ONS ONCC Chemo Renewal Exam 2026/2027 – Complete
Exam-Style Questions with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
Question 1
A nurse is preparing to administer intravenous cyclophosphamide in an outpatient
infusion center. According to USP 800 and ONS guidelines, which personal protective
equipment (PPE) is REQUIRED for the nurse during administration?
A. A single pair of powder-free latex gloves
B. Double chemotherapy-tested gloves, a disposable impermeable gown, and eye/face
protection
C. Standard nitrile examination gloves and a cloth isolation gown
D. A surgical mask and face shield only
Correct Answer: B
Rationale: USP 800 and ONS guidelines mandate that healthcare workers wear double
chemotherapy-tested gloves, a disposable impermeable gown, and eye/face protection
when administering hazardous drugs such as cyclophosphamide. Distractor A is
incorrect because single gloves and latex are insufficient; chemotherapy-tested nitrile
gloves are required, and double gloving is standard. Distractor C is incorrect because
standard examination gloves and cloth gowns are permeable to hazardous drugs.
Question 2
A pharmacist is compounding a batch of gemcitabine for an infusion center. Under USP
800, when is a closed system transfer device (CSTD) required?
,A. Only when compounding vesicant chemotherapy agents
B. During compounding and administration of hazardous antineoplastic drugs when the
dosage form allows
C. Only if a prior spill has occurred in the compounding area
D. CSTDs are optional and not required by USP 800
Correct Answer: B
Rationale: USP 800 requires the use of CSTDs during both compounding and
administration of hazardous antineoplastic drugs whenever the dosage form and
packaging allow, to minimize environmental contamination and occupational exposure.
Distractor A is incorrect because CSTD requirements apply to all hazardous
antineoplastics, not only vesicants. Distractor D is incorrect because USP 800 mandates
CSTD use as part of a comprehensive hazardous drug handling program.
Question 3
A nurse discovers a broken glass vial of 5-fluorouracil on the floor of the infusion suite.
What is the FIRST action the nurse must take?
A. Immediately begin wiping the spill with paper towels
B. Don appropriate PPE, alert others, restrict access to the area, and obtain the
chemotherapy spill kit
C. Call housekeeping to clean the spill with standard disinfectant
D. Open windows to ventilate the room before approaching the spill
Correct Answer: B
Rationale: The first priority in any hazardous drug spill is to protect personnel by
donning appropriate PPE (double chemotherapy gloves, gown, eye/face protection),
,restrict access to prevent exposure, and use the designated chemotherapy spill kit.
Distractor A is incorrect because cleaning without PPE exposes the nurse to hazardous
drug contact. Distractor C is incorrect because housekeeping staff may not be trained in
hazardous drug spill cleanup, and standard disinfectants are inappropriate.
Question 4
An empty vial previously containing doxorubicin is ready for disposal. According to
NIOSH and ONS standards, which disposal method is correct?
A. Place in a regular trash receptacle because the vial is empty
B. Dispose in a yellow-labeled trace chemotherapy waste container
C. Place in a red biohazard bag for incineration with standard medical waste
D. Return the empty vial to the pharmacy for reuse
Correct Answer: B
Rationale: Empty vials that previously contained hazardous drugs are classified as trace
chemotherapy waste and must be discarded in designated trace chemotherapy waste
containers (typically yellow-labeled) for proper incineration. Distractor A is incorrect
because empty hazardous drug vials retain residual drug and must not enter regular
waste streams. Distractor C is incorrect because red biohazard bags are for infectious
waste, not hazardous drug waste.
Question 5
Which of the following drugs is classified as a hazardous drug on the NIOSH List of
Antineoplastic and Other Hazardous Drugs in Healthcare Settings?
A. Acetaminophen
B. Cyclophosphamide
, C. Metoprolol
D. Omeprazole
Correct Answer: B
Rationale: Cyclophosphamide is an alkylating agent and antineoplastic drug listed by
NIOSH as a hazardous drug requiring safe handling precautions. Distractors A, C, and D
are not classified as hazardous drugs on the NIOSH list and do not require
chemotherapy-specific PPE or CSTDs.
Question 6
A charge nurse is creating the staffing assignment for the day. One of the scheduled
nurses is in her first trimester of pregnancy. According to ONS and institutional policy,
which assignment is MOST appropriate?
A. Assign the nurse to administer oral chemotherapy only, with standard gloves
B. Exclude the pregnant nurse from handling, preparing, or administering hazardous
drugs and reassign to non-chemotherapy duties
C. Allow the nurse to administer chemotherapy if she wears an N95 respirator
D. Assign the nurse to compounding only, not administration
Correct Answer: B
Rationale: ONS and USP 800 recommend that pregnant healthcare workers avoid
exposure to hazardous drugs, including during preparation, administration, and disposal;
reassignment to non-chemotherapy duties is the safest course. Distractor A is incorrect
because oral chemotherapy agents (e.g., capecitabine, temozolomide) are also
hazardous. Distractor C is incorrect because respiratory protection alone does not
eliminate dermal and environmental exposure risks.
Exam-Style Questions with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
Question 1
A nurse is preparing to administer intravenous cyclophosphamide in an outpatient
infusion center. According to USP 800 and ONS guidelines, which personal protective
equipment (PPE) is REQUIRED for the nurse during administration?
A. A single pair of powder-free latex gloves
B. Double chemotherapy-tested gloves, a disposable impermeable gown, and eye/face
protection
C. Standard nitrile examination gloves and a cloth isolation gown
D. A surgical mask and face shield only
Correct Answer: B
Rationale: USP 800 and ONS guidelines mandate that healthcare workers wear double
chemotherapy-tested gloves, a disposable impermeable gown, and eye/face protection
when administering hazardous drugs such as cyclophosphamide. Distractor A is
incorrect because single gloves and latex are insufficient; chemotherapy-tested nitrile
gloves are required, and double gloving is standard. Distractor C is incorrect because
standard examination gloves and cloth gowns are permeable to hazardous drugs.
Question 2
A pharmacist is compounding a batch of gemcitabine for an infusion center. Under USP
800, when is a closed system transfer device (CSTD) required?
,A. Only when compounding vesicant chemotherapy agents
B. During compounding and administration of hazardous antineoplastic drugs when the
dosage form allows
C. Only if a prior spill has occurred in the compounding area
D. CSTDs are optional and not required by USP 800
Correct Answer: B
Rationale: USP 800 requires the use of CSTDs during both compounding and
administration of hazardous antineoplastic drugs whenever the dosage form and
packaging allow, to minimize environmental contamination and occupational exposure.
Distractor A is incorrect because CSTD requirements apply to all hazardous
antineoplastics, not only vesicants. Distractor D is incorrect because USP 800 mandates
CSTD use as part of a comprehensive hazardous drug handling program.
Question 3
A nurse discovers a broken glass vial of 5-fluorouracil on the floor of the infusion suite.
What is the FIRST action the nurse must take?
A. Immediately begin wiping the spill with paper towels
B. Don appropriate PPE, alert others, restrict access to the area, and obtain the
chemotherapy spill kit
C. Call housekeeping to clean the spill with standard disinfectant
D. Open windows to ventilate the room before approaching the spill
Correct Answer: B
Rationale: The first priority in any hazardous drug spill is to protect personnel by
donning appropriate PPE (double chemotherapy gloves, gown, eye/face protection),
,restrict access to prevent exposure, and use the designated chemotherapy spill kit.
Distractor A is incorrect because cleaning without PPE exposes the nurse to hazardous
drug contact. Distractor C is incorrect because housekeeping staff may not be trained in
hazardous drug spill cleanup, and standard disinfectants are inappropriate.
Question 4
An empty vial previously containing doxorubicin is ready for disposal. According to
NIOSH and ONS standards, which disposal method is correct?
A. Place in a regular trash receptacle because the vial is empty
B. Dispose in a yellow-labeled trace chemotherapy waste container
C. Place in a red biohazard bag for incineration with standard medical waste
D. Return the empty vial to the pharmacy for reuse
Correct Answer: B
Rationale: Empty vials that previously contained hazardous drugs are classified as trace
chemotherapy waste and must be discarded in designated trace chemotherapy waste
containers (typically yellow-labeled) for proper incineration. Distractor A is incorrect
because empty hazardous drug vials retain residual drug and must not enter regular
waste streams. Distractor C is incorrect because red biohazard bags are for infectious
waste, not hazardous drug waste.
Question 5
Which of the following drugs is classified as a hazardous drug on the NIOSH List of
Antineoplastic and Other Hazardous Drugs in Healthcare Settings?
A. Acetaminophen
B. Cyclophosphamide
, C. Metoprolol
D. Omeprazole
Correct Answer: B
Rationale: Cyclophosphamide is an alkylating agent and antineoplastic drug listed by
NIOSH as a hazardous drug requiring safe handling precautions. Distractors A, C, and D
are not classified as hazardous drugs on the NIOSH list and do not require
chemotherapy-specific PPE or CSTDs.
Question 6
A charge nurse is creating the staffing assignment for the day. One of the scheduled
nurses is in her first trimester of pregnancy. According to ONS and institutional policy,
which assignment is MOST appropriate?
A. Assign the nurse to administer oral chemotherapy only, with standard gloves
B. Exclude the pregnant nurse from handling, preparing, or administering hazardous
drugs and reassign to non-chemotherapy duties
C. Allow the nurse to administer chemotherapy if she wears an N95 respirator
D. Assign the nurse to compounding only, not administration
Correct Answer: B
Rationale: ONS and USP 800 recommend that pregnant healthcare workers avoid
exposure to hazardous drugs, including during preparation, administration, and disposal;
reassignment to non-chemotherapy duties is the safest course. Distractor A is incorrect
because oral chemotherapy agents (e.g., capecitabine, temozolomide) are also
hazardous. Distractor C is incorrect because respiratory protection alone does not
eliminate dermal and environmental exposure risks.
