1|Page
ONS/ONCC CHEMOTHERAPY IMMUNOTHERAPY
CERTIFICATION EXAM NEWEST 2025/ 2026 ACTUAL
EXAM| COMPLETE 250 REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+ (MOST RECENT!!)
A patient receiving pembrolizumab develops new shortness of breath,
dry cough, and O₂ sat 91%. Chest CT shows patchy ground‑glass
opacities. What is the most likely cause?
A. Viral pneumonia
B. Immune‑related pneumonitis
C. Pulmonary embolism
D. Heart failure -Correct Answer: B
Checkpoint inhibitors can cause immune‑mediated pneumonitis, a
potentially life‑threatening toxicity requiring prompt recognition and
corticosteroid therapy.
A patient receiving high‑dose methotrexate has delayed clearance and
rising creatinine. Which intervention is most critical?
A. Increase leucovorin rescue and IV hydration
B. Administer filgrastim
C. Reduce the next methotrexate dose
D. Switch to oral leucovorin -Correct Answer: A
pg. 1
,2|Page
Delayed methotrexate clearance can cause severe toxicity. Management
includes aggressive hydration, alkalinization, and increased leucovorin
rescue.
A patient receiving rituximab develops rigors, fever, and hypotension 10
minutes into the infusion. What is the nurse’s first action?
A. Slow the infusion
B. Stop the infusion and assess
C. Administer acetaminophen
D. Restart at half the rate -Correct Answer: B
Rituximab infusion reactions require immediate interruption of the
infusion and patient assessment before any further action.
A patient receiving paclitaxel develops flushing, chest tightness, and
back pain within minutes. What is the most likely cause?
A. Anxiety
B. Acute hypersensitivity reaction
C. Delayed reaction
D. Cardiac ischemia -Correct Answer: B
Paclitaxel can cause early hypersensitivity reactions due to the solvent
Cremophor; infusion must be stopped.
A patient on immunotherapy develops severe fatigue, weight gain, and
cold intolerance. Which lab is most important?
pg. 2
,3|Page
A. CBC
B. TSH and free T4
C. ALT/AST
D. Calcium -Correct Answer: B
Immune‑related hypothyroidism is common with checkpoint inhibitors;
thyroid function must be assessed.
A patient receiving 5‑FU infusion develops painful redness on palms and
soles. What is the toxicity?
A. Neuropathy
B. Hand‑foot syndrome
C. Stevens‑Johnson syndrome
D. Allergic reaction -Correct Answer: B
5‑FU commonly causes palmar‑plantar erythrodysesthesia (hand‑foot
syndrome).
A patient receiving cyclophosphamide reports dark urine and suprapubic
pain. What is the most likely toxicity?
A. Hemorrhagic cystitis
B. Renal failure
C. UTI
D. Dehydration -Correct Answer: A
pg. 3
, 4|Page
Cyclophosphamide metabolites (acrolein) can cause bladder irritation
and bleeding; hydration and mesna reduce risk.
A patient receiving nivolumab develops jaundice, RUQ pain, and
elevated ALT/AST. What is the most likely cause?
A. Viral hepatitis
B. Immune‑related hepatitis
C. Gallstones
D. Alcoholic liver disease -Correct Answer: B
Checkpoint inhibitors can cause immune‑mediated hepatitis requiring
steroids and treatment hold.
A patient receiving oxaliplatin reports difficulty swallowing cold liquids
and tingling in hands when touching cold objects. What is the cause?**
A. Anaphylaxis
B. Acute cold‑induced neuropathy
C. Esophageal spasm
D. Panic attack -Correct Answer: B
Oxaliplatin causes acute neuropathy triggered by cold exposure;
symptoms are transient but distressing.
A patient receiving anthracycline therapy has a cumulative dose
approaching the lifetime limit. What is the primary concern?
A. Renal failure
pg. 4
ONS/ONCC CHEMOTHERAPY IMMUNOTHERAPY
CERTIFICATION EXAM NEWEST 2025/ 2026 ACTUAL
EXAM| COMPLETE 250 REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+ (MOST RECENT!!)
A patient receiving pembrolizumab develops new shortness of breath,
dry cough, and O₂ sat 91%. Chest CT shows patchy ground‑glass
opacities. What is the most likely cause?
A. Viral pneumonia
B. Immune‑related pneumonitis
C. Pulmonary embolism
D. Heart failure -Correct Answer: B
Checkpoint inhibitors can cause immune‑mediated pneumonitis, a
potentially life‑threatening toxicity requiring prompt recognition and
corticosteroid therapy.
A patient receiving high‑dose methotrexate has delayed clearance and
rising creatinine. Which intervention is most critical?
A. Increase leucovorin rescue and IV hydration
B. Administer filgrastim
C. Reduce the next methotrexate dose
D. Switch to oral leucovorin -Correct Answer: A
pg. 1
,2|Page
Delayed methotrexate clearance can cause severe toxicity. Management
includes aggressive hydration, alkalinization, and increased leucovorin
rescue.
A patient receiving rituximab develops rigors, fever, and hypotension 10
minutes into the infusion. What is the nurse’s first action?
A. Slow the infusion
B. Stop the infusion and assess
C. Administer acetaminophen
D. Restart at half the rate -Correct Answer: B
Rituximab infusion reactions require immediate interruption of the
infusion and patient assessment before any further action.
A patient receiving paclitaxel develops flushing, chest tightness, and
back pain within minutes. What is the most likely cause?
A. Anxiety
B. Acute hypersensitivity reaction
C. Delayed reaction
D. Cardiac ischemia -Correct Answer: B
Paclitaxel can cause early hypersensitivity reactions due to the solvent
Cremophor; infusion must be stopped.
A patient on immunotherapy develops severe fatigue, weight gain, and
cold intolerance. Which lab is most important?
pg. 2
,3|Page
A. CBC
B. TSH and free T4
C. ALT/AST
D. Calcium -Correct Answer: B
Immune‑related hypothyroidism is common with checkpoint inhibitors;
thyroid function must be assessed.
A patient receiving 5‑FU infusion develops painful redness on palms and
soles. What is the toxicity?
A. Neuropathy
B. Hand‑foot syndrome
C. Stevens‑Johnson syndrome
D. Allergic reaction -Correct Answer: B
5‑FU commonly causes palmar‑plantar erythrodysesthesia (hand‑foot
syndrome).
A patient receiving cyclophosphamide reports dark urine and suprapubic
pain. What is the most likely toxicity?
A. Hemorrhagic cystitis
B. Renal failure
C. UTI
D. Dehydration -Correct Answer: A
pg. 3
, 4|Page
Cyclophosphamide metabolites (acrolein) can cause bladder irritation
and bleeding; hydration and mesna reduce risk.
A patient receiving nivolumab develops jaundice, RUQ pain, and
elevated ALT/AST. What is the most likely cause?
A. Viral hepatitis
B. Immune‑related hepatitis
C. Gallstones
D. Alcoholic liver disease -Correct Answer: B
Checkpoint inhibitors can cause immune‑mediated hepatitis requiring
steroids and treatment hold.
A patient receiving oxaliplatin reports difficulty swallowing cold liquids
and tingling in hands when touching cold objects. What is the cause?**
A. Anaphylaxis
B. Acute cold‑induced neuropathy
C. Esophageal spasm
D. Panic attack -Correct Answer: B
Oxaliplatin causes acute neuropathy triggered by cold exposure;
symptoms are transient but distressing.
A patient receiving anthracycline therapy has a cumulative dose
approaching the lifetime limit. What is the primary concern?
A. Renal failure
pg. 4
