EAQ Hematology
A child diagnosed with lymphoma is receiving extensive radiation therapy. The most common side effect of this treatment is: fatigue. seizures. neuropathy. lymphadenopathy.
a
A first-born 7-month-old of African American heritage has a sudden onset of uncontrollable screaming and crying and is brought to the emergency room. The infant and his or her parents are visiting from a country in the Caribbean. After determining that there is no injury present, what actions would the nurse expect to take? Ask the parents if their child had any recent vomiting, diarrhea, or fever recently. Prepare the infant to have arterial blood gases drawn and a chest x-ray. Medicate the infant for an imaging examination and obtain blood laboratory work. Obtain vital signs and vigorously palpate the infant's abdomen.
a
Nursing considerations related to the administration of chemotherapeutic drugs include: many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. good handwashing is essential when handling chemotherapeutic drugs, but gloves are not necessary. infiltration will not occur unless superficial veins are used for the intravenous infusion. anaphylaxis cannot occur because the drugs are considered toxic to normal cells.
a
The health care provider orders a transcranial Doppler (TCD) test for a child with sickle cell anemia (SCA). How does the nurse expect the health care provider to explain the reasoning behind ordering the test? "The test will help us: Know whether the child is at risk for cerebrovascular accident." Identify the different types of abnormal hemoglobin." Determine whether sickle cell anemia was inherited by the child." Identify whether there are other coexisting conditions."
a
The most important nursing consideration when caring for a child with sickle cell anemia is to: teach parents and child how to minimize crises. refer parents and child for genetic counseling. help the child and family to adjust to a short-term disease. observe for complications of multiple blood transfusions.
a
The nurse finds that a child is pale, gets easily fatigued, and has lack of energy. The nurse asks the parents to get a complete blood count (CBC) test. What does the nurse suspect from these symptoms? Anemia Sickle cell anemia Splenic sequestration Chest syndrome
a
The nurse is assessing a child with immune thrombocytopenia (ITP). The nurse observes that there is no active bleeding in the child. Which medications does the nurse expect in the child's prescription? Anti-D antibody Penicillin prophylaxis Opioids (narcotics) Kytril (Granisetron)
a
The nurse is assessing a child with short stature and malnutrition. The medical history of the child also indicates oral candidiasis. Which condition does the nurse suspect in the child? Human immunodeficiency virus Non-Hodgkin lymphoma Disseminated intravascular coagulation Immune thrombocytopenia
a
The nurse is caring for a child with severe aplastic anemia. Which treatment of choice is the nurse likely to expect for the child? Bone marrow transplantation Electrolyte replacement Chemotherapy Blood transfusions
a
The nurse is providing information about the side effect of the prescribed irradiation and chemotherapy to an adolescent with Hodgkin lymphoma (HL). About which side effect does the nurse inform? Infertility Chronic crippling Hemorrhage Myalgias
a
The nurse observes that a child experiences nausea and vomiting after chemotherapy. Which intervention does the nurse implement to prevent these side effects? Administers the antiemetic before chemotherapy begins Administers dexamethasone (Decadron) after chemotherapy Provides frequent mouthwashes with normal saline Administers fewer fluids after the chemotherapy session
a
The parents of a 7-month-old girl with a sickle cell crisis ask why the nurses keep giving their daughter pain medication so often. Which response best explains the rationale for the nurses' action? "We are trying to control her pain by giving her a combination of medications in small, frequent doses so she can still drink her bottle and be awake some of the time." "Because this is the first time she is experiencing a sickle cell crisis, we want to give her as little medication as possible." "We can give her stronger doses of pain medication less frequently if you prefer." "If we give her larger amounts of medication, she could reach tolerance of the medications much faster."
a
The parents of a child with leukemia are anxious during a nose bleeding episode and requests platelet transfusions for the child. What action does the nurse take? Tries to stop the bleeding by applying pressure at the site Obtains a prescription for platelet transfusions Gives platelet transfusions when bleeding stops Informs that transfusions may cause side effects
a
The parents tell the nurse that their child has frequent nosebleeds that usually stop within 5 to 10 minutes. Which intervention does the nurse suggest to the parents to prevent nosebleeds? "Insert petroleum jelly in the nostril after a nosebleed." "Administer aspirin (Ecotrin) after a bleeding episode." "Decrease the temperature in the child's room." "Administer opioids when the bleeding stops."
a
What is administered to a child who presents with hemophilia A and is at risk for joint bleeding? Primary prophylaxis Secondary prophylaxis Anti-D antibody Intravenous heparin
a
What is the most appropriate action for stopping an occasional episode of epistaxis (nose bleeding)? Have the child sit up and lean forward. Apply ice under the nose and above lip. Have the child lie down quietly with feet elevated. Apply continuous pressure to the nose with thumb and forefinger for at least 1 minute.
a
Which condition in a child indicates a deficiency of one of the factors (proteins) necessary for blood coagulation? Hemophilia Aplastic anemia Sickle cell anemia Apheresis
a
The nurse finds that the hemoglobin levels in a child with anemia did not improve after taking oral iron supplements. What actions does the nurse take? Ask the parents if they administered the prescribed doses. Assess whether the child has gastrointestinal problems. Assess the child for chronic hemoglobinuria. Increase iron-rich foods in the child's diet. Suggest the parents give fresh cow's milk to the child.
abc
The nurse is caring for a child with leukemia. Which interventions does the nurse implement to reduce the risk for hemorrhage in the child? Avoids skin punctures when possible Removes urine immediately after voiding Asks the child to avoid running or biking Provides meticulous mouth care Gives a platelet transfusion during a nosebleed
abcd
The nurse is educating the parents of a child about the symptoms that would indicate sickle cell anemia. Which symptoms does the nurse describe? Painful joints Big and swollen spleen Chest pain Hypoxia Hearing loss
abcd
The nurse is providing care to a child who is undergoing chemotherapy for leukemia. What side effects are likely to be expected in the child? . Nausea and vomiting Anorexia Mucosal ulceration Mood changes Enlarged spleen
abcd
The nurse is reading the reports of a child with aplastic anemia (AA). Which findings indicate that the child has severe AA? Less than 25% bone marrow cellularity Absolute reticulocyte count less than 40,000/mm 3 Absolute granulocyte count less than 500/mm 3 Platelet count less than 20,000/ mm 3 Presence of mild or moderate cytopenia
abcd
Which interventions does the nurse implement to alleviate neurotoxic effects in a child after chemotherapy? Administers stool softeners Provides a footboard or high-top shoes Provides support during ambulation Administers Mesnex (mesna) as prescribed Provides a soft or liquid diet
abce
A child with leukemia is treated with chemotherapeutic agents in different phases. Which are the treatment phases? Induction therapy Prophylactic therapy Antiretroviral therapy Intensification therapy Maintenance therapy
abde
The nurse is caring for a child with human immunodeficiency virus (HIV) infection. Which medications does the nurse expect to find in the child's prescription? Zidovudine (Retrovir) Delavirdine (Rescriptor) Deferoxamine (Desferal) Nelfinavir (Viracept) Hydroxyurea (Hydrea)
abde
The nurse is teaching a group of adolescents about human immunodeficiency virus (HIV) and ways to prevent it. What is included in the teaching? Routes of virus transmission Dangers of recreational drug use Abstinence from sexual activity Importance of HIV testing Myths associated with HIV
abde
The nurse is caring for a child with severe anemia. The child has to undergo several blood tests. What actions does the nurse take to prepare the child for the test? Explains why all the tests are necessary Tells the parents to stay out of the laboratory Demonstrates the procedure on a doll Describes the test step by step Does not perform the tests if the child is not ready
acd
What does the nurse expect the primary health care provider to prescribe for a child with mucositis? Aquaphor healing ointment Lemon glycerin swabs Clotrimazole troche (clotrimazole lozenges) Chlorhexidine gluconate (Peridex) Milk of Magnesia
acd
The nurse is monitoring a child during a blood transfusion procedure. What precautions does the nurse take? Takes vital signs before, after, and during the blood transfusion Uses blood within an hour of its arrival from the blood bank Administers the first 50 mL of blood volume slowly Uses an appropriate filter for administering blood Stops the transfusion if there is any reaction in the child
acde
A child has acquired mucosal ulceration after chemotherapy, which makes eating uncomfortable. Which intervention does the nurse implement to prevent anorexia in the child? The nurse: Obtains an order for tube feedings. Provides a bland, moist, soft diet. Provides parenteral nutrition. Provides mostly fluids in the diet.
b
A child is prescribed oral iron for iron deficiency anemia. What intervention does the nurse implement to ensure the absorption of iron in the child? Ensures the child drinks adequate fluids Gives citrus juice with the oral iron Gives milk with medications Increases iron rich foods in the diet
b
The nurse is caring for a child with thalassemia. What does the nurse observe in this child? Prolonged bleeding from any part Complications due to blood transfusions Epistaxis and bleeding gums Complications from chemotherapy
b
The nursing instructor is teaching a group of students about hemophilia A. Which statement by the student indicates effective learning? "Hemophilia A does not cause bleeding in the subcutaneous tissue." "This condition occurs as a result of the deficiency of antihemophilic factor." "Hemophilia A gets worse if antihemophilic factor is increased in blood." "Patients with hemophilia A bleed at a faster rate and for longer periods."
b
The nursing instructor is teaching a group of students about the use of antiretroviral drugs in the therapeutic management of human immunodeficiency virus (HIV) infection. Which statement by the student indicates a need for additional learning? "The drugs prevent further deterioration of the immune system." "The drugs help prevent reproduction of the virus and cure HIV." "The protease inhibitor indinavir (Crixivan) is an antiretroviral drug." "The drugs suppress viral replication and delay disease progression."
b
The parent of a 6-month-old infant asks the nurse about the food that can be included in the child's diet. What does the nurse suggest? "Feed breast milk only." "Include cereals in the diet." "Provide fresh cow's milk." "Give carrots and peas."
b
What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy? Lemon glycerin swabs for cleansing Mouthwashes with normal saline Mouthwashes with hydrogen peroxide Local anesthetic such as viscous lidocaine before meals
b
Which is an ideal treatment for a child after splenectomy? Iron dextran injection Prophylactic antibiotics Diphenhydramine (Benadryl) Intravenous heparin
b
Which symptom is seen in a child with disseminated intravascular coagulation (DIC)? Rickettsial infections Increased tendency to bleed Mucosal inflammation Yellow, fatty bone marrow
b
A child is prescribed hematopoietic stem cell transplantation for severe combined immunodeficiency disease. What is administered to the child to improve the humoral immunity until the transplant is performed? Influenza vaccines Pneumocystis carinii pneumonia (PCP) prophylaxis Intravenous immunoglobulin Varicella vaccine Dapsone
bc
The nurse is informing a group of parents in a nursing camp about the importance of genetic counseling. Which parents would need genetic counseling? Parents of a child with: Leukemia Sickle cell disease Thalassemia Hemophilia A Hodgkin lymphoma
bcd
A child is diagnosed with Wiskott-Aldrich syndrome. Which conditions will be evident in the child at birth and as the child grows older? Sterility Sinusitis Herpes simplex Eczema Bloody diarrhea
bcde
Which interventions does the nurse apply during an episode of epistaxis in a child? Ask the child to lie down and be calm Apply pressure to the nose with thumb and forefinger Insert wadded tissue into each nostril Apply ice to the bridge of the nose Ask the child to breathe through mouth
bcde
The nurse is caring for a child with leukemia. What does the nurse include in the child's plan of care? Allows few visitors at a time in the patient's room. Report any elevation of temperature at once. Increase proteins in the child's diet. Take precautions during skin punctures. Ask family members to practice strict hand washing.
bce
The nurse is instructing about preventing bleeding episodes to the parents of a child with hemophilia. What instructions does the nurse provide? Restrict sports activity like tennis or golf Encourage participation in swimming Soften toothbrush before brushing Use finger punctures for blood samples Avoid using aspirin for controlling pain
bce
A child has acquired stomatitis after chemotherapy. The parents are worried and tell the nurse that the child consumes only juices and very few solid foods. What is the nurse's response? "You may ask the primary health care provider for food supplements." "You must persuade the child to eat more solid foods." "The child may eat well after the ulcers heal." "The child may require parenteral nutrition for hydration."
c
A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The first action by the nurse is to: administer 100% oxygen to relieve hypoxia. administer meperidine (Demerol) to relieve symptoms. notify the practitioner because chest syndrome is suspected. notify the practitioner because child may be having a stroke.
c
An infant with sickle cell anemia (SCA) is prescribed the hemoglobin electrophoresis test. What is the purpose of this test? To identify whether the child is at risk for cerebrovascular accident To confirm the presence of sickle cell anemia To detect different types of hemoglobin To rule out disorders other than sickle cell anemia
c
Antithymocyte globulin (ATG) is administered intravenously to a child with aplastic anemia (AA). The child is susceptible to side effects of ATG, such as fever, chills, and myalgias. Which medication is administered to prevent these side effects? Prophylactic antibiotics Stavudine (Zerit) Methylprednisolone (Medrol) Pentam (Pentamidine)
c
Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include: restricting oral fluids. instituting strict isolation. using good handwashing. giving live vaccines appropriate for age.
c
The blood report of a 5-year-old child reveals a reduction in hemoglobin below the normal value concentration. Which physiologic defect does the nurse expect in the child? Iron deficiency anemia due to decreased iron Cyanosis due to deoxygenated hemoglobin Reduction in oxygen-carrying capacity of blood Bone marrow failure due to reduction in hemoglobin
c
The nurse is teaching the parents how to provide care for their child with sickle cell anemia. Which intervention does the nurse include in the teaching? "Enforce bladder control to avoid bedwetting." "Report immediately if the spleen size decreases." "Provide daily fluid intake as specified." "Report fever if more than 100 degrees F."
c
The nurse suspects that a child with enlarged lymph nodes and fever has leukemia. Which test does the nurse evaluate to confirm the condition? Peripheral blood smear Lumbar puncture Bone marrow biopsy Tourniquet test
c
The parent of a child with immune thrombocytopenia (ITP) asks the nurse what kind of sport activity will be beneficial for the child. What does the nurse respond? "Sports such as gymnastics are the best." "Avoid all kinds of sport activity." "Encourage swimming or walking." "Any kind of indoor activity is good."
c
The parents of a child taking oral iron supplements report that the child's stools are a tarry green color. What is the best response the nurse provides to the parents? "It is because of toxicity. You need to lower the dose." "You should avoid giving the dose at night." "Tarry green color is expected with oral iron supplements." "Stop the dose immediately. It is a side effect."
c
The parents of a child with leukemia are worried that chemotherapy will cause alopecia in the child. What does the nurse inform the parents? "Hair loss is seen in children with thin hair." "Your child may feel extremely embarrassed initially." "Hair will regrow 3 to 6 months after the treatment ends." "I think you should not inform the child about the hair loss."
c
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? Apply warm, moist compresses. Apply pressure for at least 1 minute. Elevate area above the level of the heart. Begin passive range of motion unless pain is severe.
c
The school nurse is discussing prevention of acquired immune deficiency syndrome with some adolescents. In the discussion, the nurse should include that: the virus is easily transmitted. the virus is only transmitted through blood. intravenous drug users should not share needles. condoms should be used if adolescents are sexually active and homosexual.
c
Which condition does the nurse ask the parents of a child with non-Hodgkin lymphoma (NHL) to report after irradiation? Bleeding Abdominal pain Fatigue Eczema
c
A 5-month-old infant born to a mother with human immunodeficiency virus (HIV) infection needs to be tested for HIV. Which test will be used for an accurate diagnosis of HIV in the child? Western blot immunoassay HIV enzyme-linked immunosorbent assay Partial thromboplastin time test HIV polymerase chain reaction
d
A child with sickle cell anemia (SCA) has a defective splenic function that increases the child's susceptibility to infections. What does the primary health care provider prescribe? Chronic transfusion therapy Antithymocyte globulin (ATG) Oral penicillin prophylaxis Pneumococcal vaccines
d
The nurse is assessing an adolescent with hemophilia A, who has also experienced several episodes of joint bleeding. Which condition will be evident in the adolescent? Fanconi syndrome Delayed sexual maturation Visual disturbances Bony changes
d
The nurse is caring for a child with sickle cell anemia (SCA). The child has acute chest syndrome and has also experienced a cerebrovascular accident (CVA). Which is the most effective treatment for the child? Hemoglobin electrophoresis Influenza vaccination Oxygen therapy Chronic transfusion therapy
d
The nurse is explaining blood components to an 8-year-old child. The nurse could best describe platelets by explaining that they: help keep germs from causing infection. make up the liquid portion of blood. carry the oxygen that is breathed from the lungs to all parts of the body. help the body stop bleeding by forming a clot (scab) over the hurt area.
d
The nurse suspects that a child is having an adverse reaction to a blood transfusion. The first action by the nurse should be to: notify the physician. take vital signs and blood pressure and compare them with baseline. dilute infusing blood with equal amounts of normal saline. stop transfusion and maintain a patent intravenous line with normal saline and new tubing.
d
The nursing instructor is teaching a student how to administer iron dextran injections to a child with severe anemia. Which instruction does the nurse give after the student administers the injection? "Place the child in a semi-Fowler position." "Do not massage the injection site." "Use the same site for the next injection." "Keep the syringe near the child's bed."
d
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: symptom of iron-deficiency anemia. adverse effect of the iron preparation. indicator of an iron preparation overdose. normally expected change caused by the iron preparation.
d