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

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.

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 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.

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

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.

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

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.

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

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.

CPHON Exam Practice Test

CPHON Exam Practice Test

CPHON Neutropenia and Infection Management