CPHON Pediatric Hematology Oncology Nurse 4 — Questions and Answers
Question 1: A child with newly diagnosed AML is found to have a WBC of 120,000/mm³. The nurse anticipates which emergent complication?
- Leukostasis causing pulmonary and CNS symptoms (Correct answer)
- Severe anemia requiring transfusion
- Spontaneous tumor regression
- Septic shock from neutropenia
Correct answer: Leukostasis causing pulmonary and CNS symptoms
Extreme leukocytosis (hyperleukocytosis) in AML causes leukostasis, where blast cells obstruct microvasculature in the lungs and brain.
Question 2: Which late effect is most commonly associated with anthracycline chemotherapy in pediatric cancer survivors?
- Cardiomyopathy and congestive heart failure (Correct answer)
- Pulmonary fibrosis
- Renal tubular dysfunction
- Peripheral neuropathy
Correct answer: Cardiomyopathy and congestive heart failure
Anthracyclines (doxorubicin, daunorubicin) cause cumulative cardiotoxicity leading to cardiomyopathy, which may appear years after treatment.
Question 3: A nurse is educating the family of a child with febrile neutropenia. Which statement by the parent indicates a need for further teaching?
- 'I will give acetaminophen to mask the fever and monitor at home for 24 hours before calling.' (Correct answer)
- 'I will bring my child to the ER immediately if a fever develops.'
- 'I will avoid crowded places while my child is neutropenic.'
- 'I will not give rectal suppositories to my child during neutropenia.'
Correct answer: 'I will give acetaminophen to mask the fever and monitor at home for 24 hours before calling.'
Parents must not delay seeking care for fever during neutropenia; delaying evaluation can allow a bacterial infection to progress to sepsis rapidly.
Question 4: A pediatric patient is receiving radiation to the spine for medulloblastoma. Which side effect should the nurse anticipate months after therapy?
- Growth retardation due to vertebral growth plate damage (Correct answer)
- Immediate paralysis
- Acute bowel obstruction
- Skin breakdown at the radiation site only
Correct answer: Growth retardation due to vertebral growth plate damage
Spinal radiation in children damages vertebral growth plates, leading to impaired spinal growth and short stature as a late effect.
Question 5: Which assessment finding is an early sign of superior vena cava (SVC) syndrome in a child with a mediastinal tumor?
- Facial edema and plethora that worsens when leaning forward (Correct answer)
- Lower extremity edema
- Sudden onset bradycardia
- Abdominal distension with ascites
Correct answer: Facial edema and plethora that worsens when leaning forward
SVC syndrome causes venous congestion above the obstruction, presenting with facial and upper extremity swelling and plethora, worsened by gravity.
Question 6: A child with sickle cell disease is being considered for hematopoietic stem cell transplant (HSCT). Which family member is the preferred donor?
- HLA-matched sibling without sickle cell disease (Correct answer)
- Unrelated matched donor from a registry
- Parent with sickle cell trait
- The patient's identical twin
Correct answer: HLA-matched sibling without sickle cell disease
An HLA-matched sibling who does not have sickle cell disease provides the best outcomes for HSCT in pediatric sickle cell patients.
Question 7: The nurse is caring for a child who received a bone marrow transplant 3 weeks ago and now develops a skin rash, diarrhea, and elevated bilirubin. These findings are most consistent with:
- Acute graft-versus-host disease (aGVHD) (Correct answer)
- Veno-occlusive disease
- Engraftment syndrome
- Cytomegalovirus infection
Correct answer: Acute graft-versus-host disease (aGVHD)
Acute GVHD classically presents with a triad of skin rash, profuse diarrhea, and liver dysfunction (elevated bilirubin) within 100 days of transplant.
CPHON Pediatric Hematology Oncology Nurse 4
A child with newly diagnosed AML is found to have a WBC of 120,000/mm³.
The nurse anticipates which emergent complication?