Chapter 43 hematology and Chapter 44 Cancer

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500. On the basis of this laboratory report, which intervention would the nurse include in the plan of care? Initiate bleeding precautions Monitor closely for signs of infection Monitor the temperature every 4 hours Initiate protective isolation precautions

Initiate bleeding precautions

A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. Which priority actions should be taken by the nurse? (Select all that apply.) A. Administer 100% oxygen to relieve hypoxia. B. Administer meperidine (Demerol) to relieve symptoms. C. Notify the practitioner because chest syndrome is suspected. D. Notify the practitioner because child may be having a stroke. E. Administer meperidine (Demerol) orally to relieve pain.

A. Administer 100% oxygen to relieve hypoxia. B. Notify the practitioner because chest syndrome is suspected. Administration of oxygen along with notifying the physician are the priority actions that should be taken by the nurse at this time. Oxygen therapy is of little therapeutic value unless the patient has hypoxia. Pain medications may be indicated, but evaluation is necessary first. Demerol is not recommended, because it produces a metabolite that is a CNS stimulant causing: anxiety, tremors, myoclonus, and seizures. These are the signs and symptoms of chest syndrome. The nurse must notify the practitioner immediately. These are not signs of a stroke. Oral demerol is also contraindicated for treatment in sickle cell disease.

What is the most appropriate action for stopping an occasional episode of epistaxis? A. Have child sit up and lean forward. B. Apply ice under the nose and above lip. C. Have the child lie down quietly with feet elevated. D. Apply continuous pressure to the nose with thumb and forefinger for at least 1 minute.

A. Have the child sit up and lean forward

What are the most common signs and symptoms of leukemia related to bone marrow involvement? A. Petechiae, infection, fatigue B. Headache, papilledema, irritability C. Muscle wasting, weight loss, fatigue D. Decreased intracranial pressure, psychosis, confusion

A. Petechiae, infection, fatigue These are signs of infiltration of the bone marrow: petechiae from lowered platelet count, infection from the depressed number of effective leukocytes, and fatigue from the anemia. These are not signs of bone marrow involvement. These are not signs of bone marrow involvement. These are not signs of bone marrow involvement.

The MOST important nursing consideration when caring for a child with sickle cell anemia is to A. teach parents and child how to minimize crises. B. refer parents and child for genetic counseling. C. help the child and family to adjust to a short-term disease. D. observe for complications of multiple blood transfusions.

A. teach parents and child how to minimize crises. Parents need specific instructions about changes in the child's condition that they should watch for, penicillin administration, adequate hydration, and environmental concerns. Genetic counseling is important, but teaching care of the child is a priority. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is having parents who are properly prepared to care for them.

The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measure should the nurse do until factor replacement therapy can be instituted? A. Apply warm, moist compresses. B. Apply pressure for at least 1 minute. C. Elevate area above the level of the heart. D. Begin passive range of motion unless pain is severe.

C. Elevate area above the level of the heart Cold should be applied to the arm. This will aid in vasoconstriction. Pressure is effective in small areas but would not work for an extremity. The initial response should include elevation. Passive range of motion is not recommended. The child can perform active range of motion after the bleeding episode has resolved.

The school nurse is discussing prevention of acquired immune deficiency syndrome with some adolescents. In the discussion the nurse should include that the A. virus is easily transmitted. B. virus is only transmitted through blood. C. intravenous drug users should not share needles. D. condoms should be used if adolescents are sexually active and homosexual.

C. intravenous drug users should not share needles. The virus is not easily transmitted. It requires direct contact with blood and body fluids on a nonintact skin surface. Body fluids may also transmit the virus. Human immunodeficiency virus is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus. Condoms should be used for both heterosexual and homosexual sex.

The nurse suspects that a child is having an adverse reaction to a blood transfusion. The FIRST action by the nurse should be to A. notify the physician. B. take vital signs and blood pressure and compare them with baseline. C. dilute infusing blood with equal amounts of normal saline. D. stop transfusion and maintain a patent intravenous line with normal saline and new tubing.

D. stop transfusion and maintain a patent intravenous line with normal saline and new tubing. These actions should be performed after the blood transfusion is stopped and infusion of normal saline has begun. These actions should be performed after the blood transfusion is stopped and infusion of normal saline has begun. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred. This is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry green color. The nurse should explain that this is a/an A. symptom of iron-deficiency anemia. B. adverse effect of the iron preparation. C. indicator of an iron preparation overdose. D. normally expected change caused by the iron preparation.

D. Normally expected change caused by the iron preparation

The nurse is explaining blood components to an 8-year-old child. The nurse could best describe platelets by explaining that they A. help keep germs from causing infection. B. make up the liquid portion of blood. C. carry the oxygen you breathe from your lungs to all parts of your body. D. help your body stop bleeding by forming a clot (scab) over the hurt area.

D. help your body stop bleeding by forming a clot (scab) over the hurt area. This is a definition of the function of white blood cells. This is a definition of plasma. This is the function of the red blood cells. Platelets are involved in homeostasis.

The nurse analyzes the laboratory results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child? Platelet count Hematocrit level Hemoglobin level Partial thromboplastin time

Partial thromboplastin time Hemophilia is deficient clotting factors so the only thing listed that would show an absence of clotting factors is a prolonged INR due to not having the factors needed to clot the blood and stop the bleeding

Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? (Select all that apply) Maintain the child in a semiprivate room Reduce the amount of environmental exposure Use strict aseptic technique for all procedures Ensure that anyone entering the child's room wears a mask Apply firm pressure to a needle stick area for at least 10 minutes

Reduce the amount of environmental exposure Use strict aseptic technique for all procedures Ensure that anyone entering the child's room wears a mask