Updated for 2026-2027
ONS FUNDAMENTALS OF CHEMOTHERAPY & IMMUNOTHERAPY
ADMINISTRATION EXAM 2026/2027 | 100 CORRECT QUESTIONS &
ANSWERS (VERIFIED STUDY GUIDE) ALREADY GRADED A+
1.
A chemotherapy-certified nurse is preparing to administer a vesicant drug through
a patient’s peripheral IV line. The patient reports mild discomfort at the site, and
the nurse notes slight swelling and erythema. Knowing the risks of extravasation,
which of the following is the most appropriate initial nursing action?
A. Slow the infusion rate and apply a warm compress
B. Stop the infusion immediately and attempt to aspirate residual drug
C. Flush the line with normal saline to relieve discomfort
D. Remove the IV line and apply gentle massage to disperse the drug
Correct Answer: B — Stop the infusion immediately and attempt to aspirate
residual drug.
Explanation: Vesicant chemotherapy drugs can cause severe tissue damage if
extravasated. The priority is to stop the infusion immediately while leaving the
catheter in place to aspirate any remaining drug. Flushing or massaging the site
can worsen tissue injury.
2.
During administration of a monoclonal antibody infusion, a patient suddenly
develops chills, flushing, and mild shortness of breath. Vital signs reveal a mild
drop in blood pressure and increased heart rate. What is the nurse’s first priority
in managing this infusion reaction?
A. Stop the infusion and assess the patient’s airway and vital signs
B. Continue the infusion at a slower rate while calling the provider
C. Administer acetaminophen and restart the infusion
D. Document the event and monitor closely without intervention
,Updated for 2026-2027
Correct Answer: A — Stop the infusion and assess the patient’s airway and vital
signs.
Explanation: Infusion reactions are common with monoclonal antibodies. The
immediate priority is to stop the infusion and assess the patient’s status to
determine severity. Supportive care and emergency interventions may follow
depending on clinical findings.
3.
A nurse is preparing to administer chemotherapy using a closed-system transfer
device (CSTD). The patient is anxious and asks why the nurse is using “extra
equipment.” Which explanation is most appropriate?
A. It helps reduce medication waste during preparation
B. It prevents contamination of the drug by outside air
C. It protects healthcare workers by minimizing exposure to hazardous drugs
D. It ensures faster drug delivery during infusion
Correct Answer: C — It protects healthcare workers by minimizing exposure to
hazardous drugs.
Explanation: CSTDs are required safety devices that prevent the escape of
hazardous drug vapors and aerosols, thereby protecting staff. Their primary
purpose is occupational safety, not patient comfort or infusion speed.
4.
Before administering a high-dose chemotherapy regimen, the nurse reviews the
patient’s recent laboratory results and notes an absolute neutrophil count (ANC) of
450/µL. The patient is afebrile and otherwise stable. Which of the following
actions is most appropriate?
A. Proceed with chemotherapy as scheduled
B. Delay chemotherapy and notify the prescribing provider
C. Administer prophylactic antibiotics and continue treatment
D. Reduce the chemotherapy dose by half and continue
Correct Answer: B — Delay chemotherapy and notify the prescribing provider.
Explanation: An ANC below 500/µL indicates severe neutropenia, placing the
,Updated for 2026-2027
patient at high risk for infection. Chemotherapy is usually delayed or modified
until counts recover, as further treatment could increase complications.
5.
While administering a cytotoxic chemotherapy drug, the nurse accidentally
punctures their glove and comes into direct contact with the drug. What is the first
action the nurse should take?
A. Immediately wash the affected area with soap and water
B. Report the incident after finishing the infusion
C. Apply alcohol swabs to the area for disinfection
D. Continue working and change gloves afterward
Correct Answer: A — Immediately wash the affected area with soap and water.
Explanation: Direct skin exposure to hazardous drugs requires immediate
washing to reduce absorption and contamination. The nurse should then follow
institutional exposure reporting and medical evaluation protocols.
6.
A patient receiving chemotherapy through a central venous catheter reports a
burning sensation near the insertion site during infusion. Upon inspection, there is
no obvious swelling or redness. What should the nurse do next?
A. Flush the catheter with saline to relieve discomfort
B. Stop the infusion and assess catheter patency and blood return
C. Apply warm compresses to reduce discomfort
D. Continue the infusion while monitoring for swelling
Correct Answer: B — Stop the infusion and assess catheter patency and blood
return.
Explanation: Pain or burning during infusion can indicate catheter malfunction or
early infiltration. The infusion should be paused immediately to check for blood
return and patency before deciding whether to continue or intervene further.
, Updated for 2026-2027
7.
A patient receiving immunotherapy develops persistent diarrhea, abdominal pain,
and weight loss over several weeks. Laboratory findings suggest inflammation but
no infection. Which adverse effect is most likely occurring?
A. Chemotherapy-induced mucositis
B. Infusion-related hypersensitivity
C. Immune-mediated colitis
D. Opportunistic infection
Correct Answer: C — Immune-mediated colitis.
Explanation: Immune checkpoint inhibitors can cause delayed autoimmune
toxicities, including colitis, due to immune system activation against normal
tissues. Symptoms develop over weeks and require prompt evaluation and possible
immunosuppressive therapy.
8.
A nurse is reviewing chemotherapy orders for a patient and notices that the
prescribed dose exceeds the standard range for the patient’s body surface area.
Which action is most appropriate?
A. Administer the dose as ordered since providers determine dosing
B. Adjust the dose based on nursing judgment and proceed
C. Hold the drug and clarify the order with the prescribing provider
D. Reduce the dose slightly to fit standard ranges
Correct Answer: C — Hold the drug and clarify the order with the prescribing
provider.
Explanation: Chemotherapy dosing errors can be life-threatening. Nurses must
verify questionable orders and clarify before administration. Independent dose
adjustment is not appropriate without provider input.
9.
During chemotherapy administration, a nurse observes fluid leaking from the IV
tubing connection. The area around the connection is wet, but there’s no evidence
of patient harm. Which step should the nurse take first?
ONS FUNDAMENTALS OF CHEMOTHERAPY & IMMUNOTHERAPY
ADMINISTRATION EXAM 2026/2027 | 100 CORRECT QUESTIONS &
ANSWERS (VERIFIED STUDY GUIDE) ALREADY GRADED A+
1.
A chemotherapy-certified nurse is preparing to administer a vesicant drug through
a patient’s peripheral IV line. The patient reports mild discomfort at the site, and
the nurse notes slight swelling and erythema. Knowing the risks of extravasation,
which of the following is the most appropriate initial nursing action?
A. Slow the infusion rate and apply a warm compress
B. Stop the infusion immediately and attempt to aspirate residual drug
C. Flush the line with normal saline to relieve discomfort
D. Remove the IV line and apply gentle massage to disperse the drug
Correct Answer: B — Stop the infusion immediately and attempt to aspirate
residual drug.
Explanation: Vesicant chemotherapy drugs can cause severe tissue damage if
extravasated. The priority is to stop the infusion immediately while leaving the
catheter in place to aspirate any remaining drug. Flushing or massaging the site
can worsen tissue injury.
2.
During administration of a monoclonal antibody infusion, a patient suddenly
develops chills, flushing, and mild shortness of breath. Vital signs reveal a mild
drop in blood pressure and increased heart rate. What is the nurse’s first priority
in managing this infusion reaction?
A. Stop the infusion and assess the patient’s airway and vital signs
B. Continue the infusion at a slower rate while calling the provider
C. Administer acetaminophen and restart the infusion
D. Document the event and monitor closely without intervention
,Updated for 2026-2027
Correct Answer: A — Stop the infusion and assess the patient’s airway and vital
signs.
Explanation: Infusion reactions are common with monoclonal antibodies. The
immediate priority is to stop the infusion and assess the patient’s status to
determine severity. Supportive care and emergency interventions may follow
depending on clinical findings.
3.
A nurse is preparing to administer chemotherapy using a closed-system transfer
device (CSTD). The patient is anxious and asks why the nurse is using “extra
equipment.” Which explanation is most appropriate?
A. It helps reduce medication waste during preparation
B. It prevents contamination of the drug by outside air
C. It protects healthcare workers by minimizing exposure to hazardous drugs
D. It ensures faster drug delivery during infusion
Correct Answer: C — It protects healthcare workers by minimizing exposure to
hazardous drugs.
Explanation: CSTDs are required safety devices that prevent the escape of
hazardous drug vapors and aerosols, thereby protecting staff. Their primary
purpose is occupational safety, not patient comfort or infusion speed.
4.
Before administering a high-dose chemotherapy regimen, the nurse reviews the
patient’s recent laboratory results and notes an absolute neutrophil count (ANC) of
450/µL. The patient is afebrile and otherwise stable. Which of the following
actions is most appropriate?
A. Proceed with chemotherapy as scheduled
B. Delay chemotherapy and notify the prescribing provider
C. Administer prophylactic antibiotics and continue treatment
D. Reduce the chemotherapy dose by half and continue
Correct Answer: B — Delay chemotherapy and notify the prescribing provider.
Explanation: An ANC below 500/µL indicates severe neutropenia, placing the
,Updated for 2026-2027
patient at high risk for infection. Chemotherapy is usually delayed or modified
until counts recover, as further treatment could increase complications.
5.
While administering a cytotoxic chemotherapy drug, the nurse accidentally
punctures their glove and comes into direct contact with the drug. What is the first
action the nurse should take?
A. Immediately wash the affected area with soap and water
B. Report the incident after finishing the infusion
C. Apply alcohol swabs to the area for disinfection
D. Continue working and change gloves afterward
Correct Answer: A — Immediately wash the affected area with soap and water.
Explanation: Direct skin exposure to hazardous drugs requires immediate
washing to reduce absorption and contamination. The nurse should then follow
institutional exposure reporting and medical evaluation protocols.
6.
A patient receiving chemotherapy through a central venous catheter reports a
burning sensation near the insertion site during infusion. Upon inspection, there is
no obvious swelling or redness. What should the nurse do next?
A. Flush the catheter with saline to relieve discomfort
B. Stop the infusion and assess catheter patency and blood return
C. Apply warm compresses to reduce discomfort
D. Continue the infusion while monitoring for swelling
Correct Answer: B — Stop the infusion and assess catheter patency and blood
return.
Explanation: Pain or burning during infusion can indicate catheter malfunction or
early infiltration. The infusion should be paused immediately to check for blood
return and patency before deciding whether to continue or intervene further.
, Updated for 2026-2027
7.
A patient receiving immunotherapy develops persistent diarrhea, abdominal pain,
and weight loss over several weeks. Laboratory findings suggest inflammation but
no infection. Which adverse effect is most likely occurring?
A. Chemotherapy-induced mucositis
B. Infusion-related hypersensitivity
C. Immune-mediated colitis
D. Opportunistic infection
Correct Answer: C — Immune-mediated colitis.
Explanation: Immune checkpoint inhibitors can cause delayed autoimmune
toxicities, including colitis, due to immune system activation against normal
tissues. Symptoms develop over weeks and require prompt evaluation and possible
immunosuppressive therapy.
8.
A nurse is reviewing chemotherapy orders for a patient and notices that the
prescribed dose exceeds the standard range for the patient’s body surface area.
Which action is most appropriate?
A. Administer the dose as ordered since providers determine dosing
B. Adjust the dose based on nursing judgment and proceed
C. Hold the drug and clarify the order with the prescribing provider
D. Reduce the dose slightly to fit standard ranges
Correct Answer: C — Hold the drug and clarify the order with the prescribing
provider.
Explanation: Chemotherapy dosing errors can be life-threatening. Nurses must
verify questionable orders and clarify before administration. Independent dose
adjustment is not appropriate without provider input.
9.
During chemotherapy administration, a nurse observes fluid leaking from the IV
tubing connection. The area around the connection is wet, but there’s no evidence
of patient harm. Which step should the nurse take first?
