ONS/ONCC CHEMOTHERAPY RENEWAL
PRACTICE EXAM: 300 QUESTIONS AND
ANSWERS WITH DETAILED RATIONALE
LATEST UPDATE 2026
1. Which of the following best describes the mechanism of action of alkylating
agents?
A. Inhibit DNA synthesis by cross-linking DNA strands
B. Inhibit topoisomerase II enzymes
C. Cause mitotic spindle disruption
D. Inhibit purine or pyrimidine synthesis
Correct Answer: A
Rationale: Alkylating agents (e.g., cyclophosphamide, cisplatin, busulfan) work by
cross-linking DNA strands, which prevents DNA replication and transcription,
leading to cell death. They are cell cycle phase-nonspecific, meaning they can act
on cells in any phase of the cell cycle. They are particularly effective against
rapidly dividing cells.
2. Which chemotherapy agent is classified as an antimetabolite?
A. Doxorubicin
B. Methotrexate
C. Vincristine
D. Cisplatin
1
,Correct Answer: B
Rationale: Methotrexate is an antimetabolite that works by inhibiting dihydrofolate
reductase, thereby blocking the synthesis of purines and thymidylate, essential for
DNA and RNA synthesis. Doxorubicin is an anthracycline. Vincristine is a vinca
alkaloid. Cisplatin is an alkylating agent.
3. A patient receiving cisplatin should be monitored for which significant toxicity?
A. Cardiotoxicity
B. Nephrotoxicity
C. Neurotoxicity
D. Ototoxicity
Correct Answer: B
Rationale: Cisplatin is a platinum-containing alkylating agent with dose-limiting
nephrotoxicity (renal toxicity). Patients must receive aggressive hydration before
and after administration to protect kidney function. Other significant toxicities
include peripheral neuropathy, ototoxicity (especially tinnitus and high-frequency
hearing loss), and myelosuppression.
4. Which of the following is a key characteristic of cell cycle-specific
chemotherapy agents?
A. They are effective only during a specific phase of the cell cycle
B. They are effective in any phase of the cell cycle
C. They are only effective in the G0 phase
D. They work by alkylating DNA strands
Correct Answer: A
2
,Rationale: Cell cycle-specific agents (such as antimetabolites and vinca alkaloids)
are most effective during a specific phase of the cell cycle (S-phase for
antimetabolites, M-phase for vinca alkaloids). They require rapidly dividing cells
to be effective. Cell cycle-nonspecific agents (such as alkylating agents) can act on
cells in any phase.
5. Which of the following chemotherapy agents is associated with dose-limiting
cardiotoxicity?
A. Bleomycin
B. Doxorubicin
C. Methotrexate
D. Cyclophosphamide
Correct Answer: B
Rationale: Doxorubicin (an anthracycline) is associated with a cumulative dose-
limiting cardiotoxicity. The maximum lifetime cumulative dose is typically 450–
550 mg/m². Cardiac monitoring (MUGA scan or echocardiogram) is recommended
to assess left ventricular ejection fraction (LVEF). The risk of cardiotoxicity
increases with higher cumulative doses.
6. Which of the following is a mechanism of action of taxanes (e.g., paclitaxel,
docetaxel)?
A. Inhibit microtubule depolymerization
B. Inhibit DNA synthesis
C. Inhibit topoisomerase I
D. Cause DNA cross-linking
Correct Answer: A
3
, Rationale: Taxanes (paclitaxel, docetaxel) work by stabilizing microtubules and
inhibiting their depolymerization. This disrupts the normal dynamics of the mitotic
spindle, causing cell cycle arrest in the M phase and subsequent cell death. This is
distinct from vinca alkaloids, which inhibit microtubule polymerization.
7. A patient receiving vincristine develops extravasation. What immediate nursing
intervention should be prioritized?
A. Apply warm compresses to the site
B. Stop the infusion immediately and aspirate residual drug
C. Administer the antidote hyaluronidase subcutaneously
D. Elevate the extremity and apply a tight bandage
Correct Answer: B
Rationale: The immediate priority for any suspected extravasation is to stop the
infusion immediately. Do not remove the IV catheter; instead, aspirate any residual
drug and blood from the catheter and tubing. Then, remove the catheter and
proceed with the appropriate antidote and site management. Vincristine is a
vesicant.
8. Which of the following is a unique side effect that occurs with the agent
oxaliplatin?
A. Hand-foot syndrome
B. Cold sensory neuropathy
C. Mucositis
D. Alopecia
Correct Answer: B
Rationale: Oxaliplatin is uniquely associated with acute cold-induced sensory
neuropathy. Patients may experience paresthesias and dysesthesias in the hands,
4
PRACTICE EXAM: 300 QUESTIONS AND
ANSWERS WITH DETAILED RATIONALE
LATEST UPDATE 2026
1. Which of the following best describes the mechanism of action of alkylating
agents?
A. Inhibit DNA synthesis by cross-linking DNA strands
B. Inhibit topoisomerase II enzymes
C. Cause mitotic spindle disruption
D. Inhibit purine or pyrimidine synthesis
Correct Answer: A
Rationale: Alkylating agents (e.g., cyclophosphamide, cisplatin, busulfan) work by
cross-linking DNA strands, which prevents DNA replication and transcription,
leading to cell death. They are cell cycle phase-nonspecific, meaning they can act
on cells in any phase of the cell cycle. They are particularly effective against
rapidly dividing cells.
2. Which chemotherapy agent is classified as an antimetabolite?
A. Doxorubicin
B. Methotrexate
C. Vincristine
D. Cisplatin
1
,Correct Answer: B
Rationale: Methotrexate is an antimetabolite that works by inhibiting dihydrofolate
reductase, thereby blocking the synthesis of purines and thymidylate, essential for
DNA and RNA synthesis. Doxorubicin is an anthracycline. Vincristine is a vinca
alkaloid. Cisplatin is an alkylating agent.
3. A patient receiving cisplatin should be monitored for which significant toxicity?
A. Cardiotoxicity
B. Nephrotoxicity
C. Neurotoxicity
D. Ototoxicity
Correct Answer: B
Rationale: Cisplatin is a platinum-containing alkylating agent with dose-limiting
nephrotoxicity (renal toxicity). Patients must receive aggressive hydration before
and after administration to protect kidney function. Other significant toxicities
include peripheral neuropathy, ototoxicity (especially tinnitus and high-frequency
hearing loss), and myelosuppression.
4. Which of the following is a key characteristic of cell cycle-specific
chemotherapy agents?
A. They are effective only during a specific phase of the cell cycle
B. They are effective in any phase of the cell cycle
C. They are only effective in the G0 phase
D. They work by alkylating DNA strands
Correct Answer: A
2
,Rationale: Cell cycle-specific agents (such as antimetabolites and vinca alkaloids)
are most effective during a specific phase of the cell cycle (S-phase for
antimetabolites, M-phase for vinca alkaloids). They require rapidly dividing cells
to be effective. Cell cycle-nonspecific agents (such as alkylating agents) can act on
cells in any phase.
5. Which of the following chemotherapy agents is associated with dose-limiting
cardiotoxicity?
A. Bleomycin
B. Doxorubicin
C. Methotrexate
D. Cyclophosphamide
Correct Answer: B
Rationale: Doxorubicin (an anthracycline) is associated with a cumulative dose-
limiting cardiotoxicity. The maximum lifetime cumulative dose is typically 450–
550 mg/m². Cardiac monitoring (MUGA scan or echocardiogram) is recommended
to assess left ventricular ejection fraction (LVEF). The risk of cardiotoxicity
increases with higher cumulative doses.
6. Which of the following is a mechanism of action of taxanes (e.g., paclitaxel,
docetaxel)?
A. Inhibit microtubule depolymerization
B. Inhibit DNA synthesis
C. Inhibit topoisomerase I
D. Cause DNA cross-linking
Correct Answer: A
3
, Rationale: Taxanes (paclitaxel, docetaxel) work by stabilizing microtubules and
inhibiting their depolymerization. This disrupts the normal dynamics of the mitotic
spindle, causing cell cycle arrest in the M phase and subsequent cell death. This is
distinct from vinca alkaloids, which inhibit microtubule polymerization.
7. A patient receiving vincristine develops extravasation. What immediate nursing
intervention should be prioritized?
A. Apply warm compresses to the site
B. Stop the infusion immediately and aspirate residual drug
C. Administer the antidote hyaluronidase subcutaneously
D. Elevate the extremity and apply a tight bandage
Correct Answer: B
Rationale: The immediate priority for any suspected extravasation is to stop the
infusion immediately. Do not remove the IV catheter; instead, aspirate any residual
drug and blood from the catheter and tubing. Then, remove the catheter and
proceed with the appropriate antidote and site management. Vincristine is a
vesicant.
8. Which of the following is a unique side effect that occurs with the agent
oxaliplatin?
A. Hand-foot syndrome
B. Cold sensory neuropathy
C. Mucositis
D. Alopecia
Correct Answer: B
Rationale: Oxaliplatin is uniquely associated with acute cold-induced sensory
neuropathy. Patients may experience paresthesias and dysesthesias in the hands,
4
