ONS/ONCC Chemotherapy Immunotherapy Certificate (OCC) — Questions and Answers

Question 1: Which integrative therapy has BEST evidence for reducing chemotherapy-related nausea and vomiting as a complement to antiemetics?

Acupuncture and acupressure (Correct answer)
Herbal supplements including ginger capsules at high doses
Magnet therapy
Aromatherapy with peppermint oil

Correct answer: Acupuncture and acupressure

Acupuncture and acupressure (particularly at the P6/Neiguan point) have the strongest evidence base among integrative therapies for reducing chemotherapy-induced nausea.

Question 2: How long should a nurse flush an implanted port access needle with normal saline to confirm patency BEFORE administering a vesicant chemotherapy agent?

1-2 mL to confirm flow
Flush until blood return is confirmed, then no saline flush needed
At least 10 mL while assessing for any resistance, swelling, or patient discomfort (Correct answer)
5 mL rapidly to clear the needle

Correct answer: At least 10 mL while assessing for any resistance, swelling, or patient discomfort

A minimum 10 mL saline flush administered slowly while assessing for resistance, swelling, and patient discomfort confirms port patency before vesicant administration.

Question 3: A terminally ill cancer patient reports existential distress and loss of meaning. Which supportive care approach is MOST appropriate?

Refer exclusively to psychiatry for pharmacological management
Increase opioid doses to reduce psychological discomfort
Initiate dignity therapy or meaning-centered counseling with palliative care support (Correct answer)
Reassure the patient that these feelings will resolve after treatment

Correct answer: Initiate dignity therapy or meaning-centered counseling with palliative care support

Dignity therapy and meaning-centered counseling are evidence-based psychotherapeutic interventions specifically designed to address existential distress in terminally ill patients.

Question 4: Which position should the nurse place a patient in if air embolism is suspected during central line removal?

High Fowler's position
Left lateral Trendelenburg (Durant's maneuver) (Correct answer)
Right lateral decubitus
Supine with legs elevated

Correct answer: Left lateral Trendelenburg (Durant's maneuver)

Left lateral Trendelenburg (Durant's maneuver) traps air in the right ventricle apex to prevent it from entering the pulmonary vasculature.

Question 5: A nurse is implementing a new evidence-based protocol for central line care. Which approach BEST demonstrates integration of evidence-based practice (EBP)?

Using only the most recent published study without consulting clinical experts
Combining current best evidence, clinical expertise, and patient preferences to guide implementation (Correct answer)
Implementing the protocol only after all staff agree it is superior
Applying the protocol as written without adaptation to the patient population

Correct answer: Combining current best evidence, clinical expertise, and patient preferences to guide implementation

Evidence-based practice integrates the best available research evidence with clinical expertise and individual patient values and preferences.

Question 6: A patient receiving fludarabine for CLL develops profound lymphopenia with opportunistic infections. Which mechanism accounts for fludarabine's profound immunosuppression?

Fludarabine inhibits IL-2 receptor signaling, preventing lymphocyte proliferation without affecting lymphocyte survival
Fludarabine's active metabolite F-ara-ATP incorporates into DNA and RNA of lymphocytes and inhibits DNA polymerase, causing selective T-cell depletion lasting months (Correct answer)
Fludarabine crosslinks immunoglobulin heavy chains, depleting B cells through antibody aggregation
Fludarabine activates mTOR in T-regulatory cells, causing paradoxical immune suppression

Correct answer: Fludarabine's active metabolite F-ara-ATP incorporates into DNA and RNA of lymphocytes and inhibits DNA polymerase, causing selective T-cell depletion lasting months

Fludarabine's active triphosphate metabolite (F-ara-ATP) inhibits DNA polymerase and incorporates into DNA/RNA, causing prolonged lymphopenia particularly of CD4+ T-cells, predisposing to opportunistic infections.

Question 7: When evaluating pain in oncology patients, which assessment approach best aligns with evidence-based practice?

Rely primarily on behavioral observation rather than self-report
Use a standardized tool and reassess within 30–60 minutes after intervention (Correct answer)
Assess pain only when the patient verbally reports discomfort
Document pain as the fifth vital sign without reassessment

Correct answer: Use a standardized tool and reassess within 30–60 minutes after intervention

Best practice requires using a validated pain scale, administering the intervention, and reassessing within 30–60 minutes to evaluate efficacy and guide further management.

Question 8: A patient with multiple myeloma develops confusion, polyuria, constipation, and a serum calcium of 13.5 mg/dL. What is the initial treatment priority?

Administer loop diuretics without IV fluids
Administer oral calcium supplements to correct the imbalance
Initiate bisphosphonate therapy as the first intervention
Begin aggressive IV normal saline hydration to promote calciuresis (Correct answer)

Correct answer: Begin aggressive IV normal saline hydration to promote calciuresis

Aggressive IV hydration with normal saline is the first-line treatment for hypercalcemia of malignancy, promoting renal calcium excretion before adding bisphosphonates.

Question 9: The nurse is educating a patient with a tunneled Hickman catheter about home care. Which instruction is MOST important?

Remove the dressing daily to inspect the exit site
Submerge the catheter in water briefly during bathing
Change the cap and flush the catheter per the prescribed protocol, and report fever above 100.4°F (Correct answer)
Clamp the catheter only during dressing changes

Correct answer: Change the cap and flush the catheter per the prescribed protocol, and report fever above 100.4°F

Fever above 100.4°F in a patient with a tunneled catheter is a red flag for catheter-related bloodstream infection requiring immediate reporting.

Question 10: Which assessment scale is MOST appropriate for evaluating pain in an oncology patient with moderate cognitive impairment?

Visual Analog Scale (VAS)
McGill Pain Questionnaire
Numeric Rating Scale (NRS) 0-10
PAINAD (Pain Assessment in Advanced Dementia) scale (Correct answer)

Correct answer: PAINAD (Pain Assessment in Advanced Dementia) scale

The PAINAD scale assesses pain through behavioral indicators (breathing, vocalization, facial expression, body language, consolability) in patients who cannot self-report reliably.

Question 11: Which quality improvement model is MOST commonly used in oncology nursing practice to implement and evaluate evidence-based changes?

Root cause analysis (RCA)
PDSA (Plan-Do-Study-Act) cycle (Correct answer)
Failure mode and effects analysis (FMEA)
Six Sigma DMAIC

Correct answer: PDSA (Plan-Do-Study-Act) cycle

The PDSA cycle is the most widely used quality improvement model in nursing and oncology practice for iterative, evidence-based practice change.

Question 12: Which document establishes legal authority for a surrogate decision-maker when an oncology patient loses decision-making capacity?

DNR order
Advance directive living will
Physician order for life-sustaining treatment (POLST)
Durable power of attorney for healthcare (Correct answer)

Correct answer: Durable power of attorney for healthcare

A durable power of attorney for healthcare legally designates a surrogate to make medical decisions when the patient lacks capacity.

Question 13: A nurse is providing spiritual care to a Muslim patient with terminal cancer who is declining end-of-life medications due to religious concerns about sedation. What is the BEST approach?

Document the refusal and take no further action
Override the patient's decision because comfort is the primary goal of hospice
Consult psychiatry for assessment of decision-making capacity
Respect the patient's religious autonomy, involve a chaplain, and explore non-sedating symptom management alternatives (Correct answer)

Correct answer: Respect the patient's religious autonomy, involve a chaplain, and explore non-sedating symptom management alternatives

Respecting patient autonomy and religious beliefs requires an interdisciplinary approach including chaplaincy, while exploring non-sedating alternatives that align with the patient's values.

Question 14: Which finding indicates a patient with cancer-associated hypercoagulability has developed a pulmonary embolism (PE)?

Fever and productive cough with purulent sputum
Gradual onset of bilateral leg edema over 3 days
Abdominal pain and flank tenderness
Sudden dyspnea, pleuritic chest pain, and tachycardia (Correct answer)

Correct answer: Sudden dyspnea, pleuritic chest pain, and tachycardia

Sudden dyspnea, pleuritic chest pain, and tachycardia are the classic triad of pulmonary embolism, a common life-threatening complication in cancer patients due to hypercoagulability.

Question 15: The oncology nurse is reviewing a study that reports a hazard ratio (HR) of 0.65 with a 95% CI of 0.50-0.85 for a new drug versus placebo. What does this mean?

The new drug reduces the risk of the event by 35%, and this is statistically significant (Correct answer)
The result is not statistically significant because the CI crosses 1.0
The new drug increases the risk of the event by 35%
The drug has no effect because the HR is less than 1.0

Correct answer: The new drug reduces the risk of the event by 35%, and this is statistically significant

An HR of 0.65 means a 35% reduction in the hazard (risk) of the event; since the 95% CI (0.50-0.85) does not cross 1.0, the result is statistically significant.

Question 16: Which element is REQUIRED for a patient to provide valid informed consent for clinical trial participation?

Physician presence is required and the nurse cannot witness consent
Written consent obtained within 24 hours of enrollment
Voluntary participation, disclosure of all risks and benefits, and patient comprehension (Correct answer)
Presence of a family member to co-sign the consent form

Correct answer: Voluntary participation, disclosure of all risks and benefits, and patient comprehension

Valid informed consent requires voluntary participation free from coercion, full disclosure of risks and benefits, and confirmation that the patient understands the information.

Question 17: A patient undergoing aggressive chemotherapy for leukemia develops hyperkalemia, hyperphosphatemia, hypocalcemia, and elevated uric acid. What syndrome is occurring?

Tumor lysis syndrome (Correct answer)
Disseminated intravascular coagulation
Syndrome of inappropriate antidiuretic hormone
Hypercalcemia of malignancy

Correct answer: Tumor lysis syndrome

Tumor lysis syndrome results from rapid destruction of cancer cells releasing intracellular contents, causing the classic electrolyte pattern of hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia.

Question 18: Blinatumomab is a bispecific T-cell engager (BiTE) that simultaneously binds CD19 on B cells and which molecule on T cells?

PD-1
CD28
CTLA-4
CD3 (Correct answer)

Correct answer: CD3

Blinatumomab bridges CD19-expressing malignant B cells and CD3-expressing T cells, forcing T cells to recognize and destroy the B cell tumor targets.

Question 19: A nurse notes an unexpected serious adverse event in a patient on a clinical trial. What is the MOST important immediate action?

Withdraw the patient from the study before reporting
Document the event in the chart, report to the principal investigator immediately, and complete the adverse event report per protocol (Correct answer)
Report directly to the FDA without involving the PI
Report the adverse event to the IRB within 10 business days

Correct answer: Document the event in the chart, report to the principal investigator immediately, and complete the adverse event report per protocol

Serious adverse events must be documented, immediately reported to the PI, and captured in the adverse event reporting system per the protocol's safety monitoring plan.

Question 20: A patient on long-term opioid therapy for cancer pain develops opioid-induced constipation unresponsive to stimulant laxatives. What is the MOST appropriate next intervention?

Administer methylnaltrexone (Relistor) to reverse peripheral opioid effects in the GI tract (Correct answer)
Discontinue the opioid and switch to NSAIDs
Increase dietary fiber intake to 30g/day
Administer a saline enema daily

Correct answer: Administer methylnaltrexone (Relistor) to reverse peripheral opioid effects in the GI tract

Methylnaltrexone is a peripherally acting mu-opioid receptor antagonist that reverses opioid-induced constipation without crossing the blood-brain barrier to reverse analgesia.

Question 21: Which situation BEST describes a breach of professional boundaries by an oncology nurse?

Accepting a small gift basket from a patient's family after discharge
Attending a patient's memorial service with the family's permission
Providing the personal phone number to a patient for after-hours contact (Correct answer)
Sitting with a distressed patient during a chemotherapy infusion

Correct answer: Providing the personal phone number to a patient for after-hours contact

Sharing personal contact information crosses professional boundaries by blurring the therapeutic relationship.

Question 22: Which dressing change frequency is recommended for a tunneled central venous catheter exit site according to current evidence-based guidelines?

Every 48 hours with antimicrobial gauze
Every 24 hours with gauze dressing
Every 7 days with transparent semi-permeable membrane dressing (unless soiled) (Correct answer)
Only when visibly soiled or loose

Correct answer: Every 7 days with transparent semi-permeable membrane dressing (unless soiled)

Current INS and CDC guidelines recommend transparent dressing changes every 7 days for tunneled CVC exit sites unless the dressing becomes wet, soiled, or loose.

Question 23: Which intervention helps prevent fibrin sheath formation on a central venous catheter?

Filling the catheter lumen with ethanol between uses
Flushing with 10 mL normal saline using a pulsatile push technique after each use (Correct answer)
Flushing with sterile water after each use
Using tissue plasminogen activator (tPA) prophylactically after every infusion

Correct answer: Flushing with 10 mL normal saline using a pulsatile push technique after each use

Pulsatile flushing with normal saline creates turbulence that dislodges debris and prevents fibrin accumulation on catheter walls.

Question 24: A patient receiving gemcitabine presents with fever of 39.2°C (102.6°F), dyspnea, and bilateral pulmonary infiltrates 48 hours after infusion. The nurse should suspect:

Gemcitabine-induced pulmonary toxicity (Correct answer)
Transfusion-related acute lung injury from a prior transfusion
Hospital-acquired pneumonia requiring antibiotics
Pulmonary embolism from hypercoagulable state

Correct answer: Gemcitabine-induced pulmonary toxicity

Gemcitabine can cause severe pulmonary toxicity presenting as acute respiratory distress with bilateral infiltrates temporally related to drug administration.

Question 25: What is the correct flushing sequence for a positive pressure implanted port after chemotherapy administration?

Heparin only → clamp
Saline → clamp → heparin
Saline → heparin → clamp while maintaining positive pressure (Correct answer)
Heparin → saline → clamp

Correct answer: Saline → heparin → clamp while maintaining positive pressure

The correct sequence is saline flush followed by heparin lock while maintaining positive pressure to prevent blood backflow and clot formation in the port.

Question 26: Which psychosocial assessment tool is recommended by ONS for identifying depression and anxiety in oncology patients receiving chemotherapy?

Hamilton Rating Scale for Depression (HAM-D)
Beck Anxiety Inventory (BAI)
Distress Thermometer with Problem List (Correct answer)
Mini-Mental State Examination (MMSE)

Correct answer: Distress Thermometer with Problem List

The NCCN Distress Thermometer with Problem List is a validated, quick screening tool recommended for identifying psychosocial distress in oncology patients.

Question 27: Which clinical findings are characteristic of superior vena cava (SVC) syndrome in an oncology patient?

Severe hypercalcemia, constipation, and confusion
Bilateral leg edema and dyspnea on exertion
Hypotension, bradycardia, and peripheral edema
Facial plethora, upper extremity edema, and distended neck veins (Correct answer)

Correct answer: Facial plethora, upper extremity edema, and distended neck veins

SVC syndrome presents with facial plethora, upper extremity and facial edema, and distended neck veins due to obstruction of venous return from the upper body.

Question 28: A nurse administers rasburicase to a patient for tumor lysis syndrome prophylaxis. Which laboratory precaution is ESSENTIAL?

Check BUN and creatinine before and after each dose
Monitor blood glucose levels for hypoglycemia
Monitor potassium levels every 2 hours post-administration
Draw uric acid samples in pre-chilled tubes and transport on ice immediately (Correct answer)

Correct answer: Draw uric acid samples in pre-chilled tubes and transport on ice immediately

Rasburicase continues to enzymatically degrade uric acid ex-vivo at room temperature; samples must be collected in pre-chilled tubes and transported on ice to ensure accurate results.

Question 29: A patient with advanced cancer rates their pain as 7/10 and is currently on scheduled oral morphine. Which WHO analgesic ladder principle guides the next step?

Increase the opioid dose or switch to a stronger opioid for uncontrolled moderate-to-severe pain (Correct answer)
Add a non-opioid adjuvant and remove the opioid
Switch to non-pharmacologic methods only
Reduce the opioid dose to prevent tolerance

Correct answer: Increase the opioid dose or switch to a stronger opioid for uncontrolled moderate-to-severe pain

The WHO analgesic ladder recommends stepping up to stronger opioids or increasing the current opioid dose when moderate-to-severe pain (≥7/10) is not controlled by the current regimen.

Question 30: Which chemotherapeutic agent is commonly linked with nephrotoxicity requiring pre- and post-hydration protocols?

Etoposide
Vincristine
Paclitaxel
Cisplatin (Correct answer)

Correct answer: Cisplatin

Cisplatin is nephrotoxic and necessitates aggressive IV hydration to prevent renal damage.

Question 31: Which dietary instruction is MOST appropriate for a patient with chemotherapy-induced taste alterations (dysgeusia)?

Eat only bland, flavorless foods
Increase salt intake to mask metallic tastes
Avoid all protein sources until taste normalizes
Experiment with cold or room-temperature foods and plastic utensils (Correct answer)

Correct answer: Experiment with cold or room-temperature foods and plastic utensils

Cold or room-temperature foods produce fewer odors and metallic tastes, and plastic utensils reduce the metallic taste often associated with chemotherapy.

ONS/ONCC Chemotherapy Immunotherapy Certificate (OCC)

The ONS/ONCC Chemotherapy Immunotherapy Certificate validates advanced-level knowledge of antineoplastic medication administration, safe drug handling, side effect management, and evidence-based oncology nursing practice. Candidates must score 80% or higher to earn this credential from the Oncology Nursing Society and Oncology Nursing Certification Corporation.

Questions

35 min

Time Limit

80%

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