Exam III PrepU questions

The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's bestresponse?

"ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason."

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."

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 values will help us monitor the disease

The nurse has received morning report on a group of pediatric clients. Which pediatric client will the nurse see first?

a child with hemophilia reporting knee pain and edema

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 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

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

The nurse will select which meal as the best choice for a child with iron-deficiency anemia?

cheeseburger, broccoli, and fresh strawberries

A nurse caring for an 8-year-old child with a bleeding disorder documents the following nursing diagnosis: Ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This nursing diagnosis would be most appropriate for a child diagnosed with which condition?

disseminated intravascular coagulation

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 parent of a child with Down syndrome calls the nurse and reports 3 weeks of a lack of energy, limping, and weight loss in the young child. What is the most appropriate response by the nurse?

"Bring your child to the primary health care provider to be examined."

An adolescent is recovering from surgery, radiation, and chemotherapy following a diagnosis of Ewing sarcoma. Which statement by the family indicates that reteaching is needed?

"Our child is looking forward to playing football again."

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."

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 nurse is explaining to a group of parents about the long-term effects of radiation therapy on children. Depending on the location of the therapy, what does the nurse include in this teaching session? Select all that apply.

-asymmetrical bone growth -demyelination of the brain -infertility -chronic malabsorption in the GI tract -growth retardation

A nurse is caring for a child diagnosed with medulloblastoma. Which would the nurse expect to include as part of the child's plan of treatment? Select all that apply.

-complete surgical resection -radiation therapy -chemo in high-risk cases

A nurse is caring for a child diagnosed with von Willebrand disease who is receiving desmopressin as part of the treatment regimen. In relation to desmopressin administration, what assessment finding(s) is important for the nurse to monitor? Select all that apply.

-electrolyte balance -intake and output -heart rate

The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of:

Ewing sarcoma

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?

Lungs

The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor?

Observation reveals nystagmus and head tilt.

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

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

The nurse is caring for an 18-month-old client with suspected iron-deficiency anemia. The nurse will expect to prepare the client for which laboratory tests first?

complete blood count and iron level

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

facial changes

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

following guidelines for reverse isolation

A child has undergone a hematopoietic stem cell transplant. When assessing the child, the nurse notes the development of a maculopapular rash on the child's palms and bottoms of the feet. Which condition would the nurse suspect?

graft-versus-host disease

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 vomitting

The nurse is planning care for a child with idiopathic thrombocytopenic purpura. Which client education should be included?

not to pick or irritate the nose

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

A hospice nurse is providing at-home care to a child with end-stage cancer. The nurse is developing a plan of care to manage the child's pain. Which medications will the nurse likely include?

opioids

An experienced nurse is orienting a new nurse to the oncology unit. Which action by the new nurse would require intervention?

pouring unused chemo medicine into a sink drain

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 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?

talk with her and her family about wearing a wig, cap, or scarf

A child with sickle cell anemia comes to the emergency department for evaluation. The nurse suspects that the child is experiencing a vaso-occlusive crisis based on assessment of which signs and symptoms? Select all that apply.

-low back pain -fever -distended abdomen

A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate

Chemotherapy affects cancer cells and normal cells that multiply rapidly.

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.

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

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

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

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

Prepare to administer factor replacement medication

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

administer broad-spectrum antibiotics IV

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

iliac crest

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

The child has been admitted to the hospital, with an absolute neutrophil count of 450. The child has been placed in neutropenic precautions. Which nursing interventions indicate that the nurse requires further education? Select all that apply.

- the child has been placed in semiprivate room -the child is being transported for an x-ray and the nurse places gloves on the child's hand

A young school-age child who is being treated for cancer has constipation and loss of appetite. What nursing interventions should the nurse suggest to the family? Select all that apply.

-add high fiber snacks such as popcorn and washed apples -increases gross motor activities such as family walks -provide adequate private time in the bathroom

The nurse is assessing a child in the pediatric intensive care unit. Which assessment finding(s) warrants immediate action? Select all that apply.

-increased D-dimer assay -petechiae -persistent oozing from -venipuncture site

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.

A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important?

Placing a "no abdominal palpation" sign above the child's bed

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

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, 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

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 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

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

While assessing an adolescent, the nurse notes pallor and a beefy red tongue. Upon questioning, the adolescent reports eating a vegetarian diet to help with weight loss. Which health care provider prescription will the nurse anticipate?

vitamin b12 injections

The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care?

giving ferrous sulfate with orange juice between meals

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 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

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

Children with acute lymphoblastic leukemia (ALL) may need periodic lumbar punctures. The nurse would teach the parent that this is done to assess for:

leukemic cells

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)

When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority?

monitor the site dressing and vital signs

When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect?

mucositis

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 providing teaching about iron supplement administration to the parents of a 10-month-old child. It is critical that the nurse emphasize which teaching point to the parents?

you must precisely measure the amount of iron