AOCNP certification, the oncology NP credential

A patient with ALK-positive lung adenocarcinoma progresses on first-line alectinib with new brain metastases; tissue shows an ALK G1202R mutation. The APRN recommends:

1. lorlatinib.
   Lorlatinib is the third-generation ALK inhibitor designed to bind despite the G1202R solvent-front mutation, and its strong CNS penetration also covers the new brain metastases.
2. ceritinib.
   Ceritinib is a second-generation ALK inhibitor like alectinib, and G1202R confers resistance to that whole generation, so a sideways switch does not overcome it.
3. crizotinib.
   Crizotinib is the first-generation ALK inhibitor; it is weaker than alectinib, enters the brain poorly, and has no activity against G1202R.
4. osimertinib.
   Osimertinib is an EGFR inhibitor; choosing it confuses the two common driver pathways in lung adenocarcinoma, and it has no activity against ALK.

Item 732893 · Flag an error

The APRN counsels a patient newly diagnosed with metastatic spinal cord compression. The strongest predictor of walking after treatment is:

1. Ability to walk at diagnosis
   Pretreatment motor function predicts outcome better than anything else: most patients who walk into treatment keep walking, while few who are already paraplegic regain it, which is why compression is treated as an emergency.
2. Radiosensitivity of the primary tumor
   Histology shapes how well radiation shrinks the tumor, but its effect on walking is smaller than baseline function; a radioresistant tumor caught early still does better than a radiosensitive one caught late.
3. Number of involved vertebral levels
   Multilevel disease changes treatment fields and planning, yet it predicts ambulation less strongly than whether the patient can walk at presentation.
4. Duration of back pain before diagnosis
   Long-standing pain reflects diagnostic delay rather than the deficit itself; what matters for walking is how much motor function is already lost when treatment starts.

Item 1009151 · Flag an error

The APRN is about to tell a patient that restaging scans show progression. After setting up a private conversation, the APRN's next statement is:

1. "The scan shows that your cancer has grown."
   Stating the result at once skips the perception and invitation steps, so the news lands without knowing the patient's understanding or readiness to hear it.
2. "What do you understand about your illness?"
   Asking for the patient's perception before giving news is the P step of SPIKES; it shows what the patient already knows or fears and lets the APRN pitch the information at that level.
3. "Do you want to start another chemotherapy?"
   Jumping to the next treatment before the patient knows the scan result reverses the order of SPIKES and asks for a decision without the information it depends on.
4. "Would you like me to call your family now?"
   Offering to call family deflects from the conversation the APRN set up; whether to involve family is settled before the meeting, not used to postpone the news.

Item 1009244 · Flag an error

Six weeks after completing 12 cycles of FOLFOX, a patient whose neuropathy was grade 1 at the last infusion now has worsening numbness that makes buttoning clothes difficult. Examination shows stocking-glove sensory loss. The APRN explains this as:

1. acute cold-induced neurotoxicity
   The acute cold-triggered dysesthesia of oxaliplatin starts within hours to days of an infusion and resolves between cycles, so it cannot explain progressive numbness weeks after therapy ended.
2. a new cause needing spine MRI
   Urgent spine imaging is for asymmetric weakness, a sensory level, or bowel and bladder change; symmetric distal sensory loss on the expected timeline does not call for it.
3. a paraneoplastic sign of recurrence
   Paraneoplastic neuropathy is rare in colorectal cancer and typically subacute and disabling; blaming recurrence for an expected drug effect leads to needless workup.
4. expected post-treatment coasting
   Oxaliplatin's cumulative sensory neuropathy often keeps worsening for 2–3 months after the last dose before it plateaus and slowly improves, so stocking-glove progression 6 weeks after FOLFOX fits coasting.

Item 1971038 · Flag an error

A 30-year-old woman received chest radiation for Hodgkin lymphoma at age 16. She has no breast symptoms. The APRN's breast cancer screening plan is:

1. breast ultrasound every 6 months
   Ultrasound is a supplement for some patients who cannot have MRI, not the screening standard for radiation survivors.
2. biennial mammography from age 40
   Biennial mammography from 40 is the USPSTF average-risk schedule; prior chest radiation puts her in a high-risk group with earlier, more intensive screening.
3. annual mammography and breast MRI
   Chest radiation in childhood or young adulthood raises breast cancer risk to a level like that of BRCA carriers, so COG and NCCN advise annual mammography plus breast MRI starting at age 25 or 8 years after radiation, whichever comes later, which is now for her.
4. genetic testing before any imaging
   Her elevated risk comes from the radiation, not from an inherited variant, so screening does not wait for genetic testing.

Item 9840004 · Flag an error