Chapter 46: Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder

A nurse is reviewing laboratory test results from several children, looking specifically at their thrombocyte levels. The nurse would identify that the child with which platelet level might be at risk for bleeding? Select all that apply. 80,000 per cubic millimeter 110,000 per cubic millimeter 234,000 per cubic millimeter 175,000 per cubic millimeter 287,000 per cubic millimeter

80,000 per cubic millimeter 110,000 per cubic millimeter Explanation: Normal thrombocyte level ranges from 150,000 to 300,000 per cubic millimeter. Therefore, a child with a thrombocyte level of 80,000 and 110,000 per cubic millimeter would be at risk for bleeding.

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor, as well as his parents. Which intervention is a priority? Providing a tour of the intensive care unit. Assessing the child's level of consciousness. Educating the child and parents about shunts. Having the child talk to another child who has had this surgery.

Assessing the child's level of consciousness. Explanation: The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure. Lower priority interventions include providing a tour of the ICU to prepare the child and parents for after the surgery, and educating the child and parents about shunts.

Parents have just been informed that their child has a malignancy. The mother breaks down in tears, while the father appears to be in shock. What is an appropriate nursing diagnosis for this family? Disturbed body image related to hair loss Decisional conflict related to cancer treatment Fear related to diagnosis of cancer Ineffective parenting related to diagnosis of cancer

Fear related to diagnosis of cancer Explanation: Although these diagnoses may all be relevant at some point in the process of treatment, at this time the parents are dealing with the shock of learning their child has cancer. Fear is the most relevant diagnosis in this situation. Disturbed body image may occur if the child loses his hair. Decisional conflict may occur if they need to make decisions regarding treatment. Ineffective parenting may also happen if the parents are unable to care for their children appropriately.

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? exercise compression lowering extremities heat

compression Explanation: Complications associated with bleeding most often involve joints and muscles. Adjunct measures include rest, ice, compression, and elevation (RICE). In addition, corticosteroids such as prednisone may be used to reduce inflammation in the joint.

Parents tell the nurse who is admitting their infant for a well-child exam that they recently saw a "white glow" in their child's left pupil. What is the nurse's best response? "Most parents mention a red color." "I will report this to the pediatrician." "Has your baby been rubbing either eye?" "A plugged tear duct would not be unusual."

"I will report this to the pediatrician." Explanation: The "white glow" may indicate retinoblastoma; immediate investigation is needed. The red reflex is indicative of eye health. Eye rubbing and a plugged tear duct are unrelated to the symptom described.

The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse, "What causes this disease?" Which response by the nurse would be most appropriate? "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional coagulation." "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." "ITP is characterized by the loss of surface area on the red blood cell membrane." "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood."

"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." Explanation: Idiopathic thrombocytopenic purpura (ITP) is primarily an autoimmune disease, which is an acquired, self-limiting disorder of hemostasis characterized by destruction and decreased numbers of circulating platelets. Hemophilia A and hemophilia B are distinguished by the particular procoagulant factor that is decreased, absent, or dysfunctional. Iron deficiency anemia occurs when the body's iron stores are depleted. Hereditary spherocytosis (HS) is characterized by loss of surface area on the red blood cell membrane.

A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching? "I must encourage a variety of iron-rich foods that he likes." "There are many iron fortified cereals that he likes." "Red meat is a good option; he loves the hamburgers from the drive-thru." "He will enjoy tuna casserole and eggs."

"Red meat is a good option; he loves the hamburgers from the drive-thru." Explanation: While iron from red meat is the easiest for the body to absorb, the nurse must limit fast food consumption from the drive-thru as it is also high in fat, fillers, and sodium. The other statements are correct.

The parents of a child diagnosed with rhabdomyosarcoma ask the nurse to explain what this means. What is the nurse's best response? "There is a tumor in the bone." "There is a tumor in the eye." "This is a tumor of the kidney." "The tumor is in the muscle."

"The tumor is in the muscle." Explanation: A rhabdomyosarcoma is a tumor of striated muscle. A nephroblastoma (Wilms tumor) is a malignant tumor that rises from the metanephric mesoderm cells of the upper pole of the kidney. Retinoblastoma is a malignant tumor of the retina of the eye. Ewing sarcoma occurs in the bone.

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? 11.0 to 13.0 seconds 21.0 to 35.0 seconds 16.0 to 18.0 seconds 6.0 to 9.0 seconds

11.0 to 13.0 seconds Explanation: The nurse would identify a prothrombin time of 11.0 to 13.0 seconds as normal for a healthy child. A result of 21.0 to 35.0 seconds would be the expected range for partial thromboplastin time and activated partial thromboplastin time. Findings of 6.0 to 9.0 seconds and 16.0 to 18.0 seconds are outside the normal range.

A nurse caring for an 8-year-old with a bleeding disorder documents the following nursing diagnosis: ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This diagnosis is most appropriate for a client with: Disseminated intravascular coagulation Hemophilia von Willebrand disease Iron-deficiency anemia

Disseminated intravascular coagulation Explanation: Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that, paradoxically, is characterized by both thrombosis and hemorrhage. The goal is for the child to maintain adequate tissue perfusion of all body systems affected by DIC and regain adequate laboratory values for hemostasis. Hemophilia and von Willebrand disorders are genetic and symptoms are caused by a deficiency in a factor needed for clotting. Iron-deficiency anemia occurs when there is not enough iron for adequate hemoglobin capacity in the red blood cells.

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? Support the adolescent's choice of comfortable clothing. Encourage the adolescent to select hats or wigs to fit one's personality. Have a Child Life specialist work with the adolescent. Refer the adolescent to a peer support group.

Encourage the adolescent to select hats or wigs to fit one's personality. Explanation: A positive body image is important, especially to an adolescent. It is important for the nurse to acknowledge the adolescent's feelings of sadness over the body changes caused by the illness. To help the adolescent have some power over the illness, the nurse should encourage the adolescent to choose wigs, hats, or scarves that fit his or her personality or even meet a goal of doing something the adolescent would not have dared to before. This could be a wig of different hair color or a big floppy hat with sequins. Whatever the choice, this gives the adolescent a feeling of being in control of the situation and able to make the decisions. Nurses should support the adolescent's choice of clothing. Most likely the adolescent will choose clothing for comfort. Loose clothing disguises weight loss or scarring while promoting self-esteem. Referring the adolescent to a support group or the help of a Child Life specialist are good interventions. Both will help the adolescent work through the feelings of loss, but neither gives the adolescent the ability to make decisions about outward appearance.

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Encourage therapeutic play activities. Ensure neutropenic precautions are in place. Remind parents to contact the child's school. Monitor daily complete blood count (CBC).

Ensure neutropenic precautions are in place. Explanation: With stem cell transplants, children are at greatest risk for infection and sepsis. The nurse should ensure neutropenic precautions are used to reduce the change of infection. Monitoring laboratory values, reminding the parent to contact the school, and encouraging therapeutic play are important, but preventing infection in the immunocompromised child is a priority.

Wilms tumor is suspected in a 5-year-old child. Which action would be avoided? abdominal palpation aspirin administration rectal suppository use fiber intake

abdominal palpation Explanation: If Wilms tumor is suspected, the abdomen should not be palpated. Palpating the abdomen may cause the tumor capsule to rupture, resulting in tumor spillage. Tumor spillage can change the tumor from stage I to stage II or III, depending on the amount of spillage that occurs.

Which mechanism is central to cancers in children? cellular growth environment race genetics

cellular growth Explanation: Certain pediatric malignancies clearly occur at times of peak physical growth and cellular maturation. This coincidence suggests that cellular growth and development are central to the mechanism of cancer in children. By contrast, environmental exposures are a primary component of carcinogenesis in adults. Genetics and race are not commonly identified as related to pediatric cancers.

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) platelet count of 250,000 hemoglobin (Hgb) of 11.2 g/dl (112 g/L) decreased white blood cells (WBCs)

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.

A client with severe chronic anemia is receiving ongoing transfusion therapy. The nurse frequently assesses the client for what major complication of this therapy? vaso-occlusive crisis fibrin clots toxic iron overload chronic idiopathic thrombocytic purpura

toxic iron overload Explanation: The major complication of an ongoing transfusion therapy program is the development of toxic iron overload, which leads to pathologic changes in body systems, including the hepatic, endocrine, and cardiac systems. Fibrin clots, chronic idiopathic thrombocytic purpura, or vaso-occlusive crisis are not complications of ongoing transfusion therapy.

A 9-year-old child is diagnosed with von Willebrand Disease (vWD) with the following characteristics: decreased quantities of all sizes of von Willebrand factor multimers and decreased activity of von Willebrand factor. The nurse identifies this as which type of vWD as being involved? type IIIB type I type III type II

type I Explanation: Signs of type I von Willebrand disease include decreased quantities of all sizes of von Willebrand factor multimers and decreased activity of von Willebrand factor. Type II involves absence of intermediate-size and large von Willebrand factor multimers, increased levels of small von Willebrand factor multimers, and decreased activity of von Willebrand factor; possibly disproportionate with quantity of von Willebrand factor. Type III involves the absence (or almost absent) of all sizes of von Willebrand factor multimers, absent or minimal activity of von Willebrand's factor, and low factor VIII level.

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching? "I bought the medication to give to her when she says she is in pain." "She has been down, but playing in soccer camp will cheer her up." "I put her legs up on pillows when her knees start to hurt." "She loves popsicles, so I'll let her have them as a snack or for dessert."

"She has been down, but playing in soccer camp will cheer her up." Explanation: Following a sickle cell crisis, the child should avoid extremely strenuous activities that may cause oxygen depletion. Fluids are encouraged, pain management will be needed, and the child's legs may be elevated to relieve discomfort, so these are all statements that indicate an understanding of caring for the child who has had a sickle cell crisis.

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 is passed to a fetus when both parents have the gene." "Sickle cell disease occurs from a random genetic mutation." "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 one of the parents has the gene."

"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.

Antiemetics are prescribed to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications? Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea. Administer the antiemetic before starting chemotherapy. Use the antiemetic after it is clear that nonpharmacologic methods are not effective. Provide the antiemetic as needed (PRN) when nausea and vomiting are reported.

Administer the antiemetic before starting chemotherapy. Explanation: Antiemetics are most effective when given before chemotherapy begins and then on a regular schedule to prevent nausea and vomiting throughout administration of chemotherapy. Nonpharmacologic measures can be used in conjunction with antiemetics but not in place of them. To wait to implement these measures could result in malnutrition.

A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate? Hair is exposed to the sun, which increases sensitivity to chemotherapy. Hair is not a living tissue, and it is easily damaged by chemotherapy. Circulation to the head causes large doses of chemotherapy to reach the scalp. Chemotherapy affects cancer cells and normal cells that multiply rapidly.

Chemotherapy affects cancer cells and normal cells that multiply rapidly. Explanation: Chemotherapy is cytotoxic to rapidly proliferating cells—malignant or normal. Normal cells that turn over rapidly include those of bone marrow, hair, and mucous membranes.

The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order? Deferasirox Succimer Edetate calcium disodium Dimercaprol

Deferasirox Explanation: Deferasirox is indicated for iron toxicity. It binds with iron, which is removed via the kidneys. Dimercaprol is indicated for blood lead levels greater than 45 mcg/dl. It removes lead from soft tissues and bone, allowing for its excretion via the renal system. Edetate calcium disodium is indicated for blood lead levels greater than 45 mcg/dl. The medication removes lead from soft tissues and bone, allowing for its excretion via the renal system. Succimer is indicated for blood lead levels greater than 45 mcg/dl; it removes lead from soft tissues and bone, allowing for its excretion via the renal system.

The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen? Facial changes Nighttime itching Urinary incontinence Loss of appetite

Facial changes Explanation: Facial changes are common and include a round face with full cheeks, often reddened, described as "moon face." Weight gain and fat pads may appear in various areas of the body. Appetite is likely to increase. Urinary incontinence and nighttime itching are not related to steroid therapy.

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? Contact the health care provider to meet with the parent. Implement strategies to address the child's pain. Provide diversional activities for the child. Ask the parent if he or she has questions about the plan of care.

Implement strategies to address the child's pain. Explanation: In this case, the nurse's priority is to address the child's pain. The child is already receiving IV fluids and oxygen. That, in combination with analgesia, will assist in resolving the crisis. Asking the parent if he or she has questions, asking the health care provider to meet with the parent, and providing distraction for the child are all appropriate interventions, but the priority is to address the child's pain.

When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority? Educate the family on proper handwashing. Evaluate pain and administer medication. Allow the child to play with a doll and syringe. Monitor the site dressing and vital signs.

Monitor the site dressing and vital signs. Explanation: Monitoring vital signs and the dressing for signs of bleeding is a priority after bone marrow aspiration. Although providing pain medication, educating on handwashing, and allowing for therapeutic play are all important, these should only be performed after first stabilizing the child.

The nurse is completing the health history of a 6-month-old infant with retinoblastoma with the child's parents. Which symptom should the nurse expect that the parents have observed? The infant's eye appears to be protruding. The infant always keeps her eyes tightly closed. One pupil appears white. The infant tugs and pulls at one ear.

One pupil appears white. Explanation: On examination, the child's pupil of the affected eye appears white because the red reflex is absent. Some might describe this symptom as a "cat's eye." Ear tugging, eye protrusion, and keeping the eyes closed are not manifestations of retinoblastoma.

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? The child has Schwachman syndrome. The child has Beckwith-Wiedemann syndrome. There is a family history of neurofibromatosis. The child has Down syndrome.

The child has Beckwith-Wiedemann syndrome. Explanation: Along with the symptoms reported by the mother, the fact that the child has Beckwith-Wiedemann syndrome suggests that the child could have a Wilms tumor. Down syndrome would point to leukemia or brain tumor. Schwachman syndrome would suggest leukemia. A family history of neurofibromatosis is a risk factor for brain tumor, rhabdomyosarcoma, or acute myeloid leukemia.

The health care provider prescribed an alkylating agent for a child's chemotherapy. Which best describes an action produced by these types of agents? They are most active in the S phase and act similarly to normal cellular metabolites necessary for cell replication. They are synthesized naturally by various bacterial and fungal agents. They are cell cycle-nonspecific, destroying both resting and dividing cells. They damage cells by acting as a substitute for a natural metabolite in an important molecule.

They are cell cycle-nonspecific, destroying both resting and dividing cells. Explanation: Alkylating agents are cell cycle-nonspecific, destroying both resting and dividing cells. During alkylation, the hydrogen atoms of some molecules within the cell are replaced by an alkyl group. This group interferes with DNA replication and RNA transcription. Interferons are the classification of drugs that are synthesized by bacterial and fungal agents. Antimetabolites are active in the S phase and act similarly to normal cellular metabolites. They alter the cell's function to destroy the cell's ability to replicate.

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? projectile vomiting, lethargy, and coma headache, vision changes, and vomiting nystagmus, ataxia, and seizures headache, epistaxis, and dizziness

headache, vision changes, and vomiting Explanation: Children with any form of brain tumor develop symptoms of increased intracranial pressure: headache, vision changes, vomiting, an enlarging head circumference, or papilledema. Lethargy, projectile vomiting, and coma are late signs. Epistaxis is not usually related to a brain tumor. A growing tumor produces specific localized signs, such as nystagmus (constant horizontal movement of the eye) or visual field defects. As tumor growth continues, symptoms of ataxia, personality change (e.g., emotional lability, irritability), and seizures may occur. These would be later symptoms.

What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)? Obtain a catheterized urine specimen. Protect the abdomen from manipulation. Assess for constipation. Control acute pain.

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.

The health care provider has just informed the parents of a 3-year-old that their child has leukemia. The mother begins crying and tells the nurse she does not want her baby to die. What is the nurse's best response? "I don't blame you for being upset; any parent would be scared too." "You are very lucky to have caught it so early; that makes the treatments easier." "I know this is scary, but leukemia has a high cure rate in children these days." "Don't worry, the health care provider is very good at treating leukemia."

"I know this is scary, but leukemia has a high cure rate in children these days." Explanation: Although cancer in children is rare compared to unintentional injury or infection, it is the leading medical cause of death among persons younger than 25 years of age. Fortunately, the overall survival rate for children with cancer today has improved. The overall 5-year survival rate is 84.5%, and for acute lymphoblastic leukemia (the most common form of childhood cancer), the 5-year survival is 88.5%

The nurse will use a special needle to start intravenous (IV) fluids through which central venous access device? A multilumen catheter An implanted port A peripherally inserted central catheter A tunneled central catheter

An implanted port Explanation: An implanted port requires a special (Huber) needle placed through the skin into the port, which is implanted surgically under the skin and over a bony prominence. The peripherally inserted central catheter (PICC) and tunneled catheters (Broviac, Hickman, Groshong) do not require a special needle for access. A multilumen catheter has more than one lumen but is not a port.

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? Risk for altered urinary elimination related to kidney impairment Risk for infection related to abnormal immune system Ineffective tissue perfusion related to poor platelet formation 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.

A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? Preparing the child for chemotherapy Preventing weight-bearing activities Placing a "no abdominal palpation" sign above the child's bed Restricting the child's visitors Ensuring that the child be allowed nothing by mouth

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.

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority? Deficient fluid volume Impaired skin integrity Risk for infection Risk for delayed growth and development

Risk for infection Explanation: Removal of the spleen places the child at significant risk for infection. Although the child's skin integrity is disrupted due to the surgery, this is not the priority nursing diagnosis. Loss of fluids occurs during surgery and adequate hydration is important to prevent a sickle cell crisis, but this diagnosis is not the priority in the postoperative period. Although the child is at risk for delayed growth and development, the priority postoperatively is to prevent infection.

The nurse is preparing a presentation for a parent group about childhood cancers, focusing on brain tumors in children younger than 14 years. Which type of tumor will the nurse include as one of the most common types in that age group? ependymoma pituitary brain stem glioma medulloblastoma

medulloblastoma Explanation: Brain tumors can occur anywhere within the brain. The most common types of tumors in children younger than 14 years old are pilocytic astrocytomas and medulloblastoma/primitive neuroectodermal tumors. In children older than 14 years, the most common types of tumors are pilocytic astrocytomas and pituitary tumors.

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: priapism. leg ulcers. behavioral addiction. seizures.

seizures. Explanation: Repeated use of meperidine for pain management during sickle cell crisis increases the risk of seizures when used in children with sickle cell anemia. Behavioral addiction is rarely a concern in the child with sickle cell anemia if the opioid is used for the alleviation of severe pain. Priapism is a complication of sickle cell anemia unrelated to meperidine administration. Leg ulcers are a complication of sickle cell anemia unrelated to meperidine administration.

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 sound waves to create images that visualize body structures and locate masses." "The MRI uses radio waves and magnets to produce a computerized image of the body." "The MRI uses radiation to examine soft tissue and bony structures 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 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.

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? Administering the measles, mumps, rubella (MMR) vaccine Plotting height and weight on a growth chart Assessing dietary intake by addressing "picky eating" and "food jags" Teaching the importance of taking water safety measures

Administering the measles, mumps, rubella (MMR) vaccine Explanation: Live vaccines (viral or bacterial) should not be administered to an immunosuppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the toddler and should be included during the well-child visit.

The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of: neuroblastoma. non-Hodgkin lymphoma. Ewing sarcoma. Hodgkin disease.

Ewing sarcoma. Explanation: Radiographs that show lesions on the bone may indicate tumors (e.g., Ewing sarcoma, osteosarcoma) or metastasis of tumors. Osteosarcoma is the most common type of bone malignancy in children. It occurs primarily in the long bones. Ewing sarcoma is a highly malignant bone cancer. It occurs in the pelvis, chest wall, vertebrae, and midshaft of the long bones. Neuroblastomas are seen in children younger than 5 years old and arise from immature nerve cells and the adrenal glands. Hodgkin disease develops from the immune system. Non-Hodgkin lymphoma is a blood cancer.

The nurse assesses that the client is at risk for an infection related to chemotherapy-induced immunosuppression. What will the nurse include in the teaching plan for the child and parents to help reduce this risk? Select all that apply. Provide a low-carbohydrate, low-protein diet. Encourage frequent, thorough handwashing. Encourage frequent contact with multiple visitors. Have the child sleep in a single bed and room. Cheer up the environment with fresh flowers and plants.

Have the child sleep in a single bed and room. Encourage frequent, thorough handwashing. Explanation: To reduce the risk of infection, the nurse should teach the child and parents about minimizing the child's exposure to potentially infectious situations. The nurse should encourage the parents to arrange for the child to sleep in a single bed and room and, if possible, avoid close contact with other family members who may be developing upper respiratory tract infections. Thorough and frequent handwashing, especially after using the bathroom and before eating, is essential. A high-calorie, high-protein diet helps to rebuild white blood cells and should be encouraged. If possible, the child's exposure to large crowds and visitors should be limited because of the increased risk of infection from these individuals. Fresh flowers and plants should be avoided because they could harbor mold spores.

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? Respiratory distress Fluid overload Pallor Infection

Infection Explanation: Factors that may precipitate a sickle cell crisis include: fever, infection, dehydration, hot or humid environment, cold air or water temperature, high altitude, or excessive physical activity. Respiratory distress and pallor are general signs and symptoms of a sickle cell crisis.

A nurse is talking with parents of a child who is to begin radiation treatment for cancer. The parents ask, "What kind of effects might we see soon after the child starts treatment?" Which effects would the nurse include when instructing the parents? Select all that apply. Shortening of the spine Loss of appetite Vomiting Sleepiness Nausea Skin redness

Loss of appetite Nausea Vomiting Skin redness Explanation: Immediate effects of radiation therapy include anorexia, nausea, vomiting, extreme fatigue, and skin reactions such as erythema and tenderness. Shortening of the spine and sleepiness are considered long-term side effects.

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? Heart Brain Rib cage Lungs

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.

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? Assessing the child's hydration status secondary to vomiting. Assessing for signs of capillary leak syndrome. Monitoring for complaints of bone pain. Monitoring for allergic reactions or anaphylaxis.

Monitoring for allergic reactions or anaphylaxis. Explanation: The nurse would monitor for infusion-related reactions and anaphylaxis if monoclonal antibodies were administered and would have epinephrine, antihistamines, and steroids available at the bedside for treatment if a reaction occurred. Assessing the level of hydration due to vomiting would be necessary if tumor necrosis factor was administered. The flu-like symptoms produced by interferons also require hydration maintenance. Monitoring for complaints of bone pain is appropriate when administering colony-stimulating factors such as filgrastim or sargramostim. Assessing for signs of capillary leak syndrome within 2 to 12 hours of the start of treatment is necessary when interleukins are used.

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 a cough and labored breathing. Examination shows temperature of 101.4° F (38.6°C) and headache. Vital signs show blood pressure measures 120/80 mm Hg. Observation reveals nystagmus and head tilt.

Observation reveals nystagmus and head tilt. Explanation: Coupled with the mother's reports, observation of nystagmus and head tilt suggest the child may have a brain tumor. Elevated blood pressure of 120/80 mm Hg may be indicative of Wilms tumor. Fever and headaches are common symptoms of acute lymphoblastic leukemia. A cough and labored breathing points to rhabdomyosarcoma near the child's airway.

What nursing action should the nurse take when caring for a child with aplastic anemia? Ensure the child is offered a low-fiber diet. Assess the child's blood pressure every hour. Provide toys that do not have sharp corners or edges. Encourage visits from friends and family.

Provide toys that do not have sharp corners or edges. Explanation: For a child with aplastic anemia, safety is of the utmost concern, with injury prevention essential to prevent hemorrhage. Toys and games with sharp edges/corners may injure the child during play. The low level of platelets would cause bleeding. High-fiber foods would be offered to prevent anal fissures associated with constipation. The child's blood pressure would not be assessed every hour because the inflation of the cuff would cause bruising/injury. Visitors would be limited to avoid exposing the child to visitors who are sick or ill.

A child with acute lymphoblastic leukemia (ALL) is receiving methotrexate for therapy. Which nursing diagnosis would best apply during therapy? Excess fluid volume related to effect of methotrexate on aldosterone secretion Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy Risk for self-directed violence related to effect of methotrexate on central nervous system Risk for impaired mobility related to depressant effects of methotrexate

Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy Explanation: Methotrexate is a chemotherapeutic agent; one of its side effects is oral mucositis. Oral ulcerations can interfere with nutrition because of pain and leave a portal for infection. Mucositis can be treated with oral swish and swallow agents or swish and spit agents (diphenhydramine, lidocaine, nystatin). Mucositis is very painful and children will not be able to eat, so alternate ways of delivering nutrition may be necessary. The child receiving methotrexate may need large volumes of hydration to prevent dehydration from the medication effects. The nursing diagnosis of fluid overload from aldosterone production would be incorrect. Methotrexate works on specific cells. It does not affect the central nervous system. The child may have decreased mobility from the cancer effects and any side effects of many drugs the child is receiving as a result of a weakened state, but methotrexate is not a depressant.

A 4-year-old child receiving vincristine develops peripheral neuropathy. The parents report that the child continues to struggle with fine motor control and state, "He can't even hold a pencil to draw a picture." Which medication would the nurse anticipate being prescribed by the primary care provider? gabapentin cisplatin prednisone ondansetron

gabapentin Explanation: Vincristine, a medication used as therapy for many childhood cancers, results in peripheral neuropathy—specific neurologic symptoms of weakness, tingling, and numbing of the extremities and sometimes the inability to walk comfortably because of a condition called foot drop. While receiving the medication, children may be unable to hold a pen or pencil or maneuver small parts of toys because their fingers are so affected. These symptoms typically subside after the medication is discontinued, but in the meantime, help the child think of tasks that can be accomplished without fine motor control. If severely impacting daily activities, additional neuroactive medications like gabapentin or aripiprazole may help with reducing neuropathic symptoms. Prednisone and cisplatin are chemotherapeutic agents, each with its own side effects and toxic effects. Ondansetron is used to relieve nausea and vomiting.

A child is scheduled for chemotherapy as treatment for leukemia. As the nurse is collaborating with another colleague, the discussion turns to the client's first phase of chemotherapy. This phase is known as: delayed intensive therapy. maintenance. sanctuary. induction.

induction. Explanation: A chemotherapy program is aimed at first achieving a complete remission or absence of leukemia cells (induction phase); second, preventing leukemia cells from invading or growing in the CNS (sanctuary or consolidation phase); third, administering delayed intensive therapy; and fourth, maintaining the original remission (maintenance phase).

Children with acute lymphoblastic leukemia (ALL) may need periodic lumbar punctures. The nurse would teach the parent that this is done to assess for: platelets. early development of septicemia. early meningitis. leukemic cells.

leukemic cells. Explanation: Acute lymphoblastic leukemia (ALL) is a rapidly progressive cancer affecting the undifferentiated or immature cells. It is the most common form of cancer in children. Throughout the course of the disease and treatment the child will be tested regularly for complete blood counts, bone marrow aspirations, lumbar punctures, and testing for renal and liver function. Lumbar punctures are performed to determine if leukemic cells have infiltrated the central nervous system. The white blood cells, temperature, and other symptoms would be indicative of meningitis and septicemia. The platelet count would be assessed for the possibility of bleeding.

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myeloid leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? earache, stiff neck, or sore throat temperature of 101°F (38.3°C) or greater difficulty or pain when swallowing blisters, ulcers, or a rash appear

temperature of 101°F (38.3°C) or greater Explanation: The parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C) or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the parents must be directed to take action at the first sign of infection in order to prevent overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes (or difficulty/pain when swallowing) are reasons to seek medical care, but are not as grave as the risk of infection.

A nurse is reviewing the medical records of several children who have undergone lead screening. The nurse would identify the child with which lead level as requiring no further action? 8 mcg/dl 20 mcg/dl 26 mcg/dl 14 mcg/dl

8 mcg/dl Explanation: A blood lead level less than 10 mcg/dl requires no action. A level of 14 mcg/dl would need to be confirmed with a repeat test in 1 month along with parental education for decreased lead exposure and then a repeat test in 3 months. Levels of 20 mcg/dl and 26 mcg/dl need to be confirmed with a repeat test in 1 week along with parental education and a referral to the local health department for investigation of the home for lead reduction.

A child with hypoplastic anemia develops hemosiderosis. What nursing instruction promotes the treatment goals? Avoid all products containing aspirin Administer daily doses of ferrous sulfate Infuse deferoxamine at home Adhere to a strict schedule of prednisone

Infuse deferoxamine at home Explanation: Treatment of anemia is through transfusion of packed red blood cells to increase erythrocyte levels. As a result of the necessary number of transfusions, hemosiderosis or the deposition of iron in body tissue can occur. Treatment for hemosiderosis is iron chelation through the use of subcutaneous infusions of deferoxamine. These infusions are to be given at home overnight for 5 to 6 nights per week. There is not enough information to determine if aspirin should be avoided. Ferrous sulfate will add more iron to the child's body and should be avoided. Children with congenital hypoplastic anemia may receive corticosteroid therapy along with transfusions of packed RBCs to raise erythrocyte levels.