ONS CHEMO CERTIFICATION EXAM
UPDATED QUESTIONS WITH
ANSWERS 2026/2027 LATEST STUDY GUIDE
What pre-administration blood tests should be included in alkylating
agents? - CORRECT ANSWER>>>>BUN, creatinine, CBC with diff
Are alkylating agents emetogenic? - CORRECT ANSWER>>>>Yes,
highly emetogenic
What is a bladder protectant typically administered with
cyclophosphamide and ifosfamide? -
CORRECT ANSWER>>>>Mesna
What is the main nursing teaching to include with oxaliplatin? -
CORRECT
ANSWER>>>>Avoid exposure to cold air and consuming cold fluids 3-
4 days following treatment
Page 1 of 41
,What are the most nephrotoxic alkylating agents? - CORRECT
ANSWER>>>>Streptozocin and semustine, affecting more than 75% of
patients, which may lead to treatment delays
What side effect can occur with alkylating agents/nitrosoureas that
may worsen with dehydration? - CORRECT ANSWER>>>>Pruritis
and itching; encourage patients to drink at least 8-10 glasses of
fluid/day, minimize salt and alcohol intake
Alkylating agents and nitrosoureas have the potential to cause what? -
CORRECT ANSWER>>>>Secondary malignancies and fertility issues
Long-term myelosuppression can lead to what? - CORRECT
ANSWER>>>>The development of a secondary malignancy, 5-10 years
after treatment
What is a short-term side efect of nitrosoureas (particularly carmustine
and lomustine)? -
CORRECT ANSWER>>>>Kidney disease
Long-term side effects of carmustine and lomustine - CORRECT
ANSWER>>>>Reduction of pulmonary function: delayed pulmonary
Page 2 of 41
,fibrosis--17 years after tx for patients who received this in
childhood/early adolescence
What test should be performed prior to treatment with carmustine or
lomustine? - CORRECT
ANSWER>>>>Baseline pulmonary function tests, there are fatal cases
of pulmonary toxicity How do antimetabolites function? - CORRECT
ANSWER>>>>By blocking DNA and RNA growth by interfering with
enzymes that are necessary for normal cell metabolism
What phase of the cell cycle do antimetabolites work? - CORRECT
ANSWER>>>>The S phase, so they are highly effective on tumors with
fast growth rates
Most common antimetabolites: - CORRECT ANSWER>>>>Azacitidine
(Vidaza), Capecitabine (Xeloda), 5-Fluorourcacil (5-FU), Cytarabine
(Ara-C), Decitabine (Dacogen), Methotrexate
What cancers does fluorouracil treat? - CORRECT
ANSWER>>>>Adenocarcinoma of colon and rectum, adenocarcinoma
of breast, gastric adenocarcinoma, pancreatic adenocarcinoma
Page 3 of 41
, What are very common side effects of antimetabolites? - CORRECT
ANSWER>>>>Mucositis, diarrhea, myelosuppression, photosensitivity,
hand-foot syndrome
Can antimetabolites be administered many routes? - CORRECT
ANSWER>>>>Yes, very correct route
Nursing teaching for methotrexate - CORRECT ANSWER>>>>Drug
is yellow, large range of doses, maintain hydration, monitor renal
function, encourage oral hygiene, discourage alcohol use, avoid folic
acid, avoid sun exposure, avoid with pleural/pericardial effusions and
ascites
What is an example of an antimetabolite whose toxicities change with
dose and rate of infusion?
- CORRECT ANSWER>>>>Cytarabine
Which antimetabolite has unique considerations for SC administration? -
CORRECT ANSWER>>>>Azacitidine
What does azacitidine treat? - CORRECT
ANSWER>>>>Myelodysplastic syndrome (MDS)
Page 4 of 41
UPDATED QUESTIONS WITH
ANSWERS 2026/2027 LATEST STUDY GUIDE
What pre-administration blood tests should be included in alkylating
agents? - CORRECT ANSWER>>>>BUN, creatinine, CBC with diff
Are alkylating agents emetogenic? - CORRECT ANSWER>>>>Yes,
highly emetogenic
What is a bladder protectant typically administered with
cyclophosphamide and ifosfamide? -
CORRECT ANSWER>>>>Mesna
What is the main nursing teaching to include with oxaliplatin? -
CORRECT
ANSWER>>>>Avoid exposure to cold air and consuming cold fluids 3-
4 days following treatment
Page 1 of 41
,What are the most nephrotoxic alkylating agents? - CORRECT
ANSWER>>>>Streptozocin and semustine, affecting more than 75% of
patients, which may lead to treatment delays
What side effect can occur with alkylating agents/nitrosoureas that
may worsen with dehydration? - CORRECT ANSWER>>>>Pruritis
and itching; encourage patients to drink at least 8-10 glasses of
fluid/day, minimize salt and alcohol intake
Alkylating agents and nitrosoureas have the potential to cause what? -
CORRECT ANSWER>>>>Secondary malignancies and fertility issues
Long-term myelosuppression can lead to what? - CORRECT
ANSWER>>>>The development of a secondary malignancy, 5-10 years
after treatment
What is a short-term side efect of nitrosoureas (particularly carmustine
and lomustine)? -
CORRECT ANSWER>>>>Kidney disease
Long-term side effects of carmustine and lomustine - CORRECT
ANSWER>>>>Reduction of pulmonary function: delayed pulmonary
Page 2 of 41
,fibrosis--17 years after tx for patients who received this in
childhood/early adolescence
What test should be performed prior to treatment with carmustine or
lomustine? - CORRECT
ANSWER>>>>Baseline pulmonary function tests, there are fatal cases
of pulmonary toxicity How do antimetabolites function? - CORRECT
ANSWER>>>>By blocking DNA and RNA growth by interfering with
enzymes that are necessary for normal cell metabolism
What phase of the cell cycle do antimetabolites work? - CORRECT
ANSWER>>>>The S phase, so they are highly effective on tumors with
fast growth rates
Most common antimetabolites: - CORRECT ANSWER>>>>Azacitidine
(Vidaza), Capecitabine (Xeloda), 5-Fluorourcacil (5-FU), Cytarabine
(Ara-C), Decitabine (Dacogen), Methotrexate
What cancers does fluorouracil treat? - CORRECT
ANSWER>>>>Adenocarcinoma of colon and rectum, adenocarcinoma
of breast, gastric adenocarcinoma, pancreatic adenocarcinoma
Page 3 of 41
, What are very common side effects of antimetabolites? - CORRECT
ANSWER>>>>Mucositis, diarrhea, myelosuppression, photosensitivity,
hand-foot syndrome
Can antimetabolites be administered many routes? - CORRECT
ANSWER>>>>Yes, very correct route
Nursing teaching for methotrexate - CORRECT ANSWER>>>>Drug
is yellow, large range of doses, maintain hydration, monitor renal
function, encourage oral hygiene, discourage alcohol use, avoid folic
acid, avoid sun exposure, avoid with pleural/pericardial effusions and
ascites
What is an example of an antimetabolite whose toxicities change with
dose and rate of infusion?
- CORRECT ANSWER>>>>Cytarabine
Which antimetabolite has unique considerations for SC administration? -
CORRECT ANSWER>>>>Azacitidine
What does azacitidine treat? - CORRECT
ANSWER>>>>Myelodysplastic syndrome (MDS)
Page 4 of 41
