ONS/ONCC CHEMOTHERAPY
IMMUNOTHERAPY CERTIFICATE RENEWAL
EXAM 2026/2027 | 100 PRACTICE
QUESTIONS, ANSWERS & RATIONALES |
ONCOLOGY NURSING PREP
Question 1: What is the main benefit of neoadjuvant chemotherapy in breast
cancer patients?
• A) It significantly increases overall survival compared to adjuvant therapy.
• B) It eliminates the need for any surgical intervention.
• C) It can shrink the tumor enough to allow lumpectomy instead of
mastectomy.
• D) It reduces the total number of chemotherapy cycles needed.
Correct Answer: C
Rationale: Neoadjuvant therapy does not increase survival compared to adjuvant
therapy. Its primary benefit is changing surgical options; if the tumor shrinks enough,
the patient may only require a lumpectomy plus radiation instead of a mastectomy.
Question 2: A comprehensive geriatric assessment (CGA) covers all of the
following EXCEPT:
• A) Functional status and comorbidities.
• B) Cognitive function and nutritional status.
• C) Genetic mutation testing and tumor markers.
• D) Polypharmacy and medication review.
Correct Answer: C
Rationale: According to the NCCN Older Adult Oncology Guidelines, a CGA includes
functional status, socioeconomic issues, psychosocial distress, comorbidities,
cognitive function, nutritional status, polypharmacy, and medication review. Genetic
mutation testing and tumor markers are not components of a CGA.
Question 3: A patient is receiving docetaxel and carboplatin through a port.
What is the best explanation for why a port was placed rather than using a
peripheral IV?
• A) Both agents are classified as vesicants requiring central access.
• B) The patient's age makes peripheral IVs unsafe.
, • C) Docetaxel is an irritant that can cause significant extravasation reactions.
• D) Carboplatin must be infused through a port to be effective.
Correct Answer: C
Rationale: Docetaxel is classified as an irritant, and central access is often preferred
to reduce the risk of extravasation and associated tissue damage. While carboplatin
is not a vesicant, the combination and the need for safe administration support the
use of a port.
Question 4: Which cell cycle phase is most vulnerable to the effects of cell
cycle-specific chemotherapy agents?
• A) G0 (resting phase)
• B) G1 (first growth phase)
• C) S (synthesis phase)
• D) M (mitotic phase)
Correct Answer: D
Rationale: Many cell cycle-specific chemotherapy agents are most effective during
the M phase (mitosis) when cells are actively dividing. G0 is the resting phase where
cells are not dividing and are generally resistant to cell cycle-specific agents. G1 and
S phases are targeted by some specific agents, but the M phase is a primary target
for drugs like vinca alkaloids and taxanes.
Question 5: Which chemotherapy agent is most strongly associated with the
development of hemorrhagic cystitis?
• A) Cyclophosphamide
• B) Doxorubicin
• C) Cisplatin
• D) Vincristine
Correct Answer: A
Rationale: Cyclophosphamide metabolism produces acrolein, a urotoxic metabolite
that causes chemical irritation of the bladder mucosa and can result in hemorrhagic
cystitis. Mesna is administered concurrently to bind acrolein and prevent this toxicity.
Question 6: A patient receiving doxorubicin should have cumulative dose
monitoring because of the risk of which organ toxicity?
• A) Pulmonary fibrosis
• B) Nephrotoxicity
• C) Cardiotoxicity
• D) Hepatotoxicity
,Correct Answer: C
Rationale: Doxorubicin, an anthracycline antitumor antibiotic, generates free radicals
that damage myocardial cells, leading to a cumulative dose-dependent
cardiomyopathy. The lifetime maximum cumulative dose is typically capped at 450 to
550 mg/m² to limit this risk.
Question 7: Which medication is used as a cardioprotectant in patients
receiving doxorubicin?
• A) Mesna
• B) Dexrazoxane
• C) Leucovorin
• D) Amifostine
Correct Answer: B
Rationale: Dexrazoxane is an iron-chelating agent that reduces anthracycline-
induced free radical formation in cardiac tissue. Mesna protects against hemorrhagic
cystitis, leucovorin is used as a rescue agent after methotrexate, and amifostine is
used to reduce xerostomia from radiation.
Question 8: A patient with metastatic triple-negative breast cancer is being
started on sacituzumab govitecan. The nurse understands that this medication
belongs to which class of anticancer agents?
• A) Immune checkpoint inhibitor
• B) Antibody-drug conjugate (ADC)
• C) Bispecific T-cell engager (BiTE)
• D) Tyrosine kinase inhibitor (TKI)
Correct Answer: B
Rationale: Sacituzumab govitecan is an antibody-drug conjugate (ADC) consisting of
an anti-Trop-2 monoclonal antibody linked to SN-38, the active metabolite of
irinotecan. This targeted delivery mechanism allows for intracellular release of the
cytotoxic payload in Trop-2-expressing tumor cells.
Question 9: A 68-year-old patient with metastatic non-small cell lung cancer
(NSCLC) and PD-L1 expression ≥ 50% is initiating first-line treatment with
pembrolizumab plus chemotherapy. According to current NCCN and ASCO
guidelines, what is the recommended duration of pembrolizumab therapy?
• A) 12 months regardless of response
• B) 24 months or until disease progression/unacceptable toxicity, whichever
occurs first
• C) Indefinitely until progression
• D) 6 cycles only
, Correct Answer: B
Rationale: Current evidence supports treating with pembrolizumab for up to 24
months or until disease progression or unacceptable toxicity, based on KEYNOTE-
189/407 trial data showing sustained benefit. Fixed-duration therapy at 24 months is
now standard to balance efficacy with toxicity and cost.
Question 10: According to the updated 2024 ASCO antiemetic guidelines, which
combination is now recommended for highly emetogenic chemotherapy (HEC)
in the delayed phase (days 2-3)?
• A) Dexamethasone alone
• B) Olanzapine plus dexamethasone
• C) Metoclopramide only
• D) Lorazepam plus prochlorperazine
Correct Answer: B
Rationale: The 2024 ASCO guidelines recommend adding olanzapine to
dexamethasone for delayed phase CINV prevention with HEC, based on improved
control over neurokinin-1 receptor antagonist combinations. Olanzapine's multi-
receptor antagonism provides superior delayed phase protection.
Question 11: Which of the following is the most common type of renal toxicity
associated with cisplatin?
• A) Glomerular damage
• B) Proximal tubular damage
• C) Distal tubular damage
• D) Interstitial nephritis
Correct Answer: B
Rationale: Cisplatin is primarily excreted by the kidneys and causes dose-limiting
nephrotoxicity, which predominantly manifests as proximal tubular damage. This can
lead to hypomagnesemia, hypokalemia, and hypocalcemia. Adequate hydration and
electrolyte monitoring are essential.
Question 12: A patient on paclitaxel reports numbness and tingling in their
hands and feet. What is the most appropriate nursing intervention?
• A) Continue the infusion and document the finding.
• B) Hold the infusion and notify the provider immediately.
IMMUNOTHERAPY CERTIFICATE RENEWAL
EXAM 2026/2027 | 100 PRACTICE
QUESTIONS, ANSWERS & RATIONALES |
ONCOLOGY NURSING PREP
Question 1: What is the main benefit of neoadjuvant chemotherapy in breast
cancer patients?
• A) It significantly increases overall survival compared to adjuvant therapy.
• B) It eliminates the need for any surgical intervention.
• C) It can shrink the tumor enough to allow lumpectomy instead of
mastectomy.
• D) It reduces the total number of chemotherapy cycles needed.
Correct Answer: C
Rationale: Neoadjuvant therapy does not increase survival compared to adjuvant
therapy. Its primary benefit is changing surgical options; if the tumor shrinks enough,
the patient may only require a lumpectomy plus radiation instead of a mastectomy.
Question 2: A comprehensive geriatric assessment (CGA) covers all of the
following EXCEPT:
• A) Functional status and comorbidities.
• B) Cognitive function and nutritional status.
• C) Genetic mutation testing and tumor markers.
• D) Polypharmacy and medication review.
Correct Answer: C
Rationale: According to the NCCN Older Adult Oncology Guidelines, a CGA includes
functional status, socioeconomic issues, psychosocial distress, comorbidities,
cognitive function, nutritional status, polypharmacy, and medication review. Genetic
mutation testing and tumor markers are not components of a CGA.
Question 3: A patient is receiving docetaxel and carboplatin through a port.
What is the best explanation for why a port was placed rather than using a
peripheral IV?
• A) Both agents are classified as vesicants requiring central access.
• B) The patient's age makes peripheral IVs unsafe.
, • C) Docetaxel is an irritant that can cause significant extravasation reactions.
• D) Carboplatin must be infused through a port to be effective.
Correct Answer: C
Rationale: Docetaxel is classified as an irritant, and central access is often preferred
to reduce the risk of extravasation and associated tissue damage. While carboplatin
is not a vesicant, the combination and the need for safe administration support the
use of a port.
Question 4: Which cell cycle phase is most vulnerable to the effects of cell
cycle-specific chemotherapy agents?
• A) G0 (resting phase)
• B) G1 (first growth phase)
• C) S (synthesis phase)
• D) M (mitotic phase)
Correct Answer: D
Rationale: Many cell cycle-specific chemotherapy agents are most effective during
the M phase (mitosis) when cells are actively dividing. G0 is the resting phase where
cells are not dividing and are generally resistant to cell cycle-specific agents. G1 and
S phases are targeted by some specific agents, but the M phase is a primary target
for drugs like vinca alkaloids and taxanes.
Question 5: Which chemotherapy agent is most strongly associated with the
development of hemorrhagic cystitis?
• A) Cyclophosphamide
• B) Doxorubicin
• C) Cisplatin
• D) Vincristine
Correct Answer: A
Rationale: Cyclophosphamide metabolism produces acrolein, a urotoxic metabolite
that causes chemical irritation of the bladder mucosa and can result in hemorrhagic
cystitis. Mesna is administered concurrently to bind acrolein and prevent this toxicity.
Question 6: A patient receiving doxorubicin should have cumulative dose
monitoring because of the risk of which organ toxicity?
• A) Pulmonary fibrosis
• B) Nephrotoxicity
• C) Cardiotoxicity
• D) Hepatotoxicity
,Correct Answer: C
Rationale: Doxorubicin, an anthracycline antitumor antibiotic, generates free radicals
that damage myocardial cells, leading to a cumulative dose-dependent
cardiomyopathy. The lifetime maximum cumulative dose is typically capped at 450 to
550 mg/m² to limit this risk.
Question 7: Which medication is used as a cardioprotectant in patients
receiving doxorubicin?
• A) Mesna
• B) Dexrazoxane
• C) Leucovorin
• D) Amifostine
Correct Answer: B
Rationale: Dexrazoxane is an iron-chelating agent that reduces anthracycline-
induced free radical formation in cardiac tissue. Mesna protects against hemorrhagic
cystitis, leucovorin is used as a rescue agent after methotrexate, and amifostine is
used to reduce xerostomia from radiation.
Question 8: A patient with metastatic triple-negative breast cancer is being
started on sacituzumab govitecan. The nurse understands that this medication
belongs to which class of anticancer agents?
• A) Immune checkpoint inhibitor
• B) Antibody-drug conjugate (ADC)
• C) Bispecific T-cell engager (BiTE)
• D) Tyrosine kinase inhibitor (TKI)
Correct Answer: B
Rationale: Sacituzumab govitecan is an antibody-drug conjugate (ADC) consisting of
an anti-Trop-2 monoclonal antibody linked to SN-38, the active metabolite of
irinotecan. This targeted delivery mechanism allows for intracellular release of the
cytotoxic payload in Trop-2-expressing tumor cells.
Question 9: A 68-year-old patient with metastatic non-small cell lung cancer
(NSCLC) and PD-L1 expression ≥ 50% is initiating first-line treatment with
pembrolizumab plus chemotherapy. According to current NCCN and ASCO
guidelines, what is the recommended duration of pembrolizumab therapy?
• A) 12 months regardless of response
• B) 24 months or until disease progression/unacceptable toxicity, whichever
occurs first
• C) Indefinitely until progression
• D) 6 cycles only
, Correct Answer: B
Rationale: Current evidence supports treating with pembrolizumab for up to 24
months or until disease progression or unacceptable toxicity, based on KEYNOTE-
189/407 trial data showing sustained benefit. Fixed-duration therapy at 24 months is
now standard to balance efficacy with toxicity and cost.
Question 10: According to the updated 2024 ASCO antiemetic guidelines, which
combination is now recommended for highly emetogenic chemotherapy (HEC)
in the delayed phase (days 2-3)?
• A) Dexamethasone alone
• B) Olanzapine plus dexamethasone
• C) Metoclopramide only
• D) Lorazepam plus prochlorperazine
Correct Answer: B
Rationale: The 2024 ASCO guidelines recommend adding olanzapine to
dexamethasone for delayed phase CINV prevention with HEC, based on improved
control over neurokinin-1 receptor antagonist combinations. Olanzapine's multi-
receptor antagonism provides superior delayed phase protection.
Question 11: Which of the following is the most common type of renal toxicity
associated with cisplatin?
• A) Glomerular damage
• B) Proximal tubular damage
• C) Distal tubular damage
• D) Interstitial nephritis
Correct Answer: B
Rationale: Cisplatin is primarily excreted by the kidneys and causes dose-limiting
nephrotoxicity, which predominantly manifests as proximal tubular damage. This can
lead to hypomagnesemia, hypokalemia, and hypocalcemia. Adequate hydration and
electrolyte monitoring are essential.
Question 12: A patient on paclitaxel reports numbness and tingling in their
hands and feet. What is the most appropriate nursing intervention?
• A) Continue the infusion and document the finding.
• B) Hold the infusion and notify the provider immediately.
