Page 1 of 74
ONCOLOGY NURSING EXAM 2026 QUESTIONS
LATEST VERSION QUESTIONS AND ANSWERS
ONCOLOGY NURSING EXAM — 250 Practice Questions
SECTION 1: CANCER PATHOPHYSIOLOGY & SCREENING (Questions 1-30)
1. A nurse is explaining the process of carcinogenesis to a client newly diagnosed with
cancer. Which of the following best describes the three stages of carcinogenesis?
A. Initiation, promotion, and progression.
B. Initiation, proliferation, and metastasis.
C. Promotion, angiogenesis, and metastasis.
D. Mutation, promotion, and progression.
Answer: A. Rationale: The three stages of carcinogenesis are initiation (a mutation occurs in
the cell's DNA), promotion (the mutated cell is stimulated to proliferate),
and progression (the tumor develops the ability to invade and metastasize). Angiogenesis is a
hallmark of cancer but is not a stage of carcinogenesis.
2. A nurse is providing education to a client about cancer prevention. Which of the
following is the most important modifiable risk factor for cancer?
A. Tobacco use.
B. Obesity.
C. Alcohol consumption.
D. Poor diet.
Answer: A. Rationale: Tobacco use is the single most important modifiable risk factor for
cancer, accounting for approximately 30% of all cancer deaths. It is linked to lung, head and
neck, esophageal, bladder, and other cancers. Smoking cessation is the most effective
preventive measure.
3. A nurse is caring for a client with a malignant tumor. Which of the following is a
characteristic of malignant cells?
A. Encapsulated and well-differentiated.
, Page 2 of 74
B. Slow growth and localized.
C. Anaplastic and invasive.
D. Resemble the tissue of origin.
Answer: C. Rationale: Malignant cells are anaplastic (poorly differentiated) and have the
ability to invade surrounding tissues and metastasize to distant sites. Benign tumors are
encapsulated, well-differentiated, and slow-growing. Anaplasia is a hallmark of malignancy.
4. A nurse is explaining the TNM staging system to a client. What does the "T" in TNM
staging represent?
A. Tumor size and extent of invasion.
B. The number of lymph nodes involved.
C. The presence of metastasis.
D. The grade of the tumor.
Answer: A. Rationale: The TNM staging system is used to describe the extent of
cancer. T describes the size and extent of the primary tumor. N describes the involvement of
regional lymph nodes. M describes the presence of distant metastasis. The grade describes
how abnormal the cells appear.
5. A nurse is teaching a client about cancer screening guidelines. According to the
American Cancer Society, at what age should average-risk individuals begin colorectal
cancer screening?
A. Age 40.
B. Age 45.
C. Age 50.
D. Age 55.
Answer: B. Rationale: The American Cancer Society recommends that average-risk
individuals begin colorectal cancer screening at age 45. Screening options include
colonoscopy every 10 years, fecal immunochemical test (FIT) annually, or stool DNA test
every 3 years. The previous recommendation was age 50, but it was lowered to 45 in 2018.
6. A nurse is caring for a client who is undergoing a breast biopsy. The client asks what
the difference is between a benign and a malignant tumor. Which of the following is the
most accurate response?
A. "Benign tumors are non-cancerous and do not spread."
B. "Malignant tumors are always fatal."
C. "Benign tumors are cancerous but slow-growing."
D. "Malignant tumors are encapsulated and easily removed."
, Page 3 of 74
Answer: A. Rationale: Benign tumors are non-cancerous, are usually encapsulated, and do
not metastasize. Malignant tumors are cancerous, can invade surrounding tissues, and
metastasize. Not all malignant tumors are fatal, as many can be treated effectively.
7. A nurse is providing education to a client about the importance of cancer screening.
Which of the following is a secondary prevention strategy for cervical cancer?
A. HPV vaccination.
B. Pap smear screening.
C. Smoking cessation.
D. Avoiding sun exposure.
Answer: B. Rationale: Secondary prevention involves early detection of disease through
screening. A Pap smear is a screening test for cervical cancer. HPV vaccination (A) is
primary prevention. Smoking cessation (C) and sun avoidance (D) are also primary
prevention.
8. A nurse is caring for a client with metastatic cancer. Which of the following is the
most common site of metastasis?
A. Liver.
B. Lungs.
C. Bones.
D. Lymph nodes.
Answer: D. Rationale: The lymph nodes are the most common site of metastasis for many
cancers, as cancer cells travel through the lymphatic system. The liver, lungs, and bones are
also common sites of metastasis, depending on the primary tumor.
9. A nurse is explaining tumor grading to a client. Which of the following is true about
tumor grading?
A. It describes the size of the tumor.
B. It describes how abnormal the cancer cells appear.
C. It describes the stage of the cancer.
D. It describes the extent of metastasis.
Answer: B. Rationale: Tumor grading describes how abnormal the cancer cells appear
under a microscope. It is based on the degree of differentiation of the cells. Staging (C)
describes the extent of the cancer, including tumor size, lymph node involvement, and
metastasis.
10. A nurse is teaching a client about cancer risk factors. Which of the following is a
known carcinogen?
, Page 4 of 74
A. Asbestos.
B. Alcohol.
C. Ultraviolet radiation.
D. All of the above.
Answer: D. Rationale: Asbestos is a known carcinogen linked to mesothelioma and lung
cancer. Alcohol is a risk factor for oral, esophageal, liver, and breast cancer. Ultraviolet
radiation is a risk factor for skin cancer. All are known carcinogens.
11. A nurse is caring for a client with a suspected paraneoplastic syndrome. Which of
the following is a paraneoplastic syndrome associated with lung cancer?
A. Syndrome of inappropriate antidiuretic hormone (SIADH).
B. Cushing's syndrome.
C. Hypercalcemia.
D. All of the above.
Answer: D. Rationale: Lung cancer can cause a variety of paraneoplastic syndromes,
including SIADH (hyponatremia), Cushing's syndrome (from ectopic ACTH production),
and hypercalcemia (from bone metastases or ectopic PTH-related peptide). These syndromes
are caused by substances produced by the tumor.
12. A nurse is providing education to a client about colon cancer screening. Which of
the following screening tests is recommended for colorectal cancer?
A. Colonoscopy.
B. Fecal immunochemical test (FIT).
C. Stool DNA test.
D. All of the above.
Answer: D. Rationale: All of the above are recommended screening tests for colorectal
cancer. A colonoscopy is the gold standard and is recommended every 10 years. FIT is
recommended annually, and stool DNA testing is recommended every 3 years. The choice of
test depends on patient preference and risk factors.
13. A nurse is teaching a client about the warning signs of cancer. Which of the
following is a warning sign of cancer?
A. A change in bowel or bladder habits.
B. A sore that does not heal.
C. Unusual bleeding or discharge.
D. All of the above.
ONCOLOGY NURSING EXAM 2026 QUESTIONS
LATEST VERSION QUESTIONS AND ANSWERS
ONCOLOGY NURSING EXAM — 250 Practice Questions
SECTION 1: CANCER PATHOPHYSIOLOGY & SCREENING (Questions 1-30)
1. A nurse is explaining the process of carcinogenesis to a client newly diagnosed with
cancer. Which of the following best describes the three stages of carcinogenesis?
A. Initiation, promotion, and progression.
B. Initiation, proliferation, and metastasis.
C. Promotion, angiogenesis, and metastasis.
D. Mutation, promotion, and progression.
Answer: A. Rationale: The three stages of carcinogenesis are initiation (a mutation occurs in
the cell's DNA), promotion (the mutated cell is stimulated to proliferate),
and progression (the tumor develops the ability to invade and metastasize). Angiogenesis is a
hallmark of cancer but is not a stage of carcinogenesis.
2. A nurse is providing education to a client about cancer prevention. Which of the
following is the most important modifiable risk factor for cancer?
A. Tobacco use.
B. Obesity.
C. Alcohol consumption.
D. Poor diet.
Answer: A. Rationale: Tobacco use is the single most important modifiable risk factor for
cancer, accounting for approximately 30% of all cancer deaths. It is linked to lung, head and
neck, esophageal, bladder, and other cancers. Smoking cessation is the most effective
preventive measure.
3. A nurse is caring for a client with a malignant tumor. Which of the following is a
characteristic of malignant cells?
A. Encapsulated and well-differentiated.
, Page 2 of 74
B. Slow growth and localized.
C. Anaplastic and invasive.
D. Resemble the tissue of origin.
Answer: C. Rationale: Malignant cells are anaplastic (poorly differentiated) and have the
ability to invade surrounding tissues and metastasize to distant sites. Benign tumors are
encapsulated, well-differentiated, and slow-growing. Anaplasia is a hallmark of malignancy.
4. A nurse is explaining the TNM staging system to a client. What does the "T" in TNM
staging represent?
A. Tumor size and extent of invasion.
B. The number of lymph nodes involved.
C. The presence of metastasis.
D. The grade of the tumor.
Answer: A. Rationale: The TNM staging system is used to describe the extent of
cancer. T describes the size and extent of the primary tumor. N describes the involvement of
regional lymph nodes. M describes the presence of distant metastasis. The grade describes
how abnormal the cells appear.
5. A nurse is teaching a client about cancer screening guidelines. According to the
American Cancer Society, at what age should average-risk individuals begin colorectal
cancer screening?
A. Age 40.
B. Age 45.
C. Age 50.
D. Age 55.
Answer: B. Rationale: The American Cancer Society recommends that average-risk
individuals begin colorectal cancer screening at age 45. Screening options include
colonoscopy every 10 years, fecal immunochemical test (FIT) annually, or stool DNA test
every 3 years. The previous recommendation was age 50, but it was lowered to 45 in 2018.
6. A nurse is caring for a client who is undergoing a breast biopsy. The client asks what
the difference is between a benign and a malignant tumor. Which of the following is the
most accurate response?
A. "Benign tumors are non-cancerous and do not spread."
B. "Malignant tumors are always fatal."
C. "Benign tumors are cancerous but slow-growing."
D. "Malignant tumors are encapsulated and easily removed."
, Page 3 of 74
Answer: A. Rationale: Benign tumors are non-cancerous, are usually encapsulated, and do
not metastasize. Malignant tumors are cancerous, can invade surrounding tissues, and
metastasize. Not all malignant tumors are fatal, as many can be treated effectively.
7. A nurse is providing education to a client about the importance of cancer screening.
Which of the following is a secondary prevention strategy for cervical cancer?
A. HPV vaccination.
B. Pap smear screening.
C. Smoking cessation.
D. Avoiding sun exposure.
Answer: B. Rationale: Secondary prevention involves early detection of disease through
screening. A Pap smear is a screening test for cervical cancer. HPV vaccination (A) is
primary prevention. Smoking cessation (C) and sun avoidance (D) are also primary
prevention.
8. A nurse is caring for a client with metastatic cancer. Which of the following is the
most common site of metastasis?
A. Liver.
B. Lungs.
C. Bones.
D. Lymph nodes.
Answer: D. Rationale: The lymph nodes are the most common site of metastasis for many
cancers, as cancer cells travel through the lymphatic system. The liver, lungs, and bones are
also common sites of metastasis, depending on the primary tumor.
9. A nurse is explaining tumor grading to a client. Which of the following is true about
tumor grading?
A. It describes the size of the tumor.
B. It describes how abnormal the cancer cells appear.
C. It describes the stage of the cancer.
D. It describes the extent of metastasis.
Answer: B. Rationale: Tumor grading describes how abnormal the cancer cells appear
under a microscope. It is based on the degree of differentiation of the cells. Staging (C)
describes the extent of the cancer, including tumor size, lymph node involvement, and
metastasis.
10. A nurse is teaching a client about cancer risk factors. Which of the following is a
known carcinogen?
, Page 4 of 74
A. Asbestos.
B. Alcohol.
C. Ultraviolet radiation.
D. All of the above.
Answer: D. Rationale: Asbestos is a known carcinogen linked to mesothelioma and lung
cancer. Alcohol is a risk factor for oral, esophageal, liver, and breast cancer. Ultraviolet
radiation is a risk factor for skin cancer. All are known carcinogens.
11. A nurse is caring for a client with a suspected paraneoplastic syndrome. Which of
the following is a paraneoplastic syndrome associated with lung cancer?
A. Syndrome of inappropriate antidiuretic hormone (SIADH).
B. Cushing's syndrome.
C. Hypercalcemia.
D. All of the above.
Answer: D. Rationale: Lung cancer can cause a variety of paraneoplastic syndromes,
including SIADH (hyponatremia), Cushing's syndrome (from ectopic ACTH production),
and hypercalcemia (from bone metastases or ectopic PTH-related peptide). These syndromes
are caused by substances produced by the tumor.
12. A nurse is providing education to a client about colon cancer screening. Which of
the following screening tests is recommended for colorectal cancer?
A. Colonoscopy.
B. Fecal immunochemical test (FIT).
C. Stool DNA test.
D. All of the above.
Answer: D. Rationale: All of the above are recommended screening tests for colorectal
cancer. A colonoscopy is the gold standard and is recommended every 10 years. FIT is
recommended annually, and stool DNA testing is recommended every 3 years. The choice of
test depends on patient preference and risk factors.
13. A nurse is teaching a client about the warning signs of cancer. Which of the
following is a warning sign of cancer?
A. A change in bowel or bladder habits.
B. A sore that does not heal.
C. Unusual bleeding or discharge.
D. All of the above.
