CNA Oncology Nursing Certification Exam — Information & Free Practice

About CNA Oncology Nursing Certification Exam

CNA Oncology Nursing Certification Exam · CA

Key exam facts

Provider

Canadian Nurses Association (CNA) owns the certification program; blueprint developed with Meazure Learning – Yardstick and oncology nurses. ProctorU supplies online proctoring; Meazure Learning supplies in-person delivery and testing analysis.

Format

Computer-based multiple-choice examination, delivered at home with an online proctor or in selected Canadian test centres. Blueprint presentation: 55–65% independent and 35–45% case-based questions.

Exam questions

Total questions: 160–165.

Time limit

Four hours (240 minutes) to complete the questions, per CNA CBT exam tips; this is question-answering time.

Passing score

Criterion-referenced pass mark set by the specialty committee using a modified Angoff method with statistical review. The pass mark is not published; results are pass or unsuccessful.

Exam fee

Canadian dollars, before applicable taxes: initial application $588 CNA member or $780 non-member; additional appointment fee $85 online or $110 in person. Eligible unsuccessful candidates may rewrite for $378 member or $500 non-member within the next two calendar years. Application/rewrite fees include a non-refundable $130 administrative fee.

Topics covered

The authority publishes percentage ranges for each content area. The practice percentages below use the midpoint of each range, normalized to 100%; they are not exact percentages published by the authority. Practice question counts may differ slightly because of rounding.

• Prevention, Early Detection and Screening for Cancer — Official range: 5–10% (Practice allocation: 7.5%)

  • Demonstrates an understanding of epidemiological data at a community, provincial, national and global level related to the incidence and prevalence of cancer, mortality and survival.
  • Performs a comprehensive assessment related to identifying overall risk factors for cancer, including the following:
  • Demonstrates an understanding of the purpose and implications of genetic testing, counselling and resources available to patients.
  • Provides teaching and support regarding cancer screening, diagnostic tests and/or genetic testing.
  • Supports patients regarding the implications of screening and test results.
  • Promotes individual and public participation in prevention, screening and early detection (e.g., screening programs, self-monitoring, HPV immunization).
  • host (e.g., family history, age, gender)
  • behavioural (e.g., tobacco use, diet, obesity)
  • environmental (e.g., occupational exposure, sun exposure, previous cancer treatments)
  • biological (e.g., HIV, HPV and EBV viruses, inflammatory bowel syndrome, H. pylori)

• Diagnosis and Staging of Cancer — Official range: 5–10% (Practice allocation: 7.5%)

  • Demonstrates an understanding of the pathophysiology of cancer (e.g., carcinogenesis, cell cycle, tumour growth, metastasis, pre-malignancy).
  • Demonstrates an understanding of how cancer is diagnosed (e.g., pathology, diagnostic imaging).
  • Integrates the findings of the history and physical exam, diagnostic investigations (e.g., pathology, radiological, tumour receptor status, tumour markers and cytogenetics related to staging of cancer).
  • Assesses the patient’s understanding of diagnosis and staging.
  • Facilitates patient learning regarding diagnosis and staging.
  • Demonstrates an understanding of classification systems of malignant tumours.

• Knowledge of Cancer Diseases — Official range: 10–15% (Practice allocation: 12.5%)

  • Demonstrates an understanding of the risk factors, clinical presentation and prognostic factors in relation to the management of the following more common cancer diseases in adults:
  • Demonstrates an understanding of the standard treatments in relation to the management of the following more common cancer diseases in adults:
  • Demonstrates an understanding of the risk factors, clinical presentation and prognostic factors in relation to the management of the following less common cancer diseases in adults:
  • Demonstrates an understanding of the standard treatments in relation to the management of the following less common cancer diseases in adults:
  • Demonstrates an understanding of the clinical presentation and prognostic factors in relation to the management of the following more common cancer diseases in children:
  • Demonstrates an understanding of the standard treatments in relation to the management of the following more common cancer diseases in children:
  • breast
  • prostate
  • lung
  • colorectal
  • genitourinary (bladder, kidney, testicular)
  • gynecological (ovarian, uterine, cervical)
  • leukemia
  • lymphoma
  • melanoma
  • head and neck (thyroid, tongue, laryngeal)
  • breast
  • prostate
  • lung
  • colorectal
  • genitourinary (bladder, kidney, testicular)
  • gynecological (ovarian, uterine, cervical)
  • leukemia
  • lymphoma
  • melanoma
  • head and neck (thyroid, tongue, laryngeal)
  • brain and central nervous system
  • gastrointestinal
  • multiple myeloma
  • non-melanoma skin cancer
  • neuroendocrine
  • brain and central nervous system
  • gastrointestinal
  • multiple myeloma
  • non-melanoma skin cancer
  • neuroendocrine
  • leukemia
  • brain and central nervous system
  • leukemia
  • brain and central nervous system
  • lymphoma
  • bone and soft tissue sarcomas
  • Wilms’ tumour
  • lymphoma
  • bone and soft tissue sarcomas
  • Wilms’ tumour

• Treatment Modalities — Official range: 20–25% (Practice allocation: 22.5%)

  • Surgery
  • Systemic Therapy: Chemotherapy, Biological Agents, Targeted Therapies, Immunotherapy, and Hormonal Therapies
  • Radiation Therapy
  • Concurrent and/or Combination Therapy
  • Cellular Therapy
  • Complementary or Alternative Therapies
  • Treatment Delivery Systems
  • Understands the role of surgery in cancer treatment (i.e., cure, control, palliation, prophylactic).
  • Assists the patient’s understanding of the role of surgery in the treatment plan.
  • Assesses for risk of physical and/or psychosocial complications related to cancer surgery (e.g., wound care, thromboembolic events, lymphedema, body image disturbance, psychological distress).
  • Implements interventions to decrease the incidence and severity of complications related to cancer surgery (e.g., wound care, pharmacological intervention, supportive care, psychosocial impacts).
  • Facilitates patient learning regarding the expected outcomes of surgical interventions (e.g., ostomy care, wound management, pain management).
  • Facilitates patient learning regarding potential future treatment modalities based on the patient’s pathological findings.
  • Understands the role of systemic therapy in cancer treatment (e.g., cure, control or palliation, adjuvant, neoadjuvant, combination).
  • Demonstrates an understanding of the mechanism of action and side effects of systemic cancer therapy drugs.
  • Assists patients and family to understand the role of systemic therapy in their treatment plan (e.g., cure, control, palliation).
  • Demonstrates an understanding of various routes of (or principles of) systemic therapy administration (e.g., intravenous, p.o, intrathecal, intraperitoneal, subcutaneous, intraarterial).
  • Applies the principles of safe administration of systemic therapy (e.g., drug dose calculation using BSA/AUC, sequence of administration).
  • Applies the principles of safe handling for cytotoxic hazardous agents (e.g., body fluids, appropriate personal protective equipment).
  • Recognizes potential side effects related to concurrent systemic therapy.
  • Facilitates patient learning regarding the outcomes of systemic therapy involving the immediate, early, late and delayed side effects.
  • Implements interventions to decrease the incidence and severity of side effects and complications and promote self-care related to systemic therapy (e.g., hydration, pharmacological intervention, fertility management).
  • Facilitates patient learning regarding systemic therapy administration at home (e.g., safe handling, monitoring, oral compliance).
  • Understands the role of radiation therapy in cancer treatment (e.g., cure, control or palliation, adjuvant, neoadjuvant, combination, prophylaxis).
  • Understands the mechanism of action and principles of various types of radiation therapy (e.g., stereotactic, brachytherapy, radioactive isotopes, hyperfractionation).
  • Assists patient to understand the role of radiation therapy in the treatment plan.
  • Demonstrates an understanding of the principles of safe practice regarding radiation (e.g., time, distance and shielding).
  • Facilitates patient learning regarding radiation safety (e.g., radioactive implants, isotopes).
  • Recognizes potential side effects related to radiation therapy.
  • Facilitates patient learning regarding the immediate, early, late and delayed side effects of radiation therapy (e.g., skin reactions, fatigue, cognitive dysfunction).
  • Implements interventions to decrease the incidence and severity of side effects and complications related to radiation therapy (e.g., skin care, pharmacological intervention).
  • Understands the role of concurrent combination therapy (e.g., systemic therapy and radiation, combination systemic therapies).
  • Assists patients to understand the role of concurrent combination therapy in their treatment plan.
  • Recognizes potential side effects related to concurrent combination therapy.
  • Facilitates patient learning regarding the outcomes of concurrent combination therapy involving immediate, early, late and delayed side effects.
  • Implements interventions to decrease the incidence and severity of side effects related to concurrent combination therapy (e.g., pharmacological intervention, mouth care).
  • Understands the roles of cellular therapy (e.g., hematopoietic stem cell transplants and chimeric antigen receptor T-cell therapy [CAR T-cell therapy]).
  • Understands the mechanism of action and principles of cellular therapy.
  • Assists the patient to understand the role of cellular therapy in the treatment plan.
  • Recognizes the acute, chronic and late side effects of cellular therapy (e.g., graft-versus-host disease [GVHD], veno-occlusive disease, cytokine release syndrome, neurological side effects).
  • Implements interventions to decrease the incidence and severity of side effects and complications related to cellular therapy (e.g., hydration, transfusion, pharmacological intervention).
  • Encourages the patient to report the use of complementary or alternative therapies (e.g., antioxidants, high-dose vitamins, herbal remedies, acupuncture, massage, physical therapy, medical marijuana).
  • Assesses patient use of complementary or alternative therapies.
  • Uses interventions to reduce the potential interaction of complementary or alternative therapies with conventional treatment modalities (e.g., pharmacist consult, dietitian consult).
  • Demonstrates an understanding of the role of treatment delivery systems (e.g., venous access devices, infusion pumps).
  • Demonstrates safe and appropriate use of treatment delivery systems.
  • Advocates for the appropriate venous access device for the patient.
  • Facilitates patient learning regarding the safe use, care and potential complications of treatment delivery devices.
  • Manages the care and maintenance of the treatment delivery device for the patient.

• Symptom and Toxicity Management — Official range: 20–25% (Practice allocation: 22.5%)

  • Oncologic Emergencies
  • Disease- and Treatment-Related Side Effects and Symptom Management
  • Recognizes the clinical presentation and risk factors for the following metabolic oncologic emergencies: i) cytokine release syndrome ii) disseminated intravascular coagulation (DIC) iii) febrile neutropenia and sepsis iv) hypercalcemia v) hypersensitivity reaction (e.g., anaphylaxis) vi) syndrome of inappropriate antidiuretic hormone (SIADH) vii) tumour lysis syndrome
  • Recognizes the clinical presentation and risk factors for the following structural oncologic emergencies: i) increased intracranial pressure ii) malignant bowel obstruction iii) neoplastic cardiac tamponade iv) spinal cord compression v) superior vena cava syndrome
  • Facilitates patient learning regarding the signs and symptoms of potential oncologic emergencies, reporting and self-care strategies.
  • Implements interventions in response to the following metabolic oncologic emergencies: i) cytokine release syndrome ii) disseminated intravascular coagulation (DIC) iii) febrile neutropenia and sepsis iv) hypercalcemia v) hypersensitivity reaction (e.g., anaphylaxis) vi) syndrome of inappropriate antidiuretic hormone (SIADH) vii) tumour lysis syndrome
  • Implements interventions in response to the following structural oncologic emergencies: i) increased intracranial pressure ii) malignant bowel obstruction iii) neoplastic cardiac tamponade iv) spinal cord compression v) superior vena cava syndrome
  • Understands that symptoms have culture-specific meanings and that clients from diverse backgrounds will describe their symptoms differently, will have different ideas of what might have caused it, will have different acceptance of it, and will have different ideas about what kind of treatment they would seek for it.
  • Assesses patient comorbidities and medication profiles that may impact disease and related side effects.
  • Assesses the patient for disease symptoms and treatment-related side effects using a standardized grading system (e.g., CTCAE), including alterations in the following: i) bone marrow function (e.g., myelosuppression) ii) mobility (e.g., gait, range of motion) iii) skin integrity (e.g., skin reactions, wounds, extravasation) iv) neurological status (e.g., seizures, peripheral neuropathy) v) mental status (e.g., confusion, depression) vi) circulation (e.g., edema, pericardial effusion, venous thromboembolism [VTE], cardiac function) vii) pulmonary function (e.g., dyspnea, effusion, cough) viii) gastrointestinal function (e.g., diarrhea, constipation, nausea, vomiting) ix) metabolic function (e.g., electrolyte or endocrine imbalances) x) urinary function (e.g., cystitis, anuria)
  • Facilitates patient learning regarding prevention and management of disease symptoms and treatment-related side effects (e.g., mouth care, adhering to an antiemetic schedule, hydration).
  • Implements interventions related to the management of disease- and treatment-related side effects, including alterations in the following: i) bone marrow function (e.g., transfusions, antibiotics) ii) mobility (e.g., assistive devices) iii) skin integrity (e.g., topical medication, skin care) iv) neurological status (e.g., pharmacological intervention) v) mental status (e.g., pharmacological intervention, referrals) vi) circulation (e.g., elevation, compressive therapy) vii) pulmonary function (e.g., oxygen therapy, pharmacological intervention) viii) gastrointestinal function (e.g., pharmacological intervention, nutritional counselling) ix) metabolic function (e.g., monitoring electrolytes, pharmacological intervention) x) urinary function (e.g., insertion and monitoring of catheters and drains)
  • Assesses the patient for immune-related adverse effects using a standardized grading system.
  • Implements interventions to manage immune-related adverse effects (e.g., increased monitoring, pharmacological intervention).
  • Facilitates patient learning regarding immune-related adverse effects and interventions (e.g., the need to consult with an organ-specific specialist).
  • Identifies common toxicities related to systemic treatment drug classes (e.g., cardiotoxicity with anthracycline, pulmonary toxicity with bleomycin, peripheral neuropathy with vinca alkaloids).
  • Assesses the patient’s pain.
  • Implements pharmacological and/or non-pharmacological interventions related to the management of pain.
  • Advocates for appropriate pain-control interventions for clients who use substances.
  • Delivers appropriate pain-control interventions for clients who use substances.
  • Evaluates the effectiveness of interventions used in the management of disease- and treatment- related side effects, immune-related adverse effects and pain.

• Supportive Care — Official range: 10–15% (Practice allocation: 12.5%)

  • Patient Diversity
  • Sexuality and Intimacy
  • Patient and Family Support Throughout the Cancer Continuum
  • Rehabilitation
  • Survivorship
  • End-of-Life Care
  • Palliative Approach to Care
  • Medical Assistance in Dying (MAiD)
  • Assesses the impact of patient diversity and family dynamics along the cancer care continuum (e.g., age of the patient, psychosocial, spiritual, cultural, socioeconomic, LGBTQ2+).
  • Facilitates effective coping strategies in relation to the cancer experience.
  • Facilitates the patient’s role as a partner in planning care along the cancer continuum.
  • Facilitates interprofessional communication in order to tailor the treatment plan and resources based on the patient’s individual needs.
  • Considers health literacy when providing information, education and care along the cancer continuum.
  • Demonstrates an awareness of the range of Indigenous health knowledges and practices (traditional and non-traditional) among Indigenous peoples.
  • Demonstrates an understanding of factors related to the patient, disease and treatments that may affect sexuality and intimacy (e.g., patient’s lifestyle and attitudes, body image, safety, sexual function, role changes).
  • Assesses factors related to the patient, disease and treatments that may affect sexuality and intimacy.
  • Facilitates patient learning regarding the impact of disease and treatment related to sexuality and intimacy.
  • Implements interventions regarding alterations in the following: i) body and self-image (e.g., alopecia, fatigue) ii) sexual function (e.g., erectile dysfunction, vaginal dryness) iii) safe sexual practice (e.g., cytotoxic body fluids) iv) fertility (e.g., diminished or loss of fertility)
  • Evaluates the effectiveness of the interventions implemented to ensure that the patient’s sexuality and intimacy needs are met.
  • Provides patient and family-centred care (e.g., for pediatric patients).
  • Assesses the patient and/or family for level of distress, quality of life and coping abilities.
  • Facilitates self-care in managing stressors along the cancer continuum (e.g., developing support systems, journaling).
  • Provides education to the patient and family regarding cancer support services and advocacy groups.
  • Evaluates the effectiveness of services to meet the patient’s supportive care needs.
  • Assesses the patient’s physical and psychological adaptation to the changes caused by cancer and/or treatment (e.g., lymphedema management, oxygen therapy, speech therapy, physical therapy, occupational therapy, home care).
  • Implements interventions to assist the patient in achieving optimum function and quality of life.
  • Evaluates the effectiveness of interventions for the patient’s optimal functioning and quality of life.
  • Recognizes the unique needs of cancer survivors: i) physical, chronic and late side effects (e.g., disability, drug-related toxicity) ii) psychosocial late effects (e.g., body image, fear of recurrence, cognitive changes) iii) developmental-specific issues (e.g., pediatric, young adults, adults, older adults) iv) risk of secondary malignancy v) ongoing treatment (e.g., maintenance therapy)
  • Provides education regarding the need for surveillance and primary care follow-up.
  • Provides education regarding healthy lifestyle choices and risk-reduction activities (e.g., tobacco cessation, diet, exercise).
  • Determines the patient and family goals for end-of-life care (e.g., hospice care, home care).
  • Recognizes the unique needs of the patient and family transitioning to end-of-life care.
  • Implements interventions for end-of-life symptom management based on the patient’s goals for care.
  • Understands key elements of the palliative approach to care along the cancer continuum.
  • Explains palliative supports and treatments to the patient and family.
  • Facilitates ongoing discussions with the patient and family regarding their goals of care (e.g., living with advanced cancer, substitute decision-maker, advance health-care directive).
  • Assesses the patient’s quality of life in relation to their palliative care.
  • Identifies the nurse’s role and professional responsibilities related to MAiD.
  • Identifies available resources to support inquiries and requests related to MAiD.
  • Understands that nurses must not impose their own views and values about MAiD onto others nor use their position to influence, judge or discriminate against those whose values are different from their own.
  • Adheres to current legislation, professional regulatory standards and employer policies regarding MAiD, including IT security safeguards that protect and preserve the privacy of the person.
  • Understands that when there is conscientious objection to MAiD, care unrelated to the activities associated with MAiD must continue to be provided.

• Continuity of Care — Official range: 5–10% (Practice allocation: 7.5%)

  • Identifies the personal issues of the patient and family that impede the continuity of care (e.g., travel, financial issues, child care, caregiving).
  • Assists the patient and family to navigate the health-care system.
  • Collaborates with the interprofessional oncology health-care team to ensure continuity of care (e.g., referral, coordination of treatment, consultation).
  • Initiates referral to supportive services to optimize patient care (e.g., speech therapy, physical therapy, sexual health, fertility management, spiritual resources, community resources).
  • Collaborates with external health professionals to assure continuity of care (e.g., survivor care, rehabilitation).
  • Identifies and advises the interprofessional team of system issues impeding the patient’s continuity of care (e.g., wait times, transition points, non-insured costs).

• Ethics, Legal Obligations and Research — Official range: 5–10% (Practice allocation: 7.5%)

  • Recognizes and understands the implications of ethical principles along the cancer continuum (e.g., autonomy, beneficence, non-maleficence, justice).
  • Applies an ethical framework to address ethical dilemmas (e.g., family/substitute decision-maker involvement, confidentiality, allocation of resources, artificial nutrition and hydration, negotiating goals of care, end of life, do not resuscitate/allow natural death, voluntary consent, MAiD requests).
  • Recognizes and understands the legal obligations along the cancer continuum regarding decision-making (e.g., informed consent, substitute decision-makers, care directives, guardianship, adult protection).
  • Critically reflects on their own beliefs and values about substance use and other high-risk behaviours.
  • Understands the purpose and design of research studies, including the types and phases of clinical trials (e.g., eligibility criteria).
  • Recognizes the unique care requirements of patients participating in a clinical trial (e.g., following protocols).
  • Refers the patient to the appropriate health-care provider to answer questions and/or ensure understanding of clinical trials and research studies.

How to prepare

Work through the topics, read the explanation after each answer, and revisit the areas where you miss questions. Use the official outline and reference materials below to guide your study.

These independent practice questions are not actual exam items and do not guarantee a passing result.

Frequently asked questions

Official sources and references

• CNA Oncology Nursing Certification Exam Blueprint and Specialty Competencies

  p. 1

• CNA Oncology Nursing Certification Exam Blueprint and Specialty Competencies

  p. 5

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