Chapter 46 Hematologic Prep U

A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse?

Have the parent bring the child to the pediatric oncology clinic as soon as possible.

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?

"I know this is scary, but leukemia has a high cure rate in children these days."

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."

In discussing the causes of iron-deficiency anemia in children with a group of nurses, the following statements are made. Which of these statements is a misconception related to iron-deficiency anemia?

"Milk is a perfect food, and babies should be able to have all the milk they want."

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?

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."

A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate?

"Preterm infants are at risk for iron-deficiency anemia."

A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching?

"Red meat is a good option; he loves the hamburgers from the drive-thru."

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching?

"She has been down, but playing in soccer camp will cheer her up."

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 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?

"These values will help us monitor the disease."

A child is receiving chemotherapy and develops stomatitis. The nurse identifies a nursing diagnosis of Impaired oral mucous membranes related to the effects of chemotherapy. What instructions would the nurse include in the child's plan of care? Select all that apply.

- Provide various soft and bland foods to minimize further irritation. - Have the child rinse the mouth with lukewarm water three times a day. - Apply a lip balm or petroleum jelly to prevent cracking.

A nurse is reviewing the medical records of several children who have undergone lead screening. The nurse would identify the child with which lead level as requiring no further action?

8 mcg/dl

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?

Abdominal palpation

A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform?

Administer broad-spectrum antibiotics intravenously.

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude?

Administering the measles, mumps, rubella (MMR) vaccine

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode?

Apply heat to the site of bleeding.

The nurse is caring for a 10-year-old boy with hemophilia. He asks the nurse for suggestions about appropriate physical activities. Which activity would the nurse most likely recommend?

Baseball

Assessment of a 6-year-old child reveals a purpural rash on the buttocks and upper thighs that had become hemorrhagic before starting to fade and leaving brown macular spots. The child also has gross hematuria. A diagnosis of Henoch-Schonlein syndrome is made. When reviewing the child's laboratory test results, which would the nurse anticipate? Select all that apply.

Elevated white blood cell count Elevated eosinophil count

The nurse identifies that the client is at risk for an infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply.

Having the child sleep in a single bed and room Encouraging frequent, thorough handwashing

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?

Iliac crest

A 15-year-old boy has been diagnosed with an osteosarcoma of the distal femur. He also demonstrates a chronic cough, dyspnea, and chest pain, along with chronic leg pain. Based on these findings, the nurse should suspect metastasis to which body area?

Lung

What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)?

Protect the abdomen from manipulation.

The nurse is teaching parents about help improving their child's nutritional status while on chemotherapy. What information would be included in the teaching? Select all that apply.

Provide nutritious snacks such as a milkshake. Suggest eating prior to chemotherapy. Encourage the child to pick foods that are appetizing. Maintain pleasant family meal times even if child is not hungry.

A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease?

Reed-Sternberg cells

Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura?

Risk for bleeding related to insufficient platelet formation

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority?

Risk for infection

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

A nurse is providing teaching to a child receiving chemotherapy and the parents. The nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if which occurs?

The child has redness or swelling at the central venous access site.

Wilms tumor is suspected in a 5-year-old child. Which action would be avoided?

abdominal palpation

A child receiving chemotherapy is experiencing significant reduction in red blood cells secondary to myelosuppression. Which agent would the nurse most likely expect to be ordered?

epoetin alfa

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:

factor VIII.

A nurse is caring for a child with Hodgkin disease who is in the induction phase of a chemotherapy regimen. The nurse explains to the parents that the goal of this phase is to:

kill enough cancerous cells to induce remission.

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:

notify a health care provider if the child develops an upper respiratory infection.

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

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.

The nurse develops a meal plan for a child with iron-deficiency anemia. Which meal would the nurse teach the parent has the highest amount of iron?

red meat, eggs, oatmeal, and dried fruit

The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for:

seizures.

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?

temperature of 101°F (38.3°C) or greater

A 9-year-old child is diagnosed with von Willebrand Disease (vWD) with the following characteristics: decreased quantities of all sizes of von Willebrand factor multimers and decreased activity of von Willebrand factor. The nurse identifies this as which type of vWD as being involved?

type 1

The oncology nurse is alert for clients displaying signs and symptoms of disseminated intravascular coagulation (DIC). Which symptom would alert the nurse to this emergency condition?

uncontrolled bleeding

A nurse practitioner suspects a 13-month-old child has a neuroblastoma. Which diagnostic test would be most helpful in confirming the nurse practitioner's suspicion?

urine catecholamine metabolites

The school nurse is providing information to parents of adolescents about prevention of cervical cancer. Which information is included in the teaching?

vaccine against human papillomavirus (HPV)

A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. As the nurse considers all of the data in the case, which anemia will the nurse discuss when collaborating with the primary healthcare provider?

vitamin B12 deficiency

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the bestresponse by the nurse?

"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning?

"I mix ferrous sulfate with milk in a bottle."

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 is passed to a fetus when both parents have the gene."

The nurse is caring for a 14-year-old client scheduled for magnetic resonance imaging (MRI). The nurse explains the test to the child and family. Which information would be most appropriate to include in the explanation?

"The MRI uses radio waves and magnets to produce a computerized image 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."

Which child is at highest risk for Ewing sarcoma?

13-year-old female who reports intermittent pain located in the pelvis

Antiemetics are ordered 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

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

A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care?

Avoiding further abdominal palpation

A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer?

Bladder

The nurse is planning care for a school-aged child recovering from being hit by a motor vehicle while riding a bicycle. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child?

Bleeding from intravenous sites

What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent?

Body appearance changes very little.

The child is prescribed liquid ferrous sulfate. The nurse should encourage the child to take which action immediately after each dose to best eliminate possible side effects?

Brush his or her teeth

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

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system?

Child reports facial palsy and vision problems

An adolescent receiving chemotherapy has lost all hair and is sad about self-image. Which action should the nurse take to support this adolescent and involve the client in decision making?

Encourage the adolescent to select hats or wigs to fit one's personality.

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority?

Ensure neutropenic precautions are in place.

The pediatric nurse reviews the radiographs of a child and observes that there are lesions on the bone. The nurse interprets this finding as suggesting which condition?

Ewing sarcoma

The mother of an 11-year-old girl who will begin radiation therapy soon asks the nurse what the family needs to do for their daughter during this time. Which interventions are most important? Select all that apply.

Expose the irradiated area to air Administer antiemetics as prescribed Help the child devise "mind games" to play during the procedure

The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen?

Facial changes

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child?

Implement strategies to address the child's pain.

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura?

Ineffective tissue perfusion related to poor platelet formation

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor?

Infection

The pediatric nurse is explaining to a new graduate nurse the differences in planning well-child maintenance for a child with cancer. Which statement by the new nurse demonstrates understanding of the teaching?

No routine live vaccines are administered while on chemotherapy.

The nurse is completing the health history of a 6-month-old infant with retinoblastoma with the child's parents. Which symptom should the nurse expect that the parents have observed?

One pupil appears white.

A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first?

Prepare to administer factor replacement medication

The nurse is caring for a client who was diagnosed with a sickle cell crisis and currently reports acute back and joint pain. Upon examination, the nurse noted the following assessments: dry mucous membranes; poor skin turgor; poor capillary refill, and pale nail beds. Which nursing concern will the nurse identify as the priority?

acute pain related to effects of sickling

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.

cytarabine hydroxyurea

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

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)?

lethargy, bruises, and lymphadenopathy

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?

lymph node biopsy

The nurse is evaluating the complete blood count of a 7-year-old child with a suspected hematological disorder. Which finding is associated with an elevated mean corpuscular volume (MCV)?

macrocytic red blood cells (RBCs)

A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 μg/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding:

removal or covering of flaking paint on the walls of the home.

A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor?

Factor VIII

The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000/mm3, hemoglobin 7.9 g/dl (79 g/L), hematocrit 28%, platelets 151,000/mm3. Which nursing action is priority?

Transfuse 1 unit of packed red blood cells.

The nurse is caring for a child with leukemia. Which nursing intervention would be the highestpriority for this child?

following guidelines for reverse isolation

The nurse is caring for a child with leukemia. The parent states a variety of symptoms. Which symptoms does the nurse identify as directly related to the child's cancer? Select all that apply.

Bruising Anorexia Sore throat Lymphadenopathy

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia (ALL)." What will confirm this diagnosis?

Bone marrow aspiration