CPHON Pediatric Hematology Oncology Nurse 2 — Questions and Answers
Question 1: A child with ALL is receiving intrathecal methotrexate. Which adverse effect is most specific to this route of administration?
- Arachnoiditis (Correct answer)
- Nephrotoxicity
- Pulmonary fibrosis
- Cardiomyopathy
Correct answer: Arachnoiditis
Intrathecal methotrexate can cause chemical arachnoiditis, presenting with headache, fever, and meningismus shortly after administration.
Question 2: When caring for a child receiving high-dose cytarabine (Ara-C), which ocular prophylaxis is routinely administered?
- Steroid eye drops (Correct answer)
- Artificial tears only
- Antibiotic eye drops
- Antiviral eye drops
Correct answer: Steroid eye drops
Steroid (dexamethasone) eye drops are given prophylactically to prevent cytarabine-induced conjunctivitis and keratitis.
Question 3: A 9-year-old with Hodgkin lymphoma has a mediastinal mass. Which pre-anesthesia concern is most critical?
- Risk of airway compression under anesthesia (Correct answer)
- Increased bleeding risk
- Renal insufficiency
- Electrolyte imbalance
Correct answer: Risk of airway compression under anesthesia
Mediastinal masses can compress the trachea or great vessels, making general anesthesia extremely dangerous due to loss of airway tone.
Question 4: Which hematologic finding is most consistent with disseminated intravascular coagulation (DIC) in a pediatric oncology patient?
- Elevated D-dimer with prolonged PT/PTT and low fibrinogen (Correct answer)
- Elevated fibrinogen with normal PT/PTT
- Thrombocytosis with shortened PT
- Elevated hemoglobin with normal coagulation studies
Correct answer: Elevated D-dimer with prolonged PT/PTT and low fibrinogen
DIC is characterized by simultaneous clotting and bleeding, resulting in elevated D-dimer, prolonged clotting times, and consumed fibrinogen.
Question 5: A toddler with Wilms tumor is post-nephrectomy. Which blood pressure parameter requires close monitoring?
- Hypertension due to remaining kidney compensation (Correct answer)
- Hypotension due to fluid overload
- Normal blood pressure is expected postoperatively
- Hypotension from renin depletion
Correct answer: Hypertension due to remaining kidney compensation
After unilateral nephrectomy, the remaining kidney may produce excess renin, leading to hypertension that requires close monitoring.
Question 6: A child with sickle cell disease and acute chest syndrome requires which immediate intervention?
- Simple or exchange transfusion and oxygen supplementation (Correct answer)
- Hydroxyurea initiation and oral hydration
- Bone marrow biopsy and IV antibiotics only
- Splenectomy and analgesics
Correct answer: Simple or exchange transfusion and oxygen supplementation
Acute chest syndrome is treated with oxygen, incentive spirometry, analgesia, and transfusion (simple or exchange) to reduce HbS percentage.
Question 7: During a bone marrow biopsy in a pediatric patient, the nurse notes the child becomes acutely tachycardic and diaphoretic. What is the priority action?
- Assess airway, breathing, and circulation and notify the provider immediately (Correct answer)
- Administer a bolus of normal saline
- Increase the rate of analgesic infusion
- Document findings and continue monitoring
Correct answer: Assess airway, breathing, and circulation and notify the provider immediately
Acute tachycardia and diaphoresis during a procedure may indicate a vasovagal response, hemorrhage, or anesthetic reaction requiring immediate assessment.
CPHON Pediatric Hematology Oncology Nurse 2
A child with ALL is receiving intrathecal methotrexate.
Which adverse effect is most specific to this route of administration?