CPHON Neutropenia and Infection Management

Question 1

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:

Accepted Answer

Febrile neutropenia (FN), a medical emergency requiring immediate blood cultures and broad-spectrum IV antibiotics

Answer

A low-grade fever that can be monitored at home

Answer

Mild neutropenia that requires only increased oral fluid intake

Answer

A reaction to chemotherapy that will resolve spontaneously

Question 2

How is the absolute neutrophil count (ANC) calculated from a complete blood count with differential?

Accepted Answer

ANC = WBC × (% segmented neutrophils + % bands) ÷ 100

Answer

ANC = WBC × % lymphocytes ÷ 100

Answer

ANC = WBC − platelet count

Answer

ANC = % neutrophils × hemoglobin

Question 3

A neutropenic child develops a central line-associated bloodstream infection. Blood cultures grow Pseudomonas aeruginosa. The nurse should anticipate which change in antibiotic therapy?

Accepted Answer

Addition of a second antipseudomonal agent (aminoglycoside or fluoroquinolone) for synergistic coverage

Answer

Switching to oral amoxicillin for completion of therapy

Answer

Discontinuing antibiotics once fever resolves

Answer

Adding vancomycin as the primary treatment for Pseudomonas

Question 4

Which food should be avoided by a neutropenic pediatric oncology patient?

Accepted Answer

Fresh salad bar items, unpasteurized dairy, raw eggs, and undercooked meats

Answer

Pasteurized milk and cooked vegetables

Answer

Packaged crackers and cooked pasta

Answer

Commercially canned foods and bottled water

Question 5

A neutropenic child develops perianal pain and redness. The nurse should avoid which common assessment action?

Accepted Answer

Rectal temperature measurement and rectal examinations

Answer

Oral temperature measurement

Answer

Inspection of the perianal area visually

Answer

Application of topical barrier cream to protect skin integrity

Question 6

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:

Accepted Answer

Notify the oncology team immediately for consideration of varicella-zoster immune globulin (VZIG) administration within 96 hours of exposure

Answer

Give the varicella vaccine immediately

Answer

Isolate the child at home for 21 days

Answer

Administer prophylactic oral acyclovir without notifying the team