Chapter 46: Hematologic or Neoplastic Disorder NCLEX style
A group of students are reviewing information about glucose-6-phosphate dehydrogenase (G6PD) deficiency. The students demonstrate understanding of the material when they identify this disorder as due to which of the following? A) X-linked recessive inheritance B) Deficiency in clotting factors C) An excess supply of iron D) Autosomal recessive inheritance
A) X-linked recessive inheritance
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? A) "We should avoid aspirin and drugs like ibuprofen." B) "He can resume participation in football in 2 weeks." C) "Swimming would be a great activity." D) "Our son cannot take any antihistamines."
B) "He can resume participation in football in 2 weeks."
The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis?
Bone marrow aspiration
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 developing a plan of care for a child with thalassemia. Which of the following would the nurse expect to include? Select all that apply. A) Packed RBC transfusions B) Deferoxamine therapy C) Heparin therapy D) Opioid analgesics E) Platelet transfusions F) Intravenous immunoglobulin
A) Packed RBC transfusions B) Deferoxamine therapy
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? A) Folic acid B) Intravenous immune globulin C) Dimercaprol D) Deferoxamine
B) Intravenous immune globulin
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? A) "She needs to eat foods that are high in fiber so she doesn't get constipated." B) "We'll try to get her to drink lots of fluids throughout the day." C) "We will place the liquid in the front of her gums, just below her teeth." D) "We need to measure the liquid carefully so that we give her the correct amount."
C) "We will place the liquid in the front of her gums, just below her teeth."
The nurse is caring for a 4-year-old boy following surgical removal of a stage I neuroblastoma. Which intervention is most appropriate for this child?
Giving medications as ordered via least invasive route
The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply.
- Having the child sleep in a single bed and room - Encouraging frequent, thorough handwashing
A child has been diagnosed with acute lymphocytic leukemia (ALL). The nurse knows that which possible complication can occur? Select all that apply.
- blindness - renal impairment - infections - epistaxis - bone pain - infertility
Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse?
"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."
The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching?
"She has been down, but playing in soccer camp will cheer her up."
The nurse is caring for a 14-year-old client scheduled for magnetic resonance imaging (MRI). The nurse explains the test to the child and family. Which information would be most appropriate to include in the explanation?
"The MRI uses radio waves and magnets to produce a computerized image of the body."
A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include?
"We'll need to have a match to a donor."
When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation?
"You will feel pressure on your hip from the needle."
Examination of a child reveals a palpable abdominal mass. A diagnosis of neuroblastoma is suspected. When reviewing the child's history and physical examination, which would the nurse expect to find? Select all that apply.
- Flushing - Constipation
An adolescent weighing 55 kg is admitted to the hospital experiencing a sickle cell crisis. Intravenous fluid therapy as well as increased oral fluids are ordered as part of his treatment plan. Based on the understanding of the amount of fluids needed to promote hemodilution, the nurse would expect the adolescent to receive how much total fluid in 24 hours? __________ mL
8,250
The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia?
A 15-year-old girl who has heavy menstrual periods
When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type? A) Hemoglobin A B) Hemoglobin F C) Hemoglobin A2 D) Hemoglobin S
A) Hemoglobin A
The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 mg/dL. Which action would the nurse expect to happen next? A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered B) Repeat testing within 1 week with education to decrease lead exposure C) Confirm with repeat testing in 1 month and referral to local health department D) Prepare to admit child to begin chelation therapy
A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered
When providing care to a child with aplastic anemia, which nursing diagnosis most likely would be the priority? A) Risk for injury B) Imbalanced nutrition, less than body requirements C) Ineffective tissue perfusion D) Impaired gas exchange
A) Risk for injury
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
A child is to receive radiation therapy this morning. The nurse would expect to see which type of drug prescribed to this child?
Antiemetic
The nurse is assessing a child with suspected thalassemia. Which of the following would the nurse expect to assess? A) Dactylitis B) Frontal bossing C) Presence of clubbing D) Presence of spooning
B) Frontal bossing
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?
Bleeding from intravenous sites
The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching? A) "We need to administer Stimate prior to dental work." B) "We should be aware that she may suffer from menorrhagia." C) "We should administer desmopressin as often as needed." D) "We understand that she may have frequent nosebleeds."
C) "We should administer desmopressin as often as needed."
The nurse is reviewing the white blood cell differential of a 4-year-old girl. Which value would lead the nurse to be concerned? A) Bands: 8% B) Segs: 28% C) Eosinophils: 10% D) Basophils: 0%
C) Eosinophils: 10%
Which mechanism is central to cancers in children?
Cellular growth
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 is caring for a child who has been admitted for a sickle cell crisis. Which of the following would the nurse do first to provide adequate pain management? A) Administer a nonsteroidal anti-inflammatory drug as ordered. B) Use guided imagery and therapeutic touch. C) Administer meperidine as ordered. D) Initiate pain assessment with a standardized pain scale.
D) Initiate pain assessment with a standardized pain scale.
The pediatric nurse examines the radiographs of a client that show that there are lesions on the bone. This finding is indicative of:
Ewing sarcoma.
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
In hemophilia A, the classic form, only females manifest a bleeding disorder.
False
The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child?
Following guidelines for protective isolation
A 9-month-old boy with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help you determine that he is actually taking it daily?
His stools will appear black.
A 15-year-old boy has been diagnosed with an osteogenic sarcoma of the distal femur. He also demonstrates a chronic cough, dyspnea, and chest pain, along with chronic leg pain. Based on these findings, the nurse should suspect metastasis to which body area?
Lungs
A nurse is explaining the difference between benign and malignant neoplasms to a group of parents. Which is the best explanation?
Malignant cells have unlimited growth.
When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority?
Monitor the site dressing and vital signs.
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 hospice nurse is providing at-home care to a child with end-stage cancer. The nurse is developing a plan of care to manage the child's pain. Which medications will the nurse likely include?
Opioids
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
What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)?
Protect the abdomen from manipulation.
A child with ALL is receiving methotrexate for therapy. Which nursing diagnosis would best apply to him during therapy?
Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy
The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately?
Temperature of 101° F (38.3° C) or greater
The school nurse is providing information to parents of adolescents about prevention of cervical cancer. Which information is included in the teaching?
Vaccine against human papilloma virus
When planning care for a child with idiopathic thrombocytopenic purpura, the nurse plans to teach her:
not to pick or irritate her nose.
The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as:
petechiae.
An experienced nurse is orienting a new nurse to the oncology unit. Which action by the new nurse would require intervention?
pouring unused chemotherapy medicine into a sink drain
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 preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority?
Calling the doctor if the child gets a sore throat
The child with thalassemia may be given which classification of medication to prevent one of the complications frequently seen with the treatment of this disorder?
Iron-chelating drugs
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?
One pupil appears white.
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?
Risk for infection
The physician orders an alkylating agent for a child's chemotherapy. Which best describes an action produced by these types of agents?
They are cell cycle-nonspecific, destroying both resting and dividing cells.
The nurse is assessing a child with aplastic anemia. Which of the following would the nurse expect to assess? Select all that apply. A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis E) Severe pain F) Warm tender joints
A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis
A client with cancer is diagnosed with typhitis. Which emergency intervention would the nurse perform?
Administer broad-spectrum antibiotics intravenously.
A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, which of the following would the nurse identify as potentially interfering with the accuracy of the results? A) Use of iron supplementation B) Blood transfusion 1 month ago C) Lack of fasting for 12 hours D) History of recent infection
B) Blood transfusion 1 month ago
How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old?
Call it a tumor of muscle tissue
What is the best response by the nurse to the parents of a child with leukemia who express guilt because they did not take immediate action when their child seemed to develop one respiratory infection after another?
"Keep in mind that the signs of leukemia are often subtle and difficult to recognize."
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? A) "You give the baby some iron, but it is not enough to sustain him after birth." B) "Because the baby grows rapidly during the first months, he uses up what you gave him." C) "The iron you give him before birth is different from what he needs once he is born." D) "If the baby didn't use up what you gave him before birth, he excretes it soon after birth."
B) "Because the baby grows rapidly during the first months, he uses up what you gave him."
A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia? A) Aplastic anemia B) Pernicious anemia C) Folic acid anemia D) Sickle cell anemia
B) Pernicious anemia
The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). Which of the following would the nurse interpret as indicative of this disorder? A) Shortened prothrombin time B) Increased fibrinogen level C) Positive fibrin split products D) Increased platelets
C) Positive fibrin split products
The nurse is teaching the parents of a child with a hematologic disorder about the functions of the various blood cells. The nurse determines that the teaching was successful when the parents state which blood cell as being primarily responsible for blood clotting? A) Granulocytes B) Erythrocytes C) Thrombocytes D) Leukocytes
C) Thrombocytes
The nurse is caring for a child recently diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse is teaching the parents about triggers that may result in oxidative stress. Which of the following responses indicates a need for further teaching? A) "I doubt he will ever eat fava beans, but they could trigger hemolysis." B) "He must avoid exposure to naphthalene, an agent found in mothballs." C) "He must never take methylene blue for a urinary tract infection." D) "My son can never take penicillin for an infection."
D) "My son can never take penicillin for an infection."
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?
Have the parent bring the child to the pediatric oncology clinic as soon as possible.
The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000mm3, hemoglobin 7.9 g/dL (79 g/L), hematocrit 28%, platelets 151,000 mm3. Which nursing action is priority?
Transfuse 1 unit of packed red blood cells
To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:
notify a health care provider if the child develops an upper respiratory infection.
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? A) "I can have the nurse administer the chelation therapy if I am uncomfortable." B) "I must be very careful to strictly adhere to the chelation regimen." C) "The deferoxamine binds to the iron so it can be removed from the body." D) "The medication can be administered while my child is sleeping."
A) "I can have the nurse administer the chelation therapy if I am uncomfortable."
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? A) Spooned nails B) Negative splenomegaly C) Oxygen saturation: 99% D) Bradycardia
A) Spooned nails
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. A) Tuna B) Salmon C) Tofu D) Cow's milk E) Dried fruits
A) Tuna B) Salmon C) Tofu E) Dried fruits
The nurse is evaluating the laboratory test results of a 7-year-old child with a suspected hematologic disorder. Which finding would cause the nurse to be concerned? A) WBC: 5.6 × 103/mm3 B) RBC: 2.8 × 106/mm3 C) Hemoglobin: 11.4 mg/dL D) Hematocrit: 35%
B) RBC: 2.8 × 106/mm3
A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. The nurse interprets this order as indicating which of the following? A) The child requires a prophylactic dose of iron. B) The child has mild to moderate iron deficiency. C) The child has severe iron deficiency. D) The child is being prepared for packed red blood cell administration.
B) The child has mild to moderate iron deficiency.
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? A) "Open your mouth so I can look inside your cheeks and lips." B) "Do you have any bruises on your feet or shins?" C) "Will you show me how you walk across the room?" D) "Let me see the palms of your hands and soles of your feet."
C) "Will you show me how you walk across the room?"
A group of newly hired nurses who will be working on the pediatric unit are attending an in-service program about sickle cell disease. During the program, the nurse manager describes the steps for managing sickle cell pain. Place these steps in the sequence in which the nurse manager would describe them.
1. Assess the pain. 2. Believe the child's report of pain. 3. Look for complications or cause of pain. 4. Give medications and use distraction. 5. Provide rest in a quiet area. 6. Administer fluids.
The nurse is caring for a 2-year-old boy with hemophilia. His parents are upset by the possibility that he will become infected with hepatitis or HIV from the clotting factor replacement therapy. Which response by the nurse would be most appropriate? A) "Parents commonly fear the worst; however, the factor will help your child lead a normal life." B) "There are risks with any treatment including using blood products, but these are very minor." C) "Although factor replacement is expensive, there's more financial strain from missing work if he has a bleeding episode." D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."
D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."
