Peds PrepU Ch. 24 ex 3
The parent of a child with Down syndrome phones the Nurse Line to report three weeks of lack of energy, limping, and weight loss in the young child. What is the most appropriate advice? a) "Give an age-appropriate dose of acetaminophen every 4 hours." b) "If symptoms persist, have the child seen within 7 days." c) "Bring the child to pediatrics to be examined." d) "Limit active play, and offer frequent small snacks and meals."
"Bring the child to pediatrics to be examined." Symptoms could indicate acute lymphoblastic leukemia (ALL). Compared with other children, children with Down syndrome have 15 times the risk of developing ALL.
The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate? a) "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." b) "I always give the ferrous sulfate with meals." c) "When I give my son ferrous sulfate I know he also needs potassium supplements." d) "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate."
"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black.
A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching? a) "Red meat is a good option; he loves the hamburgers from the drive-thru." b) "There are many iron fortified cereals that he likes." c) "I must encourage a variety of iron-rich foods that he likes." d) "He will enjoy tuna casserole and eggs."
"Red meat is a good option; he loves the hamburgers from the drive-thru." While iron from red meat is the easiest for the body to absorb, the nurse must limit fast food consumption from the drive-thru as it is also high in fat, fillers, and sodium. The other statements are correct.
The nurse is teaching the parents of a 4-year-old girl with thalassemia about sound nutritional choices. The nurse asks the mother about good snack choices to send to preschool. Which response by the mother would indicate a need for further teaching? a) "She likes string cheese and saltine crackers." b) "Yogurt and granola is a good choice." c) "I can send apple slices with yogurt dip." d) "She can bring graham crackers and peanut butter."
"She can bring graham crackers and peanut butter." Children with thalassemia should avoid foods that are high in iron. Peanut butter is high in iron and should be avoided. Yogurt, granola, string cheese, saltine crackers, and apples are appropriate choices.
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? a) "These values will help us monitor the disease." b) "The doctor will discuss these findings with you when he comes to the hospital." c) "These labs are just common labs for children with this disease." d) "I'm really not allowed to discuss these findings with you."
"These values will help us monitor the disease." This response answers the parent's questions. In the nonsevere form, the granulocyte count remains about 500, the platelets are over 20,000, and the reticulocyte count is over 1%. The other responses do not address what the parents are asking and would block therapeutic communication.
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: a) "We will need to gradually decrease the dosage." b) "He might develop a rounded face from this drug." c) "We should administer the drug on an empty stomach." d) "We should check our son's urine for glucose."
"We should administer the drug on an empty stomach." Corticosteroids are commonly administered with food to decrease the risk for gastrointestinal upset. Corticosteroids can disrupt glucose balance, so urine should be checked for glucose. A moon face is an adverse effect of corticosteroids. Corticosteroids need to be tapered gradually to reduce the risk of adrenal insufficiency.
The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? a) Teaching the importance of taking water safety measures b) Assessing dietary intake by addressing "picky eating" and "food jags" c) Plotting height and weight on a growth chart d) Administering the measles, mumps, rubella (MMR) vaccine
Administering the measles, mumps, rubella (MMR) vaccine Live vaccines (viral or bacterial) should not be administered to an immune suppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the toddler and should be included during the well-child visit.
A child is to receive radiation therapy this morning. The nurse would expect to see which type of drug prescribed to this child? a) Antipyretic b) Antiemetic c) Antineoplastic d) Analgesic
Antiemetic Radiation therapy causes nausea because it destroys rapid-growing cells. Among these are the cells of the stomach lining, the reason that nausea occurs.
A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode? a) Elevate the injured area such as a leg or arm. b) Administer factor VIII replacement. c) Apply direct pressure to the area. d) Apply heat to the site of bleeding.
Apply heat to the site of bleeding. Ice or cold compresses, not heat, would be applied to the site of bleeding. Direct pressure is applied until the bleeding stops. The injured part is elevated unless elevating would contribute to further injury. Factor VIII replacement is given to replace the missing clotting factor.
The nurse is providing preoperative care for a 7-year-old boy with a brain tumor and his parents. Which intervention is priority? a) Providing a tour of the intensive care unit b) Having the child talk to another child who has had this surgery c) Assessing the child's level of consciousness d) Educating the child and parents about shunts
Assessing the child's level of consciousness The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure. Lower priority interventions include providing a tour of the ICU to prepare the child and parents for after the surgery, and educating the child and parents about shunts.
What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent? a) Body appearance changes very little. b) No special procedure is necessary for removal. c) No tunneling is needed when the port is inserted. d) Flushing of the device is not necessary.
Body appearance changes very little. An implanted port has nothing extending through the skin and may be obvious only as a slight protrusion at the insertion site. Some tunneling from the port to a central vein is needed. Removal of the port requires a surgical procedure. Flushing of the port is necessary when used and on a regular basis.
The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis? a) Complete white blood count b) Lethargy, bruising, and pallor c) Bone marrow aspiration d) 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.
How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old? a) Describe it as a bone tumor b) Call it a tumor of muscle tissue c) Explain that it develops in nerves outside the brain and spinal cord d) Indicate that the more commonly used name is Hodgkin's disease
Call it a tumor of muscle tissue A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children. The other descriptors are incorrect.
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? a) Writing down phone numbers and appointments b) Keeping a written copy of the treatment plan c) Using acetaminophen if the child needs an analgesic d) Calling the doctor if the child gets a sore throat
Calling the doctor if the child gets a sore throat Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points but secondary to guarding against infection.
The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system? a) Observing petechiae, purpura, or unusual bruising b) Palpation of abdomen reveals enlarged liver and spleen c) Noting adventitious breath sounds during auscultation d) Child reports of facial palsy and vision problems
Child reports of facial palsy and vision problems The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising results from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia, and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis.
A child receiving chemotherapy is experiencing significant reduction in red blood cells secondary to myelosuppression. Which agent would the nurse most likely expect to be ordered? a) Sargramostim b) Gamma interferon c) Epoetin alfa d) Filgrastim
Epoetin alfa Epoetin alfa is a colony-stimulating factor used to stimulate production of red blood cells. Filgrastim is a colony-stimulating factor used to stimulate production of granulocytes. Sargramostim is a colony-stimulating factor used to stimulate production of granulocytes. Gamma interferon is used to stimulate macrophage production to fight bacteria and fungus.
The pediatric nurse examines the radiographs of a client that show that there are lesions on the bone. This finding is indicative of: a) Ewing sarcoma. b) Hodgkin disease. c) neuroblastoma. d) non-Hodgkin lymphoma.
Ewing sarcoma. Radiographs that show lesions on the bone may indicate tumors (e.g., Ewing sarcoma, osteosarcoma) or metastasis of tumors and warrant further investigation by bone scan, CT, or MRI. Positron emission tomography is the most effective test to diagnose Hodgkin disease, non-Hodgkin lymphoma, a neuroblastoma, bone tumors, lung and colon cancers, and brain tumors.
A 9-month-old boy with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help you determine that he is actually taking it daily? a) His stools will appear black. b) He will develop diarrhea. c) His reticulocyte count will have decreased. d) He will be less irritable than he was at his last visit.
His stools will appear black. A side effect of ferrous sulfate therapy is to color stools black.
A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? a) Iliac crest b) Sternum c) Femur d) Anterior tibia
Iliac crest Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.
The nurse preparing a client for diagnostic testing for disseminated intravascular coagulation knows this is a result indicative of this disease: a) Decreased fibrogen/fibrin degradation products b) Increased D-dimer assay c) Increased antithrombin III d) Decreased fibrinopeptide A level
Increased D-dimer assay Results indicative of disseminated intravascular coagulation include: increased D-dimer assay, decreased antithrombin III, increased fibrogen/fibrin degradation products, and increased fibrinopeptide A level.
A child with ALL is beginning treatment with methotrexate in an attempt to eradicate the leukemic cells. The stage of therapy represents the: a) Consolidation stage b) Induction stage c) Sanctuary stage d) Delayed intensive-therapy stage
Induction stage An induction stage is the first attempt at eradicating the leukemic cells to induce or achieve a complete remission.
Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? a) Ineffective breathing pattern related to decreased white blood count b) Risk for infection related to abnormal immune system c) Risk for altered urinary elimination related to kidney impairment d) Ineffective tissue perfusion related to poor platelet formation
Ineffective tissue perfusion related to poor platelet formation Idiopathic thrombocytopenic purpura results in decreased platelets, so bleeding into tissue can occur.
Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? a) Ineffective tissue perfusion related to poor platelet formation b) Risk for altered urinary elimination related to kidney impairment c) Ineffective breathing pattern related to decreased white blood count d) Risk for infection related to abnormal immune system
Ineffective tissue perfusion related to poor platelet formation Idiopathic thrombocytopenic purpura results in decreased platelets, so bleeding into tissue can occur.
The child with thalassemia may be given which classification of medication to prevent one of the complications frequently seen with the treatment of this disorder? a) Potassium supplements b) Vitamin supplements c) Factor VIII preparations d) Iron-chelating drugs
Iron-chelating drugs Frequent transfusions can lead to complications and additional concerns for the child, including the possibility of iron overload. For these children, iron-chelating drugs such as deferoxamine mesylate (Desferal) may be given. Vitamin and potassium supplements would not be given to treat the iron overload. Factor VIII preparations are given to the child with hemophilia.
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)? a) Hemoglobin (Hgb) of 11.2 g/dL b) Macrocytic red blood cells (RBCs) c) Decreased white blood cells (WBCs) d) Platelet count of 250,000
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.
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)? a) Platelet count of 250,000 b) Macrocytic red blood cells (RBCs) c) Decreased white blood cells (WBCs) d) Hemoglobin (Hgb) of 11.2 g/dL
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 14-year-old experiencing difficulty breathing is sent for a radiograph. The nurse knows that difficulty breathing may be indicative of: a) Mediastinal mass b) Tumor in the liver c) Lymphadenopathy d) Retinoblastoma
Mediastinal mass Difficulty breathing or respiratory distress may indicate a mediastinal mass (which may be seen on a radiograph). Presence of a white reflection in the pupil of the eye may indicate retinoblastoma. Enlarged or tender axillary lymph nodes may indicate lymphadenopathy. Hepatomegaly or splenomegaly may be caused by an infection or tumor in the liver or abdomen.
The nurse prepares to collect a 24-hour urine specimen for catecholamines from the child admitted with which likely childhood cancer diagnosis? a) Wilms tumor b) Osteogenic sarcoma c) Retinoblastoma d) Neuroblastoma
Neuroblastoma Most neuroblastomas secrete catecholamines, which are excreted in urine. The other tumors do not.
A 6-year-old boy visits the doctor's office with his mother. He has a rash on his buttocks, posterior thighs, and the extensor surface of his arms and legs. His joints are tender and swollen. The physician diagnoses him with Henoch-Schönlein syndrome. The nurse should expect what laboratory results in this case? a) Decreased white blood cell count b) Normal platelet count c) Elevated platelet count d) Decreased platelet count
Normal platelet count In Henoch-Schönlein syndrome, laboratory studies show a normal platelet count. Sedimentation rate, WBC count, and eosinophil count are elevated.
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? a) Observation reveals a cough and labored breathing b) Observation reveals nystagmus and head tilt c) Vital signs show blood pressure measures 120/80 mm Hg d) Examination shows temperature of 101.4° F (38.6°C) and headache
Observation reveals nystagmus and head tilt Coupled with the mother's reports, observation of nystagmus and head tilt suggest the child may have a brain tumor. Elevated blood pressure of 120/80 mm Hg may be indicative of Wilms tumor. Fever and headaches are common symptoms of acute lymphoblastic leukemia. A cough and labored breathing points to rhabdomyosarcoma near the child's airway.
What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)? a) Assess for constipation. b) Obtain a catheterized urine specimen. c) Protect the abdomen from manipulation. d) Control acute pain.
Protect the abdomen from manipulation. Manipulation can release malignant cells into the abdominal cavity. Constipation may be a problem following surgical intervention. Pain is uncommon; obtaining a urine specimen is not a priority.
A nurse is caring for a 12-year-old girl who is recovering from surgery for removal of a brain tumor. Which intervention should the nurse implement to avoid increasing intracranial pressure? a) Apply saline eye drops, as prescribed b) Regulate the rate of IV fluid infusions carefully c) Place a sterile towel under wet dressings d) Sponge the client's face
Regulate the rate of IV fluid infusions carefully Be certain to regulate the rate of IV fluid infusions carefully because an increase in the infusion rate has the potential to increase intracranial pressure. The other answers refer to other interventions, unrelated to intracranial pressure.
A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 μg/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding: a) Putting child safety locks on kitchen cabinets b) Placing house plants out of reach of children c) Removal or covering of flaking paint on the walls of the home d) Putting medicine away where children cannot reach it
Removal or covering of flaking paint on the walls of the home The usual sources of ingested lead are paint chips or paint dust, home-glazed pottery, or fumes from burning or swallowed batteries. A child with a blood lead level over 5 μg/dL needs to be rescreened to confirm the level and then active interventions begun to prevent further lead exposure, such as removal of the child from the environment containing the lead source or removal of the source of lead from the child's environment. Removal of the lead source is not an easy task in homes because simple repainting or wallpapering does not necessarily remove the source of peeling paint adequately. After some months, the new paint will begin to peel because of the defective paint underneath. The walls must therefore be covered by paneling or dry wall or other solid protective material.
The nurse is assessing an adolescent with suspected osteosarcoma. What would the nurse be least likely to assess? a) Gait changes b) Severe bone pain c) Erythema of the extremity d) Swelling of the extremity
Severe bone pain Osteosarcoma typically is characterized by dull bone pain that may be present for several months, eventually progressing to limp or gait changes. The affected limb may exhibit erythema and swelling, warmth, and tenderness.
The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect? a) Absence of bruising b) Capillary refill in less than 2 seconds c) Spooning of nails d) Pink palms and nail beds
Spooning of nails A convex shape of the fingernails termed 'spooning' can occur with iron deficiency anemia. Capillary refill in less than 2 seconds, pink palms and nail beds, and absence of bruising are normal findings.
Children with ALL may need periodic lumbar punctures. You would teach the mother this is done to assess for: a) early meningitis. b) platelets. c) leukemic cells. d) early development of septicemia.
leukemic cells. Leukemic cells in cerebrospinal fluid must be identified because, if present, they require additional therapy.
To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to: a) prevent the child from drinking an excess amount of fluids per day. b) administer an iron supplement daily. c) notify a health care provider if the child develops an upper respiratory infection. d) encourage the child to participate in school activities, such as long-distance running.
notify a health care provider if the child develops an upper respiratory infection. Reduction of oxygen and dehydration lead to increased sickling of cells. Early prevention of these with respiratory illness is important.
A child is receiving chemotherapy and develops stomatitis. The nurse identifies a nursing diagnosis of impaired oral mucous membranes related to the effects of chemotherapy. What instructions would the nurse include in the child's plan of care? Select all that apply. a) Have the child rinse the mouth with lukewarm water three times a day. b) Give the child acidic foods (e.g., orange juice) to cleanse the mouth. c) Apply a lip balm or petroleum jelly to prevent cracking. d) Provide various soft and bland foods to minimize further irritation. e) Vigorously rub the child's gums with gauze to clean them.
• Have the child rinse the mouth with lukewarm water three times a day. • Apply a lip balm or petroleum jelly to prevent cracking. • Provide various soft and bland foods to minimize further irritation. For the child with stomatitis, the nurse should provide soft foods to prevent further abrasions, have the child rinse the mouth three times a day with lukewarm water to promote comfort and healing, avoid giving the child acidic foods that would further irritate the tissue, and apply a lip balm or petroleum jelly to prevent cracking of the lips. The nurse should offer a soft toothbrush to minimize discomfort.
A 10-year-old who is receiving chemotherapy has received ondansetron before this therapy session. About an hour later, the child tells the nurse that his mouth feels really dry. The child has urinated several times and his skin turgor is normal. Which response by the nurse would be most appropriate? a) "Let me increase your intravenous fluids." b) "You might be having a severe allergic reaction. Are you itchy?" c) "This indicates an infection. We need to start antibiotics." d) "The drug you got to help with the nausea can cause dry mouth."
"The drug you got to help with the nausea can cause dry mouth." Ondansetron is associated with dry mouth. Increasing IV fluids may or may not be appropriate. The child is urinating and his skin turgor is normal so it doesn't appear that he is dehydrated and in need of extra fluid. A severe allergic reaction would more likely be manifested by itching, hives, and increasing respiratory distress. Dry mouth is not an indicator of infection.
When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation? a) "You will feel pressure on your hip from the needle." b) "You will have to lie on your back and hold your breath." c) "You won't feel any pain at all, because you will be asleep." d) "You will need to lie still afterward to prevent a headache."
"You will feel pressure on your hip from the needle." Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. It is usually done under local anesthesia or conscious sedation.
A nurse is reviewing the medical records of several children who have undergone lead screening. The nurse would identify the child with which lead level as requiring no further action? a) 8 mcg/dL b) 26 mcg/dL c) 20 mcg/dL d) 14 mcg/dL
8 mcg/dL A blood lead level less than 10 mcg/dL requires no action. A level of 14 mcg/dL would need to be confirmed with a repeat test in 1 month along with parental education for decreased lead exposure and then a repeat test in 3 months. Levels of 20 mcg/dL and 26 mcg/dL need to be confirmed with a repeat test in 1 week along with parental education and a referral to the local health department for investigation of the home for lead reduction.
The nurse is caring for a 2-year-old girl who is receiving chemotherapy using antitumor antibiotics. Which intervention would the nurse question? a) Maintaining meticulous hand-washing procedures b) Assessing for tachypnea and adventitious breath sounds c) Assessing the mouth for redness, lesions, or ulcers d) Administering antiemetics prior to chemotherapy
Assessing the mouth for redness, lesions, or ulcers Antitumor antibiotics do not cause mucositis, so it would not be necessary to assess the mouth for redness, lesions, or ulcers. Antitumor antibiotics cause nausea and vomiting, so administering antiemetics prior to chemotherapy would be appropriate. Antitumor antibiotics do cause myelosuppression, so meticulous hand washing would be appropriate. Antitumor antibiotics do cause myelosuppression, placing the child at risk for infection; therefore, assessing for tachypnea and adventitious breath sounds would be appropriate.
A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care? a) Performing dressing changes to the affected area b) Administering analgesics for pain c) Preparing the child for amputation d) Avoiding further abdominal palpation
Avoiding further abdominal palpation After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft. Therefore, excessive handling of the tumor may result in tumor seeding and metastasis. Preoperatively, the child with Wilms tumor does not have a wound; therefore, dressing changes are not necessary. Although the child may experience abdominal pain, avoiding further abdominal palpation would be the priority. Surgical removal of the tumor and affected kidney is the treatment of choice for Wilms tumor. Amputation would be more likely for a child with osteosarcoma.
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? a) Brain b) Bladder c) Blood d) Kidney
Bladder The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult cancer.
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? a) Cells are only susceptible to treatment by radiation during certain phases of the cell cycle b) It is difficult to locate where the cancer cells are in the body, so the entire body must be irradiated c) Insurance companies typically allow only a short radiation treatment per week, to contain costs d) Radiation therapy is very weak, and therefore it takes a long time to achieve therapeutic doses
Cells are only susceptible to treatment by radiation during certain phases of the cell cycle Radiation is not effective on cells that have a low oxygen content (a proportion of cells in every tumor), nor is it effective at the time of cell division (mitosis). Therefore, radiation schedules are designed so that therapy occurs over a period of 1 to 6 weeks and includes time intervals when cells will be in a susceptible stage.
A nurse is counseling parents of a 7-year-old boy with leukemia regarding the goals of the chemotherapy program for their son. What should she mention as the first goal? a) Administration of delayed intensive therapy b) Maintaining the original remission c) Complete absence of leukemia cells d) Prevention of leukemia cells from invading or growing in the CNS
Complete absence of leukemia cells A chemotherapy program is aimed at first achieving a complete remission or absence of leukemia cells (induction phase); second, preventing leukemia cells from invading or growing in the CNS (sanctuary or consolidation phase); third, administering delayed intensive therapy; and fourth, maintaining the original remission (maintenance phase).
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? a) Factor XIII b) Factor VIII c) Factor X d) Factor V
Factor VIII The most common types of hemophilia are factor VIII deficiency and factor IX deficiency, which are inherited as sex-linked recessive traits, with transmission to male offspring by carrier females.
The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? a) Providing age appropriate activities b) Grouping nursing care c) Following guidelines for protective isolation d) Encouraging the child to share feelings
Following guidelines for protective isolation The child with leukemia is susceptible to infection, especially during chemotherapy. Infections such as meningitis, septicemia, and pneumonia are the most common causes of death. To protect the child from infectious organisms, follow standard guidelines for protective isolation. Grouping nursing care to provide rest is important, but not the highest priority. Encouraging the child to share feelings and providing age-appropriate activities are important, but psychological issues are a lower priority than physical.
A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed? a) His daughter tugs and pulls at one ear. b) The infant always keeps her eyes tightly closed. c) He has noticed one pupil appears white. d) His daughter's eye appears to be protruding.
He has noticed one pupil appears white. As the tumor grows against the retina of the eye, the red reflex is no longer visible; the pupil appears white.
A child is diagnosed with sickle-cell anemia. Which component of the blood, the one responsible for the transport of oxygen, is defective in this disorder? a) Hemoglobin b) Thrombocytes (platelets) c) Plasma d) Leukocytes (white blood cells)
Hemoglobin The component of RBCs that allows them to carry out the transport of oxygen is hemoglobin, composed of globin, a protein, and heme, an iron-containing pigment. Fetal hemoglobin differs from adult hemoglobin; for this reason, diseases such as sickle-cell anemia or the thalassemias, which are disorders of the beta chains, do not become apparent clinically until this hemoglobin change has occurred (at approximately 6 months of age).
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: a) seizures. b) leg ulcers. c) priapism. d) behavioral addiction.
seizures. Repeated use of meperidine for pain management during sickle cell crisis increases the risk of seizures when used in children with sickle cell anemia. Behavioral addiction is rarely a concern in the child with sickle cell anemia if the narcotic is used for the alleviation of severe pain. Priapism is a complication of sickle cell anemia unrelated to meperidine administration. Leg ulcers are a complication of sickle cell anemia unrelated to meperidine administration.
A nurse is reviewing laboratory test results from several children, looking specifically at their thrombocyte levels. The nurse would identify that the child with which platelet level might be at risk for bleeding? Select all that apply. a) 80,000 per cubic millimeter b) 175,000 per cubic millimeter c) 287,000 per cubic millimeter d) 110,000 per cubic millimeter e) 234,000 per cubic millimeter
• 80,000 per cubic millimeter • 110,000 per cubic millimeter Normal thrombocyte level ranges from 150,000 to 300,000 per cubic millimeter. Therefore, a child with a thrombocyte level of 80,000 and 110,000 per cubic millimeter would be at risk for bleeding.
The nurse caring for adolescents with cancer uses the following recommended psychosocial interventions to help the adolescents cope with their disease. Select all that apply. a) Control the amount of information given out about the adolescents' conditions. b) Encourage the adolescents to make plans for the future. c) Discourage relationships with other adolescents who have cancer. d) Encourage adolescents to engage in their usual activities. e) Be an advisor, not a friend to the adolescents to promote cooperation in the care plan. f) Postpone return to school for as long as possible to ensure eventual successful return.
• Control the amount of information given out about the adolescents' conditions. • Encourage the adolescents to make plans for the future. • Encourage adolescents to engage in their usual activities. The nurse should encourage usual activities and plans for the future and control the amount of information outsiders know about the child's condition. Relationships with other children with cancer should be encouraged as well as an early return to school. The nurse should be a friend as well as an advisor to the adolescents.
The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching? a) "I put her legs up on pillows when her knees start to hurt." b) "I bought the medication to give to her when she says she is in pain." c) "She loves popsicles, so I'll let her have them as a snack or for dessert." d) "She has been down, but playing in soccer camp will cheer her up."
"She has been down, but playing in soccer camp will cheer her up." Following a sickle cell crisis, the child should avoid extremely strenuous activities that may cause oxygen depletion. Fluids are encouraged, pain management will be needed, and the child's legs may be elevated to relieve discomfort, so these are all statements that indicate an understanding of caring for the child who has had a sickle cell crisis.
The nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains how the test works to the family. Which response accurately describes this test? a) "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." b) "The MRI uses radiation to examine soft tissue and bony structures of the body." c) "The MRI uses radio waves and magnets to produce a computerized image of the body." d) "The MRI uses sound waves to create images that visualize body structures and locate masses."
"The MRI uses radio waves and magnets to produce a computerized image of the body." The MRI uses radio waves and magnets to produce a computerized image of the body. The bone scan is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement. The ultrasound uses sound waves to create images that visualize body structures and locate masses. Radiography uses radiation to examine soft tissue and bony structures of the body.
The child has been diagnosed with severe iron deficiency anemia. The child requires 5 mg/kg of elemental iron per day in three equally divided doses. The child weighs 47.3 lb (21.5 kg). How many milligrams of elemental iron should the child receive with each dose? Record your answer using a whole number.
36 The dose should be calculated using weight in kilograms. 21.5 kg x 5 mg/1 kg = 107.5 mg/day. 107.5 mg/3 doses = 35.8333 mg/dose Rounded to the nearest whole number = 36 mg
The nurse must calculte the absolute neutophil count for an immune suppressed child. Which is the accurate ANC based on the following laboratory results? Total white blood cell count (WBC): 3000. WBC differential: 10% segmented neutrophils, 8% neutrophil bands. a) 300 b) 240 c) 540 d) 60
540 The ANC is not measured directly; it must be calculated. Step 1: Determine the total percentage of neutrophils. 10% + 8% = 18% (0.18) Step 2: Multiply the WBC by the total percent of neutrophils. 3000 X 0.18 = 540 ANC
The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? a) A 7-month-old boy who has started table food b) An 8-year-old girl who carries her lunch to school c) A 15-year-old girl who has heavy menstrual periods d) A 3-month-old boy who is totally breastfed
A 15-year-old girl who has heavy menstrual periods Adolescents with heavy menstrual flows lose enough blood each month to cause iron-deficiency anemia.
A nurse is assessing an 8-year-old child brought to the emergency department by his mother. The child has a history of sickle-cell anemia and reports acute back pain and joint pain. His mucous membranes are dry; skin turgor is poor. Capillary refill is slowed and nail beds are pale. The child is diagnosed with sickle-cell crisis. Which nursing diagnosis would the nurse most likely identify as a priority? a) Acute pain related to effects of sickling b) Deficient fluid volume related to clustering of sickled cells c) Ineffective peripheral tissue perfusion related to the effects of sickled cells d) Ineffective coping related to chronic illness
Acute pain related to effects of sickling Although ineffective peripheral tissue perfusion and deficient fluid volume would apply, acute pain would be the priority. Once pain is relieved, the child is able to relax, thus reducing the metabolic demand for oxygen and helping to end the sickling. There is no information to correlate with a nursing diagnosis of ineffective coping.
An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom should the nurse most expect as a result of excessive iron deposits? a) An enlarged spleen b) An enlarged heart c) An enlarged thyroid gland d) Enlarged lymph nodes
An enlarged spleen The child with thalassemia major may have both an enlarged spleen and liver due to excessive iron deposits and fibrotic scarring in the liver and the spleen's increased attempts to destroy defective RBCs.
The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order? a) Succimer b) Dimercaprol c) Edentate calcium disodium d) Deferasirox
Deferasirox Deferasirox is indicated for iron toxicity. It binds with iron, which is removed via the kidneys. Dimercaprol is indicated for blood lead levels greater than 45 mcg/dL. It removes lead from soft tissues and bone, allowing for its excretion via the renal system. Edentate calcium disodium is indicated for blood lead levels greater than 45 mcg/dL. The medication removes lead from soft tissues and bone, allowing for its excretion via the renal system. Succimer is indicated for blood lead levels greater than 45 mcg/dL; it removes lead from soft tissues and bone, allowing for its excretion via the renal system.
What is a well-defined risk management technique that the nurse can teach children and parents to prevent cancer? a) Eliminate aerosol sprays from the living area b) Avoid artificial colors, flavors, and fragrances in foods, cosmetics, and household items c) Limit sun exposure throughout childhood and adolescence d) Incorporate more preservative-free foods into the diet
Limit sun exposure throughout childhood and adolescence Limiting sun exposure by using shade, clothing, and sunscreen applied correctly will reduce the risk of skin cancer. Sun exposure is cumulative throughout life; the greatest exposure tends to occur in childhood and adolescence. Tanning booths should not be used. The other choices could have some merit, but none has been scientifically confirmed.
The nurse is caring for a 5-year-old boy who will soon die of cancer and is experiencing dyspnea and increasing levels of pain. What would be the priority for pain management with this child? a) Preventing addiction to the opioid medications b) Following the physician's rigid guidelines regarding dosages c) Preventing and alleviating pain d) Monitoring the child's vital signs frequently
Preventing and alleviating pain Recommendations for pain management in this setting place no limits on the dosage of analgesics but rather encourage aggressive dosing and even rapid escalation of dosages to achieve and maintain pain control. The recommendations also state that prevention and alleviation of pain is the nurse's primary goal; that children, parents, and clinicians are equal partners in pain management; and that the nurse's role includes performing and evaluating interventions. Addiction is not an issue with a dying child who is in pain. Vital signs are monitored frequently regardless of the child's pain level. Additionally, the focus of the question is on pain management of the dying child.
The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? a) Earache, stiff neck, or sore throat b) Difficulty or pain when swallowing c) Temperature of 101° F (38.3° C) or greater d) Blisters, ulcers, or a rash appear
Temperature of 101° F (38.3° C) or greater The parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C) or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the parents must be directed to take action at the first sign of infection in order to prevent overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes, or difficulty or pain when swallowing are reasons to seek medical care, but are not as grave as the risk of infection.
A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the nurse to possible neurologic compromise? a) Hematuria b) Petechiae c) Widely fluctuating blood pressure d) Equal pupillary response
Widely fluctuating blood pressure A key aspect of the nurse's role is to assess the child for signs and symptoms of impaired tissue perfusion in the various body systems that may be affected by DIC. Unstable or abnormal blood pressure such as wide fluctuations in blood pressure or unequal pupil size may suggest neurologic compromise. Hematuria would suggest renal compromise. Petechiae would be indicative of bleeding into the skin.
A group of nursing students is discussing the diagnosis of iron deficiency anemia, and one of the students asks what foods would be good for this child to eat. Which foods are high in iron? Select all that apply. a) Cheese b) Peanut butter c) Oatmeal d) Egg yolks e) Raisins f) Milk
• Peanut butter • Oatmeal • Egg yolks • Raisins Egg yolks, raisins, peanut butter and oatmeal are food sources high in iron. Milk and cheese are not food sources that are high in iron.
Question: A group of newly hired nurses who will be working on the pediatric unit are attending an in-service program about sickle cell disease. During the program, the nurse manager describes the steps for managing sickle cell pain. Place these steps in the sequence in which the nurse manager would describe them. -Believe the child's report of pain. -Provide rest in a quiet area. -Give medications and use distraction. -Look for complications or cause of pain. -Assess the pain. -Administer fluids.
Assess the pain. Believe the child's report of pain. Look for complications or cause of pain. Give medications and use distraction. Provide rest in a quiet area. Administer fluids. The ABCs of managing sickle cell pain are assess the pain (use a pain assessment tool); believe the child's report of pain; complications or cause of pain (look for complications); drugs and distraction: pain medication (opiates and nonsteroidal anti-inflammatory drugs (NSAIDs), if no contraindications); use fixed dosing; give on a timed schedule; no PRN dosing for pain medications; distraction with music, TV, and relaxation techniques; environment (rest in quiet area with privacy); and fluids.
The primary intervention for beta-thalassemia is a chronic transfusion program of packed white blood cells with iron chelation. a) False b) True
False The primary intervention for beta-thalassemia is a chronic transfusion program of packed red blood cells with iron chelation. Such a program facilitates adequate oxygenation of body tissues and practically eliminates all symptoms of thalassemia.
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? a) Brain b) Rib cage c) Heart d) Lungs
Lungs Metastasis occurs early with bone tumors because of the extensive vascular system in bones. Metastasis to the lungs is very common; as many as 25% of adolescents will have lung metastasis already by the time of initial diagnosis. When this is present, the adolescent usually has noticed a chronic cough, dyspnea, and chest pain in addition to chronic leg pain. Other common sites of metastasis are brain and other bone tissue.
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. The nurse recognizes that this is the likely cause of this type of anemia: a) Acute blood loss b) Vitamin B12 deficiency c) Sickle-cell disorder d) Iron deficiency
Vitamin B12 deficiency Vitamin B12 is necessary for the maturation of RBCs. Pernicious anemia results from deficiency or inability to use the vitamin, resulting in RBCs that appear abnormally large and are immature megaloblasts (nucleated immature red cells). Thus, pernicious anemia is one of the megaloblastic anemias. In children, the cause is more often lack of ingestion of vitamin B12 rather than poor absorption. Adolescents may be deficient in vitamin B12 if they are ingesting a long-term, poorly formulated vegetarian diet as the vitamin is found primarily in foods of animal origin.
What signs and symptoms has the elementary school nurse noted that create suspicion of a brain tumor in a student? Select all that apply. a) Ringing in the ears b) Clumsiness in movement c) Reddened sclera d) Nausea and vomiting e) Headache on awakening
• Clumsiness in movement • Nausea and vomiting • Headache on awakening Most brain tumors in children occur in the cerebellum or brain stem, so that initial symptoms are those of increased intracranial pressure (ICP). Incoordination is also a frequent sign. Ringing in the ears and reddened sclera do not create suspicion of a brain tumor
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? a) Keeping a written copy of the treatment plan b) Writing down phone numbers and appointments c) Using acetaminophen if the child needs an analgesic d) Calling the doctor if the child gets a sore throat
Calling the doctor if the child gets a sore throat Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points but secondary to guarding against infection.
The nurse is educating the parents of a 16-year-old boy who has just been diagnosed with Hodgkin disease. Which discussion is most appropriate at this time? a) Explaining how to care for skin after radiation therapy b) Describing the two ways of staging the disease c) Telling about the drugs and side effects of chemotherapy d) Informing the parents about postoperative care
Describing the two ways of staging the disease It would not be necessary for the nurse to inform the parents about postoperative care since this is not a treatment method for the disease. The treatment of choice for Hodgkin disease is chemotherapy, but radiation therapy may be necessary; however, discussing the treatment methods may be overwhelming at this time. Upon first learning the diagnosis, it is most helpful for the nurse to explain that staging refers to the spread of the disease (stages I through IV); and that A means the child is asymptomatic, while B means that symptoms are present.
The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? a) Providing age appropriate activities b) Grouping nursing care c) Encouraging the child to share feelings d) Following guidelines for protective isolation
Following guidelines for protective isolation The child with leukemia is susceptible to infection, especially during chemotherapy. Infections such as meningitis, septicemia, and pneumonia are the most common causes of death. To protect the child from infectious organisms, follow standard guidelines for protective isolation. Grouping nursing care to provide rest is important, but not the highest priority. Encouraging the child to share feelings and providing age-appropriate activities are important, but psychological issues are a lower priority than physical.
A nurse is giving instructions to the father of a boy who is receiving chemotherapy (including methotrexate) regarding how best to care for the boy during this period of treatment. What should the nurse mention to him? a) Be sure that the boy receives only live-virus vaccines b) Give the boy folic acid supplements c) Keep him away from people with known infections d) Give him aspirin to help manage pain
Keep him away from people with known infections A child receiving chemotherapy is particularly susceptible to contracting an infection so should be kept away from people with known infections. Caution parents, while children are receiving chemotherapy, not to give them aspirin for pain as, in addition to increasing the child's susceptibility to Reye syndrome, aspirin may interfere with blood coagulation, a problem that may already be present because of lowered thrombocyte levels. A parent who wants to give a child vitamins should check with the primary health care provider to be certain the vitamin preparation will not interfere with a chemotherapeutic agent. Administration of a vitamin that contains folic acid, for example, could interfere with the effectiveness of methotrexate, a folic acid antagonist. Caution parents that live-virus vaccines should not be given during chemotherapy as, if the child's immune mechanism is deficient, these vaccines could cause widespread viral disease.
The nurse is assessing a 4-year-old girl whose mother reports that she is not eating well, is losing weight, and has started vomiting after eating. Which risk factor from the health history suggests the child may have a Wilms tumor? a) The child has Schwachman syndrome. b) There is a family history of neurofibromatosis. c) The child has Beckwith-Wiedemann syndrome. d) The child has Down syndrome.
The child has Beckwith-Wiedemann syndrome. Along with the symptoms reported by the mother, the fact that the child has Beckwith-Wiedemann syndrome suggests that the child could have a Wilms tumor. Down syndrome would point to leukemia or brain tumor. Schwachman syndrome would suggest leukemia. A family history of neurofibromatosis is a risk factor for brain tumor, rhabdomyosarcoma, or acute myelogenous leukemia.
The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply. a) Encouraging frequent close contact with numerous visitors b) Having the child sleep in a single bed and room c) Providing a low-carbohydrate, low-protein diet d) Encouraging frequent, thorough handwashing e) Cheering up the environment with fresh flowers and plants
• Having the child sleep in a single bed and room • Encouraging frequent, thorough handwashing To reduce the risk of infection, the nurse should teach the child and parents about minimizing the child's exposure to potentially infectious situations. The nurse should encourage the parents to arrange for the child to sleep in a single bed and room and, if possible, avoid close contact with other family members who may be developing upper respiratory tract infections. Thorough and frequent handwashing, especially after using the bathroom and before eating, is essential. A high-calorie, high-protein diet helps to rebuild white blood cells and should be encouraged. If possible, the child's exposure to large crowds and visitors should be limited because of the increased risk of infection from these individuals. Fresh flowers and plants should be avoided because they could harbor mold spores.
The mother of an 11-year-old girl who will begin radiation therapy soon asks the nurse what the family needs to do for their daughter during this time. Which interventions should the nurse mention? Select all that apply. a) Increase amounts of fresh fruit and vegetables rich in cellulose b) Help the child devise "mind games" to play during the procedure c) Administer antiemetics as prescribed d) Encourage lengthy soaks in the bath e) Apply skin creams and lotions to irradiated skin f) Expose the irradiated area to air
• Help the child devise "mind games" to play during the procedure • Administer antiemetics as prescribed • Expose the irradiated area to air To care for the child who is receiving radiation therapy, the family should expose irradiated area to air but not to direct heat or sunlight, administer antiemetics as prescribed, and help the child devise "mind games" to play during the procedure, among other things. Because some skin preparations are drying and some interfere with radiation, do not apply creams or lotions unless prescribed. Avoid lengthy soaks in bath water or swimming pools. Reduce amounts of fresh fruit and vegetables rich in cellulose, and eliminate apple juice from the child's diet, because these may contribute to diarrhea and subsequent fluid loss.