This is Part 1 of the OCN (Oncology
Certified Nurse) Exam 7th Edition
Comprehensive Test Bank by the
Oncology Nursing Society.
Table of Contents:
- Chapter 1: Cancer Pathophysiology and Etiology — Questions 1–10
- Chapter 2: Treatment Modalities and Nursing Implications — Questions 11–20
- Chapter 3: Symptom Management and Supportive Care — Questions 21–30
- Chapter 4: Oncologic Emergencies — Questions 31–40
- Chapter 5: Psychosocial and Palliative Care — Questions 41–50
Q1. A client receiving chemotherapy has an absolute neutrophil count (ANC) of 450/mm3. Which
action should the nurse take?
A. Place the client in a private room and implement neutropenic precautions
B. Encourage the client to eat fresh fruits and vegetables
C. Administer the next dose of chemotherapy as scheduled
D. Obtain a blood culture to rule out infection
Correct Answer: Place the client in a private room and implement neutropenic precautions ✅
Rationale: An absolute neutrophil count (ANC) below 500/mm3 indicates severe
neutropenia, placing the client at high risk for life-threatening infection. The nurse should place the
client in a private room and implement neutropenic precautions, which include strict hand hygiene,
avoiding fresh flowers and plants, and restricting visitors who are ill. Option B is incorrect because
fresh fruits and vegetables may harbor bacteria and should be avoided in severely neutropenic
clients; cooked or canned foods are safer alternatives. Option C is incorrect because chemotherapy
may need to be delayed or the dose reduced when the ANC is critically low, depending on the
treatment protocol and provider orders. Option D is incorrect because blood cultures are obtained
only if there is clinical suspicion of infection, not as a routine precaution. The key concept is that
nurses must recognize the significance of severe neutropenia and implement appropriate protective
,measures to prevent infection. Client education on infection prevention is essential. Documentation
of the ANC and interventions is critical for continuity of care and safety.
Q2. A nurse is administering intravenous chemotherapy to a client. The client reports pain and
burning at the infusion site. Which action should the nurse take first?
A. Stop the infusion immediately
B. Apply a warm compress to the site
C. Aspirate the remaining medication from the tubing
D. Notify the provider
Correct Answer: Stop the infusion immediately ✅
Rationale: Pain and burning at the infusion site during intravenous chemotherapy
administration suggest extravasation, which is the leakage of vesicant medication into surrounding
tissues. The first action is to stop the infusion immediately to prevent further tissue damage. Option
B is incorrect because applying a warm compress is not the first action and may worsen the injury
depending on the medication; specific antidotes and compresses are used based on the vesicant.
Option C is incorrect because aspirating the remaining medication is not the first action and may
cause further tissue damage. Option D is incorrect because the nurse should first stop the infusion
before notifying the provider. The key concept is that extravasation is a medical emergency requiring
prompt intervention. The nurse should stop the infusion, leave the IV catheter in place, aspirate any
remaining medication if protocol permits, and notify the provider immediately. Documentation of
the event and interventions is essential. The nurse should also apply appropriate compresses and
antidotes based on the specific vesicant. Client education on reporting symptoms during infusion is
critical for early detection.
Q3. Which of the following is the most common site of metastasis for breast cancer?
A. Bone
B. Liver
C. Lung
D. Brain
Correct Answer: Bone ✅
,Rationale: The most common site of metastasis for breast cancer is the bone, followed by
the liver, lung, and brain. Bone metastases can cause pain, pathologic fractures, hypercalcemia, and
spinal cord compression. Option B is incorrect because the liver is a common site but not the most
common. Option C is incorrect because the lung is a common site but not the most common. Option
D is incorrect because the brain is a less common site of metastasis. The key concept is that nurses
must be aware of the common sites of metastasis for different cancer types to monitor for signs and
symptoms. For breast cancer, bone pain, fractures, and hypercalcemia are important assessment
findings. Nurses should educate clients on reporting new or worsening pain. Documentation of
assessment findings and interventions is essential for continuity of care.
Q4. A client with cancer is receiving radiation therapy. Which instruction should the nurse include in
the teaching?
A. "You should avoid washing the treated area with soap and water."
B. "You should apply a heating pad to the treated area for comfort."
C. "You should expose the treated area to sunlight to promote healing."
D. "You should use a mild moisturizer on the treated area."
Correct Answer: "You should avoid washing the treated area with soap and water." ✅
Rationale: During radiation therapy, the treated area should be gently cleansed with
lukewarm water and patted dry, without soap, because soap can remove the radiation markings and
irritate the skin. Option B is incorrect because heating pads should not be used on the treated area
as they can cause burns and worsen skin reactions. Option C is incorrect because the treated area
should be protected from sunlight and extreme temperatures. Option D is incorrect because
moisturizers should only be used if approved by the radiation oncologist; some products can
interfere with treatment or worsen skin reactions. The key concept is that nurses must educate
clients on proper skin care during radiation therapy to minimize skin reactions and prevent
complications. Clients should avoid tight clothing, harsh chemicals, and extreme temperatures.
Documentation of the teaching session is essential for continuity of care.
Q5. A nurse is assessing a client who is 5 days post-chemotherapy. Which finding is most concerning
for sepsis?
A. Temperature of 38.3 degrees C (101 degrees F)
B. White blood cell count of 3,000/mm3
C. Mild fatigue
D. Nausea and vomiting
, Correct Answer: Temperature of 38.3 degrees C (101 degrees F) ✅
Rationale: A temperature of 38.3 degrees C or higher in a client who is 5 days post-
chemotherapy is concerning for sepsis because the client is likely neutropenic during this time.
Neutropenic sepsis is a life-threatening emergency requiring immediate intervention. Option B is
incorrect because a white blood cell count of 3,000/mm3 may be low but does not by itself indicate
sepsis; the ANC is more specific. Option C is incorrect because mild fatigue is a common side effect of
chemotherapy and not specific to sepsis. Option D is incorrect because nausea and vomiting are
common side effects and not specific to sepsis. The key concept is that nurses must recognize the
signs of neutropenic sepsis and act quickly. The client should be evaluated immediately with a
complete blood count, blood cultures, and broad-spectrum antibiotics. Documentation of the
assessment and interventions is critical for continuity of care and quality improvement.
Q6. Which of the following is a risk factor for the development of oral mucositis in a client receiving
chemotherapy?
A. Poor oral hygiene
B. High fluid intake
C. Frequent use of mouthwash
D. Adequate nutrition
Correct Answer: Poor oral hygiene ✅
Rationale: Poor oral hygiene is a significant risk factor for the development of oral mucositis
because it allows bacteria to proliferate and worsens the inflammatory response. Option B is
incorrect because high fluid intake may actually help maintain oral moisture and reduce the severity
of mucositis. Option C is incorrect because frequent use of alcohol-containing mouthwash can
worsen mucositis, but non-alcohol mouthwash may be helpful. Option D is incorrect because
adequate nutrition supports tissue healing and may reduce the risk of mucositis. The key concept is
that nurses must assess oral hygiene practices and educate clients on proper oral care during
chemotherapy. Clients should use a soft-bristled toothbrush, avoid alcohol-based mouthwashes, and
rinse with saline or sodium bicarbonate solutions. Documentation of the assessment and
interventions is essential for continuity of care. Early intervention can prevent severe mucositis and
its complications.
Q7. A nurse is caring for a client with tumor lysis syndrome. Which laboratory finding is most
characteristic of this condition?
A. Hyperkalemia
Certified Nurse) Exam 7th Edition
Comprehensive Test Bank by the
Oncology Nursing Society.
Table of Contents:
- Chapter 1: Cancer Pathophysiology and Etiology — Questions 1–10
- Chapter 2: Treatment Modalities and Nursing Implications — Questions 11–20
- Chapter 3: Symptom Management and Supportive Care — Questions 21–30
- Chapter 4: Oncologic Emergencies — Questions 31–40
- Chapter 5: Psychosocial and Palliative Care — Questions 41–50
Q1. A client receiving chemotherapy has an absolute neutrophil count (ANC) of 450/mm3. Which
action should the nurse take?
A. Place the client in a private room and implement neutropenic precautions
B. Encourage the client to eat fresh fruits and vegetables
C. Administer the next dose of chemotherapy as scheduled
D. Obtain a blood culture to rule out infection
Correct Answer: Place the client in a private room and implement neutropenic precautions ✅
Rationale: An absolute neutrophil count (ANC) below 500/mm3 indicates severe
neutropenia, placing the client at high risk for life-threatening infection. The nurse should place the
client in a private room and implement neutropenic precautions, which include strict hand hygiene,
avoiding fresh flowers and plants, and restricting visitors who are ill. Option B is incorrect because
fresh fruits and vegetables may harbor bacteria and should be avoided in severely neutropenic
clients; cooked or canned foods are safer alternatives. Option C is incorrect because chemotherapy
may need to be delayed or the dose reduced when the ANC is critically low, depending on the
treatment protocol and provider orders. Option D is incorrect because blood cultures are obtained
only if there is clinical suspicion of infection, not as a routine precaution. The key concept is that
nurses must recognize the significance of severe neutropenia and implement appropriate protective
,measures to prevent infection. Client education on infection prevention is essential. Documentation
of the ANC and interventions is critical for continuity of care and safety.
Q2. A nurse is administering intravenous chemotherapy to a client. The client reports pain and
burning at the infusion site. Which action should the nurse take first?
A. Stop the infusion immediately
B. Apply a warm compress to the site
C. Aspirate the remaining medication from the tubing
D. Notify the provider
Correct Answer: Stop the infusion immediately ✅
Rationale: Pain and burning at the infusion site during intravenous chemotherapy
administration suggest extravasation, which is the leakage of vesicant medication into surrounding
tissues. The first action is to stop the infusion immediately to prevent further tissue damage. Option
B is incorrect because applying a warm compress is not the first action and may worsen the injury
depending on the medication; specific antidotes and compresses are used based on the vesicant.
Option C is incorrect because aspirating the remaining medication is not the first action and may
cause further tissue damage. Option D is incorrect because the nurse should first stop the infusion
before notifying the provider. The key concept is that extravasation is a medical emergency requiring
prompt intervention. The nurse should stop the infusion, leave the IV catheter in place, aspirate any
remaining medication if protocol permits, and notify the provider immediately. Documentation of
the event and interventions is essential. The nurse should also apply appropriate compresses and
antidotes based on the specific vesicant. Client education on reporting symptoms during infusion is
critical for early detection.
Q3. Which of the following is the most common site of metastasis for breast cancer?
A. Bone
B. Liver
C. Lung
D. Brain
Correct Answer: Bone ✅
,Rationale: The most common site of metastasis for breast cancer is the bone, followed by
the liver, lung, and brain. Bone metastases can cause pain, pathologic fractures, hypercalcemia, and
spinal cord compression. Option B is incorrect because the liver is a common site but not the most
common. Option C is incorrect because the lung is a common site but not the most common. Option
D is incorrect because the brain is a less common site of metastasis. The key concept is that nurses
must be aware of the common sites of metastasis for different cancer types to monitor for signs and
symptoms. For breast cancer, bone pain, fractures, and hypercalcemia are important assessment
findings. Nurses should educate clients on reporting new or worsening pain. Documentation of
assessment findings and interventions is essential for continuity of care.
Q4. A client with cancer is receiving radiation therapy. Which instruction should the nurse include in
the teaching?
A. "You should avoid washing the treated area with soap and water."
B. "You should apply a heating pad to the treated area for comfort."
C. "You should expose the treated area to sunlight to promote healing."
D. "You should use a mild moisturizer on the treated area."
Correct Answer: "You should avoid washing the treated area with soap and water." ✅
Rationale: During radiation therapy, the treated area should be gently cleansed with
lukewarm water and patted dry, without soap, because soap can remove the radiation markings and
irritate the skin. Option B is incorrect because heating pads should not be used on the treated area
as they can cause burns and worsen skin reactions. Option C is incorrect because the treated area
should be protected from sunlight and extreme temperatures. Option D is incorrect because
moisturizers should only be used if approved by the radiation oncologist; some products can
interfere with treatment or worsen skin reactions. The key concept is that nurses must educate
clients on proper skin care during radiation therapy to minimize skin reactions and prevent
complications. Clients should avoid tight clothing, harsh chemicals, and extreme temperatures.
Documentation of the teaching session is essential for continuity of care.
Q5. A nurse is assessing a client who is 5 days post-chemotherapy. Which finding is most concerning
for sepsis?
A. Temperature of 38.3 degrees C (101 degrees F)
B. White blood cell count of 3,000/mm3
C. Mild fatigue
D. Nausea and vomiting
, Correct Answer: Temperature of 38.3 degrees C (101 degrees F) ✅
Rationale: A temperature of 38.3 degrees C or higher in a client who is 5 days post-
chemotherapy is concerning for sepsis because the client is likely neutropenic during this time.
Neutropenic sepsis is a life-threatening emergency requiring immediate intervention. Option B is
incorrect because a white blood cell count of 3,000/mm3 may be low but does not by itself indicate
sepsis; the ANC is more specific. Option C is incorrect because mild fatigue is a common side effect of
chemotherapy and not specific to sepsis. Option D is incorrect because nausea and vomiting are
common side effects and not specific to sepsis. The key concept is that nurses must recognize the
signs of neutropenic sepsis and act quickly. The client should be evaluated immediately with a
complete blood count, blood cultures, and broad-spectrum antibiotics. Documentation of the
assessment and interventions is critical for continuity of care and quality improvement.
Q6. Which of the following is a risk factor for the development of oral mucositis in a client receiving
chemotherapy?
A. Poor oral hygiene
B. High fluid intake
C. Frequent use of mouthwash
D. Adequate nutrition
Correct Answer: Poor oral hygiene ✅
Rationale: Poor oral hygiene is a significant risk factor for the development of oral mucositis
because it allows bacteria to proliferate and worsens the inflammatory response. Option B is
incorrect because high fluid intake may actually help maintain oral moisture and reduce the severity
of mucositis. Option C is incorrect because frequent use of alcohol-containing mouthwash can
worsen mucositis, but non-alcohol mouthwash may be helpful. Option D is incorrect because
adequate nutrition supports tissue healing and may reduce the risk of mucositis. The key concept is
that nurses must assess oral hygiene practices and educate clients on proper oral care during
chemotherapy. Clients should use a soft-bristled toothbrush, avoid alcohol-based mouthwashes, and
rinse with saline or sodium bicarbonate solutions. Documentation of the assessment and
interventions is essential for continuity of care. Early intervention can prevent severe mucositis and
its complications.
Q7. A nurse is caring for a client with tumor lysis syndrome. Which laboratory finding is most
characteristic of this condition?
A. Hyperkalemia
