CPHON Pediatric hematology oncology
nursing certification focusing on
childhood cancers, blood disorders, and
specialized treatments.
Question 1
A 16-year-old survivor of Hodgkin lymphoma treated with chest radiation at age
14 is being seen for a survivorship visit. Which screening recommendation is most
appropriate for this patient?
A) Annual complete blood count
B) Annual mammography beginning 8 years after radiation or at age 25,
whichever is later
C) Annual echocardiogram
D) Annual thyroid function tests
Rationale: Patients treated with chest radiation for Hodgkin lymphoma are at
significantly increased risk for breast cancer. Screening should begin 8-10 years
after radiation or at age 25, whichever is later. The other screenings may be
appropriate but are not the priority for this specific late effect.
Question 2
A 4-year-old child with acute lymphoblastic leukemia (ALL) is completing
therapy. The nurse is preparing the family for transition to survivorship care.
Which component is essential in a survivorship care plan?
A) A summary of treatment received, potential late effects, and a follow-up
schedule
B) A list of all hospitalizations during treatment
C) Contact information for the child's school
D) Financial records for insurance purposes
Rationale: Survivorship care plans are mandated by the American College of
Surgeons Commission on Cancer and should include a detailed treatment
,summary, recommendations for follow-up care, and potential late effects. They
facilitate coordination between oncology and primary care providers.
Question 3
A 15-year-old patient with acute myeloid leukemia (AML) is being prepared for
hematopoietic stem cell transplantation (HSCT). The nurse is discussing fertility
preservation. Which intervention should be offered prior to conditioning?
A) Sperm banking for male patients
B) Ovarian transposition for female patients
C) Testicular biopsy for male patients
D) Ovarian suppression with GnRH agonists
Rationale: Sperm banking is the most established and effective fertility
preservation method for post-pubertal males. For females, oocyte or embryo
cryopreservation is the gold standard. Ovarian transposition is used to move
ovaries out of radiation fields. GnRH agonists for ovarian suppression remain
controversial.
Question 4
A child with a history of neuroblastoma treated with high-dose chemotherapy and
autologous stem cell transplant at age 3 is now 12 years old. The nurse should
monitor for which late effect?
A) Sensorineural hearing loss
B) Essential hypertension
C) Type 1 diabetes mellitus
D) Juvenile rheumatoid arthritis
Rationale: Platinum-based chemotherapy (cisplatin, carboplatin) used in
neuroblastoma treatment is associated with sensorineural hearing loss. This is a
well-documented late effect that requires serial audiology evaluations.
Question 5
An 8-year-old patient with ALL is transitioning from active treatment to
,maintenance therapy. The nurse should educate the family about which aspect of
health maintenance?
A) Adherence to the immunization schedule, including live vaccines after
completion of therapy
B) Complete avoidance of all physical activity
C) Restriction of all dairy products
D) Daily aspirin therapy
Rationale: Immunizations are a critical component of health maintenance for
pediatric oncology patients. Live vaccines (MMR, varicella) can be given after
immune recovery, typically 3-12 months after completion of chemotherapy. The
immunization schedule should be followed.
DOMAIN II: PEDIATRIC HEMATOLOGY AND ONCOLOGY NURSING
PRACTICE — 18% of Exam
Question 6
A 7-year-old child presents with fever, pallor, bruising, and bone pain. The
complete blood count shows hemoglobin 6.8 g/dL, white blood cell count
85,000/mm³ with 80% blasts, and platelets 18,000/mm³. Which diagnosis is most
likely?
A) Acute lymphoblastic leukemia (ALL)
B) Aplastic anemia
C) Immune thrombocytopenic purpura (ITP)
D) Hodgkin lymphoma
Rationale: The classic presentation of ALL includes fever, pallor (anemia),
bruising (thrombocytopenia), and bone pain (bone marrow infiltration). The
presence of blast cells and leukocytosis strongly suggests leukemia. ALL is the
most common pediatric malignancy.
Question 7
Which cytogenetic abnormality in pediatric ALL is associated with a favorable
prognosis?
, A) Philadelphia chromosome (t(9;22))
B) Hyperdiploidy (>50 chromosomes)
C) t(4;11) (MLL rearrangement)
D) Hypodiploidy
Rationale: Hyperdiploidy (>50 chromosomes) in pediatric ALL is associated with
a favorable prognosis. Conversely, the Philadelphia chromosome, MLL
rearrangements, and hypodiploidy are associated with poor prognosis and may
require more intensive therapy.
Question 8
A 3-year-old child is diagnosed with a Wilms tumor. Which clinical presentation is
most characteristic of this tumor?
A) An asymptomatic abdominal mass discovered incidentally
B) Hematuria and flank pain
C) Hypertension and headache
D) Gross hematuria with dysuria
Rationale: Wilms tumor (nephroblastoma) classically presents as an
asymptomatic, palpable abdominal mass discovered incidentally by a parent or
during a routine examination. Hematuria occurs in about 25% of cases.
Hypertension may occur due to renin secretion but is not the most characteristic
presentation.
Question 9
A 5-year-old child with sickle cell disease is being evaluated for fever. Which
assessment finding should the nurse prioritize?
A) Heart rate 120 bpm
B) Oxygen saturation 88% on room air
C) Respiratory rate 24 breaths/min
D) Temperature 101.2°F (38.4°C)
Rationale: An oxygen saturation of 88% on room air in a child with sickle cell
disease is concerning for acute chest syndrome (ACS), a life-threatening
complication. ACS is one of the leading causes of death in children with sickle cell
disease and requires immediate intervention.
nursing certification focusing on
childhood cancers, blood disorders, and
specialized treatments.
Question 1
A 16-year-old survivor of Hodgkin lymphoma treated with chest radiation at age
14 is being seen for a survivorship visit. Which screening recommendation is most
appropriate for this patient?
A) Annual complete blood count
B) Annual mammography beginning 8 years after radiation or at age 25,
whichever is later
C) Annual echocardiogram
D) Annual thyroid function tests
Rationale: Patients treated with chest radiation for Hodgkin lymphoma are at
significantly increased risk for breast cancer. Screening should begin 8-10 years
after radiation or at age 25, whichever is later. The other screenings may be
appropriate but are not the priority for this specific late effect.
Question 2
A 4-year-old child with acute lymphoblastic leukemia (ALL) is completing
therapy. The nurse is preparing the family for transition to survivorship care.
Which component is essential in a survivorship care plan?
A) A summary of treatment received, potential late effects, and a follow-up
schedule
B) A list of all hospitalizations during treatment
C) Contact information for the child's school
D) Financial records for insurance purposes
Rationale: Survivorship care plans are mandated by the American College of
Surgeons Commission on Cancer and should include a detailed treatment
,summary, recommendations for follow-up care, and potential late effects. They
facilitate coordination between oncology and primary care providers.
Question 3
A 15-year-old patient with acute myeloid leukemia (AML) is being prepared for
hematopoietic stem cell transplantation (HSCT). The nurse is discussing fertility
preservation. Which intervention should be offered prior to conditioning?
A) Sperm banking for male patients
B) Ovarian transposition for female patients
C) Testicular biopsy for male patients
D) Ovarian suppression with GnRH agonists
Rationale: Sperm banking is the most established and effective fertility
preservation method for post-pubertal males. For females, oocyte or embryo
cryopreservation is the gold standard. Ovarian transposition is used to move
ovaries out of radiation fields. GnRH agonists for ovarian suppression remain
controversial.
Question 4
A child with a history of neuroblastoma treated with high-dose chemotherapy and
autologous stem cell transplant at age 3 is now 12 years old. The nurse should
monitor for which late effect?
A) Sensorineural hearing loss
B) Essential hypertension
C) Type 1 diabetes mellitus
D) Juvenile rheumatoid arthritis
Rationale: Platinum-based chemotherapy (cisplatin, carboplatin) used in
neuroblastoma treatment is associated with sensorineural hearing loss. This is a
well-documented late effect that requires serial audiology evaluations.
Question 5
An 8-year-old patient with ALL is transitioning from active treatment to
,maintenance therapy. The nurse should educate the family about which aspect of
health maintenance?
A) Adherence to the immunization schedule, including live vaccines after
completion of therapy
B) Complete avoidance of all physical activity
C) Restriction of all dairy products
D) Daily aspirin therapy
Rationale: Immunizations are a critical component of health maintenance for
pediatric oncology patients. Live vaccines (MMR, varicella) can be given after
immune recovery, typically 3-12 months after completion of chemotherapy. The
immunization schedule should be followed.
DOMAIN II: PEDIATRIC HEMATOLOGY AND ONCOLOGY NURSING
PRACTICE — 18% of Exam
Question 6
A 7-year-old child presents with fever, pallor, bruising, and bone pain. The
complete blood count shows hemoglobin 6.8 g/dL, white blood cell count
85,000/mm³ with 80% blasts, and platelets 18,000/mm³. Which diagnosis is most
likely?
A) Acute lymphoblastic leukemia (ALL)
B) Aplastic anemia
C) Immune thrombocytopenic purpura (ITP)
D) Hodgkin lymphoma
Rationale: The classic presentation of ALL includes fever, pallor (anemia),
bruising (thrombocytopenia), and bone pain (bone marrow infiltration). The
presence of blast cells and leukocytosis strongly suggests leukemia. ALL is the
most common pediatric malignancy.
Question 7
Which cytogenetic abnormality in pediatric ALL is associated with a favorable
prognosis?
, A) Philadelphia chromosome (t(9;22))
B) Hyperdiploidy (>50 chromosomes)
C) t(4;11) (MLL rearrangement)
D) Hypodiploidy
Rationale: Hyperdiploidy (>50 chromosomes) in pediatric ALL is associated with
a favorable prognosis. Conversely, the Philadelphia chromosome, MLL
rearrangements, and hypodiploidy are associated with poor prognosis and may
require more intensive therapy.
Question 8
A 3-year-old child is diagnosed with a Wilms tumor. Which clinical presentation is
most characteristic of this tumor?
A) An asymptomatic abdominal mass discovered incidentally
B) Hematuria and flank pain
C) Hypertension and headache
D) Gross hematuria with dysuria
Rationale: Wilms tumor (nephroblastoma) classically presents as an
asymptomatic, palpable abdominal mass discovered incidentally by a parent or
during a routine examination. Hematuria occurs in about 25% of cases.
Hypertension may occur due to renin secretion but is not the most characteristic
presentation.
Question 9
A 5-year-old child with sickle cell disease is being evaluated for fever. Which
assessment finding should the nurse prioritize?
A) Heart rate 120 bpm
B) Oxygen saturation 88% on room air
C) Respiratory rate 24 breaths/min
D) Temperature 101.2°F (38.4°C)
Rationale: An oxygen saturation of 88% on room air in a child with sickle cell
disease is concerning for acute chest syndrome (ACS), a life-threatening
complication. ACS is one of the leading causes of death in children with sickle cell
disease and requires immediate intervention.
