ONS ONCC Chemo Renewal
QUESTIONS AND ANSWERS
2025/2026 EXAM.
1. What is the main benefit of neoadjuvant chemotherapy for a breast cancer
patient?
A) It increases overall survival compared to adjuvant therapy.
B) It decreases the need for radiation therapy.
C) It changes the timing of treatment and can change surgical options if the tumor
is shrunk enough.
D) It eliminates the need for any surgical intervention.
Correct Answer: C
Rationale: Neoadjuvant therapy does not increase survival time compared to
adjuvant therapy. It only changes the timing of treatment and can change surgical
options if the tumor is shrunk enough. If this occurs, the patient may only require a
lumpectomy plus radiation therapy instead of receiving a mastectomy.
2. The NCCN Other Adult Oncology Clinical Practice Guidelines (CPGs) state
that more than 60% of cancer in the United States occurs in people age
______ and older.
A) 50
B) 55
C) 60
D) 65
Correct Answer: D
Rationale: Currently, more than 60% of cancers in the United States occur in
people age 65 and older, and as the oncology population ages, nearly half (46%) of
cancer survivors are 70 years of age or older.
,3. Which of the following is a core domain of a comprehensive geriatric
assessment (CGA) in older adults with cancer?
A) Tumor mutational burden
B) Chemotherapy dose intensity
C) Functional status and cognitive function
D) Circulating tumor DNA levels
Correct Answer: C
Rationale: Comprehensive geriatric assessment includes evaluation of functional
status, cognitive function, nutritional status, comorbidities, polypharmacy, and
social support. Tumor markers and genetic profiling are not part of CGA.
4. A patient is receiving docetaxel and carboplatin for lung cancer. Why might
a central venous access device (port) be recommended?
A) She is older in age, requiring a central line.
B) All IV chemotherapy requires a port.
C) Two of the agents (docetaxel and carboplatin) are irritants and can cause
significant reaction if they extravasate.
D) Vesicants in her regimen make a port mandatory.
Correct Answer: C
Rationale: Docetaxel and carboplatin are categorized as irritants. Docetaxel can
cause a significant reaction if it extravasates, leading to edema, pain, and possible
blister formation. This is the most likely cause for port placement, not age alone.
5. ______ can cause inflammation, pain, and burning but rarely cause tissue
necrosis comparable to a vesicant.
A) Vesicants
B) Irritants
C) DNA-binding agents
D) Non-DNA-binding agents
Correct Answer: B
Rationale: Irritants cause inflammation, pain, and burning at the extravasation site
,but rarely cause tissue necrosis. Vesicants, in contrast, can cause blistering and
severe tissue destruction.
6. ______ can cause blistering and significant pain and tissue damage and
destruction, leading to tissue death.
A) Irritants
B) Vesicants
C) Antiemetics
D) Growth factors
Correct Answer: B
Rationale: Vesicants are chemotherapeutic agents that can cause blistering, severe
pain, tissue damage, and necrosis if extravasated. Examples include anthracyclines
(doxorubicin), vinca alkaloids, and nitrogen mustards.
7. A further classification of an antineoplastic agent’s potential to cause
damage is whether its mechanism of action includes ______.
A) Protein binding
B) Cell cycle specificity
C) DNA binding
D) Receptor antagonism
Correct Answer: C
Rationale: DNA-binding agents (e.g., alkylating agents, platinum compounds,
anthracyclines) bind to DNA, leading to cellular damage that may be more severe
and prolonged in surrounding tissues after extravasation. This classification helps
predict vesicant potential.
8. A patient receiving cisplatin reports tinnitus and a feeling of fullness in the
ears. What is the priority nursing action?
A) Administer furosemide to reduce fluid overload.
B) Notify the provider immediately and prepare for audiometry.
C) Reassure the patient that this is a temporary side effect.
D) Decrease the infusion rate by half.
, Correct Answer: B
Rationale: Cisplatin causes cumulative ototoxicity, often starting with tinnitus and
high-frequency hearing loss. The provider should be notified to assess and possibly
modify therapy. Audiometry should be ordered.
9. Which antiemetic regimen is most appropriate for a patient receiving
highly emetogenic chemotherapy (e.g., cisplatin ≥70 mg/m²)?
A) Aprepitant + ondansetron + dexamethasone
B) Metoclopramide alone
C) Prochlorperazine as needed
D) Ondansetron only
Correct Answer: A
Rationale: Current guidelines recommend a three-drug regimen of NK1 receptor
antagonist (aprepitant), 5-HT3 antagonist (ondansetron), and dexamethasone for
highly emetogenic chemotherapy.
10. A patient develops a fever of 38.5°C (101.3°F) and neutropenia (ANC
200/mm³) 10 days after chemotherapy. What is the most appropriate initial
intervention?
A) Administer acetaminophen and discharge home with follow-up.
B) Obtain blood cultures and initiate broad-spectrum IV antibiotics.
C) Give oral ciprofloxacin and have the patient return in 24 hours.
D) Delay antibiotics pending culture results.
Correct Answer: B
Rationale: Febrile neutropenia is an oncologic emergency requiring immediate
blood cultures and empiric broad-spectrum IV antibiotics. Delays increase
morbidity and mortality.
11. Which chemotherapy agent requires an test for glucose-6-phosphate
dehydrogenase (G6PD) deficiency before administration due to risk of
hemolytic anemia?
QUESTIONS AND ANSWERS
2025/2026 EXAM.
1. What is the main benefit of neoadjuvant chemotherapy for a breast cancer
patient?
A) It increases overall survival compared to adjuvant therapy.
B) It decreases the need for radiation therapy.
C) It changes the timing of treatment and can change surgical options if the tumor
is shrunk enough.
D) It eliminates the need for any surgical intervention.
Correct Answer: C
Rationale: Neoadjuvant therapy does not increase survival time compared to
adjuvant therapy. It only changes the timing of treatment and can change surgical
options if the tumor is shrunk enough. If this occurs, the patient may only require a
lumpectomy plus radiation therapy instead of receiving a mastectomy.
2. The NCCN Other Adult Oncology Clinical Practice Guidelines (CPGs) state
that more than 60% of cancer in the United States occurs in people age
______ and older.
A) 50
B) 55
C) 60
D) 65
Correct Answer: D
Rationale: Currently, more than 60% of cancers in the United States occur in
people age 65 and older, and as the oncology population ages, nearly half (46%) of
cancer survivors are 70 years of age or older.
,3. Which of the following is a core domain of a comprehensive geriatric
assessment (CGA) in older adults with cancer?
A) Tumor mutational burden
B) Chemotherapy dose intensity
C) Functional status and cognitive function
D) Circulating tumor DNA levels
Correct Answer: C
Rationale: Comprehensive geriatric assessment includes evaluation of functional
status, cognitive function, nutritional status, comorbidities, polypharmacy, and
social support. Tumor markers and genetic profiling are not part of CGA.
4. A patient is receiving docetaxel and carboplatin for lung cancer. Why might
a central venous access device (port) be recommended?
A) She is older in age, requiring a central line.
B) All IV chemotherapy requires a port.
C) Two of the agents (docetaxel and carboplatin) are irritants and can cause
significant reaction if they extravasate.
D) Vesicants in her regimen make a port mandatory.
Correct Answer: C
Rationale: Docetaxel and carboplatin are categorized as irritants. Docetaxel can
cause a significant reaction if it extravasates, leading to edema, pain, and possible
blister formation. This is the most likely cause for port placement, not age alone.
5. ______ can cause inflammation, pain, and burning but rarely cause tissue
necrosis comparable to a vesicant.
A) Vesicants
B) Irritants
C) DNA-binding agents
D) Non-DNA-binding agents
Correct Answer: B
Rationale: Irritants cause inflammation, pain, and burning at the extravasation site
,but rarely cause tissue necrosis. Vesicants, in contrast, can cause blistering and
severe tissue destruction.
6. ______ can cause blistering and significant pain and tissue damage and
destruction, leading to tissue death.
A) Irritants
B) Vesicants
C) Antiemetics
D) Growth factors
Correct Answer: B
Rationale: Vesicants are chemotherapeutic agents that can cause blistering, severe
pain, tissue damage, and necrosis if extravasated. Examples include anthracyclines
(doxorubicin), vinca alkaloids, and nitrogen mustards.
7. A further classification of an antineoplastic agent’s potential to cause
damage is whether its mechanism of action includes ______.
A) Protein binding
B) Cell cycle specificity
C) DNA binding
D) Receptor antagonism
Correct Answer: C
Rationale: DNA-binding agents (e.g., alkylating agents, platinum compounds,
anthracyclines) bind to DNA, leading to cellular damage that may be more severe
and prolonged in surrounding tissues after extravasation. This classification helps
predict vesicant potential.
8. A patient receiving cisplatin reports tinnitus and a feeling of fullness in the
ears. What is the priority nursing action?
A) Administer furosemide to reduce fluid overload.
B) Notify the provider immediately and prepare for audiometry.
C) Reassure the patient that this is a temporary side effect.
D) Decrease the infusion rate by half.
, Correct Answer: B
Rationale: Cisplatin causes cumulative ototoxicity, often starting with tinnitus and
high-frequency hearing loss. The provider should be notified to assess and possibly
modify therapy. Audiometry should be ordered.
9. Which antiemetic regimen is most appropriate for a patient receiving
highly emetogenic chemotherapy (e.g., cisplatin ≥70 mg/m²)?
A) Aprepitant + ondansetron + dexamethasone
B) Metoclopramide alone
C) Prochlorperazine as needed
D) Ondansetron only
Correct Answer: A
Rationale: Current guidelines recommend a three-drug regimen of NK1 receptor
antagonist (aprepitant), 5-HT3 antagonist (ondansetron), and dexamethasone for
highly emetogenic chemotherapy.
10. A patient develops a fever of 38.5°C (101.3°F) and neutropenia (ANC
200/mm³) 10 days after chemotherapy. What is the most appropriate initial
intervention?
A) Administer acetaminophen and discharge home with follow-up.
B) Obtain blood cultures and initiate broad-spectrum IV antibiotics.
C) Give oral ciprofloxacin and have the patient return in 24 hours.
D) Delay antibiotics pending culture results.
Correct Answer: B
Rationale: Febrile neutropenia is an oncologic emergency requiring immediate
blood cultures and empiric broad-spectrum IV antibiotics. Delays increase
morbidity and mortality.
11. Which chemotherapy agent requires an test for glucose-6-phosphate
dehydrogenase (G6PD) deficiency before administration due to risk of
hemolytic anemia?
