Ch. 46 Cellular regulation hematology
The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with sickle cell disease. The nurses in the group make the following statements. Which statement is most accurate regarding this condition? "The trait or the disease is seen in one generation and skips the next generation." "If the trait is inherited from both parents the child will have the disease." "The disease is most often seen in individuals of Asian decent." "Males are much more likely to have the disease than females."
"If the trait is inherited from both parents the child will have the disease." Explanation: When the trait is inherited from both parents (homozygous state), the child has sickle cell disease, and anemia develops. The trait does not skip generations. The trait occurs most commonly in black clients. Either sex can have the trait and disease. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1711
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? "When I give my son ferrous sulfate I know he also needs potassium supplements." "I always give the ferrous sulfate with meals." "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." "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." Explanation: 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. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1698
A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate? "Infants with pyloric stenosis require ferrous sulfate." "Preterm infants are at risk for iron-deficiency anemia." "Your infant may have been having excessive diarrhea." "Ferrous sulfate helps improve red blood cell formation."
"Preterm infants are at risk for iron-deficiency anemia." Explanation: Infants born prematurely are at risk for iron-deficiency anemia because iron stores are built during the last few weeks of gestation. Although some infants with pyloric stenosis may require an iron supplement, such as ferrous sulfate, not all infants will. Infants with excessive diarrhea may develop iron-deficiency anemia, and ferrous sulfate helps improve red blood cell formation, but this does not explain why a preterm infant is being prescribed an iron supplement. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1707
A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the nurse to provide? "Sickle cell disease occurs from a random genetic mutation." "Sickle cell disease is passed to a fetus when both parents have the gene." "Sickle cell disease is passed to a fetus when one of the parents has the gene." "Sickle cell diseas can be passed to the fetus in many ways. We will know more at birth."
"Sickle cell disease is passed to a fetus when both parents have the gene." Explanation: Sickle cell disease is an inherited disease. The recessive gene is passed from both parents who either have the disease or the trait. There is no need for further testing to determine the cause. There are no other ways to pass the disease other than through genetics. Informing the parents that the gene was passed from both parents is most informative. Sickle cell anemia is not a dominant disease, which is passed when only one parent has the gene, nor is caused by a random mutation. p. 1711.
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." "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." "The MRI uses sound waves to create images that visualize body structures and locate masses." "The MRI uses radiation to examine soft tissue and bony structures of the body."
"The MRI uses radio waves and magnets to produce a computerized image of the body." Explanation: 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. p. 1691.
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? "This is a hereditary disease that is transmitted by one affected gene." "Sickle cell anemia is common in people of Asian descent." "The sickle shape of red blood cells decreases oxygen to tissues." "Fluid restriction is necessary to control sickle cell anemia."
"The sickle shape of red blood cells decreases oxygen to tissues." Explanation: 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. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1711
A nurse is caring for a 7-year-old child with hemophilia who requires an infusion of factor VIII. The child is fearful about the process and is resisting treatment. How should the nurse respond? "Would you like to administer the infusion?" "Would you help me dilute this and mix it up?" "Will you help me apply this adhesive bandage?" "Please be brave; we need to stop the bleeding."
"Would you help me dilute this and mix it up?" Explanation: The best response for a 7-year-old child is to use distraction and involve the child in the infusion process in a developmentally appropriate manner. A 7-year-old child is old enough to assist with the dilution and mixing of the factor. Asking for help with the band-aid would be best for a younger child. The nurse will wait until the child reaches adolescence to be taught to administer one's own factor infusions. Telling the child to be brave is not helpful and does not teach. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1723
The child has been prescribed chemotherapy. In order to properly calculate the child's dose, the nurse must first figure the child's body surface area (BSA). The child is 130 cm tall and weighs 27 kg. Calculate the child's BSA. Record your answer using two decimal places.
0.99 Explanation: Square root of (height [cm] x weight [kg] divided by 3,600) = BSA. The child is 130 cm tall and weighs 27 kg: 130 x 27 = 3,510; 3,510/3,600 = 0.975; and the square root of 0.975 is 0.9874. The BSA would be 0.987, when rounded to the hundredths place = 0.99. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, LABORATORY AND DIAGNOSTIC TESTING, p. 1702.
The nurse is caring for a child in sickle cell crisis. To best promote hemodilution, the nurse would expect to administer how much fluid per day intravenously or orally? 150 ml/kg of fluids 110 ml/kg of fluids 130 ml/kg of fluids per day 120 ml/kg of fluids per day
150 ml/kg of fluids Explanation: To promote hemodilution in sickle cell crisis, the nurse would provide 150 ml/kg of fluids per day or as much as double maintenance, either orally or intravenously. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, HEMOGLOBINOPATHIES, p. 1715.
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 Osteogenic sarcoma Non-Hodgkin lymphoma Acute lymphoblastic leukemia (ALL)
Acute lymphoblastic leukemia (ALL) Explanation: 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%. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1724
A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform? Administer broad-spectrum antibiotics intravenously. Maintain fluid restriction to below maintenance levels. Monitor serum sodium levels. Administer diuretics.
Administer broad-spectrum antibiotics intravenously. Explanation: Typhlitis (neutropenic enterocolitis) is an inflammatory process of the gastrointestinal tract that occurs with the induction phase of leukemia chemotherapy. The recommended interventions for treatment are to administer broad-spectrum antibiotics or antifungals intravenously, provide supportive care to manage symptoms, and provide IV nutrition. The client should be kept NPO. The nurse should assess for any signs of bowel perforation or shock. Administering diuretics would not be needed and may cause harm. Monitoring sodium levels as well as other electrolytes would be necessary to evaluate IV nutrition. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1706
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? Apply heat to the site of bleeding. Apply direct pressure to the area. Elevate the injured area such as a leg or arm. Administer factor VIII replacement.
Apply heat to the site of bleeding. Explanation: 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. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, CLOTTING DISORDERS, p. 1723.
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? Avoiding further abdominal palpation Performing dressing changes to the affected area Administering analgesics for pain Preparing the child for amputation
Avoiding further abdominal palpation Explanation: 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. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1721
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 Keeping a written copy of the treatment plan Writing down phone numbers and appointments Using acetaminophen if the child needs an analgesic
Calling the doctor if the child gets a sore throat Explanation: 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. p. 1701.
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? Child reports facial palsy and vision problems Observing petechiae, purpura, or unusual bruising Noting adventitious breath sounds during auscultation Palpation of abdomen reveals enlarged liver and spleen
Child reports facial palsy and vision problems Explanation: 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 result 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. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1724
The nurse is concerned that a school-aged child has iron-deficiency anemia. What did the nurse assess in this client? Shyness Thumb-sucking Asking many questions Craving for ice cubes
Craving for ice cubes Explanation: In school-aged children, there is an association between iron-deficiency anemia and pica or the craving for ice cubes. Iron-deficiency anemia is not associated with shyness, thumb-sucking, or inquisitive behavior. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1707-1708
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 V Factor VIII Factor X Factor XIII
Factor VIII Explanation: 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. p. 1718.
A high school football player has been diagnosed as having osteosarcoma of the femur. The parents are angry because they told their son not to play football. Which health teaching points would the nurse include in the teaching plan for the adolescent and his parents? Osteosarcoma often follows trauma, such as a football injury. You can expect some discoloration of the leg following chemotherapy. Football injuries do not contribute to the development of a tumor. Tumor growth is related to your dislike of milk.
Football injuries do not contribute to the development of a tumor. Explanation: Osteosarcoma is the most malignant form of bone cancer. It is caused by the embryonic mesenchymal tissue that forms in the bones. A football injury may predispose more scrutiny of a lesion but it will not be the cause of the cancer, nor will the dislike of milk. Osteosarcoma may be treated with chemotherapy and radiation. It may also involve an amputation. The parents who state they are angry at their adolescent for playing football are more likely projecting their fears of the diagnosis and the future for their son. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1732
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? Tell the parent to administer acetaminophen every 4 hours until the fever dissipates. Ask whether any family members or other close associates are ill. Have the parent bring the child to the pediatric oncology clinic as soon as possible. Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order.
Have the parent bring the child to the pediatric oncology clinic as soon as possible. Explanation: The preschooler is considered immunosuppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1701
A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? Iliac crest Sternum Anterior tibia Femur
Iliac crest Explanation: 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. p. 1690.
Which site is most frequently used to perform a bone marrow aspiration? Humerus Iliac crest Rib cage Femur
Iliac crest Explanation: The preferred site for bone marrow aspiration in children is the iliac crest. The other sites are not used for a bone marrow aspiration. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1690
Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? Ineffective tissue perfusion related to poor platelet formation Risk for altered urinary elimination related to kidney impairment Risk for infection related to abnormal immune system Ineffective breathing pattern related to decreased white blood count
Ineffective tissue perfusion related to poor platelet formation Explanation: Idiopathic thrombocytopenic purpura (ITP) results from an immune response following a viral infection that produces antiplatelet antibodies. These antibodies destroy the platelets which cause petechiae, purpura, and excessive bleeding. ITP does not affect the kidneys. Breathing difficulties would not occur with decreased white blood cells. It occurs when there is decreased red blood cells. The child who develops ITP has no different immune system than other children who are healthy.
The nurse is caring for a child with sickle-cell anemia admitted to the pediatric unit. The child reports severe pain and fever. The nurse notes the following laboratory values: white blood cells 18,000/mm3, hemoglobin 6.6 mg/dl (66 g/L), and bilirubin 8 mg/dl (136.83 µmol/L). Which nursing action is priority? Initiate intravenous access. Administer pain medication. Assess the child's temperature. Begin an exchange transfusion.
Initiate intravenous access. Explanation: In a situation where the child is experiencing a sickle cell crisis, a priority nursing action is to initiate intravenous access to begin rehydrating the child to halt the sickling process. Administering pain medication and assessing temperature are also important but can be performed after ensuring IV access is obtained. An exchange transfusion may be performed if other interventions are unsuccessful. p. 1715.
Nursing students are reviewing information about childhood cancers. They demonstrate understanding of the information when they identify what as the most frequent type? Wilms tumor Leukemia Brain stem tumor Non-Hodgkin lymphoma
Leukemia Explanation: Although Wilms tumor, brain stem tumors, and non-Hodgkin lymphoma can occur in children, the most frequent type of cancer in children is leukemia. p. 1724.
A 15-year-old boy has been diagnosed with an osteosarcoma of the distal femur. He also demonstrates a chronic cough, dyspnea, and chest pain, along with chronic leg pain. Based on these findings, the nurse should suspect metastasis to which body area? Lungs Heart Brain Rib cage
Lungs Explanation: 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. p. 1732.
The nurse is caring for a child with disseminated intravascular coagulation (DIC). The nurse notices signs of neurologic deficit. Which nursing action is appropriate? Continue to monitor neurologic signs. Notify the physician. Evaluate respiratory status. Inspect for signs of bleeding.
Notify the physician. Explanation: If neurologic deficits are assessed, immediate reporting of the findings is necessary to begin treatment to prevent permanent damage. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Disseminated Intravascular Coagulation, pp. 1720-1721.
A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? Restricting the child's visitors Placing a "no abdominal palpation" sign above the child's bed Ensuring that the child be allowed nothing by mouth Preparing the child for chemotherapy Preventing weight-bearing activities
Placing a "no abdominal palpation" sign above the child's bed Explanation: Nephroblastoma (Wilms tumor) metastasizes rapidly, so it is important that the child's abdomen not be palpated any more than necessary for diagnosis, because handling appears to aid metastasis. There is no need to restrict the child's visitors. Ensuring nothing by mouth would be appropriate prior to surgery. Preventing weight-bearing activities would be appropriate for a child with Ewing sarcoma. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1734-1735
A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first? Document the presence of hemarthrosis in the client's chart Notify the client's primary health care provider Assess the client's urine and stool for blood Prepare to administer factor replacement medication
Prepare to administer factor replacement medication Explanation: Many clients with hemophilia have repeated episodes of hemarthrosis or bleeding into the joints, and develop functional impairment of the joints, despite careful treatment. To assist in limiting impairment, the nurse would prepare to administer factor replacement medications, such as plasma, recombinant clotting factor VIII, or a clotting promotor medication. The nurse would document the finding, notify the health care provider, and assess the client for additional symptoms after limiting the amount of blood loss. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1722
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. Assess for constipation. Control acute pain. Obtain a catheterized urine specimen.
Protect the abdomen from manipulation. Explanation: 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. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1735
The nurse is caring for a school-age child recovering from an allogeneic stem cell transplant. What nursing action best ensures the child does not develop an infection after the transplant? Select all that apply. Restrict all visits from other children. Provide sterilized age-appropriate play materials. Send for total body irradiation immediately after the transplant. Arrange time for studying while in the hospital. Encourage eating raw vegetables for each meal after the procedure.
Restrict all visits from other children. Provide sterilized age-appropriate play materials. Explanation: To prevent the child from contracting an infection until the WBC count returns to a safe range, the child is restricted from interacting with other children either by remaining in the hospital or employing visiting restrictions at home. The nurse should provide sterilized play materials the child would enjoy as appropriate. Total body irradiation is completed before the transplant, not after. Studying will not reduce the child's risk of developing an infection after the transplant. The only raw fruits that are permitted are those with thick skin such as bananas and oranges. Other raw fruits and vegetables are avoided because these foods can carry bacteria. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Nursing Process Overview for the Child with an Alteration in Cellular Regulation (Hematologic Disorder or Cancer), p. 1694.
A 5-year-old client has been diagnosed with leukemia and is currently on chemotherapy and radiation. The child is having difficulty due to mucositis. Which is the most appropriate nursing diagnosis for this child? Pain due to neoplastic process in bone Disturbed body image related to loss of hair after chemotherapy Compromised family coping related to long-term chemotherapy regimen Risk for imbalanced nutrition, less than body requirements, related to inflammation
Risk for imbalanced nutrition, less than body requirements, related to inflammation Explanation: Mucositis is inflammation of the oral mucosa, which puts this child at risk for risk for imbalanced nutrition. The client may have pain due to neoplastic process in the bone, but that is not mentioned in the scenario. The client may have lost hair, but that is not mentioned. The client's family coping is also not mentioned. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1697
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 Enlarged mandibular growth Increased growth of long bones Depigmented areas on the abdomen
Slightly yellow sclera Explanation: In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not manifestations of this health problem. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1713
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 Equal pupillary response Hematuria Petechiae
Widely fluctuating blood pressure Explanation: 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 BP fluctuations) or unequal pupil size may suggest neurologic compromise. Hematuria would suggest renal compromise. Petechiae would be indicative of bleeding into the skin. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, CLOTTING DISORDERS, p. 1718.
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? urinalysis complete blood cell count (CBC) bone marrow aspiration magnetic resonance imaging (MRI)
complete blood cell count (CBC) Explanation: After obtaining the child's history and symptoms, the nurse would prepare the child for laboratory blood studies to assess the child's white blood cell (WBC) count. A complete blood cell (CBC) count will provide data on the child's WBC level. A bone marrow aspiration would be scheduled based on the results of the CBC as it is required to confirm the diagnosis of leukemia. A urinalysis is done for many disorders. In regard to childhood cancers, it is done to assist assessment for neuroblastoma. MRIs can also be done for many disorders. Brain tumors are common childhood cancers where MRIs are used. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1725
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? epoetin alfa filgrastim sargramostim gamma interferon
epoetin alfa Explanation: 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. p. 1699.
A child with cancer is dying and in hospice care. When developing the plan of care, which intervention should the nurse include as the primary focus? keeping the child pain-free managing the symptoms of dyspnea providing emotional support delivering appropriate developmental care
keeping the child pain-free Explanation: Children die from cancer. They may die at home or in the hospital, and hospice care can be provided in either setting. Children with terminal cancer often experience a great deal of pain, particularly when death is imminent. The primary goal of caring for a dying child is the prevention and alleviation of pain. The nurse would work with the parents to determine the pharmacologic and nonpharmacologic methods which work best. Many times, dyspnea and agitation can occur as a result of pain. These symptoms are reduced with pain management. Any care to the child, even in hospice care, should be developmentally appropriate. Emotional support is a necessity, both for the child and the parents, but pain relief is the priority. p. 1705.
A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphoblastic leukemia (ALL)? joint pain and swelling anorexia and weight loss abdominal pain, nausea, and vomiting lethargy, bruises, and lymphadenopathy
lethargy, bruises, and lymphadenopathy Explanation: Although all of these symptoms could be related to leukemia, the most likely are lethargy, bruises, and lymphadenopathy. Joint pain and swelling could also be juvenile arthritis or another disorder. Anorexia and weight loss are fairly nonspecific, as is abdominal pain, nausea, and vomiting. With ALL, because the bone marrow overproduces lymphocytes and therefore is unable to continue normal production of other blood components, the first symptoms of ALL in children usually are those associated with decreased RBC production (anemia) such as pallor, low-grade fever, and lethargy. A low thrombocyte (platelet) count will lead to petechiae and bleeding from oral mucous membranes and cause easy bruising on arms and legs. As the spleen and liver begin to enlarge from infiltration of abnormal cells, abdominal pain, vomiting, and anorexia occur. As abnormal lymphocytes invade the bone periosteum, the child experiences bone and joint pain. Central nervous system (CNS) invasion leads to symptoms such as headache or unsteady gait. On physical assessment, painless, generalized swelling of lymph nodes is revealed. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1724
A child with sickle cell anemia comes to the emergency department for evaluation. The nurse suspects that the child is experiencing a vaso-occlusive crisis based on assessment of which signs and symptoms? Select all that apply. low back pain fever distended abdomen splenic enlargement increased reticulocyte count
low back pain fever distended abdomen Explanation: Vaso-occlusive crisis is manifested by bone pain (most commonly in the lumbosacral spine), fever, leukocytosis, distended abdomen, and acute abdominal pain. Splenic enlargement and increased reticulocyte count suggest acute splenic sequestration. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, HEMOGLOBINOPATHIES, p. 1711.
A 12-year-old child is suspected of having Hodgkin lymphoma. When preparing the child and family for diagnostic testing, which test would the nurse describe as being used to confirm the diagnosis? 24-hour urine test lymph node biopsy chest computed tomography liver function tests
lymph node biopsy Explanation: Hodgkin lymphoma is confirmed by biopsy of the lymph nodes. Further studies such as bone marrow analysis, liver function tests, chest and abdominal computed tomography scans, lymphangiography, and abdominal biopsy are done to classify the clinical stage of the disorder. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1727
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) decreased white blood cells (WBCs) platelet count of 250,000 hemoglobin (Hgb) of 11.2 g/dl (112 g/L)
macrocytic red blood cells (RBCs) Explanation: 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. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1686
A child with stage III rhabdomyosarcoma develops tumor lysis syndrome. Which actions would be appropriate to include when providing care to this child? Select all that apply. monitoring serum chemistry levels managing electrolytes using oral and IV solutions specific to electrolyte needs starting exchange transfusion or apheresis to decrease number of WBCs administering allopurinol or rasburicase to reduce uric acid production monitoring intake and output; providing dialysis if renal failure occurs
monitoring serum chemistry levels managing electrolytes using oral and IV solutions specific to electrolyte needs administering allopurinol or rasburicase to reduce uric acid production monitoring intake and output; providing dialysis if renal failure occurs Explanation: With tumor lysis syndrome, the nurse should provide IV hydration to flush cell by-products through the kidneys; administer diuretics; administer allopurinol or rasburicase to reduce uric acid production; monitor serum chemistry levels; manage hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia using oral and IV solutions specific to electrolyte needs; monitor intake and output; and provide dialysis if renal failure occurs. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, TABLE 46.3 Oncologic Emergencies, p. 1706.
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. purpura. ecchymosis. poikilocytosis.
petechiae. Explanation: Petechiae are pinpoint hemorrhages that occur anywhere on the body and do not blanch with pressure. Purpura are larger areas of hemorrhage in which blood collects under the tissues and appear purple in color. Ecchymosis refers to areas of bruising. Poikilocytosis refers to the variation in the size and shape of the red blood cells commonly found in children with thalassemia. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1719
The nurse is caring for a client with terminal cancer who is experiencing dyspnea and increasing levels of pain. What would be the priority for pain management with this child? preventing and alleviating pain monitoring the child's vital signs frequently following the health care provider's rigid guidelines regarding dosages preventing addiction to the opioid medications
preventing and alleviating pain Explanation: 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 health care providers 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. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1705
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: removal or covering of flaking paint on the walls of the home. putting child safety locks on kitchen cabinets. putting medicine away where children cannot reach it. placing house plants out of reach of children.
removal or covering of flaking paint on the walls of the home. Explanation: 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 drywall or other solid protective material. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1698
The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect? capillary refill in less than 2 seconds pink palms and nail beds absence of bruising spooning of nails
spooning of nails Explanation: 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. p. 1708.
A 3-year old child is brought to the emergency department by the parents. Assessment reveals bruising and bleeding from the nose and mouth. The nurse suspects which condition? von Willebrand disease (vWD) hemophilia chronic iron deficiency anemia disseminated intravascular coagulation (DIC)
von Willebrand disease (vWD) Explanation: The primary clinical manifestations of vWD are bruising and mucous membrane bleeding from the nose, mouth, and gastrointestinal tract. Bleeding associated with vWD may be severe and lead to anemia and shock, but deep bleeding into joints and muscles, like that seen in hemophilia, is rare except with type III vWD. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Von Willebrand Disease, p. 1724.
A 3-year-old child presents with bruising and mucous membrane bleeding from the nose and mouth. The nurse knows that these symptoms are indicative of: von Willebrand disease. hemophilia. chronic iron-deficiency anemia. disseminated intravascular coagulation (DIC).
von Willebrand disease. Explanation: von Willebrand disease occurs because there is a deficiency of the von Willebrand factor. This factor is responsible for binding factor VIII, protecting this "glue" that attaches platelets to the site of injury from breakdown. The primary clinical manifestations of von Willebrand disease are bruising and mucous membrane bleeding from the nose and mouth. Bleeding may be mild or can become severe and lead to anemia and shock. Deep bleeding into joints and muscles is rare. This is typically associated with hemophilia. A child does not bleed with iron-deficiency anemia. The child with DIC would be bleeding from every orifice. Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - Page 1723
