1|Page
RN ONCOLOGY A RELIAS ACTUAL EXAM
PREP 2026 ALL QUESTIONS AND CORECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK | NEW AND REVISED
1. A patient receiving myelosuppressive chemotherapy has an absolute neutrophil
count (ANC) of 300/mm³ and develops a fever of 38.5°C. Which intervention
should the nurse implement first?
A. Administer acetaminophen as ordered.
B. Obtain blood cultures and then initiate broad-spectrum IV antibiotics.
C. Notify the provider after completing a full assessment.
D. Place the patient in reverse isolation.
*Rationale: Febrile neutropenia (ANC <500/mm³ with fever >38.3°C or
sustained >38.0°C) is an oncologic emergency. Immediate empiric IV antibiotics
are required after obtaining blood cultures. Acetaminophen (A) treats fever but
not the underlying infection. Notification (C) should happen quickly but not
delay antibiotics. Reverse isolation (D) is important but not the first priority.
Option B is correct.*
2. A patient with advanced ovarian cancer is receiving cisplatin. The nurse should
monitor for which potentially irreversible adverse effect?
A. Cardiotoxicity
B. Nephrotoxicity and ototoxicity
C. Peripheral neuropathy
D. Pulmonary fibrosis
Rationale: Cisplatin is associated with dose-dependent nephrotoxicity and
ototoxicity (hearing loss, tinnitus) that can be irreversible. Cardiotoxicity (A) is
more common with anthracyclines. Peripheral neuropathy (C) is common with
taxanes and platinum agents but often partially reversible. Pulmonary fibrosis
(D) is associated with bleomycin. Option B is correct.
3. A patient receiving doxorubicin (Adriamycin) for breast cancer has an
echocardiogram showing a decreased left ventricular ejection fraction (LVEF)
,2|Page
from 60% to 45%. The nurse anticipates which intervention?
A. Continue doxorubicin at the same dose.
B. Hold doxorubicin and consult cardiology for possible discontinuation.
C. Increase the dose of doxorubicin to overcome resistance.
D. Administer a loop diuretic to improve cardiac function.
Rationale: Doxorubicin causes cumulative dose-dependent cardiotoxicity. A
significant decline in LVEF typically indicates the need to stop the drug.
Continuing (A) or increasing (C) would worsen heart failure. Diuretics (D) do
not address the cause. Option B is correct.
4. A patient is receiving radiation therapy to the head and neck region. Which
symptom is most likely to occur after the first week of treatment?
A. Alopecia of the scalp
B. Mucositis and dysphagia
C. Radiation pneumonitis
D. Myelosuppression
Rationale: Radiation to the head/neck causes acute mucositis and dysphagia
starting in the second week. Alopecia (A) occurs if the scalp is irradiated.
Radiation pneumonitis (C) is a late effect (months later). Myelosuppression (D)
is more common with large field radiation or concurrent chemotherapy but not
typically the earliest symptom. Option B is correct.
5. A patient with metastatic lung cancer is receiving pembrolizumab (Keytruda).
The nurse should monitor for signs of immune-related adverse events (irAEs).
Which finding is most concerning?
A. Grade 1 rash on the trunk
B. Mild fatigue
C. New-onset diarrhea 6 times per day with abdominal pain
D. Pruritus without rash
Rationale: Immune checkpoint inhibitors can cause immune-mediated colitis.
Diarrhea with abdominal pain suggests significant colitis, which can lead to
perforation. Grade 1 rash (A) and mild fatigue (B) are common but less severe.
Pruritus (D) is also common. Option C requires prompt evaluation and steroids.
Option C is correct.
6. A patient undergoing chemotherapy reports severe nausea that is not relieved by
ondansetron. The patient is scheduled to receive highly emetogenic chemotherapy.
Which addition to the antiemetic regimen is most appropriate?
,3|Page
A. Diphenhydramine
B. Aprepitant (neurokinin-1 receptor antagonist)
C. Metoclopramide
D. Lorazepam
*Rationale: For highly emetogenic chemotherapy, a three-drug regimen
including a 5-HT3 antagonist (ondansetron), a neurokinin-1 antagonist
(aprepitant/fosaprepitant), and dexamethasone is standard. Adding aprepitant
significantly improves control. Metoclopramide (C) is less effective for acute
emesis. Lorazepam (D) is adjunctive for anticipatory nausea. Option B is
correct.*
7. A patient with acute leukemia develops tumor lysis syndrome (TLS) after
initiation of chemotherapy. The nurse assesses a serum uric acid of 12 mg/dL.
Which intervention should be prioritized?
A. Administer allopurinol as ordered.
B. Administer rasburicase (recombinant urate oxidase) as ordered.
C. Force oral fluids to 5 L/day.
D. Prepare the patient for hemodialysis.
*Rationale: Rasburicase rapidly lowers uric acid and is indicated for TLS with
markedly elevated uric acid (>10 mg/dL) or when allopurinol is insufficient.
Allopurinol (A) prevents further uric acid formation but does not lower existing
uric acid as rapidly. Oral fluids (C) are important but not the priority.
Hemodialysis (D) is for severe TLS with renal failure not responding to medical
management. Option B is correct.*
8. A patient with breast cancer is receiving trastuzumab (Herceptin) as part of
adjuvant therapy. Before each dose, the nurse must assess:
A. Serum potassium level
B. Left ventricular ejection fraction (LVEF)
C. Liver function tests
D. Platelet count
Rationale: Trastuzumab is associated with cardiotoxicity, particularly when used
after or with anthracyclines. LVEF should be monitored at baseline and
periodically during treatment. Option B is correct.
9. A patient with multiple myeloma develops severe bone pain in the lumbar spine
and new-onset lower extremity weakness and urinary retention. Which action
should the nurse take first?
, 4|Page
A. Administer a high dose of oral opioid pain medication.
B. Notify the provider immediately and prepare for emergent imaging (MRI).
C. Apply a warm compress to the back.
D. Place the patient in a supine position with legs elevated.
Rationale: This presentation is suspicious for spinal cord compression, an
oncologic emergency. Immediate evaluation (MRI) and intervention are critical
to prevent permanent paralysis. Pain medication alone (A) or compresses (C) do
not address the underlying emergency. Positioning (D) is not specific. Option B
is correct.
10. A patient receiving cyclophosphamide (Cytoxan) develops hemorrhagic
cystitis. Which preventive measure should the nurse emphasize for future cycles?
A. Limit fluid intake to 1 L/day.
B. Administer mesna and encourage vigorous hydration.
C. Avoid allopurinol.
D. Monitor urine output every 4 hours.
Rationale: Mesna binds to acrolein, the toxic metabolite of cyclophosphamide,
preventing hemorrhagic cystitis. Hydration (B) and frequent voiding also help.
Limiting fluids (A) would worsen toxicity. Allopurinol (C) is used for TLS
prevention. Monitoring output (D) is important but not preventive. Option B is
correct.
11. A patient with head and neck cancer is receiving concurrent chemoradiation
and reports severe oral pain with difficulty eating. The oral mucosa appears
erythematous with patchy ulcerations. Which intervention is most appropriate?
A. Use lemon-glycerin swabs to clean the mouth.
B. Prescribe a compounded mouthwash (lidocaine, diphenhydramine,
aluminum hydroxide) (magic mouthwash) and consider mucosal protectants.
C. Encourage crunchy foods to mechanically debride ulcers.
D. Discontinue oral care to avoid further trauma.
Rationale: Mucositis pain is managed with topical anesthetics (lidocaine),
antihistamines, and coating agents. Lemon-glycerin swabs (A) can be irritating.
Crunchy foods (C) worsen pain. Discontinuing oral care (D) leads to infection.
Option B is correct.
12. A patient with chronic lymphocytic leukemia (CLL) receiving rituximab
develops fever, chills, and hypotension during the first infusion. The nurse’s
priority action is to:
RN ONCOLOGY A RELIAS ACTUAL EXAM
PREP 2026 ALL QUESTIONS AND CORECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK | NEW AND REVISED
1. A patient receiving myelosuppressive chemotherapy has an absolute neutrophil
count (ANC) of 300/mm³ and develops a fever of 38.5°C. Which intervention
should the nurse implement first?
A. Administer acetaminophen as ordered.
B. Obtain blood cultures and then initiate broad-spectrum IV antibiotics.
C. Notify the provider after completing a full assessment.
D. Place the patient in reverse isolation.
*Rationale: Febrile neutropenia (ANC <500/mm³ with fever >38.3°C or
sustained >38.0°C) is an oncologic emergency. Immediate empiric IV antibiotics
are required after obtaining blood cultures. Acetaminophen (A) treats fever but
not the underlying infection. Notification (C) should happen quickly but not
delay antibiotics. Reverse isolation (D) is important but not the first priority.
Option B is correct.*
2. A patient with advanced ovarian cancer is receiving cisplatin. The nurse should
monitor for which potentially irreversible adverse effect?
A. Cardiotoxicity
B. Nephrotoxicity and ototoxicity
C. Peripheral neuropathy
D. Pulmonary fibrosis
Rationale: Cisplatin is associated with dose-dependent nephrotoxicity and
ototoxicity (hearing loss, tinnitus) that can be irreversible. Cardiotoxicity (A) is
more common with anthracyclines. Peripheral neuropathy (C) is common with
taxanes and platinum agents but often partially reversible. Pulmonary fibrosis
(D) is associated with bleomycin. Option B is correct.
3. A patient receiving doxorubicin (Adriamycin) for breast cancer has an
echocardiogram showing a decreased left ventricular ejection fraction (LVEF)
,2|Page
from 60% to 45%. The nurse anticipates which intervention?
A. Continue doxorubicin at the same dose.
B. Hold doxorubicin and consult cardiology for possible discontinuation.
C. Increase the dose of doxorubicin to overcome resistance.
D. Administer a loop diuretic to improve cardiac function.
Rationale: Doxorubicin causes cumulative dose-dependent cardiotoxicity. A
significant decline in LVEF typically indicates the need to stop the drug.
Continuing (A) or increasing (C) would worsen heart failure. Diuretics (D) do
not address the cause. Option B is correct.
4. A patient is receiving radiation therapy to the head and neck region. Which
symptom is most likely to occur after the first week of treatment?
A. Alopecia of the scalp
B. Mucositis and dysphagia
C. Radiation pneumonitis
D. Myelosuppression
Rationale: Radiation to the head/neck causes acute mucositis and dysphagia
starting in the second week. Alopecia (A) occurs if the scalp is irradiated.
Radiation pneumonitis (C) is a late effect (months later). Myelosuppression (D)
is more common with large field radiation or concurrent chemotherapy but not
typically the earliest symptom. Option B is correct.
5. A patient with metastatic lung cancer is receiving pembrolizumab (Keytruda).
The nurse should monitor for signs of immune-related adverse events (irAEs).
Which finding is most concerning?
A. Grade 1 rash on the trunk
B. Mild fatigue
C. New-onset diarrhea 6 times per day with abdominal pain
D. Pruritus without rash
Rationale: Immune checkpoint inhibitors can cause immune-mediated colitis.
Diarrhea with abdominal pain suggests significant colitis, which can lead to
perforation. Grade 1 rash (A) and mild fatigue (B) are common but less severe.
Pruritus (D) is also common. Option C requires prompt evaluation and steroids.
Option C is correct.
6. A patient undergoing chemotherapy reports severe nausea that is not relieved by
ondansetron. The patient is scheduled to receive highly emetogenic chemotherapy.
Which addition to the antiemetic regimen is most appropriate?
,3|Page
A. Diphenhydramine
B. Aprepitant (neurokinin-1 receptor antagonist)
C. Metoclopramide
D. Lorazepam
*Rationale: For highly emetogenic chemotherapy, a three-drug regimen
including a 5-HT3 antagonist (ondansetron), a neurokinin-1 antagonist
(aprepitant/fosaprepitant), and dexamethasone is standard. Adding aprepitant
significantly improves control. Metoclopramide (C) is less effective for acute
emesis. Lorazepam (D) is adjunctive for anticipatory nausea. Option B is
correct.*
7. A patient with acute leukemia develops tumor lysis syndrome (TLS) after
initiation of chemotherapy. The nurse assesses a serum uric acid of 12 mg/dL.
Which intervention should be prioritized?
A. Administer allopurinol as ordered.
B. Administer rasburicase (recombinant urate oxidase) as ordered.
C. Force oral fluids to 5 L/day.
D. Prepare the patient for hemodialysis.
*Rationale: Rasburicase rapidly lowers uric acid and is indicated for TLS with
markedly elevated uric acid (>10 mg/dL) or when allopurinol is insufficient.
Allopurinol (A) prevents further uric acid formation but does not lower existing
uric acid as rapidly. Oral fluids (C) are important but not the priority.
Hemodialysis (D) is for severe TLS with renal failure not responding to medical
management. Option B is correct.*
8. A patient with breast cancer is receiving trastuzumab (Herceptin) as part of
adjuvant therapy. Before each dose, the nurse must assess:
A. Serum potassium level
B. Left ventricular ejection fraction (LVEF)
C. Liver function tests
D. Platelet count
Rationale: Trastuzumab is associated with cardiotoxicity, particularly when used
after or with anthracyclines. LVEF should be monitored at baseline and
periodically during treatment. Option B is correct.
9. A patient with multiple myeloma develops severe bone pain in the lumbar spine
and new-onset lower extremity weakness and urinary retention. Which action
should the nurse take first?
, 4|Page
A. Administer a high dose of oral opioid pain medication.
B. Notify the provider immediately and prepare for emergent imaging (MRI).
C. Apply a warm compress to the back.
D. Place the patient in a supine position with legs elevated.
Rationale: This presentation is suspicious for spinal cord compression, an
oncologic emergency. Immediate evaluation (MRI) and intervention are critical
to prevent permanent paralysis. Pain medication alone (A) or compresses (C) do
not address the underlying emergency. Positioning (D) is not specific. Option B
is correct.
10. A patient receiving cyclophosphamide (Cytoxan) develops hemorrhagic
cystitis. Which preventive measure should the nurse emphasize for future cycles?
A. Limit fluid intake to 1 L/day.
B. Administer mesna and encourage vigorous hydration.
C. Avoid allopurinol.
D. Monitor urine output every 4 hours.
Rationale: Mesna binds to acrolein, the toxic metabolite of cyclophosphamide,
preventing hemorrhagic cystitis. Hydration (B) and frequent voiding also help.
Limiting fluids (A) would worsen toxicity. Allopurinol (C) is used for TLS
prevention. Monitoring output (D) is important but not preventive. Option B is
correct.
11. A patient with head and neck cancer is receiving concurrent chemoradiation
and reports severe oral pain with difficulty eating. The oral mucosa appears
erythematous with patchy ulcerations. Which intervention is most appropriate?
A. Use lemon-glycerin swabs to clean the mouth.
B. Prescribe a compounded mouthwash (lidocaine, diphenhydramine,
aluminum hydroxide) (magic mouthwash) and consider mucosal protectants.
C. Encourage crunchy foods to mechanically debride ulcers.
D. Discontinue oral care to avoid further trauma.
Rationale: Mucositis pain is managed with topical anesthetics (lidocaine),
antihistamines, and coating agents. Lemon-glycerin swabs (A) can be irritating.
Crunchy foods (C) worsen pain. Discontinuing oral care (D) leads to infection.
Option B is correct.
12. A patient with chronic lymphocytic leukemia (CLL) receiving rituximab
develops fever, chills, and hypotension during the first infusion. The nurse’s
priority action is to:
