A nurse is planning care for a child who has neutropenia due to leukemia. Which of the following interventions should the nurse include in the plan of care?

Screen the child's visitors for active infections.

Monitor the child for indications of active bleeding.

Initiate a low-protein diet for the child.

Prepare the child for a platelet transfusion.

Answer and Explanation

The Correct Answer is A

A. Screen the child's visitors for active infections: Children with neutropenia have a significantly reduced ability to fight infections due to low neutrophil counts. Screening visitors for signs of infection helps prevent exposure to pathogens, which is a critical infection-control measure in neutropenic patients.

B. Monitor the child for indications of active bleeding: While monitoring for bleeding is important in leukemia, bleeding risk is primarily related to thrombocytopenia, not neutropenia. This intervention is relevant but not the priority for infection prevention.

C. Initiate a low-protein diet for the child: A low-protein diet is not indicated and may be harmful, as children with leukemia require adequate protein for growth, immune function, and recovery. Dietary restrictions should focus on food safety, not protein limitation.

D. Prepare the child for a platelet transfusion: Platelet transfusions are indicated for thrombocytopenia, not neutropenia. While supportive care may include transfusions, infection prevention through visitor screening is more directly related to neutropenic risk.

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Correct Answer is A

Explanation

A. Respiratory rate 10/min: Magnesium sulfate can cause central nervous system depression, and respiratory depression is a life-threatening adverse effect. A respiratory rate below 12/min indicates potential magnesium toxicity and requires immediate intervention, making it the priority assessment finding.

B. 2+ deep-tendon reflexes: A reflex grade of 2+ is normal and indicates that neuromuscular function is intact. While deep-tendon reflexes are monitored for magnesium toxicity, this finding does not represent an immediate threat.

C. 3+ pedal edema: Peripheral edema is a common finding in preeclampsia due to fluid shifts and vascular permeability. While it requires monitoring, it is not immediately life-threatening compared with respiratory depression.

D. Urinary output 35 mL/hr: Although reduced urine output can increase the risk of magnesium accumulation, 35 mL/hr is slightly below normal but not critically low. Monitoring is necessary, but the priority remains the depressed respiratory rate.

A. Obtain a provider order for vaginal/anal culture. B. Obtain a provider prescription for antibiotics. C. Obtain a provider prescription for ibuprofen 600 mg every 6 hr for mild to moderate pain. D. Obtain a provider prescription for phenazopyridine. E. Obtain a provider order for a urine culture.

Correct Answer is ["B","D","E"]

Explanation

A. Obtain a provider order for vaginal/anal culture: A vaginal or anal culture is not indicated at this time because the client’s symptoms—dysuria, urinary frequency, and positive leukocyte esterase—are consistent with a urinary tract infection rather than a sexually transmitted infection or perianal infection.

B. Obtain a provider prescription for antibiotics: The client demonstrates signs of a urinary tract infection, including dysuria, positive leukocyte esterase, elevated WBC count, and cloudy urine. Prompt initiation of antibiotics is important in pregnancy to prevent complications such as pyelonephritis and preterm labor.

C. Obtain a provider prescription for ibuprofen 600 mg every 6 hr for mild to moderate pain: Ibuprofen is generally avoided during the third trimester because it can cause premature closure of the fetal ductus arteriosus and oligohydramnios. Alternative analgesics that are safe in pregnancy should be used instead.

D. Obtain a provider prescription for phenazopyridine: Phenazopyridine is a urinary analgesic that can help relieve dysuria and urinary discomfort while the client awaits antibiotic therapy. It does not treat the infection itself but improves client comfort.

E. Obtain a provider order for a urine culture: A urine culture is indicated to confirm the presence of infection and identify the causative organism. This ensures that antibiotic therapy can be tailored appropriately, which is especially important in pregnancy to reduce maternal and fetal complications.

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Body System	Findings
Gastrointestinal	Client states, "I'm nauseated all the time. I vomit a few times a day, too." Client states, "I've been a little constipated, but it's not too bad." Abdomen without tenderness on palpation. Bowel sounds hypoactive. Oral mucous membranes sticky.
Genitourinary	Also reports they are urinating less and that urine is dark yellow and odorous. Clean-catch urine specimen obtained. Urine noted to be dark yellow and concentrated
Cardiovascular	Heart rate regular. No edema. Heart rate 92/min Blood pressure 102/66 mm Hg

A nurse is planning care for a child who has neutropenia due to leukemia. Which of the following interventions should the nurse include in the plan of care?

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