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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Prepare the child and family for a bone marrow biopsy to confirm diagnosis and classify leukemia type.
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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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Order a sweat chloride test to rule out cystic fibrosis as a cause of abnormal blood results.
Answer & explanation
Correct: Prepare the child and family for a bone marrow biopsy to confirm diagnosis and classify leukemia type.
When a child's CBC reveals anemia and an elevated lymphoblast count, combined with a peripheral blood smear showing abnormal white blood cell morphology, these findings strongly suggest acute lymphoblastic leukemia, the most common childhood malignancy. The definitive next step is preparing the child and family for a bone marrow biopsy, which confirms the diagnosis and classifies the leukemia type — information essential for determining the appropriate chemotherapy regimen and prognosis. Without histological confirmation from bone marrow analysis, treatment cannot begin. A psychiatric evaluation for anxiety about blood draws is not a clinical priority and would delay necessary diagnostic workup. Administering a blood transfusion immediately to correct anemia is premature; while anemia may eventually require transfusion, treatment decisions must await a confirmed diagnosis, and transfusing without understanding the underlying cause could complicate the diagnostic picture. Ordering a sweat chloride test to rule out cystic fibrosis is unrelated to the presentation; cystic fibrosis does not cause elevated lymphoblasts or abnormal white cell morphology on peripheral smear. This question is categorized under Maternal-Newborn in the course field but is clearly a pediatric oncology question; the correct clinical reasoning points to bone marrow biopsy as the priority action.
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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?