ONS Chemotherapy Certification Exam
2026–2027 | Comprehensive 100-Question
Practice Test with Answers & Rationales|
Pdf Access Already Graded A+.
1. Which statement best describes the primary goal of antineoplastic chemotherapy?
A. Eliminate all rapidly dividing cells
B. Destroy or inhibit malignant cells while minimizing damage to normal tissues
C. Prevent all chemotherapy-related adverse effects
D. Stimulate bone marrow production
Answer: B
Rationale: Chemotherapy is intended to destroy or inhibit cancer cells while limiting injury to
healthy tissues. Because many normal cells also divide rapidly, adverse effects can occur.
2. A patient receiving cytotoxic chemotherapy asks why treatment is often given in cycles.
Which response is most appropriate?
A. "Cycles allow the cancer cells to become resistant."
B. "Cycles provide time for healthy tissues to recover between treatments."
C. "Cycles prevent chemotherapy from entering the bloodstream."
D. "Cycles eliminate the need for laboratory monitoring."
Answer: B
Rationale: Treatment cycles allow normal tissues, particularly bone marrow and gastrointestinal
tissues, to recover between doses while maintaining antitumor treatment intensity.
,3. Which laboratory value is most important before administering many cytotoxic
chemotherapy agents?
A. Hemoglobin A1c
B. Absolute neutrophil count
C. Serum amylase
D. Total bilirubin only
Answer: B
Rationale: The ANC helps determine the patient's ability to fight infection and whether
treatment may need to be delayed because of myelosuppression.
4. A patient receiving chemotherapy develops severe neutropenia. Which complication is the
priority concern?
A. Constipation
B. Infection
C. Alopecia
D. Taste changes
Answer: B
Rationale: Neutropenia significantly increases infection risk. Fever in a severely neutropenic
patient requires urgent evaluation.
5. Which mechanism is characteristic of many antimetabolite chemotherapy drugs?
A. They interfere with DNA or RNA synthesis.
B. They directly increase platelet production.
C. They permanently increase renal filtration.
D. They stimulate tumor blood-vessel formation.
Answer: A
Rationale: Antimetabolites interfere with metabolic pathways needed for nucleotide production
and DNA/RNA synthesis.
6. Which adverse effect is most commonly associated with chemotherapy-induced
myelosuppression?
,A. Neutropenia
B. Hypercalcemia
C. Cataracts
D. Hypertension
Answer: A
Rationale: Bone marrow suppression can produce neutropenia, anemia, and
thrombocytopenia. Neutropenia is a major infection risk.
7. A nurse is reviewing a chemotherapy order. Which finding requires clarification before
administration?
A. The patient's height and weight are documented.
B. The treatment cycle is documented.
C. The chemotherapy dose is missing.
D. The patient's allergy history is documented.
Answer: C
Rationale: A complete chemotherapy order should include the drug, dose, route, schedule, and
other required parameters. A missing dose must be clarified before administration.
8. Which patient characteristic is particularly important when calculating many chemotherapy
doses?
A. Hair color
B. Body surface area
C. Eye color
D. Marital status
Answer: B
Rationale: Many antineoplastic medications are dosed according to body surface area, although
dosing methods vary by medication and clinical circumstance.
9. Why are chemotherapy medication orders independently verified?
A. Chemotherapy medications have no significant risks.
B. Small errors can result in serious patient harm.
, C. Verification eliminates the need for patient identification.
D. Only pharmacy personnel need to know the dose.
Answer: B
Rationale: Antineoplastic drugs can have narrow therapeutic windows and serious toxicity.
Independent verification helps identify medication, dose, route, patient, and protocol errors.
10. Which nursing action is essential immediately before chemotherapy administration?
A. Confirm the patient's identity using approved identifiers.
B. Ask the patient to sign the medication label.
C. Skip assessment if the patient received chemotherapy previously.
D. Administer the drug before reviewing laboratory results.
Answer: A
Rationale: Correct patient identification is a fundamental medication-safety requirement and is
especially important for high-alert medications such as chemotherapy.
Questions 11–20: Safe Handling and Administration
11. Which personal protective equipment is generally appropriate when handling hazardous
antineoplastic medications?
A. No PPE if the medication is in a closed container
B. Appropriate chemotherapy-rated gloves and protective gown according to institutional policy
C. Cotton gloves only
D. Surgical mask only
Answer: B
Rationale: Hazardous drugs require appropriate PPE to reduce occupational exposure. Exact PPE
requirements depend on the drug, task, and institutional policy.
12. A chemotherapy solution spills on the floor. What should the nurse do first?
A. Wipe it up with a paper towel using bare hands.
B. Leave the area and allow another patient to walk through.
2026–2027 | Comprehensive 100-Question
Practice Test with Answers & Rationales|
Pdf Access Already Graded A+.
1. Which statement best describes the primary goal of antineoplastic chemotherapy?
A. Eliminate all rapidly dividing cells
B. Destroy or inhibit malignant cells while minimizing damage to normal tissues
C. Prevent all chemotherapy-related adverse effects
D. Stimulate bone marrow production
Answer: B
Rationale: Chemotherapy is intended to destroy or inhibit cancer cells while limiting injury to
healthy tissues. Because many normal cells also divide rapidly, adverse effects can occur.
2. A patient receiving cytotoxic chemotherapy asks why treatment is often given in cycles.
Which response is most appropriate?
A. "Cycles allow the cancer cells to become resistant."
B. "Cycles provide time for healthy tissues to recover between treatments."
C. "Cycles prevent chemotherapy from entering the bloodstream."
D. "Cycles eliminate the need for laboratory monitoring."
Answer: B
Rationale: Treatment cycles allow normal tissues, particularly bone marrow and gastrointestinal
tissues, to recover between doses while maintaining antitumor treatment intensity.
,3. Which laboratory value is most important before administering many cytotoxic
chemotherapy agents?
A. Hemoglobin A1c
B. Absolute neutrophil count
C. Serum amylase
D. Total bilirubin only
Answer: B
Rationale: The ANC helps determine the patient's ability to fight infection and whether
treatment may need to be delayed because of myelosuppression.
4. A patient receiving chemotherapy develops severe neutropenia. Which complication is the
priority concern?
A. Constipation
B. Infection
C. Alopecia
D. Taste changes
Answer: B
Rationale: Neutropenia significantly increases infection risk. Fever in a severely neutropenic
patient requires urgent evaluation.
5. Which mechanism is characteristic of many antimetabolite chemotherapy drugs?
A. They interfere with DNA or RNA synthesis.
B. They directly increase platelet production.
C. They permanently increase renal filtration.
D. They stimulate tumor blood-vessel formation.
Answer: A
Rationale: Antimetabolites interfere with metabolic pathways needed for nucleotide production
and DNA/RNA synthesis.
6. Which adverse effect is most commonly associated with chemotherapy-induced
myelosuppression?
,A. Neutropenia
B. Hypercalcemia
C. Cataracts
D. Hypertension
Answer: A
Rationale: Bone marrow suppression can produce neutropenia, anemia, and
thrombocytopenia. Neutropenia is a major infection risk.
7. A nurse is reviewing a chemotherapy order. Which finding requires clarification before
administration?
A. The patient's height and weight are documented.
B. The treatment cycle is documented.
C. The chemotherapy dose is missing.
D. The patient's allergy history is documented.
Answer: C
Rationale: A complete chemotherapy order should include the drug, dose, route, schedule, and
other required parameters. A missing dose must be clarified before administration.
8. Which patient characteristic is particularly important when calculating many chemotherapy
doses?
A. Hair color
B. Body surface area
C. Eye color
D. Marital status
Answer: B
Rationale: Many antineoplastic medications are dosed according to body surface area, although
dosing methods vary by medication and clinical circumstance.
9. Why are chemotherapy medication orders independently verified?
A. Chemotherapy medications have no significant risks.
B. Small errors can result in serious patient harm.
, C. Verification eliminates the need for patient identification.
D. Only pharmacy personnel need to know the dose.
Answer: B
Rationale: Antineoplastic drugs can have narrow therapeutic windows and serious toxicity.
Independent verification helps identify medication, dose, route, patient, and protocol errors.
10. Which nursing action is essential immediately before chemotherapy administration?
A. Confirm the patient's identity using approved identifiers.
B. Ask the patient to sign the medication label.
C. Skip assessment if the patient received chemotherapy previously.
D. Administer the drug before reviewing laboratory results.
Answer: A
Rationale: Correct patient identification is a fundamental medication-safety requirement and is
especially important for high-alert medications such as chemotherapy.
Questions 11–20: Safe Handling and Administration
11. Which personal protective equipment is generally appropriate when handling hazardous
antineoplastic medications?
A. No PPE if the medication is in a closed container
B. Appropriate chemotherapy-rated gloves and protective gown according to institutional policy
C. Cotton gloves only
D. Surgical mask only
Answer: B
Rationale: Hazardous drugs require appropriate PPE to reduce occupational exposure. Exact PPE
requirements depend on the drug, task, and institutional policy.
12. A chemotherapy solution spills on the floor. What should the nurse do first?
A. Wipe it up with a paper towel using bare hands.
B. Leave the area and allow another patient to walk through.
