Health Promotion and Maintenance
39. A child is receiving chemotherapy for the treatment of osteosarcoma. Which morning laboratory result must a nurse report immediately to the physician?
Health Promotion and Maintenance
39. A child is receiving chemotherapy for the treatment of osteosarcoma. Which morning laboratory result must a nurse report immediately to the physician?
. Absolute neutrophil count of 1200.
. Platelet count of 150,000.
. Urine dipstick positive for heme.
. WBC count of 4500.
Test-Taking Tip
When given laboratory values, consider both the range of normal values as well as expected values for given medical conditions. Pay attention to those values that are abnormal for the child even with the stated diagnosis and treatment.
Content Area: Child Health, Oncology; Integrated Process: Nursing Process, Evaluation; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Laboratory Values
Health Promotion and Maintenance
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Answer 1 is incorrect because an absolute neutrophil count (ANC) of 1200 is just below the normal range of 1500 or greater. This slightly low value is not unexpected for a child with cancer who is receiving chemotherapy. An ANC of less than 500 should be reported since this would meet the criteria for neutropenia. Answer 2 is incorrect because this is within the range of normal (150,000 to 400,000) for the platelet count. If the platelet count fell below 100,000, the physician should be notified. Answer 3 is correct because a positive urine dipstick for the presence of red blood cells could indicate hemorrhagic cystitis, a complication of chemotherapy agents, including cyclophosphamide and ifosfamide. This finding should be communicated immediately to the physician. Answer 4 is incorrect because a white blood cell (WBC) count of 4500 is just below the range of normal (5000 to 10,000), which is expected for a child receiving chemotherapy.