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ONS ONCC Chemo Renewal Exam Actual Exam
2026/2027 | Complete Chemotherapy
Immunotherapy Renewal Exam Prep with
Verified Questions and Answers | Updated for
Current Guidelines | A+ Graded
SECTION 1: NEW AGENTS & UPDATED GUIDELINES
Q1: A patient with metastatic triple-negative breast cancer is being started on sacituzumab
govitecan. The nurse understands that this medication belongs to which class of anticancer
agents?
A. Immune checkpoint inhibitor
B. Antibody-drug conjugate (ADC). [CORRECT]
C. Bispecific T-cell engager (BiTE)
D. Tyrosine kinase inhibitor (TKI)
Correct Answer: B
Rationale: Sacituzumab govitecan is an antibody-drug conjugate (ADC) consisting of an anti-
Trop-2 monoclonal antibody linked to SN-38, the active metabolite of irinotecan (B). This
targeted delivery mechanism allows for intracellular release of the cytotoxic payload in Trop-2-
expressing tumor cells. It is not an immune checkpoint inhibitor (A), BiTE (C), or TKI (D).
Q2: A 68-year-old patient with metastatic non-small cell lung cancer (NSCLC) and PD-L1
expression ≥50% is initiating first-line treatment with pembrolizumab plus chemotherapy.
According to current NCCN and ASCO guidelines, what is the recommended duration of
pembrolizumab therapy?
A. 12 months regardless of response
B. 24 months or until disease progression/unacceptable toxicity, whichever occurs first.
[CORRECT]
C. Indefinitely until progression
D. 6 cycles only
Correct Answer: B
,2
Rationale: Current evidence supports treating with pembrolizumab for up to 24 months or until
disease progression or unacceptable toxicity (B), based on KEYNOTE-189/407 trial data
showing sustained benefit. Fixed-duration therapy at 24 months is now standard to balance
efficacy with toxicity and cost, rather than indefinite treatment (C) or arbitrary 12-month limits
(A).
Q3: A patient with relapsed/refractory multiple myeloma is prescribed teclistamab. The nurse
recognizes this agent represents which therapeutic class?
A. CAR-T cell therapy
B. Bispecific antibody targeting BCMA and CD3. [CORRECT]
C. Proteasome inhibitor
D. Anti-CD38 monoclonal antibody
Correct Answer: B
Rationale: Teclistamab is a bispecific T-cell engager (BiTE) antibody that simultaneously binds
BCMA on myeloma cells and CD3 on T cells, activating T-cell-mediated cytotoxicity (B). Unlike
CAR-T (A), it is an off-the-shelf product administered subcutaneously. It is not a proteasome
inhibitor (C) or anti-CD38 antibody (D).
Q4: According to the updated 2024 ASCO antiemetic guidelines, which combination is now
recommended for highly emetogenic chemotherapy (HEC) in the delayed phase (days 2-3)?
A. Dexamethasone alone
B. Olanzapine plus dexamethasone. [CORRECT]
C. Metoclopramide only
D. Lorazepam plus prochlorperazine
Correct Answer: B
Rationale: The 2024 ASCO guidelines recommend adding olanzapine to dexamethasone for
delayed phase CINV prevention with HEC (B), based on improved control over neurokinin-1
receptor antagonist combinations. Olanzapine's multi-receptor antagonism (dopamine, serotonin,
histamine, muscarinic) provides superior delayed phase protection.
Q5: A patient with HER2-low metastatic breast cancer is starting trastuzumab deruxtecan. What
is the critical monitoring requirement specific to this ADC?
A. Routine cardiac ejection fraction monitoring every 3 months
B. Interstitial lung disease/pneumonitis surveillance. [CORRECT]
, 3
C. Hepatic function monitoring only pre-treatment
D. Peripheral neuropathy assessment weekly
Correct Answer: B
Rationale: Trastuzumab deruxtecan carries a black box warning for interstitial lung disease
(ILD) and pneumonitis, with an incidence of approximately 10-15% (B). Nurses must educate
patients on respiratory symptoms and ensure immediate evaluation. Cardiac monitoring (A) is
less critical than with trastuzumab; hepatic monitoring (C) and neuropathy (D) are not the
primary concerns.
Q6: A 55-year-old with metastatic colorectal cancer and MSI-high status is initiating nivolumab
plus ipilimumab. What is the current recommended duration of combination therapy?
A. Until progression or unacceptable toxicity
B. Nivolumab 3 mg/kg plus ipilimumab 1 mg/kg for 4 doses, then nivolumab maintenance.
[CORRECT]
C. 12 months fixed duration
D. Ipilimumab indefinitely with nivolumab for 2 years
Correct Answer: B
Rationale: The approved regimen for MSI-H colorectal cancer is nivolumab 3 mg/kg plus
ipilimumab 1 mg/kg every 3 weeks for 4 doses, followed by nivolumab maintenance every 2
weeks (B). This limited ipilimumab exposure reduces severe toxicity while maintaining efficacy.
Indefinite ipilimumab (D) is not recommended due to toxicity.
Q7: A patient with advanced endometrial cancer is prescribed dostarlimab. Which biomarker
determines eligibility for this agent?
A. HER2 amplification
B. dMMR/MSI-H status. [CORRECT]
C. BRCA1/2 mutation
D. PD-L1 CPS ≥10
Correct Answer: B
Rationale: Dostarlimab is approved for dMMR (mismatch repair deficient) recurrent or
advanced endometrial cancer based on the GARNET trial (B). While pembrolizumab has broader
indications, dostarlimab specifically requires dMMR/MSI-H status. PD-L1 status (D) is not
required for this indication.
ONS ONCC Chemo Renewal Exam Actual Exam
2026/2027 | Complete Chemotherapy
Immunotherapy Renewal Exam Prep with
Verified Questions and Answers | Updated for
Current Guidelines | A+ Graded
SECTION 1: NEW AGENTS & UPDATED GUIDELINES
Q1: A patient with metastatic triple-negative breast cancer is being started on sacituzumab
govitecan. The nurse understands that this medication belongs to which class of anticancer
agents?
A. Immune checkpoint inhibitor
B. Antibody-drug conjugate (ADC). [CORRECT]
C. Bispecific T-cell engager (BiTE)
D. Tyrosine kinase inhibitor (TKI)
Correct Answer: B
Rationale: Sacituzumab govitecan is an antibody-drug conjugate (ADC) consisting of an anti-
Trop-2 monoclonal antibody linked to SN-38, the active metabolite of irinotecan (B). This
targeted delivery mechanism allows for intracellular release of the cytotoxic payload in Trop-2-
expressing tumor cells. It is not an immune checkpoint inhibitor (A), BiTE (C), or TKI (D).
Q2: A 68-year-old patient with metastatic non-small cell lung cancer (NSCLC) and PD-L1
expression ≥50% is initiating first-line treatment with pembrolizumab plus chemotherapy.
According to current NCCN and ASCO guidelines, what is the recommended duration of
pembrolizumab therapy?
A. 12 months regardless of response
B. 24 months or until disease progression/unacceptable toxicity, whichever occurs first.
[CORRECT]
C. Indefinitely until progression
D. 6 cycles only
Correct Answer: B
,2
Rationale: Current evidence supports treating with pembrolizumab for up to 24 months or until
disease progression or unacceptable toxicity (B), based on KEYNOTE-189/407 trial data
showing sustained benefit. Fixed-duration therapy at 24 months is now standard to balance
efficacy with toxicity and cost, rather than indefinite treatment (C) or arbitrary 12-month limits
(A).
Q3: A patient with relapsed/refractory multiple myeloma is prescribed teclistamab. The nurse
recognizes this agent represents which therapeutic class?
A. CAR-T cell therapy
B. Bispecific antibody targeting BCMA and CD3. [CORRECT]
C. Proteasome inhibitor
D. Anti-CD38 monoclonal antibody
Correct Answer: B
Rationale: Teclistamab is a bispecific T-cell engager (BiTE) antibody that simultaneously binds
BCMA on myeloma cells and CD3 on T cells, activating T-cell-mediated cytotoxicity (B). Unlike
CAR-T (A), it is an off-the-shelf product administered subcutaneously. It is not a proteasome
inhibitor (C) or anti-CD38 antibody (D).
Q4: According to the updated 2024 ASCO antiemetic guidelines, which combination is now
recommended for highly emetogenic chemotherapy (HEC) in the delayed phase (days 2-3)?
A. Dexamethasone alone
B. Olanzapine plus dexamethasone. [CORRECT]
C. Metoclopramide only
D. Lorazepam plus prochlorperazine
Correct Answer: B
Rationale: The 2024 ASCO guidelines recommend adding olanzapine to dexamethasone for
delayed phase CINV prevention with HEC (B), based on improved control over neurokinin-1
receptor antagonist combinations. Olanzapine's multi-receptor antagonism (dopamine, serotonin,
histamine, muscarinic) provides superior delayed phase protection.
Q5: A patient with HER2-low metastatic breast cancer is starting trastuzumab deruxtecan. What
is the critical monitoring requirement specific to this ADC?
A. Routine cardiac ejection fraction monitoring every 3 months
B. Interstitial lung disease/pneumonitis surveillance. [CORRECT]
, 3
C. Hepatic function monitoring only pre-treatment
D. Peripheral neuropathy assessment weekly
Correct Answer: B
Rationale: Trastuzumab deruxtecan carries a black box warning for interstitial lung disease
(ILD) and pneumonitis, with an incidence of approximately 10-15% (B). Nurses must educate
patients on respiratory symptoms and ensure immediate evaluation. Cardiac monitoring (A) is
less critical than with trastuzumab; hepatic monitoring (C) and neuropathy (D) are not the
primary concerns.
Q6: A 55-year-old with metastatic colorectal cancer and MSI-high status is initiating nivolumab
plus ipilimumab. What is the current recommended duration of combination therapy?
A. Until progression or unacceptable toxicity
B. Nivolumab 3 mg/kg plus ipilimumab 1 mg/kg for 4 doses, then nivolumab maintenance.
[CORRECT]
C. 12 months fixed duration
D. Ipilimumab indefinitely with nivolumab for 2 years
Correct Answer: B
Rationale: The approved regimen for MSI-H colorectal cancer is nivolumab 3 mg/kg plus
ipilimumab 1 mg/kg every 3 weeks for 4 doses, followed by nivolumab maintenance every 2
weeks (B). This limited ipilimumab exposure reduces severe toxicity while maintaining efficacy.
Indefinite ipilimumab (D) is not recommended due to toxicity.
Q7: A patient with advanced endometrial cancer is prescribed dostarlimab. Which biomarker
determines eligibility for this agent?
A. HER2 amplification
B. dMMR/MSI-H status. [CORRECT]
C. BRCA1/2 mutation
D. PD-L1 CPS ≥10
Correct Answer: B
Rationale: Dostarlimab is approved for dMMR (mismatch repair deficient) recurrent or
advanced endometrial cancer based on the GARNET trial (B). While pembrolizumab has broader
indications, dostarlimab specifically requires dMMR/MSI-H status. PD-L1 status (D) is not
required for this indication.
