bolus in the ED
Correct answer: Subcutaneous infusion via syringe driver
Subcutaneous infusion via a syringe driver provides continuous pain control for patients who cannot swallow, and is well tolerated at home.
AOCNP Advanced Oncology Certified Nurse Practitioner 4
A patient with colorectal cancer is found to have a RAS mutation.
What is the implication for treatment?