PEDS Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder 2

The parents of a child diagnosed with rhabdomyosarcoma ask the nurse to explain what this means. What is the nurse's best response?

"The tumor is in the muscle."

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 preparing a presentation for a local parent group about nutritional measures to prevent anemia. The group of parents have children between the ages of 4 and 8. The nurse would recommend a daily iron intake of which amount?

10 mg

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

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

A young school-age child who is being treated for cancer has constipation and loss of appetite. What nursing interventions should the nurse suggest to the family? Select all that apply.

Add high-fiber snacks such as popcorn and washed apples to the diet. Increase gross motor activities such as family walks. Provide adequate private time in the bathroom.

A parent calls the pediatric oncology clinic about the child having headaches after chemotherapy. What is the nurse's best advice?

Administer acetaminophen as needed.

The nurse will use a special needle to start intravenous (IV) fluids through which central venous access device?

An implanted port

A child being treated for leukemia is diagnosed with neutropenia. What nursing instructions directly prevent client infections? Select all that apply.

Avoid large crowds. Inspect the skin daily for scratches or scrapes. Remove house plants, flowers, and goldfish from the home environment. Stay away from people who have obvious colds, rashes, or other infections.

Parents bring their daughter to the health care facility for evaluation. They report that lately the child seems rather pale and really tired. What would the nurse most likely find with further assessment if the child has acute lymphoblastic leukemia (ALL)? Select all that apply.

Bleeding from the oral mucous membranes Headache Painless cervical lymphadenopathy Low-grade fever

The child is prescribed liquid ferrous sulfate. The nurse should encourage the child to take which action immediately after each dose to best eliminate possible side effects?

Brush his or her teeth

Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor?

Christmas factor

The nurse is educating the parents of a 16-year-old boy who has just been diagnosed with Hodgkin disease. Which discussion is most appropriate at this time?

Describing the two ways of staging the disease.

The nurse is providing care to an adolescent who has been diagnosed with cancer. Which actions would be appropriate for the nurse to take to foster the adolescent's ability to cope? Select all that apply.

Encourage the adolescent to engage in usual activities. Encourage the adolescent to make plans for the future. Control the amount of information given to others about the adolescent's condition.

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority?

Ensure neutropenic precautions are in place.

A nursing instructor is describing childhood hematologic disorders to students. Which would the instructor include as being commonly affected by hematologic disorders? Select all that apply.

Erythrocytes Leukocytes Thrombocytes

The nurse has been asked to participate in a community health teaching session. Which interventions would the nurse include to help achieve the 2030 National Health Goals to reduce the incidence of anemias? Select all that apply.

Explain the importance of healthy eating for adolescent participants. Instruct pregnant women to take iron supplementation as prescribed. Review foods that are rich in iron that should be a part of a school-age child's diet.

A nurse is reviewing laboratory test results of a child with iron-deficiency anemia. Which laboratory results would be communicated with the next shift during shift hand-off? Select all that apply.

Iron-binding capacity 390 ug/100 ml Serum ferritin 8 ug/100ml Hematocrit 30%

A 14-year-old adolescent with Hodgkin disease is experiencing difficulty breathing and is sent for a radiograph. Which finding should the nurse expect to see on the x-ray report?

Mediastinal mass

The nurse is caring for a 6-year-old boy 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.

The nurse is planning care for a child with idiopathic thrombocytopenic purpura. Which client education should be included?

Not to pick or irritate the nose

The nurse is caring for a child with disseminated intravascular coagulation (DIC). The nurse notices signs of neurologic deficit. Which nursing action is appropriate?

Notify the physician.

A 6-year-old child has been found to have a stage II brain tumor. The parent asks the nurse to explain what "stage II" means. Which information would the nurse provide?

The cancer has spread in the brain itself but the chance of complete surgical removal is good.

Which symptom would lead the nurse to suspect that a child is developing a common side effect of vincristine?

The child says the fingertips feel numb.

The nurse is preparing clients for diagnostic testing for cancer. Which test is used to differentiate a neuroblastoma from other tumors?

Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA)

The nurse is caring for 9-year-old boy 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. He has an oral temperature of 38.6°C (101.5°F). Which intervention would be the priority?

administering prescribed broad-spectrum IV antibiotics

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

allopurinol

Which mechanism is central to cancers in children?

cellular growth

After teaching the parents of a child diagnosed with sickle cell disease, the nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if the child develops which signs or symptoms? Select all that apply.

chest pain severe dizziness sudden change in vision

A nurse is counseling parents of a child with leukemia regarding the goals of the chemotherapy program for their child. What should the nurse mention as the first goal?

complete absence of leukemia cells

A child with cancer is dying and in hospice care. When developing the plan of care, which intervention should the nurse include as the primary focus?

keeping the child pain-free

When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect?

mucositis

An adolescent who had radiation for a previous malignancy has presented to the pediatric oncology clinic. Which malignancy is the nurse concerned could develop as a complication?

osteosarcoma

A nurse is performing assessments during a well child visit. Which assessment is most important for screening for a malignancy?

plot and analyze height and weight

A nurse in the emergency department is examining a 6-month-old with symmetrical swelling of the hands and feet. The nurse immediately suspects:

sickle cell disease.

The nurse is caring for a 6-year-old girl with leukemia who is having an oncologic emergency. Which signs and symptoms would indicate hyperleukocytosis?

tachycardia and respiratory distress

A child diagnosed with beta-thalassemia presents with the classic findings of hyperbilirubinemia, splenomegaly, hepatomegaly, delayed growth and sexual maturation, and abnormal facial appearance. What category of the disease do these symptoms represent? thalassemia major

thalassemia major

While administering a blood transfusion to a child with a hematologic disorder, the nurse notes the child develops urticaria and wheezing. Which collaborative interventions will the nurse begin? Select all that apply.

Give an antihistamine. Apply oxygen as needed. Discontinue the transfusion.

A child with hemophilia A is scheduled for surgery. Which precautions would the nurse institute with this client?

Handle the child gently when transferring to a stretcher.

During a physical examination of a 13-year-old boy, the nurse observes a single, enlarged, rubbery-feeling cervical lymph node in the armpit. The boy also reports unexplained loss of weight and malaise. Which condition should the nurse most suspect in this client?

Hodgkin lymphoma

A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease?

Reed-Sternberg cells

A child with acute lymphoblastic leukemia (ALL) is receiving methotrexate for therapy. Which nursing diagnosis would best apply during therapy?

Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy

A parent contacts the oncology clinic nurse with concerns about mucositis following chemotherapy. Which are appropriate interventions for the nurse to include? Select all that apply.

Serve soft foods rather than hard or crunchy foods. Encourage rinsing the mouth with lukewarm water. Have the child drink fluids as often as possible to remain hydrated. Use a soft toothbrush and swish with an antibiotic mouthwash.

The child has been diagnosed with cancer and is being treated with chemotherapy. Which findings are common side effects of this type of treatment? Select all that apply.

The child's mother states, "It seems like he catches every bug that comes along." The child has no hair on his head. The child's mother states that she often has to repeat herself because he can't hear very well. The child reports feeling nauseated.

A 9-month-old infant with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help the nurse determine that the infant is actually taking it daily?

The stools will appear black.

The health care provider prescribed an alkylating agent for a child's chemotherapy. Which best describes an action produced by these types of agents?

They are cell cycle-nonspecific, destroying both resting and dividing cells.

A 13-year-old, diagnosed with beta-thalassemia major is seen in the pediatric clinic. The nurse completes an assessment and notes that the client is below the 10th percentile in height for age. What assumption can the nurse make based on this information?

This finding is a common manifestation of the client's diagnosis.

A child with hypoplastic anemia develops hemosiderosis. The therapy for this is:

deferoxamine.

The child has been admitted to the hospital, with an absolute neutrophil count of 450. The child has been placed in neutropenic precautions. Which nursing interventions indicate that the nurse requires further education? Select all that apply.

The child has been placed in a semiprivate room. The child is being transported to radiology for an x-ray and the nurse places gloves on the child's hands.

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. What does this prescription indicate to the nurse?

The child has mild to moderate iron deficiency.

A 9-year-old boy will be undergoing a hematopoietic stem cell transplantation, with donor cells being provided by his 12-year-old sister. The nurse recognizes that this type of transplantation is:

Allogeneic

A child with sickle cell anemia is scheduled for a splenectomy. After the parents receive teaching about the rationale for this surgery, the nurse determines that the teaching was successful when the parents make which statement?

"It will help to decrease the amount of anemia."

Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy?

Practice frequent, gentle oral hygiene

Children with acute lymphoblastic leukemia (ALL) may need periodic lumbar punctures. The nurse would teach the parent that this is done to assess for: You Selected: leukemic cells.

leukemic cells.

The nurse is collecting data from the caregivers of a child brought to the clinic setting. The parents tell the nurse that the child's skin seems to be an unusual color. The nurse notes that the child's skin appears bronze-colored and jaundiced. This observation alerts the nurse to the likelihood that this child has which disorder?

Thalassemia

Which diagnosis would be most appropriate for an infant with a large retinoblastoma after surgery?

Disturbed sensory perception related to enucleation

A child is sent to pediatric intensive care following surgery for a brain tumor. Which prescription would the nurse question?

elevate head of bed 90 degrees

The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care?

giving ferrous sulfate with orange juice between meals

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor?

Infection

The nurse assesses a child and notes the following: oral temperature 102.1°F (39°C), plethora, and new onset difficulty speaking. Which health care provider prescription will the nurse request? Select all that apply.

Initiate intravenous (IV) normal saline. Obtain computed tomography (CT) scan. Administer acetaminophen every 4 hours. Call laboratory for complete blood count (CBC).

The nurse is caring for an 18-month-old client with suspected iron-deficiency anemia. The nurse will expect to prepare the client for which laboratory tests first?

complete blood count and iron level

A child has undergone a hematopoietic stem cell transplant. When assessing the child, the nurse notes the development of a maculopapular rash on the child's palms and bottoms of the feet. Which condition would the nurse suspect?

graft-versus-host disease

A nurse is caring for a newborn whose screening test result indicates the possibility of sickle cell anemia (SCA) or sickle cell trait. The nurse would expect the test result to be confirmed by which lab tests?

hemoglobin electrophoresis

A child is scheduled for chemotherapy as treatment for leukemia. As the nurse is collaborating with another colleague, the discussion turns to the client's first phase of chemotherapy. This phase is known as:

induction.

A client with severe chronic anemia is receiving ongoing transfusion therapy. The nurse frequently assesses the client for what major complication of this therapy?

toxic iron overload

The oncology nurse is alert for clients displaying signs and symptoms of disseminated intravascular coagulation (DIC). Which symptom would alert the nurse to this emergency condition?

uncontrolled bleeding

Parents of a 10-year-old have just been informed that their child has stage III cancer. They ask the nurse what this means. What is the nurse's best response?

"The cancer cells have spread to the lymph nodes."

The parents of a child diagnosed with cerebral astrocytoma ask the nurse about their child's prognosis. Which response by the nurse would be most appropriate?

"The prognosis is favorable with complete surgical resection and the child usually experiences minimal neurologic deficits post-operatively."

The nurse is caring for a 6-year-old boy 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.

A group of nursing students is discussing the diagnosis of iron deficiency anemia. The students demonstrate an understanding of the need for dietary iron when suggesting the inclusion of what foods into the diet of a 4-year-old diagnosed with this form of anemia? Select all that apply.

Egg yolks Raisins Peanut butter Oatmeal