FUNDAMENTALS OF CHEMOTHERAPY IMMUNOTHERAPY
ADMINISTRATION EXAM LATEST 2025 ACTUAL EXAM
ALL 130 QUESTIONS AND CORRECT ANSWERS (ALREADY GRADED A+)
| LATEST EDITION
ONS/ASCO 2025 Safety Standards • NIOSH Alert • USP <800> • FDA Monographs
Correct answers are BOLD; each rationale cites the 2025 safety standard or guideline.
1. Prior to beginning a nivolumab infusion, which patient assessment is MOST
critical for immediate safety?
A. Skin turgor
B. Last dose timing and any prior infusion-related reactions (IRR)
documented
C. Family history
D. Dietary intake
B. ONS/ASCO 2025: IRR risk increases with repeated exposure; verify prior
reactions and pre-medicate per protocol.
2. According to USP <800> (2025), the minimum glove thickness for handling vial-
adaptor spikes of hazardous drugs is:
A. 0.05 mm nitrile
B. 0.1 mm nitrile, double-gloved, changed every 30 min or immediately if
contaminated
C. Single latex glove
D. Cotton glove liner only
B. USP <800> Table 5: ≥ 0.1 mm nitrile, double-gloved, with timed changes to
prevent permeation.
3. A spill of 50 mL of cyclophosphamide occurs on the counter. The FIRST action per
NIOSH 2025 Alert is:
A. Wipe with alcohol
B. Don PPE, restrict area, apply spill powder/gelling agent from chemo spill
kit
C. Call housekeeping
D. Ventilate room
B. NIOSH 2025: contain spill, don chemo-rated PPE, use adsorbent powder
before wiping; prevents aerosolization.
4. When verifying an order for pembrolizumab 200 mg IV q3 weeks, the nurse
confirms the dose is appropriate for a patient with:
A. BSA 1.8 m² (dose is flat, not weight/BSA-based)
pg. 1
, B. Any BSA; pembrolizumab is flat-dose 200 mg q3w (FDA 2025 label)
C. Weight < 50 kg only
D. CrCl < 30 mL/min
B. FDA label 2025: flat dosing (200 mg q3w or 400 mg q6w) regardless of BSA;
renal adjustment not required.
5. During peripheral IV administration of vincristine, the nurse ensures the catheter
is:
A. 22 G in hand vein
B. 20 G or larger in forearm vein, with blood return confirmed every 5 min
C. 24 G in thumb vein
D. Any gauge if patient reports no pain
B. ONS 2025 vesicant guideline: vincristine requires robust peripheral flow; large
vein, frequent blood-return checks.
6. Pre-medication for paclitaxel infusion includes dexamethasone to prevent:
A. Cardiotoxicity
B. Hypersensitivity reaction (HSR) due to Cremophor EL vehicle
C. Diarrhea
D. Hemorrhagic cystitis
B. FDA paclitaxel label 2025: dexamethasone 10–20 mg PO/IV 30–60 min pre-
dose to reduce Cremophor-related HSR.
7. A patient on cisplatin develops acute tinnitus. The nurse’s priority is to:
A. Reassure and continue
B. Hold infusion, notify provider, assess for ototoxicity, document severity
C. Increase rate
D. Administer diphenhydramine
B. ONS 2025: cisplatin ototoxicity is dose-limiting; hold, assess, consider dose
reduction or discontinuation.
8. The correct sequence for removing chemo-contaminated PPE per USP <800> is:
A. Gloves, gown, goggles
B. Goggles, gown, inner gloves last (double-glove removal in contaminated
area)
C. Gown first, then anything
D. Mask first
B. USP <800> Appendix A: remove goggles/face shield first, then gown, then
inner gloves last to avoid self-contamination.
9. For a patient receiving high-dose methotrexate (> 1 g/m²), the nurse monitors
serum methotrexate levels:
A. Once weekly
B. At 24, 48, 72 hours post-infusion until level < 0.1 µmol/L
C. Only if symptomatic
pg. 2
, D. Never
B. ONS/ASCO 2025 HD-MTX protocol: levels q24h until < 0.1 µmol/L to guide
leucovorin rescue and prevent nephrotoxicity.
10. If a patient experiences Grade 2 infusion reaction to rituximab (moderate
hypotension), the nurse should:
A. Continue at same rate
B. Stop infusion, give IV fluids ± epinephrine per protocol, resume at 50 %
rate after stabilization
C. Switch to oral drug
D. Discontinue permanently
**B.] ONS 2025 IRR guideline: Grade 2 requires interruption, supportive care,
and cautious re-challenge with reduced rate.
11. The recommended filter size for administering liposomal doxorubicin is:
A. 0.22 µm hydrophilic
B. 0.2 µm hydrophobic (PTFE) to prevent liposome disruption
C. 5 µm
D. No filter needed
**B.] FDA Doxil 2025: use 0.2 µm hydrophobic filter; hydrophilic filters can
rupture liposomes.
12. When programming an elastomeric pump for 5-FU continuous infusion, the
nurse verifies:
A. Patient pushes button hourly
B. Pump reservoir volume, infusion duration, flow rate (mL/h), and patient
education on pump care
C. Gravity drip only
D. No verification needed
**B.] ONS 2025: ambulatory pumps require verification of programmed rate vs.
prescription and patient teaching.
13. A patient on bleomycin reports dyspnea on exertion. SpO2 is 94 % on room air.
Next step:
A. Encourage exercise
B. Hold bleomycin, obtain pulmonary function tests ± CXR, assess for
bleomycin pneumonitis
C. Increase flow rate
D. Administer bronchodilator and continue
**B.] ONS 2025: bleomycin pulmonary toxicity can be fatal; any new dyspnea
warrants workup and dose hold.
14. Correct site for central line blood return verification before cyclophosphamide
push:
A. Any lumen
pg. 3
ADMINISTRATION EXAM LATEST 2025 ACTUAL EXAM
ALL 130 QUESTIONS AND CORRECT ANSWERS (ALREADY GRADED A+)
| LATEST EDITION
ONS/ASCO 2025 Safety Standards • NIOSH Alert • USP <800> • FDA Monographs
Correct answers are BOLD; each rationale cites the 2025 safety standard or guideline.
1. Prior to beginning a nivolumab infusion, which patient assessment is MOST
critical for immediate safety?
A. Skin turgor
B. Last dose timing and any prior infusion-related reactions (IRR)
documented
C. Family history
D. Dietary intake
B. ONS/ASCO 2025: IRR risk increases with repeated exposure; verify prior
reactions and pre-medicate per protocol.
2. According to USP <800> (2025), the minimum glove thickness for handling vial-
adaptor spikes of hazardous drugs is:
A. 0.05 mm nitrile
B. 0.1 mm nitrile, double-gloved, changed every 30 min or immediately if
contaminated
C. Single latex glove
D. Cotton glove liner only
B. USP <800> Table 5: ≥ 0.1 mm nitrile, double-gloved, with timed changes to
prevent permeation.
3. A spill of 50 mL of cyclophosphamide occurs on the counter. The FIRST action per
NIOSH 2025 Alert is:
A. Wipe with alcohol
B. Don PPE, restrict area, apply spill powder/gelling agent from chemo spill
kit
C. Call housekeeping
D. Ventilate room
B. NIOSH 2025: contain spill, don chemo-rated PPE, use adsorbent powder
before wiping; prevents aerosolization.
4. When verifying an order for pembrolizumab 200 mg IV q3 weeks, the nurse
confirms the dose is appropriate for a patient with:
A. BSA 1.8 m² (dose is flat, not weight/BSA-based)
pg. 1
, B. Any BSA; pembrolizumab is flat-dose 200 mg q3w (FDA 2025 label)
C. Weight < 50 kg only
D. CrCl < 30 mL/min
B. FDA label 2025: flat dosing (200 mg q3w or 400 mg q6w) regardless of BSA;
renal adjustment not required.
5. During peripheral IV administration of vincristine, the nurse ensures the catheter
is:
A. 22 G in hand vein
B. 20 G or larger in forearm vein, with blood return confirmed every 5 min
C. 24 G in thumb vein
D. Any gauge if patient reports no pain
B. ONS 2025 vesicant guideline: vincristine requires robust peripheral flow; large
vein, frequent blood-return checks.
6. Pre-medication for paclitaxel infusion includes dexamethasone to prevent:
A. Cardiotoxicity
B. Hypersensitivity reaction (HSR) due to Cremophor EL vehicle
C. Diarrhea
D. Hemorrhagic cystitis
B. FDA paclitaxel label 2025: dexamethasone 10–20 mg PO/IV 30–60 min pre-
dose to reduce Cremophor-related HSR.
7. A patient on cisplatin develops acute tinnitus. The nurse’s priority is to:
A. Reassure and continue
B. Hold infusion, notify provider, assess for ototoxicity, document severity
C. Increase rate
D. Administer diphenhydramine
B. ONS 2025: cisplatin ototoxicity is dose-limiting; hold, assess, consider dose
reduction or discontinuation.
8. The correct sequence for removing chemo-contaminated PPE per USP <800> is:
A. Gloves, gown, goggles
B. Goggles, gown, inner gloves last (double-glove removal in contaminated
area)
C. Gown first, then anything
D. Mask first
B. USP <800> Appendix A: remove goggles/face shield first, then gown, then
inner gloves last to avoid self-contamination.
9. For a patient receiving high-dose methotrexate (> 1 g/m²), the nurse monitors
serum methotrexate levels:
A. Once weekly
B. At 24, 48, 72 hours post-infusion until level < 0.1 µmol/L
C. Only if symptomatic
pg. 2
, D. Never
B. ONS/ASCO 2025 HD-MTX protocol: levels q24h until < 0.1 µmol/L to guide
leucovorin rescue and prevent nephrotoxicity.
10. If a patient experiences Grade 2 infusion reaction to rituximab (moderate
hypotension), the nurse should:
A. Continue at same rate
B. Stop infusion, give IV fluids ± epinephrine per protocol, resume at 50 %
rate after stabilization
C. Switch to oral drug
D. Discontinue permanently
**B.] ONS 2025 IRR guideline: Grade 2 requires interruption, supportive care,
and cautious re-challenge with reduced rate.
11. The recommended filter size for administering liposomal doxorubicin is:
A. 0.22 µm hydrophilic
B. 0.2 µm hydrophobic (PTFE) to prevent liposome disruption
C. 5 µm
D. No filter needed
**B.] FDA Doxil 2025: use 0.2 µm hydrophobic filter; hydrophilic filters can
rupture liposomes.
12. When programming an elastomeric pump for 5-FU continuous infusion, the
nurse verifies:
A. Patient pushes button hourly
B. Pump reservoir volume, infusion duration, flow rate (mL/h), and patient
education on pump care
C. Gravity drip only
D. No verification needed
**B.] ONS 2025: ambulatory pumps require verification of programmed rate vs.
prescription and patient teaching.
13. A patient on bleomycin reports dyspnea on exertion. SpO2 is 94 % on room air.
Next step:
A. Encourage exercise
B. Hold bleomycin, obtain pulmonary function tests ± CXR, assess for
bleomycin pneumonitis
C. Increase flow rate
D. Administer bronchodilator and continue
**B.] ONS 2025: bleomycin pulmonary toxicity can be fatal; any new dyspnea
warrants workup and dose hold.
14. Correct site for central line blood return verification before cyclophosphamide
push:
A. Any lumen
pg. 3
