ONS/ONCC Chemotherapy & Immunotherapy
Certificate Exam 2026 – Verified Questions &
Correct Answers (Latest Updated Study Guide)
ONS/ONCC CHEMOTHERAPY & IMMUNOTHERAPY CERTIFICATE EXAM 2026 Verified
Questions & CORRECT ANSWERs — Latest Updated Study Guide
This question study guide mirrors the format and depth of the actual ONS/ONCC
exam. Read each question carefully, review the CORRECT ANSWER and EXPERT
RATIONALE, then revisit any topic where you feel uncertain before test day.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
1. Which personal protective equipment (PPE) is MOST important when
preparing chemotherapy agents?
A. Surgical mask and gloves
B. N95 respirator and gown
C. Double chemotherapy-rated gloves, gown, and eye protection
D. Single gloves and face shield only
E. Standard isolation gown and surgical mask
✔ CORRECT ANSWER: C. Double chemotherapy-rated gloves, gown, and eye
protection
EXPERT RATIONALE: NIOSH and ONS guidelines require double chemotherapy-
rated gloves, a closed-front gown made of low-permeability fabric, and eye/face
protection when preparing or handling hazardous drugs to minimize dermal and
mucosal exposure.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
2. A patient is receiving doxorubicin. The nurse knows the lifetime cumulative
dose limit is:
A. 200 mg/m²
B. 350 mg/m²
,C. 450 mg/m²
D. 550 mg/m²
E. 650 mg/m²
✔ CORRECT ANSWER: D. 550 mg/m²
EXPERT RATIONALE: The lifetime cumulative dose of doxorubicin is generally
capped at 550 mg/m² (or 450 mg/m² in patients with prior chest radiation) to
reduce the risk of irreversible cardiomyopathy and heart failure.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
3. Which chemotherapy agent is classified as a vesicant?
A. Carboplatin
B. Rituximab
C. Fluorouracil (5-FU)
D. Methotrexate
E. Vincristine
✔ CORRECT ANSWER: E. Vincristine
EXPERT RATIONALE: Vincristine is a vesicant, meaning extravasation can cause
severe tissue necrosis. Nurses must monitor IV sites closely during administration
and know the antidote protocol.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
4. When an extravasation of a vesicant is suspected, the FIRST nursing action is:
A. Apply ice to the site immediately
B. Administer the antidote subcutaneously
C. Notify the physician
D. Stop the infusion immediately and disconnect the IV tubing
,E. Flush the line with normal saline
✔ CORRECT ANSWER: D. Stop the infusion immediately and disconnect the IV
tubing
EXPERT RATIONALE: The priority is to stop further drug infiltration. The tubing
is disconnected (not flushed) to avoid pushing more drug into the tissue.
Subsequent steps include aspirating residual drug and following site-specific
antidote protocols.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
5. Which antidote is used for extravasation of anthracyclines such as
doxorubicin?
A. Sodium thiosulfate
B. Hyaluronidase
C. Vitamin C topical
D. Dexrazoxane (Totect)
E. Dimethyl sulfoxide (DMSO)
✔ CORRECT ANSWER: D. Dexrazoxane (Totect)
EXPERT RATIONALE: Dexrazoxane (Totect) is the FDA-approved antidote for
anthracycline extravasation. It must be administered IV within 6 hours of
extravasation. DMSO was previously used but is no longer the standard of care for
anthracyclines.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
6. A nurse is preparing to administer intrathecal chemotherapy. Which drug
should NEVER be given intrathecally?
A. Methotrexate
B. Cytarabine
, C. Hydrocortisone
D. Vincristine
E. Thiotepa
✔ CORRECT ANSWER: D. Vincristine
EXPERT RATIONALE: Intrathecal administration of vincristine is uniformly fatal.
It causes ascending paralysis and death. ONS and ISMP list this as a high-alert
medication error. Vincristine must always be labeled "For IV use only — fatal if given
by other routes."
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
7. Which emetogenic category does cisplatin belong to?
A. Minimal
B. Low
C. Moderate
D. High
E. Very low
✔ CORRECT ANSWER: D. High
EXPERT RATIONALE: Cisplatin is one of the most highly emetogenic
chemotherapy agents. It requires prophylactic antiemetic regimens including a 5-
HT3 antagonist, NK1 receptor antagonist, and dexamethasone before
administration.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
8. Which of the following is a hallmark sign of tumor lysis syndrome (TLS)?
A. Hypercalcemia
B. Hypernatremia
Certificate Exam 2026 – Verified Questions &
Correct Answers (Latest Updated Study Guide)
ONS/ONCC CHEMOTHERAPY & IMMUNOTHERAPY CERTIFICATE EXAM 2026 Verified
Questions & CORRECT ANSWERs — Latest Updated Study Guide
This question study guide mirrors the format and depth of the actual ONS/ONCC
exam. Read each question carefully, review the CORRECT ANSWER and EXPERT
RATIONALE, then revisit any topic where you feel uncertain before test day.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
1. Which personal protective equipment (PPE) is MOST important when
preparing chemotherapy agents?
A. Surgical mask and gloves
B. N95 respirator and gown
C. Double chemotherapy-rated gloves, gown, and eye protection
D. Single gloves and face shield only
E. Standard isolation gown and surgical mask
✔ CORRECT ANSWER: C. Double chemotherapy-rated gloves, gown, and eye
protection
EXPERT RATIONALE: NIOSH and ONS guidelines require double chemotherapy-
rated gloves, a closed-front gown made of low-permeability fabric, and eye/face
protection when preparing or handling hazardous drugs to minimize dermal and
mucosal exposure.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
2. A patient is receiving doxorubicin. The nurse knows the lifetime cumulative
dose limit is:
A. 200 mg/m²
B. 350 mg/m²
,C. 450 mg/m²
D. 550 mg/m²
E. 650 mg/m²
✔ CORRECT ANSWER: D. 550 mg/m²
EXPERT RATIONALE: The lifetime cumulative dose of doxorubicin is generally
capped at 550 mg/m² (or 450 mg/m² in patients with prior chest radiation) to
reduce the risk of irreversible cardiomyopathy and heart failure.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
3. Which chemotherapy agent is classified as a vesicant?
A. Carboplatin
B. Rituximab
C. Fluorouracil (5-FU)
D. Methotrexate
E. Vincristine
✔ CORRECT ANSWER: E. Vincristine
EXPERT RATIONALE: Vincristine is a vesicant, meaning extravasation can cause
severe tissue necrosis. Nurses must monitor IV sites closely during administration
and know the antidote protocol.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
4. When an extravasation of a vesicant is suspected, the FIRST nursing action is:
A. Apply ice to the site immediately
B. Administer the antidote subcutaneously
C. Notify the physician
D. Stop the infusion immediately and disconnect the IV tubing
,E. Flush the line with normal saline
✔ CORRECT ANSWER: D. Stop the infusion immediately and disconnect the IV
tubing
EXPERT RATIONALE: The priority is to stop further drug infiltration. The tubing
is disconnected (not flushed) to avoid pushing more drug into the tissue.
Subsequent steps include aspirating residual drug and following site-specific
antidote protocols.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
5. Which antidote is used for extravasation of anthracyclines such as
doxorubicin?
A. Sodium thiosulfate
B. Hyaluronidase
C. Vitamin C topical
D. Dexrazoxane (Totect)
E. Dimethyl sulfoxide (DMSO)
✔ CORRECT ANSWER: D. Dexrazoxane (Totect)
EXPERT RATIONALE: Dexrazoxane (Totect) is the FDA-approved antidote for
anthracycline extravasation. It must be administered IV within 6 hours of
extravasation. DMSO was previously used but is no longer the standard of care for
anthracyclines.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
6. A nurse is preparing to administer intrathecal chemotherapy. Which drug
should NEVER be given intrathecally?
A. Methotrexate
B. Cytarabine
, C. Hydrocortisone
D. Vincristine
E. Thiotepa
✔ CORRECT ANSWER: D. Vincristine
EXPERT RATIONALE: Intrathecal administration of vincristine is uniformly fatal.
It causes ascending paralysis and death. ONS and ISMP list this as a high-alert
medication error. Vincristine must always be labeled "For IV use only — fatal if given
by other routes."
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
7. Which emetogenic category does cisplatin belong to?
A. Minimal
B. Low
C. Moderate
D. High
E. Very low
✔ CORRECT ANSWER: D. High
EXPERT RATIONALE: Cisplatin is one of the most highly emetogenic
chemotherapy agents. It requires prophylactic antiemetic regimens including a 5-
HT3 antagonist, NK1 receptor antagonist, and dexamethasone before
administration.
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
━━━━━━━━━━━━
8. Which of the following is a hallmark sign of tumor lysis syndrome (TLS)?
A. Hypercalcemia
B. Hypernatremia
