Exam 5 Practice Questions
Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? "It will help rule out a second malignancy." "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." "A sample of cerebrospinal fluid is needed to check for possible central nervous system infection." "The spinal tap will help relieve pressure and headache for your child."
"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."
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 avoid aspirin and drugs like ibuprofen." "He can resume participation in football in 2 weeks." "Our son cannot take any antihistamines." "Swimming would be a great activity."
"He can resume participation in football in 2 weeks."
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? "ITP is characterized by the loss of surface area on the red blood cell membrane." "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor." "ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason." "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 which the immune system attacks and destroys the body's own platelets, for an unknown reason."
The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with sickle cell disease. The nurses in the group make the following statements. Which statement is most accurate regarding this condition? "Males are much more likely to have the disease than females." "If the trait is inherited from both parents the child will have the disease." "The trait or the disease is seen in one generation and skips the next generation." "The disease is most often seen in individuals of Asian decent."
"If the trait is inherited from both parents the child will have the disease."
The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate? "When I give my son ferrous sulfate I know he also needs potassium supplements." "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate." "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." "I always give the ferrous sulfate with meals."
"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."
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." "Your infant may have been having excessive diarrhea." "Infants with pyloric stenosis require ferrous sulfate." "Ferrous sulfate helps improve red blood cell formation."
"Preterm infants are at risk for iron-deficiency anemia."
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." "I put her legs up on pillows when her knees start to hurt." "She has been down, but playing in soccer camp will cheer her up." "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."
A nurse is conducting a class to a group of parents on sickle cell anemia. Which statement by a parent indicates teaching has been effective? "This is a hereditary disease that is transmitted by one affected gene." "Fluid restriction is necessary to control sickle cell anemia." "The sickle shape of red blood cells decreases oxygen to tissues." "Sickle cell anemia is common in people of Asian descent."
"The sickle shape of red blood cells decreases oxygen to tissues."
Lana, who has thalassemia major, is scheduled for a bone marrow transplant, and her mother is highly anxious about this upcoming procedure. The nurse recognizes which statement is most accurate and best exemplifies patient-centered care? "If you can hold her still during the procedure, the pain will pass more quickly for her." "We will go to great lengths to make sure Lana doesn't develop an infection." "Lana will need to lie still while the new bone marrow infuses into her bones." "She will not need any further bone marrow aspirations after this."
"We will go to great lengths to make sure Lana doesn't develop an infection."
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 by the parents indicates the need for additional teaching? "We will place the liquid in the front of her gums, just below her teeth." "She needs to eat foods that are high in fiber so she doesn't get constipated." "We'll try to get her to drink lots of fluids throughout the day." "We need to measure the liquid carefully so that we give her the correct amount."
"We will place the liquid in the front of her gums, just below her teeth."
A 9-year-old child with leukemia is scheduled to undergo an allogeneic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? "You won't need to receive the high doses of chemotherapy before the transplant." "You'll need to have an incision in your hip area to instill the cells." "The risk for rejection is much less with this type of transplant." "We'll need to have a match to a donor."
"We'll need to have a match to a donor."
Gerri's father is a Hodgkin lymphoma survivor, having experienced the active disease as an adolescent. Because of his disturbing memories of having this disease, he is highly anxious that the care team assess Gerri for Hodgkin lymphoma. What is the most likely first sign that Hodgkin lymphoma is beginning to develop in Gerri? A single, enlarged submaxillary lymph node Sharp pain in joints from blocked lymph drainage Easy bruising from a shortage of platelets and RBCs Discolored fingernails from clotting in distal extremities
A single, enlarged submaxillary lymph node
The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? Teaching the importance of taking water safety measures Plotting height and weight on a growth chart Administering the measles, mumps, rubella (MMR) vaccine Assessing dietary intake by addressing "picky eating" and "food jags"
Administering the measles, mumps, rubella (MMR) vaccine
An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom should the nurse most expect as a result of excessive iron deposits? Enlarged lymph nodes An enlarged heart An enlarged spleen An enlarged thyroid gland
An enlarged spleen
Autoimmune acquired hemolytic anemia can occur in any child. The nurse identifies which usual cause of this disorder as important for team members to know? Allergy to the protein found in fish or shrimp A mutant gene similar to sickle-cell anemia An elevated (increased) eosinophil cell count Antibody production against red blood cells
Antibody production against red blood cells
The nurse is caring for clients receiving anticoagulant therapy for embolism prevention. Which factors are a part of the intrinsic pathway for coagulation? Select all that apply. Stuart factor Antihemophilic factor Stable factor Christmas factor Hageman factor
Antihemophilic factor Christmas factor Hageman factor
A child develops treatment-related thrombocytopenia. When preparing the plan of care for the child, which would the nurse include? Select all that apply. When drawing blood, obtaining extra amounts as a precautionary measure Applying pressure to a puncture site for a full 5 minutes Limiting the use of adhesive tape on the child's skin Administering medications orally or intravenously Allowing frequent blood-drawing procedures for laboratory testing
Applying pressure to a puncture site for a full 5 minutes Limiting the use of adhesive tape on the child's skin Administering medications orally or intravenously
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? Bladder Brain Blood Kidney
Bladder
What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent? Body appearance changes very little. No tunneling is needed when the port is inserted. No special procedure is necessary for removal. Flushing of the device is not necessary.
Body appearance changes very little.
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? Keeping a written copy of the treatment plan Using acetaminophen if the child needs an analgesic Writing down phone numbers and appointments Calling the doctor if the child gets a sore throat
Calling the doctor if the child gets a sore throat
Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor? Stuart factor Proconvertin Christmas factor Antihemophilic factor
Christmas factor
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. Encouraging frequent, thorough handwashing Providing a low-carbohydrate, low-protein diet Cheering up the environment with fresh flowers and plants Encouraging frequent close contact with numerous visitors Having the child sleep in a single bed and room
Encouraging frequent, thorough handwashing Having the child sleep in a single bed and room
The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Remind parents to contact the child's school. Ensure neutropenic precautions are in place. Encourage therapeutic play activities. Monitor daily complete blood count (CBC).
Ensure neutropenic precautions are in place.
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. Erythrocytes Plasma Thrombocytes Whole blood Leukocytes
Erythrocytes Thrombocytes Leukocytes
The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of: Hodgkin disease. Ewing sarcoma. non-Hodgkin lymphoma. neuroblastoma.
Ewing sarcoma.
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? The duration of each period will be short. Expect menstrual bleeding to be heavy. Bruising may occur in the perineal area. Occasional skipped periods can be expected.
Expect menstrual bleeding to be heavy.
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 X Factor VIII Factor V Factor XIII
Factor VIII
The child in the room next to Gerri's is a boy with ALL. Although his parents knew he wasn't well, they had no idea his diagnosis would be leukemia. A review of this boy's electronic health record would most likely note what early signs commonly seen in a child with ALL? Nodules and an abdominal rash Headaches and sleepiness Fatigue and leg bruises Joint pain and coughing
Fatigue and leg bruises
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? Ask whether any family members or other close associates are ill. Tell the parent to administer acetaminophen every 4 hours until the fever dissipates. Have the parent bring the child to the pediatric oncology clinic as soon as possible. Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order.
Have the parent bring the child to the pediatric oncology clinic as soon as possible.
A child is diagnosed with sickle cell anemia. Which test will the nurse expect the primary health care provider to prescribe for this client? Hemoglobin level Thrombocyte level Metabolic screening test Leukocyte level
Hemoglobin level
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? Pallor Infection Respiratory distress Fluid overload
Infection
A nurse is giving instructions to the father of a boy who is receiving chemotherapy (including methotrexate) regarding how best to care for the boy during this period of treatment. What should the nurse mention to him? Be sure that the boy receives only live-virus vaccines Give the boy folic acid supplements Keep him away from people with known infections Give him aspirin to help manage pain
Keep him away from people with known infections
A child is receiving methotrexate as part of his chemotherapy protocol. The nurse would anticipate administering which agent to counteract the toxic effects of methotrexate? Nystatin Cyclosporine Leucovorin Mesna
Leucovorin
Nursing students are reviewing information about childhood cancers. They demonstrate understanding of the information when they identify what as the most frequent type? Leukemia Wilms tumor Non-Hodgkin lymphoma Brain stem tumor
Leukemia
The nurse begins administering blood to a pediatric client with hemoglobinopathy. During the transfusion, the nurse notes: a rash on the child's chest, face, and extremities; temperature 101.8°F (38.8°C); respirations 34 breaths/minute; and the child reports nausea. Which actions will the nurse take? Select all that apply. Monitor the child's urine output. Call the child's primary health care provider. Stop the blood transfusion. Assess the child's vital signs. Administer only IV normal saline (NS).
Monitor the child's urine output. Call the child's primary health care provider. Stop the blood transfusion. Assess the child's vital signs. Administer only IV normal saline (NS).
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? Siblings and parents should not receive nonlive vaccines. Growth may be stunted due to chemotherapy. No routine live vaccines are administered while on chemotherapy. Eliminate second-hand smoke within the home.
No routine live vaccines are administered while on chemotherapy.
A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first? Notify the client's primary health care provider Assess the client's urine and stool for blood Prepare to administer factor replacement medication Document the presence of hemarthrosis in the client's chart
Prepare to administer factor replacement medication
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. Assess for constipation. Protect the abdomen from manipulation. Control acute pain.
Protect the abdomen from manipulation.
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? Disturbed body image related to loss of hair after chemotherapy Compromised family coping related to long-term chemotherapy regimen Pain due to neoplastic process in bone Risk for imbalanced nutrition, less than body requirements, related to inflammation
Risk for imbalanced nutrition, less than body requirements, related to inflammation
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? Impaired skin integrity Risk for delayed growth and development Risk for infection Deficient fluid volume
Risk for infection
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? Bradycardia Oxygen saturation: 99% Negative splenomegaly Spooned nails
Spooned nails
Gerri had surgery for a brain tumor 2 weeks ago. The care unit protocol specifies that the administration of stool softeners be given before and after surgery when not contraindicated. What is the rationale for this protocol? Constipation stimulates the release of pituitary hormones. Straining with bowel movements increases intracranial pressure. Constipation can lead to anal fissures, which can be a source of infection. Children in Trendelenburg positions cannot effectively move their bowels
Straining with bowel movements increases intracranial pressure.
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? The child has severe iron deficiency. The child requires a prophylactic dose of iron. The child is being prepared for packed red blood cell administration. The child has mild to moderate iron deficiency.
The child has mild to moderate iron deficiency.
The nurse will select which meal as the best choice for a child with iron-deficiency anemia? cheeseburger, broccoli, and fresh strawberries chicken breast, French fries, and sweetened tea two slices of pepperoni pizza and a glass of skim milk peanut butter sandwich, cheese stick, and applesauce
cheeseburger, broccoli, and fresh strawberries
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: hematomas. petechiae. purpura. ecchymoses.
ecchymoses.
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. platelets. factor IX. plasmin.
factor VIII.
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)? abdominal pain, nausea, and vomiting joint pain and swelling anorexia and weight loss lethargy, bruises, and lymphadenopathy
lethargy, bruises, and lymphadenopathy
A child is receiving a blood transfusion. Which sign or symptom would alert the nurse that the child is experiencing a hemolytic reaction? urticaria respiratory distress diaphoresis lower back pain
lower back pain
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: purpura. poikilocytosis. ecchymosis. petechiae.
petechiae
While assessing an adolescent, the nurse notes pallor and a beefy red tongue. Upon questioning, the adolescent reports eating a vegetarian diet to help with weight loss. Which health care provider prescription will the nurse anticipate? hydroxyurea orally folic acid supplement vitamin B12 injections ferrous sulfate daily
vitamin B12 injections
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? "You are very lucky to have caught it so early; that makes the treatments easier." "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." "I don't blame you for being upset; any parent would be scared too."
"Don't worry, the health care provider is very good at treating leukemia."
Joey, who has sickle-cell anemia, is being treated for sickle-cell crisis. Which statement by his father would best assure the nurse that Joey is receiving adequate nursing care? "He never used to understand why he had these crises, but now, he can describe the reason." "He says that his pain is actually quite manageable now." "He says that the nurses he's met so far are such nice people." "He's looking forward to getting home, but he really doesn't mind it here."
"He says that his pain is actually quite manageable now."
**Which nursing interventions would be appropriate for the plan of care designed for a child diagnosed with hemophilia who is experiencing an episode of active bleeding? Select all that apply. Schedule regular active range-of-motion exercises Administer ibuprofen as prescribed for pain Performing passive range-of-motion exercises Schedule physical therapy Applying splints to extremities
Schedule regular active range-of-motion exercises Administer ibuprofen as prescribed for pain Applying splints to extremities
A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the nurse to possible neurologic compromise? Equal pupillary response Widely fluctuating blood pressure Hematuria Petechiae
Widely fluctuating blood pressure
After teaching the parents of a child diagnosed with pernicious anemia about the disorder and treatment, the nurse determines that the teaching was successful when the parents state: "He'll need to have those vitamin shots for the rest of his life." "He needs to eat more green leafy vegetables to cure the anemia." "He might get constipated from the supplement." "We'll need to plan for a bone marrow transplant soon."
"He'll need to have those vitamin shots for the rest of his life."
The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning? "My child's stools are darker than usual." "I mix ferrous sulfate with milk in a bottle." "I brush my child's teeth once every day." "My child takes ferrous sulfate after meals."
"I mix ferrous sulfate with milk in a bottle."
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." "I make sure our child is up to date on all immunizations." "We always take water along when we are on an outing." "I make sure my child wears a good warm coat and gloves during winter."
"Our family is taking a fun hiking trip up in the mountains next week."
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? "We need to seek medical attention for abdominal pain." "We should call the doctor for any fever over 100°F (37.8°C)." "We must be compliant with vaccinations and prophylactic penicillin." "We must watch for unusual headache, loss of feeling, or sudden weakness."
"We should call the doctor for any fever over 100°F (37.8°C)."
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? 6.0 to 9.0 seconds 11.0 to 13.0 seconds 21.0 to 35.0 seconds 16.0 to 18.0 seconds
11.0 to 13.0 seconds
A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately? Little is known regarding cancer prevention in adults, although much prevention information is available for children. Adult cancers are more responsive to treatment than are those in children. Environmental and lifestyle influences in children are strong, unlike those in adults. Children's cancers, unlike those of adults, often are detected accidentally, not through screening.
Children's cancers, unlike those of adults, often are detected accidentally, not through screening.
The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order? Dimercaprol Edetate calcium disodium Succimer Deferasirox
Deferasirox
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? Use guided imagery and therapeutic touch. Administer meperidine as ordered. Initiate pain assessment with a standardized pain scale. Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered.
Initiate pain assessment with a standardized pain scale.
The nurse is caring for a 13-year-old boy with acute myeloid leukemia (AML) who is experiencing feelings of powerlessness due to the effects of chemotherapy. What intervention will best help the teen's sense of control? Providing realistic expectations of treatments and outcomes Acknowledging the boy's feelings of anger with the disease Recognizing abilities that are unaffected by the disease Involving the boy in decisions whenever possible
Involving the boy in decisions whenever possible
What is a well-defined risk management technique that the nurse can teach children and parents to prevent cancer? Avoid artificial colors, flavors, and fragrances in foods, cosmetics, and household items Eliminate aerosol sprays from the living area Limit sun exposure throughout childhood and adolescence Incorporate more preservative-free foods into the diet
Limit sun exposure throughout childhood and adolescence
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? Brain Lungs Heart Rib cage
Lungs
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? The cancer has spread in the brain itself but the chance of complete surgical removal is good. The tumor has not extended into the surrounding tissue and can be completely removed surgically. Cancer cells have spread to local lymph nodes. Tumors have spread systemically throughout the body.
The cancer has spread in the brain itself but the chance of complete surgical removal is good.
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? Auscultation reveals wheezing with diminished lung sounds. The parents report that their son is irritable and not gaining weight. The parents report that their son is vomiting and not eating well. The child has a maculopapular rash on his palms.
The parents report that their son is vomiting and not eating well.
Why do nurses teach childhood cancer survivors to inform adult health care providers of their prior disease and treatments? To obtain health insurance To participate in cancer research To monitor for late effects To access community support groups
To monitor for late effects
What nursing action should the nurse take when caring for a child with aplastic anemia? encourage visits from friends and family assess the child's blood pressure every hour assure the child is offered a low-fiber diet provide toys that do not have sharp corners or edges
provide toys that do not have sharp corners or edges
Lana has received iron chelation therapy by deferoxamine in the past. Which statement by her mother would best assure the nurse she understands the use and action of iron chelation therapy? "I know the drug acts to remove excess iron from my child." "I have to check Lana's pulse before I turn on the pump." "The drug is used to increase the level of iron in bone cells." "The drug has minimal side effects, so I can't really give it wrong."
"I know the drug acts to remove excess iron from my child."
A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the nurse to provide? "Sickle cell disease occurs from a random genetic mutation." "Sickle cell disease is passed to a fetus when one of the parents has the gene." "Sickle cell disease is passed to a fetus when both parents have the gene." "Sickle cell diseas can be passed to the fetus in many ways. We will know more at birth."
"Sickle cell disease is passed to a fetus when both parents have the gene."
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. Circulation to the head causes large doses of chemotherapy to reach the scalp. Hair is not a living tissue, and it is easily damaged by chemotherapy. Chemotherapy affects cancer cells and normal cells that multiply rapidly.
Chemotherapy affects cancer cells and normal cells that multiply rapidly.
A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode? Apply direct pressure to the area. Elevate the injured area such as a leg or arm. Administer factor VIII replacement. Apply heat to the site of bleeding.
Apply heat to the site of bleeding.
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? "Will you show me how you walk across the room?" "Do you have any bruises on your feet or shins?" "Open your mouth so I can look inside your cheeks and lips." "Let me see the palms of your hands and soles of your feet."
"Will you show me how you walk across the room?"
The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia (ALL)." What will confirm this diagnosis? Complete white blood count History of leukemia in twin Bone marrow aspiration Lethargy, bruising, and pallor
Bone marrow aspiration
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. Avoid application of creams and lotions. Encourage snug-fitting clothing. Use mild soap to clean the skin. Soak the area in warm water for 30 to 40 minutes frequently. Expose the skin to air frequently.
Expose the skin to air frequently. Avoid application of creams and lotions. Use mild soap to clean the skin.
The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen? Nighttime itching Facial changes Urinary incontinence Loss of appetite
Facial changes
A 12-year-old child is suspected of having Hodgkin lymphoma. When preparing the child and family for diagnostic testing, which test would the nurse describe as being used to confirm the diagnosis? Chest computed tomography 24-hour urine test Lymph node biopsy Liver function tests
Lymph node biopsy
When caring for a 7-year-old client diagnosed with sickle cell anemia, which clinical manifestation will the nurse report to the health care provider first? facial droop respiratory rate 23 breaths/min hemoglobin level of 10 g/dl (100 g/l) dactylitis of the hands and feet
facial droop (The nurse would first report any signs or symptoms which can indicate a life-threatening situation is occurring. A facial droop is a potential sign of a stroke or silent cerebral ischemia, which is life-threatening and requires emergent care. Sickle cell disease causes chronic anemia, with a hemoglobin level of 6 to 9 g/dl (60 to 90 g/l) with a normal level in a child at 11 to 13 g/dl (110 to 130 g/l). The chronic anemia causes the child to have a poor appetite and severe, acute abdominal pain (caused by sludging, which leads to enlargement of the spleen), swelling of the hands and feet (dactylitis), and increased respirations.)
A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child? bleeding mucositis vital signs infection symptoms
infection symptoms
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 pork, broccoli, white rice, and strawberries tuna salad with eggs, whole wheat crackers, and blueberries chicken, corn, brown rice, and oranges
red meat, eggs, oatmeal, and dried fruit
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. Apply a lip balm or petroleum jelly to prevent cracking. Give the child acidic foods (e.g., orange juice) to cleanse the mouth. Provide various soft and bland foods to minimize further irritation. Have the child rinse the mouth with lukewarm water three times a day. Vigorously rub the child's gums with gauze to clean them.
Apply a lip balm or petroleum jelly to prevent cracking. Provide various soft and bland foods to minimize further irritation. Have the child rinse the mouth with lukewarm water three times a day.
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? Remain in an upright position for at least 15 minutes Not eat or drink for one hour Drink a glass of milk Brush his or her teeth
Brush his or her teeth
How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old? Indicate that the more commonly used name is Hodgkin lymphoma Describe it as a bone tumor Call it a tumor of muscle tissue Explain that it develops in nerves outside the brain and spinal cord
Call it a tumor of muscle tissue
Lana develops idiopathic thrombocytopenic purpura (ITP) after a viral infection. The nurse identifies which action as most important? Caution Lana and her mother that she will bruise easily. Show Lana how to do a finger-stick test for glucose. Tell Lana to report if she develops a sharp headache. Show her mother how to test Lana's urine for protein.
Caution Lana and her mother that she will bruise easily.
A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? Iliac crest Sternum Femur Anterior tibia
Iliac crest
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? Ask the parent if he or she has questions about the plan of care. Contact the health care provider to meet with the parent. Implement strategies to address the child's pain. Provide diversional activities for the child.
Implement strategies to address the child's pain
The sickle-cell trait (hemoglobin AS) occurs in about 8% of Blacks, and although typically benign, there is some concern that intense physical exercise in such individuals could lead to cardiac deaths from occlusive crises. It has been reported that patients with sickle-cell disease are more prone to kidney and renal failure as well as rhabdomyolysis during times of extreme exertion. Controversies as to whether testing of athletes for sickle cell should be mandatory continue to exist. Although occurrences of death associated with sickle cell and exertion are rare, the National Collegiate Athletic Association (NCAA) has mandated testing for athletes (Lawrence, 2014). Based on the previous study, which would be the best exercise for Joey, who has sickle-cell disease, and his father who has the sickle-cell trait? Playing video games with each other Joining a swimming program at their local YMCA Watching sports together on TV each evening Organizing a touch (no contact) football game each weekend
Joining a swimming program at their local YMCA
In discussing the causes of iron-deficiency anemia in children with a group of nurses, the following statements are made. Which of these statements is a misconception related to iron-deficiency anemia? "Caregivers sometimes don't understand the importance of iron and proper nutrition." "Milk is a perfect food, and babies should be able to have all the milk they want." "A family's economic problems are often a cause of malnutrition." "Children have a hard time getting enough iron from food during their first few years."
"Milk is a perfect food, and babies should be able to have all the milk they want."
Gerri's school nurse informs another nurse that his mother forbids him to play basketball because she heard a friend's son developed osteosarcoma when he was injured playing the sport. The nurses collaborate to plan a unified response to her concerns. What would be the best advice to give Gerri's mother regarding her understanding of osteosarcoma? Evidence has shown that bone cancer is associated with active, organized sports. Osteosarcoma more often occurs in girls, so the boy's diagnosis is unusual. The sports injury more likely led to diagnosis of the tumor but was not the cause of it. The boy's inadequate calcium intake was a more likely cause of his health problem.
The sports injury more likely led to diagnosis of the tumor but was not the cause of it.
The nurse is preparing clients for diagnostic testing for cancer. Which test is used to differentiate a neuroblastoma from other tumors? Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) Urinalysis Serum chemistries Complete blood count (CBC) with differential
Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA)
A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. The nurse recognizes that the likely cause of this type of anemia is: sickle-cell disorder. iron deficiency. acute blood loss. Vitamin B12 deficiency.
Vitamin B12 deficiency.
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? Sickle cell anemia Folic acid anemia Pernicious anemia Aplastic anemia
Pernicious anemia
Following discharge from the hospital, parents assume the responsibility of administering chemotherapy at home. To determine whether parents followed adequate protection for themselves while handling chemotherapy drugs, researchers asked 50 parents of children with acute lymphoblastic leukemia to fill in a questionnaire asking about their experience with chemotherapy drugs. Seventy-two percent of parents reported receiving instruction on safe handling of oral chemotherapy. Ninety percent of parents, however, reported they did not use protective gear such as gloves during preparation of oral chemotherapy. Although tablet crushers were designated for use with oral chemotherapy by 61% of parents, 22% used the same device to crush other nonchemotherapy medications. Over 50% of parents disposed of medication waste with regular garbage or poured the remainder down the sink (Held, Ryan, Champion, et al., 2013). Based on this study, which statement by Gerri's mother would cause the nurse to believe she needs additional education about safe administration of Gerri's oral chemotherapy? "I'll call for advice if Gerri vomits a pill or refuses to take one." "I know his pills' side effects and will observe for them carefully." "I know I have to give the medicine according to a schedule." "I know to wash my hands before handling his pills."
"I know to wash my hands before handling his pills."
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? Applying EMLA to the lumbar puncture site Educating the family about chemotherapy and its side effects Administering promethazine as ordered for nausea Educating the child and family about the testing procedures
Educating the child and family about the testing procedures
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? The majority of childhood cancers can be prevented. Childhood cancers are usually localized when found. Most childhood cancers affect the tissues rather than organs. Unlike adult cancers, childhood cancers are less responsive to treatment.
Most childhood cancers affect the tissues rather than organs.
A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? Restricting the child's visitors Ensuring that the child be allowed nothing by mouth Preparing the child for chemotherapy Preventing weight-bearing activities Placing a "no abdominal palpation" sign above the child's bed
Placing a "no abdominal palpation" sign above the child's bed
