OCN Practice Test 2026: 25 Free Questions + Answers
Published 2026-10-19 · Facts and text checked 2026-10-16 · Questions from our OCN study guide · Reviewed by Hana N., Quality Reviewer
The Oncology Certified Nurse (OCN) exam from ONCC has 165 multiple-choice questions, 145 of them scored, in 3 hours, and you pass with a scaled score of 55 on a 25-75 scale. Below are 25 free OCN practice questions from our study guide, each with the correct answer and an explanation.
The questions are mixed across the 2026 test content outline and levels, so the set feels like a slice of the real exam. Use the topic pages to drill the areas where you missed the most.
| Fact | Value and source |
|---|---|
| Exam body | Oncology Nursing Certification Corporation (ONCC)ONCC: Oncology Certified Nurse (OCN) · checked 2026-10-12 |
| Number of questions | 165 questions (145 scored, 20 unscored)ONCC: Oncology Certified Nurse (OCN) · checked 2026-10-12 |
| Exam time | 3 hours (includes a 15-minute tutorial and a post-test survey)ONCC: Oncology Certified Nurse (OCN) · checked 2026-10-12 |
| Passing score | Scaled score of 55 (scale 25-75; not a percentage)ONCC: Oncology Certified Nurse (OCN) · checked 2026-10-12 |
Want a verdict instead of a practice set? Take the free "Am I ready?" quiz: 25 different questions, your score and the topics to study next.
25 free OCN practice questions
Question 1Easy
According to standard pain assessment guidelines, how should the nurse document pain intensity?
- A.Document based on the patient's vital signs
- B.Use descriptive terms like mild, moderate, severe
- C.Use a smiley face scale for all patients
- D.Use a numeric rating scale from 0 to 10 at each assessment
Show answer and explanation
Correct answer: D. Use a numeric rating scale from 0 to 10 at each assessment
The 0-10 numeric rating scale is the standard for consistent documentation of pain intensity. Descriptive terms are subjective and not standardized.
From practice test 3 of our OCN study guide (question 47). Original question, not an official exam item.
Question 2Easy
A patient with advanced ovarian cancer is scheduled for surgery. The surgeon explains that the goal is to remove as much tumor as possible, but some microscopic disease will remain. This type of surgery is:
- A.Curative resection
- B.Palliative surgery
- C.Prophylactic surgery
- D.Debulking (cytoreductive) surgery
Show answer and explanation
Correct answer: D. Debulking (cytoreductive) surgery
Debulking (cytoreductive) surgery aims to remove all visible tumor when complete resection is impossible, leaving microscopic disease for adjuvant therapy. Curative resection removes all tumor with a margin; palliative surgery relieves symptoms; prophylactic surgery removes high-risk organs.
From practice test 3 of our OCN study guide (question 108). Original question, not an official exam item.
Question 3Easy
A patient with chronic myeloid leukemia who is taking imatinib reports new-onset ankle swelling and muscle cramps in the legs. The nurse recognizes these symptoms as:
- A.Common side effects of imatinib that can be managed symptomatically.
- B.Signs of deep vein thrombosis requiring immediate evaluation.
- C.Indicators of renal impairment needing dose adjustment.
- D.Allergic reaction to the medication requiring discontinuation.
Show answer and explanation
Correct answer: A. Common side effects of imatinib that can be managed symptomatically.
Fluid retention (e.g., ankle swelling) and muscle cramps are well-documented side effects of imatinib. These are usually mild to moderate and can be managed with diuretics, electrolyte supplementation, and supportive measures. They do not typically signal DVT, allergic reaction, or renal impairment.
From practice test 4 of our OCN study guide (question 91). Original question, not an official exam item.
Question 4Easy
A patient newly diagnosed with breast cancer says, 'I need to learn everything I can about my treatment options so I can make the best decision.' This statement reflects which type of coping?
- A.Emotion-focused coping, because the patient is managing anxiety by seeking information.
- B.Avoidance coping, because the patient is focusing on intellectual details to avoid feelings.
- C.Problem-focused coping, because the patient is taking action directed at the stressful situation.
- D.Meaning-focused coping, because the patient is reappraising the situation to find purpose.
Show answer and explanation
Correct answer: C. Problem-focused coping, because the patient is taking action directed at the stressful situation.
Problem-focused coping involves actions aimed at managing or changing the stressful situation; researching treatment options is a direct action. Emotion-focused coping manages the emotional response, not the situation itself.
From practice test 7 of our OCN study guide (question 18). Original question, not an official exam item.
Question 5Easy
A terminally ill patient with a do-not-resuscitate (DNR) order is being transferred from the hospital to a skilled nursing facility. Which document ensures that the DNR order remains immediately actionable in the new setting without requiring a new physician's order?
- A.Advance directive
- B.POLST form
- C.Living will
- D.Health care proxy
Show answer and explanation
Correct answer: B. POLST form
A POLST form contains medical orders that are portable across care settings, making DNR orders actionable immediately upon transfer. A living will and advance directive are not medical orders; a health care proxy designates a surrogate but does not contain treatment orders.
From practice test 7 of our OCN study guide (question 42). Original question, not an official exam item.
Question 6Medium
A 55-year-old uninsured patient with average colorectal cancer risk refuses colonoscopy because he cannot take time off work. Which alternative screening method is most appropriate for him?
- A.Annual fecal immunochemical test (FIT)
- B.Flexible sigmoidoscopy every 5 years
- C.No screening is necessary given his age and risk level
- D.Computed tomography colonography every 5 years
Show answer and explanation
Correct answer: A. Annual fecal immunochemical test (FIT)
FIT is a stool-based test that requires no preparation, time off, or sedation, making it feasible for patients who cannot undergo colonoscopy. CT colonography and sigmoidoscopy still require bowel preparation and time off, and avoiding screening altogether is not appropriate for average-risk patients aged 45-75.
From practice test 7 of our OCN study guide (question 72). Original question, not an official exam item.
Question 7Medium
A 34-year-old patient with breast cancer refuses a recommended mastectomy and opts for bilateral mastectomy instead, citing family history anxiety. The surgeon feels this is excessive and requests an ethics consultation. Which situation most clearly warrants ethics committee involvement?
- A.The patient's family members are divided about the correct course of action.
- B.The patient has decision-making capacity and the surgeon does not agree with her choice.
- C.The patient's capacity is in question due to possible depression.
- D.The patient and surgeon disagree about the extent of surgery.
Show answer and explanation
Correct answer: C. The patient's capacity is in question due to possible depression.
Ethics committee involvement is most appropriate when the patient's decision-making capacity is in doubt. Disagreement alone does not warrant consultation if the patient has capacity.
From practice test 9 of our OCN study guide (question 99). Original question, not an official exam item.
Question 8Medium
A patient on capecitabine reports tingling and mild erythema on the palms without pain or interference with daily activities. According to the grading system, what grade of hand-foot syndrome is this?
- A.Grade 1
- B.Grade 2
- C.Grade 3
- D.Grade 4
Show answer and explanation
Correct answer: A. Grade 1
Grade 1 hand-foot syndrome is defined by mild erythema, swelling, or dysesthesia that does not disrupt normal activities. Pain or blistering indicates Grade 2 or higher. This patient has only mild symptoms, consistent with Grade 1.
From practice test 9 of our OCN study guide (question 124). Original question, not an official exam item.
Question 9Medium
A 70 kg patient is started on intravenous fluids for tumor lysis syndrome prophylaxis. What minimum hourly urine output should be maintained?
- A.70 mL
- B.100 mL
- C.140 mL
- D.200 mL
Show answer and explanation
Correct answer: C. 140 mL
The goal urine output for TLS prevention is at least 2 mL/kg per hour. For a 70 kg patient, this equates to 140 mL per hour. An output of 70 mL would be insufficient and indicates the need for increased hydration.
From practice test 2 of our OCN study guide (question 37). Original question, not an official exam item.
Question 10Medium
A patient with acute leukemia and an absolute neutrophil count of 200 cells/µL develops a temperature of 38.6°C. Blood cultures are drawn. Which initial empiric antibiotic should the nurse prepare to administer?
- A.Vancomycin
- B.Cefepime
- C.Metronidazole
- D.Gentamicin
Show answer and explanation
Correct answer: B. Cefepime
Cefepime (or piperacillin-tazobactam) is the standard empiric monotherapy for febrile neutropenia, covering most gram-negative and gram-positive organisms. Vancomycin is not added initially unless specific indications are present.
From practice test 2 of our OCN study guide (question 140). Original question, not an official exam item.
Question 11Medium
When evaluating the strength of evidence for a clinical intervention, which of the following study designs is generally considered the highest level on the hierarchy of evidence?
- A.Randomized controlled trial
- B.Systematic review of randomized controlled trials
- C.Case-control study
- D.Cohort study
Show answer and explanation
Correct answer: B. Systematic review of randomized controlled trials
Systematic reviews and meta-analyses of randomized controlled trials sit at the top of the evidence hierarchy because they synthesize results from multiple high-quality studies, reducing bias and increasing precision.
From practice test 9 of our OCN study guide (question 68). Original question, not an official exam item.
Question 12Medium
A patient with chemotherapy-induced peripheral neuropathy asks about non-drug treatments. Which integrative therapy has evidence for reducing neuropathy symptoms?
- A.Acupuncture
- B.Aromatherapy with lavender oil
- C.Healing touch therapy
- D.Music therapy
Show answer and explanation
Correct answer: A. Acupuncture
Acupuncture has been studied and shown benefit for chemotherapy-induced peripheral neuropathy, while the others have less robust evidence for this specific condition.
From practice test 3 of our OCN study guide (question 44). Original question, not an official exam item.
Question 13Medium
When preparing a hazardous chemotherapy drug, which device is required by NIOSH to minimize exposure during transfer?
- A.Needleless system
- B.Syringe filter
- C.Electronic infusion pump
- D.Closed system transfer device (CSTD)
Show answer and explanation
Correct answer: D. Closed system transfer device (CSTD)
NIOSH mandates the use of a CSTD for hazardous drugs to prevent aerosolization and leakage during transfer.
From practice test 8 of our OCN study guide (question 82). Original question, not an official exam item.
Question 14Medium
The nurse is preparing to administer antibiotics to a febrile neutropenic patient. Blood cultures have not yet been drawn. What is the most appropriate action?
- A.Hold antibiotics until the patient's temperature exceeds 39°C
- B.Draw cultures quickly but do not delay antibiotics; start within 15 minutes
- C.Administer antibiotics first, then draw cultures later
- D.Delay antibiotics until all cultures are obtained
Show answer and explanation
Correct answer: B. Draw cultures quickly but do not delay antibiotics; start within 15 minutes
Antibiotics should not be delayed for culture collection; if cultures cannot be drawn within 15 minutes, start the antibiotic and draw cultures as soon as possible.
From practice test 2 of our OCN study guide (question 154). Original question, not an official exam item.
Question 15Medium
A recently bereaved spouse says, 'I don't know how I'm going to manage everything.' Which nursing response best exemplifies a concrete offer of support?
- A.'Would you like to talk to a social worker?'
- B.'I'll pray for you.'
- C.'What is the one thing that feels overwhelming right now?'
- D.'You are strong, you will get through this.'
Show answer and explanation
Correct answer: C. 'What is the one thing that feels overwhelming right now?'
This question offers concrete, specific help by identifying the most immediate need. It avoids clichés, general reassurances, or premature referrals, and opens the door for the nurse to provide practical assistance tied to the person's stated concern.
From practice test 2 of our OCN study guide (question 67). Original question, not an official exam item.
Question 16Medium
A 70-year-old patient with lung cancer refuses chemotherapy, stating 'I don't want to be poisoned.' The nurse is concerned about decision-making capacity. Which finding would most suggest the patient has adequate capacity?
- A.The patient can repeat back the risks and benefits of chemotherapy and the alternatives
- B.The patient can state the names of family members
- C.The patient has a living will
- D.The patient's Mini-Mental State Examination score is above 24
Show answer and explanation
Correct answer: A. The patient can repeat back the risks and benefits of chemotherapy and the alternatives
Capacity requires understanding and ability to repeat relevant information; orientation, a living will, or a screening score alone do not demonstrate capacity. The ability to reiterate risks and benefits indicates understanding, a key component of capacity.
From practice test 9 of our OCN study guide (question 37). Original question, not an official exam item.
Question 17Medium
A patient undergoes an open right hemicolectomy and requires opioid analgesia. On postoperative day 1, the patient has no bowel sounds and has not passed flatus. Which medication, if available, is most appropriate to include in the ileus management plan?
- A.Alvimopan
- B.Metoclopramide
- C.Erythromycin
- D.Neostigmine
Show answer and explanation
Correct answer: A. Alvimopan
Alvimopan is a peripheral mu-opioid receptor antagonist that shortens postoperative ileus in patients receiving opioid analgesia, as supported by the ERAS protocol.
From practice test 2 of our OCN study guide (question 112). Original question, not an official exam item.
Question 18Medium
A patient is receiving a chemotherapy agent that works by directly crosslinking DNA strands, preventing replication and transcription. This drug is most likely a member of which class?
- A.Antitumor antibiotic
- B.Alkylating agent
- C.Antimetabolite
- D.Plant alkaloid
Show answer and explanation
Correct answer: B. Alkylating agent
Alkylating agents such as cyclophosphamide and cisplatin crosslink DNA; antimetabolites mimic building blocks, plant alkaloids affect microtubules, and antitumor antibiotics intercalate or generate free radicals.
From practice test 8 of our OCN study guide (question 8). Original question, not an official exam item.
Question 19Medium
A 28-year-old woman tests positive for a BRCA1 mutation. She had no previous breast imaging. According to high-risk screening guidelines, what is the recommended schedule?
- A.Annual breast MRI starting at age 25 and annual mammography starting at age 40
- B.Annual mammography starting at age 30, no MRI needed
- C.Annual breast MRI starting at age 25 and annual mammography starting at age 30
- D.Alternating mammography and MRI every 6 months starting at age 25
Show answer and explanation
Correct answer: C. Annual breast MRI starting at age 25 and annual mammography starting at age 30
For BRCA mutation carriers, guidelines recommend annual breast MRI beginning at age 25, with annual mammography added at age 30. Option B incorrectly delays mammography to 40. Option D suggests alternating, which is not standard.
From practice test 8 of our OCN study guide (question 125). Original question, not an official exam item.
Question 20Medium
A patient with advanced lung cancer reports pain that is 8 out of 10. According to the WHO analgesic ladder, which first-line treatment is most appropriate?
- A.Ibuprofen 600 mg every 6 hours
- B.Morphine 5-10 mg IV push
- C.Codeine 30 mg every 4 hours
- D.Celiac plexus block
Show answer and explanation
Correct answer: B. Morphine 5-10 mg IV push
Non-opioids and weak opioids are insufficient at this intensity.
From practice test 6 of our OCN study guide (question 151). Original question, not an official exam item.
Question 21Hard
Why is intravenous calcium contraindicated in a patient with tumor lysis syndrome who has asymptomatic hypocalcemia?
- A.It increases the calcium-phosphate product and promotes crystal deposition
- B.It interferes with uric acid excretion
- C.It may cause cardiac arrhythmias
- D.It stimulates further phosphate release from cells
Show answer and explanation
Correct answer: A. It increases the calcium-phosphate product and promotes crystal deposition
In TLS, hypocalcemia is driven by hyperphosphatemia; adding calcium raises the calcium-phosphate product, worsening crystal deposition in soft tissues and kidneys. Calcium is reserved for symptomatic hypocalcemia.
From practice test 2 of our OCN study guide (question 88). Original question, not an official exam item.
Question 22Hard
A nurse is caring for a patient with stage IV lung cancer who has just started palliative chemotherapy. The patient reports difficulty managing new symptoms, concerns about treatment costs, and frequent thoughts about mortality. This situation best illustrates:
- A.The concept of stacked demands, where multiple stressors (diagnosis, treatment, symptoms, existential concerns) occur simultaneously.
- B.The patient's lack of effective coping strategies.
- C.A need for immediate psychiatric referral.
- D.Typical adjustment that usually resolves without nursing intervention.
Show answer and explanation
Correct answer: A. The concept of stacked demands, where multiple stressors (diagnosis, treatment, symptoms, existential concerns) occur simultaneously.
Stacked demands refer to the simultaneous presence of multiple stressors common in oncology, which can overwhelm coping resources. The scenario explicitly lists several domains. Distractors pathologize or minimize the situation.
From practice test 7 of our OCN study guide (question 146). Original question, not an official exam item.
Question 23Hard
A 62-year-old patient with advanced pancreatic cancer is admitted with a pain score of 9/10. The nurse considers the traditional three-step WHO ladder versus the modified two-step approach for cancer pain. Which of the following best supports using the modified two-step approach in this patient?
- A.Using a strong opioid initially increases the risk of opioid-induced hyperalgesia and should be avoided
- B.Starting with codeine and acetaminophen allows for a safer initial trial of analgesia
- C.Immediate use of morphine provides faster pain relief and reduces time to achieve stable pain control
- D.The modified approach is recommended only for opioid-tolerant patients and should not be used here
Show answer and explanation
Correct answer: C. Immediate use of morphine provides faster pain relief and reduces time to achieve stable pain control
The modified two-step approach bypasses weak opioids for patients presenting with moderate-to-severe cancer pain, prioritizing rapid and effective relief. In this patient with severe pain (9/10), starting directly with a strong opioid like morphine is indicated to achieve faster pain control.
From practice test 4 of our OCN study guide (question 90). Original question, not an official exam item.
Question 24Hard
A patient on chemotherapy develops oral lesions. On examination, white plaques are seen that can be scraped off, revealing an erythematous base. This finding is most consistent with which condition?
- A.Radiation-induced mucositis
- B.Herpes simplex virus infection
- C.Oral candidiasis
- D.Chemotherapy-induced mucositis
Show answer and explanation
Correct answer: C. Oral candidiasis
Oral candidiasis typically presents as white, curd-like plaques that are removable, leaving a raw, erythematous surface. Mucositis appears as diffuse confluent ulcerations without removable plaques, and herpes simplex presents with clustered vesicles.
From practice test 6 of our OCN study guide (question 157). Original question, not an official exam item.
Question 25Hard
Which patient is at highest risk for developing refeeding syndrome upon initiation of nutritional support?
- A.A 50-year-old man with localized prostate cancer and 5% weight loss over 6 months
- B.A 60-year-old woman with breast cancer who has maintained oral intake but has mild nausea
- C.A 35-year-old woman with ovarian cancer who has consumed fewer than 500 calories daily for 10 days
- D.A 70-year-old man with colon cancer who has lost 8% body weight over 3 months
Show answer and explanation
Correct answer: C. A 35-year-old woman with ovarian cancer who has consumed fewer than 500 calories daily for 10 days
Refeeding syndrome risk is highest in patients with prolonged minimal intake (>7-10 days) and significant weight loss. The patient in C has very low caloric intake for 10 days; the others have less severe malnutrition.
From practice test 3 of our OCN study guide (question 10). Original question, not an official exam item.
Want the full OCN preparation?
These questions come from our OCN study guide: full-length practice tests with every answer explained, flashcards, an AI study tutor and the audiobook.
Quick answers
How many questions are on the OCN exam?
165 multiple-choice questions with four options: 145 are scored and 20 are unscored (ONCC).
How long is the OCN exam?
3 hours, which includes a 15-minute tutorial and a post-test survey (ONCC).
What is the passing score for the OCN?
A scaled score of 55 on a scale from 25 to 75. It is not a percentage: the raw number of correct answers needed varies by test form and is not published (ONCC 2026 Test Registration Manual).
How much does the OCN exam cost?
$420 for nonmembers and $300 for ONS or APHON members (ONCC). Fees can change, so check ONCC before you apply.
What is on the OCN exam?
Six weighted areas from the 2026 Test Content Outline: Care Continuum 14%, Oncology Nursing Practice 15%, Treatment Modalities 20%, Symptom Management and Supportive Care 25%, Oncologic Emergencies 16% and Psychosocial Dimensions of Care 10%.
Can I retake the OCN exam?
Yes, once your current 90-day test window has expired; the same test cannot be taken more than once per window. After three failed attempts within three years you must wait one year. ONCC DoubleTake, bought with the first application, covers a second attempt applied for within 180 days.