Wong Ch. 26 Leukemia
1. A toddler with leukemia is on intravenous chemotherapy treatments. The toddler's lab results are WBC: 1000; neutrophils: 7%; nonsegmented neutrophils (bands): 7%. What is this child's absolute neutrophil count (ANC)? (Record your answer in a whole number.)
ANS: 140 To calculate an ANC for a WBC = 1000; neutrophils = 7%; and nonsegmented neutrophils (bands) = 7%, the steps are Step 1: 7% + 7% = 14%. Step 2: 0.14 ´ 1000 = 140 ANC.
5.ID: 46117090 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 Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and 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, including asparaginase (Elspar).
17.ID: 46117207 A child with lymphoma is receiving extensive radiotherapy. What is the most common side effect of this treatment? a Fatigue b Seizures c Neuropathy d Lymphadenopathy
a Fatigue is the most common side effect of radiotherapy. For children, the fatigue may be distressing because they cannot keep up with their peers. Seizures are unlikely, because irradiation would not usually be cranial for lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents but not of radiotherapy. Lymphadenopathy is one of the findings of lymphoma, not a side effect of radiotherapy.
Wong Ch.26 Nclex Review 8.ID: 46117039 What are the most common signs and symptoms of leukemia related to bone marrow involvement? a Petechiae, infection, fatigue b Headache, papilledema, irritability c Muscle wasting, weight loss, fatigue d Decreased intracranial pressure, psychosis, confusion
a Petechiae, infection, and fatigue are signs of infiltration of the bone marrow. Petechiae occur from a lowered platelet count, infection occurs from the depressed number of effective leukocytes, and fatigue occurs from the anemia. Headache, papilledema, and irritability are not signs of bone marrow involvement. Muscle wasting, weight loss, and fatigue are not signs of bone marrow involvement. Decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.
16.ID: 46117097 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 cMouthwashes with hydrogen peroxide d Local anesthetic such as viscous lidocaine before meals
b Normal saline mouthwashes are the preferred mouth care for this age group. The rinse will keep the mucosal surfaces clean without adverse effects on mucosa or problems if the child swallows the rinse. Lemon glycerin swabs can irritate eroded tissue and can decay teeth. Hydrogen peroxide delays healing by breaking down protein. Viscous lidocaine is not recommended for toddlers, because it depresses the gag reflex and the child may have resultant aspiration.
9.ID: 46117046 Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include to a restrict oral fluids. b institute strict isolation. c use good hand-washing technique. d give immunizations appropriate for age.
c Good hand-washing technique is the most effective means to prevent disease transmission in children with myelosuppression. There is no indication to reduce fluids in children with myelosuppression. Strict isolation is not necessary in children with myelosuppression. The child should not receive any live vaccines, because the immune system is not capable of responding appropriately to them.
18.ID: 46117216 A child is status post hematopoietic stem cell transplantation (HSCT) and is preparing for discharge home. Based on the nurse's knowledge of HSCT, which concepts are important to include in the discharge teaching plan of care? (Select all that apply.) a Preparing the child to return to school within six weeks b Keeping the child on a high-calcium diet c Avoiding live plants and fresh vegetables d Avoiding influenza vaccinations e Practicing good hygiene
c, e. Children should have a diet high in calcium or be placed on calcium supplements to reduce the risk of osteopenia.<br>Live plants and fresh vegetables should be avoided because they carry bacteria.<br>Practicing good hand hygiene is essential to prevent the spread of infection.<br>Children cannot return to school for 6-12 months after HSCT. Either in-hospital or home schooling is required.<br>Children and their families should be encouraged to get yearly influenza vaccination.
