EVOLVE - ch. 44 (The Child With Cancer) + Extra

Which findings are consistent with tumor lysis syndrome? A. Hypercalcemia and hyperkalemia B. Hypochloremia and hypokalemia C. Hyponatremia and hyperphosphatemia D. Hyperuricemia and hyperkalemia

D. The hallmark characteristics of tumor lysis syndrome are: hyperuricemia, hypocalcemia, hyperphosphatemia, and hyperkalemia.

A pediatric oncology patient undergoing chemotherapy treatment is refusing to eat despite providing the child's "favorite foods" and allowing for alternate feeding patterns independent of meal time. What etiological theories might account for the child's loss of desire to eat? (Select all that apply.) A. The patient anticipates that he/she will be nauseous and/or vomit as part of the treatment sequence. B. The patient is refusing to eat in an attempt to gain control over his/her surroundings. C. The "correct" food has just not been found and more food selections should be offered. D. The patient is experiencing symptoms of depression. E. The patient is refusing to eat because his/her parents did not make the food.

A, B, D Anorexia and/or a refusal to eat sometimes accompanies chemotherapy interventions in patients. Thus, even in the context of being offered "favorite foods," the child may not want to eat. Theories proposed for this persistent anorexia and/or refusal include but are not limited to: possible depression, attempts at control, gaining control over one's environment, a conditioned response reflecting aversion during treatment and/or stress.

Which findings are not consistent with tumor lysis syndrome? A. Hypercalcemia and hyperkalemia B. Hypochloremia and hypokalemia C. Hyponatremia and hyperphosphatemia D. Hyperuricemia and hyperkalemia E. Hypercalcemia and hypokalemia

A, B, E The hallmark characteristics of tumor lysis syndrome are: hyperuricemia, hypocalcemia, hyperphosphatemia, and hyperkalemia.

In taking care of a pediatric oncology patient, which diagnostic finding would indicate a critical concern for the development of infection? A. Absolute neutrophil count of 250 mm3 B. Temperature of 99.2 degrees Fahrenheit C. White blood cell count 7,000 mm3 D. Platelet count 100,000 mm3

A. An absolute neutrophil count of less than 500 mm3 is of critical concern as it indicates the potential for overwhelming infection. None of the other measurement parameters are reflective of this fact.

The pediatric nurse is performing a well child assessment. Which finding if noted would require further investigation? A. Palpation of an abdominal mass without pain expression. B. No report of pain or tenderness in arms or legs. C. Buccal mucosa pink and intact. D. Grey appearance of tympanic membrane on otoscopic exam. E. Bruises observed following light touch to the extremities. F. Report of a headache

A. In a pediatric patient detection of an abdominal mass, regardless of pain expression requires further diagnostic work up as it may be evidence of Wilm's tumor. All of the other findings represent normal variations and as such do not require further investigation.

A child diagnosed with lymphoma is receiving extensive radiation therapy. The MOST common side effect of this treatment is: A. fatigue. B. seizures. C. neuropathy. D. lymphadenopathy.

A. fatigue. Fatigue is the most common side effect of radiation therapy. For children the fatigue may be especially distressing because it means that they cannot keep up with their peers. Seizures are unlikely because irradiation would not usually involve the cranial area for treatment of lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents. Lymphadenopathy is one of the findings of lymphoma.

Nursing considerations related to the administration of chemotherapeutic drugs include: A. many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. B. good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary. C. infiltration will not occur unless superficial veins are used for the intravenous infusion. D. anaphylaxis cannot occur because the drugs are considered toxic to normal cells.

A. many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward. Infiltration and extravasations are always a risk, especially with peripheral veins. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents.

A poor prognosis following surgical treatment for operable cancers is associated with: A. when there is evidence of metastasis. B. presence of postoperative nausea. C. the amount of pain medication that the patient takes in the first 24 hours postsurgery. D. if the tumor is encapsulated and localized.

A. when there is evidence of metastasis. Poor prognosis following surgical treatment for operable cancers is associated with cancers that have metastasized. Presence of postoperative nausea and/or the amount of pain medication provided during the first 24 hours postoperatively do not correlate with a poor prognosis but rather are dependent on individual tolerance and perception of nausea and pain. If a tumor is encapsulated and localized, this is associated with an easier surgical procedure and a better health outcome.

Which findings would the nurse suspect to be observe during a work up for in a pediatric patient suspected of having a brain tumor? (Select all that apply.) A. Vomiting following eating B. Headaches upon arising that dissipates as the day progresses C. Decreased pulse pressure D. Abnormal cranial nerve examination E. Negative Babinksi sign

B, C, D The presence of brain tumor would cause a variety of clinical symptoms depending on the location and extent of the tumor. Expected physical findings are associated with headache upon arising that subsides as the day progresses, a decreased pulse pressure, abnormal neurological exam which includes cranial nerve abnormalities as well as a positive Babinski reflex. Vomiting specifically associated with eating is not directly correlated with a brain tumor. Vomiting can be present but may or not be associated with nausea or feeding.

With regard to incidence of childhood cancer, which statement is accurate? A. In children there is a high incidence of cancer. B. Despite a low incidence, there is high morbidity in children under the age of 15. C. Gender does not affect incidence of childhood cancers. D. Higher incidence in found in African American children as compared to Caucasians.

B. Despite a lower incidence of childhood cancer, there is a higher morbidity associated with specific age groups. Different subtypes of cancer are affected by gender, age and ethnicity. A higher incidence of cancers are found in Caucasian children as compared to African American children.

An example of a disease process with underlying immune adaptation l potentially leading to a cancer diagnosis is? A. Fanconi anemia B. Wiskott Aldrich syndrome C. Klinefelter syndrome D. Retinoblastoma

B. Wiskott Aldrich syndrome is an example of an immunodeficiency state may place the individual at increased risk to develop certain cancers. Fanconi anemia and Klinefelter syndrome are examples of chromosomal abnormalities which can potentially lead to development of cancer. Retinoblastoma is an example of "two-hit" hypothesis of inheritance leading to development of cancer states.

A pediatric patient has been diagnosed with leukemia and presents with a white blood cell (WBC) count of 80,000 mm3. Which statement if provided by a nursing student indicates that additional teaching is needed with regard to pathophysiological mechanisms of leukemia? A. The increase in WBC provides protection against bacterial infections. B. Although the WBC count is elevated, there are increased blast cells which help to protect the patient against infection. C. The amount of white blood cells is greatly increased, which affords protection against viral infections. D. Increases in white blood cells are expected but associated with a low leukocyte count.

B. Although the WBC count is elevated, there are increased blast cells which help to protect the patient against infection. In leukemia, white blood cell (WBC) count is elevated with an increase in blast or immature cells, which limit the functional ability of WBCs being able to fight off infection. Increases in WBC do not provide protection against bacterial or viral infections. Although one expects to see an increase in the overall WBC, it is associated with a low leukocyte count.

What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy? A. Lemon glycerin swabs for cleansing B. Mouthwashes with normal saline C. Mouthwashes with hydrogen peroxide D. Local anesthetic such as viscous lidocaine before meals

B. Mouthwashes with normal saline Lemon glycerin swabs can irritate eroded tissue and decay teeth. Normal saline mouthwashes are the preferred mouth care for this age-group. The rinse will keep the mucosal surfaces clean without risking adverse effects on the mucosa or adverse effects caused by the child swallowing the rinse. Hydrogen peroxide delays healing by breaking down protein. Viscous lidocaine is not recommended for toddlers because it depresses the gag reflex.

Which findings would the nurse suspect to be observe during a work up for in a pediatric patient suspected of having a supratentorial brain tumor? A. Vomiting not related to feeding. B. Headache upon arising. C. Personality changes. D. Seizures. E. Visual deficits.

C, D, E The presence of a supratentorial brain tumor typically presents with behavior or personality changes, seizures, visual disturbances or hemiparesis. Vomiting not related to feeding and headache upon arising are typically seen with infratentorial brain tumors.

Administration of colony stimulating agents for the pediatric oncology patient are based on the fact that A. increase the time frame for genetic adaptation. B. delays the onset of cellular regeneration. C. it will stimulate production of blood cell components. D. increase bone marrow recovery time.

C. Colony stimulating agents used in the treatment of pediatric oncology patients help to restore functional integrity of the bone marrow leading to decreased likelihood of infections. They decrease bone marrow recovery time and stimulate bone marrow growth of specific cellular components.

Pediatric oncology patients are affected by medical management of their respective disease process and yet it is critical to include health promotion measures as part of their overall care. Which health promotion is not indicated in the plan of care? A. Continuation of dental hygiene treatment plan consistent with developmental age of child. B. Family members should receive live measles, mumps and rubella vaccinations as warranted. C. No treatment should be given if the patient has been exposed to varicella. D. The patient should not receive live attenuated vaccines during the course of chemotherapy protocol.

C. If a pediatric oncology patient has been exposed to varicella, dependent on the time frame either varicella immune zoster immunoglobulin should be administered (within 96 hours of exposure) and/or treatment with antiviral agents should be provided if the patient develops varicella. This treatment is indicated as the development of varicella can lead to increased morbidity and mortality. All of the other options should be included in a health promotion plan of care.

A pediatric patient has been diagnosed with leukemia and presents with a white blood cell (WBC) count of 80,000 mm3. In teaching a group of nursing students about the disease process, how would the nursing instructor describe the proliferation of white blood cells and their ability to fight off infection? A. The increase in WBC provides protection against viral infections but not bacterial infections. B. Although the WBC count is elevated, there are limited blast cells which leads to an increased likelihood that the patient will develop an infection. C. There is an increase in immature cells which reduce the body's ability to fight off infection. D. Although the WBC count is elevated, they are overwhelmed with mature cells that predispose the individual to develop an infection.

C. In leukemia, WBC count is elevated with an increase in blast or immature cells which limit the functional ability of WBCs being able to fight off infection.

A pediatric oncology patient is undergoing chemotherapy. Which treatment option would the nurse anticipate being included in the plan of care in order to prevent the development of sterile hemorrhagic cystitis? A. Restrictive fluid intake. B. Inclusion of dairy foods in the diet. C. Implementing a frequent voiding plan throughout the course of the day to the patient. D. Limiting mobility during course of chemotherapy.

C. Providing a frequent voiding plan to encourage the patient to void upon urge, immediately upon arising, before bedtime and one nighttime void will help to prevent possibility of urinary stasis. Encouraging fluid intake rather than restricting fluid is the mainstay of treatment. Dairy foods in the diet provide no effective treatment against the development of sterile hemorrhagic cystitis. Similarly, limiting mobility is not indicated.

A young pediatric oncology patient has stomatitis. Which intervention if observed by the charge nurse would warrant immediate action? A. The nurse assigned to the patient was offering mouth care using a sponge toothbrush. B. The nurse offers the patient frequent mouth rinses. C. The nurse is preparing to use viscous lidocaine to offer pain relief. D. The nurse administers sucralfate as ordered.

C. Use of viscous lidocaine is contraindicated in mucosal alterations as it can lead to potential aspiration and seizure activity. All of the other interventions are appropriate and can be used for symptomatic relief of stomatitis.

When treating nausea and vomiting as a side effect of chemotherapy and/or radiotherapy, ondansetron (Zofran) is the preferred drug of choice because? A. It has a shorter onset of action. B. It can be administered via several different routes. C. It does not cause extrapyramidal side effects. D. It has no adverse side effects if administered appropriately.

C. Zofran is a 5-hydroxytryptamine-3 receptor antagonist and is considered the antiemetic of choice for oncology patients as it produces no extrapyramidal side effects. Pharmacodynamics and pharmacokinetic features aside, the preference for this medication is due to producing no extrapyramidal side effects. Any medication even if administered properly has the potential to cause side effects. The ability to administer via different routes does not indicate a preferred drug choice.

A pediatric oncology patient has been discharged home following a course of chemotherapy. Which information should be included as part of discharge planning with regard to health promotion? A. No further treatments are needed and the patient can resume routine health assessments as developmentally appropriate. B. There are no restrictions based on activity and/or contacts with friends and family members. C. Certain restrictions will be in place related to immunizations that can be administered. D. The patient should limit fluid intake for several months in order to prevent overhydration from occurring.

C. Certain restrictions will be in place related to immunizations that can be administered. With regard to discharge planning for a pediatric oncology patient following a course of chemotherapy, certain restrictions will be in place related to immunizations that can be administered as the patient cannot receive any live viruses. Chemotherapy protocols typically involve a series of treatment therapies, so further treatment will be needed along with possible restrictions of activity and/or contacts with family members until the patient has recovered from effects of immunosuppression due to chemotherapy. Fluids should not be limited at this time as the patient should maintain or increase fluid intake so as to remain hydrated.

A pediatric oncology patient is undergoing chemotherapy. Which observation would lead the nurse to suspect that the patient has developed sterile hemorrhagic cystitis? A. Absence of hematuria B. Presence of proteinuria C. Complaints by the patient that it burns upon urination D. Increased sensation of thirst.

C. Complaints by the patient that it burns upon urination Clinical symptoms associated with sterile hemorrhagic cystitis include dysuria and hematuria. Presence of proteinuria is associated with an unrelated finding. Increased sensation of thirst is associated with an unrelated finding.

The nurse is preparing to administer ondansetron (Zofran) to a pediatric patient. For which clinical symptom is this considered to be the drug of choice? A. Headache relief B. To promote increased energy C. Nausea and vomiting D. Pain relief

C. Nausea and vomiting Zofran is a 5-hydroxytryptamine-3 receptor antagonist and is considered the antiemetic of choice for oncology patients as it produces no extrapyramidal side effects. This medication does not treat headaches. This medication does not promote energy. This medication does not provide pain relief.

Which finding if observed would warrant intervention regarding the administration of an antiemetic in a chemotherapy protocol for a pediatric patient? A. Providing the medication on a scheduled basis regardless of the patient's clinical symptoms. B. Administering the medication via the parenteral route prior to infusion of chemotherapy protocol. C. Providing medication with sips of water following clinical symptoms of nausea and/or vomiting. D. Administering 30 to 60 minutes prior to initiation of therapy.

C. Providing medication with sips of water following clinical symptoms of nausea and/or vomiting. Administering an antiemetic by mouth is not the preferred route especially when the patient is having symptoms of nausea and vomiting. Preferred route is parenteral. Antiemetic medication should be provided on a scheduled basis, via parenteral route and prior to initiation of chemotherapy, typically 30 to 60 minutes. Anticipatory management of an antiemetic is part of chemotherapy and/or radiation protocols. It is typically given 30 to 60 minutes prior to the infusion.

Which physical finding would suggest that a pediatric oncology patient has stomatitis? A. Intact buccal mucosa B. Presence of epistaxis C. Red painful area noted in the pharynx D. Nasal congestion

C. Red painful area noted in the pharynx Stomatitis is the presence of ulcers within the oral cavity. They are associated with red, eroded painful areas in the mouth or pharynx. An intact buccal mucosa is normal finding. Presence of epistaxis indicates a nosebleed. Nasal congestion is an unrelated finding.

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include: A. restricting oral fluids. B. instituting strict isolation. C. using good handwashing. D. giving immunizations appropriate for age.

C. using good handwashing. There is no indication that fluids should be reduced. Strict isolation is not necessary. Good hand washing is the most effective means of preventing disease transmission. The child should not receive any live vaccines. The immune system is not capable of responding appropriately to the vaccine.

A pediatric oncology patient has developed a nose bleed. Which testing parameter would be indicted in order to decide if medical treatment is needed? A. Chest X-ray B. CT of the nose C. Lumbar puncture D. Platelet count

D. Pediatric oncology patients are at an increased risk for hemorrhage and bleeding. Evidence of a nose bleed may indicate thrombocytopenia and as such a platelet count should be obtained. Imaging studies such as CT and chest x-ray will not provide information related to hemostasis. An invasive procedure such as a lumbar puncture would be indicated if there was possibility of an infectious process.

You are reviewing information relative to a patient's medical history for treatment of leukemia. Patient is exhibiting no clinical symptoms at this point in the treatment plan. In comparing bone marrow reports prior to and 6 months following chemotherapy, what information do you hope to obtain that would assist in evaluating the plan of care? A. Expectation that the results will be consistent indicating that goals have been met. B. Increased likelihood that atypical cells will be present suggesting a revision of the plan of care. C. Pancytopenic response indicating that chemotherapy treatment was successful. D. Determination of response to clinical therapy comparing pre and post procedure that will provide evidence to interpret whether medical treatment has been effective.

D. Bone marrow biopsies are used both to diagnose as well as evaluate clinical response to chemotherapy (therapeutic management) used in the treatment of leukemia. While one would hope that the intervention was successful, until the results are compared and read by the pathologist, there is no way to state equivocally what the results will be at the histological level. Consistent findings pre and post treatment would indicate that treatment goals have not been met. Similarly, if clinical response is favorable, then one would not expect to see atypical cells. As the patient is not experiencing any symptoms, a diagnosis of pancytopenia would not be expected as this would indicate bone marrow failure.

An example of a disease process that is based on a "two-hit" hypothesis leading to a cancer diagnosis is: A. Fanconi anemia B. Wiskott Aldrich syndrome C. Klinefelter syndrome D. Retinoblastoma

D. Retinoblastoma is an example of "two-hit" hypothesis of inheritance leading to development of cancer states. Wiskott Aldrich syndrome is an example of an immunodeficiency state may place the individual at increased risk to develop certain cancers. Fanconi anemia and Klinefelter syndrome are examples of chromosomal abnormalities which can potentially lead to development of cancer.

The best approach that would facilitate improved outcomes when using surgical treatment for operable cancers is A. when there is evidence of adjacent tissue involvement. B. performing amputation rather than attempting resection. C. using multiple excisions to remove the tumor. D. if the tumor is encapsulated and localized.

D. Tumors that are localized and encapsulated represent the best approach for improved outcomes for the surgical cancer patient as this indicates that the tumor is not showing evidence of metastasis. Evidence of adjacent tissue involvement means that the tumor has already metastasized. Resection of bone rather than amputation is associated with improved outcomes. Minimal incision surgical approach is favored to improve functioning and help maintain cosmesis.

A critical concept that needs to be maintained during intravenous administration of chemotherapy for a pediatric patient is? A. Positioning the patient in a semi-fowler's position. B. Not use an infusion device but rather allow for a free-flow line. C. Continue the infusion regardless if the patient develops a rash. D. Maintaining the integrity of the parenteral access line.

D. Administration of chemotherapy via parenteral access requires that the integrity of the access line be maintained and monitored by the nurse. If there is any indication that the site as infiltrated, then the infusion must be immediately stopped. Patient positioning is variable depending on patient comfort. An infusion device must be used as this is considered to be a titratable infusion. If the patient develops a rash in response to chemotherapy, this may be an indication of a hypersensitivity reaction. Intervention is required with notification of health care provider and discontinuing the infusion.

The nurse in planning care for the pediatric oncology patient anticipates implementing which action with regard to the administration of an antiemetic in a chemotherapy protocol? A. Providing the medication on a prn basis based on patient's presenting symptoms of nausea and/or vomiting. B. Administering the medication via the oral route following infusion of chemotherapy protocol. C. Providing medication with sips of water following clinical symptoms of nausea and/or vomiting. D. Administering 30 to 60 minutes prior to initiation of therapy.

D. Anticipatory management of an antiemetic is part of chemotherapy and/or radiation protocols. It is typically given 30 to 60 minutes prior to the infusion and administered in a scheduled sequence rather than based on a prn or when the patient presents symptomatically. Preferred route of administration is via parenteral route especially if the anticipated risk for nausea and/or vomiting is increased.

You are working with the parents of a pediatric oncology patient who has successfully responded to therapy. The parents have questions regarding what to expect as the child continues to grow and develop throughout the life cycle. Which response would be appropriate with regard to the parent's concern? A. As the therapy has been successful, growth and development should proceed along a normal sequence. B. It may be a good idea to schedule your child for repeat imaging studies on a yearly basis so as to make sure that the child remains in remission. C. There may be anticipated growth and developmental delays associated with chemotherapy treatments but they are typically self-limiting in nature. D. Genetic counseling may be something to consider as the child reaches adulthood and is considering having children his/herself if the type of cancer that the child had was inherited.

D. Even though medical treatment has been noted as being successful, continued observation and medical follow up is indicated. Growth and development should be monitored in accordance with recommended pediatric screening guidelines. Although imaging studies may be required at some point in time for follow up, yearly imaging studies may not be needed. Genetic counseling when the child reaches adulthood should be considered especially if the type of cancer was inherited. Growth and developmental delays are not considered to be normal and may not be self-limiting.

The nurse is assessing a pediatric oncology patient's nutritional status. Which diagnostic tests would provide best practice approach? A. Albumin, blood urea nitrogen (BUN) and daily weight B. Skinfold assessments and daily weight C. Intake and output with daily calorie count D. Serum prealbumin, albumin and transferrin

D. No one diagnostic test or measurement provides enough evidence to evaluate the nutritional well-being of an individual patient. BUN provides evidence of hydration status but typically should be viewed using a BUN creatinine ratio to provide detailed information about a patient's renal status. Skinfold assessments while important again do not provide enough evidence even with the addition of a daily weight to evaluate one's nutritional status. Intake and output measurements in combination with daily calorie count are representative of hydration and nutritional support but do not provide information relative to nutritional body stores.

You are working with the parents of a pediatric oncology patient who has successfully responded to therapy but is now experiencing body image changes as a result of hair loss due to chemotherapy regimen. The parents are upset about this change in their child's appearance. Which response would be appropriate with regard to the parent's concern? A. As the therapy has been successful, it is important to focus on that rather than body image changes. B. Tell the parents that the child's hair will grow back soon. C. Tell the parents that the child's hair will grow back stronger and healthier. D. Acknowledge the parent's concern and focus on available options that may be used to help with body image concerns.

D. Acknowledge the parent's concern and focus on available options that may be used to help with body image concerns. Even though medical treatment has been noted as being successful, continued observation and medical follow up is indicated. Growth and the fact that a child has lost his/her hair may be traumatic for both the child and parents. Acknowledging the parent's concerns and helping to focus on available options that may be used to help with body image concerns is an appropriate response. Focusing on the success of the overall treatment with the exclusion of the parent's concerns is not appropriate. Telling the parents that the child's hair will grow back and/or be even stronger does not acknowledge their concern.

What is a primary reason for using parenteral administration of chemotherapy agents for cancer patients? A. Chemotherapy medications are only available in parenteral forms. B. Decreased likelihood of infiltration or extravasation. C. Parenteral routes lead to decreased absorption of medication. D. Allowing for infusion of therapies without having to perform multiple venipuntures.

D. Allowing for infusion of therapies without having to perform multiple venipuntures. Use of parenteral medication allows for infusion of therapies without having to perform multiple venipunctures. Chemotherapy medications can be given by multiple routes: by mouth, topically, and parenteral. With parenteral administration, there is an increased likelihood that infiltration or extravasation may occur due to the nature of the type of solution combined with the type of venous access. Use of the parenteral route leads to increased absorption of the medication.

What instructions does the nurse provide for following a bone marrow procedure being performed on a pediatric patient for detection of leukemia? A. The patient will have to remain on a low-bacteria diet until the results are obtained. B. Patient should expect to have slight swelling at the site which will lessen within 24 hours of the procedure. C. Round the clock pain medication will be prescribed for the first 24 hours following the procedure. D. No activity restrictions are provided.

D. No activity restrictions are provided. Typically, there are no activity restrictions following a bone marrow procedure. The patient can expect some local soreness at the site but this is usually self-limiting without the need for round the clock pain medication. Dietary restrictions are not typically seen following a bone marrow procedure unless the patient is immunosuppressed as a result of the disease process and/or therapeutic regimen. Swelling at the site is not typically seen following a bone marrow procedure.

In taking care of a pediatric oncology patient, which diagnostic finding would indicate a critical concern for the development of bleeding? A. Absolute neutrophil count of 1000 mm3 B. Temperature of 99.2° F C. White blood cell count 18,000 mm3 D. Platelet count 50,000 mm3

Platelet count 50,000 mm3 The platelet count indicates a critical concern relative to coagulation and the patient is at risk for bleeding episodes. An absolute neutrophil count of 1000 mm3 is within normal range. Although the recorded temperature is elevated, it does not indicate a critical concern relative to infection as it can be due to other hypermetabolic processes in the body. A white count of this value suggests an infectious process.