CPHON Test Review

A Pediatric Hematology Oncology Nurse (CPHON) is an advanced nursing practitioner who participates in the care of children and adolescents with blood disorders and cancer. This specialty is concerned with all aspects of the child's assessment, treatment and care.

Credentialing Organization

Oncology Nursing Certification Corporation is the credentialing organization. You will be required to take an examination, the fee for which will depend on whether you are a member of the Oncology Nursing Society (ONS) or the Association of Pediatric Hematology/Oncology Nurses (APHON). There are discounts available for applicants age 65 and over. Your nursing license number and expiration date as well as information about past nursing experience will be required when applying. Upon passing the examination, you will be given the following credential: Certified Pediatric Hematology Oncology Nurse (CPHON). The certification is valid for a limited number of years and then must be renewed.

Eligibility

Before being certified as a pediatric hematology oncology nurse, you'll need:

  • A year or more experience as a registered nurse (RN). This experience must have taken place during the three year period prior to applying for the exam.
  • One thousand hours or more as a nurse working in pediatric oncology or hematology. This experience should fall within the 30 month period prior to applying for the exam.
  • Ten contract hours of continuing education in either oncology or oncology nursing at an accredited institution. These hours should fall within the three years prior to applying for the exam.

About the Certification Exam

The exam consists of 165 questions, divided into nine subject areas representing knowledge essential to advanced practice as a nurse. Of these questions, 125 count toward the final score. (The remainder are questions being statistically tested for inclusion in future exams.) The questions on the test are based on the CPHON Test Blueprint, which was derived from a role delineation study of pediatric nurses, based on current roles and behaviors of nurses in the pediatric oncology field. The questions are divided into nine areas: Psychosocial Dimensions of Care (10 percent), Disease-Related Biology (10 percent), Treatment (23 percent), Supportive Care and Symptom Management (22 percent), Pediatric Oncology and Hematologic Emergencies (13 percent), Long-Term Follow-Up and Survivorship (8 percent), Health Maintenance (2 percent), End of Life Care (6 percent), Professional Performance (6 percent).

Nursing Certification Central

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Certified Pediatric Hematology Oncology Nurse (CPHON) Practice Questions

1. The most common malignancy in children is:

  1. brain tumor
  2. leukemia
  3. lymphoma
  4. Ewing's sarcoma

2. The most reliable diagnostic test for Hodgkin's lymphoma is:

  1. positive test for Epstein-Barr virus
  2. the presence of Reed-Sternberg cells on a lymph node biopsy
  3. the presence of enlarged cervical and axillary lymph nodes on physical examination
  4. the presence of a mediastinal mass on a computed tomography scan

3. Which of the following drugs is most likely to cause hemorrhagic cystitis and delayed fibrosis of the bladder?

  1. Cisplatin
  2. Methotrexate
  3. Cyclophosphamide
  4. Dexamethasone

4. The hemolytic-uremic syndrome is best managed with:

  1. anticoagulants
  2. red-cell and platelet transfusions
  3. corticosteroids
  4. diuretics

5. Platelet transfusions are indicated in which of the following circumstances?

  1. When the blood count is less than 25,000 cells/mm3 but the patient is not bleeding
  2. When surgery is scheduled and the blood count is less than 50,000 cells/mm3
  3. When platelets have been refrigerated for up to 30 days
  4. When 1 unit of platelets increases the patient's platelet count by 25,000 cells/mm3

Certified Pediatric Hematology Oncology Nurse (CPHON) Answer Key

1. Answer: B

Leukemia is the commonest malignancy in children with a preponderance of acute lymphoblastic leukemia. Acute myelocytic leukemia is less common, accounting for only about 20% of cases. Even less common are the promyelocytic and myelomonocytic leukemias and myelodysplasia, a preleukemic condition found mostly in adults. The chronic leukemias are far less common in the pediatric age-groups. Brain tumors are the commonest solid malignant tumor in children, but even benign tumors can considerably damage a developing brain. Lymphomas are also fairly common with non-Hodgkin's lymphoma more frequently seen in the younger age-groups while Hodgkin's lymphoma is commoner in the 15-17-year-old age-group. Ewing's sarcoma, a type of bone tumor found in children, is far less common than the others mentioned above.

2. Answer: B

The hallmark diagnostic criterion of Hodgkin's disease is the presence of the eponymous Reed- Sternberg cells, almost always found on a lymph node biopsy. These are giant cells with polypoid or multiple nuclei and eosinophilic nucleoli. These represent a minority, only 1%-5% of the cell population against a background of small lymphocytes and fewer other cell types such as granulocytes and fibroblasts. Immunochemical markers, especially positive for CD 15 and CD 30 are also helpful in distinguishing Hodgkin's from non-Hodgkin's lymphomas. There are four main histologic subtypes that are important in prognosis and treatment decisions. In addition to these, a so-called nodular lymphocyte predominant form occurs with tightly packed nodules under low-power microscopy.

3. Answer: C

Chemotherapeutic agents have numerous toxic effects on the urogenital system, and some may outlast the acute treatment phase. Cisplatin is predominantly nephrotoxic and may cause reduction in the glomerular filtration rate, but it is less likely to affect the bladder. Methotrexate does not usually cause bladder problems. Dexamethasone is a steroid and is unlikely to be responsible for hemorrhagic cystitis. Alkylating agents and cyclophosphamide in particular can cause hemorrhagic cystitis and delayed fibrosis of the bladder. Consequently, vigorous hydration and urine monitoring are indicated for this drug, especially when high doses are given. Radiation may also cause hemorrhagic cystitis, especially when combined with chemotherapy, resulting in a synergistic effect.

4. Answer: B

The hemolytic-uremic syndrome in children usually is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. It is divided into diarrhea positive (D+) and diarrhea negative (D-) forms. The former is commoner in the 7-month-old to 6-year-old age-group and is often preceded by colitis due to Escherichia coli. This organism may secrete a so-called Shigella toxin that can injure the endothelial cells of the gut and kidney. For renal failure, dialysis is the management choice. Hemoglobin levels should be kept above 7 g/dL, and low platelet counts with a hemorrhagic diathesis may be corrected with platelet transfusions. Supportive care, intravenous immunoglobulins, and anticonvulsants for seizures may be needed. Corticosteroids, anticoagulants, and diuretics are not helpful.

5. Answer: B

Thrombocytopenia (low platelet count) is common in cancer and leukemia patients, especially when receiving chemotherapy. Spontaneous major bleeding rarely occurs when the count is above 20,000 cells/mm3, and most authorities do not give transfusions unless the count dips below 10,000 cells/mm3 with no obvious bleeding. In patients scheduled for surgery or in patients who have vascular brain tumors, keeping the count above 50,000 cells/mm3 is advised. Unlike whole blood or packed red blood cells, platelets are kept in a small amount of plasma at room temperature and agitated for up to 5 days. One unit of platelets derived from 500 mL of whole blood should raise the platelet count by about 10,000 cells/mm3, but this is often not achieved due to fever, multiple prior platelet transfusions, or hypersplenism. A recipient platelet count should be obtained 1 hour after the completed transfusion. Often it is more practical to give 6-8 units at once.

CPHON Exam Blueprint and Breakdown

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Last Updated: 12/29/2017


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