A nurse works on a pediatric oncology unit. After receiving report, which child should the nurse assess first?
A.
Having infusion of D5 NS and sodium bicarbonate
B.
On high-dose methotrexate (Rheumatrex), urine pH of 7.8
C.
Receiving cyclophosphamide (Cytoxan), urine specific gravity of 1.008
D.
2 days post-tumor resection, complaining of pain
ANS: B
Patients on high-dose methotrexate need their urine pH to be higher than 7.0. This child needs the nurse's attention first. An IV with NaHCO3 is common prior to receiving methotrexate. A urine specific gravity of ≤ 1.010 is required for children on chemotherapy. Pain would be an expected finding 2 days postoperatively, and should be treated, but not before the nurse assesses the other child.
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