ONS CHEMOTHERAPY BIOTHERAPY
CERTIFICATION 2025/26 UPDATED QUESTIONS
WITH COMPLETE ANSWERS RATED TO PASS!!
Introduction
This 80-item examination mirrors the length and cognitive scope of the 2025-2026 ONS
Chemotherapy/Biotherapy Certificate final assessment. Domains span safe
handling/preparation, administration procedures, toxicity management, patient
education, regulatory standards, biotherapy/immunotherapy, and emergency care. All
items are original, board-style, and aligned with the most recent ONS standards, NIOSH
advisories, and FDA drug-label updates for mastery-level performance.
Question 1
A 58-year-old female with metastatic breast cancer is scheduled for her first dose of IV
trastuzumab. Which pre-infusion assessment is MOST critical for safe administration?
A. Baseline left-ventricular ejection fraction (LVEF)
B. 24-hour dietary recall
C. Bone-density scan
D. Pulmonary-function test
Answer: A. Baseline left-ventricular ejection fraction (LVEF)
Solution: Trastuzumab carries a boxed warning for cardiomyopathy; current ONS
guidelines require documented LVEF ≤ 50 % before initiation. Dietary recall (B) is
irrelevant; DEXA (C) and PFTs (D) are not mandated.
Question 2
During doxorubicin infusion the nurse notes a 3 cm area of erythema and swelling at the
IV site. The patient reports stinging. The FIRST action is:
A. Slow the infusion rate
B. Stop the infusion immediately
C. Apply warm compresses
D. Administer hydrocortisone IV
Answer: B. Stop the infusion immediately
Solution: Classic signs of extravasation—stop drug, leave cannula, aspirate, initiate
antidote protocol. Slowing (A) worsens tissue exposure; compresses (C) and steroids
(D) follow only after infusion is halted.
pg. 1
,Question 3
A patient receiving cisplatin 80 mg/m² is to be pre-medicated to prevent nephrotoxicity.
Which regimen is evidence-based?
A. Amifostine 910 mg/m² IV 30 min before cisplatin
B. Mannitol 20 g IV push after cisplatin
C. Normal saline 2–3 L over 6 h pre- and post-cisplatin
D. Furosemide 40 mg PO BID × 3 days
Answer: C. Normal saline 2–3 L over 6 h pre- and post-cisplatin
Solution: Vigorous hydration remains the gold-standard nephro-protectant. Amifostine
(A) is no longer recommended for routine renal protection; mannitol (B) and
furosemide (D) do not reduce nephrotoxicity risk.
Question 4
Which statement complies with 2025 NIOSH safe-handling standards for oral anticancer
drugs?
A. Tablets may be crushed if the patient has dysphagia
B. Staff should wear chemo gloves when counting tablets
C. Patients may split tablets at home with a kitchen knife
D. Unit-dose packages need no special disposal
Answer: B. Staff should wear chemo gloves when counting tablets
Solution: NIOSH 2025 requires double gloving and counting under ventilated hood.
Crushing (A) creates aerosol hazard; home splitting (C) is prohibited; all packaging (D)
is trace chemo waste.
Question 5
A patient on 5-FU develops intractable vomiting and watery diarrhea within 48 h. WBC
is 0.8 × 10⁹/L. The probable diagnosis is:
A. 5-FU cardiotoxicity
B. Chemotherapy-induced nausea and vomiting (CINV)
C. Grade 4 neutropenic colitis (typhlitis)
D. Radiation recall
Answer: C. Grade 4 neutropenic colitis (typhlitis)
Solution: Severe cytopenia + GI symptoms = neutropenic enterocolitis, a life-
threatening 5-FU toxicity. CINV (B) does not cause diarrhea; cardiotoxicity (A) presents
chest pain; recall (D) needs prior radiation.
pg. 2
, Question 6
A 0.22 µm inline filter is used during which infusion?
A. Etoposide
B. Paclitaxel
C. Carboplatin
D. Cyclophosphamide
Answer: B. Paclitaxel
Solution: Paclitaxel vehicle (Cremophor EL) requires a 0.22 µm NON-DEHP filter to
remove micelles. Etoposide (A) and platinum drugs (C) use 0.2 µm DEHP-compatible
filters; cyclophosphamide (D) has no micelle issue.
Question 7
Which biotherapy agent is MOST associated with cytokine-release syndrome (CRS)
within the first 2 hours of infusion?
A. Rituximab
B. Trastuzumab
C. Bevacizumab
D. Pembrolizumab
Answer: A. Rituximab
Solution: Rituximab carries the highest CRS incidence, especially during cycle 1.
Trastuzumab (B) and bevacizumab (C) rarely cause CRS; pembrolizumab (D) immune-
related adverse events are delayed.
Question 8
A patient receives high-dose methotrexate 12 g/m². Which rescue agent and target lab
value are correct?
A. Leucovorin 15 mg PO q6h until MTX level < 0.1 µM
B. Glucarpidase 1,000 units IV if MTX > 1 µM at 48 h
C. Folic acid 1 mg daily until creatinine normalizes
D. Leucovorin 50 mg IV q6h until MTX < 0.05 µM
Answer: D. Leucovorin 50 mg IV q6h until MTX < 0.05 µM
Solution: Standard rescue is IV leucovorin 50 mg q6h, titrated to renal function, until
plasma MTX < 0.05 µM. Glucarpidase (B) is for > 5 µM or renal failure; leucovorin 15 mg
(A) is under-dosed.
pg. 3
CERTIFICATION 2025/26 UPDATED QUESTIONS
WITH COMPLETE ANSWERS RATED TO PASS!!
Introduction
This 80-item examination mirrors the length and cognitive scope of the 2025-2026 ONS
Chemotherapy/Biotherapy Certificate final assessment. Domains span safe
handling/preparation, administration procedures, toxicity management, patient
education, regulatory standards, biotherapy/immunotherapy, and emergency care. All
items are original, board-style, and aligned with the most recent ONS standards, NIOSH
advisories, and FDA drug-label updates for mastery-level performance.
Question 1
A 58-year-old female with metastatic breast cancer is scheduled for her first dose of IV
trastuzumab. Which pre-infusion assessment is MOST critical for safe administration?
A. Baseline left-ventricular ejection fraction (LVEF)
B. 24-hour dietary recall
C. Bone-density scan
D. Pulmonary-function test
Answer: A. Baseline left-ventricular ejection fraction (LVEF)
Solution: Trastuzumab carries a boxed warning for cardiomyopathy; current ONS
guidelines require documented LVEF ≤ 50 % before initiation. Dietary recall (B) is
irrelevant; DEXA (C) and PFTs (D) are not mandated.
Question 2
During doxorubicin infusion the nurse notes a 3 cm area of erythema and swelling at the
IV site. The patient reports stinging. The FIRST action is:
A. Slow the infusion rate
B. Stop the infusion immediately
C. Apply warm compresses
D. Administer hydrocortisone IV
Answer: B. Stop the infusion immediately
Solution: Classic signs of extravasation—stop drug, leave cannula, aspirate, initiate
antidote protocol. Slowing (A) worsens tissue exposure; compresses (C) and steroids
(D) follow only after infusion is halted.
pg. 1
,Question 3
A patient receiving cisplatin 80 mg/m² is to be pre-medicated to prevent nephrotoxicity.
Which regimen is evidence-based?
A. Amifostine 910 mg/m² IV 30 min before cisplatin
B. Mannitol 20 g IV push after cisplatin
C. Normal saline 2–3 L over 6 h pre- and post-cisplatin
D. Furosemide 40 mg PO BID × 3 days
Answer: C. Normal saline 2–3 L over 6 h pre- and post-cisplatin
Solution: Vigorous hydration remains the gold-standard nephro-protectant. Amifostine
(A) is no longer recommended for routine renal protection; mannitol (B) and
furosemide (D) do not reduce nephrotoxicity risk.
Question 4
Which statement complies with 2025 NIOSH safe-handling standards for oral anticancer
drugs?
A. Tablets may be crushed if the patient has dysphagia
B. Staff should wear chemo gloves when counting tablets
C. Patients may split tablets at home with a kitchen knife
D. Unit-dose packages need no special disposal
Answer: B. Staff should wear chemo gloves when counting tablets
Solution: NIOSH 2025 requires double gloving and counting under ventilated hood.
Crushing (A) creates aerosol hazard; home splitting (C) is prohibited; all packaging (D)
is trace chemo waste.
Question 5
A patient on 5-FU develops intractable vomiting and watery diarrhea within 48 h. WBC
is 0.8 × 10⁹/L. The probable diagnosis is:
A. 5-FU cardiotoxicity
B. Chemotherapy-induced nausea and vomiting (CINV)
C. Grade 4 neutropenic colitis (typhlitis)
D. Radiation recall
Answer: C. Grade 4 neutropenic colitis (typhlitis)
Solution: Severe cytopenia + GI symptoms = neutropenic enterocolitis, a life-
threatening 5-FU toxicity. CINV (B) does not cause diarrhea; cardiotoxicity (A) presents
chest pain; recall (D) needs prior radiation.
pg. 2
, Question 6
A 0.22 µm inline filter is used during which infusion?
A. Etoposide
B. Paclitaxel
C. Carboplatin
D. Cyclophosphamide
Answer: B. Paclitaxel
Solution: Paclitaxel vehicle (Cremophor EL) requires a 0.22 µm NON-DEHP filter to
remove micelles. Etoposide (A) and platinum drugs (C) use 0.2 µm DEHP-compatible
filters; cyclophosphamide (D) has no micelle issue.
Question 7
Which biotherapy agent is MOST associated with cytokine-release syndrome (CRS)
within the first 2 hours of infusion?
A. Rituximab
B. Trastuzumab
C. Bevacizumab
D. Pembrolizumab
Answer: A. Rituximab
Solution: Rituximab carries the highest CRS incidence, especially during cycle 1.
Trastuzumab (B) and bevacizumab (C) rarely cause CRS; pembrolizumab (D) immune-
related adverse events are delayed.
Question 8
A patient receives high-dose methotrexate 12 g/m². Which rescue agent and target lab
value are correct?
A. Leucovorin 15 mg PO q6h until MTX level < 0.1 µM
B. Glucarpidase 1,000 units IV if MTX > 1 µM at 48 h
C. Folic acid 1 mg daily until creatinine normalizes
D. Leucovorin 50 mg IV q6h until MTX < 0.05 µM
Answer: D. Leucovorin 50 mg IV q6h until MTX < 0.05 µM
Solution: Standard rescue is IV leucovorin 50 mg q6h, titrated to renal function, until
plasma MTX < 0.05 µM. Glucarpidase (B) is for > 5 µM or renal failure; leucovorin 15 mg
(A) is under-dosed.
pg. 3
