Peds: PrepU Ch. 24
The nurse is concerned that a school-aged child has iron-deficiency anemia. What did the nurse assess in this client? -Craving for ice cubes -Asking many questions -Shyness -Thumb-sucking
Craving for ice cubes In school-aged children, there is an association between iron-deficiency anemia and pica or the craving for ice cubes. Iron-deficiency anemia is not associated with shyness, thumb-sucking, or inquisitive behavior.
The pediatric nurse examines the radiographs of a client that show that there are lesions on the bone. This finding is indicative of: -Ewing sarcoma. -Hodgkin disease. -non-Hodgkin lymphoma. -neuroblastoma.
Ewing sarcoma Radiographs that show lesions on the bone may indicate tumors (e.g., Ewing sarcoma, osteosarcoma) or metastasis of tumors. Osterosarcome is the most common type of bone malignancy in children. It occurs primarily in the long bones. Ewing sarcoma is a highly malignant bone cancer. It occurs in the pelvis, chest wall, vertebrae and midshaft of the long bones. Neuroblastomas are seen in children younger than 5 years old and arise from immature nerve cells and the adrenal glands. Hodgkin disease develops from the immune system. Non-Hodgkin is a blood cancer.
Nursing students are reviewing information about childhood cancers. They demonstrate understanding of the information when they identify what as the most frequent type? -Brain stem tumor -Non-Hodgkin lymphoma- -Wilms tumor -Leukemia
Leukemia Although Wilms tumor, brain stem tumors, and non-Hodgkin lymphoma can occur in children, the most frequent type of cancer in children is leukemia.
A 5-year-old client has been diagnosed with leukemia and is currently on chemotherapy and radiation. The child is having difficulty due to mucositis. Which is the most appropriate nursing diagnosis for this child? -Disturbed body image related to loss of hair after chemotherapy -Risk for imbalanced nutrition, less than body requirements, related to inflammation -Pain due to neoplastic process in bone -Compromised family coping, related to long-term chemotherapy regimen
Risk for imbalanced nutrition, less than body requirements, related to inflammation Mucositis is inflammation of the oral mucosa, which puts this child at risk for risk for imbalanced nutrition. The client may have pain due to neoplastic process in the bone, but that is not mentioned in the scenario. The client may have lost hair, but that is not mentioned. The client's family coping is also not mentioned.
The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for: -priapism. -leg ulcers. -behavioral addiction. -seizures.
seizures. Repeated use of meperidine for pain management during sickle cell crisis increases the risk of seizures when used in children with sickle cell anemia. Behavioral addiction is rarely a concern in the child with sickle cell anemia if the narcotic is used for the alleviation of severe pain. Priapism is a complication of sickle cell anemia unrelated to meperidine administration. Leg ulcers are a complication of sickle cell anemia unrelated to meperidine administration.
The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate? -"When I give my son ferrous sulfate I know he also needs potassium supplements." -"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." -"I always give the ferrous sulfate with meals." -"We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate."
"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black.
The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure? -Antineoplastic -Analgesic -Antiemetic -Antipyretic
Antiemetic Radiation has systemic effects. Radiation sickness that includes nausea and vomiting is the most frequently encountered systemic effect. It also occurs to some extent as a result of the release of toxic substances from destroyed tumor cells. To counteract this, a child is prescribed an antiemetic before each procedure. The child does not need an analgesic, antipyretic, or antineoplastic agent prior to receiving a radiation treatment.
The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? -Writing down phone numbers and appointments -Using acetaminophen if the child needs an analgesic -Keeping a written copy of the treatment plan -Calling the doctor if the child gets a sore throat
Calling the doctor if the child gets a sore throat Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points but secondary to guarding against infection.
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? -Gamma interferon -Epoetin alfa -Filgrastim -Sargramostim
Epoetin alfa Epoetin alfa is a colony-stimulating factor used to stimulate production of red blood cells. Filgrastim is a colony-stimulating factor used to stimulate production of granulocytes. Sargramostim is a colony-stimulating factor used to stimulate production of granulocytes. Gamma interferon is used to stimulate macrophage production to fight bacteria and fungus.
A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse? -Ask whether any family members or other close associates are ill. -Tell the parent to administer acetaminophen every 4 hours until the fever dissipates. -Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order. -Have the parent bring the child to the pediatric oncology clinic as soon as possible.
Have the parent bring the child to the pediatric oncology clinic as soon as possible. The preschooler is considered immune suppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization.
A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? -Sternum -Anterior tibia -Iliac crest -Femur
Iliac crest Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.
A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child? -Implement strategies to address the child's pain. -Provide diversional activities for the child. -Ask the parent if he or she has questions about the plan of care. -Contact the health care provider to meet with the parent.
Implement strategies to address the child's pain. In this case, the nurse's priority is to address the child's pain. The child is already receiving IV fluids and oxygen. That in combination with analgesia will assist in resolving the crisis. Asking the parent if he or she has questions, asking the health care provider to meet with the parent, and providing distraction for the child are all appropriate interventions, but the priority is to address the child's pain.
A child with acute lymphoblastic leukemia (ALL) is receiving methotrexate for therapy. Which nursing diagnosis would best apply during therapy? -Risk for self-directed violence related to effect of methotrexate on central nervous system -Risk for impaired mobility related to depressant effects of methotrexate -Excess fluid volume related to effect of methotrexate on aldosterone secretion -Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy
Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy Methotrexate is a chemotherpeutic agent that has one of its side effects of cauisng oral mucositis. Oral ulcerations can interfere with nutrition because of pain and leave a portal for infection. Mucositis can be treated with oral swish and swallow agents or swish and spit agents (benadryl, lidocaine, nystatin). Mucositis is very painful and children will not be able to eat, so alternate ways of delivering nutrition may be necessary. The child receiving methotrexate may need large volumes of hydration to prevent dehydration from the medication effects. The nursing diagnosis of fluid overload from aldosterone production would be incorrect. Methotrexate works on specific cells. It does not affect the central nervous system. The child may have decreased mobility from the cancer effects and any side effects of many drugs the child is receiving and because the child is in a weakend state but methotrexate is not a depressant.
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 infant will develop diarrhea. -The infatn will be more irritable than at the last visit. -The reticulocyte count will have decreased.
The stools will appear black. Oral iron supplements are dark in color because the iron is pigmented. As a result of digestion of this pigment, the stools of an infant taking iron will be dark to black. Taking iron supplements will cause constipation, not diarrhea. After treatment with iron, the reticulocyte count should increased, not decreased. Children with iron deficiency are tired and many times irritable. With correction of the deficiency, the infant should be less irritable and have more energy.
The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000mm3, hemoglobin 7.9 g/dL (79 g/L), hematocrit 28%, platelets 151,000 mm3. Which nursing action is priority? -Transfuse 1 unit of packed red blood cells. -Administer antibiotics intravenously stat. -Ask the child to rate pain on a scale 0 to 10. -Provide the family with preop instructions.
Transfuse 1 unit of packed red blood cells. In a situation where the child exhibits signs of anemia related to acute hemorrhage, the nurse should anticipate administering a transfusion of packed red blood cells to improve oxygenation and circulation. Administration of antibiotics, pain assessment, and family education can be performed after the beginning the blood transfusion.
Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? -"It will help rule out a second malignancy." -"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." -"A sample of cerebrospinal fluid is needed to check for possible central nervous system infection." -"The spinal tap will help relieve pressure and headache for your child."
"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." The cerebrospinal fluid is checked so the clinician can determine whether leukemic cells have invaded the central nervous system. It is common for a chemotherapy medication, usually methotrexate, to be administered immediately following lumbar puncture as treatment for potential infiltration. The other responses are incorrect.
The parent of a child on chemotherapy contacts the health care provider because her child was exposed to chickenpox and wants to know what to do. What is the nurse's best response? -"Your child can be given zoster immune globulin to prevent chickenpox." -"Your child can receive nonlive vaccines which will prevent chickenpox." -"Your child can't receive any live-virus vaccines while on chemotherapy." -"Nothing can prevent chickenpox, but give your child diphenhydramine for itching."
"Your child can be given zoster immune globulin to prevent chickenpox." Zoster immune globulin may be administered if the child has not been immunized against varicella and is exposed to chickenpox during chemotherapy. Caution parents that live-virus vaccines should not be given during chemotherapy because if the child's immune mechanism is deficient these vaccines could cause widespread viral disease. Nonlive vaccines are also not given while receiving chemotherapy since the immune system cannot mount the response necessary to create immunity. Although diphenhydramine may help itching, there is a preventative with zoster immune globulin.
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 whites -Peanut butter -Cheese -Egg yolks -Oatmeal -Raisins
-Egg yolks -Raisins -Peanut butter -Oatmeal Egg yolks, raisins, peanut butter and oatmeal are food sources high in iron. Cheese is not as high in iron. Avoid egg whites for young children because of allergies.
The child has been prescribed chemotherapy. In order to properly calculate the child's dose, the nurse must first figure the child's body surface area (BSA). The child is 130 cm tall and weighs 27 kg. Calculate the child's BSA. Record your answer using two decimal places.
0.99 Square root of (height [cm] x weight [kg] divided by 3,600) = BSA. The child is 130 cm tall and weighs 27 kg: 130 x 27 = 3,510; 3,510/3,600 = 0.975; and the square root of 0.975 is 0.9874. The BSA would be 0.987, when rounded to the hundredths place = 0.99.
The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? -Plotting height and weight on a growth chart -Assessing dietary intake by addressing "picky eating" and "food jags" -Administering the measles, mumps, rubella (MMR) vaccine -Teaching the importance of taking water safety measures
Administering the measles, mumps, rubella (MMR) vaccine Live vaccines (viral or bacterial) should not be administered to an immune suppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the toddler and should be included during the well-child visit.
A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode? -Apply heat to the site of bleeding. -Administer factor VIII replacement. -Apply direct pressure to the area. -Elevate the injured area such as a leg or arm.
Apply heat to the site of bleeding. Ice or cold compresses, not heat, would be applied to the site of bleeding. Direct pressure is applied until the bleeding stops. The injured part is elevated unless elevating would contribute to further injury. Factor VIII replacement is given to replace the missing clotting factor.
The nurse is providing preoperative care for a 7-year-old boy with a brain tumor and his parents. Which intervention is priority? -Educating the child and parents about shunts -Providing a tour of the intensive care unit -Having the child talk to another child who has had this surgery -Assessing the child's level of consciousness
Assessing the child's level of consciousness The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure. Lower priority interventions include providing a tour of the ICU to prepare the child and parents for after the surgery, and educating the child and parents about shunts.
The nurse is caring for a 2-year-old girl who is receiving chemotherapy using antitumor antibiotics. Which intervention would the nurse question? -Assessing the mouth for redness, lesions, or ulcers -Maintaining meticulous hand-washing procedures -Assessing for tachypnea and adventitious breath sounds -Administering antiemetics prior to chemotherapy
Assessing the mouth for redness, lesions, or ulcers Antitumor antibiotics do not cause mucositis, so it would not be necessary to assess the mouth for redness, lesions, or ulcers. Antitumor antibiotics cause nausea and vomiting, so administering antiemetics prior to chemotherapy would be appropriate. Antitumor antibiotics do cause myelosuppression, so meticulous hand washing would be appropriate. Antitumor antibiotics do cause myelosuppression, placing the child at risk for infection; therefore, assessing for tachypnea and adventitious breath sounds would be appropriate.
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? -Kidney -Bladder -Brain -Blood
Bladder The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult cancer.
The nurse is planning care for a school-aged child recovering from being hit by a motor vehicle while riding a bicycle. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child? -Bleeding from intravenous sites -Sudden onset of knee pain -Blurred vision -Nausea and vomiting
Bleeding from intravenous sites Disseminated intravascular coagulation is an acquired disorder of blood clotting that results from excessive trauma. The child begins to develop petechiae or have uncontrolled bleeding from puncture sites from injections or intravenous therapy. Blurred vision, nausea, vomiting, and a sudden onset of knee pain are not manifestations associated with disseminated intravascular coagulation.
The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis? -Complete white blood count -History of leukemia in twin -Lethargy, bruising, and pallor -Bone marrow aspiration
Bone marrow aspiration Bone marrow aspiration and biopsy are diagnostic. An abnormal white blood count and symptoms of lethargy, bruising, and pallor only create suspicion of leukemia; a twin may or may not be affected.
The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system? -Palpation of abdomen reveals enlarged liver and spleen -Child reports of facial palsy and vision problems -Noting adventitious breath sounds during auscultation -Observing petechiae, purpura, or unusual bruising
Child reports of facial palsy and vision problems The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising results from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia, and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis.
The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? -Following guidelines for protective isolation -Providing age-appropriate activities -Grouping nursing care -Encouraging the child to share feelings
Following guidelines for protective isolation The child with leukemia is susceptible to infection, especially during chemotherapy. Infections such as meningitis, septicemia, and pneumonia are the most common causes of death. To protect the child from infectious organisms, follow standard guidelines for protective isolation. Grouping nursing care to provide rest is important, but not the highest priority. Encouraging the child to share feelings and providing age-appropriate activities are important, but psychological issues are a lower priority than physical.
A high-school football player has been diagnosed as having osteosarcoma of the femur. The parents are angry because they told the adolescent not to play football. Which health teaching points would the nurse include in the teaching plan for the adolsecent and parents? -You can expect some discoloration of the leg following chemotherapy. -Osteosarcoma often follows trauma, such as a football injury. -Football injuries do not contribute to the development of a tumor. -Tumor growth is related to your dislike of milk.
Football injuries do not contribute to the development of a tumor. Osteosarcoma is the most malignant form of bone cancer. It is caused from the embryonic mecenchymal tiisue that forms in the bones. A football injury may predispose more scrutiny of a lesion but it will not be the cause of the cancer, nor will the dislike of milk. Osteosarcoma may be treated with chemotherapy and radiation. It may also involve an amputation. The parents who state they are angry at their adolescent for playing football is more likely projecting their fears of the diagnosis and the future for their adolescent.
A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care care should be given priority? -Beginning active range-of-motion exercises -Seeing that the child ingests a protein-rich diet -Maintaining a fluid intravenous line -Encouraging the child to take deep breaths hourly
Maintaining a fluid intravenous line Sickle cells clump together and prevent normal blood flow. This leads to tissue hypoxia. With a vaso-occlusive crisis, the cells are clumped together and prevent blood flow to the joint or organ. The blood with the clumped sickled cells is very viscous. Adequate hydration is crucial in relieving the problems of a vaso-occlusive crisis. The hydration dilutes the blood and decreases the viscosity. During a crisis the recommended fluid intake (IV and PO) is 150 ml/kg/day. During a vaso-occlusive crisis, the child has severe pain. The goal is to get the pain under control and increase blood flow. Range of motion excercises will add to the increased pain during this period of time, so should not be started until crisis in under control. The diet and hourly deep breaths are important, but they are not crucial to correcting the crisis.
When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority? -Educate the family on proper handwashing. -Allow the child to play with a doll and syringe. -Evaluate pain and administer medication. -Monitor the site dressing and vital signs.
Monitor the site dressing and vital signs. Monitoring vital signs and the dressing for signs of bleeding is a priority after bone marrow aspiration. Although providing pain medication, educating on handwashing, and allowing for therapeutic play are all important, these should only be performed after first stabilizing the child.
The nurse is planning care for a child with idiopathic thrombocytopenic purpura. Which client education should be included? -To use mainly cold water to wash -What foods are high in folic acid -Not to pick or irritate the nose -To apply a soothing cream to lesions
Not to pick or irritate the nose Idiopathic thrombocytopenic purpura (ITP) occurs as an immune reponse following a viral infection. It produces antiplatelet antibodies which destroy platelets. This leads to the classic symptoms of petechaie, purpura, and excessive bruising. Without adequate platelets, children bleed easily from lesions. If the child "picks" the nose, an area could be opened and bleeding could occur. Folic acid will have no effect on the disease process. The lesions are not itchy and are open or draining, so cold water washing and soothing lotions are not required.
What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)? -Obtain a catheterized urine specimen. -Protect the abdomen from manipulation. -Control acute pain. -Assess for constipation.
Protect the abdomen from manipulation. Manipulation can release malignant cells into the abdominal cavity. Constipation may be a problem following surgical intervention. Pain is uncommon; obtaining a urine specimen is not a priority.
The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis? -Increased growth of long bones -Depigmented areas on the abdomen -Slightly yellow sclera -Enlarged mandibular growth
Slightly yellow sclera In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not manifestations of this health problem.
The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? -Blisters, ulcers, or a rash appear -Earache, stiff neck, or sore throat -Temperature of 101° F (38.3° C) or greater -Difficulty or pain when swallowing
Temperature of 101° F (38.3° C) or greater The parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C) or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the parents must be directed to take action at the first sign of infection in order to prevent overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes, or difficulty or pain when swallowing are reasons to seek medical care, but are not as grave as the risk of infection.
A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching? -"There are many iron fortified cereals that he likes." -"Red meat is a good option; he loves the hamburgers from the drive-thru." -"I must encourage a variety of iron-rich foods that he likes." -"He will enjoy tuna casserole and eggs."
"Red meat is a good option; he loves the hamburgers from the drive-thru." While iron from red meat is the easiest for the body to absorb, the nurse must limit fast food consumption from the drive-thru as it is also high in fat, fillers, and sodium. The other statements are correct.
The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching? -"She loves popsicles, so I'll let her have them as a snack or for dessert." -"I bought the medication to give to her when she says she is in pain." -"She has been down, but playing in soccer camp will cheer her up." -"I put her legs up on pillows when her knees start to hurt."
"She has been down, but playing in soccer camp will cheer her up." Following a sickle cell crisis, the child should avoid extremely strenuous activities that may cause oxygen depletion. Fluids are encouraged, pain management will be needed, and the child's legs may be elevated to relieve discomfort, so these are all statements that indicate an understanding of caring for the child who has had a sickle cell crisis.
The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate? -"The doctor will discuss these findings with you when he comes to the hospital." -"I'm really not allowed to discuss these findings with you." -"These labs are just common labs for children with this disease." -"These values will help us monitor the disease."
"These values will help us monitor the disease." This response answers the parent's questions. In the nonsevere form, the granulocyte count remains about 500, the platelets are over 20,000, and the reticulocyte count is over 1%. The other responses do not address what the parents are asking and would block therapeutic communication.
The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply. -Providing a low-carbohydrate, low-protein diet -Having the child sleep in a single bed and room -Encouraging frequent, thorough handwashing -Cheering up the environment with fresh flowers and plants -Encouraging frequent close contact with numerous visitors
-Having the child sleep in a single bed and room -Encouraging frequent, thorough handwashing To reduce the risk of infection, the nurse should teach the child and parents about minimizing the child's exposure to potentially infectious situations. The nurse should encourage the parents to arrange for the child to sleep in a single bed and room and, if possible, avoid close contact with other family members who may be developing upper respiratory tract infections. Thorough and frequent handwashing, especially after using the bathroom and before eating, is essential. A high-calorie, high-protein diet helps to rebuild white blood cells and should be encouraged. If possible, the child's exposure to large crowds and visitors should be limited because of the increased risk of infection from these individuals. Fresh flowers and plants should be avoided because they could harbor mold spores.
A 15-year-old client diagnosed with von Willebrand disease has reached menarche. Based on this fact, what information is most important for the nurse to convey to the client? -The duration of each period will be short. -Bruising may occur in the perineal area. -Occasional skipped periods can be expected. -Expect menstrual bleeding to be heavy.
Expect menstrual bleeding to be heavy. Females diagnosed with von Willebrand disease are at risk for menorrhagia. Bruising in the perineal area is not a risk unless there is some sort of trauma at the site. Von Willebrand disease does not cause intermittent periods or shorten the duration of menses.
Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura? -Risk for infection related to abnormal immune system -Risk for bleeding related to insufficient platelet formation -Risk for altered urinary elimination related to kidney impairment -Ineffective breathing pattern related to decreased white blood count
Risk for bleeding related to insufficient platelet formation Idiopathic thrombocytopenic purpura is the result of a decrease in the number of circulating platelets in the presence of adequate megakaryocytes, which are precursors to platelets. Because bleeding can occur with this disease process, the diagnosis most appropriate for the patient at this time is risk for bleeding related to insufficient platelet formation. Reduced numbers of platelets would not increase the patient's risk for infection. Reduced numbers of platelets does not increase the patient's risk for renal impairment. Reduced risk of platelets will not lead to an ineffective breathing pattern.
The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's bestresponse? -"ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood." -"ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor." -"ITP is characterized by the loss of surface area on the red blood cell membrane." -"ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason."
"ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason." Idiopathic thrombocytopenic purpura (ITP) is primarily an autoimmune disease, which is an acquired, self-limiting disorder of hemostasis characterized by destruction and decreased numbers of circulating platelets. The child will exhibit symptoms of excessive petechaie, pupura, and brusing. Hemophilia A and hemophilia B are distinguished by the particular procoagulant factor that is decreased, absent, or dysfunctional. Iron-deficiency anemia occurs when the body's iron stores are depleted. Hereditary spherocytosis (HS) is characterized by loss of surface area on the red blood cell membrane.
A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate? -"Infants with pyloric stenosis require ferrous sulfate." -"Preterm infants are at risk for iron-deficiency anemia." -"Your infant may have been having excessive diarrhea." -"Ferrous sulfate helps improve red blood cell formation."
"Preterm infants are at risk for iron-deficiency anemia." Infants born prematurely are at risk for iron-deficiency anemia because iron stores are built during the last few weeks of gestation. Although some infants with pyloric stenosis may require an iron supplement, such as ferrous sulfate, not all infants will. Infants with excessive diarrhea may develop iron-deficiency anemia, and ferrous sulfate helps improve red blood cell formation, but this does not explain why a preterm infant is being prescribed an iron supplement.
A nurse is conducting a class to a group of parents on sickle cell anemia. Which statement by a parent indicates teaching has been effective? "Sickle cell anemia is common in people of Asian descent." "Fluid restriction is necessary to control sickle cell anemia." "The sickle shape of red blood cells decreases oxygen to tissues." "This is a hereditary disease that is transmitted by one affected gene."
"The sickle shape of red blood cells decreases oxygen to tissues." The sickle shape of the red blood cells impedes the flow of blood through the vessels, thus causing hypoxia to the tissues. Sickle cell anemia is a hereditary disease but it is autosomal recessive, meaning it requires two genes in order for the disease to be transmitted. Sickle cell anemia is common in people of African, Mediterranean, and Indian descent. Hydration is important to controlling sickle cell anemia. Dehydration is a trigger for sickle cell crisis.
The nurse is preparing a 12-year-old client and the parents for radiation treatments that will occur for several weeks. Which nursing instructions are appropriate? Select all that apply. -Do not wash off the marks drawn on the skin. -Encourage lengthy soaks in the bathtub. -Schedule a tour of the radiation department. -Encourage high calorie meals and snacks. -Help the child develop "mind games" for diversion. -Encourage fresh fruit and vegetables.
-Encourage high calorie meals and snacks. -Schedule a tour of the radiation department. -Help the child develop "mind games" for diversion. -Do not wash off the marks drawn on the skin. Encourage high-calorie meals when the child is not nauseated. Schedule a tour of the radiation department if possible to reduce the child's anxiety. Help the child devise mind games for diversion during radiation, since the child has to lie still for a period of time. If the area to be radiated is marked on the child's skin, do not wash of the marks. Reduce amounts of fresh fruit and vegetables because they may contribute to diarrhea and fluid loss. Avoid long soaks in bath water or swimming pools because this is hard on the skin.
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? -"You'll need to have an incision in your hip area to instill the cells." -"The risk for rejection is much less with this type of transplant." -"You won't need to receive the high doses of chemotherapy before the transplant." -"We'll need to have a match to a donor."
"We'll need to have a match to a donor." An allogenic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.
A pediatric nurse is providing a session on risk factors for childhood cancers. Which risk factor does the nurse include in this teaching session? Select all that apply. -genetic predisposition for certain cancers -environmental exposure, such as cigarette smoke -absence of tumor suppressor cells that allow abnormal growth -viral triggers -accumulation of mutations in the cell that transform to neoplasm -genetic markers that fail to suppress cancer
-viral triggers -genetic predisposition for certain cancers -genetic markers that fail to suppress cancer -absence of tumor suppressor cells that allow abnormal growth -accumulation of mutations in the cell that transform to neoplasm Oncogenic (cancer-causing) viruses such as HPV may be directly responsible for tumor growth. According to this viral theory, oncogenic viruses have the ability to change the structure of DNA or RNA in cells. C-type RNA viruses, for example, have been implicated in leukemia. As more and more evidence is compiled on the nature of genes, specific markers in tumors that apparently fail to suppress, or stimulate, cancer-causing genes are being identified; almost all childhood cancers have such markers or a genetic trigger or predisposition to cancer. Somatic mutation theory postulates that an accumulation of mutations in the cell is what ultimately results in the transformation to a neoplastic state. In some children, because of their genetics, tumor suppressor cells may not be present, allowing abnormal growth stimulated by viruses to continue. Environmental factors do not seem to be a factor in children. In adults, tumors may grow because normal cell growth has been altered by environmental exposures, such as chronic exposure to chemical irritants or cigarette smoke. In contrast, in children tumors most frequently occur in organs unexposed to the environment such as leukemia of the bone marrow.
A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately? -Environmental and lifestyle influences in children are strong, unlike those in adults. -Children's cancers, unlike those of adults, often are detected accidentally, not through screening. -Little is known regarding cancer prevention in adults, although much prevention information is available for children. -Adult cancers are more responsive to treatment than are those in children.
Children's cancers, unlike those of adults, often are detected accidentally, not through screening. Children's cancers are often found during a routine checkup, following an injury, or when symptoms appear---not through screening procedures or other specific detection practices. A very small percentage of children may be followed closely because they are known to be at high risk genetically. Most children's cancers are highly responsive to therapy. Few prevention strategies are available for children, although many are known to be effective for adults. Several lifestyle and environmental influences regarding children's cancers are suspect, but few have been scientifically documented. The reverse is true in the adult population.
A child with acute lymphoblastic leukemia (ALL) is beginning treatment with methotrexate in an attempt to eradicate the leukemic cells. Which stage of therapy is the child undergoing? -Delayed intensive-therapy stage -Sanctuary stage -Consolidation stage -Induction stage
Induction stage The induction stage is the first attempt at eradicating the leukemic cells to induce or achieve a complete remission. The next stage of therapy is the consolidation stage. Medications given during this stage are used to reduce the leukemic cell burden. The next stage of treatment is the maintenance stage. Treatment during this stage is to eliminate all the residual leukemic cells. There is another stage which methotrexate is used. The drug is a central nervous system prophylaxis. Medications during this stage are given to reduce any risk of developing central nervous system involvement from the cancer cells. The sanctuary stage and delayed intensive-therapy stages are not actual or correct stages of chemotherapy medication administration.
Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? -Risk for altered urinary elimination related to kidney impairment -Risk for infection related to abnormal immune system -Ineffective tissue perfusion related to poor platelet formation -Ineffective breathing pattern related to decreased white blood count
Ineffective tissue perfusion related to poor platelet formation Idiopathic thrombocytopenic purpura (ITP) results from an immune response following a viral infection that produces antiplatelet antibodies. These antibodies destroy the platelets which cause petechiae, purpura and excessive bleeding. ITP does not affect the kidneys. Breathing difficulties would not occur with decreased whit blood cells. It occurs when there is decreased red blood cells. The child who develops ITP has no different immune system than othe children who are healthy.
