The Oncology Nursing Certification Corporation – Oncology Certified Nurse (ONCC – OCN) exam is a comprehensive and challenging assessment for men and women who want to enter this exciting field of health care.
The ONCC – OCN Exam covers 11 general topics:
- In the section on health promotion and disease prevention (5 percent of the test), questions address epidemiology and prevention.
- The domain on screening, early detection, and diagnosis (7 percent) covers the risk factors for cancer, screening, early detection, risk reduction guidelines, and diagnostic testing.
- The section addressing the scientific basis for practice including research (10 percent) has questions on carcinogenesis, immunology, genetics, specific cancers, classification, common metastatic sites, and research protocols and clinical trials.
- The cancer treatment modalities domain of the ONCC – OCN exam (15 percent) covers vascular access devices; surgery; radiation; targeted therapies; biotherapy; chemotherapy; hematopoietic stem cell transplant; and complementary, alternative, and integrative modalities.
- In the section on symptom management (22 percent), questions address etiology and the pattern of symptoms; toxicity and rating scales; pharmacological and nonpharmacological interventions; complementary, alternative, and integrative modalities; and alterations in comfort, protective mechanisms, gastrointestinal function, genitourinary function, respiratory function, circulatory function, nutrition, and neurological function.
- The psychosocial dimensions of care domain (7 percent) covers cultural, spiritual, and religious diversity; financial concerns; psychosocial disturbances and alteration; anxiety, grief, and depression; altered body image; loss of personal control; patient and family support groups; learning styles and barriers to learning; social relationships; and coping mechanisms and skills.
- Oncological emergencies (10 percent) includes disseminated intravascular coagulation, the syndrome of inappropriate diuretic hormone secretion, septic shock, tumor lysis syndrome, hypersensitivity and/or anaphylaxis, hypercalcemia, cardiac tamponade, spinal cord compression, superior vena cava syndrome, and increased intracranial pressure.
- The sexuality domain of the ONCC – OCN exam (5 percent) covers reproductive issues, STD [sexually transmitted disease] and HIV [human immunodeficiency virus] risk, and sexual dysfunction.
- Survivorship (8 percent) addresses psychosocial, physical, and cognitive alterations; personal and family issues; acute effects; late effects; recurrence and/or secondary malignancies; and rehabilitation and long-term follow-up
- The end-of-life care domain (6 percent) covers grief and the bereavement process, reimbursement issues and community resources, and hospice.
The section on professional performance (5 percent) covers local, state, and national resources; the application of the statement on the scope and standards of oncology nursing practice; sources of data for evidence-based practice; education process; legal issues; ethical issues; patient advocacy; quality assurance; professional development; and multidisciplinary collaboration.
ONCC-OCN Exam Practice Questions
1. Which of the following is not a definite environmental risk factor for cancer?
b. Sun exposure
c. Electromagnetic field exposure
d. Radon gas
2. Which of the following viruses is most closely linked to Burkitt lymphoma?
a. Human immunodeficiency virus (HIV)
b. Epstein-Barr virus
c. Hepatitis B
d. Human papilloma virus (HPV)
3. Which of the following statements about tobacco use is NOT true?
a. It is the single most important cause of cancer mortality in the United States
b. Inhaled tobacco smoke but not chewing tobacco is highly carcinogenic
c. Smokers who quit before age 50 halve their risk of dying in the next 15 years
d. Secondary smoke has not been established as carcinogenic
4. Which of the following cancers does NOT have a well-established screening procedure?
5. Tumor markers:
a. Include PSA, CEA, CA-125
b. May always distinguish benign from malignant conditions
c. Are always useful for diagnosis of a specific cancer
d. Are never useful gauges of effective therapy
1. C: Numerous environmental factors increase the risk of specific cancers and cancer generally. Asbestos exposure is perhaps the most documented environmental carcinogen for mesothelioma and lung cancer and may have a synergistic effect with smoking-related lung cancer. Melanoma has been firmly linked to excessive sun exposure, especially youthful sunburn, and probably plays some role in squamous and basal cell skin cancers. Radon gas exposure, especially in miners and those workers involved with nuclear waste, most likely increases the risk of lung cancer. Whether proximity to electromagnetic fields (ex.power lines) results in an increased cancer risk has been debated for many years and studies have mostly been observational with conflicting results. The advent of widespread cell phone use has added to the controversy but no definite statement about their cancer risk may be made at this time.
2. B: Viral etiology of cancer has been studied extensively over the past two decades and links with a variety of well-established cancers. This does not imply that the virus is always a direct cause of the cancer; it may act along with genetic or environmental entities or degrade immune surveillance. HIV has been associated with Kaposi sarcoma, especially in young homosexual males. It also may increase the risk of B-cell lymphoma. Hepatitis B and C viruses may cause or lead to hepatocellular carcinoma, which accounts for the largest majority of viral-linked cancers. Epstein-Barr virus, the cause of infectious mononucleosis, has been linked to Burkitt lymphoma, predominantly in Africans, and several other cancers, including nasopharyngeal and parotid. HPV, especially type 16, is a major cause of cervical neoplasia, and the virus has also been detected in a substantial number of squamous cell carcinomas of the oral cavity, head, and neck.
3. B: Tobacco use accounts for 30% of all cancer deaths and almost 90% of lung cancer deaths. In addition to lung, cancers of the upper airway and esophagus, bladder, pancreas, kidney, and perhaps cervix and colon have been shown to be increased in smokers. While cigarette use is far and away the most important source, cigars, chewing tobacco, snuff, and secondary smoke from others are all linked to a heightened risk of cancer. While many have quit smoking, about a quarter of the population still uses tobacco in the United States, and the number is higher in many other countries. Quitting before age 50 may halve the risk of dying in the next 15 years and those who have quit have a greatly decreased risk after age 70.
4. A: Mammography has been the cornerstone of breast cancer screening for many years. T ACS recommends starting annually for women age 40 and older; NCI allows every 1 to 2 years for women older than 40. There has been a very recent conflict over these guidelines by a federal task force that suggested age 50 as the starting point for mammograms and every two years thereafter. Pap smears to detect cervical dysplasia and carcinomas at a very early stage have been well established for many years. While previously recommended for women when they become sexually active, one professional gynecology group has now stated that biannual smears starting at age 21 may be adequate. Colonoscopy with polypectomy has revolutionized colorectal cancer screening and prevention and has most likely led to the recent decline in this cancer. Lung cancer screening remains difficult. Chest x-rays and sputum cytology are inadequate and spiral CT or other sophisticated scanning techniques (ex., PET scans) are still under evaluation.
5. A: Along with imaging studies and biopsy-cytology, tumor markers are playing an important role in cancer diagnosis and treatment. These are products in the blood either produced directly by the tumor or reflecting the body’s reaction to the tumor. Some of the well-known ones are PSA, CEA, alpha-fetoprotein, CA-125, and CA 19-9. Unfortunately, they are often nonspecific and may be produced by benign conditions. PSA may be elevated in benign prostatic hypertrophy, as well as in prostate cancer, and this has led to quite a controversy over the value of annual PSA screening tests for men. Too often, false-positives and false-negatives confound a specific diagnosis so these markers are best used as confirmatory to other diagnostic measures. Once a definite diagnosis is made, the level of the marker may often be used as an indicator of treatment efficacy. Sometimes decisions regarding treatment (ex. surgery) are influenced by the magnitude of the tumor marker.