ONS/ONCC Chemotherapy Immunotherapy Certificate
Exam /ONS/ONCC Chemotherapy Immunotherapy
Certificate Exam Preparation Latest Questions and
Answers (Verified Answers)
Question 1
A client is receiving an intravenous vesicant chemotherapy agent. The nurse
observes swelling, redness, and pain at the insertion site, with no blood
return upon aspiration. The nurse should immediately suspect:
A) Flare reaction.
B) Phlebitis.
C) Extravasation.
D) Infiltration.
E) Hypersensitivity reaction.
Correct Answer: C) Extravasation.
Rationale: Extravasation is the leakage of a vesicant (a drug that can
cause blistering and tissue necrosis) into the extravascular tissue
around the intravenous site. Signs include swelling, redness, pain,
and absent blood return, requiring immediate action.
Question 2
When administering a hazardous chemotherapy agent, the oncology nurse
should don personal protective equipment (PPE) including:
A) Surgical mask, clean gloves, and eye protection.
B) N95 respirator, sterile gloves, and gown.
C) Chemotherapy-specific gloves (double gloving), impermeable gown, and
eye/face protection.
D) Standard hospital gown and non-latex gloves.
E) Single pair of latex gloves and a surgical mask.
Correct Answer: C) Chemotherapy-specific gloves (double gloving),
impermeable gown, and eye/face protection.
Rationale: Safe handling of hazardous chemotherapy agents requires
specialized PPE to protect against exposure. This includes
chemotherapy-tested/rated gloves (often double-gloved), an
impermeable gown, and eye/face protection to prevent skin, eye,
and mucous membrane contact.
Question 3
A client receiving a platinum-based chemotherapy agent (e.g., cisplatin)
complains of ringing in the ears and difficulty hearing high-pitched sounds.
The nurse should assess for signs of:
A) Cardiotoxicity.
,B) Nephrotoxicity.
C) Ototoxicity.
D) Neurotoxicity.
E) Hepatotoxicity.
Correct Answer: C) Ototoxicity.
Rationale: Platinum-based chemotherapy agents, particularly
cisplatin, are known for their ototoxic effects, which can manifest as
tinnitus (ringing in the ears) and high-frequency hearing loss.
Audiometric monitoring is often performed.
Question 4
Which of the following is a primary goal of immunotherapy in cancer
treatment?
A) Directly killing cancer cells through cytotoxic agents.
B) Stimulating or restoring the body's immune system to recognize and
destroy cancer cells.
C) Blocking specific growth pathways unique to cancer cells.
D) Irradiating cancer cells with high-energy beams.
E) Replacing damaged bone marrow.
Correct Answer: B) Stimulating or restoring the body's immune system
to recognize and destroy cancer cells.
Rationale: Immunotherapy harnesses the power of the client's own
immune system to fight cancer. It works by enhancing the immune
response against tumor cells, often by removing immune
checkpoints or providing engineered immune cells.
Question 5
A client receiving a checkpoint inhibitor (e.g., pembrolizumab) develops new
onset diarrhea (4-6 stools/day) with abdominal cramping. The nurse should
immediately suspect:
A) Chemotherapy-induced diarrhea.
B) Normal gastrointestinal upset.
C) Immune-related colitis (irAE).
D) Infectious colitis.
E) Irritable bowel syndrome exacerbation.
Correct Answer: C) Immune-related colitis (irAE).
Rationale: Checkpoint inhibitors can cause immune-related adverse
events (irAEs) due to exaggerated immune activation. Diarrhea and
abdominal cramping are classic symptoms of immune-related colitis,
requiring prompt evaluation and management (often with
corticosteroids).
,Question 6
When providing education to a client on oral chemotherapy, the nurse should
emphasize:
A) Oral chemotherapy is safer than intravenous chemotherapy.
B) The client can stop taking the medication if side effects occur.
C) Strict adherence to the prescribed dose and schedule, and safe handling
precautions at home.
D) Oral chemotherapy does not require laboratory monitoring.
E) The medication can be shared with family members if they have similar
symptoms.
Correct Answer: C) Strict adherence to the prescribed dose and
schedule, and safe handling precautions at home.
Rationale: Oral chemotherapy agents are potent, hazardous
medications. Adherence is critical for efficacy and safety, and clients
must be educated on safe handling (e.g., gloves, not
crushing/breaking, proper disposal) to prevent exposure to
themselves and others.
Question 7
A client with neutropenia (Absolute Neutrophil Count < 500/mm³) develops a
fever of 101.5°F (38.6°C). The nurse should immediately suspect:
A) Drug-induced fever.
B) Viral infection.
C) Febrile neutropenia (oncologic emergency).
D) Allergic reaction.
E) Dehydration.
Correct Answer: C) Febrile neutropenia (oncologic emergency).
Rationale: Febrile neutropenia (fever in a neutropenic client) is a life-
threatening oncologic emergency. The lack of neutrophils (infection-
fighting white blood cells) means the client cannot mount a typical
immune response, and infection can rapidly become overwhelming.
Immediate workup and broad-spectrum antibiotics are required.
Question 8
Which of the following is a common adverse effect associated with alkylating
agents (e.g., cyclophosphamide) that requires aggressive hydration and
mesna administration?
A) Cardiotoxicity.
B) Hemorrhagic cystitis.
C) Peripheral neuropathy.
D) Pulmonary fibrosis.
, E) Alopecia.
Correct Answer: B) Hemorrhagic cystitis.
Rationale: Cyclophosphamide and ifosfamide (alkylating agents) can
cause hemorrhagic cystitis (inflammation and bleeding of the
bladder lining) due to the metabolite acrolein. Aggressive hydration
and the uroprotectant mesna are used to prevent this.
Question 9
A client receiving a cytotoxic chemotherapy agent complains of severe
nausea and vomiting. Which type of antiemetic medication is most effective
for chemotherapy-induced nausea and vomiting (CINV)?
A) Antihistamines.
B) Dopamine antagonists (e.g., prochlorperazine).
C) Serotonin receptor antagonists (5-HT3 antagonists, e.g., ondansetron).
D) Anticholinergics.
E) Benzodiazepines.
Correct Answer: C) Serotonin receptor antagonists (5-HT3 antagonists,
e.g., ondansetron).
Rationale: 5-HT3 receptor antagonists (e.g., ondansetron,
granisetron) are highly effective first-line agents for preventing and
treating chemotherapy-induced nausea and vomiting due to their
action on serotonin receptors in the GI tract and chemoreceptor
trigger zone.
Question 10
The nurse is preparing to administer an intravenous chemotherapy agent.
What is the final verification step before administration?
A) Client's weight.
B) Reviewing the medication order against the client's identification and
confirming client allergies.
C) Checking the client's blood pressure.
D) Ensuring the client has eaten.
E) Documenting the administration.
Correct Answer: B) Reviewing the medication order against the client's
identification and confirming client allergies.
Rationale: The "5 Rights" of medication administration (Right Client,
Right Drug, Right Dose, Right Route, Right Time) are paramount.
The final verification involves comparing the order to the client's
identity (two identifiers) and confirming allergy status to prevent
medication errors.
Exam /ONS/ONCC Chemotherapy Immunotherapy
Certificate Exam Preparation Latest Questions and
Answers (Verified Answers)
Question 1
A client is receiving an intravenous vesicant chemotherapy agent. The nurse
observes swelling, redness, and pain at the insertion site, with no blood
return upon aspiration. The nurse should immediately suspect:
A) Flare reaction.
B) Phlebitis.
C) Extravasation.
D) Infiltration.
E) Hypersensitivity reaction.
Correct Answer: C) Extravasation.
Rationale: Extravasation is the leakage of a vesicant (a drug that can
cause blistering and tissue necrosis) into the extravascular tissue
around the intravenous site. Signs include swelling, redness, pain,
and absent blood return, requiring immediate action.
Question 2
When administering a hazardous chemotherapy agent, the oncology nurse
should don personal protective equipment (PPE) including:
A) Surgical mask, clean gloves, and eye protection.
B) N95 respirator, sterile gloves, and gown.
C) Chemotherapy-specific gloves (double gloving), impermeable gown, and
eye/face protection.
D) Standard hospital gown and non-latex gloves.
E) Single pair of latex gloves and a surgical mask.
Correct Answer: C) Chemotherapy-specific gloves (double gloving),
impermeable gown, and eye/face protection.
Rationale: Safe handling of hazardous chemotherapy agents requires
specialized PPE to protect against exposure. This includes
chemotherapy-tested/rated gloves (often double-gloved), an
impermeable gown, and eye/face protection to prevent skin, eye,
and mucous membrane contact.
Question 3
A client receiving a platinum-based chemotherapy agent (e.g., cisplatin)
complains of ringing in the ears and difficulty hearing high-pitched sounds.
The nurse should assess for signs of:
A) Cardiotoxicity.
,B) Nephrotoxicity.
C) Ototoxicity.
D) Neurotoxicity.
E) Hepatotoxicity.
Correct Answer: C) Ototoxicity.
Rationale: Platinum-based chemotherapy agents, particularly
cisplatin, are known for their ototoxic effects, which can manifest as
tinnitus (ringing in the ears) and high-frequency hearing loss.
Audiometric monitoring is often performed.
Question 4
Which of the following is a primary goal of immunotherapy in cancer
treatment?
A) Directly killing cancer cells through cytotoxic agents.
B) Stimulating or restoring the body's immune system to recognize and
destroy cancer cells.
C) Blocking specific growth pathways unique to cancer cells.
D) Irradiating cancer cells with high-energy beams.
E) Replacing damaged bone marrow.
Correct Answer: B) Stimulating or restoring the body's immune system
to recognize and destroy cancer cells.
Rationale: Immunotherapy harnesses the power of the client's own
immune system to fight cancer. It works by enhancing the immune
response against tumor cells, often by removing immune
checkpoints or providing engineered immune cells.
Question 5
A client receiving a checkpoint inhibitor (e.g., pembrolizumab) develops new
onset diarrhea (4-6 stools/day) with abdominal cramping. The nurse should
immediately suspect:
A) Chemotherapy-induced diarrhea.
B) Normal gastrointestinal upset.
C) Immune-related colitis (irAE).
D) Infectious colitis.
E) Irritable bowel syndrome exacerbation.
Correct Answer: C) Immune-related colitis (irAE).
Rationale: Checkpoint inhibitors can cause immune-related adverse
events (irAEs) due to exaggerated immune activation. Diarrhea and
abdominal cramping are classic symptoms of immune-related colitis,
requiring prompt evaluation and management (often with
corticosteroids).
,Question 6
When providing education to a client on oral chemotherapy, the nurse should
emphasize:
A) Oral chemotherapy is safer than intravenous chemotherapy.
B) The client can stop taking the medication if side effects occur.
C) Strict adherence to the prescribed dose and schedule, and safe handling
precautions at home.
D) Oral chemotherapy does not require laboratory monitoring.
E) The medication can be shared with family members if they have similar
symptoms.
Correct Answer: C) Strict adherence to the prescribed dose and
schedule, and safe handling precautions at home.
Rationale: Oral chemotherapy agents are potent, hazardous
medications. Adherence is critical for efficacy and safety, and clients
must be educated on safe handling (e.g., gloves, not
crushing/breaking, proper disposal) to prevent exposure to
themselves and others.
Question 7
A client with neutropenia (Absolute Neutrophil Count < 500/mm³) develops a
fever of 101.5°F (38.6°C). The nurse should immediately suspect:
A) Drug-induced fever.
B) Viral infection.
C) Febrile neutropenia (oncologic emergency).
D) Allergic reaction.
E) Dehydration.
Correct Answer: C) Febrile neutropenia (oncologic emergency).
Rationale: Febrile neutropenia (fever in a neutropenic client) is a life-
threatening oncologic emergency. The lack of neutrophils (infection-
fighting white blood cells) means the client cannot mount a typical
immune response, and infection can rapidly become overwhelming.
Immediate workup and broad-spectrum antibiotics are required.
Question 8
Which of the following is a common adverse effect associated with alkylating
agents (e.g., cyclophosphamide) that requires aggressive hydration and
mesna administration?
A) Cardiotoxicity.
B) Hemorrhagic cystitis.
C) Peripheral neuropathy.
D) Pulmonary fibrosis.
, E) Alopecia.
Correct Answer: B) Hemorrhagic cystitis.
Rationale: Cyclophosphamide and ifosfamide (alkylating agents) can
cause hemorrhagic cystitis (inflammation and bleeding of the
bladder lining) due to the metabolite acrolein. Aggressive hydration
and the uroprotectant mesna are used to prevent this.
Question 9
A client receiving a cytotoxic chemotherapy agent complains of severe
nausea and vomiting. Which type of antiemetic medication is most effective
for chemotherapy-induced nausea and vomiting (CINV)?
A) Antihistamines.
B) Dopamine antagonists (e.g., prochlorperazine).
C) Serotonin receptor antagonists (5-HT3 antagonists, e.g., ondansetron).
D) Anticholinergics.
E) Benzodiazepines.
Correct Answer: C) Serotonin receptor antagonists (5-HT3 antagonists,
e.g., ondansetron).
Rationale: 5-HT3 receptor antagonists (e.g., ondansetron,
granisetron) are highly effective first-line agents for preventing and
treating chemotherapy-induced nausea and vomiting due to their
action on serotonin receptors in the GI tract and chemoreceptor
trigger zone.
Question 10
The nurse is preparing to administer an intravenous chemotherapy agent.
What is the final verification step before administration?
A) Client's weight.
B) Reviewing the medication order against the client's identification and
confirming client allergies.
C) Checking the client's blood pressure.
D) Ensuring the client has eaten.
E) Documenting the administration.
Correct Answer: B) Reviewing the medication order against the client's
identification and confirming client allergies.
Rationale: The "5 Rights" of medication administration (Right Client,
Right Drug, Right Dose, Right Route, Right Time) are paramount.
The final verification involves comparing the order to the client's
identity (two identifiers) and confirming allergy status to prevent
medication errors.
