Chapter 24 PREP U

"We will place the liquid in the front of her gums, just below her teeth." -place behind the teeth because it can stain the teeth

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement indicates the need for additional teaching?

bone involvement

A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain?

Prepare to administer factor replacement medication

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

Grieving related to advanced disease and poor prognosis

A child diagnosed with stage IV neuroblastoma has undergone abdominal surgery to remove the tumor. He is now receiving chemotherapy. Which nursing diagnosis would be most important?

increased susceptibility to infection

A child has just been diagnosed with acute lymphoblastic leukemia. The nurse is aware that the result of an overproduction of immature white blood cells in the bone marrow is:

maintaining adequate hydration

A child is receiving carboplatin as part of a chemotherapy protocol. What would be most important for the nurse to include in the child's plan of care?

"He can use petroleum jelly if the skin becomes reddened."

A child is scheduled to undergo radiation therapy as part of his treatment plan for newly diagnosed cancer. After teaching the child and parents about this treatment, the nurse determines that additional teaching is needed when the parents state:

CNS disease

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent:

blood transfusion 1 month ago

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, what would the nurse identify as potentially interfering with the accuracy of the results?

Use mild soap and nonscented moisturizer.

A mother contacts the oncology nurse concerned about the redness and tenderness of her child's skin following radiation treatments. What is the nurse's best response?

disseminated intravascular coagulation

A nurse caring for an 8-year-old child with a bleeding disorder documents the following nursing diagnosis: Ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This nursing diagnosis would be most appropriate for a child diagnosed with which condition?

"Will you show me how you walk across the room?"

A nurse is conducting a physical examination of a 5-year-old with suspected iron-deficiency anemia. How would the nurse evaluate for changes in neurologic functioning?

Avoiding rectal exams, suppositories, and enemas Placing a mask on the child when outside the room Discouraging fresh flowers in the child's room

A nurse is instituting neutropenic precautions for a child. What information would the nurse most likely include? Select all that apply.

"Because the baby grows rapidly during the first months, he uses up what you gave him."

A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate?

iliac crest

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?

Intravenous immune globulin

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3. Which medication would the nurse most likely expect to be ordered?

Chemotherapy affects cancer cells and normal cells that multiply rapidly.

A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate?

allogenic

A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. Which is this type of BMT called

relax any eating pressures

A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention

X-linked recessive inherited disorder in which a blood-clotting factor is deficient

Parents of a hemophiliac child ask the nurse, Can you describe hemophilia to us? Which response by the nurse is descriptive of most cases of hemophilia?

swimming golf bowling (as well as walking, jogging, tennis, & fishing)

Parents of a school-age child with hemophilia ask the nurse, Which sports are recommended for children with hemophilia? Which sports should the nurse recommend? (Select all that apply.)

Impaired skin integrity related to desquamation from cellular destruction

The nurse is caring for a 5-year-old boy undergoing radiation treatment for a neuroblastoma. Which nursing diagnosis would be most applicable for this child?

Concentrating on consuming primarily high-calorie shakes and puddings

The nurse is caring for a 9-year-old boy who is having chemotherapy. The nurse is developing a teaching plan for the child and family about nutrition. What instruction would the nurse be least likely to include?

Initiate pain assessment with a standardized pain scale.

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management?

following guidelines for reverse isolation

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

"I can have the nurse administer the chelation therapy if I am uncomfortable."

The nurse is caring for a child with thalassemia who is receiving chelation therapy at home using a battery-operated pump. After teaching the parents about this treatment, which statement by the mother indicates a need for additional teaching?

"I mix ferrous sulfate with milk in a bottle."

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning?

Increased red blood cell destruction occurs.

The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia?

rapid promotion of complete remission

The nurse is describing the phases of treatment to a child who was diagnosed with leukemia and his parents. How would the nurse describe the induction stage?

packed RBC transfusion Deferoxamine therapy

The nurse is developing a plan of care for a child with thalassemia. What information would the nurse expect to include? (Select all that apply).

"He takes his antibiotics twice a day"

The nurse is educating the parents of a 4-year-old boy with a Wilms tumor who is about to have chemotherapy prior to surgery. Which statement by the parents indicates that the nurse should review the instructions about preventing infection?

Most childhood cancers affect the tissues rather than organs.

The nurse is planning a discussion group for parents with children who have cancer. How would the nurse describe a difference between cancer in children and adults?

Avoidance of IM injections. Acetaminophen (Tylenol) for mild pain controld. Soft tooth brush for dental hygiene

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child? (Select all that apply.)

Normal adult hemoglobin is replaced by abnormal hemoglobin.

Parents of a child with sickle cell anemia ask the nurse, What happens to the hemoglobin in sickle cell anemia? Which statement by the nurse explains the disease process?

"She has been down, but playing in soccer camp will cheer her up."

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching?

Explain to child that when hair regrows, it may have a slightly different color or texture.

The nurse is preparing a child for possible alopecia from chemotherapy. Which should be included?

Calling the doctor if the child gets a sore throat

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?

Medulloblastoma

The nurse is preparing a presentation for a parent group about childhood cancers, focusing on brain tumors in children. What would the nurse describe as the most common type of brain tumor?

Chlorhexidine gluconate (Peridex) Anti-fungal troches (lozenges) Lip balm (Aquaphor)

The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child? (Select all that apply.)

Iron-fortified infant cereal by age 4 to 6 months

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breast-fed infant. Which should be suggested?

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."

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?

painless, enlarged lymph node

The nurse is reviewing the medical record of a child diagnosed with non-Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child?

milk is a poor source of iron

The nurse is teaching parents about the importance of iron in a toddlers diet. Which explains why iron deficiency anemia is common during toddlerhood?

Clinical manifestations are similar regardless of the cause of the anemia.

The nurse is teaching parents of an infant about the causes of iron deficiency anemia. Which statement best describes iron deficiency anemia in infants?

tuna salmon tofu dried fruits

The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply.

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

The nurse reviews for a family how the development of synthetic recombinant anti-hemophilic factor has improved the management of hemophilia, because this drug: (Select all that apply).

hepatomegaly jaundice protruding teeth pathological fractures cardiac failure

The nurse reviews the classic symptoms of thalassemia major (Cooleys anemia), such as: (Select all that apply).

Denver for skiing

The nurse would ask the patient with hemophilia A to reconsider a vacation he has planned to:

with orange juice

The nurse would instruct the parent to give ferrous sulfate drops to the child:

Application of sunblock to the skin to prevent burning Appetite stimulation Conservation of energy Provision for expressions of anger Preparation for delay in sexual development

The nursing care of a 12-year-old child receiving radiation therapy for non-Hodgkins disease, should include:

Rarely cause addiction because they are medically indicated

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. Which is appropriate for the nurse to explain about narcotic analgesics?

formula is so expensive. we switched to regular milk right away

The statement by a mother that may indicate a cause for her 9-month-old having iron deficiency anemia is:

it is important for my child to drink plenty of fluids

The statement made by a parent indicating understanding of health maintenance of a child with sickle cell anemia is:

cream of wheat

When teaching the mother of a young child about iron deficiency anemia, the nurse would tell her that a rich source of iron is:

Risk for bleeding related to insufficient platelet formation

Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura?

Adequate dosage will turn the stools a tarry green color.

Which should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations?

Notify the health care provider if a fever of 38.5 C (101.3 F) or greater occurs. Give penicillin as prescribed. Notify the health care provider if your child begins to develop symptoms of a cold

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.)

increasing the daily fluid intake

A 12-year-old child is admitted to the hospital with a diagnosis of sickle cell crisis. The nurse has completed an assessment and is creating a plan of care. What aspect of the plan of care is most important to the client's outcome?

This finding is a common manifestation of the client's diagnosis.

A 13-year-old, diagnosed with beta-thalassemia major is seen in the pediatric clinic. The nurse completes an assessment and notes that the client is below the 10th percentile in height for age. What assumption can the nurse make based on this information?

mediastinal mass

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

lethargy, bruises, and lymphadenopathy

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)?

Risk for imbalanced nutrition, less than body requirements, related to inflammation

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?

The cancer has spread in the brain itself but the chance of complete surgical removal is good.

A 6-year-old child has been found to have a stage II brain tumor. The parent asks the nurse to explain what "stage II" means. Which information would the nurse provide?

Allogeneic

A 9-year-old boy will be undergoing a hematopoietic stem cell transplantation, with donor cells being provided by his 12-year-old sister. The nurse recognizes that this type of transplantation is:

"We'll need to have a match to a donor."

A 9-year-old child with leukemia is scheduled to undergo an allogeneic hematopoietic stem cell transplant (HSCT). When teaching the child and parents, what information would the nurse include?

Avoid large crowds. Inspect the skin daily for scratches or scrapes. Remove house plants, flowers, and goldfish from the home environment. Stay away from people who have obvious colds, rashes, or other infections.

A child being treated for leukemia is diagnosed with neutropenia. What nursing instructions directly prevent client infections? Select all that apply.

to decrease fever produced from the medication

A child diagnosed with idiopathic thrombocytopenic purpura (ITP) is scheduled to receive an infusion of intravenous immunoglobulin (IVIG) due to low platelet counts. Prior to the infusion, the nurse administers acetaminophen to the child. The nurse would explain to the parents that acetaminophen is administered to obtain which expected outcome?

elevate head of bed 90 degrees

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

Expose the skin to air frequently. Avoid application of creams and lotions. Use mild soap to clean the skin.

A child receiving radiation therapy has a nursing diagnosis of Impaired skin integrity related to the effects of radiation therapy as manifested by erythema and dryness of the skin. Which would the nurse include in the child's plan of care? Select all that apply.

to allow higher doses of chemotherapy

A child with cancer is scheduled for a stem cell transplant. The parents ask the nurse why this procedure is being done. What is the nurse's best answer?

Handle the child gently when transferring to a stretcher.

A child with hemophilia A is scheduled for surgery. Which precautions would the nurse institute with this client?

The child has mild to moderate iron deficiency.

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

Bladder

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?

"Preterm infants are at risk for iron-deficiency anemia."

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?

sickle cell disease

A nurse in the emergency department is examining a 6-month-old with symmetrical swelling of the hands and feet. The nurse immediately suspects:

Using aseptic technique for the procedure.

A nurse is assisting with a bone marrow aspiration and biopsy for a 6-year-old child. Which would be most important?

electrolyte balance intake/output heart rate

A nurse is caring for a child diagnosed with von Willebrand disease who is receiving desmopressin as part of the treatment regimen. In relation to desmopressin administration, what assessment finding(s) is important for the nurse to monitor? Select all that apply.

Apply heat to the site of bleeding.

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?

Widely fluctuating blood pressure

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

Bone marrow stem cell transplant

A nurse is providing care to a child with thalassemia major. The nurse understands that cure of the disorder is achieved with which treatment?

Eggs Fortified cereal Green leafy vegetables

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

Infection

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor?

Erythrocytes Leukocytes Thrombocytes

A nursing instructor is describing childhood hematologic disorders to students. Which would the instructor include as being commonly affected by hematologic disorders? Select all that apply.

Administer acetaminophen as needed.

A parent calls the pediatric oncology clinic about the child having headaches after chemotherapy. What is the nurse's best advice?

Have the parent bring the child to the pediatric oncology clinic as soon as possible.

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?

headache, vision changes, and vomiting

A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor?

adequate hydration and pain management.

A school-age child is admitted in vasoocclusive sickle cell crisis. The childs care should include:

Administer an antiemetic before chemotherapy begins.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?

Keeping the child's lips moist with petroleum jelly to prohibit cracking

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

Factor VIII

A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor?

factor VIII.

After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with:

Encourage the adolescent to select hats or wigs to fit one's personality.

An adolescent receiving chemotherapy has lost all hair and is sad about self-image. Which action should the nurse take to support this adolescent and involve the client in decision making?

IV infusion

An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which route?

Administer the antiemetic before starting chemotherapy

Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications?

eliminate excess iron

Chelation therapy is begun on a child with b-thalassemia major. The purpose of this therapy is to:

leukemic cells.

Children with acute lymphoblastic leukemia (ALL) may need periodic lumbar punctures. The nurse would teach the parent that this is done to assess for:

The child's fluid intake will improve.

In caring for a child with sickle cell disease, the highest priority goal is:

inject deeply into a large muscle.

Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include to:

may induce seizures

Meperidine (Demerol) is not recommended for children in sickle cell crisis because:

decrease in blood platelets

Myelosuppression, associated with chemotherapeutic agents or some malignancies such as leukemia, can cause bleeding tendencies because of a(n):

Leukemia

Nursing students are reviewing information about childhood cancers. They demonstrate understanding of the information when they identify what as the most frequent type?

"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse?

"The cancer cells have spread to the lymph nodes."

Parents of a 10-year-old have just been informed that their child has stage III cancer. They ask the nurse what this means. What is the nurse's best response?

The bone marrow releases a stem cell. Thrombopoietin acts on the cell. The myeloid cell becomes a megakaryocyte. Erythropoietin helps the cell turn into a red blood cell.

The blood cell becomes an erythrocyte. Rank the following steps in the proper order of occurrence.

The child has been placed in a semiprivate room. The child is being transported to radiology for an x-ray and the nurse places gloves on the child's hands.

The child has been admitted to the hospital, with an absolute neutrophil count of 450. The child has been placed in neutropenic precautions. Which nursing interventions indicate that the nurse requires further education? Select all that apply.

36 mg/dose

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.

Brush his or her teeth

The child is prescribed liquid ferrous sulfate. The nurse should encourage the child to take which action immediately after each dose to best eliminate possible side effects?

Use a support group Stimulate appetite Maintain adequate hydration Delay immunizations Report exposure to infectious diseases

The family of a child receiving chemotherapy for leukemia should be taught to focus on the childs care in regard to the need to: (Select all that apply).

Cells are only susceptible to treatment by radiation during certain phases of the cell cycle

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?

risk for infection

The most recent blood count for a child who received chemotherapy last week shows neutropenia. The priority nursing diagnosis for this child is:

Spooned nails

The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help provide additional evidence for this suspicion?

red meat, eggs, oatmeal, and dried fruit

The nurse develops a meal plan for a child with iron-deficiency anemia. Which meal would the nurse teach the parent has the highest amount of iron?

Facial changes

The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen?

stop drug infusion immediately

The nurse is administering an IV chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action?

Bone marrow aspiration

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia (ALL)." What will confirm this diagnosis?

Observation reveals nystagmus and head tilt.

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?

The parents report that their son is vomiting and not eating well.

The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma?

The child has Beckwith-Wiedemann syndrome.

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?

Slightly yellow sclera

The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis?

A 15-year-old adolescent who has heavy menstrual periods

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia?

administering prescribed broad-spectrum IV antibiotics

The nurse is caring for 9-year-old boy undergoing chemotherapy whose complete blood count (CBC) with differential reports 7% banded and 13% segmented neutrophils with a white blood cell count of 2,540. He has an oral temperature of 38.6°C (101.5°F). Which intervention would be the priority?

Deferasirox

The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order?

"He can resume participation in football in 2 weeks."

The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching?

"We should administer desmopressin as often as needed."

The nurse is caring for a 13-year-old girl with von Willebrand disease (hemophilia). After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching?

Administering a sedative as ordered to keep the child still.

The nurse is caring for a 6-year-old boy with an abdominal neuroblastoma prior to having a magnetic resonance imaging (MRI) scan without contrast done. Which intervention would the nurse expect to perform?

Monitoring for allergic reactions or anaphylaxis.

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

Ensure neutropenic precautions are in place.

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority?

Initiate intravenous access.

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?

Restrict all visits from other children. Provide sterilized age-appropriate play materials.

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.

complete blood count and iron level

The nurse is caring for an 18-month-old client with suspected iron-deficiency anemia. The nurse will expect to prepare the client for which laboratory tests first?

Educating the child and family about the testing procedures

The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. What action would be the priority?

thalassemia

The nurse is collecting data from the caregivers of a child brought to the clinic setting. The parents tell the nurse that the child's skin seems to be an unusual color. The nurse notes that the child's skin appears bronze-colored and jaundiced. This observation alerts the nurse to the likelihood that this child has which disorder?

An excessive destruction of platelets

The nurse is conducting a staff in-service on childhood blood disorders. Which describes the pathology of idiopathic thrombocytopenic purpura?

Describing the two ways of staging the disease.

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?

"You may feel pressure on your hip during the procedure."

The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child?

"Has your child recently had the measles, mumps, rubella (MMR) vaccine?"

The nurse is obtaining a health history on a child diagnosed with idiopathic thrombocytopenic purpura (ITP). After asking about a viral illness, what question should the nurse ask next to gather more information?

Not to pick or irritate the nose

The nurse is planning care for a child with idiopathic thrombocytopenic purpura. Which client education should be included?

Bleeding from intravenous sites

The nurse is planning care for a school-aged child recovering from being hit by a motor vehicle while riding a bicycle. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child?

Encourage high calorie meals and snacks. Schedule a tour of the radiation department. Help the child develop "mind games" for diversion. Do not wash off the marks drawn on the skin.

The nurse is preparing a 12-year-old client and the parents for radiation treatments that will occur for several weeks. Which nursing instructions are appropriate? Select all that apply.

Increased D-Dimer assay

The nurse is preparing a child for diagnostic testing to diagnose disseminated intravascular coagulation (DIC). Which results would the nurse identify as indicating this condition?

10 mg

The nurse is preparing a presentation for a local parent group about nutritional measures to prevent anemia. The group of parents have children between the ages of 4 and 8. The nurse would recommend a daily iron intake of which amount?

antiemetic

The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure?

giving ferrous sulfate with orange juice between meals

The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care?

"Heparin helps to reduce the consumption of platelets."

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

bruising anorexia sore throat lymphadenopathy

The nurse is providing care to a child with leukemia. When assessing the child, which signs and symptoms would the nurse likely find? Select all that apply.

"We should call the doctor for any fever over 100°F (37.8°C)."

The nurse is providing family education for the prevention or early recognition of vaso-occlusive events in sickle cell anemia. Which response by a family member indicates a need for further teaching?

Assessing the child's level of consciousness.

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor, as well as his parents. Which intervention is a priority?

Positive fibrin split products

The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). What would the nurse interpret as indicative of this disorder?

11.0 to 13.0 seconds

The nurse is reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin finding?

"She can bring graham crackers and peanut butter."

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?

Administering oxygen Administering analgesics Maintaining fluid intake

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply.

joints

The nurse treating clients with hemophilia knows that if bleeding is not treated effectively, which body part is at greatest risk for the development of chronic, disabling disease?

An implanted port

The nurse will use a special needle to start intravenous (IV) fluids through which central venous access device?

uncontrolled bleeding

The oncology nurse is alert for clients displaying signs and symptoms of disseminated intravascular coagulation (DIC). Which symptom would alert the nurse to this emergency condition?

hyperkalemia hypocalcemia hyperuricemia

The parents bring their 4-year-old son to the emergency department. The child is receiving chemotherapy for acute lymphoblastic leukemia. The parents report that the child has become lethargic and has had significant episodes of vomiting and diarrhea. Why findings would lead the nurse to suspect the child may be experiencing tumor lysis syndrome? (Select all answers that apply).

"ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason."

The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's best response?

No routine live vaccines are administered while on chemotherapy.

The pediatric nurse is explaining to a new graduate nurse the differences in planning well-child maintenance for a child with cancer. Which statement by the new nurse demonstrates understanding of the teaching?

Administering the measles, mumps, rubella (MMR) vaccine

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude?

notify a health care provider if the child develops an upper respiratory infection.

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:

Protect the abdomen from manipulation.

What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)?

positioning the child on the unaffected side.

What would be most appropriate to include in the plan of care for a child who has undergone surgery for removal of an astrocytoma?

25%

When both parents have sickle cell trait, which is the chance their children will have sickle cell anemia?

Monitor the site dressing and vital signs.

When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority?

Ensure all side rails are padded.

When providing care for a toddler with hemophilia who is being prepped for an elective procedure, which nursing action is priority?

Painful swelling of hands and feet; painful joints

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis?

Measles, rubella, mumps

Which immunization should not be given to a child receiving chemotherapy for cancer?

Practice frequent, gentle oral hygiene

Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy?

Enlarged, firm, nontender lymph nodes

Which is a common clinical manifestation of non-Hodgkin disease?

Unrestricted proliferation of immature white blood cells (WBCs) occurs.

Which is most descriptive of the pathophysiology of leukemia?

conscious or unconscious sedation

Which is the most effective pain-management approach for a child who is having a bone marrow aspiration?

cellular growth

Which mechanism is central to cancers in children?

birth prior to 37 weeks' gestation frequent vomiting and regurgitation drinking 48 oz milk in a bottle daily maternal anemia during pregnancy

Which risk factors will the nurse identify when screening infants for iron-deficiency anemia? Select all that apply.

Increased incidence occurs in families of Mediterranean extraction.

Which statement best describes b-thalassemia major (Cooley anemia)?

Elevated homovanillic acid (HVA) with 24-hour urine collection -they are elevated with neuroblastoma

Which test result would the nurse least likely expect to find in a child diagnosed with Wilms tumor?

abdominal palpation

Wilms tumor is suspected in a 5-year-old child. Which action would be avoided?

assess neurological status

n admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. The priority nursing intervention is:

cervical axillary inguinal

A 14-year-old boy is diagnosed with non-Hodgkin disease. When palpating for enlarged lymph nodes, the nurse would expect to find which nodes as most commonly enlarged? Select all that apply.

if bleeding occurs, apply pressure, ice, elevate, and rest the extremity

A 2-year-old child has been diagnosed with hemophilia A. The information the nurse would include in a teaching plan about home care would be:

vaso-occlusive

A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis for severe abdominal pain. The nurse recognizes that the type of crisis the child is most likely experiencing is:

Avoiding further abdominal palpation

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?