chapter 46

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?

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

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?

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

A child with hemophilia A has had repeated episodes of hemarthrosis. Which assessment finding is most important to consider?

Decreased range of motion

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

Prepare to administer factor replacement medication

While inspecting the skin of a child, the nurse notes blotchy areas of hemorrhage. When notifying the health care provider, the nurse would identify the client's skin as having:

ecchymoses.

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)?

lethargy, bruises, and lymphadenopathy

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

A nurse is caring for a child with Hodgkin disease who is in the induction phase of a chemotherapy regimen. The nurse explains to the parents that the goal of this phase is to:

kill enough cancerous cells to induce remission.

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?

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

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with sickle cell anemia. The nurses in the group make the following statements. Which statement is most accurate regarding sickle cell anemia?

"If the trait is inherited from both parents the child will have the disease."

A child receiving chemotherapy wants to have a large birthday party and invite all the classmates. When the parent asks the nurse about this, what is the nurse's best response?

"It is better to avoid large groups right now."

A parent is angry about the adolescent's diagnosis of osteosarcoma. The parent is telling the adolescent that if he hadn't played football last year and broken his leg, this would not have happened. What is the nurse's best response to the parent's statement?

"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though."

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

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

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

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

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

The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which action is contraindicated in the client's care?

Abdominal palpation

A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform?

Administer broad-spectrum antibiotics intravenously.

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

Chemotherapy affects cancer cells and normal cells that multiply rapidly.

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.

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.

A 15-year-old client diagnosed with von Willebrand disease has reached menarche. Based on this fact, what information is most important for the nurse to convey to the client?

Expect menstrual bleeding to be heavy.

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child?

Implement strategies to address the child's pain

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

Ineffective tissue perfusion related to poor platelet formation

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

Leukemia

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

Monitor the site dressing and vital signs.

A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important?

Placing a "no abdominal palpation" sign above the child's bed

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.

Provide various soft and bland foods to minimize further irritation. Have the child rinse the mouth with lukewarm water three times a day. Apply a lip balm or petroleum jelly to prevent cracking.

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

Risk for bleeding related to insufficient platelet formation

A 9-month-old infant with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help the nurse determine that the infant is actually taking it daily

The stools will appear black.

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

complete blood cell count (CBC)

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

factor VIII.

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

headache, vision changes, and vomiting

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)

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?

uncontrolled bleeding

A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell anemia. The couple ask the nurse how this happened. Which statement is accurate for the nurse to provide?

"Sickle cell anemia is passed to a fetus when both parents have the gene."

he nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains to a family how the test works. Which response accurately describes this test?

"The MRI uses radio waves and magnets to produce a computerized image of the body."

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?

Antiemetic

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?

Observation reveals nystagmus and head tilt.

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

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

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

Slightly yellow sclera

A child with 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 administering allopurinol or rasburicase to reduce uric acid production monitoring intake and output; providing dialysis if renal failure occurs

A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which would the nurse include as an adjunctive measure to control bleeding?

compression

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?

red meat, eggs, oatmeal, and dried fruit

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.

The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for:

seizures.

The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect?

spooning of nails