APHON Certification Practice Exam Questions
with Answers and Rationales | Updated 2026 |
100% Correct Answers (Association of Pediatric
Hematology/Oncology Nurses (APHON)
1. Which of the following lab values indicates tumor lysis
syndrome?
A. Elevated calcium
B. Decreased uric acid
C. Elevated potassium
D. Decreased phosphate
Answer: C. Elevated potassium
Rationale: Tumor lysis syndrome (TLS) results in the release of
intracellular contents leading to hyperkalemia, hyperuricemia,
hyperphosphatemia, and hypocalcemia. Elevated potassium is a hallmark
of TLS and a medical emergency due to the risk of cardiac arrhythmias.
3. What is the priority nursing intervention for a child with a
central venous line and fever? A. Administer antipyretics
B. Remove the central line
C. Obtain blood cultures
D. Apply cool compresses
Answer: C. Obtain blood cultures
Rationale: In a child with a central line and fever, blood cultures should
be obtained from all lumens of the catheter before initiating antibiotics.
,Fever may indicate central line-associated bloodstream infection
(CLABSI). Immediate removal is not warranted unless sepsis or
malfunction occurs.
A child receiving vincristine is at risk for which of the
following adverse effects? A. Hemorrhagic cystitis
B. Peripheral neuropathy
C. Cardiomyopathy
D. Renal failure
Answer: B. Peripheral neuropathy
Rationale: Vincristine, a vinca alkaloid, is known for causing
neurotoxicity, especially peripheral neuropathy (manifested by foot drop,
constipation, or jaw pain). Hemorrhagic cystitis is associated with
cyclophosphamide or ifosfamide. Cardiomyopathy is linked to
anthracyclines (e.g., doxorubicin), and renal toxicity is seen with cisplatin.
4. The parents of a child with leukemia ask about the purpose
of intrathecal chemotherapy. What is the correct response? A.
“It helps to protect the kidneys from drug toxicity.”
B. “It targets leukemia cells in the central nervous system.”
C. “It helps treat skin involvement of the disease.”
D. “It ensures uniform drug distribution.”
Answer: B. “It targets leukemia cells in the central nervous system.”
Rationale: Intrathecal chemotherapy is administered into the CSF to
prevent or treat CNS involvement in leukemia. The blood-brain barrier
prevents many systemic chemotherapies from penetrating the CNS
effectively.
,5. The nadir period following chemotherapy refers to:
A. Maximum energy level
B. Highest neutrophil count
C. Lowest blood cell count
D. Time of tumor shrinkage
Answer: C. Lowest blood cell count
Rationale: The nadir is when blood cell counts (especially neutrophils) are
at their lowest, typically 7–14 days post-chemotherapy. It is a critical time
when patients are most susceptible to infection.
6. Which of the following is a common late effect of cranial radiation
in children?
A. Immunosuppression
B. Nephrotoxicity
C. Cognitive impairment
D. Osteoporosis
Answer: C. Cognitive impairment
Rationale: Cranial radiation in children, especially those under 5, is
associated with neurocognitive delays, including problems with memory,
attention, and processing speed.
8. Which symptom is most concerning in a patient with a mediastinal
mass?
A. Fever
B. Fatigue
C. Stridor
D. Anorexia
Answer: C. Stridor
, Rationale: A mediastinal mass may compress the airway. Stridor is a sign
of airway obstruction and is a medical emergency requiring immediate
intervention.
9. Which of the following vaccines is contraindicated during
chemotherapy?
A. DTaP
B. MMR C. Hepatitis B
D. Influenza (inactivated)
Answer: B. MMR
Rationale: The MMR vaccine is live and contraindicated in
immunocompromised patients. Inactivated vaccines like DTaP, Hep B, and
inactivated influenza are safe.
10. What is the most appropriate intervention for mucositis?
A. Encourage mouth rinses with saline
B. Use glycerin swabs
C. Brush with a firm toothbrush
D. Administer broad-spectrum antibiotics
Answer: A. Encourage mouth rinses with saline
Rationale: Saline rinses help clean the mouth and reduce irritation.
Glycerin and firm toothbrushes may worsen mucosal damage.
What is the most appropriate way to manage anticipatory nausea and
vomiting?
A. Administer ondansetron after symptoms begin
B. Use acupressure therapy
C. Administer antiemetics before chemotherapy
D. Restrict oral fluids
with Answers and Rationales | Updated 2026 |
100% Correct Answers (Association of Pediatric
Hematology/Oncology Nurses (APHON)
1. Which of the following lab values indicates tumor lysis
syndrome?
A. Elevated calcium
B. Decreased uric acid
C. Elevated potassium
D. Decreased phosphate
Answer: C. Elevated potassium
Rationale: Tumor lysis syndrome (TLS) results in the release of
intracellular contents leading to hyperkalemia, hyperuricemia,
hyperphosphatemia, and hypocalcemia. Elevated potassium is a hallmark
of TLS and a medical emergency due to the risk of cardiac arrhythmias.
3. What is the priority nursing intervention for a child with a
central venous line and fever? A. Administer antipyretics
B. Remove the central line
C. Obtain blood cultures
D. Apply cool compresses
Answer: C. Obtain blood cultures
Rationale: In a child with a central line and fever, blood cultures should
be obtained from all lumens of the catheter before initiating antibiotics.
,Fever may indicate central line-associated bloodstream infection
(CLABSI). Immediate removal is not warranted unless sepsis or
malfunction occurs.
A child receiving vincristine is at risk for which of the
following adverse effects? A. Hemorrhagic cystitis
B. Peripheral neuropathy
C. Cardiomyopathy
D. Renal failure
Answer: B. Peripheral neuropathy
Rationale: Vincristine, a vinca alkaloid, is known for causing
neurotoxicity, especially peripheral neuropathy (manifested by foot drop,
constipation, or jaw pain). Hemorrhagic cystitis is associated with
cyclophosphamide or ifosfamide. Cardiomyopathy is linked to
anthracyclines (e.g., doxorubicin), and renal toxicity is seen with cisplatin.
4. The parents of a child with leukemia ask about the purpose
of intrathecal chemotherapy. What is the correct response? A.
“It helps to protect the kidneys from drug toxicity.”
B. “It targets leukemia cells in the central nervous system.”
C. “It helps treat skin involvement of the disease.”
D. “It ensures uniform drug distribution.”
Answer: B. “It targets leukemia cells in the central nervous system.”
Rationale: Intrathecal chemotherapy is administered into the CSF to
prevent or treat CNS involvement in leukemia. The blood-brain barrier
prevents many systemic chemotherapies from penetrating the CNS
effectively.
,5. The nadir period following chemotherapy refers to:
A. Maximum energy level
B. Highest neutrophil count
C. Lowest blood cell count
D. Time of tumor shrinkage
Answer: C. Lowest blood cell count
Rationale: The nadir is when blood cell counts (especially neutrophils) are
at their lowest, typically 7–14 days post-chemotherapy. It is a critical time
when patients are most susceptible to infection.
6. Which of the following is a common late effect of cranial radiation
in children?
A. Immunosuppression
B. Nephrotoxicity
C. Cognitive impairment
D. Osteoporosis
Answer: C. Cognitive impairment
Rationale: Cranial radiation in children, especially those under 5, is
associated with neurocognitive delays, including problems with memory,
attention, and processing speed.
8. Which symptom is most concerning in a patient with a mediastinal
mass?
A. Fever
B. Fatigue
C. Stridor
D. Anorexia
Answer: C. Stridor
, Rationale: A mediastinal mass may compress the airway. Stridor is a sign
of airway obstruction and is a medical emergency requiring immediate
intervention.
9. Which of the following vaccines is contraindicated during
chemotherapy?
A. DTaP
B. MMR C. Hepatitis B
D. Influenza (inactivated)
Answer: B. MMR
Rationale: The MMR vaccine is live and contraindicated in
immunocompromised patients. Inactivated vaccines like DTaP, Hep B, and
inactivated influenza are safe.
10. What is the most appropriate intervention for mucositis?
A. Encourage mouth rinses with saline
B. Use glycerin swabs
C. Brush with a firm toothbrush
D. Administer broad-spectrum antibiotics
Answer: A. Encourage mouth rinses with saline
Rationale: Saline rinses help clean the mouth and reduce irritation.
Glycerin and firm toothbrushes may worsen mucosal damage.
What is the most appropriate way to manage anticipatory nausea and
vomiting?
A. Administer ondansetron after symptoms begin
B. Use acupressure therapy
C. Administer antiemetics before chemotherapy
D. Restrict oral fluids
