Page | 1
ONS ONCC CHEMO RENEWAL 2025
BRAND NEW ACTUAL EXAM WITH
QUESTIONS AND ANSWERS.
1. Which of the following agents would you anticipate a
hypersensitivity reaction more often occurring after the patient
has already received several doses? - correct answer -
Although hypersensitivity and infusion reactions can occur at
any time and potentially with any chemotherapy agent, there
are certain agents that have a higher risk of causing a reaction.
For some agents, the reaction is more likely to occur after they
have received a few doses and have already been exposed to
the same agent. On the other hand, there are agents where the
hypersensitivity reactions can occur almost immediately on
exposure. Reactions to platinum drugs (e.g., carboplatin,
cisplatin, oxaliplatin) usually occur after multiple treatments.
However, reactions caused by taxanes (e.g., paclitaxel,
docetaxel) usually occur within the first hour of the first or
second treatment. Reactions to monoclonal antibodies like
rituximab and cetuximab usually occur with the first treatment
as well. (Information from Zetka article)
2. Why use AUC instead of BSA for carboplatin dosing? - correct
answer -Carboplatin's elimination by the kidneys occurs in a
reliable manner that makes AUC the optimal method for dosing
the drug. Basically, AUC is a method of expressing the
, Page | 2
intended exposure to the drug over time. Verification of
carboplatin doses can be daunting if institutional policies are
not clear regarding which formula to use under what conditions.
In the absence of clear institutional direction, documentation in
the orders and plan of care must state the process used to
determine the intended dose.
3. Mrs. Kearns is receiving her first dose of paclitaxel and about
20 minutes into the infusion, you notice that she begins to start
clearing her throat a lot. She also states that she is having
some lower back pain. You decide that you will take another
set of vital signs. While you are waiting for the monitor to reveal
her blood pressure, she begins to breathe heavier and appears
short of breath.
4. What is the first/immediate thing you need to do for Mrs.
Kearns? - correct answer -a. Stop the paclitaxel infusion
5. Since you know that Mr. Rylan is getting R-CHOP, which of the
following pretreatment test results do you feel is a priority to
review prior to starting his chemotherapy? - correct answer -Mr.
Rylan is receiving doxorubicin as part of his chemotherapy
regimen. The patient's ejection fraction should be tested prior
to starting doxorubicin. Periodic monitoring is also suggested in
addition to testing ejection fraction one year post completion of
therapy. Per the prescribing information, one should assess left
ventricular cardiac function (e.g., MUGA or echocardiogram)
, Page | 3
prior to initiation of doxorubicin, during treatment to detect
acute changes, and after treatment to detect delayed
cardiotoxicity
6. Mr. Rylan is receiving RCHOP. What is the lifetime cumulative
dose of doxorubicin that Mr. Rylan should not exceed? - correct
answer -Lifetime cumulative dose of doxorubicin is 550 mg/m2
except when patient has received prior chest irradiation or
when receiving concomitant cyclophosphamide where the
cumulative dose decreases to 450 mg/m2. Mr. Rylan is
receiving cyclophosphamide as part of RCHOP regimen so
therefore should not exceed 450 mg/m2.
7. Which of the following offers the highest risk for developing
cardiotoxicity? - correct answer -The risk of cardiotoxicity is
generally proportional to the cumulative exposure of
doxorubicin. The probability of developing cardiotoxicity is
estimated to be 1 to 2% at a total cumulative dose of 300
mg/m2 of doxorubicin, 3 to 5% at a dose of 400 mg/m2, 5 to
8% at a dose of 450 mg/m2, and 6 to 20% at a dose of 500
mg/m2, when doxorubicin is administered every 3 weeks.
There is an additive or potentially synergistic increase in the
risk of cardiotoxicity in patients who have received radiotherapy
to the mediastinum or concomitant therapy with other known
cardiotoxic agents such as cyclophosphamide, taxanes, and
trastuzumab. Cardiotoxicity can occur at lower doses in
patients who have received mediastinal radiation or those that
have underlying heart disease. Coadministration of coenzyme
ONS ONCC CHEMO RENEWAL 2025
BRAND NEW ACTUAL EXAM WITH
QUESTIONS AND ANSWERS.
1. Which of the following agents would you anticipate a
hypersensitivity reaction more often occurring after the patient
has already received several doses? - correct answer -
Although hypersensitivity and infusion reactions can occur at
any time and potentially with any chemotherapy agent, there
are certain agents that have a higher risk of causing a reaction.
For some agents, the reaction is more likely to occur after they
have received a few doses and have already been exposed to
the same agent. On the other hand, there are agents where the
hypersensitivity reactions can occur almost immediately on
exposure. Reactions to platinum drugs (e.g., carboplatin,
cisplatin, oxaliplatin) usually occur after multiple treatments.
However, reactions caused by taxanes (e.g., paclitaxel,
docetaxel) usually occur within the first hour of the first or
second treatment. Reactions to monoclonal antibodies like
rituximab and cetuximab usually occur with the first treatment
as well. (Information from Zetka article)
2. Why use AUC instead of BSA for carboplatin dosing? - correct
answer -Carboplatin's elimination by the kidneys occurs in a
reliable manner that makes AUC the optimal method for dosing
the drug. Basically, AUC is a method of expressing the
, Page | 2
intended exposure to the drug over time. Verification of
carboplatin doses can be daunting if institutional policies are
not clear regarding which formula to use under what conditions.
In the absence of clear institutional direction, documentation in
the orders and plan of care must state the process used to
determine the intended dose.
3. Mrs. Kearns is receiving her first dose of paclitaxel and about
20 minutes into the infusion, you notice that she begins to start
clearing her throat a lot. She also states that she is having
some lower back pain. You decide that you will take another
set of vital signs. While you are waiting for the monitor to reveal
her blood pressure, she begins to breathe heavier and appears
short of breath.
4. What is the first/immediate thing you need to do for Mrs.
Kearns? - correct answer -a. Stop the paclitaxel infusion
5. Since you know that Mr. Rylan is getting R-CHOP, which of the
following pretreatment test results do you feel is a priority to
review prior to starting his chemotherapy? - correct answer -Mr.
Rylan is receiving doxorubicin as part of his chemotherapy
regimen. The patient's ejection fraction should be tested prior
to starting doxorubicin. Periodic monitoring is also suggested in
addition to testing ejection fraction one year post completion of
therapy. Per the prescribing information, one should assess left
ventricular cardiac function (e.g., MUGA or echocardiogram)
, Page | 3
prior to initiation of doxorubicin, during treatment to detect
acute changes, and after treatment to detect delayed
cardiotoxicity
6. Mr. Rylan is receiving RCHOP. What is the lifetime cumulative
dose of doxorubicin that Mr. Rylan should not exceed? - correct
answer -Lifetime cumulative dose of doxorubicin is 550 mg/m2
except when patient has received prior chest irradiation or
when receiving concomitant cyclophosphamide where the
cumulative dose decreases to 450 mg/m2. Mr. Rylan is
receiving cyclophosphamide as part of RCHOP regimen so
therefore should not exceed 450 mg/m2.
7. Which of the following offers the highest risk for developing
cardiotoxicity? - correct answer -The risk of cardiotoxicity is
generally proportional to the cumulative exposure of
doxorubicin. The probability of developing cardiotoxicity is
estimated to be 1 to 2% at a total cumulative dose of 300
mg/m2 of doxorubicin, 3 to 5% at a dose of 400 mg/m2, 5 to
8% at a dose of 450 mg/m2, and 6 to 20% at a dose of 500
mg/m2, when doxorubicin is administered every 3 weeks.
There is an additive or potentially synergistic increase in the
risk of cardiotoxicity in patients who have received radiotherapy
to the mediastinum or concomitant therapy with other known
cardiotoxic agents such as cyclophosphamide, taxanes, and
trastuzumab. Cardiotoxicity can occur at lower doses in
patients who have received mediastinal radiation or those that
have underlying heart disease. Coadministration of coenzyme
