Neutropenia and Infection Management 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 Neutropenia and Infection Management flashcards as text
A child receiving chemotherapy has an absolute neutrophil count (ANC) of 350/µL and a temperature of 38.3°C. The nurse recognizes this as:
Answer: Febrile neutropenia (FN), a medical emergency requiring immediate blood cultures and broad-spectrum IV antibiotics
Febrile neutropenia is defined as ANC <500/µL (or <1000 with expected decline to <500) AND temperature ≥38.3°C (once) or ≥38.0°C sustained. It is a medical emergency requiring immediate intervention.
How is the absolute neutrophil count (ANC) calculated from a complete blood count with differential?
Answer: ANC = WBC × (% segmented neutrophils + % bands) ÷ 100
ANC is calculated by multiplying the total WBC count (in cells/µL) by the fraction that are neutrophils (segmented + band forms), representing the absolute number of mature and near-mature neutrophils capable of fighting infection.
A neutropenic child develops a central line-associated bloodstream infection. Blood cultures grow Pseudomonas aeruginosa. The nurse should anticipate which change in antibiotic therapy?
Answer: Addition of a second antipseudomonal agent (aminoglycoside or fluoroquinolone) for synergistic coverage
Pseudomonas aeruginosa bacteremia carries high mortality in neutropenic patients and warrants combination therapy with a beta-lactam plus an aminoglycoside or fluoroquinolone for synergistic killing and reduced resistance emergence.
Which food should be avoided by a neutropenic pediatric oncology patient?
Answer: Fresh salad bar items, unpasteurized dairy, raw eggs, and undercooked meats
Neutropenic diet restrictions aim to minimize exposure to pathogens; raw produce (especially salad bars with shared utensils), unpasteurized products, raw eggs, and undercooked meats harbor bacteria and fungi that healthy immune systems handle but neutropenic patients cannot.
A neutropenic child develops perianal pain and redness. The nurse should avoid which common assessment action?
Answer: Rectal temperature measurement and rectal examinations
Rectal temperatures and rectal examinations are absolutely contraindicated in neutropenic patients because the trauma to friable, poorly healing rectal mucosa can introduce bacteria from gut flora into the bloodstream, causing bacteremia.
A child receiving chemotherapy for ALL is exposed to a sibling at home who develops varicella (chickenpox) the next day. The child is not known to be immune. The most important immediate action is:
Answer: Notify the oncology team immediately for consideration of varicella-zoster immune globulin (VZIG) administration within 96 hours of exposure
Varicella in an immunocompromised child can be fatal. VZIG (VariZIG) must be administered within 96 hours of exposure to prevent or attenuate disease in immunocompromised varicella-susceptible patients. The team must be notified immediately.