A child with acute lymphoblastic leukemia (ALL) who is receiving chemotherapy has the following lab results: WBC 9,000, Hemoglobin 12, and Platelets 20,000. When planning this child’s care, which risk should the nurse consider most significant?

Correct Answer: C

Rationale: Correct Answer: C - Hemorrhage Rationale: 1. Platelets are critically low at 20,000, putting the child at high risk for bleeding. 2. Hemorrhage is a major concern due to impaired clotting ability. 3. Anemia (low hemoglobin) can contribute to bleeding but is not the primary concern. 4. Infection risk is elevated but not as immediate as the risk of hemorrhage with such low platelets.

Correct Answer: C

Rationale: The correct answer is C: Monitoring oxygen saturation. In DIC, there is impaired blood flow leading to inadequate perfusion of tissues. Monitoring oxygen saturation is crucial to assess tissue perfusion and ensure adequate oxygen delivery. This intervention directly addresses the underlying problem of ineffective tissue perfusion by evaluating the effectiveness of oxygenation. Repositioning the client every 2 hours (choice A) may help prevent pressure ulcers but does not directly address tissue perfusion. Administering oxygen (choice B) and encouraging deep breathing and coughing (choice D) may be beneficial but do not specifically target monitoring the client's oxygen saturation to evaluate tissue perfusion.

Correct Answer: A

Rationale: The correct answer is A: Filgrastim (Neupogen). The child's low white-blood-cell count due to chemotherapy increases the risk of infection. Filgrastim is a granulocyte colony-stimulating factor that stimulates the production of white blood cells, reducing the risk of infection. Ondansetron (B) is an antiemetic for nausea/vomiting, not related to low WBC count. Oprelvekin (C) is an interleukin-11 used for thrombocytopenia, not for low WBC count. Epoetin alfa (D) is used for anemia, not low WBC count.

Correct Answer: C

Rationale: The correct answer is C: Leukemia. Leukemia is the most common form of childhood cancer, accounting for around 30% of all childhood cancers. It affects the blood and bone marrow, leading to abnormal production of white blood cells. Lymphoma (A) and brain tumors (B) are also common childhood cancers but not as prevalent as leukemia. Osteosarcoma (D) is a type of bone cancer that is rare in children compared to leukemia. Thus, based on the prevalence and incidence rates, leukemia is the most common form of childhood cancer.

Correct Answer: B

Rationale: The correct answer is B: Obtain a blood pressure on the child; notify the physician. Rationale: 1. Blurred vision and headache in a child with acute glomerulonephritis may indicate hypertension, a serious complication. 2. Obtaining a blood pressure reading is crucial to assess for hypertension, a common manifestation in glomerulonephritis. 3. Notify the physician immediately for further evaluation and management of the elevated blood pressure to prevent complications like hypertensive encephalopathy or seizures. Summary of other choices: A: Checking urine for increased hematuria is important but not the priority when the child is exhibiting symptoms of hypertension. C: Reassuring the child and encouraging bed rest does not address the potential serious complication of hypertension. D: Although obtaining serum electrolytes and sending a urinalysis are important in managing glomerulonephritis, addressing the acute symptoms of blurred vision and headache takes precedence.