Pediatrics: Hematology/oncology questions
A 12-year-old patient presents with ataxia and poor coordination. A head CT reveals a tumor in the posterior fossa. Which action is priority for this patient?
Assess for signs of high ICP
Which statement, made by an infant's parent, would indicate the infant is at risk for having inherited sickle cell anemia?
"my mother had sickle cell disease", "I have cousins with sickle cell disease", "My husband and I are both carries of the trait."
The parents of a 3-year-old patient who is undergoing radiation therapy ask the nurse why radiation is necessary. What is the best response from the nurse?
"to eliminate cancer cells." , "to promote bone marrow suppression.", "to prevent further growth of the cancer cells."
The nurse is completing discharge teaching of a patient who originally presented with symptoms of aplastic anemia. Which statement, made by the parents, indicates teaching was effective?
"we bought a new soft-bristle toothbrush yesterday"
The mother of a child with hemophilia calls the provider's office and states that the child was struck with a baseball during a game. Which question, by the nurse, is most appropriate?
"where on his body did he get hit with the baseball?"
The nurse is caring for a 17-year-old with single-node Hodgkin lymphoma who reports right upper quadrant pain, nausea and vomiting. The nurse notes icteric skin and sclera, and abdominal distention. Which prescription would the nurse anticipate?
Obtain serum AST and ALT levels
A child is admitted to the hospital with Non-Hodgkin lymphoma, and reports having lower abdominal pain of 6/10. The nurse notes a temperature of 102.3° F, heart rate 107 and respiratory rate 14. Which actions are most important for the nurse to take?
Obtain urine culture, obtain blood culture
On assessment of a patient with aplastic anemia, the nurse notes peripheral pulses 1+, cool extremities, and capillary refill of 4 seconds. Which actions should the nurse take?
Obtain vital signs, notify the HCP, and complete a neurologic examination
The clinic nurse wants to develop a teaching program for parents of patients at risk for developing iron deficiency anemia (IDA). Which patient does the nurse correctly identify as being at greatest risk for developing IDA?
Older homes are more likely to have lead paint and pipes. Lead exposure is a risk factor for iron deficiency and IDA
The nurse is caring for a pediatric patient with immune thrombocytopenic purpura (ITP) who is returning to the unit after a tonsillectomy. Which action by the nurse demonstrates appropriate understanding of patient safety?
Pad the bed rails
Which description represents a common disease presentation for a child with aplastic anemia?
Pallor and fatigue
Which physical assessment findings indicate a patient may have decreased hemoglobin?
Pallor, tachycardia, and decreased LOC
A child feels stiffness, tingling and aches in the knee joints and has a tendency toward prolonged bleeding. Which test is the healthcare provider most likely to prescribe? Bleeding time Tourniquet test Clot retraction time Partial thromboplastin time
Partial thromboplastin time The symptoms hint that the child may be suffering from hemophilia. In hemophilia, factor VIII, an intrinsic clotting factor, is deficient. Partial thromboplastin time measures the activity of thromboplastin, which depends on intrinsic clotting factors. The partial thromboplastin time is increased in hemophilia. Bleeding time reflects platelet function, which is normal in hemophilia. The tourniquet test measures platelet function and capillary fragility, which are normal in hemophilia. The clot retraction test measures the degree to which a clot shrinks, and it is usually normal in hemophilia.
Which presentation is a nurse most likely to see in a patient with chronic immune thrombocytopenic purpura (ITP)?
Petechial rash, bleeding gums
The nurse is caring for a child receiving chemotherapy and notes bruising on the arms and legs. Which test will help identify the cause for bruising?
Platelet levels
The nurse receives an intershift report on four assigned patients with iron deficiency anemia (IDA). After a review of each patient's history, combined with the shift report information, which patient should the nurse see first?
Premature infants and those with gastrointestinal impairment are at increased risk for IDA due to the prevalence of immature red blood cells and the inability to absorb iron. Pallor indicates inadequate perfusion and must be further assessed and treated.
two-year-old child presents with fever, night sweats, splenomegaly, and blood studies indicating presence of Reed-Sternberg cells. Which action is a priority for the nurse to take?
Prepare child for bone marrow aspiration
A four-year-old child comes to the Emergency Department with his mother, who states that the child is just not feeling himself. The child has been irritable and often seems out of breath. A urinalysis shows evidence of uric acid crystals. Which action should the nurse do first?
Prepare child for chest x-ray to look for mediastinal disease and tracheal deviation.
The nurse notes the vital signs of a patient with sickle cell anemia (SCA) after splenectomy to be as follows: heart rate, 122; respiratory rate, 24; blood pressure, 80/48; and temperature of 100.3° F. The patient appears drowsy but is easy to arouse. Based on this assessment, which initial action should the nurse take?
Prepare for an IV line
The nurse is caring for a child with Non-Hodgkin's Lymphoma who presents in a tripod position, is diaphoretic, and has shortness of breath. The nurse notes a left-sided tracheal deviation, diminished lung sounds on the right side, and SpO2 of 84 percent. Which action is most important for the nurse to take?
Prepare for intubation
The pediatric nurse is caring for a patient with beta-thalassemia who has been transferred to the unit for treatment. Before admission, the patient was experiencing complications of the disorder. Which action should the nurse take in initiating the treatment process?
Prepare patient for possible blood transfusion, if ordered.
A 24-hour urine collection done on a two-year old patient shows elevation of both homovanillic (HVA) and vanillylmandelic (HMA) acid. Which order from the provider would the nurse anticipate next?
Prepare the patient for biopsy
The emergency department nurse triages several patients with Von Willebrand disease (vWD). Which patient should the nurse see first?
The child with a headache after rolling of the couch who is lethargic
The nurse receives a report from the day shift on the assigned children with hemophilia. Which patient should the nurse see first?
The child with a right arm fracture and a factor activity level of 48%
The nurse is preparing a 3-year-old patient for a positron emission tomography (PET) scan to diagnose a neck mass. The child's caregiver asks what will be done to prevent potential discomfort and restlessness of the child during the procedure. What should the nurse respond?
"Your child will be sedated prior to the procedure"
The mother of a child who was recently diagnosed with retinoblastoma asks if it is possible to delay treatment until the child is out of school for the summer. Which is the appropriate response by the nurse?
"Delaying treatment may lead to extraocular manifestations and worse prognosis"
The nurse is educating a parent of a child newly diagnosed with sickle cell anemia. Which statements, made by the parent, indicate teaching was effective?
"I keep bottles of water with me whenever we go out.", "I made an appointment for the year 4 immunizations", "I will call the HCP as soon as I notice any cough or fever", and "we only play in the snow for about 20 minutes at a time."
The nurse suspects that a female adolescent patient has iron deficiency anemia because she complains of weakness, palpitations, and always feeling cold. Which follow-up questions should the nurse ask?
"how heavy is your monthly period?", "what types of foods do you eat on a typical day?", and "how long have you experienced these symptoms?"
The mother of a young child diagnosed with neuroblastoma asks the nurse how this could have happened to her baby. Which is the best response from the nurse to explain the etiology of neuroblastoma?
"it could be possibly associated with ur previous work as a farmer."
A 2-year-old patient diagnosed with beta-thalassemia requires chelation therapy. The child's parents state, "So we bring her here for the needle to be placed for each treatment." Which response by the nurse is most appropriate?
" you will be taught how to prepare medications for chelation therapy."
The mother of a 10-year-old questions the nurse regarding the method of chemotherapy administration and is concerned the child will require frequent IV insertions. With which statement should the nurse respond?
"A central venous catheter may be implanted for long-term chemotherapy administration."
A parent of a breastfed infant with iron deficiency anemia (IDA) questions the need for iron supplementation. Which response by the nurse is most appropriate?
"Because the infant is growing so rapidly, his body needs extra iron."
A patient with iron deficiency anemia (IDA) is preparing for discharge from the emergency department. During discharge teaching, which statement made by the parent indicates teaching has been effective?
"Iron helps my child's body make healthy RBCs with hemoglobin.
The parents of a child with sickle cell anemia are concerned about subsequent children having the disease. Which response by the nurse is most accurate? "Sickle cell anemia is not inherited." "All siblings will have sickle cell anemia." "There is a 25% chance of a sibling having sickle cell anemia." "There is a 50% chance of a sibling having sickle cell anemia."
"There is a 25% chance of a sibling having SCA." SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, there is a 25% chance that each subsequent child will have the disorder
A concerned mother brings her 11-year-old in because of repeated nosebleeds. The nurse notes pallor and tachycardia. The child has a platelet count of 45,000/mm3 and a granulocyte count of 750 mm3. After ensuring the child is stable, which questions would be important for the nurse to ask?
"What new medications has your child recently begun taking?", "Has your child been exposed to any chemicals recently?", and "What other symptoms, such as fever or rashes, have you noticed recently?"
The nurse is caring for a child with prolonged bleeding after losing a tooth. The nurse notes bruising around the gum line. Which laboratory values would be concerning to the nurse?
2% factor VIII activity and prothrombine time 20 seconds
A child is suspected of having leukemia. What is the most definitive method for the diagnosis of leukemia? Lumbar puncture Physical assessments Peripheral blood smear Bone marrow aspirate or biopsy
A bone marrow aspirate or biopsy shows a monotonous infiltration of blast cells, which is a definitive diagnosis of leukemia. A lumbar puncture is done to collect samples to determine whether there is any central nervous system involvement. Physical manifestations are generally not severe and in most instances, physical signs and symptoms are few. A peripheral blood smear is done initially to check for immature forms of leukocytes and blood counts, but is not a definitive method.
The nurse is caring for a child with disseminated intravascular coagulation (DIC) after a surgical procedure. The nurse notes continued bleeding from the ears and intravenous (IV) site and a hemoglobin of 6.7. The child has had no urine output for the past 2 hours. After notifying the health care provider, which orders would the nurse anticipate?
Administer clotting factor, administer a normal saline fluid bolus, and transfuse packed red blood cells
The nurse is caring for a four-year-old child with leukemia who is receiving chemotherapy. The parent reports that the child has abdominal pain, nausea, and vomiting. Upon exam, the nurse notes poor skin turgor, pallor, dry mucus membranes, and poor appetite. Which action should the nurse take first?
Administer normal saline IV bolus
A child diagnosed with leukemia reports nausea, vomiting, and anorexia related to chemotherapy treatment. The nurse notes a hemoglobin count of 10, WBC count of 8, platelet count of 103,000, and an albumin level of 2.1. Which prescription would the nurse anticipate?
Administer total parenteral nutrition
The nurse is caring for a child with hepatosplenomegaly related to beta-thalassemia. Which actions should the nurse take to minimize the risks related to this disorder?
Assess for signs of bleeding, tell the patient to avoid contact sports, monitor patient for signs of abdominal trauma
What ethnic group has the highest incidence of sickle cell disease? Whites Hispanics Native Americans African Americans
African Americans African Americans have the highest incidence of sickle cell disease; Hispanics have the second-highest incidence of sickle cell disease. Native Americans and whites have lower incidences of sickle cell disease than do African Americans and Hispanics.
The nurse is caring for a 16-year-old admitted for complications of hemophilia. Which psychosocial interventions are important for the nurse to implement?
Allow friends to visit, allow the patient to express feelings, assess the patient's understanding of safety precaution, and ask the patient if he or she would like to be introduced to other patients of the same age with the same diagnosis
The mother of a 5-year-old patient reports unexplained weight loss in the child over the past month, frequent epistaxis, and persistent diarrhea. Which other findings support a possible diagnosis of cancer?
Anemia and mass in the child's neck
What is the most common hematologic disorder of infancy and childhood? Anemia Leukemia Immune thrombocytopenia Disseminated intravascular coagulation
Anemia is the most common hematologic disorder of infancy and childhood. Leukemia is a neoplastic disorder. Immune thrombocytopenia and disseminated intravascular coagulation are hematologic disorders that are less common than anemia.
A female patient with Von Willebrand disease (vWD) presents with an open leg fracture after falling at cheerleading practice. The nurse notes no other fractures, but the bleeding continues after 35 minutes. Which action should the nurse take first?
Apply a pressure dressing to the affected area
After the circumcision of a newborn male, the nurse notes prolonged bleeding. Which actions should the nurse take?
Apply gentle pressure for 10-15 minutes and notify the provider about the prolonged bleeding time
The parents of a 2-year-old report that the child has had episodes of epistaxis three times in the last week. On assessment, the nurse notes bruising across the chest and back. Which actions are important for the nurse to take?
Ask whether there is any gum bleeding when teeth are brushed, observe the parent child interaction for signs of abuse, determine length of time the bleeding lasts with each nosebleed, and while obtaining the health history, ask specifically how the bruises occurred.
The home care nurse observes that the family of a chronically ill child is depressed and often speaks about guilt and sadness. What action does the nurse take? Asks the parents to meet with support groups Tells the parents to move the child to a hospital setting Assures the family members that the child will be well soon Tells the parents that they should accept their child's condition
Asks the parents to meet with support groups The nurse uses evidence-based practice to suggest positive coping strategies to the parents, such as engaging in support groups. Moving the child to a hospital setting will not reduce sadness and guilt in parents. The nurse does not provide false assurances to the parents and provides unbiased information about the child's illness. Telling the parents that they should accept their child's condition will not help to reduce guilt.
A two-year-old child diagnosed with Hodgkin Lymphoma presents with enlarged neck lymph nodes, and an x-ray reveals widening of the mediastinum. Which action should the nurse take first?
Assess airway
child with sickle cell anemia (SCA) presents with pain and swelling in the right knee and complaints of abdominal pain. The nurse notes abdominal distention. Which action should the nurse take next?
Assess vital signs and notify the HCP. Administer IV fluids, Provide IV pain meds, encourage use of IS, and perform ROM exercise with the affected joint.
The nurse is educating the parents of a child with leukemia about necessary homecare. During the teaching session, the mother states, "We plan to let him return to baseball practice next week." Which information is most important for the nurse to include in the response?
Avoid physical exhausting activites
The parents of a seven-year-old child report swelling in the child's neck and recent fatigue. They are apprehensive about the diagnosis and ask the nurse about the progression of Hodgkin lymphoma. Which information should the nurse include in the response?
Begins in the lymph nodes
A patient with a purpuric rash and platelet count of 55,000 has just undergone a bone marrow biopsy. Which diagnostic test results would be expected from the biopsy for a diagnosis of immune thrombocytopenic purpura (ITP)?
Bone marrow results will be normal
The postoperative care of a preschool child who has had a brain tumor removed should include which action? No administration of analgesics Recording of colorless drainage as normal on the nurses' notes Placement of the child on the right side in the Trendelenburg position Close supervision of the child while he or she is regaining consciousness
Close supervision of the child while he or she is regaining consciousness The child must be observed closely, with careful and frequent assessment of the vital signs and monitoring for signs of increasing intracranial pressure. Any changes should be reported immediately to the practitioner. Colorless drainage may represent cerebrospinal fluid leaking from the incision site. This needs to be reported to the practitioner immediately. The child should not be positioned in the Trendelenburg position after surgery. Analgesics may be used for postoperative pain as needed.
The mother of a 10-month-old reports that the child has been pale, tires quickly, and sometimes has difficulty breathing. Which orders would the nurse anticipate for this patient?
Collect blood for CBC, prepare patient for insertion of an IV line, obtain vital signs, including pulse oximetry, and notify the provider of any concerning results.
A patient with sickle cell anemia presents with pallor, lethargy, headache, and a history of fainting spells. Which provider order would the nurse anticipate?
Collect blood for type and cross-matching
What treatment method has greatly improved the prognosis for children with HIV infection? Combination antibiotic therapy Combination analgesic therapy Combination antiemetic therapy Combination antiretroviral therapy
Combination antiretroviral therapy has greatly improved the prognosis for children with HIV infection. Combination antibiotic therapy is not used to treat HIV. Combination analgesic therapy has not improved the prognosis for children with HIV infection; nor has combination antiemetic therapy.
The nurse is caring for a child with hemophilia after the child fell from a bike. The child reports abdominal pain and complains of leg pain. After an initial assessment during which vital signs are noted to be within the normal range, the nurse notes bruising over the lower abdomen, abdominal distention, and hematuria. Which priority order from the provider would the nurse anticipate?
Obtain an abdominal computer tomography (CT) scan.
A 2-month-old formula-fed baby is brought in for a routine checkup. The parent of the baby tells the nurse that a friend has advised her to give fresh cow's milk to the baby instead of formula milk because it has high nutritional value. What is the nurse's best response? Fresh cow's milk is the best source of nutrition for a 2-month-old baby. The mother can start giving cow's milk to her baby at 3 months of age. Cow's milk should be avoided before 12 months of age, because it may cause sickle cell anemia. Cow's milk should be avoided before 12 months of age, because it may cause iron-deficiency anemia.
Cow's milk should be avoided before 12 months of age, because it may cause iron-deficiency anemia. It is important for a nurse to educate the parents about appropriate measures to be taken to prevent iron-deficiency anemia. Fresh cow's milk contains a heat-labile protein that can induce gastrointestinal bleeding in children younger than 12 months. It can also cause gastrointestinal mucosal damage in these children, leading to bleeding. Therefore, fresh cow's milk should not be given to children before 12 months of age, because it may cause iron-deficiency anemia due to gastrointestinal bleeding. Sickle cell anemia is not caused by cow's milk; instead it is an inherited genetic disease.
The nurse is caring for a 16-year-old child diagnosed with Hodgkin Lymphoma who reports shortness of breath, and chest pain. The nurse notes hoarseness of patient's voice when speaking. Which prescription would the nurse take first?
Obtain an emergency chest radiograph
A seven-year-old child with a brain tumor appears irritable and refuses to eat. The nurse notes that the patient is exhibiting bulging eyes. The parents report recent personality changes and a drop in grades. Which provider order would the nurse implement first to address the patient's symptoms?
Elevate head of bead
The nurse is caring for a child with Wilms tumor. The health care provider has ordered an abdominal ultrasound, IV fluid rehydration, and oral pain medication. Which action should be priority for the nurse?
Ensure patient safety during diagnostic testing.
A 10-year-old patient with aplastic anemia presents with the following vital signs: blood pressure of 118/70, heart rate of 112, respiratory rate of 28, temperature of 102.3° F. The nurse can anticipate which orders from the provider?
Obtain a blood culture, administer antibiotics, administer an antipyretic, and obtain a complete blood count
What are the most common clinical manifestations of hemophilia? select all that apply. Fever Excessive bruising Nausea and vomiting Hemorrhage from any trauma Prolonged bleeding from or in the body
Excessive bruising, hemorrhage from any trauma, and prolonged bleeding from or in the body. The most common clinical manifestations of hemophilia are prolonged bleeding anywhere from or in the body, hemorrhage from any trauma, and excessive bruising. Fever, nausea and vomiting are not common clinical manifestations of hemophilia.
The nurse is caring for a five-year-old child who is scheduled for surgery to remove a brain tumor. The child's caregivers indicate that they are concerned that the child will have a difficult time adjusting post-surgery. What is the best action by the nurse to address the caregiver's concerns?
Explain to the child in simple terms what to expect before and after surgery.
Which situation identifies an environment in which a child may be at increased risk of developing cancer?
Exposure to radiation fro repeated CT scans
What causes the facial deformities in children with untreated or inadequately treated beta-thalassemia?
Extramedullary marrow expansion
The nurse is caring for a child with suspected cancer. Which signs and symptoms should the nurse expect to note on assessment?
Fatigue, Headache, weight loss, lymphadenopathy
The nurse is caring for a child who is post-op after a recent nephrectomy. Which assessment/study is priority to ensure the patient meets the expected outcomes?
Fluid intake and output
A four-year-old patient receiving chemotherapy reports gum inflammation, nausea, and a burning sensation in the stomach. Which other symptom might the nurse expect?
Hair loss
What is a common side effect of several chemotherapeutic drugs? Hair loss Glossomegaly Increased energy Increased appetite
Hair loss Hair loss is a common side effect of several chemotherapeutic drugs. Glossomegaly is not a common side effect of chemotherapeutic drugs, although stomatitis is. Decreased energy, rather than increased energy, is a common side effect of chemotherapeutic drugs. Reduced appetite, rather than increased appetite, is a common side effect of chemotherapeutic drugs.
The nurse is evaluating a child who was admitted for persistent cough, dyspnea, swelling, and discomfort in the neck and axilla. Lymph node biopsy confirmed that the child has Non-Hodgkin Lymphoma. Which question would best determine the effectiveness of nursing care to this patient?
Has the child's respiratory status remained stable?
A six-year-old child with leukemia presents with altered level of consciousness (LOC) and sluggish pupils but no cardiac compromise after falling from a bike. The nurse notes a platelet count of 10,000, WBC of four, and hemoglobin of seven. After the patient's airway is stabilized, which priority order should the nurse anticipate?
Obtain a head CT
What is the most appropriate way to stop an occasional episode of epistaxis? Having the child sit up and lean forward Applying ice under the nose and above the lip Having the child lie down quietly with the feet elevated Applying continuous pressure to the nose with the thumb and forefinger for 1 minute
Having the child sit up and lean forward Having the child sit up and lean forward is the intervention used to prevent the child from aspirating blood. Pressure, not ice, is indicated for an occasional episode of epistaxis. Having the child lie with the feet elevated could lead to aspiration. Continuous pressure for 10 minutes is recommended; one minute would not be long enough.
The nurse is explaining blood components to an 8-year-old child. The nurse, drawing on knowledge of child development, understands that the most appropriate description of platelets is that they do what? Make up the liquid portion of blood Help keep germs from causing infection Carry the oxygen we breathe from the lungs to all parts of the body Help the body stop bleeding by forming a clot (scab) over the hurt area
Help the body stop bleeding by forming a clot (scab) over the hurt area Platelets are involved in clotting. Keeping germs from causing infections is the function of white blood cells. Plasma is the liquid portion of blood. Carrying oxygen is the function of the red blood cells.
An emergency department nurse prepares to treat a child with disseminated intravascular coagulation (DIC) experiencing increased clotting. The nurse reviews the health care provider's prescriptions and prepares to administer which medication?
Heparin
The nurse is assessing a child with non-Hodgkin's Lymphoma and notes elevated serum sodium, serum potassium, BUN, and uric acid levels. The child reports urinating only once in the past two days. Which action is most important for the nurse to take?
Initiate IV fluid resuscitation to prevent kidney failure
What is the best way to administer parenteral iron preparations? Injection into the deltoid muscle Injection into a large muscle with the use of the Z-track method Injection into a large muscle with the use of the air-lock method Injection into a large muscle followed by massage to increase absorption
Injection into a large muscle with the use of the Z-track method The best way to administer parenteral iron preparations is injecting the medication into a large muscle with the use of the Z-track method. Never inject iron into the deltoid muscle. It is not appropriate to massage the site after injection of iron because this may worsen skin staining and irritation. When iron is being injected into the muscle, the Z-track method is preferred over the air-lock method.
What is the most common form of childhood cancer? Sarcoma Epistaxis Leukemia Retinoblastoma
Leukemia Leukemia is the most common form of childhood cancer. Epistaxis is not cancer; it is the medical term for a nosebleed. Sarcoma is not the most common form of childhood cancer; nor is retinoblastoma.
A four-year-old child diagnosed with leukemia presents with a headache, nausea and vomiting, and slight confusion. Which action should the nurse take?
Lumbar puncture
A 10-year-old patient presents to the pediatric clinic with maxillary hyperplasia, malocclusion, hypochromic anemia, and elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Which additional assessments should the nurse perform?
Measure oxygen saturation, perform a complete abdominal assessment, evaluate peripheral pulses in all extremities, and evaluate parent's understanding of treatment.
A patient with immune thrombocytopenic purpura (ITP) is admitted to the hospital for medication therapy. The patient begins receiving intravenous (IV) steroids. What should the nurse plan to do to safely administer the medication?
Monitor for bleeding and monitor the transition from IV to oral steroids
A child being treated for pain related to neuroblastoma reports abdominal pain and nausea. The nurse notes abdominal distention and diminished bowel sounds. The patient's last bowel movement was two days ago. What is the nurse's priority action?
Notify the HCP
The nurse is caring for a 9-year-old who fell over the handlebars of a bike yesterday. The abdomen is distended, and the child has blood oozing from the nose and ears. Which actions should the nurse take?
Notify the HCP, and prepare to transfer to ICU
During the medication reconciliation for a patient with Von Willebrand disease (vWD), the nurse notes the child has been taking ibuprofen as needed for headaches. Which action is most important for the nurse to take?
Provide additional education to the caregivers about avoiding medications that affect platelet function.
The nurse is caring for a child with immune thrombocytopenic purpura (ITP) who has intravenous (IV) fluids running at 25 mL/hr. The insertion site shows no sign of bleeding. The provider orders intramuscular (IM) ceftriaxone to treat a suspected bacterial infection. Which action is most important for the nurse to take?
Question the order for IM injection and have it changed to IV injection
The nurse is caring for a patient with Von Willebrand disease. The patient mentions his catch in the last football game. Which action is most important for the nurse to take?
Refer the child to the hospital social worker for follow-up, provide the family and child with information to cope with the diagnosis, discuss the importance of avoiding contact sports with the child and family.
What is the primary treatment for hemophilia? Exercise Corticosteroids Pain management Replacement of missing clotting factor
Replacement of missing clotting factor Replacement of the missing clotting factor is the primary therapy hemophilia. Exercise is important but not the primary therapy for hemophilia. Corticosteroids are helpful for hematuria and chronic synovitis but are not the primary therapy for hemophilia. Treatment of pain is important but not the primary therapy for hemophilia.
The nurse in a pediatric hematology unit admits a patient with sickle cell anemia, transferred from the emergency department. Which finding warrants immediate additional assessment by the nurse?
SOB and a white blood cell count of 16,000
The nurse is assessing a female child diagnosed with Hodgkin lymphoma. When taking a patient history, which information from the patient's parents would the nurse expect?
She has a poor appetite, she has had a lot of unexplained fevers lately, she doesn't have much energy for play anymore
The nurse reviews the laboratory report of a child with leukemia who is receiving chemotherapy. The nurse notices that the platelet count is severely reduced. Based on the laboratory report, what does the nurse include in the plan of care? To use a soft brush for dental care To encourage frequent fluid intake To monitor the child's temperature every four hours To administer a broad-spectrum antibiotic as prescribed
Soft brush for dental care Severe thrombocytopenia puts the child at an increased risk of bleeding. To reduce chances of gum bleeding, the nurse should use a soft brush for dental care. Frequent fluid intake should be encouraged to reduce the risk of cystitis but will not help with the platelet count. Temperature monitoring will help to detect fever but will not aid in restoring platelets. Broad-spectrum antibiotics may be administered if symptoms of infection are present but this intervention will not affect the platelet count.
How can the nurse explain the difference between bone marrow transplantation and stem cell transplantation?
Stem cells are infused into the blood stream. Bone marrow replaces the contents of long bones.
A nurse is caring for a child receiving a chemotherapeutic agent intravenously (IV). The child begins to complain of stinging pain at the IV site. What is the most appropriate nursing action in this situation? Stopping the infusion Cleaning the area around the IV site Waiting 30 minutes to see whether the pain disappears Adjusting the IV rate and making the IV more comfortable for the child
Stopping the infusion Stinging pain and redness at the cannulation site are signs of infiltration. Chemotherapy agents are vesicants that can cause severe cellular damage if the drug infiltrates, so the infusion must be stopped immediately. Cleaning the IV site or adjusting the IV is not appropriate or effective in this situation. Waiting 30 minutes to see whether the pain disappears increases the possibly of severe cellular damage.
A nurse suspects that a child receiving a blood transfusion is experiencing an adverse reaction. What is the nurse's priority action? Taking vital signs Stopping the transfusion Diluting the infusing blood Notifying the health care provider
Stopping the transfusion, obtaining new tubing, and maintaining a patent IV line with normal saline solution are the priority nursing actions. The nurse should take vital signs and notify the health care provider as appropriate after priority responsibilities have been fulfilled. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused, so stopping the transfusion, rather than diluting the blood is appropriate.
The mother of a child presents to the clinic with concerns that the child is running into things more often, and telling her "I didn't see that." The nurse notes 20/30 and 20/50 vision in the right and left eyes, respectively, along with nystagmus and strabismus. Which additional information should the nurse obtain to support a suspicion of a brain tumor in the posterior fossa?
Symptom severity during the day
What does the nurse recognize as the most important nursing consideration in the care of a child with sickle cell anemia? Referring the parents and child for genetic counseling Helping the child and family adjust to a short-term disease Teaching caregivers about need for multiple blood transfusions Teaching the parents and child how to recognize signs and symptoms of crisis
Teaching the parents and child how to recognize signs and symptoms of crisis Teaching the parents and child how to recognize signs and symptoms of crisis is most important for the well-being and safety of the child. Genetic counseling is important, but teaching the care of the child is a priority. Parents need specific instructions on the need to watch for changes in the child's condition, including adequate hydration, and environmental concerns. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is properly preparing the parents to care for them.
The nurse understands that which is accurate regarding the necessity of a bone marrow biopsy for the diagnosis of aplastic anemia?
To assess for the absence of precursors to mature red blood cells
The nurse conducts an assessment on a child who presents with swelling and discomfort in the axilla, persistent cough, and dyspnea. Which assessment is a priority?
Tracheal position
When preparing a child to receive chemotherapy, the nurse can expect to see which values in the patient's electronic health record?
WBC levels
