CHEMOTHERAPY & BIOTHERAPY
CERTIFICATION EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE - 1. Pharmacology and Mechanism of
Action - 2. Safe Handling and Administration - 3. Oncologic
Emergencies - 4. Patient Assessment and Education - 5.
Management of Treatment-Related Toxicities - 6. Biotherapy
and Targeted Therapy
1. A patient with metastatic colorectal cancer receiving cetuximab therapy develops a grade 3
acneiform rash across the face and upper chest. Which of the following interventions should the
oncology nurse anticipate implementing first?
A. Discontinue the cetuximab permanently due to hypersensitivity risk
B. Initiate topical clindamycin 1% and oral doxycycline 100 mg twice daily
C. Apply high-potency topical corticosteroid cream to the affected areas
D. Reduce the cetuximab dose by 50% for the subsequent cycle
CORRECT ANSWER : B
Rationale: Prophylactic or reactive treatment with tetracycline-class antibiotics (like
doxycycline) and topical antibiotics is standard practice for managing epidermal growth factor
receptor (EGFR) inhibitor-induced acneiform rashes. High-potency topical steroids are
generally avoided on the face, and permanent discontinuation or dose reduction is typically
reserved for higher-grade toxicities that do not respond to supportive care.
2. During the administration of intravenous paclitaxel, a patient suddenly complains of severe
lower back pain, flushing, and dyspnea within five minutes of infusion initiation. What is the
immediate priority action for the nurse?
A. Administer diphenhydramine IV push and slow the infusion rate by half
B. Stop the infusion immediately and maintain intravenous access with normal saline
C. Administer prescribed prophylactic hydrocortisone and resume the infusion after symptoms
subside
, D. Reassure the patient that this is a mild, expected infusion reaction and continue monitoring
CORRECT ANSWER : B
Rationale: Severe lower back pain and dyspnea early in a taxane infusion are hallmark signs of
a severe hypersensitivity reaction. The immediate priority is to stop the infusion, disconnect the
tubing, maintain IV access with a new line of normal saline, and initiate emergency protocols.
Slowing the rate or continuing the infusion is contraindicated for acute hypersensitivity
reactions.
3. A patient receiving doxorubicin reports mild fatigue, but physical assessment reveals bilateral
peripheral pitting edema, jugular venous distension, and a newly developed third heart sound
(S3). Which late complication of therapy must the nurse suspect?
A. Acute chemotherapy-induced peripheral neuropathy
B. Acute tumor lysis syndrome
C. Chronic cumulative cardiotoxicity leading to heart failure
D. Anthracycline-induced hypersensitivity pneumonitis
CORRECT ANSWER : C
Rationale: Doxorubicin is well-known for causing cumulative, dose-dependent cardiotoxicity
that can manifest as left ventricular dysfunction and congestive heart failure, indicated here by
S3 gallop, edema, and jugular venous distension. Peripheral neuropathy is more typical of
taxanes or vinca alkaloids, while tumor lysis syndrome presents with metabolic derangements
rather than heart failure signs.
4. A nurse is preparing to administer vincristine to a patient with lymphoma. Which of the
following administration practices is critical to prevent a fatal medication error?
A. Dilute the dose in a 250 mL IV bag of normal saline for a 30-minute infusion
B. Administer the dose as a direct IV push into a freely flowing IV line, utilizing a minibag
gravity method if required by institutional policy
C. Administer the medication via the intrathecal route to maximize central nervous system
penetration
D. Use an ambulatory infusion pump programmed for a continuous 24-hour delivery
CORRECT ANSWER : B
, Rationale: Vincristine is fatal if administered intrathecally and must always be given via the
intravenous route. To prevent accidental intrathecal administration, institutional safety
standards require vincristine to be dispensed in a minibag rather than a syringe when given IV
push, ensuring it cannot be mistaken for spinal chemotherapy.
5. A patient receiving high-dose methotrexate therapy has a serum methotrexate level of 12
micromol/L at 24 hours post-infusion, along with a rising serum creatinine level. Which
medication is the critical antidote that the nurse must ensure is administered?
A. Leucovorin calcium
B. Mesna
C. Allopurinol
D. Dexrazoxane
CORRECT ANSWER : A
Rationale: Leucovorin (folinic acid) rescue is administered following high-dose methotrexate to
salvage normal cells and mitigate severe systemic toxicity, especially in the presence of delayed
clearance and renal dysfunction. Mesna is used to prevent hemorrhagic cystitis from
oxazaphosphorines (ifosfamide/cyclophosphamide), allopurinol prevents tumor lysis syndrome,
and dexrazoxane protects against anthracycline cardiotoxicity.
6. A patient with non-Hodgkin lymphoma is undergoing treatment and is at high risk for tumor
lysis syndrome. Laboratory results show potassium 6.2 mEq/L, uric acid 11 mg/dL, phosphorus
7.5 mg/dL, and calcium 6.4 mg/dL. Which medication should the nurse expect to administer to
address the elevated uric acid specifically?
A. Sevelamer hydrochloride
B. Calcium gluconate
C. Rasburicase
D. Sodium bicarbonate
CORRECT ANSWER : C
Rationale: Rasburicase is a recombinant urate-oxidase enzyme that rapidly metabolizes existing
uric acid into allantoin, a soluble and easily excreted metabolite, making it highly effective for
hyperuricemia in tumor lysis syndrome. Allopurinol prevents new uric acid formation but does
not break down existing uric acid. Calcium gluconate treats hypocalcemia-related symptoms,
and sevelamer binds phosphorus.
, 7. A nurse is caring for a patient receiving ifosfamide therapy. Which adjunctive agent must the
nurse ensure is co-administered to prevent urothelial toxicity?
A. Leucovorin
B. Mesna
C. Amifostine
D. Dexrazoxane
CORRECT ANSWER : B
Rationale: Mesna (2-mercaptoethane sulfonate sodium) binds to toxic urotoxic metabolites
(acrolein) in the bladder, neutralizing them and preventing hemorrhagic cystitis associated with
ifosfamide and high-dose cyclophosphamide. Leucovorin is for methotrexate rescue,
dexrazoxane is for anthracycline cardiotoxicity, and amifostine is a broad cytoprotectant used
less commonly.
8. A patient receiving an intravenous infusion of a vesicant chemotherapeutic agent reports a
stinging sensation at the needle insertion site. The nurse checks for blood return and finds none,
and no swelling is observed. What is the immediate priority action?
A. Flush the line forcefully with 10 mL of normal saline to clear the vein
B. Stop the infusion immediately, leave the needle/cannula in place, and attempt to aspirate
residual drug
C. Elevate the affected arm and apply warm compresses for 20 minutes
D. Slow the infusion rate and continue to monitor the site every 5 minutes
CORRECT ANSWER : B
Rationale: The absence of blood return and patient-reported stinging are early indicators of a
potential extravasation. The nurse must immediately stop the infusion, leave the access device in
place to attempt aspiration of any residual vesicant from the site, and follow institutional
extravasation protocols. Flushing forcefully can worsen tissue damage.
9. A patient with breast cancer is prescribed trastuzumab. Prior to initiating therapy, which baseline
diagnostic assessment is critical to establish?
A. Pulmonary function tests (PFTs)
B. 24-hour urine collection for creatinine clearance
CERTIFICATION EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE - 1. Pharmacology and Mechanism of
Action - 2. Safe Handling and Administration - 3. Oncologic
Emergencies - 4. Patient Assessment and Education - 5.
Management of Treatment-Related Toxicities - 6. Biotherapy
and Targeted Therapy
1. A patient with metastatic colorectal cancer receiving cetuximab therapy develops a grade 3
acneiform rash across the face and upper chest. Which of the following interventions should the
oncology nurse anticipate implementing first?
A. Discontinue the cetuximab permanently due to hypersensitivity risk
B. Initiate topical clindamycin 1% and oral doxycycline 100 mg twice daily
C. Apply high-potency topical corticosteroid cream to the affected areas
D. Reduce the cetuximab dose by 50% for the subsequent cycle
CORRECT ANSWER : B
Rationale: Prophylactic or reactive treatment with tetracycline-class antibiotics (like
doxycycline) and topical antibiotics is standard practice for managing epidermal growth factor
receptor (EGFR) inhibitor-induced acneiform rashes. High-potency topical steroids are
generally avoided on the face, and permanent discontinuation or dose reduction is typically
reserved for higher-grade toxicities that do not respond to supportive care.
2. During the administration of intravenous paclitaxel, a patient suddenly complains of severe
lower back pain, flushing, and dyspnea within five minutes of infusion initiation. What is the
immediate priority action for the nurse?
A. Administer diphenhydramine IV push and slow the infusion rate by half
B. Stop the infusion immediately and maintain intravenous access with normal saline
C. Administer prescribed prophylactic hydrocortisone and resume the infusion after symptoms
subside
, D. Reassure the patient that this is a mild, expected infusion reaction and continue monitoring
CORRECT ANSWER : B
Rationale: Severe lower back pain and dyspnea early in a taxane infusion are hallmark signs of
a severe hypersensitivity reaction. The immediate priority is to stop the infusion, disconnect the
tubing, maintain IV access with a new line of normal saline, and initiate emergency protocols.
Slowing the rate or continuing the infusion is contraindicated for acute hypersensitivity
reactions.
3. A patient receiving doxorubicin reports mild fatigue, but physical assessment reveals bilateral
peripheral pitting edema, jugular venous distension, and a newly developed third heart sound
(S3). Which late complication of therapy must the nurse suspect?
A. Acute chemotherapy-induced peripheral neuropathy
B. Acute tumor lysis syndrome
C. Chronic cumulative cardiotoxicity leading to heart failure
D. Anthracycline-induced hypersensitivity pneumonitis
CORRECT ANSWER : C
Rationale: Doxorubicin is well-known for causing cumulative, dose-dependent cardiotoxicity
that can manifest as left ventricular dysfunction and congestive heart failure, indicated here by
S3 gallop, edema, and jugular venous distension. Peripheral neuropathy is more typical of
taxanes or vinca alkaloids, while tumor lysis syndrome presents with metabolic derangements
rather than heart failure signs.
4. A nurse is preparing to administer vincristine to a patient with lymphoma. Which of the
following administration practices is critical to prevent a fatal medication error?
A. Dilute the dose in a 250 mL IV bag of normal saline for a 30-minute infusion
B. Administer the dose as a direct IV push into a freely flowing IV line, utilizing a minibag
gravity method if required by institutional policy
C. Administer the medication via the intrathecal route to maximize central nervous system
penetration
D. Use an ambulatory infusion pump programmed for a continuous 24-hour delivery
CORRECT ANSWER : B
, Rationale: Vincristine is fatal if administered intrathecally and must always be given via the
intravenous route. To prevent accidental intrathecal administration, institutional safety
standards require vincristine to be dispensed in a minibag rather than a syringe when given IV
push, ensuring it cannot be mistaken for spinal chemotherapy.
5. A patient receiving high-dose methotrexate therapy has a serum methotrexate level of 12
micromol/L at 24 hours post-infusion, along with a rising serum creatinine level. Which
medication is the critical antidote that the nurse must ensure is administered?
A. Leucovorin calcium
B. Mesna
C. Allopurinol
D. Dexrazoxane
CORRECT ANSWER : A
Rationale: Leucovorin (folinic acid) rescue is administered following high-dose methotrexate to
salvage normal cells and mitigate severe systemic toxicity, especially in the presence of delayed
clearance and renal dysfunction. Mesna is used to prevent hemorrhagic cystitis from
oxazaphosphorines (ifosfamide/cyclophosphamide), allopurinol prevents tumor lysis syndrome,
and dexrazoxane protects against anthracycline cardiotoxicity.
6. A patient with non-Hodgkin lymphoma is undergoing treatment and is at high risk for tumor
lysis syndrome. Laboratory results show potassium 6.2 mEq/L, uric acid 11 mg/dL, phosphorus
7.5 mg/dL, and calcium 6.4 mg/dL. Which medication should the nurse expect to administer to
address the elevated uric acid specifically?
A. Sevelamer hydrochloride
B. Calcium gluconate
C. Rasburicase
D. Sodium bicarbonate
CORRECT ANSWER : C
Rationale: Rasburicase is a recombinant urate-oxidase enzyme that rapidly metabolizes existing
uric acid into allantoin, a soluble and easily excreted metabolite, making it highly effective for
hyperuricemia in tumor lysis syndrome. Allopurinol prevents new uric acid formation but does
not break down existing uric acid. Calcium gluconate treats hypocalcemia-related symptoms,
and sevelamer binds phosphorus.
, 7. A nurse is caring for a patient receiving ifosfamide therapy. Which adjunctive agent must the
nurse ensure is co-administered to prevent urothelial toxicity?
A. Leucovorin
B. Mesna
C. Amifostine
D. Dexrazoxane
CORRECT ANSWER : B
Rationale: Mesna (2-mercaptoethane sulfonate sodium) binds to toxic urotoxic metabolites
(acrolein) in the bladder, neutralizing them and preventing hemorrhagic cystitis associated with
ifosfamide and high-dose cyclophosphamide. Leucovorin is for methotrexate rescue,
dexrazoxane is for anthracycline cardiotoxicity, and amifostine is a broad cytoprotectant used
less commonly.
8. A patient receiving an intravenous infusion of a vesicant chemotherapeutic agent reports a
stinging sensation at the needle insertion site. The nurse checks for blood return and finds none,
and no swelling is observed. What is the immediate priority action?
A. Flush the line forcefully with 10 mL of normal saline to clear the vein
B. Stop the infusion immediately, leave the needle/cannula in place, and attempt to aspirate
residual drug
C. Elevate the affected arm and apply warm compresses for 20 minutes
D. Slow the infusion rate and continue to monitor the site every 5 minutes
CORRECT ANSWER : B
Rationale: The absence of blood return and patient-reported stinging are early indicators of a
potential extravasation. The nurse must immediately stop the infusion, leave the access device in
place to attempt aspiration of any residual vesicant from the site, and follow institutional
extravasation protocols. Flushing forcefully can worsen tissue damage.
9. A patient with breast cancer is prescribed trastuzumab. Prior to initiating therapy, which baseline
diagnostic assessment is critical to establish?
A. Pulmonary function tests (PFTs)
B. 24-hour urine collection for creatinine clearance
