ONS/ONCC CHEMOTHERAPY & IMMUNOTHERAPY
CERTIFICATE EXAM 2026: COMPREHENSIVE
ONCOLOGY NURSING REVIEW | VERIFIED
QUESTIONS & ANSWERS, DETAILED RATIONALES &
COMPLETE CERTIFICATION EXAM PREPARATION
GUIDE
SECTION 1: FOUNDATIONS OF CHEMOTHERAPY AND IMMUNOTHERAPY
This section covers core concepts including mechanisms of action, cell cycle dynamics,
and classification of chemotherapeutic and immunotherapeutic agents.
1. A patient is receiving a cell cycle-specific chemotherapeutic agent. The nurse
understands that this type of medication is MOST effective against tumor cells that
are:
A. In the G0 resting phase
B. Actively undergoing cell division
C. Resistant to apoptosis
D. Located in the central necrotic portion of the tumor
Answer: B
,2. Which of the following immunotherapeutic agents functions by blocking the
interaction between PD-1 and PD-L1, thereby enhancing T-cell-mediated antitumor
activity?
A. Rituximab
B. Trastuzumab
C. Pembrolizumab
D. Bevacizumab
Answer: C
3. A nurse is preparing to administer a vesicant chemotherapeutic agent. Which of the
following actions is MOST critical to prevent extravasation injury?
A. Administering the drug through a peripheral IV in the antecubital fossa
B. Ensuring a blood return before and during administration
C. Infusing the medication over 30 minutes
D. Applying a warm compress to the IV site
Answer: B
4. The Oncology Nursing Society (ONS) recommends that chemotherapy safety
standards include all of the following EXCEPT:
A. Verification of the patient's identity using at least two identifiers
B. Documentation of informed consent
C. Administration of chemotherapy by unlicensed assistive personnel under direct
supervision
D. Assessment of baseline laboratory values prior to administration
Answer: C
5. A patient receiving rituximab develops fever, chills, and rigors within 30 minutes of
the start of the infusion. The nurse should FIRST:
A. Stop the infusion and administer diphenhydramine
B. Slow the infusion rate and administer acetaminophen
C. Stop the infusion and notify the healthcare provider
D. Continue the infusion and monitor vital signs
, Answer: A
6. Which of the following chemotherapeutic agents is classified as an alkylating agent
and requires dose adjustment based on renal function?
A. Doxorubicin
B. Cisplatin
C. Paclitaxel
D. Methotrexate
Answer: B
7. The mechanism of action of trastuzumab involves:
A. Inhibition of angiogenesis
B. Binding to HER2/neu receptors
C. Blockade of immune checkpoint proteins
D. Direct DNA intercalation
Answer: B
8. A patient with cancer is prescribed an antiemetic regimen containing aprepitant.
The nurse understands that this medication belongs to which drug class?
A. Serotonin receptor antagonist
B. Dopamine receptor antagonist
C. Neurokinin-1 receptor antagonist
D. Corticosteroid
Answer: C
9. When administering chemotherapy via a central venous access device (CVAD),
which of the following actions is ESSENTIAL to confirm proper catheter placement and
function?
A. Aspirating for blood return prior to each administration
B. Flushing the catheter with 10 mL of normal saline
CERTIFICATE EXAM 2026: COMPREHENSIVE
ONCOLOGY NURSING REVIEW | VERIFIED
QUESTIONS & ANSWERS, DETAILED RATIONALES &
COMPLETE CERTIFICATION EXAM PREPARATION
GUIDE
SECTION 1: FOUNDATIONS OF CHEMOTHERAPY AND IMMUNOTHERAPY
This section covers core concepts including mechanisms of action, cell cycle dynamics,
and classification of chemotherapeutic and immunotherapeutic agents.
1. A patient is receiving a cell cycle-specific chemotherapeutic agent. The nurse
understands that this type of medication is MOST effective against tumor cells that
are:
A. In the G0 resting phase
B. Actively undergoing cell division
C. Resistant to apoptosis
D. Located in the central necrotic portion of the tumor
Answer: B
,2. Which of the following immunotherapeutic agents functions by blocking the
interaction between PD-1 and PD-L1, thereby enhancing T-cell-mediated antitumor
activity?
A. Rituximab
B. Trastuzumab
C. Pembrolizumab
D. Bevacizumab
Answer: C
3. A nurse is preparing to administer a vesicant chemotherapeutic agent. Which of the
following actions is MOST critical to prevent extravasation injury?
A. Administering the drug through a peripheral IV in the antecubital fossa
B. Ensuring a blood return before and during administration
C. Infusing the medication over 30 minutes
D. Applying a warm compress to the IV site
Answer: B
4. The Oncology Nursing Society (ONS) recommends that chemotherapy safety
standards include all of the following EXCEPT:
A. Verification of the patient's identity using at least two identifiers
B. Documentation of informed consent
C. Administration of chemotherapy by unlicensed assistive personnel under direct
supervision
D. Assessment of baseline laboratory values prior to administration
Answer: C
5. A patient receiving rituximab develops fever, chills, and rigors within 30 minutes of
the start of the infusion. The nurse should FIRST:
A. Stop the infusion and administer diphenhydramine
B. Slow the infusion rate and administer acetaminophen
C. Stop the infusion and notify the healthcare provider
D. Continue the infusion and monitor vital signs
, Answer: A
6. Which of the following chemotherapeutic agents is classified as an alkylating agent
and requires dose adjustment based on renal function?
A. Doxorubicin
B. Cisplatin
C. Paclitaxel
D. Methotrexate
Answer: B
7. The mechanism of action of trastuzumab involves:
A. Inhibition of angiogenesis
B. Binding to HER2/neu receptors
C. Blockade of immune checkpoint proteins
D. Direct DNA intercalation
Answer: B
8. A patient with cancer is prescribed an antiemetic regimen containing aprepitant.
The nurse understands that this medication belongs to which drug class?
A. Serotonin receptor antagonist
B. Dopamine receptor antagonist
C. Neurokinin-1 receptor antagonist
D. Corticosteroid
Answer: C
9. When administering chemotherapy via a central venous access device (CVAD),
which of the following actions is ESSENTIAL to confirm proper catheter placement and
function?
A. Aspirating for blood return prior to each administration
B. Flushing the catheter with 10 mL of normal saline
