OCN Oncology Certified Nurse Exam — Questions and Answers

Question 1: What is the primary mechanism by which ionizing radiation destroys cancer cells?

Inducing DNA strand breaks that lead to cell death (Correct answer)
Inhibiting protein synthesis in tumor cells
Disrupting the cell membrane integrity
Blocking nutrient supply to the tumor

Correct answer: Inducing DNA strand breaks that lead to cell death

Ionizing radiation damages DNA by causing single- and double-strand breaks, which prevents cancer cells from replicating and leads to apoptosis.

Question 2: Which personal protective equipment (PPE) is required when handling hazardous chemotherapy drugs?

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

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

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

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

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

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

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

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

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

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 7: What is brachytherapy?

Radiation delivered by a machine positioned at a long distance from the patient
Placement of radioactive sources directly inside or adjacent to the tumor (Correct answer)
Targeted radiopharmaceutical therapy given intravenously
A low-dose rate form of external beam radiation

Correct answer: Placement of radioactive sources directly inside or adjacent to the tumor

Brachytherapy involves placing radioactive implants (seeds, wires, or catheters) directly within or next to the tumor to deliver a concentrated local dose.

Question 8: What is the most common site of metastasis for breast cancer?

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

Correct answer: Liver, lungs, bone, and brain

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

Question 9: A patient asks about the difference between palliative care and hospice. The nurse's best response is that palliative care:

Is only appropriate when curative treatment has stopped
Focuses solely on pain control with no psychosocial support
Can be provided alongside curative or active treatment at any stage (Correct answer)
Is only covered by insurance for patients with fewer than 6 months to live

Correct answer: Can be provided alongside curative or active treatment at any stage

Palliative care can be integrated at any point in the illness trajectory alongside curative or life-prolonging treatments.

Question 10: A patient undergoing pelvic radiation for cervical cancer reports vaginal dryness and dyspareunia. The nurse should recommend:

Vaginal moisturizers and dilator use as prescribed (Correct answer)
Increased oral fluid intake
Abstinence from all sexual activity permanently
Hormone replacement therapy only

Correct answer: Vaginal moisturizers and dilator use as prescribed

Vaginal moisturizers and use of a vaginal dilator help maintain vaginal patency and moisture after pelvic radiation–induced mucosal changes.

Question 11: Which psychological condition is most common in cancer survivors and requires routine screening?

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

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

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

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

Hepatotoxicity
Neurotoxicity
Cardiomyopathy (Correct answer)
Nephrotoxicity

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 14: Tumor grade refers to which pathological characteristic?

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

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

3,000 hours
1,000 hours (Correct answer)
2,000 hours
500 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 16: 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
High-protein diet with increased red meat intake
Low-residue, low-fat diet avoiding raw fruits, vegetables, and dairy (Correct answer)
High-fiber diet with increased raw vegetables and whole grains

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

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

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 18: A patient with non-Hodgkin lymphoma is receiving rituximab. Which pre-infusion assessment finding should cause the nurse to withhold the drug and notify the provider?

Heart rate of 82 beats per minute
Blood pressure of 118/76 mmHg
Serum creatinine of 0.9 mg/dL
Temperature of 37.8°C (100°F) with suspected active infection (Correct answer)

Correct answer: Temperature of 37.8°C (100°F) with suspected active infection

Rituximab can cause fatal infusion reactions and reactivation of infections; active infection warrants holding the drug and consulting the oncologist before proceeding.

Question 19: 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)
Increased sensitivity to chemotherapy
Stable tumor growth without spread
Enhanced response to hormone therapy

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 20: Cultural competence in oncology nursing primarily means:

Learning only the dominant language of the patient population
Treating all patients exactly the same regardless of background
Adapting care to respect patients' cultural beliefs, values, and communication preferences (Correct answer)
Assuming family members speak for patients from collectivist cultures

Correct answer: Adapting care to respect patients' cultural beliefs, values, and communication preferences

Cultural competence involves recognizing and adapting to each patient's cultural context — including beliefs about illness, decision-making, and communication — to provide equitable, respectful care.

Question 21: 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
Administer scheduled opioid analgesics
Notify the physician immediately for spinal cord compression evaluation (Correct answer)

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 22: For cancer pain management, the WHO analgesic ladder recommends starting with which class for mild pain?

Strong opioids immediately
Non-opioid analgesics (e.g., acetaminophen, NSAIDs) (Correct answer)
Adjuvant medications only
Epidural analgesia

Correct answer: Non-opioid analgesics (e.g., acetaminophen, NSAIDs)

The WHO analgesic ladder begins with non-opioid analgesics for mild pain (Step 1) and escalates to opioids only as pain severity increases.

Question 23: All of the following, except the next, are the malignancies most frequently linked to cardiac tamponade:

Breast cancer
Thyroid cancer (Correct answer)
Lymphoma
Leukemia

Correct answer: Thyroid cancer

Cardiac tamponade, often caused by malignant pericardial effusion, is most frequently linked to cancers that commonly metastasize to the pericardium. Breast cancer, lung cancer, lymphoma, and leukemia are among the primary malignancies with a higher incidence of causing cardiac tamponade. Thyroid cancer, while it can metastasize, is significantly less frequently associated with cardiac tamponade compared to the other listed options.

Question 24: Tamoxifen requires conversion by CYP2D6 to its active metabolite endoxifen. What is the nursing implication?

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

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 25: Which radiation therapy technique uses multiple precisely aimed beams to deliver a high dose to a small tumor while minimizing exposure to surrounding healthy tissue?

3D conformal radiation therapy (3D-CRT)
Intensity-modulated radiation therapy (IMRT)
Total body irradiation (TBI)
Stereotactic radiosurgery (SRS) (Correct answer)

Correct answer: Stereotactic radiosurgery (SRS)

Stereotactic radiosurgery (SRS) delivers highly precise, high-dose radiation to a small target in a single or few sessions, sparing adjacent normal tissue.

Question 26: Which organization provides the primary standards for safe handling of hazardous drugs in oncology nursing?

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

Correct answer: Oncology Nursing Society (ONS)

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

Question 27: Lynch syndrome (hereditary non-polyposis colorectal cancer) is caused by mutations in which genes?

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

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 28: A neutropenic patient with fever should receive empiric broad-spectrum antibiotics within:

1 hour of presentation (Correct answer)
4 hours of presentation
24 hours of presentation
6 hours of presentation

Correct answer: 1 hour of presentation

Current guidelines recommend initiating empiric IV antibiotics within 1 hour of presentation in febrile neutropenia to reduce morbidity and mortality.

Question 29: Cytokine release syndrome (CRS) is a potentially life-threatening complication most associated with which therapies?

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

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 30: Which element is essential in a comprehensive cancer survivorship care plan?

Only future treatment plans
Summary of treatment received and schedule of recommended follow-up (Correct answer)
List of dietary supplements to take
Contact information of insurance provider only

Correct answer: Summary of treatment received and schedule of recommended follow-up

A survivorship care plan must include a treatment summary and follow-up schedule so the patient and primary care provider can manage long-term and late effects.

Question 31: A survivor who completed treatment 2 years ago reports fear of recurrence at every follow-up visit. The nurse should:

Dismiss the concern since treatment is complete
Tell the patient to stop worrying
Acknowledge the fear, assess its impact on functioning, and refer to psychosocial support if needed (Correct answer)
Reduce follow-up visit frequency to limit anxiety triggers

Correct answer: Acknowledge the fear, assess its impact on functioning, and refer to psychosocial support if needed

Fear of recurrence is a normal and prevalent survivorship issue; validating the experience and connecting the patient with psychosocial resources is the standard approach.

Question 32: What is the primary purpose of a radiation therapy simulation appointment?

To identify and map the treatment field, verify patient positioning, and create immobilization devices (Correct answer)
To educate the patient about chemotherapy side effects
To administer the first fraction of radiation
To perform a biopsy for treatment planning

Correct answer: To identify and map the treatment field, verify patient positioning, and create immobilization devices

Simulation is a planning session in which the radiation oncology team uses imaging to delineate the tumor, design the treatment field, and fabricate immobilization devices for reproducibility.

Question 33: Which laboratory finding most strongly indicates tumor lysis syndrome (TLS) in a newly treated leukemia patient?

Elevated serum sodium
Decreased serum potassium and elevated calcium
Elevated serum albumin and decreased BUN
Elevated serum potassium, phosphate, and uric acid with decreased calcium (Correct answer)

Correct answer: Elevated serum potassium, phosphate, and uric acid with decreased calcium

TLS is characterized by hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia due to rapid cell destruction releasing intracellular contents.

Question 34: Financial toxicity in oncology refers to:

Overprescribing of expensive medications
Medications that cause liver damage affecting financial decision-making
Hospital billing errors that harm patients financially
The negative financial burden experienced by patients due to cancer treatment costs, affecting well-being and adherence (Correct answer)

Correct answer: The negative financial burden experienced by patients due to cancer treatment costs, affecting well-being and adherence

Financial toxicity describes the economic harm caused by cancer treatment costs — including medical bills, lost wages, and out-of-pocket expenses — which can lead to non-adherence and poor outcomes.

Question 35: Which chemotherapy agent is classified as a vesicant and requires careful monitoring for extravasation?

Fluorouracil
Vincristine (Correct answer)
Cyclophosphamide
Methotrexate

Correct answer: Vincristine

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

Question 36: Which laboratory finding is NOT consistent with tumor lysis syndrome?

Hyperuricemia
Hyperphosphatemia
Hypercalcemia (Correct answer)
Hyperkalemia

Correct answer: Hypercalcemia

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

Question 37: When educating a patient about tamoxifen therapy for hormone receptor-positive breast cancer, the nurse should emphasize reporting:

Mild vaginal dryness
Occasional headache
Leg pain, swelling, or shortness of breath (Correct answer)
Mild hot flashes and night sweats

Correct answer: Leg pain, swelling, or shortness of breath

Tamoxifen increases the risk of thromboembolic events; leg pain, swelling, and dyspnea are signs of DVT or pulmonary embolism requiring urgent evaluation.

Question 38: An advance directive (living will) in oncology primarily serves to:

Authorize billing for cancer treatments
Restrict information sharing with family members
Assign a healthcare power of attorney
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 39: Which statement best describes intensity-modulated radiation therapy (IMRT)?

Delivers a uniform radiation dose across the entire treatment field
Uses radioactive isotopes implanted directly into the tumor
Delivers a single high-dose fraction using a Gamma Knife device
Modulates the intensity of individual radiation beamlets to conform precisely to tumor shape while sparing adjacent organs (Correct answer)

Correct answer: Modulates the intensity of individual radiation beamlets to conform precisely to tumor shape while sparing adjacent organs

IMRT uses computer-controlled modulation of beam intensity across multiple beamlets to sculpt the dose distribution around the tumor and minimize dose to nearby critical structures.

Question 40: Which of the following best prevents tumor lysis syndrome in high-risk patients starting chemotherapy?

Restricting IV fluids to prevent fluid overload
Prophylactic potassium supplementation
Allopurinol or rasburicase plus aggressive IV hydration (Correct answer)
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 41: Bevacizumab (Avastin) targets tumor angiogenesis by inhibiting which growth factor?

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

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 42: Which statement best describes the mechanism of action of checkpoint inhibitors such as pembrolizumab?

They stimulate bone marrow production of neutrophils
They block inhibitory signals that cancer cells use to evade T-cell immune surveillance (Correct answer)
They prevent cancer cell DNA replication by cross-linking DNA strands
They directly kill cancer cells by binding to tumor antigens

Correct answer: They block inhibitory signals that cancer cells use to evade T-cell immune surveillance

Pembrolizumab (anti-PD-1) blocks the PD-1/PD-L1 pathway that tumors exploit to suppress T-cell activity, restoring the immune system's ability to recognize and destroy cancer cells.

Question 43: Before administering paclitaxel, the nurse should premedicate with which agents to prevent hypersensitivity reactions?

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

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 44: Metastasis occurs through which sequence of events?

Apoptosis → local invasion → circulation
Colonization → circulation → local invasion
Angiogenesis → extravasation → intravasation
Local invasion → intravasation → circulation → extravasation → colonization (Correct answer)

Correct answer: Local invasion → intravasation → circulation → extravasation → colonization

The metastatic cascade involves invasion of local tissue, entry into blood/lymphatics (intravasation), survival in circulation, exit (extravasation), and growth at a distant site.

Question 45: Which of the following is a late effect of radiation therapy to the pelvis that a nurse should include in patient education?

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

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

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

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 47: Which of the following is the correct definition of brachytherapy?

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

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 48: Which organization administers the OCN certification examination?

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

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 49: A patient with advanced cancer reports existential distress, stating 'I feel like my life has had no meaning.' Which nursing response best reflects a palliative care approach?

'Try not to think about it and focus on positive things.'
'This is normal at this stage — everyone feels this way.'
'Would you like me to arrange for a chaplain or counselor to speak with you?' (Correct answer)
'You should speak to your oncologist about antidepressants.'

Correct answer: 'Would you like me to arrange for a chaplain or counselor to speak with you?'

Palliative care addresses spiritual and existential distress; offering a chaplain or counselor validates the patient's experience and connects them with appropriate support.

Question 50: Lymphedema education for a patient who had axillary lymph node dissection should include which instruction?

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

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 51: 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?

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

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 52: Which of the following is a key component of a survivorship care plan (SCP)?

Full pathology and surgical operative reports
Summary of cancer treatment received plus a follow-up plan for surveillance and late effects (Correct answer)
Insurance billing codes for all treatments received
A list of all oncology team members and their credentials

Correct answer: Summary of cancer treatment received plus a follow-up plan for surveillance and late effects

A survivorship care plan includes a treatment summary and a forward-looking plan covering surveillance schedules, late effects, and health promotion.

Question 53: Which corticosteroid is most commonly used as part of antiemetic regimens for highly emetogenic chemotherapy?

Methylprednisolone
Prednisone
Dexamethasone (Correct answer)
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 54: A nurse with an active OCN credential who allows it to lapse must do which of the following to regain the credential?

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

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 55: Parents of young patients receiving radiation treatments that affect the central nervous system should be informed about post-radiation somnolence. What time of year does this neurological syndrome typically occur?

Within 5 to 8 weeks (Correct answer)
Within 3 to 6 months
Immediately
Within 1 to 2 weeks

Correct answer: Within 5 to 8 weeks

Post-radiation somnolence syndrome is a well-recognized, transient neurological side effect that can occur after radiation treatments affecting the central nervous system. This syndrome, characterized by increased sleepiness, lethargy, and sometimes irritability, typically manifests within 5 to 8 weeks after the completion of radiation therapy. Parents should be informed about this delayed onset to help them understand and manage their child's symptoms.

Question 56: Which electrolyte abnormality is the most life-threatening complication of tumor lysis syndrome?

Hyperkalemia (Correct answer)
Hyperphosphatemia
Hypocalcemia
Hyperuricemia

Correct answer: Hyperkalemia

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

Question 57: Which of the following is a cell-cycle-specific chemotherapy agent?

Vincristine (Correct answer)
Cisplatin
Carmustine
Cyclophosphamide

Correct answer: Vincristine

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

Question 58: What is the primary mechanism of action of taxanes such as paclitaxel?

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

Correct answer: Stabilizing microtubules to prevent mitosis

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

Question 59: A patient receiving irinotecan develops profuse diarrhea within 24 hours of infusion. This is best managed with:

Atropine (Correct answer)
Octreotide
Metoclopramide
Loperamide

Correct answer: Atropine

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

Question 60: Hyperviscosity syndrome is most commonly associated with which cancer?

Cervical cancer
Waldenström macroglobulinemia or multiple myeloma (Correct answer)
Colon cancer
Pancreatic cancer

Correct answer: Waldenström macroglobulinemia or multiple myeloma

Hyperviscosity syndrome results from excess paraproteins (IgM in Waldenström, or IgG/IgA in myeloma) thickening the blood and impairing flow.

Question 61: When educating a patient about neutropenia precautions, which food should the nurse instruct the patient to avoid?

Canned vegetables
Raw sushi (Correct answer)
Pasteurized yogurt
Cooked chicken breast

Correct answer: Raw sushi

Raw or undercooked seafood poses a high risk of bacterial contamination and should be avoided by neutropenic patients who cannot mount an adequate immune response.

Question 62: Which type of biopsy provides the least invasive tissue diagnosis for accessible superficial tumors?

Fine needle aspiration (FNA) (Correct answer)
Incisional biopsy
Excisional biopsy
Open surgical 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 63: Which non-pharmacologic intervention is evidence-based for managing cancer-related fatigue?

High-dose vitamin C supplementation
Aerobic exercise (Correct answer)
Prolonged bed rest
Strict caloric restriction

Correct answer: Aerobic exercise

Moderate aerobic exercise is the most evidence-based intervention for cancer-related fatigue, improving energy and quality of life.

Question 64: Which of the following treatments is recommended for a patient whose liver-metastasizing renal cell carcinoma is surgically incurable?

Nilotinib
Fluorouracil
Cetuximab
Temsirolimus (Correct answer)

Correct answer: Temsirolimus

For a patient with surgically incurable, liver-metastasizing renal cell carcinoma (RCC), Temsirolimus is a recommended treatment. Temsirolimus is an mTOR inhibitor that has been specifically approved for the treatment of advanced renal cell carcinoma, particularly in patients with poor prognostic features. It targets pathways involved in cancer cell growth and proliferation, making it an effective systemic therapy when surgical cure is not an option.

Question 65: 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 66: A patient receiving bevacizumab (a VEGF inhibitor) should be monitored most closely for which specific complication?

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

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 67: A patient on long-term opioid therapy for cancer pain reports worsening constipation unresponsive to laxatives. Which agent is specifically FDA-approved for opioid-induced constipation in cancer patients?

Senna with docusate
Lactulose
Naloxegol or methylnaltrexone (Correct answer)
Polyethylene glycol

Correct answer: Naloxegol or methylnaltrexone

Peripherally acting mu-opioid receptor antagonists (PAMORAs) like naloxegol and methylnaltrexone are specifically approved for opioid-induced constipation without reversing central analgesia.

Question 68: Targeted therapy with imatinib (Gleevec) works by inhibiting which specific molecular target?

EGFR receptor
BCR-ABL tyrosine kinase (Correct answer)
VEGF receptor
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 69: Colony-stimulating factors (e.g., filgrastim/G-CSF) are used in oncology patients primarily for which purpose?

To prevent anemia from chemotherapy
To reduce nausea from radiation
To stimulate neutrophil production and reduce febrile neutropenia risk (Correct answer)
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 70: A nurse is caring for a patient with a low-dose rate (LDR) cervical brachytherapy implant. Which safety precaution is most important?

Limit time near the patient and keep distance; pregnant visitors and children should not visit (Correct answer)
Ensure the patient wears lead shielding at all times
Instruct visitors to stand at the foot of the bed as far as possible
Double-glove and wear an N95 mask when entering the room

Correct answer: Limit time near the patient and keep distance; pregnant visitors and children should not visit

Radiation safety for LDR brachytherapy requires limiting time and maximizing distance from the radioactive source; pregnant women and children are especially restricted to protect them from radiation exposure.

Question 71: Which chemotherapy agent is classified as an alkylating agent?

Doxorubicin
Vincristine
Cyclophosphamide (Correct answer)
Methotrexate

Correct answer: Cyclophosphamide

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

Question 72: Return to work after cancer treatment is supported by which nursing intervention?

Returning to work immediately after the last chemo dose
Avoiding any discussion of employment during cancer care
Advising permanent disability leave for all survivors
Connecting the patient with occupational therapy and informing them of ADA workplace accommodations (Correct answer)

Correct answer: Connecting the patient with occupational therapy and informing them of ADA workplace accommodations

Nurses help survivors return to work by facilitating occupational therapy referrals and educating about ADA rights to reasonable workplace accommodations.

Question 73: Which domain represents the largest portion of the OCN exam blueprint?

Symptom Management (Correct answer)
Oncology Nursing Practice
Treatment Modalities
Health Promotion

Correct answer: Symptom Management

Symptom Management consistently represents the largest percentage of questions on the OCN exam blueprint.

Question 74: The nurse is assessing a cancer patient for distress. Which validated tool is recommended by NCCN for this purpose?

Distress Thermometer (Correct answer)
Beck Depression Inventory
PHQ-9 Depression Scale
Hamilton Anxiety Rating Scale

Correct answer: Distress Thermometer

The NCCN Distress Thermometer is a validated, brief (0–10) screening tool recommended for routine distress screening in oncology patients.

Question 75: Tumor lysis syndrome (TLS) is most likely to occur in which cancer type?

Highly proliferative tumors such as Burkitt lymphoma or ALL (Correct answer)
Hormone-sensitive breast cancer
Well-differentiated thyroid cancer
Slow-growing solid tumors

Correct answer: Highly proliferative tumors such as Burkitt lymphoma or ALL

TLS most commonly occurs with highly proliferative hematologic malignancies like Burkitt lymphoma or ALL due to rapid cell lysis releasing intracellular contents.

Question 76: IV fluids are given as part of the initial care for a cancer patient who has early sepsis.

Vasopressors
Immunoglobulins
Antifungals
Antibiotics (Correct answer)

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

Intrathecal (Correct answer)
Intravenous
Oral
Subcutaneous

Correct answer: Intrathecal

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

Question 78: Which of the following best describes the action of monoclonal antibodies used in cancer immunotherapy?

Target specific antigens on cancer cells to trigger immune destruction (Correct answer)
Block all cell division non-selectively
Directly alkylate DNA to halt replication
Replace deficient white blood cells in the bone marrow

Correct answer: Target specific antigens on cancer cells to trigger immune destruction

Monoclonal antibodies bind to specific antigens expressed on cancer cells, flagging them for destruction by the immune system.

Question 79: What lab value must be assessed before administering methotrexate at high doses?

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

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

Doxorubicin (Adriamycin)
5-Fluorouracil (5FU)
Cyclophosphamide (Cytoxan)
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 81: 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 82: Which antifungal drug interaction is most important to monitor in patients receiving voriconazole and certain chemotherapy agents?

Decreased steroid effectiveness
CYP450 enzyme inhibition increasing chemotherapy drug levels (Correct answer)
Increased antibiotic resistance
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 83: A patient receiving cisplatin needs prehydration primarily to prevent which toxicity?

Nephrotoxicity (Correct answer)
Cardiotoxicity
Hepatotoxicity
Pulmonary toxicity

Correct answer: Nephrotoxicity

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

Question 84: 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)
HER2
LAG-3 only

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

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

Correct answer: Everolimus and temsirolimus

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

Question 86: What is the term for giving chemotherapy before the primary surgical procedure to shrink a tumor?

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

Correct answer: Neoadjuvant therapy

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

Question 87: Which type of radiation therapy delivers a high dose to a small target with steep dose fall-off, minimizing exposure to surrounding tissue?

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

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

Doxorubicin
Gemcitabine
High-dose methotrexate (Correct answer)
Paclitaxel

Correct answer: High-dose methotrexate

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

Question 89: Which route of administration is used for intrathecal chemotherapy?

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

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

Limiting patient questions to save time
Using teach-back method to confirm patient understanding (Correct answer)
Relying on family members to teach the patient
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 91: Tumor heterogeneity refers to which biological characteristic of cancers?

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
Identical genetic profiles across primary and metastatic sites

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

Increase intake of yogurt containing live cultures for gut health
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

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 93: What is the nadir in the context of chemotherapy administration?

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

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 94: 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
Family member's educational background
Patient's insurance coverage

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 95: The MASCC risk index is used in oncology to:

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

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

An unrelated comorbidity
A sign of tumor lysis syndrome
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 97: 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 98: 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
Respect the patient's expressed preference to have the spouse receive information, and document this preference (Correct answer)
Immediately share all information with the spouse

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

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

Correct answer: Vascular endothelial growth factor (VEGF)

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

Question 100: A patient with leukemia develops petechiae, prolonged bleeding from IV sites, and a platelet count of 8,000/mm³. The priority nursing intervention is:

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

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

Thalidomide and lenalidomide (Correct answer)
Methotrexate alone
Filgrastim
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 102: Dyspnea in a patient with lung cancer should first be assessed for which reversible cause?

Anxiety disorder only
Terminal decline only
Tumor spread only
Pleural effusion (Correct answer)

Correct answer: Pleural effusion

Pleural effusion is a common, treatable cause of dyspnea in lung cancer patients and should be assessed and drained if present.

Question 103: A patient receiving carboplatin reports ringing in the ears and decreased hearing. Which action should the oncology nurse take first?

Notify the provider and document the findings (Correct answer)
Increase oral fluid intake to flush the drug
Reassure the patient this is expected and temporary
Administer an antiemetic as ordered

Correct answer: Notify the provider and document the findings

Ototoxicity is a serious adverse effect that requires prompt provider notification and documentation before treatment continues.

Question 104: A patient with known lung cancer develops distant heart sounds, jugular venous distension, and hypotension. The nurse suspects:

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

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

Hyponatremia
Hyperglycemia (Correct answer)
Thrombocytopenia
Hypocalcemia

Correct answer: Hyperglycemia

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

Question 106: Which nursing intervention is the priority when a patient receiving chemotherapy develops neutropenic fever (temperature ≥38.3°C)?

Obtain blood cultures and initiate broad-spectrum antibiotics promptly (Correct answer)
Place the patient in strict isolation and notify the dietitian
Discontinue the chemotherapy infusion immediately
Administer acetaminophen and monitor for 2 hours

Correct answer: Obtain blood cultures and initiate broad-spectrum antibiotics promptly

Neutropenic fever is an oncologic emergency requiring immediate blood cultures and broad-spectrum antibiotic administration within one hour.

Question 107: Which immune checkpoint inhibitor targets PD-1?

Pembrolizumab (Correct answer)
Atezolizumab
Ipilimumab
Durvalumab

Correct answer: Pembrolizumab

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

Question 108: Cancer-related fatigue (CRF) differs from normal fatigue in which key way?

CRF only occurs during chemotherapy
CRF is caused only by anemia
CRF is not relieved by rest or sleep (Correct answer)
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 109: What does the term 'nadir' refer to in chemotherapy nursing?

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

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

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

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 111: A 60-year-old male patient is admitted to the oncology unit with a new diagnosis of small cell carcinoma of the right lung and a cough as his main complaints. The syndrome of the superior vena cava is identified. Which medical procedures would you anticipate being prescribed for this patient?

Surgical consultant to place a chest tube
Chemotherapy with adjuvant radiation therapy (Correct answer)
Transfusion of two units of packed red blood cells
Thoracentesis under local anesthesia

Correct answer: Chemotherapy with adjuvant radiation therapy

For a patient diagnosed with small cell carcinoma of the right lung presenting with superior vena cava (SVC) syndrome, the most appropriate medical procedure is chemotherapy with adjuvant radiation therapy. Small cell lung cancer is highly sensitive to both modalities, and this combined approach aims to rapidly reduce the tumor size, thereby alleviating the compression on the superior vena cava and improving the patient's symptoms.

Question 112: What is the definitive emergency treatment for malignant cardiac tamponade?

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

Correct answer: Pericardiocentesis

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

Question 113: A patient who completed chest radiation 6 weeks ago presents with fever, dry cough, and dyspnea. Which radiation complication is most likely?

Radiation esophagitis
Pericarditis
Radiation dermatitis
Radiation pneumonitis (Correct answer)

Correct answer: Radiation pneumonitis

Radiation pneumonitis typically occurs 1–3 months after chest irradiation and presents with fever, dry cough, and dyspnea due to inflammatory lung damage.

Question 114: A nurse is preparing to administer rituximab infusion. Which pre-medication is typically given to reduce infusion reactions?

Lorazepam and morphine
Acetaminophen and diphenhydramine (Correct answer)
Epinephrine and hydrocortisone
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 115: 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
Blood return is sluggish and the site shows swelling with infusion (Correct answer)
The IV was placed 6 hours ago in the antecubital fossa
Patient reports mild anxiety about the infusion

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

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

Correct answer: Estrogen receptor-positive

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

Question 117: Which oncogene is frequently amplified in HER2-positive breast cancer, making it a therapeutic target?

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

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 118: Which electrolyte abnormality is NOT associated with tumor lysis syndrome?

Hyperphosphatemia
Hyperuricemia
Hyperkalemia
Hypocalcemia (Correct answer)

Correct answer: Hypocalcemia

TLS causes hyperkalemia, hyperphosphatemia, hyperuricemia, and resultant hypocalcemia—not hypercalcemia; calcium falls because phosphate binds it.

Question 119: A survivor completing treatment should receive a survivorship care plan from which care setting?

The emergency department
Only from primary care after 5 years
Only if the patient requests it in writing
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 120: Which intervention is most appropriate for a patient experiencing grade 3 oral mucositis?

Encourage use of commercial mouthwash with alcohol to reduce bacteria
Apply topical antifungal rinse three times daily
Recommend soft foods and saline rinses every 8 hours
Provide parenteral nutrition and administer prescribed opioid analgesics (Correct answer)

Correct answer: Provide parenteral nutrition and administer prescribed opioid analgesics

Grade 3 mucositis involves inability to eat adequately and severe pain, requiring nutritional support and strong analgesics.

Question 121: Which of the following is a common dose-limiting toxicity of cisplatin?

Cardiotoxicity
Nephrotoxicity (Correct answer)
Pulmonary fibrosis
Hepatotoxicity

Correct answer: Nephrotoxicity

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

Question 122: Which agent is used as antidote or reversal for severe methotrexate toxicity when leucovorin is insufficient?

N-acetylcysteine
Glucarpidase (carboxypeptidase G2) (Correct answer)
Dexrazoxane
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 123: Which chemotherapy agent class is most commonly associated with secondary leukemia as a long-term complication?

Alkylating agents and topoisomerase II inhibitors (Correct answer)
Antimetabolites
Taxanes
Vinca alkaloids

Correct answer: Alkylating agents and topoisomerase II inhibitors

Alkylating agents and topoisomerase II inhibitors are most strongly linked to treatment-related myelodysplastic syndrome and AML.

Question 124: Which statement best describes the mechanism of action of monoclonal antibodies such as trastuzumab?

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

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

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

Correct answer: Body surface area (BSA)

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

Question 126: Which mechanism explains why cancer cells continue to divide without responding to normal growth-stop signals?

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

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 127: Aromatase inhibitors (e.g., anastrozole, letrozole) are used in postmenopausal breast cancer patients to achieve which effect?

Increase progesterone levels
Suppress ovarian estrogen production
Block conversion of androgens to estrogen in peripheral tissues (Correct answer)
Block estrogen at the receptor directly

Correct answer: Block conversion of androgens to estrogen in peripheral tissues

Aromatase inhibitors block the aromatase enzyme that converts androgens to estrogens in peripheral tissues, the main estrogen source in postmenopausal women.

Question 128: 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
Eosinophils and basophils
Cytotoxic T lymphocytes (CD8+ T cells) and natural killer (NK) cells (Correct answer)
B lymphocytes exclusively

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 129: Which statement best reflects the nurse's role in informed consent for cancer treatment?

The nurse witnesses the signature, reinforces information, and ensures the patient's questions are answered (Correct answer)
The nurse obtains the legal informed consent independently
The nurse's only role is to give the patient the consent form
Informed consent for cancer treatment does not require nursing involvement

Correct answer: The nurse witnesses the signature, reinforces information, and ensures the patient's questions are answered

Informed consent is obtained by the physician; the nurse's role is to witness, reinforce information, and act as an advocate ensuring the patient's questions are addressed.

Question 130: Hypercalcemia of malignancy is most commonly caused by which mechanism?

Vitamin D toxicity from supplements
Parathyroid hormone-related protein (PTHrP) secreted by the tumor (Correct answer)
Increased dietary calcium absorption
Primary hyperparathyroidism coincidental to cancer

Correct answer: Parathyroid hormone-related protein (PTHrP) secreted by the tumor

Most cancer-related hypercalcemia is caused by PTHrP secreted by tumors, which mimics PTH and drives osteoclast-mediated bone resorption.

Question 131: What cumulative dose of doxorubicin is associated with the greatest risk of cardiomyopathy?

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

Correct answer: 450–550 mg/m²

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

Question 132: Cognitive changes after chemotherapy, commonly called 'chemo brain,' are best described as:

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

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

It checks for drug resistance to predict the next cycle dose
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 measures tumor marker levels to assess treatment response

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

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

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 135: Which scale is most commonly used in clinical practice to assess cancer pain intensity?

ECOG Performance Status
Glasgow Coma Scale
Numerical Rating Scale (NRS) 0–10 (Correct answer)
Karnofsky Performance Status

Correct answer: Numerical Rating Scale (NRS) 0–10

The 0–10 Numerical Rating Scale (NRS) is the most widely used clinical tool to assess pain intensity in cancer patients.

Question 136: The nurse is assessing oral mucositis in a chemotherapy patient using the NCI grading scale. Which finding corresponds to Grade 3 mucositis?

Life-threatening requiring urgent intervention
Asymptomatic with mild erythema
Symptomatic but able to eat a modified diet
Severe symptoms preventing adequate oral intake (Correct answer)

Correct answer: Severe symptoms preventing adequate oral intake

NCI Grade 3 mucositis is characterized by severe symptoms that prevent adequate oral intake, requiring enteral or parenteral nutritional support.

Question 137: Bisphosphonates such as zoledronic acid are used in oncology to treat which complications?

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

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

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

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 139: A proto-oncogene becomes an oncogene through which process?

Deletion of the gene entirely
Mutation, amplification, or translocation that causes gain-of-function overactivation (Correct answer)
Loss-of-function mutation in a tumor suppressor
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 140: What is the purpose of using a CVAD (central venous access device) for chemotherapy?

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

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

Antimetabolites
Anthracyclines (Correct answer)
Alkylating agents
Vinca alkaloids

Correct answer: Anthracyclines

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

Question 142: 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 143: CAR-T cell therapy requires which critical patient preparation step?

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

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

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

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

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

Correct answer: Back pain

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

Question 146: Which factor most commonly triggers a cancer survivor's distress around surveillance imaging?

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

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

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

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.

Question 148: EGFR inhibitors such as erlotinib are most effective in NSCLC patients who have which characteristic?

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

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 149: 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 150: Which of the following best describes the concept of 'informed consent' in oncology?

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
The patient signs a form agreeing to any treatment the physician recommends

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

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

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

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

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 153: A patient's ANC is 450 cells/mm³. Based on this value, the nurse understands the patient is at:

No increased infection risk
Moderate to severe risk requiring neutropenic precautions (Correct answer)
Low risk requiring only hand hygiene reinforcement
Mild risk and standard precautions are sufficient

Correct answer: Moderate to severe risk requiring neutropenic precautions

An ANC below 500 cells/mm³ indicates severe neutropenia and high infection risk requiring protective precautions.

Question 154: 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 4
Grade 3 (Correct answer)
Grade 1
Grade 2

Correct answer: Grade 3

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

Question 155: Which chemotherapy agent is associated with hemorrhagic cystitis as a major side effect?

Irinotecan
Vinorelbine
Cyclophosphamide (Correct answer)
Cisplatin

Correct answer: Cyclophosphamide

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

Question 156: Which cancer screening recommendation aligns with current American Cancer Society guidelines for average-risk adults?

Annual mammography recommended starting at age 30 for all women
Cervical cancer screening every 10 years starting at age 20
Colorectal cancer screening beginning at age 45 (Correct answer)
Annual PSA testing for all men beginning at age 40

Correct answer: Colorectal cancer screening beginning at age 45

The ACS updated guidelines recommend colorectal cancer screening beginning at age 45 for average-risk individuals.

Question 157: Hot flashes in breast cancer survivors receiving aromatase inhibitors are best managed initially with which non-pharmacological approach?

Lifestyle modifications including layered clothing, cool room temperatures, and avoiding triggers (Correct answer)
Increased caffeine intake
Sedating antihistamines
High-dose estrogen replacement

Correct answer: Lifestyle modifications including layered clothing, cool room temperatures, and avoiding triggers

Non-pharmacological strategies such as trigger avoidance, cool environments, and layered clothing are recommended first because estrogen is contraindicated in breast cancer.

Question 158: A patient with multiple myeloma presents with confusion, polyuria, and constipation. Serum calcium is 13.5 mg/dL. The priority nursing intervention is:

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

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

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

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

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

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

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

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 162: Sexual health concerns in cancer survivors should be addressed using which approach?

Avoid the topic unless the patient raises it first
PLISSIT model (Permission, Limited Information, Specific Suggestions, Intensive Therapy) (Correct answer)
Only address sexual health at the last visit
Refer all sexual concerns to psychiatry without discussion

Correct answer: PLISSIT model (Permission, Limited Information, Specific Suggestions, Intensive Therapy)

The PLISSIT model provides a structured framework for progressively addressing sexual health concerns in cancer survivors within nursing practice.

Question 163: A cancer patient reports nausea that is worse with movement and relieved by staying still. Which antiemetic class best targets this type of nausea?

Dopamine antagonists
5-HT3 antagonists
Corticosteroids
Antihistamines/anticholinergics (Correct answer)

Correct answer: Antihistamines/anticholinergics

Motion-related nausea is vestibular in origin and is best managed with antihistamines or anticholinergics such as meclizine or scopolamine.

Question 164: CAR-T cell therapy works by:

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

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.

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%

To Pass

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