RN Nursing · Oncological Disorders in Children · Practice question
A 7-year-old child suspected of having leukemia has a CBC and peripheral blood smear ordered. The CBC shows anemia and an increased number of lymphoblasts, while the peripheral smear reveals abnormal-shaped white blood cells. Based on these findings, what is the nurse's priority action?
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Order a sweat chloride test to rule out cystic fibrosis as a cause of abnormal blood results.
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Schedule the child for a psychiatric evaluation to address potential anxiety about blood draws.
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Administer a blood transfusion immediately to correct the anemia noted in the CBC.
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✓
Prepare the child and family for a bone marrow biopsy to confirm diagnosis and classify leukemia type.
Answer & explanation
Correct: Prepare the child and family for a bone marrow biopsy to confirm diagnosis and classify leukemia type.
When a child presents with clinical and laboratory findings strongly suggestive of leukemia — including anemia, an elevated number of lymphoblasts on the complete blood count, and abnormal white blood cells on peripheral smear — the definitive next step is a bone marrow biopsy. This procedure is required to confirm the diagnosis of leukemia, determine the specific subtype (such as acute lymphoblastic leukemia versus acute myeloid leukemia), and classify the disease for treatment planning. The nurse's role is to prepare both the child and the family for this procedure through age-appropriate education, emotional support, and procedural teaching. Ordering a sweat chloride test is inappropriate here because cystic fibrosis does not explain lymphoblastosis or abnormal white cell morphology; that test is used to diagnose cystic fibrosis, which presents with respiratory and gastrointestinal symptoms, not hematological malignancy. Scheduling a psychiatric evaluation does not address the medical urgency of a suspected hematological malignancy and would inappropriately delay diagnosis. Administering a blood transfusion immediately is not a priority action; while the child has anemia, transfusion is not indicated until the diagnosis is confirmed and the degree and symptomatic impact of anemia are fully evaluated by the oncology team.
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- A 7-year-old child suspected of having leukemia has a CBC and peripheral blood smear ordered. The CBC shows anemia and an increased number of lymphoblasts, while the peripheral smear reveals abnormal-shaped white blood cells. Based on these findings, what is the nurse's priority action?