C HAPTER 6: L EUKEMIA
1. Which statement made by a nurse to the parents of a child with leukemia should
be included in discharge instructions?
a. Your sons blood pressure must be taken daily while he is on
chemotherapy.
b. Limit your sons fluid intake just in case he has central nervous system
(CNS) involvement.
c. Your son must receive all of his immunizations in a timely manne r.
d. Your sons temperature should be taken daily.
ANS: D
An elevated temperature may be the only sign of an infection in an
immunosuppressed child. Parents should be instructed to monitor their childs
temperature daily because of the risk for infection, but it is not necessary to
take a blood pressure daily. Fluid is never withheld as a precaution against
increased intracranial pressure. If a child had confirmed CNS involvement
with increased intracranial pressure, limiting fluid intake might be more
appropriate. Children who are immunosuppressed should not receive any live
virus vaccines.
2. What is the most appropriate nursing action when the nurse notes a reddened area
on the forearm of a neutropenic child with leukemia?
a. Massage the area.
b. Turn the child more frequently.
c. Document the finding and continue to observe the area.
d. Notify the physician immediately.
, ANS: D
Any signs of infection in a child who is immunosuppressed must be reported
immediately because it is considered a medical emergency. When a ch ild is
neutropenic, pus may not be produced and the only sign of infection may be
redness. In a child with neutropenia, a reddened area may be the only sign of
an infection. The area should never be massaged. The forearm is not a typical
pressure area; therefore, the likelihood of the redness being related to
pressure is very small. The observation should be documented, but because it
may be a sign of an infection and immunosuppression, the physician must
also be notified.
3. What is the nurses best response to a mother whose child has a diagnosis of acute
lymphoblastic leukemia and is expressing guilt about not having responded
sooner to her childs symptoms?
a. You should always call the physician when your child has a change in
what is normal for him.
b. It is better to be safe than sorry.
c. It is not uncommon for parents not to notice subtle changes in their
childrens health.
d. I hope this delay does not affect the treatment plan.
ANS: C
Suggesting that noticing subtle changes in their childrens health is not
uncommon minimizes the role the mother played in not seeking early medical
attention. It also displays empathy, which helps to build trust, thereby
enabling the mother to talk about her feelings. Identifying concerns and
clarifying misconceptions will help families cope with the stress of chronic
illness. The goal is to relieve the mothers guilt and build trust so that she can
talk about her feelings. Telling the mother that she should have called the
1. Which statement made by a nurse to the parents of a child with leukemia should
be included in discharge instructions?
a. Your sons blood pressure must be taken daily while he is on
chemotherapy.
b. Limit your sons fluid intake just in case he has central nervous system
(CNS) involvement.
c. Your son must receive all of his immunizations in a timely manne r.
d. Your sons temperature should be taken daily.
ANS: D
An elevated temperature may be the only sign of an infection in an
immunosuppressed child. Parents should be instructed to monitor their childs
temperature daily because of the risk for infection, but it is not necessary to
take a blood pressure daily. Fluid is never withheld as a precaution against
increased intracranial pressure. If a child had confirmed CNS involvement
with increased intracranial pressure, limiting fluid intake might be more
appropriate. Children who are immunosuppressed should not receive any live
virus vaccines.
2. What is the most appropriate nursing action when the nurse notes a reddened area
on the forearm of a neutropenic child with leukemia?
a. Massage the area.
b. Turn the child more frequently.
c. Document the finding and continue to observe the area.
d. Notify the physician immediately.
, ANS: D
Any signs of infection in a child who is immunosuppressed must be reported
immediately because it is considered a medical emergency. When a ch ild is
neutropenic, pus may not be produced and the only sign of infection may be
redness. In a child with neutropenia, a reddened area may be the only sign of
an infection. The area should never be massaged. The forearm is not a typical
pressure area; therefore, the likelihood of the redness being related to
pressure is very small. The observation should be documented, but because it
may be a sign of an infection and immunosuppression, the physician must
also be notified.
3. What is the nurses best response to a mother whose child has a diagnosis of acute
lymphoblastic leukemia and is expressing guilt about not having responded
sooner to her childs symptoms?
a. You should always call the physician when your child has a change in
what is normal for him.
b. It is better to be safe than sorry.
c. It is not uncommon for parents not to notice subtle changes in their
childrens health.
d. I hope this delay does not affect the treatment plan.
ANS: C
Suggesting that noticing subtle changes in their childrens health is not
uncommon minimizes the role the mother played in not seeking early medical
attention. It also displays empathy, which helps to build trust, thereby
enabling the mother to talk about her feelings. Identifying concerns and
clarifying misconceptions will help families cope with the stress of chronic
illness. The goal is to relieve the mothers guilt and build trust so that she can
talk about her feelings. Telling the mother that she should have called the
