1
FUNDAMENTALS OF CHEMOTHERAPY
IMMUNOTHERAPITY ADMINISTRATION FULL
PACKAGE QUESTIONS ANSWERS AND
RATIONALES 2026-27 LATEST UPDATED VERSION
INSTANT DOWNLOAD PDF..!!
INTRODUCTION
The Fundamentals of Chemotherapy Immunotherapy Administration Exam is a high-stakes
certification assessment administered by the Oncology Nursing Society (ONS) and the
Oncology Nursing Certification Corporation (ONCC) . This comprehensive examination
validates a nurse's foundational knowledge and clinical competence in administering
antineoplastic therapies, including both traditional chemotherapy agents and newer
immunotherapies . The exam is designed for registered nurses who administer these
complex therapies to patients with cancer and non-cancer diagnoses . Successful completion
of the course, including achieving a minimum score of 80% on the post-test, results in the
awarding of an ONS Provider Card, which is valid for two years and is often required before
RNs can independently administer chemotherapy or immunotherapy . This question bank
contains 150 advanced, exam-style questions that mirror the content, difficulty, and format
of the actual ONS Fundamentals exam . Each question includes a detailed rationale
explaining the correct answer and why other options are incorrect. With this resource, you
will identify knowledge gaps, build confidence, and develop the test-taking strategies
needed to pass the exam on your first attempt.
CORE DOMAINS TESTED
1. Cell Cycle and Pharmacology – Phases of the cell cycle (Interphase: G1, S, G2; Mitotic
phase: M; Cytokinesis) . Mechanisms of action: alkylating agents (DNA cross-linking),
antimetabolites (interfere with DNA/RNA synthesis in S phase), antitumor antibiotics
(intercalation, topoisomerase II inhibition), and targeted therapies .
2. Chemotherapy and Immunotherapy Agents – Classification, mechanism,
administration, and side effects of common agents: cyclophosphamide (alkylating,
hemorrhagic cystitis, mesna), cisplatin/carboplatin (platinum agents,
hypersensitivity), doxorubicin (anthracycline, cardiotoxicity, lifetime max 550 mg/m²,
dexrazoxane), bleomycin (pulmonary toxicity), 5-FU/capecitabine (hand-foot
syndrome), oxaliplatin (cold sensitivity), vincristine (IV piggyback via gravity), and
immunotherapy agents (checkpoint inhibitors, CAR T-cell therapy) .
,2
3. Safe Handling and Administration – PPE requirements, hazardous drug handling,
extravasation management, vesicant agents, and administration routes. Vincristine
must be administered via IV piggyback via gravity (ISMP recommendation) .
4. Adverse Effects and Symptom Management – Chemotherapy-induced nausea and
vomiting (CINV): acute (<24 hours), delayed (24 hours to 5 days), breakthrough,
anticipatory, and refractory . Emetogenicity classification: HEC (>90%), MEC (30-90%),
low (10-30%), minimal (<10%) . Myelosuppression (most common dose-limiting
toxicity), nadir (lowest blood counts, typically 7-10 days), neutropenic fever (101°F or
>100.4°F for >1 hour), thrombocytopenia, anemia, and hand-foot syndrome .
5. Immunotherapy and Targeted Therapies – Innate vs. adaptive immunity, immune-
related adverse events (irAEs), checkpoint inhibitors (PD-1, PD-L1, CTLA-4), CAR T-cell
therapy, and hormone therapies. Corticosteroids for irAE management .
6. Complications and Emergency Management – Hypersensitivity reactions (immediate
and delayed), infusion reactions, extravasation, tumor lysis syndrome, and oncologic
emergencies .
7. Treatment Goals and Terminology – Curative, control, palliative; neoadjuvant (pre-
surgery), adjuvant (post-surgery), conditioning/preparative therapy (for stem cell
transplant); dose density and dose intensity .
,3
QUESTIONS 1-100
Q1: Which phases of the cell cycle correctly describe the sequence
of events from the end of one division to the beginning of the next?
A) Mitosis, G1, S, G2
B) Interphase (G1, S, G2), Mitosis, Cytokinesis
C) G1, G2, S, Mitosis
D) Cytokinesis, Mitosis, G1, S
Rationale: The correct answer is B. The cell cycle consists of
interphase (G1, S, G2), mitotic phase, and cytokinesis . Interphase is
the period of growth and DNA replication, followed by mitosis
(nuclear division) and cytokinesis (cytoplasmic division).
Q2: A patient is receiving a chemotherapy regimen that includes an
antimetabolite. This agent is most likely to be most effective during
which phase of the cell cycle?
A) G1 phase
B) S phase
C) G2 phase
D) M phase
Rationale: The correct answer is B. Antimetabolites work by
interfering with enzymes needed for normal cell metabolism, blocking
DNA and RNA synthesis. They are cell cycle phase-specific and
primarily active during the S phase (synthesis phase) of the cell cycle .
Q3: A nurse is caring for a patient scheduled to receive neoadjuvant
chemotherapy. What is the primary purpose of this treatment?
A) To treat micrometastatic disease after surgery
B) To shrink the tumor before surgery
, 4
C) To prepare the patient for stem cell transplant
D) To relieve symptoms in advanced disease
Rationale: The correct answer is B. Neoadjuvant therapy is treatment
given prior to surgery to shrink the tumor . This may make the tumor
more resectable and can improve surgical outcomes. Adjuvant
therapy is given after primary treatment to lower the risk of
recurrence, conditioning therapy prepares for stem cell transplant,
and palliative therapy focuses on symptom relief.
Q4: A patient receiving carboplatin develops a hypersensitivity
reaction during a later dose of their treatment course. This reaction
is most commonly associated with:
A) The first dose of therapy
B) Late doses of carboplatin
C) Doses given with radiation
D) The use of IV premedication
Rationale: The correct answer is B. Hypersensitivity reactions can
occur with late doses of carboplatin . This is a well-documented
phenomenon where patients who have tolerated several cycles may
develop immune-mediated hypersensitivity. The mechanism is
thought to involve the development of antibodies to the platinum
agent.
Q5: A patient is receiving cyclophosphamide and the provider
orders mesna to be administered. What is the primary purpose of
mesna?
A) To prevent anaphylaxis
B) To reduce nausea and vomiting
C) To protect the bladder from hemorrhagic cystitis
D) To prevent cardiotoxicity
FUNDAMENTALS OF CHEMOTHERAPY
IMMUNOTHERAPITY ADMINISTRATION FULL
PACKAGE QUESTIONS ANSWERS AND
RATIONALES 2026-27 LATEST UPDATED VERSION
INSTANT DOWNLOAD PDF..!!
INTRODUCTION
The Fundamentals of Chemotherapy Immunotherapy Administration Exam is a high-stakes
certification assessment administered by the Oncology Nursing Society (ONS) and the
Oncology Nursing Certification Corporation (ONCC) . This comprehensive examination
validates a nurse's foundational knowledge and clinical competence in administering
antineoplastic therapies, including both traditional chemotherapy agents and newer
immunotherapies . The exam is designed for registered nurses who administer these
complex therapies to patients with cancer and non-cancer diagnoses . Successful completion
of the course, including achieving a minimum score of 80% on the post-test, results in the
awarding of an ONS Provider Card, which is valid for two years and is often required before
RNs can independently administer chemotherapy or immunotherapy . This question bank
contains 150 advanced, exam-style questions that mirror the content, difficulty, and format
of the actual ONS Fundamentals exam . Each question includes a detailed rationale
explaining the correct answer and why other options are incorrect. With this resource, you
will identify knowledge gaps, build confidence, and develop the test-taking strategies
needed to pass the exam on your first attempt.
CORE DOMAINS TESTED
1. Cell Cycle and Pharmacology – Phases of the cell cycle (Interphase: G1, S, G2; Mitotic
phase: M; Cytokinesis) . Mechanisms of action: alkylating agents (DNA cross-linking),
antimetabolites (interfere with DNA/RNA synthesis in S phase), antitumor antibiotics
(intercalation, topoisomerase II inhibition), and targeted therapies .
2. Chemotherapy and Immunotherapy Agents – Classification, mechanism,
administration, and side effects of common agents: cyclophosphamide (alkylating,
hemorrhagic cystitis, mesna), cisplatin/carboplatin (platinum agents,
hypersensitivity), doxorubicin (anthracycline, cardiotoxicity, lifetime max 550 mg/m²,
dexrazoxane), bleomycin (pulmonary toxicity), 5-FU/capecitabine (hand-foot
syndrome), oxaliplatin (cold sensitivity), vincristine (IV piggyback via gravity), and
immunotherapy agents (checkpoint inhibitors, CAR T-cell therapy) .
,2
3. Safe Handling and Administration – PPE requirements, hazardous drug handling,
extravasation management, vesicant agents, and administration routes. Vincristine
must be administered via IV piggyback via gravity (ISMP recommendation) .
4. Adverse Effects and Symptom Management – Chemotherapy-induced nausea and
vomiting (CINV): acute (<24 hours), delayed (24 hours to 5 days), breakthrough,
anticipatory, and refractory . Emetogenicity classification: HEC (>90%), MEC (30-90%),
low (10-30%), minimal (<10%) . Myelosuppression (most common dose-limiting
toxicity), nadir (lowest blood counts, typically 7-10 days), neutropenic fever (101°F or
>100.4°F for >1 hour), thrombocytopenia, anemia, and hand-foot syndrome .
5. Immunotherapy and Targeted Therapies – Innate vs. adaptive immunity, immune-
related adverse events (irAEs), checkpoint inhibitors (PD-1, PD-L1, CTLA-4), CAR T-cell
therapy, and hormone therapies. Corticosteroids for irAE management .
6. Complications and Emergency Management – Hypersensitivity reactions (immediate
and delayed), infusion reactions, extravasation, tumor lysis syndrome, and oncologic
emergencies .
7. Treatment Goals and Terminology – Curative, control, palliative; neoadjuvant (pre-
surgery), adjuvant (post-surgery), conditioning/preparative therapy (for stem cell
transplant); dose density and dose intensity .
,3
QUESTIONS 1-100
Q1: Which phases of the cell cycle correctly describe the sequence
of events from the end of one division to the beginning of the next?
A) Mitosis, G1, S, G2
B) Interphase (G1, S, G2), Mitosis, Cytokinesis
C) G1, G2, S, Mitosis
D) Cytokinesis, Mitosis, G1, S
Rationale: The correct answer is B. The cell cycle consists of
interphase (G1, S, G2), mitotic phase, and cytokinesis . Interphase is
the period of growth and DNA replication, followed by mitosis
(nuclear division) and cytokinesis (cytoplasmic division).
Q2: A patient is receiving a chemotherapy regimen that includes an
antimetabolite. This agent is most likely to be most effective during
which phase of the cell cycle?
A) G1 phase
B) S phase
C) G2 phase
D) M phase
Rationale: The correct answer is B. Antimetabolites work by
interfering with enzymes needed for normal cell metabolism, blocking
DNA and RNA synthesis. They are cell cycle phase-specific and
primarily active during the S phase (synthesis phase) of the cell cycle .
Q3: A nurse is caring for a patient scheduled to receive neoadjuvant
chemotherapy. What is the primary purpose of this treatment?
A) To treat micrometastatic disease after surgery
B) To shrink the tumor before surgery
, 4
C) To prepare the patient for stem cell transplant
D) To relieve symptoms in advanced disease
Rationale: The correct answer is B. Neoadjuvant therapy is treatment
given prior to surgery to shrink the tumor . This may make the tumor
more resectable and can improve surgical outcomes. Adjuvant
therapy is given after primary treatment to lower the risk of
recurrence, conditioning therapy prepares for stem cell transplant,
and palliative therapy focuses on symptom relief.
Q4: A patient receiving carboplatin develops a hypersensitivity
reaction during a later dose of their treatment course. This reaction
is most commonly associated with:
A) The first dose of therapy
B) Late doses of carboplatin
C) Doses given with radiation
D) The use of IV premedication
Rationale: The correct answer is B. Hypersensitivity reactions can
occur with late doses of carboplatin . This is a well-documented
phenomenon where patients who have tolerated several cycles may
develop immune-mediated hypersensitivity. The mechanism is
thought to involve the development of antibodies to the platinum
agent.
Q5: A patient is receiving cyclophosphamide and the provider
orders mesna to be administered. What is the primary purpose of
mesna?
A) To prevent anaphylaxis
B) To reduce nausea and vomiting
C) To protect the bladder from hemorrhagic cystitis
D) To prevent cardiotoxicity
