FLORIDA BOARD OF NURSING ONCOLOGY
NURSING CERTIFICATION EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A client receiving chemotherapy with a vesicant medication
suddenly reports burning and pain at the peripheral IV site. The
nurse observes swelling and erythema around the catheter. What is
the nurse's priority action?
A. Slow the infusion and reassess the site in 15 minutes
B. Stop the infusion immediately while leaving the catheter in place
C. Remove the catheter immediately and apply a pressure dressing
D. Flush the catheter rapidly with normal saline
Answer: B. Stop the infusion immediately while leaving the catheter
in place
Rationale: Suspected extravasation of a vesicant is an oncologic
emergency. The infusion should be stopped immediately, but the
catheter should generally remain in place initially so that residual
medication can be aspirated and, when indicated, an antidote can be
administered through the existing access. Flushing can spread the
vesicant into surrounding tissue, and immediate catheter removal can
eliminate the route needed for aspiration and antidote administration.
2. A patient receiving intensive chemotherapy has an absolute
neutrophil count (ANC) of 350 cells/mm³. Which assessment finding
requires the most immediate nursing intervention?
1
,A. Mild fatigue after walking to the bathroom
B. Oral temperature of 38.3°C (100.9°F)
C. Decreased appetite for two days
D. Platelet count of 110,000/mm³
Answer: B. Oral temperature of 38.3°C (100.9°F)
Rationale: An ANC below 500 cells/mm³ represents severe
neutropenia, placing the patient at substantial risk for life-threatening
infection. Fever in a profoundly neutropenic patient is an emergency
requiring rapid evaluation and initiation of empiric antimicrobial
therapy according to institutional protocols. Waiting for additional
symptoms can allow sepsis to progress rapidly.
3. A patient receiving chemotherapy has a platelet count of
18,000/mm³. Which nursing intervention is most appropriate?
A. Encourage vigorous tooth brushing to prevent gingivitis
B. Administer aspirin for headache
C. Use a soft toothbrush and institute bleeding precautions
D. Encourage contact sports to maintain physical conditioning
Answer: C. Use a soft toothbrush and institute bleeding precautions
Rationale: Severe thrombocytopenia significantly increases the risk for
spontaneous bleeding. A soft toothbrush, avoidance of invasive
procedures when possible, prevention of falls and trauma, and
monitoring for overt or occult bleeding are appropriate. Aspirin and
vigorous brushing can increase bleeding risk.
4. A patient with metastatic cancer develops new confusion, muscle
weakness, constipation, and excessive thirst. Laboratory results
show a serum calcium level of 13.8 mg/dL. Which complication
should the nurse suspect?
2
,A. Tumor lysis syndrome
B. Hypercalcemia of malignancy
C. Disseminated intravascular coagulation
D. Syndrome of inappropriate antidiuretic hormone secretion
Answer: B. Hypercalcemia of malignancy
Rationale: Hypercalcemia of malignancy can produce neurologic
changes, weakness, constipation, polyuria, polydipsia, dehydration,
and cardiac dysrhythmias. It can result from tumor secretion of
parathyroid hormone-related peptide, osteolytic activity, or other
mechanisms. Severe hypercalcemia requires prompt treatment,
commonly including IV hydration and additional calcium-lowering
therapy.
5. A patient with small-cell lung cancer develops headache,
confusion, nausea, and a serum sodium concentration of 118 mEq/L.
Which complication is most likely?
A. Diabetes insipidus
B. Syndrome of inappropriate antidiuretic hormone secretion
C. Tumor lysis syndrome
D. Hyperaldosteronism
Answer: B. Syndrome of inappropriate antidiuretic hormone
secretion
Rationale: Small-cell lung cancer is strongly associated with SIADH.
Excess antidiuretic hormone causes water retention and dilutional
hyponatremia. Severe hyponatremia may cause headache, confusion,
seizures, and coma. Fluid restriction and carefully controlled
correction of sodium are commonly used, depending on severity and
clinical circumstances.
3
, 6. A patient with leukemia develops petechiae, oozing from
venipuncture sites, hematuria, and abnormal coagulation studies.
Which condition should the nurse suspect?
A. Disseminated intravascular coagulation
B. Iron-deficiency anemia
C. Hyperkalemia
D. Tumor lysis syndrome
Answer: A. Disseminated intravascular coagulation
Rationale: DIC involves widespread activation of coagulation with
consumption of platelets and clotting factors, resulting in both
thrombosis and bleeding. Patients may develop petechiae, ecchymoses,
bleeding from invasive sites, hematuria, gastrointestinal bleeding, and
abnormal coagulation results. DIC requires urgent treatment of the
underlying cause and supportive management.
7. A patient receiving chemotherapy develops potassium 6.7 mEq/L,
phosphorus 6.2 mg/dL, uric acid 10.5 mg/dL, and calcium 6.8
mg/dL. Which oncologic emergency is most consistent with these
findings?
A. SIADH
B. Tumor lysis syndrome
C. Hypercalcemia of malignancy
D. Superior vena cava syndrome
Answer: B. Tumor lysis syndrome
Rationale: Tumor lysis syndrome results from rapid destruction of
malignant cells, releasing intracellular potassium, phosphorus, and
nucleic acids. Nucleic acid metabolism increases uric acid, while
phosphorus binds calcium and can cause hypocalcemia. Severe TLS
can produce acute kidney injury, dysrhythmias, seizures, and death.
4
NURSING CERTIFICATION EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A client receiving chemotherapy with a vesicant medication
suddenly reports burning and pain at the peripheral IV site. The
nurse observes swelling and erythema around the catheter. What is
the nurse's priority action?
A. Slow the infusion and reassess the site in 15 minutes
B. Stop the infusion immediately while leaving the catheter in place
C. Remove the catheter immediately and apply a pressure dressing
D. Flush the catheter rapidly with normal saline
Answer: B. Stop the infusion immediately while leaving the catheter
in place
Rationale: Suspected extravasation of a vesicant is an oncologic
emergency. The infusion should be stopped immediately, but the
catheter should generally remain in place initially so that residual
medication can be aspirated and, when indicated, an antidote can be
administered through the existing access. Flushing can spread the
vesicant into surrounding tissue, and immediate catheter removal can
eliminate the route needed for aspiration and antidote administration.
2. A patient receiving intensive chemotherapy has an absolute
neutrophil count (ANC) of 350 cells/mm³. Which assessment finding
requires the most immediate nursing intervention?
1
,A. Mild fatigue after walking to the bathroom
B. Oral temperature of 38.3°C (100.9°F)
C. Decreased appetite for two days
D. Platelet count of 110,000/mm³
Answer: B. Oral temperature of 38.3°C (100.9°F)
Rationale: An ANC below 500 cells/mm³ represents severe
neutropenia, placing the patient at substantial risk for life-threatening
infection. Fever in a profoundly neutropenic patient is an emergency
requiring rapid evaluation and initiation of empiric antimicrobial
therapy according to institutional protocols. Waiting for additional
symptoms can allow sepsis to progress rapidly.
3. A patient receiving chemotherapy has a platelet count of
18,000/mm³. Which nursing intervention is most appropriate?
A. Encourage vigorous tooth brushing to prevent gingivitis
B. Administer aspirin for headache
C. Use a soft toothbrush and institute bleeding precautions
D. Encourage contact sports to maintain physical conditioning
Answer: C. Use a soft toothbrush and institute bleeding precautions
Rationale: Severe thrombocytopenia significantly increases the risk for
spontaneous bleeding. A soft toothbrush, avoidance of invasive
procedures when possible, prevention of falls and trauma, and
monitoring for overt or occult bleeding are appropriate. Aspirin and
vigorous brushing can increase bleeding risk.
4. A patient with metastatic cancer develops new confusion, muscle
weakness, constipation, and excessive thirst. Laboratory results
show a serum calcium level of 13.8 mg/dL. Which complication
should the nurse suspect?
2
,A. Tumor lysis syndrome
B. Hypercalcemia of malignancy
C. Disseminated intravascular coagulation
D. Syndrome of inappropriate antidiuretic hormone secretion
Answer: B. Hypercalcemia of malignancy
Rationale: Hypercalcemia of malignancy can produce neurologic
changes, weakness, constipation, polyuria, polydipsia, dehydration,
and cardiac dysrhythmias. It can result from tumor secretion of
parathyroid hormone-related peptide, osteolytic activity, or other
mechanisms. Severe hypercalcemia requires prompt treatment,
commonly including IV hydration and additional calcium-lowering
therapy.
5. A patient with small-cell lung cancer develops headache,
confusion, nausea, and a serum sodium concentration of 118 mEq/L.
Which complication is most likely?
A. Diabetes insipidus
B. Syndrome of inappropriate antidiuretic hormone secretion
C. Tumor lysis syndrome
D. Hyperaldosteronism
Answer: B. Syndrome of inappropriate antidiuretic hormone
secretion
Rationale: Small-cell lung cancer is strongly associated with SIADH.
Excess antidiuretic hormone causes water retention and dilutional
hyponatremia. Severe hyponatremia may cause headache, confusion,
seizures, and coma. Fluid restriction and carefully controlled
correction of sodium are commonly used, depending on severity and
clinical circumstances.
3
, 6. A patient with leukemia develops petechiae, oozing from
venipuncture sites, hematuria, and abnormal coagulation studies.
Which condition should the nurse suspect?
A. Disseminated intravascular coagulation
B. Iron-deficiency anemia
C. Hyperkalemia
D. Tumor lysis syndrome
Answer: A. Disseminated intravascular coagulation
Rationale: DIC involves widespread activation of coagulation with
consumption of platelets and clotting factors, resulting in both
thrombosis and bleeding. Patients may develop petechiae, ecchymoses,
bleeding from invasive sites, hematuria, gastrointestinal bleeding, and
abnormal coagulation results. DIC requires urgent treatment of the
underlying cause and supportive management.
7. A patient receiving chemotherapy develops potassium 6.7 mEq/L,
phosphorus 6.2 mg/dL, uric acid 10.5 mg/dL, and calcium 6.8
mg/dL. Which oncologic emergency is most consistent with these
findings?
A. SIADH
B. Tumor lysis syndrome
C. Hypercalcemia of malignancy
D. Superior vena cava syndrome
Answer: B. Tumor lysis syndrome
Rationale: Tumor lysis syndrome results from rapid destruction of
malignant cells, releasing intracellular potassium, phosphorus, and
nucleic acids. Nucleic acid metabolism increases uric acid, while
phosphorus binds calcium and can cause hypocalcemia. Severe TLS
can produce acute kidney injury, dysrhythmias, seizures, and death.
4
