ANCC Oncology Nursing Certification 1 — Questions and Answers
Question 1: A patient undergoing chemotherapy develops an absolute neutrophil count (ANC) of 450 cells/mcL. Which precaution is most important?
- Contact precautions for MRSA
- Neutropenic precautions to prevent infection (Correct answer)
- Droplet precautions for influenza
- Reverse isolation with positive pressure room
Correct answer: Neutropenic precautions to prevent infection
An ANC below 500 cells/mcL indicates severe neutropenia (nadir), requiring protective neutropenic precautions to reduce infection risk.
Question 2: Which oncologic emergency is characterized by hypercalcemia, hyperkalemia, hyperphosphatemia, and hyperuricemia after cancer treatment?
- Superior vena cava syndrome
- Tumor lysis syndrome (Correct answer)
- Spinal cord compression
- Syndrome of inappropriate ADH (SIADH)
Correct answer: Tumor lysis syndrome
Tumor lysis syndrome results from rapid destruction of cancer cells releasing intracellular contents into the bloodstream.
Question 3: A patient receiving IV chemotherapy via a peripheral line reports burning pain at the site with surrounding erythema and blanching. This is most consistent with:
- Phlebitis
- Extravasation of a vesicant agent (Correct answer)
- Allergic reaction to the drug
- Thrombosis at the catheter site
Correct answer: Extravasation of a vesicant agent
Burning, erythema, and blanching at a chemotherapy infusion site indicate extravasation of a vesicant, which can cause tissue necrosis.
Question 4: The nurse is caring for a patient with cancer who reports severe, uncontrolled pain rated 9/10. According to the WHO analgesic ladder, which step of therapy is indicated?
- Step 1: Non-opioid analgesics alone
- Step 2: Weak opioids with or without non-opioids
- Step 3: Strong opioids with or without non-opioids (Correct answer)
- Step 4: Interventional procedures only
Correct answer: Step 3: Strong opioids with or without non-opioids
Severe pain (7–10) corresponds to Step 3 of the WHO analgesic ladder, requiring strong opioids such as morphine or oxycodone.
Question 5: Which chemotherapy agent is classified as an alkylating agent?
- Vincristine
- Cyclophosphamide (Correct answer)
- Methotrexate
- Doxorubicin
Correct answer: Cyclophosphamide
Cyclophosphamide is an alkylating agent that works by cross-linking DNA strands, preventing cancer cell replication.
Question 6: A patient with small cell lung cancer presents with facial edema, distended neck veins, and arm swelling. What is the suspected oncologic emergency?
- Tumor lysis syndrome
- Superior vena cava syndrome (Correct answer)
- Pericardial tamponade
- Hypercalcemia of malignancy
Correct answer: Superior vena cava syndrome
Superior vena cava syndrome is caused by tumor compression of the SVC, producing characteristic venous congestion in the upper body.
ANCC Oncology Nursing Certification 1
A patient undergoing chemotherapy develops an absolute neutrophil count (ANC) of 450 cells/mcL.
Which precaution is most important?