Oncology Nursing Questions for the Prometric Exam 2026: 20 MCQs with Answers on Chemotherapy Safety, Extravasation, Neutropenia, Tumour Lysis, Radiation Care, Pain and Palliative Care, Central Lines and Oncological Emergencies

Oncology nursing questions sit inside the medical-surgical and pharmacology domains of the registered nurse paper, usually 6 to 10 questions, and the Gulf's new cancer centres (Dubai, Abu Dhabi, Riyadh, Doha, Kuwait) recruit chemotherapy-competent nurses constantly. The exam tests safety first: who may give chemotherapy, what to do when it leaks, how to protect a neutropenic patient, and how to recognise the emergencies. This set covers what recurs. Physicians sit a separate paper (oncology specialist questions).

Chemotherapy safety

Question 1

Before administering chemotherapy, the nurse verifies the prescription against the protocol. Which check is essential?

1. The patient's room number
2. Two chemotherapy-competent nurses independently verify the patient's identity with two identifiers, the drug, dose calculated from current height and weight (body surface area) or renal function, route, cycle day, cumulative dose where relevant, recent blood counts and organ function, and informed consent, before any drug is connected
3. Only the pharmacist's label
4. Verification by one nurse is sufficient

Answer: B. Chemotherapy is a high-alert medication; independent double-checking and a current weight are standards audited in every Gulf oncology unit. Vincristine is never given intrathecally and is dispensed in a minibag, not a syringe, for that reason.

Question 2

Which personal protective equipment is required when administering intravenous chemotherapy?

1. Standard gloves only
2. Two pairs of chemotherapy-rated (nitrile) gloves, a disposable impermeable gown with closed front and cuffs, eye protection when splashing is possible, closed-system transfer devices, and disposal of all contaminated items in cytotoxic waste; pregnant or breastfeeding staff may decline to handle cytotoxics
3. A surgical mask only
4. No protection is needed for pre-mixed bags

Answer: B. Patient excreta are considered contaminated for about 48 hours after most agents; a spill kit must be on the unit.

Question 3

During a peripheral infusion of doxorubicin, the patient reports burning at the cannula site and the nurse sees swelling. The first actions are:

1. Flush the cannula with saline to clear the drug
2. Stop the infusion immediately, leave the cannula in place and aspirate as much drug as possible, mark the area, notify the physician, apply the antidote per protocol (dexrazoxane for anthracyclines, with cold compresses; hyaluronidase and warm compresses for vinca alkaloids), elevate the limb, document with photographs and complete an incident report
3. Continue the infusion at a slower rate
4. Apply heat to all vesicant extravasations

Answer: B. Flushing spreads the vesicant. Vesicants (anthracyclines, vinca alkaloids, mechlorethamine) cause tissue necrosis and are ideally given through a central line.

Question 4

A patient is to receive cisplatin, a highly emetogenic agent. The antiemetic plan the nurse expects is:

1. Metoclopramide as needed only
2. Prophylaxis before chemotherapy with a 5-HT3 antagonist, an NK1 receptor antagonist and dexamethasone, with olanzapine as a fourth agent, continued for delayed nausea on days 2 to 4, plus non-pharmacological measures and assessment at each visit
3. No antiemetic until vomiting starts
4. Lorazepam alone

Answer: B. Anticipatory nausea is prevented by controlling the first cycle well; dexamethasone raises glucose in diabetic patients, which the nurse monitors.

Question 5

A patient on 5-fluorouracil has painful oral ulceration and cannot eat. The nursing management of mucositis includes:

1. Mouthwashes containing alcohol and vigorous brushing
2. Regular gentle oral care with a soft brush and bland rinses (saline or sodium bicarbonate), topical and systemic analgesia including opioids if needed, a soft or liquid diet, monitoring for candidiasis and herpes simplex, hydration and nutritional support, and a dental assessment before treatment where possible
3. Stop all oral care until healed
4. Hydrogen peroxide rinses hourly

Answer: B. Oral cryotherapy (ice chips) during bolus 5-FU reduces mucositis; alcohol-based and peroxide rinses worsen it.

Myelosuppression

Question 6

A patient on day 10 after chemotherapy has a temperature of 38.3 °C and a neutrophil count of 0.4 × 10⁹/L. The nurse's priority actions are:

1. Give paracetamol and recheck in four hours
2. Recognise febrile neutropenia as an emergency, obtain blood cultures from the central line and peripherally, urine and other cultures, and ensure broad-spectrum intravenous antibiotics are given within one hour of presentation, with a full assessment for a source, strict hand hygiene and monitoring for sepsis
3. Rectal temperature to confirm fever
4. Wait for the consultant round

Answer: B. Rectal temperatures and suppositories are avoided in neutropenia; paracetamol can mask fever and is given only after cultures and antibiotics are arranged.

Question 7

Which measures protect a neutropenic patient from infection?

1. Fresh flowers and raw salads to boost immunity
2. Meticulous hand hygiene by all staff and visitors, a single room where possible, no fresh flowers or plants, a neutropenic (low-microbial) diet avoiding raw or undercooked foods per unit policy, avoiding sick visitors and crowds, daily skin and mouth care, no rectal procedures, and prompt reporting of any fever or chills
3. Prophylactic antibiotics for every patient
4. Restricting all visitors

Answer: B. Granulocyte colony-stimulating factor is given by subcutaneous injection per protocol to shorten neutropenia in high-risk regimens.

Question 8

A patient has a platelet count of 18 × 10⁹/L after chemotherapy. The nurse should:

1. Give intramuscular injections as prescribed
2. Implement bleeding precautions: no intramuscular injections or rectal temperatures, a soft toothbrush and electric razor, avoidance of aspirin and NSAIDs, pressure on puncture sites for five minutes, monitoring for petechiae, bruising, epistaxis, melaena, haematuria and headache, and preparing for platelet transfusion per the prescriber's threshold (often below 10 × 10⁹/L, or higher if bleeding or before procedures)
3. Encourage vigorous exercise
4. Give aspirin for headache

Answer: B. A sudden severe headache in a thrombocytopenic patient is treated as a possible intracranial bleed.

Question 9

A patient with anaemia from chemotherapy has a haemoglobin of 72 g/L and is breathless on exertion. Appropriate nursing actions include:

1. Encourage the patient to walk long distances to build tolerance
2. Assess for symptoms and bleeding, plan activity with rest periods, administer red cell transfusion as prescribed with full transfusion checks and observations, monitor oxygen saturation, and teach energy conservation; erythropoiesis-stimulating agents are used selectively because of thrombosis risk
3. Iron tablets alone
4. No action; this is expected

Answer: B. Cancer-related fatigue is the most common and under-treated symptom; exercise programmes help once acute anaemia is corrected.

Oncological emergencies

Question 10

A patient with Burkitt lymphoma starting chemotherapy has a potassium of 6.3 mmol/L, phosphate 2.5 mmol/L, calcium 1.8 mmol/L, urate 850 micromol/L and reduced urine output. The nurse recognises:

1. Dehydration; encourage oral fluids
2. Tumour lysis syndrome; cardiac monitoring, aggressive intravenous hydration as prescribed, strict intake and output, administration of rasburicase or allopurinol as prescribed, treatment of hyperkalaemia, avoidance of potassium and phosphate in fluids, and preparation for renal replacement if needed; prevention with hydration and urate-lowering therapy before treatment in high-risk patients
3. Hypercalcaemia; bisphosphonates
4. Sepsis; antibiotics

Answer: B. Rasburicase is contraindicated in G6PD deficiency, which is common in Gulf populations; screening is done before use.

Question 11

A patient with metastatic breast cancer reports new back pain, difficulty walking and tingling in both legs. The nurse should:

1. Give analgesia and reassess tomorrow
2. Recognise possible metastatic spinal cord compression, keep the patient flat with spinal precautions until assessed, perform and document a neurological assessment including bladder function, notify the physician urgently for high-dose dexamethasone and urgent MRI of the whole spine, and prepare for radiotherapy or surgery
3. Encourage mobilisation to prevent clots
4. Arrange outpatient physiotherapy

Answer: B. Neurological outcome depends on function at the time of treatment; patients who can walk at diagnosis usually keep walking.

Question 12

A patient with lung cancer has facial and arm swelling, distended neck veins, headache and breathlessness that worsen when lying flat. The nurse recognises and manages:

1. Heart failure; diuretics only
2. Superior vena cava syndrome; position upright, give oxygen, avoid venepuncture and blood pressure measurement in the upper limbs, monitor the airway and neurological status, and notify the physician for urgent imaging and treatment (stenting, radiotherapy, chemotherapy or steroids depending on the cause)
3. Anaphylaxis; adrenaline
4. Normal fluid retention

Answer: B. Stridor or altered consciousness indicate airway or cerebral compromise and are emergencies.

Question 13

A patient with squamous cell lung cancer is confused, constipated, polyuric and dehydrated with a corrected calcium of 3.4 mmol/L. Nursing management includes:

1. Fluid restriction and calcium supplements
2. Intravenous isotonic saline as prescribed, strict intake and output, safety measures for confusion, mobilisation where possible, administration of a bisphosphonate (or denosumab) as prescribed, monitoring of the ECG and calcium, and stopping thiazides and calcium or vitamin D supplements
3. Thiazide diuretics
4. Bed rest to prevent bone pain

Answer: B. Immobility worsens hypercalcaemia; loop diuretics are used only after rehydration.

Radiation and access devices

Question 14

A patient receiving external beam radiotherapy to the breast asks how to care for the skin. The nurse advises:

1. Scrub the area daily and apply alcohol-based lotions
2. Wash gently with lukewarm water and mild unperfumed soap, pat dry, use moisturisers recommended by the radiotherapy team, avoid rubbing, perfumes, deodorants with metal, adhesive tape, heat pads, ice and sun exposure on the treated area, wear loose cotton clothing, and keep the skin marks intact; report moist desquamation or pain
3. Wash off the treatment marks every evening
4. Apply talcum powder liberally

Answer: B. External beam radiotherapy does not make the patient radioactive; family contact is unrestricted.

Question 15

A patient has a sealed-source brachytherapy implant for cervical cancer. The nurse's radiation safety measures include:

1. Unlimited visiting and bed rest in a shared room
2. Time, distance and shielding: a private room with a radiation warning sign, limiting time at the bedside and organising care efficiently, standing as far from the source as possible, using lead shielding where provided, no pregnant staff or visitors and no children, visitors limited to about 30 minutes a day at a distance, a dosimeter badge, and never touching a dislodged source with the hands (use long forceps and a lead container and notify radiation safety)
3. Rotating the patient every hour to avoid pressure sores
4. Removing the applicator if the patient is uncomfortable

Answer: B. The patient is kept on bed rest with a catheter and low-residue diet to prevent displacement of the applicator; radioactive iodine therapy for thyroid cancer, by contrast, makes body fluids radioactive.

Question 16

Which practice is correct for care of an implanted port used for chemotherapy?

1. Access the port with a standard hypodermic needle
2. Aseptic non-touch technique with a non-coring (Huber) needle, confirm blood return before every infusion of a vesicant, flush with saline using push-pause and lock per policy (saline or heparin) after use and at least monthly when not in use, change the needle every seven days during continuous use, and assess the site for swelling, pain or redness
3. Skip the blood return check if the line flushes easily
4. Use a 1 mL syringe to flush forcefully

Answer: B. Small syringes generate high pressures that can rupture a catheter; absence of blood return in a vesicant infusion requires investigation before proceeding.

Pain, communication and end of life

Question 17

A patient with bone metastases rates her pain 8 out of 10 despite regular paracetamol and codeine. According to the WHO analgesic ladder the nurse expects:

1. Another weak opioid
2. A switch to a strong opioid such as oral morphine with regular (modified-release) and breakthrough (immediate-release, about one sixth of the daily dose) doses, a regular laxative and an antiemetic initially, adjuvants such as NSAIDs or dexamethasone for bone pain, radiotherapy referral, and reassessment within 24 hours; dose reduction or an alternative opioid in renal impairment
3. Withholding opioids because of addiction
4. Pethidine intramuscularly

Answer: B. Addiction is rare in cancer pain; respiratory depression is uncommon when doses are titrated to pain. Gulf controlled-drug prescriptions have strict documentation requirements.

Question 18

A patient asks the nurse, "Am I dying? Nobody tells me anything." The best response is:

1. "You should ask your doctor; I cannot discuss that."
2. Sit down, explore what the patient already knows and wants to know ("What have the doctors told you so far? What are you most worried about?"), respond honestly within the nurse's role and the agreed care plan, acknowledge emotions, and arrange a conversation with the physician, respecting any family wishes about disclosure only where the patient themselves prefers it
3. "Don't worry, you will be fine."
4. Change the subject

Answer: B. In Gulf practice families often request non-disclosure; the patient's own wish about information is explored first, and the SPIKES framework guides bad-news conversations.

Question 19

A patient in the last days of life has noisy "rattling" breathing, is unresponsive and comfortable, and the family is distressed. The nurse should:

1. Deep suctioning every hour
2. Explain to the family that the sound is from secretions the patient cannot clear and is not usually distressing to the patient, reposition on the side, reduce intravenous fluids if prescribed, administer anticholinergic medication (such as glycopyrronium or hyoscine) as prescribed, provide mouth care, and support the family, including religious rituals they wish to observe
3. Start intravenous antibiotics
4. Transfer to ICU

Answer: B. Deep suctioning is distressing and ineffective; anticipatory prescribing covers pain, agitation, secretions, nausea and breathlessness.

Question 20

A patient with advanced cancer has a documented do-not-attempt-resuscitation decision and an agreed comfort-care plan. The patient's son demands that she be intubated when she deteriorates. The nurse should:

1. Intubate because the family insists
2. Continue the agreed comfort care, calmly explain the documented decision and its basis in the patient's condition and wishes, involve the physician and palliative team to meet the family promptly, offer chaplaincy or religious support, and document the discussion; the DNAR decision follows the hospital's and national legal framework and is not reversed by a relative's demand alone
3. Call security to remove the son
4. Ignore the family

Answer: B. UAE, Saudi, Qatari and Kuwaiti frameworks permit withholding futile resuscitation with documented medical consensus; euthanasia is not permitted, but comfort care and allowing natural death are.

How to practise

• Learn the safety rules: double checks, PPE, vesicant extravasation steps and antidotes, intrathecal vincristine prohibition, port care.
• Know the emergencies: febrile neutropenia within one hour, tumour lysis, cord compression, SVC syndrome, hypercalcaemia.
• Know the counts and thresholds: neutropenia, platelet precautions, transfusion thresholds.
• Practise the communication scenarios: disclosure, family requests, end-of-life care with cultural sensitivity.

Oncology and palliative care chapters with explanations are in the Registered Nurse bank; related sets are the medical-surgical questions, pharmacology questions, infection control questions and fluid and electrolyte questions.

Frequently asked questions

How many oncology questions are in the Prometric nursing exam?

About 6 to 10 of 150, within the medical-surgical and pharmacology domains, with palliative care questions appearing across the paper.

Which oncology nursing topics come up most?

Chemotherapy safety and extravasation, febrile neutropenia and protective precautions, bleeding precautions, oncological emergencies, radiation safety and cancer pain management.

Do I need a chemotherapy certificate to work in a Gulf oncology unit?

Most employers require a recognised chemotherapy administration competency (for example ONS-based training) in addition to the licence; it is not part of the licensing exam.

Are end-of-life and DNAR questions in the exam?

Yes, at the level of principles: comfort care, communication, family involvement and following documented decisions within the legal framework.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.