Peds ch 27

Which statement by a mother may indicate a cause for her 9-month-old's iron deficiency anemia? a. "Formula is so expensive. We switched to regular milk right away." b. "She almost never drinks water." c. "She doesn't really like peaches or pears, so we stick to bananas for fruit." d. "I give her a piece of bread now and then. She likes to chew on it."

"Formula is so expensive. We switched to regular milk right away."

Which statement made by a parent indicates an understanding of health maintenance of a child with sickle cell disease? a. "I should give my child a daily iron supplement." b. "It is important for my child to drink plenty of fluids." c. "He needs to wear protective equipment if he plays contact sports." d. "He shouldn't receive any immunizations until he is older."

"It is important for my child to drink plenty of fluids."

A nurse is reinforcing teaching to the parent of a child who has a new prescription for liquid oral iron supplements. Which of the following statements by the parent indicates an understanding? A. "I should take my child to the emergency department if his stools become dark." B. "My child should avoid eating citrus fruits while taking the supplements." C. "I should give the iron with milk to help prevent an upset stomach." D. "My child should take the supplement through a straw."

"My child should take the supplement through a straw."

The nurse finds an adolescent with Hodgkin's disease crying. The adolescent says, "I am so scared." What is the most appropriate nursing response to this comment? a. "I understand how you must feel." b. "You shouldn't feel that way." c. "Is this the strongest feeling you've had today?" d. "Tell me what's got you scared."

"Tell me what's got you scared."

A 6-year-old child with leukemia asks, "Who will take care of me in heaven?" What is the best response by the nurse? a. "Who do you think will take care of you?" b. "Your grandparents and God will take care of you." c. "Your mom will know more about that than I do." d. "Why are you asking me that?"

"Who do you think will take care of you?"

A 2-year-old child has been diagnosed with hemophilia A. What information should the nurse include in a teaching plan about home care? a. If bleeding occurs, apply pressure, ice, elevate, and rest the extremity. b. Children's aspirin in lowered doses may be given for joint discomfort. c. A firm, dry toothbrush should be used to clean teeth at least twice a day. d. Do not permit interactive play with other children

. If bleeding occurs, apply pressure, ice, elevate, and rest the extremity.

The nurse, caring for a child receiving chemotherapy, notes that the child's abdomen is firm and slightly distended. There is no record of a bowel movement for the last 2 days. What do these assessment findings suggest? a. Peripheral neuropathy b. Stomatitis c. Myelosuppression d. Hemorrhage

. Peripheral neuropathy

when both parents have the sickle cell trait. chances of child having sickle cell.

1 in 4. 25%

What should be included in the nursing care of a 12-year-old child receiving radiation therapy for Hodgkin's disease? (Select all that apply.) a. Application of sunblock b. Appetite stimulation c. Conservation of energy d. Provision for expressions of anger e. Preparation for premature sexual development

1. Application of sunblock 2. Appetite stimulation 3. Conservation of energy 4. Provision for expressions of anger

stages of dying

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

How has synthetic recombinant antihemophilic factor improved the management of hemophilia? (Select all that apply.) a. Eliminates the need for frequent transfusions. b. Can be administered by family at home. c. Prevents hemorrhage. d. Reduces cost of care of the hemophiliac. e. Reduces risk of HIV and hepatitis A and B transmission.

1. Eliminates the need for frequent transfusions. 2. Can be administered by family at home. 3. Reduces cost of care of the hemophiliac. 4. Reduces risk of HIV and hepatitis A and B transmission.

What are the classic symptoms of thalassemia major (Cooley's anemia)? (Select all that apply.) a. Hepatomegaly b. Jaundice c. Protruding teeth d. Pathological fractures e. Renal failure

1. Hepatomegaly 2. Jaundice 3. Protruding teeth 4. Pathological fractures

A school-aged child is living with a chronic disease process. How would the nurse anticipate chronic illness will effect growth and development? (Select all that apply.) a. Delayed bonding with parents b. Delayed toilet training c. Impaired sense of belonging d. Decreased feelings of independence e. Impaired speech development

1. Impaired sense of belonging 2. Decreased feelings of independence

The nurse is caring for a child with a low platelet count. What skin assessments would alert the nurse to bleeding? (Select all that apply.) a. Petechiae b. Purpura c. Ecchymosis d. Hematoma e. Lymphadenopathy

1. Petechiae 2. Purpura 3. Ecchymosis 4. Hematoma

Why would the nurse urge the family of a dying 12-year-old boy to include his 8-year-old sister in care? (Select all that apply.) a. She will feel less neglected by the parents. b. She can make amends for past hostilities to her brother. c. She will feel increased helplessness. d. She can express her feelings through care. e. She can experience being supportive of her parents and brother.

1. She will feel less neglected by the parents. 2. She can make amends for past hostilities to her brother. 3. She can express her feelings through care. 4. She can experience being supportive of her parents and brother.

The family of a child receiving chemotherapy for leukemia should be taught to focus on which aspect(s) of the child's care? (Select all that apply.) a. Using a support group b. Stimulating appetite c. Maintaining adequate hydration d. Continuing with scheduled immunizations e. Reporting exposure to infectious diseases

1. Using a support group 2. Stimulating appetite 3. Maintaining adequate hydration 4. Reporting exposure to infectious diseases

The nurse explains that the COPP medical regimen for the treatment of Hodgkin's disease uses a combination of which drugs? (Select all that apply.) a. Vincristine b. Cyclophosphamide c. Methotrexate d. Prednisone e. Procarbazine hydrochloride

1. Vincristine 2. Cyclophosphamide 3. Prednisone 4. Procarbazine hydrochloride

effects on chronic illness on growth and development: TODDLER

1. autonomy 2. physical restrictions impede development of motor and language skills. 3. toilet training may be delayed 4. fear may erode self-confidence 5. separation anxiety occurs

effects of chronic illness on growth and development: ADOLESCENT

1. identity 2. adolescent feels loss of control and inability to conform to peers. 3. the developing self concept may become negative. 4. adolescent may grieve for a lost ability 5. enforced dependence may inpair plans for future goals. 6. rebellion results in decreased compliance

effects of chronic illness on growth and development: SCHOOL AGE

1. industry 2. loss of grade level in school because of illness and inability to participate or compete can lead to a sense of inferiority. 3. sense of independence and accomplishment can be lost 4. being different from peers may impede child's sense of belonging

effects of chronic illness on growth and development: PRESCHOOLER

1. initiativd 2. impaired ability to experience world outside of family impedes social skills. 3. overprotective parents delay teaching self-discipline 4. child may develop negative body image. 5. child develops sense of guilt at his or her inability to master tasks

Which of the following orders written for a child admitted with a diagnosis of sickle cell anemia should the nurse question? (select all that apply) A. restrict fluids B. provide a high-calorie, high protein diet C. administer meperidine (Demerol) 25 mg IM for pain q6h D. administer oxygen at 2 liters via nasal cannula prn

1. restrict fluids 2. administer meperidine (Demerol) 25 mg IM for pain q6h

effects on chronic illness on growth and development INFANCY

1. trust 2. a visible defect can delay bonding. 3. prolonged illness may separare child from family 4. irritability promotes parental negativity

By what age do children realize that death is final and permanent? A. 3 years B. 5 years C. 7 years D. 10 years

10 years

It is recommended that iron-fortified formula begiven to infants through age A. 3 months B. 6 months C. 9 months D. 12 months

12 months

Which principle should the nurse teach the parent concerning administering liquid iron preparations to the child with iron-deficiency anemia? A. Allow the preparation to mix with saliva and bathe the teeth between swallowing B. Warm the medication before administering C. Administer between meals D. Administer in the bottle of formula

Administer between meals

What will the nurse teach the parents of a child with a low platelet count to avoid? a. Benadryl b. Aspirin c. Caffeine d. Prednisone

Aspirin

On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. What is the priority nursing intervention? a. Assessing neurological status b. Inserting an intravenous line c. Monitoring vital signs during platelet transfusions d. Providing family education about how to prevent bleeding

Assessing neurological status

What is the result of a deficiency of factor IX? a. Thalassemia b. Idiopathic thrombocytopenic purpura c. Hemophilia A d. Christmas disease

Christmas disease

The child receiving a transfusion complains of back pain and itching. What is the best initial action by the nurse? a. Notify the charge nurse. b. Disconnect intravenous lines immediately. c. Give diphenhydramine (Benadryl). d. Clamp off blood and keep line open with normal saline

Clamp off blood and keep line open with normal saline.

What would the nurse include in a teaching plan about mouth care of a child receiving chemotherapy? a. Use commercial mouthwash. b. Clean teeth with a soft toothbrush. c. Avoid use of a Water-Pik. d. Inspect the mouth weekly for ulcerations.

Clean teeth with a soft toothbrush.

The nurse is teaching the parents of a young child with iron deficiency anemia about nutrition. What food would the nurse emphasize as being a rich source of iron? a. An egg white b. Cream of Wheat c. A banana d. A carrot

Cream of Wheat

A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain the children's risk of inheriting this disease? a. Every fourth child will have the disease; two others will be carriers. b. All of their children will be carriers, just as they are. c. Each child has a one in four chance of having the disease and a two in four chance of being a carrier. d. The risk levels of their children cannot be determined by this information.

Each child has a one in four chance of having the disease and a two in four chance of being a carrier

The nurse caring for a child with aplastic anemia is reviewing the laboratory results and notes a white blood cell (WBC) count of 6000 mm3 and a platelet count of 20,000 mm3. Which nursing intervention should be incorporated into the plan of care? 1. Encourage naps 2. Encourage a diet high in iron 3. Encourage quiet play activities 4. Maintain strict isolation precautions

Encourage quiet play activities

What is a characteristic manifestation of Hodgkin's disease? A. Petechiae B. Erythematous rash C. Enlarged lymph nodes D. Pallor

Enlarged lymph nodes

What important focus of nursing care for the dying child and the family should the nurse implement? a. Nursing care should be organized to minimize contact with the child. b. Adequate oral intake is crucial to the dying child. c. Families should be made aware that hearing is the last sense to stop functioning before death. d. It is best for the family if the nursing staff provides all of the child's care

Families should be made aware that hearing is the last sense to stop functioning before death.

What should the nurse closely assess in a child receiving a transfusion? a. Fever b. Lethargy c. Jaundice d. Bradycardia

Fever

A child is diagnosed with iron deficiency anemia. What will the nurse explain can occur if this disorder goes untreated? a. Hemorrhage b. Heart failure c. Infection d. Pulmonary embolism

Heart failure

A nurse is caring for an infant whose screening test reveals a potential diagnosis of sickle cell disease. Which of the following tests should be performed to distinguish if the infant has the trait or the disease? A. Sickle solubility test B. Hemoglobin electrophoresis C. Complete blood count D. Transcranial Doppler

Hemoglobin electrophoresis

A child with thalassemia major receives blood transfusions frequently. What is a complication of repeated blood transfusions? a. Hemarthrosis b. Hematuria c. Hemoptysis d. Hemosiderosis

Hemosiderosis *excessive deposits of iron

An adolescent is diagnosed with Hodgkin's disease. Lymph nodes on both sides of her diaphragm have been found to be involved, including cervical and inguinal nodes. Which disease stage is this? a. I b. II c. III d. IV

III

A child has just been diagnosed with acute lymphoblastic leukemia. What is the result of an overproduction of immature white blood cells in the bone marrow? a. Decreased T-cell production b. Decreased hemoglobin c. Increased blood clotting d. Increased susceptibility to infection

Increased susceptibility to infection

The nurse is presenting information on the congenital disorder of hemophilia A. What fact will the nurse include? a. It is seen in males and females equally. b. It is transmitted by symptom-free females. c. It is a sex-linked dominant trait. d. It is a defective gene located on the Y chromosome

It is transmitted by symptom-free females

The nurse notes that a 4-year-old child's gums bleed easily and he has bruising and petechiae on his extremities. Which lab value is consistent with these symptoms? a. Platelet count of 25,000/mm3 b. Hemoglobin level of 8 g/dL c. Hematocrit level of 36% d. Leukocyte count of 14,000/mm3

Platelet count of 25,000/mm3

The most recent blood count for a child who received chemotherapy last week shows neutropenia. What is the priority nursing diagnosis for this child? a. Risk for infection b. Risk for hemorrhage c. Altered skin integrity d. Disturbance in body image

Risk for infection

A nurse is reinforcing teaching about the management of epistaxis to an adolescent. Which of the following positions should the nurse instruct the adolescent to take when experiencing a nosebleed? A. Sit up and lean forward B. Sit up and tilt the head up C. Lie in a supine position D. Lie in a prone position

Sit up and lean forward

The nurse is dealing with a preschool child with a life-threatening illness. What should the nurse remember the child's concept of death is at this age? a. That it is final b. Only a fear of separation from her parents c. That a person becomes alive again soon after death d. An understanding based on simple logic

That a person becomes alive again soon after death

A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain. Which type of crisis is the child most likely experiencing? a. Aplastic b. Hyperhemolytic c. Vaso-occlusive d. Splenic sequestration

Vaso-occlusive

What will the nurse administer with ferrous sulfate drops when providing them to a child on the pediatric unit? a. With milk b. With orange juice c. With water d. On a full stomach

With orange juice

Nursing care of an adolescent with cancer who is refusing to cooperate with treatment should include A. allowing the adolescent to make some choices B. asking the parents to make the adolescent cooperate C. restricting visits from friends until the behavior is modified D. withholding the influences of group therapy until the behavior changes

allowing the adolescent to make some choices

The diagnostic test that confirms a diagnosis of leukemia is a(n) A. spinal tap B. Bone marrow aspiration C. complete blood count D. x-ray of the bones

bone marrow aspiration

adolescent on death

can understand abstract concept of death but has own feelings of own immortality. may express anger at person who died.

a child with newly diagnosed leukemia does not have all immunizations up to date. Which is an essential step in response to this? A. delay treatment until all immunizations have taken effect because a child with leukemia is immuno-compromised and prone to serious illness B. delay active immunizations during chemotherapy C. Administer immunizations on alternating days from chemotherapy D. Give immunizations according to the expected schedule; they do not interfere with treatment

delay active immunizations during chemotherapy

When caring for a child on steroid therapy, it is important to seek immediate medical attention if the child A. vomits B. develops a fever C. skips a meal D. loses her hair

develops a fever

What would be the initial nursing action when a child receiving a transfusion of packed red blood cells complains of chills and back pain? A. reduce the infusion rate B. take the child's blood pressure C. administer Benadryl as ordered D. discontinue the transfusion

discontinue the transfusion

Anxiety can be decreased in both the family and the child who has cancer by A. not telling the child that he or she has cancer B. explaining all procedures before they are done C. placing the child with an older child who has the same diagnosis D. discouraging the child who has the same diagnosis

explaining all procedures before they are done

The nurse reinforces instructions to the parents of a child with sickle cell anemia regarding the precipitating factors related to pain crisis. Which, if identified by a parent as a precipitating factor, indicates the need for further teaching? A. Stress B. Trauma C. Infection D. Fluid overload

fluid overload

Immediate nursing care of a child with hemophilia who has hemarthrosis includes A. application of heat B. active and passive range-of-motion exercises C. immobilization of the area of pain D. withholding factor VIII

immobilization of the area of pain

The greatest concern of a nurse caring for a child with ITP is A. injuries that might initiate bleeding B. a reaction to excess platelets C. noncompliance with aspirin therapy D. development of a secondary bacterial infection

injuries that might initiate bleeding

Which presents the greatest risk to the child with hemophilia? A. Hematuria B. Hemarthrosis C. Intracranial bleeding D. Iron deficiency anemia

intracranial bleeding

Stage 2 Hodgkin's disease

involves 2 or more lymph nodes in area or on same side of diaphragm

Stage 3 Hodgkin's disease

involves lymph node regions on both sides of diaphragm; involves adjacent organ or spleen

Stage 4 Hodgkin's disease

is diffuse disease; least favorable prognosis

A child who is in a vasoocclusive crisis caused by sickle cell anemia is experiencing acute pain. The nurse understands that Demerol (Meperidine) is not an appropriate pain medication to administer to this child because it: A. is very addictive B. is not strong enough C. may induce seizures D. cannot be given by mouth

may induce seizures

An appropriate nursing intervention for the child admitted to the hospital in sickle cell crisis would be to A. apply ice to painful areas B. encourage the child to ambulate C. provide foods high in iron at meals D. monitor the child's response to analgesics

monitor the child's response to analgesics

Thalassemia major (Cooley's anemia) is treated primarily with: A. a diet high in iron B. multiple blood transfusions C. bed rest until the sedimentation rate is normal D. oxygen therapy

multiple blood transfusions

infants on death

no concept. doesn't understand. reacts on emotional level to amxiety of parents

Iron supplement absorption is increased by taking it with A. orange juice B. cereal C. milk D. eggs

orange juice

Children with Hodgkin's disease usually present with a(n) A. unexpected sudden weight gain B. painless cervical neck lump C. enlarged abdomen D. high fever

painless cervical neck lump

Signs and symptoms that might indicate that a child has ITP include A. headaches and hematuria B. anemia and purpura C. petechiae and purpura D. hematuria and petechiae

petechiae and purpura

school age on death

realizes death is final. may be interested in details may fear parents will die

RICE acronym

rest, ice, compression, elevation

Stage 1 Hodgkin's disease

restricted to a single site or localized to a group of lymph nodes; asymptomatic

Children with hemophilia should avoid A. swimming B. salicylates C. citrus fruits D. analgesics

salicylates *aspirin contains it

When the patient experiences apprehension and urticaria while receiving a blood transfusion, the nurse: A. slows the transfusion and takes the patient's vital signs B. observes the child for further transfusion reactions C. stops the transfusion, allows normal saline solution to run slowly, and notifies the charge nurse D. stops what he or she is doing and obtains the patient's history

stops the transfusion, allows normal saline solution to run slowly, and notifies the charge nurse

The nurse observes a mother giving an oral iron supplement to her 6 year old child with iron deficiency anemia. Which action by the mother indicates the need for further teaching? A. The mother administered the iron with milk B. The mother administered the iron with water C. The mother administered the iron with apple juice D. The mother administered the iron with orange juice

the mother administered the iron with milk

preschoolers on death

thinks death is temporary. may blame self. respond by relying on their experience. turning to fantasy

Children who carry the sickle cell trait A. have a 10% chance of developing the disease B. have a 25% chance of developing the disease C. have a 50% chance of developing the disease D. will not develop any symptoms of the disease

will not develop any symptoms of the disease