AOCNP Advanced Oncology Certified Nurse Practitioner 5 — Questions and Answers
Question 1: A patient undergoing radiation to the mediastinum is at risk for which long-term cardiac complication?
- Dilated cardiomyopathy only
- Constrictive pericarditis and coronary artery disease (Correct answer)
- Atrial fibrillation exclusively
- Mitral valve prolapse
Correct answer: Constrictive pericarditis and coronary artery disease
Mediastinal radiation can cause constrictive pericarditis, coronary artery disease, valvular disease, and cardiomyopathy as late complications.
Question 2: Which biomarker is most useful for monitoring response to therapy in patients with hepatocellular carcinoma?
- CEA
- CA 19-9
- Alpha-fetoprotein (AFP) (Correct answer)
- PSA
Correct answer: Alpha-fetoprotein (AFP)
Alpha-fetoprotein (AFP) is the primary tumor marker used to monitor treatment response and surveillance in hepatocellular carcinoma.
Question 3: A patient with breast cancer develops brain metastases with significant vasogenic edema and headache. What is the initial pharmacologic management?
- Mannitol IV bolus
- Dexamethasone (Correct answer)
- Phenytoin prophylaxis
- Furosemide IV
Correct answer: Dexamethasone
Dexamethasone is the first-line treatment for vasogenic edema from brain metastases, rapidly reducing inflammation and cerebral swelling.
Question 4: What is the recommended duration of anticoagulation for cancer-associated venous thromboembolism (VTE)?
- 3 months then discontinue
- 6 months then reassess
- At least 6 months with continuation as long as cancer is active (Correct answer)
- Lifelong anticoagulation regardless of disease status
Correct answer: At least 6 months with continuation as long as cancer is active
Guidelines recommend at least 6 months of anticoagulation for cancer-associated VTE, with continuation as long as the cancer remains active or treatment is ongoing.
Question 5: A patient with multiple myeloma develops hypercalcemia of malignancy. Which mechanism is primarily responsible?
- Increased renal calcium reabsorption from PTH excess
- Osteoclast activation by RANKL overexpression from myeloma cells (Correct answer)
- Parathyroid gland hyperplasia
- Increased vitamin D absorption from the gut
Correct answer: Osteoclast activation by RANKL overexpression from myeloma cells
Myeloma cells overexpress RANKL and other osteoclast-activating factors, leading to osteolytic bone destruction and calcium release into the bloodstream.
Question 6: Which intervention has the strongest evidence for reducing cancer-related fatigue during active treatment?
- High-dose corticosteroids
- Complete bed rest
- Aerobic exercise (Correct answer)
- Methylphenidate
Correct answer: Aerobic exercise
Aerobic exercise has the strongest evidence base for reducing cancer-related fatigue during and after treatment, improving both physical and psychological well-being.
Question 7: A patient with ovarian cancer has completed platinum-based chemotherapy and achieved complete response. She carries a BRCA1 mutation. What is the recommended maintenance therapy?
- Bevacizumab monotherapy
- Olaparib (PARP inhibitor) (Correct answer)
- Lenalidomide
- Tamoxifen
Correct answer: Olaparib (PARP inhibitor)
Olaparib maintenance is recommended for BRCA-mutated ovarian cancer after response to platinum-based chemotherapy, significantly prolonging progression-free survival.
AOCNP Advanced Oncology Certified Nurse Practitioner 5
A patient undergoing radiation to the mediastinum is at risk for which long-term cardiac complication?