BARKLEY CPHON PEDIATRIC HEMATOLOGY ONCOLOGY PRACTICE EXAM QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains:
1. Pathophysiology and Treatment of Childhood Cancers
2. Hematological Disorders and Blood Transfusion Therapy
3. Chemotherapy Administration and Biotherapy
4. Symptom Management, Pain, and Palliative Care
5. Oncologic Emergencies and Critical Care
6. Psychosocial and Ethical Issues in Pediatric Oncology
7. Infection Control and Immunocompromised Patient Care
8. Survivorship, Late Effects, and Health Maintenance
Introduction
This comprehensive examination is designed to assess the advanced knowledge and clinical judgment required for
certified pediatric hematology/oncology nurses. The test bank encompasses a wide array of multiple-choice and
scenario-based questions that challenge the candidate to apply theoretical foundations to complex, real-world
patient care situations. Emphasis is placed on critical thinking, evidence-based practice, and the safe, ethical, and
effective management of pediatric oncology patients across the continuum of care. This assessment serves as a
vital tool for exam preparation, evaluating readiness for the certification examination and the challenges of the
clinical environment.
Section One: Questions 1 – 100
1. A 4-year-old with Acute Lymphoblastic Leukemia (ALL) is receiving induction chemotherapy. On day 21, the
child is febrile to 38.9°C with an absolute neutrophil count (ANC) of 150/mm³. Which of the following is the
,priority nursing action?
A. Administer scheduled acetaminophen.
B. Initiate broad-spectrum IV antibiotics.
C. Obtain a blood culture and then administer antibiotics.
D. Notify the provider of the fever only.
🟢C
🔴 RATIONALE: In a febrile neutropenic patient, the immediate priority is to obtain blood cultures before
antibiotics are started to identify the causative organism, but antibiotics must be administered promptly without
delay to prevent sepsis. The initiation of antibiotics should happen as soon as possible after cultures are drawn.
2. Which of the following laboratory values best indicates a response to therapy in a patient with Burkitt's
lymphoma?
A. Decrease in LDH.
B. Increase in hemoglobin.
C. Normalization of platelet count.
D. Decrease in serum calcium.
🟢A
🔴 RATIONALE: Lactate dehydrogenase (LDH) is a tumor marker that reflects tumor burden and cell turnover. A
significant decrease in LDH correlates with tumor lysis and is a positive indicator of response to chemotherapy
in Burkitt's lymphoma.
3. A 2-year-old boy has been diagnosed with Hemophilia A. His parents are educated about home
management. Which of the following instructions is most important to include in the teaching plan?
A. Administer desmopressin acetate (DDAVP) for minor bleeds.
B. Administer Factor VIII concentrate at the first sign of a bleed.
,C. Use a soft toothbrush and padded corners on furniture.
D. Avoid all physical activity to prevent trauma.
🟢B
🔴 RATIONALE: The cornerstone of management for Hemophilia A is the early replacement of Factor VIII to
prevent joint damage and complications from bleeding. Parents should be taught to administer the factor
concentrate at home as soon as a bleed is suspected.
4. A 16-year-old patient is experiencing severe chemotherapy-induced nausea and vomiting. The nurse notes
that the patient is refusing all antiemetics due to the side effect of sedation. Which of the following is the
most appropriate nursing intervention?
A. Document the refusal and allow the patient to manage symptoms independently.
B. Request a consult with the patient's parents to force medication administration.
C. Discuss the options of alternative antiemetics with the oncologist.
D. Administer the antiemetic via a suppository against the patient's will.
🟢C
🔴 RATIONALE: It is essential to respect the patient's autonomy while addressing the underlying issue. The
nurse should advocate for the patient by communicating their concerns to the physician and exploring
alternative antiemetics that may have a more favorable side effect profile, such as those not causing sedation.
5. What is the primary pathophysiological mechanism of anemia of chronic disease in a pediatric oncology
patient?
A. Acute blood loss from surgery.
B. Iron deficiency due to poor diet.
C. Decreased erythropoietin production and impaired iron utilization.
D. Vitamin B12 malabsorption due to chemotherapy.
, 🟢C
🔴 RATIONALE: Anemia of chronic disease is caused by a complex interaction of inflammatory cytokines that
inhibit erythropoiesis, decrease erythropoietin production, and impair iron utilization by sequestering it in the
reticuloendothelial system. This is a hallmark of chronic illness, including cancer.
6. A child with medulloblastoma is scheduled for a lumbar puncture for intrathecal chemotherapy. Which
nursing action is most important to prevent a post-lumbar puncture headache?
A. Positioning the patient supine for 1-2 hours post-procedure.
B. Ensuring the patient remains flat for 4-6 hours post-procedure.
C. Administering IV fluids at a maintenance rate.
D. Encouraging the patient to sit upright to increase CSF pressure.
🟢B
🔴 RATIONALE: Maintaining the patient in a flat position for several hours after a lumbar puncture minimizes
CSF leakage from the puncture site, which is the primary cause of post-dural headache.
7. A nurse is caring for a child receiving a blood transfusion. Fifteen minutes into the transfusion, the child
develops hives and pruritus. The child's vital signs are stable. What is the most appropriate initial nursing
action?
A. Stop the transfusion immediately and notify the blood bank.
B. Slow the transfusion rate and administer diphenhydramine.
C. Stop the transfusion, disconnect the tubing, and keep the IV line open with normal saline.
D. Continue the transfusion and monitor the child closely for changes.
🟢C
🔴 RATIONALE: The patient is experiencing a mild allergic reaction (urticaria). The transfusion must be stopped
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains:
1. Pathophysiology and Treatment of Childhood Cancers
2. Hematological Disorders and Blood Transfusion Therapy
3. Chemotherapy Administration and Biotherapy
4. Symptom Management, Pain, and Palliative Care
5. Oncologic Emergencies and Critical Care
6. Psychosocial and Ethical Issues in Pediatric Oncology
7. Infection Control and Immunocompromised Patient Care
8. Survivorship, Late Effects, and Health Maintenance
Introduction
This comprehensive examination is designed to assess the advanced knowledge and clinical judgment required for
certified pediatric hematology/oncology nurses. The test bank encompasses a wide array of multiple-choice and
scenario-based questions that challenge the candidate to apply theoretical foundations to complex, real-world
patient care situations. Emphasis is placed on critical thinking, evidence-based practice, and the safe, ethical, and
effective management of pediatric oncology patients across the continuum of care. This assessment serves as a
vital tool for exam preparation, evaluating readiness for the certification examination and the challenges of the
clinical environment.
Section One: Questions 1 – 100
1. A 4-year-old with Acute Lymphoblastic Leukemia (ALL) is receiving induction chemotherapy. On day 21, the
child is febrile to 38.9°C with an absolute neutrophil count (ANC) of 150/mm³. Which of the following is the
,priority nursing action?
A. Administer scheduled acetaminophen.
B. Initiate broad-spectrum IV antibiotics.
C. Obtain a blood culture and then administer antibiotics.
D. Notify the provider of the fever only.
🟢C
🔴 RATIONALE: In a febrile neutropenic patient, the immediate priority is to obtain blood cultures before
antibiotics are started to identify the causative organism, but antibiotics must be administered promptly without
delay to prevent sepsis. The initiation of antibiotics should happen as soon as possible after cultures are drawn.
2. Which of the following laboratory values best indicates a response to therapy in a patient with Burkitt's
lymphoma?
A. Decrease in LDH.
B. Increase in hemoglobin.
C. Normalization of platelet count.
D. Decrease in serum calcium.
🟢A
🔴 RATIONALE: Lactate dehydrogenase (LDH) is a tumor marker that reflects tumor burden and cell turnover. A
significant decrease in LDH correlates with tumor lysis and is a positive indicator of response to chemotherapy
in Burkitt's lymphoma.
3. A 2-year-old boy has been diagnosed with Hemophilia A. His parents are educated about home
management. Which of the following instructions is most important to include in the teaching plan?
A. Administer desmopressin acetate (DDAVP) for minor bleeds.
B. Administer Factor VIII concentrate at the first sign of a bleed.
,C. Use a soft toothbrush and padded corners on furniture.
D. Avoid all physical activity to prevent trauma.
🟢B
🔴 RATIONALE: The cornerstone of management for Hemophilia A is the early replacement of Factor VIII to
prevent joint damage and complications from bleeding. Parents should be taught to administer the factor
concentrate at home as soon as a bleed is suspected.
4. A 16-year-old patient is experiencing severe chemotherapy-induced nausea and vomiting. The nurse notes
that the patient is refusing all antiemetics due to the side effect of sedation. Which of the following is the
most appropriate nursing intervention?
A. Document the refusal and allow the patient to manage symptoms independently.
B. Request a consult with the patient's parents to force medication administration.
C. Discuss the options of alternative antiemetics with the oncologist.
D. Administer the antiemetic via a suppository against the patient's will.
🟢C
🔴 RATIONALE: It is essential to respect the patient's autonomy while addressing the underlying issue. The
nurse should advocate for the patient by communicating their concerns to the physician and exploring
alternative antiemetics that may have a more favorable side effect profile, such as those not causing sedation.
5. What is the primary pathophysiological mechanism of anemia of chronic disease in a pediatric oncology
patient?
A. Acute blood loss from surgery.
B. Iron deficiency due to poor diet.
C. Decreased erythropoietin production and impaired iron utilization.
D. Vitamin B12 malabsorption due to chemotherapy.
, 🟢C
🔴 RATIONALE: Anemia of chronic disease is caused by a complex interaction of inflammatory cytokines that
inhibit erythropoiesis, decrease erythropoietin production, and impair iron utilization by sequestering it in the
reticuloendothelial system. This is a hallmark of chronic illness, including cancer.
6. A child with medulloblastoma is scheduled for a lumbar puncture for intrathecal chemotherapy. Which
nursing action is most important to prevent a post-lumbar puncture headache?
A. Positioning the patient supine for 1-2 hours post-procedure.
B. Ensuring the patient remains flat for 4-6 hours post-procedure.
C. Administering IV fluids at a maintenance rate.
D. Encouraging the patient to sit upright to increase CSF pressure.
🟢B
🔴 RATIONALE: Maintaining the patient in a flat position for several hours after a lumbar puncture minimizes
CSF leakage from the puncture site, which is the primary cause of post-dural headache.
7. A nurse is caring for a child receiving a blood transfusion. Fifteen minutes into the transfusion, the child
develops hives and pruritus. The child's vital signs are stable. What is the most appropriate initial nursing
action?
A. Stop the transfusion immediately and notify the blood bank.
B. Slow the transfusion rate and administer diphenhydramine.
C. Stop the transfusion, disconnect the tubing, and keep the IV line open with normal saline.
D. Continue the transfusion and monitor the child closely for changes.
🟢C
🔴 RATIONALE: The patient is experiencing a mild allergic reaction (urticaria). The transfusion must be stopped
