Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder

The nurse is providing care to a child with disseminated intravascular coagulation and is preparing to administer heparin. The parent asks why the heparin is being given. Which response by the nurse would be most appropriate?

"Heparin helps to reduce the consumption of platelets."

A nurse is providing teaching to the parents of a child diagnosed with sickle cell anemia. The discussion is focused on precipitating factors for sickle cell crisis. Which statement by the parents requires the nurse to reinforce the teaching?

"Our family is taking a fun hiking trip up in the mountains next week."

Parents ask why their child is receiving prednisone to treat leukemia because it is not a chemotherapy drug. Which nursing instruction is most accurate?

"Prednisone decreases swelling caused by dead or dying cancer cells."

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 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 anemia 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 nurse is conducting a class to a group of parents on sickle cell anemia. Which statement by a parent indicates teaching has been effective?

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

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state:

"We should administer the drug on an empty stomach."

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."

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 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 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 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

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

A nurse caring for an 8-year-old with a bleeding disorder documents the following nursing diagnosis: ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This diagnosis is most appropriate for a client with:

Disseminated intravascular coagulation

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

Ewing sarcoma.

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

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

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

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.

A child with leukemia is receiving methotrexate for therapy. Which nursing diagnosis should the nurse use to best guide this child's care at this time?

Impaired oral mucous membrane related to effects of chemotherapy.

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

Ineffective tissue perfusion related to poor platelet formation

A child with hypoplastic anemia develops hemosiderosis. What nursing instruction promotes the treatment goals?

Infuse deferoxamine at home

A school-aged child with cancer is receiving chemotherapy. Which nursing action would best promote the oral comfort of a child receiving chemotherapy?

Keeping the child's lips moist with Vaseline to prohibit cracking

A 15-year-old boy has been diagnosed with an osteogenic sarcoma 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 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 14-year-old adolescent with Hodgkin disease is experiencing difficulty breathing and is sent for a radiograph. Which finding should the nurse expect to see on the x-ray report?

Mediastinal mass

The nurse is caring for a 6-year-old boy with non-Hodgkin lymphoma who is being treated with monoclonal antibodies. What recommendation would the nurse include in the child's plan of care?

Monitoring for allergic reactions or anaphylaxis.

The nurse is caring for a child with disseminated intravascular coagulation (DIC). The nurse notices signs of neurologic deficit. Which nursing action is appropriate?

Notify the physician

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

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

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

Prepare to administer factor replacement medication

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.

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

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 a group of 13-year-old boys and girls about screening and prevention of reproductive cancers. Which subjects would be included in the nurse's teaching plan? Select all that apply.

Self examination is an effective screening method for testicular cancer. Provide information regarding the benefits of receiving the HPV vaccine. A Papanicolaou (PAP) smear does not require parent consent in most states. Sexually transmitted disease is a risk factor for cervical cancer.

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 child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. What does this prescription indicate to the nurse?

The child has mild to moderate iron deficiency

A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the nurse to possible neurologic compromise?

Widely fluctuating blood pressure

The nurse is caring for a child admitted with suspected leukemia. The nurse has taken the child's history and performed an assessment. The nurse will plan to prepare the child for which additional diagnostic test first?

complete blood cell count (CBC)

A child is sent to pediatric intensive care following surgery for a brain tumor. Which prescription would the nurse question?

elevate head of bed 90 degrees

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

following guidelines for reverse isolation

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

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 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