100+ Free CPHON Practice Questions

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Question 1

Score: 0/0

A child with cancer has a platelet count of 15,000/microL and is scheduled for a lumbar puncture with intrathecal chemotherapy. What should occur before the procedure?

Give fresh frozen plasma instead of platelets

Transfuse platelets to achieve a count ≥ 50,000/microL before the procedure

Proceed without platelet transfusion since the count is adequate

Cancel the procedure permanently

to track

2026 Statistics

Key Facts: CPHON Exam

~75%

Pass Rate

ONCC

165

Total Questions

125 scored

3 hrs

Time Limit

ONCC

2,000 hrs

Required Experience

Pediatric hem/onc

$300-$420

Exam Fee

ONCC

4 years

Certification Validity

ONCC

The CPHON (Certified Pediatric Hematology Oncology Nurse) exam is administered by ONCC with an approximate 75% pass rate. It consists of 165 multiple-choice questions (125 scored, 40 pretest) over 3 hours. Treatment modalities is the largest domain at 24%. Candidates must hold an active RN license with 2,000 hours of pediatric hematology/oncology nursing experience. The credential is valid for 4 years and is supported by both ONS and APHON (Association of Pediatric Hematology/Oncology Nurses).

Sample CPHON Practice Questions

Try these sample questions to test your CPHON exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 4-year-old child presents with bone pain, fatigue, pallor, and petechiae. CBC shows WBC 45,000/microL with 80% blasts. What is the MOST likely diagnosis?

A.Iron deficiency anemia

B.Acute lymphoblastic leukemia (ALL)

C.Sickle cell crisis

D.Immune thrombocytopenia (ITP)

Explanation: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, typically presenting in children ages 2-5 with bone pain, fatigue, pallor (anemia), petechiae/bruising (thrombocytopenia), and often elevated WBC with circulating blast cells. The presence of 80% blasts on CBC is characteristic. Diagnosis is confirmed by bone marrow biopsy. ALL accounts for approximately 75% of childhood leukemias and has cure rates exceeding 90% with current treatment protocols.

2Which chromosomal abnormality in childhood ALL is associated with the BEST prognosis?

A.Philadelphia chromosome t(9;22)

B.Hyperdiploidy (>50 chromosomes)

C.MLL rearrangement t(4;11)

D.Hypodiploidy (<44 chromosomes)

Explanation: Hyperdiploidy (>50 chromosomes) in childhood ALL is associated with a favorable prognosis, with event-free survival rates exceeding 90%. Hyperdiploid leukemia cells are more susceptible to apoptosis and respond well to chemotherapy, particularly methotrexate and 6-mercaptopurine. In contrast, the Philadelphia chromosome t(9;22), MLL rearrangements, and hypodiploidy are associated with high-risk disease requiring more intensive treatment.

3Neuroblastoma most commonly arises from which embryonic tissue?

A.Mesoderm

B.Neural crest cells (sympathetic nervous system)

C.Endoderm

D.Ectoderm

Explanation: Neuroblastoma originates from neural crest cells of the sympathetic nervous system. The most common primary site is the adrenal medulla, but tumors can arise anywhere along the sympathetic chain. It is the most common extracranial solid tumor in children, predominantly affecting those under 5 years. MYCN amplification is the most important prognostic biomarker, with amplification associated with aggressive disease and poor outcomes.

4Which tumor marker is elevated in neuroblastoma and used for diagnosis and monitoring?

A.Alpha-fetoprotein (AFP)

B.Urine catecholamines (VMA and HMA)

C.CA-125

D.Beta-hCG

Explanation: Neuroblastoma produces catecholamines, and elevated urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA/HMA) are found in approximately 90% of cases. These metabolites are used for initial diagnosis and ongoing disease monitoring. Alpha-fetoprotein is elevated in hepatoblastoma and certain germ cell tumors, while CA-125 is associated with ovarian cancer and beta-hCG with germ cell tumors.

5Wilms tumor (nephroblastoma) typically presents in which age group?

A.Adolescents (14-18 years)

B.Children ages 3-4 years

C.Neonates (0-1 month)

D.School-age children (10-12 years)

Explanation: Wilms tumor is the most common renal malignancy in children, with a peak incidence at 3-4 years of age. The classic presentation is an asymptomatic abdominal mass discovered by a parent or during a routine examination. Associated findings may include hematuria, hypertension, and abdominal pain. It is associated with congenital syndromes including WAGR syndrome, Denys-Drash syndrome, and Beckwith-Wiedemann syndrome. The overall survival rate exceeds 90%.

6Which genetic syndrome significantly increases the risk of developing childhood cancer and requires cancer surveillance?

A.Turner syndrome

B.Li-Fraumeni syndrome (TP53 mutation)

C.Klinefelter syndrome

D.Marfan syndrome

Explanation: Li-Fraumeni syndrome is caused by germline TP53 mutations and carries a lifetime cancer risk exceeding 70%, with multiple cancer types including soft tissue sarcomas, osteosarcoma, breast cancer, brain tumors, and leukemia. Children with Li-Fraumeni require comprehensive cancer surveillance protocols. Other syndromes with increased cancer risk include Down syndrome (ALL), neurofibromatosis (optic glioma, MPNST), and retinoblastoma (RB1 mutations).

7A child with sickle cell disease is at increased risk of which neurological complication that requires routine screening?

A.Peripheral neuropathy

B.Stroke (cerebrovascular accident)

C.Seizure disorder

D.Meningitis

Explanation: Children with sickle cell disease have an 11% risk of stroke by age 20 due to sickle cell vasculopathy. Transcranial Doppler (TCD) ultrasonography is recommended annually for children ages 2-16 to identify those at high risk (elevated blood flow velocity >200 cm/s). Chronic transfusion therapy to maintain HbS <30% significantly reduces stroke risk. Stroke prevention represents one of the most important health promotion activities in sickle cell nursing care.

8Which immunization is contraindicated in a child who is actively receiving chemotherapy?

A.Inactivated influenza vaccine

B.Live varicella (chickenpox) vaccine

C.Hepatitis B vaccine

D.Inactivated polio vaccine (IPV)

Explanation: Live vaccines are contraindicated in immunocompromised children receiving chemotherapy because the attenuated organisms can cause active infection in patients with impaired immune function. This includes varicella, MMR (measles-mumps-rubella), live attenuated influenza, and rotavirus vaccines. Inactivated vaccines (influenza, hepatitis B, IPV) may be given but may have reduced immunogenicity. Live vaccine schedules are resumed after immune reconstitution, typically 3-6 months after completing chemotherapy.

9What is the MOST important cancer screening recommendation for children with Down syndrome?

A.Annual brain MRI

B.Regular CBC monitoring due to increased risk of leukemia (ALL and AML)

C.Annual bone scan

D.Quarterly chest X-rays

Explanation: Children with Down syndrome (trisomy 21) have a 10-20 fold increased risk of developing leukemia, particularly acute lymphoblastic leukemia and acute megakaryoblastic leukemia (a subtype of AML). Regular monitoring of CBC is important for early detection. Additionally, transient abnormal myelopoiesis (TAM) occurs in approximately 10% of neonates with Down syndrome and can progress to AML in some cases. Awareness of these risks is essential for health promotion in this population.

10Which phase of ALL treatment is specifically designed to eliminate residual leukemia cells in the central nervous system?

A.Induction

B.CNS-directed therapy (intrathecal chemotherapy)

C.Delayed intensification

D.Maintenance

Explanation: CNS-directed therapy using intrathecal (IT) chemotherapy (methotrexate, cytarabine, and/or hydrocortisone) is administered throughout ALL treatment to prevent and treat CNS leukemia. The blood-brain barrier prevents systemic chemotherapy from adequately reaching the CNS, making IT therapy essential. Historically, cranial radiation was used for CNS prophylaxis, but modern protocols use IT chemotherapy alone for most patients to avoid the neurocognitive and endocrine late effects of radiation.

About the CPHON Exam

Specialty certification for registered nurses in pediatric hematology and oncology nursing. The CPHON validates expertise in caring for children with cancer and blood disorders, covering treatment modalities, symptom management, developmental considerations, and family-centered care.

Questions

165 scored questions

Time Limit

3 hours

Passing Score

Pass/Fail (scaled)

Exam Fee

$300 (ONS/APHON member) / $420 (non-member) (ONCC)

CPHON Exam Content Outline

14%

Health Promotion and Disease Prevention

Genetic counseling, screening, immunizations, health maintenance in immunocompromised children

18%

Scientific Basis and Pathophysiology

Cancer biology, hematologic disorders, genetics, staging, diagnostic workup

24%

Treatment Modalities

Chemotherapy, radiation, surgery, immunotherapy, transplant, clinical trials

20%

Symptom Management

Pain, nausea/vomiting, mucositis, infection, bleeding, nutrition, fatigue

14%

Psychosocial and End-of-Life

Developmental considerations, coping, palliative care, bereavement, family support

10%

Professional Practice

Evidence-based practice, ethics, education, quality improvement, advocacy

How to Pass the CPHON Exam

What You Need to Know

Passing score: Pass/Fail (scaled)
Exam length: 165 questions
Time limit: 3 hours
Exam fee: $300 (ONS/APHON member) / $420 (non-member)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CPHON Study Tips from Top Performers

1Focus on treatment modalities (24% of exam) — know chemotherapy classifications, safe handling, and pediatric-specific protocols

2Master symptom management (20%) — understand age-appropriate pain assessment tools and antiemetic protocols for children

3Review developmental milestones and how they affect care delivery, communication, and psychosocial support

4Know common childhood cancers (ALL, neuroblastoma, Wilms tumor, brain tumors) and their staging systems

5Complete at least 100 practice questions before scheduling your exam

Frequently Asked Questions

What is the CPHON exam pass rate?

The CPHON exam has an approximate 75% pass rate. The exam uses a scaled scoring system where 125 of the 165 questions are scored (40 are unscored pretest items). With dedicated preparation using practice questions and hands-on pediatric oncology experience, most well-prepared candidates pass on their first attempt.

What are the CPHON eligibility requirements?

To sit for the CPHON exam, you need: 1) A current, active, unencumbered RN license. 2) A minimum of 2,000 hours of pediatric hematology/oncology nursing practice within the last 4 years. 3) At least 10 contact hours of continuing education in pediatric hematology/oncology nursing within the last 4 years.

How hard is the CPHON exam?

The CPHON is an advanced specialty certification. Treatment modalities (24% of the exam) is typically the most challenging domain, covering chemotherapy protocols, radiation therapy, immunotherapy, and transplant for pediatric patients. With 60-100 hours of study over 8-12 weeks, experienced pediatric hem/onc nurses are well-prepared.

What content domains are on the CPHON exam?

The CPHON covers 6 domains: Health Promotion and Disease Prevention (14%), Scientific Basis and Pathophysiology (18%), Treatment Modalities (24%), Symptom Management (20%), Psychosocial and End-of-Life (14%), and Professional Practice (10%). Treatment modalities is the largest section covering chemotherapy, radiation, and immunotherapy.

How should I study for the CPHON exam?

Plan for 60-100 hours of study over 8-12 weeks. Focus heavily on treatment modalities (24%) and symptom management (20%). Use the ONCC test content outline as your study framework. Review pediatric-specific drug protocols, age-appropriate dosing, and developmental considerations. Complete at least 100 practice questions and score 80%+ consistently before scheduling.