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

Question 1: Before starting chemotherapy, which baseline assessment is most critical?

Electrocardiogram
Liver function tests
Complete blood count (CBC) (Correct answer)
Urinalysis

Correct answer: Complete blood count (CBC)

A Complete Blood Count (CBC) is the most critical baseline assessment before chemotherapy because many chemotherapy drugs are myelosuppressive, meaning they can suppress bone marrow function. This assessment provides vital information about the patient's white blood cells, red blood cells, and platelets, which helps determine if the patient can safely receive treatment and guides dose adjustments.

Question 2: Which quality improvement model is MOST commonly used in oncology nursing practice to implement and evaluate evidence-based changes?

PDSA (Plan-Do-Study-Act) cycle (Correct answer)
Failure mode and effects analysis (FMEA)
Root cause analysis (RCA)
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 3: CDK 4/6 inhibitors such as palbociclib are approved in combination with endocrine therapy for which breast cancer subtype?

Hormone receptor-positive/HER2-negative breast cancer (Correct answer)
Triple-negative breast cancer
Inflammatory breast cancer
HER2-positive breast cancer

Correct answer: Hormone receptor-positive/HER2-negative breast cancer

CDK 4/6 inhibitors arrest cell cycle progression at the G1/S checkpoint and are approved for HR+/HER2- advanced breast cancer in combination with endocrine therapy.

Question 4: 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)
Increase dietary fiber intake to 30g/day
Discontinue the opioid and switch to NSAIDs
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 5: Which type of central venous access device is MOST appropriate for a patient requiring 6 months of intermittent chemotherapy infusions?

Peripheral IV catheter
Non-tunneled central venous catheter
Implanted port (port-a-cath) (Correct answer)
Midline catheter

Correct answer: Implanted port (port-a-cath)

An implanted port is the preferred long-term vascular access device for intermittent chemotherapy due to its durability, low infection risk, and patient comfort.

Question 6: Which position should the nurse place a patient in if air embolism is suspected during central line removal?

Right lateral decubitus
Left lateral Trendelenburg (Durant's maneuver) (Correct answer)
High Fowler's position
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 7: Which clinical findings are characteristic of superior vena cava (SVC) syndrome in an oncology patient?

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

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 8: Why is documentation critical in oncology nursing?

It shortens shift time
It replaces verbal reporting
It helps justify overtime hours
It shows proof of professional accountability (Correct answer)

Correct answer: It shows proof of professional accountability

Comprehensive and accurate documentation in oncology nursing is crucial for demonstrating professional accountability and ensuring continuity of care. It provides a legal record of assessments, interventions, patient responses, and communication. This is vital for legal protection, quality assurance, and effective team collaboration, ensuring patient safety and optimal outcomes.

Question 9: A patient receiving chemotherapy reports moderate-to-severe cancer-related fatigue. Which assessment finding would indicate a potentially treatable contributing cause?

Weight loss of 2 lbs over 3 weeks
Mild insomnia reported by the patient
Hemoglobin of 7.5 g/dL with symptoms of dyspnea on exertion (Correct answer)
ANC of 2,000/mm³ at end of cycle

Correct answer: Hemoglobin of 7.5 g/dL with symptoms of dyspnea on exertion

Anemia (Hgb 7.5 g/dL) with symptomatic dyspnea is a directly treatable cause of cancer-related fatigue, warranting evaluation for RBC transfusion or erythropoiesis-stimulating agents.

Question 10: A patient is being screened for a clinical trial and is found to have a liver function test that exceeds the protocol's eligibility criteria. What does the nurse understand about this?

The patient cannot be enrolled; eligibility criteria are legally binding safety parameters that cannot be waived (Correct answer)
The exclusion applies only to the first 2 cycles and can be re-evaluated
The PI can waive the exclusion criterion for a qualified patient
The patient may enroll with a signed consent acknowledging the deviation

Correct answer: The patient cannot be enrolled; eligibility criteria are legally binding safety parameters that cannot be waived

Clinical trial eligibility criteria are binding safety and scientific parameters established in the protocol; enrollment of ineligible patients constitutes a protocol deviation or violation.

Question 11: A nurse is implementing a new evidence-based protocol for central line care. Which approach BEST demonstrates integration of evidence-based practice (EBP)?

Applying the protocol as written without adaptation to the patient population
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
Using only the most recent published study without consulting clinical experts

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 12: A patient with advanced cancer and dyspnea at rest has oxygen saturation of 94% on room air. Which intervention is MOST evidence-based for managing refractory dyspnea?

Pursed-lip breathing exercises as the sole intervention
High-flow oxygen regardless of saturation level
Low-dose oral or IV opioids to reduce the sensation of breathlessness (Correct answer)
Anxiolytics as first-line therapy

Correct answer: Low-dose oral or IV opioids to reduce the sensation of breathlessness

Low-dose opioids are the most evidence-based pharmacologic intervention for refractory dyspnea in cancer patients, regardless of oxygen saturation.

Question 13: A patient on high-dose ifosfamide becomes acutely confused, agitated, and develops visual hallucinations. What neurotoxic complication is occurring?

Electrolyte imbalance from vomiting
Wernicke's encephalopathy
Opioid toxicity
Ifosfamide-induced encephalopathy (Correct answer)

Correct answer: Ifosfamide-induced encephalopathy

Ifosfamide-induced encephalopathy is a potentially life-threatening CNS toxicity presenting with confusion, agitation, hallucinations, and seizures requiring immediate drug cessation.

Question 14: Which nutritional screening tool is MOST commonly recommended for oncology patients to identify malnutrition risk?

Body Mass Index (BMI) measurement alone
24-hour dietary recall only
Patient-Generated Subjective Global Assessment (PG-SGA) (Correct answer)
Serum albumin level

Correct answer: Patient-Generated Subjective Global Assessment (PG-SGA)

The PG-SGA is the oncology-specific nutrition screening tool validated for cancer patients, assessing weight loss, food intake, symptoms, functional capacity, and physical exam findings.

Question 15: Which factor MOST increases a patient's risk for chemotherapy extravasation injury?

Multiple prior IV attempts in the same vein and fragile veins (Correct answer)
Slow infusion rate over 60 minutes
Use of a large-bore peripheral IV catheter
Young age and good hydration status

Correct answer: Multiple prior IV attempts in the same vein and fragile veins

Fragile veins with multiple prior cannulation sites have compromised integrity, significantly increasing the risk of extravasation during chemotherapy infusion.

Question 16: Why is regular oral assessment important during chemotherapy?

To assess speech clarity
To check for tooth decay
To detect signs of mucositis (Correct answer)
To evaluate hydration status

Correct answer: To detect signs of mucositis

Regular oral assessment is crucial during chemotherapy because many agents cause mucositis, an inflammation and ulceration of the mucous membranes lining the digestive tract, including the mouth. Early detection allows for timely interventions to manage pain, prevent infection, and maintain nutritional intake. This significantly improves patient comfort and outcomes.

Question 17: A patient receiving high-dose cyclophosphamide reports severe bladder pain, urinary frequency, and grossly bloody urine. What complication has occurred?

Hemorrhagic cystitis from acrolein metabolite accumulation (Correct answer)
Bladder cancer as a late effect
Urinary tract infection
Renal failure from drug nephrotoxicity

Correct answer: Hemorrhagic cystitis from acrolein metabolite accumulation

Hemorrhagic cystitis is caused by acrolein, a toxic metabolite of cyclophosphamide that accumulates in the bladder, causing mucosal damage and bleeding.

Question 18: What is a core ethical principle guiding oncology nursing practice?

Competitiveness
Beneficence (Correct answer)
Negligence
Intimidation

Correct answer: Beneficence

Beneficence is a core ethical principle in nursing that mandates acting in the best interest of the patient and promoting their well-being. In oncology, this means providing compassionate care, alleviating suffering, and striving for positive outcomes. Nurses prioritize the patient's health and welfare in all aspects of their practice.

Question 19: Which dressing change frequency is recommended for a tunneled central venous catheter exit site according to current evidence-based guidelines?

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
Every 48 hours with antimicrobial gauze

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 20: A nurse wants to find the best evidence for managing chemotherapy-induced nausea. Which resource provides the MOST credible, peer-reviewed clinical practice guidelines?

ASCO, ONS, or NCCN clinical practice guidelines (Correct answer)
Patient advocacy websites
General internet search engines
Pharmaceutical manufacturer prescribing information only

Correct answer: ASCO, ONS, or NCCN clinical practice guidelines

Professional organization guidelines from ASCO, ONS, and NCCN are developed through systematic evidence review and expert consensus, providing the most credible clinical practice guidance.

Question 21: A nurse is preparing to access an implanted port. Which action is ESSENTIAL to prevent infection?

Use a non-coring Huber needle with strict aseptic technique (Correct answer)
Palpate the port without gloves to locate the septum accurately
Use the smallest gauge needle available
Clean the site with povidone-iodine and allow it to dry for 30 seconds

Correct answer: Use a non-coring Huber needle with strict aseptic technique

A non-coring Huber needle is required to access implanted ports without coring the silicone septum, and strict aseptic technique prevents catheter-related bloodstream infections.

Question 22: Which class of targeted therapy works by inhibiting the BCR-ABL tyrosine kinase, making it effective in chronic myeloid leukemia (CML)?

Tyrosine kinase inhibitors (TKIs) (Correct answer)
CDK 4/6 inhibitors
Monoclonal antibodies
mTOR inhibitors

Correct answer: Tyrosine kinase inhibitors (TKIs)

Tyrosine kinase inhibitors like imatinib directly block BCR-ABL, the constitutively active kinase driving CML proliferation.

Question 23: A patient receiving docetaxel develops periorbital edema and weight gain of 5 lbs in one week. What does the nurse recognize?

Capillary leak syndrome related to fluid accumulation (Correct answer)
Cardiac tamponade
Syndrome of inappropriate antidiuretic hormone (SIADH)
Allergic reaction requiring epinephrine

Correct answer: Capillary leak syndrome related to fluid accumulation

Docetaxel causes fluid retention and capillary leak syndrome manifesting as peripheral edema, pleural effusion, and weight gain.

Question 24: A patient with a power-injectable PICC requires a CT scan with contrast. What is the nurse's responsibility before the procedure?

Remove the PICC before the scan to prevent malfunction
Confirm the PICC is rated for power injection and document the maximum pressure and flow rate (Correct answer)
Flush the PICC with heparin before the scan
Instruct the radiologist to use peripheral access for contrast only

Correct answer: Confirm the PICC is rated for power injection and document the maximum pressure and flow rate

Power-injectable PICCs must be confirmed as rated for contrast injection, with maximum pressure and flow rate documented to prevent catheter rupture.

Question 25: A patient receiving CAR-T cell therapy develops fever (39.5°C), hypotension, and hypoxia 18 hours post-infusion. First-line treatment for this severe cytokine release syndrome (CRS) is:

Epinephrine 0.3 mg IM for presumed anaphylaxis
High-dose methylprednisolone 2 mg/kg IV
Tocilizumab (anti-IL-6 receptor antibody) (Correct answer)
Plasmapheresis to remove circulating cytokines

Correct answer: Tocilizumab (anti-IL-6 receptor antibody)

Tocilizumab, an anti-IL-6 receptor antibody, is the first-line treatment for severe CRS (grade ≥3) from CAR-T therapy, as IL-6 is the primary cytokine driving this syndrome.

Question 26: A patient's oncologist recommends a treatment listed as Category 1 in the NCCN Guidelines. What does this designation mean?

Expert opinion supports this as a preferred option with limited evidence
The treatment is experimental and only available in clinical trials
High-level evidence with uniform consensus that the recommendation is appropriate (Correct answer)
The treatment is approved by the FDA for this indication

Correct answer: High-level evidence with uniform consensus that the recommendation is appropriate

NCCN Category 1 designations indicate high-level evidence (usually from RCTs) with uniform consensus among NCCN panel members supporting the recommendation.

Question 27: A hospice patient with cancer develops the death rattle (noisy breathing). What is the MOST appropriate nursing intervention?

Initiate mechanical ventilation support
Administer high-dose diuretics to reduce secretions
Reposition the patient, explain the sound to family, and administer anticholinergic medications if ordered (Correct answer)
Perform aggressive oral suctioning to clear the airway

Correct answer: Reposition the patient, explain the sound to family, and administer anticholinergic medications if ordered

The death rattle results from secretions the patient can no longer clear; repositioning helps drainage, family education reduces distress, and anticholinergics (glycopyrrolate/hyoscine) reduce secretion production.

Question 28: Which patient statement about managing chemotherapy-induced constipation indicates a need for further teaching?

I should take an over-the-counter enema if I miss more than one day (Correct answer)
I will use a stimulant laxative as directed by my provider
I will increase my fiber intake and fluid consumption
I will report any abdominal pain or bloating to my nurse

Correct answer: I should take an over-the-counter enema if I miss more than one day

Enemas are contraindicated in neutropenic or thrombocytopenic cancer patients due to risk of infection and rectal bleeding.

Question 29: Which symptom requires immediate attention during chemotherapy infusion?

Mild nausea
Loss of appetite
Shortness of breath (Correct answer)
Fatigue

Correct answer: Shortness of breath

Shortness of breath during chemotherapy infusion can indicate a serious adverse reaction, such as an allergic reaction, pulmonary toxicity, or fluid overload, which requires immediate medical intervention. While fatigue, mild nausea, and loss of appetite are common side effects, shortness of breath signals a potentially life-threatening emergency that demands prompt assessment and action.

Question 30: 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 drug has no effect because the HR is less than 1.0
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%

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 31: A patient with a new PICC line develops sudden onset of dyspnea, hypotension, and a 'sucking' sound during catheter manipulation. What complication is occurring?

Air embolism (Correct answer)
Pneumothorax
Pulmonary embolism
Catheter fracture

Correct answer: Air embolism

Air embolism can occur during open central catheter manipulation and presents with sudden dyspnea, hypotension, and a mill-wheel murmur or sucking sound.

Question 32: Which intervention is the MOST critical in preventing tumor lysis syndrome in high-risk patients?

Placing the patient on continuous telemetry only
Restricting dietary potassium
Administering calcium gluconate prophylactically
Aggressive IV hydration and allopurinol or rasburicase administration before chemotherapy (Correct answer)

Correct answer: Aggressive IV hydration and allopurinol or rasburicase administration before chemotherapy

Aggressive IV hydration dilutes metabolites and promotes renal excretion, while allopurinol or rasburicase prevents uric acid accumulation before chemotherapy initiation.

Question 33: A nurse notes an unexpected serious adverse event in a patient on a clinical trial. What is the MOST important immediate action?

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
Withdraw the patient from the study before reporting

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 34: A patient with advanced cancer is transitioning to hospice care. What is the PRIMARY goal of hospice care?

Achieve remission using aggressive chemotherapy
Maximize comfort, dignity, and quality of life while supporting the patient and family (Correct answer)
Prolong survival at all costs with curative intent
Provide wound care and medication management only

Correct answer: Maximize comfort, dignity, and quality of life while supporting the patient and family

Hospice care's primary goal is comfort-focused care that maximizes quality of life, manages symptoms, and supports the patient and family through the dying process.

Question 35: 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?

Override the patient's decision because comfort is the primary goal of hospice
Consult psychiatry for assessment of decision-making capacity
Document the refusal and take no further action
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 36: Which laboratory pattern is most consistent with checkpoint inhibitor-induced immune-related thyroiditis progressing to hypothyroidism?

Hyperkalemia with hyponatremia (adrenal pattern)
Low cortisol with elevated ACTH (pituitary pattern)
Elevated LH and FSH with low estrogen
Elevated TSH with low free T4 (Correct answer)

Correct answer: Elevated TSH with low free T4

Checkpoint inhibitor-induced thyroiditis most commonly results in hypothyroidism (elevated TSH, low free T4), which typically requires lifelong levothyroxine replacement.

Question 37: A patient's ANC is 450/mm³ on day 10 of their chemotherapy cycle. What is the nurse's priority intervention?

Continue normal care with standard handwashing only
Delay the neutropenic precautions until ANC is below 100/mm³
Restrict all visitors and enforce neutropenic precautions (Correct answer)
Administer prophylactic antibiotics without a provider order

Correct answer: Restrict all visitors and enforce neutropenic precautions

An ANC below 500/mm³ indicates severe neutropenia, requiring immediate implementation of neutropenic precautions to prevent life-threatening infection.

Question 38: Which chemotherapy agent requires extra caution with peripheral IV administration due to its extreme vesicant properties?

Vincristine (Correct answer)
Cyclophosphamide
Carboplatin
Fluorouracil (5-FU)

Correct answer: Vincristine

Vincristine is a potent vesicant that causes severe tissue necrosis on extravasation, requiring central venous access and vigilant infusion monitoring.

Question 39: A patient receiving a continuous 5-FU infusion via ambulatory pump reports that the pump alarmed and the site feels warm. What is the nurse's priority?

Increase the infusion rate to complete the dose on schedule
Apply a warm compress and continue monitoring
Stop the infusion, assess for extravasation, and notify the provider (Correct answer)
Reset the pump alarm and reassess in 30 minutes

Correct answer: Stop the infusion, assess for extravasation, and notify the provider

Warmth at the infusion site during chemotherapy administration suggests possible extravasation, requiring immediate cessation and assessment.

Question 40: Trastuzumab (Herceptin) targets which receptor overexpressed in HER2-positive breast cancer?

VEGFR-2
HER2/neu (ErbB2) (Correct answer)
EGFR (HER1)
HER3

Correct answer: HER2/neu (ErbB2)

Trastuzumab is a monoclonal antibody that selectively binds to the extracellular domain of HER2/neu (ErbB2), inhibiting downstream proliferative signaling.

Question 41: Which integrative therapy has BEST evidence for reducing chemotherapy-related nausea and vomiting as a complement to antiemetics?

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

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 42: What should be done immediately after a chemotherapy spill on a countertop?

Use a chemotherapy spill kit (Correct answer)
Cover it with a paper towel
Leave the area and wait for supervisor
Call housekeeping services

Correct answer: Use a chemotherapy spill kit

A chemotherapy spill is a hazardous incident that requires immediate and specialized handling to protect staff and patients from exposure. A designated chemotherapy spill kit contains the necessary PPE, absorbent materials, and disposal bags. This allows for safe containment, cleaning, and disposal of the spilled hazardous drug according to established protocols, minimizing risk.

Question 43: Which patient population is at HIGHEST risk for developing oral mucositis during chemotherapy?

Patients receiving immunotherapy checkpoint inhibitors
Patients receiving hormonal therapy for breast cancer
Patients receiving oral targeted therapies only
Patients receiving high-dose methotrexate, 5-FU, or those undergoing bone marrow transplant conditioning (Correct answer)

Correct answer: Patients receiving high-dose methotrexate, 5-FU, or those undergoing bone marrow transplant conditioning

High-dose antimetabolites (methotrexate, 5-FU) and myeloablative conditioning regimens for bone marrow transplant carry the highest risk of severe oral mucositis.

Question 44: The nurse is educating a patient with a tunneled Hickman catheter about home care. Which instruction is MOST important?

Change the cap and flush the catheter per the prescribed protocol, and report fever above 100.4°F (Correct answer)
Remove the dressing daily to inspect the exit site
Submerge the catheter in water briefly during bathing
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 45: 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)
Using tissue plasminogen activator (tPA) prophylactically after every infusion
Flushing with sterile water after each use

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 46: Hand-foot skin reaction (HFSR) with painful, thickened skin on palms and soles is a characteristic toxicity of which class?

CDK 4/6 inhibitors (palbociclib, ribociclib)
Proteasome inhibitors (bortezomib, carfilzomib)
Multikinase inhibitors targeting VEGFR (sorafenib, sunitinib) (Correct answer)
Anti-PD-1 monoclonal antibodies (pembrolizumab, nivolumab)

Correct answer: Multikinase inhibitors targeting VEGFR (sorafenib, sunitinib)

HFSR is a class effect of VEGFR-targeting multikinase inhibitors (sorafenib, sunitinib, regorafenib, cabozantinib) due to disruption of skin repair mechanisms.

Question 47: Why is a closed-system transfer device (CSTD) recommended during chemotherapy preparation?

To prevent exposure to hazardous drugs (Correct answer)
To reduce medication cost
To speed up drug reconstitution
To prevent microbial contamination

Correct answer: To prevent exposure to hazardous drugs

A Closed-System Transfer Device (CSTD) is specifically designed to prevent the escape of hazardous drug aerosols or vapors into the environment and the entry of environmental contaminants into the drug. This technology significantly reduces healthcare worker exposure to chemotherapy drugs during preparation and administration. It enhances safety for personnel handling these potent medications.

Question 48: Which class of chemotherapeutic agents is known to cause cardiotoxicity as a major side effect?

Topoisomerase inhibitors
Alkylating agents
Antimetabolites
Anthracyclines (Correct answer)

Correct answer: Anthracyclines

Anthracyclines, such as doxorubicin, are known for their effectiveness but also for their potential to cause dose-dependent cardiotoxicity.

Question 49: A patient with cancer-related anorexia-cachexia syndrome asks if there are medications that can help with appetite. Which agent has FDA approval for this indication in cancer patients?

Megestrol acetate (Megace) (Correct answer)
Metoclopramide
Dexamethasone at standard doses
Ondansetron

Correct answer: Megestrol acetate (Megace)

Megestrol acetate is FDA-approved for treating anorexia and cachexia in cancer patients and promotes appetite and weight gain through progesterone receptor activity.

Question 50: 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
5 mL rapidly to clear the needle
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)

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 51: A patient on high-dose methotrexate reports decreased urine output and dark urine. Which intervention should the nurse anticipate?

Administering leucovorin rescue immediately without provider order
Stopping oral medications only
Increasing urine alkalinization with sodium bicarbonate and aggressive hydration (Correct answer)
Restricting IV fluids to prevent overload

Correct answer: Increasing urine alkalinization with sodium bicarbonate and aggressive hydration

Urine alkalinization and aggressive hydration prevent methotrexate precipitation in the renal tubules, reducing nephrotoxicity risk.

Question 52: Ipilimumab was the first FDA-approved immune checkpoint inhibitor (2011) and targets which molecule?

PD-1 on T cells
PD-L1 on tumor cells
CTLA-4 on T cells (Correct answer)
CD28 on T cells

Correct answer: CTLA-4 on T cells

Ipilimumab targets CTLA-4, a negative regulator of T cell activation in lymph nodes, thereby amplifying anti-tumor immune responses in melanoma.

Question 53: A cancer patient receiving corticosteroids long-term for symptom management is at risk for which complication requiring prophylactic management?

Renal failure and electrolyte wasting
Peripheral neuropathy and cardiac arrhythmias
Osteoporosis, hyperglycemia, and Pneumocystis jirovecii pneumonia (PCP) (Correct answer)
Thrombocytopenia and bleeding

Correct answer: Osteoporosis, hyperglycemia, and Pneumocystis jirovecii pneumonia (PCP)

Long-term corticosteroid use in cancer patients risks osteoporosis, steroid-induced hyperglycemia, immunosuppression, and PCP, often requiring prophylactic calcium/vitamin D, glucose monitoring, and TMP-SMX.

Question 54: Which intervention is MOST effective for managing cancer-related depression in oncology patients?

Administering corticosteroids to improve mood
Combined pharmacotherapy (antidepressants) and psychotherapy (CBT or supportive counseling) (Correct answer)
Opioid dose reduction
Increasing physical activity without any pharmacotherapy

Correct answer: Combined pharmacotherapy (antidepressants) and psychotherapy (CBT or supportive counseling)

The combination of antidepressant pharmacotherapy with psychotherapy (especially CBT) has the strongest evidence for treating cancer-related depression.

Question 55: A patient reports severe burning at the IV site during vincristine infusion. The nurse notes swelling and blanching. What is the IMMEDIATE action?

Flush the line with normal saline forcefully
Apply a warm compress and continue the infusion
Stop the infusion, disconnect the IV, aspirate residual drug, and notify the provider (Correct answer)
Slow the infusion rate and apply ice

Correct answer: Stop the infusion, disconnect the IV, aspirate residual drug, and notify the provider

These signs indicate extravasation; the infusion must be stopped immediately and residual drug aspirated before any other intervention to minimize tissue damage.

Question 56: Why is confidentiality important in oncology nursing practice?

To protect patient privacy and trust (Correct answer)
To avoid legal issues
To avoid documenting sensitive information
To reduce workload

Correct answer: To protect patient privacy and trust

Confidentiality is paramount in oncology nursing to safeguard sensitive patient information and maintain the patient's trust in healthcare providers. Protecting privacy ensures patients feel secure sharing personal details, which is crucial for accurate diagnosis and effective treatment planning. It also upholds their fundamental right to privacy.

Question 57: A patient with prostate cancer metastatic to the spine develops sudden onset of lower extremity weakness and urinary retention. What emergency should the nurse suspect?

Leptomeningeal carcinomatosis
Spinal cord compression from epidural metastasis (Correct answer)
Chemotherapy-induced peripheral neuropathy
Deep vein thrombosis

Correct answer: Spinal cord compression from epidural metastasis

New neurological deficits and urinary retention in a cancer patient with spinal metastases indicate malignant spinal cord compression, a neurological emergency requiring immediate intervention.

Question 58: Which finding would MOST concern the oncology nurse when caring for a patient experiencing chemotherapy-induced peripheral neuropathy (CIPN)?

Sensitivity to cold during oxaliplatin infusion
Temporary numbness after infusion
Inability to button a shirt or walk without assistance (Correct answer)
Mild tingling in fingertips

Correct answer: Inability to button a shirt or walk without assistance

Loss of fine motor control and gait instability indicate severe functional impairment from CIPN, requiring urgent provider notification and possible dose modification.

Question 59: Which sleep hygiene strategy has the STRONGEST evidence for managing insomnia in cancer patients?

Long-term benzodiazepine use as first-line therapy
Melatonin supplementation as the only non-pharmacologic intervention
Cognitive behavioral therapy for insomnia (CBT-I) (Correct answer)
Daytime naps of 3+ hours to compensate for nighttime sleep loss

Correct answer: Cognitive behavioral therapy for insomnia (CBT-I)

CBT-I is the first-line, evidence-based treatment for insomnia in cancer patients, with sustained benefits that outlast pharmacologic interventions.

Question 60: Which assessment scale is MOST appropriate for evaluating pain in an oncology patient with moderate cognitive impairment?

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

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 61: What is the nurse's FIRST action when a patient on chemotherapy develops signs of anaphylaxis (urticaria, bronchospasm, hypotension)?

Administer corticosteroids IV and observe for 15 minutes
Document the reaction and notify the provider after stabilizing the patient
Slow the infusion rate and administer diphenhydramine
Stop the infusion immediately, call for help, and prepare epinephrine (Correct answer)

Correct answer: Stop the infusion immediately, call for help, and prepare epinephrine

Anaphylaxis is a life-threatening emergency requiring immediate infusion cessation, activation of emergency response, and administration of epinephrine.

Question 62: A patient with advanced cancer is being discharged with a PCA pump for home pain management. Which education point is MOST critical for caregiver safety?

Only the patient should press the PCA button; caregiver-controlled dosing increases overdose risk (Correct answer)
Caregivers should increase the basal rate if the patient's pain is uncontrolled
The PCA can be used by anyone in the home for breakthrough pain management
Caregivers may press the PCA button for the patient when they appear uncomfortable

Correct answer: Only the patient should press the PCA button; caregiver-controlled dosing increases overdose risk

PCA is designed for patient-only activation; caregiver- or nurse-activated dosing bypasses the safety feature that prevents dosing while the patient is sedated, risking respiratory depression.

Question 63: Which finding indicates a patient with cancer-associated hypercoagulability has developed a pulmonary embolism (PE)?

Gradual onset of bilateral leg edema over 3 days
Fever and productive cough with purulent sputum
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 64: A patient post-bone marrow transplant develops fever, diarrhea with bloody stool, and a maculopapular rash on the palms and soles. What complication is suspected?

Chemotherapy-induced mucositis
Clostridium difficile infection
Cytomegalovirus colitis
Graft-versus-host disease (GVHD) (Correct answer)

Correct answer: Graft-versus-host disease (GVHD)

The triad of fever, diarrhea, and maculopapular skin rash (especially palms/soles) post-transplant is classic for acute graft-versus-host disease.

Question 65: Which study design provides the HIGHEST level of evidence for evaluating the effectiveness of a new chemotherapy regimen?

Randomized controlled trial (RCT) (Correct answer)
Expert consensus guidelines
Case series
Retrospective cohort study

Correct answer: Randomized controlled trial (RCT)

The randomized controlled trial is the gold standard study design for establishing causal efficacy by minimizing bias through randomization and controlled comparison.

Question 66: A patient enrolled in a Phase I clinical trial asks the nurse what the primary goal of this phase is. What is the correct response?

To evaluate the drug's safety, tolerability, and maximum tolerated dose in humans (Correct answer)
To confirm the drug's benefit in a large population
To compare the new drug with the current standard of care
To determine the drug's effectiveness in treating the cancer

Correct answer: To evaluate the drug's safety, tolerability, and maximum tolerated dose in humans

Phase I trials primarily establish safety, tolerability, pharmacokinetics, and maximum tolerated dose in a small group of patients, not efficacy.

Question 67: A patient with a PICC line develops pain, erythema, and a palpable cord along the arm. What complication does the nurse suspect?

Catheter migration
Air embolism
Catheter occlusion
Thrombophlebitis (Correct answer)

Correct answer: Thrombophlebitis

Pain, redness, and a palpable cord along the vessel indicate thrombophlebitis, a known complication of PICC lines requiring immediate evaluation.

Question 68: Which clinical presentation is most consistent with septic shock in a neutropenic oncology patient?

Temperature of 101°F, normal blood pressure, elevated WBC of 12,000/mm³
Temperature of 100.6°F, systolic BP of 85 mmHg despite fluid resuscitation, lactate of 3.2 mmol/L (Correct answer)
Temperature of 99.8°F, tachycardia of 95 bpm, ANC of 1,500/mm³
Temperature of 99.0°F, normal blood pressure, ANC of 800/mm³

Correct answer: Temperature of 100.6°F, systolic BP of 85 mmHg despite fluid resuscitation, lactate of 3.2 mmol/L

Septic shock is defined by infection-related hypotension refractory to fluid resuscitation and elevated lactate (≥2 mmol/L) indicating tissue hypoperfusion.

Question 69: A patient receiving cisplatin-based chemotherapy develops a serum creatinine of 2.1 mg/dL. Which intervention is the highest priority?

Hold the next cisplatin dose and notify the oncologist (Correct answer)
Administer furosemide immediately
Increase the infusion rate to clear the drug faster
Administer sodium bicarbonate IV

Correct answer: Hold the next cisplatin dose and notify the oncologist

Cisplatin is nephrotoxic, and a rising creatinine indicates renal impairment requiring dose hold and provider notification before proceeding.

Question 70: Which document outlines the ethical principles for conducting research involving human subjects and forms the foundation of clinical trial ethics in the US?

Belmont Report (Correct answer)
Declaration of Helsinki
Common Rule (45 CFR 46)
Nuremberg Code

Correct answer: Belmont Report

The Belmont Report (1979) established the foundational ethical principles of respect for persons, beneficence, and justice for all US federally funded human subjects research.

Question 71: The nurse suspects a PICC line has migrated based on the patient's complaint of gurgling sounds in the ear during infusion. What does this indicate?

Air in the infusion line
Catheter tip has migrated into the jugular vein (Correct answer)
Normal catheter sounds during infusion
The patient has developed atrial fibrillation

Correct answer: Catheter tip has migrated into the jugular vein

Gurgling or swishing sounds in the ear during PICC infusion indicate catheter tip migration into the jugular vein, requiring imaging confirmation and repositioning.

Question 72: A patient with lung cancer on opioids develops progressive confusion, hyperreflexia, and seizures. Labs show serum sodium of 118 mEq/L. What is occurring?

Syndrome of inappropriate antidiuretic hormone (SIADH) (Correct answer)
Tumor lysis syndrome
Opioid toxicity
Hypercalcemia of malignancy

Correct answer: Syndrome of inappropriate antidiuretic hormone (SIADH)

SIADH causes dilutional hyponatremia with neurological manifestations; it is common in small cell lung cancer due to ectopic ADH secretion.

Question 73: Which is the MOST appropriate initial nursing intervention for a patient who develops cardiac tamponade from a malignant pericardial effusion?

Position the patient upright, administer IV fluids, and prepare for emergency pericardiocentesis (Correct answer)
Administer IV furosemide to reduce fluid accumulation
Initiate CPR immediately
Place the patient supine and administer nitroglycerin

Correct answer: Position the patient upright, administer IV fluids, and prepare for emergency pericardiocentesis

Cardiac tamponade requires upright positioning to optimize venous return, IV fluids to maintain preload, and preparation for emergency pericardiocentesis to relieve pressure.

Question 74: After extravasation of doxorubicin, what is the recommended topical treatment to minimize tissue damage?

Apply cold compress and administer dexrazoxane IV per protocol (Correct answer)
Apply hyaluronidase topically to the site
Apply warm compress for 20 minutes four times daily
Inject sodium thiosulfate subcutaneously around the site

Correct answer: Apply cold compress and administer dexrazoxane IV per protocol

Cold compresses limit drug spread, and dexrazoxane is the FDA-approved antidote for anthracycline extravasation that prevents progressive tissue necrosis.

Question 75: A patient on a clinical trial wants to withdraw from the study. What does the nurse explain about their rights?

Withdrawal is only permitted if the PI approves the reason
The patient can withdraw at any time without penalty or loss of standard care benefits (Correct answer)
Withdrawal requires a 30-day notice period per protocol
The patient must complete the study since they signed the consent form

Correct answer: The patient can withdraw at any time without penalty or loss of standard care benefits

Patients have the right to withdraw from any clinical trial at any time without penalty, coercion, or loss of access to standard care, as guaranteed by federal research ethics regulations.

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

90 min

Time Limit

80%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

ons.org — Test delivery, fees, passing score, retake policy, test dates, score validity, late registration, renewal · verified Oct 2026