NURS405 Unit 1 KC/AC

A nurse is preparing a teaching plan for the family of a child with allergic rhinitis. When describing the immune reaction that occurs, the nurse would identify the role of which immunoglobulin? IgA IgG IgM IgE

IgE The immunoglobulin involved in the immune response associated with allergic rhinitis is IgE. IgA, IgG, and IgM are not involved in this response.

The nurse is discussing discharge instructions with the parents of a 6-year-old who had a tonsillectomy. What is the most important thing to stress? Encourage the child to drink liquids. Apply an ice collar. Inspect the throat for bleeding. Administer analgesics.

Inspect the throat for bleeding. Inspecting the throat for bleeding is the most important discharge information to give the parents. Hemorrhage is unusual postoperatively but may occur any time from the immediate postoperative period to as late as 10 days after surgery. The nurse should inspect the throat for bleeding. Mucus tinged with blood may be expected, but fresh blood in the secretions indicates bleeding. Administering analgesics, encouraging fluids and applying an ice color are important but not as important as assessing for bleeding.

A child is brought to the emergency department by his parents because he suddenly developed a barking cough. Further assessment leads the nurse to suspect that the child is experiencing croup. What would the nurse have most likely assessed? Toxic appearance Dysphagia Inspiratory stridor High fever

Inspiratory stridor A child with croup typically develops a bark-like cough often at night. This may be accompanied by inspiratory stridor and suprasternal retractions. Temperature may be normal or slightly elevated. A high fever, dysphagia, and toxic appearance are associated with epiglottitis.

A 4-year-old child has developed acute lymphoblastic leukemia (ALL). Nursing care for the child with ALL involves taking axillary, rather than rectal, temperatures because the child: is prone to diarrhea. is anemic. has a low white blood cell count. has a low platelet count.

has a low platelet count. In ALL, the bone marrow becomes unable to maintain the normal levels of red blood cells, white blood cells, and platelets. Children with ALL bruise and bleed easily. If a rectal thermometer is inserted it can cause bleeding from the irritation of the mucosal membrane because of the decreased platelet count. Using a rectal thermometer also is invasive so there is a large possibility of introducing microorganisms to the child. This could be damaging to the child if the child is neutropenic and has no immune defenses. The child may be prone to diarrhea because of the chemotherapy drugs but that is not the primary reason for not using the rectal temperature. Nursing care for the child should also be provided in the least invasive manner possible. That means not using any IM or SQ injections.

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)? hemoglobin (Hgb) of 11.2 g/dl (112 g/L) platelet count of 250,000 macrocytic red blood cells (RBCs) decreased white blood cells (WBCs)

macrocytic red blood cells (RBCs) When the MCV is elevated, the RBCs are larger and referred to as macrocytic. The WBC count does not affect the MCV. The platelet count and Hgb are within normal ranges for a 7-year-old child.

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? "Sickle cell anemia is common in people of Asian descent." "Fluid restriction is necessary to control sickle cell anemia." "This is a hereditary disease that is transmitted by one affected gene." "The sickle shape of red blood cells decreases oxygen to tissues."

"The sickle shape of red blood cells decreases oxygen to tissues." 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.

When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which type as having the highest incidence? Neuroblastoma Acute lymphoblastic leukemia (ALL) Non-Hodgkin lymphoma Osteogenic sarcoma

Acute lymphoblastic leukemia (ALL) Acute lymphoblastic leukemia accounts for approximately 32% of all childhood cancers. Neuroblastomas account for 8%; non-Hodgkin lymphoma accounts for 6%; osteogenic sarcoma accounts for 3%.

A group of nursing students are reviewing the medications used to treat asthma. The students demonstrate understanding of the information when they identify which agent as appropriate for an acute episode of bronchospasm? Cromolyn Salmeterol Albuterol Ipratropium

Albuterol Albuterol is a short-acting β2-adrenergic agonist that is used for treatment of acute bronchospasm. Salmeterol is a long-acting β2-adrenergic agonist used for long-term control or exercise-induced asthma. Ipratropium is an anticholinergic agent used as an adjunct to β2-adrenergic agonists for treatment of bronchospasm. Cromolyn is a mast cell stabilizer used prophylactically but not to relieve bronchospasm during an acute wheezing episode.

A group of nursing students are reviewing information about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding of the information when they identify which finding? An increase in oxygen saturation leads to a much larger decrease in pO2. Children develop hypoxemia more rapidly than adults do. Children's demand for oxygen is lower than that of adults. Children's bronchi are wider in diameter than those of an adult.

Children develop hypoxemia more rapidly than adults do. Children develop hypoxemia more rapidly than adults do because they have a significantly higher metabolic rate and faster resting respiratory rates than adults do, which leads to a higher demand for oxygen. A smaller decrease in oxygen saturation reflects a disproportionately much larger decrease in pO2. The bronchi in children are narrower than in adults, placing them at higher risk for lower airway obstruction.

A nurse practitioner is assessing a client who has a fever, malaise, and a white blood cell count that is elevated. What principle should guide the nurse's management of the client's care? The client is exhibiting signs and symptoms of leukemia. There is a need for the client to be assessed for lymphoma. The client should undergo diagnostic testing for multiple myeloma. Infection is the most likely cause of the client's change in health status.

Infection is the most likely cause of the client's change in health status. Leukocytosis is most often the result of infection. It is only considered pathologic (and suggestive of leukemia) if it is persistent and extreme. Multiple myeloma and lymphoma are not likely causes of this constellation of symptoms.

A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention? Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential Monitoring the client's blood pressure and reviewing the client's hematocrit Monitoring the client's heart rate and reviewing the client's hemoglobin Monitoring the client's breathing and reviewing the client's arterial blood gases

Monitoring the client's temperature and reviewing the client's complete blood count (CBC) with differential Clients with neutropenia often do not exhibit classic signs of infection. Fever is the most common indicator of infection, yet it is not always present. No definite symptoms of neutropenia appear until the client develops an infection. A routine CBC with differential can reveal neutropenia before the onset of infection.

A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? Anemia Pancytopenia Thrombocytopenia Neutropenia

Neutropenia Fever and infection result from a decrease in neutrophils (neutropenia). Decreased red blood cells (anemia) cause weakness, fatigue, dyspnea on exertion, and pallor in AML. Pancytopenia, an overall decrease in all blood components, is not cause of fever in clients with AML. Decreased platelet count (thrombocytopenia) causes petechiae and bruising in AML.

The nurse is preparing to perform a physical examination of a child with asthma. Which technique would the nurse be least likely to perform? Inspection Percussion Auscultation Palpation

Palpation When examining the child with asthma, the nurse would inspect, auscultate, and percuss. Palpation would not be used.

The nurse is examining an 8-year-old boy with tachycardia and tachypnea. The nurse anticipates which test as most helpful in determining the extent of the child's hypoxia? Pulse oximetry Chest radiograph Pulmonary function test Peak expiratory flow

Pulse oximetry Pulse oximetry is a useful tool for determining the extent of hypoxia. It can be used by the nurse for continuous or intermittent monitoring. Pulmonary function testing measures respiratory flow and lung volumes and is indicated for asthma, cystic fibrosis, and chronic lung disease. Peak expiratory flow testing is used to monitor the adequacy of asthma control. Chest radiographs can show hyperinflation, atelectasis, pneumonia, foreign bodies, pleural effusion, and abnormal heart or lung size.

An oncology nurse is providing health education for a client who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia? The different leukemias all involve the development of cancer in the lymphatic system. The different leukemias all result in a decrease in the production of white blood cells. The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function. The different leukemias all involve unregulated proliferation of white blood cells.

The different leukemias all involve unregulated proliferation of white blood cells. Leukemia commonly involves unregulated proliferation of white blood cells. Decreased production of red blood cells is associated with anemias. Decreased production of white blood cells is associated with leukopenia. The leukemias are not characterized by their involvement with the lymphatic system.

A nurse in the emergency department is examining a 6-month-old with symmetrical swelling of the hands and feet. The nurse immediately suspects: Cooley anemia idiopathic thrombocytopenic purpura (ITP) sickle cell disease hemophilia

sickle cell disease Symmetrical swelling of the hands and feet in the infant or toddler is termed dactylitis; aseptic infarction occurs in the metacarpals and metatarsals and is often the first vaso-occlusive event seen with sickle cell disease. Symmetrical swelling of the hands and feet are not typically seen with the other conditions listed.

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia (ALL)." What will confirm this diagnosis? Lethargy, bruising, and pallor Bone marrow aspiration Complete white blood count History of leukemia in twin

Bone marrow aspiration 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.

A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator? Platelet value of 350,000/mm3 Leukocyte count of 11,500/mm3 Hematocrit of 60% Erythrocyte count of 6.5 m/?L

Hematocrit of 60% Although all results are elevated, the diagnostic indicator is the elevated hematocrit (normal = 42% to 52% for a male). These results are used in combination with other indicators (e.g., splenomegaly) for a definitive diagnosis.

A child being treated for leukemia is diagnosed with neutropenia. What nursing instructions directly prevent client infections? Select all that apply. Inspect the skin daily for scratches or scrapes. Remove house plants, flowers, and goldfish from the home environment. Stay away from people who have obvious colds, rashes, or other infections. Increase the intake of fresh fruits and vegetables. Avoid large crowds.

Inspect the skin daily for scratches or scrapes. Remove house plants, flowers, and goldfish from the home environment. Stay away from people who have obvious colds, rashes, or other infections. Avoid large crowds. Strategies to prevent infections in a child with neutropenia include avoiding large crowds; inspecting the skin daily for scratches or scrapes; removing house plants, flowers, and goldfish from the home environment; and staying away from people who have obvious colds, rashes, or other infections. The child's intake of fresh fruits and vegetables should be limited because this could be a source for bacteria.

Parents bring their daughter to the health care facility for evaluation. They report that lately the child seems rather pale and really tired. What would the nurse most likely find with further assessment if the child has acute lymphoblastic leukemia (ALL)? Select all that apply. Low-grade fever Painless cervical lymphadenopathy Headache Chest pain Bleeding from the oral mucous membranes

Low-grade fever Painless cervical lymphadenopathy Headache Bleeding from the oral mucous membranes Assessment findings associated with ALL include low-grade fever, lethargy, petechiae, bleeding from the oral mucous membranes, and easy bruising. As the spleen and liver begin to enlarge, abdominal pain, vomiting, and anorexia occur. Physical assessment reveals painless, generalized swelling of lymph nodes, especially the submaxillary or cervical nodes.

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for? Diarrhea The onset of a bacterial infection Abdominal pain Bleeding

The onset of a bacterial infection ymphopenia (a lymphocyte count less than 1,500/mm3) can result from ionizing radiation, long-term use of corticosteroids, uremia, infections (particularly viral infections), some neoplasms (e.g., breast and lung cancers, advanced Hodgkin disease), and some protein-losing enteropathies (in which the lymphocytes within the intestines are lost) (Kipps, 2010). When lymphopenia is mild, it is often without sequelae; when severe, it can result in bacterial infections (due to low B lymphocytes) or in opportunistic infections (due to low T lymphocytes).

For a client diagnosed with pernicious anemia, the nurse emphasizes the importance of lifelong administration of Vitamin A Vitamin C Folic acid Vitamin B12

Vitamin B12 For a client with pernicious anemia, the nurse emphasizes the importance of lifelong administration of vitamin B12. The nurse teaches the client or a family member the proper method to administer vitamin B12 injections. Administration of vitamin A, folic acid, or vitamin C is not recommended for this condition.

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? A 15-year-old adolescent who has heavy menstrual periods An 8-year-old child who carries lunch to school A 3-month-old infant who is totally breastfed A 7-month-old infant who has started table food

A 15-year-old adolescent who has heavy menstrual periods Adolescents with heavy menstrual flows lose enough blood each month to cause iron-deficiency anemia.

A child is in the emergency department with an asthma exacerbation. Upon auscultation the nurse is unable to hear air movement in the lungs. What action should the nurse take first? Administer corticosteroids Start a peripheral IV Administer oxygen Administer a beta-2 adrenergic agonist

Administer a beta-2 adrenergic agonist When lungs sounds are unable to be heard in a child with asthma, the child is very ill. This means there is severe airway obstruction. The air movement is so severe wheezes cannot be heard. The priority treatment is to administer an inhaled short term bronchodilator (beta-2 adrenergic agonist). The child may require numerous inhalations until bronchodilation occurs and air can pass through the bronchi. Oxygen can be started but until the bronchi are dilated no oxygen can get through to the lung fields. In IV would need to be started and IV steroids administered to reduce the inflammation, but the priority is bronchodilation.

A child has been prescribed a nasal cannula for oxygen delivery. What should the nurse do before applying the cannula? Assess the lung sounds Test the oxygen saturation Assess patency of the nares Add humidification to the delivery device

Assess patency of the nares A nasal cannula is a good delivery device for children, because it allows them to eat and talk unobstructed. Because the device is designed for flow through the nares, the patency of the nares should be assessed prior to using the cannula. If the nares are blocked from secretions, suctioning may be required. If there is a defect in the upper airway causing blockage, the nasal cannula may not be an appropriate oxygen delivery device. The oxygen saturation should have been measured and used as a guide for the prescription of oxygen therapy. Adding humidification is a way to keep the upper airways from becoming too dry, but oxygen can be started before humidity is added. Anytime a child is sick enough to require oxygen all respiratory assessments, including lung sounds, should be done. It does not matter, however, what the lung sounds are if the child is in enough distress to require oxygen. The lung sounds can be assessed after oxygen is started.

A child is hospitalized with pneumonia. The nurse assesses an increase in the work of breathing and in the respiratory rate. What intervention should the nurse do first to help this child? Notify the health care provider Administer oxygen Obtain oxygen saturation levels Elevate the head of the bed

Elevate the head of the bed The child who is experiencing increased work of breathing should be placed in a position to better open the airway and provide more room for lung expansion. Generally this is accomplished by elevating the head of the bed. If this does not improve the work of breathing, then administering oxygen should be done. The oxygen saturation should be measured because it will provide information as to the severity of the respiratory problem, but this measurement will not directly help the child. The health care provider should be notified if the child continues to deteriorate.

A nurse is teaching a school-aged child with iron-deficiency anemia and her parents about dietary measures to increase iron intake. The nurse determines that the teaching was successful when they state which food is high in iron? Select all that apply Citrus fruits Fortified cereal Green leafy vegetables Eggs Milk

Fortified cereal Green leafy vegetables Eggs Foods high in iron include meat, cheese, eggs, green leafy vegetables, and fortified cereal. Citrus fruits and milk are not iron-rich foods.

The nurse is caring for 9-year-old boy undergoing chemotherapy whose complete blood count (CBC) with differential reports 7% banded and 13% segmented neutrophils with a white blood cell count of 2,540. He has an oral temperature of 38.6°C (101.5°F). Which intervention would be the priority? restricting visitors with symptoms of infection assessing for signs of infection every 8 hours administering prescribed broad-spectrum IV antibiotics monitoring his vital signs every 4 hours

administering prescribed broad-spectrum IV antibiotics The priority intervention for this child is administering prescribed broad-spectrum IV antibiotics. His absolute neutrophil count (ANC; calculated by adding the bands and segs [21%] and then multiplying this [0.20] by the white blood cell count [2540] to yield an ANC of 508) indicates he has neutropenia and his temperature indicates he may have an infection. Monitoring vital signs, restricting visitors with symptoms of infection, and assessing for signs of infection are valid interventions related to neutropenia but are of lesser importance at this point.

A nurse is caring for a client with a history of GI bleeding, sickle cell anemia, and a platelet count of 22,000/μl. The client, who is dehydrated and receiving dextrose 5% in half-normal saline solution at 150 ml/hour, complains of severe bone pain and is scheduled to receive a dose of morphine sulfate. For which administration route should the nurse question an order? I.M. I.V. Oral Subcutaneous (subQ)

I.M. A client with a platelet count of 22,000/μl bleeds easily. The nurse should avoid using the I.M. route because the area is highly vascular. The client may bleed readily when penetrated by a needle, and it may be difficult for the nurse to stop the bleeding. The client's existing I.V. access would be the best route, especially because I.V. morphine is effective almost immediately. Oral and subQ routes are preferred over I.M., but they're less effective for acute pain management than I.V.

A child has been diagnosed with acute lymphoblastic leukemia (ALL). The nurse knows that which possible complications can occur? Select all that apply. epistaxis bone pain renal impairment blindness infections infertility

epistaxis bone pain renal impairment blindness infections infertility If CNS involvement occurs, it can cause significant complications, including blindness and seizures. Kidney involvement, resulting from invasion of leukemia cells or obstruction of renal tubules with uric acid crystals, is another serious complication. The kidneys enlarge, and their function will be impaired. Because the number of functioning WBCs is reduced and the drugs used for treatment are immunosuppressive, children with leukemia are at high risk for infection. Because platelet production is limited, children with leukemia are also prone to hemorrhage. Epistaxis (nosebleed) is the most common kind of bleeding. Children with acute leukemia experience pain because of the vast number of WBCs that invade the periosteum of the bones. Males are at risk for testicular invasion with leukemic cells, which may not be destroyed with chemotherapy. If the testes are found to have leukemic invasion, local radiation is necessary for effective treatment. If a boy is past puberty and is producing sperm, sperm banking may be suggested before chemotherapy and radiation to preserve sperm for reproduction later in life.