OCN Oncology Certified Nurse Exam — Questions and Answers

Question 1: A patient receiving doxorubicin (an anthracycline) asks why the nurse is monitoring cumulative lifetime dose. The nurse explains this is done to prevent:

Hepatotoxicity
Peripheral neuropathy
Renal failure
Cardiomyopathy (Correct answer)

Correct answer: Cardiomyopathy

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

Question 2: Which of the following best describes the purpose of the OCN certification?

To grant oncology nursing licensure at the state level
To authorize nurses to prescribe oncology medications
To validate specialized knowledge in oncology nursing practice (Correct answer)
To qualify nurses for hospital administration roles

Correct answer: To validate specialized knowledge in oncology nursing practice

The OCN credential validates that a nurse has demonstrated specialized knowledge and expertise in oncology nursing practice.

Question 3: PARP inhibitors such as olaparib are most effective in cancers with defects in which pathway?

Homologous recombination repair (BRCA1/2 mutations) (Correct answer)
PI3K/AKT/mTOR pathway
RAS/MAPK signaling pathway
VEGF signaling 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 4: Which route of administration bypasses the blood-brain barrier most effectively for CNS tumors?

Oral
Intravenous
Intrathecal (Correct answer)
Subcutaneous

Correct answer: Intrathecal

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

Question 5: What is the nadir in the context of chemotherapy administration?

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

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 6: The 'teachback' method in patient education is best described as:

Reading written instructions aloud to the patient
Asking the patient to explain the information back in their own words to confirm understanding (Correct answer)
Testing the patient with a multiple-choice quiz
Showing a video and asking if they have questions

Correct answer: Asking the patient to explain the information back in their own words to confirm understanding

Teach-back is an evidence-based health literacy technique where the nurse asks the patient to restate information to verify comprehension before discharge.

Question 7: Hormonal therapy with tamoxifen is most appropriate for which breast cancer receptor profile?

Estrogen receptor-positive (Correct answer)
HER2-positive, ER-negative
Triple-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 8: What is the recommended minimum hours of oncology nursing practice required before sitting for the OCN exam?

1,000 hours (Correct answer)
500 hours
2,000 hours
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 9: Which agent is used as antidote or reversal for severe methotrexate toxicity when leucovorin is insufficient?

Glucarpidase (carboxypeptidase G2) (Correct answer)
N-acetylcysteine
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 10: Cognitive changes after chemotherapy, commonly called 'chemo brain,' are best described as:

Psychosis and hallucinations
Difficulties with memory, concentration, and processing speed (Correct answer)
Permanent dementia in all patients
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 11: Which of the following drugs is typically prescribed to a leukemia patient as a preventative measure against P. carinii pneumonia?

Prednisone
Vincristine (Oncovin)
Bacrtrim (Correct answer)
Oral nystatin suspension

Correct answer: Bacrtrim

Bacrtrim (Trimethoprim-sulfamethoxazole) is a commonly prescribed antibiotic for leukemia patients as a preventative measure against *Pneumocystis jirovecii* pneumonia (PJP), formerly known as *Pneumocystis carinii* pneumonia (PCP). Leukemia patients are often immunocompromised due to their disease and chemotherapy, making them highly susceptible to opportunistic infections like PJP. Bacrtrim effectively reduces the risk of developing this serious lung infection.

Question 12: A survivor completing treatment should receive a survivorship care plan from which care setting?

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)
The emergency department

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

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

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 14: 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 15: 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
Serum creatinine of 0.9 mg/dL
Blood pressure of 118/76 mmHg
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 16: Which cancer screening recommendation aligns with current American Cancer Society guidelines for average-risk adults?

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

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 17: A patient receiving cisplatin-based chemotherapy develops tinnitus and decreased hearing. Which intervention is the priority?

Notify the oncologist and hold the next dose (Correct answer)
Reassure the patient this is temporary
Increase IV fluid rate
Administer antihistamines

Correct answer: Notify the oncologist and hold the next dose

Tinnitus and hearing loss are signs of cisplatin-induced ototoxicity, a serious irreversible adverse effect requiring immediate provider notification before continuing therapy.

Question 18: Which statement about cancer-related fatigue (CRF) best reflects current evidence-based practice?

Exercise is contraindicated until treatment is completed
Moderate aerobic exercise during treatment is the most effective intervention for CRF (Correct answer)
Patients should rest completely and avoid all physical activity
CRF resolves immediately after chemotherapy ends

Correct answer: Moderate aerobic exercise during treatment is the most effective intervention for CRF

Evidence consistently shows that moderate aerobic exercise is the most effective evidence-based intervention for reducing cancer-related fatigue during and after treatment.

Question 19: Hyperviscosity syndrome is most commonly associated with which cancer?

Pancreatic cancer
Colon cancer
Waldenström macroglobulinemia or multiple myeloma (Correct answer)
Cervical 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 20: Which laboratory finding is NOT consistent with tumor lysis syndrome?

Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypercalcemia (Correct answer)

Correct answer: Hypercalcemia

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

Question 21: Bisphosphonates such as zoledronic acid are used in oncology to treat which complications?

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

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

Hydrocortisone
Dexamethasone (Correct answer)
Methylprednisolone
Prednisone

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

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

Correct answer: Pericardiocentesis

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

Question 24: A patient receiving vincristine (a vinca alkaloid) should be monitored closely for which toxicity?

Nephrotoxicity
Cardiotoxicity
Pulmonary fibrosis
Peripheral neuropathy (Correct answer)

Correct answer: Peripheral neuropathy

Vincristine's dose-limiting toxicity is peripheral neuropathy, manifesting as paresthesias, weakness, and autonomic dysfunction.

Question 25: 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
Cytotoxic T lymphocytes (CD8+ T cells) and natural killer (NK) cells (Correct answer)
B lymphocytes exclusively
Eosinophils and basophils

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

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

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

Single gloves only
Double gloves, gown, and eye protection (Correct answer)
N95 mask and gloves
Surgical mask and gown 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 28: Which cancer screening test detects precancerous lesions and is recommended for cervical cancer prevention?

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

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 29: Tumor heterogeneity refers to which biological characteristic of cancers?

Identical genetic profiles across primary and metastatic sites
Genetic diversity among cells within the same tumor, leading to varied drug sensitivities (Correct answer)
The spread of cancer to multiple organs
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 30: 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
Sunscreen is only needed at the beach
Avoid all sun exposure permanently indoors

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

Methotrexate
Fluorouracil
Cyclophosphamide
Vincristine (Correct answer)

Correct answer: Vincristine

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

Question 32: CAR-T cell therapy requires which critical patient preparation step?

High-dose steroid premedication only
Lymphodepleting chemotherapy before infusion (Correct answer)
Complete fasting for 24 hours
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 33: Which assessment finding in a patient with cancer indicates hypercalcemia of malignancy requiring urgent intervention?

Serum calcium of 13.5 mg/dL with confusion and polyuria (Correct answer)
Serum calcium of 8.8 mg/dL with paresthesias
Serum calcium of 10.1 mg/dL with mild fatigue
Serum calcium of 9.0 mg/dL with muscle cramps

Correct answer: Serum calcium of 13.5 mg/dL with confusion and polyuria

A serum calcium above 12 mg/dL with neurological symptoms (confusion) and polyuria represents severe hypercalcemia of malignancy requiring urgent IV hydration and bisphosphonate therapy.

Question 34: Which type of radiation therapy delivers a high dose to a small target with steep dose fall-off, minimizing exposure to surrounding tissue?

Stereotactic radiosurgery (SRS) (Correct answer)
Conventional fractionated radiotherapy
Total body irradiation
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 35: Which of the following treatments is recommended for a patient whose liver-metastasizing renal cell carcinoma is surgically incurable?

Fluorouracil
Cetuximab
Nilotinib
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 36: Which dietary recommendation is evidence-based for cancer survivors to reduce recurrence risk?

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

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 37: 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
Providing only written materials without verbal explanation
Limiting patient questions to save time

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 38: Which early sign of increased intracranial pressure (ICP) from brain metastases should the oncology nurse recognize?

Tachycardia with narrowed pulse pressure
Bradycardia with widened pulse pressure
Morning headache that improves upon sitting upright (Correct answer)
Decreased deep tendon reflexes bilaterally

Correct answer: Morning headache that improves upon sitting upright

Headache that is worst in the morning and improves when upright is a classic early sign of elevated ICP from brain metastases due to positional changes in cerebrospinal fluid pressure.

Question 39: 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 loss is permanent for all chemotherapy patients
Hair may never return after any chemotherapy
Hair will return within 2 weeks of the last dose

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

Mutation, amplification, or translocation that causes gain-of-function overactivation (Correct answer)
Loss-of-function mutation in a tumor suppressor
Deletion of the gene entirely
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 41: A patient on long-term opioid therapy reports no bowel movement in 4 days. The most appropriate first intervention is:

Administer an enema without further assessment
Recommend increased dietary fiber only
Discontinue the opioid immediately
Add a stimulant laxative such as senna (Correct answer)

Correct answer: Add a stimulant laxative such as senna

Opioid-induced constipation requires a stimulant laxative (e.g., senna) as first-line treatment; fiber alone is insufficient with opioids.

Question 42: Aromatase inhibitors (e.g., anastrozole, letrozole) are used in postmenopausal breast cancer patients to achieve which effect?

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

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

Filgrastim
Ondansetron
Thalidomide and lenalidomide (Correct answer)
Methotrexate alone

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

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

Correct answer: Liver, lungs, bone, and brain

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

Question 45: The Warburg effect in cancer cells refers to which metabolic phenomenon?

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

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 46: As part of nursing interventions for the treatment of nausea, patients are urged to:

Avoid brushing their teeth when they are nauseated
Eat high-protein and high-potassium foods
Consume more frequent meals with small portions (Correct answer)
Use spicy sauces and gravies

Correct answer: Consume more frequent meals with small portions

For patients experiencing nausea, consuming more frequent meals with small portions is a recommended nursing intervention. Large meals can overwhelm the digestive system and worsen nausea, whereas smaller, more frequent intakes are often better tolerated, helping to maintain nutritional intake without triggering severe discomfort. This approach helps manage symptoms and supports the patient's overall well-being during treatment.

Question 47: A patient on high-dose corticosteroids for brain metastases should be monitored for which common complication?

Hyponatremia
Hyperglycemia (Correct answer)
Hypocalcemia
Thrombocytopenia

Correct answer: Hyperglycemia

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

Question 48: For cancer pain management, the WHO analgesic ladder recommends starting with which class for mild pain?

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

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

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

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 50: 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)
Ondansetron and dexamethasone only
Lorazepam and morphine

Correct answer: Acetaminophen and diphenhydramine

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

Question 51: What is brachytherapy?

Placement of radioactive sources directly inside or adjacent to the tumor (Correct answer)
Radiation delivered by a machine positioned at a long distance from the patient
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 52: A breast cancer survivor asks if she can use herbal supplements during follow-up care. The nurse's best response is:

Supplements only matter during active chemotherapy
Always discuss supplements with your oncologist because some can interact with cancer treatments (Correct answer)
All herbal supplements are safe for cancer survivors
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 53: What cumulative dose of doxorubicin is associated with the greatest risk of cardiomyopathy?

750 mg/m²
450–550 mg/m² (Correct answer)
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 54: Which calculation method is most commonly used to determine chemotherapy dosing?

Body surface area (BSA) (Correct answer)
Age-based dosing tables
Ideal body weight only
Actual 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 55: According to the WHO analgesic ladder, what class of medication is used at Step 3 for severe cancer pain?

Adjuvant analgesics only
Weak opioids (e.g., codeine)
Non-opioid analgesics (e.g., acetaminophen)
Strong opioids (e.g., morphine) (Correct answer)

Correct answer: Strong opioids (e.g., morphine)

Step 3 of the WHO analgesic ladder uses strong opioids such as morphine, oxycodone, or hydromorphone for severe pain.

Question 56: Which intervention is most effective in preventing chemotherapy-induced nausea and vomiting (CINV) prior to a highly emetogenic regimen?

Restricting all oral intake for 12 hours before chemotherapy
Administering antiemetics only after nausea begins
Pre-medicating with a 5-HT3 antagonist, a NK1 antagonist, and dexamethasone (Correct answer)
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 57: Which electrolyte abnormality is the most life-threatening complication of tumor lysis syndrome?

Hypocalcemia
Hyperkalemia (Correct answer)
Hyperuricemia
Hyperphosphatemia

Correct answer: Hyperkalemia

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

Question 58: Cachexia in cancer patients is best described as:

Simple malnutrition from decreased oral intake
Dehydration due to vomiting
A metabolic syndrome of weight loss, muscle wasting, and inflammation (Correct answer)
A side effect of antiemetics

Correct answer: A metabolic syndrome of weight loss, muscle wasting, and inflammation

Cancer cachexia is a complex metabolic syndrome driven by inflammation and tumor factors, causing involuntary weight loss and muscle wasting that cannot be fully reversed by nutrition alone.

Question 59: A patient receiving bleomycin should be monitored closely for which life-threatening complication?

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

Correct answer: Pulmonary fibrosis

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

Question 60: A patient with leukemia develops petechiae, prolonged bleeding from IV sites, and a platelet count of 8,000/mm³. The priority nursing intervention is:

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

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 61: 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 62: TNM staging for solid tumors classifies cancers based on which three factors?

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

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

Cardiomyopathy (Correct answer)
Neurotoxicity
Nephrotoxicity
Hepatotoxicity

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

Informed consent for cancer treatment does not require nursing involvement
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

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

HER2
PD-1 (programmed death-1) (Correct answer)
LAG-3 only
CTLA-4 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 66: 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 67: Which cancer type has a strong etiological link to Helicobacter pylori infection?

Liver cancer
Colon cancer
Pancreatic 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 68: Lynch syndrome (hereditary non-polyposis colorectal cancer) is caused by mutations in which genes?

Mismatch repair genes (MLH1, MSH2, MSH6, PMS2) (Correct answer)
BRCA1 and BRCA2
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 69: 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 1
Grade 3 (Correct answer)
Grade 2
Grade 4

Correct answer: Grade 3

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

Question 70: EGFR inhibitors such as erlotinib are most effective in NSCLC patients who have which characteristic?

ALK rearrangement
Activating EGFR mutation (Correct answer)
PD-L1 negative status
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 71: Which intervention is most appropriate when a patient develops chemotherapy extravasation of a vesicant agent?

Apply warm compresses and continue the infusion at a slower rate
Flush the IV line with normal saline and apply a warm compress
Stop the infusion immediately, aspirate residual drug, and apply cold compresses for most vesicants (Correct answer)
Discontinue the IV and massage the affected area vigorously

Correct answer: Stop the infusion immediately, aspirate residual drug, and apply cold compresses for most vesicants

For vesicant extravasation, the infusion must be stopped immediately, residual drug aspirated, the IV removed, and cold compresses applied (except for vinca alkaloids which require warmth).

Question 72: Metastasis occurs through which sequence of events?

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

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

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

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

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

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

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

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 76: Which chemotherapy agent class is most commonly associated with secondary leukemia as a long-term complication?

Taxanes
Alkylating agents and topoisomerase II inhibitors (Correct answer)
Antimetabolites
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 77: 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:

< 1500 cells/mm³
< 1000 cells/mm³
< 500 cells/mm³ (Correct answer)
< 100 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 78: A patient with multiple myeloma presents with confusion, polyuria, and constipation. Serum calcium is 13.5 mg/dL. The priority nursing intervention is:

Restrict fluid intake
Administer IV bisphosphonates immediately
Administer oral calcium supplements
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 79: 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)
Administer supplemental oxygen to all patients regardless of SpO2
Restrict fluid intake

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

A sign of tumor lysis syndrome
A predictable on-target side effect (Correct answer)
An unrelated comorbidity
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 81: What is the purpose of using a CVAD (central venous access device) for chemotherapy?

To improve oral bioavailability
To safely administer vesicants and reduce peripheral vein damage (Correct answer)
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 82: A nurse is caring for a patient with cancer-related fatigue. Which recommendation is most evidence-based?

Recommend high-dose vitamin C supplementation
Complete bed rest throughout treatment
Encourage a structured, moderate aerobic exercise program (Correct answer)
Avoid all physical activity until treatment ends

Correct answer: Encourage a structured, moderate aerobic exercise program

Evidence consistently supports moderate aerobic exercise as the most effective intervention for cancer-related fatigue during and after treatment.

Question 83: What lab value must be assessed before administering methotrexate at high doses?

Complete blood count only
Creatinine clearance/renal function (Correct answer)
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 84: Trastuzumab (Herceptin) is indicated for cancers that overexpress which receptor?

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

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 85: Which route of administration is used for intrathecal chemotherapy?

Intraperitoneal
Intravenous
Subcutaneous
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 86: Late cardiovascular effects of cancer treatment are most associated with which therapies?

Antiemetics and pain medications
Colony-stimulating factors
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 87: Before administering paclitaxel, the nurse should premedicate with which agents to prevent hypersensitivity reactions?

Metoclopramide and dexamethasone
Acetaminophen and ibuprofen
Ondansetron and lorazepam
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 88: Which chemotherapy agent is classified as an alkylating agent?

Vincristine
Doxorubicin
Methotrexate
Cyclophosphamide (Correct answer)

Correct answer: Cyclophosphamide

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

Question 89: Which assessment tool is validated specifically for measuring overall symptom burden in cancer patients?

Mini-Mental State Examination
Braden Scale
Edmonton Symptom Assessment System (ESAS) (Correct answer)
CAGE questionnaire

Correct answer: Edmonton Symptom Assessment System (ESAS)

The Edmonton Symptom Assessment System (ESAS) measures 9–10 common cancer symptoms using 0–10 scales and is validated for oncology populations.

Question 90: When teaching a patient about neutropenic precautions at home, which instruction is most important?

Avoid all physical activity
Avoid raw fruits, vegetables, and crowds; report fever promptly (Correct answer)
Restrict fluid intake to 1 liter per day
Take prophylactic antibiotics without physician guidance

Correct answer: Avoid raw fruits, vegetables, and crowds; report fever promptly

Neutropenic patients must avoid infection sources (raw produce, crowds) and report fever immediately, as infection can become life-threatening rapidly.

Question 91: 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 92: Which clinical feature differentiates superior vena cava (SVC) syndrome from other oncologic emergencies?

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

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

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

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

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

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 95: Which of the following accurately describes anticipatory nausea and vomiting in chemotherapy patients?

A conditioned response where nausea occurs before chemotherapy begins, triggered by associated cues (Correct answer)
Vomiting caused by morphine administration
Nausea triggered by delayed serotonin release 5 days after chemotherapy
Nausea caused by tumor-produced emetic factors

Correct answer: A conditioned response where nausea occurs before chemotherapy begins, triggered by associated cues

Anticipatory nausea is a classically conditioned response where patients develop nausea before treatment in response to sights, smells, or other cues associated with chemotherapy.

Question 96: What is the first-line treatment for opioid-induced constipation in oncology patients?

Stimulant laxative (e.g., senna) with or without a stool softener (Correct answer)
Increased dietary fiber alone
Increased water intake alone
Enemas as needed only

Correct answer: Stimulant laxative (e.g., senna) with or without a stool softener

A stimulant laxative such as senna should be started prophylactically with opioid therapy because opioids suppress bowel motility.

Question 97: Bevacizumab (Avastin) targets tumor angiogenesis by inhibiting which growth factor?

Platelet-derived growth factor (PDGF)
Epidermal growth factor (EGF)
Vascular endothelial growth factor (VEGF) (Correct answer)
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 98: Which organization provides the primary standards for safe handling of hazardous drugs in oncology nursing?

Joint Commission (TJC)
Oncology Nursing Society (ONS) (Correct answer)
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 99: Which antiemetic class is considered first-line for chemotherapy-induced nausea and vomiting (CINV)?

Corticosteroids alone
Dopamine antagonists (e.g., metoclopramide)
Benzodiazepines alone
5-HT3 receptor antagonists (e.g., ondansetron) (Correct answer)

Correct answer: 5-HT3 receptor antagonists (e.g., ondansetron)

5-HT3 receptor antagonists are the cornerstone of CINV prophylaxis, especially for highly emetogenic chemotherapy regimens.

Question 100: Which chemotherapy drug requires leucovorin rescue to prevent life-threatening toxicity?

High-dose methotrexate (Correct answer)
Paclitaxel
Gemcitabine
Doxorubicin

Correct answer: High-dose methotrexate

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

Question 101: Why are immobilization devices (e.g., thermoplastic masks, body molds) used during radiation therapy?

To protect the patient's skin from radiation burns
To reduce radiation scatter to surrounding staff
To shield critical organs from the radiation beam
To ensure reproducible patient positioning for each treatment fraction (Correct answer)

Correct answer: To ensure reproducible patient positioning for each treatment fraction

Immobilization devices hold the patient in the exact same position for every treatment fraction, ensuring the radiation beam targets the tumor consistently throughout the course of therapy.

Question 102: 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 103: A patient asks about the difference between palliative care and hospice. The nurse's best response is that palliative care:

Focuses solely on pain control with no psychosocial support
Can be provided alongside curative or active treatment at any stage (Correct answer)
Is only appropriate when curative treatment has stopped
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 104: A patient is prescribed bevacizumab. The nurse knows this drug targets which molecular pathway?

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

Correct answer: Vascular endothelial growth factor (VEGF)

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

Question 105: Which hallmark of cancer involves the tumor's ability to grow its own blood supply?

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

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

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

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

Morning headache, nausea, and papilledema (Correct answer)
Hypoglycemia
Peripheral edema
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 108: Which of the following is a cell-cycle-specific chemotherapy agent?

Carmustine
Cisplatin
Vincristine (Correct answer)
Cyclophosphamide

Correct answer: Vincristine

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

Question 109: 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)
Immediate plasmapheresis
Prophylactic potassium supplementation

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

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

Correct answer: Back pain

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

Question 111: A patient undergoing radiation therapy to the chest asks if they can hug their grandchildren. The correct response is:

'Contact with family is fine only after your last radiation session.'
'You should avoid anyone under 18 for the duration of treatment.'
'Radiation makes you radioactive so you must avoid all contact.'
'External beam radiation does not make you radioactive — you are safe to hug family members.' (Correct answer)

Correct answer: 'External beam radiation does not make you radioactive — you are safe to hug family members.'

External beam radiation does not make patients radioactive; restrictions on contact apply only to patients with implanted or ingested radioactive sources.

Question 112: What is the primary goal of palliative care in oncology?

To hasten death in terminal patients
To replace all active cancer treatment
To improve quality of life by managing symptoms and psychosocial needs (Correct answer)
To provide curative treatment

Correct answer: To improve quality of life by managing symptoms and psychosocial needs

Palliative care focuses on relieving suffering and improving quality of life for patients and families, and can be delivered alongside curative treatment.

Question 113: Dyspnea in a patient with lung cancer should first be assessed for which reversible cause?

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

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

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

Correct answer: Neoadjuvant therapy

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

Question 115: Which drug class inhibits the mammalian target of rapamycin (mTOR) pathway in cancer treatment?

Everolimus and temsirolimus (Correct answer)
Bevacizumab and ramucirumab
Erlotinib and gefitinib
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 116: A patient receiving immunotherapy with pembrolizumab develops a new onset dry cough and dyspnea at rest. The nurse should suspect:

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

Correct answer: Immune-mediated pneumonitis

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

Question 117: Which nursing intervention is the priority when a patient receiving chemotherapy develops neutropenic fever (temperature ≥38.3°C)?

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

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 118: A patient with cancer reports a pain level of 7/10 currently on acetaminophen alone. According to the WHO analgesic ladder, what is the next appropriate step?

Initiate strong opioids such as morphine immediately (Step 3)
Add a non-opioid adjuvant like gabapentin only
Add a weak opioid such as tramadol or codeine (Step 2) (Correct answer)
Refer the patient to a pain specialist before changing therapy

Correct answer: Add a weak opioid such as tramadol or codeine (Step 2)

The WHO three-step analgesic ladder recommends adding a weak opioid (Step 2) when a non-opioid alone provides inadequate pain control before escalating to strong opioids.

Question 119: Which treatment is the immediate priority for a patient with confirmed malignant spinal cord compression?

High-dose corticosteroids (dexamethasone) (Correct answer)
Chemotherapy
Surgical decompression
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 120: Which type of gene mutation is found in the germline and can be inherited by offspring?

Somatic mutation (acquired)
Frameshift mutation only
Silent 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 121: The nurse is assessing a cancer patient for distress. Which validated tool is recommended by NCCN for this purpose?

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

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

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

Correct answer: Acute promyelocytic leukemia (APL)

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

Question 123: A patient's caregiver asks about the purpose of a 'nadir' blood count check after chemotherapy. The nurse's best explanation is:

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

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

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

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

BCR-ABL tyrosine kinase (Correct answer)
HER2 receptor
VEGF receptor
EGFR 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 126: A patient with bone metastases reports sudden inability to void and new lower extremity weakness. The nurse should suspect:

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

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

Radioactive source placed inside or near the tumor (Correct answer)
Fractionated external beam radiation
Systemic radiolabeled antibody therapy
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 128: 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 129: 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)
Sedating antihistamines
High-dose estrogen replacement
Increased caffeine intake

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 130: CAR-T cell therapy works by:

Delivering radiation to tumor cells via antibodies
Blocking checkpoint proteins on T cells
Stimulating NK cells with cytokines
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 131: A neutropenic patient with fever should receive empiric broad-spectrum antibiotics within:

1 hour of presentation (Correct answer)
24 hours of presentation
6 hours of presentation
4 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 132: The MASCC risk index is used in oncology to:

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

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 133: 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)
Apply heat to the site to promote absorption
Flush the IV line rapidly with saline

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

Restrict fluid intake to reduce swelling
Avoid blood pressure cuffs and blood draws on the affected arm (Correct answer)
Apply tight compression wraps daily without guidance
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 135: A patient receiving bevacizumab (a VEGF inhibitor) should be monitored most closely for which specific complication?

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

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

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
Full pathology and surgical operative reports

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 137: When caring for a patient with malignant pleural effusion, which intervention provides the most immediate relief of dyspnea?

Applying supplemental oxygen via nasal cannula at 2 L/min
Administering a diuretic such as furosemide
Positioning in high Fowler's and assisting with thoracentesis (Correct answer)
Encouraging incentive spirometry every hour

Correct answer: Positioning in high Fowler's and assisting with thoracentesis

Thoracentesis to drain the effusion provides immediate relief of dyspnea by re-expanding the compressed lung; high Fowler's positioning aids breathing while preparing for the procedure.

Question 138: Which of the following is frequently affected when Hodgkin's lymphoma is diagnosed?

Goin
Neck (Correct answer)
Chest
Back

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

Vinorelbine
Irinotecan
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 140: 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 increase platelet counts
To prevent anemia from chemotherapy
To reduce nausea from radiation

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

CAR-T cell therapy and bispecific antibodies (Correct answer)
Oral targeted therapy
Alkylating chemotherapy
Hormone 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 142: 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 143: Which oncogene is frequently amplified in HER2-positive breast cancer, making it a therapeutic target?

KRAS
MYC
ERBB2 (HER2/neu) (Correct answer)
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 144: Immune-related adverse events (irAEs) from checkpoint inhibitors most commonly affect which organ systems?

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

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 145: Financial toxicity in oncology refers to:

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

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

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

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

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

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 148: Adaptive or particular immunity is demonstrated by:

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

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

Antimetabolites
Alkylating agents
Anthracyclines (Correct answer)
Vinca alkaloids

Correct answer: Anthracyclines

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

Question 150: Which immune checkpoint inhibitor targets PD-1?

Ipilimumab
Atezolizumab
Durvalumab
Pembrolizumab (Correct answer)

Correct answer: Pembrolizumab

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

Question 151: When educating a patient about neutropenia precautions, which food should the nurse instruct the patient to avoid?

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

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 152: Which statement about cancer survivorship is accurate?

Survivorship encompasses physical, emotional, social, and financial effects from diagnosis onward (Correct answer)
Long-term side effects of treatment are rare and not worth discussing
Survivorship care begins only after a patient is declared cured
Follow-up visits are only needed to monitor for cancer recurrence

Correct answer: Survivorship encompasses physical, emotional, social, and financial effects from diagnosis onward

Cancer survivorship begins at diagnosis and encompasses the full spectrum of physical, psychological, social, and financial challenges throughout and beyond treatment.

Question 153: Which antifungal drug interaction is most important to monitor in patients receiving voriconazole and certain chemotherapy agents?

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

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

Loperamide
Atropine (Correct answer)
Metoclopramide
Octreotide

Correct answer: Atropine

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

Question 155: A patient with cancer develops sudden onset of confusion. Which potentially reversible cause should the nurse investigate first?

Terminal restlessness
Opioid tolerance
Hypercalcemia (Correct answer)
Disease progression to the brain

Correct answer: Hypercalcemia

Hypercalcemia of malignancy is a common and reversible cause of acute confusion in cancer patients and must be ruled out promptly.

Question 156: Which type of biopsy provides the least invasive tissue diagnosis for accessible superficial tumors?

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

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

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)
Insist the patient hear the information directly
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 158: Which assessment is essential before providing cancer patient education to ensure effectiveness?

Patient's insurance coverage
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

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

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

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 160: 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
Polyethylene glycol
Lactulose
Naloxegol or methylnaltrexone (Correct answer)

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

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

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

Hair thinning
Mild hot flashes
Leg pain and swelling (Correct answer)
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 163: A survivor who completed treatment 2 years ago reports fear of recurrence at every follow-up visit. The nurse should:

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

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

Increased nutrient intake
Overproduction of hormones
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.

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

Checking for saved progress...

Exam Rules

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

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

Sources & references

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

oncc.org — Fees, score validity, renewal, test delivery, exam format, passing score, retake fee, retake policy, score release, test dates · verified Oct 2026