7-Week Preparation Guide

Certifying Body: Oncology Nursing Certification Corporation (ONCC)

Exam: Certified Pediatric Hematology Oncology Nurse (CPHON)

Format: Computer-based, multiple choice; 165 questions (125 scored + 40 pretest)

Time: 3 hours

Passing Score: Scaled score of 55 (25–75 scale)

Cost: $300 (ONCC member) / $420 (non-member)

Validity: 4 years; recertification via ONCC ILNA points or re-examination

Eligibility: Active RN license + 2,000 hours in pediatric hematology/oncology in past 4 years + 10 contact hours in oncology (past 3 years)

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About the Exam

The CPHON validates specialized knowledge in pediatric hematology and oncology nursing. Certified nurses care for children and young adults with cancer and blood disorders, working in children’s hospitals, pediatric oncology units, and hematology clinics.

Exam Content Domains (per ONCC)

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Week-by-Week Study Plan

Weeks 1–2: Pediatric Hematology Foundations

Goal: Build comprehensive knowledge of pediatric blood disorders

Key Topics:

• •Sickle cell disease: pathophysiology, vaso-occlusive crises, acute chest syndrome, stroke prevention, hydroxyurea therapy
• •Hemophilia: types A (Factor VIII) and B (Factor IX), bleeding management, inhibitor development, desmopressin
• •Thalassemia: alpha vs. beta, transfusion dependence, iron overload management, chelation therapy
• •Aplastic anemia: etiology, immunosuppressive therapy, HSCT indication
• •ITP (immune thrombocytopenic purpura): diagnosis, first-line treatment, when to treat vs. watch
• •DIC (disseminated intravascular coagulation): labs, treatment
• •Pediatric leukemias: ALL (most common childhood cancer), AML, CML — presentation, workup, treatment protocols

Daily Schedule (2 hours/day):

• •Days 1–3: Sickle cell disease — pathophysiology, complications, management
• •Days 4–5: Hemophilia and bleeding disorders
• •Days 6–7: Thalassemia and other anemias
• •Days 8–10: ITP, DIC, and platelet disorders
• •Days 11–12: Pediatric leukemias (ALL, AML)
• •Days 13–14: Review and practice questions

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Weeks 3–4: Pediatric Oncology and Solid Tumors

Goal: Master childhood cancer types and treatment protocols

Key Topics:

• •Brain tumors: medulloblastoma, gliomas, ependymoma; increased ICP management
• •Neuroblastoma: staging (INSS), opsoclonus-myoclonus, MYCN amplification
• •Wilms tumor (nephroblastoma): presentation, treatment approach, genetics
• •Rhabdomyosarcoma: types (embryonal, alveolar), staging, treatment
• •Osteosarcoma and Ewing sarcoma: differences, treatment, limb-salvage
• •Hepatoblastoma: presentation, AFP monitoring
• •Retinoblastoma: genetics (RB1 gene), presentation, treatment
• •Lymphoma: Hodgkin vs. Non-Hodgkin in pediatric patients

Daily Schedule (2 hours/day):

• •Days 1–3: CNS tumors — types, treatment, neuro assessment
• •Days 4–5: Neuroblastoma and Wilms tumor
• •Days 6–7: Sarcomas (rhabdomyosarcoma, osteosarcoma, Ewing)
• •Days 8–9: Rare tumors (hepatoblastoma, retinoblastoma, germ cell)
• •Days 10–11: Lymphoma (Hodgkin and Non-Hodgkin)
• •Days 12–14: Review and practice questions

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Weeks 5–6: Treatment Modalities and Symptom Management

Goal: Understand chemotherapy, radiation, surgery, HSCT, and supportive care

Key Topics:

• •Chemotherapy: classes (alkylating agents, antimetabolites, vinca alkaloids, anthracyclines, platinum agents), side effects, nursing considerations
• •Weight-based dosing: BSA calculation, pediatric dosing considerations
• •Radiation therapy: types, acute and late effects, nursing care during radiation
• •Surgery: pre/post-operative considerations in pediatric oncology
• •HSCT: autologous vs. allogeneic, conditioning regimens, GVHD, engraftment
• •CAR-T cell therapy: mechanism, CRS (cytokine release syndrome), neurotoxicity management
• •Tumor lysis syndrome: risk factors, prevention, treatment (rasburicase, hydration)
• •Neutropenic fever: assessment, empiric antibiotics, neutropenic precautions
• •Mucositis: grading, prevention, management (oral care protocols)
• •Nausea/vomiting: anticipatory, acute, delayed; antiemetics (ondansetron, aprepitant)
• •Pain management: WHO pain ladder adapted for pediatrics, opioid safety, non-pharmacologic approaches
• •Anemia and thrombocytopenia: transfusion support, thresholds, irradiated products

Daily Schedule (2 hours/day):

• •Days 1–3: Chemotherapy classes, mechanisms, and side effects
• •Days 4–5: HSCT and cellular therapy (CAR-T)
• •Days 6–7: Tumor lysis syndrome and oncologic emergencies
• •Days 8–9: Neutropenic fever, infection prevention
• •Days 10–11: Mucositis, nausea, nutrition
• •Days 12–14: Pain management and palliative care; review

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Week 7: Psychosocial, Professional Practice & Final Review

Goal: Complete preparation; exam readiness

Key Topics:

• •Family-centered care: developmental stages, family dynamics, sibling impact
• •Developmental considerations: age-appropriate care, school reintegration, play therapy
• •Grief and bereavement: pediatric end-of-life care, palliative vs. hospice, cultural considerations
• •Survivorship: late effects of treatment, long-term follow-up guidelines
• •Ethics: informed consent (pediatric assent + parental consent), clinical trials, end-of-life decisions
• •Documentation and quality improvement

Daily Schedule:

• •Days 1–2: Psychosocial care, developmental stages, family support
• •Days 3–4: Ethics, survivorship, professional practice
• •Day 5: Full-length practice exam
• •Days 6–7: Targeted review of weak areas; final preparation

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Test-Taking Tips

1. Think pediatric-specific — developmental stage affects assessment, communication, and treatment response
2. Weight-based dosing is critical — pediatric chemo doses are calculated by BSA, not flat adult doses
3. Tumor lysis syndrome is heavily tested — know risk tumors (Burkitt, ALL, bulky disease), prevention, and treatment
4. Oncologic emergencies — TLS, neutropenic sepsis, spinal cord compression, superior vena cava syndrome, increased ICP
5. HSCT complications — GVHD (acute vs. chronic), VOD/SOS, engraftment syndrome, graft failure
6. Blood product safety — irradiated products for HSCT patients, CMV-negative for certain populations
7. Family-centered care — ONCC emphasizes psychosocial content; don’t neglect Domain IV
8. Read qualifiers carefully — “MOST appropriate,” “FIRST action,” “BEST response”
9. Eliminate wrong answers — usually 2 can be eliminated quickly
10. Manage time — ~1.4 minutes per question; flag difficult ones and return

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Key Classifications and Scales

Karnofsky/Lansky Performance Scale: Functional status assessment for pediatric patients

WHO Pain Ladder: Step 1 (non-opioid) → Step 2 (weak opioid) → Step 3 (strong opioid)

CTCAE Grading (Common Terminology Criteria for Adverse Events): Grade 1–5 severity for side effects

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Recommended Resources

Primary:

• •ONCC CPHON Test Content Outline (oncc.org)
• •Pediatric Nursing: A Critical Thinking Approach — relevant chapters
• •APHON (Association of Pediatric Hematology/Oncology Nurses) resources
• •Children’s Oncology Group (COG) guidelines

Supplementary:

• •Chemotherapy and Biotherapy Guidelines and Recommendations for Practice — ONS
• •Palliative Care Nursing: Quality Care to the End of Life
• •ONCC practice exam

Free Resources:

• •COG Long-Term Follow-Up Guidelines (survivorshipguidelines.org)
• •NCCN Guidelines (certain pediatric protocols)
• •APHON clinical resources

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Sources

• •Oncology Nursing Certification Corporation (ONCC) — oncc.org
• •ONCC CPHON Test Content Outline and Candidate Handbook
• •Association of Pediatric Hematology/Oncology Nurses (APHON) — aphon.org
• •Children’s Oncology Group (COG) — childrensoncologygroup.org