Bone Marrow Transplant and Stem Cell Therapy Flashcards
6 cards from real CPHON practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Bone Marrow Transplant and Stem Cell Therapy flashcards as text
A nurse caring for a pediatric HSCT patient notes that the mucous membranes are dry, the patient has not urinated in 8 hours, and the central venous pressure is low. The most appropriate initial nursing action is:
Answer: Notify the provider and prepare to administer IV fluid bolus per protocol
Signs of dehydration and decreased perfusion (dry mucous membranes, oliguria, low CVP) in an HSCT patient require prompt provider notification and IV fluid resuscitation, as these patients cannot tolerate oral intake adequately when ill and have high insensible losses.
What is the correct technique for infusing hematopoietic stem cells (bone marrow or PBSC product)?
Answer: Infuse the product slowly via central line with the patient on continuous cardiac monitor, without a leukocyte filter
Stem cell infusions are given via central line with continuous vital sign monitoring. Leukocyte reduction filters must NOT be used as they trap the CD34+ progenitor cells; infusion rate is carefully titrated based on the patient's tolerance.
A HSCT recipient on day +45 develops fever, dry cough, and hypoxemia. Chest CT shows bilateral ground-glass opacities. The nurse should prepare the patient for which diagnostic procedure?
Answer: Bronchoscopy with bronchoalveolar lavage (BAL)
Bilateral ground-glass opacities in an immunocompromised HSCT patient require bronchoscopy with BAL to obtain lower respiratory tract specimens for culture, cytology, and PCR testing for fungi, bacteria, and viruses — minimally invasive compared to open biopsy.
What is the role of granulocyte colony-stimulating factor (G-CSF) in HSCT, and when is it typically given?
Answer: Administered post-transplant to accelerate neutrophil engraftment and shorten the duration of neutropenia
G-CSF (filgrastim) is given to HSCT recipients after stem cell infusion to stimulate proliferation and differentiation of donor-derived neutrophil precursors, shortening the duration of post-transplant neutropenia.
Which isolation precaution is most critical for a pediatric HSCT patient during the pre-engraftment neutropenic phase?
Answer: Protective/reverse isolation in a positive-pressure HEPA-filtered room
Profoundly neutropenic HSCT patients require protective (reverse) isolation in a positive-pressure room with HEPA filtration to protect them from environmental fungi (Aspergillus) and airborne pathogens, rather than isolation to protect others from the patient.
A CPHON nurse is educating the family of a child who will undergo autologous HSCT for neuroblastoma. Which statement by the parent indicates a need for further teaching?
Answer: 'My child can receive any blood product because we're using their own cells'
This statement is incorrect — even autologous HSCT patients require irradiated and CMV-safe blood products to prevent transfusion-associated GVHD and CMV transmission during immunosuppression.