OCN Oncology Nursing Foundations: 15 Free Practice Questions
Published 2026-10-21 · Facts and text checked 2026-10-16 · Questions from our OCN study guide · Reviewed by Hana N., Quality Reviewer
These free OCN practice questions cover Oncology Nursing Foundations, part of II. Oncology Nursing Practice on the exam. Carcinogenesis, immunology, clinical trials, staging and professional practice. Each question comes from a practice test in our OCN study guide and shows the correct answer with an explanation. The full exam has 165 questions (145 scored, 20 unscored).
Carcinogenesis, immunology, clinical trials, staging and professional practice. On the exam this is part of II. Oncology Nursing Practice (15%). Open each answer to read the explanation.
Question 1Easy
When a patient refuses a recommended treatment after education, what must the nurse document?
- A.The family's agreement with the refusal.
- B.That the patient was informed of risks and benefits and declined.
- C.That the physician was notified and the patient abandoned care.
- D.The patient's reasons and the nurse's opinion.
Show answer and explanation
Correct answer: B. That the patient was informed of risks and benefits and declined.
Documentation of informed refusal should include that the patient received information about risks and benefits and voluntarily chose not to proceed, along with any follow-up plans.
From practice test 7 of our OCN study guide (question 14). Original question, not an official exam item.
Question 2Medium
When a patient lacks decision-making capacity, the surrogate decision-maker is ethically obligated to:
- A.Choose the option that maximizes survival
- B.Make decisions based on the surrogate's own values
- C.Follow the physician's recommendation
- D.Apply the patient's known values and preferences
Show answer and explanation
Correct answer: D. Apply the patient's known values and preferences
Surrogates must use substituted judgment, applying the patient's known values, not their own or survival maximization.
From practice test 7 of our OCN study guide (question 19). Original question, not an official exam item.
Question 3Medium
A nurse reviews a clinical practice guideline recommending a certain antiemetic regimen for highly emetogenic chemotherapy. The patient has a history of cardiac arrhythmia, and the guideline's recommended agent carries a risk of QT prolongation. How should the nurse apply this evidence?
- A.Use a lower dose of the recommended agent to reduce risk.
- B.Consult the pharmacist to select an alternative that the guideline does not mention.
- C.Modify the regimen based on clinical expertise and patient-specific factors, then document the rationale.
- D.Follow the guideline because it is evidence-based.
Show answer and explanation
Correct answer: C. Modify the regimen based on clinical expertise and patient-specific factors, then document the rationale.
Evidence-based practice integrates research evidence with clinical expertise and patient values. The guideline provides general evidence, but the nurse's expertise is needed to individualize care, especially when patient-specific risks like arrhythmia complicate the recommendation.
From practice test 8 of our OCN study guide (question 127). Original question, not an official exam item.
Question 4Hard
According to NCCN guidelines, which statement best describes a Category 1 recommendation?
- A.Expert opinion only
- B.Any level of evidence with nonuniform consensus
- C.High-level evidence with uniform NCCN consensus
- D.Lower-level evidence but uniform NCCN consensus
Show answer and explanation
Correct answer: C. High-level evidence with uniform NCCN consensus
Category 1 recommendations are based on high-level evidence (e.g., RCTs) and uniform consensus among NCCN panel members, indicating the strongest level of recommendation.
From practice test 5 of our OCN study guide (question 41). Original question, not an official exam item.
Question 5Medium
A 75-year-old patient with advanced non-small cell lung cancer and an ECOG performance status of 3 is recommended for palliative radiation therapy. The oncologist also suggests considering a clinical trial for an experimental agent with significant toxicity. Which principle is most relevant when questioning the recommendation?
- A.Autonomy
- B.Nonmaleficence
- C.Justice
- D.Beneficence
Show answer and explanation
Correct answer: B. Nonmaleficence
Nonmaleficence requires avoiding harm. An experimental agent with significant toxicity in a patient with poor performance status may cause more harm than benefit. The nurse should weigh the risk-benefit ratio and advocate for interventions with a favorable balance.
From practice test 5 of our OCN study guide (question 160). Original question, not an official exam item.
Question 6Medium
Which finding indicates the need for a formal capacity assessment in a patient refusing chemotherapy?
- A.The patient chooses to defer the decision to a family member.
- B.The patient expresses a preference for alternative medicine.
- C.The patient cannot repeat information about the treatment after being told.
- D.The patient states they want to die at home.
Show answer and explanation
Correct answer: C. The patient cannot repeat information about the treatment after being told.
A key element of decision-making capacity is the ability to understand and appreciate relevant information. Inability to repeat it suggests a barrier to informed decision-making.
From practice test 7 of our OCN study guide (question 52). Original question, not an official exam item.
Question 7Medium
Which approach to evidence-based practice is most appropriate for a clinical question that arises during a busy shift?
- A.Conduct a systematic literature search using PICO.
- B.Consult a pre-appraised resource such as an ONS PEP summary.
- C.Rely on clinical experience without seeking evidence.
- D.Design a quality improvement project to answer the question.
Show answer and explanation
Correct answer: B. Consult a pre-appraised resource such as an ONS PEP summary.
Pre-appraised resources save time by providing synthesized evidence. A full literature search is too time-consuming for bedside questions; relying solely on experience does not integrate research evidence.
From practice test 7 of our OCN study guide (question 26). Original question, not an official exam item.
Question 8Hard
A patient with stage IV colorectal cancer requests a high-dose chemotherapy regimen that has a less than 5% response rate but significant toxicity. The oncologist is hesitant. Which ethical principle is most directly concerned with avoiding the harm of this treatment?
- A.Justice
- B.Autonomy
- C.Nonmaleficence
- D.Beneficence
Show answer and explanation
Correct answer: C. Nonmaleficence
Nonmaleficence is the obligation to avoid causing harm. Administering a treatment with high toxicity and minimal benefit violates this principle. Beneficence (doing good) also applies, but nonmaleficence directly addresses the harm-to-benefit ratio.
From practice test 3 of our OCN study guide (question 103). Original question, not an official exam item.
Question 9Easy
When formulating a clinical question for evidence-based practice, what does the acronym PICO stand for?
- A.Planning, Implementation, Control, Observation
- B.Population, Intervention, Comparison, Outcome
- C.Patient, Issue, Concern, Objective
- D.Problem, Intervention, Clinical, Outcome
Show answer and explanation
Correct answer: B. Population, Intervention, Comparison, Outcome
PICO is a widely used framework for constructing focused clinical questions. It stands for Population, Intervention, Comparison, and Outcome.
From practice test 6 of our OCN study guide (question 161). Original question, not an official exam item.
Question 10Medium
A patient with stage IV lung cancer declines chemotherapy despite strong evidence that it improves survival and quality of life. The patient states he prefers to focus on comfort only. What is the nurse's most appropriate action?
- A.Respect the patient's decision and ensure the patient understands the risks of refusal (informed refusal).
- B.Contact the oncologist to mandate treatment.
- C.Ask the family to persuade the patient.
- D.Emphasize the benefits of chemotherapy and encourage the patient to reconsider.
Show answer and explanation
Correct answer: A. Respect the patient's decision and ensure the patient understands the risks of refusal (informed refusal).
Patient autonomy is a core ethical principle; when a patient refuses evidence-based treatment, the nurse must respect that decision and ensure informed refusal by confirming the patient understands the consequences. Overriding autonomy is inappropriate unless capacity is impaired.
From practice test 9 of our OCN study guide (question 107). Original question, not an official exam item.
Question 11Medium
An oncology nurse is leading a formal evidence-based practice project to update a clinical policy. Which approach is most appropriate for gathering evidence?
- A.Review the hospital's existing policy manual.
- B.Ask a colleague known for clinical expertise for their opinion.
- C.Search primary literature using databases like PubMed and appraise individual studies.
- D.Use NCCN guidelines directly without further search.
Show answer and explanation
Correct answer: C. Search primary literature using databases like PubMed and appraise individual studies.
For formal projects requiring the highest currency and control over evidence selection, searching primary literature is appropriate. Pre-appraised resources may not include the most recent studies needed for policy updates.
From practice test 6 of our OCN study guide (question 13). Original question, not an official exam item.
Question 12Easy
A nurse believes that a certain chemotherapy regimen is always poorly tolerated based on prior experience and tends to emphasize articles supporting this view while discounting studies showing better tolerance. This is an example of which cognitive bias?
- A.Recency bias
- B.Confirmation bias
- C.Availability bias
- D.Anchoring bias
Show answer and explanation
Correct answer: B. Confirmation bias
Confirmation bias is the tendency to favor information that confirms preexisting beliefs while ignoring contradictory evidence. The nurse's selective attention to supporting articles exemplifies this bias.
From practice test 5 of our OCN study guide (question 18). Original question, not an official exam item.
Question 13Medium
A nurse wants to know whether physical activity reduces fatigue in breast cancer survivors. Which PICO question is correctly formatted?
- A.In breast cancer survivors (P), does physical activity (I) compared to no intervention (C) reduce fatigue (O)?
- B.In breast cancer survivors, does physical activity (I) reduce fatigue (O) compared to no intervention (C)?
- C.In breast cancer survivors, does physical activity reduce fatigue?
- D.Does physical activity reduce fatigue in breast cancer survivors?
Show answer and explanation
Correct answer: A. In breast cancer survivors (P), does physical activity (I) compared to no intervention (C) reduce fatigue (O)?
The PICO format requires specifying Population, Intervention, Comparison, and Outcome. Option B explicitly labels all four elements. The other options omit or misplace components.
From practice test 5 of our OCN study guide (question 88). Original question, not an official exam item.
Question 14Medium
A patient on cisplatin requests ginger for breakthrough nausea. The evidence is mixed, but ginger has a low side effect profile and no known interactions with the chemotherapy. What is the nurse's best action?
- A.Recommend ginger as an evidence-based intervention
- B.Refuse the request because the evidence does not support ginger
- C.Ignore the request and continue standard antiemetics
- D.Inform the patient of the mixed evidence, discuss the low risk, and support the trial
Show answer and explanation
Correct answer: D. Inform the patient of the mixed evidence, discuss the low risk, and support the trial
When evidence is weak but the intervention is low risk and the patient values it, the nurse should inform the patient of the uncertainty and support their choice. Option B accomplishes this. Option A is overly restrictive. Option C misrepresents the evidence strength. Option D disregards patient preferences.
From practice test 3 of our OCN study guide (question 20). Original question, not an official exam item.
Question 15Medium
A 70-year-old patient undergoing chemotherapy reports feeling tired but otherwise has no complaints. The nurse notices the patient has lost 5 pounds since last visit and seems withdrawn. Which action best demonstrates beneficence in this situation?
- A.Inform the physician of the weight loss and let them decide.
- B.Wait for the patient to bring up concerns at the next visit.
- C.Document the weight loss and continue monitoring.
- D.Ask the patient if they would like to speak with a dietitian, social worker, or counselor.
Show answer and explanation
Correct answer: D. Ask the patient if they would like to speak with a dietitian, social worker, or counselor.
Beneficence requires proactive identification of unmet needs. The patient's weight loss and withdrawal may indicate depression or malnutrition.
From practice test 5 of our OCN study guide (question 142). Original question, not an official exam item.
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