CH 46 PREP U
Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? "It will help rule out a second malignancy." "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." "The spinal tap will help relieve pressure and headache for your child." "A sample of cerebrospinal fluid is needed to check for possible central nervous system infection."
"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." Explanation: The cerebrospinal fluid is checked so the clinician can determine whether leukemic cells have invaded the central nervous system. It is common for a chemotherapy medication, usually methotrexate, to be administered immediately following lumbar puncture as treatment for potential infiltration.
A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the nurse to provide? "Sickle cell disease occurs from a random genetic mutation." "Sickle cell disease is passed to a fetus when both parents have the gene." "Sickle cell disease is passed to a fetus when one of the parents has the gene." "Sickle cell diseas can be passed to the fetus in many ways. We will know more at birth."
"Sickle cell disease is passed to a fetus when both parents have the gene." Explanation: Sickle cell disease is an inherited disease. The recessive gene is passed from both parents who either have the disease or the trait. There is no need for further testing to determine the cause. There are no other ways to pass the disease other than through genetics. Informing the parents that the gene was passed from both parents is most informative. Sickle cell anemia is not a dominant disease, which is passed when only one parent has the gene, nor is caused by a random mutation.
The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? Calling the doctor if the child gets a sore throat Keeping a written copy of the treatment plan Writing down phone numbers and appointments Using acetaminophen if the child needs an analgesic
Calling the doctor if the child gets a sore throat Explanation: Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points—but secondary to guarding against infection.
The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of: Ewing sarcoma. Hodgkin disease. non-Hodgkin lymphoma. neuroblastoma.
Ewing sarcoma. Explanation: Radiographs that show lesions on the bone may indicate tumors (e.g., Ewing sarcoma, osteosarcoma) or metastasis of tumors. Osteosarcoma is the most common type of bone malignancy in children. It occurs primarily in the long bones. Ewing sarcoma is a highly malignant bone cancer. It occurs in the pelvis, chest wall, vertebrae, and midshaft of the long bones. Neuroblastomas are seen in children younger than 5 years old and arise from immature nerve cells and the adrenal glands. Hodgkin disease develops from the immune system. Non-Hodgkin lymphoma is a blood cancer.
A 15-year-old client diagnosed with von Willebrand disease has reached menarche. Based on this fact, what information is most important for the nurse to convey to the client? Bruising may occur in the perineal area. Expect menstrual bleeding to be heavy. Occasional skipped periods can be expected. The duration of each period will be short.
Expect menstrual bleeding to be heavy. Explanation: Females diagnosed with von Willebrand disease are at risk for menorrhagia. Bruising in the perineal area is not a risk unless there is some sort of trauma at the site. Von Willebrand disease does not cause intermittent periods or shorten the duration of menses.
Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? Ineffective tissue perfusion related to poor platelet formation Risk for altered urinary elimination related to kidney impairment Risk for infection related to abnormal immune system Ineffective breathing pattern related to decreased white blood count
Ineffective tissue perfusion related to poor platelet formation Explanation: Idiopathic thrombocytopenic purpura (ITP) results from an immune response following a viral infection that produces antiplatelet antibodies. These antibodies destroy the platelets which cause petechiae, purpura, and excessive bleeding. ITP does not affect the kidneys. Breathing difficulties would not occur with decreased white blood cells. It occurs when there is decreased red blood cells. The child who develops ITP has no different immune system than other children who are healthy
The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis? Slightly yellow sclera Enlarged mandibular growth Increased growth of long bones Depigmented areas on the abdomen
Slightly yellow sclera Explanation: In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not manifestations of this health problem.
A group of nursing students are reviewing the different types of chemotherapeutic agents used to treat childhood cancers. The students demonstrate understanding of the information when they identify which as antimetabolites? Select all that apply. mitoxantrone cytarabine hydroxyurea dactinomycin carboplatin
cytarabine hydroxyurea Explanation: Cytarabine and hydroxyurea are antimetabolites. Mitoxantrone and dactinomycin are antitumor antibiotics. Carboplatin is a miscellaneous agent.
A 5-year-old client has been diagnosed with leukemia and is currently on chemotherapy and radiation. The child is having difficulty due to mucositis. Which is the most appropriate nursing diagnosis for this child? Pain due to neoplastic process in bone Disturbed body image related to loss of hair after chemotherapy Compromised family coping related to long-term chemotherapy regimen Risk for imbalanced nutrition, less than body requirements, related to inflammation
Risk for imbalanced nutrition, less than body requirements, related to inflammation Explanation: Mucositis is inflammation of the oral mucosa, which puts this child at risk for risk for imbalanced nutrition. The client may have pain due to neoplastic process in the bone, but that is not mentioned in the scenario. The client may have lost hair, but that is not mentioned. The client's family coping is also not mentioned.
The nurse is assessing a 4-year-old girl whose mother reports that she is not eating well, is losing weight, and has started vomiting after eating. Which risk factor from the health history suggests the child may have a Wilms tumor? The child has Down syndrome. The child has Beckwith-Wiedemann syndrome. The child has Schwachman syndrome. There is a family history of neurofibromatosis.
The child has Beckwith-Wiedemann syndrome. Explanation: Along with the symptoms reported by the mother, the fact that the child has Beckwith-Wiedemann syndrome suggests that the child could have a Wilms tumor. Down syndrome would point to leukemia or brain tumor. Schwachman syndrome would suggest leukemia. A family history of neurofibromatosis is a risk factor for brain tumor, rhabdomyosarcoma, or acute myeloid leukemia
A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which would the nurse include as an adjunctive measure to control bleeding? compression heat exercise lowering extremities
compression Explanation: Complications associated with bleeding most often involve joints and muscles. Adjunct measures include rest, ice, compression, and elevation (RICE). In addition, corticosteroids such as prednisone may be used to reduce inflammation in the joint.
The nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains to a family how the test works. Which response accurately describes this test? "The MRI uses radio waves and magnets to produce a computerized image of the body." "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." "The MRI uses sound waves to create images that visualize body structures and locate masses." "The MRI uses radiation to examine soft tissue and bony structures of the body."
"The MRI uses radio waves and magnets to produce a computerized image of the body." Explanation: The MRI uses radio waves and magnets to produce a computerized image of the body. The bone scan is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement. The ultrasound uses sound waves to create images that visualize body structures and locate masses. Radiography uses radiation to examine soft tissue and bony structures of the body.
A 9-year-old child with leukemia is scheduled to undergo an allogeneic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? "We'll need to have a match to a donor." "The risk for rejection is much less with this type of transplant." "You won't need to receive the high doses of chemotherapy before the transplant." "You'll need to have an incision in your hip area to instill the cells."
"We'll need to have a match to a donor." Explanation: An allogeneic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.
The child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1 oral steroids and vincristine through an intravenous line 2 high-dose methotrexate and 6-mercaptopurine 3 low doses of 6-mercaptopurine and methotrexate 4 chemotherapy through an intrathecal catheter
-oral steroids and vincristine through an intravenous line -high-dose methotrexate and 6-mercaptopurine -low doses of 6-mercaptopurine and methotrexate -chemotherapy through an intrathecal catheter Explanation: During induction, the child receives oral steroids and IV vincristine. During consolidation, the child receives high doses of methotrexate and 6-mercaptopurine. During maintenance, the child receives low doses of methotrexate and 6-mercaptopurine. During central nervous system prophylaxis, the child receives intrathecal chemotherapy.
The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which action is contraindicated in the client's care? Intravenous fluids Abdominal palpation Foley catheter placement Supine positioning
Abdominal palpation Explanation: Abdominal palpation is contraindicated preoperatively in a client with a Wilms tumor. Cells may break loose and spread the tumor. Intravenous fluids and supine positioning are appropriate in the client's care. A Foley catheter is typically not placed.
A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform? Administer broad-spectrum antibiotics intravenously. Maintain fluid restriction to below maintenance levels. Monitor serum sodium levels. Administer diuretics.
Administer broad-spectrum antibiotics intravenously. Explanation: Typhlitis (neutropenic enterocolitis) is an inflammatory process of the gastrointestinal tract that occurs with the induction phase of leukemia chemotherapy. The recommended interventions for treatment are to administer broad-spectrum antibiotics or antifungals intravenously, provide supportive care to manage symptoms, and provide IV nutrition. The client should be kept NPO. The nurse should assess for any signs of bowel perforation or shock. Administering diuretics would not be needed and may cause harm. Monitoring sodium levels as well as other electrolytes would be necessary to evaluate IV nutrition.
Antiemetics are prescribed to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications? Administer the antiemetic before starting chemotherapy. Provide the antiemetic as needed (PRN) when nausea and vomiting are reported. Use the antiemetic after it is clear that nonpharmacologic methods are not effective. Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea.
Administer the antiemetic before starting chemotherapy. Explanation: Antiemetics are most effective when given before chemotherapy begins and then on a regular schedule to prevent nausea and vomiting throughout administration of chemotherapy. Nonpharmacologic measures can be used in conjunction with antiemetics but not in place of them. To wait to implement these measures could result in malnutrition.
The father of an 8-year-old boy who is receiving radiation therapy is upset that his son has to go through 6 weeks of treatments. He doesn't understand why it takes so long. In explaining the need for radiation over such a long time, what should the nurse mention? Cells are only susceptible to treatment by radiation during certain phases of the cell cycle It is difficult to locate where the cancer cells are in the body, so the entire body must be irradiated Radiation therapy is very weak, and therefore it takes a long time to achieve therapeutic doses Insurance companies typically allow only a short radiation treatment per week, to contain costs
Cells are only susceptible to treatment by radiation during certain phases of the cell cycle Explanation: Radiation is not effective on cells that have a low oxygen content (a proportion of cells in every tumor), nor is it effective at the time of cell division (mitosis). Therefore, radiation schedules are designed so that therapy occurs over a period of 1 to 6 weeks and includes time intervals when cells will be in a susceptible stage.
A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately? Adult cancers are more responsive to treatment than are those in children. Children's cancers, unlike those of adults, often are detected accidentally, not through screening. Environmental and lifestyle influences in children are strong, unlike those in adults. Little is known regarding cancer prevention in adults, although much prevention information is available for children.
Children's cancers, unlike those of adults, often are detected accidentally, not through screening. Explanation: Children's cancers are often found during a routine checkup, following an injury, or when symptoms appear—not through screening procedures or other specific detection practices. A very small percentage of children may be followed closely because they are known to be at high risk genetically. Most children's cancers are highly responsive to therapy. Few prevention strategies are available for children, although many are known to be effective for adults. Several lifestyle and environmental influences regarding children's cancers are suspect, but few have been scientifically documented. The reverse is true in the adult population.
A child is diagnosed with sickle cell anemia. Which test will the nurse expect the primary health care provider to prescribe for this client? Hemoglobin level Leukocyte level Thrombocyte level Metabolic screening test
Hemoglobin level Explanation: The component of red blood cells (RBCs) that allows them to carry out the transport of oxygen is hemoglobin, composed of the protein globin and heme, an iron-containing pigment. Fetal hemoglobin differs from adult hemoglobin; for this reason, diseases such as sickle cell anemia or the Thalassemias, which are disorders of the beta chains, do not become clinically apparent until this hemoglobin change has occurred (at approximately 6 months of age). Leukocyte and thrombocyte levels are not typically tested in clients with sickle cell anemia. Metabolic screening is a test completed on newborns to assess for common metabolic disorders, such as sickle cell anemia, hypothyroidism, and phenylketonuria (PKU). However, this test is used to diagnose, not determine symptom severity or prognosis
The nurse is caring for a child admitted with suspected leukemia. The nurse has taken the child's history and performed an assessment. The nurse will plan to prepare the child for which additional diagnostic test first? urinalysis complete blood cell count (CBC) bone marrow aspiration magnetic resonance imaging (MRI)
complete blood cell count (CBC) Explanation: After obtaining the child's history and symptoms, the nurse would prepare the child for laboratory blood studies to assess the child's white blood cell (WBC) count. A complete blood cell (CBC) count will provide data on the child's WBC level. A bone marrow aspiration would be scheduled based on the results of the CBC as it is required to confirm the diagnosis of leukemia. A urinalysis is done for many disorders. In regard to childhood cancers, it is done to assist assessment for neuroblastoma. MRIs can also be done for many disorders. Brain tumors are common childhood cancers where MRIs are used.
A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor? headache, vision changes, and vomiting projectile vomiting, lethargy, and coma headache, epistaxis, and dizziness nystagmus, ataxia, and seizures
headache, vision changes, and vomiting Explanation: Children with any form of brain tumor develop symptoms of increased intracranial pressure: headache, vision changes, vomiting, an enlarging head circumference, or papilledema. Lethargy, projectile vomiting, and coma are late signs. Epistaxis is not usually related to a brain tumor. A growing tumor produces specific localized signs, such as nystagmus (constant horizontal movement of the eye) or visual field defects. As tumor growth continues, symptoms of ataxia, personality change (e.g., emotional lability, irritability), and seizures may occur. These would be later symptoms.
A pediatric nurse is conducting a class for a group of nursing students about children with cancer. The nurse determines that the teaching was successful when the class identifies which as reflecting typical signs of pediatric cancers? Select all that apply. pain related to compression, infiltration, or obstruction caused by the tumor secretion of a substance by the tumor that interferes with normal organ function changes in bowel or bladder habits with rectal bleeding unusual lump or nonhealing wound Alterations caused by tumor metabolism or cell death
pain related to compression, infiltration, or obstruction caused by the tumor secretion of a substance by the tumor that interferes with normal organ function Alterations caused by tumor metabolism or cell death Explanation: Childhood cancer symptoms are compression, infiltration, or obstruction caused by the tumor; changes in blood cell production such as decreased hemoglobin, hematocrit, white blood count, or platelets; secretion of a substance by the tumor that interferes with normal organ functioning; and metabolic, electrolyte, hormonal, or immunologic alterations caused by tumor metabolism or cell death.
The nurse is reviewing the medical record of a child diagnosed with Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child? painless, enlarged lymph node anorexia weight loss night sweats
painless, enlarged lymph node Explanation: Children with Hodgkin lymphoma typically present with swollen, painless, and rubbery-feeling lymph nodes in the cervical or supraclavicular region. Depending on the extent of the disease at diagnosis, other symptoms may be present. However, this child was diagnosed in stage I (asymptomatic). If the lymph nodes of the chest are involved, the child has moved to the symptomatic stages and may experience dyspnea and cough. Chest pain may result from the pressure exerted by the enlarged nodes. General symptoms can also include fever, drenching night sweats, and weight loss.
The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning? "I brush my child's teeth once every day." "My child's stools are darker than usual." "I mix ferrous sulfate with milk in a bottle." "My child takes ferrous sulfate after meals."
"I mix ferrous sulfate with milk in a bottle." Explanation: Ferrous sulfate may not be absorbed if taken with milk or tea, and if the parent mixes the medicine with milk in a bottle, there is also concern that if the child does not drink the entire amount of medication. Ferrous sulfate may be taken after meals to prevent gastrointestinal irritation. Dark stools are a common side effect of ferrous sulfate. Parents should be encouraged to brush the child's teeth thoroughly to prevent teeth staining.
The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? Plotting height and weight on a growth chart Assessing dietary intake by addressing "picky eating" and "food jags" Administering the measles, mumps, rubella (MMR) vaccine Teaching the importance of taking water safety measures
Administering the measles, mumps, rubella (MMR) vaccine Explanation: Live vaccines (viral or bacterial) should not be administered to an immunosuppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the toddler and should be included during the well-child visit.
The nurse is providing preoperative care for a 7-year-old boy with a brain tumor, as well as his parents. Which intervention is a priority? Assessing the child's level of consciousness. Providing a tour of the intensive care unit. Educating the child and parents about shunts. Having the child talk to another child who has had this surgery.
Assessing the child's level of consciousness. Explanation: The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure. Lower priority interventions include providing a tour of the ICU to prepare the child and parents for after the surgery, and educating the child and parents about shunts.
The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia (ALL)." What will confirm this diagnosis? Complete white blood count Lethargy, bruising, and pallor History of leukemia in twin Bone marrow aspiration
Bone marrow aspiration Explanation: Bone marrow aspiration and biopsy are diagnostic. An abnormal white blood count and symptoms of lethargy, bruising, and pallor only create suspicion of leukemia; a twin may or may not be affected.
The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Encourage therapeutic play activities. Monitor daily complete blood count (CBC). Ensure neutropenic precautions are in place. Remind parents to contact the child's school.
Ensure neutropenic precautions are in place. Explanation: With stem cell transplants, children are at greatest risk for infection and sepsis. The nurse should ensure neutropenic precautions are used to reduce the change of infection. Monitoring laboratory values, reminding the parent to contact the school, and encouraging therapeutic play are important, but preventing infection in the immunocompromised child is a priority.
The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen? Loss of appetite Nighttime itching Urinary incontinence Facial changes
Facial changes Explanation: Facial changes are common and include a round face with full cheeks, often reddened, described as "moon face." Weight gain and fat pads may appear in various areas of the body. Appetite is likely to increase. Urinary incontinence and nighttime itching are not related to steroid therapy.
A high school football player has been diagnosed as having osteosarcoma of the femur. The parents are angry because they told their adolescent not to play football. Which health teaching points will the nurse include in the teaching plan for the adolescent and parents? Osteosarcoma often follows trauma, such as a football injury. There will be some discoloration of the leg following chemotherapy. Football injuries do not contribute to the development of a tumor. Tumor growth is related to the adolescent's dislike of milk.
Football injuries do not contribute to the development of a tumor. Explanation: Osteosarcoma is the most malignant form of bone cancer. It is caused by the embryonic mesenchymal tissue that forms in the bones. A football injury may predispose more scrutiny of a lesion, but it will not be the cause of the cancer, nor will the dislike of milk. Osteosarcoma may be treated with chemotherapy and radiation. It may also involve an amputation. The parents who state they are angry at their adolescent for playing football are more likely projecting their fears of the diagnosis and the future for their adolescent.
A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? Restricting the child's visitors Placing a "no abdominal palpation" sign above the child's bed Ensuring that the child be allowed nothing by mouth Preparing the child for chemotherapy Preventing weight-bearing activities
Placing a "no abdominal palpation" sign above the child's bed Explanation: Nephroblastoma (Wilms tumor) metastasizes rapidly, so it is important that the child's abdomen not be palpated any more than necessary for diagnosis, because handling appears to aid metastasis. There is no need to restrict the child's visitors. Ensuring nothing by mouth would be appropriate prior to surgery. Preventing weight-bearing activities would be appropriate for a child with Ewing sarcoma.
A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease? elevated lymphocytes Reed-Sternberg cells T-lymphocyte surface markers megakaryocyte cells
Reed-Sternberg cells Explanation: With Hodgkin disease, lymphocytes proliferate in the lymph glands, and special Reed-Sternberg cells (large, multinucleated cells that are probably nonfunctioning monocyte-macrophage cells) develop. Although these lymphocytes are capable of DNA synthesis and mitotic division, they are abnormal because they lack both B- and T-lymphocyte surface markers and cannot produce immunoglobulins as do usual B-lymphocytes. There will be elevated lymphocytes, but this is present in leukemias as well. T-lymphocyte surface markers are lacking in Hodgkin disease. Megakaryocyte cells are normal cells in the bone marrow and produce platelets.
The nurse is talking with a 9-year-old child diagnosed with acute leukemia who will soon begin chemotherapy. The child expresses worry that when her hair falls out friends won't like her or want to play with her anymore. Which response by the nurse would be best? Reassure the child that her hair will grow back in 3 to 6 months. Tell the child that having chemotherapy is the only way she'll get better. Talk with her and her family about wearing a wig, cap, or scarf. Distract the child with a book or educational computer games.
Talk with her and her family about wearing a wig, cap, or scarf. Explanation: The child undergoing chemotherapy may want to wear a wig, especially when returning to school. Encourage the family to choose the wig before chemotherapy is started so that it matches the child's hair and the child has time to get used to it. A cap or scarf often is appealing to a child, particularly if it carries a special meaning for him or her. The hair will most likely grow back, chemotherapy is necessary, and distraction can decrease the anxiety, but these are not the best responses for this child.
The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate? "The doctor will discuss these findings with you when he comes to the hospital." "These values will help us monitor the disease." "These labs are just common labs for children with this disease." "I'm really not allowed to discuss these findings with you."
This response answers the parent's questions. In the nonsevere form, the granulocyte count remains about 500, the platelets are over 20,000, and the reticulocyte count is over 1%. The other responses do not address what the parents are asking and would block therapeutic communication.
After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with: platelets. factor IX. plasmin. factor VIII.
factor VIII. Explanation: In hemophilia A, the problem is with factor VIII, and in hemophilia B the problem lies with factor IX. Platelets are problematic in idiopathic thrombocytopenic purpura (ITP). Plasmin is involved in the pathophysiologic events of disseminated intravascular coagulation.
The nurse is reviewing the laboratory test results of a child with thalassemia. Which results would the nurse expect to find with the hemoglobin electrophoresis? Select all that apply. hemoglobin F hemoglobin A2 hemoglobin A hemoglobin S
hemoglobin F hemoglobin A2 Explanation: In thalassemia, the hemoglobin electrophoresis would reveal the presence of hemoglobin F and A2 only. Hemoglobin S would be found with sickle cell disease.
A 12-year-old child is suspected of having Hodgkin lymphoma. When preparing the child and family for diagnostic testing, which test would the nurse describe as being used to confirm the diagnosis? 24-hour urine test lymph node biopsy chest computed tomography liver function tests
lymph node biopsy Explanation: Hodgkin lymphoma is confirmed by biopsy of the lymph nodes. Further studies such as bone marrow analysis, liver function tests, chest and abdominal computed tomography scans, lymphangiography, and abdominal biopsy are done to classify the clinical stage of the disorder
The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as: petechiae. purpura. ecchymosis. poikilocytosis.
petechiae. Explanation: Petechiae are pinpoint hemorrhages that occur anywhere on the body and do not blanch with pressure. Purpura are larger areas of hemorrhage in which blood collects under the tissues and appear purple in color. Ecchymosis refers to areas of bruising. Poikilocytosis refers to the variation in the size and shape of the red blood cells commonly found in children with thalassemia.
What are important considerations when the nurse is planning care for the family of a child with cancer? Select all that apply. child's gender prognosis of cancer family's coping strategies prevention and alleviation of pain monitoring for side effects of treatment stage of grief of child, parents, and siblings
prognosis of cancer family's coping strategies prevention and alleviation of pain monitoring for side effects of treatment stage of grief of child, parents, and siblings Explanation: The nurse will need to consider the prognosis, the family's coping, prevention and alleviation of pain, monitoring for side effects of chemotherapy and radiation, and the stage of grief of the child, parents, and siblings. The child's gender is irrelevant to planning nursing care.
The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect? capillary refill in less than 2 seconds pink palms and nail beds absence of bruising spooning of nails
spooning of nails Explanation: A convex shape of the fingernails termed 'spooning' can occur with iron deficiency anemia. Capillary refill in less than 2 seconds, pink palms and nail beds, and absence of bruising are normal findings.
How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old? Call it a tumor of muscle tissue Describe it as a bone tumor Explain that it develops in nerves outside the brain and spinal cord Indicate that the more commonly used name is Hodgkin lymphoma
Call it a tumor of muscle tissue Explanation: A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children.
A child is diagnosed with iron-deficiency anemia. Which diagnostic test results would the nurse expect to be altered? transferrin saturation serum ferritin total iron-binding capacity serum iron level
serum ferritin Explanation: During the first stage of iron deficiency, the depletion of iron stores is most commonly identified by a decrease in serum ferritin. During the second stage, the lack of transport iron is identified primarily by a decrease in transferrin saturation. A decrease in serum iron and an increase in total iron-binding capacity are likely to be evident as well.
The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse, "What causes this disease?" Which response by the nurse would be most appropriate? "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional coagulation." "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood." "ITP is characterized by the loss of surface area on the red blood cell membrane."
"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." Explanation: Idiopathic thrombocytopenic purpura (ITP) is primarily an autoimmune disease, which is an acquired, self-limiting disorder of hemostasis characterized by destruction and decreased numbers of circulating platelets. Hemophilia A and hemophilia B are distinguished by the particular procoagulant factor that is decreased, absent, or dysfunctional. Iron deficiency anemia occurs when the body's iron stores are depleted. Hereditary spherocytosis (HS) is characterized by loss of surface area on the red blood cell membrane.
The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply. Administering oxygen Administering analgesics Maintaining fluid intake Promoting exercise and activity Administering platelets
Administering oxygen Administering analgesics Maintaining fluid intake A vaso-occlusive crisis occurs when sickle-shaped cells are clumped together in a joint or organ. This causes severe pain and hypoxia to the tissues. The management for a vaso-occlusive crisis is to provide adequate pain relief, oxygen to correct the hypoxemia, and increased IV fluids to thin out viscosity and allow the cells to flow in the vascular system. Platelet administration is not indicated as part of the treatment. Children and adults experiencing a sickle cell crisis experience a high degree of pain, so exercise and activity is postponed until the crisis is over. Activity is encouraged when the child is not in crisis as it promotes growth and a positive self-image.
An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom should the nurse most expect as a result of excessive iron deposits? An enlarged spleen An enlarged heart Enlarged lymph nodes An enlarged thyroid gland
An enlarged spleen Explanation: The child with thalassemia major may have both an enlarged spleen and liver due to excessive iron deposits, fibrotic scarring in the liver, and the spleen's increased attempts to destroy defective RBCs.
A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? Iliac crest Sternum Anterior tibia Femur
Iliac crest Explanation: Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.
A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care plan should be given priority? Beginning active range-of-motion exercises Seeing that the child ingests a protein-rich diet Maintaining fluids through an intravenous line Encouraging the child to take deep breaths hourly
Maintaining fluids through an intravenous line Explanation: Sickle cells clump together and prevent normal blood flow. This leads to tissue hypoxia. With a vaso-occlusive crisis, the cells are clumped together and prevent blood flow to the joint or organ. The blood with the clumped sickled cells is very viscous. Adequate hydration is crucial in relieving the problems of a vaso-occlusive crisis. The hydration dilutes the blood and decreases the viscosity. During a crisis the recommended fluid intake (IV and PO) is 150 ml/kg/day. During a vaso-occlusive crisis, the child has severe pain. The goal is to get the pain under control and increase blood flow. Range-of-motion exercises will add to the increased pain during this period of time, so should not be started until crisis in under control. The diet and hourly deep breaths are important, but they are not crucial to correcting the crisis.
The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate? "When I give my son ferrous sulfate I know he also needs potassium supplements." "I always give the ferrous sulfate with meals." "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate."
My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." Explanation: When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black.
Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura? Risk for infection related to abnormal immune system Risk for bleeding related to insufficient platelet formation Risk for altered urinary elimination related to kidney impairment Ineffective breathing pattern related to decreased white blood count
Risk for bleeding related to insufficient platelet formation Explanation: Idiopathic thrombocytopenic purpura is the result of a decrease in the number of circulating platelets in the presence of adequate megakaryocytes, which are precursors to platelets. Because bleeding can occur with this disease process, the diagnosis most appropriate for the client at this time is risk for bleeding related to insufficient platelet formation. Reduced numbers of platelets would not increase the client's risk for infection. Reduced numbers of platelets does not increase the client's risk for renal impairment. Reduced risk of platelets will not lead to an ineffective breathing pattern.
A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child? infection symptoms vital signs mucositis bleeding
infection symptoms Explanation: The neutrophils are the primary means of fighting bacterial infection. When the neutrophil count is very low, the child has the potential to have an overwhelming bacterial infection. The child is at the greatest risk when the neutrophil count is less than 500/µL (0.50 ×109/L). The nurse's priority would be to assess for signs and symptoms of infection. A bacterial infection can be life-threatening for this child. This child would be placed in neutropenic precautions. This is a form of isolation where the child is protected from health care workers and outside visitors. Among other precautions, no plants or raw fruits or vegetables would be allowed in the room, and the child should have no rectal examinations or medications and not experience a urinary catheterization. To prevent an infection, the nurse would administer broad spectrum antibiotics. The vital signs should be assessed every 4 hours, and alterations could indicate more problems than just infection. Mucositis occurs when there is an ulcerated oral mucosa. It should be assessed but is not the priority. Bleeding would be more related to low platelet count and not neutrophils.
A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphoblastic leukemia (ALL)? joint pain and swelling anorexia and weight loss abdominal pain, nausea, and vomiting lethargy, bruises, and lymphadenopathy
lethargy, bruises, and lymphadenopathy Explanation: Although all of these symptoms could be related to leukemia, the most likely are lethargy, bruises, and lymphadenopathy. Joint pain and swelling could also be juvenile arthritis or another disorder. Anorexia and weight loss are fairly nonspecific, as is abdominal pain, nausea, and vomiting. With ALL, because the bone marrow overproduces lymphocytes and therefore is unable to continue normal production of other blood components, the first symptoms of ALL in children usually are those associated with decreased RBC production (anemia) such as pallor, low-grade fever, and lethargy. A low thrombocyte (platelet) count will lead to petechiae and bleeding from oral mucous membranes and cause easy bruising on arms and legs. As the spleen and liver begin to enlarge from infiltration of abnormal cells, abdominal pain, vomiting, and anorexia occur. As abnormal lymphocytes invade the bone periosteum, the child experiences bone and joint pain. Central nervous system (CNS) invasion leads to symptoms such as headache or unsteady gait. On physical assessment, painless, generalized swelling of lymph nodes is revealed.
The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myeloid leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? earache, stiff neck, or sore throat blisters, ulcers, or a rash appear temperature of 101°F (38.3°C) or greater difficulty or pain when swallowing
temperature of 101°F (38.3°C) or greater Explanation: The parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C) or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the parents must be directed to take action at the first sign of infection in order to prevent overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes (or difficulty/pain when swallowing) are reasons to seek medical care, but are not as grave as the risk of infection.
The health care provider has just informed the parents of a 3-year-old that their child has leukemia. The mother begins crying and tells the nurse she does not want her baby to die. What is the nurse's best response? "Don't worry, the health care provider is very good at treating leukemia." "I don't blame you for being upset; any parent would be scared too." "I know this is scary, but leukemia has a high cure rate in children these days." "You are very lucky to have caught it so early; that makes the treatments easier."
"I know this is scary, but leukemia has a high cure rate in children these days." Explanation: Although cancer in children is rare compared to unintentional injury or infection, it is the leading medical cause of death among persons younger than 25 years of age. Fortunately, the overall survival rate for children with cancer today has improved. The overall 5-year survival rate is 84.5%, and for acute lymphoblastic leukemia (the most common form of childhood cancer), the 5-year survival is 88.5%
A nurse is conducting a class to a group of parents on sickle cell anemia. Which statement by a parent indicates teaching has been effective? "This is a hereditary disease that is transmitted by one affected gene." "Sickle cell anemia is common in people of Asian descent." "The sickle shape of red blood cells decreases oxygen to tissues." "Fluid restriction is necessary to control sickle cell anemia.
"The sickle shape of red blood cells decreases oxygen to tissues." Explanation: The sickle shape of the red blood cells impedes the flow of blood through the vessels, thus causing hypoxia to the tissues. Sickle cell anemia is a hereditary disease but it is autosomal recessive, meaning it requires two genes in order for the disease to be transmitted. Sickle cell anemia is common in people of African, Mediterranean, and Indian descent. Hydration is important to controlling sickle cell anemia. Dehydration is a trigger for sickle cell crisis.
The parent contacts the health care provider because their preschool-aged child has a temperature of 101.5°F (38.6°C). The child received outpatient chemotherapy 1 week ago. Which is the most appropriate response by the nurse? Instruct the parent to administer acetaminophen every 4 hours until the fever dissipates. Ask whether any family members or other close associates are ill. Have the parent bring the child to the pediatric oncology clinic as soon as possible. Instruct the parent to immediately obtain and give the antibiotic that the oncologist calls in to the pharmacy.
Have the parent bring the child to the pediatric oncology clinic as soon as possible. Explanation: The preschool-aged child is considered immunosuppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization. The other responses may be implemented after the child arrives to the clinic.
