ONS CHEMO CERTIFICATION RENEWAL EXAM
LATEST 2023-2024 ACTUAL EXAM 350 QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES|AGRADE
How do alkylating agents function? - ANSWER-By causing a break in the DNA helix strand, causing
interference with DNA replication, which results in cell death
What is the most common subcategory of alkylating agents? - ANSWER-Nitrogen mustards
Examples of nitrogen mustards (alkylating agents) - ANSWER-Cyclophosphamide (Cytoxan), Ifosfamide
(Ifex), Bendamustine (Treanda)
What type of chemo agents act similar to alkylating agents, but do not possess an alkyl group molecule
to attach to and destroy DNA? - ANSWER-Platinum-based chemo
Examples of common platinum-based drugs - ANSWER-Cisplatin (Platinol) and Carboplatin (Paraplatin)
What is another subcategory of alkylating agents? - ANSWER-Nitrosoureas
Function of nitrosoureas - ANSWER-Cross the blood-brain barrier, making them effective in treating
some brain tumors, melanomas, and lymphomas
Common nitrosoureas - ANSWER-Carmustine (BiCNU), Lomustine (CeeNu), Streptozocin (Zanosar)
Two major warnings of carmustine (BiCNU) - ANSWER-Myelosuppression and pulmonary toxicity
What type of cancers does carmustine (BiCNU) treat? - ANSWER-Brain tumors (ex. glioblastoma),
multiple myeloma, Hodgkin's and non-Hodgkin's lymphoma
Two major warnings of lomustine (CeeNu) or (Gleostine) - ANSWER-Delayed myelosuppression and risk
of overdosage
,What types of cancers does lomustine (Gleostine) treat? - ANSWER-Brain tumors and Hodgkin's
lymphoma
What type of cancer does streptozocin (Zanosar) treat? - ANSWER-Metastatic islet cell carcinoma of the
pancreas
What major warning does streptozocin (Zanosar) have? - ANSWER-Renal toxicity
What are the dose-limiting toxicities of alkylating agents? - ANSWER-Bone marrow suppression, GI
toxicities (N/V/D), renal toxicities, hepatotoxicity, pulmonary fibrosis, hypersensitivities
Hypersensitivity may occur with late doses of what? - ANSWER-Carboplatin
What is possible in patients receiving alkylating agents, particularly when there is a high tumor burden? -
ANSWER-Tumor lysis syndrome
What pre-administration blood tests should be included in alkylating agents? - ANSWER-BUN, creatinine,
CBC with diff
Are alkylating agents emetogenic? - ANSWER-Yes, highly emetogenic
What is a bladder protectant typically administered with cyclophosphamide and ifosfamide? - ANSWER-
Mesna
What is the main nursing teaching to include with oxaliplatin? - ANSWER-Avoid exposure to cold air and
consuming cold fluids 3-4 days following treatment
What are the most nephrotoxic alkylating agents? - 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? -
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? - ANSWER-Secondary malignancies
and fertility issues
Long-term myelosuppression can lead to what? - 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)? - ANSWER-
Kidney disease
Long-term side effects of carmustine and lomustine - ANSWER-Reduction of pulmonary function:
delayed pulmonary 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? - ANSWER-Baseline
pulmonary function tests, there are fatal cases of pulmonary toxicity
How do antimetabolites function? - 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? - ANSWER-The S phase, so they are highly
effective on tumors with fast growth rates
Most common antimetabolites: - ANSWER-Azacitidine (Vidaza), Capecitabine (Xeloda), 5-Fluorourcacil
(5-FU), Cytarabine (Ara-C), Decitabine (Dacogen), Methotrexate
What cancers does fluorouracil treat? - ANSWER-Adenocarcinoma of colon and rectum,
adenocarcinoma of breast, gastric adenocarcinoma, pancreatic adenocarcinoma
LATEST 2023-2024 ACTUAL EXAM 350 QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES|AGRADE
How do alkylating agents function? - ANSWER-By causing a break in the DNA helix strand, causing
interference with DNA replication, which results in cell death
What is the most common subcategory of alkylating agents? - ANSWER-Nitrogen mustards
Examples of nitrogen mustards (alkylating agents) - ANSWER-Cyclophosphamide (Cytoxan), Ifosfamide
(Ifex), Bendamustine (Treanda)
What type of chemo agents act similar to alkylating agents, but do not possess an alkyl group molecule
to attach to and destroy DNA? - ANSWER-Platinum-based chemo
Examples of common platinum-based drugs - ANSWER-Cisplatin (Platinol) and Carboplatin (Paraplatin)
What is another subcategory of alkylating agents? - ANSWER-Nitrosoureas
Function of nitrosoureas - ANSWER-Cross the blood-brain barrier, making them effective in treating
some brain tumors, melanomas, and lymphomas
Common nitrosoureas - ANSWER-Carmustine (BiCNU), Lomustine (CeeNu), Streptozocin (Zanosar)
Two major warnings of carmustine (BiCNU) - ANSWER-Myelosuppression and pulmonary toxicity
What type of cancers does carmustine (BiCNU) treat? - ANSWER-Brain tumors (ex. glioblastoma),
multiple myeloma, Hodgkin's and non-Hodgkin's lymphoma
Two major warnings of lomustine (CeeNu) or (Gleostine) - ANSWER-Delayed myelosuppression and risk
of overdosage
,What types of cancers does lomustine (Gleostine) treat? - ANSWER-Brain tumors and Hodgkin's
lymphoma
What type of cancer does streptozocin (Zanosar) treat? - ANSWER-Metastatic islet cell carcinoma of the
pancreas
What major warning does streptozocin (Zanosar) have? - ANSWER-Renal toxicity
What are the dose-limiting toxicities of alkylating agents? - ANSWER-Bone marrow suppression, GI
toxicities (N/V/D), renal toxicities, hepatotoxicity, pulmonary fibrosis, hypersensitivities
Hypersensitivity may occur with late doses of what? - ANSWER-Carboplatin
What is possible in patients receiving alkylating agents, particularly when there is a high tumor burden? -
ANSWER-Tumor lysis syndrome
What pre-administration blood tests should be included in alkylating agents? - ANSWER-BUN, creatinine,
CBC with diff
Are alkylating agents emetogenic? - ANSWER-Yes, highly emetogenic
What is a bladder protectant typically administered with cyclophosphamide and ifosfamide? - ANSWER-
Mesna
What is the main nursing teaching to include with oxaliplatin? - ANSWER-Avoid exposure to cold air and
consuming cold fluids 3-4 days following treatment
What are the most nephrotoxic alkylating agents? - 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? -
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? - ANSWER-Secondary malignancies
and fertility issues
Long-term myelosuppression can lead to what? - 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)? - ANSWER-
Kidney disease
Long-term side effects of carmustine and lomustine - ANSWER-Reduction of pulmonary function:
delayed pulmonary 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? - ANSWER-Baseline
pulmonary function tests, there are fatal cases of pulmonary toxicity
How do antimetabolites function? - 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? - ANSWER-The S phase, so they are highly
effective on tumors with fast growth rates
Most common antimetabolites: - ANSWER-Azacitidine (Vidaza), Capecitabine (Xeloda), 5-Fluorourcacil
(5-FU), Cytarabine (Ara-C), Decitabine (Dacogen), Methotrexate
What cancers does fluorouracil treat? - ANSWER-Adenocarcinoma of colon and rectum,
adenocarcinoma of breast, gastric adenocarcinoma, pancreatic adenocarcinoma
