A patient who has smoked for 30 years asks, "What is the point of quitting now? The damage is already done." Which response by the nurse is most accurate?

"Some damage is permanent, but quitting stops promotion and lowers your risk over time."

"Quitting reverses the DNA damage that has already occurred in your lung cells."

"Risk stays the same after quitting, but your breathing and circulation will improve."

"Once a cell is initiated, cancer will develop unless the cell is surgically removed."

While caring for a patient with a temporary low-dose-rate cervical brachytherapy implant, the nurse finds the radioactive source lying in the bed linens. Which action is correct?

Pick it up with long-handled forceps and place it in the lead container

Pick it up with double chemotherapy gloves and return it to the applicator

Remove the linens with the source and send them to the laundry in a sealed bag

Leave the room and wait for the radiation oncologist to arrive before acting

A patient is scheduled to receive cisplatin 75 mg/m² for the first time. Which antiemetic prophylaxis regimen does the nurse anticipate?

NK1 antagonist, 5-HT3 antagonist, dexamethasone and olanzapine

5-HT3 antagonist and dexamethasone on day 1, then dexamethasone on days 2–3

Prochlorperazine before chemotherapy and every 6 hours as needed afterward

Lorazepam, metoclopramide and diphenhydramine every 6 hours for 3 days

A patient with neutropenic fever received blood cultures and IV antibiotics 2 hours ago. Blood pressure is now 82/46 mm Hg, heart rate 124/min and serum lactate 4.6 mmol/L. Which order should the nurse anticipate FIRST?

IV crystalloid bolus of 30 mL/kg within the first 3 hours

IV furosemide to keep urine output above 0.5 mL/kg/h

Packed red blood cell transfusion to raise oxygen delivery

Oral rehydration solution 1 L over the next 4 hours

The parent of a healthy 13-year-old asks how many doses of HPV vaccine are needed. What should the nurse explain?

Two doses, because the series starts before age 15

Three doses, because the child is older than 12

One dose, because the child is not yet sexually active

Two doses, but only if started after age 15

The spouse of a patient receiving daily external beam radiation for lung cancer asks whether it is safe to sleep in the same bed. Which response by the nurse is accurate?

"Yes. External beam radiation does not make your spouse radioactive."

"Yes, but only after 48 hours have passed since the last treatment."

"No. Stay at least 6 feet apart until the full course is completed."

"No. Sleep separately on treatment days and share a bed on weekends."

A postmenopausal woman is starting anastrozole for hormone receptor-positive breast cancer. Which baseline assessment does the nurse anticipate?

Bone mineral density by DEXA scan

Echocardiogram for ejection fraction

Audiogram for high-frequency loss

ONCC's Oncology Certified Nurse

Free ONCC's Oncology Certified Practice Questions

10 sample questions for the ONCC's Oncology Certified Nurse, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Care Continuum, Psychosocial Dimensions of Care, Oncology Nursing Practice, Treatment Modalities, Symptom Management and Palliative Care, Oncologic Emergencies.

Question 1 · Care Continuum
A nurse leads a community program that provides free nicotine replacement and counseling to adults who smoke. This program is an example of which level of prevention?
- A.Secondary prevention
- B.Primary prevention
- C.Tertiary prevention
- D.Quaternary prevention
Show answer and explanation
Answer: B. Primary prevention
Tobacco cessation removes exposure to a carcinogen before cancer develops, which is primary prevention. Secondary prevention is early detection through screening such as LDCT, and tertiary prevention limits disability or recurrence in people who already have cancer.
Question 2 · Oncology Nursing Practice
A patient who has smoked for 30 years asks, "What is the point of quitting now? The damage is already done." Which response by the nurse is most accurate?
- A."Quitting reverses the DNA damage that has already occurred in your lung cells."
- B."Risk stays the same after quitting, but your breathing and circulation will improve."
- C."Some damage is permanent, but quitting stops promotion and lowers your risk over time."
- D."Once a cell is initiated, cancer will develop unless the cell is surgically removed."
Show answer and explanation
Answer: C. "Some damage is permanent, but quitting stops promotion and lowers your risk over time."
Initiation causes irreversible DNA damage, but promotion is reversible and depends on continued exposure, so stopping tobacco use lowers cancer risk over time. Quitting does not reverse initiating mutations. Risk does decline after cessation, and initiated cells do not inevitably progress to cancer.
Question 3 · Treatment Modalities
While caring for a patient with a temporary low-dose-rate cervical brachytherapy implant, the nurse finds the radioactive source lying in the bed linens. Which action is correct?
- A.Pick it up with double chemotherapy gloves and return it to the applicator
- B.Remove the linens with the source and send them to the laundry in a sealed bag
- C.Leave the room and wait for the radiation oncologist to arrive before acting
- D.Pick it up with long-handled forceps and place it in the lead container
Show answer and explanation
Answer: D. Pick it up with long-handled forceps and place it in the lead container
A dislodged sealed source is never handled by hand; the nurse uses long-handled forceps to place it in the lead container kept in the room, then notifies radiation safety. Gloves provide no shielding, sending linens to laundry spreads the hazard, and leaving the source exposed without containment increases exposure to others.
Question 4 · Symptom Management and Palliative Care
A patient is scheduled to receive cisplatin 75 mg/m² for the first time. Which antiemetic prophylaxis regimen does the nurse anticipate?
- A.5-HT3 antagonist and dexamethasone on day 1, then dexamethasone on days 2–3
- B.Prochlorperazine before chemotherapy and every 6 hours as needed afterward
- C.NK1 antagonist, 5-HT3 antagonist, dexamethasone and olanzapine
- D.Lorazepam, metoclopramide and diphenhydramine every 6 hours for 3 days
Show answer and explanation
Answer: C. NK1 antagonist, 5-HT3 antagonist, dexamethasone and olanzapine
Cisplatin is highly emetogenic, and current guidelines recommend four-drug prophylaxis with an NK1 antagonist, a 5-HT3 antagonist, dexamethasone and olanzapine. A two-drug regimen suits moderate-risk agents, a single dopamine antagonist suits low-risk agents, and lorazepam is an adjunct for anticipatory nausea.
Question 5 · Oncologic Emergencies
A patient with neutropenic fever received blood cultures and IV antibiotics 2 hours ago. Blood pressure is now 82/46 mm Hg, heart rate 124/min and serum lactate 4.6 mmol/L. Which order should the nurse anticipate FIRST?
- A.IV crystalloid bolus of 30 mL/kg within the first 3 hours
- B.IV furosemide to keep urine output above 0.5 mL/kg/h
- C.Packed red blood cell transfusion to raise oxygen delivery
- D.Oral rehydration solution 1 L over the next 4 hours
Show answer and explanation
Answer: A. IV crystalloid bolus of 30 mL/kg within the first 3 hours
Hypotension with a lactate of 4 mmol/L or higher indicates sepsis-induced hypoperfusion, and sepsis guidelines call for rapid IV crystalloid resuscitation of about 30 mL/kg within the first 3 hours, adding vasopressors if mean arterial pressure stays below 65 mm Hg. A diuretic worsens hypovolemia, red cell transfusion is not first-line resuscitation without severe anemia, and oral fluids are too slow and unreliable in shock.
Question 6 · Care Continuum
The parent of a healthy 13-year-old asks how many doses of HPV vaccine are needed. What should the nurse explain?
- A.Three doses, because the child is older than 12
- B.One dose, because the child is not yet sexually active
- C.Two doses, because the series starts before age 15
- D.Two doses, but only if started after age 15
Show answer and explanation
Answer: C. Two doses, because the series starts before age 15
A 2-dose HPV series is recommended when vaccination begins before the 15th birthday. Three doses are required when the series starts at 15 or older or in immunocompromised persons, and sexual activity does not change the number of doses.
Question 7 · Oncology Nursing Practice
A patient with advanced HIV infection develops violaceous plaques on the legs and oral mucosa. The nurse recognizes that the likely malignancy is associated with which infectious agent?
- A.Epstein-Barr virus
- B.Human herpesvirus 8
- C.Human papillomavirus
- D.Human T-lymphotropic virus 1
Show answer and explanation
Answer: B. Human herpesvirus 8
Kaposi sarcoma, which presents as violaceous skin and mucosal lesions in immunosuppressed patients, is caused by human herpesvirus 8. Epstein-Barr virus is linked to Burkitt and Hodgkin lymphoma and nasopharyngeal carcinoma, HPV to cervical and oropharyngeal cancers, and HTLV-1 to adult T-cell leukemia/lymphoma.
Question 8 · Treatment Modalities
The spouse of a patient receiving daily external beam radiation for lung cancer asks whether it is safe to sleep in the same bed. Which response by the nurse is accurate?
- A."Yes, but only after 48 hours have passed since the last treatment."
- B."Yes. External beam radiation does not make your spouse radioactive."
- C."No. Stay at least 6 feet apart until the full course is completed."
- D."No. Sleep separately on treatment days and share a bed on weekends."
Show answer and explanation
Answer: B. "Yes. External beam radiation does not make your spouse radioactive."
External beam radiation is delivered from a machine outside the body and leaves no radioactive material in the patient, so no precautions are needed. Time and distance restrictions apply to temporary sealed implants and unsealed radiopharmaceuticals, not to external beam therapy.
Question 9 · Symptom Management and Palliative Care
A postmenopausal woman is starting anastrozole for hormone receptor-positive breast cancer. Which baseline assessment does the nurse anticipate?
- A.Echocardiogram for ejection fraction
- B.Pulmonary function with DLCO
- C.Audiogram for high-frequency loss
- D.Bone mineral density by DEXA scan
Show answer and explanation
Answer: D. Bone mineral density by DEXA scan
Aromatase inhibitors lower estrogen and accelerate bone loss, so a baseline DEXA scan with calcium, vitamin D and exercise counseling is recommended. Echocardiograms monitor anthracyclines and trastuzumab, DLCO monitors bleomycin, and audiograms monitor cisplatin.
Question 10 · Oncologic Emergencies
A patient with sepsis-associated DIC is bleeding from the gums and IV sites. The fibrinogen is 85 mg/dL. Which blood product is most specifically indicated to correct this value?
- A.Cryoprecipitate
- B.Packed red blood cells
- C.Albumin 25%
- D.Irradiated platelets
Show answer and explanation
Answer: A. Cryoprecipitate
Cryoprecipitate is concentrated in fibrinogen, factor VIII and von Willebrand factor and is given when fibrinogen falls below about 150 mg/dL in a bleeding patient with DIC. Red cells replace oxygen-carrying capacity but not clotting factors, albumin is a volume expander with no hemostatic effect, and platelets correct thrombocytopenia rather than a low fibrinogen.

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