BARKLEY OCN ONCOLOGY NURSING PRACTICE EXAM 2] QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains
1. Foundations of Oncology Nursing
2. Symptom Management and Palliative Care
3. Oncologic Emergencies and Critical Care
4. Cancer Treatments and Modalities
5. Psychosocial and Ethical Considerations
6. Professional and Legal Standards
7. Survivorship and End-of-Life Care
8. Patient and Family Education
Introduction
This comprehensive examination is designed to rigorously assess the knowledge, clinical judgment, and decision-
making skills of oncology nurses. It covers a broad spectrum of critical topics, from foundational pathophysiology
and treatment modalities to complex symptom management and oncologic emergencies. The assessment includes
multiple-choice questions and scenario-based items that challenge the test-taker to apply theoretical knowledge to
real-world clinical situations. Success on this exam indicates a high level of proficiency in providing safe, ethical,
and patient-centered care, emphasizing evidence-based practice and the ability to navigate the multifaceted
challenges of the oncology setting.
,Section One: Questions 1-100
1. A patient with acute myeloid leukemia (AML) is receiving induction chemotherapy with cytarabine and
idarubicin. The nurse should prioritize monitoring for which life-threatening complication associated with
this specific regimen?
A. Tumor lysis syndrome
B. Hemorrhagic cystitis
C. Cardiac toxicity
D. Differentiation syndrome
🟢 C. Cardiac toxicity
🔴 RATIONALE: Idarubicin is an anthracycline chemotherapy agent with a known, dose-dependent risk of
cardiotoxicity, which can manifest as acute or chronic cardiomyopathy. While cytarabine can cause other side
effects, the combination with an anthracycline necessitates vigilant cardiac monitoring. Tumor lysis syndrome is
more commonly associated with rapidly proliferative tumors, and hemorrhagic cystitis is a classic side effect of
cyclophosphamide and ifosfamide, not this regimen. Differentiation syndrome is a risk with agents like all-trans-
retinoic acid (ATRA).
2. A patient receiving bevacizumab (Avastin) for metastatic colorectal cancer reports a new onset of a severe
headache and visual changes. What is the nurse's priority action?
A. Administer PRN acetaminophen for headache
B. Notify the provider immediately
C. Reassure the patient that these are common side effects
D. Position the patient in a supine position
,🟢 B. Notify the provider immediately
🔴 RATIONALE: Bevacizumab, a VEGF inhibitor, carries a risk of posterior reversible encephalopathy syndrome
(PRES), which presents with symptoms including severe headache, visual disturbances, and altered mental
status. This is a medical emergency requiring immediate provider notification and further evaluation.
Administering acetaminophen or positioning the patient does not address the underlying pathophysiology.
These are not considered common, benign side effects.
3. Which of the following signs is a hallmark of a hypercalcemic crisis in a patient with malignancy?
A. Perioral numbness
B. Muscle twitching
C. Hyporeflexia
D. Trousseau's sign
🟢 C. Hyporeflexia
🔴 RATIONALE: Hypercalcemia depresses neuromuscular excitability, leading to symptoms such as lethargy,
weakness, and hyporeflexia. Options A, B, and D (perioral numbness, muscle twitching, and Trousseau's sign) are
classic signs of hypocalcemia, which increases neuromuscular irritability.
4. A patient with stage IV non-small cell lung cancer is experiencing severe dyspnea and anxiety. The nurse
identifies the priority nursing diagnosis as:
A. Ineffective Breathing Pattern
B. Anxiety
C. Powerlessness
D. Impaired Gas Exchange
, 🟢 D. Impaired Gas Exchange
🔴 RATIONALE: While all options are relevant, Impaired Gas Exchange is the priority diagnosis because it
represents a physiological threat to the patient's survival. Dyspnea and anxiety are significant, but the nurse
must first address the underlying pathophysiology affecting oxygenation. The ABCs (Airway, Breathing,
Circulation) always take precedence, and gas exchange is the core component of "Breathing."
5. When administering an oral chemotherapeutic agent to a patient, which action is most critical to ensure
safe handling and administration?
A. Checking the patient's blood pressure prior to administration
B. Administering the drug with a full glass of water
C. Crushing the tablet if the patient has difficulty swallowing
D. Wearing personal protective equipment (PPE), including gloves
🟢 D. Wearing personal protective equipment (PPE), including gloves
🔴 RATIONALE: Oral chemotherapeutic agents are hazardous drugs and pose a risk to healthcare workers
through accidental exposure. Wearing appropriate PPE, especially gloves, is a critical standard precaution to
prevent dermal absorption. Crushing tablets is contraindicated unless specifically approved due to safety and
efficacy concerns. Blood pressure checks and administering with water are general medication administration
steps but not specifically the most critical for safe handling.
6. A patient's laboratory results show a platelet count of 18,000/µL. Which of the following interventions
should the nurse include in the plan of care?
A. Encourage the use of a soft-bristled toothbrush
B. Administer a stool softener
ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains
1. Foundations of Oncology Nursing
2. Symptom Management and Palliative Care
3. Oncologic Emergencies and Critical Care
4. Cancer Treatments and Modalities
5. Psychosocial and Ethical Considerations
6. Professional and Legal Standards
7. Survivorship and End-of-Life Care
8. Patient and Family Education
Introduction
This comprehensive examination is designed to rigorously assess the knowledge, clinical judgment, and decision-
making skills of oncology nurses. It covers a broad spectrum of critical topics, from foundational pathophysiology
and treatment modalities to complex symptom management and oncologic emergencies. The assessment includes
multiple-choice questions and scenario-based items that challenge the test-taker to apply theoretical knowledge to
real-world clinical situations. Success on this exam indicates a high level of proficiency in providing safe, ethical,
and patient-centered care, emphasizing evidence-based practice and the ability to navigate the multifaceted
challenges of the oncology setting.
,Section One: Questions 1-100
1. A patient with acute myeloid leukemia (AML) is receiving induction chemotherapy with cytarabine and
idarubicin. The nurse should prioritize monitoring for which life-threatening complication associated with
this specific regimen?
A. Tumor lysis syndrome
B. Hemorrhagic cystitis
C. Cardiac toxicity
D. Differentiation syndrome
🟢 C. Cardiac toxicity
🔴 RATIONALE: Idarubicin is an anthracycline chemotherapy agent with a known, dose-dependent risk of
cardiotoxicity, which can manifest as acute or chronic cardiomyopathy. While cytarabine can cause other side
effects, the combination with an anthracycline necessitates vigilant cardiac monitoring. Tumor lysis syndrome is
more commonly associated with rapidly proliferative tumors, and hemorrhagic cystitis is a classic side effect of
cyclophosphamide and ifosfamide, not this regimen. Differentiation syndrome is a risk with agents like all-trans-
retinoic acid (ATRA).
2. A patient receiving bevacizumab (Avastin) for metastatic colorectal cancer reports a new onset of a severe
headache and visual changes. What is the nurse's priority action?
A. Administer PRN acetaminophen for headache
B. Notify the provider immediately
C. Reassure the patient that these are common side effects
D. Position the patient in a supine position
,🟢 B. Notify the provider immediately
🔴 RATIONALE: Bevacizumab, a VEGF inhibitor, carries a risk of posterior reversible encephalopathy syndrome
(PRES), which presents with symptoms including severe headache, visual disturbances, and altered mental
status. This is a medical emergency requiring immediate provider notification and further evaluation.
Administering acetaminophen or positioning the patient does not address the underlying pathophysiology.
These are not considered common, benign side effects.
3. Which of the following signs is a hallmark of a hypercalcemic crisis in a patient with malignancy?
A. Perioral numbness
B. Muscle twitching
C. Hyporeflexia
D. Trousseau's sign
🟢 C. Hyporeflexia
🔴 RATIONALE: Hypercalcemia depresses neuromuscular excitability, leading to symptoms such as lethargy,
weakness, and hyporeflexia. Options A, B, and D (perioral numbness, muscle twitching, and Trousseau's sign) are
classic signs of hypocalcemia, which increases neuromuscular irritability.
4. A patient with stage IV non-small cell lung cancer is experiencing severe dyspnea and anxiety. The nurse
identifies the priority nursing diagnosis as:
A. Ineffective Breathing Pattern
B. Anxiety
C. Powerlessness
D. Impaired Gas Exchange
, 🟢 D. Impaired Gas Exchange
🔴 RATIONALE: While all options are relevant, Impaired Gas Exchange is the priority diagnosis because it
represents a physiological threat to the patient's survival. Dyspnea and anxiety are significant, but the nurse
must first address the underlying pathophysiology affecting oxygenation. The ABCs (Airway, Breathing,
Circulation) always take precedence, and gas exchange is the core component of "Breathing."
5. When administering an oral chemotherapeutic agent to a patient, which action is most critical to ensure
safe handling and administration?
A. Checking the patient's blood pressure prior to administration
B. Administering the drug with a full glass of water
C. Crushing the tablet if the patient has difficulty swallowing
D. Wearing personal protective equipment (PPE), including gloves
🟢 D. Wearing personal protective equipment (PPE), including gloves
🔴 RATIONALE: Oral chemotherapeutic agents are hazardous drugs and pose a risk to healthcare workers
through accidental exposure. Wearing appropriate PPE, especially gloves, is a critical standard precaution to
prevent dermal absorption. Crushing tablets is contraindicated unless specifically approved due to safety and
efficacy concerns. Blood pressure checks and administering with water are general medication administration
steps but not specifically the most critical for safe handling.
6. A patient's laboratory results show a platelet count of 18,000/µL. Which of the following interventions
should the nurse include in the plan of care?
A. Encourage the use of a soft-bristled toothbrush
B. Administer a stool softener
