The nurse should concern for which while a child who is on chemotherapy?

NORCET 5 Prelims - Sept 2023 (Shift-1)

Child Health Nursing (Pediatrics)

Medium

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

Explanation

The primary concern for a child on chemotherapy is the risk of life-threatening infection due to myelosuppression (bone marrow suppression).
Chemotherapy drugs suppress the production of white blood cells (neutropenia), leaving the child's immune system unable to fight off pathogens.
Therefore, protecting the child from sources of infection, such as contact with sick individuals, is the highest nursing priority.
This intervention is a core component of neutropenic precautions, which are essential for immunocompromised patients.

Option B: Hourly vital sign monitoring is excessive and not standard practice unless the child is clinically unstable (e.g., in septic shock or having an acute infusion reaction).
Option C: Fluid intake should be encouraged, not restricted, to promote the excretion of chemotherapy drugs and prevent renal toxicity, such as hemorrhagic cystitis.
Option D: Complete restriction of physical activity leads to deconditioning, fatigue, and other complications. Activity should be encouraged as tolerated to maintain muscle strength and well-being.

Visual 1: Infographic: 'Neutropenic Precautions.' This visual would list key infection control measures for patients with low white blood cell counts, such as strict hand hygiene, no fresh flowers/fruits, avoiding crowds, and wearing a mask.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing care for a pediatric patient undergoing chemotherapy, focusing on infection control to guide bedside assessment, documentation, and the next nursing action.
Patient and family education is a critical nursing role. The nurse must teach the family how to recognize early signs of infection (fever, chills, sore throat) and when to seek immediate medical attention.
A fever in a neutropenic child is a medical emergency. The nurse's immediate actions include obtaining blood cultures and administering broad-spectrum antibiotics as prescribed, often within the first hour.
What if? If the child's platelet count was critically low (e.g., less than 20,000/mm³), the priority would shift to include bleeding precautions. In this case, limiting activities that could cause injury (related to Option D) would become a much higher priority, although infection risk remains critical.

How to Approach the Question

First, identify the core subject: nursing care for a child on chemotherapy.
Recall the primary and most life-threatening side effects of chemotherapy. Myelosuppression (leading to neutropenia, anemia, and thrombocytopenia) is the most critical.
Prioritize the side effects. The risk of infection from neutropenia is often the most immediate life-threatening concern.
Evaluate each option against this priority. Does the action address the risk of infection, bleeding, or anemia appropriately?
Eliminate options that are contraindicated. Fluid restriction and complete activity restriction are generally incorrect for chemotherapy patients.
Select the option that directly addresses the highest priority risk, which is preventing infection.

Concept Tested & Keywords

Concept Tested: Nursing care for a pediatric patient undergoing chemotherapy, focusing on infection control.
Stem keywords: child, chemotherapy, nurse, concern
Lead-in keywords: which
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

QTJmCK2BWfaRbXSiX6COcW