Preparing for the CPHON® Exam: Post-Test

What percent of all cancer cases in the U.S. involve children?

What is the leading cause of death in the United States from disease in children who are older than 1 year?

Patients who are immunocompromised have increased susceptibility to infections, such as pneumonia. The causative organism of pneumocystis pneumonia is a: 

Which of the following therapies treat B-thalassemia minor?

What is the most dominant hemoglobin (Hb) type in sickle cell anemia?

Which one of the following statements describes oncogenes?

The study of chromosomes is known as “cytogenetics.” The lab process that identifies chromosomal variations is called “karyotyping.” Which one of the following statements is true?

Which one of the following statements accurately portrays childhood cancer?

What nursing intervention can help minimize the common side effects of corticosteroids in a 2-year-old child with acute leukemia?

An infant undergoing treatment for acute lymphoblastic leukemia developed a perirectal fissure. The nurse should prioritize  educating the parents about which one of the following topics?

A 15-year-old male with AML is admitted to the hospital for his next round of chemotherapy. To minimize fatigue, what environmental factors can the nurse encourage during the hospitalization?

A 2.5-year-old currently on treatment for acute leukemia throws himself down on the floor crying when the nursing assistant attempts to carry the patient to the lab-draw room without his parents. This behavior is:

A 14-year-old patient with a suspected new diagnosis of acute leukemia is admitted to the pediatric oncology service. While performing your admission assessment, you notice slight nasal flaring with a respiratory rate of 24, and dried blood at both nares. You receive notification of these new lab results: Potassium 6.3 mEq/L, Uric Acid 8.2 mg/dL and Calcium 7.8 mg/dL. Your first intervention should be to:

A 5-year-old female patient came to the hospital presenting with symptoms of acute leukemia (fever, fatigue, prolonged nosebleed, marked pallor, and hepatosplenomegaly). After receiving normal chest x-ray results, the oncologist obtained a Bone Marrow Aspirate (BMA) and biopsy. Why was it imperative for the patient to have a chest x-ray before her diagnostic BMA/biopsy?

Which of the following situations requires replacement of the non-power Central Venous Access device (CVAD) line?

A 15-year-old patient has nodular involvement of three lymph nodes on the same side of her diaphragm. What staging classification would this make the patient’s Hodgkin lymphoma?

While receiving VAMP chemotherapy treatment for Hodgkin lymphoma, a 15-year-old female patient experiences adverse symptoms that you recognize as anaphylaxis. What is one immediate intervention you should take to help her?

A 7-year-old boy presents with a lump in his axilla. He reports no other symptoms. Blood work results indicate Reed-Sternberg cells and small B lymphocytes. The lump is a swollen lymph node. The patient is diagnosed with Hodgkin lymphoma. What histological subtype does he fall under?

A 10 year-old-boy is receiving treatment for Burkitt lymphoma, Stage IV, Risk Group B. Which of the following monoclonal antibodies would you expect to be part of his treatment plan?

Which symptoms commonly occur in a child with a brain tumor that has metastasized to the spine?

Your patient recently completed his chemotherapy and will be discharged home today. He had significant nausea and vomiting throughout the night and has no urinary output this morning. After administering a PRN antiemetic, what is the priority nursing intervention?

A patient is starting radiation therapy for the treatment of medulloblastoma. The nurse should instruct parents to most urgently report which of the following acute effects to the treatment team?

A 14-year-old female is admitted to the hospital for routine chemotherapy. You note a serum sodium of 129 mEq/L on her morning labs. After assessing the patient and noting the only pertinent abnormal finding to be a complaint of thirst, you immediately notify the provider of the patient’s exam and abnormal lab values. Which of the following orders do you anticipate?

You are asked to participate in a patient consenting for a Phase II clinical trial. What is the goal of a Phase II clinical trial? 

Jerking of isolated muscle, nausea, sweating, and vision changes are symptoms of which seizure type?

What developmental concern are you minimizing by enforcing that a 4-year-old patient’s hospital bed is a safe place where no invasive procedures are performed?

A metaiodobenzylguanidine (MIBG) scan is often sensitive to neuroblastoma and is extremely useful in determining metastatic disease. What medication would protect a patient’s thyroid from radiation exposure?

A 2-year-old girl with Stage IV high-risk neuroblastoma meets the eligibility criteria for a Phase III clinical trial. What does Phase III assess?

Ten days after receiving her first cycle of chemotherapy for neuroblastoma, a 2-year-old patient needs a red blood cell transfusion. Considering that the patient received previous transfusions, within how many hours or days prior to transfusion does her cross-matching need to be done?

A pediatric patient’s neuroblastoma has metastasized to the bone and bone marrow, and his doctor recommends a Hematopoietic Cell Transplant (HCT) as part of an aggressive treatment regimen. Which of the following statements would be accurate to tell the patient’s parents about Hematopoietic Cell Transplant (HCT)?

For his autologous transplant conditioning, a pediatric male patient will receive carboplatin (Paraplatin®), thiotepa (Thioplex®), etoposide (Toposar®, VePesid®) and cyclophosfamide (Cytoxan®, Procytox®). Which chemotherapeutic agent puts him at risk for chemical burns?

Which of the following statements is true about the type of chemotherapy appropriate for childhood cancer?

You are treating a teenager who has mucositis and is unable to talk. Which intervention would you implement to improve the teen’s participation in health care decisions?

Your patient is receiving doxorubicin (Adriamycin®, Rubex®). What acute side effect would you expect?

A child with Beckwith-Wiedemann Syndrome (BWS) should be screened for the development of:

A 15-year-old high school athlete has been complaining of pain and swelling in her left knee. For the last several weeks, she has been more fatigued than usual and has little appetite. She has not had a fever. Based on the patient’s presentation, the pediatrician suspects some type of knee injury. In addition to a history and physical exam, what initial test would you expect the provider to order?

Which patient with Sickle Cell Disease (SCD) is at risk for triggering red blood cell sickling?

Why is a newborn with SCD usually not anemic or symptomatic in the first few months of life?

After playing in the snow three days earlier, a 9-year-old patient with sickle cell disease was brought to the emergency department (ED) complaining of pain in her right leg that had persisted for two days. She had no fever, cough, or upper respiratory symptoms. The patient walked with a limp and reported leg pain as 6/10. Based on the her initial presentation to the ED, what specific acute complications could place her at risk? 

Which diagnostic test results support a diagnosis of Vaso-Occlusive Crisis (VOC)?

A 9-year-old female patient with SCD was recently admitted to the hospital after experiencing a Vaso-Occlusive Crisis (VOC) and Acute Chest Syndrome (ACS). What forms of non-pharmacological treatment could help this patient and prevent her from getting Acute Chest Syndrome (ACS) and pneumonia in the future? 

A previously healthy 11-year-old female was recently diagnosed with Immune Thrombocytopenic Purpura (ITP). She has some bruising and petechiae but no active bleeding.  What education should you provide to this patient and her parents?

During a platelet transfusion, your patient develops fever and chills. What is the priority for managing a transfusion reaction?

Which organ is involved in platelet destruction in Immune Thrombocytopenia Purpura (ITP)?

Blood products are leukocyte-reduced in order to prevent which one of the following conditions?

The goal of irradiating blood products prior to administration is to prevent:

Which action is most important prior to beginning a platelet transfusion for a patient who has never received a platelet transfusion?

A child diagnosed with iron deficiency anemia presents to the emergency department four hours after receiving a red blood cell transfusion. Her symptoms include fever, chills, and hypoxia. What is the most likely diagnosis?

What diagnosis might you suspect in a patient who presents with the test results below? All other values are WNL.

• Decreased hemoglobin
• Elevated reticulocyte count
• Positive titers for Epstein Barr Virus (EBV) 
• Positive Direct Coombs
• Red cell agglutination seen on blood smear

Which bleeding disorder manifests primarily in a decrease in the platelet count?