1.3 Test Content Outline and Study Strategy

The current CPHON Test Content Outline (TCO) is not a five-domain pamphlet, and it is not the older six-domain list still circulating in third-party blogs and cached local outlines. The 2021 role-delineation study, the 2026 ONCC Test Registration Manual, and the official TCO PDF all describe six subject areas. Some ONCC webpage copy still says 'five major subject areas.' That webpage line is stale. Study from the PDF at https://www.oncc.org/sites/default/files/2024-11/2025_CPHON_Test_Content_Outline.pdf. Pair it with the 2026 CPHON test references at https://www.oncc.org/2026-cphon-test-references and the credential page at https://www.oncc.org/certified-pediatric-hematology-oncology-nurse-cphon.

Scored items on any form are about weight × 125. Not every sub-area appears on every form. Do not treat a missing sub-bullet as a promise it will be absent from yours. Build coverage from the six official percentages, then use later chapters of this guide to go deep on diseases, modalities, organ-system effects, and named emergencies.

The six subject areas

I. Care Continuum — 6% (~8 scored). Transitions among primary care and levels of specialty care, end-of-life care, health promotion and maintenance, and survivorship. The slice is small, which makes it easy to under-study. Survivorship teaching, vaccine catch-up after therapy, and hospice transitions are still scored items. Eight items can be the difference between a scaled 54 and a scaled 55.

II. Pediatric Hematology and Oncology Nursing Practice — 18% (~23 scored). This is the disease book: leukemias, lymphomas, central nervous system tumors, neuroblastoma, Wilms tumor and other renal tumors, bone and soft-tissue sarcomas, retinoblastoma, hepatoblastoma, germ-cell tumors, sickle cell disease, thalassemia, hemophilia and von Willebrand disease, immune thrombocytopenia, and marrow-failure syndromes. Presentation, pathophysiology, genetics, diagnostics, staging, and prognosis are taught inside those diseases, not as a separate trivia deck. Adult solid-tumor shortcuts fail here. Wilms tumor is not 'just a kidney mass,' and sickle cell pain is not 'just oncology pain.'

III. Treatment Modalities and Side Effects — 21% (~26 scored). Chemotherapy, biotherapy, immunotherapy, cellular therapies including chimeric antigen receptor T-cell (CAR-T) therapy, radiation (including I-131-MIBG and proton beam), hematopoietic stem cell transplantation, surgery, transfusion, leukapheresis, and coagulation therapy — plus the side-effect profiles that travel with each modality. Pediatric protocol logic matters: induction versus consolidation versus delayed intensification versus maintenance is not adult cycle language. Vesicant handling, radiation-field teaching, and transplant isolation are nursing actions, not optional extras.

IV. Symptom Management and Supportive Care — 26% (~33 scored). This is the largest slice. Organ-system acute, chronic, and late effects run across neurologic, respiratory, cardiovascular, gastrointestinal, renal and genitourinary, musculoskeletal, integumentary, endocrine, reproductive, hematologic/immune, sensory, and related systems. Mucositis care, antiemetic teaching with generic drug names, neuropathy, cardiomyopathy surveillance after anthracyclines, fertility preservation, and school re-entry all live here. If you only drill cancer types, you under-weight the exam.

V. Pediatric Hematologic and Oncologic Emergencies — 21% (~26 scored). Named emergencies, not a generic 'the child looks sick' category. High-yield labels include tumor lysis syndrome, typhlitis (neutropenic colitis), superior vena cava syndrome, spinal cord compression, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone secretion, increased intracranial pressure, anaphylaxis to asparaginase, hemorrhagic cystitis, sepsis in neutropenia, and related crises. Know recognition, the first nursing actions, and what must not be delayed for a 'watch and wait' note.

VI. Psychosocial Dimensions of Care — 8% (~10 scored). Developmental care, family systems, siblings, school, fertility conversations, cultural and spiritual care, and professional boundaries. Ten scored items still decide a scaled 55 for candidates who treat this area as optional soft content. A preschooler's procedure teaching is not an adolescent's fertility discussion, and neither is an adult 'shared decision-making' script with the ages swapped.

Together, Symptom Management, Treatment Modalities, and Emergencies are 26% + 21% + 21% = 68% of scored items. Add Practice at 18% and you have 86%. Continuum and Psychosocial are the remaining 14%, and they are still required.

Map study hours to the six weights

If you have 100 hours, allocate about 6 hours to Care Continuum, 18 to Practice, 21 to Treatment Modalities, 26 to Symptom Management, 21 to Emergencies, and 8 to Psychosocial. If you have 80 hours, keep the same ratios: about 5, 14, 17, 21, 17, and 6 hours. If you have 120 hours, scale up: about 7, 22, 25, 31, 25, and 10. Do not spend 40 hours on leukemia subtypes and 2 hours on supportive care. That inverts the TCO.

Three pediatric-specific habits should cut across every hour block:

1. Dose like a pediatric hematology/oncology nurse. Items use milligrams per kilogram or milligrams per square meter with body-surface area (BSA). Adult flat doses, 'one tablet' logic, and brand-name recall will not help. ONCC uses generic drug names only.
2. Match care to developmental stage. Infant, toddler, preschooler, school-age child, adolescent, and young adult are different teaching, consent, play, and family problems. A toddler's central-line teaching is parent-heavy; an adolescent's is privacy- and identity-heavy.
3. Name the emergency. Study typhlitis, tumor lysis, superior vena cava syndrome, and spinal cord compression as labeled pediatric oncology crises, not as generic emergency-department slang.

Official practice items and what not to use

ONCC offers a free 50-question CPHON practice test at oncc.org/practice-tests. Use it to see item style: question or incomplete statement, four options, one correct answer, generic drug names. It is not a study-guide replacement, and it is not a predictor of a scaled 55. Fifty items cannot cover six subject areas at the depth of 125 scored questions.

Discard local third-party lists that recycle old domain names and weights, including any 'five-area' outline and any six-area list that does not match the current TCO percentages (6, 18, 21, 26, 21, 8) and names. Those lists send you into the wrong chapters and will not match the 2026 manual or the TCO PDF.

A practical study sequence

Start with Emergencies and Symptom Management so the largest, time-critical slices are fluent before you fatigue. Layer Treatment Modalities with pediatric protocol logic and side effects. Then study disease-specific Practice (leukemias, solid tumors, hemoglobinopathies, coagulopathies). Finish with Care Continuum and Psychosocial using family and developmental scenarios rather than abstract theory. Throughout, say vincristine, methotrexate, and ondansetron — not the brand names on the vial.

When you open later chapters of this guide, you are not leaving this outline. Care continuum, leukemias, solid tumors, hematologic disorders, modalities, organ-system effects, named emergencies, and psychosocial care are the TCO in reading order. Keep the pie chart in view. If a study session does not map to one of the six official subject areas, it is optional enrichment, not exam coverage. The passing standard remains a scaled 55, not a percentage, and the form you see will mix the six areas with 40 hidden pretest items. Study the weights. Sit the clock. Dose like a pediatric nurse.