ONS/ONCC Chemotherapy
Immunotherapy Certificate Verified And
Graded A+
Comprehensive Certificate Review Assessment
Q1: A patient receiving cisplatin-based chemotherapy has a white blood cell count of 1.2 × 10⁹/L
and a neutrophil count of 0.6 × 10⁹/L. The patient's absolute neutrophil count (ANC) is:
A. 0.6 × 10⁹/L [CORRECT]
B. 1.2 × 10⁹/L
C. 0.4 × 10⁹/L
D. 1.8 × 10⁹/L
Correct Answer: A
Rationale: Correct because ANC = (Total WBC × % neutrophils + % bands) ÷ 100. Given direct
neutrophil count of 0.6 × 10⁹/L, ANC is 0.6, indicating severe neutropenia (Grade 4).
Q2: A patient is receiving doxorubicin (Adriamycin) through a peripheral IV. During the infusion,
the patient reports burning and swelling at the IV site, and the nurse notes erythema and edema
without blood return. The nurse should immediately:
A. Apply a warm compress to the site
B. Stop the infusion, aspirate residual drug, and remove the IV catheter [CORRECT]
C. Flush the line with normal saline
D. Slow the infusion rate and continue
Correct Answer: B
Rationale: Correct because doxorubicin is a vesicant; extravasation protocol requires immediate
stop, aspiration, removal of catheter, then cold compress application, elevation, and provider
notification.
Q3: A patient receiving nivolumab (Opdivo) for metastatic melanoma presents with new-onset
watery diarrhea, 6-8 stools per day, abdominal pain, and no blood or fever. Stool studies are
negative for infection. Grade of this immune-related adverse event (irAE) and appropriate
management is:
A. Grade 1 – symptomatic treatment with loperamide, continue immunotherapy
B. Grade 2 – prednisone 0.5-1 mg/kg/day, hold immunotherapy [CORRECT]
C. Grade 3 – prednisone 1-2 mg/kg/day, infliximab, hold immunotherapy
D. Grade 4 – IV methylprednisolone, infliximab, permanent discontinuation
Correct Answer: B
,Rationale: Correct because 6-8 stools/day is Grade 2 colitis (increase of 4-6 stools over baseline);
management includes holding immune checkpoint inhibitor and starting prednisone 0.5-1
mg/kg/day.
Q4: Which of the following medications requires a closed system transfer device (CSTD) during
preparation and administration per USP <800> guidelines?
A. Ondansetron
B. Cyclophosphamide [CORRECT]
C. Dexamethasone
D. Diphenhydramine
Correct Answer: B
Rationale: Correct because cyclophosphamide is a NIOSH Group 1 antineoplastic hazardous
drug; USP <800> requires CSTD for all NIOSH Group 1 drugs to reduce exposure risk.
Q5: A patient is receiving carboplatin and has a creatinine clearance (CrCl) of 35 mL/min. The
nurse should anticipate:
A. Full dose with no adjustment
B. Dose reduction based on Calvert formula [CORRECT]
C. Hold chemotherapy until renal function improves
D. Double the dose
Correct Answer: B
Rationale: Correct because carboplatin is renally excreted; dose is calculated using the Calvert
formula (target AUC × (CrCl + 25)), requiring adjustment based on renal function.
Q6: A patient receiving 5-FU (fluorouracil) develops severe palmar-plantar erythrodysesthesia
(hand-foot syndrome) with blistering and desquamation. According to CTCAE grading, this is
Grade:
A. Grade 1 (mild erythema, no pain)
B. Grade 2 (erythema, swelling, pain, not interfering with ADL)
C. Grade 3 (blistering, desquamation, ulceration, interfering with ADL) [CORRECT]
D. Grade 4 (life-threatening consequences)
Correct Answer: C
Rationale: Correct because Grade 3 hand-foot syndrome involves blistering, desquamation,
ulceration, and severe pain limiting activities of daily living; requires dose interruption or
reduction.
Q7: A patient receiving pembrolizumab (Keytruda) develops new-onset shortness of breath, non-
productive cough, and hypoxemia. CT chest shows ground-glass opacities. The most likely
diagnosis and first-line treatment is:
A. Pulmonary embolism – anticoagulation
B. Pneumonia – antibiotics
C. Immune-related pneumonitis – corticosteroids [CORRECT]
, D. Disease progression – next-line chemotherapy
Correct Answer: C
Rationale: Correct because immune checkpoint inhibitor pneumonitis is a common irAE;
diagnosis of exclusion after ruling out infection; first-line treatment is systemic corticosteroids
(prednisone 1-2 mg/kg/day or IV methylprednisolone).
Q8: A patient receiving vincristine (a vinca alkaloid) by IV push. The nurse accidentally infiltrates
the IV, and the patient develops localized pain and erythema. The specific antidote for vinca
alkaloid extravasation is:
A. Dexrazoxane
B. Hyaluronidase [CORRECT]
C. Sodium thiosulfate
D. Phentolamine
Correct Answer: B
Rationale: Correct because hyaluronidase (150-900 units diluted in 1-6 mL normal saline) is the
recommended antidote for extravasation of vinca alkaloids (vincristine, vinblastine, vinorelbine)
and taxanes.
Q9: A patient with acute myeloid leukemia (AML) receiving induction chemotherapy develops
fever of 38.5°C, hypotension, and an absolute neutrophil count (ANC) of 0.2 × 10⁹/L. The nurse
should:
A. Administer antipyretics and monitor
B. Obtain blood cultures and initiate broad-spectrum IV antibiotics immediately [CORRECT]
C. Wait for culture results before antibiotics
D. Administer G-CSF first
Correct Answer: B
Rationale: Correct because febrile neutropenia (ANC <0.5 with fever >38.3°C or sustained >38.0°C
for >1 hour) is a medical emergency; guidelines recommend blood cultures then immediate broad-
spectrum IV antibiotics (e.g., cefepime or piperacillin/tazobactam or carbapenem).
Q10: Which of the following is a cell cycle phase-specific (CCS) antineoplastic agent that acts
during the S-phase?
A. Cisplatin
B. Methotrexate [CORRECT]
C. Doxorubicin
D. Cyclophosphamide
Correct Answer: B
Rationale: Correct because methotrexate is an antimetabolite that inhibits dihydrofolate reductase
during S-phase (DNA synthesis); cisplatin, doxorubicin, and cyclophosphamide are cell cycle
non-specific (CCNS).
Q11: A patient with a total WBC of 4,500/μL has 60% segmented neutrophils and 5% band
neutrophils. The ANC is:
Immunotherapy Certificate Verified And
Graded A+
Comprehensive Certificate Review Assessment
Q1: A patient receiving cisplatin-based chemotherapy has a white blood cell count of 1.2 × 10⁹/L
and a neutrophil count of 0.6 × 10⁹/L. The patient's absolute neutrophil count (ANC) is:
A. 0.6 × 10⁹/L [CORRECT]
B. 1.2 × 10⁹/L
C. 0.4 × 10⁹/L
D. 1.8 × 10⁹/L
Correct Answer: A
Rationale: Correct because ANC = (Total WBC × % neutrophils + % bands) ÷ 100. Given direct
neutrophil count of 0.6 × 10⁹/L, ANC is 0.6, indicating severe neutropenia (Grade 4).
Q2: A patient is receiving doxorubicin (Adriamycin) through a peripheral IV. During the infusion,
the patient reports burning and swelling at the IV site, and the nurse notes erythema and edema
without blood return. The nurse should immediately:
A. Apply a warm compress to the site
B. Stop the infusion, aspirate residual drug, and remove the IV catheter [CORRECT]
C. Flush the line with normal saline
D. Slow the infusion rate and continue
Correct Answer: B
Rationale: Correct because doxorubicin is a vesicant; extravasation protocol requires immediate
stop, aspiration, removal of catheter, then cold compress application, elevation, and provider
notification.
Q3: A patient receiving nivolumab (Opdivo) for metastatic melanoma presents with new-onset
watery diarrhea, 6-8 stools per day, abdominal pain, and no blood or fever. Stool studies are
negative for infection. Grade of this immune-related adverse event (irAE) and appropriate
management is:
A. Grade 1 – symptomatic treatment with loperamide, continue immunotherapy
B. Grade 2 – prednisone 0.5-1 mg/kg/day, hold immunotherapy [CORRECT]
C. Grade 3 – prednisone 1-2 mg/kg/day, infliximab, hold immunotherapy
D. Grade 4 – IV methylprednisolone, infliximab, permanent discontinuation
Correct Answer: B
,Rationale: Correct because 6-8 stools/day is Grade 2 colitis (increase of 4-6 stools over baseline);
management includes holding immune checkpoint inhibitor and starting prednisone 0.5-1
mg/kg/day.
Q4: Which of the following medications requires a closed system transfer device (CSTD) during
preparation and administration per USP <800> guidelines?
A. Ondansetron
B. Cyclophosphamide [CORRECT]
C. Dexamethasone
D. Diphenhydramine
Correct Answer: B
Rationale: Correct because cyclophosphamide is a NIOSH Group 1 antineoplastic hazardous
drug; USP <800> requires CSTD for all NIOSH Group 1 drugs to reduce exposure risk.
Q5: A patient is receiving carboplatin and has a creatinine clearance (CrCl) of 35 mL/min. The
nurse should anticipate:
A. Full dose with no adjustment
B. Dose reduction based on Calvert formula [CORRECT]
C. Hold chemotherapy until renal function improves
D. Double the dose
Correct Answer: B
Rationale: Correct because carboplatin is renally excreted; dose is calculated using the Calvert
formula (target AUC × (CrCl + 25)), requiring adjustment based on renal function.
Q6: A patient receiving 5-FU (fluorouracil) develops severe palmar-plantar erythrodysesthesia
(hand-foot syndrome) with blistering and desquamation. According to CTCAE grading, this is
Grade:
A. Grade 1 (mild erythema, no pain)
B. Grade 2 (erythema, swelling, pain, not interfering with ADL)
C. Grade 3 (blistering, desquamation, ulceration, interfering with ADL) [CORRECT]
D. Grade 4 (life-threatening consequences)
Correct Answer: C
Rationale: Correct because Grade 3 hand-foot syndrome involves blistering, desquamation,
ulceration, and severe pain limiting activities of daily living; requires dose interruption or
reduction.
Q7: A patient receiving pembrolizumab (Keytruda) develops new-onset shortness of breath, non-
productive cough, and hypoxemia. CT chest shows ground-glass opacities. The most likely
diagnosis and first-line treatment is:
A. Pulmonary embolism – anticoagulation
B. Pneumonia – antibiotics
C. Immune-related pneumonitis – corticosteroids [CORRECT]
, D. Disease progression – next-line chemotherapy
Correct Answer: C
Rationale: Correct because immune checkpoint inhibitor pneumonitis is a common irAE;
diagnosis of exclusion after ruling out infection; first-line treatment is systemic corticosteroids
(prednisone 1-2 mg/kg/day or IV methylprednisolone).
Q8: A patient receiving vincristine (a vinca alkaloid) by IV push. The nurse accidentally infiltrates
the IV, and the patient develops localized pain and erythema. The specific antidote for vinca
alkaloid extravasation is:
A. Dexrazoxane
B. Hyaluronidase [CORRECT]
C. Sodium thiosulfate
D. Phentolamine
Correct Answer: B
Rationale: Correct because hyaluronidase (150-900 units diluted in 1-6 mL normal saline) is the
recommended antidote for extravasation of vinca alkaloids (vincristine, vinblastine, vinorelbine)
and taxanes.
Q9: A patient with acute myeloid leukemia (AML) receiving induction chemotherapy develops
fever of 38.5°C, hypotension, and an absolute neutrophil count (ANC) of 0.2 × 10⁹/L. The nurse
should:
A. Administer antipyretics and monitor
B. Obtain blood cultures and initiate broad-spectrum IV antibiotics immediately [CORRECT]
C. Wait for culture results before antibiotics
D. Administer G-CSF first
Correct Answer: B
Rationale: Correct because febrile neutropenia (ANC <0.5 with fever >38.3°C or sustained >38.0°C
for >1 hour) is a medical emergency; guidelines recommend blood cultures then immediate broad-
spectrum IV antibiotics (e.g., cefepime or piperacillin/tazobactam or carbapenem).
Q10: Which of the following is a cell cycle phase-specific (CCS) antineoplastic agent that acts
during the S-phase?
A. Cisplatin
B. Methotrexate [CORRECT]
C. Doxorubicin
D. Cyclophosphamide
Correct Answer: B
Rationale: Correct because methotrexate is an antimetabolite that inhibits dihydrofolate reductase
during S-phase (DNA synthesis); cisplatin, doxorubicin, and cyclophosphamide are cell cycle
non-specific (CCNS).
Q11: A patient with a total WBC of 4,500/μL has 60% segmented neutrophils and 5% band
neutrophils. The ANC is:
