ONS/ONCC Chemotherapy & Immunotherapy Certification
Review – 2025–2026 Antineoplastic agents, safety protocols,
immune-based therapies, toxicity recognition, and oncology
best practices.
Fundamentals & Safety Protocols (Questions 1-25)
1. What is the primary purpose of using a closed system transfer device (CTSD) when handling
hazardous drugs?
A) To speed up the drug preparation process
B) To reduce the risk of microbial contamination
C) To contain and prevent the escape of hazardous drug vapors and aerosols ✓
D) To make it easier to inject drugs into the IV bag
2. According to the OSHA Hazardous Drugs standard, which type of personal protective
equipment (PPE) is mandatory for administering vesicant chemotherapy?
A) Single gloves and a face mask
B) Double gloves, a disposable gown made of low-permeability fabric, and eye protection ✓
C) A single glove and a standard lab coat
D) Double gloves and a surgical mask
3. The first priority if a chemotherapeutic agent extravasates is to:
A) Apply a warm compress immediately
B) Stop the infusion immediately and disconnect the IV tubing (leaving the catheter in place) ✓
C) Increase the IV flow rate to dilute the agent
D) Administer the antidote as per protocol
4. Which of the following is the correct sequence for donning PPE?
A) Gown, mask, goggles, gloves
B) Gown, gloves, mask, goggles
C) Gown, mask/respirator, goggles, gloves ✓
D) Gloves, gown, mask, goggles
5. The most critical step in preventing medication errors during chemotherapy administration
is:
A) Having the patient state their name and date of birth
B) Independent double verification by two qualified clinicians ✓
,C) Checking the medication label against the MAR (Medication Administration Record) yourself
D) Confirming the patient's allergy status
6. A patient is scheduled to receive a chemotherapy regimen known to be highly emetogenic.
When should antiemetics be administered for maximum effect?
A) At the first sign of nausea, after the chemotherapy has started
B) 30 minutes after the chemotherapy infusion is complete
C) Prior to the administration of chemotherapy ✓
D) The night before chemotherapy is scheduled
7. Which organization's guidelines are considered the benchmark for safe handling of
hazardous drugs in the US?
A) The Joint Commission (TJC)
B) Centers for Disease Control and Prevention (CDC)
C) National Institute for Occupational Safety and Health (NIOSH) ✓
D) American Society of Clinical Oncology (ASCO)
8. The appropriate action for a small, non-acute spill of a hazardous drug on a countertop is
to:
A) Wipe it up with paper towels and dispose of them in the regular trash.
B) Use a commercial hazardous drug spill kit and follow the contained procedure. ✓
C) Flush the area with water and notify housekeeping.
D) Cover the spill with a cloth and alert the charge nurse.
9. Which of the following is the MOST reliable method for verifying a patient's identity before
administering chemotherapy?
A) Checking the name on the patient's wristband and the room number.
B) Asking the family member to confirm the patient's name.
C) Using two patient identifiers, such as name and date of birth, by comparing the MAR to the
patient's wristband. ✓
D) Recognizing the patient from previous visits.
10. The disposal of items used in the administration of hazardous drugs (e.g., gloves, IV
tubing, empty vials) should be in:
A) A regular biohazard bag.
B) A puncture-proof container labeled as trace chemotherapy waste. ✓
C) The regular trash can in the patient's room.
D) A sharps container.
,11. A patient develops facial flushing, a feeling of fullness, and chest tightness during a
paclitaxel infusion. Your first action should be to:
A) Slow the infusion rate and observe.
B) Stop the infusion immediately and maintain a patent IV line with normal saline. ✓
C) Administer PRN diphenhydramine and continue the infusion.
D) Reassure the patient that this is a common side effect.
12. The purpose of pre-medicating with corticosteroids before certain monoclonal antibodies
is primarily to:
A) Prevent alopecia
B) Reduce the risk of neutropenia
C) Prevent hypersensitivity reactions and infusion reactions ✓
D) Enhance the antitumor effect of the drug
13. Which laboratory value is most critical to check before administering a chemotherapy
agent known to cause profound myelosuppression?
A) Serum Creatinine
B) Alanine Aminotransferase (ALT)
C) Complete Blood Count (CBC) with differential ✓
D) Serum Magnesium
14. A nurse is compounding IV cyclophosphamide. In addition to double gloves and a gown,
what specific piece of respiratory PPE is required?
A) Surgical Mask
B) N95 Respirator
C) A NIOSH-approved ventilated cabinet (e.g., BSC or CACI) is the primary engineering control;
if not available, a respirator may be used per policy, but the cabinet is the standard. ✓
15. The "5 Rights" of medication safety include:
A) Right Patient, Right Drug, Right Dose, Right Route, Right Time ✓
B) Right Patient, Right Diagnosis, Right Dose, Right Route, Right Time
C) Right Patient, Right Drug, Right Dose, Right Room, Right Time
D) Right Patient, Right Drug, Right Dose, Right Route, Right Provider
16. Which vein site is generally PREFERRED for the administration of vesicant chemotherapy?
A) Dorsum of the hand
B) Wrist or antecubital fossa
C) A forearm vein with good blood flow ✓
D) Any site that is easy to access
, 17. The maximum time a peripheral IV site used for a vesicant should be left in place is
typically:
A) 24 hours ✓
B) 48 hours
C) 72 hours
D) Until the completion of the chemotherapy cycle
18. A patient calls the clinic 7 days after receiving FOLFOX chemotherapy reporting a
temperature of 101.5°F (38.6°C). This is a:
A) Non-urgent issue; advise Tylenol and call back if it persists.
B) A common side effect; reassure the patient.
C) A medical emergency; instruct the patient to go to the emergency room immediately. ✓
D) An expected reaction; schedule an appointment for next week.
19. The primary reason for using a 0.22-micron filter with some monoclonal antibodies (like
rituximab) is to:
A) Remove microbial contamination.
B) Remove particulate matter and protein aggregates that can form during storage. ✓
C) Slow the infusion rate to prevent reactions.
D) Enhance the potency of the drug.
20. Which of the following best describes the role of the oncology nurse in informed consent
for chemotherapy?
A) To obtain the signed consent form from the patient.
B) To explain the treatment plan and potential risks and benefits in detail.
C) To witness the patient's signature and verify the patient understood the discussion with the
provider. ✓
D) To ensure the patient agrees to all treatment recommendations.
21. A patient experiences an anaphylactic reaction during cetuximab infusion. After stopping
the infusion and calling for help, the nurse's next immediate action should be to:
A) Administer epinephrine as per protocol. ✓
B) Start a normal saline bolus.
C) Place the patient in Trendelenburg position.
D) Administer IV diphenhydramine.
22. The primary toxicities of anthracyclines (e.g., doxorubicin) that require lifetime dose
monitoring are:
A) Neuropathy and nephrotoxicity
B) Hemorrhagic cystitis and SIADH
Review – 2025–2026 Antineoplastic agents, safety protocols,
immune-based therapies, toxicity recognition, and oncology
best practices.
Fundamentals & Safety Protocols (Questions 1-25)
1. What is the primary purpose of using a closed system transfer device (CTSD) when handling
hazardous drugs?
A) To speed up the drug preparation process
B) To reduce the risk of microbial contamination
C) To contain and prevent the escape of hazardous drug vapors and aerosols ✓
D) To make it easier to inject drugs into the IV bag
2. According to the OSHA Hazardous Drugs standard, which type of personal protective
equipment (PPE) is mandatory for administering vesicant chemotherapy?
A) Single gloves and a face mask
B) Double gloves, a disposable gown made of low-permeability fabric, and eye protection ✓
C) A single glove and a standard lab coat
D) Double gloves and a surgical mask
3. The first priority if a chemotherapeutic agent extravasates is to:
A) Apply a warm compress immediately
B) Stop the infusion immediately and disconnect the IV tubing (leaving the catheter in place) ✓
C) Increase the IV flow rate to dilute the agent
D) Administer the antidote as per protocol
4. Which of the following is the correct sequence for donning PPE?
A) Gown, mask, goggles, gloves
B) Gown, gloves, mask, goggles
C) Gown, mask/respirator, goggles, gloves ✓
D) Gloves, gown, mask, goggles
5. The most critical step in preventing medication errors during chemotherapy administration
is:
A) Having the patient state their name and date of birth
B) Independent double verification by two qualified clinicians ✓
,C) Checking the medication label against the MAR (Medication Administration Record) yourself
D) Confirming the patient's allergy status
6. A patient is scheduled to receive a chemotherapy regimen known to be highly emetogenic.
When should antiemetics be administered for maximum effect?
A) At the first sign of nausea, after the chemotherapy has started
B) 30 minutes after the chemotherapy infusion is complete
C) Prior to the administration of chemotherapy ✓
D) The night before chemotherapy is scheduled
7. Which organization's guidelines are considered the benchmark for safe handling of
hazardous drugs in the US?
A) The Joint Commission (TJC)
B) Centers for Disease Control and Prevention (CDC)
C) National Institute for Occupational Safety and Health (NIOSH) ✓
D) American Society of Clinical Oncology (ASCO)
8. The appropriate action for a small, non-acute spill of a hazardous drug on a countertop is
to:
A) Wipe it up with paper towels and dispose of them in the regular trash.
B) Use a commercial hazardous drug spill kit and follow the contained procedure. ✓
C) Flush the area with water and notify housekeeping.
D) Cover the spill with a cloth and alert the charge nurse.
9. Which of the following is the MOST reliable method for verifying a patient's identity before
administering chemotherapy?
A) Checking the name on the patient's wristband and the room number.
B) Asking the family member to confirm the patient's name.
C) Using two patient identifiers, such as name and date of birth, by comparing the MAR to the
patient's wristband. ✓
D) Recognizing the patient from previous visits.
10. The disposal of items used in the administration of hazardous drugs (e.g., gloves, IV
tubing, empty vials) should be in:
A) A regular biohazard bag.
B) A puncture-proof container labeled as trace chemotherapy waste. ✓
C) The regular trash can in the patient's room.
D) A sharps container.
,11. A patient develops facial flushing, a feeling of fullness, and chest tightness during a
paclitaxel infusion. Your first action should be to:
A) Slow the infusion rate and observe.
B) Stop the infusion immediately and maintain a patent IV line with normal saline. ✓
C) Administer PRN diphenhydramine and continue the infusion.
D) Reassure the patient that this is a common side effect.
12. The purpose of pre-medicating with corticosteroids before certain monoclonal antibodies
is primarily to:
A) Prevent alopecia
B) Reduce the risk of neutropenia
C) Prevent hypersensitivity reactions and infusion reactions ✓
D) Enhance the antitumor effect of the drug
13. Which laboratory value is most critical to check before administering a chemotherapy
agent known to cause profound myelosuppression?
A) Serum Creatinine
B) Alanine Aminotransferase (ALT)
C) Complete Blood Count (CBC) with differential ✓
D) Serum Magnesium
14. A nurse is compounding IV cyclophosphamide. In addition to double gloves and a gown,
what specific piece of respiratory PPE is required?
A) Surgical Mask
B) N95 Respirator
C) A NIOSH-approved ventilated cabinet (e.g., BSC or CACI) is the primary engineering control;
if not available, a respirator may be used per policy, but the cabinet is the standard. ✓
15. The "5 Rights" of medication safety include:
A) Right Patient, Right Drug, Right Dose, Right Route, Right Time ✓
B) Right Patient, Right Diagnosis, Right Dose, Right Route, Right Time
C) Right Patient, Right Drug, Right Dose, Right Room, Right Time
D) Right Patient, Right Drug, Right Dose, Right Route, Right Provider
16. Which vein site is generally PREFERRED for the administration of vesicant chemotherapy?
A) Dorsum of the hand
B) Wrist or antecubital fossa
C) A forearm vein with good blood flow ✓
D) Any site that is easy to access
, 17. The maximum time a peripheral IV site used for a vesicant should be left in place is
typically:
A) 24 hours ✓
B) 48 hours
C) 72 hours
D) Until the completion of the chemotherapy cycle
18. A patient calls the clinic 7 days after receiving FOLFOX chemotherapy reporting a
temperature of 101.5°F (38.6°C). This is a:
A) Non-urgent issue; advise Tylenol and call back if it persists.
B) A common side effect; reassure the patient.
C) A medical emergency; instruct the patient to go to the emergency room immediately. ✓
D) An expected reaction; schedule an appointment for next week.
19. The primary reason for using a 0.22-micron filter with some monoclonal antibodies (like
rituximab) is to:
A) Remove microbial contamination.
B) Remove particulate matter and protein aggregates that can form during storage. ✓
C) Slow the infusion rate to prevent reactions.
D) Enhance the potency of the drug.
20. Which of the following best describes the role of the oncology nurse in informed consent
for chemotherapy?
A) To obtain the signed consent form from the patient.
B) To explain the treatment plan and potential risks and benefits in detail.
C) To witness the patient's signature and verify the patient understood the discussion with the
provider. ✓
D) To ensure the patient agrees to all treatment recommendations.
21. A patient experiences an anaphylactic reaction during cetuximab infusion. After stopping
the infusion and calling for help, the nurse's next immediate action should be to:
A) Administer epinephrine as per protocol. ✓
B) Start a normal saline bolus.
C) Place the patient in Trendelenburg position.
D) Administer IV diphenhydramine.
22. The primary toxicities of anthracyclines (e.g., doxorubicin) that require lifetime dose
monitoring are:
A) Neuropathy and nephrotoxicity
B) Hemorrhagic cystitis and SIADH
