CPHON® Pediatric Hematology and Oncology Decision Guide Study Guide

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A young adult remembers having leukemia but cannot name the medicines received. Before arranging long-term follow-up, the nurse obtains the treatment summary and identifies anthracycline exposure, radiation history, and previous complications that affect surveillance.

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An adolescent moving away for college has missed two follow-up visits. The nurse identifies a receiving clinician, transfers the survivorship plan, confirms who will order surveillance, and rehearses how the adolescent will request appointments independently.

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A survivor with previous chest irradiation reports new exertional breathlessness several months before a scheduled follow-up visit. The nurse arranges prompt clinical evaluation instead of treating the existing surveillance appointment as sufficient reassurance for the new symptom.

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After another relapse, a family wants more time at home while considering further treatment. The nurse coordinates a goals discussion, home symptom support, and clear contact arrangements without assuming the family has chosen to stop cancer therapy.

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A child has fatigue, petechiae, and persistent leg pain with anemia and thrombocytopenia. The nurse explains that marrow testing identifies abnormal blood-forming cells and supports leukemia classification, while the blood count describes its effects on circulating cells.

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A parent asks why flow cytometry is needed after blasts were seen in marrow. The nurse explains that cell markers help identify the leukemia lineage and that this classification supplies information beyond simply recognizing immature cells.

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A parent hears that a chromosome change was found in their child's leukemia and worries that every sibling has it. The nurse clarifies that leukemia-cell findings do not by themselves establish an inherited familial condition.

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A family interprets a high-grade pathology report as proof that a tumor has spread throughout the body. The nurse distinguishes microscopic aggressiveness from anatomic extent and explains why staging information is still needed for treatment planning.

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A child with a paraspinal mass has elevated urinary catecholamine metabolites. The nurse explains why spinal MRI and tissue characterization remain important: the studies address neural involvement, diagnosis, and biologic risk beyond the biochemical finding.

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After induction, a child's marrow meets the morphologic remission criterion, but flow cytometry detects residual leukemic cells. Explain that the tests measure disease at different levels of sensitivity. The team uses the MRD result at that specified treatment time point, together with other risk features, to determine the protocol-defined treatment pathway.

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A child newly diagnosed with hemophilia B has an affected maternal uncle. The nurse connects the family pattern with X-linked inheritance and confirms that the care plan identifies factor IX deficiency rather than assuming factor VIII replacement.

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A parent describes a dose-finding study as proof that the new drug works better than standard therapy. The nurse explains the study's safety and dosing objectives and asks the research team to review expected benefits and uncertainties.

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A child with sickle cell disease has worsening pallor, a hemoglobin substantially below baseline, and very few reticulocytes. The nurse reports concern for impaired red-cell production and communicates recent illness and exposure history while arranging urgent assessment.

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A study requires assent from developmentally capable adolescents. A parent signs permission while the adolescent remains confused and reluctant. The nurse pauses enrollment steps and requests a discussion that addresses the adolescent's understanding and the protocol's requirements.

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Before discharge, a caregiver correctly names the child's diagnosis but cannot explain what to do for fever. The nurse rehearses the actual call and assessment plan, then asks the caregiver to repeat the action sequence independently.

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A child feels well after induction, and the family asks whether further treatment is optional. The nurse explains the purpose of subsequent phases and connects continued therapy with controlling leukemia that may remain despite visible clinical improvement.

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A family questions why lumbar punctures with treatment are planned when no neurologic symptoms are present. The nurse explains CNS-directed prevention and separately verifies that each medicine and route match the prescribed protocol before administration proceeds.

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After several vincristine doses, a child has new difficulty climbing stairs and fewer bowel movements. The nurse assesses gait, strength, abdominal symptoms, and stool history, then reports the combined pattern before the next treatment decision.

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A child receiving an asparaginase product develops persistent upper abdominal pain and vomiting. The nurse recognizes a treatment-associated pancreatic warning pattern, promptly informs the team, and prepares for evaluation rather than assuming ordinary chemotherapy-related nausea.

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A caregiver reports that a child with hemophilia has received the usual prescribed replacement but joint pain continues to worsen. The nurse escalates the persistent symptoms and communicates the product, administration time, and response to the hematology team.

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Three children receive peripheral-blood stem cells: one receives their own stored cells, another receives cells from an HLA-matched nonidentical sibling, and the third receives cells from an identical twin. Classify these transplants as autologous, allogeneic, and syngeneic, respectively. Explain donor immune effects and graft-versus-host disease risk when teaching the child receiving the nonidentical sibling's graft.

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A caregiver asks for additional red cells because the child's hemoglobin remains below the laboratory reference range. The nurse explains why the hematology team balances oxygen delivery against viscosity and checks the indication-specific target before further transfusion.

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A child develops rash and diarrhea after a donor transplant. A parent believes this means the donor cells are successfully attacking leukemia. The nurse distinguishes the potential antileukemic effect from possible injury to healthy recipient tissues.

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A family asks whether CAR T-cell infusion is the same as a stem-cell transplant. The nurse explains that the infused cells are engineered immune effectors directed at a target and reviews why close monitoring follows the infusion.

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A family asks why a neuroblastoma surrounding major structures is receiving chemotherapy before attempted removal. The nurse explains that shrinking disease and planning around critical anatomy may improve the balance between tumor control and operative harm.

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A child with neuroblastoma is being considered for iodine-131 MIBG treatment after uptake studies. The nurse explains why tumor uptake matters and prepares the family for a radiopharmaceutical pathway rather than describing an ordinary external-beam appointment.

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During medication reconciliation, a caregiver says doses are skipped whenever the child is tired. The nurse explores the reason, clarifies the prescribed plan with the team, and creates a practical administration routine that addresses the family's concern.

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A caregiver replaces all brushing with foam swabs because the child's mouth is sore. The nurse assesses lesions, bleeding risk, pain, and fluid intake, discusses a gentle individualized cleaning plan, and explains the different roles of brushing and moistening.

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An infusion slows and the child protects the cannulated arm. Before changing pump limits, the nurse examines the site and distal circulation. New swelling and burning lead to stopping the infusion and initiating extravasation assessment without flushing.

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A school-age child uses a validated faces scale consistently and reports significant pain while watching a cartoon. The nurse accepts the report, assesses its location and character, and plans relief rather than substituting an adult's impression.

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A child received blood elsewhere and is scheduled for another transfusion. The nurse obtains the outside transfusion and antibody history for blood-bank review. When the caregiver later reports jaundice and worsening pallor, the nurse communicates the recent transfusion and arranges urgent evaluation.

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After prescribed opioid analgesia, a child is difficult to rouse but still grimaces during movement. The nurse promptly assesses breathing and sedation, obtains assistance, and avoids interpreting reduced activity as proof of successful pain control.

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An adolescent stops attending school because of exhaustion. The nurse reviews sleep, pain, mood, medicines, nutrition, and blood-count trends, then coordinates assessment of identified contributors and a tailored activity plan rather than treating inactivity as the only cause.

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A caregiver asks why GM-CSF remains prescribed during neuroblastoma immunotherapy despite an adequate neutrophil count. The nurse explains its role within the combined immune treatment and confirms the planned product and schedule with the oncology team.

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A survivor treated with an anthracycline feels healthy and asks why cardiac follow-up continues. The nurse explains delayed myocardial injury and confirms that the treatment summary and individualized surveillance plan are available to the current clinician.

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A survivor with prior nephrectomy and nephrotoxic treatment has repeatedly elevated blood pressure but no urinary complaints. The nurse identifies a renal follow-up concern and communicates the exposure history rather than waiting for pain or visible urine changes.

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A child previously treated with cisplatin follows conversation in clinic but repeatedly misses classroom instructions. The nurse reviews hearing-surveillance results and requests audiologic and school support assessment instead of attributing the change solely to attention problems.

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A child's height percentile falls steadily after cranial irradiation while peers continue their expected growth. The nurse reviews serial measurements and pubertal history, then communicates the pattern for endocrine assessment rather than waiting for a single extreme measurement.

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An adolescent survivor assumes regular menstruation guarantees future fertility after gonadotoxic treatment. The nurse explains the limits of that inference, reviews the exposure history, and offers confidential, developmentally appropriate discussion and referral for individualized reproductive counseling.

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A survivor previously treated with CNS-directed therapy manages simple assignments but struggles with planning multistep projects. The nurse explores the change, reviews hearing and sleep concerns, and supports referral for neuropsychological assessment and appropriate school accommodations.

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An adolescent with substantial corticosteroid exposure develops persistent hip pain and a limp. The nurse reports the focal symptoms and treatment history for evaluation rather than recommending that the adolescent simply exercise through presumed loss of conditioning.

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A child receiving curative therapy has persistent pain, nausea, and family distress despite routine interventions. The nurse recommends palliative consultation to improve symptom control and communication while the oncology team continues the planned cancer-directed treatment course.

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A caregiver starts an herbal mixture advertised for immunity but does not consider it a medicine. The nurse asks for the ingredient list and coordinates interaction review with the pharmacist before the family continues adding it to treatment.

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A child recently treated with myelosuppressive chemotherapy arrives febrile and lethargic, with the blood count still pending. The nurse activates urgent assessment and the febrile-neutropenia pathway rather than waiting for the neutrophil result before initiating care.

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A febrile child with a multilumen central line develops poor perfusion while peripheral culture attempts fail. Coordinate cultures from the available central-line lumens and immediate prescribed antipseudomonal antibiotics. Alert the team to the instability because it can justify additional Gram-negative coverage or a glycopeptide. Continued pursuit of a peripheral specimen must not postpone treatment.

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Soon after therapy begins for bulky leukemia, a child has rising potassium, phosphate, uric acid, and creatinine with falling calcium. The nurse recognizes a linked tumor-lysis pattern and escalates monitoring and treatment rather than addressing each result in isolation.

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A child with a highly treatment-sensitive bulky malignancy already has elevated uric acid and impaired renal function. The nurse recognizes that preventing new uric-acid formation differs from removing existing uric acid and checks the planned risk-specific strategy.

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A hospitalized child with sickle cell pain develops fever, cough, and a new oxygen requirement. The nurse urgently reports the change and prepares for pulmonary evaluation rather than attributing the symptoms solely to rib pain or anxiety.

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A caregiver reports that a young child with sickle cell disease is suddenly pale and unusually sleepy, and the abdomen seems larger. The nurse directs immediate emergency evaluation for possible splenic sequestration rather than scheduling a routine assessment.

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A child with paraspinal neuroblastoma develops a new limp and difficulty passing urine. The nurse escalates urgently for possible spinal cord compression and communicates the timing of motor and bladder changes rather than treating them as separate problems.

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A child with a mediastinal mass becomes breathless when lying flat before a planned biopsy. The nurse maintains the position that eases breathing and urgently requests multidisciplinary review before routine preprocedure sedation or forced supine positioning.

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During a peripheral infusion, a child reports burning and the site becomes swollen. The nurse stops the infusion, avoids flushing, keeps the cannula available initially, and promptly obtains the agent-specific extravasation plan and expert assessment.

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A child recently given an asparaginase product develops severe persistent upper abdominal pain and repeated vomiting. The nurse promptly reports possible pancreatitis and prepares for laboratory and clinical evaluation rather than administering an antiemetic as the sole response.

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After CAR T-cell infusion, a child develops fever, falling blood pressure, and increasing oxygen needs. The nurse activates urgent cellular-therapy assessment and communicates the timing while supporting evaluation for both cytokine-mediated toxicity and possible infection.

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A child with hemophilia avoids bearing weight and says one ankle feels warm, although swelling is minimal. The nurse recognizes a possible early joint bleed and promptly contacts the hematology team rather than requiring visible bruising first.

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A young child believes a port procedure is punishment for misbehavior. The nurse corrects the belief with simple language, demonstrates the sequence using play materials, and helps the child choose a realistic coping strategy and support person.

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An adolescent stops contributing when caregivers answer every question. The nurse directs developmentally appropriate questions to the adolescent, offers an opportunity for private discussion, and works with the family to support gradually increasing participation in everyday care decisions.

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A sibling begins missing activities and says asking for attention would burden the family. The nurse helps caregivers arrange predictable individual time, age-appropriate information, and school or counseling support while preserving activities that matter to the sibling.

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A caregiver repeatedly misses morning appointments because the only available ride arrives later. The nurse explores scheduling and transport resources with the social worker, then confirms a feasible plan instead of repeating instructions about the importance of attendance.

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During worsening illness, one caregiver wants spiritual support while another prefers quiet practical planning. The nurse asks each person about priorities, coordinates requested resources, and supports the child's own questions without assuming one response represents the entire family.