OB/PEDS (Pre-Quiz) 46 & 47

The nurse is preparing to administer IVIG to a child who has not received the medication before. What medication should the nurse expect to administer prior to the infusion?

Diphenhydramine

A nurse is preparing a presentation for a group of new parents and is planning to discuss nutrition during the first year. As part of the presentation, the nurse is planning to address foods that should be avoided to reduce the risk of possible food allergies. Which would the nurse include? (Select all that apply.)

Eggs Shrimp Peanuts

The nurse on a pediatric unit finds a child having extreme shortness of breath, a swollen tongue, and urticaria on her face and neck. The nurse notices her lunch tray to have a half-eaten peanut butter and jelly sandwich. The client is allergic to peanuts. What is the first medication the nurse should be prepared to administer?

Epinephrine

A child receiving chemotherapy is experiencing significant reduction in red blood cells secondary to myelosuppression. Which agent would the nurse most likely expect to be ordered?

Epoetin alfa

A nurse is reviewing the history and physical examination of an infant diagnosed with juvenile idiopathic arthritis. What is often the first sign of juvenile idiopathic arthritis?

Fussiness

The nurse is preparing to administer an intravenous immunoglobulin infusion. While reconstituting the product according the manufacturer's instructions, the nurse knows to take which step for proper preparation?

Gently roll the vial to mix the medication.

The nurse is administering the prescribed intravenous immunoglobulin to a 10-year-old child. What step would be most important for the nurse to do?

Have epinephrine available.

The nurse is reviewing the laboratory test results of a child with thalassemia. Which results would the nurse expect to find with the hemoglobin electrophoresis? (Select all that apply.)

Hemoglobin A2 Hemoglobin F

A group of students are reviewing the effects of sickle cell anemia on the various parts of the body. The students demonstrate a need for additional study when they identify what as an effect?

High urine specific gravity

When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect stings, the nurse integrates knowledge that this response is related to which immunoglobulin?

IgE

A child with systemic lupus erythematosus is receiving hydroxychloroquine sulfate. Which instruction would the nurse emphasize when teaching the child and parents about this drug?

Importance of yearly eye examinations

A group of nursing students are reviewing information about the immune system. The students demonstrate understanding of the information when they identify what as being produced by the thymus?

Lymphocyte T cells

The nurse is caring for a 6-year-old child with non-Hodgkin lymphoma who is being treated with monoclonal antibodies. What recommendation would the nurse include in the child's plan of care?

Monitoring for allergic reactions or anaphylaxis

An infant born to a mother who was HIV positive was tested at birth and found to be negative. The infant is scheduled for follow-up testing. Which test would the nurse expect to be performed?

Polymerase chain reaction (PCR) test

The nurse is caring for a 5-year-old child who will soon die of cancer and is experiencing dyspnea and increasing levels of pain. What would be the priority for pain management with this child?

Preventing and alleviating pain

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority?

Risk for infection

The nurse is caring for a 3-year-old child with suspected iron-deficiency anemia. Which test would the nurse expect to be ordered to confirm the diagnosis?

Serum ferritin

The nurse is assessing an adolescent with suspected osteosarcoma. What would the nurse be least likely to assess?

Severe bone pain

The nurse is caring for a 17-year-old adolescent in the terminal phase of osteosarcoma. Which action demonstrates integration of the recommendations of the American Academy of Pediatrics (AAP) Committee on Bioethics?

Telling the adolescent exactly what to expect of further treatments

The nurse is administering IVIG. Which assessment findings would indicate a potential anaphylaxis? (Select all that apply.)

The client appears increasingly nervous. The client's temperature is elevated one degree higher than it was prior to the administration of the IVIG. There are inspiratory wheezes heard with auscultation of the lung fields.

The nurse is preparing a care plan for a 3-year-old client diagnosed with severe combined immune deficiency. What is the primary goal for this client?

The client will remain free from infection.

A 6-month-old infant has been admitted to the hospital with severe bloody diarrhea. The nurse notes petechiae and eczema with signs of secondary infection. As the nurse documents the infant's history, the parents report easy bruising and prolonged bleeding after circumcision. Based on these findings, the nurse suspects a diagnosis of:

Wiskott--Aldrich syndrome.

A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer?

bladder

A 10-year-old child who is receiving therapy has received ondansetron before this therapy session. About an hour later, the child tells the nurse that his mouth feels really dry. The child has urinated several times and his skin turgor is normal. Which response by the nurse would be most appropriate?

"The drug you got to help with the nausea can cause dry mouth."

The nurse is providing family education about the administration of cyclosporine A. Which response by the family indicates a need for further teaching?

"The medication is best absorbed with the vitamin C in citrus juices."

The nurse is teaching the parents of a 4-year-old child with a peanut allergy about diet and possible unexpected locations of peanuts or peanut oil in food products. After describing this to the parents, which response by the parent would indicate a need for further teaching?

"We can't go wrong with hamburgers and hot dogs."

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state:

"We should administer the drug on an empty stomach."

The nurse is providing family education for the prevention or early recognition of vaso-occlusive events in sickle cell anemia. Which response by a family member indicates a need for further teaching?

"We should call the healthcare provider for any fever over 100°F (37.8°C)."

A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include?

"We'll need to have a match to a donor."

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

8 mcg/dL

The nursing instructor has completed a presentation on normal immune function. Which statement by a student would suggest a need for further education?

"Humoral immunity is generally functional at birth."

The parents of a newborn have asked the nurse questions about immunizations. Which comments by the parents demonstrate knowledge of immunizations after speaking with the nurse? (Select all that apply.)

"Immunizations may be killed or modified organisms." "Many vaccines are given in the form of an injection." "Immunizations prevent some types of bacterial infections."

The nurse is teaching the parents of a 4-year-old child with thalassemia about sound nutritional choices. The nurse asks the parent about good snack choices to send to preschool. Which response by the parent would indicate a need for further teaching?

"My child can bring graham crackers and peanut butter."

After teaching the parents of a child diagnosed with pernicious anemia about the disorder and treatment, the nurse determines that the teaching was successful when the parents state:

"Our child will need to have those vitamin shots for life."

The nurse is caring for a 2-year-old child with sickle cell anemia and describing the acute and chronic manifestations of sickle cell anemia to the parent. Which statement by the parent indicates a need for further teaching?

"The acute manifestations, like splenic sequestration, are most often life-threatening."

Nurses who will be working on the pediatric unit are attending an in-service program about sickle cell disease. During the program, the nurse manager describes the steps for managing sickle cell pain. Place these steps in the sequence in which the nurse manager would describe them.

1) Assess the pain. 2) Believe the child's report of pain. 3) Look for complications or cause of pain. 4) Give medications and use distraction. 5) Provide rest in a quiet area. 6) Administer fluids.

The nurse is observing a child demonstrate the use of an Epipen. The nurse determines that the child has performed the procedure correctly. Place the steps in the proper sequence that was demonstrated by the child.

1) Grasps Epipen with black tip pointing downward 2) Forms a fist around the Epipen 3) Pulls off the gray safety release 4) Jabs the Epipen firmly into the outer thigh at a 90-degree angle 5) Holds Epipen in place for 10 seconds 6) Massages site for 10 seconds after removing Epipen

A group of nursing students are reviewing the process of blood cell formation. The students demonstrate understanding of this process when they place the formation events in their proper sequence. What is the proper sequence?

1) Multipotent stem cell 2) Myeloid progenitor 3) Megakaryocyte/erythroid progenitor 4) Megakaryocyte 5) Platelets

The nurse is reviewing the results of a clotting study for a healthy 6-year-old child. What would the nurse document as a normal prothrombin finding?

11.0 to 13.0 seconds

The nurse is caring for a child in sickle cell crisis. To best promote hemodilution, the nurse would expect to administer how much fluid per day intravenously or orally?

150 mL/kg of fluids

The nurse is reviewing the medical history of a 4-year-old child. What would the nurse identify as potentially indicative of a primary immunodeficiency? (Select all that apply.)

Acute otitis media, one episode every 3 to 4 weeks over the past year. Recurrent deep abscess of the thigh Oral thrush, persistent over the past 6 to 7 months

The nurse is caring for a 6-year-old child with an abdominal neuroblastoma prior to having a magnetic resonance imaging (MRI) scan without contrast done. Which intervention would the nurse expect to perform?

Administering a sedative as ordered to keep the child still

The nurse is caring for 9-year-old child undergoing chemotherapy whose complete blood count (CBC) with differential reports 7% banded and 13% segmented neutrophils with a white blood cell count of 2,540. The child has an oral temperature of 38.6°C. Which intervention would be the priority?

Administering prescribed broad-spectrum IV antibiotics

The nurse is reviewing the results of a rheumatoid factor test of several clients diagnosed with juvenile idiopathic arthritis. Which client would be most likely to demonstrate a positive rheumatoid factor?

Adolescent with polyarticular disease

What would the nurse expect to be ordered for a child with acute lymphoblastic leukemia who develops tumor lysis syndrome?

Allopurinol

A group of students are reviewing the different classes of drugs used for cancer chemotherapy. The students demonstrate understanding of these agents when they identify what as cell cycle-specific agents?

Antimetabolites

A nurse is preparing a teaching plan for a child with hemophilia and parents. Which would the nurse be least likely to include to manage a bleeding episode?

Apply heat to the site of bleeding.

The nurse is caring for a child who is beginning to show signs and symptoms of anaphylaxis. Which intervention would be the priority?

Assessing patency of the airway

The nurse is caring for a 2-year-old child who is receiving chemotherapy using antitumor antibiotics. Which intervention would the nurse question?

Assessing the mouth for redness, lesions, or ulcers

A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care?

Avoiding further abdominal palpation

The nurse is caring for a 10-year-old child with hemophilia. The child asks the nurse for suggestions about appropriate physical activities. Which activity would the nurse most likely recommend?

Basaeball

The nurse is caring for a 10-year-old child with iron toxicity. What would the nurse expect the healthcare provider to order?

Deferasirox

The nurse is assessing an 11-year-old child diagnosed with acute myelogenous leukemia (AML) who came to the emergency department. What would alert the nurse to the need for immediate intervention?

CBC indicates hyperleukocytosis.

The nurse is preparing a discharge teaching plan for the parents of an 8-year-old child with leukemia. Which instruction would be the priority?

Calling the healthcare provider if the child gets a sore throat

A child is diagnosed with a latex allergy. When developing the teaching plan for this child, the nurse would include what foods to avoid? (Select all that apply.)

Cherries Bananas Pineapples

The nurse is assessing a 10-year-old child with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system?

Child report facial palsy and vision problems

A child is diagnosed with severe combined immunodeficiency syndrome. What would the nurse expect to find when reviewing the child's history and physical examination?

Chronic diarrhea

The nurse is caring for a child with systemic lupus erythematosus. The healthcare provider will most likely order which test to monitor the child's progress?

Complement assay (C3 and C4)

The nurse is caring for a 4-year-old child with HIV. The child is taking nucleoside analogue reverse transcriptase inhibitors (NRTI) as part of a three-drug regimen. The nurse knows to monitor for signs of a fatal hypersensitivity reaction that can occur with:

abacavir

A nurse is preparing a presentation for a parent group on childhood cancers. As part of the presentation, the nurse plans to discuss rhabdomyosarcoma. What are some common sites where rhabdomyosarcoma occurs? (Select all that apply.)

head extremities neck

A nurse is assessing a child with cancer and suspects that the child has developed sepsis based on what findings? (Select all that apply.)

hyperkalemia increased blood urea nitrogen (BUN) absolute neutrophil count (ANC) less than 500

The nurse is providing care to a child and is to collect a 24-hour urine specimen for catecholamines. The nurse integrates knowledge of this testing as indicative of:

neuroblastoma.

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as:

petechiae

The nurse is administering meperidine as ordered for pain management for a 10-year-old child in sickle cell crisis. The nurse would be alert for:

seizures

A 10-month-old infant has been admitted to the hospital with severe hemolytic anemia and chronic hypoxia. The nurse notes icteral sclerae, jaundice of the skin, and frontal and maxillary bossing. The nurse interprets these findings as most likely indicating:

β-Thalassemia major.