The nurse should be concerned for which while a child is on chemotherapy?

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-1)

Explanation

Chemotherapy causes myelosuppression, leading to neutropenia, which is a significant decrease in infection-fighting white blood cells.
A compromised immune system makes the child extremely vulnerable to bacteria, viruses, and fungi.
Even a minor infection can quickly become life-threatening sepsis in a neutropenic child.
Therefore, preventing exposure to pathogens by avoiding contact with sick individuals is the most critical nursing priority.

Option B: Monitoring vitals hourly is excessive for a stable child. Standard protocol is typically every 4 hours.
Option C: Fluid restriction is generally contraindicated. Children on chemotherapy are at risk for dehydration from side effects like vomiting and diarrhea, so encouraging fluids is important.
Option D: Completely restricting all physical activity is unnecessary and can lead to deconditioning. Light activity is encouraged as tolerated.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing care for a pediatric patient with chemotherapy-induced immunosuppression to guide bedside assessment, documentation, and the next nursing action.
The nurse's primary role is to implement and enforce strict infection control measures, known as neutropenic precautions, to protect the immunocompromised child.
Patient and family education is a crucial nursing responsibility. This includes teaching how to create a safe home environment by emphasizing handwashing, avoiding crowds, and screening visitors for illness.
A fever of 38°C (100.4°F) or higher in a neutropenic child is a medical emergency. This condition, known as febrile neutropenia, requires immediate medical evaluation and initiation of broad-spectrum antibiotics to prevent rapid progression to sepsis.

How to Approach the Question

First, identify the core clinical context of the question: a child receiving chemotherapy.
Recall the most significant and life-threatening side effect of most chemotherapy regimens, which is bone marrow suppression (myelosuppression).
Understand that myelosuppression leads to neutropenia, a condition that drastically increases the risk of severe infection.
Evaluate each option based on this primary risk. Option A directly addresses infection prevention, making it the highest priority.
Analyze the other options. Recognize that hourly vitals, fluid restriction, and total activity restriction are not standard, universal care measures for this patient population and are often contraindicated.
Conclude that protecting the child from infection is the most critical and universally applicable nursing concern.

Concept Tested & Keywords

Concept Tested: Nursing care for a pediatric patient with chemotherapy-induced immunosuppression.
Stem keywords: child, chemotherapy, nurse, concerned
Lead-in keywords: which
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 893-895

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) p. 133-135

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 7-9

Practise the full NORCET 5 Prelims - Sept 2023 (Shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.