CPHON Pediatric Hematology Oncology Nurse 5 — Questions and Answers
Question 1: A nurse administering vincristine notices the IV site shows swelling and erythema. What is the priority action?
- Stop the infusion immediately and manage as a vesicant extravasation (Correct answer)
- Slow the infusion rate and apply a warm compress
- Flush the line with normal saline and continue the infusion
- Notify the physician and document, then continue at a slower rate
Correct answer: Stop the infusion immediately and manage as a vesicant extravasation
Vincristine is a vesicant; extravasation can cause severe tissue necrosis and requires immediate cessation and specific extravasation management.
Question 2: Which infection is of greatest concern in an asplenic pediatric oncology patient?
- Encapsulated bacterial organisms such as Streptococcus pneumoniae (Correct answer)
- Candida albicans
- Herpes simplex virus
- Pneumocystis jirovecii
Correct answer: Encapsulated bacterial organisms such as Streptococcus pneumoniae
The spleen filters encapsulated bacteria; asplenic patients are at high risk for overwhelming sepsis from Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.
Question 3: A 6-year-old receiving dexamethasone as part of ALL maintenance therapy shows increased appetite, weight gain, and mood changes. The nurse explains to the family that these effects are:
- Expected steroid side effects that are monitored and usually resolve when the drug is discontinued (Correct answer)
- Signs of relapse that require immediate evaluation
- Permanent changes requiring dietary medication adjustments
- Allergic reactions that necessitate stopping the medication
Correct answer: Expected steroid side effects that are monitored and usually resolve when the drug is discontinued
Corticosteroids like dexamethasone commonly cause appetite increase, cushingoid features, and behavioral changes that typically resolve after therapy ends.
Question 4: Which lab trend indicates effective response to treatment in a child with tumor lysis syndrome (TLS)?
- Decreasing uric acid, potassium, and phosphorus levels with normalizing creatinine (Correct answer)
- Increasing uric acid with stable electrolytes
- Decreasing WBC with rising uric acid
- Normalizing hemoglobin with unchanged electrolytes
Correct answer: Decreasing uric acid, potassium, and phosphorus levels with normalizing creatinine
Effective TLS management is confirmed by declining uric acid, potassium, and phosphorus alongside improving renal function.
Question 5: A child with osteosarcoma is being evaluated for limb-salvage surgery versus amputation. Which nursing priority addresses the child's psychosocial needs?
- Facilitate age-appropriate discussion about body image and involve the child in decision-making (Correct answer)
- Reassure the child that surgery will cure the cancer
- Focus all teaching on parents to reduce child's anxiety
- Delay psychosocial support until after surgery
Correct answer: Facilitate age-appropriate discussion about body image and involve the child in decision-making
Involving the child in decision-making and addressing body image concerns respects their developmental stage and supports psychological adjustment.
Question 6: A child with chronic immune thrombocytopenic purpura (ITP) has a platelet count of 8,000/mm³ and reports a severe headache. What is the most urgent concern?
- Intracranial hemorrhage requiring immediate neurological evaluation (Correct answer)
- Migraine from stress related to illness
- Sinusitis causing referred headache
- Medication-related headache from IVIG
Correct answer: Intracranial hemorrhage requiring immediate neurological evaluation
A severe headache with critically low platelets raises urgent concern for intracranial hemorrhage, a rare but life-threatening complication of ITP.
Question 7: Which action best demonstrates the nurse's role in pediatric oncology survivorship care?
- Educating families about long-term follow-up needs and potential late effects based on treatment received (Correct answer)
- Discharging the patient once treatment is complete with no further instructions
- Referring all survivorship concerns to social work only
- Focusing education solely on preventing cancer recurrence
Correct answer: Educating families about long-term follow-up needs and potential late effects based on treatment received
Survivorship nursing involves comprehensive education about monitoring for late effects of treatment, psychosocial support, and coordination of long-term follow-up care.
CPHON Pediatric Hematology Oncology Nurse 5
A nurse administering vincristine notices the IV site shows swelling and erythema.
What is the priority action?