Free OCN Practice Test: 50 Questions With Rationales
This free OCN practice test has 50 original, unofficial adult-oncology questions—not a full-length exam or clinical protocol. Pick an answer, then open the rationale to see why it's right, why each other option isn't, and the source behind it.
Practice questions
Question 1 of 50
Oncologic Emergencies
A patient receiving chemotherapy for lymphoma calls the clinic 9 days after her most recent cycle. Her oral temperature 10 minutes ago was 38.4°C (101.1°F). She says she otherwise feels fine. Her absolute neutrophil count (ANC) yesterday was 300/mm³. What is the nurse's best instruction?
- A. Recheck your temperature in 1 hour and call back if it is still up.
- B. Take acetaminophen now and come in for blood work tomorrow morning.
- C. Come to the clinic or emergency department now for evaluation and antibiotics.
- D. Drink extra fluids and start the antibiotic left over from your last infection.
Show answer and rationale — Question 1
Correct answer: C. Come to the clinic or emergency department now for evaluation and antibiotics.
Her ANC of 300/mm³ meets the neutropenia criterion used in febrile-neutropenia guidance (below 500/mm³), and a single oral temperature of 38.3°C (101°F) or higher counts as fever. Together that is febrile neutropenia, a medical emergency even when the patient feels well. ASCO and IDSA recommend the first dose of empiric antibiotics within 1 hour of triage, so she needs to be seen now. CDC's patient guidance is simpler still: call right away for any temperature of 38°C (100.4°F) or higher during chemotherapy.
Why the other choices don't fit:
- A: Do not wait an hour to call during chemotherapy. The formal fever definition includes a lower temperature sustained for an hour, but that is not a home waiting instruction: CDC advises immediate contact at 38.0°C (100.4°F) or higher.
- B: This delays care overnight, and an antipyretic can mask the fever the team needs to assess.
- D: Leftover antibiotics are not an evaluation, cultures, or appropriate empiric therapy.
Takeaway: During chemotherapy, report 38.0°C (100.4°F) or higher immediately. Don't wait for a second reading.
Source: ASCO/IDSA, Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy, Recommendation: initial empiric antibacterial therapy within 1 hour of triage; IDSA, Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer (2010 update), Definitions: fever and neutropenia; CDC, Watch Out for Fever, Steps to take: immediate call at 100.4°F (38°C) during chemotherapy; NCI, Infection and Neutropenia during Cancer Treatment, Signs of infection; catheter-site redness/swelling; urgent contact; ways to prevent infection.
Question 2 of 50
Care Continuum
A 58-year-old man with no symptoms asks about lung cancer screening. He smoked 1 pack a day for 25 years and quit 10 years ago. He has no health problems that limit his life expectancy and would be willing and able to undergo curative lung surgery if needed. Based on the current USPSTF recommendation, what should the nurse tell him?
- A. He no longer qualifies because he has quit smoking.
- B. He meets the criteria for annual low-dose CT screening.
- C. He should have a yearly chest X-ray instead of a CT scan.
- D. He should wait until age 65 to start screening.
Show answer and rationale — Question 2
Correct answer: B. He meets the criteria for annual low-dose CT screening.
USPSTF recommends annual low-dose CT for adults aged 50 to 80 with at least a 20 pack-year history who currently smoke or quit within the past 15 years. He is 58, has 25 pack-years (1 pack a day × 25 years), and quit 10 years ago, so he qualifies.
Why the other choices don't fit:
- A: Quitting only ends eligibility once 15 years have passed. He is at 10.
- C: The recommended test is low-dose CT, not chest X-ray.
- D: The recommended range starts at 50, not 65.
Takeaway: For USPSTF screening, check four things: age 50–80, 20+ pack-years, current smoking or quitting within 15 years, and health and willingness to undergo curative lung surgery.
Source: USPSTF, Lung Cancer: Screening (2021), Recommendation Summary; Recommendation Information; Patient Population Under Consideration.
Question 3 of 50
Care Continuum
A patient newly diagnosed with head and neck cancer says, "There's no point in quitting smoking now. I already have cancer." Which response by the nurse is best?
- A. "Quitting now can help your treatment work better and lower your risk of side effects."
- B. "That's understandable. Focus your energy on treatment and worry about smoking later."
- C. "Cutting down to a few cigarettes a day during treatment removes most of the risk."
- D. "It's better to wait until treatment ends so you aren't dealing with withdrawal too."
Show answer and rationale — Question 3
Correct answer: A. "Quitting now can help your treatment work better and lower your risk of side effects."
Stopping tobacco after a cancer diagnosis still helps. It is linked with better treatment response, fewer and less serious side effects, faster recovery, and longer survival. NCI's tobacco monograph describes diagnosis as a teachable moment when patients should be offered evidence-based cessation treatment.
Why the other choices don't fit:
- B: Delaying the conversation wastes the period when quitting can affect treatment outcomes.
- C: There is no support for the idea that cutting down removes most of the risk. The benefit comes from stopping.
- D: This repeats a common myth. It is never too late to quit, and waiting gives up benefits during treatment.
Takeaway: A cancer diagnosis is a reason to quit, not a reason it no longer matters.
Source: American Cancer Society, Benefits of Quitting Tobacco If You Have Cancer, Benefits of quitting tobacco; Myths about quitting tobacco; NCI, Tobacco Control Monograph 23: Treating Smoking in Cancer Patients, Chapter 1, Chapter 1, pp. 3 and 6–7; Figure 1.1 and its note (page image inspected).
Question 4 of 50
Care Continuum
A patient finishing treatment for colon cancer will now see her primary care provider for most of her care. She asks what she should bring to that first visit. Which item is most important?
- A. The date of her next oncology appointment.
- B. A list of the foods she ate during treatment.
- C. Copies of every lab result from treatment.
- D. A treatment summary and follow-up care plan.
Show answer and rationale — Question 4
Correct answer: D. A treatment summary and follow-up care plan.
A survivorship care plan pairs a summary of the treatment she received with a plan for follow-up: which checkups and tests she needs, which late effects to watch for, and who is responsible for each part of her care. That is what lets a primary care provider take over safely.
Why the other choices don't fit:
- A: An appointment date says nothing about what treatment she had or what to watch for.
- B: A food log doesn't tell the new provider about treatment exposures or follow-up needs.
- C: A stack of raw results is not a plan. The provider needs a usable summary.
Takeaway: Treatment summary plus follow-up plan is the core handoff at the end of treatment.
Source: NCI, Follow-Up Medical Care, Survivorship care plans; late effects.
Question 5 of 50
Care Continuum
A woman who had chemotherapy and chest radiation 8 years ago reports new shortness of breath when climbing stairs. She says, "This can't be from my cancer treatment. That was years ago." What is the nurse's best response?
- A. Agree that problems this far out are unrelated to treatment.
- B. Tell her this symptom means the cancer has come back.
- C. Explain that some effects appear years later and arrange an evaluation.
- D. Suggest she mention it at her next annual checkup.
Show answer and rationale — Question 5
Correct answer: C. Explain that some effects appear years later and arrange an evaluation.
Some treatment effects, called late effects, show up months or even years after treatment ends. That is one reason follow-up care continues. A new symptom deserves assessment for late effects and for other causes.
Why the other choices don't fit:
- A: Time since treatment does not rule out a treatment-related cause.
- B: No one can conclude recurrence from one symptom without an evaluation.
- D: A new change in breathing shouldn't wait for a routine annual visit.
Takeaway: Late effects can appear years later. New symptoms get evaluated, not explained away.
Source: NCI, Follow-Up Medical Care, Survivorship care plans; late effects.
Question 6 of 50
Care Continuum
A patient receiving chemotherapy for metastatic breast cancer is referred to the palliative care team for pain and fatigue. She becomes upset and says, "So they're giving up on me." What should the nurse explain?
- A. Palliative care can be given alongside cancer treatment to manage symptoms and stress.
- B. Palliative care is used only in the last weeks of life.
- C. She will need to stop chemotherapy before the palliative team can see her.
- D. Palliative care and hospice are two names for the same service.
Show answer and rationale — Question 6
Correct answer: A. Palliative care can be given alongside cancer treatment to manage symptoms and stress.
Palliative care focuses on relieving symptoms, side effects, and emotional and practical problems. It can start at diagnosis and be given at the same time as treatment aimed at the cancer. The referral is about her comfort and quality of life, not about stopping treatment.
Why the other choices don't fit:
- B: Palliative care is not limited to the end of life. It can be used at any stage.
- C: There is no requirement to stop cancer treatment to receive palliative care.
- D: Hospice is end-of-life care focused on comfort and quality of life when curative treatment is no longer the goal. Palliative care can also be provided earlier, alongside cancer treatment.
Takeaway: Palliative care can run alongside cancer treatment. Hospice focuses on comfort and quality of life near the end of life.
Source: NCI, Palliative Care in Cancer, When palliative care is used; hospice distinction; goals and spiritual concerns.
Question 7 of 50
Care Continuum
A patient with metastatic pancreatic cancer who has Medicare Part A asks whether he qualifies for the Medicare hospice benefit. Which condition must be met?
- A. He must stop taking all of his medications.
- B. His doctors certify a life expectancy of 6 months or less if the illness follows its normal course, and he chooses comfort care.
- C. He must be admitted to an inpatient hospice facility.
- D. He must agree that he can never return to cancer treatment.
Show answer and rationale — Question 7
Correct answer: B. His doctors certify a life expectancy of 6 months or less if the illness follows its normal course, and he chooses comfort care.
Medicare covers hospice when the hospice doctor (and the patient's regular doctor, if there is one) certify a terminal illness with a life expectancy of 6 months or less if the illness follows its normal course, and the patient accepts comfort care instead of care to cure the terminal illness and related conditions. He also signs a statement choosing hospice.
Why the other choices don't fit:
- A: Hospice covers medicines for pain and symptom management. Stopping all medicines is not a condition.
- C: Hospice care is usually given at home or where the person lives. An inpatient stay isn't required.
- D: Patients may revoke the hospice election at any time by filing a signed statement with the hospice, restoring coverage of the benefits they had waived.
Takeaway: Two anchors: a certified prognosis of 6 months or less if the illness follows its normal course, and choosing comfort care for the terminal illness. The choice can be reversed.
Source: Medicare.gov, Hospice care, Eligibility conditions; CMS, Hospice, Hospice Coverage; Items and Services Included in the Hospice Benefit; 42 CFR 418.28, Revoking the election of hospice care, Paragraphs (a), (b), and (c).
Question 8 of 50
Care Continuum
A patient who is stable and just starting treatment asks, "How can I make sure my wishes are followed if I can't speak for myself someday?" What is the nurse's best first action?
- A. Tell her this is something to think about if her condition gets worse.
- B. Tell her that a do-not-resuscitate order will be written automatically if she becomes very ill.
- C. Explain that her family will make the decisions, so planning isn't needed.
- D. Ask about her values and goals, then help her start planning with her team and chosen supports.
Show answer and rationale — Question 8
Correct answer: D. Ask about her values and goals, then help her start planning with her team and chosen supports.
Advance care planning works best early, while the patient is well enough to think it through. It starts with the patient's own values and goals for care, and it involves the care team and the people she would want involved. Documenting those wishes is part of the process.
Why the other choices don't fit:
- A: Waiting for a crisis is exactly what she is trying to avoid.
- B: Resuscitation decisions are not made automatically. They reflect the patient's wishes and a clinician's order.
- C: Assuming family will decide ignores her own stated wish to direct her care.
Takeaway: Advance care planning starts early and starts with the patient's values.
Source: NCI, Palliative Care in Cancer, When palliative care is used; hospice distinction; goals and spiritual concerns; NIA, Advance Care Planning: Advance Directives for Health Care, What is advance care planning?; advance directives; planning before a medical crisis.
Question 9 of 50
Oncology Nursing Practice
Biomarker testing of a patient's colon tumor finds a harmful gene change. Her adult daughter asks whether this means she inherited the same change. What is the nurse's best response?
- A. "Yes. Any change found in the tumor was inherited and can be passed on."
- B. "No. Changes found in tumors are never inherited."
- C. "A tumor result alone can't show that. Genetic counseling and germline testing can clarify it."
- D. "You should consider preventive surgery based on your mother's tumor result."
Show answer and rationale — Question 9
Correct answer: C. "A tumor result alone can't show that. Genetic counseling and germline testing can clarify it."
Tumor (biomarker) testing looks for changes in cancer cells to help guide treatment. Most tumor changes are acquired, but some may point to an inherited variant. Germline testing, usually using blood or saliva, can clarify whether the finding reflects hereditary cancer risk. A finding in the mother does not establish the daughter's result. Genetic counseling helps decide who should be tested.
Why the other choices don't fit:
- A: Tumor changes are usually acquired. A tumor result is not proof of an inherited variant.
- B: "Never" is wrong. A tumor finding can sometimes reflect an inherited variant, which is why follow-up testing may be offered.
- D: A relative's tumor result alone is not enough to recommend preventive surgery. Personal and family history and appropriate genetic evaluation still matter.
Takeaway: Tumor testing guides treatment. Germline testing answers the family-risk question.
Source: NCI, Genetic Testing for Inherited Cancer Risk, Genetic versus tumor testing; VUS results; genetic counseling; NCI, Biomarker Testing for Cancer Treatment, Biomarker vs inherited-risk testing.
Question 10 of 50
Oncology Nursing Practice
A hereditary cancer panel reports a variant of uncertain significance (VUS) in BRCA2 and no harmful variants. The patient asks whether she should schedule a risk-reducing mastectomy based on this result. What is the nurse's best response?
- A. "A VUS isn't a confirmed harmful variant. Your genetics team will guide care using your personal and family history."
- B. "A VUS means the same thing as a positive BRCA2 result."
- C. "A VUS means your risk is normal, so you can skip routine screening."
- D. "You'll need to repeat the same test every year until the result changes."
Show answer and rationale — Question 10
Correct answer: A. "A VUS isn't a confirmed harmful variant. Your genetics team will guide care using your personal and family history."
A VUS means the lab found a gene change but doesn't yet have enough evidence to call it harmful or harmless. It is not a basis for more intensive screening or preventive surgery on its own. Care decisions rest on personal and family history, with genetics professionals watching for reclassification.
Why the other choices don't fit:
- B: A VUS is not a positive result. Treating it as one can lead to unneeded surgery.
- C: A VUS doesn't rule out risk either. Screening still follows her history and standard recommendations.
- D: Reclassification comes from new evidence, not from repeating the same test.
Takeaway: A VUS is an unanswered question, not a positive or a negative.
Source: NCI, Genetic Testing for Inherited Cancer Risk, Genetic versus tumor testing; VUS results; genetic counseling.
Question 11 of 50
Oncology Nursing Practice
A patient enrolled in a clinical trial signed the consent form 3 weeks ago. She now tells the nurse she wants to stop taking part. What should the nurse tell her?
- A. "You agreed to finish the study when you signed the form."
- B. "You can leave only if you are having a serious side effect."
- C. "You'll have to pay back the cost of the study treatment."
- D. "You can leave the study at any time. I'll let the team know so they can discuss your next steps."
Show answer and rationale — Question 11
Correct answer: D. "You can leave the study at any time. I'll let the team know so they can discuss your next steps."
Taking part in a clinical trial is voluntary. Informed consent is an ongoing process, not a one-time signature, and participants can leave a study at any time. The research team then talks with the patient about safely stopping and about other care options.
Why the other choices don't fit:
- A: Signing consent does not remove the right to withdraw.
- B: No reason is required to leave a study.
- C: Leaving a study is not grounds for a withdrawal penalty or loss of benefits to which she is otherwise entitled. Any ordinary care costs are a separate issue.
Takeaway: Consent can be withdrawn at any time, for any reason.
Source: NCI, Are Clinical Trials Safe?, Informed consent; institutional review boards; HHS OHRP, Informed Consent FAQs, What are the basic elements of informed consent?; additional elements: costs and orderly withdrawal.
Question 12 of 50
Oncology Nursing Practice
A patient's staging summary lists her cancer as T2 N1 M0. She asks what "M0" means. What should the nurse explain?
- A. The tumor has not grown into nearby tissue.
- B. The cancer has not spread to nearby lymph nodes.
- C. No distant spread (metastasis) was found.
- D. The cancer cells look close to normal.
Show answer and rationale — Question 12
Correct answer: C. No distant spread (metastasis) was found.
In the TNM system, T describes the main tumor, N describes spread to nearby lymph nodes, and M describes whether the cancer has spread to distant parts of the body. M0 means no distant metastasis was found.
Why the other choices don't fit:
- A: Growth of the primary tumor is described by T, not M.
- B: Lymph node spread is described by N. Here N1 actually means some node involvement.
- D: How abnormal the cells look is the tumor grade, which is not part of the TNM letters.
Takeaway: T = tumor, N = nodes, M = metastasis.
Source: NCI, Cancer Staging, The TNM Staging System; NCI, Tumor Grade, Opening definition: cell appearance versus stage.
Question 13 of 50
Oncology Nursing Practice
A patient with lung cancer walks on his own and handles all of his self-care. He can no longer do any work activities, but he is up and about more than half of his waking hours. What is his ECOG performance status?
- A. ECOG 1
- B. ECOG 2
- C. ECOG 3
- D. ECOG 4
Show answer and rationale — Question 13
Correct answer: B. ECOG 2
ECOG 2 describes a person who is ambulatory and capable of all self-care but unable to carry out any work activities, and who is up and about more than 50% of waking hours. That matches this patient exactly.
Why the other choices don't fit:
- A: ECOG 1 means the person can still do light or sedentary work, such as office work.
- C: ECOG 3 means only limited self-care and being in bed or a chair more than 50% of waking hours.
- D: ECOG 4 means completely disabled, with no self-care, and confined to bed or chair.
Takeaway: ECOG 2 combines all self-care, inability to work, and being up more than half of waking hours; ECOG 3 includes limited self-care and more than half of waking hours in bed or a chair.
Source: NCI SEER Training, ECOG Performance Status, Grade table (Oken et al., 1982).
Question 14 of 50
Oncology Nursing Practice
An outpatient oncology clinic is adding a new hazardous drug to its workflow. According to NIOSH, which set of factors should the facility's exposure assessment consider?
- A. The drug's dosage form, routes and frequency of exposure, work practices, and existing controls.
- B. The drug's cost and how many patients will receive it each month.
- C. Only the job titles of the staff who will handle the drug.
- D. Nothing, if the drug is given by mouth rather than by vein.
Show answer and rationale — Question 14
Correct answer: A. The drug's dosage form, routes and frequency of exposure, work practices, and existing controls.
NIOSH says worker exposure depends on factors unique to each setting: the dosage form; routes of exposure; frequency, duration, and magnitude of exposure; work practices; and whether engineering controls, administrative controls, or PPE are in place. It encourages each facility to do its own assessment.
Why the other choices don't fit:
- B: Cost is not an exposure measure. Patient volume may affect how often staff handle the drug, but these two facts alone omit routes, duration, magnitude, work practices, and controls.
- C: Job title alone says nothing about how the drug is actually handled.
- D: Oral hazardous drugs still require assessment. Dosage form is one of the factors, not an exemption.
Takeaway: Hazardous drug risk is assessed by how the drug is handled, not by assumption.
Source: NIOSH, Managing Hazardous Drug Exposures: Information for Healthcare Settings (Pub. 2023-130), Publication overview.
Question 15 of 50
Oncology Nursing Practice
A patient considering a clinical trial says, "The study was approved by an institutional review board, so the new drug must work." How should the nurse respond?
- A. "That's right. Approval means the treatment has been proven effective."
- B. "Approval means the board has guaranteed you will benefit."
- C. "Approval means you don't need to sign a consent form."
- D. "The board reviews the study to protect participants. Approval doesn't mean the treatment works."
Show answer and rationale — Question 15
Correct answer: D. "The board reviews the study to protect participants. Approval doesn't mean the treatment works."
An institutional review board (IRB) reviews a study to protect the rights and safety of the people taking part, including checking that risks are reasonable and that informed consent is proper. IRB approval is not a finding that a treatment is effective or that an individual participant will benefit.
Why the other choices don't fit:
- A: The IRB reviews participant protections and the study plan; approval does not certify treatment effectiveness.
- B: No one can guarantee a participant will benefit.
- C: IRB approval doesn't replace informed consent. Consent is one of the things the IRB protects.
Takeaway: IRB approval is about participant protection, not proof of benefit.
Source: NCI, Are Clinical Trials Safe?, Informed consent; institutional review boards.
Question 16 of 50
Treatment Modalities
A surgeon plans to remove as much of a patient's ovarian tumor as is safely possible, knowing that removing all of it would cause too much damage to nearby organs. What is this type of surgery called?
- A. Debulking surgery
- B. Curative resection
- C. Prophylactic surgery
- D. Reconstructive surgery
Show answer and rationale — Question 16
Correct answer: A. Debulking surgery
Debulking removes part, but not all, of a tumor when removing the entire tumor would harm nearby organs or tissues. It is often combined with other treatments.
Why the other choices don't fit:
- B: A curative resection aims to remove all of the cancer.
- C: Prophylactic surgery removes tissue before cancer develops, to lower risk.
- D: Reconstructive surgery restores appearance or function after cancer surgery.
Takeaway: Debulking means removing as much as safely possible, not all.
Source: NCI, Surgery to Treat Cancer, How surgery works against cancer (debulking).
Question 17 of 50
Treatment Modalities
A patient with breast cancer will receive chemotherapy to shrink the tumor before she has surgery. How is this chemotherapy described?
- A. Adjuvant
- B. Neoadjuvant
- C. Maintenance
- D. Salvage
Show answer and rationale — Question 17
Correct answer: B. Neoadjuvant
Chemotherapy given before the main local treatment, such as surgery or radiation, to shrink a tumor is called neoadjuvant chemotherapy.
Why the other choices don't fit:
- A: Adjuvant therapy is given after the main treatment to lower the chance the cancer returns.
- C: Maintenance describes the purpose of keeping a response going over time, not treatment timed before surgery.
- D: Salvage describes treatment used after cancer has not responded to other treatments, not planned treatment before surgery.
Takeaway: Neoadjuvant = before the main treatment. Adjuvant = after.
Source: NCI, Chemotherapy to Treat Cancer, How chemotherapy is used with other treatments; How to know whether chemotherapy is working; NCI Dictionary of Cancer Terms, Maintenance therapy, Definition; NCI Dictionary of Cancer Terms, Salvage therapy, Definition.
Question 18 of 50
Treatment Modalities
A patient taking an oral chemotherapy drug tells the nurse, "I barely have any side effects, so I don't think this medicine is doing anything." What should the nurse explain?
- A. "You're probably right. Ask your doctor to raise the dose."
- B. "Take an extra dose each day until you notice side effects."
- C. "Side effects don't show how well the drug is working. Your team checks that with exams and tests."
- D. "Stop the medicine until your next appointment, since it isn't helping."
Show answer and rationale — Question 18
Correct answer: C. "Side effects don't show how well the drug is working. Your team checks that with exams and tests."
Side effects have nothing to do with how well chemotherapy is fighting the cancer. Some people assume severe side effects mean it's working and no side effects mean it isn't; neither is true. The care team judges response with physical exams, blood tests, and scans.
Why the other choices don't fit:
- A: Few side effects is not evidence the drug is failing, and dose changes belong to the prescriber.
- B: Taking extra doses on her own is unsafe.
- D: Stopping on her own could interrupt effective treatment.
Takeaway: Judge response by tests and exams, never by how many side effects the patient has.
Source: NCI, Chemotherapy to Treat Cancer, How chemotherapy is used with other treatments; How to know whether chemotherapy is working.
Question 19 of 50
Treatment Modalities
A patient's adult daughter asks whether it is safe to hug her father after his daily external beam radiation treatment, or whether he is radioactive. What should the nurse tell her?
- A. "He stays radioactive for about 24 hours after each treatment."
- B. "Keep at least 6 feet away from him during the treatment course."
- C. "Pregnant family members should avoid him for a week after each session."
- D. "External beam radiation doesn't make him radioactive. Hugging is safe."
Show answer and rationale — Question 19
Correct answer: D. "External beam radiation doesn't make him radioactive. Hugging is safe."
External beam radiation comes from a machine outside the body. It does not leave radioactive material in the patient, so he does not give off radiation and normal contact is safe.
Why the other choices don't fit:
- A: No radioactivity remains after external beam treatment.
- B: Distance precautions apply to some internal sources, not to external beam treatment.
- C: This confuses external beam with precautions sometimes used for internal radiation sources.
Takeaway: External beam: no radioactivity afterward. Internal sources are a different question.
Source: NCI, External Beam Radiation Therapy for Cancer, Will external beam radiation therapy make me radioactive?.
Question 20 of 50
Treatment Modalities
A patient received low-dose-rate brachytherapy with a temporary implant. Today the radiation source and the catheter were removed. His wife, who is pregnant, asks when she can sit close to him. What should the nurse tell her?
- A. "Right away. Once the source is removed, no radiation remains in his body."
- B. "You'll need to stay 6 feet away for the next 2 weeks."
- C. "Only after he's been in a private room for another 72 hours."
- D. "Not until after your baby is born."
Show answer and rationale — Question 20
Correct answer: A. "Right away. Once the source is removed, no radiation remains in his body."
With a temporary implant, the radiation source is taken out at the end of treatment. After the catheter or applicator is removed, there is no radiation in the body, and it is safe for people to be near the patient, including young children and pregnant women.
Why the other choices don't fit:
- B: Distance limits apply while a source is in place or with some permanent implants, not after a temporary source is removed.
- C: Once the source is out, isolation is not needed for radiation safety.
- D: No lasting restriction applies after a temporary source has been removed.
Takeaway: Precautions depend on whether a source is still in the body.
Source: NCI, Brachytherapy to Treat Cancer, What to expect when the catheter is removed.
Question 21 of 50
Treatment Modalities
A patient's own stem cells are collected and frozen. He then receives high-dose chemotherapy, and his stored cells are returned to him. What type of transplant is this?
- A. Allogeneic
- B. Autologous
- C. Syngeneic
- D. Haploidentical
Show answer and rationale — Question 21
Correct answer: B. Autologous
In an autologous transplant, the stem cells come from the patient himself. They are collected, stored, and given back after high-dose treatment.
Why the other choices don't fit:
- A: Allogeneic transplants use cells from a donor.
- C: Syngeneic transplants use cells from an identical twin.
- D: Haploidentical transplants use cells from a half-matched donor, often a family member.
Takeaway: Auto = self. Allo = donor.
Source: NCI, Stem Cell Transplants in Cancer Treatment, Types of stem cell transplant; graft-versus-host disease; NCI Dictionary of Cancer Terms, Haploidentical donor, Definition: partially matched donor; parent, child or sibling.
Question 22 of 50
Treatment Modalities
Which statement best describes graft-versus-host disease (GVHD) after an allogeneic stem cell transplant?
- A. The recipient's immune system rejects the donor's cells.
- B. The donor cells fail to grow because of an infection.
- C. Chemotherapy used before transplant damages the recipient's skin.
- D. Immune cells from the donor attack the recipient's healthy tissues.
Show answer and rationale — Question 22
Correct answer: D. Immune cells from the donor attack the recipient's healthy tissues.
In GVHD, white blood cells from the donor (the graft) see the patient's body (the host) as foreign and attack healthy tissues. It happens with allogeneic transplants because the cells come from someone else.
Why the other choices don't fit:
- A: This is the opposite direction: rejection of the graft by the host.
- B: Failure of donor cells to grow is graft failure, not GVHD.
- C: Treatment-related skin damage is not GVHD, though GVHD can affect the skin.
Takeaway: GVHD runs graft → host.
Source: NCI, Stem Cell Transplants in Cancer Treatment, Types of stem cell transplant; graft-versus-host disease.
Question 23 of 50
Treatment Modalities
A patient's cancer responded well to a targeted therapy but is now growing again while she takes it as prescribed. She asks how this can happen. Which explanation is most accurate?
- A. Cancer cells can change so the target no longer responds, or use another pathway to grow.
- B. Growth on treatment proves she must have been missing doses.
- C. Targeted drugs gradually lose their strength while stored at home.
- D. Only traditional chemotherapy can stop working; targeted drugs cannot.
Show answer and rationale — Question 23
Correct answer: A. Cancer cells can change so the target no longer responds, or use another pathway to grow.
Cancer cells can become resistant to targeted therapy. The target itself can change so the drug no longer interacts well with it, or the cancer can find a different pathway to grow that doesn't depend on the target.
Why the other choices don't fit:
- B: Resistance can develop even with perfect adherence. Assuming otherwise blames the patient without evidence.
- C: Resistance is a change in the cancer, not in the stored medicine.
- D: Resistance is a known drawback of targeted therapy.
Takeaway: Resistance comes from changes in the cancer: altered target or a new growth pathway.
Source: NCI, Targeted Therapy to Treat Cancer, Drawbacks of targeted therapy (resistance).
Question 24 of 50
Treatment Modalities
A patient starting an immune checkpoint inhibitor asks how the drug fights cancer. Which explanation is correct?
- A. It directly kills fast-dividing cells, the way chemotherapy does.
- B. It replaces bone marrow that was damaged by earlier treatment.
- C. It blocks checkpoint proteins, releasing a brake so T cells can attack cancer cells.
- D. It carries radiation straight to the tumor.
Show answer and rationale — Question 24
Correct answer: C. It blocks checkpoint proteins, releasing a brake so T cells can attack cancer cells.
Checkpoint proteins act like brakes that keep immune responses from getting too strong. Some cancer cells use them to avoid attack. Checkpoint inhibitors block these proteins so T cells are better able to kill cancer cells. The same release of the brake explains why immune-related side effects can occur.
Why the other choices don't fit:
- A: That describes cytotoxic chemotherapy, not immunotherapy.
- B: That describes a stem cell transplant.
- D: That describes a radioactive drug or internal radiation, not a checkpoint inhibitor.
Takeaway: Checkpoint inhibitors take the brakes off T cells.
Source: NCI, Immune Checkpoint Inhibitors, How checkpoint inhibitors work.
Question 25 of 50
Treatment Modalities
A patient scheduled for CAR T-cell therapy asks what will happen to the T cells collected from her blood. What should the nurse explain?
- A. They will be frozen unchanged and given back to strengthen her immune system.
- B. They will be changed in a lab to recognize a protein on her cancer cells, grown, and then infused.
- C. They will be exposed to radiation to destroy them before chemotherapy.
- D. They will be matched and given to another patient who needs them.
Show answer and rationale — Question 25
Correct answer: B. They will be changed in a lab to recognize a protein on her cancer cells, grown, and then infused.
In CAR T-cell therapy, a patient's T cells are collected and changed in the lab so they make a receptor (a chimeric antigen receptor, or CAR) that recognizes a specific protein on cancer cells. The cells are multiplied and then given back to the patient.
Why the other choices don't fit:
- A: The cells are engineered, not returned unchanged.
- C: The collected cells are the treatment. They are not destroyed.
- D: In the autologous CAR T process described here, the patient's own cells come back to her.
Takeaway: CAR T: collect, engineer, expand, infuse.
Source: NCI, T-cell Transfer Therapy, CAR T-cell therapy.
Question 26 of 50
Symptom Management and Supportive Care
A patient beginning chemotherapy asks what she can do at home to lower her risk of infection. Which teaching is most important?
- A. Check your temperature only if you have chills.
- B. Stay in bed as much as possible until treatment ends.
- C. Keep your home sterile and don't allow any visitors.
- D. Wash your hands often, ask others to do the same, and avoid people who are sick.
Show answer and rationale — Question 26
Correct answer: D. Wash your hands often, ask others to do the same, and avoid people who are sick.
Clean hands are one of the most important ways to prevent infection during chemotherapy. Patients should wash often and ask family members and clinicians to do the same. Limiting contact with people who are sick also reduces exposure.
Why the other choices don't fit:
- A: CDC advises taking a temperature any time the patient feels warm, flushed, chilled, or unwell, not only with chills.
- B: Bed rest does not prevent infection.
- C: A sterile home and a ban on all visitors are not realistic or required.
Takeaway: Hand hygiene first, for the patient and everyone around her.
Source: NCI, Infection and Neutropenia during Cancer Treatment, Signs of infection; catheter-site redness/swelling; urgent contact; ways to prevent infection; CDC, Watch Out for Fever, Steps to take: immediate call at 100.4°F (38°C) during chemotherapy.
Question 27 of 50
Symptom Management and Supportive Care
A patient with a low platelet count from chemotherapy asks whether she can use ibuprofen for occasional pain and how to care for her mouth. She has no current pain or other new symptoms. What should the nurse advise?
- A. Ibuprofen is fine to take. Floss firmly to prevent gum bleeding.
- B. Aspirin is a safer choice than ibuprofen for occasional pain.
- C. Check with the team before taking aspirin or ibuprofen, and use a soft toothbrush.
- D. Any over-the-counter pain reliever is fine as long as she takes it with food.
Show answer and rationale — Question 27
Correct answer: C. Check with the team before taking aspirin or ibuprofen, and use a soft toothbrush.
Aspirin and ibuprofen can raise bleeding risk, and patients receiving chemotherapy should check with their team before taking any over-the-counter medicine. With low platelets, gentle mouth care with a very soft toothbrush lowers the chance of gum bleeding.
Why the other choices don't fit:
- A: This combines a medicine that can raise bleeding risk with rough oral care.
- B: Aspirin also increases bleeding risk.
- D: Taking a medicine with food doesn't address bleeding risk.
Takeaway: Low platelets: clear OTC pain relievers with the team, and keep oral care gentle.
Source: NCI, Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment, When to call about bleeding symptoms; avoiding medicines that increase bleeding risk; gentle mouth care.
Question 28 of 50
Symptom Management and Supportive Care
A patient receiving chemotherapy has low hemoglobin and reports new fatigue. Which explanation of how anemia can cause fatigue is correct?
- A. Fewer red blood cells carry less oxygen to the body's tissues.
- B. Anemia lowers the white blood cells that make energy.
- C. Anemia directly damages the muscles.
- D. Anemia makes the body produce too much sugar.
Show answer and rationale — Question 28
Correct answer: A. Fewer red blood cells carry less oxygen to the body's tissues.
Red blood cells carry oxygen. When there are fewer of them, less oxygen reaches the tissues, which can cause tiredness. Anemia is one of several possible causes of fatigue during cancer treatment, so it is assessed alongside the others.
Why the other choices don't fit:
- B: White blood cells fight infection. They don't supply energy.
- C: Anemia does not directly damage muscle.
- D: Anemia has nothing to do with blood sugar production.
Takeaway: Anemia → less oxygen delivery → fatigue. It is one cause among several.
Source: NCI, Fatigue and Cancer Treatment, Causes (including anemia); ways to manage fatigue; NCI, Anemia and Cancer Treatment, What is anemia?; symptoms; red blood cells and oxygen.
Question 29 of 50
Symptom Management and Supportive Care
A patient with treatment-related fatigue has no new urgent symptoms. He asks whether he should stay in bed as much as possible to save energy. What is the best advice?
- A. Yes. Complete bed rest is the best way to recover energy.
- B. Push through with vigorous exercise every day, however tired he feels.
- C. Sleep as much as possible during the day.
- D. Balance activity and rest in a plan fitted to him, and report new or worsening symptoms.
Show answer and rationale — Question 29
Correct answer: D. Balance activity and rest in a plan fitted to him, and report new or worsening symptoms.
Fatigue is managed with a plan that fits the person, balancing activity and rest and addressing contributing causes. Staying active as able, with guidance from the care team, can help. Extended inactivity is not the answer.
Why the other choices don't fit:
- A: Complete bed rest is not recommended and can make weakness worse.
- B: Activity should be tailored and approved by the team, not forced regardless of symptoms.
- C: Long daytime sleep can disrupt nighttime sleep and doesn't resolve fatigue.
Takeaway: Fatigue plans are individual: balanced activity and rest, not bed rest.
Source: NCI, Fatigue and Cancer Treatment, Causes (including anemia); ways to manage fatigue.
Question 30 of 50
Symptom Management and Supportive Care
A patient with a sore mouth during chemotherapy asks how to care for her mouth each day. Which advice is best?
- A. Eat crunchy, dry foods to help keep the mouth clean.
- B. Brush gently with a soft toothbrush and rinse as the care team recommends.
- C. Switch to a firm-bristled toothbrush to clear debris faster.
- D. Stop brushing until the soreness goes away.
Show answer and rationale — Question 30
Correct answer: B. Brush gently with a soft toothbrush and rinse as the care team recommends.
Keeping the mouth clean matters even more when it is sore. Gentle brushing with a soft toothbrush and regular rinsing with the rinse the team recommends help keep the mouth clean without adding injury.
Why the other choices don't fit:
- A: Crunchy, dry foods can scrape and irritate a sore mouth. Soft, moist foods are easier.
- C: A firm brush can injure sore tissue.
- D: Stopping oral hygiene raises the risk of infection.
Takeaway: Sore mouth: keep cleaning it, gently.
Source: NCI, Mouth and Throat Problems and Cancer Treatment, Daily mouth care; when to call your team.
Question 31 of 50
Symptom Management and Supportive Care
A patient calls to say her mouth sores have become so painful that she has barely been able to drink anything since yesterday. What should the nurse advise?
- A. This is expected. Wait until the next treatment visit.
- B. Drink orange juice to help the sores heal faster.
- C. Come in to be seen today, because not being able to drink is a serious problem.
- D. Stop drinking until the sores heal to avoid pain.
Show answer and rationale — Question 31
Correct answer: C. Come in to be seen today, because not being able to drink is a serious problem.
Mouth problems that keep a patient from eating or drinking need prompt attention. She is at risk of dehydration, and the team can treat the pain and assess the sores. This is a reason to call and be seen, not to wait.
Why the other choices don't fit:
- A: Inability to drink is not something to wait out.
- B: Acidic juices can make mouth sores hurt more.
- D: Stopping fluids makes dehydration worse.
Takeaway: When mouth pain stops fluids, it is time to be seen.
Source: NCI, Mouth and Throat Problems and Cancer Treatment, Daily mouth care; when to call your team.
Question 32 of 50
Symptom Management and Supportive Care
A patient receiving treatment calls to report many more loose stools than usual. What should the nurse do first?
- A. Ask how many stools compared with her usual, how much she is drinking, and about dizziness, fever, or blood.
- B. Tell her to take the maximum dose of an over-the-counter antidiarrheal without calling back.
- C. Tell her to stop drinking fluids to slow the diarrhea.
- D. Reassure her that diarrhea is expected and needs no follow-up.
Show answer and rationale — Question 32
Correct answer: A. Ask how many stools compared with her usual, how much she is drinking, and about dizziness, fever, or blood.
In this call, begin by assessing how much the stool pattern has changed from her normal, how much fluid she is taking in, and whether there are signs of dehydration or other warning signs. The team then gives instructions that fit her treatment and severity.
Why the other choices don't fit:
- B: Self-treating at the maximum dose without assessment can miss a serious problem.
- C: Cutting fluids increases the risk of dehydration.
- D: Diarrhea during treatment can become serious and needs follow-up.
Takeaway: Compare with baseline, check hydration, then follow the team's plan.
Source: NCI, Diarrhea and Cancer Treatment, Talk with your care team; dehydration.
Question 33 of 50
Symptom Management and Supportive Care
A patient is starting a scheduled opioid for cancer pain and asks how it will affect her bowels. Which response is best?
- A. "Stop the opioid if you become constipated."
- B. "Use an enema every day to be safe."
- C. "Wait a week without a bowel movement before calling us."
- D. "Opioids often cause constipation. Let's ask your team about a bowel plan now."
Show answer and rationale — Question 33
Correct answer: D. "Opioids often cause constipation. Let's ask your team about a bowel plan now."
Opioid pain medicines commonly cause constipation. Planning prevention when the opioid starts, usually with a bowel regimen the team prescribes, and tracking bowel movements works better than waiting for a problem.
Why the other choices don't fit:
- A: Stopping needed pain control on her own leaves pain untreated.
- B: Daily enemas are not a self-directed prevention plan and can be harmful for some patients.
- C: Waiting a week delays care for a predictable side effect.
Takeaway: When the opioid starts, the bowel plan starts.
Source: NCI, Constipation and Cancer Treatment, Medicines that cause constipation; prevention.
Question 34 of 50
Symptom Management and Supportive Care
The nurse is reassessing a patient's cancer pain after a change in treatment. Besides a 0-to-10 rating, what information is most useful?
- A. How many pain pills are left in the bottle.
- B. Where the pain is, what it feels like, when it happens, how it affects activities, and how treatment is working.
- C. Whether the patient looks calm.
- D. Nothing further. The number is enough.
Show answer and rationale — Question 34
Correct answer: B. Where the pain is, what it feels like, when it happens, how it affects activities, and how treatment is working.
A useful pain assessment describes location, quality, timing, what makes it better or worse, how it affects daily activities, and how well treatment is working. A number alone can't show whether the plan fits the pain.
Why the other choices don't fit:
- A: A pill count doesn't describe the pain.
- C: Appearance can be misleading. The patient's report guides the assessment.
- D: A single number leaves out what the team needs to adjust care.
Takeaway: Pain assessment is more than a number.
Source: NCI, Pain and Cancer, Describing your pain.
Question 35 of 50
Symptom Management and Supportive Care
A patient receiving chemotherapy reports numbness in his feet. Which teaching best protects him?
- A. Walk barefoot at home so you can feel the floor better.
- B. Test bath water with your foot before getting in.
- C. Clear tripping hazards, wear sturdy shoes, check water temperature before bathing, and report the numbness.
- D. Numbness is expected, so there's no need to mention it to the team.
Show answer and rationale — Question 35
Correct answer: C. Clear tripping hazards, wear sturdy shoes, check water temperature before bathing, and report the numbness.
Numbness raises the risk of falls and burns. Practical steps help: remove clutter and rugs, wear shoes with good support, and have someone with normal sensation check the water temperature before bathing. Nerve changes should be reported so the team can assess them.
Why the other choices don't fit:
- A: Bare feet with reduced sensation raise the risk of injury.
- B: Numb skin can't judge temperature, so this invites a burn.
- D: The team needs to know about new nerve symptoms.
Takeaway: Numb feet: prevent falls and burns, and tell the team.
Source: NCI, Nerve Problems (Peripheral Neuropathy) and Cancer Treatment, Symptoms; ways to prevent falls and burns; reporting nerve symptoms.
Question 36 of 50
Symptom Management and Supportive Care
Six months after surgery with axillary lymph node removal, a patient notices that her arm on that side feels heavy and looks a little swollen. What should the nurse do?
- A. Arrange an evaluation for possible lymphedema.
- B. Reassure her that swelling this long after surgery is not related.
- C. Tell her she must never lift anything with that arm again.
- D. Tell her to stop all exercise permanently.
Show answer and rationale — Question 36
Correct answer: A. Arrange an evaluation for possible lymphedema.
Heaviness, tightness, and swelling in the limb on the side of lymph node treatment can be early signs of lymphedema, which can develop months or years later. Early evaluation matters because early treatment works better.
Why the other choices don't fit:
- B: Lymphedema can appear long after surgery.
- C: Absolute lifting bans aren't the right response to a first symptom.
- D: Stopping all exercise isn't recommended and isn't part of an evaluation.
Takeaway: New heaviness or swelling on the treated side gets evaluated early.
Source: NCI, Lymphedema and Cancer Treatment, Signs and symptoms; early evaluation.
Question 37 of 50
Symptom Management and Supportive Care
A patient notices redness and some drainage around his implanted port site. He has not had a fever. What should the nurse advise?
- A. Wait until a fever develops before calling.
- B. Cover the site and mention it at the next routine visit.
- C. Put leftover antibiotic ointment on it and watch it.
- D. Call the team now, because redness and drainage can mean infection even without fever.
Show answer and rationale — Question 37
Correct answer: D. Call the team now, because redness and drainage can mean infection even without fever.
Redness, swelling, or drainage around a catheter or port site can be signs of infection and should be reported right away. The absence of fever does not rule out infection.
Why the other choices don't fit:
- A: Fever isn't required. Local signs alone are a reason to call.
- B: Waiting for a routine visit delays assessment of a possible infection.
- C: Self-treatment can hide a worsening infection.
Takeaway: Local signs at a line site are reason enough to call.
Source: NCI, Infection and Neutropenia during Cancer Treatment, Signs of infection; catheter-site redness/swelling; urgent contact; ways to prevent infection.
Question 38 of 50
Symptom Management and Supportive Care
Rasburicase is ordered for a patient at high risk for tumor lysis syndrome. The patient is of Mediterranean ancestry, and her G6PD status is unknown. What should the nurse do before the first dose?
- A. Give it now and send a G6PD test afterward.
- B. Hold administration until the G6PD screening result is reviewed and deficiency is excluded.
- C. Give half the dose until results return.
- D. Give it as a rapid IV push to shorten exposure.
Show answer and rationale — Question 38
Correct answer: B. Hold administration until the G6PD screening result is reviewed and deficiency is excluded.
Rasburicase is contraindicated in G6PD deficiency because it can cause severe hemolysis. The prescribing information tells clinicians to screen patients at higher risk, such as those of African or Mediterranean ancestry, before starting. Ordering or collecting the test is not enough: the result must be reviewed before administration, and the drug must not be given to a patient with G6PD deficiency.
Why the other choices don't fit:
- A: Testing after the dose defeats the purpose of screening.
- C: A smaller dose doesn't remove the contraindication.
- D: The label says not to give rasburicase as an IV bolus. It is infused.
Takeaway: Higher-risk ancestry and unknown G6PD status: review the screening result before rasburicase. Do not administer it in G6PD deficiency.
Source: Sanofi, Elitek (rasburicase) US prescribing information, PDF pp. 1–2: boxed warning, sections 2.1, 4, and 5.2.
Question 39 of 50
Oncologic Emergencies
During a peripheral infusion of a vesicant, the patient reports burning at the IV site, and the nurse sees swelling. What should the nurse do first?
- A. Flush the line with saline to dilute the drug.
- B. Slow the infusion rate and keep watching the site.
- C. Stop the infusion, call for help, leave the device in place, and aspirate any remaining drug without flushing.
- D. Remove the catheter right away and apply heat.
Show answer and rationale — Question 39
Correct answer: C. Stop the infusion, call for help, leave the device in place, and aspirate any remaining drug without flushing.
Suspected extravasation of a vesicant is an emergency. First actions: stop the infusion, get help, leave the access device in place, and aspirate residual drug from it without flushing. Antidotes, compresses, and device removal follow the drug-specific protocol.
Why the other choices don't fit:
- A: Flushing pushes more drug into the tissue.
- B: Continuing the infusion at any rate adds to the injury.
- D: Removing the device first loses the chance to aspirate drug. Heat versus cold depends on the specific drug.
Takeaway: Stop, get help, leave it in, aspirate, don't flush.
Source: eviQ (Cancer Institute NSW), Extravasation management: clinical procedure (ID 4156), Primary actions: stop, send for assistance, leave access, aspirate, do not flush; drug-specific management.
Question 40 of 50
Oncologic Emergencies
A patient with prostate cancer that has spread to bone reports 3 days of worsening back pain that is worse lying flat. Today his legs feel heavy, and he is unsteady when he walks. What is the priority?
- A. Report this immediately. Suspected spinal cord compression needs an urgent whole-spine MRI.
- B. Apply a heating pad and reassess next week.
- C. Encourage more walking to prevent stiffness.
- D. Schedule a routine outpatient MRI for next month.
Show answer and rationale — Question 40
Correct answer: A. Report this immediately. Suspected spinal cord compression needs an urgent whole-spine MRI.
Worsening back pain in someone with bone metastases, plus new leg heaviness and unsteady gait, suggests metastatic spinal cord compression. The Christie guidance calls for urgent whole-spine MRI and clinical assessment when this is suspected. New neurologic symptoms need emergency escalation, not a routine outpatient scan.
Why the other choices don't fit:
- B: Heat and waiting delay diagnosis while function may be declining.
- C: More activity doesn't address a possible compression, and some patients need spinal precautions.
- D: A routine scan is far too slow for new neurologic symptoms.
Takeaway: Back pain plus new neurologic signs in someone with bone metastases: urgent MRI.
Source: The Christie NHS Foundation Trust, Overview of the management of MSCC due to cancer, PDF pp. 1–2: signs and symptoms; Referral for imaging; Hospital admission.
Question 41 of 50
Oncologic Emergencies
Two days after starting chemotherapy for a high-grade lymphoma, a patient's labs show potassium, phosphate, and uric acid above the reference range and calcium below it. Which condition does this pattern suggest?
- A. Syndrome of inappropriate antidiuretic hormone (SIADH)
- B. Hypercalcemia of malignancy
- C. Disseminated intravascular coagulation (DIC)
- D. Tumor lysis syndrome (TLS)
Show answer and rationale — Question 41
Correct answer: D. Tumor lysis syndrome (TLS)
Tumor lysis syndrome is marked by high uric acid, high potassium, high phosphate, and low calcium as cancer cells break down and release their contents. It usually follows the start of treatment but can occur before it. It needs urgent assessment because of risks such as kidney injury and arrhythmias.
Why the other choices don't fit:
- A: SIADH mainly causes low sodium.
- B: Hypercalcemia means calcium is high, not low.
- C: DIC is a clotting and bleeding disorder, identified by coagulation tests and platelets.
Takeaway: High K, high phos, high uric acid, low Ca: think TLS.
Source: eviQ, Prevention of tumour lysis syndrome (ID 108), Background: characteristic metabolic pattern; History.
Question 42 of 50
Oncologic Emergencies
Four days after CAR T-cell infusion, a patient has a temperature of 39.2°C (102.6°F). Her blood pressure stayed low after a fluid bolus, and norepinephrine has been started as her only vasopressor. She is on oxygen at 2 L/min by nasal cannula. The team attributes these findings to cytokine release syndrome (CRS), not another cause. Using American Society for Transplantation and Cellular Therapy (ASTCT) consensus grading, what grade is her CRS?
- A. Grade 1
- B. Grade 2
- C. Grade 3
- D. Grade 4
Show answer and rationale — Question 42
Correct answer: C. Grade 3
ASTCT grades CRS by the more severe of hypotension or hypoxia attributable to CRS, with fever required at its initial presentation. Needing one vasopressor is grade 3. Her low-flow nasal cannula oxygen would be grade 2 on its own, but the hypotension sets the grade.
Why the other choices don't fit:
- A: Grade 1 is fever without hypotension or hypoxia.
- B: Grade 2 is hypotension without vasopressors, or low-flow oxygen. She needs a vasopressor.
- D: Grade 4 requires multiple vasopressors (excluding vasopressin) or positive-pressure ventilation.
Takeaway: CRS grade follows the worse of blood pressure support and oxygen support.
Source: eviQ, Cytokine release syndrome (CRS) — ASTCT, ASTCT grading table and footnotes a–d.
Question 43 of 50
Oncologic Emergencies
Five days after CAR T-cell infusion, a patient is alert, but her immune effector cell-associated encephalopathy (ICE) score has dropped from 10 at baseline to 9 because she can no longer name one of three objects. According to the eviQ ICANS assessment tool, what should the nurse do?
- A. Document the score and recheck tomorrow.
- B. Notify the physician immediately.
- C. Give acetaminophen and reassess in 4 hours.
- D. Wait until the score falls to 6 or lower before calling.
Show answer and rationale — Question 43
Correct answer: B. Notify the physician immediately.
The eviQ tool instructs nurses to notify the physician immediately for an ICE score of 9 or below. Naming, writing, attention, orientation, and command-following are part of the assessment. A new naming deficit needs prompt evaluation for immune effector cell-associated neurotoxicity syndrome (ICANS) and other causes.
Why the other choices don't fit:
- A: Waiting until tomorrow ignores the tool's immediate-notification threshold.
- C: Acetaminophen doesn't treat neurotoxicity and delays evaluation.
- D: The tool calls for notification at 9, not 6. A score of 6 falls in its grade-2 ICE band, but the overall ICANS grade is determined by the most severe attributable neurologic finding, not the ICE score alone.
Takeaway: Any drop in the ICE score to 9 or below gets an immediate call.
Source: eviQ, ICANS assessment tool (ID 3835), PDF p. 1: immediate-notification instruction, ICE assessment and overall ICANS grading; p. 4 version.
Question 44 of 50
Oncologic Emergencies
A patient with advanced cancer suddenly becomes short of breath and has chest pain that worsens with a deep breath. She has no leg swelling or leg pain. What should the nurse do?
- A. Treat this as an emergency and get immediate medical evaluation.
- B. Rule out a blood clot, since she has no leg symptoms.
- C. Have her rest and recheck her tomorrow.
- D. Give her an inhaler and see if breathing improves.
Show answer and rationale — Question 44
Correct answer: A. Treat this as an emergency and get immediate medical evaluation.
Sudden trouble breathing and chest pain that worsens with a deep breath are signs of pulmonary embolism (PE), and CDC advises seeking medical help immediately. A PE can occur without any signs of a deep vein clot in the leg. Cancer also raises clot risk.
Why the other choices don't fit:
- B: No leg symptoms doesn't rule out PE.
- C: Delay could be fatal if this is a PE.
- D: An inhaler doesn't address a possible clot and delays evaluation.
Takeaway: PE can happen without leg symptoms. Sudden dyspnea plus pleuritic chest pain is an emergency.
Source: CDC, About Venous Thromboembolism (Blood Clots), Signs and symptoms: PE.
Question 45 of 50
Oncologic Emergencies
A patient receiving a checkpoint inhibitor develops a new dry cough and shortness of breath when climbing stairs. What should the nurse do?
- A. Tell her it's probably a cold and to drink more fluids.
- B. Recommend a cough suppressant and continuing treatment without notifying the oncology team.
- C. Wait until her next scheduled infusion to discuss it.
- D. Report it promptly so she can be evaluated for possible pneumonitis.
Show answer and rationale — Question 45
Correct answer: D. Report it promptly so she can be evaluated for possible pneumonitis.
Checkpoint inhibitors can cause inflammation of the lungs (pneumonitis). New cough or shortness of breath needs prompt evaluation for pneumonitis and other causes. The oncology team determines what evaluation and treatment changes are needed; the nurse should not dismiss the symptoms or wait for the next infusion.
Why the other choices don't fit:
- A: Assuming a cold can delay recognition of a serious immune-related effect.
- B: Suppressing the cough without notifying the team does not evaluate possible lung inflammation or another serious cause.
- C: Waiting until the next infusion delays evaluation of a symptom that can worsen.
Takeaway: New cough or dyspnea on a checkpoint inhibitor: report it and evaluate for pneumonitis.
Source: NCI, Organ-Related Inflammation and Immunotherapy, Respiratory system.
Question 46 of 50
Psychosocial Dimensions of Care
During a visit, a patient says she has been skipping doses of her oral cancer medicine because she can't afford the copay. What is the nurse's best response?
- A. "You need to take every dose no matter what it costs."
- B. "I'll note in your chart that you are noncompliant."
- C. "Thank you for telling me. Let's connect you with our financial counselor or social worker today."
- D. "There's no help available for medication costs, unfortunately."
Show answer and rationale — Question 46
Correct answer: C. "Thank you for telling me. Let's connect you with our financial counselor or social worker today."
Cost can lead patients to skip or delay treatment. The helpful response explores the barrier without blame and connects the patient with people who can help, such as a financial navigator or social worker, and with possible assistance resources. The oncology team also needs to know about the missed doses so the treatment plan can be addressed safely.
Why the other choices don't fit:
- A: This ignores a real barrier and won't change what she can afford.
- B: Labeling her doesn't solve the problem and may discourage honesty.
- D: Help is often available. Ruling it out without checking leaves her without options.
Takeaway: Treat cost as a barrier to solve, not a patient failing.
Source: NCI, Financial Toxicity and Cancer Treatment (PDQ), Patient Version, Effects on care; ways to reduce financial burden; NCI, Emotions and Cancer, Difficult feelings; talking with the health care team; practical and financial support.
Question 47 of 50
Psychosocial Dimensions of Care
A patient tells the nurse she has been crying most days and can't concentrate at work. She asks, "Shouldn't I just stay positive?" What is the best response?
- A. "It's normal to have hard feelings. Tell me more about how this is affecting you, and let's look at support options."
- B. "Yes, a positive attitude is the most important part of beating cancer."
- C. "It sounds like you have major depression."
- D. "Try not to think about it too much."
Show answer and rationale — Question 47
Correct answer: A. "It's normal to have hard feelings. Tell me more about how this is affecting you, and let's look at support options."
Difficult emotions are common with cancer. Patients don't need to force a positive attitude. The nurse's role is to acknowledge the feelings, learn how they're affecting daily life, and connect the patient with help, such as counseling or support services.
Why the other choices don't fit:
- B: Pressure to stay positive can make patients feel guilty for having normal feelings.
- C: A diagnosis can't be made from one statement. It needs a proper assessment.
- D: Brushing the feelings off doesn't assess or support her.
Takeaway: Acknowledge, assess, and connect to support. Don't demand positivity.
Source: NCI, Emotions and Cancer, Difficult feelings; talking with the health care team; practical and financial support.
Question 48 of 50
Psychosocial Dimensions of Care
While discussing treatment choices, a patient says, "I keep wondering what all of this means for my faith." What should the nurse do?
- A. Change the subject back to the treatment plan.
- B. Ask what is important to her and offer to connect her with a chaplain or spiritual advisor if she wants.
- C. Share the nurse's own religious beliefs to comfort her.
- D. Assume she wants her own congregation's clergy called right away.
Show answer and rationale — Question 48
Correct answer: B. Ask what is important to her and offer to connect her with a chaplain or spiritual advisor if she wants.
Spiritual concerns are part of whole-person care and are among the issues palliative care addresses. The nurse follows the patient's lead, asks what matters to her, and offers resources she chooses.
Why the other choices don't fit:
- A: Ignoring the concern misses a real need.
- C: Imposing the nurse's beliefs isn't patient-centered.
- D: Assuming a preference without asking takes the choice away from her.
Takeaway: Let the patient define her spiritual needs, then offer what she wants.
Source: NCI, Palliative Care in Cancer, When palliative care is used; hospice distinction; goals and spiritual concerns.
Question 49 of 50
Psychosocial Dimensions of Care
The husband of a patient receiving treatment tells the nurse he is exhausted from caregiving, working, and managing the household. What is the best response?
- A. "Caregiving is part of marriage, so try to push through."
- B. "Your wife's needs have to come before yours right now."
- C. "You'll need to hire a full-time home aide."
- D. "That's a lot to carry. Let's talk about what you need and who could share some of these tasks."
Show answer and rationale — Question 49
Correct answer: D. "That's a lot to carry. Let's talk about what you need and who could share some of these tasks."
Caregivers need support too. Helping them name what they need, ask others for help, and share responsibilities protects both the caregiver and the patient. The nurse can also point to support services.
Why the other choices don't fit:
- A: Telling him to push through ignores real strain and risk of burnout.
- B: Dismissing his needs doesn't help either of them.
- C: One costly solution may not fit or be available. Start by assessing his needs.
Takeaway: Assess the caregiver's needs and help him share the load.
Source: NCI, Support for Caregivers of Cancer Patients, Asking for help; caring for yourself.
Question 50 of 50
Psychosocial Dimensions of Care
A 29-year-old woman with newly diagnosed breast cancer will soon start chemotherapy that may affect her fertility. She hopes to have children someday. What is the nurse's best action?
- A. Tell her fertility can be addressed after treatment is finished.
- B. Advise her to postpone chemotherapy for several months to plan a pregnancy first.
- C. Discuss her goals and help arrange a prompt referral to a fertility specialist before treatment starts.
- D. Assure her that fertility preservation always works.
Show answer and rationale — Question 50
Correct answer: C. Discuss her goals and help arrange a prompt referral to a fertility specialist before treatment starts.
Fertility should be discussed before treatment begins, because some preservation options must happen first. A timely referral to a fertility specialist, coordinated with the oncology team, lets her consider options without an unsafe delay.
Why the other choices don't fit:
- A: Waiting until after treatment may close off options.
- B: Delaying treatment is a decision for her and her oncology team, not a nursing instruction.
- D: No preservation method is guaranteed to work.
Takeaway: Talk fertility before the first treatment, and refer promptly.
Source: NCI, Female Fertility and Cancer Treatment, Talk about fertility before treatment.
Review your answers
Go back through every question you missed, and every one you got right but couldn't fully explain. For each, write down the specific concept, not just the content area. "Hospice eligibility" is useful. "Care Continuum" is too broad to study. Then open the linked source for that concept, pick the two concepts that need the most work, and study those next.
A note on your score: it describes your answers to these 50 questions. It is not an ONCC scaled score, a prediction of whether you'll pass, or a measure of readiness. With only 5 to 13 questions per content area, a result in one area is a hint about what to review, not a verdict on what you know.
For a self-check, record your first answer before opening each explanation. Count only answers made before seeing the key: number correct ÷ number answered × 100. Leave questions you revealed without answering out of that percentage; with no answers recorded, there is no percentage to report. If you answered all 50 before revealing them, each correct answer is worth 2 percentage points.
Answer key
Show the complete answer key
| # | Content area | Topic | Answer |
|---|---|---|---|
| 1 | Oncologic Emergencies | Fever with neutropenia during chemotherapy | C |
| 2 | Care Continuum | Lung cancer screening eligibility | B |
| 3 | Care Continuum | Tobacco cessation after diagnosis | A |
| 4 | Care Continuum | Survivorship care plan | D |
| 5 | Care Continuum | Late effects | C |
| 6 | Care Continuum | Palliative care alongside treatment | A |
| 7 | Care Continuum | Medicare hospice benefit eligibility | B |
| 8 | Care Continuum | Advance care planning | D |
| 9 | Oncology Nursing Practice | Tumor (somatic) vs germline testing | C |
| 10 | Oncology Nursing Practice | Variant of uncertain significance | A |
| 11 | Oncology Nursing Practice | Right to withdraw from a clinical trial | D |
| 12 | Oncology Nursing Practice | TNM staging | C |
| 13 | Oncology Nursing Practice | ECOG performance status | B |
| 14 | Oncology Nursing Practice | Hazardous drug exposure assessment | A |
| 15 | Oncology Nursing Practice | Institutional review board | D |
| 16 | Treatment Modalities | Debulking surgery | A |
| 17 | Treatment Modalities | Neoadjuvant therapy | B |
| 18 | Treatment Modalities | Side effects and treatment response | C |
| 19 | Treatment Modalities | External beam radiation safety | D |
| 20 | Treatment Modalities | Temporary brachytherapy after source removal | A |
| 21 | Treatment Modalities | Autologous transplant | B |
| 22 | Treatment Modalities | Graft-versus-host disease | D |
| 23 | Treatment Modalities | Resistance to targeted therapy | A |
| 24 | Treatment Modalities | Checkpoint inhibitor mechanism | C |
| 25 | Treatment Modalities | CAR T-cell therapy | B |
| 26 | Symptom Management and Supportive Care | Infection prevention teaching | D |
| 27 | Symptom Management and Supportive Care | Bleeding precautions with thrombocytopenia | C |
| 28 | Symptom Management and Supportive Care | Anemia and fatigue | A |
| 29 | Symptom Management and Supportive Care | Managing fatigue | D |
| 30 | Symptom Management and Supportive Care | Daily mouth care | B |
| 31 | Symptom Management and Supportive Care | Mouth sores affecting intake | C |
| 32 | Symptom Management and Supportive Care | Assessing diarrhea | A |
| 33 | Symptom Management and Supportive Care | Preventing opioid-related constipation | D |
| 34 | Symptom Management and Supportive Care | Comprehensive pain assessment | B |
| 35 | Symptom Management and Supportive Care | Safety with peripheral neuropathy | C |
| 36 | Symptom Management and Supportive Care | Recognizing possible lymphedema | A |
| 37 | Symptom Management and Supportive Care | Vascular access site infection | D |
| 38 | Symptom Management and Supportive Care | Rasburicase and G6PD | B |
| 39 | Oncologic Emergencies | Suspected vesicant extravasation | C |
| 40 | Oncologic Emergencies | Suspected metastatic spinal cord compression | A |
| 41 | Oncologic Emergencies | Tumor lysis syndrome pattern | D |
| 42 | Oncologic Emergencies | Grading cytokine release syndrome | C |
| 43 | Oncologic Emergencies | Early ICANS | B |
| 44 | Oncologic Emergencies | Possible pulmonary embolism | A |
| 45 | Oncologic Emergencies | Possible immune-related pneumonitis | D |
| 46 | Psychosocial Dimensions of Care | Cost-related nonadherence | C |
| 47 | Psychosocial Dimensions of Care | Emotional distress | A |
| 48 | Psychosocial Dimensions of Care | Spiritual needs | B |
| 49 | Psychosocial Dimensions of Care | Caregiver strain | D |
| 50 | Psychosocial Dimensions of Care | Fertility before treatment | C |
What this OCN practice test covers
Every question is tagged to one of the six content areas in ONCC's 2026 OCN Test Content Outline. The number of questions in each area follows ONCC's official weights as closely as whole questions allow.
| Content area | ONCC weight | Questions here |
|---|---|---|
| Care Continuum | 14% | 7 |
| Oncology Nursing Practice | 15% | 7 |
| Treatment Modalities | 20% | 10 |
| Symptom Management and Supportive Care | 25% | 13 |
| Oncologic Emergencies | 16% | 8 |
| Psychosocial Dimensions of Care | 10% | 5 |
| Total | 100% | 50 |
How we got those counts: 50 × each weight gives 7, 7.5, 10, 12.5, 8, and 5. Two areas land on a half question, so we gave the extra question to the more heavily weighted of the two (Symptom Management and Supportive Care) and rounded Oncology Nursing Practice down. That's our arithmetic, not an ONCC form.
The set samples topics within each area. It doesn't cover every item on the outline, and ONCC notes that not every sub-area appears on every form of the real exam either (2026 manual, p. 6).
How this compares with the OCN exam
The Oncology Certified Nurse (OCN) credential is awarded by the Oncology Nursing Certification Corporation (ONCC); it is not initial RN licensure. ONCC describes the credential here.
| Row label | This practice test | The OCN exam |
|---|---|---|
| Questions | 50 | 165: 145 scored plus 20 unscored pretest questions you can't identify (2026 manual, p. 6) |
| Format | Four options, one best answer | Four options, only one correct (2026 manual, p. 4) |
| Time | Untimed | A three-hour session with no scheduled breaks; the clock keeps running if you step out (2026 manual, pp. 4 and 33) |
| Drug names | Generic names only | Generic names only (ONCC OCN page) |
| Scoring | Number correct out of the questions you answer | A scaled score from 25 to 75; 55 passes (2026 manual, p. 38) |
That last row trips people up. A scaled score of 55 is not 55% correct. Scaled scoring adjusts for small differences in difficulty between exam forms, so there's no honest way to convert a percentage on any practice set, including this one, into a predicted OCN score. ONCC explains its scoring and equating here.
Is there an official free OCN practice test?
Yes. ONCC offers one free 50-question OCN practice test through its online store, with the correct answer, a rationale, and a reference for each item. You see the same 50 questions each time, in a different order. From the time you acquire it, you have 12 months to start it, and once you open it you can use it as often as you like for 14 days. Details are on ONCC's practice tests page and its free OCN practice-test description.
ONCC also posts five OCN sample questions with an answer key that anyone can read without an account.
Our suggestion: use both. ONCC's own samples show its published item style, and this set gives you 50 more questions with an explanation for every option. ONCC is clear that its practice tests don't contain actual exam questions either.
For application and eligibility requirements, use ONCC's official OCN page.
Sources and verification
These practice questions are original. They were written for this page, and they are not ONCC exam items or rewrites of them. ONCC's content outline decided which topics to include. The answers rest on the clinical guidelines, drug labeling, and government health sources linked beside each rationale, not on the outline itself.
Official exam sources
- ONCC 2026 OCN Test Content Outline: content areas and weights
- ONCC 2026 Certification Test Registration Manual, valid January 1, 2026: question count, format, session, and scoring
- ONCC Oncology Certified Nurse (OCN) page: credential, generic drug names, and official application information
- ONCC Practice Tests and OCN Sample Test Questions
Clinical sources used in the rationales
- ASCO/IDSA, Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy
- IDSA, Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer (2010 update)
- CDC, Watch Out for Fever
- NCI, Infection and Neutropenia during Cancer Treatment
- USPSTF, Lung Cancer: Screening (2021)
- American Cancer Society, Benefits of Quitting Tobacco If You Have Cancer
- NCI, Tobacco Control Monograph 23: Treating Smoking in Cancer Patients, Chapter 1
- NCI, Follow-Up Medical Care
- NCI, Palliative Care in Cancer
- Medicare.gov, Hospice care
- CMS, Hospice
- 42 CFR 418.28, Revoking the election of hospice care
- NIA, Advance Care Planning: Advance Directives for Health Care
- NCI, Genetic Testing for Inherited Cancer Risk
- NCI, Biomarker Testing for Cancer Treatment
- NCI, Are Clinical Trials Safe?
- HHS OHRP, Informed Consent FAQs
- NCI, Cancer Staging
- NCI, Tumor Grade
- NCI SEER Training, ECOG Performance Status
- NIOSH, Managing Hazardous Drug Exposures: Information for Healthcare Settings (Pub. 2023-130)
- NCI, Surgery to Treat Cancer
- NCI, Chemotherapy to Treat Cancer
- NCI Dictionary of Cancer Terms, Maintenance therapy
- NCI Dictionary of Cancer Terms, Salvage therapy
- NCI, External Beam Radiation Therapy for Cancer
- NCI, Brachytherapy to Treat Cancer
- NCI, Stem Cell Transplants in Cancer Treatment
- NCI Dictionary of Cancer Terms, Haploidentical donor
- NCI, Targeted Therapy to Treat Cancer
- NCI, Immune Checkpoint Inhibitors
- NCI, T-cell Transfer Therapy
- NCI, Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment
- NCI, Fatigue and Cancer Treatment
- NCI, Anemia and Cancer Treatment
- NCI, Mouth and Throat Problems and Cancer Treatment
- NCI, Diarrhea and Cancer Treatment
- NCI, Constipation and Cancer Treatment
- NCI, Pain and Cancer
- NCI, Nerve Problems (Peripheral Neuropathy) and Cancer Treatment
- NCI, Lymphedema and Cancer Treatment
- Sanofi, Elitek (rasburicase) US prescribing information
- eviQ (Cancer Institute NSW), Extravasation management: clinical procedure (ID 4156)
- The Christie NHS Foundation Trust, Overview of the management of MSCC due to cancer
- eviQ, Prevention of tumour lysis syndrome (ID 108)
- eviQ, Cytokine release syndrome (CRS) — ASTCT
- eviQ, ICANS assessment tool (ID 3835)
- CDC, About Venous Thromboembolism (Blood Clots)
- NCI, Organ-Related Inflammation and Immunotherapy
- NCI, Financial Toxicity and Cancer Treatment (PDQ), Patient Version
- NCI, Emotions and Cancer
- NCI, Support for Caregivers of Cancer Patients
- NCI, Female Fertility and Cancer Treatment
Exam format, content outline, and ONCC practice-test details last verified September 23, 2026. The sources behind each answer were checked on the same date. Checking sources is not the same as professional clinical review, and this set has not been validated as a predictor of exam performance.
AI tools assisted with drafting, editing, and source checking. The patient scenarios are hypothetical, not actual encounters or firsthand clinical experience.
By the Castleport Test Prep Editorial Team.
Castleport Test Prep is an independent exam prep publisher and is not affiliated with, endorsed by, or approved by the Oncology Nursing Certification Corporation (ONCC). These are original, unofficial practice questions, not actual examination items. Exam and credential names are used to identify their subjects; trademarks belong to their respective owners. This study resource does not replace clinical judgment or your facility's protocols.