OCN Oncology Certified Nurse Exam — Questions and Answers

Question 1: A patient with multiple myeloma presents with confusion, polyuria, and constipation. Serum calcium is 13.5 mg/dL. The priority nursing intervention is:

Initiate aggressive IV hydration with normal saline (Correct answer)
Restrict fluid intake
Administer oral calcium supplements
Administer IV bisphosphonates immediately

Correct answer: Initiate aggressive IV hydration with normal saline

Aggressive IV hydration with normal saline is the first-line treatment for hypercalcemia of malignancy to dilute calcium and promote renal excretion.

Question 2: A nurse wants to renew the OCN credential through continuing education. How many CE hours are required for renewal?

20 CE hours
10 CE hours
45 CE hours
30 CE hours (Correct answer)

Correct answer: 30 CE hours

Renewal through CE requires 30 oncology-specific nursing contact hours within the 4-year certification period.

Question 3: Disseminated intravascular coagulation (DIC) in cancer is most commonly associated with which malignancy?

Breast cancer
Acute promyelocytic leukemia (APL) (Correct answer)
Chronic lymphocytic leukemia
Multiple myeloma

Correct answer: Acute promyelocytic leukemia (APL)

APL (AML-M3) is classically associated with DIC due to release of procoagulant granules from malignant promyelocytes.

Question 4: A patient receiving cisplatin-based chemotherapy should be monitored most closely for which electrolyte imbalance?

Hypernatremia
Hypercalcemia
Hyperkalemia
Hypomagnesemia (Correct answer)

Correct answer: Hypomagnesemia

Cisplatin causes renal tubular damage leading to significant magnesium wasting and hypomagnesemia.

Question 5: A patient receiving bleomycin should be monitored closely for which life-threatening complication?

Cardiac arrhythmia
Pulmonary fibrosis (Correct answer)
Hepatic veno-occlusive disease
Renal failure

Correct answer: Pulmonary fibrosis

Bleomycin can cause pulmonary fibrosis and pneumonitis; cumulative dose limits and pulmonary function monitoring are essential.

Question 6: Which drug class inhibits the mammalian target of rapamycin (mTOR) pathway in cancer treatment?

Everolimus and temsirolimus (Correct answer)
Bevacizumab and ramucirumab
Ipilimumab and nivolumab
Erlotinib and gefitinib

Correct answer: Everolimus and temsirolimus

Everolimus and temsirolimus are mTOR inhibitors used in renal cell carcinoma, neuroendocrine tumors, and certain breast cancers.

Question 7: A newly diagnosed cancer patient tells the nurse, 'I just can't believe this is happening to me.' The nurse's best therapeutic response is:

'Everything will be fine, many people beat cancer.'
'You need to stay positive to fight this disease.'
'Let me give you the statistics on your survival odds.'
'I understand this must be very difficult and shocking for you right now.' (Correct answer)

Correct answer: 'I understand this must be very difficult and shocking for you right now.'

Acknowledging the patient's emotional state with empathic reflection validates their experience and builds therapeutic trust.

Question 8: The MASCC risk index is used in oncology to:

Predict 5-year survival
Calculate chemotherapy dosing
Identify low-risk febrile neutropenia patients eligible for oral antibiotics (Correct answer)
Stage solid tumors

Correct answer: Identify low-risk febrile neutropenia patients eligible for oral antibiotics

The MASCC (Multinational Association for Supportive Care in Cancer) score stratifies febrile neutropenia into low vs. high risk, guiding outpatient vs. inpatient management.

Question 9: Palliative sedation is defined as:

Routine sedation for procedures
Intentionally reducing consciousness to relieve refractory suffering at end of life (Correct answer)
Using benzodiazepines to treat chemotherapy anxiety
Administering opioids to hasten death

Correct answer: Intentionally reducing consciousness to relieve refractory suffering at end of life

Palliative sedation is the monitored use of sedating medications to reduce consciousness in terminally ill patients with refractory, intractable suffering.

Question 10: What is the most appropriate dietary recommendation for a patient experiencing radiation-induced diarrhea from pelvic irradiation?

Liquid-only diet for the duration of radiation treatment
Low-residue, low-fat diet avoiding raw fruits, vegetables, and dairy (Correct answer)
High-fiber diet with increased raw vegetables and whole grains
High-protein diet with increased red meat intake

Correct answer: Low-residue, low-fat diet avoiding raw fruits, vegetables, and dairy

A low-residue, low-fat diet reduces bowel stimulation and stool frequency, easing radiation-induced diarrhea by decreasing the bulk that passes through the irritated bowel.

Question 11: Which antifungal drug interaction is most important to monitor in patients receiving voriconazole and certain chemotherapy agents?

Decreased steroid effectiveness
Increased antibiotic resistance
CYP450 enzyme inhibition increasing chemotherapy drug levels (Correct answer)
Reduced antiemetic efficacy

Correct answer: CYP450 enzyme inhibition increasing chemotherapy drug levels

Voriconazole inhibits CYP450 enzymes and can dramatically increase plasma levels of chemotherapy drugs metabolized by the same pathway, causing toxicity.

Question 12: Cancer-related fatigue (CRF) differs from normal fatigue in which key way?

CRF is not relieved by rest or sleep (Correct answer)
CRF only occurs during chemotherapy
CRF is caused only by anemia
CRF resolves after one full night of sleep

Correct answer: CRF is not relieved by rest or sleep

Cancer-related fatigue is uniquely persistent and is not relieved by rest, distinguishing it from normal activity-related fatigue.

Question 13: A patient completing chemotherapy asks when their hair will return. The nurse's best evidence-based response is:

Most patients see hair regrowth within 3–6 months after chemotherapy ends (Correct answer)
Hair will return within 2 weeks of the last dose
Hair loss is permanent for all chemotherapy patients
Hair may never return after any chemotherapy

Correct answer: Most patients see hair regrowth within 3–6 months after chemotherapy ends

Hair typically begins to regrow within 3–6 months after chemotherapy ends, though texture and color may initially differ from pre-treatment hair.

Question 14: Lymphedema education for a patient who had axillary lymph node dissection should include which instruction?

Avoid all physical activity permanently
Restrict fluid intake to reduce swelling
Apply tight compression wraps daily without guidance
Avoid blood pressure cuffs and blood draws on the affected arm (Correct answer)

Correct answer: Avoid blood pressure cuffs and blood draws on the affected arm

BP cuffs and venipuncture on the affected arm increase lymphatic load and infection risk, and should be avoided to prevent or worsen lymphedema.

Question 15: What cumulative dose of doxorubicin is associated with the greatest risk of cardiomyopathy?

750 mg/m²
100 mg/m²
450–550 mg/m² (Correct answer)
200 mg/m²

Correct answer: 450–550 mg/m²

Cardiotoxicity from doxorubicin significantly increases when the cumulative dose exceeds 450–550 mg/m².

Question 16: The immune system recognizes cancer cells through a process called immune surveillance. Which cells are the primary cancer-killing effectors?

Platelets and red blood cells
B lymphocytes exclusively
Eosinophils and basophils
Cytotoxic T lymphocytes (CD8+ T cells) and natural killer (NK) cells (Correct answer)

Correct answer: Cytotoxic T lymphocytes (CD8+ T cells) and natural killer (NK) cells

CD8+ cytotoxic T cells and NK cells are the primary immune effectors that recognize and destroy cancer cells expressing tumor-associated antigens.

Question 17: A patient is prescribed bevacizumab. The nurse knows this drug targets which molecular pathway?

BCR-ABL tyrosine kinase
HER2/neu receptor
Vascular endothelial growth factor (VEGF) (Correct answer)
EGFR tyrosine kinase

Correct answer: Vascular endothelial growth factor (VEGF)

Bevacizumab is a monoclonal antibody that targets VEGF, inhibiting tumor angiogenesis.

Question 18: Which of the following is the correct definition of brachytherapy?

Systemic radiolabeled antibody therapy
Fractionated external beam radiation
High-energy proton beam delivered externally
Radioactive source placed inside or near the tumor (Correct answer)

Correct answer: Radioactive source placed inside or near the tumor

Brachytherapy involves placing a radioactive source directly inside or adjacent to the tumor, delivering high local doses.

Question 19: Which psychological condition is most common in cancer survivors and requires routine screening?

Bipolar disorder
Personality disorders
Depression and anxiety (Correct answer)
Schizophrenia

Correct answer: Depression and anxiety

Depression and anxiety affect up to 40% of cancer survivors and should be routinely screened using validated tools such as the PHQ-9 and GAD-7.

Question 20: CAR-T cell therapy requires which critical patient preparation step?

High-dose steroid premedication only
Bone marrow biopsy on day of infusion
Complete fasting for 24 hours
Lymphodepleting chemotherapy before infusion (Correct answer)

Correct answer: Lymphodepleting chemotherapy before infusion

Lymphodepleting chemotherapy (conditioning) before CAR-T infusion removes endogenous lymphocytes to create space for the engineered T-cells to expand.

Question 21: A patient receiving immunotherapy with pembrolizumab develops a new onset dry cough and dyspnea at rest. The nurse should suspect:

Pulmonary embolism from prolonged immobility
Pleural effusion from disease progression
Immune-mediated pneumonitis (Correct answer)
Hospital-acquired pneumonia

Correct answer: Immune-mediated pneumonitis

PD-1 inhibitors like pembrolizumab can cause immune-related pneumonitis, requiring prompt evaluation and possible immunosuppressive therapy.

Question 22: Which organization administers the OCN certification examination?

National League for Nursing
American Society of Clinical Oncology
Oncology Nursing Certification Corporation (Correct answer)
American Nurses Association

Correct answer: Oncology Nursing Certification Corporation

The Oncology Nursing Certification Corporation (ONCC) is the body responsible for administering the OCN and other oncology nursing credentials.

Question 23: A cancer patient is receiving high-dose methotrexate. What is the primary antidote used to rescue normal cells?

Mesna
Leucovorin (folinic acid) (Correct answer)
Amifostine
Dexrazoxane

Correct answer: Leucovorin (folinic acid)

Leucovorin (folinic acid) rescue bypasses the dihydrofolate reductase blockade caused by methotrexate, protecting normal cells from folate depletion toxicity.

Question 24: Which assessment tool is recommended by ONS for routine screening of cancer symptom burden?

Edmonton Symptom Assessment System (ESAS) (Correct answer)
APACHE II Score
Glasgow Coma Scale
Confusion Assessment Method (CAM)

Correct answer: Edmonton Symptom Assessment System (ESAS)

The Edmonton Symptom Assessment System (ESAS) is a validated, multi-symptom tool widely endorsed for routine oncology symptom screening.

Question 25: A patient with bone metastases reports sudden inability to void and new lower extremity weakness. The nurse should suspect:

Spinal cord compression — a medical emergency (Correct answer)
Urinary tract infection
Dehydration
Medication side effect from antiemetics

Correct answer: Spinal cord compression — a medical emergency

Urinary retention combined with new lower extremity weakness in a patient with bone metastases signals spinal cord compression, requiring emergent imaging and intervention.

Question 26: Which process allows cancer cells to invade surrounding tissues by breaking down the extracellular matrix?

Increased cell adhesion
Decreased VEGF production
Matrix metalloproteinase (MMP) secretion (Correct answer)
Upregulation of E-cadherin

Correct answer: Matrix metalloproteinase (MMP) secretion

Cancer cells secrete matrix metalloproteinases (MMPs) that degrade the basement membrane and extracellular matrix, enabling local invasion and metastasis.

Question 27: Which non-pharmacological intervention has the strongest evidence for reducing cancer-related fatigue?

Massage therapy alone
High-dose vitamins
Moderate aerobic exercise (Correct answer)
Complete bed rest

Correct answer: Moderate aerobic exercise

Multiple systematic reviews show that moderate aerobic exercise is the most evidence-based non-pharmacological intervention for cancer-related fatigue.

Question 28: A nurse notes that a patient's absolute neutrophil count (ANC) is 450 cells/mm³. Which classification and action is correct?

Normal range; no special precautions needed
Critical value; administer packed red blood cells immediately
Mild neutropenia; encourage handwashing only
Severe neutropenia (< 500); initiate neutropenic precautions and notify provider (Correct answer)

Correct answer: Severe neutropenia (< 500); initiate neutropenic precautions and notify provider

An ANC below 500 cells/mm³ is severe neutropenia, placing the patient at very high infection risk and requiring immediate neutropenic precautions, provider notification, and possible filgrastim therapy.

Question 29: Which cancer screening test detects precancerous lesions and is recommended for cervical cancer prevention?

Chest CT scan
CA-125 blood test
Colonoscopy only
Papanicolaou (Pap) smear and HPV testing (Correct answer)

Correct answer: Papanicolaou (Pap) smear and HPV testing

Pap smear and co-testing with HPV detection identify cervical dysplasia before it progresses to invasive cancer, making cervical cancer highly preventable.

Question 30: What is the purpose of using a CVAD (central venous access device) for chemotherapy?

To allow the patient to go home sooner
To reduce drug costs
To safely administer vesicants and reduce peripheral vein damage (Correct answer)
To improve oral bioavailability

Correct answer: To safely administer vesicants and reduce peripheral vein damage

CVADs provide reliable venous access for vesicant infusions, protecting peripheral veins and reducing extravasation risk.

Question 31: A patient with known lung cancer develops distant heart sounds, jugular venous distension, and hypotension. The nurse suspects:

Heart failure exacerbation
Cardiac tamponade (Correct answer)
Pulmonary embolism
Myocardial infarction

Correct answer: Cardiac tamponade

Beck's triad (muffled heart sounds, JVD, hypotension) is classic for cardiac tamponade, which can result from malignant pericardial effusion.

Question 32: Which of the following best prevents tumor lysis syndrome in high-risk patients starting chemotherapy?

Restricting IV fluids to prevent fluid overload
Allopurinol or rasburicase plus aggressive IV hydration (Correct answer)
Prophylactic potassium supplementation
Immediate plasmapheresis

Correct answer: Allopurinol or rasburicase plus aggressive IV hydration

Allopurinol (or rasburicase for very high-risk cases) combined with aggressive IV hydration is the standard prophylaxis for TLS in high-risk patients.

Question 33: When educating a survivor about sun protection after cancer treatment, the nurse should emphasize:

Sunscreen is only needed at the beach
Use SPF 30+ broad-spectrum sunscreen, wear protective clothing, and avoid peak UV hours (Correct answer)
Avoid all sun exposure permanently indoors
SPF 15 is sufficient for all cancer survivors

Correct answer: Use SPF 30+ broad-spectrum sunscreen, wear protective clothing, and avoid peak UV hours

Many cancer treatments increase photosensitivity; survivors need SPF 30+, protective clothing, and UV avoidance during peak hours (10 AM–4 PM).

Question 34: Which factor most commonly triggers a cancer survivor's distress around surveillance imaging?

Overconfidence about being cured
Discomfort with lying still in the scanner
Lack of understanding of scan technology
Scanxiety — fear of recurrence around scheduled scans or test results (Correct answer)

Correct answer: Scanxiety — fear of recurrence around scheduled scans or test results

Scanxiety is the well-recognized pattern of heightened anxiety around surveillance imaging that many cancer survivors experience throughout their follow-up.

Question 35: Which assessment is essential before providing cancer patient education to ensure effectiveness?

Patient's readiness to learn, health literacy, preferred learning style, and language (Correct answer)
Whether the patient has internet access
Patient's insurance coverage
Family member's educational background

Correct answer: Patient's readiness to learn, health literacy, preferred learning style, and language

Effective patient education begins with assessing readiness to learn, health literacy, language, and preferred learning style to tailor teaching appropriately.

Question 36: The Warburg effect in cancer cells refers to which metabolic phenomenon?

Preferential use of aerobic glycolysis even in the presence of oxygen (Correct answer)
Decreased glucose uptake by cancer cells
Preferential use of fatty acids for energy
Increased oxidative phosphorylation exclusively

Correct answer: Preferential use of aerobic glycolysis even in the presence of oxygen

The Warburg effect describes how cancer cells preferentially use glycolysis (even with oxygen present) to meet their high energy and biosynthetic demands.

Question 37: Which of the following is frequently affected when Hodgkin's lymphoma is diagnosed?

Back
Chest
Neck (Correct answer)
Goin

Correct answer: Neck

Hodgkin's lymphoma is a cancer that originates in the lymphatic system, and its most common initial presentation is painless swelling of lymph nodes. The lymph nodes in the neck (cervical region) are frequently the first to be affected and noticed by patients. This characteristic presentation in the neck is a key diagnostic indicator for Hodgkin's lymphoma.

Question 38: A patient undergoing radiation therapy to the chest develops a dry, desquamating skin reaction at the treatment site. What is the most appropriate nursing intervention?

Apply petroleum-based ointment and cover with a dry dressing
Rub the area vigorously to remove dead skin cells
Gently cleanse with mild soap and water and apply a recommended moisturizer (Correct answer)
Apply an alcohol-based antiseptic to prevent infection

Correct answer: Gently cleanse with mild soap and water and apply a recommended moisturizer

Gentle cleansing with mild soap and water followed by a radiation-approved moisturizer minimizes irritation and supports skin integrity during radiation-induced dermatitis.

Question 39: Cytokine release syndrome (CRS) is a potentially life-threatening complication most associated with which therapies?

CAR-T cell therapy and bispecific antibodies (Correct answer)
Hormone therapy
Alkylating chemotherapy
Oral targeted therapy

Correct answer: CAR-T cell therapy and bispecific antibodies

CRS is a systemic inflammatory response caused by massive cytokine release when immune cells are activated by CAR-T cell therapy or bispecific antibodies.

Question 40: A patient with cancer reports a new severe headache rated 10/10 that began suddenly. The nurse's priority action is to:

Notify the provider immediately — this may indicate CNS metastasis or hemorrhage (Correct answer)
Document and reassess at the next scheduled assessment
Administer PRN acetaminophen and reassess in 1 hour
Apply a cool cloth and dim the lights

Correct answer: Notify the provider immediately — this may indicate CNS metastasis or hemorrhage

A sudden severe 'thunderclap' headache in a cancer patient is a red-flag symptom warranting immediate provider notification to rule out CNS emergency.

Question 41: When educating a patient about neutropenia precautions, which dietary instruction is most important?

Limit fluid intake to reduce kidney workload
Avoid undercooked meats, raw eggs, and unpasteurized products (Correct answer)
Increase raw fruit and vegetable intake to boost vitamins
Switch to a vegan diet to reduce inflammation

Correct answer: Avoid undercooked meats, raw eggs, and unpasteurized products

Patients with neutropenia must avoid foods at high risk for bacterial contamination, including raw/undercooked meats, raw eggs, and unpasteurized dairy.

Question 42: What lab value must be assessed before administering methotrexate at high doses?

Creatinine clearance/renal function (Correct answer)
Complete blood count only
Liver enzymes only
Serum calcium

Correct answer: Creatinine clearance/renal function

High-dose methotrexate requires adequate renal clearance to prevent toxic accumulation; creatinine clearance must be assessed before dosing.

Question 43: Due to severe and incurable pancreatic cancer, a patient was given hospice care and sent home with orders for morphine, lorazepam, and 2 L of oxygen. According to the nurse, which of the following situations poses the most risk to the patient's and the family's safety during the initial home visit?

The are five entrance steps to the home
The patient's wife is smoking in the living room (Correct answer)
There is only one bathroom

Correct answer: The patient's wife is smoking in the living room

The presence of oxygen therapy in the home creates a significant fire hazard, as oxygen is highly combustible. Smoking in the same room as a patient receiving oxygen therapy dramatically increases the risk of a fire or explosion. This poses an immediate and severe threat to the patient's and family's safety, far outweighing other environmental factors.

Question 44: Doxorubicin has a cumulative lifetime dose limit primarily because of which toxicity?

Hepatotoxicity
Cardiomyopathy (Correct answer)
Nephrotoxicity
Neurotoxicity

Correct answer: Cardiomyopathy

Doxorubicin accumulates in cardiac tissue and can cause irreversible cardiomyopathy; the total lifetime dose is capped at 450–550 mg/m².

Question 45: A patient receiving external beam radiation develops brisk erythema and moist desquamation. This is classified as what grade of acute skin toxicity per CTCAE?

Grade 3 (Correct answer)
Grade 2
Grade 4
Grade 1

Correct answer: Grade 3

Moist desquamation is CTCAE Grade 3 radiation dermatitis, requiring wound care and possible treatment interruption.

Question 46: Trastuzumab (Herceptin) is indicated for cancers that overexpress which receptor?

Estrogen receptor (ER)
HER2 (human epidermal growth factor receptor 2) (Correct answer)
Androgen receptor (AR)
Progesterone receptor (PR)

Correct answer: HER2 (human epidermal growth factor receptor 2)

Trastuzumab is a monoclonal antibody that targets HER2-overexpressing cancers, most commonly HER2+ breast and gastric cancers.

Question 47: A survivor completing treatment should receive a survivorship care plan from which care setting?

Only if the patient requests it in writing
Only from primary care after 5 years
The emergency department
The treating oncology team at the end of active treatment (Correct answer)

Correct answer: The treating oncology team at the end of active treatment

The Commission on Cancer requires that oncology programs provide a comprehensive survivorship care plan to patients completing active treatment.

Question 48: What is the primary mechanism of action of taxanes such as paclitaxel?

DNA cross-linking
Blocking folate metabolism
Stabilizing microtubules to prevent mitosis (Correct answer)
Inhibiting topoisomerase II

Correct answer: Stabilizing microtubules to prevent mitosis

Taxanes like paclitaxel stabilize microtubules, preventing their disassembly and thus blocking cell division.

Question 49: A patient with multiple myeloma develops sudden severe back pain and lower extremity weakness. The priority nursing action is to:

Apply a heating pad to the lumbar area
Encourage ambulation to prevent deconditioning
Notify the physician immediately for spinal cord compression evaluation (Correct answer)
Administer scheduled opioid analgesics

Correct answer: Notify the physician immediately for spinal cord compression evaluation

Sudden back pain with neurological deficits in a myeloma patient suggests spinal cord compression, an oncologic emergency.

Question 50: CAR-T cell therapy works by:

Stimulating NK cells with cytokines
Delivering radiation to tumor cells via antibodies
Blocking checkpoint proteins on T cells
Genetically engineering patient T cells to recognize and kill cancer cells (Correct answer)

Correct answer: Genetically engineering patient T cells to recognize and kill cancer cells

CAR-T therapy collects a patient's T cells, engineers them to express chimeric antigen receptors targeting cancer antigens, and reinfuses them.

Question 51: A patient with advanced cancer reports dyspnea at rest. Which nursing intervention is most effective for immediate relief?

Encourage deep breathing exercises
Position the patient upright and use a fan directed at the face (Correct answer)
Restrict fluid intake
Administer supplemental oxygen to all patients regardless of SpO2

Correct answer: Position the patient upright and use a fan directed at the face

Upright positioning and a fan blowing air toward the face stimulate facial cold receptors and reduce the sensation of dyspnea.

Question 52: Which of the following is a late effect of radiation therapy to the pelvis that a nurse should include in patient education?

Radiation recall reaction within 30 days
Vaginal stenosis and sexual dysfunction (Correct answer)
Transient hair loss at the treatment site only
Acute nausea during treatment sessions

Correct answer: Vaginal stenosis and sexual dysfunction

Vaginal stenosis is a late effect of pelvic radiation that can cause sexual dysfunction; patients should be taught to use vaginal dilators and lubricants to minimize this complication.

Question 53: A patient receiving radiation therapy to the head and neck region develops painful ulcerations of the oral mucosa. Which condition does this describe?

Radiation recall dermatitis
Mucositis (Correct answer)
Radiation pneumonitis
Xerostomia

Correct answer: Mucositis

Mucositis is inflammation and ulceration of the mucosal lining caused by radiation damage to rapidly dividing epithelial cells in the mouth and throat.

Question 54: Bevacizumab (Avastin) targets tumor angiogenesis by inhibiting which growth factor?

Vascular endothelial growth factor (VEGF) (Correct answer)
Epidermal growth factor (EGF)
Platelet-derived growth factor (PDGF)
Fibroblast growth factor (FGF)

Correct answer: Vascular endothelial growth factor (VEGF)

Bevacizumab is a monoclonal antibody that binds and neutralizes VEGF, preventing the formation of new blood vessels that tumors need to grow.

Question 55: The nurse is creating a care strategy for the multiple myeloma patient. Which priority intervention is included by the nurse in the care plan?

Monitoring red blood cell count
Providing frequent oral care
Coughing and deep breathing
Encouraging fluids (Correct answer)

Correct answer: Encouraging fluids

Multiple myeloma often leads to complications such as hypercalcemia, kidney dysfunction, and increased risk of infection. Encouraging fluids is a priority intervention because it helps prevent kidney damage by flushing out excess calcium and protein byproducts. Adequate hydration is crucial for maintaining overall organ function and reducing the risk of these serious complications.

Question 56: Which assessment finding in a patient receiving bevacizumab (Vectibix) warrants immediate intervention?

Sudden onset of severe headache and hypertension (Correct answer)
Mild fatigue and low-grade fever
Transient flushing during administration
Mild nausea after infusion

Correct answer: Sudden onset of severe headache and hypertension

Bevacizumab can cause hypertensive crisis and increases risk of intracranial hemorrhage; sudden severe headache with hypertension is an emergency.

Question 57: What is the recommended minimum hours of oncology nursing practice required before sitting for the OCN exam?

500 hours
2,000 hours
1,000 hours (Correct answer)
3,000 hours

Correct answer: 1,000 hours

Candidates must have a minimum of 1,000 hours of oncology nursing practice within the past 2.5 years to be eligible for the OCN exam.

Question 58: A patient receiving high-dose corticosteroids as part of cancer treatment should be monitored for which complication?

Hypotension and bradycardia
Thrombocytopenia and anemia
Hypoglycemia and weight loss
Hyperglycemia, fluid retention, and immunosuppression (Correct answer)

Correct answer: Hyperglycemia, fluid retention, and immunosuppression

Corticosteroids cause hyperglycemia by increasing gluconeogenesis, promote sodium and fluid retention, and suppress immune function increasing infection risk.

Question 59: Colony-stimulating factors (e.g., filgrastim/G-CSF) are used in oncology patients primarily for which purpose?

To stimulate neutrophil production and reduce febrile neutropenia risk (Correct answer)
To prevent anemia from chemotherapy
To reduce nausea from radiation
To increase platelet counts

Correct answer: To stimulate neutrophil production and reduce febrile neutropenia risk

G-CSF agents like filgrastim stimulate the bone marrow to produce neutrophils, reducing the depth and duration of chemotherapy-induced neutropenia.

Question 60: Which clinical feature differentiates superior vena cava (SVC) syndrome from other oncologic emergencies?

Sudden onset chest pain radiating to the jaw
Severe lower extremity edema and ascites
Facial and upper extremity edema, venous distension of the neck and chest, and dyspnea (Correct answer)
Bilateral lower extremity weakness with saddle anesthesia

Correct answer: Facial and upper extremity edema, venous distension of the neck and chest, and dyspnea

SVC syndrome presents with facial/arm edema, visible chest and neck vein distension, and dyspnea due to obstruction of venous return from the upper body to the right atrium.

Question 61: The IOM's Six Aims of Quality Healthcare include all of the items below, with the exception of:

Safe and rapid (Correct answer)
Safe and effective
Patient-centered and timely
Efficient and equitable

Correct answer: Safe and rapid

The Institute of Medicine (IOM), now the National Academy of Medicine, outlined six aims for quality healthcare: safe, effective, patient-centered, timely, efficient, and equitable. The option 'safe and rapid' is incorrect because 'rapid' is not one of the distinct aims. Instead, 'timely' is the correct aim, focusing on reducing harmful delays for both those who receive and those who give care.

Question 62: A patient on a VEGFR tyrosine kinase inhibitor (TKI) develops hypertension. The nurse should recognize this as:

A sign of tumor lysis syndrome
An unrelated comorbidity
A predictable on-target side effect (Correct answer)
An allergic reaction requiring discontinuation

Correct answer: A predictable on-target side effect

Hypertension is a predictable, on-target side effect of VEGFR TKIs because VEGF normally promotes vasodilation.

Question 63: Which personal protective equipment (PPE) is required when handling hazardous chemotherapy drugs?

N95 mask and gloves
Surgical mask and gown only
Double gloves, gown, and eye protection (Correct answer)
Single gloves only

Correct answer: Double gloves, gown, and eye protection

NIOSH and ONS guidelines require double chemotherapy-rated gloves, a protective gown, and eye/face protection when handling hazardous drugs.

Question 64: A patient's caregiver asks about the purpose of a 'nadir' blood count check after chemotherapy. The nurse's best explanation is:

It measures tumor marker levels to assess treatment response
It determines when the patient can resume a normal diet
It identifies the point of lowest bone marrow function to monitor for infection and bleeding risk (Correct answer)
It checks for drug resistance to predict the next cycle dose

Correct answer: It identifies the point of lowest bone marrow function to monitor for infection and bleeding risk

The nadir is the lowest point of blood cell counts after chemotherapy (typically 7–14 days), representing the period of greatest vulnerability to infection and bleeding complications.

Question 65: Tumor grade refers to which pathological characteristic?

The presence of distant metastases
How differentiated (similar to normal tissue) the cancer cells appear under microscopy (Correct answer)
The number of lymph nodes involved
The physical size of the tumor

Correct answer: How differentiated (similar to normal tissue) the cancer cells appear under microscopy

Tumor grade reflects the degree of cellular differentiation: low grade (well differentiated) cells look like normal cells, while high grade (poorly differentiated) cells are more abnormal and aggressive.

Question 66: Hormonal therapy with tamoxifen is most appropriate for which breast cancer receptor profile?

Estrogen receptor-positive (Correct answer)
Triple-negative
HER2-positive, ER-negative
PR-negative, ER-negative

Correct answer: Estrogen receptor-positive

Tamoxifen is a selective estrogen receptor modulator (SERM) used in estrogen receptor-positive breast cancers.

Question 67: A patient is prescribed leucovorin rescue therapy following high-dose methotrexate. The nurse explains that leucovorin works by:

Providing folate to rescue normal cells from methotrexate toxicity (Correct answer)
Neutralizing the alkaline properties of methotrexate in the bloodstream
Enhancing renal clearance of methotrexate
Stimulating bone marrow recovery after drug-induced suppression

Correct answer: Providing folate to rescue normal cells from methotrexate toxicity

Leucovorin (folinic acid) bypasses the methotrexate block on dihydrofolate reductase, rescuing normal cells while cancer cells remain sensitive.

Question 68: Which immune checkpoint inhibitor targets PD-1?

Durvalumab
Pembrolizumab (Correct answer)
Ipilimumab
Atezolizumab

Correct answer: Pembrolizumab

Pembrolizumab (Keytruda) is a monoclonal antibody that targets the PD-1 receptor on T cells, restoring anti-tumor immunity.

Question 69: Which chemotherapy class works by intercalating into DNA strands and inhibiting topoisomerase II?

Anthracyclines (Correct answer)
Vinca alkaloids
Antimetabolites
Alkylating agents

Correct answer: Anthracyclines

Anthracyclines such as doxorubicin intercalate into DNA and inhibit topoisomerase II, preventing DNA replication.

Question 70: Which type of biopsy provides the least invasive tissue diagnosis for accessible superficial tumors?

Open surgical biopsy
Excisional biopsy
Fine needle aspiration (FNA) (Correct answer)
Incisional biopsy

Correct answer: Fine needle aspiration (FNA)

Fine needle aspiration uses a thin needle to withdraw cells from a mass with minimal invasion and no general anesthesia, making it the least invasive biopsy technique.

Question 71: Neutropenic fever in a cancer patient is defined as a single oral temperature ≥38.3°C (101°F) or ≥38°C (100.4°F) for 1 hour AND an ANC of:

< 1000 cells/mm³
< 100 cells/mm³
< 500 cells/mm³ (Correct answer)
< 1500 cells/mm³

Correct answer: < 500 cells/mm³

IDSA guidelines define neutropenic fever as fever with an ANC <500 cells/mm³, or <1000 cells/mm³ with expected decline to <500.

Question 72: Lynch syndrome (hereditary non-polyposis colorectal cancer) is caused by mutations in which genes?

BRCA1 and BRCA2
Mismatch repair genes (MLH1, MSH2, MSH6, PMS2) (Correct answer)
RB1 and TP53
APC and PTEN

Correct answer: Mismatch repair genes (MLH1, MSH2, MSH6, PMS2)

Lynch syndrome is caused by germline mutations in DNA mismatch repair genes, leading to microsatellite instability and increased risk of colorectal, endometrial, and other cancers.

Question 73: Which of the following best describes the concept of 'informed consent' in oncology?

The patient signs a form agreeing to any treatment the physician recommends
The patient receives complete information about diagnosis, treatment options, risks, benefits, and alternatives to make a voluntary decision (Correct answer)
Consent is only required for surgical procedures
Family members can always provide consent instead of the patient

Correct answer: The patient receives complete information about diagnosis, treatment options, risks, benefits, and alternatives to make a voluntary decision

Informed consent requires that patients receive full disclosure of their condition, options, risks, benefits, and alternatives and voluntarily agree to the proposed treatment.

Question 74: A patient on high-dose corticosteroids for brain metastases should be monitored for which common complication?

Hyperglycemia (Correct answer)
Hypocalcemia
Thrombocytopenia
Hyponatremia

Correct answer: Hyperglycemia

Corticosteroids cause insulin resistance and gluconeogenesis, commonly causing hyperglycemia that requires monitoring and management.

Question 75: A patient with breast cancer is prescribed tamoxifen. The nurse should instruct the patient to report which serious adverse effect immediately?

Mild hot flashes
Leg pain and swelling (Correct answer)
Hair thinning
Mild vaginal dryness

Correct answer: Leg pain and swelling

Tamoxifen increases the risk of thromboembolic events; leg pain and swelling may indicate deep vein thrombosis requiring urgent evaluation.

Question 76: A patient declines further chemotherapy and wants to focus on quality of life. The nurse's most appropriate response is:

Document and support the patient's autonomous decision, ensuring comfort care is in place (Correct answer)
Withhold all medications as requested
Contact the physician to override the patient's decision
Educate the patient until they change their mind

Correct answer: Document and support the patient's autonomous decision, ensuring comfort care is in place

Patient autonomy is a core ethical principle; the nurse should support, document, and facilitate the patient's informed decision to pursue comfort-focused care.

Question 77: IV fluids are given as part of the initial care for a cancer patient who has early sepsis.

Immunoglobulins
Vasopressors
Antibiotics (Correct answer)
Antifungals

Correct answer: Antibiotics

Sepsis is a life-threatening condition caused by the body's overwhelming response to an infection. While IV fluids are crucial for resuscitation, the primary treatment for sepsis, especially in an immunocompromised cancer patient, is the prompt administration of broad-spectrum antibiotics. These medications target the underlying bacterial infection, which is essential to prevent further deterioration and improve survival rates.

Question 78: TNM staging for solid tumors classifies cancers based on which three factors?

Tissue grade, Necrosis, and Margin status
Tumor size/extent, lymph Node involvement, and Metastasis (Correct answer)
Treatment response, Nodular pattern, and Metastasis
Tumor type, Necrosis, and Molecular markers

Correct answer: Tumor size/extent, lymph Node involvement, and Metastasis

TNM staging uses primary tumor extent (T), regional lymph node involvement (N), and distant metastasis (M) to classify cancer stage and guide treatment.

Question 79: A breast cancer survivor asks if she can use herbal supplements during follow-up care. The nurse's best response is:

Always discuss supplements with your oncologist because some can interact with cancer treatments (Correct answer)
All herbal supplements are safe for cancer survivors
Supplements only matter during active chemotherapy
Supplements are never safe after cancer treatment

Correct answer: Always discuss supplements with your oncologist because some can interact with cancer treatments

Many herbal supplements interact with hormonal therapies or have estrogenic activity; oncologist review before use is essential in breast cancer survivors.

Question 80: Which agent is used as antidote or reversal for severe methotrexate toxicity when leucovorin is insufficient?

Glucarpidase (carboxypeptidase G2) (Correct answer)
Dexrazoxane
N-acetylcysteine
Mesna

Correct answer: Glucarpidase (carboxypeptidase G2)

Glucarpidase rapidly converts methotrexate to inactive metabolites in the plasma, used when methotrexate levels remain dangerously high despite leucovorin rescue.

Question 81: Tamoxifen requires conversion by CYP2D6 to its active metabolite endoxifen. What is the nursing implication?

Monitor for hypoglycemia regularly
Administer only with antacids
Avoid CYP2D6 inhibitors (e.g., fluoxetine) that reduce tamoxifen efficacy (Correct answer)
Encourage high-fat diet to improve absorption

Correct answer: Avoid CYP2D6 inhibitors (e.g., fluoxetine) that reduce tamoxifen efficacy

CYP2D6 inhibitors like fluoxetine block conversion of tamoxifen to its active metabolite, potentially reducing therapeutic efficacy in ER+ breast cancer.

Question 82: A patient with newly diagnosed cancer refuses to discuss prognosis with the physician, saying 'Just tell my wife everything.' How should the nurse respond?

Insist the patient hear the information directly
Override the patient's wishes because the prognosis affects treatment decisions
Immediately share all information with the spouse
Respect the patient's expressed preference to have the spouse receive information, and document this preference (Correct answer)

Correct answer: Respect the patient's expressed preference to have the spouse receive information, and document this preference

Patient autonomy includes the right to delegate information-sharing; the nurse should honor and document this preference while ensuring the designated person is properly informed.

Question 83: Which route of administration bypasses the blood-brain barrier most effectively for CNS tumors?

Intrathecal (Correct answer)
Subcutaneous
Intravenous
Oral

Correct answer: Intrathecal

Intrathecal administration delivers chemotherapy directly into the cerebrospinal fluid, bypassing the blood-brain barrier.

Question 84: Which oncogene is frequently amplified in HER2-positive breast cancer, making it a therapeutic target?

ERBB2 (HER2/neu) (Correct answer)
KRAS
MYC
BCL-2

Correct answer: ERBB2 (HER2/neu)

ERBB2 gene amplification produces excess HER2 protein on the cell surface, driving uncontrolled cell proliferation in HER2-positive breast cancer.

Question 85: A nurse is preparing to administer rituximab infusion. Which pre-medication is typically given to reduce infusion reactions?

Epinephrine and hydrocortisone
Acetaminophen and diphenhydramine (Correct answer)
Lorazepam and morphine
Ondansetron and dexamethasone only

Correct answer: Acetaminophen and diphenhydramine

Acetaminophen and diphenhydramine are standard pre-medications before rituximab to reduce fever and hypersensitivity infusion reactions.

Question 86: Immune checkpoint inhibitors such as nivolumab work by blocking which protein to restore T-cell function?

CTLA-4 only
PD-1 (programmed death-1) (Correct answer)
LAG-3 only
HER2

Correct answer: PD-1 (programmed death-1)

Nivolumab is an anti-PD-1 antibody that blocks the PD-1 checkpoint, preventing tumor cells from suppressing T-cell immune responses.

Question 87: A patient receiving bevacizumab (a VEGF inhibitor) should be monitored most closely for which specific complication?

Hypertension and wound healing impairment (Correct answer)
Severe ototoxicity
Peripheral neuropathy
Prolonged QT interval

Correct answer: Hypertension and wound healing impairment

Bevacizumab inhibits vascular endothelial growth factor, leading to hypertension, impaired wound healing, and risk of arterial thromboembolism or GI perforation.

Question 88: Which chemotherapy agent is classified as an alkylating agent?

Methotrexate
Cyclophosphamide (Correct answer)
Vincristine
Doxorubicin

Correct answer: Cyclophosphamide

Cyclophosphamide is an alkylating agent that works by cross-linking DNA strands to prevent cell replication.

Question 89: A patient undergoing radiation therapy to the thorax develops difficulty swallowing, odynophagia, and a sensation of food sticking. Which acute radiation complication is occurring?

Radiation-induced neuropathy
Radiation esophagitis (Correct answer)
Radiation pneumonitis
Mucositis

Correct answer: Radiation esophagitis

Radiation esophagitis causes inflammation of the esophageal mucosa, resulting in dysphagia and odynophagia when the esophagus is within or near the radiation field.

Question 90: A patient's pain is described as burning and shooting down the leg following spinal metastasis. This type of pain is classified as:

Neuropathic pain (Correct answer)
Somatic nociceptive pain
Psychogenic pain
Visceral nociceptive pain

Correct answer: Neuropathic pain

Burning, shooting, or electric shock-like pain radiating along a nerve distribution is characteristic of neuropathic pain.

Question 91: A patient expresses fear about alopecia from chemotherapy. The most therapeutic nursing response is:

'Your hair will grow back, so it isn't really a big deal.'
'Alopecia only affects about half of patients, so you may not experience it.'
'Many patients feel the same way — let's talk about what this means for you and explore options like wigs or scalp cooling.' (Correct answer)
'Focus on surviving the cancer, not your hair.'

Correct answer: 'Many patients feel the same way — let's talk about what this means for you and explore options like wigs or scalp cooling.'

Acknowledging the patient's concern and collaborating on solutions (wigs, scalp cooling) is the therapeutic approach that respects emotional impact and patient autonomy.

Question 92: Before administering paclitaxel, the nurse should premedicate with which agents to prevent hypersensitivity reactions?

Metoclopramide and dexamethasone
Ondansetron and lorazepam
Acetaminophen and ibuprofen
Corticosteroids, diphenhydramine, and an H2 blocker (Correct answer)

Correct answer: Corticosteroids, diphenhydramine, and an H2 blocker

Paclitaxel's Cremophor EL solvent causes hypersensitivity reactions; premedication with a steroid, antihistamine, and H2 blocker is required.

Question 93: Spinal cord compression in oncology patients most commonly presents initially with:

Bowel and bladder incontinence
Back pain (Correct answer)
Sensory loss only
Complete paralysis

Correct answer: Back pain

Back pain is the earliest and most common presenting symptom of malignant spinal cord compression, often preceding neurologic deficits.

Question 94: A patient receiving irinotecan develops profuse diarrhea within 24 hours of infusion. This is best managed with:

Loperamide
Metoclopramide
Octreotide
Atropine (Correct answer)

Correct answer: Atropine

Early-onset diarrhea with irinotecan is cholinergic in nature and is treated with atropine.

Question 95: Which type of radiation therapy delivers a high dose to a small target with steep dose fall-off, minimizing exposure to surrounding tissue?

Total body irradiation
Brachytherapy
Conventional fractionated radiotherapy
Stereotactic radiosurgery (SRS) (Correct answer)

Correct answer: Stereotactic radiosurgery (SRS)

Stereotactic radiosurgery (SRS) delivers high-dose, precise radiation to a small target using multiple beams that converge, sparing surrounding tissue.

Question 96: Radiation-induced skin reactions are graded using which system in oncology practice?

NCI Common Terminology Criteria for Adverse Events (CTCAE) (Correct answer)
Fitzpatrick Skin Type Scale
Norton Scale
Braden Scale

Correct answer: NCI Common Terminology Criteria for Adverse Events (CTCAE)

The NCI CTCAE provides standardized grading of radiation dermatitis from Grade 1 (faint erythema) to Grade 4 (skin necrosis), guiding intervention.

Question 97: What is the correct action if extravasation of a vesicant chemotherapy agent is suspected?

Increase the infusion rate to dilute the drug
Stop the infusion immediately and leave the needle in place (Correct answer)
Flush the IV line rapidly with saline
Apply heat to the site to promote absorption

Correct answer: Stop the infusion immediately and leave the needle in place

The infusion must be stopped immediately and the needle left in place so residual drug can be aspirated before further intervention.

Question 98: A patient receiving cisplatin needs prehydration primarily to prevent which toxicity?

Hepatotoxicity
Nephrotoxicity (Correct answer)
Pulmonary toxicity
Cardiotoxicity

Correct answer: Nephrotoxicity

Cisplatin is highly nephrotoxic, and aggressive IV hydration before and after administration is required to protect renal function.

Question 99: PARP inhibitors such as olaparib are most effective in cancers with defects in which pathway?

RAS/MAPK signaling pathway
Homologous recombination repair (BRCA1/2 mutations) (Correct answer)
VEGF signaling pathway
PI3K/AKT/mTOR pathway

Correct answer: Homologous recombination repair (BRCA1/2 mutations)

PARP inhibitors exploit synthetic lethality in BRCA-mutated cells that cannot repair DNA through homologous recombination, leading to cancer cell death.

Question 100: Which type of gene mutation is found in the germline and can be inherited by offspring?

Germline mutation (hereditary) (Correct answer)
Frameshift mutation only
Silent mutation only
Somatic mutation (acquired)

Correct answer: Germline mutation (hereditary)

Germline mutations are present in all cells of the body from birth and can be passed to children, as seen with BRCA1/2 and Lynch syndrome mutations.

Question 101: Cognitive changes after chemotherapy, commonly called 'chemo brain,' are best described as:

Difficulties with memory, concentration, and processing speed (Correct answer)
Permanent dementia in all patients
Psychosis and hallucinations
Complete memory loss

Correct answer: Difficulties with memory, concentration, and processing speed

Chemo-related cognitive impairment (CRCI) typically manifests as subtle difficulties with attention, short-term memory, and processing speed that may improve over time.

Question 102: What is the most common site of metastasis for breast cancer?

Kidney and adrenal glands
Colon and rectum
Liver, lungs, bone, and brain (Correct answer)
Spleen and pancreas

Correct answer: Liver, lungs, bone, and brain

Breast cancer most commonly metastasizes to the liver, lungs, bone, and brain.

Question 103: Which drug requires REMS (Risk Evaluation and Mitigation Strategy) program enrollment due to teratogenicity in oncology?

Thalidomide and lenalidomide (Correct answer)
Filgrastim
Methotrexate alone
Ondansetron

Correct answer: Thalidomide and lenalidomide

Thalidomide and lenalidomide are teratogenic drugs managed under REMS (THALOMID REMS and REVLIMID REMS) requiring pregnancy testing, contraception, and restricted dispensing.

Question 104: Which intervention is most effective in preventing chemotherapy-induced nausea and vomiting (CINV) prior to a highly emetogenic regimen?

Pre-medicating with a 5-HT3 antagonist, a NK1 antagonist, and dexamethasone (Correct answer)
Restricting all oral intake for 12 hours before chemotherapy
Administering antiemetics only after nausea begins
Prescribing a benzodiazepine as the sole antiemetic agent

Correct answer: Pre-medicating with a 5-HT3 antagonist, a NK1 antagonist, and dexamethasone

CINV guidelines recommend a triple-drug prophylactic regimen (5-HT3 antagonist + NK1 antagonist + dexamethasone) before highly emetogenic chemotherapy.

Question 105: What term describes cancer that has spread from its original site to distant organs or tissues?

Locally advanced
Recurrent
In situ
Metastatic (Correct answer)

Correct answer: Metastatic

Metastatic cancer refers to malignant cells that have traveled from the primary tumor site to distant parts of the body.

Question 106: A nurse with an active OCN credential who allows it to lapse must do which of the following to regain the credential?

Submit a late fee only
Complete 10 extra CE hours
Apply for a grace period extension
Retest by examination (Correct answer)

Correct answer: Retest by examination

A lapsed OCN credential cannot be reinstated through CE hours; the nurse must retake and pass the OCN examination.

Question 107: A nurse notes blood return is absent from a patient's port during chemotherapy infusion. What is the priority action?

Continue infusion if no patient complaints
Flush aggressively with normal saline
Increase the infusion rate to clear the port
Stop the infusion and assess for extravasation or port malfunction (Correct answer)

Correct answer: Stop the infusion and assess for extravasation or port malfunction

Loss of blood return may indicate port malfunction or tip migration; the infusion must be stopped immediately and the access assessed before continuing.

Question 108: Secondary malignancies are a long-term risk for cancer survivors primarily because of:

Chemotherapy and radiation damage to normal DNA in healthy tissues (Correct answer)
Unhealthy lifestyle choices only
Age-related degeneration after age 70 only
Genetic predisposition only in BRCA carriers

Correct answer: Chemotherapy and radiation damage to normal DNA in healthy tissues

Alkylating agents and radiation are directly mutagenic to normal cells and increase lifetime risk of secondary malignancies such as therapy-related AML.

Question 109: Which corticosteroid is most commonly used as part of antiemetic regimens for highly emetogenic chemotherapy?

Prednisone
Dexamethasone (Correct answer)
Methylprednisolone
Hydrocortisone

Correct answer: Dexamethasone

Dexamethasone is the preferred corticosteroid in CINV regimens due to its potency, long half-life, and synergistic antiemetic effect with 5-HT3 antagonists.

Question 110: Which route of administration is used for intrathecal chemotherapy?

Subcutaneous
Into the cerebrospinal fluid space (Correct answer)
Intravenous
Intraperitoneal

Correct answer: Into the cerebrospinal fluid space

Intrathecal chemotherapy is injected directly into the cerebrospinal fluid via lumbar puncture or Ommaya reservoir to treat or prevent CNS disease.

Question 111: Tumor heterogeneity refers to which biological characteristic of cancers?

Identical genetic profiles across primary and metastatic sites
The spread of cancer to multiple organs
Genetic diversity among cells within the same tumor, leading to varied drug sensitivities (Correct answer)
Uniform cell populations within a tumor

Correct answer: Genetic diversity among cells within the same tumor, leading to varied drug sensitivities

Tumor heterogeneity means different cells within one tumor have different mutations, making some subpopulations resistant to specific treatments.

Question 112: A patient with small cell lung cancer presents with facial swelling, venous distension of the neck and chest, and dyspnea. This presentation is most consistent with:

Pulmonary embolism
Tension pneumothorax
Cardiac tamponade
Superior vena cava (SVC) syndrome (Correct answer)

Correct answer: Superior vena cava (SVC) syndrome

SVC syndrome is caused by obstruction of the SVC, commonly by mediastinal tumors, leading to facial edema, neck vein distension, and dyspnea.

Question 113: Which type of radiation therapy delivers treatment from a source located outside the patient's body?

Radiopharmaceutical therapy
Brachytherapy
Intraoperative radiation therapy
External beam radiation therapy (EBRT) (Correct answer)

Correct answer: External beam radiation therapy (EBRT)

External beam radiation therapy (EBRT) uses a machine located outside the body to direct radiation beams at the tumor site.

Question 114: What is the definitive emergency treatment for malignant cardiac tamponade?

IV atropine
Emergent chest surgery
Pericardiocentesis (Correct answer)
IV corticosteroids

Correct answer: Pericardiocentesis

Pericardiocentesis (needle drainage of the pericardial effusion) is the definitive emergency treatment to relieve tamponade physiology.

Question 115: Which of the following is a common long-term side effect of cisplatin-based chemotherapy?

Hepatic veno-occlusive disease
Pulmonary fibrosis
Nephrotoxicity and ototoxicity (Correct answer)
Cardiomyopathy

Correct answer: Nephrotoxicity and ototoxicity

Cisplatin is well known for causing cumulative nephrotoxicity and ototoxicity (hearing loss/tinnitus) as major long-term toxicities.

Question 116: Targeted therapy with imatinib (Gleevec) works by inhibiting which specific molecular target?

VEGF receptor
EGFR receptor
BCR-ABL tyrosine kinase (Correct answer)
HER2 receptor

Correct answer: BCR-ABL tyrosine kinase

Imatinib is a tyrosine kinase inhibitor that specifically targets the BCR-ABL fusion protein, which drives CML cell proliferation.

Question 117: Which chemotherapy drug requires leucovorin rescue to prevent life-threatening toxicity?

Paclitaxel
Doxorubicin
Gemcitabine
High-dose methotrexate (Correct answer)

Correct answer: High-dose methotrexate

Leucovorin (folinic acid) rescue is used after high-dose methotrexate to protect normal cells from folate depletion toxicity.

Question 118: Which nursing intervention best supports a patient's autonomy during the informed consent process for a clinical trial?

Witnessing the signature promptly to avoid treatment delays
Telling the patient to trust the oncologist's recommendation
Explaining only the benefits to encourage enrollment
Ensuring the patient has adequate time to ask questions and understands they may withdraw at any time (Correct answer)

Correct answer: Ensuring the patient has adequate time to ask questions and understands they may withdraw at any time

True informed consent requires that patients fully understand risks, benefits, and alternatives and know they can withdraw without penalty; the nurse's role is to ensure comprehension and protect autonomy.

Question 119: Which organization provides the primary standards for safe handling of hazardous drugs in oncology nursing?

American Cancer Society (ACS)
National Cancer Institute (NCI)
Oncology Nursing Society (ONS) (Correct answer)
Joint Commission (TJC)

Correct answer: Oncology Nursing Society (ONS)

The Oncology Nursing Society (ONS) publishes evidence-based guidelines for chemotherapy administration and hazardous drug safety.

Question 120: A patient is prescribed ondansetron for chemotherapy-induced nausea. The nurse should monitor for which cardiac side effect?

Atrial fibrillation
Bradycardia
Hypertension
QT prolongation (Correct answer)

Correct answer: QT prolongation

Ondansetron (a 5-HT3 antagonist) can cause QT interval prolongation, increasing the risk of serious dysrhythmias such as torsades de pointes.

Question 121: According to the NCCN distress thermometer guidelines, a distress score at which threshold warrants referral to psychosocial support services?

4 or above (Correct answer)
2 or above
8 or above
6 or above

Correct answer: 4 or above

NCCN guidelines recommend referral to appropriate resources when a patient scores 4 or higher on the Distress Thermometer.

Question 122: Which cancer type has a strong etiological link to Helicobacter pylori infection?

Colon cancer
Gastric (stomach) adenocarcinoma (Correct answer)
Liver cancer
Pancreatic cancer

Correct answer: Gastric (stomach) adenocarcinoma

H. pylori infection causes chronic gastric inflammation that over decades can progress to intestinal metaplasia, dysplasia, and gastric adenocarcinoma.

Question 123: What is the term for giving chemotherapy before the primary surgical procedure to shrink a tumor?

Salvage therapy
Neoadjuvant therapy (Correct answer)
Adjuvant therapy
Consolidation therapy

Correct answer: Neoadjuvant therapy

Neoadjuvant therapy is given before surgery to reduce tumor size and potentially allow for less extensive surgical resection.

Question 124: Which dietary recommendation is evidence-based for cancer survivors to reduce recurrence risk?

Elimination of all carbohydrates
High-protein meat-only diet
Plant-forward diet rich in vegetables, fruits, and whole grains, limiting processed meats (Correct answer)
Daily megadose antioxidant supplements

Correct answer: Plant-forward diet rich in vegetables, fruits, and whole grains, limiting processed meats

Major cancer organizations recommend a plant-rich, minimally processed diet that limits red and processed meats to reduce cancer recurrence risk.

Question 125: Which of the following is a cell-cycle-specific chemotherapy agent?

Carmustine
Cisplatin
Cyclophosphamide
Vincristine (Correct answer)

Correct answer: Vincristine

Vincristine is cell-cycle-specific, acting in the M phase by binding to tubulin and preventing spindle formation.

Question 126: Adaptive or particular immunity is demonstrated by:

Large lymphocyte production
Acute-phase protein production
A cell-mediated response (Correct answer)
An inflammatory response

Correct answer: A cell-mediated response

Adaptive immunity, also known as acquired or specific immunity, is characterized by its ability to recognize specific pathogens and mount a targeted, memory-based response. A cell-mediated response, primarily involving T-lymphocytes, is a hallmark of this system, directly attacking infected cells or coordinating other immune cells. This differs from innate immunity, which includes non-specific responses like acute-phase protein production and inflammation.

Question 127: Which ONS/ASCO guideline recommends the use of a validated tool such as the FACT-G or EORTC QLQ-C30 in oncology practice?

Standardized assessment of health-related quality of life (Correct answer)
Evidence-based pain management algorithms
Infection prevention in neutropenic patients
Chemotherapy administration safety standards

Correct answer: Standardized assessment of health-related quality of life

FACT-G and EORTC QLQ-C30 are validated instruments used to systematically measure health-related quality of life in cancer patients.

Question 128: A postmastectomy patient asks about lymphedema prevention. Which instruction should the nurse include?

Perform vigorous exercise with the affected arm to stimulate drainage
Avoid blood pressure measurements and venipunctures in the affected arm (Correct answer)
Wear a compression garment only during sleep
Apply heat packs to the affected arm to improve lymphatic flow

Correct answer: Avoid blood pressure measurements and venipunctures in the affected arm

Avoiding blood pressure cuffs and needle sticks in the affected arm prevents lymphatic obstruction and infection that can trigger or worsen lymphedema.

Question 129: Which chemotherapy agent is associated with hemorrhagic cystitis as a major side effect?

Irinotecan
Cisplatin
Vinorelbine
Cyclophosphamide (Correct answer)

Correct answer: Cyclophosphamide

Cyclophosphamide's metabolite acrolein irritates the bladder lining, causing hemorrhagic cystitis; mesna and hydration are used for prevention.

Question 130: Epithelial-to-mesenchymal transition (EMT) in cancer enables which key behavior?

Cancer cells to lose cell junctions and gain migratory and invasive properties (Correct answer)
Enhanced response to hormone therapy
Stable tumor growth without spread
Increased sensitivity to chemotherapy

Correct answer: Cancer cells to lose cell junctions and gain migratory and invasive properties

EMT is a developmental process hijacked by cancer cells to lose epithelial characteristics and gain mesenchymal traits, enabling migration and metastasis.

Question 131: Which patient situation is the most appropriate indication for a peripherally inserted central catheter (PICC) rather than a peripheral IV?

Long-term vesicant chemotherapy requiring reliable venous access (Correct answer)
Rapid IV fluid bolus in an emergency
Single dose of IV acetaminophen for fever
One-time IV contrast for a CT scan

Correct answer: Long-term vesicant chemotherapy requiring reliable venous access

PICC lines are indicated for patients requiring prolonged IV therapy with vesicant chemotherapy, reducing the risk of extravasation and preserving peripheral veins.

Question 132: Which of the following communication strategies improves medication adherence in cancer outpatients?

Using teach-back method to confirm patient understanding (Correct answer)
Relying on family members to teach the patient
Limiting patient questions to save time
Providing only written materials without verbal explanation

Correct answer: Using teach-back method to confirm patient understanding

The teach-back method — asking patients to explain instructions in their own words — confirms comprehension and significantly improves adherence.

Question 133: What does the term 'nadir' refer to in chemotherapy nursing?

The lowest point of blood cell counts after chemotherapy (Correct answer)
The peak drug concentration in the blood
The point of maximum tumor shrinkage
The highest point of nausea after infusion

Correct answer: The lowest point of blood cell counts after chemotherapy

Nadir is the period of lowest blood counts, typically 7–14 days after chemotherapy, when infection risk is greatest.

Question 134: Late cardiovascular effects of cancer treatment are most associated with which therapies?

Colony-stimulating factors
Antiemetics and pain medications
Anthracyclines, trastuzumab, and chest radiation (Correct answer)
Oral hormone therapy only

Correct answer: Anthracyclines, trastuzumab, and chest radiation

Anthracyclines and trastuzumab cause cardiomyopathy, while chest radiation causes pericarditis, coronary artery disease, and valvular damage as late effects.

Question 135: An oncology nurse is preparing to administer a vesicant chemotherapy agent via peripheral IV. Which assessment finding requires the nurse to hold the infusion and reassess access?

The patient's blood pressure is 130/82 mmHg
Patient reports mild anxiety about the infusion
Blood return is sluggish and the site shows swelling with infusion (Correct answer)
The IV was placed 6 hours ago in the antecubital fossa

Correct answer: Blood return is sluggish and the site shows swelling with infusion

Sluggish blood return with swelling during vesicant infusion indicates possible extravasation, which must be stopped immediately to prevent tissue necrosis.

Question 136: Which mechanism explains why cancer cells continue to divide without responding to normal growth-stop signals?

Overproduction of hormones
Increased nutrient intake
Overactivation of apoptosis
Insensitivity to antigrowth signals (dysregulation of tumor suppressor pathways) (Correct answer)

Correct answer: Insensitivity to antigrowth signals (dysregulation of tumor suppressor pathways)

Loss of tumor suppressor gene function (e.g., RB, p53) removes the normal brake on cell division, allowing cancer cells to ignore antigrowth signals.

Question 137: Which of the following is a sign of increased intracranial pressure (ICP) in a patient with brain metastases?

Peripheral edema
Hypoglycemia
Morning headache, nausea, and papilledema (Correct answer)
Hypotension and tachycardia

Correct answer: Morning headache, nausea, and papilledema

Increased ICP classically presents with morning headache (worse when lying flat), nausea/vomiting, and papilledema on fundoscopic exam.

Question 138: Which of the following is a common dose-limiting toxicity of cisplatin?

Hepatotoxicity
Nephrotoxicity (Correct answer)
Cardiotoxicity
Pulmonary fibrosis

Correct answer: Nephrotoxicity

Cisplatin causes significant nephrotoxicity; aggressive hydration and amifostine may be used to minimize renal damage.

Question 139: What is 'equianalgesic dosing' used for in pain management?

Measuring pain using a standardized scale
Determining when to stop opioid therapy
Converting between different opioids or routes while maintaining equivalent pain control (Correct answer)
Calculating the maximum safe opioid dose

Correct answer: Converting between different opioids or routes while maintaining equivalent pain control

Equianalgesic dosing provides conversion ratios between opioids or routes to maintain equivalent analgesia when switching medications.

Question 140: Which electrolyte abnormality is the most life-threatening complication of tumor lysis syndrome?

Hypocalcemia
Hyperkalemia (Correct answer)
Hyperphosphatemia
Hyperuricemia

Correct answer: Hyperkalemia

Hyperkalemia is the most immediately life-threatening complication of TLS because it can cause fatal cardiac arrhythmias.

Question 141: An advance directive (living will) in oncology primarily serves to:

Assign a healthcare power of attorney
Restrict information sharing with family members
Authorize billing for cancer treatments
Document the patient's wishes for end-of-life care in case they cannot speak for themselves (Correct answer)

Correct answer: Document the patient's wishes for end-of-life care in case they cannot speak for themselves

A living will is an advance directive that documents a patient's treatment wishes (e.g., CPR, ventilation) in the event they become incapacitated.

Question 142: A patient with cancer-related hypercalcemia of malignancy is most likely to present with which set of symptoms?

Fatigue, constipation, polyuria, and confusion (Correct answer)
Diarrhea, muscle cramps, and perioral tingling
Hypertension, peripheral edema, and weight gain
Bradycardia, hypotension, and skin flushing

Correct answer: Fatigue, constipation, polyuria, and confusion

Hypercalcemia classically presents with fatigue, constipation, polyuria/polydipsia, and altered mental status (bones, stones, groans, moans).

Question 143: A proto-oncogene becomes an oncogene through which process?

Loss-of-function mutation in a tumor suppressor
Deletion of the gene entirely
Mutation, amplification, or translocation that causes gain-of-function overactivation (Correct answer)
Normal aging-related methylation

Correct answer: Mutation, amplification, or translocation that causes gain-of-function overactivation

Proto-oncogenes become oncogenes when mutations, amplifications, or chromosomal translocations cause the gene product to become constitutively active.

Question 144: A patient with leukemia develops petechiae, prolonged bleeding from IV sites, and a platelet count of 8,000/mm³. The priority nursing intervention is:

Implement bleeding precautions and prepare for platelet transfusion (Correct answer)
Administer aspirin for discomfort
Apply heat to bleeding sites
Encourage the patient to ambulate to prevent DVT

Correct answer: Implement bleeding precautions and prepare for platelet transfusion

A critically low platelet count with active bleeding requires immediate bleeding precautions and preparation for platelet transfusion.

Question 145: Which treatment is the immediate priority for a patient with confirmed malignant spinal cord compression?

Radiation therapy
Surgical decompression
High-dose corticosteroids (dexamethasone) (Correct answer)
Chemotherapy

Correct answer: High-dose corticosteroids (dexamethasone)

High-dose dexamethasone is given immediately to reduce spinal cord edema while definitive treatment (radiation or surgery) is arranged.

Question 146: Bisphosphonates such as zoledronic acid are used in oncology to treat which complications?

Liver metastases
Bone metastases, hypercalcemia of malignancy, and osteoporosis prevention (Correct answer)
Lymphedema
Brain metastases

Correct answer: Bone metastases, hypercalcemia of malignancy, and osteoporosis prevention

Zoledronic acid inhibits osteoclast activity to reduce skeletal-related events from bone metastases and treat hypercalcemia of malignancy.

Question 147: Which tumor marker is most specific for monitoring colorectal cancer recurrence?

PSA
Alpha-fetoprotein (AFP)
Carcinoembryonic antigen (CEA) (Correct answer)
CA-125

Correct answer: Carcinoembryonic antigen (CEA)

CEA is the most widely used tumor marker for monitoring colorectal cancer response to treatment and surveillance for recurrence after resection.

Question 148: What is the nadir in the context of chemotherapy administration?

The point of lowest blood cell counts after chemotherapy (Correct answer)
The peak drug concentration in blood
The cumulative lifetime dose limit
The first day of a new chemotherapy cycle

Correct answer: The point of lowest blood cell counts after chemotherapy

The nadir is the lowest point of blood counts (especially neutrophils) following chemotherapy, typically occurring 7–14 days after treatment.

Question 149: Oral chemotherapy education should stress which of the following to patients?

Share doses with caregivers if they have the same cancer
Store in the bathroom medicine cabinet for convenience
Never handle tablets with bare hands and use safe disposal methods (Correct answer)
Crush tablets to improve absorption

Correct answer: Never handle tablets with bare hands and use safe disposal methods

Oral chemotherapy is still a hazardous drug requiring gloves for handling and proper disposal to protect the patient and household members.

Question 150: Immune-related adverse events (irAEs) from checkpoint inhibitors most commonly affect which organ systems?

Brain exclusively
Heart and kidneys only
Skin, GI tract, liver, and endocrine glands (Correct answer)
Bone marrow only

Correct answer: Skin, GI tract, liver, and endocrine glands

Checkpoint inhibitors cause autoimmune-like reactions most frequently in skin (rash), gut (colitis), liver (hepatitis), and endocrine organs (thyroiditis).

Question 151: Which oncology nursing organization publishes the standards of oncology nursing practice and the OCN certification?

National Cancer Institute (NCI)
American Nurses Association (ANA)
Oncology Nursing Society (ONS) (Correct answer)
American Society of Clinical Oncology (ASCO)

Correct answer: Oncology Nursing Society (ONS)

The Oncology Nursing Society (ONS) establishes standards of oncology nursing practice and administers the OCN (Oncology Certified Nurse) certification examination.

Question 152: Total body irradiation (TBI) is most commonly used as a preparative regimen for which procedure?

Palliative treatment of bone metastases
Hematopoietic stem cell transplantation (HSCT) (Correct answer)
Surgical resection of solid tumors
Prophylactic cranial irradiation in lung cancer

Correct answer: Hematopoietic stem cell transplantation (HSCT)

TBI is used as part of the conditioning regimen before hematopoietic stem cell transplantation to eradicate residual malignancy and suppress the immune system to prevent graft rejection.

Question 153: Which chemotherapy agent is classified as a vesicant and requires careful monitoring for extravasation?

Methotrexate
Cyclophosphamide
Vincristine (Correct answer)
Fluorouracil

Correct answer: Vincristine

Vincristine is a vesicant that can cause severe tissue necrosis if it extravasates from the vein.

Question 154: Which statement best describes the mechanism of action of monoclonal antibodies such as trastuzumab?

They alkylate DNA strands to prevent cell replication
They inhibit topoisomerase enzymes causing DNA strand breaks
They target specific antigens on cancer cells to inhibit growth or trigger immune destruction (Correct answer)
They interfere with microtubule polymerization during mitosis

Correct answer: They target specific antigens on cancer cells to inhibit growth or trigger immune destruction

Monoclonal antibodies bind to specific cell surface antigens, blocking signaling pathways or flagging cells for immune-mediated destruction.

Question 155: Which psychosocial issue is most commonly reported by long-term cancer survivors?

Fear of recurrence (Correct answer)
Indifference about follow-up care
Post-traumatic growth only
Complete return to pre-cancer psychological baseline

Correct answer: Fear of recurrence

Fear of cancer recurrence is the most commonly reported psychosocial concern among cancer survivors and can significantly impair quality of life.

Question 156: Which factor most strongly predicts a patient's ability to understand and act on cancer-related health information?

Health literacy level (Correct answer)
Age
Socioeconomic status
Education level

Correct answer: Health literacy level

Health literacy — the ability to obtain, understand, and use health information — is the strongest predictor of a patient's ability to navigate cancer care.

Question 157: The acronym ONS stands for which professional organization closely associated with the OCN credential?

Oncology Nurse Specialists
Oncological Nursing Standards
Outpatient Nursing Services
Oncology Nursing Society (Correct answer)

Correct answer: Oncology Nursing Society

ONS, the Oncology Nursing Society, is the professional organization that promotes oncology nursing excellence and is affiliated with ONCC.

Question 158: A patient receiving doxorubicin (an anthracycline) asks why the nurse is monitoring cumulative lifetime dose. The nurse explains this is done to prevent:

Cardiomyopathy (Correct answer)
Renal failure
Hepatotoxicity
Peripheral neuropathy

Correct answer: Cardiomyopathy

Anthracyclines like doxorubicin cause dose-dependent cardiotoxicity; cumulative dose is tracked to reduce the risk of irreversible cardiomyopathy.

Question 159: Which calculation method is most commonly used to determine chemotherapy dosing?

Actual body weight only
Age-based dosing tables
Ideal body weight only
Body surface area (BSA) (Correct answer)

Correct answer: Body surface area (BSA)

Chemotherapy doses are most commonly calculated using body surface area (m²) to standardize dosing across patient sizes.

Question 160: Which dietary instruction is most appropriate for a neutropenic patient?

Follow a high-fiber diet including raw grains and sprouts
Consume only commercially canned or well-cooked foods (Correct answer)
Eat fresh fruits and vegetables washed under running water
Increase intake of yogurt containing live cultures for gut health

Correct answer: Consume only commercially canned or well-cooked foods

Neutropenic patients follow a low-microbial diet, avoiding raw or undercooked foods that harbor pathogens.

Question 161: Which of the following chemotherapy drugs is administered to treat the spread of prostate cancer?

Cyclophosphamide (Cytoxan)
5-Fluorouracil (5FU)
Doxorubicin (Adriamycin)
Mitoxantrone (Novantrone) (Correct answer)

Correct answer: Mitoxantrone (Novantrone)

Mitoxantrone (Novantrone) is an anthracenedione antineoplastic agent commonly used in the treatment of hormone-refractory metastatic prostate cancer. It works by interfering with DNA synthesis and repair, thereby inhibiting the growth of cancer cells. The other listed drugs are typically used for different types of cancer.

Question 162: Which laboratory finding is NOT consistent with tumor lysis syndrome?

Hypercalcemia (Correct answer)
Hyperphosphatemia
Hyperkalemia
Hyperuricemia

Correct answer: Hypercalcemia

TLS causes hypocalcemia (not hypercalcemia) because phosphate released from lysed cells binds calcium, lowering serum levels.

Question 163: EGFR inhibitors such as erlotinib are most effective in NSCLC patients who have which characteristic?

ALK rearrangement
PD-L1 negative status
Activating EGFR mutation (Correct answer)
KRAS mutation

Correct answer: Activating EGFR mutation

Activating mutations in the EGFR gene (exons 19 and 21) predict sensitivity to EGFR tyrosine kinase inhibitors in non-small cell lung cancer.

Question 164: Which hallmark of cancer involves the tumor's ability to grow its own blood supply?

Evading apoptosis
Limitless replicative potential
Sustained angiogenesis (Correct answer)
Self-sufficiency in growth signals

Correct answer: Sustained angiogenesis

Sustained angiogenesis is a hallmark of cancer in which tumors secrete VEGF and other factors to grow new blood vessels that supply nutrients and oxygen.

OCN Oncology Certified Nurse Exam

The OCN (Oncology Certified Nurse) exam is administered by the Oncology Nursing Certification Corporation (ONCC) and validates expert knowledge in oncology nursing practice. The exam covers cancer biology, treatment modalities including chemotherapy and radiation, symptom management, palliative care, oncologic emergencies, patient education, psychosocial care, and pharmacology. Candidates must hold a current RN license and meet clinical practice requirements in oncology nursing.

165

Questions

180 min

Time Limit

70%

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