CPHON Pediatric Hematology Oncology Nurse 3 — Questions and Answers
Question 1: Which chemotherapy agent is most associated with hemorrhagic cystitis in pediatric patients?
- Cyclophosphamide (Correct answer)
- Vincristine
- Doxorubicin
- Asparaginase
Correct answer: Cyclophosphamide
Cyclophosphamide is metabolized to acrolein, which irritates the bladder lining causing hemorrhagic cystitis; mesna and hydration are used for prevention.
Question 2: A child with neuroblastoma is scheduled for a MIBG scan. Which medication must be given before the procedure?
- Potassium iodide to protect the thyroid (Correct answer)
- Ondansetron to prevent nausea
- Diphenhydramine to prevent allergic reaction
- Hydrocortisone to reduce inflammation
Correct answer: Potassium iodide to protect the thyroid
Potassium iodide (or Lugol's solution) is given before MIBG scans to block thyroid uptake of radioactive iodine.
Question 3: Which is the most appropriate nursing intervention for a child experiencing vincristine-induced constipation?
- Prophylactic bowel regimen with stimulant laxatives started at initiation of vincristine (Correct answer)
- Increase dietary fiber and wait for natural resolution
- Administer enemas after each vincristine dose
- Hold vincristine until bowel function normalizes
Correct answer: Prophylactic bowel regimen with stimulant laxatives started at initiation of vincristine
Vincristine causes autonomic neuropathy leading to constipation; a prophylactic bowel regimen is standard practice from the start of therapy.
Question 4: A 12-year-old receiving asparaginase develops sudden severe abdominal pain with elevated lipase and amylase. The nurse should suspect:
- Asparaginase-induced pancreatitis (Correct answer)
- Tumor lysis syndrome
- Typhlitis
- Vincristine-induced ileus
Correct answer: Asparaginase-induced pancreatitis
Asparaginase is a well-known cause of pancreatitis in pediatric oncology patients, manifesting with abdominal pain and elevated pancreatic enzymes.
Question 5: The nurse is preparing to administer a platelet transfusion to a child with acute leukemia who previously had a severe transfusion reaction. Which product modification is most appropriate?
- Leukoreduced and irradiated platelets (Correct answer)
- CMV-negative platelets only
- Washed platelets only
- Standard platelets with premedication
Correct answer: Leukoreduced and irradiated platelets
Leukoreduction reduces febrile reactions and CMV transmission, while irradiation prevents transfusion-associated graft-versus-host disease in immunocompromised patients.
Question 6: A child with T-cell lymphoma develops a pleural effusion. Upon thoracentesis, the fluid appears milky white. This finding is most consistent with:
- Chylothorax from thoracic duct obstruction by tumor (Correct answer)
- Empyema from bacterial infection
- Hemothorax from vessel rupture
- Exudative effusion from inflammation
Correct answer: Chylothorax from thoracic duct obstruction by tumor
A milky white pleural effusion (chylothorax) results from lymphatic obstruction by tumor, causing chyle to accumulate in the pleural space.
Question 7: Which lab value is most important to monitor before administering methotrexate to prevent severe toxicity?
- Serum creatinine and creatinine clearance (Correct answer)
- Serum potassium
- Complete blood count only
- Serum bilirubin
Correct answer: Serum creatinine and creatinine clearance
Methotrexate is renally excreted; impaired renal function leads to drug accumulation and severe toxicity including mucositis and myelosuppression.
CPHON Pediatric Hematology Oncology Nurse 3
Which chemotherapy agent is most associated with hemorrhagic cystitis in pediatric patients?