Nurs 232 Exam 3

What home care considerations should be taught to families w children w sickle cell diseases? *refer to familes want to know home care considerations for child w sickle cell disease

*immunizations up to date -periodic heart and eye exams -take full ATB if ordered -assess child's pain and give pain med -give extra fluids for hot weather, when ill, physical activity, and traveling -contact physician if child has high fever, common illness longer 1 day, seizures, change in behavior, severe pain, abnormal skin color or breathing pattern

What clinical manifestations of leukemia would indicate bone marrow failure

*large joint or bone pain *overt signs of bleeding *petechiae

What should nurse do it pt w either hemophilia or Von Willebrand disease is bleeding?

-apply pressure -apply ice -immobilize and elevate affected area -administer factor replacement *once acute bleed stopped ROM to prevent contractures

What is the universal initial reaction of parent to child having a life-threatening illness/injury? What other reactions may occur? *similar to grieving process

#1) shock and disbelief -anger & guilt -deprivation & loss -anticipatory waiting -readjustment or mourning

How is pyloric stenosis diagnosed?

#1) ultrasound -blood tests for dehydration and electrolyte imbalances

What foods should pt w GER avoid?

-greasy -spicy -chocolate -peppermint -citrus -caffeine

What are physical assessment findings of a dying child?

-Agitation or restlessness -Decreased urine production -Moaning or grunting -Incontinence -Typically unconscious final hours -Tachypnea and dyspnea -Extremely weak, too weak to speak/swallow -Decreased oral intake/anorexia -Deterioration of hearing and vision -Death rattle -Cool, clammy skin -Cyanosis and mottling

When is the recommended times for screening for iron deficiency anemia?

-12 mos old -males: 1x in adolescence -females: every 5 yrs starting at 13 yrs

What are the 2 most common types of leukemia?

-ALL= Acute Lymphoblastic Leukemia *most common* -AML= Acute Myeloid Leukemia

What are the clinical manifestations of GI dysfunction?

-Abd pain or distention -N/V, diarrhea, constipation -Absent, hypoactive, or hyperactive BS -Spitting up/regurgitation -failure to thrive -GI bleeding -juandice -dysphagia

What are the clinical manifestations of GERD?

-Arching of back during feeding -Regurgitation or spitting up -Refusal of feedings -Irritable and frequently hungry -Vomiting -Eat often but lose weight -Sleep disturbances -respiratory symptoms like aspiration and apnea

What preventative measures may be implemented for pt w/ ITP?

-Avoid aspirin -Avoid contact sports -Safe environment

What are the goals of treatment of Hemophilia and Von Willebrand disease?

-Avoid aspirin, NSAIDS, and meds affecting platelet function -safety measures & environment (ex: bike helmets, not contact sports) -pain management -factor replacement -maintain appropriate weight

What is the overall management for pt w sickle cell anemia

-Avoid triggers -Penicillin from birth to 5 yrs (increased risk infection) -Immunizations (including Pneumovax) -prevent infection w handwashin & decrease exposure to sick people -Folic acid (help promote RBC production) -frequent transfusion -Screenings for stroke, vision problems,kidney and pulmonary functions -Hydroxyrea med to increase fetal hgb

What are the normal lab values for BUN/creatinine?

-BUN : 10-20 -Creatinine: 0.5-1.2

What is Hemarthrosis and what can it lead to? *r/t hemophilia

-Bleeding into joint spaces like knee, ankle, and elbow *can lead to limited ROM from pain and swelling>>>bone changes and flexion deformities

What are common side effects of chemo?

-Bone marrow suppression=Neutropenic, Anemic, Thrombocytopenic -Anorexia and weight loss -Constipation -Oral ulcers and rectal irritation/fissures (mucous membranes effected increasing risk of infection) -N/V -Pain

What diagnostic tests might the physician order for pt presenting to hospital w/ symptoms of long bone pain, weakness, decreased appetite, weight loss, bruising and petechiae, confusion for suspected cancer?

-CBC differential (RBC, hgb, hct, platelet, all diff types of WBC) -bone marrow aspiration/biopsy (take cells right from bone marrow to analyze) -lumbar puncture (see if spread to CSF) - MRI,CT, PET, ultrasound, cxr (better picture) -biopsy of tumor -electrolytes or other studies drawn

How does cancer differ in children than adults?

-Children: mostly r/t genetics and embryonic. Cancer is fast growing and the immune system is less responsive b/c not as developed. Less incidence of cancer caused by exposure. -Adults: mostly r/t lifestyle habits and environmental exposure to toxins/carcinogen. Focus on decreasing exposure and changing lifestyle.

What are risk factors of GER?

-Chronic respiratory disorders -Horizontal position -Obesity -Prematurity -Short narrow esophagus -Small stomach -Neuro impairment -Large feedings -liquid diet

What is med may be given to pt w/ hemophila and when is it administered?

-Factor VIII replacement for Hemophila A -Factor IX replacement for Hemophila B *administered IV at time of bleed or used prophylactically for severe hemophilia

What are the clinical manifestations of Acute Appendicitis?

-Fever -Anorexia/lack of appetite -Rigidity -Most intense pain at McBurney's point -Abd guarding -N/V -periumbilical pain moves to RLQ

What are the potential clinical manifestations of pyloric stenosis?

-Fewer, smaller stools -Irritable -Small regurgitation after feeding -Hungry after emesis -Projectile vomiting (obstruction increases) -Olive-sized mass in RUQ -Nonbilious emesis and blood tinged -Dehydration -poor weight gain -metabolic alkalosis -peristaltic wave

What meds might be provided for pt w GER?

-H2 blocker (ranitidine, famotidine) -PPI (omeprazole)

What types of pain meds might be prescribed for pt w/ sickel cell crisis?

-Morphine -Hydromorphine (Dilaudid) -NSAID's like Keterolac or ibuprofen

What are the normal RR for each of the following ages: -Newborn -1 yrs -3 yrs -6 yrs -10 yrs -17 yrs

-Newborn: [30-55] -1 yrs: [25-40] -3 yrs: [20-30] -6 yrs: [16-22] -10 yrs: [16-20] -17 yrs: [12-20]

Children have vague clinical manifestations of cancer. Which s/s would concern the nurse for possible cancer?

-Pain= leg pain w/ tumor or long bone pain w/ leukemia -Anemia= weakness w/ leukemia -Neuro symptoms= ataxia or confusion -Infection -Cachexia= decreases appetite and weight loss -Bruising and petechiae -Palpable mass

What are triggers for sickling for pts w sickle cell anemia?

-Physical or emotional stress -Illness -Trauma -Infection -Extreme temp changes -Dehydration -hypoxia -fever

When is there a sharp increase in incidence of ALL and what increases risk ? *most common *5 yr survival rate 92%

-Sharp peak in ages 2-3 yrs, but can occur at any age -risks: down syndrome, genetic factors, and immune deficiency

What clinical manifestations would pt present for suspected leukemia?

-Swollen lymph nodes (lymphadenopathy) -CNS (headache, vomiting, papilledema, inability to move eyes laterally) -Anorexia -Lethargy -Pallor -Enlarged liver (hepatomegaly) and spleen -Large joint or bone pain -Bleeding (overt signs like bruising, petechiae, nose bleeds) -Fever -Malaise -Very high WBC count

What is an adolescent's understanding of death?

-adult understanding -intellectually capable of understanding death -developmental conflicts w/ identity vs inferiority

What clinical manifestations will occur in child indicating GERD instead of GER?

-arching back during feedings -refusal of feedings -respiratory symptoms (i.e aspiration and apnea) -sleep disturbances *will have s/s of GER too: regurgitation/spitting up/vomiting, frequently hunggry and irritable, eat often but lose weight

What post-op care should the nurse perform for a child w/ cleft lip and cleft palate repair repair?

-arm immobilizers for 2 weeks (keep hands out of mouth) -pain management -decrease crying -distraction -feeding adaptation (feed w/ syringe or drink from cup)

What guidance can the nurse give for parents of a 7 yr old that are overwhelmed w leukemia diagnosis and don't know what to say to him?

-be honest, factual, and realistic w info -provide images or written material and explain -provide resources to help -utilize child life, social work, or clergy

What are some strategies for communicating w dying child?

-be receptive -ask what they know -talk what's worrying them -ask what's important to them -nonverbal expression of feelings -reassure not abandoned -let them know always be loved and remembered

What can cause iron deficiency anemia? *most common type of anemia and nutritional deficiency in children

-blood loss -malabsorption -poor nutritional intake -increased physiologic demands for blood prodction (ex: growth periods)

What are s/s of stroke, a type of sickle cell crisis?

-blurry vision -vision changes -headache -weakness -difficulty w speech

Pt w/ sickle cell anemia will have shortened lifespan of blood cellls and tissue destruction causing multiple s/s. What are common organs affected?

-brain -eyes -lungs -liver -spleen -kidneys -penis -extremities -bones -skin

What growth and development considerations are there for an infant w a chronic condition? *refer to growth and development w chronic condition

-bright light and high-pitched noises can affect dev -promote bonding by engage parents w face-to face interaction -provide sensory stimuli like mobiles, soft music, and different textures

Since cancer has an increase rate of survival, what physical late effects of cancer and treatment might pt experience?

-cardiotoxicity (baseline ekg and monirot heart function) -pulmonary fibrosis (lung involvement) -ototoxicity -chronic pain -neuropathy -bone loss/osteoporosis -secondary cancers -amputation/scarring/disfigurement -short stature -changes in function, mobility, cognitive ability -infertility -chronic infection

What treatment may be provided for pt w leakumia?

-chemotherapy (ex: intrathecal done w/ lumbar puncture for fluid analysis then administer chemo through spinal column) -radiation for CNS, T-cell leukemia, or testicular involvement

What other clinical manifestations will older children w GERD have?

-chest pain -heartburn -dysphagia

What growth and development considerations are there for an adolescent w a chronic condition? *refer to growth and development w chronic condition

-dev identity, body image, and self-concept -abstract thinking -dev understanding of short term and long term consequences r/t condition -more aware of differences from peers -unable to cope w differrences, withdraw social activities, or engage in risk behaviors -educate to help learn about condition, care needed, and problem solving -discuss sexual maturation and importance of protected activity -provide opportunities to express concerns

What can influence a child's reaction to loss?

-developmental level -concept of loss and death -relationship w/ deceased -circumstances of loss -caregiver's ability to communicate and provide emotional support -support from peers and others -prior experience w loss -religious and cultural beliefs

What are the differences in cancer for children vs parents? *refer to pediatric differences

-embryonal and nonepitheleal (adults= most epithelial ) -fast growing and become ill over days to weeks (adults= slow growing from carcinogen) -child immature immune system -cell growth rapidly, so cancer rapidly progresses -neuroblastoma in very young children -lower levels immunoglobulins so vulnerable bacterial and viral infections -apoptosis not well developed

What can cause cancer in children?

-embryonic= problems during development in womb -oncogenic= cancer type cells -genetic alterations -environmental exposure (less)

What education should be provided to parents to help child through cancer therapy? *refer to families want to know cancer therapy

-extra rest periods w shorter activity periods -suitcase available for complicatoins -encouraged to share observations and concerns w s/s of child -nutritious intake when ready to eat -treat them app for age and utilize child life for planning activities -maintain contact w peer group and family by arranging phone calls, videocam, and other communication -seek info from other parents, internet, and other resources -complementary therapies discussed w oncologist -take time to relax so have enough energy for child's therapy

What are associated problems w cleft lip and palate?

-feeding difficulties -bonding affected -dental issues -hearing problems and increased risk of ear infection -speech/language problems -self esteem issues

What treatment options are available for pt w GER?

-feeding modification -thickening feedings -smaller feedings -positioning upright -avoid greasy, spicy foods, chocolate, peppermint, citrus, and caffeine -meds like H2 receptor antagonist or PPI -Nissen Fundoplication surgery if severe

Pt is being treated w/ chemo and presents w very minimal WBC to fight off infection, what s/s might nurse be assessing for infection

-fever -chills or sweats -cough -sore throat or new mouth sore -SOB -nasal congestion -stiff neck -burning or pain w/ urinating -unusual vaginal discharge or irritation -redness, soreness, swelling, or pain in an area like would or port -Diarrhea -vomiting -Abd or rectum pain -new onset pain -changes in skin, urination, or mental status

What education should be provided for parents of child w cancer to enhance nutritional intake? *refer to families want to know nutrition and the child w cancer

-frequent small feedings -integrate fav foods and cultural foods -nutritious snacks available -sprinkle dried mlk on ceral -smooth, soft foods like milkshakes, pudding, or soft casseroles well tolerated -avoid spicy or acidic foods -do not force to eat; make food readily available -dont encourage food at therapy if causes vomiting -antiemetics as ordered -report weight loss and increased fatigue -schedule health visits -may need feeding tube or TPN

What coping help while a preschool child more than likely need r/t physical effects of cancer treatment and how can nurse help? *refer to children need help in coping w physical effects of cancer treatment

-girl may be upset w hair loss bc look like a boy; can be devestatign -ask parents and child what loss is like for them -offer resources for wigs, hats, and other ideas -introduce to other children w hair loss and those who've regrown it

What complimentary therapies can be taught to pt w cancer to help w/ side effects of treatment?

-herbal meds if approved by physician -music therapy -meditation -peppermint oil

What are the normal lab values for an CBC? 1) hgb 2) hct 3) rbc 4) wbc 5) platelets

-hgb : 12-18 -hct : 37-52% -rbc: 4.2-6.1 -wbc: 5,000-10,000 -platelets: 150,000-400,000

What should families be taught to call physician w child w sickle cell disease?

-high fever -common illness longer 1 day -seizures -change in behavior -severe pain -abnormal skin color or breathing pattern

What are pediatric differences r/t hematological functions in infants?

-higher RBC -RBC fall until 2-3 mos then begin increasing -adult RBC levels reached in adolescence -higher WBC -lower platelet levels -lower clotting factor (need vitamin K)

What ages have the highest rates of AML and what increases risk ? *5 yr survival rate 64%

-highest in first 2 yrs of life and adolescence -risks: ionizing radiation or chemicals like chemo exposure in utero, or chromosomal/genetic abnormalities

How will pt be diagnosed with GER?

-hx -Upper GI - pH probe -endoscopy

How would pt w/ sickle cell crisis be treated?

-hydration (rehydrate sickle cells to return to normal shape) -oxygen administration (increase o2 carrying capacity for hgb, comfort, and relieve pulmonary complications) -pain meds -bed rest (decrease energy requirements) -transfusion (improve O2 and decrease sickling event) -aggressively treat infection

What is the treatment for iron deficiency anemia?

-identify cause -foods high in iron -iron supplementation

What are some GI differences in infants?

-immature GI system -small stomach capacity(20ml) -increased intestinal motility (need frequent feedings) -relaxed cardiac sphincter (frequent spit ups) -greater length of small intestine to body size (more prone losing fluids) -immature liver (more jaundice) -deficient in digestive enzymes (until 4-6 mos)

How should we inform parents of their child's chronic illness or disability? *refer to families want to know "informing parents of childs condition"

-in person, private setting, free from interruptions -tell both parents together and allow for additional support persons -present info in small amounts -plan and organize info using simple, direct language -share accurate up to date info -talk about strengths and positives, and limitations and characteristics of child -evaluate family's needs and support -plan follow-up discussion

What growth and development considerations are there for an school age w a chronic condition? *refer to growth and development w chronic condition

-increased understanding of condition and participating in aspects of care -begin understanding how to manage their condition and long term needs -assume more responsibility for care -need to gain social skills, interact peers, master new info for sense of industry -senses different from peers and may feel left out -allowed to participate in activities as much as condition allows -encourgae interaction w children sam age group w same type of chronic condition

Why are infants and adolescents at increased risk of anemia?

-infants don't consume enough solid food after 6 mos or drink cows milk b/4 1 yr -adolescents may eat higher fat and less vitamins and mineral or starting menstraution

What are potential complications from treatment of cancer?

-infection>> sepsis >> death -tumor lysis syndrome

What growth and development considerations are there for an toddler w a chronic condition? *refer to growth and development w chronic condition

-interfere w dev of autonomy or self control -can lose independence -offer choices -allow time for child to practice and learn skill

What is a preschooler's understanding of death?

-little bit more aware -can see/feel body deteriorate -alter self-concept -describe illness in terms of body mutilation -believes death is temporary and person will return -magical thinking (think caused or punishment) -confuse death w being away or asleep -may have experience of death of pet

What are the clinical manifestations of Hemophilia? *typically no symptoms until after 6 mos of age

-low levels of factor VIII or IX and prolonged PTT -mild, moderate, severe bleeding tendencies -spontaneous bleeding -bleeding into joint space (Hemarthrosis) -easy bruising -hematuria -bleeding after tooth extraction/circumcision/minor trauma or surgical procedure -intracranial bleeding (w/ severe hemophilia)

What's the potential treatment for ITP?

-may only closely observe pt depending on platelet level -corticosteriods -Intravenous immune globulin (IVIG) -Intravenous anti-D immunoglobulin -splenectomy in severe cases

What are some neutropenic precautions/protective isolation for pt w/ severe neutropenia as a result of chemo treatment?

-meticulous handwashing -mask if pt leaves or sick caregivers/visitors -no live plants, fresh flowers, fresh raw fruits, veggies, sushi or other items that might transmit infection -positive pressure room w/ HEPA filtration system -monitor closely for s/s infection -limit visitors -up to date w/ immunizations

What important nursing care should be provided for children w cancer?

-monitor for complications of treatment -psychosocial support -development assessment -administer meds -treat side effects (antiemetic for N/V) -pain management -promote optimal nutrition and monitor weight -hydration (2x maintenance) -prevent infection (ex: neupogen stimulate WBC)

What meds may be given to pt w sickle cell anemia?

-morphine, hydromorphone, ketorolac, or ibuprofen (pain) -penicillin (infection) -folic acid (RBC production) -iron-chelating drug like exjade or desferel (frequent transfusions) -hydroxyurea (increase fetal hgb)

What coping help while a school age child more than likely need r/t physical effects of cancer treatment and how can nurse help? *refer to children need help in coping w physical effects of cancer treatment

-most difficult time w changes that interfere w industry -amputation decreases ability to participate in sports, dancing, and school work -assist child to adapt to new sports -partner w schools, coaches, and families to help child participate in activities

What coping help while a adolescents child more than likely need r/t physical effects of cancer treatment and how can nurse help? *refer to children need help in coping w physical effects of cancer treatment

-most worries about changes w hair loss and cushingoid features bc look different from peers -introduce to other children own age coping w similar condition

What are clinical manifestations of ITP?

-multiple ecchymosis (bruising) -petechiae -mucosal bleeding in mouth and nose -low platelet count (generally <20,000)

What differences does infant experience as a result of GI differences such as: small stomach capacity, increased GI motility, relaxed cardiac sphincter, greater length of small intestine to body, immature liver

-need frequent feedings -frequent spit ups -more prone to losing fluids through intestines -more jaundice presentation

What are the normal HR ranges for the following ages: -newborn -infant to 2 yrs -2 to 6 yrs -6 to 10 yrs -10 to 16 yrs

-newborn HR is: [100-170] -infant to 2 yrs: [80-130] -2 to 6 yrs: [70-120] -6 to 10 yrs: [70-110] -10 to 16 yrs: [60-100]

How is sickle cell anemia diagnosed?

-newborn screening -hgb electrophoresis

What is a toddler's understanding of death?

-no true understanding or concept -know they feel sick or tired -do not associate physical symptoms w illness/death

What is an infant's understanding of death?

-not aware -sense emotions of caregivers -sense separation

What is is the focused clinical management of pt w sickle cell anemia

-pain control -hydration -oxygenation -prevent infection -prevent associated complications

What growth and development considerations are there for an preschool w a chronic condition? *refer to growth and development w chronic condition

-recognize association between body parts and problems w chronic condition -magical thinking -believe they caused condition or punishment -may interfere w independence -explain purpose of treatments and procedures in terms they can understand and emphasize that not a punishment -use play so shild can learn self care and feel sense of accomplishment -give positive feedback

What clinical manifestations will nurse most commonly see w pt w GER?

-regurgitation, spitting up, or vomiting -frequently hungry and irritable -eat often but lose weight

What safety measures should be taught to pt w/ clotting factor deficiency like hemophilia or Von Willebrand disease?

-safe environment -bike helmet -no contact sports

Since cancer has an increase rate of survival, what psychosocial late effects of cancer and treatment might pt experience?

-separation -unconnected w peer group -gear of death/second cancer -dealing w/ late effects like infertility -memories -family stress -change in economic status -insurance concerns

What are clinical manifestations of cleft lip?

-simple dimple >>.to a complete separation of floor to nose -unilateral or bilateral -nasal deformitity (maybe) *usually apparent at birth

What are the normal lab values for an electrolyte panel? 1) sodium 2) potassium 3) calcium 4) magnesium

-sodium: 135-145 -potassium: 3.5-5 -calcium: 9-10.5 -magnesium: 1.2-2

What are clinical manifestations of cleft palate?

-soft palate or both hard &soft -clefts of hard palate form a continuous opening between mouth and nasal cavity -unilateral or bilateral *less obvious

Treatment of cancer may be curative, supportive, or end of life care. What are examples of clinical therapy that may be provided for children w cancer?

-surgery (debunk, remove, or stage tumor) -chemotherapy (caustic to veins so use central line) -radiation (shrink tumor) -biotherapy -bone marrow/stem cell transplant (can be curative) -complimentary therapies (helps w/ side effects of treatment)

What should familes of pts w cancer be instructed to report if child is receiving chemo? *refer to families want to know reportable events for chil receiving chemo

-temp >101F -any bleeding i.e. nosebleed, petechiae, brusing blood in stool or urine -pain or discomfort w urination or defecation -sores in mouth -vomiting or diarrhea -persistent pain anywhere including headache -s/s infection i.e cough,fever, runny nose, or tugging at ears -central line infection i.e. redness, drainage, or tenderness -exposure to communicable diseases

What is a school age's understanding of death?

-understand death is permanent -death anxiety and fear -knows difference between temp separation and death -not realize death can occur at any age -by 9-10 yrs old has adult understanding

How should providers discuss a child's condition to families? *refer to families want to know "discussing child's condition"

-use child's name -avoid labeling child's condition ex: child w diabetes rather than diabetic child

What oral care should be taught to families of pt w cancer? *refer to families want to know oral care

-visit dentist early in treatment for assessment -brush teeth 2x/day w soft tooth brush and rinse w water -use toothettes or gauze of very low platelets to help prevent bleeding and infection (ex: 40,000) -antibacterial mouthwash if ordered -report bleeding, infection, or other oral care needs

If pt is being discharged and is neurtopenic as a result of chemo treatment, what should the nurse teach the pt to implement neutropenic precautions at home?

-wash hands frequently -avoid crowded places or sick people -do not share food, drinks, utensils, toothbrushes -shower/bathe daily -use unscented lotion to prevent dry cracked skin -cook meat and eggs all the way -thoroughly was raw fruits and veggies -protect skin from direct contact w/ pet urine or feces by wearing gloves to clean up after pet and wash hands immediately afterwards -use gloves for gardening -clean teeth and gums w/ soft toothbush and use mouthwash to prevent sores if ordered -keep all household surfaces clean -get seasonal flu shot as soon as available

Match the following blood cells w the correct description: 1) __ carries O2, nutrient, and rids the body of waste 2) __ fight off pathogen; many different types of this cell 3) __ helps w clotting 4) __ part of RBC that carries O2 5) __shows up 1st for infection --bacterial infection 6)__ recognizes antigen and produces antibodies --viral infection 7)__ phagocyte that lives longer life takes over after neutrophil 8)__ respond to parasite or allergic response 9)__ release histamine for allergies or inflammation 10)__ immature WBC 11)__ immature RBC

1) RBC 2) WBC 3) platelet 4) Hgb 5) neutrophil 6) lymphocytes 7) monocytes 8) eosinophil 9) basophil 10) bands 11) reticulocytes

Match the following potential interventions for the common side effects of chemo? 1) blood transfusion if anemia severe/hgb 7-8 or platets very low; protect body from bruising; careful hand hygiene; use masks if sick 2) antiemetics 30-60mins before like ondansetron (Zofran) and other therapies like relaxation, hypnosis, or desensitization 3) pay attention to changes in taste affecting food choices; consult dietitian 4) good oral hygiene, soft toothbrush or toothette; no commercial mouthwas; special mouthwash 5) stool softener or laxative like miralax; incrase fluids and fibers 6) acetaminophen or morphine for pain; not NSAID bc bleeding; acetaminophen masks fever so careful assessment for infection; teach deep breathing and other nonpharmacological methods

1) Bone marrow suppression (usually 7-10 days after start) 2) N/V (immediately or 5-6 hrs after chemo lasting 48 hrs) 3) Anorexia and weight loos 4) oral ulcers 5) constipation (more common later on w decreased intake and activity) 6) pain *refer to table 24-4

How would the nurse assess and provide interventions for the following common side effects of chemo: 1) ___Bone Marrow Suppression (anemia, thrombo, neutro) 2) ___ N/V 3) ___ anorexia and weight loss 4) ___oral ulcers/ stomatasis 5) ___ constipation 6) ___ pain 7) ___anemia 8) ___thrombocytopenia

1) CBC-- signs of bleeding, pain, bleeding precaution, neutropenic/protective isolation 2) ask-- antiemetics, hydration, provide foods that sound good, peppermint oil 3) weight/BMI & how much eat-- high cal, protein, and fat, TPN/tube feed, supplements 4) oral assessment--hydration, special mouth wash/rinse, oral care 5) abd assessment & monitor BM-- fiber, fluids, movement as tolerated, bowel protocol 6) pain scale-- pain med, complimentary therapy, distraction 7) CBC, temp, fatigue--transfusion PRBC, monitor transfusion reaction 8) CBC & bleeding--soft toothbrush/toothette, prevent falls/bumping, try to avoid w/ rectal temps, enema, IM injection

What are the 5 stages of grief? *applies to death, divorce, diagnosis of chronic illness, move

1) Denial and isolation 2) Anger 3) Bargaining 4) Depression 5) Acceptance *is a process, not linear; people go through stages differently in different order *helps adapt to loss

What are the 3 types of self-reporting pain assessment tools? When are they used?

1) FACES pain rating scale **3 yrs and up 2) Oucher Scale ** 3-12 yrs 3) Numeric Pain Scale **5 yrs if can count to 10 and identify larger number OR by 7-8 yrs

What 2 manifestations will be noticed when assessing and performing diagnostic tests for pt w pyloric stenosis?

1) Peristalic wave on exam 2) olive-sized mass in RUQ w/ palpation

Match the following digestive enzyme w/ its function 1) ___carb digestion 2) ___aids in fat absorption 3) ___ aids in protein metabolism a) lipase b) typsin c) amylase

1) c 2) a 3) b

Identify the reasons the ohyscian May order the following interventions for pt w sickle cell crisis? 1) bedrest 2) IV fluids 3) morphine 4) O2 5) IS 6) ampicillin 7) ketoralac 8) folic acid 9) hydroxyurea

1) decrease energy requirements 2) Rehydrate cells to return normal shape 3) pain management 4) improve oxygenation you return normal shape 5) Prevent atelectasis and pneumonia by keep lung expanded while bedrest 6) broad spectrum ATB treat infection 7) NSAID for pain management 8) increase RBC production to help anemia 9) decrease frequency of vasoocclusive crisis by increase fetal hgb

Match the following description of factors that can impact the blood cell 1) RBC 2) WBC 3) platelet 4) Hgb 5) neutrophil 6) lymphocytes 7) monocytes 8) eosinophil 9) basophil 10) bands 11) reticulocytes

1) increase dehydration--decrease anemia, bleeding, sickle cell, hemolysis from transfusion 2) increase infection, neupogen, corticosteriod--decrease chemo 3) increase injury--decrease chemo 4) increase dehydration--decrease anemia, bleeding, sickle cell 5)increase bacterial infection 6) increase viral infection 7) increase infection, cut, wound 8) increase parasites or allergies 9) increase allergies or inflammation 10) increase w/ leukemia 11) increase w/ sickle cell crisis

Match the following clinical manifestations of sickle cell anemia r/t to the common organs affected: 1)__brain 2)__eyes 3)__lungs 4)__liver 5)__spleen 6)__kidneys 7)__penis 8)__extremities 9)__bones 10)__skin

1) stroke 2) retinopathy, retinal detachment, diminished vision 3) pneumonia, fibrosis 4) enlargement, scarring 5)infection, splenic sequestration 6)enuresis, hematuria, inability to concentrate urine 7) priapism 8) vaso-occlusive, chronic ischemia 9)chronic ischemia, infection, degeneration, aseptic necrosis or femoral head 10) decreased peripheral circulation

What types of acute events aka Acute Sickle Cell Exacerbations can occur?

1) vaso-occlusive crisis 2) Acute chest pain 3) Splenic sequestration 4) stroke

Why might pt w/ sickle cell anemia receive the following drugs? 1) Morphine 2)Hydromorphone (Dilaudid) 3) Ketorolac or ibuprofen NSAIDS 4) Penicillin 5) Folic acid 6) Exjade or Desferel 7) Hydroxyurea

1, 2, and 3) pain management 5) birth to 5 yrs b/c high risk of infection 6) inron chelating drug used for iron overload from frequent transfusions 7) cytotoxic drug increasing fetal hgb= decreased vaso-occlusive crisis

Explain the pathophysiology of sickle cell anemia and how it can lead to organ damage?

1. hgb s normal globular shape when oxygenation 2. when stressed hgb s will change 3. hgb sticks together forming log, rigid rods 4. RBC becomes curved to crescent/sickle shape 5. sickle cells are rigid obstructivng capillary blood flow 6. engorgement and tissue ischemia 7. further sickling 8. large infarction 9. organ damage

What are the steps of pyloric stenosis that leads to an obstruction

1. narrowing of passage between stomach and small intestines 2. partially obstructing lumen of the stomach 3. inflammation and edema 4. obstruction

Who is most commonly pts w Acute Appendicitis?

10-17 yrs but can occur at any age

When does the hard and soft palate &/or lip fail to fuse for pt w/ cleft lip &/or cleft palate?

1st trimester

When do symptoms of pyloric stenosis appear and what is the first sign?

2-8 weeks after birth starting w small regurgitation after feedings

What is the stomach capacity in an infant requiring the need for frequent feedings?

20 ml

How should parent be educated on how to feed their baby w cleft lip/palate?

Feed upright position, watch them, keep upright for a while after feeding, use special longer nipples

By what age will a child understand death is permanent? and then have an adult understanding of death?

6 yrs= death is permanent 9-10 yrs old= adult understanding

What is pt deficient in w Hemophila A? Hemophila B?

A= Factor VIII 8 b= Factor IX 9

What feeding adaptations should be taught for parents of child w/ cleft lip/palate repair surgery?

Feed w/ syringe or drink from cup *Don't want them to suck as much so avoid nipples, pacifiers, straws, and metal utensils

What should the nurse frequently assess for pt going through chemo treatment that measures both mature (segmented) and immature neutrophils (bands)?

Absolute Neutrophil count

What is the most common reason for emergency surgery in children?

Acute Appendicitis *common for 10-17 yr old

What is inflammatino of the appendix? What age does it most commonly occur w?

Acute Appendicitis; 10-17 yrs *most common emergency surgery in children

What is the typical understanding to death by an adolescent?

Adult understanding *by age 9-10 yrs

What is considered a reduction in number of RBC, hgb, and hct values caused by loss/destruction or impaired/decreased rate of RBC production

Anemia *many causes

What term describes programmed cell death when the cell realizes something is wrong and destroys itself?

Apoptosis

Why would the nurse be concerned when pt w Acute Appendicitis reports that they have a sudden relief of pain and are feeling better?

Appendix has ruptured

What is a child w cleft lip/palate more at risk for?

Aspiration r/t feeding difficulties from not being able to form a seal around nipple *feed upright position, watch them, keep upright for a while after feeding, use special longer nipples

How should nurse assess bowel post op after laparoscopic pyloromyotomy for pt w pyloric stenosis?

Assess BS and for distention

What should the nurse always be concerned about for adolescent female pt?

Iron deficiency anemia r/t blood loss from starting menstraution

What should parents feed their child w/ cleft lip/palate before surgery and then afterwards?

Before= long nipple After= syringe or drink cup

How is leukemia typically diagnosed?

Blood counts (CBC differential) and bone marrow biopsy *watch for bleeding, lot of bruisng, and painful

What is Splenic Sequestration? *r/t sickle cell anemia

Blood trapped in speen *life threatening *may need splenectomy

What typically occurs 7-10 days after starting chemo that puts pt at incrased risk of infection, weakness, and bleeding?

Bone marrow suppression causing: -neutropenia (low WBC) -anemia (low RBC) -thrombocytopenia (low platelet) *nadir=lowest point when expect bone marrow suppression to happen

What education must be provided for pts receiving either bone marrow of stem cell transplant for cancer?

Can be curative, but has complications of rejection or allergic reaction so must take meds to suppress immune response to foreign body and donor marrow

What is considered the #1 disease related cause of death in children?

Cancer *leukemia is most common type

What should the nurse be concerned about when a child presents to the hospital and parents state: "he has normal activity, growth and development has always been on target, but he has become more clumsy and experiences ataxia"

Cancer such as a brain tumor

What term describes chemicals or processes that, when combined with genetic traits and an interaction with one another, cause cancer

Carcinogen

What causes pyloric stenosis and when do symptoms appear?

Cause is unknown; symptoms appear between 2-8 weeks after birth

How would the nurse explain the importance of central line for chemotherapy to a pts family that want to continue to use peripheral IV bc they're concerned w the increased risk of infection?

Chemotherapy is very caustic/damaging to the veins, so it requires central line to minimize tissue injury

What is a facial malformation that occurs during embryonic development early in pregnancy from failure of fusion of hard and soft palates and/or lip?

Cleft Lip &/or Cleft Palate

What correction is done for child w/ cleft lip? When is it performed?

Cleft lip repair done between 3-5 months

What correction is done for child w/ cleft palate? When is it performed?

Cleft palate repair closed by 12 mos *timing varies w/ size, severity, and surgeon preference

What med may be given to pt w/ Von Willebrand disease or mild and moderate hemophilia and how does it work? *given IV or intranasally

DDAVP (Desmopressin) or Vasopressin *increases release of vWF stores, stimulates release of factor VIII, increase platelet adhesiveness, and shortens bleeding time

What may cause iron defiency anemia in an infant?

Drinking too much milk decreases appetite for other foods *help by restricting amount of milk can drink and provide iron supplementation

Why might a child w/ leukemia experience long bone pain?

Excessive activity of WBC in bone marrow

What type of blood transfusion may be ordered for pt w sickle cell crisis?

Exchange transfusion where pts blood removed and replaced w donor blood

T or F: pt w ITP will receive platelets bc low platelet count

False bc body will just attack them

T or F: it is important for cancer pt that is neutropenic from chemo is up to date w/ all immunizations so if any are missed like MMR they should get the vaccine during hospital visit

False! *no live vaccines for pt or family b/c can shed virus and get infection

T or F: there is a decrease in the incidence of childhood cancer w new education on prevention

False! Theres an increase in incidence, but also an increase in survival *research and protocols conducted by cooperative group called "Children's Oncology Group (COG)" for state of the art treatment

Sometimes children start off w/ peripheral IV for chemo until a central line can be placed. What is an important nursing role when a pt has peripheral IV? *very rare

Frequently check to make sure it hasn't infiltrated and caused tissue damage *very caustic to veins

What is a more serious manifestation of GER?

GERD *manifestations of GER + refusal of feeding, sleep disturbances, resp symptoms (risk aspiration and apnea), arching back w feedings *older children have dysphagia, heartburn, chest pain

What would be considered when gastric contents return into esophagus due to relaxation of lower esophageal sphincter?

Gastroesophageal Reflux (GER) *very common in children

What is a group of hereditary disorders that result from a deficiency of specific clotting factors?

Hemophilia and Von Willebrand Disease

Hospital policy differs for precautions for pts considered neutropenic according to absolute neutrophil count, however what might be implemented?

If neutropenic/ ANC value is very low, pt will be in protective isolation or neutropenic precautions *ex: if severe pt will not leave room but if they have to for a scan, they have to wear mask and everyone must leave the elevator *ex: if pt was not considered neutropenic then they could go into playroom

What is a bleeding disorder characterized by increased destruction of platelets in spleen from inappropriate autoimmune response?

Immune Throbocytopenia Purpura (ITP) *cause is unknown and ursually follows infectious illness

Pts w sickle cell anemia may need frequent transfusions, what does this increase the risk of?

Iron overload *may need iron-chelating drug like Exjade or Desferel

Who is at highest risk for anemia?

Infants and adolescents

Why is it important to frequently feed infants?

Infants have smaller stomach capacities (20ml) and increased intestinal motility

To decrease risk of infiltration bc chemo is caustic to veins the pt may have an infusaport, PICC line, broviac, etc. What does this increase the pts risk for?

Infection *make sure lines are maintained and dressing changes are sterile

What is the term for a method of med delivery in which the drug is introduced into the spinal canal *ex: lumbar puncture

Intrathecal

What is important to educate to pt and families before starting chemotherapy?

Kills normal and cancerous cells

What surgery may be performed for pts w pyloric stenosis? What post op care is important for nurse to perform?

Laparoscopic pyloromyotomy -start fluids slowly -bowel assessment -pain management -monitor for infection *most go home 24-48 hr post op

What is cancer of WBC where they are growing out of control producing lot of immature WBC, so not effective in fighting off infection? The bone marrow will be full of cells causing complaints long bone pain.

Leukemia *2 types=differ based on mutation in lymphoid or myeloid cell

What treatment is done for pts w ruptured appendix?

May have immediate surgery /OR/ may treat w ATB and postpone surgery *may have to insert drain

Where is the pain the most intense for pt w Acute Appendicitis?

McBurney's point?

Pts undergoing chemo may not have a noticeable immune response to infection from not having enough WBC to start a response. Because of this, what important nursing interventions might be indicated?

Monitor pt closely, the physician may order a prophylactic ATB to decrease risk of infection

What approach is taken for child w cleft lip/palate?

Multidisciplinary approach: -pediatrician -surgeon -speech -dentist -social

What is the cause of cleft lip/palate?

Multifactorial! -genetic (family hx) -environmental (smoking, alcohol use, anticonvulsant use, steroid use, folate deficiency)

What is described as a decrease production of blood cells in the bone marrow

Myelosuppression

What is a pH probe?

NG tube w/ probe placed right above stomach for pH levels for GER diagnosis

What term describes the lowest point in a lab value or serum blood titer

Nadir

What surgery wraps around top of somach to prevent reflux?

Nissen Fundoplication *severe cases of GERD

What treatment might be done for pt if they have severe case of GERD?

Nissen Fundoplication surgery to wrap around top of stomach to prevent reflux

What term describes a gene involved in normal cell growth that was mutated, causing the growth of cancer cells. *can be inherited or caused by exposure to substances in the environment that cause cancer

Oncogenes *Oncogenic is a cancer type cell

What else should the nurse be concerned about if pt has cleft lip/palate and why?

Other congenital anomaly b/c same time as formation of other major organ systems *1st trimester

What is Acute Chest Syndrome and what does is cause? *r/t sickle cell anemia

Pulmonary infiltrates and infection resulting in: -fever -chest pain -tachypnea -cough -wheezing *may be life threatening

What happens in sickle cell anemia to the blood cells?

Partial or complete replacement of normal hgb w/ hgb s in RBC

Pt w cancer reports increased sensitivity to smell causing lots of nausea? Other than antiemetic, what could the nurse give to decrease nausea

Peppermint oil *place in room on cotton ball to help w changes in smell and increased nausea

What is the hypertrophic obstruction from narrowing of passage between stomach and small intestine?

Pyloric stenosis *recognized pretty early in life between 2-8 weeks after birth

Where most likely would a child report pain w Acute Appendicitis?

Periumbilical pain move to RLQ as inflammation worsens *Start at umbilicus then move down to RLQ *most intense at McBurney's point

What information should be taught to parents of a child w GER on proper positioning when eating?

Position fully upright for at least 30 mins *not semi fowlers or infant car seat

What age group is it important to explain that their cancer is not a punishment and not their fault?

Preschool

As the obstruction from inflammation and edema increases w pyloric acid, what clinical manifestation will occur?

Projectile vomiting

What are clinical manigestations of Von Willebrand disease?

Prolonged and excessive mucocutaneous bleeding -easy bruising -recurrent epistaxis (nosebleeds) -increased bleeding ex: surgery and dental extractions -menorrhagia (heavy menstraul bleeding in adolescent females)

What term describes cancers that appear after the primary cancer in treatment but are of a different histologic type *most commonly solid tumors

Secondary cancers

Parents are concerned that their child has a cognitive issue bc they suddenly started wetting the bed every night after their grandmas funeral. What might be the cause of this?

Regression can occur as a result of loss *normal

Sickle cells return to normal shape when rehydrated and reoxygenated, however how is the body still negatively affected?

Sickle cells are more fragile and have shortened lifespan leading to chronic hemolytic anemia

What is vaso-occlusive crisis (acute pain crisis) and what occurs? *r/t sickle cell anemia

Sickle cells cause occlusion resulting in: -pain -tissue engorgement -painful swelling of hands and feet -priaprim (prolonged erection) -severe abd pain *depend what area of body is affected

Why is it important to get baseline assessment of development level and continue to monitor? What ages are we going to monitor even closer?

Some treatments and forms of cancer can have an affect on cognition and development. Pts 6 and under will monitor closest

What important feeding adaptations should nurse do for pt post op after laparoscopic pyloromyotomy for pyloric stenosis?

Start fluids slowly by starting w glucose ater, then 1/2 strength formula/breast milk, them full regular diet

What is the only known cure to sickle cell anemia?

Stem Cell Transplant *not widely used; used for pts w severe complications *need HLA compatible match--best w/ siblings *can have complications post transplant

What is the purpose of an infusaport and how does the nurse access it?

Sterile procedure bc accessing central vein to get chemotherapy or lab draws so don't have to poke as much. Use emla cream or numbing spray over site and wait 45 mins to an hr special needle stabilize

Infants are deficient in digestive enzymes until how old?

Sufficient quantities by 4-6 mos *wait to introduce foods

The nurse should be monitoring for tumor lysis syndrome, a complication from cancer treatment. Why/how does this occur for pt w/ tumor? *monitor and report s/s like: N/V, diarrhea, muscle cramps/ twitches, weakness and fatigue, paresthesia, irregular heart rate, confusion, restlessness, irritability, delirium, hallucinations,seizures

Treatment w/ chemo and radiation will break down tumor, which will put out lots of potassium and other electrolytes and substances into bloodstream. Can occur if cancer cells break down too quickly in the body releasing their contents in to the blood faster than the kidneys can remove them.

When might children start to present w/ signs of sickle cell anemia?

Usually asymptomatic until after 4-6 mos of life b/c higher levels of fetal hgb

What should be included in diet to increase absorption of iron to help correct decreased RBC's in anemia?

Vitamin C increases absorption ex: oranges, tomatoes, berries, kiwi

What do infants need right afater birth r/t lower clotting factor?

Vitamin K

What is the most common hereditary bleeding disorder?

Von Willebrand disease

What is a pt deficient in w Von Willebrand disease?

Von Willebrand factor (vWF)

Why are children w/ leukemia at an increased risk for infection?

WBC are reproducing so rapidly in the bone marrow that they aren't effective b/c they are immature *immature WBC= bands

What are the most common signs and symptoms of leukemia related to bone marrow involvement? a) Petechiae, infection, fatigue b) Headache, papilledema, irritability c) Muscle wasting, weight loss, fatigue e) Decreased intracranial pressure, psychosis, confusion

a) Petechiae, infection, fatigue *Petechiae occur from a lowered platelet count, infection occurs from the depressed number of effective WBC, and fatigue occurs from the anemia.

Which assessment finding is of greatest concern in a child who has sickle cell anemia and of experiencing sickle cell pain crisis a) oxygen saturation of 91% b) hgb 8.2 c) hct 30% d) platelet 205,000

a) oxygen saturation of 91%

In taking care of a pediatric oncology patient, which diagnostic finding would indicate a critical concern for the development of infection? a) Absolute neutrophil count of 250 b) Temp of 99.2F c) WBC 7,000 d) Platelet count 100,000

a) Absolute neutrophil count of 250 *An absolute neutrophil count of < 500 is considered severe nuetropenic and iis a critical concern bc it indicates the potential for overwhelming infection *WBC normal range 5,000-10,000

A child with lymphoma is receiving extensive radiotherapy. What is the most common side effect of this treatment? a) Fatigue b)Seizures c) Neuropathy d) Lymphadenopathy

a) Fatigue *For children may be distressing because they can't keep up with their peers

In performing a work up for a school aged child who reports frequent abdominal pain symptoms, what info would be critical to collect in order to make an accurate clinical diagnosis? a) Find out the duration, onset and quality characteristics of the symptoms b) Ask the child's parents for detailed information c) Find out if the child has any food allergies or food intolerances d) Take and document VS to establish a clinical baseline

a) Find out the duration, onset and quality characteristics of the symptoms. *School-age children typically relate recurrent abd pain so it is critical to obtain these factors *Asking the parents' for detailed information may be needed but not at present to determine what type of pain the child is experiencing. *it is important to note food allergies and food intolerance, but the primary concern is abd pain presentation *VS should be recorded but it is not the most important piece of data that must be collected

What is the most appropriate action to stop an occasional episode of epistaxis (nosebleed) from von willlebrand disease? a) Have the child sit up and lean forward. b) Apply ice under the nose and above the lip. c) Have the child lie down quietly with the feet elevated. d) Apply continuous pressure to the nose with the thumb and forefinger for at least 1 minute.

a) Have the child sit up and lean forward *used to prevent the child from aspirating blood. Pressure, not ice, is indicated. Continuous pressure for 10 minutes is recommended; 1 minute would not be long enough. *Lying the child down with the feet elevated can potentially lead to aspiration.

The potential effects of chronic illness or disability on a child's development vary at different ages. What is a threat to a toddler's normal development? a) Hindered mobility b) Poorly defined body image c) Limited opportunities for socialization d) Limited opportunities to achieve and accomplish

a) Hindered mobility *inhibit the toddler's developing autonomy, the critical task of toddlerhood. *A child's sense of achievement and accomplishment begins to develop during the school-age years *body image, socialization, and development of peer relationships is important for adolescents

What is the most important nursing consideration when caring for a child with sickle cell anemia? a) Teach the parents and child how to minimize crises b) Refer the parents and child for genetic counseling c) Help the child and family to adjust to a short-term disease d) Observe for complications of multiple blood transfusions

a) Teach the parents and child how to minimize crises *including preventing infections, maintaining adequate hydration; and avoidance of extreme cold. *Genetic counseling is important, but teaching care for the child is a priority *Sickle cell anemia is a long-term, chronic illness *Multiple blood transfusions are an option for some children with sickle cell disease. The priority is that the child and the parents are properly prepared to manage the chronic disease.

Nurse is caring for a child receiving chemotherapy. The nurse should be aware that the child may experience which of the following side effects? (select all that apply) a) anemia b) weight gain c) polycythemia d) mucositis e) leukocytosis f) thrombocytopenia

a) anemia d) mucositis f) thrombocytopenia

A pt undergoing chemo treatment is refusing to eat despite providing the child's "favorite foods" and allowing for alternate feeding patterns independent of meal time. What etiological theories might account for the child's loss of desire to eat? (select all apply) a) anticipates that they will have N/V as part of the treatment sequence b) refusing to eat in an attempt to gain control over their surroundings c) The "correct" food has just not been found and more food selections should be offered d) experiencing symptoms of depression. e) refusing to eat because his/her parents did not make the food.

a) anticipates that they will have N/V as part of the treatment sequence b) refusing to eat in an attempt to gain control over their surroundings d) experiencing symptoms of depression. *even in the context of being offered "favorite foods," the child may not want to eat. *anorexia and refusal include possible depression, attempts at control, a conditioned response reflecting aversion during treatment and/or stress.

The parent of a 3 yr old cold asks the nurse for suggestions on how to decrease their child's constipation. Which of the following would be the best response by the nurse? a) be sure to increase the amount of fluid that your child drinks each day b) be sure to add fresh fruits and veggies, such as ba as and grapes to your child's diet c) decrease the amount of whole grains in your child's diet d) increased the amount of milk the cold drinks each day

a) be sure to increase the amount of fluid that your child drinks each day *bananas can bind a child up and cause constipation

Which of the following are clinical manifestations of pyloric stenosis? (select all apply) a) blood tinged emesis b) metabolic acidosis c) poor weight gain d) decreased appetite e) irritable f) dehydration g) more frequent stools

a) blood tinged emesis c) poor weight gain e) irritable f) dehydration *small regurgitation, projectile vomiting, nonbilious emesis, may be blood tinged, hungry after emesis, poor weight gain, irritable, fewer smaller stools, dehydration, metabolic alkalosis, peristalic wave, mass RUQ

Which should be included in discharge teaching of newborn w severe cleft lip and palate? (select all apply) a) burp frequently while eating b) elevate head and chest while feeding c) expect weight gain of 4-5 ounces per week d) ignore occasional vomiting

a) burp frequently while eating b) elevate head and chest while feeding *normal weight gain is 5-7 oz

A 4-year-old's concept of death is that a) death is temporary b) death is permanent c) death is personified in various forms d) death is inevitable at some age

a) death is temporary *The concept that death is permanent by 6 yrs and the inevitability of death is more representative of the understanding of 9-10 yrs old

Which of the following scenarios would the nurse have to intervene for parent's helping feed their child GERD? (select all apply) a) feeding child on lap in bed in semi-fowlers position b) thickening formula w rice cereal c) providing smaller, more frequent feedings d) feeding child in infant car seat e) positioning fully upright while feeding oranges f) keep child sitting upright for 30 mins after

a) feeding child on lap in bed in semi-fowlers position d) feeding child in infant car seat e) positioning fully upright while feeding oranges *no semi fowlers position, no infant car seat, and no citrus foods

Which of the following nursing interventions is the most appropriate when working with the school age child who has a terminal illness? a) give factual explanations of the disease, medication, and procedures b) perform all care for the child c) tell the child that everything will be ok d) reinforce that being in the hospital is not a punishment for any thoughts or actions

a) give factual explanations of the disease, medication, and procedures *d is referring to preschool age children

Which of the following age group's understanding of death is: not actually aware of death, sense emotion and separation of caregiver, can feel loss if they are close but can't conceptualize it a) infant b) toddler c) preschool d) school age e) adolescent

a) infant

The nurse is teaching the family of a child w sickle cell anemia about triggers that may cause a pain crisis. Which of the following would be included in teaching? (Select al apply) a) infection b) overhydration c) hot humid day d) stress at school e) being outside on a cold winter day

a) infection c) hot humid day d) stress at school e) being outside on a cold winter day

Nursing considerations related to the administration of chemotherapeutic drugs include a) many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. b) good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary. c) infiltration will not occur, unless superficial veins are used for the intravenous infusion. d) anaphylaxis can't occur, because the drugs are considered toxic to normal cells

a) many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. *Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward *Infiltration and extravasations are always a risk, esp w/peripheral veins *Anaphylaxis is a possibility

When performing a PA what clinical manifestations would concern the nurse that the pt might have cancer? (Select all apply) a) neuro symptoms like ataxia and confusion b) anemia and weakness c) increased appetite and weight gain d) bruising and petechiae e) increased WBC and immune response f) long bone pain

a) neuro symptoms like ataxia and confusion b) anemia and weakness d) bruising and petechiae f) long bone pain

When performing diagnostic tests for pt w suspected pyloric stenosis, what would be a pertinent positive? (select all apply) a) pH 7.47 b) Elevated BUN and creatinine c) pH 7.33 d) Olive-sized mass in RLQ e) Hypochloremia and hypokalemia

a) pH 7.47 b) Elevated BUN and creatinine e) Hypochloremia and hypokalemia *metabolic alkalosis, mass in RUQ, dehydration, and electrolyte imbalances

A nurse is caring for a 5 yr old who has terminal cancer. Which of the following statements are true? (Select all that apply) a) parents may be at different stages in dealing with child's death b) Child is thinking about future and knows he may not be able to participate c) dying child may become clingy and act like a toddler d) whispering in the room will help the child cope e) death of a child may have long-term disruptive affects on family f) Child doesn't fully understand the concept of death

a) parents may be at different stages in dealing with child's death c) dying child may become clingy and act like a toddler e) death of a child may have long-term disruptive affects on family f) Child doesn't fully understand the concept of death *b is describing adolescent and d is considered scary

Which of the following foods is richest in iron? a) shrimp b) baked potato w skin c) enriched pasta d) grapefruit

a) shrimp *other ex: meats, tofu, green veggies, beans, nuts, grains, dried fruit *iron, folic acid, and vitamin b12 are important for RBC production

What type of hematologic alteration is autosomal recessive a) sickle cell anemia b) leukemia c) hemophilia d) von willebrand disease e) ITP

a) sickle cell anemia

What type of hematologic alteration causes and increase in immature RBC (reticulocytes)? a) sickle cell anemia crisis b) leukemia c) hemophilia d) von willebrand disease e) ITP

a) sickle cell anemia crisis *vaso-occlusive crisis bc RBC decreasing size bone marrow responds by releasing

What would indicate that the appendix ruptured? a) sudden relief of pain b) nothing would change, need more testing c) mild to moderate abd pain d) severe abd pain

a) sudden relief of pain

What environmental factors might cause cleft lip/palate? (select all that apply) a) taking anticonvulsant b) smoking c) taking folic acid d) taking steroid med e) alcohol use

a) taking anticonvulsant b) smoking d) taking steroid med e) alcohol use *folic acid deficiency and family hx

An important nursing consideration when caring for a child w sickle cell anemia is which of the following? a) teach the parents and child how to avoid triggers b) refer the parents and child for genetic counseling c) help the family adjust to short term diseas d) observe for complications of multiple blood transfusions

a) teach the parents and child how to avoid triggers *chronic long term disease

Which of the following observations would be most concerning to a nurse caring for a toddler w diagnosis of idiopathic thrombocytopenia purpura ? a) the child is jumping up and down on bed b) mother of child placing blankets along side of crib c) an order for acetaminophen for discomfort d) petechiae on bilateral legs

a) the child is jumping up and down on bed *petechiae is an expected finding *padding the side of the crib helps prevent injury *can give acetaminophen for discomfort—no aspirin b/c increases risk of bleeding

Which of the following treatments will be provided for pt w ruptured appendix? (select all apply) a) treat w ATB b) postpone surgery c) immediate surgery d) insert drain

a) treat w ATB b) postpone surgery c) immediate surgery d) insert drain *may have immediate surgery OR treat w ATB, insert drain, and pospone surgery

Which of the following types of sickle cell crises is caused by dehydration, temp extremes, infection, hypoxia, stress. Symptoms include pain, tissue engorgement, painful swelling of hands and feet, priapism, severe abd pain a) vaso-occlusive crisis b) splenic sequestration c) acute chest syndrome d) stroke

a) vaso-occlusive crisis

Which of the following indicate that pt has GER? (select all apply) a) vomiting b) irritable c) eat often but lose weight d) dyphagia e) sleep disturbances

a) vomiting b) frequently hungry and irritable c) eat often but lose weight *dysphagia and sleep disturbances are manifestations of GERD

What type of genetic disorder is Hemophilia A & B? a) x-linked recessive b) autosomal recessive c) autosomal dominant d) it's not a genetic disorder

a) x-linked recessive

Which of the following statements demonstrates by a mother of an 8 mos old child w/ iron-deficiency anemia demonstrates an understanding of this disorder? a) "I will mix the iron sulfate in her morning bottle of formula" b) "I will make sure to include infant cereal in her diet each day" c) "I will give the iron sulfate w/ a meal to improve absorption" d) "My baby may be prone to diarrhea due to the meds"

b) "I will make sure to include infant cereal in her diet each day" *infants should be introduced to solids by 6 mos like cereal, which is usually is fortified w iron *meals do not help w absorption; only take w meals if GI upset *iron may cause constipation

With regard to incidence of childhood cancer, which statement is accurate? a) In children there is a high incidence of cancer. b) Despite a low incidence, there is high morbidity in children under the age of 15. c) Gender does not affect incidence of childhood cancers. d) Higher incidence in found in African American children as compared to Caucasians.

b) Despite a low incidence, there is high morbidity in children under the age of 15 *A higher incidence of cancers are found in Caucasian children

Which findings would the nurse suspect to be observe during a work up for in a pediatric patient suspected of having a brain tumor? (select all apply) a) Vomiting following eating b) Headache upon arising that dissipates as the day progresses c) Decreased pulse pressure d) Abnormal neuro exam e) Negative Babinski sign

b) Headache upon arising that dissipates as the day progresses c) Decreased pulse pressure d) Abnormal neuro exam *abnormal neurological exam which includes cranial nerve abnormalities and + Babinski reflex. *Vomiting can be present but may or not be associated with nausea or feeding and is not directly correlated with a brain tumor

Which of the following groups have an increased incidence of sickle cell anemia? (select all apply) a) Caucasian b) Indian c) Asian d) African e) Mediterranean f) Middle Eastern

b) Indian d) African e) Mediterranean f) Middle Eastern

What is appropriate mouth care for a toddler with stomatosis (oral ulcer) r/t chemo? a) Lemon glycerin swabs for cleansing b) Mouthwashes with normal saline c) Mouthwashes with hydrogen peroxide d) Local anesthetic such as viscous lidocaine before meals

b) Mouthwashes with normal saline *The rinse will keep the mucosal surfaces clean *Lemon glycerin swabs can irritate eroded tissue and can decay teeth. *Hydrogen peroxide delays healing

An infant with GER is receiving several medications. A proton pump inhibitor is one of the medications the infant is receiving. Which medication(s) is/are proton pump inhibitor(s)? (select all apply) a) Ranitidine (Zantac) b) Omeprazole (Prilosec) c) Pantoprazole (Protonix) d) Ondansetron (Zofran) e) famotidine (Pepcid)

b) Omeprazole (Prilosec) c) Pantoprazole (Protonix) *PPI blocks the action of acid- producing cells. *Ranitidine and famotidine are H2 blockers which inhibits the action of histamine at the H2 receptor site in the stomach=inhibition of gastric acid secretion. *Ondansetron (Zofran) is an aniemetic used to decrease N/V

Several nurses tell their nursing supervisor that they want to be able to attend the funeral of a child for whom they had cared. They say that they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral is a) appropriate because families expect this expression of concern b) appropriate because it can assist in the resolution of personal grief c) inappropriate because it is considered unprofessional behavior on the part of the nurses d) inappropriate because it increases burnout of the nursing staff

b) appropriate because it can assist in the resolution of personal grief

What type of genetic disorder is sickle cell anemia? a) x-linked recessive b) autosomal recessive c) autosomal dominant d) it's not a genetic disorder

b) autosomal recessive *can have carriers that rarely exhibit manifestations of disease

A 4 yr old child has ingested a toxic dose of iron. The parent reports that the child vomited and complained of gastric pain an hour ago but "feels fine" now. The parent is not certain when the child ingested the iron tablets. The most appropriate recommendation by the nurse to the parent is to a) observe the child closely for 2 more hours b) bring the child to the hospital immediately c) administer activated charcoal d) administer ipecac to induce vomiting if the child does not vomit again within 1 hour

b) bring the child to the hospital immediately *for assessment and possible gastric lavage. *The period of concern for complications of iron toxicity is from 30 minutes to 6 hours. *Activated charcoal does not bind iron and is not a course of treatment for this child. *Ipecac is not recommended for poisonings.

The nurse is caring for a child dying from cancer. A physical sign that the child is approaching death is a) rapid pulse b) change in respiratory pattern c) sensation of cold although body feels hot d) loss of hearing followed by loss of other senses

b) change in respiratory pattern *may become labored w periods of apnea; pulse becomes weak and slowed; there is a sensation of heat, although the body feels cold; hearing is the last sense to go

A 9 yr old boy has several physical disabilities. His father explains to the nurse that his son concentrates on what he can do, rather than what he cannot do, and is as independent as possible. Based on the nurse's knowledge of family-centered care and various disabilities, the nurse interprets the child's behavior and father's attitude as that the a) father is experiencing denial b) child is using an adaptive coping style c) child is using a maladaptive coping style d) father is experiencing grief

b) child is using an adaptive coping style

What should the nurse NOT do when performing an abd assessment and palpates a mass? a) assess for other symptoms of cancer b) continue palpating mass to determine size of potential tumor c) report this abnormal finding to physician d) get complete pt hx

b) continue palpating mass to determine size of potential tumor *don't keep palpating mass bc could cause tumor cells to shed off and spread cancer (metastasis)

The parent of newly diagnosed child w ALL are questioning reason to do lumbar puncture. What would be the most appropriate response from nurse? (select all apply) a) determine if child has infection b) determine if there are any infiltration in the CNS c) determine if there's increased ICP d) administer intrathecal chemotherapy

b) determine if there are any infiltration in the CNS d) administer intrathecal chemotherapy

Which of the following precautions should be taken when pt has bleeding condition? a) apply minimal pressure after injection of venipuncture b) do not take rectal temp c) give injections rather than start IV d) use NSAID for pain relief

b) do not take rectal temp *avoid or minimize invasive procedures and do not give NSAIDs b/c increase risk of bleeding

Morphine 2 mg IV q 2 hrs for pain is ordered for 12 yr old who just had abd surgery. Which is most appropriate nursing action? a) ask physician for an oral pain med b) encourage use of IS every hr during day and when awake at night c) give morphine over 1 hr in syringe pump d) give morphine w Benadryl to prevent itching

b) encourage use of IS every hr during day and when awake at night *to help w lung expansion to prevent pneumonia and atelectasis

Which statement best describes the technique to feed an infant w cleft lip? a) thicken feeding and enlarge nipple opening to allow for easier delivery b) feed upright and slowly, slowing for frequent breaks c) lay the infant on his right side to prevent aspiration d) give small, frequent feedings to prevent aspiration

b) feed upright and slowly, slowing for frequent breaks

A 6 yr old pt is admitted w diagnosis of acute lymphocytic leukemia (ALL). Monitoring for which condition is nurse's higihest priority? a) pain b) infection c) anemia d) hemorrhage

b) infection *highest risk for infection r/t decreased WBC from destruction

What type of hematologic alteration causes and increase in immature WBC (bands)? a) sickle cell anemia b) leukemia c) hemophilia d) von willebrand disease e) ITP

b) leukemia

Critical safety considerations that must be included if parenteral iron injections are used as part of therapy include (select all apply) a) type and cross match. b) no massage following injection c) multiple injections are preferred over intravenous route. d) no more than 1 ml should be given via injection e) there is no need for a test dose administration if administered IV

b) no massage following injection. d) no more than 1 ml should be given via injection *Administration via injection is done into a large muscle Prefer IV over IM if more than one injection is needed *No more than 1 ml is given via injection *test dose is recommended if using IV route to high potential for allergic reaction.

Which of the following types of sickle cell crises is life threatening, caused by pooling of blood in in the spleen. Symptoms include profound anemia, hypovolemia, and shock a) vaso-occlusive crisis b) splenic sequestration c) acute chest syndrome d) stroke

b) splenic sequestration

Which of the following might cause sickling for pt w/ sickle cell anemia? a) fluid volume excess b) spo2 <93% b) partly cloudy day outside c) flu d) extrenious exercise e) stressful job

b) spo2 <93% c) flu d) extrenious exercise e) trauma *Physical or emotional stress, Illness, Trauma, Infection, Extreme temp changes, Dehydration, hypoxia, ,fever

A 4 yr child's sibling dies from SIDS and the parents are concerned bc the child showed more outward grief when their cat died than for the sibling's death. Based on the nurse's knowledge of development, the nurse explains that a) this behavior suggests maladaptive coping, and a referral is needed for counseling b) the child is not old enough to have a concept of death c) the child is not old enough to have formed a significant attachment to her sibling d) the death may be so painful and threatening that the child must deny it for now to protect her psyche

b) the child is not old enough to have a concept of death *death is permanent= 6 yrs; adult understanding=9 to 10 yrs

Which of the following age group's understanding of death is: no true understanding, they may feel sick but they can't associate the physical symptoms wi illness or death a) infant b) toddler c) preschool d) school age e) adolescent

b) toddler

The parents of a child with sickle cell anemia (SCA) are concerned about subsequent children having the disease. Which response by the nurse is most accurate? a) "SCA is not inherited." b) "All siblings will have SCA." c) "There is a 25% chance of a sibling having SCA." d) "There is a 50% chance of a sibling having SCA."

c) "There is a 25% chance of a sibling having SCA." *SCA is inherited autosomal recessive disorder

You are the nurse caring for following pts. Which pt would you assess 1st a) 12 yr old w sickle cell anemia in vaso-occlusive crisis rating pain 8/10 b) 7 yr old diagnosed w hemophilia A w right knee bleed rating his pain 4/10 on FACES scale c) 2 yr old w sickle cell anemia in vaso-occlusive crisis w RR of 46 bpm d) 3 yr old w ITP w platelet count of 50,000

c) 2 yr old w sickle cell anemia in vaso-occlusive crisis w RR of 46 bpm *Normal RR for 1 yrs: [25-40] and 3 yrs: [20-30] *tachypneic concerned w oxygenation; could be from complication acute chest syndrome

A school-age child with gastroenteritis experiencing acute diarrhea and mild dehydration is being given oral rehydration solution (ORS). The child's mother calls the clinic nurse because the child is also occasionally vomiting. What should the nurse recommend? a) Bring the child to the hospital for intravenous fluids b) Alternate giving ORS and carbonated drinks c) Continue to give ORS frequently in small amounts d) Institute a nothing by mouth (NPO) status for the child for 8 hours, and resume ORS if vomiting has subsided

c) Continue to give ORS frequently in small amounts. *Vomiting is not a contraindication to the use of ORS unless it is severe. Small, frequent intake of ORS is recommended. *NPO status is not indicated. *Carbonated drinks should not be used bc they could exacerbate fluid loss and dehydration.

The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted? a) Apply warm, moist compresses b) Apply pressure for at least 1 min c) Elevate the area above the level of the heart d) Begin passive range-of-motion unless the pain is severe

c) Elevate the area above the level of the heart *initial response should include elevation of the arm to minimize bleeding *Cold compress *Pressure is effective in small areas but would not be as effective for an extremity *ROM after the bleeding episode has resolved

Which question would the nurse utilize in order to assess family stress levels with regard to chronic disease of their 4-year-old child? a) Do you find satisfaction in your work? b) What is your educational level? c) How do you think your other children feel about their brother's condition? d) Are there any other problems that I could help you with?

c) How do you think your other children feel about their brother's condition? * Asking about "other problems" is too general of a question and may not provide the nurse with any additional information. Avoid yes or no qs

When treating nausea and vomiting as a side effect of chemotherapy and/or radiotherapy, ondansetron (Zofran) is the preferred drug of choice because? a) It has a shorter onset of action b) It can be administered via several different routes c) It does not cause extrapyramidal side effects d) It has no adverse side effects if administered appropriately

c) It does not cause extrapyramidal side effects *The ability to administer via different routes does not indicate a preferred drug choice

Which of the following types of sickle cell crises is life threatening, caused by pulmonary infiltrates and infection. Symptoms include fever, chest pain, tachypnea, cough, and wheezing. a) vaso-occlusive crisis b) splenic sequestration c) acute chest syndrome d) stroke

c) acute chest syndrome

A 4 yr old has been admitted to acute care setting w diagnosis of leukemia. Which room assignment is best for pt? a) 4 yr old w/ juvenille ITP b) 4 yr old who also has leukemia c) alone in private room d) 5 yr old post appendectomy

c) alone in private room *will eventually want pt to interact w peers and other children w disease, but want minimize contact w others bc high risk of infection from decreased WBC

What type of genetic disorder is Von Willebrand Disease? a) x-linked recessive b) autosomal recessive c) autosomal dominant d) it's not a genetic disorder

c) autosomal dominant

Nurse overhears the parent of a critically injured child who is praying at the child's bedside say "I will stop drinking and smoking". The nurse understands that the parent is in which stage of grieving process a) denial b) acceptance c) bargaining d) anger

c) bargaining

Which of the following would the nurse teach a family indicating that a child is near death? (select all apply) a) warm, pink skin b) bradypnea and dyspnea c) cheyne stokes respiration d) death rattle e) agitation or restlessness f) unconscious

c) cheyne stokes respiration d) death rattle e) agitation or restlessness f) unconscious *will have cool clammy skin, tachypnea and dyspnea, grunting or moaning, loss of sensory functions

A child has frequent nose bleeds w/out warning producing varying amount of blood. Inspection of the nose area reveals irritated mucosa but no evidence of picking or trauma. The child has no hx of allergic rhinitis or upper respiratory infections. Denies taking any medication, either prescribed or over the counter. Based on this information the nurse would: a) maintain wait full management as most nose bleeds originate from anterior portion of nose. b) suggest that the patient use humidification to prevent dryness of nasal passages. c) consider referral to ENT for evaluation for other comorbidities. d) increase fluid content to maintain humidification as this may be due to environmental dryness.

c) consider referral to ENT for evaluation for other comorbidities. *alerts the nurse that there may be other underlying comorbidities such as leukemia, thrombocytopenia, and clotting factor deficiencies like Von Willebrand Disease

Parents of a 10 yr old with in operable brain tumor insist that the child not be informed of his condition. Parents are reluctant to tell a child he's dying due to: a) fear b) anger c) denial d) shock

c) denial *could also be a)fear bc afraid of scaring child

What information should be included for parents administering iron sulfate for infant w iron defieceny anemia? (Select all apply) a) causes diarrhea b) give orange juice, mangos, or strawberries to help w absorption c) don't mix w formula d) give in corner of mouth w syringe e) report dark black tarry or green stools

c) don't mix w formula d) give in corner of mouth w syringe *causes constipstion so increase fluids, fiber, and mobility. Fiber includes fiber, cereal, apples, prunes. Avoid bananas bc binding *vitamin c helps w absorption but under 2-3 yrs shouldn't have strawberries bc allergies *dark stools is expected *can take w food if N/V

Which one is the best ways to assess that the GI system is working post op? a) active bowel sounds b) non-distended c) flatus d) pt denies tenderness

c) flatus or bowel movement

What type of hematologic alteration commonly manifests w bleeding into the joints? a) sickle cell anemia b) leukemia c) hemophilia d) von willebrand disease e) ITP

c) hemophilia

What type of hematologic alteration is either treated w factor VIII or IX replacement a) sickle cell anemia b) leukemia c) hemophilia d) von willebrand disease e) ITP

c) hemophilia

What type of hematologic alteration is x-linked so predominantly in males a) sickle cell anemia b) leukemia c) hemophilia d) von willebrand disease e) ITP

c) hemophilia

What type of hematologic alteration is a result of clotting factor deficiency (select all apply) a) sickle cell anemia b) leukemia c) hemophilia d) von willebrand disease e) ITP

c) hemophilia d) von willebrand

Which of the following treatments will be provided for pt w uncomplicated appendicitis? a) treat w ATB b) postpone surgery c) immediate surgery d) insert drain

c) immediate surgery

A pediatric pt has been diagnosed with leukemia and presents w WBC count of 80,000. In teaching a group of nursing students about the disease process, how would the nursing instructor describe the proliferation of WBC and their ability to fight off infection? a) increase in WBC provides protection against viral infections but not bacterial infections. b) Although the WBC count is elevated, there are limited band cells which leads to an increased likelihood that the patient will develop an infection. c) There is an increase in immature cells which reduce the body's ability to fight off infection. d) Although the WBC count is elevated, they are overwhelmed with mature cells that predispose the individual to develop an infection.

c) increase in immature cells which reduce the body's ability to fight off infection *In leukemia, WBC count is elevated with an increase in band or immature cells which limit the functional ability of WBCs being able to fight off infection.

A child with sickle cell anemia develops severe chest pain, fever, a cough, and dyspnea. The nurse's 1st action is to a) administer 100% oxygen to relieve hypoxia. b) administer pain medication to relieve symptoms. c) notify practitioner because chest syndrome is suspected. d) notify practitioner because child may be having a stroke.

c) notify practitioner because chest syndrome is suspected * must notify the practitioner immediately *Breathing 100% oxygen to relieve hypoxia may be ordered by the practitioner, but the 1st action is notify bc these symptoms indicate a medical emergency * Pain meds may be indicated, but eval is necessary 1st

When should nurse contact physician when caring for post op pt who had GI surgery and returned to unit 5 hrs ago? a) has not voided b) has small amount of redness along entire incision c) only has oral pain meds ordered d) oral temp 98.6 F (37 C)

c) only has oral pain meds ordered

A young pediatric oncology patient has stomatitis. Which intervention if observed by the charge nurse would warrant immediate action? a) assigned to the patient was offering mouth care using a sponge toothbrush b) offers the patient frequent mouth rinses c) preparing to use viscous lidocaine to offer pain relief d) administers sucralfate as ordered

c) preparing to use viscous lidocaine to offer pain relief *contraindicated bc it can lead to aspiration and seizure activity

Which of the following age group's understanding of death is: Little more aware, see/feel bodies deteriorate, impacts how they view themselves, describe illness in terms of body mutilation, magical thinking, believes death is temporary and dead person will return, confuse death with being away or asleep, think they caused it or it's a punishment, some experience death w animals or pet a) infant b) toddler c) preschool d) school age e) adolescent

c) preschool

The nurse is assigned to a child w/ ALL who has a platelet count of 35,000. The nurse should implement which of the following interventions? a) all visitors should be discouraged from coming to the hospital b) isolation precautions should be started immediately c) provide a soft toothbrush for mouth care d) Monitor child's VS, including BP q 4 hrs

c) provide a soft toothbrush for mouth care *low platelet count (normal 150,000-400,000) so at increased risk for bleeding

The care of a newborn with a cleft lip and palate before surgical repair includes a) little to no sucking b) gastrostomy feedings c) providing nonnutritive and nutritive sucking d) positioning infant in near-horizontal for feeding

c) providing nonnutritive and nutritive sucking *The appropriate positioning for the infant is the upright position.

If nurse if taking care of severely neutropenic pt w ANC of 50, what new pt assignment would be the least concerning? a) pt w/ MRSA b) pt w/ cdiff c) pt going for orthopedic surgery d) pt w/ rsv

c) pt going for orthopedic surgery *as long as pt does not have an infection

What might concern a nurse for pt who has low WBC count and is in neutropenic precautions? (select all apply) a) pts parents wash hands when entering room b) pts parents don't wear mask when visiting c) pts friends bring flowers d) pts mom thoroughly cleaned, pealed and cooked apples to make applesauce e) pt has delivery for fruit basket from aunt

c) pts friends bring flowers e) pt has delivery for fruit basket from aunt *no live plants, fresh flowers, fresh raw fruits/veggies, sushi or other items that transmit infection *pts family should be performing meticulous handwashing but don't have to wear a mask if not sick

A 6 yr old girl has been receiving chemotherapy. She is also receiving TPN via a central line. Which of the following nursing diagnoses is the highest priority? a) Imbalances nutrition: less than body requirements b) risk for deficient fluid volume c) risk for infection d) activity intolerance

c) risk for infection

Which of the following are risk factors for GER? (select all apply) a) thick solid foods b) short wide esophagus c) small stomach d) prematurity e) anorexia

c) small stomach d) prematurity *also liquid diet, short narrow esophagus, obesity, neuro impairment, chronic respiratory disorders, large feedings, horizontal position

The nurse is caring for an 8-year-old child hospitalized with a chronic illness. The child has a leukemia and a parent is rooming-in. The parent insists on providing almost all of the child's care and tells the nurses how to care for the child. When planning the child's care, the primary nurse should recognize that the parent is a) controlling and demanding. b) assuming the nurse's role. c) the expert in care of the child. d) afraid to allow the nurses to function independently.

c) the expert in care of the child *philosophy of family-centered care states that the parents are the experts in the care of their child. In family-centered care, it is critical that the nurse works collaboratively w family in caring for the child *however, also this is an importnant time for child w industry so try to allow child independence and perform some care needs

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include to a) restrict oral fluids b) institute strict isolation c) use good hand washing technique d) give immunizations appropriate for age

c) use good hand washing technique *Strict isolation is not necessary *should not receive any live vaccines, bc immune system is not capable of responding appropriately to them

Why is it important to do thorough diagnostic workup before confirming cancer diagnosis

clinical manifestations are vague and could be signs of other illnesses

The nurse in planning care for the pediatric oncology patient anticipates implementing which action with regard to the administration of an antiemetic in a chemotherapy protocol? a) Providing the med as a prn basis based on patient's presenting symptoms of N/V b) Administering med via the PO following infusion of chemotherapy protocol c) Providing med with sips of water following clinical symptoms of N/V d) Administering 30- 60 mins prior to initiation of therapy

d) Administering 30- 60 mins prior to initiation of therapy *Preferred route of administration is via parenteral route especially if the anticipated risk for N/V is increased

You are working with the parents of a pediatric oncology pt who has successfully responded to therapy. The parents have questions regarding what to expect as the child continues to grow and develop throughout the life cycle. Which response would be appropriate? a) As the therapy has been successful, growth and development should proceed along a normal sequence. b) It may be a good idea to schedule your child for repeat imaging studies on a yearly basis so as to make sure that the child remains in remission. c) There may be anticipated growth and developmental delays associated with chemo treatments and they are typically self-limiting d) Genetic counseling may be something to consider as the child reaches adulthood and is considering having children his/herself if the type of cancer that the child had was inherited.

d) Genetic counseling may be something to consider as the child reaches adulthood and is considering having children *Growth and development should be monitored in accordance with recommended pediatric screening guidelines *delays are not considered to be normal and may not be self-limiting *Although imaging studies may be required at some point in time for follow up, yearly imaging studies may not be needed

Which findings are consistent with tumor lysis syndrome? a) Hypercalcemia and hyperkalemia b) Hypochloremia and hypokalemia c) Hyponatremia and hyperphosphatemia d) Hyperuricemia and hyperkalemia

d) Hyperuricemia and hyperkalemia *The hallmark characteristics of tumor lysis syndrome are: hypocalcemia, hyperuricemia, , hyperphosphatemia, and hyperkalemia.

In developing palliative care for a child with a terminal disease, the nurse would incorporate: a) Efforts to restore level of function to pre-disease status. b) Have the child hospitalized as this clinical setting is the best place to provide this type of care. c) It begins when the likelihood of impending death becomes clearly evident. d) It allows for the incorporation of a multidisciplinary approach to meet the emerging needs of the patient and family members.

d) It allows for the incorporation of a multidisciplinary approach to meet the emerging needs of the patient and family members.

A critical concept that needs to be maintained during intravenous administration of chemotherapy for a pediatric patient is? a) Positioning the patient in a semi-fowler's position. b) Not use an infusion device but rather allow for a free-flow line. c) Continue the infusion regardless if the patient develops a rash. d) Maintaining the integrity of the parenteral access line.

d) Maintaining the integrity of the parenteral access line. *access line be maintained and monitored. If there is any indication that the site as infiltrated, then the infusion must be immediately stopped. *pt positioning is variable depending on pt comfort. *If pt develops a rash in response to chemo, this may be an indication of a hypersensitivity reaction so must notify of HC provider and discontinuing the infusion

A pediatric oncology patient has developed a nose bleed. Which testing parameter would be indicted in order to decide if medical treatment is needed? a) Chest x-ray b) CT of the nose c) Lumbar puncture d) Platelet count

d) Platelet count *increased risk for hemorrhage and bleeding r/t thrombocytopenia and as such a platelet count should be obtained

A child has a NG tube after surgery for acute appendicitis. What is the purpose of the NG tube? a) Maintain electrolyte balance b) Maintain an accurate record of output c) Prevent the spread of infection d) Prevent abd distention

d) Prevent abd distention *used to maintain gastric decompression until intestinal activity returns *may adversely affect electrolyte balance by removing stomach secretions

A child is exhibiting signs of clinical dehydration. Which laboratory value would support a diagnosis of hypertonic dehydration? a) Serum sodium level of 135 mEq/dL b) serum osmolality of 275 mOsm/L c) Calculation of loss of body fluid weight at 25 mL/kg d) Serum sodium level of 150 mEq/dL

d) Serum sodium level of 150 mEq/dL *increase in serum sodium levels in proportion to fluid loss. Normal serum sodium level ranges between 135 and 145 mEq/dL. *Normal serum osmolality is within the 270 to 300 mOsm/L. *Calculation of loss of body fluid weight in terms of moderate loss would be at 50 mL/kg with 100 mL/kg being severe

The universal 1st reaction of parents to a child's life threatening illness or death is: a) acceptance b) anger c) depression d) shock

d) Shock

The nurse suspects a child is having an adverse reaction to a blood transfusion for sickle cell anemia. What should the nurse's 1st action be? a) Notify the physician. b) Take vital signs and blood pressure and compare them with baseline values. c) Dilute infusing blood with equal amounts of normal saline. d) Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing.

d) Stop the transfusion and maintain a patent intravenous line with normal saline and new tubing. *it is essential to minimize the amount of blood that is infused into the child. The physician should be notified and VS should be assessed after the blood transfusion is stopped and NS is infusing

A child is coming to the clinic w parents for a sports physical. Upon reviewing the pts hx, there is a notation that the child has been recently treated 6 mos ago for ITP. Based on this info, the nurse would provide this recommendation? a) The child should not play any sports or participate in any physical activity while in school b) The child should take art classes rather than participate in sporting events c) The child will have to repeat blood work before any determination can be made d) The child can play non-contact sports but will have to be monitored if any bruising or bleeding should occur

d) The child can play non-contact sports but will have to be monitored if any bruising or bleeding should occur *ITP being idiopathic, it is important to protect the pt from impending trauma r/t contact. As part of normal growth and development should be able to engage in non-contact sports activities.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry black color. The nurse should explain that this is a) a symptom of iron-deficiency anemia. b) an adverse effect of the iron preparation. c) an indicator of an iron preparation overdose. d) a normally expected change due to the iron preparation.

d) a normally expected change due to the iron preparation. *An adequate dosage of iron turns the stools a tarry black color. This is considered a normal abnormal effect related to iron medication. Tarry black stools are not a sign of iron-deficiency anemia nor are they an indicator of iron preparation overdose.

The nurse knows that a definitive diagnosis of pyloric stenosis will be made by which of the following tests? a) abd x-ray b) colonoscopy c) CT scan d) abd ultrasound

d) abd ultrasound

Which of the following factors plays a significant role in the nurses ability to provide safe and effective care to terminally ill children a) knowledge of advance psychomotor skills b) understanding of the dying process c) experience with terminally ill adults d) acknowledgment of on feelings about dying and death

d) acknowledgment of on feelings about dying and death

Which of the following interventions by the nurse should have the highest priority for the family following the death of their child? a) verbalizing sorrow and sadness for the loss of their child b) discouraging the family from holding or touching their child c) asking the family to immediately leave the room so that all medical equipment can be removed d) allowing the family to be alone with her child

d) allowing the family to be alone with her child

The nurse should qs which order written by the physician treating a 10yr old boy w sick cell who was just admitted w Vaso-occlusive crisis a) morphine sulfate PCA: 1 mg/hr basal rate and 0.5 mg bolus every 10 mins b) iv fluids of D5 0.45NS at 2x maintanence rate c) oxygen at 1-2 l/min by NC to keep O2 >93% d) ambulate in hall 4x/day

d) ambulate in hall 4x/day *should be bedrest

For a mother wanting to continue breastfeeding her child w GERD, which of the following foods can she include in her diet w/out causing worsening symptoms in her child? a) chocolate b) apples c) peppermint d) grapefruit e) coffee

d) apples *no greasy, spicy, chocolate, peppermint, citrus, caffeine

The nurse is explaining blood components to an 8 yr child. Based on the nurse's knowledge of child development, the most appropriate description of platelets is that they a) help keep germs from causing infection b) make up the liquid portion of blood c) carry the oxygen you breathe from your lungs to all parts of your body d) help your body stop bleeding by forming a clot (scab) over the hurt area

d) help your body stop bleeding by forming a clot (scab) over the hurt area. *WBC help protect the body from infection. The liquid portion of blood id known as plasma. RBC are involved in O2 of tissues in the body.

Which of the following is the priority problem for pt w/ leukemia? a) pain b) nutritional deficit c) bleeding d) infection

d) infection *greatest risk for infection b/c immature WBC

Which is the best description of a neutrophil? a) make antibodies against previously "seen" substances b) secrete histamine c) help clot blood d) line blood vessels in order to defend against infection

d) line blood vessels in order to defend against infection *type of WBC that increases w/ bacterial infection *lymphocytes make antibodies, basophil release histamine, platelet help clot blood

Which of the following age group's understanding of death is: death anxiety, a lot of fear and anxiety regarding death, Understands the difference between temporary separation and death, understand death is permanent by 6yrs and adult understanding by 9-10 yrs, may not realize that death can occur at any age a) infant b) toddler c) preschool d) school age e) adolescent

d) school age

Which of the following would the nurse have to correct a student nurse explaining post op care for pt after laparoscopic pyloromyotomy for pyloric stenosis? a) providing acetaminophen for mild pain b) assessing bowel sounds and for distention c) watching for s/s of infection like fever, redness, pain, pus at site d) starting w 1/2 strength formula then full

d) starting w 1/2 strength formula then full *start w/ glucose water, then 1/2, then full

Which of the following types of sickle cell crises causes symptoms like blurry vision, vision changes, headaches, weakness, and difficulty w speech a) vaso-occlusive crisis b) splenic sequestration c) acute chest syndrome d) stroke

d) stroke

What type of hematologic alteration is hereditary autosomal dominant a) sickle cell anemia b) leukemia c) hemophilia d) von willebrand disease e) ITP

d) von willebrand

What type of hematologic alteration is manifested w mucous all bleeding like nosebleeds, mucocutaneuous tissue bleeding, and heavy periods a) sickle cell anemia b) leukemia c) hemophilia d) von willebrand disease e) ITP

d) von willebrand

What type of hematologic alteration is treated w DDAVP (Desmopressin) a) sickle cell anemia b) leukemia c) hemophilia d) von willebrand disease e) ITP

d) von willebrand

What type of hematologic alteration is treated w steroids or immunoglobulins a) sickle cell anemia b) leukemia c) hemophilia d) von willebrand disease e) ITP

e) ITP

What type of hematologic alteration has low platelet counts from immune system destruction which can result in easy brusing/exchymosis and petechiae a) sickle cel anemia b) leukemia c) hemophilia d) von willebrand disease e) ITP

e) ITP *cause is unknown

Which of the following age group's understanding of death is: and intellectually capable of understanding death, may cause developmental conflicts, adult understanding, disrupts development of identity a) infant b) toddler c) preschool d) school age e) adolescent

e) adolescent

What treatment is done for pts w uncomplicated appendicitis?

immediate surgical removal

Who is affected by hemophilia?

males

Who is affected by Von Willebrand disease?

males and females

What may be prescribed to prevent infection by stimulating WBC count?

neupogen

What should be avoided post op after cleft lip/palate repair surgery?

nipples, pacifiers, straws, and metal utensils *Don't want them to suck as much

Why do gastric contents return to esophagus in pts w/ GER?

relaxation of lower esophageal sphincter

What are common sites for infiltration of leukemia?

testicles, spinal cord, and bone marrow

Why do pts sometimes experience pain in hands from sickle cell anemia?

vasoclusion happening *hands will appear swollen