A nurse is reviewing the medical record of a 24-month-old child who has acute lymphocytic leukemia.Which of the following actions should the nurse take?

Choice A rationale

While it’s important for a child to have adequate sleep, waiting until the child indicates that they are tired before putting them to bed may not be the best approach. Children often do not recognize their own signs of fatigue and may become overtired, which can actually make it more difficult for them to fall asleep and stay asleep.

Choice B rationale

Allowing a child to watch an animated movie before bedtime may seem like a harmless routine, but it can actually interfere with their sleep. The light from the screen can suppress the production of melatonin, the hormone that regulates sleep, and the content of the movie can be stimulating rather than relaxing.

Choice C rationale

Waking your child up during a night terror can be beneficial. Night terrors occur during the deepest stages of sleep and can be frightening for both the child and the parents. By gently waking your child before the usual time of a night terror, you can interrupt the sleep cycle and potentially prevent the night terror from occurring.

Choice D rationale

While it may be tempting to allow your child to sleep in your bed, especially if they are experiencing night terrors, this is not typically recommended. Co-sleeping can create a dependency and make it more difficult for the child to learn to self-soothe and fall asleep independently.

The correct answer is C.

Choice A reason: A White Blood Cell (WBC) count of 20,000/mm³ is significantly higher than the normal range for children, which is typically between 5,000 to 10,000/mm³. In the context of acute lymphoblastic leukemia (ALL), a high WBC count could indicate an active disease process or a reaction to treatment, rather than a therapeutic effect.

Choice B reason: A hemoglobin level of 5.5 g/dL is quite low, as the normal range for children is generally between 11 to 16 g/dL. This level of hemoglobin suggests anemia, which is a common condition in patients with leukemia due to the disease itself or as a side effect of chemotherapy. It does not necessarily indicate that the treatment is having a therapeutic effect.

Choice C reason: A Platelet count of 150,000/mm³ is within the lower end of the normal range for children, which is approximately 150,000 to 450,000/mm³. This can be considered a sign that the treatment is working effectively, as it indicates bone marrow recovery and the production of platelets is returning to normal levels.

Choice D reason: A Red Blood Cell (RBC) count of 3/mm³ is extremely low. The normal range for children’s RBC count is about 4 million to 5.5 million/mm³. Such a low RBC count would indicate severe anemia and is not a sign of effective treatment for ALL.