Maternal Chapter 46

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? A. 8 mcg/dl B. 14 mcg/dl C. 20 mcg/dl D. 26 mcg/dl

A. 8 mcg/dl 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.

Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor? A. Christmas factor B. Stuart factor C. Antihemophilic factor D. Proconvertin

A. Christmas factor Factor IX is also known as plasma thromboplastin component or Christmas factor. Its function is to activate factor X. Factor X is the Stuart factor. Stuart factor's function is to activate factor II in the clotting cascade. Factor VIII is the antihemophilic factor. It is a platelet cofactor and also helps activate factor X. Factor VII is proconvertin. It is considered a stable factor and also acts to activate factor X.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? A. Iliac crest B. Sternum C. Anterior tibia D. Femur

A. Iliac crest Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.

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? A. No routine live vaccines are administered while on chemotherapy. B. Siblings and parents should not receive nonlive vaccines. C. Growth may be stunted due to chemotherapy. D. Eliminate second-hand smoke within the home.

A. No routine live vaccines are administered while on chemotherapy. Children with cancer need much of the same well-child maintenance care that all children do, with one exception. While they are undergoing chemotherapy, which causes a decreased immune response, they should not receive "routine" vaccines, especially live vaccines. The siblings in the home can receive all nonlive vaccines, and the entire family (including the child undergoing treatment) is encouraged to receive a yearly flu vaccine. Growth and development are monitored during well-child visits, but it is not necessarily true that growth and development may be stunted. It is always a good idea to eliminate second-hand smoke for all children, not just for children with cancer. Childhood cancers do not seem to be related to environmental contaminants.

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? A. "The trait or the disease is seen in one generation and skips the next generation." B. "If the trait is inherited from both parents the child will have the disease." C. "The disease is most often seen in individuals of Asian decent." D. "Males are much more likely to have the disease than females."

B. "If the trait is inherited from both parents the child will have the disease." When the trait is inherited from both parents (homozygous state), the child has sickle cell disease, and anemia develops. The trait does not skip generations. The trait occurs most commonly in black clients. Either sex can have the trait and disease.

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? A. Factor V B. Factor VIII C. Factor X D. Factor XIII

B. Factor VIII The most common types of hemophilia are factor VIII deficiency and factor IX deficiency, which are inherited as sex-linked recessive traits, with transmission to male offspring by carrier females.

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: A. destroy any remaining cancer cells. B. kill enough cancerous cells to induce remission. C. destroy any residual cancer cells. D. follow up for recurrent disease or late effects.

B. kill enough cancerous cells to induce remission. During induction, the initial phase, intensive therapy is given to kill enough cancerous cells to induce a remission. In the consolidation phase, intensive therapy is given to destroy remaining cancer cells. The maintenance phase is a designated period during which treatment is continued to destroy any residual cancer cells. During the observation phase, therapy has ended and the child is followed up for recurrent disease or late effects of treatment.

A school-aged child with cancer is receiving chemotherapy. Which nursing action would best promote the oral comfort of a child receiving chemotherapy? A. Having the child solely eat or drink cold foods to reduce mucosal pain B. Encouraging the use of acidic fruit juices to decrease mouth organisms C. Keeping the child's lips moist with petroleum jelly to prohibit cracking D. Vigorously brushing the teeth and gums to remove secretions

C. Keeping the child's lips moist with petroleum jelly to prohibit cracking The mouth of a child receiving chemotherapy can become very inflamed and painful. It is important for the nurse to assess the oral cavity for redness, lesions, and plaques frequently. If the child is NPO, ice chips can be used to provide hydration to the mucosa. It is important to use a soft-bristle toothbrush when brushing the teeth. Excessive pressure on the gums will cause bleeding. If the gums are very inflamed, the child may use a saltwater solution or commercial mouthwash to keep the mouth clean. Instruct the child that this may cause burning. If burning or stinging occurs then discontinue the practice and provide solutions with pain medication. Using a petroleum product on the lips will provide hydration to the lips and keep them from being irritated or cracking. Drinking cold or hot foods will cause more pain in the mouth and may cause further irritation. Acidic fruit juices will cause increased pain and irritation in the mouth and may cause more inflammation.

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group, A. "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate? B. "When I give my son ferrous sulfate I know he also needs potassium supplements." C. "I always give the ferrous sulfate with meals." D. "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." E. "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate."

D. "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black.

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? A. Bladder B. Blood C. Brain D. Kidney

A. Bladder The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult cancer.

The nurse is providing postoperative care to a school-age child after a splenectomy and notes the following: temperature 102.1ºF (39ºC), heart rate 120 bpm, respiratory rate 28 breaths/minute, blood pressure 78/36 mm Hg, and oxygen saturation 90%. Which nursing action is priority? A. Administer acetaminophen orally. B. Give recombinant erythropoietin. C. Reassess temperature in 30 minutes. D. Place the child in a supine position.

D. Place the child in a supine position. For a child showing signs of acute blood loss, a priority is to lay the child flat to provide adequate circulation to the brain. Administering acetaminophen and reassessing the temperature can be performed later. Erythropoietin may be given to increase RBC production, but this is not a priority in the immediate period of acute blood loss.

The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect? A. capillary refill in less than 2 seconds B. pink palms and nail beds C. absence of bruising D. spooning of nails

D. spooning of nails A convex shape of the fingernails termed 'spooning' can occur with iron deficiency anemia. Capillary refill in less than 2 seconds, pink palms and nail beds, and absence of bruising are normal findings.