ONS/ONCC Chemotherapy &
Immunotherapy Certification Practice
Exam 2026: 150 Questions with
Answers & Rationales
Section 1: Foundations of Oncology Nursing & Safe Handling (Questions 1-
30)
1. What is the primary purpose of the ONS Chemotherapy and
Immunotherapy Certificate?
A. To license nurses to prescribe chemotherapy
B. To validate specialized knowledge and competence in administering these
agents
C. To replace state nursing board requirements
D. To certify a facility for chemotherapy administration
Answer: B. To validate specialized knowledge and competence in
administering these agents
Rationale: The ONS/ONCC certificate is a credential that demonstrates a
nurse has acquired the specialized knowledge and competence required for
safe administration of chemotherapy and immunotherapy.
2. According to ONS guidelines, what is the minimum level of personal
protective equipment (PPE) required for administering hazardous drugs?
A. Standard precautions only
B. Gloves and a surgical mask
C. Two pairs of chemotherapy-tested gloves, a chemotherapy gown, and a
face shield or goggles
D. A gown and single gloves
,Answer: C. Two pairs of chemotherapy-tested gloves, a chemotherapy gown,
and a face shield or goggles
Rationale: ONS and NIOSH recommend double gloving with chemotherapy-
tested gloves, a disposable, closed-front chemotherapy gown, and eye/face
protection (goggles or face shield) for all hazardous drug administration.
3. What does "NIOSH" stand for and what is its role in hazardous drug
safety?
A. National Institute for Occupational Safety and Health; publishes a list of
hazardous drugs
B. National Institute of Oncology Safety and Health; certifies oncology
nurses
C. National Organization for Infection Safety; sets PPE standards
D. Nursing Institute for Occupational Safety; provides continuing education
Answer: A. National Institute for Occupational Safety and Health; publishes
a list of hazardous drugs
Rationale: NIOSH is the federal agency that conducts research and publishes
the "NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare
Settings," which identifies drugs requiring safe handling precautions.
4. What is the recommended frequency for changing chemotherapy gloves
during administration?
A. Every 15 minutes
B. Every 30 minutes
C. Every 60 minutes
D. Only if visibly soiled
Answer: B. Every 30 minutes
Rationale: ONS guidelines recommend changing chemotherapy gloves every
30 minutes during continuous administration and immediately if they are
torn, punctured, or contaminated.
5. Which of the following is NOT a recommended component of a hazardous
drug spill kit?
A. Chemotherapy-tested gloves
,B. Absorbent pads
C. Dustpan and broom
D. Disposable gown and goggles
Answer: C. Dustpan and broom
Rationale: A spill kit should contain absorbent pads, two pairs of
chemotherapy-tested gloves, a disposable gown, goggles, a mask, a scoop,
and a puncture-resistant container. Brooms and dustpans can aerosolize the
drug and should not be used.
6. What is the correct procedure for removing PPE after administering
hazardous drugs?
A. Remove gloves first, then gown
B. Remove gown first, then gloves
C. Remove both together
D. No specific order is required
Answer: A. Remove gloves first, then gown
Rationale: The correct order is to remove the outer gloves first, then the
gown, then the inner gloves, performing hand hygiene between each step to
minimize skin contact with contaminants.
7. Where should chemotherapy waste be disposed?
A. Regular trash
B. Red biohazard bag
C. Yellow chemotherapy waste container
D. Sharps container only
Answer: C. Yellow chemotherapy waste container
Rationale: Hazardous drug waste (including empty IV bags, tubing, and
contaminated PPE) must be disposed of in designated yellow chemotherapy
waste containers, often labeled "Trace Chemo" or "Hazardous Drug Waste."
8. What is the primary route of occupational exposure to hazardous drugs
for nurses?
A. Inhalation
, B. Dermal absorption
C. Ingestion
D. Needlestick injury
Answer: B. Dermal absorption
Rationale: The most common route of occupational exposure is dermal
(skin) absorption, often through splashes, spills, or contact with
contaminated surfaces. Proper PPE and surface decontamination are critical.
9. What is the recommended location for preparing hazardous drugs?
A. At the patient's bedside
B. In a designated biological safety cabinet (BSC) or containment isolator
C. In an open area with good ventilation
D. In a medication room with a standard laminar flow hood
Answer: B. In a designated biological safety cabinet (BSC) or containment
isolator
Rationale: Hazardous drugs must be prepared in a Class II or III biological
safety cabinet (BSC) or a containment isolator designed to protect the
worker from exposure.
10. What is the purpose of "closed system transfer devices" (CSTDs)?
A. To increase the speed of drug administration
B. To mechanically prevent the transfer of contaminants and hazardous drug
vapors
C. To reduce the cost of chemotherapy
D. To allow for bedside preparation
Answer: B. To mechanically prevent the transfer of contaminants and
hazardous drug vapors
Rationale: CSTDs (e.g., PhaSeal, Equashield) are devices that provide a
closed, leak-proof system for transferring hazardous drugs, reducing the risk
of environmental contamination and occupational exposure.
11. What should a nurse do immediately after a chemotherapy spill on the
skin?
Immunotherapy Certification Practice
Exam 2026: 150 Questions with
Answers & Rationales
Section 1: Foundations of Oncology Nursing & Safe Handling (Questions 1-
30)
1. What is the primary purpose of the ONS Chemotherapy and
Immunotherapy Certificate?
A. To license nurses to prescribe chemotherapy
B. To validate specialized knowledge and competence in administering these
agents
C. To replace state nursing board requirements
D. To certify a facility for chemotherapy administration
Answer: B. To validate specialized knowledge and competence in
administering these agents
Rationale: The ONS/ONCC certificate is a credential that demonstrates a
nurse has acquired the specialized knowledge and competence required for
safe administration of chemotherapy and immunotherapy.
2. According to ONS guidelines, what is the minimum level of personal
protective equipment (PPE) required for administering hazardous drugs?
A. Standard precautions only
B. Gloves and a surgical mask
C. Two pairs of chemotherapy-tested gloves, a chemotherapy gown, and a
face shield or goggles
D. A gown and single gloves
,Answer: C. Two pairs of chemotherapy-tested gloves, a chemotherapy gown,
and a face shield or goggles
Rationale: ONS and NIOSH recommend double gloving with chemotherapy-
tested gloves, a disposable, closed-front chemotherapy gown, and eye/face
protection (goggles or face shield) for all hazardous drug administration.
3. What does "NIOSH" stand for and what is its role in hazardous drug
safety?
A. National Institute for Occupational Safety and Health; publishes a list of
hazardous drugs
B. National Institute of Oncology Safety and Health; certifies oncology
nurses
C. National Organization for Infection Safety; sets PPE standards
D. Nursing Institute for Occupational Safety; provides continuing education
Answer: A. National Institute for Occupational Safety and Health; publishes
a list of hazardous drugs
Rationale: NIOSH is the federal agency that conducts research and publishes
the "NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare
Settings," which identifies drugs requiring safe handling precautions.
4. What is the recommended frequency for changing chemotherapy gloves
during administration?
A. Every 15 minutes
B. Every 30 minutes
C. Every 60 minutes
D. Only if visibly soiled
Answer: B. Every 30 minutes
Rationale: ONS guidelines recommend changing chemotherapy gloves every
30 minutes during continuous administration and immediately if they are
torn, punctured, or contaminated.
5. Which of the following is NOT a recommended component of a hazardous
drug spill kit?
A. Chemotherapy-tested gloves
,B. Absorbent pads
C. Dustpan and broom
D. Disposable gown and goggles
Answer: C. Dustpan and broom
Rationale: A spill kit should contain absorbent pads, two pairs of
chemotherapy-tested gloves, a disposable gown, goggles, a mask, a scoop,
and a puncture-resistant container. Brooms and dustpans can aerosolize the
drug and should not be used.
6. What is the correct procedure for removing PPE after administering
hazardous drugs?
A. Remove gloves first, then gown
B. Remove gown first, then gloves
C. Remove both together
D. No specific order is required
Answer: A. Remove gloves first, then gown
Rationale: The correct order is to remove the outer gloves first, then the
gown, then the inner gloves, performing hand hygiene between each step to
minimize skin contact with contaminants.
7. Where should chemotherapy waste be disposed?
A. Regular trash
B. Red biohazard bag
C. Yellow chemotherapy waste container
D. Sharps container only
Answer: C. Yellow chemotherapy waste container
Rationale: Hazardous drug waste (including empty IV bags, tubing, and
contaminated PPE) must be disposed of in designated yellow chemotherapy
waste containers, often labeled "Trace Chemo" or "Hazardous Drug Waste."
8. What is the primary route of occupational exposure to hazardous drugs
for nurses?
A. Inhalation
, B. Dermal absorption
C. Ingestion
D. Needlestick injury
Answer: B. Dermal absorption
Rationale: The most common route of occupational exposure is dermal
(skin) absorption, often through splashes, spills, or contact with
contaminated surfaces. Proper PPE and surface decontamination are critical.
9. What is the recommended location for preparing hazardous drugs?
A. At the patient's bedside
B. In a designated biological safety cabinet (BSC) or containment isolator
C. In an open area with good ventilation
D. In a medication room with a standard laminar flow hood
Answer: B. In a designated biological safety cabinet (BSC) or containment
isolator
Rationale: Hazardous drugs must be prepared in a Class II or III biological
safety cabinet (BSC) or a containment isolator designed to protect the
worker from exposure.
10. What is the purpose of "closed system transfer devices" (CSTDs)?
A. To increase the speed of drug administration
B. To mechanically prevent the transfer of contaminants and hazardous drug
vapors
C. To reduce the cost of chemotherapy
D. To allow for bedside preparation
Answer: B. To mechanically prevent the transfer of contaminants and
hazardous drug vapors
Rationale: CSTDs (e.g., PhaSeal, Equashield) are devices that provide a
closed, leak-proof system for transferring hazardous drugs, reducing the risk
of environmental contamination and occupational exposure.
11. What should a nurse do immediately after a chemotherapy spill on the
skin?
